JP2003159257A - Medical instrument guiding apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical instrument guiding apparatus in which manipulation of a functional part (for example, a clamping forceps, a bioptome, a biopsy brush, an ultrasonic probe) of a treating member can be steadily and easily carried out, by enhancing the using condition of the treatment tool. <P>SOLUTION: A treating section 13 of the treatment tool 10 is guided to a position close to an affected area H3 within a body lumen of a patient H in the longitudinal direction of a sheath 8 using a rail portion 9 by detachably engaging a c-shaped projecting part 14 of the treatment tool 10 with the rail part 9 of the sheath 8. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical instrument guide apparatus used in an endoscopic treatment apparatus for observing and treating a lesion with an endoscope.

[0002]

2. Description of the Related Art An endoscopic treatment apparatus for treating a lesion in a body cavity with a treatment tool under the observation of an endoscope has been conventionally known. In this endoscopic treatment device, the operator needs to guide the treatment tool to the field of view of the endoscope. In particular, in the case of neurosurgery, an endoscope or a treatment tool is used by inserting it into a deep hole-shaped surgical site opened on the body surface. At this time, the operator must carefully insert the treatment instrument while directly checking the tip of the treatment instrument.

Further, in the prior art relating to this type of endoscopic treatment device, there is, for example, one in which the endoscope or the treatment tool is formed into a crank shape so that the operator can directly directly see the distal end portion of the treatment tool being inserted. is there.

Furthermore, a treatment instrument insertion conduit, such as a known sheath or a known instrument insertion channel provided in an endoscope, is provided, and the treatment instrument is inserted into the treatment instrument insertion conduit. It is also known that by doing so, the operation of inserting the treatment tool is facilitated.

Also, for example, Japanese Patent Laid-Open No. 2000-166936.
The publication discloses a device that uses a combination of a treatment tool and a sheath. Here, a technique is shown in which the degree of freedom of the treatment range by the treatment instrument is expanded and the treatment range is widened by guiding the treatment instrument by the treatment instrument insertion conduit of the sheath.

Further, Japanese Patent Application Laid-Open No. 10-295626 discloses a structure in which an endoscope is provided in one blade of a retractor having two blades and an insertion space for a treatment tool is provided between the two blades. It is shown. Furthermore, JP-A-5
JP-A-307143 discloses a treatment tool guide using a guide tube.

[0007]

However, in an example in which the endoscope or the treatment tool is formed into a crank shape, it becomes easy for the operator to confirm the treatment tool being inserted, but the operation of inserting the treatment tool itself is difficult. However, there is no improvement in terms of relying on the skill of the surgeon. Therefore, the operator still has to carefully insert the treatment tool, which may cause fatigue of the operator particularly in a long-time operation, which may lower the efficiency of the operation itself.

Further, in the case where there is a treatment instrument insertion conduit like a sheath, the treatment instrument can be easily guided from outside the body cavity to within the field of view of the endoscope inside the body cavity. However, in this case, since the treatment tool can be operated only straight ahead along the axial direction of the treatment tool insertion conduit of the sheath, there is a limit to the treatment capability.

When a treatment tool and a sheath are used in combination as in Japanese Patent Laid-Open No. 2000-166936, the treatment tool can be easily guided by the treatment tool insertion conduit of the sheath, and the treatment range is widened. However, in this case, the device becomes large and complicated, and the operation of the treatment becomes complicated, so that the device becomes expensive and the operation of the treatment tool becomes complicated.

Further, in Japanese Patent Laid-Open No. 10-295626, there is a problem that the retractor itself narrows the operation space of the treatment instrument, and body tissues such as nerve tissue and vascular tissue that cannot be excluded into the body cavity. Cannot be used if is present.

Further, when a guide tube is used as in Japanese Patent Laid-Open No. 5-307143, the operation of the treatment tool is restricted by the distal end opening of the tube at the site of the subject to be medically treated. Furthermore, the movement of the proximal operation portion of the treatment instrument is restricted by the proximal end opening of the tube, which makes it difficult to use the treatment instrument in the use state desired by the operator. That is, conventionally, the degree of freedom in operating the treatment tool is significantly limited in the region where the medical treatment is desired.

The present invention has been made in view of the above circumstances, and an object thereof is to improve the usage state of a treatment tool and to provide a functional part of the treatment tool (for example, grasping forceps, biopsy forceps, biopsy brush, ultra-fine probe, and so on). It is intended to provide a medical instrument guide device capable of stably and easily operating a sonic probe or the like).

[0013]

According to a first aspect of the present invention, there is provided a medical instrument having a medical function portion for performing medical treatment on a subject, and a medical instrument having a predetermined length, wherein the medical treatment is performed on the subject. A medical instrument guide whose one end can be arranged in the vicinity of the target site of the action, a guiding means capable of guiding the medical function section along the length direction of the medical instrument guide, and the medical function section of the medical instrument. A medical instrument guide device, comprising: an engaging means provided in the vicinity of the engaging means, which engages with the guiding means in a disengageable manner. Then, the present claim 1
In the invention, the engaging means of the medical instrument is removably engaged with the guiding means of the medical instrument guide, and the medical function part of the medical instrument is covered by the guiding means along the length direction of the medical instrument guide. The sample can be guided to a position in the vicinity of the target site of medical treatment.

According to a second aspect of the present invention, the medical instrument guide has an outer tube into which another medical instrument different from the medical instrument can be inserted, and the outer tube has an outer peripheral surface along the axial direction of the outer tube. 2. The medical device guide apparatus according to claim 1, wherein the guiding means is extended. In the invention according to claim 2, the guide means on the outer peripheral surface of the mantle tube can guide the medical function part of the medical device along the axial direction of the mantle tube to a position near the target site of the medical procedure in the subject. It was done.

