Medical Insertion Device

Abstract

To provide a medical inserter which allows forceps A and a recovery bag B to be used separately with enhanced sealing properties, and in particular for the forceps A, further enhances the sealing properties and support properties during use, while reducing frictional resistance and allowing easy operation. [Solution] A removable cap 30 is provided for closing a base end opening 11b of a pipe main body 11 to be inserted transvaginally, and insertion openings 41, 42 for separately passing through a forceps A and a recovery bag B are provided on a main wall surface portion 31 of the cap 30. The insertion opening 41 corresponding to the forceps A is provided with a fitting tube portion 410 continuing in a cylindrical shape from its periphery, and a plurality of annular protrusions 411 that come into close contact with the outer circumferential surface of the forceps A are provided in an array on the inner circumferential surface of the fitting tube portion 410 over the entire circumference.

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 to remove the excised uterus, and to be usable when suturing the vaginal wall stump.

[0003] In the insertion tool disclosed in Patent Document 1, the cap attached to the base end opening of the main body has a hole for inserting an instrument such as forceps, and a cylindrical part extending from the periphery of the hole. Here, the inner circumferential surface of the hole and the inner circumferential surface of the cylindrical part 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 part comes into close contact with the instrument. This increases the contact area between the cap and the instrument, making it possible to suppress leakage of pneumoperitoneum gas.

[0004] By the way, the instrument used with this type of insertion tool to extract the excised uterus is not limited to ordinary forceps, but also known as a retrieval bag. The retrieval bag has a pouch portion for storing the excised uterus inserted in a folded state inside the shaft, and when used, the pouch protrudes from the tip of the shaft and unfolds to store the uterus. In general, the shaft diameter of the retrieval bag is considerably larger than that of the forceps. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] JP 2022-102154 A 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 is for forceps, and the inner diameter of the hole and the cylindrical part is designed to match the shaft diameter of the forceps. With this type of insertion tool, only forceps can be inserted into the hole in the cap, and other instruments (recovery bags) with significantly different shaft diameters cannot be used. If the size of the hole were expanded to accommodate a recovery bag, a gap would easily form between the forceps and the hole when inserted, and there is a risk of pneumoperitoneum gas leaking out from this gap.

[0007] In addition, 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 peripheral surface of the forceps tends to closely contact and stick to the straight inner peripheral surface of the cylindrical portion, which increases the frictional resistance with the cap when the forceps are inserted, making it difficult to operate the forceps smoothly.

[0008] The present invention has been made in response to the problems associated with the prior art as described above, and aims to provide a medical insertion device that can be used with multiple types of instruments (e.g., forceps and retrieval bags) with different outer diameters, each of which can be used with enhanced sealing properties, and that can be easily operated by reducing frictional resistance while further enhancing the sealing properties and support properties during use for any one of the instruments (e.g., forceps). [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 removable cap for closing a base end opening of a pipe body to be inserted transvaginally, At least a part of the main wall surface of the cap is formed in a thin sheet shape, and the sheet-like portion is provided with a plurality of insertion openings through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted. Integral molding A fitting tube portion is provided in any one of the insertion openings, the fitting tube portion being connected from its periphery in a cylindrical shape and into which the instrument is inserted and passed through the insertion opening. Integral molding A plurality of annular projections are arranged on the inner peripheral surface of the fitting cylinder in the axial direction of the fitting cylinder, the projections being in close contact with the outer peripheral surface of the device over the entire circumference. Integral molding The protrusions are integrally formed so as to be closely arranged on the inner peripheral surface of the fitting tube portion, and an annular recess is formed between adjacent protrusions so as not to abut against the outer peripheral surface of the instrument, Any other of the insertion openings does not have the fitting tube portion and is integrally molded with an inner diameter larger than that of the one insertion opening, and a crimping portion is integrally molded along its periphery to elastically expand in diameter by pressing the instrument corresponding to the other insertion opening and to come into close contact with the outer circumferential surface of the instrument, The crimping portion is integrally formed as a taper inclined toward the inside where the periphery of the insertion opening portion located on the reference plane of the front and back of the main wall portion intersects with the insertion opening portion. It is characterized by: Effect of the Invention

[0010] The medical inserter of the present invention allows a plurality of types of instruments with different outer diameters to be used with each type having an increased sealing ability, and for any one of the instruments, the sealing ability and supportability during use can be further increased while reducing frictional resistance and allowing easy operation. [Brief description of the drawings]

