JPH0474014B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Field of Application] The present invention is used in intracranial surgery, and particularly relates to procedures such as suction removal of damaged areas such as intracerebral hemorrhage and brain tumors.

[Prior art and problems to be solved by the invention] Typical cerebrovascular disorders include cerebral hemorrhage and subarachnoid hemorrhage. In order to remove intracerebral hematomas and the like after these intracerebral hemorrhages, CT has recently been shown in, for example, "Neurosurgery" Vol. 14, No. 2, February 1986.
(Computer tomography) Stereotactic brain surgery is being performed using the guidance method.

Stereotactic neurosurgery involves fixing a stereotactic neurosurgery device to the patient's head, positioning the device to the affected area in the brain, and moving treatment tools such as drainage tubes to the affected area. insert,
Surgery is performed, and by using CT to capture and position the affected area using tomographic images, the accuracy of positioning has improved, making it possible to minimize the invasiveness to the patient.

The surgical equipment used for this stereotaxic brain surgery is
61-25377. This is a technique in which a surgical target site in the brain is determined using CT, a sheath is punctured at this target point using a surgical device attached to the skull, and hematoma and the like are removed by suction through the sheath.

By the way, a method of removing intracerebral hematoma in stereotactic brain surgery involves inserting a metal suction tube into the hematoma and suctioning out the hematoma with a suction device such as a syringe. If this method cannot completely remove the hematoma, an indwelling tube is placed in the hematoma cavity, a hematoma lysing agent such as Urokinase is injected, and after several hours the dissolved hematoma is suctioned out from the indwelling tube. Hematoma lysis is being performed. Furthermore, in recent years, a method of crushing a hematoma using an ultrasonic suction device and removing the hematoma by suction is also being practiced. Stereotaxic brain surgery is also used to perform biopsies of brain tumors, ablation treatments using Nd-YAG laser light, and the like.

By the way, in stereotaxic intracerebral hematoma removal using the CT guidance method, the hematoma aspiration situation cannot be observed in real time and the surgical operation is performed blindly, so there is a very high risk of damaging the brain parenchyma. If you try too hard to avoid it, you may not be able to completely remove the intracerebral hematoma. Furthermore, in order to avoid damaging the brain parenchyma, the surgical operation must be performed while sequentially checking the status of hematoma aspiration using CT, which results in an extremely long surgical time and is highly invasive to the patient. Furthermore, the fatigue of the operator becomes extremely large.

Using a suction device such as a syringe to remove the hematoma by suction has the risk of aspirating the brain parenchyma due to the highly viscous nature of the hematoma, and the hematoma tends to clog the lumen of the suction tube. , there is a problem in that the surgery often has to be interrupted. In order to prevent hematoma from clogging, the diameter of the suction tube must be increased, which increases the degree of damage to the brain parenchyma.

In the hematoma lysis method, the dissolving ability of the hematoma lysing agent is very small, so it is not clinically satisfactory, and there is a risk of infection due to long-term catheter indwelling and frequent administration of the lysing agent. Long-term indwelling causes great pain to patients.

Although the method using an ultrasonic suction device is very effective, there is a risk of damaging the brain parenchyma due to blind operation, and there is no device to fix the ultrasonic suction device and move it forward and backward, so it is necessary to use the device manually. Since the robot must be held in position while moving forward and backward, there is a risk of damage to the brain parenchyma due to incorrect operation.

The above-mentioned problems are common to conventional stereotactic brain surgery, not only for aspiration removal of intracerebral hematoma but also for brain tumor surgery.

[Object of the Invention] The present invention has been made in view of the above circumstances, and it can safely and reliably treat disorders in a short period of time while directly observing the treatment status of disorders such as hematomas and tumors in real time. An object of the present invention is to provide an endoscope device that can perform partial treatment.

[Means and effects for solving the problems] The endoscope apparatus of the present invention includes a first connection part that can be detachably connected to the telescope hand part between the telescope and the treatment instrument, and a treatment instrument. a second connection part that can be detachably connected to the telescope; a hollow part that communicates with the channel of the telescope and can accommodate the treatment tool; a sliding means for moving the treatment tool forward and backward with respect to the telescope; and a fixing means for fixing the telescope at a desired position to the telescope.

