WO2014054772A1 - Body cavity illuminating instrument and body cavity illuminating device - Google Patents

Description

Body cavity lighting device and body cavity lighting device

The present invention relates to an intraluminal illumination device and an intraluminal illumination device, and more particularly to an intraluminal illumination device and an intraluminal illumination device provided with temperature detection means for detecting the ambient temperature of the distal end portion of an insertion portion inserted into the body cavity. About.

In recent years, endoscopic surgery using a rigid endoscope (rigid endoscope) such as a laparoscope has been widely performed because the invasiveness to patients is small compared to surgical operations for performing abdominal surgery, thoracotomy, etc. . For example, in laparoscopic surgery, a cylindrical trocar is inserted into several positions on the patient's abdomen, and an endoscope (laparoscope) or a treatment instrument is inserted into the abdominal cavity through this trocar, and the monitor is used for internal surgery. Treatment is performed using a treatment tool while observing an endoscopic image.

Recently, single-hole laparoscopic surgery (SPS), in which a single hole is made in the umbilicus and laparoscopic surgery is performed, has been rapidly spreading. In this single-hole laparoscopic surgery, the post-surgical scar is only one place on the umbilical portion, so it is not noticeable and is cosmetically superior.

However, in single-hole laparoscopic surgery, since there is only one opening (insertion hole) formed in the body wall to access the body cavity, the endoscope and the treatment tool interfere inside and outside the body cavity. Easy to operate and easy to cramp. In addition, when the endoscope and the treatment tool interfere with each other, the endoscope may not be positioned conveniently for observation, which may hinder observation and treatment of the treatment target site.

Against this background, there is an increasing demand for reducing the diameter of the insertion portion of the endoscope. If it is possible to reduce the diameter of the insertion portion of the endoscope, even if an opening for the endoscope is formed in a portion other than the umbilicus, the opening size is reduced and the postoperative scar is made inconspicuous. be able to. In addition, problems on the operation surface and the observation surface can be eliminated as compared with the case of accessing the body cavity from one opening.

Here, in general, the endoscope has a function for illuminating the inside of the body cavity as well as a function for observing the inside of the body cavity. In other words, a light guide for transmitting illumination light from the light source device is inserted through the insertion portion of the endoscope, and the illumination light emitted from the emission end is irradiated into the body cavity through the illumination window. It has come to be. For this reason, if the insertion portion of the endoscope is made too thin, the occupied space for inserting and arranging the light guide is insufficient, and the brightness of the illumination light is insufficient.

On the other hand, Patent Document 1 discloses a system including an endoscope for observing the inside of a body cavity and an illumination tool (illumination probe) that is configured separately from the endoscope and illuminates the inside of the body cavity. Is disclosed. According to this system, even when the brightness of the illumination light emitted from the endoscope is insufficient, the desired brightness can be secured by the illumination light emitted from the illumination tool. Moreover, since illumination light can be irradiated to an observation position from various directions, it becomes easier to observe the observation position. However, no measures have been taken to prevent adverse effects on the subject due to illumination light irradiation. If the subject that is the observation target site is irradiated with strong illumination light or irradiated with illumination light for a long time, the illumination light There is a risk that the subject will be adversely affected by heat.

On the other hand, Patent Document 2 proposes a technique for preventing adverse effects on the subject due to the heat of illumination light. That is, the endoscope apparatus disclosed in Patent Document 2 includes a temperature sensor at the distal end portion of the insertion portion that is inserted into the body cavity, and detects the outer peripheral temperature of the distal end portion of the insertion portion by the temperature sensor. By adjusting the amount of illumination light using temperature information output from the sensor, adverse effects on the subject due to the heat of the illumination light can be prevented.

JP-A-10-137184 Japanese Patent Laid-Open No. 10-286234

By the way, as shown in FIG. 15, the illumination light emitted from the exit end face of the light guide has the highest light intensity at the center O of the exit end face of the light guide, and the light intensity tends to decrease as the distance from the center O increases. . For this reason, in order to prevent an adverse effect on the subject due to the heat of the illumination light, the temperature of the illumination light emitted from the exit end face of the light guide (preferably the center of the exit end face) is directly detected, It is desirable to adjust the amount of illumination light in accordance with the detected temperature.

However, in the endoscope apparatus disclosed in Patent Document 2, the temperature sensor is disposed at a position (adjacent to the cover glass) shifted from the light guide emission end face, and illumination emitted from the light guide emission end face. The temperature of light cannot be detected directly. For this reason, even if the temperature of the illuminating light becomes a temperature that adversely affects the subject, a temperature difference occurs between the temperature around the outside of the distal end of the insertion portion detected by the temperature sensor, and the adjustment of the amount of illumination light There is a possibility that a time lag will occur before the process is performed, and the adverse effect on the subject due to the heat of the illumination light may occur.

The present invention has been made in view of such circumstances, and directly detects the temperature of illumination light emitted from the exit end face of the light guide while reducing the diameter of the insertion portion inserted into the body cavity. An object of the present invention is to provide an intraluminal illumination tool and an intraluminal illumination device that can prevent adverse effects on the subject due to the heat of illumination light.

