CN219594673U - Novel combined endoscope - Google Patents

Abstract

The utility model discloses a novel combined endoscope. In the present utility model, a novel combination endoscope includes: the outer sheath is provided with a channel, and both ends of the channel are open; a puncture needle operably inserted into and through the sheath channel, the needle of the puncture needle being located outside the sheath; the puncture needle is provided with a cavity, and the needle head of the puncture needle is provided with an opening communicated with the cavity; the imaging member is operatively inserted into the cavity of the needle; the handle tube body is detachably connected with the proximal end of the outer sheath, and is provided with a plurality of pipelines; the handle tube is operably connected to the proximal end of the sheath with the plurality of conduits in communication with the passageway after the needle and imaging member are withdrawn from the sheath; the sheath, the puncture needle and the imaging element are operably assembled to form a puncture member with a gas-liquid path interface for externally connecting a gas source or a liquid source; the sheath is operatively assembled with the handle tube to form a functional member. Compared with the prior art, the treatment pain of the patient is relieved, and the risk is reduced.

Description

Novel combined endoscope

Technical Field

The utility model relates to a medical instrument, in particular to a novel combined endoscope.

Background

Currently, endoscopes can be used for gynecological treatment of polyps via Pi Gong cavity punctures, uterine fibroids or chest minimally invasive procedures. Taking the example that an endoscope is used for chest minimally invasive surgery, chest minimally invasive surgery taking a thoracoscope as a guide is the mainstream direction of chest surgery development. Thoracoscopy is a minimally invasive technique whereby a thoracic surgeon performs surgical procedures on an intrathoracic lesion through a chest wall incision with the aid of an endoscope, a high definition television screen, and minimally invasive instruments. The traditional Chinese medicine composition has the advantages of small wound, light pain, quick recovery, reliable curative effect, safety, reliability and the like, and is popular with patients and chest surgeons. However, with respect to the outer diameter of the current thoracoscope and instrument, the operation can be completed by making about 2-4 incisions of about 1 cm on the chest wall during the operation, and the complications such as pneumothorax, pulmonary infection, thoracic mucosa adhesion and the like still occur due to the number and the size of the incisions. There is therefore a need for an instrument that solves the above mentioned problems.

Disclosure of Invention

The utility model aims to provide a novel combined endoscope, so that the problems can be solved, the treatment pain of a patient can be relieved, and the operation risk can be reduced.

In order to solve the above technical problems, embodiments of the present utility model provide a novel combined endoscope, including:

an outer sheath having a channel, both ends of the channel being open;

a needle operably inserted into and through the passage of the outer sheath, the needle of the needle being located outside the outer sheath; the puncture needle is provided with a cavity, and the needle head of the puncture needle is provided with an opening communicated with the cavity;

an imaging member, said imaging member being operatively inserted into the cavity of said needle; and

the handle tube body is detachably connected with the proximal end of the outer sheath and is provided with a plurality of pipelines; the handle tube being operatively connected to the proximal end of the sheath with the plurality of tubes in communication with the passageway after the needle and imaging member are withdrawn from the sheath;

wherein the sheath, the needle and the imaging member are operably assembled to form a piercing member having a gas-liquid path interface thereon for externally connecting a gas source, the piercing member being operable for passage of a gas or liquid and for discharge from a distal end of the piercing member; the sheath is operably assembled with the handle tube to form a functional member.

Compared with the prior art, the imaging part is inserted into the puncture needle, the puncture needle is inserted into the outer sheath, the puncture needle penetrates through the human body, an incision is not needed to be cut by a surgical knife, and the imaging part can conduct shooting guide when the puncture needle penetrates through the human body. In addition, the sheath, the puncture needle and the imaging piece form a puncture member, and the puncture member is provided with a gas-liquid path interface for externally connecting a gas source, so that gas can enter a human body to form a cavity, human tissues and organs can not interfere with imaging, and meanwhile, the puncture needle and other parts can be prevented from interfering with other organs. After the outer sheath and the puncture needle enter the human body to the corresponding positions, the puncture needle and the imaging piece are removed from the outer sheath together, the proximal end of the outer sheath is connected with the handle tube body-shaped functional member, and the functional member can be used for inserting a working device into the outer sheath and injecting or sucking gas or liquid.

