JP2006061272A - Medical instrument holding device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical instrument holding device which facilitates the replacement of various kinds of instruments during an operation while ensuring a state of sterilization, and improves the surgery efficiency. <P>SOLUTION: This medical instrument holding device which can selectively hold a plurality of surgical instruments is equipped with an arm rack 12, a sterilized drape 14, a pre-sterilized first adapter 16, a pre-sterilized second adapter 18, and a pre-sterilized surgical instrument position-adjusting mechanism 86. The drape 14 is attachable to/detachable from the arm rack 12, and when covering the arm rack 12, the drape 14 is used to separate a region into the arm rack 12 and the outside. The first adapter 16 has a connecting section under a state of sterilization which can be attached to/detached from the arm rack 12 while keeping the state of sterilization from outside of the drape 14. The second adapter 18 is attachable to/detachable from the first adapter, and has a pre-sterilized surgical instrument holding section 84 which selectively holds a surgical instrument depending on a surgery. The pre-sterilized surgical instrument position-adjusting mechanism 86 is provided on the second adapter 18, and can change the position of the surgical instrument to the arm rack 12. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a medical instrument holding apparatus that holds various surgical tools such as a treatment tool and an endoscope used in a surgical operation.

  In general, in a surgical operation, a patient is placed so as to lie on an operating table, and a surgeon performs a surgical operation on the surgical site of the patient from the side of the patient. For example, a medical instrument (hereinafter referred to as a surgical instrument) is inserted through a hole formed in the patient's body surface by an incision or the like to perform a surgical operation.

  When performing a surgical operation, the operation is performed using various observation devices and treatment tools. For example, an endoscope for observing the back side of the surgical site, which is difficult to directly view with a surgical microscope, or an ultrasound observation to confirm the internal structure of the organization performing a surgical incision during surgery. Use surgical tools such as acoustic probes. There are various types of surgical tools such as various endoscopes with different lengths, thicknesses, observation directions, etc., ultrasonic probes for ultrasonic observation devices for observing the deep part of the body, and therapeutic instruments using various energies. used. Surgical tools that are inserted into the surgical site during surgery are frequently replaced depending on the status of the surgery.

  Since it is sometimes necessary to hold these surgical tools for a long time during surgery, various devices have been devised, such as medical instrument holding devices disclosed in Patent Documents 1 to 4, for example.

  For example, in the holding device disclosed in Patent Documents 1 to 3, a plurality of arms are connected by joints. This holding device includes a brake that can be selectively switched between a fixed state in which the surgical tool is fixed and a released state in which the surgical tool is released in a part of the joint. After the surgical instrument is moved to a desired position in the released state, the surgical instrument can be held at that position by switching the brake to the fixed state.

Patent Document 4 discloses a surgical apparatus having a configuration in which a surgical microscope is covered with a sterilization drape and a surgical instrument such as an electric knife can be attached via a sterilizable adapter.
JP-A-7-227398 JP-A-8-52158 JP 2001-258903 A JP 2003-325543 A

  The medical instrument holding device disclosed in Patent Document 1 to Patent Document 3 has a complicated structure. For this reason, it is difficult to sterilize the holding device itself with high-pressure steam or gas. Therefore, the medical device holding device is actually used with a sterilized drape so that it is not necessary to perform difficult sterilization after use. The drape is applied to the entire medical device holding device. If it does so, since the surgical instrument connection part of a medical instrument holding | maintenance apparatus will be covered by drape, it will become difficult to replace | exchange a surgical instrument connection part during an operation.

  In addition, the surgical device disclosed in Patent Document 4 requires a dedicated adapter for one surgical tool, and when replacing a surgical tool used during surgery, it is also necessary to replace the adapter. Once the adapter is connected to the surgical device, the connection is unclean, and it is difficult to keep the adapter clean during the operation. For this reason, of course, it cannot be reconnected to the surgical apparatus. Therefore, it is impossible to replace the attached surgical instrument with a different type of surgical instrument during the operation.

  This invention was made in order to solve such a subject, The place made into the objective is to be able to replace | exchange various surgical instruments easily during a surgery, and to improve surgical efficiency, ensuring a sterilization state. It is an object of the present invention to provide a medical device holding device that can perform the above-described operation.

  In order to solve the above problems, the medical instrument holding device of the present invention can selectively hold a plurality of surgical tools. The medical instrument holding device is capable of being fixed to a desired position, an arm portion supported by the support portion, and supporting the surgical instrument so as to be movable and tiltable, and detachable from the arm portion. A sterilized drape that separates a region into the arm portion and the outside thereof when the arm portion is covered; and a first sterilized first adapter that can be attached to and detached from the arm portion from the outside of the drape. A second adapter that is detachable from the first adapter and has a surgical instrument holding portion that is changed by a selected surgical instrument, and is sterilized in advance.

  For this reason, when the second adapter is attached to and detached from the first adapter while the first adapter is attached to the arm portion, the surgical instrument can be exchanged during the operation. Therefore, various surgical tools can be easily exchanged during the operation while ensuring a sterilized state, and the surgical efficiency can be improved.

  Preferably, the second adapter includes a position adjusting mechanism that adjusts the position of the surgical instrument with respect to the arm portion.

  For this reason, the imbalance accompanying replacement | exchange of a surgical instrument can be eliminated.

  According to the present invention, it is possible to provide a medical instrument holding device capable of easily exchanging various surgical tools during surgery and improving surgical efficiency while ensuring a sterilized state.

  The best mode for carrying out the present invention (hereinafter referred to as an embodiment) will be described below with reference to the drawings.

  First, a first embodiment will be described with reference to FIGS.

  As shown in FIG. 1A, a medical instrument holding device (surgical instrument holding means) 10 includes an arm mount 12, a sterilized drape 14, a first adapter (first connecting means) 16, and a first adapter. 2 adapters 18. The second adapter 18 holds, for example, a small-diameter endoscope set 110 described later as a medical instrument (surgical instrument).

  The arm base 12 includes an installation part (support base) 22, a crank-shaped (L-shaped) support arm 24, a link mechanism 26, an extension arm 28, a rolling mechanism part 30, and a grip part 32. The installation unit 22 is slidably and detachably attached to a side rail 34 a disposed on the operating table 34. The installation portion 22 is fixed to the side rail 34a by a fixing screw (not shown) at a position suitable for surgery.

  One horizontal end of the support arm 24 is connected to the installation part 22 so as to be rotatable around the common first rotation axis Oa extending in the vertical direction, for example, by the installation part 22 and the support arm 24. The other end portion of the support arm 24 extends upward perpendicular to the one end portion and is eccentric with respect to the first rotation axis Oa. A link mechanism 26 is supported at the upper end of the other end of the support arm 24 so as to be rotatable about a second rotation axis Ob perpendicular to the first rotation axis Oa.

  The link mechanism 26 includes first to fourth arms 26a to 26d. A first arm 26a is supported on the upper end portion of the support arm 24 shown in FIG. 1A so as to be rotatable around the second rotation axis Ob. One end of the second arm 26b is connected to the upper end of the first arm 26a. One end of the third arm 26c is connected to the lower end of the first arm 26a. The upper end of the fourth arm 26d is connected to the other end of the second arm 26b. The lower end of the fourth arm 26d is connected to the other end of the third arm 26c. The second arm 26b and the third arm 26c are parallel to each other, and the fourth arm 26d and the first arm 26a are parallel to each other.

  The first and second arms 26a and 26b are supported so as to be rotatable around a third rotation axis (joint) Oc. The first and third arms 26a and 26c are supported so as to be rotatable around a fourth rotation axis (joint) Od. The third and fourth arms 26c and 26d are supported so as to be rotatable around a fifth rotation axis (joint) Oe. The second and fourth arms 26b and 26d are supported so as to be rotatable around a sixth rotation axis (joint) Of. A parallelogram is constituted by each side (first to fourth arms 26a to 26d) connecting the rotation axes Oc, Od, Oe, Of in order. The second arm 26b is rotatable in a plane orthogonal to the second rotation axis Ob.

