WO2017119108A1

WO2017119108A1 - Endoscope treatment device

Info

Publication number: WO2017119108A1
Application number: PCT/JP2016/050400
Authority: WO
Inventors: 則仁和田; 卓也宮崎; 義彦日村
Original assignee: 学校法人慶應義塾; 株式会社トップ
Priority date: 2016-01-07
Filing date: 2016-01-07
Publication date: 2017-07-13
Also published as: JP6824507B2; JPWO2017119108A1; TW201733517A

Abstract

Provided is an endoscope treatment device which is capable of ensuring a sufficient operation space and field of view and which makes it easy to grasp a sense of distance. This endoscope treatment device 1 is provided with: flexible inner tubes 20 in which an endoscope 2 and a plurality of treatment instruments 3 are inserted to be capable of moving forward and backward; and an outer tube 30 in which the inner tubes 20 can be inserted. The inner tubes 20 are provided at a distal end part thereof with first bending operation parts 22, 25, 28 which, when the endoscope 2 and the treatment instruments 3 are advanced, bend and protrude the endoscope 2 and the treatment instruments 3 in a direction towards the outer circumference of the outer tube 30. Distal parts of the endoscope 2 and the treatment instruments 3 which protrude from the inner tubes 20 are each provided with second bending operation parts 2a, 3a, 70 which bend the endoscope 2 and the treatment instruments 3 in a direction toward the inner circumference of the outer tube 30.

Description

Endoscopic treatment device

The present invention relates to an endoscope treatment apparatus that combines an endoscope and a treatment tool introduced into a body cavity through a channel of the endoscope and sutures a tissue part in the body cavity.

Conventionally, a technique for performing treatment in a body cavity by inserting an endoscope and a treatment tool such as a forceps or a knife into the body cavity has been performed.

As an endoscopic treatment apparatus for performing this type of procedure, an endoscope, the treatment tool used under observation of the endoscope, and the endoscope and the treatment tool are respectively advanced and retracted. There is known an endoscope treatment apparatus including a plurality of inner tubes that can be freely inserted and an outer tube into which the inner tubes can be inserted (for example, see Patent Document 1).

This endoscopic medical device has a distal end opposed to a treatment portion, and then advances the endoscope to protrude from the inner tube disposed at the center in the radial direction, and advances each treatment tool to advance the endoscope. The procedure is performed by projecting from the inner tube placed around the endoscope.

International Publication No. WO2015 / 107994

However, in the endoscope medical device, since the treatment tool protrudes in parallel along the endoscope, the work space of the treatment tool is narrow, and the field of view of the endoscope is blocked by the treatment tool and the field of view is narrow. There is an inconvenience of becoming. Furthermore, since each of the treatment tools protrudes in a direction away from the endoscope, there is a disadvantage that it is difficult to grasp the sense of distance between the treatment tools.

In view of the above points, an object of the present invention is to provide an endoscopic medical device that can secure a sufficient working space and a visual field and that can easily grasp a sense of distance.

In order to achieve such an object, an endoscope treatment apparatus according to the present invention includes a flexible endoscope, a flexible treatment tool used under observation of the endoscope, Endoscopic treatment apparatus comprising a plurality of flexible inner tubes and a plurality of outer tubes into which the endoscope and the treatment instrument can be inserted and removably inserted into the interior. And when the endoscope and the treatment instrument are advanced, the endoscope, the treatment instrument, and the distal end of the inner tube are directed toward the outer peripheral direction of the outer tube. A first bending operation portion for bending and projecting the distal end portion of the endoscope and the treatment instrument protruding from the inner tube toward the inner circumferential direction of the outer tube. Bend the endoscope and the treatment tool The second bending operation portion and being provided respectively to.

In the endoscope treatment apparatus according to the present invention, since the first bending operation portion for projecting the endoscope and the treatment tool is provided at the respective distal end portions of the inner tube, the flexible inner device is provided. When the endoscope and the treatment instrument advance in the inner tube, the endoscope and the treatment tool are bent toward the outer peripheral direction of the outer tube by the first bending operation portion and protrude from the inner tube.

And since the 2nd bending operation part is provided in the front-end | tip part which protrudes from the inner tube among the said endoscope and the said treatment tool, it is bent again toward the inner peripheral direction of the said outer tube.