That is, the treatment tool is inserted into the patient's head and positioned by the sliding means of the adapter.

[Example] Hereinafter, an example of the present invention will be described with reference to the drawings.

1 to 10 relate to the first embodiment of the present invention, FIG. 1 is a sectional view of the adapter, and FIG. 2 is a sectional view of the adapter.
3 is an external view of the slide device, 4 is a sectional view of the support body, 5 is a sectional view of the support body fixed with a presser belt, 6 is an explanatory diagram of the sliding state shown in the figure.
The figure shows a sectional view of the support body fixed with the presser arm, Fig. 7 is a sectional view of the telescope, Fig. 8 is a sectional view of the sheath, Fig. 9 is an outline drawing of the mandolin, and Fig. 10 is a sectional view of the endoscope device. It is an overall configuration diagram.

In this embodiment, the present invention is applied to a brain surgery device.

In FIG. 10, an endoscope device 1 includes a sheath 2, a telescope 3, an adapter 4, and a stereotactic brain surgery device 5.
and an ultrasonic suction device 6 and a fixing device 7 as treatment instruments.
and a generator 8.

The head 9 of the patient is attached to the ring 1 of the stereotactic neurosurgery device 5.
1 and provided on this ring 11.
The book head is fixed to the stereotactic neurosurgery device 5 by a head fixing pin 12 . One side of the ring 11 is slidable in the X, Y, and Z directions,
A positioning device 13 that can rotate in the α direction is provided, and a curved arm 14 is connected to the positioning device 13. The arm 14 is provided with the sheath 2 so as to be slidable in the β direction. Further, at the top of the ring 11, a fixing device 7 is provided in which a curved arm 16 for holding the sheath 2 together with an arm 14 is connected.

The sheath 2 is held by a sheath holder 17 by an arm 14 and an arm 16. Furthermore, this sheath holder 17 supports a slide device 19 via a support 18.

The sheath 2 has an eyepiece part 21 diagonally rearward on the side.
The telescope 3 is connected thereto, and the adapter 4 to which the ultrasonic suction device 6 is connected is provided behind the telescope 3. A light guide 22 that can supply illumination light is connected to the telescope 3, and a water supply tube 23 that can supply irrigation fluid such as physiological saline is connected to the sheath 2.

A cord 2 is connected from the rear end of the ultrasonic suction device 6.
4 and the drainage tube 26 extend, and the cord 24
is connected to the generator 8, and the drainage tube 26 is connected to a collection bin 27 for collecting the waste fluid associated with the generator 8. This collection bin 2
A tube 28 extending from 7 is connected to a drainage container (not shown) via a pump 29.

In FIG. 3, the support 18 includes a support member 31 and a support body 33. This support member 31
is interposed between the distal end of the arm 14 and the rotating member 30 supported by the arm 16 to hold the sheath 2, and the support body 33 is provided on the rear end surface of the support member 31. and is fixed to the support member 31 by a fixing screw 32. Rod-shaped support shafts 34, 34 are provided on the rear end surface of the support body 33 in parallel to the axial direction of the sheath 2, and the slide device 19 is supported. This slide device 19 is constructed by sandwiching the two support shafts 34, 34 between a slide body 36 and a fixing plate 37, and using a fixing screw 38 that passes through the fixing plate 37 and is screwed into the slide body 36. It is fixed to support shafts 34, 34. A support body 39 is provided on the top of the slide body 36 so as to be slidable in the axial direction of the sheath 2. The adapter 4 is fixed to the upper part of the support body 39.

A rack (not shown) is provided on the upper surface of the slide body 36 in the axial direction of the sheath 2, and is adapted to mesh with a pinion (not shown) provided in the support body 39. Both ends of this pinion project from the support body 39, and a knob 41 is fixed to the projecting ends. By rotating this knob 41, the support body 39 can be moved in the axial direction.

A reference line 35 is provided on the side surface of the slide body 36.
Further, a scale 40 is engraved on the side surface of the support body 39, so that the amount of movement of the support body 39 by rotating the knob 41 can be visually observed.

