JP5782267B2 - Trocar's outer tube - Google Patents

Description

  The present invention relates to an outer tube portion of a trocar provided on an abdominal wall as an entrance for inserting a laparoscope or a surgical instrument into the abdominal cavity.

  Conventionally, in laparoscopic surgery, an outer tube of a trocar is installed on the abdominal wall as an entrance for inserting a laparoscope or a surgical instrument into the abdominal cavity. The outer tube is installed by puncturing the abdominal wall with a trocar having an inner needle set on the outer tube and pulling out the inner needle. In this way, instruments such as a laparoscope and a treatment tool are inserted into the abdominal cavity through trocar mantles installed at a plurality of locations on the abdominal wall, and the surgical site is observed and treated.

  When a plurality of mantle tubes are installed on the abdominal wall in this way, a plurality of scars remain after the operation. Therefore, there is an increasing number of cases where a laparoscopic surgical method called the single port method (SPS), which has been developed so that only one scar is required, is employed as an epoch-making technique.

  In the single port method, first, the umbilicus is incised with a size of about 1.5 to 2.0 cm, and the main port is set at the incision. Next, an outer tube of one camera trocar and two or three treatment instrument trocars is installed in the main port. Then, a laparoscope and a treatment tool are inserted into the abdominal cavity through these mantle tubes, and a laparoscopic operation is performed. This requires only one incision for the main port.

  In the trocar cannula placed on the abdominal wall, infection through the cannula or foreign substances entering the body through the cannula can be prevented, or the outflow of carbon dioxide injected into the abdominal cavity through the cannula In order to prevent this, it is necessary to keep the instrument insertion port of the mantle tube airtight.

  In trocars that support the single-port method, the mechanism for maintaining the airtightness of the instrument insertion port is basically a check valve for maintaining the airtightness when no instrument is inserted, and the outer periphery of the instrument when the instrument is inserted. It has a double structure with an outer peripheral close-contact valve that adheres and maintains airtightness. This valve structure is housed in a substantially cylindrical valve case (trocar head) constituting the instrument insertion port of the outer tube, as in the case of the conventional trocar. As the check valve, a valve utilizing the self-shape restoring property due to the elasticity of the valve itself such as a duckbill valve is used.

  On the other hand, as a technique related to a general trocar, in Patent Document 1, an airtight valve is rotatably provided in a mouthpiece portion of an outer tube, and an endoscope can be inserted into an end portion of the mouthpiece portion in an airtight state. A trocar fitted with an elastic valve seat with a hole is described. In this elastic valve seat, the insertion hole is hermetically closed by joining with the hermetic valve. Further, this elastic valve seat also has a function of tightly holding the base part in close contact with the outer periphery of the instrument when the instrument is inserted.

  Patent Document 2 describes an indwelling port for allowing repeated access to the body during or after surgery. In this indwelling port, when the indwelling port is not in use, the opening of the indwelling port is blocked by a plug attached to the outer flange with a mooring string in order to prevent infection and foreign matter from entering the body. It has become.

JP-A-6-121768 Special table 2009-545417

  However, according to the trocar corresponding to the single port method having the valve structure including the duckbill valve described above, when the instrument inserted into the outer tube of the trocar is pulled out, the duckbill valve may be inverted due to friction with the instrument. In this case, the inverted valve body that is not the original storage shape interferes with the insertion instrument in the valve case, and the operability of instrument insertion deteriorates. In addition, even after the instrument is pulled out, it remains in an inverted state without being restored to its original shape, and the function of maintaining airtightness may be impaired.

  In order to avoid these phenomena, the outer shape of the valve body is set to a size that secures an operating space sufficient for smooth deformation and shape restoration of the valve body itself with respect to the outer diameter of the instrument to be inserted. There is a need to. For example, in a conventional product, a trocar valve case used for an instrument having an outer diameter of 5 mm has an outer diameter of 10 to 20 mm, which is about four times the outer diameter of the instrument.

  However, when the outer diameter of the valve case is large in this way, if a plurality of trocars are used in the single port method, the valve cases of the respective outer tubes are interfered with each other, and the tips of the outer tubes of the respective trocars are simultaneously brought close to each other. The position within the abdominal cavity where it can be severely limited.

