JP3493579B2 - Work support device - Google Patents

Description

Description: BACKGROUND OF THE INVENTION [0001] 1. Field of the Invention [0002] The present invention relates to a work supporting apparatus, and more particularly, to a treatment tool located at the tip of a thin tube portion including one or a plurality of pairs of joints. The present invention relates to a guide manipulator and a work support device that can guide a user to an intended position and orientation and thereby support the work. 2. Description of the Related Art Conventionally known examples include the following. JP-A-8-224241 discloses a manipulator for operating a treatment tool in endoscopic surgery.
There is disclosed a manipulator in which the bending of an insertion portion and the opening and closing of a treatment tool attached to the tip of the manipulator are driven by a wire. [0003] Japanese Patent Application Laid-Open No. 8-173442 discloses a master-slave manipulator in which a master manipulator and a slave manipulator are connected via a link mechanism, and the slave moves like a master. The following known examples are disclosed as a method of bending a treatment tool inserted into a body cavity and a manipulator provided with the treatment tool. Japanese Patent Application Laid-Open No. 8-224247 discloses a manipulator including a bias member and a plurality of bending rings for bending portions including wires for bending operation. Japanese Patent Application Laid-Open No. 3-80826 discloses a bending device using a heat-sensitive deformable member set to bend in different directions. Japanese Patent Application Laid-Open No. 8-173445 discloses a surgical instrument for guiding a treatment tool to a treatment site under an endoscope.
Disclosed is a tube for an endoscope treatment tool that has a bending habit in a predetermined direction that is predetermined in advance, always projects in a predetermined direction from a treatment tool outlet at the distal end of the endoscope, and guides the tube tip to a target site. Have been. [0006] Japanese Patent Application Laid-Open No. 7-184929 proposes a surgical apparatus for bundling a plurality of surgical tools. Japanese Patent Application Laid-Open No. Hei 5-317235 proposes cleaning an objective lens of an endoscope. In this known example, a fluid ejection nozzle is formed on a distal end cover detachably provided at the distal end of an endoscope. [0007] In a device for supporting a surgical operation by inserting an instrument through a small hole, it is assumed that a plurality of surgical tools such as a thin manipulator and an endoscope lens are passed through an elongated tube. You. For minimally invasive treatment with little damage to the human body, it is necessary to make the hole as small as possible, and the tube passing therethrough cannot be made large. In addition, the number of surgical tools passed through can be changed as necessary, so it can not be made thicker,
It will be elongated. For example, in a brain surgery, the length of the insertion portion is about 15 to 20 cm, but it is difficult to position the distal end with rigidity with a thin surgical tool. In addition, during the operation, the lens of the endoscope is stained by blood or the like, and requires cleaning.
There is a problem that the passage of a plurality of tubes for guiding a fluid for washing becomes complicated. In the manipulator disclosed in Japanese Patent Application Laid-Open No. 8-224241, the manipulator and the treatment tool are integrated. In JP-A-8-173442, a master manipulator and a slave manipulator are integrated. For this reason, when changing the treatment tool portion at the distal end, it is necessary to replace the entire manipulator, which lacks simplicity when prompt treatment is required. Further, as shown in FIG. 13, in the conventional bending method, one bending portion which can be operated independently is formed by connecting a plurality of bending frames, and a minute space is formed between each adjacent frame. By bending the angle, a large bending angle is realized in the entire bending portion. FIG. 13a shows a configuration in which one bending portion can bend in one direction, and FIG. 13b shows a configuration in which a plurality of adjacent frames are connected so that the bending direction is different by 90 degrees and can be bent in multiple directions. ing. In Japanese Patent Laid-Open Publication No. Hei 8-224241, a plurality of curved pieces are connected to form one curved portion.
