JP2002291746A - Diagnostic apparatus in body cavity - Google Patents

Abstract

PROBLEM TO BE SOLVED: To precisely perform various types of examinations, diagnoses, etc., to be performed by inserting a hand into the body cavity. SOLUTION: An operator palpates or moves the organ by inserting the operator's hand into the body cavity and a diagnostic apparatus body 11 is installed on a finger of the hand to be inserted into the body cavity. The diagnostic apparatus body 11 comprises a fingerstall part 12 into which the operator' s finger is inserted and a tip cover part 13 closing the tip of the fingerstall part 12. The tip cover part 13 is provided with a lighting means 17 lighting the body cavity and an observation means 18 observing the both cavity inside under the lighting by the lighting means 17. The fingerstall part 12 is provided with an ultrasonic transducer 19, which is so constituted that multiple ultrasonic vibrators 19a are aligned therein to perform an electronic scanning. The fingerstall part 12 is provided with an opening part 22 so as to enable the palpation by the operator's finger.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to the insertion of an operator's hand into a body cavity, such as in the abdominal cavity or other body cavity, for palpation, etc. The present invention relates to a diagnostic device.

[0002]

2. Description of the Related Art Among endoscopes as an example of a diagnostic apparatus for a body cavity, there is an endoscope, such as a laparoscope, which performs diagnosis or treatment by being inserted directly into a body cavity from a body epidermis. Laparoscope, etc.
The endoscope to be inserted from the body epidermis is introduced into the body cavity through cylindrical guide means such as a trocar inserted in the body cavity in advance. This type of endoscope usually does not have a path for inserting a treatment tool such as forceps, that is, a treatment tool insertion channel, and includes other guide means in addition to guide means for inserting the endoscope. Is inserted into the body cavity, and the treatment tool is inserted through the guide means.

Further, not only instruments such as an endoscope and a treatment tool, but also a technique of inserting a hand of an operator or the like into a body cavity to perform a direct contact diagnosis or the like is also used. This is what is called hand assist. Furthermore, in recent years, an in-vivo diagnostic device has been developed that can be carried not only by palpation but also by putting it on the operator's finger and bringing it into the body cavity. For example, Japanese Patent Application Laid-Open No. HEI 3-1850 proposes that a case is provided at the tip of a finger sack to be attached to a finger of a hand performing hand assist, and an ultrasonic probe is provided in the case. It is configured as follows. As described above, when the ultrasonic diagnostic apparatus is attached to the finger of the operator's hand, in addition to the observation in the body cavity obtained by the laparoscopic inserted into the body cavity via the trocar and the palpation by the operator's finger, ,
By operating the ultrasonic probe, information on internal tissues can be obtained, so that the accuracy of examination and diagnosis in a body cavity can be significantly improved.

[0004]

By the way, the position of the finger inserted into the body cavity with the ultrasonic diagnostic apparatus mounted can be confirmed to some extent by an endoscope through a trocar as a guide means. Since the endoscope is constrained by the trocar, its field of view is limited. For this reason, when an ultrasonic examination is to be performed on an organ in a body cavity, for example, the back side of the liver, it cannot be performed under observation with an endoscope. Therefore, it is necessary to perform the examination in a so-called groping state, and it is not possible to acquire information such as a change in the color tone of the organ in question.

The present invention has been made in view of the above points, and an object of the present invention is to make it possible to more accurately perform various tests and diagnoses performed by inserting a hand into a body cavity. It is in.

[0006]

In order to achieve the above-mentioned object, the present invention provides a diagnostic apparatus main body having a finger insertion portion into which a finger is inserted, and a visual field including a front of a fingertip in the finger insertion portion. An endoscope observation unit, provided in the finger insertion unit, and, when a finger is inserted into the finger insertion unit, an ultrasonic wave directed to a position where the abdominal part of the finger abuts in a direction substantially orthogonal to the finger. And an ultrasonic observation unit provided with an ultrasonic transducer for transmitting and receiving the signals.

That is, the body cavity diagnostic apparatus of the present invention uses a diagnostic mechanism based on ultrasonic waves and a diagnostic mechanism based on an endoscope when an operator or the like inserts a hand into a body cavity to perform an internal examination of the body cavity. The in-vivo diagnostic device is provided so that it can be worn on a finger. In the endoscope observation section, the front comes into view from the fingertip of the finger inserted into the finger insertion section. Therefore, when the finger is advanced in the body cavity, it is possible to reliably observe the front in the advancing direction. Further, since the endoscope observation unit is provided at the tip of the finger insertion unit, the direction of the observation visual field can be easily changed by bending the finger. On the other hand, the transmitting / receiving direction of the ultrasonic wave from the ultrasonic transducer constituting the ultrasonic observation unit is a position where the abdominal part of the finger contacts. Therefore, palpation is performed with a finger wearing the in-vivo diagnostic device, and as a result, it is possible to perform ultrasonic diagnosis on a site estimated to be a lesion or the like.

