Surgery assistance instrument

Abstract

The present invention ensures a surgical field on a side deeper than a tubular body inserted into a natural orifice. A disclosed surgery assistance instrument may be one that comprises a passage for a surgical instrument provided therein and is mounted on a tubular body to be inserted into a natural orifice of a living body. The disclosed surgery assistance instrument comprises: a biological tissue exclusion device that is operated so as to move biological tissue, that is on a side deeper than the leading end of the tubular body, outwardly in the radial direction of the tubular body; and a fixing mechanism for fixing the biological tissue exclusion device to the tubular body.

Description

Surgical support equipment

[0001] The present disclosure relates to surgical assist instruments.

[0002] U.S. Patent No. 5,929,999 discloses a surgical access port system for performing natural orifice surgical procedures, the system including a flexible tubular body that forms a passageway for surgical instruments, the flexible tubular body being inserted into the natural orifice.

[0003] Japanese Patent Application Laid-Open No. 2017-94205

[0004] Even when a tubular body (tubular main body) such as that described in Patent Document 1 is used, biological tissue located at the rear side of the tip of the tubular body inserted into a natural orifice may block the surgical field space in front of the tip of the tubular body. For example, biological tissue located at the rear side of the tip of the tubular body may sag due to gravity, blocking the surgical field space in front of the tip of the tubular body. As a result, it is not possible to ensure sufficient surgical field space behind the tubular body.

[0005] Therefore, a technique for securing a surgical field deeper than the tubular body inserted into the natural orifice is desired.

[0006] One aspect of the present disclosure is a surgical support instrument. The disclosed surgical support instrument may be attached to a tubular body that has an internal passage for a surgical instrument and is inserted into a natural orifice of a living body. The disclosed surgical support instrument may include a biological tissue expulsion device that operates to move biological tissue located deeper than the tip of the tubular body in a radially outward direction of the tubular body, and a fixing mechanism that fixes the biological tissue expulsion device to the tubular body.

[0007] In another aspect, the disclosed surgical support instrument may include a tubular body having a passage therein for a surgical instrument and inserted into a natural opening in a living body, and a biological tissue expulsion device provided on the tubular body and operable to move biological tissue located deeper than the tip of the tubular body radially outward from the tubular body.

[0008] Further details will be described in the following embodiments.

[0009] FIG. 1 is a side view of a surgical support instrument. FIG. 2 is an explanatory diagram of a use state of an expander. FIG. 3 is an explanatory diagram showing an expander and attachment of a surgical support instrument to the expander. FIG. 4 is an explanatory diagram of a fixing mechanism. FIG. 5 is an explanatory diagram of a use state of an expander with a surgical support instrument attached. FIG. 6 is an explanatory diagram of the operation of a biological tissue expulsion device. FIG. 7 is a diagram showing a fabricated example of a surgical support instrument. FIG. 8 is an explanatory diagram of a state in which a surgical support instrument according to a fabricated example is attached to an expander and its operation. FIG. 9 is a diagram showing the expansion of a surgical field by a surgical support instrument. FIG. 10 is a diagram showing a modified example of the fixing mechanism. FIG. 11 is a diagram showing a modified example of a biological tissue expulsion device. FIG. 12 is a diagram showing a modified example of a fixing mechanism. FIG. 13 is a diagram showing a modified example of a biological tissue expulsion device. FIG. 14 is a diagram showing a modified example of a surgical support instrument.

[0010] <1. Overview of surgical support equipment>

[0011] (1) A surgical support instrument according to an embodiment is a surgical support instrument attached to a tubular body inserted into a natural orifice of a living body, and includes a biological tissue expulsion device that operates to move biological tissue located deeper than the tip of the tubular body in a radially outward direction of the tubular body, and a fixing mechanism for fixing the biological tissue expulsion device to the tubular body. In this case, the biological tissue located deeper than the tip of the tubular body can be moved by the biological tissue expulsion device to secure a surgical field.

