JPH09528A - Endoscopic operation aid - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscopic operation aid which enables fully observing an operation field by means of an endoscope from a desired direction while securing the space for the operation field. SOLUTION: This endoscopic operation aid, which includes an at-hand grip, an inserted part 2 for securing the space for an operation field inside a living body by being inserted into and displaced inside the living body, and a mounting part on which an endoscope 6 for observing the space for the operation field is mounted and held, is provided with an endoscope mounting part moving means by which the endoscope mounting part can be moved with respect to the inserted part 2. As the inserted part 2 of the aid is lifted and a large space for the operation field is created inside the living body, the space for the operation field can be fully observed by means of the endoscope 6 from a desired direction.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic surgery auxiliary device used for securing an operative field when performing endoscopic surgery on a site inside a living body.

[0002]

2. Description of the Related Art In recent years, an endoscope is not limited to a medical field represented by the digestive tract in the medical field, but the skin is incised and the endoscope is inserted from there to perform observation and treatment. , Is also widely used in the surgical field.

When observing the inside of a living body with an endoscope and performing a required treatment, it is necessary to secure a space as a surgical field in front of the visual field direction. For example, observing the organs in the abdominal cavity,
When performing the required treatment, the required space is secured by loading CO ₂ gas into the abdominal cavity. As described above, it is necessary to newly form a space portion as a work area for observing with an endoscope and treating the target portion such as the abdominal cavity or the chest cavity.

By the way, there has been proposed an instrument for securing a visual field space for an endoscope as known from Japanese Patent Publication No. 49-45519 and Japanese Patent Publication No. 49-238390. These are gastrointestinal tracts, which are used to supplementally expand a part of the narrowed lumen using an elastic thin wire-shaped auxiliary member. That is, the lumen cannot be expanded sufficiently large.

At the time these were proposed, the endoscopic surgical procedure was not considered, nor necessary, to further dilate the lumen. However, nowadays, in addition to the endoscope, many treatment tools are inserted to perform various treatments within the same field of view of the endoscope, and a larger space is provided at the treatment site. There is a need to secure it.

Under these circumstances, the ones proposed in Japanese Patent Publication No. 49-45519 and Japanese Patent Publication No. 49-238390 have the following problems in endoscopic procedures.
It is becoming less than satisfactory.

On the other hand, as an instrument for securing a surgical field space for performing percutaneous endoscopic surgery, a type in which a strip member having a narrow width is attached to the distal end portion of the endoscope and both are suspended as hooks Is proposed.

[0008]

However, in this type, since the endoscope is also lifted together when the space is secured by hoisting it, it is possible to observe the largely secured base area of the operative field with the endoscope. Can not. For example, in order to observe the lower part in the space, the endoscope is directed downward, and at that time, the strip member is also lowered, and the fat or the skin which is required to be lifted by the strip member is removed. As it hangs down, the visual field space collapses, and the lower part of the view cannot be observed as expected.

The present invention has been made in view of the above-mentioned problems, and an endoscopic operation capable of sufficiently observing the operative field from a desired direction with an endoscope while securing a operative field space. The purpose is to provide an auxiliary device for use.

[0010]

The present invention observes the operative field space, a hand-side gripping part, an insertion part for securing the operative field space in the living body by inserting and displacing it in the living body. In an auxiliary device for endoscopic surgery, comprising: a mounting portion for mounting and holding an endoscope for moving, the endoscope mounting portion movable for moving the endoscope mounting portion relative to the insertion portion. It is characterized by comprising means. While creating a large operative field space in the living body while hoisting the insertion part of this auxiliary device,
The operative field space can be sufficiently observed with an endoscope from a desired direction.

[0011]

BEST MODE FOR CARRYING OUT THE INVENTION

<First Embodiment> A first embodiment of the present invention will be described with reference to FIGS. (Structure) FIG. 1 shows the auxiliary device for endoscopic surgery (hereinafter,
This is called a retractor. ) Shows the whole. The retractor 1 is connected to an insertion portion 2 formed by a spatula-shaped elongated strip member to be inserted into a living body and a proximal end portion 3 of a grip portion of the insertion portion 2 and is substantially connected to the insertion portion 2. The retractor 1 is provided with a vertically provided arm portion 4 and a grip 5 connected to the bent extension side end of the arm portion 4, and constitutes a body of the retractor 1. Further, a mounting tube 7 into which the insertion portion of the endoscope 6 is inserted is provided so as to follow the insertion portion 2. The mounting tube 7 constitutes an endoscope mounting portion for mounting the endoscope 6 in a detachable state. The endoscope mounting portion is rotatably connected to the base end portion 3 of the retractor 1 via a ball joint mechanism (means) 8 as described later.

A base end portion 3 of the insertion portion 2 has a relatively thick member 11 and a block member 1 attached and fixed to the member 11.
2, the arm portion 4 is attached and fixed to the block member 12.

