JP4592007B2 - Object internal treatment device and object internal treatment system - Google Patents

Description

  The present invention relates to an object internal treatment apparatus and an object internal treatment system that perform excision of a target site inside the object, and more particularly to an apparatus and system for treating a lesion in a patient.

Conventionally, surgical treatment of a lesion in a patient has been performed by an operator directly operating a treatment tool introduced into the patient from an incised portion. In recent years, a method has also been devised in which a surgeon does not directly touch a treatment tool introduced into a patient from an incised portion and is remotely operated from outside the patient.
JP 2001-104333 A

  In the above-described surgical treatment of a lesion in a patient, an observation screen by an endoscope may be hidden by a treatment tool, so that the field of view is narrowed and the lesion and its surroundings may be difficult to see.

  In addition, when a plurality of treatment tools are introduced into a patient's body, the treatment tools or the treatment tool and the endoscope are likely to interfere with each other. Therefore, the treatment tool and the endoscope may not reach the lesioned part. is there.

  In order to solve the above problems, the present applicant has already decided that the flexible cylindrical main body portion to be introduced into the object is the center of the bottom surface on the object side among the bottom surfaces of the main body portion. A central hole for inserting an endoscope for observing the target site, and a treatment tool for treating the target site provided to penetrate the main body from the side surface of the main unit. An object internal treatment device including a plurality of peripheral hole portions to be inserted has been proposed (Japanese Patent Application No. 2004-11954).

  An object of the present invention is to further develop this application and obtain an object internal processing apparatus and an object internal processing system that are more convenient to use.

In the object internal treatment device of the present invention, a cylindrical main body part introduced into the object is provided so as to penetrate the main body part from the center of the bottom surface of the object side distal end part, and the target part is observed. A central hole for inserting an endoscope to be inserted, and at least one periphery for inserting a treatment instrument that is disposed radially outside the central hole and penetrates the main body and treats the target site A radially open groove that is continuous with the peripheral hole, and a lid member is inserted into the radially open groove so as to be movable in the radial direction. An urging member that urges and supports the lid member inward is provided.

It is preferable that the lid member of the object internal treatment device of the present invention has a semicircular groove with a semicircular cross section through which the treatment tool passes.

The urging member of the object internal treatment device of the present invention can be provided with a pair with different positions in the length direction of the main body, and the pair of urging members are located on the distal end side. It is practical that the inward biasing force is weaker than the inward biasing force of the rearward biasing member.

The lid member preferably has a rotation fulcrum at its rear part.

A forceps raising base can be provided in the radially open groove of the object internal treatment device of the present invention.

  It is practical that the urging member is an O-ring.

  The object internal treatment system of the present invention includes the object internal treatment device, a main body operation means for operating the main body part outside the object, and an endoscope operation means for operating the endoscope outside the object. And a treatment instrument operating means for operating the treatment instrument outside the object.

  The object internal treatment system preferably includes an image display device for displaying an image by an endoscope.

  It is preferable that the endoscope used for the object internal treatment system is a stereoscopic endoscope capable of observing the target portion in three dimensions.

  It is practical that the treatment instrument has observation means capable of observing the vicinity of the distal end of the treatment instrument.

  It is practical that the treatment instrument has illumination means that can illuminate the vicinity of the distal end of the treatment instrument.

  The treatment instrument preferably has an air / water supply means capable of cleaning the tip of the observation means.

  It is preferable that an image display device for displaying an image by the observation means is connected to the treatment instrument.

  It is practical that the main body has a bendable bending portion.

  It is practical that the treatment instrument has a bendable bending portion.

According to the present invention, since the treatment instrument can be guided in the guide groove of the lid member and can be advanced and retracted in the axial direction of the main body, the operation of the treatment instrument is facilitated and the treatment time can be shortened.

