WO2021085471A1 - Surgery-assisting device - Google Patents

Surgery-assisting device Download PDF

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Publication number
WO2021085471A1
WO2021085471A1 PCT/JP2020/040423 JP2020040423W WO2021085471A1 WO 2021085471 A1 WO2021085471 A1 WO 2021085471A1 JP 2020040423 W JP2020040423 W JP 2020040423W WO 2021085471 A1 WO2021085471 A1 WO 2021085471A1
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WO
WIPO (PCT)
Prior art keywords
end side
straight line
side straight
sleeve
rail
Prior art date
Application number
PCT/JP2020/040423
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French (fr)
Japanese (ja)
Inventor
友貴 堀瀬
賢 正宗
Original Assignee
学校法人東京女子医科大学
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
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Application filed by 学校法人東京女子医科大学 filed Critical 学校法人東京女子医科大学
Priority to JP2021553651A priority Critical patent/JPWO2021085471A1/ja
Publication of WO2021085471A1 publication Critical patent/WO2021085471A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50Supports for surgical instruments, e.g. articulated arms

Definitions

  • the present invention relates to a surgical support device provided with an operation arm extending in a sleeve, and more particularly to a surgical support device capable of performing various operations by inserting a sleeve into a real hole provided in a body wall.
  • a surgical support device including a linear sleeve and an operation arm extending within the sleeve has been widely used.
  • a surgical support device it is necessary to make a hole in the abdominal wall, chest wall, etc. for the sleeve to penetrate, but this is compared with surgery that opens a wide area around the affected area (for example, open surgery or thoracotomy).
  • surgery that opens a wide area around the affected area (for example, open surgery or thoracotomy).
  • it has the advantage of being extremely minimally invasive.
  • the linear sleeve can be rotated in both the front-back direction and the left-right direction around the holes made in the abdominal wall, chest wall, etc., using the holes as fulcrums.
  • the doctor who is the operator uses this rotation function to bring the tip of the operation arm closer to the affected part of the patient and perform a predetermined treatment (imaging). , Suction, excision, etc.).
  • Patent Document 1 discloses a surgical support device provided with a sleeve bent in a substantially central region. However, even in the device disclosed in Japanese Patent Application Laid-Open No. 2011-239975 (Patent Document 1), it cannot be used in such a way that the position where the ribs exist is used as a fulcrum for the rotation operation.
  • Patent Document 2 discloses a surgical support device having a bent tip portion. However, even in the device disclosed in Japanese Patent Application Laid-Open No. 2017-189571 (Patent Document 2), it is not possible to use the device in such a way that the position where the ribs are present is used as a fulcrum for the rotation operation.
  • An object of the present invention is to provide a surgical support device that can be used such that the position where the ribs are present is used as a fulcrum of the rotation operation.
  • the present invention provides a sleeve including a base end side straight line portion, a tip end side straight line portion, and a side view arcuate curved portion provided between the base end side straight line portion and the tip end side straight line portion. Allows rotation of an arc track rail that slidably holds the curved portion in a direction along the arc shape, a rail holding arm that holds the arc track rail, and the rail holding arm.
  • a rotary bearing that supports the rail holding arm and an operation arm that extends within the sleeve are provided, and the base end side straight line portion and the tip end side straight line portion are arranged substantially in a straight line.
  • the center of curvature of the curved portion is on the extension line of the base end side straight line portion and the tip end side straight line portion, and is on the rotation axis of the rotary bearing. ..
  • the curved portion slides and moves in an arc shape with respect to the arc race rail with the center of curvature of the curved portion as a fulcrum, and the rail holding arm with the arc track rail rotates the rotary bearing.
  • the center of curvature of the curved portion can be regarded as a virtual hole, and the virtual hole can be aligned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
  • the present invention comprises a sleeve provided with a base end side straight portion, a tip end side straight portion, and a curved portion provided between the proximal end side straight portion and the tip end side straight portion, and the sleeve. It holds an arc-shaped sliding portion in a side view, an arc track rail that holds the sliding portion slidably in a direction along the arc shape of the sliding portion, and the arc track rail.
  • a rail holding arm, a rotating bearing that supports the rail holding arm while allowing rotation of the rail holding arm, and an operating arm extending in the sleeve are provided, and the base end side straight portion and the said
  • the extension line of the straight end side straight portion is orthogonal to the rotation axis of the rotary bearing, and the center of curvature of the sliding portion is the extension line of the base end side straight line portion, the extension line of the tip end side straight line portion, and the said.
  • It is a surgical support device characterized in that it is located at a position offset from the intersection of the rotation axes of the rotation bearing in a direction perpendicular to the extension line and the rotation axis.
  • the sliding portion slides and moves in an arc shape with respect to the arc track rail with the center of curvature of the sliding portion as a fulcrum
  • the rail holding arm with the arc track rail is a rotary bearing.
  • the arc track rail has a one-side rail member and a other-side rail member that are opposed to each other and slidably sandwich the curved portion.
  • the curved portion can be reliably held in a slidable manner.
  • the one-side rail member and the other-side rail member are displaced from each other so as to be displaced between the state in which the curved portion is slidably sandwiched and the state in which the curved portion is removable. It is preferable that they are combined.
  • the installation work and the removal work of the arc track rail and the curved portion are easy.
  • the operation arm has an expansion / contraction function and a shaft rotation function with respect to the sleeve.
  • the operation arm has an imaging function, a suction function, an excision function, or a therapeutic function.
  • the curved portion slides and moves in an arc shape with respect to the arc race rail with the center of curvature of the curved portion as a fulcrum, and the rail holding arm with the arc track rail rotates the rotary bearing.
  • the center of curvature of the curved portion can be regarded as a virtual hole, and the virtual hole can be aligned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
  • the sliding portion slides and moves in an arc shape with respect to the arc track rail with the center of curvature of the sliding portion as a fulcrum, and the rail holding arm with the arc track rail rotates.
  • the center of curvature of the sliding portion can be regarded as a virtual hole, and the virtual hole can be positioned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
  • FIG. 1 is a schematic perspective view of the surgery support device 100 according to the first embodiment of the present invention
  • FIG. 2 is a schematic side view of the surgery support device 100 according to the present embodiment
  • FIG. 3 is the present embodiment.
  • FIG. 4 is a schematic front view of the surgery support device 100 according to the embodiment
  • FIG. 4 is a schematic rear view of the surgery support device 100 according to the present embodiment
  • FIG. 5 is a schematic plane of the surgery support device 100 according to the present embodiment.
  • FIG. 6 is an enlarged view of the VI portion of FIG. 1
  • FIG. 7 is a schematic perspective view of one side rail member 30 of the surgery support device 100 according to the present embodiment
  • FIG. 8 is a schematic perspective view of the present embodiment. It is a schematic perspective view of the other side rail member 40 of the operation support device 100 which concerns on the form.
  • the surgical support device 100 of the present embodiment is located between the proximal end side straight portion 11, the distal end side straight portion 12, and the proximal end side straight portion 11 and the distal end side straight portion 12. It is provided with a sleeve 10 having a curved portion 13 having a substantially semicircular arc shape in a side view.
  • the base end side straight line portion 11 and the tip end side straight line portion 12 of the sleeve 10 of the present embodiment are arranged substantially in a straight line. Further, the center of curvature C of the curved portion 13 is located on an extension line of the base end side straight line portion 11 and the tip end side straight line portion 12.
  • the operation arm 70 extends in the sleeve 10 (the base end portion and the tip end portion of the operation arm 70 are exposed from the sleeve 10).
  • the operation arm 70 has an expansion / contraction function (for example, a function of appearing and disappearing with respect to the tip of the straight end portion 12 on the tip side) and an axis rotation function (a function of rotating around its own axis) with respect to the sleeve 10. There is. It has been confirmed that these functions can be realized by using a wire manufactured by Asahi Intecc Co., Ltd., even though the sleeve 10 has a curved portion 13.
  • the operation arm 70 may have an endoscope and realize a function of photographing an internal condition, or may have an aspirator and realize a function of aspirating internal tissues. It may have an electrosurgical knife 71 to realize a function of excising body tissue, or may have an irradiator of laser light or ultraviolet rays to realize a therapeutic function.
  • the surgical support device 100 of the present embodiment slidably holds the curved portion 13 of the sleeve 10 in the direction along the arc shape of the curved portion 13. It has 20.
  • the arc track rail 20 of the present embodiment has one side rail member 30 and the other side rail member 40 facing each other.
  • the pipe diameter of the sleeve 10 is 8 mm (selected from a range of approximately 5 to 12 mm), and the radius of curvature r of the curved portion 13 of the sleeve 10 is 50 mm (relative to the center of the pipe diameter). (Measured value of) (selected from a range of approximately 30 to 70 mm), and one side groove 33 is formed in the one side rail member 30 so as to correspond to these dimensions, and the other side rail.
  • the other side groove 43 is formed in the member 40.
  • the one-side rail member 30 and the other-side rail member 40 are displaced from each other so as to be displaced between the state in which the curved portion 13 is slidably sandwiched and the state in which the curved portion 13 is removable.
