JPWO2016092983A1 - Auxiliary tool and endoscope system - Google Patents

Abstract

An auxiliary tool for assisting movement of the treatment instrument having an insertion body inserted into the channel of the endoscope with respect to the channel includes a flexible part that forms an insertion passage through which the treatment tool is inserted, and the flexible part A connecting portion that can be connected to the endoscope so that the channel communicates with the insertion passage; a main body that is provided in the flexible portion and has a first joint; and is attached to and detached from the first joint. A second joint that can be connected, and a holding body that holds the operation portion connected to the insertion portion of the endoscope or the insertion portion in cooperation with the main body;

Description

  The present invention relates to an auxiliary tool that is attached to an endoscope and assists the operation of a treatment tool, and an endoscope system having the auxiliary tool.

  The treatment tool used by being inserted into the channel of the endoscope may be inserted into and removed from the channel by another assistant who operates the endoscope. It is efficient for the treatment to be performed by the surgeon alone. For example, International Publication No. 2013/065509 discloses an auxiliary tool having an operating body that allows an operator to perform an operation of inserting / removing a treatment tool with respect to a channel, that is, an advance / retreat operation. The auxiliary member fixing member is attached (fixed) to the outer periphery of the insertion portion of the endoscope.

  Endoscopes having different outer diameters according to the insertion target, treatment target, and the like are run up, and an appropriate one is selected and used. In the auxiliary tool disclosed in the specification of International Publication No. 2013/065509, the fixing member may not be attached to the outer peripheral surface of the insertion portion depending on the outer diameter of the insertion portion of the selected endoscope.

  It is an object of the present invention to provide an auxiliary tool that can be appropriately attached to an insertion portion regardless of the outer diameter of the insertion portion of an endoscope and can assist the movement of a treatment tool.

  According to an aspect of the present invention, an auxiliary tool for assisting movement of a treatment tool having an insert inserted into a channel of an endoscope with respect to the channel can form an insertion passage through which the treatment tool is inserted. A flexible part, a connecting part that is provided in the flexible part and is connectable to the endoscope so as to communicate the channel and the insertion passage, and a main body that is provided in the flexible part and has a first joint And a holding body having a second joint detachably connected to the first joint, and holding the operation portion connected to the insertion portion of the endoscope or the insertion portion in cooperation with the main body. Is provided.

FIG. 1 is a schematic view showing an endoscope system according to the first embodiment, showing a state where a treatment tool is inserted into a channel of the auxiliary tool and the endoscope with the auxiliary tool attached to the endoscope. . FIG. 2 is a schematic diagram illustrating a distal end surface of a distal end configuration portion of an insertion portion of the endoscope of the endoscope system according to the first embodiment. FIG. 3 is a longitudinal sectional view showing an auxiliary tool of the endoscope system according to the first embodiment. 4A is a cross-sectional view showing a state in which a flexible tube having an appropriate outer diameter is held by the main body and the holding body of the auxiliary tool along the line IV-IV in FIG. 3. 4B is a cross-sectional view showing a state in which the flexible tube having an inappropriate outer diameter is held by the main body and the holding body of the auxiliary tool along the line IV-IV in FIG. 3. FIG. 5A is a schematic cross-sectional view showing an example of a state in which a holding body is to be attached to the main body of the holding portion of the auxiliary tool. FIG. 5B is a schematic cross-sectional view showing another example of a state in which the holder is to be attached to the main body of the holding part of the auxiliary tool. FIG. 6A shows a flexible tube having an appropriate outer diameter (the same outer diameter as that shown in FIG. 4B) along the line IV-IV in FIG. It is a cross-sectional view which shows the state hold | maintained with a body. 6B differs from the main body of the holding part of the auxiliary tool and FIG. 4A with a flexible tube having an inappropriate outer diameter (the same outer diameter as shown in FIG. 4A) along the line IV-IV in FIG. It is a cross-sectional view which shows the state hold | maintained with a holding body. FIG. 7 is a longitudinal sectional view showing an auxiliary tool of the endoscope system according to the second embodiment. FIG. 8A is a cross-sectional view showing a state in which the flexible tube having the first outer diameter is held by the main body and the holding body of the auxiliary tool along the line VIII-VIII in FIG. 8B is a cross-sectional view showing a state in which the flexible tube having the second outer diameter is held by the main body of the holding part of the auxiliary tool and the holding body different from FIG. 8A along the line VIII-VIII in FIG. . 9A is a cross-sectional view showing a state in which the flexible tube having the first outer diameter is held by the main body and the holding body of the auxiliary tool along the line VIII-VIII in FIG. 9B is a cross-sectional view showing a state in which the flexible tube having the second outer diameter is held by the main body of the holding part of the auxiliary tool and the same holding body as FIG. 9A along the line VIII-VIII in FIG.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.

First, a first embodiment will be described with reference to FIGS. 1 to 6B.
An endoscope system (endoscope device) 10 according to this embodiment includes an endoscope 12, a treatment tool 14, and an auxiliary tool 16. The treatment instrument 14 is movable with respect to a treatment instrument insertion channel 40 described later of the endoscope 12. One end (tip) of the auxiliary tool 16 disposed near the distal end of the insertion portion 22 of the endoscope 12 is detachably fixed to the insertion portion 22 or the operation portion 24 of the endoscope 12. The end (base end) is detachably held by the operation unit 24 of the endoscope 12. The auxiliary tool 16 is used to assist the movement (advance and retreat and rotation) of the treatment tool 14 having an insert 82 (described later) through which the surgeon is inserted into the channel 40 of the endoscope 12 with respect to the channel 40. It is done. That is, the auxiliary tool 16 assists the surgeon to move the treatment tool 14 extended from one end of the auxiliary tool 16 relative to the endoscope 12.

