WO2020049713A1

WO2020049713A1 - Endoscope system

Info

Publication number: WO2020049713A1
Application number: PCT/JP2018/033184
Authority: WO
Inventors: 佐藤　英幸
Original assignee: オリンパス株式会社
Priority date: 2018-09-07
Filing date: 2018-09-07
Publication date: 2020-03-12

Abstract

The present invention is an endoscope system comprising an endoscope that includes an elongated insertion part, an instrument channel running parallel to the insertional part on the outside the insertional part, and an instrument passing through the instrument channel, said system having an actuation member which rotates around an axis of rotation parallel to the longitudinal axis of the insertion part, and comprising: a rotational member that is provided to the distal end of the insertion part, and is rotated about the longitudinal axis of the instrument channel by the transmission of the actuation force of the actuation member; and an attachment member that attaches to the distal end of the insertional part to achieve a state in which the actuation force of the actuation member can be transmitted to the rotational member. The relative rotation, with respect to the instrument channel, of the instrument passing through the instrument channel is restricted, and the distal end of the instrument is rotated by the rotation of the instrument channel in tandem with the rotation of the rotational member.

Description

Endoscope system

The present invention relates to an endoscope system.

It is known that a treatment tool is passed through a treatment tool channel provided in an insertion portion of an endoscope, and a treatment or the like for a lesion in a body is performed using the treatment tool.
Some treatment tools have directionality, such as grasping forceps that open and close. In order to perform appropriate treatment using a treatment tool having directivity, it is necessary to appropriately adjust the relationship between the distal end of the treatment tool and a lesion.

Patent Document 1 describes that a cap is attached to a distal end of an endoscope and a treatment tool protruding from the endoscope is rotated. In the technique described in Patent Literature 1, a wire drawn out of a cap is wound around a treatment tool. When the wire is driven, the treatment tool can be rotated around the longitudinal axis or held so as not to rotate.

Japanese Patent No. 6129114

There is a demand for performing more complicated treatment using a treatment tool under endoscopic observation. To achieve this, the use of a treatment tool that can bend more greatly is being considered.
With the mechanism of Patent Document 1, it is possible to rotate a treatment instrument that can be more greatly curved around the longitudinal axis, but if the treatment instrument that protrudes from a channel provided in the endoscope is largely curved, the curved portion becomes invisible. It occupies much of the field of view of the mirror, making the procedure difficult.

In view of the above circumstances, the present invention provides an endoscope system that can perform a treatment with a good visual field even when using a treatment tool that can be greatly bent, and that can appropriately adjust the relationship between the treatment tool tip and a lesion. The purpose is to do.

The present invention is an endoscope system including an endoscope provided with an elongated insertion section, a treatment tool channel running parallel to the insertion section outside the insertion section, and a treatment tool passed through the treatment tool channel.
The endoscope system includes a driving member provided at a distal end portion of the insertion portion and rotating around a rotation axis parallel to a longitudinal axis of the insertion portion, and a distal end portion of the insertion portion provided on an outer peripheral side of the insertion portion. The rotating member rotates around the longitudinal axis of the treatment instrument channel by transmitting the driving force of the driving member, and the driving force of the driving member can be transmitted to the rotating member by being attached to the distal end of the insertion portion. And a mounting member to be in a state.
The relative rotation of the treatment tool passed through the treatment tool channel with respect to the treatment tool channel is regulated, and the distal end of the treatment tool is rotated by the rotation of the treatment tool channel along with the rotation of the rotating member.

According to the present invention, it is possible to perform a treatment with a good visual field even when using a treatment tool that can be greatly bent, and it is possible to appropriately adjust the relationship between the treatment tool tip and a lesion.

1 is an overall configuration diagram of an endoscope system according to a first embodiment of the present invention. It is an enlarged view which shows the front end side of the endoscope system in a partial cross section. It is a figure showing the state where a treatment instrument projected from a channel unit. FIG. 4 is a cross-sectional view of an external channel through which a treatment tool insertion portion is passed. It is a perspective view showing the tip part of the endoscope system concerning a second embodiment of the present invention. It is sectional drawing of a 2nd channel front-end | tip part. It is a figure which shows a hook-shaped electrode. It is a figure showing one process at the time of use of the endoscope system. It is a figure showing composition of a modification of a drive mechanism. It is a figure showing composition of a modification of a drive mechanism. It is a figure showing composition of a modification of a drive mechanism.

