JP6644664B2 - Seal unit for trocar - Google Patents

Description

  The present invention is a patent application that is subject to the application of Article 19 of the Japan Medical Research and Development Agency, “Medical and Industrial Cooperation Business Promotion Project” entrusted research and the Industrial Technology Enhancement Act, Article 19 Related to a seal unit.

  BACKGROUND ART In the medical field, arthroscopic surgery such as laparoscopic surgery or thoracoscopic surgery is known as a minimally invasive surgical operation that does not require laparotomy. In arthroscopic surgery, in addition to a rigid endoscope for securing a visual field in a body cavity such as the abdominal cavity or the thoracic cavity, a treatment tool such as forceps, an electric scalpel, a stapler, or a treatment tool or a rigid endoscope is used. A trocar device is used as an insertion aid for insertion into the inside (see Patent Document 1).

  The trocar device includes a trocar having a pipe through which a treatment tool and the like can be inserted, and a trocar shaft mounted on the trocar when the pipe is inserted into a body cavity. When the trocar shaft is mounted on the trocar, the trocar shaft is inserted into the pipe portion, and the puncture portion at the tip of the trocar shaft is exposed from the tip of the pipe portion. When a trocar device is used, an incision is formed by partially incising the skin of the patient's abdomen or the like before inserting the trocar. When inserting the trocar, the trocar is inserted into the incision from the puncture portion of the trocar shaft. The pipe portion of the trocar is inserted following the puncture portion of the trocar shaft, and the pipe portion is inserted. When the pipe section is inserted, the trocar shaft is withdrawn from the trocar. The trocar is fixed with the pipe portion inserted into the body cavity, and is used as an insertion port for inserting a treatment tool or the like in this state.

  Further, in the arthroscopic surgery, a pneumoperitoneum treatment is performed in which a space necessary for performing a procedure is secured in a body cavity by injecting carbon dioxide into the abdominal cavity to expand the abdominal cavity. The trocar device is provided with a connection port to which an air supply pipe of a gas supply device that supplies carbon dioxide gas is connected. Further, the trocar device is provided with a seal unit so that carbon dioxide gas does not leak from the insufflated abdominal cavity when the treatment tool is inserted and removed.

  The seal unit has a seal for maintaining airtightness when a treatment tool or the like is inserted, and a protector for protecting the seal. Since the distal end of the treatment tool or the like comes into contact with the back surface of the seal when the treatment tool or the like is inserted, the protector is disposed on the base end side of the seal and protects the seal from abutment of the treatment tool or the like.

  In Patent Literature 1, the seal is configured by a plurality of seal segments, and is overlapped so as to be entirely circular so that a part of the adjacent seal segments overlap. Further, the protector is also composed of a plurality of protector segments, and is overlapped so as to form a circle as a whole so that a part of the adjacent protector segments overlap. Since the protector is intended to protect the seal, the protector covers the entire surface of the seal. Specifically, the protector segments are overlapped so as to overlap each other so that an opening through which the treatment tool is inserted is not formed in the central portion of the protector.

Japanese Patent No. 4727195

    However, the seal unit described in Patent Document 1 has the following problem. First, since the seal is formed by superposing a plurality of thin seal segments, if the treatment tool is inserted unless the seal is integrated with the protector, such as gas leakage from a gap between the segments, the seal may be damaged. There is a concern that performance will decrease.

  Secondly, since the seal is formed by overlapping the seal segments and is used integrally with the closely adhered protector, it is difficult to increase the flexibility of the entire seal and to obtain a good operation feeling. This is because, when the flexibility of each seal segment is increased for the overlap of the seal segments, the sealing performance is further reduced in a state where the treatment tool is inserted as described as the first problem. is there.

  Third, a protector in which protector segments are overlapped with each other at the base end side of the seal so that an opening is not formed at the center is arranged, and the protector covers the entire rear surface of the seal. Therefore, since there is no opening at the center of the protector at the position corresponding to the opening of the center of the seal, if the balance of each segment of the protector is poor, when inserting the treatment tool, guide the distal end of the treatment tool into the opening of the seal. Hard to do.

The trocar seal unit of the present invention is built in a trocar into which a treatment tool is inserted, and seals and centers the trocar seal unit for maintaining the airtightness of the inside of the trocar in communication with the body cavity when the treatment tool is inserted. With a guide. The seal is made of a single elastically deformable material having a circular planar shape, and has an opening at the center in the radial direction for inserting the treatment instrument. The centering guide is arranged on the base end side of the seal in the axial direction of the trocar, and guides the treatment instrument to the center position in the radial direction. The centering guide is composed of a plurality of segments, and the plurality of segments are overlapped so that a part of the adjacent segment overlaps, so that the planar shape is a circle as a whole , and a convex shape is formed on the tip side. A dome shape , and the material of the plurality of segments is higher in hardness than the seal, and further, in a state where the plurality of segments are overlapped, an opening is formed at a radial center, and the segments are formed. , A fan-shaped portion forming a dome shape, and an overlapping region in which each adjacent segment overlaps, and the overlapping region is an outer periphery of the centering guide in a width direction orthogonal to a boundary line between the fan-shaped portion and the overlapping region. And the width of the overlap increases monotonously from the central opening .

  The trocar seal unit of the present invention is built in a trocar into which a treatment tool is inserted, and seals and centers the trocar seal unit for maintaining the airtightness of the inside of the trocar in communication with the body cavity when the treatment tool is inserted. With a guide. The seal is made of a single material having a circular planar shape, and has an opening formed at the center in the radial direction for inserting the treatment instrument. The centering guide is arranged on the base end side of the seal in the axial direction of the trocar, and guides the treatment instrument to the center position in the radial direction. The centering guide is composed of a plurality of segments, and the plurality of segments are overlapped so that a part of the adjacent segments overlap with each other, so that the planar shape has a circular shape as a whole, and The material of the segment is higher in hardness than the seal, and further, an opening is formed at the center in the radial direction when the plurality of segments are overlapped.

Preferably, the length of the arc of the sector is one fourth of the circumference of the centering guide.

When the treatment tool is not inserted through the trocar, the opening of the seal and the opening of the centering guide preferably have the same diameter.

  It is preferable that the area of an overlapping region, which is a portion where the adjacent segments overlap, is equal to or less than half of each segment.

In each of the plurality of segments, a cutout portion that cuts out the center of the arc of the fan-shaped portion and that forms a part of the opening is formed, and the side of the overlap region on the opening side is cutout. Preferably, it is connected smoothly to the notch.

  A rubber cover for integrally holding the seal and the centering guide is provided.The rubber cover is disposed between the inner flange to which the outer peripheral portion of the seal and the centering guide is fixed, and between the inner flange and the outer peripheral portion of the rubber cover, It is preferable to have a bellows portion that allows radial movement of the seal and the centering guide by elastic deformation.

  The hardness of the centering guide is higher than that of the rubber cover in addition to the seal, and the resistance when expanding the opening of the centering guide is the resistance when expanding the opening of the seal and the bellows of the rubber cover are elastically deformed. It is preferable that the resistance is larger than the resistance force at the time of making.

  The seal is preferably formed of silicone rubber having a JIS A hardness of 30 as measured by a durometer, and the centering guide is preferably formed of polyurethane having a JIS A hardness of 90 as measured by a durometer.

  ADVANTAGE OF THE INVENTION According to this invention, in the sealing unit for trocars, the sealing performance can be improved, and it is possible to easily guide the trocar to the center opening position of the seal when the treatment tool is inserted.

It is a schematic diagram of a laparoscopic system. It is sectional drawing in the abdominal cavity in the state where the trocar was inserted. It is an external appearance perspective view of the trocar apparatus with a camera in the state where the camera part was stored. 1 is an external perspective view of a trocar device with a camera in a state where a camera unit is expanded. It is an exploded perspective view in the state where a trocar shaft was removed from a trocar with a camera. FIG. 4 is an exploded perspective view of the camera-equipped trocar disassembled into an inner cylinder member and an outer cylinder member. It is an exploded perspective view of a trocar with a camera. It is a front view of a trocar shaft. FIG. 3 is an enlarged view of a distal end portion of the camera-equipped trocar in a state where the camera unit is stored. FIG. 3 is an enlarged view of a distal end portion of the camera-equipped trocar in a state where the camera unit is stored. FIG. 3 is an explanatory diagram of a deployment mechanism of a camera unit. FIG. 4 is an explanatory diagram of a deployment mechanism when the camera unit is viewed from the back. It is a side view of the trocar apparatus with a camera in the state where the camera part was stored. FIG. 2 is a side view of the trocar device with a camera in a state where a camera unit is expanded. It is sectional drawing of the trocar apparatus with a camera in the state which stored the camera part. It is sectional drawing of the trocar apparatus with a camera in the state which expanded the camera part. It is explanatory drawing of a cam groove. FIG. 4 is an explanatory diagram of a deployment assist mechanism in a state where a trocar shaft is at an initial position. FIG. 7 is an explanatory diagram of the deployment assist mechanism in a state where the trocar shaft has started contacting the camera unit. FIG. 5 is an explanatory diagram of the deployment assist mechanism in a state where the trocar shaft is at a terminal position. It is explanatory drawing which shows the positional relationship of the press part of a trocar shaft, and a camera part. It is a rear perspective view of the press part of a trocar shaft. FIG. 3 is an exploded perspective view showing an outer cylinder lock mechanism. It is a 1st explanatory view of the assembling method of a lock release operation member. It is a 2nd explanatory view of the assembling method of a lock release operation member. It is the 3rd explanatory view of the assembling method of the lock release operation member. It is explanatory drawing of the lock release operation member in the state in which the outer cylinder was in the holding position. It is explanatory drawing of the lock release operation member of the state which released the lock of the outer cylinder. It is explanatory drawing of the lock release operation member in the state where the outer cylinder was in the holding release position. It is an enlarged view of the hinge part in the state where the camera part was expanded. It is an enlarged view of the hinge part in the state where the camera part was stored. FIG. 4 is a first explanatory view of a method of attaching a camera unit. FIG. 9 is a second explanatory view of a method of attaching the camera unit. It is the 3rd explanatory view of the attaching method of the camera section. It is an enlarged view which shows the positional relationship of the projection part of a puncture part, and a camera part. It is a front view of the pipe part in the state where the camera part was stored, and the ridge part of the puncture part. It is a front view of the pipe part in the state where the camera part was developed, and the ridge part of the puncture part. It is a side view which shows the winding of fat around a camera part. It is a top view which shows the winding of fat around a camera part. It is explanatory drawing which shows the modification of a ridge part. It is a rear perspective view of an airtight structure unit. It is an exploded perspective view of an airtight structure unit. FIG. 3 is an exploded perspective view (cross-sectional view) of the airtight structure unit. It is a perspective view of a dome type seal and a centering guide. It is sectional drawing of the head part in which the airtight structure unit was accommodated. It is a rear view of a centering guide. It is explanatory drawing of the segment of a centering guide. It is a rear view of the seal unit in the state where the treatment tool was inserted. It is a rear view of the seal unit in the state where the inserted treatment tool moved in the radial direction.

[First Embodiment]
[Overall configuration of laparoscope system]
The laparoscopic system 10, which is an example of the in-vivo observation system shown in FIG. 1, is used by a medical staff ST including a doctor to observe the inside of the body cavity (more specifically, the abdominal cavity) of the patient P during laparoscopic surgery. Used for The laparoscope system 10 includes an endoscope system and a trocar device 12 with a camera according to the present invention. The endoscope system includes an endoscope 11, a processor 18, a monitor 19, and a console 20. The camera-equipped trocar device 12 includes a camera-equipped trocar 16 and a trocar shaft 17 (see FIG. 5).

  The trocar 16 with a camera is obtained by adding a camera function to a trocar which is an insertion instrument used as an insertion port for inserting a treatment tool 22 such as forceps into a body cavity.

  The processor 18 executes image processing on each of an endoscopic image of the abdominal cavity taken by the endoscope 11 and a trocar image of the abdominal cavity taken by the camera of the camera-equipped trocar 16. The processor 18 has an image synthesizing function for synthesizing an endoscope image and each trocar image. As shown in FIG. 1, a composite image of the endoscopic image and the trocar image is displayed on the monitor 19 of the processor 18. The visual field in the abdominal cavity is provided to the medical staff ST by such a composite image. Note that, instead of or in addition to displaying the composite image, the endoscope image and the trocar image may be displayed in independent display windows.

  As shown in FIG. 2, the endoscope 11 is inserted through the trocar 21 into the abdominal cavity of the patient P. The trocar 21 for the endoscope 11 is a normal trocar without a camera, unlike the trocar 16 with a camera. The trocar 21 is an insertion device used as an insertion port for inserting the endoscope 11 into the abdominal cavity. The trocar 21 has a substantially cylindrical pipe portion and a head portion provided on the base end side of the pipe portion and having a larger diameter than the pipe portion. An insertion hole penetrating the inside of the trocar 21 in the axial direction is provided in the pipe portion, and the endoscope 11 is inserted into the insertion hole.

  In laparoscopic surgery, when the trocars 21 and 16 are inserted into the abdominal cavity, the skin of the abdominal wall 23 of the patient P is incised with a scalpel to form incisions 26 and 27. The abdominal wall 23 is formed of skin, subcutaneous tissue such as fat 23A (see FIGS. 24A and 24B), and muscle tissue. In this example, since one trocar 21 for the endoscope 11 and two trocars 16 with two cameras are used in total, the number of the incisions 26 and 27 is one incision for the endoscope 11. There are a total of three parts 26 and two incisions 27 for the treatment tool 22. Regarding the positions of the three incisions 26, 27, for example, the incision 26 for the treatment tool 22 is provided on the left and right of the incision 26 for the endoscope 11 at the center. Note that the number and position of the incisions 26 and 27 in this example are merely examples, and are appropriately determined according to the target site of the operation, the number of treatment tools to be used, and the like.

  The trocar 21 is inserted into the incision 26 and fixed to the abdominal wall 23. The camera-equipped trocar 16 is inserted into each of the two incisions 27 and fixed to the abdominal wall 23. As a result, the trocar 21 can be used as an insertion port for the endoscope 11, and the trocar 16 with camera can be used as an insertion port for the treatment tool 22.

