JP6647166B2 - 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 Engineering Cooperative Business Promotion Project Demonstration Project” commissioned research and the Industrial Technology Strengthening Act in FY2016. The present invention relates to a trocar used for endoscopic surgery.

  In recent years, minimally invasive surgery such as laparoscopic surgery for inserting an endoscope into the abdominal cavity has been required to maintain and improve the quality of life (QOL) of patients. Laparoscopic surgery inflates the abdominal wall by injecting carbon dioxide into the abdominal cavity to ensure space and field of view for the procedure. Then, a small hole is made in the abdominal wall, a device called a trocar is inserted, and surgical instruments such as an endoscope (such as a CCD camera) and forceps are inserted into the patient's body from there, and the image displayed on the monitor by the endoscope It is common to perform surgery while observing (Patent Documents 1 and 2).

  In such a conventional endoscopic surgery, since only one endoscope is usually inserted, the field of view is limited, and there is very little information that an operator can determine by looking at the monitor during the procedure. On the other hand, a wider field of view can be secured by additionally inserting an endoscope, but it is necessary to make a new hole in the body wall to insert the endoscope, which increases the burden on the patient. Would. Therefore, a proposal has been made to attach a small camera to a trocar used for laparoscopic surgery to expand the observation field of view in laparoscopic surgery (Patent Document 3).

That is, Patent Literature 3 employs a mechanism that, when a trocar is inserted into the abdominal cavity, stores the camera in the trocar, and deploys the camera outside the trocar when the tip of the trocar is inserted into the abdominal cavity. Have been.
However, since it is necessary to install a mechanism for operating the storage and deployment of the camera in the trocar, there is a problem that the inner diameter and outer shape of the trocar itself become large, which increases the burden on the patient.

JP 2013-046789 A JP 2006-167475 A JP 2014-1329779 A

The object of the invention is a benzalkonium provide a trocar having a space-saving camera deployment mechanism.

An embodiment of the present invention for solving the above problems has the following configuration.
(1) A trocar including a pipe portion for inserting a medical device into a body and a head portion, wherein the pipe portion includes a pipe portion outer tube and a pipe portion inner tube, and the head portion includes a head portion. Including the outer cylinder and the head inner cylinder, the pipe outer cylinder and the head outer cylinder are integrally molded or integrally joined, and the pipe inner cylinder and the head inner cylinder are integrally molded or integrally joined A trocar, characterized in that an outer peripheral surface of the pipe outer cylinder has a tapered portion whose outer diameter decreases from a rear end to a front end on the head portion side.
(2) At the tip of the pipe inner cylinder, there is provided a camera part which is rotatably supported between an unfolded state in which it is rotated out of the pipe part and a stored state in which it is stored in the pipe part. The pipe outer cylinder is externally slidable on the pipe inner cylinder so as to be slidable in the axial direction, and the camera section is stored in the pipe section while being slid toward the tip of the pipe section (1). The trocar according to (1).
(3) The trocar according to (1) or (2), wherein the outer tube of the pipe portion and the outer tube of the head portion are integrally formed via a thick region.
(4) The trocar according to any one of (1) to (3), wherein the pipe outer cylinder is a resin tube, and is integrally formed with the head outer cylinder.
(5) The trocar according to any one of (1) to (3), wherein the pipe outer cylinder is a metal tube, and is integrally joined to the head outer cylinder in the thick region.
(6) The trocar according to any one of (1) to (5), having a uniform thickness region (A) at a distal end portion of the pipe outer cylinder.
(7) The trocar according to any one of (1) to (6), which has a uniform thickness region (B) at a rear end portion of the pipe outer cylinder.
(8) The trocar according to any one of (1) to (7), wherein a seal member whose inner peripheral surface is pressed against the outer peripheral surface of the pipe inner cylinder is attached to the thick region.
(9) The trocar according to any one of (6) to (8), which has a corrugated region in a cross section other than the region (A) and the region (B) on the outer peripheral surface of the pipe outer cylinder. .
(10) The trocar according to any one of (1) to (9), wherein the medical device is inserted into the body through the pipe inner cylinder.
(11) The trocar according to any one of (8) to (10), wherein the sealing material is pressed by a sealing material pressing member formed on an outer peripheral surface with a screw groove screwed to an inner peripheral surface of the thick region. .

  According to the present invention, since the outer peripheral surface of the pipe portion outer cylinder has a tapered portion having a smaller outer diameter from the rear end portion to the front end portion on the head portion side, the pipe portion outer cylinder can be made thinner, and The trocar can be easily inserted into the trocar, and the strength can be ensured.

