JP2005254002A - Endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope having excellent operability and working efficiency in projecting a therapeutic instrument from an opening of the tip of a channel for inserting a plurality of therapeutic instruments to perform an endoscopic treatment. <P>SOLUTION: This endoscope includes: an insert part having an observation optical system and provided with the therapeutic instrument inserting channel; a curved part disposed at the tip of the insert part; a curve operating part disposed at the base end of the insert part to operate the curved part, wherein the insert part is provided to be freely rotatable to the curve operating part. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an endoscope having a plurality of treatment instrument insertion channels and a treatment instrument swinging base for swinging a treatment instrument protruding from an opening of each treatment instrument insertion channel.

  A medical endoscope that allows the user to observe organs in the body cavity by inserting an elongated insertion part into the body cavity, or to perform various treatments using the treatment tool inserted into the treatment tool insertion channel as necessary. Mirrors have been widely used in the past.

  In addition, a technique such as providing a plurality of treatment instrument insertion channels in an endoscope, inserting various treatment instruments into each treatment instrument insertion channel, and resecting a lesion site in a body cavity endoscopically is also possible. Its usefulness is widely recognized. For example, the endoscope disclosed in Japanese Patent Application Laid-Open No. 2001-212078 includes a two forceps raising mechanism that rises in different directions, and a method of performing treatment by inserting treatment tools through two treatment tool insertion channels, respectively. It is shown.

  In the endoscope, a forceps raising mechanism that rises in different directions is provided at the distal end openings of the two treatment instrument insertion channels, and a grasping treatment instrument (hereinafter referred to as the treatment instrument insertion channel) is inserted into one treatment instrument insertion channel. The treatment is performed by combining a grasping forceps) with an incision treatment instrument (hereinafter referred to as an incision tool) such as a needle-shaped electric knife inserted into the other treatment instrument insertion channel. Specifically, it is described that the mucosa of the lesion or its vicinity is lifted by grasping forceps and then excised with an incision tool.

  However, in the endoscope disclosed in Japanese Patent Application Laid-Open No. 2001-212078, each elevator is operated with one elevator operation wire. For this reason, it is easy to control the treatment tool in the raising direction, but it is difficult to control in the inversion direction. In addition, when the treatment instrument is in the straight state, it is in the maximum upside-down state, so that the amount of advancement / retraction force of the treatment instrument tends to increase as the raising operation is performed. Further, when the treatment tool is raised a little, the amount of advancement / retraction force becomes heavy instead, and it is difficult to smoothly perform delicate operations on the grasping forceps and the incision tool.

  The present invention has been made in view of the above circumstances, and has excellent operability and workability when performing endoscopic treatment by projecting a treatment tool from the distal end openings of a plurality of treatment tool insertion channels. The aim is to provide a mirror.

  A first endoscope of the present invention includes an observation optical system, an insertion portion in which a treatment instrument insertion channel is formed, a bending portion disposed on a distal end side of the insertion portion, and the insertion portion. And a bending operation portion that is disposed on the base end side and that can operate the bending portion, and the insertion portion is provided to be rotatable with respect to the bending operation portion.

  The second endoscope of the present invention is characterized in that, in the first endoscope, a rotation operation portion of the insertion portion is disposed on a distal end side of the bending operation portion.

  The third endoscope of the present invention is characterized in that in the first endoscope, a rotation fixing means capable of fixing a rotation state of the insertion portion with respect to the bending operation portion is provided.

  ADVANTAGE OF THE INVENTION According to this invention, the endoscope excellent in the operativity and workability | operativity at the time of performing an endoscopic treatment can be provided by making a treatment tool protrude from the front-end | tip opening of a some treatment tool penetration channel.