  On the other hand, according to the above-mentioned trocar, the opening and closing operation of the airtight valve for closing the elastic valve seat is performed by the lever provided above the flange screwed to the outer peripheral surface of the base part. The outer diameter of the part is considerably large. Therefore, this trocar is also not suitable for the single port method. Furthermore, the above-described indwelling port is also not suitable for the single port method because the mooring string and the outer flange protrude considerably outward in the radial direction.

  An object of the present invention is to provide an outer tube portion of a trocar in which the configuration around the instrument insertion port is as compact as possible without deteriorating the performance of the means for maintaining the airtightness of the instrument insertion port in view of the problems of the prior art. There is to do.

  To achieve the above object, the outer tube portion of the trocar according to the present invention includes an insertion tube portion to be inserted into a patient's body, and a cylindrical shape positioned on the body surface side in a state where the insertion tube portion is inserted into the body. An instrument insertion port, an annular contact member whose outer periphery is fixed to the inner wall of the instrument insertion port, and when the instrument is inserted, tightly closes the instrument insertion port by closely contacting the inner periphery with the instrument, and the instrument insertion A frustoconical lid for opening / closing the instrument insertion port by inserting / removing it into the mouth, and a flexible connection for connecting the connection part on the end surface of the instrument insertion port and the end surface of the lid in the opening direction And the connection member supports the lid on the opening direction side of the instrument insertion port when the instrument insertion port is opened, and the connection member supports the lid when the instrument insertion port is closed. Extends from the site along the axial direction of the instrument insertion slot, curves in the middle, Characterized in that exhibits a shape leading to the end face of the movable cover Te.

  In this configuration, when the instrument is inserted into the outer tube, the tightness member maintains the airtightness of the instrument insertion port, and when the instrument is not inserted, the instrument insertion port is closed with a lid. The airtightness of the is reliably maintained. Therefore, the airtight maintenance function does not fail like a duckbill valve in a conventional trocar, and it is not necessary to provide a valve case with a large outer diameter at the instrument insertion port in order to prevent the malfunction.

  In addition, since the end faces of both the instrument insertion port and the lid are connected by the flexible connection member as described above, the connection member does not greatly expand in the radial direction of the instrument insertion port, and the instrument insertion There is no need to provide a mechanism for opening and closing the lid around the mouth. Therefore, the performance of the means for maintaining the airtightness of the instrument insertion port is not deteriorated, and the outer tube portion of the trocar suitable for the single port method can be provided with a compact configuration around the instrument insertion port.

  In the present invention, an operation piece for moving the lid body to open and close the instrument insertion port is provided at a position opposite to the connection site in the peripheral part of the lid body, The outer side in the direction perpendicular to the axis of the lid may be an operation surface facing in the outer direction.

  According to this, by operating the operation surface with the thumb of the hand holding the outer tube portion, the instrument insertion port can be easily opened and closed by the lid with only one hand. Therefore, in the meantime, other operations can be performed with the other hand.

  Moreover, in this invention, when the said instrument insertion port is obstruct | occluded by the said cover body, the said operation surface may be adjacent to the outer peripheral surface of this instrument insertion port. According to this, the operation surface can be easily operated with the thumb of the hand holding the mantle tube. Further, since the operation surface does not protrude from the outer diameter of the outer peripheral surface of the instrument insertion port, the configuration around the instrument insertion port can be kept compact.

  Further, in the present invention, the proximal end portion of the insertion tube portion is an enlarged diameter portion having a diameter larger than that of the insertion tube portion on the distal end side from the proximal end portion, and the instrument insertion port includes the outer wall portion and the inner wall portion. And the outer wall portion and the inner wall portion are coupled to each other on the end face side of the instrument insertion port, and the enlarged diameter portion is fitted between the outer wall portion and the inner wall portion, thereby the instrument insertion port and the insertion tube. The outer diameter of the instrument insertion port is smaller than the outer diameter of the outer diameter of the insertion tube portion plus the thicknesses of the outer wall portion, the inner wall portion, and the enlarged diameter portion. Also good.

