Endoscope assembly and device for assisting operation of treatment or surgical instrument

Abstract

An endoscope assembly (10) for assisting the operation of a treatment or surgical instrument is provided with: an imaging element (11); and a shaft that accommodates the imaging element (11) or is connected to the imaging element (11). The endoscope assembly (10) is provided with: a handle part (14) extending from a shaft (13); and an attachment tool (15) for a treatment or surgical tool, the attachment tool (15) being attached to the shaft (13).

Description

Technical Field

[0001] The present invention relates to an endoscope assembly for assisting the operation of a treatment or surgical instrument. Background Art

[0002] As a conventional ear surgery, the following microscopic surgery was performed ( Figure 1 In Figure 1 (A) 1953-Wulstein: A bone incision 102 is provided in the ear bone 101 to enable visual identification of the affected part 100, light 104 is irradiated from a microscope 103, and surgery is performed while observing the affected part 100 under the microscope 103 (reference numeral 105 is the auricle). This method has the following problems: the bone incision 102 is invasive in order to form it, and if the bone incision 102 is reduced in order to reduce the invasiveness, a blind spot is easily formed.

[0003] Endoscopic surgery, which has the greatest advantage of low invasiveness, has been developing rapidly in recent years. Endoscope 107 is inserted into the external auditory canal 106, the affected part 109 is irradiated from the front end 108 of the endoscope 107, and the surgery is performed while observing under the endoscope 107. Figure 1 In Figure 1 (B) 1998 ~ Tarabichi) Endoscopic surgery has only recently become possible.

[0004] Recently, Yamauchi et al., the inventors of the present application, have developed an underwater ear endoscopy surgery (OTOS) in which the area around the affected part is filled with water or an aqueous solution 110 and the operation is performed under observation under an endoscope 111 in water. Figure 1 In Figure 1 (C), 2014 ~ Yamauchi, Patent Document 1).

[0005] However, in endoscopic surgery, since the operating space is extremely narrow, one-hand surgery (one-hand surgery) is performed with the dominant hand while holding the endoscope 112 with one hand. Figure 2 In Figure 2 A) is common. One-hand surgery can provide a good visual field, but on the other hand, the learning curve is a weakness because the surgical operation requires practice. In addition, ear surgery involves the removal of the lesion using suction, grasping, traction, peeling, excision, facial nerve stimulation, and electrocoagulation to stop bleeding, and the reconstruction of the eardrum and sound transmission through related operations, but it is not easy to do all of this with one hand.

[0006] It is also possible to fix the endoscope 112 with a commercially available endoscope holder 114 and perform two-hand surgery (two-hand surgery) with both hands performing the operation. Figure 2 In Figure 2 (B)), however, if the endoscope 112 is fixed, the visual field is fixed and cannot be freely moved, and it is difficult to grasp the three-dimensional sense. In addition, there are problems such as the blurred surgical visual field and difficulty in observation when the patient moves, and the expensive fixation device.

[0007] There is also a method of three-hand surgery in which an assistant holds the endoscope 112 and the operator performs the surgery with both hands. Figure 2 In Figure 2 (C)) However, it is difficult to master and requires teamwork, and such surgery cannot always be performed easily. In addition, in three-hand surgery, the hands interfere in the narrow part of the external auditory canal and cannot be performed in all surgical procedures. Prior Art Literature Patent Literature

[0008] Patent Document 1: WO2017 / 171085 Summary of the invention (Problems to be solved by the invention)

[0009] An object of the present invention is to provide an endoscope that enables a long working tool such as a treatment or surgical instrument to be operated by the hand holding the endoscope. (Technical solutions to solve problems)

[0010] The present invention includes the following embodiments. Item 1. An endoscope assembly for assisting the operation of a treatment or surgical instrument, the endoscope assembly comprising: an imaging element; and a shaft that accommodates the imaging element or is connected to the imaging element, The endoscope assembly comprises: a handle portion extending from the shaft; and A mounting device for a treatment or surgical instrument, wherein the mounting device is mounted on the shaft. Item 2. In the endoscope assembly according to Item 1, the attachment tool is located closer to the front end side of the shaft than the handle portion. Item 3. The endoscope assembly according to Item 1, wherein a treatment or surgical instrument is mounted on the mounting tool. Item 4. The endoscope assembly according to Item 3, wherein the treatment or surgical instrument is a rod-shaped instrument having an operating handle.

[0011] Item 5. The endoscope assembly according to any one of Items 1 to 4, wherein the shaft includes a distal shaft portion and a proximal shaft portion, and the distal shaft portion is rotatable relative to the proximal shaft portion. Item 6. In the endoscope assembly according to Item 5, the distal end side shaft portion and the proximal end side shaft portion are connected by a flexible connection member. Item 7. The endoscope assembly according to Item 5 further comprises a traction member, wherein the base end of the traction member is fixedly mounted on the front end side shaft portion, the tip of the traction member extends outward from the base end side shaft portion, and the front end side shaft portion is bent by pulling the traction member back toward the base end side. Item 8. According to any one of items 1 to 4, the endoscope assembly comprises a front end shaft portion, a base end shaft portion, and a generally cylindrical member, the generally cylindrical member is mounted on the outer peripheral surface of the base end shaft portion and is rotatable relative to the base end shaft portion, and the mounting device for the treatment or surgical instrument is mounted on the generally cylindrical member.

[0012] Item 9. The endoscope assembly according to any one of Items 1 to 4, wherein the shaft includes a distal end shaft portion and a proximal end shaft portion, The handle portion is mounted on the outer periphery of the base end side shaft portion along a portion of the length direction of the base end side shaft portion. The endoscope assembly comprises: a traction member having a base end fixedly mounted on the front end shaft portion, extending through the outer sides or inner cavities of the front end shaft portion and the base end shaft portion, and having a terminal end at a position closer to the base end than the base end shaft portion; and A mechanism for selectively sending out or pulling back the pulling member extends through the handle portion from the outside of the handle portion to the inside of the handle portion. Item 10. The endoscope assembly according to any one of Items 1 to 4, wherein the imaging element is housed inside the shaft. Item 11. The endoscope assembly according to any one of Items 1 to 4, wherein the imaging element is connected to the base end of the shaft. Item 12. A device for assisting the operation of a treatment or surgical instrument, used in connection with an endoscope having a photographing device, The operation assisting device includes a shaft that allows the front end to pass through and allows the imaging device to capture an image of the subject. The shaft has: a handle portion extending from the shaft; and A mounting device for a treatment or surgical instrument, wherein the mounting device is mounted on the shaft. (Effects of the Invention)

[0013] According to the present invention, the operator can perform the surgical operation with both hands while coordinating with the patient's movement and obtaining a good field of vision, thereby improving the operability of the surgical operation. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Figure 1 In the figure, (A) is an illustration of surgical operation under a microscope, (B) is an illustration of otoscope surgery through the external auditory canal, and (C) is an illustration of underwater otoscope surgery. (Quoted from URL: http: / / kompas.hosp.keio.ac.jp / sp / contents / medical_info_presentation_201708.html) Figure 2 In the figure, (A) is an illustration of one-hand surgery, (B) is an illustration of two-hand surgery, and (C) is an illustration of three-hand surgery. (Quoted from URL:http: / / kompas.hosp.keio.ac.jp / sp / contents / medical_info_presentation_201708.html) Figure 3 It is a perspective view of the endoscope assembly according to the first embodiment. Figure 4 It is used in trans-external auditory endoscopic surgery (TEES) Figure 3 Diagram of endoscope components. Figure 5 It is a perspective view of an endoscope assembly according to a second embodiment. Figure 6 It is held with the left hand Figure 5 Schematic diagram of the states of endoscope components. Figure 7 This is a diagram for explaining how to install the equipment. Figure 8 It is a perspective view of an endoscope assembly according to a third embodiment. Fig. 9 It means that Figure 8 A schematic diagram of a process in which the shaft of an endoscope assembly is inserted into the external auditory canal and the distal end side shaft portion is bent relative to the proximal end side shaft portion. Fig.10 yes Figure 8 A diagram of a modified example of an endoscope assembly according to an embodiment of the present invention. Fig.11 It is a figure which shows an example of a fixing member. Fig.12It is a perspective view of an endoscope assembly according to a fourth embodiment. Fig.13 yes Fig.12 Side view of the endoscope assembly. Fig.14 In (A) and (B) are Figure 2 (A) One-handed transmastoid superior semicircular canal occlusion. Fig.15 Among them, (A) and (B) are diagrams showing the superior semicircular canal occlusion via mastoid sinus performed by two-handed operation in the case of the endoscope assembly according to the fourth embodiment. DETAILED DESCRIPTION

