Port for thoracoscopic surgery

Abstract

To provide a thoracoscopic port which allows for stable manipulation of a scope and a surgical instrument by alleviating burden on an assistant who is operating and holding the scope while securing free operation of them in a single-hole thoracoscopic surgery.SOLUTION: A thoracoscopic port includes: a retractor 10 formed of an outer ring 11 located on body surface side, an elastic inner ring 12 located in a thoracic cavity, and an elastic sleeve 13 connected to the outer ring 11 and the inner ring 12 at both ends and located in the thoracic cavity from a body surface; and a holder ring 20 which is made of a rubber elastic member and a portion of which is attached by being connected to the retractor 10 directly or indirectly. The holder ring 20 is located in such a manner that an opening 135 in the retractor 10 is partitioned by a part or the whole of a peripheral surface in top view, and the holder ring 20 is formed so as to be movable with a connection part with the retractor 10 as fulcrum.SELECTED DRAWING: Figure 1

Description

【Technical Field】 【0001】 The present invention relates to a port for thoracoscopic surgery that is inserted into a surgical wound to introduce an endoscope and surgical instruments into the chest cavity during thoracoscopic surgery. 【Background Art】 【0002】 In thoracoscopic surgery, a cylindrical thoracic port that reaches from the body surface into the chest cavity is inserted into a plurality of incisions provided in the intercostal space, and medical instruments such as a thoracoscope and forceps are inserted into the chest cavity through the passage of the thoracic port for surgery. 【0003】 Examples of the thoracic port used for this include a cylindrical portion formed in an oval cross-section by a synthetic resin having mechanical strength that does not collapse internally when placed in the intercostal space, and outer flanges and inner flanges provided at both ends of the cylindrical portion, and an instrument in which the inner cavity of the cylindrical portion is partitioned into two or three by a partition portion (Patent Document 1), or a thoracic port for thoracoscopic surgery including a flange located on the body surface side, a collar located on the chest cavity side, a flexible cylindrical sleeve located from the body surface side into the chest cavity, and a suction tube provided parallel to the axial direction along the outer peripheral surface of the sleeve (Patent Document 2) have been proposed. 【Prior Art Documents】 【Patent Documents】 【0004】 【Patent Document 1】 Japanese Patent No. 6302467 【Patent Document 2】 Japanese Patent No. 6418612 【Summary of the Invention】 【Problems to be Solved by the Invention】 【0005】 According to the device described in the aforementioned conventional patent document 1, the tubular port set in the intercostal space is flexible while possessing mechanical strength, and its oval shape allows it to fit into the intercostal space and increase the contact area, thereby reducing the burden on the patient through a smooth incision. Furthermore, since the lumen of the port is divided into multiple sections, multiple instruments such as thoracoscopic scopes (hereinafter simply referred to as scopes) and forceps can be applied to the pleural cavity from a single port. In addition, according to the device described in patent document 2, by equipping the port with a suction tube, surgical smoke generated by the use of electrosurgical units, etc., can be appropriately discharged from the surgical field. 【0006】 Meanwhile, single-port surgery, which has become widespread in laparoscopic surgery, is also developing in thoracoscopic surgery in recent years, and there is a need for port devices that are suitable for this single-port thoracoscopic surgery. In single-port surgery, multiple scopes and surgical instruments are inserted into the pleural cavity simultaneously through a single port (opening). Unlike laparoscopic surgery, thoracoscopic surgery does not require pneumoperitoneum, and because there are no valves or other airtight seals at the port opening, the freedom of surgical manipulation is high. However, while the surgeon is operating the forceps and energy devices, an assistant must constantly operate and hold the scope in an appropriate position, and there are concerns about stable operation and holding. In addition, holding the scope in an appropriate position for a long period of time is a burdensome task. 