JP5235706B2 - Treatment endoscope - Google Patents

Treatment endoscope Download PDF

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JP5235706B2
JP5235706B2 JP2009022106A JP2009022106A JP5235706B2 JP 5235706 B2 JP5235706 B2 JP 5235706B2 JP 2009022106 A JP2009022106 A JP 2009022106A JP 2009022106 A JP2009022106 A JP 2009022106A JP 5235706 B2 JP5235706 B2 JP 5235706B2
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distal end
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bending portion
observation window
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直幸 内藤
慎也 小松
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Hoya Corp
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    • 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
    • A61B1/012—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 characterised by internal passages or accessories therefor
    • A61B1/018—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 characterised by internal passages or accessories therefor for receiving instruments

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Description

この発明は処置用内視鏡に関する。   The present invention relates to a treatment endoscope.

内視鏡においては一般に、遠隔操作により屈曲自在な湾曲部が挿入部の先端付近に設けられて、湾曲部の先端側に観察窓と処置具突出口等が配置されている。ただし、処置用内視鏡では、湾曲部の先端側と基端側の双方に観察窓と処置具突出口を配置して、処置能力を高めたもの等もある（例えば、特許文献１、２）。   In an endoscope, generally, a bending portion that can be bent by remote operation is provided in the vicinity of the distal end of the insertion portion, and an observation window, a treatment instrument protrusion, and the like are disposed on the distal end side of the bending portion. However, some treatment endoscopes have an improved treatment capability by arranging observation windows and treatment tool protrusions on both the distal end side and the proximal end side of the bending portion (for example, Patent Documents 1 and 2). ).

特開２００４−２２３０５３JP 2004-223053 A 特開２００５−９５５９０JP-A-2005-95590

近年の処置用内視鏡を用いた手術の進歩は目ざましく、粘膜切開術や粘膜剥離術等がごく当たり前のように実施されるようになり、最近では、胃壁等のような生体壁全層の切除を行う試みもなされている。   Recent progress in surgery using endoscopes for treatment is remarkable, and mucosal dissection and mucosal dissection have been carried out as usual. Attempts have also been made to perform resection.

しかし、特許文献１に記載されているような従来の処置用内視鏡で生体壁全層の切除を行おうとすると、切除中に処置具の切開電極が振らついたり内視鏡の観察窓位置が切除部位に対して振らついたりして、安定した状態で切除処置を行うことができない場合がある。   However, if the entire wall of the living body is to be excised with a conventional endoscope for treatment as described in Patent Document 1, the incision electrode of the treatment tool is shaken during the excision, or the observation window position of the endoscope May swing to the excision site, and the excision procedure may not be performed in a stable state.

また、生体壁全層を切除する場合には、生体壁の表面側の状態だけでなく、生体壁の裏面側の血管の走行状態等にも気を配って切除を行う必要があるが、従来の処置用内視鏡ではそのような機能が得られない。   Further, when excising the entire layer of the living body wall, it is necessary to perform excision not only in the state of the surface side of the living body wall but also in the running state of the blood vessel on the back side of the living body wall. Such a function cannot be obtained with this treatment endoscope.

本発明は、生体壁全層の切除等を行う際に、高周波電極や観察窓が切除対象に対して振らつくことなく、安全かつ円滑に切除処置等を行うことができ、また、生体壁の表面側の状態だけでなく、裏面側の血管の走行状態等も観察しながら安全に切除処置等を行うことができる処置用内視鏡を提供することを目的とする。   The present invention can perform a resection treatment and the like safely and smoothly without the high-frequency electrode and the observation window being shaken with respect to the resection object when performing resection of the entire layer of the living body wall. It is an object of the present invention to provide a treatment endoscope that can safely perform excision and the like while observing not only the surface side state but also the running state of blood vessels on the back side.

上記の目的を達成するため、本発明の処置用内視鏡は、遠隔操作により屈曲自在な湾曲部が挿入部の先端付近に設けられて、湾曲部の先端側又は基端側の少なくとも一方に観察窓が配置され、処置具を挿通するための処置具挿通チャンネルが挿入部内に挿通配置された処置用内視鏡において、処置具挿通チャンネルの出口である処置具突出口が湾曲部の先端側又は基端側の少なくとも一方に配置されると共に、処置具突出口から突き出された高周波処置具の高周波電極の先端を係脱自在に係合させるための電極係合部が、湾曲部の先端側又は基端側であって処置具突出口とは反対側の位置に設けられているものである。   In order to achieve the above object, the treatment endoscope of the present invention is provided with a bending portion that can be bent by remote operation in the vicinity of the distal end of the insertion portion, and at least one of the distal end side or the proximal end side of the bending portion. In a treatment endoscope in which an observation window is arranged and a treatment instrument insertion channel for inserting the treatment instrument is inserted and arranged in the insertion portion, the treatment instrument projection port that is an outlet of the treatment instrument insertion channel is the distal end side of the bending portion Alternatively, an electrode engaging portion that is disposed on at least one of the proximal end side and that removably engages the distal end of the high-frequency electrode of the high-frequency treatment instrument that protrudes from the treatment instrument protrusion is on the distal end side of the bending portion Or it is the base end side, and it is provided in the position on the opposite side to the treatment tool protrusion port.

