JP2005296412A - 内視鏡治療装置 - Google Patents

内視鏡治療装置 Download PDF

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JP2005296412A
JP2005296412A JP2004118182A JP2004118182A JP2005296412A JP 2005296412 A JP2005296412 A JP 2005296412A JP 2004118182 A JP2004118182 A JP 2004118182A JP 2004118182 A JP2004118182 A JP 2004118182A JP 2005296412 A JP2005296412 A JP 2005296412A
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introduction guide
treatment
guide tube
endoscope
distal end
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Hirota Okada
裕太 岡田
Yorio Matsui
頼夫 松井
Ryuta Sekine
竜太 関根
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Olympus Corp
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Priority to EP08014776A priority patent/EP1985246B1/en
Priority to EP05007799.9A priority patent/EP1586275B1/en
Priority to US11/104,883 priority patent/US20050228224A1/en
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Priority to US12/612,461 priority patent/US8221306B2/en
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    • A61B2017/2905—Details of shaft flexible
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Abstract

【課題】複数の軟性導入ガイドチューブによって誘導した複数の処置具により処置する場合の制約が軽減できる内視鏡治療装置を提供することにある。
【解決手段】湾曲操作可能な湾曲部１１，１２を有した複数の導入ガイドチューブ４ａ，４ｂを備え、複数の導入ガイドチューブ４ａ，４ｂを連結して固定し、この固定する部位を前記導入ガイドチューブ４ａ，４ｂの湾曲部１１，１２を動かすときの支点２７とした内視鏡治療装置。
【選択図】 図１

Description

本発明は、湾曲機能付の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で治療する内視鏡治療装置及びその導入ガイドチューブに関する。
従来、軟性の導入ガイドチューブを通じて処置具を体腔内に誘導し、内視鏡による観察下で前記処置具により治療する内視鏡治療装置が知られている。この種の内視鏡治療装置で使用される導入ガイドチューブはチャンネルチューブとも呼ばれている。最近、この種の導入ガイドチューブにあって、チューブ先端付近に湾曲部を設け、手元側操作部によって湾曲部を湾曲可能ならしめた湾曲機能付きの導入ガイドチューブが提案されている（特許文献１参照）。この内視鏡治療装置では、複数の湾曲機能付きの導入ガイドチューブを通じてそれぞれ処置具を体腔内に導き、導入ガイドチューブの湾曲部を湾曲することにより、体腔内における処置具の向きを調節するようになっている。
特開２０００−３３０７１号公報
上述したような湾曲機能付きの柔軟な導入ガイドチューブは体腔内において自由に動き得るため、その導入ガイドチューブにより誘導した処置具により処置する場合、柔軟な導入ガイドチューブに負荷が加わると、その導入ガイドチューブ自体が動いてしまい、処置具による治療に制約を受けてしまうことがあった。特に、生体組織の挙上または生体組織を広げるように処置具によって生体組織を把持して動かそうとすると、その牽引力の反作用による大きな負荷が柔軟な導入ガイドチューブに加わり、その導入ガイドチューブ自体が容易に動いて逃げてしまう。このように軟性導入ガイドチューブを用いる場合、処置具を思うように操作できないことがあり、処置具による治療に制約を受けてしまうことがあった。
本発明は前記課題に着目してなされたもので、その目的とするところは、複数の軟性導入ガイドチューブによって誘導した複数の処置具により処置する場合の制約が軽減できる内視鏡治療装置を提供することにある。
請求項１に係る発明は、軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で処置具により治療する内視鏡治療装置において、各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、前記複数の導入ガイドチューブの前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍同士を連結して固定したことを特徴とする内視鏡治療装置である。
請求項２に係る発明は、軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で処置具により治療する内視鏡治療装置において、各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、少なくとも１つの湾曲部よりも手元側端近傍を含む前記複数の導入ガイドチューブにおける挿入部の少なくとも一部を一体的に連結した構造に形成したことを特徴とする内視鏡治療装置である。
請求項３に係る発明は、前記複数の導入ガイドチューブの前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍同士を連結具により連結して固定したことを特徴とする請求項１に記載の内視鏡治療装置である。