In order to achieve the above object, an intraluminal illumination device according to an aspect of the present invention has an elongated insertion portion that is inserted into a body cavity, and a plurality of optical fibers that guide illumination light are bundled in the insertion portion. A light guide in the body cavity in which the light guide is configured to be inserted and disposed along the longitudinal direction and emits illumination light from the emission end face of the light guide, and is a temperature composed of a thermocouple that detects the ambient temperature of the distal end portion of the insertion portion The thermocouple includes first and second metal parts made of different metals, and at least one of the first and second metal parts is a metal strand embedded in a plurality of optical fibers. The contact portion between the first and second metal portions is exposed at the tip end side of the light emitting end surface of the light guide.

In a preferred aspect of the present invention, the first and second metal parts are composed of a pair of metal strands embedded in a plurality of optical fibers.

In a preferred aspect of the present invention, the outer peripheral portion of the light guide is covered with a cylindrical metal sheath, and one of the first and second metal portions is a metal element embedded in a plurality of optical fibers. The other metal part is made of a metal sheath.

Further, in a preferred aspect of the present invention, the contact portion of the first and second metal portions is exposed at the front end side central portion of the light emitting end face of the light guide.

In order to achieve the above object, an intraluminal illumination device according to another aspect of the present invention includes an intraluminal illumination tool according to an aspect of the present invention and an insertion unit based on the detection result of the temperature detection means. A temperature abnormality determining means for determining a temperature abnormality of the distal end portion, and a light amount adjusting means for adjusting the light intensity of the illumination light when the temperature abnormality determining means determines that the distal end portion of the insertion portion is abnormal in temperature.

The preferred embodiment of the present invention further includes warning means for issuing an alarm warning when the temperature abnormality determining means determines that the distal end portion of the insertion portion is abnormal in temperature.

According to the present invention, it is possible to save the space of the temperature detecting means made of a thermocouple, and it is possible to reduce the diameter of the insertion portion. Further, it is possible to directly detect the temperature of the illumination light emitted from the exit end face of the light guide, and it is possible to prevent an adverse effect on the subject due to the heat of the illumination light.

FIG. 1 is an overall configuration diagram showing an embodiment of a medical observation system. FIG. 2 is a schematic diagram illustrating a configuration example of an endoscope. FIG. 3 is a schematic diagram illustrating a configuration example of a needle light. FIG. 4 is a cross-sectional view illustrating a configuration example of the light guide. FIG. 5 is a cross-sectional view showing another configuration example of the light guide. FIG. 6 is a schematic view showing a configuration example of a trocar. FIG. 7 is a flowchart showing a procedure for inserting the intra-body-cavity insertion tool into the abdominal cavity. FIG. 8A is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 8B is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 8C is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 8D is a diagram schematically illustrating how the intra-body-cavity insertion tool is inserted into the abdominal cavity. FIG. 9 is a cross-sectional view schematically showing how the intracorporeal insertion tool is inserted into the abdominal cavity. FIG. 10 is a schematic view showing a scope unit. FIG. 11 is a plan view illustrating a configuration example of the connection fixture. FIG. 12 is a plan view showing another configuration example of the connection fixture. FIG. 13A is a plan view showing still another configuration example of the connection fixture. FIG. 13B is a plan view showing still another configuration example of the connection fixture. FIG. 14A is an explanatory diagram for explaining a method of inserting a trocar into the abdominal cavity. FIG. 14B is an explanatory diagram for explaining a method of inserting a trocar into the abdominal cavity. FIG. 14C is an explanatory diagram for explaining a method of inserting the trocar into the abdominal cavity. FIG. 15 is a graph showing the light quantity distribution of the illumination light emitted from the emission end face of the light guide.

Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the accompanying drawings.

[Medical observation system]
FIG. 1 is an overall configuration diagram showing an embodiment of a medical observation system. As shown in FIG. 1, a medical observation system 10 according to the present embodiment includes an endoscope 100 for observing a portion to be observed in a body cavity, and a needle light (illumination) that irradiates illumination light into the body cavity of the subject. ) 200, a light source device 400 that supplies illumination light to the needle light 200, and a processor device 500 that generates an endoscopic image. The processor device 500 is connected to a monitor 600 for displaying an endoscopic image.

[Endoscope]
FIG. 2 is a schematic diagram illustrating a configuration example of the endoscope 100. An endoscope (electronic endoscope) 100 shown in FIG. 2 includes a rigid insertion portion 102 to be inserted into a body cavity of a subject, a grip portion 104 provided at the rear end of the insertion portion 102, and a grip portion 104. And a signal cable 122 extending from the rear end. A connector 124 that is detachably connected to the processor device 500 is provided at the end of the signal cable 122.

The observation window 110 for taking in the image light of the subject is attached to the tip of the insertion unit 102. An objective optical system 112 and a solid-state image sensor 120 (CMOS sensor, CCD sensor, etc.) are disposed behind the observation window 110. Subject light that has passed through the observation window 110 and the objective optical system 112 is incident on the imaging surface (light receiving surface) of the solid-state imaging device 120. The solid-state imaging device 120 photoelectrically converts incident subject light to convert it into an electrical signal (imaging signal) and output it. The electrical signal output from the solid-state imaging device 120 is input to the processor device 500 via the signal cable 122 and the connector 124.

As shown in FIG. 2, the processor device 500 includes a CPU 502, a DSP (Digital Signal Processor) 504, a DIP 506, and a display control circuit 508. The CPU 502 controls the overall operation of the processor device 500.

The DSP 504 performs various signal processing such as color separation, color interpolation, gain correction, white balance adjustment, and gamma correction on the electrical signal output from the solid-state imaging device 120 to generate image data. Image data generated by the DSP 504 is input to a DIP (digital image processing circuit) 506.

