WO2014054775A1 - Medical-use observation system, endoscope, and illumination tool - Google Patents

Description

Medical observation system, endoscope, and lighting device

The present invention relates to a medical observation system, an endoscope, and an illuminator, and in particular, an endoscope for observing the inside of a body cavity and an endoscope are configured separately and illuminates the inside of the body cavity. The present invention relates to a medical observation system including an illuminator that emits the illumination light.

Endoscopic surgery using a rigid endoscope such as a laparoscope (hereinafter referred to as “endoscope”) because the invasion to a patient is small compared to a surgical operation in which laparotomy or thoracotomy is performed in recent years. Surgery is widely performed. 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 includes 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. A system is disclosed. In this system, the illumination light from the same light source device is distributed and supplied to the endoscope and the illumination tool via the light guide cable, and the inside of the body cavity is illuminated by the illumination light emitted from the endoscope and the illumination tool. It can be done.

JP-A-10-137184

By the way, in the system disclosed in Patent Document 1, even when the brightness of illumination light emitted from an endoscope is insufficient, it is possible to ensure a desired brightness with illumination light emitted from a lighting fixture. Become. Moreover, since illumination light can be irradiated to an observation position from various directions, it becomes easier to observe the observation position.

However, in the system disclosed in Patent Document 1, the endoscope inserted into the body cavity and the illumination tool must be operated separately, and there is a problem that the operation tends to be complicated. Further, when the tip of the illuminating device exists outside the observation range of the endoscope, the position of the illuminating device cannot be grasped. For this reason, even if the tip of the illuminator contacts the organ, there is no means for confirming the state, and the tip of the illuminator may be damaged by contacting the organ.

The present invention has been made in view of such circumstances, and provides a medical observation system, an endoscope, and a lighting tool that can ensure the operability and safety of an endoscope and a lighting tool inserted into a body cavity. The purpose is to provide.

In order to achieve the above object, a medical observation system according to an aspect of the present invention includes an insertion portion that is inserted into a body cavity, and an endoscope for observing the inside of a body cavity, and an endoscope An illuminating device that is configured as a separate body and has an insertion portion that is inserted into the body cavity and that emits illumination light for illuminating the inside of the body cavity, and the distal end portions of the endoscope insertion portion and the illumination tool insertion portion And integrating means for integrating the inside of the body cavity.

In a preferred aspect of the present invention, the integrating means includes a magnetic force generating means provided at a distal end portion of one of the insertion portion of the endoscope and the insertion portion of the illumination tool, and the other insertion portion. It consists of a magnetic body provided at the distal end portion, and the distal end portions are integrated in the body cavity by attracting the magnetic body by the magnetic force generated by the magnetic force generating means.

Also, in a preferred aspect of the present invention, the magnetic force generating means is composed of an electromagnet that generates a magnetic force by energization, and further includes switching means that can switch ON / OFF of energization to the electromagnet.

In a preferred embodiment of the present invention, the magnetic force generating means is constituted by a permanent magnet.

Also, in a preferred aspect of the present invention, the insertion portion of the endoscope does not include an illumination means for illuminating the inside of the body cavity.

An endoscope according to another aspect of the present invention has an insertion portion that is inserted into a body cavity, and is an endoscope for observing the inside of the body cavity. A magnetic force generation means is provided that is configured separately from the endoscope and generates a magnetic force that attracts a magnetic body provided in an illuminator for irradiating illumination light for illuminating the inside of the body cavity.

In addition, an illumination tool according to still another aspect of the present invention is configured separately from an endoscope for observing the inside of a body cavity, has an insertion portion inserted into the body cavity, and illuminates the inside of the body cavity. In the illuminator that irradiates the illumination light, a magnetic body that is attracted by the magnetic force generated by the magnetic force generating means provided in the endoscope is provided at the tip of the illuminator.

An endoscope according to still another aspect of the present invention has an insertion portion that is inserted into a body cavity, and is an endoscope for observing the inside of the body cavity. The magnetic body is provided separately from the endoscope, and is attracted by the magnetic force generated by the magnetic force generating means provided in the illuminator for illuminating the illumination light for illuminating the inside of the body cavity.

In addition, an illumination tool according to still another aspect of the present invention is configured separately from an endoscope for observing the inside of a body cavity, has an insertion portion inserted into the body cavity, and illuminates the inside of the body cavity. In the illuminator that irradiates the illumination light, magnetic force generating means for generating a magnetic force for attracting the magnetic body provided in the endoscope is provided at the tip of the illuminator.

