JP2004267583A - Laparoscope defogging device, member for defogging laparoscope, optical transmission member for defogging laparoscope and defogging method for laparoscope - Google Patents

Laparoscope defogging device, member for defogging laparoscope, optical transmission member for defogging laparoscope and defogging method for laparoscope Download PDF

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JP2004267583A
JP2004267583A JP2003064518A JP2003064518A JP2004267583A JP 2004267583 A JP2004267583 A JP 2004267583A JP 2003064518 A JP2003064518 A JP 2003064518A JP 2003064518 A JP2003064518 A JP 2003064518A JP 2004267583 A JP2004267583 A JP 2004267583A
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laparoscope
laparoscopic
light
cylindrical body
fog
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JP2004267583A5 (en
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Takeshi Ohira
猛 大平
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Priority to PCT/JP2004/002637 priority patent/WO2004080294A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • A61B1/127—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements with means for preventing fogging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy

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Abstract

<P>PROBLEM TO BE SOLVED: To favorably prevent fogging on a laparoscope caused by not only the temperature difference but also oil contents such as a fat and to prevent the occurrence of a scattered light caused by coating, even if the coating of a material showing hydrophilicity such as titanium oxide is used for an optical transmission member for preventing defogging. <P>SOLUTION: This laparoscope defogging device is provided with a cylindrical body 3 having openings 30 and 31 in its both ends, allows the laparoscope 1 to insert from the opening 30 in the proximal end of the cylindrical body 3, and is provided with the optical transmission member 4 positioned in the opening 31 in the distal end of the cylindrical body 3 or in a part close to the opening 31. The optical transmission member 4 is provided with an external surface 40 and an internal surface 41 and, at least, the external surface 40 is formed with a hydrophilic coating. This device is further provided with a light guide 35 for emitting the light from the distal end of the cylindrical body 3 and a moisture feed passage 37 for feeding the moisture to the optical transmission member 4. <P>COPYRIGHT: (C)2004,JPO&NCIPI

Description

【０００１】
【発明の属する技術分野】
本発明は、腹腔鏡防曇装置に係り、より詳しくは、腹腔鏡とは別体の装置を腹腔鏡に装着することによって、腹腔鏡の先端部の曇り等を防止する手法に関するものである。本明細書において、「防曇」という言葉は広義で用いており、水蒸気による曇りのみならず、油膜や組織片の付着によって曇ることも含むものである。
【０００２】
【従来の技術】
腹腔鏡は、長尺状の本体と、本体の先端に設けた透光部と、本体の基端に設けた撮像部と、該本体の壁面に沿って延設された光ファイバからなるライトガイドと、ライトガイドに光を供給する光源と、該撮像部とモニターとを連結する伝送部とを有している。腹腔鏡手術の際には、該本体を腹腔に挿入し、ライトガイドから腹腔を照らし、撮像部からの像をモニターに表示する。
【０００３】
しかしながら、腹腔鏡手術の際には、腹腔鏡の本体の先端部の透光部が曇ったり、あるいは有機物が付着したりするので、手術中において、いかに先端部の透光を良好に保つかが極めて重要である。
【０００４】
腹腔鏡を腹腔に挿入した際に、腹腔鏡の先端が曇る主要な理由は、手術室の温度と体温との温度差にある。したがって、腹腔鏡の先端部位を加熱して体温と同じ温度に保つという手法が行なわれる。しかしながら、単に腹腔鏡の先端を加温しただけでは、先端部に付着した有機物等を除去することはできない。
【０００５】
また、腹腔鏡に送水手段を付加し、送水手段から送水によって腹腔鏡の先端部を洗浄するという手法も提案された。しかしながら、腹腔鏡の先端に付着する有機物の多くは脂肪であり、先端の透光部に油膜を形成してしまい、単に送水するだけでは付着した脂肪等を除去することはできない。
【０００６】
したがって、腹腔鏡の先端に有機物が付着することで光学像が不良となった場合には、都度、腹腔鏡を人体から取り出して清浄した後再び人体に挿入しているのが実状である。しかしながら、腹腔鏡手術中に腹腔鏡を取り出すということは、その間手術の進行が止まってしまうわけであり、一刻を争うような場合には、患者の生命にも関わる問題である。
【０００７】
一方、物体の表面に光触媒である酸化チタンを塗膜することで、物体表面の親水性を向上させることができ、その親水性を利用したセルフクリーニング効果が知られている。ここに、既存の腹腔鏡の先端の透光部（ガラスないしレンズ部）に酸化チタンをコーティングするということが考えられた。しかしながら、酸化チタン被膜を腹腔鏡のレンズ部のみにコーティングすることは技術的に難しい。腹腔鏡の先端に直接酸化チタンをコーティングした場合に、酸化チタンコーティングがレンズ部とライトガイドの光軸を共に被覆してしまうとレンズ部を通した画像にコーティングの膜厚内で屈折した青色散乱光が入り、視野障害が起きてしまうという問題がある。また、酸化チタンコーティングガラスの厚さを薄くすることで散乱光をなるべく押さえることも検討されたが、ガラスを薄くすることは安全性の面で問題があった。
【０００８】
【特許文献１】特開平６−２２９０２
【特許文献２】特開２００１−２９９６７８
【０００９】
【発明が解決しようとする課題】
本発明の目的は、温度差による腹腔鏡の曇りのみならず、脂肪等の油成分による曇りをも良好に防止する腹腔鏡の防曇装置を提供することにある。
【００１０】
本発明の他の目的は、防曇を目的として、光触媒である酸化チタン等の親水性・阻油性を呈する物質のコーティングを透光部材に用いる場合であっても、該コーティングに起因する散乱光が生じないようにすることにある。
【００１１】
【課題を解決するための手段】
かかる課題を解決するために本発明が採用した腹腔鏡防曇装置は、両端に開口を有する筒状体を有し、該筒状体の基端の開口から腹腔鏡を挿入可能に構成されている。該筒状体の先端の開口あるいは開口に近接した部位に位置して透光部材が設けられ、該透明部材は外側表面と内側表面とを有し、少なくとも該外側表面には親水性のコーティングが形成されている。該装置は、さらに、該筒状体の先端から光を照射するためのライトガイドと、該透光部材に水分を供給するための水分供給路とを備えている。一つの好ましい態様では、該筒状体の先端の開口には中空部に向って突出する縁部が形成されており、該縁部の周面が該開口を画定している。
【００１２】
該筒状体は、既存の腹腔鏡とは別体で用意され、該腹腔鏡を該筒状体の基端の開口から該筒状体の中空部に挿入させた状態で人体の腹部に挿入される。使用時において、筒状体の基端側は、人体の外部に位置している。腹腔への光の照射は、該腹腔鏡のライドガイドではなく、該筒状体のライトガイドを用いて該筒状体の先端から光を照射することで行い、該透光部材を介して腹腔鏡が光像を得る。腹腔鏡の先端は、筒状体と透光部材によって保護されているので、腹腔鏡の先端自体が曇ることはない。手術中、該透光部材には水分供給路から水分が供給されており、該透光部材に設けた親水性のコーティングによって、該透光部材の表面がセルフクリーニングされる。親水性のコーティングによって、透光部材の表面が温度差で曇ることがなく、また、透光部材の表面に油成分等が付着し難くなっている。透光部材の表面に油成分が付着した場合であっても、親水性コーティングの表面と油との間に水が入っていくので、油が自然に浮かび上がって油成分が自動的にとれてしまう。腹腔を照射する光は、服鏡腔のライトガイドではなく、筒状体のライトガイドによって案内されるため、ライトガイドからの光軸が透光部材を通過することがなく、よって、親水性コーティングに起因する散乱光が生ずることがない。したがって、透光部材の厚みを大きく取ることができる。
【００１３】
酸化チタン被膜等の親水性コーティングには寿命があり、親水性コーティングのメンテナンスや装置のランニングコスト等を考慮すると、透光部材は、ある部材に完全に固定されて一体化されたものではないことが望ましい。したがって、望ましくは、該透光部材は、手術時には、該筒状体の先端の開口あるいは開口に近接した部位に位置して、脱落しないように固定されており、かつ、容易に交換自在である。具体的な態様としては、該透光部材は該筒状体の先端の開口に着脱自在であること、あるいは、該透光部材は該腹腔鏡の先端に着脱自在であること、あるいは、該透光部材は、該腹腔鏡の先端の縁部と該縁部との間に挟持されることで固定されること、が例示される。
【００１４】
水分供給路は、好ましい態様では、該筒状体の内周面と該腹腔鏡の外周面との間に形成された間隙であり、あるいは、水分供給路は該筒状体の壁内に延設されている。該筒状体の基端側には水分供給口が設けてあり、該水分供給路は該水分供給口を介して水分供給源と流体連通されている。一つの好ましい態様では、該水分供給源は水タンクであり、該水タンクは直接該水供給口に連結されている。水分供給源として、筒状体に装着可能な小型の水タンクを採用することで、水分を供給するライン（例えば、可撓性パイプ）が不要となり、水分供給ラインが手術の妨げになることがない。好ましくは、水タンクの上面には水分供給用の開閉蓋が設けてあり、必要に応じて水タンクに水分を補給する。また、長時間に及ぶ手術の場合には、他の水分供給源から可撓性パイプを介して水分を供給してもよい。透光部材の外側表面を効率よく濡らすには、該水分供給路の先端からは、該透光部材の外側表面を横切るように水分が供給されるように構成することが望ましい。具体的な構成例では、該水分供給路の先端を、筒状体の先端に突成した縁部の周面に形成された一つ又は複数の開口とする。
