JP7049640B2 - Endoscope aid - Google Patents

Description

The present invention relates to an endoscope assisting tool, and more particularly to an endoscopic assisting tool that provides a bird's-eye view to an endoscope practitioner.

A camera that takes images inside the body cavity in order to widen the field of view in the body cavity during endoscopic treatment, and a camera that is connected to the camera and holds the abdominal wall between different surfaces of the abdominal wall to fix the camera in the body cavity. An endoscopic system including a magnet, a fixing magnet, and a control unit for controlling a camera is known (for example, Patent Document 1).

Japanese Unexamined Patent Publication No. 2008-307226

However, the endoscopic system described above requires a separate attachment / detachment instrument such as attachment / detachment forceps. In addition, since one image sensor is planned to be mounted on one endoscope system, in order to obtain a sufficiently wide field of view, multiple endoscope systems are individually placed in the body cavity. Need to be placed.

Therefore, an object of the present invention is to provide an endoscope assisting tool that can be attached and detached with a simple operation and can give a panoramic view of a treatment area to an endoscope practitioner.

In order to solve the above-mentioned problems, the present invention includes a cap that is detachably attached to the tip of the endoscope, a slider that can slide along the tube wall of the attached endoscope, and the cap. Provided between the slider and the slider, the tip takes a first position away from the tube of the endoscope when the slider approaches the cap, and the tip of the endoscope moves away from the cap when the slider moves away from the cap. A plurality of arms attached to the tip of the arm so as to image a treatment area by the endoscope when the tip takes the first position and a plurality of arms taking a second position approaching the tube. Provided is an endoscope assisting tool comprising a unit and a light source for irradiating light toward the treatment area.

In the above invention, it is preferable that the endoscope assisting tool further has a fixing portion for fixing the endoscopic assisting tool to a desired position on the abdominal wall of the patient in a detachable manner.

Further, in the endoscope assisting tool of the present invention, the fixing portion includes a magnetic material attached to the cap and a permanent magnet or an electromagnet that attracts the permanent magnet from the outside of the abdominal wall. , Are preferred.

Further, in the present invention, the endoscope assisting tool further has an operation unit for operating the plurality of arms so that the plurality of arms move between the first position and the second position. That is preferable.

In the above-mentioned endoscope assisting tool of the present invention, the operation unit is driven so that the slider is brought closer to the cap and the slider is driven away from the cap. And, are preferred.

In the above invention, it is preferable that the endoscope assisting tool further has a holding mechanism for holding the arm in the first position.

In the above invention, the endoscope assisting tool further includes a releasing mechanism for releasing the state in which the arm takes the first position when the tip of the endoscope is inserted into the cap. Is preferable.

According to the present invention, it is possible to provide an endoscope assisting tool that can be attached and detached with a simple operation and can give a field of view overlooking the treatment area to the practitioner of the endoscope.

It is a schematic diagram which shows the use example of an endoscope assisting tool. It is a schematic diagram which shows how the endoscope assisting tool of FIG. 1 is introduced into a body cavity. It is a perspective view which shows the state which the endoscope assisting tool which concerns on the typical embodiment of this invention is attached to the tip part of an endoscope. FIG. 3 is a cross-sectional perspective view of the endoscope assisting tool of FIG. It is a top view and a side view which shows the endoscope assisting tool in a closed state. It is a top view and a side view which shows the endoscope assisting tool in a half-open state. It is a top view and a side view which shows the endoscope assisting tool in an open state. FIG. 6 is a partial cross-sectional view taken along the line AA of FIG. It is a side view which shows the endoscope assisting tool which concerns on modification 1. FIG. It is a side view which shows the endoscope auxiliary tool which concerns on the modification 2.

Hereinafter, the endoscope assisting tool according to a typical embodiment of the present invention will be described in detail with reference to the drawings. Here, the present invention will be described assuming a situation in which the endoscopic assistive device is applied to endoscopic surgery called NOTES (Natural Orifice Translumenal Endoscopic Surgery), but the present invention describes other types of endoscopes or endoscopic surgery. It can also be applied to endoscopic surgery.
Since the drawings are for conceptually explaining the present invention, the dimensions, ratios, or numbers may be exaggerated or simplified as necessary for easy understanding.

