Endoscopic instruments

Abstract

The present invention provides an endoscopic treatment instrument. The endoscopic treatment instrument includes (a) a base having a through-opening configured to accommodate an endoscope, (b) a structural part coupled to the base and having an internal cavity, and (c) a working tube provided in the internal cavity for accommodating surgical instruments, wherein the structural part includes one or more movable arms configured to transition between an open configuration and a closed configuration.

Description

[Technical Field]

[0001] The present invention generally relates to the field of surgical instruments, and particularly to a treatment instrument for use with an endoscope for performing surgical procedures, biopsies and other testing procedures with minimal invasion. [Background Art]

[0002] An endoscope is an elongated device for viewing the interior of the body, and usually includes a light source and means for transmitting an image from a region of interest in the body to a physician. Many endoscopes are also equipped with surgical tools or provided with an internal channel that allows insertion of a surgical tool to the region of interest to perform surgery, biopsy and other procedures. Current endoscopic submucosal dissection (ESD) procedures are performed using an endoscope with a single working channel, which cannot be said to be sufficient in terms of instrument operability, triangulation, stability and power transmission.

[0003] Carbon dioxide (CO2) insufflation is commonly used to stabilize and support the surgical field during endoscopic procedures. However, CO2 insufflation may not only lead to flatulence and postoperative patient discomfort, but also poses the risk of CO2 embolism. Dual-channel endoscopes capable of holding multiple endoscopic instruments have also been developed to enable triangulation. However, due to the narrow spacing between the channels, the instruments cannot be moved independently of the endoscope, which results in insufficient angles for triangulation. Furthermore, the addition of such working channels cannot solve the problem of insufficient power transmission at the distal end of the endoscope, because the movement of the additional instrument is controlled by the endoscope, the transmitted power is the same as that of a single-channel endoscope, and the movement of the instrument will follow the movement of the endoscope.

[0004] Therefore, there is a need for an endoscopic treatment instrument that can overcome the drawbacks of the prior art. Other desirable features and characteristics will become apparent from the following detailed description of the invention and the appended claims, when read in conjunction with the accompanying drawings and this disclosure of background art. [Overview of the project]

[0005] In one aspect of the present invention, an endoscopic treatment instrument can be provided. The endoscopic treatment instrument includes (a) a base having a through-opening configured to accommodate an endoscope, (b) a structural part coupled to the base and having an internal cavity, and (c) a working tube provided in the internal cavity for accommodating surgical instruments, the structural part including one or more movable arms configured to transition between an open configuration and a closed configuration.

[0006] In one embodiment, the endoscopic instrument according to the present disclosure may further include an overtube having a proximal end and a distal end, the distal end of which may be connected to the end opposite to the structural part of the base.

[0007] In one embodiment, the sheath tube may include a plurality of rings.

[0008] In one embodiment, the outer tube may include a guide channel, and the guide channel and the through-opening may be aligned to accommodate the endoscope.

[0009] In one embodiment, the sheath may include a plurality of auxiliary conduits for housing a plurality of cables.

[0010] In one embodiment, the outer tube may include an inner wall and an outer wall, the inner wall defining a main path, and a plurality of auxiliary paths provided in the space between the inner wall and the outer wall.

[0011] In some embodiments, the endoscopic instrument according to the present disclosure may further include a plurality of cables. At least one of the plurality of cables may terminate on the structure in order to transition the structure between an open and a closed configuration. At least one of the plurality of cables may terminate on the working tube in order to guide a surgical instrument.

[0012] In one embodiment, the base may further include a plurality of auxiliary through-holes for accommodating a plurality of cables.

[0013] In one embodiment, the structure may include two movable arms facing each other on either side within an internal cavity. When the two movable arms are in the open position, they may be configured to extend outward away from the longitudinal axis extending along the length of the structure.

[0014] In some embodiments, the endoscopic instrument according to the present disclosure may further include an outer sheath for covering a structural part.

[0015] In one embodiment, the motion of the work tube may include translational motion of the work tube along the x, y, and / or z axes, and rotational motion of the surgical instrument along the pitch axis (vertical oscillation axis), yaw axis (deviation axis), and / or roll axis (lateral oscillation axis).

[0016] In one embodiment, the surgical instrument may be selected from the group consisting of gripping devices, electrocautery devices, sutures, loops, forceps, scissors, suction devices, injectors, clamps, and irrigation devices.

[0017] In one embodiment, the endoscopic instrument according to the present disclosure may have two working tubes.

[0018] In one embodiment, the endoscopic instrument according to the present disclosure may further include a transmission interface located at the proximal end of the sheath, the transmission interface being configured to actuate a plurality of cables.

[0019] In one embodiment, the transmission interface may be configured to be manually driven to operate multiple cables.

[0020] In one embodiment, the transmission interface may be configured to be operably connected to an actuator and driven by that actuator.

[0021] In one embodiment, the transmission interface includes a plurality of driven members for actuating a plurality of cables, and each of the plurality of cables may be connected to any one of the plurality of driven members.

[0022] The present invention can be better understood by referring to the detailed description of the invention in conjunction with the non-limiting embodiments and the accompanying drawings described below. BRIEF DESCRIPTION OF THE DRAWINGS

[0023] [Figure 1] Figure 1 is a rear upper perspective view of the endoscopic treatment instrument according to the present embodiment, showing a state where the structural portion is in an open configuration. The structural portion according to this embodiment includes four arms (two movable arms and two immovable arms) and two working tubes. The proximal end of each arm is coupled to the base. Further, the distal ends of the two movable arms included in the structural portion are expanded or pivoted outward in a direction away from the longitudinal axis extending along the length direction of the structural portion. [Figure 2] Figure 2 shows a front view of the endoscopic treatment instrument of Figure 1. [Figure 3] Figure 3 shows a top view of the endoscopic treatment instrument of Figure 1. [Figure 4] Figure 4 shows a side view of the endoscopic treatment instrument of Figure 1. [Figure 5] Figure 5 is a front view of the endoscopic treatment instrument in a state where the structural portion is in a closed configuration. In this embodiment, the arms of the structural portion are substantially parallel to the longitudinal axis extending along the length direction of the structural portion. [Figure 6] Figure 6 is a top view of the endoscopic treatment instrument of Figure 5. [Figure 7] Figure 7 is a side view of the endoscopic treatment instrument of Figure 5. [Figure 8] Figure 8 is an overhead view taken from the upper right front of an endoscopic treatment instrument provided with an outer sheath according to the present embodiment. [Figure 9] Figure 9 is an overhead view taken from the upper front side of the outer sheath and the transmission interface of the endoscopic treatment instrument according to the present embodiment. [Figure 10]FIG. 10 is a top-front perspective overhead view of the cuff, outer sheath, and transmission interface of the endoscope treatment tool according to the present embodiment. [Figure 11] FIG. 11 is a top-front perspective overhead view of the working tube of the endoscope treatment tool according to the present embodiment. [Figure 12] FIG. 12 shows a joint ring connecting the outer sheath and the cuff in the endoscope treatment tool according to the present embodiment. (A) is a side view, (B) is a top-front perspective overhead view, (C) is a front view, (D) is a side view. [Figure 13] FIG. 13 shows a first ring of the outer sheath. (A) is a side view, (B) is a top-front perspective overhead view, (C) is a front view, (D) is a side view. [Figure 14] FIG. 14 shows a second ring of the outer sheath. (A) is a side view, (B) is a top-front perspective overhead view, (C) is a front view, (D) is a side view. [Figure 15] FIG. 15 is a cross-sectional view of the outer sheath of the endoscope treatment tool in a state of being used in combination with an endoscope. MODE FOR CARRYING OUT THE INVENTION

[0024] In one aspect of the present invention, an endoscope treatment tool is provided. The endoscope treatment tool comprises: (a) a base portion having a through opening configured to accommodate an endoscope; (b) a structural portion coupled to the base portion and having an internal cavity; (c) a working tube provided in the internal cavity for accommodating a surgical instrument, and wherein the structural portion includes one or more movable arms configured to be transitionable between an open configuration and a closed configuration.

