Endoscope with a controllable movable intermediate section proximal to the bending section

Abstract

Endoscope with an endoscope control body (1) with control elements (11, 12), a flexible insertion tube (2) on the distal side of the endoscope control body (1), and a bending section (4) at the distal end of the endoscope, wherein a controllable movable intermediate section (3) is provided proximal to the bending section (4) as a section of the flexible insertion hose (2), in a wall area of ​​the intermediate section (3) at least one pull rope (31 - 34) extends which can be controlled from the proximal side in order to cause a curvature of the intermediate section (3) as a controlled movement, that at least one pull rope (31 - 34) runs spirally in the extension direction of the intermediate section (3), characterized by the fact that the wall area of ​​the intermediate section (3) is an elastic rubber tube in which spiral channels for the respective pull ropes (31 - 34) are formed in the longitudinal direction, a ring element (30) is arranged at the distal end of the intermediate section (3), wherein at least one pull rope (31 - 34) is anchored to the ring element (30), and the spiral channels in the intermediate section (3) run exclusively in a spiral manner and have a distal end at the ring element (30).

Description

[0001] The invention relates to an endoscope having an endoscope control body with control elements, a flexible insertion tube on the distal side of the endoscope control body, and a bending section at the distal end of the endoscope.

[0002] Such an endoscope can be used to examine, for example, the intestine or esophagus or also the duodenum, the bile duct, the gall bladder, the pancreatic duct, the pancreas, etc.

[0003] Such an endoscope is inserted into a patient's body tract (intestine, esophagus, etc.) and pushed through to the desired examination site. It is almost impossible to avoid the outer wall of the endoscope touching the inner wall of the body tract as the endoscope is advanced. If the pressure of the endoscope on the inner wall of the body tract becomes too great, if the inner wall of the body tract has a previous injury, or if the same spot on the inner wall of the body tract is repeatedly pressed with the endoscope, the inner wall of the body tract can be injured.

[0004] US 2017 / 0042412 A1 discloses three bending sections arranged one behind the other. Each bending section has an assigned control actuator, such as a motor, whose axis is connected to the proximal end of the respective traction cable. The traction cables run straight, i.e., parallel to the axis of an endoscope.

[0005] US 2015 / 0164594 A1 discloses a complex robotic surgical system in which, among other things, tubular sheaths with a spiral arrangement of traction cable elements can be used.

[0006] The present invention aims to provide an endoscope which reduces the risk of injury to an inner wall of the body tract into which the endoscope is inserted.

[0007] This object is achieved by an endoscope having the features of claim 1. An alternative endoscope is shown in claim 2.

[0008] Advantageous further training is the subject of dependent claims.

[0009] In the invention, an endoscope comprises an endoscope control body with control elements, a flexible insertion tube at the distal side of the endoscope control body, and a bending section at the distal end of the endoscope. Proximal to the bending section, a controllable, movable intermediate section is provided as a section of the flexible insertion tube.

[0010] At least one traction cable extends through a wall region of the intermediate section, which can be controlled from the proximal side to effect a curvature of the intermediate section as a controlled movement. The at least one traction cable runs spirally in the direction of extension of the intermediate section.

[0011] In claim 1, the wall region of the intermediate section is an elastic rubber hose in which spiral channels for the respective traction cables are formed in the longitudinal direction, a ring element is arranged at the distal end of the intermediate section, wherein the at least one traction cable is anchored to the ring element, and the spiral channels in the intermediate section run exclusively in a spiral manner and have a distal end on the ring element.

[0012] In claim 2, a joint system is provided in the intermediate section, which consists of joint members fastened to one another and pivotable relative to one another, on the outer surfaces of which the traction cables are anchored in a spiral-like manner so as to be displaceable in the longitudinal direction of the intermediate section.

[0013] The controllable, movable intermediate section enables active, controllable movement of the flexible insertion tube to assist insertion into a specific body tract. This allows obstacles resulting from the shape of the specific body tract to be more easily overcome through repeated, active, controllable movement of the flexible insertion tube. The risk of injury to the inner wall of the body tract is reduced.

[0014] The controllable, movable intermediate section can be adjacent to the bending section. Thus, the controllable, movable intermediate section is located as distally as possible. The distal section of the flexible insertion tube is inserted into the body tract first. The more proximal sections of the flexible insertion tube follow the movement of the distal section of the flexible insertion tube within the body tract.

