JP2007289580A - Apparatus for detecting position of treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an apparatus for detecting the position of a treatment instrument when inserting or drawing the treatment instrument into or out of a treatment insertion channel which credibly recognizes the treatment instrument by increasing resistance when the treatment instrument moves in either insertion or drawing direction and passes though a predetermined position and by keeping the resistance substantially constant when the treatment instrument moves in the reverse direction. <P>SOLUTION: First and second insertion resistance increasing sections 30 and 31 comprising annular undulating projections 32 are formed on the outer surface of a flexible tube 14 so as to increase resistance at a predetermined position when a flexible cord 12 of a forceps apparatus 10 passes through a plug member 20 of a treatment introducing section 4. Each undulating projection 32 has a slanting surface 32a rising moderately from one side, and a part descending from the distal part 32b of the slanting surface 32a is formed in a concave surface 32c. When the undulating projections 32 enter a slit 26 formed between right and left wall sections W from the slanting surface 23a side, the undulating projections deform and lie down. When the undulating projections 32 enter the slit in the reverse direction, the distal parts 32b of the undulating projections deform elastically in the standing-up direction. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention provides a treatment for causing an operator to recognize that the distal end of the treatment tool has reached a predetermined position in the treatment tool insertion channel when the treatment tool is inserted into the treatment tool insertion channel of the endoscope. The present invention relates to a tool position detecting device.

  In an endoscope used for medical purposes, not only simply examining the state of the body cavity of a subject, but if there is an affected part in the body, the tissue cell can be collected, It has a configuration that allows treatment. That is, in order to insert a treatment instrument into the body under the control of the endoscope, the endoscope is provided with a treatment instrument insertion channel for inserting forceps and other treatment instruments in the insertion portion, and the treatment instrument insertion channel. The proximal end portion of the insertion portion communicates with a treatment instrument introducing portion provided in the main body operation portion, and the distal end is opened as a treatment instrument outlet with the observation portion provided on the distal end surface and the distal side surface of the insertion portion.

  The treatment tool inserted through the endoscope is provided with an operating part at the tip of a flexible cord, and the operating part is constituted by, for example, a forceps operating part, a high-frequency knife, a snare wire or the like. The treatment instrument is inserted into the treatment instrument insertion channel from the treatment instrument introduction section, but does not enter the observation field of view by the observation section until it is led out from the treatment instrument outlet at the distal end of the insertion section. Accordingly, when the operating portion at the distal end of the treatment tool is suddenly led out from the treatment tool outlet when the treatment tool is being inserted, depending on the operation mode, for example, the treatment tool is strongly inserted into the treatment tool insertion channel. When pushed in, it suddenly protrudes from the treatment instrument outlet, and its operating part may collide with the inner wall of the body cavity, possibly damaging the inner wall of the body cavity.

Therefore, when the treatment instrument reaches a predetermined position in the treatment instrument insertion channel, in order to make it recognized by the operator who operates the endoscope, a scale, a sign, and a sign on the outer surface of the flexible cord of the treatment instrument. Although there is a configuration in which a display unit composed of an uneven portion is provided, an operator often performs an operation without gazing at the treatment tool. Therefore, the display unit provided on the outer surface of the flexible cord is a safety measure. Not necessarily effective. In consideration of the above points, when forming an uneven portion at a predetermined position of the flexible cord of the treatment instrument and inserting the treatment instrument into the forceps channel (treatment instrument insertion channel), or when pulling out from the forceps channel A configuration in which an operator recognizes that the flexible cord has passed a predetermined position in the forceps channel due to a change in state that occurs when the uneven portion of the flexible cord passes through the forceps plug. However, this is disclosed in Patent Document 1. As a result, for example, when the treatment tool is extracted from the forceps channel, it is extracted with force until the state change portion reaches the position of the forceps plug, and the operation change recognizes that the state change portion has reached the position of the forceps plug. After that, it is possible to perform an operation of slowly pulling out, and it is possible to prevent the occurrence of a situation in which the distal end of the treatment instrument jumps out of the forceps channel and scatters body fluid or the like around.
Japanese Patent Laid-Open No. 10-137256