[0025] As shown in FIG. 1 and FIG. 3, the structural portion (24) can be coupled to the base portion (1) at a first end (25) of the base portion (1). As shown in FIG. 8, a second end (26) of the base portion (1) is coupleable to the outer sheath (23).

[0026] In one embodiment, as shown in Figure 1, the shape of the base (1) may be substantially annular, and an internal cavity may be created by a structural part (24) connected to the annular base (1). The endoscopic instrument according to the present invention is intended to be used as the end that is inserted first into a body cavity or organ lumen. Therefore, the contour of the outer structural part (24) may be annular in accordance with the base (1), and its end may be tapered to facilitate insertion and movement.

[0027] The structural part (24) may be formed by either an arm portion or a plate portion (details to be described later) connected to the periphery of the annular end of the base portion (1). In the embodiment shown in Figure 1, four plate portions are provided. In Figure 1, one of the plate portions is in an open configuration.

[0028] As shown in the embodiments of Figures 1-8, the structural part (24) may have four arms (i.e., two movable side arms and two fixed upper and lower arms). In another embodiment, all four arms of the structural part (24) may be configured to transition between open and closed configurations. The structural part (24) is in the open configuration when one or more movable arms (2) rotate or extend outward away from the longitudinal axis, as shown in Figure 1. Here, the longitudinal axis extends along the length of the structural part (24). Figures 1-4 show the structural part (24) in the open configuration, and Figures 5-7 show the structural part (24) in the closed configuration. The movement of the movable arms (2) is facilitated by the first cuff pin (3), the second cuff pin (4), and the third cuff pin (8). The cuff bar (7) connects the arm sections to each other, allowing the arm sections to be opened (i.e., rotated outwards) or closed.

[0029] The movement of the arm (2) can be achieved by any suitable means. Such means include, for example, any electrical mechanism or drive mechanism that can open and close the arm (2) by transmitting a signal from a control means in a control panel to the arm (2).

[0030] Figure 11 shows an example of a working tube (5). This working tube (5) has eight insertion ports (i.e., ports for inserting cables) arranged in two rows. The cables will be described in more detail later. There are four insertion ports in each row, spaced at 90-degree intervals. When the structural part (24) is in a closed configuration, the working tube (5) fits within the internal gap (27) surrounded by the structural part (24). When the structural part (24) is in an open configuration, the working tube (5) can protrude from the internal gap (27) (i.e., it can protrude further distally from the distal end of the arm). The working tube (5) functions as a guide for surgical instruments, allowing the surgical instruments to move in the desired direction while being supported inside the working tube (5). As shown in Figure 3, the working tube (5) is connected to a cable (17) that can control the movement of the working tube (5), enabling precise positioning and manipulation of surgical instruments.

[0031] In one embodiment, as shown in Figure 8, the endoscopic instrument according to the present disclosure may further include a sheath (23). This sheath (23) has a proximal end and a distal end, the distal end of which is connected to the end of the base (1) on the opposite side of the structural part (24). For example, the distal end of the sheath can be connected to the second end (26) of the base (1).

[0032] The outer tube (23) may include a connecting ring (11) that connects the outer tube to the cuff, a first ring (12) of the outer tube, and a plurality of second rings (13) of the outer tube. The connecting ring (11) that connects the outer tube to the cuff serves to connect the cuff (22) to the other rings that make up the outer tube (i.e., the first ring (12) and the plurality of second rings (13) of the outer tube). A connecting ring (11) according to one embodiment is shown in Figure 12. As an example, the connecting ring (11) can be properly fixed to the cuff (22) by twisting it. The first ring (12) of the outer tube serves to connect the second ring (13) of the outer tube to the connecting ring (11). A first ring (12) of the outer tube according to one embodiment is shown in Figure 13. The multiple second rings (13) of the mantle may extend along the entire length of the mantle. The multiple second rings (13) make the mantle flexible. A second ring (13) according to one embodiment is shown in Figure 14.

[0033] As an example, the endoscopic treatment instrument according to this disclosure can be configured such that, when housing an endoscope, the distal end of the endoscope is positioned further distal to the distal end of the structural part (24) along the longitudinal axis.

[0034] In one embodiment, the outer tube (23) may have a guide channel, and the guide channel and the through-opening may be aligned with each other to accommodate the endoscope.

[0035] In one embodiment, the sheath tube (23) has a plurality of auxiliary conduits and can accommodate a plurality of cables. The auxiliary conduits may also be capable of accommodating surgical instruments. For example, the plurality of auxiliary conduits of the sheath tube may run substantially parallel to the main conduit. For example, each of the plurality of auxiliary conduits may be configured to accommodate one of the plurality of cables. The auxiliary conduits may also be capable of receiving surgical instruments, for example, through a PTFE tube (20) for surgical instruments as shown in Figure 15. The diameter of the auxiliary conduit for receiving surgical instruments can be larger than the diameter of the auxiliary conduit for accommodating cables for moving the work tube (5).

[0036] In one embodiment, the outer tube (23) may have an inner wall and an outer wall, the inner wall may define a main path, and a plurality of auxiliary paths may be arranged in the space between the inner wall and the outer wall.

[0037] An example of a sheath (23) is shown in Figure 15. The endoscope (21) is housed within the main pathway of the sheath (23). The PTFE tubing for surgical instruments (20) is housed within the two auxiliary pathways shown at the left and right ends of Figure 15, respectively. The cables (17) are housed within other auxiliary pathways of the sheath (23).

[0038] In some embodiments, the endoscopic instrument according to the present disclosure may further include a plurality of cables. At least one of the plurality of cables may be terminated on the structural part (24) to transition the associated arms of the structural part (24) between open and closed configurations. At least one of the plurality of cables may also be terminated on the working tube (5) to guide the surgical instrument. Non-limiting examples of the plurality of cables include a plurality of fishing lines or a plurality of ultra-high molecular weight polyethylene (UHMWPE) braided wires. Such cables may be housed in PTFE tubes that serve to guide the cables with low friction. One cable may be housed in each PTFE tube. For example, a cable for opening the cuff (opening cable) may be housed in a PTFE tube attached (with adhesive, etc.) to the first ring (12) of the sheath tube, so that the first ring (12) functions as a stopper for those PTFE tubes. For example, a cable for closing the cuff (closure cable) may be housed inside a PTFE tube that terminates at the distal end of the movable arm (2). For example, a cable for moving the work pipe may be housed inside a PTFE tube attached (with adhesive, etc.) to the immovable arm and movable arm of the cuff.

[0039] For example, four cables for opening the cuff (22) and two cables for closing the cuff (22) can be provided. The four opening cables can release the hinge mechanism by pulling four pistons (6) inside the cuff. For example, two closing cables may be positioned toward the distal end of the cuff and routed around the cuff. For example, the closing cables can be terminated at the distal end of the movable arm (2). When the closing cables are pulled, the movable arm moves to the closed position.

