Patent Publication Number: US-2021161371-A1

Title: Endoscope

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation application of PCT/JP2018/030811 filed on Aug. 21, 2018, 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 an endoscope including an insertion section that is provided with a portion configured to actively bend. 
     2. Description of the Related Art 
     Medical endoscopes are provided with an elongated insertion section insertable into a subject, thereby allowing observation of the inside of the subject and treatment using an instrument such as a treatment instrument. An endoscope for renal pelvis/urinary organs (pyeloureteroscope) disclosed, for example, in Japanese Patent Application Laid-Open Publication No. 2016-187554 is known as such a medical endoscope. 
     Examples of treatment using an endoscope for renal pelvis/urinary organs include treatment for removing a urinary stone. In this treatment, an optical fiber cable is caused to protrude from an insertion section of the endoscope, and a stone is broken up by irradiating the stone with laser light using the optical fiber cable. 
     When performing this treatment, a user of the endoscope irradiates a stone with laser light while operating both the endoscope and the optical fiber cable at the same time. More specifically, when performing this treatment, the user of the endoscope performs, with one hand, an operation of bending an insertion section and an operation of rotating the insertion section about a longitudinal axis while holding the operation section. At the same time, the user of the endoscope performs, with the other hand, an operation of advancing and retracting the insertion section in a direction along the longitudinal axis and an operation of advancing and retracting the optical fiber cable in the direction along the longitudinal axis. 
     SUMMARY OF THE INVENTION 
     An endoscope according to an aspect of the present invention includes: an insertion section configured to be inserted into a subject, and including a bending portion configured to bend in a predetermined direction in response to pulling and relaxing of a pair of wires; an operation section connected to a proximal end side of the insertion section; a pulling mechanism to which the pair of wires is connected, the pulling mechanism being disposed at the operation section and configured to pull and relax the pair of wires; a holding portion disposed at the operation section, and holding a treatment member inserted in a channel provided inside the insertion section; and a driving member disposed at the operation section, and configured to move the holding portion in a direction along a longitudinal axis of the treatment member, wherein the pulling mechanism includes a pulley to which the pair of wires is connected, a shaft member protruding from the pulley, and having a central axis coinciding with a central axis of the pulley, and a support portion supporting the shaft member such that the shaft member is rotatable about the central axis, and configured to allow a movement of the shaft member in a first direction and a second direction that are parallel to the central axis of the shaft member. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a diagram illustrating a schematic configuration of an endoscope; 
         FIG. 2  is a diagram illustrating a schematic configuration of the endoscope; 
         FIG. 3  is a diagram illustrating a pulling mechanism portion and wires; 
         FIG. 4  is a cross-sectional view taken along line IV-IV of  FIG. 3 , illustrating a shaft member located at an end of a movable range in a first direction; 
         FIG. 5  illustrates the shaft member located at an end of the movable range in a second direction, in a cross section of  FIG. 4 ; 
         FIG. 6  is a diagram illustrating a modification of an operation lever; and 
         FIG. 7  is a diagram illustrating a modification of a driving portion. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     A preferred embodiment of the present invention will now be described with reference to the drawings. Note that in each of the drawings to be referred to in the following description, the scale varies between components such that each of the components is large enough to be recognizable in the drawings. The present invention is not limited only to the embodiment illustrated in the drawings in terms of the quantity of the components, the shape of the components, the size ratio of the components, and the relative positional relationship between the individual components illustrated in the drawings. 
       FIG. 1  is a diagram illustrating a schematic configuration of an endoscope.  FIG. 2  is a diagram illustrating a channel provided in the endoscope.  FIG. 3  is a diagram illustrating a pulling mechanism portion and wires provided in the endoscope. 
     An endoscope  1  illustrated in  FIG. 1  includes an elongated insertion section  2  insertable into a subject. The insertion section  2  has a configuration that allows observation of the inside of the subject. In the present embodiment, the subject is a human body, for example. In the present embodiment, the endoscope  1  is an endoscope for renal pelvis/urinary organs (pyeloureteroscope), for example. In the present embodiment, the endoscope  1  is embodied as a so-called videoscope, for example. 
