JP2002017752A - Endoscopic surgery system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscopic surgery system that is not affected by individual difference between surgeons, can easily and rapidly move and change magnification of a visual field of an endoscope, and has good operability. SOLUTION: This endoscopic surgery system comprises the endoscope 7 inserted into a coelom for picking up an image in the coelom, a monitor 13 for displaying the observed image of the endoscope 7, a three-dimensional manipulator 9 for moving and changing magnification of the observed visual field of the endoscope 7, a treating tool 6 inserted into the coelom for extracting a lesion, and a treating tool holder 8 for holding the treating tool 6. The surgery system has a detecting means 11 for detecting a force added to the treating tool 6, and the three-dimensional manipulator 9 is driven based on a detection result of the detecting means 11.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic surgical operation system for performing a surgical operation under an endoscope.

[0002]

2. Description of the Related Art In recent years, so-called endoscopic surgery, in which the invasion of a patient is smaller than that of a surgery for performing laparotomy, thoracotomy, and the like, has been actively performed. In particular, laparoscopic surgery is widely performed.

In this endoscopic surgical operation, an observation field of view obtained by an endoscope is displayed on a TV monitor, and a treatment tool is operated while looking at the screen to remove an affected part. At this time, the endoscope is held in a dedicated endoscope support device and the treatment tool is held by hand or fixedly supported by the dedicated support device,
The visual field of the endoscope is moved by moving the endoscope support device and moving the entire endoscope. The following is disclosed as a device for electrically moving the endoscope support device.

Japanese Unexamined Patent Publication No. Hei 10-118015 discloses an endoscopic surgical operation system in which an operation switch for supporting a field-of-view changing operation of an endoscope is connected to a treatment tool.

[0005] UPS5815640 discloses an apparatus for moving an endoscope by a foot switch. Japanese Patent Application Laid-Open No. HEI 10-118006 discloses that a CCD (solid-state imaging device) is moved in a direction orthogonal to the optical axis direction without moving the endoscope body.
A device incorporating a D moving mechanism is disclosed.

[0006] When performing a surgical operation under an endoscope, the endoscope is first fixed at an angle and a position at which the operation site is easy to see without hindering the treatment by an endoscope support device. Next, while observing the monitor image of the surgical site obtained from the endoscope, the treatment tool is operated to remove the affected part or the like. At this time, it is necessary to move and zoom the monitor image of the surgical site, which is likely to be out of the observation field of view, while holding the treatment tool by using a foot switch or a hand switch attached to the treatment tool.

[0007] In addition, the removal of the affected part often involves a wide area, the blind part such as the back side of the organ around the affected part, etc. At this time, it is necessary to largely move the endoscope and change the observation angle and position, and it is necessary to change the observation angle and position inside the body cavity. It is desired that the endoscope can be freely moved.

[0008] At this time, information on resistance and tactile sensation obtained by the operator moving the endoscope by hand plays a large role. In other words, the surgeon inputs information such as internal organs that are invisible to the eyes through many years of experience to the head, and based on the information of sensation obtained by transmitting the endoscope, The operation is performed with great care so as not to cause any obstacles.

[0009]

However, the operation switch of the treatment tool disclosed in JP-A-10-118015 is
When the treatment tool is freely moved according to the treatment of the affected part, the operation direction of the switch does not match the visual field movement direction. In addition, it is troublesome to grasp the hand of the hand holding the treatment tool or move the fingers during operation, which not only results in an increase in the size and weight of the grasping part of the treatment tool, impairs operability, but also the operator's dominant hand and hand size. Due to individual differences, not all doctors can obtain satisfactory operability.

In using the foot switch of US Pat. No. 5,815,640, a large number of foot switches such as energy treatment tools are placed on the floor during the operation. Be careful not to operate different switches
Quick operation cannot be performed. In addition, since the operation is performed with the foot, finer adjustment of the visual field is required as compared with the input by hand.

Further, when the visual field is moved as described in US Pat. No. 5,815,640, the endoscope body is moved electrically.
Since information such as the tactile sensation and pressure obtained through the endoscope cannot be obtained, the operation must be performed more carefully and quick operation cannot be performed. In addition, when the visual field is moved by a combination of the inclination around the insertion point of the abdominal wall and the expansion and contraction of the endoscope, the affected part cannot be observed from various angles.

The field-of-view moving device disclosed in Japanese Patent Application Laid-Open No. HEI 10-118006 can move the field of view quickly because the endoscope main body does not move, but the range in which images can be captured is narrow.
Can not move a large field of view. Further, this visual field movement is a planar visual field movement, and the affected part cannot be observed from various angles. These have led to increased fatigue of the operator and prolonged operation time.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and has as its object to easily and quickly move and zoom the field of view of an endoscope without being affected by individual differences among operators. An object of the present invention is to provide an endoscope operation system with good operability.

[0014]

To achieve the above object, the present invention provides an endoscope which is inserted into a body cavity and captures an image of the inside of the body cavity, and displays an observation image of the endoscope. A display device, a visual field changing means such as movement and magnification change of an observation visual field of the endoscope, a treatment tool inserted into a body cavity to remove an affected part, and a treatment tool holding device for holding the treatment tool And a detecting means for detecting a force applied to the treatment tool, wherein the visual field changing means is driven based on a detection result of the detecting means.

