Patent Application
20100042078
1. Field of the Invention
The present invention relates to an intra-body-cavity insertion instrument guide and an intra-body-cavity insertion instrument guide system for guiding an intra-body-cavity insertion instrument for obtaining a space in a body cavity to allow an organ in the body cavity to be operated on in a surgical operation.
2. Description of the Related Art
In cardiac surgery, sterna are cut (e.g., median sternotomy) to allow access to the chest cavity. In this case, a retractor is set in the opening made in the chest and separates widely the sterna and organs, to create a large opening. Surgical instruments are deployed through the opening, and cardiac surgery is then carried out.
One of most common forms of cardiac surgery is coronary artery bypass grafting (CABG). In CABG, occlusion in one or plural coronary arteries is bypassed by connecting a graft to a coronary artery on the downstream side of the occlusion. The technique for connecting a graft to a coronary artery is known as an anastomosis. As a graft, for example, a mammary artery which is cut from the chest wall is used. In that case, an upstream end of the mammary artery is left intact while the other downstream end of the mammary artery is connected to the coronary artery. Alternatively as a graft, an artery or vein cut from any part of the human body may be used. Also alternatively, a piece of artificial blood vessel may be used as a graft. In that case, an upstream end of the piece grafted is connected to an artery such as an aorta while the other downstream end thereof is connected to the coronary artery. In this manner, occlusion in plural coronary arteries at various positions in the heart, such as in the front, side, or back of the heart, is bypassed by using plural grafts.
Meanwhile, in recent years, as minimally invasive surgery, endoscopic operations have been carried out in the aforementioned CABG, to conduct various procedures by forming a hole in a wall of a human body cavity such as an abdominal wall and by further inserting an endoscope or a surgical instrument into the body cavity through the hole. In that case, a monitor camera is inserted at a position in the body cavity which corresponds to an affected portion appearing on a CT image picked up prior to the operation.
Such an endoscopic surgical operation, for example as disclosed in Patent Document 1, uses a retractor whose plural flat plates are inserted into a body cavity and then open in fan-like fashion, so that organs other than a target organ to be operated on are pressed and excluded, thereby to maintain a view field for a monitor camera.
Patent Document 1: Jpn. Pat. Appln. KOKAI Publication No. 6-154152
Accordingly, the present invention provides an intra-body-cavity insertion instrument guide and an intra-body-cavity insertion instrument guide system, which are capable separating a target organ existing deep in a body cavity from other organs, to obtain a space for surgery.
According to one aspect of the invention, there is provided an intra-body-cavity insertion instrument guide comprising: an insertion section that is inserted into a body cavity; and a guide section that is formed at the insertion section and guides an intra-body-cavity insertion instrument for obtaining a space for operating on an organ in the body cavity, to a side opposite to an insertion hole into which the insertion section is inserted, in relation to the organ.
According to one other aspect of the invention, there is provided an intra-body-cavity insertion instrument guide system comprising: an intra-body-cavity insertion instrument that obtains, in a body cavity, a space for operating on an organ in the body cavity; and a guide that includes an insertion section inserted into the body cavity, and a guide section that is formed at the insertion section and guides the intra-body-cavity insertion instrument to a side opposite to an insertion hole into which the insertion section is inserted, in relation to the organ.
Hereinafter, best mode for carrying out the present invention will be described with reference to the drawings.
The intra-body-cavity insertion instrument guide 10 according to the present embodiment includes an insertion section 12 to be inserted into a body cavity. The insertion section 12 is made of a soft tube which is prone to bending. An end of the insertion section 12 is formed as a tapered hard top end 14 in order to improve insertability. A lumen 16 for inserting an intra-body-cavity insertion instrument is formed throughout the whole length of the insertion section 12. The lumen 16 functions as a guide section for guiding the intra-body-cavity insertion instrument toward a side opposite to an insertion hole in which the insertion section 12 is inserted, in relation to an organ.
Specifically, as denoted at (1) in
Further, as illustrated in
Once the operating space 32 is obtained in this manner, two ends of the cord 24 outside the human body are then engaged on the ribs 18 or a frame not illustrated, and the obtained operating space 32 can be thereby maintained.
Since the target organ 22 is supported by pinching (i.e., not by cantilevering), rigidity of the intra-body-cavity insertion instrument may be so low that rigidity of such a thin instrument as the cord 24 is satisfactory.
