WO2016092983A1 - Outil d'assistance et système d'endoscope - Google Patents

Outil d'assistance et système d'endoscope Download PDF

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Publication number
WO2016092983A1
WO2016092983A1 PCT/JP2015/080775 JP2015080775W WO2016092983A1 WO 2016092983 A1 WO2016092983 A1 WO 2016092983A1 JP 2015080775 W JP2015080775 W JP 2015080775W WO 2016092983 A1 WO2016092983 A1 WO 2016092983A1
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WO
WIPO (PCT)
Prior art keywords
holding
endoscope
joint
auxiliary tool
holding body
Prior art date
Application number
PCT/JP2015/080775
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English (en)
Japanese (ja)
Inventor
山谷　高嗣
Original Assignee
オリンパス株式会社
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Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to JP2016543088A priority Critical patent/JPWO2016092983A1/ja
Publication of WO2016092983A1 publication Critical patent/WO2016092983A1/fr

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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

Definitions

  • 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.
  • 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.
  • 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.
  • An object of the present invention is to provide an auxiliary tool that can be appropriately attached to the insertion portion regardless of the outer diameter of the insertion portion of the endoscope and can assist the movement of the treatment tool.
  • 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.
  • 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.
  • FIG. 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.
  • 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.
  • 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
  • FIG. 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
  • 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.
  • FIG. 8B is a transverse 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.
  • An endoscope system (endoscope device) 10 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.
  • tip of the auxiliary tool 16 is demonstrated here.
  • the operation unit 24 is held at the tip of the auxiliary tool 16
  • the case where the operation unit 24 is held at the tip of the auxiliary tool 16 is, for example, a case where the entire length of the insertion unit 22 is short.
  • 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 is a known appropriate one having a channel 40 described later.
  • 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.
  • a channel tube (treatment instrument insertion channel tube) 42 constituting the treatment instrument insertion channel 40 is disposed inside the insertion portion 22.
  • 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.
  • 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.
  • 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.
  • a suction mechanism is not always necessary.
  • 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.
  • 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.
  • the operation unit 24 has a folding stop 62, a treatment instrument introduction unit 64, a gripping 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 section 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.
  • 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 part 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 72a and 72b, 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.
  • 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 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.
  • the flexible part 102 is preferably a tube that is easy to bend, is not easily broken, and has good slipperiness 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.
  • a tube or the like in which the insertion passage 120 in the flexible portion 102 is coated with a fluorine-based resin is used.
  • 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 the distal end 102a and the 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.
  • 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.
  • 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 base end side 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.
  • 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.
  • 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
  • the holding body 138 is selected from a plurality of types according to the size of the outer diameter of the insertion portion 22 and the folding stop 62 of the operation portion 24, and is attached to the main body 132.
  • FIG. 4A shows a holding body 138 specialized for holding a flexible tube portion 36 having an outer diameter of ⁇ A
  • FIG. 6A shows a flexible tube portion 36a having an outer diameter of ⁇ B ( ⁇ A).
  • a holding body 138a specialized for holding is shown.
  • the reference numeral 138 is mainly used for description.
  • 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.
  • 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.
  • the holding body 138 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 174a and 174b 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 164b of the first joint 152.
  • 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.
  • 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.
  • 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 176a and 176b 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.
  • the holding arm 176 cooperates with the base body 172 to The outer peripheral surface is pressed.
  • 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 ⁇ A is prevented from coming off from the holding body 138.
  • FIG. 4B shows a state where the flexible tube portion 36a of the insertion portion 22 having an outer diameter of ⁇ B ( ⁇ A) is disposed between the holding arms 176.
  • FIG. 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.
  • the holding body 138 is not appropriate for the flexible tube portion 36a having an outer diameter of ⁇ B, and the flexible tube portion 36a comes off between the arm-shaped protrusions 176a and 176b of the holding arm 176.
  • 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 ⁇ A, but the flexible tube portion 36a having an outer diameter of ⁇ B is used. It can be said that it is not suitable for holding.
  • a holding body 138a shown in FIG. 6A When holding the flexible tube portion 36a having an outer diameter of ⁇ B, 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.
  • 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.
  • the flexible tube portion 36a having the outer diameter of ⁇ B can be obtained in the same manner as the other holding body 138 holds the flexible tube portion 36 having the outer diameter of ⁇ A at at least three points. At least three points can be held.
  • the holding arm 178 of the holding body 138a when the flexible tube portion 36 having an outer diameter of ⁇ A 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 ⁇ B, but the flexible tube portion 36 having an outer diameter of ⁇ A is used. It can be said that it is not suitable for holding.
  • 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 part 106 is detachable with respect to the outer peripheral surface of the insertion part 22, it is preferable that it is firmly fixed appropriately.
  • 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.
  • 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.
  • 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.
  • 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. 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.
  • the connecting portion 104 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.
  • 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.
  • the holding body 138 includes, for example, the diameter of the insertion portion 22 of the endoscope 12 used for endoscopic submucosal dissection (ESD), endoscopic retrograde pancreatic pancreas, and the like.
  • the lineup is adapted to the diameter of the insertion portion 22 of the endoscope 12 used for cholangiography (Endoscopic Retrograde Cholangiopancreatography: ERCP).
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • the position can be changed to a position close to the outer surface of the insertion portion 22.
  • 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.
  • 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.
  • the holding body 138 of the holding portion 106 is selected according to the outer diameter ⁇ A 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.
  • 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.
  • 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.
  • the holding portion 106 is detachably attached to, for example, the folding stop 62, that is, the operation portion 24.
  • 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.
  • 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.
  • 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.
  • the 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).
  • Assistance tool 16 is reused after being cleaned, disinfected and sterilized.
  • the holder 138 can be selected and attached to the main body 132 of the holding unit 106 in accordance with the outer diameter of the insertion unit 22 or the folding stop 62 of the operation unit 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.
  • auxiliary tool 16 corresponding to the endoscope 12 can be realized.
  • 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.
  • 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.
  • 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.
  • 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.
  • FIGS. 7 to 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.
  • 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.
  • 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.
  • the holding body 238 is formed in a removable strip shape.
  • the holding body 238 is preferably formed of, for example, a rubber material.
  • 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.
  • the 1st fixing member 246a is arrange
  • 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.
  • the holding body 238 is selected from a plurality.
  • 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.
  • a plurality of holding bodies 238 of the auxiliary tool 16 according to this embodiment are lined up in accordance with 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.
  • the insertion portion 22 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.
  • one opening hole (second joint) 244a is always equidistant from one end 239a of the holding body 238.
  • 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, ⁇ A and ⁇ B) of the plurality of insertion portions 22.
  • 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.
  • the auxiliary tool 16 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).
  • Endoscopic pancreatobiliary imaging
  • 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 and 138a .. holding body, 152... First joint, 162.
  • 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.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Biophysics (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Endoscopes (AREA)

