Medical insertion device

Abstract

To provide a medical inserter which enables the use of forceps A and a recovery bag B in the state of separately enhancing sealability and is easily operable by reducing friction resistance while further enhancing the sealability at the time of use together with supportability particularly relating to the forceps A.SOLUTION: This device is provided with a detachable cap 30 for closing the base end opening 11b of a pipe main body 11 to be inserted through the vagina, and an insertion port part 4142 for separately penetrating forceps A and a recovery bag B is provided on the main wall surface part 31 of the cap 30. An insertion port part 41 corresponding to the forceps A is provided with a fitting cylinder part 410 cylindrically continued from its peripheral edge, and a plurality of annular projecting parts 411 brought into close contact with the outer peripheral surface of the forceps A over the whole periphery are arranged side by side on the inner peripheral surface of the fitting cylinder part 410.SELECTED DRAWING: Figure 13

Description

[Technical Field]

[0001] The present invention relates to a medical inserter that can be inserted transvaginally and used for hysterectomy. [Background technology]

[0002] Various instruments have been proposed for use in laparoscopic hysterectomy. For example, Patent Document 1 discloses an insertion tool that is inserted transvaginally and used to hold the uterus during hysterectomy, to insert and remove instruments such as forceps used to remove the excised uterus, and to be used when suturing the vaginal wall stump.

[0003] The insertion tool disclosed in Patent Document 1 has a cap attached to the proximal opening of the main body, which is provided with a hole for inserting an instrument such as forceps, and a cylindrical portion extending from the periphery of the hole. The inner circumferential surfaces of the hole and the cylindrical portion are continuous on the same cylindrical surface, and when an instrument such as forceps is inserted through the hole, the inner circumferential surface of the cylindrical portion comes into close contact with the instrument. This increases the contact area between the cap and the instrument, thereby preventing leakage of pneumoperitoneum gas.

[0004] The instrument used with this type of insertion tool to remove the excised uterus is not limited to ordinary forceps; a retrieval bag is also known. The retrieval bag contains the excised uterus and is inserted in a folded state inside the shaft. When in use, the bag protrudes from the tip of the shaft and unfolds to contain the uterus. Generally, the shaft diameter of the retrieval bag is significantly larger than that of the forceps. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Japanese Patent Publication No. 2022-102154 Summary of the Invention [Problem to be solved by the invention]

[0006] In the conventional insertion tool described above, the only hole in the cap was designed to accommodate forceps, and the inner diameter of the hole and cylindrical portion was designed to match the shaft diameter of the forceps. With this type of insertion tool, only forceps could be inserted into the hole in the cap, and other instruments (recovery bags) with significantly different shaft diameters could not be used. If the size of the hole were expanded to accommodate a recovery bag, a gap would likely form between the hole and the forceps when inserted, which could result in leakage of pneumoperitoneum gas.

[0007] Furthermore, the cylindrical portion extending from the periphery of the hole in the cap increases the contact area between the cap and the instrument when the forceps are inserted, improving support and sealing, but the outer surface of the forceps tends to come into close contact with the straight inner surface of the cylindrical portion, making it easy for the forceps to stick. This increases frictional resistance with the cap when the forceps are inserted, making it difficult to operate the forceps smoothly.

[0008] The present invention was made in response to the problems associated with the prior art as described above, and aims to provide a medical inserter that can be used with multiple types of instruments (e.g., forceps and retrieval bags) with different outer diameters, each with enhanced sealing properties, and that, for any one instrument (e.g., forceps), can be easily operated by reducing frictional resistance while further enhancing sealing properties and support during use. [Means for solving the problem]

[0009] In order to achieve the above object, one aspect of the present invention is to A medical inserter having a detachable cap for closing a base end opening of a pipe body to be inserted transvaginally, At least a portion of the main wall surface of the cap is formed in a thin film sheet shape, and the sheet-like portion is provided with a plurality of insertion openings through which a plurality of types of axial instruments having different outer diameters are separately inserted, One of the insertion openings is provided with a fitting tubular portion that extends from its periphery in a tubular shape and into which the instrument that has been passed through the one insertion opening is fitted, The present invention is characterized in that a plurality of annular protrusions that come into close contact with the outer peripheral surface of the appliance over the entire circumference are arranged on the inner peripheral surface of the fitting cylindrical portion in the axial direction of the fitting cylindrical portion. [Effects of the Invention]

[0010] The medical inserter according to the present invention allows a plurality of types of instruments with different outer diameters to be used with each having an improved sealing performance, and for any one of the instruments, the sealing performance during use is further improved together with the support performance, while frictional resistance is reduced, making it easy to operate. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a side view showing a medical inserter according to a first embodiment. [Figure 2] FIG. 1 is a perspective view showing a medical inserter according to a first embodiment. [Figure 3] FIG. 2 is a perspective view showing the cap according to the first embodiment as viewed from above. [Figure 4] FIG. 2 is a perspective view showing the cap according to the first embodiment, as viewed from below. [Figure 5] FIG. 2 is a plan view showing the cap according to the first embodiment. [Figure 6] FIG. 2 is a bottom view showing the cap according to the first embodiment. [Figure 7] FIG. 2 is a front view showing the cap according to the first embodiment. [Figure 8] FIG. 2 is a rear view showing the cap according to the first embodiment. [Figure 9] FIG. 2 is a right side view showing the cap according to the first embodiment. [Figure 10] FIG. 2 is a left side view showing the cap according to the first embodiment. [Figure 11] FIG. 2 is a vertical cross-sectional view showing the cap according to the first embodiment. [Figure 12] 1 is a plan view showing a state in which each insertion opening of the cap according to the first embodiment is closed with a stopper. FIG. [Figure 13]3 is an enlarged longitudinal cross-sectional view showing each insertion opening of the cap according to the first embodiment. FIG. [Figure 14] 10A to 10C are explanatory views showing the operation of closing each insertion opening with a stopper in the cap according to the first embodiment. [Figure 15] 5A and 5B are explanatory views showing the function of a fitting tube portion of one insertion opening portion of the cap according to the first embodiment. [Figure 16] FIG. 2 is an explanatory diagram showing two types of instruments used in the medical inserter according to the first embodiment. [Figure 17] FIG. 1 is an explanatory diagram showing an image of a laparoscopic hysterectomy. [Figure 18] FIG. 2 is an explanatory view showing the medical insertion device according to the first embodiment in use during hysterectomy surgery. [Figure 19] FIG. 19 is an explanatory diagram showing the medical inserter in use, following FIG. 18. [Figure 20] 20 is an explanatory view showing a state of use of the medical inserter following FIG. 19 when forceps are used as the instrument. FIG. [Figure 21] FIG. 21 is an explanatory diagram showing the medical inserter in use, continuing from FIG. 20. [Figure 22] FIG. 22 is an explanatory diagram showing the state of use of the medical inserter, following FIG. 21. [Figure 23] FIG. 20 is an explanatory view showing the state of use of the medical inserter, subsequent to FIG. 19, when a retrieval bag is used as the instrument. [Figure 24] FIG. 24 is an explanatory diagram showing the state of use of the medical inserter, following FIG. 23. [Figure 25] FIG. 25 is an explanatory diagram showing the medical inserter in use, following FIG. 24. [Figure 26] FIG. 26 is an explanatory diagram showing the state of use of the medical inserter, following FIG. 25. [Figure 27] FIG. 27 is an explanatory diagram showing the medical inserter in use, following FIG. 26. [Figure 28] FIG. 10 is a perspective view showing a cap according to a second embodiment, as viewed from above. [Figure 29] FIG. 10 is a perspective view showing a cap according to a second embodiment, as viewed from below. [Figure 30]FIG. 10 is a plan view showing a cap according to a second embodiment. [Figure 31] FIG. 10 is a bottom view showing the cap according to the second embodiment. [Figure 32] FIG. 10 is a front view showing a cap according to a second embodiment. [Figure 33] FIG. 10 is a rear view showing the cap according to the second embodiment. [Figure 34] FIG. 10 is a right side view showing a cap according to a second embodiment. [Figure 35] FIG. 10 is a left side view showing a cap according to a second embodiment. [Figure 36] FIG. 10 is a plan view showing a state in which each insertion opening of the cap according to the second embodiment is closed with a stopper. [Figure 37] FIG. 10 is an explanatory diagram showing dimensions of a cap according to a second embodiment when each insertion opening is closed with a stopper. DETAILED DESCRIPTION OF THE INVENTION

