Medical system

A medical system includes an insertion slave apparatus to be inserted into a body, a treatment slave apparatus to be inserted into the body together with the insertion slave apparatus to treat an object, an insertion master portion having a similar figure to the insertion slave apparatus and including a movable portion, wherein the insertion slave apparatus is to perform following actuation according to operation input to the insertion master portion, a treatment master portion to be operated by an operator, wherein the treatment slave apparatus is to perform following actuation according to operation input to the treatment master portion, and a connecting portion coupling the insertion master portion and the treatment master portion to each other, wherein the movable portion is to be moved through the connecting portion to operate the insertion master portion by holding and operating the treatment master portion.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a medical system wherein an insertion slave apparatus and a treatment slave apparatus are used together with each other, and the insertion slave apparatus is operated by an insertion master portion and the treatment slave apparatus is operated by a treatment master portion.

2. Description of the Related Art

In Jpn. Pat. Appln. KOKAI Publication No. 2007-185385, an electrical bending endoscope is disclosed as an insertion slave apparatus. The electrical bending endoscope includes an insertion portion being long and configured to be inserted into the body. An endoscope bending portion is provided in the distal end portion of the insertion portion and configured to be actuated to be bent. A driving unit is coupled to the proximal end portion of the insertion portion, and an actuation portion is built into the driving unit and configured to actuate the endoscope bending portion to be bent. The driving unit is connected to a control unit through the universal cord, and an operation portion is connected to the control unit through a connecting cord. When the operation portion is operated, the actuation portion is actuated, and then, the endoscope bending portion is actuated to be bent.

In Jpn. Pat. Appln. KOKAI Publication No. 8-173442, a master-slave manipulator is disclosed as a treatment slave apparatus. The master-slave manipulator includes a middle axial portion being elongated and configured to be inserted into the body. A slave manipulator portion is coupled to the distal end portion of the middle axial portion and configured to grasp an object of treatment. On the other hand, a master manipulator portion is coupled to the proximal end portion of the middle axial portion. When the master manipulator portion is operated, the slave manipulator portion is actuated.

BRIEF SUMMARY OF THE INVENTION

In an aspect of the present invention, a medical system includes: an insertion slave apparatus configured to be inserted into a body; a treatment slave apparatus configured to be inserted into the body together with the insertion slave apparatus and configured to be used together with the insertion slave apparatus to treat an object of treatment; an insertion master portion having a similar figure to the insertion slave apparatus and including a movable portion configured to be moved, wherein the insertion slave apparatus is configured to perform following actuation according to operation input to the insertion master portion; a treatment master portion configured to be operated by an operator, wherein the treatment slave apparatus is configured to perform following actuation according to operation input to the treatment master portion; and a connecting portion coupling the insertion master portion and the treatment master portion to each other, wherein the movable portion is configured to be moved through the connecting portion to operate the insertion master portion by holding and operating the treatment master portion.

DETAILED DESCRIPTION OF THE INVENTION

Hereinafter, each embodiment of the present invention will be explained referring to the drawings.

Referring toFIGS. 1 to 23, a first embodiment of the present invention will be explained.

Referring toFIGS. 1 and 2, an electrical bending endoscope36will be explained as an insertion slave apparatus in a medical system.

The endoscope36includes an endoscope insertion portion37ebeing long and flexible and configured to be inserted into the body. A distal end rigid portion38is provided in the distal end portion of the endoscope insertion portion37e. The proximal end portion of the endoscope insertion portion37eis coupled to an endoscope driving unit39e, and the endoscope driving unit39eis held by an endoscope stand42of a trolley41. A universal cord43extends from the endoscope driving unit39e, and a light source connector44and an electrical connector45are provided at the extending end portion of the universal cord43and connected to a light source apparatus46and a video processor47of the trolley41, respectively. Here, the video processor47is connected to a system controller48. Illumination light is produced in the light source apparatus46, transmitted to an illumination optical system in the distal end rigid portion38through a light guide extending between the light source connector44and the illumination optical system, and emitted to an object of observation from the illumination optical system. An observation image is imaged by an imaging unit in the distal end rigid portion38and an image signal is produced, and then, the image signal is output to the video processor47through an imaging cable extending between the imaging unit and the electrical connector45, and the observation image is displayed in a monitor49of the trolley41by the video processor47. In the distal end portion of the endoscope36, an up and down direction and a left and right direction are determined corresponding to the up and down direction and the left and right direction in the observation image displayed in the monitor49.

A first endoscope bending portion51efand a second endoscope bending portion51esare arranged in the axial direction on the proximal end side of the distal end rigid portion38in the endoscope insertion portion37e. The first and the second endoscope bending portion51ef,51esare configured to be actuated to be bent in the up and down direction and the left and right direction. On the other hand, an endoscope bending driving portion52ebis provided at the distal end part of the endoscope driving unit39e. The endoscope bending driving portion52ebincludes a first and a second up and down directional, and left and right directional endoscope bending driving motor53efu,53efl,53esu,53eslfor actuating the first and the second endoscope bending portion51ef,51esto be bent in the up and down direction and the left and right direction. Sprockets are coupled to the endoscope bending driving motors53efu,53efl,53esuand53esland endoscope wires are wound around the sprockets. The one end side parts and the other end side parts of the endoscope wires are inserted through the endoscope driving unit39eand the endoscope insertion portion37e, and coupled to the endoscope bending portions51efand51es. When the sprocket is rotated by the endoscope bending driving motor53efu,53efl,53esuor53esland the endoscope wire is actuated to be advanced and retreated, the endoscope bending portion51efor51esis actuated to be bent. Furthermore, an endoscope rotational driving portion52eris provided in the proximal end part of the endoscope driving unit39e. The endoscope rotational driving portion52erincludes an endoscope rotational driving motor53er. The endoscope rotational driving portion52eris configured to actuate the whole endoscope36to be rotated about the central axis of the endoscope36.

Moreover, a grasping instrument channel58gand a high-frequency treatment instrument channel58hextend through the endoscope insertion portion37e, and a grasping manipulator57gand a high-frequency treatment manipulator57hare inserted through the grasping instrument channel58gand the high-frequency treatment instrument channel58h, respectively. The proximal end portions of the instrument channels58gand58hare connected to instrument guide pipes59gand59hin the proximal end portion of the endoscope insertion portion37e. Instrument insertion openings61gand61hare provided at the extending end portions of the instrument guide pipes59gand59hand the manipulators57gand57hare configured to be inserted into the instrument insertion openings61gand61h. On the other hand, the distal end portions of the instrument channels58gand58hare connected to instrument protrusion openings62gand62hin the distal end rigid portion38, and the manipulators57gand57hare configured to protrude from the instrument protrusion openings62gand62h.

Here, a direction of a field of view of the endoscope36and opening directions of the instrument protrusion openings62gand62hare substantially parallel to the centrally axial direction of the endoscope36and substantially parallel to one another. The grasping instrument protrusion opening62gis arranged on the left side and the high-frequency treatment instrument protrusion opening62his arranged on the right side on the basis of the field of view of observation of the endoscope36.

