Medical manipulator and medical manipulator system

Abstract

A medical manipulator according to the present invention comprises: a flexible manipulator section; an arm that has a first bending section and a second bending section, and is positioned at the tip end of the flexible manipulator section; an artificial muscle that drives the bending of the first bending section; and a wire that drives the bending of the second bending section.

Description

Medical manipulator and medical manipulator system

[0001] The present invention relates to a medical manipulator and a medical manipulator system, and is not limited to U.S. Provisional Patent Application No. 63 / 562,855 provisionally filed in the United States on March 8, 2024, U.S. Provisional Patent Application No. 63 / 635,021 provisionally filed in the United States on April 17, 2024, U.S. Provisional Patent Application No. 63 / 648,937 provisionally filed in the United States on May 17, 2024, U.S. Provisional Patent Application No. 63 / 664,879 provisionally filed in the United States on June 27, 2024, U.S. Provisional Patent Application No. 63 / 664,879 provisionally filed in the United States on July 10, 2024, and U.S. Provisional Patent Application No. 63 / 664,879 provisionally filed in the United States on July 10, 2024. Priority is claimed to U.S. Provisional Patent Application No. 63 / 669,306, U.S. Provisional Patent Application No. 63 / 688,972 provisionally filed in the United States on August 30, 2024, U.S. Provisional Patent Application No. 63 / 691,009 provisionally filed in the United States on September 5, 2024, U.S. Provisional Patent Application No. 63 / 695,602 provisionally filed in the United States on September 17, 2024, and U.S. Provisional Patent Application No. 63 / 737,339 provisionally filed in the United States on December 20, 2024, the contents of which are incorporated herein by reference.

[0002] Conventionally, medical manipulator systems have been used for observing and treating the inside of hollow organs such as the digestive tract. In medical manipulator systems, the insertion section inserted into the hollow organ can be driven electrically. The user can control the operation of the insertion section from an operating device located outside the body.

[0003] Patent Document 1 describes a medical system equipped with an electrically driven endoscope. In the medical system described in Patent Document 1, the endoscope is electrically driven, which reduces fatigue of the surgeon.

[0004] International Publication No. 2021 / 145411

[0005] However, the conventional medical manipulator system disclosed in Patent Document 1 and the like is not necessarily easy to use, and is not a system that allows treatment using a medical manipulator (such as an endoscope) to be carried out more efficiently.

[0006] In view of the above circumstances, an object of the present invention is to provide a medical manipulator and a medical manipulator system that enable observation and treatment to be performed more efficiently.

[0007] In order to solve the above problems, the present invention proposes the following means: A medical manipulator according to a first aspect of the present invention comprises a manipulator flexible section, an arm having a first bending section and a second bending section and disposed at the tip of the manipulator flexible section, an artificial muscle that drives the first bending section to bend, and a wire that drives the second bending section to bend.

[0008] According to the medical manipulator and medical manipulator system of the present invention, observation and treatment can be carried out more efficiently.

[0009] FIG. 1 is an overall view of an electric endoscope system according to a first embodiment; FIG. 2 is a view showing an insertion manipulator of an electric endoscope system inserted into the large intestine; FIG. 3 is a view showing the tip of the insertion section of the insertion manipulator; A front view of the tip section as seen from the tip side; A cross-sectional view of the tip section; FIG. 4 is a view showing a bending section of the insertion manipulator; A view showing a nodal ring of the bending section; FIG. 5 is a view showing a first channel tube of the insertion manipulator; A cross-sectional view of a proximal channel tube of the first channel tube; A functional block diagram of a drive unit; A functional block diagram of a video control unit; A view showing a modified example of the bending section; A view showing a first channel tube inserted through the modified example of the bending section; A view showing a modified example of the insertion section; A view showing a spiral tube; A view showing a modified example of the tip section; A view showing a stiffness variable device according to a second embodiment; An overall view of the stiffness variable device; A view showing the stiffness variable unit; A view showing the stiffness variable unit; A view showing the operation of the stiffness variable unit; A view showing the operation of the stiffness variable unit; A view showing the operation of the stiffness variable unit; A view showing the operation of the stiffness variable unit; A view showing a modified example of the stiffness variable unit. 10 is a diagram showing the same modified example of the hardness variable section. FIG. 11 is a diagram showing another modified example of the hardness variable section. FIG. 12 is a diagram showing the same modified example of the hardness variable section. FIG. 13 is a diagram showing another modified example of the hardness variable section. FIG. 14 is a diagram showing another modified example of the hardness variable section. FIG. 15 is a diagram showing another modified example of the hardness variable section. FIG. 16 is a diagram showing a high-frequency knife in a manipulator tool according to a third embodiment. FIG. 17 is a diagram showing the high-frequency knife applying a marking. FIG. 18 is a diagram showing a local injection needle. FIG. 19 is a diagram showing the local injection needle performing local injection. FIG. 19 is a diagram showing the high-frequency knife performing an incision. FIG. 19 is a diagram showing the high-frequency knife performing an incision. FIG. 20 is a diagram showing a basket. FIG. 21 is a diagram showing the basket recovering a target portion. FIG. 21 is a diagram showing a manipulator tool according to a fourth embodiment. A cross-sectional view of the manipulator tool. A diagram showing a modified example of the manipulator tool. A diagram showing the artificial muscle arranged at another position. A diagram showing the artificial muscle arranged at another position. A diagram showing the artificial muscle arranged at another position. A diagram showing the artificial muscle arranged at another position. A diagram showing the artificial muscle arranged at another position. A diagram showing another modified example of the manipulator tool. A diagram showing a suturing device according to a fifth embodiment. A diagram showing an image captured by the scope of the insertion manipulator. 10A and 10B are views showing a needle being transferred from a first jaw to a second jaw of the suturing device, and a view showing a needle being transferred from a first jaw to a second jaw of the suturing device.A view showing a needle being passed from the first jaw to the second jaw of the suturing device. A view showing a needle being passed from the first jaw to the second jaw of the suturing device. A view showing a sutured defect. A view showing the operation of the anchor applier. A view showing the operation of the anchor applier. A view showing the operation of the anchor applier. A view showing the operation of the anchor applier.

[0010] First Embodiment An electric endoscope system 1000 according to a first embodiment of the present invention will be described with reference to Figs. 1 to 13. Fig. 1 is an overall view of the electric endoscope system 1000 according to this embodiment. The electric endoscope system 1000 is an example of a medical manipulator system. The medical manipulator includes an insertion manipulator 100 to be inserted into the body, an electrically driven endoscope, a catheter, a treatment tool, an endoluminal device, and the like.

[0011] The electric endoscope system 1000 is a medical system for observing and treating the inside of a patient's body. The electric endoscope system 1000 includes an insertion manipulator 100, a treatment manipulator 400, a drive unit 500, a video control unit 600, an operation unit 800, and a display unit 900.

[0012] FIG. 2 is a diagram showing the insertion manipulator 100 inserted into the large intestine. The insertion manipulator 100 is a device that is inserted into a patient's lumen to observe and treat an affected area. The insertion manipulator 100 has high insertability and can be inserted, for example, as far as the ascending colon AC or cecum CE of the large intestine, as shown in FIG. 2. The insertion manipulator 100 is detachable from a drive unit 500 and an image control unit 600. An internal path 101 is formed inside the insertion manipulator 100. In the following description, the side of the insertion manipulator 100 that is inserted into the patient's lumen will be referred to as the "tip side (distal side) A1," and the side that is attached to the drive unit 500 will be referred to as the "base side (proximal side) A2."

