U.S. patent application number 11/104883 was filed with the patent office on 2005-10-13 for endoscope therapeutic device.
This patent application is currently assigned to OLYMPUS CORPORATION. Invention is credited to Matsui, Raifu, Okada, Yuta, Sekine, Ryuta.
Application Number | 20050228224 11/104883 |
Document ID | / |
Family ID | 34934933 |
Filed Date | 2005-10-13 |
United States Patent
Application |
20050228224 |
Kind Code |
A1 |
Okada, Yuta ; et
al. |
October 13, 2005 |
Endoscope therapeutic device
Abstract
In an endoscope therapeutic device having a plurality of
introduction guide tubes for introducing a treatment tool into a
body cavity, the introduction guide tubes are mutually joined at a
position more proximal than bending portions thereof. Accordingly,
the effects caused by the movement of the plurality of the
introduction guide tubes are mutually invalidated at a joint
portion as a fulcrum, so that the position of the introduction
guide tube is relatively stabilized in the body cavity. As joining
methods, there are integration, usage of a joint tool, and usage of
an over tube. The operability is improved when the introduction
guide tube is provided at the distal end thereof with a mechanism
for retaining and/or rotating a distal end of a treatment tool
inserted therethrough.
Inventors: |
Okada, Yuta; (Tokyo, JP)
; Sekine, Ryuta; (Tokyo, JP) ; Matsui, Raifu;
(Tokyo, JP) |
Correspondence
Address: |
SCULLY SCOTT MURPHY & PRESSER, PC
400 GARDEN CITY PLAZA
SUITE 300
GARDEN CITY
NY
11530
US
|
Assignee: |
OLYMPUS CORPORATION
TOKYO
JP
|
Family ID: |
34934933 |
Appl. No.: |
11/104883 |
Filed: |
April 13, 2005 |
Current U.S.
Class: |
600/104 ;
600/139; 600/153 |
Current CPC
Class: |
A61B 2017/3445 20130101;
A61B 1/00135 20130101; A61B 2017/00398 20130101; A61B 1/018
20130101; A61B 1/00087 20130101; A61B 17/3421 20130101; A61B
1/00071 20130101; A61B 34/70 20160201; A61B 2017/347 20130101; A61B
2017/2927 20130101; A61B 1/00133 20130101; A61B 2017/2929 20130101;
A61B 2017/2905 20130101; A61B 2017/2906 20130101 |
Class at
Publication: |
600/104 ;
600/153; 600/139 |
International
Class: |
A61B 001/005 |
Foreign Application Data
Date |
Code |
Application Number |
Apr 13, 2004 |
JP |
2004-118182 |
Claims
1. An endoscope therapeutic device for introducing a treatment tool
into a body cavity and performing treatment by the treatment tool
under observation by an endoscope, the endoscope therapeutic device
comprising: a plurality of introduction guide tubes for introducing
the treatment tool into a body cavity, each of the plurality of
introduction guide tubes comprise an insertion portion, one or more
bending portions provided at a distal side of the insertion portion
and being bendable by a bending operation; and a mutual joint for
joining at least two of the plurality of introduction guide tubes
disposed at a position proximal to the distal-most bending portions
of each of the at least two introducing guide tubes.
2. An endoscope therapeutic device according to claim 1, wherein
all of the plurality of the introduction guide tubes are joined at
the position proximal to the distal-most bending portion of each of
the introduction guide tubes.
3. An endoscope therapeutic device according to claim 1, wherein
the mutual joint of the at least two introduction guide tubes is
achieved by a configuration in which at least part of the
respective insertion portions of the at least two introduction
guide tubes are integrally joined.
4. An endoscope therapeutic device according to claim 1, wherein
the mutual joint of the at least two introduction guide tubes
comprises a joint tool.
5. An endoscope therapeutic device according to claim 4, wherein
the joint tool comprises a mechanism for resiliently deforming at
least part of the joint tool for joining the at least two
introduction guide tubes.
6. An endoscope therapeutic device according to claim 1, wherein
the mutual joint comprises an over tube for receiving introduction
guide tubes to be joined inserted therethrough and tightening a
member inserted through the distal part.
7. An endoscope therapeutic device according to claim 1, wherein at
least one of the plurality of introduction guide tubes is provided
at the distal portion thereof with an operating mechanism for
retaining a distal portion of a treatment tool inserted through the
introduction guide tube and for moving the treatment tool.
8. An endoscope therapeutic device for introducing a treatment tool
into a body cavity and performing treatment by the treatment tool
under observation by an endoscope, the endoscope therapeutic device
comprising: the endoscope comprising an insertion portion and a
bending portion; at least one introduction guide tube for
introducing the treatment tool into a body cavity, the introduction
guide tube comprising an insertion portion and at least one bending
portion provided at a distal side of the insertion portion of the
at least one introduction guide tube, the bending portion of the
introduction guide tube being bendable by a bending operation; and
a joint tool for detachably joining the insertion portion of the
endoscope and a portion of the at least one introduction guide tube
at a position proximal to the distal-most bending portion of the at
least one introduction guide tube.
9. An endoscope therapeutic device according to claim 8, wherein
the at least one introduction guide tube comprises a plurality of
introduction guide tubes, wherein the plurality of the introduction
guide tubes are mutually joined at the position proximal to the
distal most bending portion of each of the introduction guide
tubes.
10. An endoscope therapeutic device according to claim 9, wherein
the joint tool also achieves a mutual joint between the plurality
of introduction guide tubes.
11. An endoscope therapeutic device according to claim 8, wherein
the joint tool comprises an over tube for receiving the endoscope
and the at least one introduction guide tube inserted therethrough,
and the over tube is mounted so that a relative position of the
introduction guide tube in a radial direction does not change at a
fixed portion in the vicinity of a distal portion of the over
tube.
12. An endoscope therapeutic device according to claim 11, further
comprising at least one suction tube inserted through the over
tube, wherein the over tube is further mounted so that the relative
position of the at least one suction tube in the radial direction
does not change at the fixed portion.
13. A therapeutic instrument joint tool for mutually joining
therapeutic instruments each having at least one bending portion
and being configured for introduction into a body cavity, the
therapeutic instrument joint tool being configured to mutually join
the therapeutic instruments at a position proximal to the
distal-most bending portions of each of the therapeutic instruments
to be joined.
14. An over tube comprising: a bending portion being bendable by a
bending operation; an insertion portion for inserting a plurality
of introduction guide tubes therein; and, a fixed portion for
mutually fixing the plurality of introduction guide tubes at a
position in the vicinity of and proximal to the bending portions of
each of the plurality of introduction guide tubes.
15. An over tube according to claim 14, wherein the insertion
portion has a plurality of insertion guide openings, corresponding
to the plurality of introduction guide tubes so that the plurality
of the introduction guide tubes can be respectively inserted
therein.
16. An introduction guide tube for receiving a treatment tool used
for treatment in a body cavity inserted therethrough, the
introduction guide tube comprising: an operating mechanism provided
at a distal portion of the introduction guide tube for retaining a
distal end of the treatment tool inserted through the introduction
guide tube and for moving the distal end of the treatment tool.
