JP4934086B2 - Medical equipment - Google Patents

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JP4934086B2
JP4934086B2 JP2008066305A JP2008066305A JP4934086B2 JP 4934086 B2 JP4934086 B2 JP 4934086B2 JP 2008066305 A JP2008066305 A JP 2008066305A JP 2008066305 A JP2008066305 A JP 2008066305A JP 4934086 B2 JP4934086 B2 JP 4934086B2
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wire
camera
portion
medical
hook
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JP2009219612A (en
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均 唐沢
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オリンパスメディカルシステムズ株式会社
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Description

  The present invention relates to a medical apparatus including a medical instrument gripping tool that grips a medical instrument fixed to the inside of an abdominal wall.

  As is well known, an endoscope, which is a medical device, includes an imaging device. The endoscope is introduced into a body cavity of a patient, and an inspection image taken by the imaging device is used to perform various examinations, various treatments, etc. Is to do.

  Such endoscopes are those that are introduced into the digestive organs such as the esophagus, stomach, large intestine, and duodenum, which are luminal channels in the body, through the anus or mouth, and the body wall is punctured from the vicinity of the umbilicus Some are introduced into the abdominal cavity via a pierced trocar. In general, an endoscope has a long insertion portion, and this insertion portion is inserted into a digestive tract or an abdominal cavity.

  In recent years, in order to reduce the pain to the patient due to the introduction of the insertion portion, for example, a system for sending a self-supporting capsule used for internal imaging of the gastrointestinal tract as described in Patent Document 1 into the GI tract has been proposed. The system of Patent Document 1 discloses a device that holds a clamp at the front end of an endoscope, includes a support that can be retracted in the endoscope, and sends out a self-supporting capsule into the GI tract.

Further, for example, Patent Document 2 discloses an endoscope apparatus in which a medical capsule can be adsorbed and held on a cylindrical hood member disposed at a distal end position of an endoscope by a suction force of a suction pump. Has been.
Special table 2001-526072 gazette JP 2007-44481 A

  However, the capsule endoscope devices described in Patent Document 1 and Patent Document 2 are effective techniques in a lumen duct such as the gastrointestinal tract, and these independent capsules are used for endoscopic observation in the abdominal cavity. Or a conventional capsule endoscope apparatus that is a medical capsule.

  In other words, in the conventional technique for introducing an endoscope into the abdominal cavity, for example, a trocar that guides an endoscope for observation into a body cavity and a treatment tool are guided to a treatment site without greatly opening because of low invasiveness. A so-called laparoscopic surgical operation is performed in which a trocar is punctured into a patient's abdomen and a therapeutic treatment is performed while observing a treatment tool and a treatment site with an endoscope. For this reason, the conventional capsule endoscope apparatus does not have a presupposed configuration for use in laparoscopic surgery.

  By the way, in this laparoscopic surgical procedure, the treatment site can be observed in detail with an endoscope, but since the range of the visual field that can be observed is relatively narrow, the treatment site in the abdominal cavity in addition to the normal endoscope It is preferable to use an imaging device such as a capsule endoscope device for wide-angle observation in which a wide-angle visual field range is set so that the whole can be observed in a wide range.

  However, in addition to a normal endoscope, when a trocar is punctured into the abdominal wall, which is the body wall, and a laparoscopic surgical operation is performed using an endoscope that observes the abdominal cavity at a wide angle, Multiple trocars must be punctured. This causes a problem that the patient is burdened more than before and is not a minimally invasive laparoscopic surgical operation.

  The conventional capsule endoscope apparatus is not assumed to be fixed to the body wall and the body tissue, and does not have a fixing function to the body wall and the body tissue. Therefore, the technique of Patent Document 1 or Patent Document 2 is based on the premise that the capsule endoscope apparatus is simply grasped and inserted into the GI tract or a body duct (inside the lumen duct). belongs to.

  Therefore, the present invention has been made in view of the above-described circumstances, and the object of the present invention is to fix and install in the body, which can perform a minimally invasive surgical operation without increasing the burden on the patient. It is an object of the present invention to provide a medical device provided with a grasping instrument for a medical device that can be easily introduced into the body, particularly the abdominal cavity, by grasping a free medical device.

To achieve the above object, the medical device of one embodiment of the present invention is a medical device used in laparoscopic surgery, an imaging device in which a predetermined angle is set, a predetermined distance from the imaging device A medical device as a small-sized imaging device that is introduced into the abdominal cavity at a position spaced apart from each other and capable of photographing at a predetermined field angle larger than the predetermined field angle of the imaging device, and a wire extending from the medical device And a gripping device for medical equipment having a grip portion for gripping the medical device and a hook portion for hooking the wire .

