JP2000166936A - Endoscopic treatment instrument - Google Patents

Endoscopic treatment instrument

Info

Publication number
JP2000166936A
JP2000166936A JP10349574A JP34957498A JP2000166936A JP 2000166936 A JP2000166936 A JP 2000166936A JP 10349574 A JP10349574 A JP 10349574A JP 34957498 A JP34957498 A JP 34957498A JP 2000166936 A JP2000166936 A JP 2000166936A
Authority
JP
Japan
Prior art keywords
treatment
endoscope
instrument
guide tube
portion
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
JP10349574A
Other languages
Japanese (ja)
Other versions
JP4242491B2 (en
Inventor
Keiichi Arai
敬一 荒井
Original Assignee
Olympus Optical Co Ltd
オリンパス光学工業株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Optical Co Ltd, オリンパス光学工業株式会社 filed Critical Olympus Optical Co Ltd
Priority to JP34957498A priority Critical patent/JP4242491B2/en
Publication of JP2000166936A publication Critical patent/JP2000166936A/en
Application granted granted Critical
Publication of JP4242491B2 publication Critical patent/JP4242491B2/en
Anticipated expiration legal-status Critical
Application status is Expired - Fee Related legal-status Critical

Links

Abstract

PROBLEM TO BE SOLVED: To provide an endoscopic treatment instrument, by which an object capable of being created from the inside of an organ by means of endoscope is extended and also even a wide range of lesion part on a wall in the deep part of a celom or the deeply infiltrated lesion part especially difficult to be treated in a conventional manner is easily treated. SOLUTION: A treatment endoscope 23 and treatment tool units 35 and 37 are inserted to the inner hole of a tool introducing guide tube 21 to be inserted to the celom so as to be freely retrogressing possible, the horizontal cross section shapes of the endoscope 23 and the units are provided with an arc part with a diameter being a little smaller than that of the inner hole of the guide tube and the endoscope 23 and the units are assembled and inserted to the tool introducing guide tube. In this case, the horizontal cross section shape of the whole assembled body is constituted to be the one having the diameter being a little smaller than that of the inner hole of the guide tube. Then the treatment endoscope and the treatment tool units are inserted to the guide tube and used.

Description

【発明の詳細な説明】 DETAILED DESCRIPTION OF THE INVENTION

【0001】 [0001]

【発明の属する技術分野】本発明は、体腔内に生じた病変部を経内視鏡的に治療する内視鏡治療装置に関する。 The present invention relates to relates to an endoscope treatment system for treating lesions caused in the body cavity Keinai endoscopically.

【0002】 [0002]

【従来の技術】胃や大腸などの消化器系臓器の体腔内壁に生じた病変部を治療する場合、まず経内視鏡的に治療する方法が考えられる。 BACKGROUND ART When treating a lesion produced on the inner wall of the body cavity of the digestive organs such as stomach and large intestine, firstly a method of treating endoscopically through is considered. これは体腔内に内視鏡を挿入し、その内視鏡の処置具挿通用チャンネルを通じて手術用処置具を体腔内まで挿入して体腔内から外科的に手術を行うものである。 This is what to insert the endoscope into a body cavity, perform surgically surgery from within a body cavity by inserting an operative instrument to the body cavity through the treatment instrument insertion channel of the endoscope.

【0003】しかし、この経内視鏡的外科手術を行う場合には病変部が大きかったり、病変部が壁部内深くまで浸潤していたりすると手に負えないことが多い。 However, large or the lesion in the case of performing through an endoscope surgery, intractable often a lesion or invading deep wall portion. このような場合には体腔の外から処置する外科手術に移行し、 Such in the case proceeds to surgical treating the outside of the body cavity,
腹腔鏡下手術や開腹手術を行うことになる。 It will perform laparoscopic surgery or open surgery.

【0004】ところで、従来の内視鏡的外科手術において用いられる内視鏡の挿入部1は図11で示すように、 Meanwhile, the insertion portion 1 of the endoscope to be used in conventional endoscopic surgery, as shown in Figure 11,
可撓管部2の先端に湾曲管3を介して先端部4を連結した構成のものであり、この挿入部1内には処置具挿通用チャンネル5が全長にわたり形成されている。 Are those having the structure connecting the front end portion 4 through the bending tube 3 at the distal end of the flexible tube portion 2, the channel 5 for the treatment instrument insertion is formed over the entire length in the insertion portion 1. 先端部4 Tip 4
の先端面には処置具挿通用チャンネル5の先端が開口すると共に、この開口に並んで、観察窓6及び照明窓7が配設されている。 The distal end surface of the tip of the treatment tool insertion channel 5 are opened, alongside the opening, observation window 6, and illumination window 7 is disposed.

【0005】そして、胃8の内壁に生じた病変部9を治療する場合、まず胃8内に挿入した挿入部1の処置具挿通用チャンネル5を通じて把持鉗子11と高周波スネア切開具12を導入し、胃8の内側から内視鏡下で病変部9を外科的に処置する。 [0005] Then, when treating lesions 9 occurring in the stomach lining 8, first introduced grasping forceps 11 and the high-frequency snare surgical tool 12 through the treatment instrument insertion channel 5 of the insertion portion 1 is inserted into the stomach 8 surgically treat lesion 9 with endoscopic from the inside of the stomach 8.

【0006】 [0006]

【発明が解決しようとする課題】しかしながら、内視鏡の挿入部1は柔らかいものであるため、膨らませた胃8 [SUMMARY OF THE INVENTION However, since the insertion portion 1 of the endoscope is soft ones, stomach inflated 8
の中で空中に浮かせた状態で挿入部1を保持しようとしても先端部4がふらついてしまい、不安定な状態になってしまう。 Also would be unsteady tip 4 in an attempt to hold the insertion portion 1 in a state of floating in the air in, it becomes unstable. 従って、挿入部1を胃の内壁面に沿わせて押し進め、胃壁で挿入部1を位置決め保持しながら先端部4を病変部9に近づけ、処置作業を行う方法が採られる。 Thus, forced insertion portion 1 and along the inner wall surface of the stomach, closer to the tip 4 to the lesion 9 while positioning holding the insertion portion 1 in the stomach wall, a method of performing treatment operations are taken. このため、胃の壁面沿いの横から病変部9の部分を観ることになり、その結果、病変部9の全体像を把握することは困難な状況にあるため、病変部9の処置作業を難しくしていた。 Therefore, it becomes possible to view the portion of the lesion 9 from the side along the wall of the stomach, resulting, for that an overall picture of the lesion 9 in difficult situations, difficult treatment work lesion 9 Was. しかも、観察系と処置系が近くなるので、病変部9の全体を観察しようとして、内視鏡の先端部4を病変部9から離すと、処置具の先端が遠くなり、 Moreover, since the observation system and the treatment system is close, trying to observe the entire lesion 9, release the distal end portion 4 of the endoscope from the lesion 9, the distal end of the treatment instrument becomes far,
処置具の先端がふらついてしまい、病変部9がつかめなくなるなどの不都合が生じる。 Will be unsteady tip of the treatment tool, the inconveniences such as lesion 9 can not grasp. 逆に処置具がふらつかないようにしようとして挿入部1の先端を病変部9に近づけると、画角が狭くなるので病変部9の一部しか見えないことになる。 When brought close to the distal end of the insertion portion 1 as trying to reverse the procedure instrument were not unsteady in the lesion 9, so that the only visible part of the lesion 9 because the angle of view becomes narrow.

【0007】加えて、ここで使用する処置具は内視鏡に具備する処置具挿通用チャンネル5に挿通してのみ使用するものであるため、処置具全体が細いものである必要があり、その結果、処置具は腰がなくなる。 [0007] In addition, the treatment instrument used here because it is intended to use only by inserting the treatment instrument insertion channel 5 comprising the endoscope, should the entire treatment tool is thin object, its a result, the treatment instrument is the waist is eliminated. このため、 For this reason,
大きい範囲の腫瘍や、大きいポリープなどを処置するには能力不足になる。 Large range of tumor and will lack the ability to treat such large polyp.

【0008】そこで、観察用内視鏡と処置具を別々に体腔内に挿入すれば良いように考えられるが、そうすると、内視鏡の視野範囲から処置具が外れてしまい思うような処置操作ができないという重大な不都合が起きる。 [0008] Therefore, it is considered the observation endoscope and the treatment tool as may be inserted separately into the body cavity, Then, the treatment operations such as I would have therapeutic instrument is removed from the field of view of the endoscope a serious disadvantage that it can not happen.

【0009】また、オーバーチューブやスライディングチューブのような案内管を用いて、処置具と内視鏡が離れてしまうことのないようにすると、1本の案内管内に2本のものを挿入することになる結果、いわゆるブタ鼻の状態になり、内視鏡の外径と処置具の外径の外接円以上の内径がある太い案内管が要ることになる。 Further, by using the guide tube, such as overtube or sliding tube and, not to be thus separated treatment instrument and the endoscope, the insertion of those two to one guide tube of become a result, the state of so-called pig nose, thick guide tube is the need to have an outer diameter and circumscribed more than ¥ inner diameter of the outer diameter of the treatment instrument of the endoscope. しかし、 But,
実際には体腔には自ずとその内径に制限が有るので、案内管の方の外径は太くすることが出来ず、内視鏡も処置具も細い外径のものしか使用できないので、観察能力と処置能力が落ちてしまうという不都合が起きる。 Actually, since naturally limited in its inner diameter there is the body cavity, the outside diameter towards the guide tube can not be thick, since the endoscope also can only use those even smaller outer diameter treatment instrument, the observation capability inconvenience that the treatment capacity will fall occurs. 特に大掛かりな手術を要する大きい病変部9や深く浸潤した病変部9を処置することが難しくなる。 It is particularly difficult to treat large lesions 9 and deeply infiltrated lesion 9 requiring large-scale operation.

【0010】一方、後述する図12で示すように、1本の処置具挿通用チャンネル18を通じて2本の処置具、 On the other hand, as shown in Figure 12 to be described later, two treatment instrument through one of the treatment instrument insertion channel 18,
例えば把持鉗子11と高周波スネア切開具12を導入し、体腔内に突き出すようにした場合、内視鏡の先端部4から突き出した2本の処置具の間隔が狭くなり、内視鏡の先端部4の前方に位置する病変部9を処置することが非常に難しいものとなる。 For example by introducing a grasping forceps 11 and the high-frequency snare incision instrument 12, when you protrude into the body cavity, the spacing of the two treatment instrument protruding from the tip 4 of the endoscope becomes narrower, the tip portion of the endoscope 4 of treating a lesion 9 located in front becomes very difficult.

【0011】また、図11で示すように、内視鏡に2本の処置具挿通用チャンネル5を設けて、その別々のチャンネル5を通じて2つの処置具を個別に挿通する形式の場合であっても内視鏡の先端部4に設けた2本のチャンネル5の間隔が元々狭いことから突き出す処置具の間隔が狭くなることには本質的に変わりはなく、特に大掛かりな手術を要する大きい病変部9や深く浸潤した病変部9を処置することが難しい。 Further, as shown in Figure 11, the provided treatment instrument insertion channel 5 of the two to the endoscope, even if through its different channels 5 of the type inserted separately two treatment tools essentially instead not to the interval of the treatment instrument protruding from it originally narrow spacing of the endoscope tip portion 4 two channels 5 provided on becomes narrower, larger lesions requiring particular large-scale surgery it is difficult to treat 9 and deeply infiltrated lesions 9.

【0012】さらに、内視鏡の処置具挿通用チャンネル5,18に処置具を挿通して病変部9を処置しようとすれば、必然的に病変部9と先端部4の間の狭い領域に処置具が突き出されることになる結果、その処置具が観察しようとする病変部9の視野を妨げることになる。 Furthermore, if an attempt treat treatment instrument lesion 9 is inserted into the treatment instrument insertion channel 5 and 18 of the endoscope, in a narrow region between the inevitably lesion 9 and the distal end portion 4 the results will be the treatment instrument is projected, would prevent the viewing of the lesion 9 whose treatment tool to be observed. しかも、2つの照明窓7から出射する照明光が処置具の表面に当り光ってしまい、病変部9を見にくくする。 Moreover, the illumination light emitted from the two illumination windows 7 would glowing contact the surface of the treatment instrument, hardly viewed lesion 9. 逆に1 On the contrary 1
つの照明窓7から一つの照明光を出射させるようにすると、処置具の影ができて影側の画像が見にくくなる。 One of when to emit one of the illumination light from the illumination window 7, the image of the shadow side is difficult to see and be shadow of the surgical instrument.

【0013】図12は腸管15の内壁に生じた病変部9 [0013] Figure 12 lesions 9 generated on the inner wall of the intestine 15
を処置する例を示すものであり、この場合に使用される内視鏡は観察方向が直視のものであり、その挿入部1には径の大きい1本の処置具挿通用チャンネル18を有する。 Are those showing an example of treating an endoscope is used in this case are those viewing direction of the direct view, the the insertion portion 1 having one of the treatment instrument insertion channel 18 large diameter. この場合でも、病変部9を正面視し難くく、処置がやりにくい。 Even in this case, click the lesion 9 hardly viewed from the front, treatment is difficult to do. また、1本の処置具挿通用チャンネル18 Also, one of the treatment instrument insertion channel 18
を通じて複数の処置具を挿通するため、各処置具の先端部を小さくする必要があり、また、その後方部位のシース部分も細いものが必要である。 For inserting a plurality of treatment instruments through, it is necessary to reduce the tip of the treatment tool, also, the sheath portion of the rear portion is also required thin object. このため、一般に腰が弱くなり、特に大掛かりな手術を要する大きい病変部9 Therefore, generally the waist becomes weak, a large lesion in particular requires a large-scale operation 9
や深く浸潤した病変部9を処置することが難くなる。 It becomes hard to be treated the lesion 9 Ya was deeply infiltrated.

【0014】尚、特願昭53−43875号では内視鏡の挿入案内用主管に処置具挿通用チャンネルと、可撓性の光学視管の先端部を挿入案内用主管の軸外側方に偏倚せしめる手段を設け、処置性能を向上したものが記されている。 [0014] Incidentally, the biasing and the treatment instrument insertion channel in the insertion guide for the main pipe of the endoscope, the distal end portion of the flexible telescope axially outward of the insertion guide for the main pipe in Japanese Patent Application Sho 53-43875 It means allowed to provided, which improved treatment performance are described.

【0015】しかしながら、この特願昭53−4387 [0015] However, this Japanese Patent Application No. Sho 53-4387
5号のものでは内視鏡の挿入部の外径に近い、大型の処置具を通すことができない。 Intended No.5 is close to the outer diameter of the insertion portion of the endoscope, it can not be passed through the large treatment tool. また、内視鏡の鉗子挿通チャンネルを通過する処置具の柄の部分は細かったり、柔らかかったりして、処置をする大きな力を先端に伝えることができず、処置性能をより向上させるには不十分であった。 Also, or handle portion of the treatment instrument through a forceps insertion channel of the endoscope Komaka', and or softer, can not be transmitted to the tip of the large forces that treatment, in order to further improve the treatment performance not It was sufficient.

【0016】また、実開昭51−149985号公報には内視鏡の外壁に誘導路を付設し、その誘導路を通じて外筒管を体内に挿入し、この外筒管内に縫合器を挿通するようにしたものが提案されている。 Further, by attaching a taxiway on the outer wall of the endoscope in Japanese Unexamined Utility Model Publication No. 51-149985, by inserting the outer cylinder tube into the body through its guide path, through which the suture instrument in the outer cylinder tube those as to have been proposed. しかしながら、この実開昭51−149985号公報のものにあっては、 However, the apparatus having the Japanese Utility Model 51-149985, JP-
内視鏡と外筒管が誘導路によって連結されているので、 Since the endoscope and the outer cylinder tube is connected by a guideway,
外形が太く複雑な形のものとなり、内視鏡の挿入性が劣るものであった。 Contour is assumed thickened complex shapes, were those insertability of the endoscope is poor.

【0017】本発明は上記各事情に着目してなされたものであり、その目的とするところは、内視鏡による臓器内側から処置することができる対象を拡大し、腹腔鏡下手術や開腹手術による臓器外側からの処置を極力避け得ると共に、従来、特に難しかった、体腔の奥の壁の大きい範囲の病変部や深く浸潤した病変部の処置についても容易に行うことが可能であり、その結果、患者の入院期間及び費用、苦痛、傷痕、ガン細胞の拡散などの負担やリスクを軽減することにある。 [0017] The present invention has been made in view of the above circumstances, and has as its object to enlarge the object that can be treated from an organ inside endoscopic, laparoscopic or open surgery together be avoided as much as possible the treatment of the organ outer by conventional, particularly difficult, it can be easily performed for the treatment of a large range of the lesion and deeply infiltrating lesions far wall of the body cavity, as a result , it is to reduce the patient's length of stay and cost, pain, scars, the burden and risks, such as diffusion of cancer cells.