[0011] [Figure 1] FIG. 1 is a side view showing a medical inserter according to a first embodiment. [Diagram 2] FIG. 1 is a perspective view showing a medical inserter according to a first embodiment. [Diagram 3] FIG. 2 is a top perspective view showing the cap according to the first embodiment. [Figure 4] FIG. 2 is a perspective view showing the cap according to the first embodiment, as viewed from below. [Diagram 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] 4 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 sectional view showing each insertion opening of the cap according to the first embodiment. FIG. [Figure 14] 5A to 5C 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 to 5C 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 hysterectomy performed under a laparoscope. [Figure 18] FIG. 2 is an explanatory diagram showing a state in which the medical insertion device according to the first embodiment is used during a hysterectomy. [Figure 19] FIG. 19 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 18. [Figure 20] FIG. 20 is an explanatory diagram showing a state of use of the medical inserter continued from FIG. 19 when forceps is used as the instrument. [Figure 21] FIG. 21 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 20. [Figure 22] FIG. 22 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 21. [Diagram 23] FIG. 20 is an explanatory diagram showing a state of use of the medical inserter continued from FIG. 19 when a retrieval bag is used as the instrument. [Figure 24] FIG. 24 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 23. [Diagram 25] FIG. 25 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 24. [Figure 26] FIG. 26 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 25. [Figure 27] FIG. 27 is an explanatory diagram showing the medical inserter in use, continuing from FIG. 26. [Figure 28] FIG. 11 is a top perspective view showing a cap according to a second embodiment. [Figure 29] FIG. 11 is a bottom perspective view showing a cap according to a second embodiment. [Diagram 30] FIG. 11 is a plan view showing a cap according to a second embodiment. [Diagram 31] FIG. 11 is a bottom view showing the cap according to the second embodiment. [Diagram 32] FIG. 11 is a front view showing a cap according to a second embodiment. [Diagram 33] FIG. 11 is a rear view showing the cap according to the second embodiment. [Diagram 34] FIG. 11 is a right side view showing a cap according to a second embodiment. [Diagram 35] FIG. 11 is a left side view showing a cap according to a second embodiment. [Diagram 36] 13 is a plan view showing a state in which each insertion opening of a cap according to a second embodiment is closed with a stopper. FIG. [Figure 37] 13 is an explanatory diagram showing dimensions of a cap according to a second embodiment when each insertion opening is closed with a stopper. FIG. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0012] Various embodiments representative of the present invention will now be described with reference to the drawings. 1 to 27 show a first embodiment of the present invention, and Fig. 28 to 37 show a second embodiment of the present invention. The 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, values, etc. shown in the embodiments described below are all examples of the present invention and do not limit the present invention.

[0013] <Overview of the medical inserter 10 according to the first embodiment> As shown in Fig. 1, the medical inserter 10 comprises a pipe body 11 to be 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 in 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 Fig. 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 composed of a tip ring 12 provided at the tip, and a main pipe section 13 occupying 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 on the tip side of the handle 20 becomes 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 elliptical 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 section 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 curing it while heating 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 section 13, and they are continuous with no gaps.

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

[0018] The outer peripheral surface of the main pipe section 13 is provided with ribs 14a, 14b that protrude in the radial direction 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 inclined with respect to a plane perpendicular to the axial direction. The ribs 14a, 14b may be formed so that their radial height gradually increases toward the base end. The configuration of the ribs 14a, 14b is not limited to that described above, and may be other configurations, such as omitting the rib 14a located at the most distal end and forming only the annular rib 14b, forming the ribs in a circular shape along the circumferential direction of the main pipe portion 13, or forming the ribs to have the same radial height.

[0020] As shown in FIG. 1, the handle 20 is provided integrally with the base end side of the main pipe section 13. The handle 20 is formed in a size and shape that allows the surgeon to easily grasp and operate the main pipe section 13. The handle 20 in this embodiment is formed to extend diagonally rearward from the base end side of the main pipe section 13, and then extend rearward in a narrow shape parallel to the axial direction of the main pipe section 13. The handle 20 is molded integrally with the main pipe section 13, for example, from the same resin material. It is preferable to provide unevenness on the surface of the handle 20 with ribs or grooves that act as anti-slip surfaces.

