JPH08322787A - Medical treatment apparatus - Google Patents
Medical treatment apparatusInfo
- Publication number
- JPH08322787A JPH08322787A JP7130566A JP13056695A JPH08322787A JP H08322787 A JPH08322787 A JP H08322787A JP 7130566 A JP7130566 A JP 7130566A JP 13056695 A JP13056695 A JP 13056695A JP H08322787 A JPH08322787 A JP H08322787A
- Authority
- JP
- Japan
- Prior art keywords
- endoscope
- hood
- treatment
- body cavity
- medical treatment
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Landscapes
- Surgical Instruments (AREA)
- Endoscopes (AREA)
Abstract
Description
【０００１】[0001]
【産業上の利用分野】本発明は、内視鏡と、この内視鏡
に付随し、その内視鏡の観察下で使用される処置具とを
備えた医療用処置装置に関する。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment apparatus equipped with an endoscope and a treatment tool attached to the endoscope and used under observation of the endoscope.
【０００２】[0002]
【従来の技術】内視鏡を通じて処置具を体腔内に挿入
し、内視鏡による観察下で、その処置具を操作すること
により体腔内での様々な処置が行われているが、最近で
は一般的な注射や生検の他に、特に切開や縫合、或いは
遺伝子治療等を行うことも提案されている。また、この
ような手技において用いる内視鏡や処置具の動作を各々
コンピュータ制御により操作する、いわゆる医療用マニ
ピュレータ装置（特開平５−３３７１１７号公報）も提
案されている。2. Description of the Related Art Various treatments are performed in a body cavity by inserting the treatment tool into the body cavity through an endoscope and operating the treatment tool under observation with the endoscope. In addition to general injection and biopsy, incision, suture, gene therapy and the like have also been proposed. There is also proposed a so-called medical manipulator device (Japanese Patent Laid-Open No. 5-337117) in which operations of an endoscope and a treatment tool used in such a procedure are controlled by a computer.
【０００３】[0003]
【発明が解決しようとする課題】しかしながら、体腔内
での術部であるところの生体組織は一般には非常に軟ら
かいものであるため、医療用マニピュレータ装置で、そ
の術部に対して微細な処置を行おうとしても、処置具等
を術部に接触させると、その術部の生体組織部分が容易
に変形を起してしまい、操作性が悪いものであった。特
に、観察視野を拡大して微細な処置を行う上ではその動
きが拡大して見えるために操作が著しく難しい。また、
変形した術部が観察視野外に出てしまうことが多く起き
る。もちろん、術部の生体組織が変形を起しやすいこと
から細胞単位での精度の高い処置や位置決めができない
などの問題があった。However, since the living tissue, which is the surgical site in the body cavity, is generally very soft, it is necessary for the medical manipulator device to perform fine treatment on the surgical site. Even if an attempt is made, when a treatment tool or the like is brought into contact with the surgical site, the living tissue portion of the surgical site is easily deformed, resulting in poor operability. In particular, when performing a fine treatment by enlarging the observation field of view, the operation is remarkably enlarged and the operation is extremely difficult. Also,
The deformed surgical site often goes out of the field of view. As a matter of course, since the living tissue of the surgical site is likely to be deformed, there is a problem that it is not possible to perform highly accurate treatment or positioning in cell units.
【０００４】本発明は前記課題に着目してなされたもの
で、その目的とするところはマイクロサージェリなどの
微細な処置を行う場合にも操作性がよく、高精度の位置
決めと処置が可能な医療用処置装置を提供することにあ
る。The present invention has been made in view of the above-mentioned problems, and its object is to have good operability even when performing fine treatment such as microsurgery, and enable highly accurate positioning and treatment. To provide a medical treatment device.
【０００５】[0005]
【課題を解決するための手段】本発明は内視鏡と、この
内視鏡に付随し、その内視鏡の観察下で使用される、少
なくとも１つの処置具とを備えた医療用処置装置におい
て、体腔内の生体組織の表面に向ける開口部を有し、少
なくとも体腔内に位置した前記内視鏡と前記処置具の一
部分を覆うフードと、このフード内の圧力を調節する圧
力調整手段とを具備したことを特徴とする医療用処置装
置である。DISCLOSURE OF THE INVENTION The present invention provides a medical treatment apparatus including an endoscope and at least one treatment tool which is attached to the endoscope and is used under the observation of the endoscope. In, a hood having an opening directed to the surface of the living tissue in the body cavity and covering at least a portion of the endoscope and the treatment tool located in the body cavity, and a pressure adjusting means for adjusting the pressure in the hood. A medical treatment apparatus comprising:
【０００６】[0006]
【作用】前記フードを術部に近接または接触させた上
で、吸引・送気手段によってフード内の圧力を下げる。
フードは術部を吸引固定する。術部がフードに固定され
た状態で処置を行う。術部をフードに固定した状態にあ
るため、その術部の生体組織が処置具から逃げたり、大
きく変形したりすることがない。このため、処置具によ
る操作が精度良く確実に行うことができる。処置の終了
時には再び吸引・送気手段によってフード内の圧力をフ
ードの外部と同等以上にしてフードと術部との密着を解
除する。Operation: The hood is brought close to or in contact with the surgical site, and then the pressure in the hood is lowered by the suction / air supply means.
The hood fixes the surgical site by suction. Treatment is performed with the surgical site fixed to the hood. Since the surgical site is fixed to the hood, the living tissue of the surgical site does not escape from the treatment tool or is significantly deformed. Therefore, the operation with the treatment tool can be performed accurately and surely. At the end of the procedure, the suction / air supply means is used again to make the pressure in the hood equal to or higher than the pressure outside the hood to release the close contact between the hood and the surgical site.