[0012] Various embodiments representative of the present invention will be described below with reference to the drawings. 1 to 27 show a first embodiment of the present invention, and Figs. 28 to 37 show a second embodiment of the present invention. A medical inserter 10 according to various embodiments can be inserted transvaginally and used for hysterectomy, and is also used to insert and remove instruments and to secure a path for removing the uterus. Note that the components, shapes, numerical values, etc. shown in the embodiments described below are all examples of the present invention and do not limit the present invention.

[0013] <Outline of the medical inserter 10 according to the first embodiment> As shown in Fig. 1, the medical inserter 10 comprises a pipe body 11 that is inserted transvaginally, and a removable cap 30 that closes the base-end opening 11b of the pipe body 11. Here, the cap 30 forms the core of the present invention. In the following explanation, the side distal to the surgeon in the axial direction along which the pipe body 11 extends is defined as the "tip" (left end in Fig. 1), and the side proximal to the surgeon is defined as the "base end" (right end in Fig. 1).

[0014] <Pipe body 11> As shown in Figure 1, the pipe body 11 is generally formed in a cylindrical shape with a circular cross section, and its tip and base ends are both open. More specifically, the pipe body 11 is made up of a tip ring 12 provided at the tip and a main pipe section 13 that occupies the base end side of the tip ring 12. A handle 20 that is held by the surgeon is provided on the base end side of the main pipe section 13. The area of ​​the pipe body 11 that is distal to the handle 20 forms the effective area L that can be inserted into the vagina.

[0015] The tip of the pipe body 11, i.e., the tip of the tip ring 12, opens in an oval shape on a plane inclined with respect to a plane perpendicular to the axis of the pipe body 11. This tip opening 11a is the part that directly communicates with the inside of the vagina. On the other hand, the base end of the pipe body 11, i.e., the base end of the main pipe portion 13, opens in a circular shape on a plane perpendicular to the axis of the pipe body 11. This base end opening 11b is the part through which various types of instruments are inserted from outside the vagina, and is closed by a removable cap 30.

[0016] The tip ring 12 is made of, for example, thermosetting acrylic resin. Specifically, the tip ring 12 is formed by injecting liquid thermosetting acrylic resin into a mold, sealing it, and then heating and curing it in this state. Alternatively, the tip ring 12 may be formed by cutting a cylindrical extrusion molded product made of thermosetting acrylic resin. The base end of the tip ring 12 has the same diameter as the tip of the main pipe portion 13, and the two are continuous with no gaps.

[0017] The inside of the main pipe 13 is a space for inserting various types of instruments, and is formed so that the outer diameter at the base end gradually increases from the outer diameter at the tip end to the outer diameter at the middle. More specifically, the main pipe 13 is composed of a cylindrical small diameter section 13a that forms the tip side connected to the tip ring 12, a cylindrical large diameter section 13b that forms the base side and has a larger diameter than the small diameter section 13a, and a tapered section 13c that continues between them.

[0018] The outer peripheral surface of the main pipe section 13 is provided with ribs 14a, 14b that protrude radially and prevent pneumoperitoneum gas (described later) from leaking along the outer peripheral surface. In this embodiment, a plurality of ribs 14a, 14b spaced apart from each other in the axial direction are provided on the outer peripheral surface of the small diameter section 13a. Of these, the rib 14a closest to the tip is not continuous around the entire circumference, but is provided only on a portion of the circumference. The other ribs 14b are provided in a continuous ring shape around the entire circumference of the pipe body 11.

[0019] Each of the ribs 14a, 14b has an elliptical shape that is inclined relative to a plane perpendicular to the axial direction. The radial height of the ribs 14a, 14b is preferably formed so that it gradually increases toward the base end. Note that the configuration of the ribs 14a, 14b is not limited to that described above. For example, the ribs 14a closest to the tip end may be omitted and only the annular rib 14b may be formed, the ribs may be circular along the circumferential direction of the main pipe portion 13, or multiple ribs may be provided with the same radial height.

[0020] As shown in FIG. 1 , the handle 20 is provided integrally with and connected to the base end side of the main pipe portion 13. The handle 20 is formed in a size and shape that allows the surgeon to easily grasp and operate the main pipe portion 13. The handle 20 in this embodiment is formed so that it extends diagonally rearward from the base end side of the main pipe portion 13, and then extends rearward in a narrow width parallel to the axial direction of the main pipe portion 13. The handle 20 is, for example, molded integrally with the main pipe portion 13 from the same resin material. It is preferable to provide unevenness on the surface of the handle 20 in the form of ribs or grooves to prevent slipping.

