JP2007244435A - Endoscope apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope apparatus reducing influences of living tissues, such as fat intervening between a living body surface and a blood vessel, and observing the blood vessel in the living body. <P>SOLUTION: A sucking sheath 9 having a distal opening part 9b on the outer circumference of a distal end part 30 of an insertion part 11 is installed to a grip part 12, the distal is adhered closely to a target tissue surface 22, and sucking is performed. By sucking the target tissue of a part opposed to the distal end opening part 9b, the target tissue part opposed to a distal surface 21 is moved to the side of an observation window and deformed, a distance between the surface and the blood vessel 41 running inside is shortened, influences of the tissues, such as fat, intervening between the surface and the blood vessel 41 are reduced, and the observation is facilitated. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an endoscope apparatus suitable for observing blood vessels under fat constituting a living tissue.

In recent years, in the medical field and the like, an endoscope apparatus using an endoscope or an endoscope apparatus has been widely used for examination, observation, and treatment with a treatment tool.
In some cases, an endoscope apparatus is used for observing blood vessel travel as an internal observation target tissue inside a living tissue in a body cavity. For example, in the conventional example of Japanese Patent No. 2528104, an endoscope apparatus is disclosed in which the distal end surface of a light guide is brought into close contact with a living tissue to suppress reflected light on the surface of the living body.
For example, there is a case where it is desired to identify a blood vessel running under the fat layer, specifically, a gastric omental artery covered with fat associated with the gastric omentum.
Japanese Patent No. 2528104 JP 2005-192945 A

  According to the above conventional example, the influence of the reflected light on the living body surface can be reduced, but the blood vessel image information is clearly detected for the fat layer from the living body surface to the blood vessel running inside the living body surface. Is difficult. Japanese Patent Application Laid-Open No. 2005-192945 discloses a medical device that protrudes in a cylindrical shape from the distal end portion of the insertion portion of the endoscope and sucks by ultrasonic vibration. The conventional example of this publication does not make it easy to observe the inside of the living body surface.

(Object of invention)
The present invention has been made in view of the above points, and observes a blood vessel as an internal observation target tissue inside a living body while reducing the influence of a living tissue such as fat interposed between the surface of the living body and the blood vessel. An object of the present invention is to provide an endoscope apparatus that can perform the above-described operation.

An endoscope apparatus according to the present invention includes an endoscope including an insertion portion provided with a distal end portion capable of closely contacting a distal end surface facing an observation window on the surface of a biological tissue to be observed;
A distal end opening is formed on the outer peripheral side of the distal end including the distal end, and communicates with the distal opening on the proximal end side of the suction sheath and the suction sheath attached to the endoscope A suction device provided with suction means for performing suction; and
By the suction operation by the suction device, the biological tissue in the portion facing the distal end opening around the distal end surface is sucked and travels from the surface of the biological tissue in the observation field of the observation window to the inside of the surface. Distance shortening means for shortening the distance to the blood vessel as the internal observation target tissue,
It is characterized by comprising.
With the above configuration, the attenuation of the amount of light incident on the observation window by the living tissue such as fat leading to the blood vessel running inside the surface of the living tissue is reduced, making it easy to observe the running state of the blood vessel. .

  ADVANTAGE OF THE INVENTION According to this invention, attenuation | damping of the light quantity which injects into the observation window by biological tissues, such as fat leading to the blood vessel currently drive | moving inside the surface of biological tissue, can be reduced, and the running state of a blood vessel can be observed easily. .

  Embodiments of the present invention will be described below with reference to the drawings.

1 to 6 relate to the first embodiment of the present invention, FIG. 1 shows the overall configuration of the endoscope apparatus of the first embodiment of the present invention, FIG. 2 shows the endoscope during blood vessel observation, and FIG. 2 shows an enlarged view of the vicinity of the distal end portion in FIG. 2, FIG. 4 shows the configuration of the distal end portion of the endoscope in the modified example, FIG. 5 shows the fat transmittance characteristics before and after heat irradiation, and FIG. It is a figure which shows the blood vessel observation method by a present Example with a flowchart.
As shown in FIG. 1, in an endoscope apparatus 1 according to a first embodiment of the present invention, for example, an optical endoscope 3 in which a distal end side is inserted into an abdomen 2, for example, is mounted with a camera head 4 incorporating an imaging means. Signal processing is performed on a camera-mounted endoscope (hereinafter simply abbreviated as an endoscope) 5, a light source device 6 that supplies illumination light to the optical endoscope 3, and an imaging unit built in the camera head 4. A camera control unit (abbreviated as CCU) 7, a monitor 8 that displays an endoscopic image captured by the imaging means by inputting a standard video signal output from the CCU 7, and an optical endoscope A suction sheath (abbreviated as “suction sheath”) 9 detachably attached to the mirror 3 and a suction device 10 which is connected to the proximal end side of the suction sheath 9 and incorporates suction means and performs suction. .

