Source: https://patents.google.com/patent/US8617054B2/en
Timestamp: 2018-04-27 04:09:32
Document Index: 568687491

Matched Legal Cases: ['arts 15', 'art 15', 'art 3', 'art 3', 'art 25', 'art 25', 'art 28', 'art 28', 'art 15', 'art 15', 'art 15', 'art 15', 'art) 31', 'art 31', 'art 36', 'art 36', 'art 36', 'art 7', 'art 7', 'art 36', 'art 36', 'art 36', 'art 36', 'art 46', 'art 47', 'art 46', 'art 47', 'art 50', 'art 56', 'art 63', 'art 63', 'art 68', 'art 68', 'art 57', 'art 56', 'art 57', 'art 71', 'art 71', 'art 50', 'art 36', 'art 36', 'art 36', 'art 36', 'art 36', 'art 92', 'art 15', 'art 58', 'art 51', 'art 51', 'art 3', 'art 203', 'art 203', 'art 203', 'art 203', 'art 203', 'art 203', 'art 203', 'art 207', 'art 203', 'arts 207', 'art 203', 'art 207', 'art 7', 'art 7', 'art 207', 'art 236', 'art 203', 'arts 237', 'art 203', 'art 203', 'art 236', 'art 243', 'art 237', 'art 243', 'art 236', 'arts 236', 'art 243', 'art 151', 'arts 147', 'art 147', 'art 156', 'art 207', 'art 157', 'art 207', 'art 156', 'art 158', 'arts 131', 'art 158', 'art 158', 'art 158', 'art 156', 'arts 160', 'arts 160', 'arts 168', 'arts 168', 'arts 168', 'arts 168', 'art 131', 'arts 168', 'art 168', 'arts 168', 'arts 168', 'art 156', 'art 207', 'art 147', 'art 157', 'art 156', 'art 157', 'arts 161', 'arts 161', 'arts 175', 'arts 175', 'arts 175', 'arts 175', 'art 131', 'arts 175', 'arts 175', 'arts 175', 'art 157', 'art 191', 'art 191', 'art 191', 'art 158', 'art 191', 'art 158', 'art 125', 'art 191', 'art 191', 'art 125', 'art 215', 'art 146', 'art 146', 'art 194', 'art 194', 'art 194', 'art 194', 'art 194', 'art 203', 'art 194', 'art 194', 'art 203', 'art 194', 'art 203', 'art 203', 'art 243', 'art 236', 'art 236', 'art 236', 'art 146', 'art 236', 'art 236', 'art 236', 'art 151', 'art 191', 'art 125', 'art 125', 'art 215', 'art 125', 'art 207', 'art 151', 'art 191', 'art 125', 'art 156', 'arts 131', 'arts 158', 'art 158', 'art 158', 'arts 160', 'art 207', 'art 157', 'arts 131', 'arts 158', 'art 158', 'art 158', 'arts 161', 'art 207', 'art 151', 'art 150', 'art 151', 'arts 207', 'art 236', 'art 36', 'art 36', 'art 35', 'art 3', 'art 35', 'art 35', 'art 35', 'art 236', 'art 243', 'art 237', 'arts 236', 'arts 237', 'art 243', 'art 236', 'art 243', 'art 236', 'art 203', 'arts 207', 'art 35', 'art 35', 'art 36', 'art 236', 'art 236', 'art 158', 'art 131', 'art 158', 'art 58', 'arts 160', 'art 158', 'art 125', 'art 215', 'art 125', 'art 151', 'art 191', 'art 147', 'art 151', 'art 191', 'art 125', 'art 125', 'art 125', 'art 125', 'art 191', 'art 125', 'art 194', 'art 203', 'art 194', 'art 194', 'art 194', 'art 194', 'art 194', 'art 203', 'art 146', 'art 151', 'art 131', 'art 147', 'art 207', 'art 131', 'art 158', 'art 207', 'Application No. 2009', 'Application No. 2009']

US8617054B2 - Medical treatment endoscope - Google Patents
US8617054B2
US8617054B2 US11435183 US43518306A US8617054B2 US 8617054 B2 US8617054 B2 US 8617054B2 US 11435183 US11435183 US 11435183 US 43518306 A US43518306 A US 43518306A US 8617054 B2 US8617054 B2 US 8617054B2
US11435183
US20070167680A1 (en )
As shown in FIGS. 1 and 2, rigid front end parts 15 are disposed to the front ends of the first arm member 8A and the second arm member 8B. A bumper 15 a is provided to the front end part 15 for limiting movement in the forward direction when gripping forceps 5 or the like are inserted from the base end side of the instrument insertion channel 6.
A video cable 20, which is connected to a viewing device 12 which includes an image pick-up unit 11 and an objective lens (optical member for viewing) 23, and two light guides (illuminating members) 21A and 21B which emit illuminating light onto illuminating lenses (illuminating optical members) 21 a, which are structural components of the illuminating members and are for lighting the object to be illuminated by forming the illuminating light bundles into a desired light bundle profile, are inserted into the first sheath 3 so as not to interfere with the second sheath 9A, the third sheath 9B and the various bending wires. A rigid sheath front end part 3A is disposed to the front end of the first sheath 3. Objective lens 23, and illuminating lenses 21 a which are on either side of the objective lens so as to interpose the objective lens 23 therebetween, are disposed to the sheath front end part 3A. In other words, the illuminating members are disposed on either side of the viewing device. As shown in FIG. 7A, a plurality of markings 22, for understanding a length of the inserted portion when the endoscope is inserted into the patient, are provided at predetermined intervals along the surface of the first sheath 3 on the hand-held side thereof.
As shown in FIGS. 1, 2A, 2B, and 10, a gripping forceps 5 is provided with a forceps insertion part 25 that has a long narrow coil sheath 25 a. A pair of forceps pieces 26A and 26B are disposed to the front end of the forceps insertion part 25. This pair of forceps pieces 26A and 26B is connected to a forceps manipulating wire 27, which is inserted into the coil sheath 25 a to enable free advancing and retracting, via a forceps linking part 28 which converts the advancing/retracting operation of the forceps manipulating wire 27 into the opening/closing operation of the paired forceps pieces 26A and 26B. A forceps linking part 28 is disposed to a front end cover 29 which is attached to the coil sheath 25 a.
