JP4662374B2 - Endoscopic blood vessel collection device - Google Patents

Description

  The present invention relates to an endoscopic blood vessel collection device that, for example, endoscopically collects a subcutaneous blood vessel such as a large saphenous vein.

A cannula and a surgical method used for endoscopically collecting a subcutaneous blood vessel such as a great saphenous vein are known, for example, from PCT / US99 / 31242 and Japanese Patent Laid-Open No. 2000-37389. .
The cannula is a straight tubular body having an instrument insertion passage therein, and an operation portion is provided at a proximal end thereof. A retractor, a rigid endoscope, and an incision forceps are inserted into the instrument insertion passage of the cannula from the operation unit side so as to be detachable. The retractor has a loop at its distal end protruding from the tip of the cannula and angled with respect to the axial direction of the cannula.

  When a subcutaneous blood vessel such as the great saphenous vein is collected endoscopically using the cannula, the following surgical method is employed. 32, reference numeral 100 denotes a lower limb, which is collected over the entire length of a blood vessel C (hereinafter referred to as a blood vessel) C such as a large saphenous vein that extends from the upper part of the neck A of the thigh to the ankle B. In this case, a skin incision E1 or E2 or E3 is provided by a knife or the like directly above the blood vessel C, for example, above the cervical part A or at the knee D or ankle B.

  Then, the blood vessel C is exposed by a die sector or the like at each skin incision E1, E2, or E3. Further, the tissue immediately above the blood vessel C is peeled off by a similar die sector or the like at a distance that can be observed with the naked eye from each skin cut E1, E2, or E3.

  FIG. 33 is a cross-sectional view taken along line XX in FIG. 32, where 101 is the epidermis, 102 is the subcutaneous tissue, 103 is the vascular connective tissue, and the blood vessel C is present below this connective tissue 103. . First, using a cannula with a conical tip attached to the tip of the cannula as a die sector, the blood vessel C and surrounding tissue are separated to form a cavity G. Here, collection of the blood vessel C extending toward the skin incision E2 and the groin A of the knee D will be described. The conical tip is removed from the tip of the cannula, the cannula is inserted into the cavity G from the skin incision E2, and it is made to follow the blood vessel C toward the skin incision E1 of the knee D while observing with a rigid endoscope. insert.

In the process of inserting the cannula into the cavity G, while operating the operation part at the proximal end of the cannula to advance and retract the retractor, the blood vessel C is held at the loop part at the distal end, and the subcutaneous tissue 102 and the blood vessel A plurality of side branches F separated from the connective tissue 103 and branched from the middle of the blood vessel C are cut with an incision forceps. By repeating this operation, the blood vessel C between the skin incision E2 and the neck A is collected.
PCT / US99 / 31242 JP 2000-37389 A

  By the way, the above-mentioned PCT / US99 / 31242 and JP-A-2000-37389 have a structure in which a retractor, a rigid endoscope and an incision forceps are removably inserted into the instrument insertion passage of the cannula. The structure is complicated. The operator holds the cannula operating portion with one hand and holds the blood vessel C by moving the retractor back and forth with the other hand. In this state, the operator changes the hand holding the retractor to the incision forceps and operates the incision forceps to cut the side branch F. Therefore, there is a problem that the surgeon cannot operate unless both hands are used.

The present invention, wherein was made in view of the circumstances, it is an object of endoscopic vessel harvesting which is excellent in operability at the time of collecting the blood vessel such as the saphenous vein in the endoscopic observation under To provide an apparatus.

To achieve the above object, the invention according to claim 1 is capable of being inserted through a proximal end, a distal end, a longitudinal axis extending from the proximal end toward the distal end, and an insertion portion of the endoscope. An endoscope channel and a treatment instrument channel through which the treatment instrument can be inserted, and an operation portion for operating the treatment instrument inserted through the treatment instrument channel is disposed at the proximal end. A sheath that can be inserted into the body from the distal end side, and is provided at the proximal end side of the sheath, and is provided to protrude laterally to the endoscope inserted through the endoscope channel. A rotation guide around the longitudinal axis of the endoscope inserted into the endoscope channel by engagement of the notch and the endoscope. , along with determining the longitudinal position of the endoscope, the distal end of the insertion portion of the endoscope the sheath Located at the distal end, and wherein the treatment instrument distal end of the surgical instrument inserted through the channel portion, inner positioning longitudinally of the endoscope relative to the sheath on observable position in the field of view of the endoscope An endoscope holding portion, and the endoscope channel is disposed on the sheath in parallel with the longitudinal axis and linearly guides the insertion portion of the endoscope along the longitudinal axis. The treatment instrument channel includes a blood vessel cutting means insertion channel that linearly guides the blood vessel cutting means along the longitudinal axis, and a blood vessel that linearly guides the blood vessel holding means along the longitudinal axis. An endoscopic blood vessel sampling device including a holding means insertion channel .
According to a second aspect of the present invention, in the endoscopic blood vessel sampling device according to the first aspect, the notch portion is a pair of elastic pieces that are engaged with the light guide base by inserting the light guide base in between. It is characterized by having .
According to a third aspect of the present invention, in the endoscopic blood vessel sampling device according to the first or second aspect, the endoscope holding portion is connected to the endoscope that is inserted through the endoscope channel. It has an inner space that houses the eye portion, and the cutout portion is formed in a peripheral wall that forms the inner space.
The invention according to claim 4 is the endoscopic blood vessel sampling device according to any one of claims 1 to 3, wherein the channel for inserting blood vessel cutting means and the channel for inserting blood vessel holding means are connected to the endoscope. A mirror channel is disposed between the sheaths with the mirror channel interposed therebetween.
The invention according to claim 5 is the endoscopic blood vessel sampling device according to any one of claims 1 to 4, wherein the endoscope holding portion is connected to the sheath so as not to rotate about the longitudinal axis. It is characterized by.
The invention according to claim 6 is the endoscopic blood vessel sampling device according to any one of claims 1 to 5, wherein the notch is inserted through an endoscope channel and is provided at a distal end of the endoscope. The endoscope is locked so as to be disposed at a position protruding from the distal end of the sheath.

