JP4896504B2 - System device consisting of a retractor and a retractor assisting device - Google Patents

Description

The invention laparotomy under or, again the small incision surgery under endoscope observation, retractors holding incision, and the a retractor to be mounted on the incision for the purpose of wound margin protection, the open wound instrument The present invention relates to a retractor mounting aid for attaching to an incision.

In recent years, surgical operation has been advocated for minimal invasiveness to patients, and small incision surgery is required to try to make as small an incision as possible even in laparotomy, and an endoscope is inserted into the body cavity while viewing the image Endoscopic surgery for advancing surgery has been widely applied, and in operations such as removing large organs, a small incision is provided in the surgical site in advance, and a retractor is attached to the incision. Endoscopic small incision surgery has been actively performed in which an operator's fingers or surgical instruments are inserted through the incision as a passage to advance the operation.
Then, these small incision surgery was developed as an application, and it was attached to the small incision wound to hold the wound and protect the wound edge. An edge protection device having a retracting portion holding function in which a ring is attached to both ends of a cylindrical elastic member in a state where both ends are expanded, and a superelastic alloy is used for at least one of the rings. There is. As a conventional means for attaching this instrument to an incision, a part of the edge of an elastic ring (hereinafter referred to as a body cavity inner ring) that is inserted into the body cavity from the incision and placed in the body cavity. Is pushed up from a ring (hereinafter referred to as a body surface side ring) on the side of the incision wound around the incision so as to reverse the elastic member through the lumen of the elastic member using elasticity (or Pull up), project about half of the inner ring of the body cavity from the ring on the surface of the body, prepare a high heel shape to prepare for insertion, further crush the formed inner ring of the body cavity and insert the tip into the incision Then, by slowly pushing the other end of the body cavity inner ring protruding from the body surface side ring into the body cavity inner ring, the body cavity inner ring is inserted into the body cavity. Ri, wherein both rings sandwich the incision from the body outside, and the elastic member is performed in the procedure such as is mounted in close contact with the abdominal wall. (See Patent Document 1)

Registered Utility Model No. 30602106

However, since the mounting means is operated by the operator's fingers, the mounting may not be successful. For example, in patients with thick subcutaneous fat, the abdominal wall of the incision is thick, so even if a device that should be physically long enough to be elastic is used, the entire inner ring of the body cavity does not reach the inside of the body cavity well. There is a case where the attachment is not successful, and in particular, when using a device having a small lumen of the elastic member corresponding to a small incision, a passage for pushing the inner ring of the body cavity into the body cavity (elastic member lumen) May be difficult due to the small size.

  Accordingly, the present invention provides a retractor mounting aid that facilitates and reliably inserts the body cavity inner ring into the body cavity in order to mount the retractor formed of the elastic ring and the elastic member as described above on the incision. It was an issue to provide.

A system device comprising a retractor and a retractor attachment assisting device of the present invention comprises two rings having at least one elasticity arranged coaxially, and a cylindrical elastic member attached to the ring with both ends expanded. A retractable device and a device for attaching the retractable device to the incision, having a mantle portion longer than the body wall of the incision , and accommodating the elastic ring in a body-like shape by crushing the elastic ring And a retractor mounting assisting device comprising an extrusion lot for extruding the accommodated ring, which is slidably inserted into and removed from the lumen of the mantle.

According to the retractor mounting aid of this configuration, the following means can be used to mount the retractor on the incision. Details will be described again in the embodiment.
1. A part of the edge of the body cavity inner ring having elasticity is pushed up (or pulled up) from the body surface side ring so as to invert the elastic member through the lumen of the elastic member using elasticity, and half the body cavity inner ring. A degree is protruded from the body surface side ring, and a high heel shape is formed to prepare for insertion. (Same as conventional means)
2. The outer trowel and the pushing lot of the device are separated, and a portion of the inner ring of the body cavity formed in the high heel shape that protrudes from the body surface side ring is inserted into the inner cavity of the outer trowel using the distal end of the outer trowel as an insertion port.
3. With the front retractor set on the mantle, the tip of the inner ring of the body cavity is inserted into the incision, and further inserted until the mantle part is fully seated. In this case, the body surface side ring is in contact with the body surface.
4). When the extrusion lot is pushed into the lumen of the mantle and the body cavity inner ring inserted into the lumen is pushed out, the body cavity inner ring is pushed into the body cavity, and the retractor is attached to the incision.
5). Finally, the device is removed from the lumen of the retractor and the installation is completed.