  According to the present invention, a minimally invasive surgical operation can be performed without increasing the burden on a patient, and a medical device that can be fixedly installed in the body is grasped and easily introduced into the body, particularly into the abdominal cavity. It is possible to realize a medical device provided with a medical instrument grasping instrument.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. In the following description, a medical device that performs laparoscopic surgery is illustrated.
(First embodiment)
First, an endoscope system 1 that is a medical device of the present invention used for laparoscopic surgery will be described below. 1 to 22 relate to the first embodiment of the present invention, FIG. 1 is a diagram showing a configuration of an endoscope system as a medical device, FIG. 2 is a cross-sectional view showing a configuration of an extracorporeal device, and FIG. FIG. 4 is a sectional view showing the configuration of the intraperitoneal camera, FIG. 5 is a diagram showing the configuration of the medical instrument gripping device, and FIG. 6 is the tip of the medical instrument gripping tool. 7 is a partial cross-sectional view showing a portion, FIG. 7 is a view showing a distal end portion of the medical instrument gripping device, FIG. 8 is a partial cross-sectional view showing the distal end portion of the medical device gripping instrument gripping the intraperitoneal camera, and FIG. The figure which shows the front-end | tip part of the holding | grip instrument for medical devices which hold | gripped the internal installation camera, FIG. 10 is a figure which shows the state by which the trocar was punctured in the patient's abdominal wall, FIG. FIG. 12 is a diagram for explaining the medical grasping instrument in the state of FIG. FIG. 13 shows an observation image of the inserted endoscope, and FIG. 13 shows the tip of the hook needle before the wire of the intra-abdominal camera is hooked and the tip of the medical instrument gripping device that holds the intra-abdominal camera. FIG. 14 shows a state in which a hook needle is punctured into the abdominal wall and the wire of the intra-abdominal camera is hooked, and a diagram for explaining the procedure for introducing the intra-abdominal camera into the abdominal cavity, FIG. FIG. 16 is a view showing an observation image of an endoscope inserted into the medical grasping instrument in the state of FIG. 14, and FIG. 16 is a state in which the hook needle that holds the wire of the intra-abdominal camera is pulled up, and the intra-abdominal camera The figure which shows the front-end | tip part of the holding | grip instrument for medical devices of the state which open | released this, FIG. 17 shows the state which pulled up the hook needle which latched the wire of the camera set in an abdominal cavity, and fixes the camera set in the abdominal cavity to an abdominal wall Illustration for explaining the procedure FIG. 18 shows a state in which the hook needle is pulled up and the fixing unit is lowered along the hook needle, and is a diagram for explaining a procedure for fixing the intra-abdominal camera to the abdominal wall, and FIG. 19 is for explaining the operation of the extracorporeal device. 20 is a diagram showing a state in which the fixing unit is installed on the abdomen and the intra-abdominal camera is fixed to the abdominal wall, and FIG. 21 is a cross-sectional view of the fixing unit and the intra-abdominal camera in the state of FIG. FIG. 22 is an overall configuration diagram of the endoscope system showing a state where the intra-abdominal camera is fixed to the abdominal wall.

  As shown in FIG. 1, an endoscope system 1 according to the present embodiment includes a rigid endoscope 2, which is a first imaging device (imaging device), an extracorporeal device 3, and a second imaging device (imaging device). A very small intra-abdominal camera (hereinafter simply referred to as a camera) 4, a flexible mirror 5 as a third imaging device (imaging device), a medical device, here a camera 4 A medical device gripping device 6 for gripping the camera, a light source device 7, a camera control unit (hereinafter abbreviated as CCU) 8 which is a signal processing device incorporating an image processing circuit, and a communication cable 17 connected to the CCU 8 And a display device 9 for displaying an observation image.

The light source device 7 supplies illumination light to the illumination optical system provided in the rigid mirror 2 and the flexible mirror 5. The light source device 7 is detachably connected by the rigid mirror 2 and the light source cable 12 and by the flexible mirror 5 and the composite cable 20 which is a universal cable.
The rigid endoscope 2 is mainly composed of a hard insertion portion 10 and an operation portion 11 connected to the proximal end of the insertion portion 10. The insertion portion 10 of the rigid endoscope 2 has an image guide and a light guide bundle inserted therein, and an imaging optical system for condensing a subject image to a rigid endoscope camera to be described later via the image guide on the distal end surface, and An illumination optical system for irradiating illumination light from the light guide bundle toward the subject is disposed.

  The operation unit 11 of the rigid endoscope 2 incorporates a camera head (not shown) on which a solid-state image sensor such as a CCD or CMOS is arranged. An optical image of the observation site illuminated by the illumination light supplied from the light source device 7 to the rigid endoscope 2 via the light source cable 12 is captured by the camera head in the operation unit 11 via the image guide of the insertion unit 10. . This rigid endoscope camera photoelectrically converts a captured optical image into an imaging signal, and the imaging signal is transmitted to the CCU 8 via the imaging cable 13. In the rigid endoscope 2 of the present embodiment, the imaging optical system is set so that the imageable angle of view α (see FIG. 22) is, for example, 70 ° to 75 °.

  The CCU 8 generates the transmitted image signal as a video signal and outputs it to the display device 9. The display device 9 is, for example, a liquid crystal display, receives a video signal output from the CCU 8, and displays a normal observation image by the rigid endoscope 2 and a wide-angle observation image by the camera 4 on the screen in a multi-two-screen display, a multi-three display. Screen display or single screen display can be switched and displayed individually. Further, the CCU 8 is detachably connected by a fixing unit 15 of the extracorporeal device 3 and an electric cable 14 described later.

Next, the extracorporeal device 3 will be described in detail below with reference to FIGS. 2 and 3.
As shown in FIGS. 2 and 3, the extracorporeal device 3 includes a fixing unit 15 that pulls and fixes the camera 4 in the body cavity, and a hook needle 16 that is a puncture needle that latches and pulls up the camera 4. It is configured.
The fixed unit 15 includes a receiver 22 and an electrical connector portion 23 electrically connected to the receiver 22 in a housing 21 formed of a nonmagnetic material. The electrical connector portion 23 is connected to the electrical cable 14 connected to the CCU 8. The fixed unit 15 transmits the power from the CCU 8 and the signal from the receiver 22 to the CCU 8 via the electric cable 14.

  A slide hole 24 is formed in the housing 21 laterally from the side surface. A wire fixing lever 26 that constitutes a fixing portion formed of a nonmagnetic material having an urging spring 25 fixed to the end face is inserted into the slide hole portion 24. The wire fixing lever 26 has a substantially rectangular parallelepiped shape and is slidably disposed along the slide hole portion 24 toward the inside of the housing 21. Further, the wire fixing lever 26 is formed with a hole portion 27 having a convex arcuate surface 27a on the biasing spring 25 side in the middle portion thereof.

  The housing 21 is formed with a wire insertion portion 28 penetrating vertically. The wire insertion portion 28 is formed with a conical tapered surface 29 so as to extend to an upper portion that becomes an opening on the upper surface of the housing 21.

  The fixing unit 15 configured as described above has a vertical direction at the slide position where the wire fixing lever 26 is pushed into the housing 21 so that the hole 27 and the wire insertion portion 28 of the wire fixing lever 26 coincide with each other. The hook needle 16 is inserted and disposed so as to be freely inserted into and removed from a hole penetrating through it.

  The hook needle 16 of the extracorporeal device 3 is formed with a cylindrical puncture needle tube 31, a needle head 32 connected to the upper portion of the puncture needle tube 31, and a hook portion 34 that is slidably inserted into the puncture needle tube 31. The puncture rod 33, the hook head 35 connected to the upper portion of the puncture rod 33, and the spring 36 interposed between the hook head 35 and the needle head 32 are configured. .