Here, the configuration of the endoscope observation unit includes an illumination unit and an observation unit, and the illumination unit can be constituted by a light guide, a light emitting diode, or the like. The observation means includes an objective optical system, and a solid-state imaging means, an image guide, and the like are arranged at an image forming position of the objective optical system. The ultrasonic transducer constituting the ultrasonic observation unit can be constituted by one ultrasonic transducer, but is constituted by a predetermined number of ultrasonic transducers arranged side by side,
If electronic scanning is performed, information on tissue tomography can be easily acquired over a predetermined range without moving a finger. Palpation will be performed with the finger inserted into the finger insertion unit, but in order to be able to perform this palpation more accurately, a configuration in which an opening for palpation is formed on the distal end side from the disposition position of the ultrasonic observation unit Just do it. Also, the field of view by the endoscope observation unit includes the front part of the fingertip. Generally, the objective lens in the endoscope uses a wide-angle lens, so that a wide field of view can be obtained. Has become. Therefore, the observation field of view of the endoscope observation unit and the observation field of view of the ultrasonic observation unit can be configured to partially overlap, whereby ultrasonic diagnosis can be performed under observation of the endoscope. In addition, the opening for palpation may be configured to be within the visual field of the endoscope observation unit.

As described above, the body cavity diagnostic device includes at least the endoscope observation unit and the ultrasonic observation unit. However, a passage can be provided in the finger insertion unit, and the endoscope is provided in the passage. It can function as washing water for cleaning the mirror observation unit or as an outflow unit of an ultrasonic transmission medium for suppressing attenuation of ultrasonic waves when transmitting and receiving ultrasonic waves by the ultrasonic observation unit. Further, at a position adjacent to the ultrasonic observation unit, a treatment tool deriving unit that projects the puncture treatment tool so as to be within the range of the visual field of observation by the ultrasonic observation unit may be provided.

[0010]

Embodiments of the present invention will be described below with reference to the drawings. First, FIG. 1 shows a schematic configuration of a system for performing a diagnosis, a treatment, and the like in a body cavity using the in-vivo diagnosis device of the present invention. In FIG. 1, diagnosis and treatment are performed in the abdominal cavity. However, it goes without saying that the in-vivo diagnostic device of the present invention can be used for other purposes. In the figure, reference numerals 1a and 1b denote trocars, and the trocars have a large diameter trocar 1a and a small diameter trocar 1b according to an instrument inserted therein.
Is stabbed into the body cavity. When actually performing the predetermined processing, one to several trocars are further inserted into the body cavity. Laparoscope 2 inside the large diameter trocar 1a
However, a treatment tool 3 such as a forceps or a high-frequency treatment tool is inserted into the small-diameter trocar 1b. That is, a trocar having a thickness corresponding to the instrument inserted therein is used.

In the above-mentioned system, for example, palpation can be performed or an organ can be moved by inserting an operator's hand into a body cavity, so-called hand assist. The in-vivo diagnostic device 10 is designed to be worn on the finger of the hand inserted into the body cavity in this manner. The in-vivo diagnostic apparatus 10 incorporates an endoscope observation mechanism and an ultrasonic observation mechanism integrally, and a specific configuration thereof is shown in FIGS. 2 and 3.

First, in FIG. 2, reference numeral 11 denotes a diagnostic device main body. The diagnostic device main body 11 has a finger insertion portion into which an operator's finger is inserted. And a distal end cover portion 13 for closing the distal end of the finger sack portion 12.
Reference numeral 2 denotes an elastic member formed in a cylindrical shape, and the distal end cover portion 13 may be formed of an elastic member similarly to the finger sack portion 12, that is, it may be formed as an integral member, but a separate hard member May be configured. The endoscope observation section is provided on the distal end cover section 13, and the ultrasonic observation section is mounted on the finger sack section 12. A cord 14 is pulled out from the base end side of the finger sack portion 12, and this cord 14
And a light source connector 14a, an endoscope signal connector 14b, and an ultrasonic signal connector 1 at each end.
4c is provided.

