Outer tube, laser transmission path and laser treatment tool

Abstract

Laser treatment tool (12) with an outer tube (80) for forming a laser transmission path (70) together with an elongated hollow waveguide path (90) for guiding laser light, wherein the outer tube (80) is formed with an inner insertion hole (81) in which the hollow waveguide path (90) is inserted, wherein the outer tube (80) has a plurality of fluid passages (84, 84a, 84b, 84c, 85) which are arranged outside the hollow waveguide path (90) inserted in the insertion hole (81) along a longitudinal direction of the insertion hole (81), wherein the laser treatment tool (12) can be inserted into a transmission path insertion hole (19) of an endoscope outer tube (21), characterized in that the outer tube (80) further comprises: projections (82) which are arranged at least two positions in a cross-sectional view of the outer tube (80). and protrude in a radial direction in such a way that in the state,in which the outer tube (80) is inserted into the transmission path entry hole (19), the tips of the projections (80) are in contact with an inner surface (19a) of the transmission path entry hole (19), and gap-forming elements (83) for forming gaps together with the inner surface (19a) of the transmission path entry hole (19), wherein the gaps are formed between adjacent projections (82) of the at least two projections (82) such that fluid passages (84, 84a, 84b, 84c, 85) are formed by the gap-forming elements (83).

Description

BACKGROUND OF THE INVENTION1. Field of the Invention:The present invention relates to a laser treatment tool according to the preamble of claim 1, for example, for performing laser treatment, comprising an outer tube for forming a laser transmission path, and an endoscopy device with such a laser treatment tool.2. Description of Technical Background:Conventionally, a treatment method using an endoscope capable of performing treatment with only a low load on the patient is used as the treatment method. According to such treatment using an endoscope, an endoscope tube is inserted into the body from the oral cavity or the like. Then, imaging or surgical intervention is performed using a front structure portion or tip structure portion (tip structure section) of the endoscope tube.Imaging is performed as described below. Illumination light is provided from the front or tip structure portion. The illumination light is reflected by the body tissue and received or picked up by a lens formed in the tip structure portion. The light is then transmitted from the endoscope tube to a device of the main part of the endoscope. The endoscope main body device (endoscope main body device) converts the light into an image and displays the image on a display device. Alternatively, imaging may also be performed as described below. An image is taken by an imaging element, for example, a CCD sensor or the like provided in the front or tip structure portion of the endoscope tube. The image signal formed by the front or tip structure portion is transmitted to a device of the endoscope main body via the endoscope tube. Then, the image is displayed on a display device.A surgical operation is performed by a tip or a front end of a suitable forceps (forceps) which are inserted through a forceps insertion opening (forceps insertion opening) referred to as a "channel" (channel) and which opens to a forceps exit (forceps exit) in the tip structure portion or the front end structure portion. As forceps or forceps, various tools may be used, for example, holding forceps or forceps, a knife, or the like.As a tool or instrument which is insertable through the forceps insertion hole and usable for a surgical operation, a tool has been proposed using a laser transmission path (laser transmission path) for supplying laser light for treatment (hereinafter, referred to as "treatment laser light" (treatment laser light)): see Patent Document 1. The laser transmission path in Patent Document 1 is characterized as guiding a gas, for example, carbon dioxide or the like, together with CO 2- laser light through a hollow tube-like waveguide path (hereinafter, referred to as "hollow waveguide path" (hollow waveguide path).The gas guided through the hollow waveguide path is characterized as acting as a cooling fluid for cooling the hollow waveguide path, the latter being heated by the laser light.As a structure of a laser transmission device using a carbon dioxide laser and usable as a processing device, a structure having a water passage (water passage) in an outer portion thereof for cooling the hollow waveguide path for transmitting the carbon dioxide laser light has been proposed (see Patent Document 2).In a cauterization operation performed using a laser for treatment, particularly endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR), it is necessary to discharge assist gas or physiological saline to securely obtain a visual field by expanding an operation target area and removing discharged substances (transposed substances) or smoke or mist, and to recover cooling water used to cool the hollow waveguide path. However, there has not been available a structure that enables both the discharge of assist gas or physiological saline and the recovery of cooling water by a laser transmission path.Prior ArtPatent LiteratureA laser treatment tool of the generic type is known, for example, from DE 198 60 483 A1. Reference is also made to the following publications:Patent Document 1: National Phase Publication of Japanese PCT Application No. 2007-533374;Patent Document 2: Japanese Patent Publication No. Hei 03-001104;U.S. Pat. No. 2004 0 179 796 A1, U.S. Pat. No. 2003 0 118 563 A1 and U.S. Pat. No. 2006 0 052 661 A1.SUMMARY OF THE INVENTIONProblems to be Solved by the InventionIn the light of the above-described problems, the present invention has an object to provide a laser treatment tool capable of guiding a plurality of fluids, a laser transmission path to be inserted into such a laser treatment tool, and an outer tube for forming the laser transmission path.means for achieving the objectTo solve this problem, a laser treatment tool and an endoscopy device having the features of the respective independent claims are proposed. The laser tool comprises an outer tube for forming a laser transmission path together with an elongate hollow waveguide path for guiding laser light, wherein the outer tube (external tube) has an inner insertion hole or an inner bore (inner insertion hole) for allowing the insertion of the hollow waveguide path, wherein the outer tube has a plurality of fluid passages (fluid passages) arranged outside the hollow waveguide path inserted in the insertion bore or the insertion hole along a longitudinal or longitudinal direction of the insertion bore or the insertion hole.The hollow waveguide path may be formed as described below. A tubular member (tubular member) is formed of a material having a highly smooth surface, for example, glass or the like. On an inner wall of the tube member, a reflective layer of silver or the like is formed. Then, on the inner surface of the reflective layer, a dielectric thin film is formed of a material having a high transmission effect or a high transmittance, for example, a cyclic olefin polymer, polyimide or the like.A laser transmission path formed using such an outer tube according to the present invention can guide or transport a plurality of fluids.This will now be described in more detail. The plurality of fluid passages are formed outside the hollow waveguide path along the longitudinal direction of the insertion hole or the insertion hole. Due to these circumstances, appropriate fluids are passed through the plurality of passages, for example, a guide passage for cooling water, a water recovery passage for recovering the cooling water, a passage for a support gas, a passage for purging (irrigation), and the like. In this way, a plurality or a plurality of required or desired fluids can be transported or guided.In an embodiment of the present invention, the plurality of fluid passages may be disposed between the hollow waveguide path inserted in the insertion hole or the insertion hole and an inner surface of the insertion hole or the insertion hole at an equal distance with respect to the inner surface.The hollow waveguide path inserted into the insertion hole or the insertion hole inside the outer tube may be positioned at a center position or the center of the outer tube with certainty. A space enclosed or defined by the plurality of fluid passages arranged at an equal interval and by an outer circumferential surface of the hollow waveguide path may function as a passage.In the present invention, the outer tube is insertable into a transmission path insertion hole or a transmission path insertion hole of an endoscope outer tube or an endoscope outer tube (endosperm external pants). The outer tube has protrusions disposed at least at two locations as viewed in the cross section of the outer tube, the protrusions protruding outward in a radial direction such that, in a state where the outer tube is inserted into the transmission path insertion hole, tips of the protrusions are in contact with an inner surface of the transmission path insertion hole or the transmission path insertion hole, gap forming parts (gap formation parts) are provided for forming gaps together with the inner surface of the transmission path insertion hole or the transmission path insertion hole, the gaps being formed between adjacent protrusions of the at least two protrusions.According to the present invention, an outer tube accommodated in a laser treatment tool can thus be provided, which outer tube absorbs smoke or mist produced during ESD or EMR processes.This will be described in detail below. In a cauterization operation (cauterization operation) performed using laser treatment, particularly in endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR), it is necessary to remove smoke or mist in order to expand the operation target area and also to achieve a safe visual field.For example, Japanese Patent Publication No. 62-148675 proposes an adjustment device for the internal pressure of a body cavity in a laser treatment device. According to this adjustment means for the internal pressure of a body cavity, an absorption tube is communicated with a gap or a distance between a protection tube and a laser transmission fiber and a forceps channel. This gap is used as an absorption or receiving channel.Japanese Patent Publication No. 2006-341066 proposes a medical treatment tool usable with an endoscope. This medical treatment tool has a flow path for a supplied fluid or an absorbed fluid between an outer circumferential surface of an insertion region or section and an inner circumferential surface of a sheath.As described above, it is necessary to provide a laser transmission path to be used in a cauterization process performed using a laser for treatment, particularly in connection with endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR), while