[0040] In one embodiment, at least one of several cables may terminate on the work tube, allowing the work tube to be moved and thus the surgical instruments to be moved. For example, the immovable arm and the movable arm may each have two passages. Each passage can accommodate two PTFE tubes to guide the work tube cables (i.e., cables for moving the work tube (5)) to the cuff (22). Each PTFE tube can accommodate one work tube cable. In an embodiment with four arms, there are a total of eight passages and sixteen PTFE tubes, and the work tube can be moved by a total of sixteen cables. Given that multiple cables terminate at each work tube, it can be understood that the work tube (5) can be moved in the desired direction by the tension of the associated cables (and the corresponding slack of their equivalent opposing cables). For example, the cable may pass through a pulley provided on the transmission interface (15) through the outer casing (23) and into the cuff (22), and be terminated on the work pipe (5).

[0041] For example, the outer pipe (23) can be made rigid by applying tension to the cables for the working pipe (i.e., cables for moving the working pipe) and the opening cables (i.e., cables for opening the cuff) that pass through multiple second rings (13) of the outer pipe. Optionally, it is also possible to transition the outer pipe (23) between a flexible configuration and a rigid configuration by adding one or more cables that terminate at the distal end of the outer pipe (23).

[0042] In one embodiment, the base (1) may further have a plurality of auxiliary through-holes for accommodating a plurality of cables. These auxiliary through-holes may run substantially parallel to the through-hole configured to accommodate the endoscope. The auxiliary through-holes can be formed as holes in the second ring (13) of the sheath. Optionally, the diameter of the sheath (23) may be made smaller by positioning some of the cables outside the second ring (13) so as not to pass through the auxiliary through-holes.

[0043] In one embodiment, the structure (24) includes two movable arms (2) facing each other on both sides within an internal cavity, and these two movable arms (2) may be configured to extend outward in a direction away from the longitudinal axis extending along the length of the structure (24) when in the open configuration. For example, when the structure (24) is in the closed configuration, at least one of the movable arms (2) may be substantially parallel to the longitudinal axis extending along the length of the structure (24). For example, the structure (24) may have two immovable arms (which may be considered as shields), such as an upper cuff shield (9) and a lower cuff shield (10). The two movable arms (2) may be provided facing each other.

[0044] In some embodiments, the endoscopic instrument according to the present disclosure may further include an outer sheath covering the structural portion (24). Non-limiting examples of the outer sheath include a thermoplastic polyurethane (TPU) sheath.

[0045] In one embodiment, the endoscopic instrument according to the present disclosure may further include a surgical instrument housed in a working tube. When the working tube receives the surgical instrument, the distal end of the surgical instrument can be positioned further distal along the longitudinal axis than the distal end of the structural part (24).

[0046] For example, the number of cables connected to each work pipe may be six to eight. In a preferred embodiment, eight cables can be connected to each work pipe.

[0047] In one embodiment, the motion of the work pipe may include translational motion of the work pipe along the x, y, and / or z axes, and rotational motion of the work pipe along the pitch, yaw, and / or roll axes.

[0048] In one embodiment, the surgical instrument may be selected from the group consisting of gripping devices, electrocautery devices, sutures, loops, forceps, scissors, suction devices, injectors, clamps, and irrigation devices.

[0049] In one embodiment, the endoscopic instrument according to the present disclosure may include two working tubes.

[0050] As an example, the endoscopic treatment instrument according to this disclosure may further include an imaging device disposed on the structural part (24). As an example, the imaging device is provided on the upper cuff shielding (9) above the distal end of the cuff.

[0051] As an example, the endoscopic treatment instrument relating to this disclosure may further include a light source provided on the structural part (24).

[0052] For example, endoscopic instruments may be disposable.

[0053] In one embodiment, as shown in Figures 9 and 10, the endoscopic instrument according to the present disclosure may further include a transmission interface (15) located at the proximal end of the sheath (23). This transmission interface is configured to actuate multiple cables.

[0054] In one embodiment, the transmission interface can be configured to operate multiple cables by being driven manually or by a robot.

[0055] In one embodiment, the transmission interface may be configured to be operably connected to an actuator and driven by that actuator.

[0056] In one embodiment, the transmission interface may include a plurality of driven members for operating a plurality of cables, each of which can be connected to one of the plurality of driven members. A non-limiting example of a driven member is a clutch. The transmission interface may be any transmission mechanism capable of applying tension to the cables by converting rotational energy into tensile energy. For example, the transmission interface may be in the form of a disk, and the driven member may be a clutch, which may constitute the interface between the disk transmission interface and the patient cart. This clutch can be connected to a pulley in the disk transmission interface, and the cables are connected to this pulley. When the motor of the patient cart rotates, the clutch of the patient cart rotates, followed by the disk clutch, and then the pulley, causing the cables to be tensioned or loosened according to the direction of rotation of the motor.

[0057] In this specification, the terms “scope” and “endoscope” are interchangeable. The term “scope” may include, but is not limited to, other devices for observing and / or manipulating the human or animal body, such as laparoscopes, duodenoscopes, colonoscopes, gastroscopy, hysteroscopes, bronchoscopes, and urethroscopes. Endoscopes typically include an insertion probe, also called an “endoscopic probe,” for insertion into a body cavity. The term “endoscope” may also be used to refer to an endoscopic probe.

[0058] In various examples, the endoscopic instruments relating to this disclosure can be used with endoscopic probes of various sizes, such as, but are not limited to, colonoscopes, gastroscopes, side-viewing endoscopes, endoscopic ultrasounds, adult and pediatric observation instruments, rigid and flexible observation instruments, and single-channel and multi-channel observation instruments. In various examples, the cuff may be appropriately used with non-gastrointestinal observation instruments.

[0059] The endoscopic instruments relating to this disclosure can be used in a variety of advanced endoscopic procedures (surgeries). Non-limiting examples of such endoscopic procedures include endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR), and peroral endoscopic myotomy (POEM).

[0060] In this specification, the term "user" may refer to any user or end-user of the endoscopic instrument according to this embodiment. Non-exclusive examples of users include endoscopists, surgeons, specialists, and support staff such as nurses and technical staff.

[0061] [cuff]