【0007】 Therefore, the present invention is particularly suitable for single-port thoracoscopic surgery and aims to provide a thoracoscopic surgical port that allows for stable operation by reducing the burden on the assistant who operates and holds the scope, while ensuring free manipulation of the scope and surgical instruments. [Means for solving the problem] 【0008】 The thoracoscopic surgery port of the present invention comprises a retractor comprising an outer ring located on the body surface, an elastic inner ring located inside the thoracic cavity, and an elastic sleeve formed in a drum shape in a front view (viewpoint from a plane parallel to the axial direction), with both ends connected to the outer and inner rings and located from the body surface into the thoracic cavity; and one or more holder rings made of rubber elastic material that are directly or indirectly attached to the retractor. The elastic sleeve has an upper portion that is formed to follow the body surface from the outer ring to the opening of the retractor, as the end on the body surface side is expanded by the outer ring. The holder ring, when viewed from above (viewpoint from a plane perpendicular to the axial direction), disclosure The opening is positioned such that it is demarcated by part or all of the circumferential surface of the holder ring. The mounting portion connecting the holder ring and the retractor is positioned on the edge of the opening on the upper surface, The holder ring is, Recording It is formed to be movable with the attachment point as a pivot. 【0009】 Furthermore, it is preferable that the holder ring be detachably attached to a mounting portion provided on the retractor. 【0010】 Furthermore, in addition to the above configuration, it is preferable that the retractor be provided with an exhaust pipe formed parallel to the axial direction of the elastic sleeve, and that it be equipped with a smoke exhaust passage from the thoracic cavity to the outside of the body, including the exhaust pipe, and that the proximal end of the exhaust pipe be provided with a bent portion on the upper surface of the retractor toward the outer circumference of the retractor, and that the bent portion serve as the attachment point for the holder ring to the retractor. [Effects of the Invention] 【0011】 According to the thoracoscopic surgical port of the present invention, by inserting a scope or the like into the holder ring, the scope or the like can be supported by the holder ring and its axial movement can be stopped. Furthermore, when operating the scope or the like, the connection between the holder ring and the retractor acts as a fulcrum, stabilizing the operation of the scope or the like and reducing the burden on the operator who is operating and holding it. [Brief explanation of the drawing] 【0012】 [Figure 1]An overall configuration diagram (front view) A and an enlarged view B showing the first embodiment of the thoracoscopic surgical port of the present invention. [Figure 2] A top view of the first embodiment described above. [Figure 3] A schematic diagram showing the application of a scope and surgical instruments to the first embodiment described above. [Figure 4] A schematic diagram illustrating the operation of the holder ring in the first embodiment. [Figure 5] An overall configuration diagram showing a second embodiment of the present invention. [Figure 6] An overall configuration diagram showing a third embodiment of the present invention. [Figure 7] An overall configuration diagram showing a fourth embodiment of the present invention. [Figure 8] An overall configuration diagram showing a fifth embodiment of the present invention. [Modes for carrying out the invention] 【0013】 The embodiments of the thoracoscopic surgical port of the present invention will be described in detail below with reference to the drawings. Figures 1 and 2 are overall configuration diagrams showing the first embodiment of the present invention, where A in Figure 1 is a front view of the overall configuration and B is an enlarged view of a part thereof. Figure 2 is a top view, and Figure 3 is a schematic diagram showing the configuration with a scope and surgical instruments applied. This type of thoracoscopic surgical port (hereinafter referred to as the thoracoscopic port) is suitable for single-port thoracoscopic surgery, a type of thoracoscopic surgery in which multiple surgical instruments 72 such as a thoracoscope (scope) 71 and forceps are inserted through a single incision. It is attached to a single incision made in the intercostal space 86, and is typically used by inserting the scope 71 and two surgical instruments (forceps, energy devices, etc.) 72 into the thoracic cavity 85 (between the parietal pleura 83 and the visceral pleura 84). 