[0013] The treatment manipulator 400 is a device that is inserted, for example, through the first channel tube 171 of the insertion manipulator 100, protrudes from the first opening 111a, and is inserted into a patient's lumen to treat an affected area. An end effector (treatment unit) that treats the affected area is disposed at the tip of the treatment manipulator 400.

[0014] The drive device 500 is detachably connected to the insertion manipulator 100 and the operation device 800. Based on operations input to the operation device 800, the drive device 500 drives a built-in motor to electrically drive the insertion manipulator 100. Based on operations input to the operation device 800, the drive device 500 also drives a built-in pump or the like to cause the insertion manipulator 100 to supply air and water and perform suction.

[0015] The image control device 600 is detachably connected to the insertion manipulator 100, and acquires captured images from the insertion manipulator 100. The image control device 600 causes the display device 900 to display the captured images acquired from the insertion manipulator 100, as well as GUI images and CG images intended to provide information to the operator.

[0016] The drive unit 500 and the image control unit 600 constitute a control unit 700 that controls the electric endoscope system 1000. The control unit 700 may further include a peripheral device such as a video printer. The drive unit 500 and the image control unit 600 may be integrated into one device.

[0017] The operating device 800 is detachably connected to the driving device 500 via an operating cable 801. The operating device 800 may be capable of communicating with the driving device 500 wirelessly rather than by wired communication. The surgeon S can electrically drive the insertion manipulator 100 by operating the operating device 800.

[0018] The display device 900 is a device capable of displaying images, such as an LCD, etc. The display device 900 is connected to the video control device 600 via a display cable 901.

[0019] The operation device 800 and the display device 900 are mounted on a cart. The cart on which the operation device 800 and the display device 900 are mounted is also referred to as a "console CON."

[0020] Hereinafter, each device of the electric endoscope system 1000 will be described.

[0021] [Insertion Manipulator 100] Fig. 3 is a diagram showing the distal end of the insertion section 110. As shown in Figs. 1 and 3, the insertion manipulator 100 includes the insertion section 110, a detachable section 150, a bending wire 160, a built-in member 170, and a scope 200.

[0022] An internal passage (lumen) 101 is formed inside the insertion manipulator 100, extending from the tip of the insertion section 110 to the base end of the detachable section 150 along the longitudinal direction (longitudinal axis direction, axial direction) A of the insertion manipulator 100. The bending wire 160 and the built-in object 170 are inserted into the internal passage 101.

[0023] The insertion section 110 is a thin, elongated member that can be inserted into a lumen. The insertion section 110 has a distal end section 111, a bending section 112, and a flexible section 119. The distal end section 111, the bending section 112, and the flexible section 119 are connected in this order from the distal end side A1 toward the proximal end side A2. The insertion section 110 has an outer sheath 118, which is the outermost covering.

[0024] 4 is a front view of the tip portion 111 as viewed from the tip side A1. The tip portion 111 is cylindrical. The tip portion 111 has a first opening 111a, a second opening 111b, a water nozzle 111d, an air nozzle 111e, and a suction nozzle 111f. The first opening 111a, the second opening 111b, the water nozzle 111d, the air nozzle 111e, and the suction nozzle 111f are formed on the tip surface of the tip portion 111.

[0025] Fig. 5 is a cross-sectional view of the distal end portion 111. The built-in part 170 passes through the internal passage 101. The built-in part 170 has a first channel tube 171, a second channel tube 172, an imaging cable 173, a light guide 174, a water supply tube 175, an air supply tube 176, and a suction tube 177. Fig. 5 also shows two treatment manipulators 400 that pass through the first channel tube 171.

[0026] The first opening 111a is an opening that communicates with the first channel tube 171. The first opening 111a is a circular opening in a front view seen from the distal end side A1. The distal end of the treatment manipulator 400 that passes through the first channel tube 171 protrudes and retracts through the first opening 111a.

[0027] The first opening 111a has notches 111n formed on both sides in a direction (LR direction described later) perpendicular to the longitudinal direction A. As shown in Fig. 3, the treatment manipulator 400 protruding from the first opening 111a to the distal end side A1 can be inserted through the notches 111n. Note that the notches 111n only need to be formed on the inner circumferential surface of the first opening 111a and do not need to penetrate in the direction perpendicular to the longitudinal direction A.

[0028] The second opening 111b is an opening that communicates with the second channel tube 172. The second opening 111b is a circular opening in a front view seen from the distal end side A1. The distal end of the treatment manipulator 400 that passes through the second channel tube 172 protrudes and retracts through the second opening 111b.

[0029] The inner diameter D1 of the first opening 111a excluding the cutout 111n is larger than the inner diameter D2 of the second opening 111b. Specifically, the inner diameter D1 of the first opening 111a excluding the cutout 111n is three to five times the inner diameter D2 of the second opening 111b.

[0030] The water supply nozzle 111d is an opening that communicates with the water supply tube 175. Liquid in a tank installed near the control device 700 passes through the water supply tube 175 and is supplied from the water supply nozzle 111d.

[0031] The air supply nozzle 111e is an opening that communicates with the air supply tube 176. Gas from a tank installed near the control device 700 passes through the air supply tube 176 and is sent out from the air supply nozzle 111e.

[0032] The suction nozzle 111f is an opening that communicates with the suction tube 177. A tank installed near the control device 700 sucks gas or liquid from the suction nozzle 111f via the suction nozzle 111f.

[0033] [Scope 200] The scope 200 is a unit for observing an affected area, etc., and is attached to the distal end portion 111. The scope 200 may be attached so as to be able to protrude from the distal end portion 111 to the distal end side A1 and be bendable. The scope 200 has an imaging unit 201 and an illumination unit 202.

[0034] The imaging unit 201 includes an imaging element such as a stereo lens and a CMOS, and captures an image of the imaging target. The imaging signal is sent to the image control device 600 via an imaging cable 173. The illumination unit 202 is connected to a light guide 174 that guides illumination light, and emits illumination light that illuminates the imaging target.

[0035] In the electric endoscope system 1000, the entire insertion manipulator 100 can be considered as an "endoscope." Also, the scope 200, the imaging cable 173, and the light guide 174 can be considered as an "endoscope."

[0036] 6 is a diagram showing the bending portion 112. The bending portion 112 has a plurality of node rings (also referred to as bending pieces) 115, a tip portion 116 connected to the tips of the plurality of node rings 115, and an outer sheath 118. The plurality of node rings 115 are connected inside the outer sheath 118 in the longitudinal direction A. The tip node ring 115 is connected to the tip portion 111. Note that the outer sheath 118 of the bending portion 112 shown in FIG. 3 is omitted from the illustration.

[0037] 7 is a diagram showing the node ring 115. The node ring 115 is a short cylindrical member made of metal. The multiple node rings 115 are connected so that the internal spaces of adjacent node rings 115 are continuous.

[0038] The nodal ring 115 has a first nodal ring 115a on the distal end side and a second nodal ring 115b on the proximal end side. The first nodal ring 115a and the second nodal ring 115b are connected by a first pivot pin 115p so as to be rotatable in the up-down direction (also referred to as the "UD direction") perpendicular to the longitudinal direction A.

[0039] In adjacent node rings 115, the second node ring 115b in the node ring 115 on the tip side and the first node ring 115a in the node ring 115 on the base side are rotatably connected by a second pivot pin 115q in the left-right direction (also referred to as the "LR direction") perpendicular to the longitudinal direction A and the UD direction.