  • it can be connected (for example, it can be screwed with a screw 25 or the like).
  • the arc track rail 20 is fixed to the tip of the rail holding arm 50, and the base end of the rail holding arm 50 is rotatably supported by the rotary bearing 60.
  • the rail holding arm 50 of the present embodiment includes a base end side arm portion 51 extending in the direction perpendicular to the rotation axis X of the rotation bearing 60, and the rotation bearing 60 from the tip end side of the base end side arm portion 51. It has an intermediate arm portion 52 extending in a direction parallel to the rotation axis X, and a tip end side arm portion 53 extending at an inclination of 22.5 ° from the tip end side of the intermediate arm portion 52.
  • the length of the base end side arm portion 51 is 95 mm
  • the length of the intermediate arm portion 52 is 73 mm
  • the length of the tip end side arm portion 53 is 105 mm
  • the rotation axis X of the rotary bearing 60 is 170 mm when viewed in the direction of.
  • the center of curvature C of the curved portion 13 is on the rotating axis X of the rotating bearing 60.
  • the rotary bearing 60 is housed in the housing 61, sealed by the lid 62, and supported by a base or arm mechanism (not shown) via the housing 61 to the lid 62.
  • the surgical support device 100 of the present embodiment as described above is extremely effective when it is desired to use the position where the ribs exist as a fulcrum for the rotation operation.
  • the position to be the fulcrum of the rotation operation (the ribs may be present) is regarded as a virtual hole
  • the center of curvature C (base end side straight line portion 11 and tip side) of the operation support device 100 of the present embodiment is regarded as a virtual hole.
  • the actual hole (about 3 cm in diameter) is located at a position separated by the radius of curvature r from the virtual hole so that the extension line of the straight portion 12 and the rotation axis X of the rotary bearing 60 can be located in the virtual hole.
  • the straight portion 12 on the tip end side of the sleeve 10 is inserted into the body through the actual hole, and the tip end side portion of the curved portion 13 is further inserted into the body.
  • an arc track rail 20 fixed to the tip of the rail holding arm 50 is slidably attached to the base end side portion of the curved portion 13.
  • the sleeve 10 is free to move in the plane shown by the paper surface of FIG. 2 by sliding the curved portion 13 in an arc shape with respect to the arc track rail 20 with the curvature center C of the curved portion 13 as a fulcrum. It can rotate (it can rotate in the front-back direction for the doctor who is the operator).
  • the rail holding arm 50 with the arcuate track rail 20 can rotate around the rotation axis X of the rotary bearing 60, so that the sleeve 10 can be rotated even in a plane perpendicular to the rotation axis X.
  • the curved portion 13 can be freely rotated around the center of curvature C as a fulcrum (it can be rotated in the left-right direction for the doctor who is the operator).
  • the center of curvature C of the curved portion 13 can be regarded as a virtual hole, and the virtual hole can be positioned at the position where the ribs are present. .. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
  • the doctor who is the operator can perform the operation as if the sleeve of the conventional linear operation support device penetrates the virtual hole.
  • the techniques cultivated in the conventional linear surgery support device can be effectively applied.
  • any position on the circumference of the radius of curvature r surrounding one real hole can be regarded as a virtual hole, it is possible to treat a plurality of affected areas. It may also be possible to perform surgery with only one (or fewer) real holes.
  • FIG. 9 is a schematic side view of the surgery support device 200 according to the second embodiment of the present invention
  • FIG. 10 is a schematic plan view of the surgery support device 200 according to the second embodiment of the present invention.
  • the operation support device 200 of the present embodiment is provided between the proximal end side straight portion 211, the distal end side straight portion 212, and the proximal end side straight portion 211 and the distal end side straight portion 212.
  • the sleeve 210 is provided with a curved portion 213 having a substantially semicircular arc shape in a side view.
  • the radius of curvature of the curved portion 213 of the sleeve 210 of the second embodiment is smaller than that of the curved portion 13 of the sleeve 10 of the first embodiment (the radius of curvature of the curved portion 213 is 0.4r). , The amount of detour is small.
  • the surgery support device 200 of the present embodiment also has an arc track rail 20 similar to the surgery support device 100 of the first embodiment.
  • the tip side arm portion 253 of the rail holding arm 250 that supports the arc track rail 20 extends in a crank shape from the intermediate arm portion 252 (see FIG. 10), with respect to the intermediate arm portion 252 and the sleeve 210. It is in a position offset to the front side of the paper surface of FIG. Therefore, the arc track rail 20 is also at a position offset toward the front side of the paper surface of FIG. 9 with respect to the sleeve 210.
  • a substantially 1/4 arc-shaped sliding portion 270 having a pipe diameter (8 mm) and a radius of curvature (50 mm) corresponding to the one-side groove portion 33 and the other-side groove portion 43 of the arc track rail 20 is formed by the arc track rail 20. It is held slidably, and both ends of the sliding portion 270 are integrally coupled to the sliding portion 270. It is fixed to the base end side straight portion 211 of the sleeve 210 via (having 280b and the like).
  • FIGS. 9 and 10 Other configurations of this embodiment are substantially the same as those of the first embodiment described with reference to FIGS. 1 to 8.
  • FIGS. 9 and 10 the same parts as those in the first embodiment are designated by the same reference numerals. Further, detailed description of the same parts as those of the first embodiment of the present embodiment will be omitted.
  • the surgical support device 200 of the present embodiment as described above is also extremely effective when it is desired to use the position where the ribs exist as a fulcrum for the rotation operation.
  • the position to be the fulcrum of the rotation operation (the ribs may be present) is regarded as a virtual hole, and the base end side straight portion 211 and the tip end side straight portion 212 of the operation support device 200 of the present embodiment.
  • a real hole (about 3 cm in diameter) is located 0.4 times the radius of curvature r from the virtual hole so that the intersection C of the extension line and the rotation axis X of the rotary bearing 60 can be located in the virtual hole. To open a hole.
  • the straight portion 212 on the tip side of the sleeve 210 (the sliding portion 270 is fixed in advance) is inserted into the body through the actual hole, and the tip side portion of the curved portion 213 is further inserted into the body.
  • the sleeve 210 is a flat surface including the intersection C shown on the paper surface of FIG. It can rotate freely in a plane offset parallel to the front side (it can rotate in the front-back direction for the doctor who is the operator).
  • the rail holding arm 250 with the arcuate track rail 20 can rotate around the rotation axis X of the rotary bearing 60, so that the sleeve 210 can be rotated even in a plane perpendicular to the rotation axis X.
  • the extension line of the base end side straight portion 211 and the tip end side straight portion 212 and the rotation axis X of the rotary bearing 60 can be freely rotated around the intersection C as a fulcrum (left-right direction for the doctor who is the operator). Can rotate to).
  • the intersection C between the extension lines of the base end side straight line portion 211 and the tip end side straight line portion 212 and the rotation axis X of the rotary bearing 60 is regarded as a virtual hole. It is possible to align the virtual hole at the position where the ribs are present. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
  • the doctor who is the operator can perform the operation as if the sleeve of the conventional linear operation support device penetrates the virtual hole.
  • the techniques cultivated in the conventional linear surgery support device can be effectively applied.
  • an arbitrary position on the circumference having a radius of 0.4 r (in the case of the illustrated example) surrounding the actual hole can be regarded as a virtual hole. Therefore, it may be possible to perform surgery on a plurality of affected areas with only one (or fewer) real holes.
  • the radius of curvature of the curved portion 213 of the sleeve 210 may be increased. It is arcuate and has a radius of curvature of 1.41r.
  • the configuration of the operation arm 70 can be easier.
  • the sleeve 210 is slightly moved in the front-rear direction from the position of the original actual hole with the actual hole when the operator rotates in the front-rear direction. It is necessary to move in the (horizontal direction in FIG. 9). Therefore, the range of the rotation operation in the front-rear direction can be substantially limited.
  • FIG. 11 is a schematic side view of the surgery support device 300 according to the third embodiment of the present invention
  • FIG. 12 is a schematic plan view of the surgery support device 300 according to the third embodiment of the present invention.
  • the surgical support device 300 of the present embodiment is provided between the proximal end side straight portion 311 and the distal end side straight portion 312, and the proximal end side straight portion 311 and the distal end side straight portion 312.
  • a sleeve 310 having a substantially semicircular curved portion 313 in a side view is provided.
  • the radius of curvature of the curved portion 313 of the sleeve 310 of the third embodiment is larger than that of the curved portion 13 of the sleeve 10 of the first embodiment (the radius of curvature of the curved portion 313 is 1.5r). , The amount of detour is large.
  • the surgery support device 300 of the present embodiment also has an arc trajectory rail 20 similar to the surgery support device 200 of the second embodiment.
  • the tip end side arm portion 253 of the rail holding arm 250 that supports the arc track rail 20 extends from the intermediate arm portion 252 in a crank shape (see FIG. 12). )
  • a substantially 1/4 arc-shaped sliding portion 270 having a pipe diameter (8 mm) and a radius of curvature (50 mm) corresponding to the one-side groove portion 33 and the other-side groove portion 43 of the arc track rail 20 is formed by the arc track rail 20. It is held slidable. However, in the present embodiment, only one end of the sliding portion 270 is interposed via a mounting portion 380 (having an L-shaped portion 380a and a connecting portion 380b) integrally coupled to the sliding portion 270. It is fixed to the base end side straight portion 311 of the sleeve 310.
