JP2005007189A - Surgical instrument holding device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical instrument holding device preventing the surgical instrument from inadvertently shifting. <P>SOLUTION: The surgical instrument holding device is provided with a holder 14 for an endoscope 20 which is equipped with an L-shaped arm (an arm member) 15, an L-shaped connecting member 16 and a receiving part 19 provided in the connecting member 16. The L-shaped arm 15 is connected to an upper rod 9 to enable the base end to rotate around a rotation axis O<SB>6</SB>. The L-shaped connecting member 16 is rotatably connected around a rotation axis O<SB>7</SB>which extends in the direction crossing at right angles with the rotation axis O<SB>6</SB>at the leading end of the arm 15. The receiving part 19 rotatably connects the endoscope 20 around a rotation axis O<SB>8</SB>. The holder 14 has a handle 50 to be grasped by an operator when the endoscope 20 is moved. The handle 50 is disposed at the intersection C of the rotation axis O<SB>6</SB>, the rotation axis O<SB>7</SB>and the rotation axis O<SB>8</SB>. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a surgical instrument holding apparatus that holds, for example, a treatment tool or an endoscope inserted into a patient's abdominal cavity on behalf of an operator.

  In general, surgical techniques using a medical rigid endoscope such as a laparoscope have progressed in recent years and have become complicated. For this purpose, a main doctor (hereinafter referred to as the main operator) who performs treatment is performing surgery with a treatment tool in both hands. At this time, the assistant also carries out the operation together with the main operator with the treatment tool.

  For this reason, the main surgeon and assistants who perform joint treatments cannot grasp and operate the endoscope for observing the surgical site in the abdominal cavity, so a dedicated assistant for holding the endoscope (Hereinafter referred to as an endoscope holder). And when you want to change the observation position and angle of view of the surgical site, the endoscope holder can change the direction of the endoscope by hand or the insertion direction according to instructions from the main surgeon or assistant who performs joint treatment. The operation such as moving back and forth is performed.

  For this reason, the endoscope holder has to keep holding the endoscope during the operation, and there is a problem that a great effort is required. Furthermore, the operating room is narrow because there are various medical devices necessary for the operation and assistants who operate it, and the presence of an endoscope holder has a problem of further reducing the space.

  Therefore, the endoscope and the treatment tool inserted into the body cavity of the patient are held by the endoscope holding device or the surgical instrument support device so that the main operator can directly operate the endoscope and the treatment tool. The system is disclosed in, for example, Patent Document 1 and Patent Document 2.

  Here, in the endoscope holding device disclosed in Patent Document 1, a holder portion is connected to the upper end portion of an arm whose lower end portion is fixed to the floor via a plurality of arms, and the inner portion is connected to the holder portion. It is configured to mount an endoscope. In order to make the endoscope movable, the connecting portions of the arms can be rotated around one axis, for example, weighted so as not to rotate spontaneously due to the weight of the arm and the endoscope. In addition, the holder portion is slidable with respect to the arm and can be fixed by a fixing screw.

In addition, the surgical instrument support device disclosed in Patent Document 2 is a flexible body composed of a hand part to which a surgical instrument is attached and a plurality of articulated bodies that support the hand part and are bendable and rotatable. And a mounting portion for mounting the flexible arm portion to the support member. Here, a plurality of piston rods that are continuously provided are slidably fitted in the connecting body of the flexible arm portion. Then, by operating the fixing lever, the piston rod is pressed, and the flexible arm portion and the hand portion are fixed.
Japanese Utility Model Publication No. 1-130304 JP-A-2-239854

  The endoscope holding device disclosed in Patent Document 1 rotates two joints by using two arms connected to each joint with their left and right hands to move the endoscope. Because there is a need, there is a problem that can move only one degree of freedom at a time.

  Also, when sliding the holder with respect to the arm, temporarily loosen the fixing screw of the holder and move the endoscope. After positioning the endoscope, retighten the fixing screw and move the holder to the arm. Therefore, it is difficult for the main surgeon to accurately perform these complicated operations during the operation.

  Furthermore, when the endoscope is operated to slide, when the fixing screw is loosened, the endoscope's own weight prevents the endoscope from being inadvertently moved in any direction different from the desired direction, ensuring safety. Therefore, it is necessary for the main operator to securely hold the endoscope in advance and prepare for the movement of the endoscope due to its own weight. Therefore, in this case as well, an operation using both hands is required in the same manner as the rotation operation of the joint between the two arms, so that the main operator holds the endoscope during the operation of operating the treatment tool alone. When the apparatus is used, it is necessary to remove the treatment tool and move the endoscope with both hands.

  The surgical instrument support device disclosed in Patent Document 2 is disclosed in the aforementioned Patent Document 1 because the entire flexible arm can be fixed and released at once by operating the fixing lever. Further, this is superior to the endoscope holding device in that the surgical instrument can be moved in a free direction at a time.

  However, in this case as well, in order to prevent the surgical instrument from being inadvertently moved in an arbitrary direction different from the desired direction due to the weight of the surgical instrument as described above, Since it is necessary for the main operator to hold the surgical instrument with certainty, a reliable operation using both hands is required, and there is a problem that is not suitable for the operation of the main operator alone.

  During the operation, the main operator, an assistant who performs treatment in cooperation with the main operator, an assistant who operates other devices, and the like often pass in the vicinity of the operating table. Therefore, as a surgical instrument holding device, it is actually desired that the amount of protrusion to the outside of the operating table including the connecting portion with the operating table is as small as possible.

  An object of the present invention is to provide a surgical instrument holding device for preventing inadvertent movement of a surgical instrument.

  According to a first aspect of the present invention, there is provided an arm member in which a base end portion is connected to a rod extending in the lateral direction so as to be rotatable about a first rotation shaft that is a central axis of the rod, and the arm member A connecting member that is rotatably connected to the distal end of the second rotating shaft extending in a direction orthogonal to the first rotating shaft, and is provided on the connecting member. And a holding part for the surgical instrument comprising a receiving part connected to be rotatable about a rotation axis, and the holding part is gripped by an operator when moving the surgical instrument. And the grip portion is arranged at an intersection of the first rotation shaft, the second rotation shaft, and the third rotation shaft.

  The invention according to claim 2 is the surgical instrument holding apparatus, wherein the grip portion includes a switch for releasing the fixation of the surgical instrument by a fixing means for fixing the surgical instrument so as not to move.

  According to the surgical instrument holding apparatus of the present invention, the surgical instrument holding part and the surgical instrument are integrally rotatable around the third rotation axis with respect to the receiving part of the connecting member. In addition, since the arm rotates around the first rotation axis and the connecting member rotates around the second rotation axis, the surgical instrument is centered on the intersection of the first rotation axis and the second rotation axis. It is possible to turn. Here, the position of the center of gravity of the portion that moves around each rotation axis is on the first rotation axis and the second rotation axis, so the center of gravity position does not change even if the endoscope pivots about the rotation axis. There will be no deviation, and the balance of the entire device will not be lost. Thereby, careless movement of the surgical instrument can be prevented.

FIG. 1 shows a schematic configuration of the entire surgical instrument holding apparatus. Reference numeral 1 denotes an attachment portion that is detachably locked to a base such as an operating table. A vertical rod 2 is erected on the attachment portion 1 along the vertical direction. The vertical rod 2 is coupled rotatably about a vertical rotation axis O ₁ via the force adjustment portion 3 with respect to the mounting part 1. Here, the force adjustment part 3 adjusts the weight of the movement of the vertical rod 2 rotating with respect to the attachment part 1.