[0021] The main pipe portion 13 is formed, for example, by injection molding of a resin into which the tip ring 12 is inserted. In this embodiment, the main pipe portion 13 and the handle 20 are integrally injection molded using the same resin material. It is preferable that the main pipe portion 13 be transparent so that instruments inserted inside the main pipe portion 13 can be seen when using the medical inserter 10. Considering these required characteristics and costs, suitable resin materials for the main pipe portion 13 and the like include polycarbonate and ABS. It should be noted that, for example, the invention described in JP 2022-102154 A, which has already been proposed by the present applicant, may be used as a mold for injection molding the main pipe portion 13 and the like.

[0022] <Cap 30> 2 to 11, cap 30, which is the core of the present invention, is detachable so as to close base-end opening 11b of pipe body 11, is formed in a shallow, bottomed cylindrical shape, and is integrally molded from a flexible material such as silicone rubber. More specifically, cap 30 has a main wall surface portion 31 forming a circular top surface, which is formed in the shape of a thin, stretchable sheet, and is equipped with a cylindrical outer wall portion 32 that surrounds and frames the outer periphery of main wall surface portion 31.

[0023] As shown in Fig. 3, the inner surface side of the main wall surface portion 31 is provided with an inner wall portion 33 that is cylindrical and has a diameter slightly smaller than the outer wall portion 32 and extends beyond the tip of the outer wall portion 32. The cap 30 is attached to the pipe body 11 in a state where the base-end opening 11b is sealed by a double seal structure in which the inner wall portion 33 fits inside the base-end opening 11b of the pipe body 11 and the outer wall portion 32 fits outside the base end of the pipe body 11. As shown in Fig. 11, the inner periphery of the outer wall portion 32 at the tip is provided with a jaw 32a that engages with the outer periphery of the base end of the pipe body 11. The outer periphery of the inner wall portion 33 at the tip is provided with a taper 33a that makes it easier to fit inside the base-end opening 11b.

[0024] In this embodiment, the main wall portion 31 is formed as a thin film sheet over its entire area, and this sheet-like portion is provided with insertion openings 41, 42 for separately passing multiple types of instruments through. Each insertion opening 41, 42 is a portion for inserting and removing an instrument into and from the inside of the pipe body 11 when the cap 30 is attached to the base-end opening 11b of the pipe body 11. The cap 30 of this embodiment is provided with two insertion openings 41, 42 to accommodate two types of instruments. The instruments here refer to multiple types of shaft-shaped medical instruments (trocars) with different outer diameters, and in this embodiment, forceps and a retrieval bag will be used as examples of the two types of instruments.

[0025] As shown in Figure 16, forceps A are used to close and suture the vaginal wall stump in the abdominal cavity after hysterectomy (see Figure 17), and are also used to remove the excised uterus, etc. Forceps A have a gripping portion A2 at the tip connected to the tip of shaft A1, and the gripping portion A2 extending from the tip of shaft A1 can be operated during operation. Recovery bag B is also used to remove the excised uterus, etc. Recovery bag B has bag body B2 inserted into shaft B1 in a folded state, and can be unfolded by protruding bag body B2 from the tip of shaft B1 during operation. Note that the instruments used with medical insertion device 10 are not limited to forceps A and recovery bag B.

[0026] Each insertion opening 41, 42 is elastically deformed by press-fitting a corresponding instrument, allowing the instrument to be inserted in a sealed state, with one insertion opening 41 corresponding to forceps A and the other insertion opening 42 corresponding to retrieval bag B. The shaft diameter (synonymous with outer diameter) of forceps A is generally narrow, for example, 4.5 to 5.8 mm, while the shaft diameter (synonymous with outer diameter) of retrieval bag B is generally wide, for example, 10.0 to 15.0 mm. As such, the outer diameter of shaft B1 of retrieval bag B is relatively larger than the outer diameter of shaft A1 of forceps A, and therefore the other insertion opening 42 is formed with an inner diameter larger than the one insertion opening 41.

[0027] As shown in Fig. 6, the insertion openings 41, 42 are disposed inside the inner wall portion 33 of the main wall portion 31 at positions eccentric from the center of the main wall portion 31, and are arranged so as to be aligned in the diameter direction with the center of the main wall portion 31 between them. As shown in Fig. 5, a raised marking 43 extending in an arc shape so as to surround the outside of each insertion opening 41, 42 is provided on the reference surface on the front side (outer surface side) of the main wall portion 31. The raised marking 43 prevents the reference surface on the front side of the main wall portion 31 from sticking to another flat surface.

[0028] As shown in FIG. 13 , one insertion opening 41 is provided with a fitting tube 410 that extends cylindrically from its periphery 41a and into which the forceps A is fitted when it is inserted. The inner peripheral surface of the insertion opening 41 and the inner peripheral surface of the fitting tube 410 are continuous on the same cylindrical surface. The inner peripheral surface of the fitting tube 410 is provided with a plurality of annular protrusions 411 that are in close contact with the outer peripheral surface of the forceps A over the entire circumference and are arranged in the axial direction of the fitting tube 410. The protrusions 411 are arranged closely to each other, and the spaces between adjacent protrusions 411 form annular recesses 412 that do not abut against the outer peripheral surface of the forceps A. In the following description, the inner periphery of the insertion opening 41 is also considered to be part of the inner periphery of the fitting tube 410.

[0029] 13, each of the protrusions 411 is formed, for example, with a smooth arc-shaped cross section, and the apex of each protrusion 411 makes localized linear contact with the outer circumferential surface of the forceps A (shaft A1). The minimum inner diameter of the fitting tube portion 410, which is surrounded by the apex of each protrusion 411, is preferably set to be slightly smaller than the outer diameter of the forceps A. Each of the protrusions 411 can reduce frictional resistance compared to when the inner circumferential surface of the fitting tube portion 410 makes surface contact with the outer circumferential surface of the forceps A. Furthermore, each of the protrusions 411 makes close contact with the outer circumferential surface of the forceps A (shaft A1) in the entire circumferential direction, thereby improving sealing performance when the forceps A is inserted.