[0062] In one embodiment, the base (1) and structural part (24) of the endoscopic instrument are collectively referred to as the "cuff." The base (1) is also called the cuff base or cuff ring and has a through-opening (such as a through-hole) for accommodating the endoscope. The endoscope can enter and exit the cuff (22) via the base (1), and can also move slightly forward of the cuff (22) so as not to obstruct the field of view. The structural part (24) of the cuff according to this embodiment includes one or more movable arms and can be in an open or closed position. When one or more of these movable arms are extended outward or rotated, the cuff, structural part, or one or more of these movable arms are said to be in an open position. Various methods may be used to connect the proximal end of the structural part to the base, for example, it can be connected with a hinge. The term "extending outwards" may include the extension of an arm along a radial direction substantially parallel to the longitudinal axis, or the movement of one end of an arm away from the longitudinal axis and subsequent rotation and extension. "Pivoting outwards" means that the distal end of one or more movable arms extends away from the longitudinal axis extending along the length of the structure. Figures 1 (rear upper side perspective), 2 (front view), 3 (top view), and 4 (side view) show a structure in an open configuration with a cuff having two movable arms and two immovable arms according to one embodiment. In the orientation shown in these drawings, the two lateral arms are movable, and the upper and lower arms are immovable. The cuff can be closed and inserted into the body of a human or animal. The closed cuff is shown in Figures 5 (front view), 6 (top view), and 7 (side view). When the cuff reaches a desired region of interest within the body, it opens to any size between its minimum and maximum widths. The "width of the cuff" refers to the maximum width of the distal end of the structure. For example, if the structure includes two opposing movable arms and two opposing immovable arms, when the two movable arms rotate outward, the width of the cuff is considered to be the distance between the distal ends of the two movable arms. It should also be interpreted that the "width" of the cuff refers to the "diameter" of the cuff.Since the structural member is in an open configuration when one or more movable arms are rotated outward, it can be understood that when we say the cuff or structural member is in an open configuration, it means that the movable arms are in an open configuration. The phrase "the structural member is moveable between an open configuration and a closed configuration" means that the cuff is movable manually or by a robot and can be opened to a width suitable for the user when performing a procedure. For example, the transition from the open configuration to the closed configuration of the cuff can be performed by the action of multiple cables that terminate at the structural member.

[0063] Because the cuff of the cuff described in this disclosure has a simple design, both its width and length can be made small, making it easy to manipulate inside the patient's body.

[0064] In this specification, the term “structural member” is intended to include at least one movable arm. For example, a structural member (24) can consist of at least one immovable part and one or more movable arms. In some embodiments, a structural member may include a total of four arms, two of which may be opposing immovable arms and two other which may be opposing movable arms. An “arm” may be a panel, plate, wall, or any elongated structure (such as a column). For example, the distal end of an arm may be tapered. In the example where the structural member has four arms, two of which are opposing immovable arms and two other which are opposing movable arms, the term “interior space” in the phrase “the structural member encloses an interior space” may refer to the area enclosed by the arms. In any case, it should be understood that the working space of the cuff according to this embodiment is not limited to its internal space, but also includes the area further distal along the longitudinal axis that can be reached as a result of the cuff being in an open position. In other words, the working space includes the area that extends outward from the cuff. Therefore, during use, the endoscope and working instruments can be used not only in the internal space but also in the area further distal along the longitudinal axis (i.e., further forward from the distal end of the arm).

[0065] In various embodiments, the structure may have four arms. In some embodiments, two of the arms may be movable and two may be immovable. In some embodiments, two movable arms may face each other, and two immovable arms may face each other. In various embodiments, the internal void contained within the arms may be circular, elliptical, or oblong. In various examples, the length of the arms may be in the range of 20 to 60 mm.

[0066] For example, the cuff may have a closed configuration. This closed configuration may also be called a non-expanded configuration, a contracted configuration, or a folded configuration. Preferably, the width of the cuff in the closed configuration may be between the inner and outer diameters of the sheath tube (23). In various examples, the inner diameter of the sheath tube (23) may be 10 to 16 mm, and the outer diameter of the sheath tube (23) may be 15 to 30 mm. For example, when used with a gastroscope or colonoscope, the width of the cuff in the closed configuration may be in the range of 10 to 30 mm.

[0067] For example, the cuff (22) may have an open configuration. This unfolded configuration may also be called the unfolded configuration or expanded configuration. The width of the cuff in the open configuration can be increased up to 80 mm. Opening the cuff to a width of 50-60 mm is preferable for colonoscopy procedures. Since the cuff can be opened to any degree between the unfolded width and the maximum unfolded width, the diameter in the open configuration can be in the range of 10-80 mm when used with a gastroscope or colonoscope.

[0068] The width of the cuff serves as an indicator of the working space size within the cuff. The term "workspace" is intended to include not only the three-dimensional space within the cuff (in either an open or closed configuration), but also the area further forward from the distal end of the structural components where the working tube and endoscope can move. The movement of surgical instruments may be limited to this working space. In various examples, the cuff can be deployed at a variety of different widths between its minimum and maximum widths.

[0069] For example, the cuffs may be made using 3D printing. Alternatively, the cuffs may be manufactured by CNC machining, injection molding, compression molding, sheet metal bending, metal stamping, or a combination of any of the above processes.

[0070] For example, cuffs can be manufactured from plastic. For instance, cuffs may be made from engineering plastics such as polycarbonate (PC) mixed with a certain proportion of glass fiber reinforcement. Further examples of plastic materials include acrylonitrile butadiene styrene (ABS), polylactic acid (PLA), polycarbonate (PC), polytetrafluoroethylene (PTFE), or mixtures of these materials. Cuffs may also be manufactured from a mixture of stainless steel or aluminum components.

[0071] [Work pipe]

[0072] In one embodiment, the endoscopic instrument according to the present disclosure may further include a surgical instrument (19) that is detachably received within the working tube (5). During use, the surgical instrument can be guided within the working tube and moved forward (i.e., further distal to the distal end of the working tube) and backward. It is also possible to move the surgical instrument outside the working tube. In another embodiment, the surgical instrument may be detachably connected to the working tube.

[0073] In this specification, the terms "surgical instrument," "instrument," "treatment instrument," "endoscopic tool," "surgical tool," "tool," and "end effector" are interchangeable. For example, the length of a surgical instrument may be made to more than 2 meters to facilitate insertion into an endoscopic treatment instrument. The activation and deactivation of a surgical instrument may be controlled by the handle of the surgical instrument. For example, the handle of a surgical instrument can be connected to a patient cart having fixing devices that correspond to the shapes and sizes of various surgical instruments. The control means may be provided with a button, and when the button is pressed, the surgical instrument can be moved up and down in a manner that mimics the movement of a hand, thereby activating or deactivating the surgical instrument.

[0074] In one embodiment, the working tube (5) can function as a guide for the surgical instrument (19) to pass through. For example, the surgical instrument can move back and forth while being supported within the working tube. In another embodiment, the working tube may control the movement of the surgical instrument. For example, the working tube may be a metal tube placed over the proximal end of the surgical instrument, enabling control of the surgical instrument.

[0075] For example, the outer diameter of the working tube may be 4.5 mm, the inner diameter may be in the range of 3 mm to 3.5 mm, and the spacing between holes may be 25 mm. The inner diameter of the working tube may be determined according to the surgical instrument, the outer diameter of which is usually 2.8 mm. Since the working tube must be able to accommodate the outer diameter of the surgical instrument, the inner diameter of the working tube can be in the range of 2.9 mm to 3.5 mm. It is preferable that the outer diameter of the working tube be as close as possible to the inner diameter of the working tube. In various examples, the outer diameter of the working tube may be in the range of 3.0 mm to 4.5 mm. In various examples, the spacing between holes on the working tube can be in the range of 10 mm to 60 mm. Furthermore, by making the inner diameter of the working tube 3 mm, this working tube can be used with standard endoscopic instruments that are designed to function with a 2.8 mm working guide.

[0076] For example, the work pipe (5) may have eight holes or openings (cable insertion points), meaning there are eight cable mounting points. In the embodiment shown in Figure 11, the eight holes are arranged in two rows of four, with one row at the proximal end of the work pipe (5) and the other row at the distal end. Four holes are provided in each row at 90-degree intervals. By forming a knot between each hole and the proximal or distal end of the work pipe (5), the cable can be terminated on the work pipe. In an alternative embodiment, a total of sixteen holes may be provided in four rows of four holes each, with two rows at the proximal end and two rows at the distal end. The holes in each row are provided at 120-degree intervals, and the rows are offset from each other. With this configuration, a knot tied between two adjacent holes will have an effective center point.