【００１５】
ライトガイドは、該筒状体の長さ方向に延出しており、該ライトガイドの基端は該筒状体基端側に設けた光供給口に連結されており、該ライトガイドの先端は該筒状体の先端に達している。したがって、ライトガイドからの光軸が筒状体の先端の開口内に位置する透光部材を通過することがなく、よって、親水性コーティングに起因する散乱光が生ずることがない。
【００１６】
腹腔鏡防曇装置は、さらにエアー供給路を備えており、該透光部材の外側表面にエアーを送気可能に構成されていることが望ましい。なぜなら、透光部材の外側表面には、手術時に飛散する小組織片等が付着する場合があり、このような小組織片が付着した場合には、親水性コーティングの効果をもってしても、小組織片等を取り除くことができない場合があるからである。好ましい態様では、該エアー供給路は、該筒状体の内周面と該腹腔鏡の外周面との間隙であり、あるいは、エアー供給路は該筒状体の壁内を延出している。エアー供給路は、該水分供給路と共通であってもよく、あるいは、エアー供給路と水分供給路とは独立していてもよい。該筒状体の基端側にはエアー供給口が設けてあり、該エアー供給路は該エアー供給口を介してエアー供給源と流体連通されている。一つの好ましい態様では、該エアー供給源はエアータンクであり、該エアータンクは直接該エアー供給口に連結されている。エアー供給源として、筒状体に装着可能な小型のエアータンクを採用することで、エアーを供給するライン（例えば、可撓性パイプ）が不要となり、エアー供給ラインが手術の妨げになることがない。他の好ましい態様では、腹腔鏡の気腹装置をエアー供給源として使用する。腹腔鏡手術においては、気腹装置から腹腔に常時エアーを送気することが行なわれており、その気腹装置からのエアーを分流させて、エアー供給路に導入する。気腹装置からのエアーを用いるものでは、筒状体の先端からは常に清浄なエアーが噴射され、噴射されるエアーは同時に手術用気腹に関与するため、手術に影響を及ぼすことがない。さらに好ましくは、該可撓性パイプには、該エアー供給口に近接してリザーバが設けてあり、エアーの送気量が不足の場合には、リザーバを圧迫することでより強力なエアーを噴射することができる。透光部材の外側表面に付着した異物を良好に除去するには、該エアー供給路の先端からは、該透光部材の外側表面を横切るようにエアーが噴射されることが望ましい。具体的な構成例では、該エアー供給路の先端を、筒状体の先端に突成した縁部の周面に形成された一つ又は複数の開口とする。
【００１７】
【発明の実施の形態】
本発明の実施の形態について、図面を参照しながら説明する。本発明に係る腹腔鏡防曇用装置は、腹腔鏡とは別体の部材であり、防曇用装置を既存の腹腔鏡に装着することで手術を行なうものである。
【００１８】
図１は、従来の腹腔鏡を示す概略図であって、腹腔鏡は、長尺状の円筒部材からなる本体１を有している。本体１の先端には透光部が、本体の基端側には撮像部が設けてある。本体１の基端側には光供給口２が設けてあり、光供給口２は光源に連結される。本体１の壁内には光ファイバからなるライトガイドが延設されており、光供給口２から供給された光をライトガイドを介して本体１の先端から照射する。撮像部は光伝送部を介してモニターと連結される。腹腔鏡手術の際には、本体１を腹腔に挿入し、ライトガイドから供給された光で腹腔を照らし、撮像部からの得られた像をモニターに表示する。腹腔鏡の基本的構成および腹腔鏡を用いた手術法は公知である。
【００１９】
図２は、本発明に係る防曇装置の全体概略図であって、防曇装置は長尺部材からなる円筒状の筒状体３を有している。筒状体３の両端は開口状となっており、基端の開口３０と先端の開口３１とを有する。筒状体３の基端の開口３０から、腹腔鏡の長尺状の本体１の先端を挿入させ、本体１の先端が筒状体３の先端に近接するまで腹腔鏡の本体１を挿入させるようになっている。防曇用部材の筒状体３の内径は、腹腔鏡の本体１の外径より大きく設計されており、腹腔鏡を筒状体３に挿入させた状態において、筒状体３の内周面と本体１の外周面との間には、僅かな空隙Ｇが形成されている。
【００２０】
筒状体３の基端側には、筒状体３と腹腔鏡の本体１との固定機構が設けてあり、固定機構を図８に例示する。図２、図８（ａ）では、筒状体３の基端には、短筒状の樹脂製の保持部材３２が設けてある。筒状体３の基端の内周面及び保持部材３２の先端部位の外周面には螺子が設けてあり、保持部材３２は螺子機構を介して筒状体３の基端に装着されている。保持部材３２の内径は、腹腔鏡の本体１の外径より僅かに大きく設計されており、腹腔鏡の本体１は遊びがない状態で短筒状の保持部材３２の内周面にフィットすることで、筒状体３内における腹腔鏡の本体１の位置を固定する。保持部材３２の内周面と腹腔鏡の本体１の外周面との間の摩擦力は、外力が作用しない状態では、筒状体３と腹腔鏡の本体１とが互いにスライドすることを規制でき、軽い操作力で腹腔鏡の本体１を防曇用装置の筒状体３の中空部に対して抜き差しできるような程度の大きさである。手術時に、筒状体３の中空部に腹腔鏡の本体１を挿入させた状態を維持する機構は、上述のように摩擦力を利用するものに限定されるものではなく、他の機構であってもよい。筒状体３と腹腔鏡とを係脱自在に固定する機構の他の構成例を図８（ｂ）、（ｃ）に示す。図８（ｂ）、（ｃ）に示す固定機構は、いずれも、筒状体３の基端側の内面と腹腔鏡の本体１の基端側の外面との間Ｇに設けられるスペーサと該スペーサの固定手段とから構成される。具体的には、図８（ｂ）では、筒状体３の内側と腹腔鏡の本体１の外側との間に位置して、本体１を挟持するように対向状に配設されたゴムパッド３２０と、筒状体３の壁に貫設された螺子３２１とを有し、螺子３２１の先端には一方のゴムパッド３２０が装着されており、螺子３２１を筒状体３の長さ方向に直交する方向に移動させることで、ゴムパッド３２０を本体１に圧着するものである。図８（ｃ）では、本体１の基端側の外周には、リング部材３２２が周設されており、リング部材３２２は凸部を有している。筒状体３の基端側には、その先端が筒状体３の壁を貫通して筒状体３の中空部に臨むバネ式ストッパーレバー３２３が設けてある。レバー３２３の先端はリング部材３２２の凸部に係合する形状を有しており、レバー３２３の操作によって、レバー先端がリング部材３２２の凸部に係脱するようになっている。レバー３２３の操作によって、筒状体３と腹腔鏡とを固定する。あるいは、図示しないが、腹腔鏡の本体１の基端側の外周面に樹脂製の短筒体あるいはリング部材を装着し、腹腔鏡の本体１を筒状体３に挿入する際に、該短筒体あるいはリング部材が筒状体３の基端側の内周面にフィットするようにしてもよい。
【００２１】
防曇装置の筒状体３の先端の開口３１内には、ガラス等の透光部材４が、脱落しない状態で設けられる。防曇装置の筒状体３内に挿入された腹腔鏡は、筒状体３の先端の開口３１に設けた透光部材４を介して光学像を得るようになっている。
【００２２】
透光部材４は、筒状体３の外方に面する外側表面４０と筒状体３の中空部に面する内側表面４１とを有しており、外側表面４０、内側表面４１には、それぞれ親水性を有する膜が形成されている。好ましくは、親水性を有する膜としては、光触媒物質の膜が挙げられ、さらに好ましくは、光触媒物質は酸化チタンであり、透光部材４の外側表面４０、内側表面４１には酸化チタンのコーティングが施されている。ライトガイドから供給される光の光軸は透光部材４を通過しないが、装着前の紫外線照射によって手術中は十分親水性を維持することが可能である。実施例に係るコーティングにはシリカ（ＳｉＯ２）が含まれている。酸化チタンコーティングにシリカを含ませることが、紫外線照射後の防曇性能暗所維持に有利なことが判った。具体的には、透光部材４であるガラスの表面に酸化チタン層を形成し、さらに酸化チタン層の上に、シリカ層を形成する。シリカ層を設けることで暗所維持性能を向上させ、もって、手術直前まで紫外線照射しなくても、手術中も持続して防曇性能を長時間維持することを可能となる。酸化チタン層およびシリカ層は、単層コーティングのため作業を容易かつ迅速に行なうことができる。酸化チタン層およびシリカ層を形成する手段は、コーティングの効率からはスパッタリングが好ましいが、コーティング方法はスパッタリングに限定されない。また、後述するように、ライトガイドの光軸は透光部材を通過しないので、透光部材の表面に２層の膜を形成するものであっても、コーティングの透過性を十分に確保することができ、また、青色散乱光が顕著となってしまうことがない。尚、酸化チタンとシリカとを混合した１層の膜を透光部材の表面に形成するものであってもよいが、酸化チタンとシリカの混合コーティングは技術的に難しく、さらに、混合の均一性を厳格に保たなければならないという量産上の課題があり、２層のコーティングが有利である。また、本発明における酸化チタンコーティングはシリカを含むものに限定されるものではなく、シリカを含まないものであってもよい。酸化チタン膜が有効に機能するための寿命を考慮すると、透光部材４は防曇用部材の筒状体３とは別体で用意することで、交換可能であることが望ましい。
【００２３】
交換可能な透光部材の好適な実施形態について説明する。図３に示すように、透光部材４は、透明の白色ガラスから構成された円板であり、両面４０，４１には酸化チタン膜が形成されている。図３おいて参照符号５は補強リングであり、補強リング５は円板状の透光部材４の外径より僅かに大きい内径を有しており、透光部材４の周面４２に装着することで、透光部材４を補強する。補強リング５の外径は、腹腔鏡の本体１の外径と実質的に同じである。透光部材４は周面に補強リング５を装着した状態で、筒状体３の先端部位に着脱自在に装着される。
【００２４】
防曇装置の筒状体３の先端において、壁の内周面の先端部位が内側に突出することで突起状の縁部３３が形成されており、縁部３３の周面３３０が開口３１を画定している。筒状体３の先端の開口３１の径は、透光部材４の径よりも小さく設計されており、透光部材４は、腹腔鏡の本体１の先端部と筒状体３の先端の開口の縁部３３の側面との間で挟持されることで固定される。腹腔鏡の本体１を防曇装置の筒状体３から取り出せば、透光部材４は固定状態から解放され、透光部材４を防曇用部材の筒状体３の基端の開口３０から取り出すことができる。尚、図示のものでは、突起状の縁部３３を筒状体３の先端に形成したが、突起状の縁部３３を筒状体３の先端に近接する部位に突成させてもよい。
【００２５】
図３には、他の実施形態に係る補強リング５０も示してある。補強リング５０は、補強リング５にくらべて大きい幅を有し、先端側を縮径してあり、大径部５１と小径部５２とからなる。大径部５１の内径は腹腔鏡の本体１の外径より僅かに大きく、補強リング５０は大径部５１を介して腹腔鏡の本体１の先端に着脱自在に固定される。小径部５２の内径は透光部材４の外径より僅かに大きく設定されている。小径部５２の内側に透光部材４を嵌めることで、小径部５２が透光部材４を補強すると共に、透光部材４が腹腔鏡の本体１の先端に固定される。小径部５２には、一つあるいは複数の切欠き５３が形成されており、後述するように、切欠き５３を介して透光部材４への水分の供給を良好に行なうようにしている。
【００２６】
透光部材４の装着は、図示のものに限定されるものではなく、要は、腹腔鏡手術時に透光部材が脱落しないように一時的に固定することができ、かつ、透光部材が交換可能であれば、他の構成であってもよい。図９は筒状体３の他の実施例を示しており、筒状体３は、先端側の短筒体３００と筒状体本体３０１との２部材から構成されており、本体３０１の先端に短筒体３００が着脱可能となっている。具体的には、本体３０１の先端側の外周面は縮径されており、外周面には螺子が形成されている。短筒体３００の基端側の内周面にも螺子が形成されており、本体３０１の外周面の螺子が短筒体３００の内周面の螺子に螺合するようになっている。この構成では、先ず透光部材４であるコーティングガラスを短筒体３００の基端から挿入し、次いで、短筒体３００の基端に本体３０１の先端を装着する。そして、本体３０１の基端から腹腔鏡の本体１を挿入させて、腹腔鏡の本体１の先端の縁部と短筒体３００の先端部位との間にコーティングガラスを挟持させる。筒状体３の先端部位を着脱自在とすることで、透光部材４であるコーティングガラスの装着を容易に行なうことができるという利点がある。
【００２７】