The invention according to claim 3 is the medical instrument guide apparatus according to claim 1, wherein the guiding means is made of a magnetizable material, and the engaging means is made of a magnetic material. Further, in the invention of claim 3, the guiding means of the magnetizable material is made to attract and engage the engaging means of the magnetic body.

[0016]

BEST MODE FOR CARRYING OUT THE INVENTION A first embodiment of the present invention will be described below with reference to FIGS. 1 to 3A and 3B. FIG. 1 shows a state in which a head H1 of a patient H on an operating table 2 is being surgically operated using the endoscopic treatment apparatus 1 incorporating the medical instrument guide apparatus according to the present embodiment. .

As shown in FIG. 2, the endoscopic treatment device 1 is provided with an endoscope 3 for confirming a surgical site.
The endoscope 3 is attached to a distal end of a multi-joint holding arm 4 whose base end is fixed to the operating table 2.

Further, the endoscope 3 is provided with an eyepiece 3b at the base end portion of a long and thin straight tubular rigid insertion portion 3a. A television camera head 5 such as a CCD camera is attached to the eyepiece 3b. Further, the television camera head 5 is connected to a monitor 7 via a controller 6 which is a video processing device.

Further, the head H1 of the patient H is preliminarily formed with a hole H2. Then, the endoscope 3 held by the holding arm 4 is inserted into the head H1 through the hole H2 of the head H1 of the patient H. Further, the optical image of the lesion H3 in the head H1 observed by the endoscope 3 is captured by the television camera head 5 of the eyepiece 3b,
At this time, the endoscopic image taken by the television camera head 5 is transmitted to the monitor 7 and can be displayed on the monitor 7. Then, the operator can observe the lesion H3 by the observation image of the endoscope 3 displayed on the monitor 7.

Further, on the outer peripheral surface of the insertion portion 3a of the endoscope 3, a sheath mounting portion 3 having, for example, a male screw shape is formed at an end portion on the eyepiece 3b side.
c is formed. A tubular sheath (medical instrument guide) 8 is attached to the sheath mounting portion 3c. As shown in FIG. 3A, a rail portion (guide means) 9 having a substantially circular cross section is provided on the outer peripheral surface of the sheath 8 along the length direction of the sheath 8.

Further, at the base end portion of the sheath 8, there is a screw hole portion 8 which is screwed into a male screw portion of the sheath mounting portion 3c of the endoscope 3.
a is formed. Then, with the insertion portion 3a of the endoscope 3 inserted in the sheath 8, the male screw portion of the sheath mounting portion 3c of the endoscope 3 is screwed into the screw hole portion 8a of the sheath 8. A sheath 8 is attached to the endoscope 3.

Further, the rail portion 9 of the sheath 8 is formed with an inclined surface-shaped insertion end portion 9a at the end portion on the screw hole portion 8a side. Further, the rail end portion 9 at the other end of the rail portion 9
b is arranged in the vicinity of the endoscope protruding end portion from which the distal end portion of the endoscope 3 projects. The rail end portion 9b forms the engagement release portion of the present embodiment.

In the endoscopic treatment device 1, the treatment tool (medical instrument) 10 for treating the lesion H3 in the body cavity is the endoscope 3.
Used with. The treatment tool 10 includes an elongated shaft 1
A grasping portion 12 that is grasped by an operator is provided at one end portion of 1, and a treatment portion (medical function portion) 13 that treats the lesion H3 is provided at the other end portion.

Further, a substantially C-shaped C-shaped projection (engaging means) 14 is provided on the outer peripheral surface of the end of the treatment instrument 10 on the side of the treatment portion 13 of the treatment instrument 10. The C-shaped projection 14 is detachably engaged with the rail portion 9 of the sheath 8. Here, the width L1 of the rail portion 9 shown in FIG.
3B and the width L2 of the opening 14a of the C-shaped projection 14 shown in FIG. 3B, the respective dimensions are set so that L2 <L1.

Next, the operation of the medical device guide apparatus according to this embodiment will be described. Here, the head H1 of the patient H on the operating table 2 using the endoscopic treatment device 1 having the above-described configuration.
The operation of performing the surgical operation will be described. First, the endoscope 3 is inserted into the head of the patient H through a hole H2 formed in the head H1. Then, at the desired position, the holding arm 4
Fixed by. During this work, the operator can observe the lesion H3 by the observation image of the endoscope 3 displayed on the monitor 7. At this time, the insertion end portion 9 of the rail portion 9
a is outside the body cavity of the patient, and the rail end portion 9b is inside the body cavity.

Then, the treatment tool 10 is inserted into the lesion H3. In this case, as shown in FIG. 2, the operator inserts the C-shaped protrusion 14 of the treatment instrument 10 into the insertion end 9 a of the rail 9 of the sheath 8.
Insert and engage. At this time, the relationship between the width L2 of the opening 14a of the C-shaped protrusion 14 and the width L1 of the rail 9 is L2.
By being set to <L1, once the C-shaped protrusion 14 of the treatment instrument 10 is engaged with the rail portion 9 of the sheath 8, the C-shaped protrusion 14 can move only along the rail portion 9. Become. That is, the operator can guide the treatment tool 10 along the axial direction of the sheath 8 in the direction of the lesion H3, and the treatment tool 10 does not detach from the sheath 8 during the guide.

When the C-shaped projection 14 of the treatment instrument 10 is guided to the rail terminal end 9b of the rail 9, the engagement between the C-shaped projection 14 and the rail 9 is naturally released. Here, by disposing the rail end portion 9b in the vicinity of the distal end portion of the endoscope 3, the treatment portion 13 of the treatment instrument 10 is disposed in the endoscope 3.
Is dissociated near the field of view.

