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WO2018147224A1 - Dispositif endoscopique - Google Patents

Dispositif endoscopique Download PDF

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Publication number
WO2018147224A1
WO2018147224A1 PCT/JP2018/003801 JP2018003801W WO2018147224A1 WO 2018147224 A1 WO2018147224 A1 WO 2018147224A1 JP 2018003801 W JP2018003801 W JP 2018003801W WO 2018147224 A1 WO2018147224 A1 WO 2018147224A1
Authority
WO
WIPO (PCT)
Prior art keywords
endoscope
retractor
locking
diameter
seat surface
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/JP2018/003801
Other languages
English (en)
Japanese (ja)
Inventor
宮城　邦彦
三澤　雅幸
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.)
JIMRO Co Ltd
Original Assignee
JIMRO Co Ltd
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 JIMRO Co Ltd filed Critical JIMRO Co Ltd
Publication of WO2018147224A1 publication Critical patent/WO2018147224A1/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
    • 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
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • G—PHYSICS
    • G02—OPTICS
    • G02B—OPTICAL ELEMENTS, SYSTEMS OR APPARATUS
    • G02B23/00—Telescopes, e.g. binoculars; Periscopes; Instruments for viewing the inside of hollow bodies; Viewfinders; Optical aiming or sighting devices
    • G02B23/24—Instruments or systems for viewing the inside of hollow bodies, e.g. fibrescopes

Definitions

  • the present invention relates to an endoscope apparatus that can be operated while inserting an endoscope into a body and observing a surgical field, and more particularly, to an endoscope apparatus that secures a cylindrical insertion space with a cylindrical retractor.
  • Patent Document 1 a small hole is made in a patient's body, and a tubular retractor is inserted into the hole to ensure the size of the hole. Insert a surgical instrument such as an endoscope or forceps into the retractor, and perform the procedure while observing the surgical field with the endoscope.
  • a surgical instrument such as an endoscope or forceps
  • an object of the present invention is to improve the operability of an endoscope by allowing the angle of a retractor to be freely adjusted.
  • the present invention is an endoscope apparatus capable of observing the surgical field in the back of the cylindrical insertion space by securing a cylindrical insertion space in the body, An endoscope, a retractor, and a connection support member that supports the retractor by connecting it to support means;
  • the retractor includes a cylindrical portion through which the endoscope and a surgical instrument are inserted, and a supported portion provided on an outer periphery of the cylindrical portion, and an outer peripheral surface of the supported portion is spherical.
  • the connection support member has a concave spherical support seat surface that receives the supported portion.
  • a spherical joint is constituted by the concave spherical support seat surface and the spherical supported portion.
  • the retractor can be freely rotated in all directions, front, back, left, and right to adjust the direction.
  • the operability of the endoscope can be improved, and the degree of freedom of endoscopic surgery can be increased.
  • the diameter of the insertion side peripheral edge that should face the insertion tip side of the endoscope on the support seat surface is smaller than the diameter of the proximal side peripheral edge that should face the hand side of the endoscope on the support seat surface. .
  • the support seat surface of the connection support member can receive and support the supported portion of the retractor from the insertion tip side.
  • the connection support member includes a first half support body having a half portion of the support seat surface, a second half support body having a remaining half portion of the support seat surface, and the support seat surface being expanded and contracted.
  • an opening / closing means for opening and closing the first half support and the second half support.
  • the opening / closing means An opening adjustment knob for opening and closing the first half support body and the second half support body between a loose position where the retractor can be attached and detached and a closed position where the retractor is fixed; An opening preventing portion for preventing further operation from the loosened position by the opening adjustment knob to the open side; Including In the loosened position, the diameter of the peripheral edge on the proximal side that should face the proximal side of the endoscope on the support seat surface is larger than the outer diameter of the supported portion, and the insertion of the endoscope on the support seat surface It is preferable that the diameter of the insertion side peripheral edge that should face the distal end side is smaller than the outer diameter of the supported portion.
  • the angle of the retractor, and thus the angle of the endoscope can be fixed.
  • the retractor By setting the first and second halved supports to the loose position, the retractor can be pulled out from the connection support member to the hand side. In addition, the retractor can be prevented from falling through the support seat when in the loose position.
  • the first and second halved supports can be opened only to the loosened position depending on the operation of the opening preventing portion, and the retractor can be reliably prevented from falling through the support seat surface.
  • the opening / closing means further includes a lock knob operable between a locked position and an unlocked position;
  • the lock knob When the lock knob is in the locked position, the first half support body and the second half support body are locked in a closed state including the loosened position and the closed position,
  • the lock knob When the lock knob is in the unlock position, it is preferable that the first half support and the second half support are released from the closed state and can be opened and closed.
  • a lock knob operable between a locked position and an unlocked position
  • the first half support body and the second half support body are locked in a closed state including the loosened position and the closed position
  • the lock knob When the lock knob is in the unlock position, it is preferable that the first half support and the second half support are released from the closed state and can be opened and closed.
  • a lock knob In order to open the first and second halved supports further from the loosened position, it is necessary to operate a lock knob different from that used when opening and closing between the loosened position and the closed
  • the endoscope apparatus further includes a holder for holding the endoscope so that the position of the endoscope can be adjusted in the axial direction between the protruding position and the retracted position with respect to the retractor, In the protruding position, the distal end of the insertion portion of the endoscope is projected from the distal end of the retractor, In the retracted position, it is preferable that the distal end of the insertion portion is retracted into the retractor.
  • the retractor is inserted into the patient's body while the distal end portion of the endoscope is retracted into the cylindrical portion and observed with the endoscope, and then the distal end portion of the endoscope is Endoscopic surgery can be performed by protruding from the part.
  • the endoscopic device further comprises a holder for holding the endoscope detachably with respect to the retractor,
  • the holder is A holder body having an engagement wall;
  • a locking member provided so as to be displaceable with respect to the holder main body between a locking position locked with the endoscope and a locking release position where the locking is released;
  • the locking member at the locking position is elastically engaged with the engagement wall and is urged in a direction from the locking release position toward the locking position by an elastic restoring force of the engagement wall.
  • the elastic engagement is released at the locking release position.
  • the locking member at the locking position can be securely locked by being elastically pressed against the endoscope. There is no need to use a coil spring or a leaf spring as the biasing means, and cleaning and the like can be facilitated.
