WO2020179014A1

WO2020179014A1 - Pericardial endoscope system

Info

Publication number: WO2020179014A1
Application number: PCT/JP2019/008859
Authority: WO
Inventors: 善朗岡崎; 俊二武井; 和敏熊谷
Original assignee: オリンパス株式会社
Priority date: 2019-03-06
Filing date: 2019-03-06
Publication date: 2020-09-10

Abstract

This pericardial endoscope system is provided with: an endoscope having an observation window at the distal end surface; a pair of passages (11, 12) disposed parallel to the endoscope; a pair of expanding wires (41, 42) disposed within the passages (11, 12); and a pair of balloons (51, 52) which are disposed at distal end parts (41a, 42a) of the expanding wires (41, 42) and expand in a first radial direction. Distal end openings (11a, 12a) of the passages (11, 12) are located on both sides of the observation window in a second radial direction. When the distal end parts (41a, 42a) protrude from the distal end openings (11a, 12a), the distal end parts (41a, 42a) have an expanded form in which the distance between the distal end parts (41a, 42a) gradually increases towards the distal ends in the second radial direction, and in the passages (11, 12), the distal end parts elastically transform into a contracted form in which the distal end parts extend substantially parallel to each other.

Description

Pericardial endoscopy system

The present invention relates to a pericardial endoscopy system.

❖ Conventionally, pericardial endoscopes have been used in surgical treatment of the heart. The endoscope is inserted into a sac-like sac that covers the surface of the heart and is placed in the gap between the heart and the pericardium. In a normal state, since the pericardium is in close contact with or close to the surface of the heart, the visual field of the endoscope is blocked by the pericardium, making it difficult to observe the heart. Therefore, in order to observe the heart with an endoscope, it is necessary to push up the pericardium to form a space between the heart and the pericardium to secure a visual field. Therefore, a device having a function of forming a space between the heart and the pericardium is known (see, for example, Patent Documents 1 and 2). The devices of U.S. Pat. Nos. 5,837,659 and 5,037,836 include a plurality of elongated frames or balloons spaced from one another.

U.S. Pat. No. 8460181 U.S. Patent Application Publication No. 2015/0313634

In order to secure a wider field of view of the endoscope, the space is expanded not only in the height direction of the field of view (vertical direction of the endoscope image) but also in the width direction of the field of view (horizontal direction of the endoscope image). There is a need. In addition to the pressing force in the height direction toward the heart, a pressing force in the width direction is applied from the pericardium to the device arranged between the heart and the pericardium. The devices of

Patent Documents

1 and 2 have insufficient resistance to the inward pressure in the width direction from the pericardium, and are easily deformed inward in the width direction. Therefore, there is a demand for a device that can ensure a stable visual field in the width direction.

The present invention has been made in view of the above circumstances, and provides a cardiovascular endoscopy system capable of stably securing a field of view of an endoscope not only in the height direction but also in the width direction. With the goal.

One aspect of the present invention is an endoscope having an observation window for observing a subject on its tip surface, a pair of passages arranged in parallel with the longitudinal axis of the endoscope, and a pair of passages in the longitudinal direction. A pair of expansion wires arranged along the line and a pair of balloons provided at the tips of the pair of expansion wires and expanding in a first radial direction orthogonal to the longitudinal axis are provided, and the pair of passages are provided. The tip openings are arranged on both sides of the observation window in the longitudinal axis and the second radial direction orthogonal to the first radial direction, and the tips of the pair of expansion wires and the pair of balloons are the pair. When the tips of the pair of expansion wires project from the pair of tip openings, the distance between the tips is such that the second diameter is toward the tip. It is a cardiovascular endoscopic system that has an dilated form that gradually expands in a direction and, when placed in the passage, elastically deforms into a contracted form that extends substantially parallel to each other along the longitudinal direction of the passage.

According to the present invention, there is an effect that the field of view of the endoscope can be stably secured not only in the height direction but also in the width direction.

