Pliers and pliers system

Abstract

Provided is a pair of forceps that can be easily used integrally with an endoscope. The forceps (1) are provided with: a forceps insertion section (21); and a treatment part (41) that is disposed inside the forceps insertion part (21), protrudes further toward the distal end than the forceps insertion part (21), and performs a predetermined treatment, the forceps insertion part (21) having: a large-diameter cylindrical part (22) in which a base end-side portion of the treatment part (41) is disposed; and a small-diameter tube section (24) which is disposed inside the large-diameter tube section (22) and into which an endoscope insertion section (11) of the endoscope (10) for observing the outside can be inserted.

Description

Technical Field

[0001] The present disclosure relates to pliers and pliers systems. Background Art

[0002] Conventionally, forceps of various shapes and sizes are used for various purposes in medical fields (see, for example, Patent Document 1). In recent years, in order to reduce the burden on the patient's body, minimally invasive endoscopic and laparoscopic surgeries have gradually become the mainstream. In particular, in digestive tract surgery, the number of open laparotomies has been greatly reduced, and laparoscopic surgeries account for about 70%. Laparoscopic surgery is performed by opening multiple holes in the patient's abdomen to allow the camera (main endoscope) and forceps to pass through.

[0003] Laparoscopic surgery has many advantages over conventional open surgery, including fewer complications for patients after surgery, a smaller suture area, and significantly fewer days of hospitalization. In addition, doctors performing laparoscopic surgery do not need to lean forward for a long time to look into the open abdomen during surgery. Moreover, since the camera magnifies the affected part and displays it on the monitor, doctors can judge the condition of the affected part in detail without having to lean forward uncomfortably. Prior art literature Patent Literature

[0004] Patent Document 1: Japanese Patent Application Publication No. 2022-181850 Summary of the invention Problems to be solved by the invention

[0005] In laparoscopic surgery, there is a blind spot of the camera. In order to reduce this blind spot, studies have been conducted on using an endoscope (sub-endoscope) together with forceps used in laparoscopic surgery. However, it is difficult to use the forceps of Patent Document 1 integrally with an endoscope.

[0006] The present disclosure has been made in view of such problems, and an object of the present disclosure is to provide a forceps that can be easily used integrally with an endoscope and a forceps system including the forceps. Technical solutions to solve problems

[0007] In order to solve the above-mentioned problems, the present invention proposes the following technical solutions. (1) Mode 1 of the present disclosure is a forceps comprising: a forceps insertion portion; and a treatment portion, which is arranged in the forceps insertion portion and protrudes toward the top end side than the forceps insertion portion to perform a specified treatment, the forceps insertion portion having: a large diameter cylinder portion, in which a portion of the base end side of the treatment portion is arranged; and a small diameter cylinder portion, which is arranged in the large diameter cylinder portion and can be used for inserting an endoscope insertion portion of an endoscope for observing the outside, the treatment portion having two holding pieces that can be opened and closed to each other, the top ends of the two holding pieces open and close on a reference plane along the axis of the large diameter cylinder portion, and the opening of the top end of the small diameter cylinder portion is arranged as a whole on either side of the reference plane that is orthogonal to the reference plane.

[0008] In the present invention, for example, in laparoscopic surgery, the endoscope insertion portion of the endoscope is inserted into the small-diameter barrel portion of the forceps in advance. In this state, while observing the outside of the endoscope insertion portion, such as the tip side of the large-diameter barrel portion, using the endoscope insertion portion, the tip side of the large-diameter barrel portion is inserted into the abdomen of the patient. Then, the treatment portion performs a prescribed treatment. Since the endoscope insertion portion can be inserted into the small-diameter cylindrical portion, the endoscope insertion portion can be easily inserted into the forceps insertion portion, and the forceps and the endoscope can be easily used integrally. In addition, the endoscope insertion part is observed through the opening of the small diameter cylinder part and closer to the top end side than the large diameter cylinder part. And, when the prescribed treatment is performed by opening and closing the two holding pieces, the opening is arranged as a whole on either side of the reference plane orthogonal to the reference plane opened and closed by the top ends of the two holding pieces. Therefore, when the endoscope insertion part is observed through the opening, the top ends of the two holding pieces are less likely to hinder the observation.

[0009] (2) Aspect 2 of the present disclosure is the forceps according to (1), and may include an opening and closing restriction portion that restricts the opening and closing range of the two holding pieces. In the present disclosure, for example, the opening and closing restriction portion can prevent excessive force from acting on the two holding pieces that are opened and closed, thereby preventing the two holding pieces from being damaged.