A reinforcing tubular member 13 is fixed to the base end of the mounting tube 7 in a fitted state. A fixed ring 14 is screwed on the outer periphery of the rear end of the tubular member 13. An elastic ring 15 is attached to the inner side of the fixed ring 14, and the fixed ring 14 is rotated and screwed forward to tighten and deform the elastic ring 15, and the endoscope inserted into the attachment tube 7 is inserted. The outer periphery of the insertion portion of 6 is tightened and fixed. As a result, the mounting tube 7
An endoscope fixing portion (means) for restrictingly fixing the endoscope 6 at an arbitrary rotational position and advancing / retreating position in a state in which the endoscope 6 is inserted therein is configured.

As shown in FIGS. 2 and 3, the ball 16 of the ball joint mechanism 8 is housed in a ball housing hole 17 formed in the block member 12 at the base end portion 3 of the insertion portion 2. A ball insertion hole 18 having a diameter larger than the outer diameter of the ball 16 is formed in the side wall of the block member 12. The ball 16 is integrally formed with an arm 19 for connecting to the reinforcing tubular member 13 of the mounting tube 7, and the cutout groove 2 for guiding the arm 19 is formed.
1 is formed continuously from the ball insertion hole 18 to the lower surface of the block member 12. The ball 16 is housed in the ball housing hole 17 through the ball insertion hole 18. At this time, the arm 19 of the ball 16 has a cutout groove 21.
Can be moved through. That is, a means for allowing the movement of guiding from the ball storage hole 17 to the lower surface side of the block member 12 is configured. And the arm 1 of the ball 16
9 is fixed to an arm 22 protruding from the reinforcing tubular member 13 at the base end of the mounting tube 7. That is, the arm 22 is fitted into the groove formed in the arm 19 and engaged with each other, and the arm 22 is connected and fixed by the screw 23 penetrating both of them.

A pressing member 25 is screwed into the upper portion of the inner surface of the ball storage hole 17. The ball 16 inserted into the ball storage hole 17 is pressed against the bottom side of the ball storage hole 17 by the pressing member 25. Pressing member 2
The rotation adjustment of 5 is performed by a knob portion 25a formed on the upper end protruding portion. A conical receiving groove for receiving the ball 16 is formed at the pushing tip end of the pressing member 25 and at the bottom of the ball storage hole 17, respectively. Thus, a ball joint mechanism 8 is configured in which the insertion portion 2 of the retractor 1 and the mounting tube 7 are relatively rotated by applying a predetermined force. The bottom of the ball storage hole 17 is lower than the position of the ball insertion hole 18, so that the ball 16 is inserted into the bottom of the ball storage hole 17 after insertion as shown in FIG. Then, the base end portion of the mounting tube 7 forms a rotation permitting distance away from the lower surface of the block member 12.

As shown in FIG. 3, the lower end of the block member 12 faces the reinforcing tubular member 13 of the mounting tube 7 and restricts the movement in the left-right direction by flange-shaped stoppers 26a, 26b.
Is provided, and this constitutes a movable area regulation mechanism. The left and right side surfaces of the tubular member 13 facing the stoppers 26a and 26b are formed flat. Further, the upper and lower surfaces of the tubular member 13 are also formed flat.

The insertion portion 2 of the retractor 1 is formed in the shape of a spatula, but as shown in FIG. 4, a suction pipe line 27 is provided inside the insertion portion 2 so as to penetrate substantially the entire length thereof. The lower end of the insertion portion 2 communicates with an opening 28 provided on the lower end side of the endoscope 6 attached to the distal end side. The rear end side of the suction conduit 27 is the insertion portion 2
Is connected to a tube mounting member 29 provided near the base end of the. A suction tube (not shown) is connected to the tube mounting member 29. That is, suction means is incorporated in the insertion portion 2 of the retractor 1 so as to have a suction function.

The mounting tube 7 has a size (thickness of diameter,
Plural types corresponding to the endoscopes 6 having different lengths are prepared. Finally, the engagement between the proximal end portion 3 and the endoscope mounting tube 7 may be of a type having a rotating shaft or other type, instead of the ball joint. (Operation) First, the operation of the retractor 1 will be described. Since the proximal end portion 3 of the insertion portion 2 of the retractor 1 and the endoscope mounting tube 7 are connected via the ball joint mechanism 8, the mounting tube 7 is the body of the retractor 1, that is, the insertion portion 2 A rotational movement is possible with respect to the base end of the.

Since the notch groove 21 is provided to the rear of the base end portion in the rotational movement of the mounting tube 7, the tip of the mounting tube 7 rotated 90 ° from the position substantially parallel to the insertion portion 2 in the vertical direction. Can be rotated to a state in which it faces downward. Regarding the rotation in the horizontal plane, it is possible to rotate the mounting tube 7 and the left and right stoppers 26a and 26b by a so-called backlash. By tightening the pressing member 25, the ball storage hole 17 and the ball 16 come into close contact with each other, so that the mounting tube 7 is fixed in an arbitrary direction, or the rotational force of the mounting tube 7 is increased or decreased. Ability adjustment is possible and easy.

The pressing member 25 is removed, and the mounting tube 7 is inserted into the insertion portion 2.
And the ball 16 is removed from the ball insertion hole 18 so that the mounting tube 7 is attached to the base end portion 3 of the retractor 1.
Can be removed from.