17. An introduction guide tube according to claim 16, wherein the
operating mechanism comprises an engaging member that engages part
of an insertion portion of the treatment tool.
18. An introduction guide tube according to claim 17, further
comprising a mechanism for selectively engaging and disengaging the
engaging member, the mechanism being actuated from a proximal side
of the introduction guide tool.
19. An introduction guide tube according to claim 16, wherein the
operating mechanism is a moving mechanism for moving the distal end
of the treatment tool in a fore-and-aft direction.
20. An introduction guide tube according to claim 16, wherein the
operating mechanism is a rotating mechanism for rotating the distal
end of the treatment tool.
21. An introduction guide tube according to claim 20, wherein the
rotating mechanism rotates in a direction about an axis of rotation
corresponding to a longitudinal axis of a treatment tool insertion
channel of the introduction guide tube or an axis extending in
parallel with the longitudinal axis.
22. An introduction guide tube according to claim 20, wherein the
rotating mechanism rotates in a same direction as an operating
direction of the operating mechanism on the proximal side of the
introduction guide tube.
23. An introduction guide tube according to claim 20, wherein the
rotating mechanism is operated such that an operating direction of
the operating mechanism on a proximal side of the introduction
guide tube is substantially parallel with an axis of rotation of
the rotating mechanism.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application is based upon and claims the benefit of
priority from prior Japanese Patent Application No.2004-118182,
filed Apr. 13, 2004, the entire contents of which is incorporated
herein by reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to an endoscope therapeutic
device for performing treatment under observation via an endoscope
by introducing a treatment tool through an introduction guide tube
with a bending function into a body cavity, and an introduction
guide tube thereof.
[0004] 2. Description of the Related Art
[0005] An endoscope therapeutic device for performing treatment
using a treatment tool under observation via an endoscope by
introducing the treatment tool through a soft introduction guide
tube into a body cavity is known in the related art. The
introduction guide tube used in the endoscope therapeutic device of
this type is referred also as a "channel tube". Recently, as an
introduction guide tube of this type, an introduction guide tube
with a bending function, in which a bending portion is provided in
the vicinity of the distal end of the tube, and the bending portion
is capable of being bent by a proximal final operating element is
proposed (See JP-A-2000-33071). This endoscope therapeutic device
is configured in such a manner that treatment tools are guided via
a plurality of introduction guide tubes with a bending function,
respectively, into a body cavity, and the directions of the
treatment tools in the body cavity are adjusted by bending the
bending portions of the introduction guide tubes.
BRIEF SUMMARY OF THE INVENTION
[0006] An endoscope therapeutic device according to the present
invention includes a plurality of introduction guide tubes for
introducing treatment tools into a body cavity, wherein the
plurality of introduction guide tubes are joined to each other at
portions proximal to the bending portions thereof. In a case where
there are a plurality of bending portions on the introduction guide
tube, a joint portion is placed in a more proximal position than
the distal-most bending portion.
[0007] In this manner, the effects caused by the movement of a
plurality of the introduction guide tubes are mutually invalidated
at a joint portion as a fulcrum, so that the position of the
introduction guide tube is relatively stabilized in the body
cavity. Therefore, the operability is improved. Also, since the
bending portions are located on the more distal side than the joint
portion, good operability can be maintained even when they are
joined.
[0008] The form of joint may be such that a part of the insertion
portion that is located on a more proximal side than the bending
portion of the introduction guide tube is integrally joined with
other introduction guide tubes. In this case, a stable connection
is achieved. It is also possible to join the introduction guide
tubes with a joint tool. In this case, since the introduction guide
tubes can be replaced, it is applicable to various embodiments. It
is also possible to provide a connecting function to an over tube
through which the introduction guide tubes are inserted.
[0009] When the joint tool is resiliently deformed to tighten the
introduction guide tubes to be inserted, a stable joint is
achieved.
[0010] In addition to the introduction guide tubes, the positions
of the endoscope, a suction tube, and the like in the body cavity
are also stabilized by being joined as a matter of course. Further,
an operating mechanism for operating the distal end of the
treatment tool to be inserted therethrough may preferably be
provided at the distal end of the introduction guide tube. Since
the introduction guide tube is provided with a function to operate
the treatment tool in addition to the function to receive the
treatment tool inserted therethrough, operability is improved.
Since the treating portion and the operating portion are located
close to each other, a delicate operation can be performed.
[0011] The operator can operate the treatment tools inserted
through the guide tubes without unlinking his/her hand from the
guide tube by operating on the proximal side of the guide tube, and
hence good operability is achieved. The operation of the treatment
tool includes, for example, the fore-and-aft movement or the
rotation of the treatment tool.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0012] These and other features, aspects, and advantages of the
apparatus and methods of the present invention will become better
understood with regard to the following description, appended
claims, and accompanying drawings where:
[0013] FIG. 1A is a perspective view of an endoscope therapeutic
device according to a first embodiment of the present
invention;
[0014] FIG. 1B is a perspective view of a distal portion of an
endoscope for use with the endoscope therapeutic device of FIG.
1A;
[0015] FIG. 2 is a lateral cross-sectional view of a joint portion
in the endoscope therapeutic device of FIG. 1A as taken along line
2-2 thereof;
[0016] FIG. 3 is an explanatory drawing showing the state of usage
of the endoscope therapeutic device according to the first
embodiment;
[0017] FIG. 4 is a perspective view showing the joint in an
enlarged manner in a state in which a treatment tool introduction
guide tube unit is built in the endoscope in the endoscope
therapeutic device according to the first embodiment;
[0018] FIG. 5 is a perspective view showing the joint for
assembling the treatment tool introduction guide tube unit to the
endoscope in the endoscope therapeutic device according to the
first embodiment;
[0019] FIG. 6 is a perspective view showing the introduction guide
tube in the treatment tool introduction guide tube unit of the
endoscope therapeutic device according to the first embodiment;
[0020] FIG. 7 is a cross-sectional view of a distal end portion of
the introduction guide tube in the treatment tool introduction
guide tube unit of the endoscope therapeutic device according to
the first embodiment;
[0021] FIG. 8 is a partial perspective view of the endoscope
therapeutic device according to a second embodiment of the present
invention;
[0022] FIG. 9 is a perspective view showing an over tube of the
endoscope therapeutic device according to the second
embodiment;
[0023] FIG. 10 is a cross-sectional view of a fixed portion of the
endoscope therapeutic device of FIG. 8 as taken along line 10-10
thereof;
[0024] FIG. 11 is an explanatory drawing showing the state of usage
of the endoscope therapeutic device according to the second
embodiment;
[0025] FIG. 12 is an exploded perspective view of the endoscope
therapeutic device according to a third embodiment of the present
invention;
[0026] FIG. 13 is an explanatory drawing showing the state of usage
of the endoscope therapeutic device according to the third
embodiment;
[0027] FIG. 14 is a perspective view showing a distal end of the
endoscope therapeutic device according to a fourth embodiment of
the present invention;
[0028] FIG. 15 is a perspective view showing the distal end of the
endoscope therapeutic device according to a fifth embodiment of the
present invention;
[0029] FIG. 16 is a perspective view showing a final operating
element of the introduction guide tube in the endoscope therapeutic
device according to a sixth embodiment of the present
invention;
[0030] FIG. 17 is a plan view of the final operating element of the
introduction guide tube in the endoscope therapeutic device
according to the sixth embodiment;
[0031] FIG. 18A and FIG. 18B are vertical cross-sectional views of
the distal end of the introduction guide tube in the endoscope
therapeutic apparatus according to the sixth embodiment;
[0032] FIG. 19A and FIG. 19B are perspective views showing the
distal end of the introduction guide tube in the endoscope
therapeutic device according to a seventh embodiment of the present
invention;
[0033] FIG. 20 is a perspective view showing the final operating
element of the introduction guide tube in the endoscope therapeutic
device according to an eighth embodiment of the present
invention;
[0034] FIG. 21 is a perspective view showing a treatment tool
rotating mechanism built in the distal end of the introduction
guide tube in the endoscope therapeutic device according to the
eighth embodiment of the present invention;
[0035] FIG. 22 is a vertical cross-sectional view of the treatment
tool rotating mechanism built in the distal end of the introduction
guide tube in the endoscope therapeutic device according to the
eighth embodiment;
[0036] FIG. 23 is a plan view showing a gear train of the treatment
tool rotating mechanism built in the distal end of the introduction
guide tube in the endoscope therapeutic device according to the
eighth embodiment;
[0037] FIG. 24 is a perspective view showing the gear train of the
treatment rotating mechanism built in the distal end of the
introduction guide tube in the endoscope therapeutic device
according to the eighth embodiment;
[0038] FIG. 25 is a perspective view of the distal end when the
introduction guide tube of the endoscope therapeutic device
according to the eighth embodiment is in use;
[0039] FIG. 26 is a vertical cross-sectional view of the distal end
of the introduction guide tube of the endoscope therapeutic device
according to the eighth embodiment when in use;
[0040] FIG. 27 is a perspective view showing the treatment tool
rotating mechanism built in the distal end of the introduction
guide tube in the endoscope therapeutic device according to a ninth
embodiment of the present invention; and
[0041] FIG. 28 is a side view of the final operating element of the
introduction guide tube in the endoscope therapeutic device
according to the ninth embodiment.