The top is curved by a small angle at a convex portion in contact with an adjacent top, and has a structure in which the entire curved portion forms a large bending angle. Also in Japanese Patent Application Laid-Open No. Hei 8-224247, the bending angle between the node rings adjacent to each other is small, and a large angle can be bent by connecting a plurality of the connecting rings. Also in Japanese Patent Application Laid-Open No. 6-105801, a plurality of bending pieces are similarly connected and rotated little by little to bend the entire bending portion in a desired direction. These examples have the disadvantage that the radius of curvature during bending is large, and when a large bending angle is required, the treatment instrument at the tip protrudes from the narrow visual field of the endoscope and becomes invisible. In JP-A-8-173445, since the tube is formed of a flexible synthetic resin, the tube is inadvertently applied to a portion of the endoscope that projects outward from the treatment instrument insertion channel. The distal end may be curved and the treatment tool located at the distal end may move unexpectedly, which poses a problem in safety during treatment. In Japanese Patent Application Laid-Open No. 3-80826, a current is supplied to an energizing cable connected to a heat-sensitive deformable member,
The heat-sensitive deformable member is deformed by applying heat. In this case, it is difficult to control the amount of deformation of the heat-sensitive member, there is a time lag until heat is sufficiently transmitted, and sufficient operability cannot be obtained. In Japanese Unexamined Patent Publication No. Hei 8-173445, the bending angle at the tip of the tube is set in advance, and it is necessary to take the tube in and out of the channel in order to obtain a desired bending angle. For this reason, the relationship between the protruding length of the tube and the bending angle is restricted, and it is difficult to obtain the posture intended by the operator. Also, if a habit is formed with a small radius of curvature, a large friction will be generated when the tube is inserted into and out of the channel, and the length of the portion with the habit will be shortened. difficult. In the manipulator disclosed in Japanese Patent Application Laid-Open No. Hei 8-224241, since the bending portion provided in the insertion portion is only a bending portion for changing the direction of the treatment instrument at the distal end, the bending portion is driven in the insertion direction of the manipulator. I can't change the orientation of the part. In JP-A-8-173442, the movement of the master is transmitted to the slave by the link mechanism, and the master and the slave are driven in the same manner.
A large space is required as a drive range on the master side. In these cases, in order to insert a plurality of manipulators, a large insertion hole or a plurality of insertion holes is required, and the degree of invasion may be increased. In JP-A-7-184929, since a plurality of surgical instruments are simply inserted into a hollow sheath,
It is difficult to stabilize the position of the distal end of the surgical tool, and there is a problem that the position is easily shifted by the force applied to the distal end. In Japanese Patent Application Laid-Open No. Hei 5-317235, since the endoscope itself is provided with a fluid injection nozzle, the insertion portion of the endoscope becomes thick, which is not suitable for performing minimally invasive surgery. The object of the present invention, the exchange of processing置具can be quickly easily, and can accommodate a plurality of treatment instrument has a rigid to maintain the attitude of the surgical instrument, excellent safety, the intention of the operator the invention is to provide a work support device having excellent drive unit in operability can be quickly reflected in multiple degrees of freedom. [0023] In order to solve the above-mentioned problems, a work support device according to the present invention has a joint at a tip and has an internal portion.
Guide to guide the position and orientation of the treatment tool
Manipulator, guide manipulator and endoscope
A guide channel having a plurality of inlets through which
An outer cylinder that wraps and holds the drain channel, and the guide manifold
The treatment instrument is placed at the rear end of the
A work support having an insertion port for guiding the inside of the
In the assisting device, a plurality of the guide manipulators are provided.
The guide manipulator has a flexible rear end,
Formed of a material that transmits translational and rotational forces,
Translates and rotates the manipulator, and
The above-mentioned link is connected via a wire attached to the id manipulator.
A drive unit having a motor for driving a node, and the drive unit
Attached to the rear end of the guide manipulator
And a holding part for the guide.
Straighten the tip and arm of the manipulator
After passing through the guide channel, the driving units are separated from each other by a space.
Of the guide manipulator so as not to interfere
Entrance side where the rear end is curved and fixed is slippery.