[0015] At least one traction cable can extend through a wall region of the intermediate section, which can be controlled from the proximal side to effect a curvature of the intermediate section as a controlled movement. Thus, the active control process of the movement of the movable intermediate section is realized in a particularly simple and easy-to-handle manner.

[0016] At least one traction cable can run spirally in the direction of extension of the intermediate section. This spiral shape allows for a particularly simple but effective controllable movement of the movable intermediate section.

[0017] A number of pull ropes can be provided in a wall area of ​​the intermediate section. The numerous pull ropes can be operated alternately.

[0018] The pull cable(s) can be independent of one or more pull cables of the bending section at the distal end of the endoscope. Thus, the intermediate section has its own separate control system, dedicated exclusively to controlling the movement of the intermediate section.

[0019] The endoscope control body can contain at least one control element for the pull cable. This makes it easy for the user to control the movement of the intermediate section. They are accustomed to finding the control elements in the endoscope control body.

[0020] The control element for the pull rope control can be operated manually.

[0021] Alternatively, the control element for the traction cable control may comprise a drive device.

[0022] The drive device can be a motor that rhythmically pulsates the tensioning and releasing of the respective tension wires. This can achieve a rhythmically pulsating movement of the intermediate section.

[0023] The wall area of ​​the intermediate section can be an elastic rubber hose with spiral channels formed longitudinally for the respective traction cables. Thus, the traction cables do not increase the thickness of the flexible insertion tube. The spiral shape is clearly and permanently predefined.

[0024] Alternatively, a joint system can be provided in the intermediate section, which consists of joint members fastened to one another and pivotable relative to one another, on the outer surfaces of which the tension wires are anchored in a spiral manner in the longitudinal direction of the intermediate section.

[0025] At least in the intermediate section, a support element can extend axially centrally. This can support the controlled movement of the intermediate section. An existing element, such as a working channel, a flushing channel, etc., can be used as such a support element.

[0026] The endoscope can be a duodenoscope, a colonoscope, a gastroscope, or a bronchoscope. However, the endoscope can also be any other type of endoscope.

[0027] The above-explained aspects of the present invention can be suitably combined. Short description of the drawing Fig. 1 shows a schematic perspective view of an endoscope of an embodiment of the present invention. Fig. Figure 2 shows a schematic perspective view of a controllable movable intermediate section of the present invention. Fig. Figure 3 shows a schematic perspective view of the controllable movable intermediate section of the present invention, with the outer shell shown transparent for clarity. Fig. Figure 4 shows a schematic perspective view of the controllable movable intermediate section of the present invention, wherein the outer shell is shown transparent for better understanding and a pull cable is pulled. Fig. Figure 5 shows a schematic perspective external view of the controllable movable intermediate section of the present invention, wherein a first traction cable is pulled. Fig. Figure 6 shows a schematic perspective external view of the controllable movable intermediate section of the present invention, wherein a second traction cable is pulled. Fig. 7 shows a schematic view of an intermediate portion of another embodiment of the present invention. Fig. Figure 8 shows a schematic view of a colon using an endoscope of the present invention. Fig. Figure 9 shows a schematic view of the colon of Fig. 8, with the endoscope in the same insertion position as in Fig. 8 and by pulling the pull ropes a wave movement of the endoscope tube is generated. Fig. Figure 10 shows a schematic view of the colon of Fig. 8 and Fig. 9, wherein the endoscope of the present invention is opposite to the position of Fig. 9 is pushed slightly further and by pulling the pull ropes a wave movement of the endoscope tube is still generated.

[0028] The present invention is described in detail below with reference to the drawings using exemplary embodiments. First embodiment

[0029] Fig. 1 shows a schematic perspective view of an endoscope of an embodiment of the present invention.

[0030] The endoscope according to the invention has an endoscope control body 1 and, distally adjoining the endoscope control body 1, a flexible insertion tube 2, the endoscope tube. The endoscope tube 2 has a controllable, movable intermediate section 3, which distally adjoins the section of the conventional flexible insertion tube 2. A bending section 4 is provided at the distal end of the endoscope. The bending section 4 is provided distally of the controllable, movable intermediate section 3.