[0015] Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. (First Embodiment) Figure 3 The endoscope assembly 10 is a perspective view of an endoscope assembly 10 for assisting the operation of a treatment or surgical instrument according to the first embodiment. The endoscope assembly 10 includes a CMOS (Complementary Metal Oxide Semiconductor) image sensor 11 constituting an imaging element and a substantially cylindrical shaft 13 accommodating the CMOS image sensor 11 .

[0016] Inside the shaft 13, an optical fiber (not shown) extends along the length direction of the shaft 13, and the optical fiber (not shown) optically connected to the light source (not shown) guides the illumination light from the light source (not shown) such as LED from the base end to the front end, and irradiates the subject. The structure of the optical system of such an endoscope is well known.

[0017] An objective lens (not shown) is built into the front end of the shaft 13, and light from the subject passes through the translucent front end 13a of the shaft 13 and the objective lens (not shown), and is imaged by the CMOS image sensor 11. The image of the subject captured by the CMOS image sensor 11 is transmitted to the signal cable 12 connected to the CMOS image sensor 11 for signal processing. The signal cable 12 is connected to a computer, and the image of the subject can be observed through a display device connected to the computer. The signal cable 12 can protrude from the side of the shaft 13 to the outside of the shaft 13.

[0018] The endoscope assembly 10 also includes a handle portion 14 extending from the shaft 13. The handle portion 14 extending from the shaft 13 means that the handle portion 14 extends beyond the diameter and / or length of the shaft 13. It should be noted that the handle portion 14 can also be detached from the shaft 13 by screws, etc., so that the handle portion 14 can be changed according to the type of surgery, the size of the operator's hand, and the preference. Specifically, in Figure 3In the embodiment, the front end of the handle portion 14 is attached to the base end of the substantially cylindrical side surface of the shaft 13, and the handle portion 14 extends from the front end to the base end at an angle relative to the axis of the shaft 13. The handle portion 14 exceeds the diameter of the shaft 13 and extends radially outwardly of the shaft 13, and extends further to the base end side than the base end of the shaft 13. The handle portion 14 exceeds the diameter of the shaft 13 and extends radially outwardly of the shaft 13, so that the space on the base end side than the base end of the shaft 13 is vacated, and it is less likely to become an interference with the second treatment or surgical instrument 18 operated by the operator with the opposite hand.

[0019] The material constituting the shaft 13 and the handle portion 14 is not limited, and may be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber. For example, when the shaft 13 and the handle portion 14 are an integrally molded product of synthetic resin, it is preferred in terms of manufacturing and operability.

[0020] The endoscope assembly 10 further includes a mounting device 15 for a treatment or surgical instrument 16, and the mounting device 15 is mounted on the shaft 13. The mounting device 15 includes a holding portion 15a for holding or gripping the treatment or surgical instrument 16, a fixing portion 15b for fixing the mounting device 15 to the side surface of the shaft 13, and a connecting portion 15c for connecting the holding portion 15a and the fixing portion 15b.

[0021] In this embodiment, the holding portion 15a is a long strip member with a roughly U-shaped cross section, which holds or clamps the first long strip portion 16b of the treatment or surgical instrument 16 in a manner that the first long strip portion 16b can move forward and backward in the length direction of the first long strip portion 16b and can be detached from the holding portion 15a. The material constituting the holding portion 15a is not limited, and can be metal, synthetic resin, or a composite material including at least one of them. For example, the holding portion 15a can also be formed of a synthetic resin, and the first long strip portion 16b can be embedded in the holding portion 15a by utilizing the elastic buckle of the holding portion 15a.

[0022] The fixing portion 15b is substantially in the shape of a truncated cone in the present embodiment, but is not particularly limited thereto as long as it can be fixed to the side surface of the shaft 13. The fixing portion 15b can be fixed to the side surface of the shaft 13 by any fixing joining method such as bonding with an adhesive or welding. The material constituting the fixing portion 15b is not limited, and may be metal, synthetic resin, or a composite material including at least any one of them. It should be noted that the synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber.

[0023] In order to improve the mobility and operability of the treatment or surgical instrument 16 mounted on the holding portion 15a, the connecting portion 15c is preferably a spring, especially an elastic member such as a metal leaf spring, or a flexible member. The connection method between the holding portion 15a and the fixing portion 15b and the connecting portion 15c is not particularly limited, and can be any known method. The material constituting the fixing portion 15c is not limited, and can be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that the synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber.

[0024] The treatment or surgical instrument 16 has a front end portion 16a, a first elongated portion 16b extending continuously from the front end portion 16a at an angle to the front end portion 16a, a second elongated portion 16c extending continuously from the front end portion 16a at an angle to the first elongated portion 16b, and an operating handle 16d mounted on the base end of the second elongated portion 16c. The diameter of the operating handle 16d is larger than that of the first elongated portion 16b and the second elongated portion 16c so that the operator (also referred to as the operator) can hold it easily. In the present embodiment, the operating handle 16d is roughly spherical, but it can also be any other arbitrary shape that is easy for the operator to hold. The material constituting the operating handle 16d is not limited, and can be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that synthetic resins include thermoplastic resins, thermosetting resins, elastomers, and rubber.

[0025] In the present embodiment, as the treatment or surgical instrument 16, a stripping piece is exemplified, but it may be other treatment or surgical instruments that can perform treatments such as stripping, collecting, cutting, crushing, and hemostasis. The treatment or surgical instrument is preferably a rod-shaped or rod-shaped instrument that can be mounted on the long strip portion of the mounting instrument 15. Such treatment or surgical instruments are not particularly limited, and examples thereof include biopsy forceps, snares, hemostatic clips, knives, ultrasonic instruments (for tissue cutting, tissue stripping, tissue crushing and / or emulsification of biological samples, etc.), high-frequency energy supply instruments, laser devices, and irrigation devices or flushing devices for supplying irrigation fluid during underwater otoscope surgery. It should be noted that there is also a case where the front end portion 16a of the treatment or surgical instrument 16 can be detached relative to the first long strip portion 16b, but in the case where the mounting instrument 15 retains a part of the treatment or surgical instrument 16, it is also regarded as retaining the treatment or surgical instrument 16.

[0026] The mounting device 15 is located closer to the front end side of the shaft 13 than the handle portion 14. In addition, preferably, the movable area of ​​the handle portion 14 does not overlap with the movable area of ​​the treatment or surgical instrument 16 so that the handle portion 14 does not interfere with the operation of the treatment or surgical instrument 16 when the operator operates the treatment or surgical instrument 16.