it is necessary to perform various functions with respect to purging, discharge of assist gas, cooling of the hollow waveguide path, and the like. Therefore, a laser transmission path has a comparatively complicated cross-sectional structure having a diameter larger than the diameter of the laser transmission path which has been used heretofore.The laser transmission path has such a larger diameter, and therefore can adopt the structure described in any of the above-mentioned Patent Documents 1 and 2 to receive smoke and mist in the ESD or EMR in a state in which the laser transmission path is inserted into the transmission path insertion hole or the transmission path insertion hole of the endoscope outer tube or the endoscope outer tube.However, according to the present invention, the outer tube is used for forming the laser transmission path, and the laser transmission path formed using the outer tube is inserted into the transmission path insertion hole of the endoscope outer tube provided in a laser treatment tool. Due to these circumstances, smoke and mist are taken up (inhaled) by the void-forming parts (gas formation parts). In a cauterization process performed using laser light, particularly in endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR), the operation target area (operation target site) can be expanded, and moreover, the field of view can be obtained reliably. Therefore, a surgical operation can be performed reliably and securely.The laser transmission path formed using the outer tube is inserted into the transmission path insertion hole or the transmission path insertion bore of the endoscope outer tube or the endoscope outer tube provided in the laser treatment tool. Due to this fact, the laser transmission path can be positioned at the center of the laser transmission path insertion hole.In an embodiment of the present invention, the outer tube may include a plurality of convex or concave parts continuously arranged in a circumferential direction of the outer tube to have a gear-like cross-section (gear-like cross-section). The convex and concave parts may be the protrusions and the gap forming parts.The convex and concave parts may be formed by a curved line instead of being formed by peaks (apex) and sides (side).The laser transmission path formed by using the external tube or the external tube can be positioned at the center or the center of the laser transmission path insertion hole with higher certainty. In addition, the concave gap forming portions formed along the circumferential direction of the outer tube can absorb smoke and mist.In another embodiment of the present invention, the outer tube may have a polygonal cross section. Apexes of the polygonal cross section may form the protrusions, and sides of the polygonal cross section may form the gap forming parts.The "polygonal cross section" represents a concept to include, for example, a polygonal cross section formed by vertices and sides, for example, in the sense of a triangular or a quadrangular / square cross section, and also in the sense of a generally polygonal cross section formed by a curved line having an inflection point.The laser transmission path formed by using the external tube or the external tube according to the present invention can be positioned at the center or the center of the laser transmission path insertion hole with higher certainty. In addition, the concave void forming portions formed by the sides of the polygonal cross section can absorb smoke and mist.In one embodiment of the present invention, the outer tube may have an elliptical cross-section. Bent portions or arc-shaped portions at ends of a longer axis or longitudinal axis of the elliptical cross section may form the protrusions. Bent portions or arc-shaped portions at ends of a short axis of the elliptical cross section may form the gap forming portions.The laser transmission path formed by using the external tube or the external tube according to the present invention can be positioned at the center or the center of the laser transmission path insertion hole with higher certainty. In addition, the concave gap forming portions formed by the arc-shaped portions at the short axis ends of the elliptical cross section can absorb smoke and mist.The laser transmission path having the hollow waveguide path is inserted into the insertion hole or the insertion bore of the outer tube described above.A plurality of fluids may be directed or guided to more safely treat the surgical target area with laser light.This will now be described in more detail. The hollow waveguide path is inserted into the insertion hole or the insertion bore of the outer tube or the outer tube. Therefore, appropriate fluids can be guided through the plurality of passages formed outside the hollow waveguide path along a longitudinal direction of the insertion bore or the insertion hole, for example, a guide passage for cooling water, a water recovery passage for recovering the cooling water, a passage for a support gas, a passage for purging, and the like. Thus, while a plurality of desired fluids are guided, the operation target area can be treated with laser light with more certainty.In an embodiment of the present invention, one of the plurality of fluid passages may be a cooling water passage for supplying cooling water for cooling the hollow waveguide path such that cooling water flows in a direction in which the laser light is guided.The cooling water may be a physiological salt solution, fresh water or the like.The hollow waveguide path heated by the laser light may be cooled by the cooling water flowing through the fluid passage. Therefore, the laser transmission path for guiding the laser light for treating the operation target area can be improved with greater certainty in view of its durability.In an embodiment of the present invention, one of the plurality of fluid passages other than the cooling water passage may be a cooling water return passage that allows the cooling water that cooled the hollow waveguide path to flow back in a direction opposite to the direction in which the laser light is guided, thus recovering the cooling water.The cooling water can be recovered. Therefore, the cooling water can be circulated. The hollow waveguide path heated by the laser light can thus be efficiently cooled.The cooling water may be circulated in the cooling water passage and the cooling water recovery passage without the cooling water running into the operation target area.In an embodiment of the present invention, one of the plurality of fluid passages other than the cooling water passage may be a flushing passage for supplying flushing water such that the flushing water flows in a direction in which the laser light is guided, the cooling water being discharged to the diseased part.The flushing water discharged toward the operation target area (diseased part) may be physiological saline.While the hollow waveguide path which is or has been heated is cooled by the cooling water, flushing water is discharged toward the operation target area (diseased part) in the body, for example, with respect to the wall of the esophagus (esophagus), the wall of the stomach, or the like. Therefore, while the treatment space is widened or expanded to obtain a visual field in a safe manner, for example, the operation target area (diseased part) can be treated with the laser light with more certainty.In an embodiment of the present invention, one of the plurality of fluid passages different from or different from the cooling water passage may be an assist gas passage for supplying assist gas such that the assist gas flows in the direction in which the laser light is guided so as to be outputted toward the diseased part.The assist gas may for example be a suitable gas, for example carbon dioxide or the like, which is more absorbable by the body than air.While the hollow waveguide path that has been heated is cooled by the cooling water, the assist gas is guided and discharged toward the operation target area in the body, for example, with respect to the wall of the esophagus, the wall of the stomach, or the like. Therefore, while the treatment space is expanded and smoke and mist are also removed to obtain a visual field in a safe manner, for example, the operation target area can be treated with the laser light with more certainty.For example, if the assist gas is a suitable gas such as carbon dioxide or the like, which is more absorbable in the body than air, advantages described below will be obtained. According to the present invention, the laser light is guided through the hollow waveguide path. The support gas is guided through the support gas passage which is located outside the hollow waveguide path and inside the outer tube. This means that the laser light and the support gas are guided through mutually separate guide paths. Therefore, the difficulty that would occur if the laser light and the assist gas were guided through the same path does not occur, namely, the difficulty that the laser light is absorbed by the assist gas, with the result that the operation target area could not be irradiated with the laser light with the necessary output power in such a case. Consequently, a decrease in the transmission efficiency with respect to the laser light which would occur due to such a difficulty can be prevented. The laser light and the assist gas are guided without lowering the transmission efficiency with respect to the laser light. The assist gas is discharged toward the operation target area in the body, for example, with respect to the wall of the esophagus, the wall of the stomach, or the like. Therefore, while the treatment space is expanded and smoke and mist are also removed to securely obtain a visual field, for example, the operation target area can be treated with the laser light with more certainty.In other words, the degree of freedom with respect to the combination of the assist gas and the laser light is enhanced. As a result, convenience is improved.The laser treatment tool also includes a laser transmission path having a hollow waveguide path inserted into the insertion hole or bore of the above-described outer tube, wherein outer protrusions and gap forming portions are provided.Thus, smoke and mist can be absorbed by the gap forming parts. Thus, the operation target area can be treated with the laser light more securely.The present invention relates to a laser treatment tool having a laser generation source, a laser control portion, and the above-described laser transmission path. The laser transmission path is inserted into the transmission path insertion hole or the transmission path insertion bore of the endoscope outer tube or the endoscope outer tube. A tip or an extreme end of the laser transmission path is provided in the vicinity of the tip opening or front opening (tip opening) of the endoscope outer tube or the endoscope outer tube.Therefore, the tip or the front end of the laser transmission path for supplying the laser light can be guided to the operation