Referring toFIGS. 1 and 3to8, manipulator apparatuses63gand63hwill be explained as treatment slave apparatuses. The manipulator apparatuses63gand63hare formed by the manipulators57gand57hand manipulator driving units39gand39h.

Referring toFIGS. 3 to 5, the manipulators57gand57hof the manipulator apparatuses63gand63hinclude manipulator insertion portions37gand37hbeing long and flexible and configured to be inserted through the instrument channels58gand58hof the endoscope36. In the grasping manipulator57g, a grasping portion64is provided at the distal end portion of the manipulator insertion portion37g. The grasping portion64is configured to be actuated to be opened and closed to grasp living tissue. In the high-frequency treatment manipulator57h, a high-frequency electrode65is provided at the distal end portion of the manipulator insertion portion37h. A high-frequency current is adapted to flow through the high-frequency electrode65and the high-frequency electrode65is configured to come in contact with living tissue to incise it with the high-frequency current. Manipulator bending portions51gand51hare provided on the proximal end sides of the grasping portion64and the high-frequency electrode65, respectively, and configured to be actuated to be bent. In the manipulator bending portions51gand51h, pitch joint portions66gpand66hpare provided on the distal end sides and yaw joint portions66gy,66hyare provided on the proximal end sides. The grasping portion64and the high-frequency electrode65are moved in the pitch directions and the yaw directions by rotational actuations of the pitch joint portions66gpand66hpand the yaw joint portions66gyand66hy, respectively.

Cassette-like manipulator driving connecting portions67gand67hare coupled to the proximal end portions of the manipulator insertion portions37gand37h. Pitch axial rotational pulleys68gpand68hpand yaw axial rotational pulleys68gyand68hyare provided in the manipulator driving connecting portions67gand67h. Pitch axial rotational manipulator wires69gpand69hpand yaw axial rotational manipulator wires69gyand69hyare wound around the pitch axial rotational pulleys68gpand68hpand the yaw axial rotational pulleys68gyand68hy, respectively. The one end side parts and the other end side parts of the pitch axial rotational manipulator wires69gpand69hpand the yaw axial rotational manipulator wires69gyand69hyare inserted through the manipulator driving connecting portions67gand67hand the manipulator insertion portions37gand37h, and coupled to the pitch joint portions66gpand66hpand the yaw joint portions66gyand66hy, respectively. When the pitch axial rotational pulley68gpor68hpor the yaw axial rotational pulley68gyor68hyis rotated and the pitch axial rotational manipulator wire69gpor69hpor the yaw axial rotational manipulator wire69gyor69hyis actuated to be advanced and retreated, the pitch joint portion66gpor66hpor the yaw joint portion66gyor66hyis actuated to be rotated. Furthermore, in the grasping manipulator57g, an opening and closing pulley68ocand an opening and closing manipulator wire69ocare used. When the opening and closing pulley68ocis rotated and the opening and closing manipulator wire69ocis actuated to be advanced and retreated, the grasping portion64is actuated to be opened and closed. On the other hand, in the high-frequency manipulator57h, the distal end portion of a current cable70is coupled to the inner end portion of the high-frequency electrode65. The current cable70is inserted through the manipulator insertion portion37h, put into the manipulator driving connecting portion67h, and connected to an electrical contact portion71.

Moreover, guide convex portions73and click holes74are formed in connecting portion housings72gand72hof the manipulator driving connecting portions67gand67has connecting mechanisms of the manipulators57gand57hand the manipulator driving units39gand39h. Furthermore, pulley spur gears75are formed in the pulleys68oc,68gp,68gy,68hpand68hy. Moreover, in the high-frequency manipulator57h, the electrical contact portion71protrudes from the connecting portion housing72h.

Referring toFIGS. 6 to 8, the manipulator driving units39gand39hinclude base portions76gand76h. Advancing and retreating portions77gand77hare provided upon the base portions76gand76h. The advancing and retreating portions77gand77hare configured to be actuated to be advanced and retreated in the central axial direction of the manipulator driving units39gand39hrelative to the base portions76gand76hby advancing and retreating driving portions52gmand52hmbuilt into the base portions76gand76h. In the advancing and retreating driving portions52gmand52hm, advancing and retreating driving motors53gmand53hmand feed screw mechanisms78are used.

Manipulator rotational portions79gand79hare housed within the advancing and retreating portions77gand77h. The manipulator rotational portions79gand79hare configured to be rotated about the central axis of the manipulator driving units39gand39hrelative to the advancing and retreating portions77gand77hby manipulator rotational driving portions52grand52hrbuilt into the advancing and retreating portions77gand77h. Manipulator rotational driving motors53grand53hrand rotational gear mechanisms81rare used in the manipulator rotational driving portions52grand52hr.

Manipulator connecting portion housing portions82gand82hare formed in the manipulator rotational portions79gand79hand are configured to house coaxially the manipulator driving connecting portions67gand67hof the manipulators57gand57h. Connecting portion insertion openings83are formed in the one end portions in the central axial direction of the manipulator rotational portions79gand79hand the manipulator driving connecting portions67gand67hare configured to be inserted into the manipulator connecting portion housing portions82gand82hthrough the connecting portion insertion openings83. Guide concave portions84are formed in the manipulator connecting portion housing portions82gand82hand configured to guide convex portions73of the manipulator driving connecting portions67gand67h. Moreover, manipulator connecting portion engaging portions85gand85hare provided in the one end surface portions of the manipulator rotational portions79gand79h. When the manipulator driving connecting portion67gor67his inserted into the manipulator connecting portion housing portion82gor82h, a click pin86of the manipulator connecting portion engaging portion85gor85his engaged with the click hole74of the manipulator driving connecting portion67gor67h, and the manipulator driving connecting portion67gor67his held relative to the manipulator rotational portion79gor79h. When a releasing lever87of the manipulator connecting portion engaging portion85gor85his operated, the click pin86and the click hole74are disengaged from each other, the manipulator driving connecting portion67gor67his released relative to the manipulator rotational portion79gor79h, and the manipulator driving connecting portion67gor67hcan be extracted from the manipulator connecting portion housing portion82gor82h.