[0027] Next, the operation of the endoscope assembly 10 is described. First, the treatment or surgical instrument 16 is mounted on the holding portion 15a of the mounting instrument 15. Then, the operator grasps the distal end portion of the shaft 13 of the endoscope assembly 10 and the operating handle 16d of the treatment or surgical instrument 16, and inserts the treatment or surgical instrument 16 and the shaft 13 from the front end into the body cavity of the subject. Figure 4 As an example, the endoscope assembly 10 of the present embodiment is inserted into the external auditory canal 1 in transcanal endoscopic ear surgery (TEES). The eardrum 3, the three semicircular canals 4, and the cochlea 5 are shown. The affected part around the eardrum 3 is illuminated from the light source (not shown) in the endoscope assembly 10, and the image of the affected part is captured by the CMOS image sensor 11. When the operator wants to change the position of the imaged affected part, the operator operates the handle 14 with the fingers of the left hand (index finger, middle finger, ring finger, etc.) to change the position of the shaft 13, thereby changing the position of the imaged affected part. In addition to the operation of the handle 14, the operator can also hold and operate the operating handle 16d of the treatment or surgical instrument 16 to perform treatment such as incision, peeling, suction, etc. on the eardrum 3 and its vicinity using the front end 16a of the treatment or surgical instrument 16. In addition, in addition to the operation with the left hand, the operator can also operate other treatment or surgical instruments 18 with the right hand to perform treatment. When the treatment of the patient is completed, the operator grasps the distal end of the shaft 13 of the endoscope assembly 10 and the operating handle 16d of the treatment or surgical instrument 16, pulls back the shaft 13 and the treatment or surgical instrument 16, and removes the endoscope assembly 10 from the body cavity of the subject.

[0028] The effects of the endoscope assembly 10 for assisting the operation of the treatment or surgical instrument according to the first embodiment described above will be described. The operator can operate the endoscope and the treatment or surgical instrument with the same hand. · The operator can operate the treatment or surgical instruments with the hand holding the endoscope, and can operate other treatment or surgical instruments with the other hand, so that the operator can operate with both hands. It is possible to operate suction, grasping, traction, peeling, and cutting with both hands. Or, other operations can also be performed with both hands. (For example, in stapes surgery, while suppressing the incus from dislocating from the anvil / hammer joint, while inserting an artificial stapes (corresponding to Japanese: ピストン))

[0029] The endoscope assembly 10 for assisting the operation of the treatment or surgical instrument of the first embodiment described above can be modified as follows. In the first embodiment, the CMOS image sensor 11 is used as the imaging element, but other imaging elements may be used. · Figure 4 Although the application of the endoscope assembly 10 to trans-external auditory canal endoscopic ear surgery (TEES) is shown, the endoscope assembly 10 can also be applied to underwater endoscopic ear surgery (UWEES) as described in Patent Document 1. In the above description, a right-handed operator uses the endoscope unit 10 with his left hand. However, the endoscope unit 10 can be used with the right hand by rotating the endoscope unit 10 180° around the axis of the shaft 13 .

[0030] (Second Embodiment) Next, an endoscope assembly 20 for assisting the operation of a treatment or surgical instrument according to a second embodiment of the present invention will be described. The description of the components corresponding to those of the first embodiment of the present invention will be omitted.

[0031] Figure 5 It is a stereoscopic view of an endoscope assembly 20 for assisting the operation of treatment or surgical instruments according to a second embodiment. The endoscope assembly 20 comprises: a CCD camera 21, which comprises a CCD (Charged coupled device) constituting a photographing element; and a substantially cylindrical shaft 23, which is connected to the CCD camera 21. At the base end of the shaft 23, the shaft 23 is connected to the CCD camera 21. In the present embodiment, the shaft 23 comprises a hollow and substantially cylindrical front end side shaft portion 23a and a hollow and substantially cylindrical base end side shaft portion 23b, and the front end side shaft portion 23a is capable of rotating relative to the base end side shaft portion 23b.

[0032] Inside the shaft 23, an optical fiber (not shown) extends along the length direction of the shaft 23. The optical fiber (not shown) guides illumination light from a light source (not shown) such as an LED connected to the base end of the optical fiber (not shown) from the base end to the front end to illuminate the subject.

[0033] A lens (not shown) is built into the front end of the shaft 23, and light from the subject passes through the translucent front end of the shaft 23 and passes through an objective lens (not shown), an optical fiber, a gradient refractive index (GRIN (refractive index distribution)) lens, and is imaged by a CCD camera 21. The image of the subject captured by the CCD 21 is transmitted to the signal cable 22 for signal processing. The signal cable 22 is connected to a computer, and the image of the subject can be observed through a display device connected to the computer. The field of view is preferably 4K or more.

[0034] The endoscope assembly 20 also includes a handle portion 24 extending from the shaft 23. Specifically, the handle portion 24 exceeds the diameter of the shaft 23 and extends radially outward from a position in the circumferential direction of the shaft 23 on the side of the shaft 23 along the length direction of the shaft 23. The handle portion 24 includes two protrusions 24a and 24b having curved surfaces, and a recess 24c is formed between the two protrusions 24a and 24b. In the present embodiment, the protrusion 24b protrudes more in a direction perpendicular to the longitudinal axis of the shaft 23 than the protrusion 24a. Except for the joint with the shaft 23, the handle portion 24 has a continuous curved surface, forming a shape that better fits the operator's hand and reduces the operator's fatigue by utilizing ergonomic design. Specifically, as Figure 6 As shown, when using the endoscope assembly 20, the operator's hand 6 is used to pinch the handle portion 24, and protrusions 24a and 24b are arranged on both sides of the interdigital web between the thumb and the index finger, so that the handle portion 24 is held in a manner that the surface of the recess 24c dividing the two protrusions 24a and 24b contacts the interdigital web.

[0035] The material constituting the shaft 23 and the handle portion 24 is not limited, and may be metal, synthetic resin, or a composite material including at least any one of them. It should be noted that synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber. For example, the shaft 23 and the handle portion 24 may be molded products of synthetic resins, respectively. The shaft 23 and the handle portion 24 may be joined by any fixed joining method such as bonding with an adhesive or welding.

[0036] The endoscope assembly 20 also includes a mounting device 25 for a treatment or surgical instrument 26 mounted on the front end side shaft portion 23a of the shaft 23. In this embodiment, the mounting device 25 is a fastener such as Figure 7As shown, the mounting tool 25 is a member having two approximately parallel flat plate portions 25a and 25b, and a vertical flat plate portion 25c that is continuous with the two approximately parallel flat plate portions 25a and 25b and extends approximately perpendicularly to the two approximately parallel flat plate portions 25a and 25b. Two parallel wide surfaces 25d and 25e on the opposite side of the mutually opposed surfaces of the two approximately parallel flat plate portions 25a and 25b constitute the outer surface of the mounting tool 25, and a treatment or surgical instrument 26 is mounted on one of the wide surfaces 25d and 25e, and the other of the wide surfaces 25d and 25e is mounted on the approximately cylindrical side surface of the shaft. In other words, one of the wide surfaces 25d and 25e of the mounting tool 25 holds the treatment or surgical instrument 26, and the other of the wide surfaces 25d and 25e of the mounting tool 25 is fixedly mounted on the approximately cylindrical side surface of the shaft. The material constituting the fixture 25 is not limited, and may be metal, synthetic resin, a composite material including at least any one of them, etc. The synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber.

[0037] The treatment or surgical instrument 26 has a front end 26a, a main strip portion 26b extending continuously from the front end 26a at an angle to the front end 26a, and an operating handle 26c installed at the base end of the strip portion 26b. The diameter of the operating handle 26c is larger than that of the strip portion 26b so that the operator (also referred to as the operator) can easily hold it. In the present embodiment, the operating handle 26c is formed into a plate-like shape of an inverted triangle after the corners of the wide surface are rounded so that the operator can easily hold it with three fingers, but the operating handle 26c can also be any other shape that is easy for the operator to hold with three fingers, such as a plate-like shape with a wide surface that is roughly semicircular. The material constituting the operating handle 26c is not limited, and can be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that synthetic resins include thermoplastic resins, thermosetting resins, elastomers, and rubber.

[0038] The attachment device 25 is located closer to the front end side of the shaft 23 than the handle portion 24. In addition, it is preferred that the handle portion 24 extends radially outward from a position different from the attachment device 25 in the circumferential direction of the shaft 23, specifically, from a position approximately 180° from the attachment device 25 in the circumferential direction, so that when the operator operates the treatment or surgical instrument 26, the handle portion 24 does not interfere with the movable area of ​​the treatment or surgical instrument 26.

