JP2015150341A - Sheath for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a sheath for endoscope capable of properly protecting a bent against a treatment instrument inserted from outside the visual field of an endoscope.SOLUTION: A sheath 70 for endoscope is composed of: a cylindrical sheath body 71 into which an insertion section 9 is removably inserted; a plurality of rigid flaps 72 annularly arranged on the tip side of the sheath body 71 in correspondence to a bend 12 of the insertion section 9 inserted into the sheath body 71; and connection sheets 73 for connecting the base end side of each flap 72 to the tip side of the sheath body 71 such that the tip side of each flap 72 is swingable relative to the radial direction of the sheath body 71. The sheath 70 is interposed between an endoscope 5 and a trocar 40.

Description

  The present invention relates to an endoscope sheath that is applied to an endoscope having a bending portion on the distal end side of an insertion portion.

  Conventionally, laparoscopic surgery, thoracoscopic surgery using an endoscope, and the like have become widespread as surgical operations aimed at minimally invasive medical treatment. In such an endoscopic surgical operation, in order to directly operate the treatment tool in a limited space, the endoscope trocar and the treatment tool trocar are arranged at different positions, In general, the treatment tool is inserted obliquely with respect to the observation axis of the mirror.

  In addition, regarding this type of surgical endoscope, a sheath for adding various functions has been proposed. For example, Patent Document 1 discloses a sheath that is detachable from an insertion portion of an endoscope body to an operation portion. An attached cleaning sheath is disclosed. Here, the endoscope disclosed in Patent Document 1 has a bending portion on the distal end side of the insertion portion for enabling visual field deployment in an arbitrary direction, and the sheath is more than the bending portion. It is mounted on the proximal side.

Japanese Patent Laid-Open No. 10-201712

  By the way, in the endoscopic surgical operation as described above, for example, when the treatment tool is inserted obliquely with respect to the observation axis of the endoscope, the operator or the like inserts the distal end of the treatment tool into the endoscope. There is a case where it is necessary to move from the outside of the visual field toward the distal end side of the endoscope. In such a case, it is necessary for the surgeon or the like to pay close attention so as not to damage the outer skin or the like of the curved portion made of a flexible resin or the like.

  The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscope sheath that can accurately protect a bending portion with respect to a treatment instrument inserted from outside the visual field of an endoscope. To do.

  An endoscope sheath according to an aspect of the present invention is an endoscope sheath that is suitable for an endoscope having a curved portion on the distal end side of an insertion portion, and is a tube through which the insertion portion is inserted in a detachable manner. And a plurality of rigid flaps annularly arranged on the distal end side of the sheath body corresponding to the curved portion of the insertion portion inserted into the sheath body, and the distal end side of the flap is the A connecting portion that connects the proximal end side of the flap to the distal end side of the sheath body so as to be expandable in the outer diameter direction of the sheath body.

  According to the endoscope sheath of the present invention, the bending portion can be accurately protected against the treatment instrument inserted from outside the field of view of the endoscope.

Schematic configuration diagram of surgical endoscope system Explanatory drawing which shows the state of the laparoscopic surgery using the surgical endoscope system Perspective view of endoscope sheath Cross-sectional view of the main part showing the distal end side of the endoscope sheath when the bending portion is not bent Cross-sectional view of the main part showing the distal end side of the endoscope sheath when the bending portion is curved Sectional drawing which shows the principal part which concerns on a 1st modification and shows the front end side of the sheath for endoscopes when the bending part is curving. End view of the endoscope sheath as viewed from the distal end side, according to the second modification The perspective view which shows the front end side of the sheath for endoscopes when a curved part is not curving same as the above The perspective view which shows the front end side of the sheath for endoscopes when a curved part is curving same as the above The principal part sectional drawing which shows the front end side of the sheath for endoscopes concerning a 3rd modification when the bending part is curving. Sectional drawing which shows the principal part which shows the front end side of the sheath for endoscopes when it concerns on a 4th modification and the bending part is curving. Sectional drawing which shows the principal part which shows the front end side of the sheath for endoscopes when it concerns on a 5th modification and the bending part is curving. The perspective view of the sheath for endoscopes related to the first disclosed example Same as above, main part sectional view showing the proximal end side of the endoscope sheath

