U.S. patent application number 11/799696 was filed with the patent office on 2007-11-22 for endoscope.
This patent application is currently assigned to Olympus Medical Systems Corp.. Invention is credited to Haruhiko Kaiya, Hidenobu Kimura, Seiji Kitano, Takayasu Miyagi, Kotaro Yoda.
Application Number | 20070270638 11/799696 |
Document ID | / |
Family ID | 38066757 |
Filed Date | 2007-11-22 |
United States Patent
Application |
20070270638 |
Kind Code |
A1 |
Kitano; Seiji ; et
al. |
November 22, 2007 |
Endoscope
Abstract
An endoscope includes: a treatment instrument elevator base
including a contact surface which contacts with a treatment
instrument inserted into a treatment instrument insertion channel,
and rotatably provided to a distal end to elevate the instrument; a
contact portion provided to the distal end to contact with the
instrument when the elevator base is elevated; a first leading
portion provided to the contact surface to lead the instrument to a
predetermined position on the contact surface as the elevator base
is rotated; a holding portion provided to the contact surface and
the contact portion, and including a grasping surface for
sandwiching the instrument with a diameter not exceeding a
predetermined value; and a second leading portion provided to the
contact portion to lead the instrument larger than the grasping
surface away from the holding portion.
Inventors: |
Kitano; Seiji; (Tokyo,
JP) ; Kimura; Hidenobu; (Tokyo, JP) ; Yoda;
Kotaro; (Tokyo, JP) ; Miyagi; Takayasu;
(Tokyo, JP) ; Kaiya; Haruhiko; (Tokyo,
JP) |
Correspondence
Address: |
Thomas Spinelli;Scully, Scott, Murphy & Presser
Suite 300, 400 Garden City Plaza
Garden City
NY
11530
US
|
Assignee: |
Olympus Medical Systems
Corp.
Tokyo
JP
|
Family ID: |
38066757 |
Appl. No.: |
11/799696 |
Filed: |
May 2, 2007 |
Current U.S.
Class: |
600/104 ;
600/114; 600/131 |
Current CPC
Class: |
A61B 1/00098 20130101;
A61B 1/018 20130101; A61B 1/0051 20130101; A61B 1/00177
20130101 |
Class at
Publication: |
600/104 ;
600/114; 600/131 |
International
Class: |
A61B 1/01 20060101
A61B001/01 |
Foreign Application Data
Date |
Code |
Application Number |
May 17, 2006 |
JP |
2006-138302 |
Aug 30, 2006 |
JP |
2006-234520 |
Claims
1. An endoscope comprising: an insertion portion including a distal
end on a distal end side thereof and inserted into a body cavity; a
treatment instrument insertion channel disposed in the insertion
portion and communicating with the distal end; a treatment
instrument elevator base including a contact surface which comes in
contact with a treatment instrument inserted into the treatment
instrument insertion channel, the treatment instrument elevator
base rotatably provided to the distal end to elevate the treatment
instrument through the contact of the contact surface with the
treatment instrument in accordance with the operation of operation
portion; a contact portion provided to the distal end to be
contactable with the treatment instrument when the treatment
instrument elevator base is elevated; a first leading portion
provided to the contact surface of the treatment instrument
elevator base to lead the treatment instrument to a predetermined
position on the contact surface in accordance with a rotating
movement of the treatment instrument elevator base; a holding
portion provided to the contact surface and the contact portion and
including a grasping surface of a predetermined size for
sandwiching, between the contact surface and the contact portion,
the treatment instrument led by the first leading portion, the
treatment instrument having a diameter not exceeding a
predetermined value; and a second leading portion provided to the
contact portion to lead and hold the treatment instrument in a
direction away from the holding portion, the treatment instrument
being larger in size than the grasping surface of the holding
portion.
2. The endoscope according to claim 1, wherein the first leading
portion is configured to form a tilted surface or a curved surface
for leading the treatment instrument to an edge portion of the
contact surface of the treatment instrument elevator base.
3. The endoscope according to claim 2, wherein the holding portion
is configured such that the grasping surface is disposed at the
edge portion of the contact surface when the treatment instrument
elevator base is elevated.
4. The endoscope according to claim 1, wherein the second leading
portion is configured to form a tilted surface or a curved surface
for leading the treatment instrument to a predetermined fixing
position.
5. The endoscope according to claim 1, wherein the treatment
instrument is a guide wire.
6. The endoscope according to claim 5, wherein the guide wire has a
diameter at least in the range of from 0.02 inches to 0.04
inches.
7. An endoscope comprising: an insertion portion including a distal
end on a distal end side thereof and inserted into a body cavity; a
treatment instrument insertion channel disposed in the insertion
portion and communicating with the distal end; a treatment
instrument elevator base including a contact surface which comes in
contact with a treatment instrument inserted into the treatment
instrument insertion channel, the treatment instrument elevator
base rotatably provided to the distal end to elevate the treatment
instrument through the contact of the contact surface with the
treatment instrument in accordance with the operation of operation
portion; a contact portion provided to the distal end to be
contactable with the treatment instrument when the treatment
instrument elevator base is elevated; a leading portion for leading
the treatment instrument to a predetermined position on the contact
portion in accordance with a rotating movement of the treatment
instrument elevator base; and a holding fixture portion provided to
the contact surface and the contact portion and including a
grasping surface for sandwiching, between the contact surface and
the contact portion, the treatment instrument led by the leading
portion, the treatment instrument having a diameter not exceeding a
predetermined value.
8. The endoscope according to claim 7, wherein the leading portion
is a tilted surface or a curved surface.
9. An endoscope comprising: an insertion portion including a distal
end on a distal end side thereof and inserted into a body cavity; a
treatment instrument insertion channel disposed in the insertion
portion and communicating with the distal end; a treatment
instrument elevator base rotatably provided to the distal end to
elevate a first treatment instrument or a second treatment
instrument inserted into the treatment instrument insertion
channel, in accordance with the operation of operation portion; a
fixing member disposed to the distal end and functioning as a
fulcrum when the treatment instrument elevator base is actuated to
change the direction of the first treatment instrument or the
second treatment instrument; a first treatment instrument holding
portion provided to the treatment instrument elevator base to hold,
at a first position, the first treatment instrument inserted into
the treatment instrument insertion channel; a second treatment
instrument holding portion provided to the treatment instrument
elevator base to hold, at a second position different from the
first position, the second treatment instrument inserted into the
treatment instrument insertion channel; a holding fixture portion
provided to each of the treatment instrument elevator base and the
fixing member to sandwich, between the treatment instrument
elevator base and the fixing member, the first treatment instrument
elevated by the treatment instrument elevator base; and a leading
portion provided to the fixing member to lead the first treatment
instrument elevated in accordance with a rotating movement of the
treatment instrument elevator base to the holding fixture portion
of the fixing member, without leading the second treatment
instrument elevated in accordance with the rotating movement of the
treatment instrument elevator base to the holding fixture
portion.
10. The endoscope according to claim 9, wherein the holding fixture
portion of the fixing member is disposed in a plane including a
locus plane defined by the movement of the first treatment
instrument holding portion in accordance with the rotating movement
of the treatment instrument elevator base.
11. The endoscope according to claim 9, wherein the leading portion
is a tilted surface or a curved surface formed on the fixing
member.
12. The endoscope according to claim 10, wherein the leading
portion is a tilted surface or a curved surface formed on the
fixing member.
13. The endoscope according to claim 9, wherein the first treatment
instrument is a guide wire having an outer diameter equal to or
less than a predetermined diameter; and wherein the second
treatment instrument is a treatment instrument having an outer
diameter greater than the predetermined diameter.
14. The endoscope according to claim 9, wherein the treatment
instrument elevator base includes a contact surface which comes in
contact with the first treatment instrument or the second treatment
instrument inserted into the treatment instrument insertion
channel, and wherein the contact surface is formed with an
elevator-base-side leading portion for leading the first treatment
instrument and the second treatment instrument in accordance with
the rotating movement of the treatment instrument elevator base
such that the first treatment instrument and the second treatment
instrument are made in contact with and held at the first position
and the second position, respectively.
15. The endoscope according to claim 9, wherein the first treatment
instrument holding portion includes a wall portion for latching the
first treatment instrument.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application claims benefit of Japanese Application No.
2006-138302 filed on May 17, 2006 and No. 2006-234520 filed on Aug.
30, 2006 the contents of which are incorporated by this
reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to an endoscope, and
particularly to an endoscope suitable for performing an operation
of exchanging treatment instruments by using a guide wire in an
endoscopy and an endoscopic operation of the pancreaticobiliary
duct system.
[0004] 2. Description of the Related Art
[0005] In recent years, an endoscopic treatment using an endoscope
has been increasingly performed in the treatment of a disease in
the digestive tract system and the pancreaticobiliary duct system.
The existing treatments of the pancreaticobiliary duct system using
an endoscope include a diagnostic treatment of performing
endoscopic cholangiography and pancreatography and also a
therapeutic treatment of removing a gallstone located in the common
bile duct or the like by using a balloon or a grasping treatment
instrument.
[0006] In performing an endoscopic treatment of a pancreatic duct,
a bile duct, a hepatic duct, or the like by using an endoscope, a
surgeon usually and commonly inserts the distal end of an insertion
portion of the endoscope into a position in the vicinity of the
duodenal papilla, and then selectively inserts a treatment
instrument, such as a catheter, into the pancreatic duct or the
bile duct while using a guide wire as a guide under X-ray
illumination.
[0007] In such an endoscopy and an endoscopic operation of the
pancreaticobiliary duct system, the guide wire is inserted in the
treatment instrument, when the treatment instrument, such as a
catheter, is inserted into a treatment instrument insertion channel
of the endoscope to be used in the observation or treatment of the
pancreaticobiliary duct system with the endoscope.
[0008] Therefore, the guide wire is moved in conjunction with the
movement of the treatment instrument with respect to the endoscope.
Thus, to exchange the treatment instrument with another treatment
instrument by using the guide wire as a guide while keeping the
distal end of the guide wire inserted in the papilla, for example,
the guide wire needs to be held within the distal end of the
insertion portion to keep the distal end of the guide wire inserted
in the papilla.
[0009] In light of the above need, there is an endoscope according
to a conventional technique, the insertion portion of which
includes guide wire fixing means for unlockably locking the guide
wire, as disclosed in Japanese Unexamined Patent Application
Publication No. 2002-034905, for example.