  • FIGS. 11 and 12 Other configurations of this embodiment are substantially the same as those of the second embodiment described with reference to FIGS. 9 and 10.
  • FIGS. 11 and 12 the same parts as those in the second embodiment are designated by the same reference numerals. Further, detailed description of the same parts as those of the second embodiment of the present embodiment will be omitted.
  • the surgical support device 300 of the present embodiment also allows the intersection C of the extension lines of the base end side straight line portion 311 and the tip end side straight line portion 312 and the rotation axis X of the rotary bearing 60 to be regarded as a virtual hole. It is possible to align the virtual hole where the ribs are. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
  • the doctor who is the operator can perform the operation as if the sleeve of the conventional linear operation support device penetrates the virtual hole.
  • the techniques cultivated in the conventional linear surgery support device can be effectively applied.
  • an arbitrary position on the circumference having a radius of 1.5r (in the case of the illustrated example) surrounding the actual hole can be regarded as a virtual hole. Therefore, it may be possible to perform surgery on a plurality of affected areas with only one (or fewer) real holes.
  • the curved portion 313 of the sleeve 310 may be formed in a substantially U shape, except that the center of curvature of the curved portion 313 in the vicinity of the actual hole is an intersection.
  • the sleeve 310 it is necessary for the sleeve 310 to move slightly in the front-rear direction (horizontal direction in FIG. 11) from the position of the original actual hole with the actual hole when the operator rotates in the front-rear direction. It should be noted that there is.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
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Abstract

The present invention is a surgery-assisting device characterized by comprising: a sleeve provided with a proximal-end linear part, a distal-end linear part, and a bent part which is arcuate in side view and which is provided between the proximal-end linear part and the distal-end-side linear part; an arc track rail for retaining the bent part so that the bent part can slide along the direction of the arc shape thereof; a rail-retaining arm for retaining the arc track rail; a rotating bearing for supporting the rail-retaining arm while allowing the rail-retaining arm to rotate; and an operating arm which extends into the sleeve, the proximal-end linear part and the distal-end linear part being positioned on a substantially straight line, and the center of curvature of the bent part being on a line of extension of the proximal-end linear part and the distal-end linear part and on the rotational axis of the rotating bearing.

Description

手術支援装置Surgical support device
 本発明は、スリーブ内に延在する操作アームを備えた手術支援装置に関し、特には、体壁に設けた実孔内にスリーブを挿入して各種の手術を行うことができる手術支援装置に関する。 The present invention relates to a surgical support device provided with an operation arm extending in a sleeve, and more particularly to a surgical support device capable of performing various operations by inserting a sleeve into a real hole provided in a body wall.
 従来より、直線状のスリーブと、当該スリーブ内に延在する操作アームと、を備えた手術支援装置が広く利用されている。このような手術支援装置を用いるには、スリーブが貫通するための孔を腹壁や胸壁等に開孔する必要があるが、患部周りを広く切り開く手術(例えば開腹手術や開胸手術)と比較すれば、著しく低侵襲であるという利点がある。 Conventionally, a surgical support device including a linear sleeve and an operation arm extending within the sleeve has been widely used. In order to use such a surgical support device, it is necessary to make a hole in the abdominal wall, chest wall, etc. for the sleeve to penetrate, but this is compared with surgery that opens a wide area around the affected area (for example, open surgery or thoracotomy). For example, it has the advantage of being extremely minimally invasive.
 直線状のスリーブは、腹壁や胸壁等に開孔した孔回りに、当該孔を支点として、前後方向にも左右方向にも回動させることができる。操作者である医師は、スリーブに対する操作アームの伸縮機能及び軸回転機能に加えて、この回動機能を利用して、患者の患部に対して操作アームの先端を近づけて、所定の処置(撮影、吸引、切除等)を施す。 The linear sleeve can be rotated in both the front-back direction and the left-right direction around the holes made in the abdominal wall, chest wall, etc., using the holes as fulcrums. In addition to the function of expanding and contracting the operation arm with respect to the sleeve and the function of rotating the shaft, the doctor who is the operator uses this rotation function to bring the tip of the operation arm closer to the affected part of the patient and perform a predetermined treatment (imaging). , Suction, excision, etc.).
特開2011-239975JP 2011-239975 特開2017-189571JP 2017-189571
 従来の手術支援装置(内視鏡下手術用鉗子)を胸部の内視鏡下手術に利用する場合、鉗子が貫通するための孔は、肋骨を避けて開孔する必要がある。しかしながら、従来の手術支援装置を用いた手術は、医師による極めてデリケートな手技を伴うものであり、症例によっては、手術の成功率を高めるために、肋骨が存在する位置にスリーブ用の孔を設けたい、それが不可ならば肋骨が存在する位置を回動操作の支点にしたい、という強いニーズが存在する。 When using a conventional surgical support device (forceps for endoscopic surgery) for endoscopic surgery on the chest, it is necessary to open the hole for the forceps to penetrate while avoiding the ribs. However, surgery using conventional surgery support devices involves extremely delicate procedures by doctors, and in some cases, in order to increase the success rate of surgery, a hole for a sleeve is provided at the position where the ribs are present. If that is not possible, there is a strong need to use the position where the ribs exist as a fulcrum for the rotation operation.
 特開2011-239975(特許文献1)には、略中央領域で屈曲したスリーブを備えた手術支援装置が開示されている。しかしながら、特開2011-239975(特許文献1)に開示された装置においても、肋骨が存在する位置を回動操作の支点にするような使われ方は不可である。 Japanese Patent Application Laid-Open No. 2011-239975 (Patent Document 1) discloses a surgical support device provided with a sleeve bent in a substantially central region. However, even in the device disclosed in Japanese Patent Application Laid-Open No. 2011-239975 (Patent Document 1), it cannot be used in such a way that the position where the ribs exist is used as a fulcrum for the rotation operation.
 特開2017-189571(特許文献2)には、屈曲した先端部を有する手術支援装置が開示されている。しかしながら、特開2017-189571(特許文献2)に開示された装置においても、やはり肋骨が存在する位置を回動操作の支点にするような使われ方は不可である。 Japanese Patent Application Laid-Open No. 2017-189571 (Patent Document 2) discloses a surgical support device having a bent tip portion. However, even in the device disclosed in Japanese Patent Application Laid-Open No. 2017-189571 (Patent Document 2), it is not possible to use the device in such a way that the position where the ribs are present is used as a fulcrum for the rotation operation.
 本発明は、以上の知見に基づいて創案されたものである。本発明の目的は、肋骨が存在する位置を回動操作の支点にするような使われ方が可能な手術支援装置を提供することである。 The present invention was devised based on the above findings. An object of the present invention is to provide a surgical support device that can be used such that the position where the ribs are present is used as a fulcrum of the rotation operation.
 本発明は、基端側直線部と、先端側直線部と、前記基端側直線部及び前記先端側直線部の間に設けられた側面視で円弧状の湾曲部と、を備えたスリーブと、前記湾曲部を当該湾曲部の前記円弧状に沿った方向に摺動可能に保持する円弧軌道レールと、前記円弧軌道レールを保持するレール保持アームと、前記レール保持アームの回動を許容しながら当該レール保持アームを支持する回動軸受と、前記スリーブ内に延在する操作アームと、を備え、前記基端側直線部と前記先端側直線部とは、略一直線上に配置されており、前記湾曲部の曲率中心は、前記基端側直線部及び前記先端側直線部の延長線上にあり、且つ、前記回動軸受の回動軸線上にあることを特徴とする手術支援装置である。 The present invention provides a sleeve including a base end side straight line portion, a tip end side straight line portion, and a side view arcuate curved portion provided between the base end side straight line portion and the tip end side straight line portion. Allows rotation of an arc track rail that slidably holds the curved portion in a direction along the arc shape, a rail holding arm that holds the arc track rail, and the rail holding arm. However, a rotary bearing that supports the rail holding arm and an operation arm that extends within the sleeve are provided, and the base end side straight line portion and the tip end side straight line portion are arranged substantially in a straight line. The center of curvature of the curved portion is on the extension line of the base end side straight line portion and the tip end side straight line portion, and is on the rotation axis of the rotary bearing. ..