[0031] The bending section 4 has an endoscope head 5 on its distal side. The bending section 4 is operated by control wires (not shown) which are actuated by a control element attached to the endoscope control body 1, such as a control wheel 11 and a control wheel 12. The control wires (not shown) extend through the endoscope, i.e. through the endoscope control body 1, the flexible insertion tube 2 and the controllable, movable intermediate section 3. For example, four control wires can be provided for the bending section 4. In particular, by actuating the control element (turning the control wheel 11), the control wires for the bending section 4 are tensioned or released such that the bending section 4 executes a bend in the desired direction. An endoscope head 5 is arranged at the distal end of the bending section 4.

[0032] The endoscope control body 1 is connected to an endoscope plug via a cable 10.

[0033] The controllable movable intermediate section 3 is described in more detail below.

[0034] The controllable movable intermediate section 3 forms part of the endoscope tube 2. More precisely, the intermediate section 3 forms a distal section of the endoscope tube 2 and borders on the bending section 4.

[0035] The endoscope tube 2 is formed as a sheath element (hollow tube) through which necessary devices extend to the bending section 4 and the endoscope head 5, such as a working channel, the pulling cables (Bowden cables) for the bending section 4, signal lines for a camera and a lighting device, and further endoscope supply lines, etc. The material used for the endoscope tube 2 is rubber or plastic.

[0036] The controllable, movable intermediate section 3 thus has a casing made of rubber or plastic. This casing contains traction cable channels that are exclusively intended for traction cables 31, 32, 33, 34 of the intermediate section 3. These traction cable channels each extend spirally along the longitudinal direction of the intermediate section 3. In the exemplary embodiment, four traction cable channels are provided, each for one of the traction cables 31, 32, 33, 34. The traction cable channels each have the same spiral shape and are offset from one another by 90 degrees in the circumferential direction.

[0037] The controllable movable intermediate section 3 has a ring element 30 on the distal side. The distal ends of the traction cables 31, 32, 33, 34 are anchored to the ring element 30 and open into their respective traction cable channels and extend spirally in the proximal direction.

[0038] The traction cable channels end at the proximal end of the intermediate section 3. From the proximal end of the intermediate section 3, the traction cables 31, 32, 33, 34 preferably extend straight to their control element described below.

[0039] Fig. 2 shows the intermediate section 3 and the bending section 4 from the outside, whereby the position of an imaginary generatrix 3A on the intermediate section 3 is indicated.

[0040] Fig. 3 shows the intermediate section 3 and the bending section 4 in the same position as in Fig. 2, where the respective outer sheath is shown transparent for better understanding. The spiral course of the traction cables 31, 32, 33, 34 in the intermediate section 3 is clearly visible. Furthermore, Fig. 3 shows how the traction cables 31, 32, 33, 34 leaving the traction cable channel formed in the intermediate section 3 extend straight in the proximal direction.

[0041] A support element (not shown) extends axially in the center of the intermediate section 3, as seen in cross-section. This support element extends, at least in the intermediate section 3, along the center axis of the intermediate section 3. A working channel or another element present in the endoscope can function as such a support element.

[0042] In the Fig. 2 and Fig. 3, the pull cables 31, 32, 33, 34 are in the deactivated position. In other words, none of the pull cables 31, 32, 33, 34 are pulled.

[0043] Fig. 4 shows a situation where, starting from the position in Fig. 3 one of the pull ropes 31, 32, 33, 34, namely the pull rope 31 is pulled in the proximal direction, see arrow F. The pulling of the pull rope is carried out by the control device explained below (not shown).

[0044] As from Fig. As can be seen in Figure 4, the traction cable 31 straightens when pulled. Thus, the pulled traction cable 31 exerts a force on the channel wall of its traction cable channel, which stretches the spiral shape of the traction cable channel in the elastic casing of the intermediate section 3. In other words, the traction cable channel of the pulled traction cable 31 shortens elastically. The mean length of the intermediate section 3 remains the same (constant). As a result, the intermediate section 3 deforms in a spiral shape.

[0045] The surface line 3A of the intermediate section 3, which is spirally deformed by pulling the first traction cable 31, is in Fig. 5 recognizable.

[0046] Thus, by pulling a traction rope in the intermediate section 3, a wave movement is generated.

[0047] If the first pulling cable 31 is released again and a second pulling cable 32 is pulled, the wave shape of the intermediate section 3 changes to another spiral in which the pulling cable channel of the pulled pulling cable 32 is stretched, see Fig. 6.

