KR102115663B1 - System for marking lesion location in minimally invasive surgery - Google Patents

Abstract

The present invention relates to a lesion marking system for laparoscopic surgery, and more specifically, to fix a marker clip and a lesion with an electronic tag (RFID) mounted on the site of the lesion by applying an existing hemostatic clip. Consisting of an applier, when used, the applier is mounted on an endoscopic instrument or surgical instrument in a state where the marker clip is loaded, so that the loaded marker clip is driven to be fixed to the lesion site. It is a technology related to the marking system.

Description

System for marking lesion location in minimally invasive surgery}

The present invention relates to a lesion marking system for laparoscopic surgery, and more specifically, to fix a marker clip and a lesion with an electronic tag (RFID) mounted on the site of the lesion by applying an existing hemostatic clip. Consisting of an applier, when used, the applier is mounted on an endoscopic instrument or surgical instrument in a state where the marker clip is loaded, so that the loaded marker clip is driven to be fixed to the lesion site. It is a technology related to the marking system.

In the existing abdominal surgery, open abdominal surgery with open abdomen was the mainstream. Open surgery is a surgical method that has been traditionally used, and is still used frequently in modern medicine. However, open surgery has the disadvantages of risk of wound infection, slow postoperative recovery, and reduced cosmetic satisfaction due to scarring. As an alternative, laparoscopic gastrectomy, first introduced by Kitano in 1994 for gastric cancer, was intended to overcome the shortcomings of the multiple open surgery described above by inserting a surgical instrument after a small puncture in the abdomen. With the development of laparoscopic surgical instruments and surgical techniques and the increasing interest of patients and doctors about the quality of life, the surgical trend of gastrointestinal cancer has recently changed from open surgery to laparoscopic surgery. Laparoscopic surgery has already been recognized as a standard surgery in early gastric cancer, and several researchers have reported the superiority of laparoscopic surgery for advanced gastric cancer. Laparoscopic surgery has several advantages, including less postoperative pain, faster recovery, and better cosmetic results than open surgery. However, it is difficult to touch the lesion by hand during surgery, and it may be difficult to determine the exact location of the lesion because of the use of an instrument. Particularly, in the case of benign lesions that grow into the early lesions or the lumen of the intestine, it is difficult to determine the location of the lesion and to determine the appropriate resection since it is not marked with the serous membrane.

In the case of gastrectomy, a method of performing endoscopic or X-ray imaging during surgery was introduced, but due to the complexity of the process and cooperative problems with others, it has not been widely performed in clinical practice, and colorectal resection is also injected with a dye under the mucous membrane. As a result, the tattooing method to mark the lesion was introduced, but since the endoscope needs to be performed one more time before surgery, there is an economic problem caused by patient discomfort and additional procedures. The more the effect is, the faster it falls. Because of these problems, doctors have had an unmet need for new medical technologies to identify lesions. Although there are some differences in opinions regarding safety resection of gastric cancer, the Japanese medical industry recommends resecting the stomach with a resection of about 20mm to 50mm, and domestic medical industry generally follows these standards. However, in order to improve the quality of life after surgery, interest in minimally invasive surgery has recently increased, and there is a continuing demand for technology development to realize this.

Previously, there have been cases in which a method for determining the location of a lesion during laparoscopic surgery using various methods has been studied.

In 2005, two people including Hyung WJ and others introduced a method of identifying lesions using laparoscopic ultrasound during surgery for subgastric tumors growing into the lumen, which has the advantage of being easily and safely performed, but the operator is proficient in laparoscopic ultrasound techniques. It has the limitation that it can fail to check the lesion because it has to be and the clip is small. In a report in 2011, Kim HI and two others suggested a method of finding a clip installed before surgery through abdominal X-rays in 80 patients with early gastric cancer, and in 2014, Kim BS and three others used Radio-Opaque Gauze. A method for confirming lesions after X-ray imaging was reported. Several methods through the above endoscope were also introduced. Jeong O. et al. Reported blood self-transfusion tattooing method to mark lesions in the intestinal tract by injecting blood collected in the lower layer of gastric mucosa with gastric endoscope in 2012 by collecting blood from patients. Xuan Y. and 3 others Also introduced was a method to check the location of lesions in the gastric membrane by injecting dye under the gastric mucosa through an endoscope during surgery without installing a clip before surgery.

