JP5007967B2 - Cannula - Google Patents

Description

  The present invention relates to a cannula for holding an incision site in general arthroscopic surgery.

In arthroscopic surgery, based on the basic concept of “minimally invasive” arthroscopic surgery, the incision location is minimized and the surgical fluid (lactic acid Ringer's solution or physiological saline injected into the treatment location) For the purpose of preventing leakage of water and the like, an instrument 1J called a cannula is often inserted into the incision site 20 of the patient 40 and held at the incision site 20 as shown in FIG.
Here, the cannula 1J has a hollow cylindrical member, and one end 1Ja of the cylindrical member is configured to be insertable into the patient's body from the incision site 20, and the other end 1Jb is inserted into the body fluid or the like from the patient's body side. The surgical liquid medicine is configured not to flow backward, and the surgical instrument 30 can be inserted.

In performing the treatment, the surgical instrument 30a fixed to the tip of the elongated rod is inserted into the cylindrical member of the cannula 1J from the other end 1Jb, and further moved from the one end 1Ja into the patient's body. Then, insert into the arthroscopic treatment area. Then, using the inserted surgical instrument 30a, necessary processing is performed under visual observation with an arthroscope (not shown).
In the cannula 1J, there are a soft type in which the cylindrical member is made of a flexible material (synthetic resin or the like) and a hard type made of a metal or other rigid member.

However, when performing the arthroscopic operation using the cannula 1J described above, if the size of the surgical instrument 30a fixed to the tip of the elongated rod is larger than the inner diameter of the cylindrical member of the cannula 1J, The surgical instrument 30 cannot be inserted into the cylindrical member of the cannula 1J. This applies not only to the hard type but also to the soft type.
For example, in the case of the soft type, although it has some flexibility, it does not have elasticity like rubber, so it is difficult to insert a surgical instrument larger than the inner diameter of the cylindrical member. It is. In addition, when a surgical instrument having a sharp tip and a curved shape is forcibly inserted, a situation in which the tip of the surgical instrument is stuck in the middle of the cylindrical member of the cannula is also expected.

  Therefore, when using a surgical instrument having a large size, it is necessary to use a cannula having a large inner diameter of the cylindrical member. However, using a cannula having a large inner diameter of the cylindrical member requires a larger incision site for the patient, which is against the basic concept of “minimum invasiveness”.

  In addition, when a cannula is used, processing with the surgical instrument must be performed by manipulating the grip at the end of the rod while the elongated rod to which the surgical instrument is connected penetrates the cylindrical member of the cannula. However, the rod penetrating the cylindrical member of the cannula has a problem that the degree of freedom of movement is limited, and the movement of the surgical instrument at the tip of the rod is also limited.

  Note that it is not possible to pull out only the cannula along the rod after the surgical instrument is inserted up to the treatment area. This is because a grip is provided at the end of the elongated rod to which the surgical instrument is connected, so that the grip is caught.

As another conventional technique, there is a cannula (Patent Document 1 and Patent Document 2) that closes an obstructed air flow that flows in a blood vessel of a patient and blocks a blood flow that flows outside the patient. However, such a cannula relates to a hemostatic cannula and does not solve the above-described problems.
There are some that apply negative pressure to the inner needle that punctures the blood vessel with a syringe and determine the puncture into the blood vessel based on the blood flow sucked from the inner needle (Patent Document 3). It cannot be resolved.

A cannula for the purpose of easily inserting and removing a surgical instrument has also been proposed (Patent Document 4), but the cannula has a conical shape as a whole, and the tip of the flap is pressed against the movable part of the seal valve. The slit is opened and is not intended for a type of cannula having a hollow cylindrical member.
Japanese National Patent Publication No. 11-514903 JP 2004-290684 A JP 2000-14791 A JP 2002-209904 A

  The present invention has been proposed in view of the above-described problems of the prior art, and without increasing the inner diameter of the cylindrical member, without limiting the degree of freedom of the rod of the surgical instrument, the surgical instrument, etc. An object of the present invention is to provide a cannula that does not restrict the movement of the surgical instrument at the tip of the rod.