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. The drawings relate to an embodiment of the present invention, FIG. 1 is a schematic configuration diagram of a surgical endoscope system, FIG. 2 is an explanatory view showing a state of laparoscopic surgery using the surgical endoscope system, and FIG. 4 is a perspective view of the endoscope sheath, FIG. 4 is a cross-sectional view of the main part showing the distal end side of the endoscope sheath when the bending portion is not bent, and FIG. 5 is an endoscope when the bending portion is bent. It is principal part sectional drawing which shows the front end side of the sheath for mirrors.

  A surgical endoscope system 1 shown in FIG. 1 includes an endoscope 5, a light source device 6, a camera control unit (CCU) 7, and a monitor 8.

  The endoscope 5 in the present embodiment is, for example, a rigid endoscope for abdominal cavity. The endoscope 5 includes an insertion unit 9 that is inserted into the abdominal cavity, and an operation unit 10 that is coupled to the insertion unit 9. It is comprised.

  The insertion portion 9 is hard and has a length that is applied to abdominal surgery. The insertion portion 9 includes a distal end hard portion 11, a bending portion 12, and a rigid tube portion 13 in order from the distal end side.

  The operation unit 10 is provided with angle levers 25 and 26 for remotely operating the bending unit 12 and various switches 27 for operating the light source device 6 and the CCU 7. The angle levers 25 and 26 are levers that can operate the bending portion 12 in four directions, up, down, left, and right, for example.

  A universal cord 30 extends from the proximal end side of the operation unit 10, and a light guide connector 31 that is detachably connected to the light source device 6 is provided at the extended end of the universal cord 30. From the light guide connector 31, the proximal end side of the insertion portion 9, the operation portion 10 and the communication cable 32 inserted into the universal cord 30 is branched, and the CCU 7 is detachably attached to the proximal end of the communication cable 32. A video connector 33 is provided for connection to the.

  The light source device 6 supplies illumination light to an illumination optical system (not shown) provided in the hard tip portion 11. That is, a light guide (not shown) that optically connects the light guide connector 31 to the illumination optical system is inserted into the universal cord 30, the operation unit 10, and the insertion unit 9 of the endoscope 5. The light source device 6 supplies illumination light to the illumination optical system via the light guide. An optical image of a subject (observation site or the like) illuminated by illumination light from the light source device 6 is captured by, for example, an imaging optical system (not shown) disposed on the distal end hard portion 11. Then, the imaging signal generated by the imaging optical system is transmitted to the CCU 7 via a communication cable (not shown).

  The CCU 7 includes, for example, an imaging signal processing circuit (not shown) that converts an imaging signal generated by the imaging optical system into a predetermined video signal, and monitors the video based on the generated video signal on the monitor 8. To display.

  In laparoscopic surgery using such an endoscope system 1, for example, as shown in FIG. 2, a plurality (three in the illustrated example) of trocars 40 to 42 are punctured into the abdominal wall. Of these, various treatment tools as surgical devices are inserted into the trocars 41 and 42, respectively, and the distal end sides of the various treatment tools are inserted into the abdominal cavity through the trocars 41 and 42. Here, in the example shown in FIG. 2, an IT knife 50 and a grasping forceps 60 are inserted into the respective trocars 41 and 42 as treatment tools.

  For example, as shown in FIG. 2, the IT knife 50 is continuously provided on a treatment portion 51 including a high-frequency treatment electrode, a shaft portion 52 provided continuously with the treatment portion 51, and a proximal end side of the shaft portion 52. , And an operation unit 52 for remotely operating the treatment unit 51.

