JP6211232B1 - Channel sheath and medical system - Google Patents

Abstract

The channel sheath (1) has a first opening (2a) for inserting a treatment instrument and can be connected to the proximal end member (2) and a proximal end member (2) that can be placed on the body surface. A cylindrical intermediate member (6) that has flexibility and can be inserted through the treatment instrument, and a second opening (8a) for projecting and retracting the treatment instrument, and is attached to and detached from a medical instrument different from the treatment instrument A distal end member (8) capable and connected to the intermediate member (6).

Description

  The present invention relates to a channel sheath and a medical system.

  Laparoscopic surgery is beneficial to patients in that post-operative recovery is fast. In laparoscopic surgery, it is necessary to treat and observe the affected area in the abdominal cavity through a limited access route. For this reason, laparoscopic surgery is less flexible and more difficult than open surgery.

  By using an endoscope having a bending mechanism at the tip for laparoscopic surgery, a deepened area in the abdominal cavity can be observed. A treatment tool for treating a deep region that can be observed using an endoscope having a bending mechanism may have a bending mechanism so that the treatment tool can reach the treatment target site. is there. In this case, since it is necessary to operate the treatment tool within the field of view of the endoscope by performing both the operation of the bending mechanism of the endoscope and the bending mechanism of the treatment tool, the degree of difficulty of the treatment is further increased. Become.

  For the purpose of facilitating the positioning of the treatment tool within the field of view of the endoscope, an external channel is known in which the treatment tool can be connected to the distal end of the endoscope (see, for example, Patent Document 1).

JP 2005-131111 A

  When the external channel disclosed in Patent Document 1 is used by being attached to an endoscope, it is necessary to introduce the endoscope to which the external channel is attached into the body through a trocar. A trocar having a larger inner diameter than the trocar having the inner diameter is required. As a result, the technique using the external channel disclosed in Patent Document 1 together with the endoscope is more invasive to the patient than when the external channel is not used.

  The present invention has been made in view of the above-described circumstances, and an object thereof is to provide a channel sheath and a medical system that are less invasive to a patient.

According to a first aspect of the present invention, there is provided a proximal end member having a first opening for inserting a treatment instrument and capable of being placed on a body surface, connectable to the proximal end member within the body , and A cylindrical intermediate member that has flexibility and allows the treatment instrument to be inserted, and a second opening for projecting and retracting the treatment instrument, and is removable from the medical instrument different from the treatment instrument in the body , And a distal end member connectable to the intermediate member.

  The distal end member includes a linear member capable of binding the medical device, and the proximal end member includes a state where the medical device is bound by the linear member and a state where the linear member is relaxed. You may have the operation part which switches.

A second aspect of the present invention is a medical system including the above-described channel sheath and an endoscope in which the distal end member of the channel sheath can be attached and detached inside the body .

  The endoscope has a positioning portion to which the distal end member can be attached so that the distal end member of the channel sheath is positioned with a predetermined positional relationship with respect to the endoscope. It may be.

  The endoscope includes an imaging unit provided at a distal end, an active bending unit disposed on a proximal side of the imaging unit, a driving unit that operates the active bending unit, and an operation of the driving unit. A control unit that controls, the control unit storing a designated position designated by an operator as a control procedure for operating the drive unit, and the designated position in a visual field region of the imaging unit A step of calculating a command value for operating the drive unit so as to enter and a step of outputting the command value to the drive unit, and controlling the operation of the drive unit according to the control procedure Good.

  According to the present invention, it is possible to provide a channel sheath and a medical system that are less invasive to a patient.

It is a perspective view which shows a part of channel sheath of 1st Embodiment of this invention. It is a perspective view which shows the proximal end member of the channel sheath. It is a fragmentary sectional view which shows the attachment aspect of the intermediate member with respect to the proximal end member. It is a figure which shows one process at the time of use of the channel sheath. It is a fragmentary sectional view showing the composition of the modification of the embodiment. It is a fragmentary sectional view showing the composition of other modifications of the embodiment. It is a perspective view which shows the channel sheath of 2nd Embodiment of this invention. It is sectional drawing which shows the proximal end member of the channel sheath. It is a side view which shows the state which attached the channel sheath to the endoscope. It is a side view which shows the structure of the modification of the embodiment. It is a perspective view which shows the structure of the other modification of the embodiment. It is a perspective view which shows the channel sheath and endoscope of 3rd Embodiment of this invention. It is a schematic diagram which shows the medical system of 4th Embodiment of this invention. It is a schematic diagram which shows the medical system of 5th Embodiment of this invention. It is a schematic diagram which shows the medical system of the modification of the embodiment.

