JP4856109B2 - Surgical instrument and surgical instrument - Google Patents

Description

  The present invention relates to a surgical instrument inserted into a body.

  In general, a surgical operation using an endoscope is widely performed. In this type of surgery, a plurality of holes are made in the patient's body wall, an endoscope is inserted into the body through one of the holes, and a long surgical instrument (treatment tool) is inserted into the body through the other hole. I have to. And while observing the biological tissue in the body with an endoscope, the biological tissue can be treated with a surgical instrument at the same time.

  During this surgical operation, one or more surgical instruments are used simultaneously with the endoscope. Therefore, it is difficult for one surgeon to operate the endoscope and a plurality of surgical instruments at the same time. For example, the surgical instrument that the surgeon has in both hands while operating the endoscope. Operations such as operating are usually performed.

Also, for example, in Patent Document 1, two through holes extending in the axial direction are provided in an insertion tube inserted into the body, an endoscope is inserted into one through hole, and a surgical instrument is inserted into the other through hole. Surgical instruments of different configurations are disclosed.
US Pat. No. 6,221,007

  Generally, in an endoscopic operation, various instruments such as an endoscope, forceps, a clip, a needle holder, and an ultrasonic scalpel are required. In the conventional surgical operation described above, the operator operates the instrument with both hands, and the operation proceeds while holding the instrument as necessary. In order to insert a surgical instrument operated by both hands into the body, it is necessary to make a plurality of holes in the body wall. Further, when an operator's assistant performs the operation of the endoscope, holes for inserting the endoscope into the body must be made in the body wall, and the number of holes increases.

  Furthermore, when an assistant performs an endoscope operation, it is necessary for an operator to give an instruction to the assistant to move the endoscope. Therefore, it is difficult to correctly orient the endoscope in the direction desired by the operator, which increases the operation time and causes the operator to become tired.

  Moreover, in the surgical instrument of patent document 1, the surgical instrument inserted in the through-hole of the insertion tube can only be moved along the axial direction of the through-hole. Due to such constraints, there is a problem that the working range of the surgical instrument is relatively narrow. Furthermore, since only one surgical instrument is combined with the endoscope, it is difficult to perform complicated work by itself.

  The present invention has been made to solve such a problem, and an object thereof is to reduce the number of holes made in the body wall and to make the holes made in the body wall as small as possible in, for example, endoscopic surgery. In addition, it is possible to perform complicated work while minimizing invasiveness, and furthermore, by using a combination of arbitrary surgical instruments (treatment tools) such as forceps and endoscopes, various surgical techniques can be performed and operation time It is an object of the present invention to provide a surgical instrument capable of shortening the length.

In order to solve the above-described problem, a surgical treatment instrument according to the present invention includes a treatment portion at a distal end portion, an elongated insertion portion to be inserted into the body, and the insertion portion provided on the proximal end side of the insertion portion. An operation unit that operates the operation unit, and a driving force transmission mechanism that is provided between the insertion unit and the operation unit and transmits a driving force generated by the operation of the operation unit to the insertion unit. The insertion portion defines a first axis in a longitudinal direction thereof, the operation portion defines a second axis in a direction extending from the driving force transmission mechanism, and the driving force transmission mechanism includes the operation portion. The second shaft is disposed between the insertion portion and the operation portion so as to be disposed at a position deviated from the first shaft of the insertion portion, and the operation portion is inserted into the base with a guide rail. An axis of the guide rail, which is arranged in an offset state with respect to the portion, and is connected to the operation portion so as to be rotatable around the second axis and the insertion portion so as to be rotatable around the first axis. It has a guide block that can move along the direction, and can transmit the driving force around the second axis of the operating portion, which is generated by operating the operating portion, as the driving force around the first axis of the inserting portion. And the driving force in the axial direction of the second axis of the operation unit is And characterized in that it can be transmitted as a driving force in the axial direction of the first axis join the club.

The operation portion and the insertion portion each have a rotation axis around a longitudinal axis, and the driving force transmission mechanism is inserted in conjunction with the rotation when the operation portion is rotated around the rotation axis. It is preferable to rotate the part around its rotation axis.
The driving force transmission mechanism includes a pulley and a belt that move in conjunction with the operation portion and the insertion portion, and when the operation portion is rotated about its rotation axis, the pulley and the belt are moved from the operation portion. It is preferable that the insertion portion is rotated about its rotation axis.

According to this invention, various surgical instruments currently used in endoscopic surgery such as an endoscope, forceps, and clips can be used in combination with a multi-degree-of-freedom forceps having a degree of freedom at the tip. A multi-degree-of-freedom forceps and a surgical instrument used in combination with the forceps can be inserted through a single hole in the body wall. By making the hole to be opened in the body wall small, it is possible to reduce the invasiveness. Moreover, by using it in combination with an arbitrary surgical instrument, various surgical techniques can be performed and the operation time can be shortened.
For example, in endoscopic surgery, it is possible to reduce the number of holes in the body wall and to make the holes in the body wall as small as possible to achieve a complicated operation while achieving minimal invasiveness. By using any surgical instrument such as a mirror in combination, it is possible to provide a surgical instrument capable of performing various surgical techniques and shortening the operation time.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

[First Embodiment]
First, a first embodiment will be described with reference to FIGS.
(overall structure)
First, a schematic configuration of the surgical instrument 1 according to this embodiment will be described with reference to FIGS.
As shown in FIGS. 1 to 4, the surgical instrument 1 includes a mantle tube (insertion means) 2. The length L1 (see FIG. 3) of the outer tube 2 is preferably 350 mm or less. The outer tube 2 is provided with a first port 2a and a second port 2b, and these ports 2a and 2b are inserted from the distal end portion to the proximal end portion of the outer tube 2. That is, the first port 2 a and the second port 2 b are formed along the axial direction of the outer tube 2. For example, a multi-degree-of-freedom forceps (treatment tool) 3 to be described later is inserted into the first port 2a, and a rigid endoscope (endoscope) 5 to be described later is inserted into the second port 2b, for example. It has become. The inner diameter of the second port 2b is set such that a rigid endoscope, forceps, clip, etc. used in normal endoscopic surgery can be inserted.

  As shown in FIGS. 3 and 4, an airtight member 11 is provided at the proximal end portion of the outer tube 2 to prevent fluid in front of the airtight member 11 from flowing backward, or the airtight member. 11 is prevented from flowing forward, so that the airtightness in the first port 2a and the second port 2b is maintained. A bent pipe-shaped guide member 14 made of a rigid material is attached to the base end portion of the first port 2a. Accordingly, the multi-degree-of-freedom forceps 3 to be described later is guided into the first port 2a through the inside of the guide member 14.

(Configuration of rigid endoscope)
By the way, although not shown, a light guide portion and an observation optical system (not shown) are formed inside the distal end portion of the rigid endoscope 5, and the front can be observed from the distal end portion.
On the other hand, as shown in FIG. 1, an optical cable connecting portion 6 that is connected to a light guide portion and can guide illumination light and an observation image guided by an observation optical system are taken at the proximal end portion of the rigid endoscope 5. A connecting portion 8 for connecting the CCD camera 7 is provided. An optical cable 21 is connected to the optical cable connecting portion 6, and is connected to a light source (not shown) via the optical cable 21. An electrical cable 22 is connected to the CCD camera 7 and connected to a camera control unit (not shown) via the electrical cable 22.

(Configuration of multi-degree-of-freedom forceps)
FIG. 5 shows the overall appearance of the multi-degree-of-freedom forceps 3 of this embodiment.
As shown in FIG. 5, the multi-degree-of-freedom forceps 3 according to this embodiment includes an elongated, substantially shaft-like insertion portion 32 and an operation portion holding portion 4 provided at the proximal end portion of the insertion portion 32. It has a main body. And the treatment part 33 is provided in the front-end | tip part of this insertion part 32 (main-body part). A handle unit (operation unit) 41 is provided at the base end of the operation unit holding unit 4 (main body unit).

  The multi-degree-of-freedom forceps 3 has a direction in which the treatment portion 33 coincides with the axial direction of the insertion portion 32 by operating the handle unit 41, as disclosed in, for example, Japanese Patent Application Laid-Open No. 2001-299768. , And a direction deviating from the axial direction so as to be bendable.

In the multi-degree-of-freedom forceps 3 of this embodiment, the insertion portion 32 is formed to be flexible and bendable. As shown in FIG. 6, the insertion portion 32 includes a bending member 51, a blade 52 that covers the bending member 51, and an outer skin 53 that covers the blade 52.
The bending member 51 is formed of a substantially spiral metal material as shown in FIG. 7, and can be arbitrarily bent in a direction perpendicular to the longitudinal axis (direction away from the longitudinal axis). The blade 52 is formed by knitting thin metal wires into a cylindrical shape, and the outer skin 53 is formed by a rigid resin. Since the bending member 51 can be bent, and the blade 52 and the outer skin 53 are each formed flexibly, the insertion portion 32 is flexible and bendable.

  Further, as shown in FIGS. 8A and 8B, the substantially spiral-shaped lumen portion of the bending member 51 is composed of a small-diameter bar, respectively, and a first drive bar 35 constituting an opening / closing link and a rotating shaft. The second drive rod 36 and the third drive rod 37 constituting the moving link are inserted, and these drive rods 35, 36, 37 protrude from the distal end portion of the insertion portion 32. These first to third drive rods 35, 36, and 37 are each formed of an elastic member, and can be independently advanced and retracted in the bendable insertion portion 32 in the axial direction.

Moreover, the treatment part 33 provided in the front-end | tip of the main-body part is comprised as follows.
As shown in FIG. 5, a support portion 38 that protrudes forward and has rigidity is integrally provided at the distal end portion of the insertion portion 32. At the distal end portion of the support portion 38, a jaw 39 having a pair of openable and closable treatment pieces 39a and 39b is opened and closed between the treatment pieces 39a and 39b of the jaw 39, and the entire jaw 39 is inserted into the insertion portion. There is provided a distal end side link mechanism 40 that is connected so as to be able to bend between a direction of 32 axial centers and a direction deviating from the axial direction. The distal end side link mechanism 40 is connected to the proximal end portions of the treatment pieces 39a, 39b and the distal end portions of the first to third drive rods 35, 36, 37, respectively.

