JP3745037B2 - Ultrasonic trocar - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an ultrasonic trocar that penetrates an abdominal cavity wall by ultrasonic vibration.
[0002]
[Prior art]
Conventionally, trocars have been used to introduce treatment tools and endoscopes from the abdominal wall into the abdominal cavity in endoscopic surgery. The trocar is composed of a trocar inner needle having a cutting edge for puncture at the tip and an outer tube. In order to penetrate this kind of trocar into the abdominal wall of the patient, the operator needs to strongly press the trocar against the abdominal wall of the patient. However, in order to penetrate the trocar, it is necessary to adjust the force appropriately, so that there is a problem that it is difficult to control. In other words, the trocar cannot be penetrated unless too much force is applied, and conversely, if excessive force is applied, there is a risk of damaging the abdominal organs.
[0003]
An invention for coping with this problem is disclosed in Japanese Patent Laid-Open No. 60-110011. That is, the present invention transmits ultrasonic vibrations to the trocar inner needle and improves the puncture ability of the trocar, thereby ensuring sufficient safety and trying to penetrate the trocar into the abdominal wall without requiring much skill. To do.
[0004]
[Problems to be solved by the invention]
However, according to the conventional trocar, it is sufficient if the diameter of the outer tube is relatively small, for example, 3 mm or 5 mm. However, there is a problem in the case where the diameter of the outer tube is relatively large such as 10 mm or more. Arise. That is, the larger the diameter of the trocar, the larger the diameter of the inner trocar needle, and thus the larger the area where the tip of the inner trocar needle touches the abdominal wall. Thereby, the problem that the area of the burn of the abdominal cavity wall by ultrasonic vibration will become large arises.
[0005]
The present invention has been made in order to solve the above-described problems. The object of the present invention is to pierce without increasing the area of the burn on the abdominal wall even for a trocar having a relatively large diameter. It is an object of the present invention to provide a trocar that can be easily performed.
[0006]
[Means for Solving the Problems]
In order to solve the above problems, the present invention relates to an ultrasonic trocar in which a trocar inner needle is inserted into an outer tube, and the trocar inner needle is ultrasonically vibrated to puncture the abdominal cavity wall. A tapered member is provided between the outer tube and the trocar inner needle so as to be separated from the outer tube and having a tip portion that continuously forms a sharp portion with the tip of the trocar inner needle. Is.
[0007]
With such a configuration, even when a trocar having a large diameter is used, penetration can be easily performed without increasing the area of the burn on the abdominal wall.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
<First Embodiment>
Hereinafter, a first embodiment of the present invention will be described. FIG. 1 is a diagram showing an overall configuration of an ultrasonic trocar system according to the present embodiment. As shown in FIG. 1, the ultrasonic trocar system includes an ultrasonic trocar 1, an ultrasonic oscillator 3, and an output control device 4. The ultrasonic trocar 1 includes a handpiece 2, a hollow outer tube 6a connected to the tip of the handpiece 2 by a joining member 5, and a trocar inner needle 7a inserted through the outer tube 6a and screwed to the handpiece. And a hollow tapered member 8a that can be inserted between the outer tube 6a and the trocar inner needle 7a.
[0009]
The ultrasonic transmission device 3 supplies energy for ultrasonic vibration to the handpiece 2, and the output control device 4 includes a foot switch that controls the output of the energy.
The connection between the handpiece 2 and the outer tube 6a is not limited to the connection by the bonding member 5 as described above, and may be used without being bonded.
[0010]
FIG. 2 is a view showing the internal structure of the handpiece 2 constituting the proximal end portion of the ultrasonic trocar 1. The handpiece 2 is provided with an ultrasonic transducer 9 on the proximal end side and a horn 10 for expanding the amplitude of ultrasonic vibration generated by the ultrasonic transducer 9 on the distal end side. The ultrasonic transducer 9 is composed of bipolar voltage input electrodes, and is configured to oscillate ultrasonically by energy supplied from the ultrasonic oscillation device 3.
[0011]
Further, a female screw is formed at the distal end of the horn 10 so that the horn 10 and the trocar inner needle 7a can be screwed together, while a male screw 7 'is formed at the proximal end of the trocar inner needle 7a. Has been. With such a configuration, even if the trocar inner needle 7a is damaged, it is economical because only the trocar inner needle 7a can be replaced without replacing the handpiece 2.
[0012]
Note that the ultrasonic transducer 9 is not limited to the bipolar voltage input electrode, and may be an electrostrictive type or a magnetostrictive type.
