Patent Application
20150025315
1. Field of the Invention
The present invention relates to a treatment instrument insertion auxiliary adapted to subserve insertion of a treatment instrument into a treatment instrument channel provided in an endoscope equipped with a rigid insertion portion and a treatment instrument insertion method.
2. Description of the Related Art
Recently, endoscopes have come to be used widely to examine affected areas and the like in a body. Also, in order to be able to deal with a situation in which it is necessary to treat an affected area, the endoscope is provided with a treatment instrument channel which allows passage of a treatment instrument. Then, a surgeon can pass the treatment instrument through the treatment instrument channel through an opening portion at a proximal end of the treatment instrument channel and cause the treatment instrument to protrude from a distal end opening of the treatment instrument channel to perform a treatment, such as a biopsy, of the affected area.
The opening portion at the proximal end of the treatment instrument channel is small in size and formed in a predetermined direction so as to point to the side of an insertion portion. Consequently, it sometimes requires skill to smoothly insert a treatment instrument with a sharp distal end shape such as a needle shape without causing damage to an inner wall of the treatment instrument channel and without causing damage to the sharp distal end shape of the treatment instrument.
Thus, a treatment instrument insertion auxiliary is sometimes used to subserve an operation of smoothly inserting a treatment instrument into the treatment instrument channel through the opening portion at the proximal end of the treatment instrument channel.
As a conventional example, for example, Japanese Patent Application Laid-Open Publication No. 11-225950 discloses a treatment instrument insertion auxiliary wherein a flexible tube bridges between a treatment instrument inlet provided in a hand side end portion and used to insert a treatment instrument and an endoscope connection portion provided at a distal end to connect to a treatment instrument insertion port of an endoscope; and a slit is formed continuously from the treatment instrument inlet to at least a location in a neighborhood of the endoscope connection portion of the flexible tube.
One aspect of the present invention provides a treatment instrument insertion auxiliary used to subserve passage of an elongated treatment instrument into a treatment instrument channel by being connected to an endoscope provided with a rigid insertion portion which includes the treatment instrument channel adapted to allow passage of the treatment instrument and a treatment instrument channel opening portion formed at a proximal end of the treatment instrument channel and used to insert the treatment instrument, the treatment instrument insertion auxiliary comprising: a receiving portion adapted to suppress vibration of a distal end side of the treatment instrument by being placed in contact with a distal end face of the treatment instrument; a first guide unit adapted to guide a distal end of the treatment instrument placed in contact with the receiving portion in a central axis direction of the treatment instrument channel opening portion; and a second guide unit adapted to guide the distal end of the treatment instrument to the treatment instrument channel opening portion.
One aspect of the present invention provides a treatment instrument insertion method for passing an elongated treatment instrument through a treatment instrument channel formed along an axis, comprising: a first step of connecting or fixing one end of a treatment instrument insertion auxiliary adapted to subserve insertion of the treatment instrument to an insertion port provided at a proximal end of the treatment instrument channel and used to insert a distal end side of the treatment instrument; a second step of placing the distal end side of the treatment instrument in contact with a receiving portion provided on the treatment instrument insertion auxiliary and adapted to suppress vibration of the distal end side of the treatment instrument; a third step of moving the distal end side of the treatment instrument whose vibration is suppressed by the second step from a position where the distal end side of the treatment instrument is placed in contact with the receiving portion in a direction of an extension of a central axis of the treatment instrument channel, making the distal end side of the treatment instrument concentric with the central axis; and a fourth step of moving the distal end side of the treatment instrument to a side of the insertion port along the direction of the extension after the distal end side of the treatment instrument is set in the direction of the extension of the central axis by the third step and inserting a distal end of the treatment instrument into the insertion port facing forward in the direction of the extension.
Embodiments of the present invention will be described below with reference to the drawings.
The ultrasound endoscope apparatus 1 includes a tube-shaped ultrasound probe 3 inserted into, for example, the urethra 2a of a patient 2, an optical scope 4 as a rigid endoscope passed through an optical scope passage channel (also referred to simply as a channel) 3a of the ultrasound probe 3, a puncture needle apparatus 5 as a treatment instrument inserted into a treatment instrument channel (also referred to simply as a channel) 4a provided in the optical scope 4, and the treatment instrument insertion auxiliary 6 used to subserve in inserting a puncture needle 5a of the puncture needle apparatus 5 into the channel 4a.
Also, the ultrasound endoscope apparatus 1 includes an ultrasound observation apparatus 8 adapted to generate an ultrasound tomographic image by performing signal processing using an ultrasound transducer 7 provided on the ultrasound probe 3, a monitor 9 as display means of displaying the generated ultrasound tomographic image, and a light source apparatus 10 adapted to supply illuminating light to the optical scope 4.