[0012] (2) The fixing mechanism may have a passage therein for passing a surgical instrument. In this case, even with the fixing mechanism, the surgical instrument can be passed through the inside of the tubular body.

[0013] (3) The fixing mechanism may include a plurality of attachment pieces that contact the inner surface of the tubular body, and a pressing portion that generates a pressing force that causes the attachment pieces to contact the inner surface of the tubular body. In this case, the pressing force fixes the fixing mechanism to the inner surface of the tubular body.

[0014] (4) The fixing mechanism may be configured to be changeable between a first configuration that allows insertion into the tubular body and a second configuration that expands from the first configuration in the radial direction of the tubular body and adheres closely to the inner surface of the tubular body. In this case, the fixing mechanism can be inserted into the tubular body in the first configuration, and then changed to the second configuration and fixed. The reverse is also possible.

[0015] (5) The fixing mechanism may include a spring that biases the fixing mechanism toward the second configuration.

[0016] (6) In the second configuration, the fixing mechanism may include a passage therein for passing a surgical instrument therethrough.

[0017] (7) The fixing mechanism may be configured to be changeable inside the tubular body between a first configuration in which the fixing mechanism is released from the tubular body and a second configuration in which the fixing mechanism is fixed to the tubular body.

[0018] (8) The biological tissue expulsion device may include one or more expulsion bodies that operate to cause bending deformation of the tubular body in a radially outward direction.

[0019] (9) The biological tissue rejection device may further include a tensioning body that tensionally drives the rejection body to cause the bending deformation in the rejection body.

[0020] (10) A surgical support instrument according to an embodiment may include a tubular body having a passage therein for a surgical instrument and inserted into a natural opening in a living body, and a biological tissue expulsion device provided on the tubular body and operable to move biological tissue located beyond the tip of the tubular body radially outward from the tubular body.

[0021] (11) Preferably, the natural orifice is an anus, and the tubular body is configured to be inserted into the anus.

[0022] <2. Examples of surgical support instruments>

[0023] Hereinafter, embodiments of the present invention will be described in more detail with reference to the drawings.

[0024] Fig. 1 shows an example of a surgical assistance instrument 100 according to an embodiment. The surgical assistance instrument 100 shown in Fig. 1 can be used, for example, in transanal total mesorectal excision (TaTME), which is a surgical technique for rectal cancer.

[0025] As shown in Fig. 2, in TaTME, an endoscopic dilator 500 for natural orifices (natural orifice access device 500) is inserted into the anus 710 of a living body 700. The dilator 500 is, for example, the surgical access port system described in Patent Document 1. As the dilator 500, for example, the transanal access platform "GelPOINT Path" by Applied Medical Resources, Inc. of the United States can be suitably used.

[0026] The surgical instrument 600 is inserted into the rectum 720 via the dilator 500. Here, the surgical instrument 600 is, for example, an endoscopic surgical instrument (laparoscopic surgical instrument). The endoscopic surgical instrument is, for example, a forceps, a scalpel, or an endoscope (laparoscope). The dilator 500 includes a tubular body 510 having a passage therein for the surgical instrument 600. The distal end 511 of the tubular body 510 is inserted into the rectum. The surgical instrument 600 is inserted into the rectum 720 from the rear end side of the dilator 500 located outside the living body 700, via the passage inside the tubular body 510.

[0027] As shown in Figure 2, when only the expander 500 is used, it may be difficult to secure the surgical field at the back side 800 of the expander 500 because biological tissue such as organs may sag due to gravity.

[0028] Therefore, the surgical support instrument 100 according to the embodiment is, for example, attached to an expander 500 and used to secure a surgical field behind the expander 500. As shown in FIG. 1 , the surgical support instrument 100 includes a biological tissue expulsion device 200 and a fixing mechanism 300 for fixing the biological tissue expulsion device 200 to the expander 500.

