JP6328950B2 - Surgical area securing device - Google Patents

Description

  The present invention relates to a surgical region securing device that prevents surgical obstructions, for example, organs or omentums other than a surgical target site from entering a surgical region in endoscopic surgery.

  2. Description of the Related Art Conventionally, an operation method in which a surgical instrument such as an endoscope or an electric knife is inserted into a body cavity of a patient, for example, an abdominal cavity, a thoracic cavity, a retroperitoneal cavity, or the like is widely known. When performing surgery with such a technique, it is desirable to move an organ or omentum (hereinafter referred to as “surgical inhibitor”) that inhibits surgery (or observation) within the body cavity to the outside of the surgical area. Yes.

  In particular, in recent years, it has been proposed to fill a body cavity with a liquid (for example, physiological saline). However, in such a surgical procedure, it is more strongly required to prevent the entry of a surgical inhibitor into the surgical region. It has been. This is because, in the case of an operation method in which a liquid is filled into a body cavity, a surgical inhibitor floats in the liquid and becomes easy to move. In the case of an operation method in which a body cavity is filled with a liquid, the liquid is discharged and supplied into the body cavity during the operation, and a turbid liquid due to bleeding or the like is sucked and taken out of the body cavity to perfuse the liquid. Patent Document 1 discloses a device for perfusing a liquid into a body cavity during endoscopic surgery.

  Therefore, conventionally, several techniques for securing a surgical region have been proposed in endoscopic surgery. For example, Patent Document 2 discloses an instrument that excludes or lifts an organ that obstructs the visual field when performing laparoscopic or thoracoscopic surgery. This instrument has a grooved balloon that is inserted into a body cavity and then expands into an elliptical shape by feeding a fluid into the body cavity, and this balloon expels or lifts a disturbing organ.

Japanese Patent No. 3316614 JP 2011-239857 A

  However, the device of Patent Document 2 has a problem in that it takes a long time to be ready for surgery because a large amount of fluid needs to be sent to the balloon in order to exclude or lift the organ with the balloon. In addition, the instrument of Patent Document 2 assumes that a working tool such as an ultrasonic coagulation / cutting device is inserted into a slight gap between the groove on the balloon surface and the tissue, and the workability thereof is assumed. Was very bad and there was a very high risk of damaging the balloon itself.

  Therefore, an object of the present invention is to provide a surgical region securing device that can secure a suitable surgical region more easily.

The surgical region securing device of the present invention is a surgical region securing device that prevents a surgical inhibitor from entering the surgical region by being installed in a body cavity filled with a liquid, and is composed of a plurality of aggregates. A skeleton structure that defines the surgical region, the skeleton structure having a ring-shaped base portion that is cut at the upper end of the skeleton structure, and a sheet material, and at least the side surface of the skeleton structure anda cover member covering the gap between wood, the upper end of the frame structure is not connected to the retractor, the sheet material is Ri porous sheet or mesh sheet material der, wherein By applying an inward force to the outer peripheral surface of the base, the diameter of the upper end of the frame structure is reduced .

  In a preferred aspect, the covering is made of a transparent sheet material. In another preferred aspect, the framework structure is variable in diameter, and the covering body has flexibility to deform following the diameter change of the framework structure.

  In another preferred embodiment, at least a part of the plurality of aggregates constituting the framework structure is a linear balloon that is inflated by fluid filling and maintains a predetermined shape. In another preferred aspect, the apparatus further includes a handle connected to the frame structure and accessible from outside the body cavity when the frame structure is placed in the body cavity.

  According to the present invention, the surgical region is determined by the framework structure, and further, the gap on the side surface thereof is covered with the covering, so that the entry of the surgical inhibitor into the surgical region is prevented. Secure surgical area.

It is an image figure which shows the mode of endoscopic surgery. 1 is a perspective view of a surgical region securing device according to a first embodiment of the present invention. It is a schematic sectional drawing of the operation area ensuring device in a body cavity. It is a perspective view of the operation area ensuring device which is a second embodiment. FIG. 5 is a development view of the surgical region securing device of FIG. 4. It is a schematic sectional drawing of the operation region ensuring device which is 3rd embodiment. It is a figure which shows an example of the frame structure which deform | transforms with a link mechanism. It is a figure showing an example of other operation field securing devices. It is a figure which shows an example of the frame structure used with the other operation area ensuring apparatus. It is a figure showing an example of other operation field securing devices.

  Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is an image diagram showing a state of endoscopic surgery. FIG. 2 is a perspective view of the surgical region securing device 10 according to the first embodiment of the present invention.

  As shown in FIG. 1, the surgical region securing device 10 of the present embodiment is used for securing a surgical region in endoscopic surgery. That is, when performing endoscopic surgery, as shown in FIG. 1, surgical instruments such as the endoscope 110 and the electric knife 112 are inserted into a body cavity from a small incision formed on the body surface, A surgical target site such as an organ is operated or observed using the endoscope 110, the electric knife 112, or the like. At this time, a retractor 114 is attached to the incision so that the incision is stably opened in a substantially circular shape and the force applied to the incision is uniform. The retractor 114 is made of a relatively elastic material such as silicone rubber. The retractor 114 is a substantially cylindrical member, and has a flange extending outwardly at the upper and lower ends thereof.

  During the operation, a perfusate (for example, physiological saline) is supplied into the body cavity via the discharge pipe 116 and the injection port 118 in order to obtain a sufficient space. The injection port 118 is a member that temporarily stores the perfusate supplied from the discharge pipe 116, distributes it in the circumferential direction, and guides it into the body cavity. The injection port 118 is a substantially cylindrical member connected to the retractor 114, and an annular groove for temporarily storing the perfusate is formed on the inner peripheral surface thereof.

  The perfusate supplied into the body cavity becomes turbid when bleeding occurs during the operation, thereby impairing the visibility of the target site. Therefore, the perfusate supplied into the body cavity is appropriately sucked to the outside through the suction pipe 117 inserted into the body cavity. That is, during endoscopic surgery, the perfusate is continuously perfused into the body cavity. In addition, the discharge / suction mode of the perfusate shown in FIG. 1 is an example, and the perfusion solution may be discharged / sucked in other modes as long as the perfusate can be continuously perfused into the body cavity. For example, the perfusate may be perfused through a trocar provided with a perfusate discharge port and a suction port. Further, FIG. 1 illustrates the case where the body cavity is filled with the perfusate, but the work space may be secured in another manner as long as the work space can be obtained. For example, the body cavity may be filled with gas instead of the perfusate, or the working space may be secured by lifting the body wall instead of filling the fluid.

  Here, when an operation is performed in a body cavity, an organ or omentum (hereinafter referred to as “surgical inhibitor”) that inhibits the operation is moved outside the operation region, and the operation target site is placed in an operation region where the operation is easy. Is desired. In particular, in the case of an operation method in which a body cavity is filled with a perfusate, surgical obstructions such as organs and omentum float in the liquid and are easy to move. When a surgical obstruction that is not directly related to surgery floats and enters the surgical field, the surgical target site cannot be observed accurately or the desired work cannot be performed. In addition, when a surgical inhibitor that is not directly related to this operation comes into contact with and sucks the perfusate suction port, smooth suction and discharge of the perfusate may be inhibited. Therefore, in the surgical method in which the body cavity is filled with the perfusate, it is strongly desired to place the surgical target site in a place where surgery is easy and to prevent the entry of surgical inhibitors that are not directly related to surgery into the surgical region. The surgical region securing device 10 of the present embodiment is a device for satisfying this demand. As shown in FIG. 1, the surgical region securing device 10 is a device that secures a surgical region by being placed in a body cavity during endoscopic surgery. . Hereinafter, the operation area securing device 10 will be described in detail.