(First embodiment)
A first embodiment of the present invention will be described.
As shown in FIGS. 1 to 4, the channel sheath 1 of this embodiment includes a proximal end member 2, an intermediate member 6, and a distal end member 8.

  As shown in FIGS. 2 and 3, the proximal end member 2 has a first opening 2 a for inserting the treatment instrument 60. The treatment instrument 60 that can be inserted into the first opening 2a of the proximal end member 2 is, for example, a flexible treatment instrument 60 that can be applied to a known flexible endoscope. Further, the proximal end member 2 can be placed on the body surface. In order to connect the proximal end member 2 of the present embodiment to the cylindrical main body portion 3 that defines the first opening 2 a, the fixing portion 4 that protrudes outward from the outer peripheral surface of the main body portion 3, and the intermediate member 6. And an engaging portion 5 attached to the main body portion 3.

The main body 3 is a cylindrical portion having an inner diameter through which the treatment instrument 60 can be inserted and having both ends opened.
For example, when the proximal end member 2 is attached to a patient's abdominal wall, the fixing portion 4 supports the outer end diameter of the main body portion 3 so as to prevent the proximal end member 2 from entering the abdominal cavity by contacting the outer surface of the abdominal wall. It has a larger ring shape.

  The engaging portion 5 has a thread groove 5a formed on the inner surface, and is connected to the main body portion 3 so as to be rotatable with respect to the main body portion 3 with the center line of the main body portion 3 as a rotation center. The thread groove 5a of the engaging portion 5 is screwed with a thread 7a of a coupler 7 provided on the intermediate member 6 described later. In order to be able to turn the engaging portion 5 by hand, the outer peripheral surface of the engaging portion 5 has a non-slip shape such as unevenness.

  Further, the proximal end member 2 of the present embodiment further includes an inner needle member (not shown) that performs puncture for fixing the proximal end member 2 to the body wall. The inner needle member has an outer diameter that is substantially the same as the inner diameter of the main body 3 and has a sharp insertion end. By inserting the inner needle member into the body wall while the inner needle member is inserted into the main body portion 3, the main body portion 3 can be inserted from outside the body into the body.

As shown in FIGS. 1 and 3, the intermediate member 6 is a cylindrical member through which the flexible treatment instrument 60 can be inserted. The intermediate member 6 has flexibility. The first end 6 a of both ends of the intermediate member 6 has a cylindrical coupler 7 that can be attached to and detached from the proximal end member 2. The coupler 7 of the intermediate member 6 has a thread 7a on the outer peripheral surface that can be screwed into a thread groove 5a formed in the engaging portion 5 at the proximal end. In a state where the coupler 7 is attached to the engaging portion 5, the intermediate member 6 is communicated with the first opening 2a. In this state, the center line of the intermediate member 6 and the center line of the main body 3 are substantially coaxial.
Of the both ends of the intermediate member 6, the second end portion 6 b opposite to the first end portion 6 a is connected to the distal end member 8 and communicated with a second opening 8 a described later.

  As shown in FIGS. 1 and 4, the distal end member 8 has a second opening 8 a for projecting and retracting the treatment instrument 60. The distal end member 8 can be attached to and detached from a medical instrument (the endoscope 10 in this embodiment) different from the treatment instrument 60 described above. As an example, the distal end member 8 of the present embodiment has a clip portion for connecting the distal end member 8 to the distal end configuration portion 13 across the outer peripheral surface of the distal end configuration portion 13 of the insertion portion 11 of the endoscope 10. 9.

  As shown in FIGS. 1 and 4, the clip portion 9 is formed in a C shape having a slightly smaller diameter than the outer peripheral surface of the distal end constituting portion 13 of the insertion portion 11 of the endoscope 10 and is elastically deformable. The clip part 9 is elastically deformed by receiving the force expanded by the tip component part 13 and is pressed against the outer surface of the tip component part 13 by the restoring force of the clip part 9 itself.

  The clip part 9 defines the direction of the second opening 8 a with respect to the tip component part 13. In the present embodiment, the orientation of the second opening 8a is defined so that the second opening 8a faces in a direction parallel to the optical axis of the imaging unit of the endoscope 10 (the visual field direction of the endoscope 10).

The usage method and operation of the channel sheath 1 of the present embodiment will be described.
As shown in FIG. 4, in this embodiment, the first trocar 50 for introducing the endoscope 10 into the patient's body and the proximal end of the channel sheath 1 are connected to the patient's body wall (for example, the abdominal wall). Attach to.
The configuration of the first trocar 50 is not particularly limited, and a known trocar can be appropriately selected according to the configuration of the endoscope 10.