FIG. 1 is a perspective view showing a trocar in an expanded state of a camera according to an embodiment of the present invention. FIG. 2 is a perspective view of the trocar in a state where a trocar shaft is removed from the trocar shown in FIG. 1. (A) is a cross-sectional view of the trocar according to one embodiment of the present invention, and (b) is a cross-sectional view obtained by rotating (a) by 90 degrees and obliquely observing from behind. (A) is a sectional view of the trocar with a trocar shaft inserted, and (b) is a partial sectional view showing a head portion thereof. FIG. 4 is an enlarged cross-sectional view of a portion X shown in FIG. (A) is a perspective view which shows a sealing material and (b) shows a sealing material holding member, respectively. 1 is an exploded perspective view of a trocar according to an embodiment of the present invention. It is an exploded perspective view of an airtight structure unit in one embodiment of the present invention. FIG. 9 is an exploded perspective view of FIG. It is a fracture | rupture perspective view which shows the assembly state of an airtight structure unit. It is sectional drawing which shows the state which rotated the airtight structure unit shown in FIG. 10 by 90 degrees. (A) and (b) are a perspective view and a cross-sectional view, respectively, showing the distal end portion of the trocar in a camera unit unfolded state. It is sectional drawing of a camera part. It is the perspective view which looked at the tip part of the trocar in the camera part deployment state from the surgeon side (front side). It is a perspective view for explaining the rotation mechanism of a camera part. 4A and 4B are a cutaway perspective view and a sectional view showing the structure of the camera unit, respectively. (A)-(d) is a perspective view which shows the usage method of a trocar. It is explanatory drawing which shows the use state of a trocar. FIG. 7 is a perspective view showing a trocar according to another embodiment of the present invention. It is a partial expanded sectional view showing a head part of a trocar concerning yet another embodiment of the present invention.

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

<Overall structure of trocar>
FIG. 1 shows a trocar 1 according to one embodiment of the present invention. The trocar 1 is used, for example, for laparoscopic surgery. The trocar 1 has a pipe portion 2 located at a distal end (distant position) when viewed in a direction to be inserted at the time of an operation, and an operator side (hereinafter, referred to as a “front side (rear side) End portion))).

  As shown in FIG. 1, a trocar 1 is equipped with a trocar shaft 4 that penetrates a pipe portion 2 from a head portion 3. The trocar shaft 4 has a puncture portion 4a formed at the front end for puncturing the abdominal cavity through the body wall, and a handle portion 4b formed at the rear end. The puncturing portion 4a has a conical shape such that the tip substantially matches the inner diameter of the pipe portion 2. The handle portion 4b is used by an operator to perform operations of inserting and removing the trocar shaft 4 from and into the trocar 1. The connector connecting portion 11a shown in FIG. 1 is where the connector portion 11 to be connected to the flexible cable 28 described later is attached. Further, a finger rest holding unit 300 for the operator to put his fingers (for example, the index finger and the middle finger) on the rear end side of the pipe part 2 may be provided.

  As shown in FIGS. 1 and 2, the trocar 1 has a camera unit 5 as an imaging unit attached to a tip of a pipe unit 2.

<Pipe section>
As shown in FIG. 3A, the pipe portion 2 of the trocar 1 holds the camera portion 5 attached to the tip of the trocar 1 in a retracted state and an expanded state. It has a double structure including the internal cylinder 22. The mechanism for setting the storage state and the unfolded state will be described later in detail. The inner diameter of the pipe inner tube 22 having the double structure is determined by the surgical instrument inserted into the trocar 1, and is usually about 5 mm to 13 mm over the entire length of the pipe 2 from the operator side to the distal end side. have. On the other hand, the outer peripheral surface of the pipe portion outer cylinder 21 has a tapered portion 95 in which the outer diameter of the pipe portion outer cylinder 21 decreases from the rear end to the front end of the head portion 3.
The pipe outer tube 21 and the pipe inner tube 22 are made of, for example, resin. The ratio of the taper can be appropriately set according to the material to be used and the length and thickness of the pipe portion 2. The tapered portion 95 can be formed by changing the thickness of the pipe outer tube 21 at the front end and the rear end. The tapered portion 95 preferably has a value obtained by subtracting the outer diameter of the front end portion from the outer diameter of the rear end portion of the pipe outer tube 21 is 0.5 mm or more, preferably about 0.8 mm to 1 mm. . For example, for a pipe 2 having a total length of 92 mm from the front end to the rear end, the outer diameter of the pipe outer tube 21 at the front end is 16 mm (wall thickness is 0.55 mm), and the outer diameter of the rear end is It is preferably about 18 mm (thickness: 1.35 mm). Thus, the pipe outer cylinder 21 has the tapered portion 95 whose diameter decreases toward the distal end. Considering the burden on the patient, it is desirable that the outer diameter of the pipe outer cylinder 21 that increases with respect to the outer diameter of the surgical tool to be used is as small as possible. However, when an operation mechanism for holding the camera unit 5 attached to the distal end in two states of a retracted state and an expanded state is required as in the present invention, an increase in the outer diameter of the pipe outer cylinder 21 is required. Tends to increase. For this reason, the tapered structure is an effective structure for further suppressing the increase in the outer diameter of the pipe outer cylinder 21 and reducing the burden on the patient, and securing the necessary strength. By adopting such a tapered structure, the thickness of the distal end portion is reduced and insertion becomes easy. Further, the overall strength of the pipe portion 2 can be ensured.

