WO2005087112A1

WO2005087112A1 - Finger assisted access device for laparoscopic operation

Info

Publication number: WO2005087112A1
Application number: PCT/JP2005/004318
Authority: WO
Inventors: Takao Ichihara; Moriatsu Takada
Original assignee: The New Industry Research Organization
Priority date: 2004-03-12
Filing date: 2005-03-11
Publication date: 2005-09-22
Also published as: JP4701164B2; JPWO2005087112A1

Abstract

A finger assisted access device for laparoscopic operation capable of effectively performing finger assisted laparoscopic operation in the field of laparoscopic surgery and also capable of securely preventing gases in an abdominal cavity from leaking. The device comprises a body formed of a spherical or ellipsoidal bag using an extensible material such as latex and several number of working ports with different shapes and arrangements projected from the body for facilitating surgery operation. A loop is installed in the center main port so that surgery instruments such as operating forceps can be hung therefrom, and thick elastic circular rings are installed in the other sub ports so that the forceps for laparoscopic operation can be easily inserted therein. At the bottom installation part of the body, the circular thick elastic ring is formed as a core material so as to be used by directly mounting on a conventional small cut wound part/wound edge protective device.

Description

Specification

Finger-assisted laparoscopic surgery access device

Technical field

[0001] The present invention mainly performs finger-assisted laparoscopic surgery in the field of laparoscopic surgery, whereby the operation is effectively performed by being attached to a small incision, and the insufflation gas is reliably prevented from leaking. The present invention relates to a surgical access device.

Background art

[0002] In recent years, with the progress of laparoscopic surgical procedures, various detailed procedures have been performed. Surgery such as partial resection of the stomach and large intestine, removal of common bile duct stones, and other bleeding procedures that could not be performed by conventional laparotomy, will be performed laparoscopically due to improvements in the skills of surgeons and improvements in instruments. I have. In laparoscopic surgery, it is necessary to provide a space in the abdominal cavity in order to secure the surgical field, and as a means for this, insufflation gas is sent into the abdominal cavity through a pneumoperitoneum punctured in the abdominal cavity. There is a method of inflating the abdominal cavity like a tent. Pneumoperitoneum gas is carbon dioxide gas that is supplied into the body to perform laparoscopic surgery, and its pressure is approximately 3 to 20 mmHg.

[0003] In laparoscopic surgery, a surgeon performs an operation through a small incision using an instrument used by remote control. Laparoscopy using a CCD camera or the like is used to provide an image of the inside of the abdomen to the surgeon. The success of laparoscopic surgery relies on the skills of surgeons who operate remotely driven instruments and perform delicate tasks.

However, in laparoscopic surgery, since the surgeon is isolated from the object to be treated, the surgeon also loses the ability to perform palpation feedback and the ability to palpate fine structures. The hand, which is the most effective instrument for a surgeon, simply operates the instrument. The instruments to be manipulated are imposed by the narrowness of the trocar, the nature of the channels through which they must pass, and lack dexterity and operability from the beginning due to their design constraints.

[0005] Therefore, in recent years, a new surgical technique that combines the advantages of both laparotomy and laparoscopic surgery is a new surgical technique (FALS: Fingers Assisted Laparoscopic Surgery; Kana Notation was developed by Fingers' Assist). These new techniques use laparoscopic techniques and operate on a slightly larger incision so that the surgeon can insert his fingers into the insufflated abdomen.

[0006] From the FALS 開, it is possible to regain the palpation feedback and three-dimensional perspective that the surgeon lost during the conversion to laparoscopic surgery. In addition, this will improve the tactile sensation and the ability to pull out using a quick fingertip. For more detailed work, it is desirable to perform the procedure in a manner similar to laparotomy. For example, suturing with a needle holder in the right hand and tweezers in the left hand is more efficient. As described above, it is necessary to introduce a treatment instrument such as forceps into the abdominal cavity in order to perform a similar procedure in the laparotomy.

[0007] As an access device for introducing a treatment instrument such as forceps into the abdominal cavity while preventing leakage of insufflation gas, for example, a multi-port trocar having a plurality of working channels and a plurality of valves has been disclosed. (Patent Document 1). This device has multiple channels with multiple valves in the housing, so that forceps with different outer diameters can be inserted separately under pneumoperitoneum, and multiple forceps can be inserted at the same time. It is also possible to do.

