JP2003199748A - Medical treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical treatment instrument easily changed over to treatment under pneumoperitoneum and treatment outside the abdominal cavity, allowing forceps operation under pneumoperitoneum, protecting an incision wound on the abdominal wall when extracting a cancer region, and causing no problem of wound infection. <P>SOLUTION: This medical treatment instrument detained in the incision wound is additionally provided with a first fixing member at an aperture part on the proximal end side of a cylindrical member, and a second fixing member at an aperture part on the distal end side. The second fixing member is additionally provided with two or more tension belts for adjusting the length between both fixing members, and the first fixing member is additionally provided with a belt resistance adjusting member with a means for airtightly locking the tension belt. A converter is airtightly fixed to the first fixing member. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

TECHNICAL FIELD The present invention relates to a medical treatment tool for making an incision. Especially in endoscopic surgery,
After the procedure under the pneumoperitoneum, the pneumoperitoneum is released and the organ is taken out of the body for treatment, or the organ is returned to the body again and the affected area can be confirmed and additional treatment can be performed by re-pneumoperitoneum operation. The present invention relates to a medical treatment tool.

[0002]

2. Description of the Related Art In recent years, endoscopic surgery has been widely performed as a method of minimally invasive surgery. Endoscopic surgery has the advantages that it is minimally invasive, has a short hospital stay, and requires less trauma. On the other hand, the surgeon operates the treatment tools such as forceps while watching the image displayed by the endoscope on the screen, which makes the operation difficult and takes a long time and causes a lot of stress. . In particular, stomach and large intestine surgery often takes a long time, and the operator is greatly stressed. For this reason, if it is assumed that a large specimen will be finally removed after endoscopic treatment, it is assumed that a small incision is made, and the procedure under the pneumoperitoneum and the organ is pulled out from the small incision to the surface of the body. There is a need for a medical treatment tool that can easily close a small opening so that it can be easily transferred to the treatment to be performed.

In Japanese Patent Laid-Open No. 11-160942, there is provided a device composed of a member for fixing the abdominal wall in between and a cylindrical member,
A simple mechanism that adjusts the distance between the members that sandwich the abdominal wall to the fixing member inserted into the abdominal cavity with a thread previously fixed to the fixing member outside the abdominal cavity and adjusts it. Disclosed is a medical treatment tool capable of inserting and manipulating forceps through a small opening at the time of re-abdomination by using two kinds of airtight members for maintaining the sex. By using this device, after sufficiently performing procedures such as detachment around the excised organ under the pneumoperitoneum, a small incision of about 3 to 5 cm is placed at the place where the organ is taken out, and the target organ is cut through the small incision. The surgeon can perform surgery by taking it out of the body and directly seeing the dissection, excision, and suturing of the lesion. However, “When the incision is recreated with a thread, the thread is caught in the abdominal wall of the incision and it is difficult to recreate it sufficiently.” “In addition to the projections that fix the fixing member spacing adjustment sheet, the rough sheet is also available. It is attached to the surrounding area, and it is difficult to perform treatment by pulling out the organ. "

Japanese Unexamined Patent Publication (Kokai) No. 10-108868 discloses a valve and a valve-equipped trocar mandrel tube capable of preventing the leakage of pneumoperitoneum gas from the abdominal cavity regardless of the type of forceps used. This valve is equipped with a flexible cylindrical member between two rings, and twists the two rings in opposite directions to insert forceps having different outer diameters and an operator's arm to perform internal treatment. It is also possible to open the valve and take out the organ outside the body for treatment. However, in this method, since the forceps and the like are fixed while being squeezed by the valve, there is a drawback that it is difficult to move forward and backward. Further, when the arm is inserted, the thickness of the arm is changed particularly by the back and forth movement, so that it becomes difficult to maintain the airtightness in some cases, and it is necessary to adjust the throttle of the valve. Furthermore, since the fixing force of the device to the abdominal wall depends only on the rubber elasticity of the cylindrical member, there is a problem that the abdominal wall cannot be flexibly accommodated and a sufficient wound retraction cannot be obtained.