  A uniform thickness region (A) is provided at the distal end of the pipe outer cylinder 21. The uniform thickness region (A) is a region in which the outer diameter (thickness) of the pipe outer cylinder 21 is uniform. The length of the uniform thickness region (A) can be set as appropriate, but is preferably, for example, about 2 to 10% of the entire length of the pipe portion 2. A uniform thickness region (B) is also provided at the rear end of the pipe outer cylinder 21. Like the uniform thickness region (A), the length of the uniform thickness region (B) is preferably about 2 to 10% of the entire length of the pipe portion 2. Such a uniform thickness region (A) and a uniform thickness region (B) exist at the front end and the rear end, and are easy to mold.

As shown in FIG. 3A, at least on the outer peripheral surface of the tapered portion 95 of the pipe outer cylinder 21, a corrugated region 90 having a cross section arranged in a row in the axial direction of the pipe is formed. Good. Since the corrugated region 90 has a rising surface facing the head portion 3 side, when the trocar 1 is indwelled and held on the abdominal wall, the trocar 1 is inadvertently released by the pressure of the gas pressed into the abdominal cavity. Can be prevented. Further, since the corrugated region 90 is formed in the tapered portion 95, it does not hinder the insertion of the trocar 1 into the abdominal cavity. When the trocar 1 is pulled out, for example, the trocar 1 may be pulled out while rotating.
The corrugated region 90 may be formed over the entire length of the pipe outer cylinder 21 as long as the thickness of the pipe outer cylinder 21 is ensured. (A) and the area other than the uniform thickness area (B).
In the embodiment shown in FIGS. 1 to 3, the corrugated region 90 is formed on the entire tapered portion 95 excluding the uniform thickness regions (A) and (B), but is formed on a part of the tapered portion 95. It may be.
The top of the rising surface of the corrugated region 90 may protrude radially from the outer surface of the tapered portion 95 (ie, a straight line extending from the outer peripheral surface of the rear end to the outer peripheral surface of the distal end), or may have strength. As long as there is no above problem, the tapered portion 95 may be located on the outer surface or inside thereof.

The pipe outer cylinder 21 is formed of a resin tube, and is formed integrally with a head outer cylinder 31 described later. The pipe inner cylinder 22 is also formed integrally with a head inner cylinder 32 described later.
The resin tube constituting the pipe outer tube 21 is made of, for example, a polycarbonate resin, an acrylic resin, a polyacetal resin, or the like. The pipe outer tube 21 and the head outer tube 31, and the pipe inner tube 22 and the head inner tube 32 may be integrally joined.

<Head part>
Next, the structure of the head unit 3 will be described. As shown in FIGS. 4A and 4B, the head part 3 includes a head part outer cylinder 31 integrally formed with the pipe part outer cylinder 21 and a head part inner cylinder integrally formed with the pipe part inner cylinder 22. 32. The head portion inner cylinder 32 includes an air supply pipe 10 that feeds gas such as carbon dioxide gas and air into the abdominal cavity. The gas fed from the air supply pipe 10 (see FIG. 1) attached to the head inner cylinder 32 is sent into the abdominal cavity through the pipe inner cylinder 22 to pressurize the abdominal cavity.

The head portion 3 includes the above-described head portion outer tube 31 and the head portion inner tube 32, and further includes an airtight structure unit 44 housed in the head portion inner tube 32 and a plug member 40 that closes the opening end 48 on the near side. Prepare. The head part outer cylinder 31 and the head part inner cylinder 32 having the opening end 48 constitute a head part main body.
The head outer cylinder 31 is preferably made of resin. Examples of the resin include a polycarbonate resin, an acrylic resin, and a polyacetal resin.

  In the head section 3, the plug member 40 has an opening 7 for inserting the trocar shaft 4 at the center. 4A and 4B, the trocar shaft 4 is inserted into the opening 7 and the handle portion 4b is engaged with the plug member 40. After the trocar shaft 4 is pulled out, a medical instrument such as a forceps (not shown, hereinafter, sometimes referred to as a surgical instrument) can be inserted through the opening 7. On the outer peripheral surface of the plug member 40, a connector portion 11 to which a flexible cable 28 (signal / power supply cable / FPC cable) extending from the camera portion 5 is connected is formed.

  As shown in FIG. 5, the head outer cylinder 31 is formed integrally with the rear end (the head 3 side) of the pipe outer cylinder 21 via the thick region 200. When the pipe outer tube 21 is a resin tube, it is formed integrally with the head outer tube 31 via the thick region 200 by a known method.

  On the inner side of the thick region 200, the inner peripheral surface is formed inside the pipe portion in order to ensure the sealing performance between the inner and outer cylinders of the pipe portion 2 and the head portion 3 formed as a double structure of the outer tube and the inner tube. A ring-shaped seal member 38 that comes into pressure contact with the outer peripheral surface of the cylinder 22 is incorporated. As shown in FIG. 5, the sealing material 38 is press-fitted into the concave portion 201 inside the thick region 200, and is extrapolated onto the pipe inner cylinder 22. At this time, the sealing material 38 sandwiches the flexible cable 28 on the inner peripheral surface. The flexible cable 28 has one end connected to the camera unit 5 as described later, and is disposed inside the pipe unit 2 toward the rear end.