[0010] (3) According to the pliers described in (1) or (2) in mode 3 of the present disclosure, the pliers insertion portion may have a fixing portion which is arranged at the middle portion of the large diameter cylinder portion in the axial direction of the large diameter cylinder portion to fix the position of the small diameter cylinder portion relative to the large diameter cylinder portion. In the present disclosure, the position of the small-diameter cylindrical portion relative to the large-diameter cylindrical portion at the middle portion in the axial direction, which is a portion with low strength, can be maintained by the fixing portion.

[0011] (4) According to the forceps described in any one of (1) to (3) of the present disclosure, the treatment portion may extend along a treatment axis along the large-diameter cylindrical portion and include a rotation operation portion that rotates the treatment portion around the treatment axis. In the present disclosure, by operating the rotation operation portion, for example, the direction around the treatment axis for a predetermined treatment by the treatment portion can be changed without changing the direction of the external field of view based on the endoscope insertion portion.

[0012] (5) Aspect 5 of the present disclosure is the forceps according to any one of (1) to (4), and may include a mounting portion to be mounted on an endoscope body of the endoscope. In the present disclosure, by attaching the endoscope body of the endoscope to the forceps using the attachment portion, an operator such as a physician can integrally operate the forceps and the endoscope body.

[0013] (6) Aspect 6 of the present disclosure is that the forceps according to any one of (1) to (5) may include a rotation restriction portion that restricts the direction of the endoscope insertion portion around the minor-diameter axis of the minor-diameter cylindrical portion. In the present disclosure, the rotation restricting portion can suppress the endoscope insertion portion from rotating about the minor-diameter axis and causing the direction of the external field of view of the endoscope insertion portion to change.

[0014] (7) According to mode 7 of the present disclosure, the forceps described in any one of (1) to (6) may also include an insertion limiting portion that limits the position of the endoscope insertion portion arranged in the small diameter cylinder in the direction of the small diameter axis of the small diameter cylinder. In the present disclosure, the insertion restriction portion can suppress a position change of the endoscope insertion portion relative to the small-diameter cylindrical portion in the direction of the minor-diameter axis.

[0015] (8) Aspect 8 of the present disclosure is a forceps system comprising: the forceps according to any one of (1) to (7); and the endoscope. In the present disclosure, a forceps system can be constructed using forceps that can be easily used integrally with an endoscope. Effects of the Invention

[0016] The forceps and the forceps system of the present disclosure can be easily used integrally with an endoscope. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] Figure 1 This is a side view showing a portion of the forceps system according to one embodiment of the present invention in section. Figure 2 yes Figure 1 A cross-sectional view taken along the cutting line A1-A1 in FIG. Figure 3 yes Figure 1 A2 view in the figure. Figure 4 It is a top view of the main parts of the pliers of the pliers system. Figure 5 The following is a diagram for explaining a technique for using the forceps system. Figure 6 It is a plan view of the main parts of the forceps system according to the first modified example of the one embodiment of the present invention. Figure 7 It is a cross-sectional view of a main part of a forceps system according to a third modified example of one embodiment of the present invention. DETAILED DESCRIPTION

[0018] Below, refer to Figures 1 to 7 An embodiment of the forceps and the forceps system according to the present invention will be described. like Figure 1 As shown, the forceps system 1 of the present embodiment includes a sub-endoscope (endoscope) 10 and a forceps 20 of the present embodiment. The sub-endoscope 10 includes an endoscope insertion portion 11, an endoscope body 16, and a display unit (not shown). Hereinafter, the endoscope insertion portion 11 side relative to the endoscope body 16 (the forceps insertion portion 21 side of the forceps 20 relative to the opening and closing operation portion 51 described later) is referred to as the distal end side. The endoscope body 16 side relative to the endoscope insertion portion 11 (the forceps 20 relative to the opening and closing operation portion 51 described later) is referred to as the proximal end side.

[0019] For example, the endoscope insertion portion 11 includes an overtube 12 , a light projecting portion 13 , and an imaging portion 14 . The outer tube 12 is formed in a tubular shape and has flexibility. The light projecting unit 13 and the imaging unit 14 are fixed inside the distal end portion of the outer tube 12 . The light projecting unit 13 has an LED (Light Emitting Diode) and the like (not shown). The light projecting unit 13 emits visible light toward the distal end. The light projecting unit 13 is connected to a power supply line (not shown). The power supply line extends toward the proximal end through the outer sleeve 12. A predetermined power is supplied to the light projecting unit 13 through the power supply line.

[0020] The imaging unit 14 has a light receiving element such as a CMOS (Complementary Metal-Oxide-Semiconductor) not shown in the figure. The imaging unit 14 converts the visible light reflected by the observation object such as the patient's tissue into an image. The imaging unit 14 converts the image into a signal. The imaging unit 14 is connected to a signal line (not shown). The signal line extends toward the base end side through the outer tube 12. The imaging unit 14 sends a signal through the signal line. As described above, the endoscope insertion portion 11 is a device for observing the outside of the endoscope insertion portion 11 , such as the distal end side of the endoscope insertion portion 11 .