  In addition, the example which hold | maintains the outer side of the insertion part 22 with the front-end | tip of the auxiliary tool 16 is demonstrated here. When the operation unit 24 is held at the tip of the auxiliary tool 16, it is preferable to hold the folding stop 62. The case where the operation unit 24 is held at the tip of the auxiliary tool 16 is a case where the entire length of the insertion unit 22 is short, for example.

  The structure of the endoscope 12 will be briefly described with reference to FIG. As the endoscope 12, a known appropriate one having a channel 40 described later may be used. As shown in FIG. 1, the endoscope 12 includes an elongated insertion portion 22, an operation portion 24 connected to a proximal end portion of the insertion portion 22, and a universal extending from a side portion of the operation portion 24. Code 26.

  The insertion portion 22 is made flexible in order from the distal end side toward the proximal end side, a rigid distal end constituting portion 32, a bending portion 34 having a bending tube that can be bent by connecting a plurality of bending pieces (not shown), and flexibly by an external force. And a flexible tube portion 36 that bends.

  Inside the insertion portion 22, a channel tube (treatment instrument insertion channel tube) 42 constituting the treatment instrument insertion channel 40 is disposed. The distal end 44 of the channel tube 42 is connected to a distal end side opening 52 described later of the distal end configuration portion 32. As is well known, the channel tube 42 is preferably branched inside the operation unit 24, for example. The first base end 46 of the channel tube 42 is connected to a hand side opening (plug connection base) 64a described later. A second base end (not shown) of the channel tube 42 is connected to a later-described suction button 76 of the suction mechanism. Note that, in the treatment instrument insertion channel 40, a portion between the distal end side opening 52 of the distal end configuration portion 32 and the branch portion of the channel tube 42 is formed as an insertion passage through which the insertion body 82 of the treatment instrument 14 is inserted. And is formed as a suction conduit. In the endoscope 12 according to this embodiment, a suction mechanism is not always necessary.

  As shown in FIG. 2, the distal end constituting portion 32 includes, on the distal end surface 32 a, a distal end side opening 52, an observation window 54, preferably two (or one) illumination window 56, and a nozzle 58. Have As shown in FIG. 1, the distal end side opening 52 is connected to and communicated with the distal end of the channel tube 42 to form the distal end portion of the treatment instrument insertion channel 40. The observation window 54 constitutes the tip of the observation optical system for observing the observation site. The illumination window 56 constitutes the tip of the illumination optical system that illuminates the observation site. The nozzle 58 can discharge gas and liquid from a discharge port (not shown) directed to the observation window 54. The discharge of gas and liquid is operated by an air / water supply button 74 described later.

  As shown in FIG. 1, the operation unit 24 includes an anti-bending 62, a treatment instrument introduction unit 64, a grasping unit 66, and an operation unit main body 68 in order from the distal end side to the proximal end side. It is preferable that the treatment instrument introducing portion 64, the gripping portion 66, and the operation portion main body 68 are integrally formed. The folding stop 62 holds the proximal end portion of the flexible tube portion 36 and suppresses the bending of the proximal end portion of the flexible tube portion 36 of the insertion portion 22.

  The treatment instrument introducing portion 64 has a proximal side opening (plug connection base) 64a to which the first base end 46 of the channel tube 42 is connected. An auxiliary tool plug 70 is attached to the proximal side opening 64 a of the treatment instrument introduction section 64. In the auxiliary tool plug 70, the liquid flowing to the proximal end side through the channel tube 42 in the state where the insertion body 82 (described later) of the treatment instrument 14 and the connecting portion 104 (described later) of the auxiliary tool 16 are inserted is inserted into the outer side of the endoscope 12. It has a valve structure that suppresses leakage. The auxiliary tool plug 70 may be the same as a known forceps plug.

  The grasping portion 66 is a part that the operator grasps with one hand such as the left hand. The operation portion main body 68 can operate the bending of the bending portion 34. The universal cord 26 extends from the side of the operation unit main body 68.

  The operation unit main body 68 includes bending operation knobs 72 a and 72 b, an air / water supply button 74, and a suction button 76. The bending operation knobs 72 a and 72 b can remotely perform the bending operation of the bending portion 34. Normally, the surgeon operates the bending operation knobs 72a and 72b with the thumb of the left hand while holding the grip 66 with the palm of the left hand. Since the air / water supply mechanism including the air / water supply button 74 and the suction mechanism including the suction button 76 are well known, description thereof is omitted here.

  The treatment instrument 14 includes an insert 82 that can be inserted into the channel 40 of the endoscope 12 and a base (operation unit) 84 that is disposed at the proximal end of the insert 82. The insert 82 is formed longer than the entire length of the channel 40, and may be several times as long, for example. The distal end of the insertion body 82 can be taken in and out of the distal end constituting portion 32 of the insertion portion 22 through the channel 40 of the endoscope 12.

The insert 82 has a sheath 92 and a wire 94 having an end effector 94a at the tip. The sheath 92 may be formed of a tube made of a resin material having simple insulation properties, for example, a coil sheath, and is selected by the end effector 94a. The wire 94 has flexibility.
As the shape of the end effector 94a, an appropriate shape such as a substantially L shape, a snare shape, or a basket shape can be used. The end effector 94a can perform an appropriate treatment using high-frequency energy on a living tissue between a counter electrode (not shown) attached to the patient.

  The base 84 has a known slider mechanism. By operating the slider mechanism at the base portion 84, the wire 94 can move along the axial direction with respect to the sheath 92. For this reason, the wire 94 can be advanced and retracted along the axial direction of the insertion body 82 with respect to the sheath 92 by the slider mechanism. Further, when the operator holds the insertion body 82, that is, the sheath 92 and the wire 94, the insertion body 82 can be rotated or rotated together around the axis of the insertion body 82.

