JP2003010197A - Trocar - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a trocar having no fear of strongly pressing an organ in an abdominal cavity in expanding the diameter of a small-diameter pierced hole formed by a tracar internal needle to the outside diameter of a sheath, and capable of simply performing work for inserting and indwelling the sheath in the body wall in a short time, and easily and stably inserting the distal end of the internal needle. SOLUTION: The position of the distal end of the internal needle 6 projected from the sheath 7 is previously adjusted by a position adjusting mechanism 26 before insertion into the body wall part, whereby the projection amount of the distal end part of the internal needle 6 projected from a dilator according to the conditions such as the thickness of the body wall to be pierced and the piecing place can be adjusted to a suitable state.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention pierces and penetrates a patient's skin and a body wall with a trocar mantle tube which is inserted into a patient's body and used as a guide tube for an insertion instrument into a body cavity. Regarding trocars to be kept in a state.

[0002]

2. Description of the Related Art In general, a trocar device for inserting a trocar mantle tube inserted into a patient's body and used as a guide tube for an insertion instrument into a body cavity in a state of piercing and penetrating the skin and body wall of the patient. Conventionally used. In this trocar device, an inner needle having a sharp puncture needle formed at its tip and an outer tube having an insertion portion for puncturing a patient are detachably combined. Then, with the inner needle and the outer tube being integrally combined, the inner needle is pierced into the skin of the patient, pierced into the body wall and inserted into the body cavity. Further, after inserting the trocar into the body cavity, the inner needle is removed from the outer tube to indwell the outer tube on the body wall to observe the lesioned part, an optical tube for performing treatment, a treatment instrument, etc. It can be used as a guide tube.

Further, Japanese Patent Laid-Open No. 11-89851 discloses an ultrasonic trocar system in which a taper adapter having a substantially conical shape is arranged between an inner needle having a relatively small outer diameter and an outer tube. Has been done. Here, the diameter of the puncture hole formed in the body wall of the patient is reduced by the small diameter inner needle to reduce the invasion to the patient, and the diameter of the small diameter puncture hole formed by the inner needle is reduced by the tapered adapter. A technique has been disclosed in which a large-diameter mantle tube is smoothly inserted into a puncture hole in a body wall of a patient by expanding the mantle tube to the outer diameter dimension.

[0004]

By the way, in the device disclosed in Japanese Patent Laid-Open No. 11-89851, the diameter of the small puncture hole in the conical portion of the tapered adapter is relatively large. Since it is designed to be expanded to the maximum, the axially protruding length of the tapered adapter projecting forward from the distal end portion of the outer tube becomes relatively long. In this way, when the protruding length of the tip of the tapered adapter is long, the diameter of the small-diameter puncture hole formed by the inner needle is expanded by the tapered adapter to the outer diameter of the mantle tube. The tip of the adapter may come into contact with, for example, an organ in the abdominal cavity and strongly press it. Therefore, it is desirable to shorten the protruding length of the tip of the tapered adapter.

If the tip of the tapered adapter has a short protruding length, the tapered adapter may not be able to penetrate the abdominal wall when it is inserted into the puncture hole in the body wall of the patient. In such a case, since a troublesome work such as exchanging a tapered adapter used during the treatment is required, there is a problem that the work time of the work of inserting and leaving the outer tube in the body wall becomes long.

Further, in the conventional trocar device, the proximal end portion of the trocar inner needle is locked to the proximal end portion side of the outer tube with a relatively light force through an elastic ring such as a C ring. Therefore, when the inner needle is punctured in the body wall of the patient, the locking portion between the base end side of the outer tube and the base end of the trocar inner needle may come off depending on the location where the user holds the trocar device. The operation of the trocar device may become unstable.

Further, the protrusion amount of the inner needle tip portion protruding from the tip portion of the outer tube is fixed while being set to a constant length. Then, during the work of puncturing the inner wall of the patient with the inner needle, the insertion amount of the inner needle tip should be determined on the spot according to the thickness of the body wall, the feeling of the fingers, the experience, etc. according to the conditions such as the puncture site. It's difficult to do that,
There is a problem that it takes time.

The present invention has been made in view of the above circumstances, and an object thereof is to open the inside of the abdominal cavity during the work of expanding the diameter of the small diameter puncture hole formed by the trocar inner needle to the outer diameter of the mantle tube. There is no danger of pressing the organ strongly, and the operation of inserting and placing the outer tube on the body wall can be performed easily and in a short time. In addition, the insertion of the tip of the inner needle is easy and stable. It is to provide a trocar that can be performed.

[0009]

According to a first aspect of the present invention, there is provided a trocar inner needle for puncturing a body wall, an outer tube into which the trocar inner needle is inserted, and between the outer tube and the trocar inner needle. A dilator that is inserted and has a puncture-hole expanding portion that expands a small-diameter puncture hole that is bored by the trocar inner needle, and a tubular portion that protrudes outward from the tip end portion of the dilator. A trocar that is movably supported in the axial direction and is used in combination with a guide member that guides the insertion of the dilator, and variably adjusts the position of the tip of the inner needle protruding from the outer tube. The trocar is characterized by being provided with an adjusting mechanism for. And in the invention of claim 1,
By adjusting the amount of protrusion of the tip of the guide member protruding outward from the tip of the dilator inserted between the mantle tube and the trocar inner needle, the thickness of the body wall to be punctured and the internal organs The amount of protrusion of the distal end portion of the guide member can be adjusted to a suitable state according to conditions such as the distance between the inner needle and the inner needle that is protruded from the outer tube by the adjustment mechanism before being inserted into the body wall portion. By adjusting the position of the tip, the thickness of the body wall to be punctured and the amount of protrusion of the inner needle tip protruding from the dilator can be adjusted to a suitable state according to conditions such as the puncture location. .

