JP2002125920A - Mantle tube insertion tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a tool realizing needling without damaging the safety of needling, without requiring picking up a tissue with forceps, without a pain and without degrading operability in the case of manipulation for needling and indwelling a mantle tube especially in the case of transvaginal approach. SOLUTION: This tool has a sucking and fixing means 8 provided at a tip part and fixed by sucking tissues, a tubular main body 7 disposed on the side of the base end of the means 8, a mantle tube insertion auxiliary tool 1 arranged parallel to this main body 7 and having a suction channel 6 communicating with the means 8, the mantle tube 2 put through this tool 1 and extended in the direction of a long shaft and a needling member 3 provided with a needling means 21 capable of needling the tissues at its tip and arranged loosely through the inside of the tube 2.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a device for puncturing and placing a mantle tube for inserting a device such as an endoscope for observing and treating the inside of a body cavity into a body.

[0002] In particular, the present invention relates to a device for puncturing and placing a mantle tube which approaches the abdominal cavity transvaginally.

[0003]

2. Description of the Related Art In recent years, diagnosis and surgery are often performed by inserting an endoscope or the like into a body cavity.

[0004] Among them, there are techniques for observing the inside of a body cavity by putting a reflux medium (air, water, etc.) into the body cavity, such as a laparoscope for putting air, and a hysteroscope or arthroscope for putting water. There is.

In obstetrics and gynecology, it is often necessary to observe the inside of the abdominal cavity, and laparoscopy is often performed. In addition, there is a technique called vaginal approach to the abdominal cavity, which is called Kurdoscopy. This is to approach the Douglas fossa from the posterior vaginal vault, reach the abdominal cavity, and diagnose and treat organs in the abdominal cavity. WO 99/05958 also discloses a vaginal approach and device. The advantage of a transvaginal approach is that it is less invasive than laparoscopic. Outpatient practice is also being conducted. In addition, it is a transvaginal approach, and the positions of the ovaries and fallopian tubes are close to each other, which seems to be effective for diagnosis and treatment thereof. In particular, it is highly effective in diagnosing infertility caused by these.

[0006] The device for transvaginal approach described in WO99 / 05958 is composed of a puncture member or a puncture needle, which is generally called a puncture member, and a mantle tube for inserting an endoscope or the like. There is disclosed a technique in which a wall is punctured, only an outer tube is left, and an endoscope is inserted therein for observation. With such a configuration, as an instrument for introducing a mantle tube for observing and treating an endoscope into a body, Japanese Patent Application Laid-Open No.
Japanese Patent Laid-Open No. 222750 discloses a similar configuration. The puncture needle (pneumoperitoneal needle) is used because a spring-biased blunt tip in the needle jumps out of the needle tip the moment the needle penetrates the body wall, and suddenly the sharp needle tip comes into contact with the organ. This is because there is an effect of preventing the operation from being performed.

Further, Japanese Patent Application Laid-Open No. 55-168307 and US Pat. No. 4,633,865 provide a holder having an opening whose opening edge is in close contact with the skin when a trocar is inserted with a laparoscope. An apparatus is described in which a holder is connected to a vacuum suction device and the skin is sucked into the holder by vacuum suction inside the holder.

Further, Japanese Patent Application Laid-Open No. Hei 2-271818 discloses a medical device introduction tube to which suction is applied, an inner tube having an inner wall formed with an insertion passage through which a medical device is inserted, and an inner tube provided around the inner tube. Is provided so as to surround the outer cylinder, which forms a suction path in a gap between the outer cylinder and the outer peripheral surface of the inner cylinder, and a suction port formed by opening a gap formed around an outlet of the insertion path in the axial direction. It is described that, by having the same, the wall of the organ is sucked to prevent the body fluid from flowing into the abdominal cavity from the close contact portion between the wall of the organ and the outer cylinder.

Further, Japanese Patent Application Laid-Open No. Hei 5-317325 discloses a guide tube for an in-vivo insertion tool for puncturing the abdominal wall prior to an examination of the abdominal cavity or the like and a surgical operation to guide the insertion of an in-vivo insertion tool such as an endoscope. It is described that the guide tube is provided with a retaining means for piercing the body of the guide tube into the body wall and fixing the guide tube to the body wall.

[0010]

In the case of transvaginal puncture and placement of a mantle tube, it is necessary to pierce the membrane and insert it into the body cavity.

At this time, there are other organs including the rectum behind the membrane. Even if a mantle tube with a puncture needle (pneumoperitoneal needle) is used, the puncture requires great care.

There is a technique called puncture of the Douglas fossae. This technique involves puncture of ascites and the like accumulated in the Douglas fossae with a needle. The needle is similarly punctured from the posterior vaginal vault with the needle. When performing these procedures, grasp the cervix and pull it up to make the posterior vaginal vault membrane pinned to increase the safety of puncture. The puncture is performed in such a manner that the puncture is opened and the direction is determined.

However, at this time, pinching and lifting the cervix is painful. Given the outpatient practice of the vaginal approach, we would like to avoid painful activities and anesthesia to prevent pain as much as possible. In addition, inserting the forceps into the narrow vagina and further inserting the puncture member, the position of the posterior vagina vault may be located at a very deep position in the narrow vaginal cavity, which obstructs the visual field. .

In addition, when inserting a trocar with a laparoscope, the body wall is lifted for the purpose of preventing damage to the organs inside the abdominal cavity, but as a method of not picking up the abdominal wall, there is a method using suction. It is disclosed in Japanese Unexamined Patent Publication No. 55-168307 and US Pat. No. 4,633,865,
These are methods that adapt to the abdominal wall and are not available for a vaginal approach.

As a device to which suction is applied, there is disclosed a device for preventing a leak in a luminal organ as disclosed in Japanese Patent Application Laid-Open No. 2-271818. It is not intended to puncture a mantle tube into a vestigial tube, nor to fix / pull a body tissue intended for placement, and there is no such disclosure.