In FIG. 4, the adapter 4 is attached to the support body 39.
The adapter 4 is sandwiched between a presser plate 43 which is fixed to the support body 39 by a fixing screw 42, and the adapter 4 can be fixed to the support body 39 by screwing in the fixing screw 42. I'm starting to be able to do it. Further, a fixing screw 44 is screwed into the lower surface of the slide body 36, and the tip of this fixing screw 44 comes into contact with the lower surface of the support body 39, and by pressing it, the support body 39 can be positioned. It's becoming like that.

The method of fixing the adapter 4 is as shown in FIG.
One end is supported by a fixing screw 46 and is wrapped about half a circumference by a presser belt 47 fixed to the main body 39, and the other end is locked to a pin 48 provided on the support main body 39, thereby fixing the adapter 4. Good too.

Further, as shown in FIG. 6, a presser arm 51 is provided on the upper part of the support body 39 via a hinge 49, and the adapter 4 is sandwiched between the support body 39 and the presser arm 51. 50 may be fixed by being locked to the supporting body 39.

In FIG. 7, the telescope 3 includes a rigid and elongated insertion section 52, a large-diameter operation section 53 connected to the rear of the insertion section 52, and a large-diameter operation section 53 connected to the rear of the insertion section 52.
The eyepiece section 21 is provided diagonally to the rear from the side of the operating section 53, and the treatment instrument attachment section 56 is provided at the rear end of the operating section 53.

The insertion section 52 is composed of a lens tube 57 and a light guide tube 58.
passes through the operating section 53 and is inserted up to the vicinity of the region from which the eyepiece section 21 extends.

The operating section 53 includes an operating section main body 55 having the eyepiece section 21 and a treatment instrument attachment section 56, and a connection that is slidably provided on the front end of the operating section main body 55 and is fixed after being positioned. It is composed of a member 59. This connecting member 59 is adapted to connect the sheath 2 inserted through the insertion section 52 to its distal end.

The lens tube 57 includes an objective lens system 61;
The refractive index gradient lens 62 is provided behind the objective lens system 61. light guide tube 5
A light guide fiber 63 is inserted through 8, and after the light guide fiber 63 is adhesively fixed at the object side end of the light guide tube 58,
The front end surface 64 is polished and the illumination light is transmitted to the front end surface 64.
It has become possible to emit more radiation. The light guide fiber 63 is inserted into the light guide tube 58 and bent laterally within the operating section 53.
The end face 67 is polished after being adhesively fixed to a light guide base 66 extending on the side of the light guide. This end surface 67 serves as an incident surface for illumination light supplied from a light source device (not shown).

A positioning member 68 is fitted and fixed to the rear end side of the connecting member 59. This positioning member 6
Reference numeral 8 denotes a fixing hole 69 into which the rear end portion of the refractive index gradient lens 62 exposed from the lens tube 57 is inserted.
Further, a channel tube 72 is provided which forms a treatment instrument channel 71 that is inserted from the front end surface of the connecting member 59 into the operating section main body 55 in parallel with the lens tube 57 and reaches the treatment instrument attachment section 56.
is now penetrating.

A lens 76 is provided on the rear end surface of the gradient index lens 62 inserted into the fixing hole 69 .

An eyepiece tube 79 is attached to the eyepiece section 21 . An eyepiece system frame 83 is provided within the eyepiece tube 79 to which a triangular prism 81 and a trapezoidal prism 82 are attached, which are provided behind the lens 76 so as to bend the optical axis of the observation optical system. . An eyepiece exterior 84 is provided at the rear end of the eyepiece tube 79, and an eyepiece 86 is further provided at the rear end of this eyepiece exterior 84.

The treatment instrument mounting portion 56 includes a closing member 88 that is fitted into the rear end of the operating section main body 55 and fixed by a screw 87, and a detachable ring 89 is screwed into the rear end of the closing member 88. Therefore, it is provided with a treatment tool adapter 91 that can be detachably attached.

The outer peripheral surface into which the closing member 88 fits is kept airtight by the operation section main body 55 and an O-ring 92, and furthermore, a hole 93 into which the channel pipe 72 fits is provided in the center. is beginning to form. This hole 93 has a channel pipe 7.
2, an O-ring 94 is disposed to maintain airtightness between the two.

