WO2012133356A1

WO2012133356A1 - Insufflation device

Info

Publication number: WO2012133356A1
Application number: PCT/JP2012/057842
Authority: WO
Inventors: 都敏平賀; 弘治山岡; 康裕奥澤
Original assignee: オリンパスメディカルシステムズ株式会社
Priority date: 2011-03-29
Filing date: 2012-03-27
Publication date: 2012-10-04

Abstract

Provided is an insufflation device wherein gas does not flow while the pneumoperitoneum needle is being inserted into the target body cavity and which is equipped with a pneumoperitoneum needle insertion detection function for safely detecting whether or not the needle has been inserted into the target body cavity. The insufflation device comprises: a pneumoperitoneum needle for insertion into the abdominal cavity and delivering the insufflated fluid into the target body cavity; and, in the insufflation means, a valve for adjusting the volume to be delivered to the pneumoperitoneum needle and a pressure sensor provided in the insufflation tube between said adjustment valve and the pneumoperitoneum needle. By detecting a negative pressure when the pneumoperitoneum needle is inserted in the abdominal cavity, the pressure sensor detects whether or not the pneumoperitoneum needle has been inserted in the abdominal cavity.

Description

Air supply device

The present invention relates to an air supply device that detects whether or not a pneumoperitoneal needle has been inserted into a target cavity in laparoscopic surgery in which ventilation is performed via a pneumoperitoneal needle.

In endoscopic surgery, gas is injected into the abdominal cavity through an insufflation needle in advance to expand the abdominal cavity to form a cavity as a treatment work space. Thereafter, an endoscope or treatment is performed using a trocar. A medical instrument such as a tool is introduced into the abdominal cavity.

If air is supplied with the tip of the pneumoperitoneum inserted subcutaneously or in a blood vessel, the concentration of carbon dioxide in the blood increases, which is not preferable. Therefore, it is desirable to detect that the tip of the pneumoperitoneal needle is reliably inserted into the abdominal cavity. As conventional examples of such techniques, the following techniques related to ultrasonic trocars (same as trocars) are known.

The ultrasonic trocar piercing device disclosed in Patent Document 1 (Japanese Patent No. 4145167) improves the piercing ability and allows the trocar to be easily inserted into the abdominal cavity even when the body cavity is not sufficiently inflated. An input device is disclosed.

That is, Patent Document 1 states that “an ultrasonic trocar that punctures a patient's abdominal cavity in an ultrasonic trocar insertion device, and gas is supplied from an air supply tube, an insertion device air supply opening to a trocar air supply opening, The gas is fed through the insertion sheath of the trocar, which constitutes an air feeding means for feeding gas to the distal end opening of the insertion sheath, and the air feeding channel leads to the abdominal cavity, the internal pressure of the abdominal cavity reaches the set value, When the insufflation condition is obtained and the flow meter detects the presence of a continuous gas flow, the controller determines that the ultrasonic trocar has penetrated the abdominal wall and proceeds to the next step. " Is disclosed.

Further, in Patent Document 2 (Japanese Patent No. 4291039), as described above, “[0071] For this reason, immediately after the tip of the inner needle penetrates the body wall, the fluctuation in the flow rate of the insufflation gas is large. Therefore, the ultrasonic output can be automatically stopped by the flow rate change of the insufflation gas flow, that is, the output of the ultrasonic output with the fluctuation of the flow rate for a predetermined time measured by the flow sensor. Can be automatically controlled to continue or stop. "

Further, “[0075] Both the flow rate and the pressure are measured to determine the puncture state of the body wall at the tip of the inner needle. For this reason, for example, when the tip of the inner needle enters the skin, The abdominal gas flows from the side hole. "

However, it is difficult to apply these techniques as they are to pneumoperitors.

For all these conventional examples, whether or not the ultrasonic trocar is inserted into the target cavity is determined by a change in the air flow rate. That is, since ventilation is performed even during puncture in the abdominal wall, for example, if the pneumoconiosis needle is accidentally inserted under the skin, gas may enter the wound.