DETAILED DESCRIPTION OF THE INVENTION
[0042] Embodiments of the invention will be described below with
reference to the accompanying drawings.
[0043] Referring now to FIG. 1 to FIG. 7, an endoscope therapeutic
device according to a first embodiment of the present invention
will be described. FIG. 1A is a perspective view of an endoscope
therapeutic device according to the first embodiment of the present
invention. A treatment tool introduction guide tube unit 1 is shown
in FIG. 1A. FIG. 1B shows an insertion portion 3 of an endoscope 2.
In the endoscope therapeutic device according to the first
embodiment, the treatment tool introduction guide tube unit 1 is
joined to the insertion portion 3 of the endoscope 2 by the joint
tool described above.
[0044] The treatment tool introduction guide tube unit 1 includes a
plurality of treatment tool introduction guide tubes 4a, 4b as
manipulators for operating the surgical operation tools including
the treatment tools such as forceps or the like. The treatment
guide tubes 4a, 4b are joined at a midsection of an insertion
portion S thereof by a joint portion 6, and is fixed and joined
integrally. A joint hood 26, which constitutes the joint portion 6
is formed of a soft material. A mode for joining the two treatment
tool introduction guide tubes 4a, 4b by the joint hood 26 is shown
in FIG. 2. It is also possible to form at least part of the
insertion portions 5 of the two treatment tool introduction guide
tubes 4a, 4b as a single flexible tube of oval shape in lateral
cross-section without using the joint hood 26 as described above.
For example, at least the joint portion 6 can be configured in such
a manner. In this case as well, a fixed structure in which the
insertion portions 5 of a plurality of the introduction guide tubes
4a, 4b are connected integrally to each other is provided.
[0045] FIG. 6 is a perspective view of the treatment tool
introduction guide tube 4a (4b). As shown in FIG. 6, the insertion
portions 5 of the treatment tool introduction guide tubes 4a, 4b
each include a distal portion 10 located at a distal extremity
thereof, a first bending portion 11 is located on the proximal side
of the distal portion 10, a second bending portion 12 is located on
the proximal side of the first bending portion 11, and a soft
portion 13 is provided behind the second bending portion 12. A
proximal final operating element 20 is provided at the proximal end
of the insertion portion 5 of each of the introduction guide tubes
4a or 4b. The proximal final operating elements 20 each include a
grip portion 21, an insertion port 22 which communicates with a
treatment tool guiding channel 14 (see FIG. 7), and a plurality of
operating members for bending the bending portions 11, 12
respectively. The operating member for bending includes two angle
knobs 23a, 23b for operating the first bending portion 11 in two
directions and one angle handle 24 for operating the second bending
portion 12 in a single (e.g., vertical) direction.
[0046] FIG. 7 is a vertical cross-sectional view of the insertion
portion 5 of the introduction guide tube in the treatment tool
introduction guide tube unit. As shown in FIG. 7, a flexible tube
15 forming the treatment tool guiding channel 14 is disposed over
the entire length in the insertion portion 5 of each of the
introduction guide tubes 4a, 4b. The treatment tool guiding channel
14 opens toward the outside at the distal extremity of the
insertion portion 5 via a channel hole 16 at the distal portion 10
and at the final operating element at the insertion port.
[0047] The first bending portion 11 includes a plurality of curved
pieces 17 joined so as to be capable of rotating freely to allow
bending in the vertical and lateral directions, and is bent in the
pulling direction of an operating wire 18 by pulling a plurality of
the operating wires 18. Although the second bending portion 12 (see
FIG. 6) also has the same configuration to be bent by means of a
plurality of the bending pieces, the second bending portion 12 is
configured so as to be bent only in the vertical direction.
[0048] As shown in FIG. 1A, the second bending portion 12 is
provided so as to extend or project from the distal end of the
joint portion 6. In other words, in the respective treatment tool
introduction guide tubes 4a, 4b, the proximal portions in the
movable sections including the bending portions 11, 12 are fixedly
supported by the joint hood 26. In the first embodiment in this
configuration, a fixing portion (fixing means) for fixing the
portions of the introduction guide tubes 4a, 4b in the vicinity of
the proximal ends of the bending portions 11, 12 respectively, and
then fixing the same to each other is provided. Also, the joint
hood 26 constitutes a therapeutic instrument joint tool for joining
a plurality of the introduction guide tubes 4a, 4b.
[0049] Then, the distal end of the joint hood 26 which supports
both of the movable sections of the respective treatment tool
introduction guide tubes 4a, 4b serves as a common fulcrum 27.
Therefore, the movable sections including the bending portions 11,
12 can move respectively on the basis of the common fulcrum 27. The
fulcrum 27 is also a common fixed point for the movable sections of
the respective introduction guide tubes 4a, 4b.