なお、高周波電極の先端にワイヤループが形成されていて、電極係合部は、ワイヤループが係脱自在な突起状に形成されていてもよく、電極係合部が、挿入部の最先端部から前方に向かって突出配置されていてもよい。或いは、電極係合部が、湾曲部の後端に隣接した部位の側面に配置されていてもよい。   Note that a wire loop may be formed at the tip of the high-frequency electrode, and the electrode engaging portion may be formed in a protruding shape that allows the wire loop to be freely engaged and disengaged. It may be arranged protruding from the front. Or the electrode engaging part may be arrange | positioned at the side surface of the site | part adjacent to the rear end of the curved part.

また、観察窓が、湾曲部の先端側と基端側の双方に設けられていれば、生体壁の表面側の状態と、裏面側の血管の走行状態等を同時に観察しながら安全に切除処置等を行うことができる。   In addition, if observation windows are provided on both the distal and proximal sides of the curved part, the ablation can be safely performed while simultaneously observing the surface state of the living body wall and the running state of the blood vessels on the back surface side. Etc. can be performed.

湾曲部の先端側に設けられる観察窓は側方に向けて設けられていてもよい。或いは、湾曲部の先端側に、観察窓が側方と前方の二方向に向けて設けられていてもよく、湾曲部の基端側に、観察窓が斜め前方に向けて設けられていてもよい。   The observation window provided on the distal end side of the bending portion may be provided facing the side. Alternatively, an observation window may be provided on the distal end side of the bending portion in two directions, side and front, or an observation window may be provided obliquely forward on the proximal end side of the bending portion. Good.

また、挿入部の先端側であって湾曲部より基端寄りの位置に、遠隔操作により屈曲自在な第２湾曲部が設けられていてもよく、その場合、湾曲部が第２湾曲部より小さな曲率半径で屈曲するようにすれば、体内での誘導時に小回りがきく。   Further, a second bending portion that can be bent by remote operation may be provided at a position closer to the proximal end than the bending portion on the distal end side of the insertion portion, and in that case, the bending portion is smaller than the second bending portion. If it bends with a radius of curvature, a small turn can be achieved during induction in the body.

本発明によれば、処置具突出口から突き出された高周波処置具の高周波電極の先端を、湾曲部の先端側又は基端側であって処置具突出口とは反対側の位置に設けられた電極係合部に係合させて高周波電極に高周波電流を通電することにより、生体壁全層の切除等の手術を行う際に、高周波電極や観察窓が切除対象に対して振らつくことなく、安全かつ円滑に切除処置等を行うことができる。また、湾曲部の先端側に観察窓を設けることにより、生体壁の裏面側の血管の走行状態等を観察しながら安全に切除処置等を行うことができる。   According to the present invention, the distal end of the high-frequency electrode of the high-frequency treatment instrument protruding from the treatment instrument protrusion is provided at a position opposite to the treatment instrument protrusion on the distal end side or the proximal end side of the bending portion. By energizing the high frequency electrode by engaging the electrode engaging portion, when performing an operation such as excision of the entire layer of the living body wall, the high frequency electrode and the observation window do not shake with respect to the resection target, A resection procedure or the like can be performed safely and smoothly. In addition, by providing an observation window on the distal end side of the bending portion, it is possible to safely perform excision and the like while observing the running state of the blood vessel on the back side of the living body wall.

本発明の第１の実施例に係る処置用内視鏡の使用状態を示す略示図である。It is a schematic diagram showing the use state of the endoscope for treatment concerning the 1st example of the present invention. 本発明の第１の実施例に係る処置用内視鏡の全体構成図である。1 is an overall configuration diagram of a treatment endoscope according to a first embodiment of the present invention. 本発明の第１の実施例に係る処置用内視鏡の挿入部の先端側部分の斜視図である。It is a perspective view of the front end side part of the insertion part of the treatment endoscope which concerns on 1st Example of this invention. 本発明の第１の実施例に係る処置用内視鏡の挿入部の先端部本体部分の側面断面図である。It is side surface sectional drawing of the front-end | tip part main-body part of the insertion part of the endoscope for treatment which concerns on 1st Example of this invention. 本発明の第１の実施例に係る処置用内視鏡に用いられるビデオプロセッサ側の装置の略示図である。1 is a schematic diagram of an apparatus on a video processor side used in a medical treatment endoscope according to a first embodiment of the present invention. 本発明の第１の実施例に係る処置用内視鏡に用いられるビデオプロセッサ側のモニタ画面の変形例の略示図である。It is a schematic diagram of the modification of the monitor screen by the side of the video processor used for the endoscope for treatment concerning the 1st example of the present invention. 本発明の第１の実施例に係る処置用内視鏡に用いられるビデオプロセッサ側の装置の変形例の略示図である。It is the schematic of the modification of the apparatus by the side of the video processor used for the treatment endoscope which concerns on 1st Example of this invention. 本発明の第１の実施例に係る処置用内視鏡の使用状態を示す略示図である。It is a schematic diagram showing the use state of the endoscope for treatment concerning the 1st example of the present invention. 本発明の第１の実施例に係る処置用内視鏡の使用状態を示す略示図である。It is a schematic diagram showing the use state of the endoscope for treatment concerning the 1st example of the present invention. 本発明の第１の実施例に係る処置用内視鏡の使用状態を示す略示図である。It is a schematic diagram showing the use state of the endoscope for treatment concerning the 1st example of the present invention. 本発明の第２の実施例に係る処置用内視鏡の挿入部の先端側部分の斜視図である。It is a perspective view of the front end side part of the insertion part of the endoscope for treatment concerning the 2nd example of the present invention. 本発明の第３の実施例に係る処置用内視鏡の挿入部の先端側部分の斜視図である。It is a perspective view of the front end side part of the insertion part of the treatment endoscope which concerns on 3rd Example of this invention. 本発明の第３の実施例に係る処置用内視鏡の挿入部の中間部本体部分の側面断面図である。It is side surface sectional drawing of the intermediate part main-body part of the insertion part of the endoscope for treatment which concerns on 3rd Example of this invention. 本発明の第３の実施例に係る処置用内視鏡の使用状態を示す略示図である。It is a schematic diagram which shows the use condition of the endoscope for treatment concerning the 3rd example of the present invention. 本発明の第４の実施例に係る処置用内視鏡の挿入部の先端側部分の斜視図である。It is a perspective view of the front end side part of the insertion part of the endoscope for treatment concerning the 4th example of the present invention.