The DIP 506 performs various types of image processing such as electronic scaling, color enhancement, and edge enhancement on the image data processed by the DSP 504. Image data that has been subjected to various types of image processing by the DIP 506 is input to the display control circuit 508.

The display control circuit 508 converts the image data from the DIP 506 into a video signal corresponding to a signal format corresponding to the monitor 600 and outputs the video signal to the monitor 600. Thereby, an observation image (endoscopic image) is displayed on the monitor 600.

In this embodiment, the insertion unit 102 of the endoscope 100 does not include an illumination unit that illuminates the body cavity. That is, there is no illumination window or light guide provided in a general endoscope, and an occupied space for arranging these members is unnecessary. For this reason, the outer diameter of the insertion portion 102 can be reduced, thereby reducing the opening size of the opening (insertion hole) formed in the body wall in order to guide the insertion portion 102 into the body cavity. it can. This makes it possible to make post-operative scars inconspicuous and reduce the burden on the subject.

In the present embodiment, the outer diameter of the insertion portion 102 is preferably 3 mm or less. In this example, the outer diameter of the insertion portion 102 is configured to 2.9 mm. By setting the outer diameter of the insertion portion 102 to 3 mm or less, the opening size of the opening (insertion hole) formed in the body wall in order to guide the insertion portion 102 into the body cavity can be reduced. This eliminates the need for suturing the opening and makes postoperative scars less noticeable. If the outer diameter of the insertion portion 102 is made too thin, the space occupied by a built-in object (for example, an image guide) built in the insertion portion 102 is insufficient, and therefore the outer diameter of the insertion portion 102 is 2 mm or more. It is preferable.

In the present embodiment, the endoscope 100 is configured by an electronic endoscope (electronic scope), but may be configured by an optical endoscope (fiber scope).

[Needle light]
FIG. 3 is a schematic diagram illustrating a configuration example of the needle light 200. FIG. 4 is a cross-sectional view illustrating a configuration example of the light guide 218.

As shown in FIG. 3, the needle light 200 includes an insertion portion 202 that is inserted into a body cavity, a grip portion 204 that is provided at the rear end of the insertion portion 202, and a light that extends from the rear end of the grip portion 204. And a guide cable 206. A light source connector 208 that is detachably connected to the light source device 400 is provided at the end of the light guide cable 206 (needed to be filled in FIG. 3).

The insertion portion 202 is made of an elongated cylindrical member having flexibility, and an illumination window 214 is attached to the distal end surface thereof. In the back of the illumination window 214, an illumination lens 216 for irradiating illumination light toward the body cavity is disposed. The illumination lens 216 faces the emission end of the light guide 218. As shown in FIG. 4, the light guide 218 includes a light guide bundle (bundle fiber) configured by bundling a plurality of optical fibers 229 in a circular shape, and the outer periphery thereof is a protection formed of a material having elasticity such as silicon. Covered with a tube 230. The light guide 218 is inserted into the insertion portion 202, the grip portion 204, and the light guide cable 206, and its incident end is exposed from the end portion of the light source connector 208.

When the light source connector 208 is connected to the light source device 400, the incident end of the light guide 218 is inserted into the light source device 400. Illumination light from the light source device 400 is guided to the distal end portion of the insertion portion 202 by the light guide 218 and is irradiated into the body cavity from the illumination lens 216 and the illumination window 214.

As shown in FIG. 3, the light source device 400 includes a light source 402, a light source driver 404, an aperture adjustment mechanism 406, an iris driver 408, and a CPU 410 that controls these units. The light source 402 is turned on and off under the control of the light source driver 404 and irradiates illumination light toward the condensing lens 412 positioned in front. As the light source 402, for example, a xenon lamp, a halogen lamp, an LED (light emitting diode), a fluorescent light emitting element, or an LD (laser diode) can be used. The light source 402 is appropriately selected depending on what endoscopic image (a visible image, a fluorescent image, or the like) is captured, that is, a wavelength to be used.

The aperture adjustment mechanism 406 is disposed between the light source 402 and the condenser lens 412 so that the endoscopic image captured by the solid-state imaging device 120 (see FIG. 2) of the endoscope 100 has substantially constant brightness. Adjust the amount of illumination light. The aperture adjustment mechanism 406 includes an aperture blade that changes the diameter (diaphragm diameter) of an aperture opening through which illumination light passes, and a motor that drives the aperture blade. The iris driver 408 adjusts the amount of illumination light incident on the light guide 218 by changing the illumination light passage area by opening and closing the aperture blades of the aperture adjustment mechanism 406.

In the present embodiment, the outer diameter of the insertion portion 202 is preferably 3 mm or less, and more preferably 2.3 mm or less. In this example, the outer diameter of the insertion portion 202 is 2.1 mm. As a result, similar to the insertion portion 102 of the endoscope 100, the opening size of the opening (insertion hole) formed in the body wall for guiding into the body cavity can be reduced, thereby reducing postoperative scars. It can be inconspicuous.