  As shown in FIG. 2, the surgical region securing device 10 includes a substantially frustoconical frame structure 12 and a covering 20 that covers the side surface of the frame structure 12. The framework structure 12 includes a substantially ring-shaped base portion 16 and a plurality of aggregates 14 extending obliquely downward from the base portion 16. The base 16 and the aggregate 14 are solid rods made of a resin having moderate elasticity such as POM (polyacetal resin). The base 16 has a substantially ring shape, and the outer diameter thereof is smaller than the inner diameter of the retractor 114 and the injection port 118, and the inner diameter passes through instruments necessary for the operation such as the endoscope 110, scalpel and forceps. The size is possible. Further, the base portion 16 is formed with a cut portion 18 cut obliquely. When an inward force is applied to the outer peripheral surface of the base portion 16, the diameter of the cut portion 18 can be reduced by causing the cut surfaces facing each other to come into contact with each other and slip. In FIG. 2, the base portion 16 has a substantially ring shape. However, the base portion 16 may have a spiral shape in which one end enters the inside in the radial direction from the other end when viewed from directly above. In this case, the base portion 16 is further easily reduced in diameter.

  A plurality of aggregates 14 extend from the base portion 16. The plurality of aggregates 14 are arranged at intervals in the circumferential direction, and each aggregate 14 extends in an inclined direction so as to proceed radially outward as it approaches the bottom surface (away from the base portion 16). . In other words, the plurality of aggregates 14 are arranged at intervals so as to form a substantially truncated cone.

  Each aggregate 14 has appropriate elasticity, and its posture (inclination direction) can be changed by applying force. Therefore, when a radially inward force is applied to each aggregate 14, the plurality of aggregates 14 spreading in a substantially frustoconical shape change their postures so that their tips move radially inward, and their maximum diameter Is reduced in diameter. As a result, the maximum diameter of the surgical region securing device 10 as a whole can be made smaller than the inner diameters of the retractor 114 and the injection port 118.

  A covering 20 is adhered to the side peripheral surface of the frame structure 12. The covering 20 is made of a transparent sheet material made of resin, for example, polyvinyl chloride or silicon. The covering body 20 has such flexibility that it can be deformed following the deformation of the frame structure 12. The covering body 20 is attached to the side peripheral surface of the frame structure 12, and the gap between the aggregates 14 is covered with the cover body 20, so that an operation inhibitor such as an organ or omentum can be removed from the gap. 12 can be prevented from entering into the surgical region defined by 12.

  Next, the state of the operation using this surgical region securing device 10 will be described with reference to FIG. FIG. 3 is a schematic cross-sectional view of the surgical region securing device in the body cavity. When the surgical region securing device 10 is set in the body cavity, a radially inward force is applied to the plurality of aggregates 14 so that the diameter is smaller than the diameter of the injection port 118. In this state, the surgical region securing device 10 is inserted through the injection port 118 and directly above the surgical target site 130a in the body cavity. If the inward force is released after the insertion, the plurality of aggregates 14 return to the original inclination by the elastic restoring force, and as a whole, spread in a substantially truncated cone shape. The inside of the surgical region securing device 10 spreading in a substantially truncated cone shape becomes a surgical region for performing endoscopic surgery. When endoscopic surgery is performed, a surgical instrument 111 such as an endoscope or an electric knife, and a suction port for sucking perfusate are disposed inside the surgical region securing device 10.

  Here, as described above, the side peripheral surface of the surgical region securing device 10 is covered with the covering 20, and surgical obstructions such as other organs and omentum enter the inside of the surgical region securing device 10. It is prevented. As a result, it is possible to effectively prevent the operation of the surgical instrument 111 from being obstructed by the surgical inhibitor. Further, if the suction port for the perfusate is arranged inside the surgical area securing device 10, the problem that the surgical obstruction sticks to the suction port can be prevented. However, the suction port for the perfusate may be disposed outside the surgical region securing device 10 as long as it can prevent the suction of the surgical inhibitor. By arranging the suction port for the perfusate outside the surgical region securing device 10, bleeding caused by surgery or the like actively flows to the outside of the surgical region securing device 10. Therefore, it is possible to keep the transparency of the surgical field high and to keep the visual field in the surgical field better.

  In addition, depending on the contents of the surgery, some treatment is performed not only on the surgical target region 130a located directly below the surgical region securing device 10 but also on another surgical target site 130b located on the side of the surgical region securing device 10. You may want to apply. In this case, the state outside the surgical region securing device 10 is confirmed with an endoscope or the like through the transparent covering 20. Then, the covering body 20 is broken with a surgical instrument 111 such as a scalpel at a position in the vicinity of another surgical target site 130b that requires treatment, and the other surgical target site 130b is accessed from the broken site. In this way, in order to access the outside of the surgical region securing apparatus 10 from the gap between the aggregates 14, it is desirable that the gap between the aggregates 14 is at least large enough to allow the surgical instrument 111 to pass therethrough. .

