JP7610237B1 - Medical Insertion Device - Google Patents

Abstract

To provide a medical insertion device that allows forceps A and a retrieval bag B to be used separately with enhanced sealing properties, and in particular, for forceps A, which can be easily operated by reducing frictional resistance while further enhancing sealing properties and support properties during use.
[Solution] A removable cap 30 is provided for closing the base end opening 11b of a pipe main body 11 that is inserted transvaginally, and insertion openings 41, 42 for separately passing through a forceps A and a recovery bag B are provided on a main wall surface portion 31 of the cap 30. The insertion opening 41 corresponding to the forceps A is provided with a fitting tube portion 410 that continues in a cylindrical shape from its periphery, and a plurality of annular protrusions 411 that come into close contact with the outer circumferential surface of the forceps A are provided in an array on the inner peripheral surface of the fitting tube portion 410 over the entire circumference.
[Selection] Figure 13

Description

The present invention relates to a medical inserter that can be inserted transvaginally and used for hysterectomy.

Various instruments have been proposed for use in laparoscopic hysterectomy. For example, Patent Document 1 discloses an insertion tool that is inserted transvaginally and used to hold the uterus during hysterectomy, to insert and remove instruments such as forceps to remove the excised uterus, and can also be used when suturing the vaginal wall stump.

In the insertion tool disclosed in Patent Document 1, the cap attached to the base end opening of the main body has a hole for inserting an instrument such as forceps, and a cylindrical portion extending from the periphery of the hole. Here, the inner surface of the hole and the inner surface of the cylindrical portion are continuous on the same cylindrical surface, and when an instrument such as forceps is inserted through the hole, the inner surface of the cylindrical portion comes into close contact with the instrument. This increases the contact area between the cap and the instrument, making it possible to suppress leakage of pneumoperitoneum gas.

The instrument used with this type of insertion tool to extract the excised uterus is not limited to ordinary forceps; a retrieval bag is also known. The retrieval bag contains the excised uterus and is inserted in a folded state inside the shaft. When in use, the bag protrudes from the tip of the shaft and unfolds to contain the uterus. In general, the shaft diameter of the retrieval bag is significantly larger than that of the forceps.

JP 2022-102154 A

In the conventional insertion tool described above, the only hole in the cap was designed to accommodate forceps, and the inner diameter of the hole and the cylindrical portion was designed to match the shaft diameter of the forceps. With this type of insertion tool, only forceps could be inserted into the hole in the cap, and other instruments (recovery bags) with significantly different shaft diameters could not be used. If the size of the hole were expanded to accommodate a recovery bag, a gap would easily form between the forceps and the hole when they were inserted, and there was a risk of pneumoperitoneum gas leaking out from this gap.

In addition, the cylindrical portion extending from around the hole in the cap increases the contact area between the cap and the instrument when the forceps are inserted, improving support and sealing, but the outer circumferential surface of the forceps tends to stick closely to the straight inner circumferential surface of the cylindrical portion. This increases the frictional resistance with the cap when the forceps are inserted, and there is a risk that the forceps cannot be operated smoothly.

The present invention was made in response to the problems of the conventional technology described above, and aims to provide a medical inserter that can be used with multiple types of instruments (e.g., forceps and retrieval bags) with different outer diameters, each with an increased sealability, and that can be easily operated by reducing frictional resistance while further increasing the sealability and supportability during use for any one of the instruments (e.g., forceps).

In order to achieve the above object, one aspect of the present invention is to
A medical inserter having a removable cap for closing a base end opening of a pipe body to be inserted transvaginally,
At least a part of the main wall surface of the cap is formed in a thin sheet shape, and a plurality of insertion openings through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted are integrally formed in the sheet-like portion,
A fitting tubular portion is integrally formed with any one of the insertion openings, the fitting tubular portion being connected from its periphery in a tubular shape and into which the instrument is inserted and passed through the one insertion opening,
A plurality of annular protrusions that are in close contact with the outer peripheral surface of the instrument over the entire circumference are integrally formed on the inner peripheral surface of the fitting cylindrical portion and arranged in the axial direction of the fitting cylindrical portion,
The protrusions are integrally formed so as to be closely arranged on the inner peripheral surface of the fitting tube portion, and an annular recess is formed between adjacent protrusions so as not to abut against the outer peripheral surface of the instrument,
Any other of the insertion openings does not have the fitting tube portion and is integrally molded with an inner diameter larger than that of the one insertion opening, and a crimping portion is integrally molded along its periphery to elastically expand in diameter by pressing the instrument corresponding to the other insertion opening and to come into close contact with the outer circumferential surface of the instrument,
The crimping portion is formed integrally as a taper inclined toward the inside where the periphery of the insertion opening portion located on the reference planes on the front and back of the main wall portion intersect .

The medical inserter of the present invention allows multiple types of instruments with different outer diameters to be used with their respective sealing properties enhanced, and for any one of the instruments, the sealing properties and support properties during use are further enhanced, while frictional resistance is reduced, making it easy to operate.

FIG. 2 is a side view showing the medical inserter according to the first embodiment. FIG. 1 is a perspective view showing a medical inserter according to a first embodiment. FIG. 2 is a top perspective view showing the cap according to the first embodiment. FIG. 2 is a bottom perspective view showing the cap according to the first embodiment. FIG. 2 is a plan view showing the cap according to the first embodiment. FIG. 2 is a bottom view showing the cap according to the first embodiment. FIG. 2 is a front view showing the cap according to the first embodiment. FIG. 4 is a rear view showing the cap according to the first embodiment. FIG. 4 is a right side view showing the cap according to the first embodiment. FIG. 2 is a left side view showing the cap according to the first embodiment. FIG. 2 is a vertical cross-sectional view showing the cap according to the first embodiment. 1 is a plan view showing a state in which each insertion opening of the cap according to the first embodiment is closed with a stopper. FIG. 3 is an enlarged longitudinal cross-sectional view showing each insertion opening of the cap according to the first embodiment. FIG. 11A to 11C are explanatory diagrams showing the operation of closing each insertion opening with a stopper in the cap according to the first embodiment. 10A to 10C are explanatory diagrams showing the operation of a fitting tube portion of one insertion opening portion of the cap according to the first embodiment. 1A to 1C are explanatory diagrams showing two types of instruments used in the medical inserter according to the first embodiment. FIG. 1 is an explanatory diagram showing an image of a hysterectomy performed under a laparoscope. FIG. 2 is an explanatory diagram showing a state in which the medical insertion device according to the first embodiment is used during a hysterectomy. FIG. 19 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 18 . FIG. 20 is an explanatory diagram showing a state of use of the medical inserter subsequent to that of FIG. 19 when forceps are used as an instrument. FIG. 21 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 20 . FIG. 22 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 21 . FIG. 20 is an explanatory diagram showing a state of use of the medical inserter subsequent to that of FIG. 19 when a retrieval bag is used as the instrument. FIG. 24 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 23 . FIG. 25 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 24 . FIG. 26 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 25 . FIG. 27 is an explanatory diagram showing a state in which the medical inserter is used, continuing from FIG. 26 . FIG. 11 is a top perspective view showing a cap according to a second embodiment. FIG. 11 is a bottom perspective view showing a cap according to a second embodiment. FIG. 11 is a plan view showing a cap according to a second embodiment. FIG. 11 is a bottom view showing the cap according to the second embodiment. FIG. 11 is a front view showing a cap according to a second embodiment. FIG. 11 is a rear view showing the cap according to the second embodiment. FIG. 11 is a right side view showing a cap according to a second embodiment. FIG. 11 is a left side view showing a cap according to a second embodiment. 13 is a plan view showing a state in which each insertion opening of a cap according to a second embodiment is closed with a stopper. FIG. 13 is an explanatory diagram showing dimensions of a cap according to a second embodiment in a state where each insertion opening is closed with a stopper. FIG.