The ultrasound probe 3 includes a rigid probe insertion portion 11 tubular in shape, and a probe grasping portion 12 provided at a rear end (proximal end) of the probe insertion portion 11 by being expanded in diameter. A distal end portion 11a of the probe insertion portion 11 protrudes with some part in a circumferential direction bending backward and the ultrasound transducer 7 of a convex type is provided along a convex surface on an inner circumferential face side of the protruding distal end portion 11a.
The ultrasound transducer 7 is connected to the ultrasound observation apparatus 8 via a signal cable 13a passed through the probe insertion portion 11 and a signal cable 13b connected to a connector of the probe grasping portion 12 at the rear end of the probe insertion portion 11.
The ultrasound observation apparatus 8 applies an ultrasound drive signal to the ultrasound transducer 7 via signal cables 13a and 13b, driving the ultrasound transducer 7 so as to transmit ultrasound as well as generating an ultrasound tomographic image from an ultrasound signal acquired by the ultrasound transducer 7.
The optical scope 4 includes a rigid insertion portion 14 and a grasping portion 15 provided at a rear end of the insertion portion 14 by being expanded in diameter. An eyepiece barrel 16 is provided near a rear end of the grasping portion 15.
The optical scope 4 includes an illuminating window 17a (see
The illuminating light generated by the light source apparatus 10 is emitted forward of the illuminating window 17a via the light guide cable 19 and the light guide 18 and through the illuminating window 17a on which a distal end face of the light guide 18 is placed.
An objective lens 21 is placed in the observation window 17b provided adjacent to the illuminating window 17a (on a center side of the illuminating window 17a, according to the present embodiment) and adapted to form an optical image of an object such as an affected area illuminated by illuminating light emitted from the illuminating window 17a.
A distal end face of an image guide fiber bundle 22 serving as image-forming transmission means passed through the insertion portion 14 is placed at an image location of the objective lens 21, and the optical image of the object formed on the distal end face is transmitted to a rear end face by the image guide fiber bundle 22. A rear end side of the image guide fiber bundle 22 is extended from the middle of the grasping portion 15 toward the eyepiece barrel 16 and the rear end face is placed in the eyepiece barrel 16.
An eyepiece lens 23 is placed in the eyepiece barrel 16, facing the rear end face of the image guide fiber bundle 22, and the surgeon can observe the optical image of the object transmitted through the image guide fiber bundle 22, by viewing through an eyepiece window 24 provided at a rear end of the eyepiece barrel 16. Note that the eyepiece window 24 is covered by clear plate glass.
Also, the channel 4a is provided by a hollow portion formed along an axis penetrating through a distal end face of the insertion portion 14 and a rear end face of the grasping portion 15 along an axial direction of the insertion portion 14 and the grasping portion 15 of the optical scope 4. The channel 4a is made up of a hollow portion of a channel tube 25 cylindrical in shape and in a configuration in
Also, a distal end of the channel 4a opens as a channel distal end opening portion (or a treatment instrument projection port) 4c. Note that, for example, a connecting tube 25a increased in thickness in a step-like manner is formed near the rear end of the channel tube 25 near the channel opening portion 4b and is detachably connected with the connection portion 51 of the treatment instrument insertion auxiliary 6.
In an inner circumferential face of the probe grasping portion 12 on a rear end side of the ultrasound probe 3, a grooved portion 27a used for circumferential positioning of the optical scope 4 passed through the channel 3a is formed to an appropriate depth from a rear end of the inner circumferential face of the probe grasping portion 12. On the other hand, a projection 27b configured to fit in the grooved portion 27a is provided at a predetermined location on an outer circumferential face of the optical scope 4 near a front-end of the grasping portion 15.
Then, the circumferential positioning of the optical scope 4 passed through the channel 3a of the ultrasound probe 3 is done by the grooved portion 27a and the projection 27b to allow the optical scope 4 to be attached to inside the channel 3a of the ultrasound probe 3 in a predetermined state of passage.
Also, a lock member 28 is provided near a rear end of the probe grasping portion 12 to restrict (block) rearward movement of the projection 27b fitted in the grooved portion 27a.
Then, for example, as shown in
In the attached state, the ultrasound transducer 7 sends and receives ultrasound within a fan-shaped angle θ in the plane of the paper, for example, shown in
Note that on a distal end side of the ultrasound probe 3, for example, plural ultrasound transducer elements are arranged along a longitudinal direction of the distal end portion 11a in a convex portion on the side of the channel 3a, forming the convex ultrasound transducer 7. Then, the ultrasound observation apparatus 8 generates an ultrasound tomographic image corresponding to the ultrasound scan field 29 from an ultrasound signal acquired by the convex ultrasound transducer 7 and displays an ultrasound tomographic image 9a, for example, on a display surface of the monitor 9 shown in
Also, as shown in
Therefore, in
As shown in
Also, as shown in
Also, the puncture needle 5a has an outside diameter D1 smaller than 2 mm and a total length L1 of about 400 mm. In this way, the puncture needle 5a is small in outside diameter D1 and very long in total length L1. Therefore, the inner needle 5c and the outer needle tube 5d are formed of rigid material such as stainless steel, and the distal end side of the puncture needle 5a becomes prone to induce vibration.