  Fixed to the third arm 26c of the link mechanism 26 is a screw shaft 38a extending from the other end of the third arm 26c in the longitudinal direction and extending in a direction away from the fifth rotation axis Oe. Has been. A counterweight 38, which is a balanced weight, is screwed onto the screw shaft 38a. The counter weight 38 is movable in the axial direction of the screw shaft 38a. That is, the counterweight 38 is supported so as to be able to contact and separate from the fifth rotation axis Oe. The counterweight 38 cancels the rotational moment around the third rotational axis Oc due to the weight of the arm gantry 12, the first and second adapters 16 and 18, and the small-diameter endoscope set 110. It is possible to keep the holding device 10 in an equilibrium state. The weight of each component is appropriately distributed so that the rotational moment due to the weight of each link around the first and second rotation axes Oa and Ob is offset. Further, the center of gravity Go (see FIG. 3) that combines the first and second adapters 16 and 18 and the endoscope set 110 is provided so as to pass through the center Oo of a ball-paired object 30a described later.

  A base end portion of an extending arm 28 extending in a direction opposite to the other end portion of the second arm 26b is attached to one end portion of the second arm 26b of the link mechanism 26. A rolling mechanism (joint) 30 for rolling a surgical instrument such as an endoscope set 110 (to be described later) is disposed at the distal end of the extending arm 28.

  As shown in FIG. 2, the rolling mechanism unit 30 includes a ball pair 30 a, a ball receiver 30 b, and a fourth electromagnetic brake 60 d described later. The ball-pair receiving part 30b is integrally disposed at the tip of the extending arm 28. The center of the ball-paired object 30a coincides with the center Oo of the ball-paired object receiving unit 30b, and is supported so as to be able to roll with respect to the ball-paired object receiving unit 30b. The ball pair 30a and the ball pair receiver 30b form a ball joint. A fourth electromagnetic brake 60d, which will be described later, can be switched between a state in which the ball pairing object 30a is allowed to roll and a state in which the ball pairing object receiving unit 30b is allowed to roll. ing.

  Connected to the rolling mechanism 30 is a substantially cylindrical grip 32 that is gripped when the surgeon moves the small-diameter endoscope set 110 during surgery. Specifically, one end portion of the cylindrical gripping portion 32 is integrally fixed to the upper end portion of the shaft 44 that is orthogonal to the central axis Op of the gripping portion 32 and is connected to the ball pair 30a. . The other end portion of the grip portion 32 is formed as a cylindrical portion 46 opened in a cylindrical shape. Therefore, an insertion hole 48 is formed in the axial center Op of the cylindrical portion 46. A positioning pin 50 for positioning the first adapter 16 with respect to the gripping portion 32 is provided on the end surface of the cylindrical portion 46 and is fitted into a notch 72d described later of the first adapter 16.

  The holding portion 32 is formed with a female screw portion 52 that is orthogonal to the axial center Op from the outer peripheral surface of the holding portion 32 and penetrates the insertion hole 48 toward the axial center Op of the insertion hole 48. A fixing knob 54 having a male screw portion 54 a that can be screwed into the female screw portion 52 is screwed into the female screw portion 52. The insertion hole 48, the positioning pin 50, the female screw portion 52, and the fixing knob 54 form a first connection portion 56a that can be attached to and detached from a second connection portion 56b described later of the first adapter 16.

  As shown in FIG. 1A, the arm mount 12 is provided with first to fourth electromagnetic brakes 60a-60d. The first electromagnetic brake 60 a is disposed on the first rotation axis Oa at the horizontal end of the support arm 24. The first electromagnetic brake 60 a can be switched between a state in which the support arm 24 can rotate around the first rotation axis Oa and a state in which the rotation is electrically restricted with respect to the installation portion 22. The second electromagnetic brake 60 b is disposed on the second rotating shaft Ob at the upper end of the support arm 24. The second electromagnetic brake 60b can be switched between a state in which the first arm 26a can rotate around the second rotation axis Ob and a state in which the rotation is electrically restricted. The third electromagnetic brake 60c is disposed on the third rotating shaft Oc at the upper end of the first arm 26a. The third electromagnetic brake 60c can be switched between a state in which the second arm 26b can rotate around the third rotation axis Oc with respect to the first arm 26a and a state in which the rotation is electrically restricted. It is. The fourth electromagnetic brake 60d is disposed on the ball-pair receiving unit 30b of the rolling mechanism unit 30 described above. The fourth electromagnetic brake 60d can be switched between a state in which the ball-paired object 30a can roll with respect to the ball-paired object receiving unit 30b and a state in which the rolling is electrically restricted.

  These first to fourth electromagnetic brakes 60 a to 60 d are controlled by a pressing operation of a switch 62 provided in the grip portion 32. As shown in FIG. 1B, the switch 62 is electrically connected to the drive circuit 64. The drive circuit 64 is electrically connected to the first to fourth electromagnetic brakes 60a-60d. When the switch 62 is pressed and turned on, the drive circuit 64 receives the signal and outputs a drive signal to release the braking action of the first to fourth electromagnetic brakes 60a-60d. For this reason, when the switch 62 is not pressed and is OFF, the first to fourth electromagnetic brakes 60a to 60d are in a braking state. That is, the arm mount 12 is normally in a state in which the operation is restricted.

  Next, the configuration of the drape 14, the first adapter 16, the second adapter 18, and the small-diameter endoscope set 110 will be described with reference to FIGS.

  As shown in FIG. 2, the drape 14 includes a hard hood portion 14a and a soft cover portion 14b. The soft cover portion 14b has a large large opening portion that is opened so as to cover the entire arm base 12, and is smaller than the large opening portion, and is slightly larger than the outer diameter of the cylindrical portion 46 of the grip portion 32 described above. And a small opening. The hard hood portion 14a is attached to the small opening of the soft cover portion 14b. The hard hood portion 14a is extrapolated to the cylindrical portion 46 of the grip portion 32, and the position of the drape 14 is fixed.

  The first adapter 16 that can be attached to and detached from the grip portion 32 has a material and a shape that can be sterilized by an autoclave (high-pressure steam sterilization) process, gas, chemicals, or the like. The first adapter 16 includes a second connection portion 56b that can be attached to and detached from the first connection portion 56a of the grip portion 32 of the arm gantry 12, and a fourth connection portion 56d that can be attached to and detached from the second adapter 18. 3 connecting portions 56c.

  The second connection portion 56b includes a connection shaft 72 that is integrally fixed to a block 74 described later. The connecting shaft 72 includes a cylindrical portion 72 a, an inclined surface 72 b, a small diameter portion 72 c, and a notch 72 d from the side separated from the block 74 toward the adjacent side. The cylindrical portion 72a is inserted into the insertion hole 48 of the grip portion 32 without play. The slope 72b is formed between the cylindrical portion 72a and the small diameter portion 72c. The notch 72d has a width and length to engage with the positioning pin 50 of the grip portion 32 without rattling.

  The third connection portion 56 c includes a block 74. The block 74 is formed with an insertion hole 76 having an axis Oq orthogonal to the axis Op of the second connecting portion 56b described above. Positioning pins 78 (see FIG. 3) for positioning the second adapter 18 with respect to the first adapter 16 are disposed at the edge of the insertion hole 76.

  The block 74 is formed with a female screw portion 80 that penetrates the insertion hole 76 from the outer peripheral surface of the block 74 toward the axis Oq of the insertion hole 76. A fixing knob 82 having a male screw portion 82a is screwed into the female screw portion 80.

  The second adapter 18 has a material and a shape that can be sterilized by an autoclave (high pressure steam sterilization) process, gas, chemicals, or the like. The second adapter 18 includes a fourth connection part 56d that can be attached to and detached from the first adapter 16, a surgical tool holding part 84 that holds the surgical tool, and a position of the surgical tool holding part 84 with respect to the fourth connection part 56d. And an adjustment mechanism portion 86 that is movable.

  The fourth connecting portion 56d includes a connecting shaft 88 that is integrally fixed to a fixing member 90 described later. The connecting shaft 88 includes a cylindrical portion 88 a, a slope 88 b, a narrow diameter portion 88 c, and a notch 88 d (see FIG. 3) from the side separated from the fixing member 90 toward the side closer to the connecting member 88. The column part 88a is inserted into the insertion hole 76 of the block 74 without play. The slope 88b is formed between the cylindrical portion 88a and the small diameter portion 88c. The notch 88d shown in FIG. 3 has a width and a length that engage with the positioning pin 78 (see FIG. 3) of the fixing member 90 without backlash.