Embodiments of the present invention will be described below with reference to the drawings.
1 to 19 relate to an embodiment of the present invention, FIG. 1 is a diagram for explaining the configuration of an endoscope, FIG. 2 is a front view of a distal end portion for explaining the configuration of a distal end surface of the distal end portion, and FIG. FIG. 4 is a diagram for explaining the relationship between the slit and the fixing pin, FIG. 5 is a diagram for explaining the rotation stopper structure, and FIG. 6 is a sectional view for explaining the rotation stopper structure. FIG. 7 is a diagram for explaining the positional relationship between the treatment instrument insertion port and the treatment instrument swing base operation knob, FIG. 8 is a perspective view for explaining the first treatment instrument swing base, and FIG. 9 is the first treatment instrument. FIG. 10 is a diagram for explaining a swinging state within the observation visual field range of the first treatment instrument and the like derived from the swing table, and FIG. 10 is a diagram for explaining a first treatment tool image and the like that swings the endoscope image; 11 is a diagram showing a state where treatment is performed using two treatment tools, a diagram showing an endoscopic image showing the treatment state of FIG. 11, and FIG. 3 is a view showing an endoscopic image in a state where the insertion portion rotating portion is rotated 90 degrees to the left, FIG. 14 is a view showing an endoscopic image rotated using the image rotation function, and FIG. 15 is a circular shape FIG. 16 is a perspective view illustrating another configuration of the treatment instrument rocking table, and FIG. 17 illustrates another positional relationship between the treatment tool insertion port and the treatment tool rocking table operation knob. FIG. 18 is a diagram for explaining another rocking state within the observation visual field range of the first treatment tool and the like derived from the first treatment tool rocking table, and FIG. 19 is a diagram for explaining the first treatment tool rocking. It is a figure explaining other rocking | fluctuation states within the observation visual field range of the 1st treatment tool etc. which were derived | led-out from the moving base.

  As shown in FIG. 1, the endoscope 1 of the present embodiment includes an insertion portion 2 and an operation portion 3, and a universal cord 4 having a light guide inserted therein extends from a side portion of the operation portion 3. ing.

  The insertion portion 2 is configured by connecting a distal end portion 5, a first bending portion 6, a second bending portion 7, and a flexible tube portion 8 in order from the distal end side, and on the distal end surface of the distal end portion 5. As shown in FIG. 2, an observation window 9, an illumination window 10, an air / water supply nozzle 11, and a forward water supply injection port 12 are provided.

  In addition, a treatment instrument swing base storage section 13 is formed at the distal end portion 5, and a first treatment instrument swing base 14 and a second treatment instrument swing base 15 are provided in the swing base storage section 13. It is arranged so that it can swing freely. The first treatment instrument swinging table 14 swings substantially in the left-right direction with respect to the viewing direction of the observation window 9, and the second treatment tool swinging table 15 is moved substantially vertically with respect to the viewing direction. It is configured to swing.

  The outer surface of the tip 5 is covered with an insulating member 16. In addition, the swing table storage portion 13 is partially opened at the distal end surface and the side surface of the distal end portion 5, and the first treatment instrument swing base 14 and the second treatment portion 14 are not made thicker. The swing range of the treatment instrument swing base 15 is widened. Furthermore, the first treatment instrument swing base 14 and the second treatment instrument swing base 15 are formed of an electrically insulating member such as ceramic, a stainless member coated with an electrically insulating film, or simply a stainless member. Has been.

  The first bending portion 6 can be bent substantially vertically and horizontally with respect to the visual field direction by operating a first bending operation portion 26 provided in the operation portion 3. On the other hand, the second bending portion 7 can be bent substantially vertically with respect to the visual field direction by operating the second bending operation portion 27. The first bending portion 6 and the second bending portion 7 are bent independently of each other, and can be bent in the upper / lower / left / right directions of the first bending portion 6. The angle is set to, for example, 210 ° / 90 ° / 100 ° / 100 °, and the bendable angle in the upper / lower direction of the second bending portion 7 is set to, for example, 90 ° / 90 °. It is the structure which can perform observation and treatment in front view.

  A first treatment instrument insertion channel 17 and a second treatment instrument insertion channel 18 are inserted into the insertion portion 2. The distal end opening of the first treatment instrument insertion channel 17 communicates with the first treatment instrument swing base 14, and the proximal end opening is a first treatment instrument insertion port provided in the operation unit 3. 19 communicates. On the other hand, the distal end side opening of the second treatment instrument insertion channel 18 communicates with the second treatment instrument swing base 15 and the proximal end opening is a second treatment instrument provided in the operation unit 3. It communicates with the insertion port 20. In the following description, the treatment instrument inserted into the first treatment instrument insertion channel 17 is referred to as a first treatment instrument 53, and the treatment instrument inserted into the second treatment instrument insertion channel 18 is a first treatment instrument 53. The second treatment tool 54 is used.

