JP2010057914A - 医療用マニピュレータ、処置システム - Google Patents
医療用マニピュレータ、処置システム Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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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
- A61B1/04—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 combined with photographic or television appliances
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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
- A61B1/313—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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00318—Steering mechanisms
- A61B2017/00323—Cables or rods
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2906—Multiple forceps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/291—Handles the position of the handle being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B2017/3445—Cannulas used as instrument channel for multiple instruments
- A61B2017/3447—Linked multiple cannulas
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
Abstract
【解決手段】先端側が硬質の材料で形成され、湾曲可能な湾曲部を有して筒状に形成されたアーム152、153と、アーム152、153の基端が接続された挿入部2と、挿入部2の先端に設けられた撮像装置5と、前記湾曲部を操作するための操作部170と、前記湾曲部と操作部170とを接続する伝達部材とを備えた医療用マニピュレータ151において、前記湾曲部は、操作部170の操作によって所定の方向に湾曲可能な第1湾曲部154、155と、第1湾曲部154、155より基端側に設けられ、アーム152、153が互いに離間するように湾曲された状態で固定可能な第2湾曲部156、157とを有し、前記伝達部材は、可撓性を有する第一領域と、前記第一領域の基端側に接続された硬質の第二領域とを有する。
【選択図】図18
Description
近年、腹壁に開ける穴の数をより少なくして患者の負担を低減するために、患者の口や鼻、肛門等の自然開口から軟性の内視鏡を挿入して手技を行うものが提案されている。このような手技に使用される医療機器として、例えば、特許文献1に記載されるような処置用内視鏡が提案されている。
この処置用内視鏡は、可撓性を有する軟性の挿入部を有し、挿入部先端には湾曲動作を行う湾曲部を有する一対のアーム部が設けられ、挿入部に配された複数のチャンネルと各々のアーム部の内腔とが連通されている。処置用内視鏡の操作部は、アーム部と操作部材で接続されており、アーム部を上下左右に湾曲操作可能に構成されている。
ユーザは鉗子等の処置具をチャンネル内に挿入し、処置具の操作部を処置用内視鏡の操作部に装着して、処置具の先端をアーム部から突出させ、操作部を上下左右に操作することによって、処置具の先端を処置対象の組織等に異なる方向からアプローチさせて手技を行う。
以下、本発明の第1実施形態の医療用マニピュレータ(以下、単に「マニピュレータ」と称する。)について、図1から図17Bを参照して説明する。
図1は、本実施形態のマニピュレータ1を含む処置システム120を示す全体図である。処置システム120は、本実施形態のマニピュレータ1に、2本の処置具100が挿入されて構成されている。
リンク部12は、先端側の第1リンク20と、基端側の第2リンク21とから構成されている。第1リンク20及び第2リンク21の組がそれぞれアーム10及び11に取り付けられている。
なお、リンク操作部15Aは、本体とリンクロッドとの固定位置を除いてリンク操作部15Aと同一の構造である。
湾曲部10Aの節輪13と湾曲操作部14Bとを接続する伝達部材30は、節輪13側の第1領域30Aと、湾曲操作部14B側の第2領域30Bとの2つの領域に分かれている。
4本の伝達部材41、42、43、及び44は、いずれも後述する操作部リンクを介して湾曲操作部14Bと接続されている。
図12は、湾曲操作部14Bの基端が右に移動した状態を示す図である。湾曲操作部14Bが移動することによって、第3伝達部材43が第3操作部リンク47を介して基端側に牽引される。こうしてアーム10の湾曲部10Aは左側に湾曲する。舌片53に軸支された第3操作部リンク47及び第4操作部リンク48の基端は、湾曲操作部14Bが左右方向に操作されるときのカバー31に対する揺動中心である第1操作部リンク45及び第2操作部リンク46の基端(図12に示す位置P1)よりも、湾曲操作部14Bの軸線方向の先端側に位置している。このため、左右方向操作時における第3伝達部材43及び第4伝達部材44の牽引量が増大され、少ないストローク(湾曲操作部の操作量)で効率よく湾曲操作を行うことができる。なお、このとき、第1伝達部材41及び第2伝達部材42は進退しない。また、湾曲操作部14Bの基端が左に移動したときの動作もほぼ同様である。
湾曲操作部14Bの基端の移動によって、揺動部材51の後方部56は上方に移動する。それに伴い、図13Bに示すように、前方部55の下側端部55Bが基端側に移動する。下側端部55Bは、切り欠き59B内を摺動し、切り欠き59Bの後端に当接した後は第2摺動部材58を押圧して基端側に移動させる。
このとき、硬性部102をより基端側の軟性部103より細径に形成すると、挿通される挿入部2のチャンネルあるいは内シース16の内面との間に一定のクリアランスが確保されるので、スムーズにアーム10、11に挿入することができる。
