JP2007044395A - Wound retractor - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a wound retractor which facilitates retraction of incisional wound in small incision. <P>SOLUTION: The wound retractor fundamentally comprises: an elastic ring 1 located in a body cavity; an lower ring 2 located on the external wound; an elastic sheet 3 which is flexible and of which each end is expanded to be connected with the lower ring 2 and the elastic ring 1 respectively; an upper ring 4 which is installed coaxially countering the lower ring 2, turnable on the sliding face contacting to the lower ring 2 and can be braked; and a plurality of inelastic line-shaped members 5 of which each end is fixed to the upper ring 4 and the elastic ring 1 and which are located through the inner face of the elastic sheet 3. Optionally, at least two plate members with a prescribed diameter are installed on positions where they counter each other, which are supported by the adjacent two of the inelastic line-shaped members 5. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a retractor expanding device for expanding and holding an incision in a small incision operation under laparotomy or endoscopic observation.

In recent years, surgical operations have been advocated for minimally invasiveness to patients, and small incision surgery is desired in which laparotomy can be completed with as little incision as possible. Endoscopes are inserted into body cavities and images are viewed. Endoscopic surgery that advances the operation while the application spreads, such as surgery to remove a large organ etc., in advance, a small incision is provided in the surgical site, and a retractor holder is attached to the incision, Endoscopic small incision surgery has been actively performed in which an operator's hand or surgical instrument is inserted through the incision as a passage to advance the operation.
And these small incision surgery was developed as an application, and as a conventional instrument for attaching to the small incision and holding the incision, for example, two circular or elliptical rings arranged coaxially and oppositely are used. There is a wound protection device having a retracting part holding function which is constructed by attaching to both ends of a cylindrical elastic member in a state where both ends are expanded, and using a superelastic alloy for at least one of the rings. (Patent Document 1)
However, with this instrument, the retractor holding part that is in contact with the abdominal wall of the incision is a flexible elastic member, so it cannot resist the incision that is about to close itself, and it is inevitable that it will be crushed somewhat. Therefore, it is important that this surgery is minimally invasive. To this end, the incision should be kept to a minimum and the incision must be used as much as possible. Not having been a drawback of this instrument. Therefore, in the case of a procedure that requires a large opening, such as taking out a large organ, using this instrument, for example, an L-shaped forceps-like retractor is hung on the incision from above the elastic member and pulled and held. That is done.

Further, in order to eliminate the above-described drawbacks, a cylindrical member provided with two opposing fixing members (a first fixing member on the outside of the body and a second fixing member on the inside of the body cavity), which is the second fixing At least two or more tension belts are attached to the member, and the length of the tension belt (the distance between the first fixing member and the second fixing member) is adjusted to the first fixing member. There is a medical treatment instrument that can cope with individual differences in the thickness of the abdominal wall and that can hold the incision in an expanded state. (Patent Document 2)
Registered Utility Model No. 30602106 JP 2002-325769 A

However, in the instrument of Patent Document 1 and the instrument that uses the retractor together, it is necessary to use two instruments, and the presence of the retractor itself can narrow the small incision or narrow the field of view. There is sex. In addition, there is a problem that an operation is troublesome because an assistant is required.
On the other hand, there is no functional problem in the instrument of Patent Document 2 in which the width of the tubular member can be adjusted by the tension belt and the incision can be expanded and retained, and the small incision should be used effectively. However, it is troublesome to adjust the tension belts one by one during the operation, and there is a problem that it is not always easy to adjust the entire circumference evenly.

  In view of this, an object of the present invention is to provide a retractor expanding device that facilitates an expanding operation of a small incision so that the small incision can be effectively expanded and used effectively in a small incision operation.

The retractor expanding device of the present invention includes an elastic ring that is inserted from an incision and is disposed in a body cavity, a lower ring that is coaxially opposed to the elastic ring and disposed at the extracorporeal incision, and one end portion of A lower ring, a cylindrical flexible elastic sheet that is connected to the elastic ring by extending the other end to the elastic ring and disposed outside the body cavity and outside the body, and provided coaxially with the lower ring. And an upper ring that can be rotated and slidable on a sliding surface that comes into contact with the upper ring, and a plurality of (effective) And four or more inelastic linear members.

