JP2012070855A - Surgical endoscopic device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical endoscopic device capable of smoothly performing surgical operation or the like by easily avoiding the interference of the flexible tube part or operation part of a soft endoscope with an operating device in the outside of the body.SOLUTION: In the flexible tube part 11, the region (highly flexible part) 11ss on the base end side of the flexibility transfer part 11x formed on the way of the flexible tube part 11 is more flexibly formed than the region on the tip side thereof so that the length Lss from the flexibility transfer part 11x to flexible insertion parts 11, 12 and 13 (that is, the length of the highly flexible part 11ss) becomes longer than the length Ls from the tips of the flexible insertion parts 11, 12 and 13 to the flexibility transfer part 11x.

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

  Generally, a flexible insertion portion of a flexible endoscope has a bending portion that can be bent by a remote operation from an operation portion at a distal end of a flexible flexible tube portion having an operation portion connected to a proximal end. The distal end main body on which the observation window is arranged is coupled to the distal end of the bending portion.

  In the flexible tube portion, a very short region on the distal end side is formed flexibly so as to bend with a small radius of curvature in the body cavity (flexible portion), and most of the other regions are pushed and pulled by the operator. In order to prevent the operating force from escaping during operation, etc., it is formed with a certain degree of hardness (low flexible part).

  However, when the flexible insertion portion of the flexible endoscope is configured as described above, depending on the surgical method, the type of surgical device used, etc., the soft extension extending from the mouth of the endoscope trocar to the hand side outside the body. It is impossible to prevent the flexible tube (low flexible part) and the operation part of the endoscope from interfering with the surgical device extending from the mouth of the device trocar, and the surgical operation and the like can be performed smoothly. There are cases where it is not possible.

  The present invention provides a surgical endoscope capable of easily avoiding a flexible tube portion and an operation portion of a flexible endoscope from interfering with a surgical device outside a body, and performing a surgical operation and the like smoothly. An object is to provide an apparatus.

  In order to achieve the above object, the surgical endoscope apparatus of the present invention is bent at the distal end of a flexible flexible tube portion having an operation portion connected to the proximal end by remote operation from the operation portion. A flexible endoscope having a flexible insertion portion configured such that a distal end body in which an observation window is arranged is coupled to a distal end of the curved portion, and a bending portion that can be connected to the distal end of the bending endoscope. An endoscopic apparatus for surgery provided with an endoscopic trocar for guiding a flexible insertion portion into the body, in a flexible tube portion, from a flexible transition portion formed in the middle thereof The region closer to the proximal end (highly flexible portion) is formed more flexibly than the region closer to the distal end, and the length from the distal end of the flexible tube portion to the flexible transition portion (Ls) Therefore, the length from the flexible transition portion to the base end of the flexible insertion portion (that is, the length Lss of the high flexible portion) is longer. Is shall.

  According to the present invention, when a flexible insertion portion is passed through an endoscope trocar and endoscopic surgery is performed, in most cases, only the highly flexible portion extends from the mouth of the trocar to the outside of the body. Therefore, even if the flexible endoscope's flexible insertion part or operation part is likely to interfere with the surgical device outside the body, the high flexible part can be bent and displaced to easily avoid interference, Surgical operations can be performed smoothly.

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 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. 2 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 plugged in.

  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 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 curved portion 12 and the distal end main body 13 are arranged on the distal end surface 13 a and connected to the distal end of the curved 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 abruptly bending and buckling in the vicinity of the connecting portion to the operation portion 14 and is not included in the flexible insertion portion.

  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. 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 (effective length Z) constituting the flexible insertion portions 11, 12, and 13 is the same as the flexible tube portion of a known endoscope, for example, a metal strip having spring properties. The outer surface of the spiral tube made of material is covered with a mesh tube, and further, the outer surface is covered with a flexible tube in which the outer skin of a synthetic resin material is covered by extrusion molding or the like.

  However, the flexible tube portion 11 has a region closer to the base end side (highly flexible portion 11ss) than a region closer to the distal end side (flexible portion 11s) than the flexible transition portion 11x formed in the middle thereof. Is more flexible.

  That is, the flexible transition portion 11x is a boundary portion between the flexible portion 11s and the high flexible portion 11ss. The flexible portion 11s and the high flexible portion 11ss can be formed to have desired flexibility by appropriately selecting the hardness of the synthetic resin material forming the outer skin, for example.

  The bending portion 12 is also the same as 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. 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.

  In the surgical endoscope apparatus according to the embodiment thus configured, the length from the distal end of the flexible insertion portion 11, 12, 13 (that is, the distal end position of the distal end portion main body 13) to the flexible transition portion 11x. From the length Ls, the length from the flexible transition portion 11x to the base ends of the flexible insertion portions 11, 12, and 13 (that is, the distal end position of the anti-bending member 16) (that is, the length of the high flexible portion 11ss) Lss is formed longer. That is, Ls <Lss.

  The length Ls may be set so that the flexible transition portion 11x is positioned in the endoscope trocar 30 during a normal endoscopic surgical operation. For example, the length Ls is set to about 25 ± 5 cm. In that case, the length Lss of the highly flexible portion 11ss is about 35 ± 5 cm. By setting in this way, endoscopic observation or the like can be performed in a stable state.

  With such a configuration, the region closer to the base end side of the flexible tube portion 11 is a higher flexible portion 11ss than the flexible portion 11s closer to the distal end side, and the length Lss of the high flexible portion 11ss is long. Therefore, when the flexible insertion portions 11, 12, and 13 are passed through the endoscope trocar 30 and an endoscopic operation is performed, the mouth of the endoscope trocar 30 is excluded except for special cases. Only the high flexible portion 11ss extends outside the body, and the flexible portion 11s hardly (or not) protrudes outward from the mouth of the endoscope trocar 30.

  Therefore, as shown in FIG. 2, the flexible endoscope 10 passed through the endoscope trocar 30 and the surgical device 50 passed through the device trocar 40 form one incision hole formed in the body wall. In the surgical method inserted into the body from B, even if the flexible tube portion 11 or the operation portion 14 of the flexible endoscope 10 and the surgical device 50 are likely to interfere with each other outside the body, the high flexible portion 11ss is easily bent and displaced. Interference can be avoided, and surgical operations can be performed smoothly.

10 flexible endoscope 11 flexible tube part (flexible insertion part)
11s flexible part (region near the tip)
11ss highly flexible part (region closer to the base end)
11x flexible transition part 12 bending part (flexible insertion part)
13 Tip body (flexible insertion part)
30 Endoscope trocar 40 Device trocar 50 Surgical device

Claims (1)

A distal end portion in which an observation window is arranged by connecting a bending portion that can be bent by a remote operation from the operation portion to a distal end of a flexible flexible tube portion having an operation portion connected to a proximal end. A flexible endoscope having a flexible insertion portion having a configuration in which a main body is connected to the distal end of the bending portion, and an endoscope trocar for guiding the flexible insertion portion of the flexible endoscope into the body An endoscopic apparatus for surgery provided with
In the flexible tube portion, the region closer to the proximal end side is formed more flexibly than the region closer to the distal end side than the flexible transition portion formed in the middle thereof,
The length (Lss) from the flexible transition part to the base end of the flexible insertion part is longer than the length (Ls) from the distal end of the flexible insertion part to the flexible transition part. Endoscopic apparatus for surgery characterized by being formed long.

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