Various embodiments representative of the present invention will be described below with reference to the drawings.
1 to 27 show a first embodiment of the present invention, and Fig. 28 to 37 show a second embodiment of the present invention. The medical inserter 10 according to various embodiments can be inserted transvaginally and used for hysterectomy, and is also used for inserting and removing instruments and for securing a path for removing the uterus. Note that the components, shapes, values, etc. shown in the embodiments described below are all examples of the present invention and do not limit the present invention.

Overview of the medical inserter 10 according to the first embodiment
As shown in Fig. 1, the medical inserter 10 includes a pipe body 11 that is inserted transvaginally, and a removable cap 30 that closes the base end opening 11b of the pipe body 11. Here, the cap 30 forms the core of the present invention. In the following description, the side distal to the surgeon in the axial direction in which the pipe body 11 extends is defined as the "tip" (left end in Fig. 1), and the side proximal to the surgeon is defined as the "base end" (right end in Fig. 1).

<Pipe body 11>
As shown in Fig. 1, the pipe body 11 is generally formed in a cylindrical shape with a circular cross section, and its tip and base ends are both open. More specifically, the pipe body 11 is composed of a tip ring 12 provided at the tip, and a main pipe section 13 occupying the base end side of the tip ring 12. A handle 20 that is held by the surgeon is provided at the base end side of the main pipe section 13. The area of the pipe body 11 on the tip side of the handle 20 becomes the effective area L that can be inserted into the vagina.

The tip of the pipe body 11, i.e., the tip of the tip ring 12, opens in an elliptical shape on a plane inclined relative to a plane perpendicular to the axis of the pipe body 11. This tip opening 11a is the part that directly communicates with the inside of the vagina. On the other hand, the base end of the pipe body 11, i.e., the base end of the main pipe section 13, opens in a circular shape on a plane perpendicular to the axis of the pipe body 11. This base end opening 11b is the part through which multiple types of instruments are inserted from outside the vagina, and is closed by a removable cap 30.

The tip ring 12 is made of, for example, thermosetting acrylic resin. Specifically, the tip ring 12 is formed by injecting liquid thermosetting acrylic resin into a mold, sealing it, and then heating and hardening it in this state. Alternatively, the tip ring 12 may be formed by cutting a cylindrical extrusion molded product made of thermosetting acrylic resin. The base end of the tip ring 12 has the same diameter as the tip of the main pipe section 13, and the two are continuous with no gaps.

The inside of the main pipe section 13 is a space for inserting multiple types of instruments, and is generally formed so that the outside diameter at the base end gradually increases in diameter from the outside diameter at the tip. More specifically, the main pipe section 13 is made up of a cylindrical small diameter section 13a that forms the tip side connected to the tip ring 12, a cylindrical large diameter section 13b that forms the base side and has a larger diameter than the small diameter section 13a, and a tapered section 13c that continues between them.

The outer peripheral surface of the main pipe section 13 is provided with ridges 14a and 14b that protrude in the radial direction and prevent pneumoperitoneum gas, described later, from leaking along the outer peripheral surface. In this embodiment, a plurality of ridges 14a and 14b spaced apart from each other in the axial direction are provided on the outer peripheral surface of the small diameter section 13a. Of these, the ridge 14a closest to the tip is not continuous around the entire circumference, but is provided only on a portion of the circumference. The other ridges 14b are provided in a continuous ring shape around the entire circumference of the pipe body 11.

Each of the ridges 14a, 14b has an elliptical shape that is inclined with respect to a plane perpendicular to the axial direction. The radial height of the ridges 14a, 14b should be formed so that it gradually increases toward the base end. The configuration of the ridges 14a, 14b is not limited to that described above, and it is also possible to, for example, omit the ridge 14a at the most distal end and form only the annular ridge 14b, to make the ridges circular along the circumferential direction of the main pipe section 13, or to arrange the ridges so that the radial heights of the multiple ridges are uniform.

As shown in FIG. 1, the handle 20 is provided so as to be integrally connected to the base end side of the main pipe section 13. The handle 20 is formed to a size and shape that allows the surgeon to easily grasp and operate the main pipe section 13. In this embodiment, the handle 20 is formed so as to extend diagonally rearward from the base end side of the main pipe section 13, and then extend rearward in a narrow shape parallel to the axial direction of the main pipe section 13. The handle 20 is, for example, integrally molded with the main pipe section 13 from the same resin material. It is preferable to provide appropriate unevenness on the surface of the handle 20 in the form of ribs or grooves to prevent slipping.

The main pipe section 13 is formed, for example, by injection molding of a resin with the tip ring 12 inserted. In this embodiment, the main pipe section 13 and the handle 20 are integrally injection molded with the same resin material. It is preferable that the main pipe section 13 is transparent so that the instruments inserted inside the main pipe section 13 can be visually confirmed when the medical inserter 10 is in use. Considering such required characteristics and costs, for example, polycarbonate or ABS is suitable as a resin material for the main pipe section 13, etc. In addition, as a mold for injection molding the main pipe section 13, etc., it is preferable to use, for example, the invention described in JP Patent Publication No. 2022-102154, which has already been proposed by the present applicant.

