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WO2012043034A1 - Dispositif médical et dispositif d'endoscope - Google Patents

Dispositif médical et dispositif d'endoscope Download PDF

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Publication number
WO2012043034A1
WO2012043034A1 PCT/JP2011/066856 JP2011066856W WO2012043034A1 WO 2012043034 A1 WO2012043034 A1 WO 2012043034A1 JP 2011066856 W JP2011066856 W JP 2011066856W WO 2012043034 A1 WO2012043034 A1 WO 2012043034A1
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WO
WIPO (PCT)
Prior art keywords
tube
fluid
state
strength
insertion portion
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2011/066856
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English (en)
Japanese (ja)
Inventor
勇太 杉山
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Medical Systems Corp
Original Assignee
Olympus Medical Systems Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Medical Systems Corp filed Critical Olympus Medical Systems Corp
Publication of WO2012043034A1 publication Critical patent/WO2012043034A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00154—Holding or positioning arrangements using guiding arrangements for insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/00078—Insertion part of the endoscope body with stiffening means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00112—Connection or coupling means
    • A61B1/00121—Connectors, fasteners and adapters, e.g. on the endoscope handle
    • A61B1/00128—Connectors, fasteners and adapters, e.g. on the endoscope handle mechanical, e.g. for tubes or pipes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • A61B1/128—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements provided with means for regulating temperature

Definitions

  • the present invention relates to a medical device capable of changing the strength of an insertion portion to be inserted into a lumen such as an intestine, and an endoscope apparatus including the medical device.
  • Endoscopes have been put to practical use in which an elongated insertion part can be inserted into a lumen such as the intestine for observation, and various treatments and treatments can be performed by inserting the treatment tool into the treatment tool channel as necessary.
  • a distal end side of an elongated insertion portion of an endoscope is provided with a bending portion configured to bend in the vertical direction and the horizontal direction.
  • the bending portion is configured to bend in accordance with operation of an operation member provided in the operation portion on the hand side.
  • the insertion part of the endoscope configured as described above is inserted toward the deep part of the large intestine through the anus, for example. At that time, the surgeon performs a twisting operation or a feeding operation for advancing the insertion portion positioned outside the body, and operates an operation member provided in the operation portion to appropriately bend the bending portion.
  • a flexible tubular overtube is placed in the sigmoid colon in advance, and then the insertion portion is inserted into the through-hole of the overtube, and this insertion portion is directed to the deep portion of the large intestine. Insert.
  • the guide wire is inserted in advance to a target site in the large intestine, and then the guide wire in the large intestine is observed through the observation window of the endoscope while the insertion portion is directed to the deep portion of the large intestine insert.
  • the overtube in the procedure of placing the overtube at the bent portion such as the sigmoid colon, the following problems occur when the flexibility of the overtube is softer than the flexibility of the insertion portion. That is, when the surgeon inserts the insertion portion into the through-hole of the overtube and pushes the insertion portion toward the deep portion of the large intestine, the overtube that has been curved along the sigmoid colon is pushed in. There arises a problem of being straightened by the insertion portion. In order to eliminate this problem, it is desirable to set the flexibility of the overtube harder than the flexibility of the insertion portion.
  • Patent Document 1 Japanese National Patent Publication No. 2007-500037 shows a catheter whose strength can be manipulated. Since this catheter is usually soft and flexible, it solves the problem that it is difficult to transmit the pressing force.
  • the catheter has an inner shaft with rigidity that can be changed by cooling and heating a desired location at one or more locations.
  • one or more fluid transport lumens for supplying heated or cooled fluid for changing the strength of the inner shaft are provided inside or outside the outer layer constituting the inner shaft. It is a configuration. For this reason, when there is one fluid transport lumen, there is a problem that it takes time until the strength of the inner shaft changes after the fluid is supplied to the fluid transport lumen. On the other hand, in order to improve responsiveness, when a fluid transport lumen is provided on the entire inner periphery or outer periphery of the outer layer, the number of fluid transport lumens increases, so that the configuration becomes complicated and the flexibility of the catheter is increased. There is a risk of damage.
  • the present invention has been made in view of the above circumstances, and a medical device including an insertion portion with excellent responsiveness, in which the hardness of the insertion portion changes by rapidly supplying a heated fluid or a cooled fluid.
  • the purpose is to provide.
  • the medical device of one embodiment of the present invention is a medical device having an insertion portion that is provided so as to be relatively movable with respect to the longitudinal axis direction of the endoscope insertion portion, and the insertion portion has a predetermined temperature.
  • a tubular strength variable member whose strength changes between the first state and the second state at the boundary; and a fluid having a temperature higher than the predetermined temperature that changes the strength variable member to the first state; or
  • An endoscope apparatus includes an endoscope having an endoscope insertion portion, and a longitudinal insertion hole through which the endoscope insertion portion is inserted into an insertion portion to be inserted into the body.
  • An overtube having a tubular strength variable member whose strength changes between a first state and a second state at a predetermined temperature, and the strength change member of the overtube in the first state.
  • a fluid supply device for supplying a fluid having a temperature higher than the predetermined temperature to be changed or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state
  • the insertion portion of the overtube is provided on the tube inner surface side of the strength varying member, and has a tube outer surface that constitutes the fluid supply path and a through hole that constitutes the insertion hole between the tube inner surface and the tube.
  • Member and said strength variable member It provided outside the tube surface, and comprises a second tube member having a luminal surface constituting the fluid return path between the tube outer surface.
  • An endoscope apparatus includes an endoscope having a treatment instrument channel in an endoscope insertion portion, and an insertion portion that can be inserted into and removed from the treatment instrument channel of the endoscope insertion portion.
  • a guide member having a tubular strength variable member whose strength changes between the first state and the second state at the boundary of the determined temperature, and the predetermined member for changing the strength variable member of the guide member to the first state.
  • a fluid supply device that supplies a fluid having a temperature higher than a predetermined temperature or a fluid having a temperature lower than the predetermined temperature that changes the strength variable member to the second state, and the insertion portion of the guide member Is provided on the tube inner surface side of the strength variable member, and includes a tube member having a tube outer surface constituting the fluid supply path and a through hole constituting the fluid recovery path between the strength varying member and the tube inner surface. ing.
  • An endoscope apparatus includes an endoscope having a treatment instrument channel in an endoscope insertion portion, and a longitudinal axis through which the endoscope insertion portion is inserted into an insertion portion to be inserted into the body.
  • An overtube having a tubular strength variable member having a direction insertion hole, the strength of which changes between a first state and a second state at a predetermined temperature, and a strength variable member of the overtube.
  • a first fluid supply for supplying a fluid having a temperature higher than the predetermined temperature to be changed to the first state or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state.
  • An apparatus an intensity variable member that is inserted and disposed in the treatment instrument channel and changes in strength between a first state and a second state with a predetermined temperature as a boundary, and predetermined in the treatment instrument channel Strength variable part inserted and arranged in the state A fluid having a temperature higher than the predetermined temperature that changes the first state to the first state or a fluid having a temperature lower than the predetermined temperature that changes the strength variable member to the second state. And a fluid having a temperature higher than the predetermined temperature or a fluid having a temperature lower than the predetermined temperature supplied from the second fluid supply device. It is supplied through a gap between the endoscope insertion portion or a gap between the strength varying member inserted and disposed in the treatment instrument channel and the treatment instrument channel.
  • FIG. 1 is a diagram for explaining an endoscope apparatus including an endoscope and an overtube as a medical device.
  • Longitudinal sectional view for explaining the configuration of the overtube Y3-Y3 line cross-sectional view of FIG. Y4-Y4 line cross-sectional view of FIG.
  • the figure explaining the procedure etc. which arrange the tube body of an overtube in the transverse colon The figure explaining the procedure etc.
  • FIGS. 9 to 14 relate to the second embodiment
  • FIG. 9 is a diagram illustrating an endoscope apparatus including an endoscope and a guide member that is a medical device.
  • Longitudinal sectional view for explaining the structure of the guide member The figure explaining the procedure after inserting the guide part of a guide member from an anus and passing through the sigmoid colon and arrange
  • FIG. 15 is a diagram for explaining an endoscope apparatus including an endoscope, an overtube, and a shape holding member.
  • the figure explaining the procedure etc. which lead out an endoscope insertion part in the descending colon via the tube body of an overtube The figure explaining the procedure etc. which arrange
  • position an endoscope insertion part to a liver curve via the tube body of an overtube The figure explaining the procedure etc.
  • the endoscope apparatus 1 of this embodiment is mainly configured by including an endoscope 10 and an overtube 20 that is a medical device.
  • the endoscope 10 mainly includes an endoscope insertion portion 11, an endoscope operation portion 12, and a universal cable 13.