[0039] The size of each component of the endoscope assembly 20 can be appropriately selected according to the purpose. For example, in the case of an ear endoscope surgery through the external auditory canal, the inner diameter of the shaft is as small as possible, for example, 2.7 mm or less. The length L1 of the portion of the treatment or surgical instrument 26 that is closer to the front end side than the portion installed on the mounting instrument 25 is preferably about 5 mm to about 15 mm. The length L2 of the portion of the treatment or surgical instrument 26 that is closer to the base end side than the portion installed on the mounting instrument 25 is preferably about 70 mm to about 100 mm. The length from the front end of the front end side shaft portion 23a to the position where the handle portion 24 is installed in the base end shaft 23b is preferably about 50 mm to about 60 mm. The length of the handle portion 24 is preferably about 40 mm to 50 mm. The length L2 is set to be longer than the length L1, thereby facilitating the subtle role played by the front end of the treatment or surgical instrument 26 in the "lever principle". It should be noted that the dimensions of the various parts are described when the endoscope assembly 20 is used for otologic endoscopic surgery through the external auditory canal, but it is natural that the operator can appropriately change the dimensions for purposes other than otologic surgery (such as surgery on other organs).

[0040] Next, the operation of the endoscope assembly 20 is described. First, the treatment or surgical instrument 26 is fixedly mounted on the mounting device 25 in advance. Next, the operator grasps the base end of the shaft 23 of the endoscope assembly 20 and the operating handle 26c of the treatment or surgical instrument 26, and inserts the treatment or surgical instrument 26 and the shaft 23 from the front end into the body cavity of the subject. When the operator wants to change the position of the affected part to be photographed, the operator operates the handle portion 24 with the fingers of the left hand (index finger, middle finger, ring finger, etc.) to change the position of the shaft 23, thereby changing the position of the affected part to be photographed. In this embodiment, the front end side shaft portion 23a of the shaft 23 can rotate relative to the base end side shaft portion 23b, and the treatment or surgical instrument 26 is fixedly mounted on the mounting device 25. Therefore, if the operator rotates the operating handle 26c of the treatment or surgical instrument 26 in the circumferential direction of the front end side shaft portion 23a, only the front end side shaft portion 23a is rotated independently in the circumferential direction relative to the base end side shaft portion 23b, so that the treatment or surgical instrument 26 can also be freely moved to any position in the circumferential direction of the longitudinal axis of the front end side shaft portion 23a (and the shaft 23). In addition, the operator can operate the treatment or surgical instrument 26 separately from the operation of the handle portion 24. For example, by holding the operating handle 26c with the thumb, index finger, and middle finger in the manner of holding chopsticks, or by moving the operating handle 26c with only the index finger, the treatment or surgical instrument 26 can be performed by suction, holding, pulling, peeling, excision, etc. using the front end portion 26a of the treatment or surgical instrument 26. Furthermore, the operator can perform treatment by operating a second treatment or surgical instrument different from the treatment or surgical instrument 26 with the right hand, separate from the operation with the left hand. When the treatment of the patient is completed, the operator directly pulls the endoscope assembly 20 back toward the base end while holding the handle 24 between the thumb and index finger, and removes the endoscope assembly 20 from the body cavity of the subject.

[0041] The effects of the endoscope assembly 20 for assisting the operation of the treatment or surgical instrument according to the second embodiment described above will be described. The operator can operate the endoscope and the treatment or surgical instrument with the same hand. · The hand holding the endoscope can be used to operate the treatment or surgical instruments, and the other hand can be used to operate other treatment or surgical instruments, so the operator can operate with both hands. It is possible to use both hands to operate suction, grasping, pulling, peeling, cutting and other techniques. Alternatively, other operations can also be performed with both hands.

[0042] The shaft 23 is composed of two components, the distal shaft portion 23a and the proximal shaft portion 23b, and the mounting tool 25 is fixedly mounted on the distal shaft portion 23. Therefore, if the operator rotates the operating handle 26c of the treatment or surgical instrument 26 in the circumferential direction of the distal shaft portion 23a, the treatment or surgical instrument 26 can be freely moved to any position in the circumferential direction of the longitudinal axis of the distal shaft portion 23a (and the shaft 23). The treatment or surgical instrument 26 is designed so that a fine surgical operation can be easily performed by operating the operating handle portion 26 c at hand and the leverage ratio of the front end of the treatment or surgical instrument 26 .

[0043] The endoscope assembly 20 for assisting the operation of the surgical instrument according to the second embodiment described above can be modified as follows. A water flow mechanism for flowing water from the base end toward the tip of the distal shaft portion 23a may be provided in the annular cross-section portion between the distal shaft portion 23a and the cylindrical region inside the distal shaft portion 23a that accommodates the lens and the optical fiber.

[0044] (Third Embodiment) Next, an endoscope assembly 30 for assisting the operation of a treatment or surgical instrument according to a third embodiment of the present invention will be described. The description of the components corresponding to those of the first embodiment of the present invention will be omitted.

[0045] Figure 8 This is a stereoscopic view of an endoscope assembly 30 for assisting the operation of a treatment or surgical instrument according to a third embodiment. The endoscope assembly 30 includes a CMOS image sensor 31 constituting a photographing element and a substantially cylindrical shaft 33, wherein the shaft 33 includes a hollow and substantially cylindrical front end shaft portion 33a for accommodating the CMOS image sensor 31, and a base end shaft portion 33b. The front end shaft portion 33a and the base end shaft portion 33b are connected by a flexible connecting member 33c therebetween, and the front end shaft portion 33a can rotate relative to the base end shaft portion 33b. The base ends and distal ends of the front end shaft portion 33a and the base end shaft portion 33b are respectively sealed to prevent water from intruding into the front end shaft portion 33a and the base end shaft portion 33b.

[0046] Inside the shaft 33, an optical fiber (not shown) extends along the length direction of the shaft 33, and the optical fiber (not shown) optically connected to the light source (not shown) guides the illumination light from the light source (not shown) such as LED from the base end to the front end to irradiate the subject. The structure of the optical system of such an endoscope is well known.

[0047] An objective lens (not shown) is built into the front end of the shaft 33, and light from the subject passes through the translucent front end of the shaft portion 33a on the front end side of the shaft 33 and passes through the objective lens (not shown), and is imaged by the CMOS image sensor 31. The image of the subject captured by the CMOS image sensor 31 is transmitted to the signal cable 32 and signal processing is performed. The signal cable 32 is connected to a computer, and the image of the subject can be observed through a display device connected to the computer.

[0048] The endoscope assembly 30 also includes a handle portion 34 extending from the shaft 33 (and the base end side shaft portion 33b). Specifically, the handle portion 34 exceeds the diameter of the shaft 33 (and the base end side shaft portion 33b) and extends radially outward from the shaft 33 (and the base end side shaft portion 33b), and extends beyond the base end of the shaft 33 (and the base end side shaft portion 33b). The handle portion 34 includes two protrusions 34a, 34b having curved surfaces, and a recess 34c is formed between the two protrusions 34a, 34b. In addition, a substantially cylindrical hole 34d is provided at the front end of the handle portion 34, and the base end portion of the base end side shaft portion 33b is embedded in the hole 34d. Except for the joint with the shaft 33, the handle portion 34 has a continuous curved surface, forming a shape that better fits the operator's hand and reduces the operator's fatigue by utilizing ergonomic design. Specifically, as Fig. 9 As shown, when using the endoscope assembly 30, the operator's hand 6 is used to pinch the handle portion 34, and protrusions 34a and 34b are arranged on both sides of the interdigital web between the thumb and the index finger. The handle portion 34 is held in a manner such that the surface of the recess 34c between the two protrusions 34a and 34b contacts the interdigital web.