  FIG. 1 to FIG. 9 and FIG. 31 show an embodiment of an object internal treatment device 200 of the present invention and an object internal treatment system 300 (FIG. 31) using the object internal treatment device 200. . The object internal treatment system 300 (object internal treatment apparatus 200) is used for treatment of a lesioned part (target part) 110 of a patient body 100 as an object. The object internal treatment device 200 includes a distal end portion 11 having a circular end surface 11d whose outer diameter decreases toward the distal end, and a bendable bending portion fixed to a connection surface 11a (FIGS. 2 to 8) of the distal end portion 11. 12. The object internal treatment system 300 further includes a main body operation means 60, an endoscope operation means 70, and a treatment instrument operation means 81.

  The main body 10 is made of a flexible cylindrical member that is introduced into the patient body 100, is introduced into the patient body 100 from the distal end side of the distal end portion 11, and is introduced to a deep portion in the body according to the position of the lesioned part 110. can do. The main body part 10 is connected to the main body part operation means 60 (FIG. 31) at the rear end thereof, and the main body part operation means 60 can introduce and lead the main body part 10 to and from the patient body 100, and the bending part. Twelve curves can be adjusted. Examples of the main body operation means 60 include manual operation by an operator, automatic sending, and a winding device. The main body 10 can be operated from the outside by the main body operation means 60.

The main body 10 includes a central hole 20 penetrating through the main body 10 from the center of the bottom surface (tip surface) 11b on the lesioned part 110 side toward the rear end surface 10c (FIG. 31) of the rear end of the main body 10. The pair of peripheral hole portions 30a that are located radially outside the central hole portion 20 and penetrate the inside of the main body portion 10 from the side surface (outer cylindrical surface) 11c of the front end portion 11 toward the rear end surface 10c of the main body portion 10. , 30b. An endoscope 21 for observing the lesioned part 110 can be inserted into the central hole part 20, and the endoscope 21 extends from the central hole part 20 toward the lesioned part 110 side. The pair of peripheral hole portions 30a and 30b are side surfaces 11c of the distal end portion 11 and are positioned to face each other on an axis perpendicular to the axis. That is, outlet holes 31a and 31b of a pair of peripheral hole portions 30a and 30b are formed on the side surface 11c of the tip portion 11 at intervals of 180 degrees. The treatment tools 40 and 41 for treating the lesioned part 110 can be inserted into the pair of peripheral hole portions 30a and 30b, respectively, and the treatment tools 40 and 41 are outward from the outlet holes 31a and 31b of the peripheral hole portions 30a and 30b. It is extended to.
If the inner diameters of the peripheral hole portions 30a and 30b are the same, the treatment tools 40 and 41 can be replaced according to the content and procedure of the treatment.

The distal end portion 11 is formed with a pair of radially open grooves 13a and 13b that are continuous with the pair of peripheral hole portions 30a and 30b and are opened in the radial direction, and a pair of circumferentially open grooves 14a and 14b along the circumferential direction. (FIGS. 3 and 4). The radially open grooves 13a and 13b are fitted with lid members 15a and 15b that are movable in the radial direction. The outer surfaces of the lid members 15a and 15b are inclined according to the circular end surface 11d of the distal end portion 11, and have the same size as the radial opening grooves 13a and 13b. When the lid members 15a and 15b are fitted into the radial opening grooves 13a and 13b, the tip portion 11 can make up for the space formed by the radial opening grooves 13a and 13b. In the radial opening grooves 13a and 13b, chamfered portions 16a and 16b that are gradually inclined inwardly toward the axial direction of the tip end portion 11 are formed. The chamfered portions 16a and 16b facilitate the inward movement of the treatment tools 40 and 41.
The cover members 15a and 15b have guide grooves 17a and 17b having semicircular cross sections extending in the axial direction on the inner surfaces. When the treatment tools 40 and 41 extend from the outlet holes 31a and 31b of the pair of peripheral hole portions 30a and 30b (FIGS. 4 to 9), the guide grooves 17a and 17b serve as distal ends. 11 is guided to advance and retreat in the axial direction. A pair of latching grooves 18a1, 18b1 (18a2, 18b2) extending in the circumferential direction are formed on the outer surface of the lid member 15a (15b). The pair of latching grooves 18 a 1 and 18 b 1 (18 a 2 and 18 b 2) are provided at different positions in the length direction of the main body 10.
The circumferential opening groove 14a (14b), the latching groove 18a1 (18b1), and the latching groove 18a2 (18b2) are respectively located on the same axis orthogonal plane, and a pair of O-rings (biasing members) 19a, 19b is locked. The pair of O-rings 19a and 19b supports and supports the cover members 15a and 15b inward.

