Traction tool

Abstract

Provided is a traction tool capable of pulling both sides of a uterus in a single operation. A traction tool 1 of the present invention includes: a pair of holding tools 2, 2; and a coupling tool 3 for coupling the pair of holding tools 2, 2. The traction tool 1 is capable of pulling both sides of a uterus 100 by pulling the coupling tool 3 in a state where both sides of the uterus 100 are held by the pair of holding tools 2, 2.

Description

traction device

[0001] The present invention relates to a traction device for traction of a uterus.

[0002] In the past, in order to safely remove the uterus without damaging the bladder or intestines that are located near the uterus, the uterus has been removed while being pulled. When removing the uterus through laparotomy, the uterus 100 has been pulled by forceps 101, 101 that grasp both sides of the uterus 100, as shown in Figure 4.

[0003] In recent years, laparoscopic hysterectomy has become popular to reduce invasiveness to patients. Because grasping and pulling both sides of the uterus with forceps is difficult during laparoscopic hysterectomy, the uterus has been moved using a uterine manipulator (see, for example, Patent Document 1). However, as shown in FIG. 5 , the uterine manipulator 110 is inserted into the uterus 100 via the vagina 111. Therefore, if the patient has a malignant tumor, the use of the uterine manipulator is not recommended due to the risk of tumor spread. Furthermore, if the patient's vagina 111 is narrow or the patient's cervical os 112 is closed, the use of the uterine manipulator 110 is difficult, even if the patient's disease is benign.

[0004] As an alternative method, as shown in Fig. 6 , a method has been implemented in which the uterus 100 is retracted by pulling a thread 120 tied around the uterus 100 with forceps 121 inserted transvaginally. However, as shown in Fig. 6 , when retracting only one side of the uterus 100 with one forceps 121, it is difficult to retract the uterus 100 in a balanced manner. Furthermore, when retracting both sides of the uterus 100 with two forceps 121, 121, it is necessary to manipulate the two forceps 121, 121 by hand (for example, one surgeon must manipulate the two forceps 121, 121 with both hands, or two surgeons must each manipulate one forceps 121 with one hand). Therefore, when there are only a few surgeons, it is difficult to retract both sides of the uterus 100 with the two forceps 121, 121. For example, in a situation where there are only two surgeons, one surgeon (doctor) will perform the procedure of removing the uterus 100, while the other surgeon (assistant, etc.) will need to operate the camera to check inside the body and the forceps 121. Since the other surgeon cannot operate the two forceps 121, 121, it is not possible to pull both sides of the uterus 100 with the two forceps 121, 121.

[0005] Japanese Patent Application Laid-Open No. 2022-102154

[0006] The present invention has been made in view of the above-mentioned circumstances, and an object of the present invention is to provide a traction device that can traction both sides of the uterus with a single operation.

[0007] In order to achieve the above object, the present invention includes, for example, the following aspects.

[0008] Item 1. A retraction device comprising: a pair of gripping tools; and a connecting tool that connects the pair of gripping tools; wherein the pair of gripping tools grip both sides of the uterus, and the connecting tool is pulled to retract both sides of the uterus.

[0009] Item 2. The towing device according to Item 1, wherein the length of the connecting device is changeable.

[0010] Item 3. The traction tool according to Item 1, wherein the portion of the coupling tool to which an apparatus for traction of the coupling tool is attached can be changed so that the tension of the pair of gripping tools becomes approximately equal.

[0011] Item 4. The towing device according to Item 2, wherein the connecting device is a chain having one end connected to one of the gripping devices and the other end connected to the other of the gripping devices, and the length of the connecting device can be changed by changing the number of rings that make up the connecting device.

[0012] Item 5. The traction tool according to Item 2, wherein the connector is a flexible string-like structure having one end connected to one of the gripping tools and the other end connected to the other gripping tool, and the length of the connector can be changed by selecting the string-like structure constituting the connector from a plurality of string-like structures of different lengths that are prepared in advance.

[0013] Item 6. A towing tool according to Item 1, wherein each of the gripping tools has a first arm and a second arm that can be opened and closed around their connection, the other end of the first arm is provided with a protrusion that protrudes in a direction perpendicular to the longitudinal direction of the first arm, and the other end of the second arm is provided with a hole for inserting the protrusion, and an external force is applied to the first arm and the second arm to fit the protrusion into the hole, thereby maintaining a closed state in which the other end of the first arm and the other end of the second arm are close to each other.