As shown in FIG. 6A, the shape of the sealing material 38 has a D-shaped opening that allows the surface on which the flexible cable 28 is arranged to correspond to the linear portion. Although not shown, the pipe inner tube 22 also has a flat portion for arranging the flexible cable 28 so as to correspond to the D-shape of the sealing member 38. Further, in order to reduce the coefficient of friction of the sealing material 38, a lubricating effect may be ensured with oils or fats that can be used for medical purposes such as silicone oil. Further, the seal member 38 is preferably formed of, for example, silicone rubber.
By providing such a sealing member 38, nitrogen gas sent into the abdominal cavity during the operation from the air supply pipe 10 (see FIG. 1) through the gap between the pipe outer tube 21 and the pipe inner tube 22 can be externally supplied. Leakage can be prevented.

In order to hold the sealing material 38 in the concave portion 201 provided on the rear end side of the thick region 200, a sealing material pressing member 39 as shown in FIG. The seal member pressing member 39 has a male screw portion (not shown) that is screwed to a female screw portion formed on the outer peripheral surface in the concave portion 201 of the thick region 200 on the outer peripheral surface 39a. Can be fixed by pressing. Further, the seal member pressing member 39 has a plurality of holes 39b for mounting a jig for screwing into the inside of the thick region 200.
4A and 4B, the illustration of the seal member 38 and the seal member pressing member 39 is omitted.

<Airtight structure unit>
Next, the airtight structure unit 44 inside the head unit 3 will be described with reference to FIGS. This airtight structure unit 44 is for preventing gas inside the body from leaking out of the pipe inner tube 22.
As shown in FIGS. 7 and 8, the airtight structure unit 44 has a duckbill valve 8 on the distal end side (distant position) of the head inner cylinder 32, and further moves toward the near side (operator side) from the duckbill valve 8. And a sealing unit 60 arranged in the same direction.
The duckbill valve 8 has a flange 8a on the outer peripheral surface. On the other hand, a step 50 is formed on the inner peripheral surface of the head inner cylinder 32 on which the airtight structure unit 44 is mounted, with which the flange 8a contacts (see FIG. 6). 51 are formed, while the corresponding projections 52 are formed on the step portion 50. Therefore, when the airtight structure unit 44 including the duckbill valve 8 is mounted, the duckbill valve 8 is kept at a predetermined position. It is to be noted that the concave portion 51 and the convex portion 52 may be provided alone or in plurals.
The seal unit 60 includes a seal holding cover 42, a dome-shaped seal fixing distal end mount 91, a dome-shaped seal 92, an airtight rubber cover 37, and a dome-shaped seal fixed from the duckbill valve 8 to the near side (the surgeon side). A front mount 93 is provided. The seal unit 60 is a seal structure for preventing leakage of gas pressurized into the abdominal cavity by being in close contact with the surgical tool when inserting and using the surgical tool. It is configured.

  The duck bill valve 8 is a duck-mouthed valve mechanism, and separates the opening 7 from the inside of the pipe 2. As shown in FIG. 9, the duckbill valve 8 is closed to prevent leakage of gas pressurized into the abdominal cavity before insertion of a surgical instrument such as the trocar shaft 4 and forceps. The shaft 4 and the surgical tool are inserted into the pipe portion 2 so as to push open the opening 81. The duckbill valve 8 is formed from an elastomer material such as silicone rubber. FIG. 10 shows the airtight structure unit 44 rotated 90 ° from the state of FIG.

Returning to FIGS. 7 and 8, the seal unit 60 will be described. The seal holding cover 42 is formed of a resin material such as polyacetal, and has a large-diameter portion 42 a fitted to the cylindrical portion 8 b closer to the front of the flange 8 a of the duckbill valve 8, and a flange portion of the dome-shaped seal fixing distal end mount 91. And a flat portion 42c having a small-diameter portion 42b for positioning the 91b.
The tip-side mount 91 for fixing the dome-shaped seal is made of a polycarbonate resin or the like, and is composed of a peripheral wall portion 91a and a flange portion 91b fitted with the dome-shaped seal 92, and a plurality of flange portions 91b (six in FIG. ) Are integrally formed.

  The dome-shaped seal 92 is formed of an elastomer material such as silicone rubber, and includes a seal portion main body 92a having the instrument insertion port 41 for inserting the trocar shaft 4 and other surgical tools, and a flange portion 92b. The flange portion 92b is provided with a positioning hole 45 through which a pin 91c provided on the dome-shaped seal fixing distal end mount 91 is inserted.

  The hermetic rubber cover 37 is formed of an elastomer material such as silicone rubber, and has a function of connecting the duckbill valve 8 and the dome-shaped seal 92 to enhance airtightness therebetween. The hermetic rubber cover 37 includes a cylindrical portion 37a, a first small-diameter portion 37b provided on the distal end side, and a second small-diameter portion 37c provided on the front side, and a dome-shaped seal is provided on the second small-diameter portion 37c. A bellows portion 371 is formed so as to follow the 92 slides. Further, a positioning hole 46 through which the pin 91c is inserted is formed in a peripheral portion (flat portion) 37d of the opening 39 in the second small diameter portion 37c.