Japanese Patent No. 4145167 Japanese Patent No. 4291039 JP 2010-82041 A

An object of the present invention is to provide an air supply device that can safely detect whether or not the pneumoperitoneum has been inserted into a target cavity without eliminating the conventional drawbacks and venting during insertion into the target cavity. And

In order to achieve the above object, an air supply device according to the present invention includes an air supply means for supplying gas, an air inserted into the abdominal cavity, and an air for supplying the fluid supplied from the air supply means into a target cavity. The abdominal needle, the air supply means has a valve for adjusting the amount of air supplied to the insufflation needle, and a pressure sensor provided in a conduit between the adjustment valve and the insufflation needle. When inserted into the abdominal cavity, the pressure sensor detects negative pressure to detect whether the abdominal abdominal needle has been inserted into the abdominal cavity or not.

Furthermore, it has a display means for displaying a detection result by the insertion state detecting means. Still further, the display means has a function of displaying a negative pressure on a measured pressure indicator on the front panel of the air supply device main body. Further, the present invention is characterized by having suction means connected between the air supply means and the insufflation needle, and the negative pressure is embodied by the suction means.

Alternatively, the air feeding device according to the present invention includes an air feeding means for feeding gas, an air feeding needle inserted into the abdominal cavity, and the fluid fed from the air feeding means to the target cavity, The air means has a valve for adjusting the amount of air supplied to the abdominal needle and a flow sensor provided in an air supply tube between the adjusting valve and the air abdominal needle, and the air abdominal needle is inserted into the abdominal cavity And a pneumoperitoneal needle insertion state detecting means for detecting that the pneumoperitoneum has been inserted into the abdominal cavity by detecting that the flow sensor has started to flow.

The insufflation device of the present invention can safely insert the insufflation needle into the target cavity by not venting the insufflation needle.

FIG. 1 shows an overall conceptual diagram of an insufflation apparatus of the present invention. FIG. 2 shows a conceptual diagram of an operation using the pneumoperitoneum of the present invention. FIG. 3 is a conceptual diagram of insertion detection of the pneumoperitoneum according to the present invention. FIG. 4 shows a more detailed conceptual diagram of the pneumoperitoneum according to the present invention. FIG. 5 is a pressure gauge graph showing insertion detection in the abdominal puncture of the pneumoperitoneum of the pneumoperitoneum according to the present invention. FIG. 6 is an explanatory diagram of an air supply device and the entire system in a laparoscopic surgical operation in which ventilation is performed via an insufflation needle. FIG. 7 shows an overall conceptual diagram of an insufflation apparatus according to another embodiment of the present invention. FIG. 8 shows a conceptual diagram of an operation using the pneumoperitoneum according to another embodiment of the present invention. FIG. 9 shows a conceptual diagram of an operation using the pneumoperitoneum apparatus of the present invention by the method of detecting the flow rate of still another embodiment of the present invention. FIG. 10 shows a conceptual diagram of the insertion detection of the insufflation apparatus of the present invention by the method of detecting the flow rate of still another embodiment of the present invention.

2. Description of the Related Art Trocars that are used to guide medical instruments such as endoscopes and treatment tools into the abdominal cavity during endoscopic surgery are known. In general, the trocar includes an outer tube as a hollow member having a guide hole, and an inner needle that is inserted into the guide hole of the outer tube and inserted into the abdominal wall. When a medical instrument is introduced into the abdominal cavity using such a trocar, the abdominal cavity is first inserted into the abdominal cavity, and gas is injected into the abdominal cavity through the abdominal cavity to expand the abdominal cavity. A cavity as a treatment work space is formed therein.

