WO2019087252A1 - Endoscope sheath and endoscope system - Google Patents

Abstract

This endoscope sheath (1) is provided with: a tubular long sheath body (4) having a lumen (7) which passes through in the longitudinal direction and in which an endoscope (2) is arranged in the longitudinal direction; a protrusion part (5) disposed on one side of the distal end opening (7a) of the lumen (7) in a radial direction of the sheath body (4), and protruding in the longitudinal direction from the distal end surface of the sheath body (4); and a deforming mechanism (6) which deforms the protrusion part (5) in a direction crossing the longitudinal direction.

Description

Endoscope sheath and endoscope system

The present invention relates to an endoscope sheath and an endoscope system.

Conventionally, an endoscope for inserting into a pericardial cavity and observing the pericardial cavity is known (see, for example, Patent Document 1).

US Patent Application Publication No. 2004/0064138

In order to observe the heart with an endoscope and treat the heart with a treatment tool, it is necessary to secure a space in front of the distal end surface of the endoscope. Furthermore, the size of the space required varies depending on the region to be observed, the treatment, and the like. However, since the gap between the heart and the pericardium is narrow, when the endoscope described in Patent Document 1 is used, the pericardium covers the distal end surface of the endoscope, and the space necessary for observation and treatment is There is a problem that it is difficult to secure.

The present invention has been made in view of the above-described circumstances, and an object thereof is to provide an endoscope sheath and an endoscope system capable of securing a space of a desired size in a pericardial cavity. Do.

In order to achieve the above object, the present invention provides the following means.
According to a first aspect of the present invention, there is provided a tubular elongated sheath body having a lumen extending in the longitudinal direction and in which the endoscope is disposed along the longitudinal direction; and a tip opening of the lumen in the radial direction of the sheath body The endoscope sheath is provided with a protrusion disposed on one side of the sheath body and projecting from the distal end surface of the sheath body in the longitudinal direction, and a deformation mechanism for deforming the protrusion in a direction intersecting the longitudinal direction.

According to this aspect, the endoscope is inserted into the pericardial cavity through the lumen of the sheath main body percutaneously disposed from the outside to the pericardial cavity. At this time, by disposing the sheath in the pericardial cavity so that the protrusion is positioned on the pericardium side and the distal end opening of the lumen is on the heart side, the protrusion separates the pericardium from the heart A space for lifting and observing the inside of the pericardial space by an endoscope is secured in front of the distal end opening of the lumen. Furthermore, by deforming the projection by the deformation mechanism, the size of the space secured by the projection can be adjusted in the direction intersecting the longitudinal direction of the sheath body. Therefore, a space of a desired size can be secured in the pericardial space.

In the first aspect, the deformation mechanism may bend and deform the projection into an arc shape in which a tip end of the projection protrudes in a direction intersecting the longitudinal direction with respect to the sheath main body.
The space in front of the distal end opening can be expanded in the radial direction of the sheath body by curving the projecting portion in an arc shape and projecting the distal end of the projecting portion radially outward with respect to the sheath body.

In the first aspect, the deformation mechanism bends and deforms the projection into an arch shape in which a midway position in the longitudinal direction of the projection protrudes in a direction intersecting the longitudinal direction with respect to the sheath main body. May be
The space in front of the distal end opening can be expanded in the radial direction of the sheath main body by curving the protruding portion in an arc shape and making the midway position in the longitudinal direction of the protruding portion project radially outward with respect to the sheath main body .

In the first aspect, the projection includes two projections juxtaposed to one another in the direction intersecting the longitudinal direction, and the deformation mechanism intersects in the radial direction in which the projections and the tip opening are arranged. The two protrusions may be bent and deformed in directions opposite to each other.
In this way, the space in front of the tip opening can be expanded in both the radial direction in which the projection and the tip opening are aligned.