  When the concave portion is provided in the flexible cord, the resistance decreases when the forceps plug passes, and when the convex portion is provided, the resistance increases. By the way, when the treatment instrument is pulled out, the resistance to the pulling changes depending on the state of the outer surface of the flexible cord or the like, for example, when body fluid or the like adheres to a part of the flexible cord. In addition, the flexible cord is thin, and even if a recess is provided in the flexible cord to provide a difference in diameter between the recess and the other part, the degree of the difference in diameter is limited. Therefore, it is often difficult for the concave portion to cause a noticeable change in the feeling when passing through the forceps plug and to make the surgeon recognize it reliably. On the other hand, when the convex part is formed on the flexible cord, it is restricted by the inner diameter of the forceps channel, but it is possible to increase the diameter difference between the convex part and the other part to give a clear difference in operation feeling. Is possible.

  Even if the position of the treatment tool is recognized by the operational feeling of increased resistance when passing through the forceps plug, the resistance that must be increased is movement in one direction, and resistance must be given to movement in the opposite direction. Rather, it is necessary to ensure the smoothness of the operation of inserting / removing the treatment tool into / from the forceps channel. In other words, in order to increase the operational feeling for the surgeon, it is necessary to increase the resistance when passing through the forceps plug, but if this is done, the resistance will increase even when operating in the opposite direction, which does not require an increase in resistance. Therefore, the operability of the treatment tool is deteriorated. On the other hand, if the increase in resistance at the time of passing through the forceps plug is suppressed in consideration of the operability of the treatment tool, it is not possible to generate the operational feeling necessary for the operator to recognize.

  The present invention has been made in view of the above points. The object of the present invention is to move the treatment instrument in either of the insertion and removal directions when the treatment instrument is inserted into and removed from the treatment instrument insertion channel. Thus, when a predetermined position is passed, the resistance can be reliably recognized by increasing the resistance, and the resistance is not substantially changed when moving in the opposite direction.

  In order to achieve the above-mentioned object, the present invention provides a treatment instrument having a treatment instrument in which an operating part is connected to the distal end of a flexible cord via a treatment instrument introduction part provided in an endoscope and fitted with a valve. When inserted into the insertion channel, it is for detecting the insertion position of the operating part of the treatment tool in the treatment tool insertion channel, and the outer surface of the flexible cord of the treatment tool is attached to the outer surface of the valve. A resistance increasing portion that increases the resistance when passing through the position is provided, and this resistance increasing portion is configured to increase the resistance when moving in one direction of the flexible cord.

  Here, it is necessary to detect the insertion position of the treatment instrument in the treatment instrument insertion channel at a position immediately before the treatment instrument is led out from the distal end opening of the treatment instrument insertion channel. If the treatment instrument is vigorously led out from the treatment instrument insertion channel, the inner wall of the body cavity may be damaged. Accordingly, when performing the operation of inserting the treatment instrument into the treatment instrument insertion channel, when the distal end of the treatment instrument reaches the position near the distal end opening, the operator who operates the endoscope is clearly recognized. Also, when the treatment instrument is pulled out from the treatment instrument insertion channel, when the treatment instrument is pulled out and reaches a position near the treatment instrument introduction section so that the tip does not suddenly jump out of the treatment instrument introduction section It is also important to make the surgeon aware of it. Either one or both of these positions can be clearly recognized by the operator.

  As is well known, an endoscope is configured by connecting an insertion portion to a main body operation portion, and a treatment instrument introduction portion is generally provided in the main body operation portion. Here, the treatment instrument insertion channel connected to the treatment instrument introduction part may be used as a part of the suction path. The body cavity is in a pressure state higher than atmospheric pressure. For this reason, there is a possibility that a body fluid or the like flows backward from the distal end opening side of the treatment instrument insertion channel, and in order to prevent the backflow from overflowing from the treatment instrument introduction section, A plug member is provided. A valve is attached to the plug member so that the treatment tool can be inserted while the plug member is attached. Normally, the valve is kept in a closed state, and when the treatment instrument is inserted, the insertion path is secured by expanding the valve. When the treatment instrument is inserted and withdrawn, the valve becomes a resistance to this operation. When the treatment instrument reaches a predetermined position, the resistance is increased, thereby allowing the operator to recognize that the treatment instrument has passed the predetermined position in the treatment instrument insertion channel.