[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 with the same resin material. It is preferable that the medical inserter 10 is transparent so that the instruments inserted inside the main pipe portion 13 can be visually confirmed when using the medical inserter 10. Considering such required characteristics and costs, for example, polycarbonate and ABS are suitable as resin materials for the main pipe portion 13 and the like. In addition, as a mold for injection molding the main pipe portion 13 and the like, for example, the invention described in JP 2022-102154 A, which has already been proposed by the present applicant, may be used.

[0022] <Cap 30> 2 to 11, the cap 30 which is the basis of the present invention is detachable so as to close the base end opening 11b of the pipe body 11, is formed in a shallow cylindrical shape with a bottom, and is integrally molded from a flexible material such as silicone rubber. More specifically, the cap 30 has a main wall portion 31 which forms a circular top surface and is formed in the shape of a thin, stretchable sheet to a certain extent, and is provided with a cylindrical outer circumferential wall portion 32 which surrounds and borders the outer circumferential end of the main wall 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, which is cylindrical and has a diameter slightly smaller than that of the outer wall portion 32 and extends beyond the tip of the outer wall portion 32. The cap 30 is attached in a state where the base end opening 11b of the pipe body 11 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 peripheral side of the tip of the outer wall portion 32 is provided with a jaw 32a that engages with the outer periphery of the base end of the pipe body 11. In addition, the outer peripheral side of the tip of the inner wall portion 33 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 in a thin sheet shape over the entire area, and this sheet-like portion is provided with insertion openings 41, 42 for passing multiple types of instruments separately. Each insertion opening 41, 42 is a portion for inserting and removing an instrument into and from the inside of the pipe body 11 in a state in which 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 assuming two types of instruments. Here, the instruments 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 described as examples of the two types of instruments.

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

[0026] Each of the insertion openings 41, 42 is elastically deformed by pressing in a corresponding instrument, and the instrument can be inserted in a sealed state. One insertion opening 41 corresponds to the forceps A, and the other insertion opening 42 corresponds to the retrieval bag B. The shaft diameter (synonymous with the outer diameter) of the forceps A is generally small, for example, φ4.5 to 5.8 mm, and the shaft diameter (synonymous with the outer diameter) of the retrieval bag B is generally large, for example, φ10.0 to 15.0 mm. Thus, the outer diameter of the shaft B1 of the retrieval bag B is relatively larger than the outer diameter of the shaft A1 of the 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 to be lined up in the diameter direction with the center of the main wall portion 31 between them. As shown in Fig. 5, a convex 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 convex 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 is connected from its periphery 41a in a cylindrical shape and into which the forceps A is inserted. Here, the inner peripheral surface of one insertion opening 41 and the inner peripheral surface of the fitting tube 410 are continuous with each other on the same cylindrical surface. In addition, on the inner peripheral surface of the fitting tube 410, a plurality of annular protrusions 411 that are in close contact with the outer peripheral surface of the forceps A over the entire circumference are arranged in the axial direction in which the fitting tube 410 extends. Here, the respective protrusions 411 are arranged closely to each other, and the space between the adjacent protrusions 411 forms an annular recess 412 that does not abut on the outer peripheral surface of the forceps A. Note that the inner circumference of the insertion opening 41 is also considered to be a part of the inner circumference of the fitting tube 410 in the following description.

[0029] 13, each of the protrusions 411 is formed, for example, in a smooth arc-shaped cross section, and the apex of each of them 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 surrounded by the apex of each of the protrusions 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. Also, each of the protrusions 411 makes intimate 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), the recesses 412 between the protrusions 411 provide play to allow 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), the inside of the tip of the fitting tube portion 410 is also provided with a reduced diameter portion 413 that extends all around in the axial direction. The reduced diameter portion 413 protrudes inward from the protrusions 411 and is in close contact with the outer periphery of the forceps A, and works together with the protrusions 411 to improve sealing performance.

[0031] When the shaft diameter of the forceps A is φ4.5 to 5.8 mm as described above, the minimum inner diameter of the fitting tube portion 410 surrounded by the apex of each convex portion 411 may be set to, for example, about φ5.2 mm. The maximum inner diameter of the fitting tube portion 410 surrounded by the valley bottom of each concave portion 412 may be set to, for example, about φ5.8 mm. Furthermore, the inner diameter surrounded by the reduced diameter portion 413 may be set to, for example, about φ3.8 mm. The length of the fitting tube portion 410 is set to, for example, about φ8.0 mm, including the depth of the insertion opening portion 41 (thickness of the main wall surface portion 31) of 2.0 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 by pressing the collection bag B into the insertion opening 42 and comes into close contact with the outer circumferential surface of the collection bag B. The crimping portion 420 is formed as a taper 421 that is inclined inward and intersects with the periphery 42a of the insertion opening 42 located on the front and back reference planes of the main wall portion 31. Here, a tip 422 where the front and back tapers 421 intersect is formed to have a strong trapezoidal cross section rather than an acute triangular cross section.