Further, when the mantle tube is actually introduced transvaginally into the abdominal cavity and the endoscope is inserted and the examination is started, it is necessary to always be aware that the mantle tube does not come off. Laparoscopy etc.
Although the body wall is thick and the mantle tube is relatively firmly held by the body tissue, there is a risk that the mantle tube may easily fall out in a thin membrane such as the vagina. When this mantle tube comes off, the vagina may be in a deep position, so it is difficult to insert it again in the same hole, and it is desirable to avoid making a new hole because the invasion becomes large. A medium for observation such as water or air leaks. This is especially true given that it is a less invasive test and is performed on an outpatient basis.

For this reason, the above-mentioned WO 99/05958 also discloses an outer tube provided with a stopper at the tip thereof. However, it is not possible to provide the outer tube with a structure for preventing the tube from being inserted into the body. However, the structure may become thicker, so that the hole diameter may be increased and the invasiveness may be increased.

Japanese Unexamined Patent Publication (Kokai) No. 5-317325 discloses a trocar outer tube for a laparoscopic tube which does not make the outer tube of the trocar structurally thicker, which punctures a needle into the abdominal wall. Also, considering the transvaginal approach,
Operability was complicated for a vaginal part with a thin wall.

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned problems, and a technique for placing a mantle tube by puncturing, particularly in a case of transvaginally approaching, without impairing the safety of puncturing, using forceps or the like. It is an object of the present invention to provide a device that can puncture without the need to pick up tissue, without causing pain, and without reducing operability. In addition, a device that does not require additional invasiveness, such as increasing the size of the insertion portion of the mantle tube so that the mantle tube does not come out during the examination while placing the mantle tube in place, is provided. The purpose is to do.

[0020]

SUMMARY OF THE INVENTION The invention of claim 1 is a mantle tube insertion device which can be transvaginally accessible into the abdominal cavity, and is provided at a distal end portion and fixed by suctioning a body tissue. An outer tube insertion aid having a fixing means, a tubular body provided on the proximal end side of the suction fixing means, and a suction channel provided in parallel with the tubular body and communicating with the suction fixing means; An outer tube, which is inserted into the assisting tool and extends in the longitudinal direction, and a piercing member which is provided with a puncturing means at a distal end thereof and which is capable of penetrating a body tissue and which is loosely inserted into the outer tube and arranged. It is an insertion device.

According to a second aspect of the present invention, there is provided a mantle tube insertion aid provided with a means for suctioning and fixing body tissue at a distal end, a mantle tube, and a fixing means for fixing the mantle tube and the mantle tube insertion aid.
The distal end of the mantle tube insertion aid is fixed to the tissue, and then the mantle tube inserted into the body tissue and the mantle tube insertion aid are fixed by the fixing means, and the mantle tube is positioned relative to the tissue. An outer tube insertion instrument for preventing the outer tube from coming off.

[0022]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described with reference to FIGS.

FIG. 1 is an exploded view of the configuration of a mantle tube assisting system according to this embodiment. In FIG. 1, reference numeral 1 denotes a mantle tube insertion aid, and a mantle tube 2 is inserted into the mantle tube insertion aid 1. A puncture needle (a puncture needle as a puncture member) is inserted inside the mantle tube 2. Insufflation needle)
3 or the insertion portion 5 of the endoscope 4 is inserted. When the outer tube 2, the puncture needle (pneumoperitoneum) 3 and the endoscope 4 are inserted as described above, a sealing means described later is provided so that water tightness can be secured between the respective instruments.

FIG. 2A shows that the mantle tube 2 is inserted into the mantle tube insertion aid 1 and further. A state where the puncture needle 3 is inserted into the outer tube 2 is shown.

The mantle tube insertion aid 1 has a tubular main body 7 having a suction channel 6 at the center, a suction fixing portion 8 provided at the front end of the tubular main body 7, and a seal member 9 provided at the rear end. The suction fixing part 8 is slightly divergently open toward the tip of the tubular body 7. Further, on the rear end side, there are provided a suction base 10 communicating with a suction pipe described later and a lock member 11 which is rotatable by pivoting. As shown in FIG. 3, the lock member 11 has an L-shaped lever 13 having a U-shaped notch 12 at one end.
And a pin 1 for pivotally supporting the lever 13.
4a, the lever 13 is inserted when the mantle tube 2 is inserted.
Is engaged with a pin 14b provided at the base end portion 15 of the outer tube 2, and the outer tube 2 and the outer tube insertion assisting tool 1 are engaged.
Is fixed.

Since the inner diameter of the tubular body 7 of the mantle tube insertion aid 1 is formed to be larger than the outer diameter of the mantle tube 2, when the mantle tube 2 is inserted into the conduit of the tubular body 7, Gaps in the conduit form a suction conduit. The sealing member 9 provided at the rear end of the tubular body 7 seals the outer periphery of the outer tube 2 when the outer tube 2 is inserted into the tubular body 7.

The mantle tube 2 is provided with a substantially cylindrical base end 15 at the base end thereof.
The insertion portion of the mantle tube 16 is fitted. Further, a luer lock type base 17 to which a connector of a tube led from an insufflation device (not shown) is connected to the base end portion 15.
Is provided. The mantle tube 16 is longer than the entire length of the mantle tube insertion aid 1, is configured to have a length such that the tip protrudes when it is inserted most into the mantle tube insertion aid 1, and the insertion tube 5 of the endoscope 4. It is configured to be shorter than the length.

As shown in FIG. 2B, the puncture needle 3
Is a tubular outer needle 18 and an air supply tube 1 inserted into the outer needle 18.
9 and a gripper 20. The cylindrical outer needle 18 is formed of a straight pipe member having the same diameter that the air supply pipe 19 can be inserted therein.
The needle 21 is formed to be thinner than the proximal end of the cylindrical outer needle 18, and the connection between the needle 21 and the proximal end of the cylindrical outer needle 18 is tapered 22. Is formed. The air supply pipe 19 forms a conduit for sending gas into the abdominal cavity. A Luer-lock type base to which a connector of a tube led from an insufflation apparatus (not shown) is connected to a proximal end of the air supply pipe 19. 23 are connected. Further, a spherical member 24 is sealed and fixed to the tip of the air supply pipe 19. The spherical member 24 is disposed inside the tubular outer needle 18, is biased by a spring 25 toward the distal end of the outer needle 18, and normally projects from the needle 21. Further, at the base end of the air supply pipe 19, a cock 27 for closing the air supply line 26 is provided at the rear end of the base 23.

