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WO2018003925A1 - Manipulateur capable de supporter un traitement médical endoscopique, instrument médical muni de celui-ci et procédé d'évaluation de l'aptitude au travail du manipulateur. - Google Patents

Manipulateur capable de supporter un traitement médical endoscopique, instrument médical muni de celui-ci et procédé d'évaluation de l'aptitude au travail du manipulateur. Download PDF

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Publication number
WO2018003925A1
WO2018003925A1 PCT/JP2017/023957 JP2017023957W WO2018003925A1 WO 2018003925 A1 WO2018003925 A1 WO 2018003925A1 JP 2017023957 W JP2017023957 W JP 2017023957W WO 2018003925 A1 WO2018003925 A1 WO 2018003925A1
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WO
WIPO (PCT)
Prior art keywords
manipulator
forceps
bent
bending
medical device
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.)
Ceased
Application number
PCT/JP2017/023957
Other languages
English (en)
Japanese (ja)
Inventor
正隆 中林
冬起 山本
直隆 酒井
和洋 遠藤
尚宏 佐田
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Utsunomiya University
Jichi Medical University
Original Assignee
Utsunomiya University
Jichi Medical University
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Utsunomiya University, Jichi Medical University filed Critical Utsunomiya University
Priority to JP2018525264A priority Critical patent/JP6711969B2/ja
Publication of WO2018003925A1 publication Critical patent/WO2018003925A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/01—Guiding arrangements therefore
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J18/00—Arms
    • B25J18/02—Arms extensible
    • B25J18/04—Arms extensible rotatable

Definitions

  • the present invention relates to a manipulator capable of supporting medical treatment such as a surgical operation and an inspection under a microscope, a medical device provided with the manipulator, and a workability evaluation method for the manipulator.
  • a surgical instrument such as a scope (endoscope) and forceps is inserted into the abdominal cavity without laparotomy, and the affected area is operated under the microscope.
  • Surgical instruments such as a scope and forceps are inserted into the abdominal cavity through a trocar (also referred to as a trocar) inserted into a hole in the abdominal wall.
  • a trocar also referred to as a trocar
  • surgical devices including active robots are actively developed.
  • Patent Document 1 discloses a surgical instrument that includes a hard exterior member and a flexible guide tube that can be bent, and includes an insertion portion that is inserted into the abdominal cavity and an inner cable that extends and contracts the exterior member.
  • the range of the guiding pipe covered by the exterior member changes by expanding and contracting the exterior member according to the use of a surgical instrument such as a camera or forceps attached to the distal end of the insertion portion. Can be straightened, or the tip side can be bent.
  • Laparoscopic surgery using such a surgical tool is performed by inserting a scope and forceps into the abdominal cavity and operating the scope and forceps by different operators.
  • the scope and forceps may be inserted into separate holes or the same hole. Since it is less invasive than perforated surgery in which forceps and scopes are inserted into separate holes, single-hole surgery in which forceps and scopes are inserted into the same hole has attracted attention.
  • the scope and the abdominal cavity are particularly crowded with the scope and forceps because the scope and the plurality of forceps are inserted into the same hole. Then, the forceps and the scope are likely to interfere with each other in the trocar or the abdominal cavity, so that the operation of the forceps and the scope is difficult.
  • the “interference” between the forceps and the scope includes not only the physical contact between the forceps and the scope but also the meaning that the forceps are reflected in the visual field of the scope in front of the affected area.
  • the position of the scope and the forceps needs to be readjusted.
  • the surgeon who operates the forceps and the scopist who operates the scope according to the operator's instructions stand near the trocar, cross their hands, and pay attention to the position and visual field of the forceps from start to finish. And scope operations.
  • Such an operation requires a heavy burden on the surgeon and the scopist and is difficult.
  • the present invention is capable of operating instruments such as a scope and forceps in a desired position and orientation while having a simple structure as compared with a surgery support robot, and interfering between medical devices in a trocar or abdominal cavity. It is an object of the present invention to provide a manipulator that can reduce the burden on the surgeon by avoiding the surgeon, a medical device provided with the manipulator, and a workability evaluation method for the manipulator.
  • the present invention relates to a manipulator that is attached to a medical instrument and passes through a hole communicating with a body cavity and is inserted into the body cavity from the distal end side.
  • a first bendable portion that can be bent at a position, a telescopic portion that can be expanded and contracted on the tip side of the first bent portion, a first bend operating portion that operates the first bent portion, an extendable operation portion that operates the expandable portion, It is characterized by providing.
  • the manipulator of the present invention includes a second bent portion that can be bent on the distal end side with respect to the expandable portion, and a second bending operation portion that operates the second bent portion.
  • the second bent portion bends with one degree of freedom and the second bent portion bends with two degrees of freedom.
  • the manipulator of the present invention includes a rotation operation unit that rotates the penetrating portion around the axis.
  • the instrument is a scope that can receive light from a medical target site or can image the target site.
  • the manipulator of the present invention is preferably used in a single-hole operation performed with a treatment tool attached to a scope and capable of treating a target part being inserted into the same hole.
  • the instrument is preferably a treatment tool capable of treating a medical target site.
  • the manipulator of the present invention preferably includes a plurality of cylinders, and the instrument is disposed inside the cylinder.
  • a manipulator according to the present invention includes a penetrating tube as a penetrating portion, a telescopic tube structure as a telescopic portion that can be bent in the body cavity with respect to the penetrating tube, constitutes a first bent portion, and can extend and contract in length.
  • a penetrating tube as a penetrating portion
  • a telescopic tube structure as a telescopic portion that can be bent in the body cavity with respect to the penetrating tube, constitutes a first bent portion, and can extend and contract in length.
  • the manipulator of the present invention includes a tip portion connected to the stretchable portion, and the tip portion is preferably formed of a flexible material and forms a second bent portion.
  • each of the first bending operation unit, the telescopic operation unit, and the second bending operation unit includes a wire to be pulled.
  • the medical device of the present invention includes the above-described manipulator and a device to which the manipulator is attached.
  • the present invention is a method for evaluating workability of a manipulator inside a model in which a simulated body cavity is present, using the above-described manipulator, and observing a treatment target in the body cavity by a scope to which the manipulator is attached
  • the touch where the tip of one or more medical instruments inserted into the body cavity together with the manipulator in which the first bent portion and the second bent portion are bent in the body cavity contacts the treatment target while changing the contact position.
  • FIG. 1st bending part (A) And (b) is a figure which shows an expansion-contraction part. (A) And (b) is a figure for demonstrating operation
  • FIG. 15 shows the abdominal model used for the 2nd test which performs a pattern touch operation
  • (a) shows a pseudo single hole and (b) shows an axial position.
  • (A) And (b) is a figure which shows the position of the contact object in an abdominal part model.
  • (A) has shown each site
  • (b) has shown the contact stand which is a contact object for a test. It is a figure which shows typically the measuring system for measuring the frequency
  • (A) And (b) is a figure for demonstrating the angle of the forceps contact surface in the contact stand shown in FIG.16 (b), and the position of a scope.
  • (A) shows a linear comparison object
  • (b) shows a bendable medical device of the present invention.
  • (A)-(c) is a figure for demonstrating the pattern touch to the contact pad of a contact stand as work content performed by a 2nd test.
  • (A)-(c) is a figure which shows the difference between the visual field of a comparison object (left figure) and the scope of a bendable scope (this embodiment) as a measurement result of the second test, respectively. is there.
  • (A) And (b) is a figure which shows the measurement result (Comparison 1 and 2 of the measured working time) of a 2nd test. It is a figure which shows the measurement result of a 2nd test (comparison 3 of the measured working time). It is a figure which shows the frequency
  • a medical device 10 shown in FIG. 1 includes a scope (endoscope) 1 and a manipulator 2 that is attached to the scope 1 and can be bent and stretched.
  • the medical device 10 is used for medical acts such as a microscopic operation in which an affected part (surgical unit) located in a body cavity is treated under a microscope, or a microscopic examination in which a predetermined part is observed under a microscope.
  • the “body cavity” is, for example, the abdominal cavity or the chest cavity.
  • a case where the medical device 10 is inserted into the abdominal cavity will be described as an example.