According to the said structure, the position and attitude | position of an endoscope with respect to a sheath are ensured.

According to the present invention, since the position and orientation of the endoscope against the sheath is secured, endoscopic vessel harvesting apparatus which is excellent in operability when collected under endoscopic observation vessel such as the saphenous vein Will be able to provide.

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

  FIG. 1 shows an endoscopic blood vessel collection device used for endoscopic blood vessel collection surgery, which includes a trocar 1, a treatment sheath 2, a die sector 3 as an expansion means, and a rigid endoscope 4 as an endoscope. It consists of and.

  As shown in FIGS. 2A and 2B, the trocar 1 is integrally formed of a synthetic resin material or the like, and a cylindrical guide tube 6 is provided in a substantially disc-shaped flange 5 so as to penetrate diagonally. It has been. The surface of the guide tube 6 is provided with a lubricating coating for improving slippage during insertion. The distal end portion 6 a of the guide tube 6 is cut at an acute angle, and the end surface of the distal end portion 6 a is formed substantially parallel to the flange 5.

  Further, an airtight ring portion 7 is integrally provided on the inner peripheral surface of the proximal end portion of the guide tube 6, and an air supply base 8 is integrally provided on the intermediate portion. An adhesive layer 9 such as an adhesive tape is provided on the lower surface of the flange 5 so that the trocar 1 can be adhesively fixed to the skin.

  Next, the treatment sheath 2 will be described as shown in FIGS. 3 and 4. The sheath body 10 has a straight cylindrical shape made of a synthetic resin material or the like, and the surface is provided with a lubrication coating for improving slippage during insertion. A cylindrical operation portion cover 11 constituting a grip portion is fitted to the proximal end of the sheath body 10, and a tip cover 12 is fitted to the distal end.

  An endoscope channel 13 is provided over the entire length of the axial center portion of the sheath body 10. The proximal end of the endoscope channel 13 passes through the operation portion cover 11 and protrudes toward the hand side, and a flange portion 13a protruding from the front end surface of the sheath body 10 is provided at the distal end. Inside the sheath body 10, a first treatment instrument channel 14 is provided at a portion eccentric to the upper side across the endoscope channel 13, and a second treatment instrument channel 15 is provided to the portion eccentric to the lower side. Is provided. Accordingly, the first treatment instrument channel 14 and the second treatment instrument channel 15 are arranged symmetrically at the farthest positions with the endoscope channel 13 in between.

  The proximal end of the first treatment instrument channel 14 opens to the first slide operation section 16 inside the operation section cover 11, and the proximal end of the second treatment instrument channel 15 is the interior of the operation section cover 11. The second slide operation unit 17 is opened. A bipolar cutter 18 as a high-frequency treatment instrument, which will be described later, is inserted into the first treatment instrument channel 14 so as to be able to advance and retreat in the axial direction, and the proximal end thereof is within the range of the long hole 16a of the first slide operation section 16. A treatment instrument operating portion 19 is provided that is slidable in the axial direction. Further, a bipolar cable 20 is connected to the bipolar cutter 18, and the bipolar cable 20 is led out from the long hole 16a.

  A blood vessel holder 21, which will be described later, is inserted into the second treatment instrument channel 15 so as to be able to advance and retreat in the axial direction, and slides in the axial direction within the range of the long hole 17a of the second slide operating portion 17 at the proximal end. A free holding element operation unit 22 is provided.

  Furthermore, a through hole 23 is provided in the axial direction on one side of the endoscope channel 13 inside the sheath body 10. A wiper rod 25 of a wiper 24 to be described later is inserted into the through hole 23 so as to be rotatable in the circumferential direction. The distal end of the wiper rod 25 is bent in an approximately L shape, and a wiper rubber 26 is provided at the tip thereof.