The operation unit 3 includes an insertion unit rotating unit 21, a swinging table operating unit 22, a gripping unit 25, a first bending operation unit 26, a second bending operation unit 27, and the like.
The insertion portion rotating portion 21 is configured to rotate integrally with the insertion portion 2, and by twisting the insertion portion rotating portion 21, the insertion portion rotating portion 21 is moved with respect to the swing table operating portion 22, the gripping portion 25, and the like. The insertion portion 2 can be rotated.

Here, the configuration of the insertion portion rotating unit 21 will be described with reference to FIGS. 3 to 6.
A flexible tube terminal member 66 is fixed to the proximal end portion of the flexible tube portion 8, and the insertion portion folding preventing member 41 is integrally held by the flexible tube terminal member 66. A tubular rotation operation ring structure 62 is integrally provided on the inner peripheral surface side of the tubular rotation operation ring 61 which is the main body of the insertion portion rotation unit 21. The flexible tube terminal member 66 is fixed.

  Further, as shown in FIG. 4, a slit 63 that is elongated in the circumferential direction is formed on the outer periphery of the rotary operation ring structure 62. Then, as shown in FIG. 5, a concavo-convex portion 71 is formed at the base end portion of the rotation operation ring 61 as shown in FIG.

  Further, the rocking table operating unit structure 64 which is an internal structure of the operation unit 3 or the rocking table operating unit 22 is provided with a fixing pin 65 disposed in the slit 63. The fixing pin 65 can be used as a guide to move in the circumferential direction.

  In addition, a rotation state holding structure portion that holds the rotation state in a state where the rotation operation ring 61 is rotated by a desired angle at the distal end portion of the exterior member 67 on the proximal end side adjacent to the rotation operation ring 61; Built-in rotating stopper structure.

  The rotation stopper structure includes a rotation / fixed switching lever that is movably held in a rotation / fixed switching lever storage portion 69 formed at an end of the exterior member 67 as shown in FIGS. 68 and an urging member 70 built in the base end side of the rotation / fixation switching lever 68. The urging force of the urging member 70 causes the distal end of the rotation / fixation switching lever 68 to move naturally. In the state, it is fitted and arranged in the concave portion of the concave-convex portion 71.

  Reference numeral 72 denotes a watertight member provided between the swinging base operation unit structure 64 and the rotation operation ring 61 and the exterior member 67. By disposing the watertight member 72, the entire insertion unit rotation unit 21 is disposed. Like other parts, it has a watertight structure. Further, the rotation angle of the rotation operation ring 61 can be configured to be capable of rotating 180 degrees to the left and right, for example.

Returning to FIG. 1, the configuration of the operation unit 3 will be described again.
The first bending operation section 26 corresponding to the first bending section 6 includes a first up / down bending operation knob 35, a left / right bending operation knob 36, a first up / down rotation / fixing lever 38, and a left / right rotation. A fixed lever 39 is provided.

  The first up / down bending operation knob 35 is connected to an up / down operation wire (not shown) extending from the first bending portion 6 inside the first bending operation portion 26 or the grip portion 25. The left / right bending operation knob 36 is connected to a left / right operation wire (not shown) extending from the first bending portion 6 inside the first bending operation portion 26 or the grip portion 25.

  The first up / down bending operation knob 35 can be switched between the rotation state and the fixed state by the first up / down rotation / fixing lever 38, and the left / right bending operation knob 36 can be switched between the rotation state and the fixed state. The rotation / fixation lever 39 can be used.

  On the other hand, the second bending operation section 27 corresponding to the second bending section 7 is provided with a second up / down bending operation knob 37 and a second up / down rotation / fixation knob 40. The second up / down bending operation knob 37 is connected to an up / down operation wire (not shown) extending from the second bending portion 7 inside the second bending operation portion 27 or the grip portion 25. The second up / down rotation / fixation knob 40 can be used to switch between the rotation state and the fixed state of the second up / down bending operation knob 37.

  An air / water supply control button 28, a suction control button 29, and an image control button 30 are provided in the vicinity of the first bending operation unit 26. Reference numeral 42 denotes a universal cord folding preventing member for preventing the universal cord 4 from being bent at the base.

  Inside the oscillating table operating unit 22, a mechanism unit (not shown) for operating the first treatment instrument oscillating table 14 and a mechanism unit for operating the second treatment instrument oscillating table 15 ( (Not shown) is built-in.

