Patent Publication Number: US-2010113872-A1

Title: Medical apparatus and procedure of installing medical apparatus in patient

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation application of PCT/JP2008/056198 filed on Mar. 28, 2008 and claims benefit of Japanese Application No. 2007-244206 filed in Japan on Sep. 20, 2007, the entire contents of which are incorporated herein by this reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to a medical apparatus that includes a medical instrument that is fixed inside the body and that makes the orientation of the medical instrument movable from outside the body and also relates to a procedure of installing the medical apparatus in a patient. 
     2. Description of the Related Art 
     It is known that an endoscope that is a medical instrument includes an image pickup apparatus, and is introduced into a body cavity of a patient to perform various examinations and treatments of a diseased part inside a body by means of an observation image that is photographed by the image pickup apparatus. 
     Such endoscopes include an endoscope that is introduced from an oral cavity or the anus into a digestive organ such as the esophagus, the stomach, the colon, or the duodenum that are luminal tracts inside the body, and an endoscope that is introduced into an abdominal cavity from the vicinity of the navel region by puncturing and penetrating a body wall. Generally, the endoscope has a long insertion portion, and the insertion portion is inserted into the digestive tract or into an abdominal cavity. 
     Recently a capsule-type medical apparatus as described, for example, in Japanese Patent Application Laid-Open Publication No. 2005-237979 has been proposed for the purpose of alleviating patient pain that is caused by introducing the insertion portion. The aforementioned Japanese Patent Application Laid-Open Publication No. 2005-237979 discloses technology for a capsule-type endoscope apparatus that is capable of reaching a target region inside a lumen while rotating upon reception of a rotating magnetic field from outside the body. 
     SUMMARY OF THE INVENTION 
     A medical apparatus of the first invention includes a medical instrument that is introduced into a body cavity and that has a driven posture control portion; a fixing portion for fixing the medical instrument to a body wall inside the body cavity; a movable portion which is interposed between the medical instrument and the fixing portion and movably connects the medical instrument to the fixing portion; and an extracorporeal device that is installed outside the body and has a posture control portion that moves the medical instrument relative to the fixing portion. 
     A medical apparatus of the second invention includes a first image pickup apparatus that is introduced into an abdominal cavity; a second image pickup apparatus that is inserted into an abdominal cavity that is different from the first image pickup apparatus; a fixing portion for fixing the second image pickup apparatus to an abdominal wall inside an abdominal cavity; a holding portion that is arranged between the second image pickup apparatus and the fixing portion, and that rotatably holds the second image pickup apparatus and the fixing portion; and an extracorporeal device that changes a posture position of the second image pickup apparatus relative to the fixing portion by means of the holding portion in a contactless manner from outside a body. 
     A procedure of installing the medical apparatus in a patient of the present invention includes a first image pickup apparatus that is introduced into an abdominal cavity; a second image pickup apparatus that is inserted into an abdominal cavity that is different from the first image pickup apparatus; a fixing portion for fixing the second image pickup apparatus to an abdominal wall inside an abdominal cavity; a holding portion that is arranged between the second image pickup apparatus and the fixing portion, and that rotatably holds the second image pickup apparatus and the fixing portion; and an extracorporeal device that changes a posture position of the second image pickup apparatus relative to the fixing portion by means of the holding portion in a contactless manner from outside a body, and the procedure comprises introducing the first image pickup apparatus into an abdominal cavity through a first trocar; introducing the second image pickup apparatus into the abdominal cavity through a second trocar using a treatment instrument; puncturing a puncture needle that is inserted in the extracorporeal device into the abdominal cavity from a body surface at a predetermined position of an abdomen; pulling the puncture needle up to a body surface side of the abdomen in a state in which a wire connected to the second image pickup apparatus is hooked to the puncture needle; removing the puncture needle from the extracorporeal device such that the wire is inserted through the extracorporeal device; and pulling the wire until the fixing portion is brought in contact with and fixed to an abdominal wall, while also placing the extracorporeal device on the abdomen body surface along the wire. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a view illustrating a configuration of an endoscope system that is a medical apparatus according to a first embodiment of the present invention; 
         FIG. 2  is a sectional view illustrating a configuration of an extracorporeal device according to the first embodiment; 
         FIG. 3  is a top view illustrating the configuration of the extracorporeal device according to the first embodiment; 
         FIG. 4  is a sectional view illustrating a configuration of an intra-abdominal camera according to the first embodiment; 
         FIG. 5  is a sectional view along a line V-V in  FIG. 4  according to the first embodiment; 
         FIG. 6  is a view illustrating a state in which an abdominal wall of a patient is punctured with trocars according to the first embodiment; 
         FIG. 7  is a sectional view illustrating a state in which a puncture needle is inserted into the extracorporeal device according to the first embodiment; 
         FIG. 8  is a view for explaining procedures for introducing an intra-abdominal camera into an abdominal cavity according to the first embodiment; 