  When the treatment instrument is inserted into the treatment instrument insertion channel, the distal end of the treatment instrument is flexible so that the operator can recognize that it has advanced to a certain position before reaching the distal end opening of the treatment instrument insertion channel. Among the sex cords, a resistance increasing portion is provided at a position passing through the valve at this time. In this case, the resistance increasing portion is set so that the resistance increases in the insertion direction of the treatment instrument. In order to make the surgeon recognize that the distal end of the treatment instrument has moved to the position before reaching the treatment instrument introduction portion when the treatment instrument is pulled out, the flexible cord has a valve at that time. A resistance increasing portion is provided at a position where it passes. In this case, the resistance increasing portion is set so that the resistance increases in the pulling-out direction of the treatment instrument. Although the resistance increasing portion is provided at one or both of the above-described positions, the resistance increasing portion may be further arranged at one or more positions as necessary.

  Here, the resistance increasing portion has directionality. That is, the resistance increases at a predetermined position when the treatment tool is operated in one of the insertion / removal directions, but the resistance does not increase so much when operated in the opposite direction. The resistance should be substantially the same as that of the part.

  As a specific configuration of the treatment instrument, an operation member such as a high-frequency knife or forceps is provided at the distal end of the flexible cord, and a handle portion is connected to the proximal end portion of the flexible cord. Is done. The flexible cord is configured by a close coil or a flexible tube formed in a coil shape in which a metal wire is in close contact. Moreover, what attached the flexible tube to the outer peripheral part of the close_contact | adherence coil is also used. In any case, the resistance increasing portion causes the valve to be caught when passing through the valve from one direction, and not to be caught when passing the valve in the opposite direction. To. Specifically, the resistance increasing portion can be composed of a wedge-shaped protrusion acting in one direction, that is, an undulating protrusion, and the outer surface of the flexible cord is formed of a flexible tube. Is provided with an elastic undulation piece on its outer surface, and the direction of the tip of the undulation protrusion piece is adjusted. Thereby, directionality can be given to the resistance increasing portion. The undulating piece may be formed in an arc shape or may be formed in an annular shape. This undulating piece moves so as to stand when operating in one direction and passes through when the valve moves in the opposite direction.

  The undulating protrusions constituting the resistance increasing portion may be provided only at a predetermined position, but in order to make the operator clearly recognize the position of the treatment tool, a plurality of undulating pieces are arranged in parallel in the axial direction. It is desirable to do. The resistance increasing portion is for detecting that the treatment tool has reached a predetermined position in the operation of inserting the treatment instrument into the treatment instrument insertion channel, but operates in the pull-out direction even if the treatment instrument is operated in the insertion direction. In any case, when the resistance increasing portion passes through the valve, the resistance increases, so that the moving speed of the treatment instrument decreases. Therefore, if the undulating protrusions are formed in a predetermined shape and arranged in a predetermined length in the axial direction, the operation speed is inevitably slowed down so that the operator does not reduce the special operation speed. There is no problem.

  By configuring as described above, the position of the treatment instrument in the treatment instrument insertion channel can be accurately detected by increasing the resistance, and the resistance increases only in the direction to be detected and moves in the opposite direction. In this case, the resistance does not substantially increase, and the operability can be kept good.

    Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows the overall configuration of the treatment instrument, and FIG. 2 shows a state in which the treatment instrument is mounted on an endoscope. In these drawings, reference numeral 1 denotes an endoscope, and the endoscope 1 includes a main body operation unit 2 and an insertion unit 3 connected to the main body operation unit 2. The main body operation section 2 of the endoscope 1 is provided with a treatment instrument introduction section 4 that serves as an entrance section for the treatment instrument. A treatment instrument insertion channel 5 is connected to the treatment instrument introduction section 4, and the treatment instrument insertion channel 5 extends from the main body operation section 2 into the insertion section 3, and an illumination window is provided at the distal end surface of the insertion section 3. Along with the observation window (not shown) and the like, the treatment tool outlet 5a is opened.

