JP3762508B2 - Endoscope device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope apparatus in which a plurality of instruments are attached to an outer tube.
[0002]
[Prior art]
In recent years, patients who are hospitalized due to abdominal damage or sudden abdominal pain due to a traffic accident or the like are first examined by an image diagnostic method such as X-ray or ultrasound. However, such image diagnosis may not always be sufficient to examine the state of abdominal damage, the state of illness, and the like. Therefore, recently, an emergency laparoscopic examination using a rigid endoscope has been performed, and a definitive diagnosis has been made as to whether or not surgery should be performed. In order to perform laparoscopic examination for these acute abdomen patients with less invasiveness, the endoscope used in this examination is required to have a smaller diameter.
[0003]
In the field of neurosurgery, tumors and lesions in the ventricle and brain parenchyma are observed or treated with a rigid endoscope. In such cases, in order to reduce the invasion to the brain parenchyma, The endoscope used for this is also desired to have a smaller diameter.
[0004]
On the other hand, the mantle tube proposed in Japanese Utility Model Publication No. 62-183813 is known. This is a method for injecting physiological saline into the mandibular canal and performing temporomandibular canal in the mandibular joint space. The inner needle, forceps, optical tube, etc. for excising the internal soft tissue are inserted, and when the inner needle, forceps, optical tube, etc. are further inserted into the outer tube, to ensure their watertightness In addition, a watertight mechanism part is incorporated in the proximal part of the outer tube. In addition, since the mantle tube is used when performing procedures such as incision of soft tissue in the temporomandibular joint cavity, it is inherently thick and thick, and it is not necessary to have a structure that actively reduces the diameter. is not.
[0005]
[Problems to be solved by the invention]
(problem)
Laparoscopy for patients with acute abdomen may require removal of organs in the abdominal cavity, blood aspiration when bleeding, or simple hemostasis, etc. In such a case, it is necessary to reinsert the thick endoscope and to puncture another mantle tube for inserting the treatment instrument. For this reason, there is a drawback that the invasion to the patient for observation and treatment is inevitably increased. Also, depending on the procedure, it may be necessary to prepare a special mantle tube different from a general trocar.
In the field of neurosurgery, it is necessary to put an endoscope, a treatment tool, etc. in a mantle tube when performing treatment in the brain. Since these conventional devices basically have an insertion section with a circular cross section, the outer tube itself through which these instruments pass is also thickened, resulting in increased invasion to the brain parenchyma. There were drawbacks.
(Object of invention)
The present invention has been made paying attention to the above-mentioned problems, and the object of the present invention is to allow a plurality of instruments to be inserted into a patient in a compact manner with only one mantle tube to be punctured. An object of the present invention is to provide an endoscope apparatus that is minimally invasive and can perform various treatments and observations as necessary.
[0006]
[Means for Solving the Problems]
The present invention relates to a mantle tube having an insertion portion to be inserted into a body cavity of a patient, an objective optical system provided at a distal end portion, and a means for receiving an image formed by the objective optical system and observing the image and a viewing telescope with a built-in bets, further, a light guide cable and connectable connector section at a proximal portion, a light guide and the light guide to the distal end portion of the light incident from the connector portion, the light guide The observation tube includes at least one instrument including a built-in illumination tube, a channel tube having a tube portion having a distal end portion opened and a proximal end portion communicating with a connector portion, and a treatment instrument having an insertion portion main body. The tube and the device are bundled by aligning the direction of the insertion axis so that the distal ends are aligned, and the observation tube and the device bundled together with the observation tube are substantially fan-shaped. Te, and the light tube and the observation scope tube Regardless of the combination serial channel pipe of the treatment instrument is an endoscope apparatus outline of the cross-sectional shape of the bundle when the bundle forms a substantially circular, characterized in that as incorporated into the mantle tube.
[0007]
DETAILED DESCRIPTION OF THE INVENTION
[First Embodiment]
A first embodiment of the present invention will be described with reference to FIGS.
(Constitution)
FIG. 1 shows an external appearance of an endoscope apparatus when a plurality of instruments are densely loaded in one outer tube 1.