As shown in
Also, the grasping portion 5b contains an urging unit 31 and a trigger button 32, where the urging unit 31 urges the inner needle 5c and outer needle tube 5d so as to protrude forward while the trigger button 32 is operated ON/OFF to unleash the urging unit 31.
When the surgeon pushes the trigger button 32, the urging unit 31 is set off and causes the inner needle 5c or outer needle tube 5d to protrude rapidly.
More specifically, when the trigger button 32 is operated the first time, the inner needle 5c protrudes, and when the trigger button 32 is operated the second time, the outer needle tube 5d protrudes to get ready to sample, i.e., to biopsy the tissue in the recess 5e. (Hereinafter referred to as “automatic biopsy.”)
After the protrusion of the outer needle tube 5d, when the surgeon pulls a non-illustrated urging lever, the urging unit 31 gets ready to urge the inner needle 5c and the outer needle tube 5d again.
Also, the grasping portion 5b is provided with a sampling lever 33 to collect biopsied tissue, and the sampling lever 33 is configured to be slidable in a longitudinal direction as shown in
Also, in an exemplary configuration shown in
When the adapter member 35 is interposed, it becomes not only easy to perform a biopsy operation using the puncture needle 5a under ultrasound observation by means of the ultrasound probe 3, but also possible to make adjustments to obtain a length convenient for biopsy by compensating for differences in the length of the puncture needle 5a regardless of whether ultrasound observations are carried out using the ultrasound probe 3.
Thus, the treatment instrument insertion auxiliary 6 according to the present embodiment can be used to subserve insertion of the elongated puncture needle 5a of the puncture needle apparatus 5 serving as the treatment instrument by being connected to the channel opening portion 4b of the optical scope 4 as shown in
Therefore, by regarding the adapter member 35 as a component of the treatment instrument insertion auxiliary 6, the treatment instrument insertion auxiliary 6 can be defined as being equipped with the adapter member (or adapter unit) 35 which in turn is equipped with a slide unit slidable along the axial direction of the channel 4a of the rigid endoscope and variable in total length. Note that the adapter member 35 is a reusable member (capable of being used repeatedly).
The adapter member 35 includes an inner tube 41 provided with a first connection portion 41a whose front end is detachably connected to the connecting tube 25a provided with the channel opening portion 4b, an outer tube 42 fitted with the inner tube 41 to become slidable and functioning as a slide unit variable in total length, where a second connection portion 42a at a rear end of the outer tube 42 is detachably connected with the connection portion 51 at the front end (distal end) of the treatment instrument insertion auxiliary 6.
Note that as indicated by chain double-dashed lines in
Also, the inner tube 41 of the adapter member 35 has a concavo-convex portion 43 formed spirally to a predetermined length on an outer circumferential face excluding opposite ends of the inner tube 41 such that a distal end of a fixing screw 44 provided near a distal end of the outer tube 42 will be inserted and engaged with the concavo-convex portion 43 shaped like triangular waves, to allow the slidable outer tube 42 to be fixed to the inner tube 41.
Also, a circumferential groove 45 is formed in the outer circumferential face of the inner tube 41 at a predetermined location in a length direction, allowing a movement restriction member 46 in the form of a C-shaped ring to be inserted and engaged with the circumferential groove 45.
The distal end of the fixing screw 44 can be pressed against the triangular wave-shaped concavo-convex portion 43 of the inner tube 41 by penetrating an inner side of the outer tube 42 from an outer side. A head of the fixing screw 44 is pointed in the shape of a triangular pyramid. When a user such as the surgeon tightens the fixing screw 44, the distal end of the fixing screw 44 is pressed against the concavo-convex portion 43 of the inner tube 41. Consequently, the outer tube 42 is fixed to the inner tube 41 so as not to move in the axial direction. Solid lines in
When the fixing screw 44 is loosened, the distal end of the fixing screw 44 is no longer pressed against the concavo-convex portion 43 of the inner tube 41, and the outer tube 42 becomes movable again in the axial direction relative to the inner tube 41.
When the movement restriction member 46 removably inserted into the circumferential groove 45 of the inner tube 41 is fitted in the circumferential groove 45, (the distal end of) the outer tube 42 can move to position β in
A projection 47 is provided on an inner circumferential face at the rear end of the outer tube 42 such that the connection portion 51 will abut against the projection 47 to keep a press-fitting length when the distal end of the connection portion 51 of the treatment instrument insertion auxiliary 6 is press-fitted as indicated by chain double-dashed lines.
