JP2009291492A - Organ holder - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an implement for holding and tugging an organ during a laparoscopic surgery, holding and tugging the organ if the organ does not have ends like intestines, or if a part of the long continuous organ is to be held, while fixing the posture of the organ without swinging the organ. <P>SOLUTION: A tubular body 3 which can be inserted into a trocar 7 to be inserted and held in a small incision 5 has a sufficient inner diameter for inserting laparoscopic surgical forceps 9. The distal end of the body 3 is inserted into one branched part 15 of a branched rubber tube 11. A hole 19 formed on a side of the distal end of the body 3 communicates with the other branched part 15 of the branched rubber tube 11. The rear end of the body 3 is inserted into a different rubber tube 27. A cord 25 passes through the body 3 via the rubber tube 27, passing from the hole 19 through the other branched part 15 of the branched rubber tube 11, to be exposed to the outside. Then, after wound around the organ 29, the cord 25 enters the body 3 from the distal end of the body via one branched part 15. The cord 25 is long enough to pass through the body 3 to be drawn out of the rubber tube 27. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a structure of a tool for grasping an organ by laparoscopic surgery, pulling the organ, or closing the organ.

  In laparoscopic surgery, a plurality of small incisions are usually formed in the abdomen, a cylindrical instrument called a trocar is inserted and held from each small incision, and carbon dioxide is injected from a certain trocar to inflate the abdominal cavity. Then, while inserting an endoscope from another trocar and observing the abdominal cavity, a surgical instrument such as scissors and forceps for laparoscopic surgery is further inserted from another trocar.

For this reason, laparoscopic surgery is said to be a less burden on the body than laparotomy, which requires a large incision.
However, laparoscopic surgery is generally difficult, and accident prevention is a major problem unless a trained surgeon is trained.

  One of the reasons that makes laparoscopic surgery difficult is because the surgeon cannot directly reach into the abdominal cavity because the field of view is limited to the narrow scope of the endoscope. Thus, it cannot be gripped and pulled as described above, so that the field of view of the affected area is not sufficient.

  Conventionally, in order to grasp and pull an organ, for example, when the organ is a rectum, the rectum is sandwiched and pulled by two forceps, but it is difficult to operate in a narrow pelvis. In addition, it has been practiced to pinch and pull the rectum with one large forceps called durian forceps, but it is difficult to take a sufficient field of view. Alternatively, both ends of the gauze wound around the rectum have been clamped and pulled with forceps, but the wound force is weak, the gauze is slippery with respect to the rectum, and is difficult to implement. Furthermore, instead of this gauze, a special belt made of silicon and provided with an uneven slipper is wound around the rectum, and the end of the wound belt is clamped with forceps and pulled. Gripping and pulling is difficult.

In order to alleviate the above problems, in Patent Document 1 below, a tube that is a loop-like string body is provided at the end of a rod-shaped tool, and a tool for grasping an organ by changing the diameter of the loop. Has been proposed.
Patent Document 2 below proposes a tool for grasping an organ by providing a string called a loop-like stylet at the end of a stick-shaped tool and opening and closing the loop.
JP 09-140717 ACT 08-000780

  However, according to Patent Document 1 or 2, since the organ is gripped by a closed loop-shaped string body, the organ cannot be implemented for an intestine that does not have an end portion. Also, when trying to grasp a part of a long and continuous organ, the loop must be moved from the end of the organ, which is difficult to implement.

Furthermore, in a state where the organ is gripped by the loop-shaped string body, the posture of the organ is not fixed and is difficult to control. In some cases, the organ is swung, and gripping and pulling are insufficient.
The above problems have been described from the viewpoint of grasping and pulling an organ. However, similar problems arise in grasping and closing an organ.

  That is, for example, conventionally, in rectal tumor surgery, the rectum is clamped with intestinal clamp forceps, the rectal lumen is closed about 2 cm on the anal side of the tumor, and rectal lavage is performed. This intestinal clamp forceps is configured such that the clamp portion at the tip is detachable, and continues to clamp the rectum while being removed from the forceps body during closure. After closing, an operation to connect the clamp part to the main body is necessary. For this reason, the operation was troublesome. Even if it is going to use the tool of the said patent document 1 or the patent document 2 for this closure, it cannot implement by the same problem as the above.