A first embodiment of the present invention will be described with reference to FIGS.
FIG. 1 is a diagram illustrating an overall configuration of an endoscope system 1 according to the present embodiment. The endoscope system 1 includes an endoscope 10, a channel unit 50 attached to the endoscope 10, and a treatment tool 80 passed through the channel unit 50.

The endoscope 10 includes an elongated insertion section 11 and an operation section 20 provided at a base end of the insertion section 11. An imaging mechanism 12 is provided at the tip of the insertion section 11. A partial region on the distal end side of the insertion portion 11 is configured as a bending portion 13 having a plurality of node rings or bending pieces and capable of performing a bending operation. The bending section 13 and the operation section 20 are connected by a wire or the like, and the bending section 13 can be bent in a desired direction by operating the operation section 20.

駆動 In the insertion section 11, a drive mechanism 30 for driving the attached channel unit 50 is provided in a region closer to the distal end than the bending section 13. Details of the drive mechanism 30 will be described later.

The channel unit 50 includes a mounting section 51 mounted on the endoscope 10 and an external channel (treatment instrument channel) 60 connected to the mounting section 51.

FIG. 2 is an enlarged view showing the distal end portion of the endoscope system 1 in a partial cross section. As shown in FIG. 2, the mounting section 51 includes a band (mounting member) 52 that can be attached to and detached from the endoscope 10, and a rotating member 53 attached to the band 52. The rotating member 53 has a cylindrical basic shape, and has a large-diameter portion 54 having an outer diameter larger than other portions at an axially intermediate portion. A plurality of teeth are formed on the outer peripheral surface of the large diameter portion 54, and the large diameter portion 54 is formed in a gear shape as a whole.

The external channel 60 (treatment instrument channel) is a flexible tube, and is formed of, for example, resin. The distal end of the external channel 60 is connected to the base end of the rotary member 53, and the internal space of the external channel 60 and the internal space of the rotary member 53 communicate with each other. The external channel 60 extends to the vicinity of the operation unit 20.
The cross-sectional shape of the internal space of the external channel 60 perpendicular to the longitudinal axis is elliptical.

The drive mechanism 30 includes a gear (drive member) 31 attached to the distal end of the insertion section 11 and a shaft 32 connected to the gear 31. The gear 31 has a plurality of teeth on the outer peripheral surface, and is arranged so that a part of the outer peripheral surface is exposed outside the insertion portion 11. The shaft 32 has flexibility. The shaft 32 has a certain rigidity, and can transmit rotation about its own axis at the proximal end to the distal end. Examples of the material of the shaft 32 include a resin and a metal.

The tip of the shaft 32 is connected to the rotation center of the gear 31. The shaft 32 extends through the insertion section 11 to the operation section 20. A disk-shaped dial 33 (see FIG. 1) is attached to the base end of the shaft 32. A part of the outer peripheral surface of the dial 33 is exposed to the operation unit 20 and can be operated by the operator of the endoscope 10. When the dial 33 is rotated, the gear 31 is rotated by rotating the shaft 32.
As shown in FIG. 2, when the band 52 is attached to the endoscope 10, the gear 31 and the large diameter portion 54 of the rotating member 53 can be engaged. The band 52 can support the external channel 60 with respect to the endoscope 10 while maintaining a state in which the gear 31 and the rotating member 53 are engaged with each other.

As shown in FIG. 1, the treatment tool 80 is provided at an elongated treatment tool insertion portion 81, an end effector 82 provided at a distal end portion of the treatment tool insertion portion 81, and a base end portion of the treatment tool insertion portion 81. And a treatment tool operation unit 83. A partial region near the distal end of the treatment tool insertion section 81 is configured as a treatment tool bending section 84 having the same structure as the bending section 13.
In the treatment tool insertion portion 81, the cross-sectional shape orthogonal to the longitudinal axis of the region closer to the base end than the treatment tool bending portion 84 is elliptical.

エンド The end effector 82 of the present embodiment is a grasping forceps that can be opened and closed. The specific configuration of the end effector 82 can be selected from the configurations of various known treatment tools depending on the application and the like.

The treatment instrument operation section 83 has a handle 85 and a trigger 86. The handle 85 and the treatment instrument bending portion 84 are connected by a wire or the like. By inclining the handle 85 with respect to the treatment tool insertion section 81, the treatment tool bending section 84 can be bent in a desired direction. The trigger 86 and the end effector 82 are connected by a wire or the like. By operating the trigger 86, the end effector 82 can be opened and closed.