【0014】 The thoracic port of this form comprises a trocar 10 consisting of an outer ring 11 that is positioned in contact with the body surface 81 when the thoracic port is inserted into the intercostal space 86, an inner ring 12 that is positioned in contact with the parietal pleura 83 on the wall side of the thoracic cavity 85 when inserted, and a cylindrical elastic sleeve 13 with ends 134 connected to the outer ring 11 and the inner ring 12, which forms a drum shape in a front view. An exhaust pipe 31 provided parallel to the axial direction on the outer peripheral surface of the elastic sleeve 13 of the trocar 10, and having a bent portion 32 provided on the upper surface of the trocar 10 and directed toward the outer peripheral direction of the elastic sleeve 13. It is composed of a holder ring 20 consisting of a ring of an elastic body detachably attached in a manner of being hooked on the bent portion 32 of the exhaust pipe 31. 【0015】 The trocar 10 sandwiches the chest wall 82 between the outer ring 11 and the inner ring 12, and by connecting both ends 134 to the outer and inner rings 11, 12, a tension (trocar force) is generated in the elastic sleeve 13. When attached to the incision wound, it opens the incision wound outward against the force trying to return to the original incision wound, and the inner cavity 135 of the elastic sleeve 13 serves as a passage for inserting the scope 71 and surgical instruments 72 into the thoracic cavity 85. 【0016】 The outer ring 11 and the inner ring 12 are formed as rings of an elastic body having the strength necessary to generate a trocar force in the elastic sleeve 13. In this example, wires 111, 121 of a superelastic alloy are coated with protective tubes and formed into an oval-shaped ring such as an oval shape. In this form, known superelastic wires such as Ni-Ti alloys are used as the core materials for the superelastic wires 111, 121, reinforcing tubes 112, 122 of a polyether block amide copolymer / polyurethane tube with relatively high elasticity are used as the protective tubes for the superelastic wires 111, 121, and silicone tubes 113, 123 are coated on the outer layer in consideration of the adhesiveness with the elastic sleeve 13. 【0017】 The size of the outer ring 11 and inner ring 12 is not specified as long as they can be securely held in the incision of the intercostal space 86 when inserted, can be inserted through the incision without force, and do not put a burden on the insertion site. However, the oval rings are set to have a major axis of 50 mm or more and 85 mm or less, and a minor axis of 40 mm or more and 65 mm or less. In this example, two types of outer ring 11 and inner ring 12 were prepared, with major axis-minus axis of 55 mm-45 mm and 80 mm-60 mm. 【0018】 Furthermore, the outer ring 11 and inner ring 12 are preferably oval or other elongated shapes as described above, as they are suitable for insertion into narrow intercostal spaces 86, but other shapes such as circular rings may also be used. In addition, the inner ring 12 is an elastic ring as described above, considering insertion from the body surface 81 into the thoracic cavity 85, but the upper ring 11 does not necessarily have to be an elastic ring. 【0019】 The elastic sleeve 13 is formed from a tubular sheet with a thickness of approximately 0.7 mm to 1.0 mm, made of a flexible elastic material (silicone resin in this example) for the purpose of protecting the incision and maintaining the opening. The cross section parallel to the axial direction is formed in a drum shape, and the cross section perpendicular to the axial direction is formed in an oval or other elongated shape to match the shape of the outer ring 11 and inner ring 12. Both ends 134 of the tubular sheet are extended around the outer ring 11 and inner ring 12, respectively, wrapped around about half a turn, and connected to the rings with adhesive. 【0020】 The size of the elastic sleeve 13 is not specified, but the inner diameter of the middle section of the sleeve, which can be inserted into an incision made in the intercostal space 86 and is applicable to thoracoscopic single-port surgery, is set to a major diameter of 20 mm or more and 50 mm or less, and a minor diameter of 12 mm or more and 30 mm or less in its natural state before incision attachment. In addition, the axial length of the elastic sleeve 13 from the bottom of the outer ring 11 that clamps the chest wall 82 to the top of the inner ring 12 is set to 12 mm or more and 30 mm or less, taking into consideration the thickness of the chest wall 82 and the elasticity of the sleeve 13. In this example, two types of inner diameters for the sleeve 13 are available: a major-minus-minus type of 25 mm-15 mm and a 45 mm-25 mm type, and two types of sleeve lengths (width between the outer ring 11 and the inner ring 12) are available: 15 mm and 20 mm. 