  • the endoscope insertion portion 11 is configured by connecting a distal end portion 14, a bending portion 15, and a flexible tube portion 16 sequentially from the distal end side.
  • an image pickup unit including an image pickup element such as a CCD or a C-MOS for picking up an image of the test part is built.
  • the bending portion 15 is configured to bend in the vertical direction and the horizontal direction, for example.
  • the flexible tube portion 16 has a predetermined flexibility.
  • the endoscope operation section 12 is provided with a bending knob 17 for bending the bending section 15, a treatment instrument channel inlet 18 for guiding the treatment instrument to a treatment instrument channel (not shown), and the like.
  • the universal cable 13 extends from the side of the proximal end side of the endoscope operation unit 12.
  • An endoscope connector 19 is provided at the proximal end portion of the universal cable 13.
  • the endoscope connector 19 is detachably connected to an external device such as the light source device 2.
  • the overtube 20 has an insertion hole 20H in the longitudinal axis direction through which the endoscope insertion portion 11 can be inserted.
  • the overtube 20 includes a tube body 21 that is an insertion portion capable of changing flexibility, and an overtube operation portion 22 having rigidity that is a gripping portion.
  • the overtube operation section 22 is provided with a first tube base 23a and a second tube base 23b.
  • the first fluid tube 3 extending from the fluid supply device 30 is connected to the first tube base 23a.
  • a second fluid tube 4 extending from the fluid supply device 30 is connected to the second tube base 23b.
  • the tube body 21 includes a tubular strength variable member 25, a tubular insertion portion insertion tube 26, a tubular tube exterior member 27, and an annular tip component member 28.
  • the insertion portion insertion tube 26 and the tube exterior member 27 are tube members having predetermined flexibility.
  • the strength varying member 25 is a tubular member whose strength such as hardness or elastic modulus changes between a first state and a second state at a predetermined temperature.
  • the strength-variable member 25 is, for example, a shape memory polymer having a glass transition temperature set between, for example, 10 degrees Celsius and 55 degrees Celsius, or a thermoplastic having a melting point set between, for example, 10 degrees Celsius and 55 degrees Celsius. It is formed in a tubular shape with a resin and a low melting point alloy.
  • the strength varying member 25 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, set to 25 degrees Celsius, and is formed with an inner diameter dimension ⁇ d, a wall thickness t, and an outer diameter dimension ⁇ D.
  • the strength of the strength variable member 25 changes from the soft state of the first state to the hard state of the second state by changing the temperature of the strength variable member 25 from a state higher than the glass transition temperature to a lower state. To do.
  • the strength of the variable strength member 25 changes from the second state to the first state when the temperature of the variable strength member 25 changes from a lower state to a higher state than the glass transition temperature.
  • the first state and the second state of the strength variable member 25 are differences in the magnitude of deformation when an external force having a predetermined magnitude is applied to the strength variable member 25 from a predetermined direction. .
  • the strength varying member 25 is easily deformable in the first state.
  • the strength variable member 25 has, for example, higher hardness in the second state than in the first state.
  • the deformation amount of the strength varying member 25 is smaller than the deformation amount set in the first state, in other words, it is difficult to deform compared to the first state.
  • the tube body 21 including the strength varying member 25 is in the first state when the tube body 21 is inserted into the large intestine, for example, the tube body 21 is passive when the tip abuts against the wall of the large intestine.
  • the contact state is then released, it has the flexibility to return to its original shape again.
  • the flexibility that returns to the original shape after the contact is released as described above is referred to as a predetermined flexibility.
  • the tube body 21 retains the shape holding force that holds the curved shape of the tube body 21 in the soft state.
  • the shape holding force in the second state of the strength variable member 25 in the present embodiment is when the endoscope insertion portion 11 is inserted into the insertion hole 20H of the tube body 21 in which the curved shape is held.
  • the distal end portion 14 comes into contact with the curved inner peripheral surface of the insertion hole 20H, the curved shape of the tube body 21 is set without being deformed.
  • the insertion portion insertion tube 26 is a first tube member.
  • the insertion portion insertion tube 26 has a through hole that constitutes an insertion hole 20H into which the endoscope insertion portion 11 of the endoscope 10 can be inserted and removed.
  • the outer diameter of the insertion portion insertion tube 26 is smaller than the inner diameter of the strength variable member 25.
  • the insertion portion insertion tube 26 is disposed on the tube inner surface side of the strength variable member 25.
  • a first gap 29 a is formed between the inner surface of the variable strength member 25 and the outer surface of the insertion tube 26.
  • the first gap 29 a is a fluid supply path through which the fluid supplied from the fluid supply device 30 is sent.
  • the tube exterior member 27 is a second tube member.
  • the tube exterior member 27 constitutes the exterior of the tube body 21.
  • the tube exterior member 27 has a through-hole having a diameter larger than the outer diameter of the strength variable member 25 that is determined in advance.
  • the tube exterior member 27 is disposed on the tube outer surface side of the strength variable member 25.
  • a second gap 29 b is formed between the outer surface of the strength variable member 25 and the inner surface of the tube exterior member 27.
  • the first clearance 29 a is configured as a fluid recovery path for recovering the fluid supplied to the first clearance 29 a to the fluid supply device 30.
  • the tip component member 28 has a central hole 28h at the center thereof.
  • An outer surface of the distal end portion of the insertion portion insertion tube 26 is disposed in the central hole 28h.
  • the outer surface of the distal end portion of the insertion portion insertion tube 26 and the inner surface of the central hole 28h are integrally fixed, for example, by adhesion.
  • a circumferential recess 28 a is formed on the outer peripheral side of the tip constituent member 28.
  • the inner surface of the distal end portion of the tube exterior member 27 is disposed in the circumferential recess 28a.
  • the depth of the circumferential recess 28 a is set to be approximately the same as the thickness of the tube exterior member 27.
  • the distal end portion of the tube exterior member 27 is externally disposed in the circumferential recess 28a, and is fixed integrally with the distal end component member 28 by, for example, adhesion.
  • annular groove 28b is formed around the central hole 28h, which is a predetermined position on the base end face of the tip component member 28.
  • the tip end portion of the variable strength member 25 is engaged.
  • the distal end portion of the strength varying member 25 is disposed in the annular groove 28b, and is fixed integrally with the distal end component member 28 by, for example, adhesion.
  • a notch portion 25a having a predetermined width dimension and a predetermined depth dimension from the front end surface is predetermined in the circumferential direction at the distal end portion of the strength varying member 25 disposed in the annular groove 28b. It is formed at intervals.
  • the depth dimension of the notch 25a is set larger than the depth dimension of the annular groove 28b.
  • the cutout portion 25a is a communication portion that connects the fluid supply path and the fluid recovery path. According to this configuration, the fluid supplied to the first gap 29a passes through the notch 25a and is supplied to the second gap 29b side as indicated by an arrow Y2.
  • the overtube operation unit 22 includes, for example, a large diameter portion 22c and a small diameter portion 22d as shown in FIGS.
  • the overtube operation unit 22 includes a central through hole 22h along the central axis.
  • a proximal end portion of the insertion portion insertion tube 26 is disposed in the central through hole 22h, and is integrally fixed to the overtube operation portion 22 by adhesion, for example.
  • a proximal end portion of the tube exterior member 27 is fitted on the outer peripheral surface of the small-diameter portion 22d of the overtube operation portion 22 and is integrally fixed to the overtube operation portion 22 by adhesion, for example.
  • an annular groove 22j in which the proximal end portion of the strength varying member 25 is engaged is disposed at a predetermined position on the distal end surface of the small diameter portion 22d and around the central through hole 22h.
  • the base end portion of the strength varying member 25 is disposed in the annular groove 22j and is integrally fixed to the overtube operation portion 22 by, for example, adhesion.
  • Numeral 22a is a first communicating hole
  • numeral 22b is a second communicating hole
  • numeral 22e is a first space part
  • numeral 22f is a second space part.
  • the first communication hole 22a communicates the first space 22e and the first gap 29a.
  • the second communication hole 22b communicates the second space 22f and the second gap 29b.
  • the first space portion 22e is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 22c with the first lid member 24a.
  • the second space portion 22f is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 22c with the second lid member 24b.
  • the first tube base 23a is fixed to the first lid member 24a.
  • the second tube base 23b is fixed to the second lid member 24b.
  • Reference numeral 24a1 is a through hole and has openings on one side and the other side of the lid member 24a.
  • Reference numeral 24b1 is a through hole, and has openings on one side and the other side of the lid member 24b.
  • the fluid supply device 30 includes a cooling device 31, a heating device 32, a liquid feed pump 33, a suction pump 34, and a fluid control unit 35.
  • Reference numeral 5 denotes a foot switch.
  • the first fluid tube 3 is connected to a first fluid base 6 a provided in the fluid supply device 30.
