Patent Application
20230329747
The invention relates to a rational arrangement technique of a lacrimal sac incision knife.
As an example of a surgery instrument for head and neck region, a nose knife which is used by inserting into nasal cavity of the patient is known (for example, patent reference 1; WO2018/070409).
According to this known knife, as a structure effective for improving the operability during the nasal cavity surgery and for preventing interference with other combined surgery instrument such like an endoscope, a construction is known to have a shank portion with a straight part and a curved part. In this art, the shank portion is connected with the grip portion and the curved part is provided with a blade portion at the front end of the curve part.
By the way, as to the surgery by inserting knife into the nasal cavity of the patient, a surgical procedure to treat nasolacrimal duct obstruction is known. According to this surgical procedure, the knife (and the endoscope) approaches to the lacrimal sac via the bone window from the nasal cavity and thus, incision is made to the lacrimal sac. Namely, this surgical procedure is positioned at a border area between the ophthalmology and the otorhinolaryngology (Dacryocystorhinostomy: hereinafter referred to as “DCR method”, especially “DCR intranasal method”).
In such a case, according to the known nasal knife, while it can be preferably used to a surgery for the general nasal cavity as a relatively large surgery area, satisfactory usability is not guaranteed to an ophthalmology as a relatively small surgery area.
Namely, in the DCR method, when surgery approach is made to the ophthalmologic disease via the nasal cavity, further modification for improving the operability by the operator is desired over the known nasal knife.
WO 2018 / 070409
This invention is made having regard to these aspects and the object of the invention is to provide with a construction technique of the lacrimal sac incision knife which can further improve the operability of the operator.
Above explained object can be achieved by the invention.
According to the invention, a lacrimal sac incision knife is provided. This lacrimal sac incision knife is insertable into nasal cavity of patient. The lacrimal sac incision knife incises the lacrimal sac located in the back of the nasal cavity. This lacrimal sac incision knife comprises a grip portion arranged to extend in a predetermined longitudinal direction to be held by user of the lacrimal sac incision knife, a shank portion connected to the grip portion, the shank portion entirely linearly extending in the longitudinal direction.
According to this invention, the lacrimal sac incision knife entirely linearly extends in the longitudinal direction and as a result, approaching capability from the nasal cavity to the lacrimal sac as an ophthalmology region can securely be provided.
Especially, the shank portion entirely linearly extends in the longitudinal direction, any unintended injury risk can effectively be decreased when the lacrimal sac incision knife approaches in the nasal cavity.
Note that the feature “extending in the longitudinal direction” may preferably comprise aspects such like: extending in a direction slightly intersecting with the longitudinal direction, or extending substantially in the longitudinal direction including a slight curve or a slight step.
As well, the feature “linearly” may preferably comprise aspects such like: extending in a direction slightly intersecting with the longitudinal direction, or extending substantially in the longitudinal direction including a slight curve or a slight step.
Further, the feature “entirely” may preferably comprise aspect substantially entirely extending but partly including intersecting region with the longitudinal direction or including non-linear region,
The shank portion comprises a base portion extending in the longitudinal direction and a blade portion connected to the base portion at the front end region in the longitudinal direction. Same with the above aspect, by arranging both the base portion and the blade portion respectively to extend in the longitudinal direction, operability of the user and any decrease of unintended injury risk of the patient can effectively be secured when the lacrimal sac incision knife approaches to the lacrimal sac via the nasal cavity.
The blade portion comprises a stabbing blade provided at the front end region in the longitudinal direction and a pair of a first side blade and a second side blade, both the first side blade and the second side blade respectively being formed at both sides in the width direction and being connected with the stabbing blade.
The terminology “pair” is typically defined by a structure such that the first side bade and the second side blade are in symmetrical.
On the other hand, the stabbing blade defines a lacrimal sac stabbing portion which can be stabbed to the lacrimal sac in a state that the holding portion is held by the user.
Typically, the stabbing is conducted by having the lacrimal sac incision knife move in the longitudinal direction. The terminology of “move in the longitudinal direction” may broadly comprise aspects to have the lacrimal sac incision knife move substantially in the longitudinal direction. For example, it may preferably comprise movement in the slightly obliqued direction including the longitudinal direction component. Especially in the surgery of approaching to the lacrimal sac via the nasal cavity, operation in which the lacrimal sac incision knife does not perpendicularly approach to the lacrimal sac may possibly often take place. Having regard to these aspects, the stabbing blade according to this invention is preferably suitable to various operations, such like the operation perpendicularly or obliquely stabbing the lacrimal sac and then, incise the lacrimal sac in the face direction of the lacrimal sac, or the multiple operation perpendicularly or obliquely stabbing the lacrimal sac and at the same time incising the lacrimal sac.