Further, an air supply port 28 is opened in a side peripheral wall portion at a distal end portion of the air supply pipe 19, and when the puncture needle 3 is punctured, gas supplied from an insufflation device (not shown) is The air is sent from the mouthpiece 23 into the body cavity through the air supply port 28 through the inside of the air supply pipe 19. The fixing pin 29 is for fixing the outer needle 18, and is for engaging and fixing with a groove (not shown) of the base end portion 15 of the outer tube 2.

Further, the grip portion 2 is provided at the base end of the outer needle 18.
0 is connected to the gripper 20 and the base 2
3 are stored.

The endoscope 4 has an insertion section 5 and an operation section 30. The operation section 30 is provided with an eyepiece section 31 and a connection section 32 for an external light guide cable (not shown). .

Note that various types of endoscopes 4 other than those disclosed in FIG. 1 can be used.

The operation of the first embodiment will be described with reference to FIGS.

A description will be given along the case of transvaginally approaching the abdominal cavity.

In a state in which the mantle tube 2 and the puncture needle 3 are combined, the mantle tube 2 is inserted into the lumen of the mantle tube insertion aid 1. Airtightness is maintained between the mantle tube 2 and the mantle tube insertion aid 1 by a seal member 9. The position of the puncture needle 3 is set so that the distal end does not protrude from the distal end of the mantle tube aid 1. Then, the suction tube 34 of the suction device 33 shown in FIG. 6 is connected to the suction base 10 of the mantle tube insertion aid 1. At this time, the cock 2 at the rear end of the puncture needle 3
7 is closed.

In this state, the distal end of the mantle tube assisting tool 1 is inserted into the vagina at a position where the posterior vaginal vault is to be punctured as shown in FIG.
Press as shown in (A). Therefore, the suction base 10
When the suction is further started, a negative pressure is applied to the distal end of the suction fixing portion 8 through the space between the puncture needle 3 and the suction channel 6, and the vaginal wall at the target site is fixed by suction. If the part is bad, start over.
Therefore, as shown in FIG. 5A, the vaginal wall is pulled up by pulling the mantle tube assisting tool 1 toward the near side, and an operation is performed such that a distance from other organs is made behind the membrane. Therefore, puncture needle 3
As shown in FIG. 5B, the grasping portion 20 is advanced with respect to the mantle tube insertion assisting tool 1 on which the body tissue is fixed, and punctures the fixed vaginal wall by suction. Spherical member 2 at the tip
4 is pushed against the vaginal wall, the needle 21 protrudes and penetrates the vaginal wall,
When the tip of the needle 21 comes into the abdominal cavity, the spherical member 24 at the distal end urged by the spring 25 projects to prevent the tip of the needle 21 from contacting another organ.

Whether the tip of the needle 21 has been reliably introduced into the abdominal cavity can be determined by the feeling when the tip of the puncture needle 3 is moved left and right,
When a syringe or the like (not shown) containing physiological saline is connected to the base 23 at the rear end of the puncture needle 3 and the cock 27 of the base 23 is opened and water is injected, water flows from the base 25 into the air supply pipe 26, Since the water flows into the abdominal cavity from the side opening behind the spherical portion 24 at the tip, it can be confirmed by responding to water injection at that time. Here, if water is injected into the abdominal cavity, the possibility that the tip of the needle 21 contacts the organ is reduced.

When it is confirmed that the tip of the needle 21 has been introduced into the abdominal cavity, the puncture needle 3 and the mantle tube 2 are carefully advanced until the needle 21 comes into contact with the mantle tube insertion assisting tool 1, and as shown in FIG. By rotating the lever 13 of the member 11,
After engaging the pin 14b at the rear end, the mantle tube assisting tool 1 and the mantle tube 2 are fixed. Then, the puncture needle 3 is pulled out from the mantle tube 2. At this time, the endoscope insertion port at the rear end of the outer tube 3 is closed with a finger so that water does not leak from the body. Then, the endoscope 4 is inserted from the rear end of the mantle tube 2.

Next, the cock (not shown) of the base 17 at the rear end of the mantle tube 2 is opened, and
, The observation medium is injected into the abdominal cavity from the distal end opening of the outer tube 2 through the gap between the outer tube 2 and the endoscope 4. When water is used as the medium, any water supply method may be used, such as manual water injection using a syringe (not shown), water injection using a pump (not shown), or a saline solution pack (not shown) being lifted and water is injected at the head. Similarly, air is supplied by a syringe (not shown) or a pump (not shown). At the hand side, the seal at the rear end of the mantle tube 2 keeps the watertight between the endoscope 4 and the mantle tube 2, so that the medium does not leak.

Here, the abdominal organs such as the ovaries, the posterior surface of the uterus and the fallopian tubes are observed under an endoscope. Further, even if the water supply liquid leaks from between the mantle tube 2 and the tissue during the observation, the water is discharged through the suction channel 6 by the suction device 33, so that the water does not drop down to the hand side. .

The endoscope 4 can be observed over a wide range by using a tip oblique mirror. In addition, if an endoscope 4 having a channel for inserting a treatment tool is used, surgery, biopsy, and the like can be performed under observation with the endoscope.

Further, as shown in FIG.
The use of the endoscope 4 having a tip bending function having a tip 7 enables observation of a wider area such as the front of the uterus. In addition, since the distal end can be bent, the operability is good without the end side of the endoscope interfering with the foot or the like outside the body. Reference numeral 38 denotes a water supply device connected to the endoscope 4.

Further, when the endoscope 4 having a water-supplying function at the tip is used, water can be directly supplied to the observation field of view of the endoscope 4, and it is expected that the field of view will be further improved.
For example, in order to diagnose the occlusion of the fallopian tube, the pigment is passed from the uterus to the fallopian tube, and the discharge of the pigment from the fallopian tube is checked, and the ascites in the blood is collected. It is effective when you are bleeding or when bleeding.