[0010] The endoscope of Japanese Unexamined Patent Application
Publication No. 2002-034905 includes an operation portion connected
to the proximal end of the insertion portion, and a treatment
instrument elevator base provided in the distal end of the
insertion portion and operable by the operation of the operation
portion. The endoscope is configured such that a top portion of a
leading surface of the treatment instrument elevator base is
provided with a slit which functions as the guide wire fixing means
for making only the guide wire engageable when the guide wire is
elevated through the operation of the treatment instrument elevator
base by the operation portion.
[0011] According to the thus configured endoscope apparatus, in the
observation or treatment of the pancreaticobiliary duct system
using the endoscope, as the treatment instrument elevator base is
elevated, the guide wire is pressed into and engaged with a
substantially V-shaped slit (a wire locking groove) provided in a
bottom portion of the treatment instrument elevator base due to the
reaction force of the guide wire itself inserted in the papilla,
and is pressed against a substantially planar upper surface of a
rigid distal end body. Thereby, the guide wire is mechanically
fixed.
[0012] Further, the endoscope provided with the treatment
instrument elevator base in the distal end thereof includes an
endoscope in which the treatment instrument elevator base is
elevated by a drive arm provided inside a side surface of the
distal end to prevent such inconvenience as interference of the
projected treatment instrument, such as the guide wire, with an
elevator wire or the like, as disclosed in Japanese Unexamined
Patent Application Publication No. 2005-304586, for example.
SUMMARY OF THE INVENTION
[0013] An endoscope according to a first aspect of the present
invention includes an insertion portion, a treatment instrument
insertion channel, a treatment instrument elevator base, a contact
portion, a first leading portion, a holding portion, and a second
leading portion. The insertion portion includes a distal end on a
distal end side thereof, and is inserted into a body cavity. The
treatment instrument insertion channel is disposed in the insertion
portion, and communicates with the distal end. The treatment
instrument elevator base includes a contact surface which comes in
contact with a treatment instrument inserted into the treatment
instrument insertion channel. Further, the treatment instrument
elevator base is rotatably provided to the distal end to elevate
the treatment instrument through the contact of the contact surface
with the treatment instrument in accordance with the operation of
an operation portion. The contact portion is provided to the distal
end to be contactable with the treatment instrument when the
treatment instrument elevator base is elevated. The first leading
portion is provided to the contact surface of the treatment
instrument elevator base to lead the treatment instrument to a
predetermined position on the contact surface in accordance with a
rotating movement of the treatment instrument elevator base. The
holding portion is provided to the contact surface and the contact
portion, and includes a grasping surface of a predetermined size
for sandwiching, between the contact surface and the contact
portion, the treatment instrument led by the first leading portion,
the treatment instrument having a diameter not exceeding a
predetermined value. The second leading portion is provided to the
contact portion to lead and hold the treatment instrument in a
direction away from the holding portion, the treatment instrument
being larger in size than the grasping surface of the holding
portion.
[0014] An endoscope according to a second aspect of the present
invention includes an insertion portion, a treatment instrument
insertion channel, a treatment instrument elevator base, a contact
portion, a leading portion, and a holding fixture portion. The
insertion portion includes a distal end on a distal end side
thereof, and is inserted into a body cavity. The treatment
instrument insertion channel is disposed in the insertion portion,
and communicates with the distal end. The treatment instrument
elevator base includes a contact surface which comes in contact
with a treatment instrument inserted into the treatment instrument
insertion channel, and is rotatably provided to the distal end to
elevate the treatment instrument through the contact of the contact
surface with the treatment instrument in accordance with the
operation of an operation portion. The contact portion is provided
to the distal end to be contactable with the treatment instrument
when the treatment instrument elevator base is elevated. The
leading portion leads the treatment instrument to a predetermined
position on the contact portion in accordance with a rotating
movement of the treatment instrument elevator base. The holding
fixture portion is provided to the contact surface and the contact
portion, and includes a grasping surface for sandwiching, between
the contact surface and the contact portion, the treatment
instrument led by the leading portion, the treatment instrument
having a diameter not exceeding a predetermined value.
[0015] An endoscope according to a third aspect of the present
invention includes an insertion portion, a treatment instrument
insertion channel, a treatment instrument elevator base, a fixing
member, a first treatment instrument holding portion, a second
treatment instrument holding portion, a holding fixture portion,
and a leading portion. The insertion portion includes a distal end
on a distal end side thereof, and is inserted into a body cavity.
The treatment instrument insertion channel is disposed in the
insertion portion, and communicates with the distal end. The
treatment instrument elevator base is rotatably provided to the
distal end to elevate a first treatment instrument or a second
treatment instrument inserted into the treatment instrument
insertion channel, in accordance with the operation of an operation
portion. The fixing member is disposed to the distal end, and
functions as a fulcrum when the treatment instrument elevator base
is actuated to change the direction of the first treatment
instrument or the second treatment instrument. The first treatment
instrument holding portion is provided to the treatment instrument
elevator base to hold, at a first position, the first treatment
instrument inserted into the treatment instrument insertion
channel. The second treatment instrument holding portion is
provided to the treatment instrument elevator base to hold, at a
second position different from the first position, the second
treatment instrument inserted into the treatment instrument
insertion channel. The holding fixture portion is provided to each
of the treatment instrument elevator base and the fixing member to
sandwich, between the treatment instrument elevator base and the
fixing member, the first treatment instrument elevated by the
treatment instrument elevator base. The leading portion is provided
to the fixing member to lead the first treatment instrument
elevated in accordance with a rotating movement of the treatment
instrument elevator base to the holding fixture portion of the
fixing member, without leading the second treatment instrument
elevated in accordance with the rotating movement of the treatment
instrument elevator base to the holding fixture portion.
[0016] The above and other objects, features and advantages of the
invention will become more clearly understood from the following
description referring to the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] FIG. 1 is a perspective view according to a first embodiment
of the present invention, illustrating a schematic configuration of
the entire system of an endoscope apparatus incorporating an
endoscope and a variety of external devices;
[0018] FIG. 2 is a vertical cross-sectional view of essential parts
according to the first embodiment of the present invention,
illustrating an internal configuration of a distal end of an
insertion portion of the endoscope;
[0019] FIG. 3 is a perspective view according to the first
embodiment of the present invention, illustrating an external
configuration of the distal end including a treatment instrument
holding mechanism;
[0020] FIG. 4 is a perspective view according to the first
embodiment of the present invention, illustrating a configuration
of a treatment instrument elevator base provided in the distal
end;
[0021] FIG. 5 is a perspective view according to the first
embodiment of the present invention, illustrating a configuration
of a contact portion provided in the distal end;
[0022] FIG. 6 is a perspective view according to the first
embodiment of the present invention, illustrating a state in which
a guide wire is fixed, being sandwiched by the treatment instrument
elevator base in an elevating movement and the contact portion;
[0023] FIG. 7 is a plan view according to the first embodiment of
the present invention, illustrating a specific configuration of a
holding fixture portion of the contact portion illustrated in FIG.
5;
[0024] FIG. 8 is a perspective view for explaining the operation of
the first embodiment, illustrating the exterior of the distal end
in a state prior to the elevating movement of the treatment
instrument elevator base, in which the guide wire is inserted in a
distal end body;
[0025] FIG. 9 is a perspective view for explaining the operation of
the first embodiment, illustrating the exterior of the distal end
in a state in which the treatment instrument elevator base is
elevated from the state illustrated in FIG. 8 and the guide wire is
led toward a fixing position by a first leading portion of the
treatment instrument elevator base;
[0026] FIG. 10 is a perspective view for explaining the operation
of the first embodiment, illustrating the exterior of the distal
end in a state in which the guide wire is further moved from the
state illustrated in FIG. 9 to the fixing position through the
elevating movement of the treatment instrument elevator base and is
fixed to the position;
[0027] FIG. 11 is a perspective view according to the first
embodiment of the present invention, illustrating the exterior of
the distal end in a state in which a large-diameter treatment
instrument including a treatment instrument such as a catheter is
led and fixed to a maximum elevated position by a second leading
portion of the contact portion through the elevating movement of
the treatment instrument elevator base;
[0028] FIG. 12 is a cross-sectional view according to the first
embodiment of the present invention in the direction of the
insertion axis of the distal end illustrated in FIG. 10,
illustrating a state in which the guide wire is grasped, being
sandwiched by a holding portion of the treatment instrument
elevator base and an end portion of the holding fixture portion of
the contact portion;
[0029] FIG. 13 is a cross-sectional view according to the first
embodiment of the present invention in the direction of the
insertion axis of the distal end illustrated in FIG. 10,
illustrating a state in which the guide wire is grasped, being
sandwiched by the holding portion of the treatment instrument
elevator base and a surface of the holding fixture portion of the
contact portion;
[0030] FIG. 14 is an operational view according to the first
embodiment of the present invention for explaining the operation
proceeding from the state illustrated in FIG. 8 to the state
illustrated in FIG. 10 and to the state illustrated in FIG. 11;
[0031] FIG. 15 is a partially exploded perspective view according
to a second embodiment of the endoscope of the present invention,
illustrating a state in which a drive arm of the distal end of the
endoscope is rotated;
[0032] FIG. 16 is a perspective view according to a third
embodiment of the endoscope of the present invention, illustrating
an external configuration of the distal end of the endoscope in a
laid state of a treatment instrument elevator base;
[0033] FIG. 17 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
the distal end of the endoscope illustrated in FIG. 16, as viewed
from the front side;
[0034] FIG. 18 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
the external configuration of the distal end in an elevated state
of the treatment instrument elevator base;
[0035] FIG. 19 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
the exterior of the treatment instrument elevator base;
[0036] FIG. 20 is a front view according to the third embodiment of
the endoscope of the present invention, illustrating the treatment
instrument elevator base illustrated in FIG. 19;
[0037] FIG. 21 is an exploded perspective view according to the
third embodiment of the endoscope of the present invention,
illustrating the treatment instrument elevator base and a drive arm
to be attached to the treatment instrument elevator base;
[0038] FIG. 22 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
the treatment instrument elevator base attached with the drive
arm;
[0039] FIG. 23 is a partial cross-sectional view according to the
third embodiment of the endoscope of the present invention,