  • the cylindrical portion includes a large-diameter cylindrical portion and a small-diameter cylindrical portion continuous with the large-diameter cylindrical portion and having a smaller diameter than the large-diameter cylindrical portion, and the insertion portion of the endoscope is inserted into the small-diameter cylindrical portion. It is preferred that A surgical instrument such as forceps can be inserted through the large-diameter tube portion. Rather than making the whole cylinder part circular, a cylinder part can be made into a small cross section.
  • the angle of the retractor can be freely adjusted in all directions, and the operability of the endoscope can be improved.
  • FIG. 1 is a side view schematically showing a state in which treatment is performed using an endoscope apparatus according to an embodiment of the present invention.
  • FIG. 2 is a front view of the endoscope apparatus.
  • FIG. 3 is a side view of the endoscope apparatus.
  • FIG. 4 is an exploded perspective view of the endoscope apparatus.
  • Fig.5 (a) is a side view which shows the hand side part (upper part) of the said endoscope apparatus in the latch release position and a partial cross section.
  • FIG. 5B is an enlarged cross-sectional view of the circle portion Vb in FIG.
  • FIG. 6A is a cross-sectional side view showing the endoscope apparatus with the locking member at the locking position and the endoscope at the protruding position.
  • FIG. 6B is a cross-sectional side view showing the endoscope apparatus with the locking member in the locking position and the endoscope in the retracted position.
  • FIG. 7 is an enlarged side cross-sectional view showing a part of the endoscope apparatus in FIG.
  • FIG. 8 is a plan sectional view taken along line VIII-VIII in FIG.
  • FIG. 9 is a bottom view taken along the line IX-IX in FIG. 3, showing the distal end portion of the endoscope apparatus in an enlarged manner.
  • FIG. 10 is a cross-sectional view of the distal end portion of the endoscope apparatus taken along line XX of FIG.
  • FIG. 11 is an arrow view along the line XX in FIG.
  • FIG. 12 is a view taken along the line XII-XII in FIG. 11 showing the distal end portion of the endoscope distal end cleaning nozzle 42.
  • 13 is a cross-sectional view taken along line XIII-XIII in FIG.
  • FIG. 14A is a plan view taken along the line XIVa-XIVa of FIG. 3, showing the connection support member of the endoscope apparatus in the closed position.
  • FIG. 14B is a plan view showing the connection support member in a loose position.
  • FIG. 15A is a front cross-sectional view taken by rotating the cross section along the XVa-XVa line in FIG.
  • FIG. 14A by 90 degrees with the connecting support member in the closed position and the retractor in a vertical state.
  • FIG. FIG. 15B is a front cross-sectional view in a state where the connecting support member is in the closed position and the retractor is inclined.
  • FIG. 16A is a front cross-sectional view showing a state where the connection support member is in a loosened position and a supported portion is taken in and out.
  • FIG. 16B is a front cross-sectional view of a state where the connection support member is in a loose position and the supported portion is seated on the support seat surface.
  • FIG. 17A is a side view of a part of the connection support member along the line XVIIa-XVIIa in FIG.
  • FIG. 14A showing the bolt head (lock knob) of the bolt nut unit in the locked position.
  • FIG. 17B is a side view showing the bolt head in the unlocked position.
  • FIG. 18A is a cross-sectional view of the bolt / nut unit (opening / closing means) taken along the line XVIIIa-XVIIIa of FIG. 14A when the connecting support member is in the closed position.
  • FIG. 18B is a cross-sectional view of the bolt / nut unit along the line XVIIIb-XVIIIb in FIG.
  • FIG. 19A is a cross-sectional view of the bolt and nut unit taken along the line XIXa-XIXa in FIG. 14B when the connection support member is in the loosened position.
  • FIG. 19A is a cross-sectional view of the bolt and nut unit taken along the line XIXa-XIXa in FIG. 14B when the connection support member is in the loosened position.
  • FIG. 19B is a cross-sectional view of the bolt / nut unit along the line XIXb-XIXb in FIG. Fig.20 (a) is sectional drawing which shows the 1st step in lock release operation of a volt
  • FIG. 20B is a sectional view taken along line XX-XXb in FIG. Fig.21 (a) is sectional drawing which shows the 2nd step in lock release operation of a volt
  • FIG. 21B is a cross-sectional view taken along line XXI-XXIb in FIG.
  • FIG. 22A is a cross-sectional view showing a third stage in the unlocking operation of the bolt and nut unit.
  • FIG. 22B is a cross-sectional view taken along line XXII-XXIIb in FIG.
  • FIG. 23 is a plan view showing the connection support member in a state in which the closed state is released.
  • the endoscope apparatus 1 is a joint endoscope apparatus used for the treatment (including surgery) of joint diseases such as intervertebral disc herniation and spinal stenosis.
  • a flexible arm 5 (supporting means) extends from or near the operating table.
  • the endoscope device 1 is supported at the tip of the flexible arm 5.
  • the distal end portion of the endoscope apparatus 1 is inserted toward the surgical field 9a in the body of the patient 9 schematically shown in FIG.
  • the endoscope apparatus 1 includes an endoscope 10, a retractor 20, a holder 30, a nozzle unit 40, and a connection support member 50. These members 10 to 50 can be disassembled and assembled with each other. In the following description, the endoscope apparatus 1 is assumed to be in an assembled state unless otherwise specified.
  • the endoscope 10 is a perspective and rigid endoscope, and includes a hand portion 11 and a rigid insertion portion 12. An eyepiece 13 and a light connector 16 are provided on the hand portion 11.
  • the insertion portion 12 extends straight from the hand portion 11 to the insertion distal end side (downward in FIG. 4). As shown in FIG. 10, the distal end surface 12 e of the insertion portion 12 is inclined with respect to a plane orthogonal to the axis L 12 of the insertion portion 12.
  • the direction (the left-right direction in FIG. 2 and the direction perpendicular to the plane of FIG. 10) perpendicular to the tilt direction along the tip surface 12e is referred to as “width direction”.
  • the side of the distal end surface 12e is facing is referred to as "front side” or “forward”
  • the opposite side is referred to as “rear side” or “rear” or “back”.
  • the proximal side is referred to as “upper side in FIG.
  • the endoscope 10 shown in FIG. 3 is directed obliquely under and forward with respect to the axis L 12.