  • the medical device 10 is inserted into the abdominal cavity 9 through a hole 8 ⁇ / b> A that penetrates the inside and outside of the abdominal wall 8.
  • the abdominal wall 8 is provided with a trocar 7 in which a pipe line 7A through which the medical device 10 is passed is formed.
  • the trocar 7 guides the medical device 10 passed through the conduit 7 ⁇ / b> A into the abdominal cavity 9.
  • 7 A of pipe lines may be inside the tube (trocker tube) with which the trocar main body was equipped.
  • a small hole 8A is formed.
  • the inner diameter of the conduit 7A of the trocar 7 is, for example, about 5 to 10 mm.
  • the scope 1 (FIG. 1) is an instrument that obtains an image of the target region (surgical field) of the treatment, and is guided to the vicinity of the affected part in the abdominal cavity 9 by the manipulator 2.
  • the scope 1 may be a fiberscope in which a large number of optical fibers are bundled, or may be a video scope that images an affected area with an imaging element such as a CCD (Charge-Coupled Device) via an objective lens.
  • an observation window through which the distal end of the optical fiber or the objective lens and the imaging element face is provided.
  • the scope 1 is inserted into the abdominal cavity 9 from the outside of the abdominal wall 8 with the manipulator 2 attached.
  • the scope 1 has flexibility, and its shape changes along the manipulator 2.
  • the scope 1 illuminates the affected area in order to obtain an image of the affected area. Therefore, the light emitted from the light source device is supplied to the affected part through the optical fiber for illumination provided in the scope 1.
  • the scope 1 may include a light such as an LED (light emitting diode) as a light source for illuminating the affected area.
  • An illumination window that emits illumination light can be provided in the vicinity of the observation window at the distal end 1A of the scope 1.
  • the image data obtained by the scope 1 is sent to a monitor (not shown). While viewing the image of the affected area displayed on the monitor, the affected area is treated and observed.
  • the manipulator 2 is inserted into the abdominal cavity 9 from the distal end 2A side, and guides the scope 1 to the vicinity of the affected part in the abdominal cavity 9 while bending and expanding / contracting.
  • the base end 2 ⁇ / b> B side of the manipulator 2 is exposed to the outside of the abdominal wall 8.
  • the front end 2A side is referred to as “front”
  • the base end 2B side is referred to as “rear”.
  • the manipulator 2 includes a penetrating tube 201 (penetrating portion) that penetrates the inside of the hole 8A (inside the pipe line 7A), a first bent portion 21 and a second bent portion 22 that can be bent with respect to the penetrating tube 201, and expansion and contraction.
  • a possible expansion / contraction part 23, a first bending part 21, a second bending part 22, and an operation part 30 for operating the expansion / contraction part 23 are provided.
  • the manipulator 2 is connected to a portion that penetrates the inside of the hole 8 ⁇ / b> A (through tube 201), a telescopic tube structure 202 that can be bent and stretchable with respect to the penetrating portion, and a telescopic tube structure 202.
  • a tip tube 203 is provided.
  • These cylinders 201, 202, and 203 accommodate the scope 1 inside and are covered with a flexible outer sheath 205 (FIG. 1).
  • the penetrating cylinder 201 is passed through the pipe line 7A of the trocar 7 and is exposed to both the outer side of the abdominal wall 8 than the pipe line 7A and the inner side of the abdominal wall 8 rather than the pipe line 7A.
  • the upper end side of the through tube 201 exposed to the outside of the abdominal wall 8 can be supported and fixed to a table or the like by a fixing device such as the clamp 5 (FIG. 9).
  • the through cylinder 201 can be fixed so as not to move in either the axial direction or the axial direction by a fixing device such as the clamp 5 or fixed so as not to move only in the axial direction. It may be allowed to move in the direction.
  • the through cylinder 201 and the telescopic cylinder structure 202 are made of a metal material such as stainless steel, for example.
  • the telescopic cylinder structure 202 has a telescopic structure, and includes an outer cylinder 202A that is connected to an end portion of the through cylinder 201 so as to be bent, and an inner cylinder 202B that is connected to the outer cylinder 202A so as to be able to advance and retract. Yes. Almost the entire inner cylinder 202B can be accommodated inside the outer cylinder 202A.
  • the through cylinder 201 and the outer cylinder 202 ⁇ / b> A constitute the first bent part 21, and the outer cylinder 202 ⁇ / b> A and the inner cylinder 202 ⁇ / b> B constitute the expansion / contraction part 23.
  • the distal end tube 203 holds the distal end 1 ⁇ / b> A of the scope 1.
  • the distal end tube 203 is made of a flexible material and can be bent, for example, as shown in FIG.
  • the tip tube 203 functions as the second bent portion 22.
  • a fluorine-based resin material can be used for the distal end tube 203.
  • the first bent portion 21 bends with one degree of freedom
  • the stretchable portion 23 stretches with one degree of freedom in the axial direction of the telescopic cylinder structure 202
  • the second bend portion 22 bends with two degrees of freedom.
  • the stretchable part 23 can be stretched on the tip 2A side with respect to the first bent part 21, and the second bendable part 22 can be bent on the tip 2A side with respect to the stretchable part 23.
  • the manipulator 2 can be rotated around the axis (one degree of freedom) on the proximal end 2B side with respect to the first bent portion 21. Therefore, the manipulator 2 has a total of 5 degrees of freedom.
  • the manipulator 2 can be provided with a rotation operation unit 206 (FIG. 2) that rotates the base end 2 ⁇ / b> B side (through tube 201) around the axis with respect to the first bent portion 21.
  • the operation part 30 (FIG. 1) includes a first bending operation wire 31 (FIG. 1) for operating the first bending part 21, a second bending operation wire 32 (FIG. 6) for operating the second bending part 22, and expansion and contraction.
  • the telescopic operation wire 33 (FIG. 4) which operates the part 23 is provided. Any one of these operation wires 31 to 33 is pulled toward the base end 2B, thereby individually operating the first bent portion 21, the second bent portion 22, and the extendable portion 23.
  • the first bent portion 21 will be described with reference to FIGS. 3 (a) and 3 (b). In FIG. 3 to FIG. 5, the scope 1 is not shown.
  • the through tube 201 and the outer tube 202A of the telescopic tube structure 202 constituting the first bent portion 21 are supported by a hinge 211 (hinge), and as shown in FIG. It is designed to bend.
  • the end portions of the through cylinder 201 and the outer cylinder 202A facing each other are cut obliquely on the inner peripheral side when bent, and the outer peripheral side when bent is connected by a hinge 211.
  • a first bending operation wire 31 is provided at a connecting portion between the through cylinder 201 and the outer cylinder 202A.
  • the first bending operation wire 31 is fixed to the inner peripheral portion of the outer cylinder 202A. From the fixed end 31A to the outer cylinder 202A, the gap between the outer cylinder 202A and the through cylinder 201, and the inside of the through cylinder 201 It is pulled out backwards. It is preferable that an appropriate member for guiding the first bending operation wire 31 is provided on the inner peripheral portion of the through tube 201.
  • the first bending operation wire 31 is pulled out from the proximal end 2B (FIG. 1) of the manipulator 2, and the first bending operation wire 31 can be pulled from the outside of the manipulator 2.
  • the hinge 211 In a free state in which the first bending operation wire 31 is not pulled, the hinge 211 is maintained in a flat state by a spring and a stopper (both not shown) provided on the hinge 211 (FIG. 3A). . At this time, the through cylinder 201 and the outer cylinder 202A extend linearly as a whole.
  • the penetrating cylinder 201 is held by gripping by a scoopist, and as shown in FIG.
  • the part 211 rotates relatively about the axis (bending axis 21A), and the interval between the through cylinder 201 and the outer cylinder 202A is reduced.
  • the outer cylinder 202A on the free end side is bent with respect to the through cylinder 201 so as to be attracted rearward.
  • the angle of bending can be adjusted by changing the length by which the fixed end 31A is retracted according to the magnitude of the force with which the first bending operation wire 31 is pulled.
  • the telescopic tube structure 202 can be bent to an angle substantially perpendicular to the through tube 201. If the first bending operation wire 31 is pulled as it is, the outer cylinder 202 ⁇ / b> A is kept bent with respect to the through cylinder 201 due to the tension of the first bending operation wire 31.