【０００７】[0007]
＜第１の実施例＞ 図１を参照して、本発明の第１の実施例を説明する。 （構成）この第１の実施例に係る医療用マニピュレータ
１を図１に示す。これは手術器械２とこれを支持する移
動用マニピュレータ３を備え、手術器械２は移動用マニ
ピュレータ３のアーム先端に対して着脱自在に搭載され
る。ここでの手術器械２は立体内視鏡５と、この立体内
視鏡５に沿って左右に隣接される、処置具手段として一
対の把持鉗子７，８を備える。各把持鉗子７，８は各々
複数方向、例えば上下左右に湾曲可能なアーム６をそれ
ぞれ持つ。<First Embodiment> A first embodiment of the present invention will be described with reference to FIG. (Structure) FIG. 1 shows a medical manipulator 1 according to the first embodiment. This comprises a surgical instrument 2 and a manipulator 3 for moving which supports the surgical instrument 2, and the surgical instrument 2 is detachably mounted on the arm tip of the manipulator 3 for moving. The surgical instrument 2 here is provided with a stereoscopic endoscope 5 and a pair of grasping forceps 7, 8 as treatment tool means, which are adjacent to each other along the stereoscopic endoscope 5 on the left and right. Each of the grasping forceps 7 and 8 has an arm 6 that can be bent in a plurality of directions, for example, vertically and horizontally.
【０００８】前記内視鏡５は挿入部１０の先端部分に、
上下左右に湾曲する湾曲機構（湾曲部）１１を有する。
共通のシース１２の挿通孔１３内には内視鏡５の挿入部
１０と一対の把持鉗子７，８が同じ向きに挿通され、把
持鉗子７，８は挿入部１０の左右両側に隣接して個別的
に配置されている。把持鉗子７，８のアーム部の先端に
は処置作業を行うための例えばグリッパ１４，１５が設
けられている。立体内視鏡５と把持鉗子７，８は手術器
械２の後端部に設けた駆動部１６によって操作される。
把持鉗子７，８は内視鏡５の視野内で自在に動かすこと
ができる。The endoscope 5 has a distal end portion of the insertion portion 10,
It has a bending mechanism (bending portion) 11 that bends vertically and horizontally.
The insertion portion 10 of the endoscope 5 and the pair of grasping forceps 7 and 8 are inserted in the same direction into the insertion hole 13 of the common sheath 12, and the grasping forceps 7 and 8 are adjacent to both left and right sides of the insertion portion 10. Individually placed. For example, grippers 14 and 15 for performing a treatment operation are provided at the tips of the arm portions of the grasping forceps 7 and 8. The stereoscopic endoscope 5 and the grasping forceps 7, 8 are operated by a drive unit 16 provided at the rear end of the surgical instrument 2.
The grasping forceps 7 and 8 can be freely moved within the field of view of the endoscope 5.
【０００９】前記シース１２の先端には同軸的にフード
１７が設けられている。フード１７は例えば透明な筒状
部材からなり、これの外径はシース１２の外径に等し
く、それらの外周面が面一に形成されている。フード１
７はシース１２の先端周縁に対して気密的に接続され
る。フード１７の先端は開口部１８を形成している。そ
して、前記内視鏡５の挿入部１０と一対の把持鉗子７，
８は全てこのフード１７の中で動く。シース１２の先端
壁面にはフード１７の間の境界に位置して送気・吸引孔
１９が設けられている。この送気・吸引孔１９は後方に
設置された圧力調整手段、例えば送気・吸引手段２０に
通じており、送気・吸引孔１９を通じて送気・吸引を行
うことによってフード１７の内部の圧力がコントロール
されるようになっている。A hood 17 is coaxially provided at the tip of the sheath 12. The hood 17 is made of, for example, a transparent tubular member, the outer diameter of which is equal to the outer diameter of the sheath 12, and the outer peripheral surfaces of which are flush with each other. Hood 1
7 is hermetically connected to the peripheral edge of the distal end of the sheath 12. An opening 18 is formed at the tip of the hood 17. Then, the insertion portion 10 of the endoscope 5 and the pair of grasping forceps 7,
All 8 move in this hood 17. An air supply / suction hole 19 is provided on the front wall surface of the sheath 12 at the boundary between the hoods 17. The air supply / suction hole 19 communicates with a pressure adjusting means installed in the rear, for example, the air supply / suction means 20, and by performing air supply / suction through the air supply / suction hole 19, the pressure inside the hood 17 is increased. Is controlled.
【００１０】前記立体内視鏡５の最先端の面部には左右
一対の照明窓２１と左右一対の観察窓２２が設けられて
いて、この照明窓２１から体腔ｃ内に照明光を照射す
る。そして、視野内を左右一対の観察窓２２を通じてフ
ード１７内、及びそのフード１７の開口部１８の外、さ
らにはフード１７の透明な壁部を通してその外部を観察
することができようになっている。各観察窓２２の内側
にはＣＣＤ等の固体撮像素子がそれぞれ設置されてお
り、各固体撮像素子は図示しないカメラコントロール回
路によって駆動制御され、各観察窓２２を通じて得られ
るそれぞれの視野像を撮像する。ＣＣＤからの画像信号
は画像処理装置２３に送られ、表示手段２４にて立体的
に観察する。表示手段２４としては図示しない例えばモ
ニターやＨＭＤ（ヘッドマウントディスプレイ）或いは
ＦＭＤ（フェイスマウントディスプレイ）等による。画
像処理装置２３には通信手段２５が接続されている。通
信手段２５によって画像処理装置２３で構成した内視鏡
像や病理診断像等を遠隔地にある別の病院や医師宅等へ
送信し、診断の補助を依頼することができる。A pair of left and right illuminating windows 21 and a pair of left and right observing windows 22 are provided on the frontmost surface of the stereoscopic endoscope 5, and illuminating light is emitted from the illuminating windows 21 into the body cavity c. The inside of the field of view can be observed through the pair of left and right observation windows 22, the outside of the opening 18 of the hood 17, and the outside through the transparent wall of the hood 17. . A solid-state image pickup device such as a CCD is installed inside each observation window 22, and each solid-state image pickup device is driven and controlled by a camera control circuit (not shown) to pick up each visual field image obtained through each observation window 22. . The image signal from the CCD is sent to the image processing device 23 and is stereoscopically observed by the display means 24. The display means 24 is, for example, a monitor, an HMD (head mount display), an FMD (face mount display), or the like (not shown). A communication unit 25 is connected to the image processing device 23. The communication unit 25 can send an endoscopic image, a pathological diagnosis image, or the like configured by the image processing device 23 to another hospital or doctor's house in a remote place to request diagnosis assistance.