US Pat. No. 5,480,410 is a flexible enclosure having an inner surface and an open end, the open end having deployment means for securing the abdominal wall and airtightness, and having at least one access opening for accessing the interior of the enclosure, A device capable of performing surgery within the abdominal cavity or inside an enclosure is disclosed. This device is composed of a flexible sheet material instead of the rigid trocar used in conventional laparoscopic and thoracoscopic surgery, and incises the deploying means that can be deformed into the shape of the incision in the abdominal wall. It is inserted from the mouth and expanded in the abdominal cavity, carbon dioxide gas for pneumoperitoneum flows into the enclosure from the abdominal cavity and the enclosure expands, and the expanding means protects the airtightness from the abdominal wall. Furthermore, if a plurality of access openings are attached to the outer peripheral surface of the enclosure, a plurality of forceps can be inserted, observation under the wound site is possible, and the wound edge is also protected. However, the enclosure is basically spherical, and the distance to each access opening attached to the outer peripheral surface is determined and fixed at the time of setting. Therefore, when inserting a plurality of treatment tools, If the treatment tool is moved significantly, other treatment tools will be dragged and moved, and the incision in the abdominal wall is large relative to the treatment tool such as forceps, and there is no fulcrum on the abdominal wall during operation, making forceps operation complicated. In addition, since the retraction of the wound part depends only on the stretching force of the sheet, there is a problem that a sufficient retraction cannot be obtained depending on the thickness of the abdominal wall.

US Pat. No. 5,640,977 discloses an apparatus having a structure having an outer sleeve and two sealing means, which enters the abdominal cavity through a small opening and uses two sealing means to form an airtight space in the outer sleeve. There is. This device is capable of treating internal organs with pneumoperitoneum when the operator's hand and arm are inserted into the body through the device, and with the third sealing means, the arm is removed. Even in the state, the airtightness of the sleeve and the body can be maintained. However, this device has a structure in which the sleeve part is bonded to the drape that covers the patient's body surface when the operator wants to pull out the internal organs to the outside of the body for treatment, and the upper side of the bonded part can be separated. Therefore, the organ cannot be taken out of the body and treated unless the drape is cut out and the entire device is taken out once or the sleeve portion is cut out. If the device is taken out, cancer tissue or the like may be attached to the abdominal wall, and if the sleeve part is cut off, it is impossible to observe and treat in the abdominal cavity by performing pneumoperitoneum again after the treatment outside the body.

US Pat. No. 5,813,409 discloses a device for separating the sleeve and the abdominal wall fixing portion and snapping and fixing the ring at the distal end of the sleeve and the abdominal wall fixing portion. Since this device can separate the sleeve and the abdominal wall fixation part, it is possible to remove the sleeve part and pull out the internal organs outside the body while leaving the abdominal wall fixation part on the abdominal wall, and cancer tissue does not adhere to the incision. After the treatment is completed, the organ can be returned to the body, the sleeve can be fixed again, and observation and treatment can be performed under the pneumoperitoneum. However, it is difficult to fit the sleeve and the ring of the abdominal wall fixing device by snapping over the entire circumference, and if there is a part where the fitting is insufficient, the airtightness cannot be maintained. Also, if
When the treatment instrument is operated through the sleeve, this device also has a drawback that the incision in the abdominal wall is large with respect to the treatment instrument such as forceps and the forceps operation becomes complicated because there is no fulcrum on the abdominal wall during the operation.

USP 5366478 and Special Table 2000-
No. 501978 discloses a device for inflating a donut-shaped balloon that is connected inside and outside the body to close the inner cavity and maintain airtightness in the abdominal cavity when a hand or forceps is inserted or removed. Since this device has a simple structure and is easy to assemble, the operation time can be shortened. However, USP5
According to the device of No. 366478, when the pneumoperitoneum is released and the organ is taken out of the body for treatment, the balloon must be deflated, and at the same time, a new retractor must be used to close the wound. There was a flaw.
In addition, in both cases, since the balloon is inflated in the circumferential direction, the height of the device from the body surface becomes high, and there is a problem that it is difficult to pull out the organ sufficiently outside the body and it is difficult to position forceps or the like at the site to be treated. It was

