Surgical instrument holding device and surgical assistance device

Abstract

The invention comprises: an adapter, to which a surgical instrument can be detachably mounted, and the adapter is provided with a restricted portion; a separator, to which the adapter can be detachably mounted; a retaining body, to which the separator can be detachably mounted; and a driving body, which supports the retaining body in a rotatable manner and applies a driving force to the retaining body, a cylindrical portion for the surgical instrument to pass through is provided on the adapter, and an insertion portion for the cylindrical portion to pass through is provided on the separator, the surgical instrument is retained on the retaining body by means of the separator and the adapter, a restricting portion is formed on the separator, and the restricting portion engages with the restricted portion to restrict the circumferential rotation of the adapter about the cylindrical portion.

Description

Technical Field

[0001] The present invention relates to the technical field of a surgical instrument holding device for holding a surgical instrument and a surgical auxiliary device equipped with the surgical instrument holding device. Background Art

[0002] In recent years, surgical procedures using surgical assist devices have become increasingly common. These devices feature multiple movable bodies connected in a rotatable manner. These movable bodies are rotated by a driver, with the movable body at one end of the connection serving as a retaining member. The multiple movable bodies are configured as arms or joints, and surgical instruments are retained by the retaining member. A portion (the distal end) of the surgical instrument is inserted into the patient's body cavity. Depending on the type and nature of the surgery, instruments such as endoscopes and forceps are used.

[0003] In a surgical assisting device, when multiple movable bodies rotate in predetermined directions, the position and posture of a surgical instrument change along with the rotation of the movable bodies, and a distal end of the surgical instrument is inserted into a patient's body cavity to perform a surgical operation.

[0004] In general, surgical operations using surgical assisting devices such as those described above are performed by a surgeon (physician) remotely controlling the surgical assisting devices in an operating room in a master-slave mode. During such surgical operations, a pivot point is set as a reference point for the position and posture of the surgical instruments.

[0005] The pivot point is a position that roughly coincides with an incision formed in a patient's body cavity for inserting a surgical instrument. When a trocar is used, the pivot point roughly coincides with the position of the trocar. Therefore, when the surgical instrument is inserted into the patient's body cavity, the position and posture of the surgical instrument are controlled so that a portion of the surgical instrument always passes through the pivot point. Passage of a portion of the surgical instrument through the pivot point prevents loads on tissue near the patient's body surface, thereby ensuring safety.

[0006] The surgical assisting device described above is provided with a surgical instrument holding device for holding surgical instruments. There are various types of surgical instrument holding devices (for example, see Patent Documents 1, 2, and 3). Such a surgical instrument holding device is provided with the aforementioned holding body, with a portion or the entire holding body serving as a holding portion for holding the surgical instrument.

[0007] As described above, there are various types of surgical instrument holding devices. These include an adapter for adapting the size and shape of a holding body to the surgical instrument, with the surgical instrument being mounted and held on the holding body via the adapter (see, for example, Patent Document 3). Furthermore, there are also types of surgical assisting devices in which a cover for separating a clean area from a non-clean area is mounted on a partition, and the partition is mounted on the holding body. In these types of surgical assisting devices, the adapter is also mounted on the partition, and the surgical instrument is held on the holding body via the partition and the adapter.

[0008] Prior art literature

[0009] Patent Literature

[0010] Patent Document 1: Japanese Patent Application Laid-Open No. 2015-228922

[0011] Patent Document 2: Japanese Patent Application Laid-Open No. 2003-284726

[0012] Patent Document 3: Japanese Patent Application Laid-Open No. 6-63003 Summary of the Invention

[0013] Problems to be solved by the invention

[0014] However, surgical instruments are used by inserting their distal ends into a patient's body cavity. For example, an endoscope built into the surgical instrument is used to observe the interior of the body cavity, or forceps provided at the distal end of the surgical instrument are used to remove a lesion.

[0015] Therefore, when the positions of various parts of the surgical instrument are unintentionally changed relative to the holder, the state inside the body cavity cannot be accurately observed with an endoscope, or it may hinder the accurate removal of the lesion site with forceps, which may reduce the accuracy and safety of the operation.

[0016] In addition, most surgical operations using surgical assist devices are performed remotely by the operator in a master-slave manner.

[0017] Therefore, when the positions of various parts of the surgical instrument change unintentionally relative to the holding body, there is a risk that the position and posture of the surgical instrument identified by the surgical operator based on the information input to the operating device serving as the host will be different from the actual position and posture of the surgical instrument, which will reduce the accuracy and safety of the operation.

[0018] Therefore, the purpose of the surgical instrument holding device and the surgical auxiliary device of the present invention is to prevent the surgical instrument from being displaced relative to the holding body to ensure the accuracy and safety of the surgery.

[0019] Solutions for solving problems

[0020] First, the surgical instrument holding device according to the present invention comprises: an adapter, a surgical instrument is detachably mounted on the adapter, and the adapter is provided with a restricted portion; a partition, the adapter is detachably mounted on the partition; a holding body, the partition is detachably mounted on the holding body; and a driving body, which supports the holding body in a rotatable manner and applies a driving force to the holding body, a cylindrical portion for the surgical instrument to pass through is provided on the adapter, and an insertion portion for the cylindrical portion to be inserted is provided on the partition, the surgical instrument is held on the holding body by means of the partition and the adapter, a restricting portion is formed on the partition, and the restricting portion is engaged with the restricted portion to restrict the rotation of the adapter in the circumferential direction of the cylindrical portion.

[0021] Thus, in a state where the adapter is attached to the spacer and the spacer is attached to the holding body, rotation of the adapter to which the surgical instrument is attached relative to the spacer is restricted.

[0022] Second, in the surgical instrument holding device according to the present invention, it is desired that a rotation-restricted portion is provided on the partition, a rotation-restricted portion is formed on the holding body, and the rotation-restricted portion is engaged with the rotation-restricted portion to restrict the circumferential rotation of the partition in the insertion portion.

[0023] Thus, in a state where the adapter is attached to the separator and the separator is attached to the holding body, the rotation of the adapter relative to the separator is restricted, and the rotation of the separator relative to the holding body is restricted.

[0024] Third, in the above-mentioned surgical instrument holding device according to the present invention, it is desired that a first snap-fit supporting portion is formed on the holding body, a second snap-fit supporting portion is formed on the partition, a first snap-fit portion is provided on the partition, and when the partition is installed on the holding body, the first snap-fit portion is elastically deformed and snap-fitted with the first snap-fit supporting portion, a second snap-fit portion is provided on the adapter, and when the adapter is installed on the partition, the second snap-fit portion is elastically deformed and snap-fitted with the second snap-fit supporting portion, the first snap-fit portion is snap-fitted to the first snap-fit supporting portion in an elastically reset state, thereby the partition is installed on the holding body, and the second snap-fit portion is snap-fitted to the second snap-fit supporting portion in an elastically reset state, thereby the adapter is installed on the partition.

[0025] Thus, the elastically deformed first engaging portion engages with the first engaging receiving portion in an elastically reset state, and the elastically deformed second engaging portion engages with the second engaging receiving portion in an elastically reset state, whereby the surgical instrument is held on the holding body by means of the partition and the adapter.

[0026] Fourthly, in the surgical instrument holding device according to the present invention, it is desirable that the rotation restricted portion and the first engaging portion are formed in a shape protruding relative to the insertion portion, and the rotation restricted portion and the first engaging portion are provided continuously.

[0027] Thus, the rotation restricted portion and the first engaging portion, both of which are shaped to protrude relative to the insertion portion, are not provided at separate positions in the partition.

[0028] Fifth, in the above-mentioned surgical instrument holding device according to the present invention, it is desirable that an attachment and detachment opening opened in a radial direction is formed in the insertion portion, and the surgical instrument attached to the adapter is inserted into or removed from the attachment and detachment opening.

[0029] Thus, the surgical instrument can be inserted and removed in the radial direction of the insertion portion, and there is no need to move the surgical instrument in the axial direction of the insertion portion to attach and detach the surgical instrument to the partition via the adapter.

[0030] Sixth, the surgical assisting device according to the present invention comprises a surgical instrument holding device for holding a surgical instrument, in the surgical assisting device, the surgical instrument holding device comprises: an adapter, the surgical instrument is detachably mounted on the adapter, the adapter is provided with a restricted portion; a partition, the adapter is detachably mounted on the partition; a holding body, the partition is detachably mounted on the holding body; and a driving body, which supports the holding body in a rotatable manner and applies a driving force to the holding body, a cylindrical portion for the surgical instrument to pass through is provided on the adapter, and an insertion portion for the cylindrical portion to be inserted is provided on the partition, the surgical instrument is held on the holding body by means of the partition and the adapter, a restricting portion is formed on the partition, and the restricting portion engages with the restricted portion to restrict the rotation of the adapter in the circumferential direction of the cylindrical portion.

[0031] Thus, in the surgical instrument holding device, in a state where the adapter is attached to the partition and the partition is attached to the holding body, rotation of the adapter to which the surgical instrument is attached relative to the partition is restricted.

[0032] Effects of the Invention

[0033] According to the present invention, when the adapter is installed on the partition and the partition is installed on the retaining body, the rotation of the adapter with the surgical instrument installed relative to the partition is restricted, thereby preventing the surgical instrument from rotating unintentionally relative to the retaining body and preventing the surgical instrument from being displaced relative to the retaining body, thereby ensuring the accuracy and safety of the operation. BRIEF DESCRIPTION OF THE DRAWINGS

[0034] Figure 1 and Figures 2 to 44The embodiments of the surgical instrument holding device and the surgical auxiliary device of the present invention are also shown. Figure 1 It is a schematic perspective view showing a surgical assisting device and the like.

[0035] Figure 2 This is a schematic diagram of surgical assist devices, etc.

[0036] Figure 3 This is a schematic perspective view of a surgical assisting device having multiple main bodies.

[0037] Figure 4 It is a three-dimensional diagram of a surgical instrument holding device and surgical instruments.

[0038] Figure 5 It is an exploded perspective view of a surgical instrument holding device and surgical instruments.

[0039] Figure 6 It is a side view showing a state in which the surgical instrument holding device and the surgical instrument are connected to the fourth movable body.

[0040] Figure 7 It is a side view showing the internal structure of the driving body, etc.

[0041] Figure 8 It is a front view of the driving body and the retaining body.

[0042] Figure 9 It is a rear view of the detection mechanism and the holding body.

[0043] Figure 10 is a cross-sectional view of the retaining body.

[0044] Figure 11 It is a three-dimensional diagram of the holding body, etc.

[0045] Figure 12 is a bottom view showing the separator and the adapter exploded.

[0046] Figure 13 It is a three-dimensional diagram of the separator.

[0047] Figure 14 is a front view of the divider.

[0048] Figure 15 It is along Figure 14 Cross-sectional view along line XV-XV.

[0049] Figure 16 This is an exploded perspective view of the adapter.

[0050] Figure 17 is a front view of the adapter.

[0051] Figure 18 It is along Figure 17A cross-sectional view taken along line XVIII-XVIII.

[0052] Figure 19 It is a plan view showing the second engaging portion and the like.

[0053] Figure 20 This is a cross-sectional view showing a state before the surgical instrument is mounted on the adapter by the mounting member.

[0054] Figure 21 It is a cross-sectional view showing a state where the surgical instrument is mounted on the adapter by the mounting member.

[0055] Figure 22 It is a cross-sectional view showing a state in which the first engaging portion of the separator is inserted into the holding body and the first engaging portion is elastically deformed.

[0056] Figure 23 This is a cross-sectional view showing a state in which the first engagement portion is elastically restored and engaged with the first engagement receiving portion, thereby attaching the spacer to the holding body.

[0057] Figure 24 This is a side view showing a state where the first detection unit detects that the spacer is attached to the holding body.

[0058] Figure 25 It is a cross-sectional view showing a state where the spacer is attached to the holding body.