According to the present invention, since the distal end portions of the insertion portion of the endoscope and the insertion portion of the illuminating device are integrated in the body cavity, it is not necessary to operate these separately and the complexity of the operation can be eliminated. Can prevent organ damage. Therefore, it is possible to ensure the operability and safety of the endoscope and the lighting tool inserted into the body cavity.

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 schematic view showing a configuration example of a trocar. FIG. 5 is a flowchart showing a procedure for inserting the intra-body-cavity insertion tool into the abdominal cavity. FIG. 6A is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 6B is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 6C is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 6D is a diagram schematically illustrating a state in which the body cavity insertion tool is inserted into the abdominal cavity. FIG. 7 is a cross-sectional view schematically showing how the intracorporeal insertion tool is inserted into the abdominal cavity. FIG. 8 is a schematic view showing the scope unit. FIG. 9 is a plan view illustrating a configuration example of the connection fixture. FIG. 10 is a plan view showing another configuration example of the connection fixture. FIG. 11A is a plan view showing still another configuration example of the connection fixture. FIG. 11B is a plan view showing still another configuration example of the connection fixture. FIG. 12A is an explanatory diagram for explaining a method of inserting a trocar into the abdominal cavity. FIG. 12B is an explanatory diagram for explaining a method of inserting a trocar into the abdominal cavity. FIG. 12C is an explanatory diagram for explaining a method of inserting the trocar into the abdominal cavity. FIG. 13 is an explanatory diagram showing a state where the distal ends of the insertion portion of the endoscope and the insertion portion of the needle light are integrated in the body cavity. FIG. 14 is a schematic diagram illustrating another configuration example of the endoscope. FIG. 15 is a schematic view showing another configuration example of the needle light.

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 this embodiment is inserted into a body cavity, an endoscope 100 for observing an observation portion in the body cavity, and inserted into the body cavity. A needle light (illuminator) 200 that irradiates illumination light into the body cavity, a light source device 400 that supplies the needle light 200 with illumination light, and a processor device 500 that generates an endoscopic image are provided. 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. Behind the observation window 110, an objective optical system 112 and a solid-state imaging device 120 (CMOS (Complementary Metal-Oxide Semiconductor) sensor, CCD (Charge-Coupled Device) sensor, etc.) are arranged. 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.

Further, in the present embodiment, a cylindrical magnet 130 is provided on the outer peripheral surface of the distal end portion of the insertion portion 102 of the endoscope 100. The magnet 130 is made of an electromagnet, and switches between an energized state and a non-energized state depending on whether power is supplied. The grip 104 is provided with an operation switch 132 for turning on / off the power to the magnet 130. The magnet 130 is electrically connected to the power supply unit 510 provided in the processor device 500 via the operation switch 132. Thus, when the operation switch 132 is turned on, the magnet 130 is energized and generates a magnetic force. On the other hand, when the operation switch 132 is turned off, the magnet 130 is in a non-energized state and does not generate a magnetic force. Magnet 130 is not limited to an electromagnet, and may be a permanent magnet.

[Needle light]
FIG. 3 is a schematic diagram illustrating a configuration example of the needle light 200. 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.

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. 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, as the needle light 200, the illumination light from the light source device 400 is guided to the distal end portion of the insertion portion by the light guide 218, and is irradiated into the body cavity from the illumination lens 216 and the illumination window 214. However, the configuration of the needle light is not limited to this, and a configuration in which an LED light source is built in the tip of the needle light may be used.

In this embodiment, a cylindrical magnetic body 244 is provided on the outer peripheral surface of the distal end portion of the insertion portion 202 of the needle light 200 as shown in FIG. The magnetic body 244 is made of a magnetic member such as iron, and is attracted by the magnetic force generated by the magnet 130.

[Tracar]
FIG. 4 is a schematic diagram illustrating a configuration example of the trocar 300. As shown in FIG. 4, 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. The guide portion 318 is connected to the base end side of the main body portion 316, and the introduction portion 320 is provided on the base end side of the guide portion 318. The hard part 314, the soft part 314, the main body part 316, the guide part 318, and the introduction part 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. 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 part 318 has an inner diameter slightly larger than the outer diameter of the insertion part 202 of the needle light 200, and has a sufficient 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 from the check valve 330 or the seal member 332, the distal end portion is inserted without buckling deformation. The part 202 can be easily pushed toward the tip 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.

[How to insert the insertion tool]
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 placing 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. 5 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. 6A to 6D are diagrams schematically showing a state where the intra-body-cavity insertion tool is inserted into the abdominal cavity. FIG. 7 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. 5 is a step that takes into account minimally invasiveness in addition to safety.

First, as shown in FIGS. 6A and 7, 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. 5).