     The endoscope  1  includes the elongated insertion section  2  formed along a longitudinal axis, an operation section  3  located at one end, namely, a proximal end of the insertion section  2 , and a universal cord  4  extending from the operation section  3 . In the following description, the other end of the insertion section  2  opposite to the proximal end will be referred to as a distal end. 
     The universal cord  4  includes a connector  4   a  connected to an external device (not illustrated). 
     The operation section  3  is a section held by a user. The operation lever  10  is disposed at the operation section  3 . A pulling mechanism portion  20 , a holding portion  30 , and a driving portion  40  are disposed at the operation section  3  (not illustrated in  FIGS. 1 and 2 ). 
     The operation lever  10  is a member that allows the user to operate the pulling mechanism portion  20  and the holding portion  30  to be described below. The operation lever  10  is exposed to an outer surface of the operation section  3 . The operation lever  10  is movable relative to the operation section  3  along a first axis A 1  and a second axis A 2  intersecting the first axis A 1 . The way the operation lever  10  moves relative to the operation section  3  is not particularly limited. The operation lever  10  may move along a straight line, or may move along a curve. 
     In the present embodiment, as illustrated in  FIGS. 1 and 2 , a distal end portion  10   a  of the operation lever  10  protrudes from the outer surface of the operation section  3 , for example. The distal end portion  10   a  of the operation lever  10  is disposed at such a position that, for example, when the user holds the operation section  3 , the thumb of the hand holding the operation section  3  reaches the distal end portion  10   a.    
     The operation lever  10  rotates about a predetermined rotation axis C, relative to the operation section  3 . The operation lever  10  also moves linearly, parallel to the rotation axis C, relative to the operation section  3 . In the present embodiment, when the operation lever  10  rotates about the rotation axis C, the distal end portion  10   a  of the operation lever  10  moves along the first axis A 1 . When the operation lever  10  moves parallel to the operation section  3 , the distal end portion  10   a  moves along the second axis A 2 . Accordingly, the first axis A 1  is a curve with a predetermined curvature, and the second axis A 2  is a straight line. In other words, when the user moves the distal end portion  10   a  along the first axis A 1 , the operation lever  10  rotates about the rotation axis C. When the user moves the distal end portion  10   a  along the second axis A 2 , the operation lever  10  moves parallel to the rotation axis C. 
     In the present embodiment, when the user holds the operation section  3  such that the insertion section  2  extends downward and such that the operation lever  10  faces the user, a vertical direction as viewed from the user is a direction along the first axis A 1 , and a horizontal direction is a direction along the second axis A 2 , for example. 
     The configuration for supporting the operation lever  10  in such a manner that the operation lever  10  is movable relative to the operation section  3 , and the configuration of the pulling mechanism portion  20 , the holding portion  30 , and the driving portion  40 , which are disposed inside the operation section  3 , will be described below. 
     As illustrated in  FIG. 2 , the operation section  3  has a treatment instrument insertion port  3   a , and a second opening  5   b . The treatment instrument insertion port  3   a  and the second opening  5   b  communicate with a channel  5  to be described below. In the present embodiment, an optical fiber cable  7  configuring a treatment member can be inserted into the channel  5  through the second opening  5   b . The optical fiber cable  7  is a treatment instrument that irradiates a stone with laser light inside the subject. 
     The treatment instrument insertion port  3   a  is open on the outer surface of the operation section  3 . In the present embodiment, an internal space  3   c  is formed in the operation section  3 , for example. The second opening  5   b  is open on an inner wall surface of the internal space  3   c . A through hole  3   d  communicating with the internal space  3   c  is formed in the outer surface of the operation section  3 . The optical fiber cable  7  is inserted into the through hole  3   d.    
     The insertion section  2  includes a distal end portion  2   a , a bending portion  2   b , and a flexible tube portion  2   c . The distal end portion  2   a , the bending portion  2   b , and the flexible tube portion  2   c  are connected in this order from the distal end toward the proximal end, along a longitudinal axis of the insertion section  2 . 