The optical endoscope 3 includes, for example, a rigid insertion portion 11, a grip portion 12 provided at the rear end of the insertion portion 11, and an eyepiece portion 13 provided at the rear end of the grip portion 12. The light guide cable 14 is connected to the base of the grip portion 12.
A light guide 15 that transmits illumination light is inserted into the insertion portion 11, and the light guide 15 is provided at an end portion thereof via a light guide cable 14 connected to a base on the side of the grip portion 12. A connector 16 is detachably connected to the light source device 6.
The light source device 6 is provided with a lamp 18 such as a halogen lamp that is lit by a lamp lighting power source supplied from a lamp lighting control circuit 17. The lamp 18 covers a visible wavelength band and has a wavelength of 1000 nm. It generates light in the infrared region that exceeds.
Only the infrared light in the infrared region of the light from the lamp 18 is transmitted by the infrared filter 19 disposed on the illumination optical path, and this infrared light is further condensed by the condenser lens 20 to be light guide cable. The illumination light enters the light guide 15 of the optical endoscope 3 through the 14 light guides.

The infrared illumination light incident on the light guide 15 is guided (transmitted) to the tip side. Then, the light is emitted from the front end surface of the light guide 15.
As shown in FIG. 2 or FIG. 3, the distal end surface 21 of the distal end portion 30 provided at the distal end of the insertion portion 11 of the optical endoscope 3 is a circular flat surface perpendicular to the axial direction of the insertion portion 11. The distal end surface 21 can be brought into close contact with a biological tissue surface 22 (abbreviated as the target tissue surface) 22 to be observed, such as the stomach omentum portion in the abdomen 2.
As shown in FIG. 3, for example, a disc-shaped transparent hood 23 made of glass or the like is attached to the distal end surface 21 of the insertion portion 11, and an objective lens 24 is provided at the center position on the inner side thereof. For example, a ring-shaped light guide 15 is disposed around the periphery.

In this case, the portion of the transparent hood 23 facing the tip surface of the ring-shaped light guide 15 has a function of an illumination window for emitting illumination light, and the central portion of the portion of the transparent hood 23 facing the objective lens 24 is It functions as an observation window through which observation light is incident.
Then, the reflected light of the illumination light emitted from the front end surface of the light guide 15 is incident on the objective lens 24, and the objective lens 24 forms an optical image at the imaging position. This optical image is transmitted to the rear eyepiece 13 side by the relay lens system 25 arranged in the insertion section 11.
The transmitted optical image can be enlarged and observed through an eyepiece 26 provided on the eyepiece 13 as shown in FIG. When the camera head 4 is attached to the eyepiece 13, an optical image transmitted through the imaging lens 27 in the camera head 4 is formed on the image sensor 28.

The imaging element 28 has sensitivity in an infrared wavelength region exceeding, for example, a wavelength of 1000 nm. This is an imaging element formed using a semiconductor detection element (photovoltaic semiconductor detection element) such as InGaAs, InAs, or InSb. An image sensor using these semiconductor detection elements has sensitivity to at least a wavelength band from 1000 nm to around 2550 nm. Note that InAs and InSb have sensitivity also in a long wavelength region longer than 2550 nm and longer than 3000 nm.
The camera cable 29 extended from the camera head 4 is connected to the CCU 7. The CCU 7 includes an image sensor drive circuit 31 and a signal processing circuit 32, and the image sensor drive circuit 31 applies an image sensor drive signal to the image sensor 28.
The image signal photoelectrically converted by the image sensor 28 by the application of the image sensor drive signal is input to the signal processing circuit 32. The signal processing circuit 32 performs signal processing for generating a video signal for the input imaging signal.