Therefore, the medical device guide device of the present embodiment having the above-described structure has the following effects. That is,
In the medical device guide apparatus according to the present embodiment, the C-shaped protrusion 14 of the treatment instrument 10 is detachably engaged with the rail part 9 of the sheath 8 so that the treatment instrument 10 can be operated by the rail part 9.
The treatment portion 13 can be easily guided along the length direction of the sheath 8 from outside the body cavity of the patient to a position in the body cavity in the vicinity of the lesion H3. Therefore, when the treatment tool 10 is inserted into the lesion H3 in the body cavity observed by the endoscope 3 and the treatment operation is performed, the insertion operation of the treatment tool 10 can be performed more easily than before. Therefore, the usage state of the treatment instrument 10 can be improved, and the operation of the treatment section 13 of the treatment instrument 10 can be stably and easily performed. As a result, it is possible to reduce the working time of the operation by the endoscopic treatment device 1 and the fatigue of the operator, and it is possible to improve the efficiency of the operation.

Further, in the medical instrument guide device according to the present embodiment, the rail portion 9 is provided on the sheath 8 and the sheath 8 according to the present embodiment is simply attached to the existing endoscope 3. Since the device can be easily provided, there is an effect that it can be implemented at low cost.

Further, in the medical instrument guide device according to the present embodiment, the C-shaped protrusion 14 is locally provided at the substantially distal end of the treatment instrument 10. Therefore, the C-shaped protrusion 14 is detached at the rail terminal end 9b. After that, the treatment tool 10 is not subjected to any restriction from the endoscope 3 or the sheath 8 after that. Therefore, the degree of freedom in operating the treatment instrument 10 in the vicinity of the lesion H3 in the body cavity of the patient can be significantly increased.

Further, FIGS. 4 to 7 show a second embodiment of the present invention. This embodiment is the above-mentioned first
The configuration of the medical device guide apparatus according to the embodiment (see FIGS. 1 to 3A and 3B) is modified as follows. In addition, in the present embodiment, the same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted.

That is, in the medical device guide apparatus according to the present embodiment, a substantially cylindrical rotary cylinder 21 is provided outside the insertion portion 3a of the endoscope 3. Here, as shown in FIG. 5, a flange-shaped protrusion 22 is formed at the tip of the insertion portion 3a. The rotary cylinder 21 is supported between the projection 22 and the eyepiece 3b in a rotatable state around the axis of the insertion section 3a.

Further, as shown in FIG. 6, a large-diameter endoscope insertion hole 23 is provided in the rotary cylinder 21 so as to extend in the axial direction of the rotary cylinder 21. The endoscope insertion hole 23 is formed in the rotary cylinder 21.
It is arranged at a position decentered from the axial center position. Then, the insertion portion 3a of the endoscope 3 is inserted into the endoscope insertion hole 23.

A guide groove portion 24 having a diameter smaller than that of the endoscope insertion hole 23 is provided in the outer peripheral portion of the rotary cylinder 21 so as to extend in the axial direction of the rotary cylinder 21. The guide groove portion 24 is arranged in a thick portion in the peripheral wall of the endoscope insertion hole 23. Both end surfaces of the guide groove portion 24 are arranged at both end portions of the rotary cylinder 21, respectively. That is, at one end of the guide groove portion 24, an insertion end portion 24a, which is arranged in the vicinity of the eyepiece portion 3b of the endoscope 3 and is obliquely cut, is formed. Further, at the other end of the guide groove portion 24, there is formed a detaching end portion 24b which is disposed in the vicinity of the projecting portion 22 at the tip portion of the endoscope 3 and serves as a detaching means in the present embodiment.

The cross-sectional shape of the guide groove 24 is
As shown in FIG. 6, it is formed in a substantially circular shape having a diameter D1. An opening 24c having a groove width L3 smaller than the diameter D1 is formed in the guide groove 24.

Further, in the treatment instrument 10 of the present embodiment, an elongated hole-shaped ball end accommodating concave portion 25 is formed on the outer peripheral surface of the distal end portion of the elongated shaft portion 11. A base end of a support shaft 26 is rotatably supported around a pin 27 on the base end side of the ball end housing recess 25. As shown in FIG. 7, a substantially spherical ball end 28 having a diameter D2 is integrally formed at the tip of the support shaft 26. The support shaft 26 is pulled out to the outside of the ball end accommodating recess 25 as shown by a solid line in FIG. 7, and the ball end 28 is shown as a dotted line in FIG. It is rotatably supported between the housing position of 25 and the housing position.

Further, a coil spring 29 is arranged with a preload between the inner bottom portion of the ball end accommodating recess 25 on the base end side and the support shaft 26. The support shaft 26 is normally biased by the biasing force of the coil spring 29 in the direction in which the ball end 28 is housed in the ball end housing recess 25.

The diameter D2 of the ball end 28 and the substantially circular diameter D1 of the cross section of the guide groove portion 24 are set to satisfy the relationship of D2 <D1. Further, the diameter D2 of the ball end 28 and the width L2 of the opening 24c of the guide groove portion 24 are set to have a relationship of L3 <D2.

Then, as shown in FIG. 4, the ball end 28 of the treatment instrument 10 is moved to the pulled-out position where it is pulled out of the ball-end accommodating recess 25, and the ball end 28 is brought into contact with the endoscope 3. It can be inserted into the inclined insertion end 24a of the guide groove 24 of the rotary cylinder 21 at a position near the portion 3b. That is, from one viewpoint, in the present embodiment, the rotary cylinder 21 functions as a medical device guide, the guide groove portion 24 functions as a guiding means, and further, the ball end 28 and the ball end 28. The structure for rotatably supporting the function as engaging means.

Next, the operation of the medical device guide apparatus of the present embodiment having the above-mentioned structure will be described. In the present embodiment, the insertion portion 3a of the endoscope 3 is previously inserted from outside the body of the patient H into the hole H2 of the head H1 and is set at a position close to the vicinity of the lesion H3 in the body cavity. Then, the treatment tool 10
Is inserted into the body of the patient H. At this time, before inserting the treatment instrument 10 into the body of the patient H, as shown in FIG. 4, the ball end 28 of the treatment instrument 10 is resisted against the spring force of the coil spring 29 to move outside the ball end accommodation recess 25. Move it to the pulled out position.