 Hyung W. J, Lim J, et al., “Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy” Surgical Endoscopy And Other Interventional Techniques, 2005, 19: 1353-1357.  Kim H. I, Hyung W. J, et al., “Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy” Surgical Endoscopy, 2011, 25: 958-963.  Kim B. Su, Yook J. H, et al., “A simplified technique for tumor localization using preoperative endoscopic clipping and radio-opaque markers during totally laparoscopic gastrectomy” The American Surgeon 2014, 80: 1266-1270.  Jeong O, Cho S. B, et al., “Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing” Surgical Endoscopy, 2012, 26: 1778-1783.  Xuan Y, Hur H, et al., “Efficacy of intraoperative gastroscopy for tumor localization in totally laparoscopic distal gastrectomy for cancer in the middle third of the stomach” Surgical Endoscopy, 2013, 27: 4364-4370.

As can be seen from the research results of the non-patent documents 1 to 5, additional manipulations are required during surgery, or these results are not actually utilized in the clinical field due to problems such as operator skill, reliability, and persistence. Therefore, there is a need to develop a technology that overcomes these drawbacks and marks the location of lesions that can be used in actual clinical settings.

 The present invention consists of a marker clip in the form of the addition of an electronic tag (RFID) and a clip sensor that secures it to the site of the lesion, a laparoscopic surgical lesion marking system capable of determining the location of the lesion without palpation by the operator during laparoscopic surgery Want to provide

In addition, the present invention is to provide a lesion marking system for laparoscopic surgery including a sleeve that moves so that the loaded marker clip is fixed to the lesion site while protecting the electronic tag fixed to the marker clip.

In addition, the present invention is to provide a lesion marking system for laparoscopic surgery, in which the angle formed by the two wires of the marker clip is changed according to the movement of the sleeve, so that the lesion site is picked up and fixed.

The problems to be solved by the present invention are not limited to the above-mentioned problems, and other problems to be solved by the present invention not mentioned herein are from those described below to those skilled in the art to which the present invention pertains. It will be clearly understood.

The laparoscopic surgical lesion marking system according to the present invention includes a marker clip on which an electronic tag (RFID) is mounted so as to check the location of the lesion in a non-contact manner; And an applier that secures the marker clip to the site of the lesion. In use, the applier is mounted on an endoscopic instrument or surgical instrument in a state where the marker clip is loaded, so that the loaded marker clip It is characterized in that it is driven to be fixed to the lesion site.

In addition, in the lesion marking system for laparoscopic surgery according to the present invention, the marker clip, two wires intersecting each other; And a sleeve that is configured to surround the two wires and is provided to be moved forward. As the sleeve moves, the angle formed by the two wires is variable, so that the two wires are fixed to the lesion site. It is characterized by being able to.

In addition, in the lesion marking system for laparoscopic surgery according to the present invention, the marker clip is characterized in that it is formed to be fixed by winding an electronic tag at a point corresponding to the intersection of the two wires.

In addition, in the lesion marking system for laparoscopic surgery according to the present invention, the applicator includes: a sleeve support portion to which a rear end portion of the sleeve can be supported; And in the state that the rear end of the sleeve is supported on the sleeve support, the clip pulling portion is configured to be pulled backward by hooking the two wire rear ends; the clip pulling portion, the rear end of the two wires Containing part; When including, by the clip pulling portion, when the force beyond the reference range is caught in the engaging portion, the engaging portion is deformed or broken so that the marker clip can be separated from the applier It is characterized by.

In addition, in the lesion marking system for laparoscopic surgery according to the present invention, the applier further includes a hollow outer surface forming an outer appearance, and the sleeve support portion and the clip pulling portion are sequentially located inside the outer surface body. Inserted into the outer surface, the opposite end of the portion to which the marker clip is mounted, connected to the sleeve support portion, the manipulation support portion exposed to the outside to be gripped by the user; And a pulling member connected to the clip pulling unit so that a user can pull the operating support unit in a gripped state.

By means of solving the above problems, the lesion marking system for laparoscopic surgery of the present invention, perforation, which is a process of conventional laparoscopic surgery-insertion of an endoscope-confirmation of a lesion using an endoscope and a probe-endoscopy in the process of resection of a lesion using an ablation apparatus, etc. Since it is a form added to the insertion process, it can be used without difficulty even for an operator who is familiar with existing surgical methods.