         FIG. 9  is a view for explaining procedures for introducing an intra-abdominal camera into an abdominal cavity, that illustrates a state in which an abdominal wall is punctured with a puncture needle to hook a wire of the intra-abdominal camera according to the first embodiment; 
         FIG. 10  is a view for explaining procedures for fixing the intra-abdominal camera to an abdominal wall, that illustrates a state in which a puncture needle which has hooked a wire of the intra-abdominal camera is pulled up according to the first embodiment; 
         FIG. 11  is a view for explaining procedures for fixing an intra-abdominal camera to an abdominal wall, that illustrates a state in which a puncture needle is pulled up and the extracorporeal device is lowered along the puncture needle according to the first embodiment; 
         FIG. 12  is a sectional view of the extracorporeal device in the state shown in  FIG. 11  according to the first embodiment; 
         FIG. 13  is a view illustrating a state in which the extracorporeal device is installed on an abdomen, and the intra-abdominal camera is fixed to the abdominal wall according to the first embodiment; 
         FIG. 14  is a sectional view of the extracorporeal device and the intra-abdominal camera in the state shown in  FIG. 13  according to the first embodiment; 
         FIG. 15  is an overall configuration diagram of the endoscope system illustrating a state in which the intra-abdominal camera is fixed to the abdominal wall according to the first embodiment; 
         FIG. 16  is a sectional view for explaining an action whereby the intra-abdominal camera is rotatably movable about an axis thereof by means of an operation of the extracorporeal device according to the first embodiment; 
         FIG. 17  is a sectional view for explaining an action whereby the intra-abdominal camera is rotatably movable while disposed at an angle relative to the axis thereof by means of an operation of the extracorporeal device according to the first embodiment; 
         FIG. 18  is a sectional view for explaining procedures for extracting the extracorporeal device from a wire of the intra-abdominal camera according to the first embodiment; 
         FIG. 19  is a view for explaining procedures for taking the intra-abdominal camera out from the abdominal cavity according to the first embodiment; 
         FIG. 20  is a sectional view illustrating a configuration of a pharmaceutical spraying apparatus of a medical instrument according to a second embodiment of the present invention; 
         FIG. 21  is an overall configuration diagram of an endoscope system illustrating a state in which the pharmaceutical spraying apparatus is fixed to an abdominal wall according to the second embodiment; and 
         FIG. 22  is an overall configuration diagram of an endoscope system illustrating a modification example that shows a state in which an image pickup apparatus capable of magnified observation is fixed to an abdominal wall. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT(S) 
     Hereunder, embodiments of the present invention will be described with reference to the drawings. In the following description, a medical apparatus that performs laparoscopic surgery will be described as an example. 
     First Embodiment  
     First, an endoscope system that is the medical apparatus according to the present invention that is used for laparoscopic surgery will be described.  FIG. 1  to  FIG. 19  relate to a first embodiment of the present invention.  FIG. 1  is a view illustrating a configuration of an endoscope system that is a medical apparatus.  FIG. 2  is a sectional view illustrating a configuration of an extracorporeal device.  FIG. 3  is a top view illustrating the configuration of the extracorporeal device.  FIG. 4  is a sectional view illustrating a configuration of an intra-abdominal camera.  FIG. 5  is a sectional view along a line V-V in  FIG. 4 .  FIG. 6  is a view illustrating a state in which an abdominal wall of a patient is punctured with trocars.  FIG. 7  is a sectional view illustrating a state in which a puncture needle is inserted into the extracorporeal device.  FIG. 8  is a view for explaining procedures for introducing an intra-abdominal camera into an abdominal cavity.  FIG. 9  is a view for explaining procedures for introducing an intra-abdominal camera into an abdominal cavity, that illustrates a state in which an abdominal wall is punctured with a puncture needle to hook a wire of the intra-abdominal camera.  FIG. 10  is a view for explaining procedures for fixing the intra-abdominal camera to an abdominal wall, that illustrates a state in which a puncture needle which has hooked a wire of the intra-abdominal camera is pulled up.  FIG. 11  is a view for explaining procedures for fixing an intra-abdominal camera to an abdominal wall, that illustrates a state in which a puncture needle is pulled up and the extracorporeal device is lowered along the puncture needle.  FIG. 12  is a sectional view of the extracorporeal device in the state shown in  FIG. 11 .  FIG. 13  is a view illustrating a state in which the extracorporeal device is installed on an abdomen, and the intra-abdominal camera is fixed to the abdominal wall.  FIG. 14  is a sectional view of the extracorporeal device and the intra-abdominal camera in the state shown in  FIG. 13 .  FIG. 15  is an overall configuration diagram of an endoscope system illustrating a state in which an intra-abdominal camera is fixed to an abdominal wall.  FIG. 16  is a sectional view for explaining an action whereby the intra-abdominal camera is rotatably movable about an axis thereof by means of an operation of the extracorporeal device.  FIG. 17  is a sectional view for explaining an action whereby the intra-abdominal camera is rotatably movable while disposed at an angle relative to the axis thereof by means of an operation of the extracorporeal device.  FIG. 18  is a sectional view for explaining procedures for extracting the extracorporeal device from a wire of the intra-abdominal camera.  FIG. 19  is a view for explaining procedures for taking the intra-abdominal camera out from the abdominal cavity. 