     The distal end portion  2   a  is disposed at the distal end of the insertion section  2 . The distal end portion  2   a  has a first opening  5   a . Although not illustrated, an image pickup unit and an illumination light emitting portion are disposed at the distal end portion  2   a.    
     The first opening  5   a  communicates with a distal end of the channel  5  provided inside the insertion section  2  and the operation section  3 . As described above, the channel  5  communicates with the treatment instrument insertion port  3   a  and the second opening  5   b  provided in the operation section  3 . 
     The treatment instrument inserted into the channel  5  through the treatment instrument insertion port  3   a  or the second opening  5   b  protrudes from the first opening  5   a . In the present embodiment, a distal end  7   a  of the optical fiber cable  7  inserted into the channel  5  through the second opening  5   b  protrudes from the first opening  5   a.    
     The image pickup unit is a device for picking up an optical image. The image pickup unit includes an objective lens and an image pickup device. Note that part of the image pickup unit may be disposed in the operation section  3 . For example, the image pickup unit may include an objective lens disposed at the distal end portion  2   a , an image pickup device disposed in the operation section  3 , and an image guide fiber inserted in the insertion section  2 . 
     The image pickup unit is electrically connected to the connector  4   a , through an electrical cable disposed in the endoscope  1 . When the connector  4   a  is connected to an external device, the image pickup unit is electrically connected to the external device. The external device includes a processor that displays an optical image picked up by the image pickup unit on a display device (not illustrated). 
     The illumination light emitting portion emits light that illuminates an object of the image pickup unit. The light source of the light emitted from the illumination light emitting portion may be disposed in the endoscope  1 , or may be disposed in an external device. Techniques for the image pickup unit and the illumination light emitting portion of the endoscope  1  are well known, and will not be described in detail. 
     The bending portion  2   b  actively bends in response to an operation of the operation lever  10  by the user. In the following description, a neutral state refers to a state in which a longitudinal axis of the bending portion  2   b  is straight. The bending portion  2   b  bends in two mutually opposing directions from the neutral state. 
     As illustrated in  FIG. 3 , a pair of wires  6  is inserted in the insertion section  2 . A distal end of each of the wires  6  is fixed near a distal end of the bending portion  2   b . The bending portion  2   b  is flexible, and the bent shape varies according to the amount of pulling the pair of wires  6  in a proximal end direction. Note that the configuration of the bending portion  2   b  having a bent shape that varies according to the amount of pulling the pair of wires  6  inserted in the insertion section  2  is the same as the configuration of a well-known endoscope, and will not be described herein. 
     A proximal end of the pair of wires  6  is connected to the pulling mechanism portion  20  disposed in the operation section  3 . The pulling mechanism portion  20  configuring a pulling mechanism pulls and relaxes the pair of wires  6 , in response to an operation of the operation lever  10  by the user. 
     The flexible tube portion  2   c  is disposed on a proximal end side of the bending portion  2   b . A proximal end of the flexible tube portion  2   c  is connected to the operation section  3 . The flexible tube portion  2   c  is flexible, and passively bends in response to an external force. 
     The configuration of the pulling mechanism portion  20 , the holding portion  30 , and the driving portion  40  disposed in the operation section  3  will now be described.  FIG. 4  is a cross-sectional view taken along line IV-IV of  FIG. 3 .  FIG. 4  illustrates a cross section in a plane including the rotation axis C of the operation lever  10 . 
     As illustrated in  FIG. 4 , the pulling mechanism portion  20  includes a pulley  21 , a shaft member  22 , and a support portion  23 . The pulley  21  is a disc-shaped member. The proximal end of the pair of wires  6  is connected to a cylindrical outer peripheral surface of the pulley  21 . The individual wires  6  are wound in different directions around the outer peripheral surface of the pulley  21 . 
     The shaft member  22  is a columnar member protruding from the pulley  21 , and is disposed such that a central axis of the shaft member  22  coincides with a central axis of the pulley  21 . The shaft member  22  may be formed as a separate member from the pulley  21 , or may be formed as an integral member with the pulley  21 . In the present embodiment, the shaft member  22  includes a pair of columns protruding parallel to the central axis of the pulley  21  from opposite end faces of the pulley  21 , for example. In the following description, one of directions parallel to the central axis of the shaft member  22  (pulley  21 ) is referred to as a first direction D 1 , and the other is referred to as a second direction D 2 . 