  In order to attach the proximal end member 2 of the channel sheath 1 to the patient's body wall, a through-hole penetrating the body wall is formed by cutting the body wall so that the main body 3 can be inserted. In the present embodiment, incision of the body wall and insertion of the main body 3 can be performed at the same time by puncturing the inner needle member into the body wall with an unillustrated inner needle member attached in the main body 3. . After the main body portion 3 is inserted into the body wall, the inner needle member is pulled out from the main body portion 3 to complete the placement of the proximal end member 2 on the body wall. Since the fixing portion 4 formed on the proximal end member 2 contacts the outer surface of the body wall around the through hole formed in the body wall, the fixing portion 4 does not enter the through hole of the body wall. Thereby, the proximal end member 2 is fixed to the body wall. Note that a stopper (not shown) or the like for preventing the main body part 3 from coming out of the body from the through hole may be provided on the main body part 3, but pressing the fixing part 4 by hand and pushing it into the body inside. However, the main body 3 can be prevented from coming off.

  Subsequently, the distal end member 8 and the intermediate member 6 are introduced into the body through the first trocar 50. Since the distal end member 8 has the clip portion 9 along the outer periphery of the distal end constituting portion 13 of the insertion portion 11 of the endoscope 10, it passes through the body portion 3 of the proximal end member 2 of the channel sheath 1. Not as small as possible. However, since the distal end member 8 is small enough to pass through the first trocar 50, the distal end member 8 can be introduced into the body through the first trocar 50.

  When the distal end member 8 and the intermediate member 6 are introduced into the body through the first trocar 50, the coupler 7 of the intermediate member 6 is located in the body. The operator inserts a known grasping forceps from the first opening 2 a of the proximal end member 2 of the channel sheath 1 to grip the coupler 7 and draws it to the vicinity of the proximal end member 2. Further, the operator pulls the coupler 7 into the main body 3 and moves it to the engaging portion 5. The operator rotates the engaging portion 5 with respect to the main body 3 while the coupler 7 is held by the grasping forceps. Thereby, the intermediate member 6 is connected to the proximal end member 2 when the screw thread 7a of the coupler 7 and the screw groove 5a of the engaging portion 5 are screw-fitted. That is, the intermediate member 6 and the first opening 2a are in communication.

  Subsequently, the endoscope 10 is introduced into the body through the first trocar 50, and the clip portion 9 of the channel sheath 1 is attached to the distal end constituting portion 13 of the insertion portion 11 of the endoscope 10 as shown in FIG. In the present embodiment, the clip portion 9 is sandwiched by the clip portion 9 so that the clip portion 9 surrounds the outer peripheral surface of the tip component portion 13, so that the second opening 8 a faces in the visual field direction of the endoscope 10. The distal end member 8 is connected to the distal end constituting portion 13.

  When the active bending portion 12 of the endoscope 10 is operated in this state, the distal end member 8 of the channel sheath 1 moves integrally with the distal end constituting portion 13. That is, the second opening 8a of the distal end member 8 moves integrally with the movement of the field of view of the endoscope 10.

  When the treatment instrument 60 is attached to the channel sheath 1 and the distal end of the treatment instrument 60 protrudes from the second opening 8 a, the end effector 61 at the distal end of the treatment instrument 60 enters the visual field of the endoscope 10, and Treatment can be performed while observing the state of the tip using the endoscope 10.

The effect of the channel sheath 1 of this embodiment will be described.
Generally, an external channel that is attached to an endoscope outside the body and inserted into the body together with the endoscope needs to be inserted through the trocar together with the endoscope and the external channel. In other words, the invasion to the patient is great.

In contrast, in the channel sheath 1 of the present embodiment, the proximal end member 2 of the channel sheath 1 is fixed to the body surface separately from the first trocar 50 for inserting the endoscope 10 into the body. The inner diameter of the trocar (first trocar 50) for inserting the endoscope 10 may be an inner diameter that allows the insertion portion 11 of the endoscope 10 to be inserted. In this embodiment, in order to introduce the channel sheath 1 into the body, it is necessary to make an incision to a site different from the site to be incised by the trocar. Can be lowered.
In the present embodiment, a trocar (first trocar 50) is used to introduce the distal end member 8 and the intermediate member 6 of the channel sheath 1 into the body. For this reason, in this embodiment, in order to place the proximal end member 2 in the patient, an incision having a size that allows the main body 3 to be inserted into the body wall is sufficient.

  In general, when a known external channel is attached to the active bending portion of the endoscope, the active bending portion of the endoscope is compared with a state where the external channel is not attached to the endoscope. Such a load is high. Therefore, conventionally, when the external channel is attached to the endoscope, when the active bending portion of the endoscope is operated, compared to the state where the external channel is not attached to the endoscope. It is conceivable that the bending accuracy decreases.