Next, after removing the pneumoperitoneum from the abdominal wall, the inner needle is inserted into the guide hole of the mantle tube, and the tip of the inner needle protrudes from the tip of the mantle tube, and the mantle tube is inserted into the abdominal wall together with the inner needle. Puncture. That is, the outer tube is introduced into the abdominal cavity while incising the abdominal wall with the inner needle. In this way, when the trocar is introduced into the abdominal cavity, the inner needle is removed from the outer tube, the medical instrument is inserted into the guide hole of the outer tube instead of the inner needle, and the medical device is inserted into the target site in the abdominal cavity. Guide to.

By the way, in the initial stage of puncturing the abdominal wall with a pneumoperitoneum or trocar, a considerable amount of force is required. However, since the puncture resistance suddenly decreases after the pneumoperitoneal needle or trocar penetrates completely into the abdominal cavity, it is easy to pierce the pneumoperitoneal needle or trocar deep inside the abdominal cavity. Abdominal needles and trocars can damage organs in the abdominal cavity.

FIG. 6 is a conceptual diagram of the entire system in a laparoscopic surgical operation in which ventilation is performed via an insufflation needle used in the present invention.

This system includes an trocar 9 punctured by a patient 22, an endoscope camera 26, a light cable 27, an imaging cable 28, a video processor 29 and a light source device 30, an endoscope system 15, an electric knife 25, and an electric knife cable. 21, an electric scalpel system including an electric scalpel output device 20, a trocar 9, a suction tube 17, a pinch valve 32, a suction system including a suction device 33, and an insufflation apparatus 1 which is a subject of the present invention.

The insufflation apparatus 1 includes a carbon dioxide supply source 2, a primary decompression device 3, a secondary decompression device 4, an on-off valve 5, a first pressure sensor 6, a second pressure sensor 7, a flow sensor 8, a control board 17, and a power supply board. 16 and the display substrate 18.

An insertion device air supply opening for connecting the air supply (pneumothorax) tube 16 to the side wall of the trocar insertion device main body, an insertion device suction opening for connecting the suction tube 17, and an operator Is provided with an operation panel as means for performing various settings, and a display unit 18 such as an LED as means for notifying that the trocar 9 has penetrated the abdominal wall.

The trocar is composed of an insertion sheath and a mantle tube as a hollow member. A base 31 for connecting the insufflation tube 16 for insufflation is provided on the side wall of the fitting mounting portion of the insufflation device 1 so as to protrude. The base 31 communicates with the insertion sheath when the proximal end portion of the insertion sheath is fitted into the fitting mounting portion.

The outer tube of the trocar 9 is formed of a cylindrical member having a guide hole, and the insertion sheath is inserted into the guide hole in a state of being almost in close contact therewith.

Next, the pipe line configuration in the trocar insertion device of this embodiment will be described. The conduit in the trocar insertion device of the present embodiment is formed across the trocar 9 that punctures the patient's abdominal cavity, a control device (not shown), and an air supply tube (pneumothorax tube) 16 and a suction tube 17 that connect them. . Further, the pipelines in the trocar insertion device of the present embodiment are divided into two pipeline systems: an air feed pipeline system of the air feed means and a suction pipeline system of the suction means.

As shown in FIG. 4, in the air supply line system, a carbon dioxide gas supply source 2 is connected to the uppermost stream end of the air supply line 16, and an adjustment valve 5 is provided on the downstream side of the gas supply source 2. A safety valve 11 is provided on the downstream side of the regulating valve 5. A first pressure sensor 6, a second pressure sensor 7, and a flow rate sensor 8 are disposed on the downstream side of the adjustment valve 5. The pressure and flow rate of the gas emitted from the regulating valve 5 can be detected by the

pressure sensors

6 and 7 and the flow rate sensor 8. The gas that has passed through the flow rate sensor 8 is supplied from an air supply tube (pneumogastric tube) 16 and a puncture device air supply opening to the trocar air supply opening, and from the trocar air supply opening to the distal end opening of the insertion sheath through the insertion sheath of the trocar. Send it in. This constitutes an air feeding means for feeding gas to the distal end opening of the insertion sheath.