[0059] Figure 26 This is a perspective view showing a state before a surgical instrument attached to an adapter is inserted into the partition in a state where the partition is attached to a holding body.

[0060] Figure 27 This is a perspective view showing a state in which a surgical instrument attached to an adapter is inserted into the partition in a state in which the partition is attached to a holding body.

[0061] Figure 28 This is a side view showing a state in which the cylindrical portion of the adapter is inserted into the insertion portion of the separator and the sliding surface of the engaging claw portion is in contact with the receiving portion of the separator.

[0062] Figure 29 It is a side view showing a state in which the cylindrical portion of the adapter is inserted into the insertion portion of the separator and the second engagement portion is elastically deformed.

[0063] Figure 30 It is a side view showing a state in which the second engagement portion is elastically restored, the engagement claw portion is engaged with the second engagement receiving portion, and the adapter is attached to the partition.

[0064] Figure 31 This is a perspective view of a state where the adapter is attached to the partition.

[0065] Figure 32This is a side view showing a state where the second detection unit detects that the adapter is attached to the partition.

[0066] Figure 33 This is a bottom view showing a partial cross section of a state in which the adapter is attached to the partition and the surgical instrument is held by the holding body via the partition and the adapter.

[0067] Figure 34 This is a rear view showing a state in which the adapter is attached to the partition and the surgical instrument is held by the holding body via the partition and the adapter.

[0068] Figure 35 It is a rear view showing the positional relationship between the detection mechanism and the second engaging portion of the adapter.

[0069] Figure 36 This is a schematic diagram showing a state in which a surgical instrument inserted into an incision moves relative to a body cavity.

[0070] Figure 37 This is a schematic diagram showing a state in which a surgical instrument inserted into an incision is tilted relative to a body cavity.

[0071] Figure 38 This is a schematic diagram showing a state in which an external force is applied to the base end portion of the second engaging portion via the outer portion.

[0072] Figure 39 It is a schematic diagram showing a state where an external force is applied to the engaging claw portion of the second engaging portion.

[0073] Figure 40 This is a schematic diagram showing a state in which an external force is applied to a portion of the second engaging portion close to the outer engaging claw portion.

[0074] Figure 41 It is a side view showing a state where the driving body is located at the first rotation position.

[0075] Figure 42 It is a side view showing a state where the driving body is located at the second rotation position.

[0076] Figure 43 It is a rear view showing an example of a detection mechanism that performs detection using detection light.

[0077] Figure 44 It is a plan view showing a second engaging portion formed in another shape, etc. DETAILED DESCRIPTION

[0078] Hereinafter, embodiments of the surgical instrument holding device and the surgical assisting device according to the present invention will be described with reference to the accompanying drawings.

[0079] The following embodiments illustrate an example of a surgical assisting device of the present invention installed on an operating room floor, etc. However, the scope of application of the surgical assisting device of the present invention is not limited to installation on an operating room floor, etc. The surgical assisting device of the present invention can also be installed on an operating room ceiling or wall.

[0080] In addition, the front, back, top, bottom, left, and right directions shown below are for convenience of description, and the implementation of the present invention is not limited to these directions.

[0081] In addition, the surgical assistance device described below has a structure for rotating the movable body, but this "rotation" refers to movement in a direction of rotation around a reference axis (central axis) including an arbitrary point, that is, also includes "rotation" movement.

[0082] <General Structure of Surgery Assisting Devices, Etc.>

[0083] First, the schematic structure of the surgical assisting device 1 and the like will be described (see Figures 1 to 3 ).

[0084] An operating table 100 is set up in an operating room, and a patient 200 lies flat on the operating table 100, for example, in a supine position (see Figure 1 ). An incision 202 is formed in a body cavity 201 of a patient 200, for example, an abdominal wall 201a. During surgery, a portion (distal end portion) of a surgical instrument described later is inserted into the incision 202. The incision 202 is a small hole for inserting a shaft-shaped surgical instrument.

[0085] The surgical support device 1 includes a base 2 placed on the floor of an operating room, for example; a cylindrical column 3 fixed to the base 2; and a main body 4 supported by the column 3. The base 2 is installed on the floor, for example, to the side of the operating table 100, and the column 3 is fixed to the base 2 at its lower end while extending vertically.

[0086] The main body 4 is supported by the column 3 so as to be movable in the vertical direction along the column 3 . The main body 4 has a structure in which each part is rotatably connected and can be fixed at a desired position in the vertical direction along the column 3 .

[0087] The main body 4 includes a first connecting arm 5 and a second connecting arm 6 that are connected to each other so as to be rotatable.

[0088] The first connecting arm 5 is formed into a horizontally extending shape, with one end in the longitudinal direction being provided as a supported cylindrical portion 5a, and the other end in the longitudinal direction being provided as a fulcrum portion 5b. The supported cylindrical portion 5a of the first connecting arm 5 is inserted through the column 3 and can be moved vertically relative to the column 3 manually or electrically, and can be rotated in an axial direction relative to the column 3 with the supported cylindrical portion 5a serving as a fulcrum.

[0089] The first connecting arm 5 can be fixed at a desired position in the vertical direction and at a desired position in the direction of rotation around the axis along the column 3 .

[0090] The second connecting arm 6 is formed into a horizontally extending shape, with one longitudinal end being provided with a fulcrum portion 6a and the other longitudinal end being provided with a support shaft portion 6b. The fulcrum portion 6a of the second connecting arm 6 is connected to the fulcrum portion 5b of the first connecting arm 5 in a state of vertical overlap and mutual rotation. The second connecting arm 6 can be rotated relative to the first connecting arm 5 with the fulcrum portion 6a serving as the fulcrum, either manually or electrically.

[0091] The main body 4 has a first movable body 7 that functions as a joint portion. The first movable body 7 is rotatably connected to the support shaft portion 6b of the second connecting arm 6 (see Figure 1 as well as Figure 2 ).

[0092] The end of the first movable body 7 on the side closest to the second connecting arm 6 is provided as a proximal connecting portion 7a, and the end opposite the second connecting arm 6 is provided as a distal connecting portion 7b. The proximal connecting portion 7a of the first movable body 7 is rotatably connected to the support shaft portion 6b of the second connecting arm 6. For example, the proximal connecting portion 7a can rotate relative to the second connecting arm 6 about a reference axis extending in the vertical direction. Thus, the first movable body 7 can rotate relative to the second connecting arm 6, providing the surgical assistance device 1 with one degree of freedom in its movement direction.

[0093] The main body 4 includes a second movable body 8 functioning as an arm portion, and the second movable body 8 is rotatably connected to the front end side connection portion 7 b of the first movable body 7 .

[0094] One longitudinal end of the second movable body 8 is provided as a proximal connection portion 8a, and the other longitudinal end is provided as a distal connection portion 8b. The proximal connection portion 8a of the second movable body 8 is rotatably connected to the distal connection portion 7b of the first movable body 7. For example, the proximal connection portion 8a of the second movable body 8 is rotatable relative to the first movable body 7 about a reference axis extending perpendicular to the direction of connection between the second movable body 8 and the first movable body 7. Thus, the second movable body 8 can rotate relative to the first movable body 7, providing the surgical assistance device 1 with one degree of freedom in its movement direction.

[0095] The second movable body 8 is provided with, for example, a link mechanism having two sets of parallel link portions 9, 9, ... and coupling pins 10, 10, ... coupling the link portions 9, 9, .... The coupling pins 10, 10 of the second movable body 8 located on the first movable body 7 side are rotatably coupled to the front end connection portion 7b of the first movable body 7.

[0096] The main body 4 includes a third movable body 12, which functions as an arm. The third movable body 12 is connected to the intermediate connecting member 11. One longitudinal end of the third movable body 12 is provided as a proximal connecting portion 12a, and the other longitudinal end is provided as a distal connecting portion 12b. The proximal connecting portion 12a of the third movable body 12 is connected to the intermediate connecting member 11, and the third movable body 12 can rotate relative to the intermediate connecting member 11, for example, about a reference axis extending orthogonally to the direction of connection between the third movable body 12 and the intermediate connecting member 11. Thus, the third movable body 12 can rotate relative to the intermediate connecting member 11, providing the surgical assistance device 1 with one degree of freedom in its movement direction.

[0097] The third movable body 12 is provided with, for example, a link mechanism having two sets of parallel link portions 13, 13, ... and coupling pins 14, 14, ... coupling the link portions 13, 13, .... The coupling pins 14, 14 on the side of the intermediate connecting member 11 of the second movable body 8 are rotatably coupled to the other end of the intermediate connecting member 11.

[0098] In addition, in the above, an example is shown in which the second movable body 8 and the third movable body 12 are connected by means of the intermediate connecting member 11, but in the surgical assisting device 1, the intermediate connecting member 11 may not be provided, and the second movable body 8 and the third movable body 12 may be connected without the intermediate connecting member 11.

[0099] The main body 4 includes a fourth movable body 15 functioning as a joint. The fourth movable body 15 is rotatably connected to the distal connection portion 12b of the third movable body 12. The end of the fourth movable body 15 on the third movable body 12 side is provided as a proximal connection portion 15a, and the end opposite the third movable body 12 is provided as a distal connection portion 15b. The proximal connection portion 15a of the fourth movable body 15 is rotatably connected to the distal connection portion 12b of the third movable body 12. For example, the proximal connection portion 15a of the fourth movable body 15 is rotatably connected to the distal connection portion 12b of the third movable body 12, and can rotate relative to the third movable body 12 about a reference axis extending in the direction of connection between the fourth movable body 15 and the third movable body 12. Thus, the rotation of the fourth movable body 15 relative to the third movable body 12 provides the surgical assistance device 1 with one degree of freedom in its movement direction.

[0100] The first movable body 7, the second movable body 8, the third movable body 12, and the fourth movable body 15 are rotated by the driving force of an electric actuator (not shown), for example. Alternatively, the first movable body 7, the second movable body 8, the third movable body 12, and the fourth movable body 15 may be rotated by the driving force of an air pressure actuator.

[0101] The main body 4 includes a surgical instrument holding device 16. The surgical instrument holding device 16 is rotatably connected to the distal end side connecting portion 15b of the fourth movable body 15.

[0102] In addition, in the above description, an example is shown in which the surgical assisting device 1 includes one main body 4 and the main body 4 has a plurality of movable bodies. However, the number of main bodies 4 provided in the surgical assisting device 1 is not limited to one, and may be a plurality (see Figure 3 In such a surgical assisting device 1, for example, when two main bodies 4, 4 are provided, the following structure may be adopted: two second connecting arms 6, 6 that can rotate respectively relative to the first connecting arm 5 are provided, and the first movable bodies 7, 7 are connected to the second connecting arms 6, 6, respectively.

[0103] By providing a plurality of main bodies 4 in this manner, it is possible to perform a surgical operation using a plurality of surgical instruments, thereby shortening the operation time, and it is also possible to perform a highly complex surgical operation using a plurality of surgical instruments of different types.

[0104] <Structure of the surgical instrument holding device>

[0105] Next, the structure of the surgical instrument holding device 16 connected to the fourth movable body 15 will be described (see Figures 4 to 19 ).

[0106] Furthermore, the surgical instrument holding device 16 has a structure in which the sixth movable body is rotatably supported by the fifth movable body. In the following description, for simplicity, the sixth movable body is supported below the fifth movable body, and the directions of the two are referred to as the up-down direction. The direction of the central axis, which serves as the reference for rotation of the sixth movable body, is referred to as the forward-backward direction. However, the forward-backward, upward-downward, downward-downward, and left-right directions are used for convenience of description, and implementation of the present invention is not limited to these directions.

[0107] As described above, the surgical instrument holding device 16 is rotatably connected to the distal end side connecting portion 15b of the fourth movable body 15 (see Figures 4 to 6 The surgical instrument holding device 16 includes: a driving body 17 rotatably connected to the fourth movable body 15 and functioning as a fifth movable body; a holding body 18 rotatably supported by the driving body 17 and functioning as a sixth movable body; a partition 19 detachably mounted on the holding body 18; and an adapter 20 detachably mounted on the partition 19.

