Surgery appliance

Abstract

To provide a surgery appliance which is used in an endoscopic surgical operation such as a single hole-type abdominoscope operation, and can change an insertion point of an endoscope in a shorter time without greatly changing a relative positional relation between the endoscope and a forceps.SOLUTION: A surgery appliance (10) to be attached to a ring-shaped retractor attached to an incision includes: a cylindrical part (11) having an inner diameter larger than an inner diameter of the incision held by the retractor; and a flat plate-like insertion part (12) provided at a top edge of the cylindrical part (11). A bottom edge of the cylindrical part (11) is a connection portion (13) for attaching to the retractor, and the cylindrical part (11) has flexibility to be freely deformable.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to a surgical instrument for use in endoscopic surgery such as single-port laparoscopic surgery. [Background technology]

[0002] Conventionally, laparoscopic surgery involves making multiple small incisions of approximately 5-12 mm in the patient's abdomen, and inserting an endoscope, forceps, or ventilation tube into these incisions to perform the desired procedure.

[0003] In such laparoscopic surgery, wounds are created by closing each incision after surgery, but there are cases where the healing time of multiple wounds differs, and wounds that do not heal smoothly can cause great stress to patients. Therefore, in order to make the procedure less invasive, single-port laparoscopic surgery is now being used more often in some procedures.

[0004] Single-port laparoscopic surgery involves making a single incision in the abdomen using the navel depression, which is known to have the advantage of allowing for faster postoperative healing and improving cosmetic appearance by making the scar less noticeable.

[0005] Recently, various surgical instruments for single-port laparoscopic surgery have been proposed. For example, a surgical instrument has been proposed in which a ring-shaped retractor is attached to an incision made in the patient's abdomen to keep it open, and a hemispherical dome main body that can be detachably attached to the retractor (see, for example, Patent Document 1).

[0006] The ring-shaped retractor has a so-called rim shape, and is made up of a body cavity side ring, a body surface side ring arranged opposite the body cavity side ring, and a tubular sheet that communicates with the inner opening of the body cavity side ring. The body cavity side ring and the tubular sheet are flexible, and the body cavity side ring can be appropriately bent and inserted into an incision made in the patient's abdomen, and the body cavity side ring can be expanded inside the body cavity to keep the incision open.

[0007] The dome body has multiple pillar-shaped ports that can be inserted into the patient's abdominal cavity while maintaining an airtight state as much as possible. Transparent materials are used as much as possible for the components of the dome body and ports, making it possible to view the patient's abdominal cavity through the dome body. Carbon dioxide gas is supplied into the abdominal cavity through an appropriate ventilation tube, creating a so-called pneumoperitoneum. [Prior art documents] [Patent documents]

[0008] [Patent Document 1] International Publication No. 2014 / 104373 Summary of the Invention [Problem to be solved by the invention]

[0009] Surgical robots are now being used in laparoscopic surgery and single-incision laparoscopic surgery. These robots are often suspended from the ceiling, allowing the endoscope and forceps to maintain their position without needing to be attached to a fixed arm, as was previously required. Furthermore, these robots make it easier to change the position of the endoscope and forceps, improving operability.

[0010] However, because the port position on the dome body installed in the patient's abdomen is fixed, restrictions imposed by the port position prevent the surgical robot from fully utilizing its high operability. More specifically, while endoscopes are generally inserted caudally, there are situations in which it is desirable to view images from the cranial side. In such cases, it is impossible to change the position of the endoscope from the caudal side to the cranial side without significantly changing the relative positions of the endoscope and forceps, which requires a relatively long time for this operation, resulting in a problem of prolonged procedure times.

[0011] The present invention provides a surgical instrument that enables the insertion position of an endoscope to be changed in a shorter time without significantly changing the relative positional relationship between the endoscope and forceps. [Means for solving the problem]

[0012] The surgical brace of the present invention is a surgical brace that is attached to a ring-shaped retractor that is attached to an incision, and has a tubular portion with an inner diameter larger than the inner diameter of the incision held by the retractor, and a flat insertion portion provided at the upper end of the tubular portion, the lower end of the tubular portion being a connection portion for attachment to the retractor, and the tubular portion is flexible and can be deformed freely.