<Cap 30>
2 to 11, the cap 30, which is the core of the present invention, is detachable so as to close the base end opening 11b of the pipe body 11, is formed in a shallow cylindrical shape with a bottom, and is integrally molded from a flexible material such as silicone rubber. More specifically, the cap 30 has a main wall surface portion 31 forming a circular top surface, which is formed in the shape of a thin, stretchable sheet to a certain extent, and is provided with a cylindrical outer wall portion 32 that surrounds and borders the outer periphery of the main wall surface portion 31.

As shown in FIG. 3, the inner surface side of the main wall surface portion 31 is provided with an inner wall portion 33, which is cylindrical and has a diameter slightly smaller than that of the outer wall portion 32 and extends beyond the tip of the outer wall portion 32. The cap 30 is attached in a state where the base end opening 11b of the pipe body 11 is sealed by a double seal structure in which the inner wall portion 33 fits inside the base end opening 11b of the pipe body 11 and the outer wall portion 32 fits outside the base end of the pipe body 11. As shown in FIG. 11, the inner peripheral side of the tip of the outer wall portion 32 is provided with a jaw 32a that engages with the outer periphery of the base end of the pipe body 11. In addition, the outer peripheral side of the tip of the inner wall portion 33 is provided with a taper 33a that makes it easier to fit inside the base end opening 11b.

In this embodiment, the main wall portion 31 is formed in a thin sheet shape over the entire area, and this sheet-like portion is provided with insertion openings 41, 42 for passing multiple types of instruments separately. Each insertion opening 41, 42 is a portion for inserting and removing an instrument into and from the inside of the pipe body 11 when the cap 30 is attached to the base end opening 11b of the pipe body 11. In the cap 30 of this embodiment, two insertion openings 41, 42 are provided assuming two types of instruments. Here, the instruments are multiple types of shaft-shaped medical instruments (trocars) with different outer diameters, and in this embodiment, forceps and a retrieval bag are used as examples of the two types of instruments.

As shown in FIG. 16, the forceps A are used to close and suture the vaginal wall stump in the abdominal cavity after the hysterectomy (see FIG. 17), and are also used to remove the excised uterus, etc. The forceps A has a gripping part A2 at its tip connected to the tip of the shaft A1, and the gripping part A2 extending from the tip of the shaft A1 can be operated during operation. The retrieval bag B is also used to remove the excised uterus, etc. The retrieval bag B is inserted in a folded state with the bag body B2 on the shaft B1, and can be unfolded by protruding the bag body B2 from the tip of the shaft B1 during operation. Note that the instruments used with the medical inserter 10 are not limited to the forceps A and the retrieval bag B.

Each of the insertion openings 41, 42 is elastically deformed by pressing in a corresponding instrument, allowing the instrument to be inserted in a sealed state, with one insertion opening 41 corresponding to forceps A and the other insertion opening 42 corresponding to retrieval bag B. The shaft diameter (synonymous with outer diameter) of forceps A is generally thin, for example, φ4.5 to 5.8 mm, while the shaft diameter (synonymous with outer diameter) of retrieval bag B is generally thick, for example, φ10.0 to 15.0 mm. In this way, the outer diameter of shaft B1 of retrieval bag B is relatively larger than the outer diameter of shaft A1 of forceps A, and therefore the other insertion opening 42 is formed with an inner diameter larger than the one insertion opening 41.

As shown in FIG. 6, each of the insertion openings 41, 42 is disposed inside the inner wall portion 33 of the main wall portion 31 at a position eccentric from the center of the main wall portion 31, and is arranged so as to be aligned in the diameter direction with the center of the main wall portion 31 between them. As shown in FIG. 5, a convex marking 43 is provided on the reference surface on the front side (outer surface side) of the main wall portion 31, extending in an arc shape so as to surround the outside of each of the insertion openings 41, 42. The convex marking 43 prevents the reference surface on the front side of the main wall portion 31 from sticking to another flat surface.

13, one insertion opening 41 is provided with a fitting tube 410 that extends from its periphery 41a in a cylindrical shape and into which the forceps A is inserted. Here, the inner peripheral surface of one insertion opening 41 and the inner peripheral surface of the fitting tube 410 are continuous with each other on the same cylindrical surface. In addition, on the inner peripheral surface of the fitting tube 410, a plurality of annular protrusions 411 that are in close contact with the outer peripheral surface of the forceps A over the entire circumference are arranged in the axial direction in which the fitting tube 410 extends. Here, each protrusion 411 is arranged closely to each other, and between adjacent protrusions 411, annular recesses 412 that do not abut the outer peripheral surface of the forceps A are formed. Note that the inner circumference of the insertion opening 41 is also considered to be part of the inner circumference of the fitting tube 410 in the following description.

As shown in FIG. 13, each of the protrusions 411 is formed, for example, with a smooth arc-shaped cross section, and the apex of each protrusion 411 makes localized linear contact with the outer circumferential surface of the forceps A (shaft A1). The minimum inner diameter of the fitting tube 410 surrounded by the apex of each protrusion 411 should be set slightly smaller than the outer diameter of the forceps A. Each protrusion 411 can reduce frictional resistance compared to when the inner circumferential surface of the fitting tube 410 makes surface contact with the outer circumferential surface of the forceps A. In addition, each of the protrusions 411 makes close contact with the outer circumferential surface of the forceps A (shaft A1) in the entire circumferential direction, thereby improving sealing performance when the forceps A is inserted.

The recesses 412 between the protrusions 411 provide play to allow the fitting tube 410 to easily deform in response to the movement of the forceps A, as shown in FIG. 15(b). Furthermore, as shown in FIG. 13 and FIG. 15(a), the inside of the tip of the fitting tube 410 is also provided with a reduced diameter portion 413 that extends all the way around in the axial direction. The reduced diameter portion 413 protrudes inward from the protrusions 411 and is in close contact with the outer periphery of the forceps A, and works in conjunction with the protrusions 411 to improve sealing performance.

When the shaft diameter of the forceps A is φ4.5 to 5.8 mm as described above, the minimum inner diameter of the fitting tube portion 410 surrounded by the top ends of each convex portion 411 may be set to, for example, φ5.2 mm. The maximum inner diameter of the fitting tube portion 410 surrounded by the valley bottoms of each concave portion 412 may be set to, for example, φ5.8 mm. Furthermore, the inner diameter surrounded by the reduced diameter portion 413 may be set to, for example, φ3.8 mm. The length of the fitting tube portion 410 is set to, for example, φ8.0 mm, including the depth of the insertion opening portion 41 (thickness of the main wall portion 31) of 2.0 mm, and a total of three convex portions 411 may be provided.