[0108] (Structure of driving body and detection mechanism)

[0109] The driving body 17 includes a bracket 21, a driving force transmission mechanism 22, and a housing 23. The driving force transmission mechanism 22 is supported by the bracket 21 and is housed in the housing 23 (see FIG. Figures 6 to 8 ).

[0110] The bracket 21 includes a first support member 24 extending in a front-to-rear direction and a second support member 25 extending in a vertical direction. The upper end of the second support member 25 is attached to the front end of the first support member 24. A coupling member 26 is attached to the upper surface of the front end of the first support member 24. A shaft insertion hole (not shown) is formed in the upper end of the front end of the bracket 21 and extends through the front-to-rear direction.

[0111] The lower end of the second support member 25 is provided as a support portion 25a and is formed in an upwardly convex arc shape. Guide protrusions 25b, 25b are provided spaced apart in the circumferential direction of the second support member 25 and protrude downward from the inner circumferential surface of the support portion 25a.

[0112] A connecting member 27 is attached to the coupling member 26 and is connected to the distal connecting portion 15b of the fourth movable body 15. The connecting member 27 is connected to the distal connecting portion 15b, thereby allowing the driving body 17 to rotate relative to the fourth movable body 15, for example, about a reference axis extending perpendicular to the direction of connection between the driving body 17 and the fourth movable body 15. Thus, the driving body 17, functioning as the fifth movable body, rotates relative to the fourth movable body 15, providing the surgical assistance device 1 with one degree of freedom in its movement direction.

[0113] The driving body 17 functioning as the fifth movable body is rotated by a driving force of an electric actuator or a pneumatic actuator (not shown).

[0114] The lower end portion of the third support member 28 is attached to the rear end portion of the first support member 24 (see Figure 7 A belt insertion hole (not shown) is formed in the first supporting member 24 at a position immediately in front of the third supporting member 28 and penetrates the first supporting member 24 in the vertical direction.

[0115] The driving force transmission mechanism 22 includes belt pulleys 29 and 30. The belt pulleys 29 and 30 are supported by the front surface of the third support member 28 in a vertically spaced arrangement. A transmission belt 31 is wound between the belt pulleys 29 and 30 through the belt insertion hole of the first support member 24. An encoder 32 is disposed on the front surface of the third support member 28 to detect the rotation angle of the upper belt pulley 29.

[0116] A drive motor 33 is mounted on the lower surface of the rear end of the first support member 24. The motor shaft of the drive motor 33 is fixed to the center of the lower belt pulley 30. Therefore, when the drive motor 33 rotates, the driving force is transmitted to the upper belt pulley 29 via the lower belt pulley 30 and the transmission belt 31. As the belt pulley 29 rotates, the rotational position of the belt pulley 29 is detected by an encoder 32.

[0117] The driving force transmission mechanism 22 includes a pulley 34 , a connecting shaft 35 , and intermediate pulleys 36 , 36 .

[0118] The pulley 34 is supported by the front surface of the upper end portion of the second support member 25 (see Figure 7 as well as Figure 8 Pulley 34 is connected to the lower belt pulley 30 via a connecting shaft 35. Connecting shaft 35 is inserted through a shaft insertion hole formed in bracket 21 and connected to the lower belt pulley 30. Therefore, the rotational force of belt pulley 30 is transmitted to pulley 34 via connecting shaft 35. Intermediate pulleys 36, 36 are supported by the front surface of second support member 25 in a left-right separated state and are located below pulley 34.

[0119] Drive ropes 37, 37 are wound around the pulley 34 and the intermediate pulleys 36, 36. When wound around one intermediate pulley 36, one end of the drive rope 37 is fixed to the pulley 34 and the other end is fixed to the retaining member 18. When wound around the other intermediate pulley 36, one end of the drive rope 37 is fixed to the pulley 34 and the other end is fixed to the retaining member 18. Therefore, when the pulley 34 rotates and the drive ropes 37, 37 are fed, the retaining member 18 rotates in the direction corresponding to the feeding direction of the drive ropes 37, 37.

[0120] A detection mechanism 38 (see Figure 7 as well as Figure 9 The detection mechanism 38 is composed of a first detection portion 39 and a second detection portion 40. The first detection portion 39 and the second detection portion 40 are arranged on the second support member 25 in a state separated from each other in the rotation direction of the holding body 18.

[0121] The first detection portion 39 has a function of detecting the attachment state of the separator 19 to the holding body 18 , and the second detection portion 40 has a function of detecting the attachment state of the adapter 20 to the separator 19 .

[0122] As described above, the first detection part 39 and the second detection part 40 are arranged on the bracket 21 in a state of being separated in the rotation direction of the retaining body 18. As a result, the positions of the first detection part 39 and the second detection part 40 are arranged in the same plane as the bracket 21, so that the space of the bracket 21 can be effectively utilized to achieve miniaturization of the surgical assistance device 1.

[0123] The first detection portion 39 includes a main body portion 41 attached to the second support member 25 , a detection pin 42 that moves relative to the main body portion 41 , and a detection switch 43 attached to the second support member 25 .

[0124] The detection pin 42 is configured to extend radially of the retaining member 18 and to move toward and away from the center of the retaining member 18 relative to the main body 41. The upper and lower ends of the detection pin 42 protrude upward and downward from the main body 41, respectively. The upper end of the detection pin 42 serves as an operating portion 42a, and the lower end serves as an operated portion 42b. The front end of the operated portion 42b is hemispherical, with a front end surface formed as a spherical portion 42c that is convex toward the front end.

[0125] The detection pin 42 is urged downward relative to the main body 41 by a spring (not shown), and the acted portion 42 b is located below the lower edge of the support portion 25 a of the second support member 25 .

[0126] The detection switch 43 is located above the operating portion 42a of the detection pin 42. When no force is applied to the detection pin 42 to move upward, the detection pin 42 is located at the lower end of the movement, the operating portion 42a is below and separated from the detection switch 43, and the detection switch 43 is in the off state. The acted portion 42b is located below the lower edge of the support portion 25a of the second support member 25. When the detection pin 42 overcomes the force of the spring and moves upward, the detection switch 43 is operated by the operating portion 42a and turns on, sending a detection signal to a detection circuit (not shown).

[0127] The second detection unit 40 includes a main body 44 attached to the second support member 25 , a detection pin 45 that moves relative to the main body 44 , and a detection switch 46 attached to the second support member 25 .

[0128] The detection pin 45 is arranged to extend radially along the retaining element 18 and to move relative to the main body 44 toward and away from the center of the retaining element 18. The upper and lower ends of the detection pin 45 protrude upward and downward from the main body 44, respectively. The upper end of the detection pin 45 serves as an operating portion 45a, and the lower end serves as an operated portion 45b. The distal end of the operated portion 45b is hemispherical, with a distal end surface formed as a spherical portion 45c that is convex toward the distal end.

[0129] The detection pin 45 is biased downward relative to the main body 44 by a spring (not shown), and the acted portion 45b is located below the lower edge of the support portion 25a of the second support member 25. The detection pin 45 of the second detection portion 40 is located slightly to the side of the detection pin 42 of the first detection portion 39.

[0130] The detection switch 46 is located above the operating portion 45a of the detection pin 45. When no force is applied to the detection pin 45 to move upward, the detection pin 45 is located at the lower end of the movement, the operating portion 45a is below and separated from the detection switch 46, and the detection switch 46 is in the off state. The acted portion 45b is located below the lower edge of the support portion 25a of the second support member 25. When the detection pin 45 overcomes the biasing force of the spring and moves upward, the detection switch 46 is operated by the operating portion 45a and turns on, sending a detection signal to a detection circuit (not shown).

[0131] The housing case 23 is divided into four parts, for example, and is formed of a first case portion 23a, a second case portion 23b, a third case portion 23c, and a fourth case portion 23d (see Figures 4 to 6 The housing 23 is formed of, for example, a resin material. By forming the housing 23 from a resin material, the driving body 17 can be made lighter, the load on the driving body 17 can be suppressed, and the driving body 17 can smoothly rotate relative to the fourth movable body 15.

[0132] The first housing portion 23 a is attached from above to the first supporting member 24 and on the rear side of the coupling member 26 , and the belt pulley 29 , the third supporting member 28 , and the like are covered by the first housing portion 23 a .

[0133] Manual switches 47, 47 are provided on both side surfaces of the first housing portion 23a. By manually operating the manual switches 47, 47, for example, the driving body 17 can be rotated relative to the fourth movable body 15. Operating one manual switch 47 rotates the driving body 17 in one direction, and operating the other manual switch 47 rotates the driving body 17 in the other direction. Alternatively, a structure may be employed in which the manual switches 47, 47 are manually operated to rotate the drive motor 33, thereby rotating the holding body 18 relative to the driving body 17. The manual switches 47, 47 are operated, for example, by a surgeon or an assistant in an operating room.

[0134] The second case portion 23 b is attached to the first support member 24 from below, and the belt pulley 30 , the connecting shaft 35 , and the like are covered by the second case portion 23 b .

[0135] The third housing portion 23c is attached to the second support member 25 from the front, and the pulley 34, intermediate pulleys 36, 36, etc. are covered by the third housing portion 23c. A component insertion hole (not shown) is formed in the lower end portion of the third housing portion 23c and passes through the component insertion hole. The drive ropes 37, 37 are guided downward from the interior of the third housing portion 23c through the component insertion hole and fixed to the holding body 18.

[0136] The fourth housing portion 23d is attached to the second support member 25 from the rear, and the detection mechanism 38 and the like are covered by the fourth housing portion 23d. A component insertion hole (not shown) is formed in the lower end portion of the fourth housing portion 23d, extending vertically therethrough. The detection pin 42 of the first detection portion 39 and the detection pin 45 of the second detection portion 40 are guided downward from the interior of the fourth housing portion 23d through the component insertion hole.

[0137] The driving body 17 constructed as described above is formed in a generally horizontally inverted L-shape as a whole, and the portion extending in the front-rear direction is composed of a narrow portion 48 having a smaller vertical width and a wide portion 49 having a larger vertical width than the narrow portion 48 .

[0138] The connecting shaft 35 is located within the narrow portion 48, while the belt pulleys 29, 30, the drive motor 33, and other components are located within the wide portion 49. The wide portion 49 is used to house the belt pulleys 29, 30, the drive motor 33, and other components, and therefore has a large vertical width. The narrow portion 48 is continuous with the lower end of the wide portion 49. A first concave space 50, open upward, is formed on the upper side of the narrow portion 48, and a second concave space 51, open downward, is formed on the lower side of the narrow portion 48.

[0139] (Structure of the holding body)

[0140] The holding body 18 is rotatably supported by the driving body 17 and functions as a sixth movable body. The holding body 18 is rotatably supported by the supporting portion 25a of the second supporting member 25 (see Figures 4 to 8 ).

[0141] The holding body 18 is formed in a substantially arc shape and has a guided groove 18a extending in the circumferential direction and opening outward on the outer periphery. The central portion of the holding body 18 is formed as an insertion hole 18b extending through the holding body 18 in the front-rear direction.

[0142] The holding body 18 is formed into a substantially arc shape with a circumferential angle of about 270 to 330 degrees, for example, and a space between both ends of the circumferential direction forms an attachment hole 18c. The attachment hole 18c communicates with the insertion hole 18b.

[0143] The inner circumference of the retaining body 18 is provided with a retaining portion 52, which holds the surgical instrument via the spacer 19 and the adapter 20. The retaining portion 52 is formed with insertion portions 53, 53, which open in opposing directions at positions 180 degrees opposite to each other. Insertion portions 53, 53 are formed at positions 90 degrees circumferentially spaced from the attachment and detachment hole 18c and communicate with the insertion hole 18b.