  • the second fluid tube 4 is connected to the second fluid base 6b.
  • the cooling device 31 is installed at a predetermined position in a supply pipe 37 that communicates the liquid feeding tank 36 provided in the fluid supply device 30 and the first fluid base 6a.
  • the cooling device 31 cools, for example, water, which is a fluid supplied from the liquid feeding tank 36 to the supply pipe 37, for example, 10 degrees Celsius, which is lower than the glass transition temperature 25 degrees of the strength variable member 25.
  • the heating device 32 heats, for example, water, which is a fluid stored in the liquid supply tank 36, to, for example, 40 degrees Celsius, which is higher than the glass transition temperature 25 degrees of the strength variable member 25.
  • the heating device 32 is also installed at a predetermined position in the supply pipe 37.
  • the liquid feed pump 33 supplies the water stored in the liquid feed tank 36 to the supply pipe 37 in the operating state.
  • the suction pump 34 is connected to a suction tank 38 and sucks fluid through a recovery line 39 or the like having one end connected to the second fluid base 6b.
  • the foot switch 5 includes, for example, a first switch 5a and a second switch 5b.
  • a cooling signal is transmitted from the foot switch 5.
  • a heating signal is transmitted from the foot switch 5 by turning on the second switch 5b.
  • the fluid control unit 35 When the fluid control unit 35 receives the cooling signal from the foot switch 5, the fluid control unit 35 turns on the cooling device 31, the liquid feed pump 33, and the suction pump 34. Thus, the supply of water stored in the liquid supply tank 36 is started by the liquid supply pump 33 and the recovery of the water supplied by the suction pump 34 is started.
  • the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and is cooled to 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37.
  • the cooling water cooled to 10 degrees Celsius is the first fluid supply path through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a. It is supplied to the gap 29a.
  • the cooling water supplied to the 1st clearance gap 29a is supplied to the 2nd clearance gap 29b via the notch part 25a. Thereafter, the cooling water is the second clearance 29b, the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39, which are fluid recovery paths. It is collected in the suction tank 38 via
  • the fluid control unit 35 instantaneously switches the liquid feeding pump 33 to the off state.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. As a result, the cooling water in the overtube 20 can be reliably recovered.
  • the fluid control unit 35 When the fluid control unit 35 receives the heating signal from the foot switch 5, the fluid control unit 35 turns on the heating device 32, the liquid feeding pump 33, and the suction pump 34. As a result, supply of water stored in the liquid supply tank 36 is started by the liquid supply pump 33 and recovery of water supplied by the suction pump 34 is started.
  • the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37 and heated to 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37.
  • the hot water heated to 40 degrees Celsius is a first gap that is a fluid supply path through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a. 29a.
  • the warm water supplied to the 1st clearance gap 29a is supplied to the 2nd clearance gap 29b via the notch part 25a.
  • the hot water passes through the second gap 29b, the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery pipe line 39, which are fluid recovery paths.
  • the suction tank 38 Through the suction tank 38.
  • the fluid control unit 35 instantaneously switches the liquid feed pump 33 to the off state, similarly to the case where the first switch 5a is turned off.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. This ensures that hot water in the overtube 20 can be collected.
  • the medical staff uses the endoscope 10, the light source device 2, the overtube 20, and the fluid supply device 30 as the endoscope device 1.
  • a foot switch 5, a display device (not shown), a video processor, and the like are prepared.
  • the medical staff prepares the overtube 20 in which the hardness of the tube body 21 is changed by, for example, 25 degrees Celsius instructed by the operator.
  • the surgeon confirms whether the overtube 20 is instructed. After confirming that the instruction is given, the surgeon operates a setting switch provided on the main panel (not shown) of the fluid supply device 30 to set the temperature of water cooled by the cooling device 31 to, for example, 10 degrees Celsius.
  • the temperature of water heated by the heating device 32 is set to 40 degrees Celsius, for example.
  • the surgeon confirms the hardness of the tube body 21 of the overtube 20. That is, it is confirmed whether or not the strength varying member 25 is in a soft state.
  • the distal end portion of the tube body 21 is inserted into the large intestine from the patient's anus as shown in FIG. Then, a hand operation such as a push-in operation or a twist operation is performed to push the tube body 21 toward the deep part of the large intestine.
  • the tube body 21 inserted from the anus 71 advances from the rectum 72 to the sigmoid colon 73 by the operator's hand operation. Then, the tube body 21 reaches the sigmoid colon 73. Thereafter, the surgeon appropriately performs a pushing operation or a twisting operation to push the tube body 21 forward, and the distal end portion of the tube body 21 is distal to the sigmoid colon 73 as shown by a two-dot chain line in FIG. Place in side descending colon 74.
  • the surgeon determines that the distal end portion of the tube body 21 has passed through the sigmoid colon 73, the surgeon holds the first switch 5a of the foot switch 5 for the purpose of holding the curved shape of the tube body 21 as it is. Turn on. Then, a cooling signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 35 that has received the cooling signal turns on the cooling device 31, the liquid feed pump 33, and the suction pump 34 to start supplying water stored in the liquid feed tank 36. Then, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37 and is cooled to, for example, 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37 to become cooling water.
  • the cooling water passes through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space portion 22e, and the first communication hole 22a, and the first gap located on the inner surface side of the strength variable member 25. 29a. Thereafter, the cooling water supplied to the first gap 29a is supplied to the second gap 29b located on the tube outer surface side of the strength varying member 25 via the notch 25a.
  • the cooling water touches the entire inner surface of the pipe of the strength variable member 25 and the entire outer surface of the pipe, so that the temperature of the variable strength member 25 is rapidly reduced. Go. Then, when the temperature of the strength variable member 25 changes below the glass transition temperature, the hardness of the strength variable member 25 is changed from the first state to the second state, and the hardness of the tube body 21 is hard. To change. That is, the tube body 21 that has been placed in the descending colon 74, in the sigmoid colon 73, in the rectum 72, and outside the anus 71 is held in its curved shape.
  • the cooling water supplied to the second gap 29b passes through the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. And collected in the suction tank 38. That is, the cooling water is continuously supplied from the fluid supply device 30 to the first gap 29 a and the second gap 29 b of the overtube 20.
  • the operator inserts the endoscope insertion portion 11 into the insertion hole 20H from the overtube operation portion 22 side of the overtube 20. Then, the surgeon pushes the endoscope insertion portion 11 and operates it. Then, the endoscope insertion part 11 moves smoothly in the insertion hole 20H toward the distal end side.
  • the distal end portion 14 and the bending portion 15 of the endoscope 10 are led out into the descending colon 74 from the distal end of the tube body 21 as indicated by the solid line in FIG.
  • the surgeon continuously performs the operation of moving the endoscope insertion portion 11 forward, that is, the pushing operation, the twisting operation, and the bending operation while observing the endoscope image displayed on the display device.
  • the endoscope insertion part 11 is inserted toward the back direction of the descending colon 74 with poor mobility.
  • the surgeon visually recognizes the endoscopic image displayed on the display device, and places the distal end portion 14 at the boundary between the descending colon 74 and the movable transverse colon 75 as shown by a two-dot chain line in FIG. It arrange
  • the operator turns on the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the hold of the curved shape of the tube body 21. Then, a heating signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 35 Upon receiving the heating signal, the fluid control unit 35 turns on the heating device 32, the liquid feed pump 33, and the suction pump 34. Then, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37, and is heated to, for example, 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37 to become hot water.
  • the warm water passes through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a, and the first gap 29a located on the inner surface side of the strength variable member 25.
  • the hot water supplied to the first gap 29a is supplied to the second gap 29b located on the outer surface side of the strength variable member 25 via the notch 25a.
  • the hot water supplied to the second gap 29b passes through the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. It is collected in the suction tank 38.
  • the hot water is continuously supplied to the first gap 29a and the second gap 29b, so that the hot water touches the inner surface and the outer surface of the strength variable member 25, so that the temperature of the strength variable member 25 is quickly increased. It rises. Then, when the temperature of the strength variable member 25 changes to the glass transition temperature or higher, the hardness of the strength variable member 25 is changed from the second state to the first state, and the hardness of the tube body 21 is determined in advance. It changes to the state which has the flexibility. That is, the tube body 21 held in the curved shape returns to a state having predetermined flexibility again.
  • the operator turns off the second switch 5b.
  • the tube body 21 is held in a desired flexibility by the body temperature.
  • the surgeon performs a hand operation to advance the predetermined flexible tube body 21 toward the deep portion along the endoscope insertion portion 11 in which the distal end portion 14 is located in the vicinity of the splenic curve 76.
  • the surgeon When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and the distal end portion of the tube body 21 as shown by a solid line in FIG. Is placed in the transverse colon 75.