[0008] However, since the working channel is supposed to have an entrance portion, and the actual forceps pass through separate channels and valve members, they are joined together in the housing and the cannula. When the forceps were inserted, there was a danger that moving both instruments would cause the instruments to interfere with each other, resulting in partial contact and damage, or a loss of power due to force.

[0009] As an access device for use in a hand-assisted laparoscopic surgery, for example, Patent Document 2 describes it. The access device is the retractor member force to which the throttle is attached, the retractor member also being formed with an inner ring and an outer ring force joined by two rings, a plastic sleeve, to retract the incision. It provides the power to help. The access device is inserted into the incision and the surgeon's hand is inserted through the access device. The restrictor is then closed around the arm to achieve a seal that prevents leakage of the injected gas.

[0010] However, the movement of the surgeon's arm is restricted in order to maintain the airtight state by the seal for preventing gas leakage. [0011] At present, as an access device for finger-assisted laparoscopic surgery, general surgical instruments other than those for laparoscopic surgery can perform finer work smoothly and efficiently while maintaining airtightness and easy detachability. What can be easily used is also demanded.

Patent Document 1: Japanese Patent Application Laid-Open No. 10-502841

Patent Document 2: JP-A-10-108868

Disclosure of the invention

Problems to be solved by the invention

[0013] The finger-assisted laparoscopic surgery access device according to the present invention has been made in view of the above circumstances, and while preventing leakage of insufflation gas, the same device can be inserted even when a plurality of forceps are inserted. The purpose of this is to prevent the use of various special instruments for laparoscopic surgery as well as conventional general surgical instruments in order to prevent surgeons from interfering with each other and to limit the movement of the surgeon's fingers. . In other words, it has secure airtightness and has a suitable access port arrangement because it can be performed safely, and instruments that have a limited range of motion of the laparoscopic surgical instruments inserted into the ports do not interfere with each other, and It is an object of the present invention to provide a finger-assisted laparoscopic surgery access device that can safely perform a complicated finger-assisted laparoscopic surgery.

Means for solving the problem

[0014] The inventors of the present invention have conducted intensive studies and experiments through the experience of actual finger-assisted laparoscopic surgery, and as a result, completed the present invention. Hereinafter, means for solving the above-described problems will be described. The present invention relates to a spherical or oval spherical main body, at least two or more extensible ports protruding into the upper hemisphere of the main body, and a small incision wound protection device at the bottom of the main body. A finger-assisted laparoscopic surgery access device, characterized by having an attachment / detachment site.

[0015] In order to solve the above problems, the present invention provides a sealed access device having various ports used for a finger-assisted laparoscopic surgical procedure. The versatile ports are described as follows: "In relation to the arrangement of the port section, a main port having a diameter and length capable of storing surgical instruments such as forceps for general surgery is arranged at the center of the upper hemisphere, and There are at least two subports around the laparoscopic surgical instruments that do not interfere with each other and maximize the range of motion of the instruments. " [0016] More specifically, for example, for example, in the arrangement of the port portion, a main port having a diameter of 10-20 (mm) and a length of 70-150 (mm) is arranged in the center of the upper hemisphere, In addition, four subports with a diameter of 10-20 (mm) and a length force of 70-150 (mm) are arranged around the main port on the left, right, back, and front sides of the upper hemisphere, respectively. It means that having a variety of ports to use for finger assisted laparoscopic surgical procedures.

[0017] Also, "the force of the subports located on the back side is shorter than the length of the other subports" is that the operation is not interrupted by the surgeon and that the operation is performed by the head. This is in consideration of the fact that it is often enforced by senior managers.

[0018] Furthermore, considering that the subport located on the near side of the subport is located on the right side or the left side of the front center, it is easy for the surgeon to use the S port. It was done. For example, in the case of right-handed surgeons, the subports can be placed on the right side from the center of the front to improve the use of the subports!