[0013] Furthermore, the surgical brace of the present invention is characterized in the following respects. (1) The insertion part is a plate made of an elastic material, allowing the trocar to be inserted at any position. (2) The cylindrical portion must be able to be seen from the outside to the inside. (3) The cylindrical portion has an expanding region that expands in diameter from the connecting portion toward the insertion portion, and a contracting region that contracts in diameter on the insertion portion side of the expanding region. (4) The tubular portion has a cylindrical shape. (5) The connection part shall be provided with a small piece-like marker protruding outward. (6) The markers are arranged as a set of two pieces, facing each other with the cylindrical part in between. (7) The insertion part is detachable from the cylindrical part. (8) The cylindrical portion is provided with a constricted portion having a diameter smaller than the outer diameter of the insertion portion, and the constricted portion is provided directly below the insertion portion. (9) The outer periphery of the insertion portion is made more rigid than the portion through which the trocar is inserted. [Effects of the Invention]

[0014] According to the present invention, a surgical instrument has a tubular portion having an inner diameter larger than the inner diameter of the incision held by the retractor, and a flat insertion portion provided at the upper end of the tubular portion, the lower end of the tubular portion being a connection portion for attachment to the retractor, and the tubular portion being flexible and deformable, so that the relative positional relationship of an endoscope or forceps inserted through a trocar or the like into the insertion portion is maintained by the insertion portion, and the tubular portion can be deformed appropriately to arbitrarily adjust the position of the endoscope. Therefore, time is not taken for adjusting the position of the endoscope or forceps, etc., and the surgical time can be shortened. [Brief explanation of the drawings]

[0015] [Figure 1] FIG. 2 is a partially cutaway explanatory view of the surgical brace of the present invention. [Figure 2] FIG. 10 is a cross-sectional explanatory view of another embodiment of the insertion portion. [Figure 3] FIG. 10 is a partially cutaway explanatory view of a surgical brace according to another embodiment. [Figure 4] FIG. 10 is an explanatory cross-sectional view of a surgical brace according to another embodiment. [Figure 5] 10A is a plan view of a tubular portion of a surgical brace according to another embodiment, and FIG. 10B is a bottom view of an insertion portion thereof. [Figure 6] FIG. 10 is an explanatory cross-sectional view of a surgical brace according to another embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0016] The surgical brace of the present invention is a surgical brace that is attached to a ring-shaped retractor that is attached to an incision made in the abdomen or the like.

[0017] The ring-shaped retractor may be any conventional retractor, and specifically, it is a so-called rim-shaped retractor made up of a body cavity side ring, a body surface side ring arranged opposite to the body cavity side ring, and a tubular sheet connecting the inner openings of the body cavity side ring and the body surface side ring. The surgical appliance of the present invention is used by being attached to the body surface side ring of the retractor.

[0018] As shown in FIG. 1, the surgical equipment 10 of the present invention has a tubular portion 11 having an inner diameter larger than the inner diameter of the incision wound held by the retractor, and a flat insertion portion 12 provided at the upper end of the tubular portion 11, and the lower end of the tubular portion 11 serves as a connection portion 13 for attaching to the retractor.

[0019] The insertion portion 12 is a plate made of silicone rubber, an elastic material, and allows a trocar (not shown) to be inserted at any position. In this embodiment, the insertion portion 12 is circular in plan view. The insertion portion 12 also has a ribbed protruding wall 12a along its outer edge. This protruding wall 12a is thicker than the plate portion inside the protruding wall 12a by the amount of the protruding wall 12a, thereby increasing the rigidity of the insertion portion 12. Therefore, the insertion portion 12 has an appropriate hardness when inserting a trocar, making it easy to insert the trocar. The insertion portion 12 is not limited to being made of silicone rubber and may be made of an appropriate elastic material.

[0020] In another embodiment, as shown in FIG. 2, the rib-like protruding wall 12a" provided along the outer edge of the insertion portion 12 may be made wider, and further, a reinforcing ring 12b made of a hard resin such as polycarbonate may be embedded in the protruding wall 12a". In this way, the protruding walls 12a, 12a" may be appropriately made highly rigid.

[0021] An endoscope or forceps inserted through the insertion portion 12 is held by the insertion portion 12, allowing it to maintain its posture. The insertion portion 12 of this embodiment shown in FIG. 1 is circular with a diameter of approximately 70 mm, taking into account the spacing between trocars, but the size may be adjusted appropriately, for example, to a diameter of approximately 100 mm. Furthermore, the shape is not limited to a circular shape in plan view, and it may also be elliptical or polygonal. Incidentally, the incision may be elliptical, and the inner diameter of an elliptical incision is considered to be the minimum diameter.

