JP2005046361A - Device and system for internal treatment of object - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a device and a system for internal treatment of an object, capable of securing the visual field in treating a lesion in the deep part inside the body of a patient without enlarging the length of incision even when a plurality of treatment instruments have to be guided into the incised part at the same time. <P>SOLUTION: A flexible tubular body to be guided into the object comprises a center hole whose section is circular for inserting an endoscope to observe the target section at the center of an end surface of the tubular body and a plurality of peripheral holes formed around the center hole at regular angle/intervals for inserting treatment instruments to treat the target section. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an object internal treatment apparatus and an object internal treatment system that perform excision of a target site inside the object, and more particularly to an apparatus and system for treating a lesion in a patient.

Conventionally, surgical treatment of a lesion in a patient has been performed by an operator directly operating a treatment tool introduced into the patient from an incised portion. In recent years, a method has also been devised in which a surgeon does not directly touch a treatment tool introduced into a patient from an incised portion and is remotely operated from outside the patient.
JP 2001-104333 A

  In the above-described surgical treatment of a lesion in a patient, it is often necessary to simultaneously introduce a plurality of treatment tools into the incised portion. In this case, the length of the incision depends on the number of treatment tools introduced at the same time. It is necessary to increase the size.

  Further, when treating a deep lesion in the patient body away from the body surface, it is necessary to increase the length of the incision because it is difficult to secure a visual field if the length of the incision is small.

  In order to solve the above problems, in the object internal treatment device of the present invention, the flexible tubular main body introduced into the object observes the target site at the center of the end surface of the main body. A central hole portion having a circular cross section for inserting an endoscope, and a plurality of peripheral hole portions that are provided in the main body portion at equal intervals around the central hole portion and into which a treatment tool for treating a target site is inserted. It is a feature.

  The object internal treatment system of the present invention is a flexible tubular main body introduced into the object, and an endoscope for observing the target site is inserted at the center of the end surface of the main body. A main body portion having a central hole portion having a circular cross section, and a plurality of peripheral hole portions provided in the main body portion at equal intervals around the central hole portion for inserting a treatment instrument for treating the target site, and the outside of the target object A main body part operating means for operating the main body part, an endoscope operating means for operating the endoscope outside the object, and a treatment tool operating means for operating the treatment tool outside the object. It is a feature.

  The endoscope is preferably a stereoscopic endoscope capable of observing a target portion in three dimensions.

  It is preferable that the treatment instrument includes observation means that can observe the vicinity of the distal end of the treatment instrument, illumination means that can illuminate the vicinity of the distal end of the treatment instrument, and air / water supply means that can clean the distal end of the observation means.

  The main body part preferably has a bendable bending part, and the treatment instrument inserted into the peripheral hole provided in the main body part also preferably has a bendable bending part.

  The object internal treatment system of the present invention preferably includes an image display means for displaying an image by an endoscope and an image display means for displaying an image by an observation means.

  According to the present invention, since a treatment tool can be arranged at equiangular intervals around an endoscope for observing a target site, a plurality of treatment tools can be simultaneously attached to an incision portion in surgical treatment of a lesion in a patient. Even when it is introduced, it is not necessary to increase the length of the incision. Further, even when treating a deep lesion in a patient, a visual field can be secured without increasing the length of the incision. Furthermore, by arranging the treatment tool so as to surround the endoscope for observing the lesioned part, the treatment tools do not interfere with each other, and the visual field is less likely to be obstructed so that the work can be performed smoothly.

  Hereinafter, embodiments according to the present invention will be described in detail with reference to FIGS. The object internal treatment device 200 and the object internal treatment system 300 according to the present embodiment are for treating a lesioned part (target part) in a patient's body as an object. The body internal treatment system 300 including the peripheral hole 30 is further provided. The target object internal treatment system 300 further includes a main body operation means 60, an endoscope operation means 70, and treatment instrument operation means 81 to 85. In the present embodiment, the case where the peripheral hole portion 30 includes five hole portions will be described, but the number of hole portions constituting the peripheral hole portion 30 can be arbitrarily set.