  The adjustment mechanism portion 86 includes a fixed member 90, a lead shaft 92 having a screw portion 92a on the outer periphery, and a moving member 94. The fixing member 90 is attached to the upper end portion of the fourth connection portion 56d. The fixing member 90 is formed in a rectangular shape, for example, and a lead shaft 92 is disposed on the longitudinal center axis Or. An operation knob 92 b that the operator rotates with a finger is integrally attached to the base end portion of the lead shaft 92 on the outside of the fixing member 90. The moving member 94 is inserted into the concave portion 90 a of the fixed member 90, is engaged with the screw portion 92 a of the lead shaft 92, and can move only along the axial direction (axis Or direction) of the lead shaft 92.

  The surgical instrument holder 84 is fixed to the fixed arm 96 that is integrally fixed to the moving member 94, the moving arm 98 that is connected to the fixed arm 96 so as to be rotatable about the rotation axis Os, and the fixed arm 96. On the other hand, a clamp knob 100 is provided for fixing the movable arm 98 with the rotation angle adjusted. The rotation axis Os is a direction orthogonal to the rotation axis Or. The endoscope set (surgical instrument) 110 is gripped by the recessed portions (surgical instrument holding portions) 96 a and 98 a of the fixed arm 96 and the movable arm 98.

  The endoscope set 110 includes a small-diameter endoscope 112, an optical adapter 114, and a TV camera 116. An optical adapter 114 is attached to the upper end portion of the endoscope 112, and a TV camera 116 is attached to the optical adapter 114. For this reason, the optical image incident on the endoscope 112 can be observed through the TV camera 116.

  Next, the balance regarding the center Oo of the ball-paired object 30a of the rolling mechanism part 30 mentioned above using FIG. 3 is demonstrated.

  Reference sign Go indicates the combined center of gravity of the grip portion 32, the first adapter 16, the second adapter 18, and the small-diameter endoscope set 110. The center of gravity Go is adjusted to a position that coincides with the intersection of the axis On and the axis Op passing through the center Oo of the ball-paired object 30a, for example. The symbol Wo indicates the direction of gravity due to the total weight of the grip portion 32, the first adapter 16, the second adapter 18, and the small-diameter endoscope set 110. Reference sign G1 indicates the position of the center of gravity of the endoscope set 110, and reference sign W1 indicates the direction of gravity due to the total weight of the endoscope set 110.

  Next, the operation of the medical instrument holding device 10 according to this embodiment will be described.

  First, the setting operation of the medical instrument holding device 10 in the operation will be described with reference to FIGS.

  A drape 14 is attached to the arm mount 12. In this case, the arm mount 12 is covered with the soft cover portion 14b so as to cover the arm mount 12 from the large opening side of the drape 14. The hard hood portion 14 a is fitted into the cylindrical portion 46 of the grip portion 32 of the arm mount 12. At this time, the insertion hole 48 of the holding part 32 is in the state opened by the hard hood part 14a.

  Next, the endoscope set 110 is attached to the second adapter 18 sterilized by autoclaving or the like. In this case, the endoscope 112 of the endoscope set 110 is inserted and clamped between the fixed arm 96 of the surgical instrument holding portion 84 and the recessed portions 96a and 98a of the movable arm 98. In this state, the clamp knob 100 is tightened to fix the moving arm 98 to the fixed arm 96 and fix the endoscope 112. That is, the endoscope set 110 is attached to the second adapter 18.

  Next, the second connection portion 56 b of the first adapter 16 sterilized by autoclaving or the like is connected to the first connection portion 56 a of the grip portion 32 through the opening of the hard hood portion 14 a of the drape 14.

  After the connection shaft 72 of the second connection portion 56b of the first adapter 16 is inserted into the insertion hole 48 of the cylindrical portion 46 of the grip portion 32, the fixing knob 54 of the grip portion 32 is tightened. Then, the inclined surface 72b of the connection shaft 72 is pressed with the tip of the male screw portion 54a of the fixing knob 54, and the connection shaft 72 is fixed with respect to the insertion direction (axis Op direction) of the insertion hole 48. By engaging the positioning pin 50 and the notch 72d, the rotation around the connection axis Op is restricted. That is, the grip portion 32 and the first adapter 16 are connected in a state where they are positioned at predetermined positions.

  Finally, the sterilized second adapter 18 is connected to the first adapter 16. In this case, the first adapter 16 is connected in the same manner as when the grip portion 32 is connected. By engaging the positioning pin 78 of the third connection portion 56c of the first adapter 16 and the notch 88d (see FIG. 3) of the fourth connection portion 56d of the second adapter 18, the connection shaft Oq. Rotation around is restricted. For this reason, the 1st adapter 16 and the 2nd adapter 18 are connected in the state positioned in the predetermined position.

  Next, a moving operation for moving the endoscope set (surgical instrument) 110 during the operation will be described.

  In order to move the endoscope 112 during the operation, the grasping portion 32 is held with one hand together with the drape 14 provided on the outer periphery of the grasping portion 32, and the switch 62 provided on the grasping portion 32 is pressed. Then, the brake action of each electromagnetic brake 60a-60d is released by the drive circuit 64 (see FIG. 1B).

  When the braking action of the first electromagnetic brake 60 a is released, the support arm 24 can rotate about the first rotation axis Oa with respect to the installation portion 22. When the second electromagnetic brake 60b is released, the entire link mechanism 26 can be rotated around the second rotation axis Ob with respect to the support arm 24, so that the endoscope 112 is also rotated around the rotation axis Ob. It becomes possible. When the third electromagnetic brake 60c is released, the second arm 26b can rotate about the third rotation axis Oc with respect to the third arm 26c. Therefore, the link mechanism 26, the rolling mechanism section 30, the grip section 32, the first adapter 16, and the second adapter are combined by the combination of the three rotations of the first to third rotating shafts Oa, Ob, and Oc. The endoscope 112 held via 18 can be moved three-dimensionally within a predetermined range.

  When the fourth electromagnetic brake 60d is released together with the first to third electromagnetic brakes 60a-60c, the ball pair 30a rolls around the center Oo of the ball pair 30a with respect to the ball pair receiving part 30b. It becomes possible. Therefore, the held endoscope 112 can be tilted in a desired direction. That is, the endoscope 112 can be moved and tilted three-dimensionally, and can be moved to an arbitrary position and angle.

  When the pressing of the switch 62 is released in a state where the endoscope 112 is disposed at a desired position and in a desired direction, a braking action is applied to the first to fourth electromagnetic brakes 60a-60d. Therefore, the endoscope 112 is fixed by the surgical instrument holder 84 in a desired direction at a desired position.

  The diameter of the insertion portion of the endoscope, which is a surgical instrument used in the medical instrument holding device 10, varies from about 2 mm to about 20 mm, and these are exchanged according to the purpose during the operation. For this reason, it is difficult to hold all the endoscopes with the common second adapter 18. Here, the operation | work which replace | exchanges to the endoscope from which the diameter of the insertion part of an endoscope differs in an operation and from which weight differs is demonstrated.

  In this case, the small-diameter endoscope set 110 shown in FIG. 4 is removed from the first adapter 16 together with the second adapter 18, and another endoscope set 120 attached to another second adapter 18 is attached to the first adapter 16. Attach to adapter 16.

  When separating the first adapter 16 and the second adapter 18, the fixing knob 82 of the third connection portion 56 c of the first adapter 16 is rotated to rotate the female screw portion 80 of the male screw portion 82 a of the fixing knob 82. Release the engagement. And the 4th connection part 56d of the 2nd adapter 18 is removed from the insertion hole 76 of the 3rd connection part 56c. Then, the second adapter 18 to which the small-diameter endoscope set 110 is attached is detached from the third connection portion 56 c of the first adapter 16.

  A fourth connection portion 56d of another second adapter 18 to which the large-diameter endoscope 122 is attached is connected to the third connection portion 56c of the first adapter 16. The configuration of another second adapter 18 is substantially the same as that of the second adapter 18 described above, and only the size capable of holding the insertion portion of the endoscope 122 in the recessed portions 96a and 98a of the surgical instrument holding portion 84 is provided. Different. In addition, the operation | work which mounts another 2nd adapter 18 in the 2nd connection part 56b of the 1st adapter 16 is performed similarly to the above-mentioned connection operation.