In one embodiment, the handle tube has a main tube portion detachably connected to the outer sheath, and at least two branch tube portions connected to the main tube portion; each of the branch pipe parts has one of the pipes therein;

one of the branch tube portions is operable for insertion and passage of the imaging member into the channel; the other of the branch pipe portions is operable for insertion and passage of a work piece into the passage.

In one embodiment, the handle tube further has a first one-way valve,

the first one-way valve is adapted to be connected to at least one of the branch pipe parts and adapted to stop the outflow of gas or liquid towards the proximal end of the outer sheath.

In one embodiment, the puncture needle is detachably connected to the imaging element; the puncture needle is provided with the gas-liquid path interface communicated with the cavity; and in the puncture member, the gas-liquid path interface is located outside the proximal end of the outer sheath.

In one embodiment, the handle tube has three of the branch tube portions; yet another of the branch pipe parts is operable for pipe fitting access to gas or liquid into the passage.

In one embodiment, the handle tube further has a three-way valve connected to the further branch tube portion.

In an embodiment, the outer sheath is provided with the gas-liquid path interface communicated with the channel, and a second one-way valve is arranged on the outer sheath and used for stopping gas or liquid from flowing out towards the proximal end of the outer sheath.

In one embodiment, the handle tube has two of the branch tube portions.

In one embodiment, the imaging member has a functional interface, an imaging light guide extension, a length shifter, and an insertion portion sequentially connected from a proximal end to a distal end;

the insertion portion is operable to be inserted into the lancet, and the length shifter is operable to be detachably connected to the proximal end of the lancet.

In one embodiment, the functional interface has an imaging interface and a light source interface; the insertion portion has an imaging member, an illuminating member, and a protective tube surrounding the imaging member and the illuminating member.

In one embodiment, the distal end of the sheath has a guide section with an outer diameter that tapers in a distal direction.

In one embodiment, the outer surface of the needle has graduation marks.

In one embodiment, the outer surface of the sheath has graduation marks.

Drawings

FIG. 1 is a schematic view of an imaging member according to an embodiment of the present utility model;

FIG. 2 is a schematic view showing the structure of a puncture needle according to an embodiment of the present utility model;

FIG. 3 is a schematic view of the structure of an outer sheath according to an embodiment of the present utility model;

FIG. 4 is a schematic view of a lancing member formed after an imaging member, a lance and a sheath are assembled in accordance with one embodiment of the present utility model;

FIG. 5 is an enlarged view of a portion of FIG. 4A;

FIG. 6 is a schematic view of the penetration of a needle into an outer sheath according to one embodiment of the present utility model;

FIG. 7 is a schematic view of the structure of the functional member formed after the handle and the sheath are assembled in accordance with an embodiment of the present utility model;

FIG. 8 is a schematic view of the structure of a penetrating tubular member and an imaging member in a functional member according to an embodiment of the present utility model;

FIG. 9 is an enlarged view of a portion of B in FIG. 8;

FIG. 10 is a schematic view of the structure of an outer sheath according to another embodiment of the present utility model;

FIG. 11 is a schematic view showing the structure of a puncture needle according to another embodiment of the present utility model;

FIG. 12 is a schematic view of a lancing member formed after assembly of an imaging member, a lance and a sheath in accordance with another embodiment of the present utility model;

FIG. 13 is a schematic view of the structure of a penetrating imaging member in a functional element according to one embodiment of the present utility model;

reference numerals: 1. an imaging member; 11. a functional interface; 111. an imaging interface; 112. a light source interface; 12. a length shifter; 121. a locking member; 122. a third luer; 13. an imaging light guide extension; 14. a metal adapter; 15. an insertion section; 151. a protective tube; 152. a lighting member; 153. an imaging member; 3. a puncture needle; 31. a T-adapter; 32. a first rotatable luer; 33. stainless steel needle tube; 331. a needle; 311. a second luer; 4. an outer sheath; 41. a first luer; 5. a gas-liquid path interface; 6. a handle tube; 60. a main pipe section; 110. a piercing member; 120. a functional member; 66. a second rotatable luer; 64. a first one-way valve; 65. a three-way valve; 421. a guide section; 2. a pipe fitting; 61. a branch pipe part; 62. a branch pipe part; 63. a branch pipe part; 71. an extension tube female luer; 72. an extension tube body; 73. an extension tube male luer; 210. a piercing member; 8. a puncture needle; 9. an outer sheath; 91. a second one-way valve; 220. a functional component.