As shown in FIGS. 2A and 2B, this gripping forceps 5 is fixed in place via a first connecting member 30A, a second connecting member 30B and a third connecting member 30C to the second arm member 8B to enable free rotation. The first connecting member 30A is tubular, with its inner peripheral surface fixed in place near the front end of the gripping forceps 5 by a screw, adhesive agent or the like. The second connecting member 30B is in the form of a short pipe, and is interposed between the bumper 15 a of the front end part 15 and the first connecting member 30A. The third connecting member 30C is in the form of a short pipe, and is formed so that the base end projects inward in the radial direction. This third connecting member 30C engages with the front end part 15, and pushes the first connecting member 30A in the forward direction. As a result, the second connecting member 30B is pushed further forward then the first connecting member 30A, coming into contact with the bumper 15 a of the front end part 15, thereby restricting movement of the gripping forceps 5 in the advancing or retracting direction. The gripping forceps 5 are attached in a freely rotating manner with respect to the instrument insertion channel 6. Note that the third connecting member 30C may also be attached to the front end part 15 by screwing, or by an adhesive agent or the like.
The gripping forceps 5 are provided with a forceps operating part (procedure operating part) 31. The forceps operating part 31 is provided with a forceps operating part main body 32 to which the coil sheath 25 a is connected, and a forceps handle 33 to which forceps manipulating wire 27 is connected and which is disposed in a freely retracting and advancing manner with respect to the forceps operating part main body 32.
As shown in FIGS. 4 through 8B, the open/close mechanism 10 is provided with a bending opening/closing wire (open/close operating member) 35, which is capable of advancing and retracting with respect to the first sheath 3; a linking part 36 to which the end of the bending opening/closing wire 35 is connected, which converts the advancing/retracting operation of the bending opening/closing wire 35 into the opening/closing operation of the first arm member 8A with respect to the first sheath 3; and a support 37 which is in the form of a short pipe that is axially supported to enable rotation about linking part 36, or, alternatively, is connected to linking part 36 in a manner so as to prevent rotation. This short pipe-shaped support 37 is fixed in place along the bending part 7 of the arm member 8A. Note that it is also acceptable to fix this short pipe-shaped support 37 further toward the base end than the bending part 7. The linking part 36 is formed extending in the form of a long plate, and one end 36 a is axially supported by a guide member 42 of the first sheath 3, explained below, to enable rotation. Note that in the case of the second arm member 8B, the one end 36 a of the linking part 36 is axially supported by a sliding member 43, explained below, that can advance and retract along the central axis C1.
The support 37 is supported by the other end 36 b of the linking part 36 via a support axis 38, to enable rotation thereof, or alternatively, is connected so that rotation is not possible. The other end 36 b of the linking part 36 is formed in the shape of a disk centered about the position of attachment to the support axis 38, with bending opening/closing wires 35 supported by the periphery thereof. The bending opening/closing wires 35 are disposed inside the first sheath 3, inserted into respective bending opening/closing wire coils 41.
The frame 45 is provided with a moving frame 45A where the open/close operating part 46 and the bending operating part 47 of the arm member 8A are disposed; and a fixed frame 45B where the open/close operating part 46 and the bending operating part 47 of the arm member 8B, and the rotation operating part 50 of the first sheath 3, are disposed. Arm clamps 52 for supporting the first arm member 8A and the second arm member 8B projecting from the base end of the first sheath 3 farther toward the hand-held side are respectively disposed along the central axis C3 to moving frame 45A and fixed frame 45B. In addition to the first arm member 8A and the second arm member 8B, the light guides 21A and 21B and the video cable 20 project out from the base end of the first sheath 3, and are connected respectively to a light source device L and a controller C. A fixing screw 45 a for connecting and fixing in place a scope holder 86, explained below, is disposed to the bottom of the fixed frame 45B. Note that with respect to fixing with the scope holder 86, it is also acceptable enable free sliding so that it is possible to adjust the position of the front end of the medical treatment endoscope 1 inside the body cavity by advancing and retracting the entire operating part.
A vertical bending operating part 56 is provided with a pair of rod-shaped first bending guides 62A and 62B in which the longitudinal ends of the first movement restricting member 60 are engaged in a manner to enable sliding, in order to cause parallel displacement of the first movement restricting member 60 in the vertical direction; a first die part 63 that is connected to the end 60 a of the first movement restricting member 60, and moves along the first bending guide 62A; a first belt member 65, in which both ends are connected to the first die part 63 so as to be in opposition to one another from the direction along the first bending guide 62A; two adjusting wheels 66 for adjusting the tension by winding the first belt member 65; a first chain belt 67 in which the bases of the bending wires 17A and 17B are connected at either end; and a first gear 68 having a small diameter part 68 b in which the first chain belt 67 engages and a large diameter part 68 a around which the first belt member 65 is wound.
A horizontal bending operating part 57 is provided with the same design as the vertical bending operating part 56. In other words, horizontal bending operating part 57 is equipped with a pair of rod-shaped second bending guides 70A and 70B in which the longitudinal ends of the second movement restricting member 61 are engaged in a manner to enable sliding, in order to cause parallel displacement of the second movement restricting member 61 in the horizontal direction; a second die part 71 that is connected to the end 61 a of the second movement restricting member 61, and moves along the second bending guide 70A; a second belt member 72, in which both ends are connected with respect to the second die part 71 so as to be in opposition to one another from the direction along the second bending guide 70A; adjusting wheels 66 for adjusting the tension by winding the second belt member 72; a second chain belt, not shown in the figures, in which the bases of the bending wires 17C and 17D are connected at either end; and a second gear 75 in which the second chain belt engages and around which the second belt member 72 is wound.