防曇装置の筒状体３の基端側近傍には、光供給口３４が形成されており、光供給口３４は図示しない光源に連結されている。筒状体３の壁内には、長さ方向に延出するライトガイド３５が設けてある。ライトガイド３５は、多数の光ファイバから構成される。光ファイバは、筒状体３の壁内に周方向に亘って密に設けてある。ライトガイド３５の基端は供給口３４に連結されていると共に、ライトガイド３５の先端は筒状体３の先端（壁の端面）にまで達しており、光源から供給される光を筒状体３の先端から照射するようになっている。図４から明らかなように、透光部材４は筒状体３の先端の開口３１内に設けてあり、ライトガイド３５は筒状体３の壁内を延出しているので、光源からの光軸が透光部材４を通過することがなく、透光部材４のコーティングの影響で照明用の光が散乱することがないようになっている。したがって、十分な厚みを有する透光部材４を採用することができ、安全面でも優れる。さらには、酸化チタンコーティングの厚みも大きくすることができ、十分な親水性を発揮させることが可能となった。
【００２８】
次に、透光部材４への水の供給機構について説明する。親水性物質の膜を有する透光部材４がセルフクリーニング効果を奏するためには、透光部材４の表面が濡れている必要がある。したがって、透光部材４の表面への水の供給機構が必要となる。一つの好ましい態様では、筒状体３の内周面と腹腔鏡の本体１の外周面との間の空隙Ｇを水分供給路とするものである。筒状体３の基端側には水の供給口３６が形成されており、供給口３６と空隙Ｇとを流体連通させる。供給口３６と空隙Ｇとの連通手段としては、筒状体３の壁を貫通する孔を設ける、あるいは、筒状体３の基端の開口３０を利用することが例示される。供給口３６から空隙Ｇに供給された水は、筒状体３の先端の縁部３３と透光部材４との当接部から外方へと沁み出し、透光部材４の外方表面４０に供給される。また、透光部材４と腹腔鏡の本体１の先端の当接部からも水が沁み出し、透光部材４の内方表面４０に供給される。透光部材４がセルフクリーニング効果を有するためには、表面が濡れていれば良く、必ずしも透光部材４に水を圧送する必要はない。
【００２９】
水分供給路の他の態様を図４，５，６に示す。図５，６ではライトガイドは省略してある。筒状体３の壁内に筒状体３の長さ方向に延出する流路３７を形成する。流路３７の基端は供給口３６に流体連通されている。流路３７の先端は筒状体３の先端にまで達している。より具体的には、流路３７の先端は筒状体３の先端の縁部３３の内周面３３０に達しており、縁部３３の内周面３３０から、透光部材４の外方表面４０に水を供給できるようになっている。流路３７の本数は特には限定されず、一つあるいは複数である。
【００３０】
水の供給源について説明する。図５には、水タンク６が示してあり、水タンク６は筒状体３に形成した供給口３６に直接連結されている。水タンク６は供給口３６に対して着脱自在である。供給口３６には送水用リリースレバー７によって開閉可能な弁が設けてあり、レバー７の操作によって、水タンク６内の水を流路３７に供給するようになっている。レバー操作によって流体の流れを制御する手段は周知である。水タンク６の上面には開閉自在の図示しない蓋が設けてあり、水タンク内に水を補給できるようになっている。水タンク６を直接本体に設けたものは、余計なパイプ等の送水ラインが無いので、手術時の操作性が良好である。
【００３１】
手術が長時間に及ぶ場合等には、水タンク６に代えて、送水パイプ８の一端を供給口に連結し、送水パイプの他端に連結された水源（例えば、送水用点滴ユニット）から供給される水を、リリースレバー７によって弁を開放することで流路３７に供給する。
【００３２】
上述の酸化チタン膜を有する透光部材は、水供給機構との相乗効果によって、良好なセルフクリーニング機能を発揮する。しかしながら、手術時には、比較的大型な異物、例えば組織の一部、が透光部材の表面に付着することがある。このような異物を良好に除去するためには、防曇装置は、送気機構を有することが望ましい。送気機構の構成としては水供給機構と類似の構成を採用することができ、筒状体３の基端側にエアー供給口３８を形成する。エアー流路としては、本体と腹膜鏡の空隙を利用するもの、あるいは、本体壁内に長さ方向に延出するエアー流路３９を形成することが例示される。また、水分供給路とエアー供給路とを一つの流路で兼用してもよい。
【００３３】
図５は、エアー供給源としてエアータンク９を示しており、エアータンク９には圧搾空気が充填されており、エアータンク９は筒状体３の供給口３８に直接連結されている。供給口３８には送気用リリースレバー１０によって開閉可能な弁が設けてあり、レバー１０の操作によって、エアータンク９内のエアーを流路３９に供給するようになっている。エアータンク９はフレキシブルな部材から構成されており、供給路先端からの送気が不十分な場合には、エアータンクを押しつぶして圧迫することで、エアーを圧送する。
【００３４】
手術が長時間に及ぶ場合等には、エアータンク９に代えて、エアーパイプの一端を供給口に連結し、パイプの他端に連結されたエアー源から供給されるエアーを、リリースレバー１０によって弁を開放することで流路３９に供給する。図７は、エアー供給源を腹腔鏡手術の際に利用する気膜装置１１としたものを示す概略図である。気膜装置１１からのエアー回路を分流して筒状体３の供給口３８に連結する。具体的には、エアー回路は分岐を有するチューブである。チューブは、基端が気膜装置１１に連結される第１チューブ１２と、第１チューブ１２の先端にその基端が連結されたＹ字管１３と、Ｙ字管１３の一方の先端にその基端が連結された第２チューブ１４と、Ｙ字管１３の他方の先端にその基端が連結された第３チューブ１５とを有し、第２チューブ１２の先端は従来の腹腔鏡手術用操作ポート１６に連結され、第３チューブ１５の先端は防曇用部材の供給口３８に連結される。第３チューブ１５には先端に近接してリザーバ１７が設けてあり、リザーバ１７は一つの好ましい例では、耐圧製ゴムから形成される。
【００３５】
このように構成されたエアー供給機構において、必要時には、エアリリースボタンをワンプッシュすることで、エアー供給路にエアーが導入され、エアー供給路の先端から透光部材の外側表面にエアーを噴射することで、外側表面に付着した組織や水分を除去することができる。さらに、エアーの送気量が不足の場合には、リザーバを圧迫することでより強力なエアーを噴射することができる。気腹装置からのエアーを用いるものでは、筒状体の先端からは常に清浄なエアーが噴射され、噴射されるエアーは同時に手術用気腹に関与するための、手術に影響を及ぼすことがない。
【図面の簡単な説明】
【図１】従来の腹腔鏡の概略図である。
【図２】本発明に係る腹腔鏡防曇装置の概略図である。
【図３】透光部材としての酸化チタン被膜を有するガラス、透光部材の補強用リング、補強用リングの他の実施態様を示す図である。
【図４】使用時における腹腔鏡と本発明に係る腹腔鏡防曇装置との関係を示す概略図である。
【図５】本発明に係る腹腔鏡防曇装置の水分供給機構およびエアー供給機構の一つの実施例を示す図および筒状体を正面から見た図である。
【図６】本発明に係る腹腔鏡防曇装置の水分供給機構およびエアー供給機構の他の実施例を示す図である。
【図７】エアー供給機構の一つの実施例を示す図である。
【図８】筒状体と腹腔鏡との固定機構を示す図である。
【図９】筒状体の他の実施例を示す図である。
【符号の説明】
１ 腹腔鏡
３ 筒状体
３０ 筒状体基端の開口
３１ 筒状体先端の開口
３３ 縁部
３３０ 縁部周面
３４ 光供給口
３５ ライトガイド
３６ 水分供給口
３７ 水分供給路
３８ エアー供給口
３９ エアー供給路
Ｇ 間隙
５ 補強リング
６ 水タンク
９ エアータンク
Ｇ 間隙[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a laparoscopic anti-fog device, and more particularly, to a method for preventing a fogging or the like at a distal end portion of a laparoscope by attaching a device separate from the laparoscope to the laparoscope. In this specification, the term "anti-fog" is used in a broad sense, and includes not only fogging due to water vapor but also fogging due to adhesion of an oil film or tissue fragments.
[0002]
[Prior art]
The laparoscope is a light guide comprising a long body, a light-transmitting part provided at the tip of the body, an imaging part provided at the base end of the body, and an optical fiber extending along a wall surface of the body. A light source that supplies light to the light guide, and a transmission unit that connects the imaging unit and the monitor. During laparoscopic surgery, the main body is inserted into the abdominal cavity, the abdominal cavity is illuminated from a light guide, and an image from the imaging unit is displayed on a monitor.
[0003]
However, during laparoscopic surgery, the light-transmitting part at the distal end of the main body of the laparoscope becomes cloudy or organic substances adhere to it, so it is important to maintain good light transmission at the distal end during the operation. Very important.
[0004]
The main reason that the tip of the laparoscope becomes cloudy when the laparoscope is inserted into the abdominal cavity is a temperature difference between the operating room temperature and the body temperature. Therefore, a method of heating the distal end portion of the laparoscope to maintain the same temperature as the body temperature is performed. However, simply heating the distal end of the laparoscope cannot remove organic substances and the like attached to the distal end.
[0005]
In addition, a method has been proposed in which a water supply means is added to the laparoscope, and the distal end of the laparoscope is washed by water supply from the water supply means. However, most of the organic matter adhering to the tip of the laparoscope is fat, and an oil film is formed on the light-transmitting portion at the tip, so that the adhering fat and the like cannot be removed simply by sending water.
[0006]