In addition, the lesion marking system for laparoscopic surgery of the present invention has the effect of being able to complete all procedures by the operator alone without manipulating the patient during surgery or cooperating with others, and also saving a lot of operation time.

1 is a view showing a lesion marking system for laparoscopic surgery of the present invention.
Figure 2 is a projection view of the marker clip of the laparoscopic surgical lesion marking system of the present invention.
3 is a view showing embodiments of the locking portion of the applier according to the present invention.
4 is a view showing the overall appearance of the applier according to the present invention.
5 is a view showing a state in which the marker clip is loaded in the applier according to the present invention.
FIG. 6 is a view showing a state in which an applier loaded with a marker clip according to the present invention is pushed.
7 and 8 are views showing a state in which the marker clip is extruded from the applicator loaded with the marker clip according to the present invention.
9 and 10 are views showing a state in which the marker clip is separated from the applier loaded with the marker clip according to the present invention.

The problems to be solved for the present invention as described above, the means for solving the problems, and specific matters including the effects of the invention are included in the following embodiments and drawings. Advantages and features of the present invention, and methods for achieving them will be clarified with reference to embodiments described below in detail together with the accompanying drawings.

The laparoscopic surgical lesion marking system according to an embodiment of the present invention, as shown in FIG. 1, is a marker clip (10) in which an electronic tag (RFID) 13 is mounted to check the location of the lesion in a non-contact manner. ; And an applicator 20 that fixes the marker clip 10 to the lesion site.

When using the laparoscopic surgical lesion marking system of the present invention, the applicator 20 in the state where the marker clip is loaded at the actual laparoscopic surgery site is mounted on an endoscopic instrument or surgical instrument, and the loaded marker clip is recalled. It is driven to be fixed to the lesion site.

This is the process of conventional laparoscopic surgery-perforation-endoscope insertion-confirmation of the lesion using an endoscope and a probe-during the lesion resection step using an ablation instrument, the marker clip (using the applicator 10) during the endoscope insertion step Since it is a type of simply adding a lesion marking system for laparoscopic surgery to fix 10) to the site of the lesion, it can be said that it is suitable for those who are familiar with the existing surgical method. In addition, when compared with the conventional laparoscopic surgical marking method, the existing method was affected by the skill of the operator, or the method was too complicated and requires cooperation. Therefore, the laparoscopic surgical lesion marking system of the present invention was developed in the direction of reducing the dependence of the operator as much as possible, reducing the burden on the patient's body, and simplifying while increasing reliability.

The marker clip 10 includes two wires 11 intersecting each other and a sleeve 20 configured to surround the two wires 11 and provided to move forward. At this time, as the sleeve 20 moves, the angle formed by the two wires 11 wrapped around it is variable, so that the two wires 11 can be fixed to the site of the lesion.

The two wires 11 are divided into two wire front ends 111 and two wire rear ends 112, as shown in FIG.

As for the two wire front end parts 111, when the sleeve 20 moves forward, the angle formed by the two wire front end parts 111 is changed based on the point where the wire 11 intersects. As the width narrows, the site of the lesion is fixed in the form of a pinch.

In addition, the two wire front end portions 111 may be configured to prevent the hook portion from being formed at the ends, so as to escape from the site of the lesion.

The two wire rear ends 112 are formed in a structure that is bent and connected in a direction close to each other, so that the two wires are based on the point at which the wire 11 intersects when the sleeve 20 moves forward. As the angle formed by the rear end portion 112 varies, the width of the sleeve 20 is inserted into the narrow portion 121.

Meanwhile, as shown in FIG. 2, the marker clip 10 is formed to be fixed by winding the electronic tag 13 at a point corresponding to an intersection of the two wires 11. To this end, the two wire front ends 111 are bent to have a gentle slope compared to the point at which the wires 11 intersect, so that the two sleeves of the wire front 111 move as the sleeve 20 moves forward. Even if the width of is narrowed, the electronic tag 13 may be fixed so as not to deviate forward.