     As shown in  FIG. 1 , an endoscope system  1  of the present embodiment that performs laparoscopic surgery is mainly constituted by a rigid endoscope  2  as a first photographing apparatus, an extracorporeal device  3  as an extracorporeal-side posture control apparatus, an extremely small intra-abdominal camera (hereunder, abbreviated to “camera”)  4  as a second photographing apparatus and also an image pickup apparatus, a light source  5 , a camera control unit (hereunder, abbreviated to “CCU”)  6  as a signal processing device with a built-in image processing circuit, and a display device  7  that is connected to the CCU  6  by a communication cable  13  and displays an observation image. 
     The light source  5  supplies an illuminating light to an illuminating optical system provided in the rigid endoscope  2 . The light source  5  and the rigid endoscope  2  are detachably connected by a light source cable  10 . 
     The rigid endoscope  2  is mainly constituted by a rigid insertion portion  8 , and an operation portion  9  sequentially connected to a proximal end of the insertion portion  8 . An image guide and a light guide bundle are inserted through the inside of the insertion portion  8  of the rigid endoscope  2 . The insertion portion  8  is also provided with, on a distal end surface thereof, a photographing optical system for condensing a subject image onto a rigid endoscope camera, described later, via the image guide, and the illuminating optical system for irradiating an illuminating light from the light guide bundle toward a subject. 
     An unshown camera head in which a solid-state image pickup device such as a CCD or a CMOS is disposed is built into the operation portion  9  of the rigid endoscope  2 . An optical image of an observation site illuminated by the illuminating light supplied from the light source  5  to the rigid endoscope  2  through the light source cable  10  is picked up by the camera head in the operation portion  9  through the image guide in the insertion portion  8 . The rigid endoscope camera photoelectrically converts the picked-up optical image into an image pickup signal. The image pickup signal is transmitted to the CCU  6  through an image pickup cable  11 . In the rigid endoscope  2  of the present embodiment, an image pickup optical system is set such that an angle of view a (see  FIG. 15 ) available for photographing is, for example, 70° to 75°. 
     The CCU  6  generates a video signal from the transmitted image signal, and outputs the video signal to the display device  7 . The display device  7  is, for example, a liquid crystal display. The display device  7  receives the video signal outputted from the CCU  6 , and displays both a normal observation image picked up with the rigid endoscope  2  and a wide-angle observation image picked up with the camera  4  on one screen or switches the normal observation image and the wide-angle observation image to separately display the images on the screen. The CCU  6  is removably connected to the extracorporeal device  3  by an electric cable  12 . 
     Next, the extracorporeal device  3  will be described in detail below with reference to  FIGS. 2 and 3 . 
     As shown in  FIGS. 2 and 3 , the extracorporeal device  3  has a receiver  31  inside a housing  21 . An extracorporeal-side posture adjustment portion  22  that is an extracorporeal posture control portion is rotatably installed in the housing  21  that is formed of a non-magnetic material. The extracorporeal-side posture adjustment portion  22  has a spherical shape in which a part thereof has been severed. 
     The extracorporeal-side posture adjustment portion  22  has a spherical body formed of a synthetic resin that is a non-magnetic material such as plastic, with a hole portion  23  passing through the spherical body at the center and with a part (a lower part, in this case) of the spherical body severed to form a flat portion  24 . The extracorporeal-side posture adjustment portion  22  has an extracorporeal-side permanent magnet  25  disposed therein around the hole portion  23 , the extracorporeal-side permanent magnet  25  being a cylindrical extracorporeal-side ferromagnetic member. The extracorporeal-side permanent magnet  25  has a north pole and a south pole that are magnetically separated by a plane along the hole portion  23 . 
     The extracorporeal-side posture adjustment portion  22  is movably disposed in a spherical concave portion  26  which has a similar spherical shape and opens at top of the housing  21 . That is, the extracorporeal device  3  has a so-called trackball mechanism that makes the posture adjustment portion  22  rotatably movable with respect to the housing  21 . 
     The housing  21  has a wire passage hole  27  that communicates with a center lower part of the spherical concave portion  26  and is located on an extension of a center line of the extracorporeal-side posture adjustment portion  22  so as to open to an underside of the housing  21 . Further, in the housing  21 , a wire fixing lever  32  (described later) that communicates with the wire passage hole  27  is slidably formed in a lateral direction, and a slide hole portion  28  is formed that opens on one side surface (in this case, the right side surface). Furthermore, a screw hole  29  is formed in the housing  21  that opens on the other side surface (in this case, the left side surface). The screw hole  29  communicates with the spherical concave portion  26 , and a posture position fixing screw  35 , described later, is screwed into the screw hole  29 . 
     The wire fixing lever  32  that is formed of non-magnetic material and which has an urging spring  34  fixed to an end surface thereof is inserted into and disposed in the slide hole portion  28  of the housing  21 . The wire fixing lever  32  has a substantially rectangular parallelepiped shape, and a hole portion  33  is formed therein which communicates with the wire passage hole  27  of the housing  21  by sliding the wire fixing lever  32  in the inward direction of the housing  21 . 
     The posture position fixing screw  35  is made of non-magnetic material and screwed into the screw hole  29  of the housing  21  to serve as a posture fixing portion. When the posture position fixing screw  35  is screwed deeply enough into the screw hole  29 , the extracorporeal-side posture adjustment portion  22  abuts against an inner end face of the housing  21 , thereby restraining movement of the extracorporeal-side posture adjustment portion  22  in the spherical concave portion  26 . 