[0040] The first nodal rings 115a and the second nodal rings 115b are alternately connected by first pivot pins 115p and second pivot pins 115q, and the bending portion 112 is free to bend in a desired direction.

[0041] An upper wire guide 115u and a lower wire guide 115d are formed on the inner peripheral surface of the second nodal ring 115b. The upper wire guide 115u and the lower wire guide 115d are arranged on both sides in the UD direction across the central axis O1 in the longitudinal direction A. A left wire guide 115l and a right wire guide 115r are formed on the inner peripheral surface of the first nodal ring 115a. The left wire guide 115l and the right wire guide 115r are arranged on both sides in the LR direction across the central axis O1 in the longitudinal direction A.

[0042] The upper wire guide 115u, the lower wire guide 115d, the left wire guide 115l, and the right wire guide 115r have through holes formed along the longitudinal direction A through which the bending wire 160 is inserted.

[0043] The bending wires 160 are wires that bend the bending portion 112. The bending wires 160 extend through the internal path 101 to the detachable portion 150. The bending wires 160 include an upper bending wire 161u, a lower bending wire 161d, a left bending wire 161l (see FIG. 3), and a right bending wire 161r.

[0044] The upper bending wire 161u and the lower bending wire 161d are wires that bend the bending portion 112 in the UD direction. The upper bending wire 161u is inserted through the upper wire guide 115u. The lower bending wire 161d is inserted through the lower wire guide 115d.

[0045] The left bending wire 161l and the right bending wire 161r are wires that bend the bending portion 112 in the LR directions. The left bending wire 161l is inserted through a left wire guide 115l. The right bending wire 161r is inserted through a right wire guide 115r.

[0046] The tip of the bending wire 160 is fixed to the tip portion 116 of the bending portion 112. The bending portion 112 can be bent freely in a desired direction by pulling or loosening each of the bending wires 160 (upper bending wire 161u, lower bending wire 161d, left bending wire 161l, right bending wire 161r).

[0047] The bending wire 160 and built-in components 170 (a first channel tube 171, a second channel tube 172, an imaging cable 173, a light guide 174, a water supply tube 175, an air supply tube 176, and a suction tube 177) are inserted through an internal path 101 formed inside the bending portion 112. Note that the built-in components 170 other than the first channel tube 171 are not shown in FIG. 6 .

[0048] The flexible section 119 is a long, flexible tubular member. The flexible section 119 has an outer sheath 118, which is the outermost layer. The tip of the flexible section 119 is connected to the bending section 112. A bending wire 160 and built-in components 170 (a first channel tube 171, a second channel tube 172, an imaging cable 173, a light guide 174, a water supply tube 175, an air supply tube 176, and a suction tube 177) are inserted through an internal passage 101 formed in the flexible section 119.

[0049] 1, the detachable unit 150 is provided at the base end of the flexible unit 119. The detachable unit 150 is attached to the drive unit 500 and the video control unit 600.

[0050] [First Channel Tube 171] As shown in Fig. 5, the first channel tube 171 is a tube having a large-diameter first treatment instrument lumen 171r. The second channel tube 172 is a tube having a second treatment instrument lumen 172r. The inner diameter D1 of the first treatment instrument lumen 171r is larger than the inner diameter D2 of the second treatment instrument lumen 172r. Specifically, the inner diameter D1 of the first treatment instrument lumen 171r is three to five times the inner diameter D2 of the second treatment instrument lumen 172r. As shown in Fig. 3, two treatment manipulators 400 can be inserted through the first treatment instrument lumen 171r.

[0051] The inner diameter D1 of the first treatment instrument lumen 171r is at least half the outer diameter of the outer sheath 118. Even in existing endoscopes (e.g., transnasal endoscopes) with a relatively large treatment instrument channel inner diameter, the treatment instrument channel inner diameter is approximately 2.4 mm (approximately 2 / 5 of the outer diameter) compared to an outer diameter of approximately 6 mm. Compared to existing endoscopes, the insertion manipulator 100 has a larger inner diameter D1 of the first treatment instrument lumen 171r relative to the outer diameter of the outer sheath 118. Therefore, a large treatment manipulator 400 can be inserted into the first treatment instrument lumen 171r, expanding the range of procedures.

[0052] Fig. 8 is a diagram showing the first channel tube 171. Note that Fig. 8 does not show the built-in components 170 other than the first channel tube 171. The first channel tube 171 has a base end channel tube 171A disposed in the flexible section 119 and a distal end channel tube 171B disposed in the bending section 112. The base end channel tube 171A and the distal end channel tube 171B are connected to each other and form a first treatment tool lumen 171r.

[0053] 9 is a cross-sectional view of the proximal channel tube 171 A. The proximal channel tube 171 A has a coil sheath 171 a, a braid tube 171 b, a first fixing portion 171 c, a second fixing portion 171 d, and a restricting wire 171 e.

[0054] The coil sheath 171a is a flexibly bendable coil sheath with good kink resistance. The coil sheath 171a forms a large-diameter first treatment tool lumen 171r through which the treatment manipulator 400 is inserted.

[0055] The braid tube 171b is a tube in which metal wires, resin wires, or the like are woven into a braid shape, and is disposed outside the coil sheath 171a. It is desirable that the braid tube 171b be disposed so as to be in contact with the outer peripheral surface of the coil sheath 171a.

[0056] The proximal channel tube 171A is a tube with a double structure of a coil sheath 171a and a braid tube 171b. Therefore, the proximal channel tube 171A maintains excellent kink resistance due to the coil sheath 171a while also having excellent torque transmission due to the braid tube 171b. By fitting the coil sheath 171a and the braid tube 171b together, the frictional force between the coil sheath 171a and the braid tube 171b is further improved, thereby further improving torque transmission.

[0057] The coil sheath 171a is fixed to the braid tube 171b at a first fixing portion 171c on the distal end side A1 in the axial direction A and at a second fixing portion 171d on the proximal end side A2 of the first fixing portion 171c.

[0058] The restricting wire 171e is connected to the first fixed portion 171c and the second fixed portion 171d, and restricts the distance L1 between the first fixed portion 171c and the second fixed portion 171d in the axial direction A. It is desirable to provide a plurality of restricting wires 171e. The restricting wire 171e is a highly rigid wire, such as a NiTi wire.

[0059] The restricting wire 171e restricts the distance L1 in the axial direction A between the first fixing portion 171c and the second fixing portion 171d, thereby preventing a decrease in torque transmission and pushability due to the expansion and contraction of the coil sheath 171a and the blade tube 171b.

[0060] The restricting wire 171e is arranged so as to alternately run inside and outside the blade tube 171b, so that the restricting wire 171e can suitably restrict the distance L1 in the axial direction A between the first fixing portion 171c and the second fixing portion 171d regardless of the curved shape of the insertion section 110.

[0061] The coil sheath 171a may be fixed to the braid tube 171b by the first fixing portion 171c and the second fixing portion 171d in a state compressed in the axial direction A. In this case, the coil sheath 171a has a biasing force that separates the first fixing portion 171c and the second fixing portion 171d in the axial direction A. A tension that pulls the braid tube 171b in the axial direction A acts on the braid tube 171b. As a result, it is possible to prevent a decrease in torque transmissibility and a decrease in pushability that would otherwise be caused by the contraction of the coil sheath 171a and the braid tube 171b. If this effect is sufficient, the restricting wire 171e is not necessarily required.