  As shown in FIGS. 1 and 7, a first treatment instrument swing base operation knob 33 and a second treatment instrument swing base operation knob which are part of the mechanism section are provided outside the swing base operation section 22. 34 is provided. The first treatment instrument swinging base operation knob 33 and the second treatment instrument swinging base operation knob 34 are located below the first treatment instrument insertion port 19 and the second treatment instrument insertion port 20. It is arranged coaxially.

  Then, by operating the first treatment instrument swing base operation knob 33, one of the two operation wires 57a and 57b corresponding to this operation is pulled, and the first treatment instrument swing base 14 is moved. It can be remotely rocked in the direction of arrow a or arrow b (left-right direction) (see FIG. 2). On the other hand, by operating the second treatment instrument swinging base operation knob 34, one of the two operation wires 57c and 57d corresponding to this operation is pulled, and the second treatment instrument swinging base 15 is moved. It can be remotely rocked in the direction of arrow c or arrow d (vertical direction) (see FIG. 2).

  In addition, a front water supply inlet 23 and a swing base operation wire washing port 24 are provided on the outer surface of the swing base operation unit 22. The oscillating table operation wire washing port 24 is opened in the oscillating table storage unit 13, and by connecting a syringe (not shown), the washing liquid or the like injected into the syringe is inserted into the operation wire insertion channel 60. The operation wire can be cleaned by feeding it. Further, the forward water supply inlet 23 communicates with the forward water injection port 12.

  As shown in FIG. 2, a first treatment instrument insertion hole 45 is formed in the first treatment instrument swing base 14, and a first distal end of the first treatment instrument insertion channel 17 indicated by a broken line. It communicates with the side opening 43. Here, reference numeral 49 denotes a center line of the first distal end opening 43, and an alternate long and short dash line indicated by reference numeral 51 is the first orthogonal to the swinging direction of the first treatment instrument swinging table 14. This is the center line of the treatment instrument insertion hole 45.

  On the other hand, a second treatment instrument insertion hole 46 is formed in the second treatment instrument swing base 15, and the second treatment instrument insertion channel 18 indicated by a broken line has a second distal end side opening 44. Communicate. Here, reference numeral 50 is a center line of the second distal end side opening 44, and an alternate long and short dash line indicated by reference numeral 52 is the second that is substantially orthogonal to the swinging direction of the second treatment instrument swinging table 15. This is the center line of the treatment instrument insertion hole 46.

  Reference numeral 47 indicates a horizontal center line on the observation window 9 which is a center line when the left and right parts are equally divided on the endoscopic image, and reference numeral 48 indicates the upper and lower parts on the endoscopic image. The center line in the vertical direction when equally divided is shown on the observation window 9.

  A state in which the first insertion hole center line 51 and the first opening center line 49 are positioned substantially on the same line, and the second insertion hole center line 52 and the second opening center line 50 Are positioned on substantially the same line as the swinging neutral position where the treatment instrument swinging bases 14 and 15 are not swinging, or simply the swinging neutral state.

  When the first treatment instrument swing base 14 is in a swing neutral state, the first insertion hole center line 51 and the left-right direction center line 47 are substantially collinear with respect to the observation window 9. A first treatment instrument swing base 14 is disposed. Further, when the second treatment instrument swinging table 15 is in the swinging neutral state, the second insertion hole center line 52 and the vertical center line 48 are substantially on the same line, and are located with respect to the observation window 9. The second treatment instrument swing base 15 is arranged. That is, as shown in FIG. 2, when the treatment instrument swing bases 14 and 15 are arranged, both the treatment instrument swing bases 14 and 15 are in a swing neutral state.

The swing structure of the first treatment instrument swing base 14 will be described with reference to FIG. The swing structure of the second treatment instrument swing base is the same as the swing structure of the first treatment instrument swing base 14, so that the swing structure of the first treatment instrument swing base 14 is the same. The explanation is omitted by explaining.
As shown in the figure, the first rotating shaft 55a and the second rotating shaft 55b are coaxially positioned on the upper surface side and the bottom surface side corresponding to the first treatment instrument insertion hole 45 of the first treatment instrument swing base 14. Is protruding. In addition, attachment holes 59 are provided on both sides of the first rotating shaft 55a and the second rotating shaft 55b, respectively. A wire terminal member 58 fixed to the ends of the operation wires 57a and 57b is rotatably disposed in the attachment hole 59.

