The present invention relates to medical systems.
In a known operation method for observing and treating the heart in the related art, a sheath is inserted into the pericardial cavity between the heart and the pericardium from the outside of the body, and a medical instrument, such as an endoscope or a treatment instrument, is led into the pericardial cavity via a route ensured inside the sheath (for example, see PTL 1).
An object of the present invention is to provide a medical system with which a plurality of medical instruments can be simultaneously and easily manipulated even in a place like the pericardial cavity, where the medical instruments directly receive body movements.
An aspect of the present invention provides a medical system including: a plurality of medical instruments each having an elongated insertion section that can be inserted into the body from the body surface; fixing parts that are provided on the insertion sections of the plurality of medical instruments, at positions away from the distal ends toward the proximal end side, and that can be coupled with and separated from each other; and manipulation parts that are provided at the proximal end side of the insertion sections of the plurality of medical instruments and that manipulate coupling and separation of the fixing parts.
In the above aspect, the fixing parts may include magnetic bodies generating magnetic forces that attract each other.
In the above aspect, the magnetic bodies may be electromagnets.
In the above aspect, at least one of the medical instruments may include a flexible bending section provided closer to the distal-end side than the fixing part is.
In the above aspect, the medical system may further include a position changing mechanism that changes the positions of the fixing parts in the longitudinal direction of the insertion sections.
In the above aspect, the medical system may further include an anti-rotation mechanism that prevents the plurality of insertion sections coupled with each other at the fixing parts from relatively rotating about an axis extending in a direction passing through the fixing parts and intersecting the direction in which the plurality of insertion sections are arranged.
In the above aspect, the anti-rotation mechanism may include the plurality fixing parts provided on each of the plurality of insertion sections, at positions away from each other in the longitudinal direction. Alternatively, the anti-rotation mechanisms may include steps that are formed at contact surfaces of the fixing parts and that are engaged with each other in the radial direction of the insertion sections.
In the above aspect, the medical instrument may be an endoscope, a sheath, or an introducer.
A medical system 100 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in
The sheaths 1A and 1B respectively include elongated cylindrical insertion sections 2A and 2B that can be inserted into the body, bending sections 3A and 3B and fixing parts 4A and 4B provided in the insertion sections 2A and 2B, and manipulation parts 5A and 5B connected to the proximal ends of the insertion sections 2A and 2B.
The insertion sections 2A and 2B have longitudinally penetrating lumens 2a and 2b, through which an endoscope 20, a treatment instrument 30, or the like are inserted. The insertion sections 2A and 2B are made of, for example, plastic, and they have such rigidity that they can transmit, to the distal ends, longitudinal linear motion and twisting motion about the longitudinal axis applied to the manipulation parts 5A and 5B and such flexibility that they can be bent in accordance with the shapes of the tissues in the living body.
The bending sections 3A and 3B are provided at the distal end portions of the insertion sections 2A and 2B and are configured such that they can be bent as a result of an operator manipulating an angle knob or the like (not shown) provided on the manipulation parts 5A and 5B. As shown in
The fixing parts 4A and 4B are formed of permanent magnets (hereinbelow, also referred to as magnets 4A and 4B) fixed to the outer circumferential surfaces of the insertion sections 2A and 2B and are provided on closer to the proximal-end side than the bending sections 3A and 3B, near the bending sections 3A and 3B. The magnet 4A provided on one insertion section 2A and the magnet 4B provided on the other insertion section 2B have opposite magnetic polarities and generate magnetic forces that attract each other.
The magnetic forces of the magnets 4A and 4B are designed such that the magnetic forces acting on the magnets 4A and 4B in a state in which the magnets 4A and 4B are coupled together are substantially equal to or smaller than the flexural rigidity and the torsional rigidity of the insertion sections 2A and 2B. This enables an operator to separate the magnets 4A and 4B that are coupled together by magnetic force, by pushing or pulling to advance or retract one of the two insertion sections 2A and 2B in the longitudinal direction or by rotating it about the longitudinal axis, while keeping the position of the other fixed.
Here, as shown in
Next, the operation of the thus-configured medical system 100 will be described.
When treatment inside the pericardial cavity Y is performed by using the medical system 100 according to this embodiment, first, an operator separately inserts the insertion sections 2A and 2B of the two sheaths 1A and 1B into the body from below the xiphisternum, and portions of the insertion sections 2A and 2B on the distal end side are disposed inside the pericardial cavity Y through holes X provided in the pericardium. Next, the operator manipulates the manipulation parts 5A and 5B located outside the body to move the insertion sections 2A and 2B, such that the magnets 4A and 4B approach each other while facing each other. When the magnets 4A and 4B have reached positions a certain distance from each other, the magnets 4A and 4B spontaneously approach each other and are coupled together by the magnetic force.