【0021】 The retractor 10, which is composed of an outer ring 11, an inner ring 12, and an elastic sleeve 13 according to the above embodiment, consists of an elliptical cylindrical portion 131 in the middle of the elastic sleeve 13 that contacts the chest wall 82, an upper surface portion 132 where one end 134a of the elastic sleeve 13 is expanded and connected to the outer ring 11 and positioned on the body surface 81 side, and a lower surface portion 133 where the other end 134b of the elastic sleeve 13 is expanded and connected to the inner ring 12 and positioned in the thoracic cavity 85, with the lumen 135 of the elliptical cylindrical portion 131 serving as a port 135 for surgical instruments 71 and 72. 【0022】 However, the shape of the retractor 10 is not limited to this form, as long as it has enough width to fit into the intercostal space 86 and open an incision, and enough space in the lumen 135 to allow insertion of the scope 71 and two surgical instruments 72 without them interfering with each other during operation. 【0023】 The exhaust pipe 31 is formed as part of a smoke exhaust passage 30 for exhausting surgical smoke generated by the use of energy devices such as electrosurgical units during surgery from the thoracic cavity 85 to an external smoke exhaust device (not shown). In this embodiment, the exhaust pipe 31 is a flexible tube provided parallel to the axial direction, in contact with the outer surface of the elliptical cylindrical portion 131 of the elastic sleeve 13 of the retractor 10. It passes through through holes provided at both ends of the elastic sleeve 13, with the distal end 312 positioned so as not to protrude beyond the inner ring 12, and the proximal end 311 positioned so as to protrude beyond the outer ring 11. The portion of the exhaust pipe 31 that passes through the through holes is fixed with adhesive. In this example, the exhaust pipe 31 is positioned at the top 136 of one of the long sides of the lumen 135 of the elastic sleeve 13, which is formed in an elliptical isooval shape, so as to have little impact on surgical manipulation by surgical instruments 72 such as forceps. 【0024】 Then, a connecting tube 33 directed toward the outer circumference of the retractor 10 at the upper surface 132 of the retractor 10 is connected to the proximal end 311 of the exhaust pipe 31 via an L-shaped connecting connector 32, and a connection adapter 34 to the smoke exhaust device is connected to the end of the connecting tube 33 to form a smoke exhaust passage 30 from the exhaust pipe 31. 【0025】 The holder ring 20 suppresses natural axial movement when the scope 71 is inserted into the lumen 23 of the holder ring 20, and also functions as a pivot point when the scope 71 is moved and operated. It is formed in a circular shape by covering a core material 21, which is formed in a ring shape from polyamide synthetic resin or the like, with a resin tube 22 (a silicone tube in this example) that has rubber elasticity and appropriate frictional force. 【0026】 The size of the holder ring 20 is selected to match the size of the scope 71 used in surgery. In this configuration, two types are available: one with an outer diameter of approximately 21.5 mm and an inner diameter of approximately 15.5 mm, and another with an outer diameter of approximately 26 mm and an inner diameter of approximately 20 mm. 【0027】 The holder ring 20 is then hooked onto the L-shaped connector 32 that connects to the connecting tube 33 provided at the proximal end 311 of the exhaust pipe 31, and secured by being sandwiched between the upper surface 132 of the elastic sleeve 13 and the connecting tube 33, thereby allowing it to be attached to the retractor 10 without being fixed in place. Here, at least a portion of the lumen 23 of the holder ring 20 attached to the retractor 10 overlaps a portion of the opening 135 of the elastic sleeve 13 in a top view, and is positioned to partition the opening 135 of the elastic sleeve. When a scope 71 or the like is inserted into the holder ring 20, it is introduced into the opening 135 without interfering with the elastic sleeve 13. The two sizes of holder rings 20 can be selected and swapped as needed, or both sizes of holder rings 20 can be attached in advance, and one that is not needed for surgery can be cut off and removed. 【0028】 Surgery using this type of thoracic port is performed by making a single incision of about 20-40 mm in the patient's intercostal space of 86. Insertion of the thoracic port into the incision is performed by utilizing the elasticity of the inner ring 12 of the thoracic port and inserting it into the thoracic cavity 85 in a compressed state. Once inserted, the inner ring 12 returns to its original natural state due to its elastic restorative force, and the chest wall 82 is held in place by the outer ring 11 in contact with the body surface 81 and the inner ring 12 in contact with the parietal pleura 83. At this time, the elastic sleeve 13, with both ends 134 expanded and connected to the outer ring 11 and inner ring 12, does not collapse due to the outward stress resisting the closing force of the incision, thus maintaining the opening and functioning as a port for the scope 71 and surgical instruments 72. 