次に本発明の第2実施形態について、図18から図20を参照して説明する。本実施形態のマニピュレータ151と上述のマニピュレータ1との異なるところは、アームの構造と、操作部の構造である。なお、上述の第1実施形態と共通する構成については、同一の符号を付して重複する説明を省略する。
挿入部2の先端には、アーム10、11に代えて、一対のアーム152及び153が取り付けられている。
第3伝達部材181及び第4伝達部材182の第一領域181A及び182Aは、ワイヤ183と、ワイヤ183が挿通されたコイル184とから形成されている。
また、上述した湾曲操作部と伝達部材とのつながりの詳細については、第1実施形態では詳細に説明しなかったが、同様の構成を第1実施形態のマニピュレータ1に適用することが可能である。
上述した2つの例では、2つの異なる領域が、いずれも同一の体腔である腹腔内に位置していたが、このパターンでは、異なる領域の少なくとも1つが、他の領域が位置する体腔と隔壁で隔絶された異なる体腔内に位置している。
胃大網動脈81Aを受け取った胸腔側の術者は、冠動脈83の狭窄部位83Aより遠位側に胃大網動脈81Aをつないでバイパスを形成し、遠位側への血液供給を確保する。
なお、バイパス血管として内胸動脈を選択した場合も、内胸動脈の胸壁からの剥離と、心臓に対する準備作業を同時に行うことができ、メリットがある。
このように、完全ヘルニアのような処置の容易でないケースであっても、マニピュレータ1を適用することで、的確かつ短時間で行うことが可能である。
また、上述の3つの例では、いずれも同一の目的を有する手術の一部がそれぞれ異なる領域で行われている例を説明したが、第1のパターン同様、それぞれ目的の異なる独立した複数の手技がそれぞれの領域で行われても構わない。
そこで、一方の術者は、図31に示すようにマニピュレータ1Aを用いて横行結腸98Aの左側の領域に対して手技を行い、もう一方の術者はマニピュレータ1Bを用いて右側の領域に対して手技を行うというように手技を分担して同時進行で行うと、より短時間で手技を進めることができる。この場合も、2つの領域が、1つの撮像装置の視野を用いて各手技を同時進行することが困難な位置関係にあれば、これら2つの領域は異なる領域であると言える。
例えば、上述の説明では、異なる2つの領域が同一の体腔内にある場合として、いずれも腹腔内に位置する例を用いたが、これに限らず、異なる2つの領域が、胸腔内、例えばそれぞれ右胸と左胸に存在する場合等の他の例もありうる。
この他、本発明は前述した説明によって限定されることはなく、添付の特許請求の範囲によってのみ限定される。
2、112 挿入部
4、170 操作部
5 撮像装置
10、11、152、153 アーム
10A、11A 湾曲部
30、41、42、43、44、177、181、182伝達部材
45、46、47、48、188、189 操作部リンク
100、101 処置具
102 硬性部
103 軟性部
120、200 処置システム、
154、155 第1湾曲部
156、157 第2湾曲部、
173、174 第2湾曲操作部
176 ロック機構
181A、182A 第一領域
181B、182B 第二領域
187 調節部
Claims (6)
- 先端側が硬質の材料で形成され、湾曲可能な湾曲部を有して筒状に形成された複数のアームと、
硬質の材料で複数のチャンネルを有して形成され、自身の先端に、前記アームの内腔と前記複数のチャンネルのそれぞれとが連通するように前記複数のアームの基端が接続された挿入部と、
前記挿入部の先端に設けられた撮像装置と、
前記湾曲部を操作するための操作部と、
前記湾曲部と前記操作部とを接続する伝達部材と、
を備えた医療用マニピュレータであって、
前記湾曲部は、
前記操作部の操作によって所定の方向に湾曲可能な第1湾曲部と、
前記第1湾曲部より基端側に設けられ、前記複数のアームが互いに離間するように湾曲された状態で固定可能な第2湾曲部とを有し、
前記伝達部材は、可撓性を有する第一領域と、第一領域の基端側に接続された硬質の第二領域とを有する。 - 請求項1に記載の医療用マニピュレータであって、
前記操作部と前記伝達部材とは、複数の操作部リンクを介して接続されており、
前記複数の操作部リンクの基端間の距離は、接続された前記複数の伝達部材の前記第二領域間の距離よりも長く、
前記複数の伝達部材は、撓み変形により互いの軸線方向の移動量の差を吸収可能な調節部を有する。 - 請求項2に記載の医療用マニピュレータであって、
前記調節部は、前記第一領域に設けられており、可撓性を有する部位の撓み変形により前記移動量の差を吸収する。 - 請求項1に記載の医療用マニピュレータであって、前記操作部は、前記伝達部材を介して前記第2湾曲部と接続された第2湾曲操作部を有し、
前記第2湾曲操作部は、前記第2湾曲部が湾曲された状態で固定されるように、前記伝達部材を保持可能なロック機構を有する。 - 請求項1に記載の医療用マニピュレータと、
前記医療用マニピュレータの前記チャンネル及び前記アームに挿通可能な処置具と、
を備えた処置システムであって、
前記処置具は、
先端に配置されて処置を行う硬質の硬性部と、
前記硬性部の基端に接続され、可撓性を有する軟性部と、を有し
前記処置具を限界まで前記医療用マニピュレータに挿入したときに、前記アームの先端からは前記硬性部のみが突出し、前記湾曲部の内腔には前記軟性部のみが位置する。 - 請求項5に記載の処置システムであって、
前記処置具は、前記硬性部の径よりも前記軟性部の径が大きく設定されており、前記アームにおいて前記湾曲部より先端側の少なくとも一部の内腔の径は、前記硬性部が進入可能かつ前記軟性部が進入不能な大きさに設定されている。
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Also Published As
Publication number | Publication date |
---|---|
EP2158836A3 (en) | 2012-10-03 |
JP2014193381A (ja) | 2014-10-09 |
JP5815081B2 (ja) | 2015-11-17 |
EP2158836A2 (en) | 2010-03-03 |
JP5550868B2 (ja) | 2014-07-16 |
EP2158836B1 (en) | 2018-05-16 |
US20100056863A1 (en) | 2010-03-04 |
US8834353B2 (en) | 2014-09-16 |
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