The generated video signal is output to the monitor 8, and an image captured by the image sensor 28 is displayed on the display surface of the monitor 8.
Further, the suction part 9 is attached so that the insertion part 11 of the optical endoscope 3 is covered and the attachment part 9a of the proximal end is fitted to the grip part 12 of the optical endoscope 3 so as to be detachably attached. The sheath 9 has a hollow cylindrical shape, and the suction sheath 9 is connected to the suction device 10 via a suction tube 34 connected to a base provided near the base end.
The inside of the suction device 10 communicates with the suction tube 34 and the hollow portion of the suction sheath 9, and the driving power is supplied to the suction pump 35 that sucks fluid such as air, and the heating element 36 provided near the tip of the suction sheath 9. A heating element power source (simply abbreviated as “power source” in FIG. 1) 37 is provided.

Further, the suction device 10 is connected to a foot switch 38 for performing ON / OFF operation of the operation of the suction pump 35 and the operation of supplying the driving power to the heat generating element 36. By operating the switch 38, the operations of the suction pump 35 and the heat generating element 36 can be turned ON / OFF.
As shown in FIG. 3, the heating element 36 is provided, for example, in a ring shape in the vicinity of the distal end portion of the suction sheath 9, for example, via a power supply line 39 embedded in the longitudinal direction of the suction sheath 9. It is electrically connected to the power source 37 shown in FIG.
FIG. 3 shows an example in which the relay lens system 25 is adopted as means for transmitting an optical image by the objective lens 24. However, as shown in FIG. 4, an image guide 25B formed by a fiber bundle is adopted. Also good. In this case, the front end surface of the image guide 25B is disposed at the imaging position of the objective lens 24, and the optical image formed on the front end surface is transmitted to the rear end surface of the image guide 25B.
In this embodiment, as shown in FIG. 2 or FIG. 3, the distal end surface 21 of the insertion portion 11 and the distal end surface of the suction sheath 9 are brought into close contact with the target tissue surface 22 to be observed, and the suction device 10 By operating the suction pump 35, the distance shortening that shortens the distance from the target tissue surface 22 of the portion facing the distal end surface 21 to the blood vessel 41 as the internal observation target tissue running inside the surface 22 It is characterized by forming means.

And by this distance shortening means, it is incident on the objective lens 24 from the illumination light and the observation window with a living tissue such as fat 42 interposed between the target tissue surface 22 and the blood vessel 41 running inside the target tissue surface 22. The attenuation of the amount of observed light is reduced so that blood vessels with good S / N can be observed (imaged). 2 and 3, the distal end surface 21 of the insertion portion 11 and the distal end surface of the suction sheath 9 have the same longitudinal position of the insertion portion 11, but are different as in the second embodiment. The position may be set.
The distance shortening means is formed as described below. By sucking the suction pump 35, the suction pump 35 sucks the air in the hollow portion around the insertion portion 11 as indicated by the arrows in FIGS. 2 and 3. This suction causes a force to be sucked from the ring-shaped tip opening 9b on the outer peripheral portion of the tip face 21 toward the inside of the tip opening 9b to the target tissue of the portion facing the tip opening 9b. As shown in FIG. 3, the target tissue is sucked inside the distal end opening 9b.

When the target tissue of the part facing the ring-shaped tip opening 9b is sucked and moved, the target tissue of the part facing the tip surface 21 on the inner peripheral side of the ring-shaped tip opening 9b is Due to the suction, it is deformed and moved so as to be drawn toward the suction device 10 side (that is, the objective lens 24 side), and the distance from the distal end surface 21 of the blood vessel 41 and the like is shortened by this deformation movement than before the deformation movement.
That is, by the suction operation of the suction pump 35, an observation field of view by the objective lens 24 arranged near the portion facing the distal end surface 21, more specifically at the center of the distal end surface 21 (the range is indicated by θ in FIG. 3). The internal tissue portion of the inner target tissue surface 22 is drawn toward the objective lens 24 side, and the distance to the blood vessel 41 as the internal observation target tissue inside the target tissue surface 22 is shortened (shortened) to easily observe the running state of the blood vessel. The status can be set. The insertion portion 11 is disposed concentrically at the center of the suction sheath 9.