According to a second aspect of the present invention, there is provided an endoscope surgical operation system comprising an endoscope inserted into a body cavity and imaging the inside of the body cavity, and an endoscope support device for supporting the endoscope. A movement mechanism for transmitting the movement in the body cavity to the outside of the body cavity, and a movement body that moves in a manner similar to the endoscope by the movement mechanism.

According to the first aspect of the present invention, the input device is operated by moving the treatment tool held by the treatment tool holding device in a direction in which the observation field of view of the endoscope projected on the display device is to be moved. By detecting the pressing direction of the endoscope with respect to the treatment tool holding device and driving the field changing means of the endoscope, the observation field can be changed to a desired position and magnification.

According to the second aspect of the present invention, by moving the moving body which moves in a manner similar to the endoscope, the movement mechanism for transmitting the movement of the moving body to the endoscope is transmitted, and the endoscope support is provided. An endoscope held by the device moves within the body cavity.

[0018]

Embodiments of the present invention will be described below with reference to the drawings.

1 to 3 show a first embodiment, and FIG.
2 is a schematic configuration diagram of an endoscopic surgical operation system, FIG. 2 is a perspective view of a detection unit, and FIG. 3 is a vertical sectional side view of the same.

In FIG. 1, a pneumoperitoneum needle (not shown) is inserted into a body cavity 2 inside a patient's abdominal wall 1, and carbon dioxide gas is sent into the body cavity 2 by the insufflation needle to inflate (pneumoperitoneum). ) Is shown. Reference numeral 3 denotes an affected part formed on the surface of a living tissue such as an internal organ of the body cavity 2. The endoscopic surgical operation system according to the present embodiment performs a procedure such as removal of the affected part 3.

Further, a first trocar 4 and a second trocar 5 are inserted into the abdominal wall 1 from different places. Into the hole of the first trocar 4, a treatment tool 6 for performing a treatment such as extraction is fixedly held by a treatment tool holding device 8 and inserted. In the hole of the second trocar 5, an endoscope, which is a laparoscope, is inserted. The mirror 7 is fixedly held and inserted by an endoscope holding device 14 using a three-dimensional manipulator 9 as a visual field changing unit. Note that the three-dimensional manipulator 9 is provided with a holding arm portion 9a composed of a plurality of joints whose rotation is controlled.

The connecting portion of the treatment instrument holding device 8 of the treatment instrument 6 is provided with a detecting means 11 for detecting the direction of the force applied to the treatment instrument 6. A TV camera 12 having a zoom function is attached to the endoscope 7, and information in the body cavity is displayed on a monitor (display device) 13 by a controller (not shown). The control means 15 controls the treatment instrument 6 obtained by the detection means 11 when the treatment instrument 6 is moved in a direction perpendicular to the axis of the shaft portion 10 of the treatment instrument 6.
The three-dimensional manipulator 9 is controlled to drive the holding arm 9a so that the observation direction of the endoscope 7 moves in the same direction as the direction of the force applied to the endoscope. Further, the detection means 11 can switch a signal to the control means 15 to an ON / OFF state by a foot switch or a hand switch (not shown).

FIGS. 2 and 3 are views showing details of the detecting means 11 provided on the treatment tool 6. The detecting means 11 includes a ring-shaped holding section 16 to which a switch input section 18 that moves integrally with the shaft section 10 of the treatment instrument 6 is connected and fixed to the treatment instrument holding apparatus 8 by springs 18a, 18b, 18c, and 18d.
Are arranged so as to be spatially held at substantially the center position.

The holding unit 16 has a switch input unit 18
The first switch 17a, the second switch 17b, and the third switch 17 are provided in a substantially equal circumferential direction with a space substantially equal to
c, a fourth switch 17d is provided. FIG. 3 is a cross-sectional view taken along the line AA shown in FIG.
The switch input unit 18 is provided with a flange 19, and switches 17e and 17f for expanding and reducing the visual field in the axial direction of the shaft 10 of the treatment instrument 6 are provided on the inner wall of the holding unit 16 with the flange 19 interposed therebetween. It is arranged.

Next, the operation of the present embodiment will be described. First, when the operator inserts the treatment instrument 6 into the body cavity 2 under observation by the endoscope 7 and performs a treatment, an image of the treatment section is detected by the endoscope 7 and the TV camera 12. This image is further displayed on the monitor 13.

When it is desired to move the observation image, the detecting means 11 is turned on by a foot switch or a hand switch (not shown), and is moved in a plane orthogonal to the shaft 10 of the treatment instrument 6 to thereby cause the springs 18a, 18b, 18c, 18d
The switch input unit 18 that moves integrally with the shaft unit 10 of the treatment tool 6 is broken by switches 17a, 17b, 17c,
17d is turned on.

Here, the signal in the ON state is input to the three-dimensional manipulator 9 of the endoscope holding device 14 via the cable from the switch and the control means 15. The rotation of a plurality of joints of the holding arm 9a is controlled by the three-dimensional manipulator 9, and the endoscope 7 moves to move the observation field of view. At this time, the control unit 15 controls the monitor 13 as viewed from the operator.
The direction of movement of the observation visual field shown in FIG.

Similarly, by moving the shaft 14 of the treatment instrument 6 in the front-rear direction, the switches 17e and 17f are input by the flange portion 18 so that the field of view can be enlarged or reduced.

For example, a rightward input switch 17a, a leftward input switch 17b, an upward switch 17c, a downward input switch 17d and a visual field moving direction are determined before the operation on the inspection image projected on the monitor 13, In addition, the enlargement input switch 17e and the reduction input switch 17f of the observation image are determined, and the control means 15 is set.