  In the channel sheath 1 of the present embodiment, the distal end member 8 of the channel sheath 1 is attached to the tip constituting portion 13 that is distal to the active bending portion 12 of the endoscope 10, and the active bending portion 12 and the vicinity thereof. Since the channel sheath 1 is not connected to the region on the distal side, the load applied to the active bending portion 12 when the active bending portion 12 is bent is low. As a result, even when the channel sheath 1 of the present embodiment is attached to the endoscope 10, the bending accuracy of the active bending portion 12 of the endoscope 10 can be maintained high.

  Further, the fixing portion 4 provided on the proximal end member 2 of the channel sheath 1 of the present embodiment can fix the proximal end member 2 to the body wall so that the proximal end member 2 does not enter the body. The position of the proximal end (first end portion 6a) of the intermediate member 6 can be fixed near the body wall so that the proximal end of the intermediate member 6 connected to the proximal end member 2 does not move relative to the body wall. It is. For this reason, it is possible to prevent the treatment instrument 60 and the intermediate member 6 from moving together so that the intermediate member 6 moves relative to the body wall when the treatment instrument 60 is advanced and retracted in the channel sheath 1. . As a result, the shift between the amount of advancement / retraction of the treatment instrument 60 relative to the channel sheath 1 and the amount of protrusion / retraction of the treatment instrument 60 from the second opening 8a is reduced, and an intuitive operation is possible.

(Modification)
A modification of the first embodiment will be described.
As shown in FIG. 5, in the present modification, the configurations of the engaging portion 5 and the coupler 7 are different from those of the first embodiment. The engaging portion 5 of this modification has an elastically deformable annular portion 5b having a through hole smaller than the maximum outer diameter of the coupler 7, instead of the thread groove 5a. Further, the engaging portion 5 of this modification is fixed to the main body portion 3.

  The coupler 7 of this modification has a small diameter portion 7b and a large diameter portion 7c alternately arranged in the center line direction instead of the thread 7a. The outer diameter of the small diameter portion 7b of the coupler 7 is substantially the same as the inner diameter of the annular portion 5b. The outer diameter of the large-diameter portion 7c of the coupler 7 is larger than the inner diameter of the through hole of the annular portion 5b to such an extent that the annular portion 5b can pass through the annular portion 5b by elastic deformation.

  In this modification, for example, the intermediate member 6 can be connected to the proximal end member 2 by pulling the coupler 7 into the main body 3 using a known grasping forceps and locking the coupler 7 to the annular portion. . In this modification, the intermediate member 6 can be easily connected to the proximal end member 2 simply by moving the coupler 7 linearly in the direction of the center line of the main body 3, so that the connection work is easy.

(Modification)
Another modification of the first embodiment will be described.
As shown in FIG. 6, in the present modification, the configuration of the coupler 7 is different from that of the first embodiment.
The coupler 7 of this modification is made of a metal that can adhere to the magnet. The coupler 7 has a screw thread 7a as in the first embodiment.

In this modification, a pick-up forceps 70 that can be coupled to the coupler 7 by magnetic force is used instead of a known gripping forceps that pulls the coupler 7 into the main body 3. The pick-up forceps 70 includes an insert 71 that can be inserted into the main body 3 and a magnet portion 72 that is fixed to the tip of the insert. The magnet portion 72 has a rod-like portion 73 that can be inserted into the coupler 7. The rod-like portion 73 of the magnet portion 72 has a cylindrical shape that is coaxial with the center line of the insert 71 of the pickup forceps 70. When the rod-like portion 73 of the magnet portion 72 is inserted into the coupler 7, the pickup forceps 70 and the intermediate member 6 are arranged so that the center line of the insert 71 of the pickup forceps 70 and the center line of the intermediate member 6 are coaxial. Are coupled by magnetic force.
In this modification, the pick-up forceps 70 and the intermediate member 6 can be connected by a magnetic force, and the intermediate member 6 can be pulled toward the proximal end member 2 side (see FIG. 3).

(Second Embodiment)
A channel sheath 1 according to a second embodiment of the present invention will be described. In the following embodiments and modifications thereof, the same reference numerals as those in the first embodiment are assigned to the same configurations as those in the first embodiment, and duplicate descriptions are omitted.

  As shown in FIGS. 7 and 8, in the channel sheath 1 of the present embodiment, the distal end member 8 can be connected to the distal end constituting portion 13 of the insertion portion 11 of the endoscope 10 instead of the clip portion 9. The configuration is different in that the linear member 80 is provided. Furthermore, the proximal end member 2 of the channel sheath 1 of the present embodiment includes a state in which the distal end constituting portion 13 of the insertion portion 11 of the endoscope 10 is bound by the linear member 80 and a state in which the linear member 80 is relaxed. There is an operation unit 85 for switching between.