[0014] Item 7. The towing tool according to Item 6, wherein the connection portion is configured by a pin that penetrates one end side of the first arm and one end side of the second arm.

[0015] The retraction device of the present invention allows for retraction of both sides of the uterus in a single operation.

[0016] FIG. 1 is a schematic diagram showing a traction device according to an embodiment of the present invention; FIG. 2 is a schematic diagram showing a state in which both sides of a uterus are tractioned by a traction device according to an embodiment of the present invention; (A) is a schematic diagram showing a state in which the gripping device is open, and (B) is a schematic diagram showing a state in which the gripping device is closed; FIG. 1 is a schematic diagram showing a conventional technique in which a uterus is tractioned by forceps gripping both sides of the uterus; FIG. 2 is a schematic diagram showing a conventional technique in which a uterus is moved by a uterine manipulator; and FIG. 3 is a schematic diagram showing a conventional technique in which one side of the uterus is tractioned by hooking one forceps on a thread that is tying the uterus.

[0017] Hereinafter, an embodiment of the present invention will be described with reference to the accompanying drawings. Fig. 1 is a schematic diagram showing a traction device 1 according to an embodiment of the present invention. Fig. 2 is a schematic diagram showing a state in which both sides of a uterus 100 are tractioned by the traction device 1 according to an embodiment of the present invention.

[0018] The traction device 1 according to the embodiment of the present invention includes a pair of gripping devices 2, 2 and a connecting device 3 that connects the pair of gripping devices 2, 2. The traction device 1 according to the present embodiment can retract both sides of the uterus 100 ( FIG. 2 ) by pulling the connecting device 3 in a state where both sides of the uterus 100 are gripped by the pair of gripping devices 2, 2.

[0019] FIG. 3(A) is a schematic diagram showing the gripping tool 2 in an open state (an open state in which the other end of a first arm 4 described later and the other end of a second arm 5 are spaced apart), and FIG. 3(B) is a schematic diagram showing the gripping tool 2 in a closed state (a closed state in which the other end of a first arm 4 described later and the other end of a second arm 5 are close together).

[0020] Each gripping tool 2 has a first arm 4 and a second arm 5 that can be opened and closed around a connection 6 between them. In this embodiment, the connection 6 is formed by a pin that penetrates one end of the first arm 4 and one end of the second arm 5 (hereinafter, the reference numeral 6 of the connection portion will be used to refer to the pin). A protrusion 7 that protrudes perpendicular to the longitudinal direction of the first arm 4 is provided on the other end of the first arm 4. A hole 8 for inserting the protrusion 7 is provided on the other end of the second arm 5. The protrusion 7 has a base end joined to the first arm 4 and has a shape that gradually increases in diameter from the base end to the tip end and then gradually decreases in diameter. The hole 8 opens on the surface of the second arm 5 and has a shape that gradually increases in diameter from the opening side to the back side and then gradually decreases in diameter. The first arm 4, the second arm 5, and the pin 6 are formed, for example, from a resin such as polyacetal or carbon fiber reinforced plastic, or a metal such as stainless steel or titanium. The protrusion 7 is made of an elastic material (for example, a resin such as polyacetal or carbon fiber reinforced plastic). The base end of the protrusion 7 can be joined to the first arm 4 by adhering the base end of the protrusion 7 to the first arm 4 with an adhesive, by heat welding the base end of the protrusion 7 to the first arm 4, or by integrally molding the first arm 4 and the protrusion 7, for example.

[0021] Each gripping device 2 applies an external force to the first arm 4 and the second arm 5 (more specifically, performs a closing operation to bring the other end of the first arm 4 and the other end of the second arm 5 closer together) and fits the protrusion 7 into the hole 8, thereby maintaining a closed state (the state of the gripping device 2 shown in Figure 3 (B)) in which the other end of the first arm 4 and the other end of the second arm 5 are close together (arrow a in Figure 3 (A) indicates the direction in which the other ends of the arms 4, 5 are brought closer together).