Note that according to the present embodiment, when the adapter member 35 is used, the connection portion 51 of the treatment instrument insertion auxiliary 6 is detachably connected by being press-fitted in the outer tube 42. In contrast, when the adapter member 35 is not used, the connection portion 51 of the treatment instrument insertion auxiliary 6 is detachably connected by being fitted over the connecting tube 25a of the channel tube 25.
The connection portion 51 of the treatment instrument insertion auxiliary 6 is made of a cylindrical member formed into a C-shaped ring with a cut (notch) provided in its longitudinal direction so that the connection portion 51 can be detachably connected by absorbing slight radial dispersion in inner diameter or outside diameter size of the connection portion 51 (or an object to which the connection portion 51 is connected).
Next, a configuration of the treatment instrument insertion auxiliary 6 according to the first embodiment will be described with reference to
As shown in
In this way, the treatment instrument insertion auxiliary 6 includes a treatment instrument guide unit 55 which in turn includes the receiving portion 53 adapted to suppress (or absorb) vibration and the like of the distal end side of the puncture needle 5a by being placed in contact with the distal end side of the puncture needle 5a, and the guide path 52 having a guide groove (guiding groove) 52a U-shaped in cross-section and adapted to guide the distal end side of the puncture needle 5a caught by the receiving portion 53 in a central axis direction of the channel opening portion 4b.
The guide path 52 and the plate members 53a and 53b are formed on the treatment instrument insertion auxiliary 6, where the guide path 52 includes the U-shaped guide groove 52a formed by bending the larger rectangular portion 56a of a flat plate 56 such as shown in
Also, as shown in
Note that when the connection portion 51 is connected (attached) so as to fit in the connecting tube 25a, the central axis of the connection portion 51 (and the central axis 02 of the guide path 52) coincides with the central axis 01 of the channel 4a of the channel tube 25. In other words, the central axis of the connection portion 51 and the central axis 02 of the guide path 52 are concentric with (common to) the central axis 01 of the channel 4a or the channel opening portion 4b and are formed on an extension of the central axis 01.
When viewed from behind (from a rear end side of) the central axis 02, the treatment instrument insertion auxiliary 6 looks as shown in
Also, as shown in
Therefore, by putting the distal end side of the puncture needle 5a into the guide groove 52a of the guide path 52 and moving the distal end side of the puncture needle 5a in a longitudinal direction of the guide groove 52a having a function of the guiding portion, the surgeon can easily insert the distal end side of the puncture needle 5a into the channel opening portion 4b. Note that since the cross-section (perpendicular to the longitudinal direction) of the guide groove 52a is U-shaped, the guide groove 52a functions as a restricting portion (guide unit) or restricting means (guiding means) which restricts (guides) the moving direction of the distal end side of the puncture needle 5a in the guide groove 52a to a direction of insertion into the channel opening portion 4b so as to coincide with a direction in which a U-shaped inner surface extends.
As can be seen from
Thus, as described later, the surgeon can set the distal end side of the puncture needle 5a easily in the guide groove 52a of the guide path 52 by placing the distal end side of the puncture needle 5a in contact with planar portions of the plate members 53a and 53b which spread in a V-shape from opposite edges of the small opening portion of the guide path 52 and moving the distal end side of the puncture needle 5a placed in contact with the planar portions toward the guide path 52. Note that although in the present embodiment, the guide groove 52a has a U-shaped cross-section, the shape of the cross-section is not limited to a U-shape and may be, for example, a C-shape formed by cutting away part of a circular shape.
Thus, the treatment instrument insertion auxiliary 6 according to the present embodiment is a treatment instrument insertion auxiliary 6 used to subserve passage of an elongated treatment instrument into a treatment instrument channel by being connected to the optical scope 4 serving as an endoscope provided with the rigid insertion portion 14 which includes the channel 4a serving as the treatment instrument channel formed along an axis and adapted to allow passage of the puncture needle 5a of the puncture needle apparatus 5 serving as the treatment instrument and the channel opening portion 4b serving as a treatment instrument channel opening portion formed at a proximal end of the treatment instrument channel and used to insert the treatment instrument, the treatment instrument insertion auxiliary comprising the treatment instrument guide unit 55 adapted to guide a distal end side of the treatment instrument in a central axis direction of the treatment instrument channel opening portion by being placed in contact with the distal end side of the treatment instrument.
Next, operation of the present embodiment will be described.
To begin with, in step S1 first, the surgeon passes the optical scope 4 through the channel 3a of the ultrasound probe 3 as shown in
Next, in step S2, under optical observation through the eyepiece window 24 of the optical scope 4, the surgeon inserts the ultrasound probe 3 into, for example, the urethra 2a and sets the distal end portion 11a of the ultrasound probe 3 to near a biopsy site where a biopsy is going to be performed.