  In FIG. 3, reference numeral 10 denotes a forceps device as a treatment tool, and the forceps device 10 includes a forceps operating portion 11 at a distal end thereof. A flexible cord 12 is connected to the forceps operating portion 11 and can be used. A handle portion 13 is connected to the proximal end portion of the flexible cord 12. The forceps operating section 11 is composed of a pair of gripping claws 11a and 11a, and is opened and closed by a link mechanism 11b. The operation of the link mechanism 11b is performed by remote operation by the handle portion 13.

  In order to enable operation of the gripping claws 11a, 11a constituting the forceps actuating unit 11, the flexible cord 12 allows the contact coil 15 to be inserted into the flexible tube 14 as shown in FIG. An operation wire 16 connected to the link mechanism 11b is extended inside the contact coil 15. The handle portion 13 has a main body shaft 17. A slit portion 17a is formed in the main body shaft 17 over a predetermined length in the axial direction, and a slider 18 that engages with the slit 17a is mounted. ing. The proximal end portion of the operation wire 16 is connected to the slider 18. By sliding the slider 18 in the axial direction of the main body shaft 17, the operation wire 16 is pushed and pulled, and the link mechanism 11 b is operated. The gripping claws 11a and 11a are opened and closed.

  The forceps device 10 configured as described above is inserted into the treatment instrument introduction section 4 from the forceps operation section 11 side, and the forceps operation section 11 provided at the distal end is derived from the treatment instrument outlet 5a to a predetermined length. Then, by opening and closing the grasping claws 11a, 11a, a treatment for collecting cells or excising the affected part is performed. In general, the insertion portion 3 of the endoscope 1 has a length of about 1.5 m, and therefore the flexible cord 12 of the forceps device 10 has a longer dimension. The treatment instrument introducing section 4 is provided with the plug member 20 shown in FIG. 2, and the forceps device 10 is inserted from the plug member 20.

  As is clear from FIG. 2, a passage 21 is formed in the treatment instrument introduction portion 4, a guide pipe 22 is attached to the passage 21, and a holder portion 22 a is formed at the tip of the guide pipe 22. . The plug member 20 is detachably attached to the holder portion 22 a of the guide pipe 22. The plug member 20 is entirely made of an elastic member such as rubber, and includes a mounting portion 23 attached to the holder portion 22a of the guide pipe 22 and a valve body 25 connected by an elastic strip 24 connected to the mounting portion 23. Has been.

  The valve body 25 is formed with a slit 26 that functions as a check valve. The passage 21 is sealed by the wall portions of the slit 26 constituting the valve body 25 being in close contact with each other. As a result, backflow from the body is prevented through the treatment instrument insertion channel 5, and when the treatment instrument insertion channel 5 is made to function as a suction path, an aspirating substance such as a body fluid does not overflow from the treatment instrument introduction section 4. It will be in the covered state. When the above-described forceps device 10 or the like is inserted as a treatment tool, the slit 26 of the valve body 25 is opened. In addition, a partition wall 27 is provided in the attachment portion 23, and a throttle passage 28 is formed in the partition wall 27, and the treatment instrument that has passed through the slit 26 passes through the throttle passage 28. The function of preventing the backflow from the body when opened is more reliably exhibited. Therefore, when the treatment instrument is inserted into the treatment instrument insertion channel 5, it always passes through the slit 26 provided in the valve body 25 of the forceps plug 23, and this slit 26 is pushed open by the treatment instrument. . Some plug members are not provided with a throttle passage. However, regardless of the structure, the plug member is provided with a valve that functions as a check valve that is opened by inserting a treatment instrument.