  • the above is merely an example of a structure that can be adopted for the first bent portion 21.
  • An expansion / contraction cylinder structure 202 (outer cylinder 202A) is connected to the through cylinder 201, and the through cylinder 201 and the expansion cylinder structure 202 are linearly extended, and the expansion cylinder structure 202 is bent with respect to the through cylinder 201.
  • the specific structure of the first bent portion 21 can be determined as appropriate.
  • the through tube 201 and the telescopic tube structure 202 are connected with a soft portion made of a flexible material interposed, and the flexible portion is bent by pulling the first bending operation wire 31. By doing so, the telescopic tube structure 202 may be bent with respect to the through tube 201.
  • the expansion / contraction part 23 will be described with reference to FIGS.
  • the outer cylinder 202A is indicated by a one-dot chain line
  • the inner cylinder 202B is indicated by a two-dot chain line.
  • the expansion / contraction cylinder structure 202 functioning as the expansion / contraction part 23 can expand and contract the entire length of the expansion / contraction cylinder structure 202 by pulling the expansion / contraction operation wire 33 and moving the inner cylinder 202B forward / backward with respect to the outer cylinder 202A.
  • channel 231 is formed in the inner cylinder 202B along the length direction.
  • the groove 231 penetrates the inner cylinder 202B in the thickness direction, and a pin 232 is inserted therein.
  • the pin 232 is provided along the radial direction at the front end portion of the outer cylinder 202 ⁇ / b> A, and an extension operation wire 332 is hung on the pin 232.
  • the groove 231 and the pin 232 function as a guide when the inner cylinder 202B is advanced and retracted relative to the outer cylinder 202A, and prevents the inner cylinder 202B from coming out of the outer cylinder 202A.
  • the length of the stroke in which the inner cylinder 202B is advanced and retracted relative to the outer cylinder 202A is equal to the length of the groove 231.
  • the pin 232 around which the extension operation wire 332 is hung is preferably provided so as to be rotatable around an axis and function as a pulley.
  • two grooves 231 are formed in the inner cylinder 202B in parallel, and when both ends of the pin 232 are inserted into the grooves 231, the inner cylinder 202B and the outer cylinder 202A are stabilized by the groove 231 and the pin 232, respectively. It is preferable because it is guided.
  • the contraction operation wire 331 is fixed to the inner peripheral portion of the inner cylinder 202B at a position on the front side of the front end of the groove 231, inside the inner cylinder 202B, inside the outer cylinder 202A, And it is pulled out through the outer side of the penetration cylinder 201 (FIG. 3A).
  • a fixed end 331A of the contracting operation wire 331 to the inner cylinder 202B is indicated by a black circle.
  • the extension operation wire 332 is fixed to the inner peripheral portion of the inner cylinder 202B at a position behind the pin 232.
  • a fixed end 332A to the inner cylinder 202B is indicated by a black circle.
  • the extension operation wire 332 is hooked on the pin 232, folded back toward the rear at the position of the pin 232, and drawn backward through the inside of the outer cylinder 202A and the through cylinder 201.
  • the positions where the operation wires 331 and 332 are arranged in the circumferential direction of the inner cylinder 202B and the outer cylinder 202A are not particularly limited. It is preferable that appropriate members for guiding the contracting operation wire 331 and the extending operation wire 332 are provided on the inner peripheral portions of the inner cylinder 202B and the outer cylinder 202A.
  • the structure described above is merely an example of a structure that can be adopted for the stretchable portion 23.
  • the telescopic cylinder structure 202 can also be composed of an inner cylinder that is bendably connected to the through cylinder 201 and an outer cylinder that is positioned on the outer periphery of the inner cylinder.
  • the expansion / contraction part 23 is not necessarily limited to sliding (advancing / retracting) the two members relatively, and for example, the expansion / contraction part 23 may be configured to be extendable / contractible by a structure such as a bellows or a spiral.
  • the structure of the operation unit that operates the expansion / contraction part 23 is not limited to the expansion / contraction operation wire 33, and instead of the expansion / contraction operation wire 33, for example, a guide tube provided inside the inner cylinder 202B and the outer cylinder 202A. It is also possible to employ a wire that is passed through and pushed and pulled.
  • the rear end side of the support member 204 is inserted inside the front end portion of the inner cylinder 202B, and the protrusion 204A (FIG. 1) of the support member 204 is engaged with the opening of the inner cylinder 202B. Is held on the inner periphery of the.
  • the support member 204 is formed in a cylindrical shape, and receives and holds the rear end side of the distal end tube 203 inside. The inner peripheral portion of the support member 204 and the outer peripheral portion of the tip tube 203 are fixed by an appropriate method.
  • the tip tube 203 protrudes forward from the support member 204.
  • the scope 1 is also disposed inside the distal end tube 203.
  • the distal end tube 203 is provided with a second bending operation wire 32 that bends the distal end tube 203. As shown in FIG. 6A, in a free state where the second bending operation wire 32 is not pulled, the distal end tube 203 extends linearly on an extension line of the axis of the telescopic tube structure 202.
  • a left operation wire 32L, a right operation wire 32R, and a lower operation wire 32D are prepared.
  • the “left and right” direction coincides with the direction of the bending axis 21A (the axis of the hinge 211), and the “up and down” direction is orthogonal to the left and right direction.
  • the left operation wire 32L is fixed to the left end portion of the distal end tube 203, and is drawn into the support member 204 through a path 204B that penetrates the inside and outside of the support member 204 along the radial direction of the support member 204. Yes.
  • the left operation wire 32L passes through the guide tube 330 provided at least at the front end in the telescopic cylinder structure 202 from the inside of the support member 204 and is pulled out rearward.
  • the left operation wire 32L is preferably guided by an appropriate guide member even in the through tube 201.
  • the right operation wire 32R and the lower operation wire 32D are respectively fixed to the distal end tube 203, and pass through the path 204B of the support member 204, the inside of the support member 204, and the guide tube 330, It is pulled out backwards.
  • the distal end tube 203 and the support member 204 including these operation wires 32L, 32R, and 32D are covered with an outer sheath 205 (FIG. 1).
  • the distal end tube 203 When the lower operation wire 32 ⁇ / b> D is pulled backward and retracted, the distal end tube 203 is expanded and contracted as shown in FIG. 6B so that the lower end portion of the distal end tube 203 is attracted to the support member 204. Bend downward with respect to. Following this, the scope 1 also faces downward.
  • the distal end tube 203 can be bent to an angle substantially orthogonal to the axis of the telescopic tube structure 202 or an angle greater than that.
  • the distal end tube 203 is bent leftward, and when the right operation wire 32R is pulled rearward, the distal end tube 203 is bent rightward. To do.
  • the distal end tube 203 can be bent downward and rightward (or leftward).
  • the field of view can be changed so that the distal end 1A of the scope 1 is turned.
  • An upper operation wire that bends the tip tube 203 upward can be provided on the tip tube 203 in the same manner as the lower operation wire 32D.
  • the manipulator 2 since the manipulator 2 extends along the abdominal wall 8 above the affected part 4 in the abdominal cavity 9, it is not necessary to observe the inner wall of the abdominal wall 8 by bending the distal end tube 203 upward.
  • the upper operation wire is omitted.
  • the medical device 10 is suitable for single-hole surgery as will be described later.
  • the first bent portion 21 and the second bent portion 22 are not bent, and the manipulator 2 is kept in a straight state extending linearly.
  • the contraction operation wire 331 FIG. 5A
  • the expansion / contraction part 23 (expandable cylindrical structure 202) may be contracted.
  • the manipulator 2 in a straight state is grasped, and as shown in FIG. 7A, the abdominal cavity 9 is inserted through the conduit 7A of the trocar 7 inserted in the hole 8A opened in a predetermined position of the abdominal wall 8 such as the vicinity of the umbilicus. It inserts in (insertion step S1). A gas is introduced into the abdominal cavity 9 as necessary.
  • the bending axis of the first bending portion 21 is set so that the scope 1 can be accessed to the vicinity of the affected area 4 (FIG. 9) by the subsequent bending and extending operations.