[0029] FIG. 3A shows a dilator 500 to which the surgical support instrument 100 can be attached. The dilator 500 includes a tubular body 510 and a cap 520 attached to the tubular body 510. The tubular body 510 is flexible. The tubular body 510 includes a distal end 511 located inside the living body 700 and a proximal end 512 opposite the distal end 511. The tubular body 510 has openings at the distal end 511 and proximal end 512, and has a hollow structure with an internal space 513. The tubular body 510 has a circumferential inner surface 514. The internal space 513 surrounded by the inner surface 514 forms a passageway through which the surgical instrument 600 passes. The passageway 513 extends in the longitudinal direction 10 of the tubular body 510 from the opening at the distal end 511 to the opening at the proximal end 512.

[0030] The cap 520 is attached to the rear end 512 of the tubular body 510 so as to close the opening at the rear end 512 of the tubular body 510. The cap 520 is provided with one or more trocar access devices 530. The trocar access devices 530 are hollow members extending rearward from the cap 520. A surgical instrument 600 is inserted from the rear end of the trocar access device 530 and passes through the tubular body 510 to gain access to the inside of a living body 700.

[0031] As shown in Figure 3(B) , the surgical support instrument 100 is inserted into the internal space 513 (passage 513) of the tubular body 510 from the rear end 512 side of the tubular body 510 with the cap 520 removed, and is fixed to the tubular body 510 within the internal space 513. The surgical support instrument 100 is fixed by the fixing mechanism 300 so as to be in close contact with the inner surface 514 of the tubular body 510. As shown in Figure 3(C) , after the surgical support instrument 100 is fixed to the tubular body 510, a cap 520 is attached to the rear end of the tubular body 510.

[0032] As an example, the surgical support instrument 100 is inserted into the tubular body 510 and fixed to the tubular body 510 in a state in which the tubular body 510 is inserted into the natural orifice 710. In this case, when the tubular body 510 is inserted into the natural orifice 710, the surgical support instrument 100 is not attached, so that the tubular body 510 can be easily inserted into the natural orifice 710.

[0033] 4 shows the fixing mechanism 300. Fig. 4(A) shows the fixing mechanism 300 in its natural state before being inserted into the internal space 513 of the tubular body 510. The fixing mechanism 300 includes multiple attachment pieces 310, 320. The fixing mechanism 300 shown in Fig. 4 includes two attachment pieces 310, 320, but may include three or more attachment pieces. Each attachment piece 310, 320 may have an outer surface 311, 321 that is an arcuate surface with substantially the same curvature as the curvature of the circumferential inner surface 514 of the tubular body 510 so as to be able to closely fit against the circumferential inner surface 514.

[0034] 1 , the attachment piece 310 has a longitudinal direction that coincides with the longitudinal direction 10 of the tubular body 510, and has a leading end 313 located on the leading end 511 side of the tubular body 510, and a rear end 314 located on the rear end 512 side of the tubular body 510. Like the attachment piece 310, the attachment piece 320 also has a longitudinal direction that coincides with the longitudinal direction 10, and has a leading end 323 and a rear end 324.

[0035] 4, the mounting pieces 310, 320 are connected to each other via a spring 330. The spring 330 connects the mounting pieces 310, 320 at first circumferential ends 310A, 320A of the mounting pieces 310, 320 that face each other.

[0036] As shown in FIG. 4A , the spring 330 biases the mounting pieces 310, 320 in a direction that moves them apart. That is, the spring 330 biases the second circumferential ends 310B, 320B of the mounting pieces 310, 320 in a direction that moves them apart. The spring 330 is, for example, a coil spring or a leaf spring. In its natural state, the spring 330 positions the outer surfaces 311, 321 of the mounting pieces 310, 320 outside a circle whose size corresponds to the circumferential inner surface 514 of the tubular body 510.

[0037] When attaching the surgical support instrument 100 to the tubular body 510, as shown in FIG. 4(B), the fixing mechanism 300 is deformed by hand or using an appropriate tool in a direction that brings the attachment pieces 310, 320 closer to each other against the biasing force of the spring 330. This brings the second circumferential ends 310B, 320B of the attachment pieces 310, 320 closer to each other. The fixing mechanism 300 is deformed to such an extent that the entire fixing mechanism 300 is positioned inside a circle whose size corresponds to the circumferential inner surface 514 of the tubular body 510. Therefore, the fixing mechanism 300 assumes a first configuration that allows it to be inserted into the tubular body 510. The surgical support instrument 100 is inserted into the tubular body 510 in the first configuration shown in FIG. 4(B).