[0030] 15(b), recesses 412 between the protrusions 411 provide play that allows the fitting tube portion 410 to easily deform in response to the movement of the forceps A. Furthermore, as shown in FIGS. 13 and 15(a), a reduced diameter portion 413 that extends around the entire circumference toward the axial direction is also provided on the inside of the tip of the fitting tube portion 410. The reduced diameter portion 413 protrudes inward more than the protrusions 411 and comes into close contact with the outer periphery of the forceps A, and works in conjunction with the protrusions 411 to improve sealing performance.

[0031] When the shaft diameter of the forceps A is 4.5 to 5.8 mm as described above, the minimum inner diameter of the fitting cylindrical portion 410 surrounded by the apexes of the convex portions 411 may be set to, for example, about 5.2 mm. The maximum inner diameter of the fitting cylindrical portion 410 surrounded by the bottoms of the concave portions 412 may be set to, for example, about 5.8 mm. The inner diameter surrounded by the reduced diameter portion 413 may be set to, for example, about 3.8 mm. The length of the fitting cylindrical portion 410, including the depth of the insertion opening 41 (thickness of the main wall surface portion 31) of 2.0 mm, may be set to, for example, about 8.0 mm, and a total of three convex portions 411 may be provided.

[0032] 13 and 14, the other insertion opening 42 is provided with a crimping portion 420 along its periphery 42a, which elastically expands in diameter when the collection bag B is pressed into it, and comes into close contact with the outer periphery of the collection bag B. The crimping portion 420 is formed as a taper 421 that slopes inward and intersects with the periphery 42a of the insertion opening 42, which is located on the reference planes on the front and back of the main wall portion 31. Here, a tip 422 where the tapers 421 on the front and back intersect is formed to have a strong trapezoidal cross section rather than an acute triangular cross section.

[0033] As described above, the shaft diameter of the collection bag B to be inserted into the other insertion opening 42 is a wide range of φ10.0 to 15.0 mm, and therefore, instead of providing a fitting tubular portion 410 similar to that of the first insertion opening 41, the insertion opening 42 is formed thin with a tapered portion 421. This configuration of the insertion opening 42 allows for increased expandability so that it can accommodate a variety of outer diameters of collection bags B.

[0034] When the shaft diameter of collection bag B is 10.0 to 15.0 mm as described above, the maximum inner diameter enclosed by periphery 42a of insertion opening 42 may be set to, for example, 12.5 mm. Furthermore, the minimum inner diameter enclosed by tip 422 of taper 421 of insertion opening 42 may be set to, for example, 7.5 mm. Here, if the maximum inner diameter 12.5 mm of insertion opening 42 matches the outer diameter of the shaft of collection bag B, for example, the ratio of the minimum inner diameter 7.5 mm of insertion opening 42 to the maximum inner diameter (shaft diameter of collection bag B) of insertion opening 42 is 0.6:1, which is an integer ratio of 3:5 and a percentage ratio of 37.5%:62.5%.

[0035] 3 and 4, the cap 30 has stopper plugs 51 and 52 for closing the insertion openings 41 and 42, respectively. The stopper plugs 51 and 52 are integrally connected to both ends of the outer peripheral wall portion 32, which is on the outer peripheral side of the main wall surface portion 31, via connecting portions 510 and 520, respectively. The stopper plugs 51 and 52 are formed as protrusions that protrude from one surface on the tip side of the connecting portions 510 and 520. As shown in FIG. 14, the stopper plugs 51 and 52 have cylindrical shaft portions 51 a and 52 a and substantially conical head portions 51 b and 52 b at the ends thereof, and the outer peripheral edges of the head portions 51 b and 52 b expand in an umbrella shape beyond the outer diameter of the shaft portions 51 a and 52 a to prevent the stopper plugs from coming out when inserted into the insertion openings 41 and 42.

[0036] The stem 51a of the stopper 51 that closes one of the insertion openings 41 is set to a length that passes through the fitting tube 410, and the outer diameter of not only the head 51b but also the stem 51a is set to be slightly larger than the inner diameter surrounded by the reduced diameter portion 413 of the fitting tube 410. By inserting the stopper 51 into the insertion opening 41 or the fitting tube 410, the insertion opening 41 is closed, and by removing the stopper 51 from the insertion opening 41 or the fitting tube 410, an instrument such as forceps A can be inserted through the insertion opening 41.

[0037] The shaft 52a of the stopper 52 that closes the other insertion opening 42 is sufficient if it is short enough to penetrate the insertion opening 42, and the outer diameter of not only the head 52b but also the shaft 52a is set to be slightly larger than the smallest inner diameter surrounded by the tip 422 of the taper 421 of the insertion opening 42. By inserting such a stopper 52 into the insertion opening 42, the insertion opening 42 is closed, and by removing it from the insertion opening 42, it becomes possible to insert an instrument with a relatively large shaft outer diameter, such as a recovery bag B, through the insertion opening 42.

[0038] 3 to 6, in this embodiment, the cap 30, the stopper plugs 51, 52, and the connecting portions 510, 520 connecting them are integrally formed from a flexible material. Here, each connecting portion 510, 520 is formed in the shape of a narrow, flat band. The pair of connecting portions 510, 520 are provided so as to extend outward from both ends of the outer peripheral wall portion 32 of the cap 30 along the diameter direction in which the two insertion openings 41, 42 are aligned, on the same plane substantially parallel to the main wall surface portion 31.

[0039] In this way, the natural restored position of each of the connecting portions 510, 520 is a state in which they extend from both ends of the outer peripheral wall portion 32 in directions opposite to each other by 180 degrees. As shown in FIG. 12 , each of the connecting portions 510, 520 can be freely bent from the restored position and elastically deformed to a closed position in which the stopper 51, 52 at the end of each connecting portion 510, 520 closes the corresponding insertion opening 41, 42. As shown in FIG. 3 , each connecting portion 510, 520 has a slit-shaped thin hinge 511, 521 recessed toward the bending side at the base end side where it bends the most to facilitate bending. In this embodiment, two thin hinges 511, 521 are provided for each connecting portion 510, 520, but one or three or more thin hinges may be provided.

[0040] Furthermore, at the tip of each connecting portion 510, 520, there is provided a tongue-shaped handle 512, 522 that bends from the center line of the entire connecting portion 510, 520 at the point where the stopper 51, 52 is provided. Each handle 512, 522 does not extend along the center line of the entire connecting portion 510, 520, i.e., in the diametric direction along which the two insertion openings 41, 42 are aligned, but is provided so as to bend at, for example, a right angle to this diametric direction. This prevents the handles 512, 522 from interfering with each other when the stopper 51, 52 is in the closed position, as shown in Fig. 12.