1 is an overall configuration diagram of a pericardial endoscope system according to an embodiment of the present invention. FIG. 1A is a front view of the sheath body and the endoscope inside the sheath body as viewed from the tip side. FIG. 1B is a vertical cross-sectional view showing the internal configuration of the distal end portion of the sheath of the pericardial endoscopy system of FIG. FIG. 2B is a diagram showing the view securing mechanism of FIG. 2A in an expanded configuration. It is a figure which shows the structural example of the flow path for supplying and discharging a fluid in a balloon. It is a figure which shows the other structural example of the flow path for supplying and discharging a fluid in a balloon. It is a figure which shows the other example of the shape of a connection wire. It is a figure explaining operation|movement in a pericardium of a visual field ensuring mechanism, It is the side view which looked at the insertion part between the heart and pericardium, and the expanded balloon from the right side. It is a figure which shows typically the arrangement of the insertion part and the expanded balloon in the line I-I of FIG. 5A. It is a figure explaining the preferable relationship of the bending angle of the bending part of the bending part of an endoscope and the angle between the tip parts of the expansion wire in an expansion mode. It is a partial block diagram of the other modification of the pericardial endoscopy system of FIG. 1A. FIG. 6 is a plan view of a modified example of the visual field securing mechanism of FIGS. 2A and 2B as viewed from above. It is a figure explaining an example of the structure and usage of the other modification of the visual field securing mechanism of FIG. 2A and FIG. 2B. It is a figure explaining the other example of the usage method of the visual field ensuring mechanism of FIG. 9A. FIG. 8 is a plan view of another modified example of the visual field securing mechanism of FIGS. 2A and 2B as viewed from above. FIG. 10B is a plan view showing the field of view securing mechanism of FIG. 10A in an expanded form. It is a whole block diagram of the other modification of the pericardial endoscopy system of FIG. 1A.

The cardiovascular endoscopy system 100 according to an embodiment of the present invention will be described with reference to the drawings.
As shown in FIG. 1A, the pericardial endoscopy system 100 according to the present embodiment includes a sheath 1 inserted into the pericardium, an endoscope 2 inserted into the sheath 1, and a heart and a pericardium. A field of view securing mechanism for securing the field of view of the endoscope 2 and a guide wire 3 are provided between them.

The sheath 1 has a long tubular sheath body 1a and an operating portion 1b connected to the base end of the sheath body 1a. Further, as shown in FIGS. 2A and 2B, the sheath 1 has a pair of lumens (passages) 11 and 12 in which the field of view securing mechanism is arranged, and a lumen 13 into which the endoscope 2 is inserted. Each

lumen

11, 12, 13 penetrates the sheath 1 in the longitudinal direction. The sheath 1 has a vertical direction and a horizontal direction that are orthogonal to the longitudinal axis of the sheath 1 and are also orthogonal to each other. As shown in FIG. 1B, on the distal end surface of the sheath body 1a, the

distal end openings

11a and 12a of the pair of

lumens

11 and 12 are arranged on both sides of the distal end opening 13a of the lumen 13 in the left-right direction. In the drawings to be referred to, U indicates the upper part, D indicates the lower part, L indicates the left side, and R indicates the right side.

The endoscope 2 includes a long insertion portion 2a that is flexible and is inserted into the lumen 13, and an operation portion 2b that is connected to the base end of the insertion portion 2a. An observation window 2c for observing a subject such as a heart or a pericardium is provided on the distal end surface of the insertion portion 2a. For example, the light from the subject enters the insertion portion 2a via the observation window 2c, is imaged by an objective lens (not shown), and is imaged by an image sensor (not shown). The endoscopic image acquired by the endoscope 2 is displayed on a display (not shown).

The insertion portion 2a has a vertical direction (first radial direction) and a left-right direction (second radial direction) orthogonal to the longitudinal axis of the insertion portion 2a and orthogonal to each other. The up-down direction corresponds to the height direction of the field of view of the endoscope 2 (longitudinal direction of the endoscopic image), and the left-right direction corresponds to the width direction of the field of view of the endoscope 2 (horizontal direction of the endoscopic image). Correspond. As shown in FIG. 1B, the pair of

distal end openings

11a and 12a are arranged on both left and right sides of the observation window 2c in a state where the vertical and horizontal directions of the insertion portion 2a coincide with the vertical and horizontal directions of the sheath 1.

The insertion portion 2a has an outer diameter smaller than the inner diameter of the lumen 13, and is capable of moving in the longitudinal direction and rotating around the longitudinal axis within the lumen 13. At the tip of the insertion portion 2a, a curved portion 2d that can bend at least downward is provided. The bending portion 2d may be bendable in the upward direction, the rightward direction, and the leftward direction. The operator can control the bending direction and the bending angle of the bending portion 2d by operating the operation portion 2b.