  In a relaxed state, the linear member 80 provided on the distal end member 8 has an annular shape larger than the outer diameter of the insertion portion 11 of the endoscope 10, and is internally viewed in the ring formed by the linear member 80. The tip structure portion 13 of the insertion portion 11 of the mirror 10 can be inserted (see FIG. 9).

  The linear member 80 extends to the proximal end member 2 along the center line of the intermediate member 6 in parallel with the intermediate member 6. The linear member 80 has a claw portion (first claw portion 81) that engages with a claw portion (second claw portion 82) provided in the proximal end member 2 in the vicinity of the proximal end member 2. Yes.

  The first claw portion 81 and the second claw portion 82 do not regulate the movement of the linear member 80 when moving the linear member 80 further toward the proximal side of the proximal end member 2, and the linear member The movement of 80 toward the distal side of the proximal end member 2 is restricted. In this embodiment, when the first claw portion 81 and the second claw portion 82 are engaged, the linear member 80 can maintain a state in which the outer peripheral surface of the tip constituting portion 13 is bound.

  The operation unit 85 switches the engagement state between the second claw portion 82 provided on the proximal end member 2 and the first claw portion 81. The operation portion 85 maintains the engaged state between the first claw portion 81 and the second claw portion 82 when not particularly operated. When the operator operates the operation unit 85, the linear member 80 can be released and the linear member 80 can be relaxed by releasing the state in which the outer peripheral surface of the tip component portion 13 is bound.

The effect of the channel sheath 1 of this embodiment is demonstrated.
The channel sheath 1 of the present embodiment is introduced into the body as in the first embodiment. Further, the first claw portion 81 is engaged with the second claw portion 82 so that the linear member 80 is in a relaxed state.
In order to connect the channel sheath 1 to the endoscope 10, first, the distal end constituting portion 13 of the insertion portion 11 of the endoscope 10 is inserted into a ring constituted by the linear member 80 in a relaxed state. Subsequently, by moving the first claw portion 81 toward the proximal side of the second claw portion 82, the ring constituted by the linear member 80 is reduced in diameter, and the linear member 80 is the outer periphery of the tip constituting portion 13. Touch the surface. When the first claw portion 81 is further moved to the proximal side of the second claw portion 82, the linear member 80 is in a state in which the tip constituting portion 13 is bound. Thereby, the distal end member 8 of the channel sheath 1 is connected to the distal end constituting portion 13 of the endoscope 10.

In the present embodiment, similarly to the first embodiment, the distal end member 8 of the channel sheath 1 operates integrally with the operation of the active bending portion 12 of the endoscope 10.
Furthermore, in this embodiment, the distal end constituting portion of the endoscope 10 is reduced in diameter by inserting the distal end constituting portion 13 of the endoscope 10 into the ring of the relaxed linear member 80 and then reducing the diameter of the linear member 80. Since the distal end member 8 of the channel sheath 1 can be connected to 13, the operation of attaching the distal end member 8 to the tip constituting portion 13 is easy.

(Modification)
A modification of the second embodiment will be described.
As shown in FIG. 10, in this modification, the distal end constituting portion 13 of the endoscope 10 has a circumferential groove 13 a into which the linear member 80 can be inserted. That is, in this modification, the medical system 100 is configured by the channel sheath 1 disclosed in the second embodiment and the endoscope 10 having the circumferential groove 13a in the distal end configuration portion 13.
The position of the distal end member 8 in the direction of the center line of the insertion portion 11 of the endoscope 10 by the linear member 80 binding the distal end constituting portion 13 in a state where the linear member 80 enters the circumferential groove 13a. Can be prevented.

(Modification)
Another modification of the second embodiment will be described.
As shown in FIG. 11, in the present modification, the distal end constituting portion 13 of the endoscope 10 has a positioning portion 13b that holds a part of the distal end member 8 at a predetermined position. That is, in this modification, the medical system 100 is configured by the channel sheath 1 disclosed in the second embodiment and the endoscope 10 having the positioning portion 13b in the distal end configuration portion 13.
As an example, the positioning portion 13b has an inner surface shape that follows the shape of the distal end member 8 so that a part of the distal end member 8 enters, and is recessed.

  Since the positioning portion 13b positions and holds the distal end member 8 at a predetermined position, the position of the distal end member 8 with respect to the tip constituent portion 13 is obtained by connecting the distal end member 8 to the tip constituent portion 13. The relationship is uniquely determined. For this reason, in this modification, the position of the second opening 8a of the channel sheath 1 with respect to the visual field of the endoscope 10 can be uniquely determined. As a result, the operator can know in advance from which position the treatment instrument 60 attached to the channel sheath 1 enters the visual field with respect to the visual field of the endoscope 10.