The treatment tool adapter 91 is kept airtight by an O-ring 90 and is fitted and fixed to the closing member 88, and has the treatment tool channel 71 on the rear end surface.
The adapter body 97 includes a treatment instrument insertion port 96 that communicates with the adapter body 97 and a socket 98 that can open and close the treatment instrument insertion port 96. A lever 95 is provided at the upper part of the socket 98, and a nut 99 is screwed into the lower part of the socket 98 so as to attach the socket 98 to the adapter main body 97.

In FIG. 8, the insertion section 52 of the telescope 3 is inserted through the upper part of the sheath insertion section 100 fixed to the sheath holder 17. A large-diameter main body part 101 is connected to the rear end of the sheath insertion part 100, and a connecting member 59 provided at the front part of the telescope 3 is further connected to the rear end of this main body part 101. A connecting portion 102 is provided so that the distal end thereof can be detachably connected. The main body portion 101 is provided with a pot 103 to which the water supply tube 23 is connected.

A telescope 3 is provided in the sheath insertion section 100.
The probe 104 of the ultrasonic suction device 6 is inserted together with the insertion portion 52 of the ultrasonic suction device 6 . This probe 10
4 is inserted through the treatment instrument channel 71, and its distal end protrudes from the sheath insertion section 100 and comes into contact with the hematoma 106.

When inserting the sheath insertion portion 100 into the brain, a mandoline 107 as shown in FIG. 9 is inserted into the sheath 2 and punctured.
This mandolin 107 has a tip portion 108 formed with a convex portion that is easy to puncture, and a tip portion 108.
an elongated insertion portion 109 connected to the rear of 08;
The insertion portion 109 includes a large-diameter connecting portion 111 connected to the rear end of the insertion portion 109 and a grip 112 provided on the rear end surface of the connecting portion 111.
1 can be detachably connected to the connecting portion 102 of the sheath 2.

As shown in FIGS. 1 and 2, the adapter 4 is connected to the rear end of the telescope 3 from which the treatment instrument attachment portion 56 has been removed.

The adapter 4 includes an adapter body 113 and a slide member 114. A connecting member 116 as a first connecting portion is fitted and fixed in the front end of the adapter body 113, and a detachable ring 115 rotatably provided by the connecting member 116 is attached to the telescope 3. Operation unit 53
It is provided so that it can be detachably connected to.

The adapter 4 is attached to the front end surface of the connecting member 116.
an O-ring 117 to prevent leakage of perfusion fluid inside the skull; and an O-ring 118 to suppress the vicinity of the vibration nodes of the probe 104 to prevent the broken probe 104 from falling into the skull if the probe 104 breaks. and is provided.

The adapter body 113 has a cylindrical shape with a hollow part 124, and the slide member 1 is attached to the rear part of the adapter body 113.
14 is slidably fitted inside.

A horn 119 of the ultrasonic suction device 6 is installed inside the slide member 114, and a probe 1 that communicates between the inside of the adapter body 113 and the inside of the sheath insertion section 100 is attached to the tip of the horn 119.
04 is fastened by a connecting portion 121. Further, a threaded portion 120 as a second connection portion is provided at the rear end of the slide member 114, and a cover 120 of the ultrasonic suction device 6 is attached to this threaded portion 120.
The tips of the two are connected by screwing together. An O-ring 12 is installed between the slide member 114 and the horn 119.
3 is provided to prevent perfusion fluid from flowing into the ultrasonic suction device 6. An O-ring 126 is provided at the portion of the outer peripheral surface of the slide member 114 that is inserted into the adapter body 113.
The interior of the adapter 4 is kept watertight to prevent perfusion fluid from leaking outside.

Cam grooves 127 are provided circumferentially on the circumference of the adapter body 113 and spirally on the circumference of the slide member 114, and a rotatable cam ring 128 is provided on the outer circumference of the adapter body 113. A cam pin 129 fixed to is engaged in the cam groove 127. Further, a groove 131 is provided in the axial direction on the outer circumference of the slide member 114, and the tip of a guide pin 132 that is screwed inward from the outer circumference of the adapter body 113 engages in the groove 131. has been done. When this cam ring 128 is rotated, the cam groove 127
The cam pin 129 is adapted to slide along. Adapter main body 113 and slide member 11
4 means that the positional relationship in the circumferential direction is regulated by the guide pin 132, so this cam pin 129
As the slide member 114 moves within the cam groove 127, the slide member 114 can move in the axial direction of the adapter body 113. As the slide member 114 moves in the axial direction with respect to the adapter body 113, the probe 104 can move in the axial direction with respect to the adapter body 113.