  In order to solve the above problems, the present invention is (1) Even when an organ does not have an end portion like an intestine, or when it is intended to grasp a long continuous part of an organ. (2) The posture of the organ is fixed, the organ is not swung, (3) Furthermore, the rectal lumen can be closed, and rectal lavage is facilitated An object of the present invention is to provide an organ grasper.

  In order to solve the above problems, the first invention is a tool for grasping an organ in laparoscopic surgery, a cylindrical main body that can be inserted into a trocar inserted and held in a small incision, and An inner diameter of the main body sufficient to insert a laparoscopic forceps, a branch-shaped rubber tube in which the tip of the main body is inserted into one branch portion, and the branch shape formed on the side of the tip of the main body A hole communicating with the other branch portion of the rubber tube, a rubber tube into which a rear end of the main body is inserted, and the other branch portion of the branch-shaped rubber tube passing through the main body through the rubber tube from the hole After being exposed to the outside and wound around the organ, it has a length sufficient to enter from the front end of the main body through the one branch portion and to be pulled out from the rubber tube through the main body. And the string An organ gripper, characterized by.

  In the second invention, the cylindrical main body is a cylindrical stainless steel tube, the branched rubber tube is a T-shaped rubber tube, and the one branched portion is an upper side of the T-shaped. And the other branch portion is the T-shaped vertical side portion, and the string body is a surgical vascular tape.

  According to a third aspect of the present invention, the organ is a large intestine, and the length of the branch portion on the distal end side is 15 to 25 mm among the upper side of the T-shape, and a portion into which a stainless steel tube is inserted Is an organ gripping tool characterized in that the length of the vertical side of the T-shape is 10 to 15.

  According to the first, second, or third invention, the organ is grasped by the following procedure. First, leave one end of the string body, and pass the other end through the rubber tube of the organ gripper to the main body, and expose it to the outside through the other branch of the branch-shaped rubber tube from the hole of the main body. Let it be in a state where In this state, the string body and the organ gripping tool are inserted into a trocar inserted and held in the small incision. Next, forceps for laparoscopic surgery are inserted from another trocar, and with these forceps, a string body along the body of the organ gripping tool is drawn into the abdominal cavity and passed under the organ. Then, a laparoscopic surgical forceps is inserted into the main body of the organ gripping tool, and the other end of the string that passes under the organ is sandwiched by the laparoscopic surgical forceps. Further, by pulling out the laparoscopic forceps from the body of the organ gripping tool, the other end of the string body is also pulled out.

  As a result, the cord body is wound around the organ, one end passes through one branch portion of the branch-shaped rubber tube, the other end passes through the other branch portion of the branch-shaped rubber tube, and both ends hold the organ. It is pulled out of the main body through a rubber tube at the rear end of the tool. By pulling these ends moderately and strongly, the organ is pressed against the string body and pressed against the branch portion of the branch-shaped rubber tube to be fixed. Both ends of the string body are clipped and fixed from above the rubber tube with other forceps or the like, and at the same time, decompression in the abdominal cavity is prevented.

As described above, (1) even when the organ does not have an end portion like the intestine, or when it is intended to grasp one part of a long and continuous organ, the other end of the string is connected to the organ. Since the string body can be wound around the organ, it can be grasped.
(2) Since the organ is pressed against the string body and pressed against the branch portion of the branch-shaped rubber tube and fixed, the posture of the organ is fixed and the organ is unlikely to swing.

According to the second invention, an inexpensive organ grasper can be obtained using a cylindrical stainless steel tube or a T-shaped rubber tube.
According to the third invention, the length of the branch portion on the tip side of the T-shaped upper side portion of the T-shaped rubber tube is 15 to 25 mm, of which the stainless steel tube is inserted. The length is 5 to 10 mm, and the length of the T-shaped vertical side is 10 to 15, which is suitable for grasping, pulling, and closing the large intestine as an organ. It can be a dimension.