     The support portion  23  is a pair of bearings supporting the shaft member  22  such that the shaft member  22  is rotatable about the central axis with respect to the operation section  3 . The support portion  23  allows a movement of the shaft member  22  in a direction parallel to the central axis. In the present embodiment, the support portion  23  includes a pair of holes provided in the operation section  3 , for example. The pair of columns of the shaft member  22  respectively protruding in the first direction and the second direction from the pulley  21  is inserted in the pair of holes of the support portion  23 . In other words, the support portion  23  of the present embodiment is a pair of sliding bearings. 
     As illustrated in  FIG. 4 , the support portion  23  supporting a first direction side of the shaft member  22  communicates with the internal space  3   c . A distal end portion  22   b  defining an end of the shaft member  22  in the second direction D 2  protrudes into the internal space  3   c  through the support portion  23 . When the shaft member  22  moves parallel to the central axis with respect to the operation section  3 , the amount by which the distal end portion  22   b  of the shaft member  22  protrudes into the internal space  3   c  changes. 
     The support portion  23  includes a stopper  24  that locks the shaft member  22  at an end in the first direction D 1 , in a movable range in a direction parallel to the central axis. The stopper  24  allows a movement of the shaft member  22  in the second direction D 2  when a force in the second direction D 2  applied to the shaft member  22  exceeds a predetermined value. 
       FIG. 4  illustrates the shaft member  22  located at the end of the movable range in the first direction D 1 .  FIG. 5  illustrates the shaft member  22  located at an end of the movable range in the second direction D 2 . 
     The stopper  24  of the present embodiment is made of an elastically deformable material. The stopper  24  is a protrusion protruding from an outer side of an outer circumference of the shaft member  22  toward the central axis. As illustrated in  FIG. 4 , when the shaft member  22  is located at the end of the movable range in the first direction D 1 , the stopper  24  is located on the inner side of (at a position closer to the central axis than) the outer circumference of the shaft member  22 . Accordingly, in this case, when the distal end portion  22   b  of the shaft member  22  comes into contact with the stopper  24 , the movement of the shaft member  22  in the second direction D 2  is restricted. 
     The stopper  24  is elastically deformed so as to be pushed away by the shaft member  22 , by a force in the second direction D 2  applied to the shaft member  22 . More specifically, the stopper  24  is moved in a direction away from the central axis of the shaft member  22 , by a force in the second direction D 2  applied to the shaft member  22 . When a force in the second direction D 2  applied to the shaft member  22  exceeds a predetermined value, the stopper  24  moves to the same position as the position of the outer circumference of the shaft member  22  from the central axis as illustrated in  FIG. 5 . In this case, the stopper  24  allows a movement of the shaft member  22  in the second direction D 2 . 
     Note that the stopper  24  of the present embodiment is disposed at a distal end of a plate spring protruding from the inner wall surface of the internal space  3   c  of the operation section  3 . In the present embodiment, the plate spring and the stopper  24  are integrally molded with a resin member configuring the inner wall surface of the internal space  3   c.    
     In the present embodiment, a proximal end of the operation lever  10  is fixed to the shaft member  22  or the pulley  21 . In other words, the rotation axis C of the operation lever  10  coincides with the central axes of the shaft member  22  and the pulley  21 . 
     Therefore, according to the endoscope  1  of the present embodiment, when the distal end portion  10   a  of the operation lever  10  moves along the first axis A 1 , the shaft member  22  or the pulley  21  rotates about the central axis (rotation axis C). In other words, when the user swings the operation lever  10  in the vertical direction, the shaft member  22  or the pulley  21  rotates about the central axis. 
     According to the endoscope  1  of the present embodiment, when the distal end portion  10   a  of the operation lever  10  moves along the second axis A 2 , the shaft member  22  or the pulley  21  moves in the first direction D 1  or the second direction D 2  parallel to the central axis. When the user moves the operation lever  10  to the left, the shaft member  22  or the pulley  21  moves in the first direction D 1 . When the user moves the operation lever  10  to the right, the shaft member  22  or the pulley  21  moves in the second direction D 2 . 