  • the outer tube 12a of the insertion portion 12 is made of metal and has a straight cylindrical shape.
  • a distal end edge (lower end edge) of the outer tube 12a is slanted and constitutes an outer edge of the inclined distal end surface 12e.
  • the image transmission means 14 and the illumination light transmission means 15 are accommodated in the outer tube 12a.
  • the image transmission means 14 includes an image transmission tube 14a and an objective lens 14b.
  • Image transfer pipe 14a is made of metal, and extends straight along the axis L 12.
  • An objective lens 14b is provided at the distal end (lower end) of the image transmission tube 14a.
  • the distal end surface of the objective lens 14b and the distal end edge of the image transmission tube 14a are slanted to form the central portion of the inclined distal end surface 12e.
  • a relay lens or the like is appropriately accommodated inside the image transmission tube 14a.
  • the proximal end (upper end) of the image transmission means 14 is optically connected to the eyepiece 13.
  • the camera head 7 is connected to the eyepiece unit 13.
  • a monitor 8 is connected to the camera head 7.
  • the image light in the observation visual field 1r is transmitted from the objective lens 14b through the image transmission tube 14a to the eyepiece unit 13, and is converted in the camera head 7 and the monitor 8. As a result, the image of the observation visual field 1r is projected on the monitor 8.
  • the illumination light transmission means 15 is configured by a bundle of optical fibers, and is accommodated in an annular space between the outer tube 12a of the insertion portion 12 and the image transmission tube 14a.
  • the distal end portion (lower end portion) of the illumination light transmission means 15 is bent so as to face the tilt direction of the observation visual field 1r.
  • An annular portion between the outer edge and the central portion of the inclined distal end surface 12e is constituted by the distal end surface (lower end surface) of the illumination light transmitting means 15.
  • the hand side (upper end part) of the illumination light transmission means 15 is optically connected to the light connector 16 of the hand part 11.
  • the illumination light source 6 is connected to the light connector 16. Illumination light from the illumination light source 6 travels through the illumination light transmission means 15 and is irradiated obliquely from the tip of the illumination light transmission means 15 to the observation visual field 1r. Thereby, the observation visual field 1r can be illuminated.
  • the retractor 20 includes a cylindrical portion 22 and a supported portion 25.
  • Tubular portion 22 is constituted by a metallic tube, and extends straight along the axis L 12.
  • the cylindrical portion 22 includes a large diameter cylindrical portion 22a and a small diameter cylindrical portion 22b.
  • the small diameter cylindrical portion 22b has a smaller diameter than the large diameter cylindrical portion 22a.
  • the cylindrical portions 22a and 22b are integrally connected to each other, so that the cylindrical portion 22 has a cross-sectional shape having a double circle with different diameters.
  • the small-diameter cylindrical portion 22b projects to the rear side in the circumferential direction of the large-diameter cylindrical portion 22a (right side in FIG.
  • the endoscope 10 is inserted into the small diameter cylindrical portion 22b of the cylindrical portion 22.
  • a surgical instrument such as the forceps 2 is inserted through the large-diameter cylindrical portion 22a.
  • a supported portion 25 is provided on the outer periphery near the upper end of the cylindrical portion 22.
  • the supported portion 25 is made of metal.
  • the outer peripheral surface of the supported portion 25 is spherical.
  • the cylinder part 22 penetrates the supported part 25 up and down. A portion of the cylindrical portion 22 above the supported portion 25 is short, and a portion below the supported portion 25 is long.
  • the holder 30 is disposed above the supported portion 25.
  • the endoscope 10 is connected to the retractor 20 via the holder 30.
  • the holder 30 includes a holder main body 30x and a locking member 34.
  • the holder main body 30x includes a horizontal clamp part 31 and a vertical columnar part 32, and is L-shaped in a side view.
  • the material of the holder body 30x is preferably a resin having a desired elasticity.
  • the clamp part 31 is extended in the front-back direction, and a pair of clamp plates 31a and 31b are provided in the front-end part.
  • the clamp plates 31a and 31b are opposed to each other in the width direction (left and right in FIG. 2), and protrude forward (leftward in FIG. 3) from the clamp portion 31.
  • a portion of the cylindrical portion 22 above the supported portion 25 is sandwiched between the clamp plates 31a and 31b.
  • a semicircular recess 31c into which the cylindrical portion 22 is fitted is formed on the opposing surfaces of the clamp plates 31a and 31b.
  • the front end portions (the left end portion in FIG. 3) of the clamp plates 31 a and 31 b are connected by a clamp connection pin 35.
  • a clamp knob 33 is provided on the clamp plate 31b on one side.
  • the clamp knob 33 is coupled to the clamp coupling pin 35 and is rotatable between the clamp position (solid line in FIG. 3) and the release position (two-dot chain line in FIG. 3) around the axis of the coupling pin 35. Yes.
  • a cam mechanism is provided at a connecting portion between the clamp knob 33 and the connecting pin 35.
  • the clamp plates 31a and 31b are approached and the cylindrical portion 22 is gripped.
  • the clamp knob 33 By setting the clamp knob 33 to the release position (two-dot chain line in FIG. 3), the clamp plates 31a and 31b are separated from each other, and the cylindrical portion 22 can be attached and detached.
  • a columnar portion 32 is connected to the rear end portion (right end portion in FIG. 3) of the clamp portion 31.
  • the columnar portion 32 protrudes upward from the rear end portion of the clamp portion 31.
  • the columnar portion 32 is arranged so as to be shifted to the rear side (right side in FIG. 3) of the retractor 20.
  • the endoscope 10 is held by the columnar portion 32 so as to be detachable and adjustable in height.
  • the hand portion 11 of the endoscope 10 is fitted to the upper end portion of the columnar portion 32.
  • the hanging protrusion 11v of the hand portion 11 is inserted into the vertical hole 32v of the columnar portion 32.
  • the insertion part 12 is arrange
  • FIG. 6A two (a plurality of) locking concave portions 11 b and 11 d are formed on the back surface of the hand portion 11 of the endoscope 10.
  • a plurality of locking recesses 11b, 11d are spaced apart one above the other (the axis L 12 parallel to direction).
  • both side surfaces in the width direction (upper and lower in the figure) of the upper locking recess 11b are slopes that spread toward the rear (right in the figure) opening.
