JP2002538873A - 制御可能な内視鏡シース - Google Patents
制御可能な内視鏡シースInfo
- Publication number
- JP2002538873A JP2002538873A JP2000604740A JP2000604740A JP2002538873A JP 2002538873 A JP2002538873 A JP 2002538873A JP 2000604740 A JP2000604740 A JP 2000604740A JP 2000604740 A JP2000604740 A JP 2000604740A JP 2002538873 A JP2002538873 A JP 2002538873A
- Authority
- JP
- Japan
- Prior art keywords
- cavity
- endoscope
- sheath
- distal end
- flexible
- 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
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
- A61B1/0051—Flexible endoscopes with controlled bending of insertion part
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/00073—Insertion part of the endoscope body with externally grooved shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/00078—Insertion part of the endoscope body with stiffening means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Biomedical Technology (AREA)
- Optics & Photonics (AREA)
- Pathology (AREA)
- Radiology & Medical Imaging (AREA)
- Biophysics (AREA)
- Engineering & Computer Science (AREA)
- Physics & Mathematics (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Endoscopes (AREA)
Abstract
Description
御可能に変位すること(deflection)が可能な作業チャンネルを具備
する内視鏡の外側のシースに関しており、更に内視鏡の操作においてシースの使
用方法に関する。
の外部場所に位置するオペレータが患者の体の内部部位において特定の外科的処
置を施すことを可能にする。一般的に内視鏡は、例えば微細なものの観察装置(
viewing device)、照明装置及び作業チャンネル等を装備する長
い可撓性の管状部材を具備する。内視鏡は、患者の外部に留まる近位端部と、患
者の体の空洞に挿入するための内視鏡チップを有する遠位端部と、を有する。
チップ14においてレンズ16を具備する。レンズ16は、観察装置17に対し
て近位に配置される。ライトは、レンズ16から発されて観察装置17により体
の空洞内の像を把握可能にし、外部モニターでの表示のために内視鏡10の管状
本体13を介して電気的又は光学的に像を伝送する。一旦伝送された像を観察し
た後で、内視鏡オペレータは、作業チャンネル18,20を介して1以上の外科
器具を挿入して、体内空洞部位において内視鏡処置を実施しても良い。これらの
内視鏡処置は、例えば患者の体の特定の内部箇所のスネア切除(snare r
esections)、注入又は生体組織検査(biospies)等を具備し
ても良い。
り、その場合には各器具が別々の作業チャンネルを介して挿入される。これらの
器具は協働するので、内視鏡チップにおけるそれらの操作性は、外科的処置が成
功する上でクリティカル(臨界的)である。しかしこの操作性は、内視鏡チップ
の直径の制約により制限されており、その内視鏡チップは順番に患者の特定の体
の空洞の寸法により管理される(dictated)。内視鏡の設計は、内視鏡
チップの直径を最小化するように改善されて、患者が感じる不快感を制限してき
た。これらの設計はしかし、内視鏡チップにおける治療装置の操作性を最大化す
ることには成功していない。例えば、従来の内視鏡の作業チャンネルは、内視鏡
と共存することに留まり、内視鏡に関して独立の動作は提示しない。その様な制
限は、それらが内視鏡の動きに追従することを強制されるので、手術部位におい
て外科器具の操作性を妨害する。
0の内部に設置されており、お互いに接近した近位に配置されており、独立した
運動性(mobility)がない状態で内視鏡に固定される。基本的には作業
チャンネル18,20は、内視鏡チップ14に達するために外科器具のための通
路を単に提供する。作業チャンネル18,20は、お互いに対してその様に接近
した近位に固定され設置されるので、内視鏡オペレータは手術部位において外科
器具に関する動きの範囲を限定してきた。この限定された運動性は、複数の外科
器具間の協働を妨げるだけではなく、より複雑な内視鏡処置における進歩の可能
性も阻害する。
器具の運動性を最適化する一方で、患者の体の空洞を介して内視鏡装置の通過を
可能にする必要な寸法的な制約を維持する、作業チャンネルを備える内視鏡装置