It has a guide hole that spreads out in the shape of
The drive unit is fixed . According to the present invention, when a plurality of guide manipulators each having a drive unit are bundled, the drive units are arranged and bound by the drive unit bending unit (second bending unit) so as not to interfere with each other. It can be bundled finely, and the degree of invasion to the human body can be reduced. Even if the drive unit is arranged and fixed, the operation of the drive unit with multiple degrees of freedom can be transmitted to the joint at the distal end and can be controlled independently irrespective of the posture of other guide manipulators or surgical tools. Furthermore, since the surgical tool can be passed from the hollow arm portion to the drive section, even if the drive section is arranged and fixed as described above, only the surgical tool can be quickly replaced without replacing the drive section. Embodiments of the present invention will be described below with reference to the drawings. The guide manipulator according to the present invention is a device for guiding the position and orientation of the treatment tool held at the distal end through the inside of a hollow insertion portion as shown in FIG. 3 described later. FIG. 1A shows an example of a configuration in which a plurality of guide manipulators and medical instruments 8 such as a stereoscopic endoscope are bundled using a guide channel 22, and FIG. 1B shows a configuration in which the guide channel 22 is inserted inside. 1 is a cross-sectional view of an inserted insertion tube 20. The cross section of the insertion tube 20 has a shape as shown by the cross section DD ′ in FIG. 1A, and an outer cylinder 21 is provided on the outermost side.
Inside, a guide channel 22 for guiding surgical tools 71 and 72 such as a lens of the endoscope 8 and a guide manipulator is wrapped and held. The guide channel 22 is provided with a necessary number of inlets 23 and 24 for introducing and guiding an endoscope lens and a surgical instrument. Also, there is a small hole through which the fluid passes. Four small holes are the fluid openings 25. The guide manipulators 17 and 72 pass through the introduction port 24 of the guide channel 22, and the medical device 8 such as an endoscope passes through the introduction port 2.
Passed through 3 . The driving section bending section 3 is made of a flexible material. The driving section bending section 3 is bent so that each driving section 5 does not interfere, and a plurality of insertion sections are bundled thinly. It is possible. Accordingly, the diameter of the guide channel 22 can be reduced, and a plurality of guide manipulators and the medical device 8 can be inserted from one small insertion hole to perform treatment. Therefore, it is possible to perform a less invasive operation on the human body than before. The drive section bending section 3 is bent,
At the same time, it is necessary to be able to transmit the translation / rotation force applied from the driving unit 5 to the insertion arm unit fixing unit 4 (FIG. 3) to the insertion arm unit 2 (FIG. 3). It is processed with a synthetic resin that has a certain degree of rigidity. FIG. 2 shows a device that incorporates a thin manipulator, a surgical tool, and an endoscope lens into a thin tube to be inserted into a body cavity to support a minimally invasive operation. The tube 20 and the entire device holding it are shown. FIG. 2 illustrates a case where one manipulator is provided in the holding device. The drive section 5 is a mechanism for driving an endoscope camera, a thin manipulator, and a surgical tool. These are held by the holding device S4 and positioned in a normal position. Holding device S4
Is fixed by the holding table S1. The patient's head S9 is fixed by the head fixing frame S3. These are fixed on the operating table S2. Among them, the embodiment of the present invention is directed to the manipulator and the insertion tube 20. FIG. 3 shows the entire configuration of the guide manipulator. The guide manipulator has an insertion section 6 and a driving section 5
Consists of The insertion section 6 includes a joint section 1, an insertion arm section 2, a bending section 3 for a driving section, and an insertion arm fixing section 4. The insertion part 6 of the guide manipulator is hollow. Therefore, in order to guide the treatment instrument into the guide manipulator, the treatment instrument can be inserted from the treatment instrument insertion port 50 provided in a part of the drive section 5 to the distal end of the insertion section 6. The position where the treatment tool insertion port 50 is installed is shown in FIG.
The position does not need to be the position shown in FIG. 3 and may be determined in the drive unit depending on the configuration of the treatment tool and the drive unit to be inserted or other instruments. By driving the joint part in the swing direction A, the insertion part in the rotation direction B, and the translation direction C, the distal end of the treatment tool is guided to a treatment target site such as an affected part, and the treatment tool can be operated. By bending the bending portion 3 for the driving portion, the position of the driving portion can be changed with respect to the insertion direction of the joint portion 1 and the insertion arm 2. The joint 1 includes a distal joint 11 and a proximal joint 12. Further, in the drawing, the rotation direction B of the insertion portion rotates about the rotation shaft 7. FIG. 4 shows a sectional structure of the joint 1. FIG.
Inside the insertion portion 6 shown in FIG.