[0022] The cylindrical portion 11 is formed into a cylindrical shape using a silicone rubber sheet or a natural rubber sheet, which provides elasticity, flexibility, and allows it to be deformed freely. In particular, it is desirable for the cylindrical portion 11 to be translucent by selecting a transparent material or forming it as thin as possible, allowing the inside to be seen from the outside and the patient's abdominal cavity to be visually observed through the cylindrical portion 11. If possible, it is desirable for the cylindrical portion 11 to be transparent. By making the inside of the patient's abdominal cavity visible through the cylindrical portion 11, it is possible to easily check the positional relationship between the incision site and the trocar and the status of the endoscope or forceps inserted into the abdominal cavity, as well as to facilitate early detection of abnormalities occurring in the abdominal cavity. The length of the cylindrical portion 11 can be appropriately set, generally between 50 and 100 mm, and in this embodiment, it is set to 70 mm.

[0023] The tubular portion 11 of this embodiment shown in Figure 1 has an expanding diameter region 11a that gradually expands in diameter from the connecting portion 13 at the lower end toward the insertion portion 12 at the upper end, and a contracting diameter region 11b that gradually contracts in diameter further toward the insertion portion 12 than this expanding diameter region 11a, and the central portion of the tubular portion 11 bulges outward to form a balloon shape.

[0024] By making the tubular portion 11 into such a balloon shape, when the tubular portion 11 bends, the bent tubular portion 11 can be positioned around the incision held by the retractor, eliminating the risk of the bent tubular portion 11 penetrating inside the incision, and preventing the workability of the treatment from being hindered.

[0025] The connecting portion 13 provided at the lower end of the tubular portion 11 is stretchable due to the elastic deformation of the tubular portion 11, and this connecting portion 13 is stretched and opened to attach to the retractor. Small markers 13a are arranged on the connecting portion 13 protruding outward to confirm the attachment direction when attaching to the retractor. In particular, it is desirable to provide a pair of markers 13a at opposing positions across the tubular portion 11. In the surgical brace 10 of the present invention, a trocar may be attached to the insertion portion 12 in advance, and then the surgical brace 10 may be attached to the retractor on the patient's abdomen. The pair of markers 13a may indicate, for example, the body length direction when attaching the trocar, and then the surgical brace 10 may be attached to the retractor, thereby allowing the trocar to be attached properly. The markers 13a provided on the connection part 13 are not limited to one set of two pieces, but may be two sets of four pieces as in this embodiment, and these markers 13a may be used as gripping pieces when attaching to the retractor. That is, by gripping and pulling each marker 13a outward, the connection part 13 is expanded, and the body surface side ring of the retractor is inserted into the tubular part 11, and then the pulling is stopped, thereby attaching to the retractor.

[0026] The surgical equipment 10 of the present invention attached to the retractor expands and stands upright against the patient's abdomen as shown in FIG. 1 when the patient's abdominal cavity is pressurized by an appropriate ventilation tube (not shown).

[0027] In another embodiment, as shown in FIG. 3, in a surgical brace 10', the tubular portion 11' may be cylindrical. Even in this case, the inner diameter of the cylindrical tubular portion 11' is larger than the inner diameter of the incision held by the retractor. An expanding diameter region 11a' that gradually expands in diameter upward is provided on the connecting portion 13' side of the tubular portion 11', and a reducing diameter region 11b' that gradually reduces in diameter upward is provided on the inserting portion 12' side of the tubular portion 11'. Note that the tubular portion 11' may have a uniform cylindrical shape from the connecting portion 13' to the inserting portion 12' without providing the expanding diameter region 11a' or the reducing diameter region 11b'.

[0028] In this embodiment, the insertion portion 12' is also a plate made of silicone rubber, an elastic material, allowing a trocar (not shown) to be inserted at any position. The insertion portion 12' is circular in plan view, and is provided with a ribbed protruding wall 12a' along the outer edge. In addition, the connecting portion 13' provided at the lower end of the tubular portion 11' is provided with a pair of small piece-like markers 13a' that protrude outward at positions facing each other across the tubular portion 11'.

[0029] In this way, the surgical appliances 10, 10' of the present invention attached to the retractor have flexible tubular portions 11, 11', so that when it is desired to change the position or posture of the endoscope or forceps inserted into the insertion portions 12, 12' via a trocar or the like, the change can be made at will without being restricted by the surgical appliances 10, 10'. Therefore, it is possible to shorten the time required for the procedure, and the procedure can be performed in a state suitable for the procedure, allowing the practitioner to perform the procedure without feeling stressed.