In Japanese Patent Laid-Open No. 11-99156, a sleeve is fixed from above and below the abdominal wall with ring-shaped members, and two valves are provided, a normal seal valve and a valve having a slit-shaped opening made of an elastic thin film. , A device having improved airtightness with and without insertion of a hand is disclosed. This device maintains air tightness by expanding the slit-shaped valve so that the contact surfaces of the folded portions are pressed against each other by the abdominal pressure when the hand and forceps are not inserted, so if the valve is opened when the hand is inserted, Since a force greater than the elastic force of the elastic thin film is not generated, the force for tightening the arm can be very small, and the operator's stress is reduced during long-term use. However, with this device, there is a drawback that the slit-shaped valve becomes an obstacle, especially when you want to remove the pneumoperitoneum and take out the organ outside the body to perform treatment or when you want to perform treatment under direct view from the wound, Further, when the treatment tool is operated through the sleeve, this device also has a drawback that the incision in the abdominal wall is large with respect to the treatment tool such as forceps, and the forceps operation is complicated because there is no fulcrum on the abdominal wall during operation. .

In US Pat. No. 5,741,298, a port is firmly fixed from the outside and the inside of the peripheral portion of the incision in the abdominal wall, and a lid attached to the port closes the inner cavity to close the abdominal cavity at the time of inserting a hand or forceps and when removing. An airtight device is disclosed. Since this device has a simple structure and is easy to assemble, the operation time can be shortened. However, this device has a drawback in that it cannot flexibly respond to the size of the incision and the thickness of the abdominal wall, and a sufficient wound retraction cannot be obtained.

In US Pat. No. 5,653,705, a taper-shaped annular member with a screw thread is screwed into the abdominal wall and fixed,
There is disclosed a device in which a detachable and flexible envelope is attached to keep airtightness in the abdominal cavity when a hand or forceps is inserted and removed. With this device, an access port to the abdominal cavity can be easily installed by simply screwing the annular member into the wound, and the annular member can serve as a fulcrum of the forceps, so that the forceps can be easily operated. However, there is a risk of damaging the wound because the annular member is screwed into the wound, and the problem of the annular member becoming bulky and the thickness of the abdominal wall and the size of the incision in order to make the angle easy to screw There was a drawback that it was not possible to respond flexibly to.

[0012]

SUMMARY OF THE INVENTION The present invention solves these drawbacks of conventional endoscopic surgery procedures, and its purpose is to achieve various abdominal wall thicknesses and incision sizes. It is possible to install it flexibly, and it is possible to perform a secondary retracting operation after installation so that the procedure around the incision is easy, and the height of the instrument from the body surface at the time of installation is low, An object of the present invention is to provide a medical treatment tool that can easily switch between a subperitoneal treatment and an extraperitoneal treatment and can perform a forceps operation when performing treatment under the pneumoperitoneum.

[0013]

That is, the present invention is as follows.
(1) A medical treatment in which a first fixing member is attached to the opening on the proximal end side of the tubular member and a second fixing member is attached to the opening on the distal end side of the tubular member. In the tool, the second fixing member is provided with two or more tension belts for adjusting the length between the two fixing members, and the first fixing member has a belt resistance having means for locking the tension belts in an airtight manner. A medical treatment tool having a converter attached with an adjusting member and airtightly fixed to the first fixing member, and (2) means for locking the tension belt in an airtight manner are provided in the vicinity of the slit of the belt resistance adjusting member. And (1) the medical treatment tool according to (1), which is a concavo-convex pattern attached to the tension belt, (3) the medical treatment tool according to (2), wherein the concavo-convex pattern is a sawtooth shape, (4) a belt for hermetically locking. Operate the uneven portion of the resistance adjustment member and pull it (1) The medical treatment tool according to any one of (1) to (3), which has means for releasing the locking with the belt, and (5) unevenness and belt resistance adjustment in which the means for releasing the locking is attached to the tension belt. The medical treatment instrument according to (4), which is a thin plate inserted between the irregularities attached to the member.
(6) The medical treatment tool according to (4), wherein a means for releasing the locking is attached to the belt resistance adjusting member, and has a protrusion capable of moving the uneven portion in the releasing direction, (7) a belt resistance adjusting member, The medical treatment tool according to any one of (1) to (6), wherein at least a part of both or one of the tension belts is made of a material having a longitudinal elastic modulus of 0.05 to 10 kg / mm ² .

[0014]

BEST MODE FOR CARRYING OUT THE INVENTION A medical treatment tool of the present invention will be described with reference to the drawings. Figure 1 shows the overall appearance. The medical treatment tool of the present invention is composed of the following parts. The first fixing member (1), the second fixing member (2), the tension belt (3), the belt resistance adjusting member (4), the tubular member (5),
A converter (6) and an airtight member (7).