[0008]
The outer tube 1 includes a cylindrical insertion portion main body 2 and a cylindrical hand main body portion 3, and the insertion portion main body 2 and the hand main body portion 3 are configured to be coaxially connected. The inner lumen 4 has an equal diameter over the entire length from the insertion portion main body 2 to the proximal main body portion 3, and a plurality of instruments are selectively loaded in the inner lumen 4 according to the intended use. The inner lumen 4 of the outer tube 1 is circular with a diameter of 2r, and a member with an outer diameter of 2r can be inserted. A gas port portion 5 is provided on the side surface of the hand main body portion 3. A rubber cap 6 is provided on the proximal end side of the lumen 4 so that a general endoscope having a circular cross section can be inserted in an airtight state.
[0009]
The instruments loaded in the outer tube 1 include an observation visual tube (optical visual tube) 10, an illumination tube 20, a forceps channel tube 30, and a coagulator 40 as an example of a treatment instrument. FIG. It shows a state where it is tightly inserted and loaded. Next, those instruments will be described in order.
First, as shown in FIG. 2, the observation visual tube 10 includes an insertion portion main body 12 and an eyepiece 13 that is obliquely connected to the proximal end portion of the insertion portion main body 12. An optical system 14 is provided. An image fiber bundle (not shown) is housed inside the insertion portion main body 12, and one end of the image fiber bundle faces the objective optical system 14 to receive an image. The other end of the image fiber bundle faces an eyepiece lens (not shown) provided inside the eyepiece 13 so that an image can be observed through the eyepiece 13. The insertion portion main body 12 has a fan-shaped cross-sectional shape indicated by a radius r and an angle θ. Here, the angle θ is 90 °. However, the angle θ is not limited to this, and may be 180 °, for example.
[0010]
FIG. 3 shows the illumination tube 20 used in the first embodiment. The illumination tube 20 includes an insertion portion main body 21 and a light guide connector 22 that is obliquely connected to a proximal end portion thereof. A light guide fiber (including a bundle) 23 is loaded inside the insertion portion main body 21, and the front end of the light guide fiber 23 reaches the front end surface portion 24 of the insertion portion main body 21. The proximal end reaches the light guide connector 22. An existing light guide cable (not shown) is connected to the light guide connector 22, and the illumination light from the existing optical device can be guided to the distal end surface portion 24 to emit the illumination light within the observation field. It is. The insertion section main body 21 has a fan-like shape having a radius r and an angle θ. Here, the angle θ is 90 °, but is not limited thereto, and may be an angle of 180 ° or 270 °, for example. The light guide fiber 23 has a circular cross-sectional shape. However, as shown in FIG. 7 to be described later, the light-guide fiber 23 may have a fan-shaped shape in accordance with the cross-sectional shape of the insertion portion main body 21.
[0011]
FIG. 4 shows a forceps channel tube 30 used in the first embodiment. The forceps channel tube 30 has an opening 32 at the distal end side of the insertion portion main body 31, and a connector portion 33 communicating with the opening 32 is provided at the proximal end side of the insertion portion main body 31. The insertion section main body 31 has a fan-shaped cross section having a radius r and an angle θ. Here, the angle θ is 90 °, but is not limited thereto, and may be 180 ° or 270 °, for example, which are separately prepared although not shown.
[0012]
FIG. 5 shows a coagulator 40 used in the first embodiment. The coagulator 40 has an insertion portion main body 41 made of an electrically insulating member. A solidification electrode 42 is provided on the distal end side of the insertion portion main body 41. Is provided with an electrode terminal 43 that can be connected to an existing high-frequency device. The coagulation electrode 42 and the electrode terminal 43 are electrically connected through a conductive passage (not shown) formed in the insertion portion main body 41. The cross-sectional shape of the insertion portion main body 41 has a fan-shaped cross section having a radius r and an angle θ. Here, the angle θ is 90 °, but is not limited thereto, and may be 180 ° or 270 °, for example, which are separately prepared although not shown.