  • the direction of the manipulator 2 around the axis may be appropriately determined in consideration of the position of 21A. In order to easily determine the direction of the manipulator 2 around the axis, it is preferable that the position of the bending shaft 21A is marked on the base end 2B side. In addition, the direction around the axis of the through tube 201 can be corrected or changed later.
  • the first bending operation wire 31 is pulled (FIG. 3B), and the first bending portion 21 within the abdominal cavity 9 as shown in FIG. 7B. Is bent (first bending step S2). Then, the telescopic tube structure 202 bent with respect to the through tube 201 extends along the abdominal wall 8 in the vicinity of the abdominal wall 8 facing the abdominal cavity 9. The bending angle can be adjusted according to the force of pulling the first bending operation wire 31. If the orientation of the manipulator 2 in the direction around the axis is appropriately determined when inserted into the abdominal cavity 9, the telescopic tube structure 202 extends upward above the affected part 4.
  • the manipulator 2 By setting the expansion / contraction part 23 of the manipulator 2 in a short state in advance, the manipulator 2 can be inserted into the abdominal cavity 9 until the front end of the penetrating tube 201 exceeds the duct 7A without interfering with the organ or the like. it can.
  • the first bending operation wire 31 can be pulled by an appropriate method.
  • the operation wire 31 can be pulled by winding the operation wire 31 by a manual operation of the handle or a power source such as a motor. It is preferable to use a device such as a foot pedal for operating the winding of the wire. The same applies to the telescopic operation wire 33 and the second bending operation wire 32.
  • the relative position between the penetrating cylinder 201 penetrating the inside of the conduit 7A of the trocar 7 and the trocar 7 is basically not displaced, and the portion of the manipulator 2 inserted into the abdominal cavity 9 is displaced. Therefore, the portion of the through cylinder 201 exposed above the trocar 7 may be supported and fixed by the clamp 5 when the first bending step S2 is completed.
  • extension operation wire 332 is pulled (FIG. 5B), and as shown in FIG. 8A, the telescopic tube structure 202 is extended along the abdominal wall 8 in the abdominal cavity 9 (extension step S3). . Then, the tip 2 ⁇ / b> A of the manipulator 2 approaches the affected part 4. Depending on the location of the affected part 4, the affected part 4 can be captured in the visual field of the scope 1 as it is.
  • the second bending operation wire 32 (32L, 32R, 32D) is selectively pulled (FIG. 6B), and the distal end tube 203 can be bent as shown in FIG. 8B (second). Bending step S4).
  • the observation window and the illumination window of the scope 1 located at the distal end 2A of the manipulator 2 face downward.
  • an image of the affected part 4 can be obtained by capturing the affected part 4 in the field of view.
  • the manipulator 2 is disposed along the abdominal wall 8 in the abdominal cavity 9, so that the affected part located below the abdominal wall 8 and a wide range around it can be accommodated in the visual field from the vicinity of the abdominal wall 8.
  • the position and orientation of the scope 1 can be adjusted by bending and expanding / contracting the manipulator 2 while confirming the image sent from the scope 1 on the monitor. At this time, if the upper end side of the through tube 201 of the manipulator 2 is not yet fixed, it can be fixed by the clamp 5 or the like. Next, the forceps 6 can be inserted into the abdominal cavity 9 to treat the affected area 4 (forceps insertion step S5).
  • the medical device 10 of the present embodiment includes the manipulator 2 having the first bent portion 21, the stretchable portion 23, and the second bent portion 22, so that the position and orientation of the scope 1 can be determined. Can be guided freely. As a result, the affected part 4 can be reliably captured in the visual field of the scope 1.
  • the treatment can be performed under a mirror view over a wide range. Further, if necessary, if the penetrating cylinder 201 is rotated around the axis manually or by the rotation operation unit 206 (FIG.
  • the manipulator 2 turns around the penetrating cylinder 201, so that it can be viewed in a wider range. Is possible.
  • the medical device 10 of the present embodiment it is possible to sufficiently cover a range (surgical field) that requires access to the scope 1 for the operation.
  • the visual field can be changed by appropriately operating the first bent portion 21, the telescopic portion 23, and the second bent portion 22 of the manipulator 2 or rotating the through tube 201 around the axis as necessary. It can be carried out.
  • the manipulator 2 has a simple structure as compared with the surgery support robot, and the manipulator 2 is directed in a predetermined direction within the abdominal cavity 9 by the bending of the first bending portion 21, and then the telescopic cylinder structure 202 is extended. Based on the basic operation, the position of the manipulator 2 itself in the abdominal cavity 9 can be easily assumed.
  • the manipulator 2 has a simple structure in that it mainly includes a plurality of cylinders 201, 202, 203 and operation wires 31, 32, 33, and can be manufactured at low cost.
  • the manipulator 2 is driven by an operation of pulling the operation wires 31, 32, and 33, for example, the operation wires 31, 32, and 33 having a small diameter can be used as compared with a case where a mechanism for pushing and pulling the wires is employed. . Since the diameters of the operation wires 31, 32, and 33 are small, an empty space in the cylinder in which the operation wires 31, 32, and 33 are accommodated can be made large, so that the outer diameter of the manipulator 2 is thin enough to be able to pass through the trocar 7 A high-performance scope 1 that is configured to have a diameter but tends to increase in diameter can be accommodated in the cylinder of the manipulator 2.
  • the manipulator 2 Since the manipulator 2 is arranged along the abdominal wall 8 in the abdominal cavity 9 because the first bent portion 21 is bent, the manipulator 2 is generally linear as shown by a two-dot chain line in FIG. Compared with the case where it extends, the space vacated in the abdominal cavity 9 can be ensured large. For this reason, even if another medical tool such as forceps 6 for endoscopic surgery is inserted into the abdominal cavity 9, interference between the manipulator 2 and the forceps 6 does not easily occur in the abdominal cavity 9. For example, when the forceps 6 are moved, it is difficult for the manipulator 2 to move and the field of view of the scope 1 to change, and a large movable range of the forceps 6 can be secured.
  • the telescopic cylinder structure 202 extending along the abdominal wall 8 in the abdominal cavity 9 may be extended or contracted, or the direction of the distal end cylinder 203 may be changed. This operation does not move the position of the forceps 6.
  • the forceps 6 are, for example, a grasping forceps for grasping an object, a peeling forceps for peeling a tissue, a scissors-type forceps having a scissor function, and the like. Further, not only the forceps 6 but also a medical instrument such as an electric knife, a clip applier for attaching a clip to a blood vessel, an automatic suturing device, an ultrasonic coagulation incision device, and the like are inserted into the abdominal cavity 9 together with the manipulator 2 for use. Can do.
  • the forceps 6 inserted into the abdominal cavity 9 via the trocar 7 is Magnify in the scope 1's field of view before 4.
  • the 1st bending part 21 is bent and the angle which the manipulator 2 makes with respect to the forceps 6 is large, the interference which the forceps 6 reflects in a visual field does not occur easily. Therefore, the forceps 6 can be easily and reliably accessed to the affected part 4 while sufficiently observing the affected part 4 without being obstructed by the forceps 6.
  • the manipulator 2 has a simple structure as compared with the surgery support robot, and the interference between the manipulator 2 and the forceps 6 can be avoided in that the position of the manipulator 2 itself can be easily assumed.
  • the medical device such as the forceps 6 from the trocar 7 inserted into the same hole 8A in a state where the penetrating cylinder 201 of the manipulator 2 penetrating the pipe line 7A of the trocar 7 is fixed.
  • the trocar 7 is provided with a conduit (for example, see 7B in FIG. 10A) into which a medical tool such as the forceps 6 can be inserted in addition to the conduit 7A.
  • a conduit for example, see 7B in FIG. 10A
  • the trocar 7A into which the manipulator 2 is inserted are separate trocars 7 1 and 7 2. Or is formed.
  • Single-hole surgery is performed by opening a single hole 8A and inserting medical devices such as the scope 1 and forceps 6 into the abdominal cavity 9 from the trocar 7 and the trocars 7 1 and 7 2 located in the hole 8A. That's it.
  • medical devices such as the scope 1 and forceps 6
  • the position of the penetrating cylinder 201 of the manipulator 2 installed in the scope 1 is fixed, as shown in FIG. 11, the area 8A 1 occupied by the manipulator 2 in the hole 8A into which the trocar 7 is inserted and in the vicinity thereof. can allocate space 8A 2 other than (hatched) to other medical devices such as forceps 6.
