Abstract:
A retractor has a rigid piercing tube and an expansion body. The expansion body has an introduction tube which is received within the piercing tube, a movable wire which is received within the introduction tube, and stationary wires which are arranged around the movable wire. The proximal end of each of the stationary wires is affixed to the distal end of the introduction tube. The distal end of each of the stationary wires is joined to the distal end of the movable wire. The respective proximal ends of the piercing tube, the introduction tube, and the movable wire are respectively joined to first, second, and third grip sections.

Description:
TECHNICAL FIELD 
       [0001]    The present invention relates to retractors, and more specifically, to a retractor that can be developed in a three-dimensional direction to be used to exclude an inside wall of a hollow organ or an organ in a body cavity. 
       BACKGROUND ART 
       [0002]    In a conventional laparotomy, the organ that inhibits the surgery can be manually spread, but it is known that the organ cannot be easily spread and that it is difficult to ensure a field of view optimum for the surgery under endoscopic surgery. For example, a method of injecting gas into the body cavity to ensure the field of view and the operation space is known, but such method requires full anesthesia and the invasiveness is not actually low. 
         [0003]    To alleviate the problem of field of view, and the like and to facilitate the endoscopic treatment, an instrument called a retractor that excludes or tugs an organ to be treated or an organ that inhibits the field of view during the treatment, and the like, has been developed. As a basic function, it is desired that an instrument can be inserted through a small opening passage such as a trocar (pallium tube) or a small incision that serves as an insertion passage when inserting the retractor into the body. Therefore, the retractor needs to have a small diameter (e.g., desirably smaller than or equal to 10 mm in the case of trocar, and smaller than or equal to 20 mm in the case of small incision) and to have a rod-like form at least at the time of insertion, whereas after the insertion into the body cavity, the retractor is demanded to be deformable to a shape an excluding section has a large area of a certain degree to widely and safely exclude the target. 
         [0004]    According to the conflicting demands described above, variously devised retractors are being proposed and are commercially available. For example, the retractor in which the excluding section opens to a fan shape has been provided (e.g., Patent Literature 1). At the time of insertion of the trocar into the abdominal cavity, a fan-shaped excluding section is folded and accommodated inside a rod-shaped tube, and is pushed out by the rod-shaped tube in the body cavity to be spread to a fan shape. A structure of opening the fan-shaped excluding section to an arbitrary size by manual operation and a structure in which an angle between the excluding section and a base section varies are known, where such structures are suited for excluding liver and intestine as the advantage thereof is that the organ can be excluded relatively widely. The shape is not limited to a fan shape, and various shapes such as a diamond shape, and the like have also been proposed. 
         [0005]    In particular, development of a retractor that more effectively excludes the organ and that excels in operability is desired. 
       CITATION LIST 
     Patent Literature 
       [0006]    Patent Literature 1: JP 6-154152 A 
       SUMMARY OF INVENTION 
     Technical Problem 
       [0007]    The present invention aims to solve the problems described above, and the object thereof is to provide a retractor that can be inserted through an incision or by being directly perforated to exclude the inside wall of the hollow organ or the organ in the body cavity, the retractor being easy to handle in the surgery and being able to freely adjust the scale of exclusion. 
       Solution to Problem 
       [0008]    The present invention is a retractor for excluding an inside wall of a hollow organ or an organ in a body cavity, and the retractor includes: 
         [0009]    a rigid perforation tube; 
         [0010]    a developing body that is configured to be accommodated and extended with respect to the perforation tube; and 
         [0011]    a grip connected to respective proximal ends of the perforation tube and the developing body, wherein 
         [0012]    the developing body includes 
         [0013]    an excluding section configured by a movable wire and a plurality of fixing wires arranged at a periphery of the movable wire, and 
         [0014]    an introducing tube extended from the excluding section, the movable wire being passed through the introducing tube; and 
         [0015]    a distal end of the movable wire and a distal end of the fixing wire are joined in the excluding section. 
         [0016]    In one embodiment, the grip includes a first grip portion, a second grip portion, and a third grip portion from a distal side; 
         [0017]    a proximal end of the perforation tube is connected to the first grip portion; 
         [0018]    a proximal end of the introducing tube of the excluding section is connected to the second grip portion; and 
         [0019]    a proximal end of the movable wire of the excluding section is connected to the third grip portion. 
         [0020]    In one embodiment, the perforation tube is a straight tube. 