On the other hand, as shown in Figures 13 and 14, the other insertion opening 42 has a crimping section 420 along its periphery 42a which elastically expands in diameter by pressing the collection bag B into it, and comes into close contact with the outer periphery of the collection bag B. The crimping section 420 is formed as a taper 421 that is inclined inward and intersects with the periphery 42a of the insertion opening 42 located on the reference planes on the front and back of the main wall section 31. Here, the tip 422 where the front and back tapers 421 intersect is formed to have a strong trapezoidal cross section rather than an acute triangular cross section.

As mentioned above, the shaft diameter of the collection bag B to be inserted into the other insertion opening 42 is a wide range of φ10.0 to 15.0 mm, so instead of providing a fitting tube 410 similar to the first insertion opening 41, the insertion opening 42 is formed thin-walled with a taper 421. This configuration of the insertion opening 42 allows for increased expandability so that it can accommodate a variety of outer diameters of the collection bag B.

When the shaft diameter of the collection bag B is φ10.0 to 15.0 mm as described above, the maximum inner diameter surrounded by the periphery 42a of the insertion opening 42 may be set to, for example, φ12.5 mm. Also, the minimum inner diameter surrounded by the tip 422 of the taper 421 of the insertion opening 42 may be set to, for example, φ7.5 mm. Here, when the maximum inner diameter φ12.5 mm of the insertion opening 42 matches, for example, the outer diameter of the shaft diameter of the collection bag B, the ratio of the maximum inner diameter of the insertion opening 42 (shaft diameter of the collection bag B) to the minimum inner diameter of the insertion opening 42 is 0.6:1, which is 3:5 in integer ratio and 37.5%:62.5% in percentage ratio.

As shown in Figs. 3 and 4, the cap 30 has stopper plugs 51 and 52 for blocking the insertion openings 41 and 42, respectively. Each stopper plug 51 and 52 is integrally connected to both ends of the outer wall portion 32, which is the outer periphery of the main wall portion 31, via connecting portions 510 and 520, respectively. Each stopper plug 51 and 52 is formed in a protrusion shape that protrudes from one surface on the tip side of the connecting portion 510 and 520. As shown in Fig. 14, each stopper plug 51 and 52 has a cylindrical shaft portion 51a and 52a with a substantially conical head portion 51b and 52b at the end thereof, and the outer peripheral edge of the head portion 51b and 52b expands in an umbrella shape from the outer diameter of the shaft portion 51a and 52a, preventing it from coming out when it is pushed into each insertion opening 41 and 42.

The shaft 51a of the stopper 51 that blocks one of the insertion openings 41 is set to a length that passes through the fitting tube 410, and the outer diameter of the shaft 51a as well as the head 51b is set to be slightly larger than the inner diameter surrounded by the reduced diameter portion 413 of the fitting tube 410. By inserting the stopper 51 into the insertion opening 41 or the fitting tube 410, the insertion opening 41 is blocked, and by removing the stopper 51 from the insertion opening 41 or the fitting tube 410, an instrument such as forceps A can be inserted through the insertion opening 41.

The shaft 52a of the stopper 52 that blocks the other insertion opening 42 is short enough to penetrate the insertion opening 42, and the outer diameter of not only the head 52b but also the shaft 52a is set to be slightly larger than the minimum inner diameter surrounded by the tip 422 of the taper 421 of the insertion opening 42. By inserting such a stopper 52 into the insertion opening 42, the insertion opening 42 is blocked, and by removing it from the insertion opening 42, it becomes possible to insert an instrument with a relatively large shaft outer diameter, such as a recovery bag B, from the insertion opening 42.

As shown in Figures 3 to 6, in this embodiment, the cap 30, the stopper plugs 51, 52, and the connecting parts 510, 520 that connect them are integrally formed from a flexible material. Here, each connecting part 510, 520 is formed in a narrow, flat band shape. The pair of connecting parts 510, 520 are provided so as to extend outward from both ends of the outer peripheral wall part 32 of the cap 30 along the diameter direction in which the two insertion opening parts 41, 42 are aligned, on the same plane that is approximately parallel to the main wall surface part 31.

In this way, the natural restoration position of each of the connecting parts 510, 520 is when they are deployed so that they extend from both ends of the outer peripheral wall part 32 in directions opposite to each other by 180 degrees. As shown in FIG. 12, each of the connecting parts 510, 520 can be freely bent from the restoration position and elastically deformed to a closed position where the stopper 51, 52 at the end of each connecting part 510, 520 closes the corresponding insertion opening part 41, 42. As shown in FIG. 3, the base end side of each connecting part 510, 520 that is most bent is provided with a slit-shaped thin-walled hinge 511, 521 that is recessed toward the bent side to make it easier to bend. In this embodiment, two thin-walled hinges 511, 521 are provided for each connecting part 510, 520, but one or three or more may be provided.

At the very tip of each connecting portion 510, 520, there is provided a tongue-shaped handle 512, 522 that is bent from the center line of the entire connecting portion 510, 520 at the point where the stopper 51, 52 is provided. Each handle 512, 522 does not extend along the center line of the entire connecting portion 510, 520, i.e., in the diametric direction in which the two insertion openings 41, 42 are aligned, but is provided so as to bend, for example, at a right angle to this diametric direction. This prevents the handles 512, 522 from interfering with each other when the stopper plugs 51, 52 are in the closed position, as shown in FIG. 12.

As shown in Figures 3 and 4, convex markings 513 and 523 are provided on the upper and lower surfaces of the handles 512 and 522, respectively. The convex markings 513 and 523 on the upper surfaces of the handles 512 and 522 shown in Figures 3 and 5, one each, are provided to raise the stopper plugs 51 and 52 so that they are easy to grasp, and the convex markings 513 and 523 on the lower surfaces of the handles 512 and 522 shown in Figures 4 and 6, three each, are provided to prevent slipping when pinched.
Here, it is preferable to make the number and shape of the protruding marks 513, 523 different on the front and back of the handles 512, 522 so that the orientation of the stopper plugs 51, 52 can be determined by touch. Note that the stopper plugs 51, 52, including the connecting parts 510, 520 and the handles 512, 522, may be referred to as the stopper plug as a whole.