[0062] As described above, the proximal channel tube 171A has good kink resistance, good torque transmission, and good pushability despite having a large-diameter first treatment tool lumen 171r. Therefore, even if the outer sheath 118, which is the outermost layer of the flexible section 119, is thin-walled, the flexible section 119 can maintain good kink resistance, good torque transmission, and good pushability.

[0063] The distal channel tube 171B may have the same configuration as the proximal channel tube 171A. However, the bending section 112 in which the distal channel tube 171B is disposed has a highly rigid nodal ring 115, and therefore has sufficient torque transmission and pushability. Therefore, the distal channel tube 171B only needs to have the coil sheath 171a that forms the first treatment tool lumen 171r, and does not need to have the braid tube 171b or the restricting wire 171e.

[0064] As described above, the outer sheath 118 can be formed from a thin film, which allows for a reduction in the diameter of the insertion manipulator 100. However, in cases where the first channel tube 171 does not have sufficient kink resistance, torque transmission ability, or pushability, the outer sheath 118 may be a multi-layer tube having an outer coil sheath through which the first channel tube 171 etc. is inserted, and an outer braid tube arranged outside the outer coil sheath.

[0065] 10 is a functional block diagram of the drive unit 500. The drive unit 500 includes an endoscope adapter 510, an operation receiving unit 520, an air supply / suction drive unit 530, a drive unit 550, and a drive controller 560.

[0066] The endoscope adaptor 510 is an adaptor to which the insertion manipulator 100 is detachably connected. The endoscope adaptor 510 connects the bending wire 160, the suction tube 177, the water supply tube 175, and the air supply tube 176 to the drive device 500.

[0067] The operation receiving unit 520 receives operation input from the operation device 800 via the operation cable 801. When the operation device 800 and the drive device 500 communicate with each other wirelessly rather than via wired communication, the operation receiving unit 520 has a known wireless receiving module.

[0068] The air supply / suction drive unit 530 is connected to the suction tube 177, the water supply tube 175, and the air supply tube 176 via the endoscope adapter 510. The air supply / suction drive unit 530 includes a pump and the like, and supplies liquid to the water supply tube 175. The air supply / suction drive unit 530 also supplies air to the air supply tube 176. The air supply / suction drive unit 530 also suctions air from the suction tube 177.

[0069] The drive unit (actuator) 550 is connected to the bending wire 160 of the insertion manipulator 100 via the endoscope adapter 510. The drive unit 550 has a drive section and an encoder (not shown). The drive section pulls or loosens the bending wire 160 using a pulley or the like. The encoder detects the amount of pulling of the bending wire 160. The detection result of the encoder is acquired by a drive controller 560 of the drive device 500.

[0070] The drive unit (actuator) 550 is also coupled to the treatment manipulator 400 to drive the treatment manipulator 400 .

[0071] The drive controller 560 controls the entire drive device 500. The drive controller 560 acquires the operation input received by the operation receiving unit 520. The drive controller 560 controls the air supply / suction drive unit 530 and the drive unit 550 based on the acquired operation input.

[0072] The drive controller 560 is a computer capable of executing programs, including a processor 561, a memory 562, a storage unit 563 capable of storing programs and data, and an input / output control unit 564. The functions of the drive controller 560 are realized by the processor 561 executing the programs. At least some of the functions of the drive controller 560 may be realized by a dedicated logic circuit.

[0073] The drive controller 560 may further include components other than the processor 561, memory 562, storage unit 563, and input / output control unit 564. For example, the drive controller 560 may further include an image calculation unit that performs part or all of the image processing and image recognition processing. By including the image calculation unit, the drive controller 560 can execute specific image processing and image recognition processing at high speed. The image calculation unit may be mounted on a separate hardware device connected via a communication line.

[0074] 11 is a functional block diagram of the image control device 600. The image control device 600 includes an endoscope adapter 610, an image capturing processing unit 620, a light source unit 630, and a main controller 660.

[0075] The endoscope adaptor 610 is an adaptor to which the insertion manipulator 100 is detachably connected. The endoscope adaptor 610 connects the imaging cable 173 and the light guide 174 to the image control device 600.

[0076] The imaging processing unit 620 is connected to the imaging cable 173. The imaging processing unit 620 converts the imaging signal acquired from the imaging unit 201 of the scope 200 via the imaging cable 173 into a captured image.

[0077] The light source unit 630 is connected to the light guide 174. The light source unit 630 generates illumination light to be irradiated onto the imaging target. The illumination light generated by the light source unit 630 is guided to the illumination unit 202 of the scope 200 via the light guide 174.

[0078] The main controller 660 is a computer capable of executing programs, including a processor 661, a memory 662, a storage unit 663 capable of storing programs and data, and an input / output control unit 664. The functions of the main controller 660 are realized by the processor 661 executing programs. At least some of the functions of the main controller 660 may be realized by a dedicated logic circuit.

[0079] The main controller 660 can perform image processing on the captured image acquired by the imaging processing unit 620. The main controller 660 can generate GUI images and CG images for the purpose of providing information to the surgeon S. The main controller 660 can display the captured image, GUI image, and CG image on the display device 900.

[0080] The main controller 660 is not limited to being an integrated hardware device. For example, the main controller 660 may be configured by separating some parts into separate hardware devices and connecting the separated hardware devices via a communication line. For example, the main controller 660 may be a cloud system in which the separated storage units 663 are connected via a communication line.

[0081] The main controller 660 may further include components other than the processor 661, memory 662, storage unit 663, and input / output control unit 664. For example, the main controller 660 may further include an image calculation unit that performs part or all of the image processing and image recognition processing that were previously performed by the processor 661. By including the image calculation unit, the main controller 660 can execute specific image processing and image recognition processing at high speed. The image calculation unit may be mounted on a separate hardware device connected via a communication line.

[0082] [Operation of Electric Endoscope System 1000] Next, the operation of the electric endoscope system 1000 of this embodiment will be described. Specifically, the procedure for observing and treating an affected area formed on the wall of the large intestine using the electric endoscope system 1000 will be described.

[0083] The surgeon S inserts the tip of the insertion section 110 of the insertion manipulator 100 into the large intestine through the patient's anus. While observing the captured image displayed on the display device 900, the surgeon S operates the operation device 800 to move the insertion section 110 and bring the tip section 111 closer to the affected area. The surgeon S also operates the operation device 800 to bend the bending section 112 as necessary.

[0084] Since the insertion manipulator 100 has good kink resistance, good torque transmission properties, and good pushability, the surgeon S can easily operate the insertion manipulator 100 .

[0085] The surgeon S inserts the treatment manipulator 400 into the first channel tube 171 and the second channel tube 172. While observing the captured image displayed on the display device 900, the surgeon S operates the operation device 800 to operate the treatment manipulator 400 and treat the affected area.

[0086] Since the insertion manipulator 100 has the large-diameter first treatment tool lumen 171r, the surgeon S can preferably perform treatment using the large treatment manipulator 400 as well.

[0087] After treating the affected area, the surgeon S removes the insertion manipulator 100 and the treatment manipulator 400, thereby completing the procedure.

[0088] The electric endoscope system 1000 according to this embodiment enables more efficient observation and treatment. Because the insertion manipulator 100 has good kink resistance, good torque transmission, and good pushability, the surgeon S can easily operate the insertion manipulator 100. Because the insertion manipulator 100 has a large-diameter first treatment tool lumen 171r, the surgeon S can also suitably perform treatment using a large treatment manipulator 400.