  Further, for example, as shown in FIG. 2, the grasping forceps 60 includes a treatment portion 61 including a pair of forceps pieces that can be opened and closed with each other, a shaft portion 62 connected to the treatment portion 61, and a shaft portion 62. An operation unit 63 that is provided on the base end side and that remotely operates the treatment unit 61 is configured. Here, the grasping forceps 60 of the present embodiment has a joint portion 62 a in the middle of the shaft portion 62, and the joint portion 62 a can be bent through an operation on the operation portion 63. That is, the grasping forceps 60 of the present embodiment is a multi-degree-of-freedom forceps capable of bending the shaft portion 62 at the joint portion 62a.

  Furthermore, the insertion part 9 of the endoscope 5 is inserted through the other trocar 40 via the sheath 70, and the distal end side of the insertion part 9 of the endoscope 5 is inserted into the abdominal cavity.

  As shown in FIGS. 1, 3 to 5, the sheath 70 includes a cylindrical sheath main body 71, and a plurality of (for example, four) flaps 72 having an annular shape disposed on the distal end side of the sheath main body 71. And a plurality of connecting sheets 73 as connecting portions for connecting the base end side of each flap 72 to the distal end side of the sheath main body 71.

  The sheath body 71 is constituted by, for example, a hard resin pipe that can be inserted through the insertion portion 9 of the endoscope 5. At the base end portion of the sheath body 71, a base 75 that fits into the distal end portion of the operation unit 10 is provided, and the base 75 is provided with an engagement groove 75 a that is substantially L-shaped. After the insertion portion 9 of the endoscope 5 is inserted into the sheath body 71, the base 75 is fitted to the distal end portion of the operation portion 10, and the engagement pin 10a protruding from the distal end portion of the operation portion 10 is engaged. The sheath 70 is attached to the endoscope 5 by engaging with the joint groove 75a.

  Each flap 72 is configured by, for example, a hard resin plate whose lateral direction is curved in a partial arc shape. As shown in FIGS. 1 and 3, the flaps 72 of the present embodiment are arranged in an annular shape, thereby constituting a substantially cylindrical member continuous with the sheath body 71 as a whole. As shown in FIGS. 4 and 5, a contact portion 72 a that can come into contact with the outer periphery of the insertion portion 9 of the endoscope 5 protrudes from the inner surface of the distal end portion of each flap 72. In addition, a tapered surface 72b is provided on the outer surface of the distal end portion of each flap 72 and is inclined toward the outer side of the distal end side.

  Each connection sheet 73 is made of, for example, a resin sheet having a predetermined hardness. The connecting sheet 73 is adhered to these outer surface sides from the distal end side of the sheath body 71 to the proximal end side of the flap 72. As a result, the base end side of each flap 72 is connected to the distal end side of the sheath body 71 so that the distal end side can swing with respect to the radial direction of the sheath body 71. More specifically, each connection sheet 73 is attached to the outer surface side of the sheath body 71 and each flap 72, so that the distal end side can move only in the opening / closing direction with respect to the radially outer side of the sheath body 71. Each flap 72 is connected to the sheath body 71 as described above.

  Here, the length of the sheath body 71 of the present embodiment is such that, for example, as shown in FIG. 4, the insertion portion is in a state where the proximal end portion is fitted to the distal end portion of the operation portion 10 via the base 75. The length is set so that the distal end of the sheath main body 71 substantially coincides with the distal end of the nine rigid tube portions 13. For example, as shown in FIG. 4, the length of each flap 72 of the present embodiment is set to be approximately equal to the length of the bending portion 12 or slightly longer than the bending portion 12. Further, for example, as shown in FIG. 4, in the insertion portion 9 of the endoscope 5 of the present embodiment, the interval l between the shoulders of each bending piece 9a is the sum of the intervals l along one bending direction. The length is set to be shorter than the length L which is the protruding length of the distal end hard portion 11 from the main body 71.

  Then, according to these settings, for example, as shown in FIGS. 4 and 5, when the sheath 70 is attached to the endoscope 5, each flap 72 is always located on the side of the bending portion 12. It becomes. Further, according to each setting described above, for example, as shown in FIG. 5, the flap 72 positioned on the inner side in the bending direction of the bending portion 12 does not protrude to the tip side from the tip hard portion 11, and the contact point thereof. The portion 72a is always in sliding contact with the distal end hard portion 11.