[0013]
The above-mentioned observation visual tube 10, illumination tube 20, forceps channel tube 30 and coagulator 40 are appropriately circularly combined in a state where the members of a suitably selected combination are tightly bundled together without a gap. Then, it is incorporated into the lumen 4 of the outer tube 1. That is, normally, it is assembled so that the tip ends of all the loaded instruments are coincident with each other and the cross-sectional shape thereof is tightly bundled together with the respective insertion axis directions being substantially circular. For example, the observation tube 10, the illumination tube 20, the forceps channel tube 30, and the coagulator 40 illustrated in FIGS. 2 to 5 are densely loaded as shown in FIG. 1 when they are assembled in the lumen 4 of the outer tube 1. The
[0014]
(Function)
First, when performing only intra-abdominal observation using this endoscope apparatus, the operator attaches an puncture inner needle to the outer tube 1 as in normal laparoscopic examination, and the abdominal cavity of a patient who has been inhaled The outer tube 1 is inserted into the. Then, a necessary instrument is mounted in the lumen 4 of the outer tube 1. For example, a combination of the observation visual tube 10 having the angle θ of 90 ° and the illumination tube 20 having the angle θ of 270 ° is selected. Then, as shown in FIG. 6, the outer peripheral portion of the bundle in which the two instruments are closely combined is inserted into the outer tube 1 in a state where the outer periphery of the cross-sectional shape becomes a perfect circle. At this time, the entire envelope including the arc of the entire substantially fan-shaped cross-sectional shape of each of the instruments in which both ends of the observation visual tube 10 and the illuminating tube 20 coincide and are tightly bundled together in the respective insertion axis directions. Since it is assembled so as to have a substantially circular shape, it can be closely packed in the lumen 4 of the outer tube 1. In this case, the arc portions of the instruments loaded in the outer tube 1 are connected to form a perfect circle as a whole.
[0015]
Next, when suction is necessary due to bleeding or the like during intraperitoneal observation, the illumination tube 20 having the angle θ of 270 ° is pulled out. As a result, as shown in FIG. The illumination tube 20 having an angle of 90 ° and the forceps channel tube 30 having an angle θ of 180 ° are combined and inserted. As a result, the distal ends of the observation visual tube 10, the illuminating tube 20, and the forceps channel tube 30 coincide with each other, and the entire cross-sectional shape of the observation tube 10, the illumination tube 20, and the forceps channel tube 30 are tightly bundled together in the respective insertion axis directions. Assembled into the inner lumen 4 of the outer tube 1 in a tightly packed state. Thus, simultaneously with intraperitoneal observation, blood or the like due to bleeding or the like can be sucked through the forceps channel tube 30. At this time, a tube from an existing suction device (not shown) is connected to the connector portion 33 of the forceps channel tube 30, and the bleeding in the abdominal cavity is sucked as necessary.
[0016]
If bleeding continues and the field of view is not improved by this suction alone, the combination shown in FIG. 1 is used. That is, instead of the forceps channel tube 30 having a θ of 180 °, a forceps channel tube 30 having an angle of 90 ° and a coagulator 40 having an angle θ of 90 ° are combined and inserted into the lumen 4 of the outer tube 1. Then, as shown in FIG. 1, the observation tube 10, the illumination tube 20, the forceps channel tube 30, and the coagulator 40 are inserted into the outer tube 4 of the outer tube 1 in a tight manner. Loaded. In this combined state, the observation visual tube 10, the illumination tube 20, the forceps channel tube 30 and the coagulator 40 have their tips aligned, and are tightly bundled together with their insertion axis directions aligned. It is assembled so that the circular arc portions of the surface shape are connected to form a substantially circular shape.
[0017]
Then, if a bleeding part is confirmed by sucking blood by the forceps channel tube 30 and moving the organ as necessary by the coagulation electrode 42 provided at the tip of the coagulator 40, the base of the coagulator 40 is obtained. A cable from an existing high-frequency device (not shown) is connected to the electrode terminal 43 provided on the end side, and the bleeding part is coagulated by the coagulation electrode 42 provided at the tip of the coagulator 40 as necessary. Then stop bleeding.
[0018]
In addition to performing suction through the forceps channel tube 30, treatment may be performed by inserting existing forceps for rapa into the forceps channel tube 30.