  Here, as shown in FIG. 5, the large-diameter endoscope set 120 has a center of gravity relative to the case where the small-diameter endoscope set 110 is attached to the medical instrument holding device 10 via the second adapter 18. Position and weight are different. For this reason, the rotational moment generated by the weight of the grip portion 32, the first and second adapters 16 and 18 and the endoscope set 120 around the center Oo of the ball pair 30a changes, and the operator feels uncomfortable with the operation. Feel. When the amount of change in the rotational moment is large, it is difficult to perform delicate operations during the operation. Therefore, it is necessary to adjust the balance of the medical instrument holding device 10 by adjusting the rotational moment. For this reason, the effect | action which performs the balance adjustment of the medical device holding | maintenance apparatus 10 is demonstrated.

  The rotational moment around the third rotational axis Oc of the arm gantry 12 due to the difference in weight or position of the endoscope sets 110 and 120 is corrected by adjusting the position by moving the counterweight 38 along the screw shaft 38a. To do.

The center of gravity of the small-diameter endoscope set 110 is G1, the weight is W1, the weight is W1, the distance between the center Oo of the ball pair 30a and the center of gravity G1 is R1, and the center of gravity of the large-diameter endoscope set 120 is G11 weight. Is W11, and the distance between the center Oo of the ball-paired object 30a and the gravity center position G11 is R11. In order to make the rotational moment around the center Oo of the ball-paired object 30a equal even if the weight of the endoscope sets 110 and 120 changes, the distance R11 may be adjusted to a position that satisfies the following formula (1). For this reason,
From R1 × W1 = R11 × W11 R11 = R1 × W1 / W11 (1)
It becomes.

  In this adjustment, the operation knob 92b shown in FIG. 2 is rotated to rotate the lead shaft 92, and the moving member 94 is turned in the direction of the axis Or while the rotation of the moving member 94 is restricted by the fixing member 90 by the screwing action of the screw portion 92a. Move directly. Then, the center-of-gravity position G11 of the large-diameter endoscope set 120 is moved to the position of the distance R11 that satisfies the above formula (1).

  Then, the rotational moment around the center Oo of the ball pair 30a when the large-diameter endoscope set 120 is attached to the second adapter 18 is a state where the small-diameter endoscope set 110 is attached to the second adapter 18. Therefore, the same operational feeling as in the state where the small-diameter endoscope set 110 is attached to the second adapter 18 can be obtained.

  In this way, during the operation, even if the surgical instrument is replaced from the small-diameter endoscope set 110 to the large-diameter endoscope set 120, the rotational moment around the center Oo of the ball-paired object 30a is kept constant and adjusted so as not to change. By doing so, the surgeon can move the surgical instrument without feeling uncomfortable.

  As described above, according to this embodiment, the following effects can be obtained.

  When exchanging the surgical instrument, the surgical instruments 110 and 120 can be exchanged in a sterilized state by attaching and detaching the second adapter 18 to and from the first adapter 16. Since the surgical tools 110 and 120 can be exchanged in this way, it is possible to deal with various operations using the medical instrument holding device 10, and thus contribute to the improvement of the surgical efficiency.

  Since the grip portion 32 is integrally provided on the arm mount 12 and the grip portion 32 is in the sterilized drape 14, sterilization of the grip portion 32 can be eliminated. Therefore, for example, the switch 62 for switching the operation of the electromagnetic brakes 60a-60d and the like can be incorporated in the grip portion 32. Further, since the grip portion 32 is disposed in the drape 14, it is not necessary to strongly seal the grip portion 32, and the design structure can be simplified.

  Of course, since the structure of the first and second adapters 16 and 18 that require sterilization such as autoclaving can be simplified, sterilization work after the end of treatment can be easily performed.

  The position adjustment mechanism 86 can adjust the positions of the surgical tools 110 and 120 and the surgical tool holder 84 steplessly within a predetermined range by rotating the operation knob 92b. It is possible to easily adjust the rotational moment generated by the weight of the first and second adapters 16 and 18 and the surgical tools 110 and 120 with respect to Oo. For this reason, the balance adjustment operation | work of the medical device holding | maintenance apparatus 10 can be performed easily and correctly.

  Since the position adjustment mechanism 86 is provided in the second adapter 18 having the surgical instrument holding portion 84, the second adapter 18 can be manufactured according to various surgical instruments such as the endoscope sets 110 and 120, for example. is there. If it does so, the adjustment range of the position adjustment mechanism part 86 can always provide the optimal thing according to the surgical tools 110 and 120. FIG.

  Since the drape 14 has the hard hood portion 14a, the hard hood portion 14a serves as a mark when the drape 14 is attached to the cylindrical portion 46 of the grasping portion 32, and the operator can easily perform the operation of covering the drape. Can be done.

  In this embodiment, only one counterweight 38 is provided on the arm mount 12, but a counterweight (not shown) may be provided at the end of the gripping portion 32 on the link mechanism 26 side, for example. Then, the moment amount around the center Oo of the ball pair 30a between the first and second adapters 16 and 18 and the endoscope set 110 can be balanced by moving the moving member 94.

  Next, a second embodiment will be described with reference to FIG. This embodiment is a modification of the first embodiment. The same members as those described in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

  As shown in FIGS. 6A and 6B, the second adapter 18 that holds the small-diameter endoscope set 110 shown in FIG. 2 has a small-diameter portion 212a of the probe 212 of the ultrasonic observation apparatus. It can be changed to the second adapter 18 of the holding type. The second adapter 18 includes a surgical instrument holder 284 having a different configuration from the surgical instrument holder 84 (see FIG. 2) of the second adapter 18 according to the first embodiment.

  FIG. 6B is a cross-sectional view of the surgical instrument holder 284. The surgical instrument holding portion 284 includes a cylindrical frame 286 that is integrally connected to the moving member 94 of the position adjustment mechanism portion 86, a screw portion 286 a formed on the outer peripheral surface of the upper end portion of the frame 286, and the screw And a ring-shaped fixed dial 288 screwed into the portion 286a. An O-ring 290a, a cylindrical collar 292, and an O-ring 290b are inserted toward an overhanging portion 286b that protrudes to the inside of the opening.

  With respect to the center line Oh of the frame 286 of the surgical instrument holder 284, the right side in FIG. 6B shows a state before fixation and the left side shows a state after fixation. When the fixed dial 288 is tightened with respect to the frame 286, the O-rings 290a and 290b are deformed, and the small-diameter portion 212a of the ultrasonic observation probe 212 is clamped and held.

  As described above, according to this embodiment, the following effects can be obtained.

  Since the surgical instrument 212 is fixed to the surgical instrument holder 284 by the O-rings 290a and 290b, which are elastic members, it is possible to prevent the surgical instrument from being damaged even when a surgical instrument with low strength is used.

  Next, a third embodiment will be described with reference to FIG. This embodiment is a modification of the first embodiment. The same members as those described in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

  The medical instrument holding device 10 according to this embodiment is different from the first embodiment in the configuration of the first adapter (first connection means) 16 and the second adapter (surgical instrument holding means) 18. .

  As shown in FIG. 7A, the first adapter 16 includes a second connection portion 56b and a third connection portion 56c. The third connection portion 56c includes a first position adjustment mechanism portion 86a for adjusting the position of the surgical instrument. The second adapter 18 includes a fourth connection portion 56d and a surgical instrument holding portion 84. The fourth connection portion 56d includes a second position adjustment mechanism portion 86b that adjusts the position of the surgical instrument in cooperation with the first position adjustment mechanism portion 86a.

  The first position adjustment mechanism portion 86 a of the first adapter 16 includes a frame 317 having a connection shaft 72. The frame 317 is formed with a recess 319 having a constant width. Three (plural) positioning holes 321a-321c are formed at appropriate intervals on the bottom surface of the recess 319. These positioning holes 321a to 321c are formed on the center line of the recess 319 in a direction orthogonal to the center line.

  Fixing female screw portions 323a-323c are formed at positions adjacent to these positioning holes 321a-321c. These fixing female screw portions 323a to 323c are formed on the center line of the recess 319 in a direction orthogonal to the center line. That is, the positioning holes 321a-321c and the fixing female screw portions 323a-323c are arranged in pairs on a straight line. The positioning holes 321a to 321c and the fixing female screw portions 323a to 323c that are close to each other are separated by a predetermined distance S, respectively.