  The main body 10 is a flexible tubular member introduced into the body of a patient (target), and can be formed with an outer diameter of 5 cm, for example. As shown in FIG. 2, the main body 10 includes a distal end portion 11 having a circular cross section whose outer diameter decreases toward the distal end, and a bendable bending portion 12 fixed to the rear end surface 11 a of the distal end portion 11. I have. The main body 10 is introduced into the patient from the distal end of the distal end 11, and can be introduced deep into the body depending on the position of the lesion. The main body part 10 can adjust the bending state of the bending part 12 in addition to the introduction and derivation of the main body part 10 into the patient body by the main body operation means 60 connected at the rear end part. Examples of the main body operation means 60 include manual operation by an operator, automatic transmission, and a winding device. The main body section 10 can be operated from the outside by the main body operation means 60.

  The main body portion 10 is provided through the center of the cross section, and is equiangular with respect to the central hole portion 20 having a circular cross section into which an endoscope for observing a lesion (target site) is inserted and the center 20a of the central hole portion 20. A peripheral hole portion 30 is provided which is provided so as to penetrate the main body portion 10 at intervals (72-degree intervals), and which includes five hole portions 31, 32, 33, 34, and 35 for inserting a treatment tool for treating a lesioned portion. It has been. For example, when the outer diameter of the main body 10 is 5 cm, the inner diameter of each of the holes 31, 32, 33, 34, and 35 can be 1.2 cm. Further, the distal end portion 11 and the central hole portion 20 may not have a circular cross section. In this case, the five hole portions 31, 32, 33, 34, and 35 can be arranged so as to surround the central hole portion 20, and the distance between adjacent hole portions is preferably the same. The central hole portion 20 and the peripheral hole portion 30 may penetrate only the tip portion 11 and the curved portion 12 may be hollow.

  A stereoscopic endoscope 21 is inserted into and penetrated through the central hole portion 20 so as to be removable. The stereoscopic endoscope 21 includes two observation optical systems 21b and 21c for stereoscopic observation of a lesioned portion and an illumination optical system 21d for illuminating the lesioned portion on a bendable cylindrical main body 21a. , 21e, and air supply / water supply systems 21f and 21g for removing cloudiness on the surfaces of the observation optical systems 21b and 21c, supplying water for cleaning, and supplying air to the patient's body are inserted and fixed. . As described above, the adoption of the stereoscopic endoscope 21 enables the lesioned part and the periphery thereof to be stereoscopically observed, so that the treatment can be performed accurately and smoothly. The stereoscopic endoscope 21 includes a main body portion 21a at the rear end thereof, lead-out, focus of the observation optical systems 21b and 21c, field of view, adjustment of zooming, brightness and direction of the illumination optical systems 21d and 21e, It is connected to an endoscope operation means 70 for performing operations such as angle adjustment, removal of fogging of the surfaces of the observation optical systems 21b and 21c, water supply for cleaning, and air supply into the patient body, The stereoscopic endoscope 21 can be operated from the outside by the endoscope operating means 70. The observation optical systems 21b and 21c are connected to an image display means 87 capable of stereoscopically displaying the lesioned part and its surrounding images at the rear end portion of the stereoscopic endoscope 21. Note that one observation optical system may be used depending on the content of treatment.

  In the holes 31, 32, 33, 34, and 35, treatment tools 41, 42, 43, 44, and 45 each having a flexible long shape are inserted and penetrated so as to be detachable. This treatment instrument 41, 42, 43, 44, 45 has a bendable bending portion, and treatment instrument operation means 81, 82, 83, 84, 85 for performing these operations at the respective rear end portions. It is connected to the. The treatment tools 41, 42, 43, 44, and 45 may be inserted into any of the holes 31, 32, 33, 34, and 35 depending on the treatment order, the shape of the lesion, and the like. In addition, treatment instruments other than the treatment instruments 41, 42, 43, 44, 45 can be inserted into the holes 31, 32, 33, 34, 35. Here, for example, when the inner diameter of each of the holes 31, 32, 33, 34, and 35 is 1.2 cm, the outer diameter of each of the treatment instruments 41, 42, 43, 44, and 45 can be 1 cm.