  • the first switch 5a of the foot switch 5 is again used for the purpose of maintaining the curved shape of the tube body 21 in the curved shape. Turn on the.
  • the cooling water is supplied in the order of the first gap 29a and the second gap 29b, and within the splenic curve 76, the descending colon 74, the sigmoid colon 73, the rectum 72, and the anus 71.
  • the tube body 21 in the soft state that has been arranged more externally is held in its curved shape.
  • the surgeon performs the pushing operation of the endoscope insertion portion 11 located in the insertion hole 20H. Then, the endoscope insertion portion 11 smoothly moves in the insertion hole 20H and is led out from the distal end of the tube body 21 into the transverse colon 75 as shown by a two-dot chain line in FIG.
  • the surgeon After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 is a liver that is a boundary between the transverse colon 75 and the ascending colon 78. It arrange
  • the operator turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 in order to release the curved shape of the tube body 21.
  • the hot water is supplied to the first gap 29a and the second gap 29b, the temperature of the strength varying member 25 starts to rise, and the hardness of the strength varying member 25 is increased from the second state. Change to the first state. That is, the tube body 21 held in the curved shape returns to the desired flexibility again.
  • the operator turns off the second switch 5b. Thereafter, the surgeon moves the tube body 21 forward toward the deep part along the endoscope insertion part 11 in which the distal end portion 14 is positioned in the vicinity of the liver curvature 77 with the flexible tube body 21 determined in advance. I do.
  • the surgeon When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and ascends the distal end portion of the tube body 21 as shown in FIG. Place in the colon 78.
  • the first switch 5a of the foot switch 5 is again used for the purpose of holding the curved shape of the tube body 21 as it is. Turn on the.
  • the cooling water is supplied in the order of the first gap 29a and the second gap 29b, and in the ascending colon 78, in the liver curve 77, in the transverse colon 75, in the splenic curve 76, and in the descending colon 74.
  • the tube body 21 in a soft state that is disposed inside, inside the sigmoid colon 73, inside the rectum 72, and outside the anus 71 is held in its curved shape.
  • the surgeon performs the pushing operation of the endoscope insertion portion 11 located in the insertion hole 20H. Then, the endoscope insertion portion 11 smoothly moves in the insertion hole 20H and is led out from the distal end of the tube body 21 into the ascending colon 78 as shown in FIG. After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward, and makes the endoscope insertion portion 11 reach the vicinity of the cecum 79 while observing the endoscope image.
  • the operator turns off the first switch 5a and turns on the second switch 5b to bring the tube body held in the second state in a curved shape into a soft state.
  • the operator confirms that the tube body 21 has changed to the desired flexibility, the operator operates the second switch 5b to turn off the large intestine while pulling back the overtube 20 and the endoscope insertion portion 11. Transition to inspection.
  • the first gap 29a is provided on the tube center side separated from the intestinal wall
  • the second gap 29b is provided on the tube outer peripheral side, which is the intestinal wall side
  • the cooling water is continuously provided in the order of the first gap 29a and the second gap 29b. Supply.
  • the cooling water cooled by the cooling device 31 can be supplied to the strength variable member 25 without being raised due to the influence of body temperature. Accordingly, it is possible to improve the responsiveness by causing the temperature of the strength varying member 25 to be lowered more quickly and changing from the first state to the second state.
  • the cooling device By stopping 31, the strength variable member 25 can be brought to a glass transition temperature or a temperature higher than the melting point by the body temperature, and the tube body 21 can be in a soft state. This ensures that the tube body 21 is removed from the body.
  • the cooling water is collected from the overtube 20 so that the body temperature can be quickly transmitted to the outer surface side of the strength variable member 25 located on the body wall side. .
  • the temperature of the strength varying member 25 starts to rise due to body temperature at the same time as the supply of cooling water is stopped.
  • the tube body in which the endoscope insertion portion 11 is in the second state when performing an inspection in the large intestine, after the distal end portion of the tube body 21 passes through the sigmoid colon of the patient, the tube body in which the endoscope insertion portion 11 is in the second state. It is supposed to be inserted into 21. However, the endoscope insertion part 11 is previously arranged at a predetermined position in the tube body 21, and the endoscope insertion part 11 and the tube body 21 are inserted from the anus 71 in a substantially integrated state, and the rectum 72, You may make it push forward to the sigmoid colon 73.
  • the water sent from the liquid supply tank 36 to the supply pipe 37 is cooled by the cooling device 31 or heated by the heating device 32 in the pipe.
  • a cooling water tank and a hot water tank may be provided, and a cooling device 31 and a heating device 32 may be provided in each tank.
  • the cooling device 31 and the heating device 32 are turned on during the inspection, so that the cooling signal is input to the fluid control unit 35 and the cooling water is supplied at the same time. Hot water can be supplied at the same time as it is input.
  • a plurality of uneven portions may be provided on the tube outer surface and the tube inner surface of the strength variable member 25.
  • the surface area in contact with the cooling water or hot water supplied to the first gap 29a and the second gap 29b is increased.
  • the responsiveness of switching from the first state to the second state or the responsiveness of switching to the opposite state can be further improved.
  • turbulence can be generated in the fluid flowing in the gaps 29a and 29b, and the heat exchange rate between the fluid and the outer surface of the tube and the inner surface of the tube can be increased.
  • the strength variable member 25 may be configured to change temperature uniformly by mixing a filler having high thermal conductivity into the shape memory polymer constituting the variable strength member 25. And by setting the direction of the filler to be mixed in a predetermined direction in advance, the heat conduction on the outer surface side and the inner surface side is improved compared to the thickness direction of the strength variable member 25, and the strength is more efficiently and uniformly. The temperature of the variable member 25 can be changed.
  • the endoscope apparatus 1A of the present embodiment is mainly configured by including an endoscope 10 and a guide member 40 that is a medical device.
  • the endoscope apparatus 1 ⁇ / b> A includes an endoscope 10, a fluid supply device 30, and a foot switch 5 having the same configuration as that of the above-described embodiment.
  • the guide member 40 is inserted into the treatment instrument channel (not shown) from the treatment instrument channel inlet 18 provided in the endoscope operation unit 12 and led out from the distal end opening (not shown) into the body.
  • the guide member 40 includes a guide part 41 as an insertion part and a rigid guide part operation part 42 as a grip part.
  • the guide part 41 is configured to be able to change flexibility.
  • the guide portion operation unit 42 is provided with a first tube base 43a and a second tube base 43b.
  • the first fluid tube 3 extending from the fluid supply device 30 is connected to the first tube base 43a
  • the second fluid tube 4 extending from the fluid supply device 30 is connected to the second tube base 43b.
  • Reference numeral 44 denotes a proximal end cover member.
  • the guide portion 41 includes a tubular variable strength member 45 that also serves as a tube exterior member, and a tubular inner layer tube 46.
  • the inner layer tube 46 is a tube member having predetermined flexibility.
  • the strength variable member 45 changes in strength between the first state and the second state at a predetermined temperature.
  • the strength variable member 45 is a shape memory polymer that has a glass transition temperature set between, for example, 10 degrees Celsius and 55 degrees Celsius, or a thermoplastic that has a melting point that is set between, for example, 10 degrees Celsius and 55 degrees Celsius. It is formed in a cylindrical shape with a resin and a low melting point alloy. That is, in the present embodiment, the distal end side of the strength varying member 45 is closed.
  • the strength variable member 45 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, set to 25 degrees Celsius, and is formed with an inner diameter dimension ⁇ d1, a wall thickness t1, and an outer diameter dimension ⁇ D1.
  • the inner layer tube 46 has a through hole 46a serving as a fluid recovery path.
  • the outer diameter of the inner layer tube 46 is smaller than the inner diameter of the variable strength member 45 in advance.
  • the inner layer tube 46 is disposed on the inner surface side of the strength variable member 45.
  • a gap 47 is formed between the tube inner surface of the strength varying member 45 and the tube outer surface of the inner layer tube 46.
  • the gap 47 is a fluid supply path through which the fluid supplied from the fluid supply device 30 is sent.
  • the length of the distal end surface of the inner layer tube 46 is set so as to be spaced from the bottom surface of the distal end portion of the strength variable member 45 by a predetermined dimension.
  • the separation part 48 is a communication part that communicates the fluid supply path and the fluid recovery path. That is, in the present embodiment, the fluid supplied to the gap 47 flows into the through hole 46a side through the separating portion 48 as indicated by an arrow Y10.
  • the guide portion 41 When the strength varying member 45 is in the first state, the guide portion 41 is passively deformed, for example, when it is inserted into the large intestine and its tip abuts against the large intestine wall. And after that, it has the predetermined flexibility which returns to an original shape by cancelling
  • the guide portion 41 has a shape holding force that holds the curved shape in the first state at the time of switching. Then, the shape holding force of the strength varying member 45 in the present embodiment moves the endoscope insertion portion 11 along the guide portion 41 that is derived from the distal end opening of the treatment instrument channel and is held in a curved shape. At this time, the curved shape of the guide portion 41 is not deformed by the moving endoscope insertion portion 11 and is set to hold the curved shape.
