Patent Publication Number: US-2015073222-A1

Title: Trocar

Description:
TECHNICAL FIELD 
     The present invention relates to a trocar. 
     This application is a continuation application based on PCT/JP2013/063257, filed on May 13, 2013, claiming priority based on Japanese Patent Application No. 2012-114445, filed in Japan on May 18, 2012. The contents of both the Japanese Patent Application and the PCT Application are incorporated herein by reference. 
     BACKGROUND ART 
     In the related art, there is known a procedure of forming a small incision for allowing a treatment instrument having an elongated insertion part or an elongated surgical instrument, such as a laparoscope apparatus, to be inserted therethrough, in a patient&#39;s abdominal wall, to thereby suppress invasiveness to a patient, instead of making a surgical incision in the abdomen, when an operation is performed. 
     For example, in the case of minimally invasive surgery when performing treatment within an abdominal cavity, it is common to attach a plurality of trocars to an abdominal wall and to introduce surgical instruments into the abdominal cavity through the trocars. Additionally, as a procedure of further reducing invasiveness to a patient, there is known a procedure of attaching a trocar, to which a plurality of ports are provided, to a patient&#39;s navel or the like, to insert surgical instruments into respective ports of the trocar. By using such a trocar, the plurality of surgical instruments can be introduced into the inside of the body through one trocar. 
     As an example of the trocar used when the plurality of surgical instruments are introduced into the inside of the body through one trocar, Japanese Unexamined Patent Application, First Publication No. 2011-98138 discloses an insertion instrument (trocar) including a plate member having a plurality of ports formed therein, and a cylindrical member to which the plate member is rotatably attached. 
     SUMMARY OF THE INVENTION 
     A trocar of a first aspect of the present invention includes a plate member that has at least one first through-hole formed therein for allowing a first surgical instrument to be inserted therethrough; at least one movable port that is provided separately from the plate member, is movable relative to the plate member, and has a second through-hole provided therein for allowing a second surgical instrument to be inserted therethrough; and a cylinder part that is provided at the plate member so as to communicate with an inside of the first respective through-hole and an inside of the second through-hole, and that is attached to an incised wound. 
     According to a second aspect of the present invention, in the trocar of the first aspect, the plate member may have a guide hole part through which the movable port is inserted, and the guide hole part may include an elongated hole portion that allows the movable port to advance and retreat in a predetermined direction. 
     According to a third aspect of the present invention, in the trocar of the second aspect, the guide hole part may further include a locking portion that locks the movable port to a part of the guide hole part. 
     According to a fourth aspect of the present invention, in the trocar of the second aspect or the third aspect, the guide hole part may further include a valve that airtightly seals the elongated hole portion, and a slit, through which the movable port is inserted and which extends in a longitudinal direction of the elongated hole portion, may be formed in the valve. 
     According to a fifth aspect of the present invention, in the trocar of any one of the first aspect to the fourth aspect, the first surgical instrument attached to a robot may be inserted through the first through-hole formed in the plate member, the second surgical instrument attached to the robot may be inserted through the second through-hole provided in the movable port, and the movable port may be moved relative to the plate member by the robot. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view illustrating a trocar of a first embodiment of the present invention. 
         FIG. 2  is a front view illustrating the trocar. 
         FIG. 3  is a cross-sectional view taken along line A-A of  FIG. 2 . 
         FIG. 4  is a schematic view illustrating one process when the trocar is used. 
         FIG. 5  is a schematic view illustrating one process when the trocar is used. 
         FIG. 6  is a schematic view illustrating one process when the trocar is used. 
         FIG. 7  is a front view of the trocar illustrating the configuration of a modified example of the embodiment. 
         FIG. 8  is a cross-sectional view taken along line B-B of  FIG. 7 . 
         FIG. 9  is a view for describing the operation of the trocar. 
         FIG. 10  is a cross-sectional view taken along line C-C of  FIG. 9 . 
         FIG. 11  is a front view showing a trocar of a second embodiment of the present invention. 
         FIG. 12  is a schematic view illustrating one process when the trocar is used. 
         FIG. 13  is a schematic view illustrating one process when the trocar is used. 
         FIG. 14  is a front view of the trocar illustrating the configuration of a modified example of the embodiment. 
     
    
    
     DESCRIPTION OF EMBODIMENTS  
     First Embodiment 
     A trocar of a first embodiment of the present invention will be described.  FIG. 1  is a perspective view illustrating a trocar of the present embodiment.  FIG. 2  is a front view illustrating the trocar.  FIG. 3  is a cross-sectional view taken along line A-A of  FIG. 2 . 