The visual field securing mechanism includes a pair of

expansion wires

41 and 42 and a pair of

balloons

51 and 52 arranged in the pair of

lumens

11 and 12, and distal end portions 41a of the pair of

expansion wires

41 and 42 arranged outside the sheath 1. , 42a, a pair of

stoppers

71, 72, and a wire operating section 8 for operating the pair of

extension wires

41, 42.

As shown in FIG. 2A, one balloon 51 is provided at the distal end portion 41 a of the one expansion wire 41, and the other balloon 52 is provided at the distal end portion 42 a of the other expansion wire 42. The

tip portions

41a and 42a penetrate through the

balloons

51 and 52, respectively. Both ends of the connecting wire 6 are fixed to the tips of the

expansion wires

41 and 42 protruding from the

balloons

51 and 52, respectively. The guide wire 3 extends in a straight line substantially parallel to the longitudinal axis of the sheath body 1a, and the base end of the guide wire 3 is fixed to a substantially central position of the connecting wire 6 in the longitudinal direction.

As shown in FIG. 3A, the inner space of the balloon 51 is sealed except for the opening 9 that opens to the outer peripheral surface of the hollow expansion wire 41. The opening 9 is an inlet/outlet of a fluid for expanding the balloon 51, and the internal space of the expansion wire 41 is used as a flow path. Similarly, the inner space of the balloon 52 is sealed except for the opening portion that opens to the outer peripheral surface of the hollow expansion wire 42. A common fluid transport unit 10 such as a syringe is connected to the base ends of the pair of

expansion wires

41 and 42, and the fluid transport unit 10 fluids into the

balloons

51 and 52 via the

expansion wires

41 and 42. Is supplied and the fluid is discharged from the

balloons

51 and 52. The proximal end of the expansion wire 41 and the proximal end of the expansion wire 42 may be connected to separate fluid transport units 10.
As shown in FIG. 3B, the opening 9 may be the tip opening of the fluid tube 14 in parallel with the

expansion wire

41 or 42.

Each of the

balloons

51 and 52 is made of a polymer resin such as polyamide, polyester or polyurethane. For example, the

cylindrical balloons

51 and 52 are attached to the side surfaces of the

expansion wires

41 and 42, respectively, leaving the expanded portion, or the donut-shaped

balloons

51 and 52 are attached to the

expansion wires

41 and 42 in the hollow portion. Each can be pasted. Each

balloon

51, 52 is expandable at least in the vertical direction of the sheath 1. The expanded balloons 51 and 52 have, for example, a cylindrical shape or an elliptic spherical shape. The expanded balloons 51 and 52 may have a flat shape in which the lateral dimension is larger than the vertical dimension. Each of the

balloons

51 and 52 may have elasticity that changes in size while maintaining its shape by being supplied with a fluid having a flow rate in a certain range.

The tip portion 41a of the expansion wire 41 and the contracted balloon 51 are housed in the lumen 11 so as to be movable in the longitudinal direction of the lumen 11. The tip portion 42a of the expansion wire 42 and the contracted balloon 52 are housed in the lumen 12 so as to be movable in the longitudinal direction of the lumen 12. A wire operating portion 8 is fixed to the proximal end portions of the pair of

expansion wires

41, 42 drawn from the proximal end openings of the

lumens

11 and 12. The operator pushes and pulls the wire operating unit 8 in the longitudinal direction of the

extension wires

41 and 42 to simultaneously move the distal end portion 41a provided with the balloon 51 and the distal end portion 42a provided with the balloon 52 to the distal end opening 11a,. It can be sunk from 12a.

The pair of

tip portions

41a, 42a has an expanded configuration when protruding from the

tip openings

11a, 12a, and has a contracted configuration when placed in the

lumens

11, 12. In the expanded form, the distance between the pair of

tip portions

41a and 42a gradually increases in the left-right direction toward the tip. In the contracted form, the pair of

tips

41a, 42a extend substantially parallel to each other along the longitudinal direction of the

lumens

11, 12. That is, the pair of

distal end portions

41a and 42a are accommodated in the

lumens

11 and 12 in a state of being elastically deformed in a contracted form, and when they protrude from the

distal end openings

11a and 12a, they are elastically restored from the contracted form to the expanded form by elastic restoring force. Deform.

