JP5554203B2 - Trocar - Google Patents

Description

  The present invention relates to a trocar used by inserting a distal end side into a patient's body.

  Some operations are performed by inserting an instrument such as an endoscope into the body cavity of a patient. In this case, a trocar (see Patent Document 1 below) is used as a guide tube for the insertion instrument, and the instrument is inserted into the body cavity through the trocar. When performing such an operation, it is common to secure a visual field (surgical field) by filling the body cavity with a gas using a trocar. However, instead of the gas, a liquid (eg, physiological saline) is put into the body cavity. A method of filling is also known (see Patent Document 2 below).

JP-A-6-189893 Japanese Patent No. 3316614

  Here, during surgery, it is very important to secure the field of view of the endoscope. However, if there is a lot of bleeding, blood stays and it is difficult to secure the necessary field of view. In order to solve such a problem, the trocar described in Patent Document 1 recirculates the reflux liquid to the front surface of the endoscope to remove clouding and dirt at the tip of the endoscope. However, this trocar is based on the premise that it is filled with gas, and when performing surgery with a liquid filled, blood remains in the vicinity of the bleeding site, so that surgery cannot be performed while securing a visual field. There was a problem. There is also a problem that effective suction is interrupted when an organ or the like is entangled in the opening of the liquid suction device.

  The present invention has been made in view of the above-described problems, and even when a surgical field is secured by filling a liquid, blood staying in the vicinity of the bleeding site is excluded, and the visual field of the endoscope is always secured. Another object of the present invention is to provide a trocar capable of continuing effective and continuous suction.

The present invention is a trocar used by inserting the distal end side into a patient's body, and is arranged concentrically so as to cover an inner tube having a central conduit serving as a passage of equipment and an outer periphery of the inner tube, An outer tube that forms an annular flow channel that opens from the inner tube to the inner tube, and the annular flow channel is divided into a discharge side chamber and a suction side chamber, and the longitudinal direction of the inner tube and the outer tube is defined in the annular flow channel. And a liquid inlet that communicates with the discharge side chamber and allows liquid to flow into the discharge side chamber, and a liquid outlet that communicates with the suction side chamber and allows liquid to flow out of the suction side chamber. released into the body fluid flowing from the inlet through the opening at the tip of the discharge side chamber, Nde write sucking liquid present in the body from the opening of the distal end of the suction-side chamber is discharged from the liquid outlet opening at the tip of the discharge side chamber Compared to the cross-sectional area of the discharge side chamber There is a nozzle formed is reduced, and wherein the opening area than the opening of the distal end of the suction-side chamber is small.

When the flow rate of the liquid discharged into the body from the opening at the tip of the discharge side chamber and the flow rate of the liquid existing in the body sucked from the opening at the tip of the suction side chamber are substantially equal, It is preferable that the flow velocity be larger than the flow velocity at the opening at the tip of the suction side chamber .

  The opening at the tip of the suction side chamber is preferably equal to or larger than the cross-sectional area of the suction side chamber.

  Moreover, it is preferable that the opening at the tip of the suction side chamber has an area five times or more than the opening at the tip of the discharge side chamber.

  According to the present invention, it is possible to eliminate blood that stays in the vicinity of the bleeding site and obstructs the visual field by the liquid flow discharged from the trocar, and it is possible to suck out liquid.

It is a figure which shows typically the front of the trocar of embodiment. It is a figure which shows the state which inserted the endoscope in the trocar of embodiment. It is a top view which shows the front-end | tip of the trocar of embodiment. It is a figure which shows the other structural example of a trocar tip. It is a figure which shows the further another structural example of a trocar tip. It is a figure which shows the example which replaced the inflow / outflow direction. It is a figure which shows typically the front of a modification. It is a top view of a modification.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

  1 and 3 show the configuration of the trocar according to the embodiment. FIG. 2 shows a state where the endoscope S is inserted into the trocar. FIG. 1 is a schematic view (front view) viewed from the side direction, showing a partial cross-section, and a portion where the liquid flows is drawn in gray. FIG. 3 is a schematic view (plan view) seen from above, and shows only the upper part. The scale has been changed from the actual scale so that the main part can be easily seen.

  The main body 10 has a cylindrical shape as a whole. In the lower part of the figure, a base 12 having a relatively large diameter is provided. At the time of surgery, the operator holds the base 12 and positions the main body 10. Further, other equipment may be fixed to the base 12.