     Next, the camera  4  will be described in detail below with reference to  FIGS. 4 and 5 . 
     The camera  4  is mainly constituted by a camera body  41  and an abdominal wall fixing portion  42  which are sequentially provided, as shown in  FIG. 4  and  FIG. 5 . 
     The camera body  41  includes a so-called capsule-type image pickup unit  43  and an intracorporeal-side posture adjustment portion  44  that is a driven posture control portion. 
     The outer shape of the image pickup unit  43  is formed with a substantially dome-shaped transparent hood  51  on a distal end side (lower side in  FIG. 4 ), and a camera housing  52  formed of non-magnetic material in which the transparent hood  51  is disposed so as to hermetically seal one surface. 
     The camera housing  52  is provided with a plurality of (in this case, two) white LEDs  53  that are illuminating portions which are disposed as light sources of illuminating light on one surface on the transparent hood  51  side. The camera housing  52  is also provided with an objective lens group  54  held in a lens holding hole formed at substantially the center of the aforementioned surface, and a solid-state image pickup device unit  55  such as a CCD or a C-MOS in which a light-receiving portion is disposed at a position where a photographing light is condensed by the objective lens group  54 . 
     A transmitter  57  is disposed inside the camera housing  52 . A battery  56  that supplies power to the transmitter  57 , the white LEDs  53 , and the solid-state image pickup device unit  55  is also contained inside the camera housing  52 . In a functional portion of the camera body  41  according to the present embodiment, an image pickup optical system that picks up an image over a wide-angle visual field area is set such that an angle of view β (see  FIG. 15 ) available for photographing is 90° or more. An image signal that is photoelectrically converted by the solid-state image pickup device unit  55  is transmitted by radio transmission from the transmitter  57  to the receiver  31  of the extracorporeal device  3 . 
     The intracorporeal-side posture adjustment portion  44  includes a main body portion  61  formed of non-magnetic material that is substantially cylindrical column in outer shape and is fitted into a proximal end (upper end in  FIG. 4 ) of the camera housing  52 ; a sphere portion  62  formed integrally with an extending end of a neck portion  62   a  which, being made of the same material as the main body portion  61 , extends from a center of the proximal end face of the main body portion  61 ; and a sphere receiving portion  64  formed of non-magnetic material that rotatably supports the sphere portion  62 . 
     An intracorporeal-side permanent magnet  63  which is a cylindrical, intracorporeal-side ferromagnetic member is contained inside the main body portion  61 . As shown in  FIG. 5 , the intracorporeal-side permanent magnet  63  has north and south poles that are magnetically separated by a plane along the center of the main body portion  61 . 
     A concave portion  65  that houses and rotatably holds the sphere portion  62  is formed in the sphere receiving portion  64 . This provides a ball joint portion  66  that constitutes a movable portion in which the sphere portion  62  is rotatably held inside the sphere receiving portion  64 . 
     The abdominal wall fixing portion  42  is formed of, for example, a flexible elastic member such as silicone rubber. The abdominal wall fixing portion  42  includes a connecting portion  71  that is fitted to a proximal end portion of the sphere receiving portion  64 , and a suction cup  72  at a rear end portion of the connecting portion  71 . Further, in the abdominal wall fixing portion  42  is formed a convex portion  73  that projects in a cylindrical shape at substantially the center of a surface of the suction cup  72 , and a through hole  74  that is formed in the center of the connecting portion  71  so as to communicate with a hole portion of the convex portion  73 . 
     A hoisting wire  45  having a predetermined length is inserted through the through hole  74  of the abdominal wall fixing portion  42 . A coupling portion  75  connected by caulking is provided at one end portion of the wire  45 . The coupling portion  75  is fitted and fixed to the center of a proximal end surface of the sphere receiving portion  64 . That is, the wire  45  is provided so as to extend from the center of the suction cup  72 . 
     The endoscope system  1  of the present embodiment having the configuration described above is used for laparoscopic surgery and for treatment inside an abdominal cavity that is one of the body cavities of a patient. 
     Next, procedures for installing the camera  4  of the endoscope system  1  of the present embodiment in an abdominal cavity as a body cavity of a patient for laparoscopic surgery, and the operation thereof will be described in detail with reference to  FIGS. 6 to 19 . 
     First, a surgeon makes two small dissections in an abdominal wall  102  of a patient  100  by using a surgical knife or the like, and punctures the dissections with trocars  110  and  111  as shown in  FIG. 6 . In this case, the surgeon makes a puncture into an abdominal cavity  101  with the trocar  111  for introducing a treatment instrument  120  such as a grasping forceps into the abdominal cavity  101  by dissecting the abdominal wall  102  or the like at another position that is separated by a predetermined distance from the trocar  110  for introducing the rigid endoscope  2  into the abdominal cavity  101 . 
     Further, as shown in  FIG. 7 , the surgeon inserts an insertion portion  93  of a puncture needle  90  into the hole portion  23  provided in the extracorporeal-side posture adjustment portion  22  of the extracorporeal device  3 . At this time, the surgeon pushes the wire fixing lever  32  into the housing  21  such that the puncture needle  90  penetrates the extracorporeal device  3 , and inserts the puncture needle  90  such that the insertion portion  93  of the puncture needle  90  penetrates the hole portion  33  of the wire fixing lever  32 . 