(Structure of Medical Treatment Tool) The structure will be briefly described. The second fixing member (2) has an opening (12) for taking out an organ, and the opening (12) of the tubular member (5). Fixed along. The other end of the tubular member (5) is connected to the first fixing member (1). An arbitrary number of tension belts (3) are attached to the second fixing member (2). The tension belt (3) is a slit (1) of the belt resistance adjusting member (4).
Place through 8). The belt resistance adjusting member (4) is arranged on the first fixing member (1). The first fixing member (1) has a converter (6) for preventing leakage of pneumoperitoneum gas.
Is attached. Airtight member (7) for converter (6)
Is attached to almost the center. The tubular member (5) and the tension belt (3) are longer than the thickness of the abdominal wall, and can be installed on any thickness of the abdominal wall. By applying tension to the tension belt (3), the incision can be made. Can be reconstructed. Since the converter (6) can be easily attached to the first fixing member (1), the pneumoperitoneum operation and the operation of taking out the organ can be easily transferred. Since the converter (6) is provided with the airtight member (7), a trocar or the like can be installed and a treatment using forceps or the like is possible.

(First Fixing Member) First Fixing Member (1)
Is attached along the opening (12) of the tubular member (5). Usually, it is produced by injection molding or compression molding. It is closely adhered to the surface of the tubular member (5) by heat welding or adhesive fixing, or is fixed by physical tightening using an O-ring or the like. The shape is circular or polygonal and has an opening (12) for organ removal in the center, but is not particularly limited.
An operator's fist can be inserted into the opening (12), and it is desirable that the size is not bulky when placed on the abdomen,
The outer dimension is 50-300mm in diameter, and the inner dimension is 30-diameter.
A ring shape of 280 mm is preferable. First fixing member (1)
When the height of the organ is as low as possible, it becomes easier to pull out the organ from the opening (12) of the first fixing member (1) to the body surface,
When a treatment tool having a long handle with the opening (12) as a fulcrum is inserted into the body, the treatment range becomes wide, which is preferably 5 to 50 m.
It is preferably m.

A belt resistance adjusting member (4) is arranged on the first fixing member (1). The belt resistance adjusting member (4) may be arranged in the body surface contact surface (13) of the first fixing member (1) or in a groove dug from the opposite side, but FIG.
As shown in (C), it is better to install a void on the side surface of the first fixing member (1) that is perpendicular to the body surface grounding surface (13), and dispose the belt adjusting member (4) in this void. Since the installation surface of the converter (6) can be made seamless with a single member, it is preferable because the airtightness can be easily secured. Further, it is preferable to install a rib at a portion where the belt resistance adjusting member (4) is fixed because the airtightness is improved.

In order to prevent the pulling belt (3) from interfering with the procedure for pulling out the organ, the first fixing member (1) has a structure in which the pulling belt (3) is pulled horizontally. It is desirable to attach a resistance adjusting member (4). A converter (6) is fitted to the first fixing member (1). The outer edge of the first fixing member (1) has a converter (6) so that the converter (6) can be fitted easily.
It is desirable to have a shape in which the claws are caught. It is desirable that the upper part of the first fixing member (1) is flat so as not to damage it, because the extracted organ is in direct contact with it. The material of the first fixing member (1) is vinyl chloride resin, polyurethane resin, polyamide resin, polyethylene resin, polypropylene resin, polyacetal resin, ABS resin, SEBS resin, silicone rubber or the like, or metal such as stainless steel. .

(Second Fixing Member) Second Fixing Member (2)
Is attached along the opening of the tubular member (5). Normal,
It is made by injection molding, compression molding or processing of extruded tubes. It is wrapped in a tubular member (5) and closely adheres to it and is heat-welded or adhesively fixed, or it is closely adhered to the surface of the second fixing member (2) and heat-welded or adhesively fixed. Alternatively, it may be fixed by physical tightening using an O-ring or the like. Approximately 20 to 8 for laparoscopic-assisted colectomy
It is preferable to set an inner diameter of about 30 to 120 mm and an outer diameter of about 40 to 200 mm for a small incision of 0 mm. The thickness is required to be not bulky in the abdominal cavity, so 0.5 to 1
About 0 mm is preferable. Since the second fixing member (2) is bent and inserted into the abdominal cavity through the incision, the material preferably has some elasticity. The material of the second fixing member (2) is vinyl chloride resin, polyurethane resin, polyamide resin, polyethylene resin, polypropylene resin, polyacetal resin, ABS resin, SEBS resin,
Silicone rubber or metal such as stainless steel is used.