[0033] Since the shaft diameter of the collection bag B to be inserted into the other insertion opening 42 is as wide as φ10.0 to 15.0 mm as described above, the fitting tube 410 similar to that of the first insertion opening 41 is not provided, but is formed thin-walled with a taper 421. Such a configuration of the insertion opening 42 can improve expandability so as to accommodate various outer diameters of the collection bag B.

[0034] When the shaft diameter of collection bag B is φ10.0 to 15.0 mm as described above, the maximum inner diameter surrounded by the periphery 42a of insertion opening 42 may be set to, for example, φ12.5 mm. Also, the minimum inner diameter surrounded by the tip 422 of taper 421 of insertion opening 42 may be set to, for example, φ7.5 mm. Here, when the maximum inner diameter φ12.5 mm of insertion opening 42 matches, for example, the outer diameter of the shaft diameter of collection bag B, the ratio of the minimum inner diameter φ7.5 mm of insertion opening 42 to the maximum inner diameter of insertion opening 42 (shaft diameter of collection bag B):minimum inner diameter of insertion opening 42 is 0.6:1, which is 3:5 in integer ratio and 37.5%:62.5% in percentage ratio.

[0035] As shown in Figs. 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 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 in a protruding shape protruding 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 are formed of cylindrical shaft portions 51a and 52a and have substantially conical head portions 51b and 52b at the ends thereof, and the outer peripheral edges of the head portions 51b and 52b are expanded in an umbrella shape from the outer diameter of the shaft portions 51a and 52a, and serve to prevent the stopper plugs from coming out when pushed into the insertion openings 41 and 42.

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

[0037] The shaft 52a of the stopper 52 that blocks the other insertion opening 42 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 minimum 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 blocked, and by removing it from the insertion opening 42, an instrument with a relatively large shaft outer diameter, such as a recovery bag B, can be inserted through the insertion opening 42.

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

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

[0040] Further, at the tip of each connecting portion 510, 520, there is provided a tongue-shaped handle 512, 522 that is bent 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 in which the two insertion openings 41, 42 are aligned, but is provided so as to be bent at 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, convex markings 513 and 523 are provided on the top and bottom surfaces of the handles 512 and 522, respectively. The convex markings 513 and 523, one each on 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 easy to grasp, and the convex markings 513 and 523, three each on the bottom surfaces of the handles 512 and 522 shown in Figures 4 and 6, are provided to prevent slipping when pinched. Here, it is preferable to make the number and shape of the protruding marks 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 parts 510, 520 and the handles 512, 522, may be referred to as the stopper plug as a whole.

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

[0043] <Function 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. Fig. 17 is an explanatory diagram showing an image of a hysterectomy surgery under a laparoscope, with the upper side of the figure being the abdominal side and the lower side being the dorsal side. When using the forceps A or the retrieval bag B through the medical insertion device 10, in either case, the patient is usually under general anesthesia. 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 Fig. 18(a), the pipe body 11 of the medical inserter 10 is inserted from the opening of the vagina and slowly advanced toward the back of the vagina, and it is confirmed by visual and tactile inspection that the cervix has entered inside the distal end ring 12 of the pipe body 11. Then, as shown in Fig. 18(b), the distal end ring 12 of the pipe body 11 is advanced to the dome part near the cervix. When checking the insertion state from the proximal end opening 11b of the pipe body 11, the cap 30 may be removed from the proximal end opening 11b.

[0045] [2] Next, the abdominal cavity is inflated by filling it with pneumoperitoneum gas (see FIG. 17), and while checking the dome portion with a laparoscopic camera, the pipe body 11 is further pushed in, and as shown in FIG. 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 in 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 a thermosetting acrylic resin, so there is no risk of it melting easily when it comes into contact with the electric scalpel.

