U.S. patent application number 11/044917 was filed with the patent office on 2005-06-23 for operating trocar.
This patent application is currently assigned to Olympus Corporation. Invention is credited to Kasahara, Hideyuki, Kogasaka, Takahiro.
Application Number | 20050137613 11/044917 |
Document ID | / |
Family ID | 19189896 |
Filed Date | 2005-06-23 |
United States Patent
Application |
20050137613 |
Kind Code |
A1 |
Kasahara, Hideyuki ; et
al. |
June 23, 2005 |
Operating trocar
Abstract
An operating trocar according to the invention includes a guide
tube inserted through a body surface to introduce an endoscope and
an operating instrument into a living body, and a flange portion
provided on the guide tube to make a predetermined angle with a
plane approximately perpendicular to an axial direction of the
guide tube, the flange portion being fixed to an outer surface of
the body surface. Preferably, the operating trocar also includes a
gastightness retaining portion provided in the guide tube to retain
gastightness between a circumferential surface of an internal hole
of the guide tube and a medical instrument such as an endoscope and
an operating instrument inserted in the internal hole of the guide
tube.
Inventors: |
Kasahara, Hideyuki; (Tokyo,
JP) ; Kogasaka, Takahiro; (Tokyo, JP) |
Correspondence
Address: |
Poul J. Esatto, Jr.
Scully, Scott, Murphy & Presser
400 Garden City Plaza
Garden City
NY
11530
US
|
Assignee: |
Olympus Corporation
Tokyo
JP
|
Family ID: |
19189896 |
Appl. No.: |
11/044917 |
Filed: |
January 27, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11044917 |
Jan 27, 2005 |
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10328237 |
Dec 23, 2002 |
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6863674 |
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Current U.S.
Class: |
606/108 ;
600/114; 604/174 |
Current CPC
Class: |
A61B 2017/3492 20130101;
A61B 17/3421 20130101 |
Class at
Publication: |
606/108 ;
600/114; 604/174 |
International
Class: |
A61F 011/00 |
Foreign Application Data
Date |
Code |
Application Number |
Dec 28, 2001 |
JP |
2001-401943 |
Claims
1-37. (canceled)
38. A method of inserting a trocar into a living body, comprising
the steps of: inserting at least a portion of the trocar into the
living body; causing at least a portion of a flange of the trocar
and an outer surface of the living body to adhere to each other;
and adhering an adhesive sheet having at least a portion wider in
area than the flange to the flange as well as the outer surface of
the living body to fix the trocar to the living body.
39. A method of inserting a trocar into a living body, comprising
the steps of: inserting at least a portion of the trocar into the
living body; and fixing the trocar to the living body by securing a
band extending from the trocar around a portion of the living body.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application is based upon and claims the benefit of
priority from the prior Japanese Patent Application No.
2001-401943, filed Dec. 28, 2001, the entire contents of the
application are incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to a trocar for introducing an
endoscope, a therapeutic instrument and the like into a living body
during operation. A trocar according to the invention is suited to,
for example, endoscopic surgical operation.
[0004] 2. Description of the Related Art
[0005] Various types of trocars for introducing endoscopes,
therapeutic instruments and the like into living bodies are
known.
[0006] Japanese Utility Model Registration No. 3024069 discloses an
art of providing a balloon-like stopper on a trocar to prevent the
trocar from coming off.
[0007] Japanese Patent Laid-Open No. 28666/1997 discloses an art of
preventing a trocar from coming off, by expanding an expanding
portion in a body cavity.
BRIEF SUMMARY OF THE INVENTION
[0008] A trocar according to the invention includes a guide tube
for introducing a medical instrument into a living body and a
flange provided on an outer circumference of the guide tube at a
location other than opposite ends thereof, the flange having a
surface which comes into contact with an outer surface of the
living body and which is oblique with respect to an axis of the
guide tube.
[0009] In addition, it is preferable that at least a part of the
trocar be formed of an elastic material so that the trocar can
follow the movement of the medical instrument.
