Medical insertion aids

Abstract

To provide a medical insertion assist tool capable of reducing costs, the number of procedures, a surgery time, and a load of a patient in a surgery of inserting a medical device into the body, and capable of improving versatility.SOLUTION: An operation instrument 60 of a medical insertion assist tool 1 includes a distal end member 61, a locking member 62, and a grip 65. The operation instrument 60 is formed with a through hole to which a guide wire 70 can be inserted. A gastrostomy tube 40 is locked to a locking part 62b of the locking member 62 and a locking part 65b of the grip 65. The distal end member 61 is configured to be movable relatively to the locking part 62b.SELECTED DRAWING: Figure 18

Description

[Technical Field]

[0001] The present invention relates to a medical insertion aid used when inserting a medical instrument into a patient's body. [Background technology]

[0002] A conventional medical insertion aid is described in Patent Document 1. This medical insertion aid is used during gastrostomy surgery to insert a gastrostomy tube, which is a medical instrument, into a patient's body, and includes a cannula needle, a dilator, a sheath, a guidewire, and an obturator.

[0003] When performing a gastrostomy surgery, a cannula needle is first pierced through the patient's abdominal body wall, and the inner needle of the cannula needle is removed while the outer needle of the cannula needle remains inserted into the body wall. A guidewire is then inserted into the outer needle of the cannula needle, and a dilator equipped with a sheath is connected to the outer needle of the cannula needle via this guidewire. The lower end of the sheath is then inserted into the patient's body wall together with the dilator, creating a perforation in the body wall.

[0004] Next, with the sheath penetrating the perforation, the dilator is removed from the sheath, and then the obturator with the gastrostomy tube attached is inserted into the sheath. At this time, the sheath is broken by the obturator. Then, after the sheath is removed from the perforation, the obturator is removed from the gastrostomy tube with the lower end of the gastrostomy tube remaining in the stomach. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Patent No. 6101206 Summary of the Invention [Problem to be solved by the invention]

[0006] The above-mentioned conventional medical insertion aids have the problem that, because both the sheath and the gastrostomy tube are inserted into the body, the number of procedures and the surgical time increase, and the burden on the patient increases. Furthermore, because the obturator with the gastrostomy tube attached is inserted into the sheath, only gastrostomy tubes with a shape that can be inserted into the sheath can be used, resulting in low versatility. Furthermore, the need for many instruments, such as a cannula needle, a dilator, a sheath, a guidewire, and an obturator, increases costs.

[0007] The present invention has been made to solve the above-mentioned problems, and aims to provide a medical insertion aid that can reduce costs, the number of procedures, the surgical time, and the burden on the patient during surgery to insert a medical instrument into the body, and can improve versatility. [Means for solving the problem]

[0008] In order to achieve the above object, the invention of claim 1 is a medical insertion aid for inserting an indwelling portion, which is the distal end of a medical instrument, inside a body wall while forming a perforation in the body wall, with the proximal end of the medical instrument remaining outside the body wall, the medical insertion aid comprising an elongated operating instrument that is inserted into the body wall together with the medical instrument while forming the perforation, the operating instrument comprising: a base provided on one end of the operating instrument, tapering toward the one end, and having a notch cut out from the outside to the inside; a first locking part provided on the operating instrument so as to leave a gap between the first locking part and the surface of the notch in the base, for locking the indwelling portion of the medical instrument; and a gripping part provided on the other end of the operating instrument.

[0009] With this medical insertion aid, when inserting the indwelling portion of the medical instrument into the body wall, the surgeon grasps the gripping portion of the operating instrument and, with the indwelling portion of the medical instrument locked by the first locking portion of the operating instrument, inserts the operating instrument together with the medical instrument into the body wall, thereby allowing the indwelling portion of the medical instrument to be inserted into the body together with the operating instrument while forming a perforation in the body wall. In this case, because the first locking portion is provided so as to leave a gap between it and the surface of the notch in the base, the amount by which the indwelling portion of the medical instrument protrudes outward from the operating instrument can be reduced, facilitating the insertion procedure.

[0010] Then, after releasing the engagement between the first engaging part of the operating instrument and the indwelling part of the medical instrument, the surgeon removes the operating instrument from the perforation using the gripping part as a guide while holding the part of the medical instrument outside the body as needed to prevent the medical instrument from slipping out of the body wall, leaving the indwelling part of the medical instrument inside the body and the proximal end outside the body.

[0011] As described above, when inserting the indwelling portion of a medical instrument into a body wall, the operating instrument equipped with the medical instrument can be inserted into the body wall without using an instrument equivalent to a conventional sheath. This allows medical instruments of shapes other than those that can be inserted into a sheath to be used, improving versatility. Furthermore, since an instrument equivalent to a conventional sheath is no longer necessary, the cost of the medical insertion aid can be reduced. For the same reason, unlike conventional methods, it is no longer necessary to attach the sheath to the dilator, remove the dilator from the sheath, and then insert the obturator equipped with the medical instrument into the sheath. This reduces the number of procedures and the time required during surgery, thereby reducing the burden on the patient. Note that, in this specification, "the surgeon grips the gripping portion" does not necessarily mean that the surgeon directly grips the gripping portion, but also includes the case where the gripping portion is gripped by a surgical device itself, such as a manipulator or robotic hand, that operates in response to the surgeon's manipulation.

[0012] The invention of claim 2 is characterized in that, in the medical insertion aid described in claim 1, the operating instrument further has a needle member having a needle that penetrates the body wall, a base connected to the base end of the needle, and a first connecting part provided on the base, and a second connecting part provided on one end of the operating instrument and connected to the first connecting part of the needle member, and the operating instrument is inserted into the body wall with the first connecting part of the needle member connected to the second connecting part.

[0013] With this medical insertion aid, when inserting the intracorporeal indwelling portion of the medical instrument into the body wall, the surgeon penetrates the needle of the needle member and then connects the second connecting part to the first connecting part of the needle member. As a result, the needle member is integrally connected to the operating instrument, and the surgeon can insert the intracorporeal indwelling portion of the medical instrument into the body together with the operating instrument while forming a perforation in the body wall by further inserting the needle member and operating instrument, while holding the gripping part of the operating instrument, into the body wall while pushing and widening the needle hole formed by the needle of the needle member.

[0014] As described above, when inserting the indwelling portion of the medical device into the body wall, instruments equivalent to the conventional sheath, dilator, and guidewire are no longer necessary, and the surgeon can perform the insertion surgery using fewer instruments than before. This further reduces the cost of medical insertion aids. For the same reason, the number of procedures and surgery time during surgery can be further reduced, thereby further reducing the burden on the patient.

[0015] The invention of claim 3 is characterized in that, in the medical insertion aid described in claim 2, the needle member is an outer needle member having a needle tube as a needle, and further comprises an inner needle member having an inner needle that can be inserted into the needle tube of the outer needle member and is removably attached inside the outer needle member, and the needle tube of the outer needle member is configured to be softer when inside the body wall than when outside the body wall.

[0016] With this medical insertion aid, before forming a perforation, the surgeon holds the holding portion of the inner needle member and penetrates the body wall together with the outer needle member while the inner needle member is removably inserted inside the outer needle member, and then removes the inner needle member from the outer needle member. Then, with the needle tube of the outer needle member penetrating the body wall, the surgeon connects the first connecting portion of the outer needle member to the second connecting portion of the operating instrument, and then inserts the outer needle member together with the operating instrument into the body wall. Since the needle tube of the outer needle member is configured to be softer when inside the body wall than when outside the body wall, it is possible to prevent the needle tube of the outer needle member from damaging organs inside the body wall. This reduces the burden on the patient during surgery.

[0017] The invention of claim 4 is characterized in that, in the medical insertion aid described in claim 3, the outer needle member further has a guide portion, and the operating instrument further has a guided portion that is guided by the guide portion when the second connecting portion is connected to the first connecting portion.

[0018] According to this medical insertion aid, the guided portion of the operating instrument is guided by the guiding portion of the outer needle member while the second connecting portion is connected to the first connecting portion, thereby improving workability when connecting the operating instrument to the outer needle member and shortening the surgical time.

[0019] The invention of claim 5 is characterized in that, in the medical insertion aid described in claim 3 or 4, a fitting hole extending in the longitudinal direction is formed on the base end side of the outer needle member, and the operating instrument further has a protrusion protruding in the longitudinal direction from an end portion on one end side of the operating instrument so that, when the first connecting portion and the second connecting portion are connected to each other, the operating instrument fits into the fitting hole in a state where it cannot rotate around an axis extending in the extension direction of the fitting hole of the outer needle member.

[0020] According to this medical insertion aid, when the first connecting part and the second connecting part are connected to each other, the protruding part of the operating instrument fits non-rotatably into the fitting hole of the outer needle member around an axis extending in the extension direction of the fitting hole of the outer needle member. This makes it possible to prevent the outer needle member from rattling relative to the operating instrument when a surgeon inserts the outer needle member and the operating instrument into the body wall while rotating them while holding the grip part of the operating instrument.

[0021] The invention of claim 6 is characterized in that, in the medical insertion device according to any one of claims 1 to 4, the second connecting part and the first connecting part are configured to be arranged so as to be spaced apart radially outward from the central axis of the needle member when the second connecting part is connected to the first connecting part.

[0022] According to this medical insertion aid, the second connecting part and the first connecting part of the operating instrument are arranged so as to be spaced apart in the radial direction from the central axis of the outer needle member when the second connecting part is connected to the first connecting part, thereby further reducing the degree to which the internal indwelling part of the medical instrument protrudes radially outward from the operating instrument when the internal indwelling part is engaged with the first engaging part.