The reason why two pressure sensors are provided is a dual monitor system that allows for safety.

In addition, the uppermost stream end of the suction tube 17 in the suction line system is the inner space of the trocar. The gas in the inner space of the trocar communicates with the insertion device suction opening via the suction tube 17. The insertion device suction opening is connected to a suction valve in the trocar insertion device body, and a suction pump in the suction device 33 is connected downstream of the suction valve. The suction pump is driven by a motor.

The downstream end of the suction pump is open to the atmosphere. The air supply device is provided with a pinch valve 32. The suction device uses electric scalpels 20, 21, and 25. The air feeding device senses that an electric scalpel has been used for the affected area, opens the pinch valve to open the suction tube, and removes smoke from the suction device. enable.

FIG. 1 is an overall conceptual diagram of a pneumoperitoneum according to the present invention. The air supply device 1 is a device that reduces the pressure of a connected pressure source to a pressure that can be supplied to an air supply target, and controls the pressure and flow rate of air supplied to the air supply target. The air supply base 31 is an output port of the air supply device, and connects the air supply tube 16 and the insufflation needle 13.

The pneumoperitoneum 13 is a needle that is inserted into the target cavity 14 and feeds the fluid (gas) output from the air feeding device 1 into the target cavity 14, and the target cavity 14 is a cavity in the human body that ensures a surgical field of view. (For example, lumens such as the abdominal cavity, stomach, and intestines). The high-pressure hose 12 is a hose that connects the air supply device 1 and the pressure source (gas supply source) 2.

The pressure source (gas supply source) 2 is connected to an air supply device (pneumoconiosis device) 1 via a high-pressure hose 12. Air is supplied from the air supply device 1 to the target cavity 14 through the air supply base 31, the air supply tube 16, and the insufflation needle 13. One side of the suction tube 36 is connected to the air supply tube 16 via the T-shaped connector 35. The other is connected to the suction device 37.

Fig. 4 shows a more detailed overview of the pneumoperitoneum.

The regulating valve 5 is electrically connected to a control circuit (not shown), and the control circuit controls the opening and closing of each valve. The

pressure sensors

6 and 7 and the flow sensor 8 are also electrically connected to the control circuit. The control circuit detects the pressure of the gas emitted from the regulating valve 5 and the detected values of the

pressure sensors

6 and 7 and the flow sensor 8. Measure the flow rate. The adjusting valve 5 is provided to adjust the amount of gas supplied to the abdominal cavity and is electrically connected to the control circuit, and receives an operation for adjusting the air supply pressure by the control circuit.

The primary decompressor reduces the pressure output from the carbon dioxide supply source, and the secondary decompressor electrically adjusts the output of the primary decompressor to a pressure that is ok even if air is sent to the abdominal cavity. The

pressure sensors

6 and 7 have a function of monitoring the internal pressure of the abdominal cavity, and the flow sensor 8 measures the amount of gas supplied to the abdominal cavity. The safety valve 11 is a safety valve that performs relief when the intra-abdominal pressure becomes high.

FIG. 2 shows a conceptual diagram of a puncture operation of an insufflation needle using the insufflation apparatus of the present invention.

Using the apparatus of FIG. 1, the adjustment valve 5 in FIG. 4 is closed, and the pneumoperitoneum needle 13 is first inserted into the abdominal wall 15 in the order of FIGS. 2A and 2B (FIG. 1A). , And further, through the peritoneum and inserted into the abdominal cavity 16 ((b) in the figure).

In this embodiment, the inside of the air supply tube 16 of the air supply device is initially evacuated by a suction device 37 connected via a T-shaped connector 35 and a suction tube 36 in the initial state (the state before FIG. 2A). Since the air is being sucked, the pressure sensor in the air feeding device indicates atmospheric pressure (0 mmHg).