[0010] In the trocar, it is general to integrate the guide tube and
the flange, but the guide tube and the flange may also be
constructed to be removably secured to each other so that the
trocar can be conveniently cleaned and stored. In addition, this
construction makes it easy to manufacture trocars.
[0011] In addition, in order to increase the adhesion between the
flange and the outer surface of the living body, it is preferable
to provide a fixing portion (for example, an adhesive layer
provided on the surface of the flange which comes into contact with
the outer surface of the living body, an adhesive sheet wider in
area than the flange and stuck to the surface of the flange
opposite to the surface which comes into contact with the outer
surface of the living body, or a fixing band extending from the
flange). Holes through which to pass sutures may also be provided
in the flange in order to fix the trocar to the living body.
[0012] In the guide tube, a gastightness retaining member (for
example, an O-ring or a valve) may also be provided so that the
gastightness of a body cavity can be efficiently retained.
[0013] It is preferable that the wall thickness of the guide tube
be made a thickness suited for the insertion of the guide tube and
the wall thickness of the flange be made a thickness which enables
the flange to easily adhere to the body surface. Accordingly, in
general, both wall thicknesses differ from each other, and in many
cases, the flange is thinner in wall thickness than the guide
tube.
[0014] Some of the above-described additional features of the
invention can also be applied to known trocars.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0015] These and other features, aspects, and advantages of the
apparatus and methods of the present invention will become better
understood with regard to the following description, appended
claims, and accompanying drawings where:
[0016] FIG. 1 is an exploded side view of a blood vessel harvester
including a trocar according to a first embodiment of the
invention;
[0017] FIG. 2A is a perspective view of the trocar according to the
first embodiment, and FIG. 2B is a longitudinal sectional view of
the same trocar;
[0018] FIG. 3 is a view showing the state in which a dissected
portion of skin is formed in a lower limb according to the first
embodiment;
[0019] FIG. 4 is a cross-sectional view showing the state in which
the trocar according to the first embodiment is fitted into the
dissection portion of skin of the lower limb and a dissector is
inserted into a cavity by using the trocar as a guide;
[0020] FIG. 5 is a general construction diagram showing the state
in which a therapeutic sheath is inserted into the cavity by using
the trocar in the first embodiment as a guide FIG. 6 is a
perspective view of a trocar according to a second embodiment of
the invention;
[0021] FIG. 7 is a cross-sectional view showing the manner in which
the trocar shown in FIG. 6 is used
[0022] FIG. 8 is a perspective view of a trocar according to a
third embodiment of the invention
[0023] FIG. 9 is a cross-sectional view showing the manner in which
the trocar shown in FIG. 8 is used;
[0024] FIG. 10 is a perspective view of a trocar according to a
fourth embodiment of the invention
[0025] FIG. 11 is a cross-sectional view showing the manner in
which the trocar shown in FIG. 10 is used
[0026] FIG. 12 is a perspective view of a trocar according to a
fifth embodiment of the invention;
[0027] FIG. 13 is a cross-sectional view showing the manner in
which the trocar shown in FIG. 12 is used;
[0028] FIG. 14 is a perspective view of a trocar according to a
sixth embodiment of the invention
[0029] FIGS. 15A to 15C are perspective views showing a plurality
of trocars which differ in the inclination angles of their guide
tubes to their flanges;
[0030] FIG. 16 is a perspective view showing the manner in which
the trocars shown in FIGS. 15A to 15C are used;
[0031] FIG. 17 is a perspective view showing the manner in which
the trocars shown in FIGS. 15A to 15C are used; and
[0032] FIG. 18A is a perspective view of a trocar according to a
seventh embodiment of the invention, and FIG. 18B is a
cross-sectional view of the trocar shown in FIG. 18A.
DETAILED DESCRIPTION OF THE INVENTION
[0033] Preferred embodiments of the invention will be described
below with reference to the accompanying drawings.
[0034] FIG. 1 shows an endoscopic blood vessel harvester including
a trocar for endoscopic operation according to a first embodiment
of the invention. As shown, the endoscopic blood vessel harvester
is made of a trocar 1, a therapeutic sheath 2, a dissector 3 which
serves as expanding means, and a rigid scope 4 which serves as an
endoscope.