[Application of endoscopic aids]
A typical scene in which the endoscope assisting tool 1 is applied will be described with reference to FIGS. 1 and 2. However, the application scenes of the endoscope assisting tool are not limited to the following scenes. Here, NOTES is a method of inserting a flexible endoscope into the body through a natural opening (for example, mouth or anus) existing in the human body, incising the cavity wall, and then invading the body cavity to treat the trunk. Is. Minimally invasiveness is one of the great attractions of NOTES, but on the other hand, the practitioner needs to perform the procedure in a limited space in the body cavity under the narrow field of view obtained from the endoscopic camera. The burden on the practitioner is heavy.

The endoscope assisting tool 1 is inserted into the body together with the endoscope while being attached to the tip of the flexible endoscope, and provides the practitioner with a bird's-eye view of the treatment area. Specifically, as shown in FIG. 2, the endoscope assisting tool 1 is attached to the tip of the flexible endoscope 101, for example, from the opening 105 formed in the stomach 104 into the body cavity 102 of the patient. Invade. In this state, the arm 4 of the endoscope assisting tool 1 is closed.

Then, as shown in FIG. 1, the endoscope assisting tool 1 is fixed by the fixing portion 7 at a position on the abdominal wall 103 where the range (treatment area) to be treated by the endoscope 101 can be sufficiently photographed, and the arm 4 is used. While irradiating the treatment area with the light source 6 mounted on the tip of the arm 4, the imaging unit 5 provided on the tip of the other arm 4 takes an image. Alternatively, the practitioner may open the arm 4 to photograph the treatment area and determine the fixed position of the endoscope assisting tool 1 while checking the image.
As a result, the practitioner can perform the treatment with the endoscope 101 while viewing the image from the endoscope assisting tool 1 in addition to the image from the built-in camera of the endoscope 101. That is, the practitioner can obtain a wide field of view.

When recovering the endoscope assisting tool 1 from the patient's body, the endoscope assisting tool 1 with the arm 4 closed is attached to the tip of the endoscope 101, and the endoscope 101 is placed in this state. It can be taken out of the patient's body. When changing the imaging range, for example, the endoscope assisting tool 1 is attached to the tip of the endoscope 101, the fixing by the fixing tool 7 is released, and then the endoscope assisting is performed at another position. The tool 1 may be moved.

[Construction of endoscope aids]
The endoscope assisting tool 1 will be specifically described with reference to FIGS. 3 to 8. In FIGS. 3 to 8, the fixing portion 7 is not shown for convenience of explanation. Further, in FIGS. 3 and 4, the illustration of all or a part of the image pickup unit and the light source among the plurality of image pickup units 5 and the plurality of light sources 6 is omitted. Further, in FIGS. 4 to 8, the operation unit 8 is not shown.

First, the general design concept of the endoscope assisting tool 1 will be described. The endoscope assisting tool 1 is appropriately designed to be carried into the body cavity while being attached to the tip of the flexible endoscope. There is. The endoscopic assist device 1 preferably has a maximum total length and a maximum diameter of 20 mm or less so that it can be particularly suitably used for endoscopic surgery by NOTES. Further, since the endoscope assisting tool 1 is to be inserted into the patient's body, it is preferably made of a sterilizable material. Further, it is preferable that the endoscope assisting tool 1 has a shape and mechanism that does not damage the inside of the body.

Specifically, the endoscope auxiliary tool 1 includes a cap 2, a slider 3, an arm 4, an image pickup unit 5, a light source 6, a fixing unit 7, and an operation unit 8. There is. Here, a plurality of similar members may be provided for the arm 4, the image pickup unit 5, and the light source 6.
Therefore, when the individual arms are described, they are described as arms 41 to 44, and when the arms are generically referred to, they are described as arm 4. Similarly, the image pickup units 51 and 52 are used for individual image pickup units, and the image pickup unit 5 is used as a generic term for these. Further, the light sources 61 and 62 refer to individual light sources, and the light source 6 is a general term for these.