請求項４に係る発明は、軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で治療する内視鏡治療装置において、各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、前記複数の導入ガイドチューブの前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍と、内視鏡の挿入部とを、連結具により着脱自在に連結して固定したことを特徴とする内視鏡治療装置である。
請求項５に係る発明は、軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で処置具により治療する内視鏡治療装置において、各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、前記複数の導入ガイドチューブの挿入部を、軟性のオーバーチューブに組み付けて、前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍を前記オーバーチューブに固定したことを特徴とする請求項１または請求項２に記載の内視鏡治療装置である。
請求項６に係る発明は、体腔内に導入され、内部に処置具が挿通される導入ガイドチューブを含む、湾曲操作可能な湾曲部を備えた治療機器を複数、前記導入ガイドチューブの湾曲部よりも手元側端近傍同士を固定する固定部を設けたことを特徴とする治療機器連結具である。
請求項７に係る発明は、湾曲操作可能な湾曲部を備えると共に、内部に処置具を挿通可能で体腔内に導入される複数の導入ガイドチューブを挿通するオーバーチューブにおいて、前記導入ガイドチューブの湾曲部よりも手元側端近傍同士を固定する固定部を設けたことを特徴とするオーバーチューブである。
請求項８に係る発明は、前記複数の導入ガイドチューブを夫々個別的に挿入可能に形成された複数の挿通ガイド孔を有したことを特徴とする請求項７に記載のオーバーチューブである。
請求項９に係る発明は、前記導入ガイドチューブ先端部に、その導入ガイドチューブに挿通された処置具の先端部分を保持してその処置具の先端部を操作する操作機構を設けたことを特徴とする請求項１から請求項８のいずれかに記載のもの。
請求項１０に係る発明は、体腔内での処置に使用する処置具を挿通する導入ガイドチューブにおいて、前記導入ガイドチューブの先端部に、その導入ガイドチューブに挿通された処置具の先端部分を保持してその処置具の先端部を操作する操作機構を設けたことを特徴とする内視鏡用導入ガイドチューブである。
本発明によれば、複数の軟性導入ガイドチューブによって誘導した複数の処置具により処置する場合の制約が軽減できる。
図１乃至図７を参照して本発明の一実施形態に係る内視鏡治療装置について説明する。
図１は処置具用導入ガイドチューブユニット１と軟性の内視鏡２を示しており、この処置具用導入ガイドチューブユニット１は、図２に示すように、内視鏡２の挿入部３に対し着脱自在に組み付けられるようになっている。
前記処置具用導入ガイドチューブユニット１は鉗子などの処置具を含む手術用器具を操作するマニピュレータとしての複数の処置具用導入ガイドチューブ４ａ，４ｂを含み、２本の処置具用導入ガイドチューブ４ａ，４ｂが一体となっている。各処置具用導入ガイドチューブ４ａ，４ｂはその挿入部５の途中部分が一体的に連結され、この連結部６の部分は軟性なものとなっている。
図６に示すように、各処置具用導入ガイドチューブ４ａ，４ｂの挿入部５は最先端に位置した先端部１０と、この先端部１０の手元側に位置した第１湾曲部１１と、この第１湾曲部１１の手元側に位置した第２湾曲部１２と、この第２湾曲部１２の後に設けられた軟性部１３とを備えてなる。
図７に示すように、各導入ガイドチューブ４ａ，４ｂの挿入部５の内部にはその全長にわたって処置具誘導用チャンネル１４を形成する可撓性チューブ１５が配置されている。処置具誘導用チャンネル１４は先端部１０のチャンネル孔１６を介して挿入部５の最先端において外部に開口している。
図７に示すように、第１湾曲部１１は複数の湾曲駒１７を回動自在に連結して上下の方向と左右の方向に湾曲する構成になっており、複数の操作ワイヤ１８の牽引によってその操作ワイヤ１８の牽引方向に湾曲させられる。また、第２湾曲部１２も、同様に複数の湾曲駒を利用して湾曲する構成であるが、この第２湾曲部１２は上下方向のみに湾曲するようになっている。
図６に示すように、各導入ガイドチューブ４ａ，４ｂの挿入部５の手元端には手元操作部２０が設けられている。手元操作部２０には把持部２１と、前記処置具誘導用チャンネル１４に通じる挿入口２２と、前記湾曲部１１，１２をそれぞれ湾曲するための複数の操作体が設けられている。この湾曲用操作体としては第１湾曲部１１を操作する２つのアングルノブ２３ａ，２３ｂと、第２湾曲部１２を操作する１つのアングルハンドル２４とが設けられている。
上述したように、各処置具用導入ガイドチューブ４ａ，４ｂはその挿入部５の途中部分が、図１及び図２に示すように、軟性の連結フード２６によって一体的に固定される状態で連結されている。また、このような連結フード２６を用いず、２つの挿入部の少なくとも一部の部分、例えば図１に示す中途部分を１本の例えば横断面形状が楕円形状可撓管として形成してもよい。この場合も複数の導入ガイドチューブ４ａ，４ｂの挿入部５が一体的に連結された固定構造になる。
前記第２湾曲部１２はその連結部６の先端から始まるように設けられている。すなわち、各処置具用導入ガイドチューブ４ａ，４ｂにおいて、湾曲部１１，１２を含む可動領域における基端部分は前記連結フード２６によって固定的に支持される。つまり、本実施形態ではこれにより導入ガイドチューブ４ａ，４ｂの湾曲部１１，１２よりも手元側端近傍を夫々固定し、湾曲部１１，１２よりも手元側端近傍同士を固定する固定部（固定手段）を構成する。また、前記連結フード２６が複数の導入ガイドチューブ４ａ，４ｂを連結する治療機器連結具を構成する。
そして、前記各処置具用導入ガイドチューブ４ａ，４ｂの可動領域の両方を支持する連結フード２６の先端部分が共通の支点２７となる。このため、湾曲部１１，１２を含む可動領域部分はその共通な支点２７を基準として互いに動き得る。また、支点２７は各導入ガイドチューブ４ａ，４ｂの可動領域部分について見ると共通する定点でもある。
一方、前記内視鏡２の挿入部３は、図１に示すように、最先端に位置した先端部３１と、この先端部３１の手元側に位置した湾曲部３２と、この湾曲部３２の手元側に位置した軟性部３３とを備える。この内視鏡２は先端部３１の先端面に観察窓３４、照明窓３５及びチャンネル口３６等を設けることにより、一般的な内視鏡と同様に観察機能等を備える。また、湾曲部３２は挿入部３の基端に設けられた図示しない操作部によって湾曲操作される。