【００１１】一方、前記移動用マニピュレータ３はベッ
ドサイドに設置される支持機構であり、直動および回転
の自由度を有する複数の軸を備えた多関節アーム構造で
構成されている。これは基部３０、水平旋回方向Ａ１と
垂直移動方向Ａ２に動作する第１の動作軸３１と、この
第１の動作軸３１に対して水平方向Ａ３に移動しかつ自
軸周りの旋回方向Ａ４に回転可能な第２の動作軸３２と
を備え、さらに第２の動作軸３２の先端にはその軸方向
に直交した旋回方向Ａ５とその旋回方向Ａ５の軸に直交
する軸まわりの旋回方向Ａ６とにそれぞれ回転可能ない
わゆる手首機能を有する器具装着部材３３が取り付けら
れている。この器具装着部材３３に対して前記手術器械
２が支持されるようになっている。手術器械２のユニッ
トはその器具装着部材３３に対して着脱可能に取り付け
られる。On the other hand, the moving manipulator 3 is a support mechanism installed at the bedside, and has a multi-joint arm structure having a plurality of axes having degrees of freedom of linear movement and rotation. This is a base 30, a first operating shaft 31 that operates in a horizontal turning direction A1 and a vertical moving direction A2, and a horizontal moving direction A3 relative to the first operating shaft 31 and a turning direction A4 around its own axis. A rotatable second operation shaft 32 is provided, and a tip end of the second operation shaft 32 has a turning direction A5 orthogonal to the axial direction and a turning direction A6 around an axis orthogonal to the turning direction A5. An instrument mounting member 33 having a so-called wrist function, which is rotatable, is attached to each. The surgical instrument 2 is supported by the instrument mounting member 33. The unit of the surgical instrument 2 is detachably attached to the instrument attachment member 33.
【００１２】移動用マニピュレータ３、内視鏡５及び把
持鉗子７，８の動作は動作入力手段３４からの信号を制
御手段３５が受けてコントロールされる。動作入力手段
３４としては前記マニピュレータをスレーブマニピュレ
ータとしてこれを遠隔操作するマスターマニピュレータ
が望ましいが、この他にジョイスティックやキーボード
入力などによってもよい。マスターマニピュレータの一
例として、内視鏡５の向きを操作するために前記ＨＭＤ
に接続されたＨＭＤ用アームと、前記把持鉗子７，８の
動きを個々に操作するための一対の処置手段操作用アー
ムとによって構成するものが考えられる。そして、前記
ＨＭＤ用アームと処置手段操作用アームの動きを検知
し、この動作入力手段３４からの情報によって移動用マ
ニピュレータ３、内視鏡５及び把持鉗子７，８を操作す
る。 （作用）図示しない術者は動作入力手段３４を用いて、
移動用マニピュレータ３を動かし、患者体壁ａにあけら
れた穿刺孔ｂを通して手術器械２のシース１２を体腔ｃ
の内部に差し込む。体腔ｃ内の画像は内視鏡５を通して
表示手段２４にて観察することができる。術者はその画
像を観察しながら動作入力手段３４を操作してフード１
７の開口部１８の中心に患部ｄを位置させるようにシー
ス１２を誘導し、そのフード１７の開口部１８の周縁を
体腔内壁ｅに近づけ、あるいは軽く接するように位置決
めする。The operation of the manipulator 3 for movement, the endoscope 5 and the grasping forceps 7, 8 is controlled by the control means 35 receiving a signal from the operation input means 34. The operation input means 34 is preferably a master manipulator that remotely operates the manipulator as a slave manipulator, but it may be a joystick or keyboard input. As an example of the master manipulator, the HMD for operating the orientation of the endoscope 5 is used.
It is conceivable that the HMD arm is connected to the HMD and a pair of treatment means operating arms for individually operating the movements of the grasping forceps 7 and 8. Then, the movements of the HMD arm and the treatment means operating arm are detected, and the moving manipulator 3, the endoscope 5 and the grasping forceps 7, 8 are operated according to the information from the operation input means 34. (Operation) An operator (not shown) uses the motion input means 34 to
By moving the manipulator 3 for movement, the sheath 12 of the surgical instrument 2 is inserted into the body cavity c through the puncture hole b formed in the body wall a of the patient.
Plug inside. The image in the body cavity c can be observed by the display means 24 through the endoscope 5. The operator operates the motion input means 34 while observing the image to operate the hood 1
The sheath 12 is guided so that the diseased part d is located at the center of the opening 18 of the No. 7, and the peripheral edge of the opening 18 of the hood 17 is brought close to the inner wall e of the body cavity or is positioned so as to be lightly contacted.
【００１３】次に、送気・吸引手段２０を操作して作動
させ、フード１７の内部を減圧する。これにより吸引
し、患部ｄの周辺組織にフード１７の開口部１８の周縁
が密着し、両者が固定する。Next, the air supply / suction means 20 is operated and activated to depressurize the inside of the hood 17. As a result, the suction is performed, and the peripheral edge of the opening 18 of the hood 17 comes into close contact with the peripheral tissue of the affected area d, and both are fixed.
【００１４】しかる後、再び動作入力手段３４を操作し
て内視鏡５、把持鉗子７，８を操作し、患部ｄに対する
手術や処置を行う。図１では縫合針３７を用いて縫合す
る状況を示している。Thereafter, the operation input means 34 is operated again to operate the endoscope 5 and the grasping forceps 7 and 8 to perform surgery or treatment on the affected area d. FIG. 1 shows a situation in which the suture needle 37 is used for suturing.
