JP2000300574A - Laryngeal surgery device - Google Patents

Abstract

(57) [Summary] [Problem] Even if a forceps piece is set to the tip of a laryngeal forceps in any direction, flare due to reflection of illumination light from the forceps piece can be prevented, and good quality Provided is a laryngeal surgery apparatus capable of performing laryngeal surgery under observation of an endoscope image. By rotating an insertion section (31) of an endoscope around an axis at a hand side, the insertion section tip (32) follows the rotation.
The insertion section 31 of the endoscope was rotatably fitted on the rod 11 so as to rotate about the axis.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a laryngeal surgery apparatus capable of performing laryngeal surgery while observing with an endoscope.

[0002]

2. Description of the Related Art Laryngeal forceps are widely used in operations for removing foreign matter such as fish bones stuck in the larynx of a person and for resection of vocal fold polyps. It is performed under observation of an endoscope inserted separately.

However, when a practitioner or the like who does not have an assistant performs an operation, only one forceps can be used at a time because the operation of the forceps and the grasping and operation of the endoscope are performed by one person. It takes time and pain for the patient.

The inventor of the present invention attaches an insertion portion of an endoscope having an observation window and an illumination window at its tip along a rod of a laryngeal forceps, and places the endoscope at a position facing the forceps piece of the laryngeal forceps. By arranging the observation window and the illumination window, the operator can hold the laryngeal forceps and endoscope with one hand while holding the second laryngeal forceps with the other hand. Invented a laryngeal surgery device that can easily perform laryngeal surgery,
A patent application has already been filed (Japanese Patent Application No. 10-314196).
issue).

In the laryngeal surgery apparatus, an insertion section of an endoscope having an observation window and an illumination window at its tip is attached along a rod of a laryngeal forceps, and the tip of the rod is rotatable around its axis. The opening and closing direction of the forceps piece can be freely changed.

[0006]

In order for the open / closed state of the forceps piece to be observed by the endoscope, the tip of the insertion portion of the endoscope must be located on the side of the forceps piece. When the distal end of the rod is rotated in order to change the opening and closing direction of the forceps piece according to the state of the case, the distal end of the insertion portion of the endoscope rotates around the axis of the rod.

As a result, the positions of the observation window and the illumination window with respect to the forceps piece change, and as shown in FIG.
The illumination window 32b may be located between the forceps piece 12 and the observation window 32a.

Then, a large amount of the light reflected by the forceps piece 12 out of the illumination light radiated from the illumination window 32b enters the observation window 32a, and a flare is generated on the observation screen.
The quality of the observed image may be greatly reduced.

Accordingly, the present invention provides a high quality endoscope which can prevent flare from being generated by the reflection of illumination light from the forceps piece, regardless of the direction in which the forceps piece is set on the distal end of the laryngeal forceps. An object of the present invention is to provide a laryngeal surgery apparatus capable of performing a laryngeal surgery under a mirror image observation.

[0010]

In order to achieve the above object, a laryngeal surgery apparatus according to the present invention comprises a forceps piece provided at a distal end portion of an elongated rigid rod having a curved front half. Along with the rod of the laryngeal forceps, which operates the forceps piece by remote control from an operation unit provided at the proximal end of the rod, an observation window and an illumination window are provided at the distal end side by side. In a laryngeal surgery apparatus in which an insertion portion of an endoscope is attached and a distal end portion of the rod is rotatable around the axis thereof together with the insertion portion distal end of the endoscope, the insertion portion of the endoscope is located close to the hand. By rotating around the axis, the insertion portion of the endoscope is rotatable around the axis along the rod so that the tip of the insertion portion rotates around the axis following the rotation. I do.

Note that the insertion portion of the endoscope is positioned around the axis 3.
The endoscope may be disposed along the rod so as to be freely rotatable by 60 °, and the endoscope may be detachably attached along the rod.

[0012] An insertion portion holding ring for rotatably inserting and holding the insertion portion of the endoscope may be protruded from the rod, and the laryngeal forceps is used when only one of a pair of forceps pieces is used. One-sided forceps that open and close may be used.

[0013]

Embodiments of the present invention will be described with reference to the drawings. FIG. 1 shows a laryngeal operation apparatus, in which a laryngeal forceps 10 for inserting the patient through the mouth into the throat and performing an operation on the larynx is provided with an endoscope 3 for observing the state of the laryngeal operation.
0 is detachably attached, and both are integrated.