  According to such an embodiment, the tubular sheath body 71 through which the insertion portion 9 is detachably inserted and the bending portion 12 of the insertion portion 9 inserted through the sheath body 71 correspond to the sheath body 71. A plurality of rigid flaps 72 that are annularly arranged on the distal end side, and the base end side of each flap 72 of the sheath main body 71 so that the distal end side of each flap 72 is swingable with respect to the radial direction of the sheath main body 71. An endoscope sheath 70 is provided with a connecting sheet 73 connected to the distal end side, and the sheath 70 is interposed between the endoscope 5 and the trocar 40, thereby observing the endoscope 5. It is possible to accurately protect the bending portion 12 against various treatment tools (for example, the IT knife 50 and the grasping forceps 60) inserted from outside the visual field of the optical system.

  That is, by interposing the sheath 70 of the present embodiment between the endoscope 5 and the trocar 40, a plurality of rigid flaps 72 can be disposed on the outer peripheral portion of the bending portion 12. Therefore, even if a treatment instrument inserted into another trocar 41, 42, etc. is inserted in a direction in contact with the bending portion 12 from outside the field of the endoscope 5, the bending portion 12 is accurately protected from the treatment tool. can do. In addition, each flap 72 is connected to the distal end side via a connecting sheet 73 so that the distal end side is swingable with respect to the radial direction of the sheath body 71, and thus protects the bending portion 12 from various treatment instruments. Meanwhile, the bending operability by the bending portion 12 can be ensured.

  In this case, each connection sheet 73 is attached to, for example, the outer peripheral side of the sheath body 71 and each flap 72, so that the distal end side of each flap 72 can move in the opening / closing direction only on the radially outer side of the sheath body 71. Since the flaps 72 are connected to the sheath body 71 so that the bending portion 12 is returned from the bending state to the non-bending state, the flaps 72 positioned on the outer side in the bending direction are the distal end hard portion 11 and the like. Can be prevented accurately.

  Here, if each flap 72 becomes longer than necessary, the amount of force required for the swinging motion of the flap 72 increases. On the other hand, if each flap 72 is too short, the sheath body 71 or the inner surface of the flap 72 and the bending portion 12 may interfere with each other and be damaged. On the other hand, by connecting each flap 72 to the sheath body 71 at a position corresponding to the last piece of the bending piece 9a constituting the bending part 12, the bending force amount of the bending part 12 is not increased more than necessary. The bending operation can be enabled over the entire area.

  Further, by providing a tapered surface 72b that is inclined toward the outer side of the distal end on the outer surface of the distal end of the flap 72, even if the treatment instrument comes into contact with the flap 72, the treatment instrument is sheathed along the tapered surface 72b. 70 can be guided radially outward (that is, in a direction away from the bending portion 12).

  Here, in the above-described embodiment, an example in which the sheath body 71 and the flaps 72 are configured by a hard resin plate has been described. However, as shown in FIG. 6, for example, the sheath body 71 and the flaps 72 are rigid. It is also possible to use a metal plate. Moreover, in the above-mentioned embodiment, although the example which employ | adopted the resin-made connection sheet | seat 73 as a connection part for connecting each flap 72 and the sheath main body 71 was demonstrated, as shown in FIG. It is also possible to employ a hinge 76 as the part.

  Moreover, for example, as shown in FIGS. 7 to 9, as the flap used for the sheath 70, a flap 80 wider than each of the above-described flaps 72 is adopted, and each of these flaps 80 is compared with other adjacent flaps 80. It is also possible to configure such that a part of it wraps. With this configuration, the bending portion 12 can be removed from various treatment instruments when the bending portion 12 is in a non-curved state (see FIG. 8) and also when the bending portion 12 is in a predetermined bending state. It becomes possible to protect accurately (see FIG. 9).

