WO2016189646A1

WO2016189646A1 - Bending mechanism and flexible medical instrument

Info

Publication number: WO2016189646A1
Application number: PCT/JP2015/065020
Authority: WO
Inventors: 原　光博; 雅敏飯田; 修哉城ケ崎
Original assignee: オリンパス株式会社
Priority date: 2015-05-26
Filing date: 2015-05-26
Publication date: 2016-12-01
Also published as: JPWO2016189646A1; JP6588540B2

Abstract

A bending mechanism (3) comprises: a plurality of bending joint members (4) serially connected so as to be rockable relative to each other about rocking axes (S); a plurality of pairs of long tension transmission members (6), each pair of which is connected to one of the bending joint members (4); and a plurality of bendable sheath members (7), each binding a pair of tension transmission members (6) in a longitudinally relatively movable manner. Each of the sheath members (7) binds a portion of a pair of tension transmission members (6), the portion extending up to a separation position disposed further toward the distal end side than a rocking axis (S) located immediately on the proximal end side of a bending joint member (4) to which the pair of tension transmission members (6) are connected, and the pair of tension transmission members (6) which are separated from each other at a position further toward the distal end side than the separation position are connected to different positions of the bending joint member (4).

Description

Bending mechanism and flexible medical device

The present invention relates to a bending mechanism and a flexible medical instrument.

2. Description of the Related Art Conventionally, a plurality of joint pieces connected in series along a longitudinal axis and a wire connected to the joint piece are provided, and by applying tension to the wire, the joint piece is swung around an oscillation axis intersecting the longitudinal axis. A bending mechanism that is dynamically driven is known (see, for example, Patent Documents 1 and 2). In such a bending mechanism, each joint piece can be selectively driven to swing by individually connecting a wire to each joint piece. Further, by connecting a plurality of wires to different positions in the circumferential direction around the longitudinal axis with respect to one joint piece, the joint piece can be driven to swing in a plurality of directions.

JP 2009-1119064 A Japanese Patent No. 4332031

However, in the bending mechanisms of Patent Document 1 and Patent Document 2, when one joint piece is driven to swing, the path length of the wire connected to the other joint piece changes, and the wire is displaced in the longitudinal direction. To do. At this time, there is a problem that other joints that are not the object to be driven unintentionally swing due to the difference in displacement amount between the plurality of wires connected to the same joint piece. In addition, since the swing angle of the other joints at this time is uncontrollable, the bending shape of the bending mechanism changes each time even if the bending mechanism is deformed to the same bending shape, and the same operation of the bending mechanism is performed. There is a problem that it is difficult to reproduce accurately.

An object of the present invention is to provide a bending mechanism and a flexible medical instrument that can prevent unintentional swinging of a joint piece and improve the reproducibility of movement.

According to a first aspect of the present invention, a plurality of components arranged in series along a longitudinal axis from a distal end side to a proximal end side and coupled so as to be able to swing with respect to each other about a swing axis that intersects the longitudinal axis. A plurality of pairs of long tension transmitting members connected to each of the plurality of curved joint members and transmitting tension for swinging the plurality of curved joint members independently of each other; A plurality of flexible sheath members that bundle each pair of the tension transmission members so as to be relatively movable in the longitudinal direction, and each of the plurality of sheath members is connected to each of the pair of tension transmission members. The pair of tension transmitting members are bundled up to a branch position disposed on the distal side of the swing axis positioned on the straight base end side of the curved joint member, and the pair is separated from each other on the distal side of the branch position. The tension transmitting member is the curved joint member. A bending mechanism that is connected to a different position.

According to the first aspect of the present invention, when a tension is applied to any one of the tension transmission members, the tension is transmitted to the curved joint member to which the tension transmission member is connected, and the curved joint members are adjacent to each other. It swings with respect to the curved joint member. Thereby, the position and attitude | position of the front-end | tip part of a bending mechanism can be changed.

In this case, a pair of tension transmission members connected to the same bending joint member are bundled by a sheath member to a position closer to the distal end side than the swing axis on the proximal side of the bending joint member. Therefore, when one bending joint member swings, the pair of tension transmitting members connected to the other same bending joint member are displaced substantially equally in the longitudinal direction. As a result, unintentional swinging of other joint pieces can be prevented, and the reproducibility of the operation can be improved.

In the first aspect, the sheath member may be a pair sheath in which a pair of sheaths each housing one tension transmission member are coupled in the radial direction.
By doing in this way, a sheath member can be manufactured simply.