  The first rotating shaft 55a and the second rotating shaft 55b are rotatably disposed in the rocking table storage portion 13, and the first rotating shaft 55a and the second rotating shaft 55b are operated by operating the first treatment instrument rocking table operating knob 33. By appropriately pulling the operation wires 57a and 57b of the book, the first treatment instrument swinging table 14 is rotated around the coaxial first rotating shaft 55a and second rotating shaft 55b as the center of rotation. It swings in the left-right direction within the storage portion 13.

  Further, in this figure, since it is in a swinging neutral state, the first treatment instrument 53 indicated by a two-dot chain line inserted through the first treatment instrument insertion channel 17 is substantially straight and the first treatment instrument insertion hole. Derived from 45 toward the outside.

  As shown in FIG. 9, the two operation wires 57 a and 57 b pass through the operation wire insertion channel 60 and are connected to a mechanism unit that operates the first treatment instrument swinging table in the swinging table operating unit 22. ing. Therefore, when the operation wires 57a and 57b are pulled by operating the first treatment instrument swinging base operation knob 33, the first treatment instrument swinging base 14 is pulled around the rotation shafts 55a and 55b. It swings left or right corresponding to the operation direction.

  As a result, the first treatment instrument 53 derived from the first treatment instrument swinging base 14 is shown by the one-dot chain line and the two-dot chain line from the swing neutral state position indicated by the solid line within the observation visual field range of the observation window 9. The range shown in FIG. At this time, the distal end of the first treatment instrument 53 swings substantially uniformly (L1≈L2) in the left-right direction from the swing neutral state position indicated by the solid line, and the swing trajectory of the distal end is indicated by the alternate long and short dash line. Draw an arc shape as follows. On the other hand, as shown in FIG. 10, an image 53a representing the first treatment instrument 53 located at the center on the endoscopic image swings to the left side end side and the right side end side of the screen.

  In the swing neutral state position shown by the solid line in FIG. 9, the first treatment instrument 53 is in a linear state, and the protruding direction of the first treatment instrument 53 is substantially collinear with the visual field center 77. . In this state, the advancing / retreating force amount of the treatment instrument becomes the lightest, so that the advancing / retreating operation of the treatment instrument can be easily performed. Moreover, the injection direction of the front water supply injection port 12 is adjusted so as to pass through the vicinity of the visual field center 77 at a distance of about 15 mm forward from the tip surface. For this reason, when water etc. are ejected from the forward water supply injection port 12, as shown in FIG. 10, the forward water supply locus | trajectory 78 which goes to the center on an endoscopic image is displayed. In this state, washing can be performed efficiently. Further, an insertion channel 60 through which the four operation wires 57a, 57b, 57c, 57d, each of which has one end disposed on the first treatment instrument swing base 14 and the second treatment instrument swing base 15, is inserted. The oscillating base operating unit 22 joins the oscillating base operating portion 22 and communicates with the oscillating base operating wire washing port 24.

The operation of the endoscope 1 configured as described above will be described.
When the treatment tools 53 and 54 are led out from the first treatment tool swinging table 14 and the second treatment tool swinging table 15, the first treatment tool is displayed on the endoscopic image as shown in FIG. Derived from the treatment instrument image 53a of the first treatment instrument 53 that is derived from the oscillating table 14 and protrudes from the lower side of the endoscope image and oscillates to the left and right of the screen, and derived from the second treatment instrument oscillating table 15. Then, the treatment instrument image 54a of the second treatment instrument 54 protruding from the right side of the endoscopic image and swinging in the vertical direction of the screen is displayed. Note that the treatment instrument images 53a and 54a indicated by solid lines in the figure indicate the treatment instruments 53 and 54 positioned in the swing neutral state described in FIG.

  When the first treatment instrument swing base 14 and the second treatment instrument swing base 15 are in the swing neutral position, the first treatment instrument 53 is positioned in the vicinity of the lateral center line 47, The second treatment instrument 54 is located near the vertical center line 48.

  Here, the lesioned part is captured at substantially the center of the endoscopic image, for example, as shown in FIG. 11, the lesioned mucosa M is lifted by the second treatment tool 54 (for example, grasping forceps), and the fold is used as the first treatment tool. When performing an incision operation by swinging left and right with 53 (for example, an incision tool), an endoscopic image as shown in FIG. 12 is displayed on the screen of the monitor 73. At this time, as shown by the solid line and the broken line in the figure, the first treatment instrument 53 and the second treatment instrument 54 can swing over a wide range in the screen.