[0022] In this embodiment, the closing operation is performed using forceps 20. Forceps 20 has a pair of gripping portions 21 that can be opened and closed (arrow c in FIG. 3A indicates the direction in which gripping portions 21 of forceps 20 close, and arrow d in FIG. 3B indicates the direction in which gripping portions 21 of forceps 20 open). Each gripping portion 21 has a protrusion 22 formed thereon. Holes 23 for inserting protrusions 22 are formed at the other end of first arm 4 and the other end of second arm 5, respectively. In this embodiment, the closing operation involves inserting the protrusion 22 formed on one gripping portion 21 into the hole 23 of the first arm 4 and the protrusion 22 formed on the other gripping portion 21 into the hole 23 of the second arm 5, and then closing the gripping portions 21, 21, so that the protrusion 22 is pushed into the hole 8 so that the small diameter portion 10 is located in the opening 12 and the large diameter portion 11 is located in the innermost portion 13, resulting in a closed state in which the other end of the first arm 4 and the other end of the second arm 5 are close to each other. In addition, opening the gripping portions 21, 21 of the forceps 20 allows the protrusions 22, 22 of the forceps 20 to be pulled out of the holes 23, 23 of the arms 4, 5, and the forceps 20 can be removed from the grasper 2.

[0023] In addition, in each gripping device 2, an opening operation can be performed to move the other end of the first arm 4 and the other end of the second arm 5 away from each other, and the protrusion 7 can be removed from the hole 8, thereby bringing the other end of the first arm 4 and the other end of the second arm 5 into an open state (the state of the gripping device 2 shown in Figure 3 (A)) where they are spaced apart (arrow d in Figure 3 (B) indicates the direction in which the other ends of the arms 4 and 5 are moved away from each other).

[0024] The connector 3 (FIGS. 1 and 2) is a chain having one end 3a connected to the first gripping device 2 and the other end 3b connected to the second gripping device 2, and the length of the connector 3 can be changed by changing the number of rings 30 constituting the connector 3. To make the number of rings 30 constituting the connector 3 changeable, for example, each ring 30 has one end 30a and the other end 30b separated and close to each other, and the first ring 30 and the second ring 30 can be connected by pushing the second ring 30 into the first ring 30 from between the one end 30a and the other end 30a of the first ring 30, or the connection between the first ring 30 and the second ring 30 can be released by pulling out the second ring 30 inserted inside the first ring 30 from between the one end 30a and the other end 30b of the first ring 30. Connecting each of the ends 3a, 3b of the connector 3 to the gripping tool 2 is achieved, for example, by inserting a ring (not shown) protruding from the gripping tool 2 inside the ring 30 constituting the ends 3a, 3b. The connector 3 is formed, for example, from a resin such as polyacetal or carbon fiber reinforced plastic, or a metal such as stainless steel or titanium. From the viewpoint of making the towing tool 1 disposable, it is preferable to form the first arm 4, the second arm 5, and the connector 3 from the above-mentioned resin. From the viewpoint of making the towing tool 1 reusable, it is preferable to form the first arm 4, the second arm 5, and the connector 3 from the above-mentioned metal.

[0025] When performing surgery to remove uterus 100, the following steps 1 to 8 are performed in sequence to bring both sides of uterus 100 into a traction state, and uterus 100 is removed in this state (hereinafter, of the pair of gripping tools 2, 2 provided on traction tool 1, one gripping tool 2 will be referred to as the "first gripping tool 2" and the other gripping tool 2 will be referred to as the "second gripping tool 2").