【0018】 [0018]

【課題を解決するための手段及び作用】本発明の内視鏡治療装置は、体腔内に挿入される器具誘導用案内管と、 Means and operation for solving the problems] endoscopic treatment apparatus of the present invention, an instrument guiding guide tube to be inserted into a body cavity,
上記器具誘導用案内管の内孔に進退自在に挿入される少なくとも一つの処置用内視鏡と、上記器具誘導用案内管の内孔に進退自在に挿入される少なくとも一つの処置具ユニットとを具備してなり、上記内視鏡と上記処置具ユニットのうち少なくとも一つのものの横断面の外形状が上記器具誘導用案内管の内孔の寸法よりもわずかに小さい径の弧の部分を持ち、上記内視鏡と上記処置具ユニットを組み合わせて上記器具誘導用案内管に入れる際にその組み合わせた全体の横断面の最長寸法が上記器具誘導用案内管の内孔の径よりわずかに小さい寸法を有する形状になるように構成したことを特徴とするものである。 At least one endoscopic treatment is inserted retractably into the inner hole of the instrument guiding the guide tube, and at least one treatment tool unit that is inserted retractably into the inner hole of the instrument guiding guide tube will be provided, having at least one outer shape portion of the arc of slightly less diameter than the dimension of the inner hole of the guide tube for inducing the instrument of the cross-section of one of the above endoscope and the treatment tool unit, the slightly smaller longest dimension than the diameter of the inner hole of the guide tube for inducing the instrument of the cross-section of the overall combination thereof when placed in the guide tube for inducing the instrument by combining the endoscope and the treatment tool unit it is characterized in that, which is configured as a shape having.

【0019】そこで、本発明の内視鏡治療装置を使用する場合、例えば予め体腔内に挿入した内視鏡挿入部の外周に上記器具誘導用案内管を被嵌し、この後、体腔内にその内視鏡挿入部を挿入し、続けて、その内視鏡挿入部に沿わせて器具誘導用案内管を体腔内に挿入する。 [0019] Therefore, when using the endoscope treatment system of the present invention, for example, fitted to the instrument guiding the guide tube to the outer periphery of the endoscope insertion portion inserted in advance into the body cavity, thereafter, into the body cavity its insert the endoscope insertion portion, it continued to inserted along its endoscope insertion portion of the instrument guiding the guide tube into the body cavity. 次に、内視鏡を一旦引き抜き、以下の処置用内視鏡と処置具ユニットを挿入して手術を行う。 Then, once pull the endoscope, it performs the surgery by inserting the following medical treatment endoscope and the treatment tool unit.

【0020】 [0020]

【発明の実施の形態】[第1実施形態]図1を参照して本発明の第1実施形態を説明する。 DESCRIPTION OF THE PREFERRED EMBODIMENTS First Embodiment Referring to FIG. 1 illustrating a first embodiment of the present invention.

【0021】(構成)図1中、21は略円筒形状に形成された器具誘導用案内管であり、この器具誘導用案内管21は図示しない内視鏡の挿入部の外周に被嵌してその内視鏡の挿入部をガイドとして体腔内に誘導される。 [0021] (Configuration) In Fig. 1, 21 is a substantially instrument guiding guide tube formed in a cylindrical shape, the instrument guiding the guide tube 21 is fitted over the outer periphery of the insertion portion of an endoscope (not shown) induced in a body cavity the insertion portion of the endoscope as a guide. 器具誘導用案内管21は可撓性のある長尺な管状部材によって形成されている。 Instrument guiding the guide tube 21 is formed by a long tubular member having flexibility. 器具誘導用案内管21の先端には硬質の補強管22が取着されている。 Stiffening tube 22 rigid is attached to the tip of the instrument guiding the guide tube 21. また、器具誘導用案内管21はその補強管22を含めて内外の径が全長にわたり等しく形成されている。 The diameter of the inner and outer instrument guiding the guide tube 21 including the stiffening tube 22 is equally formed over the entire length.

【0022】上記器具誘導用案内管21の内孔には処置操作の観察を目的として特別に作られた1本の処置専用内視鏡23(以下、処置用内視鏡と呼ぶ)と、2本の処置具用案内管24がそれぞれ独立的に挿入されるようになっている。 [0022] The instrument guiding the guide tube 21 of the bore in the specially-made one treatment only endoscope for the purpose of observation of the treatment operation 23 (hereinafter, referred to as a medical treatment endoscope) and, 2 treatment instrument guide tube 24 of the present is adapted to be inserted each independently. これら3つの器具は一緒または個別的に器具誘導用案内管21内に進退自在に挿入配置される。 These three instruments are retractably inserted located together or individually instrument guiding the guide tube 21. また、3つの器具の横断面の外形状(横断面形状とも呼ぶ)はその総和の横断面形状が略円形になり、それらの器具の直線部が、近接(接触する場合を含む)するように密集して配置される充填した関係で組み合わされるように構成されている。 Further, (also referred to as a cross-sectional shape) three external shape of the cross section of the instrument becomes cross-sectional shape is generally circular and the sum, as the linear portion of their instrument proximate (including when in contact) is configured to be combined with a filling relationship are arranged densely. そして、上記3つの器具のうち少なくとも一つのものの横断面の外形状が上記器具誘導用案内管21の内孔の寸法よりもわずかに小さい径の弧の部分を持ち上記3つの器具を組み合わせて上記器具誘導用案内管21に入れる際にその組み合わせた全体の横断面の最長寸法が上記器具誘導用案内管21の内孔の径よりわずかに小さい寸法を有する形状になるように構成されている。 Then, the combination of at least one thing in the cross section of the outer shape of one said 3 has a portion of the arc of slightly less diameter than the dimension of the inner hole of the instrument guiding the guide pipe 21 instruments among the three instruments longest dimension of the cross section of the whole of combined when placing the instrument guiding the guide pipe 21 is configured to a shape having a slightly smaller than the diameter of the inner hole of the instrument guiding the guide tube 21.

【0023】上記処置用内視鏡23の挿入部25は先端部26と湾曲部27と可撓管部28とからなり、この挿入部25の横断面形状はその略全長にわたり同じく半円形に形成されている。 The insertion portion 25 of the treatment endoscope 23 is composed of a front end portion 26 and the bending portion 27 the flexible tube section 28., the cross-sectional shape of the insertion portion 25 is also formed in a semicircular shape along its substantially entire length It is. 挿入部25の横断面形状における円弧部の半径は上記器具誘導用案内管21の内孔の半径よりも僅かに小さく形成され、上記挿入部25は器具誘導用案内管21の内孔の半円の領域に略密に配置され、 The radius of the circular arc portion in the cross-sectional shape of the insertion portion 25 is formed slightly smaller than the radius of the inner hole of the instrument guiding the guide tube 21, semi-circular inner hole of the insertion portion 25 instrument guiding the guide tube 21 disposed Ryakumitsu in the region,
前後に進退自在に挿入される。 Inserted retractably back and forth.

【0024】処置用内視鏡23の先端部26には一般的な内視鏡と同様に観察手段と照明手段が組み込まれ(共に図示せず)、先端部26の先端面にはその観察手段の観察レンズ29と、その照明手段の照明レンズ30が配設されている。 [0024] (not both shown) common endoscope as well as observation means and the illuminating means is incorporated in the distal end portion 26 of the medical treatment endoscope 23, the observation means on the distal end surface of the distal end portion 26 and the observation lens 29, the illumination lens 30 is disposed in the illumination means.

【0025】各処置具用案内管24は全長にわたりその横断面形状が円の1/4の扇形である可撓性のある長尺な管状部材によって形成されており、これらの処置具用案内管24の先端には硬質の補強管24aが取着されている。 [0025] Each treatment instrument guide tube 24 is formed by a flexible elongate tubular member is a quarter of the sector of the cross-sectional shape is circular over the entire length, the guide tube for these treatment instrument reinforcing tube 24a of hard is attached to the distal end 24. また、処置具用案内管24はその補強管24aを含めて略全長にわたり内外の径が等しく形成されている。 Moreover, treatment instrument guide tube 24 is the diameter of the inside and outside are formed equally over substantially the entire length including its reinforcing tube 24a. 各処置具用案内管24の横断面形状における円弧部の半径は上記器具誘導用案内管21の内孔の半径より僅かに小さい。 The radius of the circular arc portion in the cross-sectional shape of the guide tube 24 for each treatment instrument is slightly smaller than the radius of the inner hole of the instrument guiding the guide tube 21. そして、2つの処置具用案内管24を組み合わせることによりその組み合わせた全体の横断面形状が略半円形になり、上記器具誘導用案内管21の内孔の半円の領域に略密に配置され、かつ上記器具誘導用案内管21内に全体及び個別的に前後に進退自在に挿入される。 By combining the two treatment instrument guide tube 24 becomes cross-sectional shape is substantially semicircular overall combination thereof, disposed Ryakumitsu in the region of the inner bore of the semicircle of the instrument guiding the guide tube 21 and it is inserted retractably around the whole and individually in the instrument guiding the guide tube 21.

【0026】以上のようにして、上記器具誘導用案内管21の内孔に配置される1本の処置用内視鏡23と2本の処置具用案内管24はその3本のものの総和の横断面形状が略円形になり、それらの接合する内側の直線部が近接して比較的密に組み合わせられて上記器具誘導用案内管21内に全体及び個別的に進退自在に配置されるようになっている。 [0026] As described above, one of the medical treatment endoscope 23 and two treatment instrument guide tube 24 which is disposed in the inner hole of the instrument guiding the guide tube 21 is the sum of that of the three cross-sectional shape is substantially circular, close the straight portion of the inner to their joining be combined relatively tightly so as to be positioned freely across and individually advance and retreat in the instrument guiding the guide pipe 21 going on.

【0027】各処置具用案内管24はいずれも左右方向の2方向または上下左右方向の4方向に湾曲させる湾曲機能を有する湾曲部31を備えてなり、その湾曲部31 The result includes a curved portion 31 having a bending function to bend in four directions of the two directions or the vertical and horizontal directions of the both guiding tube 24 each treatment instrument lateral direction, the curved portion 31
は手元側での操作により強制的に湾曲させられることによって処置具用案内管24の先端部分を上下左右に移動したり処置具用案内管24の先端の向きを変えたりすることができるようになっている。 As can be changing the forced tip orientation of moving the distal end portion of the treatment instrument guide tube 24 vertically and horizontally by being curved or treatment instrument guide tube 24 by the operation from the proximal going on.

【0028】また、処置具用案内管24の湾曲部31は種々の偏倚または変向を得るために複数の湾曲部分を組み合わせて構成しても良い。 Further, the curved portion 31 of the treatment instrument guide tube 24 may be constructed by combining a plurality of curved portions in order to achieve various biasing or deflection. 例えば手元側部分を左右に広がる向きに湾曲し、先端側部分を内側に向ける湾曲を行うようにすると、図1で示すように病変部39を処置する上で都合が良い。 For example curved in a direction extending the proximal portion to the left and right, when to perform bending to direct the leading end portions inward, convenient in treating lesions 39 as shown in Figure 1.

【0029】各処置具用案内管24には把持鉗子32や高周波スネア切開具36等の治療等に必要な処置具が個別的に挿通されるようになっている。 [0029] so that the treatment instrument required for treatment such as grasping forceps 32 and the high-frequency snare incision tool 36 in guide tube 24 for each treatment tool is individually inserted. 本実施形態では、 In this embodiment,
左側の処置具用案内管24に把持鉗子32を挿入して1 Insert the grasping forceps 32 on the left side of the treatment instrument guiding pipe 24 1
つの処置具ユニット(処置装置)35を構成し、右側の処置具用案内管24に高周波スネア切開具36を挿入して別の処置具ユニット(処置装置)37を構成している。 One of the Configure treatment tool unit (treatment device) 35, constitute another treatment tool unit (treatment device) 37 by inserting the high-frequency snare incision tool 36 on the right side of the treatment instrument guiding pipe 24.

【0030】尚、上記各処置具ユニットは把持鉗子32 [0030] Incidentally, the respective treatment tool unit grasping forceps 32
や高周波スネア切開具36等の処置具が単独の場合も含むものとする。 And a treatment instrument such as a high-frequency snare incision tool 36 is intended to include the case of alone.

【0031】(作用・効果)この第1実施形態の内視鏡治療装置を用いて胃38の内壁に生じた病変部39を切除する内視鏡的外科手術を行う場合について説明する。 [0031] will be described for performing an endoscopic surgical procedure to resect a lesion 39 produced on the inner wall of the stomach 38 using (Function and Effect) The endoscope therapeutic device of the first embodiment.
まず、胃38内に比較的太径の図示しない、例えば軟性内視鏡を挿入し、この内視鏡の挿入部に予め外装しておいた器具誘導用案内管21を、その軟性内視鏡の挿入部に沿ってスライドしながらその先端部分が病変部39の近くになるまで誘導する。 First, not shown relatively large diameter in the stomach 38, e.g., by inserting a flexible endoscope, the instrument guiding the guide tube 21 which had been previously fitted on the insertion portion of the endoscope, the flexible endoscope the tip portion is guided to become close to the lesion 39 while sliding along the insertion portion. この後、器具誘導用案内管2 After this, the instrument guidance for the guide tube (2)
1の挿入した後の姿勢を維持しながら上記内視鏡のみを抜き取る。 While maintaining the 1 insertion posture after extracting only the endoscope.

【0032】次に、平面部分が互いに合うようにして1 Next, as the planar portions meet each other 1
本の処置用内視鏡23と2本の処置具用案内管24を円柱状に束ね、これらを一緒に器具誘導用案内管21の内孔に挿入する。 The medical treatment endoscope 23 and guide tube 24 for the two treatment instrument of the present bundled into a cylindrical shape, inserted them into the inner hole of the instrument guiding the guide tube 21 together. そして、器具誘導用案内管21の先端開口から処置用内視鏡23と処置具用案内管24の先端部分を突き出すようにする。 Then, to protrude the leading portion of the treatment instrument guide tube 24 and the medical treatment endoscope 23 from the distal end opening of the instrument guiding the guide tube 21. この後、右側の処置具用案内管24には把持鉗子32を挿通し、左側の処置具用案内管24には高周波スネア切開具36を挿入する。 Thereafter, the right side of the treatment instrument guiding tube 24 inserted through the grasping forceps 32, the left side of the treatment instrument guiding tube 24 for inserting the high-frequency snare incision instrument 36.

【0033】ついで、図1で示すように、右側の処置具用案内管24と左側の処置具用案内管24に挿入した把持鉗子32と高周波スネア切開具36を進退操作し、また、各処置具用案内管24の湾曲機能を利用し、その案内管24の湾曲部31を適宜湾曲操作することにより、 [0033] Then, as shown in Figure 1, the grasping forceps 32 and the high-frequency snare incision instrument 36 inserted to the right of the therapeutic-instrument guide tube 24 and the left treatment instrument guide tube 24 is moved back and forth, also, each treatment utilizing the bending function of the ingredients for the guide tube 24, by appropriately bending operation of the bending portion 31 of the guide tube 24,
把持鉗子32と高周波スネア切開具36の先端の位置決め操作を行う。 The positioning operation of the tip of the grasping forceps 32 and the high-frequency snare incision instrument 36.

【0034】このような操作を行うことにより病変部3 [0034] lesions 3 by carrying out such an operation
9に高周波スネア切開具36のスネアワイヤ36aのループ部分を掛けると共に、把持鉗子32により病変部3 With multiplying the loop portion of the snare wire 36a of the high-frequency snare incision tool 36 to 9, the lesion 3 by the grasping forceps 32
9を把持して隆起させながら高周波スネア切開具36のスネアワイヤ36aで病変部39の根元部分を絞り込み、そのスネアワイヤ36aに高周波を通電して病変部39を切除する。 9 gripped by uplift while narrowing the root portion of the lesion 39 with the snare wire 36a of the high-frequency snare incision instrument 36, by applying a high frequency to excise the lesion 39 in the snare wire 36a.

【0035】この際、処置具ユニット35,37から独立した処置用内視鏡23により病変部39の状態と把持鉗子32及び高周波スネア切開具36の位置や動きを観察しながら操作を行うことができるため、処置作業が容易であり、かつ迅速に処置することができる。 [0035] In this case, be operated while observing the position and movement of the treatment instrument unit endoscope 23 for independent treatment of 35 and 37 and the state of the lesion 39 grasping forceps 32 and the high-frequency snare incision instrument 36 because it can be treated work is easy, and quickly treated.

【0036】以上の如く、処置用内視鏡23による観察機能及び湾曲機能と、処置具ユニット35,37による処置機能及び湾曲機能とが独立しているために、処置用内視鏡23の先端部26を病変部39に対して斜め上に位置させることができる。 [0036] As mentioned above, in order to the observation function and bending function according to the medical treatment endoscope 23, the treatment function and bending function according to the treatment tool unit 35 and 37 are independent, the tip of the medical treatment endoscope 23 the part 26 can be positioned obliquely upward with respect to the lesion 39. また、病変部39と処置具ユニット35,37の動きや位置等を観察して処置操作の全体像を確実に把握することができる。 Further, it is possible to reliably grasp the overall picture of the treatment operation by observing the lesion 39 with the movement and position of the treatment tool unit 35,37 and the like. しかも、器具誘導用案内管21によって各器具の位置が安定的に保持されるので、病変部39の処置作業を確実かつ迅速に行うことができる。 Moreover, since the position of each appliance is stably held by the instrument guiding the guide tube 21, it is possible to perform treatment operations of the lesion 39 reliably and quickly.