Further, a support member 5 of a link mechanism unit 4 including a parallelogram link for holding a surgical instrument is connected to the upper end portion of the vertical rod 2. The support member 5 is connected to be rotatable about a _second rotation axis O ₂ in the horizontal direction orthogonal to the rotation axis O ₁ of the vertical rod 2.

Further, the support member 5 has a lower end portion of the swivel arm 6 extending in the vertical direction and an end portion of the lower rod 7 extending in the horizontal direction, each being rotatable about the second rotation axis O _2. While being supported, a rotational force amount adjusting unit 8 disposed on the second rotation axis O ₂ is connected. The rotational force amount adjustment unit 8 adjusts the weight of the movement of the turning arm 6 relative to the support member 5.

In addition, a middle part of the upper rod 9 arranged in parallel with the lower rod 7 at the upper end of the swivel arm 6 has a third rotational axis O ₃ parallel to the _second rotational axis O ₂ via the joint part 10. It is rotatably supported at the center.

Further, the other end portion of the lower rod 7 and one end portion of the upper rod 9 are rotated around the fourth and fifth rotation axes O ₄ and O ₅ parallel to the _second and _third rotation axes O ₂ and O _3. They are connected in parallel by connecting rods 13 arranged in parallel to the swivel arm 6 via movable joints 11 and 12. And the link mechanism part 4 which consists of a parallelogram link which can be deform | transformed by the turning arm 6, the upper rod 9, the lower rod 7, and the connection rod 13 is comprised.

Further, the end of the upper rod 9 opposite to the end on the joint 12 side is extended outward through the joint 10, and a surgical instrument holding part 14 is connected to the extended part. The holding portion 14 is provided with an L-shaped arm 15 and an L-shaped connecting member 16. Here, one L-shaped component 15 a of the L-shaped arm 15 rotates around the rotation axis O _6, which is the central axis of the upper rod 9, via the rotational force amount adjusting unit 17 to the extended portion of the upper rod 9. Connected as possible. The rotational force amount adjusting unit 17 adjusts the weight of the movement of the holding unit 14 relative to the upper rod 9.

Further, around the rotational axis O ₇ of the distal end portion of one of L-shaped components 16a at the tip portion of the other L-shaped configuration portion 15b of the L-shaped arms 15 in the L-shaped connecting member 16 is perpendicular to the rotation axis O ₆ Are connected to each other via a rotational force amount adjusting unit 18 so as to be rotatable. This rotational force amount adjusting unit 18 adjusts the weight of the movement of the L-shaped connecting member 16 rotating with respect to the rotation axis O ₇ of the L-shaped component 15b.

Further, the other L-shaped component 16b of the L-shaped connecting member 16 is provided with a surgical instrument receiving portion 19 as shown in FIG. The receiving portion 19 is formed with an insertion hole 19a for a surgical instrument. An endoscope 20 as a surgical instrument is inserted into the insertion hole 19 a of the receiving portion 19, and the endoscope 20 is in the insertion direction of the endoscope 20 via the endoscope holding member 21. It is rotatably connected around a rotation axis O _8. The endoscope 20 is equipped with a TV camera 23 via a TV adapter 22. Further, the rotation axis O ₈ is arranged in a state orthogonal to the rotation axis O ₇ , and the rotation axes O ₆ , O ₇ , O ₈ intersect at an intersection C.

  In addition, two sets of counterweights 24 and 25 are arranged on the link mechanism portion 4 formed of a parallelogram link in a balanced state with respect to the holding portion 14 to which the endoscope 20 as a surgical instrument is attached. Yes. Here, the first counterweight 24 is attached to be movable along the shaft 26 of the lower rod 7. Further, the second counterweight 25 is attached to the support member 5 so as to be movable along a guide arm 27 disposed coaxially with the pivot arm 6 and on the opposite side of the pivot arm 6.

Also, FIG. 2 shows the internal structure of the rotary force adjusting portion 8 around the rotation axis O ₂ as seen from the arrow Q in FIG. Here, small-diameter shaft portions 28 and 29 that are reduced in diameter by one step are formed at both ends of the support member 5.

Further, a through hole 30 coaxial with the rotation axis O ₂ is formed in the axial center portion of the support member 5. A slide shaft 31 is inserted into the through hole 30. A flange 32 is formed at one end portion of the slide shaft 31, and a male screw portion 34 that is screwed into a screw hole 33 a formed in the adjustment dial 33 is formed at the other end portion.

A long hole 35 that is long in the axial direction of the support member 5 is formed in one small-diameter shaft portion 28 of the support member 5. Further, a key groove 36 is formed in the slide shaft 31 at a position corresponding to the small diameter shaft portion 28. A key 37 is engaged with the key groove 36 through a long hole 35 of the small diameter shaft portion 28. Then, the slide shaft 31 to the support member 5, and is slidably supported without rotating on the rotation axis O _2.

  A bearing member 38 of the swivel arm 6 is rotatably connected to the small diameter shaft portion 28 of the support member 5. The bearing member 38 is provided with a substantially cylindrical bearing body 38a. A ring-shaped convex portion 39 projects from the center portion of the inner peripheral surface of the bearing body 38a. Ring-shaped collars 40 and 41 are disposed on both sides of the ring-shaped convex portion 39.

  Further, an O-ring 42 and a washer 43 are arranged in this order from the collar 41 side between the adjustment dial 33 screwed into the male threaded portion 34 of the slide shaft 31 and the collar 41 arranged in the bearing member 38. . The ring-shaped convex portion 39 of the bearing member 38 between the collars 40 and 41 is supported by the O-ring 42 and the washer 43 as the male screw portion 34 of the slide shaft 31 and the screw hole 33a of the adjustment dial 33 are screwed. 5 is attached to the small diameter shaft portion 28.

  Further, an arm connecting portion 44 connected to the lower end portion of the swing arm 6 and an arm connecting portion 45 connected to the upper end portion of the guide arm 27 project from the outer peripheral surface of the bearing member 38.

  A bearing member 46 of the lower rod 7 is rotatably connected to the other small diameter shaft portion 29 of the support member 5. The bearing member 46 is provided with a substantially cylindrical bearing body 46a. A ring-shaped convex portion 47 projects from the central portion of the inner peripheral surface of the bearing body 46a. Ring-shaped collars 48 and 49 are disposed on both sides of the ring-shaped convex portion 47.

  The bearing member 46 is rotatably connected to the small-diameter shaft portion 29 of the support member 5 through collars 48 and 49 on both sides of the ring-shaped convex portion 47, similarly to the bearing member 38 of the swivel arm 6.

  FIG. 3 shows the configuration of the main part of the holding part 14 of the surgical instrument. Here, the endoscope holding member 21 is provided with a grip portion 50 that is formed in a substantially cylindrical shape and has a knurled outer peripheral surface. An endoscope connecting portion 51 connected to the endoscope 20 is provided on one end side of the cylindrical grip portion 50.

  The endoscope connecting portion 51 is provided with an insertion hole 53 through which the insertion portion 52 of the endoscope 20 is inserted, and a large-diameter hole portion 54 having a larger diameter than the insertion hole 53. Further, a screw hole 56 into which the endoscope fixing screw 55 is screwed is formed in the peripheral wall portion of the large diameter hole portion 54.

  When the endoscope 20 is attached to the endoscope holding member 21, the insertion portion 52 of the endoscope 20 is inserted into the insertion hole 53 of the endoscope connecting portion 51, and the insertion of the endoscope 20 is performed. The stepped portion 58 between the portion 52 and the proximal end portion 57 is inserted into the large-diameter hole portion 54 of the endoscope connecting portion 51 and the step portion 59 between the insertion hole 53 and the large-diameter hole portion 54 is inserted. It is screwed and fixed by an endoscope fixing screw 55 in a state where it is abutted against.