  As described above, the rotation of the insertion portion, the first treatment tool, and the first treatment tool can be obtained by providing the swinging base operation portion and the insertion portion rotation portion in the vicinity of the first treatment tool insertion port and the second treatment tool insertion port. The operation of swinging and advancing / retreating the two treatment tools can be performed in cooperation. This greatly improves treatment workability.

  In addition, by deriving the two treatment tools from the swing tool neutralized treatment tool swinging table, the respective treatment tools can be swung in both the up-and-down directions and the endoscopic image. Since the treatment tool image is displayed from the left and right center position and the vertical center position toward the center of the image, the treatment tool is optimally selected by observing the lesion in the center of the screen and performing endoscopic observation and treatment. While being able to approach smoothly from the direction, it is possible to perform work by oscillating the treatment instrument without feeling uncomfortable while observing the endoscopic image. This greatly improves operability and workability.

  Furthermore, when the endoscopic treatment is performed by grasping the lesion in the center of the screen, the treatment tool is led out in a straight line, so that the amount of advancing / retreating force of the treatment tool becomes the lightest, and the advancement / retraction operation of the treatment tool is performed. It can be done easily.

  By these things, it is possible to operate each treatment tool delicately and with good response, and an endoscope excellent in incision work can be provided.

  In addition, since the swing neutral position is set at the center in the left-right direction and the center in the vertical direction, it is easy to observe the endoscopic image of the swing neutral position by bringing each treatment instrument to the center of the screen. Therefore, it is possible to smoothly perform the operation of removing the first treatment tool and the second treatment tool from the first treatment tool swing table and the second treatment tool swing table. At this time, since the treatment instrument is removed in a straight state, damage to the treatment instrument can be reduced.

  In FIG. 12, the endoscopic image shows a state in which the first treatment tool 53 (incision tool) is taken out from the lower side of the lesioned mucosa M. On the contrary, the cutting edge of the first treatment tool 53 is shown. If it is desired to make an incision from the upper side of the lesioned mucosa M, the operation is performed as described below.

  First, the insertion portion rotating portion 21 shown in FIG. 1 is operated to rotate the insertion portion 2 to the left by about 90 °. At this time, as shown in FIG. 13, the lesion is rotated 90 ° right in the monitor screen. In this state, the rotation / fixation switching lever 68 is operated to fix the rotation state of the insertion portion 2.

  Next, the grasping forceps and the cutting tool are exchanged in this state. That is, the first treatment instrument 53 side is a grasping forceps, and the second treatment instrument 54 side is an incision instrument. Thus, the lesioned mucosa M can be incised from above by swinging the incision tool.

  At this time, the endoscope image shown in FIG. 13 is rotated 90 ° to the left by using an image rotation function in a video processor (not shown) connected to the endoscope 1. As a result, the endoscopic image shown in FIG. 14 is displayed on the screen of the monitor 73. As a result, the surgeon can perform the work smoothly as described above while observing the endoscopic image.

  Thus, by providing the insertion portion rotating portion, it is possible to perform a treatment by twisting only the insertion portion with respect to the operation portion. This eliminates the need to twist the operation unit together as in the prior art, and reliably prevents other operations of the operation unit from being hindered.

  In addition, even when the first treatment tool and the second treatment tool are interchanged by performing the treatment with the image rotation function to freely change the orientation of the screen so that the surgeon can easily see the endoscope image, The rocking operation can be performed with certainty.

  Note that the first bending unit 6 and the second bending unit are used instead of the first bending operation unit 26 that operates the first bending operation unit and the second bending operation unit 27 that operates the second bending operation unit. 7 may be configured to be electrically controlled.

  Further, the bending direction may be assigned so as to be interlocked with the image rotation function. Specifically, alignment is performed so that the vertical and horizontal directions of the endoscopic image displayed on the monitor are the vertical and horizontal directions of the curve. As a result, even when the insertion portion is twisted, the bending operation can be performed with reference to the vertical and horizontal directions of the endoscopic image. This prevents the surgeon from confusing the bending operation when a mechanism for rotating the insertion portion is provided. .