[0026] Step 1: Adjust the length of the connector 3 according to the size of the subject's uterus 100. Step 2: With the protrusions 22, 22 of the forceps 20 inserted into the holes 23, 23 of the arms 4, 5 of the first gripping tool 2, insert the first gripping tool 2 and the forceps 20 into the subject's body through a body opening formed in the body, so that one side of the uterus 100 is positioned between the other end of the first arm 4 and the other end of the second arm 5 of the first gripping tool 2 (at this time, the first gripping tool 2 inside the body and the second gripping tool 2 outside the body are connected via the connector 3 passing through the body opening). Step 3: Close the first gripping tool 2 with the forceps 20, so that one side of the uterus 100 is grasped by the first gripping tool 2 (i.e., one side of the uterus 100 is sandwiched between the other end of the first arm 4 and the other end of the second arm 5 of the first gripping tool 2). Operation 4: The gripping portions 21, 21 of the forceps 20 are opened to remove the forceps 20 from the first gripping tool 2, and the forceps 20 are pulled out from the body cavity to the outside. Operation 5: With the protrusions 22, 22 of the forceps 20 inserted into the holes 23, 23 of the arms 4, 5 of the second gripping tool 2, the second gripping tool 2 and the forceps 20 are inserted into the body of the subject through the body cavity, and the other side of the uterus 100 is positioned between the other end of the first arm 4 and the other end of the second arm 5 of the second gripping tool 2 (at this time, the first gripping tool 2, the second gripping tool 2, and the connecting tool 3 are all positioned inside the body). Task 6: By closing the second grasping tool 2 with the forceps 20, the other side of the uterus 100 is grasped by the second grasping tool 2 (i.e., the other side of the uterus 100 is sandwiched between the other end of the first arm 4 and the other end of the second arm 5 of the second grasping tool 2). Task 7: The grasping parts 21, 21 of the forceps 20 are opened to remove the forceps 20 from the first grasping tool 2, and the connecting tool 3 is sandwiched between the grasping parts 21, 21 of the forceps 20. Task 8: By pulling the forceps 20 to pull the connecting tool 3, both sides of the uterus 100 are pulled (more specifically, the first grasping tool 2 grasping one side of the uterus 100 and the second grasping tool 2 grasping the other side of the uterus 100 are pulled. The arrow X in Figure 2 indicates the direction in which the forceps 20 is pulled to pull the connecting tool 3).

[0027] The connector 3 may be pulled by a forceps 40 other than the forceps 20. In this case, the operations 7 and 8 are changed as follows.

[0028] Task 7: The gripping portions 21, 21 of the forceps 20 are opened to remove the forceps 20 from the first gripping tool 2, and the forceps 20 is removed from the body through the body opening to the outside of the body, after which the forceps 40 are inserted into the body through the body opening and the connecting tool 3 is clamped between the pair of gripping portions of the forceps 40. Task 8: The forceps 40 is pulled to retract the connecting tool 3, thereby retracting both sides of the uterus 100 (more specifically, the first gripping tool 2 gripping one side of the uterus 100 and the second gripping tool 2 gripping the other side of the uterus 100 are retracted).

[0029] According to the retraction tool 1 of this embodiment, it is possible to retract both sides of the uterus 100 by a single operation of retracting the connector 3. Therefore, even in a situation where there are only a few surgeons, it is possible to retract both sides of the uterus 100. For example, in a situation where there are only two surgeons, one surgeon (assistant) can operate a camera for checking inside the body with one hand while operating the forceps 20 or 40 with the other hand to retract the connector 3, and with both sides of the uterus 100 in retraction, the other surgeon (doctor) can perform the operation of removing the uterus 100.

[0030] Furthermore, according to the traction tool 1 of this embodiment, the length of the connecting tool 3 is changeable, so that it can be used to traction the uterus 100 of various sizes.

[0031] From the viewpoint of traction of the uterus 100 in a balanced manner, it is desirable that the tensions of the pair of grippers 2, 2 are approximately equal. To achieve this, it is desirable that the position of the coupling device 3 to which an instrument (corresponding to the forceps 20) for traction on the coupling device 3 is attached be changeable so that the tensions of the pair of grippers 2, 2 are approximately equal. For example, the coupling device 3 may be provided with multiple "portions for attaching an instrument for traction on the coupling device 3 (hereinafter referred to as "attachment portions")," and the "attachment portion" that provides the most balanced traction may be determined as the position to attach the instrument. Furthermore, the "attachment portion" may be made slidable in the longitudinal direction of the coupling device 3, thereby making it possible to change the position of the coupling device 3 to which the instrument is attached.

[0032] The present invention is not limited to the above-described embodiment and can be modified in various ways.

[0033] For example, instead of providing a protrusion 7 on the other end of the first arm 4 and a hole 8 on the other end of the second arm 5 in each gripping tool, a magnet may be provided on each of the other ends of the first arm 4 and the second arm 5. In this case, the magnet provided on the other end of the first arm 4 and the magnet provided on the other end of the second arm 5 attract each other, maintaining a closed state in which the other ends of the first arm 4 and the second arm 5 are close to each other.

[0034] Alternatively, each ring constituting the connector 3 may be threaded at one end into a cylindrical body at the other end to form a continuous loop. In this case, the length of the connector 3 can be changed by performing the following operations 1 and 2. Operation 1: With one end of the first ring removed from the cylindrical body at the other end, push the second ring into the first ring from between one end and the other end (cylindrical body) of the first ring, and then thread one end of the first ring into the cylindrical body at the other end to connect the first and second rings. Operation 2: With one end of the first ring removed from the cylindrical body at the other end, pull out the second ring inserted inside the first ring from between one end and the other end (cylindrical body) of the first ring to release the connection between the first and second rings.