Next, the operation of performing endoscopic surgery using the retractor 1 on the subcutaneous tissue of the chest and abdomen will be described with reference to FIG. When the endoscope 6 is used for the subcutaneous tissue, it is necessary to first peel the subcutaneous fat from the incision 31 to make a space under the skin. Create this space using Retractor 1.

In this case, the retractor 1 is inserted through the incision 31.
By inserting the insertion part 2 of the above and pulling up the grip 5 upward, the spatula part of the insertion part 2 lifts up the skin or fat and creates a space 32 under the skin. In this case, the deepest part of the peeled part is close to the non-peeled part, so that lifting cannot be sufficiently performed.
If the conventional retractor in which the endoscope mounting tube 7 is fixed in parallel with the insertion portion 2 is used when the tip end side of the is to be lifted most, the field of view is directed upward and the area to be treated is I couldn't see it. However, in the case of the movable endoscope mounting tube 7 as in the present invention, it is possible to direct the endoscope tip to a desired region, and a good visual field can be obtained. Then, for example, a suction procedure or a procedure using the endoscope 6 can be performed through the suction conduit 27 of the insertion section 2.

In addition, although bleeding often occurs during the peeling operation under the skin, in such a case, hemostasis is performed by using a high frequency electrode or the like. Then, the smoke may fill the subcutaneous space and the endoscopic image may not be visible. Conventionally, another suction tube was forcibly inserted from a small incision, so the operability in the vicinity of the incision was significantly deteriorated.However, in the present invention, the suction duct is built in the retractor. This improves operability.

Further, since the mounting tube 7 can be removed, by mounting the mounting tube 7 corresponding to various endoscopes 6 having different sizes, the endoscope having a size suitable for the size of the visual field space is mounted and used. be able to. For example, even if the space is small, a work area for the treatment tool can be secured, and the operability of surgery is improved.

Incidentally, finally, the engagement between the base end portion 3 of the insertion portion 2 and the mounting tube 7 is not limited to the ball joint mechanism, and other engagement methods, for example, a type having a rotating shaft, etc. However, it goes without saying that it has the same action and the same effect. <Second Embodiment> A second embodiment of the present invention will be described with reference to FIG. (Structure) This second embodiment is the ball 1 in the ball joint mechanism (means) 8 in the first embodiment.
6 is an embodiment in which the fixing means of 6 is modified. A groove 40 into which the ball 16 can be inserted is provided in the base end portion 3 of the insertion portion 2 of the retractor 1, that is, the block member 12, and an elastic body such as silicone rubber or latex is provided in a portion 41a on one inner side of the groove 40. The brake pad 41 made of is fitted and provided. In addition, the brake pad 41
A pressing plate 42 is movably installed at the other position opposite to. The pressing plate 42 is attached to the tip frame portion 44 of the screw member 43 provided on the block member 12. The pressing plate 42 is also made of an elastic material such as silicone rubber or latex. The screw member 43 is the brake pad 4
The pressing plate 42 is screwed and mounted so as to advance and retract toward the position 1. A handle portion 45 is integrally provided on the screw member 43. Further, the brake pad 41 and the pressing plate 42 are provided so as to be detachable.
Other parts are the same as those in the first embodiment. (Operation) Although the same operation as that of the first embodiment can be obtained, further, in this second embodiment, by operating the handle portion 45 of the screw member 43, the pressing plate 42 moves,
The ball 16 can be fixed by being sandwiched between the brake pad 41 and the pressing plate 42. Brake pad 4
Since 1 and the pressing plate 42 are both formed of an elastic body, a strong amount of fixing force can be obtained. (Effects) The same effects as those of the first embodiment can be obtained, but a stronger fixing force amount can be obtained by the elastic brake pad 41 and the pressing plate 42. Further, since the brake pad 41 and the pressing plate 42 are detachable, even if they are repeatedly fixed and released, they can be easily replaced, and a stable and strong fixing force can always be obtained. <Third Embodiment> A third embodiment of the present invention will be described with reference to FIG. (Structure) This embodiment is a modification of the means for fixing the ball 16 of the ball joint mechanism (means) 8 in the first embodiment. Here, a locking groove 61 is formed on a part of the peripheral surface of the ball 16. On the other hand, at the base end portion 3 of the insertion portion 2, a locking pin 62 that engages with the locking groove 61 is provided on the inner wall corresponding to the storage space of the ball storage hole 17 that stores the ball 16 of the coil spring. It is elastically biased by 63. As a method of fixing the locking pin 62 to the base end portion 3, a mounting hole 64 is formed in the bottom portion of the ball housing hole 17, and a cup-shaped mounting screw member 65 formed of a cylindrical body having one end closed inside the mounting hole 64. Is screwed in, and the locking pin 62 and the coil spring 63 are housed in the mounting screw member 65. The locking pin 62 has a flange 66 formed at one end,
One end of the coil spring 63 abuts against the flange 66. The tip portion of the locking pin 62 passes through the hole 67 formed in the closed tip wall of the mounting screw member 65, and the ball storage hole 1
7, and engages with the locking groove 61 of the ball 16 in a click manner.