に関する必要性が存在する。
より明白になるかあるいは、本発明の実施により理解されても良い。本発明の利
点及び目的は、記載する請求項において特に指摘される要素及び組み合わせによ
り実現され達成されるであろう。
るように、本発明の制御可能な内視鏡シースは、内視鏡を包囲するための可撓性
の細長いシースを具備する。可撓性のシースは、シース内で且つ内視鏡に隣接し
て伸張する可撓性の作業腔を含んで、腔が内視鏡に関して且つ内視鏡の遠位チッ
プを越えて動くことを可能にする。可撓性の作業腔は変位可能な遠位端部を具備
する。内視鏡シースはまた、腔の遠位端部の変位(detlection)を制
御するために腔の遠位端部に接続する制御装置を具備する。
ワイア部材は、弾性的な記憶と同様に、自然に変位した状態を有しており、更に
ワイア部材が内視鏡の遠位チップを越えて伸張すると直ぐに、その変位させる弾
性的な記憶に戻る。腔の遠位端部は、ワイア部材の遠位端部の変位に対応して変
位する。
して配設される補強部材を具備する。腔は更に、自然に変位した状態及び弾性的
な記憶を有する変位可能な腔チップを具備する。補強部材の材料は、十分な剛性
を有して、腔チップの弾性的な記憶だけを妨げる。腔チップは、補強部材を越え
て一旦伸張すると、その当初の変位した位置に戻り、従って腔の遠位端部を変位
させる。
設された可撓性の伸張部を具備する。可撓性の伸張部は、腔に沿って腔の近位か
ら遠位端部まで伸張する可撓性の細長い部材に接続する。細長い部材は可撓性の
伸張部に偏心して(eccentrically)接続する。細長い部材の近位
の引っ張りは、可撓性の伸張部に偏心して接続する細長い部材の対応する長さを
縮小し更に可撓性の伸張部を変位させる。この変位に対応して、腔の遠位端部は
変位する。
体の空洞への内視鏡装置の挿入を具備しており、内視鏡装置は内視鏡と、内視鏡
を包囲する可撓性の細長いシースと、外科器具を含むためにシースと共に且つ内
視鏡に隣接して伸張する可撓性の腔とを有する。更に、体の空洞を介し且つ手術
部位の近位における内視鏡装置の操作と、一旦手術部位の近位に達した後、内視
鏡の遠位チップを越えた腔の遠位端部の伸張と、更に腔の伸張した遠位端部を変
位させることによる外科器具の操作と、を具備する。
を有していて腔の近位に配設される、ワイア部材を更に具備する。その様な内視
鏡装置に関して、変位する手順は、内視鏡の遠位チップを越えてワイア部材を伸
張することを具備する。
態及び弾性的な記憶を有する腔を具備する。その様な内視鏡装置に関して変位す
る手順は、内視鏡の遠位チップを越えて補強部材を伸張することを具備しており
、そこでは補強部材は、腔の遠位端部がその自然に変位する状態を保持すること
を妨げる。
撓性の伸張部に偏心して接続する細長い部材を具備する。細長い部材は、腔の近
位端部から腔の遠位端部の近位の地点まで伸張しており、可撓性の伸張部が腔の
遠位端部に存在する。その様な内視鏡装置に関して変位する手順は、細長い部材
を近位端部で引き込んで、細長い部材の遠位端部を縮め更に可撓性の伸張部を変
位させることを具備する。
分的に記載から明白になり、あるいは本発明の実施により理解されても良い。本
発明の利点は、記載する請求項において特に指摘される要素及び組み合わせによ
り実現され達成されるであろう。
けのものであり、請求項のように本発明を制限するものではないことが理解され
るべきである。 添付する図面は、本明細書の一部分に組み込まれており更にそれを構成してお
り、本発明の幾つかの実施の形態を図示しており、記述と共に本発明の原理を説
明するように機能する。
詳細に説明する。可能な場合は常に、同じ参照番号が同じ又は同様な部分の説明
のために図面を通して使用される。
は、内視鏡を包囲し更に曲げ可能な遠位端部を有する。シースは、シース内で且
つ内視鏡の外側に沿って伸張する、少なくとも一つの腔、更に好適には複数の腔
、を更に具備する。外科的部位における処置において内視鏡器具は、腔に挿入さ
れて外科的処置を実施する。腔は、内視鏡の外側に沿って設置されるので、内視
鏡の内部の作業チャンネルは除去されて、内視鏡の直径を減少可能である。内視
鏡外部に沿って腔を配置することにより、内視鏡装置の全体の横断面寸法は、減
少されても良く、従って患者の処置可能なチャンネルを介して内視鏡装置の操作
性を最適化する。
より変位するように制御されても良い。制御装置は、腔の遠位端部に接続して、
腔の遠位端部の変位を制御する。その様にシースは、操作性のある(opera
tive)チャンネルを介して、内視鏡を含む装置全体の運動性(mobili
ty)を最適化する。腔はまた、器具の遠位端部が部位により以上に接近して無
数の(myriad)方向においてお互いに対して独立に動くことを可能にする
ことにより、手術部位において外科器具の操作性を向上する。この改善された操
作性を可能にするために、腔は、テフロン、ポリプロピレン、ポリテトラフルオ
ロエチレン、テトラフルオロエチレン又はナイロン等の、可撓性プラスティック
材料から製作されることが好ましい。
内視鏡シース28は内視鏡30を包囲する。シース28は、内視鏡30の外部に
存在する近位端部36から遠位端部38まで伸張する腔32,34を具備する。
シース28はまた、腔32,34をカバーするスロット31と一体であって内視
鏡30の周囲上に伸張する、中央の覆い29を具備する。覆い29と31,及び
腔32,34は、人体への挿入に適切な材料により製作されることが好ましい。
多くは、図2と3には示されない。例えば、内視鏡装置の近位端部は、従来の内
視鏡の近位ハンドルを具備しており、本発明のシースを受容するように形成され
る。