  The puncture needle tube 31 is an elongated metal tube of about 3 mm formed in a sharp needle shape whose tip is cut obliquely. The needle head 32 has an outer diameter larger than that of the puncture needle tube 31 and is formed integrally with the puncture needle tube 31 with the tip side formed in a conical shape. The needle head 32 is configured such that the hook needle 16 does not fall down below the housing 21 by abutting against a tapered surface 29 formed on the upper portion of the housing 21.

  The puncture rod 33 is an elongated metal rod body, and a hook head 35 connected to the upper portion is urged by a spring 36 in a direction away from the needle head 32. Thereby, the puncture rod 33 has the hook portion 34 formed at the tip thereof accommodated in the puncture needle tube 31.

  When the hook needle 16 is pushed into the puncture needle tube 31 by the user against the urging force of the spring 36 (arrow F in FIG. 3), the hook portion 34 formed at the tip of the hook needle 16 is inserted into the puncture needle tube. It protrudes from the tip of 31.

  The hook needle 16 configured in this way is inserted into the wire insertion portion 28 of the housing 21 and the hole portion 27 of the wire fixing lever 26, and the wire fixing lever 26 is applied by the urging force of the urging spring 25. The housing 21 is inserted and fixed by the pressing force toward the outside of the housing 21. That is, the hook needle 16 is pressed against the outer peripheral surface of the puncture needle tube 31 by an arc surface 27 a formed on one side surface of the hole portion 27 of the wire fixing lever 26, and comes into contact with the inner surface of the wire insertion portion 28. It is fixed in a state inserted through the body 21.

Next, the camera 4 will be described in detail below with reference to FIG.
As shown in FIG. 4, the camera 4 is mainly configured by a camera body 41 and an abdominal wall fixing portion 42 that is a contact portion with the body wall.

  The camera body 41 is a so-called capsule-type imaging unit, and is disposed on the tip side (downward in FIG. 4) so as to have a substantially dome-shaped transparent hood 51 and the transparent hood 51 hermetically seal one surface. The outer shape is formed by the camera casing 52 formed of a nonmagnetic material.

  The camera housing 52 is provided with a plurality of, here two, white LEDs 53 serving as illumination light sources on one surface of the transparent hood 51 side, and a lens holding hole formed substantially at the center of the one surface. And a solid-state image sensor unit 55 such as a CCD or C-MOS having a light receiving portion disposed at a position where photographing light is collected by the objective lens group 54. Yes.

  In addition, a transmitter 57 is disposed in the camera housing 52, and a battery 56 for supplying power to the transmitter 57, the white LED 53, and the solid-state image sensor unit 55 is incorporated. Note that the functional unit of the camera body 41 of the present embodiment has an imaging optical system that captures a wide-angle field of view so that the imageable view angle β (see FIG. 22) is, for example, 90 ° or more. Is set. The image signal photoelectrically converted by the solid-state image sensor unit 55 is wirelessly transmitted from the transmitter 57 to the receiver 22 disposed in the casing 21 of the extracorporeal device 3.

  The abdominal wall fixing portion 42 is formed of, for example, a flexible elastic member such as silicon rubber, and has a connection portion 61 fitted to the proximal end portion of the camera housing 52 and an upper end portion serving as a proximal end side of the connection portion 61. And a suction cup 62 serving as a pressure adjusting unit on the camera 4 side. In addition, the abdominal wall fixing part 42 has a convex part 63 that protrudes in a cylindrical shape substantially at the center of the surface of the suction cup 62, and a through hole 64 in the central part of the connecting part 61 so as to communicate with the hole part of the convex part 63. Is formed.

  A lifting wire 45 having a predetermined length is inserted into the through hole 64 of the abdominal wall fixing portion 42, and a connecting portion 65 connected to one end portion of the wire 45 by caulking is provided. The connecting portion 65 is fitted and fixed to the center of the base end surface of the camera housing 52. That is, the wire 45 is provided so as to extend from the center of the suction cup 62. The suction cup 62 formed of an elastic member pulls the wire 45 with a certain tension or more, so that the end of the suction cup 62 is in close contact with the body wall while being expanded and deformed. The wire 45 may be a thread such as a surgical suture system, or may be a metal stranded wire.

  Returning to FIG. 1, the flexible mirror 5 includes a flexible insertion portion 18. The distal end portion of the insertion portion 18 of the flexible mirror 5 is provided with a distal end portion 18a on which a solid-state imaging device such as a CCD or CMOS is disposed, and a bending portion 18b. The bending portion 18b is operated to bend by two bending operation knobs 19a that are rotatably superimposed on the operation portion 19 of the flexible mirror 5.

  Further, from the operation unit 19, a composite cable 20 is extended which is the above-described universal cable through which a communication line for sending and receiving imaging signals and supplying power and a light guide for illumination are inserted. The flexible mirror 5 is configured such that the internal light guide bundle is connected to the light source device 7 and the internal communication line is connected to the CCU 8 by the composite cable 20.

  Since this flexible mirror 5 has been used conventionally, detailed description of other configurations will be omitted. In the endoscope system 1 of the present embodiment, the flexible mirror 5 is used for the third imaging device (imaging device). However, it is a matter of course that a rigid endoscope having a hard insertion portion may be used.

Next, the structure of the medical instrument gripping device 6 of the present embodiment will be described in detail below with reference to FIGS.
As shown in FIGS. 5 and 6, the medical device gripping device 6 of the present embodiment includes a gripping portion 71 for holding the above-described camera 4 and a metal having the gripping portion 71 disposed at the tip. An adapter outer tube 81 made of a hard or synthetic resin, and a metal or hard synthetic resin that is disposed inside the adapter outer tube 81 and through which the insertion portion 18 of the flexible mirror 5 is inserted. The adapter inner pipe 77 is formed, and a substantially cylindrical operation portion 83 provided at the base end so as to communicate with each of the pipes 81, 77.