[0023] The invention of claim 7 is characterized in that, in the medical insertion aid according to any one of claims 1 to 4, the operating instrument is an integral combination of a connecting member having a second connecting portion and a first locking portion, a holding member having a holding portion, and a rod-shaped connecting member that connects the connecting member and the holding member, and the holding member is constructed by overlapping a hollow first holding member and a hollow second holding member, and one of the first holding member and the second holding member has a plurality of recesses therein that are arranged at intervals along the extension direction of the one member, and the connecting member extends along the extension direction of the one member, and has a convex portion at its end on the holding member side, and the convex portion is connected to the holding member in a state where it is selectively fitted into any one of the plurality of recesses.

[0024] According to this medical insertion aid, the length of the connecting member between the gripping member and the linking member, i.e., the length of the operating tool, can be changed by changing one of the recesses into which the protrusion of the connecting member fits. This allows the indwelling portion of the medical tool to be appropriately inserted into the body wall, even when the length of the medical tool varies.

[0025] The invention of claim 8 is characterized in that, in the medical insertion aid described in any one of claims 1 to 4, the operating instrument further has a second locking portion on the other end side for locking the base end portion of the medical instrument.

[0026] According to this medical insertion aid, the operating instrument further has a second locking portion at the other end for locking the base end of the medical instrument. This allows the internal indwelling portion of the medical instrument to be inserted into the body wall with the internal indwelling portion of the medical instrument locked to the first locking portion and the base end of the medical instrument locked to the second locking portion, making the insertion procedure easy.

[0027] The invention of claim 9 is characterized in that the medical insertion aid described in claim 1 further comprises an outer needle member having a needle tube, an inner needle member having an inner needle that can be inserted into the needle tube of the outer needle member and that is removably attached inside the outer needle member, and a guide wire that can be inserted into the needle tube of the outer needle member, and the operating instrument is configured to allow the guide wire to be inserted and has a through hole that extends through the operating instrument in the extension direction.

[0028] With this medical insertion aid, the surgeon penetrates the needle tube of the outer needle member through the body wall with the inner needle of the inner needle member inserted into the needle tube of the outer needle member, then removes the inner needle member from the outer needle member and passes a guidewire through the needle tube.The surgeon then grasps the gripping portion of the operating instrument, and with the indwelling portion of the medical instrument locked to the first locking portion of the operating instrument, inserts the operating instrument into the body wall via the guidewire with the indwelling portion of the medical instrument locked to the first locking portion of the operating instrument.As a result, the indwelling portion of the medical instrument is inserted into the body together with the operating instrument, forming a perforation in the body wall.

[0029] As described above, when inserting the indwelling portion of the medical device into the body wall, instruments equivalent to the conventional sheath and dilator are no longer necessary, and the surgeon can perform the insertion surgery using fewer instruments than before. This further reduces the cost of medical insertion aids. For the same reason, the number of procedures and surgery time during surgery can be further reduced, and therefore the burden on the patient can be further reduced.

[0030] The invention of claim 10 is characterized in that, in the medical insertion aid described in claim 9, the operating instrument has a tip member having a base and a locking member having a first locking portion, the through hole extends through the tip member and the locking member, and the tip member and the locking member are configured to be relatively movable within a predetermined range along the extension direction of the operating instrument.

[0031] According to this medical insertion aid, the tip member and the locking member are configured to be relatively movable within a predetermined range along the extension direction of the operating instrument, so that the distance between the first locking part and the base can be changed in the extension direction of the operating instrument. As a result, when locking the medical instrument to the first locking part, the locking operation can be more easily performed by widening the distance between the first locking part and the base.

[0032] The invention of claim 11 is characterized in that, in the medical insertion aid described in claim 10, the operating instrument further comprises: a gripping member having a gripping portion and a second locking portion for locking the base end of the medical instrument; a hollow first tubular member extending in the extension direction of the operating instrument and connected to the locking member and the gripping member; a second tubular member extending in the extension direction of the operating instrument while fitting into an inner hole of the first tubular member, one end connected to the tip member and the other end extending through the gripping member to the opposite side of the locking member of the holding member, and having an inner hole that forms at least a part of the through hole; and an operating member connected to the other end of the second tubular member, and having an opening that communicates with the inner hole of the second tubular member.

[0033] According to this medical insertion aid, the gripping member has a second locking portion for locking the base end of the medical instrument. This allows the indwelling portion of the medical instrument to be inserted into the body wall with the indwelling portion of the medical instrument locked to the first locking portion and the base end of the medical instrument locked to the second locking portion, facilitating the insertion procedure. Furthermore, the through hole extends through the distal end member and the locking member, and the second tubular member has an inner hole that forms at least a part of the through hole. This allows the guide wire to be inserted into the through hole of the distal end member, passing through the inner hole of the second tubular member and the opening of the operating member and into the operating instrument.

[0034] Furthermore, the second tubular member is provided so as to extend in the extension direction of the operating instrument while fitting into the inner hole of the first tubular member, one end of which is connected to the tip member and the other end of which extends outward on the opposite side of the gripping member from the locking member. And because the operating member is connected to the other end side of the second tubular member, the surgeon can easily perform the operation of moving the tip member relative to the locking member by operating this operating member in the extension direction of the operating instrument.

[0035] The invention of claim 12 is characterized in that, in the medical insertion aid described in claim 11, the operating member is provided to be slidable relative to the gripping member and is fitted into the gripping member in a state where it cannot rotate around the central axis of the second tubular member.

[0036] According to this medical insertion aid, the operating member is fitted to the gripping member in a state where it cannot rotate around the central axis of the second tubular member, and this operating member is connected to the tip member via the second tubular member. This makes it possible to prevent the tip member from rattling relative to the operating instrument when the surgeon inserts the operating instrument into the body wall while rotating it while holding the gripping portion of the operating instrument. [Brief explanation of the drawings]

[0037] [Figure 1] 1 is a perspective view showing the configuration of a medical insertion aid according to a first embodiment of the present invention. [Figure 2A] FIG. 2 is a perspective view showing the configuration of an outer needle member. [Figure 2B] 2B is a perspective view showing a cross-sectional configuration along line Y1-Y1 in FIG. 2A. [Figure 2C] FIG. 10 is a perspective view showing the configuration of the connecting portion side of the outer needle member. [Figure 3A] FIG. 2 is a front view showing the configuration of the mounting member. [Figure 3B] FIG. 4 is a bottom view showing the configuration of the mounting member. [Figure 3C] FIG. 4 is a left side view showing the configuration of the mounting member. [Figure 4] FIG. 10 is a cross-sectional view showing the connection state of the attachment member and the outer needle member. [Figure 5A] 5 is a diagram showing a cross-sectional configuration taken along line Y2-Y2 in FIG. 4. [Figure 5B] FIG. 10 is a bottom view showing the connection state of the outer needle member and the attachment member. [Figure 6] 5 is a diagram showing a cross-sectional configuration taken along line Y3-Y3 in FIG. 4. [Figure 7A] FIG. 2 is a perspective view showing the appearance of a connecting rod. [Figure 7B] FIG. [Figure 7C] FIG. 2 is a plan view showing the vicinity of the insertion portion of the connecting rod. [Figure 8] FIG. 2 is a view showing a first grip member and a second grip member. [Figure 9A] FIG. 10 is a diagram showing a state in which the operating tool is set to the shortest size. [Figure 9B] 9B is a diagram showing a state in which the operating tool is set to a longer size than that of FIG. 9A. FIG. [Figure 9C] 9C is a diagram showing a state in which the operating tool is set to a longer size than that shown in FIG. 9B. [Figure 9D] FIG. 10 is a diagram showing a state in which the operating tool is set to its maximum size. [Figure 10] FIG. 2 is a perspective view showing the configuration of an inner needle member. [Figure 11A] FIG. 10 is a perspective view showing a state in which the outer needle member and the inner needle member are connected. [Figure 11B]FIG. 10 is a cross-sectional view showing the outer needle member and the inner needle member connected together. [Figure 12] FIG. 1 is a perspective view showing the configuration of a gastrostomy tube. [Figure 13] FIG. 10 is a diagram showing the gastrostomy tube attached to the operating instrument. [Figure 14A] FIG. 10 is a view showing the state in which the outer needle member and the inner needle member have been punctured into the body wall. [Figure 14B] 14B is a diagram showing a state in which the inner needle member has been removed from the state shown in FIG. 14A. FIG. [Figure 15] FIG. 10 is a view showing a state in which the operating tool is connected to the outer needle member. [Figure 16] FIG. 10 is a diagram showing a state in which a gastrostomy tube is inserted into the body together with a medical insertion aid. [Figure 17] FIG. 1 is a diagram showing a gastrostomy tube attached to a human body. [Figure 18] FIG. 10 is a perspective view showing the configuration of an operating instrument for a medical insertion aid according to a second embodiment of the present invention. [Figure 19] FIG. 2 is a front view showing the configuration of the operating tool. [Figure 20] FIG. 2 is a cross-sectional view showing the configuration of the operating tool. [Figure 21A] FIG. 2 is a perspective view showing the configuration of a tip member. [Figure 21B] FIG. 2 is a perspective view showing the configuration of the insertion portion side of the distal end member. [Figure 21C] FIG. 3 is a cross-sectional view showing the configuration of a tip member. [Figure 22A] FIG. 4 is a front view showing the configuration of a locking member. [Figure 22B] FIG. 4 is a cross-sectional view showing the configuration of a locking member. [Figure 22C] FIG. 10 is a left side view showing the configuration of the locking member. [Figure 23] FIG. 2 is a cross-sectional view showing the configuration of the tip member, the locking member, and the vicinity thereof. [Figure 24] FIG. 2 is a plan view showing the configuration of an outer tube. [Figure 25] FIG. 2 is a view showing a first grip member and a second grip member. [Figure 26]FIG. 10 is a cross-sectional view showing the outer tube attached to the grip. [Figure 27A] FIG. 2 is a perspective view showing the configuration of a handle. [Figure 27B] FIG. 2 is a perspective view showing the configuration of the grip side of the handle. [Figure 28A] FIG. 2 is a cross-sectional view showing the configuration in the vicinity of the handle. [Figure 28B] FIG. 2 is a bottom view showing the configuration in the vicinity of the handle. [Figure 28C] 28B is a diagram showing the cross-sectional configuration along the line Y4-Y4 in FIG. 28A. FIG. [Figure 29A] FIG. 10 shows the tip member in a closed position. [Figure 29B] FIG. 10 illustrates the tip member in the open position. [Figure 30A] FIG. 10 is a plan view showing the handle when the tip member is in a closed position. [Figure 30B] FIG. 10 is a plan view showing the state of the handle when the tip member is in the open position. [Figure 31A] FIG. 10 shows the gastrostomy tube attached to the locking member when the tip member is in the open position. [Figure 31B] FIG. 10 shows the gastrostomy tube attached to the locking member with the tip member in the closed position. [Figure 32] FIG. 10 shows the gastrostomy tube attached to the operating tool. [Figure 33] FIG. 10 is a view showing a state in which a guide wire is inserted into an outer needle member. [Figure 34] FIG. 10 is a view showing a state in which a guide wire has passed through an operating instrument. [Figure 35] FIG. 10 is a diagram showing a state in which a gastrostomy tube is inserted into the body together with an operating instrument. [Figure 36] FIG. 1 is a diagram showing a state in which a guidewire and a gastrostomy tube are inserted into a human body. [Figure 37] 10A and 10B are diagrams showing modified examples of the inner tube; [Figure 38] FIG. 10 is a diagram showing another modified example of the inner tube. [Figure 39A]FIG. 10 is a perspective view showing a modified example of the tip member. [Figure 39B] FIG. 10 is a perspective view showing a modified example of the tip member from a different angle. [Figure 39C] FIG. 10 is a cross-sectional view showing a modified example of the tip member. [Figure 40A] FIG. 10 is a cross-sectional view showing a modified example of the handle. [Figure 40B] FIG. 10 is a cross-sectional view showing another modified example of the handle. DETAILED DESCRIPTION OF THE INVENTION