  On the other hand, the handle unit 41 at the base end portion of the main body has two forceps handles (first handle 42 and second handle 43) for opening and closing the treatment pieces 39a and 39b of the jaw 39, and these handles 42. , 43 can be opened and closed, and the entire handle unit 41 is connected to be able to bend between the axial direction of the operation portion holding portion 4 and the direction away from the axial direction (operation portion). Attachment portion) 44 is provided.

  The handle unit 41 is provided with a handle support portion 46 in which two handles 42 and 43 are rotatably connected by a pivot 45. In addition, a finger hook ring 42a is provided at the other end of the first handle 42 so that the surgeon can hook a finger other than the thumb during operation. The second handle 43 is provided with a finger ring 43a on which the surgeon hangs his / her thumb during operation.

  One end portions of two handles 42 and 43 are connected to the proximal side link mechanism 44, and proximal ends of the first drive rod 35, the second drive rod 36, and the third drive rod 37 are connected. The parts are connected to each other.

In this embodiment, the handle unit 41 of the multi-degree-of-freedom forceps 3 has two directions (a first bending direction shown in FIGS. 8A and 8B) deviating from the axial direction of the operation portion holding portion 4; In each of the second bending directions shown in FIGS. 9A and 9B, the bending operation can be performed in a swinging state.
In the first bending direction shown in FIGS. 8 (A) and 8 (B), as shown in FIG. 8 (A), the entire handle unit 41 is straightly extended along the axial direction of the operation portion holding portion 4. As shown in FIG. 8B, the entire handle unit 41 is moved from the axial direction of the operation portion holding portion 4 toward the first handle 42 along the plane of the opening / closing operation direction of the two handles 42 and 43, as shown in FIG. Thus, a bending operation can be performed between a bending position bent at a substantially right angle.
In the state where the handle unit 41 is held at the reference position shown in FIG. 8A, the jaw 39 of the treatment portion 33 is held at the reference position straightly extended along the axial direction of the insertion portion 32. It has become. When the handle unit 41 is bent from the reference position shown in FIG. 8 (A) to the bent position shown in FIG. 8 (B), the second and third operations are interlocked with the operation of the handle unit 41. The drive rods 36 and 37 are retracted relative to the insertion portion 32, and the jaw 39 of the treatment portion 33 is inserted in the same direction as the operation direction of the handle unit 41 as indicated by an arrow in FIG. The bending operation is performed at a bending position that is bent at a substantially right angle from the axial direction of 32 axes.
Accordingly, a degree of freedom in one axial direction is ensured in which the jaw 39 of the treatment portion 33 is bent in a direction away from the axial direction of the insertion portion 32.

  9A and 9B show a state in which the multi-degree-of-freedom forceps 3 is rotated by 90 ° in the direction around the axis of the insertion portion 32 from the state shown in FIGS. 8A and 8B. Note that FIG. 9B shows a bent position in which the entire handle unit 41 is rotated, for example, obliquely downward in FIG. 9B.

As shown in FIG. 9 (A), the entire handle unit 41 is extended straight along the axial direction of the operation portion holding portion 4, and the entire handle unit 41 is shown in FIG. 9 (B). The bending operation is possible between the bending position where the rotation operation is performed in the vertical direction.
In a state in which the handle unit 41 is held at the reference position shown in FIG. 9A, the jaw 39 of the treatment portion 33 is held at the reference position straightly extended along the axial direction of the insertion portion 32. It has become. When the handle unit 41 is bent from the reference position shown in FIG. 9 (A) to the bent position shown in FIG. 9 (B), the second and third operations are interlocked with the operation of the handle unit 41. The drive rods 36 and 37 advance and retreat in different directions along the axial direction, and the jaw 39 of the treatment portion 33 is inserted in the same direction as the operation direction of the handle unit 41 as indicated by an arrow in FIG. The bending operation is performed at a bending position bent in an obliquely upward direction deviating from the 32 axial direction.
As a result, the above-described uniaxial direction in which the jaw 39 of the treatment portion 33 is bent in a direction deviating from the axial direction of the insertion portion 32 (a direction different from the first bending direction shown in FIGS. 8A and 8B). Different degrees of freedom in one axial direction are ensured.

  Therefore, in the multi-degree-of-freedom forceps 3 of this embodiment, the jaw 39 of the treatment portion 33 is separated from the axial direction of the insertion portion 32 in two directions (the first bending direction shown in FIGS. 8A and 8B). The degree of freedom in the biaxial direction to be bent in the swinging state is secured in the second bending direction shown in FIGS. 9 (A) and 9 (B).

  When the multi-degree-of-freedom forceps 3 is operated, the first drive rod 35 is moved in the axial direction by opening and closing between the two handles 42 and 43 around the pivot 45. At this time, when the first drive rod 35 is advanced by opening the two handles 42 and 43, the first and second treatment pieces 39a and 39b are opened. Conversely, when the first drive rod 35 is retracted by closing the two handles 42 and 43, the first and second treatment pieces 39a and 39b are closed.

  In addition, when the multi-degree-of-freedom forceps 3 is inserted into the first port 2a of the outer tube 2, the multi-degree-of-freedom forceps 3 corresponding to the portion that comes into contact with the distal end outlet of the first port 2a The distal end stopper pin 12 (see FIGS. 3 and 4) is provided, and the hard distal end surface of the operation portion holding portion 4 is brought into contact with the proximal end portion of the guide member 14. The distal end stopper pin 12 and the proximal end portion of the guide member 14 function as movement restricting means for restricting the movement of the multi-degree-of-freedom forceps 3 relative to the outer tube 2 in the axial direction.

(Operation by multi-degree-of-freedom forceps configuration)
With the above configuration, the multi-degree-of-freedom forceps 3 operates as follows.
As shown in FIG. 10, since the insertion portion 32 can be bent (curved), the handle unit 41 combines the movement of the arrow A direction, the arrow B direction, and their movements with respect to the distal end portion of the insertion portion 32. Can be moved in any direction.

  As shown in FIG. 11, even when the insertion portion 32 is curved, when the handle unit 41 is rotated around the axis of the operation portion holding portion 4 as indicated by the arrow A, the insertion portion 32 is indicated by the arrow B. Thus, it rotates around its axis (corresponding to the movement indicated by arrow A in FIG. 3).

As shown in FIG. 5, when the handle unit 41 is moved in the direction of arrow A, the direction of arrow B, and any direction that combines them, the jaw 39 of the treatment unit 33 corresponds to these operations, and the arrow C, arrow It is moved in any direction that combines the movement indicated by D and those movements.
Further, the opening / closing operation of the handle 42 and the handle 43 causes the first drive rod 35 to move forward and backward, and the jaw 39a and the jaw 39b open / close with respect to each other.

(Operation by the above configuration)
With the configuration as described above, the surgical instrument 1 according to this embodiment can be moved as follows.
First, as shown in FIG. 12, the surgical instrument 1 is inserted into the body through a trocar 10 provided in a hole formed in the body wall H.
The surgical instrument 1 is moved in an arbitrary direction that combines the movements indicated by the arrows A and B around the insertion point O of the trocar 10 opened in the body wall H, and the movements thereof.

As shown in FIG. 3, the distal end stopper pin 12 abuts against the distal end outlet portion of the first port 2 a, and the distal end surface of the operation portion holding portion 4 abuts against the proximal end portion of the guide member 14, thereby providing a high degree of freedom. The movement of the forceps 3 in the axial direction is restricted with respect to the outer tube 2. For this reason, when the handle unit 41 of the multi-degree-of-freedom forceps 3 is held and operated in the front-rear direction (axial direction), the multi-degree-of-freedom forceps 3 is inserted into the first port 2a as shown by an arrow C in FIG. The outer tube 2 is moved along the axial direction of the trocar 10.
Similarly, since the first and second ports 2a and 2b in which the multi-degree-of-freedom forceps 3 and the rigid endoscope 5 are respectively provided are provided at positions eccentric from the axial center of the outer tube 2, the multi-degree-of-freedom By operating the forceps 3 with the handle unit 41 or operating the rigid endoscope 5, the outer tube 2 rotates around its axis as shown by an arrow D in FIG.
The multi-degree-of-freedom forceps 3 inserted through the first port 2a of the outer tube 2 rotates around the axis of the first port 2a as indicated by an arrow A in FIG.
The rigid endoscope 5 inserted into the second port 2b of the outer tube 2 is moved in the axial direction of the second port 2b as shown by an arrow B in FIG. 3, and further, as shown by an arrow C in FIG. Then, it rotates around the axis of the second port 2b.

  The effective length L2 (see FIG. 3) of the rigid endoscope used in the normal endoscopic surgery is about 300 mm. For this reason, in the surgical instrument 1 in this embodiment in which the length L1 of the outer tube 2 is 350 mm or less, the rigid endoscope 5 used in a normal endoscopic operation can be used.

(Clip applier combined with a mantle tube)
FIG. 13 is a diagram in which a clip applier 61 that is normally used in endoscopic surgery is inserted into the second port 2b provided in the outer tube 2 in the system of the surgical instrument 1 of this embodiment. is there. That is, in the above-described embodiment, the rigid endoscope 5 is changed to the clip applier 61.
As shown in FIG. 13, the clip applier 61 includes a treatment portion 62 provided at the distal end portion thereof and an operation portion 63 provided at the proximal end portion. Further, even when the clip applier 61 is inserted into the second port 2 b of the outer tube 2, the airtight member 11 keeps the airtightness.

(Operation when the clip applier and outer tube are combined)
As shown in FIG. 12, the surgical instrument 1 has a movement indicated by arrows A and B around the insertion point O of the trocar 10 disposed on the body wall H, and an arbitrary combination of these movements. Moved in the direction of. This is the same as when combined with the rigid endoscope 5 described above.

  The distal end stopper pin 12 of the multi-degree-of-freedom forceps 3 is abutted against the distal end outlet portion of the first port 2a, and the distal end surface of the operation portion holding portion 4 is abutted against the proximal end portion of the guide member 14. The movement of the forceps 3 in the axial direction is restricted with respect to the outer tube 2. For this reason, by holding the handle unit 41 of the multi-degree-of-freedom forceps 3 and operating it along the axial direction of the trocar 10 in the front-rear direction, as shown by the arrow C in FIG. It is moved in the axial direction. This is the same as when combined with the rigid endoscope 5 described above.