図３及び図４に示すように、前記処置具用導入ガイドチューブユニット１は内視鏡２の挿入部３に沿わせて並べられる状態で連結具４０によって内視鏡２の挿入部３に組み付けられる。連結具４０は内視鏡２の湾曲部３２を避けて軟性部３３の先端付近部位に配置される。この連結具４０によって前記導入ガイドチューブユニット１の先端付近部位が連結されるため、図３に示すように、各処置具用導入ガイドチューブ４ａ，４ｂの湾曲部１１，１２を含む可動領域部分は内視鏡２の湾曲部３２と対応して配置され、それらは相対的に動き得るようになっている。
図４及び図５に示すように、前記連結具４０は導入ガイドチューブユニット１の連結部６を差し込める挿入孔４１と、内視鏡２の挿入部３を差し込める挿入孔４２とを形成したバンド部材４３からなり、このバンド部材４３は一端のヒンジ部４４を中心として他端側が開くことができる開閉自在なものである。また、バンド部材４３の開くことができる他端縁の一方には突起４５が形成され、他方にはその突起４５が嵌って係着する孔４６が形成されている。
次に、この内視鏡治療装置を使用する場合について説明する。図３に示すように、導入ガイドチューブユニット１を内視鏡２の挿入部３に組み付けて一つのユニットとして体腔内に誘導される。このように一つに組み付けたユニットを体腔内へ誘導する際には図示しない誘導ガイド体としてトラカ―ルまたはオーバーチューブ等を用いて体腔内に誘導するようにしてもよい。
そして、前記内視鏡２によって体腔内を観察しながらその内視鏡２の挿入部３に組み付けられた導入ガイドチューブユニット１における各導入ガイドチューブ４ａ，４ｂを通じて各種の処置具（吸引具も含む）を体腔内に導入して所要の処置を行なう。内視鏡２に設けたチャンネルを通じて他の処置具を導入して併せて処置するようにしてもよい。
図３は生体組織４７を挙上する場合の状況を示す。このような処置例では、一方の導入ガイドチューブ４ａを通じて導入した把持鉗子４８を用いて生体組織４７を挙上し、他方の導入ガイドチューブ４ｂを通じて導入した把持鉗子４９を用いて生体組織４７を抑え、各処置具を逆向きに動かす。つまり、各導入ガイドチューブ４ａ，４ｂの湾曲部１１，１２をそれぞれ湾曲操作し、把持鉗子４８，４９に逆向きの動きを与えて生体組織４７を挙上する。
ここで、各把持鉗子４８，４９を誘導する各導入ガイドチューブ４ａ，４ｂの可動領域部分は支点２７を基準に逆向きに動くため、支点２７に加わる支持力は互いに打ち消し合い、各導入ガイドチューブ４ａ，４ｂの可動領域部分は支点２７を基準点とし、これを定点とする動きとなる。したがって、把持鉗子４８，４９に加えるようとする力が逃げてしまわずに、そのまま生体組織４７に力を加えることができる。このような挙動は、生体組織４７を挙上する場合に限らず、生体組織４７を広げる場合のような手術操作においても同様である。
ところで、軟性の導入ガイドチューブまたは軟性の内視鏡を単独で使用すると仮定した場合にあっては、把持鉗子から受ける反作用によって柔軟な挿入部の部分が体腔内空間を浮遊し、自由に動き得る状態になる。このため、反作用による力が柔軟な挿入部に逃げて生体組織に加える力が極端に小さくなり易い。
しかし、本実施形態では、把持鉗子４８，４９を誘導操作する各導入ガイドチューブ４ａ，４ｂの可動領域部分が、共通の支点２７で固定的に支持されているので、支点２７に加わる反作用の支持力が支点２７部分で互いに打ち消し合って導入ガイドチューブ４ａ，４ｂの可動領域部分を安定的に支持できるようになる。つまり、導入ガイドチューブ４ａ，４ｂ自体が動いて力が逃げてしまうことがない。また、支点２７が定点と見なせ、その支点２７を基準として把持鉗子４８，４９を思うように誘導して迅速な処置操作を行なうことができる。このように生体組織の挙上または生体組織を広げる場合のように生体組織の２個所の部位を２つの処置具によって把持してその２個所の部位を逆向きに動かす場合であっても、思うように強い力で確実に処置することができるようになる。
なお、上述した実施形態では、導入ガイドチューブユニット１を内視鏡２の挿入部３に対し組み付けて使用するようにした場合について述べた。しかし、導入ガイドチューブユニット１を単独で使用する場合でも同様の作用効果が得られる。もっとも、導入ガイドチューブユニット１を内視鏡２の挿入部３に組み付けて使用する場合はそれらの使用中、内視鏡２との位置関係が関連付けられ、状況把握が容易であると共に、ユニット全体が安定した支持バランスが得られるため、一層、操作上の安定性が増し、使用し易い。
また、内視鏡２に設けたチャンネルを通じて処置具を使用する場合にも上述したような支持する機能が得られる使用形態も考えられると共に他にも種々の使用形態が想定できるものである。
次に、図８乃至図１１を参照して本発明の他の実施形態に係る内視鏡治療装置について説明する。上述した実施形態と同様なものについては同一の符号を付して説明する。
図８に示すように、本実施形態での処置具用導入ガイドチューブユニット１は２本の処置具用導入ガイドチューブ４ａ，４ｂを軟性素材から形成されたオーバーチューブ６１内に挿通して一体的に組み立てるようにしたものである。ここで、処置具用導入ガイドチューブ４ａ，４ｂは先の実施形態の場合と同様である。
図９に示すように、オーバーチューブ６１には２本の処置具用導入ガイドチューブ４ａ，４ｂをそれぞれ別々に挿通するための２つの挿通孔６２ａ，６２ｂが並列に配設されており、各挿通孔６２ａ，６２ｂは仕切り壁６３によって互いに仕切られ、導入ガイドチューブ４ａ，４ｂをそれぞれ別々にガイドするが、一部が連通し、且つ、互いに近接して形成されている。
また、図９及び図１０に示すように、一方の挿通孔６２ｂに位置した側壁には固定用ネジ６４が螺合されており、このネジ６４によって挿通孔６２ｂに挿通された導入ガイドチューブ４ｂを締め付けてその導入ガイドチューブ４ｂを固定できるようになっている。また、他方の挿通孔６２ａに挿通された導入ガイドチューブ４ａは前記ネジ６４によって前記導入ガイドチューブ４ｂを締め付けたとき、オーバーチューブ６１自体が弾性的に変形することにより同時に締め付けられ、その挿通孔６２ｂに固定される。つまり、本実施形態ではこれにより導入ガイドチューブ６１の湾曲部１１，１２よりも手元側端近傍を夫々固定し、湾曲部１１，１２よりも手元側端近傍同士を固定する固定部（固定手段）を構成する。また、オーバーチューブ６１自体が複数の導入ガイドチューブ６１を連結する治療機器連結具を構成する。
また、図８に示すように、２本の処置具用導入ガイドチューブ４ａ，４ｂそれぞれがオーバーチューブ６１に装着されたときはその先端部１０及び湾曲部１１，１２の領域部分はオーバーチューブ６１の先端から露出して前方へ突き出している。通常は軟性部１３の先端部分も少なくとも僅かに突き出すように装着される。