FIG. 2 shows a laryngeal forceps 10, in which a rod 11 inserted from a patient's mouth is rigid, and the front half is formed in an arc shape near 90 ° so that the tip can be easily positioned in the larynx. It is formed to be curved.

At the distal end of the rod 11, a pair of forceps pieces 12 which can be opened and closed like a beak are arranged. The forceps piece 12 of this embodiment is of a so-called one-sided type including a movable forceps piece 12a and a fixed forceps piece 12b.

The laryngeal forceps 10 is a so-called universal laryngeal forceps, and a tip mounting shaft 112 to which a pair of forceps pieces 12 are attached is freely rotated around the axis by 360 ° by loosening a manual tightening nut 111, thereby tightening. If the nut 111 is tightened, the tip mounting shaft 112 becomes the rod 11
To a fixed state.

A grip 1 is provided at the proximal end of the rod 11.
An operation unit 13 including a 3a and a pistol-triggered operation lever 13b is formed. Then, by loosening the rod fixing nut 14, the rod 11 becomes rotatable around the axis by 360 °, and by tightening the rod fixing nut 14, the rod 11 is fixed to the grip 13a.

Reference numeral 13c denotes a return leaf spring for returning the operation lever 13b to the standby position. The endoscope holding unit 50 attached to the back of the grip 13a will be described later with reference to FIG.

The operation lever 13b is connected to the movable forceps piece 12a via an operation wire (not shown) passed through the rod 11.
13 in a standby state.
When the forceps piece 12 is open and the operation lever 13b is pulled toward the grip 13a, the movable forceps piece 12a operates to close the forceps piece 12 as shown in FIG.

The intermediate portion of the rod 11 and the tip mounting shaft 112
, An insertion portion holding ring 20 for inserting and holding the insertion portion 31 of the endoscope 30 is attached. Insert retaining ring 2
Reference numeral 0 denotes a member having a spring property, as shown in FIG.

The insertion portion holding ring 20 is detachable from the laryngeal forceps 10, and FIG. 4 shows a state in which the two insertion portion holding rings 20 are removed from the laryngeal forceps 10. The rod 11 and the distal end mounting shaft 112 each have a portion to which the insertion portion holding ring 20 is attached is formed slightly thinner than the adjacent portion, so that the outer surface of the insertion portion holding ring 20 hardly protrudes from the laryngeal forceps 10. .

As shown in FIGS. 5 and 6 showing the VV cross section and the VI-VI cross section of FIG. 2, the insertion portion holding ring is attached to each of the small diameter portions of the rod 11 and the tip mounting shaft 112. 20
Is fitted with the spring working.

Accordingly, the insertion portion holding ring 20 cannot be moved in the axial direction, and can be rotated around the axes of the rod 11 and the tip mounting shaft 112 in a state where frictional resistance is exerted by a spring force. In addition, the insertion part holding ring 20 does not necessarily have to come off from the laryngeal forceps 10.

FIG. 7 shows the endoscope 30 and the insertion section 3.
1 is sheathed by a known flexible tube and can be freely bent in any direction. The outer skin of the insertion portion 31 is, for example, a tube made of polyurethane resin.

An observation window and an illumination window are arranged side by side on the distal end surface of the distal end main body 32 connected to the distal end of the insertion section 31, and an object in front of the distal end main body 32 (in the direction of the extension of the axis). And can be observed.

An objective optical system is built in the distal end body 32, and the image of the subject formed there is inserted into the insertion section 3.
The light is transmitted to the proximal side of the insertion portion 31 by the image guide fiber bundle inserted into the inside 1, and is enlarged and observed through the eyepiece portion 33.

A light guide cable 36 projects laterally from a support section 34 provided between the proximal end of the insertion section 31 and the eyepiece section 33. The illumination light guide fiber bundle is inserted through the entire length of the light guide cable 36 from within the insertion portion 31, the exit end thereof is located at the illumination window portion of the distal end main body 32, and the entrance end is located at the light guide. It is located at the light guide connector 37 attached to the tip of the cable 36. 39 is a pressure regulating valve.

Therefore, by connecting the light guide connector 37 to an external light source device (not shown),
It is possible to illuminate a subject in front of the distal end portion main body 32.
In addition, the incident end of the light guide fiber bundle may be arranged on the support portion 34, and the illumination light may be supplied from a miniature bulb or the like detachably provided thereat. In that case, the light guide cable 36 and the light guide connector 37 are unnecessary.

