JP6824507B2 - Endoscopic treatment device - Google Patents

Description

The present invention relates to an endoscopic treatment device that combines an endoscope and a treatment tool introduced into the body cavity through the channel of the endoscope to suture the tissue portion in the body cavity.

Conventionally, a procedure has been performed in which an endoscope and a treatment tool such as forceps or a scalpel are inserted into the body cavity to perform treatment in the body cavity.

As an endoscopic treatment device for performing this kind of procedure, the endoscope, the treatment tool used under the observation of the endoscope, and the endoscope and the treatment tool are advanced and retreated, respectively. An endoscopic treatment device including a plurality of inner tubes that can be freely inserted and an outer tube into which the inner tube can be inserted is known (see, for example, Patent Document 1).

In this endoscopic medical device, the tip of the endoscope is made to face the treated portion, the endoscope is advanced to protrude from an inner tube arranged in the center in the radial direction, and each treatment tool is advanced to the subject. The procedure is performed by projecting it from an inner tube placed around the endoscope.

International Publication WO2015 / 107994

However, in the endoscopic medical device, since the treatment tool is projected in parallel along the endoscope, the working space of the treatment tool is narrow, and the field of view of the endoscope is blocked by the treatment tool to narrow the field of view. There is an inconvenience of becoming. Further, since each of the treatment tools protrudes in the direction away from the endoscope, there is an inconvenience that it is difficult to grasp the sense of distance of each treatment tool.

In view of the above points, an object of the present invention is to provide an endoscopic medical device that can secure a sufficient working space and a field of view and can easily grasp a sense of distance.

In order to achieve such an object, the endoscopic treatment apparatus of the present invention includes a flexible endoscope, a flexible treatment tool used under the observation of the endoscope, and the above. An endoscopic treatment device including a plurality of flexible inner tubes into which the endoscope and the treatment tool can be inserted and retracted, and an outer tube into which the plurality of inner tubes can be inserted. Therefore, when the endoscope and the treatment tool are advanced, the endoscope and the treatment tool are attached to the respective tip portions of the inner tube toward the outer peripheral direction of the outer tube. A first bending operation portion is provided to bend and project the endoscope, and the tip portion of the endoscope and the treatment tool protruding from the inner tube is inside the endoscope and the treatment tool so as to project toward the inner circumference of the outer tube. It is characterized in that a second bending operation unit for bending the endoscope and the treatment tool is provided, respectively.

In the endoscopic treatment apparatus of the present invention, since the first bending operation portion for projecting the endoscope and the treatment tool is provided at the tip of each of the inner tubes, the inner tube has flexibility. When the endoscope and the treatment tool move forward in the inner tube, they are bent toward the outer peripheral direction of the outer tube by the first bending operation portion and protrude from the inner tube.

Then, since the second bending operation portion is provided at the tip portion of the endoscope and the treatment tool protruding from the inner tube, the outer tube is bent again in the inner peripheral direction.

Therefore, in the endoscopic treatment device of the present invention, the endoscope and the treatment tool are bent in the outer peripheral direction of the outer tube at the first bending operation portion and in the inner peripheral direction of the outer tube at the second bending operation portion. Since it is close to the part to be treated, the field of view and the work space can be widened. In addition, when performing a procedure on the treated portion with a plurality of treatment tools, the endoscope can see the movement of the plurality of treatment tools from a direction different from the advancing / retreating direction of each treatment tool, thus giving a sense of distance. It can be easily grasped.

In the endoscopic treatment device of the present invention, a third bending operation portion that is flexible, flexible, and can be held in a bent state is provided between the tip end and the base end of the outer tube. Is preferable.

According to this, since the inner tube inserted into the outer tube, the endoscope, and the treatment tool are all flexible, the outer tube can be held in the bent state at the third bending operation portion. ..

Further, in the endoscopic treatment apparatus of the present invention, a plurality of first engaging portions extending in the axial direction from the distal end side to the proximal end side are provided on the inner peripheral surface of the outer tube, separated in the circumferential direction. It is preferable that the outer peripheral surface of the inner tube is provided with a second engaging portion that extends in the axial direction from the tip end side to the proximal end side and slidably engages with the first engaging portion.