A second aspect of the present invention is an endoscope system comprising the endoscope sheath according to any one of the above, and an endoscope disposed along the longitudinal direction in the lumen of the endoscope sheath. is there.
In the second aspect, an elongated treatment tool having an end effector for treating a living body at its tip, the endoscope and the treatment tool are inserted along the longitudinal direction, and the endoscope and the treatment tool are And a sheath mutually positioned in a direction intersecting the longitudinal direction, wherein the deformation mechanism is configured such that a distance from a longitudinal axis of the treatment tool to a portion of the projecting portion that most protrudes in a direction intersecting the longitudinal direction is the The projection may be bendable to an angle which is greater than the maximum radius of the end effector from the longitudinal axis of the treatment tool.
In this way, the space secured by the projection can be expanded to a position that does not interfere with the treatment tool to be rotated or the treatment tool fixed at any rotation angle.

In the second aspect, the endoscope is a direct view type in which an objective optical system is disposed on the tip end surface, and the deformation mechanism is a portion that protrudes most in the direction intersecting the longitudinal direction of the protrusion. And the line connecting the optical axis position of the objective optical system at the tip end face of the endoscope with the optical axis of the objective optical system to an angle at which the viewing angle of the objective optical system is larger than half. The protrusion may be bendable.
By doing this, the space secured by the projection can be extended to the outside of the field of view of the objective optical system.

According to the present invention, it is possible to secure a space of a desired size in the pericardial cavity.

BRIEF DESCRIPTION OF THE DRAWINGS It is a whole block diagram of the endoscope system which concerns on one Embodiment of this invention. It is a longitudinal cross-sectional view of the front-end | tip part of the endoscope system which shows the internal structure of the hood of FIG. It is a figure explaining the usage method of the endoscope system of FIG. It is a figure explaining the usage method of the endoscope system of FIG. It is the top view seen from the upper side which shows the modification of the hood in the endoscope system of FIG. It is the front view which looked at the endoscope system of FIG. 4 from the front end side. It is the top view seen from the upper side which shows the other modification of the hood in the endoscope system of FIG. It is the side view which looked at the hood of Drawing 6A from the right side. It is the top view seen from the upper side which shows the other modification of the hood in the endoscope system of FIG. It is a figure which shows the curved-deformed state of the hood of FIG. 7A. It is a figure explaining the relationship between the bending angle of the hood on either side and the viewing angle of an objective optical system. It is a figure explaining the relationship between the curvature angle of a hood, the largest radius of a treatment tool, and a rotation radius.

An endoscope sheath 1 and an endoscope system 100 according to an embodiment of the present invention will be described with reference to the drawings.
An endoscope system 100 according to the present embodiment is, as shown in FIGS. 1 and 2, a circular tubular endoscope sheath 1 in which a bendable and deformable hood (projecting portion) 5 is provided at a tip end portion; The endoscope 2 disposed in the endoscope sheath 1 and provided with the bending portion 2b at the distal end portion, and the operation portion 3 connected to the base end of the endoscope sheath 1 and operating the bending of the hood 5 and the bending portion 2b And have.

The endoscope sheath 1 is provided with a circular tubular long sheath main body 4, a hood 5 protruding in the longitudinal direction from the distal end surface of the sheath main body 4, and a deformation mechanism 6 for bending and deforming the hood 5. . The endoscope sheath 1 has a radial direction orthogonal to the longitudinal axis, and has a vertical direction and a lateral direction orthogonal to each other.

The sheath body 4 has flexibility that can be curved along the shape of tissue in the body, and can be inserted into the pericardial space. The sheath main body 4 has an endoscope lumen 7 which penetrates in the longitudinal direction and in which the endoscope 2 is disposed along the longitudinal direction, and a tip opening 7a of the endoscope lumen 7 is opened at the tip surface of the sheath body 4 doing.

The hood 5 is a columnar or plate-like member fixed to the annular tip end surface of the sheath main body 4 and protruding in the longitudinal direction from the tip end surface, and is disposed above the tip opening 7a. The hood 5 is formed of a flexible material such as resin, has a linear shape along the longitudinal direction of the sheath main body 4 in a natural state where no external force acts, and can be elastically curved in the vertical direction. Alternatively, the hood 5 is arranged in the longitudinal direction, and a plurality of curved pieces (not shown) swingably connected to each other about the swing axis in the left-right direction, like the general curve portion of the endoscope 2 , And may be configured to be bent in the vertical direction by the swinging of the bending piece.