The rotation operating part 50 is disposed further toward the front end side of the frame 45 than the arm clamp 52, and is provided with a sheath connector 82, to which a rotation knob 81 is disposed and the base end of the first sheath 3 is connected; and a rotation support 83 for supporting the sheath connector 82 in a manner to enable rotation. A screw hole 83 a is formed in the rotation support 83, and a through hole 82 a is formed in the sheath connector 82. The rotation of the sheath connector 82 with respect to the rotation support 83 is restricted as a result of the engagement of a stopping screw or the like at the position where the screw hole 83 a and the through hole 82 a are overlapped. The amount of rotation is preferably on the order of 180 degrees to either side. Note that a through hole 83 b is disposed to the rotation support 83 for insertion of the light guides 21A and 21B and the video cable 20.
When opening the first arm member 8A and the second arm member 8B with respect to the first sheath 3 from the starting state shown in FIGS. 5A and 7A, the open/close handle 55 is slide with respect to the open/close operating part main body 53 a predetermined distance toward the hand-held side. The bending opening/closing wire 35 is thus retracted with respect to the first sheath 3 toward the hand-held side. Accompanying this, the other end 36 b of the linking part 36 receives a rotational torque toward the base end side of the first sheath 3. The other end 36 b side of the linking part 36 is rotated about the one end 36 a by a predetermined angle in the direction away from the central axis C1 of the first sheath 3. As shown in FIGS. 6A and 8A, the support 37 rotates with respect to first sheath 3, and opens. In this case, the position of the open/close handle 55 is fixed in place by the rack 53A of open/close operating part main body 53, and the position of the bending opening/closing wire 35 is thus fixed in place with respect to the first sheath 3.
When closing the first arm member 8A and the second arm member 8B with respect to the first sheath 3, the open/close handle 55 is advanced forward with respect to the open/close operating part main body 53, while pressing on the release button 55A of the open/close handle 55. The bending opening/closing wire 35 is advanced forward with respect to the first sheath 3 at this time. Accompanying this, the rotational torque applied on the linking part 36 is released, and the other end 36 b of the linking part 36 is rotated about the one end 36 a of the linking part 36 in a direction toward the central axis C1 of the first sheath 3. As a result, the support 37 rotates with respect to the first sheath 3 and closes, i.e., resumes the starting state.
The patient PT is placed on his/her back, and a typical endoscope 1A is introduced into the open-ended lumen 88 of an over-tube 90 from the base end 91 of the over-tube 90. This open-ended lumen 88 extends along the axial direction of the over-tube 90. The over-tube 90 is then inserted from the mouth M of the patient PT into the esophagus ES, and positioned in the stomach ST as shown in FIG. 18. Next, the stomach ST is inflated by relaying air into it, after which an opening SO is formed in the stomach wall by excision. The insertion part 92 of the over-tube 90 and the endoscope 1A are introduced into the abdominal cavity AC via the opening SO. Next, the endoscope 1A is withdrawn from the over-tube 90, and the first sheath 3 of the medical treatment endoscope 1 is inserted in its place into the lumen 88 of the over-tube 90, so as to project out from the front end of the over-tube 90.
As an example here, the case will be explained where a high-frequency knife 85 is inserted into the second sheath 9A and the first arm member 8A. First, the high-frequency knife 85 is inserted into the instrument insertion channel 6, and the front end of the high-frequency knife 85 comes into contact with the bumper 15 a that is provided to the front end part 15 of the first arm member 8A. The front end of the high-frequency knife 85 is urged toward the bumper 15 a by pushing the high-frequency knife 85 further in from the base end side, so that the knife operating part, not shown, of the high-frequency knife attaches into the attachment part 58 of the operating part 51. In this way, advancing and retracting of the high-frequency knife 85 with respect to the first arm member 8A is restricted. Note that the high-frequency knife 85 is supported to enable free rotation with respect to the first arm member 8A and the operating part 51.
For example, the arm members are not limited to two; rather, three or more arm members may be provided. It is also acceptable to design the front end of the second arm member so as to enable relative displacement of the gripping forceps in the advancing/retracting direction with respect to the second arm member. In addition, while an illuminating member for radiating illuminating light on the target object was formed using the light guides 21A and 21B and an illuminating lens 21 a, it is also acceptable to provide an illuminating member by disposing a light emitting element, an LED for example, to the sheath front end part 3A.
The medical treatment endoscope 200 according to this embodiment is provided with a first sheath 203 having a flexibility, a sheath front end part 203A having a rigidity which is provided at the front end of the first sheath 203, and a bending part 203B that is provided to a base end of the sheath front end part 203A. Openings are provided at front ends of the first sheath 203 and the bending part 203B. As shown in FIGS. 30 and 31, these openings form a first lumen 202 through which the first arm member 208A (a second sheath), the second arm member 208B (a third sheath), a video cable 220 and the like, are inserted. Furthermore, the sheath front end part 203A which is provided to the open end of the bending part 203B has an opening 203 a through which the first arm member 208A and the second arm member 208B are respectively passed.
As shown in FIG. 31, the first arm member 208A and the second arm member 208B are provided to the sheath front end part 203A. An instrument insertion channel (a second lumen) 206, through which instruments such as gripping forceps 205B are inserted and which is open at the distal end, and a bending part 207, which projects out from the sheath front end part 203A and carries out bending operations, are disposed to each of these arm members 208A and 208B respectively. Openings 203 a for enabling advance of the bending parts 207 in the lateral direction are provided on each side of the sheath front end part 203A where the first arm member 208A and the second arm member 208B are disposed. The bending part 207 is equipped with the same structure as the bending part 7 shown in FIG. 1. Namely, a plurality of joint wheels 216 are mutually axially supported to enable rotation, and are connected along the direction of the central axes of the first arm member 208A and the second arm member 208B. Furthermore, as in the case of the preceding bending part 7, bending wires 117A, 117B, 117C, and 117D extended along the inside of the bending part 207 are connected to the joint wheel 216 that is disposed farthest toward the front end. The bending wires 117A, 117B, 117C, and 117D are each inserted into and pass through the joint wheels 216 at positions so as to divide a circumferential periphery of the joint wheels 216 into quarters.