The cap 2 is a resin member that is detachably attached to the tip of the endoscope 101. The cap 2 may be made of, for example, an acrylic cured resin, and more preferably made of a biocompatible and sterilable material. In the present embodiment, the cap 2 is a disk-shaped member having an opening in the center, and as shown in FIGS. 3 and 4, the side walls 21 and 22 and the claws extending from the outer edge along the tube wall of the endoscope 101. It has 23 and 24.

The side walls 21 and 22 are arranged at positions separated from each other so as to face each other, and holes 21A and 22A for inserting the operation unit 8 (wires 81 and 82) are formed in each of the side walls 21 and 22. These holes 21A and 22A will be described later in relation to the holes 31 and 32 of the slider 3.

The claw portions 23 and 24 are also provided at distant positions facing each other and project inward at the tip (see FIG. 8). The claw portions 23 and 24 together with the receiving portions 33 and 34 of the slider 3 form a snap-fit mechanism, which will be described later.

Next, the slider 3 is a resin member that can slide along the tube wall of the mounted endoscope 101. The slider 3 may be made of an acrylic cured resin like the cap 2, and more preferably made of a biocompatible and sterilable material. In the present embodiment, as shown in FIG. 4, the slider 3 is a disk-shaped member having an opening in the center, and has an outer diameter substantially equal to or slightly smaller than the outer diameter of the cap 2. Further, the inner diameter of the slider 3 is substantially the same as or slightly larger than the outer diameter of the endoscope 101 so that the endoscope 101 can be inserted.

The slider 3 has receiving portions 33, 34 extending from the outer edge toward the cap 2 side, for example, as shown in FIG. For example, when the slider 3 approaches the cap 2 as shown in FIG. 6B, the receiving portions 33 and 34 of the slider 3 and the claw portions 23 and 24 of the cap 2 partially come into contact with each other and elastically deform. When the slider 3 is further pushed inside the cap 2 against the elastic force of the receiving portions 33, 34 and the claw portions 23, 24 generated at that time, FIG. 7B shows the receiving portions 33, 34 and the claw portions. 23 and 24 fit into each other. In this state, the receiving portions 33, 34 and the claw portions 23, 24 restrict the movement of each other, and the slider 3 is pushed into the cap 2 (this corresponds to the state in which the arm 4 is open). Will hold.

Therefore, the receiving portions 33, 34 of the slider 3 and the claw portions 23, 24 of the cap 2 form a holding mechanism for the arm 4. With such a holding mechanism, the arm 4 can be maintained in an open state without continuing to pull the operation unit 8 (wire 81), and the operability of the endoscope assisting tool 1 is improved.

Moving on to the description of the arm 4, the plurality of arms 4 (41 to 44) are resin members provided between the cap 2 and the slider 3 as shown in FIGS. 5 to 7, and are in an open state (the first). It can rotate between the closed state (second position) and the closed state (second position). Here, the open state is the state of the arm 4 when the slider 3 approaches the cap 2, and at this time, the tip of the arm 4 moves away from the tube wall of the endoscope 101. The closed state is the state of the arm 4 when the slider 3 moves away from the cap 2. At this time, the tip of the arm 4 approaches the tube wall of the endoscope 101.

The arm 4 may be made of, for example, an acrylic cured resin, and more preferably made of a biocompatible and sterilable material.
The length of the arm 4 may be determined, for example, in consideration of the allowable size of the endoscope assisting tool 1 and the required visual field range.

In the present embodiment, for example, as shown in FIG. 3, four arms 41 to 44 are provided, and the arms 41, 42 and the arms 43, 44 are arranged at positions separated from each other so as to face each other. The arms 41 and 42 are for the image pickup units 51 and 52, and the arms 43 and 44 are for the light sources 61 and 62. However, at least two arms 4 may be used for the imaging unit 5.