は、説明されるべき制御装置を操作することにより、遠位端部又は手術部位にお
いて外科器具の動きを制御しても良い。外科器具の制御された動きは、腔の壁の
制御された遠位端部の変位から生じる。
、オペレータは作業箇所において外科器具に関して向上した制御を獲得する。腔
32,34は一般的に、医療器具を収容するように設計されており、内視鏡30
の周囲の付近の種々の位置に配設される。図2に示される好適な実施の形態は2
つの腔32,34を具備するが、本発明による制御可能な内視鏡シースは、内視
鏡の周囲に配置された任意の数の腔を具備しても良いことが理解されるべきであ
る。腔は内視鏡30の周りで等しい間隔を有して、オペレータに作業箇所におい
て最大範囲の動きを与えるようにすることが好ましい。例えば図2に示すように
、腔32,34は内視鏡周囲の対向する側に設置される。
挿入において、内視鏡装置の遠位端部38は一般的に平らである。言い換えれば
内視鏡30の遠位端部と、シース28と、その腔32,34とは、実質的に同じ
平面において終結して、内視鏡装置が患者に不必要な苦痛と不快感を与えないで
、体の空洞の輪郭(contours)を通り通過することを可能にする。一以
上の腔32,34が伸張する状態を有する内視鏡装置の挿入は可能であるが、伸
張する腔32,34は、内視鏡30の観察装置27の視野を妨害したり、あるい
は体の空洞の側壁に衝突する可能性があるので、それは好ましくない。
34は、オペレータが望むように内視鏡チップ40を越えて伸ばされる。腔は同
時に伸張しても良いが、各腔は独立して伸張して内視鏡オペレータに外科手術部
位における改善された遠位端部制御を提供することが好ましい。前に述べたよう
に内視鏡チップ40を越えた腔32,34の所定の伸張を可能にするために、各
腔32,34は、図3で最も良く分かるように、シース28のスロット31内に
存在する。腔32,34の動きを補助するために、腔32,34の外側面及び/
又はスロット31の内側面は、テフロン、ポリプロピレン又はナイロン等の潤滑
性被覆又は樹脂を有することが好ましい。内視鏡チップ40に対して腔32,3
4を動かすために、オペレータは近位端部において腔32,34を進めたり又は
引き込んだりする。この近位端部の操作により、腔32,34をシース28のス
ロット31内で動かす。例えば、内視鏡チップ40を越えて特定の腔32,34
の遠位端部を進めるために、オペレータは腔32,34の近位端部を外科手術部
位に向かって、望むように押す。内視鏡チップ40から腔32,34を引き込む
ために、逆の操作が実施される。腔32,34を進めたり引き込んだりするため
及び遠位端部においてそれらの変位を生じるための特定の配置を、本明細書で説
明する。
位を制御することにより、内視鏡オペレータは無数の方法で処置部位において外
科器具の位置を操作しても良い。腔32,34は、内視鏡チップ40を越えて伸
張し更にオペレータが望む任意の方向で変位して良いので、この運動性及び制御
の向上により、外科器具の適用区域は最適化される。更に腔32,34は手術(
operation)部位に、より接近して外科器具を輸送可能であるので、内
視鏡チップ40を越えて腔32,34の遠位端部を伸張することにより、オペレ
ータは外科器具及び手術に関して制御を改善可能である。例えば体の特定の空洞
において、操作チャンネルの外形は、内視鏡装置が操作チャンネルを縦走する(
traverse)ことが出来ないようなものであっても良い。その様な状態に
おいて、内視鏡30の内視鏡チップ40を越えた腔32,34の伸張及び制御に
よりオペレータは、従来の内視鏡では従来到達不能であった場所における外科的
処置を実施可能である。
具間の相互作用及び連絡が可能である。例えば、一方の器具は体の空洞内で対象
物を捕まえ更に操作しても良い一方で、他方の器具は所定の処置を実施しても良
い。腔32,34は、内視鏡30の対向する端部において分散されることが好ま
しいので、外科器具は、従来の内視鏡を使用において以前は達成不能であった種
々の角度においてお互いに連絡可能である。
るための装置を具備する。制御装置又はアクチュエータは、好適な実施の形態に
従い且つ図2と3に示されるように、ワイア部材42を具備する。ワイア部材4
2は、内視鏡装置の近位端部から遠位端部へ伸張しており、腔32,34の壁に
沿って且つ内視鏡30に隣接して伸張することが好ましい。ワイア部材42は、
腔32,34の壁の変位を補助する弾性的な記憶を有する。ワイア部材42の弾
性的な記憶は、内視鏡30及び/又は覆い29及びスロット31の剛性により妨
げられるので、ワイア部材42の遠位端部は、内視鏡30の遠位端部及び/又は
覆い29及びスロット31を越えて伸張された時だけに、その弾性的な記憶に戻
る。ワイア部材42は、ニチノール、ばね鋼又は同様な弾性特性の別の適切な材
料から形成されることが好ましい。ワイア部材42はまた、平らか又は卵型であ
ることが好ましいが、しかし別の形状の構造は本発明の範囲に含まれる。
内視鏡30に隣接して伸張する管状部材43内に含まれる。管状部材43は、腔
32,34の外側に固定するように配設されており、腔の近位端部から遠位端部
へ伸張する。管状部材43の遠位端部は、ワイア部材42が管状部材43の境界
(confines)を越えて伸張出来ないようにシールされる。管状部材43
の近位端部はしかし、ワイア部材42の近位端部の操作を可能にするように開い
ている。
らな状態、即ち単一平面に留まる。一旦手術部位に到達すると、腔32,34は
内視鏡チップ40を越えて伸張される。一旦腔32,34が望むように配置され
ると、ワイア部材42は内視鏡チップ40を越えて前進し、所定の遠位端部の変
位を生じる。管状部材43内でワイア部材42を動かすために、オペレータは近
