Surgical instrument

Abstract

To provide a surgical instrument that enables a user to intuitively know the depth to which a surgical instrument is inserted without clogging a surgical instrument hole in a spinal endoscopic surgery, preferably a biportal endoscopic surgery. [Solution] A surgical instrument 1 used in endoscopic spinal surgery in which an endoscope hole 100 for inserting an endoscope into the human body and a surgical instrument hole 200 for inserting a surgical instrument are provided separately, and the surgical instrument hole 200 includes a tubular body 2 that is inserted into the surgical instrument hole 200 and holds the opening of the surgical instrument hole 200, and an insertion instrument 3 that is inserted into the surgical instrument hole 200 with the tubular body 2 removably attached. The insertion instrument 3 has an extension member 4 that extends coaxially with the tubular body 2 and has a space 4a provided inside that connects to the outside, and a tip portion 5 that is sharply formed at one end that is inserted into the surgical instrument hole 200 of the extension member 4 and has a hole 5a that connects to the space 4a. The insertion instrument 3 is attached by being inserted into the tubular body 2, and the tip portion 5 is positioned so as to protrude from the tubular body 2.

Description

[Technical field]

[0001] The present invention relates to a surgical instrument for biportal endoscopic surgery. [Background technology]

[0002] In endoscopic spinal surgery for spinal canal stenosis, lumbar disc herniation, etc., the method described in Patent Document 1, for example, is used. In this surgical method, a hole is made in the affected area, and an endoscope and surgical instruments are inserted into the hole to remove the intervertebral disc or bone protrusions that compress the nerves. The hole made in the affected area is made as small as possible to make the procedure minimally invasive. Therefore, the surgical method of inserting an endoscope and surgical instruments into this hole has the problem that the surgical field is narrow and the operability of the surgical instruments is poor. In order to solve this problem, biportal endoscopic surgery has been performed recently.

[0003] In this surgical method, two holes are made in the affected area, and an endoscope is inserted into one hole and surgical instruments into the other. By providing a hole for the endoscope, the field of view can be secured without being obstructed by the surgical instruments, and by providing a hole for the surgical instruments, work can be performed in a direction different from the visual axis of the endoscope, improving operability. In addition, in this surgical method, water is returned from the hole for inserting the endoscope to the hole for inserting the surgical instruments, allowing blood and pieces of the removed intervertebral disc and bone that occur during surgery to flow out, keeping the surgical field clear. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] Special Publication No. 2011-522579 Summary of the Invention [Problem to be solved by the invention]

[0005] However, there is a problem that the holes for inserting surgical instruments can become clogged with fragments of intervertebral discs and bones contained in the circulating water, as well as muscles and ligaments in the surgical wound. In addition, there is a risk that damage to the spinal nerves will result in serious disabilities after surgery. Therefore, the surgeon must take great care not to damage the spinal nerves with the instruments inserted into the surgical instrument holes, but it is difficult to recognize the position where the surgical instruments are inserted from the surface of the body.

[0006] The present invention has been devised in consideration of the above-mentioned problems, and relates to a surgical instrument used in spinal endoscopic surgery, preferably biportal endoscopic surgery, that allows the user to intuitively know the depth to which a surgical instrument is inserted without clogging the surgical instrument hole. [Means for solving the problem]

[0007] The surgical instrument of the present invention is a surgical instrument used in endoscopic spinal surgery in which an endoscope hole for inserting an endoscope into the human body and a surgical instrument hole for inserting a surgical instrument are provided separately, and the surgical instrument comprises a tubular body that is inserted into the surgical instrument hole and holds the opening of the surgical instrument hole, and an insertion instrument that is inserted into the surgical instrument hole with the tubular body removably attached, the insertion instrument having an extension member that extends coaxially with the tubular body and has a space inside that communicates with the outside, and a tip portion that is sharply formed at one end of the extension member that is inserted into the surgical instrument hole and has a hole that communicates with the space, and the insertion instrument is attached by being inserted into the tubular body, and the tip portion is positioned so as to protrude from the tubular body.