[0041] As shown in Figures 3 and 4, raised markings 513 and 523 are provided on the top and bottom surfaces of the handles 512 and 522, respectively. The raised markings 513 and 523, one on each of the top surfaces of the handles 512 and 522 shown in Figures 3 and 5, are provided to raise the stopper plugs 51 and 52 so that they are easier to grip, and the raised markings 513 and 523, three on each of the bottom surfaces of the handles 512 and 522 shown in Figures 4 and 6, are provided to prevent slipping when gripped. Here, it is preferable to make the number and shape of the raised markings 513, 523 different on the front and back of the handles 512, 522 so that the orientation of the stopper plugs 51, 52 can be determined by touch. Note that the stopper plugs 51, 52, including the connecting portions 510, 520 and the handles 512, 522, may also be referred to as the stopper plug as a whole.

[0042] Furthermore, the outer peripheral wall 32 of the cap 30 is provided with a protruding piece 44 at one end perpendicular to the diametric direction in which the insertion openings 41, 42 are aligned, which protrudes easily when attaching or detaching the cap 30. The protruding piece 44 is integrally molded in the shape of a thin, approximately triangular tongue, and as shown in Figures 9 and 10, is provided so as to protrude outward from the outer peripheral wall 32 on a plane parallel to the reference plane of the main wall 31 and on the same plane as the main wall 31. Here, the protruding piece 44 may be used, for example, to mark the size of the cap 30.

[0043] <Action of the medical insertion device 10 according to the first embodiment> Next, the operation of the medical inserter 10 according to the first embodiment will be described. Figure 17 is an explanatory diagram showing an image of a laparoscopic hysterectomy, with the upper side of the figure representing the abdominal side and the lower side representing the dorsal side. When using forceps A or retrieval bag B through medical insertion device 10, the patient is usually under general anesthesia in either case. Note that the following explanation is merely an example and may differ depending on the operator (surgeon) and the patient's condition.

[0044] [1] First, as shown in Figure 18(a), insert the pipe body 11 of the medical insertion instrument 10 from the opening of the vagina and slowly push it toward the back of the vagina, and confirm by visual and tactile inspection that the cervical os has entered the interior of the distal ring 12 of the pipe body 11. Then, as shown in Figure 18(b), push the distal ring 12 of the pipe body 11 up to the dome portion near the cervical os. Here, when checking the insertion state from the proximal opening 11b of the pipe body 11, the cap 30 may be removed from the proximal opening 11b.

[0045] [2] Next, with the abdominal cavity inflated by filling it with pneumoperitoneum gas (see Figure 17), the pipe body 11 is further pushed in while checking the dome portion with a laparoscope camera, and as shown in Figure 19, the dome portion is excised with an electric scalpel while visually checking the position of the dome portion. The dome portion against which the tip ring 12 is pressed appears to be deformed and raised inside the abdominal cavity. The electric scalpel is applied repeatedly along the dome portion to excise it. In this embodiment, the tip ring 12 is made of thermosetting acrylic resin, so there is no risk of it easily melting when it comes into contact with the electric scalpel.

[0046] By removing the dome of the uterus, pneumoperitoneum gas in the abdominal cavity enters the vagina and the inside of the pipe body 11. At this time, because the base end opening 11b of the pipe body 11 is closed by the cap 30, the pneumoperitoneum gas is less likely to leak through the pipe body 11, and good visibility into the abdominal cavity can be maintained. In addition, the protrusions 14a, 14b and the tapered portion 13c provided on the outer surface of the pipe body 11 adhere closely to the inner wall of the vagina, thereby restricting the pneumoperitoneum gas from leaking out along the outer surface of the pipe body 11.

[0047] <<How to use forceps A>> [3] The excised uterus is then extracted. If forceps A (see Figure 16) are used, the stopper 51 is removed from the insertion opening 41 of the cap 30 while the pipe body 11 remains inserted into the vagina. Then, as shown in Figure 20, forceps A is inserted into the pipe body 11 from the insertion opening 41 to grasp the excised uterus. If the excised uterus is to be extracted using forceps from the abdominal cavity side (see Figure 17) or if a recovery bag B is to be placed into the abdominal cavity, operation with forceps A through the pipe body 11 is not performed.

[0048] As shown in FIG. 15 , when the forceps A are inserted through the insertion opening 41, the shaft A1 of the forceps A is fitted into the fitting tube 410 that is connected to the insertion opening 41. This increases the contact area between the cap 30 and the forceps A compared to when the insertion opening 41 does not have the fitting tube 410. If the inner circumferential surface of the fitting tube 410 were smooth, the forceps would stick to the outer circumferential surface of the forceps A, increasing resistance. However, the inner circumferential surface of the fitting tube 410 is provided with unevenness in which annular convex portions 411 and concave portions 412 are alternately arranged. Therefore, the outer circumferential surface of the forceps A does not come into close contact with the inner circumferential surface of the fitting tube 410. Therefore, even if the contact area between the fitting tube 410 and the forceps A increases, it is possible to reduce frictional resistance during insertion of the forceps A and improve sealing performance.

[0049] 15(b), when forceps A is moved up, down, left, and right while inserted through insertion opening 41, insertion opening 41 itself deforms, creating a gap. However, because fitting tube 410 connected to insertion opening 41 is cylindrical and has a predetermined length, fitting tube 410 elastically deforms along its entire length to follow the movement of forceps A. Moreover, the tip of fitting tube 410 has reduced-diameter portion 413 that fits tightly against the outer periphery of forceps A, and because it is a free end with no support from the surroundings, it easily deforms while maintaining a tight fit to follow the movement of forceps A, thereby reliably suppressing leakage of pneumoperitoneum gas.

[0050] [4] Then, as shown in Figure 21, the uterus grasped with forceps A is pulled into the inside of pipe body 11. Next, forceps A is temporarily pulled out from insertion opening 41 of cap 30, and as shown in Figure 22, cap 30 is removed from pipe body 11, and the excised uterus is pulled out from inside pipe body 11 with forceps A. If the excised uterus does not fit inside pipe body 11, the pipe body 11 is removed and the uterus is pulled out directly. Thereafter, pipe body 11 is inserted again into the vagina, and the vaginal wall stump is closed and sutured.