(Tensile Belt) The tension belt (3) is connected to the second fixing member (2) and is arranged so as to pass through the slit (18) of the belt resistance adjusting member (4). As shown in FIG. 2, the width of the tension belt (3) is preferably 10 mm or more in order to open a large incision (as circular as possible), but if it is excessively wide, it is difficult to insert it into the incision. It is preferably in the range of 10 to 60 mm. The thickness is preferably a sheet shape of 0.1 to 5 mm in order to keep the height of the tool on the body surface low. The length of the tension belt (3) is preferably long in order to correspond to various abdominal walls, but if it is too long, it will be exposed on the body surface when retracting,
In order to limit the puncture site such as a trocar, the practical length is preferably 30 to 200 mm.

It is preferable that the tension belt (3) is provided with a ratchet groove (17) having a sawtooth shape as shown in FIG. 3 so that the size of the incised wound does not shrink when the incised wound is opened. The depth of the ratchet groove (17) is preferably designed to be about 0.5 to 2.5 mm in order to keep the thickness thin. The ratchet groove (17) is shown in FIG.
It may be attached to a part as shown in FIG. As shown in FIG. 4, it is preferable that the angle A of the ratchet groove (17) be an acute shape because the resistance at the time of retraction is reduced. The ratchet groove (17) attached to the tension belt (3) may be attached to the side surface, but it is better to make it on the side opposite to the opening (12) as shown in FIG. 1 when the organ is pulled out. Since it does not come into contact with the groove (17), there is no fear of damaging the organ, which is preferable.

As a material, a material having appropriate flexibility and good slipperiness is preferable. In order to perform a smooth operation, the tension belt (3) preferably has an appropriate hardness (a material having a Shore hardness of A40 to D60) so as to deform the whole or a part thereof such as unevenness.
The sheet material is a non-woven fabric or a woven fabric, or is produced by extrusion molding, injection molding, compression molding, or the like, but is not particularly limited. Polyamide resin, vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, etc. can be used. A sheet containing a resin or a metal mesh is also preferable because it has little deformation.

(Belt Resistance Adjustment Member) The belt resistance adjustment member (4) is attached to the first fixing member (1). The belt resistance adjusting member (4) is provided with a slit (18) through which the tension belt (3) passes. In order to ensure airtightness, it is preferable that the slit (18) has substantially the same shape as the cross section of the tension belt. Around the slit, unevenness (19) corresponding to the unevenness of the tension belt (3) is attached,
The tension belt (3) is locked to prevent the retracted state from contracting. The belt resistance adjusting member (4) is preferably provided with a rib (14) or a recess so as to keep airtightness when the belt resistance adjusting member (4) is arranged on the first fixing member (1). An example is shown in FIG.

It is desirable that the belt resistance adjusting member (4) is provided with a means for releasing the locked state of the tension belt (3) so that the retracted state and the contracted state can be flexibly switched. For example, as shown in FIG. 6, by inserting a thin plate (20) between the tension belt (3) and the unevenness (19) of the belt resistance adjusting member (4), the engagement of the unevenness (19) can be released. . The thin plate (20) may be provided as a separate member, or the thin plate (20) may be provided as the first fixing member (1).
It may be fixed so that it can slide.

Further, as shown in FIGS. 7 and 8, a projection portion (21) extended from the unevenness (19) is provided so that the unevenness of the belt resistance adjusting member (4) can be moved in a direction in which it can be released from the locked state. It is also possible to attach it and operate it to move the unevenness (19). As shown in FIG. 7, the belt resistance adjusting member (4) has notches (2) near both ends of the unevenness (19) so that the unevenness (19) can be surely moved.
It is desirable to attach 2). FIG. 8 is composed of two parts and has a structure in which when the protrusion (21) of the part including the unevenness (19) is pulled, the part moves downward according to the guide attached to the remaining parts. The locked state is released by the movement of the part including the unevenness (19) on the lower side.