[0049] The materials constituting the shaft 33 (i.e., the front end side shaft portion 33a, the base end side shaft portion 33b, and the connecting member 33c) and the handle portion 34 are not limited, and may be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that synthetic resins include thermoplastic resins, thermosetting resins, elastomers, and rubbers. For example, the shaft 33 and the handle portion 34 may be molded products of synthetic resins, respectively. The connection between the shaft 33 and the handle portion 34 can be performed by any fixed connection method such as bonding with an adhesive, welding, etc.

[0050] The endoscope assembly 30 further includes a mounting device 35 for a treatment or surgical instrument 36 mounted on the distal end shaft portion 33a of the shaft 33. In the present embodiment, the mounting device 35 includes: a first ring 35a that surrounds the periphery of the long portion 36a of the treatment or surgical instrument 36 at a predetermined position along the length direction of the long portion 36a; and a second ring 35b that is connected to the first ring 35a and surrounds the periphery of the distal end shaft portion 33a at a predetermined position along the length direction of the distal end shaft portion 33a. The first ring 35a of the mounting device 35 holds the treatment or surgical instrument 36, and the second ring 35b is fixedly mounted on the distal end shaft 33a of the shaft 33.

[0051] Even if the treatment or surgical instrument 36 is constrained by the first ring 35a, it has a movable area for the tip of the treatment or surgical instrument 36 to make a circle in a small range. The material constituting the mounting tool 35 is not limited, and may be metal, synthetic resin, or a composite material including at least one of them. It should be noted that the synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber.

[0052] The treatment or surgical instrument 36 has a long strip portion 36a and an operating handle 36b mounted on the base end of the long strip portion 36a. The long strip portion 36a is formed of a flexible material and can be bent. The diameter of the operating handle 36b is larger than that of the long strip portion 36b so that the operator can easily hold it. In the present embodiment, the operating handle 36b is formed into a plate-like shape of an inverted triangle after the corners of the wide surface are rounded so that the operator can easily hold it with three fingers, but the operating handle 36b can also be any other shape that is easy for the operator to hold with three fingers, such as a plate-like shape with a wide surface that is roughly semicircular. The material constituting the operating handle 36b is not limited, and can be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that synthetic resins include thermoplastic resins, thermosetting resins, elastomers, and rubber.

[0053] The mounting tool 35 is located closer to the front end side of the shaft 33 (and the front end side shaft part 33a) than the handle part 34. In addition, it is preferable that the handle part 34 extends radially outward from a position different from the mounting tool 35 in the circumferential direction of the shaft 33, specifically, from a position approximately 180° from the mounting tool 35 in the circumferential direction, so that when the operator operates the treatment or surgical tool 36, the handle part 34 does not interfere with the movable area of ​​the treatment or surgical tool 36.

[0054] And, if Fig. 9As shown, the endoscope assembly 30 is provided with a rope-shaped traction member 38. The front end of the traction member 38 is fixedly mounted on the front end side shaft portion 33a, and the base end extends outward from the base end side shaft portion 33b, and the terminal is formed at a position closer to the base end than the base end of the base end side shaft portion 33b. The traction member 38 is, for example, a wire. A part of the traction member 38 passes through the outside or inner cavity of each of the front end side shaft portion 33a and the base end side shaft portion 33b. The traction member 38 may pass through the outer side of the front end side shaft portion 33a and the outer side of the base end side shaft portion 33b and extend, may pass through the inner cavity of the front end side shaft portion 33a and the outer side of the base end side shaft portion 33b and extend, may pass through the outer side of the front end side shaft portion 33a and the inner cavity of the base end side shaft portion 33b and extend, may pass through the inner cavity of the front end side shaft portion 33a and the inner cavity of the base end side shaft portion 33b and extend, may pass through the inner cavity of the front end side shaft portion 33a and the inner cavity of the base end side shaft portion 33b and extend.

[0055] The size of each component of the endoscope assembly 30 can be appropriately selected according to the purpose. For example, in the case of endoscopic surgery through the external auditory canal, the inner diameter of the shaft is as small as possible, for example, 2.7 mm or less. The length of the portion of the treatment or surgical instrument 36 that is closer to the front end than the portion mounted on the mounting instrument 35 is preferably about 5 mm to about 15 mm. The distance L3 from the front end of the front end side shaft portion 33a to the front end of the treatment or surgical instrument 36 is preferably about 5 mm to about 15 mm.

[0056] The length of the portion of the treatment or surgical instrument 36 closer to the proximal end than the portion mounted on the mounting instrument 35 is preferably about 70 mm to about 100 mm. The length from the distal end of the distal shaft portion 33a to the position of the proximal shaft 33b where the handle portion 34 is mounted is preferably about 50 mm to about 60 mm. The length of the handle portion 34 is preferably about 40 mm to 50 mm.

[0057] like Fig. 9 As shown, the length L4 of the external auditory canal is about 25 mm to 30 mm, the diameter L5 of the external auditory canal is 5 mm to 9 mm, the length L6 is 5 mm to 8 mm, and the length L7 is 5 mm to 10 mm. When the endoscope assembly 30 is used for endoscopic surgery of the auditory canal, the endoscope assembly 30 only needs to be designed in a manner suitable for the anatomical structure.

[0058] Next, the operation of the endoscope assembly 30 is described. First, the treatment or surgical instrument 36 is fixedly mounted on the mounting device 35 in advance. Then, the operator grasps the base end of the shaft 33 of the endoscope assembly 30 and the operating handle 36b of the treatment or surgical instrument 36, and inserts the treatment or surgical instrument 36 and the shaft 33 from the front end into the body cavity of the subject. In the case where the operator wants to change the position of the affected part to be photographed, the operator operates the handle portion 34 with the fingers of the left hand (index finger, middle finger, ring finger, etc.), and by changing the position of the shaft 33, the position of the affected part to be photographed can be changed. Since the treatment or surgical instrument 36 is fixedly mounted on the mounting device 35, if the operator rotates the operating handle 36b of the treatment or surgical instrument 36 in the circumferential direction of the longitudinal axis of the front end side shaft portion 33a, the treatment or surgical instrument 26 can be moved in the circumferential direction of the longitudinal axis of the front end side shaft portion 33a (and the shaft 33). In addition, by pulling the traction member 38 back toward the base end in the direction of the arrow, the distal end shaft portion 33a is bent relative to the base end shaft portion 33b at an angle θ. If the distal end shaft portion 33a is in a straight line relative to the base end shaft portion 33b, and the unbent state is set to an angle θ=0°, θ can be within a range of 0° to 120°.

[0059] In addition, the operator can operate the treatment or surgical instrument 36 separately from the operation of the handle portion 34. For example, by holding the operation handle 36b with the thumb, index finger, and middle finger in the manner of holding chopsticks, or by moving the operation handle 36b with only the index finger, the front end of the treatment or surgical instrument 33 can be used for suction, holding, pulling, peeling, excision, and other treatments. In addition, the operator can use the right hand to operate a treatment or surgical instrument different from the treatment or surgical instrument 36 to perform treatment, separately from the operation with the left hand. When the treatment of the patient is completed, the operator pulls the endoscope assembly 30 back in the proximal direction while holding the handle portion 34 between the thumb and index finger, and removes the endoscope assembly 30 from the body cavity of the subject.