Insertion part holding ring 20 in the middle part of insertion part 31
Is externally covered by a metal collar 35 such as stainless steel. The distal end main body 32 that engages with the insertion portion holding ring 20 is also made of metal such as stainless steel.

The distal end main body 32 and the metal collar 35 are sized and formed without large irregularities on the surface of the adjacent insertion portion 31 so that the endoscope 30 does not catch on the mucous membrane surface or the like when the endoscope 30 is used alone. Is formed.

Returning to FIG. 1, the insertion portion 31 of the endoscope 30
Are bent and arranged along the rod 11 of the laryngeal forceps 10, and are inserted into two insertion portion holding rings 20 as shown in FIG. 8 showing a VIII-VIII section and FIG. 9 showing an IX-IX section. Passed to the extent that it cannot be tightened. Therefore, when the support portion 34 of the endoscope 30 is rotated around the axis at the hand side, the rotation is transmitted to the distal end main body 32 via the insertion portion 31 and the distal end main body 32 rotates around the axial line.

As shown in FIG. 10 showing a cross section taken along line X--X, the support portion 34 of the endoscope 30 is loosely held by the endoscope holding frame 54 of the endoscope holding portion 50. The manual screw 51 is attached to the slightly thinner screw receiving portion 38.
, The holding state is maintained.

When the manual screw 51 is loosened, the support portion 34 becomes rotatable about the axis, and the distal end main body 32 can be rotated about the axis via the insertion portion 31.
By loosening the manual screw 51, it can be moved slightly (for example, about 10 mm) in the axial direction.

The endoscope holding frame 54 sandwiches the support arm 52 fixed to the grip 13a in a sandwich manner, and a knob screw 53 penetrates both members to screw a nut 55 and a screw on the back side. I agree.

Therefore, if the knob screw 53 is loosened, the support arm 52 and the endoscope holding frame 54 can be rotated around the knob screw 53, and the operator can use The angle of attachment of the eyepiece 33 to the laryngeal forceps 10 can be adjusted and used according to the state of the operation to be performed.

As shown in FIG. 1, the distal end body 32 is located immediately behind the forceps piece 12 of the laryngeal forceps 10,
As shown in FIG. 11 showing arrow A, the forceps piece 12 is positioned by the insertion portion holding ring 20 in a direction in which the open / close state of the forceps piece 12 is observed from the side.

The observation window 32a and the illumination window 32b are
2 is disposed on the distal end surface of the distal end portion main body 32 so as to face the front end portion 2 in the state shown in FIGS.
As shown in (2), the forceps piece 12 is observed on the observation screen 100 in a state of protruding from below.

Then, when the tightening nut 111 is loosened and the tip mounting shaft 112 is rotated to open the movable forceps piece 12a forward as shown in FIG. 13, the forceps piece 12 is moved as shown in FIG. The image is observed on the observation screen 100 so as to protrude from the right side.

Further, when the tightening nut 111 is further loosened and the tip mounting shaft 112 is rotated, as shown in FIG. 15, the forceps piece 12 is opened in the direction opposite to that of FIG.
As shown in FIG. 16, the forceps piece 12 is
Is observed in a state protruding from above.

However, in this state, the insertion portion 31 is largely twisted, and as shown in FIG. 17, the insertion portion holding ring 20 attached to the intermediate portion of the rod 11 is rotated around the rod 11 to insert the insertion portion. It is preferable that the portion 31 is smoothly displaced. In this case, the catch at the time of insertion from the mouth is reduced, and the insertion becomes easy.

When the tightening nut 111 is loosened and the tip mounting shaft 112 is rotated to open the forceps piece 12 in a direction opposite to that in FIG. 13, the forceps piece 12 is moved to the observation screen 100 as shown in FIG. Observed to protrude from the left.

Then, as shown in FIG. 21, the illumination window 32b is located between the forceps piece 12 and the observation window 32a, and the illumination light radiated from the illumination window 32b is reflected by the forceps piece 12. A large amount of the emitted light enters the observation window 32a, causing flare.

Then, when the manual screw 51 is loosened and the support portion 34 of the endoscope 30 is rotated, for example, 90 ° around the axis as shown in FIG. As shown in FIG. 20, the illumination window 32b comes out of the state between the forceps piece 12 and the observation window 32a.

Therefore, by tightening the manual screw 51 to fix this state, it is possible to perform a treatment by the laryngeal operation apparatus under favorable endoscopic image observation free from flare.