According to this, when the outer tube bends, each inner tube can slide in the outer tube in a state where the first engaging portion and the second engaging portion are engaged with each other, which hinders the bending of the outer tube. Each inner tube, the endoscope inserted therein, and the treatment tool can be bent while maintaining the positional relationship with the outer tube.

Explanatory drawing which shows the endoscopic treatment apparatus of embodiment of this invention. Explanatory perspective view showing the inside of the outer tube in an axial cross section. FIG. 1 Cross-sectional view of the endoscopic treatment device in FIG. Explanatory drawing which shows the inner tube of an endoscopic treatment apparatus. Explanatory drawing which shows the guide member of an endoscopic treatment apparatus. Explanatory drawing which shows the use state of an endoscopic treatment apparatus. It is explanatory drawing which shows the inner tube which concerns on the modification, FIG. 7A is a front view which shows the state attached to the outer tube, FIG. 7B is a front view of the inner tube, FIG. 7C is A- It is a cross-sectional view of line A.

The endoscopic treatment device 1 according to the embodiment of the present invention will be described with reference to FIG. The endoscopic treatment device 1 includes a flexible endoscope 2, forceps 3 (corresponding to the treatment tool of the present invention), and an inner tube used to assist the insertion of the endoscope 2 and forceps 3 into the body. 20 and an outer tube 30 into which the inner tube 20 is inserted are provided.

In the present embodiment, the forceps 3 will be described as an example of the treatment tool, but the treatment tool is not limited to this, and may be a scalpel, a grasping peeling forceps, or a biopsy forceps.

The outer tube 30 is a substantially tubular body whose base end portion projects outward in the radial direction, and is provided with a bendable portion 31 in the middle in the axial direction, and an air leakage prevention ring 32 and a valve are provided at the base end portion. A seat 32a (see FIG. 6) is attached.

In the present embodiment, the bent portion 31 is flexibly formed in a bellows shape by an elastomer. The bent portion 31 is not limited to a bellows shape, and may be formed of a soft plastic such as polypropylene or vinyl chloride, or a soft flexible material such as rubber.

On the other hand, of the outer tube 30, the distal end side and the proximal end side of the bent portion 31 are provided with a hard portion 30a that is harder than the bent portion 31. The hard portion 30a is made of a hard plastic such as ABS or polycarbonate or a hard material such as hard rubber.

The air leakage prevention ring 32 is adhered to the valve seat 32a. The air leakage prevention ring 32 is detachably attached to the main body of the outer tube 30. The valve seat is formed with a plurality of holes through which the inner tube 20 is inserted. As a result, it is possible to prevent air in the body cavity from leaking from a portion of the outer tube 30 in which the inner tube 20 is not inserted or an outer peripheral portion of the inner tube 20 in which the inner tube 20 is inserted.

Subsequently, the internal structure of the outer tube 30 will be described with reference to FIGS. 2 and 3.

The outer tube 30 has a guide portion 33 extending in the axial direction from the tip end side to the base end side on the inner wall surface. A plurality of the guide portions 33 are provided at equal intervals in the circumferential direction with respect to the inner wall surface. A rail member 40 can be sandwiched and attached to the guide portion 33.

As shown in FIG. 3, the rail member 40 has a bottom portion that extends narrowly in the circumferential direction from the lower end (outer surface) of the neck portion and a head that extends wide in the circumferential direction from the upper end (inner side surface) of the neck portion. It is formed in a substantially flat bottom rail shape by the portion. On the other hand, as shown in FIG. 3, the guide portion 33 has an inner surface shape that matches the outer surface shape of the neck portion and the bottom portion of the rail member 40, so that the rail member 40 can be sandwiched as described above. it can.

The rail member 40 is made of a hard material equal to or equivalent to the hard portion 30a, for example, a hard material such as ABS or polycarbonate or a hard material such as hard rubber, and is a long body having flexibility.

The bottom portion of the rail member 40 extends along the axial direction from the tip end side to the base end side on the outer surface, thereby forming a guided portion 41 that engages with the guide portion 33 of the outer tube 30 in the present invention. To do. The shape of the guided portion 41 is not limited to this, as long as it engages with the guide portion 33, and may be provided intermittently along the axial direction.