[0019] In addition, in the main port at the center, "a suspension loop for suspending and using a surgical instrument for laparotomy is characterized," and the movement of fingers of the surgeon is restricted. Without

In addition, not only various special instruments for laparoscopic surgery but also conventional general surgical instruments can be easily used. In addition, there is a lid such as a slit valve or cap at the tip of the power port to maintain airtightness. The feature is that various kinds of special instruments for laparoscopic surgery can be inserted. "

Further, the finger-assisted laparoscopic surgery access device according to the present invention is characterized in that “the body and the port are integrally molded from latex-based natural rubber or latex-based synthetic rubber”. Have. As a result, the port usually has a shape that protrudes from the main body, but can be pushed into the main body with a surgical instrument such as a special instrument for laparoscopic surgery. Surgical instruments can be guided to the sub-abdominal region while preventing leakage of operating gas.

[0021] The finger-assisted laparoscopic surgery access device according to the present invention includes a “body part for accommodating a forearm part, and a fastener capable of inserting and removing surgical instruments such as forceps for general surgery on a side surface of the body part”. A part for attaching and detaching a small incision wound protection device at the bottom of the body part For example, by attaching the rubber bag attached by the surgeon to the main body with a powerful glue, the hand is fixed with the forearm rather than with the wrist. It is possible to put the tip into the abdominal cavity.

The finger-assisted laparoscopic surgery access device according to the present invention is mounted on a wrap protector, and various surgical instruments are put in and out of the fastener. Preferably, the fastener is an airtight fastener.

The finger-assisted laparoscopic surgery access device according to the present invention is “translucent” so that, for example, a general surgery forceps suspended from a central main port can be grasped with the naked eye. Surgery can be performed and the operation work in the abdominal cavity can be performed quickly, and such operation work can be performed easily that the surgical instruments inserted into the subports do not interfere with each other.

[0024] The present invention also provides a device having a ring structure in which a portion to be attached to and detached from the small incision wound protection device has a stumped edge and a circular and thick elastic ring or the like is used as a core material. The feature is that it can be directly attached to the wound protection device and has easy detachability in order to cope with the insertion of fingers.

The invention's effect

[0025] The access device for finger assisted laparoscopic surgery according to the present invention has the following effects by using the above means. In other words, not only can various laparoscopic surgical instruments be used easily, but also conventional general surgical instruments can be used with the suspension loop of the main port, enabling safe advanced laparoscopic surgical operation under finger-assisted operation. It has the following effects.

[0026] Further, the arrangement of the subports has an effect of avoiding mutual interference of the inserted laparoscopic surgical instruments and ensuring the maximum movable range of various instruments. Furthermore, it has the effect that it can be directly attached to the wound edge protection device, and it is easy to attach and detach it to cope with the insertion of fingers.

BEST MODE FOR CARRYING OUT THE INVENTION

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. Note that the present invention is not limited to the illustrated configuration. In the conditions of the diameter and length of each port, the arrangement of the subports, and the angle to the main body, there are optimal values according to the laparoscopic surgical instrument to be used. Regarding the configuration of the access device according to the above, various design changes are possible.

Example 1

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 external view of a finger-assisted laparoscopic surgery access device showing an example of an embodiment of the present invention. As shown in FIG. 1, the present embodiment has a central main port, a long port 2-4, and a short port 5 as working ports in a finger-assisted laparoscopic operation, and also has an elliptical spherical shape force. And a mounting ring 7 located at the bottom of the main body.

FIG. 2 is a front view of a finger-assisted laparoscopic surgery access device showing an example of an embodiment of the present invention. A long port 4 is located to the right of the center in front of the front. This is designed to make it easy for the surgeon to use with his right hand.

FIG. 3 is a plan view of a finger-assisted laparoscopic surgery access device showing an example of an embodiment of the present invention. The positional relationship of each port arranged above the main body is shown. The long ports 2 and 3 located on the left and right as viewed from the operator and the main port 1 located at the center are arranged substantially in a straight line. From the front view of FIG. 2, the long ports 2 and 3 are respectively disposed on the upper left and upper right of the main body, and the longitudinal direction of the port also protrudes radially at the center of the main body. This ensures the maximum range of motion of the inserted instruments, ensures that the surgical operation in the abdominal cavity is immediate and that the inserted instruments do not interfere with each other and is durable (torn). (No air leakage) to form an optimal body and port angle.