As shown in FIG. 4, for example, the arms 41 to 44 are rotatably attached to the slider 3 at one end (lower end) via the shafts 41A to 44A. Further, an imaging unit 5 (51, 52) or a light source 6 (61, 62) is attached to the other end (tip) of the arms 41 to 44.

Then, as shown in FIG. 8, the arms 41 to 44 and the cap 2 are connected to the cap 2 via the connecting pieces 91 to 94 to form a link mechanism. Specifically, for example, taking the connecting piece 93 as an example, one end of the connecting piece is attached to an intermediate position in the longitudinal direction of the arm 43 via the shaft 43B, and the other end of the connecting piece 93 is the shaft 43C. It is attached to the cap 2 via. Therefore, in conjunction with the vertical movement of the slider 3, the connecting piece 93 rotates about the shaft 43C, whereby the arm 43 opens and closes. As the connecting pieces 91 to 94, a metal material having a certain strength and not affecting the living body, such as stainless steel, is used.

Next, the operation unit 8 will be referred to. The operation unit 8 is a member that operates the plurality of arms 4 so as to move between the open state (first position) and the closed state (second position) of the plurality of arms 4. Here, the operation unit 8 is a metal wire, and as shown in FIG. 3, the wire 81 (first wire) driven to bring the slider 3 closer to the cap 2 and the slider 3 away from the cap 2. Includes a wire 82 (second wire) driven in such a manner. The wires 81 and 82 may be a single wire or may be a combination of a plurality of wires.

In order to enable the operation unit 8 to open and close the arm 4, in the present embodiment, the operation unit 8 is inserted into the hole 21A of the cap 2 and the hole 31 of the slider 3, and the operation unit 8 is inserted into the slider 3 by, for example, a stick. It is fixed to 3. As a result, the slider 3 is interlocked with the operation unit 8. Specifically, by pulling the wire 81 in the X direction of FIG. 3, the slider 3 approaches the cap 2, and by pulling the wire 82 in the Y direction of FIG. 3, the slider 3 moves away from the cap 2. This enables the operation unit 8 to open and close the arm 4. However, as the operation unit 8, a method other than the wire may be used.

The operation unit 8 is preferably inserted into, for example, a stainless steel sheath (not shown) so as to improve operability and not damage the living body.
Further, the operation unit 8 may be inserted through the hole 22A of the cap 2 and the hole 32 of the slider 3 shown in FIG. 4, and the arm 4 may be opened and closed by the plurality of operation units 8. The opening / closing operation by the plurality of operation units 8 improves the stability of work.

Next, the image pickup unit 5 will be described. The imaging unit 5 is attached to the tip of the arm 4 and photographs the treatment area by the endoscope 101. In the present embodiment, for example, as shown in FIG. 5, two image pickup units 51 and 52 are provided, but three or more image pickup units 5 may be provided. Further, the image that can be captured by the image pickup unit 5 may be a moving image or a still image, and the captured image is output to an external display or a storage device by wire or wirelessly.

Here, it is preferable that the plurality of imaging units 5 are arranged at positions separated from each other from the viewpoint of expanding the range of the field of view of the practitioner. Therefore, the image pickup units 51 and 52 are attached to the tips of the arms 41 and 42 located on opposite sides of each other.

The image pickup unit 5 is an image pickup device such as a CCD or CMOS sensor, and is preferably small in size, has a short focal length, and has a wide angle. As the image pickup unit 5, for example, an image pickup element having a sensor size of 1/18 inch, a width of 3.0 mm × a height of 3.0 mm × a depth of 4.0 mm, a focal length of 0.96 mm, an angle of view of 55 degrees, and a frame rate of 30 fps is adopted. Therefore, it is considered possible to sufficiently observe the state of the treatment area of the endoscope 101 while suppressing the dimensions of the entire endoscope assisting tool 1.

Moving on to the description of the light source 6, the light source 6 irradiates light toward the treatment area of the endoscope 101. The light source 6 is, for example, an LED (light emitting diode), and in the present embodiment, as shown in FIG. 6, two light sources 61 and 62 are adopted. However, at least one light source 6 is sufficient as long as the practitioner can sufficiently observe the treatment area of the endoscope 101.