As shown in FIG. 9, the belt resistance adjusting member (4) is divided into two parts (4A, 4B), and the unevenness (19) is formed.
A spring is attached to the lower side of the component (4B) including the
9) may be movable up and down. Further, as shown in FIG. 10, the belt resistance adjusting member (4) has two parts (4A,
4B), and the unevenness (19) may be pulled out in the horizontal direction. As shown in FIG. 11, the belt resistance adjusting member (4) may be divided into three parts, and the unevenness (19) may be opened and moved by the unevenness operating portion (24). Further, the inside of the belt resistance adjusting member (4) may be made hollow to reduce the pressure and release the locking.

Since the tension belt (3) is provided with unevenness (19) so as to suppress the reduction of the degree of retraction of the incision layer, resistance is generated during the retraction operation. In order to perform a smooth operation, the belt resistance adjusting member (4) has an appropriate hardness (Shore hardness A so as to deform the whole or a part thereof such as the unevenness (19).
40 to D60) is desirable. As the material, vinyl chloride resin, polyurethane resin, polyamide resin, polyethylene resin, polypropylene resin, polyacetal resin, ABS resin, SEBS resin, and silicone rubber are used.

(Cylindrical member) The cylindrical member (5) has a wall thickness of 0.0.
It has a flat surface of 5 to 3 mm or a tubular shape with a taper, and is usually produced by extrusion molding or inflation molding, but is not particularly limited. The size of the tubular member (5) varies depending on the site to be treated and the purpose, but when used for laparoscopic-assisted colectomy, the outer diameter is 30 to 30.
0 mm is desirable. During use, treatment tools such as endoscopes and forceps frequently come in and go out, so it is preferable to select a material that is not bulky, is moderately flexible, and is hard to break or tear even when the treatment tool hits, for example, Materials such as soft vinyl chloride resin, polyurethane resin, polyethylene resin, polyamide resin, polypropylene resin, polyester resin, SEBS resin, silicone rubber and natural rubber are preferable.

(Converter) The converter (6) is installed on the first fixing member (1) to ensure the airtightness in the abdominal cavity during the insufflation. When attaching and detaching, it may be fixed by unevenness or screws with the first fixing member (1), but a tab (11) is attached to the end of the converter (6),
It is convenient and preferable to adopt a mode of fitting to the side surface of the first fixing member (1). Usually, it is molded by injection molding, compression molding or the like. As for the converter (6), the airtight member (7) having no opening is attached as shown in FIGS. 1 (B) and 12, and the first airtight member (8) as shown in FIG. And a second airtight member (9) attached, FIG.
A type in which the first airtight member (8) and the second airtight member (9) are integrally molded as shown in FIG. An airtight member (7) is attached to the converter (6), and a window (10) is formed in the center thereof. The size of the window (10) is determined by the size of the treatment instrument to be inserted, and the diameter is 1 to 250 mm,
It is suitable to set the diameter to 1 to 150 mm. The height is 1-40 so that it does not get in the way during treatment.
mm is suitable. The material is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin,
Hard resin such as polyacetal resin, polycarbonate resin, polysulfone resin or silicone rubber, natural rubber,
Synthetic rubber such as NBR is used.

(Airtight Member) The airtight member (7) is arranged to maintain airtightness when inserting the trocar or forceps as shown in FIG. It is a diaphragm without openings. Thickness is 0.1-3mm
Is preferred. This is because if it is less than 0.1 mm, the valve is likely to be deformed by the pressure of carbon dioxide, and if it exceeds 3 mm, the frictional resistance at the time of inserting a treatment tool such as forceps becomes large and the insertion becomes difficult. The inner diameter is preferably 0.5 mm to 80 mm according to the outer diameter of the treatment tool or the like. The material of the airtight member preferably has a tear strength of 5 to 100 N / mm so that the airtightness can be maintained when a treatment tool such as a trocar is inserted. Further, those having flexibility are more preferable, and for example, natural rubber, silicone rubber, vinyl chloride resin, urethane resin, SEBS resin and the like are preferable.