[0144] The surfaces of the insertion portions 53, 53 that face each other in the left-right direction are formed as sliding portions 53a, 53a (see Figure 8 as well as Figure 11 ) In addition, among the surfaces forming the insertion portion 53, the surfaces that are continuous with the sliding portion 53a and face each other in the vertical direction are formed as rotation restricting portions 53b, 53b.

[0145] Front opening edges of the insertion portions 53 , 53 of the holding body 18 are formed as first engagement receiving portions 54 , 54 , respectively.

[0146] The guide protrusions 25b, 25b of the second supporting member 25 are inserted into the guided grooves 18b, and the holding body 18 is guided by the guide protrusions 25b, 25b and rotates relative to the driving body 17. Although not shown, the guide protrusions 25b, 25b are formed in a shape to suspend the holding body 18, and have the function of preventing the holding body 18 from falling off the driving body 17.

[0147] The holding body 18 rotates relative to the driving body 17, for example, in a direction about a reference axis extending in a direction perpendicular to the direction in which the holding body 18 and the driving body 17 are connected. Thus, the holding body 18, functioning as the sixth movable body, rotates relative to the driving body 17, functioning as the fifth movable body, thereby providing the surgical assistance device 1 with one degree of freedom in its movement direction.

[0148] As described above, the first movable body 7 rotates relative to the second connecting arm 6, the second movable body 8 rotates relative to the first movable body 7, the third movable body 12 rotates relative to the intermediate connecting member 11, the fourth movable body 15 rotates relative to the third movable body 12, the driving body 17 rotates relative to the fourth movable body 15, and the holding body 18 rotates relative to the driving body 17, so that the movement direction of the surgical assisting device 1 has six degrees of freedom.

[0149] The retaining member 18 rotates due to the driving force of the drive motor 33. Specifically, when the drive motor 33 rotates, the belt pulley 30, to which the motor shaft is fixed, rotates. As the belt pulley 30 rotates, the belt pulley 29 rotates via the transmission belt 31, and the pulley 34 rotates via the connecting shaft 35. The rotation of the pulley 34 transmits the drive ropes 37, 37 via the intermediate pulleys 36, 36, causing the retaining member 18 to rotate in the direction corresponding to the transmission direction of the drive ropes 37, 37. At this time, the encoder 32 detects the rotational position of the belt pulley 29 and calculates the rotational angle (rotational position) of the retaining member 18 relative to the driving member 17.

[0150] (Structure of the separator)

[0151] A portion of a cover for separating a clean area from a non-clean area is mounted on the partition 19 , and the cover separates the clean area where the patient 200 is located from the non-clean area where the surgical assisting device 1 is located.

[0152] The partition 19 is formed of a resin material and each part is formed into one piece. The partition 19 has: an insertion portion 55 with the front-to-back direction as the axial direction; and a flange-shaped receiving portion 56 extending outward from the rear edge of the insertion portion 55 (see FIG. Figures 12 to 15 ).

[0153] The insertion portion 55 is formed into a substantially arcuate surface with a circumferential angle of about 200 to 300 degrees. Forming notches 55a, 55a opening forward are formed in the front half of the insertion portion 55 at positions opposite to the circumferential angle of 180 degrees.

[0154] The partition 19 is provided with rotation-restricted portions 57, 57 that protrude from the outer circumferential surface of the insertion portion 55. The rotation-restricted portions 57, 57 are provided on the opposite side of the insertion portion 55 at 180 degrees in the circumferential direction and protrude outward from the rear half of the insertion portion 55. The rotation-restricted portions 57, 57 are portions that are inserted into the insertion portions 53, 53 when the partition 19 is attached to the retaining body 18, and are formed in a generally rectangular parallelepiped shape.

[0155] The spacer 19 has first engaging portions 58, 58 provided continuously with the rotation restricted portions 57, 57. The first engaging portions 58 are located in the notches 55a for forming the insertion portion 55 and are elastically deformable relative to the rotation restricted portions 57 in the radial direction of the insertion portion 55.

[0156] In this manner, the rotation restricted portion 57 and the first engaging portion 58 are provided continuously in the separator 19. Therefore, the rotation restricted portion 57 and the first engaging portion 58, which are shaped to protrude relative to the insertion portion 55, are not provided at separate positions in the separator 19. Therefore, when the separator 19 is formed by injection molding, the mold structure can be simplified, and the separator 19 can be easily formed.

[0157] The first engaging portion 58 is formed by a deformed portion 59 that protrudes forward from the front surface of the rotation-restricted portion 57, and a protruding portion 60 that protrudes outward from the front end of the deformed portion 59. The protruding portion 60 is formed into a roughly triangular prism shape, with the front end tapering as it moves outward from the deformed portion 59. The front surface forms a sliding inclined surface 60a, and the rear surface forms an engaging surface 60b. The sliding inclined surface 60a is formed as an inclined surface that approaches the front end of the deformed portion 59 as it moves forward, while the engaging surface 60b is formed as a surface facing rearward. The protruding portion 60 of the first engaging portion 58 is located forward of the front end of the insertion portion 55.

[0158] The receiving portion 56 is formed into a generally arcuate surface, for example, with an angle of approximately 200 to 300 degrees in the circumferential direction, corresponding to the insertion portion 55. An inclined surface 56a is formed on the outer periphery of the receiving portion 56, which shifts inward as it moves forward. The circumferential end edges of the receiving portion 56 are formed as restricting portions 56b, 56b.

[0159] Second engagement receiving portions 61, 61 are provided at both circumferential ends of the receiving portion 56. A recess 56c is formed in a portion of the front side of the receiving portion 56, so that the second engagement receiving portion 61 is formed in a shape where the recess 56c is thinner than the other portions.

[0160] As described above, the insertion portion 55 and the receiving portion 56 of the separator 19 are formed in a substantially arc shape with an angle of about 200 to 300 degrees in the circumferential direction, and the space between the two circumferential ends forms the attachment and detachment opening 19 a .

[0161] (Adapter structure)

[0162] The adapter 20 is formed into a size and shape corresponding to various surgical instruments of different sizes and shapes and is appropriately attached to the partition 19 so that the surgical instruments are held by the holding body 18 via the partition 19 .

[0163] The adapter 20 is composed of an insertion member 62 and a mounting member 63 (see Figure 12 、 Figure 16 、 Figure 17 as well as Figure 18 ).

[0164] The insertion member 62 is formed of a resin material and is integrally formed. The insertion member 62 includes a cylindrical portion 64 whose front-to-rear direction is an axial direction, and a flange-shaped pressing portion 65 extending outward from a rear edge of the cylindrical portion 64 .

[0165] The cylindrical portion 64 is formed into a generally cylindrical shape, with a screw groove 64a formed on the outer circumference of the rear half. Slits 64b, 64b, 64b, 64b, opening forward, are formed at regular intervals around the circumference of the cylindrical portion 64. These slits 64b, 64b, 64b also exist in the area where the screw groove 64a is formed. The areas between the slits 64b, 64b, 64b of the cylindrical portion 64 are provided as fastening portions 66, 66, 66, respectively. The fastening portions 66, 66, 66 are elastically deformable in directions toward and away from the center of the cylindrical portion 64.

[0166] The pressing portion 65 is formed in a substantially annular shape, and has an inclined surface 65 a formed on the outer periphery thereof so as to be displaced toward the inner periphery as the pressing portion 65 moves forward.

[0167] The front surface of the pressing portion 65 is provided with an arc-shaped restricted portion 65b that is slightly protruding forward relative to the rest of the pressing portion 65. The pressing portion 65 is provided with outwardly open notches 65c, 65c spaced apart in the circumferential direction.

[0168] The adapter 20 is provided with second engaging portions 67, 67 protruding from the outer periphery of the pressing portion 65. The second engaging portions 67, 67 protrude rearward from positions near the notches 65c, 65c on the rear surface of the pressing portion 65 (see FIG. Figure 16 、 Figure 17 as well as Figure 19 The circumferential distance between the second engagement portions 67 and 67 is the same as the circumferential distance between the second engagement receiving portions 61 and 61 of the separator 19, and the second engagement portions 67 and 67 are located about 80 to 120 degrees apart in the circumferential direction of the pressing portion 65.

[0169] The second engaging portion 67 is composed of a base end portion 68, a folded portion 69, an outer portion 70 and an engaging claw portion 71. The base end portion 68 is continuous with the pushing portion 65 and extends in the protruding direction from the pushing portion 65. The folded portion 69 is continuous with the base end portion 68 and is formed in a folded shape. The outer portion 70 is continuous with the folded portion 69 and a portion is located at a position facing the base end portion 68. The engaging claw portion 71 is continuous with the outer portion 70 and is bent at a right angle relative to the outer portion 70 in a direction close to the pushing portion 65.

[0170] The longitudinal direction is defined as the continuous direction of the base end portion 68, the folded portion 69, the outer portion 70, and the engaging claw portion 71 of the second engaging portion 67. The thickness direction is defined as the direction perpendicular to the longitudinal direction and connecting the inner and outer circumferential surfaces of each portion. Therefore, the width direction of the base end portion 68, the folded portion 69, the outer portion 70, and the engaging claw portion 71 is perpendicular to both the longitudinal and thickness directions, and the base end portion 68, the folded portion 69, the outer portion 70, and the engaging claw portion 71 have the same width.

[0171] The base end portion 68 has a thickness T1 that is smaller than its width and is formed into a shape extending in the front-rear direction (see Figure 19 ).

[0172] The thickness T2 of the folded portion 69 is thicker than the thickness T1 of the base end portion 68. The folded portion 69 is formed into a rearwardly convex U-shape, and a portion of one front end surface is continuous with the rear end surface of the base end portion 68. Thus, a portion of one front end surface of the folded portion 69 is continuous with the rear end surface of the base end portion 68, and a stepped surface 69a is formed at the boundary between the folded portion 69 and the base end portion 68.

[0173] The outer portion 70 has a thickness T3 that is the same as the thickness T2 of the folded portion 69 and is formed to extend in the front-to-back direction. Therefore, the thickness T3 of the outer portion 70 is thicker than the thickness T1 of the base end portion 68. The outer portion 70 is positioned parallel to the base end portion 68 and is formed to extend in the front-to-back direction.

[0174] The outer portion 70 is longer than the base end portion 18 , is located on the outer circumference of the pressing portion 65 , and extends from the rear side to the front side of the pressing portion 65 . A portion of the outer portion 70 is located in the notch 65 c .

[0175] In the adapter 20, the outer portions 70, 70 are located on the outer periphery of the pressing portion 65, so the outer shape tends to be larger accordingly. However, the pressing portion 65 has notches 65c, 65c formed therein, and the outer portions 70, 70 are located in the notches 65c, 65c, respectively. Therefore, although the outer portions 70, 70 are located on the outer periphery of the pressing portion 65, the notches 65c, 65c, are formed, which allows the outer shape to be reduced accordingly, achieving miniaturization.

[0176] The engaging claw portion 71 protrudes from the front end of the outer portion 70 toward the cylindrical portion 64, and has a thickness T4 that is the same as the thickness T3 of the outer portion 70. Therefore, the thickness T4 of the engaging claw portion 71 is thicker than the thickness T1 of the base end portion 68. The engaging claw portion 71 is located in front of the pressing portion 65 and is at a fixed distance from the front surface of the pressing portion 65.

[0177] The front end portion of the engagement claw portion 71 is formed in a shape that becomes thinner toward the front end and has a sliding surface 71 a that is inclined so as to be displaced rearward as it approaches the front end and an engagement surface 71 b that faces rearward.

[0178] The second engaging portion 67 has the above-described structure. The thickness T1 of the base end portion 68 is thinner than the thickness T2 of the folded portion 69 , the thickness T3 of the outer portion 70 , and the thickness T4 of the engaging claw portion 71 . The base end portion 68 is elastically deformable in the thickness direction.