According to a second aspect of the present invention, the adjusting mechanism includes a plurality of stages of engaging groove portions arranged in parallel in the guide member along the axial direction, and the dilator. The trocar according to claim 1, further comprising: a lock mechanism that selectively engages and disengages with the mating groove portion. Further, according to the invention of claim 2, the locking mechanism of the dilator is selectively locked to the engaging groove portions of the guide member, which are arranged in parallel along the axial direction. The position of the tip of the inner needle protruding from the outer tube is adjusted by variably adjusting the relative position with respect to.

According to a third aspect of the present invention, the lock mechanism has a claw portion releasably engaged with at least one engagement groove portion of the guide member, and the claw portion is the engagement groove portion. An urging member that generates an urging force for urging the urging member in the engagement direction, and an operation unit that moves the claw portion in a disengagement direction with the engagement groove portion against the urging force of the urging member. The trocar according to claim 2, further comprising: In the invention according to claim 3, the claw portion is moved in the direction of releasing the engagement with the engaging groove portion against the urging force of the urging member by the operation of the operation portion, so that the claw portion is projected from the outer tube. The amount of protrusion of the tip of the inner needle is switched to a state in which it can be adjusted to a desired state. Further, when the amount of protrusion of the tip of the inner needle protruding from the outer tube is adjusted to a desired state, the claw portion of the lock mechanism is attached to one of the engaging groove portions of the guide member corresponding to the adjusted position. By being held by the urging force of the urging member in the engaged state, the protrusion amount of the inner needle tip portion protruding from the outer tube can be reliably held in a state adjusted to a desired state. .

According to a fourth aspect of the present invention, the trocar inner needle is connected to a handpiece having a vibrator for transmitting ultrasonic vibrations to the trocar inner needle, and the handpiece is capable of engaging and disengaging the guide member. The trocar according to claim 1, further comprising a guide member locking mechanism that is locked to the. In the invention of claim 4, the guide member and the trocar are detachably locked by the guide member locking mechanism of the handpiece including the vibrator for transmitting ultrasonic vibration to the trocar inner needle. The relative position with the inner needle can be fixed at a set position.

[0013]

BEST MODE FOR CARRYING OUT THE INVENTION A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 shows a schematic configuration of the entire trocar system 1 of the present embodiment. This trocar system 1 is a handpiece unit 2 of an ultrasonic trocar which is grasped and operated by an operator, and an ultrasonic oscillating device which is connected to the handpiece unit 2 via a connection cable 3 and supplies energy for ultrasonic vibration. 4 and an output control device 5 such as a foot switch or a hand switch for controlling the energy output.

The handpiece unit 2 of the ultrasonic trocar has a trocar inner needle 6 for puncturing a body wall, an outer tube 7 into which the trocar inner needle 6 is inserted, an outer tube 7 and a trocar inner needle 6. A dilator 8 inserted between the dilator 8 and a guide member 9 formed of a flexible tubular member inserted into the dilator 8 are provided. The guide member 9 may be hard. The handpiece unit 2 of the ultrasonic trocar according to the present embodiment has the trocar inner needle 6, the outer tube 7, the dilator 8 and the guide member 9 assembled to each other, and their respective constituent parts. Are separated and used as appropriate. Note that FIG. 1 shows a state in which the trocar inner needle 6, the outer tube 7, the dilator 8, and the guide member 9 are respectively assembled.

The trocar inner needle 6 is provided with a substantially linear probe 10 as shown in FIG. A grip portion 11 on the near side is provided at the base end portion of the probe 10. A substantially cylindrical housing 12 is provided on the grip portion 11 on the proximal side.

Further, as shown in FIG. 4, an ultrasonic transducer 13 which is an element for generating ultrasonic vibration is disposed in the housing 12. A horn 14 for amplifying ultrasonic vibration is arranged at the tip of the ultrasonic vibrator 13. The tip of the horn 14 extends forward from the tip of the housing 12, and the base end of an ultrasonic vibration transmission rod (vibration transmission member) 15 is detachably connected to the tip of the horn 14 by screwing. The tip of this vibration transmission rod 15 has a conical shape,
Alternatively, a tapered puncture needle (inner needle body) 16 such as a triangular pyramid or a quadrangular pyramid is provided. Thereby, the mechanical vibration of the ultrasonic transducer 13 is transmitted to the puncture needle 16 at the tip of the ultrasonic vibration transmitting rod 15 via the horn 14. A guide member locking mechanism 17, which will be described later, is provided at the lower end of the grip 11 so as to lock the guide member 9 in a disengageable manner.