Further, as shown in FIG. 3, the head portion of the adjacent rail member 40 and the inner peripheral surface of the outer tube 30 constitute the first engaging portion 42 in the present invention.

The rail member 40 has the guided portion 41 engaged with the guide portion 33, and the tip portion thereof is fixed to the hard portion 30a on the tip end side of the outer tube 30 with an adhesive or the like. Other parts are not fixed to the outer tube 30. As a result, when the outer tube 30 is bent, each rail member 40 slides and follows and bends, so that the bending of the outer tube 30 is not hindered.

The inner tube 20 is inserted and attached so as to be sandwiched between the first engaging portions 42 of the outer tube 30, and the diameter and number of the inner tubes 20 can be freely changed according to the procedure.

As shown in FIG. 4, the inner tube 20 is a flexible tubular body, and a treatment tool such as an endoscope 2, forceps 3, or a scalpel can be inserted into the inner tube 20. The outer peripheral surface of the inner tube 20 is hydrophilically processed.

In the present embodiment, as shown in FIG. 3, the inner tube 20 is attached with a device having an outer diameter of 5.3 mm and a device having an outer diameter of 3.2 mm (shown by a virtual line) having different outer diameters. Also, those having the same outer diameter may be attached.

As shown in FIG. 4, the inner tube 20 is made of a soft plastic such as polypropylene or vinyl chloride, a soft material such as rubber to a soft portion 20a, and a hard plastic such as ABS or polycarbonate which is harder than the soft portion 20a. Hard portions 20b made of a hard material such as hard rubber are alternately coupled in the axial direction.

As shown in FIG. 4, the inner tube 20 has a second engaging portion 21 that engages with the first engaging portion 42 and is slidable from the tip end to the base end of the outer peripheral surface, and the insertion depth. It is equipped with a scale (not shown) for grasping.

In the present embodiment, the second engaging portion 21 is a wide rectangular protrusion protruding from the outer peripheral surface of the inner tube 20, but has an arbitrary shape as long as it can be engaged with the first engaging portion 42. be able to.

The second engaging portion 21 is intermittently provided in a part of the portion extending from the tip end to the base end of the inner tube 20. In the present embodiment, the hard portions 20b on the distal end side and the proximal end side are provided, respectively.

The inner tube 20 is attached to the outer tube 30 by sandwiching the second engaging portion 21 with the first engaging portion 42 of the outer tube 30. Specifically, the second engaging portion 21 of the inner tube 20 is attached to the first engaging portion 42 adjacent to the bent portion 31 of the outer tube 30.

Therefore, in the present embodiment, the soft portion 20a on the tip side is arranged inside the bent portion 31 of the outer tube 30, so that when the outer tube 30 is bent by the bent portion 31, the inner tube 20 bends. Do not interfere.

Further, since the second engaging portion 21 of the inner tube 20 is slidable with respect to the first engaging portion 42 of the outer tube 30, each inner tube 20 slides when the outer tube 30 is bent. Since it follows and bends while following, the bending of the outer tube 30 is not hindered from this configuration as well.

On the other hand, the soft portion 20a on the proximal end side is inserted into the valve seat of the air leakage prevention ring 32, and a part thereof protrudes from the proximal end of the outer tube 30. Since the soft portion 20a can be bent, the inner tube 20 can be bent outward in the radial direction, and interference between the endoscope 2 and the base end portion of the forceps can be avoided.

A bendable swing pipe 22 and a nose cover 23 are attached to the tip of the inner tube 20.

The swing pipe 22 is a pipe having flexibility in which thin ring-shaped members are connected in an articulated manner and can be bent only in any one direction. For example, the swing pipe 22 is configured as a processed product of a stainless steel pipe and is straightened. It can be configured as a bending mechanism that bends in only one direction from the state. Further, the swing pipe 22 can also be configured by connecting a pipe made of a flexible soft material or a ring made of a hard plastic material such as ABS or polycarbonate.

The nose cover 23 is fixed to the tip of the swing pipe 22. The nose cover 23 is made of a plastic similar to or softer than the swing pipe 22, for example, a soft plastic such as vinyl chloride, rubber, or the like. Since the nose cover 23 is made of a soft material, it does not damage the tissue even if it comes into contact with the tissue.