【0037】勿論、処置具ユニット35,37の位置が自由に選べ、不必要に近接させることがないので、処置用内視鏡23の観察視野を妨げることがない。 [0037] Of course, choose freely the position of the treatment tool units 35 and 37, since there is no possible to close unnecessarily, not to interfere with the observation field of the medical treatment endoscope 23. また、観察しようとする視野が処置具ユニット35,37の影に入ったりすることを極力避け得るので、明瞭な画像で観察することができる。 Further, since the field of view to be observed can avoided as much as possible to or enter the shadow of the treatment tool units 35 and 37, can be observed in a clear image.

【0038】また、処置具ユニット35,37の案内管24の方にも湾曲機能が付いているので、2本の処置具の距離を十分に離して使用することができる。 Further, since with even bending function towards the guide tube 24 of the treatment tool units 35 and 37 can be used sufficiently separation between the two treatment instrument. 従って、 Therefore,
操作性が良いと共に、特に大掛かりな手術となる大きい病変部39や深く浸潤した病変部39であっても容易に対処することが可能である。 Operability with good, it is possible to cope easily even larger lesion 39 or deeply infiltrated lesion 39 to be particularly large-scale operation.

【0039】さらに、左右横方向に処置具を動かせるので、例えば、体壁を横方向に伸ばして、伸びた箇所を電気メスで切開するなどの様々な処置にも適用が可能なものである。 [0039] Further, since move the treatment instrument in the left-right horizontal direction, for example, stretching the body wall laterally, those that can be applied to various treatments, such as cutting the stretched portion in the electric knife.

【0040】[第2実施形態]図2を参照して本発明の第2実施形態を説明する。 [0040] describing the Second Embodiment The second embodiment of the present invention with reference to FIG.

【0041】(構成)本実施形態では上記器具誘導用案内管21内に挿通される処置用内視鏡23の先端部26 [0041] (Configuration) tip 26 of the treatment endoscope 23 in the present embodiment to be inserted into the instrument guiding the guide pipe 21
の横断面形状が円形であり、一方、挿入部25の湾曲部27及び可撓管部28の横断面形状が上側のみを半円形状にしたものである。 Cross-sectional shape of a circle, whereas, in which cross-sectional shape of the curved portion 27 and the flexible tube portion 28 of the insertion portion 25 has only the upper semicircular shape. 挿入部25の湾曲部27及び可撓管部28はその下側半分が切除された形状であり、この切除後の空間部分によって、後述する1本の処置具用案内管24を嵌め込む収納用空間41を形成する。 The bending portion 27 and the flexible tube portion 28 of the insertion portion 25 is in the form of lower half thereof is excised, the space part after the resection, a housing to fit the one treatment instrument guide tube 24 to be described later to form a space 41.

【0042】上記処置用内視鏡23の先端部26における先端面には、観察手段の観察レンズ29と照明手段の照明レンズ30の他に挿通用チャンネル(処置具挿通管路)42の先端が開口している。 [0042] the distal end surface of the distal end portion 26 of the treatment endoscope 23, is in addition to insertion channel (instrument insertion conduit) 42 of the tip of the illumination lens 30 of the observation lens 29 of the observation unit illuminating means It is open. この挿通用チャンネル42は挿入部25の全長にわたり形成されるものである。 This insertion channel 42 is intended to be formed over the entire length of the insertion portion 25. ここで、観察レンズ29は先端部26の先端面における比較的下側部位に位置して配置され、照明レンズ3 Here, the observation lens 29 is arranged positioned relatively lower portion of the front end surface of the distal end portion 26, an illumination lens 3
0はその近くの左右に位置して配置されている。 0 is arranged at the left and right sides of the nearby. さらに挿通用チャンネル42の先端開口は比較的上側に位置する部位に配置されている。 Further distal opening of the insertion channel 42 is disposed in a portion located relatively upward. つまり、挿通用チャンネル4 In other words, the insertion channel 4
2の先端開口は観察レンズ29及び収納用空間41よりも上側に位置して配置されている。 2 of the tip opening is such that it is located above the observation lens 29 and the housing space 41.

【0043】上記処置具用案内管24は全長にわたりその断面形状が半円扇形の断面形状を有した可撓性のある長尺な管状部材によって形成されており、上記処置用内視鏡23の収納用空間41内に適合して嵌め込まれる形状に構成されている。 [0043] The treatment instrument guide tube 24 is formed by a long tubular member having flexibility which the cross-sectional shape having a semicircular sector cross-sectional shape over the entire length of the treatment endoscope 23 It is configured in a shape to be fitted to conform to housing space 41. つまり収納用空間41内に処置具用案内管24を抱き込むように嵌め込んで収納したときの総和の横断面形状が略円形になり、両器具の直線部が接する状態で密に配置される関係で両器具が組み合わされ、上記器具誘導用案内管21内に纏めて一緒に挿通可能なように構成されている。 Are densely arranged in other words the state in which the cross-sectional shape of the sum when the housing is fitted so as to embrace the treatment instrument guide tube 24 to the accommodating space 41 becomes approximately circular, straight portions of the instrument in contact both instruments are combined in relation, and is configured to be inserted together are summarized in the instrument guiding the guide tube 21.

【0044】しかして、処置具用案内管24の横断面形状は半円形であり、この半円形と、処置用内視鏡23の湾曲部27及び可撓管部28の部分の横断面形状の半円形とを合わせた横断面形状が略円形となり、この総和の円形の外径が上記器具誘導用案内管21の内径よりも小さくなるように、各器具は円弧と直線を組み合わせた横断面形状にて構成されている。 [0044] Thus, the cross-sectional shape of the guide tube 24 for the treatment instrument are semi-circular, and this semi-circular, cross-sectional shape of the portion of the curved portion 27 and the flexible tube portion 28 of the treatment endoscope 23 cross-sectional shape obtained by combining the semicircular becomes substantially circular, cross-sectional shape the outer diameter of the circular of the sum to be smaller than the inner diameter of the instrument guiding the guide tube 21, each instrument that combines an arc and a straight line It is composed of.

【0045】また、処置具用案内管24は前述した第1 Further, the treatment instrument guiding tube 24 first described above
実施形態と同様に湾曲機能を有する湾曲部31を有しており、その湾曲部31は手元側での操作により強制的に湾曲させられるようになっている。 Embodiment and has a curved portion 31 having a curved function similarly, the curved portion 31 is adapted to be forcibly bent by the operation from the proximal side.

【0046】(作用)本実施形態では1本の処置用内視鏡23の収納用空間41に処置具用案内管24が抱き込むようにした形に組み合わせられ、そして、両器具を器具誘導用案内管21内にまとめて挿入するようにしたものである。 The combined into a form as therapeutic-instrument guide tube 24 is Komu embrace the housing space 41 of the endoscope 23 for one treatment with (working) embodiment and instrument induces both instruments it is obtained so as to insert together into the guide tube 21.

【0047】そこで、第1実施形態で述べたと同様に器具誘導用案内管21を体腔内に導入し、器具誘導用案内管21の先端から処置用内視鏡23及び処置具用案内管24の先端部分を突き出し、さらに処置具用案内管24 [0047] Therefore, an instrument guiding the guide tube 21 in the same manner as described in the first embodiment is introduced into the body cavity, the instrument guiding the guide tube 21 distal from the view of the mirror 23 and the therapeutic-instrument guide tube 24 for the treatment protruding the distal end portion, the guide pipe 24 for further treatment instrument
を下側に湾曲して収納用空間41から離脱させて前方へ進める。 It was allowed to disengaged from the housing space 41 curved lower advances forward.

【0048】そして、図2で示すように、処置用内視鏡23の挿通用チャンネル42を通じて把持鉗子32を挿通し、処置具用案内管24には鋏鉗子44を挿通して、 [0048] Then, as shown in Figure 2, inserted through the grasping forceps 32 through the insertion channel 42 of the medical treatment endoscope 23, the treatment instrument guiding tube 24 by inserting the scissors 44,
病変部39を切除する手技を行う。 Performing a procedure to excise the lesion 39.

【0049】また、処置用内視鏡23の挿通用チャンネル42を通じて把持鉗子32を挿通すると共に、第1実施形態で述べた如く、処置具用案内管24に高周波スネア切開具36を挿通して病変部39の高周波切除を行うこともできる。 [0049] Also, the insertion of the grasping forceps 32 through the insertion channel 42 of the medical treatment endoscope 23, as described in the first embodiment, by inserting the high-frequency snare incision tool 36 in guide tube 24 for the treatment instrument it is also possible to perform high-frequency ablation of the lesion 39.

【0050】(効果)本実施形態では処置具用案内管2 [0050] (Effect) In the present embodiment treatment instrument guide tube 2
4に処置用内視鏡23と処置具用案内管24を後入れする際、それらの先端部が分かれていないので、複数の器具を挿入するにも拘らず、複数の器具がバラバラになり難く、また、引っ掛かりや挿入抵抗が少なく、複数の器具を器具誘導用案内管21に挿入しやすい。 When the post-inserting the treatment instrument guide tube 24 and the medical treatment endoscope 23 to 4, since their tip is not known, although the insert multiple instruments, hardly becomes a plurality of instruments apart in addition, less caught or insertion resistance, easily insert multiple instruments instrument guiding the guide tube 21.

【0051】処置具用案内管24としては1本のみ用いるので、その占有空間を大きくすることが可能であり、 [0051] Since use only one as the guide tube 24 for the treatment instrument, it is possible to increase the space occupied,
案内管24の内部空間を第1実施形態のものに比べ大きくすることができる。 The inner space of the guide tube 24 can be made larger than that of the first embodiment. 従って、大きい処置具を挿入して使用することができる。 Therefore, it can be used by inserting a large treatment tool.

【0052】また、第1実施形態の場合では主に横方向から処置操作を行うようにしたが、本実施形態では縦方向から処置操作ができるので、腫瘍のできた粘膜を把持鉗子32で引っ張り上げて大きく隆起させてから鋏鉗子44で剥離するなどの手技が容易である。 [0052] Further, although as in the case of the first embodiment mainly perform the treatment operation from the side, because in this embodiment it is treated operated from longitudinal, pulling up was possible tumor mucosa grasping forceps 32 procedures such as peeling with scissors 44 from greatly raised Te is easy.

【0053】さらに、処置用内視鏡23の先端部26を大きくすることができるため、大きな観察光学系及び照明光学系を組み込むことができ、それらの能力を高めることが容易である。 [0053] Further, it is possible to increase the front end portion 26 of the medical treatment endoscope 23, it is possible to incorporate a large observation optical system and an illumination optical system, it is easy to increase their capacity.

【0054】[第3実施形態]図3を参照して本発明の第3実施形態を説明する。 [0054] illustrating a Third Embodiment A third embodiment of the present invention with reference to FIG.

【0055】(構成)本実施形態では上記器具誘導用案内管21内に挿通される処置用内視鏡23の挿入部25 [0055] (Configuration) insertion portion 25 of the instrument guiding guide tube endoscope 23 for the treatment to be inserted into the 21 in this embodiment
が先端部26を含めてその横断面形状が上側のみの半円形である。 There the cross sectional shape is a semi-circular upper only including the tip 26. また、湾曲機能付きの処置具用案内管24の横断面形状は前述した第2実施形態と同様に下側のみの半円形であり、その挿入部25と処置具用案内管24の直線部分が互いに接合されたときの総和の横断面形状が略円形になり、両器具の平面部分が接合した組み合わせの状態で、上記処置具用案内管24内に挿通可能なように構成されている。 Further, the cross-sectional shape of the therapeutic-instrument guide tube 24 with a bending function is a semi-circular lower only as in the second embodiment described above, the linear portion of the insertion portion 25 and the treatment instrument guide tube 24 cross-sectional shape of the sum is in a substantially circular shape when joined together, in a state of combination plane portions of both the instrument are joined, and is configured to be inserted through the treatment instrument guide tube 24.

【0056】上記処置用内視鏡23の挿入部25における先端部26の下側面部(処置具用案内管24との境界面側に向く部分)には観察手段の観察レンズ29と照明手段の照明レンズ30が前後に並べて配設してなり、この処置用内視鏡23は側方視観察と側方視照明を行う側視型形式のものとなっている。 [0056] the observation lens 29 and the illumination means of the observation means on the lower side surface portion (the portion facing the boundary surface side between the guide tube 24 for the treatment instrument) of the distal end portion 26 of the insertion portion 25 of the treatment endoscope 23 illumination lens 30 is arranged back and forth will be disposed, the treatment endoscope 23 has become a side-viewing format to observe and side viewing illuminating viewed laterally.

【0057】上記観察レンズ29の内側には図示しない固体撮像素子などの撮像手段が設けられ、また照明レンズ30の内側には図示しないライトガイドファイバの先端が配置されている。 [0057] The inside of the viewing lens 29 is provided imaging means such as a solid-state image pickup element (not shown), also the tip of the light guide fiber of the inside of the illumination lens 30 (not shown) is disposed. 上記ライトガイドファイバはその手元側遠位端から同じく図示しない光源装置からの光を受け、その光を側方へ向けた照明レンズ30に伝達して体腔内を照明するようになっている。 The light guide fiber receives light from the light source device also not shown from the proximal distal end, so as to illuminate the body cavity is transmitted to the illumination lens 30 toward the light laterally.

【0058】また、処置用内視鏡23の挿入部25における先端部26の下面部には挿通用チャンネル42の出口42aが形成され、この出口42aには処置具を曲げる処置具起上台43が具備されている。 [0058] Moreover, the outlet 42a of the insertion channel 42 in the lower surface of the distal end 26 of the insertion portion 25 of the treatment endoscope 23 is formed, the treatment instrument elevator base 43 to bend the treatment tool in the outlet 42a is It is provided. 処置具起上台4 The treatment instrument raiser 4
3は先端部26に所定の角度の範囲内で回転自在に枢着されている。 3 is rotatably pivoted within a predetermined angle to the tip section 26. そして、通常、処置具起上台43は倒伏して出口42a内に収納された姿勢にあるが、処置用内視鏡23の図示しない操作部に設けた起上操作レバーを回転させると、これに連動する起上ワイヤー(図示せず) Then, usually, but the treatment instrument elevator base 43 is in a posture which is housed in the outlet 42a and laid down, rotating the elevator operation lever provided in the operation unit (not shown) of the medical treatment endoscope 23, to interlocking raising wire (not shown)
の牽引により起上するようになっている。 It is adapted to the raising by the traction. その他の構成については、前述した第1実施形態または第2実施形態のものと同様の構成である。 The rest of the configuration is the same configuration as that of the first embodiment or the second embodiment described above.

【0059】(作用)これまでの例と同様に、予め、図示しない内視鏡を用いて、病変部39の近くに先端がくるように器具誘導用案内管21を体腔内に挿入して留置する。 [0059] (Operation) As in previous examples, in advance, using an endoscope (not shown), indwelling instrument guiding the guide tube 21 to come tip near the lesion 39 is inserted into the body cavity to. 処置用内視鏡23の挿入部25と処置具用案内管24を抱き合わせると共に、処置用内視鏡23の観察レンズ29よりも先端が後方に位置するように処置具用器具誘導用案内管21をずらす。 With tying the insertion portion 25 and the treatment instrument guide tube 24 of the medical treatment endoscope 23, the treatment instrument instrument guiding the guide tube so that the tip is located behind the observation lens 29 of the medical treatment endoscope 23 shifting the 21. この状態のまま、処置用内視鏡23により器具誘導用案内管21の内壁を観察しながら処置用内視鏡23の挿入部25と処置具用案内管24の両方を一緒に器具誘導用案内管21内に挿入していく。 In this state, the guide instrument induce both together the insertion portion 25 and the treatment instrument guide tube 24 of the medical treatment endoscope 23 while observing the inner wall of the instrument guiding the guide tube 21 by treatment endoscope 23 It will be inserted in the tube 21.

【0060】処置用内視鏡23の挿入部25の先端部2 [0060] the insertion portion 25 of the medical treatment endoscope 23 tip 2
6が器具誘導用案内管21の先端から突き出し、処置用内視鏡23により体腔壁が見え、その先端部26が器具誘導用案内管21の先端から突き出したことを確認したら、処置用内視鏡23の湾曲部27を湾曲させつつ、その挿入部25を適宜回転させて、病変部39を真上から観察するようにする。 6 protrudes from the distal end of the instrument guiding the guide tube 21, confirm that the body cavity wall by treatment endoscope 23 is visible, the tip portion 26 protruding from the distal end of the instrument guiding the guide pipe 21, the vision treatment while bending the bending portion 27 of the mirror 23, the insertion portion 25 is rotated appropriately, so as to observe the diseased part 39 from above. このとき、処置具用案内管24も挿入部25と一緒に回転させる。 At this time, to rotate with the even insertion portion 25 treatment instrument guide tube 24.