Further, as shown in FIG. 2, the trocar outer tube 7 is provided with a tubular elongated insertion portion 19 having a relatively large diameter (for example, a diameter of about 13 mm) and a proximal end portion of the insertion portion 19. A hand side end portion 20 is provided. Here, a distal end inclined surface 19a that is inclined with respect to a direction orthogonal to the center line direction of the insertion portion 19 is formed at the distal end portion of the insertion portion 19. Further, the proximal end portion 20 is provided with a cylindrical large-diameter tubular portion 20a and an insertion guide member 20b engaged with the open end portion of the large-diameter tubular portion 20a. A substantially flange-shaped finger hook 20c is formed on the outer peripheral surface of the large-diameter cylindrical portion 20a.

Further, as shown in FIG. 4, the insertion guide member 20b is provided with a sealing member 20d such as a valve for sealing the inside of the outer tube 7 when the insertion device inserted therein is inserted.

Further, as shown in FIG. 5 (B), the dilator 8 is provided with a tubular elongated insertion portion 21 and a proximal end portion 22 arranged at the proximal end portion of the insertion portion 21. .
Further, the insertion portion 19 of the outer tube 7 is attached to the distal end portion of the insertion portion 21.
A large-diameter straight tip end pipe portion 23 for positioning, which is set to have an outer diameter dimension substantially the same as the inner diameter dimension, is provided. A tapered, substantially conical puncture hole expanding portion 24 is further arranged on the distal end side of the distal straight tube portion 23.

Further, a straight tube-shaped break-preventing portion 25 is provided at the tip of the cone of the puncture hole expanding portion 24. The length of the bend preventing portion 25 is set to an appropriate dimension from the tip of the cone of the puncture hole expanding portion 24. Further, a tip end inclined surface 25a that is inclined with respect to the direction orthogonal to the center line direction of the insertion portion 21 is formed at the tip end portion of the bend preventing portion 25.

Further, a large-diameter cylindrical portion 22a having a large diameter is provided at the end portion 22 on the proximal side of the dilator 8 and a cylindrical shape having a diameter smaller than that of the large-diameter cylindrical portion 22a. A small-diameter cylindrical portion 22b is provided. Here, as shown in FIG. 4, the inner diameter dimension of the large diameter tubular portion 22a is set to be substantially the same as the outer diameter dimension of the large diameter tubular portion 20a of the trocar outer tube 7. When the dilator 8 and the trocar outer tube 7 are connected, the large-diameter cylindrical portion 22a of the dilator 8 is releasably engaged with the large-diameter cylindrical portion 20a of the trocar outer tube 7 in the vicinity of the open end thereof. Has been done. The base end of the operation handle 27 is screwed and fixed to the outer peripheral surface of the large-diameter cylindrical portion 22a of the dilator 8.

A position adjusting mechanism 26, which will be described later, is provided above the small-diameter cylindrical portion 22b of the dilator 8 to variably adjust the position of the tip of the trocar inner needle 6 protruding from the outer tube 7.
Is provided.

Further, as shown in FIG. 6, the guide member 9 is provided with an elongated straight pipe portion 28 and a handle portion 29 connected to the end portion of the straight pipe portion 28 on the base end side. Here, since the straight pipe portion 28 comes into contact with the probe 10 that vibrates ultrasonically, for example, Teflon (registered trademark): PTFE is used.
It is made of a flexible material such as (polytetrafluoroethylene) having high heat resistance and high slipperiness. Also, for example, a hard metal pipe having Teflon (registered trademark) attached to the inner peripheral surface can achieve the same effect.

Further, the inner diameter of the straight pipe portion 28 is set to be substantially the same as the outer diameter of the puncture needle 16 of the trocar inner needle 6. Then, on the proximal end side of the straight pipe portion 28, a positioning portion 28 having a diameter substantially the same as the inner diameter dimension of the insertion portion 21 of the dilator 8 is provided.
a is formed.

Further, the handle portion 29 is inserted into the large-diameter cylindrical body 30 inserted into the guide member locking mechanism 17 of the grip portion 11 on the proximal side of the trocar inner needle 6 and the position adjusting mechanism 26 of the dilator 8. And an elongated small-diameter cylindrical body 31 are provided. Here, a ring-shaped first engagement groove portion 32 is formed on the outer peripheral surface of the large-diameter cylindrical body 30. Further, on the outer peripheral surface of the small-diameter cylindrical body 31, ring-shaped second engaging groove portions 33 are arranged in a plurality of stages along the axial direction, in this embodiment four stages are arranged side by side.

Further, the guide member locking mechanism 17 of the trocar inner needle 6 has a housing 12 as shown in FIG. 8 (A).
A substantially cylindrical lock mechanism support member 3 connected to the lower end of the
4 are provided. A guide pin 35 and a cylindrical guide cylinder 36 are provided on the outer peripheral surface of the lock mechanism support member 34 so as to project therefrom. These guide pins 35 and the guide cylinder 36 are arranged in the circumferential direction of the lock mechanism supporting member 34 by 180 degrees.
They are placed facing each other at a distance.

Further, a ring-shaped lock member 18 is arranged on the outer peripheral surface of the lock mechanism support member 34. A pin insertion hole 18a into which the guide pin 35 is axially movably inserted is formed on the outer peripheral surface of the lock member 18, and a lock button 37 is screwed in a protruding state. This lock button 37 has a guide cylinder 36.
Is formed with an insertion hole 38 into which is inserted movably in the axial direction. The lock member 18 is supported so as to be movable in the direction orthogonal to the axial direction of the trocar inner needle 6 with the guide pin 35 and the guide cylinder 36 as a guide.