The stereoscopic endoscope (endoscope) 21 has a hollow flexible tube that can be bent, and two observation optical systems 21a for stereoscopically observing the lesioned part 110 at the distal end thereof. And an illumination optical system 21b for illuminating the lesioned part 110, an air supply / water supply system 21c for removing cloudiness on the surface of the observation optical system 21a, supplying water for cleaning, and supplying air to the patient body 100. Are inserted and fixed (FIGS. 5, 7, and 9). When the stereoscopic endoscope 21 is employed, the lesioned part 110 and its periphery can be observed in a three-dimensional manner, so that treatment can be performed accurately and smoothly.
In addition, as shown in FIG. 31, the stereoscopic endoscope 21 has a rear end portion in which the distal end portion of the stereoscopic endoscope 21 is introduced and derived, the focus of the observation optical system 21a, the visual field, zooming adjustment, and illumination. Endoscope operation means 70 for adjusting the brightness, direction, and angle of the optical system 21b, removing cloudiness on the surface of the observation optical system 21a, supplying water for cleaning, and supplying air to the patient body 100, etc. Is connected. Therefore, the stereoscopic endoscope 21 can be operated from the outside by the endoscope operating means 70. The observation optical system 21 a is connected to an image display device 83 that is arranged at the rear end of the stereoscopic endoscope 21 and can display the lesioned part 110 and its surrounding images in a three-dimensional manner. Note that one observation optical system may be used depending on the content of treatment.

The treatment instrument 40 is, for example, for incising a desired location, and a high-frequency current is passed from a scalpel tip to a desired position (lesioned portion 110) through a bendable cylindrical flexible tube portion 40a. An incision high-frequency knife 40b for incision, an observation optical system (observation means) 40c for observing the vicinity of the distal end of the incision high-frequency knife 40b, and an illumination optical system (illumination means) 40d for illuminating the vicinity of the distal end of the incision high-frequency knife 40b Further, an air supply / water supply system (air supply / water supply means) 40e that removes fogging of the surface of the observation optical system 40c, supplies water for cleaning, and supplies air to the patient's body 100 is inserted and fixed (FIG. 5).
As shown in FIG. 31, the treatment instrument 40 has, at its rear end portion, introduction, lead-out, bending, and control of the excision operation by the incision high-frequency knife 40b, the focus, field of view, and zooming of the observation optical system 40c. Tool for adjusting the brightness, adjusting the brightness, direction, and angle of the illumination optical system 40d, removing fogging on the surface of the observation optical system 40c, supplying water for cleaning, and supplying air to the patient body 100 An operating means 81 is connected. The treatment instrument 40 can be operated from the outside by the treatment instrument operation means 81.
Further, an image display device 84 capable of displaying an image near the tip of the incision high-frequency knife 40b is connected to the observation optical system 40c of the treatment instrument 40 at the rear end thereof. Note that two observation optical systems 40c may be provided, and the vicinity of the distal end of the incision high-frequency knife 40b may be observed stereoscopically. Further, infrared light observation, fluorescence observation, zoom observation, ultrasonic observation, confocal observation, optical coherent tomography observation (OCT), and the like can be performed.

  The treatment tool 41, for example, assists incision by the treatment tool 40 by grasping the periphery of the lesioned part 110, and a grasping forceps 41b capable of grasping an object on a bendable cylindrical flexible tube part 41a. Is inserted and fixed. The other basic configuration is the same as that of the treatment instrument 40, and is omitted.

  The treatment tools 40 and 41 may be inserted into any of the pair of peripheral hole portions 30a and 30b according to the treatment order, the shape of the lesioned portion, and the like. In addition, treatment tools other than the treatment tool 40 and the treatment tool 41 can be inserted into the peripheral hole portions 30a and 30b.