     As shown in  FIG. 1 , the trocar  1  of the present embodiment includes a plate member  2 , a movable port  11 , and a cylinder part  17 . 
     As shown in  FIGS. 1 and 2 , the plate member  2  is a substantially disk-shaped member in which a through-hole (a first surgical instrument port  3  or a first through-hole) for allowing a surgical instrument to be inserted therethrough is formed. The first surgical instrument port  3  is a hole in which an opening having a circular cross-section is formed, and one port is formed in the plate member  2 . The configuration of a surgical instrument to be inserted through the first surgical instrument port  3  is not particularly limited. For example, a treatment instrument, having an elongated insertion part, a laparoscope, or the like can be inserted through the first surgical instrument port  3 . Additionally, the first surgical instrument port  3  is provided with an airtight valve  4  in which a slit  5  is formed. 
     Additionally, the plate member  2  has a guide hole part  6  through which the movable port  11  is inserted, at a position spaced apart from the first surgical instrument port  3 . 
     The guide hole part  6  has an elongated hole portion  7  that allows the movable port  11  to advance and retreat in a predetermined direction, locking portions  8  that lock the movable port  11  to a part of the guide hole part  6 , and an airtight valve  9  that airtightly seals the elongated hole portion  7 . 
     As shown in  FIG. 2 , the elongated hole portion  7  is a hole that is elongated in one predetermined direction (this direction is hereinafter referred to as a “longitudinal direction of the elongated hole portion  7 ”) as is viewed from a thickness direction of the plate member  2  (viewed from a top surface). The longitudinal direction of the elongated hole portion  7  is, for example, a direction directed to a twisted position with respect to a central axis of the through-hole of the plate member  2 , a direction orthogonal to the central axis of the plate member  2 , or the like. In addition, the longitudinal direction of the elongated hole portion  7  is appropriately selected and set in consideration of the movement direction of the movable port  11  with respect to the first surgical instrument port  3 . Additionally, the elongated hole portion  7  may be a curved line in its longitudinal direction. For example, the elongated hole portion  7  may be formed in a curved shape, such as a circular-arc elongated hole centered on the central axis of the through-hole, an S-shape, a J-shape, or a U-shape. 
     Each locking portion  8  has a bulged shape formed at an intermediate portion of the elongated hole portion  7  in the longitudinal direction, and is formed so as to slide on an outer surface of the movable port  11  when the movable port  11  moves with respect to the plate member  2 . The elongated hole portion  7  and the movable port  11  have little sliding resistance at both ends of the elongated hole portion  7  in the longitudinal direction, as compared to the locking portion  8 . Accordingly, when the movable port  11  is moved with respect to the plate member  2  from one end  7   a  of the elongated hole portion  7  to the other end  7   b  thereof in the longitudinal direction or to its opposite direction, it is necessary to move the movable port  11  with the capability of exceeding sliding resistance against the locking portion  8 . By providing the locking portion  8 , a possibility that the movable port  11  may be moved to the intermediate portion of the elongated hole portion  7  in the longitudinal direction by the weight of movable port  11  itself is suppressed to be low. As a result, the movable port  11  is locked to the one end  7   a  or the other end  7   b  of the elongated hole portion  7 . 
     The airtight valve  9  provided in the elongated hole portion  7  is a membrane-like member having flexibility. The airtight valve  9  is formed with a slit  10  extending in the longitudinal direction of the elongated hole portion  7 . The movable port  11  is inserted through the slit  10  of the airtight valve  9  so as to expand the slit. Accordingly, the region of the elongated hole portion  7  outside a portion into which the movable port  11  is inserted is brought into an airtight state by the airtight valve  9 . 
     As shown in  FIGS. 2 and 3 , the movable port  11  is provided separately from the plate member  2  and moves relative to the plate member  2 . The movable port  11  includes a main body  13  in which a through-hole (a second surgical instrument port  12  or a second through-hole) for allowing a surgical instrument to be inserted therethrough is provided, and a flap portion  16  that is formed to overhang radially outward of the main body  13 . 
     The main body  13  is formed in the shape of a cylinder, and a hole in which an opening having a circular cross-section is formed serves as the second surgical instrument port  12 . A surgical instrument capable of being inserted through the second surgical instrument port  12  is not particularly limited, which is similar to the first surgical instrument port  3 . Additionally, the second surgical instrument port  12  is provided with an airtight valve  14  made of a flexible membrane-like member in which a slit  15  is formed. 
