WO2010128738A1

WO2010128738A1 - Wound retractor

Info

Publication number: WO2010128738A1
Application number: PCT/KR2009/006113
Authority: WO
Inventors: 홍두표; 류성엽
Original assignee: (주)다림써지넷
Priority date: 2009-05-07
Filing date: 2009-10-22
Publication date: 2010-11-11
Also published as: KR100919775B1

Abstract

The present invention relates to a wound retractor adapted to be inserted into an abdominal incision of a patient during the operation and then open up the incision, not only to support the operation but also to stop a specimen from coming in contact with the incision and thus to prevent infection due to the specimen. In particular, the wound retractor is configured in such a way that an operation assistant does not need to pull off the wound refractor directly or by using a wire fixed nearby to open an incision wide, and that the opening of an incision can be performed in an efficient manner, independently of different abdominal thicknesses of patients. Further, the wound retractor being coupled to a trocar can also be used for laparoscopic surgery. To this end, the wound retractor of the present invention comprises: a cannula which includes a flexible contact part with an increasing inner diameter downward from the middle portion and an anti-separation ring provided at the lower end of the contact part, with the ring being elastic in nature to prevent separation thereof from an abdominal incision of a patient where the ring is inserted; a fixed case, to which the top end of the contact part of the cannula is coupled and fixed and which has a hollow in the middle to communicate with an opening of the cannula; and an expansion means for expanding the inner diameter of the contact part against an external force that is applied by the abdominal incision in contact with the contact part.

Description

Wound Retractor

The present invention is inserted into the abdominal incision of the patient at the time of surgery to support the surgery by opening the incision, and also to the sound retractor (Wound Retractor) to prevent the infection from the extraction by blocking the surgical extract contact with the incision In more detail, there is no need to open the incision by pulling the retractor directly by the surgical assistant or by a wire fixed around the periphery, and it is possible to efficiently open the incision even if the patient's abdominal thickness varies. It is a tractor. It is also aound retractor that can be combined with trocar and used in laparoscopic surgery.

Recently, in order to minimize the remaining scars after surgery, the incision in the abdomen is made as small as possible. Here, the incision in the abdomen is inserted into the surgical instruments for surgery, or cut off the abdomen for taking out the extract (organs, humps, cancer tissue, etc.) generated during the operation, or refers to a portion punctured the abdomen.

The smaller the incision, the less space for surgery. Thus, in the related art, a surgical assistant (for example, a nurse) pulls the incision directly to open it, or snaps the incision into and out of the incision with a forceps, connects the wire to the forceps, and pulls the incision around to secure the abdominal surgery space. Surgery was performed.

As described above, the conventional method of opening the incision is cumbersome and constrains the doctor's activity space.

In addition, the incision cuts the abdominal skin tissue. Therefore, in a surgery that may cause secondary infection (transition), such as cancer removal, the incision should not be exposed to the wound tissue or the surgical instruments.

For example, in the case of laparoscopic surgery using trocar, the trocar is inserted into the incision and the surgical instrument is inserted into the abdomen through the trocar, so there is no fear that the surgical instrument will come into contact with the incision superficial tissue. Since it is not possible to make a separate incision in the abdomen, and wrap the inside and outside of the incision with a plastic or the like to remove the extract so that the contact does not contact the incision wound tissue is a conventional surgical method.

The present invention has been made to solve the above problems, does not require additional manpower or tools, and also open the incision for the abdominal surgery without restricting the doctor's active space, the insertion of surgical instruments inserted, It is an object of the present invention to secure a surgical space such as movement and extraction of an extract, and to surround a wound tissue of an incision and prevent a cancer cell or the like from spreading (infecting) to the wound tissue.

The sound retractor of the present invention for achieving the above object is

The inner diameter gradually increases while going up and down from the center, and the elastic contact portion,

A bushing provided at the bottom of the contact portion and including an anti-separation ring to prevent detachment from the patient's abdominal incision inserted with elasticity;

A fixing case in which an upper end of the contact portion of the bushing is fixedly coupled and a hollow is formed in the center thereof to communicate with the opening of the bushing;

And expansion means for expanding the inner diameter of the contact portion against an external force applied by the abdominal incision contacting the contact portion.