illustrating an attached state of a rotation shaft of the drive arm
to the treatment instrument elevator base;
[0040] FIG. 24 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
the distal end of the endoscope in which the drive arm is
shown;
[0041] FIG. 25 is a partial cross-sectional view of a modified
example according to the third embodiment of the endoscope of the
present invention, illustrating an attached state of the rotation
shaft of the drive arm to the treatment instrument elevator
base;
[0042] FIG. 26 is a cross-sectional view according to a
conventional example, illustrating a protection tube and a coil
tube, through which an operation wire is inserted;
[0043] FIG. 27 is a cross-sectional view of the protection tube and
the coil tube, through which the operation wire is inserted, in a
state in which the coil tube illustrated in FIG. 26 is damaged;
[0044] FIG. 28 is a cross-sectional view according to the third
embodiment of the endoscope of the present invention, illustrating
the protection tube and the coil tube, through which the operation
wire is inserted;
[0045] FIG. 29 is a cross-sectional view according to the third
embodiment of the endoscope of the present invention, illustrating
the protection tube and the coil tube, through which the operation
wire is inserted, in a state in which the coil tube illustrated in
FIG. 28 is damaged;
[0046] FIG. 30 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
an insulating block;
[0047] FIG. 31 is a perspective view according to the third
embodiment of the endoscope of the present invention, illustrating
the insulating block, as viewed in a different angle from the angle
of FIG. 30;
[0048] FIG. 32 is a front view according to the third embodiment of
the endoscope of the present invention, illustrating the distal end
in a state in which the treatment instrument elevator base and the
insulating block are attached to a rigid distal end portion;
[0049] FIG. 33 is a top view according to the third embodiment of
the endoscope of the present invention, illustrating the distal end
in the state in which the treatment instrument elevator base and
the insulating block are attached to the rigid distal end
portion;
[0050] FIG. 34 is a diagram for explaining the operation of the
third embodiment, illustrating a state prior to the elevating
movement of the treatment instrument elevator base, in which the
guide wire is inserted in the distal end body;
[0051] FIG. 35 is a diagram for explaining the operation of the
third embodiment, illustrating the state prior to the elevating
movement of the treatment instrument elevator base, as viewed in a
different angle from the angle of FIG. 34;
[0052] FIG. 36 is a diagram for explaining the operation of the
third embodiment, illustrating an initial state in which the guide
wire is led by a leading surface of the treatment instrument
elevator base toward a treatment instrument holding portion;
[0053] FIG. 37 is a diagram for explaining the operation of the
third embodiment, illustrating a state in which the treatment
instrument elevator base is further elevated and the guide wire is
led to the treatment instrument holding portion;
[0054] FIG. 38 is a diagram for explaining the operation of the
third embodiment, illustrating a state in which a wall portion of
the further elevated treatment instrument elevator base is set in a
wall portion release groove of the insulating block;
[0055] FIG. 39 is a diagram for explaining the operation of the
third embodiment, illustrating a state in which the guide wire is
sandwiched and fixed by the treatment instrument elevator base and
the insulating block;
[0056] FIG. 40 is a diagram for explaining the operation of the
third embodiment, illustrating a state in which the guide wire is
led by a guide wire leading portion of the insulating block;
[0057] FIG. 41 is a diagram for explaining the operation of the
third embodiment, illustrating the state in which the guide wire is
sandwiched and fixed by the treatment instrument elevator base and
the insulating block, as viewed in a different angle from the angle
of FIG. 39;
[0058] FIG. 42 is a diagram for explaining the operation of the
third embodiment, illustrating only the treatment instrument
elevator base and the guide wire in the state in which the guide
wire is sandwiched and fixed by the treatment instrument elevator
base and the insulating block;
[0059] FIG. 43 is a diagram for explaining the operation of the
third embodiment, illustrating only the insulating block and the
guide wire in the state in which the guide wire is sandwiched and
fixed by the treatment instrument elevator base and the insulating
block;
[0060] FIG. 44 is a diagram for explaining the operation of the
third embodiment, and for explaining the treatment instrument
elevator base in elevating the large-diameter treatment instrument;
and
[0061] FIG. 45 is a front view of the treatment instrument elevator
base illustrated in FIG. 44 for explaining the operation of the
third embodiment.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0062] Embodiments of the present invention will be described below
with reference to the drawings.
First Embodiment
[0063] FIGS. 1 to 14 illustrate a first embodiment of the present
invention. FIG. 1 is a perspective view according to the first
embodiment, illustrating a schematic configuration of the entire
system of an endoscope apparatus incorporating an endoscope and a
variety of external devices. FIG. 2 is a vertical cross-sectional
view of essential parts, illustrating an internal configuration of
a distal end of an insertion portion of the endoscope. FIG. 3 is a
perspective view illustrating an external configuration of the
distal end including a treatment instrument holding mechanism.
[0064] As illustrated in FIG. 1, an endoscope 1 of the first
embodiment is configured to form an endoscope system in combination
with an equipment group including external devices of a light
source device 2, an image processor 3, a monitor 4, an input
keyboard 5, a suction pump device 6, and a water supply tank 7, for
example. The above equipments are placed on a rack 9 equipped with
carriers 8.
[0065] The endoscope 1 is configured to include an elongated
insertion portion 10 inserted into a body cavity, an operation
portion 11 provided on the proximal side and connected to the
proximal end of the insertion portion 10, and a universal cord 12,
the proximal end of which is connected to the operation portion
11.
[0066] The insertion portion 10 is configured to include an
elongated flexible tube portion 13 having flexibility, a bending
portion 14 connected to the distal end of the flexible tube portion
13, and a rigid distal end 15 provided consecutively to the bending
portion 14 and disposed at the most distal end position of the
insertion portion 10.
[0067] Further, the distal end of the universal cord 12 connected
to the operation portion 11 is provided with a connector 12a. The
connector 12a is provided with a light guide connector portion and
an electric contact portion, and is connected to the light source
device 2, which is one of the external devices.
[0068] The connector 12a is also connected to the image processor 3
through a signal cable 16a, which is connected to an internal
signal line.
[0069] The outer circumferential surface of the distal end 15 of
the endoscope 1 is formed with a concave cutout portion 15a having
a cutout side surface. On one side of the side portion of the
cutout portion 15a, a channel opening 15A (see FIG. 2) is disposed.
Further, beside the channel opening 15A, an illumination lens (an
illumination window) 24a forming an illumination optical system and
an objective lens (an observation lens) 24b forming an observation
optical system are juxtaposed, as illustrated in FIG. 3.
[0070] Further, a rear end wall surface 15b of the cutout portion
15a of the distal end 15 is provided with a nozzle 24c projecting
from the rear end wall surface 15b to supply air and water. The
nozzle 24c is used to spray fluid, such as water and air, onto the
outer surface of the objective lens 24b for cleaning the lens
surface.
[0071] Although not illustrated, the illumination lens 24a is
connected to a light guide functioning as an optical transmission
path. The inside of the objective lens 24b is disposed with a CCD
(Charge Coupled Device), which is an image pickup device forming
the observation optical system. The CCD is connected to a circuit
board for extracting an image signal.
[0072] The not-illustrated light guide, CCD, and circuit board
described above are disposed in a storage portion formed in a rigid
distal end portion 24, which forms a distal end body in the distal
end 15.
[0073] The operation portion 11 of the endoscope 1 is provided with
a bending operation portion 17 for bending the bending portion 14
of the insertion portion 10 in the vertical or lateral direction,
an air and water supply button 18, and a suction operation button
19. Further, the proximal end of the operation portion 11 is
provided with an insertion opening 21 which communicates with a
treatment instrument insertion channel 26 (see FIG. 2).
[0074] Through the operation of the air and water supply button 18,
a surgeon can cause the nozzle 24c of the distal end 15 to
selectively squirt gas and liquid. Further, through the operation
of the suction operation button 19, the surgeon can selectively
generate suction force in the channel opening 15A of the distal end
15 through the treatment instrument insertion channel 26 to thereby
remove mucus and so forth present in the body cavity.
[0075] Although not illustrated, the operation portion 11 includes
therein an elevator base actuating mechanism (not illustrated) for
operating an elevator wire 30 connected to a treatment instrument
elevator base 23. The elevator base actuating mechanism (not
illustrated) is provided with a not-illustrated connection member,
such as a link member. Via the connection member, such as a link
member, the proximal end of the elevator wire 30 is connected to an
elevating operation knob 16 provided to the operation portion
11.
[0076] Accordingly, as the surgeon operates the elevating operation
knob 16 of the operation portion 11, the elevator wire 30 is
operated and pulled via the above-described connection member, such
as a link member, which forms the elevator base actuating
mechanism. Thus, the treatment instrument elevator base 23 is
operated and elevated about an elevator base rotation fulcrum 28.
Thereby, a guide catheter and a guide wire 33, which are inserted
into the treatment instrument insertion channel 26 and drawn out
from the channel opening 15A, are elevated as the treatment
instrument elevator base 23 is elevated.
[0077] A configuration of the distal end 15 of the insertion
portion 10 will now be described with reference to FIG. 2.
[0078] As illustrated in FIG. 2, the distal end 15 is configured to
include, for example, the rigid distal end portion 24 formed of
metal, such as stainless steel, and forming the distal end body,
and a distal end cover 25 formed of a nonconductive material, such
as a resin, and covering a periphery of the rigid distal end
portion 24.
[0079] The distal end cover 25 is fixed to the rigid distal end
portion 24 by adhesion or the like. The distal end cover 25 is
attached to the rigid distal end portion 24 to insulate the rigid
distal end portion 24 and to ensure the airtight state, for
example. The distal end cover 25 may be a disposable cover
configured to be attachable and detachable with respect to the
rigid distal end portion 24.
[0080] Further, the rigid distal end portion 24 is formed with an
introduction guide path 27 for guiding the introduction of a
treatment instrument or the like toward the distal end. The
introduction guide path 27 is formed to communicate with the
treatment instrument insertion channel (an insertion hole) 26,
which serves as a treatment instrument insertion guide path
provided in the insertion portion 10 of the endoscope 1.
[0081] The distal end side of the introduction guide path 27 is
provided with a storage space 22 which is an open space formed by
the rigid distal end portion 24 and the distal end cover 25. An
opening of the storage space 22 forms the channel opening 15A which
forms a distal end opening of the treatment instrument insertion
channel 26.
[0082] Inside the storage space 22, the treatment instrument
elevator base 23 is provided for elevating the treatment
instruments, such as the guide wire 33 and a guide catheter, which
are introduced through the treatment instrument insertion channel
26, to a desired position. The treatment instrument elevator base
23 is rotatably and axially supported at an end thereof by the
elevator base rotation fulcrum 28 provided to the rigid distal end
portion 24.
[0083] The elevator base rotation fulcrum 28 is disposed below a
distal end opening of the introduction guide path 27. The treatment
instrument elevator base 23 is installed to be able to perform an
elevating movement by rotating about the elevator base rotation
fulcrum 28 in the storage space 22 from a standby position
indicated by the solid line in FIG. 2 to a treatment instrument
elevated position indicated by the virtual line in the figure.