  According to this, since the outer diameter of the instrument insertion port is considerably smaller than in the conventional case, the range in which access by the instrument inserted through the outer tube portion is difficult is considerably narrower than in the conventional case. That is, the intraperitoneal observation and treatment can be performed without much limiting the range that is difficult to access simultaneously by the instrument inserted in the abdominal cavity.

FIG. 1 is a front view of a trocar according to an embodiment of the present invention, and a side view of an inner needle of the trocar. It is sectional drawing when the instrument insertion port is obstruct | occluded by the cover body about the head part of the mantle tube in the trocar of FIG. 1, and when not obstruct | occluded. It is a perspective view when the instrument insertion port about the mantle tube of the trocar of FIG. 1 is obstruct | occluded by the cover body, and when not obstruct | occluded. It is explanatory drawing which shows a mode that the mantle tube of FIG. 2 is used in the case of the laparoscopic surgery by a single port method compared with the conventional case.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1A is a front view of a trocar according to an embodiment of the present invention. As shown in the figure, the trocar 1 includes an outer tube 2 installed on the abdominal wall or a main port in the single port method, and an inner needle 3 inserted into the outer tube 2 when the outer tube 2 is installed.

  The outer tube 2 includes a head portion 10 constituting a cylindrical instrument insertion opening 11 and an insertion pipe section 20 for guiding the instrument inserted from the instrument insertion opening 11. The head unit 10 includes a lid 12 for opening and closing the instrument insertion port 11 by being inserted into and removed from the instrument insertion port 11.

  FIG. 1B is a front view of the inner needle 3. As shown in the figure, the inner needle 3 includes a needle portion 31 on the distal end side, a support portion 32 to which the proximal end of the needle portion 31 is fixed, and a collar portion provided between the needle portion 31 and the support portion 32. 33. The needle portion 31 is made of plastic, not metal.

  That is, the trocar 1 is a blade rest locator in which the tip 34 of the needle portion 31 is sharply configured with plastic instead of a metal blade. According to this, when installing the mantle tube 2, the tip of the needle part 31 can be pushed along the fiber direction without cutting the tissue of the abdominal wall and reach the abdominal cavity.

  FIG. 2A is a cross-sectional view of the head portion 10 portion of the outer tube 2. In the figure, a state when the instrument insertion port 11 of the head unit 10 is closed with a lid 12 is shown. As shown in the figure, the head portion 10 has an annular contact member 14 whose outer periphery is fixed to the inner wall 13 of the instrument insertion port 11, and a connection member 17 that connects the end surface 15 of the instrument insertion port 11 and the lid 12. And an operation piece 18 fixed to the periphery of the lid 12.

  The lid 12 is formed of a truncated cone-shaped soft member, and the end surface 16 on the opening direction side is connected to the end surface 15 of the instrument insertion port 11 by a connecting member 17. The opening direction means a direction in which the lid 12 is moved when the instrument insertion port 11 is opened.

  The close contact member 14 has a function in which the inner periphery 14a is in close contact with the periphery of the instrument and hermetically closes the instrument insertion port 11 when the instrument is inserted through the inside. The connection member 17 is configured by a flexible member that supports the lid 12 above the instrument insertion port 11 when the instrument insertion port 11 is opened and flexes in accordance with the position of the lid 12 when closed.

  The connection member 17 extends along the axial direction of the instrument insertion port 11 from the connection site 15a on the end surface 15 of the instrument insertion port 11 when the instrument insertion port 11 is closed by the lid 12 as shown in FIG. It is curved in the middle and exhibits a U-shape that reaches the end face 16 of the lid 12.

  FIG. 2B is a cross-sectional view showing a state when the instrument insertion port 11 is not closed by the lid body 12. As shown in the figure, the connection member 17 supports the lid 12 above the instrument insertion slot 11 when the instrument insertion slot 11 is opened. The connecting member 17 is configured by a flexible member that performs such support and can exhibit the above-described U shape.