  • the conduit 7B into which the forceps 6 is inserted is formed separately.
  • the entire region including the adjacent holes 8A and 8A can be considered in the same manner as described above. That is, an area other than the area occupied by the manipulator 2 in the entire area including the holes 8A and 8A is assigned to another medical instrument, and the manipulator 2 and the other medical instrument such as the forceps 6 are operated without affecting each other. However, an appropriate treatment can be easily performed.
  • the medical device 10 is particularly suitable for single-hole surgery in which the manipulator 2 and forceps 6 are congested in the abdominal cavity 9 or the trocar 7, but is also applicable to perforated surgery performed by making holes in a plurality of locations on the abdominal wall 8. can do.
  • the medical device 10 is not limited to single-hole surgery, and is highly effective for preventing interference between medical devices that are crowded in the abdominal cavity 9 or the trocar 7. For example, when a plurality of (for example, two) holes are opened to perform a surgical operation under the microscope, the medical device such as the manipulator 2 or forceps 6 of the medical device 10 used for the operation is crowded in the abdominal cavity 9 or the trocar. Even if it does, interference between medical devices can be prevented. As shown in FIG. 10C, the manipulator 2 and the forceps 6 are inserted in the adjacent holes 8A and 8A, respectively, and even if the axis of the scope 1 and the axis of the forceps 6 are close to each other, Can prevent interference.
  • the position of the manipulator 2 in the trocar 7 (or 7 1 , 7 2 ) is fixed, and an area other than the area occupied by the manipulator 2 is assigned to the forceps 6, so that the scopist who operates the manipulator 2 The chance that the hand and the hand of the operator who operates the forceps 6 intersect each other is reduced. If the position of the manipulator 2 in the trocar 7 is fixed, it is not necessary to grip the manipulator 2. Therefore, it is possible to perform a single-hole operation in which the surgeon operates the manipulator 2 by himself to set the field of view of the scope 1 and then holds the forceps 6 to perform the treatment.
  • FIG. 12 shows a medical device 20 according to a modification of the present invention.
  • the medical device 20 includes a scope 1 and a manipulator 3 attached to the scope 1.
  • the manipulator 3 is different from the above-described manipulator 2 only in that it does not have the second bent portion 22.
  • the manipulator 2 shown in FIG. 12 includes a through cylinder 201, a telescopic cylinder structure 202 (outer cylinder 202 ⁇ / b> A and inner cylinder 202 ⁇ / b> B), and a tip 207 connected to the front side of the telescopic cylinder structure 202.
  • the distal end portion 207 is disposed along the axis of the telescopic cylinder structure 202 and is not bent with respect to the telescopic cylinder structure 202.
  • an observation window and an illumination window of the scope 1 are arranged at the distal end portion 207. These observation window and illumination window are preferably provided at the lower end of the distal end portion 207 when the manipulator 3 extends in the abdominal cavity 9 along the abdominal wall 8. If it does so, the effect similar to when the front-end
  • the manipulator 3 shown in FIG. 12 the manipulator 3 is inserted into the abdominal cavity 9 from the trocar 7, the first bent portion 21 is bent in the abdominal cavity 9, and the extendable portion 23 is extended to the vicinity of the affected portion 4.
  • the affected part 4 located below can be observed from above with the scope 1.
  • observation window and the illumination window of the scope 1 can be provided in the telescopic cylinder structure 202 without connecting the distal end portion 207 to the telescopic cylinder structure 202.
  • observation window and the illumination window of the scope 1 are provided not at the lower end of the distal end portion 207 but at the distal end 2A, and the bending angle is adjusted by the first bending operation wire 31 so that the distal end 2A faces the affected area 4 You may make it set the attitude
  • the manipulator 2 can be configured to have a smaller diameter because the operation wire 32 for operating the distal end portion 207 is not necessary.
  • the medical device of the present invention can also be applied to other medical instruments of the scope 1.
  • the manipulator 12 provided in the medical device shown in FIG. 13 is attached to a flexible forceps 16 operated by a wire.
  • the operation tube 16A of the forceps 16 is accommodated in the penetrating tube 201, the telescopic tube structure 202, and the distal end tube 203 of the manipulator 12, and operates by pulling the operation wire forward and forward of the distal end 12A of the manipulator 12.
  • a jaw 16B of the forceps 16 is disposed.
  • the manipulator 12 is inserted into the abdominal cavity 9 from the trocar 7, the first bent portion 21 is bent, the extendable portion 23 is extended, and further, the second bent portion 22 is bent as necessary. Since the jaw 16B can be guided to a desired position to perform the treatment, a wide surgical field can be covered. In the manipulator 12, the second bent portion 22 can be omitted.
  • the manipulator 12 extends along the abdominal wall 8 in the abdominal cavity 9, interference with other medical instruments inserted into the abdominal cavity 9 from the trocar 7 hardly occurs. Even if the manipulator 12 and the linear scope are inserted into the abdominal cavity 9 from the same trocar 7, the manipulator 12 can be prevented from being reflected in the visual field of the scope.
  • test examples conducted by the inventors of the present invention using the medical device 10 similar to that of the above-described embodiment (FIG. 1) will be described.
  • the manipulator 2 of the medical device 10 is attached to the scope 1.
  • the movable ranges of the first and second bent portions 21 and 22 and the stretchable portion 23 of the medical device 10 (FIG. 1) used in the first test and the second test are as follows.
  • the bending axis 21A is a rotation axis and the through cylinder 201 is
  • the telescopic cylinder structure 202 can be bent up to 90 ° (FIG. 3B). That is, the angle ⁇ 1 (first bending angle) of the bending operation by the first bending portion 21 is 0 ° to 90 °.
  • the minimum length of the telescopic cylinder structure 202 (FIG. 4A) is 120 mm, and the maximum length is 210 mm. Therefore, the expansion / contraction range D (stroke) by the expansion / contraction operation in the axial direction of the expansion / contraction cylinder structure 202 is 90 mm.
  • the medical device 10 is fixed to the position and inclination (posture) assumed to be used by the clamp 5 or the like (FIG. 8A), and the length of the telescopic cylinder structure 202 and the first bending angle ⁇ 1 are both kept constant.
  • the bending angle of the two-degree-of-freedom of the tip tube 203 was confirmed by the illumination light emission angle.
  • a bending angle ⁇ 2a (second downward bending angle) directed downward of the tip tube 203 by measuring an angle formed by a light beam emitted from the tip of the tip tube 203 with respect to an extension line of the axis of the telescopic tube structure 202;
  • a bending angle ⁇ 2b (second left / right bending angle) of the distal end tube 203 directed in the left-right direction can be obtained.
  • the downward bending angle ⁇ 2a (second downward bending angle) is 0 to 120 °, with the position of the extension line of the axis of the telescopic cylinder structure 202 being 0 °.
  • the bending angle ⁇ 2b (second bending angle) in the left-right direction is ⁇ 120 to 120 ° with the position of the extension line of the axis of the telescopic cylinder structure 202 being 0 °.
  • FIG. 14A shows members used for FLS Task one.
  • FLS Task one as shown in FIG. 14A, a peg board 40 to which a plurality of bar-like pegs 41 are fixed, a plurality of rubber rings 42, and a pair of linear gripping forceps 43 are used.
  • a pegboard corresponding to the pegboard 40 shown in FIG. 14A and a pair of grips shown in FIG. A pair of grasping forceps corresponding to the forceps 43 and the same ring 42 as the ring 42 shown in FIG.
  • FIG. 14A and the corresponding member used in the first test is not necessarily the same except for the ring 42, each member used in the first test will be described in the following description. Are denoted by the same reference numerals as those assigned to the corresponding members in FIG.
  • the number of times the ring 42 is gripped and moved between the pegs 41 is “6”, whereas in the first test, the number of times the ring 42 is gripped and moved between the pegs 41 is “3”. It is. Also, in FLS Task one, the user moves the peg 41 by gripping the ring 42 while viewing the image displayed on the monitor screen with the image data obtained from the scope that holds the peg board 40 in the field of view. On the other hand, in the first test, the same operation is performed while viewing the pegboard 40 from the eye lens provided in the medical device 10. Except for these points, the first test complies with FLS Task one.