[0084] Further, the treatment instrument elevator base 23 is fixed
with the distal end of the elevator wire 30. The elevator wire 30
is led to the operation portion 11 through a guide pipe 31 and a
guide tube 32, which are inserted through the insertion portion 10,
and is connected to the not-illustrated elevator base actuating
mechanism described above. Furthermore, the treatment instrument
elevator base 23 is configured to be operated and elevated about
the elevator base rotation fulcrum 28 in accordance with the
pulling operation of the elevator wire 30.
[0085] The endoscope 1 of the present embodiment is improved to be
able to position the treatment instrument, such as the guide wire
33, by fixing the treatment instrument to an appropriate position
on the treatment instrument elevator base 23, even if the treatment
instrument is applied with external force.
[0086] The above-described configuration will now be specifically
described with reference to FIGS. 2 to 7.
[0087] FIG. 4 is a perspective view illustrating a configuration of
the treatment instrument elevator base provided in the distal end.
FIG. 5 is a perspective view illustrating a configuration of a
contact portion provided in the distal end. FIG. 6 is a perspective
view illustrating a state in which the guide wire is fixed, being
sandwiched by the treatment instrument elevator base in the
elevating movement and the contact portion. FIG. 7 is a plan view
illustrating a specific configuration of a holding fixture portion
of the contact portion illustrated in FIG. 5.
[0088] As illustrated in FIGS. 2 and 3, the treatment instrument
elevator base 23 is formed with a contact surface 23a which comes
in contact with the treatment instrument, such as the guide wire 33
and the guide catheter. The contact surface 23a is formed by, for
example, a tilted surface tilted with respect to the introduction
axis of the introduction guide path 27.
[0089] An upper part of the contact surface 23a is formed with a
first leading portion 23b for guiding and leading the treatment
instrument, such as the guide wire 33, in accordance with the
rotating movement (the elevating movement) of the treatment
instrument elevator base 23, while being in contact with the
treatment instrument.
[0090] The first leading portion 23b forms a part of the treatment
instrument holding mechanism. Specifically, as illustrated in FIG.
4, the first leading portion 23b is formed such that an edge
portion of the contact surface 23a of the treatment instrument
elevator base 23 extending from the upper part of the contact
surface 23a toward the objective lens 24b, for example, forms a
tilted surface or a curved surface.
[0091] The degree of tilt of the first leading portion 23b or the
degree of curvature (the degree R) of the curved surface is not
particularly limited, as long as the degree of tilt or the degree
of curvature allows the first leading portion 23b to smoothly lead
the guide wire 33 in contact with the first leading portion 23b to
a later-described holding portion 23c which forms the holding
fixture portion of the treatment instrument elevator base 23.
[0092] Further, the first leading portion 23b of the treatment
instrument elevator base 23 is provided with the holding portion
23c which is at least consecutive to the first leading portion 23b
to sandwich and fix the guide wire 33. The holding portion 23c is
formed as a part of the first leading portion 23b.
[0093] As illustrated in FIG. 4, the holding portion 23c is formed
as a grasping surface having a predetermined size required to
sandwich and hold the guide wire 33, which has a diameter not
exceeding a predetermined value and is led by the first leading
portion 23b, together with a later-described contact portion
34.
[0094] The guide wire 33 having a diameter not exceeding a
predetermined value corresponds to the guide wire 33 used in a
normal treatment and having a diameter in the range of from
approximately 0.02 inches to approximately 0.04 inches, for
example. However, the guide wire 33 is not limited to the guide
wire 33 having the above-described diameter.
[0095] To increase the holding force for holding the guide wire 33,
the grasping surface of the holding portion 23c may be formed into
a circular arc shape to fit the circular arc shape of the guide
wire 33 or into a substantially V-shaped groove, for example.
Further, the grasping surface may be formed to have a large contact
area with the guide wire 33. That is, the holding portion 23c is
formed to have high holding force for holding the guide wire 33,
irrespective of the shape of the grasping surface.
[0096] The rigid distal end portion 24, in which the treatment
instrument elevator base 23 of the above configuration is rotatably
attached, is provided with the contact portion 34 projecting toward
the inside of the storage space 22 to form a part of the treatment
instrument holding mechanism, as illustrated in FIGS. 2 and 3.
[0097] The contact portion 34 is formed by an insulating material,
for example. As illustrated in FIGS. 3 and 5, a lower part of the
contact portion 34 on the side of the objective lens 24b, for
example, is formed with a holding fixture portion 34a which comes
in contact with and fixes the guide wire 33 stored in the holding
portion 23c of the treatment instrument elevator base 23.
[0098] The holding fixture portion 34a is formed to be located at a
position opposite to the holding portion 23c of the treatment
instrument elevator base 23 and to project toward the holding
portion 23c when the treatment instrument elevator base 23 is
elevated.
[0099] FIG. 7 illustrates a cross section in the horizontal
direction of the holding fixture portion 34a of the contact portion
34. As illustrated in FIG. 7, the holding fixture portion 34a
includes an effective holding portion 34a1 having a width required
to reliably come in contact with and fix the above-described guide
wire 33 having a diameter not exceeding a predetermined value
(specifically, the small-diameter guide wire 33 having a diameter
of approximately 0.02 inches, for example).
[0100] In the above case, it is desirable to set a width L of the
holding fixture portion 34a to be less than a radius G (see FIG.
14) of a large-diameter treatment instrument 33A including the
above-described treatment instrument such as a catheter. It is also
desirable to set a width O of the effective holding portion 34a1 of
the holding fixture portion 34a to be substantially the same as or
at least equal to or greater than the diameter of the
small-diameter guide wire 33.
[0101] Further, a corner portion 40a extending from the effective
holding portion 34a1 to a later-described second leading portion
34b is formed into a circular arc shape, for example (see FIG. 7),
to easily lead the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter, rather than
the guide wire 33, to the later-described second leading portion
34b.
[0102] The shape of the corner portion 40a is not limited to the
circular arc shape, and may be a tapered shape, for example. That
is, the corner portion 40a can take any shape, as long as the shape
allows the corner portion 40a to smoothly lead the large-diameter
treatment instrument 33A including the treatment instrument such as
a catheter to the second leading portion 34b.
[0103] The upper part of the contact portion 34 is formed with the
second leading portion 34b for guiding and leading the
large-diameter treatment instrument 33A including the treatment
instrument such as a catheter, which is larger in size than the
grasping surface of the holding portion 23c, in a direction away
from the holding fixture portion 34a (a direction away from the
objective lens 24b) in accordance with the rotating movement (the
elevating movement) of the treatment instrument elevator base
23.
[0104] The large-diameter treatment instrument 33A including the
treatment instrument such as a catheter, which is larger in size
than the grasping surface of the holding portion 23c, is the
treatment instrument having a diameter equal to or greater than
approximately 0.04 inches, for example.
[0105] The second leading portion 34b forms a part of the treatment
instrument holding mechanism. Specifically, as illustrated in FIGS.
5 and 7, the second leading portion 34b is formed such that an edge
portion extending from the corner portion 40a of the holding
fixture portion 34a in a direction opposite to the objective lens
24b forms a tilted surface or a curved surface.
[0106] The degree of tilt of the second leading portion 34b or the
degree of curvature (the degree R) of the curved surface is not
particularly limited, as long as the degree of tilt or the degree
of curvature allows the second leading portion 34b to smoothly lead
the large-diameter treatment instrument 33A including the treatment
instrument such as a catheter, which is in contact with the second
leading portion 34b, to a later-described holding fixture portion
34d.
[0107] Further, a portion of the second leading portion 34b apart
from the holding fixture portion 34a by a predetermined distance is
formed with the holding fixture portion 34d which holds and fixes
the large-diameter treatment instrument 33A including the treatment
instrument such as a catheter by sandwiching the large-diameter
treatment instrument 33A together with the contact surface 23a of
the treatment instrument elevator base 23. The holding fixture
portion 34d is provided at a position opposite to the holding
fixture portion 34a with respect to the second leading portion
34b.
[0108] Similarly to the holding portion 23c of the treatment
instrument elevator base 23, the grasping surface of the holding
fixture portion 34d may be formed into a circular arc shape to fit
the circular arc shape of the large-diameter treatment instrument
33A including the treatment instrument such as a catheter or into a
substantially V-shaped groove, for example. Further, the grasping
surface may be formed to have a large contact area with the
large-diameter treatment instrument 33A including the treatment
instrument such as a catheter.
[0109] The present embodiment described above is configured such
that the holding fixture portion 34d is provided on the second
leading portion 34b of the contact portion 34. However, the
configuration is not limited to the above. Thus, the embodiment may
be configured such that the holding fixture portion 34d is not
provided, and that a part of the second leading portion 34b and the
contact surface 23a of the treatment instrument elevator base 23
hold and fix the large-diameter treatment instrument 33A including
the treatment instrument such as a catheter.
[0110] The proximal end of the second leading portion 34b of the
contact portion 34 is formed with a release groove 34c, in which an
edge portion of the contact surface 23a of the treatment instrument
elevator base 23 is inserted and released in the direction of the
contact portion 34. Accordingly, the treatment instrument elevator
base 23 and the contact portion 34 can sandwich the guide wire 33
or the large-diameter treatment instrument 33A including the
treatment instrument such as a catheter, while obtaining
predetermined holding force, and thus can hold and fix the guide
wire 33 or the large-diameter treatment instrument 33A.
[0111] FIG. 6 illustrates the state in which the treatment
instrument elevator base 23 forming the treatment instrument
holding mechanism and the contact portion 34 provided to the rigid
distal end portion 24 hold and fix the small-diameter guide wire 33
while sandwiching the guide wire 33. That is, the guide wire 33 is
positioned and firmly grasped and fixed by the grasping surface
formed by the holding portion 23c of the treatment instrument
elevator base 23 and the holding fixture portion 34a of the contact
portion 34.
[0112] Further, when the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter is employed,
the large-diameter treatment instrument 33A including the treatment
instrument such as a catheter is guided by the second leading
portion 34b via the holding fixture portion 34a of the contact
portion 34, and thereafter is positioned by the holding fixture
portion 34d provided on the second leading portion 34b and by the
contact surface 23a of the treatment instrument elevator base
23.
[0113] The operation of the endoscope 1 of the present embodiment
will now be described with reference to FIGS. 8 to 14.