次に、この内視鏡治療装置を使用する場合について述べる。まず、図１１に示すように、２本の処置具用導入ガイドチューブ４ａ，４ｂそれぞれをオーバーチューブ６１に装着して一つのユニットとし、これを例えばトラカ―ル等のガイド手段を用いて体腔内に誘導する。ここで、オーバーチューブ６１の先端から突き出す導入ガイドチューブ４ａ，４ｂはオーバーチューブ６１の先端を支点２７として保持されているため、導入ガイドチューブ４ａ，４ｂの動きは安定したスムーズな動きとなる。また、導入ガイドチューブ４ａ，４ｂにより処置具としての把持鉗子４８，４９を逆向きに操作する場合はその支点２７に加わる逆向きの力成分同士が互いに打ち消し合う。したがって、導入ガイドチューブ４ａ，４ｂの可動操作領域部分は支点２７を基準点として動き、把持鉗子４８，４９に加える力を生体組織４７にそのまま加えることができる。
これとは異なるが、各々の導入ガイドチューブ４ａ，４ｂの第２湾曲部１２の領域部分をオーバーチューブ６１内に位置させたまま、第１湾曲部１１のみをオーバーチューブ６１から突き出し、第１湾曲部１１と第２湾曲部１２の境界部付近を前記ネジ６４等によって前記オーバーチューブ６１上に固定してもよい。このときは、第１湾曲部１１のみが、第１湾曲部１１と第２湾曲部１２の境界部付近を支点として湾曲動作することになる。つまり、本発明は最も手元側の第２湾曲部１２の手元側付近に限らず、湾曲部の中途部に位置する部分を固定する形態のものであってもよいものである。
また、本実施形態では内視鏡２は前記ユニットとは別体であり、図１１に示すように、前記ユニットのオーバーチューブ６１に添って体腔６５内に誘導され、処置する状態を観察したり、別の高周波ナイフ６６等の処置具を誘導したりすることができるようになっている。図１１は内視鏡２を通じて導入した高周波ナイフ６６によって把持鉗子４８，４９によって挙上した生体組織４７を切開する状況を示している。
次に、図１２及び図１３を参照して本発明のさらに他の実施形態に係る内視鏡治療装置について説明する。上述した実施形態と同様なものについては同一の符号を付す。
本実施形態は上述した２本の処置具用導入ガイドチューブ４ａ，４ｂ及び内視鏡２を連結具７１によって連結するようにしたものである。連結具７１は図１２に示すように、導入ガイドチューブ４ａの挿入部５を嵌め込む孔部７２と、導入ガイドチューブ４ｂの挿入部５を嵌め込む孔部７３と、内視鏡２の挿入部３を嵌め込む孔部７４とを放射状に配置してなる弾性部材７５を備える。また、連結具７１の各孔部７２，７３，７４には部材を途中から出し入れするためのスリット７６が形成されている。
図１３は本実施形態の使用状況を示している。連結具７１の孔部７２，７３，７４にそれらに対応した導入ガイドチューブ４ａの挿入部５、導入ガイドチューブ４ｂの挿入部５および内視鏡２の挿入部３をそれぞれ嵌め込んで装着している。また、前記連結具７１は内視鏡２の先端部３１に取付け固定される。この位置で導入ガイドチューブ４ａ，４ｂの軟性部１３の先端付近部分を固定的に保持するため、その支持部分が導入ガイドチューブ４ａ，４ｂの支点２７となる。したがって、図１３に示すように、連結具７１によって導入ガイドチューブ４ａ，４ｂ及び内視鏡２を連結すると、内視鏡２の挿入部３を囲む近接位置に導入ガイドチューブ４ａ，４ｂが配置される。そして、上述した場合と同様に使用することが可能になる。
次に、図１４を参照して本発明のさらに他の実施形態に係る内視鏡治療装置について説明する。上述した実施形態と同様なものについては同一の符号を付して説明する。
本実施形態では湾曲機能付きの軟性オーバーチューブ８０を用いる。このオーバーチューブ８０の先端側部分は湾曲部８１となっており、この湾曲部８１はオーバーチューブ８０の手元側に配置した図示しない操作部によって湾曲操作される。このオーバーチューブ８０には導入ガイドチューブ８２を挿通する孔８３と、２本の吸引用チューブ８４ａ，８４ｂをそれぞれ別々に挿通する２つの孔８５と、内視鏡２の挿入部３を挿通する孔８６とが区画して形成されている。
そして、図１４に示すように、オーバーチューブ８０の各孔８３，８５，８６にそれぞれ対応する導入ガイドチューブ８２、吸引用チューブ８４ａ，８４ｂ、内視鏡２の挿入部３が、それぞれ挿通することにより、これらが一つにユニット化される。オーバーチューブ８０に装着された導入ガイドチューブ８２及び吸引用チューブ８４ａ，８４ｂはその径方向へふら付くことなく前後に進退自在に装着される。前記導入ガイドチューブ８２及び吸引用チューブ８４ａ，８４ｂにおいて、オーバーチューブ８０の先端から突き出す可動領域部分には前記同様の湾曲部８７が構成されている。オーバーチューブ８０の先端から突き出す湾曲部８７の基端側部分はそのオーバーチューブ８０に支持され、オーバーチューブ８０の先端付近が、これより先に突き出した可動領域部分の支点となる。
これを使用する場合は、図１４に示すように、オーバーチューブ８０の先端から導入ガイドチューブ８２、吸引用チューブ８４ａ，８４ｂ及び内視鏡２の挿入部３を突き出す。そして、例えば、２本の吸引用チューブ８４ａ，８４ｂの先端を生体組織４７に当てその生体組織４７を吸着する。また、オーバーチューブ８０の先端から突き出した吸引用チューブ８４ａ，８４ｂの湾曲部８７を適宜、湾曲操作し、生体組織４７を牽引して引き挙げることができる。また、吸引用チューブ８４ａ，８４ｂの湾曲部８７を互いに離反する向きに湾曲させると、生体組織４７を広げることができる。
これらの使用にあたっても、各吸引用チューブ８４ａ，８４ｂの可動領域部分が共通の支点で固定的に支持されているので、吸引用チューブ８４ａ，８４ｂに加わる反作用の力が互いに打ち消し合ってオーバーチューブ８０の先端を支点として、吸引用チューブ８４ａ，８４ｂを思うように強い力で確実に操作することができる。また、導入ガイドチューブ８２からは処置具を突き出して処置することもできる。
なお、前記導入ガイドチューブ８２を吸引用チューブとしたものでもよい。吸引用チューブ８４ａ，８４ｂを前記同様な処置具導入ガイドチューブに置き換えたものでもよい。
次に、図１５を参照して本発明のさらに他の実施形態に係る内視鏡治療装置について説明する。上述した実施形態と同様なものについては同一の符号を付して説明する。
本実施形態は軟性オーバーチューブ９０を用い、この軟性オーバーチューブ９０の先端部分に複数のマニュピレータ９１ａ，９１ｂを一体に設けたものである。一方のマニュピレータ９１ａには人の手指の動きと類似の自由度を備えた先端作業部９２が設けられ、他方のマニュピレータ９１ｂには人の手首の動きと類似の自由度を備えた湾曲機能付きの湾曲部９３が設けられている。各マニュピレータ９１ａ，９１ｂは図示しない操作入力手段によって別々に遠隔操作される。この操作入力手段としては、人の手の動きがそのまま入力される、例えば、グローブ型入力装置とする。