[0046] By removing the dome of the uterus, the pneumoperitoneum gas in the abdominal cavity enters the vagina and the inside of the pipe body 11. At this time, since the base end opening 11b of the pipe body 11 is closed by the cap 30, the pneumoperitoneum gas is unlikely to leak through the pipe body 11, and visibility inside the abdominal cavity can be maintained in a good state. In addition, the protrusions 14a, 14b and the tapered portion 13c provided on the outer circumferential surface of the pipe body 11 are in close contact with the inner wall of the vagina, so that the pneumoperitoneum gas is also restricted from leaking out along the outer circumferential surface of the pipe body 11.

[0047] <<How to use forceps A>> [3] The resected uterus is then removed. If forceps A (see FIG. 16) are to be used, the stopper 51 is removed from the insertion opening 41 of the cap 30 while the pipe body 11 is still inserted into the vagina. Then, as shown in FIG. 20, forceps A is inserted into the inside of the pipe body 11 from the insertion opening 41 to grasp the resected uterus. If the resected uterus is to be removed using forceps from the abdominal cavity side (see FIG. 17) or if a recovery bag B is to be placed in 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 is inserted into the insertion opening 41, the shaft A1 of the forceps A is fitted into the fitting tube 410 connected to the insertion opening 41. This increases the contact area between the cap 30 and the forceps A compared to when the fitting tube 410 is not provided in the insertion opening 41. If the inner peripheral surface of the fitting tube 410 is a smooth surface without irregularities, the forceps A will stick to the outer peripheral surface of the forceps A and resistance will increase, but the inner peripheral surface of the fitting tube 410 is provided with irregularities in which annular convex portions 411 and concave portions 412 are alternately arranged. Therefore, the outer peripheral surface of the forceps A does not stick closely to the inner peripheral surface of the fitting tube 410, and even if the contact area between the fitting tube 410 and the forceps A increases, it is possible to reduce frictional resistance when the forceps A is inserted and increase sealing performance.

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

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

[0051] [5] When suturing the vaginal wall stump closed, the suture needle is grasped by the gripping portion A2 of the forceps A and inserted as it is into the inside of the pipe body 11. Furthermore, 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. Note that 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 from 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 opening 42 that is not being used is 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 parts 510, 520 are bent, but the connecting parts 510, 520 are easily deformed with a small curvature due to the slit-shaped thin hinges 511, 521, and the overall shape is compact and not bulky.

[0053] [7] Then, the pipe body 11 with the cap 30 attached is inserted again into the vagina. This fills the abdominal cavity with pneumoperitoneum gas, and good visibility can be ensured again. Under these circumstances, the vaginal wall stump where the uterus was removed is closed and sutured from the abdominal side by laparoscopic surgery. At this time, the pipe body 11 is manipulated to assist the suturing. Specifically, the pipe body 11 inserted into the vagina is slightly retracted, and the vaginal wall stump is supported from the inside by the tip ring 12. After the vaginal wall stump is sutured, the pipe body 11 is slowly pulled out of the vagina, and the surgery is completed.

[0054] <<How to use collection bag B>> [8] Next, a case where the retrieval bag B (see FIG. 16) is used instead of the forceps A described above will be described. The procedures [1] and [2] above are the same as when the forceps A is used, but when the retrieval bag B is used, the stopper 52 is removed from the insertion opening 42 of the cap 30 while the pipe body 11 is still inserted into the vagina. Then, as shown in FIG. 23, the retrieval bag B is inserted into the inside of the pipe body 11 from the insertion opening 42. Next, as shown in FIG. 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 corresponding to the retrieval bag B can be inserted with a shaft diameter of, for example, 10.0 to 15.0 mm. That is, since the insertion opening 42 needs to have a wide hole diameter, the fitting tube portion 410 of the insertion opening 41 is not provided, and instead, as shown in FIG. 13, a crimping portion 420 that is easy to expand in diameter is provided. Such a crimping portion 420 of the insertion opening 42 increases the expandability so as to be able to accommodate various outer diameters of the retrieval bag B, and also increases the sealing property by closely contacting the outer peripheral surface of the retrieval bag B. In addition, when the connecting portion 520 of the stopper 52 is removed from the insertion opening 42, it naturally returns to a restored position extending laterally on the same plane approximately parallel to the main wall portion 31 so as not to be hit by 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 opening edge of the bag B2 is closed by pulling the string attached to the bag B2, as shown in Fig. 26. Then, the string is cut by an operating part or the like at the base end side of the shaft B1 of the retrieval bag B, and only the shaft B1 of the retrieval bag B is pulled out from the insertion opening 42 of the cap 30, as shown in Fig. 27. At this time, the insertion opening 42 is easily elastically deformed by the crimping part 420, in the same way as when the 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 due to the elastic deformation of the crimping part 420, and also due to the double seal structure between the outer peripheral wall part 32 and the inner wall part 33 of the cap 30, and the outflow of pneumoperitoneum gas is suppressed. Next, the pipe body 11 and the bag body B2 are pulled out of the body, and after removing the bag body B2, the pipe body 11 is inserted again into the vagina. The subsequent process is the same as the process from [5] to [7] when the forceps A is used.