In addition to the configuration of the retractor expanding device, at least two adjacent non-elastic linear members are positioned in the middle of the non-elastic linear member and at the position where they hit the abdominal wall of the incision wound. Two plate members having a predetermined area to be held are provided at least at positions facing each other.

Furthermore, as means provided as necessary, or as specific means suitable for each part,
1. Among the small incision operations, those adapted to endoscopic pneumoperitoneum surgery are configured by providing the upper ring with a valve device for maintaining airtightness inside the body cavity.
2. The inelastic linear member is made of a flexible thread.
3. The braking means provided on the sliding surfaces of the upper ring and the lower ring is configured as an uneven continuous engagement groove provided in a direction facing each other.
4). The elastic ring is formed including a superelastic alloy.
5. The upper ring or the upper ring and the lower ring are provided with a lever for rotating operation.
Such means are selectively provided.

According to the retractor expanding device of this configuration, by linearly rotating the upper ring and the lower ring, the linear member connected to the upper ring and the elastic ring is pulled in conjunction with the upper ring side. As a result, the elastic ring is pulled up toward the upper ring, and a force that presses the elastic sheet in the outer circumferential direction is generated, and the elastic sheet lumen is held so as not to be crushed by the tension of the linear member. When this is attached to the incision, the incision is held open to a predetermined size by the holding force of the linear member against the force of crushing the elastic member to close the incision. be able to. Further, if a further turning operation is applied from this state, the elastic sheet is further opened in the outer circumferential direction by the linear member, so that the incision can be expanded.
By this action, an instrument suitable for the purpose described above, which is required for the small incision operation that is important to be minimally invasive, keeps the incision to the minimum necessary, and uses the provided incision to the maximum extent, is provided. be able to.
In order to obtain this action, the instrument is attached to the incision, the lower ring is held and the upper ring is rotated, and the upper ring and the lower ring are fixed at appropriate positions by the braking means. Therefore, it is possible to make the operation very simple and trouble-free.
Further, as an accompanying action and effect, the portion that hits the body wall is a flexible elastic sheet, and since it is in close contact with the entire incision, the wound protection effect and bleeding prevention effect are high.
Furthermore, since the distance between the ring and the elastic ring expands / contracts depending on the degree of rotation of the upper ring and the lower ring, the difference in the thickness of the abdominal wall due to individual differences is absorbed, and it is always possible to hold in an appropriate compressed state. it can.

In addition, when the plate member having a predetermined area held by the inelastic linear member is provided at two or more locations facing each other, and at least the two plate members are attached to the retracted portion so as to hit the width direction of the incision, Since the incision can be held and expanded by the surface of the plate member, it is functionally more efficient than holding and expanding by a set of lines of only the linear members.
In addition, in the case of an instrument using only linear members, in order to obtain an actual expansion effect, at least four (two per plate member) are assumed to require about 6 to 12 linear members. 2 sets).

In addition, if a valve device is provided on the upper plate, it becomes possible to maintain airtightness in the abdominal cavity, so that endoscopic abdominal surgery (in which the abdominal cavity is inflated with pneumoperitoneum gas and the surgical space is secured) (Endoscopic surgery). In this case, as a valve device to be applied, the above-mentioned characteristics of the small incision operation, a large opening can be formed, and as described in Japanese Patent Laid-Open No. 10-108868, the valve device is coaxially arranged oppositely. An iris valve that includes a pair of rings and a cylindrical elastic member having an opening having a predetermined cross-sectional area each having an end attached to the ring is particularly preferable.
In addition, if a flexible thread is used as the inelastic linear member, the elastic sheet may be damaged by the thread even if the flexible elastic sheet is pressed inward from the inside because of inelasticity and flexibility. It can be securely held and expanded.
Further, if the braking means of the upper and lower rings is configured as a concavity and convexity of the continuous engagement groove, it can be surely locked and the tension strength can be finely adjusted in multiple stages. In addition, when the ring is rotated and the rotation is stopped at an appropriate position, it is locked by the engagement groove at that position, so that no other operation is required. Since the engagement can be released by slightly rotating and floating the upper ring, a very easy operation can be achieved.
In addition, when a superelastic alloy is used for the elastic ring, it can be crushed into a narrow shape when inserted into a body cavity due to its action rich in elasticity and restoring force. By returning to the ring shape, it can be reliably held from within the body cavity.
In addition, if the upper ring or the upper ring and the lower ring are provided with a lever for the rotation operation, the rotation operation can be performed more easily.
In the small incision operation aimed at by the present invention due to the above-described effects, a retractor expanding device that makes it very easy to expand a small incision as much as possible and use it effectively is provided. be able to.