[0089] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and modifications can be configured by appropriately combining them.

[0090] (Variation 1-1) Fig. 12 is a diagram showing a bending portion 112A which is a variation of the bending portion 112. Note that in Fig. 12, illustration of the built-in components 170 other than the first channel tube 171 is omitted. The bending portion 112 does not have multiple node rings 115, but has multiple ring members 115A. The multiple ring members 115A are arranged in the axial direction A. The built-in component 170 including the first channel tube 171 passes through the multiple ring members 115A. The bending wire 160 passes through a wire guide 115g formed in the ring member 115A.

[0091] 13 is a diagram showing the first channel tube 171 inserted through the bending portion 112A. The bending portion 112A has lower torque transmission and pushability compared to the bending portion 112 to which the node ring 115 is connected. For this reason, it is desirable that the distal end portion of the first channel tube 171 inserted through the bending portion 112A be a tube with a double structure of a coil sheath 171a and a braid tube 171b. It is also desirable that the distal end portion of the first channel tube 171 inserted through the bending portion 112A have a restriction wire 171e that restricts the distance between the ends.

[0092] 14 is a diagram showing an insertion section 110A, which is a modified example of the insertion section 110. The insertion section 110A has a telescopic section 117 in addition to a tip section 111, a bending section 112, and a flexible section 119. The telescopic section 117 is a member that connects the tip section 111 to the tip section 116 of the bending section 112, and is driven by a driving section (actuator) 550 or the like to be telescopic along the longitudinal direction A. The outer periphery of the telescopic section 117 is formed in a bellows shape. By telescoping the telescopic section 117, the surgeon S can accurately control the position of the tip section 111 in the longitudinal direction A.

[0093] FIG. 15 is a diagram showing a spiral tube 180. The surgeon may insert the insertion section 110 into the spiral tube 180, which is separate from the insertion section 110. The spiral tube 180 is a tube with fins 181 spirally wound around its outer periphery. The spiral tube 180 is driven by a drive unit (actuator) 550 or the like and is rotatable about a rotation axis extending in the longitudinal direction A. By rotating the spiral tube 180, the surgeon can advance and retreat the spiral tube 180 and the insertion section 110 within the lumen. For example, the surgeon can easily insert the tip portion 111 of the insertion section 110 deep into the large intestine.

[0094] FIG. 16 is a diagram showing a tip portion 111A, which is a modified example of the tip portion 111. The tip portion 111A has a cutout portion 111g, which is formed by cutting out a portion of the cylindrical main body. The cutout portion 111g extends in the longitudinal direction A. A first opening 111a of the tip portion 111A is provided on the base end side A2 of the cutout portion 111g. The first opening 111a opens to the tip side A1. A scope 200 is attached to the tip of the tip portion 111A. In addition to the scope 200, which is an insertion camera, the tip portion 111A also has a treatment camera 111c. The treatment camera 111c is provided on the tip side A1 of the cutout portion 111g. The first opening 111a and the treatment camera 111c are provided opposite each other. The treatment camera 111c can capture images of the treatment manipulator 400 protruding from the first opening 111a treating the affected area. Since the direction in which the treatment camera 111c faces and the direction in which the treatment manipulator 400 projects are opposite, the surgeon can perform treatment while always visually checking the tip of the treatment manipulator 400.

[0095] Second Embodiment A variable hardness device 300 according to a second embodiment of the present disclosure will be described with reference to Fig. 17 to Fig. 25. In the following description, components common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.

[0096] Fig. 17 is a diagram showing the rigidity variable device 300 being inserted through the bending portion 112. The rigidity variable device (rigidizer, introducer) 300 is a device having a rigidity variable portion 310 that can be inserted through the first treatment tool lumen 171r. In Fig. 17, the rigidity variable device 300 is inserted through the first treatment tool lumen 171r. Note that the first channel tube 171 and the second channel tube 172 are not shown in Fig. 17.

[0097] 18 is an overall view of the stiffness variable device 300. The stiffness variable device 300 includes a stiffness variable section 310, an insertion section 320, and a drive unit 340.

[0098] 19 and 20 are diagrams illustrating the hardness variable section 310. The hardness variable section 310 is an elongated member that can be inserted through the first treatment tool lumen 171r and whose hardness can be changed by applying a predetermined operation. The hardness variable section 310 includes multiple vertebrae 311 and a wire 312. The vertebrae 311 are formed in a bowl shape. The multiple vertebrae 311 are connected in the longitudinal direction while overlapping each other. The wire 312 is inserted through the multiple vertebrae 311 and fixed to the vertebrae at the tip. As shown in FIG. 20 , by pulling the wire 312 toward the proximal end, adjacent vertebrae 311 come into close contact with each other, increasing frictional force and fixing the shape of the hardness variable section 310. By loosening the wire 312, the shape of the hardness variable section 310 can be changed.

[0099] The insertion section 320 is a flexible, elongated member that can be inserted through the first treatment tool lumen 171r. The insertion section 320 is provided at the proximal end of the hardness variable section 310.

[0100] The drive unit 340 is provided at the proximal end of the insertion section 320. The drive unit 340 moves the insertion section 320 forward and backward in the longitudinal axis direction and rotates the insertion section 320 about the longitudinal axis. The drive unit 340 may be integrated into the drive device 500.

[0101] 21 to 25 are diagrams showing the operation of the hardness variable section 310. As shown in FIG. 21 , the surgeon S inserts the insertion section 110 of the insertion manipulator 100 from the anus of the patient, starting from the tip, into the large intestine. As shown in FIG. 22 , the surgeon S places the bending section 112 at a portion of the large intestine that curves greatly. As shown in FIG. 23 , the surgeon S advances the shape-variable hardness section 310 to place the shape-variable hardness section 310 in the bending section 112. The surgeon S fixes the shape of the hardness variable section 310 that passes through the bending section 112. As shown in FIG. 24 , the surgeon S advances the insertion section 110. The bending section 112 advances along the hardness variable section 310, the shape of which is fixed. The insertion manipulator 100 can smoothly pass through a portion of the large intestine that curves greatly. When the hardness variable section 310 is no longer needed, the surgeon S releases the wire of the hardness variable section 310, and in the softened state, removes the hardness variable section 310 from the bending section 112 as shown in FIG.

[0102] The variable stiffness device 300 according to this embodiment allows observation and treatment to be performed more efficiently. The surgeon S can use the variable stiffness device 300 to smoothly insert the insertion manipulator 100 to the target site.

[0103] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and modified examples can be configured by appropriately combining them.

[0104] (Variation 2-1) FIGS. 26 and 27 are diagrams illustrating a hardness variable unit 310A, which is a variation of the hardness variable unit 310. The hardness variable unit 310A includes a tube 313 and multiple wires 314 inserted through the tube 313. The wires 314 are metal wires, resin wires, or the like. As shown in FIG. 27 , negative pressure is applied to the internal space of the tube 313 by suction, causing the multiple wires 314 to come into contact with each other. This creates friction between the multiple wires 314 and between the wires 314 and the tube, inhibiting movement between the wires 314. This fixes the shape of the hardness variable unit 310A. By roughening the surface of the wires 314 to increase the contact resistance, the aforementioned frictional force increases, further increasing the hardness of the hardness variable unit 310A, whose shape is fixed.