Further, in the figures, reference numeral 15 denotes an endoscope observation device, and 16 denotes an ultrasonic observation device. The endoscope observation device 15 has a built-in light source unit and a processor for processing a video signal, and is additionally provided with a monitor 15a for displaying a video signal processed by the processor.
Further, the ultrasonic observation apparatus 16 includes a signal processing unit, and a monitor 16a for displaying an ultrasonic image obtained by processing the signal processing unit is additionally provided. Among the connectors 14a to 14c of the cord 14, the light source connector 14a and the endoscope signal connector 14b are detachably connected to the endoscope observation device 15, and the ultrasonic signal connector 14c is an ultrasonic signal connector. It is detachably connected to the observation device 16. Note that the light source unit and the processor may be configured as separate devices.

FIG. 3 shows the configuration of an endoscope observation unit and an ultrasonic observation unit which constitute the diagnostic apparatus main body 11. First, an endoscope observation unit includes an illumination unit 17 for illuminating the inside of a body cavity, and an observation unit 18 for observing the inside of the body cavity under illumination by the illumination unit 17.
It is composed of The illuminating means 17 has at least a light guide, and a divergent lens is attached to the tip of the light guide as needed. The observation means 18 includes an objective optical system 18a, a solid-state imaging device 18b, and a signal cable 18c connected to the solid-state imaging device 18b. The configuration of the ultrasonic observation mechanism includes an ultrasonic transducer 19 configured to perform electronic scanning by arranging a number of ultrasonic transducers 19 a in parallel, and a signal cable 20. The light guide 17a and the signal cables 18c and 20 are integrated into one and inserted into the cord 14. Further, the tip cover 1
3, a passage 21 is provided, and the front end of the passage 21 is open to the front end surface of the front end cover 13. Passage 2
1 is connected to a tube (not shown) which is independent of the cord 14 or
It is drawn out together with 4.

The illuminating means 17 and the observing means 18 face the distal end face of the distal end cover portion 13, and they are arranged at positions close to each other. The observation field of view by the observation means 18 includes an extension of the fingertip when the finger is inserted in front of the distal end cover 13, that is, when the finger is inserted into the finger sack 12.

On the other hand, when a finger is inserted into the finger sack portion 12, the ultrasonic transducer 19 sets the scanning range below the belly of the finger, and performs, for example, electronic convex scanning. I have. Then, in the finger sack portion 12, the mounting position of the ultrasonic transducer 19 is a position on the base side by a predetermined interval from the fingertip portion, preferably a position between the first joint and the second joint of the finger, An opening 22 is provided in a range between the second joint and the fingertip of the finger pad, and the opening 22 is an opening for palpation.

The body cavity diagnostic apparatus 10 thus configured
As shown in FIG. 1, the diagnostic device main body 11 is guided into a body cavity in a state where the diagnostic device main body 11 is inserted into a finger of an operator who performs hand assist, for example, an index finger. Here, the laparoscope 2 is previously inserted into the body cavity via at least the trocar 1a in the body cavity, and when the operator inserts a hand into the body cavity, the hand is moved within the range of the field of view of the laparoscope 2. And is displayed on the monitor of the laparoscope 2. Therefore, the operator's hand is placed under monitoring by the laparoscope 2, and the hand can be safely and directed in a desired direction. Moreover, since the diagnostic device main body 11 attached to the finger is provided with the endoscope observation unit having the observation unit 18 that has a field of view of the extension of the fingertip, the state in which the hand is advanced is inward. It can be confirmed by the monitor 15a constituting the endoscope observation device 15.

Since the finger sack portion 12 is made of an elastic member, the inserted finger can be bent. Therefore, by turning the visual field of the observation means 18 in a desired direction, it is inserted into the trocar 1a, It is possible to surely observe the state of the inner wall of the body cavity, organs, and the like at a site that cannot be observed with the laparoscope 2 having a limited field of view. Based on the observation result by the endoscope observation unit in the in-vivo diagnostic device 10, if there is a change in color tone or a change in the shape of the inner wall of the body cavity or an organ, etc., the opening 22 is arranged at the site. The finger of the surgeon can directly touch the inner wall of the body cavity through the opening 22, and the position can be palpated. In addition, not only performing palpation but also moving the finger forward with respect to that position allows the ultrasonic transducer 19 constituting the ultrasonic observation unit to abut the palpated position. Therefore, by operating the ultrasonic transducer 19 and transmitting and receiving ultrasonic waves to and from the relevant portion, information on the state of the internal tissue can be obtained. That is, since the endoscopic observation, the palpation with the finger, and the ultrasonic examination can be used together, the diagnostic accuracy is remarkably improved. In addition, since the intra-body cavity diagnostic device 10 is worn on a finger inserted into the body cavity, the laparoscope 2
It is possible to make various diagnoses on the back side of an organ that cannot be examined.