  As shown on the screen of the monitor 19 in FIG. 1, the endoscope 11 inserted into the central trocar 21 provides a bird's-eye view of the entire region to be treated in the abdominal cavity, and is located on both sides of the endoscope 11. The camera-equipped trocar 16 provides a visual field around the distal end portion 22A of the treatment instrument 22.

  As shown in FIG. 2, at the time of laparoscopic surgery, a pneumoperitoneum treatment for expanding the abdominal cavity by injecting carbon dioxide into the abdominal cavity is performed. The pneumoperitoneum treatment secures a space for performing the treatment in the abdominal cavity. The normal trocar 21 and the camera-equipped trocar 16 are provided with a connection port (see FIGS. 3 and 4 for the connection port 49 of the camera-equipped trocar 16) to which an air supply pipe of a gas supply device (not shown) is connected. ing. The carbon dioxide gas supplied from the gas supply device is injected into the abdominal cavity through the trocar 21 and the camera-equipped trocar 16.

  As described above, insufflation is performed in laparoscopic surgery, so that the trocar 21 and the camera-equipped trocar 16 seal the insertion holes in an airtight manner to prevent gas leakage from the inside of the body cavity to the outside of the body cavity through the respective insertion holes. It has an airtight structure for sealing. The airtight structure of the camera-equipped trocar 16 will be described later in detail.

[Schematic configuration of endoscope]
As shown in FIG. 2, the endoscope 11 is, for example, a rigid endoscope in which the insertion portion 11A is formed of a hard member such as a metal. At the distal end of the insertion portion 11A, there are provided an illumination window for irradiating illumination light to a subject (such as a viscera) in the abdominal cavity, and a camera unit 28 for receiving the light reflected by the subject and photographing the subject. . As is well known, the camera unit 28 includes an image sensor (not shown) that photoelectrically converts received light, such as a CCD (Charge-Coupled Device) image sensor or a CMOS (Complementary metal-oxide-semiconductor) image sensor. A photographing lens (not shown) for forming an optical image of a subject on an imaging surface of the element.

  The image sensor is, for example, a color image sensor, and outputs a captured image as three color image signals of R (Red), G (Green), and B (Blue). The imaging device is capable of capturing a moving image and outputs an image signal at a predetermined frame rate. The image signals are sequentially output to the processor 18 via signal lines.

  A signal line, a light guide, and the like are provided in the insertion portion 11A. The light guide guides illumination light supplied from a light source device (not shown) to the illumination window. At the base end of the endoscope 11, one end of a universal cable (not shown) in which a signal line and a light guide are arranged is provided. At the other end of the universal cable, a connector for connecting the light guide to the light source device and a connector for connecting the signal line to the processor 18 are provided. The endoscope 11 is connected to the light source device and the processor 18 via a universal cable.

[Overall configuration of trocar device with camera]
As shown in FIGS. 3 to 7, the camera-equipped trocar device 12 includes a camera-equipped trocar 16 and a trocar shaft 17. A trocar shaft 17 is detachably attached to the trocar 16 with a camera. The camera-equipped trocar 16 includes a cylindrical pipe part 31 and a head part 32 provided at a base end of the pipe part 31. The head 32 has a substantially cylindrical shape with a larger diameter than the pipe 31. The camera-equipped trocar 16 is provided with an insertion hole 33 that penetrates the inside of the pipe portion 31 in the axial direction (Z-axis direction) and through which the treatment tool 22 and the like are inserted.

[Schematic configuration of trocar with camera]
As shown in FIG. 6, the camera-equipped trocar 16 has a double structure in which a main part is constituted by an inner cylinder member 16A and an outer cylinder member 16B, and most of the inner cylinder member 16A is included in the outer cylinder member 16B. It has become. The inner tube member 16A includes a pipe portion inner tube 31A and a head portion inner tube 32A provided on the base end side of the pipe portion inner tube 31A. The pipe inner tube 31A and the head inner tube 32A are made of, for example, resin, and both are integrally formed. The outer tube member 16B includes a pipe portion outer tube 31B and a head portion outer tube 32B provided on the base end side of the pipe portion outer tube 31B. In this example, the pipe outer cylinder 31B and the head outer cylinder 32B are made of, for example, resin, and both are integrally formed.

  The retractable (retractable) camera section 36 is provided at the distal end of the pipe section inner cylinder 31A. As shown in FIG. 3, the camera unit 36 pops up and expands in a storage position where the camera unit 36 is stored inside the pipe unit inner tube 31A, and as shown in FIG. 4, in a direction protruding from the outer peripheral surface of the pipe unit inner tube 31A. It is provided so as to be displaceable between a deployed position. The inner cylinder member 16A and the outer cylinder member 16B are relatively slidably provided along the axial direction (Z-axis direction). As will be described later, the camera unit 36 is deployed and stored by sliding the pipe outer tube 31B with respect to the pipe inner tube 31A.

  A non-slip 41 is formed on the outer peripheral surface of the pipe outer cylinder 31B. The non-slip 41 is for fixing the pipe portion 31 to the abdominal wall 23 at a desired insertion position. The non-slip 41 is configured such that a plurality of irregularities formed in a circumferential direction around the Z-axis are arranged in the Z-axis direction on the outer peripheral surface of the pipe portion outer cylinder 31B. The anti-slip 41 has a higher coefficient of friction than a portion having no irregularities. The non-slip 41 is formed over substantially the entire length of the pipe outer cylinder 31B in the Z-axis direction. Therefore, the slip stopper 41 and the abdominal wall 23 can be engaged at any position in the Z-axis direction of the pipe outer cylinder 31B. By this engagement, the pipe outer cylinder 31B can be fixed to the abdominal wall 23 at a desired insertion depth.

  As shown in FIGS. 6 and 7, the main part of the head part 32 is composed of a head part inner cylinder 32A and a head part outer cylinder 32B. As shown in FIG. 7, the camera-equipped trocar 16 has a built-in airtight structure unit 42, and the airtight structure unit 42 is accommodated in the head inner tube 32A. A rear cover 43 that covers an opening on the base end side is attached to the base end of the head inner cylinder 32A. The head inner tube 32A is provided with a connection port 49 (see also FIGS. 3 and 4) to which a gas supply device is connected. As described above, carbon dioxide is injected into the abdominal cavity through the connection port 49, and an insufflation treatment is performed. The airtight structure unit 42 has a function of preventing gas leakage from inside the abdominal cavity to outside the body.

  The head section 32 is provided with a connector section 44. The connector section 44 is a connector for connecting a communication cable (not shown) for electrically connecting to the processor 18. The connector portion 44 is provided on the rear cover 43. When the rear cover 43 is attached to the head portion inner cylinder 32A, the connector portion 44 is disposed at a position facing the outer peripheral surface of the head portion 32. The connector section 44 is electrically connected to the camera section 36 via a flexible cable (not shown) provided in a gap between the inner cylinder member 16A and the outer cylinder member 16B. The connector unit 44 relays an image signal from the camera unit 36 to the processor 18 and relays a control signal from the processor 18 to the camera unit 36.

  An opening 43 </ b> E for inserting the trocar shaft 17 and the treatment tool 22 is formed on the rear surface of the rear cover 43. Further, a grip portion 43D formed of a plurality of irregularities is formed on the outer peripheral surface of the rear cover 43 in the circumferential direction around the Z axis. The grip portion 43D functions as a non-slip when the head portion inner cylinder 32A is gripped and operated.

  Further, four engagement holes 43A are formed on the outer peripheral surface of the rear cover 43 at intervals of about 90 ° in the circumferential direction. Engagement claws 35 that engage with the respective engagement holes 43A are formed on the outer peripheral surface of the head portion inner cylinder 32A. The rear cover 43 is mounted on the head inner cylinder 32A by the engagement between the engagement holes 43A and the engagement claws 35.

  Slots 43F, which are grooves extending in the Z-axis direction, are formed on both sides of each engagement hole 43A. Thus, a portion of the rear cover 43 where the engagement hole 43A is formed can be elastically deformed. When the engagement hole 43A is engaged with the engagement claw 35, the portion where the engagement hole 43A is formed is elastically deformed radially outward so as to ride on the engagement claw 35. The formation of the slit 43F facilitates the engagement between the engagement hole 43A and the engagement claw 35.

  A fitting groove 43 </ b> B extending in an arc shape in the circumferential direction is formed in a base end portion of the rear cover 43. The fitting groove 43B is fitted with a fitting claw 54A (see FIG. 6) provided on the handle portion 54 of the trocar shaft 17. By fitting the fitting groove 43B and the fitting claw 54A, the trocar shaft 17 is mounted on the head inner cylinder 32A as shown in FIGS.

  As shown in FIGS. 6 and 7, a notch 43C is formed in a part of the fitting groove 43B, and the fitting claw 54A is inserted into the fitting groove 43B from the notch 43C and inserted. From the position, the handle portion 54 is rotated around the axis and fitted. The fitting completion position corresponds to an initial position (see FIGS. 12A, 13A, and 3) of the trocar shaft 17 described later.

  A lock release operation member 46 is disposed on the outer peripheral surface of the head outer cylinder 32B. The lock release operation member 46 is an operation unit for releasing an outer cylinder lock mechanism that locks sliding of the outer cylinder member 16B with respect to the inner cylinder member 16A. As will be described later, the lock release operation member 46 is a component of the outer cylinder lock mechanism together with the engaging portion 47 provided on the outer peripheral surface of the head inner cylinder 32A. The engaging portions 47 are provided on the outer peripheral surface of the head inner tube 32A, and are disposed at two positions at positions facing each other in the circumferential direction around the axis of the outer peripheral surface, that is, at two positions at approximately 180 ° intervals in the circumferential direction. I have.

  The unlocking operation member 46 is disposed at a position facing two engagement portions 47 in the circumferential direction around the Z axis of the head outer cylinder 32B. The unlocking operation is performed by simultaneously operating the two unlocking operation members 46 arranged opposite to each other so as to be sandwiched by hand. When the lock release operation is performed, the outer cylinder member 16B becomes slidable with respect to the inner cylinder member 16A.

  The head outer cylinder 32B is provided with a cam plate 51 extending further rearward from the base end. A cam groove 52 is formed on the outer peripheral surface of the cam plate 51. The cam plates 51 are arranged at two positions facing each other in the circumferential direction of the head outer cylinder 32B, that is, at approximately 180 ° intervals in the circumferential direction. The cam plate 51 is engaged with the handle portion 54 (see FIG. 6) of the trocar shaft 17 to change the rotation of the trocar shaft 17 around the axis to slide the outer cylinder member 16B in the Z-axis direction. As will be described in detail later, the rotation of the trocar shaft 17 causes the head unit outer cylinder 32B to slide, and the camera unit 36 is deployed and stored.

[Schematic configuration of trocar shaft]
As shown in FIGS. 3 and 4, the trocar shaft 17 is mounted on the camera-equipped trocar 16 when inserting the pipe portion 31 into a body cavity. In FIG. 5 showing a state where the trocar shaft 17 is removed from the trocar 16 with a camera, the trocar shaft 17 includes a shaft portion 53 and a handle portion 54 provided at a base end of the shaft portion 53 and having a larger diameter than the shaft portion 53. ing. A puncturing section 55 is provided at the tip of the shaft section 53. When the trocar shaft 17 is mounted on the camera-equipped trocar 16, the shaft portion 53 is inserted into the insertion hole 33 of the pipe portion 31. In this state, as shown in FIG. 3, the shaft portion 53 penetrates the insertion hole 33, and the puncture portion 55 projects from the tip of the pipe portion 31 and is exposed to the outside.

  As shown in FIG. 3, puncturing section 55 has a tapered shape in which the outer diameter around the Z axis is smallest at the distal end and gradually increases toward the proximal end side. In this example, the shape of the puncture portion 55 is a shell shape in which the contour line indicating the outer peripheral surface is a curve in a vertical cross section (YZ cross section) cut along the Z-axis direction. In the longitudinal section, a conical shape in which the contour indicating the outer peripheral surface is a straight line may be used. When the camera-equipped trocar 16 is inserted into the body cavity, the trocar 16 is punctured from the puncture portion 55 into the incision portion 27 (see FIG. 2). Then, the incision portion 27 is pushed and spread by the puncture portion 55, and the pipe portion 31 behind the puncture portion 55 is inserted into the pushed and opened incision portion 27.

  As shown in FIG. 5, the shaft portion 53 has a puncture portion 55, a shaft portion main body 56, and a connecting portion 57. The connecting portion 57 connects the puncturing portion 55 and the shaft portion main body 56. The maximum diameter of the puncture portion 55 and the maximum diameter of the shaft portion main body 56 are substantially equal, and the cross-sectional area of a cross section (XY cross section) orthogonal to the Z-axis direction is substantially equal. On the other hand, in the cross section (X-Y cross section) of the shaft portion 53, the cross-sectional area of the connecting portion 57 is formed smaller than the cross-sectional areas of the puncture portion 55 and the shaft portion main body 56. The connecting portion 57 is arranged so as to be offset from the central axis of the shaft portion 53. Specifically, the connecting portion 57 is offset and disposed in a direction away from the storage position of the camera portion 36.

  With the trocar shaft 17 mounted, the camera unit 36 is located behind the puncture unit 55. When inserting the pipe section 31 into the body cavity, the camera section 36 is stored in the pipe section 31. The connecting portion 57 is provided to secure a space for storing the camera portion 36 behind the puncture portion 55 when the trocar shaft 17 is mounted on the trocar 16 with a camera.

  The handle portion 54 is gripped when the trocar shaft 17 is mounted on the trocar 16 with a camera, pulled out, or rotated in the inserted state. On the outer peripheral surface of the handle portion 54, two pin arrangement plates 58 are provided. The pin disposing plate 58 extends to the distal end side where the puncturing portion 55 is located, and a cam pin 59 that engages with the cam groove 52 of the head outer cylinder 32B is provided on an inner peripheral surface 58C facing the cam plate 51. ing. The two pin arranging plates 58 are provided at two positions corresponding to the positions of the two cam plates 51 in the circumferential direction around the Z axis of the handle portion 54, that is, at two positions at approximately 180 ° intervals in the circumferential direction. Are located.

  More specifically, the two pin arrangement plates 58 are devised in the following shape in consideration of moldability by a mold.