前記軟性オーバーチューブ９０には内視鏡２の挿入部３を導入する挿通チャンネル９５が形成されている。ここでの内視鏡２は観察機能だけの極細の挿入部３のものである。
この内視鏡治療装置を使用する場合は、図１５に示すように、人の手指の動きと類似の自由度が得られる左右のマニュピレータ９１ａ，９１ｂを用いて処置具を把持しての処置または生体組織を直接に摘むなどの処置を行なう。この処置形態では人の手首の動きと類似の動きのものとなり、手と同じ使用感覚で使用することができるため、その操作性を一段と向上できる。また、その使用方法の習得も容易である。
また、左右のマニュピレータ９１ａ，９１ｂは軟性オーバーチューブ９０の先端部分に取り付けられ、一体になって固定的に支持されている。このため、この支持部分が、可動領域部分としてのマニュピレータ９１ａ，９１ｂの支点となる。したがって、各マニュピレータ９１ａ，９１ｂを用いて逆向きに操作するような場合にあっては、各マニュピレータ９１ａ，９１ｂに加わる力が互いに打ち消し合ってオーバーチューブ９０の先端を支点として各マニュピレータ９１ａ，９１ｂを思うように強い力で確実に操作することができる。
次に、図１６乃至図１８を参照して、前述したような導入ガイドチューブの部分を改良した他の治療装置について説明する。この治療装置での導入ガイドチューブ１００は、図１７に示すように、軟性の挿入部１０１と、操作部１０２を備え、操作部１０２には把持部位１０３と、前記挿入部１０１の湾曲部１０４を湾曲操作するための複数のアングルノブ１０５と、前記挿入部１０１のチャンネル１０６に通じる挿入口１０７と、後述する処置具操作機構１０８を操作する処置具操作レバー１０９などを備えたものである。アングルノブ１０５にはその操作位置をロックするブレーキノブ１０５ａが付設されている。また、処置具操作レバー１０９にもブレーキノブを設けてもよい。
そして、図１８（ａ）（ｂ）に示すように、把持鉗子などの処置具１１０の挿入部１１０ａを、導入ガイドチューブ１００の操作部１０２の挿入口１０７からそのチャンネル１０６内に挿入して、そのチャンネル１０６の先端開口１０６ａから体腔内に突き出せるようになっている。
図１６及び図１８（ａ）（ｂ）に示すように、挿入部１０１の先端部内には前記処置具操作機構１０８が組み込み構成されている。ここでの処置具操作機構１０８は挿入部１０１の先端部内には処置具１１０の挿入部１１０ａを挿通可能としたリング状の可動子１１５が前後軸方向へ直線的に移動自在に設けられている。この可動子１１５には挿入部１１０内に挿通した操作ワイヤ１１６の先端が接続されている。そして、上述した操作部１０２の処置具操作レバー１０９を操作することによって操作ワイヤ１１６を前後軸方向へ進退して可動子１１５を前後軸方向へ移動させ、前記処置具操作機構１０８の可動子１１５を前後方向へ移動操作して、処置具の先端を前後に移動させる移動操作機構を構成している。また、前記可動子１１５は、手元側より操作される操作ワイヤ１１６により、処置具１１０の挿入部１１０ａの一部に係止する係止部材としての把持アーム１１７を選択的に係止及び解放する操作を行う機構を構築している。
図１８（ａ）（ｂ）に示すように、処置具１１０の挿入部１１０ａの一部に係止する係止部材としての複数の把持アーム１１７は可動子１１５から前方へ突き出している。各把持アーム１１７の先端側部分は図１８（ｂ）に示すフリーな状態では外側へ広がるように弾性的に付勢されている。また、各把持アーム１１７の先端には押え部１１８が一体に形成されている。各把持アーム１１７の外側には締付具１２１が装着され、この締付具１２１は可動子１１５と押え部１１８の間の範囲内でスライド自在である。また、挿入部１０１の先端部内には締付具１２１を前後方向へ直線的に案内するガイドレール１２２が形成されている。ガイドレール１２２の前端と後端には立ち上がり壁からなる位置決めストッパ１２３ａ，１２３ｂが形成され、締付具１２１の前後の移動終端位置をそれぞれ規定するようになっている。
前記締付具１２１はガイドレール１２２にガイドされるスライド部１２４と、前記把持アーム１１７の外周をスライドする締付リング部１２５とを備える。そして、図１８（ａ）に示すように、締付具１２１を後退させた場合には締付具１２１によって各把持アーム１１７を締め付け、各把持アーム１１７の押え部１１８を処置具１１０の挿入部１１０ａの外周に押し当て前記可動子１１５により処置具１１０を把持する。
図１８（ａ）に示すような処置具拘束状態で、操作ワイヤ１１６によって可動子１１５を前後方向へ移動操作すれば、処置具１１０を一緒に前後方向へ移動させることができる。このように処置具１１０の先端部分を直接に把持してその先端部分を前後方向へ移動させる操作を行なうため、処置具１１０の手元側部分を手で押し引き操作する場合のように導入ガイドチューブや内視鏡の操作部から手を離して操作する煩雑な操作が必要なく、処置具１１０の進退操作を操作部から手を離すことなく容易に行なうことができる。
また、図１８（ｂ）に示すように、締付具１２１を前進させると、各把持アーム１１７の先端側部分が開き、処置具１１０を解放する。つまり、各把持アーム１１７の押え部１１８は処置具１１０の挿入部１１０ａから退避し、処置具１１０の把持を解除する。このため、処置具１１０のみを前後方向または回転方向へ自由に動かすことができ、処置具１１０の操作性が向上する。
この導入ガイドチューブ１００は上述した治療システムの装置における導入ガイドチューブとして利用され、各種の処置具の導入等に使用することができる。もちろん、複数の導入ガイドチューブ１００の可動領域部分に加わる支持力を共通支点で打ち消すように連結するユニット形態にも同様に適用できることもちろんである。既存の一般的な導入ガイドチューブでは単に処置具を挿通するものであるが、ここでの導入ガイドチューブ１００では処置具１１０を積極的に回転や進退する操作が可能であるから、処置具１１０を確実に操作することができる。また、導入ガイドチューブ１００を内視鏡２とは別に単独に使用するときにも優れた効果を奏し得る。
次に、図１９（ａ）（ｂ）を参照して、上述した導入ガイドチューブの変形例について説明する。この形式の導入ガイドチューブ１３０では上述した導入ガイドチューブ１００とは処置具進退機構が相違する。すなわち、この処置具進退機構は、導入ガイドチューブ１３０における先端部１３１に別部材の最先端部材１３２を、複数の押し棒１３３を介して前後方向へ移動自在に支持してなり、導入ガイドチューブ１３０における操作部１０２に設けた処置具操作レバー１０９を操作することにより、前記押し棒１３３を進退させ、最先端部材１３２を前後方向へ移動させるようになっている。