         [0021]    In one embodiment, a cross-section of the movable wire has a substantially circular shape. 
         [0022]    In further embodiment, a cross-section of the fixing wire has a partial circular ring shape in which a part of the cross-section substantially coincides with one part of an outer periphery of the cross-section of the movable wire. 
         [0023]    In one embodiment, a curve of the fixing wire in the excluding section is controlled by pushing or pulling at least one of the second grip portion or the third grip portion with respect to the first grip portion. 
       Advantageous Effects of Invention 
       [0024]    According to the present invention, a retractor that can freely exclude the organ can be provided. The retractor of the present invention can form a cocoon-shaped structure configured to an arbitrary size in an excluding section by pushing and pulling a grip separated into three portions. The cocoon-shaped structure enables the organ to be freely excluded. 
         [0025]    According to the present invention, the organ within a predetermined range can be excluded without injecting gas into the body cavity, and hence, a so-called gas-less surgery can be performed. 
     
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         [0026]      FIG. 1  is a view schematically showing one example of a retractor of the present invention, and is a perspective view of the retractor showing a state in which a developing body is opened. 
           [0027]      FIGS. 2( a ) to 2( c )  are views showing the retractor of the present invention shown in  FIG. 1 , where  FIG. 2( a )  is a schematic view of the retractor showing a state in which the developing body is accommodated in a perforation tube,  FIG. 2( b )  is a schematic view of the retractor showing a state in which the developing body is extended from the perforation tube to carry out a cocoon-shaped development in an excluding section of the developing body, and  FIG. 2( c )  is a schematic view of the retractor showing a state in which a cocoon-shaped structure is developed in the excluding section of the developing body extended from the perforation tube. 
           [0028]      FIGS. 3( a ) and 3( b )  are views schematically showing one example of the developing body configuring the retractor of the present invention, where  FIG. 3( a )  is a cross-sectional view in a longitudinal direction of a distal end portion of the retractor of the present invention showing a state in which the developing body is accommodated in the perforation tube, and  FIG. 3( b )  is a partially cutout cross-sectional view of the distal end portion of the retractor of the present invention showing the developing body extended from the perforation tube and in which the cocoon shape is developed. 
           [0029]      FIG. 4  is a view schematically showing one example of a cross-sectional view (cross-sectional view of movable wire and fixing wire) in a direction orthogonal to a long axis of the developing body configuring the retractor of the present invention. 
           [0030]      FIGS. 5( a ) to 5( c )  are cross-sectional views of the wire schematically showing an example of a cross-section of a fixing wire of the developing body configuring the present invention. 
           [0031]      FIG. 6  is a schematic view seen from a distal end side of the retractor when the developing body is extended from the perforation tube and developed in the retractor of the present invention. 
           [0032]      FIGS. 7( a ) to 7( c )  are schematic cross-sectional views of the retractor showing one example of the retractor of the present invention, where  FIG. 7( a )  is a view showing a state in which the first grip portion, and the second grip portion and the third grip portion are separated when the developing body is accommodated in the perforation tube,  FIG. 7( b )  is a view showing a state in which the developing body is extended from the perforation tube, and the first grip portion and the second grip portion, and the second grip portion and the third grip portion are respectively brought into contact, and  FIG. 7( c )  is a view showing a state in which the developing body is extended from the perforation tube, and the first grip, and the second grip portion and the third grip portion are separated. 
       
    
    
     DESCRIPTION OF EMBODIMENTS 
       [0033]    The present invention will be described in detail using the drawings. 
         [0034]      FIG. 1  is a view schematically showing one example of a retractor of the present invention, and is a perspective view of the retractor showing a state in which a developing body is opened. 
         [0035]    A retractor  100  of the present invention includes a rigid or hard perforation tube  110 , a developing body  120  that can be accommodated and extended with respect to the perforation tube  110 , and a grip  160  connected to a respective proximal end of the perforation tube  110  and the developing body  120 . 
         [0036]      FIGS. 2( a ) to 2( c )  are side views of the retractor  100  of the present invention shown in  FIG. 1 . As shown in  FIG. 2( a ) , the retractor  100  of the present invention has, for example, the developing body completely accommodated in the perforation tube  110  immediately before use. The proximal end of the perforation tube  110  is connected to a first grip portion  162  of the grip  160 . 