The lock member 18 has a pin insertion hole 18
An engaging claw portion 39 that is engaged with the first engaging groove portion 32 of the guide member 9 in a disengageable manner is provided in the vicinity of a inwardly. Further, the engaging claw portion 39 is provided inside the guide tubular body 36.
A compression coil spring 40 for urging the guide member 9 toward the engagement direction with the first engagement groove portion 32 of the guide member 9 is provided. When the inner trocar needle 6 and the guide member 9 are assembled, the spring force of the compression coil spring 40 causes the trocar inner needle 6 to move.
As shown in (A), the engaging claw portion 39 of the lock member 18 of the guide member locking mechanism 17 of the trocar inner needle 6 is held in a locked state in which it is engaged with the first engaging groove portion 32 of the guide member 9. It is like this. Further, by pushing the lock button 37 against the spring force of the compression coil spring 40 in this locked state, the lock member 18 moves to the right in FIG. The engaging claw portion 39 is disengaged from the first engagement groove portion 32 of the guide member 9 so that the lock is released.

Further, as shown in FIG. 8B, the position adjusting mechanism 26 of the dilator 8 has a small-diameter cylindrical portion 22 of the dilator 8.
A substantially cylindrical lock mechanism support member 41 connected to b is provided on the upper side of the small diameter cylindrical portion 22b so as to project. A guide pin 42 and a cylindrical guide cylinder 43 are provided on the outer peripheral surface of the lock mechanism support member 41 so as to project therefrom. The guide pin 42 and the guide cylinder 43 are arranged in the lock mechanism support member 41.
Are opposed to each other at a position separated by 180 ° in the circumferential direction.

Further, a substantially ring-shaped lock member 44 is arranged outside the lock mechanism support member 41. A pin insertion hole 44a into which the guide pin 42 is axially movably inserted is formed on the outer peripheral surface of the lock member 44, and a lock button (operation portion) 45 is screwed in a protruding state. ing. The lock button 45 has an insertion hole 46 into which the guide cylinder 43 is inserted so as to be movable in the axial direction.
Are formed. The lock member 44 is supported so as to be movable in the direction orthogonal to the axial direction of the trocar inner needle 6 with the guide pin 42 and the guide cylinder 43 as a guide. As shown in FIG. 5 (A), the lock button 45 is arranged in a state (180 ° apart) in a direction opposite to the operation handle 27 of the dilator 8 with respect to the center line of the trocar inner needle 6. There is.

Further, the lock member 44 is shown in FIG.
As shown in (B), the second engagement groove portion 3 at any position of the guide member 9 is directed inward in the vicinity of the pin insertion hole 44a.
Two engaging claw portions 47 that are disengageably engaged with the projection 3 are provided in a protruding manner. Further, a compression coil spring (biasing member) 48 for urging the engaging claw portion 47 toward the engaging direction with the second engaging groove portion 33 of the guide member 9 is provided inside the guide cylinder body 43. Has been done.

When the dilator 8 and the guide member 9 are assembled, the lock member 44 in the position adjusting mechanism 26 of the dilator 8 is engaged by the spring force of the compression coil spring 48, as shown in FIG. 9B. The claw portion 47 is held in a locked state in which it is engaged with the second engagement groove portion 33 at any position of the guide member 9. Further, in this locked state, by pushing the lock button 45 against the spring force of the compression coil spring 48, the lock member 44 moves to the right in FIG.
As shown in (A), the engaging claw portion 47 of the lock member 44 is disengaged from the second engaging groove portion 33 of the guide member 9 and the lock is released. Therefore, by moving the guide member 9 in the axial direction with respect to the dilator 8 while the position adjusting mechanism 26 of the dilator 8 is unlocked, the position of the tip of the inner needle 6 protruding from the outer tube 7 is variably adjusted. You can do it.

Then, for example, the engaging claw portion 47 of the lock member 44 is connected to the second engaging groove portion 3 at the uppermost position of the guide member 9.
3 is adjusted to be in a state of being engaged with FIG.
As shown in (A), the protruding amount of the inner needle 6 protruding from the outer tube 7 can be set to be large. Here, the engagement claw portion 47 of the lock member 44 is adjusted to be in a state of being engaged with the second engagement groove portion 33 at the lowermost position of the guide member 9, so as to show the outer cover as shown in FIG. 10 (B). The amount of protrusion of the inner needle 6 protruding from the tube 7 can be set to a small state.

Next, the operation of the above configuration will be described.
When the trocar system 1 of the present embodiment is used, the handpiece unit 2 of the ultrasonic trocar is preliminarily assembled with the trocar inner needle 6, the outer tube 7, the dilator 8 and the guide member 9 as shown in FIG. Is set to the open state. At this time, the distal end of the straight pipe portion 28 of the guide member 9 is held in a state of being protruded by a predetermined length from the bend preventing portion 25 of the dilator 8 and the puncture needle 16 of the trocar inner needle 6 is guided. The straight tube portion 28 of the member 9 is held in a state of being projected from the tip end portion thereof.