The sleeve 12 is formed in a hollow shape, the front end receiving portion 121 having an inner diameter equal to or greater than the maximum separation distance between the two wire rear end portions 112, the maximum separation between the two wire rear end portions 112 The rear end accommodation portion 122 formed to have an inner diameter less than a distance, and the front end accommodation portion 121 and the rear end accommodation portion 122 are connected, and the front end accommodation portion 121 and the rear end accommodation portion 122 are connected. ), The intermediate accommodation portion 123 having an inner circumferential surface inclined according to the difference in inner diameter.

Accordingly, when the sleeve 12 having the above-described structure moves forward, the two wire front end portions 111 are positioned as the rear end receiving portion 122, and the two wire front end portions 111 move the sleeve ( 12) The angle formed by the two front ends of the wires 111 is variable as it is inserted inside.

That is, the sleeve 12 not only serves as a cap for protecting the electronic tag 13 from inside the body, but also changes the angle of the two wires 11 of the marker clip 10 to change the lesion area. It serves to pick up and fix.

Meanwhile, the marker clip 10 may be formed of STS304 material.

When designing the marker clip (10), the inside of the stomach and large intestine has high humidity and high acidity, so it is resistant to moisture resistance and oxidation, and has excellent tensile strength and excellent elasticity, making STS a candidate for STS301 and STS304 materials. Table 1 below shows the results of comparing tensile strength, yield strength, and Poisson's ratio for the final determination.

In the case of tensile strength, the tensile strengths of STS304 and STS301 materials are similar within a difference of about 15%, but in the case of yield strength, the yield strength of STS304 material is as small as 20%. The marker clip 10 and the applier 20 are both expected to be less deformed in the product state because there is little external force, but in the processing step, it is advantageous that the yield strength is small, which is formed of STS304 material. Would be desirable.

The applicator 20 is a sleeve support portion 21 that can be supported by the rear end portion of the sleeve 12, and the rear end portion of the sleeve 12 is supported by the sleeve support portion 21, the two wires It includes a clip pulling portion 22 configured to be hooked to the rear end portion 112 and pulled backward.

The sleeve support portion 21 is provided with a plurality of incision lines 211 in which a portion of the sleeve 12 is incised, so that the sleeve 12 can be inserted only to the required portion inside, the When the sleeve 12 is inserted, it can be stably supported.

The clip pulling portion 22 includes a locking portion 221 for catching the two wire rear end portions 112. When the marker clip 10 is loaded in the applicator 20, the two wire rear end portions 112 are caught by the engaging portion 221. In this state, when the marker clip 10 is pulled by the clip pulling portion 22, when a force greater than a reference range is applied to the locking portion 221, the locking portion 221 is deformed or broken so that the The marker clip 10 can be separated from the applicator 20.

The locking portion 221 may be formed as an annular (a), tongs (b) or a circular annular (c), as shown in FIG. 3.

Preferably, the engaging portion 221 may be formed in a ring (a). The structure of the annular (a) is simpler in shape than the tongs (b) or the circular annular (c), and is capable of both deformation and breakage, and may be removed from the annular portion when the clip is rotated and fixed. The problem with is also a part that can sufficiently solve the above problems by adjusting the properties of materials such as stiffness.

In addition, the applicator 20, as shown in Figure 4, further comprising a hollow outer surface 23 forming an exterior, the sleeve support portion 21 and the inside of the outer surface 23 The clip pulling portion 22 is a form that is sequentially inserted.

On the opposite end of the portion where the marker clip 10 is mounted on the outer surface 23, the operation support portion 24 and the clip pulled out to be connected to the sleeve support portion 21 and exposed to the user so as to be gripped by the user It is connected to the part 22 is provided with a pulling member 25 to allow the user to pull in the state of holding the operation support 24. That is, after the user supports the manipulation support portion 24 with the palm of the hand, the pull member 25 is pulled with a finger to separate the marker clip 10.

Hereinafter, in the lesion marking system for laparoscopic surgery according to the present invention, the principle of fixing the marker clip 10 to the site of the lesion will be described.

First, as shown in Figure 5, before attaching the applicator 20 to the endoscopic instrument or surgical instrument, by inserting the marker clip 10 into the outer surface 23, the sleeve 12, ) Is inserted into the sleeve support portion 21, and the marker clip 10 is loaded into the applicator 20 in a manner in which the two wire rear ends 112 are caught by the locking portion 221. At this time, the sleeve support portion 21 and the clip pulling portion 22 is inserted in a form that does not protrude to the outside of the outer surface 23 due to the force of the user, the rear end receiving portion 122 of the sleeve ) Is located inside the sleeve support portion 21.