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 of FIG. 5 is a procedure step utilizing 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. 8 is a schematic diagram showing the scope unit 700. FIG. 9 is a plan view showing a configuration example of the connection fixture 706. As shown in FIGS. 9 and 10, 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. 8, 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, the connecting fixtures 706 are inserted into the trocar 704 without entering 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. .

In addition, the connection fixture 706 is not limited to the configuration shown in FIG. 9, and for example, the configuration shown in FIGS.

FIG. 10 is a plan view showing another configuration example of the connection fixture 706. As shown in FIG. 10, the connection fixture 706 is formed with 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.

11A and 11B are plan views showing still another configuration example of the connection fixture 706. FIG. The configuration shown in FIG. 11A is the same as the configuration shown in FIG. 9 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. 11B is the same as the configuration shown in FIG. 10 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. 6B, 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. 5).

The trocar 300 (needle light trocar) shown in FIG. 4 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.

Here, a method for inserting the trocar 300 in the present embodiment will be described with reference to FIGS. 12A to 12C. 12A to 12C are explanatory views showing a method of inserting the trocar 300. FIG.

First, as shown in FIG. 12A, 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 it reaches the peritoneum).

Next, as shown in FIG. 12B, the trocar 300 with the 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. 12C, 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. 12A to 12C, 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. 12B and 12C. 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, the needle light 200 inserted into the trocar 300 can be fixed obliquely, and the illumination of the treatment target site can be stably performed. 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 method of the insertion method shown in FIGS. 12A to 12C is not limited to the trocar 300, and can be similarly applied to any type of medical instrument that can be directly inserted (punctured) from the patient's body skin. Thus, it is possible to obtain the same effects as when the trocar 300 is inserted.

After the needle light 200 is inserted into the abdominal cavity through the trocar 300 inserted into the second opening 712 as described above, the needle light 200 is inserted from the first opening 702 as shown in FIG. 6C. The unit 202 is removed (step S14 in FIG. 5).

Next, as shown in FIG. 6C, 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. 5).

Next, the insertion portion 102 of the endoscope 100 is removed from the first opening 702 (step S18 in FIG. 5).

Next, as shown in FIG. 6D, through the fourth opening 716 formed at a position different from the first to third openings 702, 712, 714 (for example, the right center of the abdomen), The insertion part 102 of the endoscope 100 is inserted (step S20 in FIG. 5).

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. 6D, 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. 5).

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.

In this embodiment, after inserting the insertion part 102 of the endoscope 100 and the insertion part 202 of the needle light 200 into the abdominal cavity of the patient as described above, when the operation switch 132 of the endoscope 100 is turned on, the processor Power is supplied from the power supply unit 510 of the apparatus 500 to the magnet 130 of the insertion unit 102 of the endoscope 100. As a result, the magnet 130 is energized and generates a magnetic force, and the magnetic body 244 of the insertion portion 202 of the needle light 200 is attracted to the magnet 130. As a result, as shown in FIG. 13, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are integrated with the distal ends thereof connected in the body cavity.

On the other hand, when the insertion portion 102 of the endoscope 100 or the insertion portion 202 of the needle light 200 is removed from the abdominal cavity, the power supply from the processor device 500 to the magnet 130 is stopped when the operation switch 132 is turned off. Accordingly, the magnet 130 is in a non-energized state and does not generate magnetic force, so that the state where the distal ends of the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are integrated is released. Then, the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 can be easily removed from the abdominal cavity.

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.

Further, since the opening can be formed at an arbitrary position corresponding to the treatment target site and the treatment target site can be accessed, the operation is not cramped and the treatment target site 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.

In this embodiment, since the insertion portion 102 of the endoscope 100 includes the magnet 130 and the insertion portion 202 of the needle light 200 includes the magnetic body 244, the insertion portion 102 of the endoscope 100 and the needle light 200 are included. The distal end portions of the insertion portion 202 and the insertion portion 202 can be integrated in the body cavity. Accordingly, when one of the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 is moved, the other is also moved integrally, so that it is not necessary to operate these separately, and the operation is complicated. In addition, the operator can grasp the positions of the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200, and can prevent organ damage. Therefore, the operability and safety of the endoscope 100 and the needle light 200 inserted into a body cavity such as the abdominal cavity can be ensured.

Further, in the present embodiment, the configuration in which the magnet 130 is provided in the insertion portion 102 of the endoscope 100 and the magnetic body 244 is provided in the insertion portion 202 of the needle light 200 is shown, but the present invention is not limited to this. As shown in FIG. 15, the insertion unit 102 of the endoscope 100 may include a magnetic body 134, and the insertion unit 202 of the needle light 200 may include a magnet 246.