【0061】次に、処置具用案内管24に高周波スネア切開具36を挿通し、その処置具案内管24を湾曲させたり進退させたりし、さらには高周波スネア切開具36 Next, by inserting the high-frequency snare incision instrument 36 to the treatment instrument guiding tube 24, or moved back and forth or is curved its therapeutic instrument guide tube 24, more high frequency snare incision instrument 36
を適宜進退させながら、病変部39に高周波スネア切開具36のループワイヤ36aを掛ける。 While reciprocating appropriately, multiplying the loop wire 36a of the high-frequency snare incision instrument 36 to the lesion 39. 続いて、処置具、例えば把持鉗子32を処置用内視鏡23の挿通用チャンネル42に挿通し、その出口42aから体腔内に先端部を突き出す。 Subsequently, the treatment instrument, for example by inserting the grasping forceps 32 to the insertion channel 42 of the medical treatment endoscope 23, eject the tip from the outlet 42a into the body cavity. さらに起上台43を適宜起上して把持鉗子32のシース先端部分を側方へ曲げるように押しながら把持鉗子32により、病変部39を掴み、病変部3 Further the grasping forceps 32 while pressing to bend the elevator 43 to the appropriate elevation to the sheath distal end portion to the side of the grasping forceps 32, grasp the lesion 39, the lesion 3
9を引っ張り上げる。 Pulling up 9. この後、高周波スネア切開具36 Thereafter, the high-frequency snare incision instrument 36
のループワイヤ36aを引き締めて、通電し、病変部3 Tightening the loop wire 36a, energized, lesion 3
9を切除する。 9 excised.

【0062】(効果)ここでの処置用内視鏡23は側方を観察する側視型のものを用いているため、病変部39 [0062] For (effect) the medical treatment endoscope 23 of where the are used as the side-view type for observing the lateral lesion 39
を真上から観察することが可能であり、高周波スネア切開具36のループワイヤ36aが病変部39の周囲に来ることが容易に分かる。 It is possible to observe from above, the loop wire 36a of the high-frequency snare incision instrument 36 is readily seen to come around the lesion 39. また、病変部39を掴む操作も、病変部39を引っ張り上げる操作も、ループワイヤ36aを締める操作のいずれも観察しながら確実に行うことができ、処置の確実性を向上することが出来る。 The operation of grasping the lesion 39 is also operated to pull up the lesion 39 also while observing any operation to tighten the loop wire 36a can be reliably performed, it is possible to improve the reliability of the treatment. さらに2本の処置具を独立して操作することができるので、失敗によるやり直しが少ない。 It is possible to operate further independently the two treatment instrument, less again by failures.

【0063】尚、本実施形態では処置用内視鏡23の観察方向がその内視鏡23の長手方向の軸に対して90度の角度にしたが、病変部39の部位によっては後方斜視にしたり、前方斜視にしても良い。 [0063] Note that the observation direction of the medical treatment endoscope 23 in the present embodiment has a 90 degree angle relative to the longitudinal axis of the endoscope 23, the rear perspective by site of the lesion 39 or, it may be forward perspective. 組み合わせて使用する処置具の種類も、クリップと電気メス、T字形状のタグで引き上げてレーザ−プローブでカットするとか色々のものが考えられる。 Type of the treatment instrument to be used in combination also clips and electrocautery, laser lifted by tags T-shaped - those various Toka cut probe is considered. また、上述した第1実施形態の場合のように、2本の処置具用案内管24を使用するようにしても良い。 Also, as in the case of the first embodiment described above, it may be used a guide tube 24 for the two treatment instrument.

【0064】[第4実施形態]図4を参照して本発明の第4実施形態を説明する。 [0064] illustrating the Fourth Embodiment The fourth embodiment of the present invention with reference to FIG. (構成)本実施形態では処置具用案内管24の代わりに先端が斜めにカットされた透明で柔軟なウレタン樹脂製のキャップ50を先端に設けた湾曲機能付きの吸引チューブ51を用いるようにした処置具ユニットの例である。 In (Configuration) This embodiment is to use a suction tube 51 with a bending function of tip instead provided cap 50 made of transparent and flexible urethane resin that is cut obliquely the tip of the treatment instrument guiding tube 24 it is an example of the treatment tool unit. また、処置用内視鏡23はその先端部26の所の横断面の外形状が略円形な外形であり、湾曲部27と可撓管部の所には横断面の外形状が三日月形状の収納用凹溝部52を形成した。 The outer shape of the cross section of at the treatment endoscope 23 is the tip section 26 is a substantially circular contour, the outer shape of the cross section at the flexible tube portion and the curved portion 27 of the crescent-shaped forming a housing for the recessed groove portion 52. 上記吸引チューブ51はその収納用凹溝部52内に嵌め込まれて収納されるようになっている。 The suction tube 51 is adapted to be accommodated in fitted in the accommodating groove part 52.

【0065】処置用内視鏡23の先端部26においての上記収納用凹溝部52を配置する側に位置する下面部には観察手段の観察レンズ29と照明手段の照明レンズ3 [0065] illumination lens of the illumination means and the observation lens 29 of the observation means on a lower surface portion located on the side of placing the accommodating groove 52 of the front end portion 26 of the treatment endoscope 23 3
0が前後方向に並べて配設され、これにより前述した第3実施形態の場合と同様、側方視観察と側方視照明を行う側視型の内視鏡を構成している。 0 is disposed side by side in the longitudinal direction, as in the third embodiment thereby foregoing, constitute the endoscope side-view type performing side viewing observation and lateral gaze illumination.

【0066】先端部26の下面部には、挿通用チャンネル42の出口42aが形成されており、この出口42a [0066] On the lower surface of the distal end 26, the outlet 42a of the insertion channel 42 is formed, the outlet 42a
には前述した第3実施形態の場合と同様、処置具の突き出し方向を調節する処置具起上台43が備えられている。 As in the third embodiment described above, the treatment instrument elevator base 43 to adjust the projecting direction of the treatment instrument are provided in the. 上記先端部26にはさらに洗浄水や空気を吹き付けて観察レンズ29の外表面を洗浄する洗浄ノズル53が配設されている。 Cleaning nozzle 53 to clean the outer surface of the tip portion 26 viewing lens 29 further spraying cleaning water and air in is provided. また、この実施形態での照明手段の光源は先端部26に内蔵される白色LEDである。 Further, the light source of the illumination means in this embodiment is a white LED built in the tip 26.

【0067】(作用)まず、前述したように、図示しない内視鏡挿入部を用いて、病変部39の近くに先端がくるように器具誘導用案内管21を体腔内に挿入して留置する。 [0067] (Operation) First, as described above, with the endoscope insertion portion not shown, an instrument guiding the guide tube 21 to come tip near the lesion 39 placed is inserted into the body cavity . 次に、処置用内視鏡23の収納用凹溝部52内に吸引チューブ51を嵌め込むことにより両者を抱き合わせて両方の器具を一緒に纏め、このように組み合わされた処置用内視鏡23と吸引チューブ51の両者を器具誘導用案内管21内に挿通し、その先端部分が体腔内の病変部39の近傍に位置する場所まで導く。 Next, collectively both instruments together tying both by fitting the suction tube 51 in the housing concave groove portion 52 of the medical treatment endoscope 23, thus the treatment endoscope 23 in combination both suction tube 51 is inserted into the instrument guiding the guide tube 21, guided to the location where the tip portion is positioned in the vicinity of the lesion 39 in the body cavity.

【0068】そして、病変部39の近傍に導いたところで、処置用内視鏡23の湾曲部27を吸引チューブ51 [0068] Then, when the led in the vicinity of the lesion 39, sucking the bending portion 27 of the medical treatment endoscope 23 Tube 51
から離れる向きに湾曲し、その処置用内視鏡23から吸引チューブ51を分離する。 Curved in a direction away from the separation of the suction tube 51 from the medical treatment endoscope 23. 例えば静脈瘤のような病変部39の場合、病変部39を視野内に捉えたら病変部3 For example, if the lesion 39 such as varicose veins, lesions 3 After capturing the lesion 39 within the field of view
9の周囲に挿通用チャンネル42を通じて挿入したループ留置具54のループワイヤ55を押し付けて位置決めさせる。 Is positioned against the loop wire 55 of the loop retaining device 54 has been inserted through the insertion channel 42 around 9. この後、病変部39に吸引キャップ50の先端部分を被せる。 Thereafter, it puts a tip portion of the suction cap 50 to the lesion 39.

【0069】そして、吸引ポンプのスイッチをオンとし、吸引キャップ50内に病変部39を吸い込む。 [0069] Then, the switch of the suction pump is turned on, sucking the lesion 39 in the suction cap 50. 吸引キャップ50内に病変部39が十分に吸い込まれたところで、その病変部39の周囲に配置した上記ループワイヤ55を絞り込み、その後、ループワイヤ55の部分を切り離し、病変部39を把束した状態で、ループワイヤ55を放出してそのまま留置する。 The suction cap 50 where the lesion 39 is sucked into the well, a state in which the said loop wire 55 arranged around the lesion 39 narrowing, then disconnect the parts of the loop wire 55, and Wataba lesions 39 in, placing it by releasing loop wire 55.

【0070】(効果)本実施形態によれば、把持鉗子やクリップで病変部39を引き上げる場合に比べて、大きな病変部39を十分に引き上げることができる。 [0070] (Effects) According to this embodiment, as compared with the case where pulling the lesion 39 with grasping forceps or clips, a large lesion 39 can be raised sufficiently. また、 Also,
吸引キャップ50内に病変部39を吸引する力を十分に強くすることができるので、病変部39の引き締め時、 Since the force for attracting the lesion 39 in the suction cap 50 can be sufficiently strong, upon tightening of the lesion 39,
または病変部39を引き上げる時、処置具の方が病変部39側に引き込まれてしまう不具合がない。 Or when pulling up the lesion 39, there is no problem that towards the treatment tool will be drawn into the lesion 39 side. 加えて、吸引力をコントロールすることにより、広範な病変部39 In addition, by controlling the suction force, extensive lesions 39
や深い病変部39であっても的確な処置が可能になる。 Even and deep lesion 39 it is possible to appropriately treating.

【0071】本実施形態では処置用内視鏡23の湾曲部27の部分から手元側にわたりその横断面形状が三日月形状の収納用凹溝部52を形成しているが、湾曲部27 [0071] In the present embodiment the cross-sectional shape over the hand side from the portion of the curved portion 27 of the treatment endoscope 23 forms an accommodating groove part 52 of the crescent-shaped, curved portion 27
も先端部26と同様、横断面形状が円形なものとしてその湾曲部27の後端に続く可撓管部28の部分から収納用凹溝部52を形成するようにしても良い。 Similarly the tip 26, the cross-sectional shape may be formed a accommodating groove part 52 from the portion of the flexible tube portion 28 which continues to the rear end of the bending portion 27 as being circular.

【0072】また、上記吸引チューブ51の横断面形状も円形のものに限るものではなく、半円、扇状、三日月状などの形状として、相手の処置用内視鏡23の横断面形状と組み合わせたときに略円形になるようにしてもかまわない。 [0072] In addition, the cross-sectional shape of the suction tube 51 is not limited to a circular one, semicircular, sectorial, as the shape, such as crescent, in combination with cross-sectional shape of the medical treatment endoscope 23 of the mating it may be set to be substantially circular when.

【0073】さらには処置用内視鏡23の先端部26の横断面形状も円形のものに限るものではなく、前述した図3で示した第3実施形態のもののように半円形状にしたものでも良い。 [0073] Further cross-sectional shape of the distal end portion 26 of the treatment endoscope 23 is not limited to a circular one, those in a semicircular shape as those of the third embodiment shown in FIG. 3 described above But good.

【0074】また、ループ留置具54の代わりに前述したような高周波スネア切開具36を用いて病変部39を焼灼して切除するようにしても良い。 [0074] In addition, it may be cut by cauterizing the lesion 39 using a high frequency snare cutting instrument 36 as described above in place of the loop retaining device 54. 粘膜下の腫瘍や陥凹型の病変部について処置する場合には、予め、処置用内視鏡23を用いて注射器を挿入し、病変部39の下に生理食塩水を注入し、筋層から病変部39を剥離し、病変部39を隆起させておくようにしても良い。 When treating the lesion tumors or depressed type submucosal in advance, and insert the syringe with the medical treatment endoscope 23, physiological saline was injected under the lesion 39, the lesion from the muscle layer the part 39 is peeled off, may be allowed to bulge the lesion 39. また、病変部39が判別し難い揚合は目印をつけておいて病変部39を処置するようにしても良い。 Also, Agego the lesion 39 is hard to determine the may be keep in earmarked treating lesions 39.

【0075】[第5実施形態]図5を参照して本発明の第5実施形態を説明する。 [0075] illustrating the Fifth Embodiment The fifth embodiment of the present invention with reference to FIG.

【0076】(構成)本実施形態では、体腔内の病変部39を引き上げる手段として、上述した第4実施形態の吸引チューブ51の代わりに2番目の処置用内視鏡60 [0076] (Configuration) In this embodiment, as means for raising the lesion 39 in the body cavity, the second in the medical treatment endoscope in place of the suction tube 51 of the fourth embodiment described above 60
を用い、これを一つの処置具ユニットとして上述した第4実施形態の処置用内視鏡23に組み合わせるようにしたものである。 The use, in which it was to combine the medical treatment endoscope 23 of the fourth embodiment described above as one of the treatment tool unit.

【0077】この2番目の処置用内視鏡60は先端部6 [0077] The endoscope 60 for the second treatment tip 6
1と湾曲部62を有する挿入部63を備えてなり、その先端部61の先端面には観察手段の観察レンズ64と照明手段の照明レンズ65とを設け、その観察レンズ64 It includes an insertion portion 63 having one curved portion 62 is provided with an illumination lens 65 of the illumination means and the observation lens 64 of the observation means on the distal end surface of the tip portion 61, the observation lens 64
の後ろの部分には観察手段としてイメージガイドファイバを設け、照明レンズ65の後ろの部分には照明手段としてライトガイドファイバを設ける。 Behind the portion of the image guide fiber is provided as an observation unit, behind the portion of the illumination lens 65 is provided a light guide fiber as illumination means. 上記先端部61の先端面には挿通用チャンネル66の先端を開口し、これにより処置具を突き出すようになっている。 The distal end surface of the tip portion 61 opens the front end of the insertion channel 66, thereby adapted to eject the treatment instrument. つまり、この2番目の処置用内視鏡60も第2実施形態での処置用内視鏡23と同様の直視型内視鏡を構成している。 That constitutes a similar direct-view endoscope and the medical treatment endoscope 23 of this second endoscopic treatment 60 The second embodiment.

【0078】(作用)処置用内視鏡23で真上から体腔内の病変部39を観察しつつ、2番目の処置用内視鏡6 [0078] (action) while observing the lesion 39 in the body cavity from above in the medical treatment endoscope 23, as viewed in a second treatment mirror 6
0で、病変部39を横方向から観察しつつ、両方の処置用内視鏡23,60を用いて各種の処置を行うことができる。 0, while observing the diseased part 39 from the side, both of the medical treatment endoscope 23,60 can perform various treatments using.

【0079】例えば、処置用内視鏡23の挿通用チャンネル42を通じて導入したループ留置具54のループワイヤ55を病変部39のまわりにおき、2番目の処置用内視鏡60の挿通用チャンネル66を通じて挿入したT [0079] For example, the loop wire 55 of the loop retaining device 54 introduced through the insertion channel 42 of the medical treatment endoscope 23 placed around the lesion 39, the second insertion channel 66 of the medical treatment endoscope 60 inserted T through
字形のタグ67を病変部39の壁に貫通させてその病変部39を引き上げ、上記ループ留置具54のループワイヤ55にて病変部39を結紮し、この後、ループワイヤ55を放出してループ留置具54を留置する。 The tag 67 of the shaped is passed through the wall of the lesion 39 pulling the lesion 39, the lesion 39 and ligated in the loop wire 55 of the loop retaining device 54, thereafter, to release the loop wire 55 loops placing a retaining device 54.

【0080】(効果)以上の如く、2つの処置用内視鏡23,60により病変部39を観察しつつ引き上げ具としての第2の処置用内視鏡60を使用するので処置がし易い。 [0080] (Effect) As mentioned above, since the use of the second endoscope 60 for the treatment of a lifting element by endoscope 23,60 for the two treatment while observing the lesion 39 treatment easily.

【0081】もちろん、処置方法は反対の組み合わせ、 [0081] Of course, the method of treatment opposite combination,
つまり、処置用内視鏡23側で引き上げ、2番目の処置用内視鏡60側で結紮して留置するようにしても良い。 In other words, pulling in the medical treatment endoscope 23 side, may be placed was ligated in the second treatment endoscope 60 side.
また、処置部位によっては処置用内視鏡23の観察方向は側方でなくて直視でも良いし、また、2番目の処置用内視鏡60には照明手段を設けなくても内視鏡23の照明手段でカバーできる症例もある。 For the viewing direction of the medical treatment endoscope 23 by treatment site may be a direct vision not laterally, also, a second treatment for endoscope internal to the mirror 60 without providing the illumination means endoscope 23 some cases can be covered by the illumination means. 2番目の処置用内視鏡60は観察手段に固体撮像素子を用いた電子内視鏡としても良い。 Endoscope 60 for the second treatment may be an electronic endoscope using a solid-state imaging device in the observation unit. これらの横断面形状も上記の形状に限るものではない。 These cross-sectional shape is also not limited to the above shape.