In this case, as shown in FIG. 8, in the gap between the mantle tube 3 and the endoscope 4, the base 17 at the rear end of the mantle tube 3 can be used as a waste liquid channel. That is, base 1
7 or a waste liquid tube 39 is attached and connected to a suction device 40, whereby water can be supplied at the distal end of the endoscope 4 and suction can be performed at the distal end of the mantle tube 2, which is behind the endoscope 4. A good visual field can be secured and unnecessary injection of the medium into the body can be avoided.

The structure of the distal water supply function may be of a type in which a water supply pipe is placed over the endoscope 4 and water is supplied from between the endoscope 4 and the pipe, or may have a built-in water supply channel.

According to the first embodiment, the following effects can be obtained.

With the aid of the mantle tube, the suction can be fixed, the peritoneum can be pulled forward, and the possibility of the needle tip hitting the organ behind can be reduced. In addition, since the puncture site can be in a stretched state, the penetrability is improved.

Further, since the puncture wall is lifted by suction and fixation, it is not necessary to pick up the cervix or the like with forceps or the like, so that the patient does not hurt. Furthermore, since it is not necessary to insert forceps into the vagina and the puncture device and the tissue grasping device are integrally configured, the number of tools to be inserted into the vagina is reduced by one, and operability can be increased.

Further, since the mantle tube insertion aid has a divergent suction fixing portion, the suction range becomes large,
The fixability is improved.

Further, since the mantle tube assisting device and the mantle tube fixed to the body tissue can be fixed, as a result, the positions of the mantle tube and the tissue are fixed, so that the mantle tube functions as a stopper. Once the mantle tube is indwelled in the body, it does not come out, so operability is good. Further, there is no need to provide a retaining structure in the mantle tube, and the mantle tube can have a simple tubular structure and the wall thickness can be reduced,
Less tissue invasion.

Further, even if the water supply liquid leaks from between the mantle tube and the tissue during the observation, the water is discharged through the suction conduit, so that the water does not hang down on the hand side and the operator, Does not wet the patient and does not cause discomfort.

FIG. 9 shows a second embodiment of the present invention.
This will be described with reference to FIGS.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

In FIG. 9, the mantle tube insertion aid 1 comprises a double tube consisting of an inner tube 41 and an outer tube 42.
The suction fixing portion 8 provided at the distal end of the outer tube 42 has a double structure composed of a divergent inner member 41a and an outer member 42a. Therefore, the inner pipe 41 and the outer pipe 42
Between the inner member 41a and the outer member 42a,
The suction channel 43 is formed. Further, a tip of the suction fixing portion 8 forms a ring-shaped suction port 44.

At the rear end of the mantle tube insertion aid 1, an inner tube 41 is provided.
A45 communicating with the suction channel 43 formed between the inner tube 41 and the outer tube 42.
Having.

The operation of the second embodiment will be described.

As shown in FIGS. 10 and 11, a puncture needle is inserted into the mantle tube 2, and further inserted into the mantle tube insertion aid 1, and these are inserted into the vagina. The distal end of the mantle tube insertion aid 1 is arranged at the puncture target site of the posterior vaginal vault, and a suction device (not shown) is attached to the base B46 communicating with the suction channel 43.
Apply suction. Then, the suction channel 43
Through the ring-shaped suction base 44 at the tip of the suction fixing portion 8.
Negative pressure is applied to fix the tissue.

However, the ring-shaped suction base 4 between the inner member 41a and the outer member 42a of the suction fixing portion 8 is not limited.
Since suction is applied to 4, the interior of the inner member 41a is not particularly subjected to a negative pressure.

Next, when the tissue is fixed, the puncture needle 3
Is performed in the same manner as in the first embodiment. After the puncture is completed, the mantle tube 2 is fixed to the mantle tube insertion aid 1 and the puncture needle 3 is removed from the mantle tube 2, as in the first embodiment.
The tissue and the mantle tube 2 are fixed via the mantle tube insertion aid 1.

Here, the observation is performed by inserting the endoscope 4 into the mantle tube 2 and sending water from the base A45 of the mantle tube insertion aid 1, or by sending water to the end using an endoscope with a water sending function. .

Then, even if the water supply liquid leaks from between the mantle tube 2 and the tissue, the water can be discharged through the inner tube 41 lumen. If necessary, a suction device can be connected to the base A56 communicating with the inner cavity of the inner tube 41 to actively drain the liquid.

According to the second embodiment, the following effects can be obtained.

In addition to the effects of the first embodiment, since there is no moving object (such as a puncture needle) that may cause a reduction in suction pressure in the suction conduit formed by the inner tube and the outer tube, there is no effect on the tissue. Suction fixing is performed firmly.

Further, since the waste liquid line and the suction line are separately provided, even if a gap is formed between the mantle tube and the tissue, the negative pressure in the suction line is not reduced, and the tissue is not squeezed. It is possible to reduce the risk of the detachment of the mantle tube due to a decrease in the fixing force. Furthermore, even if the liquid leaks from the gap, the liquid can be discharged from the base A communicating with the inner cavity, and the patient and the operator do not get discomfort without getting wet.

FIG. 1 shows a third embodiment of the present invention.
This will be described with reference to FIGS.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

The suction fixing portion 8 provided at the distal end of the tubular main body 7 of the mantle tube insertion assisting tool 1 is formed in a shape that is easily adapted to the posterior vaginal vault. That is, the shape of the suction fixing section 8 is the same as that of FIG.
2 (A) and 2 (B), as shown in FIG.
As shown in FIGS. 3 (A) and (B), the shape is a crescent-shaped 48. FIG. 14 (A) is a view of the cervix and Goto's fornix viewed from the vaginal opening, and FIG. 14 (B) shows a state where the suction fixing portion 8 of the mantle tube insertion aid 1 is positioned at the puncture site. I have.

According to the third embodiment, since the tip shape of the suction fixing portion of the mantle tube insertion assisting tool corresponds to the shape of the puncture site, the visibility of the tip is good and the operability is good. It has the effect of being good.