[0105] (Variation 2-2) FIGS. 28 and 29 are diagrams illustrating a hardness variable unit 310B, a variation of the hardness variable unit 310. The hardness variable unit 310B includes multiple vertebrae 311 and a tube 313. The tube 313 passes through the multiple vertebrae 311. As shown in FIG. 29 , the internal space of the tube 313 is positively pressurized by supplying air, causing the tube 313 to expand, thereby increasing the frictional force between adjacent vertebrae 311 and fixing the shape of the hardness variable unit 310. Because the hardness variable unit 310B creates a positive pressure in the internal space of the tube 313, it is easier to improve the frictional force between the multiple vertebrae 311, etc., compared to other embodiments in which the internal space of the tube 313 is negatively pressurized, thereby making the hardness variable unit 310B stronger. This is because, in embodiments in which the internal space of the tube 313 is negatively pressurized, pressure can only be reduced by the amount of atmospheric pressure, whereas in embodiments in which the internal space of the tube 313 is positively pressurized, there is no such limitation and stronger pressure can be applied.

[0106] (Variation 2-3) Figures 30 and 31 are diagrams showing a hardness variable unit 310C, which is a variation of the hardness variable unit 310. The hardness variable unit 310C has an outer tube 315, an inner tube 316, and multiple cables 317. The inner tube 316 passes through the internal space of the outer tube 315. The multiple cables 317 pass through a space V sandwiched between the outer tube 315 and the inner tube 316. As shown in Figure 31, by creating a negative pressure in the space V by suction, the multiple cables 317 come into contact with each other, and the shape of the hardness variable unit 310C is fixed. The negative pressure in the space V may also be created by hydraulic pressure.

[0107] (Variation 2-4) Figure 32 is a diagram showing a hardness variable section 310D, which is a variation of the hardness variable section 310. The hardness variable section 310D has a plurality of spine sections 311 and a shape memory alloy wire 318. When electricity is passed through the shape memory alloy wire 318, the spine sections 311 are tightly attached to the hardness variable section 310D in the same way as the hardness variable section 310, so that the hardness variable section 310D can be switched between a state in which its shape is fixed and a state in which its shape is variable.

[0108] Third Embodiment A treatment manipulator 400 according to a third embodiment of the present disclosure will be described with reference to Fig. 33 to Fig. 40. In the following description, configurations common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.

[0109] 33 is a diagram showing a high-frequency knife 430. The treatment manipulator 400 includes a bendable treatment instrument arm 410 and treatment instruments (forceps 420, a high-frequency knife 430, a local injection needle 440, a basket 450, etc.) that are inserted through the treatment instrument arm 410.

[0110] The treatment instrument arm 410 is a hollow, elongated member. Similar to the bending section 112 of the insertion manipulator 100, the treatment instrument arm 410 has a plurality of nodal rings (also called bending pieces) 415, and can be bent in the up-down and left-right directions by being driven by a wire or the like.

[0111] Treatment instruments (such as forceps 420, high-frequency knife 430, local injection needle 440, and basket 450) can be inserted through the internal space (lumen, channel) of the treatment instrument arm 410. The treatment instruments can be passively bent, but do not necessarily have the function of actively bending.

[0112] 34 is a diagram showing the high-frequency knife 430 to which the marking M is applied. The surgeon S inserts the high-frequency knife 430 into the treatment instrument arm 410, causing the tip of the high-frequency knife 430 to protrude from the tip of the treatment instrument arm 410. The surgeon S bends the treatment instrument arm 410 to position the tip of the high-frequency knife 430 at a desired position. The surgeon S cauterizes the living tissue with the tip of the high-frequency knife 430 to apply the marking M to the living tissue.

[0113] The first treatment instrument lumen 171r has a large diameter, and therefore can accommodate the insertion of two treatment instrument arms 410. As shown in Fig. 34, for example, the surgeon S can insert a high-frequency knife 430 into one treatment instrument arm 410 and a forceps 420 into the other treatment instrument arm 410, thereby treating the target site using two treatment instruments.

[0114] 35 is a diagram showing the local injection needle 440. The surgeon S removes the high-frequency knife 430 from the treatment instrument arm 410. Next, the surgeon S inserts the local injection needle 440 into the treatment instrument arm 410, causing the tip of the local injection needle 440 to protrude from the tip of the treatment instrument arm 410.

[0115] 36 is a diagram showing the local injection needle 440. The surgeon S bends the treatment instrument arm 410 to position the tip of the local injection needle 440 at a desired position. The surgeon S pierces the living tissue with the tip of the local injection needle 440 to locally inject the local injection liquid.

[0116] 37 and 38 are diagrams showing the high-frequency knife 430 making an incision. The surgeon S removes the local injection needle 440 from the treatment instrument arm 410. Next, the surgeon S inserts the high-frequency knife 430 into the treatment instrument arm 410. The surgeon S pulls the biological tissue together using the forceps 420. While checking the marking M, the surgeon S incises the target portion of the biological tissue with the high-frequency knife 430.

[0117] 39 is a diagram showing the basket 450. The surgeon S removes the two treatment instrument arms 410 together with the treatment instruments. Next, the surgeon S inserts the large-diameter treatment instrument arm 410A into the first treatment instrument lumen 171r. The surgeon S inserts the basket 450 into the large-diameter treatment instrument arm 410A. The basket 450 has a larger outer diameter than the high-frequency knife 430 and the local injection needle 440. The large-diameter treatment instrument arm 410A has a larger inner diameter of its hollow portion than the treatment instrument arm 410, allowing the basket 450 to be inserted therethrough. Alternatively, the large-sized basket 450 alone can be directly inserted into the first treatment instrument lumen 171r without the large-diameter treatment instrument arm 410A.

[0118] FIG. 40 is a diagram showing a basket 450 for retrieving a target region T. The surgeon S retrieves the target region T, which has been incised and dissected, using the basket 450. The large basket 450 allows the surgeon S to efficiently retrieve the target region T. Because the first treatment tool lumen 171r has a large diameter, a larger basket 450 can be inserted compared to baskets that have been used conventionally. Furthermore, because the first treatment tool lumen 171r has a large diameter, even if a larger amount of target region T or tissue is retrieved at one time than conventionally, it can be easily retrieved without getting stuck in the first treatment tool lumen 171r. Furthermore, because the first treatment tool lumen 171r has a large diameter, there is an advantage that not only baskets but also other treatment tools larger than conventionally can be inserted.

[0119] The treatment manipulator 400 according to this embodiment allows observation and treatment to be performed more efficiently. Because the insertion manipulator 100 has a large-diameter first treatment tool lumen 171r, two treatment manipulators 400 can be inserted therethrough and used simultaneously. Furthermore, because a large-diameter treatment manipulator 400 can be inserted through the first treatment tool lumen 171r, a large, multifunctional, and high-performance treatment manipulator 400 can be used.

[0120] Although the third embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and modifications can be configured by appropriately combining them.

[0121] Fourth Embodiment A treatment manipulator 400B according to a fourth embodiment of the present disclosure will be described with reference to Fig. 41 and Fig. 42. In the following description, configurations common to those already described will be assigned the same reference numerals, and duplicate description will be omitted.

[0122] 41 is a diagram showing a treatment manipulator 400B. Similar to the treatment manipulator 400 of the above embodiment, the treatment manipulator 400B is a device that is inserted into a patient's lumen through the first channel tube 171 of the insertion manipulator 100 and treats an affected area. The treatment manipulator 400B is driven by a drive unit (actuator) 550 and the like. The treatment manipulator 400B differs from the treatment manipulator 400 in that two treatment instrument arms 410 are arranged on the distal end surface of a single manipulator flexible section 417. The treatment manipulator 400B has the advantage of being easier to insert than the treatment manipulator 400.