Further, the intra-body-cavity insertion instrument guide 10 can be configured to be thin since the cord 24 is used as an intra-body-cavity insertion instrument. Accordingly, there is an effect that even a small hole is satisfactory for insertion of the intra-body-cavity insertion instrument guide 10.
In the second embodiment, a PTFE (i.e., Teflon (registered trademark)) tube 34 is used as an intra-body-cavity insertion instrument. Side holes 38 which allow a cord 36, as a pulling member for pulling an organ from inside of a body cavity to outside of the human body, to pass are formed at near two ends of the PTFE tube 34, as illustrated in
The intra-body-cavity insertion instrument guide according to the second embodiment of the invention is an endoscope 26 including a forceps channel having a diameter which allows such a PTFE tube 34 to be inserted. The present embodiment will now be described referring to an example of using the endoscope 26 as an intra-body-cavity insertion instrument guide. Needless to say, however, the intra-body-cavity insertion instrument guide may be made of a soft tube which is prone to bending as in the first embodiment.
Specifically, a forceps channel for inserting a pair of biopsy forceps is provided in an insertion section 40 of the endoscope 26, and connects a top end of the insertion section 40 to a section which is positioned outside the human body when the insertion section 40 is inserted into a body cavity 20. The present embodiment uses the forceps channel as a guide section. The PTFE tube 34 is inserted from an inlet port 42 of the forceps channel, extends through the forceps channel, and protrudes from an outlet port 46 of a tapered hard top end 14.
As illustrated in
As illustrated in
Further, the cord 36 is inserted into the side hole 38 in the top end side of the PTFE tube 34 pulled out of the human body, and is then engaged on the ribs 18 or a frame not illustrated. If the endoscope 26 is now pulled out of the human body, the PTFE tube 34 is left remain in the body cavity 20 since the top end of the endoscope 26 is fixed. Hence, through the trocar 48 after the endoscope 26 has been pulled out, the cord 36 inserted into the rear end side or the side hole 38 of the PTFE tube 34 is grasped by the forceps 50, further pulled out of the human body, and then engaged on the ribs 18 or a frame not illustrated. In this manner, the PTFE tube 34 lifts up the bottom face of the target organ 22 against gravity in the body cavity 20, and separates the target organ 22 from another organ 30. A operating space 32 for surgery can accordingly be obtained between the target organ 22 and the another organ 30.
Thus, also according to the second embodiment, the operating space 32 can be obtained by supporting the target organ 22 by pinching (i.e., not by cantilevering).
Further, the second embodiment uses the PTFE tube 34 which has a certain width, as an intra-body-cavity insertion instrument, in place of a thin cord in the first embodiment. Therefore, when the intra-body-cavity insertion instrument is positioned lower in the gravitational direction, the target organ 22 is pressed against the intra-body-cavity insertion instrument due to gravity, so that not only the operating space 32 can be obtained but also movement of the target organ 22 such as pulsation can be restricted.
Since the guided PTFE tube 34 is once left remain in the body cavity 20, the position of the PTFE tube 34 can be finely adjusted by using the forceps 50.
In the third embodiment, a PTFE tube 34 as described above is used as an intra-body-cavity insertion instrument, and an engaging member 52 is provided at a top end of the PTFE tube 34. An engaging hole 54 is formed in the engaging member 52.
In case of an endoscope 26 as an intra-body-cavity insertion instrument guide according to the third embodiment of the invention, the engaging hole 54 of the engaging member 52 is grasped by a pair of biopsy forceps 28 which is extended through a forceps channel and made to protrude from an outlet port 46.
Therefore, the PTFE tube 34 can be guided simultaneously together with the endoscope 26 by inserting the endoscope 26 into the body cavity 20 while maintaining the grasp as described above. Further, when the PTFE tube 34 reaches an opposite side over a target organ 22, the grasp by the biopsy forceps 28 is then released, and the endoscope 26 is pulled out of the human body. The PTFE tube 34 is then left remain in the body cavity 20.
Thereafter, two ends of the PTFE tube 34 are engaged on ribs 18 or a frame not illustrated by the cord 36, as described in the second embodiment. Accordingly, an operating space 32 for surgery can be thereby obtained between the target organ 22 and another organ 30.
The cord 36 in the top end side of the PTFE tube 34 may be inserted into the engaging hole 54 of the engaging member 52.