[0060] The effects of the endoscope assembly 30 for assisting the operation of the treatment or surgical instrument according to the third embodiment will be described. The operator can operate the endoscope and the treatment or surgical instrument with the same hand. · The hand holding the endoscope can be used to operate the treatment or surgical instruments, and the other hand can be used to operate other treatment or surgical instruments, so the operator can operate with both hands. It is possible to use both hands to operate suction, grasping, pulling, peeling, cutting and other techniques. Alternatively, other operations can also be performed with both hands. The shaft 33 is composed of three components, namely, a distal shaft portion 33a, a proximal shaft portion 33b, and a flexible connecting member 33c, and the mounting tool 35 is fixedly mounted on the distal shaft portion 33a. Therefore, if the operator rotates the operating handle 36b of the treatment or surgical tool 36 in the circumferential direction of the distal shaft portion 33a, the treatment or surgical tool 36 can be freely moved in the circumferential direction of the longitudinal axis of the distal shaft portion 33a (and the shaft 33). The endoscope assembly 30 includes a traction member 38, the base end of which is fixedly mounted on the front end shaft portion 33a, and the tip of which extends outward from the base end shaft portion 33b. Therefore, by pulling the traction member 38 back toward the base end in the direction of the arrow, the front end shaft portion 33a can be bent at an angle θ relative to the base end shaft portion 33b. The treatment or surgical instrument 36 is designed so that a fine surgical operation can be easily performed by operating the operating handle portion 36 b at hand and the leverage ratio of the front end of the treatment or surgical instrument 36 .

[0061] The endoscope assembly 30 for assisting the operation of the treatment or surgical instrument of the third embodiment described above can be modified as follows. ·like Fig.10 As shown, the hole 34d extends deeper in the handle portion 34, so that the base end of the base end side shaft portion 33b can move forward and backward in the hole 34d along the axial direction of the hole 34d. According to this structure, the length of the base end shaft portion 33b protruding from the handle portion 34 can be adjusted, and the length of the shaft 33 can be adjusted, and the shaft 33 can be rotated relative to the handle portion 34, so that the relative rotation angle of the handle and the shaft can be adjusted. Furthermore, by providing a fixing member 39 for fixing the position of the base end shaft portion 33b in the handle portion 34, the position of the base end shaft portion 33b relative to the handle portion 34 can be fixed at a desired position. The fixing member 39 is Fig.10 The handle 34 is disposed at the distal end of the handle 34 and can move forward and backward along the axial direction of the hole 34d (i.e., the distal end direction and the proximal end direction). Fig.11 As shown, the fixing member 39 has: an operating portion 39a, which is exposed on the handle portion 34; a limiting portion 39b, which extends in the hole 34d; and a connecting portion 39c, which passes through a hole (not shown) provided in the handle portion 34 and is connected to the operating portion 39a and the limiting portion 39b, and the cross-section of the limiting portion 39b is larger at the distal end side than at the base end side of the limiting portion 39b. Therefore, when the fixing member 39 is moved in the distal end direction, the limiting portion 39b of the fixing member 39 contacts the base end shaft portion 33b and limits the axial movement of the base end shaft portion 33b along the hole 34d. Thus, the position of the base end shaft portion 33b relative to the handle portion 34 can be fixed. When the fixing member 39 is moved in the base end direction, the limiting portion 39b of the fixing member 39 leaves the base end shaft portion 33b, and the base end shaft portion 33b is released from the restriction.

[0062] ·Apart from Fig.10 , Fig.11 In addition to the embodiment of the fixing member 39 shown in the figure, one or more protrusions may be provided on the portion of the handle portion 34 that contacts the base end shaft portion 33b (e.g., the wall surface that defines and forms the hole 34d), and one or more recesses may be provided on the outer peripheral surface of the base end shaft portion 33b along the base end shaft portion 33b, and the position of the base end shaft portion 33b relative to the handle portion 34 may be fixed at a desired position by fitting the protrusions and the recesses. The structure of the fixing member is not limited as long as the axial movement of the base end shaft portion 33b along the hole 34d can be restricted. In the third embodiment, the treatment or surgical instrument 36 is exemplified as the treatment or surgical instrument, but other treatment or surgical instruments as described in the first embodiment may be used.

[0063] (Fourth Embodiment) Next, an endoscope assembly 40 for assisting the operation of a treatment or surgical instrument according to a fourth embodiment of the present invention will be described. The description of components corresponding to the second embodiment or the third embodiment of the present invention will be omitted.

[0064] Fig.12 This is a stereoscopic view of an endoscope assembly 40 for assisting the operation of a treatment or surgical instrument according to a fourth embodiment. The endoscope assembly 40 includes a CMOS image sensor 41 constituting a photographing element and a substantially cylindrical shaft 43, wherein the shaft 43 includes a hollow and substantially cylindrical front end shaft portion 43a for accommodating the CMOS image sensor 41, and a base end shaft portion 43b. The front end shaft portion 43a and the base end shaft portion 43b are connected by a flexible connecting member 43c therebetween, and the front end shaft portion 43a and the base end shaft portion 43b are relatively rotatable. In this embodiment, the flexible connecting member 43c is a silicon tube. The image of the subject photographed by the CMOS image sensor 41 is transmitted to a signal cable 42 connected to the CMOS image sensor 41 and signal processing is performed. The signal cable 42 is connected to a computer, and the image of the subject can be observed through a display device connected to the computer.

[0065] The endoscope assembly 40 further includes a handle portion 44 extending from the shaft 43. Specifically, the handle portion 44 exceeds the diameter of the base end side shaft portion 43b of the shaft 43 and extends radially outward from the base end side shaft portion 43b. Fig.13As shown, a generally cylindrical member 47 is provided on a portion of the outer peripheral surface of the base end side shaft portion 43b arranged around the CMOS image sensor 41 in the longitudinal direction, and a handle portion 44 is provided on a portion of the outer peripheral surface of the generally cylindrical member 47 in the longitudinal direction. The length of the handle portion 44 is shorter than that of the base end side shaft portion 43b, and the handle portion 44 is located between the two ends of the base end side shaft portion 43b in the longitudinal direction. The generally cylindrical member 47 can rotate in the circumferential direction around the axis center and can rotate relative to the base end side shaft portion 43b. The base end side shaft portion 43b and the handle portion 44 are fixed to each other. As shown in FIG. Fig.12 As shown, the distance L8 from the front end side shaft portion 43a to the substantially cylindrical member 47 can be appropriately changed according to the purpose, for example, in the case of an ear endoscope surgery through the external auditory canal, it is about 40 mm to 80 mm. The length L9 of the handle can also be appropriately changed according to the purpose, for example, in the case of an ear endoscope surgery through the external auditory canal, it is about 100 mm to 200 mm.

[0066] The handle portion 44 in the present embodiment is substantially cylindrical, has a substantially constant cross-sectional area from one end to the other end in the longitudinal direction, and has a compact shape that is unlikely to interfere with the performance of surgery. The material constituting the shaft 43 and the handle portion 44 is not limited, and may be metal, synthetic resin, or a composite material including at least any one of them. It should be noted that synthetic resins include thermoplastic resins, thermosetting resins, elastomers, and rubbers. For example, the shaft 43 and the handle portion 44 may be molded products of synthetic resins, respectively. The shaft 43 and the handle portion 44 may be joined by any fixed joining method such as bonding with an adhesive or welding.

[0067] The endoscope assembly 40 also includes a mounting device 45, which is indirectly mounted on the front end side shaft portion 43a of the shaft 43 via a roughly cylindrical member 47, and is used to mount a treatment or surgical instrument 46. The mounting device 45 includes: a first fixing portion 45a, which is used to fix the mounting device 45 to the treatment or surgical instrument 46; a second fixing portion 45b, which is used to fix the mounting device 45 to the side of the roughly cylindrical member 47; and a connecting portion 45c, which connects the first fixing portion 45a and the second fixing portion 45b. The connecting portion 45c is shown as a torsion spring in this embodiment, but it can also be a leaf spring or any elastic member that can be deformed by applying force. One end of the connecting portion 45c is clamped between the first fixing portion 45a and the long strip portion 46b of the treatment or surgical instrument 46, and the other end of the connecting portion 45c is clamped between the second fixing portion 45b and the roughly cylindrical member 47, forming a roughly V-shape. The angle θ of the V-shape can be changed by moving the position of the treatment or surgical instrument 46 relative to the handle portion 44. For example, in a state where no force is applied, θ takes an angle of about 30 degrees, but the angle can be reduced by bringing the treatment or surgical instrument 46 closer to the handle portion 44. The mounting device 45 is located at a position closer to the front end side of the shaft 43 than the handle portion 44. At a position closer to the base end side than the position where the mounting device 45 is mounted in the treatment or surgical instrument 46, a cylindrical member 50 for fixing the treatment or surgical instrument 46 at a position closer to the base end side than the mounting device 45 is arranged in a manner fixed to the elongated portion 46b or the first fixing portion 45a of the treatment or surgical instrument 46 so that the treatment or surgical instrument 46 can be inserted into the opening of the cylindrical member 50. When the cylindrical member 50 is fixed to the elongated portion 46b of the treatment or surgical instrument 46, the cylindrical member 50 may be detachable or slidable relative to the elongated portion 46b and may be fixed at any position in the longitudinal direction of the elongated portion 46b.

