JP2022068068A - Percutaneous total endoscopic disc herniated grasping forceps - Google Patents

Abstract

To solve the problem that, when pulling out a herniated disk, a grip forceps used for a percutaneous total endoscope often slips and is difficult to pull out, because of a small mouth surface and insufficient gripping force.SOLUTION: Since a device of the present invention has protruding teeth at a tip of a movable jaw, and their fragmented fixed jaws, when gripping and pulling out a herniated disk by whole jaws, the protruding teeth work as a wall that dams an intervertebral disc, thereby making movement less slippery and removal easier. Since the protruding teeth are not sharp, the risk of damaging a nerve or a membrane around the nerve does not increase. The movable jaw does not become structurally weak.SELECTED DRAWING: Figure 7

Description

The present invention relates to grasping forceps for removing soft tissues such as herniated discs used in spinal percutaneous total endoscopic surgery.

There is a method using a spinal percutaneous total endoscope in minimally invasive spinal surgery. What is the spinal percutaneous total endoscope 900? The main body part 901, which is the part to be inserted into the body as shown in FIGS. 1 and 2, is an elongated cylinder with an outer diameter of about 6 mm to less than 7 mm, and the lens barrel 902 is among them. The light source path 903, the perfusion channel 904, and the working lumen 905 are integrated. An outer cylinder 906 is inserted into the body through the skin incision S, a main body portion 901 is inserted into the body, and water is flowed from the perfusion channel 904 to wash the area around the target while magnifying the image from the connected camera on the monitor. The image is copied and operated on the spine B, intervertebral disc D, etc. with an instrument such as forceps 100 inserted into the working cavity 905. The instrument that can be inserted into the working lumen 905 is an instrument that has an elongated cylindrical shape with an outer diameter of about 2.5 mm to 4 mm and a length of about 200 mm to 400 mm, and has a handle etc. attached.

In percutaneous total endoscopic herniated disc resection, the grasping forceps for percutaneous total endoscopy shown in Fig. 3 are usually used. The tip side T has a fixed jaw 110 and a movable jaw 120, an elongated shaft 930, and a rod 940 in it. There is a handle 950 on the hand side H, and the rod 940 slides in the shaft 930 by operating the handle, and the movable jaw 120 connected to the rod 940 opens and closes (FIG. 4a is the maximum open state, FIG. 4b is the closed state). ). As shown in FIGS. 4 and 5, the jaw opening surfaces 111 and 121 of the fixed jaw 110 and the movable jaw 120 are recessed and the edges are blunt-edged. , 122). Depending on the type of instrument, as shown in Fig. 6, there are also those with small sawtooth structures 113 and 123 in which a plurality of angular small protrusions are lined up instead of blunt blades. In surgery, while observing the herniated disc, the movable jaw is closed by operating the handle, the herniated disc is grasped, and the herniated disc is pulled out to the hand side H.

JP 2005-21346

Since the gripping forceps used in the percutaneous total endoscope are thin as described above, the area of the jaw opening surface of the fixed jaw 110 and the movable jaw 120 is small, and it cannot be said that the gripping force is sufficient. .. Disc hernias are soft, moist, slippery, and moored to the surroundings, often slipping and difficult to pull out.

For endoscopic instruments that are not for spinal percutaneous total endoscopy, there are already those with large serrations on the margin of the jaw opening as shown in FIG. 7 of Patent Document 1 in order to improve the gripping force. .. The large saw blade has its tip deeply bitten into the tissue to obtain gripping force. However, this entails significant risks in spinal surgery. In other words, in spinal surgery, there are nerves and nerve-protecting membranes in the immediate vicinity of the excision target, and there is a risk of damaging them, which must be avoided.
In addition, in spinal percutaneous total endoscopic surgery, strength is required because a load is applied even though it is a minute instrument, but in a large sawtooth structure, the jagged recesses become fragile, where distortion is likely to occur and occlusion becomes poor. It ends up.
As shown in Fig. 6, forceps having a large number of serrated structures on the jaw opening do not increase the risk of nerve injury, but do not exert sufficient gripping force for soft and slippery disc herniated disks.

The instrument of the present invention is a grasping forceps for removing hernia for a percutaneous total endoscope, and as shown in FIGS. 7.8 and 9, the tip side thereof is composed of a fixed jaw and a movable jaw, and the movable jaw and the movable jaw. The tip of the fixed jaw is curved, and each jaw opening surface is in the shape of a spoon. There is one protruding tooth at the tip of the movable jaw, and the protruding tooth curvesly protrudes toward the fixed jaw side, and the inner wall of the protruding tooth is turned back at an angle equal to or greater than the part perpendicular to the long axis of the movable jaw. There is a part where the protrusion is visible, and the length of the protrusion is remarkable. When viewed from the front, the protruding teeth have a chevron shape with a rounded tip. The protruding teeth are not blade-shaped and have no sharp parts. The tip of the fixed jaw has a shape that is cut off by the amount of the above-mentioned protruding teeth, and has a spoon shape with a part of the tip open.

As a subtype, as shown in Fig. 9, the protruding tooth may have a polygonal protruding shape with a straight tip or an obtuse angle when viewed from the front.

Protruding teeth are blunt protrusions, and even if they pinch the nerve, they do not pierce the perineurium and damage the deep nerve itself, so they are less likely to leave irreversible damage.