[0035] In the above embodiment, the first arm 4 and the second arm 5 of each gripping device 2 are opened and closed about the pin 6 (connection portion) that penetrates one end of each arm, but instead of providing the pin 6 on each gripping device 2, the first arm 4 and the second arm 5 of each gripping device 2 can be made to be openable and closable about the connection portion by making the first arm 4 and the second arm 5 of each gripping device 2 an integrally molded resin structure or a metal spring structure, or by connecting the first arm 4 and the second arm 5 of each gripping device 2 with an adhesive, etc. In this case, too, for example, in each gripping device 2, a protrusion that protrudes in a direction perpendicular to the longitudinal direction of the first arm 4 is provided on the other end side of the first arm 4, and a hole for inserting the protrusion is provided on the other end side of the second arm 5, and by applying an external force to the first arm 4 and the second arm 5 to fit the protrusion into the hole, a closed state in which the other end side of the first arm 4 and the other end side of the second arm 5 are close to each other is maintained.

[0036] Furthermore, in the above embodiment, the protrusion 7 and the hole 8 having a shape that expands and contracts in diameter are shown as the configuration for maintaining the closed state in which the other end of the first arm 4 and the other end of the second arm 5 are close to each other, but the configuration for maintaining the closed state in which the other end of the first arm 4 and the other end of the second arm 5 are close to each other is not limited to the above configuration. For example, the closed state can be maintained by imparting elasticity to the protrusion provided on the first arm 4 or by imparting elasticity to the periphery of the hole in the second arm 5 so that the protrusion can be pressed into the hole.

[0037] Furthermore, in the above embodiment, an example was shown in which the connector 3 was configured from a chain with multiple rings 30 connected to it, but the connector 3 may also be a string-like structure with one end connected to one gripping device 2 and the other end connected to the other gripping device 2. The string-like structure is formed from a flexible material such as resin or plastic. Even when the connector 3 is configured from the above string-like structure, the same effect as when the connector 3 is configured from a chain can be obtained. Note that when the connector 3 is configured from the above string-like structure, it is possible to change the length of the connector 3 by preparing a plurality of string-like structures with different lengths in advance and selecting a string-like structure to configure the connector 3 from the plurality of string-like structures.

[0038] Furthermore, it is not necessarily required that the length of the connector 3 be changeable, and the connector 3 may have a fixed length.

[0039] REFERENCE SIGNS LIST 1 traction tool 2 gripping tool 3 connecting tool 4 first arm 5 second arm 6 pin 8 hole 10 small diameter part 11 large diameter part 12 opening 13 inner part 22 protrusion 100 uterus

Claims

1. A traction device comprising a pair of grasping tools and a connecting tool that connects the pair of grasping tools, capable of traction on both sides of the uterus by pulling the connecting tool while grasping both sides of the uterus with the pair of grasping tools.

2. The towing device according to claim 1, wherein the length of said connector is variable.

3. The towing tool according to claim 1, wherein the portion of said coupling tool to which an apparatus for towing said coupling tool is attached can be changed so that the tensions of said pair of gripping tools become approximately equal.

4. A towing device as described in claim 2, wherein the connector is a chain having one end connected to one of the gripping devices and the other end connected to the other of the gripping devices, and the length of the connector can be changed by changing the number of rings that make up the connector.

5. A towing device as described in claim 2, wherein the connector is a flexible string-like structure having one end connected to one of the gripping devices and the other end connected to the other gripping device, and the length of the connector can be changed by selecting the string-like structure constituting the connector from a plurality of string-like structures of different lengths prepared in advance.

6. A towing device as described in claim 1, in which each of the gripping devices has a first arm and a second arm that can be opened and closed around their connection, the other end of the first arm has a protrusion that protrudes in a direction perpendicular to the longitudinal direction of the first arm, and the other end of the second arm has a hole for inserting the protrusion, and by applying an external force to the first arm and the second arm to fit the protrusion into the hole, a closed state in which the other end of the first arm and the other end of the second arm are close to each other is maintained.

7. A towing tool as set forth in claim 6, wherein said connection portion is constituted by a pin passing through one end side of said first arm and one end side of said second arm.

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