[0058] <Medical Insertion Device 10 Sizes> 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, for example, three classes are prepared: tip outer diameter φ31 mm and effective length 172 mm, tip outer diameter φ35 mm and effective length 174 mm, and tip outer diameter φ39 mm and effective length 176 mm. These specific sizes are due to the substantial length required to access the abdominal cavity through the vagina, and three sizes of cap 30 are prepared according 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 is also prepared in similar shapes, the size between both ends of a pair of connecting parts 510, 520 extending on both sides of the main wall part 31 will be quite long. Even when the two insertion openings 41, 42 in the main wall part 31 are closed with stopper plugs 51, 52 to bend the connecting parts 510, 520, these bent parts will be significantly bulkier outside the outer diameter of the cap 30. Therefore, in order to make the size of the cap 30 as compact as possible, a cap 30A of the 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 is the same as the medical inserter 10 according to the first embodiment described above in terms of the configuration of the pipe body 11 except for the size, and is not shown in the drawings, but the configuration of the cap 30A is slightly different. Below, the cap 30A will be described in terms of differences from the first embodiment, and the same parts will be denoted by the same reference numerals and duplicated 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 shape 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 in the same straight line as the diameter direction in which the insertion openings 41, 42 are arranged, 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 arranged.

[0062] 31, the pair of connecting parts 510A, 520A extend symmetrically at an angle θ of about 40 degrees from the center of the insertion opening 41, based on a straight line in the diameter direction along which the insertion openings 41, 42 are aligned. According to the shape of the pair of connecting parts 510A, 520A, when the insertion openings 41, 42 are closed with stoppers 51, 52 to bend the connecting parts 510A, 520A, as shown in FIG. 37, when the connecting parts 510A, 520A are inclined at about 40 degrees (solid line in the figure) than when the connecting parts 510A, 520A are deployed left and right at 180 degrees (two-dot chain line in the figure), the outer diameter of the part can be made smaller (W1>W2 in the figure).

[0063] Similarly to the first embodiment, the leading ends of the connecting parts 510A, 520A are provided with tongue-shaped handles 512A, 522A bent from the center line of the connecting parts 510A, 520A. Each handle 512A, 522A is bent at an angle greater than a right angle from the center line of the connecting parts 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 arranged 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 relates to a medical inserter 10 having a removable cap 30, 30A for closing a proximal end opening 11b of a pipe body 11 to be inserted transvaginally, At least a portion of the main wall surface portion 31 of the cap 30, 30A is formed in a thin sheet shape, and a plurality of insertion openings 41, 42 through which a plurality of types of shaft-shaped instruments A, B having different outer diameters are separately inserted are provided in the sheet-like portion. A fitting tube portion 410 is provided in one of the insertion openings 41 and 42, the fitting tube portion 410 being connected in a cylindrical shape from its periphery and into which the instrument A is inserted and inserted into the one insertion opening 41. The fitting tube portion 410 is characterized in that a plurality of annular protrusions 411, which are in close contact with the outer circumferential surface of the instrument A over the entire circumference, are arranged on the inner circumferential surface of the fitting tube portion 410 in the axial direction of the fitting tube portion 410.

[0066] According to the medical inserter 10, at least a part 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 prone to elastic deformation. Therefore, when the instruments A, B corresponding to the respective inner diameters of the insertion openings 41, 42 provided in the sheet-like portion are inserted, the insertion openings 41, 42 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 tube portion 410 extending cylindrically from its periphery, so that the instrument A inserted through the insertion opening 41 fits into the fitting tube portion 410. This increases support by the length of the fitting tube 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 difficult for gaps to form between them and improving sealing.