[0021] The endoscope body 16 is connected to the base end of the outer tube 12. A power supply line and a signal line are connected to the endoscope body 16. For example, the endoscope body 16 supplies a predetermined power to the power supply line and receives a signal sent from the imaging unit 14 from the signal line. The endoscope body 16 appropriately processes the received signal for the display unit. The display unit has a liquid crystal panel, and is connected to the endoscope body 16. The display unit displays an image based on a signal processed appropriately. Next, the forceps 20 will be described.

[0022] The forceps 20 includes a forceps insertion portion 21, a treatment portion 41, an opening and closing operation portion 51, an opening and closing restriction portion 56, and a rotation operation portion 61. Figure 1 and Figure 2 As shown, the forceps insertion portion 21 includes a large-diameter cylinder portion 22 , a fixing portion 23 , a first small-diameter cylinder portion (small-diameter cylinder portion) 24 , a second small-diameter cylinder portion 25 , and a bracket 26 . like Figure 1 As shown, the large diameter cylinder portion 22 has a top cylinder piece 30 and a base cylinder piece 31. The inner diameter of the top cylinder piece 30 and the inner diameter of the base cylinder piece 31 are equal to each other. The outer diameter of the top cylinder piece 30 and the outer diameter of the base cylinder piece 31 are equal to each other. The length of the top cylinder piece 30 and the length of the base cylinder piece 31 are equal to each other. The top cylinder piece 30 and the base cylinder piece 31 are coaxially arranged. The distal end barrel piece 30 is arranged on the distal end side of the proximal end barrel piece 31 . Furthermore, the length of the top end barrel piece 30 and the length of the base end barrel piece 31 may be different from each other.

[0023] Hereinafter, the common axis of the distal end cylinder piece 30 and the proximal end cylinder piece 31 (the axis of the large diameter cylinder portion 22) is referred to as the axis O1. The direction perpendicular to the axis O1 is referred to as the radial direction, and the direction circumferentially around the axis O1 is referred to as the circumferential direction. A through hole (not shown) penetrating in the radial direction is formed in the base end cylindrical piece 31. The through hole extends over a predetermined range in the circumferential direction.

[0024] like Figure 1 and Figure 2 As shown, the fixing portion 23 is formed in a disk shape having an outer diameter equal to the outer diameter of the top end cylinder piece 30. The fixing portion 23 is arranged on the axis O1 between the top end cylinder piece 30 and the base end cylinder piece 31. Through holes 23a and 23b are formed in the fixing portion 23. The through holes 23a and 23b penetrate the fixing portion 23 along the axis O1 direction. For example, the through holes 23a and 23b are arranged in a manner of sandwiching the axis O1 in the radial direction. The fixing portion 23 is fixed to the top end cylinder piece 30 and the base end cylinder piece 31 by welding. In addition, the method of fixing the fixing portion 23 to the top end cylinder piece 30 and the base end cylinder piece 31 is not limited to welding, and may be adhesive, pressure welding, etc. The fixing portion 23 is disposed at a middle portion of the large-diameter cylindrical portion 22 in the direction of the axis O1.

[0025] The first small-diameter cylinder 24 and the second small-diameter cylinder 25 are formed in a tubular shape. The outer diameter of the first small-diameter cylinder 24 and the outer diameter of the second small-diameter cylinder 25 are smaller than the inner diameter of the top cylinder piece 30 and the inner diameter of the base cylinder piece 31. The first small-diameter cylinder 24 and the second small-diameter cylinder 25 are arranged inside the top cylinder piece 30 and the base cylinder piece 31 of the large-diameter cylinder 22. The first small diameter cylinder portion 24 is disposed in the through hole 23a of the fixing portion 23. The second small diameter cylinder portion 25 is disposed in the through hole 23b of the fixing portion 23. The fixing portion 23 fixes the positions of the first small diameter cylinder portion 24 and the second small diameter cylinder portion 25 relative to the large diameter cylinder portion 22. like Figure 1 As shown, the bracket 26 has a flat plate portion 33 and a cylindrical portion 34 . The flat plate portion 33 is formed in a disk shape and is disposed on the axis O1. The outer diameter of the flat plate portion 33 is equal to the outer diameter of the top tube piece 30. Through holes 33a and 33b are formed coaxially with the through holes 23a and 23b in the flat plate portion 33. The inner diameter of the through hole 33a is smaller than the inner diameter of the through hole 23a.