     The surgeon causes the insertion portion  93  to sufficiently project from a bottom surface of the extracorporeal device  3  in a manner such that the extracorporeal device  3  is located to an adequate degree on the side of the puncture needle  90  on which the hands of the surgeon are located (upper side in  FIG. 7 ). In this state, a wall surface of the hole portion  33  of the wire fixing lever  32  is in abutment with and restrains the insertion portion  93  of the puncture needle  90  by means of an urging force of the urging spring  34  on the wire fixing lever  32  so that the extracorporeal device  3  does not fall off from the puncture needle  90 . The puncture needle  90  has a hook portion  92  that is formed by notching in the needle portion  91 . 
     Next, as shown in  FIG. 8 , the surgeon inserts the insertion portion  8  of the rigid endoscope  2  into the abdominal cavity  101  through the trocar  110 . Subsequently, the surgeon inserts the camera  4  grasped by the treatment instrument  120  such as a grasping forceps into the abdominal cavity  101  through the trocar  111 . At this time, the surgeon may insert the camera  4  into the abdominal cavity  101  while checking an image obtained by the rigid endoscope  2 . 
     When the camera  4  is introduced into the abdominal cavity  101  through the trocar  111 , the convex portion  73  that projects in a cylindrical shape from approximately the center of the surface of the suction cup  72  is grasped by the treatment instrument such as a grasping forceps. Since the convex portion  73  is provided at the approximate center of the adhering surface of the suction cup  72 , the camera  4  can be easily grasped by the treatment instrument in a balanced manner. Consequently, the surgeon can easily pass the camera  4  through the trocar  111  when introducing the camera  4  into the abdominal cavity. That is, the surgeon can easily introduce the camera  4  into the abdominal cavity  101  without causing the camera  4  to get caught in the trocar  111 . 
     Next, as shown in  FIG. 9 , while checking the image obtained by the rigid endoscope  2 , the surgeon punctures the abdominal wall  102  with the puncture needle  90  which holds the extracorporeal device  3 . Subsequently, the surgeon hooks the hook portion  92  formed in the needle portion  91  of the puncture needle  90  onto the wire  45  of the camera  4  while viewing the image obtained by the rigid endoscope  2 . 
     Thereafter, as shown in  FIG. 10 , the surgeon extracts the puncture needle  90  to outside the body from the abdominal cavity  101  (in the upward direction in  FIG. 10 ) in a state in which the wire  45  is hooked in the hook portion  92  of the needle portion  91 . Subsequently, as shown in  FIG. 11 , along with extracting the puncture needle  90  from the abdominal cavity  101 , the surgeon moves the extracorporeal device  3  relative to the insertion portion  93  of the puncture needle  90  in the direction of the abdomen (downward direction in  FIG. 11 ) of the patient  100 , and pulls the puncture needle  90  until the wire  45  passes through the hole portion  23  provided in the extracorporeal-side posture adjustment portion  22 . 
     At this time, by pushing the wire fixing lever  32  of the extracorporeal device  3  towards the inside of the housing  21 , the surgeon can easily slide the extracorporeal device  3  relative to the insertion portion  93  of the puncture needle  90 . As shown in 
       FIG. 12 , when the wire  45  passes through the hole portion  23  of the extracorporeal-side posture adjustment portion  22 , the surgeon moves the extracorporeal device  3  relative to the wire  45  in the direction of the abdomen of the patient  100  (downward direction in  FIG. 12 ) while pulling the wire  45  itself (upward direction in  FIG. 12 ). 
     That is, the surgeon can easily slide the extracorporeal device  3  relative to the insertion portion  93  of the puncture needle  90  and the wire  45  of the camera  4  by maintaining a state in which the wire fixing lever  32  of the extracorporeal device  3  is pushed towards the inside of the housing  21  (F direction in  FIG. 12 ). 
     Subsequently, as shown in  FIG. 13 , the surgeon pulls the wire  45  of the camera  4  until the abdominal wall  102  is sandwiched between the extracorporeal device  3  and the camera  4  in a state in which the extracorporeal device  3  is placed on the abdomen of the patient  100 . At this time, after confirming based on the image obtained by the rigid endoscope  2  that the suction cup  72  of the camera  4  is placed in intimate contact with an inner surface of the abdominal wall  102  as shown in  FIG. 14 , the surgeon stops pushing in the wire fixing lever  32  of the extracorporeal device  3 . 
     The wire fixing lever  32  of the extracorporeal device  3  is thereby moved upon reception of the urging force of the urging spring  34 , so that the hole portion  33  enters a state in which the hole portion  33  is misaligned with the wire passage hole  27  of the housing  21 . The wire  45  inserted through the hole portion  33  and the wire passage hole  27  is caught therein and is thereby fixed to the housing  21 . As a result, the extracorporeal device  3  and the camera  4  are fixed in a state in which the abdominal wall  102  is sandwiched therebetween. 