  When the treatment tool 40 and the treatment tool 41 are extended from the peripheral hole portions 30a and 30b (exit holes 31a and 31b), the treatment tool 40 and the treatment tool 41 are directed outward from the distal end portion 11. However, since the guide members 17a and 17b of the lid members 15a and 15b are guided in the axial direction, the distal end portions of the treatment instrument 40 and the treatment instrument 41 are easily arranged at desired positions. Further, since the chamfered portions 16a and 16b which are gradually inclined in the axial direction of the distal end portion 11 are formed in the radial opening grooves 13a and 13b, the treatment tool 40 and the treatment tool 41 are moved to the vicinity of the central hole portion 20. The movement becomes even easier. Therefore, even when the lesioned part 110 is close to the distal end surface 11b (near the central hole part 20), the treatment tool 40 and the treatment tool 41 are easily arranged near the lesioned part 110.

Next, a procedure for surgical treatment of the lesioned part 110 by the object internal treatment system 300 (object internal treatment apparatus 200) of the present invention will be described.
First, an appropriate portion for treating the lesioned part 110 is necessary for introducing the object internal treatment device 200 into the patient body 100 (for example, about 5 cm if the outer diameter of the main body 10 is 5 cm). Just make an incision. Even for a treatment that requires a plurality of treatment tools (two treatment tools 40 and 41 in this embodiment), a minimal incision is required, so the burden on the patient is small.

  Next, as shown in FIG. 31, the main body unit operating means 60, the endoscope operating means 70, the treatment tool operating means 81, and the image display devices 83 and 84 are the main body unit 10, the stereoscopic endoscope 21, and the treatment tool. The object internal treatment device 200 in a state of being connected to 40 and 41 is introduced into the patient body 100 through the incision. At the time of introduction, by operating the treatment instrument operation means 81, the treatment instruments 40 and 41 do not extend from the outlet holes 31a and 32a of the peripheral holes 30a and 30b, but the main body 10 (the distal end 11). It is assumed that it is housed inside. That is, as shown in FIGS. 1 to 3, the lid members 15a and 15b are not moved outward. If it does in this way, the treatment tools 40 and 41 extended from the main-body part 10 (or cover member 15a, 15b which moved outward) can reduce a possibility that the patient body 100 may be injured during introduction | transduction. The main body 10 is introduced at a position where the visual field range of the observation optical system 21a (stereoscopic endoscope 21) can observe the lesioned part 110 and its surroundings and the distal end portions of the treatment tools 40 and 41. stop.

Thereafter, in order to extend the treatment tools 40 and 41 from the distal end portion 11, when the treatment tools 40 and 41 are pushed into the lesioned part 110, the distal ends of the treatment tools 40 and 41 are exited from the peripheral hole portions 30a and 30b. It extends from the holes 31 a and 31 b and pushes the lid members 15 a and 15 b outward of the main body 10. Since the lid members 15a and 15b are urged inward by the O-rings 19a and 19b, the lid members 15a and 15b move outward (in the radial direction) by a certain distance, and subsequent movement is restricted. That is, the main body 10 of the present embodiment is a type in which the lid members 15a and 15b are translated outward.
The treatment instruments 40 and 41 are guided in the guide grooves 17a and 17b of the lid members 15a and 15b in the axial direction (perpendicular to the distal end surface 11b) in a state where movement of the lid members 15a and 15b is restricted. It is extended. The distal end portions of the treatment tools 40 and 41 are arranged at a desired position near the lesioned part 110 by operating the treatment tool operation means 81. Before incising (removing) the lesioned part 110 with the incision high-frequency knife 40b of the treatment instrument 40, the lesioned part 110 is grasped with the grasping forceps 41b of the treatment instrument 41 (FIGS. 4 and 5).
The incision position (broken line in FIGS. 6 to 9) of the lesioned part 110 is determined, and the incision high-frequency knife 40b is applied to the end of the incision position. Subsequently, while grasping the lesioned part 110 with the grasping forceps 41b, the grasping forceps 41b (lesioned part 110) is pulled near the distal end of the stereoscopic endoscope 21 (FIGS. 8 and 9), and is used for incision along the incision position. The incision is gradually made with the high-frequency knife 40b. Further, the incision can be similarly performed by pushing the incision high-frequency knife 40b along the incision position while holding the lesioned part 110 with the grasping forceps 41b.