  The operation piece 18 is provided at a position on the side opposite to the connection site 15 a in the peripheral portion on the end face 16 side of the lid 12. In the operation piece 18, an outer side in a direction perpendicular to the axis of the lid 12 is an operation surface 18 a along the opening / closing direction of the lid 12, facing the outside direction.

  The operation surface 18 a is adjacent to the outer peripheral surface 11 a of the instrument insertion port 11 when the instrument insertion port 11 is closed by the lid 12. That is, it becomes the same level as the outer peripheral surface 11a in the radial direction of the instrument insertion port 11. As a result, the operation surface 18a is suitable for moving and operating the lid 12 in the opening / closing direction with the thumb of the hand holding the head unit 10.

  As shown in FIG. 2, in the insertion tube portion 20, the base end portion is an enlarged diameter portion 21 having a diameter larger than that of the insertion tube portion 20 on the distal end side from the base end portion. The instrument insertion port 11 includes an outer wall portion 11b and an inner wall portion 11c, and the outer wall portion 11b and the inner wall portion 11c are coupled on the end face 15 side. The enlarged diameter portion 21 is fitted between the outer wall portion 11b and the inner wall portion 11c, whereby the head portion 10 and the insertion tube portion 20 are coupled. The close contact member 14 is fixed to the lower end of the inner wall 13 in the inner wall portion 11c.

  Further, a space 22 is formed between the lower end of the inner wall portion 11c and the lower end of the enlarged diameter portion 21, and there is provided a room for the contact member 14 to bend when the instrument is inserted. Moreover, the diameter of the inner wall 13 of the inner wall portion 11c is larger than the inner diameter of the insertion tube portion 20 by about the thickness of the contact member 14, and there is provided a room for the contact member 14 to bend when the instrument is pulled out.

  That is, the diameter-enlarged portion 21 has an inner diameter that is large enough to accommodate the inner wall portion 11 c to which the contact member 14 is fixed, and the outer wall portion 11 b covers the outside of the enlarged-diameter portion 21. As a result, the outer diameter of the instrument insertion port 11 is smaller than the outer diameter of the outer diameter of the insertion tube portion 20 plus the thicknesses of the outer wall portion 11b, the inner wall portion 11c, and the enlarged diameter portion 21.

  A value obtained by adding the thicknesses of the outer wall portion 11 b, the inner wall portion 11 c and the enlarged diameter portion 21 is equal to the thickness of the instrument insertion port 11. Therefore, the outer diameter of the head portion 10 is a size obtained by adding the thicknesses of the contact member 13 and the instrument insertion port 11 to the inner diameter of the insertion tube portion 20.

  FIGS. 3A and 3B are perspective views of the outer tube 2 when the instrument insertion port 11 is closed by the lid body 12 and when it is not closed, respectively. As shown in FIG. 5A, when the instrument insertion port 11 is closed by the lid 12, when considering a cylindrical shape in which the outer wall of the instrument insertion port 11 is extended upward, the connecting member 17 and the operation piece 18 are used. Is located inside the cylindrical shape.

  Further, as shown in FIG. 5B, when the instrument insertion port 11 is not closed by the lid body 12, the lid body 12 is supported by the connection member 17 above the instrument insertion port 11. In this state, an insertion portion for an instrument such as a laparoscope or a treatment instrument can be easily inserted from the instrument insertion port 11.

  When the trocar 1 is used, the operator punctures a predetermined portion of the abdominal wall of the patient with the tip 34 of the inner needle 3 in the trocar 1 into which the inner needle 3 has been inserted as shown in FIG. The tube part 20 is inserted into the abdominal cavity. At this time, since the trocar 1 is a blade rest locator, it is possible to push the tissue along the fiber direction without cutting the tissue and reach the abdominal cavity. Next, the inner needle 3 is pulled out from the outer tube 2. Thereby, the installation of the outer tube 2 is completed. The outer tube 2 is installed at several necessary positions.