  Further, a small-diameter portion 60 having a reduced diameter is formed at the distal end portion of the endoscope connecting portion 51 in the endoscope holding member 21. Further, a fitting recess 61 is formed on the outer peripheral surface of the small diameter portion 60.

  An intermediate ring 62 is rotatably connected to the small diameter portion 60 of the endoscope holding member 21. A flange 63 protruding from the inner peripheral surface of the intermediate ring 62 is engaged in the fitting recess 61 of the small diameter portion 60 and prohibits movement in the thrust direction. Further, a flange-shaped ring receiver 64 projects from the outer peripheral surface of the intermediate ring 62.

  A fixing ring 65 is attached to the ring receiver 64 of the intermediate ring 62. An engaging portion 66 having a diameter smaller than that of the ring receiver 64 is formed at one end portion of the fixing ring 65, and a screw hole portion 67 is formed at the other end portion. The screw hole 67 is screwed into a male screw portion 68 formed in the receiving portion 19 of the L-shaped connecting member 16.

  Next, the balance of the link mechanism unit 4 composed of parallelogram links will be described with reference to FIG. Here, it is assumed that each arm constituting the link mechanism unit 4, that is, the swing arm 6, the upper rod 9, the lower rod 7, and the connecting rod 13 has no weight.

Incidentally, in FIG. 5, r is the center of gravity of the rotation radius, G ₁ is the aforementioned L-shaped arm 15 from the distal portion of the pivot arm 6, the weight applied to that point is M _1. Further, if the distance from the rotation axis O ₃ to G ₁ is R ₁ , the center of gravity of the _first counterweight 24 is GW ₁ , its weight is MW ₁ , and the distance from the rotation axis O ₂ to GW ₁ is RW _1. , balance of the upper rod 9 around the rotation axis O ₃ is given by the following equation (1).

M ₁ × R ₁ = MW ₁ × RW ₁ (1)
Then, the center of gravity which is synthesized by _{G 1} and GW ₁ is the intersection _{G 2} of the swivel arm 6 linearly H connecting between _{G 1} and the GW ₁ by this condition. Here, the distance from the rotation axis O ₂ to G ₂ is R ₂ , the weight applied to G ₂ is M ₂ = M ₁ + MG ₁ , the center of gravity of the _second counterweight 25 is GW ₂ , and the rotation axis O ₂ to GW _When the distance to ₂ is RW ₂ and the weight of the second counterweight 25 is MW ₂ , the balance around the rotation axis O ₂ is expressed by the following equation (2).

M ₂ × R ₂ = MW ₂ × RW ₂ (2)
At this time, the center of gravity of the entire link mechanism 4 consisting of parallelogram link is on the rotation axis O _2.

Further, the center of gravity position when assembled with the endoscope 20, TV adapter 22, TV camera 23 or the like of the accessory to an endoscope holding member 21 is disposed on the rotary shaft O _8. Furthermore, the position of the center of gravity of these when combined L-shaped connecting member 16, i.e., the center of gravity of the part which rotates the rotation shaft O ₇ around is disposed on the rotation axis O _7. Further, the endoscope connecting portion 51 is arranged such that the center of gravity when the L-shaped arm 15 is combined with these, that is, the center of gravity of the portion rotating around the rotation axis O ₇ is arranged on the rotation axis O _6. The positional relationship between the stepped portion 59 and the stepped portion 58 of the endoscope 20 is defined.

Incidentally, in accordance with the case of mounting a variety of different endoscopes center of gravity position and TV adapter, etc., with respect to the intersection point C of the rotary shaft O _6, O _7, O _8, the direction and the rotation axis O ₈ of the rotary shaft O ₈ By connecting the endoscope holding member 21 formed by shifting the position of the step portion 59 of the endoscope connecting portion 51 in the orthogonal direction, the position of the center of gravity does not change from the above case.

For example, heavy upper portion of the endoscope 20, the step portion 59 is the rotation axis of the rotary shaft O ₇ position of the center of gravity of the part which rotates around the rotation axis O ₇ inner if there from above endoscope connection portion 51 O ₇ , an endoscope holding member 21 formed in a state of being disposed at a position shifted downward in FIG.

Alternatively, when the same endoscope holding member 21 is used, when the stepped portion 58 of the endoscope 20 is abutted against the stepped portion 59 of the endoscope connecting portion 51, the endoscope 20 and the TV adapter are used. 22. Stepped endoscope 20 so that the center of gravity when accessories such as TV camera 23 are combined is always at a fixed position with respect to intersection C of rotation axes O ₆ , O ₇ , O _8. It suffices if the portion 58 is formed. In order to keep the weight constant, the endoscope holding member 21 can be handled by changing the material of different specific gravity or the thickness of the grip portion 50.

Next, the balance adjustment method of the link mechanism part 4 which consists of a parallelogram link is demonstrated. First, the balance adjustment work relating to the deformation of the link mechanism portion 4 formed of a parallelogram link, that is, the rotation of the rotation axis O ₃ of the upper rod 9 will be described.

  During the balance adjustment operation, the movement of the endoscope 20 is confirmed while the swivel arm 6 is held by hand so as not to rotate. At this time, when the endoscope 20 moves upward or downward, a moving ring (not shown) of the first counterweight 24 is rotated, and the counterweight 24 is moved along the shaft 26 of the lower rod 7. Thus, the endoscope 20 is set to an optimal position where it does not move.

Next, the balance adjustment work around the rotation axis O ₂ is performed by moving the second counterweight 25 along the guide arm 27 in a state where the restraint of the swing arm 6 is released. Since this is the same as the movement of the first counterweight 24 described above, description thereof is omitted.

In actual use, it is performed after optimally adjusting the amount of rotational force of each movable part of the link mechanism part 4 formed of a parallelogram link. Here, a description will be given rotation axis O ₂ around the force adjustment on the basis of FIG.

  First, when the adjustment dial 33 is rotated, the key 37 engaged with the key groove 36 of the slide shaft 31 through the threaded engagement with the male thread portion 34 of the slide shaft 31 and the long hole 35 of the small diameter shaft portion 28 of the support member 5 is used. The slide shaft 31 does not rotate, but moves or generates thrust in the right direction in FIG. 2, and the adjustment dial 33 moves in the left direction in FIG.

  As a result, the collar 48 is pressed by the flange 32 of the slide shaft 31 at the portion of the bearing member 46 of the lower rod 7, and the ring-shaped convex portion 47 of the bearing member 46 is sandwiched between the collars 48 and 49. Is adjusted.

  Moreover, the ring-shaped convex part 39 inside the bearing member 38 of the turning arm 6 is sandwiched between the collars 40 and 41, and the amount of rotational force is adjusted. In this case, the amount of rotational force can be gradually adjusted by the elasticity of the O-ring 42 disposed between the adjustment dial 33 and the collar 41.

  Next, the operation of the above configuration will be described. First, the attachment part 1 of this apparatus is attached to an operating table. Subsequently, in a state where the insertion portion 52 of the endoscope 20 used during the operation is inserted into the large-diameter hole portion 54 and the insertion hole 53 of the endoscope holding member 21, the screw hole 56 of the endoscope connection portion 51. The endoscope fixing screw 55 is screwed and fixed, and the endoscope 20 is assembled to the endoscope holding member 21.