[0035] As shown in FIGS. 2A and 2B, the trocar 1 comprises a flange
5 which has an approximately disk-like shape and is provided with a
cylindrical guide tube 6 in such a manner that the guide tube 6 is
obliquely inserted through the flange 5. In many cases, trocars are
integrally molded from a synthetic resin material (for example,
polysulfone), or formed of a metal (for example, SUS 304 stainless
steel). In the first embodiment, the trocar 1 is formed of an
elastic material (for example, silicone rubber) so that the trocar
1 has elasticity. As a matter of course, when the trocar 1 is to be
given elasticity, the whole of the trocar 1 need not be formed of
an elastic material, and only the necessary part of the trocar 1
may be formed of an elastic material. In many cases, the portions
of guide tubes that are to be inserted into the bodies of patients
do not need great elasticity, but flange portions which come into
contact with the body surfaces of patients need great elasticity.
In view of this situation, an elastic material can also be used
mainly for the flange portions.
[0036] The outer surface of the guide tube 6 is covered with a
lubricating coating for improving the smoothness of insertion of
the guide tube 6. A tip 6a of this guide tube 6 is cut at an acute
angle, and the end surface of the tip 6a is formed approximately in
parallel with the flange 5.
[0037] In addition, the inner circumferential surface of the
proximal end of the guide tube 6 is integrally provided with a
gastight ring portion 7 which serves as a gastightness retaining
member (a sealing member), and an intermediate portion of the guide
tube 6 is integrally provided with a gas feed connecting portion 8.
The gastightness retaining member is provided on a side closer to
the proximal end than the gas feed connecting portion 8 (on a side
far from the interior of a patient). This construction aims to
prevent a gas fed into the trocar 1 through the gas feed connecting
portion 8 from leaking out of the trocar 1 at the proximal end. In
addition, the bottom or contact surface of the flange 5a (the
surface of the flange 5 which comes into contact with the patient)
is provided with an adhesive layer 9 (for example, adhesive tape)
so that the trocar 1 can be adhesively fixed to the skin of the
patient.
[0038] As shown in FIG. 1, the therapeutic sheath 2 has a sheath
body 10. The sheath body 10 has the form of a straight cylinder
made of a synthetic resin material or the like, and the outer
surface of the sheath body 10 is covered with a lubricating coating
for improving the smoothness of insertion of the sheath body 10.
The sheath body 10 is constructed so that a rigid scope 4 can be
freely inserted into and extracted from the interior of the sheath
body 10. In addition, the sheath body 10 is provided with a first
therapeutic instrument channel and a second therapeutic instrument
channel. A bipolar cutter 18 is inserted through the first
therapeutic instrument channel as a high-frequency therapeutic
instrument. The bipolar cutter 18 is constructed to move axially
back and forth when a therapeutic instrument manipulating portion
19 is slid axially back and forth. In addition, a blood vessel
holder 21 is inserted through the second therapeutic instrument
channel, and is constructed to move axially back and forth when a
holder manipulating portion 22 is slid axially back and forth.
[0039] The dissector 3 has a straight cylindrical inserting tube
36, as shown in FIG. 1. An axial portion of this inserting tube 36
is provided with an inserting passage through which to insert an
inserting portion 35 of the rigid scope 4. The outer surface of the
inserting tube 36 is covered with a lubricating coating for
improving the smoothness of insertion of the inserting tube 36. A
dissecting portion 38 made of a transparent synthetic resin
material formed into a conical shape is fixed to the distal end of
the inserting tube 36.
[0040] The rigid scope 4 has the inserting portion 35 and an
eyepiece portion 31, and a light guide connecting portion 33 is
provided on the side of the rigid scope 4.
[0041] A case where the blood vessel harvester constructed in the
above-described manner is used to extract an extraction target
blood vessel (hereinafter referred to simply as a blood vessel)
along the full length thereof will be described below with
illustrative reference to a great saphenous vein which extends from
the inguinal region of the thigh to the ankle of either of the
lower limbs.