In addition, as described later, the tip surface 21 is brought into close contact with the target tissue surface 22, thereby suppressing the unevenness of the target tissue surface 22 inside the observation field θ and substantially interposing the living tissue interposed around the internal blood vessel 41. It is also possible to make the fat 42 layer formed on the substrate uniform.
Further, in this case, when the living tissue intervening around the blood vessel 41 running inside the target tissue surface 22 from the target tissue surface 22 is fat 42 by generating heat, the transmittance is increased ( In other words, the transmittance of light in the fat 42 layer portion is increased so that the blood vessel 41 under the fat 42 can be more easily observed. That is, when the living tissue around the blood vessel 41 is substantially fat 42, the heat generating element 36 has a function of a transmittance increasing means for increasing the transmittance for infrared light used for illumination and observation.

FIG. 5 shows a characteristic example of a measurement result in which the fat permeability is improved by heat irradiation of the fat. FIG. 5 shows the measurement results of fat permeability before and after heat irradiation.
This heat irradiation condition is shown, for example, when a 1200 W dryer is used as a heat source and the fat to be measured is irradiated with heat for 10 seconds. Thus, by heat irradiation, the transmittance of at least infrared light of fat can be increased, and an observation image of a blood vessel or the like under fat can be obtained with a good S / N.
Next, an operation in the case where a surgical operation or the like is performed with the endoscope apparatus 1 under observation with the endoscope 5 using, for example, the stomach in the abdomen 2 as an observation target tissue will be described.

As shown in FIG. 1, the insertion portion 11 of the endoscope 5 is inserted into the abdominal portion 2 via a trocar (not shown), and the stomach is covered with the greater omentum portion. In the case of an adult or the like, the greater omentum is thickened in the tissue with the fat 42, and it is difficult to grasp the running state of the blood vessel 41 inside the target tissue surface 22 due to the tissue of the fat 42. There is a case.
In such a case, the running state of the blood vessel 41 can be observed by a method as shown in FIG. As shown in step S <b> 1 of FIG. 6, the surgeon brings the distal end surface 21 of the insertion portion 11 of the endoscope 5 and the distal end surface of the suction sheath 9 into close contact with the target tissue surface 22.
Next, the surgeon steps on the foot switch 38 as shown in step S2 to turn on the foot switch 38. Then, the suction pump 35 starts a suction operation, and the heat generating element 36 starts a heat generation operation. Then, as shown in the outline in step S3, the living tissue in the observation visual field θ is configured, the fat 42 layer from the target tissue surface 22 to the blood vessel 41 is made uniform, and the fat 41 layer is thinned (shortened), Further, the transmittance can be increased so that blood vessels can be observed.

In this case, by the suction operation of the suction pump 35, the target tissue surface 22 portion facing the distal end opening 9b of the suction sheath 9 is drawn inside the distal end opening 9b as shown in FIG. 2 or FIG. By this pulling-in operation, the target tissue surface 22 portion facing the distal end surface 21 of the insertion portion 11 disposed at the center position of the distal end opening 9b is deformed and moved so as to be pulled toward the endoscope side. In the illustrated examples of FIGS. 2 and 3, the target tissue portion of the portion facing the distal end surface 21 moves upward relative to the target tissue portion that is outside the distal end opening 9 b.
When the blood vessel 41 as the internal observation target tissue in the present example is traveling inside the target tissue due to this movement, the blood vessel 41 also moves from the position indicated by the dotted line in FIG. In other words, it is deformed and moved to the objective lens 24 side.

In this way, the portion facing the distal end surface 21, that is, the blood vessel 41 as the internal observation target tissue that enters the observation visual field θ by the objective lens 24 can be moved to the objective lens 24 side, and the distance therebetween can be shortened.
In this case, in particular, the fat 42 portion interposed around the blood vessel 41 is thinned by a distance shortening function or distance shortening means for shortening the distance from the target tissue surface 22 to the blood vessel 41, and the illumination light is emitted from the fat 42 portion. The illumination light for illuminating the blood vessel 41 can be attenuated, and the attenuation of the observation light when the light reflected by the blood vessel 41 enters the objective lens 24 can be reduced.