以下、図面を参照して本発明の実施例を説明する。
図２は、本発明の第１の実施例に係る処置用内視鏡の全体構成を示しており、可撓性の挿入部１の最先端には、いわゆる側方視型用の先端部本体２が設けられている。 Embodiments of the present invention will be described below with reference to the drawings.
FIG. 2 shows the overall configuration of the treatment endoscope according to the first embodiment of the present invention, and a distal end body for a so-called side view type is provided at the forefront of the flexible insertion portion 1. 2 is provided.

挿入部１の先端付近の先端部本体２の基端側に隣接する領域には、挿入部１の基端側からの遠隔操作により屈曲自在な湾曲部３が設けられている。なお、挿入部１の長さは例えば５０ｃｍ〜１．５ｍ程度、湾曲部３の長さは例えば数ｃｍ程度である。   In a region adjacent to the proximal end side of the distal end portion main body 2 near the distal end of the insertion portion 1, a bending portion 3 that can be bent by remote operation from the proximal end side of the insertion portion 1 is provided. The length of the insertion portion 1 is about 50 cm to 1.5 m, for example, and the length of the bending portion 3 is about several cm, for example.

湾曲部３の基端側に隣接していわゆる前方斜視型用の中間部本体４が設けられ、挿入部１の先端側であって中間部本体４の基端側に隣接する領域には、挿入部１の基端側からの遠隔操作により屈曲自在な第２湾曲部５が設けられている。なお、第２湾曲部５の長さは例えば数ｃｍ〜１０数ｃｍ程度であり、湾曲部３の方が第２湾曲部５より小さな曲率半径で屈曲し、誘導に際して小回りがきく。   An intermediate body 4 for a so-called front perspective type is provided adjacent to the proximal end side of the bending portion 3, and is inserted into the distal end side of the insertion portion 1 and adjacent to the proximal end side of the intermediate body 4. A second bending portion 5 that can be bent by a remote operation from the base end side of the portion 1 is provided. Note that the length of the second bending portion 5 is, for example, about several centimeters to several tens of centimeters, and the bending portion 3 bends with a smaller radius of curvature than the second bending portion 5, and a small turn is required for guidance.

挿入部１の基端に連結された操作部９０には、湾曲部３を屈曲させる遠隔操作をするための湾曲操作ノブ９１と、第２湾曲部５を屈曲させる遠隔操作をするための第２湾曲操作ノブ９２が互いに独立して設けられている。   The operation unit 90 connected to the base end of the insertion unit 1 includes a bending operation knob 91 for performing a remote operation for bending the bending unit 3 and a second operation for performing a remote operation for bending the second bending unit 5. The bending operation knobs 92 are provided independently of each other.

また、先端部本体２に設けられた観察窓を通して撮像される観察像についての制御を行うための先端側観察像制御ボタン９３と、中間部本体４に設けられた観察窓を通して撮像される観察像についての制御を行うための中間側観察像制御ボタン９４や、挿入部１内に挿通配置されている処置具挿通チャンネルの入口である処置具挿入口９５等が操作部９０に配置されている。９９は、後述するビデオプロセッサに接続するためのコネクタ部である。   Further, a distal-side observation image control button 93 for controlling an observation image picked up through an observation window provided in the tip portion main body 2 and an observation image picked up through an observation window provided in the intermediate portion main body 4. An intermediate-side observation image control button 94 for performing control on the above, a treatment instrument insertion port 95 that is an entrance of a treatment instrument insertion channel that is inserted and disposed in the insertion section 1, and the like are disposed on the operation section 90. Reference numeral 99 denotes a connector for connecting to a video processor described later.

図３は、挿入部１の先端付近を示しており、中間部本体４には、前方斜視用観察窓４１と照明窓４２が斜め前方に向けて配置されると共に、処置具挿通チャンネル６の出口である処置具突出口４３が前方斜視用観察窓４１と同方向に向けて開口配置されている。   FIG. 3 shows the vicinity of the distal end of the insertion portion 1. In the intermediate body 4, a front perspective observation window 41 and an illumination window 42 are disposed obliquely forward, and the outlet of the treatment instrument insertion channel 6. The treatment tool protrusion 43 is an opening arranged in the same direction as the front perspective observation window 41.

先端部本体２には、側方視用観察窓２１と照明窓２２が側方に向けて配置されると共に、処置具突出口４３から突き出された内視鏡用高周波処置具（図示せず）の高周波電極の先端を係脱自在に係合させるための電極係合部７１が、先端部本体２の先端から（したがって挿入部１の最先端部から）前方に向けて突出して設けられている。   The distal end body 2 is provided with a side-view observation window 21 and an illumination window 22 facing sideways, and an endoscopic high-frequency treatment instrument (not shown) protruding from the treatment instrument projection port 43. An electrode engaging portion 71 for releasably engaging the tip of the high-frequency electrode is provided so as to protrude forward from the tip of the tip portion main body 2 (and hence from the most distal portion of the insertion portion 1). .