The proximal end of the wiper rod 25 extends to the rotation operation unit 27 inside the operation unit cover 11 and is rotatably supported on the inner wall of the operation unit cover 11. A wiper operation portion 28 is fixed to the proximal end of the wiper rod 25, and the wiper operation portion 28 is rotatable within a range of a long hole 27 a in the circumferential direction of the operation portion cover 11.
Accordingly, the treatment instrument operation unit 19, the retainer operation unit 22, and the wiper operation unit 28 are disposed within a range where the thumb and index finger of the hand can reach with the operation unit cover 11 being gripped.

Further, a torsion coil spring 29 made of a coil spring is provided inside the rotation operation unit 27 in a state of being fitted to the wiper rod 25. The torsion coil spring 29 is interposed between the end surface of the sheath body 10 and the wiper operation portion 28 in a compressed state, and urges the wiper 24 toward the proximal end of the sheath body 10. In addition, the torsion coil spring 29 is also locked to the end surface of the sheath body 10 and the side surface of the wiper operation portion 28, and biases the wiper rubber 26 in the direction of retracting to the side of the objective lens 4 a of the rigid mirror 4. Has been.
In addition, an endoscope holding unit 30 is provided on the proximal side of the operation unit cover 11 in a state of being fixed to the endoscope channel 13. The endoscope holding portions 30 and 39 have a lumen sufficient to accommodate the eyepiece 31 of the rigid endoscope 4, and are provided on the eyepiece 31 on a part (upper part) of the peripheral wall 32. A notch 34 is provided in which the light guide base 33 is inserted and engaged.

Accordingly, as shown in FIGS. 5 to 7, the insertion portion 35 of the rigid endoscope 4 is inserted into the endoscope channel 13, and the light guide base 33 is inserted into and engaged with the cutout portion 34, so that the eyepiece portion 31 is viewed internally. When held on the mirror holding unit 30, the rigid mirror 4 is prevented from rotating with respect to the treatment sheath 2, and the vertical posture of the rigid mirror 4 is set.
Next, the die sector 3 will be described. As shown in FIG. 8, an insertion passage 37 through which the insertion portion 35 of the rigid endoscope 4 is inserted is provided at the axial center portion of the straight cylindrical insertion tube portion 36. ing. The surface of the insertion cylinder part 36 is provided with a lubricating coating for improving slippage during insertion. A peeling member 38 formed in a conical cylinder shape by a transparent synthetic resin material is fixed to the distal end of the insertion cylinder portion 36. An endoscope holding portion 39 is provided at the proximal end of the insertion tube portion 36 so as to hold the eyepiece portion 31 of the rigid endoscope 4. The endoscope holding part 39 preferably has the same configuration as the endoscope holding part 30 of the treatment sheath 2.
Next, the bipolar cutter 18 will be described as shown in FIGS. That is, the cutter body 40 is made of a transparent insulating member such as a synthetic resin material, and has a shape in which the cross section of the belt-like plate body is curved in an arc shape along the arc-shaped inner peripheral surface of the sheath body 10, and the distal end Is provided with a V-groove 41 cut into a V-shape.

  A body-side electrode 42 is fixed to the upper part of the bottom of the V-groove 41, and a cut electrode 43 is fixed to the lower part. Lead wires 44 and 45 are connected to the body-side electrode 42 and the cut electrode 43, respectively. These lead wires 44 and 45 are wired along the upper and lower surfaces of the cutter body 40 and connected to the bipolar cable 20. . Furthermore, the lead wires 44 and 45 are covered and insulated by insulating films 46 and 47.

  Next, the blood vessel holder 21 will be described as shown in FIG. The blood vessel retainer 21 is formed in a substantially triangular shape in plan view with a synthetic resin material or the like, and the upper surface is formed on a flat surface 48 and the lower surface is formed on an arc concave surface 49. The operation rod 50 is connected to a position biased to one side of the rear end of the blood vessel retainer 21, and the operation rod 50 is inserted into the second treatment instrument channel 15 so as to freely advance and retract.

The peeling part 51 that peels the tissue at the distal end of the blood vessel retainer 21 has an acute angle, and first tapered surfaces 52a and 52b are formed symmetrically. Furthermore, slopes 53a and 53b are formed on the upper and lower surfaces of the peeling portion 51 so that the upper and lower surfaces become narrower toward the tip. The skirt portion of the first tapered surface 52a opposite to the joint portion of the blood vessel retainer 21 with the operation rod 50 is formed as an arc-shaped second tapered surface 54, and the second tapered surface 54 is formed in the blood vessel retainer. 21 is connected to a hook portion 55 that hooks a blood vessel at the rear end composed of 21 flat surfaces.
Next, the wiper 24 will be described as shown in FIG. That is, the wiper rubber 26 fixed to the distal end of the wiper rod 25 is fixed to the L-shaped bent portion of the wiper rod 25 by adhesion or insert molding, and is perpendicular to the axial direction of the wiper rod 25. Is provided. This wiper rubber 26 has a flexible scraping portion 26 a having a triangular cross section, and blood, mucous membrane, fat, etc. attached to the objective lens surface 4 a of the rigid mirror 4 by the rotation of the wiper rubber 26. The foreign object can be scraped off. At this time, since the scraping portion 26a has flexibility, even if there is a step between the distal end surface of the sheath body 10 and the objective lens surface 4a, the scraping portion 26a can overcome the step and rub against the objective lens surface 4a. It has become.