And the upper end of the contact portion of the bushing is provided with a fixing ring,

The fixing case is made to include an upper case and a lower case to be coupled and assembled, characterized in that the upper case and the lower case inner surface is formed with a fixing groove for receiving the fixing ring is fixed,

The expansion means

A pulling member provided at the upper inner surface of the contact portion;

It is provided in the fixed case, and comprises a coupling member coupled to the pulling member,

The pulling member is characterized in that the coupling member is coupled to extend the inner diameter of the contact portion against the external force by pulling the inner surface of the contact portion,

The pulling member has elasticity,

An upper end of the pulling member is provided with a locking ring having elasticity,

The engaging member is characterized in that the engaging groove is accommodated by the engaging ring is accommodated, and a plurality of engaging projections that the lower end of the engaging ring is formed.

The present invention having the configuration as described above is simply inserted into the incision, after being inserted simply by pulling the pull member to the engaging member to secure the surgical space by extending the inner diameter against the external force of the incision, Not only does the contact cover the wound tissue of the incision to prevent the surgical instrument or extract from contacting the wound tissue, but the outer surface of the contact with the expanded inner diameter is intimately adhered to the wound tissue, so that even the blood of the extract generated during surgery is in contact with the wound tissue. You can block. It may also be used in conjunction with trocars for laparoscopic surgery.

1 is a perspective view of a wheel retractor according to the present invention;

2 is an exploded perspective view of FIG.

3 is a cross-sectional view of the Wound Retractor before and after insertion into the patient's abdomen.

Figure 4 is a perspective view of various types of trocar coupled with the retractor.

5 is an exploded perspective view of the trocar shown in FIG. 4 first;

WR: Wound Retractor T1, T2, T3: Trocar

10: bushing 11: contact portion

12: release prevention ring 13: fixed ring

14: hook portion 15: opening

20: fixing case 23, 24: fixing groove

30: expansion means 31: pulling member

32: engaging ring 33: gripping portion

36: coupling member 37: locking groove

38: locking projection 100: the body

200: valve 300: sealing member

Hereinafter, with reference to the drawings will be described the present invention in more detail.

Figure 1 is a perspective view of the sound retractor (Wound Retractor) according to the invention, Figure 2 is an exploded perspective view of Figure 1, Figure 3 is an expansion means in the state before the retractor is inserted into the incision and the incision It is a cross-sectional view before and after opening the incision through.

And Figure 4 is a perspective view of a variety of trocars that can be used in conjunction with the retractor according to the invention, Figure 5 is an exploded perspective view of the trocar having a valve structure and a filter structure of the trocar shown in FIG.

As shown in Figures 1 to 3, the sound retractor WR (Wound Retractor) of the present invention is roughly inserted into the abdominal incision 10, the upper end of the bushing 10 is fixed and coupled to the outside of the abdomen It includes a fixed case 20, expansion means 30 to extend the inner diameter of the bushing 10.

The bushing 10 is pulled by the contact portion 11, the release prevention ring 12, the fixing ring 13, the hook portion 14, and the expansion means 30, 31, the engaging ring 32, wave Branches 33 are included.

The contact portion 11 is made of a flexible material having elasticity, and has a shape in which the inner diameter gradually increases from the center to the top and bottom. Thus, the separation prevention ring 12 provided at the bottom is caught in the abdomen of the incision, and the fixed case 20 coupled to the top is supported by being caught at the outside of the abdomen of the incision, and the pulling member 31 is in contact with the upper portion of the inner surface 11. As the inner diameter becomes longer (expanded) as it is pulled out, the incision is opened and the outer surface is in close contact with the incision wound tissue. Here, the inner diameter is long (expanded) is based on the inner diameter of the state pressed by the external force of the incision before pulling the pulling member 31, and is not based on the inner diameter before being inserted into the incision.