  Then, after the assembly work of the endoscope 20, the TV adapter 22, the TV camera 23, etc. is completed, as shown in FIG. 3, the bottom surface of the intermediate ring 62 of the endoscope holding member 21 is L-shaped connecting member 16. The contact part 19 is contacted. In this state, the fixing ring 65 is rotated and the screw hole portion 67 of the fixing ring 65 is screwed into the male screw portion 68, whereby the endoscope holding member 21 is fixed to the receiving portion 19 of the L-shaped connecting member 16. The

At this time, have become integrally rotatable about a rotation axis O ₈ to receiving portion 19 of the L-shaped connecting member 16 and endoscope holding member 21 and the endoscope 20. Further, to rotate the L-arm 15 about the axis of rotation O _6, since about a rotation axis O ₇ is L-shaped connecting member 16 rotates, about the intersection C of the rotary shafts O _6, O ₇ The endoscope 20 can be turned. Here, since the position of the center of gravity of the portion moving around each of the rotation axes O ₆ and O ₇ is on the respective rotation axes O ₆ and O ₇ , the endoscope 20 is centered on the rotation axes O ₆ , O ₇ and O ₈ . The center of gravity does not deviate even if it turns, so that the balance of the entire apparatus is not lost.

Next, the movement and the balance of the link mechanism unit 4 including the parallelogram link of the present apparatus will be described with reference to FIGS. 6 (A) and 6 (B). First, when the endoscope 20 is horizontally moved in the left-right direction in FIG. 6A, the rotation of the entire link mechanism portion 4 of the parallelogram link around the rotation axis O _{2 and} the parallelogram as shown in FIG. This is performed by a combination of deformation operations of the link mechanism 4 of the shape link. Furthermore, the horizontal movement of the direction perpendicular to the paper surface of the endoscope 20 in FIG. 6 (A) is carried out by the turning of the rotary shaft O ₁ around the vertical rod 2.

Moreover, the horizontal movement as well as rotation of the entire link mechanism portion 4 of the rotary shaft O ₂ around the parallelogram as shown in FIG. 6 (B) when moving in the vertical direction of the endoscope 20, parallelogram This is performed by a combination of deformation operations of the link mechanism 4 of the shape link.

  Therefore, in the case of the above configuration, two sets of counterweights 24 and 25 are arranged on the link mechanism portion 4 formed of a parallelogram link in a state of being balanced with respect to the holding portion 14 to which the endoscope 20 is attached. Thus, the endoscope 20 is held in a balanced state at any position and angle. Therefore, there is no concern about the natural fall of the surgical instrument such as the endoscope 20, and the amount of moving force of the surgical instrument such as the endoscope 20 can be reduced, and the operability can be improved.

  In addition, since the counterweights 24 and 25 for maintaining the balance with respect to the holding unit 14 to which the endoscope 20 is attached are arranged in two, the link of the parallelogram link by the movement of the endoscope 20 is arranged. The counterweights 24 and 25 do not protrude greatly from the operating table mounting portion 1 when the mechanism portion 4 is deformed. Therefore, since the entire surgical instrument holding device can be reduced in size, it is possible to prevent the link mechanism portion 4 of the parallelogram link from coming into contact with the operator and the patient during the operation. Further, since the balance adjustment of the two counterweights 24 and 25 can be performed independently, setting is easy.

Further, by rotating the adjusting dial 33 of the rotary shaft O ₂ about the competence adjustment portion 8 of the link mechanism 4 of the parallelogram link, modifications and parallelogram link mechanism 4 of the parallelogram The amount of turning rotational force of the entire mechanism unit 4, that is, the amount of vertical and horizontal moving force of the endoscope 20, can be adjusted at a time, and the adjustment can be performed in a short time. Therefore, it is possible to easily adjust the vertical and horizontal moving force amounts of the endoscope 20, and to improve the operability for moving the endoscope 20 held by the surgical instrument holding portion 14. Can do. In addition, since the number of adjustment handles and the like can be reduced as compared with the conventional one, the entire apparatus can be reduced in size.

Further, since the L-shaped arm 15 and the L-shaped connecting member 16 can be rotated 360 degrees around the rotation axis O ₆ and the rotation axis O ₇ without limitation, the L-shape arm 15 and the L-shaped connection member 16 can be easily operated during the operation. The character-shaped arm 15 can be directed freely, and usability can be further enhanced.

  In addition, since the endoscope holding member 21 and the L-shaped connecting member 16 can be separated from each other, when the endoscope 20 is attached or disinfected, these can be separated and performed. It is possible to improve workability such as attachment work of the endoscope 20 and disinfection work.

In this surgical instrument holding device, the vertical rod 2 is straight and coaxial with the rotation axis O ₁ , but it is not limited to this, and there is no problem even if it is bent. Further, in the present surgical instrument holding apparatus it has been arranged to the rotation axis O ₁ distributes a counterweight 24, 25 in two directions, for example, synthesized from the link mechanism 4 of the parallelogram linkage to the endoscope 20 By arranging the center of gravity so that it coincides with the intersection of the rotation axis O ₁ and the rotation axis O ₂ , the operating table to which the attachment unit 1 is attached or the base such as the column installed on the floor can be inclined in any direction. never balance around the rotation axis O ₁ collapses.

In this surgical instrument holding device, as shown in FIG. 3, the center of gravity of each member that moves around each of the rotation axes O ₄ , O ₅ , and O ₆ is on the respective rotation axes, but the present invention is limited to this. If an appropriate weight is applied to each power adjustment unit instead of a thing, slight unbalance does not affect operability.

  FIG. 6C shows a modification of the surgical instrument holding device. In this configuration, the holding part 14 of the surgical instrument is balanced with one counterweight of the link mechanism part 4 formed of a parallelogram link.

That is, here, the rotation axis O ₉ is disposed between the rotation axis O ₂ and the rotation axis O ₃ of the link mechanism portion 4 of the parallelogram link, and the upper end portion of the vertical rod 2 is rotated around the rotation axis O ₉ . It is movably linked.

In order to unify the conditions, the distance from the weight and the rotary shaft O ₂ counterweight 71 to the center of gravity of the counterweight 71, respectively the rotation radius of the rotary arm 6 to the same as in the above MW _1, RW _1, r and the conditions of the G ₁ is also the same.

In this case, in order to establish a balance, it is necessary to make the center of gravity synthesized by G ₁ and GW ₁ coincide with the rotation axis O ₂ . That is, a distance K is required between the rotation axis O ₂ and the rotation axis O _{9 to} which the lower rod 7 and the swing arm 6 are connected.

Therefore, the center of gravity of the counterweight 71 moves on an arc having a radius of RW ₁ + K at the maximum by deformation and turning of the link mechanism portion 4 of the parallelogram link. In this case, the counterweights 24 and 25 The counterweight 71 has a larger protrusion than when the two are divided into two.

  In the surgical instrument holding device, the surgical instrument holding unit 14 is configured to hold the endoscope 20 as a surgical instrument. However, the holding unit 14 holds various other surgical instruments. Can do. For example, FIG. 7 shows a configuration in which the treatment instrument 81 is held by the holding unit 14 of the surgical instrument.

  Here, 82 is a rotatable treatment instrument holding member obtained by deforming the endoscope holding member 21 of the surgical instrument holding apparatus of FIG. The treatment instrument holding member 82 is provided with an insertion hole 84 through which the insertion portion 83 of the treatment instrument 81 is inserted. Further, a ring-shaped groove 85 is formed in the peripheral wall portion of the insertion hole 84, and a rubber O-ring 86 for sealing is attached thereto.