  As shown in FIG. 8, the two pin arrangement plates 58 are provided such that the cam pins 59 are arranged at 180 ° intervals in the circumferential direction around the Z axis. The two pin disposition plates 58 are extended portions in which the cam pins 59 are disposed on one end side of the pin disposition plate 58 and extend in a direction orthogonal to a coupling line Lp connecting the two cam pins 59 opposed to each other. 58E. The coupling line LP coincides with the direction in which the cam pins 59 protrude.

  Further, the extension portion 58E is formed in a direction that is point-symmetric with respect to the rotation center O of the trocar shaft 17. That is, in FIG. 8, the extension 58E of the right pin arrangement plate 58 extends downward from the position of the cam pin 59, and conversely, the extension 58E of the left pin arrangement plate 58 extends from the position of the cam pin 59. It extends upward.

  The cross section of the pin disposition plate 58, which is orthogonal to the Z axis of the trocar shaft 17, has a wedge shape in which the thickness on the cam pin 59 side is large and the thickness becomes thinner as the distance from the cam pin 59 increases in the extension 58E. An inner peripheral surface 58C of the pin disposing plate 58 is formed by a plane extending in a direction orthogonal to the coupling line Lp of the cam pin 59, and an outer peripheral surface 58D of the pin disposing plate 58 has a part of the cross-sectional shape. , And a curved surface having a portion that overlaps the arc shape of a circle centered on the rotation center O (for example, a concentric circle of the outer peripheral surface of the pipe portion 31).

  By forming the pin arranging plate 58 in such an arrangement and shape, moldability by a mold is good. This is because, for example, when using a mold that is divided into two above and below the joining line Lp, the direction in which the two molds are removed after molding is the vertical direction orthogonal to the joining line Lp. In this case, if the inner peripheral surface 58C of the pin disposing plate 58 is formed as a plane extending in a direction orthogonal to the coupling line Lp, the two dies can be extracted vertically.

  The cross-sectional shape of the pin disposing plate 59 is a wedge shape in which the thickness on the cam pin 59 side is large, and the extension portion 58E becomes thinner as the distance from the cam pin 59 increases, and the outer peripheral surface 58D has a cross-sectional shape. A part of the shape is formed as a curved surface having a portion overlapping with the arc shape of the circle centered on the rotation center. That is, the shape of the cross section of the pin disposition plate 59 becomes thinner along the direction in which the mold is removed, and thus does not hinder the removal of the mold. Thereby, good formability of the pin arrangement plate 58 is ensured.

[Camera unit and deployment mechanism]
As shown in FIGS. 9A, 9B and 10, the camera section 36 is provided in a cutout 61 formed at the tip of the pipe section inner tube 31A. The camera unit 36 includes a camera unit 62, a mount 63, and a housing 64. The camera unit 62 includes an image sensor such as a CCD image sensor or a CMOS image sensor and a shooting lens 62A, similarly to the camera unit 28 of the endoscope 11. Further, the camera unit 62 may be provided with an illuminating unit (not shown) including a light emitting element such as an LED (Light Emitting Diode) on both sides of a lens barrel 62B having a photographing lens 62A.

  The camera unit 62 is communicably connected to the connector 44 provided on the head 32 by a flexible cable (not shown). Communication of an image signal output from the camera unit 62 and a control signal transmitted from the processor 18 are performed between the camera unit 62 and the processor 18 via the flexible cable and the connector unit 44. Although not shown, one end of the flexible cable is connected to the base end side of the camera unit 36, is disposed in a gap between the pipe inner tube 31 </ b> A and the pipe outer tube 31 </ b> B, and the other end is connected to the connector 44. It is extended.

  The camera unit 62 is attached to a housing 64 via a mount 63. Here, when the pipe portion 31 is viewed straight from the front end side in the Z-axis direction, the position where the notch portion 61 and the camera portion 36 are arranged is set above the pipe portion 31. The housing 64 has a shape surrounding the upper side and both side edges in the width direction of the camera unit 62, and has an upper surface portion 64A covering the upper side and a side surface portion 64B covering each of both side surfaces.

  The upper surface portion 64A has a shape corresponding to the shape of the cutout portion 61 of the pipe portion 31, and the outer peripheral surface is formed by a curved surface according to the outer diameter of the pipe portion 31. Thereby, as shown in FIG. 9A, when the camera unit 36 is at the storage position, the housing 64 is fitted into the notch 61 and forms a part of the upper surface of the pipe unit 31.

  The camera section 36 is provided rotatably between a storage position and a deployed position with the base end side as a fulcrum. As shown in FIG. 10, a pair of left and right rotation pins 65 is provided on the outer surface of each side surface portion 64B located at both ends of the camera portion 36. Each rotation pin 65 protrudes outward from each of both ends of the camera section 36 in the width direction of the camera section 36. The rotation pin 65 forms a rotation axis of the camera unit 36. At the base end side of the inner periphery of the notch 61, a bearing 67 for rotatably supporting each rotation pin 65 is provided. Here, the pivot pins 65 provided on each side surface 64B at both ends of the camera portion 36 and the bearing portions 67 provided on the inner periphery of the cutout portion 61 constitute hinge portions provided at both ends of the camera portion 36. I do.

  The camera section 36 is displaceably held by the action of the hinge section. Specifically, the camera unit 36 is rotated from the storage position illustrated in FIG. 9A around the rotation pin 65 on the base end side, and is deployed so as to jump up on the distal end side as illustrated in FIG. 9B. I do. In the deployed position shown in FIG. 9B, the photographing lens 62A is arranged so as to face the distal end so that the treatment tool 22 protruding from the insertion hole 33 can be photographed.

  As shown in FIGS. 10 and 11, a spring 71 is attached to the camera unit 36 and is urged to the deployed position by the spring 71. The spring 71 is, for example, a coil spring, and two springs are used. A hook 64 </ b> C to which one end of a spring 71 is attached is provided at a base end of the housing 64. The pipe inner tube 31 </ b> A is provided at the base end side of the notch 61 with two housing recesses 72 for housing the two springs 71, respectively. The two housing recesses 72 are formed so that their longitudinal directions coincide with the Z-axis direction, and are arranged in parallel. The groove of the housing recess 72 is formed at a depth such that the spring 71 does not protrude from the outer diameter of the pipe inner tube 31A when the spring 71 is housed. This prevents the spring 71 from interfering with the inner peripheral surface of the pipe outer cylinder 31B that slides with respect to the pipe inner cylinder 31A.

  Further, each accommodation recess 72 is provided with a hook 72A to which the other end of the spring 71 is attached. The spring 71 is attached to the hook 64C and the hook 72A, respectively, in a state where the spring 71 is longer than a natural length to which no external force is applied. Therefore, when the spring 71 is attached to the hook 64C and the hook 72A, the spring 71 generates an urging force in a contracting direction. Since the hook 64C provided at the base end of the camera section 36 is located above the pivot pin 65, the hook 64C is pulled to the base end side by the biasing force in the contraction direction generated by the spring 71. Due to this pulling, a rotational force acts on the camera section 36 with the rotation pin 65 as a fulcrum toward the deployed position, and the camera section 36 is urged toward the deployed position.

  As shown in FIGS. 12A and 12B and FIGS. 13A and 13B, the deployment and storage of the camera unit 36 are performed by a sliding operation of the pipe outer tube 31B. As shown in FIGS. 12A and 13A, the pipe portion outer cylinder 31B retracts further from the holding position to hold the camera portion 36 in the storage position, and as shown in FIGS. 12B and 13B, Slide along the axial direction between the holding release position where the holding is released.

  As described above, the camera unit 36 is urged by the spring 71 toward the deployed position. As shown in FIG. 12A and FIG. 13A, in the holding position, the distal end of the pipe outer cylinder 31B covers the rear part of the camera unit 36 in the holding position. As a result, the pipe outer cylinder 31B restricts the deployment of the camera unit 36 against the urging force of the spring 71, and holds the camera unit 36 in the storage position. 13A, when the trocar shaft 17 is mounted on the trocar 16 with a camera, the camera section 36 is stored in the storage space formed by the connecting section 57 at the storage position.

  On the other hand, when the pipe part outer cylinder 31B slides to the holding release position shown in FIGS. 12B and 13B, the distal end of the pipe part outer cylinder 31B retracts from the rear part of the camera unit 36. Thereby, the holding of the pipe portion outer cylinder 31B with respect to the camera portion 36 is released. When the holding is released, the camera unit 36 pops up and expands by the bias of the spring 71.

  In this example, the outer cylinder member 16B having the pipe outer cylinder 31B corresponds to the holding member. The spring 71 and the outer cylinder member 16B constitute a deployment mechanism that releases the holding of the camera unit 36 by the release operation of the outer cylinder member 16B, and pops up and deploys the camera unit to the deployment position.

[Operation mechanism for expanding and storing the camera unit]
As shown in FIGS. 12A and 12B, the sliding operation of the pipe outer cylinder 31B is performed by a rotating operation of the trocar shaft 17 around the axis. As described above, the cam plate 51 provided with the cam groove 52 is provided in the head outer cylinder 32B of the outer cylinder member 16B. The cam groove 52 engages with a cam pin 59 (see FIG. 5) provided on the trocar shaft 17. The cam groove 52 and the cam pin 59 constitute an operation mechanism for sliding the pipe outer cylinder 31B toward the base end by rotating the trocar shaft 17.

  As shown in FIG. 14, the outer peripheral surface of the cam plate 51 has a curved surface in accordance with the curvature of the head outer cylinder 32B (see also FIGS. 3 and 4). The cam groove 52 has an inclined portion 52E that is inclined with respect to the axial direction, and a position in the Z-axis direction is different between one first end 52A and the other second end 52B of the inclined portion 52E. . The first end 52A is located relatively on the proximal side in the Z-axis direction, and the second end 52B is located on the distal side.

  The cam groove 52 has a guide groove 52C and a linear portion 52D in addition to the inclined portion 52E. One end of the guide groove 52C is connected to the second end 52B, and extends in the Z-axis direction toward the base end. One end of the straight portion 52D is connected to the first end 52A, and extends in the circumferential direction.

  As shown in FIGS. 12A and 12B and FIGS. 13A and 13B, in a state where the trocar shaft 17 is mounted on the trocar 16 with a camera, the handle portion 54 is fitted by the fitting claw 54A and the fitting groove 43B. It is attached to the head part inner cylinder 32A. Therefore, the position of the trocar shaft 17 in the Z-axis direction is fixed with respect to the inner cylindrical member 16A. When the trocar shaft 17 is mounted on the camera-equipped trocar 16, the cam pins 59 provided on the head outer cylinder 32B engage with the cam grooves 52 provided on the head inner cylinder 32A. Since the position of the trocar shaft 17 in the Z-axis direction is fixed with respect to the inner cylindrical member 16A, when the trocar shaft 17 rotates, the outer cylindrical member 16B is engaged by the engagement between the cam pin 59 and the inclined portion 52E of the cam groove 52. Slides with respect to the trocar shaft 17 and the inner cylindrical member 16A.

  Specifically, first, as shown in FIGS. 12A and 13A, when the pipe outer tube 31B is at the holding position, the camera unit 36 is at the storage position. In the state of the holding position, the cam pin 59 is located in the section between the first end 52A of the cam groove 52 and the linear portion 52D. The initial position of the trocar shaft 17 is a position where the cam pin 59 abuts on an end of the straight portion 52D opposite to the first end 52A. That is, the initial position of the trocar shaft 17 is the end position when the trocar shaft 17 is rotated counterclockwise as viewed from the tip side in the Z-axis direction.

  Even when the trocar shaft 17 is rotated clockwise as viewed from the distal end side, the pipe section is not used while the cam pin 59 is located at the first end 52A from the initial position, that is, while the cam pin 59 is in the section of the linear section 52D. The outer cylinder 31B does not slide in the axial direction and maintains the state of the holding position. The straight portion 52D is provided to secure a play for preventing the pipe portion outer cylinder 31B from starting sliding immediately after the trocar shaft 17 is rotated. By ensuring such play, the careless rotation of the trocar shaft 17 at the initial position prevents the holding of the camera unit 36 from being released.

  When the trocar shaft 17 starts rotating clockwise as viewed from the distal end from the initial position, the cam pin 59 reaches the first end 52A. Thereafter, when the trocar shaft 17 further rotates clockwise, the cam pin 59 engages with the inclined portion 52E of the cam groove 52, and the engagement position of the cam pin 59 moves from the first end 52A to the second end 52B. . By the action of the cam pin 59 and the inclined portion 52E, as shown in FIGS. 12B and 13B, the pipe outer tube 31B slides rearward with respect to the pipe inner tube 31A and retreats to the holding release position. As a result, the holding of the camera unit 36 is released, and the camera unit 36 is popped up and deployed at the deployment position.

  Here, the position where the cam pin 59 of the trocar shaft 17 reaches the second end 52B is referred to as the release completion position of the trocar shaft 17. The release completion position is the end position of the clockwise rotation of the trocar shaft 17.

  On the other hand, when the camera unit 36 shown in FIGS. 12B and 13B is in the deployed position, the pipe outer tube 31B is in the holding release position, and the trocar shaft 17 is in the release completed position. At the release completion position, the cam pin 59 is located at the second end 52B of the cam groove 52. In this state, when the trocar shaft 17 is rotated counterclockwise when viewed from the distal end side, the cam pin 59 moves from the second end 52B of the inclined portion 52E toward the first end 52A. By the action of the cam pin 59 and the inclined portion 52E of the cam groove 52, as shown in FIGS. 12A and 13A, the pipe outer tube 31B slides forward with respect to the pipe inner tube 31A and advances to the holding position.

  As the pipe portion outer cylinder 31B advances, the housing 64, which is the rear portion of the camera portion 36 in the deployed position, is pressed against the tip of the pipe portion outer tube 31B, and the camera portion 36 is rotated about the pivot pin 65 and stored. Pushed into position. In the storage position, the rear portion of the camera section 36 is covered with the tip of the pipe outer cylinder 31B. Accordingly, the expansion of the camera section 36 by the pop-up to the expanded position due to the bias of the spring 71 is restricted, and the camera section 36 is held at the storage position.