Further, it does not exclude the operation of only incising the lacrimal sac without stabbing operation.
Further, the stabbing blade may typically preferably be arranged to be symmetrical pair structure such that the stabbing blade is connected with each of the first side blade and the second side blade, respectively. Moreover, by appropriately setting the opening angle of stabbing blades and setting the connecting angle of the stabbing blade to the first side blade and the second side blade, blade group can be provided such that the pair of the stabbing blades and the pair of the first side blades (namely, the first side blade and the second side blade) respectively extends to different directions. By such construction, when incising the lacrimal sac, appropriate blade can be selected in accordance with the complicated shape of the lacrimal sac and as a result, usability of the lacrimal sac incision knife can be improved.
One of the first side blade and the second side blade defines a first lacrimal sac incision portion which incises the lacrimal sac in any one side of the longitudinal direction of the lacrimal sac as the lacrimal sac knife is operated to move in any one side of the width direction, In this case, following aspects may preferably be comprised such that the lacrimal sac is incised by using any one of the first side blade and the second side blade without using the stabbing blade, and such that the lacrimal sac is incised by using any one of the first side blade and the second side blade after slightly stabbing the lacrimal sac by the stabbing blade (or by the connecting region with the stabbing blade).
The other of the first side blade and the second side blade defines a second lacrimal sac incision portion which incises the lacrimal sac in the other side of the longitudinal direction of the lacrimal sac, as the state is kept such that the hold portion is held by the user and as the lacrimal sac knife is operated to move in the other side of the width direction. In this case, both the aspect also to use the stabbing blade and the aspect not to use the stabbing blade can preferably be comprised.
The “one” and the “other” of longitudinal extending direction of the lacrimal sac are typically be defined by an aspect of opposing to each other by 180 degrees. However, the aspect of intersecting to each other by any angle other than 180 degrees may be comprised. Further, for example, an aspect may be comprised such that the lacrimal sac is multiply incised in the direction intersecting the longitudinal extending direction to open the incised region (such type of the surgery is called as “petal type” or “flower petal type”).
Moreover, as to the direction, various types may be comprised for example to incise the lacrimal sac step by step or in a curved manner or in a zigzag manner. Further, the direction is required only to comprise at least a component of the longitudinal extending direction of the lacrimal sac and aspect to incise the lacrimal sac in the other direction may also be comprised.
The terminology of “the state is kept such that the hold portion is held by the user” is defined such that the gripping state is kept without changing the gripping hand of the grip portion when incising the lacrimal sac in any one of the direction or in the other direction. By this, it is not necessary to change the gripping hand when changing the incising direction after the stabbing as is the case of the single edged knife (for example changing by 180 degrees). Thus, necessity of changing the gripping hand can be abbreviated and as a result, usability in the ophthalmologic field via the nasal cavity as relatively narrow operation area can be improved.
Further, in a case that the lacrimal sac is incised by the above explained petal type or the flower petal type, the user is not required to change the gripping hand of the grip portion and can conduct multiple incise operations to multiple directions in a precise and quick manner. As a result, the usability of the lacrimal sac incision knife can further be improved.
Further, as to the lacrimal sac incision knife according to the invention, the specific size of the component parts is optimized in accordance with the size of the lacrimal sac as the surgery object. While the size of the lacrimal sac deviates in general based on individual difference, the invention optimizes the size so as to correspond to such difference specifically as follows:
The blade portion has a length size of approximately from 3.0 mm to 10.0 mm in the longitudinal direction, a maximum width size of approximately from 1.0 mm to 2.0 mm in the width direction.
The stabbing blade has a blade length size of approximately 1.0 mm to 4.0 mm in the longitudinal direction, a maximum width size of approximately from 1.0 mm to 2.0 mm in the width direction.
The first side blade and the second side blade respectively have a blade length size of approximately 2.0 mm to 6.0 mm in the longitudinal direction.
As a further preferable aspect of the invention, with respect to the lacrimal sac incision knife as explained above, the base portion may be arranged to have a length in the longitudinal direction approximately twice as long as the length of the blade portion.
By such construction, the rigidity of the base portion can be improved maintaining the operability of the lacrimal sac incision knife.
As a further preferable aspect of the invention, with respect to the lacrimal sac incision knife as explained above, the shank portion may be arranged to have a length in the longitudinal direction as from approximately 15.0 mm (millimeter) to approximately 50.0 mm, and the base portion is arranged to have a length in the longitudinal direction as from approximately 5.0 mm to approximately 47.0 mm,
As a further preferable aspect of the invention, with respect to the lacrimal sac incision knife as explained above, each of the first side blade and the second side blade may be arranged such that the closer to the stabbing blade, the gradually narrower the width becomes in the width direction.
By such construction, stabbing capability and incision capability can further be improved.