  The treatment tool 41 is for holding, for example, the periphery of a lesioned part and used for incision by the treatment tool 42 or the treatment tool 45. The treatment tool 41 is attached to a bendable cylindrical main body 41a. A grasping forceps 41b capable of grasping an object, an observation optical system (observation means) 41c for observing the vicinity of the tip of the grasping forceps 41b, and an illumination optical system (illumination means) 41d, 41e for illuminating the vicinity of the tip of the grasping forceps 41b; The observation optical system 41c has a surface for removing fogging, supplying water for cleaning, and supplying air / water supply systems (air supply / water supply means) 41f and 41g for supplying air to the patient's body. Yes. At the rear end of the treatment instrument 41, the main body 41a is introduced, led out, bent, the gripping force is controlled by the grasping forceps 41b, the focus, field of view, and zooming of the observation optical system 41c are adjusted, and the illumination optical systems 41d and 41e are bright. , Adjustment of direction and angle, removal of fogging of the surface of the observation optical system 41c, water supply for cleaning, and air supply into the patient's body, etc. The tool operation means 81 can be operated from the outside. The observation optical system 41c is connected to an image display means 91 capable of displaying an image near the tip of the grasping forceps 41b by the observation optical system 41c at the rear end portion of the treatment instrument 41. It should be noted that two observation optical systems can be provided so that the vicinity of the tip of the grasping forceps 41b can be observed three-dimensionally. Alternatively, infrared light observation, fluorescence observation, zoom observation, ultrasonic observation, confocal observation, optical coherent tomography observation (OCT), and the like can be performed.

  The treatment tool 42 is for excising a lesioned portion gripped by the treatment tool 41, for example, and this treatment tool 42 is a curving cylindrical main body 42a that can cut an object. Observation optical system (observation means) 42c for observing the vicinity of the distal ends of the forceps 42b and the scissors forceps 42b, illumination optical systems (illumination means) 42d and 42e for illuminating the vicinity of the distal ends of the scissors forceps 42b, and the surface of the observation optical system 42c An air supply / water supply system (air supply / water supply means) 42f and 42g for removing fogging, supplying water for cleaning, and supplying air into the patient's body are inserted and fixed. At the rear end of the treatment tool 42, the main body 42a is introduced, led out, bent, the excision operation is controlled by the scissors forceps 42b, the focus, field of view, and zooming of the observation optical system 42c are adjusted, and the brightness of the illumination optical systems 42d and 42e is adjusted. , Adjustment of direction and angle, removal of fogging of the surface of the observation optical system 42c, water supply for cleaning, and air supply into the patient's body, etc. The tool operating means 82 can be operated from the outside. The observation optical system 42c is connected to an image display means 92 capable of displaying an image near the tip of the scissors forceps 42b by the observation optical system 42c at the rear end portion of the treatment instrument 42. It should be noted that two observation optical systems can be provided so that the vicinity of the tip of the scissors forceps 42b can be observed in three dimensions. Alternatively, infrared light observation, fluorescence observation, zoom observation, ultrasonic observation, confocal observation, optical coherent tomography observation (OCT), and the like can be performed.