 本発明によれば、スリーブは、湾曲部の曲率中心を支点として円弧軌道レールに対して湾曲部が円弧状に摺動移動することと、円弧軌道レールを伴うレール保持アームが回動軸受の回動軸線回りに回動することと、が相俟って、前後方向にも左右方向にも回動することができる。このため、湾曲部の曲率中心を仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能となる。 According to the present invention, in the sleeve, the curved portion slides and moves in an arc shape with respect to the arc race rail with the center of curvature of the curved portion as a fulcrum, and the rail holding arm with the arc track rail rotates the rotary bearing. In combination with the rotation around the moving axis, it can rotate in both the front-rear direction and the left-right direction. Therefore, the center of curvature of the curved portion can be regarded as a virtual hole, and the virtual hole can be aligned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
 あるいは、本発明は、基端側直線部と、先端側直線部と、前記基端側直線部及び前記先端側直線部の間に設けられた湾曲部と、を備えたスリーブと、前記スリーブに取り付けられた側面視で円弧状の摺動部と、前記摺動部を当該摺動部の前記円弧状に沿った方向に摺動可能に保持する円弧軌道レールと、前記円弧軌道レールを保持するレール保持アームと、前記レール保持アームの回動を許容しながら当該レール保持アームを支持する回動軸受と、前記スリーブ内に延在する操作アームと、を備え、前記基端側直線部及び前記先端側直線部の延長線は、前記回動軸受の回動軸線と直交しており、前記摺動部の曲率中心は、前記基端側直線部及び前記先端側直線部の前記延長線及び前記回動軸受の前記回動軸線の交点から、当該延長線及び当該回動軸線に垂直な方向にオフセットされた位置にあることを特徴とする手術支援装置である。 Alternatively, the present invention comprises a sleeve provided with a base end side straight portion, a tip end side straight portion, and a curved portion provided between the proximal end side straight portion and the tip end side straight portion, and the sleeve. It holds an arc-shaped sliding portion in a side view, an arc track rail that holds the sliding portion slidably in a direction along the arc shape of the sliding portion, and the arc track rail. A rail holding arm, a rotating bearing that supports the rail holding arm while allowing rotation of the rail holding arm, and an operating arm extending in the sleeve are provided, and the base end side straight portion and the said The extension line of the straight end side straight portion is orthogonal to the rotation axis of the rotary bearing, and the center of curvature of the sliding portion is the extension line of the base end side straight line portion, the extension line of the tip end side straight line portion, and the said. It is a surgical support device characterized in that it is located at a position offset from the intersection of the rotation axes of the rotation bearing in a direction perpendicular to the extension line and the rotation axis.
 当該発明によれば、スリーブは、摺動部の曲率中心を支点として円弧軌道レールに対して摺動部が円弧状に摺動移動することと、円弧軌道レールを伴うレール保持アームが回動軸受の回動軸線回りに回動することと、が相俟って、前後方向にも左右方向にも回動することができる。このため、摺動部の曲率中心を仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能となる。 According to the present invention, in the sleeve, the sliding portion slides and moves in an arc shape with respect to the arc track rail with the center of curvature of the sliding portion as a fulcrum, and the rail holding arm with the arc track rail is a rotary bearing. In combination with the rotation around the rotation axis of the above, it is possible to rotate in both the front-rear direction and the left-right direction. Therefore, the center of curvature of the sliding portion can be regarded as a virtual hole, and the virtual hole can be positioned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
 以上の各発明において、前記円弧軌道レールは、互いに対向して前記湾曲部を摺動可能に挟む一側レール部材及び他側レール部材を有していることが好ましい。 In each of the above inventions, it is preferable that the arc track rail has a one-side rail member and a other-side rail member that are opposed to each other and slidably sandwich the curved portion.
 この場合、湾曲部を摺動可能な態様で確実に保持することができる。 In this case, the curved portion can be reliably held in a slidable manner.
 また、この場合、更に、前記一側レール部材及び前記他側レール部材は、前記湾曲部を摺動可能に挟んだ状態と前記湾曲部を取り外し可能な状態との間で変位するように、互いに結合されていることが好ましい。 Further, in this case, the one-side rail member and the other-side rail member are displaced from each other so as to be displaced between the state in which the curved portion is slidably sandwiched and the state in which the curved portion is removable. It is preferable that they are combined.
 これによれば、円弧軌道レールと湾曲部との取り付け作業及び取り外し作業が容易である。 According to this, the installation work and the removal work of the arc track rail and the curved portion are easy.
 前記操作アームは、前記スリーブに対して、伸縮機能と、軸回転機能と、を有していることが好ましい。 It is preferable that the operation arm has an expansion / contraction function and a shaft rotation function with respect to the sleeve.
 更に、前記操作アームは、撮影機能、吸引機能、切除機能、または、治療機能を有していることが好ましい。 Further, it is preferable that the operation arm has an imaging function, a suction function, an excision function, or a therapeutic function.
 本発明によれば、スリーブは、湾曲部の曲率中心を支点として円弧軌道レールに対して湾曲部が円弧状に摺動移動することと、円弧軌道レールを伴うレール保持アームが回動軸受の回動軸線回りに回動することと、が相俟って、前後方向にも左右方向にも回動することができる。このため、湾曲部の曲率中心を仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能となる。 According to the present invention, in the sleeve, the curved portion slides and moves in an arc shape with respect to the arc race rail with the center of curvature of the curved portion as a fulcrum, and the rail holding arm with the arc track rail rotates the rotary bearing. In combination with the rotation around the moving axis, it can rotate in both the front-rear direction and the left-right direction. Therefore, the center of curvature of the curved portion can be regarded as a virtual hole, and the virtual hole can be aligned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
 あるいは、本発明によれば、スリーブは、摺動部の曲率中心を支点として円弧軌道レールに対して摺動部が円弧状に摺動移動することと、円弧軌道レールを伴うレール保持アームが回動軸受の回動軸線回りに回動することと、が相俟って、前後方向にも左右方向にも回動することができる。このため、摺動部の曲率中心を仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能となる。 Alternatively, according to the present invention, in the sleeve, the sliding portion slides and moves in an arc shape with respect to the arc track rail with the center of curvature of the sliding portion as a fulcrum, and the rail holding arm with the arc track rail rotates. In combination with the rotation around the rotation axis of the moving bearing, it can rotate in both the front-rear direction and the left-right direction. Therefore, the center of curvature of the sliding portion can be regarded as a virtual hole, and the virtual hole can be positioned at the position where the ribs exist. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
本発明の第1実施形態に係る手術支援装置の概略斜視図である。It is a schematic perspective view of the operation support device which concerns on 1st Embodiment of this invention. 本実施形態に係る手術支援装置の概略側面図である。It is a schematic side view of the operation support device which concerns on this embodiment. 本実施形態に係る手術支援装置の概略正面図である。It is a schematic front view of the operation support device which concerns on this embodiment. 本実施形態に係る手術支援装置の概略背面図である。It is a schematic rear view of the operation support device which concerns on this embodiment. 本実施形態に係る手術支援装置の概略平面図である。It is a schematic plan view of the operation support device which concerns on this embodiment. 図1のVI部拡大図である。It is an enlarged view of the VI part of FIG. 本実施形態に係る手術支援装置の一側レール部材の概略斜視図である。It is a schematic perspective view of the one-side rail member of the operation support device which concerns on this embodiment. 本実施形態に係る手術支援装置の他側レール部材の概略斜視図である。It is a schematic perspective view of the other side rail member of the operation support device which concerns on this embodiment. 本発明の第2実施形態に係る手術支援装置の概略側面図である。It is a schematic side view of the operation support device which concerns on 2nd Embodiment of this invention. 本発明の第2実施形態に係る手術支援装置の概略平面図である。It is a schematic plan view of the operation support device which concerns on 2nd Embodiment of this invention. 本発明の第3実施形態に係る手術支援装置の概略側面図である。It is a schematic side view of the operation support device which concerns on 3rd Embodiment of this invention. 本発明の第3実施形態に係る手術支援装置の概略平面図である。It is a schematic plan view of the operation support device which concerns on 3rd Embodiment of this invention.
 以下、図面を参照して本発明の実施の形態について説明する。 Hereinafter, embodiments of the present invention will be described with reference to the drawings.
(第1実施形態の構成)
 図1は、本発明の第1実施形態に係る手術支援装置100の概略斜視図であり、図2は、本実施形態に係る手術支援装置100の概略側面図であり、図3は、本実施形態に係る手術支援装置100の概略正面図であり、図4は、本実施形態に係る手術支援装置100の概略背面図であり、図5は、本実施形態に係る手術支援装置100の概略平面図であり、図6は、図1のVI部拡大図であり、図7は、本実施形態に係る手術支援装置100の一側レール部材30の概略斜視図であり、図8は、本実施形態に係る手術支援装置100の他側レール部材40の概略斜視図である。
(Structure of the first embodiment)
FIG. 1 is a schematic perspective view of the surgery support device 100 according to the first embodiment of the present invention, FIG. 2 is a schematic side view of the surgery support device 100 according to the present embodiment, and FIG. 3 is the present embodiment. FIG. 4 is a schematic front view of the surgery support device 100 according to the embodiment, FIG. 4 is a schematic rear view of the surgery support device 100 according to the present embodiment, and FIG. 5 is a schematic plane of the surgery support device 100 according to the present embodiment. FIG. 6 is an enlarged view of the VI portion of FIG. 1, FIG. 7 is a schematic perspective view of one side rail member 30 of the surgery support device 100 according to the present embodiment, and FIG. 8 is a schematic perspective view of the present embodiment. It is a schematic perspective view of the other side rail member 40 of the operation support device 100 which concerns on the form.