  • the back portion of the columnar portion 32 has a housing recess 32b that opens rearward, and has a U-shaped cross section.
  • the locking member 34 is accommodated in the accommodating recess 32b.
  • the locking member 34 has a shape in which the central portion is bent into a generally “ ⁇ ” shape in a side view.
  • the upper end portion of the locking member 34 protrudes above the columnar portion 32.
  • a locking claw 34 b is formed at the upper end of the locking member 34.
  • both side surfaces of the locking claw 34b in the width direction (upper and lower in the figure) are inclined surfaces that approach each other as they protrude forward (leftward in the figure).
  • the central part of the locking member 34 is connected to the columnar part 32 via a locking connection pin 36. Further, the locking member 34 is rotatable (displaceable) between the locking position (FIG. 6A) and the locking release position (FIG. 5A) around the locking connection pin 36. ing.
  • the locking member 34 at the unlocking position is unlocked with respect to the endoscope 10. That is, the locking claw 34b comes off from the locking recesses 11b and 11d. *
  • the locking member 34 at the locking position is locked with the endoscope 10.
  • the locking claw 34b is locked to one of the locking recesses 11b and 11d.
  • the distal end portion (lower end portion) of the insertion portion 12 is slightly protruded from the distal end portion of the retractor 20.
  • the endoscope 10 is in the protruding position.
  • the endoscope 10 in the state where the locking claw 34 b is locked in the lower locking recess 11 d, the distal end portion of the insertion portion 12 is located inside the retractor 20 rather than the distal end portion of the retractor 20.
  • the endoscope 10 is in the retracted position.
  • Engagement recess 11b for locking the locking claw 34b by selecting 11d, the endoscope 10, is movable back and forth (position adjustable) in two steps along the axis L 12 with respect to the retractor 20 .
  • the height difference between the locking recesses 11b and 11d, and hence the height difference between the retracted position and the protruding position is, for example, about several mm to several tens of mm.
  • the back wall 32w engagement wall that separates the housing recess 32b and the vertical hole 32v at the back of the columnar portion 32 is cantilevered with its upper end released. It can be deformed.
  • a wall projection 32d is formed on the back surface of the back wall 32w.
  • an engaging projection 34d is formed at the center of the front surface of the locking member 34.
  • the engaging protrusion 34d is positioned above the wall protrusion 32d.
  • the back wall 32w is not elastically deformed and is in a vertical neutral state. The elastic engagement between the locking member 34 and the back wall 32w is released.
  • the nozzle unit 40 is further held by the holder 30.
  • the nozzle unit 40 includes a head portion 41 and nozzles 42 and 43.
  • the head portion 41 includes a body 41a and two (plural) tube connectors 41b and 41d, and is formed in a substantially T shape in a front view.
  • the material of the head portion 41 is preferably made of a metal having a known or low influence on the living body, such as stainless steel. Note that a resin may be used as the material of the head portion 41.
  • a vertical groove 41c is formed at the center in the width direction on the front surface of the body 41a. Flutes 41c extend straight along the axis L 12.
  • the body 41a is detachably fixed to the front side portion (front side in FIG. 2) of the columnar portion 32 of the holder 30.
  • the hand portion 11 of the endoscope 10 covers the upper side of the body 41a.
  • the insertion portion 12 is passed through the vertical groove 41c.
  • a body 41 a is sandwiched between the insertion portion 12 and the columnar portion 32.
  • tube connectors 41b and 41d are provided so as to protrude from both side portions on the upper side of the body 41a.
  • a cleaning liquid supply tube 4b is connected to the endoscope cleaning tube connector 41b.
  • the upstream end of the cleaning liquid supply tube 4b is connected to a supply source of the cleaning liquid 4w.
  • the cleaning liquid 4w may be a physiological saline solution or a chemical solution.
  • the auxiliary tube 4d is connected to the auxiliary tube connector 41d.
  • two nozzles 42 and 43 are connected to the body 41a. These nozzles 42 and 43 are made of a metal tube such as stainless steel. As shown in FIG. 2, the upper end portion of the endoscope tip cleaning nozzle 42 is connected to the endoscope cleaning tube connector 41b inside the body 41a. And the upper end part of the auxiliary nozzle 43 is continued to the auxiliary tube connector 41d. As shown in FIG. 4, the nozzles 42 and 43 are aligned in the width direction and extend straight from the body 41 a downward (in the insertion tip direction) in parallel with the insertion portion 12.
  • the nozzles 42 and 43 are inserted into the small diameter cylindrical portion 22 b of the cylindrical portion 22 together with the insertion portion 12.
  • the nozzles 42 and 43 are disposed on both sides in the width direction (up and down in the figure) and obliquely forward (left in the figure) with respect to the insertion portion 12.
  • the nozzles 42 and 43 are disposed at positions symmetrical to each other with respect to a center line that extends forward and backward (left and right in FIG. 9) through the insertion portion 12.
  • the tip portions (lower end portions) of the nozzles 42 and 43 reach near the tip portion of the insertion portion 12.
  • the tip portions of the nozzles 42 and 43 slightly protrude from the tip portion of the retractor 20 at the protruding position.
  • the tip portions of the nozzles 42 and 43 are slightly retracted into the retractor 20.
  • the nozzle unit 40 cleaning means including the endoscope front end cleaning nozzle 42 has a function of cleaning the front end surface 12e.
  • a tip piece 45 tip portion is provided at the tip portion (lower end portion) of the endoscope tip cleaning nozzle 42. Tip of the distal end piece 45 and thus the endoscope tip washing nozzle 42 is projected slightly distal end side of the axis L 12 to (lower) than the insertion portion 12.
  • the tip piece 45 is arranged on the side in the width direction orthogonal to the tilt direction of the tip surface 12 e of the insertion portion 12 or on the diagonal side (here, diagonally forward (lower left in the figure)). Yes.
  • the distal end piece 45 and the distal end surface of the endoscope distal end cleaning nozzle 42 are blocked.
  • two (a plurality of) discharge holes 45 a are formed on the side of the peripheral surface of the tip piece 45 facing the tip surface 12 e.
  • the discharge hole 45a has a slit shape.
  • Two discharge holes 45a (slits) are arranged vertically (in the axial direction of the nozzle 42). At least a part of the discharge holes 45a is located below the front end surface 12e.