FIG. 3 is a cross-sectional view of the handpiece 2, the outer tube 6a, the tapered member 8a, and the trocar inner needle 7a constituting the central portion of the ultrasonic trocar 1. Two grooves 11 and 12 are formed at the tip of the handpiece 2. An O-ring 13 is attached to the proximal end of the outer tube 6 a, and the outer tube 6 a can be attached to the handpiece 2 by fitting the O-ring 13 into the groove 11. Further, an O-ring 14 is also attached to the proximal end of the tapered member 8a, and the tapered member 8a can be attached to the handpiece 2 by fitting the O-ring 14 into the groove 12. Yes.
[0013]
The outer tube 6a is made of a material such as plastic, metal, or Teflon, and is a hollow member having an outer diameter of 10 mm or more. The taper-shaped member 8a is a hollow member made entirely of a compliant member such as Teflon. A gap is opened between the outer tube 6a and the tapered member 8a.
The trocar inner needle 7a is a solid member made of a material such as a titanium alloy or an aluminum alloy. A gap is opened between the tapered member 8a and the trocar inner needle 7a. The gap prevents the ultrasonic vibration from being transmitted to the tapered member 8a even when the trocar inner needle 7a is ultrasonically vibrated.
[0014]
FIG. 4 is a cross-sectional view of the outer tube 6a, the tapered member 8a, and the trocar inner needle 7a constituting the distal end portion of the ultrasonic trocar 1. The distal end of the outer tube 6a, the distal end of the tapered member 8a, and the cutting edge of the distal end of the inner trocar needle 7a are formed in an acute angle so that they are continuous, and can penetrate the abdominal cavity wall. ing.
Next, the operation of the ultrasonic trocar system configured as described above will be described.
[0015]
First, the tapered member 8a and the outer tube 6a are attached to the handpiece 2 so that the O-rings 13 and 14 are fitted in the grooves 11 and 12, respectively. Then, a small incision is made with a scalpel or the like at a position where the trocar inner needle 7a is to be inserted on the abdominal cavity wall. Thereafter, the tip of the trocar inner needle 7a is applied to the incised portion, and the switch of the output control device 4 such as a foot switch is turned on. Then, energy is transmitted from the ultrasonic oscillator 3 to the ultrasonic transducer 9 in the handpiece 2 to generate ultrasonic vibration. The generated ultrasonic vibration is transmitted to the tip of the trocar inner needle 7a after the amplitude is enlarged by the horn 10. By this transmitted ultrasonic vibration, the tip of the trocar inner needle 7a is gradually penetrated into the abdominal cavity wall from the incision. Thereafter, the incision is further expanded by the tip of the tapered member 8a, and finally the outer peripheral surface of the mantle tube 6a can be easily penetrated into the abdominal wall.
[0016]
The tip of the trocar inner needle 7a performs ultrasonic vibration, but since there is a gap between the trocar inner needle 7a and the tapered member 8a, ultrasonic vibration is generated in the tapered member 8a and the outer tube 6a. I don't get it. In addition, depending on the usage mode such as inserting the trocar inner needle 7 obliquely with respect to the abdominal wall, the ultrasonic vibration of the trocar inner needle 7a may be transmitted to the tapered member 8a, but the tapered member 8a is made of Teflon. In this case, the ultrasonic vibration is not transmitted to the tapered member 8a and the outer tube 6a.
[0017]
In addition, the tapered member 8a does not vibrate ultrasonically as described above, but the tip of the tapered member 8a is formed in an acute angle so as to be continuous with the tip of the trocar inner needle 7a. The outer peripheral surface can be easily penetrated into the abdominal wall.
As described above, according to the present embodiment, even when the ultrasonic trocar 1 having a relatively large diameter of 10 mm or more is penetrated into the abdominal cavity wall, the trocar inner needle 7a has a diameter of 3 mm or 5 mm. In addition, since it is the same size as that used for a relatively small ultrasonic trocar, there is no concern that the area of the burn on the abdominal cavity wall due to ultrasonic vibration will increase. Further, since the sharpened portion is continuously formed by the tip of the tapered member 8a and the tip of the trocar inner needle 7a, the ultrasonic trocar 1 is attached to the abdominal wall even if only the trocar inner needle 7a vibrates ultrasonically. Can be easily penetrated.
<Second Embodiment>
FIG. 5 is a cross-sectional view of the tip portion of an ultrasonic trocar showing a second embodiment of the present invention. In addition, the same code | symbol is attached | subjected to the same or equivalent structural member as 1st Embodiment, and description is abbreviate | omitted.