The operator performs treatment on the affected part 3 with the treatment tool 6 while checking the observation image displayed on the monitor 13 of the endoscope 7 arranged before the start of the treatment. At this time, when the affected part 3 extends over a wide area or when another observation position is confirmed, it is necessary to move the observation image projected on the monitor 13.

Here, when the detection means 11 is set to the ON state, for example, when the observation image is to be moved to the right, the treatment tool 6 is moved to the right so that the switch input section 18 moves integrally with the shaft 10. Moves, switch 17
a, a signal is input to the control means 15, the signal is input from the control means 15 to the manipulator 9, and a plurality of joints of the holding arm 9 a of the endoscope holding device 14 are rotationally controlled, and the endoscope 7 is moved rightward. Moves.

Next, when it is desired to enlarge the visual field, the switch input section 16 is moved by pulling the treatment instrument 6 along the axis of the shaft 10 toward the surgeon, and the switch 17e is turned on to send a signal to the control means 15. Input, TV camera 12
Is input to a controller (not shown) to expand the field of view.
The visual field movement and the visual field magnification operation may be performed simultaneously with the visual field movement moving in a plane perpendicular to the shaft 14 of the treatment instrument 6 and the visual field magnification moving in the axial direction of the shaft 14 of the treatment instrument 6. .

According to the present embodiment, the following effects can be obtained.

A. It is possible to easily and quickly perform a field-of-view movement and a magnification (magnification / reduction) operation in a minute range without being affected by individual differences between operators while holding and holding the treatment tool.

B. The direction in which the treatment tool is moved matches the direction of the observation image, and the operator can quickly move the visual field without being confused.

C. Since the treatment tool has input means for driving the field-of-view changing means, the grip portion of the treatment tool can be reduced in size and operability is good, and the field of view can be changed by attaching to a general treatment-tool holding device.

FIGS. 4 to 6 show an endoscopic surgical operation system according to a second embodiment. The same components and operations as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted.

FIG. 4 is a diagram schematically showing an endoscopic surgical operation system. A first trocar 4 and a second trocar 5 are inserted into the abdominal wall 1 from different places. In the hole of the first trocar 4, a treatment tool 26 for performing a treatment such as extraction is fixed and held by the treatment tool holding device 20, and is inserted into the hole of the second trocar 5. The mirror 21 is rotatably held by an endoscope support device 22 via a spring 33 in a spatial manner. The endoscope 21 has an objective lens 28, an image sensor 27, and a variable power lens 29.

The image pickup device 27 includes a known image pickup device 2 which can be moved in the field of view using a drive element such as a motor (not shown).
7 drive mechanism, and the variable power lens 29 is provided with a zoom mechanism using a drive element such as a motor (not shown). In addition, the endoscope 21 is provided with the first joint 3 so that the visual field can be moved and the observation angle can be arbitrarily changed in the body cavity 2.
0 and a second joint 31, and the imaging unit 32 is configured to be movable.

Further, the endoscope 21 is a body cavity 2 of the endoscope 21.
A movement equivalent to the movement body 24 is performed via a movement mechanism 23 for transmitting the movement of the body outside the body cavity. Further, a detection unit 53 for driving the image pickup device 27 driving mechanism via the control unit 15 is provided at a connection portion of the treatment device holding device 20 with the shaft portion 25 of the treatment device 26.

FIG. 5 is a diagram showing details of the detecting means 53 provided in the treatment tool holding device 20. The detecting means 53
The shaft portion 25 of the treatment tool 26 is fixed, and the treatment tool 26 is spatially held. The detecting means 53 includes a base ring 53a.
A small-diameter central disk 53b disposed at the center of the base ring 53a; and four thin plate portions 61a, 6 provided between the central disk 53b and the base ring 53a.
1b, 61c and 61d are provided.

The shaft 25 is fixed to the center disk 53b. Further, each of the thin plate portions 61a, 61b, 6
Strain gauges 62a, 62b, 62c, and 62d are attached to connection portions between 1c and 61d and the center disk 53b, respectively.

Then, by applying a force to the shaft portion 25 of the treatment instrument 26, the thin plate portions 61a, 61b, 61c,
61d is elastically deformed, and the force applied to the treatment instrument 26 is detected by measuring output signals from the respective strain gauges 62a, 62b, 62c, 62d output according to the deformation. That is, arrows Z ₁ , Z ₂ , X ₁ , X ₂ , and Y in FIG.
When a force in each direction of ₁ (on the front side of the paper) and Y ₂ (on the other side of the paper) is applied, a signal corresponding to each force is output.

[0044] For example, if the force pulling the treatment tool 26 to the left as indicated by the arrow Z ₁ in FIG. 5 is applied four strain gauges 62a, 62b, 62c, signal elongation is output from 62d. Further, an arrow Z ₂ in FIG.
When a force for pushing in the right direction is applied as shown in FIG. 7, contraction signals are output from the four strain gauges 62a, 62b, 62c and 62d. When an upward force is applied to the treatment instrument 26, a contraction signal is output from the strain gauge 62b, and an extension signal is output from the strain gauge 62d.

The detecting means 53 is connected to the control means 15. Then, the four strain gauges 62a, 62
The output signals from b, 62c and 62d are sent to the control means 15, where the signals are analyzed to detect in which direction and how much operating force is applied to the treatment instrument 26. It has become.