図４は、先端部本体２部分の側面断面図であり、照明窓２２と側方視用観察窓２１が前後に並んで配置されると共に、側方視用観察窓２１の表面に空気又は水を吹き付けるための送気送水ノズル２９等が配置されている。２１Ａは対物光学系、２１Ｂは固体撮像素子である。   FIG. 4 is a side cross-sectional view of the distal end portion main body 2 portion. The illumination window 22 and the side viewing observation window 21 are arranged side by side, and air or water is placed on the surface of the side viewing observation window 21. An air supply / water supply nozzle 29 and the like for spraying are provided. 21A is an objective optical system, and 21B is a solid-state image sensor.

２５は、固定ビス２６により先端部本体２に着脱自在に取り付けられた電気絶縁材からなる先端キャップである。電極係合部７１は、その先端キャップ２５の先端に一体成形されて、前方に向けて突出する突起状に形成されている。   Reference numeral 25 denotes a tip cap made of an electrically insulating material that is detachably attached to the tip portion main body 2 by a fixing screw 26. The electrode engaging portion 71 is integrally formed at the tip of the tip cap 25 and is formed in a protruding shape that protrudes forward.

電極係合部７１の根元部分には、その部分だけ局部的に外径が小さくされた括れ部７１ａが形成されており、図示されていない高周波電極の先端に設けられたワイヤループをその括れ部７１ａに任意に係脱させることができる。   The base portion of the electrode engaging portion 71 is formed with a constricted portion 71a whose outer diameter is locally reduced only at that portion, and a wire loop provided at the tip of a high-frequency electrode (not shown) is connected to the constricted portion. 71a can be arbitrarily engaged and disengaged.

図５は、内視鏡観察像等を制御するためのビデオプロセッサ１００と内視鏡観察像を表示するためのモニタ１０１等を示しており、側方視用観察窓２１を通して得られた内視鏡観察像１２１がモニタ１０１に大きく表示されて、その内視鏡観察像中に、前方斜視用観察窓４１を通して得られた内視鏡観察像１４１が表示される。いわゆるピクチャー・イン・ピクチャーである。１５１は、その画像に関するデータ等を表示するためのサブ表示領域である。   FIG. 5 shows a video processor 100 for controlling an endoscopic observation image and the like, a monitor 101 for displaying the endoscopic observation image, and the like. A mirror observation image 121 is displayed largely on the monitor 101, and an endoscope observation image 141 obtained through the front perspective observation window 41 is displayed in the endoscope observation image. This is so-called picture-in-picture. Reference numeral 151 denotes a sub display area for displaying data relating to the image.

ただし、図６に示されるように、側方視用観察窓２１で得られた内視鏡観察像１２１と前方斜視用観察窓４１を通して得られた内視鏡観察像１４１を一つのモニタ１０１中に同じ大きさに表示しても差し支えない。   However, as shown in FIG. 6, an endoscope observation image 121 obtained through the side viewing observation window 21 and an endoscope observation image 141 obtained through the front perspective observation window 41 are displayed in one monitor 101. They can be displayed in the same size.

また、図７に示されるように、側方視用観察窓２１を通して得られた内視鏡観察像１２１と前方斜視用観察窓４１を通して得られた内視鏡観察像１４１を、別のモニタ１０１，２０１に並べて表示してもよい。   Further, as shown in FIG. 7, an endoscopic observation image 121 obtained through the side viewing observation window 21 and an endoscopic observation image 141 obtained through the front perspective observation window 41 are displayed on another monitor 101. , 201 may be displayed side by side.

図８は、本実施例の処置用内視鏡を用いて胃壁５００の全層切除処置を行う一例の第１段階を示しており、中間部本体４に設けられた処置具突出口４３から内視鏡用の針状高周波処置具３００等を突出させて、胃内側から胃壁５００に小さな穿孔５０１を形成する。   FIG. 8 shows a first stage of an example of performing full-thickness resection of the stomach wall 500 using the treatment endoscope of the present embodiment, and shows the first stage from the treatment tool protrusion 43 provided in the intermediate body 4. A small needle 501 is formed in the stomach wall 500 from the inside of the stomach by projecting the needle-like high-frequency treatment instrument 300 or the like for endoscope.

次いで胃内において、図９に示されるように、針状高周波処置具３００に代えて、内視鏡用高周波処置具の一つである高周波スネア４００を処置具突出口４３から突出させる。高周波スネア４００は、ワイヤ電極４０１の先端にワイヤループ４０２を備えている。   Next, in the stomach, as shown in FIG. 9, a high-frequency snare 400 that is one of the endoscope high-frequency treatment instruments is projected from the treatment instrument projection port 43 instead of the needle-like high-frequency treatment instrument 300. The high-frequency snare 400 includes a wire loop 402 at the tip of the wire electrode 401.

そして、図１０に示されるように、湾曲部３の屈曲操作と高周波スネア４００の突出操作等により、高周波スネア４００のワイヤループ４０２を電極係合部７１に係合させる。具体的には、電極係合部７１の括れ部７１ａにワイヤループ４０２を引っ掛け、内視鏡外に露出するワイヤ電極４０１を弛みのない緊張状態にする。   Then, as shown in FIG. 10, the wire loop 402 of the high frequency snare 400 is engaged with the electrode engaging portion 71 by the bending operation of the bending portion 3 and the protruding operation of the high frequency snare 400. Specifically, the wire loop 402 is hooked on the constricted portion 71a of the electrode engaging portion 71, and the wire electrode 401 exposed to the outside of the endoscope is brought into a tension state without slack.

