Tissue adhesive sheet insertion device (scored type) for percutaneous total spinal endoscopy

Abstract

To solve the problem that, in surgery under a spine percutaneous whole endoscope, when inserting a tissue adhesion sheet by pushing it with a stick at the time of damaging a dura mater, the tissue adhesion sheet adheres to the stick, to thereby have a hard time to peel it off.SOLUTION: An appliance is a cylindrical object used for inserting a tissue adhesion sheet. Since it is inserted into an endoscope after being set in an intraluminal tip, by pushing it with a push rod, it is peeled off easily from a body, and can be pushed onto dura mater. A larger tissue adhesion sheet can be inserted into a limited space such as an inner cavity inside of a smaller appliance than the case of being insertable into an inner cavity of the endoscope.SELECTED DRAWING: Figure 5

Description

[Technical Field]

[0001] The present invention relates to an instrument for assisting in the insertion of tissue adhesive sheets during percutaneous total endoscopic spinal surgery. [Background technology]

[0002] In order to minimize invasiveness in spinal surgery, there is a method using a spinal percutaneous total endoscope, which is an endoscope with a small diameter but which has all the necessary functions. As shown in Figures 1 and 2, the main body 901, which is the part inserted into the body, is a long, thin cylinder with an outer diameter of about 6 to 7 mm, and inside it, the scope tube 902, light source path 903, irrigation water path 904, and working lumen 905 are integrated. An outer tube 906 is inserted into the body through the skin incision S, and inside The main body 901 is inserted into the cavity, and water is run through the irrigation channel 904 to wash the area around the target, while an image from a camera connected to the tube 902 is magnified and displayed on a monitor, and an instrument such as forceps 200 inserted into the working cavity 905 is used to operate on the vertebral arch 4, intervertebral disc 5, etc. Instruments that can be inserted into the working cavity 905 are basically long, cylindrical instruments with an outer diameter of about 2.5 mm to 4 mm and a length of about 200 mm to 400 mm, with handles or the like attached.

[0003] In laminoplasty for spinal stenosis, as shown in Figure 3, the dural canal 2 (a cavity surrounded by the dura mater 1, through which spinal fluid, the spinal cord, and nerve roots pass) is expanded by removing the surrounding tissues, such as the herniated disc 3, vertebral arch 4, intervertebral disc 5, and ligamentum flavum, which are compressing the dural canal. During this process, the dura mater 1, which is a thin membrane, may be damaged. If damaged, cerebrospinal fluid may leak through the hole, causing symptoms of low spinal pressure, or nerves may become trapped in the hole, causing neurological symptoms. Therefore, the hole must be closed to prevent cerebrospinal fluid from leaking out. While suturing is the traditional method for closure, it can also be covered with a tissue adhesive sheet. Tissue adhesive sheets 10, such as Tachoseal (manufactured by CSL Behring), are sheet-like biological tissue adhesives and closures, as shown in Figure 4, which combine a sponge-like collagen sheet support 11 with an adhesive surface 12 to which the active ingredients, human fibrinogen and human-derived thrombin fraction, are fixed. These have the advantage of being able to adhere even in liquids. This is particularly useful in percutaneous total endoscopic surgery, where the surgical field is immersed in irrigation fluid, as it can be used without draining the irrigation fluid. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] Patent No. 5192254 Summary of the Invention [Problem to be solved by the invention]

[0005] When using tissue adhesive sheets in percutaneous total endoscopic spinal surgery, they are cut to an appropriate size and inserted into the working cavity of the percutaneous total endoscope, then pushed to the tip of the endoscope with a rod. However, this procedure causes the tissue adhesive sheet to stick to the tip of the rod. However, since only one instrument can be inserted, it is not possible to insert another instrument to remove it. Therefore, the tissue adhesive sheet was somehow removed by rubbing the tip of the rod against the corners of the surrounding bones, but in many cases there were no conveniently shaped corners nearby, which was not easy and also required shifting the field of view.

[0006] As with other surgical procedures, dural damage occurs with some frequency in percutaneous endoscopic spinal surgery, and it is necessary to make tissue adhesive sheets easier to use as a treatment for this. [Means for solving the problem]

[0007] The tissue adhesive sheet insertion device for spinal percutaneous total endoscope of the present invention will be referred to as the device below. As shown in Figures 5 to 11, the device 100 has a long, thin cylindrical main body 110 with an outer diameter that allows it to be inserted into the working cavity of a percutaneous total endoscope, and two or four scoring lines 112 extend from the tip 111 of the main body toward the proximal side. The scoring lines widen halfway through to form slits 113, which continue toward the proximal side but do not continue all the way to the proximal end 114 of the main body. A push rod 120 is located within the lumen of the main body, and an enlarged portion 121 is located at the proximal end of the push rod 120. A spring 130 is located between the proximal end 114 of the main body and the enlarged portion 121. The push rod 120 can slide within the lumen of the main body. The inner diameter of the ring 140 is slightly larger than the outer diameter of the main body, and it fits over the outer surface of the main body. The thickness of the opening device 150 is smaller than the gap between the slits 113, and its width is larger than the gap between the slits. [Effects of the Invention]

[0008] To use this instrument, as shown in Figure 12, first insert spreader 150 into the slit and twist it to spread scoring line 112, expanding the tip of main body 110. Then, a tissue adhesive sheet cut to an appropriate size is placed over main body tip 111 with adhesive surface 12 facing downwards (Figure 12a). The spreader is then removed, compressing the tissue adhesive sheet. Moving ring 140 toward the tip closes the scoring line securely (Figure 12b). The main body is inserted into the working lumen of the spinal percutaneous total endoscope and advanced. At this time, the ring at the tip is moved toward the proximal end. Once the tip of the main body reaches the target dura, pushing push rod 120 pushes out the tissue adhesive sheet from the lumen at the tip of the main body (Figure 12c), stretching slightly and adhering it to the dura.