In the first aspect, a plurality of flat plate-like members having through-holes that are disposed on the base end side of each of the bending joint members so as to intersect the longitudinal axis and penetrate in the plate thickness direction and into which the sheath member is inserted. A guide member may be provided.
By doing so, the wiring path of the tension transmitting member can be defined by wiring the sheath member in the direction along the longitudinal axis via the through hole of the guide member.

In the first aspect, the guide member may be disposed on a plane including the swing axis.
By doing so, the tension transmitting member is curved around the swing axis, thereby further reducing the difference in displacement between a pair of tension transmitting members connected to the same bending joint member. The swing of the piece can be prevented more reliably.

In the first aspect, the through-holes may be provided so that the pair of tension transmission members are arranged at substantially the same distance in the same direction with respect to the swing axis.
By doing so, the pair of tension transmission members connected to the same bending joint member bend around the swing axis with the same curvature, so that the difference in displacement between the pair of tension transmission members is further reduced. In addition, unintended swinging of the joint piece can be prevented more reliably.

In the first aspect, the guide member may have an opening that penetrates in the plate thickness direction on the radially inner side of the through hole.
By doing in this way, built-in objects, such as a treatment tool and piping, can be wired in the direction along a longitudinal axis from the base end side to the tip end side of a bending mechanism via an opening.

According to a second aspect of the present invention, there are provided a plurality of units arranged in series along the longitudinal axis from the distal end side to the proximal end side and coupled to each other so as to be capable of swinging around a swing axis that intersects the longitudinal axis. A plurality of pairs of long tension transmitting members connected to each of the plurality of curved joint members and transmitting tension for swinging the plurality of curved joint members independently of each other; A plurality of flat plate-shaped guide members that are arranged on the base end side of each of the curved joint members so as to intersect the longitudinal axis and have through-holes that penetrate the plate thickness direction and into which the tension transmission member is inserted, A bending mechanism in which a pair of tension transmission members are inserted into the through holes.

According to the second aspect of the present invention, when a tension is applied to any one of the tension transmission members, the tension is transmitted to the curved joint member to which the tension transmission member is connected, and the curved joint members are adjacent to each other. It swings with respect to the curved joint member. Thereby, the position and attitude | position of the front-end | tip part of a bending mechanism can be changed.

In this case, the pair of tension transmitting members connected to the same bending joint member are bundled by passing through the same through hole of the guide member. Therefore, when one bending joint member swings, the pair of tension transmitting members connected to the other same bending joint member are displaced substantially equally in the longitudinal direction. As a result, unintentional swinging of other joint pieces can be prevented, and the reproducibility of the operation can be improved.

In the second aspect, the guide member may be disposed on a plane including the swing axis.
In the second aspect, the through-holes may be provided so that the pair of tension transmission members are arranged at substantially the same distance in the same direction with respect to the swing shaft.

A third aspect of the present invention is a soft medical instrument including any one of the bending mechanisms described above and a cylindrical outer sheath having flexibility that covers the outer periphery of the bending mechanism.
According to this aspect, by covering the bending mechanism with the outer sheath, it is possible to prevent the bending mechanism from coming into direct contact with the tissue in the body even when the bending mechanism is inserted into the body, thereby protecting the tissue and the bending mechanism and smoothing the bending mechanism. Operation can be ensured.

According to the present invention, it is possible to prevent unintentional swinging of the joint piece and improve the reproducibility of the operation.

It is a whole lineblock diagram showing a medical system provided with a flexible medical instrument concerning one embodiment of the present invention. It is a perspective view of the front-end | tip part of the bending mechanism which concerns on one Embodiment of this invention, and a flexible medical device. It is a perspective view of the joint piece in the bending mechanism of FIG. It is a front view of the guide plate in the bending mechanism of FIG. It is a side view which shows the structure of the sheath member in the bending mechanism of FIG. FIG. 6 is a cross-sectional view taken along the line II of the sheath member of FIG. 5. It is a figure which shows the modification of the through-hole in the guide plate of FIG. It is a side view of the modification of the sheath member of FIG. FIG. 9 is a II-II cross-sectional view of the sheath member of FIG. It is a side view of the modification of the bending mechanism of FIG. FIG. 11 is a cross-sectional view taken along the line III-III of the bending mechanism of FIG. 10.