  • the ring 42 passed through the peg 41 standing on the peg board 40 is gripped by the gripping forceps 43 operated by the subject and moved to a different peg 41.
  • the pegboard 40 is fixed inside the abdomen model 50.
  • a large number of insertion portions 510 into which the grasping forceps 43 can be inserted are prepared over a wide range of the abdominal wall 51 of the abdominal model 50 (FIG. 15).
  • the grasping forceps 43 is inserted into the simulated abdominal cavity 52 inside the abdominal model 50 through the star-shaped opening 511 formed in the insertion portion 510 and held inside the annular holding body 512 of the insertion portion 510. Is done.
  • the grasping forceps 43 and the medical device 10 are inserted into the abdominal cavity 52 from a predetermined insertion portion 510 of the abdominal model 50. At this time, the grasping forceps 43 is inserted into the insertion portion 510 indicated by the broken line in FIG. 15B, and the medical device 10 is inserted into the insertion portion 510 indicated by the alternate long and short dash line in FIG.
  • the positional relationship between the grasping forceps 43 and the medical device 10 in this state is referred to as an axial position.
  • the medical device 10 (FIG. 1) is fixed at a predetermined position and posture by a clamp 5 or the like so that the entire pegboard 40 is accommodated in the visual field of the scope 1.
  • the first bent portion 21 is bent at an appropriate angle within the abdominal cavity 52 with respect to the through tube 201
  • the second bent portion 22 is also bent at an appropriate angle with respect to the expandable portion 23.
  • the second bent portion 22 is bent at least downward.
  • the length of the expansion / contraction part 23 is also adjusted suitably.
  • the subject can grasp the entire image of the pegboard 40 by viewing from the eye lens provided in the scope 1.
  • Subjects consisted of 10 right-handed adult men with no history. Assume that all the subjects are masters of FLSTask one training using the members shown in FIG.
  • the subject moves the ring 42 passed through the peg 41 of the pegboard 40 fixed inside the abdominal model 50 to the other peg 41 by the grasping forceps 43 while checking the image of the pegboard 40. At this time, each ring 42 is moved between the pegs 41 by the grasping forceps 43 according to a predetermined procedure.
  • a measurer different from the subject measures the time required from when the grasping forceps 43 first contacts the ring 42 to the end of a series of operations for moving each ring 42 according to a predetermined procedure.
  • the same test subject performs the same operation as described above using a comparison object 90 (FIG. 18A) simulating a typical rigid endoscope instead of the medical device 10.
  • the time required for the work was measured.
  • the comparison object 90 to be used is one in which the flexible body is integrated with the cylindrical body inside the metallic cylindrical body. Even if the flexible mirror itself is easily deformed, the comparative object 90 is difficult to deform as a whole because the flexible mirror is covered with a cylindrical body formed of a hard material that is difficult to deform.
  • the comparison target 90 is configured linearly along the axis over the entire range inserted into the abdominal cavity 52.
  • the comparison target 90 does not have a function of bending or stretching.
  • the comparison object 90 is inserted into the abdominal cavity 52 from the same insertion portion 510 as that of the medical device 10, and is fixed at a predetermined position and posture by the clamp 5 or the like so that the entire pegboard 40 is in the visual field.
  • the operation of moving each ring 42 between the pegs 41 is performed by a pair of gripping forceps 43 that form an axial position with the comparison object 90.
  • FIG. 14 (b) shows the average time required for work for all subjects when the medical device 10 is used and when the comparison object 90 is used.
  • “Straight” in FIG. 14B means the comparison object 90
  • “Flexion” means the medical device 10 of the present invention that can be bent. The same applies to FIGS. 21 to 23. From FIG. 14B, the required time when the medical device 10 is used is shorter than the required time when the comparison object 90 is used. A significant difference can be observed between the time required for both.
  • the significance probability p is calculated by a significant difference test by a known method for the data group of the comparison object 90 shown in FIG. 14B and the data group of the present invention, and p ⁇ 0.01. Have confirmed. This means that the difference in the measured values between the data groups occurs with a probability exceeding 99%, so that there is sufficient between the measured values of the data group of the comparison target 90 and the measured values of the data group of the present invention. There is a significant difference in reliability.
  • the significance probability p is calculated by the significant difference test between the data groups. When p ⁇ 0.01, the difference in the measured values between the data groups is It is described as “significant”.
  • the workability of the medical device 10 is higher than that of the comparison target 90.
  • the difference in the field of view between when the medical device 10 is used and when the comparison object 90 is used, and the number of contact between the forceps inserted into the abdominal cavity 52 and the medical device are the results of the first test. It is presumed that
  • the second test pattern touch test
  • the workability of the medical device 10 is evaluated through work different from the first test.
  • the distal ends 63A of the pair of forceps 63 (medical instruments) are defined in the patterns P1 to P3 in the abdominal cavity 52 as shown in FIGS. Touch the contact pad.
  • the forceps 63 are crossed. This is based on the assumption that the forceps often cross each other during the operation.
  • the contact table 60 includes a pad installation portion 61 provided with contact pads 601 to 606, and a pedestal 62 that supports the pad installation portion 61.
  • the pedestal 62 includes a box-shaped member 621 to which the pad installation unit 61 is attached, and a plate-shaped member 622 that supports the member 621.
  • the contact pads 601 to 606 are installed on the upper surface side of the pad installation unit 61 at an equal angle with respect to the plane center of the pad installation unit 61 so as to form a circle as a whole.
  • the shape of each contact pad 601 to 606 is not limited, but is circular here.
  • the contact pads 601 to 606 are made of a base material using iron and plating applied to the surface of the base material with brass.
  • the pad installation part 61 and the base 62 are made of wood.
  • the contact pads 601 to 606 are made of a conductor such as metal so that the contact of the forceps 63 with each of the contact pads 601 to 606 can be electrically detected, and the pad installation portion 61 is made of an insulator such as wood. Is preferred.
  • the measurement system 70 used for that purpose includes a device 71 shown in FIG. 17, a personal computer (PC) 76, a forceps 63, and a manipulator 2.
  • PC personal computer
  • the device 71 includes a microcomputer 711 connected to a power source (not shown), a breadboard 712 (substrate), and wiring (not shown) between the microcomputer 711 and the breadboard 712.
  • An LED 75 (Light Emitting Diode) is wired on the breadboard 712.
  • the microcomputer 711 includes an integrated circuit (IC), a memory, and an input / output terminal.
  • a personal computer 76 is connected to the microcomputer 711 by a USB (Universal Serial Bus) cable. Serial communication is possible between the microcomputer 711 and the personal computer 76.
  • USB Universal Serial Bus
  • the forceps 63 and the manipulator 2 in which conductivity is given to the contactable parts are used in the second test.
  • a range that is proximal to the metal distal end 63A and is inserted into the abdominal cavity 52 is covered with a metal film 63B.
  • the metal expandable cylinder structure 202 is not covered with the outer sheath 205 (FIG. 1) and is exposed on the surface of the manipulator 2.
  • the calculation unit of the personal computer 76 makes the number of contact between the forceps 63 and the manipulator 2 based on the electric signal. Count. The contact between the forceps 63 and the manipulator 2 is notified when the LED 75 is turned on when the electric circuit is energized. Therefore, the test is performed while confirming that the circuit is operating normally by turning on the LED 75. Can proceed.
  • the contact table 60 is configured so that the pad placement unit 61 is arranged at a position (AC) assuming a predetermined part of the living organ 200 (here, the liver) shown in FIG. It is fixed to (abdominal cavity 52).
  • the member 622 of the pedestal 62 of the contact table 60 is disposed on a plate 623 (FIG. 16B) provided inside the abdominal model 50 where the target living organ is located.
  • position A corresponds to the left outer lobe area of the liver
  • position B corresponds to the upper right lobe area of the liver
  • position C corresponds to the lower right lobe area of the liver.
  • the contact table 60 is configured to be able to adjust the inclination of the pad installation portion 61.
  • the plate-like portion of the pad installation portion 61 extends substantially horizontally when it is 0 °, which is attached to the abdomen model 50 and parallel to the ground contact surface of the plate 623 on which the pedestal 62 is installed.