Here, the trocar inner needle 6 and the guide member 9
8A is assembled, the engaging claw portion 39 of the lock member 18 in the guide member locking mechanism 17 of the trocar inner needle 6 is fitted into the first engaging groove portion 32 of the guide member 9 as shown in FIG. 8A. It is held in the engaged and locked state.

Further, in this embodiment, the position of the tip of the inner needle 6 protruding from the outer tube 7 can be variably adjusted by the position adjusting mechanism 26 of the dilator 8. At this time, by pressing the lock button 45 of the position adjusting mechanism 26 against the spring force of the compression coil spring 48,
The lock member 44 moves to the right in FIG. 9B, and the engagement claw portion 47 of the lock member 44 is disengaged from the second engagement groove portion 33 of the guide member 9 as shown in FIG. 9A. Lock is released. When the position adjusting mechanism 26 of the dilator 8 is unlocked, the guide member 9 is moved to the dilator 8
The axial position of the inner needle 6 projected from the outer tube 7 can be variably adjusted.

Here, for example, when the thickness of the abdominal wall H of the patient is large as shown in FIG.
The engaging amount of the inner needle 6 protruding from the outer sheath tube 7 is increased by adjusting the engaging claw portion 47 of the second engaging groove portion 33 of the guide member 9 to be engaged with the second engaging groove portion 33. Can be set to state. Further, as shown in FIG. 10B, when the thickness of the abdominal wall portion H of the patient is thin, the lock member 4
By adjusting the engaging claw portion 47 of No. 4 to the second engaging groove portion 33 at the lowermost position of the guide member 9,
The protruding amount of the inner needle 6 protruding from the outer tube 7 can be set to a small state.

Further, with the handpiece unit 2 assembled as shown in FIG. 1, the trocar outer tube 7 is punctured into the skin and body wall of the patient, and the operation of leaving the trocar outer tube 7 in place is performed. At the time of puncturing work by the handpiece unit 2, the ultrasonic oscillator 4 is driven as the output control device 5 is operated. At this time, energy for ultrasonic vibration is supplied from the ultrasonic oscillator 4 to the ultrasonic vibrator 13 of the handpiece unit 2 through the connection cable 3, and the ultrasonic vibrator 13 generates ultrasonic vibration. . The ultrasonic vibration output from the ultrasonic vibrator 13 is transmitted to the ultrasonic vibration transmission rod 15 in a state of being amplified by the horn 14. As a result, the mechanical vibration of the ultrasonic vibrator 13 is transmitted through the horn 14 to the ultrasonic vibration transmission rod 15
Is transmitted to the puncture needle 16 of the trocar inner needle 6 at the tip of the.

Thereafter, with the handpiece unit 2 held, the operation of puncturing the abdominal wall H of the patient with the puncture needle 16 of the trocar inner needle 6 is performed. At this time, since the puncture needle 16 of the trocar inner needle 6 is punctured in the abdominal wall portion H in a state where ultrasonic vibration is transmitted to the puncture needle 16 of the trocar inner needle 6, the puncture needle 16 of the trocar inner needle 6 is lightly pressed. Can easily puncture the abdominal wall portion H. By this operation, a small diameter puncture hole is formed in the abdominal wall portion H.

Further, in a state where the handpiece unit 2 is inserted up to the break-preventing portion 25 near the puncture hole expanding portion 24 of the dilator 8, only the trocar inner needle 6 is pulled out from the handpiece unit 2. In this state, by further pushing the handpiece unit 2 into the abdominal wall portion H, the diameter of the small diameter puncture hole formed by the inner trocar needle 6 formed by the conical portion of the puncture hole expansion portion 24 of the dilator 8 is covered. The work of expanding the outer diameter of the pipe 7 is performed.

Before the work of expanding the hole diameter of the puncture hole, if the position of the tip of the guide member 9 protruding outward from the tip of the dilator 8 is close to the organ in the abdominal cavity, the handle of the guide member 9 is pulled. Operation of gripping the portion 29 with fingers and pulling the handle portion 29 of the guide member 9 in the axial direction with respect to the dilator 8 to reduce the amount of protrusion of the tip portion of the guide member 9 that is outwardly projected from the tip portion of the dilator 8. Is done. At this time,
The guide member 9 functions as a guide when inserting the dilator 8. In general, the body wall consists of multiple layers,
Even if punctured by the puncture needle 16, if the puncture needle 16 is pulled out from the body wall, the positions of the individual puncture holes in the plurality of layers forming the body wall will be displaced due to the influence of muscles. In particular, the position of the peritoneum, which is the deepest layer of the body wall, tends to shift. Therefore,
If the guide member 9 is still inserted through the body wall, the insertion shaft of the dilator 8 is guided when the puncture hole is expanded, and the expansion work can be facilitated.

Further, during the work of expanding the diameter of the puncture hole, it is projected to the outside from the tip portion of the dilator 8 according to the distance between the organ in the abdominal cavity and the tip portion of the straight tube portion 28 of the guide member 9. A projecting amount adjustment work for adjusting the projecting amount of the tip portion of the guide member 9 is performed. During the work of adjusting the amount of protrusion of the guide member 9, the handle portion 2 of the guide member 9 is attached to the dilator 8.
By appropriately combining the operation of pulling 9 in the axial direction and the operation of pushing it out, the amount of protrusion of the tip end portion of the guide member 9 protruding outward from the tip end portion of the dilator 8 is arbitrarily adjusted.