Therefore, in the endoscope treatment apparatus according to the present invention, the endoscope and the treatment tool are bent in the outer peripheral direction of the outer tube at the first bending operation portion, and are bent in the inner peripheral direction of the outer tube at the second bending operation portion. Since it approaches the part to be treated, the field of view and the work space can be widened. In addition, when performing a procedure on a treatment site with a plurality of treatment tools, the endoscope can see the movement of the plurality of treatment tools from a direction different from the advancing / retreating direction of each treatment tool. It can be easily grasped.

In the endoscope treatment apparatus according to the present invention, a third bending operation portion that is flexible, can be bent, and can be held in a bent state is provided between the distal end and the proximal end of the outer tube. It is preferable.

According to this, since the inner tube inserted through the outer tube, the endoscope, and the treatment instrument are all flexible, the outer tube can be held in a bent state at the third bending operation portion. .

In the endoscopic treatment apparatus of the present invention, the inner peripheral surface of the outer tube is provided with a plurality of first engaging portions that are spaced apart in the circumferential direction and extend in the axial direction from the distal end side to the proximal end side, It is preferable that the outer peripheral surface of the inner tube is provided with a second engaging portion that extends in the axial direction from the distal end side to the proximal end side and that slidably engages with the first engaging portion.

According to this, when the outer tube is bent, each inner tube can slide in the outer tube with the first engagement portion and the second engagement portion engaged, thereby preventing the outer tube from bending. Each inner tube, the endoscope inserted therein and the treatment instrument can be bent while maintaining the positional relationship with the outer tube.

Explanatory drawing which shows the endoscopic treatment apparatus of embodiment of this invention. The explanatory perspective view which shows the inside of an outer tube in the cross section of an axial direction. Sectional view taken along the line III-III of the endoscope treatment apparatus in FIG. Explanatory drawing which shows the inner tube of an endoscopic treatment apparatus. Explanatory drawing which shows the guide member of an endoscope treatment apparatus. Explanatory drawing which shows the use condition of an endoscope treatment apparatus. FIG. 7A is an explanatory view showing an inner tube according to a modified example, FIG. 7A is a front view showing a state where the inner tube is attached to the outer tube, FIG. 7B is a front view of the inner tube, and FIG. It is A sectional view.

An endoscope treatment apparatus 1 according to an embodiment of the present invention will be described with reference to FIG. The endoscope treatment apparatus 1 includes a flexible endoscope 2, forceps 3 (corresponding to the treatment tool of the present invention), and an inner tube used for assisting insertion of the endoscope 2 and forceps 3 into the body. 20 and an outer tube 30 into which the inner tube 20 is inserted.

In the present embodiment, the forceps 3 is described as an example of a treatment tool, but the treatment tool is not limited to this, and may be a scalpel, a gripping and peeling forceps, or a biopsy forceps.

The outer tube 30 is a substantially cylindrical body with a base end portion projecting radially outward, and a bendable portion 31 that can be bent is provided in the middle of the axial direction. The base end portion includes an air leakage prevention ring 32 and a valve. A sheet 32a (see FIG. 6) is attached.

In the present embodiment, the bent portion 31 is flexibly formed in an accordion shape by an elastomer. The bent portion 31 is not limited to the bellows shape, and may be formed of a soft plastic material such as polypropylene or vinyl chloride, or a soft flexible material such as rubber.

On the other hand, in the outer tube 30, the distal end side and the proximal end side of the bent portion 31 are provided with hard portions 30 a that are harder than the bent portion 31. The hard portion 30a is made of a hard material such as hard plastic such as ABS or polycarbonate or hard rubber.

The air leakage prevention ring 32 is bonded to the valve seat 32a. The air leakage prevention ring 32 is detachably attached to the main body of the outer tube 30. A plurality of holes through which the inner tube 20 is inserted are formed in the valve seat. Thereby, it can prevent that the air in a body cavity leaks from the location where the inner tube 20 of the outer tube 30 is not inserted, and the outer peripheral part of the inserted inner tube 20.

Subsequently, the internal structure of the outer tube 30 will be described with reference to FIGS. 2 and 3.