Detailed Description

For the purpose of making the objects, technical solutions and advantages of the present utility model more apparent, embodiments of the present utility model will be described in detail below with reference to the accompanying drawings. However, those of ordinary skill in the art will understand that in various embodiments of the present utility model, numerous technical details have been set forth in order to provide a better understanding of the present utility model. However, the technical solutions claimed in the claims of the present utility model can be realized without these technical details and various changes and modifications based on the following embodiments.

Throughout the specification and claims, unless the context requires otherwise, the word "comprise" and variations such as "comprises" and "comprising" will be understood to be open-ended, meaning of inclusion, i.e. to be interpreted to mean "including, but not limited to.

The following detailed description of various embodiments of the present utility model will be provided in connection with the accompanying drawings to provide a clearer understanding of the objects, features and advantages of the present utility model. It should be understood that the embodiments shown in the drawings are not intended to limit the scope of the utility model, but rather are merely illustrative of the true spirit of the utility model.

Reference throughout this specification to "one embodiment" or "an embodiment" means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases "in one embodiment" or "in an embodiment" in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.

As used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. It should be noted that the term "or" is generally employed in its sense including "and/or" unless the context clearly dictates otherwise.

In the following description, for the purposes of clarity of presentation of the structure and manner of operation of the present utility model, the description will be made with the aid of directional terms, but such terms as "forward," "rearward," "left," "right," "outward," "inner," "outward," "inward," "upper," "lower," etc. are to be construed as convenience, and are not to be limiting.

Embodiments of the present utility model are described below with reference to the accompanying drawings.

One embodiment of the present utility model relates to a novel combination endoscope. As shown in fig. 1, 2 and 3, the novel combination endoscope includes: an outer sheath 4, a puncture needle 3, an imaging element 1 and a handle tube 6. As shown in fig. 4, the sheath 4, the needle 3, and the imaging element 1 are operatively assembled to form a piercing member 110, and the piercing member 110 has a gas-liquid port 5 thereon for externally connecting a gas source, the piercing member 110 being operative for the passage of gas or liquid and for evacuation from the distal end of the piercing member 110. As shown in fig. 7, the sheath 4 is operatively assembled with the handle tube 6 to form a functional member 120. The sheath 4 has a channel, both ends of which are open. And the puncture needle 3 has a cavity, and the needle 331 of the puncture needle 3 has an opening communicating with the cavity. The handle tube body 6 is detachably connected with the proximal end of the outer sheath 4, and the handle tube body 6 is provided with a plurality of pipelines; when the needle 3 and imaging member 1 are withdrawn from the sheath 4, the handle tube 6 is operatively connected to the proximal end of the sheath 4, and a plurality of conduits are in communication with the passageway.

In use, as shown in fig. 4 and 5, the outer sheath 4, the puncture needle 3 and the imaging element 1 are assembled together to form the puncture member 110, the puncture needle 3 is inserted into the channel and penetrates the outer sheath 4, the needle 331 of the puncture needle 3 is located outside the outer sheath 4, the imaging element 1 is inserted into the cavity of the puncture needle 3, and the imaging element 1 can be peeped through the opening of the needle 331 to the outside. The gas-liquid path interface 5 is connected with an extension tube male luer interface 73, an extension tube body 72 and an extension tube female luer interface 71. The puncture needle 3 punctures the human body, the outer sheath 4 and the imaging piece 1 are taken into the human body together, and carbon dioxide can be supplied into the puncture member 110 through the gas-liquid path interface 5 in the process of entering, so that the gas finally enters the human body, the puncture needle 3 and other parts are isolated from other organs of the human body, the use is safer, and the pain of a patient is reduced. After the proper position is reached, the puncture needle 3 is pulled out of the proximal end of the outer sheath 4 together with the imaging member 1, the outer sheath 4 is withdrawn, the channel in the outer sheath 4 is now free, the handle tube 6 is again attached to the proximal end of the outer sheath 4 as in fig. 7, and the imaging member 1 and biopsy and therapeutic instruments, such as bioptomes, basket, laser fiber or electrode, etc., can be accessed through the handle tube 6 as in fig. 8 for performing an examination. And the imaging member 1 and the biopsy and therapeutic instrument can be inserted into the outer sheath 4 from different conduits without interfering with the ocular member of the imaging member 1, the control end of the biopsy and therapeutic instrument, etc.