[0038] The operation portions 317, 327 provided on the attachment pieces 310, 320 can be suitably used to transform the attachment pieces 310, 320 into the first form shown in FIG. 4B . The operation portion 317 (and operation portion 327) can be an operation recess 317 formed on the rear end 314 of the attachment piece 310. The operation recess 317 is a portion of the outer surfaces 311, 321 of the attachment pieces 310, 320 that are recessed radially inward. By clamping the two operation recesses 317, 327 from the rear ends 314, 324 of the fixing mechanism 300 with an appropriate clamping tool such as forceps, the attachment pieces 310, 320 can be brought closer together and transformed into the form shown in FIG. 4B . Note that the operation recesses 317, 327 are sufficient as long as the outer surfaces 311, 321 of the attachment pieces 310, 320 are recessed; it is not necessary for the inner surfaces of the attachment pieces 310, 320 to be convex radially inward.

[0039] With the fixing mechanism 300 in the first configuration, the surgical support instrument 100 is inserted with the biological tissue expulsion device 200 side through the opening at the rear end 512 of the tubular body 510, as shown in Fig. 3(B). Then, as shown in Fig. 3(C), the surgical support instrument 100 is inserted until the biological tissue expulsion device 200 protrudes forward from the opening at the tip end 511 of the tubular body 510. The insertion operation can be performed, for example, by advancing the instrument holding the operation portions 317, 327.

[0040] When the surgical support instrument 100 is inserted to the position shown in FIG. 3C , the attachment pieces 310, 320 are released from their approximate position as shown in FIG. 4C . The release of the proximity can be performed, for example, by releasing the clamping force of the instrument holding the operation units 317, 327. When the attachment pieces 310, 320 are released from their approximate position, the biasing force of the spring 330 causes the attachment pieces 310, 320 to move away from each other, and the outer surfaces 311, 321 of the attachment pieces 310, 320 come into close contact with the inner surface 514 of the tubular body 510. This causes the fixing mechanism 300 to assume a second configuration in which it is in close contact with the inner surface 514 of the tubular body 510. In this way, the fixing mechanism 300 is reciprocally transformable between the first configuration and the second configuration.

[0041] 4(C) , the spring 330 generates a pressing force in the radially outward direction of the attachment pieces 310, 320, which presses the attachment pieces 310, 320 against the tubular body 510. In other words, the spring 330 functions as a pressing portion. The attachment pieces 310, 320 are pressed against the tubular body 510, thereby fixing the attachment pieces 310, 320 (fixing mechanism 300) to the tubular body 510. In other words, by pressing the attachment pieces 310, 320 against the tubular body 510, the outer surfaces 311, 321 of the attachment pieces 310, 320 frictionally engage with the inner surface 514 of the tubular body 510, and the attachment pieces 310, 320 are fixed in position to the tubular body 510.

[0042] By fixing the fixing mechanism 300 to the tubular body 510, the biological tissue expulsion device 200 provided on the fixing mechanism 300 can be fixed to the tubular body 510. This fixation makes it possible to prevent the biological tissue expulsion device 200 from moving or rotating unnecessarily in the longitudinal direction 10. Note that, if it is desired to move or rotate the biological tissue expulsion device 200 after fixation, it is sufficient to return it to the first form shown in Fig. 4(B) and perform the movement or rotation operation.

[0043] As described above, the fixing mechanism 300 is configured to be changeable inside the tubular body 510 between a first configuration (FIG. 4(B)) in which it is released from the tubular body 510 and a second configuration (FIG. 4(C)) in which it is fixed to the tubular body 510. In the first configuration, the biological tissue expulsion device 200 can be moved, etc. In the second configuration, the biological tissue expulsion device 200 can be fixed in position relative to the tubular body 510, allowing the biological tissue expulsion device 200 to be stably operated.