The outer tube 30 has an inner wall surface provided with a guide portion 33 extending in the axial direction from the distal end side to the proximal end side. A plurality of the guide portions 33 are provided at equal intervals in the circumferential direction with respect to the inner wall surface. The rail member 40 can be sandwiched and attached to the guide portion 33.

As shown in FIG. 3, the rail member 40 includes a bottom portion that extends narrowly in the circumferential direction from the lower end (outer side surface) of the neck portion, and a head that extends in the circumferential direction from the upper end (inner side surface) of the neck portion. Are formed in a substantially flat bottom rail shape. On the other hand, as shown in FIG. 3, the guide portion 33 has an inner surface shape that matches the outer surface shape of the neck portion and the bottom portion of the rail member 40, so that the rail member 40 can be sandwiched as described above. it can.

The rail member 40 is made of a hard material that is the same as or equivalent to the hard portion 30a, for example, a hard material such as hard plastic such as ABS or polycarbonate, or hard rubber, and is a long body having flexibility.

The bottom portion of the rail member 40 extends along the axial direction from the distal end side to the proximal end side on the outer side surface, thereby constituting the guided portion 41 that engages with the guide portion 33 of the outer tube 30 in the present invention. To do. The shape of the guided portion 41 is not limited to this, and any shape that engages with the guiding portion 33 may be used, and may be provided intermittently along the axial direction.

Further, as shown in FIG. 3, the head portion of the adjacent rail member 40 and the inner peripheral surface of the outer tube 30 constitute the first engagement portion 42 in the present invention.

The rail member 40 is fixed to the hard portion 30a on the distal end side of the outer tube 30 with an adhesive or the like with the guided portion 41 engaged with the guide portion 33. Other portions are not fixed to the outer tube 30. Thus, when the outer tube 30 is bent, each rail member 40 follows and bends while sliding, so that the bending of the outer tube 30 is not hindered.

The inner tube 20 is inserted and attached so as to be sandwiched between the first engagement portions 42 of the outer tube 30, and the diameter and number of the inner tubes 20 can be freely exchanged according to the procedure.

As shown in FIG. 4, the inner tube 20 is a flexible cylindrical body, and a treatment instrument such as the endoscope 2, the forceps 3, and the scalpel can be inserted therein. The inner tube 20 has a hydrophilic process on the outer peripheral surface.

In the present embodiment, as shown in FIG. 3, the inner tube 20 is attached with a device having a different outer diameter such as a device having an outer diameter of 5.3 mm and a device having an outer diameter of 3.2 mm (shown by a virtual line). Alternatively, the same outer diameter may be attached.

As shown in FIG. 4, the inner tube 20 is made of a soft material such as polypropylene and vinyl chloride, a soft material such as rubber, and a soft portion 20a. Hard portions 20b made of a hard material such as hard rubber are alternately connected in the axial direction.

As shown in FIG. 4, the inner tube 20 includes a second engagement portion 21 that is slidable by engaging with the first engagement portion 42 from the distal end to the proximal end of the outer peripheral surface, and an insertion depth. And a scale (not shown) for grasping.

In the present embodiment, the second engagement portion 21 is a wide rectangular protrusion protruding from the outer peripheral surface of the inner tube 20, but may have any shape as long as the second engagement portion 21 can be engaged with the first engagement portion 42. be able to.

The second engagement portion 21 is provided intermittently at a part of the portion from the distal end to the proximal end of the inner tube 20. In this embodiment, it is provided in the hard part 20b of the front end side and the base end side, respectively.

The inner tube 20 is attached to the outer tube 30 by the second engaging portion 21 being sandwiched between the first engaging portions 42 of the outer tube 30. Specifically, the second engagement portion 21 of the inner tube 20 is attached to the first engagement portion 42 adjacent to the bent portion 31 of the outer tube 30.

For this reason, in this embodiment, since the soft portion 20a on the distal end side is disposed inside the bent portion 31 of the outer tube 30, when the outer tube 30 is bent at the bent portion 31, the inner tube 20 is bent. I do not disturb.

Moreover, since the 2nd engaging part 21 of the inner tube 20 can slide with respect to the 1st engaging part 42 of the outer tube 30, when the outer tube 30 bends, each inner tube 20 slides, respectively. Therefore, the bending of the outer tube 30 is not hindered from this configuration.