The linking part 236 is formed as a plate-shaped member, the thickness and width dimensions thereof being determined so as to obtain the desired rigidity. The support 237 is constructed so that its base end side is supported to enable free rotation about a support axis 240 at the sheath front end part 203A, and to grip the first arm member 208A with link-shaped gripping members 237 a that are provided at its front end side. In this way, both the first arm member 208A and the second arm member 208B are fixed in place by the gripping parts 237 a of the supports 237 extending from the sheath front end part 203A, and cannot advance or retract with respect to the first sheath 203. An opening 203 b is formed in the sheath front end part 203A that supports the base end side of the supports 237, for enabling advance of the supports 237 in the lateral direction.
One end 236 a of the linking part 236 is supported to enable free rotation about a support axis 238 at the front end of the open/close operating part 243, and the other end is supported to enable free rotation about a support axis 239 of the gripping part 237 a. A front end of the open/close operating part 243 that is connected to the one end 236 a of the linking part 236 is positioned farther toward the front end of the arm members 208A and 208B than the other end 236 b of the linking member 236 that is connected to support 237. In other words, the construction is provided in which the two linking parts 236 and the two supports 237 form a pantograph structure at the front end of the first sheath 203, and modification of this pantograph structure is carried out by advance and retraction of the open/close operating part 243, thereby pushing apart or pulling closed the first arm member 208A and the second arm member 208B.
Next, the operating part of the medical treatment endoscope 200 will be explained. As shown in FIGS. 32 through 36, this medical treatment endo scope 200 is provided with an operating part 151 that has a frame 145, which includes a moving frame 145A and a fixed frame 145B, and a mount 187 on which the frame 145 is mounted. The moving frame 145A and the fixed frame 145B are connected to the mount 187 via a slide mechanism 190 that is provided to their respective underbodies. The slide mechanism 190 includes slide rails 198 a that are provided to a mount 187 side of base wall members 190 a of the moving frame 145A and the fixed frame 145B, and a slide block 198 b that is provided to the frame 45 side of the mount 187 and engages with the two slide rails 198 a in a manner that enables sliding. The moving frame 145A and the fixed frame 145B are connected via a sliding mechanism 148 in which a slide rail 148 a, provided to a lateral surface of the fixed frame 145B, and a slide block 148 b, provided to a lateral surface of the moving frame 145A, engage in a manner to enable sliding. The slide rail 148 a is disposed parallel to the slide rail 198 a of the slide mechanism 190.
The moving frame 145A and the fixed frame 145B are each provided with the slide mechanism 190, and are connected via the slide mechanism 148. As a result, the moving frame 145A and the fixed frame 145B can both be made to slide with respect to mount 187. However, in the case of this embodiment, the base wall member 190 a of the fixed frame 145B is fixed to the mount 187, and only the moving frame 145A is able to slide with respect to the fixed frame 145B and the mount 187 via the slide mechanisms 148 and 198.
Respective bending operating parts 147 are provided corresponding to the first arm member 208A and the second arm member 208B. The bending operating part 147 is provided with a roughly rectangular frame member 170; a vertical bending operating part 156 for moving the bending part 207 in a vertical direction, for example; a horizontal bending operating part 157 for moving the bending part 207 in a direction perpendicular to the moving direction of the vertical bending operating part 156, i.e., a horizontal direction, for example; and an attachment part 158 for attaching the instrument operating parts 131A and 131B in a manner so as to enable rotation. The attachment part 158 is constructed such that the two slide blocks 158A and 158B are disposed opposite one another, and so as to be fixed in place by a tubular member 193 which passes through these slide blocks 158A and 158B. The slide block 158A is constructed to be able to slide in the horizontal direction after engaging with the two slide rails 160 a that form the first movement restricting member 160 which is provided to permit relative displacement of the attachment part 158 in the horizontal direction only. The slide block 158B is constructed to be able to slide in the vertical direction after engaging with the two slide rails that form the second movement restricting member 161 which is provided to permit relative displacement of the attachment part 158 in the vertical direction only.
The vertical bending operating part 156 is provided with first bending guides 196 for causing relative displacement of the first movement restricting member 160 in the vertical direction; a first belt member 165 connected to first die parts 160 b that are provided at the center along the longitudinal direction of the two slide rails 160 a that form the first movement restricting member 160; four adjusting wheels 166 for adjusting the tension by winding the first belt member 165; a first gear 168 that is connected to the first belt member 165; and a first chain belt 167 which is connected to the first gear 168.
The first bending guide 196 is provided with two slide rails 196 a that are equipped to the frame body of the frame member 170, and slide blocks 196 b that engage with the two slide rails 196 a respectively in a manner to enable sliding, and which are connected at either end of the two slide rails 160 a of the first movement restricting member 160.
The ends of the first belt member 165 are each connected to the first die parts 160 b via four adjusting wheels 166. The first chain belt 167 and the first gear 168 are attached to a plate-shaped gear box 156 a, as shown in FIG. 41. The large diameter parts 168A of the first gear 168 that are connected to the first belt member 165 are attached to one surface side of the gear box 156 a, and the small diameter parts 168B, which have the same axes as the large diameter parts 168A, are disposed inside grooves 156 b that are formed in the other surface side of the gear box 156 a. The first belt member 165 is fixed in place at the outer peripheral surface of the large diameter parts 168A. When the first movement restricting member 160 moves due to an operational input at the bending operating part 131, the first belt member 165 is pulled in one direction accompanying this, and the large diameter parts 168A begin to rotate. The first chain belt 167 which is housed inside the a groove 156 b engages with the small diameter part 168B. The bending wires 117A and 117B which extend from the first sheath 203 are each connected to an end of the first chain belt 167.