【００１５】また、必要に応じて、通信手段２５によっ
て画像処理装置２３で構成した内視鏡像や病理診断像等
を遠隔地にある別の病院や医師宅等へ送信し、診断の補
助を依頼することができる。これにより診断の正確度を
向上させることができる。 （効果）患部ｄを処置する際、その患部ｄのある周辺組
織部分がフード１７の開口周縁に吸着されることによっ
てその処置対象部位をフード１７側、つまり、内視鏡５
や把持鉗子７，８のある手術器具２側にいわば一体的に
位置を固定するため、その処置作業時に患部ｄが変形し
て処置具から逃げたり、術部が視野外に出てしまったり
することが防げる。このため、その処置作業の操作性が
極めてよい。特に微細な処置を行う場合、観察視野を拡
大して微細な処置を行う上でも、より安全に高精度の処
置を行うことができる。 ＜変形例＞まず、図２（ａ）は前述した第１の実施例に
おいての一方の把持鉗子７をはさみ鉗子３８に置き換え
たものである。これによれば、一方の把持鉗子８で患部
ｄを押さえた上で、他方のはさみ鉗子３８にて切開を加
えることができる。前述した第１の実施例の効果に加
え、一方の把持鉗子８で患部ｄを押さえるため、より一
層、患部ｄの固定が確実となり、処理しやすくなる。If necessary, the communication means 25 sends the endoscopic image and the pathological diagnostic image formed by the image processing device 23 to another hospital or doctor's house in a remote place to request diagnosis assistance. can do. This can improve the accuracy of the diagnosis. (Effect) When treating the affected area d, the peripheral tissue portion having the affected area d is adsorbed to the opening peripheral edge of the hood 17, so that the treatment target portion is located on the hood 17 side, that is, the endoscope 5.
Since the position is integrally fixed on the side of the surgical instrument 2 having the gripping forceps 7 and 8, the affected part d is deformed and escapes from the treatment tool during the treatment work, or the surgical site goes out of the visual field. Can be prevented. Therefore, the operability of the treatment work is extremely good. In particular, when performing a fine treatment, it is possible to perform a safe and highly accurate treatment even when performing a fine treatment by enlarging the observation field of view. <Modification> First, FIG. 2 (a) replaces one of the grasping forceps 7 with the scissors forceps 38 in the first embodiment described above. According to this, it is possible to press the affected area d with one grasping forceps 8 and then make an incision with the other scissors forceps 38. In addition to the effect of the first embodiment described above, since the affected part d is held down by one of the grasping forceps 8, the affected part d can be more reliably fixed and can be easily processed.
【００１６】図２（ｂ）は前述した第１の実施例におい
ての一方の把持鉗子７を遺伝子注入処置具３９に置きか
えたものである。遺伝子注入処置具３９は注入物を装填
して生体組織に穿刺する注入針４０を備えてなり、生体
組織に注入針４０を穿刺した状態で何らかの手段でその
注入物を注出する。例えば注入針４０に連通した注入物
収納用リザーバとそのリザーバを伸縮操作する操作手段
を具備するものが考えられる。操作手段は手動でも自動
でもよい。フード１７による吸引と把持鉗子８によって
患部ｄを固定し、その上で遺伝子注入処置具３９を使用
するため、患部ｄの特定の腫瘍細胞に確実かつ正確に遺
伝子を注入することができる。FIG. 2B is a diagram in which one of the grasping forceps 7 in the above-described first embodiment is replaced with the gene injection treatment tool 39. The gene injection treatment tool 39 is provided with an injection needle 40 that is loaded with an injectable substance and punctures a living tissue, and injects the injectable substance by some means in a state where the injecting needle 40 is punctured in the biological tissue. For example, it is conceivable to provide a reservoir for accommodating an injectate that communicates with the injection needle 40 and an operation means for expanding and contracting the reservoir. The operation means may be manual or automatic. Since the affected area d is fixed by suction with the hood 17 and the grasping forceps 8 and the gene injection treatment tool 39 is used on the fixed area, the gene can be reliably and accurately injected into the specific tumor cells of the affected area d.
【００１７】また、前述した第１の実施例においての一
対の把持鉗子７，８がそれぞれモノポーラ止血手段を有
するものとしてもよい。これによれば、処置した際の出
血時にモノポーラ電気凝固によって止血を行うことがで
きる。Further, the pair of grasping forceps 7 and 8 in the above-mentioned first embodiment may each have a monopolar hemostatic means. According to this, hemostasis can be performed by monopolar electrocoagulation at the time of bleeding during treatment.
【００１８】また、前述した第１の実施例においての一
対の把持鉗子７，８が一対のバイポーラ止血手段を有す
るものとしてもよい。これによれば、処置した際の出血
時にバイポーラ電気凝固によって止血を行うことができ
る。 ＜第２の実施例＞図３及び図４を参照して、本発明の第
２の実施例を説明する。 （構成）この第２の実施例は前述した第１の実施例にお
ける医療用マニピュレータ１とその基本的な構成を同じ
くするが、以下の構成で相違するものである。すなわ
ち、内視鏡５は挿入部１０の先端部分にはその左右両側
に個別的に隣接して生体検査用生体鉗子４１と把持鉗子
４２とが個別的に配置されている。生体鉗子４１と把持
鉗子４２とは複数方向、例えば上下左右に湾曲可能なア
ーム４３を有し、このアーム４３の先端に鉗子部を設け
てある。Further, the pair of grasping forceps 7, 8 in the above-mentioned first embodiment may have a pair of bipolar hemostatic means. According to this, hemostasis can be performed by bipolar electrocoagulation at the time of bleeding during treatment. <Second Embodiment> A second embodiment of the present invention will be described with reference to FIGS. (Structure) This second embodiment has the same basic structure as the medical manipulator 1 in the first embodiment described above, but is different in the following structure. That is, in the endoscope 5, the biopsy forceps 41 and the grasping forceps 42 are individually arranged adjacent to the left and right sides of the distal end portion of the insertion section 10 individually. The biological forceps 41 and the grasping forceps 42 have an arm 43 that can be bent in a plurality of directions, for example, vertically and horizontally, and a forceps portion is provided at the tip of this arm 43.
【００１９】図３で示すように、内視鏡５の挿入部１０
の下面部には病理診断手段４４が配設されている。そし
て、この内視鏡５の挿入部１０と生体鉗子４１と把持鉗
子４２、及び病理診断手段４４は前述した共通のシース
１２の挿通孔１３の内部に挿通されて同じ向きに配置さ
れる。As shown in FIG. 3, the insertion portion 10 of the endoscope 5 is
A pathological diagnosis means 44 is disposed on the lower surface of the. Then, the insertion section 10, the living body forceps 41, the grasping forceps 42, and the pathological diagnosis means 44 of the endoscope 5 are inserted into the insertion hole 13 of the common sheath 12 described above and arranged in the same direction.