On the other hand, a slide pipe 24, slide knobs 25a and 25b, a slide stopper 26, and a degassing prevention valve 27 are attached to the base end portion of the inner tube 20.

Wire members 28a and 28b are attached to the inner tube 20 from the tip end side to the base end side. Specifically, the tip portions of the wire members 28a and 28b are fixed to the nose cover 23, pass through the outside of the swing pipe 22, and are shafted in the order of the hard portion 20b, the soft portion 20a, the hard portion 20b and the soft portion 20a. It is embedded along the direction, extends rearward from the base end portion of the inner tube 20, and the base end portion is fixed to the slide knobs 25a and 25b.

The slide knobs 25a and 25b are configured to be slidable with respect to the slide pipe 24. Therefore, when the tip of the inner tube 20 protrudes from the tip of the outer tube 30, the swing pipe 22 is bent outward in the radial direction by pulling the slide knob 25a toward the base end side. be able to. On the contrary, by pulling the slide knob 25b toward the base end side, the swing pipe 22 can be returned to a straight line without bending.

The slide knobs 25a and 25b are provided with a through hole extending toward the slide pipe 24, and a slide stopper 26 having a protrusion inserted into the through hole at the tip thereof is attached.

Therefore, with the slide knob 25a or the slide knob 25b being pulled, the slide stopper 26 is pushed in and frictionally engaged with the slide pipe 24 to lock the slide knobs 25a and 25b at the desired positions to be pulled. Can be done.

The swing pipe 22, the slide knob 25a, and the wire member 28a correspond to the first bending operation portion of the present invention.

The degassing prevention valve 27 prevents air from leaking from the body cavity, for example, the abdominal cavity, from the inner tube 20 into which the treatment tool is not inserted.

Next, a means for holding the bending of the outer tube 30 will be described with reference to FIG.

The guide member 60 is engaged with a portion of the first engaging portion 42 of the outer tube 30 to which the inner tube 20 is not attached.

As shown in FIGS. 3 and 5, the guide member 60 is a long member in which the engaged portion 61 engaged with the first engaging portion 42 is formed along the axial direction. In the present embodiment, the engaged portion 61 is a wide rectangular protrusion protruding from the outer peripheral surface of the inner tube 20, but may have an arbitrary shape as long as it can be engaged with the first engaging portion 42. Can be done.

The guide member 60 includes a substantially cylindrical main body portion 62 and a shaft portion 63 inserted into the main body portion 62.

The main body 62 is provided with windows 62a intermittently along the axial direction. The base end portion of the main body portion 62 has a cross section having a substantially fan strip and a circular hole at the top thereof. The main body portion 62 is made of a hard material having the same or the same hardness as the hard portion 20b of the inner tube 20. The shaft portion 63 has a substantially columnar shape and is made of a semi-hard material such as a wire or a copper wire.

As a result, when the outer tube 30 is bent by the bent portion 31, the outer tube 30 is held in the bent state by the shaft portion 63. Further, since the main body portion 62 is provided with the window portion 62a, it does not hinder bending.

The bent portion 31 and the guide member 60 correspond to the third bent operating portion of the present invention.

As shown in FIGS. 1 and 6, a treatment tool such as an endoscope 2 and forceps 3 is inserted into the inner tube 20.

The endoscope 2 and the forceps 3 each have a bending portion 2a, 3a that can be bent at the tip end portion, and a driving unit 70 that operates the bending portion 2a, 3a at the base end portion.

The drive unit 70 includes a motor 71, a drive side pulley 72, a wire 73, and a driven side pulley 74.

The motor shaft of the motor 71 is connected to the drive-side pulley 72, and one end of the wire 73 is bridged over the drive-side pulley 72. The wire 73 is accommodated so as to be movable in the axial direction inside the endoscope 2 and the forceps 3, and the other end thereof is bridged to the driven pulley 74.

Therefore, when the motor 71 is rotated, the drive side pulley 72 is rotated, the wire 73 is moved, the driven side pulley 74 is rotated, and the bent portions 2a and 3a are bent.