Further, at the time of expanding the hole diameter of the puncture hole, with the operation handle 27 of the dilator 8 and the finger hook portion 20c of the trocar outer tube 7, the handpiece unit 2 is further pushed into the abdominal wall portion H. , And the operation of rotating the trocar outer tube 7 around the axis of the center line is simultaneously performed. Thereby, the puncture hole expansion portion 24 of the dilator 8
Along with the pushing operation of the conical portion, the work of expanding the hole diameter of the small diameter puncture hole to the outer diameter of the outer tube 7 is performed. Then, at the time of this work, the insertion portion 1 of the trocar outer tube 7 is moved by the puncture hole expansion portion 24 of the dilator 8.
The insertion portion 19 of the trocar mantle tube 7 is continuously inserted into the puncture hole of the abdominal wall portion H that has been expanded to have the same diameter as that of the insertion portion 9. Thereby, the insertion portion 19 of the trocar outer tube 7 is inserted into the puncture hole of the abdominal wall portion H.

When the insertion portion 19 of the trocar outer tube 7 is inserted into the puncture hole of the abdominal wall portion H, the abdominal wall expanded to a large diameter by the inserting operation of the insertion portion 19 of the trocar outer tube 7 at this time. Due to the elasticity of the tissue around the puncture hole of the portion H, the insertion portion 19 of the trocar outer tube 7 is relatively firmly fixed.
Is fixed in the puncture hole. In this state, subsequently, the assembly unit of the dilator 8 and the guide member 9 is pulled out to the outside from the trocar outer tube 7. As a result, the trocar outer tube 7 is indwelled in the puncture hole of the abdominal wall portion H in a penetrating state.

Therefore, the following effects are obtained with the above-mentioned structure. That is, in the trocar system 1 of this embodiment, the handpiece unit 2 of the ultrasonic trocar is used.
Since the guide member 9 of the flexible tubular member that is protruded to the outside from the tip portion of the dilator 8 that is inserted between the outer tube 7 and the trocar inner needle 6 in FIG. The tip of the dilator 8 comes into contact with an organ in the abdominal cavity during the dilation operation in which the diameter of the small puncture hole is expanded to the outer diameter of the outer tube 7 by the conical portion of the puncture expansion portion 24 of the dilator 8. The guide member 9 can be brought into contact with an organ in the abdominal cavity before. Therefore, it is possible to reliably prevent the distal end portion of the dilator 8 from coming into contact with the organ in the abdominal cavity during the dilation work, so that the safety of the dilation work can be improved.

Further, the handle portion 29 of the guide member 9 is grasped with fingers, and the handle portion 2 of the guide member 9 is held against the dilator 8.
By appropriately combining the operation of pulling 9 in the axial direction and the operation of pushing it out, it is possible to arbitrarily adjust the amount of protrusion of the tip end portion of the guide member 9 protruding outward from the tip end portion of the dilator 8. Therefore, the trocar outer tube 7
The amount of protrusion of the distal end of the guide member 9 can be adjusted to a suitable state in accordance with conditions such as the thickness of the abdominal wall portion H to be punctured and the distance between the abdominal wall and the internal organ. There is no danger of pressing the organs in the abdominal cavity strongly during the dilation work in which the diameter of the small puncture hole formed in the portion H is expanded to the outer diameter of the outer tube 7, and the outer tube 7 is attached to the abdominal wall H. The work of inserting and detaining can be performed easily and in a short time.

The dilator 8 has a puncture hole extension 2
Since the straight tube-shaped break-preventing portion 25 is provided at the tip of the cone of FIG. 4, when the lateral pressing force acts on the flexible guide member 9 projecting outward from the tip of the dilator 8, the dilator 8 The force acting in the direction in which the guide member 9 is buckled at the tip of the cone of the puncture hole expansion portion 24 can be dispersed over a wide range of the straight tubular break preventing portion 25 of the dilator 8. Therefore, the puncture hole expansion portion 24 of the dilator 8
It is possible to prevent a large buckling force from acting locally on the guide member 9 at the tip end of the conical shape, and to prevent the buckling of the guide member 9. In addition, during the dilation work, the break preventing portion 25 of the dilator 8 can also function as a guide member for the dilation work, and the workability of the dilator 8 during the dilation work can be improved.

Further, in the present embodiment, the guide member locking mechanism 17 of the handpiece unit 2 is used in FIG.
As shown in (A), since the engaging claw portion 39 of the lock member 18 is engaged with the first engaging groove portion 32 of the guide member 9 to lock the guide member 9, the guide member 9 is locked. The relative position between the needle 9 and the trocar inner needle 6 can be fixed at the set position. Therefore, when the inner needle 6 is punctured into the body wall of the patient, there is no possibility that the locking portion between the proximal end side of the outer tube 7 and the proximal end of the trocar inner needle 6 will come off, and the trocar as in the prior art will not occur. It is possible to prevent the operation of 1 from becoming unstable.