In the case of this embodiment, three sets of grooves 156 b for housing the first chain belt 167 and the small diameter parts 168B in the gear box 156 a are prepared. By pairing these with the different diameter large diameter parts 168A, it is possible to select a reduction gear ratio at the vertical bending operating part 156. This reduction gear ratio is determined based on a force required at the bending part 207 which performs the bending operation through bending wires 117A and 117B, and a force required for an operation of the bending operating part 147, these required forces being values that can be known in advance.
The horizontal bending operating part 157 is provided with the same construction as the vertical bending operating part 156. In other words, the horizontal bending operating part 157 is provided with second bending guides 197 that are connected to two ends of a longitudinal direction of the second movement restricting member 161 for causing movement of the second movement restricting member 161 in the horizontal direction; a second belt member 172 connected to second die parts 161 b that are respectively provided at the center along the longitudinal direction of the two slide rails 161 a that form the second movement restricting member 161; four adjusting wheels 166 for adjusting the tension by winding of the second belt member 172; a second gear 175 that is connected to the second belt member 172; and a second chain belt 173.
The second bending guide 197 is provided with two slide rails 197 a that are provided to the frame body of the frame member 170, and slide blocks 197 b that engage with the two slide rails 197 a respectively in a manner to enable sliding, and which is connected at either end of the two slide rails 161 a of the second movement restricting member 161.
Each end of the second belt member 172 is connected to the second die parts 161 b via four adjusting wheels 166. The second chain belt 173 and the second gear 175 are attached to a plate-shaped gear box 157 a, as shown in FIG. 42. Large diameter parts 175A of the second gear 175 which are connected to the second belt member 172 are attached on one surface side of the gear box 157 a, and small diameter parts 175B, which have the same axes as the large diameter parts 175A, are disposed inside grooves 157 b that are formed in the other surface side of the gear box 157 a. The second belt member 172 is fixed in place at the outer peripheral surface of the large diameter parts 175A. When the second movement restricting member 161 moves due to operational input at the bending operating part 131, the second belt member 172 is pulled in one direction accompanying this, and the large diameter parts 175A begin to rotate. The second chain belt 173 that are housed inside the grooves 157 b engage with the small diameter parts 175B. The bending wires 117C and 117D which extend from the first sheath 203 are each connected to an end of the second chain belt 173. Furthermore, three sets of grooves 157 b are prepared in the gear box 157 a. By pairing these with the different diameter large diameter parts 175A, it is possible to select a reduction gear ratio at the horizontal bending operating part 157.
As shown in the schematic cross-sectional view in FIG. 37, the sheath advance/retract part 191, which is connected to the first arm clamp 152A, is provided with a first tubular member 191 a, a second tubular member 191 b which is disposed nested inside the first tubular member 191 a, and a die part 191 c that supports the base end of the second tubular member 191 b. An instrument sheath 192 is installed between the die part 191 c on the base end side and the attachment part 158, this instrument sheath 192 connecting an opening of the die part 191 c and an opening of the tubular member 193 of the attachment part 158. The instrument insertion part 125 having a coil sheath that is connected to gripping forceps or the like at the front end is inserted into the sheath advance/retract part 191 and the instrument sheath 192. Of the two tubular members 191 a and 191 b that are disposed in nesting form, the first tubular member 191 a is supported by the first arm clamp 152A and is fixed in place to the fixed frame 145B, while the second tubular member 191 b is connected to the die part 191 c and is fixed in place to the moving frame 145A. Accordingly by advancing and retracting the moving frame 145A with respect to the fixed frame 145B, it is possible to advance and retract the second tubular member 191 b with respect to the first tubular member 191 a, and thereby advance and retract the instrument insertion part 125 which is inserted inside the second tubular member 191 b with respect to the first sheath 203. As a result, the high-frequency scalpel 205A that is disposed to the front end of the first arm member 208A can be made to project out from the front end of the front end part 215A, and to be retracted back from this projecting position.
The open/close operating part 146 is attached to the frame member 170 of the fixed frame 145B. As shown in FIGS. 38 through 40, the open/close operating part 146 is provided with an open/close operating part main body 153; an open/close handle 155 to which the base end of the bending opening/closing wire 244 is connected and which can advance and retract with respect to the open/close operating part main body 153; and a gear 154 for restricting the position of the open/close handle 155 with respect to the open/close operating part main body 153. A rack 155 a is formed to the open/close handle 155 for restricting movement toward the front end side when the open/close handle 155 is pulled toward the hand-held side. This rack 155 a is for restricting the advance of the open/close handle 155 with respect to the open/close operating part main body 153 through engagement with a claw 154 b of a gear 154 that is provided inside the open/close operating part main body 153. In this restricted state, the claw 154 b of the above-mentioned gear 154 can be moved away and released from the rack 155 a by pressing a release button 154 c that is provided opposite the claw 154 b via a gear main body 154 a of the gear 154. When a starting state for the open/close mechanism 210 is defined as a state in which the first arm member 208A and the second arm member 208B are closed at a position along a direction of a central axis C1 of the first sheath 203, then, in this starting state, the open/close handle 155 is set so as to be positioned toward the front end side of the open/close operating part main body 153.
The sheath operating part 194 is disposed vertically positioned to a stand part 194A that is attached to the gear box 157 a of the fixed frame 145B. The sheath operating part 194 can be freely attached to or released from the stand part 194A. The sheath operating part 194 is provided with a bending knob 195 for bending operation of the bending part 203B provided to the front end side of the first sheath 203. The operating sheath 204 which extends from the first sheath 203 is connected to a front end part 194 a of the sheath operating part 194. Four bending wires 201B, which are inserted into each of the joint wheels 201 of the bending part 203B are inserted into the operating sheath 204. As in the case of the typical medical treatment endoscope, the four bending wires 201B can be advanced or retracted by turning the bending knob 195 that is provided to the sheath operating part 194, enabling bending operation of the bending part 203B to be carried out by the aforementioned advance/retract operation.