On the other hand, when it is not necessary to maintain airtightness in the abdominal cavity as in the case of a lifting type intraperitoneal observation, the observation viewing tube 10 having the angle θ of 90 ° and the illumination tube 20 having the angle θ of 90 ° or 180 ° are combined. It may be inserted into the outer tube 1 in such a state that conventional laparoscopic forceps are inserted from the remaining space to perform the treatment. In this case, all of the bundled instruments loaded in the lumen 4 of the outer tube 1 are not connected to the circular arc portions of the respective cross-sectional shapes, but the entire envelope shape including those circular arc portions is a substantially circular shape. Become.
[0019]
(effect)
A forceps channel cavity or an electrode for hemostasis can be inserted as needed into one cannula 1 punctured into the abdominal cavity, so that a new puncture can be made when another treatment is required. It is not necessary for the patient to be performed, and it is minimally invasive to the patient. Also, the surgeon can quickly perform the observation procedure on the patient with peace of mind.
Furthermore, since the insertion portion of the endoscope is a cylinder, an existing mantle tube can be used, and the operator is not burdened in terms of cost.
[0020]
Instead of the coagulator 40, another treatment tool such as an extruding element may be used. [Second Embodiment]
(Constitution)
The fan-shaped angle forming the cross-sectional shape of the observation visual tube 10, the illumination tube 20, the forceps channel tube 30, and the coagulator 40 in the first embodiment is an angle that is a multiple of 360 / N °. Yes.
[0021]
(Function)
The same as in the first embodiment.
(effect)
Since the fan-shaped angle is every 360 / N °, up to N observation tubes 10, illumination tubes 20, forceps channel tubes 30 and coagulators 40 combined with the first embodiment are simultaneously applied to the outer tube 1. Since it can be inserted, the number of combinations can be increased.
[0022]
[Third Embodiment]
(Constitution)
The observation viewing tube 10 is provided with an image pickup device such as a solid-state image pickup device at a distal end portion thereof, and an electric connector portion that can be connected to a camera control unit (not shown) is provided at a proximal end portion of the insertion portion main body 12. is there.
(Function)
The same as in the first embodiment.
(effect)
Since an image sensor is used for the image transmission system, it is possible to observe sufficiently brightly even if the illumination tubes 20 with a small number of light guide elements (LG) are used.
[0023]
In the above-described embodiment, the cross-sectional shape of the insertion portion main body of each instrument inserted into the lumen of the outer tube 1 is a fan shape that is surrounded by one arc and a radius passing through both ends of the arc. However, the fan-shaped cross-sectional shape of the present invention is not limited to this, and the arc-shaped cross-sectional shape of each instrument is not limited to this. What is necessary is just the shape which connects the other end of each edge | side extended from the both ends of the circular arc at one point. For example, as shown in FIGS. 8A and 8B, the region of each instrument 50 may be such that the intersection of sides passing through both ends of the arc is shifted from the center P of the arc. Each of the bundled instruments 50 has an arc shape in each cross-sectional shape and complements each other, and the entire envelope shape including the arc portion of the entire cross-sectional shape of the bundled instruments is matched to the lumen 4 of the outer tube 1. Any circular shape that fits closely may be used.
[0024]
<Appendix> According to the above description, the following matters are obtained.
(1) An objective optical system provided at the distal end portion, means for receiving an image formed by the objective optical system and observing the image, and a transverse section including the means and the objective optical system. A viewing fan having a substantially fan-shaped insertion portion body;
Connector portion connectable to the light guide cable at the base end portion, a light guide for guiding the light incident from the connector portion to the distal end portion, and the insertion portion main body incorporating the light guide and having a substantially fan-shaped cross section A lighting tube having
A channel tube having an insertion portion main body having a substantially cross-sectional cross section, in which a distal end portion is open and a proximal end portion is embedded in a tube portion communicating with a connector portion,
A treatment instrument having an insertion portion main body made of an insulating member having a substantially fan-shaped cross section, and the distal end portion of the illumination tube, the channel tube, at least one of the treatment tools, and the optical viewing tube. The entire envelope shape including the circular arc of the substantially fan-shaped cross section of each instrument is configured to be substantially circular in a bundled state in which the directions of the insertion shafts are aligned so as to coincide with each other. An endoscope apparatus characterized by being incorporated.