Further, a lid 68 having the same shape as the pressing member 25 is detachably provided in the ball storage hole 17. Like the pressing member 25, the lid 68 may tighten the ball 16 if necessary, but here, in particular, the ball storage hole 1
A bearing portion that rotatably supports the ball 16 is formed between the bearing portion and the bottom surface of the bearing 7. (Operation) The locking pin 62 is constantly pressed against the peripheral surface of the ball 16 by the urging force of the coil spring 63, and the tip of the locking pin 62 is engaged with the locking groove 61 of the ball 16. There is. Therefore, the movement of the ball 16 in the rotation direction is restricted by the locking pin 62. Further, since the locking pin 62 is elastically biased by the coil spring 63, the locking pin 62 is retracted to allow the ball 16 to rotate when the ball 16 is intentionally rotated. (Effect) According to this configuration, the mounting tube 7 integrated with the ball 16 can be fixed without any particular operation, but when it is desired to rotate the mounting tube 7, a slight rotational force is applied to the mounting tube 7. It becomes possible to rotate, and it is fixed when the mounting tube 7 stops rotating.

By the way, as described above, there are many cases of bleeding during the subcutaneous peeling work using the retractor, and in that case, in general, a high frequency electrode or the like is used for hemostasis. However, in this case, the smoke may fill the subcutaneous space and the endoscopic image may not be visible.

Therefore, in the retractor of each of the above-described embodiments, the generated smoke is sucked and removed by the suction conduit 27 formed in the retractor. However, the inside of the suction pipe 27 is structurally narrow, and the opening 28
Except for the above, since the inside of the pipeline is a closed space, it is difficult to clean the inside of the pipeline, and it may not be possible to perform sufficient cleaning.

Therefore, the structure of the retractor which can easily and sufficiently clean the suction conduit 27 will be described below. FIG. 8 shows a suction pipe line 2 with good cleanability.
A first example of structure 7 is shown. As shown, the retractor insertion portion 2 includes an insertion portion main body 2a that is a spatula-shaped member fixed to a base end portion 3 (see FIG. 10),
It is composed of an elastic conduit cover 2b which is detachably attached to the insertion section main body 2a. On the lower surface of the insertion portion main body 2a,
A concave long groove 71 is formed over substantially the entire length in the longitudinal direction, and by mounting the conduit cover 2b on the insertion portion main body 2a so as to close the opening of the long groove 71 from below,
A suction line 27 is formed. In this case, on the lower surface side of the distal end portion of the insertion portion 2, the mounted endoscope 6
The conduit lid 2b is attached to the insertion portion main body 2a so that the opening 28, which is a suction port, is formed on the tip side of the tip of the insertion portion body 2a.

In order to detachably attach the conduit cover 2b to the insertion portion main body 2a, the conduit cover 2b is provided at the opening side edge of the long groove 71.
A locking groove 73 for inserting and locking the side edge of 2b is provided.

The rear end side of the suction pipe line 27 is connected to a tube mounting member 29 provided near the base end portion of the insertion portion 2.
A suction tube (not shown) is connected to the tube mounting member 29.

The other structure is exactly the same as that of the first embodiment shown in FIGS. According to the above configuration, the same operational effect as that of the first embodiment can be obtained by the use mode shown in FIG. By removing the suction pipe line 27, the suction pipe line 27 can be exposed.
The inside of the can be easily cleaned and can be sufficiently cleaned. Therefore, the inside of the suction conduit 27 can always be kept clean. Also,
By making the duct lid 72 disposable, the cleanliness is further improved and the device can be managed hygienically.

9 to 11 show a second embodiment of the structure of the suction line. As shown in FIG. 9, the retractor
The insertion portion 2 of is composed of an insertion portion main body 2c fixed to the base end portion 3 (see FIG. 10) and having an inverted concave cross section with an open lower side, and a lid body 2d detachably fitted to the insertion portion main body 2c. Become.
The insertion portion main body 2c is formed as an engagement guide portion 74 in which both sides of the lower opening edge portion are bent outwardly in a convex shape, and both side edge portions of the lid body 2d are formed as the engagement guide portions 74.
The lid 2d can be slid along its longitudinal direction while being engaged with the guide groove 74a. Therefore, the lid body 2d is engaged with the guide groove 74a of the engagement guide portion 74 from the base end of the insertion portion main body 2c,
When the lid body 2d is slid along the engagement guide portion 74 in this engaged state, the opening of the insertion portion main body 2c is closed by the lid body 2d, and the suction conduit 27 is formed.

In this case, on the lower surface side of the distal end portion of the insertion portion 2, an opening 28, which is a suction port, is formed on the distal end side of the mounted endoscope 6 so that the opening portion 28 is formed. It is preferred that the slide be regulated.