The outer peripheral wall portion 32 of the cap 30 is provided with a protruding piece 44 at one end perpendicular to the diameter direction in which the insertion openings 41, 42 are aligned, which is easy to grip when attaching or detaching the cap 30. The protruding piece 44 is integrally molded in a thin plate shape, approximately triangular tongue shape, and is provided so as to protrude outward from the outer peripheral wall portion 32 on the same plane as the main wall portion 31, on a plane parallel to the reference plane of the main wall portion 31, as shown in Figures 9 and 10. Here, the protruding piece 44 may be a portion for indicating, for example, the size of the cap 30.

<Function of the medical inserter 10 according to the first embodiment>
Next, the operation of the medical inserter 10 according to the first embodiment will be described.
Fig. 17 is an explanatory diagram showing an image of a hysterectomy surgery under laparoscopy, with the upper side of the figure being the abdominal side and the lower side being the dorsal side. When using the forceps A or the retrieval bag B through the medical insertion device 10, the patient is usually under general anesthesia in either case. Note that the following explanation is merely an example and may differ depending on the operator (surgeon) and the patient's condition.

[1] First, as shown in FIG. 18(a), insert the pipe body 11 of the medical insertion device 10 from the opening of the vagina and slowly advance it toward the back of the vagina, and confirm by visual and tactile inspection that the cervix has entered inside the tip ring 12 of the pipe body 11. Then, as shown in FIG. 18(b), advance the tip ring 12 of the pipe body 11 to the dome near the cervix. When checking the insertion state from the base end opening 11b of the pipe body 11, the cap 30 may be removed from the base end opening 11b.

[2] Next, the abdominal cavity is inflated by filling it with pneumoperitoneum gas (see FIG. 17), and while checking the dome portion with a laparoscopic camera, the pipe body 11 is further pushed in, and as shown in FIG. 19, the dome portion is resected with an electric scalpel while visually checking the position of the dome portion. The dome portion against which the tip ring 12 is pressed appears to be deformed and raised within the abdominal cavity. The electric scalpel is applied repeatedly along the dome portion to resect it. In this embodiment, the tip ring 12 is made of a thermosetting acrylic resin, so there is no risk of it melting easily when it comes into contact with the electric scalpel.

By removing the uterine dome, the pneumoperitoneum gas in the abdominal cavity enters the vagina and the inside of the pipe body 11. At this time, the base end opening 11b of the pipe body 11 is closed by the cap 30, so the pneumoperitoneum gas is unlikely to leak through the pipe body 11, and visibility inside the abdominal cavity can be maintained in good condition. In addition, the protrusions 14a, 14b and the tapered portion 13c on the outer surface of the pipe body 11 adhere closely to the inner wall of the vagina, thereby preventing the pneumoperitoneum gas from leaking out along the outer surface of the pipe body 11.

<<How to use forceps A>>
[3] The resected uterus is then removed. When using forceps A (see FIG. 16), the stopper 51 is removed from the insertion opening 41 of the cap 30 while the pipe body 11 is still inserted into the vagina. Then, as shown in FIG. 20, the forceps A is inserted into the inside of the pipe body 11 from the insertion opening 41 to grasp the resected uterus. Here, when the resected uterus is to be removed using forceps from the abdominal cavity side (see FIG. 17) or when a recovery bag B is to be placed in the abdominal cavity, the operation using the forceps A through the pipe body 11 is not performed.

As shown in FIG. 15, when the forceps A is inserted into the insertion opening 41, the shaft A1 of the forceps A is fitted into the fitting tube 410 connected to the insertion opening 41. This increases the contact area between the cap 30 and the forceps A compared to when the fitting tube 410 is not present in the insertion opening 41. If the inner peripheral surface of the fitting tube 410 is a smooth surface without any irregularities, it will stick to the outer peripheral surface of the forceps A and cause a large resistance, but the inner peripheral surface of the fitting tube 410 has irregularities in which annular convex portions 411 and concave portions 412 are alternately arranged. Therefore, the outer peripheral surface of the forceps A does not stick closely to the inner peripheral surface of the fitting tube 410, and even if the contact area between the fitting tube 410 and the forceps A increases, it is possible to reduce frictional resistance when inserting the forceps A and improve sealing performance.

As shown in FIG. 15(b), when the forceps A is moved up, down, left and right while inserted into the insertion opening 41, the insertion opening 41 itself deforms, creating a gap. However, since the fitting tube 410 connected to the insertion opening 41 is cylindrical and has a certain length, the fitting tube 410 elastically deforms along its entire length to follow the movement of the forceps A. Furthermore, the tip of the fitting tube 410 has a reduced diameter section 413 that fits tightly against the outer periphery of the forceps A, and since it is a free end with no support from the surroundings, it easily deforms while still following the movement of the forceps A and maintaining a tight fit, thereby reliably preventing leakage of pneumoperitoneum gas.

[4] Then, as shown in Figure 21, the uterus grasped with forceps A is pulled into the inside of the pipe body 11. Next, forceps A is temporarily pulled out from the insertion opening 41 of the cap 30, and as shown in Figure 22, the cap 30 is removed from the pipe body 11, and the excised uterus is pulled out from inside the pipe body 11 with forceps A. If the excised uterus does not fit inside the pipe body 11, the pipe body 11 is removed and the uterus is pulled out directly. After that, the pipe body 11 is reinserted into the vagina, and the vaginal wall stump is sutured closed.

[5] When suturing the vaginal wall stump closed, the suture needle is grasped with the gripping portion A2 of the forceps A and inserted as is into the inside of the pipe body 11. The forceps A is then inserted into the abdominal cavity through the inside of the pipe body 11, and the suture needle is handed over to the forceps from the abdominal cavity side. At this time, the cap 30 is still removed from the base end opening 11b of the pipe body 11. Then, the forceps A is pulled out from inside the pipe body 11. Note that when inserting the suture needle using the forceps from the abdominal cavity side, the suture needle is not handed over by the forceps A through the pipe body 11.

[6] Next, after the forceps A are pulled out of the pipe body 11, the insertion opening 41 of the cap 30 is blocked with the stopper 51, and the cap 30 in this state is then attached to the base end opening 11b of the pipe body 11 to close it. At this time, the other insertion openings 42 that are not being used are blocked with the stopper 52 from the beginning. When the insertion openings 41, 42 of the cap 30 are blocked with the stopper 51, 52, the connecting parts 510, 520 are bent, but the connecting parts 510, 520 are easily deformed with a small curvature due to the slit-shaped thin hinges 511, 521, and the overall shape is compact and not bulky.