[0179] The mounting member 63 is formed in a substantially cylindrical shape with its axial direction extending in the front-rear direction, and has operation grooves 63a, 63a, ... formed on the outer peripheral surface of the front half thereof in a circumferential direction thereof. (See Figures 16 to 18 ) The mounting member 63 is formed with operation grooves 63a, 63a, ..., so that when the mounting member 63 is gripped and rotated, the mounting member 63 can be easily rotated, thereby improving operability.

[0180] A threaded portion 63b is formed on the inner circumferential surface of the rear half of the mounting member 63. The threaded portion 63b is threadedly engaged with the threaded groove 64a of the cylindrical portion 64. When the mounting member 63 is rotated, the threaded position of the threaded portion 63b relative to the threaded groove 64a changes, causing the mounting member 63 to move forward and backward relative to the cylindrical portion 64, and elastically deforming the fastening portions 66, 66, 66. As the fastening portions 66, 66, 66 elastically deform, the diameter of the cylindrical portion 64 changes.

[0181] The front half of the mounting member 63 is provided as a deformation restricting portion 63 c that restricts deformation of the first engaging portions 58 , 58 of the partition 19 when the partition 19 is mounted on the holding body 18 .

[0182] <Structure of surgical instruments>

[0183] The structure of the surgical instrument 80 held by the holding body 18 will be described below (see Figures 4 to 6 ).

[0184] The surgical instrument 80 is provided as an endoscope unit including an endoscope, for example, and includes a shaft 81 extending forward and backward, a camera head 82 coupled to the rear end of the shaft 81 , and a light guide 83 coupled to the middle portion of the shaft 81 .

[0185] A plurality of lenses (not shown) are arranged in the axial direction inside the shaft portion 81. An imaging element (not shown) is arranged inside the camera head 82.

[0186] The cable 84 is connected to the camera head 82 , and signals are transmitted and received between the imaging element and an imaging circuit (not shown) via the cable 84 , and current is supplied to the imaging element via the cable 84 .

[0187] The light guide 83 includes: an annular coupling portion 83a coupled to the shaft portion 81; an intermediate portion 83b protruding from the coupling portion 83a and approximately perpendicular to the shaft portion 81; and a light incident portion 83c perpendicular to the intermediate portion 83b, the light incident portion 83c being located above the shaft portion 81 and approximately parallel to the shaft portion 81.

[0188] The light guide cable 85 is connected to the light entrance portion 83c of the light guide 83, and light is guided to the interior of the shaft portion 81 via the light guide cable 85 from a light source (not shown), and illumination light L is irradiated from the front end portion of the shaft portion 81 (see FIG. Figure 6 ).

[0189] The distal end of the shaft 81 of the surgical instrument 80 is inserted into a body cavity 201 through an incision 202 formed in a patient 200. While the distal end of the shaft 81 is inserted into the body cavity 201, illumination light is irradiated from the distal end of the shaft 81, and an imaging element captures the interior of the body cavity 201. The image of the interior of the body cavity 201 captured by the imaging element is transmitted as an imaging signal via a cable 84 to an operating device (control device) (not shown) operated by a surgeon (physician), enabling the surgeon to remotely observe the interior of the body cavity 201.

[0190] <Attaching the Surgical Instrument to the Adapter>

[0191] Next, the operation of attaching the surgical instrument 80 to the adapter 20 will be described (see Figure 20 as well as Figure 21 ).

[0192] In a state where the mounting member 63 is not mounted on the cylindrical portion 64 of the insertion member 62, the shaft portion 81 of the surgical instrument 80 is inserted into the insertion member 62 and the mounting member 63 from behind (see FIG. Figure 20 At this time, the mounting member 63 is in a state where the threaded portion 63b is not threadedly engaged with the threaded groove 64a or the threaded engagement range of the threaded portion 63b and the threaded groove 64a is small. Therefore, the diameter of the cylindrical portion 64 is large, and the shaft portion 81 can be easily inserted into the cylindrical portion 64.

[0193] When the shaft 81 is inserted through the insertion member 62 and the mounting member 63, the mounting member 63 is manually rotated in a predetermined direction, and the screw engagement range of the screw portion 63b and the screw groove 64a is increased, and the cylindrical portion 64 is tightened by the mounting member 63 (see Figure 21 ).

[0194] When the mounting member 63 rotates and the screw engagement range between the screw portion 63 b and the screw groove 64 a increases, the diameter of the cylindrical portion 64 decreases, the shaft portion 81 is fastened by the fastening portions 66 , 66 , 66 , and the surgical instrument 80 is mounted on the adapter 20 .

[0195] Conversely, when the mounting member 63 is rotated in the opposite direction to reduce the screw engagement range between the screw portion 63 b and the screw groove 64 a , the diameter of the cylindrical portion 64 increases, and the surgical instrument 80 can be pulled out of the adapter 20 and removed.

[0196] By rotating the mounting member 63 while the shaft 81 is inserted through the insertion member 62 and the mounting member 63 , the surgical instrument 80 can be mounted on the adapter 20 . By rotating the mounting member 63 in the opposite direction, the surgical instrument 80 can be removed from the adapter 20 .

[0197] Therefore, the surgical instrument 80 can be easily attached to and detached from the adapter 20 , and the workability of attaching and detaching the surgical instrument 80 to and from the adapter 20 can be improved.

[0198] <Installation of the Spacer to the Holding Body>

[0199] Next, the installation operation of the spacer 19 to the holding body 18 will be described (see Figures 22 to 25 ).

[0200] The insertion portion 55 of the partition 19 is inserted into the insertion hole 18b of the holding body 18 from the rear, and the first engaging portions 58, 58 are respectively inserted into the insertion portions 53, 53 of the holding body 18 from the rear (see FIG. Figure 22 At this time, the spacer 19 is inserted into the holding body 18 in a direction in which the attachment and detachment opening 19a is located on the lower side.

[0201] When the partition 19 is inserted forward into the retaining body 18, the sliding inclined surfaces 60a, 60a of the protruding portions 60, 60 of the first engaging portions 58, 58 slide on the end edges of the sliding portions 53a, 53a of the retaining body 18, respectively, and the deformation portions 59, 59 of the first engaging portions 58, 58 elastically deform in a direction approaching each other, so that the protruding portions 60, 60 slide on the sliding portions 53a, 53a, respectively.

[0202] When the partition 19 is further inserted forward into the holding body 18, the protruding portions 60, 60 of the first engaging portions 58, 58 pass over the sliding portions 53a, 53a (see Figure 23 The protruding portions 60, 60 pass over the sliding portions 53a, 53a and protrude rearward from the retaining body 18, thereby elastically returning the first engaging portions 58, 58 to a direction of separation from each other. The engaging surfaces 60b, 60b of the protruding portions 60, 60 are respectively engaged with the first engaging receiving portions 54, 54 of the retaining body 18.

[0203] Furthermore, the elastically restored state of the first engaging portion 58 when the engaging surface 60b is engaged with the first engaging receiving portion 54 includes, in addition to the original state before the elastic deformation of the first engaging portion 58, a state in which the degree of deformation is less than the state in which the sliding inclined surface 60a of the protruding portion 60 slides on the sliding portion 53a of the retaining body 18 and elastically deforms. Therefore, the state of the first engaging portion 58 when the engaging surface 60b is engaged with the first engaging receiving portion 54 may also be a state in which the degree of elastic deformation is less than the state in which the sliding inclined surface 60a slides on the sliding portion 53a and elastically deforms.

[0204] When the engaging surfaces 60b, 60b of the protrusions 60, 60 are respectively engaged with the first engaging supporting parts 54, 54 of the retaining body 18, the supporting part 56 of the partition 19 is in a state of being connected to the rear surface of the retaining body 18, and the partition 19 is installed on the retaining body 18 when the protrusions 60, 60 and the supporting part 56 clamp the retaining body 18 in the front-to-back direction.

[0205] When the receiving portion 56 contacts the rear surface of the holding body 18, the inclined surface 56a formed on the receiving portion 56 slides on the spherical surface 42c of the acted portion 42b, and the detection pin 42 moves upward (see FIG. Figure 24 ), the action portion 42b is provided on the detection pin 42 of the first detection portion 39. When the detection pin 42 moves upward, the detection switch 43 is operated by the operating portion 42a and becomes on, and a detection signal is sent to the detection circuit, thereby detecting that the separator 19 is properly attached to the holding body 18.

[0206] As described above, when the partition 19 is mounted on the holding body 18, the rotation restricted portions 57, 57 of the partition 19 are inserted into the insertion portions 53, 53 of the holding body 18, respectively, and the rotation restricted portions 57, 57 are in contact with the rotation restricting portions 53b, 53b, ... of the insertion portions 53, 53 (see FIG. Figure 23 as well as Figure 25 ). Thus, the rotation restricting portions 53 b, 53 b, . . . restrict the rotation of the partition 19 relative to the holding body 18.

[0207] The protruding portions 60 , 60 projecting rearward from the holding body 18 are displaced toward each other to elastically deform the deforming portions 59 , 59 of the first engaging portions 58 , 58 , thereby pulling the partition 19 rearward from the holding body 18 , thereby removing the partition 19 from the holding body 18 .

[0208] <Attaching the Adapter to the Divider>

[0209] Next, the installation operation of the adapter 20 to the partition 19 will be described (see Figures 26 to 33 ).

[0210] In a state where the surgical instrument 80 is mounted on the adapter 20 and the partition 19 is mounted on the holding body 18, the adapter 20 is mounted on the partition 19 (see Figure 26 When the adapter 20 is mounted on the partition 19, first, the portion of the shaft 81 of the surgical instrument 80 that is closer to the front side than the portion mounted on the adapter 20 is inserted into the interior of the partition 19 from below through the mounting hole 18c of the holder 18 and the mounting and dismounting opening 19a of the partition 19 (see Figure 27 ).

[0211] Then, the mounting member 63 and the cylindrical portion 64 of the adapter 20 are inserted into the insertion portion 55 of the partition 19 from the rear (see Figure 28 When the mounting member 63 and the cylindrical portion 64 are inserted forward into the insertion portion 55 , the sliding surfaces 71 a , 71 a of the engaging claws 71 , 71 of the second engaging portions 67 , 67 respectively contact the outer peripheral edge of the rear surface of the receiving portion 56 of the partition 19 .

[0212] Then, when the mounting member 63 and the cylindrical portion 64 are inserted forward into the insertion portion 55, the sliding surfaces 71a, 71a of the engaging claws 71, 71 slide on the outer peripheral edge of the rear surface of the receiving portion 56, and the second engaging portions 67, 67 are elastically deformed in the direction of separation from each other, and the engaging claws 71, 71 step onto the outer peripheral surface of the receiving portion 56 (see FIG. Figure 29 At this time, the base end portion 68 of the second engaging portion 67 is thinner than the other portions, and therefore, the base end portion 68 is mainly elastically deformed.

[0213] When the mounting member 63 and the cylindrical portion 64 are further inserted forward into the insertion portion 55, the sliding surfaces 71a, 71a of the engaging claws 71, 71 slide on the outer peripheral surface of the receiving portion 56 and pass over the receiving portion 56 (see FIG. Figure 30 The engaging claws 71, 71 pass over the receiving portion 56, and the second engaging portions 67, 67 are elastically reset in the direction in which the engaging claws 71, 71 approach each other, and the engaging surfaces 71b, 71b of the engaging claws 71, 71 are respectively engaged with the second engaging receiving portions 61, 61 of the partition 19 (see Figure 31 ).

[0214] Furthermore, the elastically restored state of the second engaging portion 67 when the engaging surface 71b is engaged with the second engaging receiving portion 61 includes, in addition to the original state before the second engaging portion 67 is elastically deformed, a state in which the degree of deformation is less than the state in which the sliding surface 71a of the engaging claw portion 71 slides on the outer peripheral surface of the receiving portion 56 and elastically deforms. Therefore, the state of the second engaging portion 67 when the engaging surface 71b is engaged with the second engaging receiving portion 61 may also be a state in which the degree of elastic deformation is less than the state in which the sliding surface 71a slides on the outer peripheral surface of the receiving portion 56 and elastically deforms.