[0038] A medical insertion aid according to a first embodiment of the present invention will be described below with reference to the drawings. The medical insertion aid 1 of the present invention is used during surgery (hereinafter referred to as "insertion surgery") to insert a gastrostomy tube 40 (see FIG. 12), which will be described later, into a patient's stomach, and includes an inner needle member 3 (see FIG. 10) in addition to the operating instrument 10 shown in FIG.

[0039] In the following explanation, for convenience, the X1 side of the arrow X1-X2 in Figure 1 will be referred to as the "front" and the X2 side as the "rear", the X3 side of the arrow X3-X4 will be referred to as the "left" and the X4 side as the "right", and the upper side will be referred to as the "top" and the lower side will be referred to as the "bottom".

[0040] As shown in FIG. 1, the operating instrument 10 includes, from left to right, an outer needle member 2, an attachment member 11, a connecting rod 12, and a grip 13.

[0041] The outer needle member 2 can be connected to the mounting member 11, and as will be described later, when the above-mentioned insertion surgery begins, it is inserted into the body wall while connected to the inner needle member 3 and not connected to the mounting member 11.

[0042] 2A, the outer needle member 2 includes an outer needle tube 20 and an outer needle base 21. In this embodiment, the outer needle member 2 corresponds to the needle member, the outer needle tube 20 corresponds to the needle and needle tube, and the outer needle base 21 corresponds to the base and base end.

[0043] The outer needle tube 20 comprises a slender, circular tubular tubular portion 20a and a base portion 20b (see Figure 4) connected to the right end of the tubular portion 20a. The tubular portion 20a extends in the axial direction by a predetermined length from the outer needle base portion 21, and its tip portion forms a tapered portion 20c whose diameter tapers toward the tip.

[0044] The tubular portion 20a of the outer needle tube 20 is made of a material (e.g., polyurethane) that becomes softer inside the body than outside the body due to body fluids or body temperature. This is to prevent the tubular portion 20a of the outer needle tube 20 from damaging the stomach wall, etc., during the above-mentioned insertion surgery.

[0045] The base 20b of the outer needle tube 20 is made of metal and has a funnel shape. As shown in FIG. 4, it has a cylindrical portion having the same diameter as the tubular portion 20a and connected to the right end of the tubular portion 20a, and a portion extending integrally to the right from this cylindrical portion and expanding in diameter into a funnel shape.

[0046] Furthermore, the outer needle base 21 is made of a hard synthetic resin, and the part of it on the outer needle tube 20 side is a conical part 21a that tapers toward the outer needle tube 20 side. This is to enable the surgeon to easily perform the task of enlarging the needle hole with the outer needle base 21 of the outer needle member 2 during insertion surgery.

[0047] 2A and 4, inner holes 21ba and 21bb are formed in the conical portion 21a, and these inner holes 21ba and 21bb extend axially through the conical portion 21a while communicating with each other. The left inner hole 21ba has a smaller diameter than the right inner hole 21bb, and the portion where the inner diameters of the inner holes 21ba and 21bb change is a stepped portion. The tubular portion 20a and base portion 20b of the outer needle tube 20 are fixed to the conical portion 21a with the base portion 20b abutting on the stepped portion between the inner holes 21ba and 21bb and the tubular portion 20a and base portion 20b fitted into the inner hole 21ba.

[0048] 2A, the portion of the outer needle base 21 opposite to the outer needle tube 20 is a connecting portion 21c having a shape in which the upper half of a cylinder is cut out, and two walls 21d, 21d are formed at the front-rear end of this connecting portion 21c so as to extend obliquely downward to the right from the conical portion 21a. In this embodiment, the connecting portion 21c corresponds to the cutout portion.

[0049] The connecting part 21c has a flat upper surface, and a groove 21e is formed in the center of the upper surface. This groove 21e has an arc-shaped cross section when viewed in the axial direction, and extends in the axial direction of the outer needle base 21. When the inner needle member 3 is inserted into the outer needle member 2, a gap is formed between the needle holding part 31a of the inner needle member 3 and this groove 21e, and the end of the connecting part 21c comes into contact with the inner needle member 3.

[0050] The inside of the lower side of the connecting portion 21c is hollow, and a pair of locking claws 21f, 21f is provided in this hollow space. When the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2, locking protrusions 11c, 11c described below of the mounting member 11 are snap-fitted onto these locking claws 21f, 21f. In this embodiment, the locking claws 21f correspond to the first connecting portion.

[0051] These locking claws 21f, 21f have a constant thickness in the vertical direction, and extend leftward from the right end of the outer needle base 21. The locking claws 21f, 21f have a shape that tapers toward the left when viewed in a plan view, and the gap between them in the front-to-rear direction narrows toward the left, with the distance between their tip ends 21g, 21g being the narrowest.

[0052] A guide groove 21h and an insertion hole 21j are further formed in the outer needle base 21. In this embodiment, the guide groove 21h corresponds to the guide portion, and the insertion hole 21j corresponds to the fitting hole. The guide groove 21h is for guiding the fitting portion 11d of the mounting member 11 when the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2, as will be described later.

[0053] 2B and 5B, the guide groove 21h extends a predetermined length from the right end of the outer needle base 21 to the left on the bottom surface of the outer needle base 21. When viewed in a plan view, the guide groove 21h extends leftward from the right end of the outer needle base 21 while its width decreases in a trapezoidal shape, and then extends further leftward with a constant width, with its left end portion being trapezoidal.

[0054] 2B to 2C and 5B, the insertion hole 21j is provided at a position at approximately the same height as the locking claws 21f, 21f inside the outer needle base 21. When the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2, an insertion portion 12d of the connecting rod 12, which will be described later, is inserted into this insertion hole 21j.

[0055] As shown in Fig. 6, the insertion hole 21j has a rectangular cross section when viewed in the axial direction, and is configured so that it extends a predetermined length to the left while continuing to the guide groove 21h, and then tapers off to a smaller height. In addition, a pair of front and rear openings 21m, 21m (see Fig. 5B) are formed on the lower side of the outer needle base 21.

[0056] Next, the mounting member 11 will be described. The mounting member 11 is connected to the grip 13 via a connecting rod 12. As shown in Figures 3A to 3C and 4, the mounting member 11 includes a base 11a, a locking portion 11b, a pair of locking projections 11c, 11c, and a fitting portion 11d. In this embodiment, the mounting member 11 corresponds to the connecting member, the locking portion 11b corresponds to the first locking portion, the locking projection 11c corresponds to the second connecting portion, and the fitting portion 11d corresponds to the guided portion.

[0057] The base 11a is configured so that the cross-sectional area when viewed in the axial direction increases from the right end to the left, and the curved surface has a curvature that increases from the right end to the left. As shown in Fig. 3C, the left end surface 11k of the base 11a is circular in side view and extends in the vertical direction.

[0058] Locking portion 11b is used to lock bumper 41 of gastrostomy tube 40 so that gastrostomy tube 40 does not slip out of operating instrument 10 during insertion surgery, and is cylindrical and extends a predetermined length to the left from left end face 11k of base portion 11a. The tip of locking portion 11b is rounded.