図１９（ａ）は最先端部材１３２を後方へ後退させた通常の位置に待機しているところであり、図１９（ｂ）は最先端部材１３２を前進させたところである。
また、図１９（ａ）（ｂ）に示すように、最先端部材１３２に形成されるチャンネル１０６の先端開口１０６ａの周縁には、弾性部材としてのリング状弾性部材１３５が配設されている。リング状弾性部材１３５はそのチャンネル１０６の先端開口１０６ａから突き出す処置具１１０の挿入部１１０ａを弾性力により締め付けて把持するものである。処置具１１０はリング状弾性部材１３５の弾性締付け力により保持され、最先端部材１３２の移動に追従するが、処置具１１０の挿入部１１０ａを手元側から押し引きする場合はリング状弾性部材１３５の保持力に抗して処置具１１０のみを移動可能な力で保持されている。処置具１１０を移動不能な強度の力で保持するようにしてもよい。
このような導入ガイドチューブ１３０の場合にも上述した導入ガイドチューブとして利用され、処置具の導入等に使用することができることはもちろん、複数の導入ガイドチューブ１３０の可動領域部分に加わる支持力を共通支点で打ち消すように連結するユニット形態のものにも同様に適用できる。
次に、図２０乃至図２６を参照して、上述した導入ガイドチューブの変形例について説明する。導入ガイドチューブ１４０は図２０に示すように、軟性の挿入部１４１及び操作部１４２を備える。前記操作部１４２には、把持部位１４３と、前記挿入部１４１の湾曲部１４４を湾曲操作するための複数のアングルノブ１４５と、前記挿入部１４１のチャンネル１４６に通じる挿入口１４７と、後述する処置具回転機構１４８を操作する処置具回転操作ノブ１４９などが設けられている。アングルノブ１４５や処置具回転操作レバー１４９にはその操作位置をロックするためのブレーキノブ１４５ａ，１４９ａが付設されている。さらに、図２０に示すように、前記操作部１４２には、チャンネル１４６を利用しての吸引または送気などの操作を行なう操作釦１３７が設けられている。
そして、図２５および図２６に示すように、導入ガイドチューブ１４０の操作部１４２の挿入口１４７から把持鉗子などの処置具１５０の挿入部１５０ａをチャンネル１４６内に挿入することにより、そのチャンネル１４６の先端開口１４６ａから体腔内に処置具１５０を突き出すようになっている。
前記処置具回転操作機構１４８は、挿入部１４１の先端部内に組み込まれ、図２１乃至図２６に示すように構成されている。すなわち、導入ガイドチューブ１４０の挿入部１４１における先端部１５１内には前記チャンネル１４６を形成する柔軟なチューブ１５２の先端が接続される筒状の接続口金１５３が設けられ、この接続口金１５３は先端部１５１に固定された支持部材１５４に固定されている。図２２に示すように、接続口金１５３と先端部１５１の先端壁１５５にわたり、筒状の回転部材１５６が配置され、この回転部材１５６は前記チャンネル１４６の長手軸またはその長手軸に平行な軸回りに回転自在に支持されている。回転部材１５６は、導入ガイドチューブ１４０の先端部１５１における先端面に開口しており、チャンネル１４６の先端開口１４６ａを形成している。
図２２に示すように、前記回転部材１５６の外周には従動用歯車としての傘歯車１５７が同軸的に形成されている。この傘歯車１５７には駆動用歯車としての傘歯車１５８が噛み合っている。傘歯車１５８の軸心は従動用歯車としての傘歯車１５７の軸心に直交して配置されている。この駆動用歯車としての傘歯車１５８は、図２２に示すように、挿入部１４１の先端部内において軸支されている。この傘歯車１５８にはピニオン歯車１５９が同軸的に一体に形成されている。そして、図２３に示すように、ピニオン歯車１５９には両側から一対のラック１６０ａ，１６０ｂが噛合するように配置されている。各ラック１６０ａ，１６０ｂは導入ガイドチューブ１４０の挿入部１４１の先端部内において図示しないガイドによって直線的にガイドされようになっている。
また、各ラック１６０ａ，１６０ｂにはそれぞれ別々に操作ワイヤ１６１ａ，１６１ｂの先端が接続されていて、この操作ワイヤ１６１ａ，１６１ｂを手元側から押し引きすることにより、ラック１６０ａ，１６０ｂを前後に移動することにより、ピニオン歯車１５９を回転することができるようになっている。
前記操作ワイヤ１６１ａ，１６１ｂは、操作部１４２に設けられた処置具回転操作ノブ１４９を操作することによって牽引され、前記ラック１６０ａ，１６０ｂを移動させる。そして、このラック１６０ａ，１６０ｂが移動することにより、ピニオン歯車１５９が傘歯車１５８と一緒に回転し、その傘歯車１５８により従動用歯車としての傘歯車１５７を回転させる。この従動用歯車としての傘歯車１５７が回転することにより、これと一緒に前記回転部材１５６が回転する。
一方、図２２及び図２５に示すように、前記回転部材１５６の先端周縁には、ゴム等の弾性部材１６５が取り付けられている。この弾性部材１６５は導入ガイドチューブ１４０の挿入部１４１における先端部１５１から外に露出している。そして、弾性部材１６５は、チャンネル１４６に挿通された処置具の先端部分に当り、その処置具との摩擦力または変形により処置具の先端部分と係着し、前記回転部材１５６と一緒に回転させる係着手段となっている。前記処置具回転操作機構１４８により導入ガイドチューブ１４０に挿通した処置具を回転することができる。
この導入ガイドチューブ１４０に把持鉗子などの処置具１５０を挿通して使用する場合、図２５及び図２６に示すように、チャンネル１４６に処置具１５０の挿入部１５０ａを挿通すると共に、処置具１５０の先端把持部１５０ｂを導入ガイドチューブ１４０の先端から突き出す。
そして、開閉操作するリンク機構１６８を操作して先端把持部１５０ｂを開くと共に、この開状態のままで僅かに後退させ、前記弾性部材１６５にリンク機構１６８の部材を押し付けて係着する。つまり、前記弾性部材１６５と、リンク機構１６８の部材との摩擦力または係合力によって処置具１５０の先端把持部１５０ｂが前記回転部材１５６と連結され、前記回転部材１５６と一緒に回転するようになる。
そこで、処置具１５０を回転して向きを変える場合、前記回転部材１５６と一緒に処置具１５０の先端把持部１５０ｂを回転させることができる。つまり、処置具１５０の先端把持部１５０ｂを直接に回転操作するため、回転操作量との正確な対応関係が維持できると共に、処置具１５０の先端把持部１５０ｂを迅速に回転させることが可能である。なお、処置具１５０の長尺な挿入部１５０ａを手元側から捻り、処置具１５０の先端把持部１５０ｂの回転を補助するようにしてもよい。