[0030] In particular, the insertion sections 12, 12' provided at the upper ends of the tubular sections 11, 11' maintain the position and posture of the endoscope or forceps inserted through these insertion sections 12, 12', making it possible to change the posture of the endoscope while maintaining almost the same relative positional relationship between the endoscope and the forceps.

[0031] The surgical instruments 10, 10' of the present invention are not limited to use in single-port laparoscopic surgery, but may also be used appropriately in other endoscopic surgical procedures and robotic surgery.

[0032] As shown in FIG. 4, in another embodiment of the surgical equipment 20, a flat insertion portion 22 provided at the upper end of a cylindrical portion 21 may be detachably attached to the cylindrical portion 21.

[0033] A male thread portion 24 is provided along the outer periphery at the upper end of a tubular portion 21 of a surgical brace 20 of this embodiment, and a female thread portion 25 that screws into the male thread portion 24 is provided on a cylindrical side wall 22a provided along the outer periphery of an insertion portion 22 that is circular in plan view. In other words, the insertion portion 22 serves as a cap that closes the opening provided at the upper end of the tubular portion 21. A reinforcing ring as shown in FIG. 2 may be embedded in the side wall 22a.

[0034] The top plate of insertion portion 22 is a plate made of silicone rubber, which is an elastic member, allowing a trocar to be inserted at any position. Because insertion portion 22 is detachable from the upper end of tubular portion 21, when inserting a trocar into insertion portion 22, by inserting the trocar into insertion portion 22 that has been removed from tubular portion 21, there is no risk of the trocar coming into contact with tubular portion 21, and it is possible to prevent tubular portion 21 from being damaged by the trocar.

[0035] Furthermore, the insertion portion 22 removed from the cylindrical portion 21 is flat, making it easy to hold and support from the back side, making it easy to apply force when inserting a trocar, allowing for smooth insertion. In particular, the insertion portion 22 has a side wall 22' provided along the outer periphery, which increases the rigidity of the outer periphery of the insertion portion 22, making it easier to insert a trocar.

[0036] A desired trocar is attached to the insertion portion 22 , and then the insertion portion 22 is attached to the cylindrical portion 21 .

[0037] The tubular portion 21 of this embodiment also has an expanding region 21a that gradually expands in diameter from the connecting portion 23 at the lower end toward the insertion portion 22 at the upper end, and a contracting region 21b that gradually contracts in diameter further toward the insertion portion 22 than this expanding region 21a, and the central portion of the tubular portion 21 bulges outward to form a balloon shape.

[0038] Furthermore, small piece-like markers 23a are arranged protruding outward at the connecting portion 23 at the lower end of the tubular portion 21 to confirm the attachment direction when attaching to the retractor. In particular, in this embodiment, the lower surface of the markers 23a has an uneven, non-slip structure to ensure that the markers 23a can be securely gripped. In this embodiment as well, the markers 23a are provided as a pair of two pieces at positions facing each other across the tubular portion 21.

[0039] In the above-described embodiment, the insertion portion 22 is attached to the tubular portion 21 via the male thread portion 24 and the female thread portion 25, but this is not limited to this embodiment. In another embodiment, as shown in the plan view of the tubular portion 31 in FIG. 5( a), a plurality of locking pieces 37 protruding outward may be provided on the outer periphery of the opening 36 at the upper end of the tubular portion 31. Meanwhile, as shown in the bottom view of the insertion portion 32 in FIG. 5( b), the insertion portion 32 may have an engagement groove 38, into which the locking pieces 37 are inserted, in a cylindrical side wall 32a provided along the outer periphery of the circular insertion portion 22 in a plan view, instead of the female thread portion 25 in FIG. 4. In this case, the tubular portion 31 and the insertion portion 32 are engaged and connected via the locking pieces 37 and the engagement groove 38, making the insertion portion 32 detachable from the tubular portion 31.

[0040] A guide groove 39 is provided in the side wall 32a of the insertion portion 32 to guide the locking piece 37 to the engagement groove 38. Furthermore, a reinforcing ring shown in FIG. 2 may be embedded in the side wall 32a.