[0123] The treatment manipulator 400B includes treatment tools (forceps 420, a high-frequency knife 430, a local injection needle 440, a basket 450, etc.), a treatment tool arm 410, an artificial muscle 470, and a wire 480.

[0124] The treatment instrument arm 410 is a hollow, elongated member. The treatment instrument arm 410 has a first bending portion 411 provided on the distal end side A1 and a second bending portion 412 provided on the proximal end side A2. When the treatment manipulator 400B is in use as shown in Fig. 41 , the first bending portion 411 is located on the distal end side A1 from the distal end surface of the distal end portion 111. A portion of the second bending portion 412 protrudes from the distal end portion 111 toward the distal end side A1.

[0125] The first bending portion 411 has a plurality of nodal rings (also called arm joints) 415, similar to the bending portion 112 of the insertion manipulator 100, and is capable of bending in the vertical and horizontal directions by being driven by artificial muscles 470.

[0126] As shown in Fig. 41 , the second bending portion 412 has a shoulder joint 416 that greatly bends the treatment instrument arm 410 in the left-right direction (LR direction). The shoulder joint 416 bends the second bending portion 412 twice in an S-shape in different directions when viewed from the up-down direction (UD direction). As shown in Fig. 41 , the tips of the second bending portions 412 of the two treatment instrument arms 410 bend away from each other in the left-right direction. Here, the distance between the central axes at the tips of the second bending portions 412 of the two treatment instrument arms 410 is defined as "distance (shoulder width) L."

[0127] When treating a target site using two treatment instrument arms 410, by appropriately separating the positions of the base ends of the two first bending portions 411, the surgeon S can secure sufficient space for treatment and easily treat the target site. Therefore, the surgeon S bends the second bending portion 412 greatly so that the distance L is appropriately long. Note that at least a portion of the two treatment manipulators 400 can be inserted through the cutout portions 111n and can extend outward in the left-right direction. Therefore, the distance L may be greater than the outer diameter of the tip portion 111 of the insertion manipulator 100.

[0128] The artificial muscle 470 constitutes at least a part of the mechanism for bending the treatment tool. The artificial muscle 470 is, for example, a McKibben artificial muscle. The artificial muscle 470 is attached to the first bending portion 411 and bends the first bending portion 411. A plurality of artificial muscles 470 are attached to the first bending portion 411 to bend the first bending portion 411 in the up / down and left / right directions.

[0129] 41 , when the treatment manipulator 400B is in use, the first bending portion 411 is disposed on the distal end side A1 relative to the distal end surface of the distal end portion 111. Therefore, the artificial muscle 470 is also disposed on the distal end side A1 relative to the distal end surface of the distal end portion 111.

[0130] 42 is a cross-sectional view of the treatment manipulator 400B. A tube 471 is attached to the artificial muscle 470 to supply fluid for operating the artificial muscle 470. The artificial muscle 470 contracts due to the fluid supplied from the tube 471.

[0131] The wire 480 is attached to the second bending portion 412. By pulling the second bending portion 412 from the proximal end side A2, the second bending portion 412 is bent.

[0132] The first bending portion 411 is driven to bend by the artificial muscle 470. The artificial muscle 470 can bend the first bending portion 411 more precisely than the wire 480. Therefore, the artificial muscle 470 is suitable for driving the first bending portion 411 to bend, which requires precise movements for treatment. Furthermore, the artificial muscle 470 is attached to the first bending portion 411 and directly bends the first bending portion 411. Therefore, the first bending portion 411 can be bent accurately without being affected by the shape of the base end side of the first bending portion 411, etc.

[0133] The second bending portion 412 is driven to bend by the wire 480. The second bending portion 412 only bends the shoulder joint 416 greatly, and does not require very precise movement. Therefore, even the wire 480 can sufficiently bend the second bending portion 412. Furthermore, driving by the wire 480 makes it easier to ensure a longer stroke than driving by the artificial muscle 470. Therefore, the wire 480 is suitable for driving the second bending portion 412, which requires a large bending movement.

[0134] The treatment manipulator 400B according to this embodiment allows observation and treatment to be performed more efficiently. The first bending portion 411, which is driven to bend by the artificial muscle 470, can precisely bend the treatment tool, allowing the surgeon S to perform observation and treatment more efficiently.

[0135] Although the fourth embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above-described embodiment and modifications can be configured by appropriately combining them.

[0136] (Variation 4-1) Figure 43 is a diagram showing a treatment manipulator 400C that is a variation of the treatment manipulator 400B. The treatment manipulator 400C has a treatment tool and an artificial muscle 470, but does not have a treatment tool arm 410. The artificial muscle 470 is attached to the treatment tool via a ring member 472. Furthermore, instead of the multiple nodal rings 415 shown in Figure 41, it is possible to use something that can withstand compressive force and bend, such as a tube or coil, and mount the artificial muscle 470 around it. Furthermore, instead of a configuration in which the artificial muscle 470 is arranged on the outside of the nodal rings 415, it is also possible to arrange something that can withstand compressive force and bend, such as a tube or coil, on the outside of the artificial muscle 470.

[0137] (Variation 4-2) Fig. 44 is a diagram showing an artificial muscle 470 placed in another position. The artificial muscle 470 may be provided on the base end side A2 relative to the second bending portion 412. The first bending portion 411 and the artificial muscle 470 are connected by a tip wire 473. The artificial muscle 470 bends the first bending portion 411 by moving the tip wire 473 back and forth. The artificial muscle 470 shown in Fig. 44 is placed at the tip portion 111, which is on the tip side A1 relative to the bending portion 112. The artificial muscle 470 is placed at the tip portion 111, which does not bend. Therefore, even if the bending portion 120 bends, the artificial muscle 470 does not bend.

[0138] (Variation 4-3) Figure 45 is a diagram showing an artificial muscle 470 placed in another position. The artificial muscle 470 shown in Figure 45 is placed in the bending section 112. The artificial muscle 470 is placed in the non-bending region E, which is sandwiched between the first pivot pin 115p and the second pivot pin 115q and does not bend. Therefore, even if the bending section 120 bends, the artificial muscle 470 does not bend.

[0139] (Variation 4-4) Figure 46 is a diagram showing an artificial muscle 470 placed in another position. The artificial muscle 470 shown in Figure 46 is placed in the flexible section 119, which is closer to the base end A2 than the bending section 112. The artificial muscle 470 is placed in the flexible section 119, which does not bend significantly. Therefore, even if the bending section 120 bends, the artificial muscle 470 does not bend.

[0140] (Variation 4-5) Figure 47 is a diagram showing an artificial muscle 470 placed in another position. The artificial muscle 470 shown in Figure 47 is placed in the flexible section 119 on the proximal side A2 of the bending section 112, at a position a distance L3 away from the proximal end of the bending section 112. The distance L3 is longer than the advance / retraction distance of the treatment manipulator 400B during treatment. Therefore, even if the treatment manipulator 400B advances / retracts during treatment, the artificial muscle 470 does not pass through the bending section 112. Therefore, even if the bending section 120 bends, the artificial muscle 470 does not bend.

[0141] (Variation 4-6) Fig. 48 is a diagram showing an artificial muscle 470 placed in another position. As shown in Fig. 48, multiple artificial muscles 470 may be arranged along the axial direction A. It is desirable that all of the artificial muscles 470 be placed in a region where they do not curve. This eliminates the need to arrange multiple artificial muscles 470 in a radially aligned arrangement, allowing the diameter of the treatment manipulator 400B to be made thinner.