  • variable strength member 45 is cylindrical
  • the variable strength member 45 may be tubular, and in that case, one end is closed with, for example, a disc-shaped lid member. And in the structure which provides a cover member, you may make it provide the annular groove for fixing the inner layer tube 46 to a cover member integrally on the one surface side of a cover member.
  • the inner layer tube 46 is provided with a notch having substantially the same configuration as the notch 25a serving as a communication portion.
  • the guide part operation part 42 has, for example, a large diameter part 42c and a small diameter part 42d. Moreover, the guide part operation part 42 is provided with the central through-hole 42h along the central axis. The proximal end portion of the inner layer tube 46 is disposed in the central through hole 42h, and is fixed integrally to the guide portion operation portion 42 by, for example, adhesion. The proximal end side opening of the central through hole 42 h is closed by the proximal end cover member 44.
  • the base end portion of the strength varying member 45 is fitted on the outer peripheral surface of the small diameter portion 42d of the guide portion operation portion 42, and is fixed integrally to the guide portion operation portion 42 by, for example, adhesion.
  • Reference numeral 42a is a communication hole
  • reference numeral 42b is a space portion.
  • the communication hole 42 a communicates the space 42 b and the gap 47.
  • the space portion 42 b is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 42 c with the lid member 49.
  • the first tube base 43 a is fixed to the lid member 49.
  • the second tube base 43 b is fixed to the base end cover member 44.
  • Reference numeral 44 h is a through hole, and has openings on one side and the other side of the lid member 44.
  • Reference numeral 49h denotes a through hole, which has openings on one side and the other side of the lid member 49.
  • the fluid supply device 30 shown in FIG. 9 includes a cooling device 31, a heating device 32, a liquid feed pump 33, a suction pump 34, and a fluid control unit 35.
  • the foot switch 5 includes, for example, a first switch 5a and a second switch 5b.
  • the fluid control unit 35 Upon receiving the cooling signal, the fluid control unit 35 turns on the cooling device 31 and starts supplying the water stored in the liquid supply tank 36 by the liquid supply pump 33 and is supplied by the suction pump 34. Start collecting water. That is, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and cooled to 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37. The cooling water cooled to 10 degrees Celsius is supplied to the gap 47, which is a fluid supply path, through the first fluid base 6a, the first fluid tube 3, the first tube base 43a, the space portion 42b, and the communication hole 42a. . Then, the cooling water supplied to the gap 47 flows into the through hole 46 a that is a fluid recovery path via the separation portion 48. Thereafter, the cooling water is recovered from the through hole 46 a into the suction tank 38 via the second tube base 43 b, the second fluid tube 4, the second fluid base 6 b, and the recovery conduit 39.
  • the fluid control unit 35 instantaneously switches the liquid feeding pump 33 to the off state.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. Thereby, the cooling water in the guide member 40 can be reliably collected.
  • the fluid control unit 35 When the fluid control unit 35 receives the heating signal, the fluid control unit 35 turns on the heating device 32 to start the supply of water stored in the liquid supply tank 36 by the liquid supply pump 33 and the supply by the suction pump 34. Start collecting water. That is, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and is heated to 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37. The hot water heated to 40 degrees Celsius is supplied to the gap 47 through the first fluid base 6a, the first fluid tube 3, the first tube base 43a, the space portion 42b, and the communication hole 42a. Then, the hot water supplied to the gap 47 flows into the through hole 46 a via the separation portion 48. Thereafter, the hot water is recovered in the suction tank 38 via the second tube base 43 b, the second fluid tube 4, the second fluid base 6 b, and the recovery conduit 39.
  • the fluid control unit 35 instantaneously switches the liquid feed pump 33 to the off state, similarly to the case where the first switch 5a is turned off.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. This ensures that hot water in the guide member 40 can be collected.
  • the medical staff uses the endoscope 10, the light source device 2, the guide member 40, and the fluid supply device 30 as the endoscope device 1A.
  • a foot switch 5, a display device (not shown), a video processor, and the like are prepared.
  • the medical staff prepares the guide member 40 whose hardness of the guide portion 41 is changed by, for example, 25 degrees Celsius instructed by the operator.
  • the surgeon confirms whether the guide member 40 has instructed. After confirming that the instruction is given, the surgeon operates a setting switch provided on the main panel (not shown) of the fluid supply device 30 to set the temperature of water cooled by the cooling device 31 to, for example, 10 degrees Celsius. The temperature of water heated by the heating device 32 is set to 40 degrees Celsius, for example.
  • the surgeon confirms the hardness of the guide portion 41 of the guide member 40. That is, it is confirmed whether or not the strength varying member 45 is in a soft state. If the surgeon confirms that the guide portion 41 has a predetermined flexibility, a channel opening (not shown) provided on the distal end surface of the distal end portion 14 from the treatment instrument channel inlet 18 to the guide portion distal end portion is provided. Insert it toward. Thereafter, the surgeon guides the guide portion 41 to the outside from the channel opening of a desired length.
  • the surgeon inserts the distal end portion of the guide portion 41 into the large intestine from the patient's anus. Then, a hand operation such as a pushing operation and a twisting operation is performed to push the guide portion 41 toward the deep part of the large intestine. Then, the operator places the distal end portion of the guide portion 41 inserted from the anus 71 in the descending colon 74 on the distal end side from the sigmoid colon 73 as shown in FIG.
  • the surgeon determines that the distal end portion of the guide portion 41 has passed through the sigmoid colon 73, the surgeon holds the first switch 5a of the foot switch 5 for the purpose of holding the curved shape of the guide portion 41 as it is. Turn on. Then, a cooling signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 30 Upon receiving the cooling signal, the fluid control unit 30 supplies the cooling water via the first fluid base 6a to the strength variable member 45 via the first fluid tube 3, the first tube base 43a, the space part 42b, and the communication hole 42a. It supplies to the clearance 47 located in the pipe inner surface side. Thereafter, the cooling water supplied to the gap 47 flows into the through hole 46a through the separation portion 48, and from the through hole 46a, the second tube base 43b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. It is collected in the suction tank 38 via That is, the cooling water is continuously supplied from the fluid supply device 30 to the gap 47 of the guide member 40.
  • the cooling water continuously supplied to the gap 47 touches the inner surface of the pipe of the strength varying member 45 and quickly reduces the temperature of the strength varying member 45.
  • the temperature of the strength variable member 45 is changed to the glass transition temperature or lower, the hardness of the strength variable member 45 is changed from the first state to the second state, and the hardness of the guide portion 41 is hard.
  • the guide portion 41 in a soft state that is disposed in the descending colon 74, the sigmoid colon 73, the rectum 72, and the anus 71 is held in its curved shape.
  • the surgeon moves the endoscope insertion portion 11 along the guide portion 41 in a hard state. That is, as shown by a broken line in FIG. 11, the distal end portion 14 of the endoscope insertion portion 11 is inserted into the rectum 72 from the anus 71, and then a hand operation such as a pushing operation and a twisting operation is performed to insert the endoscope.
  • the part 11 is introduced into the descending colon 74 along the hard guide part 41 as shown by the solid line in FIG.
  • the surgeon further inserts the endoscope insertion portion 11 toward the back of the descending colon 74 having poor mobility while observing the endoscope image displayed on the display device. Then, the surgeon visually recognizes the endoscopic image displayed on the display device and arranges the distal end portion 14 at a desired position in the vicinity of the splenic curve 76 as indicated by a two-dot chain line in FIG.
  • the surgeon turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the curved shape of the guide portion 41. Then, a heating signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 35 Upon receiving the heating signal, the fluid control unit 35 supplies the hot water via the first fluid base 6a to the pipe of the variable strength member 45 via the first fluid tube 3, the first tube base 43a, the space 42b, and the communication hole 42a. It supplies to the clearance gap 47 located in the surface side. Thereafter, the hot water supplied to the gap 47 flows into the through hole 46a through the separation portion 48, and passes through the second tube cap 43b, the second fluid tube 4, the second fluid cap 6b, and the recovery conduit 39 from the through hole 46a. Through the suction tank 38.
  • the hot water continuously supplied to the gap 47 touches the inner surface of the strength variable member 45 and quickly raises the temperature of the strength variable member 45. Then, when the temperature of the strength variable member 45 changes to the glass transition temperature or higher, the hardness of the strength variable member 45 is changed from the second state to the first state, and the hardness of the guide portion 41 is set in advance. It changes to the defined flexibility. That is, the guide part 41 held in the curved shape returns to the desired flexibility state again.