[0077] For example, the endoscopic instrument may include two working tubes (5), each of which can accommodate one surgical instrument. The working tubes (5) are compatible with commercially available surgical instruments such as gripping devices and electrocautery knives. For example, the total length of the working tubes (5) can be 45 mm. Each working tube (5) can be driven by eight cables. Sixteen holes (cable insertion points) may be provided on the working tubes (5), and two holes can be used for each knot in the fishing line. The arrangement of these holes may be such that the knots are in specific positions. Cables can be secured to the working tubes (5) using a clove hitch and two stopper knots. It should be understood that each working tube may be driven by fewer or more cables than eight. In an embodiment in which each working tube is driven by six cables, the degrees of freedom are 5. For example, each cable mounting point may have three knots. For example, these three knots may consist of one clove hitch and two stopper knots. The number of knots per cable mounting point can range from one to five. The more knots there are, the thicker the cable becomes at the mounting point, thus increasing its load-bearing strength.

[0078] [Mantle tube]

[0079] In this specification, the terms “overtube” and “colonoscopy sheath” are interchangeable. The overtube can enclose the entire length or a portion thereof of the endoscope probe. The overtube may be flexible or rigid. An example of a flexible overtube is shown in Figure 8. In one embodiment, the overtube may be formed from a plurality of adjacent rings (such as a series of rings). The distance between the rings may be any appropriate distance, as long as it can support and accommodate the associated endoscope, tubing, and piping carrying surgical instruments and cables. Each ring may contain any appropriate number of holes, the positions of which may correspond to auxiliary conduits located on the base that will be the end connected to the overtube. In other words, when the rings are connected to form a sheath tube, the holes in them form auxiliary guideways, which house the cables, and the cables run from one end of the sheath tube to the working tube or structural section where they terminate. In another embodiment, the cables may be laid along the outer surface of the sheath tube. The rings forming the sheath tube allow the sheath tube to follow the curvature of the endoscope, providing flexibility. In one embodiment, the sheath tube may be rigidized after insertion into the region of interest. Rigidizing the sheath tube can be done by tensioning the multiple cables terminating on the sheath tube to shorten the cables, thereby stabilizing the endoscopic instrument. In the example shown in Figure 8, the outer diameter of the sheath tube is 25 mm and the total length is 500 mm. The sheath tube shown in Figure 8 can be manufactured from a single plastic-like material and may be manufactured by 3D printing, extrusion molding, or injection molding.

[0080] In this specification, the terms “channel” and “lumen” are interchangeable and refer to a hollow compartment formed along the longitudinal axis within the sheath tube, suitable for functioning as a working tube, irrigation, or endoscopic instrument, imaging probe, or treatment passage. For example, a channel can be formed as a hole drilled along the longitudinal direction in a single material from which the channel is made. As shown in Figures 12-14, a main channel and / or auxiliary channels may be provided within a series of rings forming the sheath tube. For example, the material forming the sheath tube (23) may be flexible.

[0081] The term "working channel" may refer to a primary or auxiliary channel. In various examples, the working channel(s) may extend along the entire length of the endoscope. For example, the working channel(s) may extend along a portion of the length of the endoscope. For example, the working channel(s) may run basically parallel to the endoscope. For example, the working channel(s) may run at an angle to the endoscope along at least a portion of its total length. In a non-limiting example, the working channel(s) may have an upward-angled exit, which can facilitate traction.

[0082] In one embodiment, multiple auxiliary conduits may be parallel to the main conduit.

[0083] In one embodiment, each of the multiple auxiliary conduits may be configured to receive one of the multiple cables.

[0084] For example, multiple auxiliary conduits may include multiple hollow tubes, such as PTFE tubes or Bowden cables. For example, there may be a total of 24 tubes, of which 16 tubes may house cables for the movement of two working tubes (5) (i.e., 8 per working tube), 4 tubes may house cables for opening the cuff, 2 tubes may house cables for closing the cuff, and 2 tubes may each house one surgical instrument.

[0085] For example, surgical instruments can be inserted via an auxiliary guideline that runs from the proximal end to the distal end of the sheath.

[0086] In one embodiment, the sheath may include an inner wall and an outer wall, with the inner wall defining a main channel and multiple auxiliary channels provided in the space between the inner and outer walls. For example, the inner wall may be an internal structure through which the endoscope can pass, and the outer wall may be an external structure that can enclose all the tubes (auxiliary channels). The main channel may also be called a "colonoscope channel." As an example, the internal structure can be manufactured from a flexible thermoplastic material (silicone, TPU, or PVC, etc.) with a special biocompatible hydrophilic coating. When wet, the endoscope slides almost frictionally inside the sheath, allowing it to move easily back and forth. As an example, the external structure may have an ultra-thin TPU outer sheath, which can prevent the colon from entering the sheath. It can also allow the sheath to slide more smoothly when in contact with the colon.

[0087] As an alternative to PTFE tubing, the outer casing may include a winding material through which the cables necessary to operate the cuff and work pipe are passed. The winding material may be placed within an auxiliary conduit and extended partially or entirely along the length of the auxiliary conduit.

[0088] In a preferred example, the first ring (12) and cuff of the sheath tube may serve to terminate a PTFE tube that houses a cable for opening the cuff. The PTFE tube that houses a cable for operating the work pipe (5) terminates on the cuff structure (24).

[0089] Instead of using the first ring (12) of the sheath as a stopper for the PTFE tube, the movement of the cable can be restricted by placing caps (also called end caps) at the proximal and / or distal ends of the sheath. These caps can fix the inner wall, outer wall, and auxiliary conduits of the sheath. Grooves through which cables can pass may be provided in the caps. Each groove can accommodate one or more cables. For example, an instrument channel may serve to guide surgical instruments through to the sheath. In this specification, the term "tool channel" includes auxiliary conduits that house surgical instruments. In the embodiment shown in Figure 15, the tool channel houses a PTFE tube for surgical instruments (20), which receives a surgical instrument (19).

[0090] For example, a pre-fabricated surgical instrument may be inserted into the working tube (5) via the instrument guide in the sheath. To allow for the removal and replacement of the surgical instrument, the working tube (5) may be aligned with the instrument guide in the sheath.

[0091] For example, the diameter of the guide channel may be 16 mm. Alternatively, the diameter of the guide channel may be considered to be the inner diameter of the sheath. The diameter of the guide channel (30) may have some variation, and it will be understood by those skilled in the art that the diameter of the guide channel depends on the outer diameter of the type of observation instrument used with the endoscopic instrument. For example, the outer diameter of a gastroscope is usually 9 mm, and the outer diameter of a colonoscope is usually 13.5 to 14 mm. A guide channel with a diameter of 16 mm makes the sheath suitable for a colonoscope, and by reducing the diameter of the guide channel to 10 mm or 11 mm, it can be used to suit a gastroscope. For example, the diameter of the guide channel can be in the range of 10 mm to 16 mm.

[0092] For example, the diameter of the auxiliary conduit may be 1.4 mm. Alternatively, the diameter of the auxiliary conduit may be in the range of 1 mm to 4 mm to accommodate cables and surgical instruments.