[0114] FIGS. 8 to 14 are perspective views and cross-sectional
views and the like for explaining the operation of the first
embodiment, illustrating the exterior of the distal end in
accordance with respective steps. FIG. 8 illustrates a state prior
to the elevating movement of the treatment instrument elevator
base, in which the guide wire is inserted in the distal end body.
FIG. 9 illustrates a state in which the treatment instrument
elevator base is elevated from the state illustrated in FIG. 8 and
the guide wire is led toward a fixing position by the first leading
portion of the treatment instrument elevator base. FIG. 10
illustrates a state in which the guide wire is further moved from
the state illustrated in FIG. 9 to the fixing position through the
elevating movement of the treatment instrument elevator base and is
fixed to the position. FIG. 11 illustrates a state in which the
large-diameter treatment instrument including the treatment
instrument such as a catheter is led to a maximum elevated position
by the second leading portion of the contact portion through the
elevating movement of the treatment instrument elevator base.
Further, FIG. 12 is a cross-sectional view in the direction of the
insertion axis of the distal end illustrated in FIG. 10 in a state
in which the guide wire is grasped, being sandwiched by the holding
portion of the treatment instrument elevator base and the end
portion of the holding fixture portion of the contact portion. FIG.
13 is a cross-sectional view in the direction of the insertion axis
of the distal end illustrated in FIG. 10 in a state in which the
guide wire is grasped, being sandwiched by the holding portion of
the treatment instrument elevator base and a surface of the holding
fixture portion of the contact portion. FIG. 14 is an operational
view for explaining the operation proceeding from the state
illustrated in FIG. 8 to the state illustrated in FIG. 10 and to
the state illustrated in FIG. 11. The following description will be
made on the assumption that the directions of the arrows A, B, C,
and D shown in FIGS. 9 to 11 correspond to the directions of the
arrows A, B, C, and D shown in FIG. 14.
[0115] It is now assumed that the surgeon performs observation or
treatment of the pancreaticobiliary ducts by using the endoscope 1
of the first embodiment. In this case, the surgeon inserts a guide
catheter into the treatment instrument insertion channel 26 from
the insertion opening 21 of the operation portion 11 of the
endoscope 1.
[0116] Then, the surgeon causes the guide catheter to project
outside the channel opening 15A, and transpapillarily inserts the
guide catheter into a pancreatic duct or a bile duct (not
illustrated). Thereafter, the surgeon exchanges the currently used
guide catheter with a treatment instrument which is to be used
next.
[0117] In the above step, the surgeon first inserts the guide wire
33 from a cap provided on the proximal end side of the guide
catheter. Then, the surgeon confirms under X-ray illumination that
the distal end of the guide wire 33 has been inserted inside the
pancreatic duct or the bile duct, and thereafter grasps by hand the
proximal end side of the guide wire 33.
[0118] In the above state, the surgeon subsequently performs an
operation of withdrawing the guide catheter. The surgeon confirms
from an observed image that the guide catheter has been withdrawn
from the papilla, and thereafter withdraws the guide catheter
further toward the proximal side.
[0119] Then, in the state in which the distal end of the guide
catheter is stored in the channel opening 15A, the surgeon operates
the elevating operation knob 16 of the operation portion 11. FIG. 8
illustrates the state prior to the operation of the elevating
operation knob 16 and thus prior to the elevation of the treatment
instrument elevator base 23. That is, as illustrated in FIG. 8, the
guide wire 33 projecting from the channel opening 15A is made in
contact with the contact surface 23a of the treatment instrument
elevator base 23 or a part of the treatment instrument elevator
base 23 by the reaction force of the guide wire 33 itself.
[0120] In the above state, the elevator wire 30 is operated and
pulled in accordance with the operation of the elevating operation
knob 16, and the treatment instrument elevator base 23 is rotated
about the elevator base rotation fulcrum 28 to be elevated as
indicated by the virtual line in FIG. 2 (or the solid line in FIG.
6).
[0121] FIG. 8 illustrates the state of the guide wire 33 brought
about in accordance with the initial elevating movement of the
treatment instrument elevator base 23. That is, as illustrated in
FIG. 8, when the elevating movement of the treatment instrument
elevator base 23 (the elevating movement in the direction of the
arrow A shown in FIG. 9) starts from the state illustrated in FIG.
8, the guide wire 33 is guided and led to the holding portion 23c
of the treatment instrument elevator base 23, while being in
contact with the first leading portion 23b via the contact surface
23a of the treatment instrument elevator base 23, with which the
guide wire 33 is in contact.
[0122] The operation of the above process will be described more in
detail. As illustrated in FIG. 14, when the elevating movement of
the treatment instrument elevator base 23 starts in the direction
of the arrow A shown in FIG. 14, the guide wire 33 is led in the
direction of the arrow B shown in FIG. 14, while being in contact
with the first leading a portion 23b. That is, the guide wire 33 is
led to the holding portion 23c of the treatment instrument elevator
base 23 by the first leading portion 23b.
[0123] Similarly, when the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter is employed,
the large-diameter treatment instrument 33A including the treatment
instrument such as a catheter is led to the holding portion 23c of
the treatment instrument elevator base 23, as illustrated in FIG.
14, via the contact surface 23a and the first leading portion 23b,
with which the large-diameter treatment instrument 33A is made in
contact by the reaction force thereof.
[0124] Further, due to the elevation of the treatment instrument
elevator base 23 in the direction of the arrow A shown in FIG. 9,
the guide wire 33 is led to the proximal end of the first leading
portion 23b of the treatment instrument elevator base 23 (in the
direction of the arrow C shown in FIG. 10) and made in contact with
the holding portion 23c of the treatment instrument elevator base
23, as illustrated in FIGS. 10 and 14. When the treatment
instrument elevator base 23 is further elevated, the guide wire 33
is moved in the direction of the arrow C shown in FIG. 14, while
being kept in contact with the holding portion 23c. Thereafter, the
guide wire 33 is made in contact with and pressed against the
holding fixture portion 34a provided to the contact portion 34 of
the rigid distal end portion 24 (see FIG. 14).
[0125] In the above process, the rigid guide wire 33 exerts the
reaction force to keep the linear shape thereof. Accordingly, the
guide wire 33 is pressed into the holding portion 23c by the
reaction force to be firmly locked therein. At the same time, in
the above state, the guide wire 33 is mechanically and firmly
fixed, being sandwiched by the holding portion 23c and the holding
fixture portion 34a of the contact portion 34, and being positioned
to the holding portion 23c, i.e., the predetermined fixing
position, through the contact of the holding fixture portion 34a
with the guide wire 33, as illustrated in FIGS. 10, 12, and 14.
FIGS. 10, 12, and 13 illustrate the state in which the guide wire
33 is firmly fixed to the predetermined position of the holding
portion 23c of the treatment instrument elevator base 23 by the
holding fixture portion 34a of the contact portion 34.
[0126] That is, in accordance with the elevation of the treatment
instrument elevator base 23, the guide wire 33 is grasped and fixed
by an end portion of the holding fixture portion 34a and the
holding portion 23c, as illustrated in FIG. 12. Then, the guide
wire 33 is grasped and fixed by the surface of the holding fixture
portion 34a and the holding portion 23c, as illustrated in FIG. 13.
The fixed state can be adjusted according to the amount of
operation of the not-illustrated operation portion. The fixed state
can be also adjusted according to the difference in the degree of
rigidity of the guide wire 33 itself.
[0127] Meanwhile, when the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter is employed,
the large-diameter treatment instrument 33A including the treatment
instrument such as a catheter is led by the first leading portion
23b of the treatment instrument elevator base 23 to the proximal
end of the first leading portion 23b (in the direction of the arrow
C shown in FIG. 14), as in the case of the guide wire 33. However,
a subsequent operation is different from the operation of the guide
wire 33.
[0128] That is, the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter is larger in
size than the grasping surface of the holding portion 23c (e.g.,
the width L, see FIGS. 7 and 14). Thus, due to the force applied in
accordance with the rotating movement (the elevating movement) of
the treatment instrument elevator base 23, the large-diameter
treatment instrument 33A is lead to the second leading portion 34b
of the contact portion 34 (in the direction of the arrow D shown in
FIGS. 11 and 14) via the effective holding portion 34a1 (see FIG.
7) of the holding fixture portion 34a and the corner portion 40a.
That is, the large-diameter treatment instrument 33A including the
treatment instrument such as a catheter is not locked by the
holding fixture portion 34a of the contact portion 34.
[0129] Thereafter, in accordance with the elevation of the
treatment instrument elevator base 23, the large-diameter treatment
instrument 33A including the treatment instrument such as a
catheter is guided and led by the second leading portion 34b of the
contact portion 34 in the direction away from the holding fixture
portion 34a (the direction away from the objective lens 24b and
indicated by the arrow D shown in FIGS. 11 and 14), while being
pressed by the contact surface 23a.
[0130] Thereafter, as the treatment instrument elevator base 23 is
further elevated, the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter is led to a
part of the second leading portion 34b or the holding fixture
portion 34d provided to the second leading portion 34b, and is made
in contact with and pressed against the second leading portion 34b
or the holding fixture portion 34d provided to the second leading
portion 34b (see FIG. 14).
[0131] Then, the surgeon confirms that the guide wire 33 has been
fixed, and thereafter completely withdraws the guide catheter to
the outside of the treatment instrument insertion channel 26 from
the side of the operation portion 11 of the endoscope 1.
Thereafter, the surgeon inserts the treatment instrument which is
to be used next from the proximal end side of the guide wire
33.
[0132] In the above step, the surgeon inserts the treatment
instrument into the treatment instrument insertion channel 26,
while using the guide wire 33 as a guide. Then, when the distal end
of the treatment instrument comes in contact with the treatment
instrument elevator base 23, the surgeon operates the elevating
operation knob 16 to lay down the treatment instrument elevator
base 23. Accordingly, when the treatment instrument passes the
treatment instrument elevator base 23, the guide wire 33 is pushed
out of the holding portion 23c by the pressing force of the
treatment instrument and is released from the fixed state. Then,
the surgeon further inserts the treatment instrument into the
pancreatic duct or the bile duct.
[0133] According to the first embodiment, therefore, the guide wire
33, which is a treatment instrument, is mechanically fixed, being
sandwiched by the holding portion 23c of the treatment instrument
elevator base 23 and the holding fixture portion 34a of the contact
portion 34. Therefore, the endoscope 1 of the present embodiment
can firmly fix and hold the guide wire 33 to an appropriate
position in the holding portion 23c of the treatment instrument
elevator base 23, even if the guide wire 33 is applied with
external force due to the movement of the insertion portion 10, for
example.