10 and 11 show another embodiment (second embodiment) of the present invention. In the present embodiment, the four peripheral hole portions 30a, 30b, 30c, and 30d are arranged in pairs at opposing positions in the orthogonal direction in the axial orthogonal cross section. That is, four peripheral hole portions 30a, 30b, 30c, and 30d outlet holes 31a, 31b, 31c, and 31d are formed on the side surface 11c of the distal end portion 11 at intervals of 90 degrees. In the peripheral hole portions 30a, 30b, 30c, and 30d, treatment instruments 40, 41, 42, and 43 each having a flexible long shape are inserted and penetrated in a detachable manner. Other configurations, operations, and effects are the same as those in the first embodiment, and will be omitted.

  The treatment tool 42 is a cylindrical flexible tube that can be bent and that supplies water for washing the lesioned part 110 and its surroundings, and sucks liquid such as blood and washing water around the lesioned part 110 and its surroundings. When the lesioned part 110 and its surroundings are washed to the part 42a, water is fed, and when a liquid such as blood and washing water around the lesioned part 110 and its surroundings is sucked, a washing water feeding and sucking tube 42b sucked from the outside is provided. The insertion is fixed. In addition, since the basic configuration is the same as that of the treatment instrument 40, it is omitted.

  The treatment tool 43 is for locally stopping hemostasis at a desired location, and applies hemostasis by heating by applying a high frequency locally to the desired location on a bendable cylindrical flexible tube portion 43a. A high-frequency hemostatic forceps 43b is inserted and fixed. In addition, since the basic configuration is the same as that of the treatment instrument 40, it is omitted.

  In the above embodiment, the main body 10 having two and four peripheral holes has been described. However, the number of peripheral holes can be arbitrarily set. The treatment tools 40, 41, 42, and 43 may be inserted into any of the peripheral holes depending on the treatment order, the shape of the lesioned part 110, and the like. In addition, treatment instruments other than the treatment instruments 41, 42, 43, and 44 can be inserted into the peripheral hole.

12 to 21 show still another embodiment (third embodiment) of the present invention. As for the main-body part 10 of this embodiment, the cover members 15a and 15b rotate centering | focusing on the rear-end part. That is, one end surface of the lid member 15a (15b) on the side of the curved portion 12 has a lid portion turning curved surface 15Xa (15Xb) formed of a part of a cylindrical circumferential surface, and a pair of radial opening grooves 13a (13b). ) Is formed with a groove turning curved surface 13Xa (13Xb) composed of a part of a cylindrical concave surface corresponding to the lid turning curved surface 15Xa (15Xb). When the lid members 15a and 15b receive the extended output from the treatment instruments 40 and 41 (the force by which the treatment instruments 40 and 41 push the lid members 15a and 15b), the lid turning curved surface 15Xa (15Xb) is turned into the groove turning curved surface 13Xa. Slide with (13Xb). Thus, the lid members 15a and 15b rotate around the pivot fulcrum X set by the lid pivot surface 15Xa (15Xb) and the groove pivot surface 13Xa (13Xb).
Further, the distal end portions on the distal end surface 11b side of the lid members 15a and 15b are gradually inclined inward according to the chamfered portions 16a and 16b, and even when the lid members 15a and 15b are opened, the distal end portion 11 (the main body portion 10). ) The overall diameter can be kept small.
The lid member 15a (15b) has a protrusion abutting surface 13Ya (13Yb) provided in the radial opening groove 13a (13b) on the rear side (curved portion 12 side) of the lid portion turning curved surface 15Xa (15Xb). A rotation restricting protrusion 15Ya (15Yb) that abuts and restricts the opening angle is provided.