 図1乃至図6に示すように、本実施形態の手術支援装置100は、基端側直線部11と、先端側直線部12と、基端側直線部11及び先端側直線部12の間に設けられた側面視で略半円弧状の湾曲部13と、を有するスリーブ10を備えている。 As shown in FIGS. 1 to 6, the surgical support device 100 of the present embodiment is located between the proximal end side straight portion 11, the distal end side straight portion 12, and the proximal end side straight portion 11 and the distal end side straight portion 12. It is provided with a sleeve 10 having a curved portion 13 having a substantially semicircular arc shape in a side view.
 図1乃至図6から明らかなように、本実施形態のスリーブ10の基端側直線部11と先端側直線部12とは、略一直線上に配置されている。また、湾曲部13の曲率中心Cは、基端側直線部11及び先端側直線部12の延長線上に位置している。 As is clear from FIGS. 1 to 6, the base end side straight line portion 11 and the tip end side straight line portion 12 of the sleeve 10 of the present embodiment are arranged substantially in a straight line. Further, the center of curvature C of the curved portion 13 is located on an extension line of the base end side straight line portion 11 and the tip end side straight line portion 12.
 スリーブ10内には、操作アーム70が延在するようになっている(操作アーム70の基端部及び先端部はスリーブ10から露出される)。操作アーム70は、スリーブ10に対して、伸縮機能(例えば先端側直線部12の先端に対して出没する機能)と、軸回転機能(自らの軸線回りに自転する機能)と、を有している。これらの機能は、スリーブ10が湾曲部13を有するにも拘わらず、朝日インテック株式会社が製造するワイヤを利用することで実現可能であることが確認されている。 The operation arm 70 extends in the sleeve 10 (the base end portion and the tip end portion of the operation arm 70 are exposed from the sleeve 10). The operation arm 70 has an expansion / contraction function (for example, a function of appearing and disappearing with respect to the tip of the straight end portion 12 on the tip side) and an axis rotation function (a function of rotating around its own axis) with respect to the sleeve 10. There is. It has been confirmed that these functions can be realized by using a wire manufactured by Asahi Intecc Co., Ltd., even though the sleeve 10 has a curved portion 13.
 更に、操作アーム70は、内視鏡を有していて体内状況の撮影機能を実現していてもよいし、吸引器を有していて体内組織の吸引機能を実現していてもよいし、電気メス71を有していて体内組織の切除機能を実現していてもよいし、レーザ光や紫外線の照射器を有していて治療機能を実現していてもよい。 Further, the operation arm 70 may have an endoscope and realize a function of photographing an internal condition, or may have an aspirator and realize a function of aspirating internal tissues. It may have an electrosurgical knife 71 to realize a function of excising body tissue, or may have an irradiator of laser light or ultraviolet rays to realize a therapeutic function.
 また、図1乃至図6に示すように、本実施形態の手術支援装置100は、スリーブ10の湾曲部13を当該湾曲部13の円弧状に沿った方向に摺動可能に保持する円弧軌道レール20を備えている。 Further, as shown in FIGS. 1 to 6, the surgical support device 100 of the present embodiment slidably holds the curved portion 13 of the sleeve 10 in the direction along the arc shape of the curved portion 13. It has 20.
 より具体的には、図7及び図8にも示すように、本実施形態の円弧軌道レール20は、互いに対向する一側レール部材30及び他側レール部材40を有している。そして、本実施形態では、スリーブ10の管径は8mmとなっており(概ね5~12mmの範囲から選択される)、スリーブ10の湾曲部13の曲率半径rは50mm(管径中心に対しての測定値)となっており(概ね30~70mmの範囲から選択される)、これらの寸法に対応するように、一側レール部材30には一側溝部33が形成されており、他側レール部材40には他側溝部43が形成されている。 More specifically, as shown in FIGS. 7 and 8, the arc track rail 20 of the present embodiment has one side rail member 30 and the other side rail member 40 facing each other. In the present embodiment, the pipe diameter of the sleeve 10 is 8 mm (selected from a range of approximately 5 to 12 mm), and the radius of curvature r of the curved portion 13 of the sleeve 10 is 50 mm (relative to the center of the pipe diameter). (Measured value of) (selected from a range of approximately 30 to 70 mm), and one side groove 33 is formed in the one side rail member 30 so as to correspond to these dimensions, and the other side rail. The other side groove 43 is formed in the member 40.
 更に、本実施形態では、一側レール部材30及び他側レール部材40は、湾曲部13を摺動可能に挟んだ状態と湾曲部13を取り外し可能な状態との間で変位するように、互いに対して結合可能(例えばネジ25等によって螺合可能)となっている。 Further, in the present embodiment, the one-side rail member 30 and the other-side rail member 40 are displaced from each other so as to be displaced between the state in which the curved portion 13 is slidably sandwiched and the state in which the curved portion 13 is removable. On the other hand, it can be connected (for example, it can be screwed with a screw 25 or the like).
 そして、円弧軌道レール20は、レール保持アーム50の先端部に固定されており、当該レール保持アーム50の基端部は、回動軸受60によって回動可能に支持されている。 The arc track rail 20 is fixed to the tip of the rail holding arm 50, and the base end of the rail holding arm 50 is rotatably supported by the rotary bearing 60.
 本実施形態のレール保持アーム50は、回動軸受60の回動軸線Xに対して垂直方向に延びる基端側アーム部51と、当該基端側アーム部51の先端側から回動軸受60の回動軸線Xに対して平行な方向に延びる中間アーム部52と、当該中間アーム部52の先端側から22.5°傾斜して延びる先端側アーム部53と、を有している。 The rail holding arm 50 of the present embodiment includes a base end side arm portion 51 extending in the direction perpendicular to the rotation axis X of the rotation bearing 60, and the rotation bearing 60 from the tip end side of the base end side arm portion 51. It has an intermediate arm portion 52 extending in a direction parallel to the rotation axis X, and a tip end side arm portion 53 extending at an inclination of 22.5 ° from the tip end side of the intermediate arm portion 52.
 例えば、基端側アーム部51の長さは95mmであり、中間アーム部52の長さは73mmであり、先端側アーム部53の長さは105mmであり、回動軸受60の回動軸線Xの方向に見て基端側アーム部51から先端側アーム部53の先端部までの長さは、170mmである。 For example, the length of the base end side arm portion 51 is 95 mm, the length of the intermediate arm portion 52 is 73 mm, the length of the tip end side arm portion 53 is 105 mm, and the rotation axis X of the rotary bearing 60. The length from the base end side arm portion 51 to the tip end portion of the tip end side arm portion 53 is 170 mm when viewed in the direction of.
 そして、本実施形態において重要な特徴として、湾曲部13の曲率中心Cは、回動軸受60の回動軸線X上にある。 And, as an important feature in this embodiment, the center of curvature C of the curved portion 13 is on the rotating axis X of the rotating bearing 60.
 その他、回動軸受60は、ハウジング61内に収容され、蓋62によって密閉され、それらのハウジング61ないし蓋62を介して、不図示の基台ないしアーム機構に支持されている。 In addition, the rotary bearing 60 is housed in the housing 61, sealed by the lid 62, and supported by a base or arm mechanism (not shown) via the housing 61 to the lid 62.
(第1実施形態の作用)
 以上のような本実施形態の手術支援装置100は、肋骨が存在する位置を回動操作の支点にしたい、という場合に極めて有効である。
(Operation of the first embodiment)
The surgical support device 100 of the present embodiment as described above is extremely effective when it is desired to use the position where the ribs exist as a fulcrum for the rotation operation.
 すなわち、回動操作の支点にしたい位置(肋骨が存在していても構わない)を仮想孔に見立てて、本実施形態の手術支援装置100の曲率中心C(基端側直線部11及び先端側直線部12の延長線と回動軸受60の回動軸線Xの交点でもある)が当該仮想孔に位置できるように、当該仮想孔から曲率半径rだけ離れた位置に実孔(直径3cm程度)を開孔する。 That is, the position to be the fulcrum of the rotation operation (the ribs may be present) is regarded as a virtual hole, and the center of curvature C (base end side straight line portion 11 and tip side) of the operation support device 100 of the present embodiment is regarded as a virtual hole. The actual hole (about 3 cm in diameter) is located at a position separated by the radius of curvature r from the virtual hole so that the extension line of the straight portion 12 and the rotation axis X of the rotary bearing 60 can be located in the virtual hole. To open a hole.
 続いて、当該実孔から、スリーブ10の先端側直線部12を体内に挿入し、更に、湾曲部13の先端側部分を体内に挿入する。 Subsequently, the straight portion 12 on the tip end side of the sleeve 10 is inserted into the body through the actual hole, and the tip end side portion of the curved portion 13 is further inserted into the body.
 この状態で、図1乃至図6に示すように、湾曲部13の基端側部分に、レール保持アーム50の先端部に固定された円弧軌道レール20を摺動可能に取り付ける。 In this state, as shown in FIGS. 1 to 6, an arc track rail 20 fixed to the tip of the rail holding arm 50 is slidably attached to the base end side portion of the curved portion 13.