Moreover, pitch axial rotational driving portions52gpand52gyand yaw axial rotational driving portions52hpand52hyare provided within the manipulator rotational portions79gand79h. Furthermore, an opening and closing driving portion52ocis provided in the grasping manipulator driving unit39g. Pitch axial rotational driving motors53gpand53hpand driving gear mechanisms81dare used in the pitch axial rotational driving portions52gpand52gy, yaw axial rotational driving motors53gyand53hyand driving gear mechanisms81dare used in the yaw axial rotational driving portions52hpand52hy, and an opening and closing driving motor53ocand a driving gear mechanism81dare used in the opening and closing driving portion52oc. When the manipulator driving connecting portion67gor67his inserted into and extracted from the manipulator connecting portion housing portion82gor82h, the pulley spur gears75of the pulleys68oc,68gp,68gyor68hp,68hyof the manipulator driving connecting portion67gor67hare engaged with and separated from the driving spur gears80at the terminal ends on the driven sides of the driving gear mechanisms81d, respectively. Here, the driving motors53oc,53gp,53gy,53hpand53hyand the driving gear mechanisms81dare supported by support base portions88, and the support base portions88are supported so as to advance and retreat in the insertion and extraction direction of the manipulator driving connecting portions67gand67h. The driving motors53oc,53gp,53gy,53hpand53hy, the driving gear mechanisms81dand the support base portions88are urged in the opposite directions to the insertion directions of the manipulator driving connecting portions67gand67hby elastic members83. Therefore, when the manipulator driving connecting portion67gor67his inserted into the manipulator connecting portion housing portion82gor82hand the pulley spur gears75are engaged with the driving spur gears80, the driving spur gears80and the pulley spur gears75can be surely engaged.

Moreover, an electrical contact receiving portion which is not shown is provided within the manipulator rotational portion79hof the high-frequency treatment manipulator driving unit39h. In the high-frequency treatment manipulator apparatus63h, when the manipulator driving connecting portion67his inserted into and extracted from the manipulator connecting portion housing portion82h, the electrical contact portion71is connected to and separated from the electrical contact receiving portion.

When the manipulator57gor57his connected to the manipulator driving unit39gor39h, and then, the advancing and retreating driving motor53gmor53hmactuates the advancing and retreating portion77gor77hand the manipulator rotational portion79gor79hto be advanced and retreated, the whole manipulator57gor57his actuated to be advanced and retreated in the centrally axial direction of the manipulator57gor57h, and the grasping portion64or the high-frequency electrode65of the manipulator57gor57his actuated to be advanced and retreated. Moreover, when the manipulator rotation driving motor53gror53hractuates the manipulator rotational portion79gor79hto be rotated, the whole manipulator57gor57his actuated to be rotated about the central axis of the manipulator57gor57h, and the grasping portion64or the high-frequency electrode65of the manipulator57gor57his actuated to be rotated. When the opening and closing driving motor53oc, the pitch axial rotational driving motor53gpor53hpor the yaw axial rotational driving motor53gyof53hyactuates the pulley68oc,68gp68hp,68gyor68hyof the manipulator57gto be rotated through the driving gear mechanism81d, the grasping portion64is actuated to be opened and closed or the joint portion66gp,66hp,66gyor66hyis actuated to be rotated.

Referring toFIG. 1again, the manipulator driving units39gand39hof the grasping manipulator apparatus63gand the high-frequency treatment manipulator apparatus63hsare coupled and fixed to the middle part of the endoscope driving unit39e. The endoscope36and both the manipulator apparatuses63gand63hare configured to be integrally actuated to be rotated by the endoscope rotational driving portion52er. The manipulator driving units39gand39hare connected to the system controller48through a compound cord91, and the high-frequency treatment manipulator driving unit39his connected to the high-frequency power apparatus92.

Referring toFIGS. 1 and 9to11, a master apparatus93will be explained.

The master apparatus93is connected to the system controller48. The master apparatus93stands on a master apparatus stand94configured to be set on a floor.

The master apparatus93includes an endoscope master95eas an insertion master portion. The endoscope master95ehas a similar figure to the distal end portion of the endoscope36. That is, in the endoscope master95e, a first arm portion96f, a second arm portion96sand a third arm portion96twhich are circular cylindrical are provided from the distal end side to the proximal end side, and the third arm portion96tis attached to the master apparatus stand94through an attachment arm portion96a. Here, in the first, the second, the third and the attachment arm portion96f,96s,96t,96a, two directions which are orthogonal to the central axis and orthogonal to each other are referred to as an up and down direction and an left and right direction, respectively. In the normal arrangement, the first arm portion96f, the second are portion96s, the third arm portion96tand the attachment arm portion96aare arranged in a straight line, and the up and down directions of the first arm portion96f, the second arm portion96s, the third arm portion96tand the attachment arm portion96asubstantially agree with one another and the left and right directions of those substantially agree with one another. InFIG. 9, arrows A, U, D, R and L refer to the centrally axial direction, the up direction, the down direction, the right direction and the left direction of the first arm portion96f, respectively. A first link portion97ffunctioning as a universal joint is interposed between the first arm portion96fand the second arm portion96sand the second link portion97sfunctioning as a universal joint is interposed between the second arm portion96sand the third arm portion96t. The arm portions96fand96son the distal end sides are rotatable in the up and down directions and the left and right directions relative to the arm portions96sand96ton the proximal end sides by the link portions97fand97s. That is, in the first link portion97f, both tongue portions98fprotrude in the axial direction at the proximal end portion of the first arm portion96fat the up position and the down position, respectively. A rotational block99fsis arranged between both the tongue portions98f, and both the tongue portions98fare pivotally attached to the rotational block99fs. Both the tongue portions98fare rotatable relative to the rotational block99fsabout a left and right directional rotational axis Olr orthogonal to the central axis of the first arm portion96fand extending in the up and down direction. On the other hand, both tongue portions98sdprotrude in the axial direction at the distal end portion of the second arm portion96sat the left position and the right position, respectively. The rotational block99fsis arranged between both the tongue portions98sdand pivotally attached to both the tongue portions98sd. The rotational block99fsis rotatable relative to both the tongue portions98sdabout an up and down directional rotational axis Oud orthogonal to the central axis of the second arm portion96sand extending in the left and right direction. The second link portion97salso has a similar configuration to that of the first link portion97f. That is, both tongue portions98spof the proximal end portion of the second link portion97sare rotatable relative to a rotational block99stabout an up and down directional rotational axis Oud, and the rotational block99stis rotatable relative to both the tongue portions98tof the distal end portion of the third link portion97tabout a left and right directional rotational axis Olr. Electromagnetic brakes55lfand55lsare provided in the link portions97fand97s. The electromagnetic brakes55lfand55lsare configured to be switched between releasing states to make the arm portions96fand96son the distal end sides rotatable relative to the arm portions96sand96ton the proximal end sides in the up and down directions and the left and right directions, and fixing states to make the arm portions96fand96son the distal end sides unrotatable relative to the arm portions96sand96ton the proximal end sides in the up and down directions and the left and right directions. Furthermore, a first up and down directional rotation angle sensor54fu, a first left and right directional rotation angle sensor54fl, a second up and down directional rotation angle sensor54suand a second left and right directional rotation angle sensor54slare provided in the first link portion97fand the second link portion97s, respectively, and configured to detect rotation angles of the arm portions96fand96son the distal end side relative to the arm portions96sand96ton the proximal end side in the up and down direction and the left and right direction. Encoders are used as the rotation angle sensors, which are configured to detect amounts of the rotation angles. The rotation angles detected by the first up and down directional, and first left and right directional rotation angle sensor54fu,54fland the second up and down directional, left and right directional rotation angle sensor54su,54slare used for control of bending actuations of the first endoscope bending portion51efand the second endoscope bending portion51esof the endoscope36in the up and down direction and the left and right direction, respectively.