[7] Then, the pipe body 11 with the cap 30 attached is inserted again into the vagina. This fills the abdominal cavity with pneumoperitoneum gas, ensuring good visibility again. Under these circumstances, the vaginal wall stump where the uterus was removed is closed and sutured from the abdominal side using laparoscopic surgery. At this time, the pipe body 11 is manipulated to assist the suturing. Specifically, the pipe body 11 inserted into the vagina can be moved back slightly and the vaginal wall stump can be supported from the inside by the tip ring 12. After the vaginal wall stump has been sutured, the pipe body 11 is slowly pulled out of the vagina, and the surgery is completed.

<<How to use collection bag B>>
[8] Next, a case where the retrieval bag B (see FIG. 16) is used instead of the forceps A described above to remove the uterus will be described. The procedures [1] and [2] above are the same as those when the forceps A is used, but when the retrieval bag B is used, the stopper 52 is removed from the insertion opening 42 of the cap 30 while the pipe body 11 is still inserted into the vagina. Then, as shown in FIG. 23, the retrieval bag B is inserted into the inside of the pipe body 11 from the insertion opening 42. Next, as shown in FIG. 24, the bag body B2 is pushed out from the tip of the shaft B1 of the retrieval bag B into the abdominal cavity.

The insertion opening 42 corresponding to the retrieval bag B can be inserted with a shaft diameter of, for example, φ10.0 to φ15.0 mm. In other words, since the insertion opening 42 needs to have a wide hole diameter, the fitting tube portion 410 in the insertion opening 41 is not provided, and instead, as shown in FIG. 13, a crimping portion 420 that is easy to expand elastically is provided. Such a crimping portion 420 of the insertion opening 42 increases the expandability so that it can accommodate various outer diameters of the retrieval bag B, and also increases the sealing ability by closely contacting the outer peripheral surface of the retrieval bag B. In addition, when the stopper 52 is removed from the insertion opening 42, the connecting portion 520 of the stopper 52 naturally returns to a restored position extending laterally on the same plane approximately parallel to the main wall portion 31 so as not to be hit by the surgeon's hand.

[9] Next, as shown in FIG. 25, the excised uterus is placed into the extruded bag body B2, and then, as shown in FIG. 26, the string attached to the bag body B2 is pulled to close the opening edge of the bag body B2. Then, the string is cut with an operating part or the like at the base end side of the shaft B1 of the recovery bag B, and only the shaft B1 of the recovery bag B is pulled out from the insertion opening 42 of the cap 30 as shown in FIG. 27. At this time, the insertion opening 42 is easily elastically deformed by the crimping part 420, just as when the shaft B1 is inserted.

Therefore, when the shaft B1 is pulled out from the insertion opening 42, the cap 30 does not come off the pipe body 11 due to the elastic deformation of the crimping portion 420, and the double seal structure between the outer wall portion 32 and the inner wall portion 33 of the cap 30, and the outflow of pneumoperitoneum gas is also suppressed. Next, the pipe body 11 and the bag body B2 are pulled out of the body, and after removing the bag body B2, the pipe body 11 is inserted again into the vagina. The subsequent processing is the same as the processing described above in [5] to [7] when using forceps A.

<Size of medical inserter 10>
In the medical inserter 10 described above, the important actual sizes are the tip outer diameter and effective length (total length of the effective region L) of the pipe body 11, and in this embodiment, for example, three classes are prepared: tip outer diameter φ31 mm and effective length 172 mm, tip outer diameter φ35 mm and effective length 174 mm, and tip outer diameter φ39 mm and effective length 176 mm. These specific sizes are due to the substantial length required to access the abdominal cavity through the vagina, and three sizes of the cap 30 are prepared according to the three classes of pipe body 11.

Caps 30 corresponding to the first two of the three classes of pipe bodies 11 are prepared in similar shapes, but if the cap 30 corresponding to the largest class of pipe body 11 is also prepared in similar shapes, the size between both ends of the pair of connecting parts 510, 520 extending on both sides of the main wall part 31 will be quite long. Even when the two insertion openings 41, 42 on the main wall part 31 are blocked with stoppers 51, 52 and the connecting parts 510, 520 are bent, these bent parts will be significantly bulkier outside the outer diameter of the cap 30. Therefore, in order to make the size of the cap 30 as compact as possible, the cap 30A of the second embodiment described below is also prepared.

<Overview of Cap 30A of Second Embodiment>
28 to 37 show a second embodiment of the present invention.
The medical inserter 10 according to the second embodiment is the same as the medical inserter 10 according to the first embodiment except for the size of the pipe body 11, and is not shown in the drawings, but the cap 30A has a slightly different configuration. Below, the cap 30A will be described in terms of differences from the first embodiment, and the same parts will be denoted by the same reference numerals and redundant description will be omitted.

<Cap 30A>
28 to 36, the cap 30A of the second embodiment is different from the cap 30 of the first embodiment in the shape of the connecting portions 510A, 520A of the stopper plugs 51, 52. That is, in the cap 30 of the first embodiment, the pair of 510, 520 extends on both sides in the same straight line as the diameter direction in which the insertion openings 41, 42 are aligned, but in the cap 30A of the second embodiment, the pair of 510A, 520A extends in a direction intersecting the diameter direction in which the insertion openings 41, 42 are aligned.

More specifically, as shown in FIG. 31, the pair of connecting parts 510A, 520A extend symmetrically at an angle θ of about 40 degrees from the center of the insertion opening 41, based on the straight line in the diameter direction along which the insertion openings 41, 42 are aligned. With such a shape of the pair of connecting parts 510A, 520A, when the insertion openings 41, 42 are blocked with stoppers 51, 52 and the connecting parts 510A, 520A are bent, as shown in FIG. 37, when the connecting parts 510A, 520A are inclined at about 40 degrees (solid line in the figure), the outer diameter of the part can be made smaller (W1>W2 in the figure) than when the connecting parts 510A, 520A are deployed to the left and right at 180 degrees (two-dot chain line in the figure).

Furthermore, as in the first embodiment, the tip of each connecting portion 510A, 520A is provided with a tongue-shaped handle 512A, 522A bent from the center line of the entire connecting portion 510A, 520A. Each handle 512A, 522A is bent at an angle greater than a right angle from the center line of the entire connecting portion 510A, 520A. As a result, as shown in FIG. 37, when the stopper plugs 51, 52 are in the closed position, the handles 512A, 522A are compactly arranged parallel to each other without interfering with each other.

<Configuration and Effects of the Present Invention>
Although various embodiments of the present invention have been described above, the present invention is not limited to the above-described various embodiments. The present invention derived from the above-described various embodiments will be described below.