【0082】[第6実施形態]図6を参照して本発明の第6実施形態を説明する。 [0082] describing the Sixth Embodiment The sixth embodiment of the present invention with reference to FIG.

【0083】(構成)本実施形態では処置用内視鏡23 [0083] (Configuration) within a treatment vision in this embodiment the mirror 23
の挿入部25の横断面形状が略半円形であり、その先端部26における先端面が45度の斜めにカットされており、この処置用内視鏡23はその観察方向が前方に45 A roughly semi-circular cross-sectional shape of the insertion portion 25, the distal end surface of the tip portion 26 is obliquely cut at 45 degrees, the treatment endoscope 23 is the viewing direction in front 45
度の斜めになっている斜視型のものとなっている。 It has become one of the perspective-type are oblique degrees. 先端部26の斜めの先端面には2つの照明レンズ30と、1 The oblique distal end surface of the distal end portion 26 and the two illumination lenses 30, 1
つの観察レンズ29と、1つの処置具挿通用チャンネル(処置具挿通管路)42の出口が設けられている。 One of the observation lens 29, the outlet of one of the treatment instrument insertion channel (instrument insertion conduit) 42 is provided. 照明レンズ30にはライトガイドファイバー束からなる照明光伝達手段がそれぞれ接続されている。 The illumination lens 30 the illumination light transmitting means comprising a light guide fiber bundle are connected. また、挿通用チャンネル42の先端の出口の内部には処置具起上台43 Further, the inside of the tip of the outlet of the insertion channel 42 raising the treatment instrument elevator 43
が配設されている。 There has been arranged.

【0084】また、本実施形態では上記処置用内視鏡2 [0084] Further, in this embodiment the treatment endoscope 2
3と対を成す湾曲機能付きの自動縫合器70が設けられ、この自動縫合器70の挿入部71は上記処置用内視鏡23の挿入部25の略半円形の横断面形状と対を成す略半円形の横断面形状を持ち、上記器具誘導用案内管2 3 and stapler 70 with a bending function of a pair are provided, the insertion portion 71 of the stapler 70 is a substantially semi-circular cross-sectional shape and a pair of insertion portions 25 of the treatment endoscope 23 substantially it has a semicircular cross-sectional shape, the instrument guiding the guide tube 2
1内にまとめて挿入されるようになっている。 It is adapted to be inserted together in one. つまり、 That is,
処置用内視鏡23の挿入部25と自動縫合器70の挿入部71を組み合わせたときの総和の横断面形状は略円形になり、それらの接合する内側の直線部が近接して比較的密に組み合わせられて上記器具誘導用案内管21内に進退自在に配置され得るようになっている。 Cross-sectional shape of the sum when combining the insertion portion 71 of the insertion portion 25 and the stapler 70 of the medical treatment endoscope 23 is in a substantially circular shape, relatively densely straight portion of the inner to their junction close combined to be adapted to be disposed retractably in the instrument guiding the guide tube 21. しかして、 Thus,
処置用内視鏡23の挿入部25と自動縫合器70の挿入部71を組み合わせたときの総和の円形な横断面形状の外径は上記器具誘導用案内管21の内孔の内径よりも僅かに小さく形成されている。 The outer diameter of the circular cross-sectional shape of the sum when combining the insertion portion 71 of the insertion portion 25 and the stapler 70 of the medical treatment endoscope 23 is slightly larger than the inner diameter of the inner hole of the instrument guiding the guide tube 21 is smaller formed.

【0085】上記自動縫合器70の挿入部71における先端部には開閉自在な一対のジョー72を有した縫合部73が設けられている。 [0085] sewn portion 73 at the distal end portion having a openable pair of jaws 72 in the insertion portion 71 of the stapler 70 is provided. 一対のジョー72はその内側に縫合用ステープル74を装着し、一対のジョー72を閉じて組織部分を挟み込むことにより組織部分をステープル74で縫合するようになっている。 A pair of jaws 72 mounted to suture staples 74 on its inner side, so as to suture the tissue portions in the staple 74 by sandwiching the tissue portion to close the pair of jaws 72. また、一対のジョー72は閉じておくことにより処置用内視鏡23の挿入部25と一緒に上記器具誘導用案内管21内に進退自在に挿入配置することができる。 The pair of jaws 72 can be combined with the insertion portion 25 of the treatment endoscope 23 is retractably inserted in the said instrument guiding the guide tube 21 by keeping closed.

【0086】(作用)処置用内視鏡23により斜め上から体腔内を観察するとき、その視野内に病変部39を捉えたら挿通用チャンネル42を通じて把持鉗子32を挿入し、この把持鉗子32で病変部39を掴む。 [0086] When observing the body cavity obliquely from above by endoscope 23 for (action) treatment, insert the gripping forceps 32 through the insertion channel 42 After capturing the lesion 39 within its field of view, with the grasping forceps 32 grab the lesion 39. この際、 On this occasion,
必要に応じて処置具起上台43を上げ下げ回動して、把持鉗子32による把持位置を調整する。 The treatment instrument elevator base 43 by raising or lowering rotated as needed, to adjust the holding position by the grasping forceps 32. 把持鉗子32で病変部39を掴んだらその把持鉗子32を処置用内視鏡23の先端部26近くまで引き込み、その状態で処置用内視鏡23の湾曲部27を湾曲させることにより病変部39を持ち上げる。 In the grasping forceps 32 Once grabbed lesion 39 pull the grasping forceps 32 to the tip 26 near the medical treatment endoscope 23, the lesion 39 by bending the bending portion 27 of the medical treatment endoscope 23 in this state the lift.

【0087】この際、自動縫合器71の縫合部73の一対のジョー72を開いてその間の位置に病変部39の根元部分を位置させる。 [0087] At this time, by opening a pair of jaws 72 of the suture portion 73 of the stapler 71 to position the root portion of the lesion 39 during position. この後、一対のジョー72の間で病変部39を挟み込み、ステープル74により縫合する。 Thereafter, sandwiched lesion 39 between the pair of jaws 72, sutured staples 74.

【0088】(効果)本実施形態では、斜め上から病変部39の全体像を捉えることができるので、病変部39 [0088] (Effect) In the present embodiment, it is possible to capture the entire image of the lesion 39 from diagonally, lesion 39
の根元部分を縫合する処置の操作がしやすい。 Easy to operation of the treatment suturing root portion of. また、前述したような処置具用案内管24を介さず、直接に器具誘導用案内管21内に自動縫合器70を挿入するようにしたので、比較的大型の自動縫合器70を使用することができる。 Further, without using the treatment instrument guide tube 24 as described above, directly since so as to insert the stapler 70 in the instrument guiding the guide tube 21, the use of relatively large stapler 70 can. さらに、自動縫合器70は異形な大型の横断面形状に形成した湾曲機能付きの処置具であるのが普通であるが、器具誘導用案内管21内に直接挿入するようにしたので、余裕をもって使用することができる。 Furthermore, the automatic suturing device 70 is normal to a curved function of the treatment instrument formed in cross-sectional shape of the profile of large, since to insert directly into the instrument guiding the guide tube 21, with a margin it can be used. その結果、処置範囲を拡大することができる。 As a result, it is possible to expand the treatment range.

【0089】尚、処置用内視鏡23の挿入部25における先端面が45度の斜めにカットしたが、そのカットする角度は45度に限るものではない。 [0089] Incidentally, although the distal end surface of the insertion portion 25 of the treatment endoscope 23 is obliquely cut at 45 degrees, the angle of the cut is not limited to 45 degrees. また、自動縫合器70の代わりに超音波振動切開具、高周波切開ハサミ鉗子、前述した高周波ワイヤ切開具または後述する図10 The ultrasonic vibration cutting instrument in place of the stapler 70, the high-frequency incision scissors forceps, high-frequency wire incision tool or below the aforementioned FIG. 10
に示すような高周波切開具などを用いれば、より広範囲な粘膜の切除が容易である。 The use of such high-frequency surgical tool, such as shown in, it is easy to cut the more extensive mucosal. さらに、縫合器の縫合方向は軸に平行な上記の例に限るものではなく、直角な方向であっても良い。 Furthermore, sutures direction of suturing device is not limited to the example of parallel above the axis, it may be a perpendicular direction.

【0090】[第7実施形態]図7を参照して本発明の第7実施形態を説明する。 [0090] illustrating a seventh embodiment of the present invention with reference to the Seventh Embodiment FIG.

【0091】(構成)本実施形態の処置用内視鏡23はその先端部26のみが比較的径の大きな円形の横断面形状を有するものである。 [0091] (Configuration) medical treatment endoscope 23 of this embodiment is one having a large circular cross-sectional shape of the relatively diameter only the distal end 26. 先端部26の側方部位には観察光学系の観察レンズ29と照明光学系の照明レンズ30 Illumination lens of the side portion of the front end portion 26 and the observation lens 29 of the observation optical system illuminating optical system 30
が設けられており、この観察レンズ29と照明レンズ3 Is provided, the illumination lens 3 and the observation lens 29
0とは円筒形のアクリル樹脂製の透明カバー75によって覆われている。 0 and is covered by a transparent cover 75 made of a cylindrical acrylic resin.

【0092】処置用内視鏡23の先端部26には湾曲部27及び可撓管部28を有してなる細管76が接続されている。 [0092] capillary 76 comprising a curved portion 27 and the flexible tube portion 28 is connected to the distal end portion 26 of the treatment endoscope 23. この細管76は先端部26の径よりも小さい径を有し、その先端は先端部26の中心軸から外れ、先端部26の上周面に一杯の上側にずれて位置し、先端部2 The capillary 76 has a diameter smaller than the diameter of the tip portion 26, the tip thereof away from the center axis of the distal end portion 26, located displaced above the full the peripheral surface on the tip 26, the distal end portion 2
6の後端に接続されている。 It is connected to the 6 rear end of.

【0093】また、処置用内視鏡23の先端部26の後端から細管76を避けた領域には上記同様に湾曲機能を有する処置具用案内管80が配置されるようになっている。 [0093] Further, in a region avoiding the capillary 76 from the rear end of the distal end portion 26 of the treatment endoscope 23 so that the therapeutic-instrument guide tube 80 having the same curved features are located. 処置具用案内管80の上側周面部分には上記細管7 The capillary 7 is an upper peripheral surface portion of the treatment instrument guide tube 80
6を嵌め込み配置するための凹溝部81を処置具用案内管80の長手方向に沿って長く形成してなり、その凹溝部81を含む部分の横断面形状の外形状は、いわゆるそら豆みたいな形になっている。 The groove portion 81 for arranging fitting 6 becomes formed long along the longitudinal direction of the treatment instrument guide tube 80, the outer shape is a so-called broad beans like a form of cross-sectional shape of the portion including the groove portion 81 It has become.

【0094】上記凹溝部81内に細管76を配置するようにして処置用内視鏡23と処置具用案内管80を密に組み合わせたときの総和の横断面形状は略円形になり、 [0094] cross-sectional shape of the sum when the densely combining the treatment instrument guide tube 80 and the medical treatment endoscope 23 so as to place the capillary 76 into the groove portion 81 becomes substantially circular,
両者は上記処置用案内管80内に進退自在に配置される。 Both are arranged to freely advance and retreat in the treatment for guiding tube 80. 上記処置具用案内管80内には同じくそら豆形状の横断面形状を有する2本の処置具挿通用チャンネル82 For two treatment instrument insertion having a cross-sectional shape of the same kidney shape in the therapeutic-instrument guide tube 80 channel 82
が貫通して設けられている。 There has been provided through.

【0095】(作用)処置用内視鏡23の先端部26の後端から細管76を避けた領域に上記処置具用案内管8 [0095] (Operation) above a region except the capillary 76 from the rear end of the distal end portion 26 of the medical treatment endoscope 23 treatment instrument guide tube 8
0を抱き合わせるようにして両者を組み合わせる。 Combining both as tying a 0. そして、両者を器具誘導用案内管21内に挿入して体腔内まで導き入れる。 Then, add lead to the body cavity by inserting both the instrument guiding the guide tube 21. 両者の先端が器具誘導用案内管21の先端から体腔内に突き出したところで、処置具用案内管8 When the both tip protrudes into the body cavity from the distal end of the instrument guiding the guide tube 21, a treatment instrument guide tube 8
0の湾曲部83に湾曲をかけて処置用内視鏡23から分離する。 Over curved bending portion 83 of 0 is separated from the medical treatment endoscope 23.

【0096】そして、図7で示すように処置用内視鏡2 [0096] Then, as viewed in the medical treatment as shown in Figure 7 the mirror 2
3によって病変部39を真上から観察しながら処置具用案内管80の2本の処置具挿通用チャンネル82を通じてそれぞれ挿入した対の処置具で病変部39を処置する。 3 treating lesion 39 in the treatment instrument pairs inserted respectively through the two treatment instrument insertion channel 82 of the treatment instrument guide tube 80 while observing the lesion 39 from directly above by. 例えば、把持鉗子32で病変部39を摘まんで引っ張り上げながら高周波スネア切開具36によって病変部39を切除する。 For example, to ablate lesions 39 by the high-frequency snare incision instrument 36 while pulling up pinching the lesion 39 with the grasping forceps 32.

【0097】(効果)処置用内視鏡23の先端部26の横断面形状が太い径の円形なものであり、湾曲部27及び可撓管部28を有する細管76はそれよりも細い径の円形のものであるため、先端部26に観察光学系と照明光学系の主要部を組み込み、細管76には他の部材を組み込むことにより、特に細管76の構造を簡単にすることができる。 [0097] (Effect) are those cross-sectional shape of the distal end portion 26 of the treatment endoscope 23 is circular larger diameter, capillary 76 having a curved portion 27 and the flexible tube portion 28 of smaller diameter than the because it is a circular, embedded a main part of an observation optical system and the illumination optical system in the distal end portion 26, by incorporating other members in capillary 76, in particular to simplify the structure of the capillary 76. また、細管76の部分の横断面形状が円形なので、その細管76を湾曲する際に偏るなどの乱れた動きを招かない。 Further, since the cross-sectional shape of the portion of the capillary 76 is circular, it does not cause turbulent movement of such biased when bending the capillary 76.

【0098】尚、本実施形態での処置具用案内管80は一本のみを用いる場合として説明したが、2本の処置具用案内管80を用いて処置用内視鏡23の先端部26の後ろに配置するようにしても良い。 [0098] Incidentally, the treatment instrument guiding tube 80 of the present embodiment has been described as a case of using only one, of the medical treatment endoscope 23 using two treatment instrument guide tube 80 distal end 26 it may be arranged behind. この場合、各処置具用案内管80には1本の処置具挿通用チャンネル82を形成するようにしても良い。 In this case, it may be formed of one of the treatment instrument insertion channel 82 in the guide tube 80 for each treatment instrument. また、使用する各処置具の組み合わせもこの例に限るものではなく、例えば、上述したような各種の組み合わせが考えられる。 Also, combinations of the treatment instrument to be used is also not limited to this example, for example, are conceivable various combinations as described above.

【0099】[第8実施形態]図8を参照して本発明の第8実施形態を説明する。 [0099] illustrating the eighth embodiment of the present invention with reference to the Eighth Embodiment FIG.

【0100】(構成)本実施形態では前述した第1実施形態のものと類似するものであるが、その処置機能のある器具が、湾曲機能付きの把持鉗子85と、湾曲機能付きの処置具用案内管86に挿通される処置具、例えば高周波処置具87としたものである。 [0100] While the (Configuration) This embodiment is similar to a that of the first embodiment described above, the instrument with its treatment function is a grasping forceps 85 with bending function, treatment tool with bending function treatment tool to be inserted into the guide tube 86, for example, it is obtained by a high-frequency treatment instrument 87. 上記把持鉗子85のシース88の部分における横断面形状は中心近くの角が鋭角な扇型であり、上記処置具用案内管86の横断面形状は中心近くの角の角度が鈍角な扇型であり、以上の2 The cross-sectional shape in the portion of the sheath 88 of the grasping forceps 85 are corner sharp fan-shaped near the center, the cross-sectional shape of the treatment instrument guide tube 86 at an angle is obtuse circular slice near the corner Yes, more than 2
つの角度を合わせると180度になり、両者を合わせた総和の横断面形状が略半円になるようになっている。 One of aligning the angular When becomes 180 degrees, the cross-sectional shape of the sum of the combined both adapted to be substantially semicircular.