  Furthermore, the shape of the endoscopic image displayed on the monitor screen may be a circular shape as shown in FIG. 15, for example. That is, the field shape may be another shape such as a circle.

  Further, the first treatment instrument swing base 14 may be configured as shown in FIG. As shown in the figure, in the present embodiment, a notch 74 is formed in a part of the first treatment instrument insertion hole 45, and a rotary slide that hits the first rotating shaft 55 a on both sides of the notch 74. A moving part 75 is formed. In addition, a substantially central portion of one operation wire 57 is disposed on the outer peripheral surface side of the first treatment instrument insertion hole 45, and the operation wire 57 is passed through the operation wire insertion channel 60 and inside the swinging table operation unit 22. And both ends are connected to a mechanism for operating the first treatment instrument swinging table. As a result, the treatment instrument swing base can be made smaller than the type shown in FIG.

  Also, the arrangement positional relationship between the first treatment instrument swinging table operation knob 33 and the second treatment instrument swinging table operation knob 34 is not limited to the relationship shown in FIG. 7, but as shown in FIG. The oscillating table operating unit 22 is configured so that the first treatment instrument oscillating table operating knob 33 for operating the first treatment instrument 53 oscillated from side to side with respect to the endoscopic image can be oscillated in the left and right direction. The second treatment instrument oscillating table operating knob 34 that is disposed on the lower side and operates the second treatment instrument 54 that is oscillated up and down with respect to the endoscopic image can be oscillated in the vertical direction. You may make it arrange | position to the side part of the rocking | fluctuation stand operation part 22. FIG.

  As a result, when the treatment instrument is swung, the operation knob to be operated can be determined instantaneously. In addition, the operability can be further improved by adopting a configuration in which the first treatment tool 53 protrudes from the lower side of the endoscopic image and the second treatment tool 54 protrudes from the right side of the endoscopic image.

  Furthermore, in the present embodiment, the swing locus of the treatment instrument is arcuate, but the swing locus is not limited to an arcuate shape. For example, as shown in FIGS. 18 and 19, the swing locus is linear. You may make it the structure to make.

  Therefore, as shown in FIG. 18, instead of projecting the first rotating shaft 55a and the second rotating shaft 55b shown in FIG. An oscillating table sliding convex portion 79 is arranged on the bottom surface of the oscillating table 14 and slides in the oscillating table sliding groove 76 formed in a straight line in the oscillating table storage unit 13 in parallel with the tip surface. Is protruding.

  As a result, by appropriately pulling the two operation wires 57a and 57b, the swinging table sliding convex portion 79 of the first treatment instrument swinging table 14 moves the swinging table sliding groove 76 in the direction of the arrow in the figure. Move as shown.

  As a result, the locus of the distal end of the first treatment instrument 53 derived from the first treatment instrument swinging base 14 becomes substantially parallel to the distal end surface of the distal end portion 5. At this time, the first treatment instrument 53 swings substantially equally (L1≈L2) from the swing neutral state position indicated by the solid line to the left and right, and when the first treatment instrument 53 is in the swing neutral position, the protruding direction of the first treatment instrument 53 is It is substantially collinear with the visual field center 77. With this configuration, the distal ends of the first treatment instrument 53 and the second treatment instrument 54 are moved substantially linearly in parallel with the distal end surface of the distal end portion 5 unlike the arc shape of the first embodiment. At this time, as shown in FIG. 19, when the endoscope image is in the swinging neutral position, the first treatment instrument 53 is positioned in the vicinity of the center line 47 in the left-right direction, and the second treatment instrument 54 is in the vertical direction. Located near the center line 48.

In this way, by moving the distal end of the treatment tool substantially parallel to the distal end surface of the distal end portion, not only the central portion of the visual field but also the peripheral portion of the visual field can be displayed sufficiently to greatly improve the incision workability. Can be improved.
The forward water supply locus 78 of the forward water supply also passes in the vicinity of the visual field center 77 at a distance of about 15 mm from the distal end surface to the second treatment instrument swing base.

  The present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the spirit of the invention. For example, the visual field on the monitor may be a round shape, an octagonal shape, or the like.

[Appendix]
According to the embodiment of the present invention as described above in detail, the following configuration can be obtained.