The short port 5 is used to insert a grasping forceps held by an assistant, and is arranged at a position farthest from the operator so as not to hinder the operation of the operator. And it is short so as not to obstruct the field of view.

FIG. 4 is a bottom view of the access device according to the embodiment of the present invention. The bottom of the main body is a part that is attached to and detached from the small incision wound protection device, and has a ring structure with a stump and a circular thick elastic ring etc. as the core material. Te ru. As a result, it can be directly attached to the wound protection device, and the ease of attachment / detachment is improved to cope with the insertion of fingers. For example, a lap disk (registered trademark) (manufacturer: Yako Electric Co., Ltd.) can be used as the small incision wound edge protection device. The upper ring of the lap disk is covered with a ring at the bottom of the main body of the access device so as to be in close contact therewith.

FIG. 5 is a left side view of a finger-assisted laparoscopic surgery access device showing an example of an embodiment of the present invention. This figure also shows the positional relationship of each port. The short port 5 used to insert the grasping forceps held by the assistant should not interfere with the operation of the surgeon, and in consideration of the fact that surgery is often performed on the upper part of the head, The longer diameter is shorter than other port groups.

[0033] Fig. 6 shows that the access device was attached to the small incision wound edge protection device under laparoscopic surgery, and the tip of a general surgical device (tweezers) suspended from the main port 1 at the center was placed under the abdominal wall. Pushing into the box to show how it works.

FIG. 7 is a cross-sectional view showing the inside of the main port 1 at the center of the finger-assisted laparoscopic surgery access device, showing an example of the embodiment of the present invention. Being stomach stomach! Also, surgical instruments such as forceps (tweezers) for general surgery can be used.

FIG. 8 shows a manner in which a free spatula is used using the central main port of the access device. The central main port is not only used for suspending surgical instruments such as forceps (tweezers) for general surgery by an internal suspension loop, but also for pushing instruments into the port from the outside as shown in Fig. 8. There is.

FIG. 9 shows a situation where a trocar is used by using a short port of the access device. In this case, the tip of the short port has a lid such as a slit valve or a cap, and the trocar penetrates the access device. Another method of penetration is to cut the tip of the short port during surgery and insert a trocar into the port.

FIG. 10 is a diagram showing a state in which a bag cock is used by using two subports of an access device. (A) shows how the bag cock is inserted into the port, and (b) shows how the bag cock is pushed further and used inside the abdominal cavity. The two subports should be relatively adjacent. For example, subports 2 and 4 in Figure 1 should be selected. FIG. 11 shows schematic dimensions of the access device according to the embodiment of the present invention. The diameter of each port is 10 (mm) to 20 (mm), and the length is 70 (mm) to 150 (mm). The dimensions take into account the diameter and length of the laparoscopic surgical instrument.

Example 2

FIG. 12 shows an appearance of an access device according to another embodiment 2 of the present invention. The ports are separated to make effective use of the ports. Separated ports allow smooth replacement of surgical instruments when multiple surgical instruments are accessed from one port.

Example 3

FIG. 13 shows an appearance of an access device according to another embodiment 3 of the present invention. As shown in the figure, wear it on the wrap protector and put various surgical instruments in and out of the zipper. By attaching the rubber bag attached to the surgeon to the main unit with a powerful glue, it is possible to fix the hand with the forearm instead of fixing the hand with the wrist and put the wrist force tip into the abdominal cavity is there.

Industrial applicability

The access device for finger-assisted laparoscopic surgery according to the present invention can effectively perform finger-assisted laparoscopic surgery in the field of laparoscopic surgery and reliably leaks gas for pneumoperitoneum. Can be used to prevent.

Brief Description of Drawings

FIG. 1 is an overall view of an access device according to an embodiment of the present invention.

FIG. 2 is a front view of the access device according to the embodiment of the present invention.

FIG. 3 is a plan view of the access device according to the embodiment of the present invention.

FIG. 4 is a bottom view of the access device according to the embodiment of the present invention.

FIG. 5 is a left side view of the access device according to the embodiment of the present invention.

