WO2020189511A1 - Tube interne médical - Google Patents

Tube interne médical Download PDF

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Publication number
WO2020189511A1
WO2020189511A1 PCT/JP2020/010864 JP2020010864W WO2020189511A1 WO 2020189511 A1 WO2020189511 A1 WO 2020189511A1 JP 2020010864 W JP2020010864 W JP 2020010864W WO 2020189511 A1 WO2020189511 A1 WO 2020189511A1
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WO
WIPO (PCT)
Prior art keywords
tip
inner tube
bent
wire
bent portion
Prior art date
Application number
PCT/JP2020/010864
Other languages
English (en)
Japanese (ja)
Inventor
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 (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 学校法人慶應義塾, 株式会社トップ filed Critical 学校法人慶應義塾
Priority to JP2021507282A priority Critical patent/JP7474993B2/ja
Publication of WO2020189511A1 publication Critical patent/WO2020189511A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/01—Guiding arrangements therefore
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles

Definitions

  • the present invention relates to a medical inner tube for inserting a medical treatment tool or the like and introducing it into a body cavity.
  • a flexible swing pipe is attached to the tip of the inner tube.
  • the tips of the two wire members are fixed to the tip side of the swing pipe.
  • the swing pipe can be bent outward in the radial direction by pulling one wire member, and can be returned to a straight line by pulling the other wire member.
  • endoscopic treatment When performing laparoscopic surgery using this endoscopic treatment device, endoscopic treatment with multiple inner tubes inserted into the outer tube and attached, and an endoscope and treatment tool inserted into each inner tube.
  • the device is inserted into the body cavity through a laparoscopic valve cap attached to a laparoscope attached to the laparoscope.
  • the bent tip of each inner tube is projected from the tip of the outer tube, and the wire member is pulled to bend the swing pipe. Further, the tip of the endoscope and the treatment tool is projected from the tip of each inner tube, and the tip is bent to perform the procedure.
  • the tip bending portion of each inner tube can be bent outward, and the tip portion of the endoscope and the treatment tool can be bent inward to perform the procedure. Therefore, a sufficient field of view of the endoscope and a working space with the treatment tools can be secured, and the distance between the treatment tools can be easily grasped, so that laparoscopic surgery can be easily performed.
  • An object of the present invention is to provide a medical inner tube that enables the endoscope and the treatment tool to face the treated portion without having to bend the endoscope and the treatment tool significantly in view of the problems of the prior art.
  • the medical inner tube of the present invention It is inserted into the outer tube so as to be located between the inner wall and the central axis, and the tip protrudes from the tip, and a flexible treatment tool or a flexible endoscope is inserted and the tip is inserted.
  • a medical inner tube that protrudes from the tip In the inner tube, the side far from the axis of the outer tube is defined as the outside, the side close to the axis of the outer tube is defined as the inside, and the direction orthogonal to the direction connecting the tip and the base end and the direction connecting the outside and the inside is defined as the vertical direction.
  • the base end is provided with a first wire that is pulled toward the base end along the inner tube.
  • the tip of the inner tube is provided with a tip bent portion having a first bent portion and a second bent portion located on the proximal end side of the first bent portion.
  • the first bending portion extends from a state in which the tip portion thereof is linear with respect to the base end portion in the vertical direction between the tip portion and the base end portion.
  • the tip of the inner tube is configured to be bendable in the inward direction by being rotatably connected in the inward direction around the moving axis.
  • the second bent portion extends from a state in which the tip portion thereof is linear with respect to the base end portion in the vertical direction between the tip portion and the base end portion.
  • the tip of the inner tube is configured to be bendable in the outer direction by being rotatably connected in the outer direction about the moving axis.
  • the tip bent portion is A first fixing portion for fixing the tip end portion of the first wire to the inside of the tip end side of the first bent portion, It is provided between the first bent portion and the second bent portion so that the first wire passes through the inside of the first rotation axis and the outside of the second rotation axis.
  • a first restraint portion that restrains the passing position of the first wire, It is provided with a second restraining portion which is provided on the proximal end side of the second bent portion and restrains the passing position of the first wire so that the first wire passes through the outside of the second rotation axis. It is characterized by.