Therefore, X1, X2, Y
When a force of 1, Y2 is applied, a signal from the detecting means 53 moves the known image pickup device 27 driving mechanism through the control means 15 in a desired direction. When the force of Z1 and Z2 in the figure is applied to the treatment tool 26, the control means 15
The passed signal moves the variable power lens 29 in a desired direction by a known zoom mechanism (not shown). In other words, when a force is applied to the treatment tool 26, the image displayed on the monitor 13 can be moved, and the field of view such as enlargement and reduction can be changed in accordance with the direction of the force applied to the treatment tool 26. Further, the ON state of the detection means 53 and the OF state
Switching to the F state can be performed by a foot switch or a hand switch (not shown).

Referring to FIG. 6, the details of the endoscope 21, the endoscope support device 22, the movement mechanism 23, and the moving body 24 will be described.

The first joint 30 and the second joint 31 of the endoscope 21 are connected to a first link 34 displaced integrally with the imaging unit 32.
And the second link 35 always displaced in parallel with the first link 34
, A third link 36, a fourth link 37 that moves in parallel with the third link 36, and a parallel link composed of shafts 38 a to 38 d.

That is, the first joint 30 has the shaft 38c,
The joint 31 is composed of a shaft 38d, and the shaft 38d is
It is fixed to. The movement mechanism 23 includes the endoscope support device 2
A rotating body 39 having a fitting shaft 39a inserted through a spring 33 into a fitting hole 22a at a connection portion with the rotating body 39;
A fifth link 40 built in and rotatably connected to a shaft 38a and a shaft 42 built in the rotating body 39 and provided on the opposite side of the imaging unit 32 of the fourth link 37 so as to be rotatable. And the sixth link 41 provided.

The fifth link 40 and the sixth link 41
Are shifted from each other in the front and rear directions in FIG. 6 so that they do not interfere with each other. The moving body 24 includes an imaging unit 32
A seventh link 43 having exactly the same shape as the first link 34 displaced integrally with the operating portion 49 having the same shape as the first link 34, and a second link 35 having the same shape as the second link 35 always displaced in parallel with the seventh link 43 An eighth link 44, a ninth link 45 having exactly the same shape as the third link 36, and a tenth link having exactly the same shape as the fourth link 37 moving in parallel with the ninth link 45;
A parallel link is formed by the shafts 47a to 47d opposed to the shafts 38a to 38d.

Here, the shaft 47d is fixed to the rotating body 39, and regulates the movement of the parallel link. Also, axis 4
A fifth link 40 is rotatably connected to 7a so as to show a displacement completely equivalent to the movement locus of the shaft 38a. Further, a shaft 48 is fixed to the tenth link 46, and a sixth link 41 is rotatably connected to the shaft 48 so that the shaft 48 moves with a displacement completely equivalent to the shaft 42. become. Therefore, the parallel link of the endoscope 21 and the parallel link of the moving body 24 have the same shape and always have the same inclination angle, and the inclination of the imaging unit 32 in the A1 direction in the drawing is the same as that of the operation unit 49 in the drawing A2. The movement locus is exactly the same as the inclination of the direction.

The spring 33 includes the endoscope 21 and the movement mechanism 23.
The spring constant and the like are set so that the sum of the weights of the moving body 24 and the moving body 24 can be held in the direction of gravity, and can follow the displacement in the direction B in the figure to be neutral and can be held spatially.

Further, the fitting hole 22 of the endoscope support device 22
The fitting shaft 39a of the rotating body 39a inserted into the
It can rotate in the direction.

Therefore, by combining the parallel link in the figure and the displacements in the directions B and C, it is possible to move the field of view arbitrarily. In addition, the operation unit 49 and the imaging unit 32 in the body cavity 2 make an equivalent movement.

Next, the operation of the present embodiment will be described.

First, the surgeon inserts the treatment instrument 26 and the endoscope 21 into the body cavity 2 via the trocars 4 and 5 as shown in FIG. The endoscope support device 22 and the treatment tool holding device 20 each having a plurality of joints and capable of freely moving and fixing are installed.

Here, while observing the image of the affected part 3 obtained by the endoscope 21 on the monitor 13, a treatment such as extraction is performed by the treatment tool 26. At this time, the surgeon changes the visual field to move the endoscope 26 greatly, such as by changing the visual field slightly or deviating from the center of the monitor 13 as the procedure progresses, or by observing another affected part or changing the observation angle. There are two uses.

When performing a small movement of the visual field or enlarging / reducing the visual field while performing the treatment, the detecting means 53 is turned on by a foot switch or a hand switch, and a force is applied to the treatment tool 26 in the direction in which the visual field is to be changed. Detecting means 5 arranged near treatment tool 26 connecting portion of holding device 20
The switch signal emitted from 3 is input to the drive mechanism (not shown) of the image sensor 27 provided in the image pickup section 32 of the endoscope 21 via the control means 15.

The image sensor 2 is driven by the image sensor 27 driving mechanism.
By moving 7, a fine visual field movement is performed. Similarly, by driving the zoom lens 29, the field of view is enlarged and reduced.

For example, a case where the center of the observation field of view currently being observed is moved to the right by a small range will be described below.

X1, X2, Y1, Y shown in FIG.
2, Z1 and Z2 are rightward movement, leftward movement, upward measurement movement, downward measurement movement, zoom UP, and zoom DOWN for changing the field of view, respectively.
Is set in the control means 15 to correspond to. When a force is applied to the treatment instrument 26 in the X1 direction, a similar force is applied to the center disk 53b that moves integrally with the shaft portion 25 of the treatment instrument 26.