Thereafter, the operator operates the treatment tool 10 outside the body of the patient H.
The ball end 28 is inserted into the insertion end portion 24a of the guide groove portion 24 of the rotary cylinder 21 and engaged therewith. Here, since the rotary cylinder 21 is rotatable about the axis of the insertion portion 3 a of the endoscope 3, the operator can arrange the guide groove portion 24 in any direction of the endoscope 3.

The relationship between the width L3 of the opening 24c of the guide groove 24 and the diameter D2 of the ball end 28 is L3 <D.
Since it is set to 2, when the ball end 28 is engaged with the guide groove portion 24, the ball end 28 can move only along the guide groove portion 24. That is, the operator places the treatment tool 10 along the endoscope 3 to move the lesion H3.
Can be guided in the direction of, and the ball end 28 of the treatment instrument 10 is guided by the guide groove portion 2 of the rotary cylinder 21 during the guidance.
Since it is not separated from the endoscope 4, the treatment instrument 10 being guided is not separated from the endoscope 3.

Further, the ball end 28 of the treatment instrument 10
However, when guided to the disengagement end 24b of the guide groove 24, the ball end 28 is naturally disengaged from the disengagement end 24b, and the engagement between the guide groove 24 and the ball end 28 is released. At this time, the detached treatment instrument 10 has no restriction from the endoscope 3, and therefore, the lesion H3 in the body cavity is not present.
An operator can freely operate the treatment tool 10 at a position near the position.

The ball end 28 separated from the guide groove 24 of the rotary cylinder 21 is automatically housed in the ball end housing recess 25 of the treatment instrument 10 by the spring force of the coil spring 29.

Therefore, according to the present embodiment having the above-described structure, the ball end 28 of the treatment instrument 10 is removably engaged with the guide groove portion 24 of the rotary tubular body 21, so that the rotary tubular body 21 can be moved. The guide groove 24 allows the treatment portion 13 of the treatment instrument 10 to be easily guided along the axial direction of the insertion portion 3a of the endoscope 3 from outside the body cavity of the patient to a position near the lesion H3 inside the body cavity. Therefore, when the treatment tool 10 is inserted into the lesion H3 in the body cavity observed by the endoscope 3 and the treatment operation is performed, the insertion operation of the treatment tool 10 can be performed more easily than before. Also in the present embodiment, similarly to the first embodiment, the usage state of the treatment tool 10 can be improved, and the operation of the treatment portion 13 of the treatment tool 10 can be stably and easily performed. As a result, it is possible to reduce the working time of the operation by the endoscopic treatment device 1 and the fatigue of the operator, and it is possible to improve the efficiency of the operation.

Further, the present embodiment has the following effects in addition to the effects of the first embodiment. That is, the ball end 28 separated from the guide groove portion 24 of the rotary cylinder 21 is automatically accommodated in the ball end accommodation recess 25 of the treatment instrument 10 by the spring force of the coil spring 29.
Since there is no protruding portion on the outer peripheral surface of the shaft portion 11 of the treatment instrument 10, it is possible to achieve further miniaturization.

Further, in the present embodiment, the rotary cylinder 21 outside the insertion portion 3a of the endoscope 3 is rotatable in the axial direction with respect to the insertion portion 3a of the endoscope 3, so the operator The guide groove portion 24 can be arranged in any direction of the endoscope 3. Therefore, the insertion operation of the treatment instrument 10 can be performed along any circumferential direction of the insertion portion 3a of the endoscope 3, and better operability can be provided.

Further, since the guide groove 24 is formed in the rotary cylinder 21 outside the insertion portion 3a of the endoscope 3, a rail-shaped projection or the like for guiding the insertion operation of the treatment instrument 10 is unnecessary. Therefore, there is an effect that further miniaturization can be realized.

8 to 10 show a third embodiment of the present invention. In this embodiment, the configuration of the medical device guide apparatus according to the first embodiment (see FIGS. 1 to 3A and 3B) is modified as follows. In addition, in the present embodiment, the same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted.

That is, in the medical instrument guide device according to the present embodiment, the insertion portion 3a of the endoscope 3 is provided with the straight pipe portion 31 made of a magnetic material. Further, as shown in FIG. 9, the eyepiece portion 3 of the endoscope 3 is provided at the base end portion of the straight pipe portion 31.
An electromagnet accommodating portion 33 in which a known electromagnet 32 is arranged is provided in the vicinity of b. Here, the electromagnet 32 is shown in FIG.
A control circuit 3 described later via a cable 34 as shown in FIG.
5 is electrically connected.

The treatment portion 1 is attached to the shaft portion 11 of the treatment instrument 10.
A tip member 36, which is a magnetic body, is arranged at the end on the 3 side. The shaft portion 11 of the treatment instrument 10 is made of a non-magnetic material except for the tip member 36.

Further, a known electric contact switch 37 is arranged on the grip portion 12 of the treatment instrument 10. This contact switch 37 is connected to the control circuit 35 via a cable 38.
Is electrically connected to. By operating the contact switch 37, the energization state of the electromagnet 32 is turned on / off.

That is, from one point of view, in the present embodiment, the insertion portion 3a of the endoscope 3 functions as a medical instrument guide, and the straight tube portion 31, the electromagnet 32, the control portion and the contact switch. 37 functions as a guiding means, and the tip member 36, which is a magnetic body, functions as an engaging means.