The release preventing ring 12 is provided on the bottom edge of the contact portion 11 and has an elasticity. Thus, the lower opening 15 of the contact portion 11 is maintained in a circular shape, and when it is inserted into the incision portion, it comes by hand so that it can be easily inserted. After insertion, the lower opening 15 of the contact portion 11 is restored. ).

The fixing ring 13 is provided at the upper edge of the contact portion 11, and is to be firmly fixed to the fixing case 20. That is, by being received and fixed in the fixing grooves (23, 24) formed on the inner surface of the upper case (20a) and the lower case (20b) to be assembled and engaged with each other so as not to be separated from the fixing case (20).

The hook portion 14 is formed to protrude from the lower inner surface of the contact portion 11. The hook portion 14 is for separating the bushing 10 from the incision after the surgery. That is, when the hook portion 14 is pulled out using a hand or a tool, the lower portion of the bushing 10 comes out through the inside (opening portion 15) and is easily separated from the incision.

By pulling the fixing case 20, it is difficult to forcibly separate the bushing 10 from the incision, and when it is forcibly removed, the wound of the incision can be enlarged. Therefore, insert the hand or tool into the bushing 10 and pull out the separation prevention ring 12 so that the separation prevention ring 12 comes out through the inner surface of the contact portion 11 so that it is easily separated from the incision and hurts the incision. Will not. By the way, the separation prevention ring 12 is not easy to catch the separation prevention ring 12, there is a risk of touching the internal tissues of the abdomen in the process of holding the wound. The hook portion 14 solves this problem.

The fixed case 20 includes an upper case 20a, a lower case 20b, and a coupling member 36 as an expansion means 30. And the hollow 25 which communicates with the opening part 15 of the bushing 10 is formed in the center.

The upper case 20a and the lower case 20b are assembled to each other to fix the upper portion of the bushing 10. And it may be coupled to the lower body of the trocar.

Fixing holes 21 and fixing protrusions 22 inserted into the fixing holes 21 are formed on the inner surfaces of the upper case 20a and the lower case 20b for mutual assembly coupling. And the inner surface is also formed with fixing grooves (23, 24) for receiving the fixing ring 13 of the bushing (10).

The expansion means 30 includes a pulling member 31 provided in the bushing 10 and a coupling member 36 provided in the fixed case 20.

The pulling member 31 is formed to protrude upward on the inner surface of the upper portion of the contact portion 11 of the bushing 10, and is made of a soft material having elasticity. And the upper end of the pulling member 31, the engaging ring 32 having elasticity, and the gripping portion 33 for the user to grip is formed.

The coupling member 36 is provided on the upper surface of the upper case 20a, and includes a locking groove 37 in which the locking ring 32 is accommodated, and a plurality of locking protrusions in which the lower end of the locking ring 32 is caught. 38) is formed.

With reference to FIG. 3, a cross-sectional view before and after inserting the Wound Retractor WR into the incision and before and after the inner diameter of the contact portion 11 is expanded through the expansion means 30 is shown. WR) Insertion process and structural change are explained.

When the lower release preventing ring 12 of the bushing 10 is retracted by hand and then forcibly pushed into the cutout, the release preventing ring 12 is restored by the elastic force and caught inside the cutout. The inner diameter of the contact portion 11 is extremely narrowed by the force applied by the cutout portion outside the contact portion 11, and the upper and lower lengths of the contact portion 11 are also reduced as the inner diameter is narrowed.

Pulling the grip portion 33 in the state inserted into the incision to hang the lower end of the locking ring 32 to the plurality of locking projections 38 in sequence, the locking ring 32 is accommodated in the locking groove 37, It is firmly fixed to the locking groove 37 and the locking protrusion 38 by the elasticity of the locking ring 32 having an increased diameter.

In addition, the locking ring 32 pulls the pulling member 31 as the locking groove 37 is caught, and the pulling member 31 pulls a predetermined upper portion of the inner surface of the contact portion 11.