Therefore, when the optical image becomes poor due to the organic matter adhering to the tip of the laparoscope, the actual situation is that the laparoscope is taken out of the human body, cleaned, and then inserted into the human body again. However, taking out the laparoscope during laparoscopic surgery means that the progress of the operation is stopped during that time, and in a case where it is urgent, the problem is related to the life of the patient.
[0007]
On the other hand, by coating titanium oxide, which is a photocatalyst, on the surface of an object, the hydrophilicity of the object surface can be improved, and a self-cleaning effect utilizing the hydrophilicity is known. Here, it was conceived that titanium oxide was coated on the light transmitting part (glass or lens part) at the tip of the existing laparoscope. However, it is technically difficult to coat the titanium oxide film only on the lens portion of the laparoscope. When titanium oxide is coated directly on the tip of the laparoscope, if the titanium oxide coating covers both the lens and the optical axis of the light guide, the blue scattering refracted within the coating thickness into the image through the lens There is a problem that light enters and a visual field obstruction occurs. It has also been considered to reduce scattered light as much as possible by reducing the thickness of the titanium oxide-coated glass, but reducing the thickness of the glass has a problem in terms of safety.
[0008]
[Patent Document 1] JP-A-6-22902
[Patent Document 2] JP-A-2001-299678
[0009]
[Problems to be solved by the invention]
SUMMARY OF THE INVENTION An object of the present invention is to provide a laparoscopic anti-fogging device capable of favorably preventing not only fogging of a laparoscope due to a temperature difference but also fogging of an oil component such as fat.
[0010]
Another object of the present invention is to provide a light-transmitting member using a coating of a substance exhibiting hydrophilicity and oil-blocking properties, such as titanium oxide, which is a photocatalyst, for the purpose of anti-fogging. Is to prevent the occurrence.
[0011]
[Means for Solving the Problems]
A laparoscopic anti-fog device adopted by the present invention to solve this problem has a tubular body having openings at both ends, and is configured so that a laparoscope can be inserted from an opening at the base end of the tubular body. I have. A light-transmitting member is provided at an opening at or near the opening at the tip of the cylindrical body, the transparent member has an outer surface and an inner surface, and at least the outer surface has a hydrophilic coating. Is formed. The apparatus further includes a light guide for irradiating light from the tip of the cylindrical body, and a moisture supply path for supplying moisture to the light transmitting member. In one preferred embodiment, an edge protruding toward the hollow portion is formed in the opening at the tip of the cylindrical body, and the peripheral surface of the edge defines the opening.
[0012]
The tubular body is prepared separately from the existing laparoscope, and is inserted into the abdomen of the human body with the laparoscope inserted into the hollow portion of the tubular body from the opening at the base end of the tubular body. Is done. In use, the proximal end of the tubular body is located outside the human body. Irradiation of light to the abdominal cavity is performed by irradiating light from the distal end of the cylindrical body using the light guide of the cylindrical body, not the light guide of the laparoscope, and the abdominal cavity is transmitted through the light transmitting member. A mirror obtains a light image. Since the distal end of the laparoscope is protected by the cylindrical body and the light transmitting member, the distal end of the laparoscope does not fog. During operation, the translucent member is supplied with moisture from a moisture supply channel, and the surface of the translucent member is self-cleaned by the hydrophilic coating provided on the translucent member. The hydrophilic coating prevents the surface of the light transmitting member from fogging due to a temperature difference, and also makes it difficult for oil components and the like to adhere to the surface of the light transmitting member. Even if the oil component adheres to the surface of the translucent member, water enters between the surface of the hydrophilic coating and the oil, so that the oil comes up naturally and the oil component is automatically removed. I will. Since the light irradiating the abdominal cavity is guided by the light guide of the tubular body, not the light guide of the mirror cavity, the optical axis from the light guide does not pass through the light transmitting member, and therefore, the hydrophilic coating is applied. No scattered light is generated due to this. Therefore, the thickness of the light transmitting member can be increased.
[0013]
Titanium oxide coatings and other hydrophilic coatings have a life span, and considering the maintenance of the hydrophilic coating and the running costs of the equipment, the light-transmitting member is not completely fixed and integrated with a certain member. Is desirable. Therefore, desirably, at the time of surgery, the translucent member is located at the opening at or near the opening at the distal end of the cylindrical body, is fixed so as not to fall off, and is easily replaceable. . As a specific mode, the light-transmitting member is detachable from an opening at the distal end of the cylindrical body, or the light-transmitting member is detachable from the distal end of the laparoscope, or It is exemplified that the optical member is fixed by being sandwiched between the edge of the distal end of the laparoscope and the edge.