次に、図２７及び図２８を参照して、上述したように処置具回転操作機構を備えた導入ガイドチューブの変形例について説明する。
図２７に示すように、この導入ガイドチューブ１７０の処置具回転操作機構では前記回転部材１５６の外周に設ける従動用歯車を平歯車１７１とする。この平歯車１７１には駆動用歯車としての平歯車１７２が噛み合っている。駆動用歯車としての平歯車１７２は挿入部１４１の先端部内において軸支されている。この平歯車１７２の軸には回転トルクを伝達するように構成したトルク伝達ワイヤ１７３の先端が接続されている。
そして、トルク伝達ワイヤ１７３を手元側から捻り回転することにより、駆動用歯車としての平歯車１７２を回転し、従動用歯車としての平歯車１７１を回転する。この平歯車１７１が回転することにより、これと一緒に前記回転部材１５６が回転する。
また、図２８に示すように、この導入ガイドチューブ１７０の操作部１４２には回転操作レバー１７５が設けられ、この回転操作レバー１７５を操作することによって前記トルク伝達ワイヤ１７３を回転させるようになっている。また、手元側の操作機構の回転操作レバー１７５による操作方向が、前記回転操作機構の挿入部先端での回転軸と略平行である。
尚、処置具回転操作機構のこれ以外の構成については上述した形態のものと略同様に構成できる。
この場合にあっても、前記形態の場合と同様にして、処置具１５０の回転向きを変えるべく使用することができる。また、従動用歯車を平歯車１７１とし、駆動用歯車を平歯車１７２とし、この平歯車１７２をトルク伝達ワイヤ１７３によって回転するようにしたから、導入ガイドチューブ１７０の先端部に組み込む機構を簡略化できる。
なお、上述した説明では処置具を進退または回転する処置具操作機構を導入ガイドチューブの先端部に処置具を組み込んだ形態のものであったが、両構成を組み合わせるなどによって処置具を進退および回転する処置具操作機構を組み込んだ形態のものとすることもできる。
上述したように処置具を進退または／および回転する処置具操作機構を組み込んだ形態の導入ガイドチューブでは以下のような課題が解決できる。
すなわち、従来のように、軟性の導入ガイドチューブによって体腔内に誘導した処置具の先端部の向きや位置を変更する場合、導入ガイドチューブの手元側で処置具の手元部を捻ったり進退したりしていた。
しかし、導入ガイドチューブ内を通じて誘導される処置具の挿入部は長尺で柔軟性のあるものであり、また、処置具の挿入部は各所で導入ガイドチューブ内壁に接し、また、蛇行していることも多い。特に、導入ガイドチューブの湾曲部が湾曲している場合はその湾曲した部分内では導入ガイドチューブ内壁に処置具の挿入部が圧接してしまう。
このような状況では導入ガイドチューブ内に位置した処置具の挿入部を手元側から押し引き、または回転する操作を加えても、その操作力は、処置具の挿入部の蛇行や捻りによって途中で吸収されてしまい易く、手元側からの操作力が処置具の先端部まで伝わり難い。
しかし、上述したように、導入ガイドチューブの先端部に処置具を進退する操作機構や処置具を回転する操作機構を組み込むようにした形態にあってはそれらの不都合がなく、操作量との正確な対応関係を維持して迅速に操作可能である。また、処置具の手元側部分を手で押し引き操作する場合のように導入ガイドチューブや内視鏡の操作部から手を離して操作する煩雑な操作が必要ではなく、処置具の進退操作を操作部から手を離すことなく容易に行なうことができる。
なお、本発明は前述したものに限定されず、他の形態にも適用が可能である。また、前述した説明によれば、以下の事項またはそれらの事項を適宜選択して組み合わせた事項が得られる。
＜付記＞
１．体腔内での処置に使用する処置具を挿通する導入ガイドチューブにおいて、前記導入ガイドチューブの先端部に、その導入ガイドチューブに挿通された処置具の先端部分を保持してその処置具の先端部を操作する操作機構を設けたことを特徴とする内視鏡用導入ガイドチューブ。
２．前記操作機構には、処置具の挿入部の一部を係止する係止部材を含むことを特徴とする項１に記載の内視鏡用導入ガイドチューブ。
３．手元側より前記係止部材を選択的に係止及び解放する操作を行う機構を含むことを特徴とする項２に記載の内視鏡用導入ガイドチューブ。
４．前記操作機構は、処置具の先端を前後に移動させる移動操作機構としたことを特徴とする項１、項２または項３に記載の内視鏡用導入ガイドチューブ。
５．前記操作機構は、処置具の先端を回転させる回転操作機構としたことを特徴とする項１、項２または項３に記載の内視鏡用導入ガイドチューブ。
６．前記回転操作機構は、処置具挿通チャンネルの長手軸或いはその長手軸に平行な軸を回転軸とする回転方向に回転可能としたことを特徴とする項５に記載の内視鏡治療装置。
７．前記回転操作機構は、手元側の操作機構の操作方向と同じ方向に回転可能としたことを特徴とする項５に記載の内視鏡治療装置。
８．前記回転操作機構は、手元側の操作機構の操作方向が、回転操作機構の挿入部先端での回転軸と略平行であることを特徴とした項５に記載の内視鏡治療装置。
本発明の一実施形態に係る内視鏡治療装置の斜視図。 同じく前記実施形態に係る内視鏡治療装置における連結部の横断面図。 同じく前記実施形態に係る内視鏡治療装置の使用状態の説明図。 同じく前記実施形態に係る内視鏡治療装置の処置具用導入ガイドチューブユニットを内視鏡に組み付け状態での連結部を拡大して示す斜視図。 同じく前記実施形態に係る内視鏡治療装置の処置具用導入ガイドチューブユニットを内視鏡に組み付ける連結具を示す斜視図。 同じく前記実施形態に係る内視鏡治療装置の処置具用導入ガイドチューブユニットにおける導入ガイドチューブを示す斜視図。 同じく前記実施形態に係る内視鏡治療装置の処置具用導入ガイドチューブユニットにおける導入ガイドチューブの縦断面図。 本発明の他の実施形態に係る内視鏡治療装置の斜視図。 同じく前記実施形態に係る内視鏡治療装置のオーバーチューブを示す斜視図。 同じく前記実施形態に係る内視鏡治療装置のオーバーチューブに導入ガイドチューブを組み付けた固定部分の横断面図。 同じく前記実施形態に係る内視鏡治療装置の使用状態の説明図。 本発明のさらに他の実施形態に係る内視鏡治療装置の展開斜視図。 同じく前記実施形態に係る内視鏡治療装置の使用状態の説明図。 本発明のさらに他の実施形態に係る内視鏡治療装置の先端部分を示す斜視図。 本発明のさらに他の実施形態に係る内視鏡治療装置の先端部分を示す斜視図。 