An operation at the time of using the endoscope system 1 of the present embodiment will be described. The endoscope system 1 is operated by two persons, a scopist operating the endoscope 10 and an operator operating the treatment tool 80.
As a preparation step, the band 52 is attached to the distal end of the insertion section 11 of the endoscope 10, and the teeth of the gear 31 and the teeth of the rotating member 53 are engaged. Through this step, the channel unit 50 is attached to the endoscope 10.

The scopist inserts the endoscope 10 to which the channel unit 50 is attached into the digestive tract of the patient, and advances the end of the endoscope to near the lesion to be treated.
The surgeon inserts the treatment tool 80 from the proximal opening of the external channel 60. The treatment tool 80 advances within the external channel 60 and the rotating member 53, and the end effector 82 protrudes from the distal end opening of the rotating member 53 as shown in FIG. At this time, as shown in FIG. 4, since the cross-sectional shape of the internal space of the external channel 60 is elliptical and the cross-sectional shape of the treatment tool insertion portion 81 of the treatment tool 80 is elliptical, the treatment tool 80 , Cannot rotate relative to the channel unit 50 about the longitudinal axis.
If necessary, the proximal end of the external channel 60 may be fixed to the bed on which the patient lies at an appropriate timing.

The operator performs a desired treatment by operating the treatment tool 80 while observing the treatment target site with the endoscope 10. The treatment may be performed by projecting the treatment instrument bending portion 84 from the rotating member 53 as necessary. When the treatment instrument bending portion 84 is projected, the degree of freedom of the position and posture of the end effector 82 is significantly improved. On the other hand, since the treatment tool 80 protrudes from the channel unit 50 outside the insertion section 11 of the endoscope 10, it is unlikely that the treatment tool bending portion 84 occupies a large area of the visual field of the endoscope 10.

When the operator wants to adjust the opening / closing direction of the end effector 82, the operator instructs the scopist to rotate the treatment tool 80. When the scopist receives the instruction and operates the dial 33, the shaft 31 rotates around the longitudinal axis, so that the gear 31 rotates. As a result, the rotating member 53 of the channel unit 50 rotates around its own cylindrical axis. The rotation of the rotating member 53 is transmitted from the external channel 60 to the treatment instrument insertion section 81 whose rotation is regulated relative to the external channel 60, and finally the treatment instrument 80 rotates around the longitudinal axis. Thereby, the opening / closing direction of the end effector 82 can be adjusted to a desired state with respect to the tissue or the like to be treated.

According to the endoscope system 1 of the present embodiment, the drive mechanism 30 provided in the endoscope 10 and the rotating member 53 provided in the channel unit 50 are engaged near the end of the endoscope 10. . Therefore, a rotational driving force can be directly applied to the distal end side of the channel unit 50. Therefore, the rotational driving force can be more reliably transmitted to the distal end of the external channel 60 than when the flexible external channel 60 is directly driven to rotate.
Furthermore, even if the external channel 60 is meandering inside the body, the treatment tool 80 can be reliably rotated to appropriately adjust the relationship between the treatment tool tip and the lesion.

In addition, since the treatment tool 80 is passed through the external channel 60 that runs in parallel with the endoscope 10, the visual field of the endoscope 10 can be reduced even if a treatment tool having a treatment tool bending portion and having a high degree of freedom is used. Large and difficult to occupy. As a result, a high degree of freedom of the treatment tool and a favorable endoscope visual field can be suitably compatible.

The content of the present embodiment is not limited to the above-described example, and various changes can be made. Some examples are given below, but not all. Further, two or more of these changes may be appropriately combined.
The cross-sectional shapes of the external channel and the treatment tool are not limited to elliptical shapes, but may be other shapes such as a polygon including a rectangle. The cross-sectional shape of the external channel and the cross-sectional shape of the treatment tool do not need to be similar to each other as long as the rotation of the treatment tool insertion portion in the external channel is restricted.
By regulating the relative rotation between the treatment tool and the rotation member by setting the cross-sectional shape of the internal space of the rotation member to a predetermined shape, the relative rotation between the treatment tool and the external channel passed through the external channel is regulated. Is also good.
-The cross-sectional shape which regulates the relative rotation of the treatment instrument insertion portion may not be provided on the entire treatment instrument insertion portion and the externally attached channel. For example, a cross-sectional shape that regulates relative rotation may be provided only in a fixed region of the distal end portion of the external channel and the treatment tool insertion portion.
The manner of engagement between the drive mechanism and the rotating member need not be the gear teeth described above. For example, a configuration may be employed in which the outer peripheral surface of the drive mechanism and the outer peripheral surface of the large diameter portion are frictionally engaged. In this case, when the friction coefficient on the drive mechanism side, that is, the friction coefficient on the endoscope side is smaller than the friction coefficient on the channel unit side, when the endoscope 10 is used without mounting the channel unit, the drive mechanism is connected to the digestive tract or the like. The burden on the tissue upon contact can be reduced.
The engagement ratio (gear ratio) between the drive mechanism and the rotating member may be set as appropriate. For example, the amount of operation of the dial 33 may be reduced by increasing the rotation of the drive mechanism at the rotating member, or may be configured to allow fine adjustment by reducing the speed.