[0068] The treatment or surgical instrument 46 has a front end 46a, a strip portion 46b extending continuously from the front end 46a at an angle to the front end 46a, and an operating handle 46c mounted on the strip portion 46b at the base end side of the strip portion 46b. The diameter of the operating handle 46c is larger than that of the strip portion 46b so that the operator can hold it easily. The material constituting the operating handle 46c is not limited, and can be metal, synthetic resin, a composite material including at least any one of them, etc. It should be noted that synthetic resin includes thermoplastic resin, thermosetting resin, elastomer, and rubber. In this embodiment, the treatment or surgical instrument 46 is connected to the approximately cylindrical member 47 via the mounting device 45, so that when the approximately cylindrical member 47 is rotated, the position of the treatment or surgical instrument 46 can be rotated around the axis of the approximately cylindrical member 47 (which can also be the axis of the axis 43) without rotating the base end side shaft portion 43b of the shaft 43.

[0069] And, if Fig.13 As shown in FIG. 1 , the endoscope assembly 40 includes a rope-shaped pulling member 48. In the present embodiment, the front end of the pulling member 48 is fixedly mounted on the front end side shaft portion 43a, passes between the CMOS image sensor 41 and the front end side shaft portion 43a, and between the CMOS image sensor 41 and the base end side shaft portion 43b, and extends outward from the base end side shaft portion 43b at a position closer to the base end than the base end of the substantially cylindrical member 47 through a hole or a slit provided on the side surface of the base end side shaft portion 43b. The pulling member 48 is, for example, a wire. The front end of the pulling member 48 is fixed to the front end side shaft portion 43a, and the pulling member 48 passes through the inner cavity of the front end side shaft portion 43a and the inner cavity of the base end side shaft portion 43b and extends, and the base end of the pulling member 48 forms a terminal end inside the handle portion 44. It should be noted that the pulling member 48 may also pass through the outside of the front end side shaft portion 43a, the base end side shaft portion 43b, and the outside of the substantially cylindrical member 47 and extend. It can extend through the inner cavity of the distal end shaft portion 43a, the outer side of the proximal end shaft portion 43b, and the inner cavity or outer side of the substantially cylindrical member 47, or it can extend through the outer side of the distal end shaft portion 43a and the inner cavity of the proximal end shaft portion 43b.

[0070] A slidable grip 49 extends through the handle 44 from the outside of the handle 44 to the inside of the handle 44 in a manner that allows the traction member 48 to be selectively delivered or retracted. The grip 49 can also be called a pull ring or a handle, and can be in any shape such as a column or a disk. The grip 49 can be slidable along the length direction ( Fig.13The base end of the traction member 48 is fixed to the gripping portion 49. When the gripping portion 49 is moved toward the front end of the handle portion 44, the traction member 48 is sent out from the handle portion 44, and the front end side shaft portion 43a can be further moved toward the front end side. If the gripping portion 49 is moved toward the base end of the handle portion 44, the traction member 48 is pulled back into the handle portion 44, and the front end side shaft portion 43a can be further pulled back toward the base end side. It should be noted that the mechanism for selectively sending out or pulling back the traction member 48 by operating the handle portion 44 from the outside is not limited to the sliding gripping portion 49, and various structures such as a member or device for winding the traction member 48 can be adopted.

[0071] Next, the operation of the endoscope assembly 40 is described. First, the treatment or surgical instrument 46 is fixedly mounted on the mounting device 45 in advance. In this embodiment, since the first fixing portion 45a is substantially cylindrical, the treatment or surgical instrument 46 can be inserted and / or removed from the opening of the first fixing portion 45a. Therefore, the treatment or surgical instrument 46 mounted on the mounting device 45 can be replaced.

[0072] Next, the operator holds the handle portion 44 of the endoscope assembly 40 and the operating handle 46c of the treatment or surgical instrument 46, and inserts the treatment or surgical instrument 46 and the shaft 43 from the front end into the body cavity of the subject. When the operator wants to change the position of the affected part to be photographed, the operator holds the holding portion 49 with one hand's fingers (index finger, middle finger, ring finger, etc.) in the manner of holding chopsticks, and changes the position of the shaft 43, thereby changing the position of the affected part to be photographed. The treatment or surgical instrument 46 and the substantially cylindrical member 47 are fixedly mounted relative to the mounting device 45, and the operator can rotate the operating handle 46c of the treatment or surgical instrument 46 in the circumferential direction of the longitudinal axis of the substantially cylindrical member 47, and move the treatment or surgical instrument 46 in the circumferential direction of the longitudinal axis of the substantially cylindrical member 47. In addition, by pulling back the traction member 48 by the operation of the winding mechanism 49, the front end side shaft portion 43a can be bent at an angle relative to the base end side shaft portion 43b.

[0073] In addition, the operator can operate the treatment or surgical instrument 46 separately from the operation of the handle portion 44. For example, by operating the operating handle 46c, the front end of the treatment or surgical instrument 46 can be used for suction, grasping, pulling, peeling, excision, and other treatments. In addition, the operator can use the right hand to operate a treatment or surgical instrument different from the treatment or surgical instrument 46 to perform treatment, separately from the operation with the left hand. When the treatment of the patient is completed, the operator pulls the endoscope assembly 40 back in the proximal direction while holding the handle portion 44 between the thumb and the index finger, and removes the endoscope assembly 40 from the body cavity of the subject.

[0074] The effects of the endoscope assembly 40 for assisting the operation of the treatment or surgical instrument according to the fourth embodiment will be described. The operator can operate the endoscope and the treatment or surgical instrument with the same hand. · The hand holding the endoscope can be used to operate the treatment or surgical instruments, and the other hand can be used to operate other treatment or surgical instruments, so the operator can operate with both hands. It is possible to use both hands to operate suction, grasping, pulling, peeling, cutting and other techniques. Alternatively, other operations can also be performed with both hands. Since the attachment tool 45 uses an elastic member, the elastic member is biased by the operation of the treatment or surgical tool 46 , thereby making it possible to change the position of the treatment or surgical tool 46 relative to the handle portion 44 .

[0075] The mounting tool 45 is fixedly mounted on the substantially cylindrical member 47. Therefore, if the operator rotates the operating handle 46c of the treatment or surgical tool 46 in the circumferential direction of the substantially cylindrical member 47, the treatment or surgical tool 46 can be freely moved in the circumferential direction of the longitudinal axis of the substantially cylindrical member 47 (and the shaft 43) without rotating the base end side shaft portion 43b of the shaft 43. The endoscope assembly 40 includes a traction member 48, the front end of which is fixedly mounted on the front end side shaft portion 43a, and the base end of which is terminated in a slidably movable gripping portion 49. Therefore, by moving the gripping portion 49 to pull the traction member 48 back toward the base end, the front end side shaft portion 43a can be bent at an angle relative to the base end side shaft portion 33b.

[0076] In addition, although the present invention has been described with reference to the first to fourth embodiments, for example, components in a certain embodiment can also be applied to other embodiments.