[0215] When the engaging surfaces 71b, 71b of the engaging claws 71, 71 are respectively engaged with the second engaging supporting parts 61, 61 of the partition 19, the pushing part 65 of the adapter 20 is in a state of being connected to the rear surface of the supporting part 56 of the partition 19, and the adapter 20 is installed on the partition 19 when the engaging claws 71, 71 and the pushing part 65 clamp the partition 19 in the front-to-back direction.

[0216] When the pressing portion 65 contacts the rear surface of the receiving portion 56, the inclined surface 65a formed on the pressing portion 65 slides on the spherical surface 45c of the acted portion 45b, and the detection pin 45 moves upward (see FIG. Figure 32 ), the action portion 45b is provided on the detection pin 45 of the second detection portion 40. When the detection pin 45 moves upward, the detection switch 46 is operated by the operating portion 45a and becomes on, and a detection signal is sent to the detection circuit, thereby detecting that the adapter 20 is properly installed on the partition 19.

[0217] As described above, when the adapter 20 is mounted on the partition 19, the restricted portion 65b of the adapter 20 is inserted between the restricting portions 56b, 56b of the partition 19, and both ends of the restricted portion 65b in the circumferential direction are in contact with the restricting portions 56b, 56b, respectively (see FIG. Figure 31 ). Thus, the adapter 20 is restricted from rotating relative to the partition 19 by the restriction portions 56 b, 56 b.

[0218] As described above, when the adapter 20 is mounted on the partition 19, the mounting member 63 and the cylindrical portion 64 of the adapter 20 are inserted into the insertion portion 55 of the partition 19, and the deformation restricting portion 63c of the mounting member 63 is in contact with or close to the first engaging portions 58, 58 of the partition 19 (see FIG. Figure 33 ).

[0219] In this way, a deformation limiting portion 63c is provided in the adapter 20. When the adapter 20 is installed on the partition 19, the deformation limiting portion 63c limits the deformation of the first engaging portions 58, 58. When the partition 19 is installed on the retaining body 18, the deformation limiting portion 63c limits the deformation of the first engaging portions 58, 58 in the direction of releasing the engaging state with the first engaging supporting portions 54, 54.

[0220] Therefore, when the partition 19 is installed on the retaining body 18 and the adapter 20 is installed on the partition 19, the deformation of the first engaging parts 58, 58 is limited by the deformation limiting part 63c, so that the partition 19 will not accidentally fall off from the retaining body 18 when the adapter 20 is installed on the partition 19, and a simple structure can be used to ensure the stable installation state of the partition 19 on the retaining body 18.

[0221] The adapter 20 is composed of an insertion member 62 through which the surgical instrument 80 is inserted and a mounting member 63 that is rotated relative to the insertion member 62 to mount the surgical instrument 80 thereto. The mounting member 63 is provided with a deformation restricting portion 63 c.

[0222] Therefore, a deformation limiting portion 63c is provided on the mounting member 63 for mounting the surgical instrument 80 on the insertion member 62, so there is no need to provide other dedicated members having a deformation limiting portion on the adapter 20, the number of components will not be increased, and a stable mounting state of the partition 19 on the retaining body 18 can be ensured.

[0223] By displacing the engaging claws 71, 71 in a direction away from each other, the second engaging portions 67, 67 are elastically deformed, and the adapter 20 is pulled rearward from the partition 19, thereby allowing the adapter 20 to be removed from the partition 19. Furthermore, while the adapter 20 is pulled rearward from the partition 19 and removed, the shaft 81 of the surgical instrument 80 is pulled downward through the attachment and detachment hole 18c of the holder 18 and the attachment and detachment opening 19a of the partition 19, thereby allowing the surgical instrument 80 to be removed from the holder 18 and the partition 19.

[0224] As described above, the retaining body 18 and the partition 19 are respectively formed with the attachment and detachment hole 18 c and the attachment and detachment opening 19 a which are open in the radial direction. The surgical instrument 80 attached to the adapter 20 is inserted into or removed from the attachment and detachment hole 18 c and the attachment and detachment opening 19 a .

[0225] Therefore, the surgical instrument 80 can be inserted and removed in the radial direction of the insertion portion 55, and there is no need to move the axial shaft portion 81 of the surgical instrument 80 toward the axial direction of the insertion portion 55 to enable the surgical instrument 80 to load and unload the partition 19 with the help of the adapter 20. Instead, the surgical instrument 80 can be quickly loaded and unloaded with the help of the adapter 20.

[0226] As described above, in the surgical instrument holding device 16 , the pressing portion 65 presses the receiving portion 56 , and the second engaging portions 67 , 67 engage with the receiving portion 56 in the elastically restored state, whereby the adapter 20 is attached to the spacer 19 .

[0227] Therefore, the following state is set: the pushing portion 65 of the adapter 20 pushes toward the supporting portion 56 of the partition 19 and the elastically deformed second engaging portions 67, 67 engage in the elastic reset state, and each part of the adapter 20 can press the supporting portion 56 at two different positions, so the adapter 20 is installed on the partition 19 in a stable state, which can prevent the surgical instrument 80 from being displaced relative to the retaining body 18, thereby ensuring the accuracy and safety of the operation.

[0228] In addition, the second engaging portion 67 of the partition 19 is formed into a shape protruding from the pushing portion 65, and the second engaging portion 67 is provided with: a base end portion 68, which is continuous with the pushing portion 65 and extends along the protruding direction from the pushing portion 65; a folded-back portion 69, which is continuous with the base end portion 68 and formed into a folded-back shape; an outer portion 70, which is continuous with the folded-back portion 69 and at least a portion is opposite to the base end portion 68 and is located on the outer peripheral side of the pushing portion 65; and an engaging claw portion 71, which is continuous with the outer portion 70 and is bent relative to the outer portion 70 in a direction close to the pushing portion 65, and the engaging claw portion 71 is engaged with the supporting portion 56.

[0229] Therefore, the pressing portion 65 presses the receiving portion 56 , and the second engaging portion 67 engages with the receiving portion 56 in an elastically restored state, whereby the adapter 20 is attached to the partition 19 . Therefore, the adapter 20 can be easily attached to the partition 19 .

[0230] Furthermore, the second engagement receiving portion 61 is provided on the receiving portion 56 , and the engaging claw portion 71 engages with the second engagement receiving portion 61 from the side opposite to the pressing portion 65 while sandwiching the receiving portion 56 .

[0231] Therefore, the adapter 20 is attached to the partition 19 by sandwiching the receiving portion 56 from opposite sides by the pressing portion 65 and the engaging claw portion 71 , thereby ensuring a stable attachment state of the adapter 20 to the partition 19 .

[0232] As described above, in the surgical instrument holding device 16 , the driving body 17 is provided with the driving force transmission mechanism 22 that transmits the driving force to the holding body 18 , and the bracket 21 that supports the driving force transmission mechanism 22 . The detection mechanism 38 is disposed on the bracket 21 .

[0233] Therefore, the detection mechanism 38 is arranged on the bracket 21 of the driving body 17 that supports the retaining body 18 in a rotatable manner, so that the detection mechanism 38 does not rotate along with the retaining body 18. The detection mechanism 38 is arranged in the non-moving part that does not move along with the retaining body 18, which can improve the detection accuracy of the detection mechanism 38 related to the position of the partition 19 and the adapter 20.

[0234] Furthermore, since the detection mechanism 38 is disposed in a non-operating portion that does not operate with the holding body 18 , a load is unlikely to be applied to cables connecting the detection mechanism 38 to the detection circuit and the power supply circuit, thereby suppressing degradation of the cables.

[0235] In addition, in the surgical instrument holding device 16, when the partition 19 is installed on the holding body 18 and when the adapter 20 is installed on the partition 19, detection is performed by the detection mechanism 38. The detection mechanism 38 is provided with a main body 41, 44 installed on the bracket 21 and detection pins 42, 45 that move relative to the main body 41, 44. Due to the action of the partition 19 and the adapter 20 on the detection pins 42, 45, the detection pins 42, 45 move, thereby performing detection.

[0236] Therefore, due to the action of the partition 19, the detection pins 42 and 45 move to detect the installation status of the partition 19 relative to the retaining body 18, and due to the action of the adapter 20, the detection pins 42 and 45 move to detect the installation status of the adapter 20 relative to the partition 19, so the partition 19 and the adapter 20 can be easily and reliably detected separately.

[0237] In addition, the partition 19 is installed on the retaining body 18 when the insertion portion 55 is inserted into the retaining body 18, and the adapter 20 is installed on the partition 19 when the partition 19 is installed on the retaining body 18 and the cylindrical portion 64 is inserted into the insertion portion 55. The installation state of the partition 19 relative to the retaining body 18 is detected based on the action of the supporting portion 56 on the detection pins 42 and 45 when the insertion portion 55 is inserted into the retaining body 18, and the installation state of the adapter 20 relative to the partition 19 is detected based on the action of the pushing portion 65 on the detection pins 42 and 45 when the cylindrical portion 64 is inserted into the insertion portion 55.

[0238] Therefore, based on the action of the supporting portion 56 extending outward from the outer periphery of the insertion portion 55 on the detection pins 42 and 45, the installation status of the partition 19 relative to the retaining body 18 is detected, and based on the action of the pushing portion 65 extending outward from the outer periphery of the cylindrical portion 64 on the detection pins 42 and 45, the installation status of the adapter 20 relative to the partition 19 is detected, thereby shortening the length of the detection pins 42 and 45 and miniaturizing the detection mechanism 38.

[0239] In addition, an inclined surface 56a is formed on the outer periphery of the supporting portion 56, and the inclined surface 56a approaches the insertion portion 55 as the insertion direction of the retaining body 18 moves toward the insertion portion 55. An inclined surface 65a is formed on the outer periphery of the pushing portion 65, and the inclined surface 65a approaches the cylindrical portion 64 as the insertion direction of the cylindrical portion 64 moves toward the insertion direction of the insertion portion 55. The inclined surfaces 56a and 65a slide on the front end portions of the detection pins 42 and 45 respectively, thereby detecting the movement of the detection pins 42 and 45 relative to the main body portions 41 and 44.

[0240] Therefore, when the separator 19 is mounted on the holding body 18, the inclined surface 56a of the receiving portion 56 slides on the detection pin 42, and when the adapter 20 is mounted on the separator 19, the inclined surface 65a of the pressing portion 65 slides on the detection pin 45. Thus, the separator 19 can be smoothly mounted on the holding body 18 and the adapter 20 can be mounted on the separator 19, and the detection pins 42 and 45 can be reliably moved to ensure the proper operating state of the detection mechanism 38.

[0241] In addition, the front end surfaces of the detection pins 42 and 45 are formed as spherical portions 42c and 45c that convex toward the front end side, so that the supporting portion 56 slides on the spherical portion 42c when the partition 19 is installed to the retaining body 18 and the pushing portion 65 slides on the spherical portion 45c when the adapter 20 is installed to the partition 19.

[0242] Therefore, the spacer 19 can be smoothly attached to the holding body 18 and the adapter 20 can be attached to the spacer 19 , and the detection pins 42 and 45 can be reliably moved to ensure an appropriate operating state of the detection mechanism 38 .

[0243] <Holding State of Surgical Instrument Holder>

[0244] As described above, with the spacer 19 attached to the holding body 18 and the surgical instrument 80 attached to the adapter 20 , the adapter 20 is attached to the spacer 19 , whereby the surgical instrument 80 is held by the holding body 18 via the spacer 19 and the adapter 20 .