  According to the present invention, a surgical instrument (10) composed of a sharp blade (11) and an opposite part (12) fixed to the tip of an elongated rod is arthroscopically extended to a patient's treatment area. In order to insert, in the cannula made of a flexible cylindrical member (2, 2B), a slit (3, 3B) parallel to the central axis is formed in the cylindrical member (2, 2B). The circumferential ends (4, 4B, 5, 5B) constituting (3, 3B) are the first ends (ed) opposite to the first ends (ed) on the patient side of the cylindrical member (2, 2B). A V-shaped cut is formed at the second end (eu) toward the first end (ed), and the first end (ed) has a slightly cut shape or is cut. The cylindrical member (2, 2B) is not configured in the shape of the slit (3, 3B). The cylindrical member (2, 2B) is constantly biased in a closed direction, and the sharp blade (11) side of the surgical instrument (10) contacts the inside of the cylindrical member (2, 2B). When inserted in such a manner, the opposite side (12) of the surgical instrument (10) can be located outside the slit (3, 3B) and the slit (3C, 3D) of the cylindrical member (2C, 2D) The end portions (4C, 4D, 5C, 5D) of the door are configured to be engageable, and the slits (3C, 3D) that engage the end portions (4C, 4D, 5C, 5D) are closed. It is configured to be able to.

  Furthermore, according to the present invention, a surgical instrument (10) composed of a sharp blade (11) fixed to the distal end of an elongated rod and a portion (12) on the opposite side is treated by a patient under arthroscopy. In order to insert into a region, in a cannula made of a cylindrical member having rigidity, the cylindrical member has a double tube structure having an inner cylinder (21E) and an outer cylinder (22E), and these inner cylinders Each of (21E) and outer cylinder (22E) has a straight slit (213E, 223E) parallel to the central axis of the inner cylinder (21E) and outer cylinder (22E) continuously from one end to the other end. The inner cylinder (21E) can be inserted with the surgical instrument (10). When inserting the surgical instrument (10), the slit (213E) of the inner cylinder (21E) and the outer cylinder Align the slit (223E) of (22E) It is allowed, and a position of the slit (223E) of the slit of the inner cylinder (21E) (213E) and outer tube (22E) as allowed to differ in the circumferential direction after insertion of the surgical instrument (10).

According to the present invention having the above-described configuration, since the continuous slit (3) is formed from one end portion to the other end portion of the cylindrical member (2), the surgical instrument (10) having a large size is formed as a cannula. When passing through the cylindrical member (2) of (1), the sharp part passes through the inside of the (11) cylindrical member (2), but the other members pass through the slit (3) or outside thereof. By doing so, it is possible to use a smaller cannula (1) than in the conventional case when using a surgical instrument (10) having a large size.
When operating the surgical instrument (10), the rod can be moved to the slit (3) or an area outside the slit (3), so that the degree of freedom of movement (movement) of the surgical instrument (10) is increased. Get higher.

In addition to this, when the surgical instrument (10) has a large member such as a handle, for example, the surgical instrument is inserted into the cannula of the present invention and removed after performing the necessary treatment. The slit (3) of the member (2) can be widened and the surgical instrument (10) can be removed therefrom. That is, unlike the conventional cannula, it is not necessary to pull back the inserted surgical instrument (10) over the entire length in the longitudinal direction of the cylindrical member (2).
Similarly, there are cases where it is desired to use the surgical instrument with the cannula removed during the operation. However, with a conventional cannula, for example, when the handle is large, it is difficult to remove the cannula. On the other hand, if the cannula of the present invention is used, the cannula can be easily removed from the surgical instrument by widening the slit (3) of the cylindrical member (2).

  Furthermore, since it is possible to clean the inside of the cylindrical member (2) through the slit (3), it is possible to keep the instrument clean.

Here, since the slit (3) forms a straight line parallel to the central axis of the cylindrical member (2), it is easy to form the slit (3) in the cylindrical member (2).
In addition, a portion where the slit (3) is formed in one end of the cylindrical member (2) (the end eu on the side separated from the patient in use) is the end on the opposite side (used In this case, since it is configured in a shape (4e, 5e) cut toward the end ed on the patient side, positioning in forming the slit (3) is facilitated. In other words, the manufacturing labor for forming the slit (3) of the present invention in a cylindrical material can be reduced.
On the other hand, the end on the opposite side of the cylindrical member (2), that is, the end (ed) on the patient side in use is the one end (the end on the side separated from the patient in use). eu) It is configured in a slightly cut shape toward the side, or is not configured in a cut shape, so that in use, the end (patient side end ed) is caught on the patient's body. Is prevented.