  The dome-shaped seal fixing front mount 93 is formed of a resin material such as polyacetal, and includes a peripheral wall portion 93a fitted with the dome-shaped seal 92 and a flange portion 93b. A positioning hole 47 through which a pin 91c provided on the distal end side mount 91 is inserted is provided.

The assembled state of the airtight structure unit 44 is shown in FIGS. In assembling, the flat part 42c, the flange parts 91b and 92b of the four parts of the dome-shaped seal fixing distal end mount 91, the dome-shaped seal 92, the airtight rubber cover 37 and the dome-shaped seal fixed front mount 93 are provided. , 37d and 93d are superimposed, and the pin 91c provided on the dome-shaped seal fixing distal end mount 91 is sequentially inserted into the holes 45, 46, 47 provided on the airtight rubber cover 37 and the dome-shaped seal fixed front mount 93. Insert it. Then, finally, the distal ends of the pins 91c are integrated by caulking with heat, and then the far-side edge 42d of the seal holding cover 42 is separated by the first small-diameter portion 37b provided on the distal end side of the hermetic rubber cover 37. By holding, the seal unit 60 is assembled.
As described above, by overlapping the flange portions 91b, 92b, 37d, and 93d and integrating the dome-shaped seal 92, in conjunction with the movement of the surgical tool inserted into the instrument insertion port 41 of the dome-shaped seal 92, The dome-shaped seal 92 acts on the bellows portion 371 provided on the hermetic rubber cover 37, and the dome-shaped seal can be moved while maintaining the close contact of the instrument insertion port 41.

Next, the airtight structure unit 44 is obtained by bringing the first small diameter portion 37b provided on the distal end side of the airtight rubber cover 37 constituting the seal unit 60 into close contact with the front surface of the flange portion 8a of the duckbill valve 8. In this state, as shown in FIG. 7, the airtight structure unit 44 is inserted into the pipe inner tube 32, and the flange portion 8a of the duckbill valve 8 is engaged with the step 32a formed on the inner surface of the pipe inner tube 32. Further, the plug member 40 is fitted to the pipe inner tube 32 from the near side.
As a result, the above-mentioned four parts are integrally pressed against the flange portion 8a of the duckbill valve 8, whereby the duckbill valve 8 and the dome-shaped seal 92 are connected in an airtight state.
In this embodiment, the airtight structure unit 44 employs a structure in which the seal unit 60 and the duckbill valve 8 are in close contact with each other. However, the seal unit 60 may be integrated with the duckbill valve 8 by using the airtight rubber cover 37. It is possible. That is, the airtight rubber cover 37 and the duckbill valve 8 may be joined or formed integrally.

<Camera part>
As shown in FIGS. 12A and 12B, the camera unit 5 is in a state of being deployed outward from the outer peripheral surface of the pipe unit 2 in the abdominal cavity. Both ends of the camera unit 5 are rotatably supported so that the camera unit 5 can be accommodated in the notch portion 23 at the distal end of the pipe inner tube 22. Thereby, the camera unit 5 can freely rotate between an unfolded state in which the camera unit 5 can be photographed outside the pipe unit 2 and a stored state in which the camera unit 5 is stored in the pipe unit 2. As described above, since the camera unit 5 in the unfolded state is located at the distal end portion of the pipe unit inner tube 22, the field of view is not obstructed by the pipe unit 2, so that it is suitable for photographing an operation field.

As shown in FIGS. 12A and 12B, the camera unit 5 includes a substantially U-shaped housing 13 and a camera mount 17 attached to the front surface of the housing 13 (in the present embodiment, the U-shaped inner bottom surface). The lenses 14a, 14b, and 14c, the light-transmitting plate 15 for protecting the image sensor, and the image sensor 16 (such as CMOS) are sequentially attached to the camera mount 17 along the light transmission direction. The lenses 14 a, 14 b, and 14 c are stacked in the lens barrel 25. A flexible cable 28 is connected to the image sensor 16. The flexible cable 28 passes between the pipe outer tube 21 and the pipe inner tube 22, specifically, a flat portion (not shown) formed in a D-shaped cross section of the pipe outer tube 21 and the pipe inner tube 22. Through the gap between the head outer tube 31 and the head inner tube 32 connected to the pipe outer tube 21 and the pipe inner tube 22, respectively, to the outside of the head portion 3 from the front edge of the head outer tube 31 on the near side. It is pulled out, drawn into the connector section 11 through an opening (not shown) formed in the surface of the connector section 11 on the head section 3 side, and connected to a circuit board 100 (see FIG. 4A) described later. Further, a translucent protective cover 18 is attached to the front surface of the lens 14a.
The lenses 14a, 14b, 14c and the protective light-transmitting plate 15 can be made of optical glass or optical resin.