         [0037]    The term “retractor” used in the present specification refers to a medical instrument for excluding, spreading, tugging, or elevating a target (e.g., organ) or anything that inhibits a field of view in a medical field, and for example, includes a trocar and a pallium tube. The operations of excluding, spreading, tugging, or elevating are sometimes collectively referred to as “retraction” or “retract”. When simply referring to “exclusion” in the present specification, this may include not only the operation of exclusion but also operations of spreading, tugging, or elevating (i.e., refers to retraction). The retractor includes an excluding section, as will be hereinafter described, for example, and is required to have such excluding section deformable to a size of a certain extent after being inserted into the body. 
         [0038]    The term “distal” used in the present specification refers to a position far from the person operating the retractor, and the term “proximal” refers to a position close to the person operating the retractor as opposed to the term “distal”. Thus, the term “distal end” represents an end farthest (i.e., at distant) from the operating person, and the term “proximal end” represents an end closest (i.e., at proximate) to the operating person when operating the retractor of the present invention. 
         [0039]    When referring again to  FIG. 2( a ) , in one embodiment, the perforation tube  110  is, for example, configured from a straight tube cut such that the distal end side has a sharp pointed shape. The angle of a tip of the distal end of the perforation tube  110  is not particularly limited, but is processed to an angle (e.g., 20° to 50°) at which the perforation into the body is facilitated. The outer diameter of the perforation tube  110  is preferably 1.7 mm to 3.5 mm, and more preferably 2.2 mm to 3 mm. Furthermore, the inner diameter of the perforation tube  100  can be selected from a range of preferably 1.5 mm to 3 mm, and more preferably 1.6 mm to 2.2 mm with respect to the outer diameter. In the present invention, the shape of the tip of the distal end of the perforation tube  110  is not necessarily limited to the description made above, and for example, may have an arbitrary shape that can be adopted to the pallium tube or the trocar in the medical field. 
         [0040]    Such perforation tube  110  is preferably made from a rigid material, for example, metal such as stainless steel, tantalum, cobalt alloy, nitinol (nickel-titanium alloy), and the like. The stainless steel includes, for example, SUS304, SUS316, and SUS316L. The retractor  100  of the present invention can reliably perforate a desired position (e.g., abdominal cavity) without being concerned about deflection, bend, breakage, and the like of the perforation tube by using the perforation tube  110  made from such rigid material. Furthermore, as the perforation tube  110  is rigid, sufficient strength can be maintained even in the cocoon-shaped development in the excluding section, to be described later, and the retraction. 
         [0041]    The grip  160  is divided into three portions, a first grip portion  162 , a second grip portion  164 , and a third grip portion  166  in the order from the distal end side. The type of material configuring the grip  160  is not particularly limited. The grip  160  is made, for example, from resin such as ABS resin, polycarbonate resin, acryl resin, and the like, metal such as stainless steel, aluminum, and the like, and the combination thereof. 
         [0042]      FIG. 2( b )  is a view schematically showing one example of the retractor  100  of the present invention, and is a schematic view of the retractor  100  showing a state in which the developing body  120  is extended from the perforation tube  110  to carry out the cocoon-shaped development in the excluding section of the developing body. 
         [0043]    In the present specification, the term “cocoon shape” is a shape formed by the curve of a plurality of fixing wires, to be described later, in the excluding section of the developing body, and for example, includes a shape of a cocoon-like or oval sphere (rugby ball, etc.). 
         [0044]    The retractor  100  of the present invention can take in and out the developing body  120  accommodated in the perforation tube  110  by pushing and pulling at least one of the second grip portion  164  and the third grip portion  166  in the grip  160  with respect to the first grip portion  162 . The developing body  120  is designed to a size having an outer diameter of preferably 1.5 mm to 3 mm, and more preferably 1.6 mm to 2 mm, and so as to freely slide in the perforation tube  110  when accommodated in the perforation tube  110  (state in which development described later is not carried out). The entire length of the retractor of the present invention is not necessarily limited and, for example, a distance from the distal end to the proximal end of the perforation tube  110  (i.e., distance from distal end of the perforation tube  110  to distal end of the first grip portion  162 ) is preferably 100 mm to 300 mm. 
         [0045]      FIG. 2( c )  is a view schematically showing one example of the retractor  100  of the present invention, and is a schematic view of the retractor  100  showing a state in which the cocoon-shaped structure is developed in the excluding section  122  of the developing body  120  extended from the perforation tube  110 . 