An embodiment of the present invention is shown in FIGS.
As shown in FIG. 1A, the main body 3 of the organ gripping tool 1 according to this embodiment is a cylindrical stainless steel tube having a length of 400 mm. The outer diameter is 8 mm, and has a size that can be inserted into the trocar 7 inserted and held in the small incision 5 in the abdomen. The inner diameter is 7 mm, and it has a size sufficient for inserting the laparoscopic forceps 9 (FIG. 3C).

  As shown in FIGS. 4A and 4F, a T-shaped rubber tube 13 used as a branched rubber tube 11 is attached to the tip of the main body 3. That is, the tip of the main body 3 is inserted into the T-shaped upper side portion 17 of the T-shaped rubber tube 13 which is one branch portion 15 of the branched rubber tube. A hole 19 is formed on the side of the tip of the main body 3, and this hole 19 is the other branch portion 15 of the branch-shaped rubber tube 11, and a T-shaped vertical side portion of the T-shaped rubber tube 13. 21 communicates. Note that arc-shaped cutouts 23 are formed on the tip side lower portion of the T-shaped upper side portion 17 of the T-shaped rubber tube 13 and the tip side of the lower end of the vertical side portion 21, respectively. A string body 25 described later is held in the notch 23.

As shown in FIGS. 4A and 4E, the rear end of the main body 3 is inserted into a rubber tube 27 having another linear shape.
These rubber tubes 13 and 27 have an outer diameter of 8 mm and an inner diameter of 6 mm, and natural rubber latex is used. Manufactured by Rusch GmbH, Germany, the manufacturer of rubber tubes.

  A string 25 shown in FIG. 2B is a surgical blood vessel tape (VesselTape). The thing of width 9mm and length 1200mm was used. Since the organ 29 is grasped by the string body 25 passed through the main body 3 of the organ grasping tool 1 (see FIG. 7 and FIG. 8), a sufficient length is required. That is, the string body 25 passes through the main body 3 via the rubber tube 27, is exposed to the outside through the T-shaped vertical side portion 21 of the T-shaped rubber tube 13 from the hole 19, and is wound around the organ 29. After that, it has a length sufficient to enter from the tip of the main body 3 through the T-shaped upper side portion 17 of the T-shaped rubber tube 13 and to be pulled out from the rubber tube 27 through the main body 3.

  In this embodiment, the target organ to be grasped and pulled is the large intestine 31. The shape of the T-shaped rubber tube 13 is determined so as to be suitable for this. That is, as shown in FIG. 1 (F), the length A of the branch portion 15 on the tip side of the T-shaped upper side portion 17 is 15 mm, and the length of the portion into which the stainless steel tube is inserted is included. B is 5 mm. The remaining 10 mm on the tip side C is only rubber. The length D of the T-shaped vertical side portion 21 is 10 mm.

The forceps 9 for laparoscopic surgery shown in FIG. 2C is used for laparoscopic surgery, and the distal end portion 35 is opened and closed by operating the handle portion 33. Extra long forceps. A plurality of short forceps 10 having the same structure as that shown in FIG.
The forceps 37 shown in FIG. 4D is used for normal surgery. As shown in FIG. 9 of the procedure for using the organ gripping tool 1, both ends of the string 25 are placed on the rubber tube 27. Used to clip from

“Procedure and Effect of Using Organ Gripper 1 According to Embodiment”
A procedure for using the organ gripping tool 1 will be described. That is,
[1] First, as shown in FIG. 2, one end of the string body 25 is left, and the other end is passed through the body 3 through the rubber tube 27 of the organ gripping tool 1, and branched from the hole 19 of the body 3. 11 is exposed to the outside through the other branch part 15 and is in a state along the main body 3. In this state, the string body 25 and the organ gripping tool 1 are inserted into the trocar 7 inserted and held in the small incision 5. As this trocar 7, for example, one having a diameter of 12 mm is used.