In the present embodiment, a temperature sensor 226 is provided as a temperature detection means for detecting the temperature of the illumination light emitted from the light guide 218. The temperature sensor 226 includes a thermocouple 236 having first and second metal parts made of different metals. As shown in FIG. 4, the thermocouple 236 is configured by a pair of metal wires 232 and 234 embedded in the light guide 218, that is, in a plurality of optical fibers 229. As shown in FIG. 3, a contact portion 237 with which a pair of metal wires 232 and 234 come into contact is exposed on the tip side (preferably the center portion of the tip surface) of the light guide 218 from the tip surface (outgoing end surface). Yes. Thereby, the temperature of the illumination light emitted from the front end surface of the light guide 218 can be directly detected. Detection data (temperature information) output from the temperature sensor 226 is input to the light source device 400 through a thermocouple 236 embedded in the light guide 218.

In addition to the above-described configuration, the light source device 400 includes a temperature abnormality determination unit (corresponding to the temperature abnormality determination unit of the present invention) 414, a memory 416, and a warning unit (corresponding to the warning unit of the present invention) 418. Yes. The temperature abnormality determination unit 414 calculates the temperature of the illumination light emitted from the tip surface of the light guide 218 based on the detection data output from the temperature sensor 226 and compares it with the reference temperature stored in the memory 416. The reference temperature is a temperature at which the object starts to be adversely affected, and is obtained in advance experimentally or empirically. As a result of the comparison, when the temperature of the illumination light detected by the temperature sensor 226 exceeds the reference temperature, the CPU 410 (corresponding to the light amount adjusting means of the present invention) 410 is instructed to control the amount of illumination light. Based on an instruction from the temperature abnormality determination unit 414, the CPU 410 controls the light source driver 404 or the iris driver 408 to reduce the amount of illumination light or turn off the light source. Further, the temperature abnormality determination unit 414 instructs the warning unit 418 to give a warning when the temperature of the illumination light exceeds the reference temperature. The warning unit 418 displays a warning based on an instruction from the temperature abnormality determination unit 414. Further, a warning lamp may be turned on or blinked, or a warning sound may be generated.

The temperature abnormality determination unit 414 obtains a temperature change (temperature change rate) per unit time based on the detection data output from the temperature sensor 226, and the temperature change rate and the reference temperature change rate stored in the memory 416. A comparison may be made.

In the present embodiment, the thermocouple 236 is configured by a pair of metal strands 232 and 234 embedded in the light guide 218. However, the configuration is not limited to this, and the configuration illustrated in FIG. .

FIG. 5 is a cross-sectional view showing another configuration example of the light guide 218. In the configuration shown in FIG. 5, one metal strand 238 is embedded in the light guide 218, that is, in a plurality of optical fibers 229. In addition, a metal sheath 240 made of a cylindrical metal member is provided on the outer peripheral portion of the light guide 218 via a protective tube 230. The thermocouple 242 includes a metal strand 238 and a metal sheath 240. A contact portion (not shown) where the metal strand 238 and the metal sheath 240 are in contact with each other is exposed on the front end side of the light guide 218 front end surface (outgoing end surface). Thereby, the temperature of the illumination light emitted from the front end surface of the light guide 218 can be directly detected.

In the configuration shown in FIG. 5, the contact portion where the metal strand 238 and the metal sheath 240 are in contact with each other is preferably provided on the distal end side of the central portion of the distal end surface of the light guide 218. This makes it possible to detect the temperature near the center of the tip surface of the light guide 218 where the light intensity of the illumination light is highest.

As described above, according to the present embodiment, since the temperature sensor 226 made of a thermocouple is provided integrally with the light guide 218, it is possible to reduce the diameter without increasing the outer diameter of the insertion portion 202. Become. In addition, since the temperature of the illumination light emitted from the front end surface of the light guide 218 can be directly detected, it is possible to adjust the amount of illumination light before the subject is adversely affected by the heat of the illumination light. As a result, the amount of illumination light can be reduced or the light source can be turned off before the distal end of the insertion portion 202 comes into contact with the organ and becomes abnormally heated. Can prevent adverse effects on

[Tracar]
FIG. 6 is a schematic diagram illustrating a configuration example of the trocar 300. As shown in FIG. 6, the trocar 300 is a guide member for guiding the needle light 200 into the body cavity, and includes an outer tube 302 and an inner needle 304.

The inner needle 304 is inserted into the outer tube 302, and is provided on an elongated shaft portion 306, a distal end portion 308 formed at the distal end of the shaft portion 306, and a proximal end side of the shaft portion 306. The head 310 is formed. In this example, the outer diameter of the shaft portion 306 of the inner needle 304 is 2.1 mm.

The tip portion 308 has a curved shape and is blunt so as not to be edged (that is, a rounded non-edge shape), but can easily penetrate the body wall. The outer diameter of the shaft portion 306 is slightly smaller than the inner diameter of the outer tube 302. The head portion 310 is formed in a columnar shape that is thicker than the shaft portion 306. When the inner needle 304 is inserted into the outer tube 302, the head portion 310 has a proximal end side of the outer tube 302 with the distal end portion 308 of the inner needle 304 protruding from the distal end of the outer tube 302 by a predetermined length. It abuts on the end face.

The outer tube 302 includes an elongated rigid portion 312 formed of a hard resin, metal, or the like, a flexible portion 314 coupled to the distal end side of the rigid portion 312, and a main body portion 316 coupled to the proximal end side of the rigid portion 312. , A guide portion 318 connected to the base end side of the main body portion 316, and an introduction portion 320 provided on the base end side of the guide portion 318. The rigid portion 312, the flexible portion 314, the main body portion 316, the guide portion 318, and the introduction portion 320 are arranged on the same axis, and an insertion passage 322 through which the needle light 200 and the inner needle 304 can be inserted is provided inside them. Is formed. In this example, the outer diameter of the rigid portion 312 is 2.3 mm.