  • the operator turns off the second switch 5b.
  • the guide portion 41 is held in a desired flexibility by the body temperature. Thereafter, the surgeon further pushes the predetermined flexible guide portion 41 toward the opening of the treatment instrument channel.
  • the distal end portion of the guide portion 41 is led out into the transverse colon 75 from the distal end portion 14 of the endoscope. If the surgeon visually recognizes that the distal end portion of the guide portion 41 is disposed at a desired position of the transverse colon 75 in the endoscopic image, the transverse portion of the transverse colon 75 and the guide portion 41 disposed in the treatment instrument channel are displayed.
  • the first switch 5a of the foot switch 5 is turned on again for the purpose of maintaining the curved shape as it is.
  • the cooling water is supplied to the gap 47, and the guide portion 41 in the soft state that has been arranged in the transverse colon 75, the treatment instrument channel, and the treatment instrument channel inlet 18 is provided. It is held in its curved shape.
  • the surgeon performs a pushing operation or a twisting operation of the endoscope insertion portion 11 to introduce the endoscope insertion portion 11 into the transverse colon 75 along the guide portion 41 in a hard state.
  • the surgeon performs an operation of advancing the endoscope insertion portion 11 while observing the endoscope image, so that the endoscope insertion portion 11 is hepatic curved 77 as indicated by a two-dot chain line in FIG. Place it at a desired position in the vicinity.
  • the surgeon stops the insertion of the endoscope insertion portion 11. Then, the operator turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the curved shape of the guide portion 41.
  • the hot water is supplied to the gap 47, the hardness of the strength varying member 45 changes from the second state to the first state, and the guide portion 41 can be preset again. Return to flexibility.
  • the operator turns off the second switch 5b, and further pushes the guide portion 41, which has changed to a predetermined flexibility, toward the opening of the treatment instrument channel.
  • the distal end portion of the guide portion 41 is led into the ascending colon 78 as shown by the solid line in FIG.
  • the first switch 5a of the foot switch 5 is again used for the purpose of holding the curved shape of the guide portion 41 in the curved shape.
  • the cooling water is supplied to the gap 47 and is in a soft state in which the cooling water is disposed in the ascending colon 78, the transverse colon 75, the treatment instrument channel, and the treatment instrument channel inlet 18.
  • the guide portion 41 is held in its curved shape.
  • the surgeon performs a pushing operation or a twisting operation of the endoscope insertion portion 11 to introduce the endoscope insertion portion 11 into the ascending colon 78 along the guide portion 41 in a hard state.
  • the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 reaches the vicinity of the cecum 79.
  • the operator turns off the first switch 5a and turns on the second switch 5b to bring the guide portion 41 held in the curved shape into a soft state.
  • the operator turns off the second switch 5b to remove the guide member 40 from the treatment instrument channel. Then, after the guide member 40 is removed, the procedure shifts to an inspection of the large intestine performed while pulling back the endoscope insertion portion 11.
  • the outer diameter dimension of the strength variable member 45 is set to the maximum outer diameter dimension permitted by the guide section 41 by arranging the strength variable member 45 on the outermost peripheral side of the guide section 41.
  • the maximum holding strength can be obtained.
  • the distal end portion of the guide portion 41 when performing an inspection in the large intestine, the distal end portion of the guide portion 41 is disposed in advance at a position where the patient's sigmoid colon 73 has passed, and then the endoscopic view is performed.
  • the mirror insertion part 11 is inserted into the large intestine along the guide part 41 which is in a hard state.
  • the guide part 41 in a soft state is disposed in the treatment instrument channel of the endoscope insertion part 11, and the endoscope insertion part 11 and the guide part 41 are inserted into the rectum 72 from the anus 71 together.
  • the guide portion 41 is led out from the distal end portion 14 and the guide portion 41 is switched to the second state or the first state so that the endoscope insertion portion 11 passes through the sigmoid colon 73. May be.
  • the hardness of the guide portion 41 is set to be hard, and the endoscope insertion portion 11 is set along the guide portion 41 in the second state. It may be inserted toward the deep part of the large intestine.
  • strength variable member 45 which comprises the guide part 41 is aimed at the improvement of the responsiveness which changes from a soft state to a hard state, or the reverse state.
  • a member having high thermal conductivity may be disposed on the surface, or a member having high thermal conductivity may be disposed on the outer surface and the inner surface of the strength variable member 25 constituting the tube body 21.
  • a high heat conductive member a silicon sheet, a graphite sheet, a PGS graphite sheet, a mesh tube knitted in a mesh shape, or grease is used.
  • the silicon sheet, the graphite sheet, or the PGS graphite sheet having a band shape is spirally wound and disposed. Thereby, the responsiveness can be improved without impairing the flexibility of the guide portion 41 and the tube body 21.
  • the endoscope insertion portion 11 is moved toward the deep portion of the large intestine along the guide portion 41.
  • the endoscope insertion portion 11 in the insertion hole 20H of the tube body 21 is moved toward the distal end of the tube body 21 while the cooling water is supplied to bring the tube body 21 into the second state.
  • the guide surface 41 is heated at the outer surface side of the strength varying member 45 by the body temperature or room temperature, and the temperature of the cooling water rises. There is a risk.
  • the distal end portion 14 of the endoscope insertion portion 11 in which the insertion portion insertion tube 26 is disposed in the insertion hole 20H there is a risk that the temperature of the cooling water may be increased by heat generated from the imaging device provided in the window or heat generated from the illumination window, and the temperature of the cooling water may be increased by heating the tube exterior member 27 at the body temperature or room temperature. May rise.
  • a heat insulating part is provided in at least one of the outer peripheral surface or inner peripheral surface of the insertion part insertion pipe 26. Accordingly, it is possible to prevent body temperature and room temperature from being transmitted to the second gap 29b side via the tube exterior member 27. In addition, it is possible to prevent the heat generated from the imaging device or the illumination window from being transmitted to the first gap 29a via the insertion portion insertion tube 26.
  • a heat insulating portion is provided on at least one of the tube outer surface and the tube inner surface of the strength varying member 45. Accordingly, it is possible to prevent body temperature and room temperature from being transmitted to the gap 47 via the strength varying member 45.
  • the heat insulation part mentioned above is a heat insulation sheet, for example, a strip
  • a heat insulating part can be provided without impairing the flexibility of the guide part 41 and the tube body 21.
  • the endoscope apparatus 1 ⁇ / b> B of the present embodiment is mainly configured by including an endoscope 10, an overtube 20 that is a medical device, and a shape holding member 50.
  • the endoscope apparatus 1B includes fluid supply apparatuses 30B1 and 30B2 and foot switches 5B1 and 5B2 having the same configuration as that of the above-described embodiment.
  • the shape holding member 50 is an elongated rod-shaped member. The shape holding member 50 is inserted into a treatment instrument channel (not shown) from a treatment instrument channel inlet 18 provided in the endoscope operation unit 12 and is disposed at a predetermined position.
  • the shape holding member 50 includes a shape holding main body 51 that is an insertion portion that can change flexibility, and a shape holding operation portion 52 having rigidity that is a gripping portion.
  • the shape holding body 51 of the present embodiment is configured by a solid strength variable member. That is, the shape-maintaining body 51 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, 25 degrees Celsius, and has an outer diameter dimension that is smaller than the inner diameter of the treatment instrument channel. One end of the shape holding body 51 is fixed to the shape holding operation unit 52.
  • a plug body with a tube cap (hereinafter abbreviated as a plug body) 53 is attached to the treatment instrument channel inlet 18 of the present embodiment.
  • the plug 53 includes a plug base 54 to which the first fluid tube 3B extending from the second fluid supply device 30B2 is connected. For example, water supplied from the first fluid tube 3B to the plug base 54 is supplied into the treatment instrument channel.
  • a communication part with a tube cap (hereinafter abbreviated as a communication part) 55 is attached to the overtube operation part 22 of the overtube 20 of the present embodiment.
  • the communication portion 55 includes a communication portion base 56 and a side hole 57.
  • a second fluid tube 4B extending from the second fluid supply device 30B2 is connected to the base 56.
  • the configuration of the first fluid supply device 30B1 and the configuration of the second fluid supply device 30B2 are the same as the configuration of the fluid supply device 30 described above, and the configuration of the first foot switch 5B1 and the configuration of the second foot switch 5B2 are the same.
  • the configuration of the foot switch 5 is the same as that described above.
  • the first fluid tube 3 ⁇ / b> B has the same configuration as the first fluid tube 3
  • the second fluid tube 4 ⁇ / b> B has the same configuration as the second fluid tube 4.
  • Other configurations are the same as those of the above-described embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.
  • the operation of the endoscope apparatus 1B configured as described above will be described.