4 and a treatment instrument guide tube 13 are included. A drive wire 15 or a return wire 16 passes through the inside of the wire guide tube 14. The joint is composed of a distal joint 11 and a proximal joint 12, and the drive wire 15 and the return wire 16 are fixed to the distal joint 11. Surface of the joint 1 and the insertion arm 2 is coated with the coating 17, the coating 17 is secured in the die 18. FIG. 5 shows the structure of the driving section 5. The insertion section 6 shown in FIG. 3 is connected to the drive section 5 by the insertion arm fixing section 4. The driving wire 15 is wound around a wire winding pulley 53 provided on an output shaft of a swing driving motor 52 via an intermediate pulley 54. The return wire 16 is connected to one end of a return spring 55, and the other end of the return spring 55 is fixed to a spring fixing plate 56. Thus, the wire 16 is always under tension. The method of pulling the return wire 16 by the return spring 55 is an example, and a method of pulling the return wire 16 by a motor other than the swinging drive motor instead of the spring is naturally possible. The parts for driving the joints such as 52 to 56 constitute the swing unit 51.
The swing unit 51 is combined with a rotation drive motor 58 via a rotation transmission unit 59. Swing unit 5
1, a rotation drive motor 58, a rotation transmission means 59, and the like constitute a rotation unit 57. The rotation unit 57 is connected to a translation drive motor 5e via translation means 5f. Swing unit 5
The translation unit 5d is constituted by integrating the rotation unit 57 including the translation unit 5 and the translation means 5f and the translation drive motor 5e. When the swing drive motor 52 is driven and the drive wire 15 is pulled or loosened, the drive wire 15 or the return wire 16 transmits a drive force to the distal joint 11 and moves in the swing direction A shown in FIG. Drive is performed. When the rotation drive motor 58 is driven, the rotation transmission means 59 transmits the rotation driving force to the swing unit 51, and the insertion section 6 drives in the rotation direction B shown in FIG. When the translation drive motor 5e is driven, the translation transmission means 5f transmits the translational driving force to the rotation unit 57, and drives the insertion section 6 in the translation direction C shown in FIG.
By these driving, the operator can guide the position and orientation of the treatment tool inserted from the treatment tool insertion port 50. Further, the insertion section 6 can be detached from the driving section 5, and only the insertion section 6 can be disposable. FIG. 6 shows the structure of the joint. In the insertion hole 1c provided in the concave support portion 1a of the base side joint portion 12,
The joint 1 is configured by inserting the insertion protrusion 1d provided on the convex support portion 1b of the distal joint 11.
Slits 1k and 1n are provided at the roots of the support portions 1a and 1b so that the support portions do not undergo plastic deformation due to the curvature at the time of insertion, so that a sufficient gripping force can be maintained even after the insertion. I do. FIG. 6 shows an example in which a slit is provided in the base-side joint 12, but a slit may be provided in the distal-side joint 11. In some cases, it may be provided on both the base side and the tip side. The return wire 16 is fixed to the wire fixing groove 1f, and is guided to the drive unit 5 by the wire guide tube 14 fixed to the wire guide tube fixing groove 1g. The driving wire 15 is fixed in the wire fixing groove 1e.
It is guided to the drive unit 5 by the wire guide tube 14. The wire fixing groove may be outside or inside the tube wall. It is of course possible to provide a fixing hole in the tube wall. The range of the swing angle is defined by the cut angles of the end faces 1i and 1j. When the joint is bent until the end faces are aligned, the driving wire 15 is connected to the end face 1i and the end face 1
The wire escape groove 1h is provided on the end face 1j so as not to be caught between the j. Thus, the range of the swing angle is defined by the end face, and the drive wire 15 does not obstruct the operation over the entire swing angle. 7a, 7b, and 7c show a guide channel state at the distal end of the insertion tube 20. FIG. As shown in FIG. 7a,
The guide channel 22 is provided with four fluid openings 25 in addition to the inlet. A thin plate 221 is provided on the end surface of the guide channel so as to surround the endoscope lens 81.