  As shown in FIG. 13, the torsion coil spring 29 formed of a coil spring provided on the wiper rod 25 of the wiper 24 has one end abutting against the end surface of the sheath body 10 and the other end connected to the wiper operation unit 28. Between them, and is locked to the side surface of the wiper operation unit 28. Accordingly, the torsion coil spring 29 generates a torque T in the circumferential direction of the wiper rod 25 and a force F that biases the sheath body 10 in the proximal end direction, and the wiper rubber 26 is on the side of the objective lens surface 4a of the rigid mirror 4. Urged in the direction of retreating in the direction of contact with the objective lens surface 4a.

9A and 9B show a state in which the insertion portion 35 of the rigid endoscope 4 is loaded into the endoscope channel 13 of the treatment sheath 2, and the bipolar cutter 18 and the blood vessel holder 21 are inserted from the distal end portion of the treatment sheath 2. Protruding. The bipolar cable 20 is connected to a high frequency generator 56, and the light guide base 33 is connected to a light guide cable 57.
Next, using the blood vessel sampling device configured as described above, sampling is performed over the entire length of a blood vessel to be collected (hereinafter referred to as a blood vessel) such as a large saphenous vein extending from the groin to the ankle of the thigh of the lower limb. The case where it does is demonstrated.
FIG. 14 shows the lower limb 60 and 61 is a blood vessel. First, when the blood vessel 61 between the knee 62 and the neck portion 63 is collected, a skin cutting portion 64 is provided by a knife or the like at one location of the knee 62 immediately above the blood vessel 61.

The blood vessel 61 is exposed by the die sector or the like at the skin cut portion 64. Further, the tissue immediately above the blood vessel 61 is peeled off by a similar die sector or the like at a distance that can be observed with the naked eye from the skin cut portion 64.
Next, as shown in FIGS. 15 and 16, the situation through the peeling member 38 is imaged by the TV camera 75 via the TV camera head 74 connected to the eyepiece 31 of the rigid endoscope 4 and is displayed on the monitor 76. Displayed as a monitor image. When the peeling member 38 is inserted along the blood vessel 61 and is slightly inserted, the guide tube 6 of the trocar 1 is inserted obliquely (substantially parallel to the blood vessel 61) toward the neck portion 63, and the distal end portion 6a is directed downward. The adhesive layer 9 on the lower surface of the flange 5 is bonded and fixed to the skin 65. In this state, the air supply tube 67 connected to the air supply pump 66 is connected to the air supply base 8.

  Since the outer peripheral surface of the insertion tube portion 36 is in close contact with the airtight ring 7, the inside of the guide tube 6 and the inside of the cavity 69 is in an airtight state, and an air supply passage is provided between the guide tube 6 and the insertion tube portion 36. 68 is secured.

The light guide base 33 of the rigid endoscope 4 is connected to the light source device 78 by a light guide cable 57. Therefore, it is possible to illuminate the cavity 69 by irradiating illumination light from the distal end portion of the rigid endoscope 4. When the air supply pump 66 is driven, air is supplied to the intracavity 69 via the air supply tube 67, the air supply base 8, and the air supply passage 68, and the intracavity 69 is expanded.
Here, in the cavity 69, the subcutaneous tissue 70 below the epidermis 65, the connective tissue 71 on the blood vessel, and the blood vessel 61 exist below the connective tissue 71 on the blood vessel, and a plurality of side branches 72 branch into the blood vessel 61. The other end of the side branch 72 is connected to the vascular connective tissue 71. Further, subcutaneous fat 73 is attached to the vascular connective tissue 71.
Next, when the monitor image is confirmed, it is displayed as shown in FIG. 17, and the operator can clearly observe the blood vessel 61 and the side branch 72 by the monitor 76. In FIG. 17, 38 a is an image of the tip of the peeling member 38 of the die sector 3.
Therefore, when the die sector 3 is inserted, the vascular connective tissue 71, the blood vessel 61, and the side branch 72 are peeled off by the peeling member 38 so that the blood vessel 61 and the side branch 72 are not damaged while the inside of the cavity 69 is observed by the monitor 76. While pushing it in a little, gradually move it back again. At this time, even if the die sector 3 is swung up and down, left and right, since the trocar 1 is fixed to the skin 65 by the adhesive layer 9, the trocar 1 does not come off the skin 65. Then, the die sector 3 is penetrated along the blood vessel 61 from the knee 62 toward the neck portion 63.