[0048] In other words, by successively pulling the various tension cables 31, 32, 33, and 34 and releasing the previously pulled tension cable, the position of the bends in intermediate section 3 shifts. One spiral shape alternates with another. If the tension cables 31, 32, 33, and 34 are pulled one after the other in the fastening sequence, one spiral shape alternates with another spiral shape offset by 90 degrees in the cross-section of intermediate section 3.

[0049] The traction cables 31, 32, 33, 34 can be alternately pulled and released by a control element arranged on the endoscope control body 1. Second embodiment

[0050] Fig. 7 shows a schematic view of an intermediate section 3 of a second embodiment of the present invention.

[0051] In the first embodiment, the traction cables 31, 32, 33, 34 are arranged in their spiral-shaped traction cable channels, which are formed in the casing of the intermediate section 3.

[0052] The second embodiment differs from the first embodiment in that the intermediate section 3 is not designed as an elastic hose but as a type of link chain.

[0053] As in Fig. As shown in Figure 7, the intermediate section 3 has a link chain as a joint system adjacent to the distal ring 30.

[0054] The link chain is formed from individual intermediate section elements 35 that are articulated to one another and function as link chain links or link rings. Each of these link chain links 35 is ring-shaped. The ring shape of the link chain link 35 has an end face as a first side and a second side opposite the first side. Each of the link chain links 35 has two opposing, radially extending joint projections 36. The joint projections 36 are provided on the first side of the ring shape of the link chain link 35. On the second side, the link chain link 35 has two opposing joint flanges 37 that extend axially away from the ring shape. Each joint flange 37 has a through opening in the radial direction. On the respective link chain link 35, the joint flanges 37 are arranged not only on opposite sides but also rotated by 90 degrees in the circumferential direction relative to the joint projections 36.The joint projections 36 engage with the openings of the joint flanges 37 of the adjacent link chain link 35. Thus, the link chain links 35 are connected to one another via the joint projections 36 and joint flanges 37 to form a long chain and are articulated to one another.

[0055] Each link chain link 35 has four eyelets 38 on its outer circumferential surface, which are equally spaced along the same circumferential line. The openings of the eyelets 38 are aligned in the proximal / distal direction.

[0056] Tension cables 31, 32, 33, 34 extend through the eyelets 38 in a spiral manner along the longitudinal direction of the intermediate section 3, as shown in Fig. 7 is shown.

[0057] Thus, each traction cable 31, 32, 33, 34 is supported and guided on the outer circumference of each link chain link 35 in such a way that the spiral shape is formed along the longitudinal direction of the intermediate section. The traction cables 31, 32, 33, 34 are guided by the eyelets 38. As an alternative to the eyelets 38, projections arranged radially extending on the outer circumference of each link chain link 35 can also be used.

[0058] Above the link chain links 35 connected to each other to form a long chain, there is a Fig. 7 elastic protective hose not shown.

[0059] Otherwise the function is the same as in the first embodiment.

[0060] It should also be noted that other joint systems can also be used in an intermediate section according to the invention. Control and drive

[0061] In all embodiments, the pull cables 31, 32, 33, 34 can be alternately pulled and relieved by a control element arranged on the endoscope control body 1.

[0062] The control of the traction cables 31, 32, 33, 34 can be done manually.

[0063] For example, an eccentric can be arranged in the endoscope control body 1, to which the four traction cables 31, 32, 33, 34 engage, each offset by 90° to each other. This eccentric can be designed as an eccentric pin to which the four traction cables 31, 32, 33, 34 are suspended in different directions.

[0064] Alternatively, a crankshaft extending perpendicular to the axis of the endoscope control body 1 can be used. The crankshaft has four mutually eccentric shaft sections (multiple cranks) in the longitudinal direction. A disk is rotatably mounted on each shaft section. The proximal end of one of the traction cables 31, 32, 33, 34 is anchored to the outer circumference of each disk. Rotating the crankshaft causes the respective disks to move alternately in the proximal and distal directions. Due to the mutually eccentric shaft sections, the disks and thus the proximal ends of the respective traction cables 31, 32, 33, 34 are moved alternately in the proximal and distal directions.

[0065] Alternatively, a swash plate can be used, in which all four traction cables 31, 32, 33, 34 can be arranged parallel to each other.

[0066] A camshaft can be used.

[0067] Any mechanism that produces an oscillating linear (translational) movement in the traction cables 31, 32, 33, 34 can be used.