     Thus, as shown in  FIG. 15 , the camera  4  is installed in a reliably stable state in the abdominal cavity  101  of the patient  100 , and laparoscopic surgery is performed by means of the endoscope system  1  of the present embodiment. In this connection, for example, one end portion of an unshown insufflation tube is attached to the trocar  110 , and a carbon dioxide gas or the like is injected into the abdominal cavity as an insufflation gas for the purpose of securing a visual field of the rigid endoscope  2  and a region in which an operation instrument or the like is operated. As shown in  FIG. 15 , the surgeon inserts the rigid endoscope  2  through the trocar  110  and the treatment instrument  120  through the trocar  111  to perform laparoscopic surgery in a state in which the camera  4  is stuck to and retained at the abdominal wall  102  inside the abdominal cavity  101 . 
     Next, the operations of the extracorporeal device  3  and the camera  4  of the endoscope system  1  of the present embodiment will be described in detail using  FIG. 16  and  FIG. 17 . 
     As shown in  FIG. 16 , when the camera  4  is rotated around an axis A (R direction in  FIG. 16 ) that is parallel to the hole portion  23  through which the extracorporeal-side posture adjustment portion  22  of the extracorporeal device  3  passes at the center thereof, the intracorporeal-side permanent magnet  63  that receives the magnetic force of the extracorporeal-side permanent magnet  25  follows the rotation and rotationally moves around a longitudinal axis a (r direction in  FIG. 16 ). 
     More specifically, the intracorporeal-side permanent magnet  63  is constantly receiving a magnetic force that attracts the south pole of the intracorporeal-side permanent magnet  63  towards the north pole of the extracorporeal-side permanent magnet  25  and attracts the north pole of the intracorporeal-side permanent magnet  63  towards the south pole of the extracorporeal-side permanent magnet  25 . Therefore, the camera body  41  of the camera  4  follows the rotation around the axis A of the extracorporeal-side posture adjustment portion  22 , and rotates using the center of the sphere portion  62  of the ball joint portion  66  as a fulcrum. 
     This allows the surgeon to rotate the camera body  41  by operating the extracorporeal-side posture adjustment portion  22  of the extracorporeal device  3 , and thus the surgeon can rotate an image picked up by the image pickup unit  43  for display on the display device  7  and thereby vertically or horizontally adjust a display position within the abdominal cavity. That is, by operating the extracorporeal-side posture adjustment portion  22  of the extracorporeal device  3 , the surgeon can change left, right, top, and bottom positions of an image photographed by the camera  4  according to left, right, top, and bottom positions of an image photographed by the rigid endoscope  2 , in a contactless manner using magnetic force. Accordingly, the surgeon can match the vertical and horizontal directions of two displayed images that are photographed by the rigid endoscope  2  and the camera  4 , and thereby avoid feeling a sense of incongruity when viewing the images on the display device  7 . 
     As shown in  FIG. 17 , when the extracorporeal-side posture adjustment portion  22  of the extracorporeal device  3  is rotated by a predetermined angle y in the horizontal direction (R direction in  FIG. 17 ), the intracorporeal-side permanent magnet  63  of the camera  4  receives the magnetic force of the extracorporeal-side permanent magnet  25  and is attracted thereby such that the intracorporeal-side permanent magnet  63  tilts at a predetermined angle δ in the horizontal direction (r direction in  FIG. 17 ). The predetermined angles γ and δ depend on the mass of the camera body  41  of the camera  4 , the intensities of the magnetic forces of the extracorporeal-side permanent magnet  25  and the intracorporeal-side permanent magnet  63 , and the like. 
     That is, when the south pole of the extracorporeal-side permanent magnet  25  is brought close to the intracorporeal-side permanent magnet  63  by rotation, the magnetic force attracting the intracorporeal-side permanent magnet  63  to the north pole side increases. At this time, since the north pole of the extracorporeal-side permanent magnet  25  goes away from the intracorporeal-side permanent magnet  63  due to the rotation, the magnetic force that attracts the intracorporeal-side permanent magnet  63  to the south pole side decreases. Consequently, the camera body  41  of the camera  4  tracks the predetermined rotational angle y in the horizontal direction of the extracorporeal-side posture adjustment portion  22 , and thus tilts by the predetermined angle δ with the center of the sphere portion  62  of the ball joint portion  66  serving as a fulcrum. 
     Accordingly, since the surgeon can tilt the camera body  41  in a contactless manner using the magnetic force by operating the extracorporeal-side posture adjustment portion  22  of the extracorporeal device  3 , the surgeon can adjust a display position so as to place an affected part to be treated at approximately the center of an image that is picked up by the image pickup unit  43  for display on the display device  7  or at a position that facilitates treatment of the affected part. That is, the surgeon can change a photographing direction of the camera  4  inside the abdominal cavity  101 . 
     The surgeon can fix the camera  4  in a desired observation direction by screwing the posture position fixing screw  35  into the housing  21  to thereby fix the extracorporeal-side posture adjustment portion  22 . 
     Subsequently, when the surgeon ends the laparoscopic surgery, as shown in  FIG. 18 , the surgeon extracts the extracorporeal device  3  from the wire  45  while pushing the wire fixing lever  32  of the extracorporeal device  3  to the inner side of the housing  21 . Thereafter, as shown in  FIG. 19 , the surgeon grasps the camera  4  inside the abdominal cavity  101  with the treatment instrument  120  such as a grasping forceps and takes out the camera  4  to outside the body from the abdominal cavity  101  through the trocar  111 . 