  • each discharge hole 45a extends obliquely along the inclination direction of the distal end surface 12e. That is, the discharge hole 45a is inclined upward toward the front side (left in FIG. 11). And as shown in FIG.12 and FIG.13, each discharge hole 45a is inclined to the upper side (hand part 11 side) as it goes to the outer periphery from the inner periphery of the front-end
  • FIG. Furthermore, the opening of the discharge hole 45a to the inner peripheral surface of the tip piece 45 is small, and the opening of the discharge hole 45a to the outer peripheral surface of the tip piece 45 is large.
  • the discharge hole 45a is expanded as it goes from the inner periphery to the outer periphery of the nozzle 42.
  • the front end surface (lower end surface) of the auxiliary nozzle 43 is orthogonal to the axis of the nozzle 43.
  • the tip opening of the nozzle 43 is directed straight downward (front of the page in FIG. 9).
  • the endoscope apparatus 1 is supported by the flexible arm 5 as follows. As shown in FIG. 1, a connection support member 50 is attached to the distal end portion of the flexible arm 5. The retractor 20 and thus the endoscope 10 are connected to and supported by the flexible arm 5 via the connection support member 50.
  • connection support member 50 includes a pair of halved supports 51, 52 and a bolt / nut unit 54 (opening / closing means).
  • the first halved support 51 has a halved grip 51c and a connecting plate 51d.
  • the half gripping part 51c is formed in a semicircular arc shape.
  • a connecting plate portion 51d extends rearward (right side in FIG. 14A) from the half-gripping portion 51c. As shown in FIG. 1, the rear end portion of the connecting plate portion 51 d is connected to the flexible arm 5.
  • the second half support body 52 has a half gripping portion 52c and a splicing plate portion 52d.
  • the half-split portion 52c is formed in a semicircular arc shape.
  • An attached plate portion 52d extends rearward (right side in FIG. 14A) from the half-grip portion 52c.
  • the front end portions (left side in FIG. 14) of the half gripping portions 51 c and 52 c are rotatably connected by a rotating shaft 53.
  • the connecting plate portion 51 d and the accessory plate portion 52 d are connected by a bolt / nut unit 54.
  • the pair of halved supports 51 and 52 are joined together and closed in an annular shape.
  • the state in which the half-supported bodies 51 and 52 and the connection support member 50 are closed in a ring shape is referred to as a “ring-closed state”.
  • the connection support member 50 is in a closed state.
  • a support seat surface 55 is constituted by the inner peripheral surfaces of the half-supported bodies 51 and 52.
  • the inner peripheral surface of the half-grip 51c is a half-seat surface 55a (a half of the support seat surface 55).
  • the inner peripheral surface of the half gripping portion 52c is a half seat surface 55b (the remaining half portion of the support seat surface 55).
  • the support seat surface 55 has a concave spherical shape.
  • the center of the concave spherical surface constituting the support seat surface 55 is located above the central portion in the thickness direction (vertical direction in FIG. 15A) of the half-supported bodies 51 and 52.
  • the diameter of the lower peripheral edge 55d (insertion-side peripheral edge) on the support seat surface 55 is smaller than the diameter of the upper peripheral edge 55c (hand-side peripheral edge).
  • the half supports 51 and 52 can be relatively rotated around the rotation shaft 53 by a small angle by the bolt / nut unit 54.
  • the half-supported bodies 51 and 52 can be slightly opened and closed between the loose position (FIG. 14B) and the closed position (FIG. 14A) within the range of the closed ring state. It has become.
  • the concave spherical support seat surface 55 is slightly expanded and contracted by slightly opening and closing the half-supported bodies 51 and 52. As shown in FIGS.
  • the concave spherical support seat surface 55 has a perfect circle shape, and the concave spherical support seat surface 55 has a concave spherical shape.
  • the diameter or curvature coincides with the diameter or curvature of the spherical outer peripheral surface of the supported portion 25.
  • connection support member 50 when the connection support member 50 is in the closed position, the supported portion 25 is received by the support seat surface 55 and is tightened by the half-supported bodies 51 and 52. Thereby, the retractor 20 and thus the endoscope 10 are fixed to the connection support member 50.
  • the diameters of the upper peripheral edge 55c and the lower peripheral edge 55d of the support seat surface 55 are both smaller than the outer diameter of the spherical supported portion 25.
  • the supported portion 25 cannot pass from the support seat surface 55 to the insertion tip side (downward in the figure) or the hand side (upward in the figure), and cannot be attached to or detached from the connection support member 50. .
  • the spherical joint between the support seat surface 55 and the supported portion 25 allows the endoscope 10 to move forward and backward as shown in FIGS. 1 and 15B as well as in the vertical posture (FIG. 15A). It can be fixed in an inclined posture in any direction on the left and right.
  • the support seat surface 55 is slightly expanded in diameter compared to the closed position, and the connection support member 50 is expanded slightly. Therefore, the tightening of the supported portion 25 is loosened, the supported portion 25 can be rotated in any direction in all directions within the support seat surface 55, and the retractor 20 and thus the endoscope 10 in any direction in all directions. The angle can be adjusted.
  • the diameter of the upper peripheral edge 55c of the support seat surface 55 is larger than the outer diameter of the supported portion 25, and the support seat.
  • the diameter of the lower peripheral edge 55d of the surface 55 is smaller than the outer diameter of the supported portion 25. For this reason, as shown in FIG.
  • the supported portion 25 can pass from the upper peripheral edge 55c of the support seat surface 55 to the hand side (upward in the figure), and the retractor 20 is connected and supported.
  • the retractor 20 can be attached to and detached from the member 50.
  • the supported portion 25 cannot pass from the lower peripheral end edge 55d of the support seat surface 55 to the insertion tip side (downward in the figure).
  • the bolt / nut unit 54 includes a nut 54a and a T-shaped bolt 54b.
  • a nut 54a is attached to the attachment plate portion 52d.
  • the nut 54a is locked to the splicing plate 52d so as to be rotatable about the axis of the nut 54a and not movable in the axial direction of the nut 54a (up and down in FIG. 18).
  • An opening adjustment knob 54c is provided on the nut 54a.
  • a long hole 51b is formed in the side portion of the connecting plate portion 51d.
