JPWO2007078003A1 - 経自然開口的または経皮的な医療システム - Google Patents
経自然開口的または経皮的な医療システム Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/041—Capsule endoscopes for imaging
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00002—Operational features of endoscopes
- A61B1/00043—Operational features of endoscopes provided with output arrangements
- A61B1/00045—Display arrangement
- A61B1/0005—Display arrangement combining images e.g. side-by-side, superimposed or tiled
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00101—Insertion part of the endoscope body characterised by distal tip features the distal tip features being detachable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00105—Constructional details of the endoscope body characterised by modular construction
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00147—Holding or positioning arrangements
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00147—Holding or positioning arrangements
- A61B1/00158—Holding or positioning arrangements using magnetic field
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00163—Optical arrangements
- A61B1/00174—Optical arrangements characterised by the viewing angles
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00163—Optical arrangements
- A61B1/00174—Optical arrangements characterised by the viewing angles
- A61B1/00183—Optical arrangements characterised by the viewing angles for variable viewing angles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00163—Optical arrangements
- A61B1/00193—Optical arrangements adapted for stereoscopic vision
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- A—HUMAN NECESSITIES
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
- A61B1/053—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion being detachable
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
- A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy
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- A—HUMAN NECESSITIES
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00283—Type of minimally invasive operation with a device releasably connected to an inner wall of the abdomen during surgery, e.g. an illumination source
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
Abstract
Description
本願は、米国特許出願11/327,788号(2006年1月6日出願)、および米国仮出願60/759,119号(2006年1月13日)を基礎とし、その内容をここに援用する。
小腸のルーメンなど、GI管(gastrointestinal tract)を見るために、ビデオ撮像カプセルが一般的に用いられている。撮像カプセルは患者に飲み込まれて、蠕動運動により小腸を運ばれ、患者のGI管の画像を収集して外部レコーダーへ伝送する。
2 操作部
3 挿入部
3A 先端面
4 先端部
5 アングルノブ
6 観察装置
7 照明装置
8 送気送液チャンネル
9 吸引チャンネル
10 作業用チャンネル
15 ユニバーサルケーブル
20 オーバーチューブ
21 送気送水装置
22 吸引装置
23 ボタン
24 制御装置
25 モニタ
30 把持鉗子
31 鉗子操作部
32 ハンドル
33 ワイヤ
34 鉗子挿入部
35 処置部
36 支持部
37 鉗子部材
40 カプセル内視鏡
41 溝
42 ピン
45 透明フード
46 ケーシング
47 磁性体
50 観察部
51 対物レンズ
52 撮像素子
54 ズーム機構
55 ズームレンズ
56 照明部
57 制御回路
58 アンテナ
59 電池
60 受信機
70 気腹針
71 マウスピース
75 磁石
76 画像
77 画像
78 切除鉗子
80 小型スコープ
81 挿入部
82 連結部材
83 湾曲部
84 照明装置
85 観察装置
90 オーバーチューブ
91 観察装置
100 オーバーチューブ
101 スリット
102 ピン
103 起上部材
103A 基端部
103B 先端部
104 観察装置
105 ケーブル
106 ルーメン
107 基端部
108 コネクタ
109 スライド部材
110 ワイヤ
111 側面
201 撮像カプセル
202 経皮的マニピュレータ
203 腹腔内腔
204 トロカール
205 腹壁
206 腹腔鏡的外科器具
207 腸
208 胃
209 受信機
212 腹腔鏡
213 治療チャネル
214 把持装置
215 軟性内視鏡
216 ホルダー
217 トロカール
218 スプリングクリップ
219 磁石
220 ハンドル
221 ハンドル
222 制御ノブ
223 開口部
224 シャフト部品
226 表示マーク
227 観察方向
228 ハンドル
229 調節ナット
230 装置
231 ロッキングナット
232 ピボットボール
233 両面接着テープ
234 ゴム膜
235 蝶番
236 アーム
237 ロッド
238 軟性部材
239 ラチェット
240 無線送信
AC 腹腔
AD 腹部
AW 腹壁
AW2 内面
PT 患者
SO 開口
ST 胃
W ターゲット部位
さらに、挿入部3の先端面3Aには、各種のチャンネル8〜10の先端開口が配設されている。送気送液チャンネル8は、体内に流体を供給したりするために用いられる管路である。吸引チャンネル9は、体内から流体を吸引するために用いられる管路である。作業用チャンネル10は、処置具を通す作業用チャンネルである。各チャンネル8〜10は、挿入部3から操作部2に向けて延びている。しなしながら、内視鏡1の構成は、これに限定されるものではない。例えば、吸引チャンネル9を省略し、作業用チャンネル10を使って吸引するように構成しても良い。また、作業用チャンネル10を複数設けても良い。