【００２０】前記病理診断手段４４は筒部４５に組み込
まれている。つまり、筒部４５の先端にはサンプル４６
を取り込むための取入れ口４７が形成され、この取入れ
口４７の内側にはスライス手段４８が設けられている。
スライス手段４８の後段にはそのスライスされたサンプ
ル４６を染色する染色手段４９とそのサンプル４６を載
せる透明なプレート５０が設けられている。プレート５
０上のサンプル４６はプレート５０を通して拡大観察手
段５１によって拡大観察される。この観察像は第２のＣ
ＣＤ５２によって信号化され、前記画像処理装置２３を
経て前記表示手段２４上で見ることができる。ここでの
表示手段２４はその画面上を２分割し、内視鏡像と病理
診断像を同時に出力表示しても良い。これら病理診断手
段４４の動作は図示しない病理診断コントロールユニッ
トによってコントロールされる。 （作用）この実施例の場合も前記第１の実施例の場合と
同様、術者は動作入力手段３４を用いて、移動用マニピ
ュレータ３を動かし、患者体壁ａにあけられた穿刺孔ｂ
を通して手術器械２のシース１２を体腔ｃの内部に差し
込む。体腔ｃ内の画像は内視鏡５を通して表示手段２４
にて観察することができる。術者はその画像を観察しな
がら動作入力手段３４を操作してシース１２の開口部１
８の中心に患部ｄを位置させるように誘導し、その開口
部１８の周縁を体腔内壁ｅに近づけ、あるいは軽く接す
るように位置決めする。The pathological diagnosis means 44 is incorporated in the tubular portion 45. That is, the sample 46 is attached to the tip of the tubular portion 45.
An intake 47 for taking in is formed, and a slicing means 48 is provided inside the intake 47.
After the slicing means 48, a dyeing means 49 for dyeing the sliced sample 46 and a transparent plate 50 on which the sample 46 is placed are provided. Plate 5
The sample 46 on 0 is magnified and observed by the magnifying and observing means 51 through the plate 50. This observation image is the second C
It is signalized by the CD 52 and can be viewed on the display means 24 via the image processing device 23. The display means 24 here may divide the screen into two and output and display the endoscopic image and the pathological diagnosis image at the same time. The operation of these pathological diagnosis means 44 is controlled by a pathological diagnosis control unit (not shown). (Operation) Also in this embodiment, as in the case of the first embodiment, the operator uses the motion input means 34 to move the manipulator 3 for movement, and the puncture hole b opened in the patient's body wall a.
The sheath 12 of the surgical instrument 2 is inserted through the inside of the body cavity c. The image in the body cavity c is displayed on the display unit 24 through the endoscope 5.
Can be observed at. The operator operates the operation input means 34 while observing the image to open the opening 1 of the sheath 12.
The affected part d is guided to the center of 8, and the peripheral edge of the opening 18 is positioned so as to come close to or lightly contact the inner wall e of the body cavity.
【００２１】次に、送気・吸引手段２０を操作して作動
させ、フード１７の内部を減圧する。これにより吸引
し、患部ｄの周辺組織にフード１２の開口部１８の周縁
を吸引密着させて固定する。Next, the air supply / suction means 20 is operated and activated to depressurize the inside of the hood 17. As a result, the suction is performed, and the peripheral edge of the opening 18 of the hood 12 is suction-adhered and fixed to the tissue around the affected area d.
【００２２】しかる後、図４（ａ）で示すように把持鉗
子４２によって患部ｄを保持しながら生体鉗子４１によ
って患部ｄの生体組織を採取する。採取されたサンプル
４６は生体鉗子４１によって図４（ｂ）で示すように病
理診断手段４４の取入れ口４７に誘導し、病理診断手段
４４内に取り込む。病理診断手段４４に取り込まれたサ
ンプル４６はスライス手段４８によってスライスされ、
染色手段４９で染色された後にプレート５０上に載せら
れる。プレート５０上のサンプル４６はプレート５０を
通して拡大観察手段５１によって拡大観察され、この観
察像は第２のＣＣＤ５２によって信号化され、前記画像
処理装置２３を経て前記表示手段２４上で表示される。
術者はそれを観察し、サンプル４６の病理診断を行う。Thereafter, as shown in FIG. 4A, the living tissue of the affected area d is collected by the living body forceps 41 while holding the affected area d by the grasping forceps 42. The collected sample 46 is guided to the intake port 47 of the pathological diagnosis means 44 by the biological forceps 41 and taken into the pathological diagnosis means 44, as shown in FIG. 4B. The sample 46 taken into the pathological diagnosis means 44 is sliced by the slicing means 48,
After being stained by the staining means 49, it is placed on the plate 50. The sample 46 on the plate 50 is magnified and observed by the magnifying and observing means 51 through the plate 50, the observed image is converted into a signal by the second CCD 52, and is displayed on the display means 24 via the image processing device 23.
The operator observes it and makes a pathological diagnosis of the sample 46.
【００２３】また、必要に応じて、画像処理装置２３に
接続された通信手段２５を通じて画像処理装置２３で構
成した内視鏡像の他に、サンプル４６の病理診断像を遠
隔地に送信する。 （効果）これによれば、内視鏡観察下での処置・手術中
にリアルタイムで病理診断ができるために、処置・手術
の時間を短縮することができ、患者の苦痛低減と術者の
疲労低減を図ることができる。また手術の一連の流れを
病理診断のために中断させることがない。If necessary, the pathological diagnosis image of the sample 46 is transmitted to a remote place in addition to the endoscopic image formed by the image processing device 23 through the communication means 25 connected to the image processing device 23. (Effect) According to this, since the pathological diagnosis can be performed in real time during the treatment / surgery under the endoscopic observation, the treatment / surgery time can be shortened, and the patient's distress and the operator's fatigue can be reduced. It can be reduced. In addition, the series of operations is not interrupted for pathological diagnosis.