[0018]
The tapered member 8b has substantially the same configuration as the tapered member 8a of the first embodiment, and a compliant member 15a made of a C-ring-shaped Teflon member is provided on the inner peripheral surface of the distal end side. Are only different. In this case, the material of the tapered member 8b may be a compliant member such as Teflon as shown in the first embodiment, but is not limited thereto, and may be a metal or plastic. Good.
[0019]
With such a configuration, the ultrasonic trocar of the present embodiment is used in the same manner as in the first embodiment.
As described above, according to the present embodiment, not only the same effect as that of the first embodiment is obtained, but also by providing the compliant member 15a such as a Teflon member at the tip of the tapered member 8b, the ultrasonic wave It is possible to prevent the ultrasonic vibration from being transmitted to the tapered member 8b and the outer tube 6a by any use mode of the trocar 1. Further, since the trocar inner needle 7a directly contacts the tapered member 8b and does not generate heat, friction powder, or friction noise due to friction, the material of the tapered member 8b is Teflon as shown in the first embodiment. Even if the compliant member is not used, the same effects as those of the first embodiment can be obtained.
<Third Embodiment>
FIG. 6 is a cross-sectional view of the tip portion of an ultrasonic trocar showing a third embodiment of the present invention. In addition, the same code | symbol is attached | subjected to the same or equivalent structural member as 1st Embodiment, and description is abbreviate | omitted.
[0020]
The trocar inner needle 7b has substantially the same configuration as the trocar inner needle 7a of the first embodiment, and a compliant member 15b such as a C-ring-shaped Teflon member is bonded to the outer peripheral surface of the trocar inner needle 7b. Or the only difference is that it is provided by fitting in a replaceable manner. In this case, the material of the tapered member 8a may be Teflon as shown in the first embodiment, but is not limited thereto, and may be metal or plastic.
[0021]
With such a configuration, the ultrasonic trocar of the present embodiment is used in the same manner as in the first embodiment.
As described above, according to the present embodiment, not only the same effects as those of the first embodiment can be obtained, but also by providing a compliant member 15b such as a Teflon member at the tip of the trocar inner needle 7b, It is possible to prevent the ultrasonic vibration from being transmitted to the tapered member 8b and the outer tube 6a by any use mode of the trocar 1. Further, since the trocar inner needle 7b is in direct contact with the tapered member 8a and does not generate heat, friction powder, or friction noise due to friction, the material of the tapered member 8b is Teflon as shown in the first embodiment. Even if the compliant member is not used, the same effects as those of the first embodiment can be obtained.
[0022]
Further, by making the compliant member 15b replaceable, even if the compliant member 15b is thermally deformed by using the ultrasonic trocar 1, it can be used again by replacing the compliant member 15b with a new one. In the case of cleaning, since it can be removed and cleaned, the cleaning property is also improved.
By the way, the trocar inner needle 7b of the present embodiment is provided with a conforming member 15b according to the trocar inner needle 7b itself. Therefore, as shown in FIG. 7, if the tapered member 8a is not used, the diameter is relatively small. It can also be used by being inserted into a small outer tube 6b having a diameter of 5 mm. Further, as described above, the outer tube 6 is not limited to the outer tube 6 having a diameter of 5 mm. Even when the outer tube having other diameters is used, a tapered member having an outer diameter corresponding to the outer tube is prepared. Then, using the same inner trocar needle 7b, the same function and effect as in the third embodiment can be achieved. For example, when using two or more types of mantle tubes during the operation, if there is only one handpiece and a trocar inner needle, a tapered member having a different diameter is attached to the mantle tube, so that the desired mantle tube can be attached to the body wall. Can be penetrated.
[0023]
8 and 9 are sectional views showing modified examples of the trocar inner needles 7a and 7b shown in the first to third embodiments.
The trocar inner needle 7c shown in FIG. 8 is made of a material such as a titanium alloy or an aluminum alloy, and is integrally formed so as to be hollow. Further, the trocar inner needle 7d shown in FIG. 9 is made of a material such as a titanium alloy or an aluminum alloy, and a solid body made of a material such as a titanium alloy or an aluminum alloy is also formed at the tip of the body portion 16 formed in the hollow. The front end portion 17 is constructed by welding. Needless to say, the trocar inner needles 7c and 7d shown in FIGS. 8 and 9 may be provided with a compliant member 15b such as a Teflon member like the trocar inner needle 7b.
[0024]
Thus, since the heat generation of the trocar inner needle itself can be suppressed by reducing the weight as compared with the solid trocar inner needles 7a and 7b, it is possible to further suppress the burn of the abdominal cavity wall.