  • the endoscope apparatus 1B is used when the endoscope insertion portion 11 is inserted, for example, to the vicinity of the cecum to perform inspection in the large intestine.
  • the endoscope apparatus 1B includes an endoscope 10, a light source device 2, an overtube 20, a shape holding member 50, fluid supply devices 30B1, 30B2, foot switches 5B1, 5B2, a display device (not shown), a video processor, and the like.
  • the operator places the shape holding member 50 in a soft state in a desired state in the treatment instrument channel of the endoscope insertion portion 11 in advance.
  • the surgeon inserts the shape holding main body 51 into the treatment instrument channel through a plug hole (not shown) of the plug 53 and brings the end surface of the shape holding operation portion 52 into contact with the plug 53.
  • the plug hole is closely attached to the outer peripheral surface of the shape-maintaining main body 51, and the distal end of the shape-maintaining main body 51 is located, for example, on the distal end side of the bending portion 15.
  • the surgeon operates a setting switch provided on a main panel (not shown) of the fluid supply devices 30B1 and 30B2, and the temperature of water cooled by the cooling device 31 provided in each fluid supply device 30B1 and 30B2. Is set to 10 degrees Celsius, for example, and the temperature of the water heated by the heating device 32 is set to 40 degrees Celsius, for example.
  • the surgeon first confirms that the hardness of the tube body 21 of the overtube 20 is a predetermined flexibility. Thereafter, the surgeon inserts the distal end portion of the tube body 21 into the large intestine from the patient's anus and places the distal end portion of the tube body 21 on the distal side of the sigmoid colon 73 as indicated by the two-dot chain line in FIG. In the descending colon 74.
  • the first switch of the first foot switch 5B1 is used for the purpose of maintaining the curved shape of the tube body 21 as it is. Turn on 5a.
  • the cooling water cooled by the first fluid supply device 30B1 is supplied from the first fluid base 6a to the first gap 29a and the second gap 29b of the tube body 21.
  • the strength varying member 25 is quickly cooled by the cooling water, and the tube body 21 arranged in the descending colon 74, the sigmoid colon 73, the rectum 72, and the outside of the anus 71 is held in a curved shape. Is done.
  • the endoscope When the operator confirms that the tube body 21 has changed to a hard state, the endoscope is inserted in which the shape-maintaining body 51 is disposed in the treatment instrument channel from the overtube operation portion 22 side into the insertion hole 20H. Insert part 11. Then, the surgeon advances the distal end portion 14 of the endoscope insertion portion 11 toward the distal end of the tube body 21.
  • the distal end portion 14 and the bending portion 15 of the endoscope insertion portion 11 are led out into the descending colon 74 in order from the distal end of the tube body 21.
  • the surgeon performs an operation of inserting the endoscope insertion unit 11 into the deep part of the large intestine while observing the endoscope image displayed on the display device. Then, as shown by a two-dot chain line in FIG. 16, the distal end portion 14 is arranged at a desired position in the vicinity of the splenic curve 76.
  • the surgeon holds the curved shape of the endoscope insertion portion 11 as it is, that is, holds the curved shape of the shape holding body 51 in the treatment instrument channel as it is.
  • the first switch 5a of the second foot switch 5B2 is turned on. Then, a cooling signal is transmitted from the second foot switch 5B2 to the second fluid supply device 30B2.
  • the second fluid supply device 30B2 Upon receiving the cooling signal, the second fluid supply device 30B2 supplies the cooling water into the treatment instrument channel via the first fluid tube 3B and the plug base 54. In this state, since the outer peripheral surface of the shape holding body 51 is in close contact with the plug hole, the cooling water is not leaked to the outside through the plug hole, and the inner peripheral surface of the treatment instrument channel and the shape holding body. It is supplied toward the channel opening through a gap with the outer peripheral surface of 51.
  • the cooling water toward the channel opening touches the outer surface of the shape holding body 51 made of a variable strength member, whereby the shape holding body 51 is quickly cooled.
  • the hardness of the guide portion 41 arranged in the treatment instrument channel of the endoscope insertion portion 11 and outside the treatment instrument channel inlet 18 (not shown) changes to a hard state. .
  • the curved shape of the endoscope insertion portion 11 is held by the shape holding main body 51 disposed in the treatment instrument channel.
  • the surgeon turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b for the purpose of changing the tube body 21 from a hard state to a soft state.
  • a heating signal is transmitted from the first foot switch 5B1 to the first fluid supply device 30B1, and hot water is supplied to the first gap 29a and the second gap 29b of the tube body 21.
  • the temperature of the strength varying member 25 of the tube body 21 rises, and the tube body 21 held in the curved shape returns to the predetermined flexibility again.
  • the operator When the operator confirms the flexibility of the tube body 21, the operator performs a hand operation to advance the tube body 21 along the endoscope insertion portion 11 in which the distal end portion 14 is located in the vicinity of the splenic curve 76. At this time, the tube body 21 moves smoothly along the endoscope insertion portion 11 in which the shape holding body 51 disposed in the treatment instrument channel is in the second state and is in a hard state.
  • the surgeon When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and the distal end portion of the tube body 21 as shown in FIG. Is placed in the transverse colon 75.
  • the cooling water that has flowed out of the channel opening into the body is collected through a gap between the outer peripheral surface of the endoscope insertion portion 11 and the inner peripheral surface of the insertion hole 20H.
  • the first foot switch 5B1 of the first foot switch 5B1 is again used for the purpose of holding the curved shape of the tube body 21 as it is.
  • the switch 5a is turned on.
  • the cooling water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and in the transverse colon 75, in the splenic curve 76, in the descending colon 74, and in the sigmoid colon.
  • the tube body 21 arranged outside 73, inside the rectum 72, and outside the anus 71 remains in a curved shape and changes to a hard state.
  • the surgeon also has the first switch 5a of the second foot switch 5B2 for the purpose of releasing the holding of the curved shape of the endoscope insertion portion 11, that is, for the purpose of returning the shape holding body 51 to a flexible state. Is turned off and the second switch 5b is turned on.
  • the hot water supplied from the second fluid supply device 30B2 flows toward the channel opening through the gap between the treatment instrument channel and the shape holding body 51. Then, the temperature of the shape holding body 51 rises, and the shape holding body held in the second state in the curved state returns to the predetermined flexibility again, so that the endoscope insertion portion 11 is flexible. It becomes the state which has sex.
  • the warm water does not flow into the body and the outer peripheral surface of the endoscope insertion portion 11 and the insertion hole 20 ⁇ / b> H. It is collected through a gap with the inner peripheral surface.
  • the surgeon turns off the second switch 5b after confirming that the shape-maintaining body 51 is in the first state. Then, the operator performs an operation of moving the endoscope insertion portion 11 located in the insertion hole 20H to the distal end side of the tube body 21. Then, the endoscope insertion portion 11 is moved to the distal opening side of the insertion hole 20H and is led out from the distal end of the tube body 21 into the transverse colon 75. Thereafter, the operator arranges the endoscope insertion portion 11 at a desired position in the vicinity of the liver curve 77 as shown by a two-dot chain line in FIG. 17 while observing the endoscope image.
  • the operator turns on the first switch 5a of the second foot switch 5B2 again for the purpose of holding the curved shape of the endoscope insertion portion 11 in the curved shape.
  • the cooling water flows in the treatment instrument channel toward the channel opening, thereby cooling the shape-maintaining body 51, and in the liver curvature 77, in the transverse colon 75, in the treatment instrument channel, and
  • the shape-maintaining main body 51 in the first state that is disposed outside the treatment instrument channel inlet 18 is held in the second state with its curved shape. That is, again, the curved shape of the endoscope insertion portion 11 in the large intestine is held in a hard state by the shape holding body 51.
  • the operator turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b for the purpose of returning the tube body 21 from the hard state to the soft state. Then, hot water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and the tube body 21 returns to the predetermined flexibility again.
  • the surgeon performs a hand operation to advance the flexible tube body 21 along the endoscope insertion portion 11 in which the curved shape is held in a hard state by the shape-maintaining body 51, and FIG.
  • the distal end of the tube body 21 is placed in the ascending colon 78 as shown in FIG.
  • the operator turns on the first switch 5a of the first foot switch 5B1 for the purpose of holding the curved shape of the tube body 21 in the curved shape.
  • the cooling water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and the strength varying member 25 is cooled, so that the inside of the ascending colon 78 and the liver curve 77 In the transverse colon 75, in the splenic curve 76, in the descending colon 74, in the sigmoid colon 73, in the rectum 72, and outside the anus 71, the tube body 21 remains in a curved shape and changes to a hard state. .