The root portions of rod-like support arms103land103rare coupled to the left end portion and the right end portion of the distal end portion of the first arm portion96fof the endoscope master95eas connecting portions, respectively. The support arms103land103ron the left side and the right side extend straight in the left direction and the right direction, respectively. Manipulator masters95gand95has treatment master portions are coupled to the terminal end portions of the support arms103land103r. The grasping manipulator master95gis arranged on the left side and configured to be used for control of actuation of the grasping manipulator57g, and the high-frequency treatment manipulator master95his arranged on the right side and configured to be used for control of actuation of the high-frequency treatment manipulator57h.

The manipulator masters95gand95hinclude columnar tilting operation portions104gtand104ht. Ball joints105g,105hare interposed between the tilting operation portions104gtand104htand the terminal end portions of the support arms103land103r. The central axes of the tilting operation portions104gtand104htform the central axes of the manipulator masters95gand95hand are configured to be arranged parallel to the central axes of the first arm portion96fof the endoscope master95eat the normal arrangement. In the manipulator masters95gand95h, an axis extending in the left and right direction of the first arm portion96fis referred to as a pitch axis P and axes extending in the up and down direction of the first arm portion96fare referred to as yaw axes Y. The tilting operation portions104gtand104htare supported by the ball joints105gand105hso as to be rotatable about the pitch axis P and the yaw axes Y relative to the terminal end portions of the support arms103land103r. Electromagnetic brakes55gband55hbare provided at the ball joints105gand105h, and the electromagnetic brakes55gband55hbare configured to be switched between releasing states to make the tilting operation portions104gtand104htrotatable relative to the terminal end portions of the support arms103land103r, and fixing states to make the tilting operation portions104gtand104htunrotatable relative to the terminal end portions of the supports arms103land103r. Moreover, pitch axial rotation angle sensors54gpand54hpand yaw axial rotation angle sensors54gyand54hyare provided at the ball joints105gand105hand configured to detect rotation angles of the tilting operation portions104gtand104htabout the pitch axis P and the yaw axes Y, respectively. The pitch axial rotation angles and the yaw axial rotation angles detected by the pitch axial rotation angle sensors54gpand54hpand the yaw axial rotation angle sensors54gyand54hyare used for control of rotational actuations of the pitch joint portions66gpand66hpand the yaw joint portions66gyand66hyof the manipulators57gand57h, respectively.

Advancing and retreating and rotational operation portions104gmand104hmare provided at the distal end sides of the tilting operation portions104gtand104htthrough guide mechanisms106gand106h. In the guide mechanisms106gand106h, the guide axes of the advancing and retreating and rotational operation portions104gmand104hmare inserted into guide bores of the tilting operation portions104gtand104ht, and the advancing and retreating and rotational operation portions104gmand104hmare configured to advance and retreat in the axial directions of the tilting operation portions104gtand104htand rotatable about roll axes R forming the central axes of the tilting operation portions104gtand104ht, relative to the tilting operation portions104gtand104ht. Electromagnetic brakes55ggand55hgare provided in the guide mechanisms106gand106h, and the electromagnetic brakes55ggand55hgare configured to be switched between releasing states to make the advancing and retreating and rotational operation portions104gmand104hmenable to advance and retreat, and rotate relative to the tilting operation portions104gtand104ht, and fixing states to make the advancing and retreating and rotational operation portions104gmand104hmunable to advance and retreat, and rotate relative to the tilting operation portions104gtand104ht. Moreover, advancing and retreating amount sensors54gmand54hmare provided in the guide mechanisms106gand106hand configured to detect amounts of advancing and retreating of the advancing and retreating and rotational operation portions104gmand104hmin the axial directions relative to the tilting operation portions104gtand104ht, and roll axial rotation angle sensors54grand54hrare provided in the guide mechanisms106gand106hand configured to detect roll axial rotation angles of the advancing and retreating and rotational operation portions104gmand104hmabout the roll axes R relative to the tilting operation portions104gtand104ht. The amounts of the advancing and retreating detected by the advancing and retreating amount sensors54gmand54hmare used for control of advancing and retreating actuations of the manipulators57gand57h, and the roll axial rotation angles detected by the roll axial rotation angle sensors54grand54hrare used for control of rotational actuations of the manipulators57gand57habout the central axes.

In the manipulator masters95gand95h, opening and closing operation portions104gocand104hocare provided on the distal end sides of the advancing and retreating and rotational operation portions104gmand104hmthrough pivot mechanisms108gand108h. The opening and closing operation portions104gocand104hocare formed by pairs of opening and closing members configured to be opened and closed by the pivot mechanisms108gand108h, and the opening and closing directions of the pairs of opening and closing members substantially agree with the left and right direction of the first arm portion96fof the endoscope master95ein the normal arrangements. Electromagnetic brakes55gpand55hpare provided in the pivot mechanisms108gand108h, and the electromagnetic brakes55gpand55hpare configured to be switched between releasing states to make the opening and closing operation portions104gocand104hocopenable and closeable and fixing states to make the opening and closing operation portions104gocand104hocunopenable and uncloseable. Moreover, opening and closing angle sensors54gocand54hocare provided in the pivot mechanisms108gand108hand configured to detect opening and closeting angles of the pairs of opening and closing members. The opening and closing angles detected by the opening and closing angle sensors54gocand54hocare used for control of opening and closing actuation of the grasping portion64of the grasping manipulator57gand control of output of a high-frequency current to the high-frequency electrode65from the high-frequency power apparatus92, respectively.

Furthermore, a leftward endoscope rotational operation button111eland a rightward endoscope rotational operation button111erare provided in tilting operation portions104gtand104hton the left side and the right side, of the manipulator masters95gand95h, respectively. The leftward endoscope rotational operation button111eland the rightward endoscope rotational operation button111erare used for control of leftward rotational actuation and rightward rotational actuation of the endoscope36about the central axis, respectively.

Moreover, first link portion releasing buttons112lf, second link portion releasing buttons112lsand manipulator master releasing buttons112are provided at the tilting operation portions104gtand104htof the manipulator masters95gand95hon the left side and the right side, respectively, and form releasing switch portions. All of the electromagnetic brakes55lf,55ls,55gb,55hb,55gg,55hg,55gpand55hpof the master apparatus93are normally in the fixing state, and the first and the second link portion97f,97sand the manipulator masters95gand95hare normally in the locking state. The first and the second link portion releasing buttons112lf,112lsare used to make the electromagnetic brake55lf,55lsof the first and the second link portion97f,97sin the releasing state to make the first and the second link portion97f,97sin the free state, respectively. The manipulator master releasing buttons112are used to make the electromagnetic brakes55gb,55hb,55gg,55hg,55gpand55hpof the manipulator masters95gand95hin the releasing state to make the manipulator masters95gand95hin the free states.