     The flap portion  16  is an annular member with a size such that the flap portion is engaged with the elongated hole portion  7  formed in the plate member  2 , and is integrally molded with the main body  13  in the present embodiment. The flap portion  16  functions as a retainer that prevents the main body  13  from slipping out of the elongated hole portion  7 . 
     The cylinder part  17  shown in  FIG. 1  is a cylindrical member. The cylinder part  17  is provided in the plate member  2  so as to communicate with the inside of the first surgical instrument port  3  formed in the plate member  2  and communicates with the inside of the second surgical instrument port  12  formed in the movable port  11 . The cylinder part  17  is attached to an incised wound by being inserted into the incised wound serving as an attachment target for the trocar  1  when the trocar  1  is used. 
     Next, the usage and operation of the trocar  1  will be described.  FIGS. 4 to 6  are schematic views illustrating one process when the trocar  1  is used. 
     In the present embodiment, there is shown an example in which the trocar  1  of the present embodiment is used in an operation under endoscopic view in which a surgeon operates by operating an elongated surgical instrument, such as a treatment instrument having an elongated insertion part or a laparoscope apparatus. 
     First, a suitable site is incised in order to guide the surgical instrument to a part to be treated of a patient&#39;s body wall, and an incised wound for allowing the cylinder part  17  of the trocar  1  shown in  FIG. 1  to pass therethrough is formed in the patient&#39;s body wall. In the present embodiment, a plurality of surgical instruments are introduced into the inside of the body through one incised wound by using the trocar  1 . Thus, the incised wound may be formed in one place of the body wall, for example, a patient&#39;s navel. 
     As shown in  FIG. 4 , mutually different surgical instruments  100  may be simultaneously attached to the first surgical instrument port  3  formed in the plate member  2  and the second surgical instrument port  12  formed in the movable port  11 , respectively. For example, a treatment instrument  101 , such as forceps, is attached to the first surgical instrument port  3  formed in the plate member  2  as a first surgical instrument, and a laparoscope apparatus  102  is attached to the second surgical instrument port  12  formed in the movable port  11  as a second surgical instrument. Although the initial position of the movable port  11  with respect to the plate member  2  may be anywhere, a case where an operation is performed in a state where the movable port  11  is located at the one end  7   a  of the elongated hole portion  7  will be described below as an example. 
     When the treatment instrument  101  introduced into the body through the first surgical instrument port  3  is used to perform a treatment on a treatment target part, as shown in  FIG. 5 , the treatment proceeds while observing the treatment target part X using the laparoscope apparatus  102  introduced into the body through the second surgical instrument port  12 . For example, when the movable port  11  is located at the one end  7   a  of the elongated hole portion  7 , the movable range of the insertion part of the laparoscope apparatus  102  is within a conic region having the one end  7   a  of the elongated hole portion  7  as a rocking center. 
     For example, a treatment target part may be observed from a different visual point obtained by changing the visual point of the laparoscope apparatus  102 , in a state where treatment is performed on the treatment target part, using the treatment instrument  101  introduced into the body through the first surgical instrument port  3 . In this case, the treatment target part may not be able to be appropriately captured within the visual field of the laparoscope apparatus  102 , in a state where the movable port  11  is located at the one end  7   a  of the elongated hole portion  7 . Additionally, if it is intended to move the laparoscope apparatus  102  to a desired position in a state where the movable port  11  is located at one end  7   a  of the elongated hole portion  7 , a case where the laparoscope apparatus  102  and the treatment instrument  101  interfere with each other is also considered. 
     In such a case, as shown in  FIG. 6 , the movable port  11  is moved from the one end  7   a  of the elongated hole portion  7  to the other end  7   b  of the elongated hole portion  7 . The movable range of the insertion part of the laparoscope apparatus  102  is within a conic region having the other end  7   b  of the elongated hole portion  7  as a rocking center. Accordingly, the treatment target part can be observed from the direction of a new visual point using the laparoscope apparatus  102 . 
     As described above, according to the trocar  1  of the present embodiment, the laparoscope apparatus  102  can be easily arranged at an optimal position for the treatment of a treatment target part. Accordingly, the treatment instrument  101  and the laparoscope apparatus  102  can be moved relative to each other so that the treatment instrument  101  and the laparoscope apparatus  102  establish a suitable positional relationship. 
     Additionally, since the movable port  11  is inserted through the elongated hole portion  7  and the movable port  11  moves along the elongated hole portion  7 , the movable port  11  is brought into a state of being supported by the elongated hole portion  7 . For this reason, there is only a little shaking of the surgical instrument  100  attached to the movable port  11 . For example, when the laparoscope apparatus  102  is attached to the movable port  11 , an image obtained using the laparoscope apparatus  102  is not easily blurred. 