  The forceps device 10 that has passed through the plug member 20 provided in the treatment instrument introduction section 4 is guided to the treatment instrument outlet 5a through the treatment instrument insertion channel 5, and the forceps operating section 11 is connected to the treatment instrument outlet 5a. As an insertion position detection unit for allowing an operator who operates the endoscope to recognize the position immediately before reaching the position, for example, when reaching a position several centimeters to tens of centimeters before the treatment instrument outlet 5a, The resistance increasing portion 30 is provided. Further, when the forceps device 10 is inserted into the body cavity and an appropriate treatment is performed and then the forceps device 10 is operated so as to be removed with force, the body fluid adhering to the vicinity of the distal end portion of the flexible cord 12 and the forceps operating portion 11 Etc. will be scattered. Accordingly, in order to detect the position immediately before the forceps operating unit 11 is pulled out from the treatment instrument insertion channel 5 and the forceps actuating portion 11 at the distal end is pulled out from the plug member 20 provided in the treatment instrument introducing portion 4, the second resistance increase is also performed. The portion 31 is provided.

  As shown in FIGS. 3 and 4, the first and second insertion resistance increasing portions 30, 31 are annular undulation protrusions 32 formed on the outer surface of the flexible tube 14 constituting the flexible cord 12. Consists of A plurality of the undulating protrusions 32 are provided at a constant pitch interval in the axial direction of the flexible tube 14. The undulating protrusion 32 has a slope portion 32a that rises gently from one side, and a portion of the slope portion 32a that descends from the tip end portion 32b is a concave surface portion 32c.

  As shown by the arrows in FIG. 5, when the undulation protrusion 32 enters from the side of the slope portion 32 a between the left and right wall portions W forming the slit 26, and slides in the rising direction, The undulating protrusion 32 is bent in the direction in which the tip 32b is compressed by its elastic force, and is deformed so as to be laid down so that it can easily get over. Therefore, the movement in this direction is performed smoothly, and this direction is a non-resistance passing direction that passes without increasing resistance during operation. Although the diameter of the undulating protrusion 32 is slightly increased, the resistance is hardly increased because a gentle curve is drawn. On the other hand, as shown by the arrows in FIG. 6, when advancing from the direction facing the concave surface portion 32 c of the undulation protrusion 32 between the wall surface portions W forming the slit 26, the tip end portion 32 b of the undulation protrusion 32 rises. Elastically deforms in the direction. And it passes through this position by elastically deforming so that the wall surface part W of the slit 26 may get over the front-end | tip part 32b of the raising / lowering protrusion 32 which stood up. Therefore, when the operation is performed in this direction, the wall surface portion W constituting the slit 26 is deformed so as to open, so that this passage is the increased resistance passage direction in which a large resistance is generated.

  Thus, there is directionality in detecting the tip position of the forceps device 10 in the treatment instrument insertion channel 5 due to the increase in resistance. The first insertion resistance increasing portion 30 that detects that the forceps operating portion 11 has reached the position near the treatment instrument outlet 5a is required when the flexible cord 12 of the forceps device 10 is operated in the insertion direction. It is. That is, as shown in part A of FIG. 3, the forceps device 10 is formed at the proximal end portion of the flexible cord 12 with the insertion direction of the forceps device 10 as the resistance increasing passage direction. Further, the second insertion resistance increasing portion 31 that detects that the treatment instrument introduction portion 4 has been reached is necessary when operated in the direction in which the flexible cord 12 of the forceps device 10 is pulled out. As shown in part B, the forceps device 10 is formed at the distal end of the flexible cord 12 with the pulling-out direction of the forceps device 10 as the resistance increasing passage direction.

  Thus, when the flexible cord 12 passes through the position of the slit 26 provided in the plug member 20 by the first and second insertion resistance increasing portions 30, 31 provided in the flexible cord 12, this is possible. Since the resistance acting on the flexible cord 12 increases, the operator who operates the forceps device 10 together with the endoscope 1 clearly confirms that the forceps actuating portion 11 has reached the front position of the treatment instrument outlet 5a. Can be detected. Therefore, after that, by carefully performing the operation of pushing the flexible cord 12 of the forceps device 10 into the treatment instrument insertion channel 5, the forceps actuating part 11 suddenly protrudes from the treatment instrument outlet 5a and damages the inner wall of the body cavity. Can be prevented. Further, when performing the operation of pulling out the forceps device 10 from the treatment instrument introducing portion 4, even if the forceps device 10 is operated so as to be vigorously removed from the treatment tool introducing portion 4 at high speed, the resistance to the operation in the pulling direction is suppressed. After the increase, the operation of the forceps actuating portion 11 at the distal end is suddenly pulled out from the plug member 20 and bound by the elasticity of the flexible cord 12 to adhere to the distal end portion and the vicinity thereof. There is no risk of spilling body fluids.