[0051] [5] When suturing the vaginal wall stump closed, the suture needle is grasped with the gripping portion A2 of the forceps A and inserted as is into the inside of the pipe body 11. Then, the forceps A is inserted into the abdominal cavity through the inside of the pipe body 11, and the suture needle is handed over to the forceps from the abdominal cavity side. At this time, the cap 30 is still removed from the base end opening 11b of the pipe body 11. Then, the forceps A is pulled out from inside the pipe body 11. When inserting the suture needle using the forceps from the abdominal cavity side, the suture needle is not handed over by the forceps A through the pipe body 11.

[0052] [6] Next, after the forceps A are pulled out of the pipe body 11, the insertion opening 41 of the cap 30 is blocked with the stopper 51, and the cap 30 in this state is then attached to the base end opening 11b of the pipe body 11 to close it. At this time, the other insertion openings 42 that are not in use are blocked with the stopper 52 from the beginning. When the insertion openings 41, 42 of the cap 30 are blocked with the stopper 51, 52, the connecting portions 510, 520 are bent, but the connecting portions 510, 520 are easily deformed with a small curvature due to the slit-shaped thin hinges 511, 521, resulting in a compact shape that is not bulky overall.

[0053] [7] Then, the pipe body 11 with the cap 30 attached is reinserted into the vagina. This fills the abdominal cavity with pneumoperitoneum gas, once again ensuring good visibility. Under these circumstances, the vaginal wall stump, which was left after the uterine resection, is closed and sutured from the abdominal side using laparoscopic surgery. At this time, the pipe body 11 is manipulated to assist the suturing. Specifically, it is advisable to slightly retract the pipe body 11 inserted into the vagina and support the vaginal wall stump from the inside with the tip ring 12. After the vaginal wall stump has been sutured, the pipe body 11 is slowly withdrawn from the vagina, completing the surgery.

[0054] <<How to use collection bag B>> [8] Next, we will explain the case where a retrieval bag B (see Figure 16) is used instead of the forceps A described above. The procedures [1] and [2] above are the same as when forceps A is used, but when retrieval bag B is used, the stopper 52 is removed from the insertion opening 42 of the cap 30 while the pipe main body 11 is still inserted into the vagina. Then, as shown in Figure 23, the retrieval bag B is inserted into the pipe main body 11 through the insertion opening 42. Next, as shown in Figure 24, the bag body B2 is pushed out from the tip of the shaft B1 of the retrieval bag B into the abdominal cavity.

[0055] The insertion opening 42, which corresponds to the retrieval bag B, can accommodate shafts with diameters of 10.0 to 15.0 mm, for example. Since the insertion opening 42 needs to have an expandable hole diameter, the insertion opening 42 does not have a fitting tube 410, but instead has a crimping portion 420 that is easily elastically expandable, as shown in FIG. 13 . The crimping portion 420 of the insertion opening 42 enhances expandability so that it can accommodate various outer diameters of the retrieval bag B, and also enhances sealing by closely contacting the outer peripheral surface of the retrieval bag B. Furthermore, when removed from the insertion opening 42, the connecting portion 520 of the stopper 52 naturally returns to its restored position, extending laterally on the same plane substantially parallel to the main wall portion 31, to avoid contact with the surgeon's hand.

[0056] [9] Next, as shown in Fig. 25, the excised uterus is placed into the extruded bag B2, and then the string attached to bag B2 is pulled to close the opening edge of bag B2, as shown in Fig. 26. Then, the string is cut with an operating part or the like at the base end of shaft B1 of retrieval bag B, and only shaft B1 of retrieval bag B is pulled out from insertion opening 42 of cap 30, as shown in Fig. 27. At this time, insertion opening 42 is easily elastically deformed by crimping part 420, just as when shaft B1 is inserted.

[0057] Therefore, when the shaft B1 is pulled out from the insertion opening 42, the cap 30 does not come off the pipe body 11 and the outflow of pneumoperitoneum gas is suppressed due to the double seal structure between the outer wall 32 and inner wall 33 of the cap 30, in addition to the elastic deformation of the crimping portion 420. Next, the pipe body 11 and the bag B2 are pulled out of the body, and after removing the bag B2, the pipe body 11 is reinserted into the vagina. The subsequent processes are the same as those of steps [5] to [7] when using the forceps A.

[0058] <Medical Insertion Device Size 10> In the medical inserter 10 described above, the important actual sizes are the tip outer diameter and effective length (total length of the effective area L) of the pipe body 11, and in this embodiment, three classes are prepared: a tip outer diameter of φ31 mm and an effective length of 172 mm, a tip outer diameter of φ35 mm and an effective length of 174 mm, and a tip outer diameter of φ39 mm and an effective length of 176 mm. These specific sizes result from the actual length required to access the abdominal cavity through the vagina, and three sizes of cap 30 are prepared to correspond to the three classes of pipe body 11.

[0059] Caps 30 corresponding to the first two of the three classes of pipe bodies 11 are prepared in similar shapes, but if the cap 30 corresponding to the largest class of pipe body 11 were also prepared in a similar shape, the size between both ends of the pair of connecting portions 510, 520 extending on both sides of the main wall surface portion 31 would be quite long. Furthermore, even when the two insertion openings 41, 42 on the main wall surface portion 31 are closed with stoppers 51, 52 and the connecting portions 510, 520 are bent, these bent portions would still be significantly bulky and extend beyond the outer diameter of the cap 30. Therefore, to make the size of the cap 30 as compact as possible, a cap 30A of a second embodiment described below is also prepared.

[0060] <Outline of Cap 30A of Second Embodiment> 28 to 37 show a second embodiment of the present invention. The medical inserter 10 according to the second embodiment has the same configuration as the medical inserter 10 according to the first embodiment except for the size of the pipe body 11, and is not shown in the drawings, but the configuration of the cap 30A is slightly different. Below, the differences between the cap 30A and the first embodiment will be explained, and similar parts will be assigned the same reference numerals and redundant explanations will be omitted.

[0061] <Cap 30A> 28 to 36, the cap 30A of the second embodiment is different from the cap 30 of the first embodiment in the shapes of the connecting portions 510A, 520A of the stopper plugs 51, 52. That is, in the cap 30 of the first embodiment, the pair of 510, 520 extends on both sides on the same straight line as the diameter direction in which the insertion openings 41, 42 are aligned, but in the cap 30A of the second embodiment, the pair of 510A, 520A extends in a direction intersecting the diameter direction in which the insertion openings 41, 42 are aligned.