[0026] The barrel 34 is formed in a cylindrical shape. The barrel 34 protrudes from the outer peripheral edge of the flat plate 33 toward the base end. The barrel 34 is arranged on the top end side of the top barrel piece 30 of the large diameter barrel 22. Between the peripheral portion of the through hole 33b of the flat plate 33 and the barrel 34, a step portion (reference numeral omitted) whose diameter is reduced toward the base end is formed. The cylinder portion 34 is butted against the top cylinder piece 30 in the direction of the axis O1 and fixed to each other by welding or the like.

[0027] The top end of the first small-diameter cylinder 24 contacts the flat plate portion 33 of the bracket 26 from the base end side of the flat plate portion 33. The space inside the first small-diameter cylinder 24 is connected to the through hole 33a of the flat plate portion 33. The space inside the second small-diameter cylinder 25 is connected to the through hole 33b of the flat plate portion 33. On the other hand, the top end of the second small-diameter cylinder 25 is separated from the flat plate portion 33 toward the base end side. The front end of the first small-diameter cylindrical portion 24 is fixed to the flat plate portion 33 by welding or the like.

[0028] Here, a first axis (small-diameter axis) O4 as the axis of the first small-diameter cylindrical portion 24 and a second axis O5 as the axis of the second small-diameter cylindrical portion 25 are defined. A first reference plane S1 including the first axis O4 and the second axis O5 is defined. A direction along the first reference plane S1 and orthogonal to the axes O4 and O5 is defined as an orthogonal direction Z. The second axis O5 side with respect to the first axis O4 in the orthogonal direction Z is defined as a first side Z1. The first axis O4 side with respect to the second axis O5 is defined as a second side Z2.

[0029] A second reference plane (reference plane) S2 is defined along the axis O1 and is orthogonal to the first reference plane S1. In addition, the second reference plane S2 may be a plane along the axis O1 and intersecting the first reference plane S1. The forceps system 1 is used in a manner that the first reference plane S1 is along the up-down direction. At this time, the forceps system is configured in a manner that the first side Z1 is at the upper side. The endoscope insertion portion 11 of the sub-endoscope 10 can be inserted into the first small-diameter cylindrical portion 24 . Furthermore, the forceps 20 may include a proximal end holder that fixes the positions of the large-diameter cylinder portion 22 , the first small-diameter cylinder portion 24 , and the second small-diameter cylinder portion 25 on the proximal end side of the forceps insertion portion 21 .

[0030] like Figure 1 and Figure 3 As shown in FIG. 1 , the treatment section 41 is configured to have a well-known link structure. The treatment section 41 includes support members 42A, 42B, first swing members 43A, 43B, second swing members 44A, 44B, an operating member 45, and a connecting member 46 (see FIG. 1 ). Figure 4 ). like Figure 1 As shown, the support members 42A and 42B are formed in a rod shape and extend in the direction of the axis O1. The support member 42A is arranged closer to the first side Z1 than the support member 42B. A gap is formed between the support member 42A and the support member 42B. Portions on the base end sides of the support members 42A and 42B are fixed to the step portion of the bracket 26 .

[0031] like Figure 1 and Figure 3 As shown, the first swing members 43A and 43B extend in the direction of the axis O1 as a whole. The first swing members 43A and 43B can rotate via the first shaft member 48 provided at the base end portions of each other. The first shaft member 48 extends in the orthogonal direction Z. Both ends of the first shaft member 48 in the orthogonal direction Z are supported by the top ends of the support members 42A and 42B. The portion of the first swing member 43A on the distal side of the first shaft member 48 constitutes a gripping piece 49A. The portion of the first swing member 43B on the distal side of the first shaft member 48 constitutes a gripping piece 49B. That is, the treatment portion 41 has two gripping pieces 49A and 49B. The holding pieces 49A and 49B can be opened to be separated from each other and closed to be in contact with each other. That is, the holding pieces 49A and 49B can be opened and closed to each other.

[0032] Here, for example, the range of (1 / 4) of the length of the holding pieces 49A, 49B in the direction of the axis O1 from the respective top ends of the holding pieces 49A, 49B is defined as the top end portions 49aA, 49aB of the holding pieces 49A, 49B. A portion of the holding pieces 49A, 49B is formed in a curved shape. Therefore, in the holding pieces 49A, 49B, the top end portions 49aA, 49aB are arranged in a shape that moves to the top end side and the second side Z2 relative to the base end. The tip portions 49aA and 49aB open and close on the second reference plane S2. Here, the tip portions 49aA and 49aB open and close on the second reference plane S2 means that the tip portions 49aA and 49aB open and close along the second reference plane S2 in a state where a certain part of the tip portions 49aA and 49aB is on the second reference plane S2.