  • the long axis of the long hole 51b is directed in the front-rear direction of the connection support member 50 (left and right in FIG. 17A).
  • Fitting recesses 51f are formed in the upper and lower side portions of the long hole 51b on the side surface of the connecting plate portion 51d.
  • a T-bolt 54b is inserted through the long hole 51b.
  • the head 54e (lock knob) of the T-shaped bolt 54b has a rectangular shape.
  • the longitudinal direction of the bolt head 54e is directed in the vertical direction, and is orthogonal to the long axis of the long hole 51b. Since the bolt head 54e is fitted into the fitting recess 51f, the bolt 54b is restrained so as not to rotate with respect to the connecting plate 51d. That is, the bolt head 54e is in the locked position.
  • a bolt 54b is screwed into the nut 54a in the long hole 51b.
  • a locking ring 54f is formed at the end of the bolt 54b.
  • a step 54d is formed inside the nut 54a.
  • the nut 54a is movable relative to the bolt 54b by a predetermined distance in the axial direction of the nut 54a and the bolt 54b (up and down in FIGS. 18 and 19). Moreover, the nut 54a cannot be separated from the bolt 54b.
  • a leaf spring 56 (open-side biasing means) is provided between the connecting plate portion 51d and the attached plate portion 52d.
  • the leaf spring 56 urges the attachment plate portion 52d in a direction (lower side in the figure) to separate it from the connecting plate portion 51d.
  • the attachment plate portion 52d is slightly separated from the connecting plate portion 51d than when it is in the closed position, and the half-supported bodies 51, 52 are separated from each other. It becomes a loose position.
  • the locking ring 54f is hooked on the step 54d.
  • the locking ring 54f and the step 54d constitute an opening preventing portion that prevents further operation from the loosened position by the opening adjustment knob 54c to the opening side.
  • the bolt 54b, the long hole 51b, and the fitting recess 51f constitute a lock mechanism that locks the half-supported bodies 51 and 52 in a closed state and can be unlocked. That is, as described above, when the bolt head 54e is in the locked position (a state in which the bolt head 54e is fitted in the fitting recess 51f and is rotationally restrained), the bolt 54b is not separable from the first half support 51, and the half support is provided. The bodies 51 and 52 are locked in the closed state (FIG. 17). The bolt head 54e can be operated between the locked position and the unlocked position as follows.
  • the bolt head 54e is in the unlocked position and can be inserted into and removed from the elongated hole 51b.
  • bolt 54b is released from the 1st half support body 51, and the connection of the half support bodies 51 and 52 by the volt
  • the half-supported bodies 51, 52 are released from the closed state and can be opened and closed. That is, the half-supported bodies 51 and 52 can be expanded more than the loosened position. Of course, it can also be closed to the closed position.
  • the endoscope apparatus 1 is used as follows, for example.
  • a small hole is made in a predetermined position on the body of the patient 9.
  • a dilator (not shown) is inserted into this hole, and then the retractor 20 is inserted into the hole so as to fit into the outer periphery of the dilator. Then pull out the dilator.
  • the cylindrical part 22 By making the cylindrical part 22 into a cross section of a different-diameter double circle composed of a large-diameter cylindrical part 22a and a small-diameter cylindrical part 22b, the cylindrical part 22 can be made into a small cross section rather than making the entire cylindrical part 22 into a perfect circular cross section. can do.
  • the assembly of the endoscope apparatus 1 may be performed before or after the retractor 20 is inserted into the body of the patient 9.
  • the upper end of the retractor 20 is sandwiched between the clamps 31, and the clamp knob 33 is moved from the release position (two-dot chain line in FIG. 3) to the clamp position (solid line in FIG. 3).
  • the retractor 20 and the holder 30 can be connected with one touch.
  • the nozzle unit 40 and the endoscope 10 are mounted on the columnar portion 32, and the locking member 34 is changed from the locking release position (FIG. 5A) to the locking position (FIG. 6). Thereby, the endoscope 10, the nozzle unit 40, and the holder 30 can be connected with one touch.
  • the endoscope 10 is kept in the retracted position (FIG. 6B), preferably by locking the locking member 34 in the lower locking recess 11d.
  • the retractor 20 can be inserted into the patient 9 while observing with the endoscope 10. And by retracting the insertion part 12 in the cylinder part 22, when inserting the retractor 20, it can prevent that the front-end
  • the nozzles 42 and 43 are also retracted, and the distal end portions (lower end portions) of the nozzles 42 and 43 are retracted into the cylindrical portion 22. Thereby, when inserting the retractor 20, it can prevent that the front-end
  • connection support member 50 is supported by the flexible arm 5, and the retractor 20 is supported by the connection support member 50.
  • the endoscope apparatus 1 is supported by the flexible arm 5.
  • the connecting plate portion 51d is connected to the flexible arm 5 in advance, and the halved supports 51 and 52 are placed in the loosened position, and the retractor 20 is halved from above.
  • the support members 51 and 52 may be inserted.
  • the diameter of the upper peripheral edge 55c at the loose position is larger than the outer diameter of the supported portion 25, the supported portion 25 is inserted into the support seat surface 55 from above and seated. be able to.
  • the retractor 20 can be prevented from falling through the support seat surface 55.
  • the halved supports 51 and 52 can only be opened to the loosened position, so that the retractor 20 can be reliably prevented from falling through the support seat surface 55.
  • connection support member 50 After inserting the retractor 20 into the body of the patient 9, the connection support member 50 can be attached to the supported portion 25.
  • the connection support member 50 can be fitted to the supported portion 25 from the side by releasing the closed state of the connection support member 50 (FIG. 23) and opening the halved supports 51 and 52 widely.
  • the bolt head 54e is set to the locked position by passing the bolt 54b through the elongated hole 51b and rotating 90 ° while closing the half-supported bodies 51 and 52. Thereby, the half-supported bodies 51 and 52 are locked in the closed state.
  • the retractor 20 is supported by the flexible arm 5 via the connection support member 50.
  • the endoscope apparatus 1 is supported by the flexible arm 5.
  • the distal end portion (lower end portion) of the insertion portion 12 is slightly protruded from the cylindrical portion 22 by setting the endoscope 10 to the protruding position (FIG. 6A).
  • the locking claw 34b of the locking member 34 is removed from the lower locking recess 11d of the endoscope 10, the endoscope 10 is slightly lowered, and then the locking claw 34b is engaged with the upper locking recess 11b. Stop.