FIG. 2 shows a deformation mechanism 6 provided inside the hood 5 for bending the hood 5 in the vertical direction. As shown in FIG. 2, the hood 5 and the sheath body 4 are formed with wire lumens 8 extending along the longitudinal direction. The deformation mechanism 6 is disposed movably in the longitudinal direction in the wire lumen 8 and includes a wire 6 a that connects the distal end portion of the hood 5 and the operation unit 3. The distal end of the wire 6 a is fixed to the distal end of the hood 5 via a hard tip 12, and the proximal end of the wire 6 a is connected to the wheel 10 (described later) of the operation unit 3.

The wire lumen 8 and the wire 6 a are provided above the central axis A of the hood 5. Thereby, when the wire 6a is pulled toward the proximal end side, the hood 5 is curved and deformed in an arc shape upward so that the wire 6a is disposed radially inward, and the tip of the hood 5 is the sheath body It is projected to be higher than four. Further, when the wire 6a is pressed toward the distal end side, the hood 5 is curved downward so that the wire 6a is disposed radially outward. The hood 5 has a gradient of stiffness that decreases in stiffness from the proximal end to the distal end so that the distal end of the hood 5 curves with a greater curvature than the proximal end. Alternatively, the hood 5 may have uniform stiffness so as to curve with a substantially uniform curvature.

Although only one wire 6 a is shown in FIGS. 1 and 2, the deformation mechanism 6 may include another wire provided below the central axis A of the hood 5. . In this case, the two wires are operated in conjunction with each other such that when one wire is pulled proximally, the other wire is pushed distally.

The endoscope 2 is a direct-view type that acquires an endoscopic image of the field of view in front of the distal end surface. The endoscope 2 has a vertical direction which is a radial direction orthogonal to the longitudinal axis and corresponds to the vertical direction of the endoscopic image. The endoscope 2 has an objective optical system 2a disposed at the distal end, and a bending portion 2b provided on the proximal end side of the objective optical system 2a and capable of being bent at least downward. Reference numeral 13 denotes a ride guide for guiding light for illumination, a signal line, and the like.

The endoscope 2 in the endoscope lumen 7 is configured such that the bending portion 2 b protrudes from the tip opening 7 a to the outside of the endoscope sheath 1, and the downward direction of the endoscope 2 is the downward direction of the sheath main body 4 And is positioned with respect to the sheath body 4 in the longitudinal direction and around the longitudinal axis and is fixed relative to the sheath body 4. Since the hood 5 is disposed on the side opposite to the downward direction in which the bending portion 2b bends with respect to the bending portion 2b, the bending portion 2b can be bent downward without being blocked by the hood 5. Here, the length in the longitudinal direction of the hood 5 is larger than the length in the longitudinal direction of the tip portion of the endoscope 2 protruding from the tip opening 7 a, and the tip of the hood 5 is more tip than the tip of the endoscope 2 It is arrange | positioned in the position protruded from the opening 7a.

The operation unit 3 has a handle 9 gripped by the operator, a wheel 10 rotatably supported by the handle 9 about its central axis, and an operation lever 11 connected to the wheel 10. The operator can bend the hood 5 upward by rotating the wheel 10 in the direction in which the wire 6 a is pulled to the proximal end side by operating the operation lever 11. The operation unit 3 is also provided with a lever (not shown) for performing a bending operation of the bending portion 2b.

Next, the operation of the endoscope sheath 1 and the endoscope system 100 will be described by taking the treatment of the left atrial appendage as an example.
In order to treat the left atrial appendage using the endoscope system 100 according to the present embodiment, integration is performed via the inside of an access sheath (not shown) disposed from below the xiphoid to the pericardial space. The endoscope sheath 1 and the endoscope 2 are inserted into the pericardial space.

Next, as shown in FIG. 3A, the endoscope sheath 1 is disposed such that the heart X is located below the endoscope 2 and the pericardium Y is located above the endoscope 2. Thereby, the pericardium Y is located in front of the distal end surface of the endoscope 2 by the hood 5 which is disposed between the distal end portion of the endoscope 2 and the pericardium Y and protrudes from the distal end of the endoscope 2. And a space S is secured in front of the distal end surface of the endoscope 2. In this state, the longitudinal direction front of the endoscope 2 can be observed. In addition, the heart X can be observed from the bottom by curving the bending portion 2 b downward so that the distal end surface of the endoscope 2 faces the heart X.