(Third embodiment)
A third embodiment of the present invention will be described.
As shown in FIG. 12, in the channel sheath 1 of the present embodiment, the distal end member 8 has a swing mechanism 86 that changes the direction of the second opening 8a.
The swing mechanism 86 has an operation wire 87 having one end fixed in the vicinity of the second opening 8 a of the distal end member 8. The operation wire 87 extends to the proximal end member 2 in parallel with the intermediate member 6 and can be operated from outside the body near the proximal end member 2. By pulling the operation wire 87, the direction of the second opening 8a changes.
In the present embodiment, since the position and posture of the treatment tool can be changed using the swing mechanism 86 within the field of view of the endoscope 10, the degree of freedom for moving the treatment tool is high.

(Fourth embodiment)
A fourth embodiment of the present invention will be described.
As illustrated in FIG. 13, the present embodiment is a medical system 100 including the channel sheath 1 and the endoscope 10 disclosed in the modification of the second embodiment and a display unit 40.

The display unit 40 includes a monitor 41 and an image processing unit 42.
The image processing unit 42 acquires an image from the endoscope 10 and displays it on the monitor 41. Further, the image processing unit 42 causes the monitor 41 to display the approach line L1 indicating the protruding direction of the treatment instrument 60 protruding from the second opening 8a (see FIG. 1) on the image acquired from the endoscope 10 on the monitor 41.

  In the present embodiment, the operator can easily grasp where the treatment tool 60 reaches in the endoscope 10 image when the treatment tool 60 is projected from the second opening 8a. For this reason, by operating the endoscope 10 so that the treatment target part is positioned on the approach line L1, the treatment tool 60 can easily reach the treatment target part to perform the treatment.

(Modification)
A modification of the fourth embodiment will be described.
In this modification, the monitor 41 has a touch panel input function (not shown). When an arbitrary position on the monitor is pointed with a finger or the like while the endoscopic image is displayed on the monitor 41, the active bending portion 12 automatically operates so that the pointed position becomes the center of the visual field. In this modification, the position of the center of the visual field can be determined by directly specifying a point on the image, so that there is little error and the operation is easy.

(Fifth embodiment)
A fifth embodiment of the present invention will be described.
As illustrated in FIG. 14, the present embodiment includes the channel sheath 1, the endoscope 10, and the sensing trocar 51 disclosed in the modified example of the second embodiment.
The endoscope 10 includes an elongated insertion unit 11, an operation unit 20, a drive unit 30, and a display unit 40.

  The insertion portion 11 has an active bending portion 12 that can be bent at a distal end portion. There is no restriction | limiting in particular in the specific structure of the active bending part 12. FIG. Accordingly, a known joint structure having one or more joints having a rotation axis, a known curved tube structure having a plurality of node rings and bending pieces (hereinafter referred to as “node rings, etc.”), and the like are appropriately selected. Can be adopted. An encoder or the like (not shown) is attached to the active bending portion 12 so that the rotation amount of each joint in the joint structure and the rotation amount of each node ring can be detected.

An observation section (tip configuration section) 13 having an image sensor, an illumination mechanism, and the like is provided further on the distal end side than the active bending section 12. In the present embodiment, the distal end member 8 of the channel sheath 1 can be connected to the observation unit 13.
The observation unit 13 has a distance measuring function for measuring the distance to the object captured in the field of view. As a mechanism for realizing the distance measuring function, a known mechanism such as stereo measurement can be appropriately selected and employed.

  The operation unit 20 includes a joystick 21 and a button 22. When the user operates the joystick 21, the operation output is transmitted to the drive unit 30, and the active bending unit 12 is driven. As a result, the observation unit 13 can be directed in a desired direction. The button 22 is used for switching the driving mode of the endoscope 10. Details of the drive mode will be described later.

  The drive unit 30 includes a drive mechanism 31 that generates a drive force for driving the active bending portion 12 and a control unit 32 that controls the operation of the drive mechanism 31. As the drive mechanism 31, various known motors can be used. The driving mechanism 31 and the active bending portion 12 are connected by a transmission member such as a wire (not shown), and the driving force generated by the driving mechanism 31 is transmitted to the active bending portion 12 via the transmission member, thereby active bending. The unit 12 is driven.

  The control unit 32 is electrically connected to the operation unit 20 and the drive mechanism 31, generates a drive signal for driving the drive mechanism 31, and transmits the drive signal to the drive mechanism 31. The generation mode of the drive signal varies depending on the drive mode, but details will be described later.