A flexible medical device and a bending mechanism according to an embodiment of the present invention will be described below with reference to the drawings.
The flexible medical device 2 according to this embodiment is applied to, for example, the medical system 100 shown in FIG.

The medical system 100 includes a slave device 101, a master device 102 to which an operation on the slave device 101 is input by a doctor A, a controller 103 that controls the slave device 101 based on an input to the master device 102, a monitor 104. The slave device 101 includes an insertion unit 1 that is inserted into the body cavity of the patient P. The flexible medical instrument 2 according to the present embodiment is provided at the distal end of the insertion portion 1.

As shown in FIG. 2, the soft medical instrument 2 according to the present embodiment includes a bending mechanism 3 and an outer sheath 19 made of a flexible material that covers the outer surface of the bending mechanism 3.
As shown in FIG. 2, the bending mechanism 3 according to this embodiment includes a plurality of joint pieces (curved joint members) 4 arranged in the longitudinal axis direction and connected in series, and a plurality of joint pieces 4 attached to each joint piece 4. A guide plate (guide member) 5, a plurality of tension transmission members 6 penetrating the guide plate 5 and the joint piece 4 and having the tip connected to any one joint piece 4, and the tension transmission member 6 covered The sheath member 7 is provided.

As shown in FIG. 3, the joint piece 4 includes a disk-shaped main body 9 having four through holes 8 arranged in the circumferential direction and penetrating in the thickness direction, and is provided at the center of the main body 9 to be long. And a first support column 10 extending to the base end side along the axis. Specifically, the main body 9 has a structure in which an outer annular portion 9a and a first support column 10 positioned at the center of the annular portion 9a are connected in the radial direction by four spokes 11. ing. Thereby, the through-hole 8 surrounded by the annular portion 9a, the first support column 10 and the two adjacent spokes 11 is formed.

The joint pieces 4 other than the most advanced joint piece 4 further include a second support column 12 extending along the longitudinal axis in the opposite direction to the first support column 10 with the main body 9 interposed therebetween. The base end of the first support column 10 is connected to the distal end of the second support column 12 provided in the adjacent joint piece 4 so as to be swingable about the swing axis S intersecting the longitudinal axis. A portion 13 is provided.

In the example shown in FIGS. 2 and 3, the connecting portion 13 is configured so that the adjacent joint pieces 4 swing around the swing axis S perpendicular to each other. However, the specific configuration of the connecting portion 13 is not limited to this. For example, the connecting portion 13 may be configured such that the swing axis S of the adjacent joint piece 4 intersects at an angle other than 90 °, and the adjacent joint pieces 4 swing around the swing axis S parallel to each other. The connecting portion 13 may be configured to move.

The guide plate 5 is a disk-shaped member, and is disposed on a plane that intersects the longitudinal axis and includes the swing axis S. As shown in FIG. 4, the guide plate 5 has one fitting hole 14 and two through holes (openings) 15 that respectively penetrate in the plate thickness direction. The fitting hole 14 is formed in the center of the guide plate 5, and the guide plate 5 is attached to the joint piece 4 by fitting the proximal end portion of the first support column 10 into the fitting hole 14. The through holes 15 are provided on both sides in the radial direction of the fitting holes 14 so as to be aligned with the fitting holes 14 along the swing axis S. By inserting a built-in object 16 such as a soft treatment instrument, piping or a flexible endoscope into the through hole 15, the built-in object 16 can be guided from the proximal end side to the distal end side of the flexible medical instrument 2. It has become.

Furthermore, the guide plate 5 has a plurality of through holes 17 arranged in the circumferential direction at intervals and penetrating in the thickness direction. At least one of the plurality of through holes 17 is provided outside the through hole 15 in the radial direction so as to be aligned with the fitting hole 14 and the through hole 15 along the swing axis S. The diameter of the through-hole 17 is larger than the outer diameter of the sheath member 7, and is formed in such a dimension that the sheath member 7 is inserted so as to be movable in the longitudinal direction.

The tension transmission member 6 is made of a metal wire.
As shown in FIGS. 5 and 6, the sheath member 7 includes a pair of sheaths in which a pair of elongated cylindrical sheaths 7 a are connected in the radial direction from the distal end to the proximal end. Each sheath 7a is formed from a flexible material. The sheath 7 a has an inner diameter larger than the outer diameter of the tension transmission member 6 and a length shorter than the length of the tension transmission member 6. In each sheath 7a, one tension transmitting member 6 is inserted movably in the longitudinal direction one by one so that the distal end and proximal end of the tension transmitting member 6 protrude from the distal end and proximal end of the sheath 7a, respectively. Yes. As a result, the pair of tension transmitting members 6 are bundled together by the sheath member 7 and branched at the distal end and the proximal end of the sheath 7a.