  The second position adjustment mechanism portion 86 b of the second adapter 18 includes a frame 325 having a surgical instrument holding portion 84. The frame 325 is formed with a convex portion 327 having a width that engages with the concave portion 319 of the first adapter 16. The convex portion 327 is provided with a positioning pin 329 that is integrally provided with the convex portion 327 and is inserted into any one of the positioning holes 321 a to 321 c of the concave portion 319. A through hole 331 is formed at a position adjacent to the positioning pin 329 at a position separated by a distance S. The positioning pin 329 and the through hole 331 are arranged on the center line of the convex portion 327 in a direction orthogonal to the center line. A fixing knob 333 having a male screw portion 333a is disposed in the through hole 331. The male screw portion 333 a of the fixing knob 333 is screwed into any of the fixing female screw portions 323 a to 323 c of the recess 319.

  Next, the operation of the medical instrument holding device 10 according to this embodiment will be described.

  In this embodiment, the replacement work of the second adapter 18 with respect to the first adapter 16 will be described. As in the first embodiment, description will be made assuming that the surgical instrument used in the medical instrument holding apparatus 10 is replaced from the small-diameter endoscope set 110 to the large-diameter endoscope set 120. The large-diameter endoscope set 120 is fixed and held in advance by another second adapter 18.

  In order to connect the second adapter 18 to which the small-diameter endoscope set 110 is fixed to the first adapter 16, the positioning pin 329 of the second adapter 18 is connected to the positioning hole 321a- of the first adapter 16. 321c is inserted into one of them. The male screw portion 333a of the fixing knob 333 of the second adapter 18 is screwed into one of the corresponding fixing female screw portions 323a to 323c of the first adapter 16 to be fixed.

  The position where one of the positioning holes 321a to 321c of the first adapter 16 into which the positioning pin 329 of the second adapter 18 is inserted is selected as described in the operation of the first embodiment. The rotational moment amount around the rotation center Oo of the even body 30a (see FIG. 2) is set to a position where the predetermined amount is reached. That is, considering the actual use situation, the balance is determined in advance to determine the position where the second adapter 18 is connected to the first adapter 16 in accordance with various surgical tools. Connect to this decision position. In this way, the first and second adjustment mechanism portions 86a and 86b are coupled to desired positions.

  For this reason, when another second adapter 18 to which the large-diameter endoscope set 120 is fixed is connected to the first adapter 16, the second adapter 18 to which the small-diameter endoscope set 110 is solidified is connected to the first adapter 16. It is fixed at a position different from the position connected to one adapter 16. Then, the balance of the rotational moment with respect to the center Oo of the ball-paired object 30a is achieved.

  As described above, according to this embodiment, the following effects can be obtained.

  Since the position adjustment mechanism 386 is a system that changes the connection position of the first and second adapters 16 and 18 to a fixed position, the shape of both the adapters 16 and 18 can be made small and simple. For this reason, both adapters 16 and 18 can be prevented from interfering with the operation.

  Next, a fourth embodiment will be described with reference to FIG. This embodiment is a modification of the first embodiment. The same members as those described in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

  The medical instrument holding device 10 according to this embodiment is different from the first embodiment in the configuration of the second adapter 18.

  As shown in FIG. 8, the second adapter 18 includes a first adjustment mechanism portion 486a and a second adjustment mechanism portion 486b. The first adjustment mechanism portion 486a has the same configuration as the adjustment mechanism portion 86 described in the first embodiment.

  The second adjustment mechanism portion 486b includes a fixing member 490, a lead shaft 492 having a screw portion 492a on the outer periphery, and a moving member 94b. The fixing member 490 is attached to the upper end portion of the fourth connection portion 56d. The fixing member 490 is connected to the moving member 94a and is formed in, for example, a rectangular shape. The lead shaft 492 is disposed on the longitudinal central axis Ot perpendicular to the central axis Or of the lead shaft 92 of the first adjustment mechanism 486a. Is arranged. An operation knob 492b that the operator rotates with a finger is integrally attached to the end of the lead shaft 492 on the outside of the fixing member 490. The moving member 94b is fitted into the concave portion 490a of the fixed member 490, is engaged with the threaded portion 492a of the lead shaft 492, and can move only along the axial direction of the lead shaft 492 (axis Ot direction). The moving member 94b is provided with the surgical instrument holding portion 84 described in the first embodiment.

  Next, the operation of the medical instrument holding device 10 according to this embodiment will be described.

  The operation for exchanging the surgical instrument from the small-diameter endoscope 112 to the large-diameter endoscope 122 is omitted because the surgical instrument is exchanged with the second adapter 18 in the same manner as in the first embodiment. To do.

  Next, the effect | action which performs balance adjustment of the rotational moment around the center Oo of the ball pair 30a is demonstrated. In this embodiment, the barycentric position of the surgical instrument can be corrected in two directions (arrow α direction and β direction in FIG. 8) with respect to the first embodiment. That is, the center position of the surgical instrument is moved in the substantially horizontal direction by the first adjustment mechanism section 486a, and the center position of the surgical instrument is moved in the substantially vertical direction by the second adjustment mechanism section 486b. In this way, the medical device holding device 10 is balanced by changing the rotational moment around the center Oo of the ball pair 30a of the medical device holding device 10.

  As described above, according to this embodiment, the following effects can be obtained.

  Since the barycentric position of the surgical instrument can be corrected in two directions (arrow α direction and β direction in FIG. 8) with respect to the first embodiment, a substantially vertical direction (arrow β direction) generated by replacement of the surgical instrument. ) Can be corrected together with the substantially horizontal direction (arrow α direction). Therefore, the amount of rotational moment around the center Oo of the ball-paired object 30a can be more accurately corrected, and the operation of moving the surgical instrument can be easily performed during operation without any sense of incongruity.

  Next, a fifth embodiment will be described with reference to FIGS. This embodiment is a modification of the first embodiment. The same members as those described in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

  The medical instrument holding device 10 according to this embodiment is different from the first embodiment in that the drape 14, the first adapter (first connecting means) 16, the second adapter (surgical instrument holding means) 18, And the structure of the arm mount 12 is different. The grip portion 32 (see FIG. 1) is removed from the arm mount 12 described in the first embodiment, and a shaft 513 described later is provided instead.

  As shown in FIGS. 9 and 10, the sterilized drape 14 is a bag-like soft cover member and includes only a large opening. The grip portion 32 is disposed outside the drape 14.

  A first connection portion 56a is disposed on the ball pair 30a. The first connecting portion 56a is integrally provided with a shaft 513. The shaft 513 includes a thin-diameter portion 513a, a large-diameter portion 513b, a step portion 513c, and a connecting shaft 513d in order in a direction away from the ball pair 30a side. A small diameter portion 513a is integrally connected to the ball pair 30a. The small diameter portion 513a has a central axis Ow. The large-diameter portion 513b, the stepped portion 513c, and the connecting shaft 513d are formed on a central axis Ow that passes through the center Oo (see FIG. 10) of the ball-paired body 30a. A switch 515 for switching the first to fourth electromagnetic brakes 60a-60d is disposed in the large diameter portion 513b. An O-ring 517 is fitted on the outer diameter of the step portion 513c. The step 513c is formed with a notch 513e having a predetermined width at a position facing a positioning pin 525 described later. The connecting shaft 513d has the same configuration as the connecting shaft 72 described in the first embodiment.

  The grasping portion 32 grasped by the surgeon is formed as a first adapter 16 that connects the arm mount 12 and the second adapter 18. The first adapter 16 includes a second connection portion 56b and a third connection portion 56c. The second connection part 56b is connected to the first connection part 56a. The third connection portion 56c is connected to a later-described fourth connection portion 56d of the second adapter 18.

  An insertion hole 521 into which the connection shaft 513d of the shaft 513 is fitted is formed in the second connection portion 56b of the first adapter 16. A large-diameter hole 523 into which the large-diameter portion 513 b of the shaft 513 is inserted is formed on the same axis Ow as the insertion hole 521 at the mouth portion of the insertion hole 521. On the bottom surface of the large-diameter hole 523, a positioning pin 525 is disposed integrally with the notch 513e for positioning the second connection portion 56b with respect to the first connection portion 56a.