     The endoscope system  1  according to each of the embodiments as described above allows a surgeon to observe body tissue in a body cavity (in this case, the abdominal cavity  101 ) from multiple viewpoints including a wide-angle viewpoint. Thus, for example, the surgeon can easily recognize an entire resection line during surgery of a large organ or resection of the large intestine. Further, the endoscope system  1  allows the surgeon to easily adjust a visual field direction of the camera  4  that is introduced into the abdominal cavity  101  separately from the rigid endoscope  2  for magnified observation, as well as fix the visual field direction. Consequently, use of the endoscope system  1  according to the present invention makes it easy to administer treatment by laparoscopic surgery. 
     Main components of the extracorporeal device  3 , including the housing  21 , the extracorporeal-side posture adjustment portion  22 , and the wire fixing lever  32 , but excluding the extracorporeal-side permanent magnet  25  are made of non-magnetic material. Further, components of the camera  4 , including the abdominal wall fixing portion  42  and the intracorporeal-side posture adjustment portion  44 , but excluding the intracorporeal-side permanent magnet  63 , are made of non-magnetic material. That is, the components disposed between the extracorporeal-side permanent magnet  25  of the extracorporeal device  3  and the intracorporeal-side permanent magnet  63  of the camera  4  are made of non-magnetic material. Thus, the camera  4  is constituted so as not to affect the magnetism of the permanent magnets  25  and  63  that are used by the extracorporeal device  3  for posture adjustment operations. 
     Second Embodiment  
     Next, a second embodiment according to the endoscope system of the present invention is described using  FIG. 20  and  FIG. 21 .  FIG. 20  and  FIG. 21  relate to the second embodiment of the present invention.  FIG. 20  is a view that illustrates a configuration of a pharmaceutical spraying apparatus.  FIG. 21  is an overall configuration diagram of an endoscope system illustrating a state in which a pharmaceutical spraying apparatus is fixed to an abdominal wall. In the following description, the same reference numerals are used to denote components that are the same as in the endoscope system  1  of the first embodiment described above, and a detailed description of those components is omitted. 
     According to the present embodiment, an example is described in which the medical instrument to be installed inside the abdominal cavity  101  is changed from the intra-abdominal camera  4  of the first embodiment to a pharmaceutical spraying apparatus  80  that includes a functional portion that sprays a tumor specific pharmaceutical on tissue inside the body. 
     As shown in  FIG. 20 , the pharmaceutical spraying apparatus  80  of the present embodiment is provided with a pharmaceutical spraying apparatus main body portion  81  together with the intracorporeal-side posture adjustment portion  44 . The pharmaceutical spraying apparatus main body portion  81  includes a housing  82  having a tapered nozzle shape and, inside the housing  82 , a receiver  84 , a control portion  85  which receives and is driven by a signal from the receiver  84 , a micropump  86  that is drivingly controlled by the control portion  85  and is installed along a pharmaceutical solution spray path  83 , and a tank  87  in which a pharmaceutical solution is stored. The tank  87  is a cartridge-type tank that is removable from the housing  82 . The receiver  84 , the control portion  85 , and the micropump  86  are supplied with power by an unshown battery. 
     Similarly to the first embodiment, as shown in  FIG. 21 , the pharmaceutical spraying apparatus  80  configured in this manner is introduced inside the abdominal cavity  101  and fixed to the abdominal wall  102 . The pharmaceutical spraying direction of the pharmaceutical spraying apparatus  80  can be changed to a desired direction by the extracorporeal device  3  to thereby spray a tumor specific pharmaceutical inside the tank  87  towards a lesion part  130 . 
     That is, the extracorporeal device  3  is provided with an unshown transmitter, and an instruction signal from the transmitter is transmitted by radio communication to the receiver  84  of the pharmaceutical spraying apparatus  80 . The receiver  84  outputs the received instruction signal to the control portion  85 , and the control portion  85  drivingly controls the micropump  86 . 
     Thus, the endoscope system  1  of the present embodiment is configured to allow operations to change the spraying direction of a pharmaceutical that is sprayed with the pharmaceutical spraying apparatus  80  inside the abdominal cavity  101  in a contactless manner using the extracorporeal device  3  that is outside the body. 
     Although not shown in the drawings, a configuration may also be adopted in which an aiming mechanism (such as a laser pointer) for enhancing the spraying accuracy by enabling confirmation of the spraying direction is incorporated into the pharmaceutical spraying apparatus  80 . 
     In the respective embodiments described above, examples have been described in which the medical instrument to be fixedly installed on the abdominal wall  102  inside the abdominal cavity  101  is the intra-abdominal camera  4  or the pharmaceutical spraying apparatus  80 . However, as shown in  FIG. 22 , for example, the medical instrument may be an image pickup apparatus  95  that is capable of magnified observation of an affected part  140  inside the abdominal cavity  101 .  FIG. 22  is an overall configuration diagram of an endoscope system illustrating a state in which an image pickup apparatus that includes a functional portion capable of magnified observation is fixed to an abdominal wall. 