[0014]
In a preferred embodiment, the water supply path is a gap formed between the inner peripheral surface of the cylindrical body and the outer peripheral surface of the laparoscope, or the water supply path extends in the wall of the cylindrical body. Is established. A water supply port is provided at the base end side of the cylindrical body, and the water supply path is in fluid communication with a water supply source via the water supply port. In one preferred embodiment, the water supply is a water tank, which is directly connected to the water supply. By employing a small water tank that can be attached to a cylindrical body as a water supply source, a line for supplying water (for example, a flexible pipe) becomes unnecessary, and the water supply line may hinder the operation. Absent. Preferably, an opening / closing lid for supplying water is provided on the upper surface of the water tank, and water is supplied to the water tank as needed. In the case of a long operation, water may be supplied from another water supply source via a flexible pipe. In order to efficiently wet the outer surface of the light-transmitting member, it is preferable that water be supplied from the tip of the water supply passage so as to cross the outer surface of the light-transmitting member. In a specific configuration example, the distal end of the water supply path is one or a plurality of openings formed on a peripheral surface of an edge formed at the distal end of the tubular body.
[0015]
The light guide extends in the length direction of the tubular body, a base end of the light guide is connected to a light supply port provided on a base end side of the tubular body, and a tip end of the light guide is It reaches the tip of the tubular body. Therefore, the optical axis from the light guide does not pass through the translucent member located in the opening at the tip of the cylindrical body, and therefore, scattered light due to the hydrophilic coating does not occur.
[0016]
It is preferable that the laparoscopic defogging apparatus further includes an air supply path, and is configured to be able to supply air to the outer surface of the light transmitting member. This is because small tissue fragments or the like scattered during surgery may adhere to the outer surface of the light-transmitting member, and when such small tissue fragments adhere, even if they have the effect of a hydrophilic coating, they may be small. This is because it may not be possible to remove a piece of tissue or the like. In a preferred embodiment, the air supply path is a gap between the inner peripheral surface of the cylindrical body and the outer peripheral surface of the laparoscope, or the air supply path extends inside the wall of the cylindrical body. The air supply path may be common to the water supply path, or the air supply path and the water supply path may be independent. An air supply port is provided at a base end side of the cylindrical body, and the air supply path is in fluid communication with an air supply source via the air supply port. In one preferred embodiment, the air supply is an air tank, and the air tank is directly connected to the air supply. By employing a small air tank that can be attached to the cylindrical body as the air supply source, a line for supplying air (for example, a flexible pipe) is not required, and the air supply line may hinder the operation. Absent. In another preferred embodiment, a laparoscopic insufflation device is used as the air supply. In laparoscopic surgery, air is constantly supplied from the insufflation device to the abdominal cavity, and the air from the insufflation device is diverted and introduced into the air supply path. In the case of using air from the insufflation device, clean air is always jetted from the tip of the tubular body, and the jetted air simultaneously affects the insufflation for surgery, so that it does not affect the operation. More preferably, the flexible pipe is provided with a reservoir close to the air supply port, and when the air supply amount is insufficient, more powerful air is injected by pressing the reservoir. can do. In order to satisfactorily remove foreign matter adhering to the outer surface of the light transmitting member, it is desirable that air be jetted from the tip of the air supply passage so as to cross the outer surface of the light transmitting member. In a specific configuration example, the tip of the air supply path is one or a plurality of openings formed on the peripheral surface of the edge protruding from the tip of the tubular body.
[0017]
BEST MODE FOR CARRYING OUT THE INVENTION
Embodiments of the present invention will be described with reference to the drawings. The laparoscopic anti-fog device according to the present invention is a member separate from the laparoscope, and performs surgery by mounting the anti-fog device on an existing laparoscope.
[0018]
FIG. 1 is a schematic view showing a conventional laparoscope, which has a main body 1 made of a long cylindrical member. A light transmitting unit is provided at the distal end of the main body 1 and an imaging unit is provided at the base end side of the main body. A light supply port 2 is provided on the base end side of the main body 1, and the light supply port 2 is connected to a light source. A light guide made of an optical fiber extends in the wall of the main body 1, and irradiates the light supplied from the light supply port 2 from the tip of the main body 1 through the light guide. The imaging unit is connected to the monitor via the optical transmission unit. At the time of laparoscopic surgery, the main body 1 is inserted into the abdominal cavity, the abdominal cavity is illuminated with light supplied from the light guide, and an image obtained from the imaging unit is displayed on the monitor. The basic configuration of a laparoscope and a surgical method using the laparoscope are known.
[0019]
FIG. 2 is an overall schematic diagram of the anti-fogging device according to the present invention. The anti-fogging device has a cylindrical tubular body 3 made of a long member. Both ends of the cylindrical body 3 are open, and have a base opening 30 and a front opening 31. The distal end of the elongated main body 1 of the laparoscope is inserted through the opening 30 at the base end of the cylindrical body 3, and the main body 1 of the laparoscope is inserted until the distal end of the main body 1 approaches the distal end of the cylindrical body 3. It has become. The inner diameter of the cylindrical body 3 of the anti-fog member is designed to be larger than the outer diameter of the main body 1 of the laparoscope, and the inner peripheral surface of the cylindrical body 3 when the laparoscope is inserted into the cylindrical body 3. A slight gap G is formed between the body and the outer peripheral surface of the main body 1.
[0020]
A fixing mechanism for fixing the cylindrical body 3 to the main body 1 of the laparoscope is provided on the base end side of the cylindrical body 3, and the fixing mechanism is illustrated in FIG. In FIG. 2 and FIG. 8A, a short tubular resin holding member 32 is provided at the base end of the tubular body 3. Screws are provided on the inner peripheral surface of the proximal end of the cylindrical body 3 and the outer peripheral surface of the distal end portion of the holding member 32, and the holding member 32 is attached to the proximal end of the cylindrical body 3 via a screw mechanism. . The inner diameter of the holding member 32 is designed to be slightly larger than the outer diameter of the main body 1 of the laparoscope, and the main body 1 of the laparoscope fits the inner peripheral surface of the short cylindrical holding member 32 without play. Then, the position of the main body 1 of the laparoscope in the tubular body 3 is fixed. The frictional force between the inner peripheral surface of the holding member 32 and the outer peripheral surface of the main body 1 of the laparoscope can prevent the cylindrical body 3 and the main body 1 of the laparoscope from sliding with each other when no external force is applied. The size is such that the main body 1 of the laparoscope can be inserted into and removed from the hollow portion of the tubular body 3 of the anti-fogging device with a light operating force. The mechanism for maintaining the state in which the main body 1 of the laparoscope is inserted into the hollow portion of the cylindrical body 3 during the operation is not limited to the mechanism using the frictional force as described above, but may be another mechanism. You may. FIGS. 8B and 8C show another configuration example of a mechanism for removably fixing the tubular body 3 and the laparoscope. Each of the fixing mechanisms shown in FIGS. 8B and 8C has a spacer provided in a space G between the inner surface on the proximal end side of the tubular body 3 and the outer surface on the proximal end side of the main body 1 of the laparoscope. And spacer fixing means. More specifically, in FIG. 8B, a rubber pad 320 is provided between the inside of the tubular body 3 and the outside of the main body 1 of the laparoscope, and is disposed to face the main body 1 so as to sandwich the main body 1. And a screw 321 penetrating the wall of the cylindrical body 3. One end of the screw 321 is provided with one rubber pad 320, and the screw 321 is orthogonal to the longitudinal direction of the cylindrical body 3. The rubber pad 320 is pressed against the main body 1 by moving the rubber pad 320 in the direction. In FIG. 8C, a ring member 322 is provided around the outer periphery of the base end side of the main body 1, and the ring member 322 has a convex portion. On the base end side of the cylindrical body 3, a spring-type stopper lever 323 whose leading end penetrates the wall of the cylindrical body 3 and faces the hollow portion of the cylindrical body 3 is provided. The distal end of the lever 323 has a shape that engages with the convex portion of the ring member 322, and the lever distal end engages and disengages with the convex portion of the ring member 322 by operating the lever 323. By operating the lever 323, the tubular body 3 and the laparoscope are fixed. Alternatively, although not shown, a short cylindrical body or ring member made of resin is attached to the outer peripheral surface on the base end side of the main body 1 of the laparoscope, and when the main body 1 of the laparoscope is inserted into the cylindrical body 3, The cylindrical body or the ring member may be fitted to the inner peripheral surface on the base end side of the cylindrical body 3.
[0021]
In the opening 31 at the tip of the tubular body 3 of the anti-fog device, a light-transmitting member 4 such as glass is provided so as not to fall off. The laparoscope inserted into the cylindrical body 3 of the anti-fog device obtains an optical image through the light transmitting member 4 provided in the opening 31 at the distal end of the cylindrical body 3.