The intra-body-cavity insertion instrument according to the third embodiment of the invention is not limited to the endoscope 26 but may of course be an intra-body-cavity insertion instrument guide 10 including a lumen 16 as described in the first embodiment.
As has been described above, according to the third embodiment, an intra-body-cavity insertion instrument which is too thick to be inserted into the lumen 16 of the intra-body-cavity insertion instrument guide 10 or the forceps channel of the endoscope 26 can be grasped and guided by the biopsy forceps 28 inserted into the lumen 16 or the forceps channel. Accordingly, the target organ 22 can be supported more stably by such a thick intra-body-cavity insertion instrument.
Also in the fourth embodiment, a PTFE tube 34 as described previously is used as an intra-body-cavity insertion instrument. In case of an endoscope 26 as an intra-body-cavity insertion instrument guide according to the fourth embodiment of the invention, a hard top end 44 is provided with an engaging member 56 for engaging and grasping the PTFE tube 34. The engaging member 56 is configured to be pivotally operated in a direction denoted by an arrow in the figure, and a grasp of the PTFE tube 34 is released by pivoting of the endoscope 26.
Therefore, the PTFE tube 34 can be guided simultaneously together with the endoscope 26 by inserting the endoscope 26 into a body cavity 20 while maintaining the grasp as described above. When the PTFE tube 34 reaches an opposite side over a target organ 22, the grasp by the engaging member 56 is then released, and the endoscope 26 is pulled out of the human body. The PTFE tube 34 is then left remain in the body cavity 20.
Thereafter, two ends of the PTFE tube 34 are engaged on ribs 18 or a frame not illustrated by the cord 36, as described in the second embodiment. Accordingly, an operating space 32 for surgery can be thereby obtained between the target organ 22 and another organ 30.
The intra-body-cavity insertion instrument guide according to the fourth embodiment of the invention is not limited to the endoscope 26 but may be of any type insofar as the intra-body-cavity insertion instrument includes an engaging member 56 pivoting of which can be operated from outside the human body.
As has been described above, according to the fourth embodiment, the intra-body-cavity insertion instrument can be grasped and guided, and accordingly, the target organ 22 can be supported more stably by a thick intra-body-cavity insertion instrument.
Such a sheet 58 as described above is wound about a top end section of a core pipe 62, as denoted by arrows in the figure, and is guided into the body cavity by an intra-body-cavity insertion instrument guide according to the fifth embodiment of the invention.
Specifically, an endoscope 26 as the intra-body-cavity insertion instrument guide according to the present embodiment is slipped in under the target organ 22, as in the second embodiment described previously. Further, when a hard top end 44 of the endoscope 26 reaches an opposite side over the target organ 22, the core pipe 62 with the aforementioned sheet 58 wound about is inserted into a forceps channel. As illustrated in
After the sheet 58 is completely spread out, the core pipe 62 is pulled out. As illustrated in
The intra-body-cavity insertion instrument according to the fifth embodiment of the invention is not limited to the endoscope 26 but may be of any type insofar as the intra-body-cavity insertion instrument can guide the core pipe 62 about which the sheet 58 is wound.
As has been described above, according to the fifth embodiment, the operating space 32 can be obtained by supporting the target organ 22 on a surface of the sheet.
As illustrated in
The present invention has been described above on the basis of embodiments. The invention, however, is not limited to the embodiments described above but may of course be variously modified or applied practically within the scope of the invention.
Additional Notes
Inventions as configured below can be extracted from the specific embodiments described above.
(1) An intra-body-cavity insertion instrument guide comprising:
an insertion section that is inserted into a body cavity; and
a guide section that is formed at the insertion section and guides an intra-body-cavity insertion instrument for obtaining a space for operating on an organ in the body cavity, to a side opposite to an insertion hole into which the insertion section is inserted, in relation to the organ.
The first to fifth embodiments correspond to embodiments relate to the intra-body-cavity insertion instrument guide described in (1). The body cavity 20 in these embodiments corresponds to the body cavity described above; the intra-body-cavity insertion sections 12 and 40 correspond to the insertion section described above; the target organ 22 corresponds to the organ described above; the cords 24, PTFE tube 34, and sheet 58 correspond to the intra-body-cavity insertion instrument described above; the lumen 16, forceps channel, biopsy forceps 28, and engaging member 56 correspond to the guide section described above; as well as the intra-body-cavity insertion instrument guide 10 and endoscope 26 correspond to the intra-body-cavity insertion instrument.