On the other hand, the soft part 20 a on the base end side is inserted into the valve seat of the air leakage prevention ring 32, and a part projects from the base end of the outer tube 30. Since the soft portion 20a can be bent, the inner tube 20 can be bent radially outward, and interference between the endoscope 2 and the proximal end portion of the forceps can be avoided.

A bendable swinging pipe 22 and a nose cover 23 are attached to the tip of the inner tube 20.

The swinging pipe 22 is a pipe having flexibility that can connect a thin ring-shaped member in a multi-joint shape and can be bent only in one arbitrary direction. It can be configured as a bending mechanism that bends only in one direction from the state. The swing pipe 22 can also be configured by connecting a pipe made of a flexible soft material and a ring made of a hard plastic material such as ABS or polycarbonate.

The nose cover 23 is fixed to the tip of the swing pipe 22. The nose cover 23 is the same as the swing pipe 22 or is made of a softer plastic than this, for example, a soft plastic such as vinyl chloride, rubber or the like. Since the nose cover 23 is made of a soft material, the tissue is not damaged even if it comes into contact with the tissue.

On the other hand, a slide pipe 24,

slide knobs

25a and 25b, a slide stopper 26, and a deaeration prevention valve 27 are attached to the proximal end portion of the inner tube 20.

Wire members

28a and 28b are attached to the inner tube 20 from the distal end side to the proximal end side. Specifically, the

wire members

28a and 28b are fixed to the nose cover 23 at the tip ends, pass through the outside of the swing pipe 22, and are arranged in the order of the hard portion 20b, the soft portion 20a, the hard portion 20b, and the soft portion 20a. It is embedded along the direction, extends rearward from the base end portion of the inner tube 20, and the base end portions are fixed to the slide knobs 25a and 25b.

The slide knobs 25 a and 25 b are configured to be slidable with respect to the slide pipe 24. For this reason, when the distal end portion of the inner tube 20 protrudes from the distal end of the outer tube 30, the swing knob 22 is pulled to the proximal end side to bend the swinging pipe 22 outward in the radial direction of the outer tube 30. be able to. Conversely, by pulling the slide knob 25b to the proximal end side, the swinging pipe 22 can be returned to an unbent linear shape.

The slide knobs 25a and 25b are provided with a through hole extending toward the slide pipe 24, and a slide stopper 26 having a protrusion inserted into the through hole at the tip is attached.

For this reason, in a state where the slide knob 25a or the slide knob 25b is pulled, the slide stopper 26 is pushed in and frictionally engaged with the slide pipe 24, thereby locking the slide knobs 25a and 25b at the desired pulled positions. Can do.

The swing pipe 22, slide knob 25a, and wire member 28a correspond to the first bending operation portion of the present invention.

The deaeration prevention valve 27 prevents air leakage from the inner cavity 20 into which a treatment tool is not inserted from a body cavity, for example, the abdominal cavity.

Next, means for holding the outer tube 30 bent will be described with reference to FIG.

The guide member 60 is engaged with a portion of the first engagement portion 42 of the outer tube 30 where the inner tube 20 is not attached.

As shown in FIGS. 3 and 5, the guide member 60 is a long member in which an engaged portion 61 that is engaged with the first engaging portion 42 is formed along the axial direction. In this embodiment, the engaged portion 61 is a wide rectangular protrusion that protrudes from the outer peripheral surface of the inner tube 20. However, the engaged portion 61 may have any shape as long as it can be engaged with the first engaging portion 42. Can do.

The guide member 60 includes a substantially cylindrical main body 62 and a shaft 63 inserted into the main body 62.

The main body 62 is provided with window portions 62a intermittently along the axial direction. The base end portion of the main body portion 62 is a substantially fan shape and has a cross section having a circular hole at the top thereof. The main body 62 is made of a hard material having the same or equivalent hardness as the hard portion 20b of the inner tube 20. The shaft portion 63 has a substantially cylindrical shape and is made of a semi-hard material such as a wire or a copper wire.

Thus, when the outer tube 30 is bent at the bent portion 31, the outer tube 30 is held in a bent state by the shaft portion 63. Further, since the main body 62 is provided with the window 62a, it does not hinder bending.

