JPH11290329A - Fixing instrument for surgical operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To surely adsorb a fixing instrument to an object to be sucked even when negative pressure to be loaded into the cavity part of the fixing instrument is low, and to surely hold an inoculating part so as not to move it by sucking the fixing instrument to the object to be sucked with high stability. SOLUTION: This instrument has an sucking member made annular in plane view while forming a hole part 2 at its central part and forming the cavity part by opening the base and a tube 5 communicated to the cavity part of this sucking member 3. Besides, the sucking plane of the sucking member 3 is practically tightly sucked to the object to be sucked over all the surface at the time of adsorption and a lot of fine adsorbing grooves are formed on the sucking plane. Then, air in the cavity part is released through the tube 5, the sucking plane of the sucking member 3 and the object to be sucked are tightly adhered, and an object to be fixed is fixed.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical fixing device, and more particularly, to a method of adsorbing an object such as a heart at the time of surgery and a method of fixing a fixed object such as a blood vessel to a surgical fixing device and an object. The present invention relates to a surgical fixing instrument that is fixed by being interposed therebetween.

[0002]

2. Description of the Related Art Myocardial infarction is a disease with a high mortality rate,
Today, it is treated by surgery to anastomose a bypass vessel to the occluded coronary artery. Conventionally, when a bypass vessel is anastomosed with the coronary artery of the heart, the heart is completely stopped and surgery is performed while maintaining the patient's blood circulation by extracorporeal circulation using a heart-lung machine.

[0003] However, since the operation performed while stopping the heart imposes a heavy burden on the patient and is one of the most invasive heart operations, it is necessary to perform the operation without stopping the heart as much as possible. Is desired. Therefore, in recent years, surgical fixing devices have been proposed in which surgery can be performed by fixing only the anastomotic portion without stopping the heart.

[0004] As a conventional surgical fixing instrument of this kind, for example, “Thoracic Surgery Vol. 51 No. 4 (Apr. 1998)
"Month)" from page 71 to page 73 discloses "an anastomosis-fixed hemostatic device in MIDCAB (hereinafter, referred to as" fixed hemostatic device ")". FIG. 9 is a partially cutaway perspective view of a conventional surgical fixing instrument. The fixed hemostatic device 50 is
As shown in FIG. 9, as can be seen from the above-mentioned document, which is referred to as a "doughnut", it is annular in plan view, and has a hole 51 at the center thereof. The outer wall surface 52A rises vertically, the inner circular portion 52B is inclined, and the bottom surface is open.
An elastic rubber suction member 52 having a cavity 53 is provided. Further, a tube 54 for extracting air, which communicates with the cavity 53, is attached to the suction member 52.

When the fixed hemostatic device 50 is to be adsorbed to an object to be adsorbed, for example, the heart, the bottom surface of the adsorbing member 52 is applied to the surface of the heart, and the cavity 53 is moved by a vacuum pump (not shown).
Suction the air inside. Then, a negative pressure is applied to the inside of the hollow portion 53 to reduce the pressure inside the hollow portion 53, and the fixed hemostatic device 5
0 is adsorbed to the heart. At this time, the coronary artery can be fixed by interposing a fixed object, for example, a coronary artery between the fixed hemostatic device 50 and the heart.
1 to stop the movement of the heart inside. Then, an operation of anastomosing the bypass blood vessel to the occluded coronary artery via the hole 51 is performed, and after the operation,
The fixed hemostatic device 50 is partially cut and removed from the heart.

[0006]

However, in the conventional fixed hemostatic device 50, since the outer wall surface 52A rises vertically, when a negative pressure is applied to the hollow portion 53, the inner circular portion 52B is closed. A part of the suction surface comes into close contact with the inner surface of the outer wall surface 52A, and the other part comes into close contact with the heart. Therefore, in order to ensure that the fixed hemostatic device 50 is adsorbed to an object to be adsorbed such as the heart,
A large negative pressure must be applied. Therefore, when the fixed hemostatic device 50 is removed after the operation, there is a concern that traces of the fixed hemostatic device 50, that is, subepicardial hematomas may remain on the heart, which is the object to be adsorbed.

[0007] In addition, since heart surgery is life-threatening when it fails, the devices used for it are:
Further high reliability is required. In other words, it is required that this type of fixation device be made to adhere to the object to be adsorbed with higher stability so as not to move the anastomosis part at the time of adsorption.