  The gripping portion 71 has two open / close jaws 72 each provided with a holding pad 73 for preventing slip, which is formed of an elastic member or the like at the tip, and a base end portion of the open / close jaw 72 is pivotally supported. A link mechanism 74 disposed on the side portion for opening / closing the open / close jaws 72 and provided at the base ends of the two open / close jaws 72 and attached in a direction in which the open / close jaws 72 are separated from each other. And a torsion spring 73a. The urging member that urges the opening / closing jaws 72 in the open state apart from each other is not limited to the torsion spring 73a, and may be an elastic member such as a leaf spring.

  That is, the two open / close jaws 72 are rotatably arranged at the distal end portion of the adapter outer tube 81 by the pivotal support 74a at both side portions extending in the proximal direction. Each link plate constituting the link mechanism 74 disposed on the base end side of one side portion of the opening / closing jaw 72 is arranged in a predetermined overlapping manner, and is formed by a rivet-shaped shaft body 74b and a wire connection pivot body 75. It is pivotally connected.

  The distal end portion of the wire strand 76a of the operation wire 76 is connected to the wire connection pivot 75 arranged at the most proximal end by caulking. That is, the operation wire 76 covers the pulling / relaxation wire element 76 a and extends to the operation portion 83 along the adapter inner tube 77. Further, the wire connection pivotal support body 75 is guided to move forward and backward by a long hole 82 formed in the adapter outer tube 81.

  The operation portion 83 has a hole portion (not shown) for introducing the insertion portion 18 of the flexible endoscope 5 into the adapter inner tube 77 from the proximal end. The operation portion 83 is provided with a grip 84 extending from the outer peripheral portion and a rotatable trigger 85. The trigger 85 is provided with a wire connection portion 85 a that extends in the operation portion 83 and is connected to the operation wire 76. In addition, a pulley 83 a for turning back the operation wire 76 so as to be connected to the wire connection portion 85 a of the trigger 85 is provided in the operation unit 83.

  That is, when the trigger 85 of the operation unit 83 is pulled, the medical device gripping device 6 rotates and moves forward so that the wire connection unit 85a draws a circular orbit as the trigger 85 rotates. And the wire strand 76a of the operation wire 76 connected to the wire connection part 85a is pulled by the wire connection part 85a.

  As a result, the link mechanism 74 is pulled by the wire strand 76a connected to the wire connecting pivot 75, and the open / close jaw 72 of the gripping portion 71 moves in a direction close to each other against the urging force of the torsion spring 73a. To do. That is, the open / close jaw 72 is closed when the trigger 85 is pulled.

  In addition, an elliptical cutout 81a is formed at the distal end opening of the adapter outer tube 81 from the opposite side circumferential portions. An annular wire retaining tube 86 is provided on the outer periphery of the distal end of the adapter outer tube 81. The wire retaining tube 86 is fixed to the adapter outer tube 81 so that the wire hook portion 86a is positioned on the outer periphery of the adapter outer tube 81 on the opposite side of the link mechanism 74 that opens and closes the grip portion 71.

Further, the adapter inner tube 77 is formed with a tip opening 77a at the tip, and when the insertion portion 18 of the flexible endoscope 5 is inserted and arranged, an inward flange portion 77b is formed in which the tip 18a abuts and is positioned. Has been.
In addition, although the adapter outer tube | pipe 81 and the adapter inner tube | pipe 77 of this Embodiment were made into the hard tube, the soft tube body formed from the soft synthetic resin may be sufficient.

The endoscope system 1 of the present embodiment configured as described above is used for laparoscopic surgery, and is used for treatment in the abdominal cavity 101 that is one of the body cavities of a patient.
Here, for the laparoscopic surgery, the procedure and operation of the endoscope system 1 according to the present embodiment installed on the abdominal cavity 101 which is the body cavity of the patient will be described in detail below with reference to FIGS. explain.
First, the surgeon treats a small incision with a scalpel or the like at one place on the abdominal wall 102 of the patient 100, and punctures the trocar 111 into the incision as shown in FIG.

  Then, as shown in FIGS. 9 and 10, the surgeon grips the camera 4 with the grip portion 71 using the medical instrument gripping device 6. That is, the surgeon pulls the trigger 85 of the operation unit 83 of the medical instrument gripping device 6 to close the two open / close jaws 72 of the gripping unit 71 so that the camera housing serving as the body of the camera body 41 is closed. Each holding pad 73 is brought into contact with the outer peripheral portion of the body 52 and the camera 4 is gripped by the grip portion 71. At this time, the operator holds the wire 45 of the camera 4 on the wire hook portion 86a of the wire retaining tube 86 of the medical instrument gripping device 6.

  By the way, the camera 4 has a gripping portion provided so that the base end portion is located a predetermined distance d1 away from the distal end portion 18a of the insertion portion 18 of the flexible endoscope 5 inserted and disposed in the gripping device 6 for medical devices. The two opening / closing jaws 72 of 71 are held by the holding pads 73. In this state, the abdominal wall fixing portion 42 of the camera 4 is positioned away from the distal end portion 18a of the insertion portion 18 by a predetermined distance d2. That is, the length of each open / close jaw 72 of the gripping portion 71 in the longitudinal direction and the size of the camera 4 are set so as to maintain the above-mentioned predetermined distances d1 and d2. As a result, the wire 45 of the camera 4 enters the imaging region of the flexible mirror 5, and the operator can easily recognize the position of the wire 45 from the observation image of the flexible mirror 5.

  Next, the surgeon inserts the puncture needle tube 31 of the hook needle 16 into the wire insertion portion 28 provided in the fixing unit 15 of the extracorporeal device 3. At this time, the surgeon pushes the wire fixing lever 26 into the housing 21 so that the puncture needle tube 31 penetrates the fixing unit 15 and inserts the puncture needle tube 31 into the hole 27 of the wire fixing lever 26. To do.

  The operator places the fixing unit 15 sufficiently on the side of the needle head 32 that is the proximal side of the puncture needle tube 31, and sufficiently protrudes the puncture needle tube 31 from the lower surface of the fixing unit 15 (see FIGS. 2 and 3). . In this state, the fixing unit 15 suppresses the arcuate surface 27a, which is one wall surface of the hole 27 of the wire fixing lever 26, abutting against the puncture needle tube 31 by the urging force of the urging spring 25 on the wire fixing lever 26. The puncture needle tube 31 is prevented from falling off.