[0033] like Figure 1 As shown, the tip of the second swing member 44A can rotate relative to the portion of the first swing member 43A closer to the base end than the first shaft member 48 via the second shaft member (not shown). The tip of the second swing member 44B can rotate relative to the portion of the first swing member 43B closer to the base end than the first shaft member 48 via the third shaft member (not shown). The operating member 45 is formed in a rod shape and extends in the direction of the axis O1. The base end side portion of the operating member 45 is arranged in the second small diameter cylinder 25. The top end portion of the operating member 45 can rotate relative to the base end side portion of the second swing member 44A and the base end side portion of the second swing member 44B via a fourth shaft member (not shown).

[0034] As described above, the proximal end side of the support members 42A, 42B and the operating member 45 in the treatment portion 41 is arranged in the second small diameter cylinder portion 25 of the forceps insertion portion 21 (large diameter cylinder portion 22). The treatment portion 41 extends along the second axis O5 along the large diameter cylinder portion 22. In this example, the second axis O5 coincides with the treatment axis which is the axis of the treatment portion 41. The grasping pieces 49A and 49B protrude toward the distal end side of the forceps insertion portion 21 and perform predetermined treatment such as grasping the tissue of the patient. In the present embodiment, the opening 24 a at the distal end of the first small-diameter cylindrical portion 24 is disposed on the second reference surface S2 .

[0035] like Figure 4 As shown, the connection member 46 has a small diameter portion 46a and a large diameter portion 46b. The small diameter portion 46a is formed in a rod shape and protrudes from the base end of the operation member 45 toward the base end side. The diameter of the small diameter portion 46a is smaller than the diameter of the operation member 45. The large diameter portion 46b is formed in a spherical shape and is provided at the base end of the small diameter portion 46a. The diameter of the large diameter portion 46b is larger than the diameter of the small diameter portion 46a.

[0036] like Figure 1 As shown, the opening and closing operation portion 51 includes an operation portion body 52 and an opening and closing pull rod 53 . The operation part body 52 is fixed to the base end of the base end cylinder piece 31 of the large diameter cylinder part 22. The operation part body 52 extends toward the second side Z2 from the base end of the base end cylinder piece 31. A first finger hole 52a is formed at the extended tip of the operation part body 52. The opening and closing rod 53 is disposed on the proximal side of the operation portion main body 52 , and extends in a direction between the proximal side and the second side Z2 .

[0037] The middle portion of the opening and closing rod 53 in the longitudinal direction is rotatably connected to the operation part body 52 via an opening and closing axis member 54. The opening and closing axis member 54 is provided in the middle portion of the operation part body 52 in the orthogonal direction Z. The opening and closing rod 53 rotates relative to the operation part body 52 on the first reference plane S1. A female thread 52 b is formed in a portion of the operation portion body 52 that is closer to the second side Z2 than a portion where the opening and closing shaft member 54 is provided. A second finger hole 53a is formed at the second side Z2 of the opening and closing lever 53. Figure 4 As shown, a dovetail groove 53b is formed on the surface of the first side Z1 portion of the opening and closing rod 53 toward the tip side. The dovetail groove 53b extends along the first side Z1 portion of the opening and closing rod 53. The large diameter portion 46b of the connecting member 46 is fitted into the dovetail groove 53b of the opening and closing rod 53. like Figure 1 As shown, a female thread 53 c is formed at a portion of the opening / closing lever 53 which is closer to the first side Z1 than a portion where the opening / closing shaft member 54 is provided.

[0038] The opening and closing restricting portion 56 includes a first restricting portion 57 and a second restricting portion 58 . In this example, screws are used as the first limiting portion 57 and the second limiting portion 58. The first limiting portion 57 is fitted into the female thread 52b. The first limiting portion 57 protrudes from the operating portion body 52 toward the opening and closing pull rod 53 side (base end side). The second limiting portion 58 is fitted into the female thread 53c. The second limiting portion 58 protrudes from the opening and closing pull rod 53 toward the operating portion body 52 side (top end side). The protrusion amounts of the restricting portions 57 and 58 can be adjusted by adjusting the positions at which the screws are fitted. In addition, the opening and closing restricting portion 56 may include only one of the first restricting portion 57 and the second restricting portion 58 .

[0039] The rotation operation portion 61 is formed in a cylindrical shape and is fitted onto the proximal end barrel piece 31 of the forceps insertion portion 21. The rotation operation portion 61 is connected to the support members 42A and 42B of the treatment portion 41 via a connecting member (not shown) fitted into a through hole of the proximal end barrel piece 31. When the rotation operation part 61 is rotated about the axis O1 relative to the forceps insertion part 21, the treatment part 41 rotates about the second axis O5. When the rotation operation part 61 is rotated, the rotation range of the rotation operation part 61 about the axis O1 is limited by the connection member being circumferentially engaged with the peripheral edge of the through hole of the base end barrel piece 31. Each component of the forceps 20 is formed of stainless steel or the like.