  The second connecting portion 56b at the base end of the first adapter 16 (gripping portion 32) is orthogonal to the axis Ow of the first adapter 16, passes through the insertion hole 521, and has an internal thread on the inner peripheral surface. A through hole having a portion 529 is formed. A fixing knob 531 is screwed into the female screw portion 529 of the through hole. For this reason, if the fixing knob 531 is turned in a state where the first connection portion 56a is disposed in the second connection portion 56b, the first connection portion 56a is fixed to the second connection portion 56b.

  The first adapter 16 is provided with a switch lever 541 at the side of the insertion hole 521 (the bottom shown in FIG. 10). The switch lever 541 is disposed on the shaft 513 that is covered with the drape 14 when the pressing portion 541a pressed by the operator with the finger and the first connection portion 56a and the second connection portion 56b are connected. A contact portion 541b that presses the switch 515, and a support portion 541c that is disposed between the pressing portion 541a and the contact portion 541b and engages with the fulcrum shaft 543 of the grip portion 32 around the axis Ou.

  The first adapter 16 is formed with a through hole 535 around the central axis Ov in the direction orthogonal to the axis Ow. The through hole 535 includes a first cylindrical portion 535a having a small diameter through hole on the second connecting portion 56b side, and a second cylindrical portion 535b having a large diameter through hole on the third connecting portion 56c side. Yes. The small diameter through hole of the first cylindrical portion 535a and the insertion hole 521 of the second connection portion 56b are not communicated with each other.

  In the lumen of the first cylindrical portion 535a, there is disposed a rotating cylinder 537 having a flange portion 537a protruding radially outward at the tip portion and a female screw portion 537b on the inner peripheral surface. The rotary cylinder 537 passes through the first cylindrical portion 535a, and the flange portion 537a at the tip end is in contact with the edge of the second cylindrical portion 535b. A proximal end portion of the rotating cylinder 537 extends further to the proximal end portion side from the first cylindrical portion 535a. An operation knob 539 operated by an operator is attached to the proximal end portion of the first cylindrical portion 535a.

  The rotary cylinder 537 is provided with a slide shaft 542 having a male screw part 542a that is screwed into the female screw part 537b of the rotary cylinder 537 described above. The slide shaft 542 is integrally provided with the male screw portion 542a provided at the base end portion and the sliding shaft portion 542b provided at the distal end portion. The sliding shaft portion 542b has substantially the same diameter as the inner peripheral surface of the second cylindrical portion 535b. A rotation restricting pin 545 that restricts the slide shaft 542 from rotating about the center axis Ov is fixed in a direction orthogonal to the center axis Ov of the slide shaft portion 542b. The rotation restricting pin 545 is engaged with a groove portion 547 formed on the inner peripheral surface of the second cylindrical portion 535b. The groove 547 is formed in parallel to the central axis Ov.

  A third connection portion 56c that can be attached to and detached from the fourth connection portion 56d is disposed at the tip of the slide shaft portion 542b of the slide shaft 542. For this reason, an insertion hole 551a, a positioning pin 551b, and a fixing knob 551c are provided at the tip of the sliding shaft portion 542b.

  For this reason, the position adjustment mechanism 86 for adjusting the amount of rotational moment with respect to the center Oo of the ball-paired object 30a by changing the position of the surgical instrument along the axis Ov is provided in the first adapter 16. Yes.

  In the second adapter 18, a fourth connection portion 56 d is integrally formed at the proximal end portion of the fixed arm 96 of the surgical instrument holding portion 84. The fourth connection portion 56d includes a connection shaft 555. The connecting shaft 555 includes a cylindrical portion 555 a, an inclined surface 555 b, a small diameter portion 555 c, and a notch 555 d from the side separated from the distal end portion of the fixed arm 96 toward the adjacent side. The cylindrical portion 555a is fitted into the insertion hole 551a of the third connection portion 56c of the first adapter 16 without play. The slope 555b is formed between the cylindrical portion 555a and the small diameter portion 555c. The notch 555d has a width and length to engage with the positioning pin 551b of the third connection portion 56c of the first adapter 16 without rattling.

  Next, the operation of the medical instrument holding device 10 according to this embodiment will be described.

  The setting operation of the medical instrument holding device 10 in the operation will be described with reference to FIGS.

  First, the sterilized drape 14 is attached to the arm mount 12.

  Next, the small-diameter endoscope set 110 is connected to the second adapter 18 previously sterilized by autoclaving or the like.

  The second connection portion 56b of the first adapter 16 sterilized in advance by autoclaving or the like is connected to the first connection portion 56a of the arm mount 12.

  In the connection work, the connecting shaft 513d of the shaft 513 of the first connecting portion 56a is inserted into the insertion hole 521 of the first adapter 16 (gripping portion 32), and the fixing knob 531 is tightened. For this reason, the slope of the connecting shaft 513d is pressed with the tip of the fixing knob 531 to fix the shaft 513 in the insertion direction of the insertion hole 521b. Furthermore, the rotation of the shaft 513 around the central axis Ow is restricted by the engagement between the positioning pin 525 and the notch 513e. That is, the grip portion 32 and the shaft 513 are integrally connected.

  At this time, the stepped portion 513c of the shaft 513 is inserted into the large-diameter hole 523 of the gripping portion 32 while pressing the O-ring 517, and the drape 14 is sandwiched between the O-ring 517 and the large-diameter hole 523 and fixed. To do. Then, even if the drape 14 is torn in the insertion hole 521, the arm mount 12 is prevented from being exposed to the outside of the drape 14 from the damaged portion of the drape 14 and becoming unclean.

  Finally, the fourth connection portion 56 d of the second adapter 18 is connected to the third connection portion 56 c of the first adapter 16. Since the operation at this time is the same as the operation when the third connection portion 56c and the fourth connection portion 56d described in the first embodiment are connected, description thereof will be omitted.

  When replacing the small-diameter endoscope 112 as the surgical instrument shown in FIGS. 9 and 10 with a new surgical instrument (for example, the large-diameter endoscope 122), as in the first embodiment, The connection between the third connection portion 56c of the first adapter 16 and the fourth connection portion 56d of the second adapter 18 is canceled. Then, the second adapter 18 equipped with a new surgical tool (for example, the large-diameter endoscope 122) is attached to the first adapter 16.

  In order to move the surgical instrument (for example, the small-diameter endoscope 112), the switch lever 541 rotates about the axis Ou of the fulcrum shaft 543 by pressing the pressing portion 541a of the switch lever 541 of the grip portion 32. For this reason, the contact portion 541b pushes the switch 515 through the drape 14. For this reason, similarly to the first embodiment, the link mechanism 26 and the rolling mechanism unit 30 are in a movable state, and the surgical instrument (the endoscope 112) can be freely moved. When the finger is released from the switch lever 541 with the surgical instrument placed at a desired position, the link mechanism 26 and the rolling mechanism section 30 are moved to a preferred position by the braking action of the first to fourth electromagnetic brakes 60a-60d. Retained.

  Next, the case where the rotational moment around the center Oo of the ball pair 30a is corrected when the surgical instrument is replaced will be described. In this embodiment, the second adapter 18 is moved on the axis Ov with respect to the first adapter 16 to change the amount of rotational moment generated by the weight. Has already been described, the operation of the adjusting mechanism will be described here.

  In order to adjust the rotation moment amount, the operation knob 539 shown in FIG. 10 is rotated. Then, since the movement of the slide shaft 542 in the direction around the axis Ov is restricted by the rotation restricting pin 545 engaged with the groove part 547 of the first adapter 16 (gripping part 32), the rotary cylinder 537 has the axis Ov. Rotate around. Then, the slide shaft 542 moves linearly on the axis Ov as the rotary cylinder 537 rotates. For this reason, according to the principle explained in the first embodiment, the amount of rotational moment around the center Oo of the ball-paired object 30a can be changed and corrected.

  As described above, according to this embodiment, the following effects can be obtained.

  Since the grip portion 32 (first adapter 16) is sterilized and disposed outside the drape 14, the operator can directly grip the grip portion 32. For this reason, the surgeon can hold the grip portion 32 stably without slipping. At this time, the switch 515 of the first to fourth electromagnetic brakes 60a-60d is disposed not in the grip portion 32 but in the drape 14, so that the structure of the grip portion 32 can be simplified.