Next, the operation of the medical device guide apparatus of the present embodiment having the above-mentioned structure will be described. In the present embodiment, the insertion portion 3a of the endoscope 3 is previously inserted from outside the body of the patient H into the hole H2 of the head H1 and is set at a position close to the vicinity of the lesion H3 in the body cavity. Then, the treatment tool 10
Is inserted into the body of the patient H. At this time, if the operator presses the switch 37 in advance before inserting the treatment instrument 10 into the body of the patient H, the control circuit 35 controls the electromagnet 32 to be in the energized state, and a magnetic force is generated in the electromagnet 32. Here, since the straight tube portion 31 of the insertion portion 3a of the endoscope 3 is a magnetic body,
Due to the magnetic force generated by the electromagnet 32, the straight tube portion 31 of the insertion portion 3a of the endoscope 3 becomes magnetic.

Therefore, when the distal end member 36 of the treatment instrument 10 is brought close to the straight tube portion 31 of the insertion portion 3a of the endoscope 3 in this state, the distal end member 36 of the treatment instrument 10 which is a magnetic body is changed to the endoscope 3. The straight tube portion 31 of the insertion portion 3a is attracted and engaged by magnetic force.

In this state, the operator attaches the endoscope 3 to the treatment instrument 10.
When the pressing force in the insertion direction of the treatment instrument 10 is applied, the distal end member 36 of the treatment instrument 10 slides along the straight tube portion 31 of the insertion portion 3a of the endoscope 3, and the treatment instrument 10 and the insertion portion of the endoscope 3 The treatment section 13 can be guided to the distal end portion of the insertion section 3a of the endoscope 3 while maintaining the connection state with the 3a.

Further, the treatment section 13 of the treatment instrument 10 is replaced with the endoscope 3
When the surgeon pushes the switch 37 again while being guided to the tip of the insertion portion 3a of the electromagnet 32, the control circuit 35 causes the electromagnet 32
The magnetic force of is released. As a result, the insertion portion 3 of the endoscope 3
The magnetic connection between a and the distal end member 36 of the treatment instrument 10 is released. At this time, the treatment tool 10 that has been removed is the endoscope 3
Since there is no limitation from the above, the operator can freely operate the treatment tool 10 at a position near the lesion H3 in the body cavity.

Therefore, according to the medical instrument guide apparatus of the present embodiment having the above-described configuration, the insertion portion 3a of the endoscope 3 is generated by the magnetic force generated by pressing the switch 37 of the grip portion 12 of the treatment instrument 10 and the electromagnet 32. Since a magnetic force is generated in the straight pipe portion 31 of the above, and the distal end member 36 of the treatment tool 10 that is a magnetic body is magnetically attracted and engaged with the straight pipe portion 31 of the insertion portion 3a of the endoscope 3, In this state, the treatment tool 10
By applying a pressing force in the insertion direction of the endoscope 3 to the distal end member 36 of the treatment instrument 10, the distal end member 36 of the treatment tool 10 is inserted into the straight pipe portion 3 of the insertion portion 3 a of the endoscope 3.
1 and slides the treatment instrument 10 and the insertion portion 3 of the endoscope 3
The treatment portion 13 can be guided to the distal end portion of the insertion portion 3a of the endoscope 3 while maintaining the connection state with a. Therefore, the treatment tool 1
Since the treatment unit 13 of 0 can be easily guided from the outside of the body cavity of the patient to the vicinity of the lesion H3 inside the body cavity along the axial direction of the insertion portion 3a of the endoscope 3, the body cavity observed by the endoscope 3 The insertion operation of the treatment instrument 10 when inserting the treatment instrument 10 into the lesion H3 inside and performing the treatment operation can be performed more easily than in the past. As a result, the first embodiment
In the same manner as the embodiment of
The operation of the treatment section 13 of the treatment instrument 10 can be performed stably and easily, the working time of the operation by the endoscopic treatment apparatus 1 and the fatigue of the operator are reduced, and thus the efficiency of the operation is improved. be able to.

Furthermore, in this embodiment, in addition to the effects of the first embodiment, the insertion portion 3a of the endoscope 3 and the treatment tool 10 are provided.
There is an effect that the shaft portion 11 can be further downsized. Further, since the operator can intentionally perform the operation of separating the insertion portion 3a of the endoscope 3 from the treatment instrument 10 by the operator's intention, it is possible to provide better operability.

11 and 12 show the fourth embodiment of the present invention.
FIG. In this embodiment, the configuration of the medical device guide apparatus according to the first embodiment (see FIGS. 1 to 3A and 3B) is modified as follows.
In addition, in the present embodiment, the same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted.

That is, in the medical device guide apparatus according to the present embodiment, a thin and hard treatment instrument guide plate 41 is attached to the proximal end side of the insertion portion 3a of the endoscope 3. A treatment instrument guide hole 42 is formed in the treatment instrument guide plate 41. The treatment instrument guide hole 42 is formed by an elongated hole portion having an outer diameter larger than the outer diameter dimension of the shaft portion 11 of the treatment instrument 10.

Further, a treatment instrument guide groove 43 is provided on the outer peripheral surface of the insertion portion 3a of the endoscope 3 along the axial direction of the insertion portion 3a of the endoscope 3. The distal end portion of the treatment instrument 10 is inserted into the treatment instrument guide groove 43 so that the treatment instrument guide groove 43 can be disengageably engaged.

That is, to explain from one point of view, in the present embodiment, the insertion portion 3a of the endoscope 3 functions as a medical instrument guide, and the treatment tool guide groove 43 functions as a guide means. The distal end portion of the treatment tool 10 functions as an engaging means.

Next, the operation of the medical device guide apparatus of this embodiment will be described. In the present embodiment, the patient H is previously
The insertion portion 3a of the endoscope 3 is inserted into the hole H2 of the head H1 from the outside of the body of the patient H, and the treatment tool 10 is set in a position close to the vicinity of the lesion H3 in the body cavity. To insert. At this time, as shown in FIG. 11, the distal end portion of the treatment instrument 10 is inserted into the treatment instrument guide hole 42 of the treatment instrument guide plate 41 of the endoscope 3 arranged outside the body of the patient H.