Referring toFIGS. 1 and 9to23, a method for using the medical system will be explained.

Here, in the medical system, operation signals and detected data are output to the system controller from the various buttons and various sensors, and actuation signals are output to the various electromagnetic brakes and the various motors from the system controller. However, the system controller is omitted for convenience of drawing inFIGS. 10,11,26and33.

Referring toFIG. 1, when the medical system is used, the endoscope36is inserted into the body such as the digestive organ and the abdominal cavity. The manipulator insertion portions37gand37hof the grasping manipulator57gand the high-frequency treatment manipulator57hare inserted into the grasping instrument channel58gand the high-frequency treatment instrument channel58hof the endoscope36and protrude from the grasping instrument protrusion opening62gand the high-frequency treatment instrument protrusion opening62h, respectively. An observation image around an object of treatment obtained by the endoscope36is displayed on the monitor49. While the observation image displayed on the monitor49is observed, the master apparatus93is operated, and then, the endoscope36is actuated to move a field of view of the endoscope36appropriately, and the grasping treatment manipulator57gand the high-frequency treatment manipulator57hare actuated to perform treatment such as incision to an object of treatment. In this way, the endoscope36, the grasping treatment manipulator57gand the high-frequency treatment manipulator57hare used together with one another.

Referring toFIGS. 9 and 10, when the master apparatus93is operated, the manipulator masters95gand95hon the left side and the right side are held by the left hand and the right hand, respectively. When the manipulator masters95gand95hare operated, the manipulator releasing buttons112of the manipulator masters95gand95hon the left side and the right side are turned on. Manipulator releasing operation signals are output to the system controller48from the manipulator releasing buttons112operated to be turned on. When the manipulator releasing operation signals are input to the system controller48from both the manipulator releasing buttons112on the left side and the right side, the system controller48outputs releasing actuation signals to the electromagnetic brakes55gb,55hb,55gg,55hg,55gpand55hpof the manipulator masters95gand95hto actuate the electromagnetic brakes55gb,55hb,55gg,55hg,55gpand55hpto be switched to the releasing states to make the manipulator masters95gand95hin the free states. Then, the manipulator masters95gand95hare operated with the manipulator releasing buttons112being turned on. On the other hand, when the first link portion97fof the endoscope master95eis operated, the first link portion releasing buttons112lfin the manipulator masters95gand95hon the left side and the right side are turned on. First link portion releasing operation signals are output to the system controller48from the first link portion releasing buttons112lfoperated to be turned on. When the first link portion releasing operation signals are input to the system controller48from both the first link portion releasing buttons112lfon the left side and the right side, the system controller48outputs a releasing actuation signal to the electromagnetic brake55lfof the first link portion97fto actuate the electromagnetic brake55lfto be switched to the releasing state to make the first link portion97fin the free state. Then, the manipulator masters95gand95hare held and moved with the first link portion releasing buttons112lfbeing turned on, the first arm portion96fis rotated through the support arms103land103r, whereby the first link portion97fis operated. Operation of the second link portion97sis similar to that of the first link portion97f.

Referring toFIGS. 9 and 10andFIG. 1, when the leftward endoscope rotational operation button111elor the rightward endoscope rotational operation button111erof the manipulator masters95gand95his turned on, a leftward rotational operation signal or a rightward rotational operation signal is output to the system controller48from the leftward endoscope rotational operation button111elor the rightward endoscope rotational operation button111er. The system controller48outputs a leftward rotational driving signal or a rightward rotational driving signal to the endoscope rotation driving motor53erof the endoscope rotational driving portion52eron the basis of the leftward rotational operation signal or the rightward rotational operation signal. The endoscope rotational driving motor53eractuates the endoscope36to be rotated leftward or rightward about the central axis of the endoscope36on the basis of the leftward rotational driving signal or the rightward rotational driving signal. As a result, the distal end portions of the endoscope36and the manipulator apparatuses63gand63hare rotated about the central axis of the distal end portion of the endoscope36relative to an object of treatment. On the monitor49, positions of the distal end portions of the manipulator apparatuses63gand63hare not changed and an object of observation is rotated.

Referring toFIGS. 9 and 10andFIGS. 12 and 13, when the first and the second link portion97f,97sof the endoscope master95eis operated to be rotated, rotation angles in the up and down direction and the left and right direction of the first and the second link portion97f,97sare detected by the first and the second up and down directional, and left and right directional rotation angle sensor54fu,54fl,54su,54sl, respectively. The rotation angle sensors54fu,54fl,54suand54sloutput data for the rotation angles to the system controller48. The system controller48outputs bending actuation signals to the first and the second up and down directional, and left and right directional endoscope bending driving motors53efu,53efl,53esu,53eslof the endoscope bending driving portion52ebon the basis of the input data for the rotation angle, and the endoscope bending driving motors53efu,53efl,53esu,53eslactuate the first and the second endoscope bending portion51ef,51esto be bent on the basis of the input bending actuation signal, respectively. The system controller48controls the first and the second up and down direction, and left and right directional endoscope bending driving motor53efu,53efl,53esu,53eslsuch that the rotation angle detected by the first and the second up and down directional, and left and right directional rotation angle sensor54fu,54fl,54su,54slis substantially equal to the bending angle in the up and down direction and the left and right direction of the first and the second endoscope bending portion51ef,51es, respectively. As a result, the distal end of the endoscope36is moved, and therefore, a field of view of observation of the endoscope36is moved. On the monitor49, positions of the distal end portions of the manipulator apparatus63gand63hare not changed and an object of observation is moved. The rotation angle of the first and the second link portion97f,97sin the endoscope master95esubstantially agrees with the bending angle of the first and the second endoscope bending portion51ef,51esin the endoscope36. Then, the whole shape of the endoscope master95ecorresponds to the whole shape of the distal end portion of the endoscope36. Then, the whole shape of the distal end portion of the endoscope36, which it is difficult to visually confirm, can be understood on the basis of the whole shape of the endoscope master95e.

Referring toFIGS. 9 and 11andFIGS. 14 and 15, when the tilting operation portion104gtor104htof the manipulator master95gor95his operated to be rotated about the pitch axis P, the pitch axial rotation angle is detected by the pitch axial rotation angle sensor54gpor54hpof the ball joint105gor105h. The pitch axial rotation angle sensor54gpor54hpoutputs data for the pitch axial rotation angle to the system controller48. The system controller48outputs pitch axial rotational driving signal to the pitch axial rotational driving motor53gpor53hpof the manipulator driving unit39gor39hon the basis of the input data for the pitch axial rotation angle, the pitch axial rotational driving motor53gpor53hpactuates the pitch joint portion66gpor66hpof the manipulator57gor57hto be rotated to move the grasping portion64or the high-frequency electrode65in the pitch direction on the basis of the input pitch axial rotational driving signal. The system controller48controls the pitch axial rotational driving motor53gpor53hpsuch that the pitch axial rotation angle detected by the pitch axial rotation angle sensor54gpor54hpis substantially equal to rotation angle of the pitch joint portion66gpor66hp.