FIG. 15 shows a fourth embodiment of the present invention.
This will be described with reference to FIG.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. In FIG. 15, the suction fixing portion 8 at the distal end of the mantle tube insertion assisting tool 1 is made of a soft resin material (for example, silicon rubber or the like). According to this configuration, it is possible to deform the suction fixing portion at the distal end of the mantle tube insertion assisting tool according to the shape of the puncture target region, and it is possible to increase the suction fixing force.

FIG. 1 shows a fifth embodiment of the present invention.
This will be described with reference to FIGS.

This embodiment discloses a puncture member.

Conventionally, as a device for inserting a mantle into the abdominal cavity by a vaginal approach, there is a combination of a puncture needle and a mantle tube as disclosed in Japanese Patent Application Laid-Open No. 7-222750. This means that at the time of puncturing, it is necessary to press the tip against the tissue, push the spring-biased spherical part into the needle once, and abut the needle tip against the tissue. For this reason, a certain amount of pushing force and momentum are required. It is necessary, and the skill and careful manipulation of the surgeon is necessary to prevent damage to the organs on the other side of the membrane. Therefore, in the present embodiment, this puncture device is configured as follows so that the surgeon can perform puncture more easily.

That is, a plurality of extension members having a puncture portion having a length close to the thickness of the body wall at the puncture site and a stopper portion having a diameter larger than that of the puncture portion and not being inserted into the body wall are attached to the puncture portion of each extension member. A puncturing member provided with a puncturing portion at the distal end configured to be integrated with each other, expanding means for moving the respective expanding members in a direction away from each other, and freely moving between the expanding members when the expanding members are in the expanded state. By using a mantle tube puncture device comprising a small mantle tube, the body tissue is punctured until the stopper part abuts the puncture part.

That is, the needle is penetrated by approximately the thickness of the body wall, the hole is expanded by expanding the expanding member, and the mantle tube which can be advanced and retracted in the expanded state is inserted into the expanded hole. I do. In addition, an endoscope is provided in the mantle tube, and the mantle tube can be inserted while checking the expanded state of the puncture hole. .

Hereinafter, a more detailed description will be given with reference to FIGS.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

FIG. 16 shows a configuration in which the puncture member 49, the support tube 50, the outer tube 2 for the endoscope, and the endoscope 4 are combined.

As shown in FIGS. 16 and 17, the puncture member 49 has a tubular portion 52 having a base portion 51 at the rear end.
And two expansion members 54a and 54b connected to the tubular portion 52 by a spring-like member 53 and provided at the distal end.
A puncturing portion 56a is provided at the distal end of each of the expansion members 54a and 54b.
The puncturing portions 56a and 56b are formed in the shape of sharp projections, and the length thereof is short, and is equal to or slightly larger than the thickness of the target tissue. For example, here, the thickness of the vaginal portion is assumed, and the length of the puncturing portions 56a and 56b is preferably about 2 to 5 mm.

The two expanding members 56a and 56b have a symmetrical shape, and the puncturing portions 56a and 56b at the distal end are combined to form one puncturing portion. Further, stopper portions 57a, 57b having steps are provided at the rear ends of the puncturing portions 56a, 56b of the expansion members 54a, 54b. When the puncturing portions 56a and 56b at the distal ends coincide with each other, the expanding members 54a and 54b have a circular cross-sectional shape, and have a diameter substantially coinciding with a lumen of a support tube described later. The lumen sides of the expansion members 54a and 54b have tapered surfaces 58a and 58b that are conically concave toward the distal ends.

The support tube 50 is a cylindrical member arranged on the outer periphery of the puncture member 49, and is arranged so as to be able to move back and forth on the outer periphery of the puncture member 49. The entire length of the support tube 50 is shorter than the puncture member 49.

The outer tube for endoscope 2 is a tubular member disposed inside the puncture member 49, and the endoscope 4 is inserted therein. The length of the insertion portion is configured to be longer than the puncturing member 49, and is a length that slightly protrudes from the distal end of the endoscope when the endoscope 4 is mounted. At the rear end, a base 17 communicating with the lumen
Is provided, and when the endoscope 4 is inserted into the abdominal cavity,
Functions as an outer tube for water supply.

The operation of the fifth embodiment will be described.

As shown in FIG. 18, the support tube 50 is positioned at the distal ends of the expansion members 54a and 54b so that only the puncturing portions 56a and 56b of the puncturing member 49 project from the distal ends.
In this state, the puncturing portions 56a and 56b at the distal end are punctured into the target site. The puncturing portions 56a and 56b are slightly longer than the body tissue (membrane), and the stopper portions 58a and 58b have a larger diameter than the puncturing portions 56a and 56b.
It is not punctured more than necessary inside the body from the membrane tissue. FIG.
As shown in FIG. 9, the support tube 50 is pulled forward (in the direction of arrow A), and the outer tube 2 on which the endoscope 4 is mounted is advanced (in the direction of arrow B). Then, as shown in FIG. 20, the tip of the mantle tube 2 hits the conical tapered portion 57 in the expansion member 54, and
The two expansion members 54a and 54b are expanded. Accordingly, the body tissue (membrane) punctured by the puncturing portion 56 at the tip also opens. When the mantle tube 2 is sufficiently advanced and the membrane hole is opened, the puncture portions 56a and 56b are further punctured, and the mantle tube 2 is inserted therein.

The above operation can be performed while observing under an endoscope arranged in the lumen of the mantle tube 2.

In particular, when the mantle tube 2 enters the body, it can be advanced while checking it with the endoscope 4, so that the puncture portions 56a and 56b pierce the membrane or communicate with the abdominal cavity. Since it is possible to know whether there are other organs, safe insertion is possible. Further, even if the puncturing sections 56a and 56b do not penetrate sufficiently, this can be confirmed under the endoscope, and in this case, the work is performed again.

When the mantle tube 2 is inserted into the abdominal cavity, the inside of the abdominal cavity is observed under an endoscope. In this case, water may be supplied from the base 17 at the rear end of the mantle tube 2.

The puncture device of the present embodiment is the same as the first puncture device described above.
Although it is possible to use in combination with the outer tube insertion aid 1 according to the fourth to fourth embodiments, the puncture device according to the present embodiment can also be used alone. is there.