その状態を保って、第２湾曲部５等を動作させて、図１に示されるように、先端部本体２を穿孔５０１から胃壁５００の裏面側に突き出させ、ワイヤ電極４０１に高周波電流を通電することにより、ワイヤ電極４０１と接触する胃壁５００が高周波焼灼により切断され、切断箇所を移動させていくことにより胃壁５００の全層切除を行うことができる。   With this state maintained, the second bending portion 5 and the like are operated to cause the distal end body 2 to protrude from the perforation 501 to the back side of the stomach wall 500 as shown in FIG. By doing so, the stomach wall 500 in contact with the wire electrode 401 is cut by high-frequency cauterization, and the entire layer of the stomach wall 500 can be excised by moving the cut portion.

その際に、先端部本体２の先端に設けられた電極係合部７１にワイヤ電極４０１の先端のワイヤループ４０２が係合した状態を保つことにより、ワイヤ電極４０１が振らつかない。したがって、安全かつ円滑に切除処置を行うことができる。   At this time, the wire electrode 401 does not shake by keeping the wire loop 402 at the tip of the wire electrode 401 engaged with the electrode engaging portion 71 provided at the tip of the tip portion main body 2. Therefore, the resection treatment can be performed safely and smoothly.

また、先端部本体２に設けられた側方視用観察窓２１もワイヤ電極４０１に対し機械的にがっちりと固定された状態になるので、切除対象部位に対して振らつかない。したがって、切除部位を常に確実に観察しながら安全かつ円滑に切除処置を行うことができる。   Further, the side-viewing observation window 21 provided on the distal end portion main body 2 is also mechanically firmly fixed to the wire electrode 401, so that it does not swing with respect to the excision target site. Therefore, the resection can be performed safely and smoothly while always observing the resection site with certainty.

そして、中間部本体４に設けられている前方斜視用観察窓４１を通して胃壁５００の表面側の状態を観察することができるだけでなく、先端部本体２に設けられている側方視用観察窓２１を通して、胃壁５００の裏面側の血管の走行状態等も観察しながら安全に切除処置等を行うことができる。   Then, not only can the state of the surface side of the stomach wall 500 be observed through the front perspective observation window 41 provided in the intermediate body 4, but also the side viewing observation window 21 provided in the distal body 2. Through this, it is possible to safely perform excision and the like while observing the running state of the blood vessel on the back side of the stomach wall 500.

図１１は、本発明の第２の実施例に係る処置用内視鏡の先端側部分を示しており、中間部本体４に設けられている処置具突出口４３内に、処置具の突出方向を制御するための処置具起上片４４を配置したものである。処置具起上片４４を操作部９０から遠隔操作することにより、処置具の誘導がより容易になる。   FIG. 11 shows a distal end portion of the treatment endoscope according to the second embodiment of the present invention, and the treatment instrument projecting direction is provided in the treatment instrument projecting port 43 provided in the intermediate body 4. The treatment tool raising piece 44 for controlling the movement is arranged. By remotely operating the treatment tool raising piece 44 from the operation unit 90, the treatment tool can be guided more easily.

図１２は、本発明の第３の実施例の処置用内視鏡の先端側部分を示しており、先端部本体２側に第２の処置具突出口２３を設けて、そこに遠隔操作可能な処置具起上片２４を配置したものである。   FIG. 12 shows the distal end portion of the treatment endoscope according to the third embodiment of the present invention, and a second treatment instrument projecting port 23 is provided on the distal end portion main body 2 side, which can be operated remotely. A treatment tool raising piece 24 is arranged.

これに対応して、図１３に示されるように、中間部本体４の側面部に第２の電極係合部７２を突出形成してもよい。その場合、先端部本体２側の電極係合部７１を省略しても差し支えない。４１Ａは対物光学系、４１Ｂは固体撮像素子である。なお、第２の電極係合部７２は電気絶縁材で形成するのがよい。   Correspondingly, as shown in FIG. 13, the second electrode engaging portion 72 may be formed to protrude from the side surface portion of the intermediate body 4. In that case, the electrode engaging portion 71 on the distal end portion main body 2 side may be omitted. 41A is an objective optical system, and 41B is a solid-state image sensor. The second electrode engaging portion 72 is preferably formed of an electrical insulating material.

このように構成することにより、図１４に示されるように、先端部本体２側の処置具突出口２３から突出させた高周波スネア４００の先端のワイヤループ４０２を第２の電極係合部７２に係合させて、胃壁５００の全層切除等を第１の実施例等と同様に安全かつ円滑に行うことができる。   With this configuration, as shown in FIG. 14, the wire loop 402 at the distal end of the high-frequency snare 400 projecting from the treatment instrument projecting port 23 on the distal end portion main body 2 side is connected to the second electrode engaging portion 72. By engaging, full-thickness resection of the stomach wall 500 and the like can be performed safely and smoothly as in the first embodiment.

図１５は、本発明の第４の実施例の処置用内視鏡の先端側部分を示しており、先端部本体２の最先端面に、前方に向いた前方視用観察窓３１と照明窓３２を設けたものである。これによって観察能がより高まる。   FIG. 15 shows the distal end portion of the treatment endoscope according to the fourth embodiment of the present invention, and the front viewing observation window 31 and the illumination window facing forward are provided on the most distal surface of the distal end body 2. 32 is provided. This further enhances the observation ability.