[0068] The resulting alternating periodic operation of the traction cables 31, 32, 33, 34 is particularly advantageous.

[0069] A crank for manual operation can be used to drive the eccentric or swash plate, crankshaft, etc.

[0070] In a preferred variant, the control of the traction cables 31, 32, 33, 34 is carried out by a motor. In this case, the direction of rotation, i.e., forward / backward, the speed, and possibly the amplitude can be selected via switches or controls on the handle of the endoscope control body 1.

[0071] Thus, the traction cables 31, 32, 33, 34 can be controlled in such a way that a manual or motor drive is obtained in which the traction cables 31, 32, 33, 34 are periodically pulled and relieved in a phase-shifted manner.

[0072] This allows the tension cables 31, 32, 33, and 34 to be periodically pulled and released one after the other in a predetermined direction of rotation, resulting in a wave-like motion of the intermediate section 3. This wave-like motion of the intermediate section 3 is not propulsion but rather an oscillating movement in which a helix appears to rotate around its axis. This wave-like motion of the intermediate section 3 is similar to that of a winding worm.

[0073] The drive can be designed so that it is activated when needed. When the drive is not in use, the tension on the pull cables 31, 32, 33, and 34 is relaxed. In this position, the endoscope according to the invention behaves like a conventional endoscope.

[0074] The frequency and amplitude of the drive mechanism can be controllable.

[0075] The direction of rotation of the drive mechanism can be reversible. Application

[0076] The Fig. 8 - 10 show an example of an application of the endoscope according to the invention in the colon 100.

[0077] In Fig. 8, the endoscope according to the invention has been advanced through the rectum 101 and the descending colon 102 into the transverse colon 103 of the large intestine 100. Relatively strong changes in direction, such as at the transition from the descending colon 102 to the transverse colon 103, complicate the advancement of the endoscope.

[0078] In the situation of Fig. 8, the bending section 4 and the distal region of the intermediate section 3 have already passed the directional changes at the transition from the descending colon 102 to the transverse colon 103. In this situation, further advancement of the endoscope may be difficult due to an unfavorable relative position between the inner wall of the colon and the intermediate section 3 of the endoscope.

[0079] In the situation of Fig. 8, a wave motion is generated in the intermediate section 3 by alternately pulling, preferably rhythmically pulsating, the traction cables. This permanently changes the relative position between the inner wall of the colon and the intermediate section 3 of the endoscope. Fig. 9 shows the same insertion position of the endoscope as in Fig. 8, whereby the relative position between the inner wall of the colon and the intermediate section 3 has changed due to the pulling of the traction cables and the resulting wave movement of the endoscope tube. The arrow W indicates the shift in the wave position of the intermediate section 3.

[0080] This constant change in relative position results in a relative position between the inner wall of the colon and intermediate segment 3, which makes it easier to advance the endoscope. The undulating movement of intermediate segment 3 temporarily coincides well with the intestinal flexions. Fig. Figure 10 shows a schematic view of the colon of Fig. 8 and Fig. 9, whereby the endoscope relative to Fig. 9 is pushed slightly further, and the wave motion of the endoscope tube continues to be generated by pulling the pull cords. Arrow S indicates the advancement of the endoscope. Advantages of the invention

[0081] The user can thus pull the pull ropes alternately, preferably in a rhythmic pulsation, and wait for those moments when advancing the endoscope is easy.

[0082] The advancing waveform facilitates the endoscope's gliding in the insertion direction. The endoscope can twist like a worm, wiggling past obstacles and thus overcoming them.

[0083] Not only is the advancement of the endoscope made easier by the present invention, but since the intermediate section 3 does not repeatedly press on the same spot on the inner wall of the colon during advancement of the endoscope, the risk of injury to the inner wall of the colon can also be reduced.

[0084] This reduces the risk of injury to the inner wall of the body tract into which the endoscope is inserted. Other alternatives

[0085] In the exemplary embodiments, the controllable, movable intermediate section 3 forms part of the endoscope tube 2. Furthermore, the intermediate section 3 forms a distal section of the endoscope tube 2 and borders the bending section 4. Alternatively, a further section of the endoscope tube 2 of a predetermined (short) length, which is not provided with the tension cables 31-34, can be located between the intermediate section 3 and the bending section 4. In this alternative, the intermediate section 3 and the bending section 4 are (slightly) spaced apart.