  Further, a small diameter portion 87 having a small diameter is formed at the distal end portion of the treatment instrument holding member 82. Further, a fitting recess 88 is formed on the outer peripheral surface of the small diameter portion 87. The treatment instrument holding member 82 is fixed to the receiving portion 19 of the L-shaped connecting member 16 by an intermediate ring 62 and a fixing ring 65 similar to those in the apparatus of FIG. In this case as well, the balance is maintained and movement is possible as with the endoscope 20.

FIGS. 8 to 9C show a first embodiment of the present invention. In the present embodiment, electrical fixing means are disposed on the rotation axis O ₁ of the vertical rod 2 of the surgical instrument holding device of FIG. 1 and the rotation axis O ₂ of the link mechanism unit 4 formed of a parallelogram link. Here, only a different part from the surgical instrument holding apparatus of FIG. 1 is demonstrated.

FIG. 8 shows a schematic configuration of the entire surgical instrument holding apparatus. Reference numeral 100 denotes a trocar inserted into the abdominal wall opening S. FIG. Further, 101 vertical rod locking portion (fixing means) for fixing the rotation around the rotation axis O ₁ of the vertical rods 2, 102 the lower rod locking unit for fixing the rotation around the rotation axis O ₂ of the lower rod 7 ( fixing means), 103 is a pivot arm lock unit for fixing the rotation around the rotation axis O ₂ of the rotary arm 6. The vertical rod lock portion 101, the lower rod lock portion 102, and the swing arm lock portion 103 include a vertical rod fixed electromagnetic brake 104, a lower rod fixed electromagnetic brake 105, and a swing arm fixed electromagnetic brake, which will be described later, as shown in FIG. 106 is built in.

  Further, a push button type switch 107 is disposed on the grip 50 of the endoscope holding member 21. The switch 107 can be connected to an electric cable (not shown) in the receiving portion 19 of the L-shaped connecting member 16 via an electric contact (not shown).

  Further, FIG. 9A is a block diagram for explaining the electric system. Here, the switch 107 is connected to the vertical rod fixed electromagnetic brake 104, the lower rod fixed electromagnetic brake 105, and the swing arm fixed electromagnetic brake 106 via the control unit 108.

FIG. 9B shows the internal structure of the turning arm lock portion 103. Here, reference numeral 109 denotes a support member disposed on the top of the vertical rod 2. A stator 112 of a swing arm fixed electromagnetic brake 106 which is a permanent magnet type non-excitation actuating brake having a permanent magnet 110 and a coil 111 built on the same axis as the rotation axis O ₂ is fixed to the support member 109 by a fixing screw 113. Yes.

Reference numeral 114 denotes a shaft disposed in the axial center portion of the brake 106. The shaft 114 by the ball bearings 115 and 116, and is rotatably supported about a rotation axis _{O 2.} A flange 117 is formed at one end of the shaft 114. A cover 118 of the brake 106 is fixed to the flange 117 with a fixing screw 119.

  Reference numeral 120 denotes a leaf spring disposed between the cover 118 and the armature 121. One end of the leaf spring 120 is fixed to the cover 118 by a fixing screw 122, and the other end is connected to the armature 121 by a rivet 123. The lower end of the swing arm 6 is connected to the cover 118 of the swing arm fixed electromagnetic brake 106. The lower rod lock portion 102 has the same configuration as this, and a description thereof will be omitted.

  FIG. 9C shows the internal structure of the vertical rod lock portion 101. The vertical rod lock portion 101 has substantially the same configuration as the above-described swivel arm lock portion 103, and only different portions will be described here.

That is, the stator 112 of the vertical rod fixed electromagnetic brake 104 is fixed to the mounting portion 1 by the fixing screw 113. Further, the vertical rod 2 is screwed and fixed to the upper part of the cover 125 of the vertical rod fixed electromagnetic brake 104 so as to be coaxial with the rotation axis O ₁ of the shaft 114 disposed in the axial center portion of the brake 104.

  Next, the operation of the above configuration will be described. First, the operation of the turning arm lock unit 103 will be described. When the switch 107 is not pressed by the operator, the armature 121 is brought into close contact with the stator 112 of the brake 106 by the magnetic force of the permanent magnet 110 and the brake is applied. That is, the shaft 114 and the cover 118 are held in a fixed state, and the turning arm 6 is locked in a non-rotatable state.

  Further, when the operator pushes in the switch 107 while holding the grip portion 50 of the endoscope holding member 21, only when the signal is input from the switch 107, the operation signal from the control unit 108 is applied to the coil 111. When energized, an electromagnetic force acts in the direction opposite to the direction of the magnetic force of the permanent magnet 110. As a result, the armature 121 is separated from the stator 112 by the restoring force of the leaf spring 120 and the brake is released, so that the shaft 114 is rotatable. Therefore, the shaft 114 and the cover 118 can be rotated, and the lock of the turning arm 6 is released.

  This effect is the same in the lower rod lock portion 102 and the vertical rod lock portion 101. When the switch 107 is pressed, the unlocking operation is simultaneously performed on the swing arm lock unit 103, the lower rod lock unit 102, and the vertical rod lock unit 101.

When the switch 107 is not pushed in, the vertical rod 2, the swing arm 6 and the lower rod 7 are held in a fixed state, that is, the link mechanism 4 of the parallelogram link is fixed. 20 can only turn around the intersection C of the rotation axes O ₆ , O ₇ , and O ₈ shown in FIG.

  Therefore, the endoscope 20 is supported at two points of the intersection C and the abdominal wall opening S where the trocar 100 is inserted, and the position and the insertion angle are fixed. When the switch 107 is pressed, the endoscope 20 can be freely moved and tilted similarly to the apparatus of FIG.

  Therefore, in the above configuration, unless the operator holds the grip 50 of the endoscope holding member 21 and presses the switch 107, the electromagnetic brakes 104, 105, 106 are not released, and the parallelogram is not released. Since the vertical rod 2, the lower rod 7 and the swivel arm 6 of the link mechanism unit 4 made of links are securely fixed, an operator accidentally applies an external force to the arms of the link mechanism unit 4 made of parallelogram links during the operation. Even if it adds, the endoscope 20 does not move and is safe. In addition, since the amount of operating force when the electromagnetic brake is released can be reduced, operability can be improved.

  Further, the vertical rod fixed electromagnetic brake 104, the lower rod fixed electromagnetic brake 105, and the swing arm fixed electromagnetic brake 106 are arranged only in a portion that fixes the horizontal and vertical movements of the endoscope 20, and the endoscope 20 is inclined. Since it is not arranged in the portion for fixing, there is no protruding portion on the patient's abdomen during the operation, and there is no possibility of impairing the workability of the operation.

  Further, the switch 107 disposed in the grip portion 50 of the endoscope holding member 21 can be connected to the electric cable in the receiving portion 19 of the L-shaped connecting member 16 via an electrical contact. The endoscope holding member 21 and the receiving portion 19 of the L-shaped connecting member 16 can be separated. Therefore, it is possible to improve the workability of the endoscope 20 attachment work and the disinfection work as in the apparatus of FIG.

  FIGS. 10 to 16 show a second embodiment of the present invention. In the present embodiment, the configuration of the attachment portion for attaching the endoscope 20 to the L-shaped connecting member 16 in the first embodiment is changed, and an electric drive mechanism is added. Only portions different from the embodiment will be described.

  In FIG. 10, reference numeral 150 denotes a support member having a built-in swivel arm driving unit described later, 151 denotes a mounting unit having a built-in vertical rod driving unit to be described later, and 157 denotes an endoscope for attaching the endoscope 20 to the L-shaped connecting member 16. This is the mirror mounting part.