Also, as shown in step S3, by sending and receiving ultrasound to/from the side of the biopsy site using the ultrasound transducer 7 provided in the distal end portion 11a of the ultrasound probe 3, the surgeon creates conditions in which the biopsy site can be observed with the ultrasound tomographic image 9a.
Next, in step S4, the surgeon connects (attaches) the connection portion 51 of the treatment instrument insertion auxiliary 6 to the connecting tube 25a of the optical scope 4. Note that the treatment instrument insertion auxiliary 6 does not necessarily have to be connected (attached) in step S4, and may be connected (attached) in a step previous to step S4.
In the following description, it is assumed that the adapter member 35 is not used.
Next, in step S5, the surgeon grips the grasping portion 15 of the optical scope 4 or a peripheral portion of the probe grasping portion 12 of the ultrasound probe 3 with one hand and grips the grasping portion 5b of the puncture needle apparatus 5 with the other hand to perform tissue sampling (biopsy) by puncture.
Since the puncture needle 5a of the puncture needle apparatus 5 has an outside diameter D1 smaller than 2 mm and a total length L1 of about 400 mm as described earlier, when the surgeon grips the grasping portion 5b on a proximal end side of the puncture needle 5a as shown in step S6, a distal end of the puncture needle 5a becomes very prone to generate vibration.
Consequently, the surgeon grips the grasping portion 5b in a gripping state in which the surgeon cannot completely stabilize the hand gripping the grasping portion 5b, i.e., in a state in which so-called shaking movements are unavoidable, and so the distal end side of the puncture needle 5a goes into a vibrational state in which the distal end side of the puncture needle 5a vibrates as if resonating at a frequency close to that of the shaking movements.
An operation in which the surgeon inserts the distal end side of the puncture needle 5a into the channel opening portion 4b with a small inner diameter (e.g., about 2 to 3 mm) alone without using the treatment instrument insertion auxiliary 6 according to the present embodiment becomes difficult to perform in a short time due to vibration such as described above. That is, the operation of inserting the distal end side of the puncture needle 5a into the channel opening portion 4b become difficult because the distal end side of the puncture needle 5a vibrates with an amplitude far greater than the inner diameter of the channel opening portion 4b.
According to the present embodiment, the treatment instrument insertion auxiliary 6 is provided with the receiving portion 53 having a large area so as to be able to suppress shaking or vibration such as described above (hereinafter simply referred to as vibration).
As shown in step S7, the surgeon places the vibrating distal end side of the puncture needle 5a in contact with a plane of the receiving portion 53.
By placing the distal end side of the puncture needle 5a in contact with the plane of the receiving portion 53, it is possible to suppress vibration of the distal end side of the puncture needle 5a. That is, as shown in step S8, the vibration of the distal end side of the puncture needle 5a goes into a suppressed state.
Note that since the receiving portion 53 is made up of the two plate members 53a and 53b so as to have a larger area, even if the distal end side of the puncture needle 5a is vibrating, the surgeon can place the distal end side of the puncture needle 5a in contact with some part of the large-area receiving portion 53. When the distal end side of the puncture needle 5a is vibrating, the receiving portion 53 absorbs vibration energy and thereby suppresses the vibration via a receiving portion-side abutting portion abutted by the vibrating portion.
After the vibration of the distal end side of the puncture needle 5a is suppressed, as shown in step S9, the surgeon causes the distal end side of the puncture needle 5a to slip or slidingly move toward the guide path 52 while keeping the distal end side of the puncture needle 5a in contact with the plane of the receiving portion 53. Incidentally, for example, as indicated by chain double-dashed lines in
As shown in step S11, the surgeon can insert the distal end side of the puncture needle 5a into the channel 4a through the channel opening portion 4b by moving or pushing in the distal end side of the puncture needle 5a housed in the guide groove 52a forward.
By pushing in the puncture needle 5a to (or to near) a position where the proximal end of the puncture needle 5a abuts the connecting tube 25a, it is possible to set the distal end of the puncture needle 5a at a position near the channel distal end opening portion 4c.
As shown in step S12, the surgeon can verify the distal end side of the puncture needle 5a (e.g., a state indicated by a chain double-dashed line in
After the biopsy, the surgeon draws the puncture needle 5a out of the channel 4a as shown in step S14. As shown in step S15, the surgeon determines whether to further perform a biopsy.