Specifically, the observation state of the blood vessel 41 with infrared light is greatly improved by reducing (or thinning) the fat 42 layer interposed from the target tissue surface 22 to the blood vessel 41 by about 1 mm by the distance reducing means. be able to. Thus, the distance shortening means can be said to be a means for thinning the fat 42 layer that is interposed between the living body surface and the blood vessel 541 and obstructs the observation when the blood vessel 41 is observed.
As described above, according to the present embodiment, even when inserted into a body cavity and performing an endoscopic surgical operation, the running state of the blood vessel 41 running inside the living tissue such as fat 42 is changed to S / N can be improved and observed. Therefore, since the surgeon can grasp the blood vessel running, it is possible to perform a treatment such as excision avoiding the blood vessel 41 portion smoothly and in a short time. Therefore, the operation time can be greatly shortened, and the burden on both the operator and the patient can be greatly reduced.

Next, a second embodiment of the present invention will be described with reference to FIGS. FIG. 7 shows the configuration of the endoscope and the suction sheath on the distal end side in this embodiment as a usage example. In this embodiment, a laser diode (abbreviated as LD) 51 as a light generating element is attached to the inner peripheral surface near the tip of the suction sheath 9 in the first embodiment, and this LD 51 is, for example, a dotted line in FIG. Like the wavelengths in a plurality of infrared regions indicated by (2), laser light is emitted at a wavelength that has a high transmittance for fat and blood vessels and a lower transmittance for blood than these.
The LD 51 has an emission surface arranged so as to emit laser light toward the center side of the distal end opening 9b of the suction sheath 9, that is, the observation visual field center side. Therefore, the LD 51 is arranged at the center of the distal end opening 9b. For example, infrared laser light is emitted in a line shape.
Further, in the present embodiment, the distal end surface 21 of the insertion portion 11 is set on the rear side in the longitudinal direction of the insertion portion 11 relative to the distal end surface of the suction sheath 9 (specifically, in FIG. 7). Shows this distance by L). In this embodiment, the endoscope and the suction sheath 9 are set in a state shown in FIG. 7 by operating the suction device 10 by the method as in the first embodiment.

In this case, if the blood vessel 41 is present within the distance L from the distal end surface 21 within the observation visual field θ, the laser light is absorbed by the blood part inside the blood vessel 41 as shown in FIG. Observed as if interrupted.
On the other hand, if the blood vessel 41 does not exist within the distance L from the distal end surface 21 within the observation visual field θ, the laser beam can be observed without interruption as shown in FIG. For this reason, the presence or absence of blood vessels can be easily confirmed in the state of the observed laser beam.

In this embodiment, blood vessel observation can be performed by the method shown in FIG. 6 of the first embodiment, but blood vessel observation may be performed by the method shown in FIG.
In the present embodiment, as shown in FIG. 7, the attachment portion 9a at the proximal end of the suction sheath 9 is fitted into the grip portion 12 of the optical endoscope 3 to be in the longitudinal direction of the grip portion 12 (FIG. 7). Is set to be slidable vertically).
As shown in FIG. 10, when blood vessel observation is performed in close contact with the target tissue surface 22, the operator closes the distal end surface of the suction sheath 9 to the target tissue surface 22 in the first step S <b> 11.

  In this case, it is assumed that the position of the attachment portion 9a of the suction sheath 9 is set on the front side of the state shown in FIG. 7 (the grip portion 12 is on the rear side of the position of FIG. 7).

Then, as shown in step S12, the surgeon turns on the foot switch 38. Then, the suction pump 35 starts the suction operation, and the heating element 36 discloses the heat generation operation. By the suction operation of the suction pump 35, the target tissue surface 22 portion facing the distal opening 9b of the suction sheath 9 is drawn into the distal opening 9b. Further, the heat generation operation of the heat generating element 36 increases the transmittance of fat for infrared light inside the target tissue surface 22 in the vicinity of the heat generating element 36. In the next step S <b> 13, the surgeon slides the insertion portion 11 toward the distal end side within the suction sheath, and brings the distal end surface 21 into close contact with the target tissue surface 22.
That is, the target tissue enters the inside of the distal end opening 9b of the suction sheath 9 by the suction operation in step S12, and the operator slides toward the distal side toward the target tissue that has entered the inside of the distal end opening 9b. The moved distal end surface 21 is pressed to bring the distal end surface 21 into close contact with the target tissue surface 22 to a state as shown in FIG.