The light sources 61 and 62 are attached to the tips of the arms 43 and 44, respectively. From the viewpoint of suppressing the dimensions of the entire endoscope assisting tool 1, the light sources 61 and 62 are preferably small, for example, width 3.0 mm × height 2.0 mm × depth 1.5 mm. Further, from the viewpoint of ensuring a clear field of view, it is considered sufficient to secure a luminous intensity of, for example, about 2200 mcd to 2700 mcd for each of the light sources 61 and 62.

As shown in FIG. 1, the fixing portion 7 is a member that removably fixes the endoscope assisting tool 1 to a desired position on the abdominal wall 103 of the patient. The fixing portion 7 may include a metal (magnetic material) 72 attached to the cap 2 and a magnet 71 (permanent magnet or electromagnet) that attracts the magnet 72 from the outside of the abdominal wall 103. However, the fixing portion 7 is not limited to the metal (magnetic material) 71 and the magnet 72, and may be any combination between the magnet, the metal (magnetic material), and the electromagnet.

[Effect of this embodiment]
As described above, the endoscope assisting tool 1 can be miniaturized so that the maximum total length and diameter can be 20 mm during transportation (when the arm is closed). That is, at the time of transportation, the total length can be reduced to less than half as compared with the time of securing the field of view (when the arm is opened).
Therefore, when the endoscope assisting tool 1 is used for a surgical procedure such as NOTES, the endoscope assisting tool 1 is attached to the tip of the endoscope 101, inserted through the patient's oral cavity, and passed through the pharynx and esophagus. Since it can be easily performed, it can be used without making an incision in the body wall. Furthermore, by using the endoscope assisting tool 1, it is possible to secure a movable range of the endoscope in the abdominal cavity where the work space is limited.

Further, when the endoscope assisting tool 1 is made of a sterilable material, safety when it is inserted into the body can be ensured.

Especially in NOTES, since the work space of the endoscope is limited, the practitioner is required to perform delicate and complicated operations, but the field of view can be expanded by a simple operation of the endoscope assisting tool 1. , It can be expected to reduce the burden on doctors and shorten the operation time.

The endoscope assisting tool 1 reaches the work space (body cavity) in a state of being attached to the endoscope, and can be installed at a desired position on the abdominal wall. In addition, after surgery, it is sufficient to attach the endoscope to the tip of the endoscope, and quick recovery is possible.

When the endoscope aid 1 is used for NOTES, for example, when it is inserted into the body and when it is collected outside the body, it is attached to the tip of the endoscope, for example, between the mouth and the body cavity. To move. At that time, the endoscope assisting tool 1 has high convenience because it does not affect the operation or operation of the endoscope.

Since the endoscope aid 1 does not have a rounded and angular portion as a whole, it does not hurt the patient's body even if it is inserted into the body while attached to the endoscope.

[Modification 1]
A modification 1 of the present embodiment will be described with reference to FIG. 9.
Modification 1 is the same as the endoscope assisting tool 1 according to the present embodiment except for the shape of the connecting piece. Therefore, the connecting piece will be described in detail, and the description of other components will be omitted.

As shown in FIG. 9, the connecting piece 95 is a metal member having a substantially L-shape. The connecting piece 95 is connected to the arm 41 via the shaft 43B at one end, and is connected to the cap 2 via the shaft 43C at the bent portion. Therefore, the connecting piece 95 functions as a link mechanism as in the connecting pieces 91 to 94 in the above-described embodiment.

In addition, as shown in FIG. 9A, the connecting piece 95 has the other end 95A of the connecting piece 95 extending toward the inside of the endoscope assisting tool 1 when the arm 4 (41) is open. Is formed in. Therefore, when the endoscope 101 is inserted into the endoscope assisting tool 1 with the arm 4 open, the tip end portion of the endoscope 101 comes into contact with the other end 95A of the connecting piece 95. When the tip of the endoscope 101 is pushed further inward, the other end 95A of the connecting piece 95 also rotates toward the cap 2.