The display unit 40 includes a monitor 41 and an image processing unit 42. The video signal acquired by the observation unit 13 is sent to the image processing unit 42 and processed, and then displayed on the monitor 41. As the display unit 40, a display mechanism of a known endoscope system can be appropriately selected and used.
The control unit 32 and the image processing unit 42 are electrically connected. Therefore, the operation unit 20 also functions as an interface for operating a cursor or the like displayed on the monitor 41.

The sensing trocar 51 includes a cylindrical main body 52 and a sensor 53 attached to the main body 52.
The basic structure of the main body portion 52 is the same as that of a known trocar, and the insertion portion 11 of the endoscope 10 can be inserted. The main body 52 may have a valve for maintaining an insufflated state, an inner needle for opening a hole in the body wall, and the like as necessary.
The sensor 53 includes the amount of advancement / retraction of the insertion portion 11 inserted through the sensing trocar 51, the amount of rotation about the axis of the insertion portion 11, and the posture of the main body 52 (the direction of the axis of the insertion portion 11 inserted through the sensing trocar 51). Can be detected. The sensor 53 can be configured using a known encoder or the like. If necessary, an auxiliary structure may be provided in the insertion portion 11 to enable detection of various operation amounts of the insertion portion 11 by the sensor 53 or to facilitate detection.
The sensor 53 is connected to the control unit 32 by, for example, a wiring (not shown). The sensor 53 is configured to be able to transmit and receive information to and from the control unit 32, and the detection value of the sensor 53 is sent to the control unit 32.

The medical system 100 has two operation modes, a manual mode (normal mode) and a lock-on mode.
In the manual mode, the control unit 32 generates a drive signal based on the operation of the joystick 21 by the user and transmits it to the drive mechanism 31. As a result, the active bending portion 12 is bent corresponding to the operation of the joystick 21.

  In the lock-on mode, the control unit 32 automatically generates a drive signal and transmits it to the drive mechanism 31 so that the observation unit 13 always faces the coordinates (interesting position) set by the user. Therefore, for example, when the user moves the endoscope 10, the active bending section 12 is driven so that the observation section 13 faces the position of interest Ts even after the movement. That is, during the lock-on mode, the active bending portion 12 is automatically driven by the control portion 32 so that the observation portion 13 faces the position of interest Ts regardless of how the user moves the endoscope 10. During the lock-on mode, the position of interest Ts is controlled so as to be always located at a predetermined position (for example, the center) of the visual field image displayed on the monitor 41.

The initial setting of the position of interest Ts is performed as follows, for example.
When the user sets one point of view image displayed on the monitor 41 as the position of interest, the control unit 32 determines the positional relationship between the insertion unit 11 and the sensing trocar 51 received from the sensor 53, the posture of the main body unit 52, and the active curvature. The coordinates of the position of interest Ts are set based on the bending state of the active bending section 12 received from the section 12 and the distance between the observation section 13 and the position of interest Ts (step S1). Thereafter, each time the insertion unit 11 is moved back and forth with respect to the sensing trocar 51 or rotated, the operation amount of the insertion unit 11 with respect to the sensing trocar 51 and the attitude of the main body 52 detected by the sensor 53 are transmitted to the control unit 32. The control unit 32 directs the observation unit 13 to the position of interest Ts again based on the operation amount of the insertion unit 11 and the posture of the main body unit 52 received from the sensor 53 and the current bending state of the active bending unit 12. A necessary operation amount of the active bending portion 12 is calculated, and a command value for operating the drive mechanism 31 is calculated (step S2). Further, the control unit 32 generates a drive signal based on the command value so as to drive the active bending unit 12 by a necessary amount of operation, and sends it to the drive mechanism 31 of the drive unit 30 (step S3). As a result of the execution of each step from step S1 to step S3, the active bending portion 12 is automatically driven by the drive mechanism 31, and the observation portion 13 faces the position of interest.

Transition between the manual mode and the lock-on mode is performed by the button 22. That is, when the button 22 is pressed, the manual mode is switched to the lock on mode, or the lock on mode is switched to the manual mode. Since the active bending section 12 is automatically driven by the control section 32 during the lock-on mode, all outputs from the joystick 21 based on the user's operation are canceled by the control section 32 except for a predetermined case described later. It is not used for driving the active bending portion 12.
In the medical system 100, the position of interest can be reset during the lock-on mode.

  In the present embodiment, the distal end member 8 of the channel sheath 1 can be attached to the observation unit 13. When the observation unit 13 is directed to the position of interest in the lock-on mode, the second opening 8a of the distal end member 8 is also integrated with the observation unit 13 to the position of interest. When the position of interest is set by each of the above steps S1 to S3, the treatment tool 60 protruding from the second opening 8a of the channel sheath 1 is also directed to the position of interest together with the observation unit 13. As a result, when the endoscope 10 automatically operates in the lock-on mode, the positional relationship between the observation unit 13 and the treatment instrument 60 does not change, and treatment is performed within the visual field while continuing to capture a desired visual field. Can do.