target area with certainty.This will be described in detail below. Usually, the endoscope outer tube has a plurality of channels. One of these channels usually comprises an image fiber or imaging fiber (image fiber). This imaging fiber has a CCD camera at one end thereof, on one side of a main body. Alternatively, the imaging fiber has a CCD camera at the tip or leading end of the canal on the side of the diseased part (dispersed part). Therefore, it is possible for the operator to reach the operation target area with the tip or extreme end of the endoscope outer tube while checking it by an image captured by the CCD camera. Consequently, the tip or the tip end of the laser transmission path inserted into the endoscope outer tube disposed in the vicinity of the tip opening or the tip opening of the endoscope outer tube can be surely guided to a position very close to the operation target area. Therefore, the assist gas or the flushing water can be discharged toward the operation target area in the body, for example, with respect to the wall of the esophagus, the wall of the stomach, or the like. Consequently, the treatment space is expanded and smoke and mist are removed to securely obtain a visual field. Also, thus, the operation target area can be treated with the laser light with greater certainty, while the hollow waveguide path that heats up can be cooled by the cooling water.The present invention also relates to a laser treatment tool having a laser generation source, a laser control portion and the above-described laser transmission path. The laser transmission path is inserted into the laser transmission path insertion hole of an endoscope outer tube such that the tip or the front end of the laser transmission path is located in the vicinity of the front opening or the tip opening of the endoscope outer tube. A fluid receiving unit (fluid inhalation unit) is connected to the clearance forming part. The gap forming portions each form a fluid absorption passage.Therefore, the laser transmission path for supplying laser light can be guided to the operation target area with certainty.In an embodiment of the present invention, the laser light may be a carbon dioxide laser.In the laser treatment tool, the plurality of fluids for treatment of the operation target area can be guided or guided with certainty. This will now be described in detail. As the laser light, laser light of a carbon dioxide laser which is highly absorbable by water is used. Therefore, if a leak occurs with respect to the laser light, the laser light is absorbed by water, and the operation target area can be treated securely.In addition, smoke or mist may be received by the gap forming parts to securely treat the operation target area. This will now be described in detail. Light of a carbon dioxide laser which is highly absorbable in water and which is highly absorbable on or in a surface of a living body is used as laser light in a bright or clear visual field. Therefore, the operation target area can be irradiated with a minimum necessary amount of laser light and thus can be securely treated.Effect of the inventionAccording to the present invention, a laser treatment tool capable of conducting or guiding a plurality of fluids, a laser transmission path that is insertable into a laser treatment tool, and an outer tube that constitutes a laser transmission path can be provided.Brief Description of the FiguresFIG. 1 is a schematic view of a configuration of a laser treatment system including an endoscope apparatus and a laser treatment apparatus. FIG. 2 is a block diagram showing a configuration of the endoscope apparatus and the laser treatment apparatus. FIG. 3 is isometric views showing a structure of an operation / operation unit that can be operated by a user (hereinafter, simply referred to as an "operation / operation unit"). FIG. 4 is isometric views showing a structure of a laser transmission path. FIG. 5 shows cross-sectional views of the laser transmission path. FIG. 6 is cross-sectional views each showing a laser transmission path of another embodiment.DESCRIPTION OF PREFERRED EMBODIMENTSHereinafter, an embodiment of the present invention will be explained with reference to the figures.FIG. 1 is a configuration view schematically showing a configuration of a laser treatment system 1 including an endoscope apparatus 10 and a laser treatment apparatus 50. FIG. 2 is a block diagram showing a configuration of the endoscope apparatus 10 and the laser treatment apparatus 50.As shown in FIG. 1, the endoscope apparatus 10 is provided in a main body 1 aof the apparatus and connected to an operation unit 12 (operation unit) via a connection cable 11. The operation / operating unit 12 corresponds to or to a laser transmission tool (laser transmission tool) and essentially has an operating region 13 (operation section) and an endoscope tube or an endoscope tube 21 (endoscope tube).The operation portion 13 includes an eye contact portion 15 (eye contact section), an up-down angle knob 16 (up-down angle knob), a left-right angle knob 17 (left-right angle knob), operation knobs 18 (operation button), a forceps / forceps insertion portion 20 (force insertion section), and the like.The operation buttons 18 receive an operation input for, for example, water supply, absorption, zooming, supply of assist gas, which will be described later, flushing with flushing water for the diseased part, circulating cooling water, or the like.The endoscope tube 21 corresponds to an endoscope outer tube and includes a flexible tube portion 22 (flexible tube section), a curved tube portion 23 (curved tube section), a tip structure portion 30 (tip structure section, which are provided in this order from a base portion toward the tip. The endoscope tube 21 has therein a forceps / forceps insertion path 19 (force insertion path) corresponding to a transmission path insertion hole or a transmission path insertion opening bore (force insertion opening). The forceps / forceps insertion path 19 communicates with the forceps / forceps insertion hole or bore 20 toward a forceps / forceps outlet 36 (forceps exit) of the tip structure portion 30, and functions as a treatment tool insertion path through which a treatment device or a treatment device, for example, forceps, a laser transmission path 70, or the like can be inserted.In Fig. 1, the endoscope tube is shown having a diameter which increases from the center of the flexible tube portion 22 toward the foremost end or tip of the curved or bendable tube portion 23. This illustration is for the purpose of facilitating understanding of the structure of the tip structure portion 30, but actually, the endoscope tube 21 has a constant diameter which enables a treatment tool or device to be inserted into a body organ such as esophagus (esophagus), stomach, internal organs, or the like.The flexible tube portion 22 has a cylindrical shape that can be curved to an appropriate extent and allows an appropriate treatment device, for example, forceps, forceps, or the like, to be inserted from the forceps / forceps insertion portion 20 to reach the tip structure portion 30. In this example, the laser transmission path 70 of the laser treatment device 50 is inserted and reaches the tip structure portion 30 as a treatment device or tool.The curved tube portion 23 can be operated to be curved in an up-and-down direction by operating the up-and-down angle adjustment knob 16.This will now be described in detail. The curved tube portion 23 is connected to the up-and-down angle adjustment knob 16 and the left-and-right angle adjustment knob 17 via a wire (not shown) inserted through the endoscope tube 21. Therefore, a rotational operation performed on the up-and-down angle adjustment knob 16 or the left-and-right angle adjustment knob 17 is transmitted to the bendable or curved tube portion 23 by means of the wire. The bendable or curved tube portion 23 is then curved in the up-and-down direction or the left-and-right direction. Therefore, the bendable or curved tube portion 23 is curved in an arbitrary direction at an arbitrary angle. Thus, the foremost or tip structure portion 30 can be oriented in an appropriate direction towards an operation target area.The foremost or tip structure portion 30 comprises light guides 31 and 35, a lens 33, a nozzle 34 and exit 36 for forceps.The light guides 31 and 35 are illumination elements for supplying light for illuminating an area to be imaged or a location to be imaged. Therefore, a location or an area in the body to which light does not pass can be illuminated by the operator or the operator such that the location or the area can be observed by the operator or the operator and thereby a surgical operation can be performed on the location or the area.The lens 33 is a lens for collecting the light supplied through the light guides 33 and 35, for example, and reflected by the location or area in the body, thus obtaining a captured image. By appropriately processing the collected information, a captured image can be obtained, and the operator can check the state of the location or the area in the body. An imaging element for converting light into an electrical signal may be provided in the vicinity of the tip structure portion 30 and connected to the endoscope apparatus 10 via a conductive wire. Or, such a device may be provided inside the endoscope device 10 such that light collected by the lens is transmitted via an image guide.The nozzle 34 is a member for discharging, for example, washing liquid for washing the lens 33 toward the lens 33.The forceps / forceps outlet 36 is an opening or an outlet for a treatment device or a treatment tool such as the laser transmission path 70 of the laser treatment device 50 or the like.The laser transmission path 70 is formed to be longer than the length L 1 of the forceps / forceps insertion path 19, thereby forming the entire length of the endoscope tube 21. The laser transmission path 70 will be described in detail later.As illustrated in FIG. 2, the laser treatment apparatus 50 includes an operation / display area 51, a power supply area 52, a signal processing area 53, a central control area 54 corresponding to the laser control area, a detection area 55, a guide light emission area 56, a laser oscillation (laser oscillation) area 57 corresponding to a laser generation source, an assist gas output area 59, a cooling water supply area 60, a cooling water recovery area 61, and a diseased part rinse treatment area 62.The operation / display portion 51 receives an operation input, for example, laser output settings, changes in an operation mode, or the like, and transmits the input signal to the central control portion 54. the operation / display portion 51 also receives a display signal regarding conditions of the laser output, an operation state of the device or the like from the central control portion 54, and displays appropriate information.The power supply section 52 supplies the electric power necessary for the operation to the central control section 54 and