[0042] FIG. 3 shows a lower limb 60, and reference numeral 61
denotes a blood vessel. A dissected portion of skin 64 is provided
between a knee 62 and an inguinal region 63. As shown, when an
operator is to extract the blood vessel 61 between the knee 62 and
the inguinal region 63, the operator provides the dissected portion
of skin 64 at one location of the knee 62 immediately above the
blood vessel 61 by means of a scalpel or the like.
[0043] Then, the operator exposes the blood vessel 61 in the
dissected portion of skin 64 by means of the dissector 3 or the
like. Further, the operator dissects tissues immediately above the
blood vessel 61 by means of the similar dissector 3 or the like
over a distance from the dissected portion of skin 64, which
distance is observable with the naked eyes.
[0044] FIG. 5 shows the manner in which the therapeutic sheath 2
having the rigid scope 4 inserted inside is inserted through the
trocar 1. In the combination shown in FIG. 5, the dissector 3 may
also be substituted for the therapeutic sheath 2. In this
substituted combination, the operator proceeds dissection with the
dissector 3. An image of the status of dissection through the
dissecting portion 38 of the dissector 3 is picked up by a TV
camera 75 via a TV camera head 74 connected to the eyepiece portion
31 of the rigid scope 4, and the picked-up image is displayed on a
monitor 76 as a monitor image.
[0045] Then, as shown in FIG. 4, the operator inserts the
dissecting portion 38 along the blood vessel 61, and when the
dissecting portion 38 is inserted to a small extent, the operator
inserts the guide tube 6 of the trocar 1 toward the inguinal region
63 obliquely (approximately in parallel with the blood vessel 61).
When the tip 6a of the trocar 1 is turned downward, the adhesive
layer 9 on the bottom surface 5a of the flange 5 is adhesively
fixed to skin 65. In this state, the operator connects a gas feed
tube 67 connected to a gas feed pump 66 to the gas feed connecting
portion 8.
[0046] In this case, since the outer circumferential surface 6f the
inserting tube 36 of the dissector 3 adheres closely to the
gastight ring portion 7, the interior of the guide tube 6 and the
interior of a cavity 69 is placed in a gastight state, and a gas
feed passage 68 is established in an annular space between an inner
surface of the guide tube 6 and the outer circumferential surface
of the inserting tube 36.
[0047] The light guide connecting portion 33 of the rigid scope 4
is connected to a light source device 78 via a light guide cable
57. Accordingly, illuminating light can be projected from a tip
portion of the rigid scope 4 to illuminate the interior of the
cavity 69. When the gas feed pump 66 is driven, a gas is fed into
the cavity 69 via the gas feed tube 67, the gas feed connecting
portion 8 and the gas feed passage 68, whereby the cavity 69 is
expanded.
[0048] At this time, in the cavity 69, a subcutaneous tissue 70 and
a connective tissue of blood vessel 71 lie under the skin 65, and a
blood vessel 61 exists under the connective tissue of blood vessel
71. The blood vessel 61 has a plurality of side branches 72, and
the branch ends of the respective side branches 72 are connected to
the connective tissue of blood vessel 71. Subcutaneous fat 73
adheres to the connective tissue of blood vessel 71.
[0049] Subsequently, the operator inserts the dissect or 3 more
deeply in the expanded cavity 69 while guiding the dissector 3 by
means of the guide tube 6. At this time, since the guide tube 6 is
formed to extend obliquely with respect to the flange 5, the guide
tube 6 can guide the dissector 3 obliquely with respect to the body
surface, thereby successfully introducing the dissector 3 along the
running direction of the blood vessel 61.