[0050] Subsequently, referring to FIG. 1B, the endoscope 2 will be
described. FIG. 1B is a perspective view of the insertion portion 3
of the endoscope 2. As shown in FIG. 1B, the insertion portion 3 of
the endoscope 2 includes a distal portion 31 located at a distal
extremity thereof, a bending portion 32 located on the proximal
side of the distal portion 31, and a soft portion 33 located on the
proximal side of the bending portion 32. The endoscope 2 has an
observation function by the provision of an inspection window 34,
an illumination window 35, and a channel port 36 at the distal end
surface of the distal portion 31. The bending portion 32 is bent by
a final operating element (not shown) provided at a proximal end of
the insertion portion 3.
[0051] FIG. 3 is an explanatory drawing showing the state of usage
of the endoscope therapeutic device 1 including the treatment tool
introduction guide tubes 4a, 4b and the endoscope 2 assembled
together according to the first embodiment. As shown in FIG. 3, the
treatment tool introduction guide tube unit 1 is joined to the
insertion portion 3 of the endoscope 2 by a joint tool 40 in a
state of being placed along the insertion portion 3 of the
endoscope 2. The joint tool 40 is disposed in the vicinity of the
distal end of the soft portion 33 averting the bending portion 32
of the endoscope 2. Since the portion of the introduction guide
tube unit 1 in the vicinity of the distal end is joined by the
joint tool 40, the movable sections of the respective treatment
tool introduction guide tubes 4a, 4b including the bending portions
11, 12 are disposed corresponding to the bending portion 32 of the
endoscope 2, and are configured to be movable with respect to each
other.
[0052] As shown in FIG. 4 and FIG. 5, the joint tool 40 includes a
band member 43 having an insertion hole 41 for allowing the joint
portion 6 of the introduction guide tube unit 1 to be inserted
therethrough and an insertion hole 42 for allowing the insertion
portion 3 of the endoscope 2 to be inserted therethrough, and the
band member 43 is capable of opening and closing so that one end
can be opened about a hinge 44 on the other end. A projection 45 is
formed on one of the edges at the openable end of the band member
43 and a corresponding hole 46 for receiving the projection 45 for
engagement is formed on the other edge.
[0053] Subsequently, a case of using the endoscope therapeutic
device will be described. As shown in FIG. 3, the operator
assembles the introduction guide tube unit 1 to the insertion
portion 3 of the endoscope 2 and guides the same into a body cavity
as one unit. When guiding the unit assembled into one piece into
the body cavity as described above, it is also possible to guide it
into the body cavity using a trocar or an over tube (not shown) as
a guiding member as is known in the art.
[0054] Then, the operator introduces the various treatment tools
(including a suction tool) into the body cavity via the respective
introduction guide tubes 4a, 4b of the introduction guide tube unit
1, which are joined to the insertion portion 3 of the endoscope 2,
while observing the body cavity by the endoscope 2 to perform a
required treatment. It is also possible to introduce another
treatment tool through the channel port 36 and corresponding
channel provided on the endoscope 2 to perform a treatment
simultaneously.
[0055] FIG. 3 shows a state in which an anatomy 47 is pulled
upward. In this example of treatment, the operator pulls up the
anatomy 47 using gripping forceps 48 introduced through one of the
introduction guide tubes 4a, holds the anatomy 47 using the
gripping forceps 49 introduced through the other introduction guide
tube 4b, and moves the respective treatment tools in the opposite
direction. In other words, the operator bends the bending portions
11, 12 of the introduction guide tubes 4a, 4b respectively, and
provides the opposite movements to the two pairs of forceps 48, 49
to pull the anatomy 47.
[0056] Here, since the movable sections of the respective
introduction guide tubes 4a, 4b which guide the respective gripping
forceps 48, 49 move in the opposite directions with reference to
the fulcrum 27, supporting forces exerted to the fulcrum 27 are
mutually invalidated (canceled), and the movable sections of the
respective introduction guide tubes 4a, 4b move with reference to
the fulcrum 27. The fulcrum 27 is approximately considered as a
fixed point. Therefore, a force to be exerted to the gripping
forceps 48, 49 does deviate and can be exerted to the anatomy 47 as
is. Such behavior is not limited to the case of puling up the
anatomy 47, but may be the same in the surgical operation such as
to expand the anatomy 47.
[0057] In general, in case of using the single soft introduction
guide tube or the soft endoscope independently, the soft portion of
the insertion portion is suspended in a space of the body cavity by
the reaction received from the gripping forceps so as to be capable
of moving freely. Therefore, a force exerted to the anatomy can
become extremely small because the force generated by the reaction
is absorbed in the soft insertion portion.
[0058] However, in the first embodiment, since the movable sections
of the respective introduction guide tubes 4a, 4b which guide the
gripping forceps 48, 49 is fixedly supported by the common fulcrum
27, the supporting forces generated by the reaction and exerted to
the fulcrum 27 are mutually invalidated at the fulcrum 27, whereby
relatively stable support of the movable sections of the
introduction guide tubes 4a, 4b is achieved. In other words, there
is less possibility that the introduction guide tubes 4a, 4b move
by themselves and hence the force is dissipated. The fulcrum 27 can
be regarded as a fixed point, and hence the grip forceps 48, 49 can
be guided as intended with reference to the fulcrum 27 to perform a
quick operation of treatment. In this manner, even when the two
portions of the anatomy are gripped by the two treatment tools and
the two portions are moved in the opposite directions as in the
case of pulling up of the anatomy or expanding the anatomy,
treatment can be performed with a strong force without any
undesirable movement of the introduction guide tubes 4a, 4b and/or
the endoscope 2.
[0059] In the first embodiment described above, the case in which
the introduction guide tube unit 1 is used by being joined to the
insertion portion 3 of the endoscope 2 has been described. However,
the same advantages can be achieved in the case in which the
introduction guide tube unit 1 having a plurality of the
introduction guide tubes joined to each other is used
independently. However, when the introduction guide tube unit 1 is
used by being joined to the insertion portion 3 of the endoscope 2,
the positional relation with respect to the endoscope 2 is
established during use, and hence the surgical situation can be
observed easily, and the stable supporting balance is provided to
the entire unit, whereby stability of operation is increased,
thereby improving usability.
[0060] In the case in which the treatment tool is used via the
channel provided in the endoscope 2, the form of usage in which the
supporting function is provided as described above is also
conceivable as well as other various forms of usage.
[0061] Referring now to FIG. 8 to FIG. 11, the endoscope
therapeutic device according to a second embodiment of the present
invention will be described. The same parts to those in the
embodiment described above will be represented by the same
reference numerals in the description.
[0062] FIG. 8 is a partial perspective view of the endoscope
therapeutic device according to the second embodiment of the
present invention. As shown in FIG. 8, the treatment tool
introduction guide tube unit 1 according to the second embodiment
is an assembly of the two treatment tool introduction guide tubes
4a, 4b integrally inserted through an over tube 61 formed of soft
material. The treatment tool introduction guide tubes 4a, 4b are
the same as those in the first embodiment.
[0063] FIG. 9 is a perspective view showing the over tube 61 of the
endoscope therapeutic device according to the second embodiment,
and FIG. 10 is a lateral cross-sectional view of a fixed portion of
the introduction guide tube built in the over tube 61. As shown in
FIG. 9, the over tube 61 is formed with two insertion holes 62a,
62b for inserting the respective two treatment tool introduction
guide tubes 4a, 4b separately in a juxtaposed manner. As shown in
FIG. 10, although the respective insertion holes 62a, 62b are
partitioned by a partitioning wall 63 for guiding the introduction
guide tubes 4a, 4b separately, the insertion holes 62a, 62b partly
communicate with each other and are formed close to each other.