[0008] With this configuration, in biportal endoscopic surgery, the tube body holds the opening of the hole through which the surgical instrument is inserted, so that the surgical instrument hole can be prevented from being clogged with fragments of intervertebral discs and bones contained in the water to be returned, and muscles and ligaments of the surgical wound. The insertion instrument also includes an extension member having a space inside that communicates with the outside, and a tip end portion that is sharply formed at one end to be inserted into the surgical instrument hole of the extension member and has a hole portion that communicates with the space. When the tip end reaches the affected area, the spine, the returning water enters through the hole portion provided at the tip end and is discharged to the outside through the space of the insertion instrument. Therefore, when the water is discharged, the surgeon can intuitively know that the tip end has reached the affected area. This makes it possible to perform endoscopic spinal surgery with greater consideration given to safety.

[0009] In one specific embodiment of the surgical instrument of the present invention, the insertion instrument is inserted into the tubular body and has an outer circumferential surface provided with at least one locking portion that abuts against the inner circumferential surface of the tubular body to lock the tubular body in place.

[0010] This configuration allows the tube with the attached insertion tool to be inserted through the surgical instrument hole without dislodging the tube.

[0011] A specific embodiment of the surgical instrument of the present invention is one in which the axial length of the tubular body is shorter than the axial length of the extension member, and the extension member includes a partition member that separates a first region including a mounting range where the tubular body is mounted from the one end into a second region other than the first region, and an adjustment member that adjusts the mounting range of the tubular body in the first region.

[0012] Since the distance from the skin to the spine differs from patient to patient, the axial length of the tube must be different for each patient. Therefore, the axial length of the tube differs for each surgery, but by providing an adjustment member, the tube can be adjusted so that the attachment range is adjacent to the tip, and any length of tube can be attached to the surgical instrument hole by the insertion tool. Effect of the Invention

[0013] The surgical instrument of the present invention can prevent the surgical instrument hole from becoming clogged during biportal endoscopic surgery, and allows the surgeon to intuitively know the position where the surgical instrument is inserted. [Brief description of the drawings]

[0014] [Figure 1] FIG. 1 is a schematic perspective view showing a surgical instrument according to a first embodiment. [Diagram 2] FIG. 2 is a plan view showing the surgical instrument of the first embodiment. [Diagram 3] Cross-sectional view taken along line AA in Figure 2. [Figure 4] FIG. 11 is a schematic perspective view showing a surgical instrument according to a second embodiment. [Diagram 5] FIG. 11 is a schematic perspective view showing a modified example of the surgical instrument of the second embodiment. [Figure 6] FIG. 11 is a schematic perspective view showing a surgical instrument according to a third embodiment. [Figure 7] FIG. 11 is a plan view showing a surgical instrument according to a third embodiment. [Figure 8] Cross-sectional view of line BB in Figure 7. [Figure 9] FIG. 13 is a schematic perspective view showing a modified example of the surgical instrument of the third embodiment. [Figure 10] FIG. 13 is a plan view showing a modified example of the surgical instrument of the third embodiment. [Figure 11] Cross-sectional view of line CC in Figure 10. [Figure 12] Schematic diagram showing biportal endoscopic surgery. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0015] The surgical instruments of the present invention are used in endoscopic spinal surgery, and in particular in biportal endoscopic surgery known as UBE (Unilateral Biportal Endoscopy), in which an endoscope hole for inserting an endoscope into the human body and a surgical instrument hole for inserting surgical instruments are provided separately.

[0016] First Embodiment A surgical instrument 1 of the first embodiment will be described in detail with reference to Figures 1 to 3 and 12. As shown in Figure 12, in a biportal endoscopic surgery in which an endoscope hole 100 for inserting an endoscope into a human body and a surgical instrument hole 200 for inserting a surgical instrument are provided, the surgical instrument 1 of the first embodiment comprises a tubular body 2 that is inserted into the surgical instrument hole 200 and holds the opening of the surgical instrument hole 200, and an insertion instrument 3 that is inserted into the surgical instrument hole 200 with the tubular body 2 detachably attached.

[0017] The tube 2 is inserted into the surgical instrument hole 200 to hold the opening of the surgical instrument hole 200, and in this embodiment has a cylindrical shape. When inserted into the surgical instrument hole 200, it is attached to the insertion instrument 3 and arranged as shown in FIG. 1. For the sake of explanation, in FIG. 2, the tube 2 is arranged in a state where it is removed from the insertion instrument 3. The axial length of the tube 2 is configured to be smaller than that of the insertion instrument 3. The tube 2 is arranged adjacent to the tip 5 described later, and in this embodiment, the open end of the tube 2 close to the tip 5 described later is inclined so that the opening width is smaller, as shown in FIG. 2.