  The auxiliary tool 16 used when the treatment tool 14 is moved back and forth and rotated with respect to the channel 40 of the endoscope 12 will be described with reference to FIGS. 1 and 3.

  The auxiliary tool 16 includes a long flexible portion 102, a connecting portion 104 that can removably connect the proximal end (connection end) side of the flexible portion 102 to the proximal side opening 64a of the endoscope 12, and A holding portion 106 that holds the outside of the insertion portion 22 of the endoscope 12 on the distal end (moving end) side of the bending portion 102 is provided.

  As the flexible portion 102, it is preferable to use a tube that is easy to bend, is not easily broken, and has good slidability with respect to the insert 82 of the treatment instrument 14. The flexible portion 102 includes, for example, a fluorine-based resin tube, a fluorine-based resin tube in which a blade is inserted to increase bending resistance, and a blade-containing urethane-based resin tube, which advances and retreats along the axial direction of the insertion body 82 of the treatment instrument 14. In order to enhance the property, a tube or the like in which the insertion path 120 in the flexible portion 102 is coated with a fluorine resin is used. In addition, although the full length of the flexible part 102 is formed short with respect to the full length of the insertion body 82 of the treatment tool 14, it is preferable on use that it is 500 mm or more.

  The flexible portion 102 has caps 112 and 114 at its distal end 102a and proximal end 102b, respectively. The distal end side base 112 is connected to the holding unit 106. The proximal end base 114 is connected to the connecting portion 104. In FIG. 3, the distal end 102 a of the flexible portion 102 is in contact with the holding portion 106, but it is also preferable that the distal end 102 a is separated by the distal end side base 112. For this reason, the holding part 106 may be mounted near the tip (near the end) of the flexible part 102. Further, in FIG. 3, the base end 102 b of the flexible portion 102 is in contact with the connecting portion 104, but it is also preferable that the base end 102 b is disposed in a state separated by the base end side base 114. For this reason, the connecting portion 104 may be mounted near the proximal end of the flexible portion 102.

  The auxiliary tool 16 forms an insertion path 120 by the flexible portion 102, the connecting portion 104, and the holding portion 106. The insertion path 120 is formed over the entire length of the auxiliary tool 16, and the insertion body 82 of the treatment tool 14 is inserted therethrough.

  The connecting portion 104 has a connection base 122 having a proximal end opening end 122 a of the insertion passage 120. The connection base 122 is connected to the auxiliary tool plug 70 while maintaining the valve structure of the auxiliary tool plug 70 at the proximal end side open end 122a. That is, in the present embodiment, the connection cap 122 of the connecting portion 104 is inserted into a recess (not shown) in the auxiliary tool plug 70 made of an elastic member, which is attached to the proximal opening 64a of the endoscope 12. Mating. For this reason, the connecting portion 104 of the treatment instrument 14 communicates with the treatment instrument insertion channel 40 of the endoscope 12 through the auxiliary instrument plug 70 of the proximal side opening (plug connection base) 64a of the endoscope 12, and the channel 40 And the insertion path 120 are communicated. The connecting portion 104 of the treatment instrument 14 is detachable from the auxiliary instrument plug 70 attached to the proximal side opening (plug connection base) 64a of the endoscope 12.

  The holding unit 106 includes a main body 132, a connection base 134 attached to the main body 132, a treatment instrument plug 136, and a holding body 138 selected from a plurality of types. A plurality of holding bodies 138 exist in accordance with at least the type of the insertion portion 22 of the endoscope 12, particularly the difference in the outer diameter of the flexible tube portion 36.

  The main body 132 is formed of, for example, a resin material and forms a proximal end portion of the insertion path 120. A connection base 134 similar to the proximal side opening (plug connection base) 64 a of the endoscope 12 is fixed to the main body 132. The treatment tool plug 136 may be the same as a known forceps plug, similarly to the auxiliary tool plug 70 described above. For this reason, the treatment instrument plug 136 prevents the body fluid in the body cavity flowing back through the treatment instrument insertion channel 40 of the endoscope 12 and the insertion passage 120 of the auxiliary instrument 16 from leaking out by the valve structure. it can. Further, the treatment instrument plug 136 into which the insertion body 82 of the treatment instrument 14 is inserted leaks fluid such as body fluid flowing through the treatment instrument insertion channel 40 of the endoscope 12 and the insertion passage 120 of the auxiliary instrument 16 to the outside. Can not be.

  A main body 132 shown in FIG. 4A has a first joint 152 to which a holding body 138 selected from a plurality of types can be attached and detached. The first joint 152 has the same size and the same shape regardless of the type of the holding body 138. The first joint 152 has a neck (concave portion) 162 and a head 164.

  The head 164 is in contact with a step (convex portion) 164a with respect to the neck 162, a pair of inclined surfaces 164b continuous with the step 164a, and a second contact surface 172b of a base 172, which will be described later, of the holding body 138. And a contact surface 164c. The contact surface 164c is continuous with the pair of inclined surfaces 164b and is formed at a position separated from the insertion path 120. The pair of inclined surfaces 164b of the head portion 164 are formed wider from the contact surface 164c toward the step 164a. The width of the neck 162 is smaller than the maximum width of the step 164 a of the head 164. For this reason, the state which has arrange | positioned the nail | claw part 174a, 174b of the 2nd joint 174 mentioned later to the neck part 162 with the level | step difference 164a can be maintained.