  The upper part 14 of the main body 10 has a double pipe structure in which cylindrical pipes are arranged in a double concentric manner, and has a central pipe line 16 and an annular flow path 18. The central pipe line 16 is an internal hollow pipe line of the inner pipe 20 and penetrates the entire main body 10 including the base portion 12 and is open at both ends. Therefore, surgical instruments such as an endoscope can be taken in and out through the central conduit 16. The annular flow path 18 is formed in a space between the inner peripheral surface of the outer tube 22 and the outer peripheral surface of the inner tube 20.

  The annular flow path 18 is divided into a discharge side chamber 18a and a suction side chamber 18b by a pair of partition walls 24 extending in the longitudinal direction of the main body 10 shown in FIG. The annular channel 18 is open on the tip side, but is closed on the base 12 side. A liquid inflow pipe 26 communicating with the discharge side chamber 18a is disposed in the vicinity of the end of the annular flow path 18 of the main body 10 on the base 12 side. A connection portion of the liquid inflow pipe 26 with the discharge side chamber 18a constitutes a liquid inflow port 26a. On the other hand, a liquid outflow pipe 28 communicating with the suction side chamber 18b is arranged in the vicinity of the end of the annular flow path 18 on the opposite side of the liquid inflow pipe of the main body 10 in the vicinity of the base 12 side. A portion of the liquid outflow pipe 28 connected to the suction side chamber 18b constitutes a liquid outlet 28a. Further, a flange portion 26b for connection with a liquid supply source is provided at the tip of the liquid inflow tube 26, and a flange portion 28b for connection with a liquid suction source is provided at the tip of the liquid outflow tube 28. Yes.

  As shown in FIG. 3, the tip side of the discharge side chamber 18 a of the annular channel 18 is closed except for the small diameter nozzle 30, and the liquid supplied from the discharge side chamber 18 a is ejected from the nozzle 30. . On the other hand, the distal end side of the suction side chamber 18b is an opening 32 as it is, and liquid in the body is sucked from the opening. The opening 32 has a larger opening area than that of the nozzle 30, and preferably has an opening area that is five times or more. The pressure loss in the opening 32 is reduced, and effective liquid suction is possible. Note that if the area of the opening 32 is less than five times, the suction flow rate increases, the liquid is disturbed near the opening 32, and the flow of the liquid ejected from the nozzle 30 may be affected. Also from this surface, it is preferable that the area of the opening 32 is five times or more that of the nozzle 30. Note that if the area of the opening 32 is less than five times, the suction flow rate increases, the liquid is disturbed near the opening 32, and the flow of the liquid ejected from the nozzle 30 may be affected. Also from this surface, it is preferable that the area of the opening 32 is five times or more that of the nozzle 30.

  Further, the tip of the upper portion 14 of the main body 10 has an obliquely cut shape, and is easy to insert into the body through the skin. The angle of the slope is set to, for example, about 30 to 60 degrees with respect to the longitudinal direction of the main body. The number of nozzles may be plural. Examples of providing a plurality of nozzles are shown in FIGS.

In addition, since the upper part 14 of the main body 10 penetrates the skin and is inserted into the body, the outer diameter is a relatively small diameter of about 15 mm or less. On the other hand, when the central duct 16 becomes a passage of an endoscope (for example, a laparoscope inserted into the abdominal cavity), if the outer diameter of the endoscope is 10 mm, an inner diameter of about 11 mm is required. The inner diameter of the trocar is determined in conformity with the outer diameter of the endoscope to be used. In addition, as the material of the upper portion of the main body 10, a synthetic resin such as polyethylene terephthalate (PET) or polycarbonate is adopted.
Other materials may be used. In addition, the partition wall 24 supports the outer tube 22 and also functions as a reinforcing material for the upper portion 14. It is also preferable to reinforce by arranging a small cylindrical spacer extending in the radial direction in other portions as appropriate. The main body 10 has a length of about 10 to 30 cm as a whole.

  When such a trocar is used, the distal end side is inserted into the patient's body through the skin. For example, an appropriate position of the abdominal cavity is positioned, an endoscope (laparoscope) is inserted through the central duct 16, and an image of the affected area is displayed on the display. In addition, this image is used to perform an operation using an instrument such as an electric knife through another trocar.

  At this time, in order to secure a surgical field, a reflux fluid (for example, physiological saline) is introduced through the fluid inflow tube 26, the reflux fluid is ejected from the nozzle 30, and further, into the abdominal cavity through the opening 32. The refluxing liquid is sucked from. In addition, the inflow amount and the suction amount of the reflux liquid per unit time are made substantially equal, and thereby the pressure in the abdominal cavity is kept constant.