  When the operation is completed, the surgical region securing device 10 is pulled out of the body cavity. When the surgical region securing device 10 is lifted upward during this lifting, the outer peripheral surface of the surgical region securing device 10 comes into contact with the inner peripheral surface of the injection port 118. By this contact, the inclination direction of the aggregate 14 is deformed inward and the entire surgical region securing device 10 is reduced in diameter, so that the surgical region securing device 10 can be pulled out of the injection port 118.

  As is apparent from the above description, according to the present embodiment, the covering 20 is attached to the side peripheral surface of the skeleton structure 12, and therefore, other than the operation region defined by the skeleton structure 12. Can effectively prevent the invasion of organs and omentum. Further, by making the covering body 20 transparent, it is possible to confirm the situation outside the surgical region securing device 10, and further, by breaking a part of the covering body 20, Access to the surgical target site 130b is also possible.

  Next, a second embodiment will be described with reference to FIGS. FIG. 4 is a perspective view of the surgical region securing apparatus 10 according to the second embodiment. FIG. 5 is a development view of the surgical region securing device 10.

  This surgical region securing device 10 is greatly different from the first embodiment in that the framework structure 12 and the covering body 20 are integrally formed and a linear balloon 30 is used as the aggregate 14. More specifically, the surgical area securing device 10 is formed by stacking two substantially trapezoidal transparent sheet materials made of resin, for example, polyvinyl chloride, silicon, etc., and partially welding these two sheet materials, Further, both ends in the circumferential direction of the welded sheet material are joined to each other. In FIG. 5, the hatched portion is a portion where two sheet materials are welded. As shown in FIG. 5, the two sheet materials are welded so that five substantially trapezoidal welds 32 are arranged at intervals in the circumferential direction. Further, the two sheet materials are welded to each other at both ends.

  A linear balloon 30 is formed between the welded portion 32 and the welded portion 32 and at the upper and lower ends of the sheet material. The linear balloon 30 is a portion where the two sheet materials are not welded, and is inflated by supplying a fluid and maintains a prescribed shape. In the present embodiment, the linear balloon 30 functions as the aggregate 14 constituting the framework structure 12. Further, the welded portion 32 that covers the gap between the linear balloons 30 functions as the covering 20 that covers the gap between the aggregates 14. An injection port 34 for supplying a fluid, for example, a liquid such as a perfusate or a gas such as air, is attached to the outer peripheral surface of the surgical region securing device 10.

  The surgical region securing device 10 can be freely bent and changed in shape when the linear balloon 30 is not filled with fluid. Further, when the linear balloon 30 is filled with fluid and the linear balloon 30 is inflated, the linear balloon 30 expands into a predesigned shape, that is, a substantially truncated cone shape, and maintains its shape.

  Next, a procedure for securing a surgical region using the surgical region securing device 10 will be described. When the surgical region is secured, the surgical region securing device 10 in which the linear balloon 30 is not filled with fluid is prepared. In addition, piping for supplying fluid is connected to the injection port 34 of the surgical region securing apparatus 10. The surgeon places the appropriately deformed surgical region securing device 10 through the injection port 118 and within the body cavity. When the surgical region securing device 10 enters the body cavity, the fluid is subsequently supplied into the linear balloon 30 via a pipe (not shown) and the injection port 34. Here, in order to prevent the fluid to be supplied from floating in the body cavity of the surgical region securing device 10, the fluid, in particular, the same kind of liquid as the perfusate supplied in the body cavity (and therefore physiological saline) Etc.). However, the gas supplied (air etc.) may be sufficient as the fluid supplied, if the floating prevention measures, such as attaching a weight to the operation area ensuring device 10, are taken.