In a state in which the insertion sections 2A and 2B are coupled together with the magnets 4A and 4B and extend substantially parallel to each other, when, as shown in
When removing the insertion sections 2A and 2B from the body, the operator separates the coupled magnets 4A and 4B by pushing, pulling, or twisting the manipulation part 5A or 5B corresponding to one of the insertion sections 2A and 2B, while maintaining the position of the other of them. As a result, the two insertion sections 2A and 2B become independently manipulatable, and thus, the two insertion sections 2A and 2B can be separately extracted from the pericardial cavity Y.
Here, according to this embodiment, in a state in which the insertion sections 2A and 2B are coupled together with the magnets 4A and 4B, as shown in
This leads to an advantage in that it is possible to easily manipulate the distal end portions of the two insertion sections 2A and 2B at will and dispose them at desired positions inside the pericardial cavity Y, even in a situation in which the insertion sections 2A and 2B inside the pericardial cavity Y directly receive the pulsation of the heart adjacent thereto and are moved. Another advantage is that, because the relative position between the endoscope 20 and the treatment instrument 30 is stably maintained even if the endoscope 20 and the treatment instrument 30 are moved by pulsation, it is possible to easily perform treatment with the treatment instrument 30, while continuing stable observation of the treatment instrument 30 with the endoscope 20.
In this embodiment, an over tube 6 formed of a non-magnetic body, as shown in
The coupled magnets 4A and 4B can be easily and reliably separated by inserting the over tube 6 attached to the exterior of one insertion section 2A into the pericardial cavity Y along the insertion section 2A, and advancing the distal end of the over tube 6 closer to the distal-end side than the magnets 4A and 4B, while forcing the distal end of the over tube 6 between the coupled magnets 4A and 4B. In a state in which the magnet 4A or 4B is covered by the over tube 6, the over tube 6 inhibits the magnets 4A and 4B from coupling together. Thus, the respective insertion sections 2A and 2B can be independently manipulated. It is desirable that the distal end portion of the over tube 6 be formed in a tapered shape gradually narrowing toward the distal end, to reduce the contact resistance with the peripheral tissues when moving in the living body.
In this embodiment, although the magnets 4A and 4B are provided only at portions of the insertion sections 2A and 2B in the circumferential direction, instead, as shown in
With this configuration, the magnets 4A and 4B are coupled together, regardless of the relative phases of the two insertion sections 2A and 2B. Accordingly, there is no need to adjust the phases of the two insertion sections 2A and 2B when the magnets 4A and 4B are coupled together inside the pericardial cavity Y, and the magnets 4A and 4B can be coupled together simply by bringing the magnets 4A and 4B toward each other. Because it is possible to rotate only one of the insertion sections 2A and 2B about the longitudinal axis while maintaining the magnets 4A and 4B in a coupled state, it is possible to change the phases of the distal end portions of the insertion sections 2A and 2B independently of each other while maintaining the relative positions of the distal end portions of the insertion sections 2A and 2B substantially constant and, thus, to change the orientations of the distal ends of the two insertion sections 2A and 2B independently of each other.
In this embodiment, although the magnets 4A and 4B that are curved in accordance with the curved shape of the outer circumferential surfaces of the insertion sections 2A and 2B are provided, instead, as shown in
This makes it possible to provide larger contact areas between the magnets 4A and 4B and, thus, to increase the coupling force of the magnets 4A and 4B.
In this embodiment, although the fixing parts 4A and 4B that are formed of permanent magnets and are fixed to the insertion sections 2A and 2B have been described, instead, as shown in
The fixing parts 40A and 40B shown in
The tube members 8 may be fixed to the outer circumferential surfaces of the insertion sections 2A and 2B.
Alternatively, the tube members (position changing mechanisms) 8 may be slidable in the longitudinal direction of the insertion sections 2A and 2B, while they may be temporarily fixed to the insertion sections 2A and 2B by the friction between the inner circumferential surfaces of the tube members 8 and the outer circumferential surfaces of the insertion sections 2A and 2B. This enables the positions of the fixing parts 40A and 40B to be easily changed in the longitudinal direction of the insertion sections 2A and 2B according to the attaching positions of the tube members 8 to the insertion sections 2A and 2B.
In the fixing parts 40A and 40B shown in
The fixing parts 40A and 40B shown in
The fixing parts 40A and 40B shown in
With the fixing parts 40A and 40B shown in
In this embodiment, fixing parts (anti-rotation mechanisms) may be provided in the insertion sections 2A and 2B, at two or more positions away from each other in the longitudinal direction.
As shown in
At this time, it is desirable that the N-pole magnet 4A and the S-pole magnet 4C be alternately arranged in this order from the distal end side in one insertion section 2A and that the S-pole magnet 4B and the N-pole magnet 4D be alternately arranged in this order from the distal end side in the other insertion section 2B. With this configuration, even though a plurality of magnets 4A and 4C; 4B and 4D are provided in the insertion sections 2A and 2B, respectively, because the coupling positions of the magnets 4A and 4B; 4C and 4D are restricted by the magnetic polarity, it is possible to accurately manipulate the coupling positions of the insertion sections 2A and 2B.