[0077] For example, the attachment device 35 including the first ring 35a and the second ring 35b of the third embodiment may be used in the second embodiment to surround the elongated portion 26b of the treatment or surgical instrument 26 and the distal end shaft portion 23a.

[0078] For example, you can also Fig.10 The hole 34a of the handle portion 34 shown, the base end side shaft portion 33b that can move in the hole 34a, and even the fixing member 39 are applied to the endoscope assembly 20 of the second embodiment. That is, by making the base end shaft 23b movable in the hole provided in the handle portion 24 and making the base end shaft 23b and even the shaft 23 slide relative to the handle portion 24, the distance between the handle portion 24 and the front end of the shaft 23 can also be adjusted. Example

[0079] Example 1. Example of superior semicircular canal occlusion via mastoid antrum To determine whether the endoscope components used to assist in the operation of treatment or surgical instruments are effective in improving the operability of the surgery, a model surgery similar to the superior semicircular canal occlusion via mastoid sinus was performed using a temporal bone model. Figure 2 (A) Fig.14 (A) Fig.14 In the surgical technique of the prototype endoscope of (B)) and the fourth embodiment of the present invention, the autologous tissue (simulated by blue silicone putty) was guided, and the time until the superior semicircular canal was closed was measured and compared respectively (Table 1, Table 2). The temporal bone model used in this experiment was the facial bone made by PHACON GmbH, Schmidt's left ear (NB503).

[0080] Experimental methods The mastoid was cut open in advance on the temporal bone model, the superior semicircular canal was opened from the inner side, and water was stored in the mastoid cavity. In the following two cases, simulated surgery was performed to evaluate the endoscope assembly for treatment or operation assistance of surgical instruments. (1) One-hand surgery. Hold the endoscope in your left hand and the 3 / 8 arc needle (corresponding to Japanese: weakly curved needle) in your right hand. Attach a small piece of silicone putty to the front end and guide it to the upper half of the prescribed tube, so that the open cavity is closed at the front and rear ends. Figure 2 (A) Fig.14 (A), (B)). (2) Hold the prototype endoscope of the fourth embodiment of the present invention with the left hand, operate the surgical instrument 46 with the left fingers, and operate it together with the 3 / 8 arc needle held with the right hand to make the small piece of silicone putty adhere and guide it to the upper semicircular canal, so that the open cavity is closed at the front and rear ends ( Fig.15 (A), (B)).

[0081] The results are shown in Tables 1 and 2. In the method (2) of the trial endoscope using the fourth embodiment, the surgical instrument 46 presses the small piece of silicone putty to prevent the small piece of silicone putty from adhering to the 3 / 8 arc needle and hindering the guidance, so that the coordinated guidance becomes easy and the operation time is significantly shortened. The average time when the endoscope assembly of the embodiment is used is 56.542 seconds (standard deviation 8.59), and the average time when operated with one hand is 84.164 seconds (standard deviation 15.0). (P=0.007, Student's t-test)

[0082] [Table 1] Table 1. Cases of using chopstick-shaped endoscopes [Table 2] Table 2. Conditions of one - hand surgery (Industrial applicability)

[0083] The endoscope assembly of the present invention can be used in various surgeries using an endoscope. Although otoscopic surgery via the external auditory canal (including middle ear endoscopy in water via the mastoid antrum) is mainly envisioned, if there are sufficient conditions such as the diameter of the external auditory canal, it can also be adapted to otoscopic surgery via the external auditory canal. For example, it is easy to perform stapedectomy, stapedial prosthesis in tympanoplasty, and columella nasi (corresponding to "コ少メラ" in Japanese) placement. Also, in the endoscope assemblies of the second and third embodiments, the shafts 23 and 33 are variably bendable, so it can also handle the removal of cholesteatomas developing in the direction of the epitympanum or mastoid antrum. In addition, it is applicable to the overall inner ear surgery under water endoscopy (semicircular canal fistula, superior semicircular canal dehiscence syndrome, cochlear implant, DDS, etc.).

[0084] In addition, the endoscope assembly of the present invention is not only applied to otological surgery, but also to nasal and paranasal sinus endoscopy, anterior skull base surgery under nasal endoscopy, pharyngeal and laryngeal endoscopy, cranial neurosurgical endoscopy, gynecological and obstetric endoscopy, arthroscopic surgery, cystoscopic surgery, and so - called keyhole surgery in veterinary endoscopic surgery. An improvement in its operability and safety can be expected. (Explanation of reference numerals)

[0085] 10, 20, 30, 40... Endoscope assemblies; 11... CMOS image sensor as a photographing element, 13, 23, 33, 43... Shafts; 14, 24, 34, 44... Handle parts; 15, 25, 35, 45... Mounting devices; 16, 26, 36, 46... Disposal or surgical instruments; 21... CCD camera as a photographing element; 16d, 26c, 36b... Operating handles; 23a, 33a, 43a... Front - end side shaft parts; 23b, 33b, 43b... Base - end side shaft parts; 33c, 43b... Connecting members; 38, 48... Traction members; 39... Fixing member; 47... Substantially cylindrical member; 49... Gripping part.

Claims

1. An endoscope assembly for assisting the operation of a treatment or surgical instrument, the endoscope assembly comprising: an imaging element; and a shaft that accommodates the imaging element or is connected to the imaging element, The endoscope assembly comprises: a handle portion extending from the shaft; and A mounting device for a treatment or surgical instrument, wherein the mounting device is mounted on the shaft.

2. The endoscope assembly according to claim 1, in, The attachment tool is located closer to the front end side of the shaft than the handle portion.

3. The endoscope assembly according to claim 1, in, The mounting tool is mounted with a treatment or surgical tool.

4. The endoscope assembly according to claim 3, in, The treatment or surgical instrument is a rod-shaped instrument having an operating handle.

5. The endoscope assembly according to any one of claims 1 to 4, in, The shaft includes a distal shaft portion and a proximal shaft portion, and the distal shaft portion is rotatable relative to the proximal shaft portion.

6. The endoscope assembly according to claim 5, in, The distal end side shaft portion and the proximal end side shaft portion are connected by a flexible connection member.

7. The endoscope assembly according to claim 5, in, The endoscope assembly further includes a pulling member, the base end of which is fixedly mounted on the front end side shaft portion, and the tip of which extends outward from the base end side shaft portion. By pulling the pulling member back toward the base end, the distal end side shaft portion is bent.

8. The endoscope assembly according to any one of claims 1 to 4, in, The shaft includes a distal shaft portion, a proximal shaft portion, and a substantially cylindrical member, the substantially cylindrical member being attached to an outer peripheral surface of the proximal shaft portion and being rotatable relative to the proximal shaft portion. The attachment device of the treatment or surgical instrument is attached to the substantially cylindrical member.

9. The endoscope assembly according to any one of claims 1 to 4, in, The shaft includes a distal end shaft portion and a proximal end shaft portion. The handle portion is mounted on the outer periphery of the base end side shaft portion along a portion of the length direction of the base end side shaft portion. The endoscope assembly comprises: A traction member, the base end of which is fixedly mounted on the front end shaft portion, extends through the outer sides or inner cavities of the front end shaft portion and the base end shaft portion, and forms a terminal end at a position closer to the base end than the base end shaft portion; as well as A mechanism for selectively sending out or pulling back the pulling member extends through the handle portion from the outside of the handle portion to the inside of the handle portion.

10. The endoscope assembly according to any one of claims 1 to 4, in, The imaging element is accommodated in the shaft.

11. The endoscope assembly according to any one of claims 1 to 4, in, The imaging element is connected to the base end of the shaft.

12. A device for assisting the operation of a treatment or surgical instrument, used in connection with an endoscope having a photographing device, The operation assisting device includes a shaft that allows the front end to pass through and allows the imaging device to capture an image of the subject. The shaft has: a handle portion extending from the shaft; and A mounting device for a treatment or surgical instrument, wherein the mounting device is mounted on the shaft.

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