         [0046]    The retractor  100  of the present invention can develop the developing body  120  by further pushing and pulling at least one of the second grip portion  164  or the third grip portion  166  in the grip  160  with respect to the first grip  162 . The developing body  120  includes the excluding section  122  and an introducing tube  130  extended from the excluding section  122 , where the excluding section  122  is configured by a movable wire  124  and a plurality of fixing wires  126  arranged at the periphery of the movable wire  124 . Moreover, the introducing tube  130  has a tubular shape, and the movable wire  124  is slidably passed therethrough. The number of fixing wires  126  arranged at the periphery of the movable wire  124  is not particularly limited, and is, for example three to twelve, and preferably six to eight. 
         [0047]    An example of a material configuring the introducing tube  130 , the movable wire  124 , and the fixing wire  126  independently includes stainless steel such as SUS304, resin such as polyamide, PTFE, and the like, stainless steel on which resin is coated, and the like. In particular, the movable wire  124  preferably has a line strength sufficient to withstand load at the time of exclusion, for example, line strength of greater than or equal to 1850 MPa, and preferably greater than or equal to 2100 MPa. 
         [0048]    The movable wire  124  and the fixing wire  126  configuring the excluding section  122 , as well as, the introducing tube  130  preferably have a smooth surface to prevent damage on the organ. Furthermore, a coating material having electrical insulating property may be applied on such surfaces to prevent generation of sparks with another instrument during the surgery. The coating material may be a material normally used for coating of a medical instrument. For example, the coating material may be porous polytetrafluoroethylene (ePTFE) film, silicone film, polyurethane film, polyethylene terephthalate (Dacron (registered trademark)) film, and the like. The thickness of the coating layer formed by the coating material is not particularly limited, but is, for example, 4 μm to 16 μm, and preferably 8 μm to 12 μm. 
         [0049]    The length of the excluding section  122  accommodated (undeveloped) in the perforation tube  110  fluctuates according to the size, and the like of the designed retractor, and hence is not necessarily limited. In one embodiment, the length of the excluding section accommodated in the perforation tube  110  is, for example, 40 mm to 120 mm, and preferably 50 mm to 80 mm. Moreover, in one embodiment, the size of the outer diameter of the excluding section  122  accommodated in the perforation tube  110  is, for example, 1.5 mm to 3 mm, and preferably 1.6 mm to 2 mm. 
         [0050]    The length in the most developed state of the excluding section  122  and the maximum diameter of the cocoon shape formed when the fixing wire  126  of the excluding section  122  is developed fluctuate by the size of the designed retractor, and the like, and thus are not necessarily limited. In one embodiment, the length of the excluding section is, for example, 35 mm to 80 mm, and preferably, 45 mm to 65 mm. Furthermore, in one embodiment, the maximum diameter of the cocoon shape is, for example, 20 mm to 80 mm, and preferably, 35 mm to 60 mm. 
         [0051]      FIGS. 3( a ) and 3( b )  are views schematically showing one example of the developing body  120  configuring the retractor of the present invention. 
         [0052]    As shown in  FIG. 3( a ) , the developing body  120  has the distal end of the movable wire  124  and the distal end of the fixing wire  126  joined at a cap  132  arranged at a tip of the distal end in the excluding section  122 . The respective proximal ends of the fixing wires  126  are also fixed with the introducing tube  130 , and the movable wire  124  is passed through the introducing tube  130 . When the developing body  120  is accommodated in the perforation tube  110 , for example, the distal end of the introducing tube  130  is located at the farthest position (i.e., more proximal side in the retractor  100 ) with respect to the ball shaped cap  132  made from SUS304, and the fixing wire  126  maintains a straightly extended state. Thus, the developing body  120  has a most deformed state in an axial direction of the perforation tube  110 , and can freely slide in the perforation tube  110 . 
         [0053]    As shown in  FIG. 3( b ) , the developing body  120  can be extended from the perforation tube  110  so that the cocoon-shaped structure can be developed by the plurality of fixing wires  126 . In such a state, each distal end of the movable wire  124  and the fixing wire  126  remains fixed to the cap  132 , whereas the cap  132  and the distal end of the introducing tube  130  move closer and each fixing wire  126  causes deflection in a direction (radial direction) away from about the axis of the movable wire  124 , and the cocoon-shaped structure by the entire plurality of fixing wires  126  can be built as the excluding section  122 . The cocoon-shaped structure excludes the inside wall of the hollow organ or the organ in the body cavity, and can form a predetermined space in the hollow cavity or the body cavity. 
