JP7402099B2 - Variable barrel and retractor instrument for spinal surgery - Google Patents

Description

The present invention relates to an outer barrel for percutaneous total spinal endoscopy and a retractor instrument used in spinal surgery.

A percutaneous total spinal endoscope was developed to minimize the invasiveness of the body during spinal surgery. What is a spinal percutaneous total endoscope 0? As shown in Figures 1 and 2, the main body part 01, which is the part to be inserted into the body, is a long and thin cylinder with an outer diameter of about 6 mm to 7 mm. A light source path 03, irrigation waterway 04, and working bore 05 are integrated, and a camera is connected to display the image on a monitor, and instruments such as forceps or drill D inserted into the working bore 05 can be viewed through a mirror. This is a surgical instrument operated by The outer tube 06 is an instrument that secures a space for the percutaneous total spinal endoscope and a working space. The main body part of the spinal percutaneous total endoscope 0 is placed inside a cylindrical outer cylinder 06 with an inner diameter slightly larger than the outer diameter of the main body part 01 of the spinal percutaneous total endoscope and an outer diameter of about 7 mm to 8 mm. Insert 01 and perform surgical operation. This spinal endoscope has been called a ``percutaneous endoscope'' in Japan, but in recent years it has come to be called a ``total endoscope.''"Percutaneousendoscope","totalendoscope", and "percutaneous total endoscope" are the same thing.
The procedure is to first penetrate the soft tissue through a small skin incision S of approximately 7 mm using a cylindrical dilator with a pointed tip to reach the vertebrae B and intervertebral discs, and then cover the dilator with outer tube 06. After inserting it into the body, remove the dilator and insert the spinal percutaneous total endoscope 0 into the outer tube. Then, while holding the outer tube with one hand and moving it, you can work with the instrument inserted into the working lumen 05, or in some cases, you can directly insert the instrument into the outer tube without a spinal percutaneous total endoscope 0. In other words, it is used as a retractor device rather than the outer tube of a percutaneous total endoscope, and the work is performed under X-ray fluoroscopy without looking through the endoscope.

Surgery to perform intervertebral disc procedures, such as disc herniectomy and interbody fusion, is performed through the narrow space between the nerves, and the outer cylinder protects the nerve in that narrow space while maintaining a path for surgical instrument insertion. There are restrictions on increasing the outer diameter of the outer cylinder because there is a risk of damaging the nerves. Since the object to be worked on is wider than the diameter of the outer cylinder, it is necessary to be able to hold the outer cylinder in one's hand and freely move it by tilting, pushing, or pulling it.

Richard Wolf Product Catalog “VERTEBRIS Lumbar-Thoracic Full-endoscopic Spinal Instrumentation”

The size of the insertion device is limited by the inner diameter of the outer tube, so it is limited to long and thin devices. On the other hand, when removing a large amount of intervertebral disc, such as in lumbar interbody fusion, a larger instrument is more efficient, and a thicker instrument is stronger and more desirable for detaching cartilage endplates from the vertebrae. However, if the outer diameter of the outer tube is increased in order to insert such a large and thick instrument, there is a risk of nerve injury as mentioned above, which is a problem.

Therefore, although the outer cylinder has the same narrow outer diameter as before, the aim is to make it possible to temporarily insert instruments that are larger than the outer cylinder diameter after it has been inserted into the body. However, since the outer cylinder must be able to be held in the hand and moved freely, large devices cannot be attached, and it is limited to items that are easy to hold with one hand.