Subsequently, with the distal end portion of the treatment instrument 10 inserted into the treatment instrument guide groove 43 of the insertion portion 3a of the endoscope 3,
Engage in a disengageable manner. In this state, the operator has the treatment tool 10
By applying a pressing force in the insertion direction of the endoscope 3 to the, the distal end portion of the treatment instrument 10 slides along the treatment instrument guide groove 43 of the endoscope 3 to insert the treatment instrument 10 and the endoscope 3. The distal end portion of the treatment instrument 10 can be guided to the distal end portion of the insertion portion 3a of the endoscope 3 while maintaining the connection state with the portion 3a. Thereby, the treatment tool 10
It is possible to easily insert the tip of the to the position near the lesion H3 in the body cavity.

Therefore, according to the medical instrument guide apparatus of the present embodiment having the above-mentioned configuration, the treatment instrument guide hole 42 of the treatment instrument guide plate 41 of the endoscope 3 is placed outside the body surface when the treatment instrument 10 is inserted. Since it is located, the operator can easily insert the treatment tool 10.

Furthermore, the present invention is not limited to the above-mentioned embodiments, and it goes without saying that various modifications can be made without departing from the gist of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. Note (Supplementary Note 1) In an endoscopic treatment device including an endoscope having an insertion portion and a treatment tool that performs treatment under observation of the endoscope, an outer portion of the endoscope insertion portion, An endoscopic treatment device comprising guide means for guiding the treatment instrument along an insertion direction of the endoscope insertion portion.

(Additional Item 2) The endoscopic treatment according to Additional Item 1, wherein the guide means limits the substantially distal end portion of the treatment instrument so as to be movable along the insertion direction of the endoscope. apparatus.

(Additional Item 3) The endoscopic treatment device according to Additional Item 1 or 2, further comprising a detaching means capable of releasing the restriction by the guide means.

(Additional Item 4) The endoscopic treatment apparatus according to Additional Item 1, 2 or 3, wherein the guide means is rotatable about the insertion axis of the endoscope insertion portion.

(Additional Item 5) The additional feature is that the guide means is a concave portion or a convex portion provided on the outer side portion of the endoscope insertion portion in the insertion axis direction of the endoscope insertion portion. Item 6. The endoscopic treatment device according to item 1 or 2 or 3.

(Additional Item 6) The endoscopic treatment apparatus according to Additional Item 1, 2 or 3, wherein the guide means is such that an outer member of the endoscope insertion portion is magnetized.

(Additional Item 7) In an endoscope having an insertion portion to be inserted into a body cavity, the distal end portion of a treatment instrument provided on the proximal end side of the insertion portion of the endoscope can be guided to the insertion portion side. An endoscope apparatus comprising: a guide member; and a guide groove on the outer periphery of the insertion portion, the guide member guiding the treatment tool in the endoscope insertion direction by the guide member.

(Additional Item 8) A medical device having a functional portion for performing medical treatment on a desired portion of a subject, and a one end portion having a predetermined length in the vicinity of the desired portion. And a guiding means capable of guiding the functional portion along the length direction thereof, and an engaging means provided in the vicinity of the functional portion and operatively engaged with the guiding means. Medical device guide.

(Additional Item 9) Furthermore, the additional item 8 further includes a mantle tube which is provided with the guiding means along the extending direction of the side surface thereof and into which another medical device different from the medical device can be inserted. Medical device guide.

(Additional Item 10) The medical device guide according to Additional Item 9, wherein the guiding means is a convex member that projects toward the side surface of the outer tube, and the engaging means is a concave portion that engages with the convex portion. .

(Additional Item 11) The above-mentioned guiding means is formed on the longitudinal direction of the side surface of the endoscope having a predetermined length, and the above-mentioned engaging portion is the distal end portion of the above-mentioned medical instrument.
Medical device guide as described.

(Additional Item 12) The medical device guide according to additional item 11, wherein the guiding means is a groove formed on the side surface of the endoscope with which the distal end portion of the medical device engages.

(Additional Item 13) The medical instrument guide according to Additional Item 8, wherein the guiding means has an engagement opening portion that is disengaged from the engagement means.

(Additional Item 14) The medical instrument guide according to Additional Item 9, wherein the guiding means is a groove provided on a side surface of the outer tube, and the engaging means is a convex portion that engages with the groove.

(Additional Item 15) The medical instrument guide according to Additional Item 8, wherein the guiding means is made of a magnetizable material, and the engaging means is made of a magnetic material.

(Additional Item 16) The medical instrument guide according to Additional Item 8, wherein the medical device is a treatment tool for applying a treatment to the desired site.

(Additional Item 17) The other medical device is an endoscope, and the one end portion of the guiding means is located in the vicinity of the end portion of the mantle tube from which the distal end portion of the endoscope projects. The medical instrument guide according to appendix 8.

(Additional Item 18) The medical device guide according to Additional Item 8, wherein the guiding means is provided on the outer surface of another medical device (sheath, endoscope).

(Additional Item 19) The medical device according to Additional Item 8, wherein the engaging means attaches and detaches the medical instrument to and from the guiding means, and engages so as to be operable in the longitudinal direction of the guiding means. guide.

(Prior Art of Supplementary Notes 1 to 6) Conventionally, when treating a lesion in a body cavity with a treatment tool under observation of an endoscope, an operator guides the treatment tool to the field of view of the endoscope. There must be. Particularly, in the case of neurosurgery, an endoscope or a treatment tool is used by inserting it into a deep hole-shaped surgical site opened on the body surface. At this time, in order not to damage the body tissues such as blood vessels and nerves on the inner wall of the body cavity at the tip of the treatment instrument being inserted, the operator carefully inserts the treatment instrument while checking the tip of the treatment instrument by looking directly. I had to.