  When the linear balloon 30 is inflated by supplying the fluid, the surgical region securing device 10 changes to a truncated cone shape as shown in FIG. Thereafter, similarly to the first embodiment, a surgical instrument such as an endoscope and an electric knife, and a suction port for sucking a liquid are disposed inside the surgical region securing device 10 that expands in a truncated cone shape. Also in this case, as in the first embodiment, the gap between the linear balloons 30 as the aggregate 14 is covered with the welded portion 32 (covering body 20). The entry of organs and omentum is effectively prevented. If necessary, the surgeon accesses a surgical target site located directly below the surgical region securing device 10 or confirms the situation outside the surgical region securing device 10 through the welded portion 32 (covering body 20). To do. As a result of confirmation, when it is desired to access an organ or the like located outside the surgical region securing device 10, the welded portion 32 (covering body 20) is broken with a surgical instrument such as a scalpel, and another organ or the like is cut from the broken portion. to access.

  When the operation is completed, the fluid is discharged from the linear balloon 30, and the surgical region securing device 10 is deformed and removed from the body cavity. The fluid in the linear balloon 30 may be forcibly aspirated and discharged by a pump or the like through the piping and the inlet 34, or the linear balloon 30 may be ruptured by using a surgical instrument such as a scalpel. It may be released inside. In any case, since the surgical region securing device 10 can be easily deformed by discharging the fluid from the linear balloon 30, the surgical region securing device 10 can easily pass through the injection port 118. The surgical region securing device 10 can be easily taken out of the body cavity.

  As is clear from the above description, in this embodiment as well, it is possible to effectively prevent the entry of other organs, omentum, etc. into the surgical region defined by the skeleton structure 12 as in the first embodiment. Moreover, since the covering 20 is transparent, it is possible to confirm the situation outside the surgical region securing device 10, and further, by breaking a part of the covering 20, the sheath 20 is positioned on the side of the surgical region securing device 10. Access to the surgical site is also possible. In the present embodiment, only the injection port 34 for supplying fluid into the linear balloon 30 is provided on the outer peripheral surface of the surgical region securing device 10, but when supplying liquid as fluid, the injection port 34 In addition, an air discharge port for releasing the air in the linear balloon 30 to the outside may be provided.

  Next, a third embodiment will be described with reference to FIG. FIG. 6 is a schematic cross-sectional view of the surgical region securing apparatus 10 according to the third embodiment. This surgical region securing device 10 is greatly different from the first embodiment in that an annular balloon 38 is provided at the lower end of the covering 20 that covers the frame structure 12. More specifically, in this embodiment, the frame structure 12 is configured by connecting an aggregate 14 that is a solid bar made of POM or the like to a ring-shaped base 16 via a hinge 40. ing. Each aggregate 14 is rotatable with respect to the base 16 by the mechanism of the hinge 40, and the inclination angle thereof can be freely changed.

  A covering 20 made of a transparent sheet material is attached to the side peripheral surface of the frame structure 12. The lower end of the sheet material is folded outward and stuck to the outer surface of the covering 20 to form an annular balloon 38. An injection port 42 is attached to the annular balloon 38, and fluid can be supplied into the annular balloon 38 via the injection port 42 and the pipe 44. When the annular balloon 38 swells and spreads along with the fluid filling, the aggregate 14 to which the covering body 20 is attached also spreads following the annular balloon 38 and its posture is restricted.

  A member denoted by reference numeral 46 is a handle that protrudes out of the body cavity and is appropriately operated by the operator when the surgical region securing device 10 is installed in the body cavity. The surgeon operates the handle 46 that has jumped out of the body cavity, and finely adjusts the position and posture of the surgical region securing device 10 located within the body cavity. Therefore, the shape and material of the handle 46 are not particularly limited as long as the handle 46 protrudes out of the body cavity and can be operated with the operator's hand or forceps when the surgical region securing device 10 is installed in the body cavity.

  Next, a procedure for securing a surgical region using the surgical region securing device 10 will be described. When securing the surgical region, the surgical region securing device 10 in which the annular balloon 38 is not filled with fluid is prepared. The surgeon places the surgical area securing device 10 having a reduced diameter through the injection port 118 and places it in the body cavity. When the surgical region securing device 10 enters the body cavity, fluid is subsequently supplied into the annular balloon 38 via the pipe 44 and the injection port 42. Here, similarly to the second embodiment, the supplied fluid is preferably a liquid, in particular, a perfusate. However, if the anti-floating measure is taken, the supplied fluid is a gas (air or the like). But you can.