     The pair of wires  6  connected to the pulley  21  is pulled and relaxed, by rotation of the pulley  21  about the central axis. For example, when the pulley  21  rotates in one direction about the central axis, one of the paired wires  6  is pulled and, the other is relaxed. In response to pulling and relaxing of the pair of wires  6 , the bending portion  2   b  bends and deforms as described above. In this manner, according to the endoscope  1  of the present embodiment, when the user moves the operation lever  10  in the vertical direction along the first axis A 1 , the bending portion  2   b  bends and deforms. 
     The holding portion  30  and the driving portion  40  are disposed in the internal space  3   c  of the operation section  3 . The optical fiber cable  7  is inserted into the internal space  3   c  through the through hole  3   d  from the outside of the operation section  3 . As described above, the optical fiber cable  7  is inserted into the channel  5  through the second opening  5   b . Note that although not illustrated, a seal member is disposed in the channel  5 . The seal member allows a movement of the optical fiber cable  7  along the longitudinal axis, and seals a gap between an inner wall of the channel  5  and the optical fiber cable  7 . The seal member is, for example, an O-shaped ring. The seal member prevents fluid that has entered the channel  5  from the first opening  5   a  from entering the internal space  3   c.    
     The holding portion  30  holds the optical fiber cable  7  in the internal space  3   c . The driving portion  40  configuring a driving member moves the holding portion  30  in a direction along a longitudinal axis of the optical fiber cable  7 , in response to a movement of the operation lever  10  along the second axis A 2 . The driving portion  40  includes a mechanism configured to convert a movement of the shaft member  22  in a direction parallel to the central axis into a movement of the holding portion  30  in the direction along the longitudinal axis of the optical fiber cable  7 . 
     In the present embodiment, the driving portion  40  includes a first arm portion  41  and a second arm portion  42  that swing about the support shaft  43  in the internal space  3   c , for example. The support shaft  43  is disposed at a position spaced away from the central axis of the shaft member  22  in a radial direction. The support shaft  43  is substantially parallel to a plane orthogonal to the central axis of the shaft member  22 . 
     The first arm portion  41  and the second arm portion  42  extend in different radial directions from the support shaft  43 . The second arm portion  42  is fixed to the first arm portion  41 . Accordingly, both the first arm portion  41  and the second arm portion  42  swing about the support shaft  43 . 
     Note that the structure for swinging the first arm portion  41  and the second arm portion  42  is not limited to the structure using the support shaft  43 . For example, the first arm portion  41  and the second arm portion  42  may be supported by an elastically deformable plate-spring-shaped member, and swing in response to deformation of the plate-spring-shaped member. 
     The first arm portion  41  extends from the support shaft  43  toward the central axis of the shaft member  22 . The first arm portion  41  is disposed so as to cross a trajectory of a movement of the distal end portion  22   b  of the shaft member  22 . As illustrated in  FIG. 4 , when the shaft member  22  is located at the end of the movable range in the first direction D 1 , the first arm portion  41  is spaced apart from the distal end portion  22   b  of the shaft member  22  by a predetermined distance. Then, when the shaft member  22  pushes away the stopper  24  and moves in the second direction D 2  by a predetermined distance or greater, the distal end portion  22   b  of the shaft member  22  comes into contact with the first arm portion  41 . 
     The driving portion  40  includes an urging portion  44  that urges the first arm portion  41  in such a direction that the first arm portion  41  is pressed against the distal end portion  22   b  of the shaft member  22 . More specifically, when the distal end portion  22   b  of the shaft member  22  is in contact with the first arm portion  41 , the urging portion  44  generates a force for urging the shaft member  22  in the first direction D 1 . 
     Note that the urging portion  44  of the present embodiment is a plate-spring-shaped member protruding from the inner wall surface of the internal space  3   c  of the operation section  3 . In the present embodiment, the urging portion  44  is integrally molded with a resin member configuring the inner wall surface of the internal space  3   c.    