[0093] For example, the diameter of the sheath may be 25 mm. The diameter of the sheath may have some variation, and it will be understood by those skilled in the art that the diameter of the sheath depends on the outer diameter of the type of observation instrument used with the endoscopic instrument. For example, the outer diameter of a gastroscope is usually 9 mm, and the outer diameter of a colonoscope is usually 13.5 to 14 mm. For example, the outer diameter of the sheath can be in the range of 10 mm to 30 mm.

[0094] The outer sheath is preferably manufactured from a biocompatible material. Examples of biocompatible materials include, but are not limited to, polytetrafluoroethylene (PTFE), polyether block amide copolymers such as PEBAX, fluoroethylene propylene (FEP), thermoplastic polyurethane (TPU), and perfluoroalkoxy (PFA).

[0095] [cable]

[0096] In one embodiment, the multiple cables may include multiple UHMWPE braided wires. In various examples, the multiple cables may include multiple metal wires, metal cables, or any non-stretchable cable.

[0097] In various embodiments, multiple cables can be connected to a transmission interface that is either manually driven or driven by a cable actuation mechanism. For example, the cable actuation mechanism may be a Cable Driven Parallel Mechanism (CDPM). The CDPM allows for the transmission of more controlled and stronger forces to surgical instruments, which is advantageous because it enables the instruments to bear greater loads and improves the precision of movements for performing ESD. This allows for the removal of large lesions in one piece rather than gradually, thus suppressing recurrence due to cell dissemination. In various embodiments, multiple cables may be connected to a transmission interface that is either manually driven or driven by a cable actuation mechanism. In this specification, the terms “actuator,” “actuation mechanism,” and “actuation unit” are interchangeable. The term “actuator” includes any device for receiving energy (such as in the form of electrical, hydraulic, or pneumatic energy) and converting it into mechanical force or motion (such as linear or rotational motion). For example, the cable actuation mechanism may be a Cable Driven Parallel Mechanism (CDPM). CDPMs allow for more controlled and stronger force transmission to surgical instruments, enabling them to bear greater loads and improving the precision of movements required for ESD. This allows for the removal of large lesions in a single piece rather than gradually, thus suppressing recurrence due to cell dissemination.

[0098] As those skilled in the art will understand, any other method (e.g., pulleys) can also be used to operate the cable.

[0099] Cables from the operating system pass through auxiliary conduits within the sheath tube and reach the structural section (24) and the working tube (5) via a number of auxiliary through-openings provided in the base (1). For example, to open the cuff, some of the cables may be terminated on the movable arms (group) of the structural section. As an example, to open the cuff, four opening cables can pull four pistons inside the cuff to open the hinge mechanism. To close the cuff, two cables may be positioned near the distal end of the cuff and routed around it. Cables can be terminated on the working tube (5) for the operation of surgical instruments.

[0100] In this specification, the term "cable entry point" may refer to an opening or through-hole that allows a cable to enter from the structure. The cable entry points may be provided on the work pipe (5). In various examples, each work pipe (5) may have sixteen cable entry points (eight cable mounting points). Cables can be accommodated by having multiple auxiliary through-holes in the base (1) and structural part (24). The term "through-hole" includes passages, conduits, or grooves for accommodating one or more cables. For example, a pair of cable entry points can be used as a single cable mounting point. In this specification, the terms "cable entry points" and "cable mounting point" are interchangeable. For example, a cable can be inserted through a cable entry point and terminated / mounted by making a knot at the entry point. For example, the auxiliary through-holes in the structural part (24) may be passages. As an example, each of the two immovable arms and two movable arms of the structural part may have two passages. Each passage can accommodate two PTFE tubes, and each PTFE tube can accommodate one work pipe cable (a cable for operating the work pipe). Overall, it can be considered that there are eight passages in the four arms, sixteen PTFE tubes, and sixteen work pipe cables. It is well known in the art that other techniques may be used to terminate the cables at the cable mounting points. For example, polymer fiber cables or UHMWPE braided cables can be terminated with knots made in the cable, and metal fiber cables can be terminated with crimping, spot welding, and / or barb joints. It is preferable that one or more of the multiple cables are terminated at one or more mounting points by knots made in the cable. Examples of knots include fringe knots and stopper knots. Fringe knots are advantageous because the cable can be moved without moving the knot.

[0101] In one embodiment, one or more of the multiple cables may be terminated at one or more mounting points by knots made within the cables.

[0102] For example, multiple work pipes (5) can be controlled and operated using cables that terminate on multiple work pipes (5).

[0103] As an example, each working tube (5) is connected to eight cables, resulting in 6 degrees of freedom (DOF), which include translational motion in the x, y, and z axes, and rotational motion along the pitch, yaw, and roll axes. If the degrees of freedom of the instrument (i.e., starting / opening or stopping / closing the instrument) are also included, the total degrees of freedom can be 7 or 8. Thanks to the antagonistic properties and configuration of the cables, a strong force can be generated with 6 degrees of freedom, while simultaneously ensuring control and stability of the surgical instrument. By adopting a configuration in which multiple cables are connected to each working tube (5), it is advantageous that the working tube can be moved in any desired direction, including the direction of exiting the internal cavity of the structural part (24). Because the working tube (5) has this ability to move, surgical instruments placed inside the working tube (5) can reach locations outside the internal cavity of the endoscopic instrument. This means that users can manipulate the device with greater flexibility even within the narrow spaces of body cavities or organ lumens.

[0104] In any case, the present invention (when used with an endoscope) provides additional pathways, allowing the user to perform necessary or desired surgical procedures simultaneously with endoscopic examinations to observe the inside of body cavities or lumens, without clearing pathways occupied by other instruments. In addition, surgical instruments used with this endoscopic instrument can be controlled independently of the endoscope. This improves the operability and controllability of instruments used in endoscopic procedures.

[0105] The endoscopic treatment instrument according to the present invention is beneficial when used with any commercially available endoscope and surgical instrument.

[0106] In one embodiment, six cables may be connected to the work tube (5). In this case, the degrees of freedom are 5. The number of cables connected to the work tube (5) may exceed six. For example, if there are eight cables per work tube (5), the degrees of freedom will be 6. By appropriately manipulating the cables, it becomes easier to bring the surgical instruments to the desired angle and position.

[0107] In some embodiments, the movement of the working tube and the corresponding movement of the surgical instruments may include translational motion of the working tube along the x, y, or z axis.

[0108] The present invention offers several advantages in that it reduces the difficulty of endoscopic submucosal dissection (ESD). Firstly, one or more work tubes (5) can provide one or more additional endoscopic instruments. For example, in an embodiment where there are two work tubes (5), the user can not only work with two endoscopic instruments but also use a third endoscopic instrument from the endoscopic work path. Because multiple endoscopic instruments can be handled simultaneously in this way, the procedure is performed at a faster speed. Furthermore, the learning curve can be shortened compared to conventional ESD. Secondly, the cable-operated work tubes (5) can control one or more additional endoscopic instruments with a maximum of 6 degrees of freedom. Also, the arrangement of the work tubes (5) allows strong force to be applied to the endoscopic instruments, enabling well-controlled and stable movement. This improves controllability, reduces the risk of perforation, and leads to a safer procedure. Thirdly, the sleeve can be held in an open position, which supports and stabilizes the surgical field. Fourthly, by separating the main and auxiliary pathways within the outer casing, the movement of the observation tool and the instrument are independent, eliminating the problem of synchronized movement of the observation tool and the instrument that is seen in conventional ESD.