The structure of the retractor on the base end side is shown in FIG. 10 so that the lid 2d can be attached to and detached from the base end side of the insertion portion main body 2c. FIG. 10 schematically shows the structure of the retractor on the proximal end side.
The detailed structure is almost the same as that of FIGS. 1 to 3 (thus, the same components are designated by the same reference numerals and detailed description thereof will be omitted), except that the lid 2d is different. From the base end side of the insertion portion main body 2c to the engagement guide portion 74
The insertion portion main body 2c is fixed to the block member 12 so as to form a gap that can be fitted in between the base end lower edge portion of the insertion portion main body 2c and the bottom surface of the block member 12. . In this configuration, the endoscope 6 is attached to the mounting tube 7
Instead, it is mounted and held directly on the tubular member 13.

In this structure, the pressing member 25 is removed so that the tubular member 13 is substantially perpendicular to the insertion portion 2 and the ball 16 is removed from the ball insertion hole 18, whereby the tubular member 13 is fixed to the proximal end portion 3 of the retractor. If removed, the lid 2d can be pulled out from the insertion portion main body 2c, and the lid 2d can be fitted into the insertion portion main body 2c, as indicated by the arrow in the figure.

FIG. 11 shows a state in which endoscopic surgery using the retractor having the structure of this embodiment is performed on the subcutaneous tissue of the chest and abdomen. When the endoscope 6 is used for the subcutaneous tissue, it is necessary to first peel the subcutaneous fat from the incision 31 to make a space under the skin. Create this space using a retractor. In this case, the incision 3
Insert the retractor insertion part 2 from 1 and grip 5
Is pulled up, the insertion portion 2 lifts the skin or fat and creates a space 32 under the skin. In this case, the deepest part of the peeled part is close to the non-peeled part, so it is not possible to secure enough space, but in such a case, lift the retractor tip side largely upward. Just go. In this case, the tip of the endoscope 6 also faces upward together with the retractor. However, if the endoscope 6 is rotated by the ball joint mechanism 8, the insertion portion 2 is directed upward even though the insertion portion 2 is directed upward. The tip of the endoscope 6 can be directed to a desired region (for example, downward), and a good visual field can be obtained. Then, when high-frequency treatment is performed for hemostasis or the like and smoke is generated in the space 32, the smoke is sucked through the suction conduit 27 from the opening portion 28 of the insertion portion 2 which is a suction port, and the tube mounting member. Suction and exhaust is performed via the suction tube 80 connected to 29. In the figure, 79
Is a light guide for transmitting illumination light to the endoscope.

As described above, according to this embodiment,
Since the insertion body 2c and the lid 2d can be separated to expose the suction conduit 27, the suction conduit 27 can be easily and sufficiently washed.

FIG. 12 shows a third embodiment of the suction pipe line structure. In the present embodiment, the upper surface of the insertion portion main body 2c is recessed inward over substantially the entire length in the longitudinal direction, that is, by forming the rib 81 on the upper surface of the insertion portion main body 2c, the longitudinal direction of the insertion portion main body 2c. I try to increase the strength against bending. The other structure is the same as that of the second embodiment.

According to this embodiment, the same effect as that of the second embodiment can be obtained, and when the grip 5 is pulled up to raise the skin by the insertion portion 2, the insertion portion main body 2c is It can be prevented from being deformed. That is, it is possible to reliably raise the skin and sufficiently form the space 32.

FIG. 13 shows a fourth embodiment of the suction line structure. As shown, the retractor insert 2 is
The insertion portion main body 2e is fixed to the base end portion 3 (see FIG. 10) and has an inverted concave cross-section that is open on the lower side, and the lid body 2f having a spring property that is detachably attached to the insertion portion main body 2e.
The lid 2f includes a curved portion 83 that is curved so as to guide the endoscope 6, and locking pieces 84 and 84 that extend from both sides of the bending portion 83 in the bending direction. The locking pieces 84 and 84 are The lid 2f is urged to expand outward by the spring property of the lid 2f. On the other hand, the insertion portion main body 2e has a lid 2f.
A locking groove 82 capable of locking the locking pieces 84, 84 is formed along the longitudinal direction thereof. Therefore, when attaching the lid 2f to the insertion portion main body 2e, first, the locking pieces 84,
84 are deformed inward so as to be close to each other against the biasing force, and in this state, the locking piece 8 is attached at the base end of the insertion portion main body 2e.
4, 84 are locked in the locking groove 82 of the insertion portion main body 2e.
Then, in the locked state, the lid 2 is attached to the insertion portion main body 2e.
If f is slid toward the tip side, the insertion portion main body 2e
Thus, according to the present embodiment, it is possible to obtain the same effect as that of the second embodiment, and the lid 2 is formed.
Since the locking pieces 84 and 84 are locked to the insertion portion main body 2e with a high locking force due to the spring property of f, the sealing property in the suction conduit 27 is improved.

FIG. 14 shows a fifth embodiment of the suction line structure. In the second embodiment, sealing members 85, 85 are mounted along both side edges of the lid 2d, and the sealing members 85, 85 are sealed in the guide groove 74a of the engaging guide portion 74 of the insertion portion main body 2c. They are engaged with each other, and other configurations are the same as those of the second embodiment.