  When the annular balloon 38 expands and expands due to the supply of fluid, the aggregate 14 also follows and expands, and its posture is restricted. Finally, the surgical region securing device 10 maintains a substantially truncated cone shape in the body cavity. Further, the surgeon operates the handle 46 as necessary to adjust the position and posture of the surgical region securing device 10. Thereafter, similarly to the first embodiment, a surgical instrument such as an endoscope and an electric knife, and a suction port for sucking a liquid are disposed inside the surgical region securing device 10 that expands in a truncated cone shape. Also in this case, as in the first embodiment, the gap between the linear balloons 30 that are the aggregates 14 is covered with the covering 20, so that other organs and omentums inside the surgical region securing device 10 are also obtained. Etc. are effectively prevented. If it will be in this state, an operator will access the operation | movement object site | part located right under the operation area ensuring apparatus 10, or will confirm the condition of the outer side of the operation area ensuring apparatus 10 through the covering body 20. FIG. As a result of confirmation, when it is desired to access an organ or the like located outside the surgical region securing apparatus 10, the covering 20 is broken with a surgical instrument such as a scalpel, and another organ or the like is accessed from the broken portion.

  When the operation is completed, the fluid in the annular balloon 38 is forcibly sucked and discharged by a pump or the like, or the fluid is discharged by rupturing the annular balloon 38. Thereby, the restraining force of the aggregate 14 is released, the surgical region securing device 10 can be reduced in diameter, and the surgical region securing device 10 can be taken out of the body cavity.

  As is clear from the above description, in this embodiment as well, it is possible to effectively prevent the entry of other organs, omentum, etc. into the surgical region defined by the skeleton structure 12 as in the first embodiment. Moreover, since the covering 20 is transparent, it is possible to confirm the situation outside the surgical region securing device 10, and further, by breaking a part of the covering 20, the sheath 20 is positioned on the side of the surgical region securing device 10. Access to the surgical site is also possible.

  In addition, all the structures demonstrated so far are examples, and the structure of the covering 20 and the structure of the frame structure 12 may be changed as appropriate. For example, in the description so far, a planar sheet material having no holes or gaps is used as the covering 20 that covers the gaps between the aggregates 14, but a plurality of holes are formed instead of such a planar sheet. Alternatively, a porous sheet material, a mesh sheet material in which a thread material is woven in a mesh shape, or the like may be used. By using a porous sheet material or a mesh-like sheet material, it is possible to reduce the resistance that the surgical region securing device 10 receives from the perfusate, and it is more effective that the surgical region securing device 10 is flowed to an unintended position. Can be prevented. In the case of using a porous sheet material or a mesh-like sheet material, the holes and meshes are sized so as not to enter a large net or the like. Of course, the portions other than the covering 20, for example, the sheet material portion constituting the linear balloon 30 in the second embodiment, and the sheet material portion constituting the annular balloon 38 in the third embodiment, Use no planar sheet material.

  Further, instead of the frame structure 12 deformed by elastic deformation as shown in FIG. 2 or the frame structure 12 deformed by a hinge mechanism as shown in FIG. 6, a frame structure 12 deformed by a link mechanism is used. Also good. FIG. 7 is a diagram illustrating an example of the frame structure 12 that is deformed by the link mechanism. The frame structure 12 includes a pair of ring-shaped aggregates 14d provided to face each other, a vertical aggregate 14a extending obliquely downward from the upper ring-shaped aggregate 14d, and the vertical aggregate 14a and a lower ring. A radial aggregate 14b connecting between the two aggregates, a circumferential aggregate 14c connecting between the longitudinal aggregates 14a, and a joint portion 48 provided between the plurality of aggregates 14. When the lower ring-shaped aggregate 14d is positioned in the downward direction, the frame structure 12 having such a configuration has a substantially quadrangular frustum shape as shown in FIG. On the other hand, when the lower ring-shaped aggregate 14d is pulled upward, as shown in FIG. 7B, the aggregates 14 are changed in angle (posture change) while affecting each other. Finally, the tip end side diameter and the base end side diameter are deformed into substantially the same truncated cone shape. The surgical region securing device 10 may be configured by attaching a covering 20 made of a transparent sheet material around the side of the framework structure 12.