Referring toFIGS. 9 and 11andFIGS. 16 and 17, when the tilting operation portion104gtor104htis operated to be rotated about the yaw axis Y relative to the terminal end portion of the support arm103lor103rin the manipulator master95gor95h, the yaw joint portion66gyor66hyis actuated to be rotated such that the yaw axial rotation angle detected by the yaw axial rotation angle sensor54gyor54hyis substantially equal to the rotation angle of the yaw joint portion66gyor66hy, and the grasping portion64or the high-frequency electrode65is moved in the yaw direction, similarly to the case for the pitch axis P.

Referring toFIGS. 9 and 11andFIGS. 18 and 19, when the advancing and retreating and rotational operation portion104gmor104hmis operated to be advanced and retreated in the axial direction relative to the tilting operation portion104gtor104htof the manipulator master95gor95h, an amount of advancing and retreating is detected by the advancing and retreating amount sensor54gmor54hmof the guide mechanism106gor106h. The advancing and retreating amount sensor54gmor54hmoutputs data for the amount of the advancing and retreating to the system controller48. The system controller48outputs an advancing and retreating actuation signal to the advancing and retreating driving motor53gmor53hmof the manipulator driving unit39gor39hon the basis of the input data for the amount of the advancing and retreating, the advancing and retreating driving motor53gmor53hmactuates the whole manipulator57gor57hto be advanced and retreated on the basis of the input advancing and retreating actuation signal to actuate the grasping portion64or the high-frequency electrode65of the distal end of the manipulator57gor57hto be advanced and retreated. The system controller48controls the advancing and retreating driving motor53gmor53hmsuch that a ratio of an amount of advancing and retreating of the whole manipulator57gor57hto the amount of the advancing and retreating detected by the advancing and retreating amount sensor54gmor54hmis substantially fixed.

Referring toFIGS. 9 and 11andFIGS. 20 and 21, when the advancing and retreating and rotational operation portion104gmor104hmis operated to be rotated about the roll axis R relative to the tilting operation portion104gtor104htin the manipulator master95gor95h, the roll axial rotation angle is detected by the roll axial rotation angle sensor54gror54hrof the guide mechanism106gor106h. The roll axial rotation angle sensor54gror54hroutputs data for the roll axial rotation angle to the system controller48. The system controller48outputs a rotational driving signal to the manipulator rotational driving motor53gror53hrof the manipulator driving unit39gor39hon the basis of the input data for the roll axial rotation angle, the manipulator rotational driving motor53gror53hractuates the whole manipulator57gor57hto be rotated about the central axes of the manipulator57gor57hon the basis of the input rotational driving signal, and the grasping portion64or the high-frequency electrode65of the distal end of the manipulator57gor57his actuated to be moved in the roll direction. The system controller48controls the manipulator rotational driving motor53gror53hrsuch that the roll axial rotation angle detected by the roll axial rotation angle sensor54gror54hris substantially equal to the rotation angle of the whole manipulator57gor57habout the central axis of the manipulator57gor57h.

Referring toFIGS. 9 and 11andFIGS. 22 and 23, when the opening and closing operation portion104gocor104hocis operated to be opened and closed in the manipulator master95gor95h, an opening and closing angle is detected by the opening and closing angle sensor54gocor54hocof the pivot mechanism108gor108h. The opening and closing angle sensors54gocand54hocoutput data for the opening and closing angles to the system controller48. Regarding the grasping manipulator master95gand the grasping manipulator apparatus63g, the system controller48outputs opening and closing actuation signal to the opening and closing driving motor53ocof the manipulator driving unit39gon the basis of the input data for the opening and closing angle, and the opening and closing driving motor53ocactuates the grasping portion64to be opened and closed on the basis of the input opening and closing actuation signal. The system controller48controls the opening and closing driving motor53ocsuch that the opening and closing angle detected by the opening and closing angle sensor54gocis substantially equal to an opening and closing angle of the grasping portion64. On the other hand, regarding the high-frequency treatment manipulator master95hand the high-frequency treatment manipulator apparatus63h, the system controller48outputs an output signal to the high-frequency power apparatus92when the opening and closing angle detected by the opening and closing angle sensor54hocis smaller than a threshold, and the high-frequency power apparatus92outputs a high-frequency current to the high-frequency electrode65on the basis of the output signal.

In the above mentioned operation of the master apparatus93and actuations of the endoscope36and the manipulator apparatuses63gand63h, the relative arrangement between the endoscope master95e, the grasping manipulator master95gand the high-frequency treatment manipulator master95hin the master apparatus93corresponds to the relative arrangement between the distal end rigid portion38as a portion to be actuated in the endoscope36, the grasping manipulator57gas a portion to be actuated in the grasping portion64and the high-frequency electrode65as a portion to be actuated in the high-frequency treatment manipulator57h. That is, in the present embodiment, the grasping manipulator master95gand the high-frequency treatment manipulator master95hare arranged on the left side and the right side relative to the central axis of the first arm portion96fof the endoscope master95e, respectively. According to this, the distal end portions of the grasping manipulator57gand the high-frequency treatment manipulator57hare arranged on the left side and the right side relative to the central axis of the distal end rigid portion38of the endoscope36, respectively. Furthermore, attitudes of the grasping manipulator master95gand the high-frequency treatment manipulator master95hrelative to the first arm portion96fsubstantially agree with attitudes of the grasping portion64of the grasping manipulator57gand the high-frequency electrode65of the high-frequency treatment manipulator57hrelative to the distal end rigid portion38, respectively. In detail, angles formed by the central axes of the manipulator masters95gand95hrelative to the up and down direction, the left and right direction and the axial direction of the first arm portion96fsubstantially agree with angles formed by the central axes of the grasping portion64and the high-frequency electrode65relative to the up and down direction, the left and right direction and the axial direction of the distal end rigid portion38, respectively. Moreover, angles formed by the opening and closing direction of the grasping manipulator master95grelative to the up and down direction, the left and right direction and the axial direction of the first arm portion96fsubstantially agree with angles formed by the opening and closing direction of the grasping portion64relative to the up and down direction, the left and right direction and the axial direction of the distal end rigid portion38, respectively. In this way, the relative arrangements substantially agree with each other, and therefore, positional relationships can be easily understood in the medical system.

The medical system according to the present embodiment has the following effects.