  Further, for example, as shown in FIG. 10, a spring 81 that is an elastic member can be employed as a connecting portion that connects each flap 72 to the sheath body 71 instead of the connecting sheet 73. If comprised in this way, when the bending part 12 is changed from a bending state to a non-bending state, each flap 72 can be returned to the position arrange | positioned with the sheath main body 71 substantially linearly. In this case, for example, as shown in FIG. 10, magnets 83 and 84 that repel each other are incorporated in the distal end hard portion 11 and in the distal end portion of each flap 72, and the distal end hard portion 11 and each flap 72 are By generating a repulsive force due to the magnetic force therebetween, the sliding resistance between the outer peripheral surface of the distal end hard portion 11 and the contact portion 72a can be reduced even when the connecting portion is constituted by the spring 81.

  Further, for example, a guide member for guiding the angle of each flap 72 by remote control from the proximal end side of the sheath main body 71 as shown in FIG. 11 is added to the sheath 70 shown in FIG. Is also possible. The guide member shown in FIG. 11 is, for example, a wire 86 whose distal end side is connected to the distal end portion of each flap 72, and the distal end side of each flap 72 is pulled to the proximal end side of the sheath body 71 by each of these wires 86. Each flap 72 can swing (tilt) at an arbitrary angle with the base end side as a fulcrum. With this configuration, for example, even when the flap 72 connected to the sheath body 71 via the spring 81 is disposed on the outer periphery of the bending portion 12, the operator or the like is excessive with respect to the angle levers 25 and 26. The bending portion 12 can be bent without inputting an appropriate operation torque or the like. In addition, since the tilt position of the flap 72 can be held via the wire 86, even if the treatment instrument or the like comes into contact with the flap 72, the impact due to the contact is caused through the distal end hard portion 11 or the like to the curved portion 12. Therefore, it is possible to prevent the occurrence of so-called image skipping or the like in which the subject on the observation image is rapidly changed by the input of external force through the treatment tool or the like.

  For example, as shown in FIG. 12, the guide member added to the sheath 70 includes a wire 86 that pulls the distal end side of the flap 72 to the proximal end side, and a spring 87 interposed in the middle of the wire 86, It may be configured to have. If comprised in this way, each flap 72 can be hold | maintained elastically by predetermined | prescribed restraint force.

  The present invention is not limited to the above-described embodiments and modifications, and various modifications and changes are possible, and these are also within the technical scope of the present invention.

  For example, in the above-described embodiment and each modification, an example in which the connection sheet 73, the hinge 76, the spring 81, and the like are employed as the connection member has been described. However, the present invention is not limited to this, for example, It is also possible to form the connecting portion by integrally forming the sheath main body 71 and the respective flaps 72 with a hard resin or the like, and providing a cut at the boundary portion from the inside.

  Further, in the above-described embodiment and each modification, the configuration using four flaps has been described, but it is needless to say that the number of flaps is not limited to that described above.

  Furthermore, for example, it is needless to say that the configurations of the above-described embodiments and the respective modifications may be combined as appropriate.

  By the way, as an endoscope sheath applied to an endoscope provided with a bending portion, for example, the configurations shown in FIGS. 13 and 14 can be adopted. A sheath 90 shown in FIGS. 13 and 14 includes a cylindrical sheath body 91 through which the insertion portion 9 of the endoscope is detachably inserted, a base 92 that is fitted to the distal end portion of the operation portion of the endoscope, A rotation mechanism 93 that rotatably connects the sheath body 91 and the base 92 is configured.

  The sheath body 91 is constituted by, for example, a hard resin pipe that can be inserted through the insertion portion 9 of the endoscope. The distal end portion of the sheath body 91 is notched in a substantially semicircular arc shape, thereby forming a bending allowance portion 91a that allows the bending portion 12 to bend in one direction.

  The base 92 is provided with, for example, an engagement groove 92a having a substantially L shape. The base 92 is held by the operating portion by engaging the engaging groove 92a with the engaging pin protruding from the distal end portion of the operating portion of the endoscope.