  As described above, since the area of the nozzle 30 (the total area when a plurality of nozzles are provided) is smaller than that of the opening 32, the flow rate of the reflux liquid from the nozzle 30 is set to be the reflux liquid from the suction opening 32. The suction speed of the endoscope is faster, and the blood flow discharged from the nozzle 30 eliminates blood that stays in the vicinity of the bleeding site and obstructs the visual field, so that the visual field of the endoscope can be maintained well.

  In addition, when the nozzle 30 is provided at the apex portion or near the apex portion of the tip slope of the upper portion 14 and the opening 32 is provided at the lower portion of the tip slope, the reflux liquid can be effectively supplied in front of the endoscope. It is possible to prevent the organ from adsorbing to the opening 32. The direction of inflow / outflow of the reflux liquid can be changed as shown in FIG. That is, a nozzle serving as a reflux liquid outlet can be provided at the lowermost part of the slope at the tip of the trocar or in the vicinity of the lowermost part, and an opening serving as a reflux liquid inlet can be provided above the slope at the front end.

  7 and 8 show a modified example in which the opening 32 is further enlarged. In this example, the partition wall 24 disposed in the annular flow path 18 is bent toward the discharge side chamber 18a on the tip side so that the cross-sectional area of the discharge side chamber 18a is reduced. In the drawing, only one of the pair of partition walls 24 is shown, but the other partition wall 24 is similarly bent toward the discharge side chamber 18a. As a result, the area of the opening 32 at the tip of the suction side chamber 18b is further expanded, and more effective liquid suction can be performed.

  In the description of the above embodiment, the case where the trocar is inserted into the abdominal cavity has been described. However, the present invention is not limited to this, and the present invention can be applied even when the trocar is inserted in another place in the body cavity.

  In the above embodiment, the case where the endoscope is inserted into the trocar has been described. However, the present invention is not limited to this case, even when a surgical instrument other than the endoscope is inserted, or when only the trocar is inserted into the body cavity. The present invention is applicable, and it is effective because the blood staying around the bleeding site can be eliminated by the water flow discharged from the nozzle 30.

  DESCRIPTION OF SYMBOLS 10 Main body, 12 base part, 14 upper part, 16 center pipe line, 18 annular flow path, 18a discharge side chamber, 18b suction side chamber, 20 inner side pipe, 22 outer side pipe, 24 partition wall, 26 liquid inflow pipe, 26a liquid inflow port, 26b Flange part, 28 liquid outflow pipe, 28a liquid outflow port, 28b flange part, 30 nozzle, 32 opening.

Claims (4)

A trocar used by inserting the tip side into the patient's body,
An inner tube having a central conduit that serves as a passage for the equipment;
An outer tube that is arranged concentrically so as to cover the outer periphery of the inner tube, and forms an annular channel that opens from the tip side to the inner tube;
Partitioning the annular flow path into a discharge side chamber and a suction side chamber, a partition facing the longitudinal direction of the inner pipe and the outer pipe in the annular flow path;
A liquid inlet that communicates with the discharge side chamber and allows liquid to flow into the discharge side chamber;
A liquid outlet that communicates with the suction side chamber and allows the liquid to flow out of the suction side chamber;
Have
Liquid flow liquid flowing in from the inlet and released into the body from the opening of the tip of the discharge side chamber, to discharge the liquid present in the body from the liquid outlet Nde write sucked from the opening of the distal end of the suction-side chamber,
The opening at the tip of the discharge side chamber is a nozzle formed with a reduced area compared to the cross-sectional area of the discharge side chamber, and the opening area is smaller than the opening at the tip of the suction side chamber . 2. The trocar according to claim 1, wherein the flow rate of the liquid discharged into the body from the opening at the tip of the discharge side chamber is substantially equal to the flow rate of the liquid present in the body sucked from the opening at the tip of the suction side chamber. Furthermore, the flow rate at the front end opening of the discharge side chamber is larger than the flow rate at the front end opening of the suction side chamber .   The trocar according to claim 1, wherein an opening at a tip of the suction side chamber is equal to or larger than a cross-sectional area of the suction side chamber.   4. The trocar according to claim 1, wherein an opening at a tip of the suction side chamber has an area five times or more as large as an opening at a tip of the discharge side chamber.

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