If a biopsy is to be performed further, the surgeon sets the distal end side of the ultrasound probe 3 to a next biopsy site as shown in step S16. Then, by repeating step S5 and subsequent operations using a new puncture needle apparatus 5, a biopsy can be performed, for example, at a biopsy site different from the previous time. After repeating multiple biopsies to perform the biopsies at plural desired biopsy sites in this way, the operation of
As described above, according to the present embodiment, since vibration is suppressed easily by placing the vibrating distal end side of the puncture needle 5a in contact with the receiving portion 53 and the distal end side of the puncture needle 5a is inserted into the channel 4a by simple actions with the vibration suppressed, even when biopsies are performed at plural locations, the surgeon can perform the biopsies smoothly by inserting the distal end side of the puncture needle 5a into the channel 4a by himself/herself in a short time.
Although in the above description, it is assumed that the adapter member 35 is not used, when the puncture needle 5a of the puncture needle apparatus 5 is passed through the channel 4a of the optical scope 4 using the adapter member 35, the distal end side of the puncture needle 5a may be set at such a position in the channel distal end opening portion 4c that is suitable for biopsy.
Next, description will be given of an operation of performing a biopsy by using the adapter member 35 and observing the ultrasound tomographic image 9a.
As shown in
In this state, the distal end side of the puncture needle 5a of the puncture needle apparatus 5 is inserted into the treatment instrument insertion auxiliary 6 from behind as described with reference to
Subsequently, with a front end face of the grasping portion 5b at the proximal end of the puncture needle 5a set at such a position as to abut an opening portion at a proximal end of the guide path 52, a total length of the adapter member 35 (more specifically, a distal end position of the outer tube 42 capable of sliding movement with respect to the inner tube 41) is adjusted to a state (state indicated by chain double-dashed lines in
Also, on an observed image based on an ultrasound tomographic image 9a, the state in which the distal end of the puncture needle 5a protrudes, for example, slightly from the channel distal end opening portion 4c is a state such as shown in
To create such a state, the outer tube 42 capable of sliding movement with respect to the inner tube 41 of the adapter member 35 is adjusted in length and fixed, for example, near the position indicated by α in
On the other hand, when the outer tube 42 is located at position β and the fixing screw 44 is kept tight at a position corresponding to β, the distal end of the puncture needle 5a is in a set state (state β) shown in
Also, when the outer tube 42 is located at position γ and the fixing screw 44 is kept tight at a position corresponding to γ, the distal end of the puncture needle 5a is in a set state (state γ) shown in
By setting the total length of the adapter member 35 such that lengths of the channel 4a and the puncture needle 5a will be appropriate using the adapter member 35 in this way, it is possible to take a biopsy from the biopsy site by automatic biopsy in a short time.
As described above, according to the present embodiment, the distal end side of the treatment instrument can be guided smoothly in the central axis direction of the channel opening portion 4b serving as a treatment instrument insertion opening portion of the channel 4a by a surgeon alone by simple actions. In other words, the puncture needle 5a of the puncture needle apparatus 5 as a treatment instrument can be inserted into the channel 4a in a short time. Consequently, even when biopsies are performed at plural locations, the biopsies can be performed at the plural locations in a short time.
Next, a second embodiment of the present invention will be described with reference to
The treatment instrument insertion auxiliary 6B allows a treatment instrument guide member (or treatment instrument guide unit) 62 made of a funnel-shaped metal member to be detachably connected (attached) to the connecting tube 25a of the channel 4a via a resilient coupling member (or connecting member) 61 of rubber or the like. By abutting a rear end face of the connecting tube 25a (i.e., an end face of the channel opening portion 4b), a distal end face of the treatment instrument guide member 62 is connected to the connecting tube 25a by the coupling member 61.
The treatment instrument guide member 62 has a ring-shaped distal end side opening portion whose distal end is equal in inner diameter to the channel opening portion 4b, and the treatment instrument guide member 62 forms a funnel shape, with its inner diameter and outside diameter spreading into a circular conical shape from the distal end side opening portion toward a rear end side of the treatment instrument guide member 62. An opening portion at a rear end forms a treatment instrument insertion opening portion (simply referred to as an insertion opening portion) 62a.
Also, according to the present embodiment, on an entire inner circumferential face of the treatment instrument guide member 62 spreading into a funnel shape, plural guide grooves (or guide ridges) 63a shaped, for example, triangular in cross-section and extended out along a longitudinal direction of the treatment instrument guide member 62 are provided densely in a circumferential direction, forming a guide path (or a guide unit) 63 adapted to guide the distal end side of the puncture needle 5a in the central axis direction of the channel 4a. The guide groove 63a is not limited to a triangular cross-section, and may be a U-shaped recess. Besides, the guide grooves 63a may form a concavo-convex portion of another cross-sectional shape. Note that according to the present embodiment, wall surfaces of the guide grooves 63a making up the guide path 63 functions as a receiving portion adapted to suppress vibration of the distal end side of the puncture needle 5a by being placed in contact with the distal end side of the puncture needle 5a. Therefore, according to the present embodiment, the guide path 63 which combines the function of the receiving portion forms a treatment instrument guide unit (which includes the receiving portion and guide path).