The soft part 314 is formed of a soft member such as rubber or soft resin. The soft portion 314 is made of the same material as the hard portion 312 (that is, hard resin, metal, etc.), and has a slit (narrow groove) along the circumferential direction or the axial direction or other direction on the outer peripheral portion thereof. A plurality may be formed and may be configured to have more flexibility than the rigid portion 312. In addition, the tip portion 314a of the soft portion 314 is formed in a tapered shape that continuously decreases in thickness over a predetermined length, and the tip side is more flexible (flexible). Yes. And the corner | angular part of the front-end | tip part 314a becomes a rounded non-edge shape. Therefore, even when the soft portion 314 disposed at the distal end portion of the outer tube 302 contacts the organ in a state where the inner needle 304 is pulled out from the outer tube 302 inserted into the body cavity, the soft portion 314 is not soft. Since it deforms itself depending on the sex, it becomes possible to prevent organ damage.

The rigid portion 312 is a portion formed at a portion surrounded by the body wall when the outer tube 302 is inserted into the body cavity, and is formed of a hard member such as a hard resin or metal. Therefore, when the trocar 300 is sent to a predetermined position in the body cavity and the inner needle 304 is extracted from the outer tube 302, a compressive force from the body wall acts on the outer tube 302. 302 is not deformed by the pressing force, and the needle light 200 can be smoothly inserted into the outer tube 302.

The main body 316 includes an elastic body layer 324 provided on the entire surface thereof, and an inner tube portion 326 provided on the inner side of the elastic body layer 324.

The elastic body layer 324 is made of an elastic member such as rubber or sponge. The elastic layer 324 preferably functions relatively thick because it functions as a means for absorbing pressure applied to the patient. As a result, when the outer tube 302 is inserted into the body cavity, even if the main body 316 of the outer tube 302 is in contact with the body wall for a long time and pressure is applied, the pressure is absorbed by the elastic layer 324. Therefore, the burden on the patient can be reduced and minimal invasiveness can be achieved.

The inner tube portion 326 is formed of a hard member such as hard resin or metal, like the hard portion 312. The inner tube portion 326 may be configured integrally with the rigid portion 312 or may be configured separately. In the latter case, the inner tube portion 326 and the hard portion 312 are connected by an adhesive or brazing.

In the inner pipe portion 326, an internal pipe line 328 that constitutes a part of the insertion path 322 is formed. A check valve 330 and a seal member 332 are arranged in parallel in the axial direction in the internal conduit 328. The check valve 330 prevents the pressurized air in the body cavity from leaking out of the body when the needle light 200 or the inner needle 304 is removed from the outer tube 302. The seal member 332 is disposed on the proximal end side with respect to the check valve 330, and when the needle light 200 or the inner needle 304 is inserted into the outer tube 302, the needle light 200 or the inner needle 304 and the inner pipe line 328 are connected. It is for sealing the gap. The check valve 330 and the seal member 332 are made of an elastic member such as rubber, for example.

The guide portion 318 is configured to have an inner diameter slightly larger than the outer diameter of the insertion portion 202 of the needle light 200 and to have a predetermined length in the axial direction. Thereby, when inserting the insertion portion 202 into the outer tube 302, even if the distal end portion of the insertion portion 202 receives a large resistance when passing through the check valve 330 or the seal member 332, the distal end portion is buckled and deformed. Without insertion, the insertion portion 202 can be easily pushed toward the distal end side.

The guide portion 318 is formed of a hard member such as a hard resin or metal, like the hard portion 312 and the inner tube portion 326. The guide portion 318 may be configured integrally with the inner tube portion 326 or may be configured separately. In the latter case, the guide portion 318 and the inner tube portion 326 are connected by an adhesive or brazing. Needless to say, the rigid portion 312, the inner tube portion 326, and the guide portion 318 may be integrally formed.

A conical introduction portion 320 having an inner diameter larger than that of the guide portion 318 is integrally provided on the proximal end side of the guide portion 318. An opening 334 for inserting the needle light 200 and the inner needle 304 into the outer tube 302 is formed on the end face on the proximal end side of the introduction part 320, and the insertion passage 322 communicates with the opening 334. It has become. The introduction portion 320 is formed so as to expand toward the proximal end side, and the needle light 200 and the inner needle 304 can be easily guided to the insertion passage 322 from the opening 334 of the introduction portion 320.

As a method of using the trocar 300 configured as described above, first, the inner needle 304 is inserted into the outer tube 302, and the distal end portion 308 of the inner needle 304 is protruded from the distal end of the outer tube 302. Then, the tip of the inner needle 304 incorporated in the outer tube 302 is inserted directly from the body skin to a predetermined depth position. Thereafter, the inner needle 304 is removed from the outer tube 302. Then, by inserting the insertion portion 202 of the needle light 200 into the outer tube 302, the insertion portion 202 of the needle light 200 can be guided into the body cavity.

In this embodiment, since known trocars 718 and 704 (see FIG. 1) that are guide members for guiding the endoscope 100 and the treatment instrument 720 into the body cavity are used, Description is omitted. In general, the trocar is composed of a mantle tube and an inner needle, as in the trocar 300 described above, and is partially incised with a scalpel or the like, and is inserted into the body cavity from the incised portion or a special incision. In addition, there is a type in which a slight incision is made even if it is incised, and then directly inserted into the body cavity from the body epidermis, and any type can be used.