Since the first and second ports 2 a and 2 b are provided at positions eccentric from the axial center of the outer tube 2, an operation with the handle unit 41 of the multi-degree-of-freedom forceps 3 or a clip applier 61 is provided. As shown by the arrow D in FIG. 12, the outer tube 2 rotates around its axis by the operation with the operation unit 63. This is the same as when combined with the rigid endoscope 5 described above.
The multi-degree-of-freedom forceps 3 inserted through the first port 2a of the outer tube 2 rotates around the axis of the first port 2a as indicated by an arrow A in FIG. This is the same as when combined with the rigid endoscope 5 described above.
The clip applier 61 inserted through the second port 2b of the outer tube 2 is moved in the axial direction of the second port 2b as shown by an arrow B in FIG. Thus, it rotates around the axis of the second port 2b.

  Then, after performing the above operation to place the surgical instrument 1 at the desired position at the desired position, the clip applier 61 is operated at the desired position by operating the operation portion 63 of the clip applier 61. Clipping is performed by the treatment section 62 provided at the distal end of the head (see FIG. 14).

  Usually, since the effective length of the surgical instrument used in the endoscopic operation is about 300 mm, the surgical instrument 1 according to this embodiment in which the length L1 of the outer tube 2 is 350 mm or less. Then, not only the clip applier 61 but also a surgical instrument used in normal endoscopic surgery, such as an electric knife, an ultrasonic coagulation / cutting device, etc., can be inserted into the body through the second port 2b and used. is there.

(effect)
As described above, according to this embodiment, the following can be said.
As shown by arrows A and B in FIG. 10, the insertion portion 32 of the multi-degree-of-freedom forceps 3 can be bent. As a result, the multi-degree-of-freedom forceps 3 can be inserted into the first port 2a through the bent guide member 14, and the handle unit (operation unit) 41 of the multi-degree-of-freedom forceps 3 can be connected to the first port 2a. It is arranged at a position off the extension shaft. Therefore, for example, as shown in FIG. 4, in order to direct the treatment portion 33 of the multi-degree-of-freedom forceps 3 in a desired direction, the handle unit 41 is bent in the direction of the surgical instrument inserted into the second port 2b. Even at times, interference between the handle unit 41 and a medical instrument (such as the rigid endoscope 5 or the clip applier 61) can be prevented. For this reason, the medical instrument inserted into the second port 2b can be freely operated, and the multi-degree-of-freedom forceps 3 can also be freely operated. In addition, since the treatment portion 33 of the multi-degree-of-freedom forceps 3 can be bent in a direction deviating from the axial direction of the distal end portion of the insertion portion 32, the degree of freedom is increased and more complicated work can be performed.

  Further, since the interference between the instruments arranged in the first and second ports 2a, 2b is prevented, the first port 2a provided in the outer tube 2 while maintaining the degree of freedom of the multi-degree-of-freedom forceps 3. And the second port 2b can be made as close as possible, so that the outer diameter of the outer tube 2 can be reduced. Therefore, since the surgical instrument 1 in this embodiment is used, the hole formed in the body wall H can also be reduced. Furthermore, two multi-degree-of-freedom forceps 3 and another surgical instrument can be inserted from one hole formed in the body wall H, the number of holes opened in the body wall H can be reduced, and the patient is invaded. Can be suppressed.

  Since the length L1 of the outer tube 2 is set to 350 mm or less, not only the rigid endoscope 5 and the clip applier 61 but also a surgical instrument having an effective length of about 300 mm used in normal endoscopic surgery. It can be used through the second port 2b, and various procedures can be performed by linking those surgical instruments with the multi-degree-of-freedom forceps 3.

  The surgical endoscope 5 can be used as a surgical instrument to be inserted into the second port 2b. In this case, the surgeon can be compared with the operator's assistant having the rigid endoscope 5 as in a normal endoscopic operation. There is no need to change the direction of the rigid endoscope 5 by giving an instruction, and the rigid endoscope 5 can be directed in a desired direction as desired by the operator. Therefore, in combination with the use of various surgical instruments, the operation is simplified and the operation time can be shortened.

  In this embodiment, the multi-degree-of-freedom forceps 3 is inserted into the first port 2a through a bent pipe-shaped guide member 14 formed of a rigid material. It is not essential. As a modification of this embodiment, an example in which the guide member 14 is omitted is shown in FIG. In the case of this modification, a rear end stopper pin 13 is provided at a position corresponding to the vicinity of the rear end outlet of the first port 2a of the insertion portion 32 of the multi-degree-of-freedom forceps 3, and the front end of the first port 2a Together with the tip stopper pin 12 provided at the outlet portion, a movement restricting means for restricting the axial movement of the multi-degree-of-freedom forceps 3 relative to the outer tube 2 is configured.

  As shown in FIG. 15, in this modified example, the guide member 14 is removed, so that the handle unit (operation unit) can be used even when the multi-degree-of-freedom forceps 3 is inserted into the first port 2a of the outer tube 2. As shown in FIG. 10, 41 can be moved with respect to the distal end portion of the insertion portion 32 in the movements indicated by the arrows A and B, and in any direction that combines these movements. As a result, the degree of freedom of the position of the handle unit 41 of the multi-degree-of-freedom forceps 3 inserted into the first port 2a increases, and the position of the operator and the position of the surgical instrument inserted into the second port 2b. According to the relationship, it is possible to obtain the effect that the position of the multi-degree-of-freedom forceps 3 can be brought to an appropriate position.

[Second Embodiment]
Next, a second embodiment will be described with reference to FIGS. This embodiment is a modification of the first embodiment. The same members as those used in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

(overall structure)
FIG. 16 shows a schematic configuration of the entire system of the surgical instrument 71 of this embodiment. As shown in FIG. 16, the surgical instrument 71 is provided with one operation unit 72 and a support portion 73 that supports the operation unit 72.

  The support portion 73 is provided with a base 74 that is fixed to a fixing portion (not shown) such as a surgical bed or an operating room floor. A support shaft 75 is erected on the base 74 in a substantially vertical direction. The support shaft 75 is rotatable with respect to the base 74 in the direction around the support shaft 75. A substantially parallelogram-shaped link mechanism 76 is disposed on the upper end of the support shaft 75. In this link mechanism portion 76, two horizontal link arms 76a and 76b and two vertical link arms 76c and 76d are arranged in parallel, respectively, and these four link arms 76a, 76b, 76c and 76d are arranged. A parallelogram link mechanism 76 is formed. Further, the distal end portion of the lateral link arm 76a arranged at the upper side position of the parallelogram shape extends in the lateral direction (the axial direction of the lateral link arm 76a), and an operation unit is provided at the extended end portion of the lateral link arm 76a. An attachment member 77 for attaching 72 to an outer tube 82 to be described later is disposed.

  On the other hand, a first weight 78 for balancing is provided at the rear end portion of the horizontal link arm 76b disposed at the lower side position of the parallelogram shape of the link mechanism portion 76, and a lower end portion of the parallel link vertical link arm 76d. A second weight 79 for balancing is provided. The first weight 78 for balancing and the second weight 79 for balancing are set so as to balance the operation unit 72 attached to the attachment member 77. In other words, an excessive force is applied to the support shaft 75 and the link mechanism portion 76 erected on the base 74 to prevent the balance from being lost.

  Further, a second adjustment that adjusts the movement of the support shaft 75 with respect to the base 74 is provided on the support portion 73 by a first adjustment knob 80 at a joint portion at the intersection of the vertical link arm 76 d and the horizontal link arm 76 b. Knobs 81 are respectively attached. The ease of movement (weight and hardness) when moving the link mechanism 76 (changing the parallelogram shape) is adjusted by the tightening amount of the first adjustment knob 80 and the second adjustment knob 81. It has come to be.

  The operation unit 72 is provided with an outer tube (insertion means) 82 to be inserted into the body. As shown in FIG. 17, the mantle tube 82 is inserted into a trocar 83 previously inserted into the body wall H of the patient, and is inserted into the body through the trocar 83.

  Then, as shown in FIG. 17, the outer tube 82 is moved by an arrow A in FIG. 17 around the insertion point O of the trocar 83 on the body wall H of the patient by the movement of the link mechanism portion 76 of the support portion 73. The first swing direction shown, the second swing direction orthogonal to the first swing direction as shown by arrow B in FIG. 17, and the arrow C in FIG. The trocar 83 is supported by the mounting member 77 so as to be movable in the direction along the axial direction.

  18 is a front view of the outer tube 82 viewed from the distal end side, FIG. 19 is a sectional view taken along the line 18A-18A in FIG. 18, and FIG. 20 is a sectional view taken along the line 18B-18B in FIG. It is shown. As shown in FIGS. 18 to 20, the outer tube 82 is formed with a plurality of ports 82 a to 82 g that are substantially parallel to the axial direction, in this embodiment, seven ports 82 a to 82 g.

  Here, a camera holding shaft 84a (see FIG. 19) is inserted into a port 82a disposed at the axial center position of the outer tube 82, and a CCD camera 84 is provided as an observation means at the tip of the camera holding shaft 84a. It is attached. Further, the ports 82b and 82c (see FIG. 18) disposed on both sides of the port 82a at the axial center position include, for example, a first multi-type having the same configuration as the multi-degree-of-freedom forceps 3 in the first embodiment. A freedom degree forceps (treatment tool) 85 and a second multi-degree-of-freedom forceps (treatment tool) 86 are respectively inserted. That is, one port 82b is formed as a forceps guide hole for the first multi-degree-of-freedom forceps 85, and the other port 82c is formed as a forceps guide hole for the second multi-degree-of-freedom forceps 86. Since the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 have the same configuration as the multi-degree-of-freedom forceps 3 described in the first embodiment, the first and second The names of the parts of the multi-degree-of-freedom forceps 85 and 86 will be described using the same reference numerals as those used in the first embodiment.

  The forceps guide holes (ports 82b and 82c) regulate movements other than axial movement and rotation around the first and second multi-degree-of-freedom forceps 85 and 86. Movements other than axial movement of the multi-degree-of-freedom forceps 85 and 86 and rotation around each axis are transmitted as movement of the entire outer tube 82. That is, the forceps guide holes 82b and 82c function as interlocking means for interlocking the first and second multi-degree-of-freedom forceps 85 and 86 with the outer tube 82.

  In FIG. 18, a light guide 87 formed of a light guiding optical fiber is inserted into a port 82d provided on the upper side of the port 82a at the axial center position. Further, in FIG. 18, for example, a scissors forceps 88 is inserted as a surgical instrument into a port 82 e provided below the port 82 a at the axial center position. The ports 82f and 82g are provided on the left and right sides of the port 82e in FIG. 18, and are used as treatment instrument ports into which other surgical instruments are inserted. As shown in FIG. 19, two handles 90 are attached to the proximal end portion of the outer tube 82. Further, an airtight member 91 is disposed on the inner peripheral surface side (ports 82a to 82g) of the base end portion of the outer tube 82.