When the treatment tools 40 and 41 are extended from the peripheral hole portions 30a and 30b, the lid members 15a and 15b rotate in a direction in which the distal end side of the lid members 15a and 15b protrudes outward with the rotation fulcrum X as the center. It moves (FIGS. 16 to 21). That is, the urging force of the O-ring 119b on the bending portion 12 side is stronger than the extended output, and even if the treatment instruments 40 and 41 push up the lid members 15a and 15b, the O-ring 119b does not expand (lid members 15a and 15b). Will not move). However, the biasing force of the O-ring 119a on the distal end surface 11b side is weaker than the extended output of the treatment tools 40 and 41. When the treatment tools 40 and 41 push up the lid members 15a and 15b, the O-ring 119a expands and the lid The distal end portion 11 side of the members 15a and 15b is in an open state. Therefore, the treatment tools 40 and 41 can move (advance and retreat) in the axial direction according to the guide grooves 17a and 17b.

When the end portions of the lid members 15a and 15b are rotated by a certain amount, the rotation restricting projections 15Ya and 15Yb are brought into contact with the projection contact surfaces 13Ya and 13Yb of the radial opening grooves 13a and 13b to move (open angle). ) Is regulated. That is, the lid members 15a and 15b are restricted from rotating by a certain amount or more. Thus, if the maximum opening angle of the lid members 15a and 15b is set, the possibility that the lid members 15a and 15b open carelessly and interfere with the surroundings (the patient's body 100) can be eliminated. Other configurations, operations, and effects are the same as those in the first embodiment, and thus are omitted.
In addition, instead of the O-ring 119b, a plurality of O-rings 119a having the same specification can be used to increase the urging force on the bending portion 12 side, and the cost for manufacturing the O-ring 119b as a separate member can be reduced. .

  22 to 30 show still another embodiment (fourth embodiment) of the present invention. In the present embodiment, the operation wire tube 50a communicates from the rear end surface 10c to the radially open grooves 13a and 13b in the main body portion 10 at different positions from the central hole portion 20 and the peripheral hole portions 30a and 30b. , 50b. In the radial opening grooves 13a and 13b, forceps raising bases 53a and 53b pivotally attached to rotating pins 52a and 52b orthogonal to a plane including the axis of the main body 10 are stored. The distal ends of the raising base operation wires 51a and 51b inserted into the operation wire tubes 50a and 50b are coupled to the forceps raising bases 53a and 53b. The forceps raising bases 53a and 53b have concave surfaces 54a and 54b for guiding the treatment instruments 40 and 41 inserted through the peripheral hole portions 30a and 30b, and the side in the short direction is shorter from the center toward the curved portion 12 side. When the raising base operation wires 51a and 51b are pulled toward the bending portion 12, they rotate around the rotation pins 52a and 52b, and the directions of the treatment instruments 40 and 41 can be changed.

  When the treatment tools 40 and 41 guided by the concave surfaces 54a and 54b of the forceps raising bases 53a and 53b come into contact with the guide grooves 17a and 17b of the lid members 15a and 15b, the axial direction of the main body 10 is followed according to the guide grooves 17a and 17b. Be guided to. By adjusting the rotation amount of the forceps raising bases 53a and 53b (the pulling amount of the raising base operation wires 51a and 51b), the extending direction of the treatment tools 40 and 41 can be easily determined. That is, the treatment instruments 40 and 41 can be extended from the distal end surface 11b in a direction parallel to the axis (FIGS. 25 and 26), or can be extended outward to guide grooves of the lid members 15a and 15b. It can also project in the axial direction by 17a and 17b (FIGS. 27 to 30). Other configurations, operations, and effects are the same as those in the first embodiment, and thus are omitted.

  A modification will be described below. FIG. 32 shows an example in which instead of the treatment instruments 40, 41, 42, and 43, endoscope insertion portions 140a, 141a, 142a, and 143a are inserted into the peripheral hole portions 30a, 30b, 30c, and 30d, respectively. is there. In this example, the incision high-frequency knife 40b, the grasping forceps 41b, the washing water feeding and suction tube 42b, and the high-frequency hemostatic forceps 43b are provided in the forceps channels 140h, 141h, and 142h provided in the insertion portions 140a, 141a, 142a, and 143a. , And 143h. Similar to the treatment instruments 40, 41, 42, and 43, the insertion portions 140a, 141a, 142a, and 143a are provided with an observation optical system, an illumination optical system, an air / water supply system, and a bending portion. If comprised in this way, since an existing endoscope can be utilized, manufacturing cost can be reduced.