[0025]
(2) An objective optical system provided at the distal end portion, an image transmission means for receiving an image formed by the objective optical system and transmitting the image to the proximal side, an objective optical system and an image transmission means are incorporated. An observation viewing tube having an insertion portion main body having a substantially fan-shaped cross section;
Connector portion connectable to the light guide cable at the base end portion, a light guide for guiding the light incident from the connector portion to the distal end portion, and the insertion portion main body incorporating the light guide and having a substantially fan-shaped cross section A lighting tube having
A channel tube having an insertion portion main body with a transverse section substantially fan-shaped, having a distal end opened and a proximal end built in a tube portion communicating with the connector portion,
An electric device having a substantially fan-shaped cross section that includes a terminal provided at the base end portion that can be connected to a high-frequency power source, a coagulation electrode that is electrically connected to the terminal and provided at the tip end portion, and the terminal and the coagulation electrode. A coagulator having an insertion portion main body made of an electrically insulating member,
In a state where the illumination tube, the channel tube, at least one of the coagulators, and the optical tube are bundled with the direction of the insertion axis aligned so that the distal ends coincide, An endoscope apparatus configured to be substantially circular and to be incorporated into a single outer tube.
[0026]
【The invention's effect】
As described above, according to the present invention, in a state where a plurality of treatment tools such as an observation visual tube, an illumination tube, a forceps channel tube, and a coagulator are selected and bundled, the illumination tube, the channel tube, and the Regardless of the combination of treatment tools, the outer shape of the bundle forms almost the same shape, and the shape is substantially the same as the shape of the inner surface of the outer tube, so that it can be inserted into the outer tube. It can be efficiently used according to the purpose within the mantle tube and can be used for observation, illumination, treatment, etc., and is minimally invasive to the patient. Became possible. Moreover, even if it is desired to thicken the individual insertion portion main body, it is not necessary to thicken the outer tube.
[Brief description of the drawings]
FIG. 1 is an external perspective view of an endoscope apparatus when a plurality of instruments are loaded in an outer tube in the first embodiment.
FIG. 2 is an external perspective view of an observation viewing tube in the first embodiment.
FIG. 3 is an external perspective view of an illumination tube in the first embodiment.
FIG. 4 is an external perspective view of a forceps channel tube in the first embodiment.
FIG. 5 is an external perspective view of a coagulator in the first embodiment.
FIG. 6 is an external perspective view of the endoscope apparatus when a plurality of other instruments are loaded in the outer tube in the first embodiment.
FIG. 7 is an external perspective view of the endoscope apparatus when a plurality of other instruments are loaded in the mantle tube in the first embodiment.
FIG. 8 is an explanatory view showing an arrangement form when a plurality of other instruments are loaded on the outer tube.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Outer tube, 2 ... Insert part main body, 3 ... Hand main body part, 4 ... Lumen, 6 ... Rubber cap 10 ... Observation tube, 20 ... Illumination tube, 30 ... Forceps channel tube, 40 ... Coagulator

Claims (1)

A mantle tube having an insertion portion for insertion into a body cavity of a patient;
An observation optical tube having a built-in objective optical system provided at the distal end portion and means for receiving the image formed by the objective optical system and observing the image ;
A connector part connectable to the light guide cable and the base end part, a light guide for guiding the light incident from the connector part to the tip part, an illumination tube incorporating the light guide,
A channel tube having a built-in tube portion with a distal end opened and a proximal end communicated with a connector portion;
A treatment instrument having an insertion portion main body, and at least one instrument .
The observation viewing tube and the device are bundled by bringing the direction of the insertion axis into contact with each other so that the distal ends coincide with each other, and the cross-sectional shape of the observation viewing tube and the device bundled together with the observation viewing tube is substantially a fan. Regardless of the combination of the observation visual tube, the illumination tube, the channel tube, and the treatment instrument, the outer shape of the cross-sectional shape of the bundle when bundled forms a substantially circular shape so that it can be incorporated into the outer tube. An endoscopic device characterized by that.

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