The outer cylinder of the present invention is composed of a first outer cylinder, a second outer cylinder, a handle box, and a stopper. The first outer cylinder has a first handle attached to the semi-cylindrical first half, and the second outer cylinder has a second handle attached to the second semi-cylindrical half. The first handle has a square frame shape that protrudes in the opening direction of the first semi-cylindrical part (that is, the opposite direction to the arc of the semicircle), and the opening direction of the square frame (that is, the direction of the penetrating surface) is parallel to the long axis of the half cylinder. It is. The second handle has a square prism shape that protrudes in the closing direction of the second semi-cylindrical part (that is, in the direction of the semicircular arc), and although the second handle fits within the frame of the first handle, The length is a little short, and there is a gap between the handles, and there is a stopper to fill the gap. The handle box has a rectangular cylindrical shape, and the first and second handles can be accommodated in its inner cavity without taking up much space. By aligning the first and second handles, placing the handle box over them, and inserting a stopper into the gap between the handles, the first and second outer cylinders become one and become stable. At that time, the first and second half cylinders come together to form a cylindrical shape.

The first handle could also be shaped like a box by adding a bottom plate to the square frame. In addition, the second handle may have a polygonal prism shape other than a rectangular prism shape, and the second handle may have a corresponding shape within the frame of the first handle. However, a square prism and a square frame are the simplest, most stable, and most desirable. The part of the square frame above opposite to the half cylinder part may be a curved plate instead of a flat plate, and the face of the square pillar above opposite to the half cylinder part may be a curved surface corresponding to that.

When the first outer cylinder, the second outer cylinder, the handle box, and the stopper are combined, the first half cylinder part and the second half cylinder part are combined to form a stable cylindrical shape, and the pointed cylinder is the same as before. It can be inserted into the body using a dilator. It is then possible to insert a percutaneous total endoscope into the outer tube lumen and operate it as usual. After the safety of the object to be operated has been confirmed, the instrument may be inserted directly into the outer tube and operated without a complete percutaneous endoscope.

When the stopper is removed from this state, the first and second outer cylinders can only slide in the longitudinal direction of the handle (that is, in the long axis direction of the combination of the first handle, second handle, and handle box). This allows the outer tube to open and allow larger instruments to be inserted. On the other hand, the maximum length of the slide (hereinafter referred to as slide length) is limited by the gap between the first and second handles, and ensuring that it does not open too wide contributes to safety. Once the operation is complete, return the slide and attach the stopper. It is permissible for nerves to be pushed aside for short distances and only for short periods of time.

Furthermore, it is also possible to remove the stopper and handle box and remove one of the outer tubes, leaving only one outer tube, further increasing the variety of instruments that can be inserted. From this state, it is possible to easily return it to its original form by inserting the dilator, the removed outer cylinder, the handle box, and the stopper in that order.

Conventional percutaneous total endoscope and outer tube. Conventional percutaneous total endoscope and the tip of the outer tube. Embodiment 1 of the present invention and a side view of a dilator. A perspective view of Embodiment 1 of the present invention (slightly slid state). FIG. 1 is a front view of the front end of Embodiment 1 of the present invention. A front view on the hand side of Embodiment 1 of the present invention. Front view of the hand side of Embodiment 1 of the present invention (when the handle box is attached). Front view of the hand side of Embodiment 1 of the present invention (when the handle box and stopper are attached). A sectional view of the handle portion of Embodiment 1 of the present invention. A sectional view of a handle portion according to Embodiment 2 of the present invention. A front view on the hand side of Embodiment 3 of the present invention.