Accordingly, the base ring 53 of the detecting means 53 which is spatially fixed and held by the treatment tool holding device 20
a, the thin plate portions 61a and 61d are elastically deformed, and the strain gauge 62a outputs a contraction signal.
Outputs a signal of elongation, and the detection means 53 (not shown)
Is moved by the driving mechanism of the image sensor 27 in a desired direction via the control means 15 to move the observation range on the TV monitor to the right.

Next, a case in which the treatment is interrupted by moving the visual field greatly or the observation angle is changed and the endoscope 21 is moved will be described.

For example, as shown in FIG. 6, when the imaging section 32 of the endoscope 21 is used to observe the point O1 of the affected part 3 at the center of the visual field, the point O2 is hidden behind the affected part 3 and cannot be observed.
In such a case, the surgeon needs to bring the imaging unit 32 of the endoscope 21 to a position 32b indicated by a two-dot chain line in the figure. At this time, the surgeon rotates the operating unit 49 by 180 degrees as a unit in the C direction so as to move to the position 49a in the figure, moves in the B1 direction as a variation in the B direction, and adjusts the angle of A2. These operations are performed while checking the image on the monitor 13.

That is, when expressed on the paper surface of FIG. 6, the desired direction of the affected part 3 is determined by the rotational displacement in the C direction with respect to the rotation axis P, and then the position and angle of the affected part 3 in the depth direction are determined in the B direction. And the displacement in the A2 direction is combined with the observation position. The displacement of the operation unit 49 in the A2 direction is the same as the displacement of A1 of the endoscope 21 by the fifth link 40 and the sixth link 41 connecting the parallel link of the moving body 24 and the parallel link of the endoscope 21 having exactly the same shape. It will be exactly the same. Further, the displacement in the direction B does not move even after the movement, even if the hand is released by the spring 33.

According to the present embodiment, the following effects can be obtained.

A. A moving body that moves exactly the same size as the endoscope in the body cavity is outside the body cavity, and the direction and angle of the endoscope in the body cavity can be clearly recognized, so that quick observation from various observation directions is possible. It is possible.

B. Since the operation of changing the field of view of the endoscope can be performed at a distance from the patient, a work space can be secured and operability is good.

C. By actually moving by hand, the user can move while feeling the pressure of touching an organ or the like inside the body cavity.

FIGS. 7 and 8 show an endoscopic surgical operation system according to a third embodiment. The same components and operations as those in the first and second embodiments are denoted by the same reference numerals and description thereof is omitted. I do.

FIG. 7 is a diagram schematically showing an endoscopic surgical operation system. Each of the joints 71a and 72b of the treatment tool holding device 71 that holds the treatment tool 26 has a built-in known electromagnetic lock (not shown), and the clutch can be released by a foot switch or a hand switch (not shown). Here, the treatment tool position fixed state or the free state of the treatment tool holding device 71 is detected, and the detection unit 53 is turned on and off.
Control means (not shown) is provided.

The first joint 30 and the second joint 31
Is held spatially in a body cavity by an endoscope support device 22. The endoscope support device 22 is provided with an index 72 having a freely bendable arm 73 that can be freely bent.

Further, in order to transmit the movement of the endoscope 21 in the body cavity 2 to the outside of the body cavity, the first joint 74 is moved through the movement mechanism 76.
and a moving body 74 having a second joint 74b. Here, assuming that the lengths of the first arm 21a and the second arm 21b of the endoscope 21 are N1 and N2, respectively, the length S1 of the first arm 74c and the second arm 74d of the moving body 74, S2 is twice as long as N1 and N2, respectively.

Further, the movement mechanism 76 has a movable range restricting means 78 for restricting a movable range of the endoscope 21 in the body cavity 2.
Is provided.

FIG. 8 is a diagram showing details of the moving body 74, the moving mechanism 76, and the movable range restricting means 78.

The first joint 30 and the second joint 31 of the endoscope 21 are connected to a first link 34 displaced integrally with the imaging unit 32.
And the second link 35 always displaced in parallel with the first link 34
, The third link 36, the fourth link 37 that moves in parallel with the third link 36, and the shafts 38 a to 38 d constitute a parallel link. Here, the shaft 38d is fixed to the rotating body 39.

The movement mechanism 76 includes a rotating body 39 having a fitting shaft 39 a inserted through a spring 33 into a fitting hole 22 a of a connecting portion with the endoscope holding device 22, and a built-in rotating body 39. Fifth link 7 rotatably connected to the shaft 38a
8 and the imaging unit 3 of the fourth link 37 built in the rotating body 39
2 and a sixth link 79 rotatably connected to the shaft 42 provided on the opposite side. Here, the fifth link 78 and the sixth link 79 do not interfere with each other because their positions are shifted in the front and rear directions in FIG.

The moving body 74 has an operation section 80 having a length twice as long as the entire length 32a of the imaging section 32, and has a length twice as long as the length 32a from the shaft 38c of the first link 34 to the imaging section 32. A second link 35 having the same shape as the second link 35;
83 which is twice as long as the length 36a between the spaces 8a and 38b
The ninth link 83 having a and the shaft 38 of the fourth link 37
The tenth link 84 having a length 84a twice as long as the distance 37a between the shaft c and the shaft 38d and the shafts 85a to 85d facing the shafts 38a to 38d constitute parallel links. Here, the shaft 85d is fixed to the rotating body 39. Further, a fifth link 78 is rotatably connected to the shaft 85a, and shows a locus completely equivalent to the movement locus of the shaft 38a.