[0040] For example, the operator grasps the opening and closing operation portion 51 of the forceps 20 with his / her hand. At this time, the operator puts the middle finger into the first finger hole 52a of the operation portion body 52, and puts the thumb into the second finger hole 53a of the opening and closing lever 53. When the operator grasps the opening and closing operation portion 51, the finger holes 52a and 53a approach each other, and the first limiting portion 57 contacts the opening and closing lever 53 from the top end side of the opening and closing lever 53. The operating member 45 moves toward the base end side relative to the forceps insertion portion 21, and the top ends 49aA and 49aB of the holding pieces 49A and 49B contact each other, and the two holding pieces 49A and 49B are closed. At this time, in the dovetail groove 53b of the opening and closing lever 53, the large diameter portion 46b of the connecting member 46 moves along the dovetail groove 53b. On the other hand, when the operator stretches the opening and closing operation portion 51, the finger holes 52a and 53a separate from each other, and the second limiting portion 58 contacts the operation portion main body 52 from the base end side of the operation portion main body 52. ​​The operation member 45 moves toward the distal end side relative to the forceps insertion portion 21, and the distal ends 49aA and 49aB of the holding pieces 49A and 49B separate from each other, and the two holding pieces 49A and 49B open.

[0041] As described above, the first limiting portion 57 and the second limiting portion 58 of the opening and closing limiting portion 56 limit the opening and closing range of the holding pieces 49A, 49B (the range from the angle formed by the holding pieces 49A, 49B when the holding pieces 49A, 49B are closed to the angle formed by the holding pieces 49A, 49B when the holding pieces 49A, 49B are opened).

[0042] For example, the outer diameter of the large diameter cylinder 22 is 5 mm, and the length of the large diameter cylinder 22 is about 30 cm to 40 cm. In the forceps insertion portion 21 , the first small diameter cylinder 24 and the second small diameter cylinder 25 are arranged inside the large diameter cylinder 22 .

[0043] Next, the operation of the forceps system 1 configured as described above will be described. For example, in laparoscopic surgery, the endoscope insertion portion 11 of the auxiliary endoscope 10 is inserted into the first small-diameter cylinder 24 of the forceps 20 in advance. When the endoscope insertion portion 11 is inserted into the first small-diameter cylinder 24 in advance, it is preferable to make the tip of the endoscope insertion portion 11 coincide with the tip of the forceps insertion portion 21. In addition, when the endoscope insertion portion 11 is inserted into the first small-diameter cylinder 24 in advance, the tip of the endoscope insertion portion 11 may be arranged closer to the base end side than the tip of the forceps insertion portion 21. The endoscope insertion portion 11 of the sub-endoscope 10 is freely attachable to and detachable from the forceps 20 .

[0044] like Figure 5 As shown, for example, a hole (not shown) is opened in the umbilical cord (navel) P5 of the patient P and a portion P6 beside the umbilical cord P5. Trocars 100 and 101 are respectively installed in the holes. The main endoscope 105 is inserted into the abdomen P7 through the trocar 100. The forceps insertion portion 21 of the forceps system 1 is inserted into the abdomen P7 through the trocar 101. The image obtained by the main endoscope 105 is appropriately displayed. The image obtained by the auxiliary endoscope 10 is displayed on the display unit. Carbon dioxide gas is injected into the abdomen P7 through the trocars 100 and 101 to expand the abdomen P7.

[0045] In this state, the operator inserts the distal end side of the large diameter cylinder 22 into the abdomen P7 of the patient P through the trocar 101 while observing the distal end side of the large diameter cylinder 22 with the endoscope insertion portion 11. Then, a predetermined treatment is performed with the treatment portion 41. The sub-endoscope 10 can be used to observe the site that is difficult to observe with the main endoscope 105, the blind spot of the main endoscope 105, and the like. Since the endoscope insertion portion 11 can be inserted into the first small-diameter cylindrical portion 24 , the endoscope insertion portion 11 can be easily inserted into the forceps insertion portion 21 , and the forceps 20 and the sub-endoscope 10 can be easily used integrally.

[0046] Since the sub-endoscope 10 and the forceps 20 can be managed separately from each other, for example, storage, cleaning, and sterilization can be easily performed only with the forceps 20 . The forceps 20 is a passive medical device and is therefore also a consumable part. Therefore, when the operation of the forceps 20 deteriorates, the forceps 20 needs to be replaced. On the other hand, the auxiliary endoscope 10 has no movable part and is therefore durable, and does not need to be replaced.