  The treatment tool 43 is used for water supply for washing the lesioned part and its surroundings, and for suctioning blood such as blood and washing water around the lesioned part, and the treatment tool 43 is curved. When the lesioned part and its surroundings are washed, water is fed to the cylindrical main body 43a, which is possible, and when the liquid such as blood and washing water around the lesioned part and the surroundings is sucked, the washing water feeding for sucking from outside Observation optical system (observation means) 43c for observing the vicinity of the distal end of the suction tube 43b and the suction tube 43b, illumination optical systems (illumination means) 43d and 43e for illuminating the vicinity of the distal end of the suction tube 43b, and the observation optical system 43c An air supply / water supply system (air supply / water supply means) 43f and 43g for removing clouding of the surface, supplying water for cleaning, and supplying air into the patient's body are inserted and fixed. At the rear end of the treatment instrument 43, the main body 43a is introduced, led out, curved, water is supplied by the suction tube 43b, the suction operation is controlled, the focus, field of view, and zooming of the observation optical system 43c are adjusted, and the illumination optical systems 43d and 43e are adjusted. It is connected to a treatment instrument operating means 83 for performing operations such as adjustment of brightness, direction, angle, removal of fogging of the surface of the observation optical system 43c, water supply for cleaning, and air supply into the patient body, This treatment tool operation means 83 can be operated from the outside. The observation optical system 43c is connected to an image display means 93 capable of displaying an image near the tip of the suction tube 43b by the observation optical system 43c at the rear end portion of the treatment instrument 43. It should be noted that two observation optical systems can be provided so that the vicinity of the tip of the suction tube 43b can be observed three-dimensionally. Alternatively, infrared light observation, fluorescence observation, zoom observation, ultrasonic observation, confocal observation, optical coherent tomography observation (OCT), and the like can be performed.

  The treatment tool 44 is for locally stopping hemostasis at a desired location. This treatment tool 44 generates heat by locally applying a high frequency to a desired location on a bendable cylindrical main body 44a. High-frequency hemostatic forceps 44b for performing hemostasis, an observation optical system (observation means) 44c for observing the vicinity of the distal end of the high-frequency hemostatic forceps 44b, and an illumination optical system (illumination means) 44d for illuminating the vicinity of the distal end of the high-frequency hemostatic forceps 44b , 44e and air supply / water supply systems (air supply / water supply means) 44f, 44g for removing cloudiness on the surface of the observation optical system 44c, supplying water for cleaning, and supplying air to the patient's body are inserted. It is fixed. At the rear end of the treatment instrument 44, the main body 44a is introduced, led out, bent, the hemostasis operation is controlled by the high-frequency hemostatic forceps 44b, the focus, field of view, and zooming of the observation optical system 44c are adjusted, and the illumination optical systems 44d and 44e are bright. It is connected to a treatment instrument operation means 84 for performing operations such as adjustment of the direction, angle, removal of fogging of the surface of the observation optical system 44c, water supply for cleaning, and air supply into the patient body. The treatment tool operation means 84 can be operated from the outside. The observation optical system 44c is connected to an image display means 94 capable of displaying an image near the tip of the high-frequency hemostatic forceps 44b by the observation optical system 44c at the rear end portion of the treatment instrument 44. Note that two observation optical systems may be provided so that the vicinity of the distal end of the high-frequency hemostatic forceps 44b can be observed three-dimensionally. Alternatively, infrared light observation, fluorescence observation, zoom observation, ultrasonic observation, confocal observation, optical coherent tomography observation (OCT), and the like can be performed.

  The treatment tool 45 is for incising a desired location, and this treatment tool 45 is formed by pressing a distal end portion that vibrates at a high frequency against a bendable cylindrical main body portion 45a at a desired position. An incision high-frequency knife 45b for performing incision, an observation optical system (observation means) 45c for observing the vicinity of the distal end of the incision high-frequency knife 45b, and an illumination optical system (illumination means) for illuminating the vicinity of the distal end of the incision high-frequency knife 45b ) 45d, 45e, removal of fogging of the surface of the observation optical system 45c, water supply for cleaning, and air supply / water supply system (air supply / water supply means) 45f, 45g for supplying air into the patient body, Is inserted and fixed. At the rear end of the treatment tool 45, the main body 45a is introduced, led out, bent, the incision operation is controlled by the incision high-frequency knife 45b, the focus of the observation optical system 45c, the visual field, the zooming is adjusted, and the illumination optical systems 45d and 45e are adjusted. It is connected to a treatment instrument operating means 85 for performing operations such as adjustment of brightness, direction, angle, removal of fogging of the surface of the observation optical system 45c, water supply for cleaning, and air supply into the patient body, This treatment tool operation means 85 can be operated from the outside. The observation optical system 45c is connected to the image display means 95 capable of displaying an image near the front end of the incision high-frequency knife 45b by the observation optical system 45c at the rear end portion of the treatment instrument 45. It should be noted that two observation optical systems can be provided so that the vicinity of the distal end of the incision high-frequency knife 45b can be observed three-dimensionally. Alternatively, infrared light observation, fluorescence observation, zoom observation, ultrasonic observation, confocal observation, optical coherent tomography observation (OCT), and the like can be performed.