[0009] The adhesive surface of the tissue adhesive sheet moves while remaining inside the lumen at the tip of the main body, so it only adheres to the lumen of the main body, and when pushed out with the push rod, it can be reliably peeled off from the device and pushed out into the dura mater.

[0010] Only instruments with an outer diameter smaller than the lumen of a spinal percutaneous endoscope can be inserted, and if a tissue adhesive sheet is to be inserted into the lumen of that instrument, only a very small one can fit. However, by using a dividing line, it can be expanded, allowing a tissue adhesive sheet larger than the lumen of the instrument to be inserted. [Brief explanation of the drawings]

[0011] [Figure 1] Schematic diagram of the lumbar cross section and instruments used during percutaneous endoscopic spinal surgery. [Figure 2] Oblique view of the tip of the outer tube and the spinal percutaneous endoscope. [Figure 3] Cross section of the spine. [Figure 4] Schematic diagram of tissue adhesive sheet. [Figure 5] Overall side view of embodiment 1 of the present invention. [Figure 6] A perspective view of the tip side of the first embodiment of the present invention. [Figure 7] Cross-sectional view of the tip side of the first embodiment of the present invention. [Figure 8] A perspective view of the hand side of the first embodiment of the present invention. [Figure 9] Cross-sectional view of the proximal side of the first embodiment of the present invention. [Figure 10] Front view of the tip of embodiments 1 and 2 of the present invention. [Figure 11] A perspective view of a dilator according to a first embodiment of the present invention. [Figure 12] Schematic diagram of embodiment 1 of the present invention in use. DETAILED DESCRIPTION OF THE INVENTION

[0012] A first embodiment of the present invention will be described using Figures 5 to 11. The main components of this instrument 100 are a main body 110 and a push rod 120. The main body 110 is a long, thin cylinder with an outer diameter of 3 to 4 mm and a length of approximately 350 mm, which can be inserted into the working cavity of a spinal percutaneous total endoscope. Two scoring lines 112 extend from the tip 111 of the main body toward the proximal side, and the scoring lines 112 widen partway to form slits 113, which do not continue to the proximal end 114 of the main body. A push rod 120 is located inside the main body cavity, and the proximal end of the push rod 120 The outer diameter has increased There is an enlarged portion 121. A spring 130 is located between the proximal end 141 of the main body and the enlarged portion 121. The push rod 120 can slide within the lumen of the main body. The inner diameter of the ring 140 is slightly smaller than the outer diameter of the main body 110. , that is, within 1 mm It is large and covers the outside of the main body.

[0013] As shown in Figure 10, there may be two secant lines 112 and two slits facing each other (a, embodiment 1), or two more lines offset by 90 degrees from the first, for a total of four (b, embodiment 2).

[0014] The thickness of the expander 150 is smaller than the gap of the slit 113, but its width is larger than the gap of the slit 113 (Figure 11a). The expander can be inserted into the slit and twisted to expand the secant line. Another possible form of expander is one in which the thickness of expander 160 is smaller than the gap in slit 113 at the tip and larger than the gap in slit 113 at the handle side (Figure 11b). By inserting and pushing this expander 160 into slit 113, the secant line can be expanded.

Claims

1. An instrument for assisting in the insertion of a tissue adhesive sheet in spinal percutaneous total endoscopic surgery, the instrument having a long, thin cylindrical body with an outer diameter that can be inserted into the working cavity of a spinal percutaneous total endoscope, Two or four score lines extend from the tip of the main body toward the handle, and the gaps between the score lines widen halfway through to form slits, but the slits do not extend to the handle end of the main body. There is a push rod inside the main body cavity, and the push rod can be slid inside the main body cavity to push out anything inserted into the tip of the main body. The inner diameter of the ring is slightly larger than the outer diameter of the main body, and the ring is placed over the outer surface of the main body. A percutaneous, total endoscopic spinal instrument characterized by the ability to open the cleavage line by inserting a dilator into the slit.

2. The spinal percutaneous total endoscopic instrument according to claim 1, characterized in that the thickness of the spreader is smaller than the gap of the slit and the width is larger than the gap of the slit, and the secant line can be spread by inserting the spreader into the slit and twisting it.

3. The spinal percutaneous total endoscopic instrument according to claim 1, characterized in that the thickness of the spreader is smaller than the gap of the slit at the tip and larger than the gap of the slit at the proximal end, and the dividing line can be spread by inserting the spreader into the slit and pushing it in.

Images