  For example, as shown in FIG. 14, the rotation mechanism 93 includes a knob portion 93 a formed integrally with the proximal end portion of the sheath body 91, and an O that seals the inner periphery of the knob portion 93 a and the outer periphery of the base 92 in a liquid-tight manner. The ring 93b and a retaining portion 93c connected to the proximal end side of the knob portion 93a are configured. Then, the rotation mechanism 93 sandwiches the flange portion 92b provided around the outer periphery of the base 92 between the proximal end of the knob portion 93a and the retaining portion 93c, thereby rotating the sheath body 91 and the base 92 relative to each other. Connect to move freely.

  According to such a configuration, the bending portion 91a is rotated in an arbitrary direction by the rotation mechanism 93 while the bending portion 12 is protected by the distal end portion of the sheath body 91 cut out in a semicircular arc shape, thereby bending the bending portion 91a. The part 12 can be curved in any direction.

  DESCRIPTION OF SYMBOLS 1 ... Surgical endoscope system, 5 ... Endoscope, 6 ... Light source device, 8 ... Monitor, 9 ... Insertion part, 9a ... Bending piece, 10 ... Operation part, 10a ... Engagement pin, 11 ... Hard tip part , 12 ... curved portion, 13 ... hard tube portion, 25, 26 ... angle lever, 27 ... switch, 30 ... universal cord, 31 ... light guide connector, 32 ... communication cable, 33 ... video connector, 40-42 ... trocar, DESCRIPTION OF SYMBOLS 50 ... IT knife (treatment tool) 51 ... Treatment part, 52 ... Shaft part, 52 ... Operation part, 60 ... Gripping forceps (treatment tool), 61 ... Treatment part, 62 ... Shaft part, 62a ... Joint part, 63 ... Operation part 70 ... Sheath 71 ... Sheath body 72 ... Flap 72a ... Contact part 72b ... Tapered surface 73 ... Connection sheet (connection part) 75 ... Base, 75a ... engagement groove 76 ... Hinge (connection) Part), 80 ... Flap, 81 Spring (connecting portion), 83, 84 ... magnet, 86 ... wire (guide member), 87 ... spring (guide member), 90 ... sheath, 91 ... sheath body, 91a ... bendable portion, 92 ... base, 92a ... engagement Fitting groove, 92b ... flange part, 93 ... rotation mechanism, 93a ... knob part, 93b ... O-ring, 93c ... retaining part

Claims (10)

An endoscope sheath adapted to an endoscope having a curved portion on the distal end side of the insertion portion,
A cylindrical sheath body through which the insertion portion is detachably inserted; and
A plurality of rigid flaps annularly arranged on the distal end side of the sheath body corresponding to the curved portion of the insertion portion inserted into the sheath body;
And a connecting portion that connects the proximal end side of the flap to the distal end side of the sheath body so that the distal end side of the flap is swingable with respect to the radial direction of the sheath body. Endoscopic sheath.   The connecting portion connects the proximal end side of the flap to the distal end side of the sheath body so that the distal end side of the flap is movable in the opening / closing direction only on the radially outer side of the sheath body. Item 2. The endoscope sheath according to Item 1.   The sheath for an endoscope according to claim 1, wherein the connecting portion is provided at a position corresponding to a last piece of the bending pieces constituting the bending portion.   The sheath for an endoscope according to claim 1, wherein the flap has a tapered surface inclined toward the outer side on the distal end side on an outer surface of the distal end portion.   The sheath for an endoscope according to claim 1, wherein the flap includes a magnet that repels a distal end hard portion that is connected to the distal end side of the bending portion of the insertion portion.   2. The endoscope sheath according to claim 1, wherein the connecting portion is configured by an elastic member that urges the flap toward a radially inner side of the sheath main body.   The endoscope sheath according to claim 6, wherein the elastic member is a spring.   The endoscope sheath according to claim 1, further comprising a guide member that guides an angle of the flap connected through the connecting portion.   The sheath for endoscope according to claim 8, wherein the guide member is a wire that pulls a distal end side of the flap toward a proximal end side.   9. The endoscope for an endoscope according to claim 8, wherein the guide member includes a wire that pulls the distal end side of the flap toward the proximal end side, and a spring interposed in the middle of the wire. sheath.

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