  • the engaging protrusion 34d gets over the wall protrusion 32d from the bottom to the top.
  • the back wall 32w and the locking member 34 are elastically deformed. Mainly, the back wall 32w is elastically deformed.
  • the engagement protrusion 34d has been climbed upward (FIG. 5B)
  • the back wall 32w and the locking member 34 are elastically restored, and the internal stress is substantially eliminated.
  • the engagement protrusion 34d gets over the wall protrusion 32d from the top to the bottom.
  • the back wall 32w and the locking member 34 are elastically deformed.
  • the back wall 32w is mainly elastically deformed so as to bend forward (FIG. 7).
  • the deformation of the back wall 32w remains without being eliminated even after the engagement protrusion 34d is climbed upward.
  • the back wall 32w urges the engaging protrusion 34d downward via the wall protrusion 32d in an attempt to elastically return backward.
  • a rotational moment is applied to the locking member 34, and the locking member 34 is urged to rotate counterclockwise in FIG.
  • both side surfaces of the locking claw 34b in the width direction are strongly pressed against both side surfaces of the locking recess 11b in the width direction (up and down in the figure).
  • the endoscope 10 can be prevented from rattling with respect to the holder 30 in the front-rear direction (left and right in FIG. 3) and the width direction (left and right in FIG. 2).
  • the locking claw 34b when the locking claw 34b is fitted into the lower locking recess 11d, the locking claw 34b can be pushed in strongly by the elastic biasing force of the back wall 32w, and the play of the endoscope 10 is prevented. it can. Since the back wall 32w of the holder 30 is provided as a biasing means for the locking member 34, there is no need to use a dedicated spring such as a coil spring or a leaf spring. Therefore, troublesome spring cleaning work can be omitted, and cleaning of the holder 30 can be facilitated.
  • the nozzles 42 and 43 are also set to the protruding position and slightly protrude from the cylindrical portion 22.
  • the retractor 20 can secure a cylindrical insertion space 20c for the endoscope 10 and the forceps 2.
  • the surgical field 9a is arranged in the back of the cylindrical insertion space 20c.
  • the forceps 2 is inserted through the large-diameter cylindrical portion 22a.
  • the operation of the forceps 2 can be facilitated by making the large-diameter cylindrical portion 22a larger in diameter than the small-diameter cylindrical portion 22b.
  • the small diameter tubular portion 22b disposed oblique endoscope 10, direct the viewing angle obliquely forward with respect to the axis L 12.
  • the surgical field 9a around the distal end of the forceps 2 can be accommodated in the field of view of the endoscope 10, and the surgical field 9a can be reliably observed.
  • the nozzles 42 and 43 By arranging the nozzles 42 and 43 on the lateral side or the oblique side of the front end surface 12e, it is possible to avoid the nozzles 42 and 43 entering the observation visual field 1r.
  • the angle of the endoscope 10 can be adjusted in all directions.
  • the connection support member 50 is closed from the loosened position and slightly loosened from the closed position by the opening adjustment knob 54c.
  • the supported portion 25 is rotatably supported within the support seat surface 55, so that the retractor 20 and thus the endoscope 10 can be freely oriented. . That is, it can be tilted or rotated in all directions, front, rear, left and right. Therefore, the operability of the endoscope 10 can be improved, and the degree of freedom of endoscopic surgery can be increased.
  • connection support member 50 By closing the connection support member 50 from the loosened position, the diameter of the upper peripheral edge 55 c becomes smaller than the outer diameter of the supported portion 25. Thereby, the spherical supported portion 25 can be supported not to be pulled out from the support seat surface 55 but also from the support seat surface 55 so as not to be pulled out.
  • connection support member 50 When the connection support member 50 is brought into the closed position by the opening adjustment knob 54c, the supported portion 25 is tightened by the half-supported bodies 51 and 52. Thereby, the angle of the retractor 20 and thus the endoscope 10 can be fixed.
  • the distal end surface 12 e can be cleaned while the endoscope 10 is inserted into the body of the patient 9 during the treatment.
  • the cleaning liquid 4w is introduced from the tube 4b through the tube connector 41b to the cleaning nozzle 42.
  • the cleaning liquid 4w flows down to the tip of the cleaning nozzle 42 and is then discharged from the upper and lower rows of discharge holes 45a.
  • the discharge direction of the cleaning liquid 4w is directed obliquely rearward and obliquely upward from the tip piece 45 in accordance with the slit shape and direction of the discharge hole 45a.
  • the cleaning liquid 4w is discharged obliquely from the side of the front end surface 12e and obliquely forward, and slightly below the front end surface 12e (front end side) toward the front end surface 12e. Moreover, as indicated by the arrow line in FIG. 11, the discharge cleaning liquid 4w spreads in a planar shape and a radial shape in accordance with the slit shape of the discharge hole 45a.
  • the width direction orthogonal to the discharge direction of the discharge cleaning liquid 4w (the arrangement direction of the plurality of arrow lines 4w in FIG. 11) is inclined upward toward the front side (left in FIG. 11). That is, the discharge cleaning liquid 4w spreads obliquely along the inclination direction of the tip surface 12e.
  • the cleaning liquid 4w can be sprayed evenly over the entire oblique tip surface 12e. Furthermore, by forming the discharge holes 45a in two upper and lower stages, two upper and lower discharge flows can be formed (FIG. 13). Thereby, even if there is some manufacturing error or assembly error in the endoscope apparatus 1, the cleaning liquid 4w can be reliably applied to the distal end surface 12e, and the distal end surface 12e can be reliably cleaned. Therefore, the distal end surface 12e can be easily cleaned even during the treatment, and there is no need to pull out the endoscope 10 for cleaning, and there is no need to set it again. For example, it is not necessary to insert a cleaning catheter into the channel of the endoscope 10 for each cleaning.
  • the surgical field 9 a can be perfused by another nozzle 43. That is, the perfusate of another route is introduced into the nozzle 43 from the tube 4d through the tube connector 41d. The perfusate is discharged straight downward from the opening (lower end) of the nozzle 43.
  • the auxiliary nozzle 43 may be used as a drainage passage. The used cleaning liquid and other unnecessary materials may be discharged from the surgical field 9 a through the nozzle 43.