[0008] Therefore, an object of the present invention is to ensure that the fixation device is adsorbed to the object even if the negative pressure applied to the cavity of the fixation device is small, and that no post-epicardial hematoma remains after the operation. Is to do so. Another object of the present invention is to ensure that the fixation device is adsorbed to the object to be adsorbed with high stability, and that the anastomotic portion is securely held so as not to move.

[0009]

SUMMARY OF THE INVENTION The present invention, which has solved the above-mentioned problems, has a ring shape in plan view, has a hole formed in the center thereof, and has a cavity formed by opening the bottom surface. An adsorbing member, a tube communicating with the hollow portion of the adsorbing member, a bottom surface of the adsorbing member and an adsorbed object facing each other with the immobilized object interposed therebetween, and air in the hollow portion via the tube. A surgical fixing instrument for fixing the fixed object by bringing the suction surface of the suction member into close contact with the suction object, wherein the suction surface of the suction member is
It is characterized in that it is made to adhere to the object to be adsorbed over substantially the entire surface at the time of suction, and that a large number of suction narrow grooves are formed on the suction surface.

[0010] At this time, the suction narrow groove includes one or two or more main suction grooves formed along a circumferential direction of the suction surface.
It can be made up of a number of capillary suction grooves formed near the outer peripheral portion and the inner peripheral portion of the suction surface.

In addition, a plurality of suction projections may be formed instead of the plurality of suction narrow grooves.

Further, a convex ring may be formed on an upper portion of the suction member, and a fixed member having a shape obtained by cutting at least a part of the ring may be attached to the convex ring. At this time, preferably, the fixed member is
It is horseshoe-shaped.

On the other hand, it is also possible to attach a fixture to the fixed member and attach a gripping member to the fixture.

The inventor of the present invention made various trial manufactures of a surgical fixing instrument in the course of reaching the present invention. Here, the prototypes and the processes leading to them will be described. The present inventor has proposed a conventional fixed hemostatic device 50 shown in FIG.
On the other hand, as shown in FIG. 7, in order to obtain high stability at the time of adsorption, the outer periphery of the open surface of the conventional fixed hemostatic device is
A fixing device 30 having a flexible fold 31 was prototyped. In this fixing device 30, the conventional fixed hemostatic device 5 shown in FIG.
It was possible to stably adsorb the substance to be adsorbed as compared with 0. This is considered to be due to the fact that the folds 31 contribute to preventing air from leaking from between the outer periphery of the suction surface 32 and the object to be sucked.

However, in this fixing device 30, the folds 3
1 does not mean that it is adsorbed on the object separately.
It is conceivable that a problem may occur when the folds 31 fluctuate during the operation and hinder the operator. Therefore, as shown in FIG. 8, a large number of suction narrow grooves 31A, 31A... Are formed on the back surface side (suction surface side) of the fold portion 31. By forming a large number of suction narrow grooves 31A, 31A,... On the back side of the fold portion 31, when a negative pressure is applied to the hollow portion 33, the suction narrow grooves 31A are formed.
Since a negative pressure is applied to A, 31A,..., The folds 31 can also be adsorbed to the object. Therefore, the problem of wobbling during the operation was solved.

However, the problem that a large negative pressure has to be applied in the cavity 33 has not been solved yet. Through these steps, the present invention has been made.

[0017]

Embodiments of the present invention will be specifically described below with reference to the drawings. FIG. 1 is a perspective view of a surgical fixing instrument according to the present invention (hereinafter, also simply referred to as “fixing instrument”), FIG. 2 is a longitudinal sectional view, FIG. 3 is a rear view of the suction member, and FIG. FIG. As shown in FIG. 1, the fixing device 1 has a circular shape in plan view, has a hole 2 in the center thereof, and has an adsorbing member 3 in which a bottom surface is opened and a cavity is formed. . At the time of the operation, the anastomotic portion of the heart is located in the hole 2. A tube 5 communicating with the cavity 4 shown in FIG. 2 and extracting air from the cavity 4 is attached to the suction member 3. Tube 5
It is also connected to a vacuum pump (not shown) via a vacuum tank (not shown). By operating the vacuum pump, the air in the cavity 4 is extracted. The adsorbing member 3 is made of a flexible polymer material such as silicon rubber and can be easily cut with scissors or the like.