According to the fifth embodiment, the following effects can be obtained.

[0091] Since a small puncture hole in body tissue is expanded and a mantle tube is inserted, it is less invasive.

Further, the puncture portion is slightly longer than the thickness of the target tissue (membrane), and the stopper portion has a diameter larger than that of the puncture portion. However, the risk of organ damage at the time of puncturing can be reduced.

Further, when inserting the puncture part, the endoscope is used to
Since the enlargement of the puncture hole and the state inside the puncture hole can be observed, safer and more reliable insertion becomes possible.

FIG. 2 shows a sixth embodiment of the present invention.
This will be described with reference to FIGS.

The same components as those of the fifth embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in FIG. 21, the puncturing member 49 includes four parts, namely, expansion members 54c, 54d, 54e and 54f, and four expansion members 54c, 54d and 54f.
e and 54f together form a circular cross-sectional configuration. Four expansion members 54c, 54d, 54e and 5
The tips of fD are all sharpened, and the four tips are integrated to form a needle-like puncture portion 56. Puncture unit 56
At the rear end, there are stopper portions 58c each having a step,
58d, 58e and 58f are provided. The length of the needle-like puncture portion 56 is shorter than that of the fifth embodiment. That is, it is the same as or slightly shorter than the target tissue thickness.

FIG. 22A shows puncturing portion 5 of puncturing member 49.
FIG. 6 is a front view of FIG. 6, showing an AA cut surface and a BB cut surface. FIG. 22B is a cross-sectional view taken along the line AA of FIG. 22A, and shows cross sections of the expansion members 54d and 54f. In the figure, 57d is an expansion member 54d
57f is a tapered portion of the expansion member 54f and has a symmetrical shape. FIG. 22C shows FIG.
FIG. 2A is a cross-sectional view taken along the line BB of FIG.
e shows a cross section. In the figure, 57c is a tapered portion of the expansion member 54c, and 57e is an expansion member 57c.
e, a symmetrical shape.

The positions of the tapered portions 57d and 57f of the expanding members 54d and 54f and the tapered portions 57c and 57e of the expanding members 54c and 54e are different, and the former is located closer to the hand.

The operation of the sixth embodiment will be described.

The puncture portion 56 is punctured at the target site with the above-mentioned expansion members 54c, 54d, 54e and 54f integrated. Next, when the mantle tube 2 is advanced to the tip, FIG.
As shown in (A), the distal end of the mantle tube 2 hits the tapered portions 57d, 57f of the expansion members 54d, 54f, and the expansion member 5
Expand 4d, 54f. Here, if it can be confirmed endoscopically that the puncturing portion 56 at the tip has penetrated the membrane, the mantle tube 2 is further pushed as it is. If it does not penetrate the membrane or if it is unknown, as shown in FIG. 24A, the puncturing portions 56c and 56e of the expansion members 54c and 54e that have not been opened are further pierced into the tissue, and Advance mantle tube 2. The distal ends of the mantle tubes 2 are expanded members 54c, 5c.
The tip is expanded by further advancing to the tapered portions 57c and 57e of 4e. As shown in FIG. 25, when the membrane is opened, the mantle tube 2 is further advanced, the mantle tube 2 is advanced into the enlarged hole, and the mantle tube 2 is placed in the body cavity. Thereafter, the endoscope 4 is inserted into the mantle tube 2 to observe the inside of the body.

FIG. 23 (B) is a diagram showing the C of FIG. 23 (A).
FIG. 24B is a cross-sectional view of FIG.
It is -D sectional drawing.

According to the sixth embodiment, the following effects can be obtained.

Since the puncture hole expansion is performed in two stages, the hole can be easily expanded and the needle can be easily introduced, for example, in the case where the membrane cannot be completely separated by the first puncture. In addition, when the abdomen is composed of a plurality of membranes, for example, transvaginal puncture has a peritoneum on the lumen side, and a single puncture may make it difficult to penetrate the peritoneum. This is effective in such a case.

Further, since the needle point can be shorter than that of the fifth embodiment, the risk of organ damage can be further reduced.

FIG. 2 shows a seventh embodiment of the present invention.
This will be described with reference to FIGS.

This embodiment discloses a combination of a puncture member (puncture needle) and a mantle tube. Note that the same components as those in the first to sixth embodiments are denoted by the same reference numerals, and description thereof will be omitted.

FIG. 26 shows that the puncture needle 3 is inserted into the dilation tube 59, and the combination thereof can be inserted into the outer tube 2.
It also shows that the endoscope 4 can be inserted into the outer tube 2. FIG. 27 shows a state in which the puncture needle 3 is inserted into the dilation tube 59 and these are inserted into the outer tube 3. FIG. 28 shows a state in which the endoscope 4 is inserted through the outer tube 3. Is shown. As shown in FIG. 27, the outer diameter of the insertion portion 3a of the puncture needle 3 is constant, and substantially coincides with the lumen (for example, 1 mm in diameter) of the dilation tube 59. The length of the insertion portion 3 a is such that the tip protrudes from the expansion tube 59 when the insertion portion 3 a is inserted deepest into the expansion tube 59. As shown in FIG. 26, at the base end of the insertion portion of the puncture needle 3, an O-ring-shaped fixing means is inserted into a receiving portion 61 provided on the grip portion 60 of the expansion tube 59 to fix them. A rubber elastic member 62 is provided.

The extension tube 59 is provided with a taper 63 at the tip. The length of the extension tube 59 is such that the tip taper portion 63 protrudes from the tip of the mantle tube 2 when attached to the mantle tube 2. I have. The outer diameter of the expansion tube 59 substantially matches the inner diameter of the mantle tube 2 (for example, 3.6 mm in diameter).
Further, as shown in FIG.
A pin 64 for connecting and fixing to the rear end of the mantle tube 2
Is provided.

As shown in FIG. 28, the tip of the mantle tube 2 is
It is cut 65 diagonally, and its tip is formed sufficiently smoothly. The outer diameter of the mantle tube 2 is 4 mm in the present embodiment.