  • the first fixed portion located inside the inner tube is attracted toward the second restraint portion located outside. .. Since the first and second bent portions can rotate inside and outside the inner tube, respectively, and the first wire passes through the inside of the first rotation axis and the outside of the second rotation axis. , The first and second bent portions are bent by the pulling of the first wire.
  • the tip bent portion is bent in an S shape as a whole, and the tip portion is in a state of being shifted outward. Therefore, the tip portion of the endoscope or treatment tool protruding from the inner tube in this state can be opposed to the treatment portion without having to be bent significantly.
  • the tip bent portion is A second fixing portion for fixing the tip end portion of the second wire to the outside on the tip end side of the first bending portion, It is provided between the first bent portion and the second bent portion so that the second wire passes outside the first rotation axis and inside the second rotation axis.
  • a third restraint portion that restrains the passing position of the second wire, It is provided on the proximal end side of the second bent portion, and includes a fourth restraint portion that restrains the passing position of the second wire so that the second wire passes through the inside of the second rotation axis. Is preferable.
  • the bent end portion of the inner tube in the S-shaped bent state as described above can be returned to the linear state by pulling the second wire in the proximal direction.
  • the first and second bent portions are composed of two or three or more cylindrical members that are continuously connected to each other.
  • one of the cylindrical members adjacent to each other includes the central axis of the cylindrical member on the side of the other cylindrical member, and is positioned symmetrically with respect to the plane of symmetry perpendicular to the vertical direction. It has two partially circular convex portions, and the other cylindrical member has two partial circular concave portions fitted to the two circular convex portions.
  • the one and the other cylindrical members adjacent to each other are connected via the circular convex portion and the circular concave portion so as to be able to rotate with each other around a rotation axis perpendicular to the plane of symmetry.
  • the one and the other cylindrical members limit the range of rotation between each other between a state in which they are arranged linearly with each other and a state in which they are arranged in a state of being bent at a predetermined angle with each other. It is preferable to have contact sliding surfaces that are in contact with each other or slide with each other in order to prevent the separation into two.
  • the first in a state where two or three or more cylindrical members are continuously connected.
  • the tip bent portion forming the second bent portion can be easily manufactured.
  • FIG. 3A is a schematic diagram for defining the directionality in the inner tube of FIG.
  • FIG. 3B is a schematic diagram for defining the directionality in the inner tube of FIG.
  • FIG. 4A is a plan view showing a state when the tip bent portion of the inner tube of FIG. 1 is linear.
  • FIG. 4B is a plan view showing a state when the tip bent portion is bent.
  • FIG. 5A is a plan view showing a state when the two cylindrical members at the tip bending portion of the inner tube of FIG. 1 are linear.
  • FIG. 5B is a side view of FIG. 5A.
  • FIG. 5C is a plan view showing a state when the two cylindrical members are bent.
  • FIG. 1 and 2 show an endoscopic treatment apparatus including an inner tube according to an embodiment of the present invention.
  • the endoscopic treatment device 1 includes an inner tube 2 into which a flexible endoscope 3 is inserted and a tip of which protrudes from the tip, and a flexible treatment tool. It is provided with a plurality of inner tubes 4 into which the inner tubes 2 and 4 are inserted and protrude from the tip, and an outer tube 5 into which the inner tubes 2 and 4 are inserted and the tips of the inner tubes 2 and 4 protrude from the tip.
  • the inner tubes 2 and 4 are arranged between the inner wall of the outer tube 5 and its central axis A.
  • Each inner tube 4 includes first and second wires 6 and 7 whose base end portions are pulled in the base end direction along the inner tube 4.
  • the side far from the central axis A of the outer tube 5 is the outer s1
  • the near side is the inner s2
  • the direction connecting the tip and the proximal end thereof is defined as the vertical direction D.
  • the tip of the inner tube 4 is provided with a tip bent portion 10 having a first bent portion 8 and a second bent portion 9 located on the proximal end side of the first bent portion 8.
  • the first bent portion 8 has a tip portion that is linear with respect to the base end portion thereof, and is between the tip end portion and the base end portion.
