JP2012065752A - Surgical endoscope apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical endoscope apparatus by which the flexible insertion section of a soft endoscope can be smoothly pushed into a trocar and passed through the same and laparoscopic operation can be effectually carried out.SOLUTION: The flexible guide tube 17 long in the longitudinal direction of the flexible insertion sections 11, 12, 13 is arranged in the flexible insertion sections 11, 12, 13, the movable cored bar 18 of a magnetic body is arranged advanceably and retractably in an axial direction in the guide tube 17, the magnetic field generating means for generating a magnetic field so as to attract the movable cored bar 18 of the flexible insertion sections 11, 12, 13 passing through the area inside the trocar 30 with magnetic force is arranged in the trocar 30 for the endoscope, the movable cored bar 18 is held in the condition where the movable cored bar 18 is located in the trocar 30 for the endoscope in the guide tube 17 by the magnetic force when the flexible insertion sections 11, 12, 13 are parsed through the trocar 30 for the endoscope.

Description

  The present invention relates to an endoscope for observing a surgical site in the body at the time of laparoscopic surgery (or thoracoscopic surgery) and the like, and a state where the endoscope is stabbed into a body wall part to guide the endoscope into the body The present invention relates to an endoscopic apparatus for surgery provided with a trocar disposed on the endoscope.

  A so-called rigid endoscope in which the insertion portion is rigid and does not bend is widely used as an endoscope for observing a surgical site in the body during laparoscopic surgery or the like (for example, Patent Document 1). Rigid endoscopes have advantages such as easy handling and superior durability compared to flexible endoscopes.

  In recent years, in laparoscopic surgery, in order to minimize the physical burden on a patient, an endoscope trocar for guiding an endoscope and a device trocar for guiding a surgical device are provided on a body wall (for example, an umbilicus). Attempts have been made to insert it into the same hole.

  However, if you do so, depending on the surgical procedure and the type of surgical device used, the endoscope may interfere with the surgical device in the body, or the endoscope cannot be positioned conveniently for observation. Sometimes.

  However, since it is difficult to displace the insertion part of the rigid endoscope that protrudes into the body from the distal end of the endoscope trocar, if the endoscope and the surgical device interfere with each other, the observation of the surgical site and the surgical operation itself are hindered. Will come.

  Therefore, it is conceivable to use a flexible endoscope provided with a flexible insertion portion instead of the rigid endoscope. If it is a flexible insertion part of a flexible endoscope, when it interferes with a surgical device in the body, it can be displaced without difficulty and observation of a surgical site and a surgical operation can be continued without any problems (for example, Patent Document 2). .

JP-A-5-269079 JP-A-6-38923

  However, if the flexible insertion part of the flexible endoscope is pushed through the trocar for endoscope that has been pierced into the patient's body wall, etc., it will be lower than the insertion part of the rigid endoscope. The flexible insertion part, which is much weaker, bends in the trocar and increases its frictional resistance. As a result, it is bent by the pushing part on the hand side and smoothly passes through the trocar. May not be possible.

  An object of the present invention is to provide a surgical endoscope apparatus that can smoothly perform laparoscopic surgery and the like by smoothly pushing a flexible insertion portion of a flexible endoscope through a trocar and passing it through.

  In order to achieve the above object, a surgical endoscope apparatus according to the present invention is a flexible endoscope having a flexible insertion portion, and for guiding the flexible insertion portion of the flexible endoscope into the body. A flexible guide tube that is elongated in the longitudinal direction of the flexible insertion portion, and a movable cored bar made of a magnetic material is placed in the guide tube. The endoscope trocar is provided with magnetic field generating means for generating a magnetic field so as to attract the movable cored bar in the flexible insertion section passing through the inner region thereof by magnetic force. When the flexible insertion portion is passed through the endoscope trocar, the movable mandrel is held by the magnetic force in the guide tube so as to be positioned in the endoscope trocar.

  In addition, the guide tube may be arrange | positioned in the substantially axial position of the flexible insertion part, and the guide tube may serve as the treatment instrument insertion channel. Further, the endoscope trocar itself may be formed of a permanent magnet.