  When the installation of the cannula 2 at the required location is completed, the surgeon injects carbon dioxide into the operative field via each installed cannula 2 to secure a space for surgical operation, Instruments such as forceps can be inserted into the abdominal cavity for observation and treatment within the abdominal cavity. Between the time when the instrument is inserted into the abdominal cavity and the time when the instrument is removed, the inner periphery 14a of the contact member 14 is in close contact with the outer periphery of the instrument, and the outer tube 2 is closed in an airtight manner. Thereby, the outflow of the carbon dioxide injected by the above-described insufflation operation is suppressed.

  For the outer tube 2 into which no instrument has been inserted, the instrument insertion port 11 of the head portion 10 is closed with the lid 12 to prevent the outflow of carbon dioxide gas or the entry of foreign matter. When the instrument is inserted, the lid 12 that closes the instrument insertion port 11 is pulled out, and the instrument insertion port 11 is opened. The operator can easily and quickly open and close the lid body 12 by operating the operating piece 18 with the thumb of the gripping hand while holding the head portion 10.

  On the other hand, when performing laparoscopic surgery by the single-port method, the surgeon first cuts the patient's umbilicus about 1.5 to 2.0 cm and installs the main port at that portion. Next, the outer tube 2 for the laparoscope and the outer tube 2 for the treatment instrument are set in the main port. The outer tube 2 is set by inserting the trocar 1 into which the inner needle 3 has been inserted into the hole for setting provided in the main port from the front end side and pulling out the inner needle 3.

  When the necessary mantle tube 2 is set, the operator secures a space for surgical operation by injecting carbon dioxide gas through the set mantle tube 2 and inserts necessary instruments into the abdominal cavity for observation and Treatment can be performed. Also in this case, the lid 12 can be opened and closed easily and quickly by operating the operating piece 18 with the thumb of the hand holding the head unit 10 as necessary.

  FIG. 4 shows how the mantle tube 2 of this embodiment is used in laparoscopic surgery by the single port method, as compared with the conventional case. FIG. 2A shows a state where the outer tube 50 of the conventional trocar is set in the main port 62 installed on the abdominal wall 61. Each instrument guided by each cannula 50 interferes with the head portions 51 of each cannula 50, so that the part in the body cavity located within a range narrower than the range indicated by the angle α in the figure. It is difficult to access at the same time.

  That is, in the conventional case, airtight maintenance in the head portion 51 when the instrument is inserted and when the instrument is not inserted is performed using a duckbill valve. Therefore, the head portion 51 has a considerably larger outer diameter D than the insertion tube portion 52 in order to prevent the duckbill valve from being reversed and to ensure smooth operation. For example, when the outer tube 50 is for an instrument having an outer diameter of 5 mm, the outer diameter D of the head portion 51 is about four times the outer diameter of the insertion tube portion 52.

  Thus, in the conventional case, since the outer diameter D of the head portion 51 is considerably large, the above-described angle α is quite large. In other words, the range that cannot be accessed simultaneously by a plurality of instruments is quite wide.

  On the other hand, in the case of the outer tube 2 of the present embodiment shown in FIG. 2B, the outer diameter d of the head portion 10 is smaller than the outer diameter of the insertion tube portion 20 as shown in FIG. It is smaller than the outer diameter obtained by adding the thicknesses of the portion 11 c and the enlarged diameter portion 21, and the size is such that the thickness of the contact member 13 and the instrument insertion port 11 is added to the inner diameter of the insertion tube portion 20. That is, it is considerably smaller than the conventional case. For this reason, the angle β indicating the range in which access by the instrument inserted through the outer tube 2 is difficult is considerably smaller than in the conventional case. Therefore, the range that is difficult to access simultaneously is not so limited.

  As described above, according to the present embodiment, when the instrument is inserted into the outer tube 2, the tightness of the instrument insertion port 11 is maintained by the contact member 14, and when the instrument is not inserted, the lid 12 is used. By closing the instrument insertion port 11, the airtightness of the instrument insertion port 11 can be reliably maintained. Therefore, the airtight maintenance function does not fail like a duckbill valve in a conventional trocar, and it is not necessary to provide a valve case with a large outer diameter at the instrument insertion port in order to prevent the malfunction.