・ State 1
In FIG. 2 (a), when the pneumoperitoneum 13 is inside the abdominal wall, the pressure sensor in the air supply device shows 0 mmHg.

・ State 2
As shown in FIG. 2 (b), when the pneumoperitoneum 13 is inserted into the abdominal cavity and inside the abdominal cavity, the abdominal cavity is aspirated by the aspiration device 37, so the pressure sensor in the insufflation device is 0 mmHg or less. (Negative pressure).

・ As shown in FIG. 2 (c), when the abdominal wall is further pulled by external force, the pressure in the abdominal cavity becomes more negative.

As described above, when the pneumothorax needle is inserted, as shown in FIG. 5B, the moment when the abdominal wall is inserted into the abdominal cavity through the peritoneum, the pressure display of the first and second pressure sensors in FIG. Is displayed in the negative pressure direction. As shown in FIG. 2C, this negative pressure display is displayed prominently when a doctor or the like pulls the abdominal wall.

Further, the pressure inside the abdominal cavity is more significantly reduced by mechanically pulling the abdominal wall by a trocar fixing device as shown in FIG. 4 of 14 of Japanese Patent No. 4145167 and the suction tube and suction device shown in 55. It is possible to make a state.

In another embodiment, in the above case, it may be detected by a flow sensor that the gas slightly enters the gas flow passage from the abdominal cavity at the moment when the pneumoperitoneum is inserted into the abdominal cavity.

In this case, the flow rate sensor detects an instantaneous flow rate in the opposite direction (negative direction) to the flow rate toward the abdominal cavity.

Alternatively, in another embodiment, in the configuration shown in FIG. 7, the inside of the abdominal wall is negatively pressured beforehand with an external force. In this configuration, insertion is detected by a flow as shown in FIG.

・ State 1
Since the air supply device is opened to the atmosphere via an air supply tube and an insufflation needle, the pressure sensor inside the air supply device detects atmospheric pressure (0 mmHg) (FIG. 8A).

Moreover, since the abdominal wall is pulled by an external force, the pressure inside the abdominal cavity is negative (0 mmHg or less).

・ State 2
When the insufflation needle is inserted into the human body and the insufflation needle is in the abdominal wall, the pressure sensor in the insufflation apparatus detects (0 mmHg) (FIG. 8B).

・ State 3
The pneumoperitoneum is further inserted, passes through the abdominal wall, and the pneumoperitoneum has reached the abdominal cavity.

At this time, the pressure sensor inside the insufflation device detects the same negative pressure (0 mmHg or less) as that in the abdominal cavity, and the insufflation device detects that the insufflation needle has reached the abdominal cavity (FIG. 8C).

As a method of applying a negative pressure in advance to the inside of the abdominal cavity by external force, it is conceivable to pull the abdominal wall by the above-mentioned doctor or the like or to mechanically pull the abdominal wall by a trocar fixing tool and a suction device as disclosed in Japanese Patent No. 4145167. It is done.

Fig. 5 shows the results of a simulation experiment using a human body model. In FIG. 5, 0 mmHg indicates atmospheric pressure. Before insertion of the pneumoperitoneum (state A), it was 0 mmHg. After insertion of the pneumoperitoneal needle (state B), when the peritoneum was pulled with an external force, a pressure change from -5.7 mmHg to -6.5 mmHg was observed. It was done.

This negative pressure expression can be displayed on the display means of the pneumoperitoneum as shown in FIG. In FIG. 3A, the pressure sensor after the pneumoperitoneal needle is inserted into the abdominal cavity displays a negative pressure. Furthermore, a threshold value is set, and when the negative pressure state is reached, the insertion state is detected, and the insertion display state can be turned on with an indicator lamp as shown in FIG.