As a result, the camera 2b and the forceps portion 3b provided at the tip of the endoscope 2 can be bent inward in the radial direction so as to face the portion to be treated.

The bent portions 2a and 3a and the driving portion 70 correspond to the second bending operating portion of the present invention.

The ON / OFF operation unit of the motor 71 may be a manual type or a mechanical control type. It is also possible to manually pull the wire without using a motor.

Further, the bent portions 2a and 3a can be formed in a bent shape and can be bent in a straight line. That is, the bent portions 2a and 3a are inserted into the inner tube 20 in a linearly extended state from the bent state, and according to this, the endoscope 2 is advanced and the bent portions 2a and 3a are inserted into the inner tube 20. When the bent portions 2a and 3a are projected from the nose cover 23 of the above, the bent portions 2a and 3a return to the original bent state, so that the bent portions 2a and 3a can be bent inward in the radial direction without providing the driving portion 70 operating portion. ..

Next, a method of using the endoscopic treatment device 1 will be described with reference to FIGS. 1 and 6. In this embodiment, a case where laparoscopic surgery (raparo) is performed will be described. However, the endoscopic treatment device 1 can also be used when performing other surgical methods, for example, natural meat transluminal endoscopic surgery (NOTES).

First, a retractor 80 attached to the opening formed on the body wall to maintain the open state of the opening and protect the opening, and an opening 80 attached to the opening 80. A valve cap 81 for a retractor is attached so that the endoscopic treatment device 1 can be introduced from the opening formed by the above and the airtightness of the abdominal cavity can be maintained.

Next, the inner tube 20 is inserted into the outer tube 30 and attached.
In the present embodiment, as shown in FIG. 1, the endoscope 2 is attached upward and the forceps 3 are arranged in the left-right direction at intervals of 60 degrees in the circumferential direction. At this point, the inner tube 20 is in a state of being buried without protruding from the tip of the outer tube 30.

Next, the endoscope 2 and the forceps 3 are inserted into the inner tube 20, respectively. At this time, the endoscope 2 and the forceps 3 are in a state of being buried without protruding from the tip of the inner tube 20.

Next, if necessary, when the outer tube 30 is bent by the bending portion 31 at an angle at which the endoscope 2 and the forceps 3 are likely to face the treated portion C, the bent state is maintained by the guide member 60. ..

The endoscopic treatment device 1 prepared as described above is inserted into the body cavity via the valve cap 81 for a retractor.

Next, the inner tube 20 is advanced, protrudes from the tip of the outer tube 30, and the slide knob 25a is pulled to bend the swing pipe 22 radially outward of the outer tube 30.

Next, the endoscope 2 is advanced and protrudes from the tip of the inner tube 20. Then, by operating the operation unit for the endoscope, the endoscope 2 is bent inward in the radial direction by the bending portion 2a to face the treated portion C.

Further, the forceps 3 are advanced, protruded from the tip of the inner tube 20, and the operating portion for the treatment tool is operated to bend the forceps 3 radially inward at the bending portion 3a and bring the forceps 3 closer to the treated portion C.

With the above, the preparation is completed and the procedure can be performed.

In the endoscopic treatment device 1 of the present embodiment, the inner tube 20 bends outward in the radial direction, and then the endoscope 2 and forceps 3 bend inward in the radial direction.

As a result, the forceps 3 can be brought closer from the left-right direction while observing the treated portion C from a bird's-eye view with the endoscope 2, so that the field of view and the work space can be widened and a sense of distance can be easily grasped. can do. Since the endoscope 2 and the forceps 3 need only be provided with one bending portion each in order to bend inward in the radial direction, it is not necessary to increase the number of joints, and the device can be miniaturized and reduced in price. Can be done.

Further, in the endoscopic treatment device 1 of the present embodiment, since the endoscope 2 is arranged upward and the forceps 3 are arranged in the left-right direction, the positions are the same as those of the eyes and the left and right hands when the operator performs laparotomy. Can be placed in. Therefore, if the forceps 3 is used as a robot forceps and can be operated as a manipulator by an operation device, the operator can perform the procedure with the same feeling as that of open surgery.