[0044] As shown in Figure 4(C), an internal space 350 surrounded by the inner surfaces 312, 322 is formed between the multiple attachment pieces 310, 320. This space 350 forms a passage 350 through which a surgical instrument 600 inserted into the tubular body 510 (expander 500) passes. When the fixing mechanism 300 is fixed to the tubular body 510 within the passage 513 of the tubular body 510, the fixing mechanism 300 has the passage 350 for the surgical instrument 600. Therefore, as shown in Figure 5, the surgical support instrument 100 and the surgical instrument 600 can be used simultaneously.

[0045] The structure of the fixing mechanism 300 is not limited to the structure shown in Fig. 4, and other structures may be used. Also, the tubular body 510 may include a part or the entirety of the fixing mechanism 300.

[0046] Returning to FIG. 1 again, and also referring to FIGS. 4, 5 and 6, the biological tissue expulsion device 200 will be described.

[0047] The biological tissue ejection device 200 operates to move biological tissue 720 within the living body 700. As shown in FIG. 5 , the biological tissue ejection device 200 is positioned further back than the distal end 511 of the tubular body 510, thereby moving the biological tissue located at the far end radially outward from the tubular body 510. For example, the biological tissue ejection device 200 can push upward biological tissue 720 that is hanging down due to gravity at the far end of the tubular body 510. The biological tissue ejection device 200 may also push downward biological tissue 720 that is rising upward from below at the far end of the tubular body 510. The biological tissue ejection device 200 can also move the biological tissue 720 in other radially outward directions (e.g., left and right directions). In this way, by using the biological tissue ejection device 200 to move the biological tissue 720 located at the far end of the tubular body 510, the surgical field at the far end of the tubular body 510 can be widened.

[0048] When the surgical assistance instrument 100 includes a plurality of tissue removal devices 200, 200, it is possible to move a wide range of the tissue 720 or to move the tissue 720 in different directions. It is preferable that each of the plurality of tissue removal devices 200 is disposed at a different position in the circumferential direction of the tubular body 510.

[0049] 1 is attached to the fixing mechanism 300 so as to extend forward (leftward in FIG. 1) from the tip 313 (323) of the fixing mechanism 300. The fixing mechanism 300 may be attached to each of the attachment pieces 310 and 320 (see FIG. 7D).

[0050] The biological tissue rejection device 200 shown in FIG. 1 includes an rejection body 210 and a pulling body 220. The rejection body 210 is, for example, a plate-shaped member. The rejection body 210 operates to move the biological tissue 720 by bending deformation. The bending deformation may be elastic deformation of the rejection body 210 or deformation in a joint structure provided in the rejection body 210. The pulling body 220 is tension-driven to bend and deform the rejection body 210. The tension-driven driving may be performed by manually pulling the pulling body 220 or by pulling it with an appropriate tool. The pulling body 220 is a film-shaped member or a wire. A tip 221 of the pulling body 220 is attached to the tip 211 of the rejection body 210, for example. The rear end (not shown) of the tensioning body 220 extends rearward from the expander 500 to enable tensioning operation outside the living body 700 (see FIG. 5).

[0051] The exclusion body 210 is provided with a first guide 230 and a second guide 240 for guiding the pulling body 220 on the exclusion body 210. The pulling body 220 on the exclusion body 210 further extends to the rear of the mounting piece 320 through an operating channel 316 (326) formed in the mounting piece 310 (320). The operating channel 316 (326) is a hole that passes through from the front end 313 (323) to the rear end 314 (324) of the mounting piece 310 (320). The pulling body 220 extending to the rear of the mounting piece 320 extends to the rear of the dilator 500 from a through-hole (not shown) formed in the trocar access device 530 or cap 520 of the dilator 500 (see FIG. 5). The pulling body 220 is operated and pulled at the rear of the dilator 500.