In this way, the user can confirm the negative pressure by providing the function of displaying the negative pressure on the measurement pressure indicator on the front panel of the air supply device. Further, the user can confirm the insertion of the pneumoperitoneum needle by turning on an insertion state display or the like on the front panel of the air feeding device. As an air supply device, negative pressure is detected through an insufflation needle, the detected negative pressure is compared with a threshold value to determine whether or not it is in an insertion state, and the result is reflected in the insertion state indicator lamp. Let Turns on when in the inserted state and turns off when not.

Furthermore, as another embodiment, a method of detecting the flow rate as in the configuration shown in FIG. 9 can be considered.

・ State 1
The insufflation apparatus is connected to an insufflation needle through an insufflation tube. The aspirator is connected to the insufflation needle through a suction tube and a T-shaped connector. Since the pneumoperitoneum is blocked by the abdominal wall while the pneumoperitoneum is inserted in the abdominal wall, no flow is generated in each connector.

・ State 2
The insertion of the pneumoperitoneum has advanced, and the abdominal wall has been perforated to reach the abdominal wall. At the moment of arrival, suction is performed from the suction device, and a flow is generated inside each connected device. This can be detected by the flow sensor in the pneumoperitoneum, which detects this flow and that the pneumoperitoneum has reached the abdominal wall.

This flow rate expression can be displayed on the display means of the insufflation apparatus as shown in FIG.
In FIG. 10A, the flow rate sensor after the pneumothorax needle is inserted into the abdominal cavity displays the flow rate.
In addition, when a threshold value for insertion detection is set and the occurrence of a predetermined flow rate is detected, the insertion state can be detected, and the completion of insertion can be displayed as shown in FIG.

As described above, the insufflation device with an insufflation needle insertion detection function of the present invention can detect the insufflation of the insufflation needle without performing insufflation, so that the insufflation needle can be inserted safely.

In addition, the increased safety makes it easier to insert the pneumoperitoneal needle, so the effect of improving the reliability of the surgical operation is great, and the work efficiency is improved as well as the accuracy, so the industrial applicability is high.

DESCRIPTION OF SYMBOLS 1 Insufflation apparatus 2 Gas supply source 3 Primary decompression apparatus 4 Secondary decompression apparatus 5 Adjustment valve 6 1st pressure sensor 7 2nd pressure sensor 8 Flow sensor 9 Trocar 10 Abdominal cavity 13 Inhalation stomach 16 Power supply board 17 Control board 18 Substrate 22 Patient 23 Operating table 25 Electric knife 26 Endoscopic camera 29 Video processor 33 Suction device

Claims

Insufflation means for supplying gas, an insufflation needle inserted into the abdominal cavity, and for sending the fluid supplied from the insufflation means into the target cavity, the insufflation amount of the insufflation needle to the abdominal needle And a pressure sensor provided in an air supply tube between the adjustment valve and the pneumoperitoneum, and the pressure sensor detects a negative pressure when the pneumothorax needle is inserted into the abdominal cavity. An insufflation apparatus comprising an insufflation needle detecting state detecting means for detecting that the insufflation needle has been inserted into the abdominal cavity.
The air supply device according to claim 1, further comprising display means for displaying a detection result by the insertion state detection means.
The air supply device according to claim 2, wherein the display means has a function of displaying a negative pressure on a measurement pressure indicator on a front panel of the air supply device main body.
The insufflation apparatus according to claim 1, further comprising a suction unit connected between the insufflation unit and the insufflation needle, and the negative pressure is embodied by the suction unit.
Insufflation means for supplying gas, an insufflation needle inserted into the abdominal cavity, and for sending the fluid supplied from the insufflation means into the target cavity, the insufflation amount of the insufflation needle to the abdominal needle A flow rate sensor provided in an air supply tube between the adjustment valve and the pneumoperitoneum, and when the pneumothorax needle is inserted into the abdominal cavity, the flow rate sensor starts to flow An insufflation apparatus having an insufflation needle insertion state detecting means for detecting that the insufflation needle has been inserted into the abdominal cavity by detecting the above.