The deformation between the contracted form and the expanded form of the

tip portions

41a and 42a is realized by the deformation of the

deformable portions

42b and 42b of the

expansion wires

41 and 42. The

deformed portions

41b and 42b are provided at the base ends of the

tip portions

41a and 42a, respectively. The

deformed portions

41b and 42b are bent or curved in mutually opposite directions in a free state in which no external force acts (see FIG. 2B), and are elastically deformable into linear shapes (see FIG. 2A). That is, the tip portion 41a is a portion between the tip of the expansion wire 41 and the deformed portion 41b, and the tip portion 42a is a portion between the tip of the expansion wire 42 and the deformed portion 42b.

The

expansion wires

41 and 42 are shape memory alloys formed of, for example, an alloy containing nickel titanium. The

extension wires

41 and 42 are, for example, round wires or rectangular wires, and may be a composite of a plurality of round wires. The preferred outer diameter of the

extension wires

41, 42 is about 0.01 mm to 5.0 mm. The core wires of the

extension wires

41 and 42 are made of a radiopaque material (for example, platinum), and the positions of the

extension wires

41 and 42 inside the body can be confirmed by an X-ray image.

When the pair of

distal end portions

41a and 42a are in the contracted form, the connecting wire 6 is bent in two at a substantially central position in the longitudinal direction and projects toward the side opposite to the sheath body 1a. The connecting wire 6 has a low rigidity that can be deformed by the elastic restoring force of the pair of

tip portions

41a and 42a. Therefore, when the pair of

distal end portions

41a and 42a is deformed from the contracted form to the expanded form, the connecting wire 6 is opened outward in the left-right direction and is deformed into a substantially linear shape or a substantially arc shape. The distance and angle between the

tips

41a and 42a in the extended form are defined by the length and rigidity of the connecting wire 6.

Here, the angle α between the pair of

distal ends

41a and 42a in the expanded form is smaller than the angle between the pair of

expansion wires

41 and 42 in the free state in which no external force acts. That is, in the expanded form, the connection wires 6 limit the lateral outward expansion of the pair of

distal end portions

41a, 42a, thereby preventing the pericardium from hanging down in the region between the

expansion wires

41, 42. To be done. Further, since the elastic restoring force outward in the left-right direction is accumulated in the pair of

tip portions

41a, 42a, narrowing inward in the left-right direction is also limited. In this way, the connecting wire 6 is effective for keeping the observation visual field constant.

As shown in FIG. 4, the connecting wire 6 may be bent in a substantially V shape. Such a connecting wire 6 whose width becomes gradually narrower toward the distal end side can be used as a dilator when advancing the sheath body 1a inside the body. Further, when the sheath body 1a is moved along the gap between the heart and the pericardium, the guide wire 3 is easily advanced. Further, it is possible to prevent the connecting wire 6 from bending in the heart sac in an unintended direction and hindering the movement of the sheath body 1a.

The pair of

stoppers

71 and 72 are for preventing the connecting wire 6 from being drawn into the

lumens

11 and 12. The

stoppers

71 and 72 are respectively fixed to the connecting portion between the

extension wires

41 and 42 and the connecting wire 6 or the vicinity thereof. In the radial direction of the connecting wire 6, the

stoppers

71 and 72 have an outer diameter larger than the inner diameter of the

tip openings

11a and 12a, respectively. The

stoppers

71, 72 abut the distal end surface of the sheath body 1a, thereby preventing the

extension wires

41, 42 from moving further toward the proximal end side.

Next, the operation of the cardiovascular endoscopic system 100 configured in this way will be described.
In order to observe the heart A by the pericardial endoscopy system 100, first, as shown in FIG. 2A, the distal ends 41a and 42a of the

expansion wires

41 and 42 and the deflated balloons 51 and 52 are placed inside the

lumens

11 and 12. The sheath body 1a is inserted from below the xiphoid process to the lumen, and the tip of the sheath body 1a is placed between the heart A and the pericardium B as shown in FIG. 5A.