[0018] The insertion device 3 includes an extension member 4 that extends in the same axial direction as the tubular body 2 and has a space 4a formed inside that communicates with the outside, and a tip portion 5 that is sharply formed at one end of the extension member 4 and has a hole portion 5a that communicates with the space 4a.

[0019] As shown in FIGS. 1 to 3, the elongated member 4 is a cylindrical tubular body configured to have a longer axial length than the tubular body 2 and a shorter circumferential length than the tubular body 2.

[0020] As shown in Figs. 2 and 3, the tubular body is divided into two regions: a first region R1 including a mounting range where the tubular body 2 is mounted from one end inserted into the surgical instrument hole 200 of the stretching member 4, and a second region R2 other than the first region R1. The first region R1 and the second region R2 are separated by a partition member 6 arranged in a substantially central portion of the stretching member 4. The partition member 6 is annular and provided so as to protrude from the circumferential surface of the stretching member 4, and the partition member 6 and the stretching member 4 are configured to be integrated. As shown in Fig. 3, the tubular internal space of the stretching member 4 becomes a space 4a that communicates with the outside. In addition, at least one or more locking portions 7 that abut against the inner circumferential surface of the tubular body 2 to lock the tubular body 2 are provided in the mounting range of the first region R1, and in this embodiment, O-rings serving as the locking portions 7 are arranged in two places.

[0021] The tip portion 5 is located at the front when inserted into the surgical instrument hole 200, and is provided integrally with one end of the elongated member 4 to be inserted into the surgical instrument hole 200. As shown in Figs. 1 to 3, the tip portion 5 is substantially conical in shape, and a hole 5a is provided at the tip, which is the apex of the cone shape. This forms a sharp tip. The hole 5a communicates with the space 4a of the elongated member 4 as shown in Fig. 3.

[0022] In the surgical instrument 1 of the first embodiment configured as described above, in a biportal endoscopic surgery, the surgeon, with the tube body 2 attached to the insertion instrument 3, grasps the second region R2 and inserts the first region R1 into the surgical instrument hole 200. As the surgeon inserts the surgical instrument 1 into the body, water flows back from the endoscope hole 100 to the surgical instrument hole 200. When the surgical instrument 1 reaches the surgical field, water enters from the hole 5a provided in the tip portion 5 located at the front when inserted into the surgical instrument hole 200, passes through the space 4a, and is discharged to the outside from the end of the extension member 4 held by the surgeon. When the water is discharged, the surgeon recognizes that the tip portion 5 has reached the surgical field, removes the tube body 2 from the insertion instrument 3, places the tube body 2 in the surgical instrument hole 200, and takes the insertion instrument 3 out of the surgical instrument hole 200.

[0023] With this configuration, the opening of the surgical instrument hole 200 is maintained by the tube body 2, so that the surgical instrument hole 200 can be prevented from being clogged by fragments of intervertebral discs or bones contained in the water to be returned during surgery, and by muscles or ligaments at the surgical wound. Furthermore, when the surgical instrument 1 of this embodiment reaches the surgical field, the water that is returned enters from the hole 5a of the tip 5 and is discharged to the outside from the end of the extension member 4, so that when the water leaks out from the end of the extension member 4, the surgeon can intuitively recognize that the tip 5 has reached the surgical field, and the safety of the surgery can be improved.

[0024] <Second embodiment> The surgical instrument 10 of the second embodiment is different from the surgical instrument 1 of the first embodiment in that an adjustment member 11 is disposed in the first region R1. Note that the same parts as those in the surgical instrument 1 of the first embodiment are given the same reference numerals and descriptions thereof will be omitted.

[0025] The surgical instrument 10 of the second embodiment further includes an adjustment member 11 for adjusting the mounting range of the tubular body 2 in the first region R1 of the extension member 4, as shown in FIGS.

[0026] The adjustment member 11 has a tubular shape and is disposed between the tube 2 of the elongated member 4 and the partition member 6 when the tube 2 is attached to the insertion instrument 3. The circumferential length of the adjustment member 11 is set to be equal to the circumferential length of the tube 2. In addition, as shown in Figs. 4 and 5, the axial length of the adjustment member 11 is appropriately changed according to the axial length of the tube 2 so that the combined axial length of the tube 2 and the axial length of the adjustment member 11 is equal to the axial length from one end where the tip portion 5 of the elongated member 4 is disposed to the partition member 6.