Thus, the upper and lower lengths of the contact portion 11 of the bushing 10 are reduced so that the release preventing ring 12 is in close contact with the inside of the cutout, and the fixed case 20 is in close contact with the outside of the cutout so that the top and bottom portions of the contact portion 11 are respectively cutout. Supported in and out, the pull member 31 pulls the upper portion of the contact in the supported state so that the contact portion 11 expands the inner diameter against the pressing force of the cut portion in contact.

In this case, the contact portion 11 has elasticity, and thus the inner diameter thereof is extended to closely contact the incision wound tissue to prevent foreign substances from penetrating into the wound tissue, and the contact portion 11 may be changed even if the thickness of the incision portion is changed in a predetermined range. There is no significant change in the length of the inner diameter that is extended.

Although not shown in the drawings, the size of the diameter of the coupling member 36 may be adjusted so that the pulling member 31 may adjust the degree of reducing the vertical length of the contact portion 11 by pulling the contact portion 11. It may be desirable to be applicable even if the inside and outside thickness of the part varies out of a certain range.

After opening the incision with the Wound Retractor (WR), a surgical radix is inserted to perform the operation, the surgical extract is taken out of the abdomen, or coupled to various types of trocars shown in FIG. 4, and the surgical instrument is inserted through the trocar. The surgery will be performed. At the time of coupling to the trocar, the pulling member 31 coupled to the coupling member 36 serves as a packing to seal a coupling gap between the trocar and the undried tractor WR to prevent the outflow of gas. For reference, the coupling structure of the trocar and the world retractor WR is not illustrated.

Figure 4 shows a number of trocars (T1, T2, T3) that can be combined with the Wound Retractor (WR) according to the present invention, the first shown trocar (T1) is wrapped around the outer edge of the surgical instrument Sealing member 300 for sealing is a trocar having a valve structure that can be detachably coupled to the plurality and discharge the gas introduced from the abdomen to the outside, the second shown trocar (T2) has only one sealing member The trocar is detachably coupled, and the third trocar T3 shown in FIG. 3 is a trocar detachably coupled to a plurality of sealing members and does not have a valve structure. The valve 200 is mounted on the sealing member. It is the trocar of the state.

The trocars T1, T2, and T3 include a main body 100 and a sealing member 300 coupled to an upper part of the main body, and a lower retractor WR is coupled to a lower part of the main body.

FIG. 5 is an exploded perspective view of the trocar T1 shown first in FIG. 4, and the main body 100 includes a body 110, a mounting member 120, a close cover 130, and a support cover 140. The member 150 includes a valve member 160, a gas amount adjusting member 170, and a filter member 180, and a lower retractor WR of the present invention is coupled to a lower portion thereof, and an upper portion of the sealing member 300. ) Is mounted.

The body 110 has a space 111 penetrating up and down,

The valve member 160 and the fixing member 150 is mounted on the support portion 113 is supported by the protrusion formed, the support portion 113 is fixed to the fixing member 150 coupled to the outer periphery of the body does not rotate Fixed step 119 is formed to prevent.

The inlet 161 and the outlet 162 of the valve member 160 are connected to the support part 113, and a plurality of distribution holes 112 are connected to the space 111 to distribute gas.

And the outer periphery of the body is formed with the distribution holes 112, the receiving portion 116 is formed to accommodate the gas amount adjusting member 170 is formed, the valve on the outer peripheral body of the opposite side of the receiving portion 116 A step groove 114 having a 'b' shape is formed to which the first step protrusion 164 of the member 160 is inserted and coupled. In addition, as the valve member 160 rotates in the vertical direction of the step groove 114, the second and third step protrusions 164a and b are engaged to assist the valve member to rotate step by step at the outer periphery of the body.