Next, the insertion portion 2a is inserted into the pericardium via the inside of the sheath body 1a, and the tip of the insertion portion 2a is placed between the heart A and the pericardium B. Next, the posture about the longitudinal axis of the insertion portion 2a is adjusted so that the upper side of the visual field of the endoscope 2 is arranged on the pericardial B side and the lower side of the visual field is arranged on the heart A side. Further, the posture of the sheath body 1a around the longitudinal axis is adjusted so that the left-right direction of the sheath body 1a matches the left-right direction of the insertion portion 2a.

The gap between the heart A and the pericardium B is narrow, and under normal conditions, there is almost no space in front of the tip of the insertion portion 2a, making it difficult to observe the heart A. Therefore, subsequently, the space S for observing the heart A is formed in front of the insertion portion 2a by the visual field securing mechanism.
Specifically, the wire operating portion 8 is pressed so that the pair of

tip portions

41a and 42a provided with the

balloons

51 and 52, respectively, are projected from the

tip openings

11a and 12a on the tip surface of the sheath body 1a. The pair of protruding

tip portions

41a and 42a self-deform from the contracted form to the expanded form by the elastic restoring force, and the pair of

balloons

51 and 52 are separated from each other in the width direction of the field of view of the endoscope toward the tip. Arranged to do so.

Next, the fluid transport unit 10 supplies fluid into the pair of

balloons

51, 52 to expand the pair of

balloons

51, 52. The expanding balloons 51 and 52 push up the pericardium B in a direction away from the heart A in the height direction of the visual field. As a result, as shown in FIGS. 5A and 5B, a space S extending in the height direction and the width direction is formed in front of the tip surface of the insertion portion 2a by the pair of expanded

balloons

51 and 52. In this state, the surface of the heart A can be satisfactorily observed by bending the curved portion 2d downward.

As described above, according to the present embodiment, the distal ends of the insertion portions 2a are expanded by expanding the pair of

balloons

51, 52 which are arranged on both the left and right sides of the observation window 2c and whose lateral distance gradually increases toward the distal end side. A space S extending in the height direction and the width direction is formed in front of the surface. As a result, the visual field of the endoscope 2 can be secured between the heart A and the pericardium B.

Here, a pressing force inward in the width direction acts on the pair of expanded

balloons

51 and 52 from the pericardium B. On the other hand, the pair of

balloons

51 and 52 are always subjected to the elastic restoring force outward in the width direction of the

tip portions

41a and 42a. Therefore, the pair of

balloons

51 and 52 can stay in the same position against the inward pressing force in the width direction from the pericardium B, and the distance between the pair of

balloons

51 and 52 in the width direction is the pericardium B. It is maintained regardless of the pressing force from. As a result, the field of view of the endoscope 2 can be stably secured not only in the height direction but also in the width direction.

Further, the connecting wire 6 that connects the pair of

expansion wires

41, 42 prevents excessive expansion of the pair of

expansion wires

41, 42 in the left-right direction, and in the expanded configuration, the distal end that tries to expand outward in the left-right direction. The elastic restoring force of the

portions

41a and 42a is maintained in a high state. Accordingly, the pair of

balloons

51, 52 can be stably resisted by the pressing force inward in the width direction from the pericardium B, and the field of view of the endoscope 2 can be secured more stably in the width direction. it can.

In the present embodiment, as shown in FIG. 2B, it is preferable that the angle α between the pair of

tip portions

41a and 42a in the extended form is larger than the viewing angle ω of the endoscope 2.
According to this configuration, the pair of

balloons

51, 52 in the expanded form are arranged outside the angle of view of the endoscope 2, and a space S is formed over the entire angle of view of the endoscope 2. As a result, the field of view of the endoscope 2 in the cardiac sac can be secured more stably.

In the present embodiment, when the bending portion 2d is bendable in the left-right direction, as shown in FIG. 6, the left and right maximum bending angle θLR is larger than the angle α between the

distal end portions

41a, 42a in the expanded form. Is preferred.
According to this configuration, by bending the curved portion 2d to the left or right at the maximum bending angle, the left end or the right end of the space S formed by the expanded balloons 51 and 52 can be observed with the endoscope 2. .. That is, when observing the left end or the right end of the space S, fine adjustment of the bending angle of the bending portion 2d is unnecessary. When observing only the left side or the right side of the space S in this way, only one of the pair of

balloons

51 and 52 on the side to be observed may be expanded.