  On the other hand, as shown in FIG. 19, the flange portion 89 for attachment to the support portion 73 described above is formed on the outer peripheral surface of the proximal end portion of the outer tube 82. Further, as shown in FIG. 20, the attachment member 77 of the support portion 73 is provided with a flange receiver 92 having a flange insertion groove 92a on the inner peripheral surface. As shown in FIGS. 19 and 20, the flange portion 89 of the outer tube 82 is inserted into the flange insertion groove 92a. The outer tube 82 is supported so as to be rotatable about the axis along the flange insertion groove 92 a of the flange receiver 92 in the mounting member 77 of the support portion 73.

  Furthermore, as shown in FIG. 21, an attachment member 77 of the support portion 73 is fixed to the outer peripheral surface of the flange receiver 92. As shown in FIG. 20, a scope holding base 93A is provided on the outer end surface of the flange receiver 92. The scope holding base 93A is provided with a scope holding arm 93 protruding from the outer end surface of the flange receiver 92. One end of a first scope holding member 94 a is connected to the distal end of the scope holding arm 93. A substantially L-shaped second scope holding member 94b (see FIG. 21) is disposed opposite to the other end of the first scope holding member 94a. As shown in FIG. 21, a camera holding shaft 84a is sandwiched between the first scope holding member 94a and the second scope holding member 94b. A scope fixing screw 95 is attached between the first scope holding member 94a and the second scope holding member 94b. Thus, even when the outer tube 82 is rotated in the axial direction along the flange insertion groove 92a of the flange receiver 92 in the mounting member 77 of the support portion 73, the camera holding shaft 84a is held in a fixed state. Yes.

  In addition, as shown in FIG. 16, the optical cable connection part 96 and the electrical contact part 97 are provided in the base end part of the camera holding shaft 84a. A light source device (not shown) is connected to the optical cable connecting portion 96 via an optical cable 98. Further, a camera control unit (not shown) is connected to the electrical contact portion 97 via an electrical cable 99.

  Further, as shown in FIGS. 19 and 22, the outer peripheral surface of the distal end portion of the insertion portion 32 of the second multi-degree-of-freedom forceps 86 hits the peripheral portion of the distal end portion of the forceps guide hole (port 82 c) of the outer tube 82. A tip stopper pin 102 that is engaged in a state is projected. As shown in FIG. 19, the rear end portion of the forceps guide hole (port 82 c) of the outer tube 82 is provided on the outer peripheral surface of the insertion portion 32 of the second multi-degree-of-freedom forceps 86 (slightly distal to the bent portion). A rear end stopper pin 103 that is engaged in a state of abutting on the peripheral portion is provided. Here, the distance between the front end stopper pin 102 and the rear end stopper pin 103 is set to be larger than the length between both ends of the forceps guide hole (port 82 c) of the outer tube 82. The second multi-degree-of-freedom forceps 86 includes a distal end engagement position where the distal end stopper pin 102 is engaged with the distal end peripheral portion of the forceps guide hole (port 82c) of the outer tube 82 and a rear end stopper. The pin 103 is supported so as to be movable in the axial direction in a range between the pin 103 and the rear end engaging position engaged with the forceps guide hole (port 82c) in a state where the pin 103 hits the peripheral portion of the rear end. Since both the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 are inserted into the forceps guide holes (ports 82b and 82c) of the outer tube 82, as indicated by an arrow A in FIG. The first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 are supported so as to be independently movable in the axial direction with respect to the outer tube 82, and further, as shown by an arrow B in FIG. The first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 are supported so as to be rotatable around their axes.

(Function)
Next, the operation of this embodiment according to the configuration of the surgical instrument 71 will be described.
When the surgical instrument 71 of this embodiment is used, the operation unit 72 is attached to the attachment member 77 of the link mechanism portion 76 of the support portion 73 as shown in FIG. A CCD camera 84 is mounted in a port 82a (camera guide hole) provided at the axial center of the outer tube 82 of the operation unit 72. In this state, the operation unit 72 is inserted into the trocar 83 previously inserted into the body wall H of the patient, and inserted into the body through the trocar 83.

  Subsequently, the first multi-degree-of-freedom forceps 85 is inserted into the port 82b of the outer tube 82, and the second multi-degree-of-freedom forceps 86 is inserted into the port 82c. Further, a surgical instrument such as a scissors forceps 88 is inserted into the port 82e (guide hole) as necessary. In this state, when the operator grasps and operates the handle unit (operation unit) 41 of the first and second multi-degree-of-freedom forceps 85 and 86, the entire operation unit 72 is freely moved as follows.

  When the operator holds the handle units 41 provided on the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 and moves the handle units 41 up and down, left and right, the surgical instrument 71 is As shown in FIG. 17, the first swing direction indicated by an arrow A in FIG. 17 and the first swing direction indicated by an arrow B in FIG. 17 centering on the insertion point O of the trocar 83 on the body wall H of the patient. The treatment can be performed by moving the head in a second swinging direction orthogonal to the one swinging direction and any other swinging direction.

  Further, until the distal end stopper pin 102 protruding from the outer peripheral surface of the distal end portion of the insertion portion 32 of the second multi-degree-of-freedom forceps 86 hits the peripheral portion of the distal end portion of the forceps guide hole (port 82c) of the outer tube 82. By pulling the second multi-degree-of-freedom forceps 86 toward the front side and further pulling the second multi-degree-of-freedom forceps 86 toward the proximal side in this state, the outer tube 82 together with the second multi-degree-of-freedom forceps 86 is shown in FIG. Is moved in the direction indicated by arrow C (on the hand side). Similarly, the rear end stopper pin 103 protruding from the outer peripheral surface of the intermediate portion of the insertion portion 32 of the second multi-degree-of-freedom forceps 86 hits the peripheral portion of the rear end portion of the forceps guide hole (port 82c) of the outer tube 82. When the second multi-degree-of-freedom forceps 86 is pushed to the state, and the second multi-degree-of-freedom forceps 86 is further pushed in that state, the outer tube 82 together with the second multi-degree-of-freedom forceps 86 is indicated by an arrow C in FIG. Move in the direction shown (direction away from the surgeon). For this reason, the CCD camera 84 attached to the outer tube 82 of the operation unit 72, the first multi-degree-of-freedom forceps 85, and the second multi-degree-of-freedom forceps 86 are simultaneously moved in the same direction. The same movement as these can also be performed by the operator holding the handle 90 and operating the handle 90.

In the foregoing, the movement in which the outer tube 82, the CCD camera 84, and the multi-degree-of-freedom forceps 85 and 86 are interlocked has been described. Next, independent movements of the CCD camera 84, the multi-degree-of-freedom forceps 85 and 86, and the scissors forceps 88 will be described.
FIGS. 23A, 23B, and 23C are explanatory views for explaining a turning operation in which the entire operation unit 72 is turned between the flange receivers 92 of the link mechanism portion 76 of the support portion 73. FIG. Here, FIG. 23A shows a state in which the entire operation unit 72 is held between the flange receivers 92 of the link mechanism portion 76 of the support portion 73 at a fixed position where the rotation angle in the direction around the axis is 0 °. In this state, the operator holds the handle unit 41 of the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 and rotates the entire operation unit 72 in the clockwise direction or the counterclockwise direction.

  FIG. 23B shows a state in which the entire operation unit 72 is driven to rotate about the axis counterclockwise from a fixed position as indicated by an arrow A in FIG. 23B, and FIG. As shown by an arrow B in FIG. 23C, the entire operation unit 72 is shown as being driven to rotate about the axis in the clockwise direction from the fixed position.

  At this time, the CCD camera 84 is held in a non-rotated state by the scope holding base 93A (see FIG. 20). For this reason, even when the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 are simultaneously rotated in the same direction by the rotation of the operation unit 72, the observation field of view of the CCD camera 84 is fixed. It is held as it is. This movement is the same when the surgeon holds the handle 90 and operates it.

  In addition, the CCD camera 84 mounted in the outer tube 82, the first multi-degree-of-freedom forceps 85, and the second multi-degree-of-freedom forceps 86 can be moved independently as follows. The CCD camera 84 can be rotated and fixed around its axis in the port 82a of the outer tube 82 by a fixing screw 95 shown in FIG. Further, the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 move independently along the axial direction with respect to the outer tube 82 as indicated by an arrow A in FIG.

  Further, the insertion portion 32 of the first multi-degree-of-freedom forceps 85 is bent as indicated by arrows A and B in FIG. Similarly, the insertion part 32 of the second multi-degree-of-freedom forceps 86 is bent. Further, the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 rotate around the axis of the bent insertion portion as indicated by arrows A and B in FIG. By this operation, the multi-degree-of-freedom forceps 85 and 86 rotate in the direction around the axis in the port 82b of the outer tube 82 as indicated by an arrow B in FIG. As a result, the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 rotate independently about the axis.

  Further, the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 open and close the first handle 42 and the second handle 43 of the handle unit 41, respectively, so that the treatment piece 39a of the jaw 39 is operated. , 39b are opened and closed.

  Furthermore, from the reference position where the handle unit 41 of the first multi-degree-of-freedom forceps 85 is straightly extended with respect to the axial direction of the operation unit holding unit 4 shown in FIG. 8A, the first unit shown in FIG. When the bending operation is performed in the bending direction 1, the jaw 39 of the treatment portion 33 moves in accordance with the operation direction of the handle unit 41 as shown by an arrow in FIG. In the same direction, it is bent at a bending position bent substantially at a right angle from the axial direction of the insertion portion 32.

  Further, from the reference position where the handle unit 41 of the first multi-degree-of-freedom forceps 85 is straightly extended with respect to the axial direction of the operation unit holding unit 4 shown in FIG. 9A, the first unit shown in FIG. When the bending operation is performed in the bending direction 2, the jaw 39 of the treatment section 33 is interlocked with the operation of the handle unit 41 as shown by the arrow in FIG. It is bent at a bending position bent in a diagonally upward direction away from the axial direction of the insertion portion 32 in the direction. Note that the second multi-degree-of-freedom forceps 86 is operated in the same manner as the first multi-degree-of-freedom forceps 85. Even when the first and second multi-degree-of-freedom forceps 85 and 86 perform these movements, the outer tube 82 is held by the support portion 73 and thus is prevented from moving.