[0064] A fixing screw 64 is screwed into a sidewall of one of the
insertion holes 62b, and the introduction guide tube 4b inserted
through the insertion hole 62b is tightened by the screw 64, so
that the introduction guide tube 4b can be fixed. The introduction
guide tube 4a inserted through the other insertion hole 62a is
tightened by resilient deformation of the over tube 61, which
occurs when the introduction guide tube 4b is tightened by the
screw 64, and is fixed to the insertion hole 62b thereby.
[0065] In other words, in the second embodiment in this
configuration, the fixing portion (fixing means) for fixing the
portions of the introduction guide tube 61 in the vicinity of the
proximal ends of the bending portions 11, 12 respectively and then
fixing the same to each other is provided. Also, the over tube 61
itself constitutes the treatment equipment joint tool for joining a
plurality of the introduction guide tubes 4a, 4b.
[0066] As shown in FIG. 8, when the two treatment tool introduction
guide tubes 4a, 4b respectively are mounted to the over tube 61,
the distal portion 10 and the sections of the bending portions 11,
12 are exposed from the distal end of the over tube 61 and project
forward (distally). Normally, the distal ends of the soft portions
13 are also projected at least slightly when mounted.
[0067] Subsequently, the case where this endoscope therapeutic
device is used will be described. FIG. 11 is an explanatory drawing
showing the state of usage of the endoscope therapeutic device. As
shown in FIG. 11, the operator mounts the two treatment tool
introduction guide tubes 4a, 4b to the over tube 61 respectively to
form a single unit, and guides the same into the body cavity using
the guide means such as trocar. Here, since the introduction guide
tubes 4a, 4b projecting from the distal end of the over tube 61 are
retained with the distal end of the over tube 61 as the fulcrum 27,
the movement of the introduction guide tubes 4a, 4b is stable and
smooth. In a case where the gripping forceps 48, 49 as the
treatment tools are operated in the opposite directions by the
introduction guide tubes 4a, 4b, the components of the force in the
opposite directions exerted to the fulcrum 27 are mutually
invalidated. Therefore, the movable operating sections of the
introduction guide tubes 4a, 4b move with reference to the fulcrum
27, and hence the force exerted to the gripping forceps 48, 49 can
be exerted to the anatomy 47 without dissipation.
[0068] Alternatively, the operator can fix the portion in the
vicinity of the boundary between the first bending portion 11 and
the second bending portion 12 onto the over tube 61 by means of the
screw 64 or the like with the sections of the second bending
portions 12 of the respective introduction guide tubes 4a, 4b
positioned within the over tube 61 and with only the first bending
portion 11 projected from the over tube 61. In this case, only the
first bending portion 11 is bent about the portion in the vicinity
of the boundary between the first bending portion 11 and the second
bending portion 12 is set as a fulcrum. In other words, the present
invention is not limited to the portion in the vicinity of the
proximal end of the proximal-most second bending portion 12, but
may take a form in which the portion located at the midsection of
the bending portion is fixed.
[0069] In the second embodiment, the endoscope 2 is provided
separately from the unit, and as shown in FIG. 11, the endoscope 2
can be guided in the body cavity 65 along the over tube 61 of the
unit for observing the state of treatment, or can guide a treatment
tool such as a separate high-frequency knife 66. FIG. 11 shows a
state of incising the anatomy 47, which is pulled up by the
gripping forceps 48, 49, by means of the high-frequency knife 66
introduced through the endoscope 2.
[0070] Referring now to FIG. 12 and FIG. 13, the endoscope
therapeutic device according to a third embodiment of the present
invention will be described. The same parts as in the embodiments
described above are represented by the same reference numerals.
[0071] The third embodiment is configured in such a manner that the
above-described two treatment tool introduction guide tubes 4a, 4b
and the endoscope 2 are joined by a joint tool 71. As shown in FIG.
12, the joint tool 71 includes a resilient member 75 having a hole
portion 72 for fitting the insertion portion 5 of the introduction
guide tube 4a, a hole portion 73 for fitting the insertion portion
S of the introduction guide tube 4b, and a hole portion 74 for
fitting the insertion portion 3 of the endoscope 2 disposed
radially. The hole portions 72, 73, 74 of the joint tool 71 each
are formed with a slit 76 for allowing the member to be put in or
removed at the midsection thereof by deforming the portions of the
resilient member 75 proximate to the slits 76 to insert the
respective insertion portions of the introduction guide tubes 4a,
4b and endoscope 2.
[0072] FIG. 13 shows the state of usage of the third embodiment.
The insertion portion 5 of the introduction guide tube 4a, the
insertion portion 5 of the introduction guide tube 4b, and the
insertion portion 3 of the endoscope 2 are mounted by being fitted
to the hole portions 72, 73, 74 of the joint tool 71 corresponding
thereto, respectively. The joint tool 71 is mounted and fixed to
the distal portion 31 of the endoscope 2. In order to fixedly
retain the soft portions 13 of the introduction guide tubes 4a, 4b
in the vicinity of the distal ends in this position, the supporting
portion serves as the fulcrum 27 of the introduction guide tubes
4a, 4b. Therefore, as shown in FIG. 13, when the introduction guide
tubes 4a, 4b and the endoscope 2 are connected by the joint tool
71, the introduction guide tubes 4a, 4b are disposed at the
position surrounding, and in the vicinity of, the insertion portion
3 of the endoscope 2. Consequently, the same usage as the second
embodiment described above is enabled. The joint tool 71 may also
be disposed at other positions of the endoscope 2 and/or
introduction guide tubes 4a, 4b.
[0073] Subsequently, referring to FIG. 14, the endoscope
therapeutic device according to a fourth embodiment of the present
invention will be described. The same parts as in the embodiments
described above are represented by the same reference numerals in
the description.
[0074] A soft over tube 80 having a bending function is employed in
the fourth embodiment. The distal portion of the over tube 80
includes a bending portion 81, and the bending portion 81 is bent
by the final operating element (not shown) disposed on a proximal
side of the over tube 80. The over tube 80 is formed with a hole 83
for receiving an introduction guide tube 82 inserted therethrough,
two holes 85 for receiving two respective suction tubes 84a, 84b
separately and a hole 86 for receiving the insertion portion 3 of
the endoscope 2 in a sectional manner.
[0075] Then, when the introduction guide tube 82, the suction tubes
84a, 84b, and the insertion portion 3 of the endoscope 2 are
inserted through the corresponding holes 83, 85, 86 of the over
tube 80 respectively, these members are unitized. The over tube 80
includes a fixed portion in the vicinity of the distal portion
thereof, so that the inserted tools can be supported so that the
relative position between the over tube 80 and the inserted tools
does not change in the radial direction. The introduction guide
tube 82 and the suction tubes 84a, 84b are mounted to the over tube
80 so as to be capable of moving in the fore-and-aft direction
without wobbling in the radial direction. The movable sections of
the introduction guide tube 82 and the suction tubes 84a, 84b
projecting from the distal end of the over tube 80 are formed with
bending portions 87 which are similar to that described above with
regard to the introduction guide tubes 4a, 4b. The proximal
portions of the bending portions 87 projecting from the distal end
of the over tube 80 are supported by the over tube 80, and the
portions of the over tube 80 in the vicinity of the distal end
serves as a fulcrum of the movable sections projecting forward
therefrom.