15 is composed of an electromagnet, similar to the magnet 130 of FIG. The grip 204 is provided with an operation switch 248 for turning on / off the power to the magnet 246. The magnet 246 is electrically connected to the power supply unit 420 provided in the light source device 400 via the operation switch 248.

Thereby, according to ON / OFF operation of the operation switch 248, the electromagnet 246 is switched between an energized state and a non-energized state, and the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 are similar to the present embodiment. Can be integrated in the body cavity.
Magnet 246 is not limited to an electromagnet, and may be a permanent magnet.

In the present embodiment, a magnet is used as means for integrating the distal end portions of the insertion portion 102 of the endoscope 100 and the insertion portion 202 of the needle light 200 in the body cavity (corresponding to “integration means” of the present invention). Although the magnetic body is used, the present invention is not limited thereto, and the distal end portions of the insertion portions may be integrated using a string-like member (mechanical fixing means) such as a surgical thread.

As described above, the medical observation system, the endoscope, and the illumination tool according to the present invention have been described in detail. However, the present invention is not limited to the above examples, and various types of the present invention are possible without departing from the gist of the present invention. Of course, improvements and modifications may be made.

In the above embodiment, the case where the endoscope is applied to an electronic endoscope (electronic scope) has been described as an example. However, the endoscope of the present invention is applied to an optical endoscope (fiber scope). You can also.

Moreover, although the said embodiment demonstrated the case where it applied to the endoscope which does not have an illumination means, the endoscope of this invention was equipped with the auxiliary illumination means which can irradiate auxiliary illumination light, for example It can be applied to an endoscope. If it is an endoscope provided with the auxiliary illumination means, a diameter can be reduced compared with the conventional general endoscope, and the effect of this invention can fully be exhibited.

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, 124 ... Connector, 130 ... Magnet, 200 ... Needle light 202 ... insertion part 204 ... grip part 206 ... light guide cable 214 ... illumination window 216 ... illumination lens 218 ... light guide 244 ... magnetic body 300 ... tracar 302 ... mantle tube 304 ... Inner needle, 400 ... light source device, 500 ... processor device, 600 ... monitor, 700 ... scope unit

Claims (9)

An endoscope having an insertion portion to be inserted into a body cavity, and observing the inside of the body cavity;
An illuminator configured to be separate from the endoscope, having an insertion portion inserted into the body cavity, and irradiating illumination light for illuminating the interior of the body cavity;
Integration means for integrating the insertion portion of the endoscope and the distal end portions of the insertion portion of the illuminator in the body cavity;
A medical observation system comprising: The integration means includes a magnetic force generating means provided at a distal end portion of one of the insertion portion of the endoscope and the insertion portion of the lighting device, and a distal end portion of the other insertion portion. The medical observation system according to claim 1, further comprising: a magnetic body provided on the body cavity, wherein the distal ends are integrated in the body cavity by attracting the magnetic body by a magnetic force generated by the magnetic force generation means. The magnetic force generating means comprises an electromagnet that generates a magnetic force when energized,
The medical observation system according to claim 2, further comprising switching means capable of switching ON / OFF of energization to the electromagnet. The medical observation system according to claim 2, wherein the magnetic force generating means is constituted by a permanent magnet. The medical observation system according to any one of claims 1 to 4, wherein the insertion portion of the endoscope does not include an illumination unit for illuminating the body cavity. An endoscope having an insertion part to be inserted into a body cavity, and observing the inside of the body cavity,
The distal end portion of the insertion portion is configured separately from the endoscope, and generates a magnetic force that attracts a magnetic body included in an illuminator for irradiating illumination light for illuminating the inside of the body cavity. An endoscope provided with magnetic force generation means. An illuminator configured separately from an endoscope for observing the inside of a body cavity, having an insertion portion inserted into the body cavity, and irradiating illumination light for illuminating the inside of the body cavity,
A lighting tool provided with a magnetic body attracted by a magnetic force generated by a magnetic force generating means provided in the endoscope at a distal end portion of the lighting tool. An endoscope having an insertion part to be inserted into a body cavity, and observing the inside of the body cavity,
The distal end portion of the insertion portion is configured separately from the endoscope, and has a magnetic force generated by a magnetic force generating means provided in an illuminator for irradiating illumination light for illuminating the body cavity. An endoscope provided with a magnetic body that is attracted. An illuminator configured separately from an endoscope for observing the inside of a body cavity, having an insertion portion inserted into the body cavity, and irradiating illumination light for illuminating the inside of the body cavity,
A lighting tool provided with a magnetic force generating means for generating a magnetic force for attracting a magnetic body provided in the endoscope at a distal end portion of the lighting tool.

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