[0052] When the tensioning body 220 attached to the rejector 210 is pulled backward (to the right in FIG. 6) from the state shown in FIG. 6(A), the tensioning body 220 is deformed as shown in FIG. 6(B). In FIG. 6(B), the rejector 210 is bent upward. Therefore, the biological tissue 720 above the rejector 210 can be moved upward. In this way, the tensioning movement of the tensioning body 220 is converted into a bending movement of the rejector 210. Note that the guides 230 and 240 prevent the tensioning body 220 from moving in a direction away from the rejector 210 (upward in FIG. 6) when the tensioning body 220 is being pulled.

[0053] 4, in order to attach the biological tissue expulsion device 200 to the tips 313, 323 of the attachment pieces 310, 320, insertion holes 315, 325 are formed at the tips 313, 323 of the attachment pieces 310, 320. The rear end of the expulsion body 210 is inserted into the insertion holes 315, 325, respectively.

[0054] Figures 7 and 8 show a manufacturing example of a surgical support instrument 100 according to an embodiment. Figure 7(A) shows a biological tissue expulsion device 200. Figure 7(B) shows a fixing mechanism 300. Figure 7(C) shows a state in which the fixing mechanism 300 has been deformed to approach the first form. Figures 7(D) and (E) show a surgical support instrument 100 in which the biological tissue expulsion device 200 of Figure 7(A) is attached to the fixing mechanism 300 of Figure 7(B).

[0055] Fig. 8(A) shows the state in which the surgical support instrument 100 is attached to the tubular body 510 of the dilator 500. When the pulling body 220 is pulled backward (to the right in Fig. 8) from the state shown in Fig. 8(B) as shown in Fig. 8(C), the biological tissue expulsion device 200 bends upward.

[0056] Figure 9 shows the results of an experiment in which a surgical support instrument 100 is attached to an expander 500 to widen the surgical field. Figure 9(A) shows the surgical field at the back of the expander 500 when the surgical support instrument 100 is not attached. Figure 9(B) shows the surgical field shown in Figure 9(A) widened upward by the biological tissue expulsion device 200 attached to the expander 500. As shown in Figure 9(B), it can be seen that the surgical field is widened upward by the biological tissue expulsion device 200.

[0057] Fig. 9(C) shows the state in which the surgical field shown in Fig. 9(A) has been expanded to the right by the biological tissue expulsion device 200 attached to the expander 500. As shown in Fig. 9(C), it can be seen that the surgical field has been expanded to the left by the biological tissue expulsion device 200.

[0058] Fig. 10 shows a modified example of the fixing mechanism 300. In Fig. 10, the fixing mechanism 300 includes two mounting pieces 310, 320 each having a semicircular cross section, and expansion bodies 361, 362 provided between the mounting pieces 310, 320. The expansion body 361 expands when air is supplied thereto and contracts when air is exhausted. The expansion body 361 is formed, for example, by a balloon.

[0059] 10(A), when the expansion bodies 361, 362 are deflated, the circle formed by the two attachment pieces 310, 320 as a whole is smaller than the circle corresponding to the inner surface of the tubular body 510 (first form). Therefore, the fixing mechanism 300 can be inserted into the inside of the tubular body 510.

[0060] When the expansion bodies 361, 362 expand, the diameter of the circle formed by the entire two attachment pieces 310, 320 expands, and the outer surfaces of the attachment pieces 310, 320 come into close contact with the inner surface of the tubular body 510 (second form). Thus, the fixing mechanism 300 is fixed to the tubular body 510.

[0061] Fig. 11 shows a modified example of the biological tissue rejection device 200. The rejection body 210 of the biological tissue rejection device 200 shown in Fig. 11 has two joints 251, 252. The rejection body 210 includes a first rejection piece 210A, a second rejection piece 210B, and a third rejection piece 210C. The first rejection piece 210A is the most distal member. The second rejection piece 210B is connected to the first rejection piece 210A via a first joint 251. The first rejection piece 210A can bend relative to the second rejection piece 210B via the first joint 251. The third rejection piece 210C is connected to the second rejection piece 210B via a second joint 252. The second rejection piece 210B is bendable relative to the second rejection piece 210B by the second joint 252. The third rejection piece 210C is attached to the fixing mechanism 300.