other sections.The signal processing section 53 processes the signal detected by the detection section 55, and transmits the signal to the central control section. In this example, the signal processing portion 53 and the detection portion 55 cooperate with each other as an OCT (Optical Coherence Tomography) device.The detection portion 55 receives reflected guide light 55a (signal light) obtained from low coherence guide light 56a (low coherence guide light) emitted from the guide light emission portion 56 and reflected by the operation target area, and due to reference light (reference light) transmitted from the guide light emission portion 56, thus interfering light is obtained. Both light species received by the detection region 55 are near infrared light species having a wavelength of 800 nm to 1 μm or the vicinity thereof.The detection portion 55 detects the light intensity of a beat signal generated by coherence of the reflected guide light 55 a(signal light) and the reference light. The signal processing section 53 performs heterodyne detection (heterodyne detection) for finding the intensity of the signal light reflected by a prescribed area of the operation target area from an intensity of the light received from the detection section 55. Thus, optical coherence tomography (optical coherence tomography) information is obtained.This is repeated while the operation target area to be detected is changed. Consequently, optical coherence tomography information can be obtained for each of the operation target areas. Therefore, the optical coherence tomography information contains a tissue profile at a location some depth from the surface. That is, in addition to a tissue profile of a mucosal membrane at the surface, a tissue profile of a portion having a submucosal layer or a muscle layer is obtained. The optical coherence tomography information is information obtained before the light is processed into an image. The signal processing section 53 transmits the optical coherence tomography information to the central control section 54.The central control section 54 performs various control operations with respect to various elements. The central control portion 54 includes a laser output control portion 54a and a storage portion 54b.The laser output control section 54 acontrols an output value for the laser light 57 afor treatment (hereinafter referred to as the "treatment laser light 57 a") output by the laser oscillation section 57 according to the output set by the operation / display section 51 or the operation mode.The storage area 54b stores appropriate data in addition to control data relating to output setting, operation mode settings and the like.As described above, the detection portion 55 receives the reflected guide light 55 a(signal light) and the reference light, and detects the light intensity of the beat signal (beat signal) generated by the interference of the light.The guide light emitting region 56 emits light in the near infrared region with low coherence having a wavelength of 800 nm to 1 μm or in the vicinity thereof. The guide light is provided for displaying a position to be irradiated with the treatment laser light 57 a. The near infrared light is invisible, but can be detected with the imaging element and converted into an image. Accordingly, the near infrared light is converted into an image signal using an imaging region 46 of the endoscope apparatus 10 as described later, and displayed on an image display region 48. Thus, the site to be irradiated with the treatment laser light 57 acan be confirmed.The laser oscillation portion 57 oscillates the treatment laser light 57 ato be used for the surgical operation. In this example, laser light of a carbon dioxide laser is used as the treatment laser light 57 a(hereinafter referred to as "CO 2- laser light") having a wavelength of 10.6 μm. Operation settings such as setting the radiation intensity of the CO 2- laser light, starting and ending irradiation, and the like are performed by manual operations using the operation / display area 51 and by the control using the central control area 54.The guide light 56a emitted by the guide light emitting portion 56, the treatment laser light 57a oscillated by the laser oscillating portion 57, and the reflected guide light 55a detected by the detecting portion 55 mentioned above are all transmitted through a hollow waveguide path 90. Accordingly, a location or an area acting on the operation target and a location or an area to be measured coincide with each other as the operation target area.The assist gas discharge portion 59 discharges carbon dioxide as the assist gas 59 a. It is desirable that the discharge pressure of the assist gas 59 apassing through the laser transmission path 70 described later is discharged toward the operation target area from a front portion or a tip of the laser transmission path 70 by means of an appropriate pressure generating member.The cooling water supply portion 60 supplies cooling water 60 ato the cooling end hollow waveguide path 90 heated by the treatment laser light 57 a. The cooling water recovery portion 61 recovers the cooling water 60 athat has cooled the hollow waveguide path 90. The cooling water 60 amay be provided through the cooling water supply portion 60 and circulated after being recovered through the cooling water recovery portion 61. The cooling water 60a may be fresh water instead of physiological saline.The diseased part treatment flushing portion 62 may provide physiological saline as the diseased part treatment water 62a for keeping the diseased part expanded or bulged during surgery.The endoscope apparatus 10 includes an operation / operation section 41, a power source section 42, a central control section 43, a diseased part gas receiving section 44 corresponding to the fluid receiving unit, an illumination section 45, an imaging section 46, and an image display section 48.The operation / operation portion 41 transmits an operation input through the operation portion 13 (see FIG. 1 ) to the central control portion 43. that is, the operation / operation portion 41 transmits a curving operation to the bendable or curved tube portion 43 generated by operating on the up-and-down angle adjustment knob 16 or the left-and-right angle adjustment knob 17, a pressing operation on one of the knobs 18, or the like. Alternatively, an operation / operation region may be provided, for example, in or on a main part or housing of a control device (not illustrated) of the endoscope device formed separately from the operation / operation region 41 of the operation unit 12, for example. An operation regarding the illumination light amount, imaging and storing still images, or the like is transmitted to the central control section 43.The power supply section 42 supplies to the central control section 43 and other sections of electrical operating condition.The central control section 43 performs various control operations on various elements.The diseased part gas receiving portion 44 receives diseased part gas 44 athat fills the diseased part via receiving guide paths 19 bcorresponding to the fluid receiving passage formed between the laser transmission path 70 described later and the forceps / forceps insertion path 19 of the endoscope tube 21.The illumination region 45 provides illumination light from the light guides 31 and 35 (see FIG. 1 ).The imaging region 46 captures an image transmitted from the lens 33 (see FIG. 1 ) and thus obtains an image necessary for the surgical operation. Images necessary for the surgical operation are obtained in real time in a continuous manner such that the operator can perform the surgical operation continuously or uniformly.The image display section 48 displays the images based on the signal transmitted from the central control section 43. Such images include the still image obtained by the imaging area 46. Accordingly, the operator or the operator can perform the surgical operation while checking the captured image displayed on the image display area 48 in real time. A preoperative image may be stored, for example, in the central control area, an attached external storage device or the like, which may be provided as a still image and which may be captured and displayed after surgery and compared with a postoperative image.Referring now to FIGS. 3 to 5, the laser transmission path 70 will be described. FIG. 3 is isometric views showing a configuration of the operation / operation / operation unit 12. That is, in detail, Fig. 3(a) is an isometric view of the bendable or curved tube portion 23, and Fig. 3(b) is an enlarged view of the portion "a" in Fig. 3(a).FIG. 4 provides an isometric view of the laser transmission path 70 in which an outer tube 80 and a tip ejection outlet member 71 (tip ejection outlet member) are partially shown in cross-section. Fig. 4(b) is an isometric view of the outer tube 80. Fig. 4(c) is an isometric view of the front ejection outlet member 71. Fig. 4(d) is an isometric view of the hollow waveguide path 90; Fig. 4(e) is an isometric view of the foremost ejection outlet member 71 in a state where the hollow waveguide path 90 is inserted therein.In Fig. 4(b), a front or tip insertion portion 80a of the outer tube 80 into which the foremost discharge outlet member 71 is insertable is transparently shown. In Figure 4(e), the foremost output outlet member 71 is shown partially cut away and the hollow waveguide path 90 is shown transparently.FIG. 5 is cross-sectional views illustrating the laser transmission path 70. FIG. 5( a) is a vertical cross-sectional view of FIG. 5( b) taken along the line C-C with respect to the laser transmission path 70 inserted into the forceps / forceps insertion path 19 of the endoscope tube 21. FIG. 5( b) is a cross-sectional view of FIG. 5( a) taken along the line A-A and viewed in the direction of the arrows of the line A-A. FIG. 5( c) is a cross-sectional view of FIG. 5( a) taken along the line B-B and viewed in the direction of the arrows of the line B-B.The laser transmission path 70 includes an outer tube 80, the front or tip output outlet member 71 and the hollow waveguide path 90. As described above, the laser transmission path 70 is formed longer than the endoscope tube 21.The outer tube 80 is a hollow flexible resin tube having an insertion space 81 corresponding to an insertion hole therein. The outer tube 80 has a diameter corresponding to an inner diameter of the forceps / forceps insertion path 19 of the endoscope tube 21. The outer tube 80 has outer circumferential convex parts 82 (outer circumferential convex parts) corresponding to the protrusions and outer circumferential concave parts 83 (outer circumferential convex parts) corresponding to the concave parts or gap forming parts. The outer circumferential concave parts 83 are respectively formed between adjacent outer circumferential convex parts 82 and except with respect to the outer circumferential convex parts 82, and the outer circumferential convex parts 82 and the outer circumferential concave parts 83 