[0059] A weight-removing hole 11e is formed inside the base 11a to reduce the weight of the mounting member 11, and is provided so as to extend into the base 11a at a position below the locking portion 11b.

[0060] 3A to 3C and 5A, the pair of locking projections 11c, 11c extend in the axial direction with a predetermined gap between them. Each of the locking projections 11c, 11c has a thin shaft portion 11ca extending leftward from the base portion 11a and a protrusion portion 11cb provided at the left end of the thin shaft portion 11ca.

[0061] The protrusion portion 11cb has a shape that protrudes outward in the front-rear direction from the thin shaft portion 11ca and then decreases in length in the front-rear direction toward the left end. When the mounting member 11 is connected to the outer needle member 2, first, the insertion portion 12d of the connecting rod 12 is inserted into the insertion hole 21j, and as a result, the protrusions 11cb, 11cb of the locking protrusions 11c, 11c are inserted from the right between the locking claws 21f, 21f of the outer needle base 21. This causes the locking claws 21f, 21f to elastically deform so as to widen the radial distance between them.

[0062] 5A, when the protrusions 11cb, 11cb climb over the tip ends 21g, 21g of the locking claws 21f, 21f, the tip ends 21g, 21g of the locking claws 21f come into contact with the protrusions 11cb, 11cb, and the locking protrusions 11c, 11c are snap-fitted into the locking claws 21f, 21f. As a result, the mounting member 11 and the outer needle member 2 are connected to each other in a locked state.

[0063] Furthermore, the fitting portion 11d is disposed below the pair of locking projections 11c, 11c, and has the same shape as the guide groove 21h when viewed from the bottom side as shown in Fig. 5B. When the mounting member 11 is connected to the outer needle member 2, the fitting portion 11d is fitted into the guide groove 21h while being guided by the guide groove 21h.

[0064] Furthermore, as shown in Figure 5B, when the mounting member 11 and the outer needle member 2 are connected to each other, the end face 11k of the mounting member 11 and the end face 21k of the outer needle member 2 are in surface contact, thereby firmly connecting the mounting member 11 and the outer needle member 2 without any rattle.

[0065] Furthermore, through holes 11f and 11g are formed in the mounting member 11 (see FIG. 4). The through hole 11f has a circular cross section when viewed in the axial direction, and extends a predetermined length from the right end of the mounting member 11 toward the left.

[0066] As shown in FIG. 3C, the through-hole 11g has a cross-sectional shape in which a circle is cut out by two straight lines extending parallel to each other in the up-down direction (that is, an oval cross-sectional shape) when viewed from the axial direction.

[0067] Next, the connecting rod 12 will be described. As shown in Figures 7A to 7C, the connecting rod 12 includes a base portion 12a, an inclined portion 12b, an eccentric portion 12c, an insertion portion 12d, and a fitting portion 12e. In the connecting rod 12, portions 12a to 12c and 12e other than the insertion portion 12d are formed in a cylindrical shape.

[0068] In this embodiment, the connecting rod 12 corresponds to the connecting member, the inserting portion 12d corresponds to the protruding portion, and the fitting portion 12e corresponds to the convex portion.

[0069] The base 12a extends in the left-right direction for a predetermined length, the inclined portion 12b continues from the left end of the base 12a and extends diagonally downward to the left, and the eccentric portion 12c continues from the left end of the inclined portion 12b and extends leftward in an eccentric state with respect to the base 12a.

[0070] Insertion portion 12d extends leftward from the left end of eccentric portion 12c, and has a cross-sectional shape like a circle cut by two parallel straight lines (that is, an oval cross-sectional shape) when viewed from the axial direction.

[0071] As shown in FIG. 4, the connecting rod 12 is attached to the mounting member 11 with the eccentric portion 12c fitted into the through hole 11f of the mounting member 11 and the insertion portion 12d fitted into the through hole 11g of the mounting member 11.

[0072] Furthermore, when the connecting rod 12 is attached to the mounting member 11, the insertion portion 12d of the connecting rod 12 protrudes leftward from the mounting member 11 (see FIG. 13). When the mounting member 11 is connected to the outer needle member 2, the insertion portion 12d is inserted into the insertion hole 21j of the outer needle member 2 and fits therein.

[0073] 6, when the insertion portion 12d is fitted into the insertion hole 21j of the outer needle member 2, the front and rear walls of the insertion portion 12d are in contact with the walls of the insertion hole 21j. As a result, even when a rotational moment around the axis acts on the connecting rod 12 during an insertion surgery, which will be described later, the mounting member 11 will not rotate or rattle relative to the connecting rod 12.

[0074] Next, we will explain the grip 13. The grip 13 is a combination of a first grip member 13A and a second grip member 13B shown in Fig. 8, and the two grip members 13A and 13B are made of synthetic resin.

[0075] In this embodiment, the grip 13 corresponds to the gripping member, the first gripping member 13A corresponds to the first gripping member, and the second gripping member 13B corresponds to the second gripping member.

[0076] The edges of the two grip members 13A and 13B are formed with recesses and protrusions that can fit together, and the grip 13 is assembled by fitting these recesses and protrusions together and fixing them together using ultrasonic welding.

[0077] The left end of each of the two grip members 13A, 13B is provided with a semicircular recess 13a for passing the connecting rod 12 through, and a locking portion 13b for locking the tubular portion 42 of the gastrostomy tube 40.

[0078] When the grip 13 is assembled, the connecting rod 12 passes through a hole formed by the two recesses 13a, 13a and protrudes to the left of the grip 13. The space between the locking portions 13b, 13b forms an locking hole for locking the tubular portion 42 of the gastrostomy tube 40, and this locking hole is circular when viewed from the axial direction, with the upper side open upward at a distance significantly narrower than the diameter of the circle.

[0079] As will be described later, during surgery to insert the gastrostomy tube 40, the tubular portion 42 of the gastrostomy tube 40 is inserted into the locking hole between the locking portions 13b, 13b, thereby locking the tubular portion 42 to the locking portions 13b, 13b. In this embodiment, the locking portion 13b corresponds to the second locking portion.

[0080] Furthermore, four fitting holes 13c (recesses) are formed on the inside of the first grip member 13A, aligned on the left and right sides. These fitting holes 13c have a circular cross-sectional shape when viewed from the front. The fitting portion 12e of the connecting rod 12 extends rearward from the right end of the base portion 12a and has a circular cross-sectional shape when viewed from the front. This fitting portion 12e is configured to be able to selectively fit into any one of the four fitting holes 13c.

[0081] That is, by changing the fitting hole 13c into which the fitting portion 12e of the connecting rod 12 fits, the length of the connecting rod 12 protruding from the grip 13 can be changed in four stages as shown in Figures 9A to 9D. As a result, the length of the operating instrument 10, i.e., the medical insertion aid 1, can be changed in four stages.

[0082] Furthermore, the right-side portions of the two grip members 13A, 13B form gripping portions 13d, 13d, and protrusions 13e, 13f are provided inside these gripping portions 13d, 13d. When the grip 13 is assembled, these protrusions 13e, 13f abut against each other, which reduces the degree to which the gripping portion 13d of the grip 13 is deformed inward when it is gripped. Note that these protrusions 13e, 13f may be omitted if not necessary.

[0083] Next, the inner needle member 3 will be described with reference to Fig. 10. When starting an insertion surgery, the inner needle member 3 is inserted into the body wall while connected to the outer needle member 2. As shown in Fig. 10, the inner needle member 3 comprises an inner needle 30 and an inner needle base 31.

[0084] The inner needle 30 is a slender, solid metal (e.g., stainless steel) needle with a circular cross section, and its tip is cut at an angle. The diameter of the inner needle 30 is set to a value slightly smaller than the inner diameter of the outer needle tube 20 of the outer needle member 2.

[0085] The inner needle base 31 is made of synthetic resin and includes a needle holding portion 31a, a base portion 31b, and an operating portion 31c. The needle holding portion 31a, base portion 31b, and operating portion 31c are integrally formed. The needle holding portion 31a is cylindrical and protrudes leftward from the base portion 31b. The inner needle 30 is fixed to the needle holding portion 31a with its right end portion fitted into the needle holding portion 31a.

[0086] The base 31b is cylindrical, and the operating portion 31c is cylindrical with a slightly smaller diameter than the base 31b. Four ribs 31d are formed on the operating portion 31c. These ribs 31d protrude radially from the operating portion 31c at a predetermined height, extend in the axial direction, and are arranged at equal intervals around the circumference of the operating portion 31c.

[0087] 11A and 11B, during insertion surgery, the inner needle member 3 is used in a state connected to the outer needle member 2. When connected in this state, the inner needle 30 is inserted into the outer needle tube 20 of the outer needle member 2 to a position where the base portion 31b of the inner needle member 3 abuts against the connecting portion 21c of the outer needle member 2. In this state, the tip portion of the inner needle 30 protrudes outward from the outer needle tube 20 by a predetermined length.

[0088] Next, the gastrostomy tube 40 will be described with reference to Figure 12. The gastrostomy tube 40 is used for gastrostomy treatment and is made of a material (such as silicone resin) that has elastically deformable properties.

[0089] The gastrostomy tube 40 includes a bumper 41, a tubular section 42, a flange 43, a port section 44, and a lid section 45. In this embodiment, the gastrostomy tube 40 corresponds to the medical device, the bumper 41 corresponds to the indwelling section, and the flange 43 and the port section 44 correspond to the base end.