【0029】 Then, the scope 71 is inserted into the holder ring 20 of the thoracic port, and while the surgeon operates surgical instruments 72 such as forceps inserted through the thoracic port to carry out the surgery, the scope 71 is held by an assistant and moved and operated around the holder ring 20 as an axis. 【0030】 According to this embodiment of the thoracic port, by providing a holder ring 20 that is attached to partition the opening 135 of the retractor used in single-port thoracoscopic surgery, when a scope 71 that fits the holder ring 20 is inserted, the axial movement of the scope 71 is restricted and held within the opening 135, so that the scope 71 can be stably held in the desired position with only a light touch, reducing the burden on the assistant holding the scope 71, and enabling surgery under stable imaging. 【0031】 Figure 4 is a schematic diagram showing the operation of the holder ring in this embodiment. Because the holder ring 20 has rubber elasticity, and the attachment point between the holder ring 20 and the retractor 10 is only a part of the holder ring 20, the scope can be freely moved in the circumferential direction M1 and angular direction M2 around the axis within the range of the lumen 135 of the elastic sleeve 13, with the attachment point between the retractor 10 and the holder ring 20 as a pivot point. As a result, the scope 71 can be moved to the desired angle even when it is inserted into the holder ring 20, reducing the burden on the assistant operating the scope 71 and enabling surgery with stable images. 【0032】 Furthermore, since the holder ring 20 can be detachably attached to the retractor 10, for example, different sized holder rings 20 can be selected or replaced depending on the diameter of the scope 71. 【0033】 Furthermore, by providing a smoke exhaust passage 30 that includes an exhaust pipe 31 for exhausting surgical smoke generated in the thoracic cavity 85 during surgery to the outside of the body, there is no need to separately set up and operate an exhaust pipe for smoke exhaust. Also, if the smoke exhaust passage 30 is provided with a bent portion 32 on the upper surface 132 of the retractor 10 that is directed outward from the retractor 10, and the bent portion 32 is used as the mounting portion for the holder ring 20, there is no need to separately provide a mounting portion for attaching the holder ring 20. 【0034】 Figures 5 to 8 show other embodiments of the present invention, each illustrating variations in the means for attaching the holder ring to the retractor. The structures of the retractor 10, the smoke exhaust passage 30, and the holder ring 20 in these embodiments are basically the same as those of the first embodiment, so the description of the similar parts will be omitted, and only the differences will be described. 【0035】 Figure 5 shows a second embodiment of the present invention. In this embodiment, the thoracic port is provided with a hook 4 on the upper surface 132 of the retractor 10 as the means for attaching the holder ring 20 to the retractor 10. The hook 4 is formed in a hook shape so that the holder ring 20 does not easily come off when operating the scope 71 or surgical instruments 72. When the holder ring 20 is attached to the upper surface 132 of the retractor 10, part or all of the lumen 23 of the holder ring 20 is fixed with adhesive to the elastic sleeve 13 in a position that allows it to partition the lumen 135 of the retractor 10 when viewed from above. Note that when using the hook 4 of this embodiment, a smoke exhaust passage 30 does not necessarily have to be provided. 【0036】 Figure 6 shows a third embodiment of the present invention. In this embodiment, the thoracic port is configured such that a portion of the outer surface of the holder ring 20 is directly connected to the retractor 10. In this embodiment, the upper surface (expansion portion) 132 of the elastic sleeve 13 and the elliptical cylindrical portion 131 near the transition portion are attached with adhesive or the like so as to divide the lumen 135 and be parallel to the outer ring 11 and facing the lumen, forming an adhesive portion 5. In this example, the adhesive portion 5 is provided on the other apex 136b of the long side of the elliptical cylindrical portion 131, diagonally opposite to the exhaust pipe 31 provided on one apex 136a side. By providing it in this position, interference between the scope 71 inserted into the holder ring 20 and other surgical instruments 72 inserted through the port can be suppressed. 