Further, as shown in FIG. 20, the scissors forceps 88 inserted into the port 82e of the outer tube 82 is also operated along the port 82e as shown by an arrow A in FIG. It moves along the axial direction and rotates around that axis as shown by arrow B. In addition, the treatment unit 100 of the scissors forceps 88 is opened and closed by operating the operation unit 101.
The above is the independent movement of the CCD camera 84, the multi-degree-of-freedom forceps 85 and 86, and the scissors forceps 88.

  Further, in the surgical instrument 71 of this embodiment, the movement of the operation unit 72 described above and the movements of the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 are combined to further increase the variety. The first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 are each operated. For example, FIG. 24 shows that the jaw 39 of the treatment section 33 in the first multi-degree-of-freedom forceps 85 is bent in a swinging state, and only the first multi-degree-of-freedom forceps 85 is pivoted while the operation unit 72 is not rotating. The state rotated in the rotation direction is shown. In this state, the rotation range M1 of the tip of the jaw 39 of the treatment portion 33 in the first multi-degree-of-freedom forceps 85 is held in a relatively small range.

  25, as in FIG. 24, the entire operation unit 72 in the surgical instrument 71 is rotated in a state where the jaw 39 of the treatment portion 33 in the first multi-degree-of-freedom forceps 85 is bent in a swinging state. In addition, a state in which the first multi-degree-of-freedom forceps 85 are simultaneously rotated around the axis is shown. In this state, the rotation range M2 of the tip of the jaw 39 of the treatment section 33 in the first multi-degree-of-freedom forceps 85 is changed to a range larger than the rotation range M1 of FIG.

  FIG. 26 shows an example in which a flexible electric knife 104 is used as a surgical instrument to be inserted into the port 82e in the surgical instrument 71 of this embodiment. Here, the second multi-degree-of-freedom forceps 86 grips a part of the treatment target tissue H1 such as the internal organs of the patient. In this state, the electric knife 104 is inserted into the body through the treatment instrument port 82e of the outer tube 82. Thereafter, the electric knife 104 is grasped by the first multi-degree-of-freedom forceps 85, guided to the treatment target tissue H1, and the treatment target tissue H1 is treated by the electric knife 104.

(effect)
As described above, according to this embodiment, the following can be said.
In the surgical instrument 71 of this embodiment, the treatment portion 33 provided at the distal end portion of the first multi-degree-of-freedom forceps 85 inserted into one port 82b of the outer tube 82 is disposed in the axial direction of the insertion portion 32. By bending in a swinging direction away from the direction, the degree of freedom when moving the first multi-degree-of-freedom forceps 85 can be increased, and the operability of the first multi-degree-of-freedom forceps 85 can be enhanced. The same applies to the second multi-degree-of-freedom forceps 86.

  The outer tube 82 is provided with three ports 82e, 82f, and 82g used as treatment tool ports into which other treatment tools of the first and second multi-degree-of-freedom forceps 85 and 86 are inserted. Therefore, the operation (treatment) can be performed by inserting a surgical instrument such as that used in a normal endoscopic surgical operation using the scissors forceps 88 as an example.

  In this embodiment, a CCD camera 84 is attached to the distal end portion of the outer tube 82 as an observation device, and an optical cable 98 connected to the optical cable connection unit 96 and an electrical connection unit 97 are attached to the proximal end portion of the outer tube 2. There is only an electric cable 99 connected to, and a space for the operation part of the surgical instrument is secured. In addition, since the insertion portions 32 of the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 can be bent in any direction, the handles of the multi-degree-of-freedom forceps 85, 86 are provided. The unit 41 can be brought to a position that avoids interference between the surgical instrument inserted into the ports 82e, 82f, and 82g, and the operation of the surgical instrument and the first and second multi-degree-of-freedom forceps 85 and 86 can be performed. While securing the degree of freedom, the intervals between the ports can be narrowed. For this reason, the outer diameter of the outer tube 82 can be reduced. That is, the hole opened in the body wall H can be made small.

  The surgical instrument inserted into the ports 82e, 82f, and 82g may be a flexible treatment instrument (electric knife 104) as shown in FIG. 26. In this case, the first multi-degree-of-freedom forceps 85 or the second multi-purpose forceps 85 may be used. A flexible treatment tool can be grasped with the freedom forceps 86 to perform treatment.

As a result, in this embodiment, it is possible to obtain very high operability while achieving minimal invasiveness.
In the surgical instrument 71 of this embodiment, the CCD camera 84, the first multi-degree-of-freedom forceps 85, and the second multi-degree-of-freedom forceps 86 are inserted into the port of the outer tube 82 of one operation unit 72. Therefore, one operator can perform operations such as moving them simultaneously. Therefore, it is not necessary for the surgeon to give instructions to the surgeon's assistant who has a rigid endoscope as an observation device, and to change the orientation of the rigid endoscope, as in normal endoscopic surgery. Therefore, the operation time can be shortened. Furthermore, the positional relationship between the CCD camera 84 and the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 may change even when movement such as changing the direction of the endoscope (rigid endoscope) is performed. Therefore, for example, it is possible to perform the work in the abdominal cavity as if the operator is directly performing with his / her hand while directly viewing with his own eyes. Therefore, the number of holes in the patient's body wall H can be reduced, the operability of the treatment tool can be increased, and the operability of the surgical operation can be improved.

  Further, the second multi-degree-of-freedom forceps 86 includes a position where the distal end stopper pin 102 abuts on a peripheral portion of the distal end portion of the forceps guide hole (port 82c) of the outer tube 82, and a rear end stopper pin 103 of the forceps guide of the outer tube 82. The hole 82c is supported so as to be movable in the axial direction within a range of a position where it abuts against the peripheral portion of the rear end portion of the hole 82c. The second multi-degree-of-freedom forceps 86 is pulled to the hand side until the tip stopper pin 102 abuts against the peripheral edge of the forceps guide hole 82c of the outer tube 82. From this state, the second multi-degree-of-freedom forceps 86 is further hand-held. The second multi-degree-of-freedom forceps 86 is pushed to a position where the rear end stopper pin 103 abuts on the peripheral edge portion of the rear end portion of the forceps guide hole 82c of the outer tube 82, and the second multi-degree-of-freedom forceps 86 is further pushed from this state. By pushing the forceps 86 with a degree of freedom, the operation unit 72 can be moved in the axial direction without releasing the hand from the forceps.

  In addition to the movement along the axial direction of the trocar 83 of the operation unit 72 by the operation of the first and second multi-degree-of-freedom forceps 85 and 86, the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 By the operation, as shown in FIG. 17, the operation unit 72 is centered on the insertion point O of the trocar 83 on the patient's body wall H, and the first swing direction indicated by the arrow A in FIG. It is possible to move in a second swing direction as indicated by an arrow B inside and any other swing direction, and the surgeon can move the first multi-degree-of-freedom forceps 85 and the second The operation unit 72 can be operated without releasing the hand from the multi-degree-of-freedom forceps 86. Thereby, the workability | operativity of a surgical operation can further be improved.

  Therefore, in the surgical instrument 71 of this embodiment, the number of holes to be formed in the body wall H is reduced, and the holes are made small, thereby minimizing the invasiveness, and the operation of the surgical instrument by fewer operators. Can be done. Furthermore, by increasing the degree of freedom of the first multi-degree-of-freedom forceps 85 and the second multi-degree-of-freedom forceps 86 and improving workability, it is possible to perform a complicated and advanced surgical operation and The operation time can be shortened.

[Third Embodiment]
The third embodiment will be described with reference to FIGS. 27 and 28. FIG. This embodiment is a modification of the second embodiment, and the same members are denoted by the same reference numerals and detailed description thereof is omitted. The overall configuration diagram will be omitted since it is almost the same as FIG.

(Constitution)
In this embodiment, the first and second multi-degree-of-freedom forceps 85 and 86 in the second embodiment are replaced with a multi-degree-of-freedom forceps 111 shown in FIG. In the multi-degree-of-freedom forceps 111 in this embodiment, the insertion portion 32 is formed of a pipe having rigidity such as stainless steel, and the insertion portion 32 is bent halfway.

(Function)
Thus, when the multi-degree-of-freedom forceps 111 is inserted into the port 82b and the port 82c of the outer tube 82 in the second embodiment, the surgical instrument inserted into the port 82e, the port 82f, and the port 82g is used. Interference is prevented. 28, when the handle unit 41 of the multi-degree-of-freedom forceps 111 is largely turned along the axis of the distal end portion of the insertion portion 32, the distal end portion of the insertion portion 32 of the multi-degree-of-freedom forceps 111 is shown. As shown by arrow B, it rotates about its axis.

(effect)
Due to the above operation, the same effects as those of the second embodiment can be obtained in this embodiment. Furthermore, in this embodiment, the multi-degree-of-freedom forceps 111 can be configured with a simple mechanism. Further, when the entire outer tube 82 is moved by holding the handle unit 41 of the multi-degree-of-freedom forceps 111, since the multi-degree-of-freedom forceps 111 has rigidity, an effect of facilitating the operation can be obtained.

[Fourth Embodiment]
Next, a fourth embodiment will be described with reference to FIGS. This embodiment is a modification of the second embodiment, and the same members are denoted by the same reference numerals and detailed description thereof is omitted.

(Constitution)
FIG. 29 shows a schematic view of the surgical instrument 121 of this embodiment. The surgical instrument 121 is inserted into a trocar 123 previously inserted into the body wall H of the patient, and an outer tube (insertion means) 122 is inserted through the trocar 123.

  30 shows a distal end surface of the outer tube 122, and FIG. 31 is a sectional view taken along the line 30A-30A in FIG. As shown in FIGS. 30 and 31, the outer tube 122 is formed with a plurality of ports 122a to 122g that are substantially parallel to the axial direction, in this embodiment, seven ports 122a to 122g.

  Here, as shown in FIGS. 30 and 31, a camera holding shaft 124a is inserted into the channel port 122a arranged at the axial center position of the outer tube 122, and an observation portion is provided at the tip of the camera holding shaft 124a. A CCD camera 124 as an apparatus is provided. In FIG. 30, a light guide 127 formed of a light guiding optical fiber is inserted into a port 122d provided on the right side of the port 122a at the axial center position.