[0090] Bumper 41 is placed in the stomach and serves to prevent gastrostomy tube 40 from slipping out of the body, and is configured with a larger diameter than tubular portion 42. Bumper 41 is a hollow member that, when viewed from the side, has a shape formed by connecting two arcs with a straight line and is open downward. A recess (not shown) is formed in the inner wall surface of bumper 41, and when gastrostomy tube 40 is attached to operating instrument 10, locking portion 11b of attachment member 11 is inserted into this recess.

[0091] The pipe portion 42 is configured in a hollow cylindrical shape and extends between the bumper 41 and the flange portion 43. The flange portion 43 is formed in a thin plate shape. The port portion 44 protrudes upward from the flange portion 43 and is also formed in a cylindrical shape.

[0092] The port portion 44 has a hole 44a for supplying nutrients into the stomach, and this hole 44a extends through the flange portion 43, the tube portion 42, and the bumper 41. The lid portion 45 extends radially outward from the flange portion 43 and has a protrusion 45a for closing the hole 44a.

[0093] Next, with reference to FIGS. 13 to 17, a surgical procedure for inserting a gastrostomy tube 40 into a patient's stomach using the medical insertion aid 1 configured as described above will be described.

[0094] First, as shown in Fig. 13, the surgeon attaches the gastrostomy tube 40 to the operating instrument 10. Specifically, after the locking portion 11b of the mounting member 11 is inserted into the recess of the bumper 41 of the gastrostomy tube 40, the upper end of the tubular portion 42 is inserted between the locking portions 13b, 13b of the grip 13 with the flange portion 43 pulled toward the grip 13.

[0095] As a result, the upper end of the tubular portion 42 is locked by the locking portions 13b, 13b, and accordingly, the flange portion 43 and the port portion 44 are also locked by the locking portions 13b, 13b. In this way, the gastrostomy tube 40 is attached to the operating instrument 10.

[0096] Next, as shown in Figure 14A, with the inner needle member 3 connected to the outer needle member 2, the inner needle 30 and the outer needle tube 20 are punctured into the body wall 50 so as to penetrate the body wall 50. Note that the body wall 50 shown in Figure 14A is an integrated representation of the abdominal wall and stomach wall, and this also applies to Figure 14B and other figures described below.

[0097] Next, the inner needle member 3 is pulled out from the outer needle member 2, leaving only the outer needle tube 20 of the outer needle member 2 penetrated through the body wall 50, as shown in FIG. 14B.

[0098] 15 , the operating instrument 10, with the gastrostomy tube 40 attached, is moved in the direction of arrow X5 in the figure, and the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2. At this time, as described above, the insertion portion 12d of the connecting rod 12 is inserted into the insertion hole 21j of the outer needle member 2, and the fitting portion 11d of the mounting member 11 is guided by the guide groove 21h of the outer needle member 2, while the locking protrusions 11c, 11c of the mounting member 11 are snap-fitted into the locking claws 21f, 21f of the outer needle member 2. This connects the mounting member 11 of the operating instrument 10 to the outer needle member 2.

[0099] Next, the surgeon pushes down the operating instrument 10 while holding the grip 13, and while expanding the needle hole formed by the inner needle member 3 and the outer needle member 2, inserts the gastrostomy tube 40 together with the operating instrument 10 into the body wall 50 (dilatation). As a result, the bumper 41 of the gastrostomy tube 40 becomes inserted into the patient's stomach, as shown in Figure 16.

[0100] Thereafter, while holding the port portion 44 of the gastrostomy tube 40 with his / her hand, the surgeon releases the bumper 41 from the attachment member 11 and removes the operating instrument 10 from the patient's stomach and body wall 50. As a result, as shown in Figure 17, the gastrostomy tube 40 is in a state where the bumper 41 is left in the stomach, the tubular portion 42 has penetrated the body wall 50, and the port portion 44 and other portions are outside the body. This completes the insertion of the gastrostomy tube 40.

[0101] As described above, the medical insertion aid 1 of the first embodiment eliminates the need for instruments equivalent to the conventional sheath and dilator when inserting the bumper 41 of the gastrostomy tube 40 into the body wall 50. As a result, the surgeon can insert the gastrostomy tube 40 into the body using fewer instruments than conventionally.

[0102] This reduces the cost of the medical insertion aid 1. For the same reason, unlike conventional methods, it is no longer necessary to attach a sheath to a dilator, remove the dilator from the sheath, and then insert the obturator with the gastrostomy tube attached into the sheath. This reduces the number of procedures and the surgical time required for the surgery to insert the gastrostomy tube 40, thereby reducing the burden on the patient.

[0103] Furthermore, since the outer needle tube 20 of the outer needle member 2 is configured to be softer when it is inside the body wall 50 than when it is outside the body wall 50, it is possible to prevent the outer needle tube 20 of the outer needle member 2 from damaging the stomach wall during surgery to insert the gastrostomy tube 40. This reduces the burden on the patient during surgery.

[0104] Furthermore, when the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2, the engaging portion 11d of the mounting member 11 is guided by the guide groove 21h of the outer needle member 2, while the locking projections 11c, 11c are snap-fitted into the locking claws 21f, 21f of the outer needle member 2. Therefore, it is possible to improve the workability when connecting the mounting member 11 of the operating instrument 10 to the outer needle member 2, and shorten the surgical time.

[0105] Furthermore, when the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2, the front and rear wall portions of the insertion portion 12d at the tip of the operating instrument 10 fit snugly into the insertion hole 21j of the outer needle member 2, so that the mounting member 11 of the operating instrument 10 and the outer needle member 2 are connected in a state where they cannot rotate around the axis. This makes it possible to prevent the outer needle member 2 from rattling relative to the operating instrument 10 when the surgeon inserts the outer needle member 2 and the operating instrument 10 into the body wall 50 while rotating them while holding the grip 13 of the operating instrument 10.

[0106] On the other hand, the connecting portion 21c of the outer needle member 2 has a shape in which adjacent radial portions are hollowed out, and the locking portion 11b of the mounting member 11 is configured to have a gap between it and the connecting portion 21c of the outer needle member 2 when the operating instrument 10 is connected to the outer needle member 2. As a result, when the bumper 41 of the gastrostomy tube 40 is locked to the locking portion 11b, the bumper 41 enters the gap between the locking portion 11b and the connecting portion 21c, reducing the degree to which the bumper 41 protrudes radially outward from the operating instrument 10.

[0107] In addition, the locking protrusions 11c, 11c of the operating instrument 10 and the connecting portion 21c and locking claws 21f, 21f of the outer needle member 2 are positioned so as to be radially spaced apart from the central axis of the outer needle member 2 when the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2, thereby further reducing the degree to which the bumper 41 protrudes radially outward from the operating instrument 10.

[0108] Furthermore, the gastrostomy tube 40 is attached to the operating instrument 10 with the bumper 41 locked to the locking portion 11b of the mounting member 11 and the flange portion 43 locked to the locking portions 13b, 13b. At this time, the eccentric portion 12c and the insertion portion 12d of the connecting rod 12 are positioned eccentrically relative to the base portion 12a, so the gastrostomy tube 40 can be brought closer to the operating instrument 10, and the degree to which the gastrostomy tube 40 protrudes outward in the radial direction of the operating instrument 10 can be reduced. As described above, the bumper 41 of the gastrostomy tube 40 can be more easily inserted into the body.

[0109] Furthermore, by changing the fitting hole 13c into which the fitting portion 12e of the connecting rod 12 fits, the length of the operating instrument 10, i.e., the medical insertion aid 1, can be changed in four stages. As a result, even if the length of the gastrostomy tube 40 varies, the gastrostomy tube 40 can be appropriately attached to the operating instrument 10 while accommodating the length.

[0110] Although the first embodiment is an example in which both the outer needle member 2 and the inner needle member 3 are used during the surgery to insert the gastrostomy tube 40, the inner needle member 3 may be omitted and only the outer needle member 2 may be used. In that case, during the insertion surgery, the outer needle member 2 is replaced with the outer needle tube 20, which is a solid needle-shaped member, and after the outer needle member 2 has punctured the body wall, the mounting member 11 of the operating instrument 10 is connected to the outer needle member 2. In this case, for example, it is preferable to use, for the outer needle tube 20, a material that is hard at the time of puncture and softens after puncture.

[0111] Furthermore, the first embodiment is an example in which a straight tube is used as the outer needle tube 20 of the outer needle member 2, but instead, the outer needle tube 20 of the outer needle member 2 may be one that is normally maintained in a curved shape and has the property of being able to insert the inner needle member 3 by elastic deformation.

[0112] Furthermore, although the first embodiment is an example in which the medical insertion aid 1 is used to insert a gastrostomy tube 40 into a body wall 50, the medical insertion aid of the present invention is not limited to this and can be used when inserting various medical instruments into the body. For example, the medical instrument to be inserted into the body is not limited to a gastrostomy tube, and various catheters can be used.

[0113] On the other hand, the first embodiment is an example in which the guide groove 21h as a guiding portion is provided on the outer needle member 2 and the fitting portion 11d as a guided portion is provided on the operating instrument 10, but the guide groove as a guided portion may be provided on the operating instrument 10 and a protrusion as a guiding portion may be provided on the outer needle member 2. Furthermore, the guide portion and the guided portion are not limited to the guide groove 21h and fitting portion 11d of the embodiment, as long as they are guided by each other. For example, one of the guiding portion and the guided portion may be configured as a recess, and the other of the guiding portion and the guided portion may be configured as a protrusion guided by the recess.

[0114] Furthermore, although the first embodiment is an example in which fitting hole 13c as a recess is formed in first grip member 13A, fitting hole 13c may also be formed in second grip member 13B, in which case fitting portion 12e of connecting rod 12 may be configured to extend forward from the right end of base portion 12a. Furthermore, the recess and protrusion in the first grip member and second grip member are not limited to fitting hole 13c and fitting portion 12e, but may be any recess and protrusion that can be fitted into each other.