In this embodiment, as shown in
Also with this configuration, when moments about the fixing parts 4A and 4B act on the distal end portions of the insertion sections 2A and 2B, as shown in
In this embodiment, as shown in
The configuration of the electromagnets 4A′ and 4B′ may be selected as appropriate. For example, as shown in
It is desirable that core members 12 made of a ferromagnetic material, such as iron, be provided inside the coils 11 to increase the magnetic force of the electromagnets 4A′ and 4B′.
Electric wires 13 for supplying currents from the power supply to the coils 11 may be printed wires formed on the side walls of the insertion sections 2A and 2B. This enables the electric wires 13 to be formed as part of the insertion sections 2A and 2B.
In this embodiment, although the fixing parts provided on the two insertion sections 2A and 2B have the magnets 4A and 4B and the magnets 4A′ and 4B′ having different magnetic polarities, instead, one fixing part may have magnets, and the other fixing part may have temporary magnets that generate magnetic force by magnetic fields generated by the magnets.
In this embodiment, the fixing parts may be of a type other than magnets, as long as they can be coupled and separated by the manipulation at the proximal end portions of the sheaths 1A and 1B. For example, the fixing parts may be hook and loop fasteners that are fixed to the outer circumferential surfaces of the insertion sections 2A and 2B and that are coupled together by contact. Alternatively, the fixing parts may include a dovetail groove formed in one of the insertion sections 2A and 2B and a dovetail projection formed in the other, and the insertion sections 2A and 2B may be coupled together by fitting the dovetail projection into the dovetail groove.
In this embodiment, although the medical system 100 includes the two sheaths 1A and 1B, it may include three or more sheaths.
In this embodiment, although the sheaths 1A and 1B that are used inside the pericardial cavity Y have been shown as an example of the medical instrument, the fixing parts 4A, 4B, 40A, and 40B described in this embodiment may be directly provided on the endoscope 20 and the treatment instrument 30, or they may be provided on an introducer or a catheter used in a blood vessel.
As a result, the following aspect is read by the above described embodiment of the present invention.
To achieve the above-described object, the present invention provides the following solutions.
An aspect of the present invention provides a medical system including: a plurality of medical instruments each having an elongated insertion section that can be inserted into the body from the body surface; fixing parts that are provided on the insertion sections of the plurality of medical instruments, at positions away from the distal ends toward the proximal end side, and that can be coupled with and separated from each other; and manipulation parts that are provided at the proximal end side of the insertion sections of the plurality of medical instruments and that manipulate coupling and separation of the fixing parts.
According to this aspect, the insertion sections of the plurality of medical instruments are inserted into the same body cavity, and the fixing parts are coupled together inside the body cavity by manipulating the manipulation parts located on the outside of the body. This makes it possible to maintain the relative positions of the distal end portions of the plurality of insertion sections substantially constant and to integrally manipulate the distal end portions of the plurality of insertion sections inside the body cavity. Hence, the plurality of medical instruments can be simultaneously and easily manipulated even in a place like the pericardial cavity, where the medical instruments directly receive body movements.
In the above aspect, the fixing parts may include magnetic bodies generating magnetic forces that attract each other.
This allows the fixing parts to be spontaneously coupled together by magnetic force simply by bringing the fixing parts toward each other.
In the above aspect, the magnetic bodies may be electromagnets.
This makes it possible to adjust the coupling force between the fixing parts and, thus, to easily manipulate coupling and separation of the fixing parts.
In the above aspect, at least one of the medical instruments may include a flexible bending section provided closer to the distal-end side than the fixing part is.
This makes it possible to move the distal ends of the insertion sections by bending movement of the bending sections, even in a state in which the insertion sections are coupled together at the fixing parts.
In the above aspect, the medical system may further include a position changing mechanism that changes the positions of the fixing parts in the longitudinal direction of the insertion sections.
This makes it possible to change the positions of the fixing parts such that the plurality of insertion sections are coupled together at positions suited for the situation.
In the above aspect, the medical system may further include an anti-rotation mechanism that prevents the plurality of insertion sections coupled with each other at the fixing parts from relatively rotating about an axis extending in a direction passing through the fixing parts and intersecting the direction in which the plurality of insertion sections are arranged.
This makes it possible to stably maintain side-by-side arrangement of the distal end portions of the plurality of insertion sections that are coupled together at the fixing parts.
In the above aspect, the anti-rotation mechanism may include the plurality fixing parts provided on each of the plurality of insertion sections, at positions away from each other in the longitudinal direction. Alternatively, the anti-rotation mechanisms may include steps that are formed at contact surfaces of the fixing parts and that are engaged with each other in the radial direction of the insertion sections.
This makes it possible to effectively inhibit relative rotation of the distal end portions of the insertion section with a simple configuration.
In the above aspect, the medical instrument may be an endoscope, a sheath, or an introducer.
This is a continuation of International Application PCT/JP2014/077065, with an international filing date of Oct. 9, 2014, which is hereby incorporated by reference herein in its entirety. This application claims the benefit of International Application PCT/JP2014/077065.
Number | Date | Country | |
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Parent | PCT/JP2014/077065 | Oct 2014 | US |
Child | 15446403 | US |