[0109] Creating and maintaining a space or tunnel in the submucosa is a difficult and dangerous task. The deployable cuff of the endoscopic instrument described herein provides a practical solution by mechanically exposing and reliably maintaining this workspace. Alternatively, this endoscopic instrument can be used not only to aspirate or invaginate tissue for resection, but also to protect the tissue and safely extract the specimen. Finally, the design of this cuff provides ample imaging opportunities, allowing the endoscopic instrument to function fully as an imaging and display device, encompassing a wide range of functions from positioning multiple mobile cameras and improving surgical field illumination to real-time, site-guided dissection using the cuff as a probe (such as a wide-area radial array ultrasound probe).

[0110] In one embodiment, the deployable cuff may further include an outer sheath.

[0111] In this specification, the term “outer sheath” includes a layer of material configured to completely or partially enclose or cover the cuff. For example, the outer sheath can minimize contact between the structural component and the patient's tissue by covering the outer surface of the structural component. It can also function as a barrier separating the cuff component from the patient's tissue by forming a protective layer surrounding the cuff. In various examples, the outer sheath may cover both the cuff and the sheath tube. The outer sheath may consist of one piece covering the cuff and another covering the sheath tube, or it may consist of a single piece covering both the cuff and the sheath tube. In various examples, the outer sheath may be made from thermoplastic polyurethane (TPU), polytetrafluoroethylene (PTFE), polyether block amide copolymers such as PEBAX, silicone, or a combination of these materials.

[0112] In some embodiments, the endoscopic instrument according to the present disclosure may further include an imaging device positioned on a deployable cuff. For example, by housing a camera at the proximal end of the structure (such as on the uppermost arm portion), a bird's-eye view of the region of interest can be obtained.

[0113] The endoscopic instrument described herein has the advantage of being able to perform an improved triangulation compared to conventional two-pathway endoscopes, as the instrument can be moved independently of the observation instrument. The term "triangulation" includes the placement of the camera between two surgical instruments (when there are two working tubes (5)), and the position of the instruments relative to the position of the camera is important and relates to the size of the working space. Triangulation also takes into consideration the importance of the camera's movement being independent of the movement of each instrument.

[0114] In one embodiment, the endoscopic instrument according to the present disclosure may further include a light source positioned on a deployable cuff. For example, accommodating illumination at the proximal end of a structural component can improve illumination of the region of interest. In another example, field illumination may be provided by reflecting / diffusing an existing light source provided in the observation instrument (similar to an umbrella-type light reflector).

[0115] In one embodiment, the endoscopic instrument according to the present disclosure may be disposable.

[0116] Endoscopic instruments have the advantage of being composed entirely of mechanical elements, thus eliminating the risk of injuring the patient due to stray currents. In other words, the base, structural parts, working tube(s), sheath, and transmission interface can all be completely constructed from mechanical elements.

[0117] The endoscopic treatment instrument according to this disclosure has the advantage of being usable with commercially available endoscopes. For example, a commercially available endoscope can be modified to incorporate the endoscopic treatment instrument according to this embodiment as an accessory. In addition, this endoscopic treatment instrument can be used with commercially available endoscopic instruments. This is an advantage compared to robotic systems that create their own endoscopic systems. Such robotic systems aim to have their own endoscopes and instruments, which increases the development costs and time required, leading to increased costs for the final product. Furthermore, because the instruments in such robotic systems are expensive, they need to be made reusable and re-sterilizable. Moreover, such robotic systems inevitably have to compete with existing endoscopic systems that already dominate the endoscopic examination industry.

[0118] In various examples, the endoscopic instrument according to this embodiment can be used in conjunction with a flexible or rigid endoscope. The endoscopic instrument can be used in surgical procedures, which include inserting the endoscopic instrument into the body of a human or animal, deploying the cuff, and controlling the cable to operate the surgical instrument.

[0119] [system]

[0120] Those skilled in the art will generally understand that applying tension to the associated cables enables the movement of the movable arms(s) and working pipes(s). The term "tension" includes the act of tightening or pulling the associated cables by applying force. In various embodiments, tension on the associated cables (and the corresponding slack of the opposing equivalent cables) allows the structural walls and / or working pipes to move in a desired direction.

[0121] The endoscopic instrument according to this disclosure may include a transmission interface (15) positioned at the proximal end of the sheath and configured to actuate multiple cables. The transmission interface can function as a medium between an operating motor on a patient trolley and multiple cables. The transmission interface (15) includes multiple driven members for actinguating multiple cables, each of which is connected to one of the multiple driven members. An example of such driven members is a clutch. For example, the transmission interface (15) may include multiple male clutches connected to the cables, and corresponding female clutches on a control trolley. The trolley can be equipped with torque sensors to measure the torsional tension of the cables, thereby controlling the cable tension. The male clutches on the transmission interface (15) may also be manually operated via knobs to allow fine adjustment of the cable length. For example, the knobs may be manually tightened or loosened before and after surgery, and tightened or loosened by a robot during surgery. For example, the male clutch may be made into a rectangular shape with a protruding section, and the female clutch may have a rectangular groove that fits the male clutch.

[0122] The endoscopic instrument according to this embodiment can be connected to an operating unit and one or more control means. For example, the operating unit and control means may be reused, while the sheath (23), cuff (22), working tube (5), cable, surgical instrument (19), and transmission interface (15) may be disposable.

[0123] The endoscopic instruments according to this embodiment can be used with commercially available endoscopes. The endoscope may have its own endoscopic system (which may include a monitor, light source, camera, control means, etc.). The backend system includes a user console and a patient trolley. The user console includes two control means for the user to move two work tubes, which also allow the user to start / stop the surgical instruments on each work tube. For example, the user console may include a screen for a graphical user interface (GUI) and / or a screen for the user to view visual feedback from the endoscopic examination system, and may also include a PC that stores the software system. The user console is physically connected to the patient trolley via cables. The patient trolley consists of a motor, motion control device, power supply, custom PCBA, and other components, and the work tubes can be operated by moving cables in response to operations on the control means.

[0124] In various examples, the control mechanism can be designed using the concept of a series arm. By moving the control mechanism in space, the end effector will move in the same way. In various examples, the series arm may have three potentiometers to determine the position of the end effector in the X, Y, and Z planes. In various examples, the end effector may have three additional potentiometers to control the vertical oscillation (pitch), yaw, and lateral oscillation (roll) of the work tube (5). Furthermore, by including two buttons, the operation of the instrument itself (such as opening and closing the gripping device or starting and stopping the electrocautery knife) can also be controlled. The starting and stopping of the end effector may be a stepwise and controlled operation.

[0125] The control device may include a back strap to allow it to fit comfortably in the user's hand and provide support. This prevents the user from feeling the weight of the control device.

[0126] For example, the operating unit can control the movement of the work pipe (5) by changing the length of cables attached to various points on the work pipe (5) by pulling them. This can be done by a cable-driven parallel mechanism (CDPM). The operating unit may also have the function of moving the work pipe (5) in a desired direction by pulling different cables (i.e., by causing longitudinal displacement of the cables). It can also monitor the tension on each cable to prevent the cables from being cut by excessive load.

[0127] As an example, the operating unit can control the movement of the cuff, sheath pipe, and work pipe via a transmission interface. The transmission interface may take the form of a disc having multiple male clutches connected to a cable, and there may be corresponding female clutches on a control trolley. In this embodiment, a torque sensor can be provided on the trolley to measure the torsional tension of the cable and control the cable tension. The male clutches on the disc may also be manually operated. For example, the male clutches may be in the form of a knob that can be turned manually to extend or retract the cable. A gasket may also be provided on the disc to minimize CO2 leakage from the CO2 blowing.