It is known in the prior art that, for example, the endoscope or the treatment tool is formed into a crank shape so that the operator can easily directly see the distal end portion of the treatment tool being inserted. Further, a treatment instrument insertion conduit that facilitates the insertion operation is known as a known sheath or a treatment instrument insertion channel provided in a known endoscope. Further, a known manipulator or the like is known, for example, as disclosed in Japanese Unexamined Patent Publication No. 2000-166936, for increasing the degree of freedom of the treatment range by the treatment tool. In addition, an endoscope is installed inside the blade of the retractor,
Those that provide a treatment tool insertion space between two blades,
It is known from JP 10-295626.

(Problems to be Solved by Additional Items 1 to 6)
However, in the case where the endoscope or the treatment tool has a crank shape, it becomes easier for the operator to confirm the treatment tool being inserted, but the insertion operation itself is improved in that it depends on the skill of the operator. However, the operator still has to carefully insert the treatment tool so that the tip of the treatment tool does not damage the body tissue. Therefore, there is a problem in that, especially in a long-time operation, it causes the operator's fatigue, and thus reduces the efficiency of the operation itself. Further, in the case where there is a treatment instrument insertion conduit, which is known as an example of a sheath, the treatment instrument can be easily guided from outside the body cavity to within the endoscope visual field within the body cavity.
The treatment capacity is limited because the treatment tool can only be operated straight ahead along the longitudinal axis of the insertion section. Further, by combining the treatment tool and the sheath as seen in Japanese Patent Laid-Open No. 2000-166936, the treatment tool can be easily guided by the treatment tool insertion conduit and the treatment range is widened, but the device becomes large and complicated. However, the operation of treatment becomes complicated. Therefore, there is a problem that the device becomes expensive and the operation of the treatment tool becomes complicated. In addition, JP-A-10-2956
In No. 26, the retractor itself has a problem of narrowing the operation space of the treatment tool, and cannot be used when there is a body tissue such as nerve tissue or vascular tissue that cannot be excluded in the body cavity. In Japanese Patent Laid-Open No. 10-295626, a guide means is provided at the tip of the endoscope.
In this case, the treatment tool must be carefully inserted up to the distal end of the endoscope, which causes fatigue of the operator and thus reduces the efficiency of the operation itself.

(Purpose of Additional Items 1 to 6) The above-mentioned problems are solved, and the treatment tool can be easily guided from the outside of the body cavity to the vicinity of the endoscope visual field inside the body cavity, and the treatment tool can be moved after being guided. An object of the present invention is to provide an endoscopic treatment device that has good performance and is inexpensive.

(Operation of Additional Items 1, 2, 4 to 6) It is that the treatment instrument can be guided along the endoscope insertion portion to a substantially distal end portion of the endoscope insertion portion by the guide means.

(Operation of Additional Item 3) In addition to the effect of Additional Item 1, the action of Additional Item 3 is that the releasing means can release the restriction of the treatment instrument by the guide means at a predetermined position.

(Effects of Supplementary Items 1 and 2) The insertion operation of the treatment tool at the time of inserting the treatment tool into the lesion portion in the body cavity observed by the endoscope and performing the treatment operation, which the prior art has, The complicated problem is solved, the working time and the operator's fatigue are reduced, and the efficiency of the operation can be improved.

(Effect of Supplementary Item 3) In addition to the effect of Supplementary Item 1, the provision of the means for detaching the treatment instrument solves the problem that the operation of the treatment instrument inserted into the body cavity is complicated, and the operation is performed. An endoscopic treatment device having good properties can be provided.

(Effect of Additional Item 4) In addition to the effect of Additional Item 1, since the constraining guide means is configured to be rotatable about the endoscope insertion axis, the treatment tool is centered on the endoscope insertion axis. Since it can be placed at any position and can be inserted along the endoscope insertion axis, better operability of inserting the treatment tool can be realized.

(Effect of Additional Item 5) In addition to the effect of Additional Item 1, since the restraint guide means is a simple concave portion or convex portion, the device can be configured more simply.

(Effect of Appendix 6) In addition to the effect of Appendix 1, the use of an electromagnet allows the device to be made smaller.

(Prior Art of Supplementary Note 7) Japanese Patent Application Laid-Open No. 10-295 discloses a device in which a guide means is provided at the tip of the endoscope insertion portion.
Known as 626.

(Problem to be Solved by Supplementary Note 7) However, in Japanese Patent Laid-Open No. 10-295626, when the treatment tool is inserted into the body cavity with the endoscope inserted outside the body cavity, the guide means is Since it is located inside the body cavity, there has been a problem that it is difficult to insert the treatment tool.

(Purpose of Supplementary Note 7) An endoscope inserted into a body cavity and an endoscope with good operability for inserting a treatment instrument into a lesion in the body cavity observed by the endoscope. It is a provision of a treatment tool guiding device.

(Operation of Supplementary Note 7) The treatment tool is inserted into the guide member provided on the proximal end side of the insertion portion of the endoscope. That is, the guide member is arranged outside the body cavity and can be easily inserted. Next, the guide groove provided on the outer circumference of the insertion portion of the endoscope can guide the treatment instrument to the lesion.

(Effect of Supplementary Note 7) Since the guide hole is located outside the body surface when the treatment instrument is inserted, the operator can easily insert the treatment instrument.

(Prior Art of Additional Items 8 to 19)
A treatment tool guide using the guide tube of 307143.

(Problems to be Solved by Additional Items 8 to 19) When a guide tube is used, the operation of the treatment tool is limited by the distal end opening of the tube at the site of the subject to be medically treated. In addition, movement of the proximal operation unit of the treatment instrument is restricted by the proximal end opening of the tube, which makes it difficult to use the treatment instrument in a use state desired by the operator. That is, conventionally, the degree of freedom in operating the treatment tool is extremely limited in the region where the medical treatment is desired.