According to the means using this instrument, the operation of mounting the retractor comprising the elastic ring and the elastic member on the incision can be performed very easily and reliably.
For example, even when the body wall is thick as described above, since the mantle portion is set longer than the body wall, the tip of the mantle can be surely positioned in the body cavity, and the inner ring of the body cavity pushed out from the tip Can be securely pushed into the body cavity. In addition, even if the elastic member lumen of the retractor has a small diameter, the insertion operation of the inner ring of the body cavity can be performed by pushing the push-out lot, so that it is not difficult to insert like the operation with fingers. .
Further, as an incidental effect, since a hard mantle can be inserted as a guide when inserted into the incision, the soft elastic ring can be inserted more smoothly than when directly inserted.

Hereinafter, an example of an embodiment of the present invention will be described in detail with reference to the drawings. FIG. 1 is an overall configuration diagram of a retractor mounting aid showing an embodiment of the present invention, and FIG. 2 is a diagram showing a jacket and an extrusion lot separated.
The retractor mounting aid of this embodiment is composed of a mantle 1 having a mantle tube 11 that is longer than the body wall of the incision wound, and a pushing lot 2 that slides removably into the lumen of the mantle 1. The cannula 1 is formed by molding or cutting with a hard resin, and is composed of a cylindrical mantle tube 11 part and a mantle base 12 serving as a gripping part, and the mantle tube 11 is longer than the abdominal wall of the incisional wound as described above. Thus, it has a lumen 112 that engages with the extrusion lot 2 described later, and the tip 111 is formed by chamfering. In this example, the mantle base 12 is integrally formed with the mantle tube 11 to form an opening 122 communicating with the inner cavity 112 of the mantle tube 11, and the lot 122 of the extrusion lot 2 described later is formed in the opening 122. A recess 123 that fits with the base 22 is provided, and a non-slip 121 is provided on the outer peripheral portion, which is a grip portion, so that the grip portion can be easily held.
The extrusion lot is formed by molding or cutting with a hard resin, and is composed of a lot 21 serving as an extrusion rod of the retractor 3, and a lot base 22 serving as a pressing portion or a gripping portion. Formed as a product. The lot 21 has an outer diameter that is slidably detachable from the inner cavity 112 of the mantle 1, and has a length such that the tip 211 protrudes from the mantle tip 111 when inserted into the mantle 1. The part 211 was formed in a shape having no corners such as a hemisphere. The lot base 22 includes a flat surface portion 221 that can be easily pressed by fingers, and is formed in a shape that fits into the concave portion 123 of the outer jacket 1.
According to this configuration, as described in the above-described effect, the mantle tube 11 is formed longer than the abdominal wall of the incision, so that the mantle inner end of the retractor 3 can be obtained by penetrating the mantle tip 111 into the body cavity. The ring 31 can be securely mounted in the abdominal cavity. Further, by using the extrusion lot 2 for inserting the body cavity ring 31 into the abdominal cavity, even if the lumen 331 of the elastic member 33 is small, it can be easily mounted.

FIG. 3 is an example of a retractor applied to the retractor mounting aid of the present invention, in which A is an overall view and B is a cross-sectional view of the ring portion. The retractor used by the present instrument is a retractor composed of two rings, which are coaxially arranged opposite to each other and elastic, and a cylindrical elastic member attached to the ring with both ends extended. When being attached to the human body, the body cavity inner side ring 31 having elasticity which is inserted into the body cavity from the incision wound and disposed in contact with the peritoneum, and the body surface side ring 32 which is disposed in contact with the body surface surrounding the incision wound. And a cylindrical elastic member 33 that is attached to the two rings 31 and 32 by expanding both ends thereof and is disposed in contact with the abdominal wall and further on the body surface from within the body cavity. , 32 and holding the wound by the elastic restoring force of the ring, and the elastic member 33 is in close contact with the incision so that the abdominal wall is not exposed to the external environment, thereby providing a wound protecting effect and a hemostatic effect. It is.
The retractor 3 of the above embodiment of the present embodiment will be described in detail. The body cavity inner ring 31 and the body surface side ring 32 are made of a superelastic alloy 34 made of a wire material such as a titanium-nickel alloy as a core material in a ring shape. The super elastic alloy 34 is covered with a protective tube 35 made of a resin tube (in this example, a polyurethane tube), and further covered with a cover tube 36 made of a silicon tube. According to this configuration, by using the superelastic alloy 34 as a core material, the rings 31 and 32 are rich in elasticity and restoring force, and can be crushed into a small diameter when inserted into or removed from the body cavity. In addition, after insertion, it can be securely held from inside the body cavity by naturally returning to the original ring shape by the restoring force. Further, since the outer layer is covered with a flexible resin, the contact with the abdominal wall can be made soft.
On the other hand, the elastic member 33 is formed by forming a flexible silicon resin thin film into a cylindrical shape, and both end portions are extended over the entire circumference, and are connected and fixed to the elastic rings 31 and 32 by adhesion or welding. The intermediate part is the contact part with the abdominal wall of the incision.