  Moreover, in the description so far, the structure which covered the whole side periphery of the frame structure 12 with the coating | covering body 20 was mentioned. However, depending on the situation of the operation, there may be a case where the organ or the like that obstructs the operation is only on one side. In such a case, a surgical region securing device 10 as shown in FIG. 8 may be used. This surgical region securing device 10 is obtained by vertically halving the surgical region securing device 10 shown in FIG. 2, and one side surface is not covered with the covering body 20 and is completely opened.

  In the above description, only the framework structure 12 having a variable diameter is illustrated, but the framework structure 12 can pass through the retractor 114 and the injection port 118 and can define a sufficient surgical region. In this case, the diameter may be unchanged. Therefore, for example, as shown in FIG. 9, a substantially cylindrical frame structure 12 including two ring-shaped base portions 16 and a plurality of aggregates 14 connecting the two base portions 16 is used. Also good. In the description so far, the surgical region securing device 10 in which the covering 20 is disposed only on the side surface of the frame structure 12 is illustrated. However, the covering 20 is also applied to the bottom surface in addition to the side surface of the frame structure 12. You may arrange. Therefore, for example, it is good also as a structure which covers both the side peripheral surface and bottom face of the frame structure 12 shown in FIG. Furthermore, as another form, as shown in FIG. 10, two skeleton structures 12 having different diameters are stacked in a double tubular shape, and one skeleton structure 12 is axially arranged with respect to the other skeleton structure 12. You may comprise so that a slide movement is possible.

  In the description so far, only the example in which the surgical region securing device 10 is disposed alone in the body cavity has been described. However, the surgical region securing device 10 may be connected to the injection port 118 and the retractor 114. Therefore, for example, a hook may be provided at the upper end of the surgical area securing device 10 and a fitting for hooking the hook may be provided at the lower end of the injection port 118. As another configuration, the surgical region securing device 10 may be fixed to the lower end of the injection port 118. In any case, by connecting the surgical region securing device 10 to the injection port 118 and the retractor 114, unintentional movement of the surgical region securing device 10 in the body cavity can be prevented, and the surgical region can be secured more stably. .

10 surgical area securing device, 12 frame structure, 14 aggregate, 16 base, 18 cutting part, 20 covering, 30 linear balloon, 32 welded part, 34 inlet, 38 annular balloon, 40 hinge, 42 inlet, 44 piping, 46 handle, 48 joint, 110 endoscope, 111 surgical instrument, 112 electric knife, 114 retractor, 116 discharge piping, 117 suction piping, 118 injection port.

Claims (5)

A surgical region securing device that prevents the entry of surgical obstructions into the surgical region by being placed in a body cavity filled with liquid,
A frame structure that is composed of a plurality of aggregates and demarcates the surgical region, and is provided with a ring-shaped base portion that is cut in the middle at the upper end thereof ;
A covering made of a sheet material and covering a gap between the aggregates on at least the side surface of the framework structure;
Have
The upper end of the framework structure is not connected to the retractor,
Said sheet material, Ri porous sheet or mesh sheet material der,
The diameter of the upper end of the framework structure is reduced by applying an inward force to the outer peripheral surface of the base portion.
An operation area securing device characterized by that. The surgical region securing device according to claim 1, further comprising:
The surgical region securing device, wherein the covering is made of a transparent sheet material. The surgical region securing device according to claim 1 or 2,
The framework structure is variable in diameter,
The covering body has flexibility to deform following the diameter change of the frame structure,
An operation area securing device characterized by that. The surgical region securing device according to any one of claims 1 to 3,
The surgical region securing device, wherein at least a part of the plurality of aggregates constituting the framework structure is a linear balloon that is inflated by fluid filling and maintains a prescribed shape. The surgical region securing device according to any one of claims 1 to 4, further comprising:
A surgical region securing device comprising a handle connected to the framework structure and accessible from outside the body cavity when the framework structure is placed in a body cavity.

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