第二 A second embodiment of the present invention will be described with reference to FIGS. In the following description, the same components as those already described are denoted by the same reference numerals, and redundant description will be omitted.

FIG. 5 is a perspective view showing the distal end side of the endoscope system 101 of the present embodiment. The channel unit 150 of this embodiment has two sets of external channels and rotating members. In the following description, the second set of external channels and the rotating member will be referred to as a second channel 151 and a second rotating member 152, respectively.
Although not shown, the gear 31 of the endoscope 10 is engaged with both the rotating member 53 and the second rotating member 152. Therefore, when the gear 31 rotates, both the rotating member 53 and the second rotating member 152 rotate.

断面 The cross-sectional shape of the internal space of the second channel 151 is circular unlike the external channel 60. In FIG. 5, the treatment tool insertion portion of the treatment tool 180 passed through the second channel 151 is also circular. Therefore, the treatment tool 180 and the second channel 151 can be relatively rotated around the longitudinal axis of the second channel 151.

FIG. 6 is a cross-sectional view of the tip of the second channel 151. A ring-shaped balloon 155 (expansion member) is arranged in the internal space at the distal end of the second channel 151. The balloon 155 expands by supplying a fluid to the inside, and contracts by collecting the fluid. A tube 156 for supplying and recovering a fluid is connected to the balloon 155. The tube 156 is connected to the balloon 155 through a through hole 151a formed in the second channel 151. The tube 156 extends in parallel with the second channel 151. A fluid supply unit such as a syringe (not shown) is connected to the base end of the tube 156.

The operation at the time of using the endoscope system 101 will be described.
As shown in FIG. 5, the end effector of the treatment tool 180 passed through the second channel 151 is a rod-shaped electrode 181. Since the electrode 181 has no directionality, there is no need to adjust the rotation of the high-frequency knife 180.

In the endoscope system 101, when the scopist operates the dial 33, both the rotating member 53 and the second rotating member 152 rotate. However, since the relative rotation between the high-frequency knife 180 and the second channel 151 is not restricted, the second rotating member 152 and the second channel 151 idle with respect to the high-frequency knife 180, and the high-frequency knife 180 does not rotate.

Some high-frequency knives have a hook-shaped electrode 182 as shown in FIG. When using the treatment tool provided with the electrode 182 through the second channel 151, it may be necessary to adjust the direction of the hook with respect to the target tissue.
In this case, the scopist operates the fluid supply means to supply the balloon 155 with fluid. Then, the balloon 155 expands so as to fill a gap between the treatment instrument insertion portion 183 and the second channel 151 as shown in FIG. As a result, both the treatment instrument insertion portion 183 and the second channel 151 frictionally engage with the balloon 155, and the relative rotation between the treatment instrument insertion portion 183 and the second channel 151 is regulated. When the dial 33 is operated in this state, the treatment tool rotates with the rotation of the second rotating member 152, and the direction of the hook can be adjusted.

Also in the endoscope system 101 of the present embodiment, similarly to the first embodiment, a treatment can be performed with a good visual field even by using a treatment tool that can be greatly bent, and the relationship between the treatment tool tip and a lesion or the like can be improved. Can be adjusted appropriately.
Furthermore, since the second channel 151 includes the balloon 155, the state where the treatment tool passed through the second channel 151 is rotated by the driving mechanism and the state where the treatment tool does not rotate can be switched by the expansion and contraction of the balloon 155. Therefore, by appropriately operating the balloon according to the type of the treatment tool passed through the second channel and the like, it is possible to perform a procedure using two treatment tools without feeling stress.

In the above description, a balloon is provided in the second channel 151. However, as another configuration, a balloon may be provided around the treatment instrument insertion portion. Also in this case, the relative rotation between the treatment tool and the second channel 151 can be regulated by inflating the balloon in the second channel 151. The conduit for supplying fluid to the balloon may run in parallel with the treatment instrument insertion portion, or may be a lumen provided in the treatment instrument insertion portion.