Hereinafter, an example of an embodiment of the present invention will be described in detail with reference to the drawings. FIG. 1 is an overall configuration diagram of a retractor expanding device showing an embodiment of the present invention, in which A is a top view and B is a side view (partially sectional view). FIG. 2 is a partially enlarged sectional view of this example, and FIG. 3 is a schematic diagram showing an expanded state of this example.
The retractor expanding device according to this embodiment is inserted from an incision wound, and is disposed in contact with the peritoneum from the inside of the body cavity, and is disposed opposite to the elastic ring 1 coaxially so as to surround the incision wound on the body surface. The lower ring 2 disposed in contact with the elastic ring 1 and the lower ring 2 are expanded and connected to the elastic ring 1 and the lower ring 2, respectively, and the tubular flexible elastic sheet 3 is disposed in contact with the incision abdominal wall from inside the body cavity to outside the body. And an upper ring 4 that is provided concentrically facing the lower ring 2, is rotatable on a sliding surface that contacts the lower ring 2, and can be braked, and the upper ring 4 and the elastic ring 1, both ends of the elastic sheet 3 are fixedly contacted with each other, and a plurality of yarns 5 arranged through the inner surface of the elastic sheet 3 are arranged. By rotating the upper ring 4 and the lower ring 2 relatively, The thread 5 tied to the upper ring 4 and the elastic ring 3 is linked to The elastic ring 1 is pulled up to the lower ring 2 side, and a force that presses the elastic sheet 3 in the outer circumferential direction is generated. The incision is opened to a predetermined size by the tension of the thread 5. It is possible to hold and even expand the incision.

Next, each part will be described. In the elastic ring 1, a superelastic alloy 11 made of a wire such as a titanium-nickel alloy is formed in a ring shape as a core material, and a resin tube (in this example, a polyurethane tube) is formed on the superelastic alloy 11. ) And a cover tube 13 made of a silicon tube. According to this configuration, by using the superelastic alloy 11 as a core material, the ring is rich in elasticity and restoring force, and can be crushed into a small diameter when inserted into or removed from the body cavity. After insertion, it can be securely retained from inside the body cavity by returning to its original ring shape by its restoring force, and its outer layer is covered with a flexible resin to soften the contact with the peritoneum. can do.
The lower ring 2 is a cylindrical ring member made of a resin molded product, and is an elastic member for connecting an elastic sheet 3 to be described later over the entire circumference on the side surface (lower side) opposite to the elastic ring 1. A sheet locking groove 21 is formed, and an O-ring 22 made of a rubber elastic member for fixing the elastic sheet 3 to the locking groove 21 is engaged. Further, an inscribed groove 23 that abuts on the upper ring 4 to be described later is formed on the surface (upper side) arranged to face the upper ring 4, and the upper ring is formed inside the inscribed groove 23. 4 and a wavy tooth-like continuous engagement groove 24 serving as a braking means is provided around one circumference. Furthermore, eight threading holes 25 for passing the thread 5, which will be described later, are provided in the middle part of the ring side surface.
The elastic sheet 3 is formed by forming a flexible silicon resin thin film sheet into a cylindrical shape, and one end portion (sheet lower end portion 31) is extended over the entire circumference and connected to the elastic ring 1 by adhesion or welding. On the other hand, the seat upper end portion 32 extends over the entire circumference as described above, is hooked in the elastic sheet locking groove 21 of the lower ring 2, and is further pressed and clamped by the O-ring 22. Connected to the lower ring 2. And the cylindrical intermediate part 33 is a contact part with the abdominal wall of an incision.
The upper ring 4 is a cylindrical ring member made of the same resin molded product as the lower ring 2. The upper surface is an opening 41 and serves as an insertion port for a hand or instrument for surgery, and the side facing the lower ring 2 (lower The outer surface is formed with a circumscribed groove 42 that contacts the lower ring 2 over the entire circumference, and the outer groove 42 serves as a sliding surface with the lower ring 2 and serves as a braking means. A wave-tooth-like continuous engagement groove 43 provided in a direction opposite to the continuous engagement groove 24 formed on the lower ring 2 is provided over one circumference, and is inscribed with the lower ring 2. , By circumscribing and engaging, each of the continuous engagement grooves 24 and 43 can be turned as a sliding surface, and the corrugated irregularities of the continuous engagement grooves 24 and 43 are matched. It has a brakeable structure. Further, the upper ring 4 is provided with eight thread retaining holes 44 for passing the thread 5 described later, and a thread retaining groove 45 is provided to securely contact the end of the thread 5. After 5 is attached to the thread retaining groove 45, an O-ring 46 made of a rubber elastic member is engaged with the groove to hold the thread 5 therebetween. In this example, the anti-slip 47 is formed on the side surface of the ring so as to be easily operated when the upper ring 4 is rotated.
The yarn 5 is made of a twisted fiber material that is inelastic and flexible and has excellent tensile strength. One end of the yarn 5 is wound around the elastic ring 1, tied to the end, and fixed by bonding. To be in contact. On the other hand, the other end is passed through the thread retaining hole 44 of the upper ring 4 and the end is bound or a fastener (not shown) is attached to the end so as not to come out of the thread retaining hole 44. Is arranged inside the thread retaining groove 45 and is further pressed and fixed by the O-ring 46. In this example, eight yarns 5 are attached at equal intervals, and the yarns 5 are in a state (length) that is slightly loosened in the normal state (pre-use state before rotation). ).
Here, the routing route of the thread 5 will be described. As described above, the thread fixed to the upper ring 4 is taken out from the thread retaining hole 44 and is put into the lumen of the instrument through the threading hole 25 of the lower ring 2. As described above, the elastic sheet 3 is connected to the elastic ring 3 through the inner surface of the elastic sheet 3 as it is. The thread 5 connected to the upper ring 4 is introduced into the instrument via the lower ring 2 because the thread 5 is arranged in a straight line from the lower ring 2 to the elastic ring 1. Is a consideration for.