  Here, the endoscope attachment portion 157 is provided with a rotating ring 163 that is rotatably connected to the L-shaped component 16b of the L-shaped connecting member 16 as shown in FIG. The rotating ring 163 is provided with a through hole 170 into which the insertion portion 52 of the endoscope 20 is inserted.

  Further, a substantially cylindrical fitting portion 167 protrudes from the lower surface side of the rotating ring 163. The fitting portion 167 is rotatably fitted in an attachment hole 16c formed in the L-shaped component 16b of the L-shaped connecting member 16. A male screw portion 169 to which a retaining ring 168 is screwed is formed at the distal end portion of the fitting portion 167.

  Further, a substantially cylindrical holding cylinder portion 171 that is expanded to have a larger diameter than the fitting portion 167 protrudes from the upper surface side of the rotating ring 163. A slide ring 173 is slidably disposed on the bottom surface 172 inside the holding cylinder portion 171. The outer diameter dimension of the slide ring 173 is smaller than the diameter of the inner peripheral surface of the holding cylinder part 171 and can slide along the inner bottom surface of the holding cylinder part 171.

  Furthermore, an endoscope insertion port 173a through which the insertion portion 52 of the endoscope 20 is inserted is formed inside the slide ring 173. The endoscope insertion port 173 a is set to have a larger diameter than the insertion portion 52 of the endoscope 20.

  Further, a screw hole 171 a is formed in the upper inner peripheral surface of the holding cylinder portion 171. A lid 175 disposed on the slide ring 173 is screwed into the screw hole 171a of the holding cylinder portion 171 and the upper surface opening of the holding cylinder portion 171 is sealed by the lid 175. Note that an endoscope insertion opening 175 a is formed in the axial center portion of the lid 175.

  Further, one end portion of the guide bar 176 is press-fitted into the peripheral wall surface of the holding cylinder portion 171 of the rotating ring 163. The other end of the guide bar 176 protrudes radially inward of the holding cylinder 171 and is slidably fitted into a slide hole 177 formed in the slide ring 173. Further, a compression coil spring 178 is disposed around the guide bar 176 between the slide ring 173 and the peripheral wall surface of the holding cylinder portion 171.

  Further, a fitting hole 179 is formed in a portion of the peripheral wall surface of the holding cylinder portion 171 of the rotating ring 163 facing the guide bar 176. A shaft 181 of the push button 180 is slidably inserted into the fitting hole 179. A male screw part 182 is formed at the tip of the shaft 181. The male screw portion 182 is screwed into a screw hole formed on the outer peripheral surface of the slide ring 173.

An annular index 183 is displayed on the insertion portion 52 of the endoscope 20. Then, when the endoscope 20 is mounted on the endoscope mounting portion 157, the index 183 and the upper surface of the lid 175 of the holding cylinder portion 171 of the rotating ring 163 are aligned with each other to rotate. The center of gravity of the member that rotates about the axes O ₆ , O ₇ , and O ₈ is set to coincide with the respective rotation axes.

  FIG. 11 shows the internal structure of the support member 150. Here, the parts different from the support member 109 of the first embodiment are as follows. First, a rotating seat 155 is supported in the support member 150 via ball bearings 153 and 154. A worm wheel 156 is fixed to one end of the rotary seat 155 with a fixing screw (not shown).

  Further, a turning arm drive motor 158 that is a motor with an electromagnetic brake is fixed inside the support member 150. A worm gear 160 that meshes with the worm wheel 156 is fixed to the output shaft 159 of the drive motor 158.

  Further, the stator 112 of the swing arm fixed electromagnetic brake 106 is fixed to the other end side of the rotary seat 155 as in the second embodiment. Other structures are the same as those of the second embodiment. In addition, the structure of the vertical rod drive part in the attachment part 151 is also the same, and the description thereof is omitted here.

  FIG. 13 shows a joystick 152 that is connected to a drive control unit, which will be described later, and can be operated by the operator with his / her foot. The joystick 152 is connected to the drive control unit 161 shown in FIG. The same switch 107 as that of the first embodiment is connected to the drive control unit 161. The switch 107 is disposed on the L-shaped component 16 b of the L-shaped connecting member 16.

  Further, in the drive control unit 161, control signals are output to the vertical rod fixed electromagnetic brake 104, the swing arm fixed electromagnetic brake 106, and the lower rod fixed electromagnetic brake 105, and also driven to the swing arm drive motor 158 and the vertical rod drive motor 162. A logic circuit (not shown) for outputting a signal is provided.

  Next, an operation for mounting the insertion portion 52 of the endoscope 20 on the endoscope attachment portion 157 will be described. First, when the push button 180 is not pushed in, the slide ring 173 in the holding cylinder portion 171 of the rotating ring 163 is pressed leftward in FIG. 12A by the spring force of the compression coil spring 178. The fixed portion of the push button 180 in the slide ring 173 is held in a state of being pressed against the inner wall surface of the holding cylinder portion 171. At this time, the endoscope insertion port 173a of the slide ring 173 is held at an eccentric position with respect to the endoscope insertion port 175a of the lid 175 and the through hole 170 of the rotating ring 163, and the insertion portion of the endoscope 20 52 is held in a state where it cannot be inserted into the through hole 170 of the rotating ring 163.

  When the push button 180 is pushed in until it hits the rotary ring 163, the shaft 181 moves inward through the fitting hole 179 of the rotary ring 163, and the slide ring 173 moves to the guide bar 176 in the slide hole 177. It moves to the right in FIG. 12A against the spring force of the compression coil spring 178 while being guided. Thereby, the endoscope insertion port 173a of the slide ring 173 is disposed coaxially with the endoscope insertion port 175a of the lid 175 and the through hole 170 of the rotation ring 163, so that the insertion portion 52 of the endoscope 20 is rotated. The ring 163 can be inserted into the through hole 170.

  In this state, when the insertion portion 52 of the endoscope 20 is inserted into the through hole 170 of the rotating ring 163 from above and then released from the push button 180, the rotating ring 163 is held by the spring force of the compression coil spring 178. The slide ring 173 in the cylindrical portion 171 is pressed leftward as shown in FIG. At this time, the insertion portion 52 of the endoscope 20 is connected to the right edge in FIG. 12B at the endoscope insertion port 173a of the slide ring 173, and the through hole 170 and the lid 175 of the rotating ring 163. The mirror insertion port 175a is sandwiched and fixed between the left edge portion in FIG. 12B.

  It should be noted that the actual fixing position of the insertion portion 52 of the endoscope 20 may be set to an optimum position by a surgical technique. However, when the balance state of this apparatus is to be perfectly balanced, The indicator 183 displayed on the mirror 20 may be aligned and fixed in a state where it is aligned with the upper surface of the lid 175 of the endoscope mounting portion 157.

Next, the operation of the drive control unit 161 will be described based on the following Table 1.

  First, when the switch 107 is pushed in, an operation signal is output to the vertical rod fixed electromagnetic brake 104, the swing arm fixed electromagnetic brake 106, and the lower rod fixed electromagnetic brake 105, and the fixing of all the electromagnetic brakes is released. In this state, when the joystick 152 is operated and a control signal is input from the joystick 152, the operation signals of the electromagnetic brakes 104, 105, and 106 are output so as to perform the operations shown in Table 1 above. A drive signal is output to each of the motors 156 and 162.

  That is, when a signal in the X direction is input by the joystick 152, no operation signal is output to the swing arm fixed electromagnetic brake 106 and the vertical rod fixed electromagnetic brake 104, and the fixed signal is held in the lower rod fixed electromagnetic brake 105. The operation signal is output and the fixing is released. At this time, a drive signal is output to the swing arm drive motor 158.