[0245] As described above, when the adapter 20 is mounted on the partition 19, the first engaging portions 58, 58 of the partition 19 and the second engaging portions 67, 67 of the adapter 20 are located on opposite sides of the cylindrical portion 64 with the retaining body 18 sandwiched therebetween in the axial direction (front-rear direction) (see FIG. Figure 32 as well as Figure 33 ).

[0246] Therefore, the first engaging parts 58, 58 and the second engaging parts 67, 67 are located in separated positions in the axial direction of the cylindrical part 64. Therefore, when the second engaging parts 67, 67 are elastically deformed to remove the adapter 20 from the partition 19, it is not easy for the fingers to accidentally touch the first engaging parts 58, 58, which can prevent the partition 19 from accidentally falling off from the retaining body 18.

[0247] In particular, the partition 19 is a component for installing a part of the covering cover. When the partition 19 accidentally falls off from the retaining body 18, the covering cover may be damaged due to contact with the surgical auxiliary device 1, etc. Therefore, by preventing the partition 19 from accidentally falling off from the retaining body 18, damage to the covering cover can also be prevented.

[0248] In addition, when the adapter 20 is mounted on the partition 19, the first engaging portions 58, 58 of the partition 19 and the second engaging portions 67, 67 of the adapter 20 are located at different positions in the circumferential direction of the cylindrical portion 64 (see FIG. Figure 34 ).

[0249] Therefore, the first locking parts 58, 58 and the second locking parts 67, 67 are located in separated positions in the circumferential direction of the cylindrical part 64. Therefore, when the second locking parts 67, 67 are elastically deformed to remove the adapter 20 from the partition 19, it is not easy for the fingers to touch the first locking parts 58, 58, which can prevent the partition 19 from accidentally falling off from the retaining body 18.

[0250] In addition, when the adapter 20 is mounted on the partition 19, two planes passing through the ends of the detection mechanism 38 in the circumferential direction of the cylindrical portion 64 and the center Q of the cylindrical portion 64 are referred to as plane S1 and plane S2 (see FIG. Figure 35 At this time, when the area where the detection mechanism 38 is located in the area divided by the plane S1 and the plane S2 is defined as the first area 72 and the other area is defined as the second area 73 , the second engaging portions 67 , 67 are located in the second area 73 .

[0251] Therefore, the multiple second snap-fitting parts 67, 67 are respectively snapped into the second snap-fitting supporting parts 61, 61 and the detection mechanism 38 and the multiple second snap-fitting parts 67, 67 are located in different areas. Therefore, it is possible to ensure the stable installation state of the adapter 20 for the partition 19, and also to prevent interference between the second snap-fitting parts 67, 67 and the detection mechanism 38 to ensure the proper operation state of the detection mechanism 38.

[0252] Furthermore, in the adapter 20 , the second engagement portions 67 , 67 protrude from the 180-degree opposite side of the pressing portion 65 in the circumferential direction, thereby ensuring the most stable attachment state of the adapter 20 to the separator 19 .

[0253] However, if the second engaging portions 67, 67 protrude from the side 180 degrees opposite to the circumferential direction of the pressing portion 65, the second engaging portions 67, 67 may be closer to the detection mechanism 38, and a finger may inadvertently come into contact with the detection mechanism 38 when the adapter 20 is attached to the partition 19. Therefore, in order to prevent such contact between a finger and the detection mechanism 38, it is desirable that the second engaging portions 67, 67 be located below a horizontal plane passing through the center Q of the cylindrical portion 64.

[0254] In addition, in the surgical instrument holding device 16, the first locking parts 58, 58 are locked to the first locking supporting parts 54, 54 in the elastic reset state, thereby the partition 19 is installed on the holding body 18, and the second locking parts 67, 67 are locked to the second locking supporting parts 61, 61 in the elastic reset state, thereby the adapter 20 is installed on the partition 19.

[0255] Therefore, the elastically deformed first engaging portions 58, 58 engage with the first engaging supporting portions 54, 54 in the elastically reset state, and the elastically deformed second engaging portions 67, 67 engage with the second engaging supporting portions 61, 61 in the elastically reset state, whereby the surgical instrument 80 is retained on the retaining body 18 by means of the partition 19 and the adapter 20, so that the surgical instrument 80 can be easily and quickly loaded and unloaded from the retaining body 18.

[0256] In addition, a cylindrical portion 64 for the surgical instrument 80 to pass through is provided in the adapter 20, and an insertion portion 55 for the cylindrical portion 64 to be inserted is provided in the partition 19. When the cylindrical portion 64 is inserted into the insertion portion 55, the partition 19 is mounted on the retaining body 18 and the adapter 20 is mounted on the partition 19.

[0257] Therefore, when the cylindrical portion 64 penetrated by the surgical instrument 80 is inserted into the insertion portion 55, the partition 19 is installed on the holding body 18, so the partition 19 and the adapter 20 are arranged on the holding body 18 in a space-saving manner, which can achieve miniaturization of the surgical instrument holding device 16.

[0258] <Operation of surgical assist device>

[0259] Next, the operation of the surgical assisting device 1 will be described (see Figures 36 to 42 ).

[0260] When performing a surgical operation, the surgical assisting device 1 constructed as described above, the first movable body 7, the second movable body 8, the third movable body 12, the fourth movable body 15, the driving body 17 functioning as the fifth movable body, and the holding body 18 functioning as the sixth movable body, perform a rotation (rotation) action to change the position and posture of the surgical instrument 80 held by the holding body 18 to a desired state.

[0261] At this time, when the first movable body 7 rotates, the second movable body 8, the third movable body 12, the fourth movable body 15, the driving body 17, and the holding body 18 operate in conjunction with the rotation of the first movable body 7, thereby changing the position or posture of the surgical instrument 80. When the second movable body 8 rotates, the third movable body 12, the fourth movable body 15, the driving body 17, and the holding body 18 operate in conjunction with the rotation of the second movable body 8, thereby changing the position or posture of the surgical instrument 80. Furthermore, when the third movable body 12 rotates, the fourth movable body 15, the driving body 17, and the holding body 18 operate in conjunction with the rotation of the third movable body 12, thereby changing the position or posture of the surgical instrument 80. When the fourth movable body 15 rotates, the driving body 17 and the holding body 18 operate in conjunction with the rotation of the fourth movable body 15, thereby changing the position or posture of the surgical instrument 80. When the driving body 17 rotates, the holding body 18 moves along with the rotation of the driving body 17 to change the position or posture of the surgical instrument 80. When the holding body 18 rotates, the surgical instrument 80 rotates along with the rotation of the holding body 18.

[0262] For example, a surgeon (physician) performs a surgical procedure by remotely controlling a surgical support device 1 installed in an operating room using a master-slave system. The master-slave system divides tasks between a master and a slave. When multiple devices operate in coordination, the master controls and operates the devices, while the slaves operate under the control of the master. In this surgical procedure, the operating device (control device) (not shown) operated by the surgeon serves as the master, and the surgical support device 1 serves as the slave.

[0263] When using the surgical assist device 1 during a surgical operation, first, the first connecting arm 5 is moved in the up-down direction relative to the column 3 according to the position of the patient 200 to set the up-down position of the main body 4, and then, the first connecting arm 5 is rotated relative to the column 3 and the second connecting arm 6 is rotated relative to the first connecting arm 5 according to the surgical position to be performed to set the position of the surgical instrument 80.

[0264] During surgical operation, the reference point for movement of the surgical instrument 80, ie, the pivot point P (see Figure 36 as well as Figure 37 ).

[0265] The pivot point P is located at a position substantially aligned with the incision 202 through which the surgical instrument 80 is inserted, and is substantially aligned with the position of the trocar 90 when the trocar 90 is used (see FIG. Figure 2 ). Therefore, when the surgical instrument 80 is inserted into the body cavity 201 of the patient 200, if a part of the surgical instrument 80 is always controlled to pass through the pivot point P to perform appropriate pivoting, even if the position of the surgical instrument 80 is relative to the original position ( Figure 36The position G) changes ( Figure 36 Position H) can also prevent load on tissues near the body surface of the patient 200, thereby ensuring safety.

[0266] In order to facilitate understanding of the surgical instrument 80 that moves in the axial direction of the shaft portion 81, Figure 36 It is shown that the surgical instrument 80 before movement and the surgical instrument 80 after movement are intentionally slightly offset in a direction orthogonal to the axial direction, and the solid line used to represent the surgical instrument 80 at position G and the dotted line used to represent the surgical instrument 80 at position H do not overlap.

[0267] Furthermore, when the surgical instrument 80 is inserted into the body cavity 201 of the patient 200, if the posture of the surgical instrument 80 is controlled so that a portion of the surgical instrument 80 always passes through the pivot point P and performs appropriate pivoting, even if the posture of the surgical instrument 80 is changed relative to the original posture ( Figure 37 The posture J) changes ( Figure 37 The posture K) can also prevent load on tissues near the body surface of the patient 200, thereby ensuring safety.

[0268] On the other hand, during a surgical operation, the operating room is occupied by the surgeon, assistants, and a plurality of surgical instruments. Therefore, especially when the area of the operating room is limited, people and instruments in the operating room may accidentally touch various parts of the surgical support device 1 .

[0269] For example, during surgery or in preparation for surgery, if a person or an instrument in the operating room accidentally touches the partition 19 and applies a force generated by the contact as an external force, the applied external force may cause the adapter 20 to be unstable in its attachment to the partition 19. On the other hand, in order to improve the workability of the installation operation, it is desirable to be able to easily attach the adapter 20 to the partition 19.

[0270] Therefore, in order to prevent problems caused by such external force and ensure ease of installation, the thickness T1 of the base end portion 68 of the second engaging portion 67 of the adapter 20 is thinner than the thickness T4 of the engaging claw portion 71 (see FIG. Figure 38 as well as Figure 39 ).

[0271] Therefore, a force F1 in the thickness direction is applied to the base end portion 68 via the outer portion 70 (see Figure 38 ) when the base end portion 68 is easily bent, and a force F2 in the thickness direction is applied to the engaging claw portion 71 (see Figure 39). Thus, when the force F1 is applied to the base end portion 68, the engagement between the engagement claw portion 71 and the receiving portion 56 is easily released, thereby making it easy to remove the adapter 20 from the partition 19. Furthermore, when the force F2 is applied to the engagement claw portion 71, the engagement between the engagement claw portion 71 and the receiving portion 56 is not easily released, thereby preventing the adapter 20 from falling off the partition 19.

[0272] In the second engagement portion 67 of the adapter 20, the thickness T3 of the outer portion 70 is thicker than the thickness T1 of the base end portion 68 (see FIG. Figure 38 as well as Figure 40 ).

[0273] Therefore, when a force F1 in the thickness direction is applied to the base end portion 68 (see Figure 38 ) when the base end portion 68 is easily bent, and when a force F2 in the thickness direction is applied to the engaging claw portion 71 (refer to Figure 40 ) The outer portion 70 is not easily bent. Thus, when a force F1 is applied to the base end portion 68, the engagement between the engaging claw portion 71 and the receiving portion 56 is easily released, thereby making it easy to remove the adapter 20 from the partition 19. Moreover, when a force F2 is applied to the engaging claw portion 71, the engagement between the engaging claw portion 71 and the receiving portion 56 is not easily released, thereby preventing the adapter 20 from falling off the partition 19.

[0274] Furthermore, as described above, if a person, an instrument, or the like in the operating room accidentally touches the partition 19 or the adapter 20 and applies external force, the endoscope may not be able to accurately observe the interior of the body cavity 201 .

[0275] In addition, surgical operations using the surgical assist device 1 are performed remotely by the surgical operator in a master-slave manner. Therefore, when the positions of various parts of the surgical instrument 80 are unintentionally changed relative to the holding body 18, the position and posture of the surgical instrument 80 identified by the surgical operator based on the information input to the operating device serving as the host may be different from the actual position and posture of the surgical instrument 80, which may reduce the accuracy and safety of the operation.