According to this structure, the sealing property inside the suction conduit 27 can be improved as compared with the second embodiment.
FIG. 15 shows a sixth embodiment of the suction line structure. As shown in the figure, the retractor insertion portion 2 is fixed to the base end portion 3 (see FIG. 10) and has an inverted concave cross-section with an opening on the lower side, and is detachably bonded and fixed to the insertion portion body 2g. It is composed of a lid 2h that is closed. The lid 2h has an adhesive layer (member) on the adhesive surface side with the insertion portion main body 2g, and is bonded to the lower surface of the insertion portion main body 2g by using this adhesive layer (member). The suction line 27 is formed by closing the opening. In this configuration, the lid 2h may be disposable. With this configuration, the same effect as that of the second embodiment can be obtained.

FIG. 16 shows a seventh embodiment of the suction line structure. In this embodiment, the suction conduit 27 is formed by fitting a heat-shrinkable tube 87 around the insertion portion main body 2g having the same shape as that of the sixth embodiment. Specifically, as shown in (a) of FIG. 16, when the insertion portion main body 2g is inserted into the heat-shrinkable tube 87 and heat is applied to the heat-shrinkable tube 87 in this state to cause shrinkage, As shown in (b), the heat-shrinkable tube 87 is adhered to the periphery of the insertion portion main body 2g in a close contact state to insert the insertion portion main body 2g.
Is closed and the suction line 27 is formed.

As a heating means for the heat shrink tube 87,
In addition to heating with hot water and heating by electric means, it is conceivable to utilize the heat when autoclave sterilizing the insertion portion 2. In addition, this heat shrinkable tube is also the sixth
Like the lid 2h of the above embodiment, it can be disposable.

FIG. 17 shows an eighth embodiment of the suction pipe line structure. The insertion portion 2 of this embodiment is fixed to the base end portion 3 (see FIG. 10) and has an insertion portion main body 2j having a concave cross section with an open upper side, and a lid body 2i detachably fitted to the insertion portion main body 2j. Consists of. That is, the vertical relationship between the insertion portion main body and the lid is opposite to that in the first to seventh embodiments.

The insertion portion main body 2j has engagement guide portions 91, which are bent outwardly on both sides of the upper opening edge portion thereof.
The lid 2i is formed as 91, so that the lid 2i can be slid along its longitudinal direction in a state where both side edges of the lid 2i are engaged with the guide grooves of the engaging guide portions 91, 91. Has become. Therefore, the lid body 2i is engaged with the guide grooves of the engagement guide portions 91, 91 from the base end of the insertion portion body 2j, and the lid body 2i is slid along the engagement guide portions 91, 91 in this engaged state. Then, the opening of the insertion portion main body 2j is closed by the lid body 2i, so that the suction conduit 27 is formed.

Further, in the state where the lid 2i is assembled to the insertion portion main body 2j, in the engagement guide portions 91, 91, slight gaps 90, 90 are formed between the lid 2i and the insertion portion main body 2j.
Is formed. That is, the lid 2i is
The gaps 90, 90 are attached to the insertion portion body 2j.
Is formed so that its central portion is slightly thicker. These gaps 90, 90 are used when subcutaneously peeling or securing a cavity.
It is located in close contact with the biological tissue, which allows the suction line 2
The airtightness inside 7 is improved.

Therefore, according to the suction pipe line structure of the present embodiment, the same effect as that of the second embodiment can be obtained.
FIG. 18 shows a ninth embodiment of the suction line structure. The insertion part 2 of the present embodiment has an insertion part main body 2m of a concave cross section which is fixed to the base end part 3 (see FIG. 10) and has an open upper side, and a concave cross section which is detachably fitted to the insertion part main body 2m. Lid 2
n and. The lid 2n includes a pair of side surface portions 93, 93 extending substantially vertically and a flat surface portion 95 extending horizontally, and step portions 94, 9 are provided between the side surface portions 93, 93 and the flat surface portion 95.
4 are formed. Then, the lid 2n is fitted into the insertion portion main body 2m from the base end of the insertion portion main body 2m in a state where the flat surface portion 95 is positioned on the upper side and the opening is directed downward, and the side surface portion 93, By sliding 93 toward the distal end side in a state of contacting the inner surfaces of the both side portions 97, 97 of the insertion portion main body 2m, the flat portion 95 closes the opening of the insertion portion main body 2m and the insertion portion main body 2m. The suction pipe line 27 is formed between them. In this case, the lid 2n is pulled out upward with respect to the insertion portion main body 2m, and the locking pieces 9 provided on both side portions 97 of the insertion portion main body 2m.
This is prevented by hitting the stepped portions 94, 94 of the lid 2n with the bumps 6, 96.

When the lid body 2n is assembled to the insertion portion body 2m, slight gaps 92, 92 are formed between the insertion portion body 2m and the lid body 2n in the step portions 94, 94. Has become. That is, the locking pieces 96, 96 are configured to partially abut the stepped portions 94, 94 of the lid 2n. The gaps 92, 92 are located in close contact with the living tissue when subcutaneously peeling or securing a cavity, and thereby the airtightness inside the suction conduit 27 is improved.