Further, a shaft 86 is fixed to the tenth link 84 and a sixth link 79 is rotatably connected to the shaft 86 so as to be rotatable. The shaft 86 moves with a displacement completely equivalent to that of the shaft 42. Therefore, the movement locus of A1 of the imaging unit 32 is
In FIG. 9, the movement trajectory and the inclination angle of A2 are indicated by the same reduction system.

Next, the structure of the movable range restricting means 78 will be described.

The movable range restricting means 78 transmits the moving body 83 from the fifth link 78 and the sixth link 79 incorporated in the moving mechanism 23 for transmitting the movement of the endoscope 21 in the body cavity 2 to the outside of the body cavity.
The moving body 88 which is led out elsewhere with the same configuration as
And stoppers 89a to 89 for restricting movement of the moving body
c.

The structure of the moving body 88 is the same as that of the second embodiment and the moving body 74, and the description is omitted. The positions of the stoppers 89a to 89c can be moved by screwing them into the frame 90 by using knobs 91a to 91c attached to the stoppers. The stoppers 89a to 89c are also provided in the front-back direction on the paper surface.

Next, the operation of the present embodiment will be described.

When performing endoscopic surgery with the present system, the index 72 attached to the endoscope holding device 22 outside the body cavity so as to keep track of the affected part 3 before performing the operation.
Is set with respect to the moving body 74 so that the position of the diseased part 3 with respect to the endoscope 21 becomes equal to the position of the affected part 3 with the arm 73 that can freely move.

Next, in order to limit the moving range of the endoscope 21, the knobs 91a to 91c of the movable range restricting means 78 are screwed and loosened to move the stoppers 89a to 89c. At this time, the moving body 88 is
The moving range is limited by a to 91c. Similarly, the moving range of the endoscope 21 in the body cavity 2 is also limited. Here, the positions of the stoppers 89a to 89c are set at positions where the endoscope 21 does not touch organs or important tissues based on information obtained before the operation, so that the endoscope 21 is inadvertent during the operation. Avoid contact with organs and important tissues.

Next, when the treatment is performed while observing the image of the endoscope 21 on the monitor 13, in the case of a minute visual field, the treatment is performed by applying a force in the direction to be moved to the treatment tool 26. Is larger, it is necessary to move the treatment tool 26. In such a case, the electromagnetic lock of the joints 71a and 72b of the treatment tool holding device 71 is released, and the treatment tool 26 is moved to a desired position. At this time,
When the electromagnetic lock of the joints 71a and 72b of the treatment tool holding device 71 is released by the control unit 77 connected to the detection unit 53, the signal of the detection unit 53 is turned off. Similarly, when the electromagnetic lock is fixed, the signal of the detecting means 53 is turned ON.

Further, in the present embodiment, as described in the configuration, the operating section 80 of the moving body 74 moves the endoscope 21 with the moving range enlarged.

According to the present embodiment, the following effects are obtained in addition to the effects of the second embodiment.

A. When the treatment tool is moved by the treatment tool holding device, the input of the visual field movement is turned off, so that it is not necessary to set ON and OFF each time with a foot switch or a hand switch, thereby reducing operator fatigue and shortening the operation time. .

B. Even if the affected part is lost due to the narrow field of view of the endoscope, the operation site can be searched for in a short time because of the extracorporeal index, thereby reducing the operation time.

C. Since the movable range of the endoscope in the body cavity can be easily regulated, the endoscope can be quickly moved during the operation, thereby reducing the fatigue of the operator and reducing the operation time.

C. When moving the observation site of the endoscope, the amount of movement of the endoscope is smaller than that of the operation unit, so that it is possible to easily perform finer visual field movement, reduce operator fatigue and reduce operation time. Become.

FIGS. 9 and 10 show a fourth embodiment.
FIG. 9 is a schematic diagram showing an endoscope 92, an endoscope support device 93, a movement mechanism for transmitting the movement of the endoscope inside the body cavity to the outside of the body cavity, and a moving body 94 in the endoscopic surgical operation system.

The endoscope 92 has a rotating shaft 96 integral with the first pulley 95. A joint 97 has a hole into which the rotating shaft 96 is fitted and a shaft of a first gear 99 integral with the second pulley 98. 100 has a hole for fitting. Second pulley 98
Are arranged coaxially with the shaft 100 of the first gear 99. Further, the joint 97 has a hole into which the shaft 102 of the rotatable second gear 101 meshes with the first gear 99 and is provided with a female screw 97a into which a screw 124 detachable from the movement mechanism 103 is screwed. Have been.

The motion mechanism 103 includes a third pulley 104
A hole in which the shaft 106 of the third gear 105, which is rotatable and meshes with the second gear 101, and a hole in which the shaft 109 of the fourth pulley 108 integrated with the moving body 94 is rotatably fitted. Have. Here, a first timing belt is wound around the first pulley 95 and the second pulley 98, and a second timing belt is wound around the third pulley 104 and the fourth pulley 108.
Timing belt 110 is idler wheels 107a to 107f
Is hung through.

Here, the first pulley 95, the second pulley 98, the third pulley 104, and the fourth pulley 108 have the same number of teeth, and the first gear 99 and the third gear 10
5 have the same module, the same pitch circle diameter,
The second gear 101 has the same module as the first gear 99 and the third gear 105. Further, the movement mechanism 103 is provided with a fitting hole 103b and a fitting shaft 97b so that the position is determined when the movement mechanism 103 is attached to the joint 97. Here, the total length 94 a of the operation unit 94 is の of the total length 92 a of the endoscope 92.