From the above, it is apparent that, as shown in fig. 4 and 5, the imaging element 1 is inserted into the puncture needle 3, the puncture needle 3 is inserted into the outer sheath 4, the puncture needle 3 punctures the human body, an incision is not required to be additionally cut by a scalpel, and the imaging element 1 can perform image capturing guidance when the puncture needle 3 punctures the human body. In addition, the sheath 4, the puncture needle 3 and the imaging element 1 form a puncture member 110, and the puncture member is provided with a gas-liquid path interface 5 for externally connecting a gas source or a liquid source, so that gas can enter a human body to form a cavity, human tissues and organs can not interfere with imaging, and meanwhile, the puncture needle 3 and other components can not interfere with other organs. After the outer sheath 4 and the puncture needle 3 are put into the corresponding positions of the human body, the puncture needle 3 and the imaging piece 1 are withdrawn from the outer sheath 4, and then the handle tube body 6 is connected to the proximal end of the outer sheath 4 to form a functional member 120, and a working instrument can be inserted into the outer sheath 4 through the functional member 120, and gas or liquid can be injected or pumped.

Implementation details of the present embodiment are specifically described below, and the following description is provided only for facilitating understanding, and is not necessary to implement the present embodiment.

Optionally, as shown in fig. 5, the distal end of the outer sheath 4 has a guiding section 421, the outer diameter of the guiding section 421 gradually decreasing in the distal direction.

Further, as shown in fig. 1, 2 and 3, the puncture needle 3 is detachably connected to the imaging element 1, and the imaging element 1 is detachably connected to the puncture needle 3. The puncture needle 3 is provided with a gas-liquid path interface 5 communicated with the cavity, and gas or liquid enters the puncture needle 3 through the gas-liquid path interface 5 and enters a human body from an opening at the distal end of the puncture needle 3. As shown in fig. 6, the puncture needle 3 is provided with a first rotatable luer 32, the proximal end of the outer sheath 4 is provided with a first luer 41, the puncture needle 3 enters the outer sheath 4, and the first luer 41 on the outer sheath 4 is matched and connected with the first rotatable luer 32 of the puncture needle 3, so that the puncture needle 3 and the outer sheath 4 are locked. As shown in fig. 4, the proximal end of the puncture needle 3 is further provided with a second luer 311, the imaging member 1 is provided with a third luer 122, and when the imaging member 1 is inserted into the puncture needle 3, the second luer 311 is matched and connected with the third luer 122, so that the imaging member 1 and the puncture needle 3 are locked. And the gas-liquid circuit 5 is located between the first rotatable luer 32 and the second luer 311. The locking connection among the puncture needle 3, the outer sheath 4 and the imaging piece 1 can be locked by screwing or buckling through internal and external threads besides luer connection. The sheath 4 is also provided with graduations.

Specifically, as shown in fig. 2, 4 and 5, the puncture needle 3 includes a stainless steel needle tube 33 and a T-shaped adapter 31, the stainless steel needle tube 33 and the T-shaped adapter 31 are connected together by a first rotatable luer 32, the air-liquid port 5 is on the T-shaped adapter 31, and a second luer 311 is at an end of the T-shaped adapter 31 remote from the stainless steel needle tube 33. The stainless steel needle cannula 33 is operatively inserted into the outer sheath 4, and the imaging member 1 is inserted from the T-adapter 31 into the stainless steel needle cannula 33.

In addition, as shown in fig. 1 and 4, the imaging element 1 has a functional interface 11, an imaging light guide extension 13, a length shifter 12, and an insertion portion 15, which are sequentially connected from the proximal end to the distal end. The insertion portion 15 is operatively inserted into the puncture needle 3, and the length shifter 12 is operatively detachably connected to the proximal end of the puncture needle 3. A third luer 122 is provided on the length shifter 12. The metal adapter 14 is located between the imaging light guide extension 13 and the insertion portion 15, and is adapted to be connected to the length shifter 12. The length shifter 12 can be connected with the metal adapter 14 on the imaging member 1 in a matching way, and after the connection, the axial displacement of the insertion part 15 is controlled, and the locking part 121 of the length shifter 12 can be locked.