[0086] In a further alternative, the intermediate section 3 provided with the pull cables 31 - 34 can extend over the entire length of the endoscope tube 2.

[0087] In the exemplary embodiments, four traction cables 31, 32, 33, 34 are provided. Alternatively, two, three, five, or more traction cables may be provided.

[0088] In the first embodiment, the pull cable channels each have the same spiral shape relative to one another. The invention is not limited to this. The pull cable channels can have different spiral shapes relative to one another. This does, however, result in the shape of the winding movement of the intermediate section 3 becoming more uneven when the pull cables are alternately pulled. Nevertheless, a wave-like movement of the intermediate section 3 results, which supports the advancement of the endoscope.

[0089] In the first embodiment, the traction cable channels (and thus the traction cables) are arranged offset by 90 degrees from each other, viewed in cross-section. The invention is not limited to this. The traction cable channels and traction cables can be arranged offset from each other at a distance other than 90 degrees.

[0090] The endoscope according to the invention can be used in any body tract. List of reference symbols 1 endoscope control body 2 flexible insertion tube 3 controllable movable intermediate section 3A imaginary surface line 4 Bending section 5 Endoscope head 10 Cable to the endoscope connector 11 Steering wheel 12 Steering wheel 30 ring element 31 Pull rope 32 traction rope 33 Pull rope 34 traction rope 35 link chain link 36 joint projection 37 Joint flange with opening 38 eyelet 100 colon 101 Rectum 102 descending colon 103 Transverse colon

Claims

[1] Endoscope with an endoscope control body (1) with control elements (11, 12), a flexible insertion tube (2) on the distal side of the endoscope control body (1), and a bending section (4) at the distal end of the endoscope, wherein a controllable movable intermediate section (3) is provided proximal to the bending section (4) as a section of the flexible insertion tube (2), in a wall region of the intermediate section (3) at least one traction cable (31 - 34) extends, which is controllable from the proximal side in order to effect a curvature of the intermediate section (3) as a controlled movement, the at least one traction cable (31 - 34) runs spirally in the direction of extension of the intermediate section (3), characterized by , that the wall area of ​​the intermediate section (3) is an elastic rubber hose in which spiral channels for the respective traction cables (31 - 34) are formed in the longitudinal direction, a ring element (30) is arranged at the distal end of the intermediate section (3), wherein the at least one traction cable (31 - 34) is anchored to the ring element (30), and the spiral channels in the intermediate section (3) run exclusively spirally and have a distal end on the ring element (30). [2] Endoscope with an endoscope control body (1) with control elements (11, 12), a flexible insertion tube (2) on the distal side of the endoscope control body (1), and a bending section (4) at the distal end of the endoscope, wherein a controllable movable intermediate section (3) is provided proximal to the bending section (4) as a section of the flexible insertion tube (2), in a wall region of the intermediate section (3) at least one traction cable (31 - 34) extends, which is controllable from the proximal side in order to effect a curvature of the intermediate section (3) as a controlled movement, the at least one traction cable (31 - 34) runs spirally in the direction of extension of the intermediate section (3), characterized by , that in the intermediate section (3) a joint system is provided which consists of joint members fastened to one another which can pivot relative to one another and on the outer surfaces of which the traction cables (31 - 34) are anchored in a spiral manner so as to be displaceable in the longitudinal direction of the intermediate section (3). [3] Endoscope according to claim 1 or 2, wherein the controllable movable intermediate section (3) is adjacent to the bending section (4). [4] Endoscope according to one of claims 1 to 3, wherein a plurality of traction cables (31 - 34) are provided in a wall region of the intermediate section (3). [5] Endoscope according to one of claims 1 to 4, wherein the traction cable or cables (31 - 34) is or are independent of one or more traction cables of the bending section (4) at the distal end of the endoscope. [6] Endoscope according to one of claims 1 to 5, wherein at least one control element for the traction cable control of the intermediate section (3) is provided in the endoscope control body (1). [7] Endoscope according to claim 6, wherein the control element for the pull cable control is manually operable. [8] Endoscope according to claim 6, wherein the control element for the pull cable control comprises a drive device. [9] Endoscope according to claim 8, wherein the drive device is a motor which controls a respective tensioning and unloading of the respective traction cables (31 - 34) in a rhythmically pulsating manner. [10] Endoscope according to one of claims 1 to 9, wherein at least in the intermediate section (3) a support element extends axially centrally.

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