さらに、図１５に示されるように、前方視用観察窓３１と並んで第３の処置具突出口３３を設けてもよい。また、術式や用途等に応じて、先端部本体２に側方視用観察窓２１を設けることなく前方視用観察窓３１のみを設けた構成を採ってもよい。   Furthermore, as shown in FIG. 15, a third treatment instrument protrusion 33 may be provided alongside the front viewing observation window 31. Further, a configuration in which only the front-viewing observation window 31 is provided without providing the side-viewing observation window 21 in the distal end portion body 2 may be adopted depending on the surgical technique, application, and the like.

なお、本発明は上記実施例に限定されるものではなく、例えば、手技や用途等によっては、第２湾曲部５は必ずしも設けられていなくてもよく、観察窓２１，３１，４１は、先端部本体２と中間部本体４の少なくとも一方に設けられていればよい。   Note that the present invention is not limited to the above-described embodiment. For example, the second bending portion 5 may not necessarily be provided depending on the technique or application, and the observation windows 21, 31, and 41 are provided at the distal ends. It suffices if it is provided on at least one of the body part 2 and the intermediate part body 4.

１ 挿入部
２ 先端部本体
３ 湾曲部
４ 中間部本体
５ 第２湾曲部
６ 処置具挿通チャンネル
２１ 側方視用観察窓
２３ 処置具突出口
４１ 前方斜視用観察窓
４３ 処置具突出口
７１ 電極係合部
７１ａ 括れ部
７２ 電極係合部
４００ 高周波スネア（高周波処置具）
４０１ ワイヤ電極（高周波電極）
４０２ ワイヤループ（先端） DESCRIPTION OF SYMBOLS 1 Insertion part 2 Front-end | tip part main body 3 Bending part 4 Intermediate | middle part main body 5 2nd bending part 6 Treatment tool insertion channel 21 Observation window for side view 23 Treatment tool protrusion 41 Observation window for front perspective 43 Treatment tool protrusion 71 Joint portion 71a Constricted portion 72 Electrode engaging portion 400 High-frequency snare (high-frequency treatment instrument)
401 Wire electrode (high frequency electrode)
402 Wire loop (tip)

Claims (10)