  • the tip of the inner tube 4 is configured to be bendable in the inner s2 direction by being rotatably connected in the inner s2 direction about the first rotation axis a1 extending along the vertical direction D.
  • the second bent portion 9 extends from the state in which the tip portion thereof is linear with respect to the base end portion in the vertical direction D between the tip portion and the base end portion.
  • the tip of the inner tube 4 is configured to be bendable in the outer s1 direction by being rotatably connected in the outer s1 direction about the moving axis a2.
  • the tip bending portion 10 has first and second fixing portions 11 and 12 for fixing the tips of the first and second wires 6 and 7 to the inner s2 and the outer s1 on the tip side of the first bent portion 8, respectively. Be prepared. Further, the tip bending portion 10 is provided between the first bending portion 8 and the second bending portion 9, and the first and third restraining portions 13 that restrain the passing positions of the first and second wires 6 and 7, respectively. , 14.
  • the first restraint portion 13 is configured such that the first wire 6 passes through s2 inside the first rotation axis a1 and s1 outside the second rotation axis a2.
  • the third restraint portion 14 restrains the passing position of the second wire 7 so that the second wire 7 passes through the outer s1 of the first rotation axis a1 and the inner side s2 of the second rotation axis a2.
  • the tip bent portion 10 is provided on the proximal end side of the second bent portion 9, and the first and second wires 6 and 7 pass through the outer s1 and the inner s2 of the second rotation axis a2, respectively.
  • the second and fourth restraint portions 15 and 16 that restrain the passing positions of the first and second wires 6 and 7, respectively, are provided. Therefore, the first and second wires 6 and 7 form a spiral that swirls around the tip bending portion 10 by 180 ° in opposite sides from the tip side to the base end side.
  • the first and second bent portions 8 and 9 are composed of two or three or more cylindrical members 17 and 18 that are continuously connected.
  • the cylindrical member 18 is a cylindrical member arranged on both sides of each of the first and second bent portions 8 and 9 in the tip bent portion 10.
  • the cylindrical member 17 is a cylindrical member arranged between the cylindrical members 18 on both sides of the tip bent portion 10.
  • the cylindrical member 17 may be omitted, and the cylindrical members 18 may be configured to be adjacent to each other.
  • 5A to 5C show a cylindrical member 17 which is adjacent to each other in the first bent portion 8 or the second bent portion 9 and is in a linear state when viewed from above, and the cylindrical member 17 is viewed from the side surface. A state and a state in which the cylindrical member 17 in a bent state is viewed from above are shown.
  • FIGS. 5A to 5C Cylindrical members 18 are connected to both sides of the two connected cylindrical members 17, and a first bent portion 8 or a second bent portion 9 is formed.
  • one of the cylindrical members 17 adjacent to each other has two partially circular convex portions 19 opposite to each other in the vertical direction D on the side of the other cylindrical member 17.
  • the two circular convex portions 19 include the central axis of the cylindrical member 17 and are located at positions symmetrical with respect to the plane of symmetry perpendicular to the vertical direction D.
  • the other cylindrical member 17 has two partially circular concave portions 20 on the side of the one cylindrical member 17 at positions symmetrical with respect to the plane of symmetry. Then, the two circular protrusions 19 of one cylindrical member 17 and the two circular recesses 20 of the other cylindrical member 17 are aligned with each other, and each cylindrical member 17 is perpendicular to the plane of symmetry. They are connected so that they can rotate with each other around a rotating axis.
  • one and the other cylindrical member 17 are arranged in a state of FIG. 5A in which the rotation range between each other is arranged linearly with each other and a state of being bent at a predetermined angle ⁇ with each other.
  • Each has an abutting sliding surface 21 that abuts or slides against each other to limit it to the state and prevent it from separating from each other.
  • the one and the other cylindrical member 17 and the cylindrical member 18 adjacent to each other are also connected and contacted by fitting the circular convex portion 19 and the circular concave portion 20 in the same manner.
  • the sliding surfaces 21 limit the range of rotation between them and prevent them from separating from each other.
  • a slide pipe 23, slide knobs 24 and 25, and a degassing prevention valve 26 are provided at the base end of each inner tube 4.
  • the slide pipe 23 is connected to the tip bent portion 10 by a guide pipe 27.
  • the degassing prevention valve 26 of each inner tube 4 is connected to the slide pipe 23 via the valve connector 28, and has a function of preventing air leakage from the inner tube 4 into which the treatment tool 29 is not inserted.