位端部でワイア部材42を進めたり引き込んだりする。この近位端部の操作によ
り、ワイア部材42は管状部材43に関連して動かされる。管状部材43内のワ
イア部材42の動きを改善するために、管状部材43の内部は、テフロン、ポリ
プロピレン又はナイロン等の潤滑性被覆又は樹脂を有することが好ましい。ワイ
ア部材42は内視鏡チップ40を越えて伸張するので、ワイア部材42の遠位端
部はその弾性的な記憶に戻る。このワイア部材42の遠位端部の変位により、管
状部材43は変位し、そのことは順番にそれが接続する腔32,34の遠位端部
の変位を生じる。内視鏡オペレータは、ワイア部材42及び/又は腔32,34
が内視鏡チップ40を越えて伸張する距離を変化することにより、腔32,34
の遠位端部の変位の程度を制御しても良い。
プ40を越えて伸張しても良い。例えばワイア部材42は、腔32,34の壁に
固定するように取り付けられても良く(管状部材を具備しないで)、あるいはそ
れ自身が管状部材43に固定するように取り付けられても良い。その様なケース
では、ワイア部材42の遠位端部は、腔32,34の遠位端部の近位に固定する
ように取り付けられるので、独立した運動性は有さないで、内視鏡チップ40を
越えたワイア部材42の伸張は、内視鏡チップ40を越えたそれの対応する腔3
2,34の伸張に依存する。所定の遠位端部の変位を生じるために、腔32,3
4は内視鏡チップ40を越えて伸張される。腔32,34の遠位端部及びワイア
部材42は内視鏡チップ40を越えて突き出るので、内視鏡チップ40を越えて
伸張するワイア部材42の遠位端部は、その弾性的な記憶によりその自然に変位
した状態に戻る。この変位は順番に、腔32,34を変位させる。腔32,34
の遠位端部の変位の程度を制御するために、内視鏡オペレータは、腔32,34
が内視鏡チップ40を越えて伸張する距離を変化しても良い。
して伸張するかどうかに係わらず、一旦ワイア部材42が内視鏡チップ40を越
えて伸張すると、ワイア部材42はその自然に曲がった位置に戻る。ワイア部材
42の遠位端部の曲がり(curvature)は、腔32,34を変位させる
。ワイア部材42が内視鏡30を曲げるには不十分な剛性を有する弾性的な記憶
を持つので、ワイア部材42は、内視鏡チップ40を越えて前進した後だけに、
その弾性的な記憶に戻る。一旦ワイア部材42が内視鏡チップ40を越えて伸張
すると、腔32,34の遠位端部は、ワイア部材42の曲がりに対応して変位す
る。
ア部材が特定の腔を制御可能に変位するように使用されても良い。腔の壁に沿っ
て分散される追加のワイア部材は、腔の方向及び変位に関して改善された制御を
提供する。例えば、腔の周囲の種々の点に沿ってワイア部材を配置することによ
り、各ワイア部材は異なる方向の変位を制御しても良い。追加のワイア部材は、
配置されると、オペレータに多数の方向において腔の遠位端部を変位する能力を
与える。
な内視鏡シース128は、補強部材50,51を有するアクチュエータを具備す
る。更に各腔53,54は、弾性的な記憶を有する変位可能な腔チップ52を具
備する。補強部材50,51は、内視鏡30の近位端部から遠位端部へ伸張して
おり、腔チップ52の弾性的な記憶だけを妨げるのに十分な遠位端部の剛性を有
する。補強部材50,51は、シリコン、ウレタン、エクスパンド(expan
ded)テフロン(teflon)又は十分な剛性を有する別の適切な材料から
形成されても良い。
設されていて内視鏡30に近接して配置される管状部材56,58の内側に存在
することが好ましい。管状部材56,58は、腔53,54の外側に固定するよ
うに配設されており、腔の近位端部から遠位端部へ伸張する。管状部材56,5
8の遠位端部は、補強部材50,51が管状部材56,58の境界を越えて伸張
出来ないようにシールされる。管状部材56,58の近位端部はしかし、補強部
材50,51の近位端部の操作を可能にするように開いている。
する一方で、装置は実質的に平らな遠位端部を有する。言い換えれば、内視鏡3
0、シース128及びその腔53,54の各々は、同じ遠位の平面付辺で終結す
る。形成されるように、内視鏡装置は、内視鏡30の遠位端部が手術部位に到達
するまで体の空洞を縦走する。所定の遠位端部の変位を生じるために、腔53,
54は内視鏡チップ40を越えて先ず伸張される。一旦内視鏡チップ40を越え
ると、腔53,54のチップ52の弾性的な記憶は、腔53,54の遠位端部を
それらの自然の変位した状態に変位させる。この変位を妨げて更に腔53,54
の遠位端部の曲がりを制御するために、補強部材50,51は内視鏡チップ40
を超えた点まで管状部材56,58内で伸張される。オペレータは、腔53,5
4及び/又は補強部材50,51が内視鏡チップ40を越えて伸張する距離を変
化することにより、腔53,54の遠位端部の変位の程度を制御しても良い。
補強部材50,51を近位端部で進めたり引き込んだりする。この近位端部の操
作により、補強部材50,51は管状部材56,58に関して動かされる。補強
部材50,51の動きを改善するために、管状部材56,58の内部は、テフロ
ン、ポリプロピレン又はナイロン等の潤滑性被覆又は樹脂を有することが好まし
い。補強部材50,51は内視鏡チップ40を越えて伸張するので、補強部材5
0,51の遠位端部は、対応する腔53,54のチップ52の変位を妨げる。
ることにより、腔53,54のチップ52の変位を制限することにより制御可能
である。ワイア部材42の前進が遠位端部の変位を促進する第1の実施の形態と
は対照的に、補強部材50,51を内視鏡チップ40を越えて進めることは、チ