[0134] Further, the endoscope 1 of the present embodiment includes
the first leading portion 23b of the treatment instrument elevator
base 23 and the second leading portion 34b of the contact portion
34. Thus, when the large-diameter treatment instrument 33A
including the treatment instrument such as a catheter is employed,
the large-diameter treatment instrument 33A including the treatment
instrument such as a catheter can be smoothly led to the
predetermined maximum elevated position by the second leading
portion 34b simply by elevating the treatment instrument elevator
base 23. Accordingly, the endoscope 1 of the present embodiment can
prevent the treatment instrument from being kinked.
[0135] Furthermore, in the endoscope 1 of the present embodiment,
the grasping surface formed by the holding portion 23c of the
treatment instrument elevator base 23 and the holding fixture
portion 34a of the contact portion 34 is formed into a circular
shape or a groove shape. Therefore, the endoscope 1 of the present
embodiment can stably and firmly lock the guide wire 33 in the
holding portion 23c, even if the outer diameter of the guide wire
33 is slightly changed.
[0136] In the first embodiment, the first leading portion 23b and
the holding portion 23c of the treatment instrument elevator base
23 and the holding fixture portion 34a and the second leading
portion 34b of the contact portion 34 are disposed such that the
guide wire 33 is fixed to the side in the vicinity of the objective
lens 24b. However, the disposition is not limited to the above.
[0137] That is, according to the disposition of the present
embodiment, the fixed state of the guide wire 33 fixed and held in
the distal end 15, for example, can be reliably confirmed from an
endoscopic image. Conversely to the first embodiment, if the first
leading portion 23b and the holding portion 23c of the treatment
instrument elevator base 23 and the holding fixture portion 34a and
the second leading portion 34b of the contact portion 34 are
disposed such that the guide wire 33 is fixed to the side opposite
to the objective lens 24b, the range of visual field covering the
fixed guide wire 33 can be expanded. Therefore, the endoscope 1 of
the present embodiment can have the effect of improving the
operability.
Second Embodiment
[0138] A second embodiment of the endoscope of the present
invention will now be described with reference to FIG. 15.
[0139] FIG. 15 relates to the second embodiment of the endoscope of
the present invention, and is a partially exploded perspective view
illustrating a state in which a drive arm of the distal end of the
endoscope is rotated. The components of FIG. 15 similar to the
components of the first embodiment will be denoted by the same
reference numerals, and the description thereof will be omitted.
Description will be made only of components different from the
components of the first embodiment.
[0140] As illustrated in FIG. 15, the rigid distal end portion 24
of the endoscope 1 of the second embodiment is provided with a
drive arm 42 for operating and rotating the treatment instrument
elevator base 23. The drive arm 42 is disposed in a concave portion
40, which is recessed from the outer circumference of the rigid
distal end portion 24 to have a circular arc (circular arc in the
direction of the axis line) cross-section, to be rotated by remote
control. The surface of the concave portion 40 is covered by a
cover member 41.
[0141] The cover member 41 is for sealing the opening of the
concave portion 40 to prevent the drive arm 42 from failing to
operate due to waste fluid in the body. Further, the cover member
41 is detachably attached to the rigid distal end portion 24 by
means of adhesion with an adhesive agent of weak adhesive force or
application of a sealing agent and fixation with screws, for
example.
[0142] An operation wire 36 for rotating the drive arm 42 is
operated and moved back and forth by the elevating operation knob
16 of the operation portion 11. The operation wire 36 includes a
wire connection member 42a fixed to the distal end thereof and
rotatably attached in a wire communication hole 42b formed in the
vicinity of the distal end of the drive arm 42.
[0143] Although not illustrated, the proximal end side of the drive
arm 42 is integrally formed with a connecting shaft portion
extending perpendicularly to the drive arm 42. The connecting shaft
portion is axially and rotatably supported by the rigid distal end
portion 24. Further, an angular shaft portion formed to the distal
end of the connecting shaft portion is fit in a shaft hole of the
treatment instrument elevator base 23.
[0144] According to the above configuration, by connecting the
drive arm 42 via the connecting shaft portion (not illustrated)
when the operation wire 36 is operated and moved back and forth,
the treatment instrument elevator base 23 rotated about the
rotation axis (the elevator base rotation fulcrum) 28 (see FIG. 2)
together with the drive arm 42.
[0145] The drive arm 42 is provided with a first chamfer 42c and a
second chamfer 42c for preventing the contact between the drive arm
42 and the concave portion 40 due to the variation in processing
tolerance of the drive arm 42 or the concave portion 40, for
example.
[0146] In the present embodiment, the proximal side of the concave
portion 40 of the rigid distal end portion 24 is provided with a
first controlling portion 43 for controlling the rotation of the
drive arm 42 in the direction of the operation portion 11, and the
distal end side of the concave portion 40 is provided with a second
controlling portion 44 for controlling the rotation of the drive
arm 42 in the direction of insertion.
[0147] Each of the first controlling portion 43 and the second
controlling portion 44 is formed by a portion of a certain
thickness forming the concave portion 40 and having a contact
surface projecting in the direction of the drive arm 42 by a
predetermined length. That is, as the drive arm 42 is made in
contact with the first controlling portion 43 and the second
controlling portion 44, the rotated drive arm 42 can be controlled
in terms of the range of rotation.
[0148] The present embodiment further includes a third controlling
portion 25a or 25b which controls the rotating movement of the
treatment instrument elevator base 23, as the means for preventing
a reduction in resistance of the drive arm 42.
[0149] The third controlling portion 25a or 25b is provided at a
predetermined position inside the distal end cover 25, as
illustrated in FIG. 2 or 15, for example. That is, the third
controlling portion 25a or 25b is formed to have a contact surface
projecting inward by a predetermined length. In other words, as the
treatment instrument elevator base 23 is made in contact with the
third controlling portion 25a or 25b, the range of rotation of the
treatment instrument elevator base 23 is controlled. As a result,
the range of rotation of the drive arm 42 connected to the
treatment instrument elevator base 23 can be also controlled.
[0150] Other configurations and operations of the present
embodiment are similar to the configurations and operations of the
first embodiment.
[0151] Therefore, according to the present embodiment, in addition
to the effects of the first embodiment, the movable range of the
drive arm 42 can be controlled. Accordingly, the present embodiment
can provide the effect of improving the resistance of the drive arm
42.
[0152] The second embodiment described above is configured such
that the first to third controlling portions 43, 44, and 25a (25b)
are provided. However, similar effects to the effects of the above
configuration can be obtained by providing at least one of the
controlling portions, instead of providing all of the controlling
portions. Further, the first to third controlling portions 43, 44,
and 25a (25b) are not limited to the portions of a certain
thickness forming the concave portion 40 and the projecting portion
projecting from the bottom surface of the distal end cover 25,
respectively. Thus, a pin may be used, for example, to control the
movable range of the drive arm 42 or the treatment instrument
elevator base 23.
Third Embodiment
[0153] A third embodiment of the endoscope of the present invention
will now be described with reference to FIGS. 16 to 33.
[0154] FIGS. 16 to 33 relate to the third embodiment of the
endoscope of the present invention. FIG. 16 is a perspective view
illustrating an external configuration of the distal end of the
endoscope in a laid state of a treatment instrument elevator base.
FIG. 17 is a perspective view of the distal end of the endoscope
illustrated in FIG. 16, as viewed from the front side. FIG. 18 is a
perspective view illustrating the external configuration of the
distal end in an elevated state of the treatment instrument
elevator base. FIG. 19 is a perspective view illustrating the
exterior of the treatment instrument elevator base. FIG. 20 is a
front view of the treatment instrument elevator base illustrated in
FIG. 19. FIG. 21 is an exploded perspective view illustrating the
treatment instrument elevator base and the drive arm to be attached
to the treatment instrument elevator base. FIG. 22 is a perspective
view illustrating the treatment instrument elevator base attached
with the drive arm. FIG. 23 is a partial cross-sectional view
illustrating an attached state of a rotation shaft of the drive arm
to the treatment instrument elevator base. FIG. 24 is a perspective
view illustrating the distal end of the endoscope, in which the
drive arm is shown. FIG. 25 is a partial cross-sectional view of a
modified example, illustrating an attached state of the rotation
shaft of the drive arm to the treatment instrument elevator base.
FIG. 26 is a cross-sectional view of a conventional example,
illustrating a protection tube and a coil tube, through which an
operation wire is inserted. FIG. 27 is a cross-sectional view of
the protection tube and the coil tube, through which the operation
wire is inserted, in a state in which the coil tube illustrated in
FIG. 26 is damaged. FIG. 28 is a cross-sectional view of the
present embodiment, illustrating the protection tube and the coil
tube, through which the operation wire is inserted. FIG. 29 is a
cross-sectional view of the protection tube and the coil tube,
through which the operation wire is inserted, in a state in which
the coil tube illustrated in FIG. 28 is damaged. FIG. 30 is a
perspective view illustrating an insulating block. FIG. 31 is a
perspective view illustrating the insulating block, as viewed in a
different direction from the direction of FIG. 30. FIG. 32 is a
front view of the distal end, illustrating a state in which the
treatment instrument elevator base and the insulating block are
attached to the rigid distal end portion. FIG. 33 is a top view of
the distal end, illustrating the state in which the treatment
instrument elevator base and the insulating block are attached to
the rigid distal end portion.
[0155] In the following description, the components similar to the
components of the first and second embodiments will be denoted by
the same reference numerals, and the description thereof will be
omitted. The description will be made only of components different
from the components of the first and second embodiments.
[0156] As illustrated in FIGS. 16 and 17, the distal end 15 of the
endoscope 1 of the present embodiment is provided with a treatment
instrument elevator base 51 and an insulating block 61 which forms
a contact portion. Similarly to the first embodiment, the treatment
instrument elevator base 51 in the laid state is stored in the
storage space 22. The treatment instrument elevator base 51 is
rotated toward the insulating block 61 to be elevated, as
illustrated in FIG. 18. Then, similarly to the first embodiment,
the treatment instrument elevator base 51 in the elevated state
sandwiches and fixes the above-described guide wire 33 or the
treatment instrument such as a catheter and a high-frequency
cautery instrument of a papillotomy knife, for example, together
with the insulating block 61.
[0157] Similarly to the first embodiment, a surface of the
treatment instrument elevator base 51 of the present embodiment is
formed with a contact surface 51a which comes in contact with the
guide wire 33 or the treatment instrument of a different type, as
illustrated in FIGS. 19 and 20. The contact surface 51a is similar
in configuration to the contact surface 23a of the first embodiment
(see FIG. 4).