The bent portion 31 and the guide member 60 correspond to the third bending operation portion of the present invention.

1 and 6, treatment tools such as an endoscope 2 and forceps 3 are inserted into the inner tube 20.

The endoscope 2 and the forceps 3 have bending

portions

2a and 3a that can be bent at the distal end portion, and drive units 70 that perform an operation of bending the bending

portions

2a and 3a at the proximal end portion, respectively.

The driving unit 70 includes a motor 71, a driving pulley 72, a wire 73, and a driven pulley 74.

The motor shaft of the motor 71 is connected to a driving pulley 72, and one end of a wire 73 is bridged over the driving pulley 72. The wire 73 is housed in the endoscope 2 and the forceps 3 so as to be movable in the axial direction, and the other end is bridged on a driven pulley 74.

For this reason, when the motor 71 is rotated, the driving pulley 72 is rotated, the wire 73 is moved, the driven pulley 74 is rotated, and the

bent portions

2a and 3a are bent.

Thereby, the camera 2b and the forceps portion 3b provided at the distal end of the endoscope 2 can be bent inward in the radial direction so as to be opposed to the treatment target portion.

The

bent portions

2a and 3a and the drive unit 70 correspond to the second bending operation portion of the present invention.

The ON / OFF operation unit of the motor 71 may be a manual type or a machine control type. Moreover, a wire can also be pulled manually, without using a motor.

Further, it is also possible to bendable in a straight line while forming the

bent portions

2a and 3a in a bent shape. That is, the

bent portions

2a and 3a are inserted into the inner tube 20 in a state where the

bent portions

2a and 3a are linearly extended, and according to this, the endoscope 2 is advanced and the

bent portions

2a and 3a are moved to the inner tube 20. When protruding from the nose cover 23, the

bent portions

2a and 3a return to the original bent state, so that the

bent portions

2a and 3a can be bent inward in the radial direction without providing the drive portion 70 operating portion. .

Next, a method of using the endoscope treatment apparatus 1 will be described with reference to FIG. 1 and FIG. In this embodiment, a case where laparoscopic surgery (Rapallo) is performed will be described. However, the endoscope treatment apparatus 1 can also be used when performing other surgical methods, for example, natural opening transluminal endoscopic surgery (NOTES).

First, the retractor 80 is attached to the retractor formed on the body wall, maintains the open state of the retractor and protects the retractor, and the retractor 80 is attached to the retractor 80. A retractor valve cap 81 that allows introduction of the endoscope treatment apparatus 1 from the opening formed by the above and maintains the airtightness of the abdominal cavity is attached.

Next, the inner tube 20 is inserted into the outer tube 30 and attached.
In the present embodiment, as shown in FIG. 1, the endoscope 2 is attached so that the endoscope 2 is arranged upward and the forceps 3 are arranged in the left-right direction at 60 degrees apart in the circumferential direction. At this time, the inner tube 20 is buried without protruding from the tip of the outer tube 30.

Next, the endoscope 2 and the forceps 3 are inserted into the inner tube 20 respectively. At this time, the endoscope 2 and the forceps 3 are buried without protruding from the tip of the inner tube 20.

Next, if the outer tube 30 is bent at the bent portion 31 at an angle at which the endoscope 2 and the forceps 3 are likely to face the treated portion C as necessary, the bent state is maintained by the guide member 60. .

The endoscopic treatment device 1 that has been prepared as described above is inserted into the body cavity via the retractor valve cap 81.

Next, the inner tube 20 is advanced, protruded from the tip of the outer tube 30, and the slide knob 25a is pulled, so that the swinging pipe 22 is bent outward in the radial direction of the outer tube 30.

Next, the endoscope 2 is advanced and protruded from the tip of the inner tube 20. And by operating the operation part for endoscopes, the endoscope 2 is bent inward in the radial direction by the bent part 2a, and is made to face the treated part C.

Further, the forceps 3 are advanced, protruded from the tip of the inner tube 20, and the treatment tool operation portion is operated, whereby the forceps 3 is bent radially inward by the bending portion 3a and brought closer to the treatment portion C.

Thus, preparation is completed and the procedure can be performed.