When a herniated disc is grabbed and then pulled toward the hand, the herniated disc generally exerts a frictional force at the part sandwiched between the margins of the maxillofacial surface, and the distorted herniated disc collides with the inner wall of the jaw. Also works. Compared to the case without protruding teeth (Fig. 5), the herniated disc is more distorted by the protruding teeth, and the inner wall where it collides has a wider part facing the pulling direction, which increases the effect of damming the herniated disc and further protrudes. The tips of the teeth turn back and catch the herniated disc, creating more resistance (Fig. 9).
On the other hand, the forceps of the large sawtooth mentioned above generate drag by perforating and biting the tissue, but the protruding tooth is a protrusion with a wide and blunt tip, so the biting force is weak and different from the large sawtooth. The gripping force is obtained in principle. If the subject is hard, its effectiveness cannot be exerted, but its demerit is not important because the subject of this instrument is a herniated disc and is soft. The gripping force is inferior in directions other than the pulling direction, but the pulling movement is not important in the main spinal percutaneous total endoscopic surgery, and it is more important that it is safer than those. Safety is ensured and the gripping force at the time of pulling out is enhanced.

Furthermore, in the present invention, since the movable jaw to which the load is most applied does not have a remarkable recessed fragile portion, deformation or breakage is unlikely to occur even when a load is applied.

Schematic diagram of the lumbar section and instrument during percutaneous total endoscopic disc herniated disk resection. Percutaneous total endoscope and perspective view of the tip of the outer cylinder. Side view of a conventional grasping forceps for a percutaneous total endoscope. Tip side side view of conventional percutaneous total endoscopic grasping forceps (a is the maximum open state, b is the closed state). Tip side side view of conventional percutaneous total endoscopic grasping forceps (sharp spoon type, recessed bottom shown by dotted line) Tip side side view of conventional percutaneous total endoscopic grasping forceps (jaw opening side edge is serrated type) A side view of the tip side of the first embodiment of the present invention (a is the maximum open state, b is the closed state). Front view of the tip of the first embodiment of the present invention. A side view of the movable jaw according to the first embodiment of the present invention (the inner wall is shown by a dotted line). Front view of the tip of the subtype of Embodiment 1 of the present invention.

Embodiment 1 of the present invention will be described with reference to FIGS. 7, 8 and 9. There is a fixed jaw 210 and a movable jaw 220 on the tip side, and the tip is curved. The jaw opening surfaces 211 and 221 of the fixed jaw 210 and the movable jaw 220 are recessed and have a spoon shape, and the edges of the jaw opening surface are straight or small sawtooth shape when viewed from the side except for the tip. The jaw opening surface 221 edge of the movable jaw 220 has one protruding tooth 223 protruding toward the fixed jaw at the tip. When viewed from the side, the protruding tooth 223 curvedly protrudes toward the fixed jaw, and the inner wall 222 of the protruding tooth has a surface perpendicular to the long axis of the movable jaw 220 (double arrow in FIG. 9) and a further tip. On the other hand, there is a part that is returned at an angle greater than or equal to a right angle. The protruding length of the protruding tooth 223 is about 15% to 40% of the forceps diameter, which is remarkable in appearance (about 17% in the figure). As shown in FIG. 8, the protruding tooth 223 has a chevron shape with a rounded tip when viewed from the front. The protruding teeth are neither blade-shaped nor sharp. The tip of the fixed jaw 210 is cut off by the amount of the protruding tooth 223, and a part of the tip becomes an open portion 213. Others are the same as before, as shown in Fig. 3, there is an elongated shaft 930 with an outer diameter of about 3 mm to 4 mm and a length of about 200 mm to 400 mm, a handle 950 on the hand side, and a rod 940 passing through the lumen of the shaft 930. There is.

When the movable jaw 220 is opened (Fig. 7a) and closed by operating the handle (Fig. 7b), the herniated disc is sandwiched between the fixed jaw 210 and the dent of the jaw opening of the movable jaw 220, and the entire circumference of the jaw margin is reached. It is occluded and gripped by. When the entire forceps is pulled toward the hand to pull out the herniated disc, the inner wall 222 of the protruding tooth 223 has a surface perpendicular to the pulling direction, and the tip is further inverted, and the wall that dams the herniated disc. It becomes less slippery and easier to remove.

As a subtype of the first embodiment of the present invention, as shown in FIG. 10, a polygonal protrusion whose tip is a straight line or an obtuse angle when viewed from the front is also conceivable.

Claims (1)

In the grasping forceps for percutaneous total endoscopy, the tip side is composed of a movable jaw and a fixed jaw, the tip of the movable jaw and the fixed jaw is curved, and the jaw opening surface of the movable jaw and the fixed jaw It has a recess and is in the shape of a spoon, and the margin of the jaw opening surface is straight or small sawtooth shape when viewed from the side except for the tip.
There is one protruding tooth at the tip of the movable jaw, and the protruding tooth curvesly protrudes toward the fixed jaw side, and the inner wall of the protruding tooth has a part perpendicular to the long axis of the movable jaw and a return part at an angle equal to or more than perpendicular to the movable jaw long axis. However, the length of the protrusion is remarkable at 15% or more of the diameter of the forceps, and the tip of the protruding tooth is curved or blunt when viewed from the front, and there is no sharp part.
A grasping forceps characterized in that the tip of the fixed jaw is cut off by the amount of the protruding tooth when viewed from the front.

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