  As described above, the cam groove 52 and the cam pin 59 constitute an operation mechanism that slides the pipe outer cylinder 31B toward the base end by rotating the trocar shaft 17, whereby the pipe outer cylinder 31B is manually slid. As compared with the case, the smooth sliding operation of the pipe outer cylinder 31B is possible. This is because, when the medical staff ST who is the operator directly grips and slides the pipe outer cylinder 31B, the gripping force of the hand causes a force in a direction other than the Z-axis direction of the pipe outer cylinder 31B. Is easy to join. Such a force hinders smooth sliding of the pipe outer cylinder 31B. Therefore, the operation mechanism reduces the force acting on the pipe outer cylinder 31B in a direction other than the Z-axis direction, and enables a smooth sliding operation of the pipe outer cylinder 31B.

  When the pipe outer cylinder 31B is at the holding release position, the cam pin 59 is located at the second end 52B of the cam groove 52. A guide groove 52C extending in the axial direction from the second end 52B is formed. Therefore, the trocar shaft 17 can be slid in the axial direction toward the base end side with respect to the pipe outer cylinder 31B by moving the cam pin 59 along the guide groove 52C. As shown in FIG. 12B and FIG. 13B, when the pipe outer cylinder 31B is at the holding release position, the camera unit 36 is at the deployed position. Therefore, since the camera section 36 is retracted from behind the puncturing section 55 in the pipe inner cylinder 31A, the puncturing section 55 can be retracted. Therefore, when the camera section 36 is deployed, the trocar shaft 17 can be removed from the trocar 16 with camera.

  When attaching the trocar shaft 17 to the camera-equipped trocar 16, the pipe outer tube 31B of the camera-equipped trocar 16 is in a state in which the trocar shaft 17 has been extracted, that is, as shown in FIGS. 12B and 13B. Then, the outer tube 31B of the pipe portion is set at the holding release position where the camera portion 36 is in the deployed position. In this state, the shaft portion 56 is inserted from the head portion 32 into the insertion hole 33 of the pipe portion 31. Since the camera section 36 is in the deployed position, the camera section 36 is retracted from the path of the puncture section 55 even at the tip of the pipe section 31, so that the puncture section 55 can be projected from the tip of the pipe section 31.

  Thereafter, the position of the cam pin 59 and the position of the guide groove 52C are adjusted by rotating the handle portion 54. When the positions of the cam pin 59 and the guide groove 52C are aligned, the circumferential position of the fitting claw 54A shown in FIGS. 6 and 7 also faces the cutout 43C of the fitting groove 43C. In this state, the trocar shaft 17 is advanced to the distal end side along the guide groove 52C with the cam pin 59, and when the cam pin 59 reaches the second end 52B, the fitting claw 54A is moved from the notch 43C to the fitting groove 43C. enter in. When the trocar shaft 17 is rotated toward the initial position, the action of the cam pin 59 and the cam groove 52 causes the pipe outer cylinder 31B to advance toward the holding position as shown in FIGS. Is stored.

  As described above, the guide groove 52 </ b> C is formed between the cam pin 59 of the trocar shaft 17 and the cam groove 52 of the pipe outer cylinder 31 </ b> B when the trocar shaft 17 is mounted on the trocar 16 with a camera or is removed from the trocar 16 with a camera. It functions as a groove for starting or releasing the engagement.

  On the other hand, in the cam groove 52, a guide groove for releasing engagement with the cam pin 59 is not formed on the side where the first end 52A and the linear portion 52D exist. For this reason, in a state where the pipe portion outer cylinder 31B is in the holding position, that is, in a state where the camera unit 36 is in the storage position shown in FIGS. 12A and 13A, the removal of the trocar shaft 17 is restricted. As shown in FIG. 13A, the camera section 36 is stored in a storage space formed by the connection section 57 of the trocar shaft 17 at the storage position. If the trocar shaft 17 is inadvertently removed in this state, the rear end of the puncture portion 55 may come into contact with the camera portion 36, and the camera portion 36 may be damaged. In order to prevent this, the guide groove 52C is formed only on the second end 52B side, and is not formed on the first end 52A side.

  As shown in FIG. 5, two sets of a cam pin 59 provided on the pin disposing plate 58 and a cam groove 52 provided on the cam plate 51 are provided, and these sets are formed by the outer cylinder member 16B. Are arranged facing each other at an interval of about 180 ° in the circumferential direction around the Z axis. By providing a plurality of sets of the cam pins 59 and the cam grooves 52 and arranging them in opposition, the engagement state is stabilized. In addition, gripping is easy and operability is good.

  Further, since the trocar shaft 17 is provided with the handle portion 54 having a larger diameter than the shaft portion 53, the trocar shaft 17 can be easily rotated.

  As shown in FIG. 14, a position mark 58A and a direction mark 58B are provided on a pin disposing plate 58 on which a cam pin 59 that engages with the cam groove 52 is provided on the handle portion 54 of the trocar shaft 17. . The position mark 58A is disposed on the outer peripheral surface of the pin disposition plate 58, and indicates the position of the cam pin 59 disposed on the inner peripheral surface.

  Since the cam pins 59 are provided on the inner peripheral surface of the pin arrangement plate 58, they are difficult to visually recognize from the outside. By providing the position mark 58A on the outer peripheral surface of the pin disposing plate 58, the position of the cam pin 59 can be easily grasped from the outside, and the cam pin 59 and the cam groove The state of engagement with 52 can be easily confirmed. Accordingly, the operation of expanding and retracting the camera unit 36 through the trocar shaft 17 and the attachment and detachment of the trocar shaft 17 to and from the outer cylinder member 16B are easy.

  The direction mark 58B indicates the rotation direction when the trocar shaft 17 is mounted on the head portion 32, that is, the rotation direction from the release completion position of the trocar shaft 17 to the initial position.

  In this example, the cam groove 52 formed in the cam plate 51 provided on the base end side of the outer cylinder member 16B corresponds to the first cam portion, and the pin arrangement provided on the base end side of the trocar shaft 17 is provided. The cam pin 59 formed on the plate 58 corresponds to a second cam portion that engages with the cam groove 52. Further, in this example, the first cam portion is a cam groove and the second cam portion is a cam pin. However, the first cam portion may be a cam pin and the second cam portion may be a cam groove.

[Camera unit deployment assistance mechanism]
As described above, when the trocar shaft 17 is rotated, the holding of the camera unit 36 by the pipe outer tube 31B is released, and the camera unit 36 is popped up and deployed to the deployed position by the bias of the spring 71. The trocar device 12 with a camera includes a deployment assist mechanism that, when the trocar shaft 17 rotates when the camera unit 36 is deployed, the connecting unit 57 contacts the camera unit 36 and pushes up the camera unit 36 from the storage position to the deployment position. The deployment assisting mechanism is constituted by the trocar shaft 17 which is rotatable within the pipe inner tube 31 </ b> A and has a connecting portion 57 that can contact the camera portion 36.

  15A to 15C show a cross section (XY cross section) orthogonal to the Z-axis direction of the pipe section 31 in a portion where the camera section 36 and the connecting section 57 are arranged. As shown in FIGS. 15A to 15C, in the cross section of the pipe section 31, the connecting section 57 is disposed at a lower position facing the camera section 36 disposed above the pipe section 31. 15A and 15B show a state where the camera unit 36 is in the storage position, and FIG. 15C shows a state where the camera unit 36 is in the unfolded position.

  15A, the rotational position of the trocar shaft 17 indicates the initial position, that is, the state where the cam pin 59 is in the linear portion 52D of the cam groove 52 (see FIG. 3). In FIG. 15B, the rotational position of the trocar shaft 17 indicates a state where the cam pin 59 is moving from the first end 52A of the inclined portion 52E to the second end 52B. In FIG. 15C, the rotational position of the trocar shaft 17 indicates the release completed position, that is, the state where the cam pin 59 is at the second end 52B of the cam groove 52 (see FIG. 4).

  As shown in FIGS. 15A to 15C, when the pipe portion 31 is viewed straight from the front end side in the Z-axis direction, the cross-sectional shape of the connecting portion 57 is from the radial center of the pipe portion 31 toward the inner wall of the pipe portion 31. It has a chevron shape with extended base. The bottom surface on the skirt side of the connecting portion 57 has a curved surface that matches the curvature of the inner wall of the pipe inner tube 31A, and comes into contact with the inner wall of the pipe inner tube 31A. When the trocar shaft 17 rotates clockwise, the connecting portion 57 rotates clockwise along the inner wall of the pipe inner tube 31A.

  When the trocar shaft 17 rotates clockwise from the initial position shown in FIG. 15A and reaches the position shown in FIG. 15B, the connecting portion 57 starts to contact the side surface portion 64B of the camera unit 36. Since the state shown in FIG. 15B is a state in which the cam pin 59 and the inclined portion 52E of the cam groove 52 are engaged, when the trocar shaft 17 rotates, the pipe outer cylinder 31B also slides toward the holding release position. Therefore, the holding of the camera unit 36 is gradually released in accordance with the sliding of the pipe unit outer cylinder 31B. Then, the camera section 36 starts popping up by the urging force of the spring 71 toward the deployed position. At this timing, the connecting portion 57 starts to contact the camera portion 36 and pushes up the camera portion 36 toward the deployed position.

  For this reason, when the camera unit 36 pops up and expands, the camera unit 36 receives assistance by the pressing force of the connecting unit 57 in addition to the urging force of the spring 71, so that the pop-up is performed only by the urging force of the spring 71. Thus, the pop-up of the camera unit 36 can be reliably developed. More specifically, fat 23A (see FIGS. 24A and 24B) and the like may adhere to the outer peripheral surface of the camera unit 36, and this may become a resistance at the time of pop-up. Even in such a case, since the deployment assist mechanism including the connecting portion 57 is provided, the deployment by the pop-up can be reliably performed.

  As shown in FIGS. 15A to 15C, in the connecting portion 57, a pressing portion 57 </ b> B that protrudes outward from the main body portion 57 </ b> A is provided on a slope that comes into contact with the side surface portion 64 </ b> B. As shown in FIGS. 16A and 16B, the pressing portion 57B is not provided over the entire length of the connecting portion 57 in the Z-axis direction, but is provided on a part thereof. Specifically, the pressing portion 57B is provided in a range facing the side surface portion 64B of the camera portion 36 in the Z-axis direction of the connecting portion 57. By thus minimizing the range in which the pressing portion 57B is provided, it is possible to prevent the storage space of the camera unit 36 from being pressed unnecessarily.

  Further, as shown in FIG. 15A, when the trocar shaft 17 is at the initial position and the camera unit 36 is in the storage position, when the pipe unit 31 is viewed straight from the front end side in the Z-axis direction, the width of the connecting unit 57 is The center position in the direction (X-axis direction) is arranged to be offset with respect to the center line C1 in the width direction (X-axis direction) of the camera unit 36. The center line C <b> 1 is a line connecting the center position of the camera unit 36 in the width direction (X-axis direction) and the center of the pipe unit 31. The center line C2 is a center line in the width direction (X-axis direction) of only the main body portion 57A of the connecting portion 57 excluding the pressing portion 57B. Offset means that the center line C1 and the center line C2 do not match.

  More specifically, in FIG. 15A, when the camera unit 36 is in the storage position, the connecting unit 57 is arranged to face the camera unit 36. In this state, the center line C1 in the width direction of the camera portion 36 does not match the center line C2 in the width direction (X-axis direction) of the connecting portion 57, and the center line C2 is different from the center line C1. , Is offset in the opposite direction (to the right in FIG. 15A) from the slope contacting the side surface portion 64B.

  As described above, when the trocar shaft 17 is in the initial position and the camera unit 36 is in the storage position, the center position in the width direction (X direction) of the connecting unit 57 with respect to the center line C1 of the camera unit 36 is set. Are arranged in an offset manner, so that the rotation amount of the trocar shaft 17 can be easily adjusted as described below.

  That is, the trocar shaft 17 not only functions as a deployment assisting mechanism for the camera unit 36 due to its rotation, but also functions as an operating mechanism for sliding and retracting the camera unit 36 by sliding the pipe unit outer cylinder 31B. When the trocar shaft 17 performs a plurality of functions as described above, it is necessary to adjust the amount of rotation of the trocar shaft 17 according to each function.

  For example, when the amount of rotation of the trocar shaft 17 required for the operation mechanism is determined, the stroke amount of the connecting portion 57 (the amount of rotation of the connecting portion 57 in the circumferential direction) is also determined. In order for the deployment assist mechanism to function, the distance between the connecting portion 57 and the side portion 64B of the camera portion 36 must be adjusted according to the determined stroke amount. By offsetting the connecting portion 57, it is easy to finely adjust the distance between the connecting portion 57 and the side surface portion 64B. As described above, the fine adjustment is easy, so that even when the trocar shaft 17 performs a plurality of functions, the amount of rotation required for one of the functions can be determined with a certain degree of freedom. Easy to adjust volume.

  In other words, by setting the cross-sectional shape of the connecting portion 57 to such a shape and arrangement, the degree of freedom in design is ensured. Specifically, in the present example, the center line C2 of the main body 57A of the connecting portion 57 is offset from the center line C1 of the camera section 36. However, theoretically, even when the pressing portion 57B is provided, the main body portion 57A can be provided so that the center line C2 and the center line C1 coincide (without offsetting).

  The reason for the offset in the present example is that the deployment of the camera section 36 is related to the sliding amount of the outer cylinder 16B, so that the distance between the pressing section 57B of the connecting section 57 and the side section 64B of the camera section 36 in the cam design. This is to ensure. As described above, by offsetting with respect to the center line C2 and the center line C1 of the main body portion 57A and making the cross-sectional shape of the connecting portion 57 including the pressing portion 57B asymmetric with respect to the center line C2, the side surface portion 64B and the pressing portion Since the distance between 57B can be increased, the degree of freedom in design is improved.

[Lock mechanism when the camera is deployed and retracted]
The camera-equipped trocar device 12 includes an outer cylinder locking mechanism that regulates the sliding of the outer cylinder member 16B having the pipe outer cylinder 31B in the Z-axis direction and locks the outer cylinder member 16B at each of the holding position and the holding release position. Have. As described above, the lock release operation member 46 is an operation member for performing a release operation of the outer cylinder lock mechanism, and constitutes the outer cylinder lock mechanism together with the engagement portion 47.