Next, a usage pattern (insertion method) of the present embodiment will be described in detail with reference to FIG. (Note that FIG. 4 is a schematic diagram and does not show the actual shape.)
The method of mounting the retractor on the incision using the retractor mounting aid of the present embodiment is based on the following procedure.
A. A part of the edge of the body cavity inner ring 31 of the retractor 3 (in the figure, the rear end 312 of the ring) utilizes the elasticity to reverse the elastic member 33 through the inner cavity 331 of the elastic member 33. By pushing up (or pulling up) from 32, about half of the body cavity inner ring 31 protrudes from the body surface side ring 32 to form a high heel shape to prepare for insertion.
B. The pushing lot 2 is removed from the mantle 1 of the device, and a portion of the body cavity inner ring 31 formed in the high heel shape protruding from the body surface side ring 32 with the distal end portion 111 of the mantle 1 as an insertion port is formed into the body cavity inner ring 31. Is inserted into the inner cavity 112 of the jacket 1 from the rear end 312.
C. With the front retractor 3 set on the mantle 1, the base 4 of the mantle tube 11 is inserted into the incision 4 from the tip 311 of the inner ring 31 of the body cavity to the body surface. Using the elasticity, the body surface side ring 32 is inserted while being pulled to a position related to the mantle base 12.
D. Then, the distal end 111 of the mantle tube 11 is securely inserted into the body cavity 6 by inserting the mantle tube 11 up to the base, bringing the body surface side ring 32 into contact with the body surface 7 and making the mantle base 12 into a state. Can be positioned.
E. In this state, when the extrusion lot 2 is pressed and inserted into the mantle lumen 112 through the opening 122 of the mantle 1 and the body cavity inner ring 31 inserted into the lumen 112 is pushed out, the body cavity inner ring 31 is inserted into the body cavity. 6 is extruded.
F. Then, by inserting the lot base 22 of the extrusion lot 2 to the fitting position of the concave portion 123 of the mantle base 12, the body cavity inner ring 31 is completely extruded from the mantle lumen 112 and positioned in the body cavity 6. At this time, due to the elastic restoring force of the ring 31, it naturally returns to the original ring shape, and the retractor 3 is attached to the incision 4.
G. Finally, the device is removed from the elastic member lumen 331 of the retractor 3 to complete the mounting.
The incision 4 is sandwiched and fixed from the body cavity 6 and the body surface 7 by the body cavity inner ring 31 and the body surface side ring 32, and the wound is held by the elastic restoring force of the elastic rings 31 and 32. Yes. Further, the peritoneum, abdominal wall 5 and further the body surface 7 in the body cavity 6 of the incision 4 are closely covered by the elastic member 33 so as to protect the wound edge.

1 is an overall configuration diagram showing an embodiment of the present invention. It is a block diagram which shows the mantle and the extrusion lot of the said embodiment. It is a block diagram which shows an example of the retractor suitable for this invention. It is the schematic which shows the usage condition of embodiment of this invention.

Explanation of symbols

1. Jacket 11 Mantle tube 111. Mantle tip 112. Mantle lumen 12. Mantle base 121. Non-slip 122. Opening 123. Recess 2. Extrusion lot 21. Lot 211. Lot tip 22. Lot base 221. Flat part
3. Retractor 31. Body cavity inner ring 311. Body cavity inner ring tip 312. Rear end of body cavity inner ring 32. Body surface side ring 33. Elastic member 331. Elastic member lumen 34. Superelastic alloy 35. Protective tube 36. Cover tube 4. Incision wound 5. Abdominal wall 6. Intraperitoneal 7. Body surface

Claims (1)

Facing coaxially, two rings and a retractor formed of a cylindrical elastic member mounted to extend both ends to the ring, the instrument for mounting the retractor to the incision having at least one of the elastic , and there were the long mantle from the body wall incision, and mantle accommodating to the lumen in Karadasama with crushed ring having the elastic, removably slid into the lumen of該Gaito A system instrument comprising a retractor and a retractor mounting assisting instrument, comprising a retractor mounting assisting instrument comprising an extrusion lot for extruding the accommodated ring.

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