[0027] The axial length of the tube body 2 is changed appropriately according to the distance from the patient's skin to the spine, and therefore the axial length of the tube body 2 varies for each surgery. Therefore, depending on the axial length of the tube body 2, the tube body 2 cannot be positioned adjacent to the tip 5, and the insertion instrument 3 may not be able to properly mount the tube body 2 in the surgical instrument hole 200. However, the surgical instrument 10 of the second embodiment configured as described above includes the adjustment member 11 disposed between the tube body 2 and the partition member 6, and therefore the adjustment member 11 allows the tube body 2 to always be positioned adjacent to the tip 5, and the tube body 2 can be mounted in the surgical instrument hole 200 regardless of the axial length of the tube body 2.

[0028] <Third embodiment> The surgical instrument 20 of the third embodiment differs from the surgical instrument 1 of the first embodiment in the configuration of the tip of the insertion instrument. Note that the same parts as those of the surgical instrument 1 of the first embodiment and the surgical instrument 10 of the second embodiment are given the same reference numerals and descriptions thereof will be omitted.

[0029] 6 to 8, in the surgical instrument 20 of the third embodiment, the tip portion 22 of the insertion instrument 21 is conical and has notches 23 on both opposing side surfaces, and each of the notches 23 has a circular hole 22a. With this configuration, the tip portion 22 has two holes 22a on the circumferential side surface. Each of the holes 22a communicates with a space 4a provided in the extension member 4.

[0030] 9 to 11, a surgical instrument 30 according to a third embodiment has a tip 32 of an insertion instrument 31 that is conical in shape and has notches 33 on both opposing sides, with elliptical holes 32a in the notches 33. In this configuration, the tip 32 also has two holes 32a on its circumferential side. Each of the holes 32a communicates with a space 4a provided in the extension member 4.

[0031] The surgical instrument (20, 30) of the third embodiment configured as described above has two or more holes (22a, 32a) provided on the side surface of the tip portion (22, 32). Therefore, when the insertion instrument (21, 31) is inserted into the surgical instrument hole 200, the hole (22a, 32a) can be prevented from becoming clogged with tissue, blood, etc. in the surgical instrument hole 200.

[0032] The present invention can be implemented in various forms with improvements, modifications, or variations based on the knowledge of those skilled in the art without departing from the spirit of the present invention. [Explanation of symbols]

[0033] 1, 10, 20, 30...Surgical instruments 2...Cylinder 3, 21, 31... Insertion tool 4. Extension member 4a Space 5, 22, 32...Tip 5a, 22a, 32a...hole 6. Partition member 7. Locking part 11. Adjustment member 23, 33...notch 100 Endoscope hole 200...Hole for surgical equipment R1...1st area R2...Second area

Claims

1. A surgical instrument for use in endoscopic spinal surgery, which has an endoscope hole for inserting an endoscope into a human body and a surgical instrument hole for inserting a surgical instrument separately provided, a tube that is inserted into the surgical instrument hole and holds an opening of the surgical instrument hole; and an insertion tool that is inserted into the surgical instrument hole in a detachable state with the tube. the insertion instrument has an extension member that extends in a coaxial direction with the tubular body and has a space inside that communicates with the outside, and a tip portion that is sharply formed at one end of the extension member that is inserted into the surgical instrument hole and has a hole that communicates with the space, The surgical instrument is characterized in that the insertion instrument is inserted into the tubular body and attached thereto, and the tip portion is disposed so as to protrude from the tubular body.

2. 2. The surgical instrument according to claim 1, wherein an outer circumferential surface of the insertion instrument, which is inserted into and attached to the tubular body, is provided with at least one locking portion that abuts against an inner circumferential surface of the tubular body to lock the tubular body.

3. The axial length of the tube is shorter than the axial length of the elongated member, The surgical instrument according to claim 1 or claim 2, characterized in that the extension member comprises a partition member that divides a first region including a mounting range where the tubular body is mounted from the one end into a second region other than the first region, and an adjustment member that adjusts the mounting range of the tubular body in the first region.

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