  The holding body 138 is selected from a plurality of types and attached to the main body 132 according to the size of the outer diameter of the insertion portion 22 and the folding stop 62 of the operation portion 24. FIG. 4A shows a holding body 138 specialized for holding a flexible tube portion 36 having an outer diameter of φA, and FIG. 6A shows a flexible tube portion 36a having an outer diameter of φB (<φA). A holding body 138a specialized for holding is shown. For the sake of simplification of description, in this embodiment, when the structure of the holding body is described, the reference numeral 138 is mainly used for description.

  The holding body 138 shown in FIGS. 4A, 5A, and 5B is formed of, for example, a resin material so that it can be appropriately elastically deformed by the finger force of the operator or assistant. The holding body 138 includes a base body 172, a second joint (a pair of engagement arms) 174 provided on the base body 172, and a pair of holding arms 176 extending from the base body 172. The base 172 has a first contact surface 172a with which the flexible tube portion 36 is contacted, and a second contact surface 172b with which the contact surface 164c of the head 164 of the first joint 152 is contacted. The second joint 174 is elastically deformable and has a pair of arm-shaped claw portions 174a and 174b that face each other. The distance between the arm-like claws 174a and 174b is smaller than the distance between the edges of the step 164a. The holding arm 176 is elastically deformable and has arm-shaped protrusions 176a and 176b facing each other. The distance between the arm-shaped protrusions 176a and 176b is smaller than the outer diameter of the insertion portion 22 held by the holding arm 176. A notch 177 is formed in the space between the pair of arm-shaped protrusions 176a and 176b. The second joint 174 is shorter than the holding arm 176. In other words, the holding arm 176 is longer than the second joint 174. For this reason, as shown to FIG. 5A, it is easy for an operator or an assistant to pick up so that the holding arm 176 may be brought close. When the holding arms 176 are held so as to be close to each other in this way, the second joint 174 is opened in conjunction with the operation (load of force F) of the holding arm 176 by the operator or assistant, and the holding portion 106 is moved. The second joint 174 of the holding body 138 is detachably engaged with the first joint 152 of the main body 132 so as to be easily connected. Then, the second joint 174 is closed by the elastic force of the holding arm 176 while the contact surface 164c of the head 164 of the first joint 152 and the second contact surface 172b of the holding body 138 are in contact. For this reason, as shown in FIG. 4A, the second joint 174 of the holding body 138 can be engaged with the first joint 152 of the main body 132 of the holding portion 106.

  In the holding body 138, the extent that the space between the base body 172 and the second joint 174 and between the base body 172 and the holding arm 176 can be deformed by the hand or finger of the surgeon or assistant. It is preferable that the other portions are formed hard.

  The claw portions 174 a and 174 b of the second joint 174 have inclined surfaces that are inclined in the same direction as the inclination direction of the pair of inclined surfaces 164 b of the first joint 152. As shown in FIG. 5B, when the second joint 174 of the holding body 138 is engaged with the first joint 152 of the main body 132 of the holding portion 106, the claw portion 174 a of the second joint 174 is closed with the second joint 174 closed. , 174 b are brought into contact with a pair of inclined surfaces 164 b of the first joint 152. In this state, by pressing the second joint 174 against the first joint 152, the contact surface 164 c of the head 164 of the first joint 152 and the second contact surface of the holding body 138 as shown in FIG. 4A. 172b is brought into contact. Therefore, the second joint 174 of the holding body 138 can be engaged with and connected to the first joint 152 of the main body 132 of the holding unit 106.

  Once the second joint 174 of the holding body 138 is engaged with the first joint 152 of the main body 132 of the holding section 106, the main body of the holding section 106 can be pulled even if the holding body 138 is pulled away from the main body 132. It is difficult for the second joint 174 of the holding body 138 to be disengaged from the first joint 152 of 132. This is due to the steps (projections) 164a164a of the first joint 152 of the main body 132 with respect to the neck 162 and the shapes of the claws 174a and 174b of the second joint 174 of the holding body 138.

  The distance between the arm-shaped protrusions 176 a and 176 b of the holding arm 176 is expanded beyond the outer diameter of the flexible tube portion 36 by elastic deformation, and the flexible tube portion 36 is held by the holding arm 176 through the notch portion 177. As shown in FIG. 4A, when the flexible tube portion 36 having an appropriate outer diameter φA is disposed on the holding arm 176, the holding arm 176 cooperates with the base body 172 to The outer peripheral surface is pressed. At this time, the flexible tube portion 36 can be held at at least three points of the arm-like projections 176a and 176b of the holding arm 176 and the first contact surface 172a of the base 172. For this reason, the flexible tube portion 36 having an outer diameter of φA is prevented from coming off from the holding body 138.

  When the holding arm 176 is opened, the claws 174a and 174b of the second joint 174 try to move in conjunction with the closing direction. For this reason, when attaching the insertion part 22 to the holding body 138, it is prevented that the nail | claw parts 174a and 174b of the 2nd joint 174 open. For this reason, the holding body 138 is prevented from falling off from the main body 132.

  FIG. 4B shows a state where the flexible tube portion 36 a of the insertion portion 22 having an outer diameter of φB (<φA) is disposed between the holding arms 176. The flexible tube portion 36 a is not pressed by the arm-shaped protrusions 176 a and 176 b of the holding arm 176. The flexible tube portion 36a is held at a maximum of two points among the arm-shaped protrusions 176a and 176b of the holding arm 176 and the first contact surface 172a of the base 172. However, the holding body 138 is not appropriate for the flexible tube portion 36a having an outer diameter of φB, and the flexible tube portion 36a comes off between the arm-shaped protrusions 176a and 176b of the holding arm 176. Therefore, the holding body 138 shown in FIGS. 4A and 4B is suitable for use to hold the flexible tube portion 36 having an outer diameter of φA, but the flexible tube portion 36a having an outer diameter of φB is used. It can be said that it is not suitable for holding.