[0041] 6, in another embodiment of the surgical equipment 40, a flexible ring 44 that abuts against the back surface of the insertion portion 22 is provided at the upper end of the tubular portion 41, and a clamping portion 45 that clamps the flexible ring 44 from above and below is provided in the insertion portion 42, so that the insertion portion 42 can be attached and detached to the tubular portion 41. The flexible ring 44 protrudes in a flange-like shape from the upper end of the tubular portion 41, and is flexible and deformable.

[0042] The insertion portion 42 having the clamping portion 45 has a circular shape in a plan view, and the clamping portion 45 is provided along the outer periphery. By providing the clamping portion 45 along the outer periphery of the insertion portion 42, the rigidity of the outer periphery is increased, thereby making the insertion portion 42 highly rigid.

[0043] The clamping portion 45 is provided with a folded piece 45a, which comes into contact with the underside of the flexible ring 44 that is in contact with the back surface of the insertion portion 22, thereby supporting the flexible ring 44 from below.

[0044] The tubular portion 41 of this embodiment also has an expanding region 41a that gradually expands in diameter from the connecting portion 43 at the lower end toward the insertion portion 42 at the upper end, and a contracting region 41b that gradually contracts in diameter further toward the insertion portion 42 than this expanding region 41a, and the central portion of the tubular portion 41 bulges outward to form a balloon shape.

[0045] The tubular portion 41 is provided with a constricted portion 46 whose diameter is smaller than the outer diameter of the insertion portion 42, and this constricted portion 46 is provided directly below the insertion portion 42. By providing the constricted portion 46 in the tubular portion 41, when an endoscope or forceps inserted into the insertion portion 42 is tilted or the insertion portion 42 is pushed down, the constricted portion 46 of the tubular portion 41 can be preferentially deformed. Therefore, the tubular portion 41 can be prevented from bending inside the incision and the inner surface of the tubular portion 41 can be prevented from coming into contact with the endoscope or forceps, preventing interference with operability.

[0046] It is desirable that the constricted portion 46 be located as far away from the incision as possible, and that it be provided immediately below the insertion portion 42. Although the tubular portion 11 shown in Fig. 1, the tubular portion 11' shown in Fig. 3, and the tubular portion 21 shown in Fig. 4 do not have a constricted portion, it is desirable to provide a constricted portion immediately below or near the insertion portions 12, 12', and 22, respectively. [Explanation of symbols]

[0047] 10,10',20,40 Surgical equipment 11, 11', 21, 31, 41 Cylindrical part 11a,11a',21a,41a Expanded area 11b,11b',21b,41b Diameter reduction area 12, 12', 22, 32, 42 Insertion part 12a,12a',12a” protruding wall 12b Reinforcement ring 13,13',23 Connection 13a, 13a', 23a markers 22a,32a side wall 24 Male thread 25 Female thread 36 Opening 37 Locking piece 38 Engagement groove 39 Guide groove 44 Flexible Ring 45 Clamping part 45a Folding piece 46 Waist

Claims

1. A surgical device to be attached to a ring-shaped retractor to be attached to an incision, a tubular portion having an inner diameter larger than the inner diameter of an incision to be held by the retractor; a flat-plate-shaped insertion portion provided at the upper end of the cylindrical portion; and a lower end of the tubular portion serving as a connection portion for attachment to the retractor; The tubular portion is flexible and can be deformed freely.

2. 2. The surgical instrument according to claim 1, wherein the insertion portion is a plate made of an elastic material, and a trocar can be inserted at any position.

3. The surgical brace according to claim 1 or 2, wherein the inside of the cylindrical portion is visible from the outside.

4. 4. The surgical instrument according to claim 3, wherein the tubular portion has an expanding region that expands in diameter from the connecting portion toward the insertion portion, and a contracting region that contracts in diameter on the insertion portion side relative to the expanding region.

5. The surgical brace according to claim 3 , wherein the tubular portion has a cylindrical shape.

6. The surgical brace according to claim 3, wherein the connecting portion is provided with a small piece-like marker that protrudes outward.

7. The surgical instrument according to claim 6, wherein the markers are arranged as a pair of two pieces facing each other with the cylindrical portion interposed therebetween.

8. 3. The surgical brace according to claim 1, wherein the insertion portion is detachable from the cylindrical portion.

9. 3. The surgical brace according to claim 1, wherein the tubular portion is provided with a constricted portion having a diameter dimension smaller than an outer diameter of the insertion portion, and the constricted portion is provided immediately below the insertion portion.

10. The surgical instrument according to claim 2, wherein the outer peripheral edge of the insertion portion has higher rigidity than the portion through which the trocar is inserted.

Images