When the peeling procedure is completed by the die sector 3, the die sector 3 is extracted from the trocar 1, and the treatment sheath 2 with the rigid endoscope 4 inserted is inserted into the guide tube 6 of the trocar 1 as shown in FIG.
If the operator holds the operation portion cover 11 of the treatment sheath 2 with one hand and advances the retainer operation portion 22 with, for example, the thumb, the blood vessel retainer 21 protrudes from the distal end cover 12 of the sheath body 10. Further, when the cutter operation unit 19 is advanced with the index finger of one hand holding the operation unit cover 11, the bipolar cutter 18 protrudes from the tip cover 12. That is, the operator can advance and retract the blood vessel retainer 21 and advance and retract the bipolar cutter 18 while holding the operation unit cover 11 with one hand.
Therefore, as shown in FIG. 18, when a large amount of subcutaneous fat 73 is present in the intravascular connective tissue 70 in the cavity 69, the treatment sheath 2 is pushed forward with the bipolar cutter 18 protruding so that the cavity 69 is moved. Can be spread. At this time, since the lower surface of the blood vessel holder 21 is formed in the arc concave surface 49, the blood vessel 61 can be advanced by sliding on the upper surface of the blood vessel 61, and the blood vessel 61 is not damaged.
Further, as shown in FIG. 19, the side branch 72 may be embedded in the subcutaneous fat 73. In this case, the blood vessel retainer 21 is protruded from the treatment sheath 2, and the peeling portion 51 of the blood vessel retainer 21 is subcutaneous fat. 73, and the treatment sheath 2 is rotated in the circumferential direction in the guide tube 6 of the trocar 1 to rotate the blood vessel retainer 21 to remove the subcutaneous fat 73 from the side branch 72. Can be peeled off. Since the state at this time is displayed as a monitor image on the monitor 76 as shown in FIG. 20, the operator can confirm the posture of the blood vessel holder 21 by the monitor image, and the blood vessel 61 and the side branch 72 may be damaged. Absent.
The treatment sheath 2 is pushed into the lumen 69 while excluding the subcutaneous fat 73 in the lumen 69, and the blood vessel holder 21 is approached to the target side branch 72. Also at this time, the arcuate concave surface 49 of the blood vessel holder 21 can be applied to the upper surface of the blood vessel 61, and the upper surface of the blood vessel 61 can be slid to advance, so that the blood vessel 61 is not damaged.
FIGS. 21A to 21C show a procedure for holding the side branch 72 by the blood vessel holder 21. Since the blood vessel retainer 21 has the first tapered surface 52a and is continuously formed on the second tapered surface 54, when the blood vessel retainer 21 is advanced, first, the first tapered surface 52a. The side branch 72 comes into contact.

When the blood vessel retainer 21 is further advanced, the side branch 72 is slid down and caught by the hook portion 55 after coming into contact with the second taper surface 52b from the first taper surface 52a. Therefore, the side branch 72 can be easily held by the forward operation of the blood vessel holder 21. When the hook 55 of the blood vessel holder 21 is hooked in the middle of the side branch 72 and the blood vessel holder 21 is pulled to the near side, a tension is applied to the side branch 72 as shown in FIG. FIG. 23 is a monitor image in a state where the side branch 72 is hooked on the hook portion 55 of the blood vessel holder 21. The operator can confirm that the side branch 72 is held by the monitor image.
Next, the bipolar cutter 18 is advanced, and the bipolar cutter 18 approaches the side branch 72 held by the blood vessel holder 21. At this time, as shown in the monitor image of FIG. 24, the blood vessel 61 can be retracted away from the bipolar cutter 18 by the blood vessel holder 21 so that the bipolar cutter 18 does not contact the blood vessel 61.

FIGS. 25A to 25C show a procedure for cutting the side branch 72 with the bipolar cutter 18. Since the V-shaped groove 41 is provided at the tip of the bipolar cutter 18, when the bipolar cutter 18 is advanced toward the side branch 72, the side branch 72 is pulled toward the bottom by the V-shaped groove 41. Therefore, as shown in FIG. 26A, the side branch 72 contacts the cut electrode 43, and the body side electrode 42 contacts the vascular connective tissue 71 or the side branch 72.
After confirming that the side branch 72 is in contact with the cut electrode 43 and the body side electrode 42 is in contact with the vascular connective tissue 71 or the side branch 72 by the monitor image, the operator operates the foot switch 80 of the high frequency generator 56. Then, a high frequency current is applied. Then, the region in contact with the body side electrode 42 of the vascular connective tissue 71 is solidified, and the side branch 72 is cut by the cut electrode 43. Therefore, as shown in FIG. 26B, the portion where the blood vessel 61 is connected to the vascular connective tissue 71 by the side branch 72 is cut off by cutting the side branch 72.
After cutting the side branch 72, as shown in FIG. 27, the blood vessel holder 21 is lifted through the lower side of the blood vessel 61, and it is confirmed whether or not the side branch 72 has been completely cut by the monitor image shown in FIG. To do.

  Further, the blood vessel holder 21 is approached to the next side branch 72 while observing the inside of the cavity 69 with the monitor image, and the same procedure as described above is repeated again together with the bipolar cutter 18 to cut the side branch 72 and connect the blood vessel 61 on the blood vessel. Separate from tissue 71.