[0062] The rejector 210 has a joint, which allows it to bend starting from the joint, as shown in Figures 11(A) and 11(B). In addition, the rejector 210 has multiple joints, which allows it to bend in multiple stages.

[0063] 11, multiple pullers 220A, 220B are provided. The first puller 220A is attached to the first rejection piece 210A, and the second puller 220B is attached to the second rejection piece 210B. When the first puller 220A is pulled, the first rejection piece 210A bends relative to the second rejection piece 210B. When the second puller 220B is pulled, the second rejection piece 210B bends relative to the third rejection piece 210C. By providing multiple pullers 220A, 220B, the bending amount of each of the multiple rejection pieces 210A, 210B can be independently controlled.

[0064] 11, deformation prevention portions 261, 262, and 263 are provided to prevent deformation of the rejector 210 in the opposite direction to the intended bending direction 270. The weight of the biological tissue 720 on the rejector 210 may cause the rejector 210 to deform in the opposite direction to the intended bending direction 270. If the rejector 210 deforms in the opposite direction to the intended bending direction 270, it may not be possible to sufficiently move the biological tissue 720 even if a bending deformation for moving the biological tissue 720 is generated in the rejector 210.

[0065] 11 , the rejector 210 is provided with deformation prevention portions 261, 262, and 263. The deformation prevention portions may be formed, for example, by abutment blocks 261 and 262 provided on both sides of the joint 251. When the first rejector piece 210A attempts to bend in the direction opposite to the intended bending direction 270, the first abutment block 261 abuts against the second abutment block 262, thereby preventing bending in the direction opposite to the intended bending direction 270.

[0066] The deformation prevention portion may be a contact block 263 that contacts the rejection piece 210B. When the second rejection piece 210B attempts to bend in the opposite direction to the intended bending direction 270, the second rejection piece 210B contacts the contact block 263 provided on the third rejection piece 210C, thereby preventing bending in the opposite direction to the intended bending direction 270.

[0067] FIG. 12 shows a modified example of the fixing mechanism 300. The fixing mechanism 300 shown in FIG. 12 includes a support 370. The support 370 is held by an operator such as a doctor or by an appropriate device, and is used to apply a force to the fixing mechanism 300 in the direction opposite to the pulling operation when the pulling body 220 is pulled. When the pulling body 220 is pulled, the pulling force also acts on the fixing mechanism 300, which may cause the fixing mechanism 300 to move backward relative to the tubular body 510. In contrast, as shown in FIG. 1, applying a force to the fixing mechanism 300 in the direction opposite to the pulling operation can prevent the fixing mechanism 300 from moving. The support 370 can also be used to move or rotate the fixing mechanism 300.

[0068] 12(A) and 12(B), the support 370 is configured as a hollow rod-shaped body through which the tensioning body 220B is inserted. The rod-shaped body 370 extends rearward of the dilator 500 together with the tensioning body 220. In FIG. 12, the tensioning body 220 is a strip-shaped film body 220A in front of the rod-shaped body 370 (leftward in FIG. 12), and a wire 220B inside and behind the rod-shaped body 370 (rightward in FIG. 12). The strip-shaped film body 220A and the wire 220B are connected to each other.

[0069] Alternatively, the tensioning body 220B may extend rearward outside the support body 370.

[0070] Fig. 13 shows a modified example of the biological tissue expulsion device 200. The biological tissue expulsion device 200 shown in Fig. 13 is deformed by an air device 281. The air device is, for example, an expandable body 281. The expandable body 281 expands when air is supplied to it and contracts when air is exhausted from it. The expandable body 281 is, for example, formed of a balloon. The expandable body 281 is disposed, for example, between the expulsion body 210 and a laminated body 282 provided on the expulsion body 210. When air is expanded into the expandable body 281 via an air supply pipe 290, the expulsion body 210 undergoes bending deformation as shown in Fig. 13(B).