In this way, the cam groove 127, the cam ring 128, the cam pin 129, the groove 131, and the guide pin 132 constitute a sliding means.

A reference line 133 is engraved in the axial direction on the outer peripheral surface of the cam ring 128.
The axial movement distance of the cam ring 128 relative to the adapter body 113 from the position of the reference line 133 and the scale 137 engraved on the scale ring 136 fixed on the outer peripheral surface of the adapter body 113 by the probe The amount of protrusion of the tip 104 from the sheath insertion section 100 can be determined.

A fixing screw 138 as a fixing means is provided at the upper rear end of the outer circumference of the adapter body 113. By screwing in this fixing screw 138, the tip of the fixing screw 138 presses the outer circumferential surface of the slide member 114. and slide the slide member 114 onto the adapter body 11.
3 at a desired position, and by loosening the fixing screw 138, the slide member 114 can be slid relative to the adapter body 113.

FIG. 1 shows a state in which the slide member 114 is retracted to the minimum, and in this state, the probe 1
The distal end surface of 04 is adapted to protrude from the sheath insertion section 100. Furthermore, FIG. 2 shows the slide member 114 in a fully extended state,
In this state, the distal end surface of the probe 104 is flush with the end surface of the sheath insertion section 100, or is slightly retracted.

The operation of the endoscope device 1 configured as described above will be explained.

The sheath 2 is fixed to a sheath holder 18 supported by the arms 14 and 16 of the stereotactic neurosurgical device 5.

Then, with the probe 104 of the ultrasonic suction device 6 attached to the horn 119, the slide member 1
The cover 1 is attached to the threaded portion 120 provided at the rear end of the cover 14.
22 is screwed in until it contacts the rear end of the slide member 114.

After that, the slide member 1 constituting the adapter 4
14 with respect to the adapter body 113 in the state shown in FIG.
16 to the telescope 3.

Support body 39 of slide device 19 to adapter 4
is fixed, and the slide device 19 is inserted into the support shafts 34, 34 so that the insertion portion 52 of the telescope 3 and the probe 104 are inserted into the sheath 2.

The telescope 3 and the ultrasonic suction device 6 of the adapter 4 are slid toward the sheath 2 side, and the connecting portion 102 of the sheath 2 and the connecting member 116 of the telescope 3 are connected. In this state, the tip of the probe 104 is flush with the tip of the sheath insertion section 100, or is slightly retracted.

Loosen the fixing screw 138 and rotate the cam ring 128 with respect to the adapter body 113, and move the slide member 114 to the scale 137 with respect to the adapter body 113.
While reading this, move it forward to the desired position.
Then, the fixing screw 138 is tightened again to fix the adapter body 113 and the slide member 114. In this state, the amount of protrusion of the tip of the probe 104 from the end surface of the sheath insertion section 100 is set.

By rotating the knob 41 provided on the slide device 19 and moving the sheath 2, telescope 3, adapter 4, and ultrasonic suction device 6 forward and backward together, hematoma and the like can be safely suctioned and removed.

According to this embodiment, the amount of protrusion of the probe 104 from the distal end of the sheath insertion section 100 can be set to a desired value, and there is no danger of the probe 104 being inadvertently protruded, so that surgery can be performed safely.

In addition, zero point adjustment is possible by assembling the sheath 2, telescope 3, adapter 4, and ultrasonic suction device 6 before surgery, and during surgery, the slide member 114 is adjusted based on the zero point scale. This allows the protrusion amount of the probe 104 to be accurately grasped at hand.

Further, even if the operator releases the ultrasonic suction device 6, the probe 104 does not protrude, so it is extremely safe.

Furthermore, since the probe 104 is elastically held by the O-ring 118, it is safe because the probe 104 will not break at the welded portion with the connecting portion 121 and fall into the skull.