The guide grooves 63a making up the guide path 63 are formed so as to extend along a longitudinal direction so that circumferential position will not change.
For example, when a bottom portion of an arbitrary guide groove 63a is cut along a cutting plane passing through the central axis of the channel 4a, the bottom portion of the guide groove 63a is cut in such a way that the circumferential position will not change at any position α long the longitudinal direction.
Also, as shown in
That is, again according to the present embodiment, by inserting the distal end side of the puncture needle 5a into a wide-open inner side of the treatment instrument guide member 62 and causing the distal end side of the puncture needle 5a to abut any of the wall surfaces making up the large number of the guide grooves 63a formed on the entire inner circumferential face of the treatment instrument guide member 62, the surgeon can suppress vibration of the distal end side of the puncture needle 5a. Subsequently, with the distal end side of the puncture needle 5a abutting the guide groove 63a, by pushing out or moving the distal end side of the puncture needle 5a forward (toward the far side), the surgeon can move the distal end side of the puncture needle 5a along the longitudinal direction of the abutted guide groove 63a and insert the distal end side into the channel opening portion 4b.
Again, according to the present embodiment, the guide path 63 serving the function of a receiving portion placed in contact with the distal end side of the puncture needle 5a is configured to be wide open.
Thus, by inserting the distal end side of the puncture needle 5a into the insertion opening portion 62a and placing the distal end side in contact with the wall surface of any of the guide grooves 63a in an inner circumferential face of the insertion opening portion 62a, the surgeon can suppress the vibration of the distal end side of the puncture needle 5a and subsequently move the distal end side of the puncture needle 5a toward the far side, thereby inserting the distal end side of the puncture needle 5a into the channel opening portion 4b by simple actions in a short time.
Note that although the insertion opening portion 62a is formed into a ring shape in the example shown in
Whereas with the configuration in
This allows the surgeon to select an insertion direction of the distal end side of the puncture needle 5a from a wider range of directions and perform an operation of inserting the distal end side of the puncture needle 5a in a direction considered to enable easier insertion. Thus, the present variation improves operability compared to the configuration of
Next, a third embodiment of the present invention will be described.
The treatment instrument insertion auxiliary 6D according to the present embodiment is configured with a wire-shaped member (referred to as wire or wire member). A hole portion 71 used to fix the treatment instrument insertion auxiliary 6D is provided in the end face of the channel tube 25 and the treatment instrument insertion auxiliary 6D can be detachably fixed (connected) by press-fitting a fixing end portion 72a of the treatment instrument insertion auxiliary 6D into the hole portion 71.
The treatment instrument insertion auxiliary 6D includes an extending portion 72b extended out rearward substantially parallel to the central axis 01 of the channel tube 25 (or channel 4a) from the fixing end portion 72a, a first receiving portion 72c formed by being extended out from an end portion of the extending portion 72b in a direction perpendicular to the central axis 01 and being folded into a U-shape (or V-shape) at the extended position, and a second receiving portion 72d formed by being bent from an end portion of the first receiving portion 72c into an L-shape so as to extend out in a direction perpendicular to the central axis 01.
As shown in the rear view of
According to the present embodiment, by placing the distal end side of the puncture needle 5a in contact with the first receiving portion 72c, for example, as shown in
As with the first embodiment or the second embodiment, the present embodiment can provide a treatment instrument insertion auxiliary which lends itself to low-cost manufacturing and allows a single surgeon to easily guide the distal end side of the treatment instrument in the central axis direction of the channel opening portion 4b serving as a treatment instrument insertion opening portion of the channel 4a without requiring an assistant. Again, in the present embodiment, a vibration-absorbing member 74 of rubber or the like with a high capability to absorb vibration may be applied as a thin film, for example, as indicated by chain double-dashed lines in
In the treatment instrument insertion auxiliary 6D according to the present embodiment, when viewed from a rear side, the receiving portions 72c and 72d are formed into a substantially V-shape using a wire member as shown in
A boundary between the rear end of the extending portion 72b and the receiving portion 75 formed into a spiral shape constitutes a guide unit 75a. In other words, a neighborhood of a center of a spiral in the receiving portion 75 constitutes the guide unit 75a located on an extension of the central axis 01 of the channel 4a.
The surgeon performs the act of placing the distal end side of the puncture needle 5a in contact with any part of the spiral-shaped wire making up the receiving portion 75. By placing the distal end side of the puncture needle 5a in contact with any part of the spiral-shaped portion making up the receiving portion 75, it is possible to suppress vibration of the distal end side of the puncture needle 5a.