Embodiment 1 of the present invention will be explained using FIGS. 3 to 9. The first outer cylinder 1 has a first handle 102 attached to the proximal side of a first semi-cylindrical part 101. As shown in FIG. 6, a first handle 102 protrudes in a direction opposite to the arc of the first half-cylindrical portion 101. The second outer cylinder 2 has a second handle 202 attached to the proximal side of the second semi-cylindrical part 201. As shown in FIG. 6, a second handle 202 protrudes in the direction of the arc of the second semi-cylindrical portion 201. The outer diameters of the two half cylinders are the same. The first handle 102 has a square frame shape (one side is continuous with a semi-cylindrical part), and the opening direction of the square frame (that is, the direction of the penetrating surface) is the same as the long axis direction of the first half-cylindrical part 101. The second handle 202 has a rectangular prism shape (one end is continuous into a semi-cylindrical shape). Although the second handle 202 can be accommodated within the frame of the first handle 102, there is little space between them in the width direction W of the handle, and the length of the second handle 202 is limited in the longitudinal direction L of the handle. is short, and there is a handle clearance S (Fig. 6). The height H of the first handle 102 and the second handle 202 is the same. In order to allow sliding between the outer cylinders, the width of the rectangular frame inner cavity of the first handle 102 is greater than the outer diameter of the half cylinder.
The handle box 3 has a square tube shape. When the first handle 102 and the second handle 202 are combined, the first handle 102 and the second handle 202 can be inserted into the inner cavity of the handle box 3 without much space (FIGS. 8 and 9a). ．．
The gap insertion part 401 of the stopper 4 has a size that allows it to be inserted into the handle gap S without much space (FIGS. 8 and 9b).
When the handle box 3 is placed over the first handle 102 and the second handle 202 (FIG. 7), only the handle parts can be slid in the vertical direction L. The slide length is limited to the length of the handle gap S (vertical length of the handle L).
From this state, when the stopper 4 is further inserted into the handle gap S (Fig. 8), all movements between the outer cylinders are restricted, the first outer cylinder 1 and the second outer cylinder 2 are integrated, and the first half cylinder part 101 and the second half cylinder part 201 come together to form a stable cylindrical shape.

In the state shown in Figure 8, it can be inserted into the body by placing it over the pointed cylindrical dilator 5 that has been inserted into the body. After that, remove the dilator 5, insert the percutaneous total endoscope into the outer tube, and operate it as usual. When inserting a large instrument, remove the percutaneous total endoscope, remove the stopper 4 to the state shown in Figure 7, temporarily widen the space between the semi-cylinders, and insert the instrument. Once the operation is complete, stopper 4 is installed again to reduce the distance between the half cylinders and avoid pressure on the nerve. If a larger instrument is required, remove the stopper 4 and handle box 3, and then remove one outer cylinder before inserting it.

In the second embodiment of the present invention, as shown in FIG. 10, a first handle 1021 has a box shape with a flat plate added to a part of the bottom of a square frame, and a second handle 2021 fits within the box shape. The rest is the same as the first embodiment.

In the third embodiment of the present invention, as shown in FIG. 11, the tips of the first handle 1022 and the second handle 2022 are curved. The rest is the same as the first embodiment.

Claims (1)

Consists of a first outer cylinder, a second outer cylinder, a handle box, and a stopper.
The first outer cylinder has a first handle attached to one end of the first semi-cylindrical part, and the second outer cylinder has a second handle attached to one end of the second semi-cylindrical part,
The first handle protrudes in the opening direction of the first half cylinder part, has a frame structure inside, the opening direction of the frame structure is parallel to the long axis of the first half cylinder, and the inner surface of the frame structure faces the first handle. It has a frame structure with two planes parallel to the handle protrusion direction,
The second handle has a rectangular prism shape that protrudes in the closing direction of the second semi-cylindrical part, and the second handle can be accommodated within the frame of the first handle. Because the vertical length of the two handles is small, there is a gap between the handles.
The handle box has a through-lumen, and the combination of the first handle and the second handle can be housed in the inner cavity, and when the handle box is placed over the first handle and the second handle , With respect to the first outer cylinder, the second outer cylinder can only slide in the vertical direction of the handle, allowing the space between the half cylinders to expand, and the sliding length is limited by the handle gap.
When the handle box is covered and a stopper is further filled in the handle gap, the space between the first outer cylinder and the second outer cylinder becomes immobile, and the first half cylinder part and the second half cylinder part combine to form a cylindrical shape. An external cylinder for total spinal endoscopy and a retractor instrument for spinal surgery, characterized in that the first external cylinder and the second external cylinder can be inserted into the body using a dilator with a pointed cylinder.

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