In addition, the upper outer circumference of the body 110 has a coupling pin groove 115 to which the stepped portion of the coupling pin 135 protruding from the bottom of the close cover 130 is formed in an annular shape. A packing groove 118 is formed in close contact with the inner surface of the cover 140 to insert a packing to prevent the outflow of gas.

The mounting member 120 includes a plurality of mounting portions 121 on which a plurality of sealing members 300 are mounted, and an insertion groove 342 formed at an inner surface end of each mounting portion 121 at a lower portion of the sealing member 300. The engaging step portion 122 that is inserted into the hook is formed, and the lower edge is formed to extend outwardly by the gas pressure inside the body to be in close contact with the inner surface of the support cover 140 to close the gap 124. have.

In addition, the mounting member 120 may be made of a soft material such as silicon, and the mounting portion may be inverted to protrude upward. After the sealing member 300 is coupled in an inverted state, the mounting part is pushed downward to return to the original state. In addition, it expands to protrude concave upward by the internal air pressure. As the mounting member is concavely expanded by the internal air pressure, the mounting portion on which the sealing member is mounted is naturally inclined toward the center of the bushing. Thus, when the surgical instrument is inserted into the sealing member and pushed into the abdomen, the surgical instrument reduces the collision between the surgical instruments without puncturing the trocar.

In addition, the mounting portion 121 may have various diameters, such as diameters of 3 mm, 5 mm, 12 mm, and 30 mm, to match the sealing member 300 to be mounted. The diameter of 30 mm is the dimension that can accommodate the circular auto suture which has the big dimension among surgical instruments.

The close cover 130 is in close contact with the support cover 140 by pressing the upper edge of the mounting member 120.

The close cover 130 has an opening 131 in the center to expose the mounting portion 121 while pressing the edge of the mounting member 120, the coupling pin hole formed in the support cover 140 on the lower surface of the edge 145 and the auxiliary coupling pin hole 146, respectively, the insertion coupling coupling pin 135 and the auxiliary coupling pin is formed to protrude.

The support cover 140 is assembled and coupled to the close cover 130 to press the edge of the mounting member 120 provided therebetween to eliminate the gap that the gas can flow out, the outer periphery of the body 110 Rotatably coupled thereto.

Since the support cover 140 is rotatably coupled to the outer circumference of the body, the doctor can arbitrarily adjust the position of the sealing member so that the surgical instruments are positioned at a position convenient for surgery.

The fixing member 150 is coupled to the outer periphery of the body 110 while covering the valve member 160, and is fastened to the fixing step 119 so as not to rotate on the outer periphery of the body. Placing the fixing member 150 is the support cover 140 is rotatably coupled to the body, so if you want to rotate the valve member 160 to hold the support that can counter the force of the valve member to rotate Because you need a point. The body 110 is difficult to grip because the exposed portion is less, the support cover is rotatable because it is difficult to counter the rotating force of the valve member is to place the fixing member.

The fixing member 150 covers the valve member 160, and has an opening 151 so that the inlet 161 and the outlet 162 are exposed to the outside and the valve member is rotatable in a certain range.

The valve member 160 has an inlet 161 through which gas is injected from the outside, and an outlet 162 through which gas is discharged from the outside, and the filter member 180 is accommodated on an inner surface side of the outlet 162. The filter accommodating part 163 is formed.

And the inner surface is caught in the step groove 114 of the body by adjusting the rotation angle at the outer periphery of the body of the valve member 160 step 1, 2, 3 step projection to adjust the gas injection amount and discharge step by step (164, 164a, 164b) are formed.

As the valve member 160 is rotated in stages, the inlet 161 and the outlet 162 are blocked (connected) or not connected to the distribution hole 112, respectively, thereby controlling the amount of gas injected or discharged step by step. .

That is, only gas can be injected, only gas can be discharged, or gas can be injected and discharged at the same time, and the amount of gas can be controlled at the time of gas injection and discharge.

The gas amount adjusting member 170 is seated on the outer circumferential receiving portion of the body and is disposed on the plurality of distribution holes 112. And a plurality of

distribution holes

172 and 174 facing one-to-one with each distribution hole. Three distribution holes are shown in the figure.