【0101】一方、処置用内視鏡23の横断面形状は略半円であり、この半円と上記処置機能側の半円の両者を合わせると、略円形になり、その円形の外径は上記処置機能部材を挿通する器具誘導用案内管21の内径よりも僅かに小さくなるように形成してある。 [0102] On the other hand, the cross-sectional shape of the medical treatment endoscope 23 is substantially semicircular, combined with both the semicircle of the semicircle and the treatment function side, substantially becomes a circle, the outer diameter of the circular than the inner diameter of the instrument guiding the guide tube 21 for inserting the treatment function member is formed to be slightly smaller. つまり、把持鉗子85と、処置具用案内管86と、処置用内視鏡23の3者を接合して纏めると、器具誘導用案内管21の内孔内に挿通できるように組立てられるように構成されている。 In other words, the grasping forceps 85, the guide tube 86 for the treatment instrument, is summarized by joining the three parties of the medical treatment endoscope 23, as assembled to allow insertion into the bore of the instrument guiding the guide tube 21 It is configured.

【0102】(作用)第1実施形態とは異なり、処置操作はシース88の横断面形状が異形の処置具と、処置具用案内管86に挿通した処置具の組み合わせにより処置する。 [0102] (Function) different from the first embodiment, the treatment operation is the cross-sectional shape of the sheath 88 is treated with a variant of the treatment instrument, the combination of the treatment instrument inserted through the treatment instrument guide tube 86.

【0103】(効果)本実施形態によれば、処置具用案内管を利用して処置具を用いる場合に比べ、大きい処置具を用いて処置することができる。 [0103] (Effects) According to this embodiment, compared with the case of using a treatment instrument using a guide tube for the treatment instrument, it can be treated with a large treatment tool. 従って、大きいポリープ等の処置を容易に行うことが可能になる。 Therefore, it is possible to easily carry out the treatment of large polyp like.

【0104】尚、処置機能を有する側の各部材の抱き合わせたときの総和の横断面形状、及びこれらを挿通する器具誘導用案内管21の横断面形状を真円ではなく、楕円などの非円形(異形)に形成しても良い。 [0104] Note that it is not a perfect circle cross-sectional shape of the total, and the cross-sectional shape of the instrument guiding the guide tube 21 for inserting these when tying members on the side having the treatment function, a non-circular, such as elliptical it may be formed in the (variant).

【0105】[第9実施形態]図9を参照して本発明の第9実施形態を説明する。 [0105] describing the Ninth Embodiment] A ninth embodiment of the present invention with reference to FIG.

【0106】(構成)本実施形態がこれまでの各実施形態のものと異なる点は器具誘導用案内管21の壁部の一部に簡易式の照明手段を組み込むようにしたところにある。 [0106] (Configuration) as differs from the embodiments of the present embodiment is far lies was to incorporate lighting means of the simple type in part of the wall of the device guiding the guide tube 21. この照明手段の照明レンズ90はその器具誘導用案内管21の先端面に設けられている。 An illumination lens 90 of the illumination means is provided on the tip surface of the instrument guiding the guide tube 21. また、照明手段のライトガイドファイバーと小型のハロゲンランプと電池とからなるバッテリーは器具誘導用案内管21の壁部内に内蔵されている。 Further, a battery comprising a light guide fiber and a small halogen lamp and the battery of the illumination means is incorporated in the wall of the instrument guiding the guide tube 21. また、処置用内視鏡23と湾曲機能付きの処置具用案内管24の横断面形状はそれぞれ半円である。 Further, the cross-sectional shape of the medical treatment endoscope 23 and the treatment instrument guiding tube 24 with bending function is semicircular, respectively.

【0107】(作用・効果)このように構成したので、 [0107] (Operation and effect) since it is configured in this manner,
内視鏡の挿入部に沿って体腔内の病変部39近くまで先端を導入された器具誘導用案内管21の照明手段を点灯して病変部39を照明することができる。 It is possible to illuminate the lesion 39 illumination means of the endoscope insertion in a body cavity along a portion lesion 39 is introduced to the tip to near an instrument guiding the guide tube 21 on. また、処置用内視鏡23と湾曲機能付きの処置具用案内管24を抱き合わせて器具誘導用案内管21内に挿入し、その処置用内視鏡23に設けられた挿通用チャンネル42を通して挿入した把持鉗子32で、病変部39を含む体腔壁を引っ張り上げて自動縫合器70で縫合する。 Moreover, tying the medical treatment endoscope 23 and the treatment instrument guiding tube 24 with bending function is inserted into the instrument guiding the guide tube 21, inserted through the insertion channel 42 provided in the treatment endoscope 23 in the grasping forceps 32 which is sutured in stapler 70 is raised to pull the body cavity wall comprising lesion 39. また、処置用内視鏡23と処置具用案内管24を通じて種々の処置具を挿入し、種々の処置を行うことができる。 Moreover, by inserting various treatment instrument through the treatment instrument guiding tube 24 and the medical treatment endoscope 23, it is possible to perform various treatments.

【0108】また、器具誘導用案内管21に照明手段を組み込んだので、処置用内視鏡23の照明手段のライトガイドの本数を削減することが可能になり、処置用内視鏡23の外径を細くすることができる、これにより、間接的且つ相対的に同時に用いる処置具用案内管24自体を太くすることが可能になり、大型の処置具、自動縫合器や超音波振動熱焼灼カッタとかを用いることができるようになる。 [0108] Moreover, since incorporating the illuminating means to the instrument guiding the guide tube 21, it is possible to reduce the light guide number of the lighting means of the medical treatment endoscope 23, the outside of the medical treatment endoscope 23 it is possible to reduce the diameter, thereby, indirectly and relatively becomes possible to thick for the guide tube 24 itself treatment instrument to be used at the same time, a large treatment instrument, stapler and ultrasonic vibration heat ablation cutter Toka will be able to be used.

【0109】本実施形態では器具誘導用案内管21の壁の全てにライトガイドを埋め込むとか、白色のLEDを先端に内蔵するとかして照明手段を構成するようにしても良い。 [0109] Toka embedding a light guide in all walls of the device guiding the guide pipe 21 in the present embodiment, by Toka incorporating a white LED to tip may be configured illumination means. この照明手段の照明光量を上げれば、処置用内視鏡23は観察手段だけでもよく、これによって処置用内視鏡23や処置具用案内管24の更なる細径化やその処置具挿通用チャンネルの径を太くすることができる。 Increasing the amount of illumination light of the illumination means, the treatment endoscope 23 may only observation means, thereby further reduce the diameter of the endoscope 23 and the treatment instrument guiding tube 24 for the treatment and for the treatment instrument insertion it can be thicker diameter of the channel.

【0110】[第10実施形態]図10を参照して本発明の第10実施形態を説明する。 [0110] illustrating a tenth embodiment of the present invention with reference to the Tenth Embodiment] FIG.

【0111】(構成)本実施形態では器具誘導用案内管21に挿入して使用される処置用内視鏡23の先端部2 [0111] (Configuration) tip 2 of the medical treatment endoscope 23 in the present embodiment is used by being inserted into the instrument guiding the guide tube 21
6の形状が、砲弾型形状のものの先端途中から後方部分を斜め45度の角度に切り取って除き、その開いた部分に砲弾型形状の外径より小さい外径を有する円筒状部9 6 the shape of, except from the middle front end of one of the shell-shape cut and rear portion at an angle of 45 ° diagonal, cylindrical portion 9 having an outer diameter smaller than that of the bullet-shaped in its open portion
1を中心を片側に寄せ付けた形に形成したものである。 It is obtained by forming into a form repel center 1 on one side.
先端部26の最大外径は器具誘導用案内管21の内径より僅かに小さく、上記円筒状部91はその最大外径の外形領域内に入り込むように構成されている。 Maximum outer diameter of the tip portion 26 is slightly smaller than the inner diameter of the instrument guiding the guide tube 21, the cylindrical portion 91 is configured so as to enter the outer region of the maximum outer diameter. 2つの外径の差の部分に形成される三日月状の段差面92には観察手段の観察レンズ29と照明手段の照明レンズ30とが後方斜めに向けて配設されている。 The crescent-shaped step surface 92 which is formed in a portion of the difference between the two outer diameter and the illumination lens 30 of the observation lens 29 of the observation unit illuminating means is disposed rearward obliquely.

【0112】この段差に対向する窪み位置にはその段差の三日月形状に近い断面形状のシース93を有する湾曲機能付きの高周波レゼクト処置具94が配置されるようになっている。 [0112] so that the high-frequency Rezekuto treatment instrument 94 with bending function to position the depression facing the step having a sheath 93 of the cross-sectional shape close to a crescent shape of the step is disposed. 高周波レゼクト処置具94はシース93 High frequency Rezekuto treatment instrument 94 sheath 93
の先端に円弧状の高周波ワイヤ95を進退自在に設けられている。 It provided an arcuate RF wire 95 to freely advance and retreat in the tip. また、先端部26は合成樹脂などの絶縁材料で作られている。 The tip portion 26 is made of an insulating material such as synthetic resin.

【0113】(作用)処置用内視鏡23に高周波レゼクト処置具94を抱き合わせてこれらを一緒に上記器具誘導用案内管21内に挿入して使用される。 [0113] (action) is used in tying frequency Rezekuto treatment instrument 94 to the treatment endoscope 23 is inserted into the instrument guiding the guide pipe 21 them together. 例えば、図示しない内視鏡を利用して食道96に器具誘導用案内管2 For example, the endoscope guide instrument induce the esophagus 96 using pipe (not shown) 2
1を挿入し、続いて処置用内視鏡23と高周波レゼクト処置具94を抱き合わせてこれらを一緒に上記器具誘導用案内管21内に挿入し、体腔内に突き出して病変部3 1 Insert, followed by tying the endoscope 23 and the high-frequency Rezekuto treatment instrument 94 for the treatment is inserted into the instrument guiding the guide pipe 21 them together, lesion 3 protrudes into the body cavity
9を確認する。 9 to confirm. 病変部39を確認したら処置用内視鏡2 After reviewing the lesion 39 within the medical treatment endoscope 2
3で後方を観察しながら食道96と胃97の境界の噴門部98に生じた病変部39(例えばバレット上皮や腫瘍)に対して円弧状の高周波ワイヤ95に通電しながら当てて引き上げることで、病変部39の組織を削ぎ落とす。 Raising against while energizing the arc-shaped high-frequency wire 95 to the lesion part 39 generated in the cardia 98 of the boundary between the esophagus 96 and stomach 97 while observing the rear (e.g. Barrett epithelial or tumor) in 3, I scraped off the tissue of the lesion 39.

【0114】(効果)もともと、噴門部98の所は狭まっているために観察が難しく、病変部39を見落としがちであった。 [0114] (effect) originally, it is difficult to observe in order to place the cardia 98 is narrowed, it tended to overlook the lesion 39. また、逆流性食道炎やバレット上皮という、噴門部98の内面の粘膜の病気が増えているが、その観察/処置が難かった。 Further, as reflux esophagitis or Barrett's epithelium, the inner surface of the mucosal diseases cardia 98 is increasing, the observation / treatment were stiff. 従来、内視鏡先端を胃97内に挿入し、内視鏡先端に湾曲を180度以上かけた状態で噴門部98の胃97側から見上げる状態で観察していたが、この方法では胃97側しか見えないし、処置をするにも内視鏡挿入部が邪魔になる。 Conventionally, to insert the endoscope distal end within the stomach 97, had been observed in a state looking up from 97 side stomach cardia 98 while applying the endoscope tip curved over 180 °, in this way the stomach 97 it only see the side, the endoscope insertion portion in the treatment in the way. 湾曲を180度以上にすると、先端部26がふらつくため、処置具が狙い通りに病変部39を捉えられないなどの欠点があった。 If curved beyond 180 degrees, the tip portion 26 fluctuates, the treatment instrument has a drawback such as not capturing the lesion 39 as aimed.

【0115】また、食道96側から観察方向が前方の、 [0115] Also, from the esophagus 96 side viewing direction is forward,
いわゆる直視型内視鏡で、観察/処置をしようとすると、噴門部98が閉じているので、押し広げながらの観察になる。 In so-called direct-view type endoscope, an attempt to observation / treatment, since cardia 98 is closed, the observation while spread. 内壁と先端が密着しているので、俗に言うところの赤玉状態になり、狭い範囲の観察しかできない。 Since the inner wall and the tip is in close contact, becomes red ball state of commonly called place, can only narrow range of observation.
噴門部98の近くにおいても、内壁は横からの観察と処置になるので病変部39を確実に捉えることができず、 In near cardia 98 also, the inner wall can not capture the lesion 39 reliably since the observation and treatment from the side,
処置がやりにくかった。 Treatment it was difficult to do. また、斜視型や側視型の内視鏡では観察は容易になるのであるが、内視鏡の処置具挿通用チャンネルの出口に設けた鉗子起上台を操作して、処置具を観察方向に曲げることになり、処置具の動きは内壁に沿って病変部39を削ぎ取るような動きにはならなかった。 Further, although the endoscope perspective-type or side-view type is become easy observation, by operating the forceps raiser stand provided at the outlet of the treatment instrument insertion channel of an endoscope, a viewing direction of the procedure instrument it becomes the bend, the movement of the treatment instrument had the movements take stripped lesions 39 along the inner wall. また、処置具挿通用チャンネルを通じて挿入することができる処置具は細く腰がないため、内壁を十分に捉えることは難しかった。 Moreover, since there is no treatment tool thin waist can be inserted through the treatment instrument insertion channel, to capture the inner wall sufficiently is difficult.

【0116】しかし、本実施形態では、観察方向をこれまでにない後方斜視にし、処置用内視鏡23の先端部2 [0116] However, in the present embodiment, the viewing direction with no rear perspective ever, the medical treatment endoscope 23 tip 2
6と上記器具誘導用案内管21を用いて噴門部98を押し広げることによって、これまで、観察や処置が難かった噴門部98の胃97側から食道96側を一度に観察と処置ができる。 By pushing the cardia 98 with 6 and the instrument guiding the guide tube 21, which until the esophagus 96 side can observe the treatment at a time from the 97 side stomach cardia 98 observation or treatment was stiff. また、処置具と処置用内視鏡23を同時に引きながら徐々に処置することで、病変部39を近くで観察しながら確実に処置することができるようになった。 In addition, by gradually treating while pulling the medical treatment endoscope 23 and the treatment instrument at the same time, it has become possible to reliably treat while observing the lesion 39 in the vicinity.

【0117】また、処置具と処置用内視鏡23が独立しているので、処置用内視鏡23の先端は固定して、病変部39を定点観察しつつ、処置具を曲げて食道96の内壁に沿うように引き動かすことができる。 [0117] Also, since the endoscope 23 for the treatment and the treatment instrument are independent, the tip of the medical treatment endoscope 23 is fixed, while the lesion 39 and fixed point observation, bending the treatment instrument esophagus 96 it can be moved pulling along the inner wall.

【0118】バレット上皮の場合、治療は全周を削ぎ落とすことになるが、内視鏡の処置具挿通用チャンネルを通しての処置具であると、シースが細いので腰が弱く、 [0118] When the Barrett epithelium, treatment is thus scraped off the entire circumference, if it is the treatment instrument through the treatment instrument insertion channel of an endoscope, weak waist because the sheath is thin,
先端が大きくできないので、処置する面積が少なくなり、全周を処置するには何回も繰り返して、処置をする必要があり、面倒であった。 Since the tip can not be increased, the area to be treated is reduced, to treat the entire circumference is repeated many times, it is necessary to the treatment, it was troublesome. しかし、本実施形態では処置具、特に高周波ワイヤ95の部分を長くできるので、 However, the treatment instrument in the present embodiment, particularly the portion of the high-frequency wire 95 can be made longer,
全周を処置する回数が少なくできる。 Number of times to treat the entire circumference can be reduced.

【0119】この他に、同様に狭まっている幽門部の観察/処置も可能である。 [0119] In addition, the observation / treatment of pyloric portion which narrows in the same manner is also possible. 十二指腸の狭窄部なども考えられる。 Such as stenosis of the duodenum are also contemplated.

【0120】尚、本実施形態の段差面92の部分のカットの角度を変えるか、光学系を変えることによって、後方斜視の角度を30度や60度などしても良い。 [0120] Incidentally, either changing the angle of the cut portion of the stepped surface 92 of the present embodiment, by changing the optical system, the angle of the rear perspective may be such as 30 degrees or 60 degrees. また、 Also,
器具誘導用案内管21の先端を斜めにカットし、短い側を処置操作に用いるようにしても良い。 The tip of the instrument guiding the guide tube 21 is obliquely cut, may be used a short side in the treatment operation. さらに、使用する処置具としては上述したものの他に、アルゴンプラズマレーザーや、ローラーによる高周波焼灼具等であっても良い。 Furthermore, in addition to the examples of the treatment instrument to be used above, and argon plasma laser may be a high-frequency cautery device due rollers.

【0121】さらには器具誘導用案内管21に挿入する処置用内視鏡は固体撮像素子が大きく、観察能力に優れた内視鏡が適しているので、固体撮像素子を内蔵する先端部分については大きな円形の横断面形状とし、これに比べて湾曲部や挿入部は非円形の小さな横断面形状のものとしても良い。 [0121] Further medical treatment endoscope to be inserted into the instrument guiding the guide pipe 21 is larger solid-state imaging device, since the endoscope with excellent observation capability is suitable for the tip portion having a built-in solid-state imaging device a large circular cross-sectional shape, the bending portion and the insertion portion than to this may be as small cross-sectional shape of the non-circular.