Therefore, according to the suction pipe line structure of this embodiment, the same effect as that of the second embodiment can be obtained, and the contact area between the insertion portion main body 2m and the lid 2n is the eighth.
Since it is larger than that of the first embodiment, the suction pipe line 27
The airtightness inside is further improved, and the rigidity in the vertical direction is also improved.

FIG. 19 shows a tenth embodiment of the suction pipe line structure. The insertion portion 2 of this embodiment has a base end portion 3 (see FIG.
0)) and has a concave cross-section main body 2t with an open top, and a concave cross-section lid 2s that is detachably fitted to the insertion main body 2t. Both sides 9 of the lid 2s
A plurality of engaging pins 98 are provided on the protrusions 3, 93, and L-shaped engaging grooves 99 that engage with the engaging pins 98 are formed on both side surfaces 97, 97 of the insertion portion body 2t. Has been done.
The engaging groove 99 extends horizontally from the first groove 99a and the side surface portion 9 of the insertion portion main body 2t extending vertically from the first groove portion 99a.
The second groove portion 99b is opened at the upper edge of 7, 97.

In this structure, the lid 2s is lowered from the upper side with respect to the insertion portion main body 2t so that the engagement pin 98 is engaged with the engagement groove 99.
When the lid 2s is slid forward with respect to the insertion portion main body 2t and the engagement pin 98 is fitted into the first groove 99a of the engagement groove 99, the engagement pin It is possible to prevent the 98 from coming off upward. In this state, the lid body 2s has the side surface portions 93, 93 with the insertion portion main body 2
It is fitted into the insertion portion main body 2t in a state of being abutted against the side surface portions 97, 97 of t, thereby closing the opening of the insertion portion main body 2t and forming the suction conduit 27 with the insertion portion main body 2t. To do.

In this way, the lid 2 is attached to the insertion portion main body 2t.
In the state where s is assembled, slight gaps 92, 92 are formed on the upper surface side of the insertion portion 2 between the insertion portion main body 2m and the lid 2n. The gaps 92, 92 are located in close contact with the living tissue when subcutaneously peeling or securing a cavity, and thereby the airtightness inside the suction conduit 27 is improved.

Therefore, according to the suction pipe line structure of this embodiment, the same effect as that of the second embodiment can be obtained, and the lid 2s is not slid over a long distance as in the above-mentioned embodiments. Therefore, it is easier to mount and disassemble.

FIG. 20 shows an eleventh embodiment of the suction line structure. In the insertion portion 2 of the present embodiment, the first pipeline component portion 100 having an arcuate cross section and the second pipeline component portion 101 having an arcuate cross section are fitted so as to overlap each other. The suction pipe line 27 is formed,
Even with such a configuration, it is possible to obtain the same effects as those of the above-described embodiments.

According to the embodiment described above, the following various configurations can be obtained. 1. A hand-side grip portion, an insertion portion that is inserted into a living body and secures a surgical field space in the living body, for example, a strip member, and an endoscope for observing the surgical field space are attached and held. An endoscopic surgical auxiliary device including a mounting portion, comprising: an endoscope mounting portion moving means for moving the endoscope mounting portion movable with respect to the insertion portion. Auxiliary device for mirror surgery. 2. The auxiliary device for endoscopic surgery according to claim 1, further comprising an endoscope mounting portion moving means that allows the endoscope mounting portion to move three-dimensionally with respect to the insertion portion. . 3. The auxiliary for endoscopic surgery according to supplementary notes 1 and 2, characterized in that a movable area regulating mechanism is provided for moving the endoscope mounting portion within a certain area within a specific plane. apparatus. 4. The endoscope mounting section according to any one of claims 1, 2 and 3, wherein the endoscope mounting section is provided with means for fixing the endoscope mounting section at an arbitrary angle, that is, at an arbitrary position with respect to the insertion section. Auxiliary device for surgery. 5. Supplementary notes 1, 2 and 3, further comprising adjusting function means capable of arbitrarily setting the amount of movable force of the endoscope mounting portion.
The auxiliary device for endoscopic surgery according to items 3 and 4. 6. The endoscopic surgery assisting device according to any one of appendices 1, 2, 3, 4, and 5, wherein a treatment means such as a suction means is incorporated in the insertion portion.

7. An auxiliary device for endoscopic surgery, comprising a hand-side gripping part, an inserting part, and an endoscopic mounting part, wherein the endoscopic mounting part is detachable. Auxiliary device. 8. The endoscopic surgery assistance according to claim 7, characterized in that it is possible to attach endoscopic mounting portions having different sizes and the like to the endoscopic surgery assistance device. apparatus. The conventional type secures separate spaces for large endoscopes with large diameters in large spaces and small endoscopes with small diameters in small spaces. You need to prepare the ingredients,
Although it is uneconomical, according to the item of item 7, an endoscope adapted to the operative field or the like can be attached and used.