図1及び図3に示すように、カプセル内視鏡40は、先端に略半球形の透明フード45を有する。さらに、基端面が溝41を除いてフラットなカプセル型のケーシング46を有する。ケーシング46の基端には、溝41を避けるように略半円形の磁性体47が一対固定されている。磁性体47は、自身が磁力を発生する硬磁性体材料でも良いし、磁場に晒したときに磁化する軟磁性体でも良い。
図5に示すように、ケーシング46内には、透明フード45に向かって観察光学装置である第2の観察部50が配置されている。第2の観察部50は、対物レンズ51と、対物レンズ51の結像位置に配置された撮像素子52とを有し、ズーム機構54でズームレンズ55を移動させることで倍率変更できるように構成されている。なお、第2の観察部50は、ズーム機構54を備えることが好ましいが、ズーム機構54は本実施態様に必須の構成要素ではない。第2の観察部50の周囲には、照明部56が第2の観察部50の視野を照らすように配設されている。照明部56には、例えば、複数のLED(Light Emitting Diode)が用いられる。第2の観察部50及び照明部56は、制御回路57に接続されている。制御回路57は、撮像素子52に接続されるカメラコントロールユニット(CCU)や、照明部56を点灯させる回路などが設けられている。さらに、制御回路57には、アンテナ58と、電池59とが接続されている。
この実施態様の作用について説明する。以下においては、生体の自然開口としての患者の口から内視鏡1を挿入して所望の医療行為を行う対象となる臓器や組織(以下、ターゲット部位という)を処置する手技について説明する。しかしながら、内視鏡1を挿入する自然開口は、口に限定されずに鼻や肛門でも良い。また、医療行為としての処置には、縫合や、観察、切開、細胞の採取など種々の行為が当てはまる。
第1の実施態様と同様に、腹腔ACで医療行為を行っているときに、小型スコープ80の湾曲部83の湾曲操作及び/又は小型スコープ80の進退操作を行い、第2の観察装置85の位置を所望の場所に移動(第2の観察装置85の視点を変更)させても良い。
この実施態様では、内視鏡1の挿入方向に異なる位置から撮影した2つの画像を使用して手技を行うことが可能になるので、ターゲット部位Wと処置具の位置関係を確認し易くなって手技が容易になる。第2の観察装置91がオーバーチューブの先端に設けられているので、位置決めが容易である。第2の観察装置91の視野の大きさは、オーバーチューブ90の先端領域からターゲット部位Wまでの距離を相対的に変えることで簡単に調節できる。このような距離の調整は、オーバーチューブ90からの内視鏡1の突出量で調整できる。この実施態様においても、第1、第2の実施態様と同様に、腹腔ACで所望の医療行為を行っているときに、オーバーチューブ90の回転や進退操作を行い、第2の観察装置91の位置を所望の状態に変更(第2の観察装置91の視点を変更)させても良い。
図34は、取り付け装置のもう1つの実施例である。経皮的マニピュレータ202のシャフトは、取り付け装置のスロットで摺動するゴム膜234を突き抜ける。経皮的マニピュレータが正しい位置にあるときには、マニピュレータを腹壁205に対して適切な位置に保持するために、ロッキングナット231は締め付けられる。
Claims (9)
- 患者の自然開口から管腔器官内に挿入され、管腔器官に開口を形成するデバイスと、
前記管腔器官に形成した前記開口から腹腔に導入される第1の観察装置と、
前記第1の観察装置の近傍に配設され、前記管腔器官に形成した前記開口から腹腔に導入される第2の観察装置と、
前記第1の装観察装置から得られる第1の画像と、前記第2の観察装置から得られる第2の画像とを選択的に表示する制御装置と、
を備える医療システム。 - 請求項1に記載の内視鏡システムであって、さらに
前記第2の観察装置を、前記腹腔内の腹壁上に保持する保持部材と、
前記第1の観察装置の先端および前記保持部材との間で、前記第2の観察装置を受け渡す受け渡し部材と、
を備える医療システム。 - 請求項2に記載の医療システムであって、前記第2の観察装置は、第1の部分と前記第1の部分と異なる第2の部分とを有し、前記第1の部分に観察用機構が設けられ、前記第2の部分は、前記保持部材に当接する取り付け部を形成する。
- 請求項3に記載の医療システムであって、前記受け渡し部材は、前記第2の観察装置を把持する把持部を有する。
- 請求項1に記載の医療システムであって、前記第2の観察装置は、取得した腹腔内の前記第2の画像の画像信号を、無線通信によって体外に送信する送信部を含む。
- 請求項2に記載の医療システムであって、前記受け渡し部材は、前記第2の観察装置の姿勢を変更する機構を有する。
- 請求項2に記載の医療システムであって、前記保持部材は、磁力、吸引力、または摩擦力を用いて、前記第2の観察装置を保持する。
- 請求項2に記載の医療システムであって、前記保持部材は、前記第2の観察装置を、患者の前記腹壁を基準として揺動する第1の揺動機構を有する。
- 請求項2に記載の医療システムであって、前記保持部材は、前記第1の揺動機構と前記第2の観察装置との相対角度を調整する第2の揺動機構を有する。
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/327,788 | 2006-01-06 | ||
US11/327,788 US20070161855A1 (en) | 2006-01-06 | 2006-01-06 | Medical procedure through natural body orifice |
US75911906P | 2006-01-13 | 2006-01-13 | |
US60/759,119 | 2006-01-13 | ||
PCT/JP2007/050046 WO2007078003A1 (ja) | 2006-01-06 | 2007-01-05 | 経自然開口的または経皮的な医療システム |
Publications (2)
Publication Number | Publication Date |
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JPWO2007078003A1 true JPWO2007078003A1 (ja) | 2009-06-11 |
JP4898709B2 JP4898709B2 (ja) | 2012-03-21 |
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Application Number | Title | Priority Date | Filing Date |
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JP2007553009A Expired - Fee Related JP4898709B2 (ja) | 2006-01-06 | 2007-01-05 | 経自然開口的または経皮的な医療システム |
Country Status (5)
Country | Link |
---|---|
US (1) | US8475361B2 (ja) |
EP (1) | EP1980194B1 (ja) |
JP (1) | JP4898709B2 (ja) |
TW (1) | TW200744518A (ja) |
WO (1) | WO2007078003A1 (ja) |
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- 2007-01-05 EP EP07706393.1A patent/EP1980194B1/en active Active
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US8475361B2 (en) | 2013-07-02 |
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EP1980194B1 (en) | 2013-05-08 |
JP4898709B2 (ja) | 2012-03-21 |
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