  As shown in FIG. 17, the engaging portion 47 formed on the outer peripheral surface of the head portion inner cylinder 32A has two engaging grooves 47A and 47B extending in a direction orthogonal to the Z-axis direction. The engagement grooves 47A and 47B have different positions in the Z-axis direction. The engagement groove 47A is a groove for locking the outer cylinder member 16B in a state where the pipe outer cylinder 31B is at the holding position. 47B is a groove for locking the outer cylinder member 16B when the pipe outer cylinder 31B is at the holding release position. The engagement groove 47A corresponds to a first engagement portion, and the engagement groove 47B corresponds to a second engagement portion.

  The lock release operation member 46 is attached to the outer periphery of the head outer cylinder 32B of the outer cylinder member 16B. The lock release operation member 46 has an operation part 46A and a support part 46B. The support portion 46B is connected to the operation portion 46A, and is a portion for supporting the operation portion 46A on the head outer cylinder 32B. A step is formed between the operation portion 46A and the support portion 46B, and the longitudinal section of the unlocking operation member 46 has a substantially crank shape.

  In the unlocking operation member 46, attachment pins 46C are provided at both ends in the width direction at a portion where the operation portion 46A and the support portion 46B are joined. The support portion 46B is provided with a mounting hole 46D in which a spring 68 for urging the unlocking operation member 46 in a predetermined direction is mounted. The support portion 46B is provided with an engagement protrusion 46E (see FIGS. 19A to 19C) on a surface opposite to the mounting hole 46D. As will be described later, the engagement convex portion 46E is engaged with each of the engagement grooves 47A and 47B, and corresponds to a regulating portion that regulates the slide of the outer tubular member 16B.

  The head outer cylinder 32B is provided with a mounting portion 66 for mounting the unlocking operation member 46. The mounting portion 66 has an opening 66A and a bearing portion 66B formed on the inner periphery of the opening 66A and rotatably supporting the mounting pin 46C.

  18A to 18C show a method of assembling the unlocking operation member 46. As shown in FIG. 18A, the unlocking operation member 46 is inserted into the opening 66A with the spring 68 attached to the support portion 46B, for example. Then, as shown in FIG. 18B, the mounting pin 46C is mounted on the bearing 66B. Then, the unlocking operation member 46 is rotated about the mounting pin 46C, and the posture of the unlocking operation member 46 is adjusted so that the support portion 46B and the inner peripheral surface of the head outer cylinder 32B are parallel.

  In this state, the spring 68 is sandwiched between the support portion 46B and the inner peripheral surface of the head outer cylinder 32B. While maintaining this posture, as shown in FIG. 18C, the inner cylinder member 16A is inserted into the outer cylinder member 16B, and the support portion 46B is connected to the inner peripheral surface of the outer cylinder member 16B and the outer peripheral surface of the inner cylinder member 16A. Between the engaging portion 47 and the engaging portion 47. In FIG. 18C, the supporting portion 46B rotates clockwise around the mounting pin 46C by the urging force of the spring 68, and is urged in a direction to press the engaging projection 46E against the engaging portion 47.

  As shown in FIGS. 19A to 19C, an engagement state between the unlocking operation member 46 and the engagement portion 47 is shown. FIG. 19A shows a state in which the pipe outer cylinder 31B is at a holding position for holding the camera unit 36 at the storage position. In the state shown in FIG. 19A, the engaging protrusion 46E is engaged with the engaging groove 47A corresponding to the first engaging portion, and the engaging protrusion 46E is pressed against the engaging groove 47A by the bias of the spring 68. Can be For this reason, the engagement between the engagement projection 46E and the engagement groove 47A restricts the axial sliding of the outer cylinder member 16B with respect to the inner cylinder member 16A, and the pipe outer cylinder 31B stores the camera unit 36. The position is locked to the holding position (see FIGS. 12A and 13A).

  FIG. 19B shows a state in which the lock release operation member 46 has been operated to release the slide lock of the outer cylinder member 16B. When the operation portion 46A is pressed, the lock release operation member 46 rotates counterclockwise around the mounting pin 46C against the bias of the spring 68. By this rotation, the support portion 46B is separated from the engagement portion 47, and the engagement between the engagement protrusion 46E and the engagement groove 47A is released. Thereby, the slide lock of the outer cylinder member 16B is released. When the slide lock of the outer cylinder member 16B is released, the pipe outer cylinder 31B is retracted to the base end side and can be moved to the holding release position.

  FIG. 19C shows a state where the pipe outer cylinder 31B is at the holding release position. As shown in FIG. 19B, when the outer cylinder member 16B is retracted to the proximal side in a state where the lock is released, the engagement protrusion 46E of the support portion 46B is engaged with the engagement groove 47B corresponding to the second engagement portion. Reach As shown in FIG. 19C, when the engagement protrusion 46E reaches the engagement groove 47B, the engagement protrusion 46E falls into the engagement groove 47B due to the urging of the spring 68, and both are engaged. At the holding release position where the engagement convex portion 46E and the engagement groove 47B are engaged, the holding of the camera portion 36 by the pipe outer tube 31B is released, and the camera portion 36 pops up and expands.

  In the state shown in FIG. 19C, the engaging protrusion 46E is engaged with the engaging groove 47B, and the engaging protrusion 46E is pressed against the engaging groove 47B by the bias of the spring 68. Therefore, the engagement of the engagement projection 46E and the engagement groove 47A restricts the axial sliding of the outer cylinder member 16B with respect to the inner cylinder member 16A. Is locked to the holding release position (see FIGS. 12B and 13B) that allows

  As described above, the outer cylinder lock mechanism including the lock release operation member 46 and the engagement portion 47 provides the following effects. That is, in the camera-equipped trocar 16, the outer cylinder member 16 </ b> B including the pipe outer cylinder 31 </ b> B is located at the outermost periphery of the pipe part 31 of the camera-equipped trocar 16. If such a pipe part outer cylinder 31B is used as an operation member for holding and deploying the storage position of the camera part 36, it is easy to touch an operator's hand, and an inadvertent slide contrary to the operator's intention is likely to occur.

  If the pipe portion outer cylinder 31B slides carelessly, there is a concern that, contrary to the operator's intention, the camera portion 36 which should be in the storage position is expanded or the camera portion 36 which should be in the expanded position is stored. is there. According to the outer cylinder locking mechanism, the pipe section outer cylinder 31B can be locked at the holding position and the holding release position, so that careless sliding of the pipe section outer cylinder 31B can be prevented.

  Further, an engagement convex portion 46E corresponding to a restricting portion that restricts sliding of the outer tubular member 16B by being engaged with each of the engaging grooves 47A and 47B is formed integrally with the lock release operation member 46. Therefore, the structure is simple. Therefore, it is advantageous in terms of parts cost and assemblability.

  Further, since the lock release operation member 46 is disposed on the head portion 32 having a larger diameter than the pipe portion 31, operability is good.

[Camera bearing structure]
As shown in FIGS. 20A and 20B, the camera unit 36 is attached to the pipe inner tube 31A, and is rotatably supported between a stored position and a deployed position. FIG. 20A shows the camera unit 36 in the storage position, and FIG. 20B shows the camera unit 36 in the unfolded position. As shown in FIG. 10, a pair of left and right rotation pins 65 are provided at both ends in the width direction (X-axis direction) of the camera unit 36, and each of the rotation pins 65 is a cutout portion of the pipe inner cylinder 31 </ b> A. It is attached to each of a pair of left and right bearings 67 formed at 61. The pair of bearing portions 67 rotatably support the respective rotating pins 65.

  Each bearing portion 67 has a distal end side receiving port 67A for receiving the pivot pin 65 at the distal end side of the pipe portion inner cylinder 31A. The bearing 67 has a substantially semicircular cross section perpendicular to the rotation pin 65, and a cutout portion corresponding to the remaining semicircle corresponds to the distal end receiving port 67A. The distal end receiving port 67A is capable of receiving the pivot pin 65 that enters from the distal end side of the pipe portion 31 along the Z-axis direction of the pipe portion 31. A drop-off prevention member 76 for preventing the rotation pin 65 supported by the bearing portion 67 from dropping is disposed at a position facing the distal end side receiving port 67A. The falling-off prevention member 76 is a strip-shaped tongue extending in the axial direction, and is provided on the pipe portion inner cylinder 31A.

  The falling-off prevention member 76 is formed integrally with, for example, the pipe inner tube 31A. One end of the falling-off prevention member 76 is a fixed end 76A fixed to the pipe inner tube 31A, and the other end on the base end side is a free end 76B, and has elasticity. With this configuration, the falling-off preventing member 76 can be elastically deformed such that the free end 76B is displaced in the width direction (X-axis direction) of the camera section 36 from the fixed end 76A (see FIG. 21B). . The falling-off prevention member 76 is made of resin, and is resin-molded integrally with the pipe inner tube 31A. The falling-off prevention member 76 is formed to have a length such that the free end 76B is located at the distal-side receiving port 67A, and the free end 76B is arranged to face the distal-side receiving port 67A. The free end 76B supports the pivot pin 65 in cooperation with the bearing 67, and closes the distal end receiving port 67A to prevent the pivot pin 65 from dropping off the bearing 67. The bearing structure of the camera unit 36 includes a rotating pin 65 corresponding to a rotating shaft, a bearing 67, and a falling-off prevention member 76.

  As shown in FIGS. 21A to 21C, each free end 76B of the left and right drop-off prevention members 76 has a protruding portion 76C that protrudes inward, that is, protrudes toward each of the opposing free ends 76B. (See also FIG. 10).

  21A to 21C show a method of attaching the camera unit 36. As shown in FIG. 21A, the camera section 36 is attached to the bearing section 67 from the distal end side of the pipe section inner cylinder 31A. At this time, as shown in FIG. 21B, the left and right rotation pins 65 are inserted between the left and right falling prevention members 76, and are brought into contact with the insides of the respective falling prevention members 76. In this state, the camera unit 36 is moved along the Z-axis direction of the pipe inner tube 31A.

  The interval between the left and right pivot pins 65 is wider than the interval between the left and right drop-off prevention members 76. Therefore, in a state in which the left and right rotation pins 65 are in contact with the left and right falling prevention members 76, the free ends 76B of the respective falling prevention members 76 are elastically deformed outward from the fixed end 76A. The elastic deformation of each of the falling-off prevention members 76 continues until the left and right rotation pins 65 are received by the left and right bearing portions 67 through the distal-side receiving ports 67A.

  As shown in FIG. 21B, when the left and right rotating pins 65 moving from the distal end toward the bearing 67 reach the position of the protrusion 76C, the amount of outward deformation of the free end 76B of the falling-off preventing member 76 is reduced. , Will be the largest. In this state, the free end 76B retreats from the front of the distal end side receiving port 67A of the bearing 67. Thus, the rotation pin 65 can enter the bearing 67.

  When the camera section 36 is further moved to the proximal end side, as shown in FIG. 21C, the rotation pin 65 enters the bearing section 67 and is received. When the rotation pin 65 is received by the bearing 67, the contact between the inside of the falling-off prevention member 76 and the rotation pin 65 is released. Therefore, the outwardly deformed free end 76B is displaced inward due to elasticity, and returns to the initial position facing the distal end receiving port 67A. Thereby, the distal end side receiving port 67A of the bearing 67 that has received the rotation pin 65 is closed, so that the rotation pin 65 is prevented from dropping out of the bearing 67. In addition, the outer peripheral surface around the axis of the rotating pin 65 is covered with the bearing 67 and the front end side receiving opening 67A, and is supported rotatably by the cooperation of these.

  As described above, the bearing structure of the rotating pin 65 is configured by the bearing portion 67 having the distal-side receiving port 67A and the falling-off preventing member 76 arranged to face the distal-side receiving port 67A. It is possible to prevent the strength of the pivot pin 65 of the camera unit 36 from being reduced while ensuring good attachment of the camera 36.

  That is, since the front-end-side receiving port 67A is formed by a substantially semicircular notch, the cross-sectional shape of the rotation pin 65 in a direction orthogonal to the rotation axis can be circular. If the receiving opening of the bearing 67 is smaller than the radius of the rotation pin 65, the rotation pin 65 cannot be inserted into the bearing 67. In that case, in order to reduce the cross-sectional shape of the rotation pin 65, it is necessary to perform processing such that at least a part of the rotation pin 65 is D-cut or I-cut. Such processing causes a reduction in the strength of the rotating pin 65. When the strength of the rotation pin 65 decreases, for example, the rotation pin 65 may be damaged in the abdominal cavity. Such inconvenience can be avoided by preventing the strength of the rotation pin 65 from decreasing.

  In addition, since the falling-off prevention member 76 is disposed in the front-end-side receiving port 67A, the rotation pin 65 is prevented from falling off from the bearing 67.

  Further, since the falling-off preventing member 76 is elastically deformable, when attaching the camera section 36 to the bearing 67, the falling-off preventing member 76 can be elastically deformed and retracted from the front end side receiving port 67A. Therefore, the pivot pin 65 can be made to enter the bearing 67 from the distal end receiving port 67A only by moving the camera section 36 from the distal end side along the axial direction, so that the mountability is good.

  The free end 76B of the falling-off prevention member 76 is provided with a protrusion 76C that protrudes inward. Therefore, the free end 76B can be largely deformed outward just before the rotation pin 65 reaches the front-end-side receiving opening 67A. For this reason, since the retreat amount of the free end 76B becomes large, it is easy to make the rotating pin 65 enter the front end side receiving opening 67A.

  In the bearing portion 67 of the present example, the substantially semicircular shape means a semicircle having an arc having a length of 50% of the circumference of the circle and a range of ± 10% based on the semicircle. That is, the concept includes a semicircle having an arc having a length of 40% to 60% of the circumference. The size of the distal end receiving port 67A decreases as the arc length of the bearing 67 approaches 60%, and increases as the arc length approaches 40%.

  For example, when the length of the arc of the bearing portion 67 is 60%, the size of the distal end receiving port 67A may be slightly smaller than the radius of the rotating pin 65 in some cases. However, even in that case, if the distal end side receiving port 67A can be elastically deformed to expand the size of the port, the bearing portion 67 can receive the pivot pin 65. In addition, as the size of the front end side receiving port 67A is made smaller, it is possible to prevent the pivot pin 65 from falling off from the bearing portion 67.