ップ52の弾性的な変位を妨げ、従って腔53,54の変位を制限する。
定の腔を制御可能に変位させるように使用されても良い。腔の壁に沿って分散さ
れた追加の補強部材は、腔の方向及び変位に関して改善された制御を提供する。
例えば、補強部材を腔の周囲の種々の点に沿って配置することにより、各補強部
材は、異なる方向の変位を制御しても良い。追加の補強部材は、配置されて、オ
ペレータに多数の方向で腔の遠位端部を変位する能力をオペレータに与える。
つ腔53,54に隣接して固定するように配設されても良い。配設されると、補
強部材の遠位端部は内視鏡30の遠位端部に沿って伸張し、腔チップ52の弾性
的な記憶を妨げるために十分な剛性を有する。所定の遠位端部の変位を生じるた
めに、前述のように、腔53,54は内視鏡チップ40を越えて伸ばされる。腔
53,54の遠位端部が内視鏡チップ40を越えて伸張するので、チップ52の
弾性的な記憶は、腔53,54の遠位端部を変位させる。腔53,54の遠位端
部の変位の程度を制御するために、内視鏡オペレータは、腔53,54の近位端
部を操作することにより腔53,54が、内視鏡チップ40を越えて伸張する距
離を変化しても良い。
鏡30の外側で腔53,54に隣接して固定するように配設されるシースガイド
60,61を具備しても良い。図6Aで最も良く分かるようにシースガイド60
,61は、ガイドピン64,65に係合するように形成される。ガイドピン64
,65は、腔53,54の壁に沿って且つ内視鏡30に隣接して固定するように
配設される。やはりシースガイド60,61の遠位端部は、腔53,54の遠位
端部の変位を妨げるために十分な剛性を有する。
鏡チップ40を越えて伸張する。腔53,54の遠位端部が内視鏡チップ40を
越えて伸張するので、ガイドピン64,65の遠位端部はもはや、シースガイド
60,61とは連絡しない。従って、それの弾性的な記憶によるチップ52の変
位は、もはやシースガイド60,61によって妨げられず、腔53,54の遠位
端部は弾性的に変位する。従って内視鏡オペレータは、どの程度距離でガイドピ
ン64,65(及びそれが取り付けられる腔53,54)の遠位端部が内視鏡チ
ップ40及びシースガイド60,61を越えて伸張するかを調整することにより
、腔53,54の遠位端部の変位の程度を制御しても良い。
可撓性の伸張部を有するアクチュエータを具備する。可撓性の伸張部は、可撓性
の細長い部材に偏心して取り付けられる。本発明に従う内視鏡シースのこの第3
の実施の形態は、図7−12に図示される。可撓性の細長い部材は、ケーブル7
0,72を具備しており、可撓性の伸張部は、球形の適合部材74,76,78
を具備しており、シース228は外側のシース82と内側のシース80とを具備
することが好ましい。球形の部材74,76,78はステンレス鋼又はプラステ
ィック材料により製作されることが好ましい。
端部へ伸張しており、そこではそれは腔153,154の遠位端部に配置された
対応する球形の適合部材74,76,78に沿って偏心して(eccentri
cally)伸張する。図9に示すようにケーブル72は、各球形の適合部材7
4,76,78を通り偏心して伸張することが好ましいが、しかしケーブル72
はこれとは別に、各球形の適合部材74,76,78の外側に沿って縦走しても
良い。
込むことを防止するために、ケーブル72の遠位端部は、図9,11と12に示
すように、停止85を具備する。停止85は、ケーブル72が縦走する通路より
も大きな表面積を有する、球形又は同様な構造であっても良い。形成されるよう
に、停止85がケーブル通路の遠位端部に拘束的に係合するので、停止85は最
も遠位端部の球形の適合部材78を越えてケーブル72を近位に引き込むことを
妨げる。
えば停止85は、ケーブル72の遠位端部を受け入れるためのチャンネルとして
作用する中空の内部を具備しても良い。形成するように、ケーブル72の遠位端
部の外側及び停止85の内側は、ケーブル72の遠位端部上の停止85の安全な
固定を可能にする補足的なネジ付き表面を具備する。これとは別にケーブル72
は、その遠位端部の停止85で永久的に含まれるように製作されても良い。特定
の構造とは関わりなく、停止85は、最も遠位端部の球形の適合部材78を越え
たケーブル72の近位への引き込みを妨げる。
ース82の内側遠位部内に存在することが好ましい。配置されるように、球形の
適合部材74,76,78は、腔153,154の遠位端部分を包囲し区画する
一方で、腔153,154の残りの部分は、腔153,154の近位端部から腔
153,154の遠位端部の近位の地点まで伸張する、内側のシース80により
包囲され区画される。内側のシース80の遠位端部は、最も近位の球形の適合部
材74に取り付けられて、外側のシース82の近位端部から遠位端部までの腔1
53,154の連続性を確保する。腔153,154の遠位端部を介して外科器
具の通過(travel)を可能にするために、球形の適合部材74,76,7
8は、内側のシース80の内側の表面寸法に実質的に等しい中空の中央通路89
を具備する(図13−15を参照)。従って腔153,154の作業チャンネル
は、内側のシース80の内側の表面寸法及び球形の適合部材74,76,78の
中央通路89により形成される。外科器具の妨害されず障害のない通路を確保す
るために、球形の適合部材74,76,78は、ステンレス鋼又はプラスティッ
ク材料により製作されることが好ましい。
雌の受容端部77を具備する。雄の端部75及び雌の受容端部77は、形状的に
お互いを補完する。特別には雄の端部75の外側の表面寸法は、雌の受容端部7
7の内側の表面寸法に近い寸法で対応する。図13に示すように端部75は、受