[0062] 31, the pair of connecting portions 510A, 520A extend symmetrically at an angle θ of approximately 40 degrees from the center of insertion opening 41, with reference to a straight line in the diameter direction along which insertion openings 41, 42 are aligned. According to the shape of the pair of connecting portions 510A, 520A, when insertion openings 41, 42 are closed with stoppers 51, 52 and each connecting portion 510A, 520A is bent, as shown in FIG. 37, when each connecting portion 510A, 520A is bent at an angle of approximately 40 degrees (solid line in the figure), the outer diameter of the portion can be made smaller (W1>W2 in the figure) than when each connecting portion 510A, 520A is deployed left and right at 180 degrees (chain double-dashed line in the figure).

[0063] Similarly to the first embodiment, tongue-shaped handles 512A, 522A are provided at the very tip of each connecting portion 510A, 520A, bending from the center line of the entire connecting portion 510A, 520A. Each handle 512A, 522A is bent at an angle greater than a right angle from the center line of the entire connecting portion 510A, 520A. As a result, as shown in Fig. 37, when the stopper plugs 51, 52 are in the closed position, the handles 512A, 522A are compactly aligned parallel to each other without interfering with each other.

[0064] <Configuration and effects of the present invention> Although various embodiments of the present invention have been described above, the present invention is not limited to the above-described various embodiments. The present invention derived from the above-described various embodiments will be described below.

[0065] First, the present invention provides a medical inserter 10 having a detachable cap 30, 30A that closes the proximal end opening 11b of a pipe body 11 that is inserted transvaginally, At least a portion of the main wall surface portion 31 of the cap 30, 30A is formed in a thin film sheet shape, and a plurality of insertion openings 41, 42 are provided in the sheet-like portion, through which a plurality of types of shaft-shaped instruments A, B having different outer diameters are separately inserted; One of the insertion openings 41, 42 is provided with a fitting tubular portion 410 that extends from its periphery in a tubular shape and into which the instrument A is inserted and inserted into the insertion opening 41, The fitting cylindrical portion 410 is characterized in that a plurality of annular protrusions 411, which are in close contact with the outer peripheral surface of the instrument A over the entire circumference, are arranged in the axial direction of the fitting cylindrical portion 410 on the inner peripheral surface of the fitting cylindrical portion 410.

[0066] According to this medical inserter 10, at least a portion of the main wall portion 31 of the cap 30, 30A is formed in a thin sheet shape, and if the cap 30, 30A is made of a flexible material, the sheet-like portion is particularly susceptible to elastic deformation. Therefore, when the insertion openings 41, 42 provided in the sheet-like portion are inserted into the instruments A, B that correspond to their respective inner diameters, they can elastically expand in diameter, thereby improving the sealing performance for each of the instruments A, B.

[0067] One of the insertion openings 41, 42 is provided with a fitting tubular portion 410 extending cylindrically from its periphery, so that the instrument A inserted through the insertion opening 41 is fitted into the fitting tubular portion 410. This increases support by the length of the fitting tubular portion 410 in the axial direction of the instrument A, and increases the contact area between the caps 30, 30A and the instrument A, making it less likely for gaps to form between them and improving sealing.

[0068] If the inner peripheral surface of the fitting cylindrical portion 410 were a straight, smooth surface without any irregularities, the outer peripheral surface of the instrument A would likely come into close contact and stick to it. Therefore, a plurality of annular protrusions 411 are arranged axially on the inner peripheral surface of the fitting cylindrical portion 410. Each protrusion 411 reduces frictional resistance compared to when the inner peripheral surface of the fitting cylindrical portion 410 comes into surface contact with the outer peripheral surface of the instrument A, allowing for smooth operation of the instrument A. Each protrusion 411 surrounds the outer peripheral surface of the instrument A in the entire circumferential direction, thereby reducing frictional resistance and improving sealing performance.

[0069] Furthermore, the present invention is characterized in that the convex portions 411 are arranged closely together on the inner surface of the fitting cylindrical portion 410, and the space between adjacent convex portions 411 forms an annular concave portion 412 that does not abut against the outer surface of the instrument A.

[0070] According to this configuration, the inner peripheral surface of the fitting tubular portion 410 has an uneven shape in which annular convex portions 411 and concave portions 412 are arranged alternately, and the concave portions 412 between the convex portions 411 provide play that makes it easier for the fitting tubular portion 410 to deform in accordance with the movement of the instrument A. Therefore, the inner peripheral surface of the fitting tubular portion 410 becomes easier to deform in accordance with the movement of the instrument A while maintaining a tight contact state, thereby improving operability and sealing performance.

[0071] Furthermore, the present invention is characterized in that any other of the insertion openings 41, 42 is formed with an inner diameter larger than the one insertion opening 41, and is provided with a crimping portion 420 along its periphery that elastically expands in diameter by pressing in the instrument B corresponding to the other insertion opening 42, and that comes into close contact with the outer peripheral surface of the instrument B.

[0072] According to this configuration, the crimping portion 420 provided in the other insertion opening portion 42 has high expandability, so even if there is a certain degree of width (variety) in the outer diameter of the instrument B, it is possible to pass each instrument B through while maintaining high sealing performance.

[0073] In addition, in the present invention, the crimping portion 420 is characterized in that it is formed as a taper 421 that is inclined inward and intersects with the peripheral edge 42a of the insertion opening portion 42 located on the reference plane of the front and back of the main wall surface portion 31.

[0074] Such a crimping part 420 can reliably increase the expandability of the inner diameter of the insertion opening 42, can be easily deformed from both the front and back sides of the insertion opening 42, and can be smoothly inserted from either the front or back without impairing the sealing performance. When the maximum inner diameter of the periphery 42a of the insertion opening 42 matches the outer diameter of the collection bag B, the ratio of the maximum inner diameter at the tip of the taper 421 of the crimping part 420 to the minimum inner diameter may be set to, for example, an integer ratio of about 3:5.

[0075] In the present invention, the cap 30A has stopper plugs 51 and 52 for closing the insertion openings 41 and 42, respectively. The stopper plugs 51 and 52 are connected to connecting portions 510A and 520A, respectively, extending from the outer periphery of the main wall surface portion 31. Each of the connecting portions 510A, 520A can be elastically deformed by bending from a restored position in which it is deployed on the same plane approximately parallel to the main wall surface portion 31 to a closed position in which the stopper plugs 51, 52 block each of the insertion openings 41, 42, and in the restored position, each of the insertion openings 41, 42 extends in a direction intersecting the diameter direction aligned with the main wall surface portion 31.