  In the present invention, when configured as a so-called “soft type” cannula (1B, 1C, 1D), the cylindrical member (2B) is always urged in a direction to close the slit (3B). (In the case of 1B), or by constructing the opposing end faces of the slits (3C, 3D) so that they can be engaged (4C, 5C; 4D, 5D). It is possible to minimize the leakage of surgical fluid (such as lactated Ringer's solution or physiological saline) injected into the region through the slits (3C, 3D).

  Alternatively, in the present invention, when it is configured as a so-called “hard type” cannula (1E), it is configured in a double tube structure having an inner cylinder (21E) and an outer cylinder (22E), and the inner cylinder (21E) and If slits (213E, 223E) are formed in the outer cylinder (22E), the positions of the inner cylinder slit (213E) and the outer cylinder slit (223E) are made different in the circumferential direction, whereby the inner cylinder (21E). Since the labyrinth seal is configured from the inside to the outside of the outer cylinder (22E), it is possible to prevent the surgical fluid from leaking through the slits (213E, 223E) to the minimum. .

Embodiments of the present invention will be described below with reference to the accompanying drawings.
First, a first embodiment will be described with reference to FIGS.
FIG. 1 is a perspective view of a cannula 1 according to the first embodiment as viewed from the front and obliquely above. In FIG. 1, a cannula 1 has, for example, a resin-made cylindrical member 2 formed with a slit 3 parallel to a central axis (not shown) of the cylindrical member 2.

  In FIG. 1, end portions in the circumferential direction across the slit 3, that is, circumferential end portions 4 and 5 constituting the slit 3 are upper end portions (longitudinal direction of the arrow U in FIG. 1) of the cylindrical member 2. Direction end) eu (the end on the side away from the patient when used), as indicated by reference numerals 4e and 5e, the lower end (in the direction of arrow D) of the cylindrical member 2 (or opposite) Side end) A cut (part A in FIG. 1) partially having an arc portion toward the ed side.

On the other hand, the lower end (in the direction of arrow D) of the cylindrical member 2 (or the opposite end) ed (the end on the patient side in use) is the portion of the A portion in the upper end eu. In this way, a large cut is not formed. At the lower end ed of the cylindrical member 2 (in the direction of arrow D), as shown in FIG. 1, the cylindrical member 2 is configured to have a slightly cut shape toward the opposite end eu side, or to a cut shape. Is not configured.
This is to prevent the end ed on the patient side from being caught on the patient's body when using the cannula.

  In addition, when the cannula 1 is mass-produced, the notch (A part) is formed simultaneously with cutting by a cutting machine (not shown) when cutting a long material tube and cutting it to the length of each cannula 1. . When the slits of the individual cannulas 1 are formed, the notches (A part) are positioned, and the molding of the slits 3 starts from the notches (A part).

  Although not shown, the cut may be a simple V-shaped notch shape without an arc portion.

  FIG. 2 is a view of a state in which the surgical instrument 10 having a sharp blade is inserted from the cross-sectional direction using the slit 3 of the cannula 1.

  In FIG. 2, the sharp blade 11 side of the surgical instrument 10 having an arbitrary cross section composed of a sharp blade 11 and a portion 12 on the opposite side of the sharp blade 11 contacts the inside of the cannula 1. Has been inserted. By inserting the surgical instrument 10 into the cannula 1 in this way, it is possible to avoid damaging human tissue during insertion.

  However, when the surgical instrument 10 is inserted so that the sharp blade 11 of the surgical instrument 10 is exposed to the outside of the slit 1 as shown in FIG. 3, the sharp blade 11 of the surgical instrument 10 damages human tissue. Therefore, it is necessary to pay sufficient attention so that such an insertion method is not adopted.

  Here, the material of the cannula may be made of a highly flexible resin, or a hard resin or a metal resistant to rust can be used.

  According to 1st Embodiment of the structure mentioned above, since the slit 3 continuous from one end part of the cylindrical member 2 to the other end part was formed, the surgical instrument 10 with a large dimension is the cylindrical member 2 of the cannula 1. For example, if the surgical instrument has a sharp blade 11, the blade 11 passes through the cylindrical member 2, and the other members are inserted so as to pass through the slit 3 or the outside thereof. Thus, when the surgical instrument 10 having a large size is used, it is possible to use the cannula 1 smaller than the conventional one.