In the endoscope system of the present embodiment, two drive mechanisms may be provided in the endoscope, and the two external channels may be configured to be independently rotatable.

As described above, each embodiment of the present invention has been described. However, the technical scope of the present invention is not limited to the above-described embodiment, and various changes may be made to each component without departing from the spirit of the present invention. And can be deleted.
Some modifications are illustrated below, but not all, and other modifications are also possible. Two or more of these changes may be appropriately combined.

-In the drive mechanism of the present invention, the shaft 132 may be formed in a tubular shape as in a modified example shown in FIG. The shaft 132 may be disposed in the insertion section 11 or may be disposed on the outer periphery of the insertion section 11.
-The drive mechanism of the present invention is not limited to the one in which the shaft extends over the entire insertion portion. For example, as in the configuration example shown in FIG. 10, the gear 31 and the dial 33 may be provided with short shafts 133A and 1313B, respectively, and the gear 31 and the dial 33 may be connected by a wire 135 wound around the

shafts

133A and 133B. By doing so, the flexibility of the insertion section 11 can be improved. When the dial and the shaft are connected by a gear or a pulley, the rotation direction of the dial and the rotation direction of the treatment tool match, and intuitive operation becomes possible.

In the present invention, the channel unit does not always need to be detached from the endoscope, and the channel unit may be always attached to the endoscope.
-Instead of connecting the rotating member and the external channel, a member corresponding to the large diameter portion may be attached to the outer surface of the external channel.
As in the modification shown in FIG. 11, in the rotating member 53, the dimension D1 of the large diameter portion 54 in the longitudinal axis direction of the external channel 60 may be smaller than the dimension D2 of the gear 31 in the same direction. In this case, the external channel can be advanced and retracted by a certain length with respect to the insertion portion of the endoscope while maintaining the state in which the rotating member and the driving member can transmit the driving force.
The configuration of the treatment instrument bending portion is not limited to the mode including the node ring and the bending piece. For example, a configuration having one or more joints in which adjacent links are rotatably connected may be employed.

The present invention can be applied to an endoscope system.

1, 101 Endoscope system 10 Endoscope 30 Drive mechanism 31 Gear (drive member)
52 band (mounting member)
53, 152 Rotating member 60 External channel (treatment instrument channel)
80, 180 Treatment instrument 151 Second channel (treatment instrument channel)
155 balloon (inflation member)

Claims

An endoscope system comprising: an endoscope including an elongated insertion portion; a treatment tool channel running parallel to the insertion portion outside the insertion portion; and a treatment tool passed through the treatment tool channel. ,
A driving member provided at the distal end of the insertion portion and rotating about a rotation axis parallel to a longitudinal axis of the insertion portion;
A rotating member that is provided at the distal end of the insertion portion and is provided on an outer peripheral side of the insertion portion and that rotates around a longitudinal axis of the treatment instrument channel by transmitting a driving force of the driving member;
A mounting member that is mounted on the distal end of the insertion portion so that the driving force of the driving member can be transmitted to the rotating member.
With
The treatment tool passed through the treatment tool channel is regulated relative rotation with respect to the treatment tool channel,
By rotating the treatment instrument channel with the rotation of the rotating member, the distal end of the treatment instrument is rotated,
Endoscope system.
The treatment tool has at least a part of the cross-sectional shape in the longitudinal direction, and a shape in which relative rotation is regulated in the treatment tool channel,
The endoscope system according to claim 1.
The treatment instrument channel is connected to the rotating member,
The internal space of the treatment instrument channel and the internal space of the rotating member are in communication,
The endoscope system according to claim 1.
At least one of the treatment tool channel and the treatment tool has an expansion member that expands by supplying a fluid, and the relative rotation is regulated by expanding the expansion member in the treatment tool channel.
The endoscope system according to claim 1.
The rotation is transmitted by frictionally engaging the driving member and the rotating member,
The friction coefficient of the driving member is smaller than the friction coefficient of the rotating member,
The endoscope system according to claim 1.
The driving member has a gear,
The rotating member has a gear-shaped large diameter portion,
The driving force can be transmitted by meshing the gear and the large diameter portion,
The endoscope system according to claim 1.
2. The endoscope system according to claim 1, further comprising a shaft connected to a base end of the driving member and disposed on an outer periphery of the insertion section or inside the insertion section. 3.