  Then, as shown in FIG. 11, the surgeon inserts the camera 4 grasped by the medical instrument grasping instrument 6 into the abdominal cavity 101 via the trocar 111. Next, the surgeon punctures the puncture needle tube 31 of the hook needle 16 inserted and held in the fixing unit 15 constituting the extracorporeal device 3 so as to penetrate at a desired position of the abdominal wall 102. At this time, the surgeon may confirm the puncture needle tube 31 punctured in the abdominal cavity 101 based on images taken by the camera 4 and the flexible endoscope 5.

  Then, as shown in FIG. 11, the operator pushes the hook head 35 in the direction indicated by the arrow F in the drawing in order to lead out the puncture rod 33 from the puncture needle tube 31. From this state, as shown in FIG. 12, the surgeon is within the imaging region of the flexible endoscope 5 in which the insertion portion 18 is inserted and disposed in the medical instrument gripping device 6, that is, from the captured image of the camera 4. The wire 45 can be confirmed.

  Next, as shown in FIGS. 13 to 15, the surgeon hooks the hook portion 34 formed on the puncture rod 33 on the wire 45 of the camera 4 while viewing the image by the flexible endoscope 5. When the wire 45 is hooked on the hook portion 34, the surgeon releases the push of the hook head 35 of the puncture rod 33. Then, the puncture rod 33 is introduced into the puncture needle tube 31 while the wire 45 is hooked on the hook portion 34. That is, as shown in FIG. 15, the surgeon approaches the wire 45 of the camera 4 to the wire 45 of the camera 4 and the hook portion 34 of the puncture rod 33 of the hook needle 16 by the image taken by the flexible endoscope 5. Can be easily performed.

  Then, the operator opens the camera 4 held by the holding part 71 of the holding device 6 for medical equipment. That is, the surgeon releases the trigger 85 of the operation unit 83 of the medical instrument gripping device 6 that is pulled to grip the camera 4. Then, the two open / close jaws 72 of the gripping portion 71 are rotated in a direction away from each other by the urging force of the torsion spring 73a to be in the open state. Thus, as shown in FIG. 16, the camera 4 is released from the gripping portion 71 while being held by the gripping portion 71.

  Thereafter, as shown in FIG. 17, the surgeon moves the puncture needle tube 31 of the hook needle 16 from the abdominal cavity 101 to the outside of the body (UP direction in the figure) while the wire 45 is hooked on the hook portion 34 of the puncture rod 33. Pull out. Then, as shown in FIG. 18, the operator pulls out the puncture needle tube 31 of the hook needle 16 from the abdominal cavity 101 and moves the fixing unit 15 toward the puncture needle tube 31 in the abdomen direction of the patient 100 (DOWN direction in the figure). The puncture needle tube 31 is pulled until the wire 45 is inserted into the wire insertion portion 28 of the fixing unit 15 by relative movement.

  At this time, the surgeon pushes the wire fixing lever 26 of the fixing unit 15 into the housing 21 (in the direction of arrow P in FIG. 19), so that the fixing unit 15 is easily relative to the puncture needle tube 31 of the hook needle 16. Can be slid. Then, when the wire 45 is inserted into the wire insertion portion 28 of the fixing unit 15, the surgeon pulls the wire 45 itself (UP direction in FIG. 19) and moves the fixing unit 15 toward the abdomen of the patient 100 (FIG. 19). (Middle, DOWN direction) This time, the wire 45 is moved relatively.

  That is, the surgeon maintains the state in which the wire fixing lever 26 of the fixing unit 15 is pushed into the inside of the housing 21, so that the fixing unit 15 can be easily moved to the puncture needle tube 31 of the hook needle 16 and the wire 45 of the camera 4. Can be slid relative to each other.

  Then, as shown in FIG. 20, the surgeon moves the wire of the camera 4 until the fixing unit 15 and the camera 4 sandwich the abdominal wall 102 with the fixing unit 15 placed on the abdomen of the patient 100. Tow 45. At this time, the surgeon releases the pushing of the wire fixing lever 26 of the fixing unit 15. At this time, the surgeon may confirm the state in which the abdominal wall fixing part 42 of the camera 4 is adsorbed to the abdominal wall 102 based on an image taken by the flexible mirror 5 inserted and disposed in the medical instrument gripping device 6. Note that FIG. 20 shows a state in which the medical instrument gripping device 6 is extracted from the trocar 111.

  Then, the wire fixing lever 26 of the fixing unit 15 receives the urging force of the urging spring 25 as shown in FIG. 21 and moves in the direction of the arrow R in the figure, so that the hole 27 passes through the wire of the housing 21. The hole 45 and the wire 45 inserted through the wire insertion part 28 are sandwiched and fixed to the housing 21. At this time, due to the deformation of the elastic suction cup 62, the wire 45 is always subjected to a certain tension or more between the wire fixing lever 26 and the suction cup 62. As a result, the fixing unit 15 and the camera 4 are always fixed with a certain tension or more applied to the wire 45, and the state in which the abdominal wall 102 is sandwiched is held and fixed.

  The surgeon treats a small incision with a scalpel or the like at a desired location different from the location where the trocar 111 of the abdominal wall 102 of the patient 100 is punctured, and punctures the trocar 110 into the incision. Then, the operator inserts the insertion portion 10 of the rigid endoscope 2 into the abdominal cavity 101 via the trocar 110.

  In this way, as shown in FIG. 22, the camera 4 is installed in the abdominal cavity 101 of the patient 100 in a stable and stable state, and laparoscopic surgery is performed by the endoscope system 1 of the present embodiment. For example, one end of a pneumoperitoneal tube (not shown) is attached to the trocar 111, and the abdominal cavity 101 is provided with a purpose of securing a visual field of the rigid endoscope 2 and a region for operating a surgical instrument or the like. As the insufflation gas, for example, carbon dioxide gas or the like is previously injected. Then, the operator performs a laparoscopic surgical operation by inserting the rigid endoscope 2 through the trocar 110 and the treatment instrument 120 through the trocar 111 while the camera 4 is adsorbed to the abdominal wall 102 and placed in the abdominal cavity 101. .