Abstract

L'invention concerne un outil d'assistance qui assiste le mouvement d'un outil de traitement par rapport à un canal d'endoscope, ledit outil de traitement comprenant un corps d'insertion qui est inséré dans le canal. L'outil d'assistance comprend : une section flexible ayant, formé à l'intérieur de cette dernière, un trajet d'insertion dans lequel l'outil de traitement est inséré; une section de liaison qui est située sur la section flexible et qui peut être reliée à l'endoscope de telle sorte que le canal et le trajet d'insertion communiquent; un corps principal qui est situé sur la section flexible et qui comprend une première articulation; et un corps de retenue comprenant une seconde articulation qui est reliée de façon détachable à la première articulation, ledit corps de retenue étant utilisé en coopération avec le corps principal pour maintenir une section d'insertion de l'endoscope ou une section de fonctionnement qui est reliée à la section d'insertion.
PCT/JP2015/080775 2014-12-10 2015-10-30 Outil d'assistance et système d'endoscope WO2016092983A1 (fr)

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JP2016543088A JPWO2016092983A1 (ja) 2014-12-10 2015-10-30 補助具及び内視鏡システム

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021209983A1 (fr) * 2020-04-14 2021-10-21 Palliare Limited Agrafe et procédé de fixation amovible de deux éléments allongés ensemble
USD961069S1 (en) 2020-04-14 2022-08-16 Palliare Limited Clip for surgical or medical purposes

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003079564A (ja) * 2001-09-12 2003-03-18 Olympus Optical Co Ltd 内視鏡装置
JP2005058749A (ja) * 2003-07-29 2005-03-10 Olympus Corp 内視鏡用アダプター及び内視鏡
JP2013198673A (ja) * 2012-03-26 2013-10-03 Olympus Medical Systems Corp 内視鏡処置具の進退補助具

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0759730A (ja) * 1993-08-25 1995-03-07 Olympus Optical Co Ltd 内視鏡カバー方式の内視鏡

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003079564A (ja) * 2001-09-12 2003-03-18 Olympus Optical Co Ltd 内視鏡装置
JP2005058749A (ja) * 2003-07-29 2005-03-10 Olympus Corp 内視鏡用アダプター及び内視鏡
JP2013198673A (ja) * 2012-03-26 2013-10-03 Olympus Medical Systems Corp 内視鏡処置具の進退補助具

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021209983A1 (fr) * 2020-04-14 2021-10-21 Palliare Limited Agrafe et procédé de fixation amovible de deux éléments allongés ensemble
USD961069S1 (en) 2020-04-14 2022-08-16 Palliare Limited Clip for surgical or medical purposes

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