  Since the surgical instrument position adjustment mechanism 86 is disposed on the first adapter 16 (gripping part 32), the configuration of the second adapter 18 (surgical instrument holding means) can be simplified. For this reason, it is possible to prevent the second adapter 18 from interfering with the surgical operation.

  In the first to fifth embodiments, the first adapter 16 and the second adapter 18 (surgical instrument holding means) are described as being separable. However, the first and second adapters 16 can be separated from each other. , 18 are not necessarily separated from each other, and the first and second adapters 16, 18 may be integrated as long as the amount of change in the moment is adjusted by the surgical instrument to be used.

  In the first to fifth embodiments, an endoscope (endoscope set) and an ultrasonic treatment tool have been described as examples of surgical instruments. However, various devices such as therapeutic instruments using various energies are used. It is done.

  Although several embodiments have been specifically described so far with reference to the drawings, the present invention is not limited to the above-described embodiments, and all the embodiments performed without departing from the scope of the invention are described. Including implementation.

  According to the above description, the following matters can be obtained. Combinations of the terms are also possible.

[Appendix]
(Additional item 1)
Surgical tools for observing and treating the surgical site;
An arm mount having a plurality of joints (supporting the surgical instrument so as to move and tilt);
A sterilized drape for separating the sterilized / non-sterile area from the external space by covering the arm mount;
A sterilizable operation comprising a sterilizable first connecting means mounted on the arm base from the outside of the drape and a holding part capable of holding a surgical instrument, and detachable from the first connecting means. A medical instrument holding device comprising a tool holding means.

(Appendix 2)
The medical instrument holding device according to claim 1, wherein the arm mount includes a gripping part that is gripped when the operator moves the surgical instrument.

(Additional Item 3)
The medical instrument holding apparatus according to claim 1, wherein the first connecting means includes a gripping part that is gripped when the surgeon moves the surgical instrument.

(Appendix 4)
The medical instrument holding device according to any one of additional items 1 to 3, wherein the surgical instrument holding unit includes a position changing unit capable of changing a position of the surgical tool (or holding unit) with respect to the first connection unit. apparatus.

(Appendix 5)
The medical instrument holding apparatus according to any one of supplementary notes 1 to 3, wherein the first connecting means includes position changing means capable of changing a position of the surgical instrument holding means with respect to the arm mount.

(Appendix 6)
The medical device according to any one of additional items 1 to 3, wherein the first connection unit and the surgical instrument holding unit include a position changing unit capable of changing the connection position of each of the first step and the step. Instrument holding device.

(Appendix 7)
The medical device holding device according to any one of appendix 1 to appendix 6, wherein the drape has an opening, and the first connecting means is connected to the arm mount through the opening. apparatus.

(Appendix 8)
An arm mount that has a ball pair at the tip, has a plurality of joints, supports the surgical tool so that it can move and tilt, and a holding portion that can hold the surgical tool, and holds the surgical tool that can be attached to and detached from the arm mount In a medical instrument holding device comprising means,
The medical instrument holding device is characterized in that the surgical instrument holding means includes position changing means capable of changing the position of the surgical instrument (or holding part) with respect to the ball pair (or arm mount).

(Appendix 9)
9. The medical instrument holding according to any one of the supplementary item 4, the supplementary item 5, and the supplementary item 8, wherein the position changing means moves the surgical instrument (or holding part) linearly (one-dimensionally). apparatus.

(Appendix 10)
9. The medical instrument holding according to any one of the additional item 4, the additional item 5, and the additional item 8, wherein the position changing unit moves the surgical instrument (or holding unit) on a plane (two dimensions). apparatus.

(Appendix 11)
11. The medical instrument holding device according to any one of claims 8 to 10, wherein the surgical instrument holding means is configured to be separated and connectable into two bodies.

(Appendix 12)
The appendix 8 or appendix 9 is characterized in that the surgical instrument holding means is configured to be separable into two bodies, and the position adjusting means is a connection position changing means for changing the coupling position of each other step by step. The medical instrument holding device as described.

(Appendix 13)
The medical instrument holding device according to any one of additional items 1 to 7, wherein the arm mount includes a ball pair.

(Appendix 14)
A medical instrument holding device capable of selectively holding a plurality of surgical tools,
A support that can be fixed in a desired position;
An arm unit supported by the support unit and movable and tiltable with respect to the support unit;
A sterilized drape that is detachable from the arm part and separates the area into the arm part and the outside thereof when the arm part is covered;
A pre-sterilized adapter having a sterilized connection that can be attached to and detached from the arm while keeping the sterilized state from the outside of the drape;
A pre-sterilized surgical instrument holder having a surgical instrument position adjusting mechanism provided on the adapter and capable of changing the position of the surgical instrument relative to the arm, and selected according to the surgical instrument; A medical instrument holding device comprising:

(Problem of appendix 14)
The medical instrument holding device disclosed in Patent Literature 1 to Patent Literature 3 can hold a specific surgical instrument. However, the balance of the rotational moment of the medical instrument holding device is often lost when it is replaced with a surgical instrument having a different specification such as shape and weight. That is, it becomes difficult to balance the medical instrument holding device when the surgical instrument is replaced.

  Further, in the technique disclosed in Patent Document 2, a miniaturization is realized by using a ball pair (ball joint) in the joint part, but the constituent parts are unbalanced when moving as a whole apparatus. For this reason, for example, the operator needs to hold the imbalance by holding a gripping part or the like, and there is a problem that the operation is difficult in performing a delicate operation. Further, in the apparatus disclosed in Patent Document 3, when the surgeon actually uses the surgical tool, the insertion axis of the surgical tool is used in a direction substantially coinciding with the gravity direction. However, in a state where the ball pair can roll, the surgical instrument is unbalanced with respect to the ball pair. For this reason, for example, the operator needs to hold the imbalance by holding a gripping part or the like, and there is a problem that the operation is difficult in performing a delicate operation. Alternatively, in order to avoid such a problem, a dedicated surgical tool is required for a specific holding device having the same weight and center of gravity. Needless to say, surgical tools are not versatile and not practical.

  In Additional Item 14, the surgical instrument can be exchanged together with the surgical instrument holding portion with respect to the adapter, and at this time, the position of the surgical instrument is moved by the position adjusting mechanism to change the moment amount with respect to the arm portion. The unbalance due to the weight of can be adjusted. For this reason, delicate operation of the surgical instrument can be easily performed.

  Therefore, according to the supplementary item 14, it is possible to provide a medical instrument holding device that can eliminate an imbalance associated with replacement of a surgical instrument.

(Appendix 15)
The adapter includes a first adapter having the sterilized state connection portion, and a second adapter that is detachable from the first adapter and coupled to the surgical instrument holding portion. The medical instrument holding device according to Supplementary Note 14.

(Appendix 16)
The arm part includes a first connection part that is detachable from the sterilization state connection part,
The first adapter includes a second connection portion having the sterilized state connection portion, and a third connection portion detachable from the second adapter,
16. The medical instrument holding device according to appendix 15, wherein the second adapter includes a fourth connection part that can be attached to and detached from the third connection part.

(Appendix 17)
The arm portion is movable and tiltable with respect to the support portion, and an allowable state in which the surgical tool can be disposed at a desired position, and movement of the surgical tool with the surgical tool disposed at a desired position. Equipped with an electromagnetic brake that can be switched to a regulated state that regulates
The first connecting portion is connected to the electromagnetic brake, and when pressed, the first connecting portion is switched to the permissible state. When the pressing is released, the first connecting portion is switched to the restricting state. Item 17. The medical instrument holding device according to Item 16, further comprising a switch to be pressed.

(Appendix 18)
The arm portion includes a grasping portion to be grasped by an operator when the surgical tool is moved relative to the arm portion,
Item 17. The medical instrument holding device according to Item 16, wherein the grip portion includes the first connection portion.

(Appendix 19)
The arm portion is movable and tiltable with respect to the support portion, and an allowable state in which the surgical tool can be disposed at a desired position, and movement of the surgical tool with the surgical tool disposed at a desired position. Equipped with an electromagnetic brake that can be switched to a regulated state that regulates
The gripping part is connected to the electromagnetic brake and is switched to the permissible state when pressed, and switched to the restricted state when released, and pressed by the operator from the outside of the drape. Item 19. The medical instrument holding device according to Item 18, further comprising a switch.