The tips of a pair of tension transmission members 6 bundled by a sheath member 7 are fixed to each joint piece 4. The pair of tension transmission members 6 are fixed one by one to the annular portion 9a of the main body 9 at positions facing each other across the first support column 10 in a plane including the longitudinal axis and perpendicular to the swing axis S. Has been. As shown in FIG. 2, the tension transmission member 6 having the distal end fixed to the joint piece 4 has a through hole 17 and a main body portion of one or more guide plates 5 arranged on the proximal side of the joint piece 4. 9 through the through hole 8 and led to the proximal end side of the insertion portion 1.

In the through hole 17 on the swing axis S, a plurality of tension transmitting members 6 fixed to the joint piece 4 to which the guide plate 5 provided with the through hole 17 is attached pass therethrough. The sheath member 7 is wired. The sheath member 7 passes through the through-hole 17 on the swing axis S, and the distal end of the sheath 7a, which is a branching position of the pair of tension transmission members 6, is disposed on the distal side of the swing axis S.

Here, the through hole 17 of the guide plate 5 has a flat rectangular shape having a major axis and a minor axis in a plane orthogonal to the longitudinal axis and the swing axis S, and two sheaths 7a are provided in the major axis direction. It has the dimension which can be inserted, and has a dimension which can insert only one sheath 7a in the short axis direction. The through-hole 17 is formed so that the long axis is parallel to the swing axis S. As a result, the pair of tension transmission members 6 penetrating through the through-hole 17 are arranged at an equal distance from the swing axis S, and are curved around the swing axis S with the same curvature.
The shape of the through hole 17 may be any shape that can define the direction of the sheath member 7 that penetrates the through hole 17. For example, as shown in FIG. The shape may be complementary to the outer shape.

The proximal end of the tension transmitting member 6 is connected to a motor (not shown) provided at the proximal end of the insertion portion 1. When the controller 103 drives the motor in accordance with the input to the master device 102 and one of the tension transmission members 6 is pulled by the motor and tension is generated in the tension transmission member 6, the tip of the pulled tension transmission member 6 is moved. The fixed joint piece 4 and the guide plate 5 attached to the joint piece 4 swing integrally around the swing axis S.

The surface of the sheath member 7 and the through hole are prevented so that the sheath member 7 does not adhere to the inner wall of the through hole 17 when the sheath member 7 comes into close contact with the inner wall of the through hole 17 due to the tension generated in the tension transmitting member 6. The 17 inner walls are made of different materials.

Next, the operation of the flexible medical instrument 2 and the bending mechanism 3 according to this embodiment configured as described above will be described.
According to the bending mechanism 3 according to the present embodiment, when the tension transmitting member 6 is pulled and tension is applied, the joint piece 4 to which the tip of the tension transmitting member 6 to which tension is applied is fixed is the swing axis. Swings around S. Thereby, the position and attitude | position of the front-end | tip part of the bending mechanism 3 can be changed. In addition, since a pair of separate tension transmission members 6 is connected to each joint piece 4, by pulling any one of the plurality of pairs of tension transmission members 6, Only one can be selectively rocked.

In this case, when one joint piece 4 swings around the swing axis S, the tension transmission member 6 connected to the other joint piece 4 has the same swing axis S as the one joint piece 4. Curve around. Thereby, the path | route length of the tension transmission member 6 connected to the other joint piece 4 changes, and the tension transmission member 6 is displaced to a longitudinal direction. However, the pair of tension transmission members 6 connected to the same joint piece 4 are bundled by the sheath member 7 so that the distal end side of the pivot axis S on the proximal side of the joint piece 4 is closer to the distal end side. It bends with the same curvature around the swing axis S through the same path. Accordingly, the displacement amounts of the pair of tension transmission members 6 connected to the other joint pieces 4 are substantially equal to each other. Thereby, it is possible to prevent the swing angle of the other joint piece 4 from unintentionally changing with the swing of one joint piece 4 and to improve the reproducibility of the operation of the bending mechanism 3. There is an advantage that you can.