As shown in FIG. 5A, when the curved portion 2d is curved downward, the

balloons

51 and 52 are arranged in order to secure the height of the space S at the observation position of the surface of the heart A by the endoscope 2. It is preferable that the following formula (1) is satisfied.
tanθ> H / 2W ... (1)
θ is the angle in the visual field direction of the endoscope 2 when the curved portion 2d is curved downward at the maximum angle with respect to the visual field direction of the endoscope 2 when the curved portion 2d is not curved. H is the maximum height dimension of the expanded balloons 51 and 52 in the vertical direction. W is along the longitudinal axis of the insertion portion 2a between the tip surface of the insertion portion 2a and the position where the diameters of the

balloons

51 and 52 are maximized in the vertical direction when the curved portion 2d is not curved. The distance in the direction.

The height of the space S is maximum at the position where the vertical diameters of the

balloons

51 and 52 are maximum (maximum diameter position), and becomes smaller as the distance from the maximum diameter position increases. Therefore, the maximum diameter position or its vicinity is suitable for observing the surface of the heart A. By satisfying the expression (1), it is possible to reliably observe the surface of the heart A at the maximum diameter position and the vicinity thereof with the endoscope 2 when the bending portion 2d is bent downward.

In the above embodiment, the pair of

lumens

11 and 12 for the field of view securing mechanism are provided on the sheath 1, but instead, they are provided on the endoscope 2 as shown in FIG. May be.
In this case, the pair of

lumens

11 and 12 penetrates the insertion portion 2a in the longitudinal direction, and the

distal end openings

11a and 12a of the pair of

lumens

11 and 12 are formed on the left and right sides of the observation window 2c on the distal end surface of the insertion portion 2a. Will be placed.
According to this configuration, since the

tip portions

41a and 42a and the

balloons

51 and 52 in the expanded form move integrally with the insertion portion 2a, the space S can always be formed in front of the tip surface of the insertion portion 2a.

In the above embodiment, as shown in FIG. 8, a tip balloon 53 disposed between the tips of the pair of

balloons

51 and 52 may be further provided. The tip balloon 53 is provided on the connecting wire 6. According to this configuration, the expanded distal balloon 53 can form the space S having a constant height in the direction along the longitudinal axis of the sheath body 1a.

As shown in FIG. 8, the tip balloon 53 may be integrated with the pair of

balloons

51 and 52. That is, the

balloons

51, 52, 53 may be realized as a single balloon. Alternatively, both ends of the tip balloon 53 may be connected to the pair of

balloons

51 and 52, and the inside of the tip balloon 53 may communicate with the inside of each of the pair of

balloons

51 and 52. In this way, the three

balloons

51, 52, 53 that are integrated or in communication with each other can be inflated and deflated at the same time.

The tip balloon 53 may be a separate body from the pair of

balloons

51, 52, and the expansion and contraction of the three

balloons

51, 52, 53 may be independently controllable. In this case, for example, only one or two of the three

balloons

51, 52, 53 may be selectively expanded, or the three

balloons

51, 52, 53 may be expanded to mutually different outer diameters. can do. As a result, the diameter of each

balloon

51, 52, 53 can be minimized and the invasion can be reduced.

In the above embodiment, as shown in FIG. 9A, the

expansion wires

41 and 42 may have

straight portions

41c and 42c on the proximal end side of the

balloons

51 and 52, respectively. The

straight portions

41c and 42c extend linearly substantially parallel to the longitudinal axis of the sheath body 1a when protruding from the

tip openings

11a and 12a.
In FIG. 9A, the

straight portions

41c and 42c are provided on the proximal end side with respect to the

tip portions

41a and 42a (that is, the

deformed portions

41b and 42b). According to this configuration, by pressing the pair of

expansion wires

41, 42 until the

linear portions

41c, 42c project from the

distal end openings

11a, 12a, the

distal end portions

41a, 42a and the

balloons

51, 52 are moved to the distal end of the sheath body 1a. The space S can be arranged at a position more distant from the surface, and the space S can be formed at a position more distant from the distal end surface of the sheath body 1a.