     Further, in the above embodiments, examples were described in which sending and receiving of various signals to the functional portion of various medical instruments (the intra-abdominal camera  4 , the pharmaceutical spraying apparatus  80 , and the image pickup apparatus  95  and the like) inside the abdominal cavity  101  and the extracorporeal device  3  are performed using radio communication by means of a receiver and a transmitter. However, a configuration may be adopted in which the wire  45  of each kind of medical instruments is changed to a transmission cable, and the transmission cable is directly connected to the CCU  6 . 
     Further, the CCU  6  that processes images of the rigid endoscope  2 , the intra-abdominal camera  4 , the image pickup apparatus  95  and the like, as well as the display device  7  are not limited to a single device, and a configuration may be adopted that is provided with a plurality of the CCU  6  and the display device  7 , respectively, in accordance with the number of medical instruments for observation to be used. 
     A mechanism that can change a visual field direction or spraying direction or the like of the various medical instruments (the intra-abdominal camera  4 , the pharmaceutical spraying apparatus  80 , the image pickup apparatus  95  and the like) installed inside the abdominal cavity  101  by operation of the extracorporeal device  3  according to the above described embodiments is not limited to the configuration of the permanent magnets  25  and  63  described above. For example, a magnetic field generating device disclosed in Japanese Patent Application Laid-Open Publication No. 2007-215583 that is known technology may be used. 
     The magnetic field generating device disclosed in Japanese Patent Application Laid-Open Publication No. 2007-215583 has a magnetic field generating unit that includes a pair of magnetic field generating parts disposed on a rotary table. The magnetic field generating device is configured to perform three-dimensional magnetic field control by combining a rotational position of the rotary table with a rotational position of the pair of magnetic field generating parts. The known technology of this kind of magnetic field generating unit may also be diverted for use as a mechanism that is capable of changing a visual field direction or spraying direction or the like of various medical instruments (the intra-abdominal camera  4 , the pharmaceutical spraying apparatus  80 , the image pickup apparatus  95  and the like) installed inside the abdominal cavity  101  by operation of the extracorporeal device  3  according to the present embodiment. 
     The invention described in each of the above embodiments is not limited to the embodiments and modifications, and may be effected by making various modifications without departing from the scope in an implementation phase. Furthermore, the aforementioned embodiments include various stages of the invention, and various inventions may be extracted by appropriately combining a plurality of constituent features disclosed. 
     For example, even if some of the constituent features are deleted from all the constituent features disclosed in the embodiments, the configuration obtained by deleting the constituent features may be extracted as the invention as long as the problems to be solved by the invention can be solved and the effects described above can be obtained. 
     The above described endoscope system  1  that is a medical apparatus includes features described in the appendices described below. 
     Appendix 1  
     A medical apparatus, including:
         a first image pickup apparatus that is introduced into an abdominal cavity;   a second image pickup apparatus that is inserted into an abdominal cavity that is different from the first image pickup apparatus;   a fixing portion for fixing the second image pickup apparatus to an abdominal wall inside an abdominal cavity;   a holding portion that is arranged between the second image pickup apparatus and the fixing portion, and that rotatably holds the second image pickup apparatus and the fixing portion; and   an extracorporeal device that changes a posture position of the second image pickup apparatus relative to the fixing portion by means of the holding portion in a contactless manner from outside a body.       

     Appendix 2  
     The medical apparatus according to appendix 1, wherein:
         a first ferromagnetic body is provided in the second photographing apparatus;   a second magnetic body that is rotatably held and that attracts the first ferromagnetic body is provided in the extracorporeal device; and   a rotational position relative to the fixing portion of the second image pickup apparatus is adjusted in a manner that tracks a rotational operation of the second magnetic body.       

     Appendix 3  
     The medical apparatus according to appendix 2, wherein the extracorporeal device includes a fixing portion that fixes a rotational position of the second magnetic body and fixes a posture position relative to the fixing portion of the second image pickup apparatus. 
     Appendix 4  
     The medical apparatus according to appendix 2 or appendix 3, wherein constituent elements of the extracorporeal device and the second image pickup apparatus, respectively, that are disposed between the first ferromagnetic body and the second ferromagnetic body are formed of non-magnetic material. 
     Appendix 5  
     A procedure of installing the medical apparatus according to appendix 1 in a patient, including:
         introducing the first image pickup apparatus into an abdominal cavity through a first trocar;   introducing the second image pickup apparatus into the abdominal cavity through a second trocar using a treatment instrument;   puncturing a puncture needle that is inserted in the extracorporeal device into the abdominal cavity from a body surface at a predetermined position of an abdomen;   pulling the puncture needle up to a body surface side of the abdomen in a state in which a wire connected to the second image pickup apparatus is hooked to the puncture needle;   removing the puncture needle from the extracorporeal device such that the wire is inserted through the extracorporeal device; and   pulling the wire until the fixing portion is brought in contact with and fixed to an abdominal wall, while also placing the extracorporeal device on the abdomen body surface along the wire.       

     Appendix 6  
     A procedure of extracting from inside an abdominal cavity the second image pickup apparatus of the medical apparatus installed by the procedure according to appendix 5, including:
         moving the extracorporeal device in a direction away from the body surface of the abdomen along the wire of the second image pickup apparatus;   extracting the wire from the extracorporeal device; and   taking out the second image pickup apparatus to outside the body from inside the abdominal cavity through the second trocar using the treatment instrument.