[0047] The forceps 20 includes the opening and closing regulating portion 56. Therefore, it is possible to suppress an excessive force from acting on the holding pieces 49A and 49B that are opening and closing, thereby preventing the holding pieces 49A and 49B from being damaged. The forceps 20 has a fixing portion 23. The fixing portion 23 can maintain the position of the first small-diameter cylindrical portion 24 relative to the large-diameter cylindrical portion 22 at a portion having low strength, which is an intermediate portion in the direction of the axis O1.

[0048] The forceps 20 has a rotation operation portion 61. Therefore, by operating the rotation operation portion 61, for example, the direction around the second axis O5 for a predetermined treatment by the treatment portion 41 can be changed without changing the direction around the first axis O4 based on the distal side field of view of the endoscope insertion portion 11. Furthermore, in the forceps system 1 of the present embodiment, the forceps system can be configured using the forceps 20 that can be easily used integrally with the sub-endoscope 10 .

[0049] The forceps system of this embodiment can have its structure variously modified as described below. exist Figure 6 In the forceps system 2 of the first modified example shown, in addition to the components of the forceps system 1 of the present embodiment, a forceps 70 is provided in place of the forceps 20. The forceps 70 includes a mounting portion 71 in addition to the components of the forceps 20. For example, the mounting portion 71 extends in the direction of the axis O1 and is formed in a U-shape with a first side Z1 open when viewed in the direction of the axis O1. For example, the mounting portion 71 is mounted on the forceps insertion portion 21. When the endoscope body 16 of the auxiliary endoscope 10 is arranged in the mounting portion 71, the endoscope body 16 is mounted on the mounting portion 71.

[0050] In the forceps system 2 of the first modified example configured as described above, by attaching the endoscope body 16 of the sub-endoscope 10 to the forceps 70 using the attachment portion 71 , an operator such as a physician can integrally operate the forceps 70 and the endoscope body 16 .

[0051] In the forceps system of the second modification, the opening 24 a of the first small-diameter cylindrical portion 24 is entirely arranged on either side (the first side Z1 or the second side Z2 ) perpendicular to the second reference plane S2 relative to the second reference plane S2 . In the forceps system of the second modified example, the endoscope insertion portion 11 is observed through the opening 24a of the first small-diameter cylinder portion 24 on the distal end side relative to the large-diameter cylinder portion 22. Furthermore, when the prescribed treatment is performed by opening and closing the holding pieces 49A and 49B, the opening 24a is disposed as a whole on either side of the second reference plane S2 that is orthogonal to the second reference plane S2 that is opened and closed by the distal ends 49aA and 49aB of the holding pieces 49A and 49B. Therefore, when the endoscope insertion portion 11 is observed through the opening 24a, the distal ends 49aA and 49aB of the holding pieces 49A and 49B are less likely to obstruct the observation.

[0052] Figure 7The forceps system 3 according to the third modified example shown includes a sub-endoscope 150 and the forceps 160 according to the present embodiment. For example, a convex line 151 that protrudes toward the outside of the endoscope insertion portion 11 is formed on the outer peripheral surface of the endoscope insertion portion 11 of the sub-endoscope 150. The convex line 151 extends along the endoscope insertion portion 11. The first small diameter cylindrical portion 161 of the forceps 160 has a small diameter hole 162 and a large diameter hole 163 formed in the portion into which the endoscope insertion portion 11 is inserted. The inner diameter of the small diameter hole 162 is smaller than that of the large diameter hole 163. The large diameter hole 163 is disposed closer to the base end than the small diameter hole 162. A key groove (not shown) that engages with the convex strip 151 of the endoscope insertion portion 11 is formed on the inner peripheral surface of the small diameter hole 162. The key groove extends along the first axis O4 of the first small diameter cylinder 161. In addition, the convex strip 151 and the key groove constitute a rotation limiting portion 170 that limits the direction of the endoscope insertion portion 11 around the first axis O4.

[0053] A female thread 163a is formed on the inner peripheral surface of the base end portion of the large diameter hole 163. A cylindrical pressing member 164 is disposed in the tip end portion of the large diameter hole 163. The pressing member 164 may be formed of, for example, synthetic rubber or the like.

[0054] The fixing member 165 is fitted into the female thread 163a of the first small-diameter cylindrical portion 161. The large-diameter hole 163 of the first small-diameter cylindrical portion 161, the pressing member 164, and the fixing member 165 constitute an insertion restriction portion 171. The fixing member 165 includes a cylindrical portion 166 and a flange portion 167 . A male thread 166a that fits with the female thread 163a is formed on the outer peripheral surface of the distal end portion of the cylindrical portion 166. The flange portion 167 protrudes outward from the proximal end portion of the cylindrical portion 166. For example, the fixing member 165 is formed of stainless steel or the like.