Further, as shown in FIG. 2, the suction surface 3A of the suction member 3 has a shape in which a central portion is located at a high position along the circumferential direction, and descends inward and outward from the central portion. It has been. For this reason, at the time of adsorption, the adsorption surfaces 3A do not come into contact with each other, and the adsorption surface 3A substantially adheres to the object to be adsorbed over the entire surface.
Therefore, the area where the suction surface 3A is in close contact with the object to be adsorbed is increased, and the negative pressure spreads over the entire surface of the suction surface 3A. Can be adsorbed.

Further, as shown in FIG. 3, a large number of suction narrow grooves are formed on the suction surface 3A of the suction member 3. The suction narrow grooves are formed like three capillaries formed by three main suction grooves 3a, 3a, 3a formed along the circumferential direction of the suction surface 3A, and branched from these main suction grooves 3a, 3a, 3a. Are formed by the capillary suction grooves 3b. The capillary suction grooves 3b are formed radially so as to extend over the entire suction surface 3 in the vicinity of the inner peripheral surface and the outer peripheral surface of the suction surface 3A, and are formed in the hollow portion 4 of the suction member 3 at the time of suction. In order to apply the negative pressure evenly, they are arranged uniformly over the entire area in plan view. These suction grooves, as shown in FIG.
Is formed in a substantially V-shaped cross section. In such a suction narrow groove, a cutting tool can be operated by, for example, an NC machine to form a rubber mold, and a cut can be formed in the suction surface 3A.
In the fixing device 1 according to the present invention, since such a suction narrow groove is formed, the suction surface 3 of the suction member 3 is formed.
A and the object to be adsorbed can be adsorbed more reliably.

A convex ring 6 is formed integrally with the suction member 3 on the upper part of the suction member 3. The convex ring 6 is formed with a fitting groove 6 </ b> A that fits into a horseshoe-shaped metal ring 7 partially cut away.
Is fitted in the fitting groove 6A, thereby preventing deformation of the suction member 3. Further, a fixing tool 8 is fixed to the ring 7, and a handle 9 is attached to the fixing tool 8, so that the ring 7 can be lifted by the handle 9.

Next, in cardiac surgery, the fixing device 1
A procedure for performing an anastomosis process using will be described. At the stage where the heart surgery is performed and a process of performing an anastomosis of the bypass blood vessel to the occluded coronary artery is performed, a coronary artery T is inserted between the heart H and the bottom surface of the suction member 3 in the fixing device 1 as shown in FIG. The suction member 3 is brought into close contact with the surface of the heart H by intervening. Thereafter, negative pressure is applied to the inside of the cavity 4 by a vacuum pump (not shown), and the air in the cavity 4 is extracted through the tube 5. In this manner, as shown in FIG. 5B, the suction surface of the suction member 3 and the surface of the heart H are sucked, and the suction member 3
And a coronary artery T interposed between the heart and the heart H are fixed. At this time, almost the entire suction surface 3A shown in FIG. 3 is in close contact with the surface of the heart H, and the suction surface 3A has three main suction narrow grooves 3a, 3a, 3a and a large number of capillary suction surfaces. Since the grooves 3b are formed (see FIG. 3), the contact area between the heart H and the suction surface 3A of the suction member 3 can be increased, and negative pressure spreads over the entire suction surface 3A. Therefore, the suction member 3 can be surely brought into close contact with the heart H without applying too much negative pressure. During the anastomosis process, a negative pressure is continuously applied to the suction member 3 by a vacuum pump (not shown) so that the suction member 3 does not come off.

When the suction member 3 is brought into close contact with the heart H, the heart H
When the coronary artery T is fixed while the anastomotic portion is not moved, as shown in FIG. 5 (c), a surgical assistant may use a handle 9 attached to the fixture 8, as shown in FIG. Thus, the anastomotic portion of the heart H to which the suction member 3 is suctioned is lifted. Then, a bypass blood vessel B is prepared at the anastomosis part, and the bypass blood vessel B is anastomosed with the coronary artery T. Coronary artery T
After the anastomosis of the bypass blood vessel B is completed, in order to remove the fixing device 1, as shown in FIG. 5 (d), the notched portion of the ring 7 is used to cut the suction portion, and the fixing device 1 is removed from the anastomotic portion. . Thus, the anastomosis process in the heart operation is completed. As described above, since the anastomosis and the coronary artery can be reliably fixed and the heart surgery can be performed by using the fixing device according to the present invention, the heart does not need to be completely stopped and the incision range can be narrowed. Also, there is no need to attach a cardiopulmonary device, and the burden on the patient is reduced,
Recovery is faster.