There is a narrow space in the heart sac where the sheath body 1a is difficult to insert but the

wires

3, 41, 42 and the contracted balloons 51, 52 can be inserted. By providing the

straight portions

41c and 42c, the

tip portions

41a and 42a and the contracted balloons 51 and 52 can be arranged even in such a narrow place, and the space S can be formed by expanding the

balloons

51 and 52. Further, by arranging the insertion portion 2a in the formed space S and bending the curved portion 2d in the left-right direction, the viewing direction can be changed without moving the sheath main body 1a.
In this case, it is preferable that the angle α between the

distal end portions

41a and 42a in the expanded form is larger than the viewing angle (total angle of view) ω of the endoscope 2. For example, the angle α between the

tip portions

41a and 42a is preferably 1.5 to 2 times the viewing angle ω of the endoscope 2.

As shown in FIG. 9B, with the distal end surface of the insertion portion 2a arranged near the distal end opening 13a of the sheath body 1a, the

distal end portions

41a and 42a and the expanded balloons 51 and 52 are arranged in the longitudinal direction of the sheath body 1a. You may move it. Thereby, the space S can be moved in the front-back direction of the visual field of the endoscope 2 without moving the sheath body 1a.

As shown in FIGS. 10A and 10B,

linear portions

41c and 42c may be provided on the

tip portions

41a and 42a (that is, between the

balloons

51 and 52 and the deforming

portions

41b and 42b). According to this configuration, by moving the deflated balloons 51, 52 forward, while observing the front field of view between the

balloons

51, 52 by the endoscope 2, the pair of

balloons

51, 52 can be placed in a narrow space in the width direction. Can be inserted. For example, to reach a large area on the back side of the heart A, it is necessary to pass through a narrow area at the base of the heart A. In such a case, as shown in FIG. 10A, the pair of deflated

balloons

51 and 52 can be passed in the base portion in a state parallel to each other. After that, the pair of

balloons

51, 52 can be moved outward in the left-right direction in a wide place on the dorsal side, as shown in FIG. 10B.

In the above embodiment, the pair of

tip portions

41a and 42a are connected to each other by the connecting wire 6, but instead, as shown in FIG. 11, the connecting wire 6 is not provided. , The pair of

expansion wires

41, 42 may be separated from each other.
The pair of

tip portions

41a and 42a separated from each other exert an elastic restoring force outward in the width direction when a pressing force applied inward in the width direction acts on the pair of

balloons

51 and 52 from the pericardium B. Therefore, the pair of

tip portions

41a and 42a that are not connected by the connecting wire 6 also suppress the inward movement of the pair of

balloons

51 and 52 due to the pressing force from the pericardium B, and the pair of balloons 51, The interval in the width direction of 51 can be maintained. By doing so, it is possible to prevent the connecting wire 6 from entering the observation field of view of the endoscope 2.

The common syringe 10, which is a fluid transport unit, was connected to the proximal ends of the

respective extension wires

41 and 42, but as shown in FIG. 11, they are individually operated for the

respective extension wires

41 and 42. A plurality (two in the figure) of syringes 10 may be connected. A grip portion 15 is fixed to each of the plurality of syringes 10. The operator can adjust the positions of the pair of

balloons

51 and 52 independently of each other by operating the grip portion 15. Further, the operator operates the syringe 10 while observing the image including the pair of

balloons

51 and 52 acquired by the endoscope 2 to adjust the sizes of the pair of

balloons

51 and 52 independently of each other. be able to. The operator moves the insertion portion 2a in the front-rear direction or bends the bending portion 2d according to the adjustment of the positions and sizes of the pair of

balloons

51 and 52 by the endoscope 2, thereby forming the space S formed. The field of view of the endoscope 2 is matched with.

The

balloons

51 and 52 move outward in the width direction as they move forward. Therefore, the space S of various sizes can be formed by making the positions and sizes of the pair of

balloons

51, 52 different in the front-rear direction.
Further, the magnitude of the pressing force applied from the pericardium B to the

balloons

51 and 52 differs depending on the position in the pericardium. Therefore, by adjusting the sizes of the

balloons

51 and 52, a space S having a constant height can be formed regardless of the magnitude of the pressing force from the pericardium B, and the height of the space S can be adjusted. Invasion can be reduced to the minimum necessary. In particular, when an artery runs at one of the

balloons

51 and 52, the size of one after expansion is made smaller than that of the other so as not to obstruct the blood flow of the artery, so that the observation is minimally invasive. be able to.