  • the pad installation part 61 pivotally supported by the pedestal 62 can be rotated toward the umbilicus side to fix the inclination angle of the pad installation part 61.
  • the second test subjects consisted of 10 adult males with no history, and all of them were masters of FLS Task one training using the members shown in FIG. 14 (a). To do.
  • the subject can grasp the entire image of the contact pads 601 to 606 by confirming the image displayed on the liquid crystal monitor based on the image data obtained from the scope 1.
  • the scope 1 corresponds to a digital video camera.
  • the position of the contact target with which the forceps 63 come into contact, the angle of the pad installation portion 61 with which the forceps 63 come into contact, the insertion position of the forceps 63 and the medical device 10 (or the comparison target 90), and the scope 1 of the medical device 10 The following test conditions are set in order to evaluate workability from each viewpoint of the observation position (or comparison object 90).
  • FIG. 16A shows an example in which the pad installation unit 61 is arranged at the position A.
  • a to C correspond to representative positions in each of a plurality of predetermined parts of the living organ.
  • the inclination angle with respect to the base 62 of the pad installation part 61 can be set to a some angle (45 degrees, 30 degrees, 0 degrees).
  • the medical device 10 including the scope 1 and the pair of forceps 63 are individually inserted into a plurality of insertion portions 510 positioned on the left-right direction axis.
  • This positional relationship is referred to as “Axial position” and is expressed as “Axial”.
  • the insertion portion 510 into which the medical device 10 is inserted is located at the center in the left-right direction in the abdominal model 50, as in the case of the pseudo single hole.
  • the forceps 63 is inserted into the insertion portion 510 (510R) separated from the central insertion portion 510 by a predetermined distance in the right direction, and the insertion portion 510 (leftward from the central insertion portion 510 by the same distance as the right direction). 510L), the forceps 63 is inserted.
  • the pseudo single hole and the axial position described above are also applied to a comparative test using the comparison object 90 (FIG. 18A).
  • the medical device 10 is moved to a predetermined position by the clamp 5 or the like toward the pad installation portion 61 of the contact table 60 installed in the abdominal model 50. Fixed to posture. At this time, the first bent portion 21 is bent with respect to the penetrating tube 201 at an appropriate angle so as to approach the abdominal wall 51 within the abdominal cavity 52, and the second bent portion 22 also has an appropriate angle and orientation with respect to the expandable portion 23.
  • the contact pad 601 to 606 is placed in the field of view of the scope 1 by being separated by a predetermined distance x (55 mm) from the tip of the scope 1 where the observation window is located to the center of the surface of the pad installation portion 61. .
  • the second bent portion 22 is bent at least downward. Moreover, the length of the expansion / contraction part 23 is also adjusted suitably.
  • the comparison object 90 shown in FIG. 18A is also fixed at a predetermined position and posture by the clamp 5 or the like toward the pad installation portion 61. Both the comparison object 90 and the medical device 10 are passed through the same insertion portion 510. Since the comparison target 90 does not bend, it extends linearly within the abdominal cavity 52. In the same manner as described above, the entire contact pads 601 to 606 are placed in the field of view of the comparison object 90 by being separated by a distance x from the tip of the comparison object 90 to the center of the surface of the pad placement unit 61.
  • the distance x is adjusted between the medical device 10 and the comparison object 90 for each of the 45 °, 30 °, and 0 ° angles of the pad installation portion 61.
  • the distance x is adjusted when tilted at 45 °, and even if the tilt angle changes, the medical device 10 and the comparison target 90 remain fixed at a predetermined position and posture, and the test is continued.
  • the pattern touch created by the present inventor will be described as the content of the work performed in the second test.
  • the subject holds the right forceps 63R inserted into the abdominal cavity 52 from the insertion part 510R of the abdominal model 50 with the right hand, and the left forceps 63L inserted into the abdominal cavity 52 from the insertion part 510L of the abdominal model 50 with the left hand. Hold with.
  • the forceps 63R and 63L are sequentially contacted with the pair of contact pads defined in the patterns shown in FIGS. 19 (a) to (c).
  • a series of pattern touch operations are performed.
  • a pair of contact pads having an angle of 180 ° is selected from the contact pads 601 to 606.
  • the forceps 63R and 63L are brought into contact with the pair of contact pads 601 and 604 defined in the initial position pattern shown in FIG. More specifically, the tip 63A of the left forceps 63L is abutted against the contact pad 604 located on the front side (umbilical side), and the tip 63A of the right forceps 63R is placed on the contact pad 601 located on the back side. Strike.
  • the pattern shown in FIG. 19B is determined by moving the forceps 63R and 63L counterclockwise from the state shown in FIG. 19A in the direction shown by the arrow in FIG. 19A.
  • the tip portions 63A of the forceps 63R and 63L are moved to the pair of contact pads 602 and 605. Then, since the distal end portion 63A of the forceps 63R is located on the left side and the distal end portion 63A of the forceps 63L is located on the right side, the forceps 63R and the forceps 63L are crossed. Further, by moving the forceps 63R, 63L counterclockwise in the direction indicated by the arrow in FIG.
  • the forceps are moved to the pair of contact pads 603, 606 defined in the pattern shown in FIG. 19C.
  • the tips 63A of 63R and 63L are moved.
  • FIG. 19A when the tip 63A of the forceps 63R and 63L is placed on the contact pads 603 and 606, the pattern touch operation is completed.
  • the contact of the tip 63A of the forceps 63 with each of the contact pads 601 to 606 is determined based on the visual observation of the image of the contact pads 601 to 606 and the touch transmitted to the hand holding the forceps 63. can do.
  • variable values (parameters) of the test conditions described above the positions (A, B, C) at which the pad placement unit 61 is arranged, the angles (45 °, 30 °, 0 °) of the pad placement unit 61, and forceps 63 and the insertion position (pseudo single hole / axial position) of the medical device 20.
  • the above pattern touch operation is performed for all combinations of these parameters.
  • a test supervisor who is not a subject, uses a stopwatch to insert a pair of forceps 63 into the abdominal cavity 52, and then completes the pattern touch operation described above to place the pair of forceps 63 in the abdominal cavity 52.
  • the time (FIGS. 21 to 22) until it was removed outside was measured.
  • the measurement system described above is performed until the pattern touching operation is completed and the pair of forceps 63 is pulled out of the abdominal cavity 52.
  • 70 (FIG. 17)
  • the total number of times the forceps 63 and the medical device 10 contacted was also measured (FIG. 23).
  • the image of the visual field containing the pad installation part 61 was acquired for every angle of the pad installation part 61 (FIG. 20).
  • FIG. 20 shows the difference in field of view when using the medical device 10 (Flexion) and when using the comparison object 90 (Straight) for each angle (45 °, 30 °, 0 °) of the pad installation part 61. Yes.
  • a black line indicating the outline of the forceps 63 and a white line indicating the outline of the contact pad 601 are added to each image.
  • the difference between the field of view obtained by the medical device 10 and the field of view obtained by the comparison object 90 is based on the bending of the medical device 10.
  • the first bending portion 21 and the second bending portion 22 are bent, so that the scope 1 looks down on the pad installation portion 61 from above. Even when the angle of the installation portion 61 is small as shown in FIGS. 20B and 20C, the pad installation portion 61 can be grasped from the front of the scope 1 almost from the front.
  • the forceps 63 that comes into contact with the contact pads 601 to 606 on the pad setting portion 61 are also observed from substantially above in the field of view even if the angle of the pad setting portion 61 changes. That is, when the medical device 10 is used, a stable field of view is ensured regardless of the posture of the treatment target with which the forceps 63 contacts.
  • the treatment target can be observed almost from the front regardless of the angle, and the reflection of the forceps 6 in the field of view remains at a constant ratio regardless of the angle of the treatment target.
  • a wide and easy-to-see field of view can be secured stably.
  • FIG. 21A shows the required time in each of the case where the medical device 10 is used and the case where the comparison object 90 is used for each position (A to C) in the treatment target.
  • the straight data group at the position A shown in FIG. 21A is a set of all measurement data at the position A where the comparison object 90 is used.
  • the Flexion data group at the position A is a set of all measurement data at the position A where the medical device 10 is used.
  • the data groups of position B and position C and the data groups shown in FIGS. 21B, 22 and 23 are a set of all measurement data satisfying the conditions.