遠隔操作により屈曲自在な湾曲部が挿入部の先端付近に設けられて、上記湾曲部の先端側又は基端側の少なくとも一方に観察窓が配置され、処置具を挿通するための処置具挿通チャンネルが挿入部内に挿通配置された処置用内視鏡において、
上記処置具挿通チャンネルの出口である処置具突出口が上記湾曲部の先端側又は基端側の少なくとも一方に配置されると共に、上記処置具突出口から突き出された高周波処置具の高周波電極の先端を係脱自在に係合させるための電極係合部が、上記湾曲部の先端側又は基端側であって上記処置具突出口とは反対側の位置に設けられていることを特徴とする処置用内視鏡。 A treatment instrument insertion channel for inserting a treatment instrument, wherein a bending section that can be bent by remote operation is provided near the distal end of the insertion section, and an observation window is disposed on at least one of the distal end side or the proximal end side of the bending section. In the treatment endoscope that is inserted and arranged in the insertion portion,
A treatment instrument protruding port that is an outlet of the treatment instrument insertion channel is disposed on at least one of the distal end side or the proximal end side of the bending portion, and the distal end of the high frequency electrode of the high frequency treatment instrument protruded from the treatment instrument protruding opening An electrode engaging portion for releasably engaging with each other is provided at a position on the distal end side or the proximal end side of the bending portion and opposite to the treatment instrument protruding port. Treatment endoscope. 上記高周波電極の先端にワイヤループが形成されていて、上記電極係合部は、上記ワイヤループが係脱自在な突起状に形成されている請求項１記載の処置用内視鏡。   The treatment endoscope according to claim 1, wherein a wire loop is formed at a distal end of the high-frequency electrode, and the electrode engaging portion is formed in a protrusion shape in which the wire loop can be freely engaged and disengaged. 上記電極係合部が、上記挿入部の最先端部から前方に向かって突出配置されている請求項２記載の処置用内視鏡。   The treatment endoscope according to claim 2, wherein the electrode engaging portion is disposed to protrude forward from the most distal end portion of the insertion portion. 上記電極係合部が、上記湾曲部の後端に隣接した部位の側面に配置されている請求項２記載の処置用内視鏡。   The treatment endoscope according to claim 2, wherein the electrode engaging portion is disposed on a side surface of a portion adjacent to a rear end of the bending portion. 上記観察窓が、上記湾曲部の先端側と基端側の双方に設けられている請求項１ないし４のいずれかの項に記載の処置用内視鏡。   The treatment endoscope according to any one of claims 1 to 4, wherein the observation window is provided on both a distal end side and a proximal end side of the bending portion. 上記湾曲部の先端側に、上記観察窓が側方に向けて設けられている請求項５記載の処置用内視鏡。   The treatment endoscope according to claim 5, wherein the observation window is provided on a distal end side of the bending portion so as to face sideways. 上記湾曲部の先端側に、上記観察窓が側方と前方の二方向に向けて設けられている請求項５記載の処置用内視鏡。   The treatment endoscope according to claim 5, wherein the observation window is provided on the distal end side of the bending portion in two directions, a lateral direction and a forward direction. 上記湾曲部の基端側に、上記観察窓が斜め前方に向けて設けられている請求項５記載の処置用内視鏡。   The treatment endoscope according to claim 5, wherein the observation window is provided obliquely forward on a proximal end side of the curved portion. 上記挿入部の先端側であって上記湾曲部より基端寄りの位置に、遠隔操作により屈曲自在な第２湾曲部が設けられている請求項１ないし８のいずれかの項に記載の処置用内視鏡。   9. The treatment according to claim 1, wherein a second bending portion that can be bent by remote operation is provided at a position closer to a proximal end than the bending portion on a distal end side of the insertion portion. Endoscope. 上記湾曲部が上記第２湾曲部より小さな曲率半径で屈曲する請求項９記載の処置用内視鏡。   The treatment endoscope according to claim 9, wherein the bending portion bends with a smaller radius of curvature than the second bending portion.
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Families Citing this family (66)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP5258609B2 (en) * 2009-02-06 2013-08-07 Ｈｏｙａ株式会社 Treatment endoscope
US10524645B2 (en) 2009-06-18 2020-01-07 Endochoice, Inc. Method and system for eliminating image motion blur in a multiple viewing elements endoscope
US9402533B2 (en) 2011-03-07 2016-08-02 Endochoice Innovation Center Ltd. Endoscope circuit board assembly
US9901244B2 (en) 2009-06-18 2018-02-27 Endochoice, Inc. Circuit board assembly of a multiple viewing elements endoscope
US9642513B2 (en) 2009-06-18 2017-05-09 Endochoice Inc. Compact multi-viewing element endoscope system
US9872609B2 (en) 2009-06-18 2018-01-23 Endochoice Innovation Center Ltd. Multi-camera endoscope
US9706903B2 (en) 2009-06-18 2017-07-18 Endochoice, Inc. Multiple viewing elements endoscope system with modular imaging units
US9554692B2 (en) 2009-06-18 2017-01-31 EndoChoice Innovation Ctr. Ltd. Multi-camera endoscope
US8926502B2 (en) * 2011-03-07 2015-01-06 Endochoice, Inc. Multi camera endoscope having a side service channel
US11278190B2 (en) 2009-06-18 2022-03-22 Endochoice, Inc. Multi-viewing element endoscope
US9474440B2 (en) 2009-06-18 2016-10-25 Endochoice, Inc. Endoscope tip position visual indicator and heat management system
US9101287B2 (en) 2011-03-07 2015-08-11 Endochoice Innovation Center Ltd. Multi camera endoscope assembly having multiple working channels
US10165929B2 (en) 2009-06-18 2019-01-01 Endochoice, Inc. Compact multi-viewing element endoscope system
US9101268B2 (en) 2009-06-18 2015-08-11 Endochoice Innovation Center Ltd. Multi-camera endoscope
US9492063B2 (en) 2009-06-18 2016-11-15 Endochoice Innovation Center Ltd. Multi-viewing element endoscope
US9713417B2 (en) 2009-06-18 2017-07-25 Endochoice, Inc. Image capture assembly for use in a multi-viewing elements endoscope
US10130246B2 (en) 2009-06-18 2018-11-20 Endochoice, Inc. Systems and methods for regulating temperature and illumination intensity at the distal tip of an endoscope
US11864734B2 (en) 2009-06-18 2024-01-09 Endochoice, Inc. Multi-camera endoscope
US11547275B2 (en) 2009-06-18 2023-01-10 Endochoice, Inc. Compact multi-viewing element endoscope system
EP3718466B1 (en) 2010-09-20 2023-06-07 EndoChoice, Inc. Endoscope distal section comprising a unitary fluid channeling component
US9560953B2 (en) 2010-09-20 2017-02-07 Endochoice, Inc. Operational interface in a multi-viewing element endoscope