  In addition, as shown in FIG. 33, an operation means 160 that can collectively or selectively operate the main body unit 10, the stereoscopic endoscope 21, and the treatment tools 40 to 43 may be provided. Furthermore, an image display device 183 capable of displaying the images from the observation optical system 21a of the stereoscopic endoscope 21 and the observation optical systems 40c and 41c of the treatment instruments 40 and 41 collectively or selectively is provided. Also good. With this configuration, a space-saving and compact system can be achieved, and treatment can be performed efficiently by a smaller number of surgeons.

Although the present invention has been described with reference to the above embodiment, the present invention is not limited to the above embodiment, and can be improved or changed within the scope of the purpose of the improvement or the idea of the present invention.

It is a front view which shows 1st embodiment of the main-body part of the target object internal treatment apparatus of this invention. It is sectional drawing which follows the II-II line of FIG. It is a perspective view of the main-body part of FIG. 1, FIG. It is sectional drawing corresponding to FIG. 1 which shows the state in which the treatment tool and the endoscope were inserted. FIG. 4 is a perspective view corresponding to FIG. 3, showing a state where a treatment tool and an endoscope are inserted. It is sectional drawing corresponding to FIG. 1 which shows an example of the treatment state by a treatment tool. FIG. 4 is a perspective view corresponding to FIG. 3. It is sectional drawing corresponding to FIG. 1 which shows another example of the treatment state by a treatment tool. FIG. 4 is a perspective view corresponding to FIG. 3. It is a perspective view which shows 2nd embodiment of the main-body part of the target object internal treatment apparatus of this invention. It is a perspective view corresponding to Drawing 10 showing the state where a treatment implement and an endoscope were inserted in the second embodiment. It is a front view of the second embodiment. It is sectional drawing which follows the XIII-XIII line | wire of FIG. It is a top view of FIG. It is a perspective view which shows 3rd embodiment of the main-body part of the target object internal treatment apparatus of this invention. It is sectional drawing which shows the state in which the treatment tool and the endoscope were inserted in 3rd embodiment. It is the same perspective view. FIG. 17 is a cross-sectional view corresponding to FIG. 16 illustrating an example of a treatment state using a treatment tool in the third embodiment. It is the same perspective view. In 3rd embodiment, it is sectional drawing corresponding to FIG. 16 which shows another example of the treatment state by a treatment tool. It is the same perspective view. It is a front view which shows 4th embodiment of the main-body part of the target object internal treatment apparatus of this invention. It is sectional drawing which follows the XXIII-XXIII line | wire of FIG. It is a perspective view of the main-body part of the same fourth embodiment. It is sectional drawing corresponding to FIG. 23 which shows the state in which the treatment tool and the endoscope were inserted in 4th embodiment. It is a perspective view of the state of FIG. It is sectional drawing corresponding to FIG. 23 which shows the state which raised the treatment tool in the 4th embodiment. It is a perspective view of the state of FIG. In 4th embodiment, it is a perspective view which shows an example of the treatment state by a treatment tool. It is sectional drawing of the state of FIG. It is a block diagram which shows the relationship between the main-body part, endoscope, treatment tool, main-body part operation means, endoscope operation means, treatment tool operation means, and image display apparatus which concern on embodiment of this invention. It is a perspective view which shows the structure of the modification of embodiment of this invention. It is a block diagram which shows the relationship between the main-body part, endoscope, treatment tool, an operation means, and an image display apparatus in another modification of embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Main-body part 10c Rear end surface 11 Front-end | tip part 11a Connection surface 11b Front-end surface (bottom surface)
11c Side surface 11d Circular end surface 12 Curved portion 13a 13b 13c 13d Radial opening groove 13Xa 13Xb Groove turning curved surface 13Ya 13Yb Protrusion abutment surface 14a 14b Circumferential opening groove 15a 15b 15c 15d Lid member 15Xa 15Xb Lid turning surface 15Ya 15Yb Movement restricting projection 16a 16b 16c 16d Chamfered portion 17a 17b 17c 17d Guide groove 18a1 18b1 18a2 18b2 Latching groove 19a 19b 119a 119b O-ring 20 Central hole 21 Stereoscopic endoscope (endoscope)
21a Observation optical system 21b Illumination optical system 21c Air / water supply system 30a 30b 30c 30d Peripheral hole 31a 31b 31c 31d Exit hole 40 41 42 43 Treatment tool 40a 41a 42a 43a Flexible tube 40b Incision high-frequency knife 40c 41c 42c 43c Observation Optical system (observation means)
40d 41d 42d 43d Illumination optical system (illumination means)
40e 41e 42e 43e Air / water supply system (air / water supply means)
41b Grasping forceps 42b Washing water feeding and suction tube 43b High-frequency hemostatic forceps 50a 50b Operation wire tube 51a 51b Raising base operation wire 52a 52b Rotating pin 53a 53b Forceps raising base 54a 54b Concave surface 60 Main body operation means 70 Endoscope operation means 81 Treatment tool operation means 83 84 183 Image display device 100 Body of patient (object)
110 Lesions (target site)
140a 141a 142a 143a Insertion part 140h 141h 142h 143h Forceps channel 160 Operating means 200 Object internal treatment device 300 Object internal treatment system X Rotation fulcrum