  When holding the flexible tube portion 36a having an outer diameter of φB, a holding body 138a shown in FIG. 6A can be used. The holding body 138a shown in FIG. 6A has a holding arm 178 that is different in length and opening from the holding arm 176 of the holding body 138 shown in FIG. 4A. On the other hand, the base 172 and the second joint 174 shown in FIG. 6A are formed in the same size and shape as the holding body 138 shown in FIG. 4A.

  By using this holding body 138a, the flexible tube portion 36a having the outer diameter of φB can be obtained in the same manner as the other holding body 138 holds the flexible tube portion 36 having the outer diameter of φA at at least three points. At least three points can be held.

  As shown in FIG. 6B, when the flexible tube portion 36 having an outer diameter of φA is held by the holding arm 178 of the holding body 138a, the holding arm 178 is too open to hold the flexible tube portion 36. It is difficult to exert power. Therefore, the holding body 138a shown in FIGS. 6A and 6B is suitable for use in holding the flexible tube portion 36a having an outer diameter of φB, but the flexible tube portion 36 having an outer diameter of φA is used. It can be said that it is not suitable for holding.

  As described above, the holding body 138 is different from the one shown in FIGS. 4A and 6A, and further, depending on the outer diameter of the insertion portion 22 and the shape of the anti-folding 62, such as for attaching to the anti-folding 62, although not shown. A plurality are lined up in a state having a body 138. In the lineup of the holding bodies 138 at this time, the size or shape of the holding arm 176 is different, but the size and shape of the second joint 174 are common.

  The main body 132 of the holding portion 106 can be easily attached to and detached from the outer surface of the insertion portion 22 by the elastic deformation of the holding arm 176 with respect to the insertion portion 22 indicated by a broken line and the notch portion 177 temporarily expanding. Can do. The holding unit 106 can detachably hold the outer peripheral surface of the insertion unit 22 by a main body 132 (a contact surface 132 a described later) and a holding arm 176.

  The holding body 138 of the holding portion 106 can be attached to and detached from the outer peripheral surface of the insertion portion 22, but it is preferable that the holding body 138 is firmly fixed appropriately. However, the fixing force of the holding body 138 of the holding portion 106 with respect to the outer peripheral surface of the insertion portion 22 is such that the operator holds the outer peripheral surface of the insertion portion 22 with the ring finger and little finger of the right hand and the holding portion 106 with the thumb and index finger of the right hand. The holding arm 176 can be appropriately moved along and around the axial direction of the insertion portion 22. That is, the position of the holding portion 106 can be appropriately shifted while the operator holds the insertion portion 22 of the endoscope 12 with the right hand. In this way, the holding unit 106 is not movable with respect to the outer periphery of the insertion unit 22 of the endoscope 12, and the operator holds the outer peripheral surface of the insertion unit 22 with the right hand, while the main body of the holding unit 106 is held. The position of 132 can be adjusted to a position where it can be easily operated with the right hand.

  The main body 132 of the holding unit 106 is formed such that a sloped contact surface 132 a inclined with respect to the longitudinal axis of the insertion path 120 of the main body 132 is continuous with the first contact surface 172 a of the base 172 of the holding body 138. Preferably it is. The contact surface 132a of the main body 132 can detachably hold the outer peripheral surface of the insertion portion 22 by the holding body 138. When the holding body 138 is attached to the outer peripheral surface of the insertion portion 22 of the endoscope 12 in a state where the holding body 138 is attached to the main body 132, the contact surface 132a of the main body 132 can be used to internally view the treatment instrument plug 136. The distal end base 112 and the distal end 102 a of the flexible portion 102 are moved closer to the insertion portion 22 of the endoscope 12, apart from the insertion portion 22 of the mirror 12. For this reason, as shown in FIG. 1, the distal end 102 a of the flexible portion 102 can be brought close to the insertion portion 22 of the endoscope 12.

  The connection method between the proximal end side opening end 122a of the connecting portion 104 and the proximal side opening portion 64a of the endoscope 12 shown in FIG. 1 is not limited to the above description. For example, any structure may be used as long as the connecting portion 104 can be detachably fixed so as not to leak into the proximal side opening 64a without using the auxiliary tool plug 70. For example, by forming the connecting portion 104 with an elastic member such as silicone rubber instead of a resin material, a structure in which the connecting portion 104 is directly fitted to the end portion of the proximal side opening portion 64a of the endoscope 12 and fixed in a watertight manner. Can be adopted. In addition, the connecting portion 104 itself of the assisting device 16 does not exist, and the proximal end base 124 of the proximal end 102b of the flexible portion 102 is directly inserted into the treatment instrument insertion channel 40 through the assisting instrument plug 70. A structure for fixing the proximal end of the auxiliary tool 16 to the endoscope 12 may be used.

  Note that the holding body 138 according to this embodiment includes, for example, the diameter of the insertion portion 22 of the endoscope 12 used for endoscopic submucosal dissection (ESD), and the endoscopic retrograde pancreatic pancreas. A lineup is made according to the diameter of the insertion portion 22 of the endoscope 12 used for Endoscopic Retrograde Cholangiopancreatography (ERCP). Further, the holding body 138 according to this embodiment is configured such that the diameter of the folding stop 62 of the operation unit 24 of the endoscope 12 used for, for example, the ESD treatment, or the folding stop of the operation unit 24 of the endoscope 12 used for the ERCP treatment, is used. The lineup is adapted to 62 diameters.

  Next, with respect to the operation of the endoscope system 10 configured as described above, an example in which an ESD treatment is performed in which the lower layer of the lesioned part P is filled with a liquid such as physiological saline and the periphery of the lesioned part P is cut with an electric knife. A brief description will be given.