Next, as shown in FIG. 3B, the treatment instrument 20 used for treatment of the left atrial appendage is inserted into the pericardial cavity through the inside of the access sheath, and the distal end of the treatment instrument 20 near the left atrial appendage Deploy. The treatment instrument 20 has an elongated shaft 21 and an end effector 22 connected to the tip of the shaft 21 for treating a living tissue. FIG. 3B shows a grasping forceps having a pair of grasping pieces 22 that can be opened and closed. The endoscope system 100 and the treatment tool 20 passing through the same access sheath are mutually positioned in the direction intersecting the longitudinal direction by the access sheath, and the tip of the endoscope system 100 and the tip of the treatment tool 20 mutually Placed close to the Therefore, the left atrial appendage can be treated by the end effector 22 of the treatment tool 20 while observing the left atrial appendage with the endoscope 2.

In this case, a downward force toward the heart X is applied from the pericardium Y to the hood 5 disposed on the pericardium Y side. As shown in FIG. 3A, when the hood 5 bends downward due to the force from the pericardium Y and the space S having a sufficient size can not be secured, the operator operates the control lever 11. The size of the space S can be adjusted by operating.

Specifically, the operator operates the operating lever 11 in the direction in which the wire 6a is pulled, thereby returning the hood 5 from the downwardly curved shape to the linear shape, as shown in FIG. 3B. The linear shape of the hood 5 can be maintained against the force from the membrane Y. Further, the operator further operates the operation lever 11 in the direction in which the wire 6a is pulled, thereby curving the hood 5 upward to lift the pericardium Y to a position further away from the heart X, and the space S It can be spread upward.
As described above, according to the present embodiment, by controlling the shape of the hood 5 disposed in the pericardial cavity with the control lever 11 outside the body, the space S having a desired size is secured in the pericardial cavity. It has the advantage of being able to

In the present embodiment, the deformation mechanism 6 deforms the hood 5 from a linear shape to an arc shape curved upward, but the deformation of the hood 5 by the deformation mechanism 6 is not limited to this, The deformation mechanism 6 may cause the hood 5 to be bent or deformed in other directions.
4 to 7B show modifications of the deformation shape of the hood 5.

In the modification of FIG. 4, two hoods 51 and 52 arranged in parallel in the left-right direction are provided, and the deformation mechanism 6 is provided on each of the hoods 51 and 52. The hood 51 on the left side is bent and deformed in an arc shape in the left direction by the deformation mechanism 6 so that the tip projects to the left. The hood 52 on the right side is bent and deformed in an arc shape in the right direction by the deformation mechanism 6 so that the front end protrudes to the right. As described above, the two hoods 51 and 52 curve outward in the left-right direction in mutually opposite directions, so that the tips of the hoods 51 and 52 are mutually separated in the left-right direction. Thus, the space S secured by the hoods 51 and 52 can be expanded in the left-right direction to a desired size.

Thus, the space S which is wide in the left-right direction is suitable, for example, when using the treatment tool 20 that requires a rotation operation such as a grasping forceps. Also, for example, as shown in FIG. 5, in a situation where the tip of the endoscope 2 is disposed beside the observation target site (for example, the left atrial appendage) Z, bending deformation in the lateral direction of the hoods 51 and 52 The space S can be expanded in the left-right direction to the observation target site Z.

The two hoods 51 and 52 may be arranged in parallel in the vertical direction. Also, four hoods may be provided in parallel in the left-right direction and the up-down direction, and the deformation mechanism may be configured to curve the four hoods in the upper right direction, the lower right direction, the upper left direction, and the lower left direction.

In the modification of FIG. 6A and FIG. 6B, three hoods 51, 52, 53 arranged in parallel in the left-right direction are provided. The deformation mechanism 6 is configured to curve the hood 51 on the left side in an arc shape in the left direction, to curve the hood 52 on the right side in an arc shape in the right direction, and to curve the hood 53 in the center in an arc shape. ing.