  • the surgeon releases the holding of the curved shape of the endoscope insertion portion 11. That is, for the purpose of returning the shape-maintaining body 51 to the first state, the first switch 5a of the second foot switch 5B2 is turned off and the second switch 5b is turned on. Then, the temperature of the shape-maintaining main body 51 is increased by the hot water supplied from the second fluid supply device 30B2, and the shape-maintaining main body 51 that has been held in the second state in the curved state is again predetermined flexibility. By returning to, the endoscope insertion portion 11 becomes flexible.
  • the surgeon performs an operation of pushing the endoscope insertion portion 11 located in the insertion hole 20H, and moves the endoscope insertion portion 11 from the distal end of the tube body 21 to the ascending colon 78 as shown in FIG. Let it be derived. After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 reaches the vicinity of the cecum 79.
  • the operator turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b to bring the tube body 21 held in the curved shape into a soft state.
  • the surgeon removes the shape holding body 51 from the treatment instrument channel. Then, the surgeon shifts to an inspection of the large intestine performed while pulling back the overtube 20 and the endoscope insertion portion 11.
  • the shape holding main body 51 is arranged in the treatment instrument channel of the endoscope 10 and the cooling water or the hot water is supplied into the treatment instrument channel.
  • the state is changed to the first state or the second state. This makes it possible to change the endoscope insertion portion 11 in which the shape-maintaining main body 51 is disposed in the treatment instrument channel between a predetermined flexible state and a hard state that maintains a curved shape.
  • the shape-maintaining main body 51 by configuring the shape-maintaining main body 51 with a solid strength variable member, it is possible to obtain higher strength than a tubular member having the same diameter. According to this configuration, the tube body 21 of the overtube 20 is moved along the endoscope insertion portion 11 by setting the shape-maintaining body 51 disposed in the treatment instrument channel to the second state in which the curved shape is maintained. Therefore, it becomes possible to insert it deeply.
  • the cooling water that has flowed into the body is collected through the gap between the outer peripheral surface of the endoscope insertion portion 11 and the inner peripheral surface of the insertion hole 20H.
  • a plurality of grooves extending in the longitudinal axis direction may be formed on the outer periphery of the shape maintaining body 51.
  • the shape holding body 51 of the shape holding member 50 is inserted and disposed in the treatment instrument channel provided in the endoscope insertion portion 11, and cooling water or hot water is supplied into the treatment instrument channel.
  • the configuration is shown.
  • the endoscope 10, the overtube 20, the guide member 40, the light source device 2, the first fluid supply device 30B1, the second fluid supply device 30B2, the first foot switch 5B1, the second An endoscope apparatus 1C including the foot switch 5B2, a display device (not shown), a video processor, and the like may be configured, and the guide portion 41 of the guide member 40 may be used as the shape maintaining body 51.
  • a gap formed by two members is used as a fluid supply path and a fluid recovery path.
  • a belt-shaped member 63 having a rectangular cross-sectional shape including two through holes 61 and 62 serving as a fluid supply path and a fluid recovery path is spirally wound to form a fluid path forming member 60.
  • the fluid path forming member 60 may be arranged on the inner surface side of the strength variable members 25 and 45 indicated by a two-dot chain line. According to this configuration, it is possible to prevent buckling by securing the strength in the longitudinal axis direction without impairing the flexibility of the tubular strength variable members 25 and 45.
  • variable strength members 25 and 45 may be provided with a plurality of fluid supply paths and fluid recovery paths. Specifically, for example, a plurality of sets of fluid supply holes 25c and fluid recovery holes 25d are provided in the meat portion 25b of the strength varying member 25 in FIG. The fluid supply holes 25c and the fluid recovery holes 25d are alternately arranged. According to this configuration, the temperature change of the strength variable member 25 can be performed more evenly.
  • the fluid supply hole 25c and the fluid recovery hole 25d communicate with each other through a communication portion (not shown) provided on the distal end side of the strength varying member 25.
  • the glass transition temperature is set to 25 degree
  • the glass transition temperature may be set within a predetermined range based on the body temperature.
  • the strength variable member is set to the first state at body temperature (for example, 36 degrees Celsius), and the second state is obtained by cooling the strength variable member with, for example, cooling water at 16 degrees Celsius, or the body temperature (for example, 36 degrees Celsius).
  • the strength variable member may be set to the second state, and the first state may be obtained by warming the strength variable member with, for example, hot water of 51 degrees Celsius. According to this configuration, it becomes possible to easily change the temperature of the shape memory polymer by reducing the difference between the environmental temperature and the glass transition temperature.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biophysics (AREA)
  • Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Mechanical Engineering (AREA)
  • Endoscopes (AREA)

Abstract

Selon l'invention, une section d'introduction dans un dispositif médical qui est conçue pour pouvoir se déplacer par rapport à la direction axiale dans le sens de la longueur d'une section d'introduction d'endoscope est équipée : d'un élément de résistance variable tubulaire, dont la résistance alterne entre un premier état et un second état à une température prédéfinie ; d'un chemin d'alimentation en fluide qui amène un fluide, à une température qui est supérieure à la température prédéfinie qui fait passer l'élément de résistance variable dans le premier état, ou un fluide, à une température qui est inférieure à la température prédéfinie qui fait passer l'élément de résistance variable dans le second état, en contact avec la surface de tube de l'élément de résistance variable et fournit le fluide ; un chemin de collecte de fluide qui collecte le fluide fourni par l'intermédiaire du chemin d'alimentation en fluide ; et une unité de raccordement qui est disposée sur le côté pointe de l'élément de résistance variable et qui raccorde le chemin de collecte de fluide et le chemin d'alimentation en fluide.
PCT/JP2011/066856 2010-09-30 2011-07-25 Dispositif médical et dispositif d'endoscope Ceased WO2012043034A1 (fr)

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US20200281652A1 (en) * 2019-03-08 2020-09-10 Neuwave Medical, Inc. Systems and methods for energy delivery
JPWO2019097688A1 (ja) * 2017-11-17 2020-11-19 オリンパス株式会社 剛性可変装置と剛性可変システムと内視鏡と剛性変更方法
EP4400028A1 (fr) * 2023-01-10 2024-07-17 FUJIFILM Corporation Dispositif de guidage d'instrument médical
EP4516200A1 (fr) * 2023-08-29 2025-03-05 FUJIFILM Corporation Surtube

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JPH0670879A (ja) * 1992-06-26 1994-03-15 Toshiba Corp 内視鏡システム
JP2006505302A (ja) * 2002-06-13 2006-02-16 ユーエスジーアイ メディカル， インコーポレイテッド 非支持解剖構造を通して器具を進めるための形状固定可能な装置および方法。

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JPS55129029A (en) * 1979-03-28 1980-10-06 Olympus Optical Co Flexible tube for endoscope
JPS58101602U (ja) * 1981-12-29 1983-07-11 株式会社町田製作所 スタイレツト
JPS62201133A (ja) * 1986-02-27 1987-09-04 オリンパス光学工業株式会社 内視鏡用插入補助具
JPH0670879A (ja) * 1992-06-26 1994-03-15 Toshiba Corp 内視鏡システム
JP2006505302A (ja) * 2002-06-13 2006-02-16 ユーエスジーアイ メディカル， インコーポレイテッド 非支持解剖構造を通して器具を進めるための形状固定可能な装置および方法。

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Publication number Priority date Publication date Assignee Title
JPWO2019097688A1 (ja) * 2017-11-17 2020-11-19 オリンパス株式会社 剛性可変装置と剛性可変システムと内視鏡と剛性変更方法
US11471030B2 (en) 2017-11-17 2022-10-18 Olympus Corporation Variable stiffness device, variable stiffness system, endoscope, and stiffness varying method
US20200281652A1 (en) * 2019-03-08 2020-09-10 Neuwave Medical, Inc. Systems and methods for energy delivery
WO2020183262A1 (fr) * 2019-03-08 2020-09-17 Neuwave Medical, Inc. Systèmes et procédés de distribution d'énergie
CN113543691A (zh) * 2019-03-08 2021-10-22 纽韦弗医疗设备公司 用于能量递送的系统和方法
JP2022524092A (ja) * 2019-03-08 2022-04-27 ニューウェーブ メディカル，インコーポレイテッド エネルギー送達のためのシステム及び方法
US11832879B2 (en) * 2019-03-08 2023-12-05 Neuwave Medical, Inc. Systems and methods for energy delivery
CN113543691B (zh) * 2019-03-08 2024-02-13 纽韦弗医疗设备公司 用于能量递送的系统和方法
JP7592960B2 (ja) 2019-03-08 2024-12-03 ニューウェーブ メディカル，インコーポレイテッド エネルギー送達のためのシステム及び方法
EP4400028A1 (fr) * 2023-01-10 2024-07-17 FUJIFILM Corporation Dispositif de guidage d'instrument médical
EP4516200A1 (fr) * 2023-08-29 2025-03-05 FUJIFILM Corporation Surtube

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