     When the distal end portion  22   b  of the shaft member  22  is in contact with the first arm portion  41 , the first arm portion  41  is swung about the support shaft  43  in accordance with a movement of the shaft member  22  parallel to the central axis, by an urging force of the urging portion  44 . 
     The holding portion  30  is disposed at a distal end portion  42   a  of the second arm portion  42 . The second arm portion  42  is disposed such that a distance between the distal end portion  42   a  and the second opening  5   b  changes when the second arm portion  42  swings about the support shaft  43 . The second arm portion  42  is disposed at such a position that the distal end portion  42   a  faces the second opening  5   b.    
     The distance between the holding portion  30  and the second opening  5   b  changes when the second arm portion  42  swings. In the present embodiment, a tangent line to a movement trajectory of the holding portion  30  passes near the second opening  5   b . Accordingly, when the second arm portion  42  swings about the support shaft  43 , the holding portion  30  moves in a direction substantially along the longitudinal axis of the optical fiber cable  7  extending out of the second opening  5   b.    
     As described above, the second arm portion  42  in which the holding portion  30  is disposed swings about the support shaft  43 , together with the first arm portion  41 . The first arm portion  41  swings about the support shaft  43  in accordance with a movement of the shaft member  22  in the first direction D 1  and the second direction D 2 . 
     In the present embodiment, when the shaft member  22  moves in the second direction D 2 , the distance between the holding portion  30  and the second opening  5   b  is reduced. When the shaft member  22  moves in the first direction D 1 , the distance between the holding portion  30  and the second opening  5   b  is increased. 
     According to the endoscope  1  of the present embodiment having the configuration described above, when the distal end portion  10   a  of the operation lever  10  moves along the second axis A 2 , the shaft member  22  moves in the first direction D 1  or the second direction D 2  parallel to the central axis. When the shaft member  22  moves in the first direction D 1  or the second direction D 2 , the holding portion  30  moves in the direction substantially along the longitudinal axis of the optical fiber cable  7 . Therefore, according to the endoscope  1  of the present embodiment, when the distal end portion  10   a  of the operation lever  10  moves in the horizontal direction along the second axis A 2 , the optical fiber cable  7  inserted in the channel  5  advances or retracts along the longitudinal axis. 
     More specifically, when the distal end portion  10   a  of the operation lever  10  moves rightward, the optical fiber cable  7  moves to the distal end  7   a  side. When the distal end portion  10   a  of the operation lever  10  moves leftward, the optical fiber cable  7  moves to the proximal end side. Accordingly, the urging portion  44  generates an urging force that urges the holding portion  30  in such a direction that the optical fiber cable  7  moves to the proximal end side. 
     The following describes a method of operating the endoscope  1  of the present embodiment when performing a treatment for removing a urinary stone in a subject. 
     First, before inserting the insertion section  2  into a subject, the user moves the operation lever  10  to the left end of the movable range such that the shaft member  22  is located at the end of the movable range in the first direction D 1 . With this operation, the shaft member  22  is locked at the end of the movable range in the first direction D 1  by the stopper  24 . 
     Subsequently, the user adjusts the position where the optical fiber cable  7  is held by the holding portion  30 . With this adjustment, the distal end  7   a  of the optical fiber cable  7  is located on the inner side of the first opening  5   a  of the channel  5 . Note that, in the endoscope  1 , at the time of manufacturing, the optical fiber cable  7  may be fixed to the holding portion  30  so as to be located at the above-described position. In this case, the user does not have to make this adjustment. 
     Then, the user inserts the insertion section  2  into the subject. When inserting the insertion section  2  into the subject, the user performs a bending operation of bending and deforming the bending portion  2   b . The user performs the bending operation by moving the operation lever  10  in the vertical direction along the first axis A 1 . 
     The shaft member  22  is locked at the end in the first direction D 1  by the stopper  24 , and is spaced away from the driving portion  40  by a predetermined distance. The holding portion  30  is urged by the urging portion  44  in such a direction that the optical fiber cable  7  moves to the proximal end side. Accordingly, as long as the user does not intentionally apply a force for moving the operation lever  10  rightward, the distal end  7   a  of the optical fiber cable  7  is held in the channel  5 . 