[0115] A medical insertion aid according to a second embodiment of the present invention will now be described with reference to the drawings. Similar to the medical insertion aid 1 of the first embodiment, a medical insertion aid 1A of the second embodiment shown in Fig. 18 is used during surgery to insert a gastrostomy tube 40 into a patient's stomach.

[0116] 18 to 20, this medical insertion aid 1A includes a guidewire 70 (see FIGS. 33 to 36), the outer needle member 2, and the inner needle member 3. Here, the outer needle member 2 and the inner needle member 3 are the same as those in the first embodiment, and therefore description thereof will be omitted.

[0117] Note that the medical insertion aid 1A of the second embodiment may use an outer needle member and an inner needle member having a configuration different from the outer needle member 2 and inner needle member 3 of the first embodiment. For example, an outer needle member having a configuration in which the connecting portion 21c of the outer needle member 2 is omitted may be used.

[0118] In the following description, for convenience, the left-right direction in FIG. 19 will be referred to as "left-right", the up-down direction as "up-down", the back side of FIG. 19 as "rear" and the front side as "front".

[0119] First, a description will be given of the operating tool 60. As shown in Figures 18 to 20, the operating tool 60 includes a tip member 61, a locking member 62, an outer tube 63, an inner tube 64, a grip 65, and a handle 66.

[0120] The tip member 61 is made of hard synthetic resin and includes a conical portion 61a, a step portion 61b, and an insertion portion 61c, as shown in Figures 21A to 21C. The conical portion 61a, step portion 61b, and insertion portion 61c are integrally formed. The conical portion 61a has a shape that tapers toward the left. This is to allow the surgeon to easily use the conical portion 61a to enlarge the needle hole during insertion surgery, as will be described later.

[0121] The step portion 61b has a shape such that the upper portion of the tip member 61 is cut out, and the upper end surface thereof is formed flat. This step portion 61b has a predetermined gap between its upper surface and a locking portion 62b (described later) of the locking member 62. In this embodiment, the tip member 61 corresponds to the base portion, and the step portion 61b corresponds to the notch portion.

[0122] The insertion portion 61c is the portion that is inserted into the mating hole 62e of the locking member 62, which will be described later, when the tip member 61 moves from the open position to the closed position, which will be described later. The upper end surface of the insertion portion 61c is formed flat, and the front and rear side surfaces have a curved shape that convex inward from the upper end surface downward.

[0123] Inner holes 61d and 61e are formed on the lower side inside the tip member 61. These inner holes 61d and 61e extend in the left-right direction across the conical portion 61a, the step portion 61b, and the insertion portion 61c, are concentric and communicate with each other, and have a circular cross section when viewed from the axial direction.

[0124] The inner hole 61d opens at the left end of the tip member 61 and extends a predetermined length from the left end toward the right of the tip member 61. The inner hole 61e has a slightly larger diameter than the inner hole 61d and extends from the right end of the inner hole 61d to the right end of the tip member 61. In this embodiment, in addition to the inner hole 61d, inner holes 64a and 66d, which will be described later, correspond to through holes.

[0125] The tip member 61 is formed by insert molding integrally with the left end of the inner tube 64. The inner tube 64 is made of metal and formed into a circular tube, with its outer circumferential surface in close contact with the inner hole 61e and its inner hole 64a concentric with and having the same diameter as the inner hole 61d of the tip member 61 so as to communicate with each other.

[0126] Next, the locking member 62 will be described. As shown in Figures 22A to 22C, the locking member 62 includes a base portion 62a, a locking portion 62b, and a fitting portion 62c. The base portion 62a, the locking portion 62b, and the fitting portion 62c are integrally formed. In this embodiment, the locking portion 62b corresponds to the first locking portion.

[0127] The base 62a is configured so that the cross-sectional area when viewed in the axial direction increases from the right end to the left, and the surface is curved and the curvature of the surface increases from the right end to the left.

[0128] The locking portion 62b is used to lock the bumper 41 of the gastrostomy tube 40 so that the gastrostomy tube 40 does not come off the operating instrument 60 during insertion surgery, and is cylindrical and extends a predetermined length to the left from the base 62a. The tip of the locking portion 62b is rounded and chamfered.

[0129] A thickness-removing hole 62d is formed inside the base portion 62a in order to reduce the weight of the locking member 62, and is provided so as to extend into the base portion 62a at a position lower than the locking portion 62b.

[0130] Furthermore, the fitting portion 62c protrudes leftward from the lower end of the base portion 62a, and a fitting hole 62e is formed inside the fitting portion 62c. This fitting hole 62e has a semicircular cross section when viewed from the left and right, and the insertion portion 61c of the tip member 61 is inserted into the fitting hole 62e when the tip member 61 moves from the open position to the closed position, which will be described later.

[0131] Furthermore, in addition to the fitting hole 62e, two round holes 62f, 62g are formed inside the locking member 62, and the fitting hole 62e and the round holes 62f, 62g are connected to each other. The round hole 62f is provided between the fitting holes 62e and 62g and has a diameter slightly larger than the outer periphery of the inner tube 64. The inner tube 64 is fitted into the round hole 62f so as to be slidable in the left-right direction.

[0132] 23, outer tube 63 is fixed to locking member 62 with adhesive, with its right end inserted into round hole 62g.

[0133] The outer tube 63 has a circular tube shape extending in the left-right direction, and has a pair of notches 63b, 63b formed at its right end, as shown in Fig. 24. These notches 63b, 63b are used to lock the right end of the outer tube 63 to the grip 65, as will be described later, and each of the notches 63b, 63b has a shape in which part of a circle is cut out in an arc shape by a straight line extending in the up-down direction when viewed from the left-right direction.

[0134] On the other hand, the inner tube 64 is a circular tube that extends in the left-right direction while inserted into the outer tube 63. The left end of the inner tube 64 is fixed to the tip member 61 as described above, and the right end is fixed to the handle 66 as described below.

[0135] The outer diameter of the inner tube 64 is set slightly smaller than the diameter of the inner hole 63a of the outer tube 63, so that the inner tube 64 is fitted to the outer tube 63 so as to be slidable in the left-right direction. In this embodiment, the outer tube 63 corresponds to the first tube member, and the inner tube 64 corresponds to the second tube member.

[0136] Next, we will explain the grip 65. The grip 65 is a combination of a first grip member 65A and a second grip member 65B shown in Figure 25, and the two grip members 65A and 65B are made of synthetic resin.

[0137] The edges of the two grip members 65A, 65B are formed with recesses and protrusions that can fit together, and the grip 65 is assembled by fitting these recesses and protrusions together and fixing them together using ultrasonic welding.

[0138] In the case of the grip members 65A and 65B, the configurations other than the edges of both are configured to be plane symmetrical to each other, so the following description will be given taking the first grip member 65A as an example.

[0139] The left end of first grip member 65A is provided with a recess 65a for passing outer tube 63 therethrough and a locking portion 65b for locking tube portion 42 of gastrostomy tube 40. Recess 65a is formed in a semicircular shape when viewed from the left and right. In this embodiment, locking portion 65b corresponds to the second locking portion.

[0140] When the grip 65 is assembled, the space between the locking portions 65b, 65b forms a locking hole for locking the tubular portion 42 of the gastrostomy tube 40. This locking hole is circular when viewed from the left and right, with the upper side opening upward at a distance considerably narrower than the diameter of the circle.

[0141] As will be described later, during surgery to insert the gastrostomy tube 40, the tubular portion 42 of the gastrostomy tube 40 is inserted into the locking hole between the locking portions 65b, 65b, whereby the tubular portion 42 is locked to the locking portions 65b, 65b.

[0142] Additionally, three ribs 65c, 65d, and 65e are provided inside first grip member 65A from left to right. A recess 65f is formed in a predetermined position above rib 65c. This recess 65f has a semicircular shape when viewed from the left and right.

[0143] Furthermore, a recess 65g is formed at a predetermined position on the upper side of the rib 65d. This recess 65g is formed by cutting out the rib 65d, and has a shape in which part of a semicircle is cut out by a straight line extending in the up-down direction when viewed from the left-right direction.

[0144] Furthermore, a recess 65h is formed at a predetermined position of the rib 65e. This recess 65h has a semicircular shape when viewed from the left-right direction and extends rightward from the left end of the rib 65e to a predetermined depth.

[0145] As shown in Figure 26, when the grip 65 is assembled, the outer tube 63 protrudes to the left of the grip 65 through the hole formed by the recesses 65g, 65g and the hole formed by the two recesses 65a, 65a.

[0146] The right end of the outer tube 63 fits into a hole formed by the two recesses 65h. Furthermore, the notches 63b at the right end of the outer tube 63 fit into holes formed by the recesses 65g. This locks the outer tube 63 to the grip 65 so that it cannot move in the left-right direction. In other words, the outer tube 63 is locked to the grip 65 in a non-detachable state.

[0147] The right side of the grip member 65A is a gripping portion 65j, which is gripped by the surgeon during the insertion surgery. Furthermore, recesses 65k and 65m are formed on the upper and lower sides of the right end portion of the grip member 65A.

[0148] This recess 65k has a rectangular shape with the lower side shortened when viewed from the left and right, and when the grip 65 is assembled, the handle 66 fits into the opening formed by the recesses 65k, 65k (see Figure 28C).