Further, an air-tight sealing member 66 made of a rubber-like member is provided on the lumen side of the rear end of the outer tube 2, and the side surface of the rear end communicates with the inner cavity of the outer tube 3. A base 68 is provided. Further, a pin 67 provided in front of the eyepiece 31 of the endoscope 4 is provided at the rear end of the mantle tube 3.
A receiving hole 69 is provided at a position corresponding to the pin 64 provided on the grip portion 60 of the expansion tube 29, and a fixing means (not shown) is provided inside.

The length of the insertion section 29 of the endoscope 4 is
When combined with, the length is such that the tips almost coincide. The end viewing angle of the endoscope 4 indicates a perspective mirror. The outer diameter of the insertion section 5 of the endoscope 4 is
(In this embodiment, 3 mm in diameter). This is a diameter that cannot be sealed by the sealing member 66 of the outer tube 2. The innermost portion of the insertion section 29 of the endoscope 4 almost coincides with the lumen of the mantle tube 2, and the sealing member 66
Is provided with an airtight holding portion 70 (for example, an outer diameter of 3.6 mm) having a diameter that is sealed by the seal.

The operation of the seventh embodiment will be described.

The puncture needle 3 is inserted into the dilation tube 59, and the combined product is inserted into the mantle tube 2 until it abuts and is fixed.

In this state, the target site such as the posterior vaginal vault is punctured. When the distal end portion of the puncture needle 3 passes through the body wall, the expanding member 59 and the mantle tube 2 are collectively removed from the puncture needle 3 so as not to pull out the puncture needle 3 from the body wall, and forward along the puncture needle 3. Proceed. The hole punctured by the puncture needle 3 is
The distal end of the mantle tube 2 is expanded by the distal end tapered portion 63 of FIG. At this time,
Since the puncture needle 3, the expansion tube 59, and the mantle tube 2 have substantially the same outer diameter and inner diameter and have almost no step, the puncture hole can be smoothly expanded to insert less pain. When the placement of the mantle tube 2 in the body is completed, only the mantle tube 2 is left in the body, and the puncture needle 3 and the dilation tube 59 are removed.

Here, the endoscope 4 is inserted into the mantle tube 2 until it abuts, and is fixed. Since the insertion portion 5 of the endoscope 4 has a diameter that cannot be sealed by the sealing member 66 of the mantle tube 2, the insertion portion 5 is inserted smoothly, and finally the large-diameter airtight holding portion 69 is pushed into the sealing member 66, and A seal is provided between the tube 2 and the endoscope 4. Here, the mantle cap 6
From 8, water is supplied, and water is supplied from the distal end of the endoscope 4 into the body cavity through the gap between the endoscope 4 and the lumen of the mantle tube 2. Since the outer diameter of the endoscope insertion section 5 is sufficiently smaller than the inner diameter of the mantle tube 2, a sufficient amount of water to be observed can be secured.

Observation is performed under the endoscope 4 while appropriately supplying water. The endoscope 4 moves back and forth with respect to the body wall together with the mantle tube 2 to change the field of view.

According to the seventh embodiment, the following effects can be obtained.

Since the outer tube and the water pipe for the endoscope are used in common, the configuration is one less than that in the case where the endoscope, the water pipe for the endoscope and the outer tube are used in combination, and the same As far as the outer diameter is concerned, a thicker endoscope (high image quality, high light intensity) can be used, and with the same endoscope, the outermost diameter can be reduced for a less invasive examination. . Further, since the mantle tube can be attached to the endoscope and water is supplied at the distal end, water can be supplied to the distal end of the endoscope, and a good visual field can be obtained.

Further, when the endoscope is inserted into the mantle tube, the diameter of the endoscope insertion portion is sufficiently smaller than the inside diameter of the mantle tube.
Furthermore, a seal member is provided in the inner cavity of the rear end of the mantle tube, and an air-tight structure is provided in which an air-tight portion having a diameter sealed by the seal member is provided at the end of the endoscope insertion portion. In order to secure a sufficient gap between them and a sufficient flow rate of water, a good field of view can be obtained.

Furthermore, since the outer diameter and inner diameter of the puncture needle, dilatation tube, and mantle tube can be made substantially the same or slightly smaller, there is almost no step at the tip. In doing so, it is possible to perform smooth puncturing without causing pain or snagging.

Further, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention.

Next, other characteristic technical matters of the present application will be additionally described as follows.

(Supplementary Item 1) A mantle tube insertion device which is transvaginally accessible in the abdominal cavity, and is provided at the distal end and is fixed by suctioning the internal tissue, and the suction fixing means An outer tube insertion aid having a tubular body provided on the proximal end side of the means, and a suction channel provided in parallel with the tubular body and communicating with the suction fixing means; An outer tube insertion device comprising: an outer tube extending in an axial direction; and a puncture member provided with a puncturing means at a distal end thereof and capable of penetrating a body tissue, and being loosely inserted into the outer tube.

(Supplementary Item 2) The puncture member is composed of a tubular needle member and a puncture needle having a spherical tip member which is disposed inside the tube, is spring-biased in the direction of the needle tip, and normally projects from the needle tip. 3. The device for inserting a mantle tube according to claim 1, wherein:

(Additional Item 3) An outer tube and a puncturing member are arranged in the suction channel so as to be able to move forward and backward, and a sealing means for keeping airtightness between the suction channel and the outer tube is provided at the rear end of the outer tube insertion aid. The mantle tube insertion device according to claim 1, characterized in that:

(Appendix 4) The tubular main body of the mantle tube insertion aid is constituted by a double tube, a suction channel is provided between the double tubes, and the mantle tube is disposed in the innermost lumen of the double tube so as to be able to move back and forth. 3. The device for inserting a mantle tube according to claim 1, wherein:

(Appendix 5) An outer tube insertion aid having a means for suctioning and fixing a body tissue at a tip thereof, an outer tube, and a fixing means for fixing the outer tube and the outer tube insertion aid, the outer tube being provided. The distal end of the insertion aid is fixed to the tissue, and then the mantle tube inserted into the body tissue and the mantle tube insertion aid are fixed by the fixing means. An outer tube insertion device for preventing a tube from falling off.