[0128] By using any suitable transmission interface for operating multiple cables, the arms of the work pipe and structural components can be made to perform the desired output or movement.

[0129] In one example, the actuation unit may include opposing banks of eight or nine linear actuators. These linear actuators correspond to the seventeen wires necessary for the movement of the two work tubes (5) and the deployment and closure of the surgical cuff attachment. In another example, the actuation unit may include twenty-two linear actuators, eleven on each side, providing sixteen wires necessary for the movement of the two work tubes (5), and further providing four wires for deployment and two wires for closure instead of one wire. In yet another example, the actuation unit may have two additional wires for each work tube (5) to control the lateral movement (roll) of the work tubes (5). This corresponds to twenty-one or twenty-two linear actuators.

[0130] As an example, the linear actuator may be a ball screw configuration, with a motor controlling each ball screw to move a slider block linearly along a horizontal axis. The slider block is supported by two additional guide rails, with sliding bearings provided at the joints between the slider block and the guide rails. Thrust bearings are provided at both ends of the ball screw to reduce axial friction load and support the ball screw. The motor is connected to the ball screw via an Oldham coupling to absorb axial displacement and ensure smooth operation. A load cell is attached to each slider block. Cables from the work pipe (5) terminate on the load cells, allowing for real-time monitoring of the tension on each cable. The load cell data lines are organized using a drag chain to protect them from wear due to bending. Limit switches mounted at both ends of the ball screw support determine the maximum stroke position of each linear actuator. The distal support also has a stopper plug for a Bowden cable, which is arranged in series with each linear actuator.

[0131] The transmission interface can be coupled to a control panel similar to that for an endoscope. Such a control panel is connected to a power supply. The control panel may include a monitor screen for viewing images taken by an endoscope coupled to or used with the endoscopic treatment instrument according to the present invention, any appropriate image management (including recording means) or expansion module for adjusting the captured images, any means of supplying water or air necessary for endoscopic procedures or surgical operations performed with the assistance of surgical instruments, and control means for controlling surgical instruments. As an example, linear actuators may be provided on the side of the patient carriage for controlling the endoscopic instrument. The linear actuators consist of a lead screw and a pair of guide rails for each actuator. These actuators are similar to the actuators described above and have a force detection function and a maximum displacement sensor. By providing a universal compliant mechanism to mediate the endoscopic instrument, the user can simply place the desired instrument on the operating carriage and it will be converted into a robotic control instrument.

[0132] The inventions described exemplary herein can be adequately implemented without any elements(or groups) or limitations(or groups) not specifically disclosed herein. Therefore, words such as "comprising," "including," and "containing" should be interpreted broadly and without limitation. Furthermore, the terms and expressions used herein are for descriptive purposes only and are not limiting. In using these terms and expressions, there is no intention to exclude equivalents of the disclosed and described features or parts thereof, and it should be recognized that various modifications are possible within the scope of the claims. Accordingly, the present invention is specifically disclosed by preferred embodiments and optional additional features, and it should be understood that those skilled in the art can modify and adapt the embodiments of the present invention as disclosed herein, and that such modifications and adaptations fall within the scope of the present invention.

[0133] The present invention is described broadly and generally herein. Narrower sub-concepts and subgroups included in the disclosure of broader concepts also constitute part of the present invention. This includes not only the general description of the present invention but also any provisos or negative limitations that exclude certain matters from its scope, regardless of whether the excluded matters are specifically described herein.

[0134] While embodiments of the present invention have been described in detail with reference to a specific set of embodiments, it will be understood by those skilled in the art that various modifications can be made to the form and details without departing from the scope of the present invention as defined by the appended claims. That is, the scope of the present invention is indicated by the appended claims and is intended to encompass the meaning and scope of equivalence of the claims and all variations that fall within that scope.

Claims

1. Endoscopic instruments, (a) A base having a through-opening configured to accommodate an endoscope, (b) A structural part connected to the base and having an internal void, (c) A working tube provided in the internal void for housing surgical instruments Includes, The structural component includes one or more movable arms configured to transition between an open configuration and a closed configuration. An endoscopic treatment instrument characterized by the following features.

2. moreover Outer tube having a proximal end and a distal end Includes, The distal end of the outer tube is connected to the end of the base that is opposite to the structural part. The endoscopic treatment instrument according to claim 1, characterized in that

3. The endoscopic instrument according to claim 2, wherein the outer sheath is formed from a plurality of rings.

4. The endoscopic treatment instrument according to claim 2 or 3, wherein the outer tube includes a guide channel, and the guide channel and the through-opening are aligned with each other to accommodate the endoscope.

5. The endoscopic instrument according to any one of claims 2 to 4, wherein the sheath includes a plurality of auxiliary conduits for housing a plurality of cables.

6. The outer tube includes an inner wall and an outer wall, The inner wall defines the guide path, The aforementioned plurality of auxiliary guideways are provided in the space between the inner wall and the outer wall. The endoscopic treatment instrument according to claim 5, characterized in that it is a endoscopic treatment instrument.

7. moreover Multiple cables Includes, In order to transition the structure between the open configuration and the closed configuration, at least one of the plurality of cables is terminated on the structure. To guide the surgical instrument, at least one of the multiple cables is terminated on the work tube. The endoscopic treatment instrument according to claim 5 or 6, characterized in that

8. The endoscopic instrument according to any one of claims 1 to 7, wherein the base further includes a plurality of auxiliary through-openings for accommodating a plurality of cables.

9. The structural part includes two movable arms that face each other on both sides within the internal gap, The two movable arms are configured to extend outward in a direction away from the longitudinal axis extending along the length of the structural part when in the open position. An endoscopic treatment instrument according to any one of claims 1 to 8, characterized in that

10. moreover Outer sheath for covering the aforementioned structural part An endoscopic treatment instrument according to any one of claims 1 to 9, including the instrument described in any one of claims 1 to 9.

11. The movement of the aforementioned work pipe is The movement of the work pipe along the x-axis, y-axis, and / or z-axis, The rotational motion of the work tube along the pitch axis, yaw axis, and / or roll axis An endoscopic treatment instrument according to any one of claims 1 to 10, including the instrument described in any one of claims 1 to 10.

12. The endoscopic treatment instrument according to any one of claims 1 to 11, wherein the surgical instrument is one or more selected from the group consisting of a gripping device, an electrocautery device, a suture, a loop, forceps, scissors, a suction device, an injector, a clamp, and an irrigation device.

13. An endoscopic treatment instrument according to any one of claims 1 to 12, having two working tubes.

14. moreover A transmission interface located at the proximal end of the outer casing and configured to operate the plurality of cables. An endoscopic treatment instrument according to any one of claims 4 to 13, including the instrument described in any one of claims 4 to 13.

15. The endoscopic instrument according to claim 14, wherein the transmission interface is configured to be manually driven to operate the plurality of cables.

16. The endoscopic treatment instrument according to claim 14, wherein the transmission interface is configured to be operably connected to and driven by an actuator.

17. The transmission interface includes a plurality of driven members for operating the plurality of cables, Each of the aforementioned multiple cables is connected to one of the aforementioned multiple driven members. An endoscopic treatment instrument according to any one of claims 14 to 16, characterized in that

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