Next, a procedure for surgical treatment of a lesion using the object internal treatment device 200 and the object internal treatment system 300 having the above-described configuration will be described.
First, an incision is made at an appropriate location for treating a lesion in a patient. Even when a treatment that requires a plurality of treatment tools is used, when the object internal treatment device 200 is used, only the amount necessary to introduce the object internal treatment device 200 into the patient (for example, the outer diameter of the main body 10). (If it is 5 cm, it is about 5 cm.) Since the incision is sufficient, the burden on the patient can be reduced.

  Next, the main body unit operating means 60, the endoscope operating means 70, the treatment instrument operating means 81 to 85, the image display means 87, and the image display means 91 to 95 are preliminarily arranged as shown in FIG. The object internal treatment device 200 connected to the endoscope 21 and the treatment tools 41 to 45 is introduced into the patient body 100 from the incision. The visual field range 22 of the stereoscopic endoscope 21 is introduced at a position where the lesioned part 110 and its periphery as shown in FIG. 4 and the distal end portions of the treatment instruments 41, 42, 43, 44, 45 can be observed. Stop and start treatment.

  In the object internal treatment device 200, treatment tools 41 to 45 are arranged so as to surround the stereoscopic endoscope 21, and the treatment tools 41 to 45 are disposed around the entire visual field range of the stereoscopic endoscope 21 during treatment. Will be placed. For this reason, it becomes easy for the surgeon to recognize the lesioned part 110 and the treatment tools 41 to 45, thereby making it easier to perform the operation. Further, since the treatment instrument can be freely replaced, for example, as shown in FIG. 4, the lesioned part 110 is lifted from the left and right with two grasping forceps 41b and 41b, and excised with an incision scalpel 45b from below to cause bleeding. Then, the operation can be easily performed by stopping the bleeding with the high-frequency hemostatic forceps 44b and applying the washing water with the washing tube 43b from above. Furthermore, even if the lesioned part 110 is in a deep part in the patient body, by introducing the object internal treatment device 200 into the deep part in the patient body, the visual field range as shown in FIG. Can be done.

A modification will be described below.
As shown in FIG. 5, instead of the main body portions 41a, 42a, 43a, 44a, and 45a, endoscope insertion portions 141a, 142a, 143a, 144a, and 145a may be used, respectively. At this time, the grasping forceps 41b, the scissors forceps 42b, the suction tube 43b, the high-frequency hemostatic forceps 44b, and the incision high-frequency knife 45b are provided with the forceps channels 141h, 142h, 143h, 144h and 145h. As with the treatment instruments 41, 42, 43, 44, and 45, the insertion portions 141a, 142a, 143a, 144a, and 145a are provided with an observation optical system, an illumination optical system, an air / water supply system, and a bending portion. If comprised in this way, since an existing endoscope can be utilized, manufacturing cost can be reduced.

  As shown in FIG. 6, the main body 10, the stereoscopic endoscope 21, and the treatment tools 41 to 45 are collectively replaced with the main body operation means 60, the endoscope operation means 70, and the treatment tool operation means 81 to 85. An operation means 160 that can be operated selectively or selectively may be provided. Further, instead of the image display means 87 and the image display means 91 to 95, the stereoscopic endoscope 21, the observation optical systems 21b and 21c of the treatment tools 41 to 45, the observation optical systems 41c, 42c, 43c, 44c, and 45c are used. An image display device 190 that can display these images collectively or selectively may be provided. With this configuration, a space-saving and compact system can be obtained, and treatment can be performed efficiently by a smaller number of surgeons.