容端部77の円錐形状の開口に寸法的に相補的な(complimentary
)直径の球形状を具備する。この相補的形態は、接合する球形の適合部材74,
76,78のそれぞれの雄の端部75及び雌の受容端部77間の安全な接合を促
進する。球形の適合部材のそれぞれの端部を接続するために、端部75は受容端
部77内に押し込まれる。受容端部77の内部により包囲される端部75の外表
面の面積の量は、端部75を受容端部77に挿入する際に使用される力の大きさ
に依存する。一般的に力が大きいほど、受容端部77は大きく端部75を包囲し
、その反対は逆である。一旦接続されると、接合する球形の適合部材74,76
,78がお互いから無管理に(uncontrollably)分離することを
防止するために、雌の受容端部77は、接続した雄の端部75の一部を取り囲む
丸い端部99を具備する。
具備することが好ましい。スロット79は、雌の受容端部77に配設される一方
で、指標タブ81は、雄の端部75に配設される。スロット79と指標タブ81
間の相互作用は、球形の適合部材間の接続を改善し、接合する球形の適合部材7
4,76,78の可撓性を制御する。端部75が受容端部77に挿入される際に
、スロット79及び指標タブ81は、スロット79が指標タブ81を受容しても
良いように整列される。端部75を受容端部77に接続する際に発揮される力に
依存して、指標タブ81は増大又は減少する深さでスロット89内に預けられて
も良い。
直接的に依存する。例えば指標タブ81が増大するスロット深さを移動可能にす
ることは、端部75が受容端部77により深く掘り入ることを可能にし、従って
接合する球形の適合部材74,76,78の可撓性を増大する。これとは別に減
少したスロット深さは、雄の端部75の雌の受容端部77への貫入を制限し、従
って接合する球形の適合部材74,76,78の変位の程度を制限する。特定の
内視鏡処置の要求によって、球形の適合部材の設計は、内視鏡オペレータがスロ
ット79内の指標タブ81の深さを変えることにより、対応してその可撓性を変
えることを可能にする。
する構造要素は、同様に配置されることが好ましい。図9に示すように、腔15
4、球形の適合部材74,76,78及びケーブル72は、2つの別個のシース
内にあることが好ましい。第1のシース、内側のシース80は、内視鏡の近位端
部から内視鏡の遠位端部の近位の地点まで伸張する。内側のシース80の遠位端
部は、球形の適合部材74,76,78で終結しており、最も近位端部の球形の
部材74に接続することが好ましい。腔154は従って、内側のシース80の内
部及び球形の適合部材74,76,78の中央通路89により区画される。内側
のシース80の近位及び遠位端部、及び中央通路89は、腔154の内部を介し
て外科器具の動きを妨げないように開いている。
ことが好ましい。ケーブル72はしかし、内側のシース80の壁内又はシース8
0の内側に沿ってやはり伸張しても良い。第2のシース、外側のシース82は、
球形の適合部材74,76,78と、ケーブル72と、内側のシース80と、腔
154とを収容する。外側のシース82は、内視鏡30の外側に沿って固定され
るように配設されており、内視鏡30の近位端部から遠位端部まで伸張する。配
置されるように外側のシース82は、シース228のスロットとして作用し、そ
こではそれは内視鏡30に関して、内側のシース80と球形の部材74,76,
78とケーブル72と腔154との動きを可能にする。外側のシース82の遠位
端部は、内側のシース80と球形の部材74,76,78とケーブル72と腔1
54とが内視鏡チップ40を越えて伸張可能にするように開いている。外側のシ
ース82の近位端部は同様に、ケーブル72と内側のシース80との近位端部の
操作を可能にするように開いている。
実質的に平らな遠位端部により横切っており、そこでは各内視鏡及びシースがそ
の腔と共に、同じ平面の周囲において遠位で終結する。一旦手術部位に達すると
、内視鏡オペレータは内視鏡装置の近位端部を操作することにより、内視鏡チッ
プ40を越えて更に手術部位の近位で一以上の腔153,154を伸張する。
ペレータにより手術部位に向かって進められる。外側のシース82内の内側のシ
ース80の動きを改善するために、外側のシース82の内側及び/又は内側のシ
ース80外側は、テフロン、ポリプロピレン又はナイロン等の潤滑性材料から構
成されることが好ましい。腔153,154は、内側のシース80の内側により
区画され更に中央通路89に取り付けられるので、内側のシース80の近位端部
の動きは、腔153,154の同様な遠位端部の動きに対応する。記載したよう
に内側のシース80の遠位端部は、最も近位端部の球形の適合部材74において
終結してそれに取り付けられる。従って、内側のシース80の近位端部が手術部
位に向かって進められるので、内側のシース80の遠位端部は同様に、球形の適
合部材74,76,78を進める。球形の適合部材74,76,78の進行は、
最も近位端部の球形の部材の腔154の遠位端部への取り付けと同様に、内側の
シース80の近位の進行に対応する内側のシース80の遠位の進行を確保する。
ル70,72の近位端部を操作して腔153,154の必要な遠位端部の変位を
形成する。挿入時に球形の適合部材74,76,78は、図9に示すように、お
互いに対して緩く向き合う。言い換えればケーブル70,72の遠位端部には、
球形の適合部材74,76,78を強制的に隣接させるには不十分な引っ張りが
作用する。内視鏡オペレータはケーブル70,72の近位端部を引き込むので、
球形の適合部材74,76,78に接続するケーブル70,72の対応する長さ
は縮まる。このケーブル70,72長さの縮小は、ケーブル70,72の遠位端