are arranged side by side in a circumferential direction of the outer tube 80, so that the outer tube 80 generally appears as a gear (gear-like) when viewed in a front cross-sectional view as illustrated in FIGS. 5( b) and 5( c). In a state where the outer tube 80 is inserted or is inserted into the endoscope tube 21, a gap between each of the outer concave parts 83 and an inner circumferential surface 19 aof the forceps / forceps insertion path 19 functions as a receiving guide path 19 b(inhalation guide path).As described above, the accommodating guide paths 19b respectively communicate with the diseased part gas accommodating portion 44 of the endoscope apparatus 10.At a front end or tip of the insertion space 81 of the outer tube 80, a foremost or tip insertion part 80a, which will be described later, for enabling the insertion of the front or tip discharge outlet member 71 is provided.A part of the insertion space 81 of the outer tube 80 other than the front or tip insertion part 80a receives part, sub or sub passages 84 (84a, 84b and 84c) corresponding to fluid passages. As shown in the cross section in FIG. 5(c), the sub passages 84 (84a, 84b, and 84c) are formed at three different locations along the circumferential direction of the outer tube 80. The sub passages 84 (84a, 84b and 84c) are formed on an inner circumferential surface of the outer tube 80 and extend in a longitudinal direction thereof.The sub passages 84 are formed in size such that inner tips thereof in the cross-sectional view of FIG. 5( c) define a circle larger by a certain amount than an outer diameter of the hollow waveguide path 90 inserted in the insertion space 81.The front or tip discharge outlet member 71 is a generally cylindrical member which can be pressurized into the foremost or tip insertion portion 80a at a front end or tip of the outer tube 80. The tip discharge outlet member 71 has a front cylindrical part 71 aon a front side (a diseased part side) thereof in an axial direction, namely, in a longitudinal direction thereof, and a rear cylindrical part 71 bon a rear side thereof.The tip output outlet member 71 has a central radiation hole 71 at a center thereof as viewed in plan. The central radiation hole 72 passes through the tip output outlet member 71 in the axial direction, namely, in the longitudinal direction thereof. Also viewed in plan view, the tip discharge outlet member 71 has a support gas discharge hole 73, a purge hole 74, and a cooling water circulation path 75 at three locations located radially outward from the central radiation hole 72.The central radiation hole 72 has a front radiation hole 72 adisposed in the front cylindrical part 71 aand a rear radiation hole 72 bdisposed in the rear cylindrical part 71 b(see FIG. 4( e)). The front radiation hole 72a has a diameter approximately equal to the diameter of the hollow waveguide path 90 and allows the hollow waveguide path 90 to be inserted therein. the rear radiation hole 72b has a diameter larger by one degree than the outer diameter of the hollow waveguide path 90 and has a gap around the hollow waveguide path 90 when inserted therein.The assist gas discharge hole 73 and the purge hole 74 pass through the tip discharge outlet member 71 in the axial direction, namely, in the longitudinal direction thereof.In contrast, the cooling water circulation path 75 extends from the rear side of the tip discharge outlet member 71 and is bent to be connected to the front side of the rear radiation hole 72 b. That is, the cooling water circulation path 75 is a through hole or a through hole passing through the rear cylindrical part 71 bfrom the rear side of the tip discharge outlet member 71 to the front side of the rear radiation part 72 b. Therefore, the assist gas discharge hole 73 communicates with the assist gas sub-passage 84a corresponding to an assist gas passage. The flushing hole 74 communicates with the diseased part treatment water sub-passage 84b corresponding to a flushing passage. The cooling water circulation path 75 is in communication with a cooling water recovery sub-passage 84c.As shown in the vertical cross-sectional view of Fig. 5(a), the hollow waveguide path 90 is a cylindrical member having a front or tip portion which is insertable into the front radiation hole 72a of the central radiation hole 72 and which has an outer diameter equal to the inner diameter of the front radiation hole 72a. The inner circumferential surface of the hollow cylindrical member is completely covered with a dielectric thin film 91, and the cylindrical member used for forming the hollow waveguide path 90 is elongated and is formed of glass or the like, namely, a material having a smooth surface and capable of forming a reflective film of silver or the like and a dielectric thin film. The dielectric thin film 91 is formed of a suitable material capable of reflecting and transmitting laser light with high efficiency, for example, COP (cyclic olefin polymer), polyimide, or the like.Since the inner circumferential surface of the hollow waveguide path 90 is covered with a reflective layer of silver or the like and the dielectric layer 91 as described above, the treatment laser light 57 a, the guide light 56 a, or the reflected guide light 55 aare guided through the guide space 92 (guide space) in the hollow waveguide path 90 and can be guided with a high transmission efficiency.As described above, the hollow waveguide path is formed of a cylindrical member having an outer diameter corresponding to the inner diameter of the front radiation hole 72 aof the central radiation hole 72. Therefore, cooling water passages 85 corresponding to the fluid passage or the cooling water passage are formed between an inner circumferential surface 80 bof the outer tube 80 and an outer circumferential surface 90 aof the hollow waveguide path 90.This will now be described in detail. The cooling water passages 85 formed between the outer circumferential surface 90 aof the hollow waveguide path 90 and the inner circumferential surface 80 bof the outer tube 80 communicate with the gap formed between the rear radiation hole 72 bof the central radiation hole 72 and the outer circumferential surface 90 aof the hollow waveguide path 90 The cooling water passages 85 communicate with the cooling water recovery sub-passage 84 ccorresponding to a cooling water recovery passage via the gap formed between the rear radiation hole 72 bof the central radiation hole 72 and the outer circumferential surface 90 aof the hollow waveguide path 90 and the cooling water circulation path 75.A base part for the assist gas sub-passage 84 ais connected to the assist gas discharge portion 59 of the laser treatment device 50. accordingly, assist gas 59 aemitted by the assist gas discharge portion 59 is guided from the base part to the foremost part or tip part of the assist gas sub-passage 84 aand can be discharged forward from the assist gas discharge hole 73 to the front or tip discharge outlet member 71.A base part of the diseased part treatment water sub-passage 84b is connected to the diseased part treatment flushing portion 62 of the laser treatment apparatus 50, respectively, treatment water 62a in the diseased part supplied through the diseased part treatment flushing portion 62 is guided from the base part to the foremost or tip part of the diseased part treatment sub-passage 84b and can be discharged forward from the flushing hole 74 of the foremost or tip discharge outlet member 71.A base part of the cooling water recovery sub-passage 84 cis connected to the cooling water recovery portion 61 of the laser treatment apparatus 50, Accordingly, cooling water 60 asupplied from the cooling water supply portion 60 is guided from the base parts to the tip parts of the cooling water passages 85, passes through the cooling water circulation path 75, is guided rearward in the cooling water recovery sub-passage 74 c, and can be recovered by the cooling water recovery portion 61.A method of using the laser treatment system 1 in endoscopic submucosal dissection (ESD) will now be described.As described above, in endoscopic submucosal dissection (ESD) using a laser treatment system 1, the operation / operation unit 12 is inserted into the body with the laser transmission path 70 inserted into the forceps / forceps insertion path 19. Based on an image of an area before the tip structure area 30, which has been captured by the imaging area 46 and which is displayed by the image display area 48, the tip structure area 30 of the operation / operation / operation unit 12 is inserted until the operation target area is reached. The operation target area is a tubular cavity (tubular cavity), for example, esophagus (esophagus), stomach, or the like, namely, an appropriate area in a living organism, for example, a human or the like.Then, the assist gas discharge portion 59 is activated to discharge assist gas 59 avia the assist gas sub-passage 84 aand the assist gas discharge hole 73 of the tip discharge outlet member 71. In this manner, the tubular cavity as the operation target area is expanded into a state in which surgical intervention can be easily performed.The diseased part treatment flushing portion 62 is activated to discharge diseased part treatment water 62 avia the diseased part treatment water sub-passage 84 band the flushing hole 74 of the tip discharge outlet member 71. In this manner, the operation target area is curved to a state in which surgical intervention can be easily performed.The operator performs treatment in the operation target area using the treatment laser light 57 awhile checking the image on the image display area 48 and while also providing the guide light 56 aand the treatment laser light 57 athat are guided via the guide space 92 of the hollow waveguide path 90 from the central radiation hole 72 of the tip output outlet member 71.Since the operation target area is cut and ablated using the treatment laser light 57 a, the tubular cavity as the operation target area is filled with smoke and mist. However, the assist gas 59a is discharged and the diseased part gas receiving portion 44 is activated, so that the diseased part gas 44a containing the smoke and the smoke from the tubular cavity can be received by the diseased part gas receiving portion 44 via the receiving guide paths 19b. Thereby, the tubular cavity as the operation target area can be kept clean.The cooling water supply portion 60 and the cooling water recovery portion 61 are activated to circulate the cooling water 60 avia the cooling water passages 85, the cooling water circulation path 75, and the cooling water recovery sub-passage 84 c. Consequently, the hollow waveguide path 90 baked by the treatment laser light 57 acan be cooled by the cooling water 60 a. The cooling water passages 85 are configured to be in contact with the outer circumferential surface of the hollow waveguide path 90 in the heated state. Consequently, the hollow waveguide path 90 can be efficiently cooled by the cooling water 60 a.As the treatment laser light 57 a, CO 