     Moreover, since the elongated hole portion  7  is provided with the locking portions  8 , the movable port  11  is locked to the elongated hole portion  7 . For example, in the present embodiment, the movable port  11  is locked to the one end  7   a  or the other end  7   b  of the elongated hole portion  7 . Thus, when the surgical instrument  100 , such as the laparoscope apparatus  102 , is moved with the one end  7   a  or the other end  7   b  of the elongated hole portion  7  as a rocking center, the position of the movable port  11  does not deviate easily. 
     For example, in the related art, if the laparoscope apparatus  102  moves unintentionally during treatment, the treatment should be interrupted until the position of the laparoscope apparatus  102  is returned so that a treatment target part falls within a visual field. In contrast, in the trocar  1  of the present embodiment, unintended movement of the laparoscope apparatus  102  does not take place easily. Thus, the treatment can be performed with ease. 
     Modified Example 1 
     Next, a modified example of the above-described first embodiment will be described.  FIG. 7  is a front view of a trocar illustrating the configuration of the present modified example.  FIG. 8  is a cross-sectional view taken along line B-B of  FIG. 7 .  FIG. 9  is a view for describing the operation of the trocar.  FIG. 10  is a cross-sectional view taken along line C-C of  FIG. 9 . 
     As shown in  FIGS. 7 and 8 , in the present modified example, rubber sheets  18  and  19  that cover a part of the elongated hole portion  7  are provided instead of the airtight valve  9  that seals the elongated hole portion  7 . The rubber sheets  18  and  19  are laminated, sheet-like, or film-like members that are elastically deformed when being pressed by the main body  13  of the movable port  11 . In the present modified example, the two rubber sheets  18  and  19  formed in the shape of a semicircle are arranged to face the plate member  2 , in a state where a gap is formed at a central portion of the elongated hole portion  7  in the longitudinal direction. Additionally, the main body  13  of the movable port  11  is disposed at the gap between the two rubber sheets  18  and  19 . 
     Moreover, in the present modified example, each locking portion  8  is formed such that a central portion is recessed, so that the movable port  11  can be locked to the center of the elongated hole portion  7 . 
     As shown in  FIGS. 9 and 10 , in the present modified example, the rubber sheet  19  is elastically deformed if the movable port  11  moves to the rubber sheet  19  side. Additionally, an airtight state is maintained by the rubber sheet  18  and the flap portion  16 . 
     Even in such a configuration, the same effects as in the first embodiment are exhibited. 
     Second Embodiment 
     Next, a trocar of a second embodiment of the present invention will be described.  FIG. 11  is a front view illustrating the trocar of the present embodiment.  FIGS. 12 and 13  are schematic views illustrating one process when the trocar is used. 
     The trocar of the present embodiment is a trocar that is suitably applied to an operation using a robot. 
     As shown in  FIG. 11 , the configuration of the plate member  2  is different from that of the above-described first embodiment in that a trocar  20  of the present embodiment does not have the locking portions  8 , and a through-hole (a third surgical instrument port  21  or the first through-hole) separate from the first surgical instrument port  3  is further formed in the plate member  2 . 
     The movable port  11  is capable of advancing and retreating in the longitudinal direction of the elongated hole portion  7  provided in the plate member  2 . 
     The third surgical instrument port  21  is arranged opposite to the first surgical instrument port  3  so that the movable port  11  is pinched between the surgical instrument ports. The third surgical instrument port  21  is provided with an airtight valve  22  having a slit  23  similar to the first surgical instrument port  3 . 
     Next, the usage and operation of the trocar  20  will be described. 
     First, the overview of a robot that performs an operation using the trocar  20  will be described. The configuration of the robot is not particularly limited, and if a robot that operates a plurality of surgical instruments is provided, the trocar  20  of the present embodiment can be suitably handled. 
     As an example of the robot, as shown in  FIG. 12 , the robot includes two arms  201  and  202  to which the treatment instrument  101  is attached, one arm  203  to which the laparoscope apparatus  102  is attached, and a control device  204  that operates the respective arms  201 ,  202 , and  203 . 
     The two arms  201  and  202  to which the treatment instrument  101  is attached are provided corresponding to the right hand and left hand of a user who operates the robot. Additionally, each of a total of three arms  201 ,  202 , and  203  is a multi joint arm, and is controlled by the control device  204  so as to move the treatment instrument  101  and the laparoscope apparatus  102  with the first surgical instrument port  3  and the second surgical instrument port  12  as a rocking center. Specifically, a robot including the configuration described in Japanese Unexamined Patent Application, First Publication No. 2000-300579 or the like may be adopted. In addition, the robot that performs an operation using the trocar  20  of the present embodiment may be a robot provided with three or more arms. 