As shown in FIGS. 7A and 7B, the hoods 51 and 52 may be bent and deformed into an arch shape in which the midway position in the longitudinal direction protrudes in the left-right direction. The hoods 51, 52 of FIGS. 7A and 7B are interconnected at their tips. The distal end of the wire 6a is fixed to the distal end of the hoods 51, 52, and the wire 6a is guided to the sheath body 4 through the space between the left and right hoods 51, 52.

When the wire 6a is pulled, as shown in FIG. 7B, the distal end of the hood 51 approaches the proximal end of the hood 51, whereby the hood 51 is deformed into an arch shape, and the midway of the hood 51 in the longitudinal direction The position protrudes to the left. Similarly, when the wire 6a is pulled, the distal end of the hood 52 approaches the proximal end of the hood 52 so that the hood 52 is deformed into an arcuate shape, and the midway position of the hood 52 in the longitudinal direction is to the right Stand out. Therefore, the hoods 51 and 52 deform in an annular shape as a whole.

The space S can be expanded in the left-right direction also by the curved deformation of the hoods 51 and 52 as described above.
The hood 51 and the hood 52 are separated from each other, and the hoods 51 and 52 can be curved and deformed independently of each other by the deformation mechanism 6 for the hood 51 and the deformation mechanism 6 for the hood 52. May be

The maximum bending angles of the hoods 51 and 52 in FIGS. 4 to 7B are preferably designed according to the viewing angle ω of the endoscope 2.
That is, as shown in FIG. 8, the optical axis and a straight line L1 connecting the leftmost projecting portion of the curved hood 51, and the optical axis position of the objective optical system 2a at the tip surface of the endoscope 2 The maximum bending angle of the hood 51 is designed such that the angle θ1 formed by the angle θ1 is larger than half the viewing angle ω of the objective optical system 2a. Similarly, an angle θ2 formed by the optical axis and a straight line L2 connecting the rightmost projecting portion of the curved hood 52 and the optical axis position of the objective optical system 2a at the tip end surface of the endoscope 2 is the objective The maximum bending angle of the hood 52 is designed to be larger than half the viewing angle ω of the optical system 2a. Therefore, the angle θ1 + θ2 formed by the lines L1 and L2 is larger than the viewing angle ω.
By doing this, the space S can be secured to the outside in the left-right direction of the field of view of the endoscope 2 by the hoods 51 and 52 that are curved and deformed.

Further, preferably, the hoods 5, 51, 52, 53 can be bent to a position not interfering with the treatment instrument 20 regardless of the rotation of the treatment instrument 20. Specifically, as shown in FIG. 9, the hoods 51, 52, 53 curve to such an angle that the distances d1, d2, d3 become larger than the maximum radius dmax of the end effector 22 from the longitudinal axis of the shaft 21. Preferably it is possible. The distances d1, d2 and d3 are orthogonal to the longitudinal axis between the radially projecting portion of the sheath body 4 with respect to the sheath body 4 of each of the hoods 51, 52 and 53 and the longitudinal axis of the shaft 21. It is the distance of the direction. In FIG. 9, in order to simplify the drawing, only the tip end faces of the hoods 51, 52, 53 are shown.

When using the treatment tool 20 at an arbitrary rotation angle fixed relative to the endoscope sheath 1, the operator has hoods 51, 52, 53 radially outward of the largest radius portion of the end effector 22. By bending the hoods 51, 52, 53 so as to be disposed, interference of the hoods 51, 52, 53 with the treatment tool 20 operating in the space S can be prevented.

In the case of the treatment tool 20 rotated about the longitudinal axis of the shaft 21 like a grasping forceps, the distances d1, d2 and d3 represent the maximum turning radius of the end effector 22 about the longitudinal axis of the shaft 21 (indicated by the broken line in FIG. 9). The hoods 51, 52, 53 can be bent to an angle larger than the circle. When the treatment tool 20 is a grasping forceps, the maximum turning radius of the end effector 22 is the turning radius of a pair of grasping pieces in a state where the pair of grasping pieces are opened to the maximum angle. Therefore, the hood 52 on the treatment tool 20 side can be bent to a larger angle than the other hoods 51 and 52.