部を球形の適合部材74,76,78に沿って、停止85が最も遠位端部の球形
の適合部材78に係合するまで、近位に引き込ませる。この特定の点においてケ
ーブル70,72の引っ張りは、球形の適合部材74,76,78を強制的にお
互いに隣接させる。球形の適合部材74,76,78がお互いに対して密着して
整列させられ更に停止85は、ケーブル72が球形の部材74を通り引き込むこ
とを防止するので、ケーブル72の連続的な近位端部の引き込みは、図12に示
すように球形の部材74,76,78の整列における曲げを生じる。腔154の
遠位端部は、球形の部材74,76,78の中央通路89に対応しており、球形
の適合部材の曲げ整列に対応して変位する。腔153,154の遠位端部の変位
量を制御するために、内視鏡オペレータは近位方向におけるケーブル70,72
の引き込みを変化して球形の適合部材74,76,78に形成される曲げ量を制
御しても良い。
すが、追加のケーブルがそれぞれの球形の部材に沿って偏心して配置されて、腔
の遠位端部の変位の方向に関する制御を改善しても良い。各ケーブルが、球形の
部材に沿って偏心して(eccentrically)配置される際に、異なる
方向の変位を制御しても良いので、これらの追加のケーブルはオペレータに、多
数の方向で腔の遠位端部を変位する能力を与える。加えて、3つ以上又は以下の
球形の部材が、腔の遠位端部の変位の程度において精度の高低を提供するように
使用されても良い。
の内視鏡装置及びこの内視鏡装置の構造において実施され得ることが、当業者に
は明白である。
考慮することにより当業者にとって明白である。本明細書及び実施例は、記載さ
れる請求項により指示される本発明の真の範囲及び精神と共に、例示としてのみ
考慮されることが意図されている。
図である。
分立体図である。
分立体図である。
を越える腔の伸張を示す。
示す。
組み込まれるような球形の適合部材の側面図である。
Claims (24)
- 【請求項1】 内視鏡と共に使用するためのシース装置において、このシー
ス装置が、 内視鏡を包囲するための可撓性の細長いシースであって、シース内で且つ内視
鏡に隣接して伸張していて腔を内視鏡に関して且つ内視鏡の遠位チップを越えて
動かすことを可能にする、可撓性の腔を前記シースが有しており、腔が変位可能
な遠位端部を有する、前記細長いシースと、 腔の遠位端部の変位を制御するために可撓性の腔に接続する制御装置と、 を具備するシース装置。 - 【請求項2】 制御装置は、腔の遠位端部の変位を制御するために腔の遠位
端部に接続する請求項1に記載の装置。 - 【請求項3】 可撓性の腔は、手術部位への外科器具の搬送を可能にするよ
うに形成される請求項1に記載の装置。 - 【請求項4】 該制御装置は、可撓性の腔に配設されたワイア部材を具備し
ており、 ワイア部材は、自然に変位した状態と、ワイア部材が内視鏡の遠位チップを越
えて伸張するので自然に変位した状態にワイア部材を戻す弾性的な記憶と、を有
する請求項2に記載の装置。 - 【請求項5】 該制御装置は、ワイア部材を含む第2の腔を具備しており、 第2の腔は可撓性の腔の壁に沿って配設されており、 それによりワイア部材は、第2の腔に関して動く請求項4に記載の装置。
- 【請求項6】 該ワイア部材は、ニチノール及びばね鋼のうちの一つから形
成される請求項4に記載の装置。 - 【請求項7】 該制御装置は、腔の外側に沿って且つ内視鏡に隣接して配設
される補強部材を具備しており、更に 腔の遠位チップは、自然に変位した状態と、腔が補強部材及び内視鏡の遠位チ
ップを越えて伸張するので、自然に変位した状態に遠位チップを戻す弾性的な記
憶とを有する請求項2に記載の装置。 - 【請求項8】 該制御装置は、補強部材を含む第2の腔を具備しており、 第2の腔は可撓性の腔の壁に沿って配設されており、 それにより補強部材は、第2の腔に関して動く請求項7に記載の装置。
- 【請求項9】 該補強部材は、内視鏡の外側に沿って且つ腔に隣接して配設
されるシースガイドであり、更に 腔は、腔の外側に沿って且つ内視鏡に隣接して配設されるガイドピンを具備し
ており、シースガイドはガイドピンに係合する請求項7に記載の装置。 - 【請求項10】 該制御装置は、腔の近位端部から遠位端部まで伸張する可
撓性の細長い部材を具備しており、 可撓性の細長い部材は、腔に偏心して接続しており、 そこでは近位方向における細長い部材の引き込みは、腔の遠位端部を変位させ
る請求項2に記載の装置。 - 【請求項11】 該細長い部材はケーブルである請求項10に記載の装置。
- 【請求項12】 シースの遠位端部内で伸張する複数の球形の適合部材を更
に具備しており、 各複数の球形の適合部材は中央通路を具備しており、 腔の遠位端部は中央通路により包囲され且つ区画される請求項11に記載の装
置。 - 【請求項13】 シースは、組紐(braid)、乳液(latex)、ポ
リプロピレン及びポリウレタンの1つから構成される請求項1に記載の装置。 - 【請求項14】 腔の外面の1つ及びシースの対応する内面は、シースに関
して腔の動きを改善するための潤滑性材料を具備する請求項1に記載の装置。 - 【請求項15】 シース内で且つ内視鏡に隣接して伸張する複数の可撓性の
腔を更に具備する請求項1に記載の装置。 - 【請求項16】 複数の可撓性の腔は、内視鏡の対向する側に配置された2
つの可撓性の腔を具備する請求項15に記載の装置。 - 【請求項17】 該腔は、可撓性のプラスティック材料から形成される請求
項1に記載の装置。 - 【請求項18】 該可撓性のプラスティック材料は、テフロン(登録商標) 、ポリプロピレン、ポリテトラフルオロエチレン、テトラフルオロエチレンとナ イロンの1つからなる請求項17に記載の装置。