  Furthermore, a first multi-degree-of-freedom forceps (treatment tool) 125 and a second multi-degree-of-freedom forceps (treatment tool) 126 described later are respectively provided on ports 122b and 122c provided on both upper and lower sides of the port 122a at the axial center position. It is supposed to be inserted. One port 122b is formed as a forceps guide hole for the first multi-degree-of-freedom forceps 125, and the other port 122c is formed as a forceps guide hole for the second multi-degree-of-freedom forceps 126. The forceps guide holes (ports 122b and 122c) restrict movements other than axial movement and rotation around the first multi-degree-of-freedom forceps 125 and second multi-degree-of-freedom forceps 126. Movements other than the axial movement and rotation of the second multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 are transmitted as movements of the entire outer tube 122. That is, the forceps guide holes (ports 122 b and 122 c) function as interlocking means for interlocking the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 and the outer tube 122.

  Further, in FIG. 30, three ports 122e, 122f, 122g provided on the left side of the axial center port 122a are used as treatment instrument ports into which other surgical instruments are inserted. Hereinafter, in this embodiment, description will be made assuming that the scissors forceps 128 is inserted into the port 122e.

  As shown in FIG. 29, the outer tube 122 having the ports 122 a to 122 g is inserted into the body through the trocar 123. As shown in FIG. 31, a sliding member 137 having a large frictional resistance against the outer tube 122 and also serving as an airtight holding function is disposed on the inner periphery of the trocar 123 so as to restrict the movement of the outer tube 122. It has become. In addition, an airtight member 136 is provided in the base end side opening of the ports 122a to 122g provided in the outer tube 122 so that the airtightness is maintained. Furthermore, a forceps guide member 129 configured integrally with the outer tube 122 is provided at the proximal end portion of the outer tube 122.

  The first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 are provided with a driving force transmission mechanism 135 described later. The driving force transmission mechanism 135 is guided by the guide 134 provided on the forceps guide member 129, so that the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 are independently pivoted. It is held so as to be movable in the direction. Further, a distal end stopper pin 138 engaged with the distal end portion outer peripheral surface of the insertion portion 32 (described later) of the second multi-degree-of-freedom forceps 126 in a state of abutting against the distal end peripheral portion of the forceps guide hole 122 c of the outer tube 122. Projected.

  Further, as shown in FIG. 29, an optical cable connecting portion 130 and an electrical connecting portion 131 are provided on the upper surface of the forceps guide member 129. The optical cable connection unit 130 is connected to a light source device (not shown) via the optical cable 132, and supplies light from the optical cable 132 and the optical cable connection unit 130 to the light guide 127. Furthermore, the electrical connection unit 131 is connected to the camera control unit (CCU) via the electrical cable 133, and the image of the CCD camera 124 is transmitted to the CCU via the electrical connection unit 131 and the electrical cable 133. ing.

(Configuration of first multi-degree-of-freedom forceps and second multi-degree-of-freedom forceps)
Next, the configurations of the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 will be described with reference to FIGS. 32 (A), (B), FIGS. 33 (A), (B), (C), and FIG. A description will be given using (B). In the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126, portions having the same configuration as the multi-degree-of-freedom forceps 3 in the first embodiment are described in the first embodiment. The same reference numerals as those of the embodiment are attached and the description thereof is omitted. Since the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 have substantially the same configuration, only the configuration of the first multi-degree-of-freedom forceps 125 will be described here. The description of the multi-degree-of-freedom forceps 126 is omitted.

FIG. 32A shows a plan view of the first multi-degree-of-freedom forceps 125 in this embodiment, and FIG. 32B shows a side view thereof.
As shown in FIGS. 32A and 32B, the first multi-degree-of-freedom forceps 125 includes an insertion portion 32, a driving force transmission mechanism portion 135 connected to the proximal end portion of the insertion portion 32, and the driving force. The power transmission mechanism unit 135 includes a main body unit that includes an operation unit holding unit 141 having a distal end connected to the force transmission mechanism unit 135. The distal end portion of the insertion portion 32 (main body portion) includes a support portion 38, a distal end side link mechanism 40 provided at the distal end portion of the support portion 38, and a treatment piece 39 interlocked with the distal end side link mechanism 40. A treatment section 33 is provided. In addition, a handle unit 41 including a hand side link mechanism (operation unit mounting portion) 44 is held at a proximal end portion of the operation unit holding unit 141 (main body unit).

Here, the configuration of the treatment section 33 and the handle unit 41 is substantially the same as that of the multi-degree-of-freedom forceps 3 in the first embodiment. Therefore, the details of these configurations and operations are omitted, and here, the configuration of the main body described above will be mainly described.
As shown in FIGS. 32A and 32B, the driving force transmission mechanism 135 is provided with a base 142. A first bearing member 143 that rotatably supports the operation portion holding portion 141 is attached to the base 142. Then, as shown in FIG. 32A, a first pulley 144 is attached to the distal end portion of the operation portion holding portion 141.

  The base 142 is provided with a second bearing member 145 and a third bearing member 146, and the shaft 147 is rotatably supported by these bearing members 145 and 146. A second pulley 148 and a third pulley 149 are attached to the proximal end and the distal end of the shaft 147, respectively. A belt 150 is hung between the second pulley 148 and the first pulley 144. Thereby, the rotation of the operation unit holding unit 141 is transmitted as the rotation of the shaft 147.

  Furthermore, the base 142 is provided with a fourth bearing member 151 that rotatably supports the insertion portion 32. The insertion portion 32 has rigidity and has a substantially pipe shape. A fourth pulley 152 is attached to the proximal end portion of the insertion portion 32. Further, a belt 153 is hung between the fourth pulley 152 and the third pulley 149. Thereby, the rotation of the shaft 147 is transmitted as the rotation of the insertion portion 32.

  With the above configuration, the rotation of the operation unit holding unit 141 is transmitted as the rotation of the insertion unit 32. That is, by rotating the handle unit 41 around the axis of the operation portion holding portion 141 as indicated by the arrow G in FIG. 32, the treatment portion 33 is indicated by the arrow H in FIG. It becomes possible to rotate around the axis of the insertion portion 32.

  Next, a method for holding the first drive rod 35, the second drive rod 36, and the third drive rod 37 (see FIGS. 8 and 9) in the drive force transmission mechanism 135 will be described. Here, the driving rod of the first multi-degree-of-freedom forceps 125 in this embodiment is divided into the proximal side and the distal end side with the driving force transmission mechanism part 135 interposed therebetween. Therefore, here, the proximal drive rod is the first proximal drive rod 35a, the second proximal drive rod 36a, and the third proximal drive rod 37a, and the distal drive rod is the first distal end. The side drive rod 35b, the second tip side drive rod 36b, and the third tip side drive rod 37b are distinguished.

  The first hand side drive rod 35 a, the second hand side drive rod 36 a, and the third hand side drive rod 37 a are connected to the hand side link mechanism 44 through the operation unit holding portion 141. The first tip side drive rod 35b, the second tip side drive rod 36b, and the third tip side drive rod 37b are connected to the tip side link mechanism 40 through the insertion portion 32, respectively. . This is the same as the multi-degree-of-freedom forceps 3 in the first embodiment.

  On the other hand, a guide rail 154 is formed on the base 142. On the guide rail 154, the first guide block 155, the second guide block 156, and the third guide block 157 that can move independently along the axial direction of the guide rail 154 are on the insertion portion 32 side. To the operation unit holding unit 141 side. As shown in FIG. 32 (B), on the first guide block 155, a first bearing holding member 158 spreading in a direction orthogonal to the axial direction of the insertion portion 32 and the operation portion holding portion 141 is provided. A second bearing holding member 159 is similarly provided on the second guide block 156, and a third bearing holding member 160 is similarly provided on the third guide block 157, respectively. Thereby, the first bearing holding member 158 can move along the axial direction of the guide rail 154 as indicated by an arrow D in FIG. Similarly, the second bearing holding unit 159 is movable along the axial direction of the guide rail 154 as indicated by an arrow E, and the third bearing holding unit 160 is indicated by an arrow F.

  As shown in FIG. 32A, the first bearing holding member 158 holds a first bearing 161 and a second bearing 162 at both ends thereof. Similarly, the third bearing holding member 159 holds the third bearing 163 and the fourth bearing 164, and the third bearing holding member 160 holds the fifth bearing 165 and the sixth bearing 166. . At this time, the rotation shafts of the first bearing 161, the third bearing 163, and the fifth bearing 165 are coaxial with the rotation shaft of the operation unit holding portion 141 that is rotatably attached to the first bearing member 143. Has been placed. On the other hand, the rotation shafts of the second bearing 162, the fourth bearing 164, and the sixth bearing 166 are arranged coaxially with the rotation shaft of the insertion portion 32 that is rotatably attached to the fourth bearing member 151. Yes.

The attachment of each of the bearings 161 to 166 and the drive rods 35, 36, and 37 of the multi-degree-of-freedom forceps 125 will be described with reference to FIGS. explain.
FIG. 33A is a view of the attachment portion where the first bearing 161 is attached to the first bearing holding member 158 in FIG. 32 as seen from the direction of the arrow A shown in FIG. Similarly, FIG. 33B shows an attachment portion in which the third bearing 163 is attached to the second bearing holding member 159 as seen from the direction of the arrow B shown in FIG. 32, and the direction of the arrow C shown in FIG. FIG. 33C shows an attachment portion in which the fifth bearing 165 is attached to the third bearing holding unit 160 as viewed from above.

33A, 33B, and 33C, the first drive rod holding member 167 is provided on the inner ring of the first bearing 161, and the third drive rod is provided on the inner ring of the third bearing 163. A fifth drive rod holding member 171 is attached to the inner ring of the holding member 169 and the fifth bearing 165, respectively. The third proximal drive rod 37a includes a first drive rod guide hole 176 (see FIG. 33C) provided in the fifth drive rod holding member 171 and a third drive rod holding member 169. It passes through the second drive rod guide hole 174 (see FIG. 33B) provided in the movably held in the axial direction. The distal end portion of the third proximal drive rod 37a is adhesively fixed to a first drive rod fixing hole 173 (see FIG. 33A) provided in the first drive rod holding member 167.
Similarly, the second proximal drive rod 36a is movable in the axial direction in a third drive rod guide hole 177 (see FIG. 33C) provided in the fifth drive rod holding member 171. It passes through while being held, and the tip of the second proximal drive rod 36a is bonded and fixed to a second drive rod fixing hole 175 (see FIG. 33B) provided in the third drive rod holding member 169. Yes.
The first proximal drive rod 35a is bonded and fixed to a third drive rod fixing hole 178 (see FIG. 33C) provided in the fifth drive rod holding member 171.