  On the back side of the flexible cable 28 connected to the imaging sensor 16, as shown in FIGS. 12A and 12B, a metal plate 19 (back plate) for reinforcing the imaging sensor is arranged. Since the metal plate 19 for reinforcing the image sensor is directly mounted on the flexible cable 28, the flatness of the image sensor 16 is maintained and the sensor is protected. As the metal plate 19 for reinforcing the imaging sensor, it is preferable to use an aluminum plate which also has a heat radiation effect of the imaging sensor 16. The space between the imaging sensor reinforcing metal plate 19 and the housing 13 is sealed with a filler 19 'such as a silicone material.

The housing 13 has a curved back surface 13a which is flush with the pipe inner tube 22 when the camera unit 5 is stored, and side surfaces 13b are formed on both sides of the back surface 13a. Since the back surface 13a has a curved surface as described above, the outer cylinder 21 of the pipe unit can be smoothly slid when the camera unit 5 is stored and unfolded. In the unfolded state of the camera section 5, the lenses 14a, 14b and 14c face the front of the pipe section 2.
As shown in FIGS. 13 and 14, projecting portions 13 c extending downward in the pipe inner tube 22 are formed on both side surfaces 13 b of the housing 13, as shown in FIGS. 13 and 14. The shaft portions 20 are formed to protrude outwardly perpendicular to the axial direction of the pipe portion 2.

  As shown in FIGS. 12 (a), (b) and FIG. 14, the shaft portion 20 has an inclined groove 24 cut obliquely from both sides of the notch portion 23 of the distal end of the pipe inner tube 22 toward the near side. And is engaged with the inclined groove 24. The center of the shaft section 20 is a shaft fulcrum S for rotating the camera section 5. This makes it possible to secure a moment when the camera unit 5 is turned upside down using the pulling force of the coil spring 12 (elastic member) described later, while being compact. In addition, since the inclined groove 24 inclined as described above is employed, the mounting of the camera unit 5 is easy.

  As shown in FIG. 15, on both sides of the bottom portion 13d of the housing 13, L-shaped portions 45 are respectively protruded downward, and a ring-shaped portion 12a at one end of the coil spring 12 is engaged with the L-shaped portions 45. Is stopped. As shown in FIG. 14, the two coil springs 12 are housed in concave grooves 46 extending along the axial direction of the pipe portion 2 from the notch portion 23 at the distal end of the pipe portion inner tube 22 toward the operator (toward the operator). The ring-shaped portion 12 b at the other end on the near side of the coil spring 12 is fixed in the concave groove 46.

One end (ring-shaped portion 12 a) of the coil spring 12 is locked at a position on the near side of the shaft portion 20 and at a position radially outward of the pipe portion 2 from the shaft portion 20. As a result, the camera unit 5 is biased to the near side. As a result, the camera section 5 rotates rearward about the pivot point S as a rotation center, and enters the deployed state.
Therefore, when the trocar 1 is pulled out from the body while the camera unit 5 is deployed in the body (in the abdominal cavity), the camera unit 5 applies the axial direction of the pipe unit 2 from the rear end to the front end at the time of removal. Since it is rotated by an external force and stored in the pipe inner tube 22, it is safe.
Particularly, when an unexpectedly large force acts on the camera unit 5 from the rear end to the front end, the L-shaped part 45 and the ring-shaped part 12a at one end of the coil spring 12 are disengaged. Since the shaft portion 20 is engaged with the inclined groove 24 of the pipe inner tube 22, the shaft portion 20 can be disengaged so as to slide on the inclined groove 24, and the camera portion 5 can be disengaged. Accordingly, in an emergency or the like, the camera unit 5 can be detached from the trocar 1 without being damaged, so that safety can be improved and the risk of damage to the camera unit 5 can be reduced.
At this time, since the other end of the coil spring 12 is fixed, the coil spring 12 does not fall into the abdominal cavity.

  In the present embodiment, the imaging sensor 16 is directly mounted on the flexible cable 28 in order to make the camera unit 5 as small as possible. The mounting unit does not have a controller function for controlling the image sensor 16, and a controller function such as clock control is provided on the circuit board 100 provided on the head unit 3 (control means, see FIG. 4B). Are located in Therefore, the end of the flexible cable 28 directly mounted on the image sensor 16 is connected to the circuit board 100 at the connector section 11 of the head section 3 and is connected to the external cable 102 (USB cable) soldered from the circuit board 100. Image signal is sent to the outside.

When the light-transmitting protective cover 18 is formed of a transparent optical resin, the inner surface adjacent to the lens 14a becomes a concave curved surface 181, as shown in FIGS. It is possible to do. Therefore, since the light-transmitting protective cover 18 itself functions as a lens, the number of lenses used can be reduced, and the distance between the light-transmitting protective cover 18 and the lenses 14a, 14b, and 14c can be reduced. As a result, the camera section 5 can be made thinner and smaller. In addition, a structure such as a peripheral wall described later can be integrally formed.
The light-transmitting protective cover 18 has a peripheral wall 182, and the peripheral wall 182 has a hole 26 formed therein. On the other hand, the camera mount 17 has a claw 27 on the distal end side, and is integrated by engaging the claw 27 with the hole 26 when the translucent protective cover 18 is attached. At this time, a sealing material 29 such as rubber is fitted between the camera mount 17 and the translucent protective cover 18 to ensure waterproofness.