- 【請求項19】 内視鏡装置において、この内視鏡装置が、 内視鏡と、 内視鏡を包囲するための可撓性の細長いシースであって、シース内で且つ内視
鏡に隣接して伸張する可撓性の腔を前記シースが有しており、腔が内視鏡の遠位
チップを越えて伸張可能であって更に変位可能な遠位端部を有する、前記細長い
シースと、 腔の遠位端部の変位を制御するために可撓性の腔に接続する制御装置と、 を具備する内視鏡装置。 - 【請求項20】 内視鏡処置において内視鏡装置を使用するための方法にお
いて、内視鏡装置が、内視鏡と、内視鏡を包囲する可撓性の細長いシースと、外
科器具を含むためにシース内で且つ内視鏡に隣接して伸張する可撓性の腔と、を
有しており、 前記方法が、 患者の体の空洞へ内視鏡装置を挿入する手順と、 体の空洞を介して且つ手術部位の近位において内視鏡装置を操作する手順と、 内視鏡の遠位チップを越えて腔の遠位端部を伸張する手順と、更に 腔の伸張した遠位端部を変位させて外科器具を操作する手順と、 を具備する内視鏡装置を使用するための方法。 - 【請求項21】 伸張する手順は、遠位方向において腔の近位端部を進める
ことを具備する請求項20に記載の方法。 - 【請求項22】 内視鏡装置は、弾性的な記憶を有していて腔に隣接して配
設されるワイア部材を具備しており、 変位させる手順が、内視鏡の遠位チップを越えてワイア部材を伸張することを
具備する請求項20に記載の方法。 - 【請求項23】 腔は、自然に変位する状態及び弾性的な記憶を遠位端部に
有しており、 変位する手順は、内視鏡の遠位チップを越えて補強部材を伸張することを具備
しており、 腔の遠位端部が自然に変位する状態を保持することを、補強部材が妨げる請求
項20に記載の方法。 - 【請求項24】 腔は、腔に沿って伸張していて遠位端部において腔に配設
される可撓性の伸張部に偏心して接続する、細長い部材を有しており、 変位する手順は、近位方向で細長い部材を引き込んで可撓性の伸張部を変位さ
せることを具備する請求項20に記載の方法。
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US09/267,109 | 1999-03-12 | ||
US09/267,109 US6179776B1 (en) | 1999-03-12 | 1999-03-12 | Controllable endoscopic sheath apparatus and related method of use |
PCT/IB2000/000251 WO2000054653A1 (en) | 1999-03-12 | 2000-03-09 | Controllable endoscopic sheath |
Publications (2)
Publication Number | Publication Date |
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JP2002538873A true JP2002538873A (ja) | 2002-11-19 |
JP4663884B2 JP4663884B2 (ja) | 2011-04-06 |
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US (6) | US6179776B1 (ja) |
EP (1) | EP1161174B1 (ja) |
JP (1) | JP4663884B2 (ja) |
AU (1) | AU2821400A (ja) |
CA (1) | CA2364059A1 (ja) |
DE (1) | DE60028014T2 (ja) |
IL (2) | IL145379A0 (ja) |
WO (1) | WO2000054653A1 (ja) |
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IL145379A (en) | 2006-04-10 |
EP1161174B1 (en) | 2006-05-17 |
US8444551B2 (en) | 2013-05-21 |
US7070559B2 (en) | 2006-07-04 |
JP4663884B2 (ja) | 2011-04-06 |
US20010000040A1 (en) | 2001-03-15 |
DE60028014D1 (de) | 2006-06-22 |
WO2000054653A1 (en) | 2000-09-21 |
AU2821400A (en) | 2000-10-04 |
US7951072B2 (en) | 2011-05-31 |
US6179776B1 (en) | 2001-01-30 |
DE60028014T2 (de) | 2006-12-21 |
US20110257479A1 (en) | 2011-10-20 |
US20060264705A1 (en) | 2006-11-23 |
EP1161174A1 (en) | 2001-12-12 |
US6761685B2 (en) | 2004-07-13 |
US20130237760A1 (en) | 2013-09-12 |
US9289111B2 (en) | 2016-03-22 |
IL145379A0 (en) | 2002-06-30 |
US20040111009A1 (en) | 2004-06-10 |
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