[0050] During the insertion of the dissector 3, while the operator
is observing the cavity 69 on the monitor 76 to take care not to
injure the blood vessel 61 nor the side branches 72, the operator
gradually advances the dissector 3 by repeating the manipulation of
pushing the dissector 3 to a small extent to dissect the connective
tissue of blood vessel 71 from the blood vessel 61 and the side
branches 72 by means of the dissecting portion 38 and then pull ng
the dissector 3 to a small extent. During this time, even if the
dissector 3 is oscillated vertically and horizontally, the trocar 1
does not at all come off the skin 65, because the trocar 1 is fixed
to the skin 65 by the adhesive layer 9. In addition, since the
trocar 1 (the guide tube 6 and the flange 5) is formed of an
elastic material, the trocar 1 can smoothly follow the movement of
the dissector 3 owing to its elastic deformation (the trocar 1 can
absorb the deformation of the body surface due to the movement of
the dissector 3).
[0051] After the operator has inserted the dissector 3 along the
blood vessel 61 from the knee 62 toward the inguinal region 63 and
completed a dissecting operation with the dissector 3 in the
above-described manner, the operator extracts the dissector 3 from
the trocar 1. Then, as shown in FIG. 5, the operator inserts the
therapeutic sheath 2 in which the rigid scope 4 is inserted, into
the guide tube 6 of the trocar 1. At this time as well, the guide
tube 6 which is formed to extend obliquely with respect to the
flange 5 can guide the therapeutic sheath 2 obliquely with respect
to the body surface, thereby successfully introducing the
therapeutic sheath 2 along the running direction of the blood
vessel 61.
[0052] When the operator grips the therapeutic sheath 2 in one hand
and advances the holder manipulating portion 22 by using, for
example, the thumb of the one hand, the blood vessel holder 21
projects from the tip of the sheath body 10. In addition, when the
operator advances the therapeutic instrument manipulating portion
19 by using the index finger of the one hand in which the
therapeutic sheath 2 is gripped, the bipolar cutter 18 projects
from the tip of the sheath body 10. Namely, the operator can move
the blood vessel holder 21 and the bipolar cutter 18 back and forth
while gripping the sheath body 10 in only one hand. Accordingly,
the operator can easily sever the side branches 72 by means of the
bipolar cutter 18 while holding the blood vessel 61 to be
extracted, by means of the blood vessel holder 21. At this time as
well, the trocar 1 (the guide tube 6 and the flange 5) which is
formed of an elastic material can smoothly follow the movement of
the therapeutic sheath 2 owing to its elastic deformation.
[0053] The operator repeats the operation of severing each of the
side branches 72 to dissect the blood vessel 61 from the connective
tissue of blood vessel 71, and when the operation advances up to
the inguinal region 63, the operator completes severing the side
branches 72. Then, the operator forms a small dissected portion of
skin in the inguinal region 63 immediately above the blood vessel
61 by means of a scalpel or the like, and draws out the blood
vessel 61 through this dissected portion of skin 64. The operator
can sever the drawn portion of the blood vessel 61, and ligates
both severed ends of the blood vessel 61 with a suture. Then, the
operator performs the operation of extracting the portion of the
blood vessel 61 that extends from the dissected portion of skin 64
of the knee 62 toward the ankle of the lower limb 60, thereby
finally extracting a single blood vessel (about 60 cm long). The
method of manipulation is basically the same as the above-described
method of harvesting the portion of the blood vessel 61 that
extends from the knee 62 to the inguinal region 63, and detailed
explanation is omitted. The vessel which is cut its both sides is
removed from the dissected portion of skin 64.
[0054] As described above, the trocar 1 according to the first
embodiment is provided with the flange 5 which is to be adhesively
fixed to the body surface. Accordingly, the trocar 1 does not need
to have a complicated stopper structure such as a balloon or an
expanding portion, and makes it possible to prevent the guide tube
6 from coming off, merely by adhesively fixing the flange 5 to the
body surface. Namely, the trocar 1 according to the first
embodiment is inexpensive in that the guide tube 6 can be
effectively prevented from coming off, by means of a simple
construction.