本発明のさらに他の実施形態に係る内視鏡治療装置における導入ガイドチューブの操作部を示す斜視図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの操作部の平面図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分の縦断面図。 本発明のさらに他の実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分を示す斜視図。 本発明のさらに他の実施形態に係る内視鏡治療装置における導入ガイドチューブの操作部を示す斜視図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分に組み込んだ処置具回転機構を示す斜視図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分に組み込んだ処置具回転機構の縦断面図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分に組み込んだ処置具回転機構の歯車列を示す平面図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分に組み込んだ処置具回転機構の歯車列を示す斜視図。 同じく前記実施形態に係る内視鏡治療装置の導入ガイドチューブの使用時における先端部分の斜視図。 同じく前記実施形態に係る内視鏡治療装置の導入ガイドチューブの使用時における先端部分の縦断面図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの先端部分に組み込んだ処置具回転機構を示す斜視図。 同じく前記実施形態に係る内視鏡治療装置における導入ガイドチューブの操作部の側面図。
符号の説明
１…処置具用導入ガイドチューブユニット、
４ａ…処置具用導入ガイドチューブ
４ｂ…処置具用導入ガイドチューブ
１１…第１湾曲部
１２…第２湾曲部
２７…支点

Claims (10)

  1. 軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で処置具により治療する内視鏡治療装置において、
    各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、前記複数の導入ガイドチューブの前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍同士を連結して固定したことを特徴とする内視鏡治療装置。
  2. 軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で処置具により治療する内視鏡治療装置において、
    各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、少なくとも１つの湾曲部よりも手元側端近傍を含む前記複数の導入ガイドチューブにおける挿入部の少なくとも一部を一体的に連結した構造に形成したことを特徴とする内視鏡治療装置。
  3. 前記複数の導入ガイドチューブの前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍同士を連結具により連結して固定したことを特徴とする請求項１に記載の内視鏡治療装置。
  4. 軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で治療する内視鏡治療装置において、
    各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、前記複数の導入ガイドチューブの前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍と、内視鏡の挿入部とを、連結具により着脱自在に連結して固定したことを特徴とする内視鏡治療装置。
  5. 軟性の導入ガイドチューブを通じて処置具を体腔内に誘導して内視鏡による観察下で処置具により治療する内視鏡治療装置において、
    各々が手元側より操作可能な少なくとも１つ以上の湾曲部を有した複数の導入ガイドチューブを備え、前記複数の導入ガイドチューブの挿入部を、軟性のオーバーチューブに組み付けて、前記湾曲部のうち少なくとも１つの湾曲部よりも手元側端近傍を前記オーバーチューブに固定したことを特徴とする請求項１または請求項２に記載の内視鏡治療装置。
  6. 体腔内に導入され、内部に処置具が挿通される導入ガイドチューブを含む、湾曲操作可能な湾曲部を備えた治療機器を複数、前記導入ガイドチューブの湾曲部よりも手元側端近傍同士を固定する固定部を設けたことを特徴とする治療機器連結具。
  7. 湾曲操作可能な湾曲部を備えると共に、内部に処置具を挿通可能で体腔内に導入される複数の導入ガイドチューブを挿通するオーバーチューブにおいて、
    前記導入ガイドチューブの湾曲部よりも手元側端近傍同士を固定する固定部を設けたことを特徴とするオーバーチューブ。
  8. 前記複数の導入ガイドチューブを夫々個別的に挿入可能に形成された複数の挿通ガイド孔を有したことを特徴とする請求項７に記載のオーバーチューブ。
  9. 前記導入ガイドチューブ先端部に、その導入ガイドチューブに挿通された処置具の先端部分を保持してその処置具の先端部を操作する操作機構を設けたことを特徴とする請求項１から請求項８のいずれかに記載のもの。
  10. 体腔内での処置に使用する処置具を挿通する導入ガイドチューブにおいて、
    前記導入ガイドチューブの先端部に、その導入ガイドチューブに挿通された処置具の先端部分を保持してその処置具の先端部を操作する操作機構を設けたことを特徴とする内視鏡用導入ガイドチューブ。
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EP05007799.9A EP1586275B1 (en) 2004-04-13 2005-04-08 Endoscope therapeutic device
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EP1586275A3 (en) 2005-12-07
EP1586275B1 (en) 2013-05-29
EP1985246B1 (en) 2012-02-01
US20050228224A1 (en) 2005-10-13
US20100048992A1 (en) 2010-02-25
US8221306B2 (en) 2012-07-17
EP1985246A1 (en) 2008-10-29

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