2- laser light highly absorbable in water is used, and the cooling water 60 ais supplied through the cooling water passages 85 around the hollow waveguide path 90. Even if the hollow waveguide path 90 is damaged and the treatment laser light 57 arouted or guided through the guide space of the guide space 92 leaks out (erroneous radiation), the outer tube 80 and the endoscope tube 21 of the operation unit 12 are prevented from being damaged by such erroneous radiation of the treatment laser light 57 a. Therefore, the operation unit 12 can provide a high degree of safety and reliability.The cooling water 60 ais supplied from the cooling water supply portion 60 and recovered to the cooling water recovery portion 61 avia the cooling water passages 85, the cooling water circulation path 75, and the cooling water recovery sub-passage 84 c. That is, the cooling water 60 acirculates without flowing to the outside. Therefore, the cooling water 60a does not need to be a physiological salt solution, but may be fresh water.After the surgical procedure is completed, the operating unit 12 is withdrawn from the body and thus endoscopic submucosal disketion (ESD) is completed. The laser treatment system 1 can be used in substantially the same manner for endoscopic mucosal resection (EMR).As described above, the outer tube 80 forms the laser transmission path 70 together with the longitudinally extended hollow waveguide path 90 for guiding the treatment laser light 57 aand allows the hollow waveguide path 90 to be inserted into the inner insertion space 81 thereof. The outer tube 80 has a plurality of sub passages 84 and cooling water passages 85 disposed outside the hollow waveguide path 90 and inserted into the insertion space 81 along the longitudinal direction of the insertion space 81. Thus, the laser transmission path 70 is formed using the outer tube 80. Therefore, the laser transmission path 70 can guide a variety of fluids (cooling water, assist gas, treatment water for the diseased part, gas of the treated part, etc.).This will now be described in more detail. The plurality of sub passages 84 and cooling water passages 85 are formed outside the hollow waveguide path 90 along the longitudinal direction of the insertion space 81. Therefore, appropriate fluids are guided and guided through the plurality of passages, for example, the cooling water passages 85 for the cooling water 60 a, the cooling water recovery sub-passage 84 cfor recovering the cooling water 60 a, and the like. Consequently, a plurality of desired fluids can be guided.The plurality of sub-passages 84 are disposed between the hollow waveguide path 90 inserted in the insertion space 81 and an inner surface of the insertion space 81 at equal intervals with respect to the inner surface. Therefore, the hollow waveguide path inserted into the insertion space 81 inside the outer tube 80 can be more surely disposed in the center of the outer tube 80. A space enclosed by the plurality of sub passages 84 arranged at an equal interval and an outer circumferential surface of the hollow waveguide path 90 may function as the cooling water passages 85.The outer tube 80 is inserted into the forceps / forceps insertion path 19 of the endoscope tube 21, and the outer tube 80 further includes outer circumferentially convex parts 82 (outer circumferentially convex parts) that are disposed at at least two places as viewed in the cross section of the outer tube 80 and that protrude outward in the radial direction such that, in the state in which the outer tube 80 is inserted into the forceps / forceps insertion path 19, tip or front parts of the outer circumferentially convex parts 82 are in contact with the inner circumferential surface of the forceps / forceps insertion path 19, and the outer circumferentially concave parts 83 for the gaps together with the inner surface of the forceps / forceps insertion path 19 are also provided, wherein the gaps are formed between adjacent outer circumferential convex parts 82, The laser transmission path 70 is formed using the outer tube 80, The laser transmission path 70 formed using the outer tube 80 is inserted into the forceps / forceps insertion path 19 of the endoscope tube 21 provided in the surgical tool 12. Therefore, smoke and mist are received by the receiving guide paths 19b formed by the outer circumferential concave portions 83. Thus, in a cauterization process performed using the treatment laser light 57 a, particularly in endoscopic submucosal dissection (ESD) or endoscopic mucos resection (EMR), the operation target area can be expanded and the visual field can be obtained securely. Consequently, surgical operations can be performed in a reliable and secure manner.The laser transmission path 70 formed using the outer tube 80 is inserted into the forceps / forceps insertion path 19 of the endoscope tube 21 included in the operation unit 12. Therefore, the laser transmission path 70 can be disposed at the center of the forceps / forceps insertion path 19.The outer tube has a plurality of outer circumferential convex parts 82 and outer circumferential concave parts 83 continuously arranged in a circumferential direction of the outer tube 80 to form a gear-like cross section. Therefore, the laser transmission path 70 formed using the outer tube 80 can be positioned at the center of the forceps / forceps insertion path 19 with more certainty. In addition, smoke and mist can be absorbed by the accommodation guide paths 19 bformed by the outer circumferential concave parts 83 provided in the circumferential direction.The laser transmission path 70 includes the hollow waveguide path 90 inserted into the insertion space 81 of the outer tube 80 described above. In the laser transmission path 70, a plurality of fluids for treatment of the operation target area with the treatment laser light 57 acan be guided or guided with certainty.This will now be described in detail. The hollow waveguide path 90 is inserted into the insertion space 81 of the outer tube 80. Thus, the plurality of sub passages 84 and the cooling water passages 85 are provided outside the hollow waveguide path 90 along the longitudinal direction of the insertion space 81. Therefore, appropriate fluids are passed through the plurality of passages, for example, the cooling water passages 85 for the cooling water water 60 a, the cooling water recovery sub-passage 84 cfor recovering the cooling water 60 a, and the like. While a plurality of desired fluids are guided, the treatment laser light 57 acan be surely treated as the operation target area.The cooling water 60 afor cooling the hollow waveguide path 90 is supplied to the cooling water passages 85 such that the cooling water 60 aflows in a direction in which the treatment laser light 57 ais directed or guided. Therefore, the hollow waveguide path 90 heated by the treatment laser light 57 acan be cooled by the cooling water 60 aflowing in the fluid passage. Consequently, the laser transmission path 70 for providing the treatment laser light 57 afor treating the operation target area can be surely improved in durability.In the cooling water recovery sub-passage 84 cbetween the plurality of sub-passages 84, the cooling water 60 athat has cooled the hollow waveguide path 90 is allowed to flow or flow in a direction opposite to the direction in which the treatment laser light 57 ais guided. As the cooling water 60a is recovered. In this manner, the cooling water 60 acan be circulated. The hollow waveguide path 90 heated by the treatment laser light 57 acan be efficiently cooled.The treatment water 62 aof the diseased part (dispersed part treatment water) is supplied to the treatment water sub-passage 84 bof the diseased part (dispersed part treatment water) among the plurality of passages 84 such that the treatment water 62 aof the diseased part flows in the direction in which the treatment laser light 57 ais guided or directed, and then discharged to the diseased part. While the hollow waveguide path 90 which has been heated is cooled by the cooling water 60 a, the treatment water 62 afor the diseased part is discharged to the operation target area (diseased part) in the body, for example, with respect to the wall of the esophagus (esophagus), the wall of the stomach, or the like. Therefore, for example, while the operation target area (diseased part) is curved or the like, in order to securely obtain a visual field, for example, the operation target area can be securely treated with the treatment laser light 57 a.To the assist gas sub-passage 84 a, among the plurality of sub-passages 84, the assist gas 59 ais supplied such that the assist gas 59 aflows in the direction in which the treatment laser light 57 ais guided or directed, and is then output toward the diseased part. Therefore, while the hollow waveguide path 90 that has been heated is cooled by the cooling water 60 a, the assist gas 59 ais guided and discharged or ejected to the operation target area in the body, for example, with respect to the wall of the esophagus (esophagus), the wall of the stomach, or the like. As the treatment space is expanded and smoke and mist are also removed to securely obtain the visual field, for example, the operation target area can be securely treated with the treatment laser light 57 a.In the above description, carbon dioxide, which is more absorbable in the body than air, was used as the assist gas 59a. This results in the advantage described below. The treatment laser light 57a is guided through the hollow waveguide path 90. The support gas 59a is guided through the support gas sub-passage 84a which is located outside the hollow waveguide path 90 and inside the outer tube 80. That is, the treatment laser light 57 aand the assist gas 59 aare guided or guided by separate guide paths or guide paths. Consequently, a difficulty that would occur if the treatment laser light 57 aand the assist gas 59 awere guided through the same guide path, namely, the difficulty that the treatment laser light 57 ais absorbed by the assist gas 59 a, with the result that the operation target region cannot be irradiated with the treatment laser light 57 awith the desired output power does not occur. As a result, a decrease in the transmission efficiency of the treatment laser light 57a caused by such a difficulty can be prevented. The treatment laser light 57 aand the assist gas 59 aare guided without reducing the transmission efficiency of the treatment laser light 57 a. The assist gas 59a is discharged toward the operation target area, for example, in association with the wall of the esophagus (esophagus), the wall of the stomach, or the like. While the treatment space is expanded and smoke and mist are removed to securely obtain the visual field, for example, the operation target area can be securely treated with the treatment laser light 57 a.In other words, there is more freedom with respect to the combination of the assist gas 59 aand the treatment laser light 57 a. As a result, convenience is improved.The laser transmission path 70 includes the