  According to the endoscope system 1 of each embodiment described above, the body tissue in the body cavity, here the abdominal cavity 101, can be observed from multiple viewpoints including a wide angle. The entire resection line at the time of colorectal resection can be easily grasped. The endoscope system 1 can perform minimally invasive surgery without increasing the burden on the patient when the camera 4 introduced into the abdominal cavity 101 is installed separately from the rigid endoscope 2 for magnification observation. Yes. As a result, by using the endoscope system 1 of the present invention, treatment by laparoscopic surgery is facilitated.

  Further, the operator can easily introduce the camera 4 into the abdominal cavity 101 by grasping the camera 4 with the medical instrument gripping instrument 6 and also has the flexible mirror 5 inserted and disposed in the medical instrument gripping instrument 6. The wire 45 of the camera 4 can be easily hooked by the hook needle 16 while confirming the captured image.

  From the above description, the endoscope system 1 which is the medical device of the present embodiment can perform a minimally invasive surgical operation without increasing the burden on the patient, and can be fixedly installed in the body. It can be set as the structure provided with the holding | grip instrument 6 for medical devices which can hold | grip the camera 4 which is an apparatus, and can introduce | transduce into the inside of a body, especially the abdominal cavity 101 easily.

(Second Embodiment)
Next, a second embodiment according to the endoscope system 1 of the present invention will be described below with reference to FIGS. FIGS. 23 to 26 relate to the second embodiment of the present invention, FIG. 23 is a diagram showing the configuration of the medical instrument gripping device, and FIG. 24 is for explaining the rotating action of the wire retaining tube. FIG. 25 is a sectional view for explaining the rotating action of the wire retaining tube, and FIG. 26 is a photographed image of the flexible mirror. Moreover, in the following description, the same code | symbol is used about the structure same as the endoscope system 1 of 1st Embodiment mentioned above, and detailed description of those structures is abbreviate | omitted.

  In the medical instrument gripping device 6 of the present embodiment shown in FIG. 23, a wire retaining tube 86 having a wire hook portion 86a is rotatably fixed to an adapter outer tube 81 by a bearing or the like (not shown). It is the structure which can be rotated around the circumference of. A substantially disk-shaped operation plate 66 for rotating the wire retaining tube 86 is rotatably disposed in the operation portion 83 of the medical instrument gripping device 6.

  The operation plate 66 is configured such that a pulley (not shown) disposed in the operation unit 83 is interlocked with the operation plate 66, and the pulley is disposed inside the adapter outer tube 81, adapter inner tube 77, and operation unit 83. The operation wire 67 to be inserted is folded and disposed. That is, both ends of the operation wire 67 are pulled and relaxed in the opposite direction by the rotation of the pulley interlocked with the operation plate 66.

  As shown in FIG. 24, cam pins 68 are provided at both ends of the operation wire 67, respectively. In FIG. 24, only one end of the operation wire 67 is shown. These cam pins 68 are engaged with cam grooves 69 formed on the inner peripheral surface of the wire retaining tube 86. The wire retaining tube 86 is formed with two cam grooves 69 facing each other.

  That is, when the operation plate 66 is rotated, one end of the operation wire 67 is pulled by the pulley, and the other end of the operation wire 67 is relaxed. Then, since the cam pin 68 provided at the end of the pulled operation wire 67 tries to move along the cam groove 69, the wire retaining tube 86 is arranged around the outer periphery of the adapter outer tube 81. Rotate in the direction.

  As a result, as shown in FIG. 25, the medical instrument gripping device 6 of the present embodiment pulls and loosens the operation wire 67 by the rotation operation of the operation plate 66, so that the cam groove 69 is within the set range. The wire retaining tube 86 can be rotated around the outer periphery of the adapter outer tube 81.

  Therefore, the surgeon can move the wire 45 of the camera 4 hooked on the wire hook portion 86 a around the outer periphery of the adapter outer tube 81 by the turning operation of the wire retaining tube 86. That is, as shown in FIG. 26, the surgeon looks at the photographed image under the observation of the flexible mirror 5 inserted and arranged in the medical instrument gripping device 6, and moves the wire of the camera 4 to a position where it can be easily caught by the hook needle 16. 45 can be moved to a desired position.

  As described above, in addition to the effects of the first embodiment, the medical instrument gripping device 6 of the endoscope system 1 of the present embodiment can rotate the wire retaining tube 86 including the wire hook portion 86a. Therefore, the position of the wire 45 of the camera 4 can be controlled to be easily hooked by the hook needle 16.

(Third embodiment)
Next, a third embodiment according to the endoscope system 1 of the present invention will be described below with reference to FIGS. FIGS. 27 to 30 relate to the third embodiment of the present invention. FIG. 27 shows the insertion portion of the flexible endoscope in which the hook unit is inserted into the treatment instrument channel and is inserted into the medical instrument gripping device. FIG. 28 is a diagram showing a state where the camera is gripped by the medical instrument gripping device of FIG. 27. FIG. 29 is a diagram illustrating the state where the hook unit is easier to hook the wire than the camera. FIG. 30 is a diagram showing a state of being pushed forward, and FIG. 30 is a diagram showing a photographed image of the camera. Also in the following description, the same reference numerals are used for the same configurations as those of the endoscope system 1 of the first embodiment described above, and detailed descriptions of those configurations are omitted.

  As shown in FIG. 27, the flexible endoscope 5 inserted and disposed in the medical instrument gripping instrument 6 of the endoscope system 1 of the present embodiment is not shown through a treatment instrument insertion port 19b provided in the operation unit 19. A hook unit 91 is inserted into the treatment instrument channel so as to protrude to the gripping portion 71 of the medical instrument gripping device 6.