First, the present invention relates to a medical inserter 10 having a removable cap 30, 30A for closing a proximal end opening 11b of a pipe body 11 to be inserted transvaginally,
At least a portion of the main wall surface portion 31 of the cap 30, 30A is formed in a thin film sheet shape, and a plurality of insertion openings 41, 42 are provided in the sheet-like portion to allow a plurality of types of shaft-shaped instruments A, B having different outer diameters to be inserted therethrough separately,
A fitting tube portion 410 is provided in any one of the insertion opening portions 41 and 42, the fitting tube portion 410 being connected in a cylindrical shape from its periphery and into which the instrument A is inserted and inserted into the one insertion opening portion 41.
The fitting tube portion 410 is characterized in that a plurality of annular protrusions 411, which are in close contact with the outer circumferential surface of the instrument A over the entire circumference, are arranged on the inner circumferential surface of the fitting tube portion 410 in the axial direction of the fitting tube portion 410.

According to this medical inserter 10, at least a portion of the main wall surface portion 31 of the cap 30, 30A is formed in a thin sheet shape, and if the cap 30, 30A is made of a flexible material, the sheet-like portion is particularly prone to elastic deformation. Therefore, when the insertion openings 41, 42 provided in this sheet-like portion are penetrated by the instruments A, B corresponding to the respective inner diameters, they can elastically expand in diameter, improving the sealing performance for each of the instruments A, B.

One of the insertion openings 41, 42 is provided with a fitting tube 410 that extends cylindrically from its periphery, so that the instrument A inserted through the insertion opening 41 fits inside the fitting tube 410. This increases support by the length of the fitting tube 410 in the axial direction of the instrument A, and increases the contact area between the caps 30, 30A and the instrument A, making it less likely for gaps to form between them and improving sealing.

If the inner peripheral surface of the fitting tube portion 410 were a straight, smooth surface without any irregularities, the outer peripheral surface of the instrument A would easily come into close contact and stick to it. Therefore, multiple annular protrusions 411 are arranged in the axial direction on the inner peripheral surface of the fitting tube portion 410. Each protrusion 411 can reduce frictional resistance compared to when the inner peripheral surface of the fitting tube portion 410 comes into surface contact with the outer peripheral surface of the instrument A, allowing for smooth operation of the instrument A. Each protrusion 411 surrounds the outer peripheral surface of the instrument A in the entire circumferential direction, making it possible to reduce frictional resistance while improving sealing performance.

The present invention is also characterized in that the protrusions 411 are arranged closely together on the inner peripheral surface of the fitting tube portion 410, and between adjacent protrusions 411 there are annular recesses 412 that do not abut against the outer peripheral surface of the instrument A.

With this configuration, the inner circumferential surface of the fitting tube portion 410 has an uneven shape with annular convex portions 411 and concave portions 412 arranged alternately, and the concave portions 412 between each convex portion 411 provide play that allows the fitting tube portion 410 to easily deform in response to the movement of the instrument A. Therefore, the inner circumferential surface of the fitting tube portion 410 becomes even easier to deform while maintaining a tight fit in accordance with the movement of the instrument A, improving operability and sealing performance.

The present invention is also characterized in that any other of the insertion openings 41, 42 is formed with an inner diameter larger than the one insertion opening 41, and is provided with a crimping portion 420 along its periphery that elastically expands in diameter by pressing the instrument B corresponding to the other insertion opening 42 into the other insertion opening 42 and that comes into close contact with the outer circumferential surface of the instrument B.

With this configuration, the crimping portion 420 provided on the other insertion opening portion 42 has high expandability, so even if the outer diameter of the instrument B has a certain degree of width (type), it is possible to pass each instrument B through while maintaining a high level of sealing.

The present invention is also characterized in that the crimping portion 420 is formed as a taper 421 that is inclined inward and intersects with the periphery 42a of the insertion opening portion 42 located on the reference planes on the front and back of the main wall portion 31.

This type of crimping section 420 can reliably increase the expandability of the inner diameter of the insertion opening 42, and can be easily deformed from both the front and back sides of the insertion opening 42, allowing smooth operation without compromising the sealing properties when penetrating from either the front or back side. When the maximum inner diameter at the periphery 42a of the insertion opening 42 matches the outer diameter of the collection bag B, the ratio of the maximum inner diameter at the tip of the taper 421 of the crimping section 420 to the minimum inner diameter can be set to, for example, an integer ratio of about 3:5.

In the present invention, the cap 30A has stopper plugs 51 and 52 for closing the insertion openings 41 and 42, respectively.
The stopper plugs 51 and 52 are connected to connecting portions 510A and 520A extending from the outer circumferential side of the main wall surface portion 31, respectively.
Each of the connecting portions 510A, 520A can be elastically deformed by bending from a restored position in which it is deployed on the same plane approximately parallel to the main wall portion 31 to a closed position in which the stopper plugs 51, 52 block each of the insertion openings 41, 42, and is characterized in that in the restored position, each of the insertion openings 41, 42 extends in a direction intersecting the diameter direction aligned with the main wall portion 31.

According to this configuration, by inserting the stopper plugs 51, 52 into the respective insertion openings 41, 42 of the cap 30A, the respective insertion openings 41, 42 of the cap 30A are blocked. On the other hand, by removing the stopper plugs 51, 52 from the respective insertion openings 41, 42 of the cap 30A, instruments such as forceps A and recovery bags B can be inserted into the respective insertion openings 41, 42. In addition, since the stopper plugs 51, 52 are connected to the connecting parts 510A, 520A that extend from the outer periphery of the main wall surface part 31, there is no risk of them being lost.

When the stopper plugs 51, 52 are not blocking the insertion openings 41, 42, the connecting parts 510A, 520A are in a restored position deployed on the same plane that is approximately parallel to the main wall surface part 31, so they do not interfere with the surgeon's operation. When the insertion openings 41, 42 are blocked by the stopper plugs 51, 52, the connecting parts 510A, 520A are elastically deformed and bent. Here, when the connecting parts 510A, 520A extend in a direction that intersects with the diameter direction in which the insertion openings 41, 42 are aligned in the natural restored position, the cap 30A has a compact shape that is not bulky overall.

In addition, the present invention provides a method for manufacturing a container having a plurality of connecting portions 510 (510A), 520 (520A) each having a tongue-shaped handle 512 (512A), 522 (522A) extending beyond the stopper plugs 51, 52 at the tip of the connecting portion 510 (510A), 520 (520A),
The handles 512 (512A), 522 (522A) are characterized by extending in a direction intersecting the longitudinal direction of the connecting portions 510 (510A), 520 (520A).