When opening the first arm member 208A and the second arm member 208B with respect to the first sheath 203 from the starting state shown in FIGS. 26 and 27, the open/close handle 155 is slid with respect to the open/close operating part main body 153 a predetermined distance toward the hand-held side. At this time, the bending opening/closing wire 244 is thus retracted with respect to the sheath front end part 203A toward the hand-held side, and the open/close operating part 243 is retracted. Accompanying this, the linking part 236 receives a rotational torque directed away from the central axis of the first sheath 203, and, as a result, the other end 236 b of the linking part 236 is rotated by a specific angle in the direction away from the central axis C1 of the first sheath 203, with the one end 236 a of the linking part 236 serving as the rotational center. As shown in FIGS. 23 through 25, the support 237 rotates with respect to the first sheath 203, and the first arm member 208A and the second arm member 208B open. In this state, the position of the open/close handle 155 is fixed in place by the rack 155 a of the open/close operating part 146, and the position of the bending opening/closing wire 244 is thus fixed in place with respect to the first sheath 203.
In contrast, when closing the first arm member 208A and the second arm member 208B with respect to the front end side of the first sheath 203, the open/close handle 155 is advanced forward with respect to the open/close operating part main body 153, while pressing on the release button 154 c. At this time, the bending opening/closing wire 244 is advanced forward with respect to the front end side of the first sheath 203. Accompanying this, the rotational torque applied on the linking part 236 is released, and the other end 236 b of the linking part 236 is rotated in a direction toward the central axis C1 of the first sheath 203, employing the one end 236 a of the linking part 236 as the rotational center. As a result, the support 237 rotates with respect to the first sheath 203 and the first arm member 208A and the second arm member 208B close, i.e., resumes the starting state.
In the case where the high frequency scalpel 205A projecting out from the front end of the first arm member 208A is to be projected out still further from the front end of the first arm member 208A, this is accomplished by advancing the moving frame 145A of the operating part 151 with respect to the fixed frame 145B. At this time, the entirety of the moving frame 145A moves in the direction that brings it closer to the first arm clamp 152A, and the members positioned in hand-held side from the second tubular member 191 b of the sheath advance/retract part 191 which is supporting the instrument insertion part 125, moves in a direction that brings it closer to the first tubular member 191 a, and the instrument insertion part 125 is advanced inside the first sheath 203. In this case, the first arm member 208A is fixed in place to the first arm clamp 152A, so that only the high frequency scalpel 205A is projected further out from the front end part 215A of the first arm member 208A. Furthermore, since the bending wires 117A, 117B, 117C, and 117D are separated from the instrument insertion part 125 at the first arm clamp 152A, the bending state of the bending part 207 is not altered by the operation to advance the moving frame 145A.
In contrast, when moving the high frequency scalpel 205A toward the hand-held side of the first arm member 208A, the moving frame 145A of the operating part 151 is retracted with respect to the fixed frame 145B. At this time, the members positioned in hand-held side from the second tubular member 191 b of the sheath advance/retract part 191 which is supporting the instrument insertion part 125, is retracted with respect to the first tubular member 191 a. In this way, the high frequency scalpel 205A is again disposed at its starting state position.
The vertical bending operating part 156 is operated in order to bend the first arm member 208A and the second arm member 208B in the vertical direction. In other words, the instrument operating parts 131A and 131B which are attached to the attachment parts 158 are gripped and moved in the vertical direction. In this case, the attachment part 158 moves vertically with the limits of the second movement restricting member 161, while at the same time, the first movement restricting member 160 moves together with the attachment part 158 along the first bending guides 196 in the vertical direction. Here, the first die parts 160 b of the first movement restricting member 160 also move in the vertical direction, so that the first belt member 165 moves accompanying this, and the first gear 168 is rotated in either direction. At this time, the first chain belt 167 is rotated in either direction, and, accompanying this, one of the bending wires 117A and 117B is advanced with respect to the first sheath 203, while the other is retracted. In this way, the joint wheels 216 of the bending part 207 are inclined accompanying the movement of the bending wires 117A and 117B, and bend vertically.
In contrast, the horizontal bending operating part 157 is operated when bending the first arm member 208A and the second arm member 208B in the horizontal direction. In other words, the instrument operating parts 131A and 131B which are attached to the attachment parts 158 are gripped and moved in the horizontal direction. In this case, the attachment part 158 moves horizontally within the limits of the first movement restricting member 160, while at the same time, the second movement restricting member 161 moves together with the attachment part 158 along the paired second bending guides 197 in the horizontal direction. Here, the second die parts 161 b of the second movement restricting member 161 also move in the horizontal direction, so that the second belt member 172 moves accompanying this, and the second gear 175 is rotated in either direction. At this time, the second chain belt 173 is rotated in either direction, and, accompanying this, one of the bending wires 117C and 117D is advanced with respect to the first sheath 203, while the other is retracted. In this way, the joint wheels 216 of the bending part 207 are inclined accompanying the movement of the bending wires 117C and 117D, and bend horizontally.
When rotating the first sheath 203 with respect to the operating part 151, the rotation knob provided to the sheath connector 181 of the rotation operating part 150 is gripped and rotated in the desired direction. As a result, the sheath connector 181 rotates relative to the rotation support 182, causing the first sheath 203 to rotate in the desired direction relative to operating part 151.
In this medical treatment endoscope 200, the first arm member 208A and the second arm member 208B that are inserted into the first sheath 203 can be moved away from the central axis C1 of the first sheath 203 using the open/close mechanism 210, and can be further bent at the bending parts 207 of the first arm member 208A and the second arm member 208B. As a result, it is possible to visually confirm the distal ends of the first arm member 208A and the second arm member 208B when a sufficient visual field has been secured for the image pick-up unit 211. As a result, it is possible to carry out the medical procedure with safety and assurance. In this case, the axial force generated by advancing or retracting the bending opening/closing wires 244 with respect to the first sheath 203 is converted into the opening/closing forces for the first arm member 208A and the second arm member 208B at the linking part 236 of the open/close mechanism 210. This point is equivalent to that of the first embodiment. However, in this embodiment, the opening/closing operation of the first arm member 208A and the second arm member 208B is carried out smoothly with a smaller amount of operating force, so that the arm members can be opened even wider.