FIG. 10 shows the handpiece 2 and the outer tubes 6a and 6b (hereinafter referred to as the outer tube 6) shown in the first to third embodiments of the present invention, and when these are penetrated into the body cavity wall. It is the schematic which shows the switch 20 which is an auxiliary tool.
[0025]
The switch 20 is roughly composed of a cylindrical switch body 21 into which the outer tube 6 can be inserted, and an opening auxiliary portion 22 connected to the tip of the switch body 21. The opening assisting portion 22 is composed of two leaf springs, and the distance between the two leaf springs decreases from the proximal end side toward the distal end side, and slightly expands at the distal end portion. A contact prevention tool 23 made of a compliant member such as a Teflon member is attached to a portion where the two leaf springs are closest to each other, and this includes an opening auxiliary portion 22 and trocar inner needles 7a, 7b, 7c, 7d (hereinafter, trocar) This is to prevent contact with the inner needle 7).
[0026]
Next, the operation for penetrating the trocar inner needle 7 into the body cavity wall using the switch 20 will be described. First, a small incision is made with a scalpel or the like at a position where the trocar inner needle 7 is to be inserted into the body cavity wall. With the distal end portion of the switch 20 inserted into the incision portion, the trocar inner needle 7 and the outer tube 6 are inserted from the proximal end side opening portion of the switch body 21 and pushed toward the distal end side. Then, the opening assisting portion 22 is opened to the outside by this pushing force, and the incision is pushed and widened, while the tip of the trocar inner needle 7 is penetrated from the incision into the body cavity. Thus, by using the switch 20, it is possible to easily penetrate the ultrasonic trocar.
[0027]
FIG. 11 is a schematic view showing another example of the switch 20 shown in FIG. The switch 30 is roughly divided into a switch body 31a and a switch body 31b. The switch main body 31a and the switch main body 31b are formed in a semi-cylindrical “<” shape, and are connected to each other by a bent portion 32 of the “<” shape. A spring (not shown) is provided inside the refracted portion 32. In a normal state, the base end side of the switch body 31a and the base end side of the switch body 31b are opened by the elastic force of the spring. It has become. Grip portions 33a and 33b are formed on the base end side of the switch body 31a and the base end side of the switch body 31b. A ratchet mechanism is constituted by 32a and 32b at the base end of the switch body 31a and the base end of the switch body 31b, and the base end side of the switch body 31a and the base end side of the switch body 31b are connected to each other. When closed, it is held in that state.
[0028]
Next, an operation for penetrating the trocar inner needle 7 into the body cavity wall using the switch 30 will be described. First, a small incision is made with a scalpel or the like at a position where the trocar inner needle 7 is to be inserted into the body cavity wall. With the distal end of the switch body 31a and the distal end of the switch body 31b inserted into the incision, the trocar inner needle 7 and the outer tube 6 are inserted from the proximal end sides of the switch bodies 31a and 31b and directed toward the distal end side. Hold the grips 33a and 33b and close while pushing. Then, the distal end of the switch body 31a and the distal end of the switch body 31b open outward and the incision is pushed and expanded, while the distal end of the trocar inner needle 7 is penetrated from the incision into the body cavity. Thus, by using the switch 30, the ultrasonic trocar can be easily penetrated.
<Appendix>
The following configuration can be derived from the above-described embodiment and the like.
[0029]
[Additional Item 1]
In an ultrasonic trocar in which a trocar inner needle is inserted into a mantle tube, and the trocar inner needle is ultrasonically vibrated to puncture the abdominal cavity wall,
A tapered member provided between the outer tube and the trocar inner needle in a state of being separated from the outer tube and the trocar inner needle and having a distal end portion that continuously forms a sharp portion with the distal end of the trocar inner needle. Ultrasonic trocar characterized by providing.
[0030]
[Appendix 2]
The ultrasonic trocar according to claim 1, wherein the tapered member is a compliant member.
[Additional Item 3]
2. The ultrasonic trocar according to claim 1, wherein a ring-shaped compliant member is provided on the inner peripheral surface of the distal end side of the tapered member.
[0031]
[Additional Item 4]
2. The ultrasonic trocar according to claim 1, wherein a C-ring-shaped compliant member is fitted to the outer peripheral surface on the distal end side of the trocar inner needle so as to be bonded or replaceable.
[Additional Item 5]
The ultrasonic trocar according to item 1, wherein the inner needle of the trocar is a hollow material.
[0032]
[Additional Item 6]
In an ultrasonic trocar in which a trocar inner needle is inserted into a mantle tube, and the trocar inner needle is ultrasonically vibrated to puncture the abdominal cavity wall,
A tapered member provided between the outer tube and the trocar inner needle in a state of being separated from the outer tube and the trocar inner needle and having a distal end portion that continuously forms a sharp portion with the distal end of the trocar inner needle. Ultrasonic trocar characterized by providing.