Furthermore, since the surgery is performed while looking directly through the telescope 3, the risk of accidentally damaging a normal part is reduced.

11 and 12 relate to a second embodiment of the present invention, in which FIG. 11 is a sectional view of the adapter, and FIG. 12 is a sectional view taken along the line A-A' in FIG. 11.

The adapter 4 includes an adapter body 142 and a slide member 143. A connecting member 116 as a first connecting portion is fitted and fixed in the front end of the adapter body 142, and a detachable ring 115 rotatably provided by this connecting member 116 is used to operate the telescope 3. It is provided so that it can be detachably connected to the section 53.

The adapter 4 is attached to the front end surface of the connecting member 116.
an O-ring 117 for preventing leakage of perfusion fluid within the skull; and an O-ring 118 for pressing the vibrating node of the probe 104 to prevent the broken probe 104 from falling into the skull if the probe 104 breaks. and is provided.

The adapter main body 142 has a cylindrical shape with a hollow portion 144, and a sliding surface 145 as a sliding means is formed on the inner surface of the cylinder. This sliding surface 14
A sliding surface 149 formed in a cylindrical shape provided at the front part of the sliding member 143 is slidably fitted inside the sliding member 5 . A slot 146 is provided in the rear part of the adapter body 142 in the axial direction, and a tightening screw 147 as a fixing means is provided in a direction perpendicular to the slot 146. It is now possible to fix the

A scale 148 is provided on the outer peripheral surface of the portion of the slide member 143 that is inserted into the adapter body 142.
42, i.e., probe 104
The protrusion amount of the tip can be set to a desired amount.

The horn 119 of the ultrasonic suction device 6 is installed inside the slide member 143, and a threaded portion 120 as a second connection portion is provided at the rear end of the slide member 143. The cover 122 of the ultrasonic suction device 6 is attached to this threaded portion 120.
The tips of the two are connected by screwing together.

To advance and retreat the adapter 4 configured as described above, loosen the tightening screw 147 and move the slide member 1 against the adapter body 142 fixed to the slide device 19.
43 to move the probe 104 forward or backward.

The amount of protrusion of the probe 104 can be determined as desired by reading the scale 148.

According to this embodiment, compared to the first embodiment, the configuration of the sliding means can be simplified and the adapter 4 can be made smaller and lighter.

Other configurations, operations, and effects are the same as those in the first embodiment.

FIG. 13 is a sectional view of an adapter fixing part according to a third embodiment of the present invention.

A threaded portion 162 is threaded onto the outer circumferential surface of the rear end portion of the adapter body 161 constituting the adapter 4, into which a tightening nut 163 is screwed. Furthermore, this threaded portion 162 is provided with a plurality of slits 164 in the axial direction, and the tightening nut 163
A slide member 166 slidably fitted into the adapter main body 161 is tightened and fixed by this.

Other configurations, operations, and effects are the same as those in the first embodiment.

FIG. 14 is a sectional view of the sliding portion of the adapter according to the fourth embodiment of the present invention.

A rack 168 is carved in the axial direction on the outer peripheral surface of the rear part of the adapter main body 167 constituting the adapter 4, and is fitted inside the front part of the slide member 169. This rack 168 is a slide member 169
The protruding amount of the probe 104 can be adjusted by rotating a knob (not shown) connected to the pinion 171. ing. Further, a fixing screw 172 is screwed into the tip of the slide member 169 in the radial direction.
The tip of this fixing screw 172 is connected to the adapter body 16.
The adapter body 167 and the slide body 169 can be fixed by coming into contact with the outer circumferential surface of the adapter body 7 .

Other configurations, operations, and effects are the same as those in the first embodiment.

FIG. 15 is a sectional view of an adapter according to a fifth embodiment of the present invention.

The outer periphery of the cylindrical adapter body 173 has a coolant inlet 1 that can supply a coolant to cool the probe 104 inserted through the adapter body 173.
74 and a refrigerant outlet 176 for discharging the refrigerant. This refrigerant inlet 174 and refrigerant outlet 176
and have respective holes 177, 177, so that airtightness can be maintained when no refrigerant is inserted. Further, tubes 178, 178 are connected to the refrigerant inlet 174 and the refrigerant outlet 176.