The present invention is not limited to the above-described embodiment. For example, the endoscope 30 may be an electronic endoscope which captures an observation image with a solid-state image sensor and transmits the image as an electric signal. Good.

[0046]

According to the present invention, by rotating the insertion portion of the endoscope around the axis at the hand side, the tip of the insertion portion rotates around the axis following the rotation, so that the forceps piece is moved to the tip of the laryngeal forceps. Regardless of the orientation, the flare is not generated in the observation image due to the reflection of the illumination light from the forceps piece, and laryngeal surgery can be performed under high-quality endoscopic image observation .

[Brief description of the drawings]

FIG. 1 is a side view of a laryngeal surgery apparatus according to an embodiment of the present invention.

FIG. 2 is a side view of the laryngeal forceps according to the embodiment of the present invention.

FIG. 3 is a front view of the insertion portion holding ring according to the embodiment of the present invention.

FIG. 4 is a side view of the laryngeal forceps according to the embodiment of the present invention.

FIG. 5 is a sectional view taken along line VV in FIG. 2 of the embodiment of the present invention.

FIG. 6 is a sectional view taken along line VI-VI in FIG. 2 of the embodiment of the present invention.

FIG. 7 is a side view of the endoscope according to the embodiment of the present invention.

FIG. 8 is VIII-VIII in FIG. 1 of the embodiment of the present invention.
It is sectional drawing.

FIG. 9 is a sectional view taken along line IX-IX in FIG. 1 of the embodiment of the present invention.

FIG. 10 is a sectional view taken along line XX in FIG. 1 of the embodiment of the present invention.

FIG. 11 is a front view of the embodiment of the present invention as viewed from the direction of arrow A in FIG. 1;

FIG. 12 is a schematic diagram illustrating an endoscopic observation image according to the embodiment of the present invention.

FIG. 13 is a side view of the laryngeal surgery apparatus according to the embodiment of the present invention.

FIG. 14 is a schematic diagram illustrating an endoscopic observation image according to the embodiment of the present invention.

FIG. 15 is a side view of the laryngeal surgery apparatus according to the embodiment of the present invention.

FIG. 16 is a schematic diagram illustrating an endoscope observation image according to the embodiment of the present invention.

FIG. 17 is a side view of the laryngeal surgery apparatus according to the embodiment of the present invention.

FIG. 18 is a schematic view illustrating an endoscopic observation image according to the embodiment of the present invention.

FIG. 19 is a rear view (view from the eyepiece side) of the laryngeal surgery apparatus according to the embodiment of the present invention.

FIG. 20 is an operation explanatory view in a front view corresponding to an arrow A showing the operation of the embodiment of the present invention.

FIG. 21 is a front view of the laryngeal surgery apparatus according to the related art and the embodiment of the present invention in a state where flare occurs.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 10 Laryngeal forceps 11 Rod 12 Forceps piece 13 Operation part 20 Insert holding ring 30 Endoscope 31 Insertion part 32 Main body 32a Observation window 32b Illumination window 50 Endoscope holding part 51 Manual screw 111 Tightening nut 112 Tip mounting shaft

Claims (5)

[Claims] A forceps piece is provided at a distal end portion of an elongated rigid rod formed by bending a front half portion, and is remotely operated from an operating portion provided at a proximal end portion of the rod. Along the rod of the laryngeal forceps to operate the forceps piece, an insertion portion of an endoscope having an observation window and an illumination window arranged at the tip is attached, and the tip of the rod is rotated around its axis. In the laryngeal surgery apparatus configured to be rotatable with the distal end of the insertion portion of the endoscope, the distal end of the insertion portion is rotated around the axis by rotating the insertion portion of the endoscope around the axis at the hand side. A laryngeal surgery apparatus characterized in that an insertion portion of the endoscope is rotatably arranged about the axis along the rod so that the endoscope rotates. 2. The endoscope according to claim 1, wherein an insertion portion of the endoscope is disposed at an angle of 360.degree.
2. The apparatus according to claim 1, wherein said first rod is rotatably disposed along said rod.
A laryngeal surgery device as described. 3. The laryngeal surgery apparatus according to claim 1, wherein the endoscope is detachably attached along the rod. 4. The laryngeal surgery apparatus according to claim 1, wherein an insertion part holding ring for rotatably inserting and holding an insertion part of the endoscope is provided on the rod. 5. The laryngeal forceps are one-sided forceps in which only one of a pair of forceps pieces is opened and closed.
The laryngeal surgery device according to claim 3 or 4.