(Modification)
A modification of the above five embodiments will be described.
As shown in FIG. 15, the present modification is a medical system 100 that includes the channel sheath 1, the endoscope 10, the display unit 40, and the electric treatment instrument 65.

  The electric treatment instrument 65 is inserted from the first opening 2 a of the channel sheath 1 and protrudes from the second opening 8 a of the channel sheath 1 through the inside of the intermediate member 6. The electric treatment tool 65 includes an end effector 61 and a drive control unit 62 that operates the end effector 61.

  In this modification, two channel sheaths 1 are connected to one endoscope 10 and the electric treatment instrument 65 is attached to the two channel sheaths 1 for use. In the present modification, the two electric treatment tools 65 are connected to one input device 66 and operate according to an input operation on the input device 66.

Even with such a configuration, the electric treatment instrument 65 can be moved integrally with the active bending operation of the endoscope 10 as in the above embodiments. Moreover, in this modification, the two electric treatment tools 65 can be moved simultaneously by the active bending operation of the endoscope 10.
Note that the medical system 100 according to the present modification may further include an electric arm 90 that holds the endoscope 10 with respect to the endoscope 10 system described above.

The electric arm 90 is connected to one input device 66 together with the electric treatment instrument 65 described above, and operates according to an input operation on the input device 66.
Even with such a configuration, the electric treatment instrument 65 can be moved integrally with the active bending operation of the endoscope 10 as in the above embodiments.

As mentioned above, although embodiment of this invention was explained in full detail with reference to drawings, the concrete structure is not restricted to this embodiment, The design change etc. of the range which does not deviate from the summary of this invention are included.
In addition, the constituent elements shown in the above-described embodiments and modifications can be combined as appropriate.

  The channel sheath and medical system of the present invention can be used when a flexible treatment tool is used together in an operation using an endoscope or a laparoscope.

DESCRIPTION OF SYMBOLS 1 Channel sheath 2 Proximal end member 2a 1st opening 3 Main-body part 4 Fixing part 5 Engagement part 5a Screw groove 5b Annular part 6 Intermediate member 6a First end part 6b Second end part 7 Coupler 7a Thread 7b Small diameter part 7c Large-diameter portion 8 Distal end member 8a Second opening 9 Clip portion 10 Endoscope 11 Insertion portion 12 Active bending portion 13 Tip configuration portion (observation portion)
13a Circumferential groove 13b Positioning unit 20 Operation unit 21 Joystick 22 Button 30 Drive unit 31 Drive mechanism 32 Control unit 40 Display unit 41 Monitor 42 Image processing unit 50 First trocar 51 Sensing trocar 52 Main body unit 53 Sensor 60 Treatment tool 61 End effector 62 Drive control unit 65 Electric treatment instrument 66 Input device 70 Pick-up forceps 71 Insert 72 Magnetic part 73 Rod-like part 80 Linear member 81 First claw part 82 Second claw part 85 Operation part 86 Mechanism 87 Operation wire 90 Electric arm 100 Medical system

Claims (5)

A proximal end member having a first opening for inserting the treatment instrument and capable of being placed on the body surface;
A cylindrical intermediate member that is connectable to the proximal end member in the body and that is flexible and can be inserted through the treatment instrument;
Wherein the treatment instrument the treatment instrument has a second opening for causing the projecting and retracting the is detachable in the body to different medical devices, and, a distal end member connectable to the intermediate member,
A channel sheath characterized by comprising: The distal end member has a linear member capable of binding the medical device,
2. The channel sheath according to claim 1, wherein the proximal end member has an operation unit that switches between a state in which the medical device is tightly bound by the linear member and a state in which the linear member is relaxed. A channel sheath according to claim 1;
An endoscope in which the distal end member of the channel sheath is removable in the body ;
Medical system equipped with.   The endoscope has a positioning portion to which the distal end member can be attached so that the distal end member of the channel sheath is positioned with a predetermined positional relationship with respect to the endoscope. The medical system according to claim 3. The endoscope is
An imaging unit provided at the distal end;
An active bending portion disposed on the proximal side of the imaging unit;
A drive section for operating the active bending section;
A control unit for controlling the operation of the driving unit;
Have
The control unit, as a control procedure for operating the drive unit,
Storing a designated position designated by an operator;
Calculating a command value for operating the drive unit so that the designated position enters the field of view of the imaging unit;
Outputting the command value to the drive unit;
The medical system according to claim 3, wherein the operation of the drive unit is controlled according to the control procedure.

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