WO2021085471A1 - Dispositif d'aide à la chirurgie - Google Patents

Dispositif d'aide à la chirurgie 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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English (en)
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
Publication date
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/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/50—Supports 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)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Ophthalmology & Optometry (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif d'aide à la chirurgie caractérisé en ce qu'il comprend : un manchon pourvu d'une partie linéaire d'extrémité proximale, une partie linéaire d'extrémité distale, et une partie courbée qui est arquée en vue latérale et qui est disposée entre la partie linéaire d'extrémité proximale et la partie linéaire côté extrémité distale ; un rail de guidage d'arc pour retenir la partie courbée de sorte que la partie courbée peut coulisser le long de la direction de la forme d'arc de celle-ci ; un bras de retenue de rail pour retenir le rail de guidage d'arc ; un palier rotatif pour soutenir le bras de retenue de rail tout en permettant au bras de retenue de rail de tourner ; et un bras d'opération qui s'étend dans le manchon, la partie linéaire d'extrémité proximale et la partie linéaire d'extrémité distale étant positionnées sur une ligne sensiblement droite, et le centre de courbure de la partie courbée étant sur une ligne d'extension de la partie linéaire d'extrémité proximale et de la partie linéaire d'extrémité distale et sur l'axe de rotation du palier rotatif.
PCT/JP2020/040423 2019-10-29 2020-10-28 Dispositif d'aide à la chirurgie WO2021085471A1 (fr)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007325936A (ja) * 2007-07-05 2007-12-20 Toshiba Corp 医療用マニピュレータ
US20100185212A1 (en) * 2007-07-02 2010-07-22 Mordehai Sholev System for positioning endoscope and surgical instruments
JP2013529978A (ja) * 2010-06-25 2013-07-25 マツィエイ ジェイ． チェトゥラキス， 側方に離間した仮想挿入点を伴う単一ポート腹腔鏡下アクセス
JP2017528299A (ja) * 2014-09-20 2017-09-28 マチェイ ジェイ． カイトラーカス， 外部ツール支持を有する単一ポート腹腔鏡下アクセスシステム

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 (ja) * 2007-07-05 2007-12-20 Toshiba Corp 医療用マニピュレータ
JP2013529978A (ja) * 2010-06-25 2013-07-25 マツィエイ ジェイ． チェトゥラキス， 側方に離間した仮想挿入点を伴う単一ポート腹腔鏡下アクセス
JP2017528299A (ja) * 2014-09-20 2017-09-28 マチェイ ジェイ． カイトラーカス， 外部ツール支持を有する単一ポート腹腔鏡下アクセスシステム

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