  • the endoscope apparatus 1 After completion of the treatment, the endoscope apparatus 1 is pulled out from the body of the patient 9 and removed.
  • the connection support member 50 When the retractor 20 is removed from the connection support member 50, the connection support member 50 is brought into a loosened position by the opening adjustment knob 54c.
  • the supported portion 25 can be pulled upward from the upper peripheral edge 55 c, and thus the retractor 20 can be separated from the connection support member 50.
  • the supported portion 25 does not fall downward from the lower peripheral edge 55d even in the loosened position, and the retractor 20 can be prevented from falling.
  • connection support member 50 In order to further open the connection support member 50 from the loosened position, an operation different from that for adjusting the opening and closing of the half-supported bodies 51 and 52 between the loosened position and the closed position is performed. Therefore, it is possible to prevent the connection support member 50 from being opened more than the loosened position although the operator does not intend it. That is, as shown in FIG. 20, with the nut 54a loosened to the loosened position, the connecting plate portion 51d and the attachment plate portion 52d are brought close to the leaf spring 56 to a position corresponding to the closed position. Then, the bolt head 54e comes out of the fitting recess 51f. Accordingly, the rotational constraint on the bolt 54b is released. As shown in FIGS.
  • Each member of the endoscope apparatus 1 is disposable, that is, discarded once used, or a member that can be sufficiently cleaned is cleaned and reused.
  • the connection support member 50 can be easily cleaned or disassembled by being able to expand (FIG. 23).
  • the present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the present invention.
  • the cross-sectional shape of the cylindrical portion 22 is not limited to the double-diameter different-diameter circle of the above-described embodiment, and may be a true circle or an ellipse or an oval.
  • a dedicated coil spring or leaf spring may be used as the biasing means for the locking member 34.
  • the hand portion 11 may be formed with only one locking recess 11b, 11d, or may be formed with three or more.
  • the endoscope 10 may be positionable three or more stages along the axis L 12 with respect to the retractor 20.
  • the endoscope 10 may be adjustable continuously positioned along the axis L 12 with respect to the retractor 20.
  • the number of discharge holes 45a is not limited to two, but may be three or more, or only one.
  • the structure of the slit-like discharge hole 45a of the endoscope front end cleaning nozzle 42 is not limited to the joint rigid endoscope of the above-described embodiment, and various structures can be used as long as the front end surface of the insertion portion is inclined.
  • the present invention can be applied to an endoscope, and can also be applied to a flexible endoscope having a flexible insertion portion.
  • the endoscope apparatus has a spherical joint structure of the spherical supported portion 25 and the concave spherical support seat surface 55.
  • the cleaning unit 40, the biasing unit of the locking member 34, the height (position) adjusting unit of the endoscope 10, and the like may be omitted or modified to other configurations.
  • the present invention can be applied to a joint endoscope for treating joint diseases such as intervertebral hernia and spinal stenosis.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Veterinary Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Biophysics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Astronomy & Astrophysics (AREA)
  • General Physics & Mathematics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Endoscopes (AREA)
  • Instruments For Viewing The Inside Of Hollow Bodies (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention améliore l'opérabilité d'un endoscope et augmente les degrés de liberté en chirurgie endoscopique. Un dispositif endoscopique (1) est équipé de : un endoscope (1) ; un écarteur cylindrique (20) ; et un élément de support de raccordement (50) qui relie l'écarteur (20) à un moyen de support (5). L'écarteur (20) comprend : une partie tubulaire (22) dans laquelle l'endoscope (10) et une pince (2) sont insérés ; et une partie soutenue sphérique (25) qui est disposée sur la partie tubulaire (22). La surface périphérique externe de la partie soutenue (25) est sous la forme d'une sphère. L'élément de support de raccordement (50) comporte une surface de siège de support sphérique évidée (55) qui reçoit la partie soutenue (25).
PCT/JP2018/003801 2017-02-07 2018-02-05 Dispositif endoscopique Ceased WO2018147224A1 (fr)

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JP2017020123A JP6918505B2 (ja) 2017-02-07 2017-02-07 内視鏡装置
JP2017-020123 2017-02-07

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CN111839977A (zh) * 2019-04-30 2020-10-30 李乾坤 内视镜夹持总成及其夹持器
CN114557739A (zh) * 2022-03-01 2022-05-31 河北医科大学第四医院 一种用于直肠手术的辅助器械
WO2025160890A1 (fr) * 2024-02-01 2025-08-07 北京大学第三医院（北京大学第三临床医学院） Appareil d'endoscope transforaminal muni d'un manche de travail mobile

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TWI695703B (zh) * 2019-04-26 2020-06-11 李乾坤 內視鏡夾持總成及其夾持器
JP2021083636A (ja) * 2019-11-27 2021-06-03 株式会社Jimro 内視鏡システム
JP7313630B2 (ja) * 2019-11-27 2023-07-25 帝人ナカシマメディカル株式会社 内視鏡装置
JP7385195B2 (ja) * 2019-11-27 2023-11-22 帝人ナカシマメディカル株式会社 内視鏡装置
JP7730497B2 (ja) * 2021-02-05 2025-08-28 株式会社Yyp 内視鏡装置
JP2023127041A (ja) * 2022-03-01 2023-09-13 株式会社ミヤタニ 外科用レトラクター

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PL2485673T3 (pl) * 2009-10-07 2020-05-18 Umc Utrecht Holding B.V. Urządzenie trzymające do przytrzymywania ręcznie obsługiwanego przyrządu medycznego

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JPH11197153A (ja) * 1997-10-07 1999-07-27 Ethicon Endo Surgery Inc 球状に湾曲した脚を有する手術時の体組織安定化装置
US20050273133A1 (en) * 2003-08-26 2005-12-08 Shluzas Alan E Access systems and methods for minimally invasive surgery

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN111839977A (zh) * 2019-04-30 2020-10-30 李乾坤 内视镜夹持总成及其夹持器
CN114557739A (zh) * 2022-03-01 2022-05-31 河北医科大学第四医院 一种用于直肠手术的辅助器械
WO2025160890A1 (fr) * 2024-02-01 2025-08-07 北京大学第三医院（北京大学第三临床医学院） Appareil d'endoscope transforaminal muni d'un manche de travail mobile

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JP6918505B2 (ja) 2021-08-11
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