FIG. 10 is an enlarged view of a section taken along the line XX of FIG. 9, and includes a pin 111 provided on the shaft 109 and a pin provided on the armature 113 of the electromagnetic brake 112 provided on the movement mechanism 103. 114 is a rotation stopper for the joint.

Next, the operation of the present embodiment will be described.

First, before performing the operation, the surgeon should check the joint 9
The endoscope 92 integrated with the endoscope 7 is attached to the endoscope support device 93 via the spring 33 and inserted into the body cavity of the patient.
Next, the fitting hole 103b of the movement mechanism 103 is inserted into the fitting shaft 97b of the joint 97, and fixed with the screw 124. At this time, the third gear 105 and the second gear 101 mesh with each other.

Next, the power of the electromagnetic clutch 112 is turned on, and the moving body 94 is moved to the boundary of the movable range of the endoscope 92 in the body cavity based on the information obtained before the operation, and The power supply of the clutch 112 is turned off. A pin 111 fixed to the shaft 109 is freely rotatable from an electromagnetic clutch 112 via a pin 114 fixed to the armature 113.

The armature 113 is rotated, and the power OF is turned on.
With F, the positions of the armatures 113 and 114 are fixed. This operation may be performed carefully before or during the operation while feeling the resistance of the organ in the body cavity 2 with the operation unit 94. Accordingly, the moving range of the moving body 94 is limited to the pin 111 and the pin 114.
Limited by the contact of

In the operation scene, the operator moves the moving body 94 to a desired position in order to operate the endoscope in the body cavity as in the second and third embodiments. At this time, the fourth pulley 108 integrated with the moving body 94 rotates around the shaft 109, and the timing belt 110
8 is transmitted to the third pulley 104. Play car 1
Numerals 07a to 107f adjust the tension of the timing belt 110, change the direction in the movement mechanism 103 freely without backlash, and assist the rotation of the timing belt 110.

The third pulley 104 has a third gear 105
Rotates about the shaft 106 as a unit with the second gear 10
1 rotates around the shaft 102 as a center of rotation. The rotation of the second gear 101 is transmitted to the first gear 99, and the second pulley 98 rotates around the shaft 100. The rotation of the second pulley 98 rotates the first pulley 95 via the timing belt 115, and moves the endoscope 92. Therefore,
The movement of the moving body 94 always moves at the same angle as the movement of the endoscope 92 in the body cavity.

Here, the total length 94 a of the moving body 94 from the axis 109 is 1/1 / the total length 92 a of the endoscope 92 from the axis 96.
2, the moving amount A2 of the moving body 94 becomes a reduction system of the moving amount A1 of the endoscope 92.

According to the present embodiment, the following effects can be obtained.

A. Since the movement mechanism and the endoscope to be inserted into the body cavity are formed separately, the operation for inserting the endoscope into the body cavity is easy and can be performed in a short time.

B. Since the moving body used by the operator to operate the endoscope is a reduction system of the endoscope in the body cavity, the size is reduced and the working space of the operator is expanded.

C. An electromagnetic clutch or the like is used as the movable range restricting means, and the range of movement of the endoscope in the body cavity can be restricted with one touch, so that preoperative setting can be performed easily and in a short time.

According to each of the above embodiments, the following configuration is obtained.

(Supplementary Note 1) An endoscope that is inserted into a body cavity to capture an image of the inside of the body cavity, a display device that displays an observation image of the endoscope, and movement and magnification of the observation field of view of the endoscope In an endoscopic surgical operation system including a visual field changing unit, a treatment tool inserted into a body cavity to remove an affected part, and a treatment tool holding device for holding the treatment tool, a force applied to the treatment tool An endoscope surgical operation system, comprising: a detection unit for detecting the visual field, wherein the visual field changing unit is driven based on a detection result of the detection unit.

(Supplementary Note 2) In the endoscopic surgical operation system including an endoscope inserted into a body cavity to capture an image of the inside of the body cavity, and an endoscope support device for supporting the endoscope, An endoscope surgical operation system comprising: a movement mechanism for transmitting the movement in the body cavity to the outside of the body cavity; and a movement body that moves in a manner similar to the endoscope by the movement mechanism.

(Appendix 3) Control means for detecting the direction of the force applied to the treatment instrument by the detection means and controlling the driving of the visual field changing means of the endoscope based on the detection result of the detection means. 2. The endoscopic surgery system according to claim 1, further comprising:

(Supplementary Note 4) The control means controls the visual field state changing means to change the visual field state of the endoscope in a direction substantially the same as the direction in which the force applied to the treatment tool is applied. 2. The endoscopic surgical operation system according to claim 1, further comprising:

(Supplementary note 5) The endoscopic surgical operation system according to supplementary note 1, wherein the detecting means is a displacement detecting means for detecting a relative position of the treatment tool with respect to the treatment tool holding device.

(Supplementary note 6) The endoscopic surgical operation system according to Supplementary note 1, wherein the detecting means is a force amount detecting means for detecting a force of the treatment tool on the treatment tool holding device.

(Supplementary note 7) The detecting means according to any one of Supplementary notes 1, 3, and 5.6, wherein the detecting means is provided near a joint between the treatment tool and the treatment tool holding device. Endoscopic surgery system.