  Further, when a signal in the Y direction is input from the joystick 152, no operation signal is output to the swing arm fixed electromagnetic brake 106 and the vertical rod fixed electromagnetic brake 104, and the fixed signal is held in the lower rod fixed electromagnetic brake 105. The operation signal is output and the fixing is released. At this time, a drive signal is output to the vertical rod drive motor 162.

  Further, when signals in the X direction and the Y direction are simultaneously input by the joystick 152, the operation of the electromagnetic brake is not changed, and a drive signal is simultaneously output to the swing arm drive motor 158 and the vertical motor 162, respectively.

  Next, operations of the swing arm drive unit and the vertical rod drive unit different from those of the first embodiment will be described. First, the operation of the swing arm drive unit will be described with reference to FIG. The turning arm drive motor 158 is rotated by the motor drive signal from the drive controller 161 based on the X direction signal from the joystick 152, and the worm wheel 156 is rotated through the worm gear 160 fixed to the output shaft 159.

  At this time, the rotary seat 155 and the swing arm fixed electromagnetic brake 106 fixed thereto rotate integrally with the worm wheel 156. Here, since the swing arm fixed electromagnetic brake 106 is held in a fixed state by the action described in the first embodiment, the rotary seat 155 and the swing arm 6 rotate integrally with the cover 118.

  Further, when an operation signal is input to the swing arm fixed electromagnetic brake 106 from the drive control unit 161 based on the signal in the Y direction from the joystick 152, the swing arm fixed electromagnetic brake 106 is operated by the operation described in the first embodiment. Is released, and the swivel arm 6 is integrated with the cover 118 to be rotatable. The same applies when the switch 107 is pressed.

  When neither the switch 107 nor the joystick 152 is operated, the swing arm fixed electromagnetic brake 106 is held in a fixed state, and the swing arm drive motor 158 is also held in a stopped state. Therefore, due to the engagement between the worm wheel 156 and the worm gear 160, the swing arm fixed electromagnetic brake 106 and the rotary seat 155 are fixed in a non-rotatable state, and the swing arm 6 is in a fixed state. The operation of the vertical rod drive unit is the same as that of the swivel arm drive unit, and a description thereof will be omitted.

  Next, the movement of the endoscope 20 will be described. When the switch 107 and the joystick 152 are not operated, the link mechanism unit 4 including the vertical rod 2 and the parallelogram link is held in a fixed state as in the first embodiment, and the endoscope 20 is at the intersection C. Only swivel motion around is possible. When the switch 107 is pushed in, the endoscope 20 can be freely moved as in the first embodiment.

  FIG. 15 is a diagram for explaining the movement of the endoscope 20 when the joystick 152 is operated in the X direction. In the figure, the joystick 152 is arranged so that the longitudinal direction of the upper rod 9 is the X direction.

  Here, when the joystick 152 is operated in the X direction, the swivel arm 6 rotates while the rotation of the vertical rod 2 is fixed, and the fixation of the lower rod 7 is released. That is, since the upper rod 9 is rotatable, the endoscope 20 does not move in the insertion direction due to the frictional force with the trocar 100, and the abdominal wall opening S through which the trocar 100 has been punctured is used as a tilt center point. Inclined in the direction of arrow E. By this action, the observation site by the endoscope 20 can be moved in the direction of arrow e in FIG.

  FIG. 16 is a diagram for explaining the movement of the endoscope 20 when the joystick 152 is operated in the Y direction. The joystick 152 is disposed so that the longitudinal direction of the upper rod 7 is the X direction.

  Here, when the joystick 152 is operated in the Y direction, the vertical rod 2 rotates and the lower rod 7 is released from being fixed while the swing arm 6 is fixed. That is, since the upper rod 9 is rotatable, the endoscope 20 does not move in the insertion direction due to frictional force with the trocar 100, and the abdominal wall opening S into which the trocar 100 has been punctured is illustrated as an inclination center point. 16 in the direction of arrow F. By this action, the observation site by the endoscope 20 can be moved in the direction of the arrow f in FIG.

  In view of the above, since the electric drive mechanism is added to the first embodiment in the above configuration, the observation field of the endoscope 20 can be moved without requiring the operator to use a special hand during the operation. Therefore, the operation time can be shortened and the operator's fatigue can be reduced.

  In addition, the electric mechanism of the observation field of the endoscope 20 does not include a drive unit in the portion related to the inclination of the endoscope 20, and is performed by electrically driving the swing arm 6 and the vertical rod 2. The driving unit can be disposed in the support member 150 and the mounting unit 151. Therefore, as in the first embodiment, there is no disturbing protrusion on the abdomen of the patient during the operation, and the workability of the operation is not impaired. Since the endoscope 20 does not move in the insertion direction with respect to the abdominal wall opening S during electric driving, there is no possibility that the distal end of the endoscope 20 moves in a direction other than the desired direction, and safety can be improved.

  In addition, various types of endoscopes can be fixed at an arbitrary position in the insertion direction on the endoscope mounting portion 157, and is highly versatile with respect to various types of endoscopes having different positions of the center of gravity and different diameters. . Furthermore, in the present embodiment, the treatment tool can be held and inserted directly instead of the endoscope 20.

  FIGS. 17 to 20 show a third embodiment of the present invention. In the surgical instrument holding device of the present embodiment, the rotational force amount adjusting unit 8 of the device of FIG. 1 is changed to the configuration shown in FIG. The support structure of the adjustment dial 33 according to the present embodiment has the same basic configuration as that of the apparatus shown in FIG.

  In this embodiment, a disc spring 641 is used as a biasing means of the adjustment dial 33, and a bearing 642 is used instead of the washer 43 of the apparatus of FIG. In FIG. 18, 643 is a collar pressed against the outer peripheral surface of the bearing member 38, and 644 is a stopper of the bearing 642.

  Therefore, in the present embodiment, since the disc spring 641 is used as the biasing means of the adjustment dial 33, it is parallel to the biasing means based on the pressure contact of the ring-shaped collars 40 and 41 and the O-ring 42 as in the apparatus of FIG. The adjustment range of the operation force amount of the quadrilateral link mechanism 4 can be widened.

  In the present embodiment, a height adjusting mechanism for adjusting the height of the entire apparatus is provided. Here, for example, a through-hole 235 penetrating in the vertical direction is formed in the fixed arm 234 of the installation portion 232 that is detachably fixed to the side rail of the operating table by a fixing screw 233 as shown in FIG. A lower shaft portion 236 of the vertical rod 2 is inserted into the through hole 235 so as to be movable in the vertical direction. The lower shaft portion 236 of the vertical rod 2 is provided with a plurality of annular grooves 236a with a predetermined interval in the axial direction.

  Furthermore, a first screw hole (not shown) is formed in the fixed arm 234 in a direction perpendicular to the through hole 235. A height fixing pin 239 is screwed into this screw hole. The position of the vertical rod 2 relative to the fixed arm 234 can be fixed by engaging the tip of the height fixing pin 239 with the annular groove 236a of the lower shaft portion 236 of the vertical rod 2. . Therefore, the vertical rod 2 can be slid vertically with respect to the fixed arm 234 and adjusted to an arbitrary height.

  FIG. 19 shows a rotational force adjustment mechanism that adjusts the weight of the rotation of the lower shaft 236 of the vertical rod 2 relative to the fixed arm 234. In this rotational force amount adjusting mechanism portion, a second screw hole 237 is formed in a direction perpendicular to the through hole 235 in the fixed arm 234. A large-diameter hole portion 651 is formed in a connection portion between the screw hole 237 and the through hole 235.