  When the procedure for cutting the side branch 72 is repeated in this way, the adherent 81 such as blood, mucous membrane, and subcutaneous fat 73 adheres to the objective lens surface 4a of the rigid endoscope 4, and the visual field by the rigid endoscope 4 may be obstructed. . In such a case, when the wiper operation unit 28 is rotated against the urging force of the torsion coil spring 29 with fingers while the operation unit cover 11 is held, as shown in FIG. The wiper 24 is rotated, and the scraped portion 26a of the wiper rubber 26 can scrape off the adhered matter 81 such as blood, mucous membrane and subcutaneous fat 73 attached to the objective lens surface 4a.

Since the wiper 24 is urged by the torsion coil spring 29, when the finger is released from the wiper operation unit 28, the wiper 24 returns to the direction of retracting from the objective lens surface 4a. Therefore, by repeating the above-described operation several times, even the deposit 81 such as the subcutaneous fat 73 that sticks to the objective lens surface 4a and does not easily fall off can be scraped cleanly. Further, when the finger is released from the wiper operation unit 28, the wiper 24 returns to the direction in which it is retracted from the objective lens surface 4a, so that the wiper 24 does not disturb the visual field of the rigid endoscope 4.
Further, when the side cutter 72 is repeatedly cut by the bipolar cutter 18, deposits 81 such as mucous membranes and subcutaneous fat 73 adhere to the inner surface of the bipolar cutter 18 as shown in FIG. 30. However, when the bipolar cutter 18 is retracted by the cutter operating unit 19 and drawn into the first treatment instrument channel 14, the mucous membrane and the subcutaneous fat 73 are scraped off by the front end surface of the sheath body 10. Therefore, the deposit 81 adhering to the bipolar cutter 18 can be easily scraped off.
In addition, as shown in FIG. 31, the adhered object 81 scraped off may adhere to the objective lens surface 4a of the rigid endoscope 4 and the visual field may be obstructed. By rotating the wiper 24 by operating 28, the deposit 81 attached to the objective lens surface 4a can be scraped off.

A procedure for cutting the side branch 72 and separating the blood vessel 61 from the connective tissue 71 on the blood vessel while repeating the operations of scraping off the adherent 81 adhering to the bipolar cutter 18 and scraping off the adhering matter 81 adhering to the objective lens surface 4a. The cutting of the side branch 72 is finished when the cervical part 63 is repeated. Then, a skin incision is formed in the neck 63 directly above the blood vessel 61 with a scalpel or the like, the blood vessel 61 is drawn out from this skin incision, the blood vessel 61 is cut, and both cutting ends of the blood vessel 61 are connected with a thread. To ligate.
Next, the blood vessel 61 is collected from the skin incision 64 of the knee 62 toward the ankle to finally collect one blood vessel (about 60 cm). The procedure method is basically the same as the method for collecting the blood vessel 61 from the knee 62 to the neck portion 63 described above, and the description thereof is omitted.
According to the embodiment, the bipolar cutter is used as the high-frequency treatment tool for cutting the side branch, but a monopolar cutter or a cutter for mechanical cutting may be used.
34 and 35 show a second embodiment, FIG. 34 is a perspective view of an ultrasonic treatment device, and FIG. 35 is a longitudinal side view of the same.
A flange-like operation unit 101 is attached to the proximal end of the treatment instrument sheath 100 to be inserted into the cavity, and a tip hood 102 having a tip cut obliquely is attached to the distal end. The operation unit 101 is rotatably supported by the fitting receiving unit 104 of the scope holder 103 that also serves as a grip, and the treatment instrument sheath 100 is configured to be rotatable with respect to the scope holder 103.

A scope fitting hole 105 and a treatment tool fitting hole 106 are provided in the operation portion 101 and the fitting receiving portion 104 of the treatment instrument sheath 100 in the axial direction thereof. An insertion portion 108 of the rigid endoscope 107 is inserted into the scope fitting hole 105, and an outer tube 110 of the ultrasonic treatment instrument 109 is inserted into the treatment instrument fitting hole 106.
An eyepiece 111 and a light guide base 112 are provided at the proximal end of the rigid endoscope 107, and these are supported by the scope holder 103. A treatment instrument operation unit 113 is provided at the proximal end of the outer tube 110 of the ultrasonic treatment instrument 109, and an ultrasonic transducer 114 is fixed to the treatment instrument operation unit 113.

A base end portion of an ultrasonic probe 115 is connected to the ultrasonic transducer 114, and the ultrasonic probe 115 is inserted into the outer tube 110 and protrudes from a distal end opening of the outer tube 110. An ultrasonic treatment tool jaw 116 is rotatably supported at the distal end portion of the outer tube 110 with a pivot pin 117 as a fulcrum, and is opened and closed with the distal end portion of the ultrasonic probe 115.
One end of an operation rod 118 is connected to the ultrasonic treatment instrument jaw 116, and the other end extends through the outer tube 110 to the treatment instrument operation section 113. A jaw opening / closing lever 119 is rotatably provided on the treatment instrument operation unit 113 with the pivot shaft 120 as a fulcrum. One end portion of the jaw opening / closing lever 119 is connected to the operation rod 118 via the notch portion 110a of the outer tube 110, and the other end portion is provided with a finger hook portion 121 that protrudes outside the treatment instrument operation portion 113.