hollow waveguide path 90 inserted into the insertion space 81 of the outer tube 80. In the laser transmission path 70, smoke and mist are received by the receiving guide paths 19 bformed by the outer circumferential concave parts 83, and thus the operation target area can be treated with the treatment laser light 57 awith greater certainty.The operation unit 12 includes the laser oscillation portion 57, the central control portion 54, and the laser transmission path 70. The laser transmission path 70 is inserted into the forceps / forceps insertion path 19 of the endoscope tube 21. The front portion or tip of the laser transmission path 70 is disposed in the vicinity of the front opening or tip opening of the endoscope tube 21. Consequently, the front end or the tip of the laser transmission path 70 for providing the treatment laser light 57 acan be guided to the operation target area with high certainty.This will now be described in detail. Usually, the endoscope tube 21 has a plurality of channels. One of the channels includes an image fiber (image fiber). The imaging fiber has an imaging area 46 at an end thereof on the side of the main body or housing. Alternatively, the imaging fiber has an imaging region 46 at the foremost end or tip of the canal on the diseased part side. Consequently, the operator or operator can enable the front end or tip of the endoscope tube 21 to reach the operation target area while checking an image captured with the imaging area 46. Consequently, the front end or tip of the laser transmission path 70 inserted into the endoscope tube 21 and disposed in the vicinity of the foremost opening or tip opening of the endoscope tube 21 can be guided to a position very close to the operation target area. Therefore, the assist gas 59 acan be discharged toward the operation target area in the body, for example, in conjunction with the wall of the esophagus (esophagus), the wall of the stomach, or the like. Thus, the treatment room is expanded and smoke and mist are removed to securely obtain the visual field, for example. Thus, the operation target area can be securely treated with the treatment laser light 57 a.The operation unit 12 includes the laser oscillation portion 57, the central control portion 54, and the laser transmission path 70. The laser transmission path 70 is inserted into the forceps / forceps insertion path 19 of the endoscope tube 21 such that the tip of the laser transmission path 70 is disposed in the vicinity of the front opening or tip opening of the endoscope tube 21. The diseased part gas receiving portion 44 is connected to the outer circumferential concave parts 83. The accommodation guide paths 19b are formed by the outer circumferential concave parts 83. Therefore, the front end or the tip of the laser transmission path 70 for providing the treatment laser light 57 acan be guided to the operation target area with certainty.As the treatment laser light 57 a, carbon dioxide laser light (CO 2- gas laser light) is used. Therefore, a plurality of fluids for treating the operation target area can be safely guided. This will now be described in detail. As the treatment laser light 57 a, carbon dioxide laser light (CO 2- gas laser light) highly absorbable in water is used. Even if the treatment laser light 57 abbroads out, the treatment laser light 57 ais absorbed by water. Thus, the operation target area can be securely dealt with.In addition, since the treatment laser light 57 ais carbon dioxide laser light (CO 2- gas laser light), smoke and mist can be received by the outer circumferential concave parts 83 to treat the operation target area securely. This will now be described in detail. Carbon dioxide (CO 2- gas) laser light, which is highly absorbable in water and which is also highly absorbable in or on a surface of the living body, is used as treatment laser light 57 ain a clear visual field. Consequently, the operation target area can be irradiated with a minimum necessary amount of laser light and thus can be securely treated.CO 2- gas which is bioabsorbable is used as the assist gas 59a. Thereby, the assist gas 59 athat fills the operation target area can be absorbed after the surgery quickly, so that the feeling of extension or pain after the surgery can be suppressed. Even if the assist gas 59a enters a blood vessel, there is no risk of air embolism of the blood vessel because the assist gas 59a is bioabsorbable.As described above, the treatment laser light 57a is guided through the hollow waveguide path 90. The assist gas 59a is guided through the assist gas sub-passage 84a and the assist gas discharge hole 83 of the front or tip discharge outlet member 71. Therefore, the assist gas 59a is discharged to the operation target area in the body, for example, in association with the wall of the esophagus (esophagus), the wall of the stomach, or the like. While the treatment space is widened and smoke and mist are removed, for example, in order to securely obtain the visual field, the operation target area can be securely treated with the treatment laser light 57 a.The operation unit 12 may include a plurality of forceps / forceps insertion paths 19. In this operation unit 12, the laser transmission path 70 is inserted into one of the forceps / forceps insertion paths 19. The front or tip of the laser transmission path 70 is disposed in the front or tip structure portion 30 of the endoscope tube 21. The operation unit 12 also has an optical system including the illumination area 45 except for the forceps / forceps insertion paths 19. Therefore, while the image obtained by the illumination area 45 is being checked, the tip structure area 30 of the endoscope tube 21 of the operation unit 12 can be guided at a position very close to the operation target area.Accordingly, the assist gas 59a is discharged from the operation target area in the body, for example, in association with the wall of the esophagus (esophagus), the wall of the stomach, or the like. Consequently, the treatment space is widened and smoke and mist are removed to securely obtain the visual field, for example. Also, the operation target area can be securely treated with the treatment laser light 57 awhile checking the captured image.In the description given above, the outer tube 80 has the outer circumferential convex parts 82 and the outer circumferential concave parts 83 to obtain a gear-like cross section. Moreover, it has the sub-passages 84 at three locations in the insertion space 81, as viewed in cross section thereof. The laser transmission path 70 formed by using the outer tube 80 is inserted into the forceps / forceps insertion path 19 of the endoscope tube 21. The receiving guide paths 19b (inhalation guide paths) are formed between the inner surface of the forceps / forceps insertion path 19 and the outer circumferentially convex parts 82. The cooling water passages 85 are formed between the outer circumferential surface of the hollow waveguide path 90 and the inner circumferential surface of the outer tube 80. Alternatively, as illustrated in FIG. 6, the laser transmission path 70 may be formed using an outer tube having a different shape.For example, the outer tube 180 shown in Fig. 6(a) has a substantially triangular shape in a cross-sectional plan view. This triangular shape is formed by three convex apizes or peaks 182 and sides 183 provided therebetween. Sides 183 are recessed radially with respect to tips 182. In a cross-sectional plan view, the outer tube 180 has the insertion space 81 at the center thereof. Also, sub-passages 184 (184a, 184b, 184c) are provided in the vicinity of the tips 182, respectively.The introducing space 81 is formed to have a diameter larger by a certain amount than the hollow waveguide path 90 to be introduced thereinto, and a cooling water passage 185 is formed around the hollow waveguide path 90 introduced thereinto.The apizes or tips 182 are in contact with the inner circumferential surface 19a of the forceps / forceps insertion path 19 of the endoscope tube 21, and form the receiving guide paths 19b (inhalation guide paths) between the inner circumferential surface of the forceps / forceps insertion path 19 and the sides 183.The outer tube 280 of FIG. 6( b) has a substantially gear-shaped shape in a cross-sectional plan view. The generally gear-shaped shape is formed of outer circumferential convex parts 82 and inner circumferential concave parts 83. the outer tube 280 is shown to have the insertion space 81 at the center thereof in a cross-sectional plan view. A passage outside the insertion space 81 is equally divided into three areas in the circumferential direction of the insertion space 81, and thus three sub passages 284 ( 284 a, 284 b, 284 c) are formed.The outer tube 380 shown in FIG. 6( c) has an elliptical shape in a cross-sectional plan view. The elliptical cross section is longer in the up-and-down direction in FIG. 6( c). The bent or curved parts 382 at both ends of the longer axis of the elliptical cross section contact or contact the inner circumferential surface 19 aof the forceps / forceps insertion hole 19. the receiving guide paths 19 bare formed between bent or curved 383 at both ends of the shorter axis of the elliptical cross section and the inner circumferential surface 19 aof the forceps / forceps insertion hole 19.It can be seen in a cross-sectional plan view that the outer tube 380 has the insertion space 81 at its center and further has sub-passages 384 ( 384 a, 384 c) inside the curved or bent parts 383 (arcted parts) at both ends of the shorter axis. Cooling water passages 385 are formed around the hollow waveguide path 90 inserted into the insertion space 81.Due to this structure, the outer tubes 180, 280 and 380 of Figs. 6(a) to 6(c) provide substantially the same effects as the outer tube 80 described above.In the description given above, carbon dioxide laser light (CO 2- gas laser light) was used as the treatment laser light 57 a. Alternatively, however, any other suitable treatment laser light may be used.In the curved tube section 23 (curved tube section), the hollow waveguide path 90 can be inserted into a protective metal tube, so that the hollow waveguide path 90 is surrounded by the protective metal tube. Thus, it is possible for the operator to freely bend the bendable or curved tube portion 23 to perform the laser treatment with high reliability and high safety in an appropriate working environment.The laser treatment device 50 may include a SAG discharge portion for discharging or ejecting an appropriate gas that is not light-absorbing and non-bioabsorbable, for example, air or the like, as a assist gas (hereinafter referred to as "SAG"). With such a configuration, the treatment laser light 57 aand the SAG can be guided and guided and output from a central radiation hole 72 in the front or tip output outlet member 71 for treating the operation target area with the treatment laser light 57 a. In this case, both the treatment laser light 57 aand the SAG are ejected or outputted toward the guide space 92 of the hollow