There is a concave part for entering. Further, a deeper concave portion 2220 is formed so as to surround the fluid opening 25 near the endoscope lens. Then, the thin plate 221 is fitted and fixed. As a result, the EE ′ cross section becomes as shown in FIG. 7B. Also, F-
An F ′ cross section is as shown in FIG. 7C. As can be seen from FIG. 7c, a fluid passage can be formed from the fluid opening 25 through the recess 2220 with respect to the endoscope lens surface. The endoscope lens 81 has a unique visual field from the center. The depth of the recess 2220,
The length obtained by adding the thickness of the thin plate 221 is set so as not to interfere with the viewing angle boundary L of the lens as shown in FIG. 7C. That is, the position of G in FIG. 7C is set so as not to interfere with the viewing angle boundary L. By doing so, it is possible to easily wash away dirt and the like on the endoscope lens surface with the fluid during observation with the endoscope. Further, by providing the guide channel with the fine holes as described above, a fluid can be passed, and a tube for washing is not required. Further, it can be used not only for cleaning but also for suction. FIG. 8 shows a method of fixing the guide manipulator to an apparatus for holding the guide manipulator in a state where the bending section 3 for the driving section is bent. The manipulator holding component 9 has a guide hole 91 through which the insertion portion 6 of the guide manipulator passes. The insertion hole exit side of the guide hole 91 is the insertion portion 6.
It has a hole having substantially the same diameter as that of the insertion portion, and the other insertion portion entrance side is spread in a slit shape. As a result, the highly rigid joint 1 and the insertion arm 2 are passed straight through, and thereafter,
The drive unit 5 can be fixed by being bent by the drive unit bending unit 3. The driving section 5 is fixed to the mounting surface 92 of the manipulator holding component 9, and the manipulator holding component 9 is fixed to the holding device at the mounting surface 93. As a result, the manipulator can be attached to the holding device while the bending angle of the driving section bending section 3 is fixed. The width of the slit of the guide hole 91 can be extended so that the insertion portion 6 can be inserted and the driving can be smoothly performed when performing the rotation driving in the rotation direction B and the translation driving in the translation direction C. It is shaped and surface-treated. When the drive section is fixed in a state where the drive section bending section 3 is bent, a gap is formed on the entrance side of the guide hole 91. If a member that fills the gap is inserted here, play of the insertion portion can be suppressed, and operation accuracy can be improved. FIG. 9 shows an embodiment of the multi-directional swing joint. Base joint 102 of distal joint 101
Of the end faces 1i and 1j that define the swing angle with respect to
By applying it to both sides of the support portion 1a or 1b, the head can be swung in multiple directions. FIG. 10 shows an embodiment of the multi-point swing joint. The joints 111 and 113 are shown in FIG.
Are the same as the distal joint 11 and the proximal joint 12, but the intermediate joint 112 includes a joint 111 and a joint 11.
The support portions 1a and 1b have opposite shapes to each other. By inserting one or more of these between the joints 111 and 113,
It is possible to have multiple swing joints. FIG. 11 shows an embodiment of a multipoint different direction swing joint. As in the embodiment of FIG. 10, the joint part 121 and the joint part 123 are joined at the end faces opposite to the support parts 1a and 1b, but the joint part 122 is formed in a state where they are joined in different directions. I have. By fitting the joint 122 in the middle, the degree of freedom of the joint tip is increased, and the intention of the operator can be more accurately reflected, and the workability can be improved. Note that FIG.
In the joint shown in FIG. 11, each movable part corresponds to one conventional curved part, and can be driven independently. FIG. 12 shows the insertion arm portion 2 and the bending portion 3 for the driving portion.
Are shown. The connection is a connection between a highly rigid metal or synthetic resin and a flexible synthetic resin. When a fluorine resin or the like is used as the drive section bending portion, the end portion 2 is not used due to the poor adhesiveness of these materials.
a, 3a, or surface treatments such as bamboo shoots like 2b, 3b, corrugations, lattices, etc., which are engaged with each other. So that you can get Further, by filling the gap between the meshes with the adhesive, the bonding force can be improved. In FIG. 12, the insertion arm portion 2 and the bending portion 3 for the driving portion are shown.