[0055] In addition, in the trocar 1 according to the first
embodiment, the flange 5 is provided on the guide tube 6 so as to
make a predetermined angle (except zero degrees) with a plane
approximately perpendicular to the axial direction of the guide
tube 6. In other words, the guide tube 6 extends through the flange
5 obliquely with respect to the extending direction of the flange
5. Accordingly, the guide tube 6 can guide an endoscope, a
therapeutic instrument and the like obliquely with respect to the
body surface. Therefore, the operator can make observations in
various directions through an endoscope inserted through the guide
tube 6, and can also guide an endoscope and a therapeutic
instrument in various directions as occasion demands. Particularly
in the case of the first embodiment used for the extraction of a
blood vessel, the dissector 3 can be guided obliquely with respect
to the body surface, thereby successfully introducing the dissector
3 along the running direction of the blood vessel 61.
[0056] In addition, since the flange 5 is provided on the outer
circumference of the guide tube 6 at a location other than the
opposite ends thereof, a part of the guide tube 6 is exposed
outside the body of the patient when the trocar 1 is inserted in
the patient. Accordingly, the operator can easily grip the trocar 1
with good operability.
[0057] The trocar 1 according to the first embodiment is provided
with, in addition to the stopper structure (the flange 5), the
gastightness retaining member (sealing member) 7 which retains the
gastightness of the gap between the circumferential surface of the
internal hole of the guide tube 6 and an outer surface of an
endoscope or a therapeutic instrument inserted in the internal hole
(or conduit) of the guide tube 6. Accordingly, the trocar 1 can
reliably retain the gastightness of a body cavity, this feature is
particularly important for endoscopic surgical operation.
[0058] In addition, since the trocar 1 according to the first
embodiment is formed of an elastic material, the whole of the
trocar 1 can smoothly follow the movement of the dissect or 3 owing
to its elastic deformation (the trocar 1 can absorb the deformation
of the body surface due to the movement of the dissector 3).
[0059] Furthermore, since the trocar 1 is formed of an elastic
material, the angle made by the flange 5 with the axis of the guide
tube 6 is variable within an elastically allowable range.
Accordingly, when the trocar 1 is inserted in the patient, the
flange 5 can easily adhere to the body surface of the patient. As a
matter of course, the angle made by the flange 5 with the axis of
the guide tube 6 can also be made variable by using a mechanical
joint (for example, the guide tube 6 is inserted through a
spherical member and a flange having a center opening which
diameter is smaller than the diameter of the spherical member and
larger than the diameter of the guide tube 6 is fitted onto the
guide tube 6 as the flange 5).
[0060] Incidentally, in the first embodiment, the whole of the
trocar 1 is formed of an elastic material, but at least one of the
flange 5 and the guide tube 6 or at least a part of the flange 5 or
at least a part of the guide tube 6 may be formed of an elastic
material. Means for fixing the flange to the body surface is not
limited to adhesion, and any fixing means that can easily fix the
flange 5 to the body surface may be used. In addition, the
gastightness retaining member (sealing member) 7 need not be an
O-ring such as that used in the first embodiment, and may have any
construction that can retain the gastightness of the body
cavity.
[0061] FIGS. 6 to 18 show other embodiments of the invention (a
second embodiment to a seventh embodiment). In these embodiments,
constituent portions common to the first embodiment are denoted by
the same reference numerals as those used in the first embodiment,
and the description of the same constituent portions is
omitted.
[0062] FIGS. 6 and 7 show a trocar 1A according to the second
embodiment of the invention. The trocar 1A according to the second
embodiment does not have the adhesive layer 9 provided on the
bottom surface 5a of the flange 5. Instead, an adhesive seal 100
having an adhesive layer 10a is stuck to the flange 5, and as shown
in FIG. 7, the flange 5 is fixed to the body surfaces 65 and 70 by
using the adhesive seal 100. Incidentally, the constructions of the
other portions are the same as those in the first embodiment.
[0063] According to the construction of the second embodiment,
since the adhesive layer 9 is not provided, it is possible to
produce the trocar 1A itself more easily, and as long as the
adhesive seal 100 has elasticity, the trocar 1A can follow the
movement of an endoscope and a therapeutic instrument to some
extent even if neither the flange 5 nor the guide tube 6 has
elasticity. For example, the seal 100 is a polyurethane film on one
side of which hypoallergenic acrylic adhesive is applied. In this
case, the seal 100 has elasticity since polyurethane is used as a
base material.