[2] Next, as shown in FIGS. 2 and 3, short laparoscopic surgical forceps 10 are inserted from the other two trocars 7, and the forceps 10 are moved along the body 3 of the organ gripping tool 1. The end of the laced string 25 is drawn into the abdominal cavity 39. At this time, the end of the string 25 is opened once.

[3] Then, as shown in FIG. 4, the large intestine 31 is lifted by one forceps 10, the string body 25 drawn in by another forceps 10 is sandwiched, and the lower part of the large intestine 31 is passed.
[4] Next, as shown in FIGS. 5 and 6, a laparoscopic forceps 9 is inserted into the body 3 of the organ gripping tool 1, and the laparoscopic forceps 9 is passed under the organ 29. The other end of the string body 25 is sandwiched. At this time, the string body 25 is closed in a loop shape.

[5] Further, as shown in FIG. 7, by pulling out the laparoscopic forceps 9 from the main body 3 of the organ gripping tool 1, the other end of the string body 25 is also pulled out.
As a result, the string body 25 is wound around the organ 29, one end passes through the T-shaped upper side portion 17 of the T-shaped rubber tube 13, and the other end is the T-shaped shape of the T-shaped rubber tube 13. The both ends are drawn out of the main body 3 through the rubber tube 27 at the rear end of the organ grasping tool 1.

[6] As shown in FIG. 8 and FIG. 9, by pulling these ends moderately strongly, the large intestine 31 is pressed against the string body 25 and pressed against the branch portion 15 of the T-shaped rubber tube 11 to be fixed. Is done. Both ends of the string body 25 are clipped and fixed with the other forceps 37 from above the rubber tube 27, and at the same time, carbon dioxide in the abdominal cavity 39 leaks from the rear end of the main body 3 and the abdominal cavity 39 is decompressed. It is prevented.

  As described above, (1) even when the organ 29 does not have an end portion like the large intestine 31, the other end of the cord body 25 is passed under the organ 29, and the cord body 25 is moved to the organ 29. Since it can be wound around, it can be gripped and pulled.

  Further, (2) the large intestine 31 is pressed against the string 25 and pressed against the T-shaped branch portion 15 of the T-shaped rubber tube 13 as shown in FIG. The posture of the large intestine 31 is fixed and the front and rear of the large intestine 31 are not easily swung. In particular, the string body 25 is held in an arc-shaped cutout 23 formed at the distal end side of the T-shaped upper side portion 17 of the T-shaped rubber tube 13 and the distal end side of the lower end of the vertical side portion 21. Thus, the contact area between the large intestine 31 and the rubber can be increased, and the gripping can be performed more firmly.

  The portion of the T-shaped upper side 17 having a length of 5 mm into which the stainless steel tube on the tip side is inserted grips the large intestine 31 with sufficient rigidity, with the stainless steel tube acting as a core material. Further, the 10 mm long portion of the upper side portion 17 and the 10 mm long portion of the vertical side portion 21 where the stainless steel tube is not the core material are elastically deformed and are sufficiently adhered to the large intestine 31.

Further, the stainless steel portion does not directly touch the large intestine 31, and the large intestine 31 is not damaged.
The applicant has many years of experience in laparoscopic surgery as a large intestine specialist, but does not know any other tool that can hold the large intestine firmly and can be pulled freely like the organ gripping tool 1. Since the large intestine can be pulled freely, a sufficient field of view of the affected area can be secured, and in particular, a field of view of the pelvic floor can be secured. Therefore, the quality of laparoscopic surgery can be improved.

In particular, the high utility value of the organ gripping tool 1 for low-grade rectal cancer, which has a high degree of difficulty, can be realized clinically.
Furthermore, according to this embodiment, the organ gripping tool 1 can be simply configured using a cylindrical stainless steel tube or a T-shaped rubber tube 13, and an inexpensive organ gripping tool 1 can be obtained.

Further, by strongly grasping the rectum with this organ gripping tool 1, the rectal lumen can be closed and rectal lavage can be facilitated. That is, the organ gripping tool 1 is used to strongly hold the rectum, and the rectal lumen is closed about 2 cm from the anus side of the tumor. Remove cancer cells as much as possible.
This eliminates the need for the conventional intraperitoneal operation of the detachable intestinal clamp forceps, which has been conventionally performed, and allows the intestinal tract to be closed as it is, so that rectal lavage can be performed efficiently and easily.