  On the other hand, when the operation of inserting the flexible cord 12 into the treatment instrument insertion channel 5 is performed, resistance to the operation is increased by the second insertion resistance increasing portion 31 provided in the vicinity of the distal end of the flexible cord 12. In addition, the first insertion resistance increasing section 30 does not increase the resistance to the operation during the pull-out operation. That is, the movement of the second insertion resistance increasing portion 31 in the insertion direction and the movement of the first insertion resistance increasing portion 30 in the pulling direction are both non-resistance passing directions, and the movement in this direction is almost different from other parts. Since there is only a resistance that does not exist, the operability is not deteriorated.

  Note that the degree of increase in resistance in the increased resistance passage direction in the first and second insertion resistance increasing portions 30 and 31 varies depending on the shape of the undulation protrusion 32 and the degree of flexibility. Therefore, by making the resistance in the increased resistance passage direction sufficiently large and keeping the lengths of the first and second insertion resistance increasing portions 30 and 31 sufficiently, even if the operation is not particularly delayed, When the first and second insertion resistance increasing portions 30 and 31 are passed, the movement speed of the forceps device 10 is automatically reduced due to the increase in resistance, thereby ensuring safety and the like.

It is composition explanatory drawing which shows the forceps apparatus inserted in the endoscope. It is principal part sectional drawing which shows the treatment tool introduction part of an endoscope. It is a front view of a forceps device, and it has written together what expanded A part and B part of the flexible cord. It is sectional drawing of the position which provided the resistance increase part of the flexible cord. It is effect | action explanatory drawing which shows the motion to the non-resistance passage direction of a resistance increase part. It is effect | action explanatory drawing which shows the motion to the resistance increase passage direction of a resistance increase part.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Main body operation part 3 Insertion part 4 Treatment tool introduction part 5 Treatment tool insertion channel 5a Treatment tool outlet 10 Forceps device 11 Forceps operation part 12 Flexible cord 13 Handle part 14 Flexible tube 15 Adhesion coil 17 Main shaft 20 Forceps plug 25 Valve body 26 Check valve 30 First resistance increasing portion 31 Second resistance increasing portion 32 Uneven projection 32a Slope portion 32b Tip portion 32c Concave surface portion

Claims (4)

When the treatment instrument having the operating portion connected to the distal end of the flexible cord is inserted into the treatment instrument insertion channel through the treatment instrument introduction portion provided in the endoscope and having a valve attached thereto, For detecting the insertion position of the operating part in the treatment instrument insertion channel,
A resistance increasing portion that increases resistance when passing through the valve position is provided on the outer surface of the flexible cord of the treatment instrument, and the resistance increasing portion reduces resistance when moving in one direction of the flexible cord. A position detection device for a treatment instrument, characterized by being configured to increase. The resistance increasing portion is configured to increase the resistance when moving in the insertion direction of the treatment instrument to a position immediately before the operating portion of the treatment instrument is led out from the distal end of the treatment instrument insertion channel. The position detection apparatus for a treatment instrument according to claim 1. The resistance increasing portion is configured to increase the resistance when moving in the pulling direction of the treatment tool to a position immediately before the operation portion of the treatment tool is pulled out from the treatment tool treatment tool introduction portion. The position detection apparatus for a treatment instrument according to claim 1 or 2, characterized in that The resistance increasing portion is formed on an outer surface of the flexible cord, and when passing through the position of the valve, the resistance increasing portion is bent when operating in a forward direction, and stands up when operating in a reverse direction. The position detection apparatus for a treatment instrument according to any one of claims 1 to 3, wherein the position detection apparatus is constituted by an undulating protrusion having elasticity.

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