(Supplementary Note 8) Displacement detecting means for detecting a relative position of the treatment tool with respect to the treatment tool holding device includes a holding portion connected and fixed to the treatment tool holding device, and a switch moving integrally with the treatment tool. The endoscopic surgical operation system according to claim 5, further comprising an input unit, an elastic member that keeps the switch input unit spatially neutral with respect to the holding unit, and a switch that detects ON and OFF. .

(Supplementary note 9) The endoscopic surgical operation system according to supplementary note 6, wherein the force amount detecting means for detecting a force of the treatment tool on the treatment tool holding device is a strain gauge.

(Supplementary note 10) The detecting means according to any one of Supplementary notes 1, 3, 5.6.7, wherein an input can be selected to be ON or OFF by a control means. Endoscopic surgery system.

(Supplementary note 11) The endoscopic surgical operation system according to supplementary note 2, wherein the endoscope in the body cavity has at least one or more joints in the body cavity.

(Supplementary note 12) The endoscopic surgical operation system according to supplementary note 2, wherein the movement mechanism comprises a combination of parallel links.

(Supplementary note 13) The endoscopic surgical operation system according to supplementary note 2, wherein the movement mechanism comprises a timing belt.

(Supplementary note 14) The endoscopic surgical operation system according to supplementary note 2, wherein the movement mechanism reduces or enlarges the movement of the endoscope in the body cavity and transmits the reduced movement to the movement of the moving body.

(Supplementary note 15) The endoscopic surgical operation system according to Supplementary note 2, wherein an index is provided at a position equivalent to the moving body with respect to the position of the affected part with respect to the endoscope.

(Supplementary note 16) The endoscopic surgical operation system according to supplementary note 2, wherein a movable range restricting means for limiting a movable range of the endoscope is provided in the moving mechanism or the moving body.

(Supplementary note 17) The endoscopic surgery system according to supplementary note 16, wherein the movable range restricting means has a stopper capable of arbitrarily changing a movable range.

(Supplementary note 18) The endoscopic surgery according to Supplementary note 2.16 or 17, wherein the movement mechanism, the moving body, and the movable range restricting means are detachable from the endoscope. Surgery system.

[0128]

As described above, according to the first aspect of the present invention, the field of view can be easily and quickly changed without holding the treatment tool and holding the treatment tool and without being affected by the individual difference of the operator ( (Field-of-view movement, magnification change), it is possible to reduce the fatigue of the operator, to greatly reduce the time required for moving the observation field of view of the endoscope, and to improve the efficiency of the operation.

According to the second aspect of the present invention, since the operation can be performed while feeling the state of the organ which is not directly visible in the body cavity with resistance, the operation can be performed quickly, so that the operation time can be reduced and the operator's fatigue can be reduced. In addition, since the affected part can be observed from various observation angles, surgery can be easily performed. Further, since the operation section of the endoscope is located away from the patient and can be operated at will in a sufficient working space, the operation time can be reduced and the operator's fatigue can be reduced.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of an endoscopic surgical operation system according to a first embodiment of the present invention.

FIG. 2 is an exemplary perspective view of a detection unit according to the embodiment;

FIG. 3 is a sectional view of the embodiment, taken along line AA of FIG. 2;

FIG. 4 is a schematic configuration diagram of an endoscopic surgical operation system according to a second embodiment of the present invention.

FIG. 5 is an exemplary perspective view of a detection unit according to the embodiment;

FIG. 6 is a longitudinal side view of the endoscope support device and the movement mechanism of the embodiment.

FIG. 7 is a schematic configuration diagram of an endoscopic surgical operation system according to a third embodiment of the present invention.

FIG. 8 is a vertical sectional side view of the movement mechanism and the movable range restricting means of the embodiment.

FIG. 9 is a longitudinal sectional side view of an endoscope support device and a movement mechanism according to a fourth embodiment of the present invention.

FIG. 10 is an enlarged sectional view showing the same embodiment and taken along line XX in FIG. 9;

[Explanation of symbols]

 Reference Signs List 6 treatment tool 7 endoscope 8 treatment tool holding device 9 three-dimensional manipulator (view changing means) 11 detecting means 13 monitor (display device) 15 control means 23 movement mechanism 24 moving body

 ──────────────────────────────────────────────────続 き Continued on the front page F term (reference) 2H040 BA03 BA04 DA02 DA11 DA21 DA51 GA02 4C060 EE21 GG28 MM24 4C061 AA24 CC06 DD01 HH21 HH60 JJ17

Claims (2)

[Claims] 1. An endoscope which is inserted into a body cavity to image the inside of the body cavity, a display device for displaying an observation image of the endoscope, and a field of view for performing movement, zooming, and the like of the observation field of view of the endoscope. An endoscopic surgical operation system comprising: a changing unit; a treatment tool inserted into the body cavity to remove an affected part; and a treatment tool holding device for holding the treatment tool. An endoscope surgical operation system, comprising: a detection unit for detecting the position of the object, wherein the visual field changing unit is driven based on a detection result of the detection unit. 2. An endoscope surgical operation system comprising: an endoscope inserted into a body cavity to image the inside of the body cavity; and an endoscope support device for supporting the endoscope, wherein the body cavity of the endoscope is provided. An endoscope surgical operation system comprising: a movement mechanism for transmitting a movement inside the body to the outside of a body cavity; and a movement body that performs a movement similar to the endoscope by the movement mechanism.