Next, the usage form of this embodiment will be briefly described.
(Attaching the instrument to the incision)
When attaching this instrument to an incision, the elastic ring 1 is crushed and made into a small diameter using its elasticity, and gradually inserted into a body cavity from a small incision previously provided in the human body. The finger is inserted through the opening 41 of the upper ring 4, the edge of the elastic ring 1 is picked up, and about half of the elastic ring 1 is pulled out from the opening 41 through the lumen of the instrument. The ring 1 is formed so as to have a high heel shape, and in this state, the elastic ring 1 is slowly pushed into the body cavity and inserted. After being inserted into the body cavity, it naturally returns to its original ring shape due to self-restoring force and comes into contact with the peritoneum and is held. This means is as described in the prior art (Registered Utility Model No. 30602106 (Patent Document 1)).
(Expansion and retention of equipment)
The means for holding and expanding the incision after the instrument is mounted on the human body holds the lower ring 2 and rotates the upper ring 4 clockwise, whereby the thread 5 is pulled by the upper ring 4 and elastically interlocked. As the ring 1 approaches the lower ring 2 and the elastic sheet 3 is expanded in the outer circumferential direction by the tension of the thread 5, the expanded state as shown in the schematic diagram of FIG. 3 is obtained, and as a result, the small incision is strongly held. Can be extended.
And if it expands to a suitable state, if rotation stops at the position, it will be locked by the unevenness | corrugation of the continuous engagement grooves 24 and 43 of the upper and lower rings 4 and 2, and it will maintain an appropriate retracted state in the approximate position. I can keep it.
(Extended retention release, removal)
When releasing the extended holding, the lower ring 2 is held, the upper ring 4 is slightly rotated clockwise, the upper ring is lifted lightly, the continuous engagement grooves 24 and 43 are unlocked, and the upper ring 4 is released. Can be released counterclockwise and returned to its original position. Also, the removal from the body cavity is performed by inserting fingers and forceps from the opening 41 of the upper ring 4, picking up the edge of the elastic ring 1, and pulling it up, as in the above-described means for attaching to the human body. The elastic ring 1 is crushed and becomes a small diameter, and one part of the elastic ring can be taken out of the body.