[Method for placing the insertion tool in the body cavity]
The medical observation system 10 of the present embodiment configured as described above is used for laparoscopic surgery, and is used for treatment in the abdominal cavity that is one of the body cavities of a patient. Here, for a laparoscopic surgical operation, a method of arranging the intra-body-cavity insertion tool (endoscope 100 and needle light 200) of the medical observation system 10 of the present embodiment in the abdominal cavity that is a patient's body cavity is illustrated in FIG. This will be described in detail below with reference to FIGS.

FIG. 7 is a flowchart showing a procedure for inserting the intra-body-cavity insertion tool constituting the medical observation system 10 of the present embodiment into the abdominal cavity. 8A to 8D are diagrams schematically showing a state where the intra-body-cavity insertion tool is inserted into the abdominal cavity. FIG. 9 is a cross-sectional view schematically showing how the intracorporeal insertion tool is inserted into the abdominal cavity. The series of steps shown in FIG. 7 is a step that takes into account minimally invasiveness in addition to safety.

First, as shown in FIGS. 8A and 9, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are integrated through a first opening (insertion hole) 702 formed in the abdominal wall. The scope unit 700 is inserted into the abdominal cavity (step S10 in FIG. 7).

The first opening 702 is an opening formed in a patient's abdomen (for example, the umbilicus) in order to insert a treatment tool such as forceps into the abdominal cavity. A trocar 704 having a size corresponding to the outer diameter of the treatment instrument (for example, a 5 mm forceps trocar) is inserted into the first opening 702, and the scope unit 700 is inserted into the abdominal cavity through the trocar 704.

Note that at least one 5 mm forceps is required for normal laparoscopic surgery. Step S10 in FIG. 7 is a procedure step using the 5 mm forceps trocar, and a 2.9 mm scope and a 2.1 mm needle light (2.9 + 2.1 = 5 mm) are inserted into the 5 mm forceps trocar together. By doing so, preparation (trocar arrangement) is possible with minimal invasiveness without opening unnecessary openings (insertion holes) in the abdominal wall.

FIG. 10 is a schematic diagram showing the scope unit 700. FIG. 11 is a plan view showing a configuration example of the connection fixture 706. As shown in FIGS. 10 and 11, the scope unit 700 includes a plurality of connecting fixtures (holding members) 706 arranged in parallel along the longitudinal direction of the insertion portion 102 of the endoscope 100. The insertion portion 102 and the insertion portion 202 of the needle light 200 are integrated. Each coupling fixture 706 is configured to be slidable along the longitudinal direction with respect to each insertion portion 102, 202.

The connecting fixture 706 is made of a thin disk-like member and is made of a resin material such as plastic. The connecting fixture 706 is formed with two through holes 708 and 710 having different inner diameters. Of these through holes 708 and 710, the first through hole 708 having a large inner diameter is a hole for inserting the insertion part 102 of the endoscope 100, and the outer diameter of the insertion part 102 of the endoscope 100. It has a slightly larger inner diameter. On the other hand, the second through hole 710 having a small inner diameter is a hole through which the insertion portion 202 of the needle light 200 is inserted, and has an inner diameter slightly larger than the outer diameter of the insertion portion 202 of the needle light 200.

As shown in FIG. 10, the insertion portions 102 of the endoscope 100 are inserted into the through holes 708 and 710 of the plurality of connection fixtures 706 configured as described above. The insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are parallel to each other in the axial direction, and the axes thereof are parallel to each other. Are integrated in close proximity.

Then, when the scope unit 700 integrated as described above is inserted into the trocar 704, each connecting fixture 706 does not enter the trocar 704 as shown in FIG. It will be in the state where it contacted | stacked and piled up. The trocar 704 guides the abdominal cavity with the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 in parallel. Therefore, by inserting the scope unit 700 integrated by the plurality of connecting fixtures 706 into the trocar 704, the endoscope 100 having no illumination means can be safely and easily guided into the abdominal cavity. .

Note that the connection fixture 706 is not limited to the configuration shown in FIG. 11, and for example, the configuration shown in FIGS. 12, 13A, and 13B can be adopted.

FIG. 12 is a plan view showing another configuration example of the connection fixture 706. As shown in FIG. 12, the connection fixture 706 has a plurality of second through holes 710A and 710B. According to this configuration, the insertion portions 202 of the plurality of needle lights 200 can be integrated with the insertion portion 102 of the endoscope 100. Thereby, when the brightness of illumination light is insufficient with only one needle light 200, a desired brightness can be ensured. The number of second through holes 710 is not limited to two, and may be three or more. A plurality of first through holes 708 may be formed.

FIGS. 13A and 13B are plan views showing still other configuration examples of the connecting fixture 706. FIG. The configuration shown in FIG. 13A is the same as the configuration shown in FIG. 11 in that the first and second through holes 708 and 710 are formed, but these through holes 708 and 710 are not separated and independent from each other. However, it is different in that it is a configuration in which some of them are connected. Similarly, the configuration shown in FIG. 13B is the same as the configuration shown in FIG. 12 in that the first through-hole 708 and the second through-holes 710A and 710B are formed, but these through-holes 708 and 710A. , 710B are different from each other in that they are not separated and independent from each other and are partially connected. Whichever of these connection fixtures 706 is used, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 can be integrated.