Although the embodiment of the present invention has been described above, the present invention is not limited to this, and the configuration and the form of the forming apparatus can be changed as appropriate. For example, the outer tube 30 and the plurality of rail members 40 may be integrated to form the first engaging portion 42. Further, the soft material, the hard material and the semi-hard material may be materials in which the softness and hardness are adjusted by changing the composition of the same type of resin.

[Modification example]
The inner tube 120 according to the modified example will be described with reference to FIGS. 7A to 7C.

The inner tube 120 is a long member having a fan-shaped shaft cross section extending along the axial direction from the tip end side to the base end side.

The inner tube 120 has a through hole in the axial direction from the tip end surface to the base end surface. The through hole is composed of a linear guide passage 121 along the axial direction from the base end toward the tip end, and a bending guide passage 122 in which the base end is continuously provided and bent at the tip end of the linear guide passage 121. The tip of the bending guide passage 122 opens on the tip surface of the inner tube 120, and the opening 123 is formed.

Therefore, when the endoscope 2 or the forceps 3 is inserted into the inner tube 120 and advanced, the endoscope 2 and the forceps 3 are bent by the bending guide passage 122 and are radially outward from the opening 123. It is projected to.

Then, as shown in FIG. 7A, the inner tube 120 has a substantially columnar shape when three pieces are combined, so that the endoscope 2 and the forceps 3 are projected substantially radially.

Therefore, according to the inner tube 120, the endoscope 2 and the forceps 3 can be bent outward in the radial direction with a simple structure.

1 ... Endoscopic treatment device, 2 ... Endoscope, 2a ... Bending part, 3 ... Forceps (treatment tool), 3a ... Bending part, 20 ... Inner tube, 21 ... Second engaging part, 22 ... Swing pipe , 25 ... slide knob, 28 ... wire member, 30 ... outer tube, 31 ... bent part, 42 ... first engaging part, 60 ... guide member, 70 ... drive part 70.

Claims (2)

A flexible endoscope and a flexible treatment tool used under the observation of the endoscope.
A plurality of flexible inner tubes into which the endoscope and the treatment tool can be inserted and retracted, respectively,
An endoscopic treatment device including a flexible outer tube into which a plurality of the inner tubes can be inserted.
At the tip of each of the inner tubes, when the endoscope and the treatment tool are advanced, the endoscope and the treatment tool are bent in a direction away from the axis of the outer tube. A first bending operation part is provided so that the portion is projected.
At the tip of the endoscope and the treatment tool protruding from the inner tube, a second bending operation portion for bending the endoscope and the treatment tool toward the axis of the outer tube is provided. Each is provided,
The outer tube includes a plurality of first engaging portions extending in the axial direction from the tip end side to the proximal end side, separated from the inner peripheral surface in the circumferential direction, and a bent portion that can be bent in the middle in the axial direction. When the outer tube is detachably engaged with the first engaging portion and extends in the axial direction of the outer tube including the position corresponding to the bent portion, and the outer tube is bent at the bent portion, the outer tube is bent. endoscopic treatment device comprising a Turkey that having a guide member for holding in a bent state. A flexible endoscope and a flexible treatment tool used under the observation of the endoscope.
A plurality of flexible inner tubes into which the endoscope and the treatment tool can be inserted and retracted, respectively,
An endoscopic treatment device including a flexible outer tube into which a plurality of the inner tubes can be inserted.
At the tip of each of the inner tubes, when the endoscope and the treatment tool are advanced, the endoscope and the treatment tool are bent in a direction away from the axis of the outer tube. A first bending operation part is provided so that the portion is projected.
At the tip of the endoscope and the treatment tool protruding from the inner tube, a second bending operation portion for bending the endoscope and the treatment tool toward the axis of the outer tube is provided. Each is provided,
The inner tube is a long member having a fan-shaped shaft cross section extending along the axial direction from the tip end side to the base end side.
The inner tube has a through hole in the axial direction from the tip end to the base end.
The through hole is a linear guide passage extending in the axial direction from the base end of the inner tube toward the tip, and is connected to the tip of the linear guide passage in a radial direction to the tip of the inner tube. An endoscopic treatment device characterized by comprising a flexion guide passage extending while flexing.