         [0054]      FIG. 4  is a schematic view showing one example of a cross-sectional view (cross-sectional view of movable wire and fixing wire) in a direction orthogonal to a long axis of the developing body  120  configuring the retractor  100  of the present invention, and is a cross-sectional view of the excluding section  122  of the accommodated (undeveloped) developing body  120 . 
         [0055]    The diameter A of the movable wire  124  and the thickness B of the fixing wire  126  in  FIG. 4  are such that a ratio (A/B) of lengths preferably satisfies, for example two to ten, and preferably three to seven from the standpoint of easiness in the development of the fixing wire  126  and providing sufficient strength to each wire  124 ,  126 . In one embodiment, A is 1.2 mm and B is 0.25 mm (A/B is 4.8). 
         [0056]    In  FIG. 4 , the movable wire  124  configuring the excluding section  122  has a substantially circular cross-section, but is not necessarily limited to such cross-sectional shape. As the force applied when the fixing wire  126  is developed is uniformly dispersed, shapes such as circle, regular polygon (square, regular hexagon, regular octagon, etc.), and the like are preferred. The plurality of fixing wires  126  having substantially the same cross-sectional shape are arranged at the periphery of the movable wire  124 . A surface where each fixing wire  126  makes contact with the movable wire  124  preferably has a shape that coincides with the outer diameter of the movable wire  124 . This is because the entire capacity of the excluding section  122  during the accommodation can be made as small as possible while avoiding an unnecessary space from being formed between the fixing wire  126  and the movable wire  124 . 
         [0057]    More specifically, the cross-section of the fixing wire  126  has a partial circular ring shape in which a part of the cross-section, as shown in  FIGS. 5( a ) to 5( c ) , substantially coincides with a part of the outer periphery of the cross-section of the movable wire  124 . In other words, the cross-section of the fixing wire  126  may have a shape as if a part of an arc is cut out as is from the circular ring as shown in  FIG. 5( a ) , may have a blunt shape in which four corners in the partial circular ring shape shown in  FIG. 5( a )  are rounded to reduce the damage of the surrounding tissues at the time of exclusion as shown in  FIG. 5( b ) , or may have a shape in which the respective cross-section is a crescent shape by having a portion corresponding to the outer edge side of the excluding section in the fixing wire  126  to a more rounded blunt shape as shown in  FIG. 5( c ) . The cross-section of the plurality of fixing wires  126  is preferably the same with respect to each other to carry out a uniform development. 
         [0058]      FIG. 6  is a schematic view seen from a distal end side of the retractor when the developing body  120  is extended from the perforation tube  110  and developed in the retractor  100  of the present invention. 
         [0059]    As shown in  FIG. 6 , when the developing body  120  is developed, each fixing wire  126  preferably has a substantially equal developing angle (θ) with respect to each other with the movable wire  124  as a center. In other words, the developing angle (θ) can be set by the number of fixing wires  126  configuring the excluding section  122 . If each fixing wire  126  is developed at substantially equal developing angle (θ) with respect to each other as shown in  FIG. 6 , the movable wire  124  can maintain a straight shape in the axial direction without causing warp. 
         [0060]    In the retractor  100  of the present invention, the extension of the developing body  120  from the perforation tube  110 , the accommodation of the developing body  120  to the perforation tube  110 , and the development or the accommodation of the excluding section  122  in the developing body  120  are controlled by the grip  160  provided at the proximal end side of the retractor  100 . 
         [0061]      FIGS. 7( a ) to 7( c )  are schematic cross-sectional views of the retractor showing one example of the retractor  100  of the present invention. 
         [0062]    As shown in  FIG. 7( a ) , in the present invention, the proximal end of the perforation tube  110  is connected to the first grip portion  162 , the proximal end of the introducing tube  130  of the excluding section  122  is connected to the second grip portion  164 , and the proximal end of the movable wire  124  of the excluding section  122  is connected to the third grip portion  166 . In the retractor  100  of the present invention, when the developing body  120  is accommodated in the perforation tube  110 , the first grip portion  162 , and the second grip portion  164  and the third grip portion  166  of the grip  160  are separated, as shown in  FIG. 7( a ) . In this state, the retractor  100  of the present invention is inserted to the inside wall of the hollow organ or the organ in the body cavity through an incision or by being directly perforated from the tip of the distal end of the perforation tube  110 . 