(Purpose of Supplementary Notes 8 to 17) The present invention is
A medical treatment that improves the usage state of the treatment tool and, as a result, enables stable and easy operation of the functional parts of the treatment tool (eg, grasping forceps, biopsy forceps, biopsy brush, ultrasonic probe, etc.). It is intended to provide an instrument guide.

(Operation of Additional Item 10) And Additional Item 1
In the invention of No. 0, the concave portion of the medical device is engaged with the convex member on the outer peripheral surface of the mantle tube, so that the medical function portion of the medical device is caused by the convex member along the length direction of the mantle tube to perform medical treatment on the subject. It is possible to guide to a position in the vicinity of the target region of.

(Operation of Supplementary Note 11) Then, Supplementary Note 1
According to the first aspect of the present invention, by engaging the engaging means of the medical instrument with the guide means of the endoscope in a disengageable manner, the medical function part of the medical instrument is covered by the guide means along the axial direction of the endoscope. The sample can be guided to a position in the vicinity of the target site of medical treatment.

(Operation of Supplementary Note 12) Then, Supplementary Note 1
According to the second aspect of the present invention, the engaging convex portion of the distal end portion of the medical device is removably engaged with the groove on the outer peripheral surface of the endoscope, so that the medical function portion of the medical device is formed by the groove on the outer peripheral surface of the endoscope. Is guided along the length direction of the medical device guide to a position in the vicinity of the target site for medical treatment in the subject.

(Operation of Additional Item 13) And Additional Item 1
According to the third aspect of the invention, the degree of freedom in operating the medical function portion of the medical instrument is increased by releasing the engagement with the engaging means by the engagement releasing portion of the guiding means of the medical instrument guide. is there.

(Operation of Appendix 14) And Appendix 1
According to the fourth aspect of the present invention, the convex portion of the engaging means is engaged with the groove on the outer peripheral surface of the outer tube so that the medical function portion of the medical device is located along the axial direction of the outer tube of the target site of the medical procedure in the subject. It is designed so that it can be guided to a nearby position.

(Operation of Additional Item 15) And Additional Item 1
According to the fifth aspect of the invention, the engaging means of the magnetic material is attracted and engaged with the guiding means of the magnetizable material.

(Operation of Supplementary Note 16) Then, Supplementary Note 1
According to the sixth aspect of the invention, treatment is applied to the target site of the medical procedure in the subject by the treatment tool.

(Operation of Supplementary Note 17) Then, Supplementary Note 1
In the invention of 7, the medical function part of the medical instrument is guided along the axial direction of the outer tube by the guiding means on the outer peripheral surface of the outer tube while the endoscope, which is another medical instrument, is inserted into the outer tube. The medical function part of the medical device is inserted into the field of view of the endoscope so as to be easily confirmed by guiding the medical function part to a position near the target part of the medical action.

[0113]

According to the present invention, the condition of use of the treatment tool is improved, and the functional portion of the treatment tool (for example, grasping forceps, biopsy forceps,
Stable operation of biopsy brush, ultrasonic probe, etc., and
It can be done easily.

[Brief description of drawings]

FIG. 1 is a perspective view showing a usage state of an endoscopic treatment device according to a first embodiment of the present invention.

FIG. 2 is a vertical cross-sectional view showing the main configuration of the endoscopic treatment device according to the first embodiment.

3A is a cross-sectional view taken along line IIIA-IIIA in FIG. 2, and FIG. 3B is a cross-sectional view showing a C-shaped projection portion of the treatment tool.

FIG. 4 is a perspective view showing a schematic configuration of an endoscopic treatment device according to a second embodiment of the present invention.

FIG. 5 is a vertical cross-sectional view of a main part showing a guide groove of an outer tube in the endoscopic treatment device according to the second embodiment.

FIG. 6 is a transverse cross-sectional view of a mantle tube in the endoscopic treatment device according to the second embodiment.

FIG. 7 is a vertical cross-sectional view showing the main configuration of a treatment tool in the endoscopic treatment device according to the second embodiment.

FIG. 8 is a perspective view showing a schematic configuration of an endoscopic treatment device according to a third embodiment of the present invention.

FIG. 9 is a vertical cross-sectional view showing the main configuration of an endoscopic treatment device according to a third embodiment.

FIG. 10 is a block diagram of a main part of an endoscopic treatment device according to a third embodiment.

FIG. 11 is a perspective view showing a schematic configuration of an endoscopic treatment device according to a fourth embodiment of the present invention.

FIG. 12 is a transverse cross-sectional view showing the main configuration of the endoscope in the endoscopic treatment device according to the fourth embodiment.

[Explanation of symbols]

8 sheath (medical device guide) 9 Rails (guide means) 10 Treatment tools (medical instruments) 13 Treatment department (medical function department) 14 C type protrusion (engagement means) H3 lesion

Claims (3)

[Claims] 1. A medical device having a medical function unit for performing a medical procedure on a subject, and a one end portion having a predetermined length and located in the vicinity of a target site of the medical procedure on the subject. A possible medical instrument guide, a guide means capable of guiding the medical function part along the length direction of the medical instrument guide, and a guide means provided in the vicinity of the medical function part of the medical instrument and disengaged from the guide means. A medical device guide device, comprising: engaging means capable of engaging. 2. The medical device guide has a mantle tube into which another medical device different from the medical device can be inserted, and the guide means is provided on the outer peripheral surface of the mantle tube along the axial direction of the mantle tube. It is extended, The claim 1 characterized by the above-mentioned.
The medical device guide device described in 1. 3. The medical device guide apparatus according to claim 1, wherein the guiding means is made of a magnetizable material, and the engaging means is made of a magnetic material.