  The surgeon grips the grip portion 66 of the operation unit 24 of the endoscope 12 with the left hand, and grips the outer peripheral surface of the insertion portion 22 with the right hand. The surgeon sees an observation image displayed on a monitor (not shown) by the observation optical system of the endoscope 12 and passes through the opening of the lumen (body cavity) T as a duct (bore) of the living tissue L through the lesioned part P. The tip component portion 32 at the tip of the insertion portion 22 is inserted toward the end. At this time, the operator appropriately operates the bending operation knobs 72a and 72b while holding the grip portion 66 of the operation portion 24 of the endoscope 12 with the left hand, and performs push-pull and twist operations of the insertion portion 22 with the right hand. . Then, the surgeon brings the distal end configuration portion 32 of the insertion portion 22 close to the lesioned portion P at an appropriate distance.

  The surgeon (another surgeon) holds the insertion portion 22 of the endoscope 12 with the right hand and maintains the positional relationship between the distal end surface 32a of the distal end constituting portion 32 of the insertion portion 22 and the lesioned portion P. ) Attaches the connecting portion 104 at the proximal end of the auxiliary tool 16 to the proximal side opening (plug connection base) 64 a of the endoscope 12.

  By attaching the proximal end of the auxiliary tool 16 to the endoscope 12, the operation portion 24 has an insertion port (treatment tool plug 136) through which the distal end of the insertion body 82 of the treatment tool 14 is inserted into the channel 40 through the auxiliary tool 16. From the proximal side opening (plug connection base) 64 a, the position can be changed to a position close to the outer surface of the insertion portion 22. Although the treatment instrument plug 136 is located at a position close to the outer surface of the insertion portion 22, the operator operates the insertion body 82 of the treatment instrument 14 with the assistant inserted into the insertion passage 120. The abutment surface 132a is spaced apart from the outer surface of the insertion portion 22 so that an assistant can easily insert the end effector 94a at the distal end of the insertion body 82 into the insertion passage 120.

  Thereafter, the assistant passes the insertion body 82 of the treatment instrument 14 through the insertion passage 120 of the auxiliary instrument 16 and the channel 40 of the endoscope 12, and places the end effector 94 a in the vicinity of the distal end constituting portion 32 of the insertion section 22 of the endoscope 12. Deploy. Then, the assistant places the holding part 106 of the auxiliary tool 16 on the outer peripheral surface of the insertion part 22 of the endoscope 12.

At this time, the holding body 138 of the holding portion 106 is selected according to the outer diameter φA of the flexible tube portion 36. For this reason, the holding body 138 appropriately holds the flexible tube portion 36 of the insertion portion 22.
When the endoscope 12 having the flexible tube portion 36a having an outer diameter of φB is used, the operator or an assistant selects the holding body 138a. For this reason, the operator or an assistant can appropriately hold the flexible tube portion 36 of the insertion portion 22 with the holding body 138a.

  Thereafter, the operator moves the right hand while maintaining the orientation and position of the distal end constituting portion 32 of the insertion portion 22 of the endoscope 12 to hold the holding portion 106 with the palm, middle finger, ring finger, and little finger of the right hand. The insertion body 82 of the treatment instrument 14 is held with the thumb and index finger of the right hand. The middle finger of the right hand may hold the holding unit 106 or may hold the insertion body 82 of the treatment instrument 14.

  The timing when the assistant attaches the auxiliary tool 16 to the endoscope 12 is preferably after the distal end constituting portion 32 of the insertion portion 22 of the endoscope 12 is close to the lesioned portion P and the insertion position with respect to the lesioned portion P is determined. . This is to minimize the movable range required when the surgeon holds the insertion part 22 of the endoscope 12 together with the holding part 106 and holds the insertion body 82 of the treatment instrument 14 with the thumb and index finger. is there. The maximum movable range of the insertion body 82 varies depending on the size of the right hand of the surgeon and the flexibility of the joint. The range in which the insertion body 82 of the treatment instrument 14 can be brought close to and separated from the holding portion 106 by one operation is, for example, about several centimeters.

  When the insertion amount into the lumen T when the distal end of the insertion portion 22 is brought close to the lesioned portion P is increased, for example, the holding portion 106 is detachably attached to the folding stop 62, that is, the operation portion 24. In this case, the operator or assistant selects a holding body (not shown) for fixing the holding portion 106 to the folding stop 62.

  A more specific explanation of how to use the right hand of the surgeon is as follows. Hold the insertion portion 22 and the tip of the auxiliary tool 16 with the three fingers of the palm, middle finger, ring finger, and little finger. The two inserts 82 of the treatment instrument 14 are picked and held. At this time, by moving the insertion body 82 of the treatment instrument 14 in the axial direction without releasing the right hand from the insertion section 22, the advancement / retraction operation (proximity and separation operation) of the insertion body 82 of the treatment instrument 14 with respect to the holding section 106 is performed. That is, a fine adjustment can be made such that the position of the insert 82 is moved about 10 mm in the axial direction. That is, the operator slightly changes the protruding length of the end effector 94a of the treatment instrument 14 with respect to the distal end constituting portion 32 of the insertion portion 22 of the endoscope 12 while holding the insertion portion 22 with the right hand. Thus, for example, a delicate procedure of performing high-frequency incision with a treatment instrument using high-frequency energy can be performed.

  The base 84 of the treatment instrument 14 is usually operated by an assistant who is not an operator of the endoscope 12 according to an instruction of the operator. The output start / output stop of the high-frequency energy is usually performed by an operator operating, for example, a foot switch.