  • the first and second wires 6 and 7, respectively, are embedded in the guide pipe 27 along the axial direction of the guide pipe 27 after passing through the second and fourth restraint portions 15 and 16, respectively, and the base end portion is a slide knob 24. , 25 fixed.
  • the slide knobs 24 and 25 are configured to be slidable with respect to the slide pipe 23. Therefore, when the tip bending portion 10 of the inner tube 4 protrudes from the tip of the outer tube 5, the tip bending portion 10 is in a linear state as shown in FIG. 4A by pulling the slide knob 24 toward the base end side. Can be bent as shown in FIG. 4B. On the contrary, by pulling the slide knob 25 toward the base end side, the tip bent portion 10 can be returned to a straight line that is not bent as shown in FIG. 4A.
  • the slide knob 24 is provided so that the stopper ring 30 can rotate.
  • the stopper ring 30 can rotate between the rotational position of the slide pipe 23 standing outward in the radial direction and the tilted rotational position. With the slide knob 24 pulled toward the base end side, the stopper ring 30 is tilted and hooked on the valve connector 28 to fix the pulled state.
  • an opening device 32 for maintaining the open state of the anus 31 and protecting the anus 31 is provided in the anus. It is attached to 31. Then, the valve cap 33 for the opening device 32 is attached to the opening device 32. The valve cap 33 allows the endoscopic treatment device 1 to be introduced from the opening formed by the opening device 32 and maintains the airtightness of the abdominal cavity.
  • the inner tubes 2 and 4 are in a state of being buried without protruding from the tip of the outer tube 5.
  • the endoscope 3 is inserted into the inner tube 2, and the treatment tool 29 is inserted into each inner tube 4. At this time, the endoscope 3 and the treatment tool 29 are in a state of being buried without protruding from the tips of the inner tubes 2 and 4.
  • the endoscopic treatment device 1 is inserted into the rectum 34 via the valve cap 33 for the mouth opening device.
  • the inner tubes 2 and 4 are advanced so that the respective tip portions protrude from the tip end of the outer tube 5.
  • the tip bending portion 10 of the inner tube 4 is bent.
  • the tip sides of the tip bending portions 10 are separated from each other in the left-right direction and face each other in a substantially parallel state.
  • the endoscope 3 and the treatment tool 29 are advanced and protruded from the tips of the inner tubes 2 and 4.
  • the tip portions of the treatment tools 29 are brought into a state of being close to each other by returning to the original state of being elastically deformed in a straight line.
  • the tip portion of the endoscope 3 is in a state of facing the tip portion of each of the treatment tools 29 which are close to each other by returning to the original state in which the endoscope 3 is elastically deformed in a straight line.
  • the procedure can be performed by bringing the treatment tool 29 close to the treatment portion while observing the treatment portion and the treatment tool 29 in the rectum 34 with the endoscope 3.
  • the tip bending portion 10 of each inner tube 2 is bent in a substantially S shape, and the treatment tool 29 bends the tip so that the tip portions of the tip bending portions 10 are separated from each other and substantially parallel to each other. It is projected from the portion 10. Therefore, the amount of bending of the treatment tool 29 when the treatment tool 29 is directed toward the portion to be treated can be reduced. Therefore, surgery in a relatively narrow body cavity such as rectal surgery can be easily performed.
  • the tip portions of the tip bending portions 10 are separated from each other and substantially parallel to each other, so that the treatment tool 29 is formed in a pre-bent shape.
  • the treatment tool 29 when the treatment tool 29 is inserted into the inner tube 2 in a linearly extended state from the bent state and the tip portion of the treatment tool 29 is projected from the inner tube 2, the treatment tool 29 is in the original bent state. You can try to go back to. As a result, the treatment tool 29 can be bent inward with each other as shown in FIG. 1 without providing an operation portion on the treatment tool 29.
  • first and second bent portions 8 and 9 of the tip bent portion 10 are two or three or more by simply laser-processing the cylindrical member for forming the tip bent portion 10 into the shape of the cylindrical members 17 and 18. It can be easily manufactured as a state in which the cylindrical members 17 and 18 are continuously connected.
  • the bent end portion 10 of the inner tube 2 is not limited to a perfect circular shape in cross section, but may be circular (cylindrical) or slightly elliptical or polygonal.
  • the tip of the inner tube 2 for the endoscope 3 may be provided with a bent portion similar to the tip bent portion 10 of the inner tube 4 for the treatment tool 29.
  • the treatment tool 29 may have a joint portion at its tip and can be bent via a wire.