Claims (15)

A central hole portion into which an endoscope for observing a target portion is provided so that a cylindrical main body portion to be introduced into the inside of the object passes through the main body portion from the center of the bottom surface of the object-side tip portion. And at least one peripheral hole portion that is provided radially outside the central hole portion and is provided so as to penetrate the main body portion, and into which a treatment instrument for treating the target site is inserted,
At the tip of the main body portion, a radially open groove continuous with the peripheral hole portion is formed, and a lid member is inserted into the radially open groove so as to be movable in the radial direction. An object internal treatment device comprising an urging member that urges and supports the object. The object internal treatment apparatus according to claim 1, wherein the lid member is formed with a semicircular groove having a semicircular cross section through which a treatment tool passes on an inner surface thereof. 3. The object internal treatment device according to claim 1, wherein the biasing member includes a pair of different positions in a length direction of the main body, and the pair of biasing members are positioned on a distal end side. An object internal treatment device in which an inward biasing force of the biasing member to be performed is weaker than an inward biasing force of the biasing member positioned rearward. 4. The object internal treatment device according to claim 1, wherein the lid member has a rotation fulcrum at a rear part thereof. 5. 5. The object internal treatment device according to claim 1, wherein a forceps raising base is provided in the radially open groove. 6. 4. The object internal treatment device according to claim 1, wherein the biasing member is an O-ring. The object internal treatment device according to any one of claims 1 to 6,
A body portion operating means for operating the body portion outside the object;
Endoscope operating means for operating the endoscope outside the object;
A treatment instrument operating means for operating the treatment instrument outside the object;
An object internal treatment system comprising: 8. The object internal treatment system according to claim 7, further comprising an image display device for displaying an image obtained by the endoscope. 9. The object internal treatment system according to claim 7 or 8, wherein the endoscope is a stereoscopic endoscope capable of observing a target part in three dimensions. The object internal treatment system according to any one of claims 7 to 9, wherein the treatment instrument includes an observation unit capable of observing the vicinity of the distal end of the treatment instrument. 11. The object internal treatment system according to claim 7, wherein the treatment tool includes an illuminating unit capable of illuminating the vicinity of the distal end of the treatment tool. The object internal treatment system according to any one of claims 7 to 11, wherein the treatment tool includes an air supply / water supply means capable of cleaning a tip of the observation means. The object internal treatment system according to any one of claims 7 to 12, wherein the treatment tool includes an image display device for displaying an image by the observation means. 14. The object internal treatment system according to any one of claims 7 to 13, wherein the main body has a bendable bending portion. The object internal treatment system according to any one of claims 7 to 14, wherein the treatment instrument has a bendable bending portion.

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