Further, since the position of the tip of the trocar inner needle 6 protruding from the outer tube 7 can be adjusted in advance by the position adjusting mechanism 26 before the insertion into the body wall, the thickness of the body wall to be punctured, The amount of protrusion of the tip of the trocar inner needle 6 that is projected from the dilator 8 can be adjusted to a suitable state according to conditions such as the puncture site. for that reason,
There is an effect that the work of puncturing the body wall of the patient with the inner needle can be efficiently performed in a short time as compared with the conventional technique.

Further, in the present embodiment, as shown in FIG. 5A, the lock button 45 of the position adjusting mechanism 26 of the dilator 8 is opposite to the operation handle 27 of the dilator 8 with respect to the center line of the trocar inner needle 6. State (18
Since they are arranged at a distance of 0 °), the lock button 45 can be easily operated.

FIG. 11 shows a second embodiment of the present invention. In this embodiment, the configuration of the handpiece unit 2 of the ultrasonic trocar in the trocar system 1 of the first embodiment (see FIGS. 1 to 10) is modified as follows. Except for this changed portion, it has the same configuration as the handpiece unit 2 of the ultrasonic trocar of the first embodiment, and the description thereof is omitted here.

That is, in this embodiment, the outer tube 7 has a relatively small insertion portion 19 (for example, a diameter of 5 mm).
Around), a short model is used. here,
The inner diameter of the insertion portion 19 of the outer tube 7 is, for example, the guide member 9
The diameter is set to be substantially the same as the outer diameter of the straight pipe portion 28. In this embodiment, the dilator 8 of the first embodiment is omitted, and the guide member 9 is inserted in the insertion portion 19 of the outer tube 7.
The straight pipe part 28 is directly inserted.

Therefore, in the present embodiment, in the locked state in which the engaging claw portion 39 of the lock member 18 is engaged with the first engaging groove portion 32 of the guide member 9 by the guide member locking mechanism 17 of the handpiece unit 2. Since the guide member 9 is locked, the relative position between the guide member 9 and the trocar inner needle 6 can be fixed at the set position. Therefore, when the inner needle 6 is punctured into the body wall of the patient, there is no risk that the locking portion between the proximal end side of the outer tube 7 and the proximal end of the trocar inner needle 6 will come off, and the trocar as in the prior art will not occur. It is possible to prevent the operation of 1 from becoming unstable.

The present invention is not limited to the above embodiment. For example, the guide member locking mechanism 1 in the ultrasonic trocar of the first embodiment shown in FIG.
As in the first modification of No. 7, the fixing screw member 51 may be releasably engaged with the second engaging groove portion 33 on the outer peripheral surface of the small diameter cylindrical body 31. Furthermore, FIG. 13 (A), (B)
The lock mechanism by the operation lever 61 may be provided as in the second modification shown in FIG.

In addition, it goes without saying that various modifications can be made without departing from the scope of the present invention. next,
Other characteristic technical matters of the present application will be additionally described as follows. Note (Additional Item 1) A trocar inner needle that punctures a body wall, an outer tube into which the trocar inner needle is inserted, and an trocar that is inserted between the outer tube and the trocar and is pierced by the trocar inner needle. A dilator having a puncture hole expanding portion that expands a small-diameter puncture hole, and a trocar having a tubular portion that projects outward from the tip portion of the dilator, the relative position of the dilator and the inner needle tip being A trocar that is provided with an adjusting mechanism for changing the trocar.

(Additional Item 2) A trocar inner needle for puncturing a body wall, a handpiece provided with a vibrator, a mantle tube into which the trocar inner needle is inserted, and an intermediary between the mantle tube and the trocar. The handpiece is provided with a dilator having a puncture-hole expanding portion that expands a small-diameter puncture hole that is inserted by the trocar inner needle, and a tubular portion that projects outward from the tip of the dilator. A trocar comprising a lock mechanism section that regulates a relative positional relationship with the shape section.

(Additional Item 3) In the trocar according to Additional Item 1, a lock mechanism portion for fixing and varying the relative position of the dilator and the tip of the inner needle is provided in the dilator, and the lock mechanism is provided in the tubular portion. A trocar which is provided with a groove-shaped portion adapted to.

[0058]

According to the first aspect of the present invention, the amount of protrusion of the tip end portion of the guide member protruding outward from the tip end portion of the dilator inserted between the outer tube and the trocar inner needle is adjusted. This allows the amount of protrusion of the tip of the guide member to be adjusted to a suitable state according to conditions such as the thickness of the body wall to be punctured and the distance to the internal organs. There is no danger of pressing the organs in the abdominal cavity strongly when the diameter of the small puncture hole is expanded to the outer diameter of the mantle tube, and the work of inserting and indwelling the mantle tube into the body wall is easy and short. Can be done in time. Furthermore, by adjusting the position of the tip of the inner needle projected from the outer tube by the adjusting mechanism in advance before inserting it into the body wall,
The thickness of the body wall to be punctured and the amount of protrusion of the inner needle tip protruding from the dilator can be adjusted to a suitable state according to the conditions such as the puncture location, so that the insertion of the inner needle tip can be facilitated. And, it can be performed stably.