【００２４】また、画像処理装置２３に接続された通信
手段２５を通じて画像処理装置２３で構成した内視鏡像
の他に、サンプル４６の病理診断像を遠隔地に送信し、
遠隔地にある別の病院や医師宅に内視鏡像や病理診断等
を送り、診断の補助を依頼することができ、診断の正確
度を向上させることができる。In addition to the endoscopic image formed by the image processing device 23, the pathological diagnosis image of the sample 46 is transmitted to a remote place through the communication means 25 connected to the image processing device 23.
An endoscopic image, pathological diagnosis, etc. can be sent to another hospital or a doctor's house in a remote place to request diagnosis assistance, and the accuracy of diagnosis can be improved.
【００２５】以上の如く、第２の実施例によれば、内視
鏡下での処置・手術中にリアルタイムで生検、病理診断
を行うことによって、処置・手術時間を短縮し、患者の
苦痛低減、術者の疲労を低減させると共に手術の流れを
中断することなく生検病理検査の可能な医療用マニピュ
レータを提供することができる。As described above, according to the second embodiment, real-time biopsy and pathological diagnosis are performed during endoscopic treatment / surgery, thereby shortening the treatment / surgery time and causing patient distress. It is possible to provide a medical manipulator capable of performing biopsy pathological examination without interrupting the flow of surgery while reducing the fatigue of the operator.
【００２６】なお、本発明は前記実施例のものに限らな
い。例えば前述した医療用マニピュレータ以外に、手動
で操作する形式の内視鏡や硬性鏡でもよい。また、その
ような内視鏡や硬性鏡の先端にフードを取り付けるよう
にしてもよい。 ［付記］ １．内視鏡と、この内視鏡に付随し、その内視鏡の観察
下で使用される、少なくとも１つの処置具とを備えた医
療用処置装置において、体腔内の生体組織の表面に向け
る開口部を有し、少なくとも体腔内に位置した前記内視
鏡と前記処置具の一部分を覆うフードと、このフード内
の圧力を調節する圧力調整手段とを具備したことを特徴
とする医療用処置装置。 ２．内視鏡と、この内視鏡に付随し、その内視鏡の観察
下で使用される、少なくとも１つの処置具とを備えた医
療用処置装置において、体腔内の生体組織の表面に向け
る開口部を有し、少なくとも体腔内に位置した前記内視
鏡と前記処置具の一部分を覆うフードと、このフード内
の圧力を調節する吸引・送気手段とを具備したことを特
徴とする医療用処置装置。The present invention is not limited to the above embodiment. For example, in addition to the above-described medical manipulator, a manually operated type endoscope or rigid endoscope may be used. A hood may be attached to the tip of such an endoscope or rigid endoscope. [Additional Notes] 1. In a medical treatment apparatus including an endoscope and at least one treatment tool which is attached to the endoscope and is used under the observation of the endoscope, an opening directed to a surface of a living tissue in a body cavity. A medical treatment apparatus having a portion, and a hood that covers at least a portion of the endoscope and the treatment tool that is located in the body cavity, and pressure adjusting means that adjusts the pressure in the hood. . 2. In a medical treatment apparatus including an endoscope and at least one treatment tool which is attached to the endoscope and is used under the observation of the endoscope, an opening directed to a surface of a living tissue in a body cavity. A hood that has a portion and covers at least a portion of the endoscope and the treatment tool located in the body cavity; and a suction / air supply unit that adjusts the pressure in the hood. Treatment device.
【００２７】３．前記処置具が把持鉗子であることを特
徴とする付記第１，２項に記載の医療用処置装置。 ４．前記処置具がはさみ鉗子であることを特徴とする付
記第１，２項に記載の医療用処置装置。 ５．前記処置具が遺伝子注入手段であることを特徴とす
る付記第１，２項に記載の医療用処置装置。 ６．前記処置具が止血手段であることを特徴とする付記
第１，２項に記載の医療用処置装置。3. The medical treatment apparatus according to any one of appendices 1 and 2, wherein the treatment tool is a grasping forceps. 4. The medical treatment device according to any one of items 1 and 2, wherein the treatment tool is scissors forceps. 5. The medical treatment apparatus according to any one of appendices 1 and 2, wherein the treatment tool is a gene injection means. 6. The medical treatment apparatus according to any one of appendices 1 and 2, wherein the treatment tool is a hemostatic means.
【００２８】７．内視鏡と、この内視鏡に付随し、その
内視鏡の観察下で生体組織のサンプルを採取しそのサン
プルの病理検査を行う生体組織検査手段とを備えた医療
用処置装置において、生体組織検査手段を、前記内視鏡
の先端部近傍に配設したことを特徴とする医療用処置装
置。7. In an apparatus for medical treatment, which includes an endoscope and a biological tissue inspection means that is attached to the endoscope and collects a sample of a biological tissue under observation of the endoscope and performs a pathological examination of the sample, A medical treatment apparatus characterized in that a tissue inspection means is disposed in the vicinity of the distal end portion of the endoscope.