As shown in FIG. 2, when operating the surgical instrument 10, the rod at the distal end of the surgical instrument 10 can move to the outside of the slit 3 or the radially outer region of the cylindrical member 2. Therefore, the degree of freedom of movement of the surgical instrument 10 is increased.
In addition to this, when the surgical instrument 10 has a large member such as a handle, for example, when removing the surgical instrument 10 from the cannula, the surgical instrument 10 extends over the entire length in the longitudinal direction of the cylindrical member 2. There is no need to pull back, and the slit 3 can be widened and the surgical instrument 10 can be removed therefrom. Similarly, when it is desired to use the surgical instrument 10 with the cannula 1 removed, the slit 3 of the cylindrical member 2 can be widened to easily remove the cannula 1 from the surgical instrument 10.

  Further, since the inside of the cylindrical member 2 can be cleaned through the slit 3, the surgical instrument can be kept clean.

Since the slit 3 forms a straight line parallel to the central axis of the cylindrical member 2, it is easy to form the slit 3 in the cylindrical member 2.
And in the both ends of the cylindrical member 2 of the cannula 1, the part where the slit 3 is formed is formed in a shape (4e, 5e) cut toward the opposite end, so that the slit 3 is formed. Positioning at the time of doing so becomes easy.
In other words, the manufacturing labor for forming the slit 3 of the present embodiment in a cylindrical material can be reduced.

  Next, 2nd Embodiment is described based on FIGS.

  4 to 6 (the cannula is indicated by reference numeral 1B), the direction in which the slit 3B is closed by the elastic repulsion of the material 2B constituting the cylindrical member when the material is a soft type (FIG. 4, Y4 and Y5) are always urged.

  That is, as shown in FIG. 4, even when the slit 3B is opened by an external force (not shown), the slit edges 4B and 5B constituting the slit 3B try to close by the biasing of the material itself in the directions of arrows Y4 and Y5. As shown in FIG. 5, the slit 3B is closed.

  Therefore, when there is no instrument, as shown in FIG. 5, the edges 4B and 5B of the slit 3B are joined together, and the slit 2B is closed. On the other hand, when the instrument 10 is inserted, there is no gap between the instrument 10 and the slit edges 4B and 5B, as shown in FIG. That is, in any case of FIG. 5 and FIG. 6, there is no gap between the edges 4B and 5B or between the edges 4B and 5B and the instrument 10, so that the patient's bodily fluids and chemicals from inside the cannula 1B Leakage can be prevented to a minimum.

  Next, a third embodiment will be described based on FIG.

In the third embodiment of FIG. 7, the opposite end of the slit 3C formed in the cylindrical member 2C is such that a part of the ring 5C is missing 5Ca on the left side of the drawing, and the interior 5Cb is a space having a circular cross section. The so-called “female” 50C is the so-called “male” 4C formed in a bead shape with a circular cross section on the right side, and the bead of the “male” 4C fits into the internal 5Cb from the defective portion 5Ca of the “female” 50C. And is configured to be engaged.
That is, if necessary, the ends 4C and 50C can be engaged with each other so that the slit 3C is closed.

FIG. 8 shows a modification of the third embodiment. The male-female structure is different from the third embodiment of FIG.
In FIG. 8, the opposite left and right end portions of the slit 3D formed in the cylindrical member 2D are arranged so that the edge portions 4D and 5D in which a part of the ring is missing (4Da and 5Da) are engaged with each other. ing.

Next, 4th Embodiment is described based on FIGS.
The cannula 1E according to the fourth embodiment shown in FIGS. 9 to 11 has a double-pipe structure having an inner cylinder 21E and an outer cylinder 22E as shown in FIG.

  The inner cylinder 21E and the outer cylinder 22E form slits 213E and 223E continuous from one end to the other end of each of the inner cylinder 21E and the outer cylinder 22E, and the slits 213E and 223E are cylindrical members 21E and 22E. Is formed in a straight line parallel to a center axis (not shown).

  The inner cylinder 21E is rotatable with respect to the outer cylinder 22E, and when the surgical instrument 10 is inserted into the cannula 1E, as shown in FIG. 10, the slit 213E of the inner cylinder 21E and the slit 223E of the outer cylinder 22E. Align the circumferential position with.

  After inserting the surgical instrument 10, as shown in FIG. 11, the positions of the slit 213E of the inner cylinder 21E and the slit 223E of the outer cylinder 22E are made different in the circumferential direction.