(First Airtight Member) First Airtight Member (8)
Is installed to keep airtightness when forceps etc. are not inserted, and the tip of the proximal end is closed with a cap, etc.
As shown in FIG. 13, a valve member such as a flap type valve or a duck bill type valve may be provided inside. Also, a type as shown in FIG. 14 in which a slit is simply added to the sheet may be used. The length of the slit may be set according to the size of the inserted trocar, treatment tool, or arm, and is 1 to 250 m.
m, especially 1 to 150 mm is preferable. In the case of integrally molding as shown in FIG. 14, it is desirable to install a thick portion so that the second airtight member is not torn even if the slit is torn. When closing with a cap etc., attach a fitting member to the proximal end inlet and fit it with unevenness,
You may fix with a screw. The cap is usually molded by injection molding, etc., and its material is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, or a slightly hard resin, or silicone rubber, natural rubber, NBR, etc. Rubber is used. A flap-type valve is a flap-shaped valve made of an elastic member such as silicone rubber, even if it is a combination of a hard molded product and a spring member, which is usually built in a trocar used in laparoscopic surgery. It may be processed and used. Since the flap type valve does not open to the outside of the body and moves only to the inside of the body, the flap is pushed outward by the positive pressure inside the body when the treatment tool or the like is not inserted, so that the flap is closed. The flap type valve is molded by injection molding or compression molding, and its material is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, silicone rubber or the like. The duckbill type valve is similarly molded by injection molding or compression molding, and is mainly made of an elastic material such as silicone rubber.

(Second Airtight Member) Second Airtight Member (9)
Is arranged to keep airtightness while inserting forceps or the like, and a seal valve having a circular hole may be attached. The seal valve is manufactured by injection molding, compression molding, sheet processing, etc., and is heat-welded or adhered to the proximal end inlet and the converter (6). The thickness of the seal valve is preferably about 0.1 to 3 mm. This is because if it is less than 0.1 mm, the valve is likely to be deformed by the pressure of carbon dioxide, and if it exceeds 3 mm, the frictional resistance at the time of inserting a treatment tool such as forceps becomes large and the insertion becomes difficult. The inner diameter matches the outer diameter of the treatment tool,
0.5 mm to 30 mm is suitable. The material of the seal valve is preferably one having flexibility, such as natural rubber,
Silicone rubber, vinyl chloride resin, urethane resin, SE
BS resin and the like are suitable.

(Usage Method) Next, an actual usage method of the medical treatment tool according to the present invention will be described. When performing a laparoscopic-assisted colectomy, first, a plurality of trocars are inserted into the abdomen, and a small incision of about 3 to 5 cm is placed at the expected site of organ removal. The second fixing member (2) is inserted into the small incision. A pull belt (3) is pulled to make a pull incision as shown in FIG. Next, the converter (6) is airtightly fixed to the first fixing member (1). Insert a trocar or the like from the airtight member (7) of the converter (6), and then insert a laparoscope,
After inserting a treatment tool to remove the large intestine, dissection of the lymph node, treatment of blood vessels, etc. under the laparoscope, and after sufficient passiveness was achieved, remove the converter (6) and remove the large intestine from the body, Under direct vision, the large intestine near the affected area is cut and sutured, and then the large intestine is returned to the body. Again, the converter (6) is attached to the first fixing member (1), and the pneumoperitoneum is performed again to observe the inside of the abdominal cavity sufficiently. When the treatment is necessary again, the treatment is performed under the pneumoperitoneum, or the pneumoperitoneum is dropped and the converter (6) is removed to perform the treatment. If it is necessary to release the tension belt during the procedure, use the release means to release it.

[0034]

The medical treatment tool of the present invention can easily switch between the treatment under the abdominal cavity and the treatment outside the abdominal cavity simply by removing the converter (6). Since the converter (6) is provided with the airtight member (7), the forceps operation by inserting the trocar can also be performed from the product of the present invention when performing treatment under the abdominal cavity. The tubular member (5) protects the incision in the abdominal wall when the cancer site is removed, and there is no problem of wound infection of cancer cells. With the ratchet mechanism of the tension belt (3), the incision can be fixed with sufficient tension applied, and the degree of the incision does not decrease. If you need to cancel,
The tension belt can also be released using a means for releasing the lock. During the operation of laparoscopic surgery, it is possible to easily switch between subperitoneal treatment and extraperitoneal treatment, and it is easy to perform treatment just below the wound site under direct vision, reducing stress on the operator and speeding up the operation time. Up, and further,
Since the surgical wound is smaller and the burden on the patient is lighter than that of laparotomy, the postoperative hospital stay of the patient is shortened, which is a great advantage for the patient and the hospital. Furthermore, the post-operative incision trace is inconspicuously small, which is cosmetically effective.