[0071] Fig. 14 shows a modified example of the surgical support instrument 100. The surgical support instrument 100 shown in Fig. 14 has a biological tissue expulsion device 200 directly attached to an expander 500 having a tubular body 510. In Fig. 14, the biological tissue expulsion device 200 is attached to the tip of the tubular body 510. In this case, the fixing mechanism 300 for fixing the biological tissue expulsion device 200 to the expander 500 is not necessary.

[0072] The present invention is not limited to the above-described embodiment, and various modifications are possible.

[0073] 10: Longitudinal direction 100: Surgery support instrument 200: Biological tissue expulsion device 210: Expulsion body 210A: First expulsion piece 210B: Second expulsion piece 210C: Third expulsion piece 211: Tip 220: Pulling body 220A: First pulling body 220B: Second pulling body 221: Tip 230: First guide 240: Second guide 251: First joint 252: Second joint 261: First contact block 262: Second contact block 263: Contact block 270: Bending direction 281: Expansion body 282: Laminated body 290: Air supply pipe 300: Fixing mechanism 310: Attachment piece 310A: First circumferential end 310B: Second circumferential end 311: Outer surface 312: Inner surface 313: Front end 314: Rear end 315: Insertion port 316: Operation passage 317: Operation recess 320: Attachment piece 320A: First circumferential end 320B: Second circumferential end 321: Outer surface 322: Inner surface 323: Front end 324: Rear end 325: Insertion port 326: Operation passage 327: Operation recess 330: Spring 350: Passage 361: Inflatable body 362: Inflatable body 500: Endoscope dilator 510: Tubular body 511: Front end 512: Rear end 513: Passage 514 : Inner surface 520: Cap 530: Trocar access device 550: Dilator 600: Surgical instrument 700: Living body 710: Natural orifice 720: Living tissue 800: Back side

Claims

1. A surgical support instrument that is attached to a tubular body that is inserted into a natural orifice of a living body, comprising: a biological tissue expulsion device that operates to move biological tissue that is deeper than the tip of the tubular body in a radially outward direction of the tubular body; and a fixing mechanism that fixes the biological tissue expulsion device to the tubular body.

2. The surgical support instrument according to claim 1, wherein the fixing mechanism has a passage therein for passing a surgical instrument.

3. A surgical support instrument as described in claim 1, wherein the fixing mechanism comprises: a plurality of attachment pieces that contact the inner surface of the tubular body; and a pressing portion that generates a pressing force that causes the plurality of attachment pieces to contact the inner surface of the tubular body.

4. The surgical support instrument according to claim 1, wherein the fixing mechanism is configured to be changeable between a first form that is large enough to be inserted into the tubular body, and a second form that expands from the first form in the radial direction of the tubular body and adheres closely to the inner surface of the tubular body.

5. The surgical support instrument according to claim 4, wherein the fixing mechanism includes a spring that biases the second configuration.

6. The surgical support instrument according to claim 4, wherein the fixing mechanism, in the second configuration, has a passage therein for passing a surgical instrument.

7. The surgical support instrument according to claim 1, wherein the fixing mechanism is configured to be changeable inside the tubular body between a first configuration in which the mechanism is released from the tubular body and a second configuration in which the mechanism is fixed to the tubular body.

8. The surgical support instrument according to claim 1, wherein the biological tissue expulsion device comprises one or more expulsion bodies that operate to cause bending deformation of the tubular body in the radially outward direction.

9. The surgical support instrument according to claim 8, wherein the biological tissue expulsion device further comprises a tensioning body that causes the expulsion body to bend by tensioning the expulsion body.

10. A surgical support instrument comprising: a tubular body having a passage therein for a surgical instrument and to be inserted into a natural opening in a living body; and a biological tissue expulsion device provided on the tubular body and operable to move biological tissue located deeper than the tip of the tubular body in a radially outward direction of the tubular body.

11. A surgical support instrument according to any one of claims 1 to 10, wherein the natural orifice is an anus, and the tubular body is configured to be inserted into the anus.

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