"Other embodiments"
In the above embodiment, the branched rubber tube 11 is the T-shaped rubber tube 13, but in other embodiments, other branched shapes, for example, a Y-shaped rubber tube can also be used.

In the above embodiment, the string body 25 is a surgical blood vessel tape. However, in other embodiments, other string bodies 25 such as a special string or a thin tube can be used.
In the above embodiment, the organ 29 has been described by taking the large intestine 31 as an example. However, in other embodiments, the present invention can be applied to other organs 29 such as the small intestine and the stomach.

BRIEF DESCRIPTION OF THE DRAWINGS The components which comprise the organ holding tool which concerns on one Embodiment of this invention, and the tool used for use are shown, (A) is a side view which shows the main body of an organ holding tool, (B) is a side view which shows a string body , (C) is a side view showing forceps for laparoscopic surgery, (D) is a side view of forceps that clips both ends of a string from the top of a rubber tube, and (E) is an organ gripping tool at the E part of (A). The exploded view which removed the rubber tube from the rear end of the main body of (A), (F) is the exploded view which removed the T-shaped rubber tube from the front-end | tip of the main body of an organ holding tool in F part of (A). FIG. 2 is a perspective view showing an initial procedure for grasping an organ using the organ grasping tool of FIG. 1. FIG. 3 is a perspective view showing the next procedure of FIG. 2. FIG. 4 is a perspective view showing the next procedure of FIG. 3. It is a perspective view which shows the procedure following FIG. FIG. 6 is a perspective view showing the next procedure of FIG. 5. FIG. 7 is a perspective view showing the next procedure of FIG. 6. FIG. 8 is a perspective view showing the next procedure of FIG. 7. It is IX-IX sectional drawing which shows the principal part of FIG.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Organ gripping tool, 3 ... Main body, 5 ... Small incision, 7 ... Trocar, 9 ... Forceps for laparoscopic surgery, 11 ... Branch shape rubber tube, 13 ... T-shaped rubber tube, 15 ... Branch part, 17 ... Upper side part, 19 ... hole, 21 ... vertical side part, 23 ... notch, 25 ... string body, 27 ... rubber tube, 29 ... organ, 31 ... large intestine, 33 ... handle part, 35 ... tip part, 37 ... forceps, 39 ... the abdominal cavity.

Claims (3)

  A tool for grasping an organ in laparoscopic surgery, a cylindrical main body that can be inserted into a trocar inserted and held in a small incision, and the above-mentioned sufficient to insert a laparoscopic surgical forceps into the main body An inner diameter of the main body, a branch-shaped rubber tube in which the tip of the main body is inserted into one branch portion, a hole formed in a side portion of the tip of the main body and communicated with the other branch portion of the branch-shaped rubber tube, A rubber tube into which the rear end of the main body is inserted, passes through the main body through the rubber tube, is exposed to the outside through the other branch portion of the branch-shaped rubber tube from the hole, and is wound around the organ And a cord body having a length sufficient to enter from the tip of the main body through the one branch portion and to be pulled out of the rubber tube through the main body. Ingredients.   The cylindrical main body is a cylindrical stainless steel tube, the branch-shaped rubber tube is a T-shaped rubber tube, the one branch portion is the upper side of the T-shape, and the other The organ gripping device according to claim 1, wherein the branch portion is the T-shaped vertical side portion, and the string body is a surgical blood vessel tape.   The organ is a rectum and a colon in the vicinity of the rectum, and the tool is a tool for closing the rectal lumen to facilitate rectal irrigation by strongly grasping the rectum. Among them, the length of the branched portion on the tip side is 15 to 25 mm, the length of the portion into which the stainless steel tube is inserted is 5 to 10 mm, and the length of the T-shaped vertical side portion is 10 mm. The organ gripping tool according to claim 2, wherein