  According to the present invention, when the flexible insertion portion is passed through the endoscope trocar, the movable cored bar is held in the guide tube in a state of being located in the trocar. Since the flexible insertion part is kept in a strong and straight state in the trocar, the flexible insertion part of the flexible endoscope is smoothly pushed into the trocar and passed through to perform laparoscopic surgery etc. Can do.

It is a side view which shows a part of surgical endoscope apparatus which concerns on the Example of this invention in a cross section. It is II-II sectional drawing in FIG. 1 of the endoscope apparatus for a surgery which concerns on the Example of this invention. It is a side view which shows a part in cross section when the endoscope apparatus for surgery concerning the Example of this invention is in use condition. It is a schematic diagram which shows the state of the endoscopic surgery in which the endoscope apparatus for operation which concerns on the Example of this invention is used.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 4 schematically shows a state in which laparoscopic surgery is performed using the surgical endoscope apparatus of the present invention.

  In order to perform an operation on the affected part A in the body such as the abdomen, an endoscope trocar 30 and a device trocar are introduced into the body through one small incision hole B formed in one part of the body wall (for example, the navel). 40 is inserted.

  The endoscope trocar 30 is a guide tube for guiding the flexible endoscope 10 into the body, and the flexible endoscope 10 is inserted into the endoscope trocar 30 from the outside. The device trocar 40 is a guide tube for guiding an endoscopic surgical device 50 such as an endoscopic forceps or an electric knife into the body, and the surgical device 50 is inserted into the device trocar 40 from the outside. Has been.

  The flexible insertion portion of the flexible endoscope 10 is connected to the flexible tube portion 11 having flexibility and the distal end of the flexible tube portion 11 so as to be arbitrarily bent by an operation from the proximal end side. The bending portion 12 and an observation window, an illumination window, and the like are arranged on the distal end surface 13a and are connected to the distal end of the bending portion 12.

  Various operation members such as a bending operation knob 15 that can be bent by remotely operating the bending portion 12 are disposed on the operation portion 14 connected to the proximal end of the flexible tube portion 11. Reference numeral 16 denotes a bend preventing member for preventing the flexible tube portion 11 from being bent suddenly and buckled in the vicinity of the connecting portion to the operation portion 14.

  The surgical endoscope apparatus of the present invention includes a flexible endoscope 10 and an endoscope trocar 30, and FIG. 1 schematically shows the configuration thereof. However, the operation unit 14 of the flexible endoscope 10 is present at a position protruding from FIG. 1, and the endoscope trocar 30 is shown in cross section.

  FIG. 1 shows the length direction compressed with respect to the radial direction of each part. The endoscope trocar 30 is a cylindrical body having an inner diameter D of, for example, about 12 mm and a length T of about 20 ± 5 cm. In this embodiment, the entire endoscope trocar 30 is magnetized into a permanent magnet. It has become. On the proximal end side of the endoscope trocar 30, a hook-like portion 31 is formed so as to protrude from the body.

  The flexible insertion portions 11, 12, and 13 of the flexible endoscope 10 have a thickness (for example, about 10 to 11 mm) that allows the outer diameter d to pass loosely through the endoscope trocar 30 and a length L of 60. It is formed to be about ± 10 cm. Of these, the length of the curved portion 12 is, for example, about 7 ± 3 cm.

  The flexible tube portion 11 that constitutes the flexible insertion portions 11, 12, and 13 is the same as the flexible tube portion of a known endoscope. For example, a spiral tube made of a metal strip having a spring property. The outer surface is covered with a mesh tube, and further, the outer surface is covered with a flexible tube in which an outer skin of a synthetic resin material is covered by extrusion molding or the like.

  Further, the bending portion 12 is similar to the bending portion of a known endoscope. For example, a reticulated tube is coated on the outer surface of a skeleton that is configured by a plurality of articulated rings being rotatably connected by rivets or the like. Further, the outer surface is covered with a bending tube covered with a flexible rubber tube or the like, and is bent by pulling the operation wire connected to the distal end portion of the bending portion 12 from the operation portion 14 side.