In the present embodiment, the distal ends of the two sheaths 7a constituting the pair sheath are arranged at the same longitudinal position, and the distal ends of the two sheaths 7a are the branch positions. As shown in FIG. 8, the two sheaths 7 a may be connected to a midway position in the longitudinal direction, and the distal ends of the two sheaths 7 a may be separated from each other. Moreover, the cross-sectional shape of the sheath 7a may be a shape other than a circle, for example, a quadrangle as shown in FIG.

Moreover, in this embodiment, what has the 1st support | pillar part 10 in the center as a joint piece 4 is employ | adopted, and what has the fitting hole 14 which fits the 1st support | pillar part 10 as a guide plate 5 is illustrated. However, instead of this, as shown in FIGS. 10 and 11, a cylindrical joint piece 18 may be adopted, and the guide plate 5 may be arranged inside the joint piece 18. In the guide plate 5 of the bending mechanism 3 in FIG. 11, the fitting hole 14 is unnecessary, and the through hole 15 is provided in the center of the guide plate 5.

In the present embodiment, the pair of tension transmission members 6 connected to the same joint piece 4 are bundled by the sheath member 7, but the sheath member 7 is omitted and the pair of tension members 6 is omitted. A pair of tension transmission members 6 may be bundled and wired along the same path by passing the transmission member 6 through the same through hole 15 of the guide plate 5.
Even in this case, it is possible to reduce the difference in displacement amount between the pair of tension transmission members 6 due to the swing of the joint piece 4 and to prevent an unintended change in the swing angle of the joint piece 4.

3

Bending mechanism

4, 18 Joint piece (curved joint member)
5 Guide plate (guide member)
6 Tension transmitting member 7 Sheath member 7a Sheath 15 Through hole (opening)
17 Through-hole 19 Outer sheath S Oscillation axis

Claims

A plurality of curved joint members arranged in series along the longitudinal axis from the distal end side to the proximal end side and coupled to each other so as to be swingable around a swing axis intersecting the longitudinal axis;
A plurality of pairs of elongated tension transmitting members connected to each of the plurality of curved joint members and transmitting tensions for swinging the plurality of curved joint members independently of each other;
A plurality of flexible sheath members for bundling each pair of the tension transmitting members so as to be relatively movable in the longitudinal direction;
Each of the plurality of sheath members includes the pair of sheath members up to a branch position disposed on the distal end side with respect to the swing axis located on the proximal side of the bending joint member to which the pair of tension transmission members are connected. Bundle the tension transmission members of
A bending mechanism in which the pair of tension transmission members separated from each other on the distal end side with respect to the branch position are connected to different positions of the bending joint member.
2. The bending mechanism according to claim 1, wherein the sheath member is a pair sheath in which a pair of sheaths each accommodating one tension transmission member is coupled in the radial direction.
2. A plurality of flat plate-shaped guide members that are arranged on the base end side of each of the curved joint members so as to intersect the longitudinal axis and have through holes through which the sheath members are inserted in the thickness direction. The bending mechanism according to claim 2.
The bending mechanism according to claim 3, wherein the guide member is disposed on a plane including the swing axis.
5. The curve according to claim 3, wherein the through hole is provided so as to dispose the pair of tension transmission members at positions that are substantially the same distance apart from each other in the same direction with respect to the swing axis. mechanism.
The bending mechanism according to any one of claims 3 to 5, wherein the guide member has an opening penetrating in a plate thickness direction on an inner side in a radial direction than the through hole.
A plurality of curved joint members arranged in series along the longitudinal axis from the distal end side to the proximal end side and coupled to each other so as to be swingable around a swing axis intersecting the longitudinal axis;
A plurality of pairs of elongated tension transmitting members connected to each of the plurality of curved joint members and transmitting tensions for swinging the plurality of curved joint members independently of each other;
A plurality of flat plate-shaped guide members that are arranged on the proximal end side of each of the bending joint members and that have a through-hole that is inserted in the plate thickness direction and into which the tension transmission member is inserted;
A bending mechanism in which a pair of tension transmission members are inserted into each of the through holes.
The bending mechanism according to claim 7, wherein the guide member is disposed on a plane including the swing axis.
The curve according to claim 7 or 8, wherein the through-hole is provided so as to dispose the pair of tension transmission members at substantially the same distance in the same direction with respect to the swing shaft. mechanism.
A bending mechanism according to any one of claims 1 to 9,
A flexible medical instrument comprising a flexible cylindrical outer sheath covering the outer periphery of the bending mechanism.