By such an operation, one end (the end on the arm 4 side) of the connecting piece 95 rotates in a direction approaching the endoscope 101. As a result, the tip of the arm 41 moves so as to approach the cap 2, and at the same time, the slider 4 is pushed downward. As a result, as shown in FIG. 9B, the open state of the arm 41 is released, and the arm 41 tends to close. That is, the connecting piece 95 corresponds to the releasing mechanism.

As described above, in the first modification, when the endoscope 101 is inserted into the endoscope assisting tool 1 with the arm 4 open, the arm 4 automatically closes. As a result, the operation of the endoscope assisting tool 1 becomes simple, and it is expected that the convenience will be improved.

Such an effect can be expected if the connecting piece 95 is introduced into any of the plurality of arms 4, but by introducing the connecting piece 95 into all the arms 4, a smoother closing operation of the arm 4 can be obtained. Can be done.

[Modification 2]
A modified example 2 of the present embodiment will be described with reference to FIG.
Modification 2 is the same as the endoscope assisting tool 1 according to the present embodiment except for the torsion spring added to the arm. Therefore, the torsion spring will be described in detail, and the description of other components will be omitted.

The torsion spring 97 urges the arm 42 in the closing direction, and is attached to the arm 42 via the shafts 42A to 42C as shown in FIG. 10A. Therefore, when the arm 42 is closed, it is possible to prevent the arm 4 from unintentionally opening. Further, in the state where the arm 42 is halfway opened as shown in FIG. 10B, the arm 42 tends to return to the closed state due to the restoring force of the torsion spring 97.

Therefore, in the second modification, it is possible to prevent the arm 4 from unintentionally opening, and when closing the open arm 4, the closing operation of the arm 4 is supported after the holding mechanism is released. This improves the operability of the endoscope assisting tool 1.

Such an effect can be expected if the torsion spring 97 is introduced into any of the plurality of arms 4, but further improvement in operability can be expected by introducing the torsion spring 97 in all the arms 4.
It is also possible to combine the modified examples 1 and 2.

Although the typical embodiments of the present invention have been described above with reference to the drawings, the present invention is not limited to these embodiments and does not deviate from the spirit and teaching of the claims. There are other improvements and modifications. It is easily understood by those skilled in the art that all such improvements and modifications are included in the technical scope of the present invention.

1 ... Endoscope aid,
2 ... Cap,
3 ... Slider,
4,41-44 ... Arm,
5,51,52 ... Imaging unit,
6,61,62 ... Light source,
7 ... Fixed part,
8 ... Operation unit.

Claims (6)

A cap that can be attached and detached to the tip of the endoscope,
A slider that can slide along the tube wall of the mounted endoscope,
It is provided between the cap and the slider, and when the slider approaches the cap, the tip takes a first position away from the tube of the endoscope, and when the slider moves away from the cap, the tip moves into the inside. Multiple arms that take a second position closer to the endoscope tube,
A plurality of imaging units attached to the tips of the plurality of arms so as to image the treatment area by the endoscope when the tip takes the first position.
A light source that irradiates the treatment area with light,
A fixing portion that removably fixes the endoscopic assist device to a desired position on the patient's abdominal wall, and
An endoscopic assistive device characterized by being equipped with. The fixing portion includes a magnetic material attached to the cap and a permanent magnet or an electromagnet that attracts the permanent magnet from the outside of the abdominal wall.
The endoscope assisting tool according to claim 1. The endoscope according to claim 1 or 2 , further comprising an operation unit for operating the plurality of arms so that the plurality of arms move between the first position and the second position. Auxiliary tool. The operation unit is
A first wire driven to bring the slider closer to the cap,
A second wire driven to move the slider away from the cap,
The endoscope assisting tool according to claim 3, further comprising : A holding mechanism that maintains the arm in the first position
The endoscope assisting tool according to any one of claims 1 to 4, further comprising. A release mechanism that releases the state in which the arm takes the first position when the tip of the endoscope is inserted into the cap.
The endoscope assisting tool according to claim 5 , further comprising.

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