In the medical system according to the present embodiment, the endoscope36performs following actuation by operation input to the endoscope master95e, and the manipulators57gand57hperform following actuations by operation inputs to the manipulator masters95gand95h. Then, the endoscope master95ecan be operated through the support arms103land103rby holding and operating the manipulator masters95gand95h, and therefore, the endoscope36and the manipulators57gand57hcan perform the following actuations solely by operating the manipulator masters95gand95h. Moreover, the relative arrangement between the endoscope master95e, the grasping manipulator master95gand the high-frequency treatment manipulator master95hcorresponds to the relative arrangement between the distal end rigid portion38of the endoscope36, the grasping portion64of the grasping manipulator57gand the high-frequency electrode65of the high-frequency treatment manipulator57h, and therefore, the positional relationship can be easily understood in the medical system. Furthermore, when the first and the second link portion97f,97sis made in the locking state, the grasping and the high-frequency treatment manipulator master95g,95his made in the free state and the grasping manipulator master95gand the high-frequency treatment manipulator master95his operated, the grasping and the high-frequency treatment manipulator master95g,95hcan be stably and smoothly operated. Moreover, when the first and the second link portion97f,97sis made in the free state, the grasping and the high-frequency treatment manipulator master95g,95his made in the locking state and the first and the second link portion97f,97sis operated by the grasping and the high-frequency treatment manipulator master95g,95hthrough the support arm103l,103r, the first and the second link portion97f,97scan be stably and smoothly operated. Therefore, the operability of the medical system is sufficiently improved.

Referring toFIGS. 24 to 26, a second embodiment of the present invention will be explained.

Referring toFIGS. 24 and 25, in a master apparatus93according to the present embodiment, a distal end rotational portion114is provided on the distal end side of a first arm portion96fin an endoscope master95e. The distal end rotational portion114is rotatable about the central axis C of the first arm portion96frelative to the first arm portion96f. An electromagnetic brake55ris interposed between the first arm portion96fand the distal end rotational portion114, and the electromagnetic brake55ris configured to be switched between a releasing state to make the distal end rotational portion114rotatable relative to the first arm portion96fand a fixing state to make the distal end rotational portion114unrotatable relative to the first arm portion96f. Moreover, a central axial rotation angle sensor54ris provided between the first arm portion96fand the distal end rotational portion114and configured to detect a rotation angle of the distal end rotational portion114relative to the first arm portion96f. The root portions of support arms103land103ron the left side and the right side are coupled to both end portions of the distal end rotational portion114which is the left end portion and the right end portion in the normal position, respectively. The distal end rotational portion releasing buttons112rare used in manipulator masters95gand95hcoupled to the terminal end portions of the support arms103land103rinstead of the endoscope rotational operation buttons111eland111er.

Referring toFIGS. 25 and 26, when the distal end rotational portion114is operated to be rotated, the distal end rotational portion releasing buttons112rof the manipulator masters95gand95hon the left side and the right side are turned on. Distal end rotational portion releasing operation signals are output to the system controller48from the distal end rotational portion releasing buttons112rturned on. When the distal end rotational portion releasing operation signals are input to the system controller48from both the distal end rotational portion releasing buttons112ron the left side and the right side, the system controller48outputs a release signal to the electromagnetic brake55rbetween the first arm portion96fand the distal end rotational portion114, and the electromagnetic brake55ris actuated to be switched to the releasing state to make the distal end rotational portion114in the free state. When the manipulator masters95gand95hare held and moved to be rotated about the central axis C of the first arm portion96fwith the distal end rotational portion releasing button112rbeing turned on, the distal end rotational portion114is operated to be rotated about the central axis C of the first arm portion96frelative to the first arm portion96fr. The central axial rotation angle sensor54rdetects a rotation angle of the distal end rotational portion114relative to the first arm portion96fand outputs data for the rotation angle to the system controller48. The system controller48outputs a rotation driving signal to the endoscope rotational driving motor53eof the endoscope rotational driving portion52eron the basis of the input data for the rotation angle. The endoscope rotational driving motor53eractuates the endoscope36to be rotated about the central axis of the endoscope36on the basis of the input rotational driving signal. The system controller48controls the endoscope rotational driving motor53ersuch that the central axial rotation angle detected by the central axial rotation angle sensor54ris substantially equal to a rotation angle of the endoscope36.

In the medical system according to the present embodiment, when the manipulator masters95gand95hare rotationally moved about the central axis C of the first arm portion96frelative to the first arm portion96fand the distal end rotational portion114is operated to be rotated about the central axis C of the first arm portion96frelative to the first arm portion96f, the endoscope36is actuated to be rotated about the central axis of the endoscope36at a rotation angle substantially equal to the rotation angle of the distal end rotational portion114. Therefore, the rotational actuation of the endoscope36can be intuitively and precisely operated.

Here, in the present embodiment, although the rotation angle sensor is used for detecting a rotation angle, a medical system may be formed with a rotation direction sensor configured to detect a rotation direction instead of a rotation angle sensor.

Referring toFIGS. 27 and 28, a third embodiment of the present invention will be explained.

In a master apparatus93according to the present embodiment, a rod-like support member115extends along an up and down directional rotation axis Oud of a first arm portion96fand passes through a first link portion97f. The parts on left end side and right end side of the support member115form support arms103land103ron the left side and the right side, respectively. In the first link portion97f, the support member115extends and penetrates a pair of tongue portions98sdof the distal end portion of a second arm portion96sand the support member115is supported by the pair of tongue portions98sdso as to be rotatable about the central axis C of the support member115relative to the pair of tongue portions98sd. In the present embodiment, the terminal end portions of the support arms103land103ras connecting portions form connecting portion rotational end portions, and the central portions of the support arms103land103rform connecting portion support portions. Moreover, the support member115extends and penetrates a rotational block99fsand is fixed to the rotational block99fs. Tongue portions98fof the proximal end portion of the first arm portion96fare fixed to the rotational block99fs. In the present embodiment, the tongue portions98fof the proximal end portion of the first arm portion96fas a movement portion form a movement portion support portion, and the distal end portion of the first arm portion96fforms a movement portion rotational end portion.

When first link portion releasing buttons112lfof the manipulator masters95gand95hare turned on and the manipulator masters95gand95hare operated to be rotated about the central axis C of the support member115, the support member115, the rotational block99fsand the first arm portion96fare operated to be rotated integrally about the central axis C of the support member115and the first arm portion96fis operated to be rotated in the up and down direction.

Here, in the case where the central axis C of the support member115is arranged at the distal end portion of the first arm portion96f, it is necessary to operate the manipulator masters95gand95hto a large extent to be rotated about the up and down directional rotation axis Oud of the first arm portion96fin order to operate the first arm portion96fto be rotated in the up and down direction, and a movement range in which the manipulator masters95gand95hare moved becomes comparatively large. In contrast, in the medical system according to the present embodiment, the central axis C of the support member115agrees with the up and down directional rotation axis Oud of the first arm portion96f. Therefore, the first arm portion96fcan be operated to be rotated in the up and down direction merely by operating the manipulator masters95gand95hto a small extent to be rotated about the central axis C of the support member115, and then, the movement range in which the manipulator masters95gand95hare moved becomes comparatively small. Therefore, the operability of the medical system is further improved.