  In addition, since the instrument insertion port 11 and the lid 12 are connected by the flexible connection member 17 as described above, the connection member 17 does not greatly expand in the radial direction of the instrument insertion port 11. There is no need to provide a mechanism for opening and closing the lid 12 around the instrument insertion opening 11. Therefore, the configuration around the instrument insertion port 11 can be made compact and suitable for the single port method without deteriorating the performance of the means for maintaining the airtightness of the instrument insertion port 11.

  That is, when applied to laparoscopic surgery by the single port method, it is possible to reduce the range in which the head portions 10 of the outer tube 2 set in the main port 62 interfere with each other. Therefore, the instrument inserted through each outer tube 2 can be brought closer to the conventional one and more pinpoint treatment can be performed.

  In addition, an operation piece 18 for moving the lid 12 to open and close the instrument insertion port 11 is provided at a position opposite to the connection site 15a in the peripheral portion of the lid 12, and the operation piece 18 is Since the outer side in the direction perpendicular to the axis of the body 12 is the operation surface 18a facing the outer direction, it is easy to operate the operation surface 18a with the thumb of the hand holding the outer tube 2. The instrument insertion port 11 can be opened and closed by the lid 12.

  Further, since the operation surface 18a is adjacent to the outer peripheral surface 11a of the instrument insertion port 11 when the instrument insertion port 11 is closed by the lid 12, the operation by the thumb of the hand holding the outer tube 2 is performed. The surface 18a can be easily operated. Moreover, since the operation surface 18a does not protrude from the outer diameter of the outer peripheral surface of the instrument insertion slot 11, the configuration around the instrument insertion slot 11 can be maintained compact.

  DESCRIPTION OF SYMBOLS 1 ... Trocar, 2 ... Outer tube, 3 ... Inner needle, 10 ... Head part, 11 ... Instrument insertion port, 11b ... Outer wall part, 11c ... Inner wall part, 12 ... Cover body, 13 ... Inner wall, 14 ... Adhesion member, 15 DESCRIPTION OF SYMBOLS ... End surface, 15a ... Connection part, 16 ... Opening direction side end surface, 17 ... Connection member, 18 ... Operation piece, 18a ... Operation surface, 21 ... Diameter expansion part.

Claims (4)

An insertion tube inserted into the patient's body;
A cylindrical instrument insertion port located on the body surface side in a state where the insertion tube part is inserted into the body,
An outer periphery is fixed to the inner wall of the instrument insertion port, and at the time of instrument insertion, an annular contact member that hermetically closes the instrument insertion port by closely contacting the periphery of the instrument,
A frustoconical lid for opening and closing the instrument insertion port by inserting and removing from the instrument insertion port;
A flexible connection member for connecting a connection site on the end surface of the instrument insertion port and an end surface on the opening side of the lid,
The connection member supports the lid on the opening direction side of the instrument insertion port when the instrument insertion port is opened, and inserts the instrument from the connection site when the lid is closed. An outer tube portion of a trocar characterized in that it extends along the axial direction of the mouth, curves in the middle, and has a shape reaching the end face of the lid. An operation piece for moving the lid to open and close the instrument insertion port is provided at a position opposite to the connection site in the peripheral part of the lid,
2. The outer tube portion of the trocar according to claim 1, wherein an outer side of the operation piece in a direction perpendicular to the axis of the lid body is an operation surface facing the outer direction. The trocar mantle tube part according to claim 2 , wherein the operation surface is adjacent to an outer peripheral surface of the instrument insertion port when the instrument insertion port is closed by the lid. The proximal end portion of the insertion tube portion is a diameter-expanded portion having a larger diameter than the insertion tube portion on the distal end side from the proximal end portion,
The instrument insertion port includes an outer wall part and an inner wall part, and the outer wall part and the inner wall part are coupled on the end face side of the instrument insertion port,
The instrument insertion port and the insertion tube part are coupled by fitting the enlarged diameter part between the outer wall part and the inner wall part,
The outer diameter of the instrument insertion port is smaller than the outer diameter obtained by adding the thicknesses of the outer wall portion, the inner wall portion, and the enlarged diameter portion to the outer diameter of the insertion tube portion. The trocar outer tube part of any one of -3.

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