(Appendix 20)
17. The medical instrument holding apparatus according to appendix 16, wherein the first adapter includes a grasping portion that is grasped by an operator when the surgical instrument is moved relative to the arm portion.

(Appendix 21)
The medical device holding apparatus according to claim 16, wherein the drape includes a hood having an opening penetrating between the first connection portion and the second connection portion.

(Appendix 22)
The arm portion includes a ball pair that supports the surgical tool in a rollable manner,
15. The medical instrument holding device according to claim 14, wherein the position adjusting mechanism includes a moving mechanism capable of contacting and separating the surgical tool at least one-dimensionally with respect to the ball pair.

(Appendix 23)
The medical instrument holding apparatus according to Item 22, wherein the moving mechanism includes a continuous moving mechanism that continuously moves the surgical tool with respect to the ball pair.

(Appendix 24)
The medical instrument holding apparatus according to item 22, wherein the moving mechanism includes a discontinuous moving mechanism that discontinuously moves the surgical tool with respect to the ball pair.

(Appendix 25)
The arm portion includes a ball pair that supports the surgical instrument in a rollable manner at one end, and the ball based on the weight of the adapter, the surgical instrument holding unit, and the surgical instrument position adjusting mechanism at the other end. With a counterweight to cancel the moment amount for the even number,
15. The medical instrument holding device according to claim 14, wherein the position adjusting mechanism includes a moving mechanism capable of contacting and separating the surgical tool at least one-dimensionally with respect to the ball pair.

(Appendix 26)
A medical instrument holding device capable of selectively holding a plurality of surgical tools,
A support that can be fixed in a desired position;
An arm unit supported by the support unit, the arm unit including a plurality of arms movable and tiltable with respect to the support unit, and a plurality of joints;
A sterilized drape that is detachable to the arm portion and separates the region into the arm portion and the outside when the arm portion is covered;
A first sterilized first adapter detachably connected to the arm portion from the outside of the drape;
A medical instrument comprising a surgical instrument holding section that can hold a surgical instrument and can be changed depending on a selected surgical instrument, and includes a pre-sterilized second adapter that can be attached to and detached from the first adapter. Instrument holding device.

(Appendix 27)
27. The medical instrument holding apparatus according to Additional Item 26, wherein the surgical instrument holding unit includes a lineup that can be changed depending on a selected surgical instrument.

(Appendix 28)
The arm part includes a first connection part that is detachable from the sterilization state connection part,
The first adapter includes a second connection portion having the sterilized state connection portion, and a third connection portion detachable from the second adapter,
The medical instrument holding device according to item 27, wherein the second adapter includes a fourth connection part that can be attached to and detached from the third connection part.

(Appendix 29)
The arm portion includes a grasping portion to be grasped by an operator when the surgical tool is moved relative to the arm portion,
29. The medical instrument holding device according to appendix 28, wherein the grip portion includes the first connection portion.

(Appendix 30)
30. The medical instrument holding apparatus according to appendix 29, wherein the first adapter includes a grasping portion that is grasped by an operator when the surgical instrument is moved with respect to the arm portion.

(Appendix 31)
27. The medical instrument holding device according to claim 26, wherein the second adapter includes a position adjustment mechanism that adjusts a position of the surgical instrument with respect to the arm portion.

(Appendix 32)
The arm portion includes a ball pair that supports the surgical tool in a rollable manner,
27. The medical instrument holding apparatus according to appendix 26, wherein the position adjusting mechanism includes a moving mechanism capable of contacting and separating the surgical tool at least one-dimensionally with respect to the ball pair.

(Appendix 33)
A medical instrument holding device capable of selectively holding a plurality of surgical tools,
A support that can be fixed in a desired position;
A parallelogram link supported by the support portion and movable and inclined with respect to the support portion; an extension arm having one end connected to a joint of the parallelogram link; An arm portion having a ball pair provided at the end;
A sterilized drape that is detachable to the arm portion and separates the region into the arm portion and the outside when the arm portion is covered;
A pre-sterilized surgical tool holding portion having a surgical tool position adjustment mechanism capable of selectively holding the surgical tool and capable of adjusting the position of the surgical tool with respect to the ball pair. Instrument holding device.

(Appendix 34)
The arm portion includes a ball pair that supports the surgical instrument in a rollable manner at one end, and the ball based on the weight of the adapter, the surgical instrument holding unit, and the surgical instrument position adjusting mechanism at the other end. With a counterweight to cancel the moment amount for the even number,
34. The medical instrument holding apparatus according to appendix 33, wherein the position adjusting mechanism includes a moving mechanism capable of contacting and separating the surgical tool at least one-dimensionally with respect to the ball pair.

(Appendix 35)
The arm portion includes a ball pair that supports the surgical tool in a rollable manner,
The position adjusting mechanism includes a moving mechanism capable of contacting and separating the surgical tool at least one-dimensionally with respect to the ball pair,
34. The medical instrument holding device according to claim 33, wherein the adapter includes a counterweight that adjusts an imbalance due to the movement of the position of the surgical instrument by the position adjusting mechanism.

(A) is a schematic perspective view of the medical device holding | maintenance apparatus which concerns on 1st Embodiment, (B) is a schematic block diagram which shows the relationship between the switch and electromagnetic brake in (A). The disassembled perspective view which shows roughly the state which decomposed | disassembled the arm mount, drape, 1st and 2nd adapter, and endoscope set of the medical device holding | maintenance apparatus which concerns on 1st Embodiment. The fragmentary sectional view which shows schematically the state which connected the arm mount, the drape, the 1st and 2nd adapter, and the endoscope set of the medical instrument holding device which concerns on 1st Embodiment. The disassembled perspective view which shows roughly the state which can mount | wear with several types of 2nd adapter with respect to the 1st adapter of the medical device holding | maintenance apparatus which concerns on 1st Embodiment. Before (Goo) and after adjusting the position of the center of gravity with the counterweight canceling out the rotational moment amount around the ball-to-body due to the position and weight of the surgical instrument of the medical instrument holding device according to the first embodiment Schematic which shows the gravity center position of (Go). (A) is a schematic perspective view which shows the state which connected the 1st and 2nd adapter of the medical device holding | maintenance apparatus which concerns on 2nd Embodiment, (B) is a surgical instrument holding | maintenance part in (A). FIG. 3 is a schematic cross-sectional view showing the vicinity. (A) is a schematic perspective view which shows the state which isolate | separated the 1st and 2nd adapter of the medical device holding | maintenance apparatus which concerns on 3rd Embodiment, (B) is the 1st and 2nd in (A). The schematic fragmentary sectional view which shows the state which connected the adapter of. The schematic fragmentary sectional view which shows the arm mount, drape, and the 1st and 2nd adapter of the medical device holding | maintenance apparatus which concerns on 4th Embodiment. The schematic perspective view which shows the state which isolate | separated the arm mount, drape, and the 1st and 2nd adapter of the medical device holding | maintenance apparatus which concerns on 5th Embodiment. The schematic fragmentary sectional view which shows the arm mount, drape, and the 1st and 2nd adapter of the medical device holding | maintenance apparatus which concerns on 5th Embodiment.

Explanation of symbols

  Go, Goo, G1, G11: center of gravity position, R1, R11: distance, 12: arm mount, 16 ... first adapter, 18 ... second adapter, 28 ... extension arm, 30 ... rolling mechanism, 30a ... Ball-paired object, 30 b. Ball-paired body receiving part, 32... Grasping part, 60 d... Fourth electromagnetic brake, 84 ... Surgical instrument holding part, 94 ... Moving member, 110. Endoscope set

Claims (2)

A medical instrument holding device capable of selectively holding a plurality of surgical tools,
A support that can be fixed in a desired position;
An arm part supported by the support part and supporting the surgical instrument so as to be movable and tiltable;
A sterilized drape that is detachable to the arm part and separates the area into the arm part and the outside thereof when the arm part is covered;
A first sterilized first adapter detachable from the outside of the drape to the arm,
A medical instrument holding device comprising: a second adapter that is detachable from the first adapter and has a surgical instrument holding portion that is changed depending on a selected surgical instrument, and is sterilized in advance.   The medical instrument holding apparatus according to claim 1, wherein the second adapter includes a position adjustment mechanism that adjusts a position of the surgical instrument with respect to the arm portion.

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