  Reference numeral 17 denotes a flexible guide tube which is one of the built-in objects inserted and arranged in the flexible tube portion 11 and the bending portion 12. The guide tube 17 is formed of a tube that is slippery and excellent in cross-sectional shape retention, such as a tetrafluoroethylene resin tube, and its distal end is fixed to the distal end body 13 and the proximal end is not shown. There is no operation part 14 fixed.

  For example, a metal movable core 18 made of a magnetic material containing iron, nickel, cobalt, or the like is inserted in the guide tube 17 so as to be movable in the axial direction. The diameter of the movable core 18 is, for example, about 2 to 3 mm, and the length is formed to be about the same as the length of the trocar 30 for endoscope. Even if the flexible tube portion 11 and the bending portion 12 are formed flexibly. The region where the movable core 18 is present on the inside is maintained in a state where the waist is strong and close to straight.

  FIG. 2 illustrates a cross section (II-II cross section in FIG. 1) perpendicular to the axial direction in a state where the flexible tube portion 11 is passed through the endoscope trocar 30. In the flexible tube portion 11, a guide tube 17 and a movable mandrel 18 are disposed at a substantially central axis position. In the space in the flexible tube portion 11 surrounding the guide tube 17, an observation system signal cable 21, an illumination light A guide 22 and other various tubes (not shown), a guide coil 23 for guiding a bending operation wire (not shown), and the like are inserted.

  For example, as shown in FIG. 3, the surgical endoscope apparatus configured as described above is inserted into the endoscope trocar 30 by inserting the flexible insertion portions 11, 12, and 13 from the outside. The guide is such that the movable core 18 disposed in the guide tube 17 is attracted to the inner position of the endoscope trocar 30 by the magnetic field formed by the endoscope trocar 30 and is always held there. Slide in the tube 17.

  As a result, even if the flexible tube portion 11 and the bending portion 12 are formed flexibly, the flexible tube portion 11 and the bending portion 12 are strong in the endoscope trocar 30 where the movable core 18 is located. Since the straight state is maintained, the flexible insertion portions 11, 12, and 13 of the flexible endoscope 10 can be smoothly pushed into and passed through the trocar 30, so that laparoscopic surgery and the like can be performed skillfully. .

  In addition, this invention is not limited to the said Example, For example, you may make it utilize a well-known treatment tool penetration channel as the guide tube 17. FIG. In that case, the movable cored bar 18 may be inserted and disposed in the treatment instrument insertion channel from the distal end side as necessary. Further, the treatment instrument insertion channel and the guide tube 17 may be provided side by side.

  In the above embodiment, the endoscope trocar 30 itself is formed of a permanent magnet. However, an independently formed permanent magnet may be attached to the endoscope trocar 30 or the electromagnet The mirror trocar 30 may be equipped.

10 flexible endoscope 11 flexible tube part (flexible insertion part)
12 Curved part (flexible insertion part)
13 Tip body (flexible insertion part)
17 Guide tube 18 Movable core 30 Endoscope trocar 40 Device trocar 50 Surgical device

Claims (4)

A flexible endoscope provided with a flexible insertion portion, and an endoscope trocar for guiding the flexible insertion portion of the flexible endoscope into the body,
A flexible guide tube that is elongated in the longitudinal direction of the flexible insertion portion is disposed in the flexible insertion portion, and a movable cored bar made of a magnetic material is disposed in the guide tube so as to be movable back and forth in the axial direction. And
The endoscope trocar is provided with a magnetic field generating means for generating a magnetic field so as to attract the movable cored bar in the flexible insertion portion that passes through an inner region thereof with a magnetic force.
When the flexible insertion portion is passed through the endoscope trocar, the movable cored bar is held by the magnetic force in a state of being positioned in the endoscope trocar in the guide tube. An endoscopic device for surgery characterized by the above.   The surgical endoscope apparatus according to claim 1, wherein the guide tube is disposed at a substantially axial position of the flexible insertion portion.   The surgical endoscope apparatus according to claim 1 or 2, wherein the guide tube also serves as a treatment instrument insertion channel.   The surgical endoscope apparatus according to any one of claims 1 to 3, wherein the endoscope trocar itself is formed of a permanent magnet.

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