Further, according to the above-described embodiment of the suction conduit structure, various structures as described below can be obtained. 1. Hand side gripping part, insertion part for securing an operative field space in the living body by inserting and displacing in the living body, and a mounting part for mounting and holding an endoscope for observing the operative field space. Further, in the retractor having a suction conduit inside the insertion portion, the insertion portion is composed of a plurality of separable components, at least one of which has a long groove portion in the axial direction of the insertion portion, Further, the retractor characterized in that the suction pipe path is formed by mounting another component on the component having the long groove portion.

2. 2. The retractor according to claim 1, wherein the insertion portion includes a conduit main body having a long groove portion and a fitting groove in the axial direction thereof, and a thin plate-shaped lid that can be inserted into the fitting groove. . 3. The retractor according to the second aspect, wherein the component forming the insertion portion has a rib in its axial direction. 4. The lid is springy and its cross-sectional shape is composed of two fitting portions into the fitting groove and a relatively large arcuate spring portion sandwiched between the fitting portions. Retractor described in.

5. The retractor according to the second aspect, wherein the component forming the lid has a flexible component in a fitting portion with the fitting groove. 6. The retractor according to item 5, wherein the flexible member is silicone rubber. 7. 2. The retractor according to claim 1, wherein the insertion portion is composed of a conduit main body having a long groove portion in its axial direction and a thin plate provided with a member having adhesiveness on one surface thereof. 8. The insertion part has a duct main body having a long groove portion in the axial direction, and a lumen having a length equal to that of the duct main body, into which the duct main body can be inserted, and after contraction, the duct main body can be closely fitted. The retractor according to the first item, which comprises a heat-shrinkable tube having.

[0062]

As described above, according to the present invention, the operative field can be easily observed and the operation efficiency can be improved even in the application example in which the observation direction is limited and the operation efficiency is not so good. Can be achieved.

[Brief description of drawings]

FIG. 1 is a schematic sectional view of an entire retractor of a first embodiment.

FIG. 2 is a sectional view of a portion of the ball joint mechanism of the retractor of the first embodiment as seen from the side.

FIG. 3 is a sectional view of the ball joint mechanism of the retractor of the first embodiment as seen from the rear.

FIG. 4 is a sectional view of the tip portion of the insertion portion of the retractor according to the first embodiment as viewed from the side.

FIG. 5 is an explanatory diagram of a use state of the retractor of the first embodiment.

FIG. 6 is a sectional view of a ball joint mechanism portion of a retractor according to a second embodiment, as viewed from the rear.

FIG. 7 is a cross-sectional view of a portion of a ball joint mechanism of a retractor of a third embodiment as seen from the side.

FIG. 8A is a vertical cross-sectional view of the tip portion of the retractor insertion portion according to the first embodiment of the suction conduit structure, and FIG. 8B is a cross-sectional view of the tip portion of the insertion portion of the retractor. .

FIG. 9 is a perspective sectional view of a distal end portion of a retractor insertion portion according to a second embodiment having a suction conduit structure.

10 is a schematic configuration diagram of a retractor base end portion having the conduit configuration of FIG.

FIG. 11 is a diagram showing a usage state of a retractor having the conduit configuration of FIG. 9.

FIG. 12 is a perspective cross-sectional view of a retractor insertion portion according to a third embodiment having a suction conduit configuration.

FIG. 13 is a perspective sectional view of a retractor insertion portion according to a fourth embodiment having a suction conduit configuration.

FIG. 14 is a perspective cross-sectional view of a retractor insertion portion according to a fifth embodiment having a suction conduit structure.

FIG. 15 is a perspective cross-sectional view of a retractor insertion portion according to a sixth embodiment having a suction conduit structure.

FIG. 16 is a perspective cross-sectional view of a retractor insertion portion according to a seventh embodiment having a suction line configuration.

FIG. 17 is a perspective sectional view of a retractor insertion portion according to an eighth embodiment having a suction conduit structure.

FIG. 18 is a perspective sectional view of a retractor insertion portion according to a ninth embodiment of a suction conduit structure.

FIG. 19 is a perspective sectional view of a retractor insertion portion according to a tenth embodiment of the suction conduit structure.

FIG. 20 is a perspective cross-sectional view of a retractor insertion portion according to an eleventh embodiment of a suction line configuration.

[Explanation of Codes] 1 ... Retractor, 2 ... Insertion part, 3 ... Base end part, 4 ... Arm part, 5 ... Grip, 6 ... Endoscope, 7 ... Mounting tube, 8 ... Ball joint mechanism (means), 16 ... Ball, 17 ... Ball storage hole, 21 ... Notch groove, 25 ... Pressing member, 27 ...
Suction line, 28 ... opening.

Claims (1)

[Claims] 1. A hand side gripping part, an insertion part for securing a surgical field space in the living body by inserting and displacing it in the living body, and the endoscope for observing the surgical field space. In the endoscopic surgical auxiliary device including a mounting portion that holds the endoscope mounting portion, an endoscope mounting portion moving means that makes the endoscope mounting portion movable with respect to the insertion portion is provided. Auxiliary device for endoscopic surgery.