  Further, a rotational force adjustment dial 238 is provided on the side surface of the fixed arm 234. The rotational force adjustment dial 238 is provided with a male screw-like screw portion 238b. The screw portion 238 b is screwed into the screw hole 237 of the fixed arm 234.

  Further, a small diameter portion 652 is formed at the tip of the screw portion 238 b of the rotational force adjustment dial 238. A ring-shaped disc spring 653 and a press contact body 654 are inserted into the small diameter portion 652. Further, a fixing screw 655 is fixed to the distal end surface of the small diameter portion 652. The disc spring 653 and the press contact body 654 are rotatably supported between the fixing screw 655 and the screw portion 238b of the rotational force adjustment dial 238.

  Then, the screw portion 238 b of the rotational force adjustment dial 238 is screwed into the screw hole 237 of the fixed arm 234, and the press contact body 654 at the tip of the screw portion 238 b is pressed against the lower shaft portion 236 of the vertical rod 2. At this time, by adjusting the screwing amount of the screw portion 238b in accordance with the rotation operation of the rotational force amount adjusting dial 238, the frictional force between the press contact body 654 and the lower shaft portion 236 is adjusted to rotate the vertical rod 2. The ability can be adjusted.

  Moreover, in this Embodiment, the structure of the surgical instrument holding | maintenance part connected with the upper rod 9 of the parallelogram link mechanism part 4 is changed. That is, an adapter attaching / detaching portion 551 fixed to a distal end portion of a connecting arm 331 detachably connected to the upper rod 9 to the surgical instrument holding portion, and an endoscope 335 detachably connected to the adapter attaching / detaching portion 551. The holding adapter 552 is provided.

  Here, for example, a slide type connecting means is provided between the holding adapter 552 and the adapter attaching / detaching portion 551 of the endoscope 335. Further, the adapter attaching / detaching portion 551 is provided with an engaging means for detachably engaging with the holding adapter 552 and a release knob 565 for releasing the engagement of the holding adapter 552. When the holding adapter 552 is attached to the adapter attaching / detaching portion 551, the holding adapter 552 is fixed to the adapter attaching / detaching portion 551 side by the engaging means, and the holding adapter 552 is engaged according to the operation of the release knob 565. Is released, and the holding adapter 552 can be detached from the adapter attaching / detaching portion 551 side.

  FIG. 20 shows a connecting portion structure between the base end portion of the connecting arm 331 and the upper rod 9 of the parallelogram link mechanism portion 4. Here, a connecting mechanism 661 with the upper rod 9 is provided at the base end of the connecting arm 331.

  The connection mechanism 661 is provided with an arm rotation block 662 fixed to the base end portion of the connection arm 331. A rotating shaft 663 serving as a rotating shaft of the connecting arm 331 is rotatably connected to the arm rotating block 662. The rotating shaft 663 is disposed in parallel with the connecting arm 331.

  A rotating screw 347 for connecting to the upper rod 9 is attached to the tip of the rotating shaft 663 so as to be able to advance and retract in the axial direction. Further, a small diameter portion 664 and a screw portion 665 are formed at the base end portion of the rotary shaft 663. The small-diameter portion 664 is provided with an O-ring 666 as a biasing unit sandwiched between a pair of bearings 667 and a collar 668.

  Further, a rotational operation force adjustment dial 669 having a screw hole 669a formed in the shaft center portion is screwed to the screw portion 665. A pair of bearings 667, an O-ring 666, and a collar 668 are supported while being sandwiched between the adjustment dial 669 and the connecting portion of the rotary shaft 663 and the arm rotary block 662.

  Then, the adjustment dial 669 is screwed into the rotation shaft 663 and the O-ring 666 is pressed to adjust the frictional force between the arm rotation block 662 and the rotation shaft 663 to adjust the rotational operation force amount. .

  In addition, this invention is not limited to the said embodiment, Of course, various deformation | transformation can be implemented in the range which does not deviate from the summary of this invention.

The perspective view which shows schematic structure of the whole surgical instrument holding | maintenance apparatus. Side view showing the structure of a force adjustment unit around the rotation axis O ₂ as seen from the arrow Q direction in FIG. 1 and a part cross-section. The longitudinal cross-sectional view which shows the principal part structure of an endoscope holding part. The perspective view which shows the state from which the endoscope holding member was removed from the L-shaped connection member. The schematic block diagram for demonstrating the balanced state of a parallelogram link. (A) is a schematic block diagram for explaining the horizontal movement of the endoscope, (B) is a schematic block diagram for explaining the vertical movement of the endoscope, and (C) is a modification of the apparatus of FIG. The schematic block diagram for demonstrating. The side view which shows the state by which the treatment tool was mounted | worn with the holding | maintenance part of the surgical instrument holding | maintenance apparatus in a partial cross section. The perspective view which shows schematic structure of the whole surgical instrument holding | maintenance apparatus of the 1st Embodiment of this invention. (A) is a block diagram for explaining an electric system, (B) is a longitudinal sectional view showing an internal structure of a swing arm locking portion, and (C) is a longitudinal sectional view showing an internal structure of a vertical rod locking portion. The perspective view which shows schematic structure of the whole surgical instrument holding | maintenance apparatus of the 2nd Embodiment of this invention. The longitudinal cross-sectional view which shows the internal structure of a supporting member. (A) is a longitudinal cross-sectional view which shows the state by which the endoscope was removed from the endoscope attachment part, (B) is a longitudinal cross-sectional view which shows the state by which the endoscope was mounted | worn to the endoscope attachment part. The perspective view which shows a joystick. The block diagram for demonstrating an electric system. The schematic block diagram for demonstrating the motion of an endoscope when a joystick is operated to the X direction. The schematic block diagram for demonstrating the motion of an endoscope when a joystick is operated to a Y direction. The perspective view which shows schematic structure of the whole surgical instrument holding | maintenance apparatus of the 3rd Embodiment of this invention. The longitudinal cross-sectional view of the principal part which shows the support structure of an adjustment dial. The longitudinal cross-sectional view of the principal part which shows the rotational force adjustment mechanism part of the lower shaft part of a vertical rod. The longitudinal cross-sectional view of the principal part which shows the connection part structure of a connection arm and a parallelogram link mechanism part.

Explanation of symbols

9 ... upper rod, O 6 _... rotary shaft (first rotary shaft), 14 ... holding portion, 15 ... L-shaped arms (arm member), O 7 _... rotational shaft (second rotational shaft), 16 ... L Character-shaped connecting member, O ₈ ... rotating shaft (third rotating shaft), 19 ... receiving portion, 20 ... endoscope (surgical instrument), C ... intersection, 50 ... gripping portion, 107 ... switch.

Claims (2)

An arm member whose base end is connected to a rod extending in the lateral direction so as to be rotatable around the axis of the first rotation shaft which is the central axis of the rod;
A connecting member connected to the tip of the arm member so as to be rotatable about the axis of the second rotating shaft extending in a direction orthogonal to the first rotating shaft;
A holding part for the surgical instrument provided on the connecting member, and having a receiving part for connecting the surgical instrument to be rotatable around a third rotation axis;
The holding part has a grip part gripped by an operator when moving the surgical instrument,
The surgical instrument holding device, wherein the grip portion is disposed on an intersection of the first rotating shaft, the second rotating shaft, and the third rotating shaft.   The gripping part includes a switch for releasing the fixing of the surgical instrument by fixing means for fixing the surgical instrument so that the surgical instrument does not move.

Images