When it is determined on the basis of the above-mentioned diagnosis results that it is necessary to take measures such as removal of the affected part,
By inserting the treatment instrument 3 such as forceps or a high-frequency treatment instrument through the trocar 1b, appropriate treatment can be easily performed. Moreover, at this time, not only the observation on the laparoscope 2 side but also the endoscope observation mechanism in the diagnostic device main body 11 allows monitoring of the place where the treatment is performed, so that the treatment can be performed very accurately, It does not damage healthy tissue or leave behind the affected area. Further, since the passage 21 is provided in the distal end cover 13 constituting the diagnostic apparatus main body 11, the treatment tool can be inserted through the passage 21. Further, the liquid can be supplied from the passage 21. Examples of the liquid supplied to the passage 21 include a cleaning fluid for cleaning the surface of the objective optical system 18a,
Also, when performing an ultrasonic inspection, the ultrasonic transducer 1
It can also be used as a supply path of an ultrasonic transmission medium interposed between the inner wall 9 and the inner wall of the body cavity.

As described above, in the diagnostic apparatus main body 11, the endoscope observation unit, the ultrasonic observation unit, and the palpation by the operator's hand are possible, but the observation field of view of the endoscope observation unit is limited. By including the direction to be palpated, the exact position can be palpated. For this purpose, as shown in FIG.
The illumination means 117 and the observation means 118 are attached to the position 13 not at the tip end but at a position diagonally below. For this purpose, the front cover 113 has an arcuate surface 113.
R is formed on the lower side. Thereby, the observation means 1
The observation field of view of the objective optical system 118a constituting 18 is in the range indicated by IF in FIG. As a result, not only the front position of the fingertip is used as the observation field of view, but also a part of the extension T to the lower position side of the opening 22 provided for palpation on the lower side enters the observation field of view IF.

With this configuration, the finger is lifted from the inner wall of the body cavity, and the state of the inner wall of the body cavity and the surface of the organ is inspected by the observation means 118. If there is a place where the sex is predicted, the finger can be brought into contact with the inner wall of the body cavity while the part is in the field of view IF observed by the observation means 118, so that palpation can be performed at an accurate position. Moreover, even when the diagnostic apparatus main body 111 is in contact with the inner wall of the body cavity or an organ or the like in order to perform palpation, the objective optical system 118a constituting the observation unit 118 can be kept in a non-contact state with the inner wall of the body cavity or the like. Since it is possible, the visual field for endoscopic observation can be secured to some extent even when palpating.

Further, the diagnostic apparatus main body 211 shown in FIG.
, The objective optical system 218a in the observation means 218
If the observation field IF is made wider, and the observation range of the ultrasonic transducer 219 constituting the ultrasonic observation section is made wider so as to be SF, the endoscope observation field IF becomes palpable. Not only the direction but also the ultrasonic observation field of view can partially overlap. Therefore, both palpation and ultrasonic examination can be performed under observation by the endoscope observation unit.

Here, as shown in FIG. 6, an endoscopic observation section comprising illumination means 317 and observation means 318 is mounted as the diagnostic apparatus main body 311 and an ultrasonic transducer as an ultrasonic observation section is provided. Although 319 is attached, a configuration in which an opening for palpation is not provided may be adopted. With this configuration, the mounting position of the ultrasonic transducer 319 can be made closer to the observation unit 318, and the ultrasonic observation field of view can be made to have a large overlap with the endoscope observation field. The position where the diagnosis is performed can be more accurately recognized. In addition, since the ultrasonic transducer 319 can be arranged at a position close to the fingertip, the ultrasonic transducer 319 can be more securely brought into close contact with the ultrasonic diagnostic position. Therefore, the accuracy of the ultrasonic diagnosis is significantly improved. However, in this case, accurate palpation cannot be performed. However, for example, if the ultrasonic transducer 319 is formed of a flexible polymer material, a certain feeling can be obtained when the ultrasonic transducer 319 touches the inner wall of a body cavity or an organ. So it's not impossible to palpate at all.