[Fig. 6] Fig. 6 is a view showing a situation in which a general operation forceps (tweezers) is used using a central main port of the access device.

FIG. 7 is an internal cross-sectional view of the central main port of the access device, showing forceps for general surgery Show a suspension loop such as hanging.

[Fig. 8] Fig. 8 is a diagram showing a state in which a free spatula is used using a central main port of an access device.

FIG. 9 is a diagram showing a situation where a trocar is used by using a sub port of an access device.

FIG. 10 is a diagram showing a state in which a bag cock is used by using two subports of an access device. (A) shows how the bag cock is inserted into the port, and (b) shows how the bag cock is pushed further and used in the abdominal cavity.

[11] FIG. 11 is a front view of the access device according to the embodiment of the present invention. Outline dimensions are shown.

FIG. 12 is an external view of an access device according to another embodiment 2 of the present invention.

FIG. 13 is an external view of an access device according to another embodiment 3 of the present invention. Explanation of symbols

1 Central main port

2 Right long port (sub port)

3 Left long port (sub port)

4 Front long port (sub port)

5 Short port (sub port)

6 Main unit

7 Mounting ring

8 Small incision wound protection device

9 tweezers

10 Suspension loop

11 Universal Bella

12 Trocker

13 Nog = f

Claims

The scope of the claims

[1] A spherical or elliptical spherical main body, at least two or more extensible ports protruding into the upper hemisphere of the main body, and a small incision wound protection device at the bottom of the main body. A finger-assisted laparoscopic surgery access device comprising:

[2] In the arrangement of the port portion, a main port having a diameter and a length capable of accommodating surgical instruments such as forceps for general surgery is arranged in the center of the upper hemisphere, and a laparoscope is provided around the main port. 2. The hand-assisted laparoscopic device according to claim 1, wherein the surgical instruments have at least two or more subports arranged so as not to interfere with each other and to maximize the movable range of the instruments. Surgical access device.

[3] In the port arrangement, a main import having a diameter of 10-30 (mm) and a length of 70-150 (mm) is arranged in the center of the upper hemisphere and has a diameter of 10-20 (mm). ) And four subports of 70-150 (mm) length around the main port.The left, right, back, and near sides of the upper hemisphere have laparoscopic surgical instruments connected to each other. 2. The access device for laparoscopic surgery under finger assistance according to claim 1, wherein the access device is arranged so as not to interfere with each other and to secure the movable range of various instruments to the maximum.

4. The access device for finger-assisted laparoscopic surgery according to claim 3, wherein a force of one of the subports located on the back side is shorter than other subports.

5. The access device for finger-assisted laparoscopic surgery according to claim 3, wherein one of the subports located on the near side is located on the right side or left side of the front center.

The hand assist according to any one of claims 2 to 5, wherein the main port has a suspension loop for suspending and using a surgical instrument for laparotomy. Access device for lower laparoscopic surgery.

[7] One or all of the main port and the Z or sub port have a lid such as a slit valve or a cap at the distal end of the power port to maintain airtightness, and from the outside to the abdominal cavity. The access device for finger-assisted laparoscopic surgery according to any one of claims 2 to 6, wherein an instrument can be inserted.

[8] The hand-assisted laparoscopic surgery according to any one of the above [1] to [7], wherein the main body and the port are integrally molded of latex-based natural rubber or latex-based synthetic rubber. Access device.

[9] A main body for accommodating the forearm, a fastener on the side surface of the main body for inserting and removing surgical instruments such as forceps for general surgery, and a small incision wound protection device on the bottom of the main body. An access device for finger-assisted laparoscopic surgery, comprising:

10. The access device for finger-assisted laparoscopic surgery according to claim 9, wherein the main body is formed of latex-based natural rubber or latex-based synthetic rubber.

[11] The access device for finger-assisted laparoscopic surgery according to any one of claims 1 to 10, having translucency.

[12] The small incision wound site has a ring structure in which a part to be attached to and detached from the wound edge protection device has a stumped shape and a circular thick elastic ring or the like as a core material. The access device for finger-assisted laparoscopic surgery according to any one of claims 1 to 11.