Here, although a manipulator is inserted through an instrument channel of an endoscope in the above mentioned embodiments, the manipulator may be inserted through a channel tube attached to the outside of the endoscope.

Referring toFIGS. 29 to 33, a fourth embodiment of the present invention will be explained.

Referring toFIGS. 29 and 30, in a medical system according to the present embodiment, an overtube apparatus117is used as an insertion slave apparatus. The overtube apparatus117is formed by an overtube118and an overtube driving unit39o. Moreover, instead of the electrical bending endoscope36, a manually bending endoscope116is used. Here, a bending portion is provided in the distal end portion of an insertion portion37eof the endoscope116and configured to be actuated to be bent in an up and down direction. An operation portion124is coupled to the proximal end portion of the insertion portion37eand configured to be held and operated by an operator. A bending operation knob125is provided in the operation portion124and configured to operate the bending portion to be bent. Furthermore, a grasping manipulator apparatus63gand a high-frequency treatment manipulator apparatus63hare used, which are similar to those according to the first embodiment, respectively. Here, manipulator driving units39gand39hof the manipulator apparatuses63gand63hare held by a stand122of a trolley41.

Referring toFIGS. 29,30and31, the overtube118includes an overtube insertion portion37obeing long and flexible and configured to be inserted into the body. A first overtube bending portion51ofand a second overtube bending portion51osare arranged in the axial direction in the distal end portion of the overtube insertion portion37oand configured to be actuated to be bent in an up and down direction and a left and right direction. An overtube connecting portion119is coupled to the proximal end portion of the overtube insertion portion37o. An endoscope channel58e, a grasping instrument channel58gand a high-frequency treatment instrument channel58hextend in the overtube insertion portion37oand the overtube connecting portion119, and the endoscope116, the grasping treatment manipulator57gand the high-frequency treatment manipulator57hare configured to be inserted through the endoscope channel58e, the grasping instrument channel58gand the high-frequency treatment instrument channel58h, respectively. The distal end portions of the endoscope channel58e, the grasping treatment instrument channel58hand the high-frequency treatment instrument channel58hare connected to an endoscope protrusion opening62e, a grasping instrument protrusion opening62gand a high-frequency treatment instrument protrusion opening62hformed in the distal end portion of the overtube insertion portion37o. On the other hand, the proximal end portion of the endoscope channel58eis connected to an endoscope insertion opening61eformed in the overtube connecting portion119. Moreover, the proximal end portions of the grasping instrument channel58gand the high-frequency treatment instrument channel58hare connected to a grasping instrument guide pipe59gand a high-frequency treatment instrument guide pipe59hin the overtube connecting portion119, similarly to the first embodiment.

A cassette-like overtube actuation connecting portion67ois provided at the proximal end portion of the overtube connecting portion119. In the overtube actuation connecting portion67o, a first up and down directional bending pulley68ofuand a first up and down directional overtube wire69ofufor actuating the first overtube bending portion51ofto be bent in the up and down direction, a first left and right directional bending pulley68ofland a first left and right directional overtube wire69oflfor actuating the first overtube bending portion51ofto be bent in the left and right direction, a second up and down directional bending pulley68osuand a second up and down directional overtube wire69osufor actuating the second overtube bending portion51osto be bent in the up and down direction and a second left and right directional bending pulley68osland a second left and right directional overtube wire69oslfor actuating the second overtube bending portion51osto be bent in the left and right direction are used. The one end side parts and the other end side parts of the overtube wires69ofu,69ofl,69osuand69oslare inserted through the overtube connecting portion119and the overtube insertion portion37oand coupled to the overtube bending portions51ofand51os. When the bending pulley68ofu,68ofl,68osuor68oslis actuated to be rotated and the overtube wire69ofu,69ofl,69osuor69oslis actuated to be advanced and retreated, the overtube bending portion51ofor51osis actuated to be bent. Moreover, a guide convex portion73and a click hole74are formed in the overtube actuation connecting portion67o, similarly to the manipulator driving connecting portions67gand67h(referring toFIGS. 3 and 4).

Referring toFIGS. 29,30,32and33, an overtube connecting portion housing portion82oand an overtube connecting portion engaging portion85oare provided in a main portion121of the overtube driving unit390and have similar configurations to those of the manipulator connecting portion housing portions82gand82hand the manipulator connecting portion engaging portions85gand85hof the manipulator driving units39gand39haccording to the first embodiment (referring toFIGS. 6 to 8). A first and a second up and down directional, and left and right directional overtube bending driving portion are provided within the main portion121and have similar configurations to those of the actuation portion52gp,52hp,52gy,52hy,52ocwithin the manipulator rotational portion79gor79haccording to the first embodiment (referring toFIGS. 6 to 8). The first and the second up and down directional, and right and left overtube bending driving portion includes a first and a second up and down directional, and left and right directional overtube bending driving motor53ofu,53ofl,53osu,53osl. The overtube driving unit390is held by the stand122of the trolley41and connected to the system controller through the overtube cord123. Moreover, the operation portion117of the endoscope116is configured to be attached to and detached from the main portion121of the overtube driving unit390by an attachment and detachment mechanism which is not shown.

Referring toFIG. 33, a master apparatus used in the present embodiment is similar to the master apparatus93according to the first embodiment as is shown inFIG. 9. However, the endoscope master95eis used as an overtube master95ofor operating the overtube118and the endoscope rotational operation buttons111eland111erare not used. When a first link portion97fof the overtube master95ois operated to be rotated, rotation angles in the up and down direction and left and right direction in the first link portion97fare detected by a first up and down directional rotation angle sensor54fuand a first left and right rotation angle sensor54fl, respectively. Similarly, rotation angles in the up and down direction and the left and right direction in a second link portion97sare detected by a second up and down directional rotation angle sensor54suand a second left and right directional rotation angle sensor54sl. The rotation angle sensors54fu,54fl,54suand54sloutput data for the rotation angles to the system controller48. The system controller48outputs bending actuation signals to the first and the second up and down directional, and left and right directional overtube bending driving motors53ofu,53ofl,53osu,53oslof the overtube driving unit390on the basis of the input data for the rotation angle, and the overtube bending driving motors53ofu,53ofl,53osu,53oslactuate the first and the second overtube bending portion51of,51osto be bent on the basis of the input bending actuation signals. The system controller48controls the first and the second up and down directional, and the left and right directional overtube bending driving motors53ofu,53ofl,53osu,53oslsuch that the rotation angle detected by the first and the second up and down directional, and left and right directional rotation angle sensors54fu,54fl,54su,54slare substantially equal to bending angle of the first and the second overtube bending portion51of,51osin the up and down direction and the left and right direction.

In the medical system according to the present embodiment, the operability of the medical system is sufficiently improved similarly to the medical system according to the first embodiment.