[0064] FIGS. 8 and 9 show a trocar 1B according to the third
embodiment of the invention. As shown in FIG. 8, the trocar 1B
according to the third embodiment is constructed so that the flange
5 and the guide tube 6 can be separated from each other.
Specifically, a fixed ring 105 is provided on the inner
circumference of the ring-shaped flange 5, and an engaging groove
6b which engages with the fixed ring 105 is formed on the outer
circumferential surface of the guide tube 6. The engaging groove 6b
obliquely extends to make a predetermined angle with a plane
perpendicular to the direction of the longitudinal axis of the
guide tube 6, and the engaging groove 6b is arranged to direct the
guide tube 6 obliquely with respect to the extending direction of
the flange 5 when the engaging groove 6b engages with the fixed
ring 105 (the flange 5 is arranged to be directed by the engaging
groove 6b so that the flange 5 makes a predetermined angle with a
plane approximately perpendicular to the axial direction of the
guide tube 6). In addition, since the engagement is so tight, a
seal capable of fully retaining the gastightness of a body cavity
is formed when the engaging groove 6b and the fixed ring 105 are
engaged with each other. Incidentally, the constructions of the
other portions are the same as those in the first embodiment. The
flange 5 and fixed ring 105 are elastomers or a soft thermoplastic
which can be plastically deformed to stretch over the guide tube.
When the flange 5 is fixed to the guide tube 6, the flange 5 and
fixed ring 105 are extended until the fixed ring 105 corresponds
with the groove 6b, at which point, the flange is relaxed and the
fixed ring 105 engages with the groove 6b.
[0065] FIG. 9 shows the state in which the guide tube 6 which is
fitted in the flange 5 is fixed to the body surface s 65 and 70. As
shown, the guide tube 6 extends obliquely with respect to the body
surfaces 65 and 70, whereby the third embodiment can serve effects
and advantages similar to those of the first embodiment.
[0066] According to the third embodiment, since the guide tube 6
and the flange 5 can be separated in the above-described manner,
the trocar 1B is superior in ease of cleaning and ease of storage,
and is also easy to manufacture. In addition, the trocar 1B is
useful in that the flange 5 and the guide tube 6 can be formed of
different materials. In addition, the engaging portion of the guide
tube 6 may use spaced projections (not shown) instead of the
engaging groove 6b where the fixed ring 105 is captured between the
spaced projections.
[0067] FIGS. 10 and 11 show a trocar 1C according to the fourth
embodiment of the invention. As shown in FIG. 10, the trocar 1C
according to the fourth embodiment does not have the adhesive layer
9 provided on the bottom surface of the flange 5. Instead, a
plurality of holes 110 for tying sutures are formed in the flange
5. Incidentally, the constructions of the other portions are the
same as those in the first embodiment.
[0068] According to the construction of the fourth embodiment, as
shown in FIG. 11 by way of example, after a needle (not shown) with
a suture 112 has been stuck into the body surface s 65 and 70, the
needle is passed through one of the holes 110 of the flange 5 and
both ends of the suture 112 are tied together, whereby the flange 5
can be fixed to the body surfaces 65 and 70 by the sutures 112.
[0069] FIGS. 12 and 13 show a trocar 1D according to the fifth
embodiment of the invention. As shown in FIG. 12, the trocar 1D
according to the fifth embodiment has a construction in which a
band 129 extending from the flange 5 has a Hook-and-Loop fastener
(for example, Velcro.RTM. fastener) 121 whose fastening halves are
respectively provided at the opposite ends of the band 129. Namely,
the flange 5 and the band 129 form a fixing belt 120 for fixing the
guide tube 6 to a living body. Incidentally, the constructions of
the other portions are the same as those in the first embodiment.
The band 129 is made of elastomer or soft thermoplastic, and is
attached to the guide tube 6 like flange 5 in the third
embodiment.