[0158] An upper part of the contact surface 51a is formed with a
treatment instrument holding portion (hereinafter referred to as
the guide wire holding portion) 51b which includes a leading
surface 51d functioning as a first leading portion for guiding and
leading the small-diameter guide wire 33 in accordance with the
rotating movement (the elevating movement) of the treatment
instrument elevator base 51 while being in contact with the guide
wire 33. The guide wire holding portion 51b of the present
embodiment forms a part of a treatment instrument holding
mechanism, and is similar in configuration to the first leading
portion 23b of the first embodiment.
[0159] The degree of tilt of the guide wire holding portion 51b or
the degree of curvature (the degree R) of the curved surface is
also not particularly limited, as long as the degree of tilt or the
degree of curvature allows the guide wire holding portion 51b to
smoothly lead and hold the small-diameter guide wire 33, with which
the guide wire holding portion 51b is in contact, to a
later-described guide wire fixing portion 51c.
[0160] The treatment instrument elevator base 51 of the present
embodiment further includes a wall portion 52 which projects upward
from a side portion, i.e., a right side portion in the drawing of
FIG. 20, of the guide wire holding portion 51b formed on the
surface on which the contact surface 51a is formed. The wall
portion 52 forms a side surface of the guide wire holding portion
51b, and extends in the direction of the proximal end, i.e., in the
direction of the later-described guide wire fixing portion 51c
which forms a holding fixture portion of the treatment instrument
elevator base 51.
[0161] As illustrated in FIG. 20, when the treatment instrument
elevator base 51 is viewed from the front side, the wall portion 52
is disposed above and apart from the guide wire holding portion 51b
by a predetermined distance to hang over the guide wire holding
portion 51b and to form a substantial U-shape connected to the
curved surface of the guide wire holding portion 51b for leading
and holding the guide wire 33, for example. On the guide wire
holding portion 51b, therefore, the wall portion 52 latches and
holds the guide wire 33 led by the guide wire holding portion
Sib.
[0162] On the above-described surface of the treatment instrument
elevator base 51 extending from the guide wire holding portion 51b
in the direction of the proximal end, the guide wire fixing portion
51c is provided consecutively to the guide wire holding portion 51b
to form the holding fixture portion for sandwiching and fixing the
small-diameter guide wire 33. The guide wire fixing portion 51c is
formed as a part of the guide wire holding portion 51b, and is
similar in configuration to the holding portion 23c of the first
embodiment.
[0163] As illustrated in FIG. 19, the guide wire fixing portion 51c
is formed as a grasping surface having a predetermined size
required to sandwich and hold the small-diameter guide wire 33,
which has a diameter not exceeding a predetermined value and is led
and held by the guide wire holding portion 51b, together with the
later-described insulating block 61.
[0164] The small-diameter guide wire 33 having a diameter not
exceeding a predetermined value corresponds to the guide wire 33
used in a normal treatment and having a diameter in the range of
from approximately 0.02 inches to approximately 0.04 inches, for
example. However, the guide wire 33 is not limited to the guide
wire 33 having the above diameter.
[0165] Similarly to the first embodiment, to increase the holding
force for holding the treatment instrument such as the
small-diameter guide wire 33 sandwiched by the guide wire fixing
portion 51c, the grasping surface of the guide wire fixing portion
51c may also be formed into a circular arc shape or a substantially
V-shaped groove, for example. Further, the grasping surface of the
guide wire fixing portion 51c is formed to have a large contact
area with the treatment instrument or the like sandwiched by the
guide wire fixing portion 51c so as to increase the holding force
for holding the treatment instrument or the like, irrespective of
the shape of the grasping surface.
[0166] In the thus configured treatment instrument elevator base
51, as illustrated in FIG. 21, a rotation supporting portion 53
extending from a proximal portion of the treatment instrument
elevator base 51 in the direction of the proximal end is drilled
with a connection hole 54, in which an elevator base drive shaft 45
of the drive arm 42 is inserted. The connection hole 54 is formed
into a cubic shape having rectangular holes surfaces, and is set to
have substantially the same size as the size of the elevator base
drive shaft 45 of the drive arm 42. Further, the connection hole 54
is drilled with a screw hole 55 which extends from one of the sides
of the connection hole 54 in an approximate center toward the
corresponding side surface of the rotation supporting portion 53 in
the direction of a diagonal of the hole surfaces (at approximately
45 degrees with respect to the side forming the hole surfaces).
[0167] A fixing screw 56 is screwed into the screw hole 55 to fix
the elevator base drive shaft 45 in the connection hole 54 of the
rotation supporting portion 53. Thereby, as illustrated in FIG. 22,
the drive arm 42 is connected and fixed to the rotation supporting
portion 53 of the treatment instrument elevator base 51. The drive
arm 42 is provided with a flange portion 46 which comes in contact
with a surface of the rotation supporting portion 53, when the
elevator base drive shaft 45 is attached to the treatment
instrument elevator base 51, to control the position of the
elevator base drive shaft 45.
[0168] In the present embodiment, as illustrated in FIG. 23, the
fixing screw 56 abuts against the corner of one of the sides of the
elevator base drive shaft 45, i.e., the diagonally lower left
corner in the drawing in the present example, to fixedly hold the
elevator base drive shaft 45 in the connection hole 54 of the
rotation supporting portion 53. In the above state, two surfaces of
the elevator base drive shaft 45 forming the corner in the circular
broken line a shown in FIG. 23, i.e., the diagonally upper right
corner in the drawing in the present example, abut against two
surfaces of the rotation supporting portion 53 forming the
connection hole 54.
[0169] Therefore, the rotation supporting portion 53 of the
treatment instrument elevator base 51 and the elevator base drive
shaft 45 are reliably fixed to each other, and the rattling arising
from the attachment of the components can be prevented.
Accordingly, the fixing force for fixing the treatment instrument
elevator base 51 and the drive arm 42 can be ensured, and a stable
operation of adjusting the elevation angle of the treatment
instrument elevator base 51 can be constantly performed.
[0170] As illustrated in FIG. 24, similarly to the second
embodiment, the drive arm 42 is stored in the concave portion 40,
which is recessed from the outer circumference of the distal end 15
into the concave shape. As the operation wire 36 is pulled and
slacked, the drive arm 42 is rotated to bring the treatment
instrument elevator base 51 into the elevated state and the laid
state.
[0171] A contact surface of the fixing screw 56, which comes in
contact with the elevator base drive shaft 45, may be formed into a
tilted surface so that the fastened fixing screw 56 causes the
above-described two surfaces of the elevator base drive shaft 45
forming the above-described corner to reliably abut against the
above-described two surfaces forming the connection hole 54.
[0172] Further, as illustrated in FIG. 25, the elevator base drive
shaft 45 may include a contact surface 45a, which is a planarized
portion of the elevator base drive shaft 45 to be in contact with
the fixing screw 56. The above configuration ensures the contact
between the fixing screw 56 and the elevator base drive shaft 45,
and the fixing force for fixing the treatment instrument elevator
base 51 and the drive arm 42 can be further ensured. Further, since
the direction of attaching the elevator base drive shaft 45 in the
connection hole 54 is regulated in the attachment process, the
drive arm 42 can be prevented from being inappropriately attached
to the treatment instrument elevator base 51.
[0173] Meanwhile, the operation wire 36, which is pulled and
slacked to bring the treatment instrument elevator base 51 into the
elevated state and the laid state via the drive arm 42, is covered
by a two-layer protection tube formed by a coil tube and a
Teflon.RTM. tube from inside of the insertion portion 10 to the
operation portion 11 of the endoscope 1. The Teflon.RTM. tube
covers the operation wire 36 as the outermost cladding member to
prevent, in the event of damage to the coil tube for some reason, a
bending portion rubber forming the cladding of the bending portion
14, for example, from being damaged from a damaged section of the
coil tube.
[0174] As illustrated in FIG. 26, according to a conventional
structure, a protection tube 37 forming the Teflon.RTM. tube and a
coil tube 38 formed of metal are not in close contact with each
other, and thus a gap S is formed. Therefore, if the coil tube 38
is damaged (e.g., cut) for some reason, the damaged section of a
damaged part B as illustrated in FIG. 27 may damage the inner
surface of the protection tube 37, while moving back and forth or
vertically vibrating with respect to the protection tube 37 through
the bending operation of the bending portion 14. Further, the
damaged part B may eventually break through the protection tube 37
and damage the bending portion rubber of the bending portion
14.
[0175] As illustrated in FIG. 28, the present embodiment is
structured such that the protection tube 37 and the coil tube 38
are made in close contact with each other. The protection tube 37
is a heat shrinkable tube, and is made in close contact with the
outer circumference of the coil tube 38 by heat treatment.
[0176] With the above configuration, if the coil tube 38 is damaged
(e.g., cut) for some reason, as illustrated in FIG. 29, the
protection tube 37 is constantly in close contact with the outer
circumference of the coil tube 38 even during the bending operation
of the bending portion 14, and thus free movement of the coil tube
38 is prevented. Therefore, the inner surface of the protection
tube 37 is prevented from being damaged by the damaged section of
the damaged part B.
[0177] As a result, the damaged part B of the coil tube 38 is
prevented from breaking through the protection tube 37 and damaging
the bending portion rubber of the bending portion 14.
[0178] The insulating block 61 of the present embodiment will now
be described with reference to FIGS. 30 and 31.
[0179] The insulating block 61 of the present embodiment
corresponds to the contact portion 34 of the first embodiment, and
includes a guide wire holding fixture portion 61a which fixes the
small-diameter guide wire 33, a guide wire leading portion 61b
which is a curved and tilted surface for leading the small-diameter
guide wire 33 to the guide wire holding fixture portion 61a, a
release groove 61c in which an edge portion of the contact surface
51a of the treatment instrument elevator base 51 is inserted, and a
wall portion release groove 61d in which the wall portion 52 of the
treatment instrument elevator base 51 is inserted.
[0180] The guide wire holding fixture portion 61a is a contact
surface, with which the small-diameter guide wire 33 comes in
contact, and which is formed by chamfering a corner on the side of
the wall portion release groove 61d into a curved surface. Further,
the guide wire leading portion 61b is formed by further chamfering
the corner on the side of the wall portion release groove 61d from
the lower side of the corner into a more curved surface than the
guide wire holding fixture portion 61a.
[0181] The reference numeral 62 denotes a holding fixture portion
for the large-diameter treatment instrument, which is the same in
configuration, operation, and effect as the holding fixture portion
of the first embodiment. Thus, detailed description of the holding
fixture portion 62 will be omitted.