In the present embodiment, the above-described connecting fixture 706 is preferably used as a means for integrating the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200, but is not limited thereto, and is, for example, an elongated cylindrical shape. You may integrate by inserting the insertion part 102 of the endoscope 100, and the insertion part 202 of the needle light 200 into the insertion assistance tool (tube-shaped thing) collectively. Further, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 may be integrally bound by a string-like member using a treatment tool. However, like this embodiment, the aspect using the connection fixture 706 is the simplest and more preferable aspect.

Referring back to FIG. After the scope unit 700 is inserted into the abdominal cavity through the first opening 702, as shown in FIG. 8B, the first formed at a position different from the first opening 702 (for example, the upper right part of the abdomen). The other needle light 200 is inserted into the abdominal cavity through the second opening 712 (step S12 in FIG. 7).

Here, the trocar 300 (needle light trocar) shown in FIG. 6 is inserted into the second opening 712, and another needle light 200 is inserted into the abdominal cavity through the trocar 300. The same applies to a third opening 714 described later.

Thereby, the insertion portions 202 of the two needle lights 200 are inserted into the abdominal cavity. For this reason, even if one of the needle lights 200 is extracted, the inside of the body cavity can be illuminated by the other needle light 200, and the endoscope 100 having no illumination means does not fall into an unobservable state.

Next, as shown in FIG. 8C, the insertion portion 202 of the needle light 200 is removed from the first opening 702 (step S14 in FIG. 7).

Next, as shown in FIG. 8C, the first and second openings 702 and 712 are connected to the first opening 714 formed at a position different from the first and second openings 702 and 712 (for example, the left central portion of the abdomen). The insertion portion 202 of the needle light 200 removed from the opening 702 is inserted into the abdominal cavity (step S16 in FIG. 7).

Next, the insertion portion 102 of the endoscope 100 is removed from the first opening 702 (step S18 in FIG. 7).

Next, as shown in FIG. 8D, through the fourth opening 716 formed at a position different from the first to third openings 702, 712, 714 (for example, the right center portion of the abdomen), The insertion part 102 of the endoscope 100 is inserted (step S20 in FIG. 7).

4th opening part 716 is an opening part formed in order to insert the insertion part 102 of the endoscope 100 in the abdominal cavity. A trocar 718 (for example, 3 mm trocar) having a size corresponding to the outer diameter of the insertion portion 102 of the endoscope 100 is inserted into the fourth opening 716, and the insertion portion 102 of the endoscope 100 is inserted through the trocar 718. Is inserted into the abdominal cavity.

Next, as shown in FIG. 8D, a treatment tool 720 such as a 5 mm forceps is inserted into the abdominal cavity through the first opening 702 (step S22 in FIG. 7).

As described above, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are arranged in the abdominal cavity of the patient, thereby making it possible to perform predetermined examinations and treatments.

As described above, according to the present embodiment, even if the endoscope 100 does not have illumination means, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are arranged according to the procedure shown in FIG. By inserting into a body cavity such as the abdominal cavity, the insertion part 102 of the endoscope 100 and the insertion part 202 of the needle light 200 can be safely placed at a desired position while always observing and illuminating the body cavity. It becomes. Even if the number of openings formed in the body wall is increased, the second to fourth openings 712, 714, and 716 pass the insertion part 102 of the endoscope 100 and the insertion part 202 of the needle light 200 through the body cavity. It is an opening for leading inward, and the size of the opening may be smaller than that of the first opening 702. For this reason, scars after the operation are not conspicuous, the burden on the patient can be reduced, and minimal invasiveness can be achieved.

Also, since an opening can be formed and accessed at an arbitrary position corresponding to the treatment target region, the operation is not cramped, and the treatment target region can be easily observed and treated. In addition, a treatment target site that cannot be directly accessed from one opening can be easily accessed, and treatment can be performed stably.

Here, a method for inserting the trocar 300 in the present embodiment will be described with reference to FIGS. 14A to 14C. 14A to 14C are explanatory views showing a method of inserting the trocar 300. FIG.

First, as shown in FIG. 14A, the inner needle 304 is incorporated in the outer tube 302, and the trocar 300 is along a direction (first direction) substantially perpendicular to the body skin that is the outer surface of the abdominal wall. Is inserted from the body surface skin to a predetermined depth in the abdominal wall. At this time, the distal end of the trocar 300 (specifically, the distal end portion 308 of the inner needle 304 protruding from the distal end of the mantle tube 302) is in the middle of the muscle layer (between the body epidermis and the peritoneum, preferably the middle position of the muscle layer). Until the peritoneum is reached.

Next, as shown in FIG. 14B, the trocar 300 with its tip inserted halfway through the muscle layer is tilted. That is, the trocar 300 is tilted obliquely so that the main body portion 316 of the outer tube 302 approaches the body skin, and the longitudinal axis direction of the insertion portion (hard portion 312 and soft portion 314) of the outer tube 302 is inclined with respect to the body skin. To be in the direction.