(Additional Item 6) The outer tube insertion instrument according to Additional Item 5, wherein the body tissue fixing means of the outer tube insertion aid is suction fixing means.

(Additional Item 7) A plurality of expansion members each having a puncturing portion having a length substantially equal to the thickness of the body wall at the puncturing site and a stopper portion having a diameter larger than that of the puncturing portion and which cannot be inserted into the body wall are provided. A puncturing member provided with a puncturing portion at the distal end configured such that the puncturing portion of the expanding member is integrated, an expanding means for moving the expanding member in a direction away from each other, and each expanding member when the expanding member is in an expanded state. An outer tube puncture device, comprising an outer tube that can move forward and backward.

(Appendix 8) An endoscope is provided in the mantle tube,
7. The instrument for inserting a mantle tube according to claim 7, wherein a state of the mantle tube insertion can be observed.

(Additional Item 9) A puncture needle provided with a puncture means, an expansion tube into which the puncture needle can be inserted, and a tapered tip, and an insertion portion into which the expansion tube can be inserted, are provided. An endoscope observation system comprising: a base communicating with a lumen; an outer tube having a seal member for keeping the expansion tube watertight when the endoscope is inserted; and an endoscope insertable into the outer tube. .

[0131]

According to the present invention, a mantle tube insertion aid having a mantle tube, a puncture member such as a puncture needle (pneumoperitoneal needle), and a suction fixing part for fixing a tissue by suction at a tip provided side by side so as to freely move back and forth. The tissue is fixed by suction and pulled up by a mantle tube insertion device consisting of a tool, and the tissue is punctured with a puncture member. Puncture became possible without the need to raise, without pain, and without reducing operability.

[0132] The outer tube insertion assisting device provided with the body tissue suction-fixing means at the tip and the outer tube can be fixed by providing fixing means, so that the outer tube is fixed to the body tissue. The inspection efficiency can be improved without the mantle tube coming out. This was achieved without increasing the invasion of the body.

[Brief description of the drawings]

FIG. 1 is a system diagram showing a first embodiment of the present invention.

FIG. 2 is a combination diagram of the first embodiment of the present invention.

FIG. 3 is a combination diagram of the first embodiment of the present invention.

FIG. 4 is a cross-sectional view of a human body (female) for explaining the first embodiment of the present invention.

FIGS. 5A and 5B are operation explanatory diagrams of the first embodiment of the present invention, wherein FIG. 5A is a diagram showing a suction state, and FIG. 5B is a diagram showing a puncture state.

FIG. 6 is an operation explanatory view of the first embodiment of the present invention.

FIG. 7 is an operation explanatory view of the first embodiment of the present invention.

FIG. 8 is an operation explanatory view of the first embodiment of the present invention.

FIG. 9 is a configuration diagram of a second embodiment of the present invention.

FIG. 10 is a diagram illustrating the operation of the second embodiment of the present invention.

FIG. 11 is an operation explanatory view of the second embodiment of the present invention.

FIG. 12 is a configuration diagram of a third embodiment of the present invention;
(A) is a sectional view, and (B) is a front view.

FIG. 13 is a configuration diagram of a third embodiment of the present invention;
(A) is a sectional view, and (B) is a front view.

FIGS. 14A and 14B are explanatory diagrams of the operation of the third embodiment of the present invention, wherein FIG. 14A is a diagram showing a body tissue and a position of a puncture part, and FIG.
Is a sectional view.

FIG. 15 is a configuration diagram of a fourth embodiment of the present invention.

FIG. 16 is a configuration diagram according to a fifth embodiment of the present invention.

FIG. 17 is a configuration diagram according to a fifth embodiment of the present invention.

FIG. 18 is an operation explanatory view of the fifth embodiment of the present invention.

FIG. 19 is an operation explanatory view of the fifth embodiment of the present invention.

FIG. 20 is an operation explanatory view of the fifth embodiment of the present invention.

FIG. 21 is a configuration diagram according to a sixth embodiment of the present invention.

FIG. 22 is a configuration diagram of a sixth embodiment of the present invention;
(A) is a front view, (B) is a cross-sectional view along AA, (C)
Is a BB sectional view.

FIGS. 23A and 23B are explanatory diagrams of the operation of the sixth embodiment of the present invention, in which FIG. 23A shows a puncturing state, and FIG.

FIGS. 24A and 24B are operation explanatory diagrams of the sixth embodiment of the present invention, in which FIG. 24A shows a puncturing state, and FIG. 24B is a front view of a puncturing part.

FIG. 25 is an operation explanatory view of the sixth embodiment of the present invention.

FIG. 26 is a system diagram according to a seventh embodiment of the present invention.

FIG. 27 is a configuration diagram of a seventh embodiment of the present invention.

FIG. 28 is a configuration diagram of a seventh embodiment of the present invention.

[Explanation of symbols]

 REFERENCE SIGNS LIST 1 mantle tube insertion aid 2 mantle tube 3 puncturing member 4 endoscope 6 suction channel 7 tubular body 8 suction fixing means 59 expansion tube

Claims (2)

[Claims] 1. A device for inserting a mantle tube which can be vaginally approached into the abdominal cavity, comprising suction fixing means provided at a distal end portion and fixed by suctioning a body tissue, and a proximal end of said suction fixing means. A mantle tube insertion assisting tool having a tubular body provided on the side and a suction channel provided in parallel with the tubular body and communicating with the suction fixing means; inserted into the mantle tube inserting aid and extending in the longitudinal direction. An outer tube insertion device, comprising: an existing outer tube; and a puncture member provided with a puncturing means at a distal end thereof and capable of penetrating a body tissue, and being loosely inserted into the outer tube. 2. A mantle tube insertion assisting tool comprising: a mantle tube insertion aid provided with means for suction-fixing body tissue at its tip; a mantle tube; and a fixing means for fixing the mantle tube and the mantle tube insertion aid. Is fixed to the tissue, and then the mantle tube inserted into the body tissue and the mantle tube insertion aid are fixed by the fixing means, the mantle tube is relatively positioned with respect to the tissue, and the mantle tube comes off. An outer tube insertion device characterized by performing a stop.