[0076] When using this unit, as shown in FIG. 14, the operator
causes the introduction guide tube 82, the suction tubes 84a, 84b,
and the insertion portion 3 of the endoscope 2 to project from the
distal end of the over tube 80. Then, for example, the distal ends
of the two suction tubes 84a, 84b are placed on the anatomy 47 to
adsorb the anatomy 47. The operator can also bend the bending
portion 87 of the suction tubes 84a, 84b which are projected from
the distal end of the over tubes 80 as needed and pull the anatomy
47 upward. The operator can also expand the anatomy 47 by bending
the bending portions 87 of the suction tubes 84a, 84b, which are
projected from the distal end of the over tube 80, as needed in the
directions away from each other.
[0077] In the usage thereof, since the movable sections of the
respective suction tubes 84a, 84b are fixedly supported at the
common fulcrum, the reaction forces exerted to the suction tubes
84a, 84b are mutually invalidated, so that the suction tubes 84a,
84b can be operated reliably with a strong force as intended about
the distal end of the over tube 80 as the fulcrum. The treatment
tools may be projected from the introduction guide tube 82 for
treatment.
[0078] The introduction guide tube 82 may be used as the suction
tube. Alternatively, the suction tubes 84a, 84b may be replaced by
the treatment tool introduction guide tubes, which are similar to
that described above.
[0079] Referring now to FIG. 15, the endoscope therapeutic device
according to a fifth embodiment of the present invention will be
described. The same parts as in the embodiments described above are
represented by the same reference numerals for description.
[0080] In the fifth embodiment, a soft over tube 90 is employed.
The soft over tube 90 is formed integrally with a plurality of
manipulators 91a, 91b at the distal end of the soft over tube 90.
One of the manipulators 91a is provided with a distal operating
section 92 having flexibility, which is similar to the movement of
the fingers of a human being, and the other manipulator 91b is
provided with a bending portion 93 with the bending function having
flexibility which is similar to the movement of the wrist of a
human being. The respective manipulators 91a, 91b are separately
and remotely operated by an operation input means (not shown). The
operation input means may be, for example, a glove-type input
device to which the movement of the hand of the human being is
input and mimicked by the manipulators 91a, 91b.
[0081] The soft over tube 90 is formed with an insertion channel 95
to which the insertion portion 3 of the endoscope 2 is introduced.
The endoscope 2 used here has an extra thin insertion portion 3
having only an observing function.
[0082] When using the endoscope therapeutic device, as shown in
FIG. 15, the operator performs treatment by gripping the treatment
tool or by nipping the anatomy directly using the left and right
manipulators 91a, 91b which have flexibility similar to the
movement of the fingers of the human being. In this treatment form,
since the movement similar to the wrist of the human being is
achieved and hence it can be used with the similar feelings as a
human hand, the operability can further be improved, and the usage
can be acquired easily.
[0083] The left and right manipulators 91a, 91b are mounted to the
distal end of the soft over tube 90, and fixedly and integrally
supported. Accordingly, this supporting portion serves as the
fulcrum of the manipulators 91a, 91b as the movable sections.
Therefore, in the case of operating in the opposite directions
using the respective manipulators 91a, 91b, the forces exerted to
the respective manipulators 91a, 91b are mutually invalidated so
that the respective manipulators 91a, 91b can be operated reliably
with a strong force as intended about the distal end of the over
tube 90 as the fulcrum.
[0084] Referring now to FIG. 16 to FIG. 18, another therapeutic
device in which the introduction guide tube as described above is
modified will be described as a sixth embodiment of the present
invention. As shown in FIG. 16 and FIG. 17, an introduction guide
tube 100 in this therapeutic device includes a soft insertion
portion 101 and a final operating element 102, and the final
operating element 102 includes a grip portion 103, a plurality of
angle knobs 105 for bending the bending portion of the insertion
portion 101, an insertion port 107 that communicates with a channel
of the insertion portion 101, and a treatment tool operating lever
109 for operating a treatment tool operating mechanism, described
later. The angle knob 105 is provided with a brake knob 105a for
locking the operating position thereof. The brake knob may be
provided also on the treatment tool operating lever 109.
[0085] FIG. 18A and FIG. 18B are vertical cross-sectional views of
a distal end of the introduction guide tube in the endoscope
therapeutic device according to the sixth embodiment. As shown in
FIG. 18A and FIG. 18B, an insertion portion 110a of a treatment
tool 110, such as gripping forceps, is inserted from the insertion
port 107 of the final operating element 102 of the introduction
guide tube 100 through a channel 106, so as to be projected into
the body cavity from an opening 106a at the distal end of the
channel 106.
[0086] A treatment tool operating mechanism 108 is built in the
distal portion of the insertion portion 101. The treatment tool
operating mechanism 108 here includes a ring-shaped movable element
115 which allows insertion of the insertion portion 110a of the
treatment tool 110 in the distal portion of the insertion portion
101 so as to be capable of linear movement in the fore-and-aft
axial direction. The distal end of an operating wire 116 inserted
through the insertion portion 110 is connected to the movable
element 115. Accordingly, a movement control mechanism in which the
operating wire 116 is moved in the fore-and-aft axial direction
when the treatment tool operating lever 109 of the above-described
final operating element 102 is operated, whereby the movable
element 115 of the treatment tool operating mechanism 108 is moved
in the fore-and-aft direction and the distal end 110a of the
treatment tool 110 is moved in the fore-and-aft direction, is
configured. The movable element 115 constitutes a mechanism for
selectively engaging and disengaging grip arms 117 as engaging
members that engage part of the insertion portion 110a of the
treatment tool 110 by the operating wire 116, which is operated on
the proximal side.
[0087] As shown in FIG. 18A and FIG. 18B, a plurality of the grip
arms 117 as engaging members that engage part of the insertion
portion 110a of the treatment tool 110 project forward from the
movable element 115. The distal portions of the respective grip
arms 117 are resiliently biased so as to open outwardly in the free
state shown in FIG. 18B. Each grip arm 117 is integrally formed
with a holding portion 118 at the distal end thereof. A tightening
member 121 is attached on the outside of each grip arm 117, and the
tightening member 121 is capable of sliding freely in the range
between the movable element 115 and the holding portion 118. The
insertion portion 101 is formed with a guide rail 122 in the distal
portion so as to guide the tightening member 121 linearly in the
fore-and-aft direction. Positioning stoppers (stepped portions)
123a, 123b formed of walls extending vertically upward are formed
at the front end and the rear end of the guide rail 122, so that
front and rear terminal positions of movement of the tightening
member 121 are defined respectively.
[0088] The tightening member 121 includes a sliding portion 124 to
be guided by the guide rail 122 and a fastening ring portion 125
that slides on the outer periphery of the grip arm 117. As shown in
FIG. 18A, when the tightening member 121 is retracted, the
respective grip arms 117 are tightened by the tightening member
121, and the holding portions 118 of the respective grip arms 117
are pressed against the outer periphery of the insertion portion
110a of the treatment member 110 to grip the treatment tool 110 by
the movable element 115.