     Also in an operation using the robot, the visual point of the laparoscope apparatus  102  may be changed similarly to the above first embodiment. As shown in  FIGS. 12 and 13 , in the present embodiment, for example, when the laparoscope apparatus  102  is attached to the second surgical instrument port  12  of the movable port  11 , the robot moves the laparoscope apparatus  102 , and the movable port  11  is moved in the longitudinal direction of the elongated hole portion  7  by the laparoscope apparatus  102 . Additionally, in surgical robots that have been known up to now, the laparoscope apparatus  102  can be positioned and can be held for a long time, and the movable port  11  can be positioned and held at arbitrary positions in the elongated hole portion  7 . Moreover, the laparoscope apparatus  102  can also be rocked using a position where the movable port  11  is positioned, as a rocking center. 
     Additionally, in the present embodiment, when the robot is being operated in a state where the treatment instrument  101  attached to the first surgical instrument port  3  is made to correspond to the right hand, and the treatment instrument  101  attached to the second surgical instrument port  12  is made to correspond to the left hand, the direction of the visual point of the laparoscope apparatus  102  can be changed with the positional relationship between the right hand and the left hand maintained by moving the laparoscope apparatus  102  attached to the movable port  11  along the guide hole part  6 . Accordingly, the visual point can be changed with the operation feeling of the surgical instrument  100  maintained. 
     Modified Example 2 
     Next, a modified example of the present embodiment will be described.  FIG. 14  is a front view illustrating a trocar of the present modified example. 
     As shown in  FIG. 14 , a trocar  2 A of the present modified example is different from the above-described respective embodiments in that the trocar  1 A has a plurality of the movable ports  11 . The trocar  1 A has two movable ports  11  (a first movable port  11 A and a second movable port  11 B), and a first surgical instrument port  3 A that has the same configuration as the above-described first surgical instrument port  3  and is disposed at a central portion of the trocar  1 A. 
     In the trocar  1 A shown in  FIG. 14 , two treatment instruments attached to left and right arms of a robot can be respectively inserted into the first movable port  11 A and the second movable port  11 B and be used. Accordingly, in a case where the respective treatment instruments are inserted into the inside of the body or the like through the first movable port  11 A and the second movable port  11 B, even when the treatment instruments attached to the robot or robots interfere with each other outside the body, it is possible to move the first movable port  11 A or the second movable port  11 B or both of the first movable port  11 A and the second movable ports  11 B, using a robot&#39;s driving force, and to avoid the interference between the treatment instruments or between the robots. 
     Although the embodiments of the present invention have been described above in detail with reference to the drawings, the specific configuration of the present invention is not limited to the embodiments, and design changes or the like are also included without departing from the scope of the present invention. 
     For example, the movable port  11  may be formed with a plurality of surgical instrument insertion through-holes. Additionally, the second surgical instrument port  12  provided in the movable port  11  may be parallel to the first surgical instrument port  3  provided in the plate member  2 , or the surgical instrument ports may be arranged at positions where the central axes thereof intersect each other or are twisted from each other. 
     Additionally, the first surgical instrument port  3  also has the same configuration as the movable port  11 . In this case, both of the first surgical instrument port  3  and the second surgical instrument port  12  move relative to the plate member  2 . 
     Additionally, instead of the treatment instrument  101 , the laparoscope apparatus  102  can also be inserted into the first surgical instrument port  3 . Additionally, instead of the laparoscope apparatus  102 , the treatment instrument  101  can also be inserted into the second surgical instrument port  12 . Additionally, flexible endoscopes may be inserted into the first surgical instrument port  3  and the second surgical instrument port  12 , respectively. That is, if surgical instruments having dimensions such that the surgical instruments can be inserted into the first surgical instrument port  3  and the second surgical instrument port  12  are provided, targets to be inserted into the first surgical instrument port  3  and the second surgical instrument port  12  are not particularly limited. 
     Additionally, although the above-described embodiments have been described in a way that the elongated insertion part of the laparoscope apparatus  102  is formed in a linear shape in order to simplify the description, the trocar of the present invention exhibits the same effects even when a distal end portion of the insertion part is curved or the laparoscope apparatus is a so-called oblique-viewing endoscope or a side-viewing endoscope. 
     Additionally, the constituent elements shown in the above-described respective embodiments can be suitably combined.