Operation and Effects
According to the intra-body-cavity insertion instrument guide described in (1), the intra-body-cavity insertion instrument can be guided to a deep portion in a body cavity. Therefore, a target organ at the deep portion in the body cavity can be separated from other organs, so that a space for surgery can be obtained.
(2) The intra-body-cavity insertion instrument guide described in (1), wherein the guide section guides the intra-body-cavity insertion instrument downwardly under the organ in a gravitational direction.
The first to fifth embodiments correspond to embodiments relate to the intra-body-cavity insertion instrument guide described in (2).
Operation and Effects
According to the intra-body-cavity insertion instrument guide described in (2), an organ is pressed against the intra-body-cavity insertion instrument due to gravity by positioning the intra-body-cavity insertion instrument at a lower position in the gravitational direction. Accordingly, not only an operating space can be obtained but also movement of an organ such as pulsation can be restricted.
(3) The intra-body-cavity insertion instrument described in (1), wherein the guide section includes a release section that releases and leaves the intra-body-cavity insertion instrument in the body cavity.
The second, fourth, and fifth embodiments correspond to embodiments relate to the intra-body-cavity insertion instrument guide described in (3). In these embodiments, the outlet port 46 and engaging member 56 correspond to the release section described above.
Operation and Effects
According to the intra-body-cavity insertion instrument guide described in (3), the guided intra-body-cavity insertion instrument is once left remain in the body cavity, and therefore, the position of the intra-body-cavity insertion instrument can further be finely adjusted.
(4) The intra-body-cavity insertion instrument guide described in (1), wherein the insertion section is a soft tube.
The first to fifth embodiments correspond to embodiments relate to the intra-body-cavity insertion instrument described in (4).
Operation and Effects
According to the intra-body-cavity insertion instrument guide described in (4), insertion along an organ can be achieved without damaging the organ.
(5) An intra-body-cavity insertion instrument guide system comprising:
an intra-body-cavity insertion instrument that obtains, in a body cavity, a space for operating on an organ in the body cavity; and
a guide that includes an insertion section inserted into the body cavity, and a guide section that is formed at the insertion section and guides the intra-body-cavity insertion instrument to a side opposite to an insertion hole into which the insertion section is inserted, in relation to the organ.
The first to fifth embodiments correspond to embodiments relate to the intra-body-cavity insertion instrument guide system described in (5). The body cavity 20 in these embodiments corresponds to the body cavity described above; the target organ 22 corresponds to the organ described above; the cords 24, PTFE tube 34, and sheet 58 correspond to the intra-body-cavity insertion instrument described above; the insertion sections 12 and 40 correspond to the insertion section described above; the lumen 16, forceps channel, biopsy forceps 28, and engaging member 56 correspond to the guide section described above; as well as the intra-body-cavity insertion instrument guide 10 and endoscope 26 correspond to the guide described above.
Operation and Effects
According to the intra-body-cavity insertion instrument guide system described in (5), the intra-body-cavity insertion instrument can be guided to a deep portion in a body cavity. Therefore, a target organ at a deep portion in the body cavity can be separated from other organs, so that a space for surgery can be obtained.
(6) The intra-body-cavity insertion instrument guide system described in (5), wherein the intra-body-cavity insertion instrument includes a pulling member for pulling from inside of the body cavity to outside of the body cavity.
The third and fifth embodiments correspond to embodiments relate to the intra-body-cavity insertion instrument guide system described in (6). The engaging member 52 and cords 60 in these embodiments correspond to the pulling member described above.
Operation and Effects
According to the intra-body-cavity insertion instrument guide system described in (6), the intra-body-cavity insertion instrument can be fixed to outside of the human body. Therefore, an obtained operating space can be steadily maintained.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2007-130896 | May 2007 | JP | national |
This is a Continuation Application of PCT Application No. PCT/JP2008/058945, filed May 15, 2008, which was published under PCT Article 21(2) in Japanese. This application is based upon and claims the benefit of priority from prior Japanese Patent Application No. 2007-130896, filed May 16, 2007, the entire contents of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2008/058945 | May 2008 | US |
| Child | 12603876 | US |