[0033]
[Additional Item 7]
A trocar inner needle that punctures the abdominal cavity wall with the ultrasonically vibrated tip,
The trocar inner needle can be inserted and attached to a plurality of types of outer tube having different diameters, and the plurality of types of outer tube and the trocar inner needle are isolated from the outer tube and the trocar inner needle. A plurality of types of tapered members having a tip portion that continuously forms a sharp portion with the tip of the trocar inner needle;
An ultrasonic trocar system comprising:
[0034]
[Additional Item 8]
A trocar inner needle that punctures the abdominal cavity wall with the ultrasonically vibrated tip,
The trocar inner needle can be inserted and attached to a plurality of types of outer tube having different diameters, and the plurality of types of outer tube and the trocar inner needle are isolated from the outer tube and the trocar inner needle. A plurality of types of tapered members having a tip portion that continuously forms a sharp portion with the tip of the trocar inner needle;
An ultrasonic trocar system comprising:
[0035]
[Additional Item 9]
In an ultrasonic trocar system in which a trocar inner needle having a cutting edge for puncture at the tip is inserted into an outer tube, and the trocar inner needle is ultrasonically vibrated to puncture an incised portion that has been previously incised on the abdominal cavity wall ,
An ultrasonic trocar system comprising an incision portion opening / closing means capable of inserting the outer tube and provided with a member for expanding the incision portion at a distal end.
[0036]
【The invention's effect】
As described above, according to the present invention, even when an ultrasonic trocar having a relatively large diameter of 10 mm or more is pierced into the abdominal wall, only the inner needle of the trocar vibrates ultrasonically. There is no worry that the area of the burn will increase. In addition, since the sharpened portion is continuously formed by the tip of the tapered member and the tip of the trocar inner needle, even if only the trocar inner needle vibrates ultrasonically, the ultrasonic trocar can be easily drilled in the abdominal cavity wall. Can be entered.
[Brief description of the drawings]
FIG. 1 is a diagram showing an overall configuration of an ultrasonic trocar system according to a first embodiment of the present invention. FIG. 2 is a diagram showing a configuration of a proximal end portion of the ultrasonic trocar 1 according to the first embodiment. FIG. 3 is a diagram showing the internal structure of the handpiece 2 that is attached. FIG. 3 shows the handpiece 2, the outer tube 6, the tapered member 8a, and the trocar constituting the central portion of the ultrasonic trocar 1 according to the first embodiment. 4 is a cross-sectional view of the outer tube 6, the tapered member 8a, and the trocar inner needle 7a constituting the distal end portion of the ultrasonic trocar 1 according to the first embodiment. 5 is a sectional view of a tip portion of an ultrasonic trocar showing a second embodiment of the present invention. FIG. 6 is a sectional view of a tip portion of an ultrasonic trocar showing a third embodiment of the present invention. Cutting off the tip of an ultrasonic trocar according to another invention of the present invention FIG. 8 is a cross-sectional view of a trocar inner needle according to the other invention. FIG. 9 is a cross-sectional view of a trocar inner needle according to the other invention. FIG. 11 is a schematic view showing a switch 20 as an auxiliary tool for penetrating these into the body cavity wall. FIG. 11 is a schematic view showing another example of the switch 20 shown in FIG. Schematic diagram showing the container 30
DESCRIPTION OF SYMBOLS 1 Ultrasonic trocar 2 Handpiece 3 Ultrasonic oscillation apparatus 4 Output control apparatus 5 Joining member 6, 6a, 6b Outer tube 7, 7a, 7b, 7c, 7d Tracar inner needle 8a, 8b Tapered member 9 Ultrasonic vibrator 10 Horn 11 Groove 12 Groove 13 O-ring 14 O-ring 15a Obedient member 15b Obedient member 16 Body portion 17 Tip portion 20 Switch 21 Switch body 22 Opening auxiliary portion 23 Contact preventer 30 Switch 31a, 31b Switch body 32 Refracted Part 33a, 33b Grip part

Claims (1)

In an ultrasonic trocar in which a trocar inner needle is inserted into a mantle tube, and the trocar inner needle is ultrasonically vibrated to puncture the abdominal cavity wall,
A tapered member provided between the outer tube and the trocar inner needle in a state of being separated from the outer tube and the trocar inner needle and having a distal end portion that continuously forms a sharp portion with the distal end of the trocar inner needle. Ultrasonic trocar characterized by providing.

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