Namely, in the medical treatment endoscope 1 according to the first embodiment, the bending opening/closing wire 35 is connected to the other end 36 b of the linking part 36, and the open/close mechanism 10 is operated by advancing and retracting the bending opening/closing wire 35. In this case, as shown in FIG. 8A, the bending opening/closing wire 35 that is connected to the other end 36 b of the linking part 36 on the arm member 8B side has a flexed part 35 a that is flexed at a position that is advanced from the sheath front end part 3A. Furthermore, as shown in FIGS. 14 and 15, a flexed part 35 a is also provided on the arm member 8A side that flexes at the front end of the guide 41A that houses the bending opening/closing wire 35. For this reason, when opening or closing the arm members 8A and 8B, this flexed part 35 a creates sliding resistance, increasing the amount of operating force for bending opening/closing wires 35.
Furthermore, as shown in FIG. 8, the bending opening/closing wire 35 is supported by the flexed part 35 a, and has the construction such that the front end side thereof moves along with the opening/closing operation of the arm members 8A and 8B. It is therefore difficult to open the first arm member 8A and the second arm member 8B to an angle greater than 45° with respect to the central axis C1 of the first sheath 3.
Accordingly, in the medical treatment endoscope 200 according to this embodiment, the construction is employed in which the one end 236 a of the linking part 236 is connected to the open/close operating part 243 at a position that is further to the front end side of the first arm member 208A and the second arm member 208B than the support part 237, and the pantograph structure that is formed by the two linking parts 236 and the two support parts 237 is altered according to the advance or retraction of the open/close operating part 243. As a result, although a relatively larger amount of operational force is required when initiating the opening operation, the amount of operating force required decreases as the linking part 236 and the support 237 are opened. Therefore, operation of the arm member near the lesion site can be carried out smoothly. Furthermore, since the open/close operating part 243 moves together with the slide member 242 that is disposed to the first sheath 203 side, along the direction of advance and retraction of the bending opening/closing wire 244, there is no change in the direction of operation accompanying the opening/closing operation as in the case of the bending opening/closing wire 35 according to the first embodiment, and the amount of movement of the bending opening/closing wire 242 is communicated without change to the linking part 236. As a result, a more efficient opening/closing movement can be carried out. In this embodiment, opening and closing are carried out by communication of the input on the hand-held side to the pantograph of the open/close mechanism 210 via the bending opening/closing wire 244. However, it is a characteristic of wire driving that the force from pushing the wire is less than the force from pulling the wire. For this reason, the present embodiment is constructed so that operation can be carried out by pulling the bending opening/closing wire 244 when opening the arm members 208A and 208B from a closed state, which requires a relatively large force. Conversely, the present embodiment is constructed so as to employ a arrangement in which the power factor of the pantograph is beneficial when closing arm members that are open, so that only a small force need be communicated from the bending opening/closing wire 244.
Furthermore, in this embodiment, openings 203 a are provided at the sheath front end part 203A, enabling the bending parts 207 to be advanced outward via these openings 203 a. By providing this type of construction, the first arm member 208A and the second arm member 208B can open beyond the objective lens 223 at the base end side of the first sheath 203. As a result, the arm members 208A and 208B are less apt to enter into the field of view of the image pick-up unit 211, making it even easier to see the instrument.
Furthermore, in the preceding first embodiment, the more that the first arm member 8A and the second arm member 8B are opened, the smaller the angle becomes at flexed part 35 a of the bending opening/closing wire 35 and the greater the force required for operation becomes. Moreover, a large force is also required to hold the arms in the open state. In particular, when force is continuously applied to hold the arms in the open state, there is a chance that the member near the flexed part 35 a or the linking part 36 could break. In contrast, in this embodiment, the force required for operation when the first arm member 208A and the second arm member 208B are in the open state is small, and the force for holding the arms in the open state is little. Furthermore, when a plate-shaped member is employed for the linking part 236, the rigidity is increased. For this reason, it is possible to avoid the application of force on the open/close mechanism 210 when the first arm member 208A and the second arm member 208B are in the open state, so that damage to the linking part 236, etc. is unlikely to occur, and reliability can be improved.
In addition, the first belt member 65 and the second belt member 72 are connected to the one end 60 a of the first movement restricting member 60 and the one end 61 a of the second movement restricting member 61, respectively. For this reason, the force for moving the first belt member 65 and the second belt member 72 becomes focused at the end part of the first movement restricting member 60 and the second movement restricting member 61. A moment is generated as a result, leading to resistance in the movement. As a result, there is an undesirable increase in the force required for operation.
Accordingly, in this embodiment, the construction is provided in which the first movement restricting member 160 and the second movement restricting member 161 are composed of the slide rails 160 a and 161 a, respectively, and the slide blocks 158A and 158B of the attachment part 158 engage with these respective slide rails 160 a and 161 a to permit sliding. According to this construction, when there is an operational input to the instrument operating part 131A, the attachment part 158 can be smoothly displaced with a light amount of operating force, without inclining resulted from the employment of the attachment part 58 as a fulcrum. Furthermore, the first belt member 165 is connected to the first die parts 160 b that are provided at the longitudinal center of the slide rails 160 a. The first movement restricting member 160 is disposed on the frame member 170 via the first bending guide 196, which has the slide rail 196 a and the slide block 196 b that engages with the slide rail 196 a in a manner to enable sliding. According to this construction, it is possible to reduce generation of a moment during the communication of the operational input from the first movement restricting member 160 to the first belt member 165 regardless of the position of the attachment part 158 on the first movement restricting member 160. This also applies to the connection between the second movement restricting member 161 and the second belt member 172. As a result, it becomes possible to realize an even greater reduction in the amount of operating force required.