Next, as shown in FIG. 14C, with the trocar 300 tilted, the tip of the trocar 300 is inserted in an oblique direction (second direction) with respect to the body skin. As a result, the distal end of the inner needle 304 inserted into the outer tube 302 passes through the peritoneum and is inserted to a depth where the distal end of the outer tube 302 is in the abdominal cavity. Thereafter, by extracting the inner needle 304 from the outer tube 302, a path for guiding the insertion portion 202 of the needle light 200 into the abdominal cavity is secured by the insertion passage 322 in the outer tube 302. Then, the distal end of the insertion portion 202 of the needle light 200 can be guided into the abdominal cavity by inserting the insertion portion 202 of the needle light 200 through the insertion passage 322 of the outer tube 302.

According to the insertion method shown in FIGS. 14A to 14C, when the trocar 300 is inserted into the abdominal cavity, the distal end of the trocar 300 is placed in the abdominal wall along a direction substantially perpendicular to the body epidermis (first direction). After insertion to a midway position (middle muscle layer), the tip of the trocar 300 extends beyond the peritoneum from a midway position in the abdominal wall along a direction (second direction) that is more acute than the first direction with respect to the body epidermis. Insert into the abdominal cavity. At this time, in the first direction, the inclination angle (insertion angle) α1 with respect to the body skin is preferably 70 to 110 degrees, more preferably 80 to 100 degrees, and particularly preferably 85 to 95 degrees. In the second direction, the inclination angle (insertion angle) α2 with respect to the body skin is preferably 60 degrees or less, more preferably 45 degrees or less, and particularly preferably 30 degrees or less.

By inserting the trocar 300 into the abdominal cavity in this way, the rigid portion 312 (the portion formed at the portion surrounded by the body wall) of the outer tube 302 is muscular as indicated by the arrows shown in FIGS. 14B and 14C. Receive greater resistance from the layer. For this reason, compared with the case where it inserts without changing the insertion direction of the trocar 300, the trocar 300 stabbed in the abdominal cavity is fixed reliably. As a result, the needle light 200 inserted into the trocar 300 is stabilized without being affected by body movement or external vibration, and damage to the target organ and other surrounding organs can be prevented. In addition, since the needle light 200 inserted into the trocar 300 is fixed in an obliquely stable state, it is possible to stably irradiate the treatment target site over a wider range. Further, if the needle light 200 can be fixed, the operation is not necessary, and the operation can be performed without adding the operation of the needle light 200 to the normal laparoscopic surgery, that is, without increasing the number of operators who operate the needle light 200. It becomes possible.

The application target of the insertion method shown in FIGS. 14A to 14C is not limited to the trocar 300, and any medical device that can be directly inserted (punctured) from the patient's body skin can be similarly applied. .

As described above, the intraluminal illumination tool and the intraluminal illumination device according to the present invention have been described in detail. However, the present invention is not limited to the above examples, and various improvements and modifications can be made without departing from the gist of the present invention. Of course, you may also do.

DESCRIPTION OF SYMBOLS 10 ... Medical observation system, 100 ... Endoscope, 102 ... Insertion part, 104 ... Grip part, 110 ... Observation window, 112 ... Objective optical system, 120 ... Solid-state image sensor, 130 ... Magnet, 200 ... Needle light, 202 DESCRIPTION OF SYMBOLS ... Insert part 204 ... Grip part 206 ... Light guide cable 208 ... Light source connector 214 ... Illumination window 216 ... Illumination lens 218 ... Light guide 226 ... Temperature sensor 232 ... Metal strand 234 ... Metal Elementary wire, 236 ... thermocouple, 238 ... metal wire, 240 ... metal sheath, 242 ... thermocouple, 300 ... trocar, 302 ... outer tube, 304 ... inner needle, 306 ... shaft, 400 ... light source device, 500 ... Processor unit, 600 ... monitor, 700 ... scope unit, 702 ... first opening, 704 ... trocar, 706 ... coupling fixture, 712 Second opening, 714 ... third opening, 716 ... fourth opening

Claims (6)

A light guide formed by bundling a plurality of optical fibers that guide illumination light is inserted and disposed along the longitudinal direction, and the light guide is emitted from the light guide; An intraluminal illumination tool that emits the illumination light from an end surface,
A temperature detection means comprising a thermocouple for detecting the ambient temperature of the distal end of the insertion portion;
The thermocouple has first and second metal parts made of different metals,
At least one of the first and second metal parts is composed of a metal strand embedded in the plurality of optical fibers,
The body cavity illumination tool, wherein the contact portion between the first and second metal portions is exposed on the distal end side of the light emitting end surface of the light guide. 2. The intraluminal illumination tool according to claim 1, wherein the first and second metal parts are made of a pair of metal strands embedded in the plurality of optical fibers. The outer periphery of the light guide is covered with a cylindrical metal sheath,
2. The body cavity according to claim 1, wherein one of the first and second metal parts is made of a metal strand embedded in the plurality of optical fibers, and the other metal part is made of the metal sheath. Lighting equipment. 4. The intraluminal illumination device according to claim 1, wherein the contact portion of the first and second metal portions is exposed at a center portion on a distal end side of the emission end face of the light guide. An intraluminal lighting device according to any one of claims 1 to 4,
Based on the detection result of the temperature detection means, temperature abnormality determination means for determining a temperature abnormality of the distal end portion of the insertion portion;
A light amount adjusting means for adjusting a light amount of the illumination light when the temperature abnormality determining means determines that the distal end portion of the insertion portion is abnormal in temperature;
An intraluminal illumination device comprising: The intra-body-cavity illumination device according to claim 5, further comprising a warning unit that issues an alarm warning when the temperature abnormality determination unit determines that the distal end portion of the insertion portion has a temperature abnormality.

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