【００２９】８．内視鏡と、この内視鏡に付随し、その
内視鏡の観察下で生体組織のサンプルを採取しそのサン
プルの病理検査を行う生体組織検査手段とを備えた医療
用処置装置において、体腔内の生体組織の表面に向ける
開口部を有し、少なくとも体腔内に位置した前記内視鏡
と前記処置手段の一部分を覆うフードと、前記フード内
の圧力を調節する吸引・送気手段とを具備したことを特
徴とする医療用処置装置。 ９．前記生体組織検査手段が生体組織スライス手段、染
色手段、拡大観察手段とを有することを特徴とする付記
第７，８項に記載の医療用処置装置。 （付記７〜９の従来技術）腹壁等の体壁に挿入孔を開
け、この挿入孔を通じて内視鏡や処置具等の手術器械を
体腔内に挿入することにより、体腔内での処置、例えば
腫瘍の摘出などを行う経皮的内視鏡下外科手段、あるい
は、経口的、経直腸的に消化管内に内視鏡を挿入し、ポ
リープ等の生検、摘出などを行う内視鏡下処置が行われ
ている。この様な内視鏡下での処置では低侵襲に組織生
検を行い、腫瘍の良悪性の判断、腫瘍の種類の特定など
を行うためにも用いられている。しかしながら、従来の
内視鏡下での生検、組織の病理診断では、生検によって
採取した組織を体外に取り出し、病理検査室に持ち込ん
だ上で改めてスライス、染色し、顕微鏡下に観察する必
要があり、時間と手間のかかる作業であった。また、手
術中の病理検査では検査中は手術が中断されてしまい、
手術時間を長びかせる原因ともなり、患者に対して苦痛
を大きくするものであった。そこで、付記６〜８のもの
では内視鏡下処置、手術中の生検・病理検査の時間を短
縮し、手術全体の時間を短縮することによって患者の苦
痛、術者の疲労を低減させると共に、手術の流れを中断
することのない、内視鏡下生検・病理検査手段を提供す
るというものである。8. In a medical treatment device including an endoscope and a biological tissue inspection means that is attached to the endoscope and collects a sample of a biological tissue under observation of the endoscope and performs a pathological examination of the sample, a body cavity A hood that has an opening directed to the surface of the living tissue inside and covers at least a portion of the endoscope and the treatment means located inside the body cavity; and suction / air supply means for adjusting the pressure in the hood. A medical treatment device comprising: 9. 9. The medical treatment apparatus according to supplementary items 7 and 8, wherein the biological tissue inspection unit includes a biological tissue slicing unit, a staining unit, and a magnifying observation unit. (Prior Art of Supplementary Notes 7 to 9) A treatment in a body cavity, for example, by opening an insertion hole in a body wall such as an abdominal wall and inserting a surgical instrument such as an endoscope or a treatment tool through the insertion hole into the body cavity Percutaneous endoscopic surgical means to remove tumors, or endoscopic procedures to biopsy or remove polyps by inserting an endoscope into the digestive tract orally or transrectally. Is being done. Such endoscopic procedures are also used to perform minimally invasive tissue biopsy, determine whether a tumor is benign or malignant, and identify the type of tumor. However, in the conventional biopsy under the endoscope and pathological diagnosis of the tissue, it is necessary to take the tissue collected by the biopsy out of the body, bring it to the pathological examination room, slice it again, stain it, and observe it under a microscope. It was a time-consuming and tedious task. Also, during the pathological examination during surgery, the operation was interrupted during the examination,
It also prolongs the operation time and causes much distress to the patient. Therefore, with the appendixes 6 to 8, the time for endoscopic treatment, biopsy / pathological examination during surgery is shortened, and the time for the entire surgery is shortened, thereby reducing the pain of the patient and the fatigue of the operator. It is intended to provide an endoscopic biopsy / pathological examination means without interrupting the flow of surgery.
【００３０】[0030]
【発明の効果】以上説明したように本発明によれば、体
腔内の術部の固定が行われることにより体腔内部位に対
する微細な手術・処置を行う場合にも操作性がよく、高
精度の処置を確実に行うことが可能にすることができ
る。As described above, according to the present invention, the operative part in the body cavity is fixed, so that the operability is good and the precision is high even when performing a fine operation / procedure on the site in the body cavity. It is possible to ensure that the treatment can be performed.
【図１】第１の実施例に係る医療用処置装置の概略的な
構成説明図。FIG. 1 is a schematic configuration explanatory view of a medical treatment apparatus according to a first embodiment.
【図２】（ａ）（ｂ）は第１の実施例に係る医療用処置
装置の変形例を示すその先端部分の斜視図。2A and 2B are perspective views of a distal end portion thereof showing a modified example of the medical treatment apparatus according to the first embodiment.
【図３】第２の実施例に係る医療用処置装置の先端部分
の側面図。FIG. 3 is a side view of the distal end portion of the medical treatment device according to the second embodiment.
【図４】同じく第２の実施例に係る医療用処置装置の先
端部分の使用状態の斜視図。FIG. 4 is a perspective view of a distal end portion of the medical treatment apparatus according to the second embodiment in use.
１…医療用マニピュレータ、２…手術器械、３…移動用
マニピュレータ、５…内視鏡、７，８…把持鉗子、１２
…シース、１３…挿通孔、１７…フード、１８…開口
部、１９…送気・吸引孔、２０…送気・吸引手段、２３
…画像処理装置、２４…表示手段、４１…生体鉗子、４
２…把持鉗子、４４…病理診断手段。1 ... Medical manipulator, 2 ... Surgery instrument, 3 ... Movement manipulator, 5 ... Endoscope, 7,8 ... Grip forceps, 12
... sheath, 13 ... insertion hole, 17 ... hood, 18 ... opening, 19 ... air supply / suction hole, 20 ... air supply / suction means, 23
... image processing device, 24 ... display means, 41 ... living body forceps, 4
2 ... Grasping forceps, 44 ... Pathological diagnosis means.