【0037】 Figure 7 shows a fourth embodiment of the present invention, where A is an overall configuration diagram and B is an enlarged view of the connecting portion 60. In this embodiment, the thoracic port is attached to the holder ring 20 on the retractor 10 indirectly via the connecting portion 60. In this embodiment, the outer ring 11 is attached by a first hook 61 provided on one end of the connecting portion 60, and the holder ring 20 is attached to a second hook 62 provided on the other end of the connecting portion 60. The outer ring 11 and the first hook 61, and / or the holder ring 20 and the second hook 62 may be detachably attached or fixed in place. If the first hook 61 is detachably attached, the connecting portion 60 can be set to any position, and if the second hook 62 is detachably attached, holder rings of different sizes can be used interchangeably. 【0038】 Figure 8 shows a fifth embodiment of this design. In this design, the chest port is provided with multiple holder rings 20. The first holder ring 20a is attached to the bent portion 32 of the smoke exhaust passage 30, similar to the first embodiment, and the second holder ring 20b is attached by hooking it onto a hook 4, similar to the second embodiment. The multiple holder rings 20 may be the same size or of different sizes, and any of the above-described means may be used for attachment. 【0039】 The methods for attaching the holder ring 20 to the retractor 10 in the first to fifth embodiments described above are not limited to these, and it is sufficient to set the holder ring 20 in a position where, in a top view, the lumen 135 of the retractor 10 is partitioned by the lumen 23 of the rubber-elastic holder ring 20. [Explanation of Symbols] 【0040】 10. Retractor 11. Outer ring 12. Inner ring 111.121. Superelastic alloy wire 112.122. Reinforcement Tube 113.123. Silicone tubing 13. Elastic sleeve 131. Oval cylinder part 132. Top surface (extended section) 133. Lower part (extended part) 134. End 135. Lumen (opening / port area) 136. Long side vertex 20. Holder Ring 21. Core material 22. (Ring) Tube 23. (Ring) Lumen 30. Smoke exhaust passage 31. Exhaust pipe 311. Proximal end 312. Distal end 32. Folding section (L-shaped connector) 33. Connecting tube 34. Connection Adapter 4. Hook-shaped hook 5. Adhesive part 60. Connecting part 61. The first hook 62. The second hook 71. Scope 72. Surgical instruments (forceps, etc.) 81. Body surface 82. Battlements 83. Parietal pleura 84. Visceral pleura 85. Thoracic cavity 86. Intercostal space

Claims

[Claim 1] A retractor comprising an outer ring positioned on the body surface, an elastic inner ring positioned within the thoracic cavity, and an elastic sleeve formed in a drum shape when viewed from the front, with both ends connected to the outer and inner rings and positioned from the body surface into the thoracic cavity, It consists of one or more holder rings made of rubber elastic material that are directly or indirectly attached to the retractor, The elastic sleeve has an upper portion that is formed to follow the body surface from the outer ring to the opening of the retractor, as the end on the body surface side is expanded by the outer ring. The holder ring is positioned such that, in a top view, the opening is demarcated by a part or all of the circumferential surface of the holder ring. The mounting portion connecting the holder ring and the retractor is positioned on the edge of the opening on the upper surface, A port for thoracoscopic surgery, characterized in that the holder ring is movable with respect to the mounting portion. [Claim 2] The holder ring is detachably attached to a mounting portion provided on the retractor, as described in claim 1, for thoracoscopic surgery. [Claim 3] The port for thoracoscopic surgery according to any one of claims 1 to 2, wherein the retractor is provided with an exhaust pipe formed parallel to the axial direction of the elastic sleeve, and the exhaust pipe is included in the port for thoracoscopic surgery that provides a smoke exhaust passage from inside the thoracic cavity to outside the body. [Claim 4] A thoracoscopic surgical port according to claim 3, wherein the proximal end of the exhaust pipe is provided with a bent portion directed toward the outer circumference of the retractor on the upper surface of the retractor, and the bent portion is used as the attachment portion of the holder ring to the retractor.

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