According to the second aspect of the invention, the locking mechanism of the dilator is selectively locked to the engaging groove portions of the guide member, which are arranged in parallel along the axial direction. The position of the inner needle tip projected from the outer tube can be adjusted by variably adjusting the relative position to the needle tip.

According to the third aspect of the present invention, the claw portion is moved in the direction of releasing the engagement with the engagement groove portion against the urging force of the urging member by the operation of the operation portion, so that it is projected from the outer tube. The amount of protrusion of the inner needle tip portion is switched to a state in which it can be adjusted to a desired state. Further, when the amount of protrusion of the tip of the inner needle protruding from the outer tube is adjusted to a desired state, the claw portion of the lock mechanism is attached to one of the engaging groove portions of the guide member corresponding to the adjusted position. By being held by the urging force of the urging member in the engaged state, it is possible to reliably hold the protruding amount of the inner needle tip portion protruding from the outer tube in a desired state.

According to the fourth aspect of the present invention, the guide member is detachably locked by the guide member locking mechanism of the handpiece having the vibrator for transmitting the ultrasonic vibration to the trocar inner needle. The relative position between the needle and the inner needle of the trocar can be fixed at the set position.

[Brief description of drawings]

FIG. 1 is a side view showing an assembled state of an entire handpiece unit of an ultrasonic trocar in a trocar system according to a first embodiment of the present invention.

FIG. 2 is a side view showing an exploded state of the ultrasonic trocar of the first embodiment.

FIG. 3 is a side view of a main part showing an assembled state of the ultrasonic trocar of the first embodiment.

FIG. 4 is a vertical cross-sectional view of a main part showing an assembled state of the ultrasonic trocar of the first embodiment.

5A and 5B show a dilator of the ultrasonic trocar according to the first embodiment, FIG. 5A is a plan view showing a positional relationship between a direction of a handle of the dilator and a lock button, and FIG.
Is a side view of the dilator.

FIG. 6 is a side view showing the guide member of the ultrasonic trocar of the first embodiment in a partial cross section.

FIG. 7 is a vertical cross-sectional view showing the peripheral structure of the guide member locking mechanism in the handpiece unit of the ultrasonic trocar of the first embodiment.

FIG. 8A is a vertical cross-sectional view of a main part showing a guide member locking mechanism in the handpiece unit of the ultrasonic trocar of the first embodiment, and FIG. 8B is a vertical cross-sectional view of a main part showing the locking mechanism of the dilator. Face view.

FIG. 9 shows an operating state of a lock mechanism of a dilator in the ultrasonic trocar of the first embodiment,
FIG. 6A is a cross-sectional view showing a disengaged state between the engaging groove portion and the claw portion of the guide member, and FIG. 9B is a transverse sectional view showing an engaging state between the engagement groove portion and the claw portion of the guide member.

FIG. 10 shows a use state of the ultrasonic trocar of the first embodiment, (A) is a side view showing the tip length of the trocar inner needle in the case of a patient whose abdominal wall is thick, and (B) shows abdominal wall The side view which shows the front-end | tip length of the trocar inner needle in the case of a thin patient.

FIG. 11 is a side view showing a state in which the trocar inner needle of the ultrasonic trocar according to the second embodiment of the present invention is inserted into a thin outer tube.

FIG. 12 is a vertical cross-sectional view of a main part showing a first modified example of the locking mechanism of the dilator in the ultrasonic trocar of the first embodiment.

13A and 13B show a second modification of the locking mechanism of the dilator in the ultrasonic trocar of the first embodiment, FIG. 13A is a side view of the locking mechanism, and FIG. 13B is a plan view of the locking mechanism.

[Explanation of symbols] 6 trocar inner needle 7 Trocar mantle 8 dilator 9 Guide member 26 Position adjustment mechanism 33 Second engaging groove portion 45 Lock button (operation part) 47 Engaging claw

Claims (4)

[Claims] 1. A trocar inner needle for puncturing a body wall, an outer tube into which the trocar inner needle is inserted, and a trocar inner needle that is inserted between the outer tube and the trocar inner needle and is pierced by the trocar inner needle. A dilator having a puncture hole expanding portion for expanding the punctured hole having a small diameter, and a tubular portion projecting outward from a tip end portion of the dilator, and supported movably in the axial direction with respect to the dilator. A trocar used in any combination with a guide member for guiding the insertion of a dilator, wherein an adjustment mechanism for variably adjusting the position of the tip of the inner needle protruding from the outer tube is provided. A trocar that does. 2. The adjusting mechanism includes a plurality of stages of engaging groove portions arranged in parallel in the guide member along an axial direction, and an engaging groove portion of the guide member, the engaging groove portions being provided in the guide member. The trocar according to claim 1, further comprising a locking mechanism that selectively engages and disengages. 3. The lock mechanism includes a claw portion releasably engaged with at least one stage engagement groove portion of the guide member, and an engagement direction of the claw portion with the engagement groove portion. A biasing member that generates a biasing force that biases the claw portion, and an operating portion that moves the claw portion in a disengagement direction with the engagement groove portion against the biasing force of the biasing member. The trocar according to claim 2, wherein: 4. The trocar inner needle is connected to a handpiece including a vibrator for transmitting ultrasonic vibrations to the trocar inner needle, and the handpiece guides locking the guide member detachably. The trocar according to claim 1, further comprising a member locking mechanism.