[0070] According to the construction of the fifth embodiment, as
shown in FIG. 13, it is possible to prevent the guide tube 6 from
coming off, by winding the fixing belt 120 around, for example, the
knee 62 of the lower limb 60.
[0071] Accordingly, since the trocar 1D according to the fifth
embodiment has belt-like stopper means, the trocar 1D can be
reliably fixed, and is particularly suited to an arm, a leg and the
like.
[0072] FIG. 14 shows a trocar 1E according to the sixth embodiment.
In the trocar 1E according to the sixth embodiment, the
gastightness retaining member (sealing member) provided in the
guide tube 6 is formed as a valve 7A. Specifically, a tubular
support portion 125 which supports a valve flap 151 in a turnable
manner extends to project into the guide tube 6 from the operator
side of the guide tube 6, and a member (for example, an elastic
body) 150 which comes into pressure contact with the outer
circumferential surface of an endoscope or a therapeutic instrument
to be inserted into the guide tube 6 is fitted to the external end
of the support portion 125. Incidentally, the valve flap 151 can
open and close the passage of the guide tube 6 by turning about a
pivot 127 provided in the support portion 125. In addition, the
valve flap 151 is biased in the closing direction by a spring 152.
The constructions of the other portions are the same as those in
the first embodiment.
[0073] According to the construction of the sixth embodiment, when
an endoscope or a therapeutic instrument is inserted into the
support portion 125 to press the valve flap 151, the valve flap 151
is turned and opened against the urging force of the spring 152,
whereby the endoscope or the therapeutic instrument can be inserted
through the guide tube 6. In this case, since the elastic body 150
comes into pressure contact with the outer circumferential surface
of the endoscope or the therapeutic instrument, the gastightness of
the body cavity can be retained. In addition, even after the
endoscope or the therapeutic instrument has been removed from the
guide tube 6, the gastightness of the body cavity can still be
retained, because the valve flap 151 is closed by the biasing force
of the spring 152.
[0074] FIGS. 15A to 15C respectively show a plurality of trocars
1F, 1G and 1H which differ in the inclination angle of the guide
tube 6 to the flange 5. These trocars 1F, 1G and 1H are used for
introducing a plurality of operating instruments 130, 2, and 132,
respectively, into the body of a patient, and the operating
instruments 130, 2, and 132 differ in access direction relative to
a therapeutic target part (affected part) O (hence, in inclination
angle relative to the body surface) as shown in FIG. 16. The
therapeutic target part O to be accessed may be an organ inside an
abdominal wall 140 as shown in FIG. 17, or may also be the blood
vessel 61 inside the lower limb 60 as described previously.
Accordingly, the kind of area to which the trocar according to the
invention can be applied is not at all be limited.
[0075] FIGS. 18A and 18B show a trocar 1I according to the seventh
embodiment of the invention. As clearly shown in FIG. 18A, in the
trocar 1I according to the seventh embodiment, a wall thickness t2
of the flange 5 is set to be thinner than a wall thickness t1 of
the guide tube 6. Incidentally, the constructions of the other
portions are the same as those in the first embodiment.
[0076] Incidentally, in the case where the wall thickness of the
flange 5 is not constant or the wall thickness of the guide tube 6
is not constant, the wall thickness of the guide tube 6 may be
determined from the average wall thickness of the portion of the
guide tube 6 that is to be inserted into a living body, while the
wall thickness of the flange 5 may be determined from the average
wall thickness of the portion of the flange 5 that is to come into
contact with a living body.
[0077] According to the construction of the seventh embodiment, the
guide tube 6 can be easily inserted into a dissected portion of
skin, and the flange 5 can be easily made to adhere to the
skin.
[0078] While there has been shown and described what is considered
to be preferred embodiments of the invention, it will, of course,
be understood that various modifications and changes in form or
detail could readily be made without departing from the spirit of
the invention. It is therefore intended that the invention be not
limited to the exact forms described and illustrated, but should be
constructed to cover all modifications that may fall within the
scope of the appended claims.
* * * * *