Subsequently, by moving the distal end side of the puncture needle 5a to a center side of the spiral, the distal end side of the puncture needle 5a can be set on the guide unit 75a at the center of the spiral located on the extension of the central axis 01 of the channel 4a, and by moving the distal end side of the puncture needle 5a along the guide unit 75a, the distal end side of the puncture needle 5a can be inserted into the channel 4a. The present variation provides advantages similar to those of the third embodiment and lends itself to low-cost manufacturing.
Note that embodiments configured by combining parts of the embodiments and the like described above are also included in the present invention. Also, the present invention can be used not only to subserve insertion of a treatment instrument such as the puncture needle apparatus 5 equipped with a linear puncture needle 5a into a treatment instrument channel when the axis is a straight line as shown in
Also, in the present invention, one or more components may be added as appropriate on the basis of a configuration described in an independent claim. Also, if a description in an original dependent claim at the time of application differs from a description literally disclosed in the original specification, the wording of the original specification may be substituted for the wording of the original dependent claim. Also, a claim cited in a dependent claim may be changed to another claim as long as consistency is maintained. Also, the present invention discloses treatment instrument insertion methods whose details are described in appendices below.
[Appendix 1] A treatment instrument insertion method for passing an elongated treatment instrument through a treatment instrument channel formed along an axis, comprising:
a first step of connecting or fixing one end of a treatment instrument insertion auxiliary adapted to subserve insertion of the treatment instrument to an insertion port provided at a proximal end of the treatment instrument channel and used to insert a distal end side of the treatment instrument;
a second step of placing the distal end side of the treatment instrument in contact with a receiving portion provided on the treatment instrument insertion auxiliary and adapted to suppress vibration of the distal end side of the treatment instrument;
a third step of moving the distal end side of the treatment instrument whose vibration is suppressed by the second step from a position where the distal end side of the treatment instrument is placed in contact with the receiving portion in a direction of an extension of a central axis of the treatment instrument channel, making the distal end side of the treatment instrument concentric with the central axis; and
a fourth step of moving the distal end side of the treatment instrument to a side of the insertion port along the direction of the extension after the distal end side of the treatment instrument is set in the direction of the extension of the central axis by the third step and inserting a distal end of the treatment instrument into the insertion port facing forward in the direction of the extension.
[Appendix 2] The treatment instrument insertion method according to appendix 1, wherein: the treatment instrument insertion auxiliary includes a guide groove coupled to the receiving portion and extended out in a direction in which guide groove becomes concentric with the central axis of the treatment instrument channel and
the third step inserts the distal end side of the treatment instrument positioned in contact with the receiving portion into the guide groove while maintaining the contact and thereby moves the distal end side of the treatment instrument in the direction of the extension on which the distal end side of the treatment instrument becomes concentric with the central axis of the treatment instrument channel
[Appendix 3] The treatment instrument insertion method according to appendix 1, wherein: the second step places the distal end side of the treatment instrument in contact with a receiving portion formed by a spiral wire or a V-shaped wire whose center is located on the extension of the central axis of the treatment instrument channel and thereby suppresses the vibration of the distal end side of the treatment instrument placed in contact with the receiving portion.
[Appendix 4] The treatment instrument insertion method according to appendix 2, wherein: the receiving portion includes two planes which spreads into a V-shape in cross-section from an open edge of the guide groove; and the second step places the distal end side of the treatment instrument in contact with either one of the two planes and the plane placed in contact suppresses the vibration of the distal end side of the treatment instrument.
[Appendix 5] The treatment instrument insertion method according to appendix 2, wherein: the receiving portion includes two planes which spreads into a V-shape in cross-section from an open edge of the guide groove; and a vibration-absorbing portion adapted to absorb vibration and provided on each of the two planes, wherein the second step places the distal end side of the treatment instrument in contact with either one of the two planes, and causes the vibration-absorbing portion to absorb the vibration of the distal end side of the treatment instrument.
[Appendix 6] The treatment instrument insertion method according to appendix 1, wherein: the receiving portion includes a V-shaped portion extended out in a direction substantially orthogonal to the central axis from a position on the extension of the central axis of the treatment instrument channel; and a vibration-absorbing portion adapted to absorb vibration and provided on a surface of the V-shaped portion, wherein the second step places the distal end side of the treatment instrument in contact with the V-shaped portion and causes the vibration-absorbing portion provided on the surface of the V-shaped portion to absorb the vibration of the distal end side of the treatment instrument placed in contact.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2012-166132 | Jul 2012 | JP | national |
This application is a continuation application of PCT/JP2013/066224 filed on Jun. 12, 2013 and claims benefit of Japanese Application No. 2012-166132 filed in Japan on Jul. 26, 2012, the entire contents of which are incorporated herein by this reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2013/066224 | Jun 2013 | US |
| Child | 14507050 | US |