         [0063]    Next, the second grip portion  164  and the third grip portion  166  are respectively pushed in toward the distal end side, that is, the first grip portion  162  side with respect to the first grip portion  162 . Thus, the introducing tube  130  and the movable wire  124  connected to the second grip portion  164  and the third grip portion  166 , respectively, are pushed out toward the distal side, and the developing body  120  is extended from the perforation tube  110 . 
         [0064]    Thereafter, the development of the fixing wire  126  is carried out from the excluding section  122  in the developing body  120 . The development of the fixing wire  126  from the excluding section  122  is carried out, for example, in the following manner according to the respective lengths of the introducing tube  130  and the movable wire  124  with respect to the length of the perforation tube  110 , the position relationship of the second grip portion  164  and the third grip portion  166  with respect to the first grip portion  162  when the developing body  120  is extended from the perforation tube  110 , and the like. 
         [0065]    In other words, as shown in  FIG. 7( b ) , when the proximal end of the first grip portion  162  is brought into contact with or is substantially brought into contact with the distal end of the second grip portion  164  under a state the developing body  120  is extended from the perforation tube  110 , only the movable wire  124  is sled toward the proximal side with the introducing tube  130  fixed with respect to the perforation tube  110  by pulling out only the third grip portion  166  toward the proximal side (hand side) with respect to the first grip portion  162  and the second grip portion  164 . Thus, the distal end of the fixing wire  126  joined with the movable wire  124  at the portion of the cap  132  is also sled toward the proximal side. On the other hand, the proximal end of the fixing wire  126  is joined to the distal end of the introducing tube  130  and is in a fixed state, so that the fixing wire  126  is curved toward the outer side. As a result, the plurality of fixing wires  126  is developed in the excluding section  122 , thus expressing the cocoon shape. The cocoon-shaped expression achieves exclusion of the inserted hollow organ or the body cavity. 
         [0066]    Alternatively, as shown in  FIG. 7( c ) , when the first grip portion  162  and the second grip portion  164  are separated under a state the developing body  120  is extended from the perforation tube  100 , only the introducing tube  130  is sled toward the distal side with respect to the perforation tube  110  and the movable wire  124  by pushing out only the second grip portion  164  toward the distal side with respect to the first grip portion  162  and the third grip portion  166 . Thus, only the proximal end of the fixing wire  126  joined to the distal end of the introducing tube  130  is sled toward the distal side and the fixing wire  126  is curved toward the outer side while maintaining the position relationship of the movable wire  124  and the fixing wire  124  at the portion of the cap  132 . As a result, the plurality of fixing wires  126  is developed in the excluding section  122 , and a cocoon-shaped structure is expressed. The cocoon-shaped expression achieves the exclusion of the inserted hollow organ or the body cavity. 
         [0067]    In  FIGS. 7( b ) and 7( c ) , the length of pulling out or pushing out the third grip portion  164  and/or second grip portion  124  is fluctuated, so that the size of the cocoon-shaped structure expressed in the excluding section  122  can be freely changed. 
         [0068]    The retractor of the present invention is used to carry out exclusion in various surgeries in the hollow organs such as stomach, small intestine, large intestine, and vagina as well as the other organs such as liver, pancreas, kidney, gallbladder, spleen, uterus, lungs, and the like. 
         [0069]    For example, in the surgery of stomach and esophagus, the retractor of the present invention is inserted to the lower surface of the hepatic left lobe interfering with the operative field to elevate it toward the abdominal side, so that the surgery can be proceeded more safely and efficiently without the interference to the operative field. Similarly, in the operation at the pelvic floor, the surgical operation of the periphery of the rectum can be efficiently carried out by spreading the uterus using the retractor of the present invention. 
       INDUSTRIAL APPLICABILITY 
       [0070]    According to the present invention, a retractor that can freely exclude the organ can be provided. Furthermore, according to the present invention, the retractor is also useful in that gas-less surgery can be carried out, for example, as the field of view and the operation space can be ensured without injecting gas into the body cavity. 
       REFERENCE SIGNS LIST 
       [0000]    
       
         
           
               100  retractor 
               110  perforation tube 
               120  developing body 
               122  excluding section 
               124  movable wire 
               126  fixing wire 
               130  introducing tube 
               132  cap 
               160  grip 
               162  first grip portion 
               164  second grip portion 
               166  third grip portion