JP5535862B2 (en) * 2010-10-12 2014-07-02 株式会社リバーセイコー High frequency peeling knife device for endoscope
US9706908B2 (en) 2010-10-28 2017-07-18 Endochoice, Inc. Image capture and video processing systems and methods for multiple viewing element endoscopes
EP3540495A1 (en) 2010-10-28 2019-09-18 EndoChoice Innovation Center Ltd. Optical systems for multi-sensor endoscopes
US10663714B2 (en) 2010-10-28 2020-05-26 Endochoice, Inc. Optical system for an endoscope
US11889986B2 (en) 2010-12-09 2024-02-06 Endochoice, Inc. Flexible electronic circuit board for a multi-camera endoscope
EP3420886B8 (en) 2010-12-09 2020-07-15 EndoChoice, Inc. Flexible electronic circuit board multi-camera endoscope
JP6054874B2 (en) 2010-12-09 2016-12-27 エンドチョイス イノベーション センター リミテッド Flexible electronic circuit board for multi-camera endoscope
CN103491854B (en) 2011-02-07 2016-08-24 恩多卓斯创新中心有限公司 Multicomponent cover for many cameras endoscope
US10517464B2 (en) 2011-02-07 2019-12-31 Endochoice, Inc. Multi-element cover for a multi-camera endoscope
EP2604172B1 (en) 2011-12-13 2015-08-12 EndoChoice Innovation Center Ltd. Rotatable connector for an endoscope
EP3659491A1 (en) 2011-12-13 2020-06-03 EndoChoice Innovation Center Ltd. Removable tip endoscope
JP6130993B2 (en) * 2012-01-10 2017-05-17 Hoya株式会社 Endoscope for large intestine and endoscope system for large intestine
US9560954B2 (en) 2012-07-24 2017-02-07 Endochoice, Inc. Connector for use with endoscope
US10595714B2 (en) 2013-03-28 2020-03-24 Endochoice, Inc. Multi-jet controller for an endoscope
US9986899B2 (en) 2013-03-28 2018-06-05 Endochoice, Inc. Manifold for a multiple viewing elements endoscope
US9636003B2 (en) 2013-06-28 2017-05-02 Endochoice, Inc. Multi-jet distributor for an endoscope
US9993142B2 (en) 2013-03-28 2018-06-12 Endochoice, Inc. Fluid distribution device for a multiple viewing elements endoscope
CN105358043B (en) 2013-05-07 2018-12-21 恩多巧爱思股份有限公司 The white balance shell being used together with more observation element endoscopes
US10499794B2 (en) 2013-05-09 2019-12-10 Endochoice, Inc. Operational interface in a multi-viewing element endoscope
US9949623B2 (en) 2013-05-17 2018-04-24 Endochoice, Inc. Endoscope control unit with braking system
US10064541B2 (en) 2013-08-12 2018-09-04 Endochoice, Inc. Endoscope connector cover detection and warning system
US9943218B2 (en) 2013-10-01 2018-04-17 Endochoice, Inc. Endoscope having a supply cable attached thereto
JP5788629B1 (en) 2013-10-15 2015-10-07 オリンパス株式会社 Energy treatment tool
US9968242B2 (en) 2013-12-18 2018-05-15 Endochoice, Inc. Suction control unit for an endoscope having two working channels
JP6256872B2 (en) * 2013-12-24 2018-01-10 パナソニックＩｐマネジメント株式会社 Endoscope system
CN105324089B (en) 2014-01-10 2017-08-08 奥林巴斯株式会社 Vaginal wall cuts utensil
WO2015112747A2 (en) 2014-01-22 2015-07-30 Endochoice, Inc. Image capture and video processing systems and methods for multiple viewing element endoscopes
US11234581B2 (en) 2014-05-02 2022-02-01 Endochoice, Inc. Elevator for directing medical tool
EP3171752B1 (en) 2014-07-21 2019-12-11 EndoChoice, Inc. Multi-focal, multi-camera endoscope systems
EP3162271A1 (en) * 2014-07-28 2017-05-03 Olympus Corporation Endoscope system
US10542877B2 (en) 2014-08-29 2020-01-28 Endochoice, Inc. Systems and methods for varying stiffness of an endoscopic insertion tube
US10123684B2 (en) 2014-12-18 2018-11-13 Endochoice, Inc. System and method for processing video images generated by a multiple viewing elements endoscope
EP3242584B1 (en) 2015-01-05 2020-07-22 EndoChoice, Inc. Tubed manifold of a multiple viewing elements endoscope
US10376181B2 (en) 2015-02-17 2019-08-13 Endochoice, Inc. System for detecting the location of an endoscopic device during a medical procedure
US10078207B2 (en) 2015-03-18 2018-09-18 Endochoice, Inc. Systems and methods for image magnification using relative movement between an image sensor and a lens assembly
US10401611B2 (en) 2015-04-27 2019-09-03 Endochoice, Inc. Endoscope with integrated measurement of distance to objects of interest
CN107529960B (en) 2015-05-12 2020-10-02 亚伯拉罕·莱维 Dynamic visual field endoscope
WO2016187124A1 (en) 2015-05-17 2016-11-24 Endochoice, Inc. Endoscopic image enhancement using contrast limited adaptive histogram equalization (clahe) implemented in a processor
US20170119474A1 (en) 2015-10-28 2017-05-04 Endochoice, Inc. Device and Method for Tracking the Position of an Endoscope within a Patient's Body
AU2016361331B2 (en) 2015-11-24 2021-10-28 Endochoice, Inc. Disposable air/water and suction valves for an endoscope
EP3419497B1 (en) 2016-02-24 2022-06-01 Endochoice, Inc. Circuit board assembly for a multiple viewing element endoscope using cmos sensors
WO2017160792A1 (en) 2016-03-14 2017-09-21 Endochoice, Inc. System and method for guiding and tracking a region of interest using an endoscope
JP6396949B2 (en) * 2016-06-20 2018-09-26 Hoya株式会社 Colonoscopy system
WO2017222716A1 (en) 2016-06-21 2017-12-28 Endochoice, Inc. Endoscope system with multiple connection interfaces to interface with different video data signal sources
CN110234264B (en) * 2017-02-01 2022-11-15 波士顿科学国际有限公司 Endoscope with multiple viewing directions

Family Cites Families (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS5486991A (en) * 1977-12-21 1979-07-10 Olympus Optical Co Device for incising in body cavity
JP3014213B2 (en) * 1992-05-01 2000-02-28 オリンパス光学工業株式会社 Oblique endoscope
JP3504391B2 (en) * 1995-08-22 2004-03-08 オリンパス株式会社 Endoscope
JP4125814B2 (en) * 1998-03-04 2008-07-30 Ｈｏｙａ株式会社 Ultrasound endoscope
JP2000116598A (en) * 1998-10-19 2000-04-25 Toshiba Corp Endoscopic instrument
JP2002085329A (en) * 2000-09-13 2002-03-26 Asahi Optical Co Ltd Endoscope
JP2002177201A (en) * 2000-10-02 2002-06-25 Olympus Optical Co Ltd Endoscope
JP4495399B2 (en) * 2003-01-24 2010-07-07 Ｈｏｙａ株式会社 2-channel endoscope
JP4533695B2 (en) * 2003-09-23 2010-09-01 オリンパス株式会社 Treatment endoscope
AU2007201675B2 (en) * 2006-05-01 2012-05-24 Ethicon Endo-Surgery, Inc. Dual-bend sphinctertome

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