 これにより、スリーブ10は、湾曲部13の曲率中心Cを支点として、円弧軌道レール20に対して湾曲部13が円弧状に摺動移動することによって、図2の紙面が示す平面内において自由に回動することができる(操作者である医師にとって前後方向に回動することができる)。 As a result, the sleeve 10 is free to move in the plane shown by the paper surface of FIG. 2 by sliding the curved portion 13 in an arc shape with respect to the arc track rail 20 with the curvature center C of the curved portion 13 as a fulcrum. It can rotate (it can rotate in the front-back direction for the doctor who is the operator).
 そして、円弧軌道レール20を伴うレール保持アーム50が回動軸受60の回動軸線X回りに回動可能であることによって、スリーブ10は、当該回動軸線Xに対して垂直な平面内においても、湾曲部13の曲率中心Cを支点として自由に回動することができる(操作者である医師にとって左右方向に回動することができる)。 The rail holding arm 50 with the arcuate track rail 20 can rotate around the rotation axis X of the rotary bearing 60, so that the sleeve 10 can be rotated even in a plane perpendicular to the rotation axis X. , The curved portion 13 can be freely rotated around the center of curvature C as a fulcrum (it can be rotated in the left-right direction for the doctor who is the operator).
 以上の通り、本実施形態の手術支援装置100によれば、湾曲部13の曲率中心Cを仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能である。 As described above, according to the surgical support device 100 of the present embodiment, the center of curvature C of the curved portion 13 can be regarded as a virtual hole, and the virtual hole can be positioned at the position where the ribs are present. .. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
 すなわち、操作者である医師は、従来の直線状の手術支援装置のスリーブがあたかも仮想孔を貫通しているかのような感覚で、手術を実施することができる。これにより、従来の直線状の手術支援装置において培った手技を有効に適用することができる。 That is, the doctor who is the operator can perform the operation as if the sleeve of the conventional linear operation support device penetrates the virtual hole. As a result, the techniques cultivated in the conventional linear surgery support device can be effectively applied.
 また、本実施形態の手術支援装置100によれば、1つの実孔に対して、それを取り囲む曲率半径rの円周上の任意の位置を仮想孔に見立てることができるため、複数の患部に対する手術を1つ(ないしより少数)の実孔のみで実現することも可能となり得る。 Further, according to the operation support device 100 of the present embodiment, since any position on the circumference of the radius of curvature r surrounding one real hole can be regarded as a virtual hole, it is possible to treat a plurality of affected areas. It may also be possible to perform surgery with only one (or fewer) real holes.
(第2実施形態の構成)
 図9は、本発明の第2実施形態に係る手術支援装置200の概略側面図であり、図10は、本発明の第2実施形態に係る手術支援装置200の概略平面図である。
(Structure of the second embodiment)
FIG. 9 is a schematic side view of the surgery support device 200 according to the second embodiment of the present invention, and FIG. 10 is a schematic plan view of the surgery support device 200 according to the second embodiment of the present invention.
 図9に示すように、本実施形態の手術支援装置200は、基端側直線部211と、先端側直線部212と、基端側直線部211及び先端側直線部212の間に設けられた側面視で略半円弧状の湾曲部213と、を有するスリーブ210を備えている。 As shown in FIG. 9, the operation support device 200 of the present embodiment is provided between the proximal end side straight portion 211, the distal end side straight portion 212, and the proximal end side straight portion 211 and the distal end side straight portion 212. The sleeve 210 is provided with a curved portion 213 having a substantially semicircular arc shape in a side view.
 但し、第1実施形態のスリーブ10の湾曲部13よりも、第2実施形態のスリーブ210の湾曲部213の方が、曲率半径が小さくなっており(湾曲部213の曲率半径は0.4r)、迂回量が小さくなっている。 However, the radius of curvature of the curved portion 213 of the sleeve 210 of the second embodiment is smaller than that of the curved portion 13 of the sleeve 10 of the first embodiment (the radius of curvature of the curved portion 213 is 0.4r). , The amount of detour is small.
 一方で、本実施形態の手術支援装置200も、第1実施形態の手術支援装置100と同様の円弧軌道レール20を備えている。但し、当該円弧軌道レール20を支持するレール保持アーム250の先端側アーム部253は、中間アーム部252からクランク状に延びていて(図10参照)、中間アーム部252及びスリーブ210に対して、図9の紙面の手前側にオフセットされた位置にある。従って、円弧軌道レール20も、スリーブ210に対して、図9の紙面の手前側にオフセットされた位置にある。 On the other hand, the surgery support device 200 of the present embodiment also has an arc track rail 20 similar to the surgery support device 100 of the first embodiment. However, the tip side arm portion 253 of the rail holding arm 250 that supports the arc track rail 20 extends in a crank shape from the intermediate arm portion 252 (see FIG. 10), with respect to the intermediate arm portion 252 and the sleeve 210. It is in a position offset to the front side of the paper surface of FIG. Therefore, the arc track rail 20 is also at a position offset toward the front side of the paper surface of FIG. 9 with respect to the sleeve 210.
 そして、円弧軌道レール20の一側溝部33及び他側溝部43に対応する管径(8mm)及び曲率半径(50mm)を有する略1/4円弧状の摺動部270が、円弧軌道レール20によって摺動可能に保持されており、当該摺動部270の両端が、当該摺動部270に一体的に結合された取付部280(対向する一対のL字状部280aと平行な一対の連絡部280bとを有する)を介して、スリーブ210の基端側直線部211に固定されている。 Then, a substantially 1/4 arc-shaped sliding portion 270 having a pipe diameter (8 mm) and a radius of curvature (50 mm) corresponding to the one-side groove portion 33 and the other-side groove portion 43 of the arc track rail 20 is formed by the arc track rail 20. It is held slidably, and both ends of the sliding portion 270 are integrally coupled to the sliding portion 270. It is fixed to the base end side straight portion 211 of the sleeve 210 via (having 280b and the like).
 本実施形態のその他の構成については、図1乃至図8を用いて説明した第1実施形態と略同様である。図9及び図10において、第1実施形態と同様の部分については、同様の符号を付している。また、本実施形態の第1実施形態と同様の部分については、詳しい説明を省略する。 Other configurations of this embodiment are substantially the same as those of the first embodiment described with reference to FIGS. 1 to 8. In FIGS. 9 and 10, the same parts as those in the first embodiment are designated by the same reference numerals. Further, detailed description of the same parts as those of the first embodiment of the present embodiment will be omitted.
(第2実施形態の作用)
 以上のような本実施形態の手術支援装置200も、肋骨が存在する位置を回動操作の支点にしたい、という場合に極めて有効である。
(Operation of the second embodiment)
The surgical support device 200 of the present embodiment as described above is also extremely effective when it is desired to use the position where the ribs exist as a fulcrum for the rotation operation.
 すなわち、回動操作の支点にしたい位置(肋骨が存在していても構わない)を仮想孔に見立てて、本実施形態の手術支援装置200の基端側直線部211及び先端側直線部212の延長線と回動軸受60の回動軸線Xとの交点Cが当該仮想孔に位置できるように、当該仮想孔から曲率半径rの0.4倍だけ離れた位置に実孔(直径3cm程度)を開孔する。 That is, the position to be the fulcrum of the rotation operation (the ribs may be present) is regarded as a virtual hole, and the base end side straight portion 211 and the tip end side straight portion 212 of the operation support device 200 of the present embodiment. A real hole (about 3 cm in diameter) is located 0.4 times the radius of curvature r from the virtual hole so that the intersection C of the extension line and the rotation axis X of the rotary bearing 60 can be located in the virtual hole. To open a hole.
 続いて、当該実孔から、スリーブ210(予め摺動部270が固定されている)の先端側直線部212を体内に挿入し、更に、湾曲部213の先端側部分を体内に挿入する。 Subsequently, the straight portion 212 on the tip side of the sleeve 210 (the sliding portion 270 is fixed in advance) is inserted into the body through the actual hole, and the tip side portion of the curved portion 213 is further inserted into the body.
 この状態で、図9及び図10に示すように、スリーブ210に固定された摺動部270に、レール保持アーム250の先端部に固定された円弧軌道レール20を摺動可能に取り付ける。 In this state, as shown in FIGS. 9 and 10, the arc track rail 20 fixed to the tip of the rail holding arm 250 is slidably attached to the sliding portion 270 fixed to the sleeve 210.
 これにより、スリーブ210は、摺動部270の曲率中心を支点として円弧軌道レール20に対して摺動部270が円弧状に摺動移動することによって、図9の紙面が示す交点Cを含む平面に対して手前側に平行にオフセットされた平面内において自由に回動することができる(操作者である医師にとって前後方向に回動することができる)。 As a result, the sleeve 210 is a flat surface including the intersection C shown on the paper surface of FIG. It can rotate freely in a plane offset parallel to the front side (it can rotate in the front-back direction for the doctor who is the operator).