[Protrusion of puncture part]
As shown in FIG. 22, on the outer peripheral surface of the puncture portion 55 of the trocar shaft 17, a plurality of protrusions 78 projecting in the radial direction and extending along the Z-axis direction of the puncture portion 55 are formed. The puncture portion 55 is first inserted into the incision portion 27 formed in the abdominal wall 23 of the patient P when the trocar 16 with camera is inserted into the abdominal cavity of the patient P, as described in FIGS. 2 and 3. As described above, the abdominal wall 23 is formed of a subcutaneous tissue such as fat 23A (see reference numeral 23A in FIGS. 24A and 24B), and the puncture portion 55 has a role of pushing and expanding the abdominal wall 23. The ridge 78 tears the subcutaneous tissue to prevent the subcutaneous tissue from wrapping around the outer peripheral surface of the puncture portion 55, and particularly to prevent the fat 23A from wrapping.

  In this example, four ridges 78 are provided. Here, when it is necessary to distinguish each of the four ridges 78 from the four ridges 78, the symbols are separately described as the ridges 78 </ b> A to 78 </ b> D. This will be described as the ridge 78.

  As shown in FIGS. 23A and 23B, the four ridges 78A, 78B, 78C, 78D intersect in a cross shape as a whole when the puncture portion 55 is viewed straight from the tip side in the Z-axis direction. Be placed. Specifically, the four projecting ridges 78A, 78B, 78C, and 78D are arranged such that the proximal ends thereof are arranged at 90 ° intervals in the circumferential direction around the Z axis of the puncturing portion 55, and At the tip of 55, the ends on the tip side intersect.

  FIG. 23A shows the positions of the plurality of ridges 78 and the camera unit 36 when the camera unit 36 is in the storage position, that is, when the trocar shaft 17 is in the initial position (see FIGS. 3 and 12A and the like). FIG. 23B shows the positional relationship between the plurality of projections 78 and the camera unit 36 in a state where the trocar shaft 17 is at the release completion position (see FIGS. 4 and 12B and the like).

  As shown in FIG. 23A, in the state where the trocar shaft 17 is in the initial position (the state where the camera section 36 is in the storage position), two of the four ridges 78A to 78D are provided. With respect to the position, the base end is disposed at a position corresponding to the position of each hinge at both ends of the camera section 36 in the circumferential direction around the Z axis of the puncture section 55. As described above, each hinge portion is provided at both ends of the camera portion 36, and each hinge portion is provided on a rotation pin 65 provided on each side surface portion 64 </ b> B of the camera portion 36 and an inner periphery of the notch portion 61. It is constituted by each bearing part 67 provided.

  FIGS. 24A and 24B are explanatory diagrams showing the wrapping of the fat 23A around the tip of the pipe portion 31 on which the camera portion 36 is arranged, based on the knowledge obtained through animal experiments. FIG. 24B is a top view of the pipe section 31 as viewed from above where the camera section 36 is disposed. As shown in FIG. 24A and FIG. 24B, in the pipe portion 31 behind the puncture portion 55, the region R1 corresponding to the ridge portion 78 has less winding of the fat 23A than the other region R2. Therefore, by arranging the ridges 78A and 78B at positions corresponding to the hinges of the camera unit 36 provided on the pipe unit 31, the peripheral region including the hinge unit of the camera unit 36 (the region R1 in FIGS. 24A and 24B). ) Around the fat 23A.

  The fat 23A wrapped around the camera unit 36 becomes a resistance when popping up to the deployed position of the camera unit 36, and thus hinders the smooth deployment of the camera unit 36. By arranging the ridges 78A and 78B at positions corresponding to the hinges of the camera unit 36, it is possible to suppress the winding of the fat 23A. Thus, the camera unit 36 can be smoothly deployed.

  In each ridge 78, an upper end portion 79 corresponding to a ridge line along the Z-axis direction has a flat surface instead of a pointed shape like a blade edge. By making the upper end portion 79 a flat surface, the following effects can be obtained. First, even if the operator touches the puncture section 55 with a hand wearing rubber gloves, the rubber gloves can be prevented from being damaged. Secondly, even when a large force acts on the puncture portion 55 when the trocar device 12 with a camera is inserted into the abdominal cavity, the ridge 78 is damaged as compared with the case where the upper end portion 79 has a pointed shape. Hard to do. Third, breakage of the seal unit included in the airtight structure unit 42 can be prevented. That is, when inserting the trocar shaft 17 into the camera-equipped trocar 16, the puncture portion 55 passes through the airtight structure unit 42. By making the ridge 78 a flat surface, it is possible to prevent the seal unit included in the airtight structure unit 42 from being damaged.

  As shown in FIGS. 23A and 23B, the maximum diameter D2 of the plurality of ridges 78 in the radial direction is equal to or less than the maximum diameter D1 of the portion where the ridge 78 is not formed on the outer peripheral surface 55 </ b> A of the puncture portion 55. It is. In this example, the maximum diameter D1 is the diameter at the proximal end of the tapered puncture portion 55, and the maximum diameter D2 of the ridge 78 is also the maximum diameter D2 at the proximal end of the ridge 78. It is a diameter connecting the upper end portions 79 of the plurality of protrusions 78 arranged in the circumferential direction.

  By setting the maximum diameter D2 of the ridge 78 to be equal to or less than the maximum diameter D1 of the puncture portion 55, the maximum protrusion amount of the ridge 78 can be regulated. Is a flat surface, the above-described first to third effects can be further enhanced.

  Further, in the present embodiment, an example has been described in which four ridges 78 are provided as the plurality of ridges 78, but the number of ridges 78 may be other than four. For example, the number of the protrusions may be three, five or more, and the plurality of protrusions 78 include two protrusions 78 </ b> A and 78 </ b> B arranged at positions corresponding to the hinges of the camera unit 36. It should just be. Further, two or more ridges 78 may be arranged at positions corresponding to one hinge.

  FIG. 25 shows an example in which eight ridges 78 are provided. Two of these are arranged at positions corresponding to the hinges of the camera section 36, similarly to the ridges 78A and 78B shown in FIG. 23A. Also, as in the example in which the four ridges 78 shown in FIGS. 23A and 23B and the eight ridges 78 shown in FIG. 25 are provided, the arrangement interval of the plurality of ridges 78 is equal. It is preferred that This is because the effect of preventing the wrapping of the fat 23A due to the provision of the plurality of ridges 78 is considered to be obtained evenly in the circumferential direction of the puncture portion 55.

[Airtight structure unit]
FIG. 26 is a perspective view of the airtight structure unit 42 shown in FIG. 7 as viewed from the base end side. As described above, the airtight structure unit 42 has a function of preventing gas leakage from inside the abdominal cavity to outside the body. The airtight structure unit 42 is housed in the head portion inner cylinder 32A, and the rear opening of the head portion inner cylinder 32A is closed by the rear cover 43.

  As shown in FIGS. 27 and 28, the airtight structure unit 42 includes a duckbill valve 81 and a seal unit 82 arranged on the base end side of the duckbill valve 81. The duckbill valve 81 prevents gas from leaking out of the insufflated body cavity through the insertion hole 33 when the treatment instrument 22 is not inserted through the camera-equipped trocar 16. On the other hand, the seal unit 82 prevents gas from leaking out of the body through the insertion hole 33 from inside the body cavity when the treatment tool 22 is inserted.

(Configuration of Duck Bill Valve)
The duck bill valve 81 is a well-known valve mechanism in the shape of a duck's mouth, and has a valve portion 81A and a circular portion 81B integrally formed at the base end of the valve portion 81A. Duck bill valve 81 is formed of an elastomer such as silicone rubber. The valve portion 81A has two facing slopes that intersect at the distal end and extend toward the proximal end. A streak-shaped opening 81C is formed at the tip of the valve portion 81A. A flange 81D projecting outward is formed at the base end of the circular portion 81B (see also FIG. 4).

  As shown in the cross-sectional view of FIG. 30, an abutting surface 83 that is in contact with the flange 81D of the duckbill valve 81 is formed on the inner wall surface of the head inner cylinder 32A to which the airtight structure unit 42 is mounted. In the head inner cylinder 32 </ b> A, the inner diameter on the tip side from the abutting surface 83 is substantially the same as the outer diameter of the circular portion 81 </ b> B of the duckbill valve 81.

(Structure of seal unit)
As shown in FIGS. 27 and 28, the seal unit 82 includes a seal holder 86, a first mount 87, a dome-shaped seal 88, an airtight rubber cover 89, a centering guide 91, and a second mount 92. The dome-shaped seal 88 corresponds to a seal in the claims, and the airtight rubber cover 89 corresponds to a rubber cover in the claims. These members are arranged in this order from the distal end side to the proximal end side with the seal holder 86 at the head, and are unitized as a seal unit 82 by being integrally assembled.

  The dome-shaped seal 88 is a member having a circular planar shape and a convex dome shape on the distal end side. The dome-shaped seal 88 has a dome-shaped seal portion 88A and a circular flange 88B formed on the outer periphery of the seal portion 88A. An opening 88C through which the treatment tool 22 and the trocar shaft 17 are inserted is formed at the center of the seal portion 88A in the radial direction, that is, at the center located at the top of the dome shape. The dome-shaped seal 88 is made of a single material having a circular planar shape, and is made of silicon rubber. The opening 88 </ b> C expands due to elastic deformation in a state of being in close contact with the outer peripheral surface of the inserted treatment tool 22. The outer peripheral surface of the treatment tool 22 and the inner periphery of the opening 88C are hermetically sealed. This prevents gas leakage from the opening 88C when the treatment tool 22 is inserted.

  The diameter of the opening 88C of the dome-shaped seal 88 is determined according to the outer diameter of the treatment tool 22 to be inserted. Since the outer diameter of the general treatment tool 22 is about 5 mm, in this example, the diameter of the opening 88 </ b> C is 4 mm, which is slightly smaller than the outer diameter of the treatment tool 22. Thus, when the treatment tool 22 is inserted, the opening 88C is expanded by elastic deformation, and the inner circumference of the opening 88C and the outer circumference of the treatment tool 22 can be brought into close contact.

  The silicone rubber used for the dome-shaped seal 88 is a silicone rubber having a JIS A hardness of 30 as measured by durometer and a relatively flexible material having a thickness of about 0.8 mm. By using a flexible material, good operability of the treatment tool 22 is ensured.

  As shown in FIG. 29, a centering guide 91 is disposed behind the dome-shaped seal 88 (at the base end of the trocar 16 with camera). The centering guide 91 is composed of four segments 93. The centering guide 91 is configured by combining the segments 93 to have a dome shape that is convex toward the distal end as a whole. Each segment 93 is partially overlapped with an adjacent segment 93.

  The overall shape of the centering guide 91 corresponds to the shape of the dome-shaped seal 88. The centering guide 91 has a dome-shaped guide portion 91A and a flange 91B formed on the outer periphery of the guide portion 91A. An opening 91C through which the treatment instrument 22 and the trocar shaft 17 are inserted is formed at a central portion corresponding to the top of the dome shape of the guide portion 91A. The diameter of the opening 91C is the same as or slightly smaller than the opening 88C of the dome-shaped seal 88. In this example, it is 4 mm, which is the same as the opening 88C. The material of the centering guide 91 is a polyurethane having a JIS A hardness of 90 as measured by durometer and a thickness of about 0.5 mm.

  In FIG. 29, FIG. 31A, and FIG. 31B showing the state where the centering guide 91 is viewed from the base end side, the four segments 93 constituting the centering guide 91 have a substantially sector shape, and the length of the arc is One-fourth of the circumference of the centering guide 91. Here, １ ／ of the circumference includes a range of ± 10%.

  In addition, the area of the overlapping region 93 </ b> A, which is a portion where the adjacent segments 93 overlap, is equal to or less than half of the entire area of each segment 93. As shown in FIGS. 31A and 31B, the overlapping region 93A has a shape in which the width of the overlapping region 93A monotonically increases from the outer periphery of the centering guide 91 toward the center.

  Each of the segments 93 is formed with a notch 93B that forms a part of the opening 91C. The side of the overlapping region 93A on the opening 91C side is smoothly connected to the cutout portion 93B. The side on the opening 91C side extends in a direction parallel to the radial direction of the centering guide 91.

  When the treatment tool 22 is inserted, the opening 91C expands according to the outer diameter of the treatment tool. This expansion is performed by displacing the adjacent segments 93 in a direction in which they are separated from each other. The opening 91C is formed by a cutout portion 93B of each segment 93, and the adjacent segment 93 has an overlapping area 93A. Therefore, even when the opening 91 </ b> C expands, the overlapping between the adjacent segments 93 is maintained, so that a gap hardly occurs between the opening 91 </ b> C and the outer periphery of the treatment tool 22.

  The centering guide 91 guides the distal end of the treatment tool 22 to the center opening 88C of the dome-shaped seal 88 by the guide portion 91A and the opening 91C when the treatment tool 22 is inserted.

  The first mount 87 is disposed on the distal end side of the dome-shaped seal 88, has an opening 87C exposing the seal portion 88A, has a convex mount portion 87A on the distal end side, and a flange formed on the outer periphery of the mount portion 87A. 87B. The first mount 87 is formed of, for example, a resin material such as polyester. The first mount 87 supports the distal end side of the seal portion 88A of the dome-shaped seal 88 by the mount portion 87A, and supports the flange 88B from the distal end side by the flange 87B. The diameter of the opening 87C is larger than the diameters of the trocar shaft 17 and the treatment tool 22, and can be inserted therethrough.

  The seal holder 86 has an opening 86C for exposing the seal portion 88A of the dome-shaped seal 88, and has a convex-shaped substantially conical cover portion 86A on the distal end side and a cylindrical portion formed on the base end side of the cover portion 86A. 86B. The diameter of the opening 86C of the seal holder 86 is slightly larger than the diameter of the opening 87C of the first mount 87. The seal holder 86 is formed of, for example, a resin material such as polyester.

  The cover part 86A supports the periphery of the mount part 87A of the first mount 87, which exposes the seal part 88A of the dome-shaped seal 88, from the front end side and covers the periphery. The cover portion 86A functions as an abutment of the mount portion 87 when the dome-shaped seal 88 and the mount portion 87A move to the distal end side with the operation of the treatment tool 22, thereby restricting the amount of movement to the distal end side. I do.