  That is, FIG. 11 shows a state where the surgical instrument 10 is not inserted, or a state after the insertion of the surgical instrument 10 is completed, and the positions of the slit 213E of the inner cylinder 21E and the slit 223E of the outer cylinder 22E. However, it becomes a so-called “labyrinth seal” which is different in the circumferential direction, and has a structure in which a surgical fluid (such as lactated Ringer's solution or physiological saline) is difficult to leak from the slits 213E and 223E.

  It should be noted that the illustrated embodiment is merely an example, and is not a description to limit the technical scope of the present invention.

The perspective view which showed the cannula of 1st Embodiment of this invention in three dimensions. Sectional drawing which showed the state which inserted the surgical instrument concerning 1st Embodiment so that a sharp blade might face the inside of a cannula. Sectional drawing which showed the state which inserted the surgical instrument concerning 1st Embodiment so that a sharp blade might face the outside of a cannula. In the cannula of 2nd Embodiment, external force is made to act on a cannula, and sectional drawing of the state which expanded the slit. FIG. 5 is a cross-sectional view showing a state where the external force is removed and the slit is closed with respect to FIG. 4. In 2nd Embodiment, even if an instrument protrudes from a slit, sectional drawing which showed the state which the instrument and the slit edge part contacted closely by the urging | biasing of the direction which closes the slit which acts on a slit. Sectional drawing of the cannula of 3rd Embodiment. Sectional drawing of the cannula of the modification of 3rd Embodiment. The perspective view which showed the cannula of 4th Embodiment in three dimensions. Sectional drawing which showed the state which shifted the position of the slit of an inner cylinder, and the slit of an outer cylinder in 4th Embodiment. Sectional drawing which showed the state which made the position of the slit of an inner cylinder and the slit of an outer cylinder correspond in 4th Embodiment. The perspective view which showed the example of an operation using the prior art cannula.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Cannula 2 ... Cylindrical member 3 ... Slit 4, 5 ... Edge 4e, 5e ... Slit edge part 10 ... Surgical instrument 11 ... Surgical instrument Sharp blade 12 ... The part of the surgical instrument opposite the sharp blade

Claims (2)

In order to insert a surgical instrument (10) composed of a sharp blade (11) and an opposite part (12) fixed to the tip of an elongated rod into the patient's treatment area under arthroscopy In the cannula made of a flexible cylindrical member (2, 2B), a slit (3, 3B) parallel to the central axis is formed in the cylindrical member (2, 2B), and the slit (3, 3B) is formed. The circumferential end (4, 4B, 5, 5B) constituting the second end (eu) on the opposite side of the first end (ed) on the patient side of the cylindrical member (2, 2B). ) Is formed with a V-shaped notch toward the first end (ed), and the first end (ed) is formed in a slightly cut shape or in a cut shape. The cylindrical member (2, 2B) closes the slit (3, 3B). The cylindrical member (2, 2B) was inserted in such a manner that the sharp blade (11) side of the surgical instrument (10) was in contact with the inside of the cylindrical member (2, 2B). Sometimes the opposite side (12) of the surgical instrument (10) can be located outside the slit (3, 3B) and the end (4C) of the slit (3C, 3D) of the cylindrical member (2C, 2D) 4D, 5C, 5D) are configured to be engageable, and the slits (3C, 3D) that engage the ends (4C, 4D, 5C, 5D) can be closed. Cannula characterized by being. In order to insert a surgical instrument (10) composed of a sharp blade (11) fixed to the tip of an elongated rod and an opposite part (12) under arthroscopy to the patient's treatment area, it is rigid In the cannula composed of a cylindrical member having a cylindrical shape, the cylindrical member has a double tube structure including an inner cylinder (21E) and an outer cylinder (22E), and the inner cylinder (21E) and the outer cylinder (22E). ) Is formed with straight slits (213E, 223E) parallel to the central axes of the inner cylinder (21E) and the outer cylinder (22E) from one end to the other end, and the inner cylinder ( 21E) can insert the surgical instrument (10). When inserting the surgical instrument (10), the slit (213E) of the inner cylinder (21E) and the slit (223E) of the outer cylinder (22E) And the surgical instrument (10 Cannula, characterized in that the position of the slit (223E) of the slit of the inner cylinder (21E) (213E) and outer tube (22E) is configured to allowed to differ in the circumferential direction after inserting the.

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