[0182] The thus configured treatment instrument elevator base 51
and insulating block 61 of the present embodiment are attached to
the rigid distal end portion 24 of the distal end 15 in a similar
manner to the first embodiment, as illustrated in FIGS. 32 and
33.
[0183] In the attached state, the guide wire fixing portion 51c of
the treatment instrument elevator base 51 and the guide wire
holding fixture portion 61a of the insulating block 61 are disposed
on substantially the same straight line. Specifically, the
alternate long and short dashed lines L1 and L2 shown in FIGS. 32
and 33 indicate the plane passed by the locus defined by the
movement of the guide wire fixing portion 51c when the treatment
instrument elevator base 51 is elevated in accordance with the
rotation thereof.
[0184] The guide wire fixing portion 51c of the treatment
instrument elevator base 51 and the guide wire holding fixture
portion 61a of the insulating block 61 are located in the plane
including both of the alternate long and short dashed lines L1 and
L2. That is, the guide wire holding fixture portion 61a of the
insulating block 61 is located in the plane including the locus
plane defined by the movement of the guide wire fixing portion 51c
of the treatment instrument elevator base 51.
[0185] Accordingly, in accordance with the elevating movement of
the treatment instrument elevator base 51, the small-diameter guide
wire 33 held by the guide wire fixing portion 51c of the treatment
instrument elevator base 51 is moved within the plane to be
effectively led to the guide wire holding fixture portion 61a of
the insulating block 61, and is reliably sandwiched and fixed by
the treatment instrument elevator base 51 and the insulating block
61.
[0186] The operation of the endoscope 1 of the present embodiment
will now be described with reference to FIGS. 34 to 45.
[0187] FIGS. 34 to 42 are perspective views for explaining the
operation of the third embodiment, and illustrate the treatment
instrument elevator base, the insulating block, and the
small-diameter guide wire in accordance with respective steps. FIG.
34 is a diagram illustrating a state prior to the elevating
movement of the treatment instrument elevator base, in which the
guide wire is inserted in the distal end body. FIG. 35 is a diagram
illustrating the state prior to the elevating movement of the
treatment instrument elevator base, as viewed in a different angle
from the angle of FIG. 34. FIG. 36 is a diagram illustrating an
initial state in which the guide wire is led by the leading surface
of the treatment instrument elevator base toward the treatment
instrument holding portion. FIG. 37 is a diagram illustrating a
state in which the treatment instrument elevator base is further
elevated and the guide wire is led to the treatment instrument
holding portion. FIG. 38 is a diagram illustrating a state in which
the wall portion of the further elevated treatment instrument
elevator base is set in the wall portion release groove of the
insulating block. FIG. 39 is a diagram illustrating a state in
which the guide wire is sandwiched and fixed by the treatment
instrument elevator base and the insulating block. FIG. 40 is a
diagram illustrating a state in which the guide wire is led by the
guide wire leading portion of the insulating block. FIG. 41 is a
diagram illustrating the state in which the guide wire is
sandwiched and fixed by the treatment instrument elevator base and
the insulating block, as viewed in a different angle from the angle
of FIG. 39. FIG. 42 is a diagram illustrating only the treatment
instrument elevator base and the guide wire in the state in which
the guide wire is sandwiched and fixed by the treatment instrument
elevator base and the insulating block. FIG. 43 is a diagram
illustrating only the insulating block and the guide wire in the
state in which the guide wire is sandwiched and fixed by the
treatment instrument elevator base and the insulating block. FIG.
44 is a diagram for explaining the treatment instrument elevator
base in elevating the large-diameter treatment instrument. FIG. 45
is a front view of the treatment instrument elevator base
illustrated in FIG. 44.
[0188] It is assumed in the following description that a surgeon
performs observation or treatment of the pancreaticobiliary ducts
by using the endoscope 1 in a similar manner to the first
embodiment. The following description will be limited to the
operation in which the guide wire 33 is sandwiched by the treatment
instrument elevator base 51 and the insulating block 61 of the
present embodiment. Other operations of the present embodiment are
similar to the operations of the first embodiment.
[0189] In a similar manner to the first embodiment, the surgeon
transpapillarily inserts the guide catheter into a pancreatic duct
or a bile duct (not illustrated), and inserts the guide wire 33
from the cap provided on the proximal end side of the guide
catheter. Then, the surgeon confirms under X-ray illumination that
the distal end of the guide wire 33 has been inserted inside the
pancreatic duct or the bile duct, and grasps by hand the proximal
end side of the guide wire 33.
[0190] Subsequently, the surgeon performs the operation of
withdrawing the guide catheter. The surgeon confirms from an
observed image that the guide catheter has been withdrawn from the
papilla, and thereafter withdraws the guide catheter further toward
the proximal side. Then, the surgeon operates the elevating
operation knob 16 of the operation portion 11.
[0191] As the elevating operation knob 16 of the operation portion
11 is operated, the treatment instrument elevator base 51 in the
laid state, as illustrated in FIGS. 34 and 35, starts to be
elevated. Then, in accordance with the elevation of the treatment
instrument elevator base 51, the guide wire 33 comes in contact
with the leading surface 51d illustrated in FIG. 35 due to the
reaction force thereof, and is led toward the guide wire holding
portion 51b, as illustrated in FIG. 36.
[0192] As the treatment instrument elevator base 51 is further
elevated, the guide wire 33 is held by the guide wire holding
portion 51b, being latched by the wall portion 52 which forms a
side surface of the guide wire holding portion 51b. As illustrated
in FIG. 37, the treatment instrument elevator base 51 is rotated
toward the insulating block 61 and further elevated, while keeping
the guide wire 33 latched and held on the guide wire holding
portion 51b by the wall portion 52. In the above process, the guide
wire 33 exerts the reaction force to keep the linear shape thereof.
Thus, the guide wire 33 is pressed into the guide wire fixing
portion 51c of the treatment instrument elevator base 51 to be
firmly locked therein.
[0193] Then, in the further elevated treatment instrument elevator
base 51, the wall portion 52 is set in the wall portion release
groove 61d of the insulating block 61, as illustrated in FIGS. 38
and 39. In the above state, as illustrated in FIG. 40, while being
held by the guide wire holding portion 51b, the guide wire 33 comes
in contact with the leading surface which forms a surface of the
guide wire leading portion 61b of the insulating block 61, and is
guided and led to the guide wire holding fixture portion 61a (in
the direction of the arrow M shown in the figure).
[0194] Then, as illustrated in FIGS. 39 and 41 to 43, the guide
wire 33 is firmly sandwiched by the guide wire fixing portion 51c
of the treatment instrument elevator base 51 and the guide wire
holding fixture portion 61a of the insulating block 61.
[0195] Meanwhile, as illustrated in FIG. 44, the large-diameter
treatment instrument 33A including the treatment instrument such as
a catheter is led toward the guide wire fixing portion 51c by the
guide wire holding portion 51b of the contact surface 51a of the
treatment instrument elevator base 51. However, the large-diameter
treatment instrument 33A comes in contact with the wall portion 52,
and is prevented from being set in the guide wire fixing portion
51c. Thus, the large-diameter treatment instrument 33A is not held
by the guide wire fixing portion 51c. That is, as illustrated in
FIG. 45, while the guide wire 33 is led to the guide wire holding
portion 51b and latched and held by the wall portion 52 of the
treatment instrument elevator base 51 at a first position in the
guide wire fixing portion 51c, the large-diameter treatment
instrument 33A is prevented by the wall portion 52 from being set
in the guide wire fixing portion 51c and is caught on the contact
surface 51a to be held at a second position.
[0196] In other words, the treatment instrument elevator base 51 is
elevated to cause the guide wire holding portion 51b, which is
formed on the contact surface 51a to come in contact with and hold
the guide wire 33 or the large-diameter treatment instrument 33A of
a different type, to lead the guide wire 33 to the first position
of the guide wire fixing portion 51c, or to come in contact with
and hold the large-diameter treatment instrument 33A having a
diameter equal to or greater than a predetermined value at the
second position on the contact surface 51a. That is, the guide wire
holding portion 51b forms an elevator-base-side leading portion for
leading the guide wire 33 or the large-diameter treatment
instrument 33A of a different type in accordance with the elevation
of the treatment instrument elevator base 51.
[0197] That is, in the present embodiment, the size of the wall
portion 52 of the treatment instrument elevator base 51 is set to
prevent the large-diameter treatment instrument 33A including the
treatment instrument such as a catheter, which has a diameter equal
to or greater than 0.04 inches, for example, from being set in the
guide wire holding portion 51b. The operation of holding and fixing
the large-diameter treatment instrument 33A in the elevated state
of the treatment instrument elevator base 51 is similar to the
operation of the first embodiment. Thus, the description thereof
will be omitted.
[0198] As described above, the endoscope 1 of the present
embodiment exerts similar effects to the effects of the first
embodiment. In addition, in the endoscope 1 of the present
embodiment, the treatment instrument elevator base 51 is provided
with the wall portion 52 which forms the side wall of the guide
wire holding portion 51b. Thus, the endoscope 1 of the present
embodiment can minimize the occurrence of unnecessary movement,
such as lateral sway of the guide wire 33 or the large-diameter
treatment instrument 33A, when the treatment instrument elevator
base 51 is elevated while keeping the guide wire 33 or the
large-diameter treatment instrument 33A latched. Accordingly, it is
possible to prevent, for the benefit of the surgeon, the
deterioration of the operability and the visibility caused by the
unnecessary movement of the guide wire 33 or the large-diameter
treatment instrument 33A appearing on the screen of the monitor 4,
and to reduce uncomfortable feeling arising from the image.
[0199] The invention described in the above embodiments is not
limited to the embodiments and the modified examples thereof, but
various modifications can be made in the phase of practicing the
present invention within a scope not departing from the gist of the
invention. Further, the embodiments include the invention at
various stages, and various inventions can be extracted by
appropriately combining a plurality of disclosed constituent
elements.
[0200] For example, even if some constituent elements are
eliminated from all constituent elements described in the
embodiments, such an arrangement with the elimination of the
constituent elements can be extracted as an invention, as long as
the object of the present invention described in the section of
Background of the Invention can be achieved and the effects
described in the section of the Detailed Description of the
Invention can be obtained.
[0201] Having described the preferred embodiments of the invention
referring to the accompanying drawings, it should be understood
that the present invention is not limited to those precise
embodiments and various changes and modifications thereof could be
made by one skilled in the art without departing from the spirit or
scope of the invention as defined in the appended claims.
* * * * *