  The hook unit 91 has a resilient long wire portion 92 provided with a hook 92 a for hooking the wire 45 of the camera 4 at the tip, and a ring portion 93 disposed at the base end of the wire portion 92. And is configured. Note that the hook unit 91 is previously operated by an operator in a state in which the hook 92a at the tip is hooked with the wire 45 of the camera 4 held by the holding portion 71 of the holding device 6 for medical equipment during an endoscopic surgical operation. Prepared by

  The medical device gripping device 6 that holds the camera 4 of the present embodiment configured as described above, and the softness that is inserted and disposed in the medical device gripping device 6 and the hook unit 91 is inserted into the treatment instrument channel 28, the operation of introducing the camera 4 into the abdominal cavity 101 through the trocar 111 in a state where the hook 92a of the hook unit 91 hooks the wire 45 at the rear position of the camera 4 as shown in FIG. Made.

  Then, at a predetermined position after introduction into the abdominal cavity 101, the hook unit 91 is pushed out by the operator so that the hook 92a in a state where the wire 45 of the camera 4 is hooked extends forward of the camera 4, and the wire 45 is hooked on the hook portion 34 of the hook needle 16. At this time, as shown in FIG. 30, since the wire 45 hooked on the hook 92 a enters the field of view of the camera 4, the operator inserts the wire 45 into the hook of the hook needle 16 while viewing the captured image of the camera 4. The part 34 can be easily hooked.

  As shown in FIG. 28, when the hook 92 a of the hook unit 91 is in a state where the wire 45 is hooked at the rear position of the camera 4, the operator uses the captured image of the flexible mirror 5 to Of course, the wire 45 can be hooked on the hook portion 34 of the hook needle 16. That is, by using the hook unit 91 according to the present embodiment, the surgeon can selectively perform either under the observation of the camera 4 or under the observation of the flexible endoscope 5 depending on various situations in the abdominal cavity 101. The wire 45 of the camera 4 may be hooked on the hook portion 34 of the hook needle 16.

(Fourth embodiment)
Next, a fourth embodiment according to the endoscope system 1 of the present invention will be described below with reference to FIGS. FIGS. 31 to 35 relate to a fourth embodiment of the present invention, FIG. 31 is a diagram showing a configuration of a wire operating instrument having a gripping forceps inserted therein, and FIG. FIG. 33 is a diagram showing a state in which the grasping forceps holding the camera are inserted into the trocar, and FIG. 33 is a diagram showing a state in which the camera is led out from the trocar and the advancing / retracting operation tube is slid forward relative to the grasping forceps in the abdominal cavity. , FIG. 34 shows a modified example, a view showing a state where the advancement / retraction operation tube and the grasping forceps holding the camera are inserted into the treatment instrument channel of the flexible endoscope, FIG. 35 shows the state in FIG. It is a figure which shows the state of the advancing / retreating operation tube which made the camera derive from a soft mirror. Also in the following description, the same reference numerals are used for the same configurations as those of the endoscope system 1 of the first embodiment described above, and detailed descriptions of those configurations are omitted.

  The endoscope system 1 according to the present embodiment includes a grasping forceps 121 that grips the camera 4 and a camera 4 shown in FIG. And a forward / backward operation tube 95 that pushes the wire 45 forward.

  The grasping forceps 121 mainly includes a grasping portion 122 that constitutes a treatment portion at its tip and that can be freely opened and closed, a resilient coil sheath 123, and an operation portion 124 for opening and closing the grasping portion 122. It is configured. Since this grasping forceps 121 has been used conventionally, description of other detailed configurations is omitted.

  The advancing / retracting operation tube 95 includes a long and rigid operation shaft tube 97, a finger hook ring portion 98 provided with two ring bodies disposed at the base end of the operation shaft tube 97, and the operation shaft tube 97. And a long hook unit 96 having elasticity and provided with a hook 96a that extends forward from the opening of the tip and hooks the wire 45 of the camera 4 at the tip.

  In the advancing / retracting operation tube 95 configured as described above, the grasping forceps 121 is inserted from the finger hook ring portion 98 into the operation shaft tube 97. The grasping forceps 121 inserted and disposed in the advancing / retracting operation tube 95 grasps the camera 4 by the grasping portion 122 when being introduced into the abdominal cavity 101 via the trocar 111 by the operator as shown in FIG. An operation is made. At this time, during the endoscopic surgical operation, the hook unit 96 is in a state where the tip hook 96a is hooked on the wire 45 of the camera 4 held by the holding portion 122 of the holding forceps 121, in advance by the operator. Be prepared.

  Further, in the camera 4, a convex portion 63 (see FIG. 4) that protrudes in a cylindrical shape at the approximate center of the surface of the suction cup 62 is gripped by the grip portion 122 of the grip forceps 121. Since the convex portion 63 is provided at substantially the center of the surface of the suction cup 62, the camera 4 can be easily gripped by the grip portion 122 of the grip forceps 121 in a balanced manner. Thus, the operator can easily introduce the camera 4 into the abdominal cavity 101 when the camera 4 is introduced into the abdominal cavity 101. That is, the operator can easily introduce the camera 4 into the abdominal cavity 101 so that the camera 4 is not caught by the trocar 111.

  Then, the operator pushes the grasping forceps 121 inserted into the trocar 111 toward the abdominal cavity 101 so that the camera 4 is led out from the trocar 111 within the abdominal cavity 101. Next, the surgeon places the finger on the finger ring portion 98 with respect to the grasping forceps 121 and slides the forward / backward operation tube 95 forward. Then, as shown in FIG. 33, the hook 96 a of the hook unit 96 in a state where the wire 45 of the camera 4 is hooked extends to the front of the camera 4. The operator can easily hook the wire 45 with the hook portion 34 of the hook needle 16 while viewing the captured image of the camera 4 because the wire 45 hooked on the hook 96a enters the field of view of the camera 4. it can.

  34, the operator grasps the camera 4 by the grasping portion 122 of the grasping forceps 121 inserted through the advance / retreat operation tube 95, and is disposed in the insertion portion 18 of the flexible endoscope 5. The camera 4 may be introduced into the abdominal cavity 101 via the instrument channel 20a. In addition, as shown in FIG. 35, the wire unit 96 of the advancing / retracting operation tube 95 is previously attached with a bending rod (upper side in the drawing), so that the operator can confirm it with a photographed image of the flexible mirror 5. However, the wire 45 of the camera 4 can be easily hooked by the hook portion 34 of the hook needle 16.