  Although the present invention has been described with reference to the above embodiment, the present invention is not limited to the above embodiment, and can be improved or changed within the scope of the purpose of the improvement or the idea of the present invention.

It is a front view which shows the structure of the target object internal treatment apparatus which concerns on embodiment of this invention. It is a perspective view which shows the structure of the target object internal treatment apparatus in which the treatment tool and the endoscope were inserted. It is a block diagram which shows the relationship between the main-body part, endoscope, treatment tool, main-body part operation means, endoscope operation means, treatment tool operation means, and image display means concerning embodiment of this invention. It is a figure which shows the example of the state of the treatment in the visual field range of the endoscope which concerns on embodiment of this invention. It is a perspective view which shows the structure of the modification of embodiment of this invention. It is a block diagram which shows the relationship between the main-body part, endoscope, treatment tool, an operation means, and an image display means in the modification of embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Main body part 20 Center hole part 21 Stereoscopic endoscope (endoscope)
30 peripheral hole portion 41 treatment tool 42 treatment tool 43 treatment tool 44 treatment tool 45 treatment tool 60 main body part operation means 70 endoscope operation means 81 treatment tool operation means 82 treatment tool operation means 83 treatment tool operation means 84 treatment tool operation means 85 Treatment Tool Operating Means 100 Patient (Subject) Body 110 Diseased Part (Target Part)
200 Object Internal Treatment System 300 Object Internal Treatment Device

Claims (16)

A flexible tubular main body introduced into the inside of the object,
At the center of the end face of the main body, a central hole with a circular cross section for inserting an endoscope for observing the target site;
A plurality of peripheral hole portions that are provided in the main body portion at equal intervals around the central hole portion and into which a treatment tool for treating the target site is inserted, and
An object internal treatment device comprising: A tubular main body having flexibility to be introduced into an object,
At the center of the end surface of the main body, a central hole portion having a circular cross section for inserting an endoscope for observing the target portion, and provided in the main body portion at equal intervals around the central hole portion, treats the target portion. A main body comprising a plurality of peripheral holes for inserting the treatment tool;
A body portion operating means for operating the body portion outside the object;
Endoscope operating means for operating the endoscope outside the object;
A treatment instrument operating means for operating the treatment instrument outside the object;
An object internal treatment system comprising: The object internal treatment apparatus according to claim 1, wherein the endoscope is a stereoscopic endoscope capable of observing a target portion in three dimensions. The target object internal treatment device according to claim 1, wherein the treatment tool includes an observation unit capable of observing the vicinity of the distal end of the treatment tool. The object treatment apparatus according to claim 4, wherein the treatment tool includes an illumination unit that can illuminate the vicinity of the distal end of the treatment tool. The object treatment apparatus according to claim 5, wherein the treatment tool includes an air / water supply unit capable of cleaning a tip of the observation unit. The object internal treatment system according to claim 2, further comprising image display means for displaying an image obtained by the endoscope. The object internal treatment system according to claim 2, wherein the endoscope is a stereoscopic endoscope capable of observing a target portion in three dimensions. The object treatment system according to claim 2, wherein the treatment tool includes observation means capable of observing the vicinity of the distal end of the treatment tool. The target object internal treatment system according to claim 9, wherein the treatment tool includes an illumination unit capable of illuminating the vicinity of the distal end of the treatment tool. The object treatment system according to claim 10, wherein the treatment tool includes an air / water supply unit capable of cleaning a tip of the observation unit. The object internal treatment system according to claim 9, further comprising image display means for displaying an image by the observation means. The target body internal treatment device according to claim 1, wherein the main body has a bendable bending portion. The object internal treatment system according to claim 2, wherein the main body has a bendable bending portion. The target object internal treatment device according to claim 1, wherein the treatment tool has a bendable bending portion. The target object internal treatment system according to claim 2, wherein the treatment instrument has a bendable bending portion.

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