The connection relationship between each drive rod and the drive rod holding member is the same for the distal end side (insertion portion 32 side). That is, the third tip side drive rod 37b is bonded and fixed to a drive rod fixing hole (not shown) of the second drive rod holding member 168. Further, the second tip side drive rod 36b passes through a drive rod guide hole (not shown) provided in the second drive rod holding member 168 while being held so as to be movable in the axial direction, and its end face is the fourth surface. It is fixed to a drive rod fixing hole (not shown) provided in the drive rod holding member 170 by adhesion.
Similarly, the first tip side drive rod 35b is movable in the axial direction in drive rod guide holes (not shown) provided in the second drive rod holding member 168 and the fourth drive rod holding member 170, respectively. It passes through while being held, and its end face is bonded and fixed to a drive rod fixing hole (not shown) provided in the sixth drive rod holding member 172.

(Independent movement of multi-degree-of-freedom forceps)
With the above configuration, the multi-degree-of-freedom forceps 125 can move as follows.
When the third proximal drive rod 37a is moved in the axial direction by the operation of the handle unit 41, the movement is transmitted to the first drive rod holding member 167 and the first bearing 161. Therefore, this movement is the movement indicated by the arrow D in FIG. 32 of the first bearing holding member 158. This movement is further transmitted to the second bearing 162 and the second drive rod holding member 168, and as a result, the axial direction of the third tip drive rod 37b bonded and fixed to the second drive rod holding member 168 is achieved. It becomes a movement.
Similarly, when the second proximal drive rod 36a is moved in the axial direction, the movement is transmitted as the movement indicated by the arrow E in FIG. 32 of the second bearing holding member 159, resulting in the distal drive. This is the axial movement of the rod 36b. Further, when the first proximal drive rod 35a is moved in the axial direction, the movement is transmitted as a movement indicated by an arrow F in FIG. 32 of the third bearing holding member 160, and as a result, the distal drive rod 35 The movement in the axial direction is 35b.

  In this way, the movements of the respective hand-side drive rods 35a, 36a, 37a are independently transmitted as the movements of the tip-side drive rods 35b, 36b, 37b, whereby the multi-degree-of-freedom forceps in the first embodiment. 3, the jaw 39 of the treatment portion 33 is bent in a swinging direction in a direction away from the axial direction of the insertion portion 32 by operating the handle unit 41. Further, the treatment pieces 39a and 39b of the treatment portion 33 are opened and closed by opening and closing operations of the first handle 42 and the second handle 43 of the handle unit 41.

  As shown by an arrow G in FIG. 32A, when the handle unit 41 is rotated around the axis of the operation portion holding portion 141, the third proximal drive rod 37a, the second proximal drive rod 36a and the first proximal drive rod 35a also rotate about the same axis, but this movement is absorbed as rotation of the first bearing 161, the third bearing 163, and the fifth bearing 165. On the other hand, the first pulley 144 is rotated by the rotation in the direction of the arrow G, the belt 150 is rotated accordingly, and the second pulley 148 is rotated. As the second pulley 148 rotates, the third pulley 149 rotates via the shaft 147. As the third pulley 149 rotates, the belt 153 rotates and the fourth pulley 152 rotates. With the rotation of the fourth pulley 152, a rotational force is transmitted to the fourth bearing member 151, and the insertion portion 32 rotates. Therefore, the insertion portion 32 also rotates around the axis of the insertion portion 32 as indicated by an arrow H in FIG. Similarly, the third tip side drive rod 37b, the second tip side drive rod 36b, and the first tip side drive rod 35b rotate about the same axis, but this movement is caused by the second bearing 162 and the fourth bearing. 164 and the rotation of the sixth bearing 166 is absorbed.

Further, the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 are each independently treated by the opening and closing operation of the first handle 42 and the second handle 43 of the handle unit 41. 39a and 39b open and close. Further, the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 operate the handle unit 41 independently so that the jaw 39 of the treatment portion 33 is disengaged from the axial direction of the insertion portion 32. Bend in a swung state in the direction of the head.
This bent state is shown in FIGS. FIG. 34 (A) is a simplified view of the multi-degree-of-freedom forceps 125 in this embodiment as viewed from the same direction as FIG. 32 (A). In FIG. 34 (A), treatment is performed by operating the handle unit 41. The state where the piece 39 is bent in the first direction is shown. FIG. 34 (B) is a simplified view of the multi-degree-of-freedom forceps in this embodiment viewed from the same direction as FIG. 32 (B). In FIG. 34 (B), by operating the handle unit 41, The figure which bent the treatment piece 39 in the 2nd direction which differs 90 degrees with respect to the bending direction of FIG. 34 (A) is shown.

As shown in FIG. 34A, in this embodiment, the axis of the operation portion holding portion 141 of the multi-degree-of-freedom forceps 125, 126 is placed at a position moved in parallel to the axis of the insertion portion 32. It is. Therefore, when the treatment piece 39 is bent by operating the handle unit 41, the operation angle of the handle unit 41 indicated by the angle A in FIG. 34A and the treatment piece indicated by the angle B in FIG. The movement angle 39 is the same. That is, the handle unit 41 and the treatment piece 39 are always parallel to the axial direction of the insertion portion 32. Similarly, as shown in FIG. 34 (B), when the treatment piece 39 is bent by operating the handle unit 41, the operation angle of the handle unit 41 indicated by an angle C in FIG. The movement angle of the treatment piece 39 indicated by an angle D in 34 (B) is the same. That is, also in this case, the handle unit 41 and the treatment piece 39 are parallel to the insertion portion 32.
The above is the independent movement of the multi-degree-of-freedom forceps 125 in this embodiment.

(Whole movement of surgical instruments)
With the above configuration, the surgical instrument 121 in this embodiment can operate as shown in FIG.
By holding the handle unit (operation unit) 41 of the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 inserted into the ports 122b and 122c of the outer tube 122, the patient can move up and down and left and right. 35, centering on the insertion point O of the trocar 123 in the body wall H of FIG. 35, a first swing direction indicated by an arrow A in FIG. Move in the swing direction. Further, by operating with the handle unit 41 of the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126, it rotates around the central axis of the outer tube 122 indicated by arrow C in FIG. To do. Further, the second multi-degree-of-freedom forceps 126 has a front surface portion (indicated by E in FIG. 31) of the driving force transmission member 135 and an abutment surface (F in FIG. 31) of the guide portion 134 provided on the forceps guide member 129. The second multi-degree-of-freedom forceps 126 is pushed further from that state, or the second multi-degree-of-freedom forceps 126 is pushed by the tip stopper pin 138 of the outer tube. 35. By pulling the second multi-degree-of-freedom forceps 126 from this state until the end of the guide hole 122c of 122 is in contact with the peripheral edge of the distal end portion, the outer tube 122 is shown in FIG. Move in the direction shown.

  As described above, the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 are operated by holding the handle unit 41 with respect to the outer tube 122, and are indicated by an arrow A in FIG. In this way, they are moved independently in the axial direction. When this operation is performed, the outer tube 122 is held against the trocar 123 by the sliding member 137 having a high frictional resistance, so that the outer tube 122 itself is prevented from moving in the axial direction.

Further, the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps 126 are operated around the axis of the insertion portion 32 by operating the handle unit 41 as indicated by an arrow B in FIG. Are moved independently.
The above is the movement of the entire surgical instrument 121 in this embodiment.

  In addition, the surgical instrument 121 in this embodiment is used in combination with a surgical instrument such as a scissors forceps 128, for example. The scissors forceps 128 is used by being inserted into a port 122e provided in the outer tube 122. Thus, the scissors forceps 128 is moved in the axial direction as indicated by an arrow C in FIG. Further, the operation unit 140 is operated to open and close the treatment unit 139 of the scissors forceps 128.

  Thus, even when the scissors forceps 128 is inserted into the port 122e provided in the outer tube 122, the first multi-degree-of-freedom forceps 125 and the second multi-degree-of-freedom forceps are used in this embodiment. Since the axis of the operation unit holding unit 141 of 126 is in a position moved in parallel to the axis of the insertion unit 32, the operation unit 140 of the scissors forceps 128, the first multi-degree-of-freedom forceps 125, and the second Interference with the handle unit 41 of the multi-degree-of-freedom forceps 126 is prevented, and the degree of freedom of each operation is secured.

(effect)
With the above operation, the surgical instrument 121 in this embodiment can obtain the following effects in addition to the effects in the second embodiment.
In this embodiment, since the multi-degree-of-freedom forceps 125 and 126 used are rigid, the operation when moving the entire surgical instrument 121 with the handle unit 41 of the multi-degree-of-freedom forceps 125 and 126 is easy. Can be.
Further, as shown in FIGS. 34A and 34B, the multi-degree-of-freedom forceps 125 and 126 used in this embodiment are arranged so that the direction of the handle unit 41 and the direction of the treatment piece 39 coincide with each other. It has become. Thereby, it is possible to obtain an effect that the treatment piece 39 can be controlled very easily when the operator works using the multi-degree-of-freedom forceps 125 and 126.

Although several embodiments have been specifically described so far with reference to the drawings, the present invention is not limited to the above-described embodiments, and all the embodiments performed without departing from the scope of the invention are not limited thereto. Including implementation.
According to the above description, the following matters can be obtained. Combinations of the terms are also possible.

[Appendix]
(Additional Item 1) An elongated insertion means having at least two ports and inserted into the body,
A main body portion having an elongated insertion portion and an operation portion disposed at a proximal end portion of the insertion portion and having a handle, and an axis of the insertion portion when the operation portion is disposed at a distal end portion of the main body portion and is bent from the attachment portion. A treatment part that bends in a direction away from the heart direction, and a treatment tool that is inserted into the port of the insertion means, and in a state where the treatment tool is inserted through the port, A surgical instrument characterized by being disposed at a position deviating from an extension axis of a port through which a treatment tool is inserted.
(Additional Item 2) The surgical instrument according to Additional Item 1, wherein the length of the insertion means is 350 mm or less.
(Additional Item 3) The surgical instrument according to Additional Item 1, wherein the insertion unit includes a CCD camera as the observation unit.