  The surgeon rotates the insert 82 around its axis while holding the insert 22 with the palm of the right hand and the three fingers of the middle finger, ring finger, and little finger while holding the insert 82 with the thumb and index finger. Move. For this reason, the insert 82 can be rotated with respect to the channel 40. Therefore, the orientation of the end effector 94a can be adjusted without moving the position and orientation of the distal end constituting portion 32 of the insertion portion 22 of the endoscope 12.

  In the ESD treatment, a plurality of treatment tools 14 are used by being exchanged for the auxiliary tool 16 and the channel 40 of the endoscope 12. The replacement work is not performed by the operator holding the insertion portion 22 of the endoscope 12, but by an assistant (another operator).

  The auxiliary tool 16 is reused by being cleaned, disinfected and sterilized.

  As described above, according to the endoscope system 10 according to this embodiment, particularly the auxiliary tool 16, the following can be said.

  The holding body 138 can be selected and attached to the main body 132 of the holding portion 106 in accordance with the outer diameter of the insertion portion 22 and the folding stop 62 of the operation portion 24. For this reason, even if the outer diameter of the insertion portion 22 of the endoscope 12 is different, by exchanging only the holding body 138, other portions can be appropriately used. For this reason, by using the auxiliary tool 16 according to this embodiment, it is not necessary to prepare an auxiliary tool corresponding to the insertion portion 22 having various outer diameters, and the management cost and the treatment cost of the auxiliary tool 16 are reduced. Can be made. Even if the types of the insertion portions 22 of the endoscope 12 are various, only the holding body 138 of the auxiliary tool 16 may be used by appropriately replacing it, so that various types of use can be made without reducing the use and storage efficiency of the auxiliary tool 16. An auxiliary tool 16 corresponding to the endoscope 12 can be realized.

  In addition, the optimal holding body 138 can be selected in accordance with the shapes of the insertion portion 22 of the endoscope 12 and the folding stop 62 of the operation portion 24. For this reason, it is easy to prevent the insertion portion 22 from being unintentionally detached from the holding portion 106 during the treatment.

  Since it is only necessary to arrange the plurality of holding bodies 138 as a lineup for the outer diameter of the insertion portion 22 (flexible tube 36), the management space for the auxiliary tool 16 can be reduced. Even if the holder 138 is deteriorated, the auxiliary tool 16 can be reused by cleaning, disinfecting, and sterilizing other parts and using the new holder 138. For this reason, the cost reduction at the time of repeatedly performing treatment using the auxiliary tool 16 can be achieved.

  Thus, according to the present embodiment, the auxiliary device that can be appropriately attached to the insertion portion 22 or the operation portion 24 regardless of the outer diameter of the insertion portion 22 of the endoscope 12 and can assist the movement of the treatment instrument 14. 16 can be provided.

  As described above, by using the assisting tool 16 according to this embodiment, the surgeon can directly advance and retract and rotate the insertion body 82 of the treatment instrument 14 with the finger of the right hand without releasing the right hand holding the insertion portion 22. Operation, that is, movement can be performed. Therefore, by using the auxiliary tool 16 according to this embodiment, for example, an advanced ESD treatment that requires the treatment tool 14 to be moved delicately can be performed accurately, safely, and in a short time. For this reason, the operator can finish the treatment efficiently in a short time. Therefore, by using the auxiliary tool 16 according to this embodiment, the burden on the operator can be reduced and the burden on the patient can be further reduced.

  Next, 2nd Embodiment is described using FIGS. 7-8B. This embodiment is a modification of the first embodiment, and the same members as those described in the first embodiment or members having the same functions are denoted by the same reference numerals as much as possible, and detailed description thereof is omitted.

  In this embodiment, the structures of the main body 232 and the holding body 238 of the holding unit 106 are different from the main body 132 and the holding body 138 of the holding unit 106 described in the first embodiment. In addition, the main body 232 of the holding portion 106 is formed with an inclined contact surface 232a inclined with respect to the longitudinal axis of the insertion path 120 of the main body 232, similarly to the contact surface 132a described in the first embodiment. Preferably it is.

  As shown in FIG. 7, in this embodiment, the holding body 238 is formed in a removable strip shape. The holding body 238 is preferably formed of, for example, a rubber material. As shown in FIG. 8A, the main body 232 includes side surfaces 240a and 240b whose normal directions are defined in opposite directions (appropriate deviation is allowed) and a pair of recesses (first joints) 242a and 242b. Have. A concave portion 242a is formed on the side surface 240a, and a concave portion 242b is formed on the side surface 240b. A holding surface 239 that holds the outer peripheral surface of the insertion portion 22 in contact with the contact surface 232 a of the main body 232 is formed on the belt-shaped holding body 238. The holding surface 239 of the holding body 238 faces the contact surface 232 a of the main body 232.

The holding body 238 is formed with a pair of opening holes (second joints) 244a and 244b. One opening hole 244a is always equidistant from one end 239a of the holding body 238. A first fixing member (second joint) 246a is disposed in the opening hole (second joint) 244a. Therefore, the opening hole 244a and the first fixing member 246a cooperate to form a second joint that is fixed to the first joint of the main body 232.
And the 1st fixing member 246a is arrange | positioned through the one recessed part 242a of the main body 232, and the one opening hole 244a of the holding body 238 so that attachment or detachment is possible. The fixing relationship between the first fixing member 246a and the one concave portion 242a of the main body 232 may be pinning or screwing.

  The distance of the other opening hole 244b from the one end 239a of the holding body 238 can be changed by selecting the holding body 238 according to the outer diameter of the insertion portion 22. A second fixing member (second joint) 246b is disposed in the opening hole (second joint) 244b. Therefore, the opening hole 244b and the second fixing member 246b cooperate to form a second joint that is fixed to the first joint of the main body 232.