 そして、円弧軌道レール20を伴うレール保持アーム250が回動軸受60の回動軸線X回りに回動可能であることによって、スリーブ210は、当該回動軸線Xに対して垂直な平面内においても、基端側直線部211及び先端側直線部212の延長線と回動軸受60の回動軸線Xとの交点Cを支点として自由に回動することができる(操作者である医師にとって左右方向に回動することができる)。 The rail holding arm 250 with the arcuate track rail 20 can rotate around the rotation axis X of the rotary bearing 60, so that the sleeve 210 can be rotated even in a plane perpendicular to the rotation axis X. , The extension line of the base end side straight portion 211 and the tip end side straight portion 212 and the rotation axis X of the rotary bearing 60 can be freely rotated around the intersection C as a fulcrum (left-right direction for the doctor who is the operator). Can rotate to).
 以上の通り、本実施形態の手術支援装置100によれば、基端側直線部211及び先端側直線部212の延長線と回動軸受60の回動軸線Xとの交点Cを仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能である。 As described above, according to the operation support device 100 of the present embodiment, the intersection C between the extension lines of the base end side straight line portion 211 and the tip end side straight line portion 212 and the rotation axis X of the rotary bearing 60 is regarded as a virtual hole. It is possible to align the virtual hole at the position where the ribs are present. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
 すなわち、操作者である医師は、従来の直線状の手術支援装置のスリーブがあたかも仮想孔を貫通しているかのような感覚で、手術を実施することができる。これにより、従来の直線状の手術支援装置において培った手技を有効に適用することができる。 That is, the doctor who is the operator can perform the operation as if the sleeve of the conventional linear operation support device penetrates the virtual hole. As a result, the techniques cultivated in the conventional linear surgery support device can be effectively applied.
 また、本実施形態の手術支援装置200によれば、1つの実孔に対して、それを取り囲む半径0.4r(図示例の場合)の円周上の任意の位置を仮想孔に見立てることができるため、複数の患部に対する手術を1つ(ないしより少数)の実孔のみで実現することも可能となり得る。 Further, according to the operation support device 200 of the present embodiment, for one real hole, an arbitrary position on the circumference having a radius of 0.4 r (in the case of the illustrated example) surrounding the actual hole can be regarded as a virtual hole. Therefore, it may be possible to perform surgery on a plurality of affected areas with only one (or fewer) real holes.
 なお、場合によっては、図9に二点鎖線で示すように、スリーブ210の湾曲部213の曲率半径を大きくしてもよい、二点鎖線で示された湾曲部213は、略1/4円弧状であって、その曲率半径は、1.41rである。 In some cases, as shown by the alternate long and short dash line in FIG. 9, the radius of curvature of the curved portion 213 of the sleeve 210 may be increased. It is arcuate and has a radius of curvature of 1.41r.
 湾曲部213の曲率半径が大きければ、操作アーム70の構成がより容易となり得る。但し、湾曲部213の曲率中心が交点Cからズレることになるため、操作者による前後方向の回動操作の際に、スリーブ210が実孔を伴って元の実孔の位置から僅かに前後方向(図9の左右方向)に移動する必要がある。このため、実質的に、前後方向の回動操作の範囲が制限され得る。 If the radius of curvature of the curved portion 213 is large, the configuration of the operation arm 70 can be easier. However, since the center of curvature of the curved portion 213 deviates from the intersection C, the sleeve 210 is slightly moved in the front-rear direction from the position of the original actual hole with the actual hole when the operator rotates in the front-rear direction. It is necessary to move in the (horizontal direction in FIG. 9). Therefore, the range of the rotation operation in the front-rear direction can be substantially limited.
(第3実施形態の構成)
 図11は、本発明の第3実施形態に係る手術支援装置300の概略側面図であり、図12は、本発明の第3実施形態に係る手術支援装置300の概略平面図である。
(Structure of Third Embodiment)
FIG. 11 is a schematic side view of the surgery support device 300 according to the third embodiment of the present invention, and FIG. 12 is a schematic plan view of the surgery support device 300 according to the third embodiment of the present invention.
 図11に示すように、本実施形態の手術支援装置300は、基端側直線部311と、先端側直線部312と、基端側直線部311及び先端側直線部312の間に設けられた側面視で略半円弧状の湾曲部313と、を有するスリーブ310を備えている。 As shown in FIG. 11, the surgical support device 300 of the present embodiment is provided between the proximal end side straight portion 311 and the distal end side straight portion 312, and the proximal end side straight portion 311 and the distal end side straight portion 312. A sleeve 310 having a substantially semicircular curved portion 313 in a side view is provided.
 但し、第1実施形態のスリーブ10の湾曲部13よりも、第3実施形態のスリーブ310の湾曲部313の方が、曲率半径が大きくなっており(湾曲部313の曲率半径は1.5r)、迂回量が大きくなっている。 However, the radius of curvature of the curved portion 313 of the sleeve 310 of the third embodiment is larger than that of the curved portion 13 of the sleeve 10 of the first embodiment (the radius of curvature of the curved portion 313 is 1.5r). , The amount of detour is large.
 一方で、本実施形態の手術支援装置300も、第2実施形態の手術支援装置200と同様の円弧軌道レール20を備えている。そして、第2実施形態の手術支援装置200と同様に、当該円弧軌道レール20を支持するレール保持アーム250の先端側アーム部253は、中間アーム部252からクランク状に延びていて(図12参照)、中間アーム部252及びスリーブ310に対して、図11の紙面の手前側にオフセットされた位置にある。従って、円弧軌道レール20も、スリーブ310に対して、図11の紙面の手前側にオフセットされた位置にある。 On the other hand, the surgery support device 300 of the present embodiment also has an arc trajectory rail 20 similar to the surgery support device 200 of the second embodiment. Then, similarly to the surgery support device 200 of the second embodiment, the tip end side arm portion 253 of the rail holding arm 250 that supports the arc track rail 20 extends from the intermediate arm portion 252 in a crank shape (see FIG. 12). ), The position offset to the front side of the paper surface of FIG. 11 with respect to the intermediate arm portion 252 and the sleeve 310. Therefore, the arc track rail 20 is also at a position offset toward the front side of the paper surface of FIG. 11 with respect to the sleeve 310.
 そして、円弧軌道レール20の一側溝部33及び他側溝部43に対応する管径(8mm)及び曲率半径(50mm)を有する略1/4円弧状の摺動部270が、円弧軌道レール20によって摺動可能に保持されている。但し、本実施形態では、当該摺動部270の一端のみが、当該摺動部270に一体的に結合された取付部380(L字状部380aと連絡部380bとを有する)を介して、スリーブ310の基端側直線部311に固定されている。 Then, a substantially 1/4 arc-shaped sliding portion 270 having a pipe diameter (8 mm) and a radius of curvature (50 mm) corresponding to the one-side groove portion 33 and the other-side groove portion 43 of the arc track rail 20 is formed by the arc track rail 20. It is held slidable. However, in the present embodiment, only one end of the sliding portion 270 is interposed via a mounting portion 380 (having an L-shaped portion 380a and a connecting portion 380b) integrally coupled to the sliding portion 270. It is fixed to the base end side straight portion 311 of the sleeve 310.
 本実施形態のその他の構成については、図9及び図10を用いて説明した第2実施形態と略同様である。図11及び図12において、第2実施形態と同様の部分については、同様の符号を付している。また、本実施形態の第2実施形態と同様の部分については、詳しい説明を省略する。 Other configurations of this embodiment are substantially the same as those of the second embodiment described with reference to FIGS. 9 and 10. In FIGS. 11 and 12, the same parts as those in the second embodiment are designated by the same reference numerals. Further, detailed description of the same parts as those of the second embodiment of the present embodiment will be omitted.
 本実施形態の手術支援装置300によっても、基端側直線部311及び先端側直線部312の延長線と回動軸受60の回動軸線Xとの交点Cを仮想孔に見立てることができ、当該仮想孔を肋骨が存在する位置に位置合わせすることが可能である。これにより、肋骨が存在する位置を回動操作の支点にするような使われ方が可能である。 The surgical support device 300 of the present embodiment also allows the intersection C of the extension lines of the base end side straight line portion 311 and the tip end side straight line portion 312 and the rotation axis X of the rotary bearing 60 to be regarded as a virtual hole. It is possible to align the virtual hole where the ribs are. This makes it possible to use the position where the ribs are present as a fulcrum for the rotation operation.
 すなわち、操作者である医師は、従来の直線状の手術支援装置のスリーブがあたかも仮想孔を貫通しているかのような感覚で、手術を実施することができる。これにより、従来の直線状の手術支援装置において培った手技を有効に適用することができる。 That is, the doctor who is the operator can perform the operation as if the sleeve of the conventional linear operation support device penetrates the virtual hole. As a result, the techniques cultivated in the conventional linear surgery support device can be effectively applied.
 また、本実施形態の手術支援装置300によれば、1つの実孔に対して、それを取り囲む半径1.5r(図示例の場合)の円周上の任意の位置を仮想孔に見立てることができるため、複数の患部に対する手術を1つ(ないしより少数)の実孔のみで実現することも可能となり得る。 Further, according to the operation support device 300 of the present embodiment, for one real hole, an arbitrary position on the circumference having a radius of 1.5r (in the case of the illustrated example) surrounding the actual hole can be regarded as a virtual hole. Therefore, it may be possible to perform surgery on a plurality of affected areas with only one (or fewer) real holes.