[0022]
The light transmitting member 4 has an outer surface 40 facing the outer side of the tubular body 3 and an inner surface 41 facing the hollow portion of the tubular body 3. Each has a hydrophilic film. Preferably, the film having hydrophilicity includes a film of a photocatalytic substance. More preferably, the photocatalytic substance is titanium oxide, and the outer surface 40 and the inner surface 41 of the light transmitting member 4 are coated with titanium oxide. It has been subjected. Although the optical axis of the light supplied from the light guide does not pass through the translucent member 4, it is possible to maintain sufficient hydrophilicity during the operation by irradiating ultraviolet rays before mounting. The coating according to the example is silica (SiO 2 )It is included. It has been found that the inclusion of silica in the titanium oxide coating is advantageous for keeping the antifogging performance after irradiation with ultraviolet light in a dark place. Specifically, a titanium oxide layer is formed on the surface of the glass that is the light transmitting member 4, and a silica layer is formed on the titanium oxide layer. By providing the silica layer, the performance of maintaining dark place is improved, so that it is possible to maintain the anti-fog performance continuously for a long time even during the operation without irradiating ultraviolet rays until immediately before the operation. The titanium oxide layer and the silica layer can be easily and quickly operated because of the single layer coating. The means for forming the titanium oxide layer and the silica layer is preferably sputtering from the viewpoint of coating efficiency, but the coating method is not limited to sputtering. Further, as described later, since the optical axis of the light guide does not pass through the light transmitting member, even if a two-layer film is formed on the surface of the light transmitting member, it is necessary to ensure sufficient transparency of the coating. And blue scattered light does not become noticeable. It is to be noted that a single-layer film in which titanium oxide and silica are mixed may be formed on the surface of the light-transmitting member. However, the mixed coating of titanium oxide and silica is technically difficult, and furthermore, the uniformity of mixing is high. Has to be kept strict, and a two-layer coating is advantageous. Further, the titanium oxide coating in the present invention is not limited to the one containing silica, and may not contain silica. In consideration of the life for the titanium oxide film to function effectively, it is desirable that the light-transmitting member 4 be replaceable by being prepared separately from the cylindrical member 3 of the anti-fog member.
[0023]
A preferred embodiment of the replaceable light transmitting member will be described. As shown in FIG. 3, the light transmitting member 4 is a disk made of transparent white glass, and a titanium oxide film is formed on both surfaces 40 and 41. In FIG. 3, reference numeral 5 denotes a reinforcing ring. The reinforcing ring 5 has an inner diameter slightly larger than the outer diameter of the disc-shaped light transmitting member 4, and is attached to the peripheral surface 42 of the light transmitting member 4. Thus, the light transmitting member 4 is reinforced. The outer diameter of the reinforcing ring 5 is substantially the same as the outer diameter of the laparoscope body 1. The light transmitting member 4 is detachably attached to the distal end portion of the tubular body 3 with the reinforcing ring 5 attached to the peripheral surface.
[0024]
At the tip of the cylindrical body 3 of the anti-fog device, a projecting edge 33 is formed by projecting inward at the tip of the inner peripheral surface of the wall, and the peripheral surface 330 of the edge 33 defines the opening 31. It is defined. The diameter of the opening 31 at the distal end of the cylindrical body 3 is designed to be smaller than the diameter of the light transmitting member 4. Is fixed by being sandwiched between the side surface of the edge portion 33 of the second member. When the main body 1 of the laparoscope is removed from the cylindrical body 3 of the anti-fog device, the light transmitting member 4 is released from the fixed state, and the light transmitting member 4 is removed from the opening 30 at the base end of the cylindrical body 3 of the anti-fog member. Can be taken out. In the illustrated example, the protruding edge 33 is formed at the tip of the cylindrical body 3, but the protruding edge 33 may be formed protruding from a portion close to the tip of the cylindrical body 3.
[0025]
FIG. 3 also shows a reinforcing ring 50 according to another embodiment. The reinforcing ring 50 has a larger width than the reinforcing ring 5, and has a reduced diameter at the distal end side, and includes a large diameter portion 51 and a small diameter portion 52. The inner diameter of the large diameter portion 51 is slightly larger than the outer diameter of the main body 1 of the laparoscope, and the reinforcing ring 50 is detachably fixed to the distal end of the main body 1 of the laparoscope via the large diameter portion 51. The inner diameter of the small diameter portion 52 is set slightly larger than the outer diameter of the light transmitting member 4. By fitting the light transmitting member 4 inside the small diameter portion 52, the small diameter portion 52 reinforces the light transmitting member 4 and the light transmitting member 4 is fixed to the distal end of the main body 1 of the laparoscope. One or a plurality of notches 53 are formed in the small-diameter portion 52, so that water can be favorably supplied to the light transmitting member 4 through the notches 53 as described later.
[0026]
The mounting of the light transmitting member 4 is not limited to the one shown in the drawing. In short, it can be temporarily fixed so that the light transmitting member does not fall off during laparoscopic surgery, and the light transmitting member can be replaced. If possible, another configuration may be used. FIG. 9 shows another embodiment of the tubular body 3. The tubular body 3 is composed of two members, a short tubular body 300 on the distal end side and a tubular body main body 301. The short cylindrical body 300 is detachable. Specifically, the outer peripheral surface on the distal end side of the main body 301 is reduced in diameter, and a screw is formed on the outer peripheral surface. Screws are also formed on the inner peripheral surface on the base end side of the short cylinder 300, and the screws on the outer peripheral surface of the main body 301 are screwed with the screws on the inner peripheral surface of the short cylinder 300. In this configuration, first, the coating glass that is the light transmitting member 4 is inserted from the base end of the short cylinder 300, and then the front end of the main body 301 is attached to the base end of the short cylinder 300. Then, the main body 1 of the laparoscope is inserted from the base end of the main body 301, and the coating glass is sandwiched between the edge of the distal end of the main body 1 of the laparoscope and the distal end portion of the short cylinder 300. By making the distal end portion of the tubular body 3 detachable, there is an advantage that the coating glass as the light transmitting member 4 can be easily mounted.
[0027]
A light supply port 34 is formed near the base end side of the tubular body 3 of the anti-fog device, and the light supply port 34 is connected to a light source (not shown). A light guide 35 extending in the length direction is provided in the wall of the tubular body 3. The light guide 35 is composed of many optical fibers. The optical fibers are densely provided in the wall of the cylindrical body 3 in the circumferential direction. The proximal end of the light guide 35 is connected to the supply port 34, and the distal end of the light guide 35 reaches the distal end (end surface of the wall) of the cylindrical body 3 so that the light supplied from the light source is transmitted to the cylindrical body 3. Irradiation is performed from the tip of No. 3. As is clear from FIG. 4, the light transmitting member 4 is provided in the opening 31 at the tip of the cylindrical body 3, and the light guide 35 extends inside the wall of the cylindrical body 3. The shaft does not pass through the light transmitting member 4, and the light for illumination is not scattered by the influence of the coating of the light transmitting member 4. Therefore, the light-transmitting member 4 having a sufficient thickness can be employed, which is excellent in safety. Furthermore, the thickness of the titanium oxide coating can be increased, and sufficient hydrophilicity can be exhibited.
[0028]
Next, a mechanism for supplying water to the light transmitting member 4 will be described. In order for the light transmitting member 4 having a film of a hydrophilic substance to exhibit a self-cleaning effect, the surface of the light transmitting member 4 needs to be wet. Therefore, a mechanism for supplying water to the surface of the light transmitting member 4 is required. In one preferred embodiment, a gap G between the inner peripheral surface of the cylindrical body 3 and the outer peripheral surface of the main body 1 of the laparoscope is used as a water supply path. A water supply port 36 is formed at the base end side of the cylindrical body 3, and fluid communication between the supply port 36 and the gap G is made. Examples of the communication means between the supply port 36 and the gap G include providing a hole penetrating the wall of the tubular body 3 or using the opening 30 at the base end of the tubular body 3. The water supplied to the gap G from the supply port 36 oozes outward from the contact portion between the edge 33 of the tip of the cylindrical body 3 and the light transmitting member 4, and the outer surface 40 of the light transmitting member 4. Supplied to Further, water seeps out from the contact portion between the light transmitting member 4 and the tip of the main body 1 of the laparoscope, and is supplied to the inner surface 40 of the light transmitting member 4. In order for the light transmitting member 4 to have a self-cleaning effect, the surface only needs to be wet, and it is not always necessary to pump water to the light transmitting member 4.
[0029]
Another embodiment of the water supply path is shown in FIGS. 5 and 6, the light guide is omitted. A flow path 37 extending in the length direction of the tubular body 3 is formed in the wall of the tubular body 3. The base end of the channel 37 is in fluid communication with the supply port 36. The tip of the flow path 37 reaches the tip of the cylindrical body 3. More specifically, the distal end of the flow path 37 reaches the inner peripheral surface 330 of the edge 33 at the distal end of the tubular body 3, and from the inner peripheral surface 330 of the edge 33, the outer surface of the light transmitting member 4. 40 can be supplied with water. The number of the channels 37 is not particularly limited, and may be one or more.
[0030]
The water supply source will be described. FIG. 5 shows a water tank 6, which is directly connected to a supply port 36 formed in the tubular body 3. The water tank 6 is detachable from the supply port 36. The supply port 36 is provided with a valve that can be opened and closed by a water supply release lever 7, and the water in the water tank 6 is supplied to the flow path 37 by operating the lever 7. Means for controlling the flow of fluid by lever operation are well known. An openable / closable lid (not shown) is provided on the upper surface of the water tank 6 so that water can be supplied into the water tank. In the case where the water tank 6 is provided directly on the main body, the operability at the time of surgery is good because there is no extra water supply line such as a pipe.