[Brief description of drawings]

FIG. 1 shows a medical treatment tool according to an embodiment of the present invention,
(A) is a perspective view showing an external view thereof, (B) is a sectional view of a converter and an airtight member, and (C) is a sectional view of a tubular member.

FIG. 2 is a schematic view showing an example of a state in which the medical treatment tool according to the present invention is placed in a wound.

FIG. 3 shows an embodiment of a tension belt of a medical treatment instrument according to the present invention, (A) is one embodiment thereof, (B) is a perspective view of another embodiment, and (C) is still another embodiment. It is a perspective view of an example.

FIG. 4 shows a ratchet groove in the tension belt shown in FIG. 3, (A) being a sectional view of an embodiment thereof, and (B).
FIG. 6 is a sectional view of another embodiment.

FIG. 5 shows an example of a belt resistance adjusting member, (A)
Is a perspective view thereof, and (B) is a sectional view.

FIG. 6 is a perspective view showing how the belt resistance adjusting member is released from an engagement state using a thin plate, (A) is a perspective view showing a relationship with the first fixing member, and (B) is before insertion into the belt resistance adjusting member. And (C) is a sectional view showing a state of being inserted.

FIG. 7 shows another embodiment of the belt resistance adjusting member,
(A) is the perspective view, (B) is sectional drawing in the state which inserted the tension belt, (C) is sectional drawing which shows the detached state of the tension belt.

FIG. 8 is a perspective view showing still another embodiment of the belt resistance adjusting member.

9A and 9B show another embodiment of the belt resistance adjusting member. FIG. 9A is a cross-sectional view of the tension belt in an engaged state, FIG. 9B is a cross-sectional view of FIG. 8A is a sectional view of the tension belt in a detached state, and FIG. 14D is a sectional view of FIG.

FIG. 10 shows still another embodiment of a belt resistance adjusting member composed of two parts, (A) is a perspective view showing an integrated state, and (B) is a separated state. It is a perspective view.

FIG. 11 shows still another embodiment of the belt resistance adjusting member composed of three parts, in which (A) is a perspective view thereof, (B) is a plan view showing an engaged state, and (C) is the top view which shows a detached state.

FIG. 12 is a sectional view showing an example of a converter.

FIG. 13 is a sectional view showing another embodiment of the converter.

FIG. 14 is a sectional view showing still another embodiment of the converter.

[Explanation of symbols]

1 First fixing member 2 Second fixing member 3 tension belt 4 Belt resistance adjustment member 5 Cylindrical member 6 converter 7 Airtight member 8 First airtight member 9 Second airtight member 10 windows 11 claws 12 openings 13 Body surface installation surface 14 ribs 15 Intraperitoneal 16 body surface 17 ratchet groove 18 slits 19 unevenness 20 thin plate 21 Projection 22 Notch 23 Spring 24 Concavo-convex operation section

Claims (7)

[Claims] 1. A medical device in which a first fixing member is attached to an opening on the proximal end side of a tubular member and a second fixing member is attached to an opening on the distal end side of the tubular member. In the treatment instrument, the second fixing member is provided with two or more tension belts for adjusting the length between the two fixing members, and the first fixing member has a means for locking the tension belts in an airtight manner. A medical treatment tool having a converter to which a belt resistance adjusting member is attached and which is airtightly fixed to a first fixing member. 2. A means for locking a tension belt in an airtight manner,
The medical treatment instrument according to claim 1, wherein the belt resistance adjusting member has an unevenness provided near a slit and an unevenness provided on a tension belt. 3. The medical treatment tool according to claim 2, wherein the unevenness has a sawtooth shape. 4. The medical treatment according to any one of claims 1 to 3, wherein the means for locking in an airtight manner has means for moving the uneven portion of the belt resistance adjusting member to release the locking with the tension belt. Tools. 5. The medical treatment tool according to claim 4, wherein the means for releasing the locking is a thin plate inserted between the unevenness provided on the tension belt and the unevenness provided on the belt resistance adjusting member. 6. The medical treatment tool according to claim 4, wherein a means for releasing the locking is attached to the belt resistance adjusting member, and has a protrusion capable of moving the uneven portion in the releasing direction. 7. A longitudinal elastic modulus of at least a part of both or one of the belt resistance adjusting member and the tension belt is 0.05 to 1.
The medical treatment tool according to any one of claims 1 to 6, which is composed of a material of 0 kg / mm ² .