(1) An observation window constituting an objective optical system that captures an endoscope image at the distal end of the endoscope insertion portion, and a first treatment instrument insertion channel disposed at a predetermined position with respect to the observation window A first treatment instrument swinging table for deriving the first treatment instrument derived from the upper or lower side of the endoscopic image and moving the first treatment instrument in a substantially horizontal direction of the screen; and a predetermined position with respect to the observation window A second treatment instrument swinging the second treatment instrument, which is arranged in the position and is led out from the right or left side of the endoscopic image and moved substantially in the vertical direction of the screen. In an endoscope having a table,
Two operation wires for swinging operation are provided on each of the first treatment instrument swinging table and the second treatment instrument swinging table,
When the first treatment instrument swinging table and the second treatment instrument swinging table are respectively set to the swing neutral state, the first treatment tool derived from the first treatment tool swinging table is the endoscope. The second treatment tool that is located in the vicinity of the center line in the left-right direction that equally divides the left and right of the image and that is derived from the second treatment instrument swinging base Endoscope located in the vicinity.

(2) The endoscope according to appendix 1, wherein the swing neutral position is a substantially central position of a swingable range of each treatment instrument swing base.

(3) The endoscope according to appendix 1, wherein the first treatment tool is derived from the lower side of the endoscopic image, and the second treatment tool is derived from the right side of the endoscopic image.

(4) The endoscope according to appendix 1, wherein one end of each of the two operation wires is rotatably attached to the treatment instrument swing base.

(5) The endoscope according to appendix 1, wherein a substantially central portion of one operation wire is disposed on the treatment instrument swinging table.

1 to 19 relate to an embodiment of the present invention, and FIG. 1 is a diagram illustrating the configuration of an endoscope. Front part front view for explaining the configuration of the front end surface of the front end part Sectional drawing explaining the principal part of an insertion part rotation part The figure explaining the relationship between a slit and a fixed pin The figure explaining the rotation stopper structure Sectional view explaining the rotating stopper structure The figure explaining the positional relationship between the treatment instrument insertion port and the treatment instrument rocking stand operation knob The perspective view explaining the 1st treatment implement rocking stand The figure explaining the rocking | fluctuation state within the observation visual field range of the 1st treatment tool etc. derived | led-out from the 1st treatment tool rocking | fluctuation stand. The figure explaining the 1st treatment tool image etc. which rock | fluctuate an endoscopic image The figure which shows the state which is treating using two treatment tools The figure which shows the endoscopic image which shows the treatment state of FIG. The figure which shows an endoscopic image in the state which rotated the insertion part rotation part 90 degree | times to the left The figure which shows the endoscopic image rotated using the image rotation function Diagram explaining a circular endoscopic image A perspective view explaining other composition of a treatment implement rocking stand The figure explaining the other positional relationship of a treatment tool insertion port and a treatment tool rocking | fluctuation base operation knob. The figure explaining the other rocking | fluctuation state within the observation visual field range of the 1st treatment tool etc. which were derived | led-out from the 1st treatment tool rocking | fluctuation stand. The figure explaining the other rocking | fluctuation state within the observation visual field range of the 1st treatment tool etc. which were derived | led-out from the 1st treatment tool rocking | fluctuation stand.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Endoscope 2 ... Insertion part 3 ... Operation part 5 ... Tip part 9 ... Observation window
13 ... Storage stand storage
14: First treatment instrument swinging table
DESCRIPTION OF SYMBOLS 15 ... 2nd treatment tool rocking | fluctuation stand 17 ... 1st treatment tool penetration channel 18 ... 2nd treatment tool penetration channel 21 ... Insertion part rotation part 53 ... 1st treatment tool
54 ... Second treatment instrument 57a, 57b, 57c, 57d ... Operation wire
60 ... Operation wire insertion channel

Claims (3)

An insertion portion having an observation optical system, in which a treatment instrument insertion channel is formed;
A bending portion disposed on the distal end side of the insertion portion;
A bending operation unit disposed on a proximal end side of the insertion unit and capable of operating the bending unit;
Have
An endoscope characterized in that the insertion portion is provided so as to be rotatable with respect to the bending operation portion.   The endoscope according to claim 1, wherein a rotation operation unit of the insertion unit is disposed on a distal end side of the bending operation unit.   The endoscope according to claim 1, further comprising a rotation fixing unit capable of fixing a rotation state of the insertion unit with respect to the bending operation unit.

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