[0068] Here, if the inner peripheral surface of the fitting tube portion 410 is a straight smooth surface without unevenness, the outer peripheral surface of the instrument A is likely to come into close contact and stick to it. Therefore, a plurality of annular protrusions 411 are arranged in the axial direction on the inner peripheral surface of the fitting tube portion 410. Each protrusion 411 can reduce frictional resistance compared to when the inner peripheral surface of the fitting tube portion 410 comes into surface contact with the outer peripheral surface of the instrument A, allowing smooth operation of the instrument A. Each protrusion 411 surrounds the outer peripheral surface of the instrument A in the entire circumferential direction, making it possible to reduce frictional resistance and improve sealing performance.

[0069] Furthermore, the present invention is characterized in that the convex portions 411 are arranged closely spaced from each other on the inner surface of the engaging tube portion 410, and the spaces between adjacent convex portions 411 form annular concave portions 412 that do not abut against the outer peripheral surface of the instrument A.

[0070] According to this configuration, the inner peripheral surface of the fitting tube portion 410 has an uneven shape in which annular protrusions 411 and recesses 412 are alternately arranged, and the recesses 412 between the protrusions 411 provide play for the fitting tube portion 410 to easily deform in accordance with the movement of the instrument A. Therefore, the inner peripheral surface of the fitting tube portion 410 becomes easier to deform while maintaining a tight contact state in accordance with the movement of the instrument A, and operability and sealing performance can be improved.

[0071] In addition, the present invention is characterized in that any other of the insertion port portions 41, 42 is formed with an inner diameter larger than the one insertion port portion 41, and is provided with a crimping portion 420 along its periphery, which elastically expands in diameter by pressing the instrument B corresponding to the other insertion port portion 42 into the other insertion port portion 42, and which is in 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 that even if the outer diameter of the instrument B has a certain degree of width (type), 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 inwardly and intersects with the peripheral edge 42a of the insertion opening portion 42 located on the reference planes on the front and back of the main wall 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 side without impairing the sealing property. When the maximum inner diameter at 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, about 3:5 in integer ratio.

[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 extending from the outer circumferential side of the main wall portion 31, respectively. 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 portion 31 to a closed position in which the stopper plugs 51, 52 block each of the insertion openings 41, 42, and is characterized in that in the restored position, each of the insertion openings 41, 42 extends in a direction intersecting the diameter direction aligned with the main wall portion 31.

[0076] According to this configuration, by inserting the stopper plugs 51, 52 into the respective insertion openings 41, 42 of the cap 30A, the respective insertion openings 41, 42 of the cap 30A are closed. Meanwhile, by removing the stopper plugs 51, 52 from the respective insertion openings 41, 42 of the cap 30A, instruments such as the forceps A and the recovery bag B can be inserted into the respective insertion openings 41, 42. In addition, since the stopper plugs 51, 52 are connected to the connecting portions 510A, 520A extending from the outer periphery side of the main wall portion 31, respectively, 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 parts 510A, 520A are in a restored position deployed on the same plane approximately parallel to the main wall surface part 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 parts 510A, 520A are elastically deformed and bent. Here, when the connecting parts 510A, 520A extend in a direction intersecting the diametric direction in which the insertion openings 41, 42 are aligned in the natural restored position, the cap 30A has a compact shape that is not bulky overall.

[0078] In addition, the present invention provides a method for manufacturing a container having a plurality of connecting portions 510 (510A), 520 (520A) each having a tongue-shaped handle 512 (512A), 522 (522A) extending beyond the stopper plugs 51, 52 at the tip of the connecting portion 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) can be easily grasped and operated when blocking the insertion openings 41, 42 with the stopper 51, 52 or when removing the stopper 51, 52 from the insertion openings 41, 42. In addition, because the handles 512 (512A), 522 (522A) extend in a direction intersecting with the longitudinal direction, when the stopper 51, 52 is in a closed position blocking the insertion openings 41, 42, it is possible to prevent interference such as overlapping between the handles 512 (512A), 522 (522A).

[0080] Furthermore, the present invention can be realized as the above-mentioned cap 30 (30A) alone. Such a cap 30 (30A) can be treated as an independent part separate from the medical inserter 10. Therefore, if the pipe body 11 is available as a ready-made product, it can be easily upgraded to the medical inserter 10 of the present invention by simply replacing 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 configuration is not limited to the above-mentioned embodiments, and the present invention includes modifications and additions that do not deviate from the gist of the present invention. For example, the specific shapes and relative sizes of the pipe body 11 and the 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 a thin sheet shape over its entire area, but only the areas around each insertion opening portion 41, 42 may be formed in a thin sheet shape, and the other areas may be molded, for example, in a plate shape of a predetermined thickness to provide rigidity.