On the other hand, as another embodiment of the fixing device according to the present invention, as shown in FIG. 6, as suction members 3 ', insertion holes 6A', which are equally spaced in the circumferential direction of the convex ring 6 ', are provided. 6
A 'can also be used. In this embodiment, insertion holes 6A ', 6A formed in the convex ring 6' are provided.
By passing a thread (not shown), fine silver plating, copper wire, or the like through A '..., It is possible to securely and securely bind the heart to the thoracotomy machine with the heart slightly lifted.

In the above embodiments, a large number of suction grooves are formed in order to increase the suction area. However, similar effects can be obtained by providing a large number of suction projections instead. In addition, the suction groove and the suction protrusion can be formed by intersecting with each other. Further, in the above embodiment,
The main suction groove and the capillary suction groove were formed as suction grooves,
The mode is not limited to this mode, and it is needless to say that an appropriate mode can be adopted.

On the other hand, the shape of the suction member is circular in plan view in the above embodiment, but is not limited to this shape.
For example, an appropriate shape such as an ellipse, an oval, and a rectangle can be used. That is, the term "annular" in the present invention means an endless shape, and the specific outer shape is not particularly limited. In each of the above embodiments,
Although the case where the fixing device is used for heart surgery has been described,
Of course, it can also be used in operations on other organs.

[0026]

As described above, according to the present invention, even if the negative pressure applied to the cavity of the fixation device is small, the fixation device is surely adsorbed to the object to be adsorbed. Etc. can be prevented from remaining. Moreover, it becomes possible to make the anastomosis part not move by adsorbing the fixing device to the object to be adsorbed with high stability.

[Brief description of the drawings]

FIG. 1 is a perspective view of a surgical fixing instrument according to the present invention.

FIG. 2 is a longitudinal sectional view of a surgical fixing instrument according to the present invention.

FIG. 3 is a rear view of the surgical fixing instrument according to the present invention.

FIG. 4 is a partially enlarged perspective view of the surgical fixing instrument according to the present invention.

FIG. 5 is an explanatory view of a heart surgery process performed using the surgical fixing instrument according to the present invention.

FIG. 6 is a perspective view of another fixing device according to the present invention.

FIG. 7 is a perspective view of a surgical fixing device according to a prototype before the present invention.

FIG. 8 is a perspective view of another surgical fixing instrument according to another prototype before the present invention.

FIG. 9 is a partially cutaway perspective view of a conventional surgical fixing instrument.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Surgical fixing instrument 2 ... Hole 3, 3 '... Suction member 3A ... Suction surface 3a ... Main suction groove 3b ... Capillary suction groove 4 ... Cavity part 5 ... Tube 6, 6' ... Convex ring 7 ... Ring 8 ... Fixture 9 ... Handle H ... Heart T ... Coronary artery B ... Bypass blood vessel

Claims (6)

[Claims] 1. A suction member having an annular shape in a plan view, a hole formed in a central portion thereof, a bottom surface being opened to form a cavity, and a communication with the cavity in the suction member. A bottom surface of the adsorbing member and the object to be adsorbed with the object interposed therebetween, and the air in the hollow portion is extracted through the tube, so that the adsorbing surface of the adsorbing member and the object to be adsorbed are removed. A surgical fixing instrument for fixing an object to be fixed by closely adhering an object, wherein the suction surface of the suction member is adapted to be in close contact with the object to be suctioned over substantially the entire surface during suction. A surgical fixing instrument, wherein a large number of suction narrow grooves are formed on the suction surface. 2. The suction narrow groove includes one or two or more main suction grooves formed along a circumferential direction of the suction surface, and a plurality of suction narrow grooves formed near an outer peripheral portion and an inner peripheral portion of the suction surface. The surgical fixing instrument according to claim 1, comprising a capillary suction groove of (1). 3. The surgical fixing instrument according to claim 1, wherein a plurality of suction projections are formed instead of the plurality of suction narrow grooves. 4. A convex ring is formed on an upper portion of the suction member,
The surgical fixing instrument according to any one of claims 1 to 3, wherein a fixed member having a shape obtained by cutting at least a part of the ring is attached to the convex ring. 5. The surgical fixing instrument according to claim 4, wherein the fixed member has a horseshoe shape. 6. The surgical fixing instrument according to claim 4, wherein a fixing tool is attached to the fixed member, and a gripping member is attached to the fixing tool.