As a further preferable aspect of the invention, with respect to the lacrimal sac incision knife as explained above, the base portion may be arranged to comprise a taper portion such that the closer to the blade portion, the gradually thinner the thickness of the taper portion becomes in the longitudinal direction. And the region where the first side blade and the second side blade are formed may be arranged such that the thickness of this region is constant.
The terminology of “gradually” is substantially defined as “sequentially”, “one by one” or “one after another”. The invention may preferably comprise not only the aspect of entirely and constantly gradually becoming thinner, but also the aspect that the decreasing ratio changes or the aspect of partly gradually becoming thinner.
By such construction, with respect to the base portion, a high rigidity provided region for the lacrimal sac incision knife can be provided. On the other hand, with respect to the blade region where the first side plate and the second side plate are formed, lacrimal sac incision operability improved region with thin thickness can be provided. Further, the taper portion the thickness of which gradually decreases connects the high rigidity provided region with the lacrimal sac incision operability improved region. As a result, smooth operability of the lacrimal sac incision knife moving in the nasal cavity can be secured.
As a further preferable aspect of the invention, with respect to the lacrimal sac incision knife as explained above, the taper portion is arranged to have a length in the longitudinal direction as from approximately 3.0 mm (millimeter) to approximately 7.0 mm, the taper portion is connected with the blade portion such that the thickness of the taper portion is gradually decreased from approximately 0.3 mm to approximately 0.15 mm as get closer to the blade portion, and the region of the blade portion where the first side blade and the second side blade are formed is arranged to have a thickness of approximately 0.15 mm in the longitudinal direction.
By such construction, the above-explained high rigidity provided region and the lacrimal sac incision operability improved region can rationally be provided.
Note that, as to the size of each component part of the lacrimal sac incision knife as explained above, for example, following typical value may preferably be adopted in order to effectively provide the invention in the actual product design. Namely:
The blade portion may have a length size of approximately 5.7 mm in the longitudinal direction, a maximum width size of approximately 1.7 mm in the width direction.
The stabbing blade may have a blade length size of approximately 1.2 mm in the longitudinal direction, a maximum width size of approximately 1.4 mm in the width direction.
The first side blade and the second side blade may respectively have a blade length size of approximately 4.5 mm in the longitudinal direction.
The shank portion may have a length in the longitudinal direction as approximately 17.3 mm.
The base portion may have a length in the longitudinal direction as approximately 11.6 mm.
The taper portion may have a length in the longitudinal direction as approximately 5 mm.
The taper portion may be connected with the blade portion such that the thickness of the taper portion is gradually decreased from approximately 0.3 mm to approximately 0.15 mm as get closer to the blade portion and the region of the blade portion where the first side blade and the second side blade are formed may have a thickness of approximately 0.15 mm in the longitudinal direction.
According to the invention, a rational construction technique of the lacrimal sac incision knife is provided.
A representative embodiment of the invention is explained according to
In figures, the structure of the lacrimal sac incision knife 1 according to the embodiment is respectively shown in
With respect to the structure of the lacrimal sac incision knife 1;
With respect to
The lacrimal sac incision knife 1 according to the embodiment is arranged mainly to comprise a grip portion 2 and a shank portion 3. Each of the grip portion 2 and the shank portion 3 is provided with elongated body to extend in the longitudinal direction L. Further, the lacrimal sac incision knife 1 as itself is also provided with elongated body and also extends in the longitudinal direction L.
In this embodiment, the grip portion 2 is made of resin, while the shank portion 3 is made of metal.
As shown in
The base portion 4 is arranged to have substantially a constant width in the width direction as shown in
The taper portion 41 according to this embodiment is arranged to have a relatively large decrease rate of the thickness in the vicinity of the step 5 and to have a relatively small and constant decrease rate of the thickness at a region apart from the step 5 and close to the blade portion 6.
The blade portion 6 comprises a stabbing blade 60, a first side blade 61 and a second side blade 62. The stabbing blade 60 is formed at the most front end region of the front side direction LF. The first side blade 61 is formed at the width right side direction WR of the blade portion 6, while the second side blade 62 is formed at the width left side direction WL of the blade portion 6. The first side blade 61 and the second side blade 62 are arranged to be a pair and continuously formed with the stabbing blade 60.
As shown in
On the other hand, as shown in
In this embodiment, a relation is arranged such that W1 is smaller than W2 (W1<W2). As to the relation between two widths, for example relation such that W1 is equal to W2, or relation such that W1 is larger than W2 can be adopted.
Further, each of the first side blade 61 and the second side blade 62 is arranged to have a taper shape, the width of which gradually increases from the width W1 as a front side (namely narrow width region) to the width W2 as a rear side (namely broad width region).