  The cylindrical portion 86B functions as a frame to which the hermetic rubber cover 89B is attached. The inner diameter of the cylindrical portion 86B is large enough to accommodate the first mount 87, the dome-shaped seal 88, the centering guide 91, and the second mount 92 therein. In the cylindrical portion 86B, a peripheral edge 86D (see FIG. 30) on the distal end located around the cover portion 86A functions as an abutting surface against the flange 81D of the duckbill valve 81 via the airtight rubber cover 89B.

  The second mount 92 is arranged on the base end side of the centering guide 91. The second mount 92 has a mount 92A having a convex shape on the distal end side, and a flange 92B formed on the outer periphery of the mount 92A. The second mount 92 is formed of, for example, a resin material such as polyester. The second mount 92 supports the base end of the guide portion 91A of the centering guide 91 by the mount portion 92A, and supports the flange 91B from the base end by the flange 92B. An opening 92C is formed in the mount 92A. The opening 92C has substantially the same diameter as the opening 87C of the first mount 87, and allows the trocar shaft 17 and the treatment tool 22 to pass therethrough.

  A plurality of pins 92D protruding toward the distal end are formed on the flange 92B. The pins 92D are arranged at equal intervals on the circumference of the flange 92B. The plurality of pins 92D are provided with a small hole 91E of the flange 91B of the centering guide 91 (see FIG. 29), a small hole 88E of the flange 88B of the dome-shaped seal 88 (see FIG. 29), and a small hole of the flange 87B of the first mount 87. Is inserted into. As a result, the centering guide 91, the dome-shaped seal 88, the first mount 87, and the second mount 92 are integrally assembled as shown in FIG.

  The pin 92D is crimped by heat welding such as ultrasonic welding while being inserted into the small holes 91E and 88E. As a result, the flange 87B of the first mount 91, the flange 88B of the dome-shaped seal 88, and the flanges of the airtight cover 92 and the centering guide 91 are fixed in close contact. Since the pin 92D is provided on the second mount 92 and protrudes toward the distal end side, the distal end side of the pin 92D to be caulked is not visible from the proximal end side of the airtight structure unit 92. By doing so, it looks better.

  The hermetic rubber cover 89 has a cylindrical cylindrical portion 89A and an inner flange 89B provided inside the cylindrical portion 89A. An opening 89C into which the trocar shaft 17 and the treatment tool 22 are inserted is formed in the inner flange 89B. A bellows portion 89D is provided between the cylindrical portion 89A and the inner flange 89B. The hermetic rubber cover 89 is formed of an elastomer such as silicone rubber having a JIS A hardness of 30 as measured by durometer. The hardness of the airtight rubber cover 89 is as soft as that of the dome-shaped seal 88. Further, in the rubber cover 89 for airtightness, the bellows portion 89D is formed to be thinner than other portions such as the peripheral edge 82A and the folded portion 89E, the bellows portion 89D has a thickness of 0.3 mm, and the thickness of other portions. Is 0.5 mm.

  A small hole into which the pin 92D of the second mount 92 is inserted is also formed in the inner flange 89B. As shown in FIG. 30, the inner flange 89B is sandwiched between the flange 88B of the dome-shaped seal 88 and the flange 91B of the centering guide 91 by inserting the pin 92D into the small hole. Thus, the first mount 87, the dome-shaped seal 88, the centering guide 91, and the second mount 92 are attached to the airtight rubber cover 89. In addition, the bellows portion 89D elastically deforms and expands and contracts, so that the dome-shaped seal 88 and the centering guide 91 are displaceably supported inside the hermetic rubber cover 89. The bellows portion 89D allows the dome-shaped seal 88 and the centering guide 91 to move in the radial direction.

  The cylindrical portion 89A of the hermetic rubber cover 89 is attached so as to cover the outer peripheral surface of the cylindrical portion 86B of the seal holder 86. A folded portion 89E that is folded inward is provided at the peripheral end on the distal end side of the cylindrical portion 89A, and the folded portion 89E covers the peripheral edge 86D of the cylindrical portion 86B of the seal holder 86.

(Assembly of seal unit)
The assembly of the seal unit 82 is performed, for example, as follows. First, the centering guide 91 is formed by overlapping the segments 93, and the pin 92D is inserted into the small hole 91E of the flange 91B, and is attached to the second mount 92.

  Next, the pin 92 </ b> D is inserted into the small hole of the inner flange 89 </ b> B, and the second mount 92 with the centering guide 91 attached is attached to the airtight rubber cover 89. A pin 92D protrudes from a small hole in the inner flange 89B of the hermetic rubber cover 89. In this state, the flange 88B of the dome-shaped seal 88 and the flange 87B of the first mount 87 are sequentially attached to the pin D projecting from the inner flange 89B of the hermetic rubber cover 89 from the tip side. After these attachments are completed, the pin 92D is crimped.

  Finally, an airtight rubber cover 89 is put on from the base end side of the seal holder 86. The cylindrical portion 89B is attached to the outer periphery of the cylindrical portion 86B, and the folded end portion 89E covers the peripheral end portion 86D. The first mount 87, the dome-shaped seal 88, the centering guide 91, and the second mount 92 fixed to the inner flange 89C are housed inside the seal holder 86. Thus, the seal holder 86, the first mount 87, the dome-shaped seal 88, the centering guide 91, the second mount 92, and the airtight rubber cover 89 are integrated, and the seal unit 82 is completed.

(Attaching the airtight structure unit to the head)
As shown in the cross-sectional view of FIG. 30, the duckbill valve 81 is pushed toward the distal end side while the outer peripheral surface of the circular portion 81B is pressed against the inner wall of the head inner cylinder 32A until the flange 81D contacts the abutting surface 83. It is attached by being done.

  When the duckbill valve 81 is mounted, an inner space S1 is formed in the head inner cylinder 32A by the outer peripheral surface of the duckbill valve 81 and the inner peripheral surface of the head inner cylinder 32A. The internal space S1 communicates with the insertion hole 33 of the pipe inner tube 31A, and a connection port 49 to which carbon dioxide gas is supplied is also connected to the internal space S1.

  After the duckbill valve 81 is attached, the seal unit 82 is attached to the base end side of the duckbill valve 81. The seal unit 82 is attached with the folded-back portion 89E of the rubber seal 89 for covering the peripheral end portion 86D of the seal holder 86 and the base end side of the flange 81D of the duckbill valve 81 in contact with each other. After the seal unit 82 is attached, the rear cover 43 is attached from the base end side of the seal unit 82.

  When the rear cover 43 is attached to the head inner cylinder 32A, the seal unit 82 is pressed from the rear cover 43, and the duckbill valve 81 is pushed toward the distal end. As a result, the flange 81D of the duckbill valve 81 is pressed against the abutting surface 83. The space between the outer peripheral surface of the duckbill valve 81 and the inner wall of the head inner cylinder 32A is hermetically sealed. Thereby, the internal space S1 is hermetically sealed.

  When the rear cover 43 is attached, the abutting surface 43G on the distal end side of the rear cover 43 and the peripheral edge 82A on the proximal end side of the seal unit 82 covered with the airtight rubber cover 89 are pressed. The folded portion 89E and the flange 81D of the duckbill valve 81 come into pressure contact with the distal end side of the seal unit 82. Due to this pressure contact, in the internal space S2 of the duckbill valve 81, the peripheral end portion on the base end side of the duckbill valve 81 is sealed. Further, by attaching the rear cover 43, the seal unit 82 is sandwiched between the duckbill valve 81 on the distal end side and the rear cover 43 on the proximal end side, and is fixed so as not to move in the Z-axis direction.

  Further, in the seal unit 82, the inner flange 89B of the hermetic rubber cover 89 and the flange 88B of the dome-shaped seal 88 are pressed against each other by the caulking of the pin 92D to be hermetically sealed. Therefore, when the treatment tool 22 is inserted through the opening 88C of the dome-shaped seal 88, the internal space S2 of the duckbill valve 81 is hermetically sealed.

(Function of airtight structure unit)
When the camera-equipped trocar 16 is inserted into the body cavity and the insufflation is performed by the supply of carbon dioxide, the pressure in the internal space S1 increases, and the openings 81C are formed on the two slopes of the valve portion 81A of the duckbill valve 81. Pressure acts in the closing direction. When the treatment tool 22 is not inserted through the opening 81C, the opening 81C is hermetically sealed by air pressure. The duckbill valve 81 is hermetically attached to the head inner cylinder 31A. Therefore, when the treatment tool 22 is not inserted through the opening 81C, gas leakage from the internal space S1 to the outside of the body is prevented.

  When the trocar shaft 17 and the treatment tool 22 are inserted through the opening 88C and the like of the dome-shaped seal 88, the opening 88C expands by elasticity and comes into close contact with the outer peripheral surface of the trocar shaft 17 and the treatment tool 22. On the other hand, the opening 81C of the duckbill valve 81 is opened when the trocar shaft 17 or the treatment tool 22 is inserted. Since the opening 81C is a streak-shaped opening, when the opening 81C is opened, a gap is formed between the opening 81C and the outer peripheral surface of the trocar shaft 17 or the treatment tool 22, and the sealing is released.

  However, when the trocar shaft 17 and the treatment tool 22 are inserted, the proximal end of the internal space S2 in the duckbill valve 81 is sealed by the seal unit 82 including the dome-shaped seal 88. For this reason, even if the opening 81C of the duckbill valve 81 is opened by the insertion of the trocar shaft 17 or the treatment tool 22, gas is prevented from leaking out of the body through the insertion hole 33 to the outside of the body.

  The seal unit 82 uses the single-piece dome-shaped seal 88 having the opening 88 </ b> C, so that airtightness is reduced by the absence of a gap between segments as compared with a conventional seal in which a seal is formed by a plurality of segments. improves.

  A centering guide 91 having a higher hardness than the dome-shaped seal 88 and having an opening 91C is arranged on the base end side of the dome-shaped seal 88. Therefore, when the treatment tool 22 is inserted into the trocar 16 with a camera, the treatment tool 22 is easily guided to the position of the opening 88 </ b> C at the center of the dome-shaped seal 88. This is because the treatment tool 22 is guided to the position of the opening 88C of the dome-shaped seal 88 if the treatment tool 22 is abutted against the base end side of the centering guide 91 and the position of the opening 91C is detected by tactile sensation. It is easier to find the position of the opening than in the case where a protector having no opening on the base end side of the seal as in the related art is arranged. Further, the hardness of the centering guide 91 is higher than that of the dome-shaped seal 88, and the frictional resistance of the treatment tool 22 is reduced.

  In this embodiment, the seal unit 82 uses a combination of a dome-shaped seal 88, a centering guide 91 composed of a plurality of segments 93, and an airtight rubber cover 89. The hardness of the dome-shaped seal 88 and the rubber cover 89 for sealing is lower than the hardness of the centering guide 91. Therefore, as described below, even when a radial force acts on the opening 88C of the dome-shaped seal 88 due to the movement of the treatment tool 22, the deformation of the opening 88C is prevented. If the deformation of the opening 88C is prevented, a gap is hardly formed between the opening 88C and the outer peripheral surface of the treatment tool 22, so that good sealing performance can be secured.

  32A and 32B are views of the seal unit 82 in a state where the treatment tool 22 is inserted, as viewed from the proximal end side. 32A shows a state in which the treatment tool 22 is at the radial center of the seal unit 82, and FIG. 32B shows a state in which the treatment tool 22 has moved from the state of FIG. 32A to the right in the radial direction of the seal unit 82. Is shown.

  When the treatment tool 22 is inserted, the opening 88C of the dome-shaped seal 88 and the opening 91C of the centering guide 91 expand according to the outer diameter of the treatment tool 22. As shown in FIG. 32A, in a state where the treatment tool 22 is at the center, the bellows portion 89D of the rubber cover 89 for airtight maintains the uniform initial state over the entire circumference with the cylindrical portion 89A.

  When the treatment tool 22 is operated to move the treatment tool 22 in the radial direction (right side in the figure) as shown in FIG. 32B, a force acts in a direction to expand the opening 91C of the centering guide 91. In order for the opening 91C to expand, the adjacent segments 93 must move in a direction in which the adjacent segments 93 are separated from each other. At this time, friction occurs due to contact of the overlapping region 93A. The resistance force at the time of expanding the opening 91C due to the frictional resistance is the resistance force at the time of expanding the opening 88C of the dome-shaped seal 88 and the resistance force at the time of elastically deforming the bellows portion 89D of the hermetic rubber cover 89. Greater than.

  Therefore, the bellows 89D is elastically deformed earlier than the opening 91 is expanded. When the bellows portion 89D is elastically deformed, the centering guide 91 and the dome-shaped seal 88 held by the inner flange 89B of the hermetic rubber cover 89 move as a whole in the radial direction. Thereby, the force for expanding the opening 88C of the dome-shaped seal 88 is also reduced, so that the deformation of the opening 88C is prevented.

  Further, by making the shape of the segment 93 constituting the centering guide 91 into a sector shape having an arc of 1/4 of the circumference of the centering guide 91, compared with the prior art using a protector constituted by semicircular segments. , The amount of overlap between adjacent segments 93 is reduced. Thereby, the smoothness of insertion and withdrawal of the treatment tool 22 into and from the opening 91C is improved. Further, by setting the area of the overlapping region to be equal to or less than half of the entire area of the segment, the amount of overlapping is reduced as compared with the related art, so that the smoothness is further improved.

  In addition, the overlapping region 93A of the adjacent segments 93 has a shape in which the overlapping width monotonously increases from the outer periphery toward the center opening 91C, so that the smoothness of the insertion and withdrawal of the treatment tool 22 into and from the opening 91C is improved. It can be further improved. This is because the treatment instrument 22 is inserted near the center of the opening 91C, so that the adjacent segments 93 are easily separated. On the other hand, the closer to the outer periphery, the farther the treatment tool 22 is located near the center, so the amount of separation between adjacent segments 93 decreases.

  As described above, in consideration of the smoothness of insertion and withdrawal of the treatment tool 22, it is preferable that the overlap region 93A be small. Therefore, by making the width of the overlapping region 93A monotonically increasing from the outer periphery toward the center opening 91C, a gap is prevented from being formed between the adjacent segments 93, and the overlapping region 93A is formed. The width can be kept to a minimum.