[0031]
When the operation is performed for a long time, instead of the water tank 6, one end of the water supply pipe 8 is connected to the supply port, and the water is supplied from a water source (for example, a water supply drip unit) connected to the other end of the water supply pipe. The supplied water is supplied to the flow path 37 by opening the valve by the release lever 7.
[0032]
The translucent member having the above-described titanium oxide film exhibits a good self-cleaning function by a synergistic effect with the water supply mechanism. However, at the time of surgery, a relatively large foreign substance, for example, a part of tissue, may adhere to the surface of the light transmitting member. In order to satisfactorily remove such foreign matter, it is desirable that the anti-fog device has an air supply mechanism. As a configuration of the air supply mechanism, a configuration similar to that of the water supply mechanism can be adopted, and an air supply port 38 is formed on the base end side of the tubular body 3. Examples of the air flow path include a method using a gap between the main body and the peritoneal mirror, and a method of forming an air flow path 39 extending in the length direction in the main body wall. Further, the water supply path and the air supply path may be shared by one flow path.
[0033]
FIG. 5 shows an air tank 9 as an air supply source. The air tank 9 is filled with compressed air, and the air tank 9 is directly connected to a supply port 38 of the tubular body 3. The supply port 38 is provided with a valve that can be opened and closed by an air supply release lever 10, and the air in the air tank 9 is supplied to the flow path 39 by operating the lever 10. The air tank 9 is made of a flexible member, and when the air supply from the supply path end is insufficient, the air is pressure-fed by squeezing and pressing the air tank.
[0034]
When the operation is performed for a long time or the like, instead of the air tank 9, one end of an air pipe is connected to a supply port, and air supplied from an air source connected to the other end of the pipe is released by a release lever 10. When the valve is opened, the gas is supplied to the flow path 39. FIG. 7 is a schematic diagram showing the air supply source used as a pneumatic membrane device 11 used during laparoscopic surgery. The air circuit from the film membrane device 11 is divided and connected to the supply port 38 of the cylindrical body 3. Specifically, the air circuit is a tube having a branch. The tube has a first tube 12 whose base end is connected to the pneumatic membrane device 11, a Y-tube 13 whose base end is connected to the front end of the first tube 12, and a Y-tube 13 at one end of the Y-tube 13. It has a second tube 14 having a proximal end connected thereto, and a third tube 15 having a proximal end connected to the other distal end of the Y-shaped tube 13. The distal end of the second tube 12 is a conventional tube for laparoscopic surgery. The distal end of the third tube 15 is connected to the supply port 38 of the antifogging member. A reservoir 17 is provided near the distal end of the third tube 15, and in one preferred example, the reservoir 17 is made of pressure-resistant rubber.
[0035]
In the air supply mechanism configured as described above, when necessary, one-push of the air release button introduces air into the air supply path and injects air from the tip of the air supply path to the outer surface of the light transmitting member. This makes it possible to remove tissue and moisture attached to the outer surface. Furthermore, when the air supply amount is insufficient, more powerful air can be injected by pressing the reservoir. In the case of using air from the insufflation device, clean air is always jetted from the tip of the tubular body, and the jetted air simultaneously affects the insufflation for surgery, so it does not affect surgery .
[Brief description of the drawings]
FIG. 1 is a schematic view of a conventional laparoscope.
FIG. 2 is a schematic view of a laparoscopic anti-fog device according to the present invention.
FIG. 3 is a view showing another embodiment of glass having a titanium oxide film as a light transmitting member, a reinforcing ring of the light transmitting member, and a reinforcing ring.
FIG. 4 is a schematic diagram showing the relationship between the laparoscope and the laparoscopic anti-fog device according to the present invention during use.
FIG. 5 is a view showing one embodiment of a water supply mechanism and an air supply mechanism of the laparoscopic defogging apparatus according to the present invention, and a view of the tubular body as viewed from the front.
FIG. 6 is a view showing another embodiment of the water supply mechanism and the air supply mechanism of the laparoscopic anti-fog device according to the present invention.
FIG. 7 is a diagram showing one embodiment of an air supply mechanism.
FIG. 8 is a view showing a fixing mechanism of the tubular body and the laparoscope.
FIG. 9 is a view showing another embodiment of the tubular body.
[Explanation of symbols]
1 Laparoscope
3 tubular body
30 Opening of the base end of the cylindrical body
31 Opening of tip of cylindrical body
33 Edge
330 Edge
34 Light supply port
35 Light Guide
36 Water supply port
37 Water supply path
38 Air supply port
39 Air supply path
G gap
5 Reinforcement ring
6 water tank
9 Air tank
G gap

Claims (35)

両端に開口を有し、基端の開口から腹腔鏡を挿入するように構成された筒状体と、該筒状体の先端の開口あるいは開口に近接した部位に位置して設けられ、外側表面と内側表面とを有し、少なくとも該外側表面には親水性のコーティングが形成されている透光部材と、該筒状体の先端から光を照射するためのライトガイドと、該透光部材に水分を供給するための水分供給路とを備えた腹腔鏡防曇装置。A tubular body having openings at both ends and configured to insert a laparoscope through a proximal opening, and an outer surface provided at a position at or near the opening at the distal end of the tubular body; And a light-transmitting member having a hydrophilic coating formed on at least the outer surface, a light guide for irradiating light from the tip of the cylindrical body, and a light-transmitting member. A laparoscopic anti-fog device having a water supply path for supplying water. 請求項１において、該透光部材は交換可能であることを特徴とする腹腔鏡防曇装置。The laparoscopic anti-fog device according to claim 1, wherein the light-transmitting member is replaceable. 請求項１，２いずれかにおいて、該透光部材は該筒状体の先端の開口に着脱自在であることを特徴とする腹腔鏡防曇装置。The laparoscopic defogging device according to any one of claims 1 and 2, wherein the light-transmitting member is detachably attached to an opening at a distal end of the tubular body. 請求項１，２いずれかにおいて、該透光部材は該腹腔鏡の先端に着脱自在であることを特徴とする腹腔鏡防曇装置。The laparoscopic anti-fog device according to any one of claims 1 and 2, wherein the translucent member is detachably attached to a tip of the laparoscope. 請求項１乃至４いずれかにおいて、該筒状体の先端の開口には中空部に向って突出する縁部が形成されており、該縁部の周面が該先端の開口を画定していることを特徴とする腹腔鏡防曇装置。In any one of claims 1 to 4, an edge protruding toward the hollow portion is formed at the opening at the tip of the cylindrical body, and the peripheral surface of the edge defines the opening at the tip. A laparoscopic anti-fog device, characterized in that: 請求項５において、該透光部材は、該腹腔鏡の先端と該縁部との間に挟持されることを特徴とする腹腔鏡防曇装置。The laparoscopic anti-fog device according to claim 5, wherein the light-transmitting member is sandwiched between a tip of the laparoscope and the edge. 請求項１乃至６いずれかにおいて、該透光部材の周面には補強リングが設けてあることを特徴とする腹腔鏡防曇装置。7. The laparoscopic anti-fog device according to claim 1, wherein a reinforcing ring is provided on a peripheral surface of the light transmitting member. 請求項１乃至７いずれかにおいて、該水分供給路は、該筒状体の内周面と該腹腔鏡の外周面との間に形成された間隙であることを特徴とする腹腔鏡防曇装置。8. The laparoscopic anti-fog device according to claim 1, wherein the water supply path is a gap formed between an inner peripheral surface of the cylindrical body and an outer peripheral surface of the laparoscope. . 請求項１乃至７いずれかにおいて、該水分供給路は、該筒状体の壁内に延設されていることを特徴とする腹腔鏡防曇装置。The laparoscopic anti-fog device according to any one of claims 1 to 7, wherein the water supply path extends in a wall of the tubular body. 請求項１乃至９いずれかにおいて、該筒状体の基端側には水分供給口が設けてあり、該水分供給路は該水分供給口を介して水分供給源と流体連通されていることを特徴とする腹腔鏡防曇装置。In any one of claims 1 to 9, a water supply port is provided at a base end side of the cylindrical body, and the water supply path is in fluid communication with a water supply source through the water supply port. Laparoscopic anti-fog device. 