<Trocar shaft>
Returning to FIG. 4 (a), the tip 4c following the puncture 4a of the trocar shaft 4 is formed in a column shape having an outer diameter substantially the same as the inner diameter of the pipe 2, and when the camera 5 is stored, In order to secure a storage space for the camera section 5, a cutout section 6 is formed in a part thereof. The connecting portion 4d from the distal end portion 4c to the handle portion 4b has a smaller outer diameter than the distal end portion 4c. This structure is adopted because the distal end portion 4c having a large outer diameter supports the distal end of the pipe portion 2 provided with the camera portion 5 from inside thereof, thereby reducing a large force applied when the trocar 1 is inserted. This is to ensure sufficient strength. The outer diameter of the columnar tip 4c is preferably smaller by about 0.1 mm than the inner diameter of the pipe 2.
Of course, there is no problem even if the connecting portion 4d has the same outer diameter as the tip portion 4c.

<How to use>
Next, a method of using the trocar 1 according to the present embodiment will be described with reference to FIGS. In FIGS. 17A to 17D, the waveform region 90 is illustrated only on the front end side, and is omitted on the rear end side. In the present invention, such a waveform region 90 can be used.
First, in the initial state shown in FIG. 17A (the storage state of the camera unit 5), the trocar shaft 4 is rotated from the camera unit storage position click groove 47a to the camera unit development position click groove 47b, and the trocar shaft 4 is rotated. A gap D is formed between the distal end wall 6a and the distal end surface of the camera unit 5 (FIG. 17B).

Next, as shown in FIG. 17C, the lock lever 34 of the pipe outer cylinder 21 is pressed, and the pipe outer cylinder 21 is slid toward the user. Thus, the camera unit 5 is deployed by the urging force of the coil spring 12 (see FIG. 12B), and the trocar shaft 4 can be pulled out. The lock lever 34 is used to hold the camera unit 5 in an expanded state or a stored state, and to operate a lock mechanism for preventing the camera unit 5 from being operated carelessly.
In this state, as shown in FIG. 17D, the trocar shaft 4 is pulled out and becomes usable as a trocar port.

  In actual use, in the initial state (retracted state of the camera section 5) shown in FIG. 17A, the puncture section 4a formed at the tip of the trocar shaft 4 punctures the abdominal cavity through the body wall. Next, as described above, the camera unit 5 is deployed in the body wall 35, the trocar shaft 4 is extracted from the trocar 1, and surgery is performed while photographing the affected part 36 in the abdominal cavity as shown in FIG.

  Therefore, the surgeon can perform surgery by inserting forceps or the like (not shown) through the opening 7 of the trocar 1 while watching the image projected on the monitor (not shown), so that the visual field is enlarged. In addition, the operation becomes easier and the safety of the operation is improved. In particular, since the camera section 5 is provided at the distal end of the pipe section 2, there is an advantage that the visual field is not obstructed by the pipe section 2 or the like.

<Other embodiments>
In the above-described embodiment, the case where the camera unit 5 and the connector unit 11 are arranged on the same side with respect to the pipe unit 2 has been described, but the camera unit 5 and the connector unit 11 may be arranged at different positions. Good. For example, as shown in FIG. 19, the camera section 5 and the connector section 11 can be arranged at a symmetric position with respect to the axis of the pipe section 2 or at a position near the symmetric position.
In this case, the external cable 102 during the operation can be arranged below the position of the operator's hand, and the camera unit 5 moves when the operator's hand touches the external cable 102, and the pipe unit 2 rotates about the pipe unit 2 as a rotation axis. In addition, it is possible to effectively prevent the projected surgical field from rotating.
The positions of the camera unit 5 and the connector unit 11 may be different from the attachment position of the camera unit in the circumferential direction of the head unit so that the operator's hand does not touch the external cable 102. For example, the connector section 11 may be arranged at an angle of 90 ° or more from the camera section 5 to the left and right with respect to the axis of the pipe section 2.
Others are the same as the above embodiment.

(Still another embodiment)
At least the pipe outer cylinder 21 may be formed of a metal tube. When the pipe portion outer cylinder 21 is a metal tube, the pipe portion outer cylinder 21 is formed of a metal tube, and then formed by performing known insert molding on the resin-molded head portion 3. At this time, in the thick region 200, an anchor portion 98 may be formed at the end of the pipe outer cylinder 21 as shown in FIG. The anchor portion 98 is for increasing the diameter of the end of the metal tube of the pipe outer tube 21 to secure sufficient strength in the thick region 200 against axial movement. A plurality of the anchor portions 98 can be formed. Reference numeral 99 denotes a chamfer.