[0055] The endoscope insertion portion 11 is disposed in the cylindrical hole of the cylindrical portion 166 of the fixing member 165 , in the cylindrical hole of the pressing member 164 , and in the small-diameter hole 162 of the first small-diameter cylindrical portion 161 . When the fixing member 165 engaged with the female thread 163a of the first small-diameter cylindrical portion 161 compresses the pressing member 164 in the direction of the first axis O4, the inner diameter of the pressing member 164 becomes smaller, and the pressing member 164 presses the endoscope insertion portion 11 from the outside over the entire circumference. Therefore, the position of the endoscope insertion portion 11 disposed in the first small-diameter cylindrical portion 161 in the direction of the first axis O4 is restricted.

[0056] In the forceps system 3 of the third modified example configured as described above, the rotation restricting portion 170 can suppress the endoscope insertion portion 11 from rotating about the first axis O4 and thus preventing the direction of the external field of view of the endoscope insertion portion 11 from changing. Furthermore, the insertion restriction portion 171 can suppress a position change of the endoscope insertion portion 11 with respect to the first axis line O4 direction of the first small-diameter cylindrical portion 161 . In addition, the forceps system 3 only needs to include one of the rotation restricting portion 170 and the insertion restricting portion 171 .

[0057] As mentioned above, one embodiment and modified examples of the present invention have been described in detail with reference to the drawings, but the specific configuration is not limited to the embodiment, and changes, combinations, deletions, etc. of the configurations are also included within the scope that does not depart from the gist of the present invention. For example, in the above-described embodiments and modifications, the forceps 20, 70, 160 may not include at least one of the opening and closing restriction portion 56 and the rotation operation portion 61. The forceps insertion portion 21 may not include at least one of the fixing portion 23, the second small-diameter cylindrical portion 25, and the bracket 26. When the forceps 20 , 70 , or 160 does not include the second small-diameter cylindrical portion 25 , the position of the operating member 45 relative to the large-diameter cylindrical portion 22 can be maintained by the two brackets 26 of the forceps insertion portion 21 . Description of Reference Numerals

[0058] 1, 2, 3 clamp system 10. 150 pairs of endoscopes (endoscopes) 11 Endoscope insertion part 20, 70, 160 pliers 21 Forceps insertion part 22 Large diameter barrel 23 Fixed part 24, 161 first small diameter cylinder (small diameter cylinder) 24a Opening 41 Disposal Department 49A, 49B gripping piece 56 Opening and closing restriction part 61 Rotation operation unit 71 Installation 170 Rotation limiting part 171 Insertion restriction section O1 Axis O4 first axis (small diameter axis) O5 Second axis (disposal axis) S2 Second reference plane (reference plane)

Claims

1. A pair of pliers comprising: a forceps insertion portion; and a treatment portion, which is arranged in the forceps insertion portion and protrudes toward the distal end side than the forceps insertion portion, and performs a predetermined treatment. The forceps insertion portion has: a large-diameter cylindrical portion in which a proximal end portion of the treatment portion is disposed; and The small diameter cylinder is arranged in the large diameter cylinder and can be inserted into an endoscope insertion portion of the endoscope for observing the outside. The treatment part has two holding pieces that can be opened and closed to each other. The top ends of the two holding pieces open and close on a reference plane along the axis of the large diameter cylinder. The opening of the tip of the small-diameter cylindrical portion is disposed as a whole on either side perpendicular to the reference plane relative to the reference plane.

2. The pliers according to claim 1, wherein: An opening and closing restriction portion is provided to restrict the opening and closing range of the two holding pieces.

3. The pliers according to claim 1, wherein: The forceps insertion portion includes a fixing portion that is disposed at a middle portion of the large-diameter cylindrical portion in the axial direction of the large-diameter cylindrical portion and fixes the position of the small-diameter cylindrical portion relative to the large-diameter cylindrical portion.

4. The pliers according to claim 1, wherein: The treatment portion extends along a treatment axis along the large diameter cylindrical portion, A rotation operation portion is provided for rotating the treatment portion around the treatment axis.

5. The pliers according to claim 1, wherein: A mounting portion is provided on which an endoscope body of the endoscope is mounted.

6. The pliers according to claim 1, wherein: A rotation restricting portion is provided to restrict the direction of the endoscope insertion portion around the minor-diameter axis of the minor-diameter cylindrical portion.

7. The pliers according to claim 1, wherein: An insertion restriction portion is provided for restricting a position of the endoscope insertion portion disposed in the small-diameter cylindrical portion in the direction of the small-diameter axis of the small-diameter cylindrical portion.

8. A pliers system comprising: The pliers according to claim 1; and The endoscope.

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