[0089] By moving the movable element 115 by the operating wire 116
in the fore-and-aft direction in the state in which the treatment
tool is constrained as shown in FIG. 18A, the treatment tool 110
can be moved in the fore-and-aft direction together with the
introduction guide tube 100. In this manner, complicated operation
such as to operate with the hand unlinked from the final operating
element of the introduction guide tube 100 or the endoscope as in a
case where the operator grips the distal end of the treatment tool
110 directly and pulls and pushes the proximal end of the treatment
tool 110 by hand to move the distal portion in the fore-and-aft
direction is not necessary, and the fore-and-aft movement of the
treatment tool 110 can be performed easily without unlinking the
hand from the final operating element.
[0090] When the tightening member 121 is moved forward as shown in
FIG. 18B, the distal portions of the respective grip arms 117 open
and release the treatment tool 110. In other words, the holding
portions 118 of the respective grip arms 117 retract from the
insertion portion 110a of the treatment tool 110 and release the
treatment tool 110 from the gripped state shown in FIG. 18A.
Therefore, the treatment tool 110 can be moved in the fore-and-aft
direction or in the rotational direction independently of the
introduction guide tube 100, whereby the operability of the
treatment tool 110 is improved.
[0091] The introduction guide tube 100 is used as the introduction
guide tube in the device in the therapeutic system described above,
and can be used for introduction of various treatment tools. It can
also be applied to an unit form in which a plurality of the
introduction guide tubes 100 are joined so that the supporting
forces exerted to the movable sections of a plurality of the
introduction guide tubes 100 are mutually invalidated at the common
fulcrum. The general existing introduction guide tube is simply
used for inserting the treatment tool therethrough. However, with
the introduction guide tube 100 disclosed here, the treatment tool
110 can be rotated or moved in the fore-and-aft direction
positively, and hence the reliable operation of the treatment tool
110 is achieved. The introduction guide tube 100 guarantees
beneficial effects also when using the introduction guide tube 100
independently and separately from the endoscope 2.
[0092] Subsequently, referring to FIG. 19A and FIG. 19B, a
modification of the above-described introduction guide tube will be
described as a seventh embodiment of the present invention. An
introduction guide tube 130 of this type differs from the
above-described introduction guide tube 100 in that there is
provided a treatment tool advancing-retracting mechanism. In other
words, the treatment tool advancing-retracting mechanism supports a
separate extremity member 132 at the distal portion 131 of the
introduction guide tube 130 via a plurality of push rods 133 so as
to be capable of moving in the fore-and-aft direction. The push
rods 133 are moved in the fore-and-aft direction by operating the
treatment tool operating lever 109 provided on the final operating
element 102 of the introduction guide tube 130, so that the
extremity member 132 is moved in the fore-and-aft direction.
[0093] FIG. 19A shows a state in which the extremity member 132 is
waiting at a normal position which is retracted backward, and FIG.
19B shows a state in which the extremity member 132 is moved
forward.
[0094] As shown in FIG. 19A and FIG. 19B, a ring-shaped resilient
member 135 as the resilient member is disposed at the peripheral
edge of the distal end opening of the channel formed on the
extremity member 132. The ring-shaped resilient member 135 is used
for gripping the insertion portion of the treatment tool 110
projected from the distal end opening of the channel by tightening
the same with a resilient force. The treatment tool 110 is retained
by the resiliently tightening force of the ring-shaped resilient
member 135 and hence follows the movement of the extremity member
132. However, the force that retains treatment tool 110 is such
that when the insertion portion 110a of the treatment tool 110 is
pushed and pulled from the proximal side, only the treatment tool
110 can move against the retaining force of the ring-shaped
resilient member 135. It is also possible to retain the treatment
tool 110 with a force of a strength that cannot move the treatment
tool 110.
[0095] The above-described introduction guide tube 130 can also be
used as the above-described introduction guide tube and as a member
for introducing the treatment tool as a matter of course, and it
can also be applied to a unit form in which a plurality of the
introduction guide tubes 130 are joined so that the supporting
forces exerted to the movable sections of a plurality of the
introduction guide tubes 130 are mutually invalidated at the common
fulcrum.
[0096] Referring now to FIG. 20 to FIG. 26, another modification of
the aforementioned introduction guide tube will be described as an
eighth embodiment of the present invention. As shown in FIG. 20,
the introduction guide tube 140 includes a soft insertion portion
141 and a final operating element 142. The final operating element
142 includes a grip portion 143, a plurality of angle knobs 145 for
bending a bending portion 144 (see FIG. 21) of the insertion
portion 141, an insertion port 147 in communication with a channel
146 (see FIG. 22) of the insertion portion 141, a treatment tool
rotating knob 149 for operating a treatment tool rotating mechanism
148 described later. The angle knob 145 and the treatment tool
rotating lever 149 are provided with brake knobs 145a, 149a for
locking the operating positions thereof. The final operating
element 142 is provided with an operating button 137 for performing
operations such as suction or air supply using the channel 146.
[0097] As shown in FIG. 25 and FIG. 26, by inserting an insertion
portion 150a of a treatment tool 150 such as the grip forceps from
the insertion port 147 of the final operating element 142 of the
introduction guide tube 140 through the channel 146, the treatment
tool 150 is projected from a distal end opening of the channel 146
into the body cavity.
[0098] The treatment tool rotating mechanism 148 is assembled in
the distal portion of the insertion portion 141, and is configured
as shown in FIG. 21 to FIG. 26. In other words, a cylindrical
connecting mouth ring 153, to which the distal end of a soft tube
152 defining the channel 146 is connected, is provided in a distal
portion 151 of the insertion portion 141 of the introduction guide
tube 140, and the connecting mouth ring 153 is fixed to a
supporting member 154 fixed to the distal portion 151. As shown in
FIG. 22, a cylindrical rotating member 156 is disposed along the
connecting mouth ring 153 and a distal wall 155 of the distal
portion 151, and the rotating member 156 is rotatably supported
about an elongated shaft of the channel 146 or a shaft extending in
parallel with the elongated shaft. The rotating member 156 opens at
the distal surface of the distal portion 151 of the introduction
guide tube 140 and forms a distal end opening 146a of the channel
146.
[0099] As shown in FIG. 22, a bevel gear 157 as a driven gear is
coaxially formed on the outer periphery of the rotating member 156.
A bevel gear 158 as a drive gear engages the bevel gear 157. The
shaft center of the bevel gear 158 is disposed orthogonally to the
shaft center of the bevel gear 157 as the driven gear. The bevel
gear 158 as the drive gear is rotatably supported in the distal
portion of the insertion portion 141. A pinion gear 159 is
coaxially and integrally formed with the bevel gear 158. As shown
in FIG. 23, a pair of racks 160a, 160b are disposed on both sides
of the pinion gear 159 so as to engage therewith. The respective
racks 160a, 160b are configured to be guided linearly by a guide,
not shown, in the distal portion of the insertion portion 0.141 of
the introduction guide tube 140.