Some of the plurality of

distribution holes

172 and 174 can distribute gas in both directions and some can distribute only in one direction, ie inside the body.

Referring to this in more detail with reference to the drawings, the gas amount adjusting member 170 is provided with an outer plate 171 having a plurality of distribution holes 172, and a plurality of further distribution holes 174 provided inside the outer plate. Including the inner plate 173 having a, the distribution hole 174 of the inner plate 173 is provided with a rubber plate 175 for opening and closing the distribution hole 172 of the outer plate 171. Thus, one flow hole is capable of outflow and inflow of gas into and out of the body based on the drawing, and the two flow holes are capable of introducing gas into the body due to the rubber plate, but the gas is not discharged out of the body.

In addition, as the valve member 160 rotates, the inlet 161 is sequentially disposed at the outer periphery of the body having no flow hole and two flow holes that allow gas to flow in only one direction, and the outlet hole 162 is rotated when the valve member 160 rotates in the same direction. The outer periphery of the body and the gas are arranged in a sequential distribution hole that allows the flow of gas in both directions. Thus, as the valve member rotates, the gas is in a state where only injection is possible, while the injection and discharge are simultaneously performed, and only the discharge is possible again. This is a reference with reference to the drawings, and by increasing the number of outlets and holes, the number of outlets, and the number of inlets, it is possible to control the amount of injection and discharge in the state that both injection and discharge are possible.

The filter member 180 is inserted and seated in the filter accommodating portion 163 of the valve member 160 and disposed on the communication holes 112 connected to the outlet 162 among the communication holes 112. Thus, noxious components are removed from the emitted gases.

The filter member 180 has a plurality of holes and is disposed between the outer filter case 181 and the inner filter case 182 that are engaged with each other and are disposed between the outer filter case 181 and the inner filter case 182 and discharged. It comprises a filter sheet 183 for directly blocking harmful components of the gas.

The filter member 180 is supported by the lower cover 186 coupled to the lower portion of the valve member 160 so as not to be separated from the filter accommodating portion 163.

In the above description of the present invention, a sound retractor having a specific shape and structure has been described with reference to the accompanying drawings. However, the present invention may be variously modified and changed by those skilled in the art. It should be interpreted as falling within the protection scope of the present invention.

Claims

The inner diameter gradually increases while going up and down from the center, and the elastic contact portion,

A bushing provided at the bottom of the contact portion and including an anti-separation ring to prevent detachment from the patient's abdominal incision inserted with elasticity;

A fixing case in which an upper end of the contact portion of the bushing is fixedly coupled and a hollow is formed in the center thereof to communicate with the opening of the bushing;

Expansion means for expanding an inner diameter of the contact portion against an external force applied by the abdominal incision contacting the contact portion;

A fixing ring is provided at the upper end of the contact portion of the bushing,

The fixed case is made of a retractor, characterized in that it comprises an upper case and a lower case that is coupled to be assembled and coupled, the inner surface of the upper case and the lower case is formed with a fixing groove for receiving the fixing ring.
The method of claim 1, wherein the expansion means

A pulling member provided at the upper inner surface of the contact portion;

It is provided in the fixed case, and comprises a coupling member coupled to the pulling member,

And the pulling member is coupled to the coupling member to extend the inner diameter of the contact portion against external force by pulling the inner surface of the contact portion.
The method of claim 2,

The pulling member has elasticity,

An upper end of the pulling member is provided with a locking ring having elasticity,

The engaging member is a retractor, characterized in that the engaging groove is accommodated by the engaging ring is accommodated, and a plurality of engaging projections that the lower end of the engaging ring is formed.
The method of claim 3, wherein

Wound retractor, characterized in that the upper portion of the pulling member is provided with a gripping portion that can be gripped by the user.
The method according to any one of claims 1 to 4,

Wound retractor, characterized in that the hook portion protrudes in the lower inner surface of the contact portion.