However, the same applies to the case where the insertion arm portion 2 is replaced with the insertion arm fixing portion 4 as it is. In addition, although the processing example in which the insertion arm part 2 is a male and the drive part bending part 3 is a female is shown, the processing may be reversed at all. As described above, according to the present invention,
Insertion and replacement of only the treatment tool can be performed quickly and easily without removing the manipulator itself, which is effective in improving workability. In addition, since the rigidity of the insertion portion is high, the position of the distal treatment device does not shift due to an unexpected external force.
Further, since operation with multiple degrees of freedom is possible by driving a wire, it is effective in improving operability and safety. Since the position and orientation of the distal end treatment tool can be guided with a small radius of curvature, it is effective in improving workability in a narrow field of view such as an endoscope. Further, since a plurality of guide manipulators can be bundled and inserted from one small insertion hole, it is effective in reducing the degree of invasion to the human body. Further, since the positions and rigidity of the distal ends of the plurality of manipulators and medical instruments can be maintained and the stability can be improved, it is effective in improving the safety and reliability of precise and fine treatment. Further, by discharging or sucking the cleaning liquid from the fluid opening, there is an effect that cleaning of the end face of the guide channel including the endoscope lens is facilitated.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a configuration diagram in which a plurality of guide manipulators and other medical instruments are thinly bundled. FIG. 2 is a configuration diagram of an apparatus for supporting a minimally invasive operation. FIG. 3 is a side view of the guide manipulator. FIG. 4 is a sectional view of an insertion portion of the guide manipulator. FIG. 5 is a side view of a drive unit of the guide manipulator. FIG. 6 is a side view of a joint of the guide manipulator. FIG. 7 is a view of the tip of a guide channel. FIG. 8 is a sectional view of a holding part of the guide manipulator. FIG. 9 is a side view of a multi-directional swing joint of the guide manipulator. FIG. 10 is a side view of a plurality of linked swinging joints of the guide manipulator. FIG. 11 is a side view of a configuration example of a guide manipulator having a plurality of joints having different swinging directions. FIG. 12 is a cross-sectional view of a joint between a highly rigid material and a flexible material of an insertion portion. FIG. 13 is a configuration diagram of a conventional bending portion. [Description of Signs] 1 Micro-joint part 2 Insertion arm part 3 Bending part for drive part 4 Insertion arm fixing part 5 Drive part 6 Insertion part 7 Insertion part rotation axis 8 One example of medical instrument 9 Manipulator holding part 11 Tip joint 12 Base Side joint 13 Treatment tool guide tube 14 Wire guide tube 15 Drive wire 16 Return wire 20 Insertion tube 21 Outer cylinder 22 Guide channel 23, 24 Inlet 25 Fluid opening 50 Treatment tool insertion port 71 First manipulator 72 Second manipulator 81 Endoscope lens A Swing direction B Rotation direction C Translation direction

──────────────────────────────────────────────────続 き Continuation of front page (56) References JP-A-9-19403 (JP, A) JP-A-63-292935 (JP, A) JP-A 2-126605 (JP, U) JP-A 57-292 87701 (JP, U) Fully open 1987-87604 (JP, U) (58) Fields investigated (Int. Cl. ⁷ , DB name) B25J 17/00-18/06 A61B 1/00 A61B 17/00 A61B 19/00

Claims (1)

(57) [Claims 1] A process which has a joint at the tip and is inserted inside
A hollow guide manipulator that guides the position and orientation of the fixture
And a plurality of guides passing through the guide manipulator and the endoscope.
A guide channel having an inlet;
And the rear end of the guide manipulator
Guides the treatment tool inside the guide manipulator
Work support device provided with an insertion port for performing
And a plurality of the guide manipulators.
The rear end of the evaporator has flexibility, translational force and rotation.
The guide manipulator is made of a material that transmits force.
Translation and rotation drive, and the guide manipulator
A motor that drives the joint via a wire attached to
A driving unit having a
And a holding part to be attached to the rear end of the
The holding component is provided at the tip of the guide manipulator.
Part and arm straight through the guide channel
After that, the driving units are so arranged that they do not spatially interfere with each other.
The rear end of the guide manipulator is curved
The guide hole that the entrance part side that is fixed with
The drive section is fixed to the rear end opening of the guide hole.
Work support apparatus characterized by that.