Further, as shown in fig. 1 and 9, the functional interface 11 has an imaging interface 111 and a light source interface 112. The insertion portion 15 has an imaging member 153, an illuminating member 152, and a protective tube 151 surrounding the imaging member 153 and the illuminating member 152. The imaging interface 111 and the imaging host device may be connected through optical eyepiece conversion, or may be directly and electrically connected to an image signal collected on the imaging member 1 and transmitted to an image processor. The illuminator 152 may be a fiber optic cable or an LED light source. The imaging member 153 may be an optical lens or an electronic lens. The light source interface 112 may be an interface connected with a light guide fiber to transmit light to the distal end of the imaging member 1 for illumination, or may be a wire interface of an LED light source of the illumination member 152, and the connection through the interface supplies power to the LED light source of the illumination member 152.

Further, as shown in fig. 7 and 8, the handle tube 6 has three branch tube portions and a main tube portion 60 connected to the three branch tube portions. One branch pipe portion has a pipe therein. The branch pipe part 61 is operable for connecting the pipe fitting 2 into the channel to introduce gas or liquid, and the pipe fitting 2 can be selected as a gas pipe or a liquid pipe according to actual requirements when the use functions are different; the branch pipe portion 62 is used for insertion of the imaging element 1; the branch tube portion 63 is used for biopsy and therapeutic instrument insertion. After withdrawing the puncture needle 3 and the imaging element 1 together from the outer sheath 4, the handle tube body 6 is mounted on the outer sheath 4, and a second rotatable luer 66 is arranged on the handle tube body 6 and is connected and locked with the first luer 41 on the outer sheath 4 in a matching way. That is, the handle tube 6 is connected to the sheath 4 to form the functional member 120, and the installation and use requirements are that different components are inserted into the branch pipe portions of the handle tube 6.

Further, as shown in fig. 7 and 8, a three-way valve 65 is connected to the branch pipe portion 61, and the pipe member 2 is inserted into one inlet of the three-way valve 65, and the other inlet is available for deflation and decompression. The imaging element 1 is inserted into the branch pipe part 62, that is, the insertion part 15 of the imaging element 1 is inserted into the branch pipe part 62 and extends into the outer sheath 4, the length shifter 12 blocks the orifice of the branch pipe part, and the length shifter 12 has a sealing function to prevent gas or liquid from leaking from the branch pipe part. The branch pipe parts 63 are provided with first check valves 64, the first check valves 64 being adapted to be connected to at least one branch pipe part and to shut off the outflow of gas or liquid towards the proximal end of the sheath 4. It will be appreciated that in other embodiments, the first non-return valve 64 may also be provided on other branch pipe parts, that is to say that the first non-return valve 64 is intended to be connected to at least one branch pipe part. The number of branch pipe parts is not limited to the above-mentioned 3, but may be 2 or more than three.

Another embodiment of the present utility model is also directed to a novel combination endoscope. As shown in fig. 10, 11, 12 and 13, the structure of the outer sheath 9 and the puncture needle 8 in the novel combination endoscope is different from that in the above-described embodiment. The sheath 9, the puncture needle 8 and the imaging element 1 are assembled to form the puncture member 210, and the handle tube 6 is assembled with the sheath 9 to form the functional member 220 after the puncture needle 8 and the imaging element 1 are withdrawn from the sheath 9. The novel combined endoscope has the gas-liquid path interface 5 positioned on the outer sheath 9, but not on the puncture needle 8, and the structure of the handle tube body is slightly different from that of the above embodiment, in this embodiment, two branch pipe parts of the handle tube body 6 are respectively a branch pipe part 62 and a branch pipe part 63, and the branch pipe part 62 is used for inserting an imaging piece; the branch tube portion 63 is used for biopsy and therapeutic instrument insertion. The branch pipe part is provided with a first one-way valve.

Further, a second one-way valve 91 is provided on the outer sheath 9, the second one-way valve 91 being adapted to stop the outflow of gas or liquid towards the proximal end of the outer sheath 9.

In addition, the outer surface of the outer sheath 9 is provided with scale marks.

In addition, the outer surface of the puncture needle 8 is provided with scale marks.