These handles 512 (512A), 522 (522A) make it easy to grasp and operate when blocking the insertion openings 41, 42 with the stopper plugs 51, 52 or when removing the stopper plugs 51, 52 from the insertion openings 41, 42. In addition, because the handles 512 (512A), 522 (522A) extend in a direction intersecting the longitudinal direction, when the stopper plugs 51, 52 are in the closed position blocking the insertion openings 41, 42, it is possible to prevent interference such as overlapping between the handles 512 (512A), 522 (522A).

Furthermore, the present invention can be realized as the above-mentioned cap 30 (30A) alone.
Such a cap 30 (30A) can be treated as an independent part separate from the medical inserter 10. Therefore, if the pipe body 11 is available as a ready-made product, it can be easily upgraded to the medical inserter 10 of the present invention by simply replacing the cap 30 (30A) of the present invention.

Although various embodiments of the present invention have been described above with reference to the drawings, the specific configuration is not limited to the above-described embodiments, and the present invention includes modifications and additions that do not deviate from the gist of the present invention. For example, the specific shapes and relative sizes of the pipe body 11 and caps 30, 30A, etc. are not limited to those shown in the drawings.

In addition, in each embodiment, the main wall portion 31 of the cap 30, 30A is formed in a thin sheet shape over its entire area, but only the areas around each insertion opening portion 41, 42 may be formed in a thin sheet shape, and the other areas may be molded, for example, into a plate shape of a predetermined thickness to provide rigidity.

Furthermore, in each embodiment, the multiple types of instruments used are two types, forceps A and collection bag B, and the insertion openings 41, 42 provided on the cap 30 are described as two corresponding to the forceps A and collection bag B, but this is not limited to this. That is, for example, a third insertion opening may be provided to accommodate forceps with a smaller or larger diameter than the forceps A, and a fitting tube may also be provided on this insertion opening, or a fitting protrusion may be provided only on the insertion opening corresponding to the smallest diameter forceps.

The medical insertion device of the present invention is not necessarily limited to laparoscopic hysterectomy surgery, but can be widely used for other laparoscopic procedures.

A… Forceps (instrument)
B…Collection bag (equipment)
Reference Signs List 10: Medical insertion instrument 11: Pipe body 11a: Tip opening 11b: Base opening 12: Tip ring 13: Main pipe section 20: Handle 30, 30A: Cap 31: Main wall surface section 32: Outer wall section 33: Inner wall section 41: One insertion opening section 410: Fitting tube section 411: Convex section 412: Concave section 42: Another insertion opening section 420: Crimping section 421: Taper 422: Tip 51, 52: Stopper 510, 510A, 520, 520A: Connection section

Claims (4)

A medical inserter having a removable cap for closing a base end opening of a pipe body to be inserted transvaginally,
At least a part of the main wall surface of the cap is formed in a thin sheet shape, and a plurality of insertion openings through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted are integrally formed in the sheet-like portion,
A fitting tubular portion is integrally formed with any one of the insertion openings, the fitting tubular portion being connected from its periphery in a tubular shape and into which the instrument is inserted and passed through the one insertion opening,
A plurality of annular protrusions that are in close contact with the outer peripheral surface of the instrument over the entire circumference are integrally formed on the inner peripheral surface of the fitting cylindrical portion and arranged in the axial direction of the fitting cylindrical portion,
The protrusions are integrally formed so as to be closely arranged on the inner peripheral surface of the fitting tube portion, and an annular recess is formed between adjacent protrusions so as not to abut against the outer peripheral surface of the instrument,
Any other of the insertion openings does not have the fitting tube portion and is integrally molded with an inner diameter larger than that of the one insertion opening, and a crimping portion is integrally molded along its periphery to elastically expand in diameter by pressing the instrument corresponding to the other insertion opening and to come into close contact with the outer circumferential surface of the instrument,
The medical inserter is characterized in that the crimping portion is integrally molded as a taper inclined toward the inside where the periphery of the insertion opening portion located on the reference planes on the front and back of the main wall portion intersect . The pair of insertion openings, which are the one insertion opening and the other insertion opening, are arranged to be aligned in a diameter direction with the center of the main wall surface portion therebetween,
the cap has stoppers for closing the pair of insertion openings,
Each of the stopper plugs is connected to a connecting portion extending from an outer circumferential side of the main wall surface portion,
The medical insertion device according to claim 1, characterized in that each of the connecting portions can be elastically deformed by bending from a restored position in which it is deployed on the same plane approximately parallel to the main wall portion to a closed position in which the stopper blocks the pair of insertion ports, and in the restored position, the centers of each of the pair of insertion ports extend in a direction that intersects obliquely on the same plane with a straight line on the same plane that overlaps in a planar view with the diameter direction aligned on the main wall portion . A tongue-shaped handle is provided at the tip of the connecting portion and extends beyond the stopper,
The medical inserter according to claim 2 , wherein the handle extends in a direction intersecting with a longitudinal direction of the connecting portion . A medical inserter including a removable cap for closing a base end opening of a pipe body that is inserted transvaginally, the cap comprising:
At least a part of the main wall surface of the cap is formed in a thin sheet shape, and a plurality of insertion openings through which a plurality of types of shaft-shaped instruments having different outer diameters are separately inserted are integrally formed in the sheet-like portion,
A fitting tubular portion is integrally formed with any one of the insertion openings, the fitting tubular portion being connected from its periphery in a tubular shape and into which the instrument is inserted and passed through the one insertion opening,
A plurality of annular protrusions that are in close contact with the outer peripheral surface of the instrument over the entire circumference are integrally formed on the inner peripheral surface of the fitting cylindrical portion and arranged in the axial direction of the fitting cylindrical portion,
The protrusions are integrally formed so as to be closely arranged on the inner peripheral surface of the fitting tube portion, and an annular recess is formed between adjacent protrusions so as not to abut against the outer peripheral surface of the instrument,
Any other of the insertion openings does not have the fitting tube portion and is integrally molded with an inner diameter larger than that of the one insertion opening, and a crimping portion is integrally molded along its periphery to elastically expand in diameter by pressing the instrument corresponding to the other insertion opening and to come into close contact with the outer circumferential surface of the instrument,
The cap is characterized in that the crimping portion is integrally molded as a taper inclined inwardly from the periphery of the insertion opening portion located on the reference planes of the front and back of the main wall portion.

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