[0276] Therefore, in the surgical instrument holding device 16 , as described above, the restricting portions 56 b and 56 b are formed on the partition 19 . The restricting portions 56 b and 56 b engage with the restricted portion 65 b to restrict the rotation of the adapter 20 in the circumferential direction of the cylindrical portion 64 .

[0277] Therefore, when the adapter 20 is installed on the partition 19 and the partition 19 is installed on the retaining body 18, the rotation of the adapter 20 with the surgical instrument 80 installed relative to the partition 19 is restricted, thereby preventing the surgical instrument 80 from rotating unintentionally relative to the retaining body 18 and preventing the surgical instrument 80 from being displaced relative to the retaining body 18, thereby ensuring the accuracy and safety of the operation.

[0278] In addition, rotation restricted portions 57 , 57 are provided on the partition 19 , and rotation restricting portions 53 b , 53 b , . . . are formed on the retaining body 18 . The rotation restricting portions 53 b , 53 b , . . . engage with the rotation restricted portions 57 to restrict the circumferential rotation of the partition 19 in the insertion portion 55 .

[0279] Therefore, when the adapter 20 is installed on the partition 19 and the partition 19 is installed on the retaining body 18, the rotation of the adapter 20 relative to the partition 19 is restricted and the rotation of the partition 19 relative to the retaining body 18 is restricted, thereby preventing the surgical instrument 80 from rotating unintentionally relative to the retaining body 18, ensuring high positioning accuracy of the surgical instrument 80 and accurately performing surgery.

[0280] In the surgical assisting device 1, during or before and after surgery, the surgical instrument holding device 16 may rotate relative to the fourth movable body 15. In this case, the driving body 17 of the surgical instrument holding device 16 rotates relative to the fourth movable body 15, and the driving body 17 can rotate relative to the fourth movable body 15 between a first rotation position and a second rotation position (see Figure 41 as well as Figure 42 ).

[0281] The first rotation position is, for example, a position where the shaft portion 81 of the surgical instrument 80 is held in a substantially horizontal state (see Figure 41 ), the second rotation position is, for example, a position where the shaft portion 81 of the surgical instrument 80 is slightly tilted relative to the vertical direction when it is located below the camera 82 (see Figure 42 ).

[0282] As described above, the surgical instrument holding device 16 is formed as a roughly L-shape as a whole, and the front part of the part extending forward and backward is set as a narrow part 48 with a small upper and lower width, and the rear part of the part extending forward and backward is set as a wide part 49 with a larger upper and lower width than the narrow part 48.

[0283] The portion of the driving body 17 extending forward and backward at the second rotational position is located near the fourth movable body 15. However, the driving body 17 is formed into a shape consisting of the narrow portion 48 and the wide portion 49 as described above. Therefore, at the second rotational position, the narrow portion 48 is close to the fourth movable body 15, and a portion of the fourth movable body 15 is located in the first concave space 50. The driving body 17 and the fourth movable body 15 are not in contact (see Figure 42 ).

[0284] Therefore, the driving body 17 can be prevented from coming into contact with the fourth movable body 15 to prevent damage to both, and the driving body 17 can be smoothly rotated relative to the fourth movable body 15 .

[0285] The driving body 17 is formed into a shape consisting of the narrow portion 48 and the wide portion 49 . Thus, the light guide 83 of the surgical instrument 80 is close to the narrow portion 48 , and the light entrance portion 83 c is located in the second concave space 51 and spaced apart from the wide portion 49 .

[0286] Therefore, damage to the driving body 17 and the light guide 83 can be prevented, and the surgical instrument 80 can be smoothly rotated in the direction of rotation about the shaft portion 81 relative to the driving body 17 without interfering with the driving body 17 .

[0287] In particular, in the driving body 17, the portion close to the connecting portion with the fourth movable body 15, that is, the connecting member 27, is set as a narrow portion 48, and the portion separated from the connecting member 27 is set as a wide portion 49. As a result, the encoder 32, the driving motor 33, and other structures required for rotating the retaining body 18 can be arranged in the wide portion 49 with a large configuration space, thereby improving the design freedom.

[0288] In addition, the axial connecting shaft 35 used to transmit the driving force from the driving motor 33 to the retaining body 18 is arranged in the narrow width portion 48, thereby reducing the outer shape of the narrow width portion 48 as much as possible, and easily and efficiently avoiding interference between the driving body 17 and the fourth movable body 15, and interference between the driving body 17 and the light guide 83.

[0289] <Other>

[0290] In the above, the detection mechanism 38 is shown as an example. The detection mechanism 38 is provided with the main body parts 41, 44 and the detection pins 42, 45 that move relative to the main body parts 41, 44. However, in the surgical instrument holding device 16, a detection mechanism 38A that detects by detection light may be used instead of the detection mechanism 38 (see Figure 43 ).

[0291] When the detection mechanism 38A is used, at least the receiving portion 56 of the spacer 19 and at least the pressing portion 65 of the adapter 20 are formed of a material capable of reflecting light or are subjected to a surface treatment capable of reflecting light.

[0292] The detection mechanism 38A includes a first detection section 39A and a second detection section 40A. A light emitting section and a light receiving section (not shown) are provided in the first detection section 39A and the second detection section 40A, respectively. Laser light (detection light) is emitted from the light emitting sections of the first detection section 39A and the second detection section 40A toward the receiving section 56 of the separator 19 and the pressing section 65 of the adapter 20, respectively.

[0293] When the laser emitted from the light-emitting portion of the first detection portion 39A is reflected by the receiving portion 56 and received by the light-receiving portion of the first detection portion 39A, the fact that the laser is received by the light-receiving portion is sent as a detection signal to the detection circuit, thereby detecting that the partition 19 is properly installed on the retaining body 18.

[0294] In addition, when the laser emitted from the light-emitting portion of the second detection portion 40A is reflected by the pushing portion 65 and received by the light-receiving portion of the second detection portion 40A, the fact that the laser is received by the light-receiving portion is sent to the detection circuit as a detection signal, thereby detecting that the detection adapter 20 is properly installed on the partition 19.

[0295] In this way, a detection mechanism 38A is set in the surgical instrument holding device 16, and the detection mechanism 38A has: a light-emitting part, which emits detection light toward the partition 19 or the adapter 20; and a light-receiving part, which receives the detection light reflected by the partition 19 or the adapter 20, thereby using the detection light reflected by the partition 19 to detect the installation status of the partition 19 relative to the holding body 18, and using the detection light reflected by the adapter 20 to detect the installation status of the adapter 20 relative to the partition 19.

[0296] Therefore, the mounting state of the partition 19 and the adapter 20 can be easily detected with a simple structure.

[0297] In addition, the rotation directions of the above-mentioned first movable body 7, second movable body 8, third movable body 12, fourth movable body 15, driving body 17 and retaining body 18 are not limited to the directions shown above. If the surgical instrument 80 can move in three orthogonal axis directions and can be set to any posture, it can be set to any direction.

[0298] In the above description, the surgical support device 1 having six degrees of freedom is shown as an example. However, the surgical support device 1 may have any structure as long as it is movable in three orthogonal axial directions.

[0299] In addition, in the above example, the adapter 20 is provided with the second engaging portion 67, and the second engaging portion 67 is formed with a stepped surface 69a at the boundary portion between the folded portion 69 and the base end portion 68. However, it is also possible that, for example, the surface in the thickness direction of the base end portion 68 is formed as a curved surface or a flat surface, and the base end portion 68 is continuous with the folded portion 69 (see Figure 44 ).

[0300] In this way, a second locking portion 67 is provided, and the surface in the thickness direction of the base end portion 68 of the second locking portion 67 is formed into a curved surface or a flat surface, and the base end portion 68 is continuous with the folded-back portion 69. As a result, stress concentration is not likely to occur at the boundary portion between the base end portion 68 and the folded-back portion 69, and the strength of the second locking portion 67 can be improved.

[0301] Description of Reference Numerals

[0302] 1: surgical assisting device; 7: first movable body; 8: second movable body; 12: third movable body; 15: fourth movable body; 16: surgical instrument holding device; 17: driving body; 18: holding body; 19: partition; 19a: opening for assembly and disassembly; 20: adapter; 52: first engaging receiving portion; 54b: rotation limiting portion; 55: insertion portion; 56b: limiting portion; 57: rotation limited portion; 58: first engaging portion; 61: second engaging receiving portion; 64: cylindrical portion; 65b: limited portion; 67: second engaging portion.

Claims

1. A surgical instrument holding device, comprising: an adapter to which a surgical instrument is detachably mounted, the adapter being provided with a restricted portion; a separator, the adapter being detachably mounted on the separator; a holding body, the partition being detachably mounted on the holding body; as well as a driving body that supports the holding body in a rotatable manner and applies a driving force to the holding body, The adapter is provided with a cylindrical portion for the surgical instrument to pass through. The separator is provided with an insertion portion for the cylindrical portion to be inserted therethrough. The surgical instrument is held on the holding body by means of the partition and the adapter. The spacer is formed with a restricting portion that engages with the restricted portion to restrict the adapter from rotating in the circumferential direction of the cylindrical portion. The partition is provided with a rotation-restricted portion, The holding body is formed with a rotation restricting portion that engages with the rotation restricted portion to restrict the rotation of the partition in the circumferential direction of the insertion portion. A first engagement receiving portion is formed on the retaining body, A second engagement receiving portion is formed on the separator, The separator is provided with a first engaging portion, which is elastically deformed and engaged with the first engaging receiving portion when the separator is mounted on the holding body. The adapter is provided with a second engaging portion, which is elastically deformed and engaged with the second engaging receiving portion when the adapter is mounted on the separator. The first engaging portion engages with the first engaging receiving portion in an elastically reset state, thereby the partition is mounted on the holding body, and the second engaging portion engages with the second engaging receiving portion in an elastically reset state, thereby the adapter is mounted on the partition. The rotation restricted portion and the first engaging portion are formed in a shape protruding relative to the insertion portion. The rotation restricted portion is provided continuously with the first engaging portion.

2. The surgical instrument holding device according to claim 1, characterized in that: The insertion portion is formed with an opening for attachment and detachment that opens in a radial direction. The surgical instrument attached to the adapter is inserted into or removed from the attachment and detachment opening.

3. A surgical assisting device comprising a surgical instrument holding device for holding a surgical instrument, wherein: The surgical instrument holding device comprises: an adapter to which the surgical instrument is detachably mounted, the adapter being provided with a restricted portion; a separator, the adapter being detachably mounted on the separator; a holding body, the partition being detachably mounted on the holding body; as well as a driving body that supports the holding body in a rotatable manner and applies a driving force to the holding body, The adapter is provided with a cylindrical portion for the surgical instrument to pass through. The separator is provided with an insertion portion for the cylindrical portion to be inserted therethrough. The surgical instrument is held on the holding body by means of the partition and the adapter. The spacer is formed with a restricting portion that engages with the restricted portion to restrict the adapter from rotating in the circumferential direction of the cylindrical portion. The partition is provided with a rotation-restricted portion, The holding body is formed with a rotation restricting portion that engages with the rotation restricted portion to restrict the rotation of the partition in the circumferential direction of the insertion portion. A first engagement receiving portion is formed on the retaining body, A second engagement receiving portion is formed on the separator, The separator is provided with a first engaging portion, which is elastically deformed and engaged with the first engaging receiving portion when the separator is mounted on the holding body. The adapter is provided with a second engaging portion, which is elastically deformed and engaged with the second engaging receiving portion when the adapter is mounted on the separator. The first engaging portion engages with the first engaging receiving portion in an elastically reset state, thereby the partition is mounted on the holding body, and the second engaging portion engages with the second engaging receiving portion in an elastically reset state, thereby the adapter is mounted on the partition. The rotation restricted portion and the first engaging portion are formed in a shape protruding relative to the insertion portion. The rotation restricted portion is provided continuously with the first engaging portion.

Images