[0083] Furthermore, in each embodiment, the 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 having 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 forceps with the smallest diameter. [Industrial Applicability]

[0084] The medical insertion instrument according to the present invention is not necessarily limited to laparoscopic hysterectomy surgery, and can be widely applied as one that can be used for other laparoscopic procedures. [Explanation of symbols]

[0085] A…Forceps (instrument) B…Collection bag (instruments) 10. Medical Insertion Device 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 portion 411…Convex part 412…Recess 42...Other insertion openings 420… Crimping section 421…Tapered 422...Tip 51,52…Stop plug 510,510A,520,520A…Connection part

Claims

1. A medical inserter having a removable cap for closing a base end opening of a pipe body to be inserted transvaginally, At least a part of the main wall surface of the cap is formed in a thin sheet shape, and a plurality of insertion openings through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted are integrally formed in the sheet-like portion, A fitting tubular portion is integrally formed with any one of the insertion openings, the fitting tubular portion being connected from its periphery in a tubular shape and into which the instrument is inserted and passed through the one insertion opening, A plurality of annular protrusions that are in close contact with the outer peripheral surface of the instrument over the entire circumference are integrally formed on the inner peripheral surface of the fitting cylindrical portion and arranged in the axial direction of the fitting cylindrical portion, The protrusions are integrally formed so as to be closely arranged on the inner peripheral surface of the fitting tube portion, and an annular recess is formed between adjacent protrusions so as not to abut against the outer peripheral surface of the instrument, Any other of the insertion openings does not have the fitting tube portion and is integrally molded with an inner diameter larger than that of the one insertion opening, and a crimping portion is integrally molded along its periphery to elastically expand in diameter by pressing the instrument corresponding to the other insertion opening and to come into close contact with the outer circumferential surface of the instrument, The medical inserter is characterized in that the crimping portion is integrally molded as a taper inclined toward the inside where the periphery of the insertion opening portion located on the reference planes on the front and back of the main wall portion intersect.

2. A pair of insertion ports, the one insertion port and the other insertion port, are arranged so as to be aligned in a diametrical direction with the center of the main wall surface portion therebetween, the cap has stoppers for closing the pair of insertion openings, Each of the stopper plugs is connected to a connecting portion extending from an outer circumferential side of the main wall surface portion, The medical insertion device according to claim 1, characterized in that each of the connecting portions 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 portion to a closed position in which the stopper blocks the pair of insertion ports, and in the restored position, the centers of each of the pair of insertion ports extend in a direction that intersects obliquely on the same plane with a straight line on the same plane that overlaps in a planar view with the diameter direction aligned on the main wall portion.

3. A tongue-shaped handle extending beyond the stopper is provided at the tip of the connecting portion, The medical inserter according to claim 2 , wherein the handle extends in a direction intersecting with a longitudinal direction of the connecting portion.

4. A medical inserter having a removable cap for closing a base end opening of a pipe body to be inserted transvaginally, the cap comprising: At least a part of the main wall surface of the cap is formed in a thin sheet shape, and a plurality of insertion openings through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted are integrally formed in the sheet-like portion, A fitting tubular portion is integrally formed with any one of the insertion openings, the fitting tubular portion being connected from its periphery in a tubular shape and into which the instrument is inserted and passed through the one insertion opening, A plurality of annular protrusions that are in close contact with the outer peripheral surface of the instrument over the entire circumference are integrally formed on the inner peripheral surface of the fitting cylindrical portion and arranged in the axial direction of the fitting cylindrical portion, The protrusions are integrally formed so as to be closely arranged on the inner peripheral surface of the fitting tube portion, and an annular recess is formed between adjacent protrusions so as not to abut against the outer peripheral surface of the instrument, Any other of the insertion openings does not have the fitting tube portion and is integrally molded with an inner diameter larger than that of the one insertion opening, and a crimping portion is integrally molded along its periphery to elastically expand in diameter by pressing the instrument corresponding to the other insertion opening and to come into close contact with the outer circumferential surface of the instrument, The cap is characterized in that the crimping portion is integrally molded as a taper inclined inwardly from the periphery of the insertion opening portion located on the reference planes of the front and back of the main wall portion.

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