During treatment of the observation target site, generally, an operation of rotating the treatment instrument 20 about the longitudinal axis to change the posture of the end effector 22 with respect to the observation target site is performed. The operator operates the hoods 51, 52, 53 in the space S by curving the hoods 51, 52, 53 so that the hoods 51, 52, 53 are disposed outside the rotational space of the end effector 22. Interference with the treatment instrument 20 can be prevented.

In the present embodiment, the endoscope 2 and the sheath body 4 are fixed and integrated with each other, but instead, the endoscope 2 and the endoscope sheath 1 are separate bodies. There may be longitudinal movement and rotation around the longitudinal axis of the endoscope 2 within the endoscope lumen 7 of the sheath body 4.
In the present embodiment, the endoscope 2 and the treatment tool 20 are mutually positioned by the access sheath, but instead, they may be mutually positioned by the endoscope sheath 1. That is, the treatment tool 20 may be inserted into the same lumen 7 as the endoscope 2 or into another lumen provided in the sheath body 4.

In the present embodiment, the single operation unit 3 is provided. However, instead of this, the endoscope 2 is provided with the operation unit for the bending portion 2 b, and the hood is used for the endoscope sheath 1. An operation unit for 5, 51, 52, 53 may be provided.
In the present embodiment, the endoscope 2 is of the direct view type, but may be of a perspective view type or a side view type instead. In the case of a perspective or side-viewing endoscope, the bending portion 2b may not be provided.

100 Endoscope System 1 Endoscope Sheath 2 Endoscope 2b Curved Part 3 Operating Part 4 Sheath Main Body 5, 51, 52, 53 Hood 6 Deformation Mechanism 6a Wire 7 Endoscope Lumen 7a Tip Opening 8 Wire Lumen 9 Handle 10 Wheel 11 Operation lever 12 Tip 20 Treatment tool 22 End effector X Heart Y Pericardium

Claims (7)

A tubular elongated sheath body having a lumen extending longitudinally through which the endoscope is disposed along the longitudinal direction;
A protrusion disposed on one side of the distal end opening of the lumen in the radial direction of the sheath body and protruding along the longitudinal direction from the distal end surface of the sheath body;
And a deformation mechanism for deforming the protrusion in a direction intersecting the longitudinal direction. The endoscope sheath according to claim 1, wherein the deformation mechanism bends and deforms the projection into an arc shape in which a tip end of the projection protrudes in a direction intersecting the longitudinal direction with respect to the sheath body. The endoscope according to claim 1, wherein the deformation mechanism bends and deforms the projection into an arch shape in which a midway position in the longitudinal direction of the projection protrudes in a direction intersecting the longitudinal direction with respect to the sheath main body. Mirror sheath. It comprises two said protrusions parallel to one another in a direction intersecting the longitudinal direction,
The deformation mechanism according to claim 2 or 3, wherein the deformation mechanism bends and deforms the two protrusions in a direction intersecting the radial direction in which the protrusions and the tip opening are arranged and in directions opposite to each other. Endoscope sheath. An endoscopic sheath according to any of claims 1 to 4;
An endoscope disposed longitudinally along the lumen of the endoscope sheath. An elongated treatment tool having an end effector for treating a living body at its tip;
The endoscope and the treatment instrument are inserted along the longitudinal direction, and the sheath which mutually positions the endoscope and the treatment instrument in the direction crossing the longitudinal direction is provided.
The deformation mechanism is such that the distance from the longitudinal axis of the treatment tool to the most projecting portion in the direction crossing the longitudinal direction of the protrusion is greater than the maximum radius of the end effector from the longitudinal axis of the treatment tool The endoscope system according to claim 5, wherein the protrusion can be bent to an angle. The endoscope is a direct view type in which an objective optical system is disposed on the tip surface,
In the deformation mechanism, a straight line connecting a portion of the projecting portion that most protrudes in the direction intersecting the longitudinal direction and the optical axis position of the objective optical system at the tip end surface of the endoscope is light of the objective optical system The endoscope system according to claim 5 or 6, wherein the protrusion can be bent to an angle at which an angle with an axis is larger than a half of a viewing angle of the objective optical system.

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