[0149] Further, recess 65m has a shape that extends obliquely downward and outward when viewed from the left and right direction, and when grip 65 is in an assembled state, recesses 65m, 65m form an opening as shown in Fig. 28B. The meaning of this opening will be described later.

[0150] Next, the handle 66 will be described with reference to Figures 27A to 28C. The handle 66 is made of synthetic resin, and as shown in Figures 27A to 27B, includes an attachment portion 66a and a grip portion 66b. The attachment portion 66a and the grip portion 66b are integrally formed. In this embodiment, the handle 66 corresponds to the operating member.

[0151] The mounting portion 66a is configured in a rectangular column shape and protrudes forward from the grip portion 66b. The grip portion 66b is larger in size in the front-to-rear direction than the mounting portion 66a, and has a shape that extends to the right from the mounting portion 66a and then bends downward.

[0152] 27A and 28A, an inner hole 66c is formed inside the mounting portion 66a so as to extend along the central axis thereof. This inner hole 66c is a round hole with a circular cross section when viewed from the left and right direction.

[0153] The inner tube 64 is fixed to the mounting part 66a with an adhesive, with its right end inserted into the inner hole 66c. The opening formed by the recesses 65m, 65m (see FIG. 28B) is for confirming the fixed state of the inner tube 64 to the mounting part 66a when assembling the operating tool 60.

[0154] As shown in Figure 28C, the mounting portion 66a is fitted into the opening formed by the recesses 65k, 65k so as to be freely slidable in the left-right direction, thereby preventing the handle 66 from rotating around the central axis of the inner tube 64 relative to the grip 65.

[0155] In addition to the inner hole 66c, an inner hole 66d and an outlet 66e are formed inside the handle 66. These inner holes 66c, 66d, and outlet 66e are connected to each other. The inner hole 66d is a circular hole with a circular cross section when viewed from the left and right, extends rightward from the inner hole 66c, and has the same diameter as the inner diameter of the inner tube 64.

[0156] The outlet 66e, which is used to withdraw the distal end of the guidewire 70 from the operating instrument 60 during insertion surgery, is groove-shaped and extends rightward from the inner hole 66d. As shown in Figures 27B and 28A, the outlet 66e has front and rear walls that extend parallel to each other, an upper wall that curves obliquely upward to the right, and a lower wall that also extends obliquely upward to the right. In other words, the outlet 66e has a shape that opens widely in the vertical direction, which allows the distal end of the guidewire 70 to be easily withdrawn from the outlet 66e.

[0157] According to the operating device 60 configured as described above, since the handle 66 is connected to the tip member 61 via the inner tube 64, by operating the handle 66 in the left-right direction, the tip member 61 moves in the left-right direction relative to the locking member 62.

[0158] Specifically, when the handle 66 is moved to the right, the insertion portion 61c of the tip member 61 fits into the fitting hole 62e of the locking member 62, and the tip member 61 moves to and stops at the closed position shown in Fig. 29A. At this closed position, the distance in the left-right direction between the tip member 61 and the locking portion 62b of the locking member 62 is minimized.

[0159] Conversely, when the handle 66 is moved leftward, the gripping portion 66b of the handle 66 comes into contact with the right end portion of the grip 65, and the tip member 61 stops at the open position shown in Fig. 29B. At this open position, the distance in the left-right direction between the tip member 61 and the locking portion 62b of the locking member 62 is maximized.

[0160] Furthermore, the word "closed" is written on the upper surface of the attachment portion 66a of the handle 66, and when the distal end member 61 is in the closed position, the word "closed" is visible from above, as shown in Fig. 30A. On the other hand, when the distal end member 61 is in the open position, the word "closed" is not visible from above, as shown in Fig. 30B. This is to improve convenience when attaching the gastrostomy tube 40 to the operating instrument 60, as will be described later.

[0161] In this case, instead of the character "closed", a symbol or character indicating that the tip member 61 is in the closed position may be used. For example, the character "CLOSE" may be used.

[0162] Next, a procedure for an insertion operation in which the gastrostomy tube 40 is inserted into the stomach of a patient using the medical insertion aid 1A configured as described above will be described.

[0163] First, the surgeon pushes the handle 66 toward the grip 65, placing the tip member 61 in the open position, and then inserts the locking portion 62b of the locking member 62 into the recess in the bumper 41 of the gastrostomy tube 40, as shown in FIG. 31A.

[0164] Next, the handle 66 is pulled to the right, and the tip member 61 moves to the closed position, whereby the bumper 41 of the gastrostomy tube 40 is held between the tip member 61 and the locking member 62, as shown in Fig. 31B. Thereafter, the surgeon inserts the tubular portion 42 of the gastrostomy tube 40 between the locking portions 65b, 65b of the grip 65, and the tubular portion 42 is locked by the locking portions 65b, 65b. As a result, the gastrostomy tube 40 is attached to the operating instrument 60, as shown in Fig. 32.

[0165] Next, as described above, the surgeon punctures the body wall 50 with the inner needle 30 and the outer needle tube 20 penetrating the body wall 50 while the inner needle member 3 is connected to the outer needle member 2, and then removes the inner needle member 3 from the outer needle member 2, leaving only the outer needle tube 20 of the outer needle member 2 penetrating the body wall 50, as shown in Figure 14B described above.

[0166] 33, the guidewire 70 is inserted into the outer needle tube 20 of the outer needle member 2, and the lower end of the guidewire 70 is inserted into the body wall 50. Next, after the outer needle member 2 is removed from the body wall 50, the tip of the guidewire 70 is inserted into the inner hole 61d of the tip member 61 of the operating instrument 60 with the gastrostomy tube 40 attached. Then, in this state, the operating instrument 60 is pushed downward along the guidewire 70.

[0167] Accordingly, the distal end of the guide wire 70 passes through the inner tube 64 and comes out upward from the outlet 66e of the handle 66, and the surgeon then pulls out the distal end of the guide wire 70. By the above operation, the guide wire 70 passes through the operating instrument 60, as shown in Figure 34.

[0168] Next, the surgeon rotates the operating instrument 60 around the central axis of the outer tube 63 and simultaneously pushes it downward along the guide wire 70, thereby dilating the puncture hole in the body wall 50 and inserting the operating instrument 60 together with the gastrostomy tube 40 into the body wall 50 (dilatation). As a result, as shown in Figure 35, the bumper 41 of the gastrostomy tube 40 becomes inserted into the patient's stomach.

[0169] Next, the surgeon holds the grip 65 and pushes down the handle 66 to move the tip member 61 to the open position. After that, while holding the port portion 44 of the gastrostomy tube 40 with his / her hand, he / she releases the state in which the bumper 41 is locked by the locking member 62 and removes the operating instrument 60 from the stomach and body wall 50 of the patient.

[0170] As a result, as shown in Figure 36, the guide wire 70 and gastrostomy tube 40 penetrate the body wall 50, the bumper 41 of the gastrostomy tube 40 is left in the stomach, and the port section 44 and other components are outside the body. Next, the surgeon pulls out the guide wire 70 from the body wall 50, and the gastrostomy tube 40 returns to the state shown in Figure 17. This completes the gastrostomy tube 40 insertion surgery.

[0171] As described above, according to the medical insertion aid 1A of the second embodiment, during surgery to insert a gastrostomy tube 40, the operating instrument 60 equipped with the gastrostomy tube 40 can be inserted into the body wall 50 without using instruments equivalent to a conventional sheath and dilator. This allows the use of gastrostomy tubes 40 with shapes other than those that can be inserted into a sheath, improving versatility. Furthermore, since instruments equivalent to a conventional sheath and dilator are no longer necessary, the cost of the medical insertion aid 1A can be reduced. For the same reason, unlike conventional devices, it is no longer necessary to attach a sheath to a dilator, and then detach the dilator from the sheath and insert an obturator equipped with a gastrostomy tube 40 into the sheath. This eliminates the need for the number of procedures and the time required during surgery, thereby reducing the burden on the patient.

[0172] Furthermore, the tip member 61 is configured to be movable relative to the locking member 62 between the closed position shown in Fig. 29A and the open position shown in Fig. 29B. As a result, when locking the bumper 41 of the gastrostomy tube 40 to the locking portion 62b of the locking member 62, the tip member 61 is moved to the open position to widen the gap between the locking portion 62b and the tip member 61, making it easier to perform the locking operation.

[0173] Furthermore, grip 65 has locking portions 65b, 65b for locking tubular portion 42 of gastrostomy tube 40. As a result, bumper 41 of gastrostomy tube 40 is locked to locking portion 62b, and with tubular portion 42 of gastrostomy tube 40 locked to locking portions 65b, 65b, bumper 41 of gastrostomy tube 40 can be inserted into body wall 50, making the insertion process easy.

[0174] In addition, since the handle 66 is connected to the right end of the inner tube 64 and the tip member 61 is connected to the left end of the inner tube 64, by operating the handle 66 in the extension direction of the operating tool 60, the tip member 61 can be easily moved relatively to the locking member 62 between the closed position and the open position.

[0175] Furthermore, the mounting portion 66a of the handle 66 is fitted to the grip 65 in a state where it cannot rotate around the central axis of the inner tube 64. This prevents the tip member 61 from rattling relative to the operating instrument 60 when the surgeon inserts the operating instrument 60 into the body wall 50 while rotating it while holding the grip 65 of the operating instrument 60.

[0176] When the tip member 61 and the inner tube 64 are insert-molded, the left end of the inner tube 64 may be configured as shown in Figure 37 or 38. In the case of the inner tube 64 shown in Figure 37, an annular groove 64b is formed in its left end. The portion of this annular groove 64b is configured to have a smaller outer diameter and a thinner wall than other portions of the inner tube 64. When the inner tube 64 is configured in this way, it is possible to prevent the inner tube 64 from coming off the tip member 61 even if the state of adhesion between the inner tube 64 and the tip member 61 weakens due to deterioration over time, etc.