  • the time required for using the medical device 10 is shorter than the time required for using the comparison object 90 (Straight).
  • the bending approach using the medical device 10 is significantly shorter in working time than the linear approach using the comparison object 90, particularly with respect to the position A and the position B.
  • FIG. 21B shows the time required for each of the case where the medical tool 10 is used and the case where the comparison target 90 is used, for each position (Single, Axial) of the forceps 63 with respect to the medical tool 10 or the comparison target 90. ing. 21B, regardless of the position of the forceps 63, the working time is significantly shorter when the medical device 10 is used (Flexion) than when the comparison object 90 is used (Straight).
  • FIG. 22 shows the time required for each of the case where the medical device 10 is used and the case where the comparison object 90 is used, for each angle (0 °, 30 °, 45 °) of the pad installation portion 61.
  • the time required for using the medical device 10 (Flexion) is shorter than the time required for using the comparison object 90 (Straight) for any of the angles 0 °, 30 °, and 45 °.
  • the data group (30 °) with the shortest working time is compared with the data group (45 °) with the longest working time in Flexion
  • the bending approach using the medical device 10 is compared with the comparison target 90.
  • Work time is shorter than the linear approach used. In the comparison of combinations of other straight data groups and flexion data groups, the time required when using the medical device 10 (flexion) is significantly shorter than the time required when using the comparison object 90 (straight). .
  • FIG. 23 shows the number of times of contact with the forceps 63 for each of the case where the medical device 10 is used and the case where the comparison object 90 is used for each position (A to C) in the treatment target. From FIG. 23, when the medical device 10 is used (Flexion), the number of times of contact between the forceps 63 and the medical device 10 is zero. That is, no contact (interference) occurs. On the other hand, when the comparison object 90 is used (Straight), although there is a difference in the number of times depending on the positions A to C, contact between the forceps 63 and the comparison object 90 is at least 20 times and more than 30 times for the positions A and B. Was measured.
  • the measurement result is abbreviate
  • the medical device 10 can be bent in the abdominal cavity 52 based on the measurement results shown from the viewpoints of the difference in field of view, the time required for work, and the number of times of contact. Therefore, regardless of the angle of the treatment target that changes due to body movement or the like, a wide and easy-to-see field of view with less reflection of the forceps 63 can be stably obtained (FIG. 20).
  • the medical device 10 can be disposed in the abdominal cavity 52 while avoiding the periphery of the pair of forceps 63 linearly extending into the abdominal cavity 52, the forceps 63 and the medical device 10 in the abdominal cavity 52 are congested.
  • the distal end portion 63A of the forceps 63 inserted into the abdominal cavity 52 together with the medical device 10 while observing the treatment target (pad placement portion 61) located in the abdominal cavity 52 is contact pads 601 to 606 to be treated.
  • the workability of the medical device 10 is quantitatively evaluated by electrically detecting the number of times the medical device 10 and the forceps 63 are in contact with each other. Can contribute to improving the workability of the medical device 10.
  • the manipulator of the present invention includes at least a penetrating portion penetrating the inside of the hole, a first bent portion that can be bent in the body cavity with respect to the penetrating portion, and an extendable portion that can be expanded and contracted on the distal side of the first bent portion.
  • first bending operation section for operating the first bending section and the expansion / contraction operation section for operating the expansion / contraction section are provided, addition of components and modification of a specific structure are allowed.
  • the manipulator of the present invention may include a third bent portion or a fourth bent portion in addition to the first bent portion and the second bent portion.
  • the third bent portion can be disposed between the first bent portion 21 and the second bent portion 22 or on the tip side of the second bent portion 22.
  • an extendable / contractible part can be disposed between the third bent part and the second bent part.
  • the manipulator of the present invention is sufficient if it includes at least one bent portion and at least one stretchable portion, and the number of bent portions and the number of stretchable portions are not limited.
  • the manipulator 2 is held by the clamp 5, but this is only an example.
  • the manipulator 2 of the present invention can be configured as a handheld type that is held by hand, supports the manipulator 2 by an arm device, and changes the posture of the manipulator 2 by operating the arm device.
  • the bent state of the two bent portions 21 and 22 and the length of the stretchable portion 23 can be adjusted.

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  • Health & Medical Sciences (AREA)
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  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Molecular Biology (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biophysics (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Optics & Photonics (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Robotics (AREA)
  • Mechanical Engineering (AREA)
  • Endoscopes (AREA)
  • Surgical Instruments (AREA)

Abstract

L'objectif de cette invention est de fournir un manipulateur avec lequel il est possible pour un instrument, tel qu'un scope ou un forceps, d'être manipulé dans la direction souhaitée, et avec lequel l'interaction entre des instruments médicaux dans un trocart, ou dans la cavité abdominale peut être évitée, réduisant ainsi la charge sur le chirurgien. Un autre objectif est de munir un instrument médical du manipulateur, et de développer une procédure d'évaluation des fonctions du manipulateur. Un manipulateur (2) est monté sur un cadre (1), l'extrémité distale est insérée dans la cavité abdominale (9), à travers une ouverture (8A) communicant avec l'intérieur de la cavité abdominale (9). Le manipulateur (2) est pourvu d'un tube (201) qui pénètre à l'intérieur de l'ouverture (8A), d'une première partie coudée (21) pouvant être pliée à l'intérieur de la cavité abdominale (9), d'une extension qui s'étend et se rétracte à l'extrémité distale de la première partie courbée, d'un fil de manipulation de courbure pour manipuler la partie courbée et d'un fil de manipulation d'extension et de rétraction pour manipuler l'extension et la rétraction.
PCT/JP2017/023957 2016-06-30 2017-06-29 Manipulateur capable de supporter un traitement médical endoscopique, instrument médical muni de celui-ci et procédé d'évaluation de l'aptitude au travail du manipulateur. Ceased WO2018003925A1 (fr)

Priority Applications (1)

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JP2018525264A JP6711969B2 (ja) 2016-06-30 2017-06-29 鏡視下医療を支援可能なマニピュレータ、それを備えた医療用具、およびマニピュレータの作業性評価方法

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JP2016-130545 2016-06-30

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GB2569177A (en) * 2017-12-08 2019-06-12 Surgerytech Aps Device
JP2019128206A (ja) * 2018-01-23 2019-08-01 浜松ホトニクス株式会社 断層撮影装置
JPWO2021049345A1 (fr) * 2019-09-13 2021-03-18
USD918387S1 (en) 2019-03-05 2021-05-04 Surgery-Tech Aps Medical device
CN115666364A (zh) * 2020-05-26 2023-01-31 苏比尔·雷 用于腹腔镜进入和伤口闭合的设备和方法
WO2023174093A1 (fr) * 2022-03-17 2023-09-21 微创优通医疗科技(嘉兴)有限公司 Mécanisme de commande et de verrouillage de courbure de poignée, poignée d'endoscope et système d'endoscope
WO2023181999A1 (fr) * 2022-03-25 2023-09-28 国立大学法人東北大学 Ensemble endoscope et dispositif d'aide au fonctionnement d'outil pour le traitement ou la chirurgie
WO2025137560A1 (fr) * 2023-12-21 2025-06-26 Verathon Inc. Arbre de dispositif médical à rigidité variable

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US11229347B2 (en) 2017-12-08 2022-01-25 Surgerytech Aps Endoscopy system
GB2569177B (en) * 2017-12-08 2019-12-04 Surgerytech Aps Endoscope system
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CN115666364A (zh) * 2020-05-26 2023-01-31 苏比尔·雷 用于腹腔镜进入和伤口闭合的设备和方法
WO2023174093A1 (fr) * 2022-03-17 2023-09-21 微创优通医疗科技(嘉兴)有限公司 Mécanisme de commande et de verrouillage de courbure de poignée, poignée d'endoscope et système d'endoscope
WO2023181999A1 (fr) * 2022-03-25 2023-09-28 国立大学法人東北大学 Ensemble endoscope et dispositif d'aide au fonctionnement d'outil pour le traitement ou la chirurgie
WO2025137560A1 (fr) * 2023-12-21 2025-06-26 Verathon Inc. Arbre de dispositif médical à rigidité variable

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