  The ultrasonic transducer 114 is connected to a power supply device 123 via a cable 122, and the power supply device 123 is provided with a foot switch 124.

  According to the above-described ultrasonic treatment instrument, the outer tube 110 including the ultrasonic probe 115 and the ultrasonic treatment instrument jaw 116 protrudes from the distal end opening of the treatment sheath 100 by grasping the treatment instrument operation unit 113 and moving it forward and backward. Die.

In addition, the ultrasonic probe 115 and the ultrasonic treatment tool jaw 116 can be directed in an arbitrary direction by grasping the operation portion 101 of the treatment sheath 100 and rotating it around its axis.
Therefore, as shown in the first embodiment, when the side branch 72 branched from the blood vessel 61 is cut, the treatment instrument operation unit 113 is grasped while observing the cavity 69 with the rigid endoscope 107, and the ultrasonic probe 115 is used. In addition, the ultrasonic treatment instrument jaw 116 is advanced and retracted, and the operation portion 101 of the treatment sheath 100 is grasped and the side branch 72 is approached between the ultrasonic probe 115 and the ultrasonic treatment instrument jaw 116.
Then, the foot switch 124 is turned on to ultrasonically vibrate the ultrasonic transducer 114, and the jaw opening / closing lever 119 is operated to close the ultrasonic treatment instrument jaw 116 and the ultrasonic probe 115 and sandwich the side branch 72. The side branch 72 can be cut.
According to the configuration described above, the following configuration is obtained.
(Supplementary Note 1) An endoscopic blood vessel that includes a sheath that can be inserted into a cavity from a skin incision, an endoscope that is inserted into the sheath, and a plurality of operation means, and that collects a blood vessel to be collected in the cavity In the sampling system, at least an operation unit such as a blood vessel cutting unit and a blood vessel holding unit is incorporated in the sheath so as to be movable in the axial direction of the sheath, and an operation unit that operates the operation unit such as the blood vessel cutting unit and the blood vessel holding unit An endoscopic blood vessel collection system characterized in that the blood vessel is concentrated on the proximal end of the sheath.

(Supplementary note 2) The supplementary note 1 is characterized in that a grip portion is provided at the proximal end of the sheath, and the operation portion is disposed within a range where the thumb and index finger of the hand can reach with the grip portion held. Endoscopic blood vessel collection system.

(Additional remark 3) The said blood vessel cutting means and the blood vessel holding means are combined with the washing | cleaning means for washing the objective lens surface of an endoscope, The endoscopic blood vessel of Additional remark 1 characterized by the above-mentioned Collection system.

(Appendix 4) The endoscopic blood vessel collection system according to appendix 1 or 3, wherein the blood vessel cutting means is a high-frequency treatment instrument.

(Appendix 5) The endoscopic blood vessel collection system according to Appendix 1 or 3, wherein the blood vessel cutting means is an ultrasonic treatment instrument.

(Appendix 6) The endoscopic blood vessel collection system according to appendix 1 or 3, wherein the blood vessel holding means is a blood vessel holder that can protrude from a distal end portion of the sheath.

(Appendix 7) The endoscopic blood vessel collection system according to appendix 1 or 3, wherein the washing means is a wiper that scrapes off the objective lens surface.

(Supplementary note 8) The endoscopic blood vessel sampling system according to supplementary note 1, wherein the sheath has an endoscope channel through which the endoscope is inserted in an axial center portion thereof.

(Supplementary note 9) A first stage in which a skin incision is formed in a part of the epidermis to expose a blood vessel to be collected immediately under the skin incision, and an expansion means including an endoscope is inserted into the cavity from the skin incision Then, a second stage of expanding the inside of the cavity under endoscopic observation, and after removing the expanding means, a treatment sheath including a plurality of operating means including an endoscope is inserted into the cavity from the skin incision. An endoscopic blood vessel collecting method comprising: a third stage of inserting and collecting the blood collection target blood vessel while cutting the blood vessel to be collected from the surrounding tissue under endoscopic observation while pushing along the blood vessel to be collected.
(Supplementary note 10) The endoscopic blood vessel collection method according to supplementary note 9, wherein the means for separating the blood vessel to be collected in the third stage from the surrounding tissue is a method of cutting a side branch.