By rotating the

expansion wires

41 and 42 around the longitudinal axis, the

balloons

51 and 52 may be rotated in the heart sac to change the posture of the

balloons

51 and 52 around the

expansion wires

41 and 42. When the expanded balloons 51 and 52 have a flat shape, the postures of the

balloons

51 and 52 are adjusted according to the three-dimensional shape of the heart A so that the

balloons

51 and 52 separate the heart A and the pericardium B from each other. The

balloons

51 and 52 can be arranged in an appropriate posture so as to expand in the direction.

100 Cardiac endoscopy system 1

sheath

11, 12 lumens (passage)
2 Endoscope 2c Observation window 2d Curved part 3

Guide wire

41, 42

Expansion wire

41a,

42a Tip part

51, 52 Balloon 53 Tip balloon 6

Connecting wire

71, 72 Stopper

Claims

An endoscope with an observation window on the tip surface for observing the subject,
A pair of passages arranged in parallel with the longitudinal axis of the endoscope,
A pair of expansion wires arranged along the longitudinal direction in the pair of passages,
A pair of balloons that are respectively provided at the distal ends of the pair of expansion wires and expand in a first radial direction orthogonal to the longitudinal axis;
Tip openings of the pair of passages are arranged on both sides of the observation window in a second radial direction orthogonal to the longitudinal axis and the first radial direction,
The distal end portions of the pair of expansion wires and the pair of balloons can project and retract from the distal end openings of the pair of passages,
The tips of the pair of extension wires are
When projecting from the pair of tip openings, the space between the tip portions has an expansion form in which the distance gradually increases toward the tip in the second radial direction,
A pericardial endoscopy system that, when placed in the passageway, elastically deforms into a contracted configuration extending substantially parallel to one another along the length of the passageway.
The pericardial endoscopy system according to claim 1, further comprising a connecting wire that connects the distal end portions of the pair of extension wires to each other.
The cardiovascular endoscopic system according to claim 2, further comprising a guide wire connected at a substantially central position in the longitudinal direction of the connecting wire.
The pericardial endoscopy system according to claim 2 or 3, further comprising a stopper that is fixed to a connection portion between the expansion wire and the connection wire or in the vicinity thereof and has an outer diameter larger than an inner diameter of a distal end opening of the passage. ..
Both ends of the connecting wire are connected to the tips of the pair of expansion wires.
The connecting wire is
When the tips of the pair of expansion wires are in the contracted form, they are folded in two.
The cardiovascular endoscopy system according to claim 4, wherein the tip portions of the pair of expansion wires are opened in the second radial direction by an elastic restoring force from the contracted form to the expanded form.
The pericardial endoscopy system according to claim 1, further comprising a distal balloon disposed between the distal ends of the pair of balloons.
The cardiovascular endoscopic system according to claim 6, wherein the inside of the tip balloon communicates with the inside of each of the pair of balloons.
Each of the pair of expansion wires has a straight line portion on the proximal end side of the balloon, and the straight line portion is linear substantially parallel to the longitudinal axis when protruding from the pair of tip openings. The pericardial endoscopy system of claim 1, extending.
The cardiovascular endoscopy system according to claim 8, wherein the straight portion is provided at the tip portion.
The pericardial endoscopy system according to claim 1, wherein an angle between the distal end portions of the pair of expansion wires in the expanded configuration is larger than a visual field angle of the endoscope.
The endoscope has a bendable portion at the tip and has a bendable portion at the tip.
The cardiovascular endoscopic system according to claim 1 or 2, wherein the balloon satisfies the following formula (1).
tanθ> H / 2W ... (1)
However,
θ is the angle in the visual field direction of the endoscope when the curved portion is curved at the maximum angle with respect to the visual field direction of the endoscope when the curved portion is not curved.
H is the maximum height dimension of the expanded balloon in the first radial direction.
W is the longitudinal axis of the endoscope between the tip surface of the endoscope and the position where the diameter of the balloon in the first radial direction is maximized when the curved portion is not curved. Is the distance in the direction along.
A sheath into which the endoscope is inserted so as to be movable in the longitudinal direction is provided.
The pericardial endoscopy system according to any one of claims 1 to 11, wherein the pair of passages are provided in the sheath.
The cardiovascular endoscopy system according to any one of claims 1 to 11, wherein the pair of passages is provided in the endoscope.