  Hereinafter, the operation of the above configuration will be described. When performing laparoscopic surgery, the endoscope 11 and the camera-equipped trocar 16 are connected to the processor 18. After the connection is completed, the processor 18 is started. Accordingly, the driving of the camera unit 28 of the endoscope 11 and the camera unit 62 of the trocar 16 with camera are started, and photographing is started. Image signals of the camera unit 28 and the camera unit 62 are input to the processor 18. The processor 18 performs image processing on the image signal, and displays a combined image obtained by combining the endoscopic image and the trocar image on the monitor 19.

  The medical staff ST inserts the endoscope 11 and the trocars 16 and 17 into the abdominal cavity while checking the composite image displayed on the monitor 19. First, three incisions 26 and 27 are made in the abdomen of the patient P, for example, as shown in FIG. A normal trocar 21 without a camera function is inserted into the central incision 26.

  On the other hand, two camera-equipped trocars 16 are inserted into the two incisions 27. The trocar 16 with a camera is inserted with the trocar shaft 17 mounted on the trocar 16 with a camera. At the time of mounting, as shown in FIGS. 12B and 13B, the outer cylinder member 16B of the trocar 16 with camera is set to the holding release position where the camera section 36 is in the deployed position.

  The slide of the outer cylinder member 16B is locked by the unlocking operation member 46. Therefore, when in the holding position, as shown in FIG. 19B, the outer cylinder member 16B is slid to the holding release position on the base end side in a state where the lock is released by pressing the unlocking operation member 46. As shown in FIG. 19C, the outer cylindrical member 16B is slid toward the holding release position, and when the engaging protrusion 46E reaches the engaging groove 47B, the engaging protrusion 46E and the engaging groove are acted on by the action of the spring 68. The outer cylinder member 16B is locked in the holding release position by the engagement of 47B.

  In this state, the shaft portion 53 is inserted from the head portion 32 into the insertion hole 33 of the pipe portion 31. As shown by the two-dot chain line in FIG. 14, the cam pin 59 is aligned with the position of the guide groove 52C, and the trocar shaft 17 is advanced to the distal end side to engage the cam pin 59 with the guide groove 52C. When the cam pin 59 reaches the second end 52B, the fitting claw 54A shown in FIG. 6 enters the fitting groove 43B from the notch 43C shown in FIG. 7, and the state shown in FIG. 4, FIG. 12B and FIG. Become. This state is a holding release position of the outer cylinder member 16B where the camera unit 36 is in the deployed position.

  When rotating the trocar shaft 17 toward the initial position, the unlock operation member 46 is pressed to lock the slide of the outer cylinder member 16B. In this state, the handle portion 54 of the trocar shaft 17 is rotated. Due to the rotation of the trocar shaft 17, the outer cylindrical member 16B slides toward the distal end along the Z-axis direction by the action of the cam pins 59 and the cam grooves 52B. Due to this sliding, the distal end of the pipe portion 31 comes into contact with the camera portion 36 at the deployed position from the rear, and rotates the camera portion 36 toward the storage position. When the outer cylinder member 16B reaches the holding position, the storage of the camera unit 36 is completed as shown in FIGS. 3, 12A and 13A.

  As described above, since the outer cylinder member 16B is slid by the rotation of the trocar shaft 17, the force acting in a direction other than the Z-axis direction is reduced as compared with the case where the pipe outer cylinder 31B is directly gripped and operated. Therefore, a smooth sliding operation of the pipe outer cylinder 31B becomes possible.

  When the trocar shaft 17 is mounted on the camera-equipped trocar 16, the puncture portion 55 is exposed from the tip of the pipe portion 31. When the trocar 16 with camera 16 is inserted, the trocar 16 is inserted from the puncture portion 55 into the incision portion 27. The puncture section 55 enters the body cavity while pushing and expanding the abdominal wall 23, and the pipe section 31 enters following the puncture section 55. At this time, the puncture unit 55 advances while tearing the subcutaneous tissue of the fat 23A.

  At this time, the subcutaneous tissue of the fat 23A constituting the abdominal wall 23 is wound around the puncture portion 55 and the pipe portion 31. As shown in FIG. 23A, when the trocar shaft 17 is at the initial position and the camera unit 36 is in the retracted position, the two ridges 78 of the puncture unit 55 are at positions corresponding to the hinges of the camera unit 36. Placed in Therefore, as shown in FIG. 24A and FIG. 24B, in the region R1 around the hinge portion including the hinge portion of the camera portion 36 behind the puncture portion 55, the wrapping of the fat 23A is larger than that in the other region R2. Is suppressed.

  When the pipe portion 31 of the camera-equipped trocar 16 is inserted to a desired depth in the body cavity, the camera portion 36 is deployed. In this case, the lock operation member 46 is pressed to release the slide lock of the outer cylinder member 16B. In this state, the handle portion 54 of the trocar shaft 17 is rotated from the initial position to the release completion position. Then, by the action of the cam pins 59 and the cam grooves 52, the outer cylinder member 16B slides from the holding position to the holding release position toward the base end. As described above, since the outer cylinder member 16B is slid by the rotation operation of the trocar shaft 17, smooth operation is possible. With this slide, the holding of the camera unit 36 is released, and the camera unit 36 pops up toward the deployed position by the urging force of the spring 71.

  Further, when rotating the trocar shaft 17 toward the release completion position, as shown in FIGS. 15A to 15C, the pressing portion 57B provided on the connecting portion 57 comes into contact with the camera portion 36 to expand the camera portion 36. Push up to position. Fat 23A may adhere to the tip of the pipe section 31 where the camera section 36 is provided, and may cause resistance when the camera section 36 pops up. Even in such a case, since the urging force of the spring 71 is assisted by the deployment assisting mechanism constituted by the connecting portion 57, the deployment of the camera unit 36 by pop-up can be reliably performed.

  In addition, the two protrusions 78A and 78B of the puncture portion 55 also suppress the winding of the fat 23A around the region R1 around the hinge portion of the camera portion 36, so that the camera portion 36 can be smoothly deployed. become.

  Further, at the holding release position where the camera section 36 is in the deployed position, as shown in FIG. 19C, the outer cylinder member 16B is engaged with the engagement projection 46E and the engagement groove 47B, and the slide is locked. . For this reason, there is no possibility that the outer cylinder member 16B slides inadvertently and the camera unit 36 is stored.

  With the camera unit 36 expanded, the trocar shaft 17 is at the release completion position. In this state, the cam pin 59 has reached the second end 52B as shown by a two-dot chain line in FIG. Therefore, the trocar shaft 17 can be removed from the camera-equipped trocar 16 while moving the cam pin 59 along the guide groove 52C.

  After the trocar shaft 17 is removed, carbon dioxide is supplied into the body cavity through the connection port 49 and the insertion hole 33 of the camera-equipped trocar 16 to perform insufflation treatment. When the treatment tool 22 is not inserted through the camera-equipped trocar 16, the internal space S <b> 1 (see FIG. 30) communicating with the insertion hole 33 is hermetically sealed by the duckbill valve 81. Therefore, gas leakage does not occur in this state.

  After completion of the insufflation procedure, the endoscope 11 is inserted into the body cavity using the trocar 21 as an insertion port. Then, the treatment tool 22 is inserted into the body cavity using the trocar 16 with camera as an insertion port.

  When the treatment tool 22 is inserted, the centering guide 91 having a hardness higher than that of the dome-shaped seal 88 and having the opening 91C easily guides into the opening 88C of the dome-shaped seal 88.

  When the treatment tool 22 is inserted, the opening 81C of the duckbill valve 81 opens. The treatment tool 22 is inserted into the opening 88C of the dome-shaped seal 88 of the airtight structure unit 42, and the opening 88C and the treatment tool 22 are in close contact. Therefore, the sealing by the duckbill valve 81 is released, but the seal of the internal space S2 (see FIG. 30) communicating with the insertion hole 33 is maintained by the airtight structure unit. In addition, since the dome-shaped seal 88 has a single-piece configuration, the sealing performance is better than that in the case where the dome-shaped seal 88 is configured with a plurality of segments.

  The medical staff ST operates the treatment tool 22 and performs a procedure while observing the inside of the body cavity through the composite image displayed on the monitor 19. Since the dome-shaped seal 88 has high flexibility, good operability of the treatment tool 22 is ensured. Even when the treatment tool 22 moves in the radial direction, the combination of the dome-shaped seal 88, the bellows portion 89D of the rubber cover 89 for airtightness, and the centering guide 91 having a higher hardness than these, as shown in FIG. Is prevented from being deformed. By preventing deformation of the opening 88C, sealing performance can be ensured.

  The present invention is not limited to the above-described embodiment, and naturally extends to a form in which the above-described embodiment is appropriately changed without departing from the present invention. For example, in the above embodiment, a plurality of inventions are included, but they may be implemented independently, or two or more inventions may be appropriately combined. Further, in the above embodiment, the seal unit including the dome-shaped seal and the centering guide can be applied to a normal trocar having no camera.

Reference Signs List 10 Laparoscope system 11 Endoscope 11A Insertion section 12 Trocar device with camera 16 Trocar with camera 16A Inner cylinder member 16B Outer cylinder member 17 Trocar shaft 18 Processor 19 Monitor 20 Console 21 Trocar 22 Treatment tool 22A Tip 23 Abdominal wall 23A Fat 26 , 27 Notch 28 Camera unit 31 Pipe section 31A Pipe section inner cylinder 31B Pipe section outer cylinder 32 Head section 32A Head section inner cylinder 32B Head section outer cylinder 33 Insertion hole 35 Engaging claw 36 Camera section 41 Non-slip 42 Airtight structure unit 43 Rear cover 43A engaging hole 43B fitting groove 43C notch 43D gripping part 43E opening 43F slot 43G abutment surface 44 connector part 46 unlocking operation member 46A operation part 46B support part 46C mounting pin 46D mounting hole 46E Convex part 47 Engagement part 47A, 47B Engagement groove 49 Connection port 51 Cam plate 52 Cam groove 52A First end 52B Second end 52C Guide groove 52D Linear part 52E Inclined part 53 Shaft part 54 Handle part 54A Fitting claw 55 Puncture Part 55A Outer peripheral surface 56 Shaft part main body 57 Connecting part 57A Main part 57B Pressing part 58 Pin arranging plate 58A Position mark 58B Direction mark 58C Inner peripheral surface 58D Outer peripheral surface 58E Extension part 59 Cam pin 61 Notch 62 Camera unit 62A Photographing lens 62B Lens barrel 63 Mount 64 Housing 64A Upper surface 64B Side 64C Hook 65 Rotating pin 66 Attachment 66A Opening 66B Bearing 67 Bearing 67A Tip side receiving port 68 Spring 71 Spring 72 Housing recess 72A Hook 76 Drop-off prevention member 76A Fixed end 76B Free end 76C Projection 78 Ridge part 79 Upper end part 81 Duck bill valve 81A Valve part 81B Circular part 81C Opening 81D Flange 82 Seal unit 82A Peripheral edge 83 Butting surface 86 Seal holder 86A Cover part 86B Cylindrical part 86C Opening 86D Peripheral edge 87 First mount 87A Mount part 87B Flange 87C Opening 88 Dome-shaped seal 88A Seal part 88B Flange 88C Opening 88E Small hole 89 Airtight rubber cover 89A Cylindrical part 89B Inner flange 89C Opening 89D Bellows part 89E Folding part 91 Centering guide 91A Guide part 91B Flange 91C Opening 91E Small hole 92 Second mount 92A Mount part 92B Flange 92C Opening 92D Pin 93 Segment 93A Overlap area C1, C2 Center line D1, D2 Maximum diameter Lp Connection line P Patient R1 Area R2 Area S 1 Internal space S2 Internal space ST Medical staff

Claims (8)

A trocar seal unit that is built into the trocar through which the treatment tool is inserted and maintains airtightness inside the trocar communicating with the body cavity when the treatment tool is inserted,
A seal formed of one elastically deformable material having a circular planar shape and having an opening formed at the center in the radial direction for inserting a treatment instrument;
A centering guide that is disposed closer to the base end than the seal in the axial direction of the trocar and guides the treatment instrument to a center position in the radial direction.
The centering guide is composed of a plurality of segments, and the plurality of segments are overlapped so that a part of the adjacent segments overlap with each other. It has a dome shape ,
And the material of the plurality of segments is higher in hardness than the seal,
Furthermore, in a state where the plurality of segments are superimposed, an opening is formed at the center in the radial direction ,
The segment has a fan-shaped portion forming the dome shape, and an overlapping area where each of the adjacent segments overlaps,
In the overlapping region, in the width direction orthogonal to the boundary between the fan-shaped portion and the overlapping region, the overlapping width monotonically increases from the outer periphery of the centering guide toward the center opening.
Seal unit for trocar. 2. The trocar seal unit according to claim 1, wherein an arc length of the sector portion is １ ／ of a circumference of the centering guide. 3. The seal unit for a trocar according to claim 1 , wherein an opening of the seal and an opening of the centering guide have the same diameter when the treatment tool is not inserted through the trocar.   The seal unit for a trocar according to any one of claims 1 to 3, wherein an area of an overlapping region where the adjacent segments overlap each other is equal to or less than half of each segment. In each of the plurality of segments, a cutout portion that is a cutout portion obtained by cutting out the arc center of the sector portion, and that forms a part of the opening, is formed.
The trocar seal unit according to any one of claims 1 to 4, wherein a side on the opening side in the overlap region is smoothly connected to the cutout portion . A rubber cover that integrally holds the seal and the centering guide,
The rubber cover,
An inner flange to which an outer peripheral portion of the seal and the centering guide are fixed,
6. A bellows portion disposed between the inner flange and the outer peripheral portion of the rubber cover, the bellows portion allowing radial movement of the seal and the centering guide by elastic deformation. The seal unit for a trocar according to claim 1 or 2 . The hardness of the centering guide is higher than the rubber cover in addition to the seal,
The resistance force when expanding the opening of the centering guide is larger than the resistance force when expanding the opening of the seal and the resistance force when elastically deforming the bellows portion of the rubber cover. Trocar seal unit. The seal is formed of silicone rubber having a JIS A hardness of 30 as measured by a durometer.
The trocar seal unit according to any one of claims 1 to 7, wherein the centering guide is formed of polyurethane having a JIS A hardness of 90 as measured by a durometer .

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