waveguide path 90. Therefore, leaking substances generated or having been generated by the cutting and the peeling of the operation target region performed using the treatment laser light 57 can be prevented from entering the central radiation hole 72 or the guide space 92.As SAG, air which is less bioabsorbable than CO 2- gas is used as the assist gas 59a. However, the SAG is certainly absorbed by the outer circumferential concave portions. In addition, the SAG sets the guide space 92 of the hollow waveguide path 90 under a positive pressure and is discharged or ejected at an amount and a pressure at which the penetration of precipitated substances into the central radiation hole 72 of the laser transmission path 70 is prevented. Therefore, the use of air as the SAG does not affect the occurrence of a feeling of stretching or pain after the surgical operation. In addition, the SAG is discharged or ejected in the above-described amount and pressure, and therefore there is no risk that an air embolism with respect to a blood vessel occurs, which would be caused when air entered the blood vessel and air bubbles remained therein. Consequently, the use of air as the SAG is safe.The laser light according to the present invention corresponds to the treatment laser light 57a in the described embodiment. The following correspondences are obtained in the same way:The endoscope outer tube corresponds to the endoscope tube 21.The transmission path insertion hole or the transmission path insertion hole corresponds to the forceps / forceps insertion path 19.The insertion hole or the insertion hole corresponds to the insertion space 81.The fluid passages correspond to the sub passages 84, 184, 284 and 384, the assist gas sub passages 84 a, 184 a, 284 aand 384 c, the diseased part treatment water sub passages 84 b, 184 band 284 b, the cooling water recovery sub passages 84 c, 184 c, 284 cand 384 c, and the cooling water passages 85, 185, 285 and 385.The inner surface of the transmission path insertion hole or the transmission path insertion hole corresponds to the inner circumferential surface 19 a.The protrusions correspond to the outer circumferential convex parts 82, the apexes 182, and the bent or curved parts 382 at both ends of the longer axis.The convex parts correspond to the outer circumferential concave parts 83, the sides 183, and the bent or curved parts 383 at both ends of the longer axis.The cooling water passage corresponds to the cooling water passage 85.The cooling water recovery passage corresponds to the cooling water recovery passage 84c.The flushing passage corresponds to the treatment water subpassage 84b for the diseased part.The assist gas passage corresponds to the assist gas sub-passage 84 a.The laser generation source corresponds to the laser oscillation region 57.The laser control region corresponds to the central region 54.The fluid receiving unit corresponds to the diseased part gas receiving portion 44.The fluid absorption passage corresponds to the receiving guide paths 19b.The laser treatment tool corresponds to the operation unit 12.However, the present invention is not limited to the above-described embodiment, but may be embodied in various forms.For example, the discharge amount or the discharge pressure of the assist gas 59 acan both be detected. The laser treatment system 1 may be deactivated when an abnormal value is detected. That is, in detail, by detecting the discharge amount or discharge amount or the discharge pressure or discharge pressure of the assist gas 59 a, whether the assist gas sub-passage 84 aor the assist gas discharge hole 73 through which the assist gas 59 ais to pass are blocked or defective or the like can be detected independently or relatively. If such blockage or damage occurs, accurate surgical treatment cannot occur and must not be performed. Therefore, stop control needs to be performed immediately by disabling the laser treatment system 1. Therefore, the laser treatment system 1 can ensure a high degree of reliability and safety.Industrial applicabilityThe present invention can be used in various apparatuses for treating a living organism using laser light. In particular, the present invention can be applied to a device for performing treatment and surgical operation using laser light transmitted within a limited space, for example, an endoscope while guiding various fluids into the limited space.List of reference characters12 Operation / operation unit 19 Forceps / forceps insertion path 19 a Innere circumferential surface 19 b Inhalations guide path 21 Endoscope tube 44 Diseased part gas inhalation region 54 Central control region 57 Laser oscillation region 57 aTreatment laser light 59 a Unterstützungs gas 60 a Kühlwasser water 62 a Behandlungs water for diseased part 70 Laser transmission path 75 Kühlwasser water circulation path 80 Outer tube / outer tube 180 Outer tube / outer tube 280 Outer tube / outer tube 380 Outer tube / outer tube 81 Insertion space 82 Convex outer circumferential portion 84 Concave outer circumferential portion 84 Part / sub-passage or passage 184 Part / sub-passage or passage 284 Part / sub-passage or passage 384 Part / sub-passage or passage 84 a Unterstützungs gas part / sub-passage or passage 184a Support gas sub / sub passage or passage 284a Support gas sub / sub passage or passage 384a Support gas sub / sub passage or passage 84b Treatment water sub / sub passage or passage for treated part 184b Treatment water sub / sub passage or passage for treated part 284b Treatment water sub / sub passage or passage for treated part 84c Cooling water recovery sub / sub passage or passage 184c Cooling water recovery sub / sub passage or passage 284c Cooling water recovery sub / sub passage or passage 3c4c Cooling water recovery sub / sub passage or passage 85 Cooling water passage or passage 185 Cooling water passage or passage 285 Cooling water passage or passage 385 Cooling water passage or feedthrough 90 hollow waveguide path 182 apex, tip 183 side 382 arc portion or bent portion at an end of the long axis or longitudinal axis 383 arc portion or bent portion at an end of the short axis or longitudinal axis

Claims

A laser treatment tool (12) comprising an outer tube (80) for forming a laser transmission path (70) together with an elongated hollow waveguide path (90) for guiding laser light, the outer tube (80) being formed with an inner insertion hole (81) into which the hollow waveguide path (90) is inserted, the outer tube (80) having a plurality of fluid passages (84, 84a, 84b, 84c, 85) disposed outside the hollow waveguide path (90) inserted in the insertion hole (81) along a longitudinal direction of the insertion hole (81), the laser treatment tool (12) being insertable into a transmission path insertion hole (19) of an endoscope outer tube (21), characterized in that the outer tube (80) further comprises: protrusions (82), which are disposed at at least two positions in a cross-sectional view of the outer tube (80) and project in a radial direction such that, in the state in which the outer tube (80) is inserted into the transmission path insertion hole (19), tips of the projections (80) are in contact with an inner surface (19a) of the transmission path insertion hole (19), and gap forming parts (83) for forming gaps together with the inner surface (19a) of the transmission path insertion hole (19), the gaps being formed between adjacent projections (82) of the at least two projections (82) such that fluid passages (84, 84a, 84b, 84c, 85) are formed by the gap forming parts (83).The laser treatment tool (12) according to claim 1, wherein the plurality of fluid passages (84, 84a, 84b, 84c, 85) are disposed between the hollow waveguide path (90) inserted in the insertion hole (81) and an inner surface (19a) of the transmission path insertion hole (19) at an equal distance with respect to the inner surface (19a).The laser treatment tool (12) according to claim 1 or 2, wherein: the outer tube (80) has a plurality of convex and concave parts (82, 83) to form a gear-like cross section, and the convex and concave parts (82, 83) form the protrusions (82) and the gap forming parts (83).The laser treatment tool (12) according to claim 1 or 2, wherein: the outer tube (80) has a polygonal cross section, and vertices of the polygonal cross section form the protrusions (82), and sides of the polygonal cross section form the gap forming parts (83).The laser treatment tool (12) according to claim 1 or 2, wherein: the outer tube (80) has an elliptical cross section, and arc-shaped parts at ends of a longer axis of the elliptical cross section form the protrusions (82), and arc-shaped parts at ends of a shorter axis of the elliptical cross section form the gap forming parts (83).The laser treatment tool (12) according to any one of the preceding claims, wherein one of the plurality of fluid passages (84, 84a, 84b, 84c, 85) is a cooling water passage (85) for supplying cooling water for cooling the hollow waveguide path (90) such that the cooling water flows in a direction in which the laser light is guided.The laser treatment tool (12) according to claim 6, wherein one of the plurality of fluid passages (84, 84a, 84b, 84c, 85) different from the cooling water passage (85) is a cooling water recovery passage (84c) for allowing the cooling water that has cooled the hollow waveguide path (90) to flow in an opposite direction to the direction in which the laser light is guided so as to recover the cooling water.The laser treatment tool (12) according to claim 6, wherein one of the plurality of fluid passages (84, 84a, 84b, 84c, 85) different from the cooling water passage (85) is a flushing passage (84b) for supplying flushing water such that the flushing water flows in the direction in which the laser light is guided and is discharged toward the diseased part.The laser treatment tool (12) according to claim 6, wherein one of the plurality of fluid passages (84, 84a, 84b, 84c, 85) different from the cooling water passage (85) is a support gas passage (84a) for supplying support gas such that the support gas flows in the direction in which the laser light is guided and is discharged toward the diseased part.The laser treatment tool (12) according to any one of the preceding claims, further comprising: a laser generation source (57); and a laser control portion (54), wherein, in the inserted state into the endoscope outer tube (21), a tip of the laser transmission path (70) is disposed in the vicinity of a tip opening of the endoscope outer tube (21).The laser treatment tool (12) according to claim 10, wherein a fluid inhalation unit is connected to the gap forming parts (23) forming the fluid absorption passages (19b).The laser treatment tool (12) of any preceding claim, wherein the laser light is carbon dioxide laser light.Endoscope device (10) having a laser treatment tool (12) according to one of the preceding claims, which is inserted into an endoscope outer tube (21) of the endoscope device (10).

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