Claims (1)
鏡の観察下で使用される、少なくとも１つの処置具とを
備えた医療用処置装置において、 体腔内の生体組織の表面に向ける開口部を有し、少なく
とも体腔内に位置した前記内視鏡と前記処置具の一部分
を覆うフードと、 このフード内の圧力を調節する圧力調整手段とを具備し
たことを特徴とする医療用処置装置。1. A medical treatment apparatus comprising an endoscope and at least one treatment tool which is attached to the endoscope and is used under the observation of the endoscope. A hood that has an opening directed to the surface of the endoscope and that covers at least a portion of the endoscope and the treatment tool located inside the body cavity; and a pressure adjusting means that adjusts the pressure in the hood. Medical treatment device.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP13056695A JP3625894B2 (en) | 1995-05-29 | 1995-05-29 | Medical treatment device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP13056695A JP3625894B2 (en) | 1995-05-29 | 1995-05-29 | Medical treatment device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPH08322787A true JPH08322787A (en) | 1996-12-10 |
| JP3625894B2 JP3625894B2 (en) | 2005-03-02 |
Family
ID=15037322
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP13056695A Expired - Fee Related JP3625894B2 (en) | 1995-05-29 | 1995-05-29 | Medical treatment device |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP3625894B2 (en) |
Cited By (19)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2000037390A (en) * | 1998-07-22 | 2000-02-08 | Olympus Optical Co Ltd | Endoscopic therapeutic instrument |
| JP2004024561A (en) * | 2002-06-26 | 2004-01-29 | Pentax Corp | Air feeding and suction operating mechanism for endoscope |
| JP2004298458A (en) * | 2003-03-31 | 2004-10-28 | Olympus Corp | Stereoscopic observation system |
| JP2005323886A (en) * | 2004-05-14 | 2005-11-24 | Olympus Corp | Ultrasonic endoscope |
| US7083616B2 (en) | 2002-09-04 | 2006-08-01 | Hitachi, Ltd. | Medical manipulator system and operating method thereof |
| JP2006223358A (en) * | 2005-02-15 | 2006-08-31 | Pentax Corp | Apparatus and system for object internal treatment |
| JP2007244435A (en) * | 2006-03-13 | 2007-09-27 | Olympus Medical Systems Corp | Endoscope apparatus |
| JP2008104620A (en) * | 2006-10-25 | 2008-05-08 | Naoki Suzuki | Endoscopic surgical robot |
| JP2008302242A (en) * | 2008-09-08 | 2008-12-18 | Olympus Corp | Endoscope |
| JP2009106738A (en) * | 2007-10-26 | 2009-05-21 | Prosurgics Ltd | Control assembly |
| JP2009183699A (en) * | 2008-02-01 | 2009-08-20 | Olympus Medical Systems Corp | Medical treatment endoscope |
| JP2009297430A (en) * | 2008-06-17 | 2009-12-24 | Fujinon Corp | Endoscope |
| WO2012132372A1 (en) * | 2011-03-29 | 2012-10-04 | パナソニック株式会社 | Endoscope device |
| US8556805B2 (en) | 2006-01-13 | 2013-10-15 | Olympus Medical Systems Corp. | Rotational force transmission mechanism, force-attenuating apparatus, medical device, and medical instrument-operation mechanism |
| US8617054B2 (en) | 2006-01-13 | 2013-12-31 | Olympus Medical Systems Corp. | Medical treatment endoscope |
| US8753262B2 (en) | 2003-07-29 | 2014-06-17 | Hoya Corporation | Internal treatment apparatus having circumferential side holes |
| US9028510B2 (en) | 2013-02-01 | 2015-05-12 | Olympus Medical Systems Corp. | Tissue excision method |
| US9173550B2 (en) | 2006-01-13 | 2015-11-03 | Olympus Corporation | Medical apparatus |
| US9289112B2 (en) | 2006-01-13 | 2016-03-22 | Olympus Corporation | Medical treatment endoscope having an operation stick formed to allow a procedure instrument to pass |
-
1995
- 1995-05-29 JP JP13056695A patent/JP3625894B2/en not_active Expired - Fee Related
Cited By (23)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2000037390A (en) * | 1998-07-22 | 2000-02-08 | Olympus Optical Co Ltd | Endoscopic therapeutic instrument |
| JP2004024561A (en) * | 2002-06-26 | 2004-01-29 | Pentax Corp | Air feeding and suction operating mechanism for endoscope |
| US7083616B2 (en) | 2002-09-04 | 2006-08-01 | Hitachi, Ltd. | Medical manipulator system and operating method thereof |
| JP2004298458A (en) * | 2003-03-31 | 2004-10-28 | Olympus Corp | Stereoscopic observation system |
| US8753262B2 (en) | 2003-07-29 | 2014-06-17 | Hoya Corporation | Internal treatment apparatus having circumferential side holes |
| JP4526298B2 (en) * | 2004-05-14 | 2010-08-18 | オリンパス株式会社 | Ultrasound endoscope device |
| JP2005323886A (en) * | 2004-05-14 | 2005-11-24 | Olympus Corp | Ultrasonic endoscope |
| JP2006223358A (en) * | 2005-02-15 | 2006-08-31 | Pentax Corp | Apparatus and system for object internal treatment |
| JP4592007B2 (en) * | 2005-02-15 | 2010-12-01 | Ｈｏｙａ株式会社 | Object internal treatment device and object internal treatment system |
| US9308049B2 (en) | 2006-01-13 | 2016-04-12 | Olympus Corporation | Medical treatment endoscope |
| US9289112B2 (en) | 2006-01-13 | 2016-03-22 | Olympus Corporation | Medical treatment endoscope having an operation stick formed to allow a procedure instrument to pass |
| US8617054B2 (en) | 2006-01-13 | 2013-12-31 | Olympus Medical Systems Corp. | Medical treatment endoscope |
| US9173550B2 (en) | 2006-01-13 | 2015-11-03 | Olympus Corporation | Medical apparatus |
| US8556805B2 (en) | 2006-01-13 | 2013-10-15 | Olympus Medical Systems Corp. | Rotational force transmission mechanism, force-attenuating apparatus, medical device, and medical instrument-operation mechanism |
| JP2007244435A (en) * | 2006-03-13 | 2007-09-27 | Olympus Medical Systems Corp | Endoscope apparatus |
| JP2008104620A (en) * | 2006-10-25 | 2008-05-08 | Naoki Suzuki | Endoscopic surgical robot |
| JP2009106738A (en) * | 2007-10-26 | 2009-05-21 | Prosurgics Ltd | Control assembly |
| JP2009183699A (en) * | 2008-02-01 | 2009-08-20 | Olympus Medical Systems Corp | Medical treatment endoscope |
| JP2009297430A (en) * | 2008-06-17 | 2009-12-24 | Fujinon Corp | Endoscope |
| JP2008302242A (en) * | 2008-09-08 | 2008-12-18 | Olympus Corp | Endoscope |
| JP2012205682A (en) * | 2011-03-29 | 2012-10-25 | Panasonic Corp | Endoscope device |
| WO2012132372A1 (en) * | 2011-03-29 | 2012-10-04 | パナソニック株式会社 | Endoscope device |
| US9028510B2 (en) | 2013-02-01 | 2015-05-12 | Olympus Medical Systems Corp. | Tissue excision method |
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| Publication number | Publication date |
|---|---|
| JP3625894B2 (en) | 2005-03-02 |
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