  As described above, the endoscope system 1 according to the present embodiment is configured so that the grasping forceps 121 that grasps the camera 4 and the wire 45 of the camera 4 are pushed forward instead of the medical instrument grasping device 6. Even with the configuration including the tube 95, the same effects as those of the above-described embodiments, in particular, the same effects as those of the third embodiment can be obtained.

  The invention described in each of the above-described embodiments is not limited to the embodiments and modifications, and various modifications can be made without departing from the scope of the invention in the implementation stage. Further, the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

  For example, even if some constituent elements are deleted from all the constituent elements shown in the embodiment, the problem to be solved by the invention can be solved and the described effect can be obtained. The deleted configuration can be extracted as an invention.

The figure which shows the structure of the endoscope system which is a medical device which concerns on 1st Embodiment. Sectional drawing showing the configuration of the extracorporeal device The top view showing the action of the hook needle of the extracorporeal device Sectional view showing the configuration of the intra-abdominal camera The figure which shows the structure of the holding instrument for medical devices The fragmentary sectional view which shows the front-end | tip part of the holding device for medical devices The figure which shows the front-end | tip part of the holding instrument for medical devices The fragmentary sectional view which shows the front-end | tip part of the holding instrument for medical devices which hold | gripped the intraperitoneal installation camera same as the above The figure which shows the front-end | tip part of the holding instrument for medical devices which hold | gripped the intraperitoneal installation camera same as the above The figure which shows the state by which the trocar was punctured in the patient's abdominal wall The figure for explaining the procedure for introducing the intra-abdominal camera into the abdominal cavity The figure which shows the observation image of the endoscope inserted in the medical holding instrument in the state of FIG. The figure which shows the front-end | tip part of the holding | grip instrument for medical devices which hold | gripped the front-end | tip part of the hook needle before hooking the wire of the intra-abdominal installation camera, and the intra-abdominal installation camera similarly The figure for demonstrating the procedure which shows the state which punctured the abdominal wall, hooked the wire of the camera set in the abdominal cavity, and introduced the camera set in the abdominal cavity into the abdominal cavity. The figure which shows the observation image of the endoscope inserted in the medical holding instrument in the state of FIG. The figure which shows the front-end | tip part of the holding | grip instrument for medical devices of the state which pulled up the hook needle | hook which hooked the wire of the intraperitoneal camera, and open | released the grip of the intraperitoneal camera The figure for demonstrating the state which showed the state which pulled up the hook needle | hook which hooked the wire of the camera installed in an abdominal cavity, and fixed the camera installed in an abdominal cavity to an abdominal wall The figure for explaining the procedure for fixing the intra-abdominal camera to the abdominal wall, showing the state in which the hook needle is pulled up and the fixing unit is lowered along the hook needle. Sectional drawing for demonstrating the effect | action of an extracorporeal device The figure which shows the state in which the fixing unit was installed on the abdomen and the intra-abdominal camera was fixed to the abdominal wall. FIG. 20 is a sectional view of the fixed unit and the intraperitoneal camera in the state of FIG. Same as above, an overall configuration diagram of an endoscope system showing a state in which the intra-abdominal camera is fixed to the abdominal wall The figure which shows the structure of the holding instrument for medical devices which concerns on 2nd Embodiment. The perspective view for explaining the rotating action of the wire retaining tube Sectional drawing for demonstrating the rotation effect | action of a wire retaining tube The figure which shows the photographed image of the flexible endoscope The figure which shows the state which concerns on 3rd Embodiment and the insertion part of the flexible mirror by which the hook unit was penetrated in the treatment tool channel was penetrated and arrange | positioned by the holding | grip instrument for medical devices. The figure which shows the state which hold | gripped the camera with the holding instrument for medical devices of FIG. Similarly, from the state of FIG. 28, the hook unit is pushed forward from the camera so that the hook needle can easily hook the wire. The figure which shows the photographed image of the camera The figure which shows the structure of the wire operating instrument which concerns on 4th Embodiment and has inserted and hold | gripped forceps. The figure which shows the state by which the holding forceps which hold | gripped the advancing / retreating operation tube and camera of FIG. 31 were penetrated in the trocar. In the same, in the abdominal cavity, the camera is led out from the trocar, and the advancing / retracting operation tube is slid forward relative to the grasping forceps, The figure which shows a state in which the grasping forceps which grasped the advancing / retreating operation tube and the camera are inserted into the treatment instrument channel of the flexible endoscope, showing a modification example, The figure which shows the state of the advancing / retreating operation tube which made the camera derive from the state of FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Endoscope system 2 ... Rigid endoscope 3 ... Extracorporeal device 4 ... Camera 5 ... Flexible endoscope 6 ... Gripping instrument 15 for medical equipment ... Fixed unit 16 ... Hook needle 18 ... Insertion part 19 ... Operation part 45 ... Wire 71 ... Grasping Part 72: Opening / closing jaw 73a ... Torsion spring 73 ... Holding pad 74 ... Link mechanism 77 ... Adapter inner pipe 81 ... Adapter outer pipe 83 ... Operation part 84 ... Grip 85 ... Trigger 86a ... Wire hook part 86 ... Wire retention tube 100 ... Patient 101 ... abdominal cavity 102 ... abdominal wall 110, 111 ... tracar

Claims (3)

  1. A medical device used in laparoscopic surgery,
    An imaging device having a predetermined angle of view;
    In a position spaced a predetermined distance from the imaging device, is introduced into the abdominal cavity, and a medical device as recordable compact imaging device with a large predetermined angle than the predetermined angle of view of the imaging device,
    A wire extending from the medical device;
    A gripping device for medical equipment, wherein the imaging device is inserted and arranged, and has a gripping portion for gripping the medical device and a hook portion for hooking the wire ;
    A medical device characterized by comprising:
  2. Furthermore, the medical equipment gripping instrument according to claim 1 in which the hook portion is arranged rotatably about the longitudinal axis, characterized in that a pivoting operably operating unit the hook portion Medical equipment.
  3. The medical appliance grasping instrument, as inserted arranged above the imaging device can photograph the wire of the medical device, wherein the graspable the medical device by the grip portion in the photographing region of the imaging device The medical device according to claim 1 or 2 .
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