     After the insertion section  2  reaches a part where a stone can be observed, the user moves the operation lever  10  rightward by a predetermined distance or greater such that the distal end  7   a  of the optical fiber cable  7  protrudes from the first opening  5   a.    
     After that, the user can perform a bending operation of the bending portion  2   b  by moving the operation lever  10  in the vertical direction with a thumb of one hand holding the operation section  3 . The user can also advance and retract the optical fiber cable  7 , and change the amount by which the optical fiber cable  7  protrudes from the first opening  5   a , by moving the operation lever  10  in the horizontal direction with the thumb of the hand holding the operation section  3 . 
     With use of the endoscope  1  of the present embodiment, the user can perform a bending operation of the insertion section  2 , an operation of rotating the insertion section  2  about the longitudinal axis, and an operation of advancing and retracting the optical fiber cable  7  at the same time, using one hand holding the operation section  3 . Therefore, with use of the endoscope  1  of the present embodiment, the user can advance and retract both the insertion section  2  and the optical fiber cable  7  at the same time, by advancing and retracting the insertion section  2  using the other hand not holding the operation section  3 . Therefore, the user can move the distal end  7   a  of the optical fiber cable  7  to a position of irradiating a stone with laser light in the subject in a short time period. 
     As described above, according to the endoscope  1  of the present embodiment, it is possible to perform an operation of moving the optical fiber cable  7  in the subject in a short time period. 
       FIGS. 6 and 7  illustrate a modification of the endoscope  1  of the present embodiment. As illustrated in  FIG. 6 , an endoscope  1  of the present modification includes an operation lever  10  in the form of a so-called joystick that tilts in all directions. 
     A first arm portion  11 , a second arm portion  12 , a third arm portion  13 , and a fourth arm portion  14  extend from the operation lever  10  in directions orthogonal to a central axis of the operation lever  10 . The first arm portion  11  and the second arm portion  12  extend in directions opposite to each other along a first axis A 1 . The third arm portion  13  and the fourth arm portion  14  extend in directions opposite to each other along a second axis A 2 . The first axis A 1  and the second axis A 2  are orthogonal. 
     Wires  6  are connected to respective distal end portions of the first arm portion  11  and the second arm portion  12 . The pair of wires  6  is arranged such that the longitudinal axis is substantially orthogonal to the first arm portion  11  and the second arm portion  12  at a connection portion between the first arm portion  11  and the second arm portion  12 . 
     In the present modification, when the operation lever  10  tilts in the direction along the first axis A 1 , the pair of wires  6  is pulled and relaxed. Accordingly, according to the endoscope  1  of the present modification, the bending portion  2   b  bends and deforms in response to tilting of the operation lever  10  in a direction along the first axis A 1 . 
     Proximal ends of a first wire  45  and a second wire  46  are connected to distal end portions of the third arm portion  13  and the fourth arm portion  14 . As illustrated in  FIG. 7 , the first wire  45  and the second wire  46  configure a driving portion  40 . The driving portion  40  of the present modification includes the first wire  45 , the second wire  46 , and a pulley  47 . 
     Distal ends of the first wire  45  and the second wire  46  are connected to a holding portion  30  in an internal space  3   c  of an operation section  3 . The pulley  47  is disposed in the internal space  3   c  of the operation section  3 . The second wire  46  is wound around the pulley  47  so that the direction is changed by 180 degrees. 
     In the present modification, the first wire  45  and the second wire  46  are arranged to form a loop. The first wire  45  and the second wire  46  advance and retract in the direction along the longitudinal axis in response to tilting of the operation lever  10  in a direction along the second axis A 2 . Then, the holding portion  30  moves in accordance with an advancement movement and a retraction movement of the first wire  45  and the second wire  46  in the direction along the longitudinal axis, so that a distance between the holding portion  30  and a second opening  5   b  changes. 
     As described above, according to the endoscope  1  of the present modification, it is possible to perform a bending operation of the bending portion  2   b  and an operation of advancing and retracting the optical fiber cable  7 , by changing the direction and angle of tilt of the operation lever  10 .