 なお、場合によっては、図11に二点鎖線で示すように、スリーブ310の湾曲部313は略U字状に形成されてもよい、但し、実穴の近傍における湾曲部313の曲率中心が交点Cからズレる場合には、操作者による前後方向の回動操作の際に、スリーブ310が実孔を伴って元の実孔の位置から僅かに前後方向(図11の左右方向)に移動する必要があることに留意が必要である。 In some cases, as shown by the alternate long and short dash line in FIG. 11, the curved portion 313 of the sleeve 310 may be formed in a substantially U shape, except that the center of curvature of the curved portion 313 in the vicinity of the actual hole is an intersection. In the case of deviation from C, it is necessary for the sleeve 310 to move slightly in the front-rear direction (horizontal direction in FIG. 11) from the position of the original actual hole with the actual hole when the operator rotates in the front-rear direction. It should be noted that there is.
10   スリーブ
11   基端側直線部
12   先端側直線部
13   湾曲部
20   円弧軌道レール
25   ネジ
30   一側レール部材
33   一側溝部
40   他側レール部材
43   他側溝部
50   レール保持アーム
51   基端側アーム部
52   中間アーム部
53   先端側アーム部
60   回動軸受
61   ハウジング
62   蓋
70   操作アーム
71   電気メス
100  手術支援装置
200  手術支援装置
210  スリーブ
211  基端側直線部
212  先端側直線部
213  湾曲部
250  レール保持アーム
251  基端側アーム部
252  中間アーム部
253  先端側アーム部
270  摺動部
280  取付部
280a L字状部
280b 連絡部
300  手術支援装置
310  スリーブ
311  基端側直線部
312  先端側直線部
313  湾曲部
380  取付部
380a L字状部
380b 連絡部
10 Sleeve 11 Base end side straight part 12 Tip side straight part 13 Curved part 20 Arc track rail 25 Screw 30 One side rail member 33 One side groove part 40 Other side rail member 43 Other side groove part 50 Rail holding arm 51 Base end side arm part 52 Intermediate arm 53 Tip side arm 60 Rotating bearing 61 Housing 62 Lid 70 Operation arm 71 Electric knife 100 Surgical support device 200 Surgical support device 210 Sleeve 211 Base end side straight part 212 Tip side straight part 213 Curved part 250 Rail holding Arm 251 Base end side arm part 252 Intermediate arm part 253 Tip side arm part 270 Sliding part 280 Mounting part 280a L-shaped part 280b Communication part 300 Surgical support device 310 Sleeve 311 Base end side straight part 312 Tip side straight part 313 Curved Part 380 Mounting part 380a L-shaped part 380b Communication part

Claims (6)

  1.  基端側直線部と、先端側直線部と、前記基端側直線部及び前記先端側直線部の間に設けられた側面視で円弧状の湾曲部と、を備えたスリーブと、
     前記湾曲部を当該湾曲部の前記円弧状に沿った方向に摺動可能に保持する円弧軌道レールと、
     前記円弧軌道レールを保持するレール保持アームと、
     前記レール保持アームの回動を許容しながら当該レール保持アームを支持する回動軸受と、
     前記スリーブ内に延在する操作アームと、
    を備え、
     前記基端側直線部と前記先端側直線部とは、略一直線上に配置されており、
     前記湾曲部の曲率中心は、前記基端側直線部及び前記先端側直線部の延長線上にあり、且つ、前記回動軸受の回動軸線上にある
    ことを特徴とする手術支援装置。
    A sleeve provided with a base end side straight line portion, a tip end side straight line portion, and a side view arcuate curved portion provided between the base end side straight line portion and the tip end side straight line portion.
    An arc track rail that slidably holds the curved portion in a direction along the arc shape of the curved portion, and
    A rail holding arm that holds the arc track rail and
    A rotating bearing that supports the rail holding arm while allowing the rail holding arm to rotate,
    An operation arm extending in the sleeve and
    With
    The base end side straight line portion and the tip end side straight line portion are arranged on a substantially straight line.
    A surgical support device characterized in that the center of curvature of the curved portion is on an extension line of the base end side straight line portion and the tip end side straight line portion and is on the rotation axis of the rotary bearing.
  2.  基端側直線部と、先端側直線部と、前記基端側直線部及び前記先端側直線部の間に設けられた湾曲部と、を備えたスリーブと、
     前記スリーブに取り付けられた側面視で円弧状の摺動部と、
     前記摺動部を当該摺動部の前記円弧状に沿った方向に摺動可能に保持する円弧軌道レールと、
     前記円弧軌道レールを保持するレール保持アームと、
     前記レール保持アームの回動を許容しながら当該レール保持アームを支持する回動軸受と、
     前記スリーブ内に延在する操作アームと、
    を備え、
     前記基端側直線部と前記先端側直線部とは、略一直線上に配置されており、
     前記基端側直線部及び前記先端側直線部の延長線は、前記回動軸受の回動軸線と直交しており、
     前記摺動部の曲率中心は、前記基端側直線部及び前記先端側直線部の前記延長線及び前記回動軸受の前記回動軸線の交点から、当該延長線及び当該回動軸線に垂直な方向にオフセットされた位置にある
    ことを特徴とする手術支援装置。
    A sleeve including a base end side straight portion, a tip end side straight portion, and a curved portion provided between the base end side straight portion and the tip end side straight portion.
    A side-viewing arcuate sliding portion attached to the sleeve,
    An arc track rail that slidably holds the sliding portion in a direction along the arc shape of the sliding portion, and
    A rail holding arm that holds the arc track rail and
    A rotating bearing that supports the rail holding arm while allowing the rail holding arm to rotate,
    An operation arm extending in the sleeve and
    With
    The base end side straight line portion and the tip end side straight line portion are arranged on a substantially straight line.
    The extension lines of the base end side straight line portion and the tip end side straight line portion are orthogonal to the rotation axis of the rotary bearing.
    The center of curvature of the sliding portion is perpendicular to the extension line and the rotation axis from the intersection of the extension line of the base end side straight line portion and the tip end side straight line portion and the rotation axis of the rotation bearing. A surgical support device characterized by being in a position offset in the direction.
  3.  前記円弧軌道レールは、互いに対向して前記湾曲部を摺動可能に挟む一側レール部材及び他側レール部材を有している
    ことを特徴とする請求項1または2に記載の手術支援装置。
    The surgical support device according to claim 1 or 2, wherein the arc track rail has a one-side rail member and a other-side rail member that slidably sandwich the curved portion so as to face each other.
  4.  前記一側レール部材及び前記他側レール部材は、前記湾曲部を摺動可能に挟んだ状態と前記湾曲部を取り外し可能な状態との間で変位するように、互いに結合されている
    ことを特徴とする請求項3に記載の手術支援装置。
    The one-side rail member and the other-side rail member are characterized in that they are coupled to each other so as to be displaced between a state in which the curved portion is slidably sandwiched and a state in which the curved portion is removable. The surgical support device according to claim 3.
  5.  前記操作アームは、前記スリーブに対して、伸縮機能と、軸回転機能と、を有している
    ことを特徴とする請求項1乃至4のいずれかに記載の手術支援装置。
    The surgical support device according to any one of claims 1 to 4, wherein the operation arm has an expansion / contraction function and an axis rotation function with respect to the sleeve.
  6.  前記操作アームは、撮影機能、吸引機能、切除機能、または、治療機能を有している
    ことを特徴とする請求項1乃至5のいずれかに記載の手術支援装置。
    The surgical support device according to any one of claims 1 to 5, wherein the operating arm has a photographing function, a suction function, an excision function, or a therapeutic function.
PCT/JP2020/040423 2019-10-29 2020-10-28 Surgery-assisting device WO2021085471A1 (en)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007325936A (en) * 2007-07-05 2007-12-20 Toshiba Corp Medical manipulator
US20100185212A1 (en) * 2007-07-02 2010-07-22 Mordehai Sholev System for positioning endoscope and surgical instruments
JP2013529978A (en) * 2010-06-25 2013-07-25 マツィエイ ジェイ. チェトゥラキス, Single-port laparoscopic access with laterally spaced virtual insertion points
JP2017528299A (en) * 2014-09-20 2017-09-28 マチェイ ジェイ. カイトラーカス, Single-port laparoscopic access system with external tool support

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100185212A1 (en) * 2007-07-02 2010-07-22 Mordehai Sholev System for positioning endoscope and surgical instruments
JP2007325936A (en) * 2007-07-05 2007-12-20 Toshiba Corp Medical manipulator
JP2013529978A (en) * 2010-06-25 2013-07-25 マツィエイ ジェイ. チェトゥラキス, Single-port laparoscopic access with laterally spaced virtual insertion points
JP2017528299A (en) * 2014-09-20 2017-09-28 マチェイ ジェイ. カイトラーカス, Single-port laparoscopic access system with external tool support

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