By adopting such construction, when lacrimal sac incision surgery is conducted (which will be explained later), the stabbing blade 60 with narrow width improves the stabbing operability to the lacrimal sac, while each front regions of the first side blade 61 and the second side blade 62 with narrow width improves the incision operability to the lacrimal sac. Further, because each of the first side blade 61 and the second side blade 62 has a taper which gradually increases its width as close to the rear side direction LB, both the stabbing capability and the incision capability are further improved.
Moreover, the width W2 of each of the first side blade 61 and the second side blade 62 is respectively arranged to be larger than the width W3 of the base portion 4. Namely, with respect to the width direction W, each of the first side blade 61 and the second side blade 62 respectively projects from the base portion 4 by a small amount. By such construction, stabbing and incision capability can be further improved when the lacrimal sac incision surgery which will be explained later is conducted.
Note that, as to such width, an aspect such that W2=W3, or W2<W3 can appropriately be adopted.
With respect to the specific dimension of each component parts of the lacrimal sac incision knife 1, following spec is given as shown in
The stabbing blade 60 is arranged to have a length L2 of approximately 1.2 mm in the longitudinal direction L and a maximum width W1 of approximately 1.4 mm in the width direction W.
Each of the first side blade 61 and the second side blade 62 is arranged to have a length L3 of approximately 4.5 mm in the longitudinal direction L, a minimum width of approximately 1.4 mm in the width direction W (to be connected to the stabbing blade 60 at this minimum width), and a maximum width W2 of approximately 1.7 mm in the width direction W. In other words, the maximum width W2 of the first side blade 61 and the second side blade 62 defines the maximum dimension size of the blade portion 6 (approximately 1.7 mm according to this embodiment).
Further, as shown in
Further, as shown in
Further, as shown in
Next, specific example of lacrimal sac incision surgery by using the lacrimal sac incision knife 1 according to this embodiment is explained in reference of
On the other hand, with respect to the eye P1 of the patient P, lacrimal grand R1 is connected and the eye P1 is connected with the lacrimal sac R4 via the puncta R2 and the canaliculus R3 and also connected with the nasal cavity P4 via the nasolacrimal duct R6. By such structure, tears are transferred to the nasal cavity P4 via the lacrimal gland R1, the eye P1, the puncta R2, the canaliculus R3, the lacrimal sac R4 and the nasolacrimal duct.
Above mentioned DCR method typically provides with an incision surgery to the lacrimal sac R4 as an example of the nasolacrimal duct obstruction. The lacrimal sac incision knife 1 according to this embodiment is inserted to the nasal cavity P4 with the endoscope from the nostrils P3 in
The lacrimal sac R4 has an elongated shape with a long axis and a short axis. While individual difference does exist, the length in the longitudinal extending direction (longitudinal direction of the lacrimal sac R4) is arranged to be approximately from 6.0 mm to 15.5 mm.
As shown in
Then, as shown in
Then, as shown in
Namely, the lacrimal sac incision knife 1 according to this embodiment, the first side blade 61 and the second side blade 62 are provided as a double edged structure and are arranged to be connected continuously to the stabbing blade 60, respectively. Thus, the user can conduct the incision operation to the lacrimal sac R4 both in the right and left side (namely both longitudinal directions R5L1 and R5L2 of the lacrimal sac R4) without inverting the lacrimal sac incision knife 1 by changing the grip of the grip portion 2 in each occasion of switching the operation.
Further, as shown in
And as shown in
Further, each of the first side blade 61 and the second side blade 62 is arranged to have multiple blades structure with contiguous and multiple directions (see
Note that, according to this embodiment, the lacrimal sac incision knife 1 approaches to the lacrimal sac R4 and then, the incision is made by the first side blade 61 and then, by the second side blade 62. However, the operation aspect of the lacrimal sac incision knife 1 is not limited to such process.
For example, the user may incise the lacrimal sac R4 by using the first side blade 61 to multiple directions including the longitudinal direction R5L1 and then, may open the lacrimal sac R4 being incised. And then, the user may incise the lacrimal sac R4 by using the second side blade 62 to multiple directions including the longitudinal direction R5L2 and then, may open the lacrimal sac R4. By these steps, the lacrimal sac R4 can be incised like opening flower (“petal type” or “flower petal type”).
Otherwise, incision aspect such that stabbing the lacrimal sac R4 by the stabbing blade 60 and then, incising the lacrimal sac R4 in the face direction can preferably be adopted.
According to the above explained embodiment, a construction technique of the lacrimal sac incision knife 1 which can further improve the operability of the operator is provided.
Same with the
Same with
1
2
3
4
41
5
6
60
61
62
| Number | Date | Country | Kind |
|---|---|---|---|
| 2020-172726 | Oct 2020 | JP | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/JP2021/014807 | 4/7/2021 | WO |