Next, as shown in FIG. 6, the structures inserted into the outer surface 23 by pressing are moved forward. For this reason, the sleeve support portion 21 and the clip pulling portion 22 are positioned at the front maximum, and the two wire rear end portions 112 are still caught in the engaging portion 221.

Next, as shown in FIG. 7, after the user mounts the applicator 20 loaded with the marker clip 10 on an endoscopic instrument or surgical instrument, positioned near the lesion site, the manipulation support 24 ) While pulling the pull member 25 while gripping. Due to this, the clip pulling portion 22 connected to the pulling member 25 moves rearward, and accordingly, the sleeve supporting portion 21 also moves rearward. At this time, the two wire rear end 112 is pressed to the front side by the pulling force, the marker clip 10 is changed to the extruded state. In addition, the sleeve 12 is moved back relative to the two wires 11 by the pulling force, so that the angle formed by the two wire front ends 111 becomes smaller. This process is performed until the locking portion 221 is completely inserted into the outer surface 23 as shown in FIG. 8.

Next, as shown in Figures 9 and 10, when the force applied to the locking portion 221 is greater than or equal to the reference, the locking portion 221 is deformed or broken, so that the two wire rear end portions 112 are The marker clip 10 is separated from the locking portion 221. At this time, similarly, the sleeve 12 is continuously moved rearward by the pulling force, so that the angle formed by the two wire front ends 111 is minimized, and the driving part is picked up and fixed. .

It will be understood that the above-described technical configuration of the present invention can be implemented in other specific forms by those skilled in the art to which the present invention pertains without changing the technical spirit or essential features of the present invention.

Therefore, the above-described embodiments are to be understood as illustrative and not restrictive in all respects, and the scope of the present invention is indicated by the following claims rather than the above detailed description, and the meaning and scope of the claims It should be construed that any altered or modified form derived from the equivalent concept is included in the scope of the present invention.

10: Marker clip
11: 2 wires
111: 2 wire front ends
112: 2 wire rear end
12: sleeve
121: shear receiving section
122: rear stage accommodation unit
123: Intermediate accommodation
13: electronic tag
20: Applier
21: sleeve support
211: incision
22: clip pull
221: jam
23: icosahedron
24: operation support
25: pull member

Claims (5)

A marker clip equipped with an electronic tag (RFID) so that the location of the lesion can be confirmed in a non-contact manner; And
It includes an applier for fixing the marker clip to the site of the lesion;
The marker clip,
Two wires intersecting each other; And
Includes a sleeve that is configured to surround the two wires and is provided to move forward.
As the sleeve moves, the angle formed by the two wires varies, so that the two wires can be fixed to the site of the lesion,
In use, the applier is mounted on an endoscopic instrument or surgical instrument with the marker clip loaded, and drives the loaded marker clip to be fixed to the lesion site. delete According to claim 1,
The marker clip is a laparoscopic surgical lesion marking system, characterized in that the electronic tag is formed to be wound and fixed at a point corresponding to the intersection of the two wires. According to claim 1,
The applier,
A sleeve support portion to which a rear end portion of the sleeve can be supported; And
Includes a clip pulling portion configured to be pulled backward by being hooked to the two wire rear ends while the rear end of the sleeve is supported by the sleeve support portion.
The clip pulling portion,
Includes; a locking portion for engaging the rear end of the two wires,
When pulled by the clip pulling portion, if a force beyond the reference range is applied to the locking portion, the locking clip is deformed or broken so that the marker clip can be separated from the applicator for lesion treatment system for laparoscopic surgery. . The method of claim 4,
The applier further comprises a hollow outer surface forming an exterior;
The sleeve support portion and the clip pulling portion are sequentially inserted into the outer surface,
At the opposite end of the portion where the marker clip is mounted on the outer surface,
An operation support part connected to the sleeve support part and exposed to the outside so that a user can grip it; And
A laparoscopic surgical lesion marking system, characterized in that it is provided; a pulling member that is connected to the clip pulling portion so that the user can pull the operating support in the gripped state.

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