Furthermore, by sliding the moving frame 145A with respect to the fixed frame 145B via the slide mechanisms 148 and 190, the instrument insertion part 125, which is inserted into the first arm member 208A, is made to advance and retract with respect to the first arm member 208A and the first sheath 203. As a result, the high frequency scalpel 205A or other such instrument can be made to project out or retract back from the front end part 215A of the first arm member 208A. Accordingly, it is possible to expand the procedure limits for the instrument for the first arm member 208A and the first sheath 203. Furthermore, the construction is provided in which the advance and retraction of the instrument is carried out by varying the length of the instrument insertion part 125 with respect to the first arm member 208A, enabling the advance and retraction of the instrument to be carried out smoothly. This type of construction provides the benefit of enabling the advance/retract mechanism for the instrument to be provided at an optional position. Furthermore, in the operating part 151 in this embodiment, the sheath advance/retract part 191 is provided to the perpendicular part that extends from the first sheath 203 to the bending operating part 147, which is essential basically. As a result, this construction succeeds in shortening the overall length of the operating part 151 while at the same time providing an instrument advance/retract mechanism. Moreover, since the sheath advance/retract part 191 is provided farther toward the first sheath 203 side than the part bending the instrument insertion part 125, the resistance between the instrument sheath 192 and the instrument insertion part 125 which is generated at the bended part of the instrument insertion part 125 is not received during operations to advance and retract the instrument. As a result, the operation of advancing and retracting the instrument can be accomplished with light force.
Moreover, the first tubular member 191 a and the second tubular member 191 b that are disposed in a nesting manner are relatively long, so that it is possible to greatly adjust the length of the instrument insertion part 125. As a result, in addition to being able to increase the advance/retract width of the instrument, the sheath advance/retract part 191 can also be used to absorb differences in the length of the instrument insertion part 125 when exchanging instruments.
Furthermore, the sheath operating part 194 which is provided with a bending knob 195 for operating the bending part 203B can be freely attached to and released from the stand part 194A that is attached to the gear box 157 a of the fixed frame 145B. According to this construction, when inserting the inserted part of the medical treatment endoscope 200 into a body cavity, the sheath operating part 194 can be operated after being detached from the stand part 194A, thereby improving operability during insertion. The sheath operating part 194 is constructed to attach to the stand part 194A when performing a treatment, to enable fine adjustment of the bending angle of the bending part 203B by rotational operation of the bending knob 195.
In this embodiment as well, the open/close mechanism 210 can be operated by operating the open/close operating part 146 of the operating part 151 to advance and retract the bending opening/closing wires 244 with respect to the first sheath 203. Furthermore, by performing operations in the state of the instrument operating part 131B of the gripping forceps 205B attached to the bending operating part 147, not only can open/close operation of the paired forceps pieces 226A and 226B of the gripping forceps 205B be performed, but it is also possible to carry out bending operation of the bending part 207. Thus, the procedure is facilitated. Moreover, by rotating the instrument operating part 131A with respect to the attachment part 158, the instrument can be rotated to the desired state. Moreover, since the bending part 207 is employed only for bending an instrument such as gripping forceps 205B, greater bending is possible, and larger force can be output, as compared to conventional endoscopes in which there is a structure that is required to bend a plurality of apparatuses such as instruments, video cable (the image guide in an optical endoscope), light guides and the like.
arm members configured to be capable of advancing from and retracting into the sheath, and having a bending part that projects out from a front end of the sheath and performs bending actions;
a wire member configured to bend the bending part;
an open/close mechanism which directs the arm members from a direction along a central axis of the sheath to a rotational direction deviated from the central axis of the sheath around a base axis of the arm members, and from the rotational direction deviated from the central axis of the sheath around the base axis of the arm members to a direction along the central axis of the sheath;
a viewing device and an illuminating member that are disposed to a front end side of the sheath;
an open/close operating member, configured to open the arm members by moving in a proximal end direction of the sheath, the open/close operating member at least partially protrudes from an opening of a distal end of the sheath and inserted in a freely advancing and retracting manner into the sheath;
linking parts, connected to the open/close operating member at a first end thereof and connected to a proximal position of the arm members at a second end thereof, and configured to be capable of turning according to the open/close operating member which advances and retracts for converting an advance/retract action of the arm members into an open/close action around the base axis of the arm members of the open/close mechanism; and
supporting members connected to the linking parts at a first end of the supporting members to be rotatable and connected to the sheath to freely advance and retract so as to support the arm members;
wherein the arm members comprise two arm members that are arranged in a radial direction of the sheath, and at least one part of the open/close operating member is disposed at a position in an area between central axes of the two arm members in a cross-section along the central axis of the sheath.
2. The medical treatment endoscope according to claim 1, wherein front ends of the two arm members are capable of relative displacement with respect to the viewing device and the illuminating member by means of at least one of a bending action of the bending part and a directional transition of the two arm members by the open/close mechanism.
3. The medical treatment endoscope according to claim 2, further comprising;
4. The medical treatment endoscope according to claim 1, wherein in the cross-section along the central axis of the sheath, the open/close operating member is disposed closer to the central axis of the sheath than a position at which the two arm members are disposed.
5. The medical treatment endoscope according to claim 1, wherein a connecting part for the linking part and the two arm members are provided so as to be positioned between a connecting part for the open/close operating member and the linking part, and the front end of the sheath, while in a state that the linking part is caused the two arm members to approach the central axis of the sheath, as a result of movement of the front end of the open/close operating member in the first direction to approach the central axis of the sheath.
6. The medical treatment endoscope according to claim 5, wherein the open/close operating member is disposed to an area opposite the viewing device, between the two arm members.
7. The medical treatment endoscope according to claim 1, wherein the viewing device is disposed to the distal end of the sheath, and the open/close mechanism opens and closes the two arm members at a more distal position than a position at which the viewing device is disposed.
8. The medical treatment endoscope according to claim 1, wherein a distal end of the open/close operating member which is connected to a front end of the linking parts is disposed at a more distal position of the arm members than that of the second end of the linking parts which is connected to the supporting members such that a pantograph framework is formed by the linking parts and the supporting members.
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Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MIYAMOTO, MANABU;KOGASAKA, TAKAHIRO;DEJIMA, TAKUMI;AND OTHERS;REEL/FRAME:018249/0373