  As shown in FIG. 8A, when the flexible tube portion 36 having an outer diameter of φA is held by the holding portion 106, the holding body 238 is selected from a plurality. Similarly, as shown in FIG. 8B, when the flexible tube portion 36a having an outer diameter of φB is held by the holding portion 106, the holding body 238a is selected from a plurality.

  The second fixing member 246b is detachably disposed through the other concave portion 242b of the main body 232 and the other opening hole 244b of the holding body 238. The fixing relationship between the second fixing member 246b and the other concave portion 242a of the main body 232 may be pinning or screwing.

  Thus, a plurality of holding bodies 238 of the auxiliary tool 16 according to this embodiment are lined up according to the outer diameter of the insertion portion 22. For this reason, the holding body 238 can be appropriately selected with respect to the main body 232.

  When the insertion portion 22 is held by the holding portion 106, the insertion portion 22 is brought into contact with the contact surface 232 a of the main body 232 of the holding portion 106 with the holding surface 239 of the holding body 238. It is held in the state.

  Next, a modification of the second embodiment will be described with reference to FIGS. 9A and 9B.

  9A and 9B, one opening hole (second joint) 244a is always equidistant from the one end 239a of the holding body 238. Here, the holding body 238 has a plurality of other opening holes (second joints) 264a and 264b at positions where the distance from the one end 239a of the holding body 238 is appropriate. The plurality of other opening holes 264a and 264b are changed according to the outer diameters (for example, φA and φB) of the plurality of insertion portions 22.

  Therefore, when the flexible tube portion 36 having an outer diameter of φA shown in FIG. 9A is held by the main body 232 and the holding body 238, and the flexible tube portion 36a having an outer diameter of φB shown in FIG. In the case of holding by the holding body 238, one of the plurality of opening holes 264a and 264b is appropriately selected and fixed by the second fixing member (second joint) 246b, so that the common holding body 238 is used. Can do.

  In addition, when fixing the holding body 238 demonstrated in 2nd Embodiment containing a modification to the main body 232, various fixing mechanisms can be selected. For example, in FIGS. 8A to 9B, convexes (not shown) formed on the side surfaces 240a and 240b of the main body 232 instead of the pair of concave portions 242a and 242b and the first and second fixing members 246a and 246b as the second joint. The portion (first joint) may be appropriately engaged with the opening holes 244a, 244b, 264a, 264b formed in the holding body 238. When using convex parts instead of the concave parts 242a and 242b, it may not be necessary to use the first and second fixing members 246a and 246b.

  The auxiliary tool 16 according to the first and second embodiments including each modification uses a side-view type endoscope, and if the treatment tool 14 is appropriately selected, an endoscopic retrograde pancreatobiliary imaging (Endoscopic) It can be used when performing Retrograde Cholangiopancreatography (ERCP).

  Although several embodiments have been specifically described so far with reference to the drawings, the present invention is not limited to the above-described embodiments, and all the embodiments performed without departing from the gist of the present invention. including.

  DESCRIPTION OF SYMBOLS 10 ... Endoscopy system (endoscope apparatus), 12 ... Endoscope, 14 ... Treatment tool, 16 ... Auxiliary tool, 22 ... Insertion part, 24 ... Operation part, 32 ... Tip structure part, 32a ... Tip surface, 34 ... curved portion, 36, 36a ... flexible tube portion, 40 ... treatment instrument insertion channel, 42 ... channel tube, 64 ... treatment instrument introduction portion, 64a ... proximal side opening portion, 66 ... gripping portion, 68 ... operation portion 70: Auxiliary tool plug, 82 ... Insert, 84 ... Base part, 102 ... Flexible part, 104 ... Connecting part, 106 ... Holding part, 120 ... Insertion path, 132 ... Main body, 132a ... Contact surface, 134 ... Connection base, 136 ... treatment instrument plug, 138, 138a ... holding body, 152 ... first joint, 162 ... neck, 164 ... head, 164a ... step, 164b ... inclined surface, 164c ... contact surface, 172 ... base, 172a: first contact surface, 172b: second contact surface , 174 ... second joint, 174a, 174b ... arm-shaped claw portion, 176 ... holding arms, 176a, 176b ... arm-like protrusions, 177 ... notched section, 178 ... holding arm.

Claims (7)

An auxiliary tool for assisting movement of a treatment tool having an insert inserted into a channel of an endoscope with respect to the channel,
A flexible portion that forms an insertion passage through which the treatment tool is inserted;
A connecting portion provided in the flexible portion and connectable to the endoscope so as to communicate the channel and the insertion passage;
A main body provided on the flexible portion and having a first joint;
A second joint that is detachably connected to the first joint, and a holding body that holds the operation portion connected to the insertion portion of the endoscope or the insertion portion in cooperation with the main body. , Aids. The holding body is engaged by an elastically deformable portion with respect to the insertion portion or the operation portion of the endoscope,
The auxiliary tool according to claim 1, wherein the second joint of the holding body is engaged with the first joint of the main body by an elastically deformable portion.   The auxiliary tool according to claim 1, wherein the holding body is detachable from the insertion portion of the endoscope.   The auxiliary tool according to claim 1, wherein the holding body is mounted in the vicinity of an end of the flexible portion.   The auxiliary tool according to claim 1, wherein the holding body is selected from a plurality of different types having the second joint in common.   The assisting tool according to claim 5, wherein the holding body selected from the plurality of types has a different shape of a portion for holding the insertion portion or the operation portion of the endoscope. An endoscope having a channel;
The auxiliary device according to claim 1, wherein the auxiliary device is connected to an end of the channel at the connection portion.
An endoscope system comprising: a treatment instrument having an insertion body capable of being inserted through the insertion passage of the auxiliary instrument and the channel of the endoscope.

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