The metal tube constituting the pipe outer tube 21 is made of, for example, a metal such as iron, copper, or aluminum, or an alloy thereof. By using the metal tube for the pipe outer tube 21, the wall thickness of the pipe 2 can be reduced. In addition, a corrugated region 90 for retaining and holding the trocar 1 described later on the abdominal wall can be made thinner.
Even when the pipe outer tube 21 is formed of a metal tube as in the present modification, the outer diameter of the pipe outer tube 21 is tapered from the rear end to the front end of the head 3. In the case of a metal tube, the thickness of the tube itself can be made thinner than that of the resin tube as in the above-described embodiment, the thickness of the rear end portion is formed to be, for example, 0.4 mm, and the front end portion is set to 0.1 mm. By forming the tapered shape to have a thickness of 2 mm, the thickness of the distal end portion can be made thinner while ensuring the strength of the tube. In addition, the said thickness of a rear end part and a front-end | tip part is an illustration, It is not limited to this and can be set suitably as long as it is a taper shape.

  Although the trocar 1 according to the embodiment of the present invention has been described above, the present invention is not limited to the above embodiment, and various improvements and improvements can be made. For example, an illumination device may be provided in the camera unit 5 so that the operation field becomes bright. In addition, the trocar of the present invention can be suitably used for endoscopic surgery in the thoracic cavity.

DESCRIPTION OF SYMBOLS 1 Trocar 2 Pipe part 3 Head part 4 Trocar shaft 4a Puncture part 4b Handle part 4c Tip part 4d Connection part 5 Camera part 6 Cutout part 7 Opening 8 Duck bill valve 10 Air supply pipe 11 Connector part 12 Coil spring (elastic member)
13 Housing 14a, 14b, 14c Lens 15 Image Sensor Protection Cover 16 Image Sensor 17 Camera Mount 18 Transparent Protective Cover 19 Image Sensor Reinforcement Metal Plate 20 Shaft 21 Pipe Part Outer Tube 22 Pipe Part Inner Tube 23 Tip Notch 24 Inclined groove 25 Lens barrel 26 Hole 27 Claw 28 Flexible cable 29 Seal material 30a, 30b Recess 31 Head outer cylinder 32 Head inner cylinder 33 Convex part 34 Lock lever 35 Body wall 37 Airtight rubber cover 38 Seal material 39 Seal material press Member 39a Outer peripheral surface 39b Hole 40 Plug member 42 Seal holding cover 44 Airtight structure unit 48 Open end 50 Step 51 Depression 52 Convex part 60 Seal unit 90 Waveform area 91 Dome-type seal fixing tip side mount 92 Dome-type seal 93 Dome-type Front mount 95 for fixing seal Supermarkets portion 98 anchor portion 99 chamfered portion 100 circuit board (control means)
102 Cable 200 Thick area 201 Depression 300 Finger rest 371 Bellows

Claims (10)

A trocar including a pipe portion for inserting a medical device into a body and a head portion,
The pipe section includes a pipe section outer cylinder and a pipe section inner cylinder,
The head section includes a head section outer cylinder and a head section inner cylinder,
Wherein is bonded to molded or integrally in one piece pipe outer cylinder and the head outer cylinder,
Wherein is bonded to molded or integrally in one piece pipe portion inner tube and the head portion inner tube,
An outer peripheral surface of the pipe outer cylinder has a tapered portion whose outer diameter decreases from a rear end portion to a front end portion of the head portion side ,
At the tip of the pipe section inner cylinder, there is provided a camera section rotatably supported between a deployed state that pivots out of the pipe section and a stored state that is stored in the pipe section. And
The pipe section outer cylinder is externally slidably mounted on the pipe section inner cylinder so as to be slidable in the axial direction, and the camera section is stored in the pipe section while being slid toward the pipe section tip. A trocar, characterized in that: The trocar according to claim 1, wherein the pipe outer cylinder is a resin tube, and is integrally formed with the head outer cylinder. The trocar according to claim 1, wherein the outer tube of the pipe and the outer tube of the head are integrally formed through a thick region. Wherein a pipe outer cylinder metal tube, trocar according to claim 3, which is joined integrally with the head portion outer tube in the thick region. The trocar according to any one of claims 1 to 4 , having a uniform thickness region (A) at a distal end portion of the outer cylinder of the pipe portion. The trocar according to any one of claims 1 to 5 , wherein a uniform thickness region (B) is provided at a rear end of the pipe outer cylinder. A uniform thickness region (A) at the end of the pipe outer cylinder;
A thickness uniform region (B) at the rear end of the pipe outer cylinder;
Wherein of the outer peripheral surface of the pipe outer cylinder, in addition to the area (A) and the area (B), trocar according to any one of claims 1 to 4, in cross-section having a wave-like waveform region. The trocar according to claim 3, wherein a seal member whose inner peripheral surface is pressed against the outer peripheral surface of the pipe portion inner cylinder is attached to the thick region. The trocar according to claim 8, wherein the seal member is pressed by a seal member pressing member formed on an outer peripheral surface with a screw groove screwed to an inner peripheral surface of the thick region.   The trocar according to any one of claims 1 to 9, wherein the medical device is inserted into a body through the pipe inner cylinder.