The perspective view which shows the whole schematic structure of the surgical instrument concerning 1st Embodiment. The front view which looked at the surgical instrument shown in FIG. 1 from the front end side. The fragmentary sectional view (side view) which follows the 2A-2A line of FIG. The top view (side view) which shows the operation state of the treatment tool (multi-degree-of-freedom forceps) in the surgical instrument concerning 1st Embodiment. The whole perspective view which shows the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 1st Embodiment. Schematic explanatory drawing for demonstrating the structure of the insertion part of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 1st Embodiment. Schematic explanatory drawing of the bending tube which comprises the insertion part of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 1st Embodiment. The operation state of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument according to the first embodiment is shown, (A) is a side view showing a state in which the handle unit and the treatment section are straightened, B is a side view showing a state in which the handle unit and the treatment portion are bent in the first bending direction. The operation state of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument according to the first embodiment is shown, (A) is a plan view showing a state in which the handle unit and the treatment section are straightened, B is a plan view showing a state in which the handle unit and the treatment portion are bent in a second bending direction. Schematic explanatory drawing for demonstrating the bending operation | movement of the insertion part of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 1st Embodiment. Schematic explanatory drawing for demonstrating the rotation of the periphery of an axis | shaft direction in the state where the insertion part of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 1st Embodiment curved. Schematic explanatory drawing for demonstrating the effect | action of the surgical instrument concerning 1st Embodiment. The top view (side view) which shows the state which made the clip applier penetrate the port in the surgical instrument concerning 1st Embodiment. The schematic explanatory drawing for demonstrating the treatment state which treats a biological tissue using the clip applier in the surgical instrument concerning 1st Embodiment. The schematic fragmentary sectional view (side view) which shows the modification of the surgical instrument concerning 1st Embodiment. The perspective view which shows the whole schematic structure of the surgical instrument concerning 2nd Embodiment. Schematic explanatory drawing for demonstrating an effect | action of the operation unit in the surgical instrument concerning 2nd Embodiment. The front view which looked at the surgical instrument concerning 2nd Embodiment from the front end side. Sectional drawing which follows the 18A-18A line shown in FIG. Sectional drawing which follows the 18B-18B line | wire shown in FIG. The top view which shows the attachment state of the scope holding member of the rear surface in the surgical instrument concerning 2nd Embodiment. Explanatory drawing for demonstrating a motion of the multi-degree-of-freedom forceps (treatment tool) with respect to the mantle tube in the surgical instrument according to the second embodiment. It explains the movement of the operation unit in the surgical instrument according to the second embodiment, (A) is a front view showing a state in which the entire operation unit is held in place, (B) is the operation unit The front view which shows the state which the whole rotated in the counterclockwise direction, (C) is the front view which shows the state in which the whole operation unit rotated in the clockwise direction. Explanatory drawing for demonstrating the state which rotated only the 1st multi-degree-of-freedom forceps in the direction of an axis | shaft in the state which the operation unit in the surgical instrument concerning 2nd Embodiment is not rotating. Explanatory drawing for demonstrating the state which rotated the operation unit in the surgical instrument concerning 2nd Embodiment, and simultaneously rotated the 1st multi-degree-of-freedom forceps around the axis. Explanatory drawing for demonstrating the state which inserted the electric knife in the body through the port of the mantle tube at the time of use of the surgical instrument concerning 2nd Embodiment. Schematic explanatory drawing for demonstrating the structure of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 3rd Embodiment. Schematic explanatory drawing for demonstrating rotation around the axis | shaft of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 3rd Embodiment. The perspective view which shows schematic structure of the whole surgical instrument concerning 4th Embodiment. The front view which looked at the surgical instrument concerning 4th Embodiment from the front end side. Sectional drawing which follows the 30A-30A line shown in FIG. The structure of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument according to the fourth embodiment is shown, (A) is a schematic plan view of the multi-degree-of-freedom forceps, and (B) is a multi-degree-of-freedom forceps. FIG. It is explanatory drawing for demonstrating attachment of the drive rod of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 4th Embodiment, (A) is the front seen from the arrow A direction shown in FIG. FIG. 36 (B) is a front view as seen from the direction of arrow B shown in FIG. 35, and (C) is a front view as seen from the direction of arrow C shown in FIG. The operation | movement state of the multi-degree-of-freedom forceps (treatment tool) in the surgical instrument concerning 4th Embodiment is shown, (A) is a schematic plane which shows the state which bent the treatment part in the 1st bending direction. FIG. 5B is a schematic side view showing a state where the treatment portion is bent in the second bending direction. Schematic explanatory drawing for demonstrating the effect | action of the surgical instrument concerning 4th Embodiment.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Surgical instrument, 2 ... Outer tube, 2a ... 1st port, 2b ... 2nd port, 3 ... Multi-degree-of-freedom forceps, 4 ... Operation part holding | maintenance part, 5 ... Rigid endoscope (endoscope), DESCRIPTION OF SYMBOLS 10 ... Tracar, 12 ... Front end stopper pin, 13 ... Rear end stopper pin, 14 ... Guide member, 32 ... Insertion part, 33 ... Treatment part, 40 ... Front end side link mechanism, 41 ... Handle unit, 44 ... Hand side link mechanism , 51 ... curved member, 52 ... blade, 53 ... outer skin

Claims (10)

An elongated insertion portion to be inserted into the body having a treatment portion at the distal end portion;
An operation unit that is provided on a base end side of the insertion unit and operates the insertion unit;
A driving force transmission mechanism that is provided between the insertion portion and the operation portion and transmits a driving force generated by the operation of the operation portion to the insertion portion;
The insertion portion defines a first axis in its longitudinal direction;
The operating portion defines a second axis in a direction extending from the driving force transmission mechanism;
The driving force transmission mechanism is
A base having a guide rail disposed between the insertion portion and the operation portion so as to dispose the second axis of the operation portion at a position off the first axis of the insertion portion; In an offset state with respect to the insertion portion, and
The operation unit is connected to the second axis and the insertion unit is rotatably supported around the first axis, and has a guide block movable along the axial direction of the guide rail, The driving force around the second axis of the operating portion, which is generated when the operating portion is operated, can be transmitted as the driving force around the first axis of the insertion portion, and the axial direction of the second axis of the operating portion The surgical treatment tool, wherein the drive force can be transmitted as the drive force in the axial direction of the first axis of the insertion portion. The operation portion includes an operation portion holding portion that extends in the axial direction of the second shaft and is rotatably supported by the driving force transmission mechanism, and a handle provided on a base end side of the operation portion holding portion. A hand side link mechanism provided between the operation unit holding unit and the handle and connected to the driving force transmission mechanism.
The insertion portion is rotatably supported by the driving force transmission mechanism, and is connected to the driving force transmission mechanism and is connected to the distal end side link mechanism that is drivingly connected to the treatment portion and operates the treatment portion. Prepared,
The driving force transmission mechanism is
The rotation of the operation unit holding unit can be transmitted to the insertion unit,
2. The treatment section is rotated by a rotation operation of the handle with respect to the operation section holding section by drivingly connecting the proximal side link mechanism and the distal end side link mechanism. Surgical treatment tool. The handle includes first and second handles that are drivingly connected to the proximal link mechanism and that can be opened and closed relative to each other.
The treatment section includes a pair of treatment pieces drivingly connected to the distal end side link mechanism,
The surgical treatment tool according to claim 2, wherein the driving force transmission mechanism opens and closes the pair of treatment pieces by a relative opening and closing operation of the first and second handles. The operation portion includes an operation portion holding portion that extends in the axial direction of the second shaft and is rotatably supported by the driving force transmission mechanism, and a handle provided on a base end side of the operation portion holding portion. A hand side link mechanism provided between the operation unit holding unit and the handle and connected to the driving force transmission mechanism.
The insertion portion includes a distal side link mechanism that is drivingly connected to the driving force transmission mechanism and is connected to the treatment portion to operate the treatment portion,
The driving force transmission mechanism is
The hand side link mechanism can transmit the rotation of the handle with respect to the operation portion holding portion to the insertion portion,
The proximal-side link mechanism and the distal-end-side link mechanism are drivingly connected, and the treatment portion is rotated by the proximal-side link mechanism by rotating the handle with respect to the operation portion holding portion. The surgical treatment tool according to any one of claims 1 to 3. An elongated insertion portion to be inserted into the body having a treatment portion at the distal end portion;
An operation unit that is provided on a base end side of the insertion unit and operates the insertion unit;
A driving force transmission mechanism that is provided between the insertion portion and the operation portion and transmits a driving force generated by operation of the operation portion to the insertion portion;
Comprising
The insertion portion defines a first axis in its longitudinal direction;
The operating portion defines a second axis in a direction extending from the driving force transmission mechanism;
The driving force transmission mechanism is
Disposing the second axis of the operation part at a position off the first axis of the insertion part, disposing the operation part in an offset state with respect to the insertion part, and
The driving force around the second axis of the operating portion, which is generated when the operating portion is operated, can be transmitted as the driving force around the first axis of the inserting portion, and the axis of the second axis of the operating portion The driving force in the direction can be transmitted as the driving force in the axial direction of the first axis of the insertion portion,
The driving force transmission mechanism is
A base having a guide rail disposed between the insertion portion and the operation portion;
A guide block connected to the insertion portion and the operation portion and movable along the axial direction of the guide rail, and the guide block is moved in the axial direction of the guide rail by the operation of the operation portion. A surgical treatment tool, wherein the treatment portion of the insertion portion is operated by the above. In the guide rail, a guide block different from the guide block is disposed so as to be movable in the axial direction of the guide rail,
The surgical treatment tool according to claim 5, wherein the another guide block is connected to the insertion portion and the operation portion separately from the guide block.   The surgical treatment instrument according to claim 6, wherein the guide block and the another guide block are independently movable with respect to the guide rail. The operation portion and the insertion portion each have a rotation axis around a longitudinal axis,
2. The drive force transmission mechanism according to claim 1, wherein when the operation unit is rotated about the rotation axis, the insertion unit is rotated about the rotation axis in conjunction with the rotation. The surgical treatment tool according to any one of claims 7 to 9.   The driving force transmission mechanism includes a pulley and a belt that move in conjunction with the operation portion and the insertion portion, and when the operation portion is rotated about its rotation axis, the pulley and the belt are moved from the operation portion. The surgical treatment instrument according to claim 8, wherein the insertion portion is rotated about a rotation axis thereof. A trocar inserted into the body wall,
The surgical treatment tool according to any one of claims 1 to 9, wherein the driving force transmission mechanism is disposed on the trocar.
A surgical instrument characterized in that there are a plurality of the surgical treatment tools disposed on the trocar.

Images