The side view which shows the blood-vessel collection device of 1st Embodiment of this invention. The embodiment is shown, (a) is a perspective view of a trocar, (b) is a longitudinal sectional side view. The longitudinal cross-sectional side view of the treatment sheath of the state which showed the same embodiment and extracted the rigid endoscope. The longitudinal section top view of the treatment sheath of the state which showed the same embodiment and extracted the rigid endoscope. The longitudinal section side view of the treatment sheath of the state which showed the embodiment and inserted the rigid endoscope. The longitudinal section top view of the treatment sheath of the state which showed the same embodiment and penetrated the rigid endoscope. The figure which shows the same embodiment and was seen from the arrow A direction of FIG. The longitudinal section side view of the tip part of the die sector which shows the embodiment. The embodiment is shown, (a) is a perspective view of the treatment sheath of the blood vessel sampling device, (b) is a perspective view of the distal end portion, (c) is a front view of the distal end portion. The bipolar cutter of the embodiment is shown, (a) is a top view, (b) is a longitudinal side view, (c) is a bottom view. The vascular retainer of the embodiment is shown, (a) is a top view, (b) is a longitudinal side view, and (c) is a front view. The wiper of the embodiment is shown, (a) is a top view, (b) is a cross-sectional view along the line BB. The perspective view of the wiper operation part of the embodiment. The figure of the state which showed the same embodiment and formed the skin cut part in the leg. Sectional drawing which shows the same embodiment, the state where the trocar was mounted | worn in the skin cut part of the leg, and the die sector was inserted in the cavity using the trocar as a guide. The whole block diagram of the state which showed the same embodiment and inserted the treatment sheath in the cavity using the trocar. The figure which shows the monitor image of the embodiment. Sectional drawing of the state which showed the same embodiment and inserted the treatment sheath in the cavity. Sectional drawing of the treatment state in the cavity which shows the embodiment. The figure which shows the monitor image of the embodiment. The same embodiment is shown, (a)-(c) is a perspective view which shows the effect | action of a blood vessel retainer. The intracavity sectional drawing of the treatment state which shows the embodiment. The figure which shows the monitor image of the embodiment. The figure which shows the monitor image of the embodiment. The same embodiment is shown, (a)-(c) is a top view which shows the effect | action of a bipolar cutter. The same embodiment is shown, (a) (b) is a sectional view in the cavity showing the action of the bipolar cutter. The intracavity sectional drawing of the treatment state which shows the embodiment. The figure which shows the monitor image of the embodiment. The perspective view of the front-end | tip part of a treatment sheath which shows the same embodiment. The perspective view of the front-end | tip part of a treatment sheath which shows the same embodiment. The perspective view of the front-end | tip part of a treatment sheath which shows the same embodiment. The figure of the state which formed the skin cut part in the leg. Sectional drawing which follows the XX line of FIG. The perspective view of the treatment sheath using the ultrasonic treatment tool which shows 2nd Embodiment of this invention. The longitudinal section side view of the treatment sheath using the ultrasonic treatment instrument of the embodiment.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Trocar 2 ... Treatment sheath 4 ... Rigid endoscope 18 ... Bipolar cutter 19 ... Cutter operation part 21 ... Blood vessel retainer 22 ... Retainer operation part 24 ... Wiper 28 ... Wiper operation part 61 ... Blood vessel 72 ... Side branch

Claims (6)

A proximal end, a distal end, a longitudinal axis extending from the proximal end toward the distal end, an endoscope channel through which an insertion portion of the endoscope can be inserted, and a treatment tool through which a treatment tool can be inserted A sheath that can be inserted into the body from the distal end side , and an operation portion that operates the treatment instrument that is inserted into the treatment instrument channel and used for operation .
A cutout portion that is provided on the proximal end side of the sheath and that is inserted into and engaged with a light guide base that protrudes laterally to an endoscope that is inserted through the endoscope channel; The rotation stop around the longitudinal axis of the endoscope inserted through the endoscope channel by the engagement of the notch and the light guide base, and determining the position of the endoscope in the longitudinal axis direction , The distal end of the insertion portion of the endoscope is positioned at the distal end of the sheath, and the distal end portion of the treatment instrument inserted through the treatment instrument channel is positioned with respect to the sheath at a position that can be observed in the visual field of the endoscope. An endoscope holding portion that is positioned in the longitudinal axis direction of the endoscope,
Comprising
The endoscope channel is disposed in parallel to the longitudinal axis in the sheath and linearly guides the insertion portion of the endoscope along the longitudinal axis.
The treatment instrument channel includes a blood vessel cutting means insertion channel for guiding the blood vessel cutting means linearly along the longitudinal axis, and a blood vessel holding means insertion means for guiding the blood vessel holding means linearly along the longitudinal axis. An endoscopic blood vessel collection device comprising a channel . The endoscopic blood vessel sampling device according to claim 1, wherein the notch includes a pair of elastic pieces that are inserted between the light guide caps and engaged with the light guide caps .   The endoscope holding portion has an inner space portion that accommodates an eyepiece portion of the endoscope that is inserted through the endoscope channel, and the cutout portion is formed in a peripheral wall portion that forms the inner space portion. The endoscopic blood vessel collection device according to claim 1 or 2, wherein the device is an endoscopic blood vessel collection device.   4. The blood vessel cutting means insertion channel and the blood vessel holding means insertion channel are arranged in the sheath with the endoscope channel positioned therebetween. The endoscopic blood vessel collection device described.   The endoscopic blood vessel sampling device according to any one of claims 1 to 4, wherein the endoscope holding portion is connected to the sheath so as not to rotate around the longitudinal axis.   The notch portion locks the endoscope so that the distal end of the endoscope installed through the endoscope channel is disposed at a position protruding from the distal end of the sheath. Item 6. The endoscopic blood vessel collection device according to any one of Items 1 to 5.

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