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

Abstract

La présente invention vise à fournir un tube interne médical qui permet à un endoscope ou à un instrument de traitement de faire face à un site à traiter sans avoir à incurver significativement l'endoscope ou l'instrument de traitement.　Le tube interne médical (4) est pourvu d'un premier fil (6) ayant une partie proximale qui est tirée le long du tube interne (4). Le tube interne (4) est pourvu, au niveau d'une partie d'extrémité distale, d'une partie de courbure d'extrémité distale (10) comprenant une première partie de courbure (8) qui peut s'incurver vers l'intérieur au plus près de la ligne d'axe central A d'un tube externe (5) et une seconde partie de courbure (9) qui peut s'incurver vers l'extérieur, ladite partie de courbure d'extrémité distale étant linéaire lorsque les deux parties ne sont pas incurvées. La partie de courbure d'extrémité distale (10) comprend : une première partie de fixation (11) pour fixer la partie d'extrémité distale du premier fil (6) à l'intérieur du côté distal de la première partie de courbure (8) ; et un premier élément de retenue (13) et un second élément de retenue (15) pour retenir la position par laquelle passe le premier fil (6).
PCT/JP2020/010864 2019-03-15 2020-03-12 Tube interne médical WO2020189511A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP2021507282A JP7474993B2 (ja) 2019-03-15 2020-03-12 医療用のインナーチューブ

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2019048881 2019-03-15
JP2019-048881 2019-03-15

Publications (1)

Publication Number Publication Date
WO2020189511A1 true WO2020189511A1 (fr) 2020-09-24

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PCT/JP2020/010864 WO2020189511A1 (fr) 2019-03-15 2020-03-12 Tube interne médical

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007275565A (ja) * 2006-04-06 2007-10-25 Olympus Medical Systems Corp 医療器具
WO2011070846A1 (fr) * 2009-12-10 2011-06-16 オリンパスメディカルシステムズ株式会社 Manipulateur médical
US20130131450A1 (en) * 2011-11-21 2013-05-23 Cook Medical Technologies Llc Endoscope stabilization system
JP2015535702A (ja) * 2012-09-19 2015-12-17 ナンヤン テクノロジカル ユニヴァーシティＮａｎｙａｎｇ Ｔｅｃｈｎｏｌｏｇｉｃａｌ Ｕｎｉｖｅｒｓｉｔｙ フレキシブルマスター‐スレーブロボット内視鏡システム
WO2017119108A1 (fr) * 2016-01-07 2017-07-13 学校法人慶應義塾 Dispositif de traitement endoscope
WO2018204202A1 (fr) * 2017-05-03 2018-11-08 Canon U.S.A., Inc. Dispositif médical orientable et procédé

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007275565A (ja) * 2006-04-06 2007-10-25 Olympus Medical Systems Corp 医療器具
WO2011070846A1 (fr) * 2009-12-10 2011-06-16 オリンパスメディカルシステムズ株式会社 Manipulateur médical
US20130131450A1 (en) * 2011-11-21 2013-05-23 Cook Medical Technologies Llc Endoscope stabilization system
JP2015535702A (ja) * 2012-09-19 2015-12-17 ナンヤン テクノロジカル ユニヴァーシティＮａｎｙａｎｇ Ｔｅｃｈｎｏｌｏｇｉｃａｌ Ｕｎｉｖｅｒｓｉｔｙ フレキシブルマスター‐スレーブロボット内視鏡システム
WO2017119108A1 (fr) * 2016-01-07 2017-07-13 学校法人慶應義塾 Dispositif de traitement endoscope
WO2018204202A1 (fr) * 2017-05-03 2018-11-08 Canon U.S.A., Inc. Dispositif médical orientable et procédé

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JP7474993B2 (ja) 2024-04-26
JPWO2020189511A1 (fr) 2020-09-24

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