[0100] Distal ends of operating wires 161a, 161b are connected to
the respective racks 160a, 160b separately, and when the operator
pushes or pulls the operating wires 161a, 161b from the proximal
side, the racks 160a, 160b move in the fore-and-aft direction, so
that the pinion gear 159 rotates.
[0101] The operating wires 161a, 161b are pulled by operating the
treatment tool rotating knob 149 provided on the final operating
element 142 to move the racks 160a, 160b.
[0102] Then, by the movement of the racks 160a, 160b, the pinion
gear 159 rotates together with the bevel gear 158, and the bevel
gear 158 rotates the bevel gear 157 as the driven gear. When the
bevel gear 157 as the driven gear rotates, the rotating member 156
rotates together.
[0103] On the other hand, as shown in FIG. 22 and FIG. 25, a
resilient member 165 formed of rubber or the like is provided at
the peripheral edge of the distal end of the rotating member 156.
The resilient member 165 is exposed outward from the distal portion
151 of the insertion portion 141 of the introduction guide tube
140. The resilient member 165 serves as anchoring member which
abuts against the distal end of the treatment tool inserted through
the channel 146, and anchors itself with respect to the distal end
of the treatment tool by a frictional force against the treatment
tool or deformation thereof, so as to cause the treatment tool to
rotate with the rotating member 156. The treatment tool inserted
through the introduction guide tube 140 can be rotated by the
treatment tool rotating mechanism 148.
[0104] When the treatment tool 150 such as the grip forceps is
inserted through the introduction guide tube 140 for use, as shown
in FIG. 25 and FIG. 26, the operator inserts an insertion portion
150a of the treatment tool 150 through the channel 146 and allows a
distal grip member 150b of the treatment tool 150 to project from
the distal end of the introduction guide tube 140.
[0105] Then, the operator opens the distal grip member 150b by
operating a link mechanism 168 for operating an openable and
closable link mechanism 168, causes the distal grip member 150b to
retract slightly in the opened state, and presses the member of the
link mechanism 168 against the resilient member 165 for anchoring.
In other words, the distal grip member 150b of the treatment tool
150 is joined with the rotating member 156 by a frictional force or
an engaging force between the resilient member 165 and the link
mechanism 168, so as to rotate with the rotating member 156.
[0106] When changing the direction of the treatment tool 150 by
rotating the same, the distal grip member 150b of the treatment
tool 150 can be rotated with the rotating member 156. In other
words, since the distal grip member 150b of the treatment tool 150
is rotated directly, accurate relation with respect to the amount
of rotation can be maintained, and the distal grip member 150b of
the treatment tool 150 can be rotated quickly. It is also possible
to twist the elongated insertion portion 150a of the treatment tool
150 from the proximal side to assist the rotation of the distal
grip member 150b of the treatment tool 150.
[0107] Referring now to FIG. 27 and FIG. 28, still another
modification of the introduction guide tube provided with the
treatment tool rotating mechanism as described above will be
described as a ninth embodiment of the invention.
[0108] As shown in FIG. 27, in the treatment tool rotating
mechanism of an introduction guide tube 170, the driven gear to be
provided on the outer periphery of the rotating member 156 is a
spur gear 171. A spur gear 172 as a drive gear engages the spur
gear 171. The spur gear 172 as the drive gear is supported in the
distal portion of the insertion portion 141. A distal end of a
torque transmission wire 173, which is configured to transmit
rotational torque, is connected to a shaft of the spur gear
172.
[0109] Then, the operator rotates the spur gear 172 as the drive
gear and the spur gear 171 as the driven gear by twisting and
rotating the torque transmission wire 173 from the proximal side.
When the spur gear 171 rotates, the rotating member 156 rotates
together therewith.
[0110] As shown in FIG. 28, a rotating lever 175 is provided on the
final operating element 142 of the introduction guide tube 170 so
that the torque transmission wire 173 is rotated by operating the
rotating lever 175. The direction of operation of the operating
mechanism on the proximal side by the rotating lever 175 is
substantially parallel to the axis of rotation of the rotating
mechanism at the distal end of the insertion portion.
[0111] The structure of the treatment tool rotating mechanism other
than those described here may be substantially the same as the
above-described embodiments.
[0112] In this case as well, as in the above-described embodiments,
the treatment tool rotating mechanism can be used for changing the
direction of rotation of the treatment tool 150. Since the driven
gear is the spur gear 171 and the drive gear is the spur gear 172,
and the spur gear 172 is rotated by the torque transmission wire
173, a mechanism to be built in the distal portion of the
introduction guide tube 170 can be simplified.
[0113] Although the treatment tool operating mechanism for moving
the treatment tool in the fore-and-aft direction or for rotating
the same is such that the treatment tool is built in the distal
portion of the introduction guide tube in the aforementioned
description, it is also possible to combine both configurations to
obtain a form in which the treatment tool operating mechanism for
moving the treatment tool in the fore-and-aft direction and
rotating the same.
[0114] As described above, in the introduction guide tube in a form
including the treatment tool operating mechanism which moves the
treatment tool in the fore-and-aft direction or/and rotating the
same, the following problems can be solved.
[0115] In other words, when the direction or the position of the
distal portion of the treatment tool introduced into the body
cavity via the soft introduction guide tube is changed as in the
related art, the proximal portion of the treatment tool is twisted
or moved in the fore-and-aft direction on the proximal side of the
introduction guide tube.
[0116] However, the insertion portion of the treatment tool
introduced via the interior of the introduction guide tube is
elongated and flexible, and the insertion portion of the treatment
tool comes into contact with the inner wall of the introduction
guide tube at many points and often snakes its way therein. In
particular, when the bending portion of the introduction guide tube
is bent, the insertion portion of the treatment tool comes into a
pressing contact with the inner wall of the introduction guide tube
at the bending portion.
[0117] Under such a circumstance, even when the operator pushes and
pull s the insertion portion of the treatment tool positioned in
the introduction guide tube from the proximal side, or adds the
rotating operation, the operating force is apt to be absorbed en
route by snaking or twisting of the insertion portion of the
treatment tool, and hence the operating force from the proximal
side is hardly transmitted to the distal portion of the treatment
tool.
[0118] However, as described above, in a form in which the
operating mechanism for moving the treatment tool in the
fore-and-aft direction or the operating mechanism for rotating the
treatment tool is built in the distal portion of the introduction
guide tube, such disadvantages can be eliminated, and quick
operation is enabled while maintaining the accurate relation with
respect to the operating amount. Also, a complicated operation such
as to operate with an operator's hand removed from the final
operating element of the introduction guide tube or the endoscope
as in a case where the operator pushes or pulls the proximal
portion of the treatment tool by hand is not necessary, and hence
the operation of the treatment tool in the fore-and-aft direction
can be performed easily without the operator removing his/her hand
from the final operating element.
[0119] While there has been shown and described what is considered
to be preferred embodiments of the invention, it will, of course,
be understood that various modifications and changes in form or
detail could readily be made without departing from the spirit of
the invention. It is therefore intended that the invention be not
limited to the exact forms described and illustrated, but should be
constructed to cover all modifications that may fall within the
scope of the appended claims.
* * * * *