[0177] 38, a pair of upper and lower grooves 64c, 64c are formed in the left end portion of the inner tube 64. Each groove 64c is formed in an arc shape when viewed from the axial direction. When the inner tube 64 is configured in this manner, as described above, even if the fixation between the inner tube 64 and the distal end member 61 weakens due to aging or the like, the inner tube 64 can be prevented from coming off the distal end member 61. In addition, during insertion surgery, the distal end member 61 and the inner tube 64 can be prevented from rotating relative to each other around the axis. The number of grooves 64c formed in the inner tube 64 is not limited to two, and may be one, three, or more.

[0178] 39A to 39C, the inner tube 64 may be bonded to the tip member 61A shown in Figures 39A to 39C to fix them together. This tip member 61A differs from the tip member 61 in that the outer peripheral surface of the insertion part 61c has a shape similar to the inner peripheral surface of the fitting hole 62e of the locking member 62, and that a through hole 61g is provided therein.

[0179] This through hole 61g has a circular cross section when viewed from the left-right direction, and has a diameter slightly larger than that of the inner tube 64. The inner tube 64 is fixed to the tip member 61 by being inserted into this through hole 61g and glued.

[0180] In the medical insertion aid 1A of the second embodiment, a handle 66A shown in Fig. 40A may be used instead of the handle 66. As shown in the figure, inner holes 66f, 66g are formed inside the handle 66A. These inner holes 66f, 66g have a circular cross section when viewed from the left and right, and are configured to be concentric and communicate with each other.

[0181] The inner hole 66f has a diameter the same as or different from the inner hole 66c, and the inner tube 64 is fixed to the mounting part 66a with an adhesive with its right end inserted into the inner hole 66f. The inner hole 66g has a smaller diameter than the inner hole 66f, and extends from the right end of the inner hole 66f to the left end of the handle 66A.

[0182] With this handle 66A, the distal end of the guide wire 70 is pulled out from the inner hole 66g during surgery to insert the gastrostomy tube 40. When configured as described above, the inner holes 64a, 66f, and 66g, in addition to the inner hole 61d, correspond to through holes.

[0183] Furthermore, in the medical insertion aid 1A of the second embodiment, a handle 66B shown in FIG. 40B may be used instead of the handle 66. As shown in the figure, an inner hole 66h is formed inside the handle 66B. This inner hole 66h has a circular cross section when viewed from the left and right, and extends through the handle 66B in the left and right direction. The inner hole 66h has a diameter that is the same as or different from the inner hole 66c described above.

[0184] The inner tube 64 is inserted into the inner hole 66h, and its right end portion extends to the right end portion of the handle 66B, and is fixed to the attachment portion 66a via an adhesive.

[0185] With this handle 66B, during surgery to insert the gastrostomy tube 40, the distal end of the guide wire 70 is pulled out from the inner hole 64a of the inner tube 64. When configured as described above, the inner hole 64a, in addition to the inner hole 61d, corresponds to a through-hole.

[0186] Although the second embodiment is an example in which the first and second tubular members are circular outer and inner tubular members 63 and 64, the first and second tubular members of the present invention are not limited to these and may be any hollow tubular members. For example, the first and second tubular members may be tubular members whose cross sections are polygonal, such as triangular or higher. [Explanation of symbols]

[0187] 1 Medical insertion aids 10 Operating equipment 11 Mounting member (connecting member) 11b Locking part (first locking part) 11c Locking protrusion (second connection part) 11d Fitting part (guided part) 12 Connecting rod (connecting member) 12d Insertion part (protrusion) 12e Fitting part (protrusion) 13 Grip (gripping member) 13A first grip member (first holding member) 13B second grip member (second holding member) 13b Locking part (second locking part) 13c Fitting hole (recess) 13d grip part 2. Outer needle member (needle member) 20 Outer needle tube (needle, needle tube) 21 Outer needle base (base, proximal end) 21c Connecting part (notch part) 21f Locking claw (first connecting part) 21h Guide groove (guide part) 21j Insertion hole (mating hole) 3 Inner needle member 30 Inner needle 31c Control unit 40 Gastrostomy tube (medical device) 41 Bumper (internal placement part) 43 Collar (base end) 44 Port (base end) 50 body wall 1A Medical Insertion Aids 60 Operating instruments 61 Tip member (base) 61b Stepped part (notch part) 61d Inner hole (through hole) 62 Locking member 62b locking portion (first locking portion) 63 Outer pipe (first pipe member) 64 Inner pipe (second pipe member) 64a Inner hole (through hole) 65 Grip (gripping member) 65b Locking part (second locking part) 65j grip part 66 Handle (operating member) 66d Inner hole (through hole) 66e Outlet (opening) 66f Inner hole (through hole) 66g Inner hole (through hole) 66h Inner hole (through hole) 70 Guidewire

Claims

1. A medical insertion aid for inserting an indwelling portion, which is a distal end of a medical instrument, inside a body wall while forming a perforation in the body wall, while leaving a proximal end of the medical instrument outside the body wall, an elongated operating instrument that is inserted into the body wall together with the medical instrument while forming the perforation; The operating device is: a base portion provided on one end side of the operating tool, tapered toward the one end side, and having a notch portion cut out from the outside toward the inside; a first locking portion that is provided on the operating instrument so as to be spaced from a surface of the notch portion of the base, and that locks the indwelling portion of the medical instrument; a grip portion provided on the other end side of the operating tool; A medical insertion aid characterized by having:

2. The medical insertion aid according to claim 1, The operating tool is a needle member having a needle that penetrates the body wall, a base portion connected to a base end portion of the needle, and a first connecting portion provided on the base portion; a second connecting portion provided on one end side of the operating instrument and connected to the first connecting portion of the needle member; and The operating instrument is inserted into the body wall with the first connecting portion of the needle member connected to the second connecting portion.

3. The medical insertion aid according to claim 2, the needle member is an outer needle member having a needle tube as the needle, an inner needle member having an inner needle that can be inserted into the needle tube of the outer needle member and that is removably attached inside the outer needle member; A medical insertion aid, characterized in that the needle tube of the outer needle member is configured to be softer when inside the body wall than when outside the body wall.

4. The medical insertion aid according to claim 3, the outer needle member further has a guide portion, The medical insertion aid, wherein the operating instrument further has a guided portion that is guided by the guiding portion when the second connecting portion is connected to the first connecting portion.

5. The medical insertion aid according to claim 3 or 4, A fitting hole extending in the longitudinal direction is formed on the base end side of the outer needle member, The medical insertion aid is characterized in that the operating instrument further has a protrusion protruding longitudinally from one end of the operating instrument so that when the first connecting portion and the second connecting portion are connected to each other, the operating instrument is fitted into the fitting hole in a state where it cannot rotate around an axis extending in the extension direction of the fitting hole of the outer needle member.

6. The medical insertion aid according to any one of claims 2 to 4, the second connecting portion and the first connecting portion are configured to be spaced apart radially outward from the central axis of the needle member when the second connecting portion is connected to the first connecting portion.

7. The medical insertion aid according to any one of claims 2 to 4, the operating tool is an integral combination of a connecting member having the second connecting portion and the first locking portion, a gripping member having the gripping portion, and a rod-shaped connecting member connecting the connecting member and the gripping member, The gripping member is configured by stacking a hollow first gripping member and a hollow second gripping member, one of the first gripping member and the second gripping member has a plurality of recesses therein that are arranged at intervals along an extension direction of the one of the first gripping member and the second gripping member, The medical insertion aid is characterized in that the connecting member extends along the extension direction of the one of the members, and the end portion on the gripping member side is a convex portion, and the convex portion is connected to the gripping member in a state where it is selectively fitted into any one of the plurality of concave portions.

8. The medical insertion aid according to any one of claims 1 to 4, The operating tool further has a second locking portion on the other end side for locking the base end portion of the medical instrument.

9. The medical insertion aid according to claim 1, an outer needle member having a needle tube; an inner needle member having an inner needle that can be inserted into the needle tube of the outer needle member and that is removably attached inside the outer needle member; a guide wire that can be inserted into the needle tube of the outer needle member; Furthermore, The operating instrument is a medical insertion aid, characterized in that the operating instrument is configured so that the guide wire can be inserted therethrough and has a through-hole extending through the operating instrument in the extending direction.

10. The medical insertion aid according to claim 9, The operating tool is a tip member having the base; a locking member having the first locking portion, the through-hole extends through the tip member and the locking member, The medical insertion aid is characterized in that the tip member and the locking member are configured to be relatively movable within a predetermined range along the extending direction of the operating instrument.

11. The medical insertion aid according to claim 10, The operating tool is a gripping member having the gripping portion and a second locking portion for locking the base end portion of the medical instrument; a hollow first tubular member extending in an extension direction of the operating instrument and connected to the locking member and the gripping member; a second tubular member that is fitted into the inner hole of the first tubular member and extends in the extension direction of the operating instrument, one end of which is connected to the tip member and the other end of which extends through the gripping member to the opposite side of the gripping member from the locking member, and that has an inner hole that constitutes at least a part of the through hole; an operating member connected to the other end of the second tubular member and having an opening communicating with an inner hole of the second tubular member; A medical insertion aid further comprising:

12. The medical insertion aid according to claim 11, The medical insertion aid is characterized in that the operating member is slidably disposed relative to the gripping member and is fitted to the gripping member in a state where it cannot rotate around the central axis of the second tubular member.

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