【0122】また、前述した実施形態では上記器具誘導用案内管の内孔及びこれに入れる器具の組み合わせた全体の横断面形状が略円形であったが、本発明ではそれに限らず、楕円や長円または他の形状のものであっても良い。 [0122] Also, although the cross-sectional shape of the whole in the embodiments described above in combination of bore and instruments Add to this the instrument guiding the guide tube is a generally circular, the present invention is not limited to this, ellipse or the length it may be of a circle or other shape.

【0123】処置用内視鏡と処置ユニットの個別の進退をより円滑にするために、それぞれを滑り性に優れる材料を用いるとか、外表面に滑り性の良いコートをするようにしてもよい。 [0123] In order to separate forward and backward of the treatment unit and the medical treatment endoscope more smoothly, Toka a material excellent in sliding property, respectively, may be a good coating slip property on the outer surface. また、処置用内視鏡と処置ユニット器具を挿入する案内管の内面に同様のコートを施しても良い。 It may also be subjected to the same coating on the inner surface of the guide tube for inserting a treatment unit device and the medical treatment endoscope.

【0124】<付記> 1. [0124] <note> 1. 体腔内に挿入される器具誘導用案内管と、上記器具誘導用案内管の内孔に進退自在に挿入される少なくとも一つの処置用内視鏡と、上記器具誘導用案内管の内孔に進退自在に挿入される少なくとも一つの処置具ユニットとを具備してなり、上記内視鏡と上記処置具ユニットのうち少なくとも一つのものの横断面の外形状が上記器具誘導用案内管の内孔の径よりもわずかに小さい径の弧の部分を持ち、上記内視鏡と上記処置具ユニットを組み合わせて上記器具誘導用案内管に入れる際にその組み合わせた全体の横断面の外形状が上記器具誘導用案内管の内孔の径よりわずかに小さい径を有する形状になるように構成したことを特徴とする内視鏡治療装置。 An instrument guiding guide tube to be inserted into a body cavity, back and forth in at least the one endoscopic treatment, the inner hole of the instrument guiding guide tube being inserted retractably into the inner hole of the instrument guiding guide tube it comprises a at least one treatment tool unit is inserted freely, at least one outer cross-sectional shape of one of the inner hole of the instrument guiding the guide tube diameter of the endoscope and the treatment tool unit It has a slightly portion of smaller diameter of the arc than, for outer shape induces the instrument of the cross-section of the overall combination thereof when placed in the guide tube for inducing the instrument by combining the endoscope and the treatment tool unit endoscopic treatment apparatus characterized by being configured as a shape having a slightly smaller diameter than the diameter of the bore of the guide tube.

【0125】2. [0125] 2. 体腔内に上記器具誘導用案内管を誘導するための第2の内視鏡を備えた第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1 comprising a second endoscope for guiding the instrument guiding the guide tube into the body cavity. 3. 3. 内視鏡と処置具ユニットの少なくとも一方における一部の横断面形状を、一部に円弧を有する非円形の形状にすると共に、この円弧の径を器具誘導用案内管の内孔の半径より僅かに小さくし、かつその円弧の部分を外側になるようにして上記内視鏡と処置具ユニットを組み合わせたときの全体の横断面形状が略円形になることを特徴とする内視鏡治療装置。 Some of the cross-sectional shape in at least one of the treatment tool unit and an endoscope, as well as the non-circular shape with a circular arc part, just the diameters of the arc than the radius of the inner hole of the instrument guiding guide tube the small and, and endoscopic treatment device, characterized in that the entire cross-sectional shape is substantially circular when combined treatment instrument unit portion of the arc and so as to be outside the endoscope.

【0126】4. [0126] 4. 内視鏡と処置具ユニットの少なくとも一方における一部の横断面形状の非円形の形状は円弧と別の曲線との組み合わせた形であることを特徴とする第3項に記載の内視鏡治療装置。 Non-circular shape of the portion of the cross-sectional shape in at least one of the treatment tool unit and the endoscope is endoscope according to paragraph 3, characterized in that the form of a combination of a circular arc and another curve treatment apparatus. 5. 5. 非円形の形状が、円弧と直線との組み合わせた略扇形状であることを特徴とする第3項に記載の内視鏡治療装置。 Non-circular shape, the endoscope treatment system according to paragraph 3, characterized in that a substantially fan shape in combination of a circular arc and a straight line.

【0127】6. [0127] 6. 内視鏡と処置具ユニットの断面形状が共に略半円であり、内視鏡と処置具ユニットを組み合わせたときの全体の断面形状が共に略円であることを特徴とする第1項に記載の内視鏡治療装置。 A substantially semicircular both the cross-sectional shape of the endoscope and the treatment tool unit, according to paragraph 1, wherein the overall cross-sectional shape when combined treatment instrument unit and an endoscope is substantially yen both endoscopic treatment apparatus. 7. 7. 内視鏡と処置具ユニットの断面形状が共に略扇形であることを特徴とする第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1, wherein the cross-sectional shape of the treatment tool unit and the endoscope is substantially sector together. 8. 8. 処置具ユニットは湾曲機能を具備してなることを特徴とする第1項に記載の内視鏡治療装置。 Treatment instrument unit endoscopic treatment system according to paragraph 1 characterized by comprising comprises a bending function.

【0128】9. [0128] 9. 処置具ユニットは湾曲機能を具備してなる処置具用案内管を有するものであることを特徴とする第1項に記載の内視鏡治療装置。 Treatment instrument unit endoscopic treatment system according to paragraph 1, characterized in that those having a treatment instrument guiding tube made comprises a bending function. 10. 10. 処置具ユニットが少なくとも2本以上のものからなることを特徴とする第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1 in which the treatment tool unit is characterized in that it consists of at least two or more. 11. 11. 処置具用案内管の少なくとも一部に湾曲機能を設けたことを特徴とする第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1, characterized in that a bending function to at least a portion of the treatment instrument guide tube.

【0129】12. [0129] 12. 少なくとも処置具ユニットの一本が処置具であり、もう一本が処置具挿通案内管であることを特徴とする第1項に記載の内視鏡治療装置。 A single at least the treatment instrument unit treatment instrument, an endoscope treatment system according to paragraph 1, wherein the other one is a treatment instrument insertion guide tube. 13. 13. 内視鏡が処置具挿通管路を具備することを特徴とする第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1 in which an endoscope is characterized by comprising a treatment instrument insertion conduit. 14. 14. 処置具用案内管は少なくとも一つ以上の処置具挿通管路を有することを特徴とする第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1 treatment instrument guide tube, characterized in that it comprises at least one or more instrument insertion conduit.

【0130】15. [0130] 15. 器具誘導用案内管は照明手段を有することを特徴とする第1項に記載の内視鏡治療装置。 The endoscope treatment system according to paragraph 1, characterized in that it comprises a lighting means fixture guiding the guide tube. 16. 16. 器具誘導用案内管の内面、その器具誘導用案内管に挿入する部分の処置具ユニットの外面、器具誘導用案内管に挿通する第2の内視鏡の外面に潤滑処理を施したことを特徴とする第1項に記載の内視鏡治療装置。 The inner surface of the instrument guiding the guide tube, the outer surface of the treatment tool unit of the portion to be inserted into the guide tube for the appliance induction characterized in that subjected to lubrication processing to the outer surface of the second endoscope inserted through the guide tube instrument induction the endoscope treatment system according to paragraph 1 to. 17. 17. 器具誘導用案内管の先端と、器具誘導用案内管に挿通される内視鏡の先端が斜めに切断された形状に形成されていることを特徴とする第1項に記載の内視鏡治療装置。 And the tip of the instrument guiding the guide tube, the endoscope treatment according to paragraph 1, wherein a distal end of an endoscope inserted through the guide tube instrument induction is formed in a shape that is obliquely cut apparatus.

【0131】18. [0131] 18. 器具誘導用案内管に挿通される内視鏡の観察方向が側視であることを特徴とする第1,2項に記載の内視鏡治療装置。 The endoscope treatment system according to the first and second paragraph of the viewing direction of the endoscope inserted through the guide tube instrument induction, characterized in that a side view. 19. 19. 器具誘導用案内管に挿通される内視鏡の観察方向は後方斜視であることを特徴とする第2項に記載の内視鏡治療装置。 The endoscope treatment system of the observation direction of the endoscope inserted through the guide tube instrument derived according to paragraph 2, which is a rear perspective. 20. 20. 器具誘導用案内管に挿通される内視鏡の観察方向は前方斜視であることを特徴とする第2項に記載の内視鏡治療装置。 The endoscope treatment system according to the second term observation direction of the endoscope inserted through the guide tube instrument induction, which is a front perspective view. 21. 21. 器具誘導用案内管に挿通される内視鏡は処置具挿通用チャンネルを具備し、その内視鏡の先端部の処置具挿通用チャンネルの先端開口部に処置具の起上手段を有することを特徴とする第2項に記載の内視鏡治療装置。 The endoscope is inserted through the guide tube instrument induce comprises a channel for treatment tool insertion, to have a raising means of the treatment instrument to the distal end opening portion of the treatment instrument insertion channel of the distal portion of the endoscope the endoscope treatment system according to paragraph 2, wherein.

【0132】 [0132]

【発明の効果】以上説明したように本発明によれば、体腔内の病変部近くまで導き入れた器具誘導用案内管内に少なくとも一つの内視鏡と少なくとも一つの処置具ユニットを抱き合わせて後入れして用いることができるので、従来の場合よりも処置がし易くなる。 According to the present invention described above, according to the present invention, tying at least one treatment tool units at least one of the endoscope and the lesion instrument guiding guide tube placed led to near the body cavity last- since it is possible to use it, it tends to be treated than in conventional. すなわち、処置用内視鏡と処置具ユニットを独立させて、別個に操作可能とすることで、広範な病変部を遠目から観察しつつ、必要ならば大型の処置具でもって処置することが可能である。 That is, by independent treatment tool unit and the medical treatment endoscope, separately that it allows operation, while observing a wide range of lesions from a long distance, can be treated with a large treatment instrument if necessary it is. 大型の処置具を用いることにより大きな病変を一括して切除できるし、広域な病変部や深く浸潤した病変部の切除を少ない回数で短時間で実施できるなどの利点がある。 It can be cut at once a large lesion by using a large treatment tool, there are advantages such as can be performed in a short time with a small number resection of broad lesions and deeply infiltrating lesions. 部分切除でないと、切断面が少ない標本が得られ、切除標本の病理検査がやり易い。 If not resected specimen cut surface is small is obtained easily spear pathological examination of the resected specimen. その上に、出血が少なく、ガンなどの腫瘍の場合、拡散転移を防ぐことができる。 Thereon, bleeding less in the case of tumors such as cancer, it is possible to prevent diffusion transfer.

【0133】また、器具誘導用案内管とこれに挿通する処置用内視鏡と各種の処置具ユニットを様々な形態で組み合わせて構成することにより、体腔内で、従来よりも、広範な病変部の処置状況の全体を観察しながら適切な手術を容易かつ迅速に行うことができるようになる。 [0133] Further, by forming a combination of the medical treatment endoscope and various treatment instruments unit inserted to the instrument guiding the guide tube in various forms, in the body cavity than conventional, extensive lesions appropriate surgery while observing the entire treatment conditions it is possible to perform easily and quickly the.

【0134】さらに、本発明では少なくともどちらかの器具の横断面形状を円形以外のものにして複数の器具を組み合わせるので、双方の器具を極力細くしないように構成することができる。 [0134] Further, since the cross-sectional shape of at least one of the instruments in the present invention with those of non-circular combining multiple instruments can be configured both instruments to avoid as much as possible narrow.

【0135】また、器具誘導用案内管の端部を病変部近くに保持するようにすれば、これまで、直視の内視鏡では側方からのアプローチしか出来なかった部位についても、例えば、後入れの内視鏡の観察方向を側視にするなどにより、病変部の上からのアプローチができるようになり処置がし易くなる。 [0135] Further, if the end portion of the instrument guiding the guide tube to retain near the lesion, to date, for the sites in direct the endoscope could only approach from the side, for example, after due to the viewing direction of the endoscope placed in a side view, easily becomes treated to allow approach from above the lesion.

【図面の簡単な説明】 BRIEF DESCRIPTION OF THE DRAWINGS

【図1】第1実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 1 is a perspective view showing a use state of the endoscope treatment system according to the first embodiment.

【図2】第2実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 2 is a perspective view showing a use state of the endoscope treatment system according to the second embodiment.

【図3】第3実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 3 is a perspective view showing a use state of the endoscope treatment system according to a third embodiment.

【図4】第4実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 4 is a perspective view showing a use state of the endoscope treatment system according to a fourth embodiment.

【図5】第5実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 5 is a perspective view showing a use state of the endoscope treatment system according to a fifth embodiment.

【図6】第6実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 6 is a perspective view showing a use state of the endoscope treatment system according to a sixth embodiment.

【図7】第7実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 7 is a perspective view showing a use state of the endoscope treatment system according to a seventh embodiment.

【図8】第8実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 8 is a perspective view showing a use state of the endoscope treatment system according to the eighth embodiment.

【図9】第9実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 9 is a perspective view showing a use state of the endoscope treatment system according to a ninth embodiment.

【図10】第10実施形態に係る内視鏡治療装置の使用状態を示す斜視図。 Figure 10 is a perspective view showing a use state of the endoscope treatment system according to a tenth embodiment.

【図11】従来の内視鏡治療装置の使用状態を示す斜視図。 Figure 11 is a perspective view showing a use state of a conventional endoscopic treatment device.

【図12】従来の内視鏡治療装置の使用状態を示す斜視図。 Figure 12 is a perspective view showing a use state of a conventional endoscopic treatment device.

【符号の説明】 DESCRIPTION OF SYMBOLS

21…器具誘導用案内管、23…処置用内視鏡、24… 21 ... instrument guiding the guide tube, endoscope for 23 ... treatment, 24 ...
処置具用案内管、39…病変部、32…把持鉗子、36 Treatment instrument guide tube, 39 ... lesion, 32 ... grasping forceps, 36
…高周波スネア切開具、35…処置具ユニット、37… ... high-frequency snare surgical tool, 35 ... treatment instrument unit, 37 ...
処置具ユニット、38…胃、39…病変部。 Treatment tool unit, 38 ... stomach, 39 ... lesions.

Claims (1)

    【特許請求の範囲】 [The claims]
  1. 【請求項1】体腔内に挿入される器具誘導用案内管と、 上記器具誘導用案内管の内孔に進退自在に挿入される少なくとも一つの処置用内視鏡と、 上記器具誘導用案内管の内孔に進退自在に挿入される少なくとも一つの処置具ユニットとを具備してなり、 上記内視鏡と上記処置具ユニットのうち少なくとも一つのものの横断面の外形状が上記器具誘導用案内管の内孔の寸法よりもわずかに小さい径の弧の部分を持ち、上記内視鏡と上記処置具ユニットを組み合わせて上記器具誘導用案内管に入れる際にその組み合わせた全体の横断面の最長寸法が上記器具誘導用案内管の内孔の径よりわずかに小さい寸法を有する形状になるように構成したことを特徴とする内視鏡治療装置。 1. A and the instrument guiding guide tube to be inserted into a body cavity, at least a one endoscopic procedure, the guide tube for inducing the instrument inserted retractably into the inner hole of the instrument guiding guide tube at least one result comprises a surgical instrument unit, at least one outer shape guide tube for inducing the instrument of the cross-section of one of the above endoscope and the treatment tool unit is inserted retractably into the inner hole of longest dimension inner has a portion of the arc of slightly less diameter than the size of the hole, the cross section of the whole in combination thereof when placed in the guide tube for inducing the instrument by combining the endoscope and the treatment tool unit There endoscopic treatment apparatus characterized by being configured as a shape having a slightly smaller than the diameter of the inner hole of the guide tube for inducing the instrument.
JP34957498A 1998-12-09 1998-12-09 Endoscopic treatment device Expired - Fee Related JP4242491B2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP34957498A JP4242491B2 (en) 1998-12-09 1998-12-09 Endoscopic treatment device

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
JP34957498A JP4242491B2 (en) 1998-12-09 1998-12-09 Endoscopic treatment device

Publications (2)

Publication Number Publication Date
JP2000166936A true JP2000166936A (en) 2000-06-20
JP4242491B2 JP4242491B2 (en) 2009-03-25

Family

ID=18404640

Family Applications (1)

Application Number Title Priority Date Filing Date
JP34957498A Expired - Fee Related JP4242491B2 (en) 1998-12-09 1998-12-09 Endoscopic treatment device

Country Status (1)

Country Link
JP (1) JP4242491B2 (en)