請求項１０において、該水分供給源は水タンクであり、該水タンクは直接該水供給口に連結されていることを特徴とする腹腔鏡防曇装置。11. The laparoscopic anti-fog apparatus according to claim 10, wherein the water supply source is a water tank, and the water tank is directly connected to the water supply port. 請求項１０において、該水分供給源は該装置と離隔しており、該水分供給源は、可撓性パイプを介して該水供給口に連結されていることを特徴とする腹腔鏡防曇装置。11. The laparoscopic anti-fog device according to claim 10, wherein the water supply is remote from the device and the water supply is connected to the water supply through a flexible pipe. . 請求項１乃至１２いずれかにおいて、該水分供給路の先端からは、該透光部材の外側表面を横切るように水分が供給されることを特徴とする腹腔鏡防曇装置。13. The laparoscopic anti-fog device according to claim 1, wherein water is supplied from a tip of the water supply passage so as to cross the outer surface of the light transmitting member. 請求項５において、該水分供給路の先端は、該縁部の周面に形成された一つ又は複数の開口であることを特徴とする腹腔鏡防曇装置。6. The laparoscopic anti-fog device according to claim 5, wherein a tip of the water supply path is one or a plurality of openings formed on a peripheral surface of the edge. 請求項１乃至１４いずれかにおいて、該ライトガイドは、該筒状体の長さ方向に延出しており、該ライトガイドの基端は該筒状体基端側に設けた光供給口に連結されており、該ライトガイドの先端は該筒状体の先端に達していることを特徴とする腹腔鏡防曇装置。15. The light guide according to any one of claims 1 to 14, wherein the light guide extends in a longitudinal direction of the tubular body, and a base end of the light guide is connected to a light supply port provided on a base end side of the tubular body. The laparoscopic defogging device is characterized in that the tip of the light guide reaches the tip of the tubular body. 請求項１乃至１５いずれかにおいて、該装置は、さらにエアー供給路を備えており、該透光部材の外側表面にエアーを送気可能に構成されていることを特徴とする腹腔鏡防曇装置。The laparoscopic defogging device according to any one of claims 1 to 15, wherein the device further includes an air supply path, and is configured to supply air to an outer surface of the light transmitting member. . 請求項１６において、該エアー供給路は、該筒状体の内周面と該腹腔鏡の外周面との間隙であることを特徴とする腹腔鏡防曇装置。17. The laparoscopic anti-fog apparatus according to claim 16, wherein the air supply path is a gap between an inner peripheral surface of the tubular body and an outer peripheral surface of the laparoscope. 請求項１６において、該エアー供給路は、該筒状体の壁内を延出していることを特徴とする腹腔鏡防曇装置。17. The laparoscopic defogging device according to claim 16, wherein the air supply path extends inside the wall of the tubular body. 請求項１６乃至１８いずれかにおいて、エアー供給路は、該水分供給路と共通であることを特徴とする腹腔鏡防曇装置。19. The laparoscopic anti-fog device according to claim 16, wherein the air supply path is common to the water supply path. 請求項１６乃至１９いずれかにおいて、該筒状体の基端側にはエアー供給口が設けてあり、該エアー供給路は該エアー供給口を介してエアー供給源と流体連通されていることを特徴とする腹腔鏡防曇装置。20. The method according to claim 16, wherein an air supply port is provided at a base end side of the cylindrical body, and the air supply path is in fluid communication with an air supply source via the air supply port. Laparoscopic anti-fog device. 請求項２０において、該エアー供給源はエアータンクであり、該エアータンクは直接該エアー供給口に連結されていることを特徴とする腹腔鏡防曇装置。21. The laparoscopic anti-fog device according to claim 20, wherein the air supply source is an air tank, and the air tank is directly connected to the air supply port. 請求項２０において、該エアー供給源は該装置と離隔しており、該エアー供給源は、可撓性パイプを介して該エアー供給口に連結されていることを特徴とする腹腔鏡防曇装置。21. The laparoscopic anti-fog apparatus according to claim 20, wherein the air supply is separated from the apparatus, and the air supply is connected to the air supply through a flexible pipe. . 請求項２２において、該エアー供給源は、腹腔鏡の気腹装置であることを特徴とする腹腔鏡防曇装置。23. The laparoscopic anti-fog device according to claim 22, wherein the air supply source is a laparoscopic insufflation device. 請求項２３において、該可撓性パイプには、該エアー供給口に近接してリザーバが設けてあることを特徴とする腹腔鏡防曇装置。24. The laparoscopic anti-fog device according to claim 23, wherein a reservoir is provided in the flexible pipe near the air supply port. 請求項１６乃至２４いずれかにおいて、該エアー供給路の先端からは、該透光部材の外側表面を横切るようにエアーが供給されることを特徴とする腹腔鏡防曇装置。The laparoscopic anti-fog device according to any one of claims 16 to 24, wherein air is supplied from a tip of the air supply passage so as to cross the outer surface of the light transmitting member. 請求項１６乃至２５いずれかにおいて、該筒状体の先端の開口には中空部に向って突出する縁部が形成されており、該エアー供給路の先端は、該縁部の周面に形成された一つ又は複数の開口であることを特徴とする腹腔鏡防曇装置。26. The cylindrical member according to claim 16, wherein the opening at the tip of the cylindrical body has an edge protruding toward the hollow portion, and the tip of the air supply path is formed on the peripheral surface of the edge. Laparoscopic anti-fog device characterized by one or more openings. 請求項１乃至２６いずれかにおいて、該装置は、該腹腔鏡が該筒状体の中空部に挿入された状態において、該腹腔鏡と該筒状体とを固定する固定機構を備えていることを特徴とする腹腔鏡防曇装置。The device according to any one of claims 1 to 26, further comprising a fixing mechanism for fixing the laparoscope and the cylindrical body when the laparoscope is inserted into a hollow portion of the cylindrical body. A laparoscopic anti-fog device characterized by the above-mentioned. 両端に開口を有する長尺筒状体を有し、該筒状体の先端には中空部に面して突出する縁部が形成されており、該筒状体の基端側には光供給口、水分供給口がそれぞれ形成されており、該筒状体の壁には長さ方向に延出するライトガイドが設けてあり、該ライトガイドの基端は該光供給口に連結されており、該ライトガイドの先端は該筒状体の先端に達していることを特徴とする腹腔鏡防曇用部材。It has a long cylindrical body having openings at both ends, and an edge protruding toward the hollow portion is formed at the tip of the cylindrical body, and light supply is provided at the base end side of the cylindrical body. A mouth and a water supply port are respectively formed, and a light guide extending in the length direction is provided on a wall of the cylindrical body, and a base end of the light guide is connected to the light supply port. A laparoscopic anti-fog member, wherein a tip of the light guide reaches a tip of the tubular body. 請求項２８において、該筒状体の壁内には長さ方向に延出する水分供給路が形成されており、該水分供給路の基端は該水分供給口に連結されており、該水分供給路の先端は該縁部の周面に形成された一つ又は複数の開口であることを特徴とする腹腔鏡防曇用部材。29. The water supply path according to claim 28, wherein a water supply passage extending in a length direction is formed in a wall of the cylindrical body, and a base end of the water supply passage is connected to the water supply port, A laparoscopic anti-fog member, wherein the tip of the supply path is one or a plurality of openings formed on the peripheral surface of the edge. 請求項２８，２９いずれにおいて、該筒状体の基端側にはエアー供給口が形成されており、該筒状体の壁内には長さ方向に延出するエアー供給路が形成されており、該エアー供給路の基端が該エアー供給口に連結されており、該エアー供給路の先端は該縁部の周面に形成された一つ又は複数の開口であることを特徴とする腹腔鏡防曇用部材。An air supply port is formed at the base end side of the cylindrical body according to any one of claims 28 and 29, and an air supply path extending in a length direction is formed in a wall of the cylindrical body. A base end of the air supply path is connected to the air supply port, and a front end of the air supply path is one or a plurality of openings formed in a peripheral surface of the edge. Laparoscopic anti-fog member. 外側表面と内側表面とを有し、少なくとも該外側表面に親水性のコーティングが形成されている腹腔鏡防曇用透光部材。A translucent member for laparoscopic anti-fog, comprising an outer surface and an inner surface, wherein at least the outer surface is provided with a hydrophilic coating. 請求項３１において、該親水性のコーティングは、酸化チタンを含むことを特徴とする腹腔鏡防曇用透光部材。32. The laparoscopic anti-fog translucent member according to claim 31, wherein the hydrophilic coating includes titanium oxide. 請求項３２において、該親水性のコーティングは、さらにシリカを含むことを特徴とする腹腔鏡防曇用透光部材。33. The laparoscopic anti-fog translucent member according to claim 32, wherein the hydrophilic coating further comprises silica. 請求項３３において、該親水性のコーティングは、該透光部材の表面に形成された酸化チタン膜と該酸化チタン膜の上に形成されたシリカ膜とからなることを特徴とする腹腔鏡防曇用透光部材。34. The laparoscopic anti-fog according to claim 33, wherein the hydrophilic coating comprises a titanium oxide film formed on the surface of the light transmitting member and a silica film formed on the titanium oxide film. Translucent member. 両端に開口を有する筒状体と、少なくとも外側表面に親水性のコーティングが形成されている透光部材とを用いた腹腔鏡の防曇方法であって、該筒状体の中空部に腹腔鏡を挿入させた状態で、該筒状体の先端の開口あるいは先端の開口に近接した部位で該腹腔鏡の先端の外側に位置させて該透光部材を設け、該透光部材に水分を供給することで、該透光部材の防曇を行なうことを特徴とする腹腔鏡の防曇方法。A method for defogging a laparoscopic scope using a tubular body having openings at both ends and a light-transmitting member having a hydrophilic coating formed on at least an outer surface thereof, wherein a laparoscope is provided in a hollow portion of the tubular body. The light-transmitting member is provided at the opening at the distal end of the cylindrical body or at a position close to the opening at the distal end outside the distal end of the laparoscope to supply moisture to the light-transmitting member. A method for defogging the laparoscope, wherein the defogging of the translucent member is performed.
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