When an affected part or the like is found as a result of examination or diagnosis using ultrasonic waves, it is desirable to be able to perform treatment using a puncture treatment tool. For this purpose, as shown in FIG. 7, a passage 4 for allowing the puncture treatment tool 400 to pass through the finger sack portion 412 constituting the diagnostic device main body 411.
01 may be provided. The passage 401 is provided at the finger sack portion 412 at the ultrasonic transducer 419.
Is opened at a position closer to the base end side than the position where is provided. As a result, when the puncture device 400 is drawn out of the passage 401, the puncture device 400 is
It becomes possible to capture within 19 observation fields of view SF.

Further, as shown in FIG. 8, a diagnostic apparatus main body 511 without an opening for palpation may be provided. In this case, the ultrasonic transducer 51
Numeral 9 is arranged at a position where the belly from the second joint to the fingertip comes into contact when a finger is inserted into the finger sack portion 512. The passage 501 through which the puncture device 500 is inserted is located on the near side of the position where the ultrasonic transducer 519 is provided.

4 to 8 are substantially the same as those shown in FIG. 3 except for the above-described structure. In these drawings, corresponding members are denoted by the same reference numerals.

[0027]

Since the present invention is constructed as described above, various tests and diagnoses performed by inserting a hand into a body cavity can be performed more accurately.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of a system for performing diagnosis, treatment, and the like in a body cavity using an in-body-cavity diagnosis device according to an embodiment of the present invention.

FIG. 2 is an overall configuration diagram of the in-vivo diagnostic device according to the first embodiment of the present invention.

FIG. 3 is a cross-sectional view of a diagnostic device main body in the in-vivo diagnostic device of FIG. 2;

FIG. 4 is a cross-sectional view of a diagnostic apparatus main body according to a second embodiment of the present invention.

FIG. 5 is a cross-sectional view of a diagnostic device main body according to a third embodiment of the present invention.

FIG. 6 is a cross-sectional view of a diagnostic device main body showing a fourth embodiment of the present invention.

FIG. 7 is a sectional view of a diagnostic device main body according to a fifth embodiment of the present invention.

FIG. 8 is a sectional view of a diagnostic device main body according to a sixth embodiment of the present invention.

[Explanation of symbols]

1a, 1b trocar 2 laparoscope 3 treatment tool 10 body cavity diagnostic device 11, 111, 211, 311, 411, 511 diagnostic device main body 12, 412, 512 finger sack portion 13 tip cover portion 14 code 15 endoscope observation device 16 Ultrasonic observation device 17, 117, 317 Illumination means 18, 118, 218, 318 Observation means 19, 219, 319, 419, 519 Ultrasonic transducer 21, 401, 501 Passage 22 Opening 400, 500 Puncture treatment tool

Claims (8)

[Claims] A diagnostic device main body having a finger insertion unit into which a finger is inserted; an endoscope observation unit having a visual field including a front of a fingertip in the finger insertion unit; and a finger provided in the finger insertion unit. An ultrasonic observation unit provided with an ultrasonic transducer for transmitting and receiving ultrasonic waves in a direction substantially orthogonal to the finger at a position where the abdominal part of the finger contacts when the finger is inserted into the insertion unit. In-vivo diagnostic device. 2. The endoscope observation section includes an illumination unit and an observation unit, the illumination unit includes a light guide or a light emitting diode, and the observation unit includes an objective optical system and an objective optical system. 2. The diagnostic apparatus according to claim 1, wherein a solid-state imaging means or an image guide is arranged at an image forming position. 3. The intracavity according to claim 1, wherein the ultrasonic transducer constituting the ultrasonic observation unit has a predetermined number of ultrasonic transducers arranged in parallel and performs electronic scanning. Diagnostic device. 4. The in-vivo diagnostic apparatus according to claim 1, wherein an observation field of view of the endoscope observation section and an observation field of view of the ultrasonic observation section are partially overlapped. 5. The body cavity according to claim 1, wherein an opening for palpation is formed in the finger insertion portion at a position on the distal end side of a position where the ultrasonic observation unit is disposed. Diagnostic device. 6. The diagnostic apparatus according to claim 5, wherein an observation field of view of the endoscope observation section includes a position of an extension of the opening for palpation. 7. The body cavity diagnostic apparatus according to claim 1, wherein a passage is opened at a position close to a position where the endoscope observation unit is disposed in the distal end cover unit. 8. A position adjacent to the ultrasonic observation unit,
2. The in-vivo diagnostic apparatus according to claim 1, wherein a treatment tool deriving unit that projects the puncture treatment tool so as to be within the range of the visual field of view by the ultrasonic observation unit is provided.