A sliding surface 179 is formed on the rear inner circumferential surface of the adapter body 173, and a sliding surface 1 formed on the front portion of the slide member 181 is formed on this sliding surface 179.
82 is slidably fitted inside. The sliding surface 179 on the adapter main body 173 side and the sliding member 18
The sliding surface 182 on the first side is kept airtight by an O-ring 180 to prevent leakage of irrigation fluid and the like. Further, a fixing screw 183 is screwed into the rear part of the adapter body 173 in the radial direction, and when the tip of this fixing screw 183 comes into contact with the outer peripheral surface of the slide member 181, the adapter body 173 and the slide body 181 are connected. It is now possible to fix the

According to this embodiment, since the probe 104 can be cooled by supplying a coolant into the adapter body 173, the heat generated by the ultrasonic vibration of the probe 104 can be suppressed and breakage of the probe 104 can be prevented.

Other configurations, operations, and effects are the same as those in the first embodiment.

FIG. 16 is a sectional view of an adapter according to a sixth embodiment of the present invention.

A plurality of windows 187 are provided on the outer peripheral surfaces of the adapter body 184 and the slide member 186 that constitute the adapter 4, through which the probe 104 inserted therein can be observed.
is provided.

The other configurations are the same as in the fifth embodiment.

According to this embodiment, the crack of the probe 104,
Even if an abnormality such as a break occurs, it can be confirmed through the window 187, so the probe 104 can be operated safely without falling into the skull.

Other functions and effects are similar to those of the first embodiment.

In each of the above embodiments, an ultrasonic suction device is connected as a treatment instrument, but the present invention is not limited to this, and includes, for example, a high frequency electrode, a laser probe,
Treatment instruments such as forceps and syringes may be connected.

Note that the endoscopic device of the present invention is not limited to intracranial surgery, but can also be applied to other medical fields.

[Effects of the Invention] As explained above, according to the present invention, it is possible to safely and reliably treat a damaged part such as a hematoma or tumor in a short time while directly observing the treatment status of the damaged part such as a hematoma or tumor in real time. can be done.

[Brief explanation of the drawing]

1 to 10 relate to the first embodiment of the present invention, FIG. 1 is a sectional view of the adapter, and FIG. 2 is a sectional view of the adapter.
3 is an external view of the slide device, 4 is a sectional view of the support body, 5 is a sectional view of the support body fixed with a presser belt, 6 is an explanatory diagram of the sliding state shown in the figure.
The figure shows a sectional view of the support body fixed with the presser arm, Fig. 7 is a sectional view of the telescope, Fig. 8 is a sectional view of the sheath, Fig. 9 is an outline drawing of the mandolin, and Fig. 10 is a sectional view of the endoscope device. The overall configuration diagram, FIGS. 11 and 12, relate to the second embodiment of the present invention, FIG. 11 is a sectional view of the adapter, and FIG. 12 is a
13 is a sectional view of the adapter fixing part according to the third embodiment of the present invention; FIG. 14 is a sectional view of the sliding part of the adapter according to the fourth embodiment of the present invention; FIG. The figure is a sectional view of an adapter according to a fifth embodiment of the invention, and FIG. 16 is a sectional view of an adapter according to a sixth embodiment of the invention. 2... Sheath, 3... Telescope, 4... Adapter, 6... Ultrasonic suction device, 113... Adapter main body, 114... Slide member, 115... Detachable ring, 116... Connection member, 120... Thread part, 124
...Hollow part, 127...Cam groove, 128...Cam ring, 129...Cam pin, 131...Groove, 132...Guide pin, 138...Fixing screw.

Claims (1)

[Scope of Claims] 1. In an endoscope apparatus having a sheath, a telescope, and a treatment tool, a first connection is provided between the telescope and the treatment tool, the first connection being removably connectable to the hand portion of the telescope. and a second part detachably connectable to the treatment instrument.
a connecting portion, a hollow portion communicating with the channel of the telescope and capable of housing the treatment instrument, a sliding means for moving the treatment instrument forward and backward with respect to the telescope, and a sliding means for moving the treatment instrument relative to the telescope. An endoscope apparatus comprising an adapter having a fixing means for fixing the endoscope at a desired position.