[0076] According to this configuration, by inserting the stopper plugs 51, 52 into the insertion openings 41, 42 of the cap 30A, the insertion openings 41, 42 of the cap 30A are closed. On the other hand, by removing the stopper plugs 51, 52 from the insertion openings 41, 42 of the cap 30A, instruments such as forceps A and retrieval bag B can be inserted into the insertion openings 41, 42. Furthermore, because the stopper plugs 51, 52 are connected to the connecting portions 510A, 520A extending from the outer periphery of the main wall portion 31, there is no risk of them being lost.

[0077] When the insertion openings 41, 42 are not blocked by the stopper plugs 51, 52, the connecting portions 510A, 520A are in restored positions deployed on the same plane substantially parallel to the main wall surface portion 31, and therefore do not interfere with the surgeon's operation. When the insertion openings 41, 42 are blocked by the stopper plugs 51, 52, the connecting portions 510A, 520A are elastically deformed and bent. Here, when the connecting portions 510A, 520A extend in a direction intersecting the diameter direction in which the insertion openings 41, 42 are aligned in their natural restored positions, the cap 30A has a compact shape that is not bulky overall.

[0078] Furthermore, in the present invention, tongue-shaped handles 512 (512A), 522 (522A) extending beyond the stopper plugs 51, 52 are provided at the tips of the connecting portions 510 (510A), 520 (520A), The handles 512 (512A), 522 (522A) are characterized by extending in a direction intersecting the longitudinal direction of the connecting portions 510 (510A), 520 (520A).

[0079] Such handles 512 (512A), 522 (522A) make it easy to grasp and operate when closing the insertion openings 41, 42 with the stoppers 51, 52 or when removing the stoppers 51, 52 from the insertion openings 41, 42. Furthermore, because the handles 512 (512A), 522 (522A) extend in a direction intersecting the longitudinal direction, when the stoppers 51, 52 are in the closed position closing the insertion openings 41, 42, it is possible to prevent the handles 512 (512A), 522 (522A) from overlapping and interfering with each other.

[0080] Furthermore, the present invention can be realized as the above-mentioned cap 30 (30A) alone. Such a cap 30 (30A) can be handled as an independent part separate from the medical inserter 10. Therefore, if the pipe body 11 is already available as a ready-made product, it can be easily upgraded to the medical inserter 10 of the present invention by simply replacing it with the cap 30 (30A) of the present invention.

[0081] Although various embodiments of the present invention have been described above with reference to the drawings, the specific configurations are not limited to the above-described embodiments, and modifications and additions that do not depart from the gist of the present invention are also included in the present invention. For example, the specific shapes and relative sizes of the pipe body 11 and caps 30, 30A, etc. are not limited to those shown in the drawings.

[0082] In addition, in each embodiment, the main wall portion 31 of the cap 30, 30A is formed in the form of a thin film sheet over its entire area, but only the areas around each insertion opening portion 41, 42 may be formed in the form of a thin film sheet, and the other areas may be molded, for example, into a plate of a predetermined thickness to provide rigidity.

[0083] Furthermore, in each embodiment, the multiple types of instruments used are two types, forceps A and retrieval bag B, and the insertion openings 41, 42 provided on the cap 30 are described as two corresponding to the forceps A and retrieval bag B, but this is not limited to this. That is, for example, a third insertion opening may be provided to accommodate forceps with a smaller or larger diameter than the forceps A, and a fitting tube may also be provided on this insertion opening, or a fitting protrusion may be provided only on the insertion opening corresponding to the smallest diameter forceps. [Industrial Applicability]

[0084] The medical inserter according to the present invention is not necessarily limited to laparoscopic hysterectomy, but can be widely applied as a device that can be used in other laparoscopic procedures. [Explanation of symbols]

[0085] A...forceps (instrument) B...Collection bag (equipment) 10...Medical inserter 11...Pipe body 11a…Tip opening 11b...Proximal opening 12...Tip ring 13...Main pipe section 20...Handle 30,30A...Cap 31...Main wall section 32...Outer peripheral wall 33…Inner wall part 41...First insertion opening 410...Fitting cylinder part 411...Convex part 412...recess 42...Other insertion openings 420... Crimping section 421...Taper 422...Tip 51, 52...Stop valve 510,510A,520,520A…Connection part

Claims

1. A medical inserter having a detachable cap for closing a base end opening of a pipe body to be inserted transvaginally, At least a portion of the main wall surface of the cap is formed in a thin film sheet shape, and a plurality of insertion openings are provided in the sheet-like portion, through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted; One of the insertion openings is provided with a fitting tubular portion that extends from its periphery in a tubular shape and into which the instrument that has been passed through the one insertion opening is fitted, A medical insertion device characterized in that the inner surface of the fitting cylindrical portion has multiple annular protrusions that are in close contact with the outer surface of the instrument around the entire circumference, and are arranged in an axial direction of the fitting cylindrical portion.

2. The medical insertion device according to claim 1, characterized in that the convex portions are closely spaced on the inner surface of the fitting cylindrical portion, and the spaces between adjacent convex portions form annular concave portions that do not abut against the outer surface of the instrument.

3. 2. The medical insertion device according to claim 1, wherein any other of the insertion openings is formed with an inner diameter larger than that of the first insertion opening, and a crimping portion is provided along its periphery that elastically expands in diameter when the corresponding instrument is pressed into the other insertion opening, and that comes into close contact with the outer peripheral surface of the instrument.

4. The medical inserter according to claim 3, wherein the crimping portion is formed as a taper that slopes inward from the periphery of the insertion opening portion located on the reference planes of the front and back of the main wall portion.

5. the cap has stoppers for closing the respective insertion openings, Each of the stop plugs is connected to a connecting portion extending from the outer periphery of the main wall surface portion, 2. The medical inserter according to claim 1, wherein each of the connecting portions is elastically deformable from a restored position in which it is deployed on the same plane approximately parallel to the main wall surface portion to a closed position in which the stopper blocks each of the insertion ports, and wherein in the restored position, each of the insertion ports extends in a direction intersecting a diameter direction in which the main wall surface portion is aligned.

6. A tongue-shaped handle extending beyond the stopper is provided at the tip of the connecting portion, The medical inserter according to claim 5, wherein the handle extends in a direction intersecting with the longitudinal direction of the connecting portion.

7. 7. The cap according to claim 1, 2, 3, 4, 5 or 6.

Images