The related technical details mentioned in the first embodiment are still valid in this embodiment, and the technical effects achieved in the first embodiment may also be achieved in this embodiment, so that the repetition is reduced, and a detailed description is omitted here. Accordingly, the related art details mentioned in the present embodiment can also be applied to the second embodiment.

While the preferred embodiments of the present utility model have been described in detail above, it should be understood that aspects of the embodiments can be modified, if necessary, to employ aspects, features and concepts of the various patents, applications and publications to provide yet further embodiments.

These and other changes can be made to the embodiments in light of the above detailed description. In general, in the claims, the terms used should not be construed to be limited to the specific embodiments disclosed in the specification and the claims, but should be construed to include all possible embodiments along with the full scope of equivalents to which such claims are entitled.

It will be understood by those of ordinary skill in the art that the foregoing embodiments are specific examples of carrying out the utility model and that various changes in form and details may be made therein without departing from the spirit and scope of the utility model.

Claims (13)

1. A novel combination endoscope, comprising:

an outer sheath having a channel, both ends of the channel being open;

a needle operably inserted into and through the passage of the outer sheath, the needle of the needle being located outside the outer sheath; the puncture needle is provided with a cavity, and the needle head of the puncture needle is provided with an opening communicated with the cavity;

an imaging member, said imaging member being operatively inserted into the cavity of said needle; and

a handle tube detachably connected to the proximal end of the sheath, the handle tube having a plurality of conduits, the plurality of conduits being in communication with the channel, the handle tube being operatively connected to the proximal end of the sheath after withdrawal of the needle and imaging member from the sheath;

wherein the sheath, the needle and the imaging member are operably assembled to form a piercing member having a gas-liquid path interface thereon for externally connecting a source of gas or liquid, the piercing member being operable for passage of gas or liquid and for expulsion from a distal end of the piercing member; the sheath is operably assembled with the handle tube to form a functional member.

2. The novel combination endoscope of claim 1, wherein the handle tube has a main tube portion detachably connected to the outer sheath, and at least two branch tube portions connected to the main tube portion; each of the branch pipe parts has one of the pipes therein;

one of the branch tube portions is operable for insertion and passage of the imaging member into the channel; the other of the branch pipe portions is operable for insertion and passage of a work piece into the passage.

3. The novel combination endoscope of claim 2, wherein the handle tube further comprises a first one-way valve,

the first one-way valve is adapted to be connected to at least one of the branch pipe parts and adapted to stop the outflow of gas or liquid towards the proximal end of the outer sheath.

4. The novel combination endoscope of claim 2, wherein the puncture needle is detachably connected to the imaging member; the puncture needle is provided with the gas-liquid path interface communicated with the cavity; and in the puncture member, the gas-liquid path interface is located outside the proximal end of the outer sheath.

5. The novel combination endoscope of claim 4, wherein the handle tube has three of the branch tube portions; yet another of the branch pipe parts is operable for pipe fitting access to gas or liquid into the passage.

6. The novel combination endoscope of claim 5, wherein said handle tube further has a three-way valve connected to said further said branch tube portion.

7. The novel combination endoscope of claim 2, wherein the sheath has the gas-liquid path port in communication with the channel, and a second one-way valve is provided on the sheath for blocking the flow of gas or liquid toward the proximal end of the sheath.

8. The novel combination endoscope of claim 7, wherein the handle tube has two of the branch tube portions.

9. The novel combination endoscope of claim 1, wherein the imaging member has a functional interface, an imaging light guide extension, a length shifter, and an insertion portion sequentially connected from a proximal end to a distal end;

the insertion portion is operable to be inserted into the lancet, and the length shifter is operable to be detachably connected to the proximal end of the lancet.

10. The novel combination endoscope of claim 9, wherein the functional interface has an imaging interface and a light source interface; the insertion portion has an imaging member, an illuminating member, and a protective tube surrounding the imaging member and the illuminating member.

11. The novel combination endoscope of claim 1, wherein the distal end of the sheath has a guide section, the outer diameter of the guide section gradually decreasing in the distal direction.

12. The novel combination endoscope of claim 1, wherein the outer surface of the puncture needle has scale marks.

13. The novel combination endoscope of claim 1, wherein the outer surface of the outer sheath has graduation marks.