In the endoscope treatment apparatus 1 of the present embodiment, the inner tube 20 is bent radially outward, and then the endoscope 2 and forceps 3 are bent radially inward.

As a result, the forceps 3 can be approached from the left and right directions while observing the treated portion C with the endoscope 2 from a bird's-eye view. can do. Since the endoscope 2 and the forceps 3 need only be provided with one bending portion in order to bend radially inward, it is not necessary to increase the number of joints, thereby reducing the size and cost of the device. Can do.

Further, in the endoscope treatment apparatus 1 according to the present embodiment, the endoscope 2 is arranged upward and the forceps 3 are arranged in the left-right direction, so that the same positions as the eyes and the left and right hands when the surgeon performs a laparotomy. Can be arranged. Therefore, if the forceps 3 is a robot forceps and can be operated as a manipulator by an operation device, the operator can perform a procedure with the same feeling as in a laparotomy.

As mentioned above, although embodiment of this invention was described, this invention is not limited to this, The structure and form of a formation apparatus can be changed suitably. For example, the first engagement portion 42 may be formed by integrating the outer tube 30 and the plurality of rail members 40. In addition, the soft material, the hard material, and the semi-hard material may be a material in which the softness is adjusted by changing the blend of the same type of resin.

[Modification]
An inner tube 120 according to a modification will be described with reference to FIGS. 7A to 7C.

The inner tube 120 is a long member having a fan-like axial cross section extending in the axial direction from the distal end side to the proximal end side.

The inner tube 120 has a through hole in the axial direction from the distal end surface to the proximal end surface. The through hole includes a linear guide passage 121 extending in the axial direction from the base end toward the distal end, and a bent guide passage 122 that is bent at the base end connected to the distal end of the linear guide passage 121. The distal end of the bending guide passage 122 opens at the distal end surface of the inner tube 120, and an opening 123 is formed.

Therefore, when the endoscope 2 or the forceps 3 is inserted and advanced with respect to the inner tube 120, the endoscope 2 and the forceps 3 are bent by the bending guide passage 122 and then radially outward from the opening 123. Protruding.

Then, as shown in FIG. 7A, the three inner tubes 120 are formed into a substantially columnar shape by combining the three, so that the endoscope 2 and the forceps 3 are projected substantially radially.

Therefore, according to the inner tube 120, the endoscope 2 and the forceps 3 can be bent radially outward with a simple configuration.

DESCRIPTION OF SYMBOLS 1 ... Endoscopic treatment apparatus, 2 ... Endoscope, 2a ... Bending part, 3 ... Forceps (treatment tool), 3a ... Bending part, 20 ... Inner tube, 21 ... 2nd engaging part, 22 ... Swing pipe , 25 ... slide knob, 28 ... wire member, 30 ... outer tube, 31 ... bent part, 42 ... first engaging part, 60 ... guide member, 70 ... drive part 70.

Claims

An endoscope having flexibility, and a treatment instrument having flexibility used under observation of the endoscope;
A plurality of flexible inner tubes that can be inserted into the endoscope and the treatment instrument so as to freely advance and retract;
An endoscopic treatment apparatus comprising an outer tube into which a plurality of the inner tubes can be inserted,
At the respective distal ends of the inner tubes, when the endoscope and the treatment instrument are advanced, the endoscope and the treatment instrument are bent toward the outer peripheral direction of the outer tube. A first bending operation part to be protruded is provided;
A second bending operation section that bends the endoscope and the treatment instrument toward an inner circumferential direction of the outer tube at a distal end portion protruding from the inner tube of the endoscope and the treatment instrument. Are provided, respectively.
The endoscopic treatment device according to claim 1,
An endoscope treatment apparatus, characterized in that a third bending operation section is provided between the distal end and the proximal end of the outer tube, which is flexible, can be bent and can be held in a bent state. .
The endoscopic treatment device according to claim 2,
The inner peripheral surface of the outer tube is provided with a plurality of first engaging portions that are spaced apart in the circumferential direction and extend in the axial direction from the distal end side to the proximal end side,
The outer peripheral surface of the inner tube is provided with a second engagement portion that extends in the axial direction from the distal end side to the proximal end side, and slidably engages with the first engagement portion. Endoscopic treatment device.