Cited By (35)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002186579A (en) * 2000-12-22 2002-07-02 Olympus Optical Co Ltd Auxiliary device for endoscope insertion
JP2003033315A (en) * 2001-07-23 2003-02-04 Olympus Optical Co Ltd Endoscope
JP2005296412A (en) * 2004-04-13 2005-10-27 Olympus Corp Endoscopic treatment apparatus
JP2006516910A (en) * 2003-01-15 2006-07-13 ユーエスジーアイ メディカル, インコーポレイテッド Endoluminal tool deployment system
JP2006223358A (en) * 2005-02-15 2006-08-31 National Cancer Center-Japan Apparatus and system for object internal treatment
WO2007078003A1 (en) * 2006-01-06 2007-07-12 Olympus Medical Systems Corp. Trans-natural opening based or transcutaneous medical system
JP2008125819A (en) * 2006-11-21 2008-06-05 Kobe Univ Over-tube
JP2008173369A (en) * 2007-01-22 2008-07-31 Olympus Medical Systems Corp Treatment tool for endoscope
JP2008536552A (en) * 2005-04-11 2008-09-11 ユーエスジーアイ メディカル インク. Method and apparatus for off-axis visualization
JP2009022764A (en) * 2004-08-12 2009-02-05 Hansen Medical Inc Robot control intravascular tissue injection system
US7637919B2 (en) 2002-01-30 2009-12-29 Olympus Corporation Anastomosis system for performing anastomosis in body
JPWO2009016834A1 (en) * 2007-07-30 2010-10-14 小山 勇 Oral digestive organ surgical device
JP2011087647A (en) * 2009-10-20 2011-05-06 Hoya Corp Overtube for treatment, and treatment system
EP2004032B1 (en) * 2006-03-22 2011-05-11 Boston Scientific Limited Endoscope working channel with multiple functionality
JP2011527199A (en) * 2008-07-11 2011-10-27 ソシエダーデ ベネフィセンテ デ センオラス オスピタル シリオ リバネス Surgical endoscope
WO2012032935A1 (en) * 2010-09-09 2012-03-15 オリンパス株式会社 Image pickup device, endoscope tip section provided with the image pickup device, and endoscope tip unit
JP2012161506A (en) * 2011-02-08 2012-08-30 Seiko Epson Corp Liquid ejecting apparatus
JP2012245161A (en) * 2011-05-27 2012-12-13 Olympus Corp Endoscope apparatus
WO2012172739A1 (en) * 2011-06-16 2012-12-20 Sakurazawa Nobuyuki Illumination suction injection exclusion cylinder for endoscopic surgery forceps
JP2013150833A (en) * 2006-06-13 2013-08-08 Intuitive Surgical Inc Minimally invasive surgical system
US8753262B2 (en) 2003-07-29 2014-06-17 Hoya Corporation Internal treatment apparatus having circumferential side holes
WO2014092197A1 (en) * 2012-12-11 2014-06-19 Olympus Corporation Endoscopic device and method of controlling endoscopic device
US9039685B2 (en) 2005-12-30 2015-05-26 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US9179832B2 (en) 2008-06-27 2015-11-10 Intuitive Surgical Operations, Inc. Medical robotic system with image referenced camera control using partitionable orientational and translational modes
US9387048B2 (en) 2011-10-14 2016-07-12 Intuitive Surgical Operations, Inc. Catheter sensor systems
JP2016526397A (en) * 2013-06-09 2016-09-05 マクロプラタ、インコーポレイテッドMacroplata,Inc. Multilumen catheter retractor system for gastrointestinal treatment by minimally invasive surgery
WO2016143143A1 (en) * 2015-03-12 2016-09-15 学校法人慶應義塾 Treatment-instrument insertion aid
WO2016143142A1 (en) * 2015-03-12 2016-09-15 学校法人慶應義塾 Treatment-instrument insertion aid
US9452276B2 (en) 2011-10-14 2016-09-27 Intuitive Surgical Operations, Inc. Catheter with removable vision probe
US9486123B2 (en) 2011-05-27 2016-11-08 Olympus Corporation Endoscope system which enlarges an area of a captured image, and method for operating endoscope system
EP1906858B1 (en) * 2005-07-01 2016-11-16 Hansen Medical, Inc. Robotic catheter system
US9757149B2 (en) 2006-06-13 2017-09-12 Intuitive Surgical Operations, Inc. Surgical system entry guide
US9962066B2 (en) 2005-12-30 2018-05-08 Intuitive Surgical Operations, Inc. Methods and apparatus to shape flexible entry guides for minimally invasive surgery
WO2018229983A1 (en) * 2017-06-16 2018-12-20 オリンパス株式会社 Endoscope and endoscope system
US10238837B2 (en) 2011-10-14 2019-03-26 Intuitive Surgical Operations, Inc. Catheters with control modes for interchangeable probes

Cited By (75)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002186579A (en) * 2000-12-22 2002-07-02 Olympus Optical Co Ltd Auxiliary device for endoscope insertion
JP4678942B2 (en) * 2000-12-22 2011-04-27 オリンパス株式会社 The endoscope insertion assisting device
JP2003033315A (en) * 2001-07-23 2003-02-04 Olympus Optical Co Ltd Endoscope
JP4594560B2 (en) * 2001-07-23 2010-12-08 オリンパス株式会社 Endoscope
US7637919B2 (en) 2002-01-30 2009-12-29 Olympus Corporation Anastomosis system for performing anastomosis in body
US7918845B2 (en) 2003-01-15 2011-04-05 Usgi Medical, Inc. Endoluminal tool deployment system
JP2006516910A (en) * 2003-01-15 2006-07-13 ユーエスジーアイ メディカル, インコーポレイテッド Endoluminal tool deployment system
US8753262B2 (en) 2003-07-29 2014-06-17 Hoya Corporation Internal treatment apparatus having circumferential side holes
US8221306B2 (en) 2004-04-13 2012-07-17 Olympus Corporation Endoscope therapeutic device
JP2005296412A (en) * 2004-04-13 2005-10-27 Olympus Corp Endoscopic treatment apparatus
JP2009022764A (en) * 2004-08-12 2009-02-05 Hansen Medical Inc Robot control intravascular tissue injection system
JP2006223358A (en) * 2005-02-15 2006-08-31 National Cancer Center-Japan Apparatus and system for object internal treatment
JP4592007B2 (en) * 2005-02-15 2010-12-01 Hoya株式会社 Within the object treating device and the object inside the treatment system
JP2008536552A (en) * 2005-04-11 2008-09-11 ユーエスジーアイ メディカル インク. Method and apparatus for off-axis visualization
EP1906858B1 (en) * 2005-07-01 2016-11-16 Hansen Medical, Inc. Robotic catheter system
US9125679B2 (en) 2005-12-30 2015-09-08 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US9962066B2 (en) 2005-12-30 2018-05-08 Intuitive Surgical Operations, Inc. Methods and apparatus to shape flexible entry guides for minimally invasive surgery
US9039685B2 (en) 2005-12-30 2015-05-26 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US9883914B2 (en) 2005-12-30 2018-02-06 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US9066739B2 (en) 2005-12-30 2015-06-30 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US9101380B2 (en) 2005-12-30 2015-08-11 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber Bragg gratings
US9241769B2 (en) 2005-12-30 2016-01-26 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US9060793B2 (en) 2005-12-30 2015-06-23 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensor using fiber bragg gratings
US9526583B2 (en) 2005-12-30 2016-12-27 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber Bragg gratings
US9084624B2 (en) 2005-12-30 2015-07-21 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US8475361B2 (en) 2006-01-06 2013-07-02 Olympus Medical Systems Corp. Percutaneous or natural-orifice medical procedure and system therefor
WO2007078003A1 (en) * 2006-01-06 2007-07-12 Olympus Medical Systems Corp. Trans-natural opening based or transcutaneous medical system
JP4898709B2 (en) * 2006-01-06 2012-03-21 オリンパスメディカルシステムズ株式会社 After natural orifice or transdermal medical system
EP2004032B1 (en) * 2006-03-22 2011-05-11 Boston Scientific Limited Endoscope working channel with multiple functionality
US9510734B2 (en) 2006-06-13 2016-12-06 Intuitive Surgical Operations, Inc. Side looking minimally invasive surgery instrument assembly
JP2014054534A (en) * 2006-06-13 2014-03-27 Intuitive Surgical Inc Minimally-invasive surgical system
JP2014054535A (en) * 2006-06-13 2014-03-27 Intuitive Surgical Inc Minimally-invasive surgical system
JP2014057851A (en) * 2006-06-13 2014-04-03 Intuitive Surgical Inc Minimally invasive surgery system
JP2014057850A (en) * 2006-06-13 2014-04-03 Intuitive Surgical Inc Minimally invasive surgery system
JP2014057849A (en) * 2006-06-13 2014-04-03 Intuitive Surgical Inc Minimally invasive surgery system
JP2014057853A (en) * 2006-06-13 2014-04-03 Intuitive Surgical Inc Minimally invasive surgery system
US20150250546A1 (en) * 2006-06-13 2015-09-10 Intuitive Surgical Operations, Inc. Minimally invasive surgical system
JP2014028228A (en) * 2006-06-13 2014-02-13 Intuitive Surgical Inc Minimally invasive surgical system
JP2013150833A (en) * 2006-06-13 2013-08-08 Intuitive Surgical Inc Minimally invasive surgical system
US9549663B2 (en) 2006-06-13 2017-01-24 Intuitive Surgical Operations, Inc. Teleoperated surgical retractor system
US9060678B2 (en) 2006-06-13 2015-06-23 Intuitive Surgical Operations, Inc. Minimally invasive surgical system
US9757149B2 (en) 2006-06-13 2017-09-12 Intuitive Surgical Operations, Inc. Surgical system entry guide
JP2015147059A (en) * 2006-06-13 2015-08-20 インテュイティブ サージカル インコーポレイテッド surgical instrument assembly
US9980630B2 (en) * 2006-06-13 2018-05-29 Intuitive Surgical Operations, Inc. Minimally invasive surgical system
US9320416B2 (en) 2006-06-13 2016-04-26 Intuitive Surgical Operations, Inc. Surgical instrument control and actuation
US9215967B2 (en) 2006-06-13 2015-12-22 Intuitive Surgical Operations Inc. Side looking minimally invasive surgery instrument assembly
JP2008125819A (en) * 2006-11-21 2008-06-05 Kobe Univ Over-tube
JP2008173369A (en) * 2007-01-22 2008-07-31 Olympus Medical Systems Corp Treatment tool for endoscope
US9125551B2 (en) 2007-01-22 2015-09-08 Olympus Corporation Lifting cap
US8602970B2 (en) 2007-01-22 2013-12-10 Olympus Medical Systems Corp. Lifting cap
JPWO2009016834A1 (en) * 2007-07-30 2010-10-14 小山 勇 Oral digestive organ surgical device
US9179832B2 (en) 2008-06-27 2015-11-10 Intuitive Surgical Operations, Inc. Medical robotic system with image referenced camera control using partitionable orientational and translational modes
US9955859B2 (en) 2008-06-27 2018-05-01 Intuitive Surgical Operations, Inc. Medical robotic system with image referenced camera control using partitionable orientational and translational modes
JP2011527199A (en) * 2008-07-11 2011-10-27 ソシエダーデ ベネフィセンテ デ センオラス オスピタル シリオ リバネス Surgical endoscope
JP2011087647A (en) * 2009-10-20 2011-05-06 Hoya Corp Overtube for treatment, and treatment system
WO2012032935A1 (en) * 2010-09-09 2012-03-15 オリンパス株式会社 Image pickup device, endoscope tip section provided with the image pickup device, and endoscope tip unit
JP2012161506A (en) * 2011-02-08 2012-08-30 Seiko Epson Corp Liquid ejecting apparatus
US9801531B2 (en) 2011-05-27 2017-10-31 Olympus Corporation Endoscope system and method for operating endoscope system
US9486123B2 (en) 2011-05-27 2016-11-08 Olympus Corporation Endoscope system which enlarges an area of a captured image, and method for operating endoscope system
JP2012245161A (en) * 2011-05-27 2012-12-13 Olympus Corp Endoscope apparatus
JP2013000308A (en) * 2011-06-16 2013-01-07 Nobuyuki Sakurazawa Illumination suction injection exclusion outer cylinder for endoscopic surgery forceps
WO2012172739A1 (en) * 2011-06-16 2012-12-20 Sakurazawa Nobuyuki Illumination suction injection exclusion cylinder for endoscopic surgery forceps
US9452276B2 (en) 2011-10-14 2016-09-27 Intuitive Surgical Operations, Inc. Catheter with removable vision probe
US9387048B2 (en) 2011-10-14 2016-07-12 Intuitive Surgical Operations, Inc. Catheter sensor systems
US10238837B2 (en) 2011-10-14 2019-03-26 Intuitive Surgical Operations, Inc. Catheters with control modes for interchangeable probes
WO2014092197A1 (en) * 2012-12-11 2014-06-19 Olympus Corporation Endoscopic device and method of controlling endoscopic device
US10085620B2 (en) 2012-12-11 2018-10-02 Olympus Corporation Endoscopic device and method of controlling endoscopic device
CN104837432A (en) * 2012-12-11 2015-08-12 奥林巴斯株式会社 Endoscopic device and method of controlling endoscopic device
JP2016502411A (en) * 2012-12-11 2016-01-28 オリンパス株式会社 The method and the endoscopic apparatus of the endoscope apparatus
JP2016526397A (en) * 2013-06-09 2016-09-05 マクロプラタ、インコーポレイテッドMacroplata,Inc. Multilumen catheter retractor system for gastrointestinal treatment by minimally invasive surgery
WO2016143143A1 (en) * 2015-03-12 2016-09-15 学校法人慶應義塾 Treatment-instrument insertion aid
WO2016143142A1 (en) * 2015-03-12 2016-09-15 学校法人慶應義塾 Treatment-instrument insertion aid
JPWO2016143142A1 (en) * 2015-03-12 2017-12-21 学校法人慶應義塾 Treatment tool insertion aid
JPWO2016143143A1 (en) * 2015-03-12 2017-12-21 学校法人慶應義塾 Treatment tool insertion aid
WO2018229983A1 (en) * 2017-06-16 2018-12-20 オリンパス株式会社 Endoscope and endoscope system

Also Published As

Publication number Publication date
JP4242491B2 (en) 2009-03-25

Similar Documents

Publication Publication Date Title
US9913573B2 (en) Endoscopic imaging system
US6755843B2 (en) Endoscopic suturing device
US7261728B2 (en) Biopsy forceps device and method
US7029435B2 (en) Endoscope having multiple working segments
JP4658557B2 (en) An applier for a single in 腔吻 case for self placement fastener
CN101374465B (en) Ablation device and system for guiding ablation device into a patient&#39;s body
US7063661B2 (en) Endoscopic mucous membrane resection instrument and endoscopic mucous membrane resection method
CN100464798C (en) A guide wire used for inserting into an internal space
JP4373146B2 (en) Endoscopic suturing device
US7014646B2 (en) Endoscopic resection devices and related methods of use
US7060025B2 (en) Method for controlling position of medical instruments
JP3722729B2 (en) Endoscopic treatment equipment
US6231585B1 (en) Device for stabilizing a treatment site and method of use
JP3429685B2 (en) The endoscope guide tube
US7981127B2 (en) Treatment sheath for endoscopic blood vessel harvesting
EP2400902B1 (en) Surgical scissors
AU2007292481B2 (en) Apparatus suitable for performing mucosal resection
ES2338248T3 (en) Endoscopic catheter with a flexible end effector to coagulate and separate tissue.
US7060024B2 (en) Apparatus for guiding an instrument used with an endoscope
EP1906847B1 (en) Endoscope retrieval instrument assembly
US7235089B1 (en) Surgical apparatus and method
US7264587B2 (en) Endoscopic subxiphoid surgical procedures
US8591399B2 (en) Surgical method utilizing transluminal endoscope and instruments
US8932208B2 (en) Apparatus and methods for performing minimally-invasive surgical procedures
US8480689B2 (en) Suturing device

Legal Events

Date Code Title Description
A621 Written request for application examination

Free format text: JAPANESE INTERMEDIATE CODE: A621

Effective date: 20051207

A131 Notification of reasons for refusal

Free format text: JAPANESE INTERMEDIATE CODE: A131

Effective date: 20071211

A521 Written amendment

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20080212

A131 Notification of reasons for refusal

Free format text: JAPANESE INTERMEDIATE CODE: A131

Effective date: 20080311

A521 Written amendment

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20080428

A02 Decision of refusal

Free format text: JAPANESE INTERMEDIATE CODE: A02

Effective date: 20080610

A521 Written amendment

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20080811

A911 Transfer of reconsideration by examiner before appeal (zenchi)

Free format text: JAPANESE INTERMEDIATE CODE: A911

Effective date: 20080919

TRDD Decision of grant or rejection written
A01 Written decision to grant a patent or to grant a registration (utility model)

Free format text: JAPANESE INTERMEDIATE CODE: A01

Effective date: 20081202

A01 Written decision to grant a patent or to grant a registration (utility model)

Free format text: JAPANESE INTERMEDIATE CODE: A01

A61 First payment of annual fees (during grant procedure)

Free format text: JAPANESE INTERMEDIATE CODE: A61

Effective date: 20081225

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20120109

Year of fee payment: 3

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20120109

Year of fee payment: 3

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20130109

Year of fee payment: 4

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20140109

Year of fee payment: 5

LAPS Cancellation because of no payment of annual fees