In this state, the target tissue surface 22 portion facing the distal end surface 21 of the insertion portion 11 disposed at the center of the distal end opening 9 b is strongly pressed against the surface of the transparent hood 23. Then, in the state of step S14, the surgeon can observe the blood vessels.
In this case, the portion facing the distal end surface 21, that is, the target tissue in the observation visual field θ, that is, the fat layer portion is made uniform and thinned, and the heat generation operation by the heating element 36 increases the transmittance of the fat layer portion. Then, the surgeon can obtain an observation image by setting the blood vessel 41 as the internal observation tissue inside the target tissue surface 22 to be easily observed.
In the above description, a light emitting element that emits light in the infrared region is provided inside the illumination window at the distal end portion 30 of the insertion portion 11, and imaging of the infrared region is performed with illumination light emitted from the light emitting element. May be.

[Appendix]
1. The distal end surface of the suction sheath is set in front of the distal end surface of the endoscope.
2. The suction sheath is slidably attached to the endoscope in the longitudinal direction of the insertion portion.
3. In the vicinity of the distal end surface of the suction sheath, a light generating element that generates light having a wavelength with low transmittance to blood is provided on the center side of the distal end opening.

  When observing and treating organs in a body cavity using an endoscope, the running state of blood vessels inside the surface is difficult to observe because of the fatty tissue that substantially forms the biological tissue of that part In this case, the biological tissue portion in the observation visual field on the distal end surface is brought closer to the observation visual field side so that blood vessels can be observed, so that the influence of fat intervening between the surface and the blood vessels can be reduced and observed. .

FIG. 1 is an overall configuration diagram of an endoscope apparatus according to a first embodiment of the present invention. FIG. 2 is a diagram showing an example of using an endoscope during blood vessel observation. FIG. 3 is an enlarged view of the vicinity of the tip in FIG. FIG. 4 is a diagram illustrating a configuration of a distal end portion of an endoscope according to a modification. FIG. 5 is a diagram showing the transmittance characteristics of fat before and after heat irradiation. FIG. 6 is a flowchart showing a blood vessel observation method according to this embodiment. FIG. 7 is a diagram showing a usage example of the distal end side of the endoscope at the time of blood vessel observation according to the second embodiment of the present invention. FIG. 8 is a diagram showing that the observation image of the laser light varies depending on the presence or absence of blood vessels. FIG. 9 is a diagram showing an example of the wavelength of laser light. FIG. 10 is a flowchart showing a blood vessel observation method.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Endoscope apparatus 2 ... Abdominal part 3 ... Optical endoscope 4 ... Camera head 5 ... Camera-mounted endoscope 6 ... Light source apparatus 7 ... CCU
DESCRIPTION OF SYMBOLS 8 ... Monitor 9 ... Suction sheath 10 ... Suction device 11 ... Insertion part 15 ... Light guide 18 ... Lamp 21 ... Tip surface 22 ... Target tissue surface 23 ... Transparent hood 24 ... Objective lens 28 ... Imaging element 35 ... Suction pump 36 ... Heat generation Element 41 ... Blood vessel 42 ... Fat

Claims (5)

An endoscope provided with an insertion portion provided with a distal end portion capable of closely contacting the distal end surface facing the observation window on the surface of the biological tissue to be observed;
A distal end opening is formed on the outer peripheral side of the distal end including the distal end, and communicates with the distal opening on the proximal end side of the suction sheath and the suction sheath attached to the endoscope A suction device provided with suction means for performing suction; and
By the suction operation by the suction device, the biological tissue in the portion facing the distal end opening around the distal end surface is sucked and travels from the surface of the biological tissue in the observation field of the observation window to the inside of the surface. Distance shortening means for shortening the distance to the blood vessel as the internal observation target tissue,
An endoscope apparatus characterized by comprising:   Furthermore, the permeability increase means which increases the transmittance | permeability with respect to the case where the said biological tissue is substantially fat was provided near the front-end | tip part of the said sheath for suction. Endoscopic device.   The endoscope apparatus according to claim 2, wherein the transmittance increasing unit is formed by a heat generating element that generates heat.   The endoscope according to claim 1, wherein the position of the distal end opening of the suction sheath can be changed with respect to the position of the distal end surface of the insertion section of the endoscope in the longitudinal direction of the insertion section. apparatus.   The endoscope apparatus according to claim 1, wherein the endoscope includes an infrared imaging unit that performs imaging under illumination light in an infrared region.

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