FIG. 4 shows a side cross-sectional view showing another embodiment of the present invention, and A and B show cross-sectional directions changed by 90 degrees.
The instrument according to the present embodiment includes four yarns 5 according to the above-described embodiment, and two adjacent yarns 5 hold a pair (two) of plates 6 facing each other. The plate 6 is preferably formed of a resin or metal thin plate member so as to be curved in conformity with the shape of the elastic sheet 3 to be contacted, but is not particularly specified. The plate 6 is attached to the thread 5 by providing holes through which the thread 5 penetrates at both ends in the width direction of the plate 6 or by forming holes through which both ends are folded back. The thread 5 is attached through the thread 5 but may be fixed by adhesion or caulking. The attachment position is determined by attaching the cylindrical intermediate portion 33 of the elastic sheet 3 contacting the abdominal wall of the incision when the incision is attached. It becomes the position to include.
When the instrument of this embodiment is attached to the incision, in order to effectively expand the incision, it is important to attach the opposing plate 6 so as to contact the abdominal wall in the width direction of the incision.
According to the instrument of this form, the instrument of the above-mentioned form can be made to hold and expand by a surface with a small number of plates 6 while using a large number of threads 5 for holding and expanding the incision.
In addition, since the other structure and usage form of this Embodiment become the same as that of the said embodiment, it abbreviate | omits.

  Furthermore, although not described in detail as an embodiment of the present instrument, a known valve device (iris valve, cross valve, duckbill valve, etc.) is provided on the upper ring 4 in response to endoscopic abdominal surgery. In order to perform the rotation operation of the lower ring 2 and the upper ring 4 more easily or in the form of being configured to be mounted directly or as a separate member, the upper ring or the upper ring and The thing of the form provided in a lower ring can be considered.

Configuration diagram showing an embodiment of the present invention (A top view, B side view (partial sectional view)) Partially enlarged sectional view of the embodiment Schematic diagram showing the expanded state of the embodiment Side surface sectional drawing which shows another embodiment of this invention (A and B show what changed the cutting direction 90 degree | times)

Explanation of symbols

1. Elastic ring 11. Superelastic alloy 12. Protective tube 13. Cover tube 2. Lower ring 21. Elastic sheet locking groove 22. O-ring 23. Inscribed groove 24. Continuous engagement groove (lower ring side)
25. Threading hole 3. Elastic sheet 31. Lower end of sheet 32. Upper end of sheet 33. Cylindrical intermediate part 30. Interior space
4). Upper ring 41. Opening 42. Circumscribed groove 43. Continuous engagement groove (upper ring side)
44. Thread retaining hole 45. Thread retaining groove 46. O-ring 47. Anti-slip processing 5. Thread 51. Yarn lower end 52. Upper end of the thread plate

Claims (7)

An elastic ring inserted from the incision and placed in the body cavity;
A lower ring disposed coaxially with the elastic ring and disposed at the extracorporeal incision wound;
A cylindrical and flexible elastic sheet that has one end portion connected to the lower ring and the other end portion expanded and connected to the elastic ring, and is disposed outside the body from inside the body cavity,
An upper ring that is provided coaxially with the lower ring, is rotatable on a sliding surface that contacts the lower ring, and can be braked;
A retractor expanding device comprising a plurality of non-elastic linear members disposed at both ends of the upper ring and the elastic ring so as to pass through the inner surface of the elastic sheet. The retractor expanding device, which has a predetermined area that is held at a position corresponding to the abdominal wall of the incision by an intermediate portion of the inelastic linear member by at least two adjacent inelastic linear members. The retractor expanding device according to claim 1, wherein two plate members are provided at least at positions facing each other.   The retractor expanding device according to claim 1 or 2, wherein the upper ring includes a valve device for maintaining airtightness inside the body cavity.   4. The retractor expanding device according to claim 1, wherein the inelastic linear member is formed of a flexible thread.   5. The retractor expanding device according to claim 1, wherein the braking means provided on the sliding surfaces of the upper ring and the lower ring are concave and convex continuous engagement grooves provided in directions opposite to each other.   The retractor expanding device according to claim 1, wherein the elastic ring includes a superelastic alloy.   7. The retractor expanding device according to claim 1, wherein a lever for rotating operation is provided on the upper ring or the upper ring and the lower ring.

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