[0142] (Variation 4-7) Figure 49 is a diagram showing a treatment manipulator 400D that is a variation of the treatment manipulator 400B. The treatment manipulator 400D does not have wires 480, and all bending portions are bent using artificial muscles 470. The surgeon S can bend all bending portions with precision.

[0143] Fifth Embodiment A suturing device 400E according to a fifth embodiment of the present disclosure will be described with reference to Figures 50 to 60. In the following description, components common to those already described will be assigned the same reference numerals, and redundant description will be omitted.

[0144] 50 is a diagram showing a suturing device 400E protruding from the distal end portion 111 of the insertion manipulator 100. Similar to the treatment manipulator 400 of the above embodiment, the suturing device 400E is a device that is inserted through the first channel tube 171 of the insertion manipulator 100 and sutures a defect D in biological tissue with a thread TH. Because the suturing device 400E has a larger outer diameter than the treatment manipulator 400, it is inserted through the first treatment tool lumen 171r rather than the second treatment tool lumen 172r. The suturing device 400E is driven by a drive unit (actuator) 550 or the like.

[0145] 50, the scope 200 is disposed at a position protruding from the distal end portion 111. The scope 200 can also be disposed at a position housed in the distal end portion 111. In other words, the scope 200 can advance and retreat relative to the insertion manipulator 100 independently of the suturing device 400E. As shown in FIG. 50, the scope 200 can be bent in a direction facing the central axis of the first channel tube (lumen) 171 while protruding from the distal end portion 111.

[0146] The suturing device 400E has a hollow, bendable arm 410E, a tip portion 411E provided at the tip of the arm 410E, a first jaw 412E, a second jaw 413E, and a needle 414E.

[0147] The arm 410E has a bending mechanism such as an artificial muscle 470 and a wire 480, similar to the treatment instrument arm 410 of the treatment manipulator 400. The arm 410E has a large-diameter hollow portion, similar to the large-diameter treatment instrument arm 410A.

[0148] The distal end portion 411E is formed in a substantially cylindrical shape. An internal space 411s of the distal end portion 411E is in communication with the hollow portion of the arm 410E. The internal space 411s of the distal end portion 411E and the hollow portion of the arm 410E form a channel 420E through which treatment devices such as an anchor applier 400F and a suture pulling tool 400G, which will be described later, can be inserted. The distal end portion 411E has a notch 411n on its upper side that is in communication with the internal space 411s. The device that can be inserted into the channel 420E is not limited to this, and various treatment tools can be inserted, including grasping forceps for pulling tissue and applying appropriate tension, treatment tools with a screw (helical coil) tip, and local injection needles for performing additional local injections.

[0149] The first jaw (upper jaw) 412E and the second jaw (lower jaw) 413E are provided on the distal end 411E and can be opened and closed in the vertical direction. In this embodiment, the first jaw 412E is rotatably attached to the distal end 411E, and the second jaw 413E is non-rotatably attached to the distal end 411E. The rotation axis RO of the first jaw 412E extends along the left-right direction. The first jaw 412E and the second jaw 413E pass the needle 414E to each other.

[0150] The first jaw 412E has a jaw body 412b formed in a substantially U-shape and a rotating arm 412a extending along the opening / closing direction P. A needle 414E is detachably attached (latched) to the tip of the rotating arm 412a.

[0151] 51 is a diagram showing an image captured by the scope 200. The space surrounded by the sides of the jaw body 412b, which is formed in a substantially U-shape, and the space surrounded by the notch 411n of the tip 411E are connected to form a field of view space (through space) VS that penetrates in the opening / closing direction P of the first jaw 412E. The imaging unit 201 of the scope 200 can capture images of the suture site and the needle 414E through the field of view space VS. Even when the first jaw 412E rotates in the opening / closing direction P, the field of view of the imaging unit 201 is not obstructed because the first jaw 412E has the field of view space VS.

[0152] The second jaw (lower jaw) 413E is housed in the distal end portion 411E. The second jaw 413E may be provided to protrude from the distal end portion 411E toward the distal end side A1. The second jaw 413E has a needle receiving portion 413a and a needle locking mechanism 413b.

[0153] The needle receiving portion 413a is a portion that receives and houses the needle 414E attached (latched) to the tip of the rotating arm 412a of the first jaw 412E.

[0154] The needle locking mechanism 413b is a mechanism for locking the needle 414E housed in the needle receiving portion 413a. The needle locking mechanism 413b is driven by a driving portion (actuator) 550 or the like.

[0155] 52 to 55 are views showing the needle 414E being passed from the first jaw 412E to the second jaw 413E. As shown in FIG. 52, the pivot arm 412a of the first jaw 412E closes downward. As shown in FIG. 53, the needle 414E is housed in the needle receiver 413a. As shown in FIG. 54, the needle locking mechanism 413b locks the needle 414E. At this time, the needle locking mechanism 413b releases the connection between the pivot arm 412a and the needle 414E. As shown in FIG. 55, the pivot arm 412a of the first jaw 412E opens upward. The needle 414E is released from the pivot arm 412a of the first jaw 412E and placed in the needle receiver 413a.

[0156] Figure 56 is a diagram showing the sutured defect D. The surgeon S pierces the circumferential edge of the defect D with the rotating arm 412a to which the needle 414E is attached (latched), and threads the thread TH around the circumferential edge of the defect D. After threading the thread TH around the circumferential edge of the defect D, the surgeon S inserts the anchor applier 400F into the channel 420E, as shown in Figure 56 .

[0157] The anchor applier 400F is capable of being inserted through a channel 420E of the suturing device 400E and protruding from the channel 420E to the distal side A1. The anchor applier 400F includes an elongated main body 410F, a first anchor 411F, a second anchor 412F, a plug 413F, and a blade 414F (see FIG. 59 ).

[0158] The first anchor 411F and the second anchor 412F are detachably attached to the distal end of the main body 410F. The first anchor 411F and the second anchor 412F are arranged side by side in the vertical direction. The first anchor 411F and the second anchor 412F have the same shape. The first anchor 411F (and the second anchor 412F) are formed in a substantially U-shape, and are provided with a distal end space (needle insertion space) S1 through which the needle 414E can be inserted, and a proximal end space (thread insertion space) S2 through which the thread TH can be inserted. The distal end space S1 and the proximal end space S2 are in communication with each other.

[0159] The plug 413F is detachably provided in the proximal space S2. When the plug 413F is disposed in the proximal space S2, the first anchor 411F and the second anchor 412F are pushed outward by the plug 413F, widening the proximal space S2. At this time, the first anchor 411F and the second anchor 412F are not fixed to the suture TH.

[0160] The blade 414F is provided on the distal end side A1 of the main body 410F so as to be able to advance and retreat. The blade 414F is provided so as to be able to advance and retreat between the first anchor 411F and the second anchor 412F. The blade 414F has a cutting edge 414a (see FIG. 59 ) and can cut the thread TH.

[0161] 57 to 60 are diagrams showing the operation of anchor applier 400F. As shown in Fig. 56, surgeon S passes needle 414E through tip space S1 of anchor applier 400F, which protrudes from channel 420E to tip side A1. Suture TH is inserted through tip space S1.

[0162] As shown in FIG. 57 , the surgeon S inserts the thread pulling tool 400G through the channel 420E. The anchor applier 400F and the thread pulling tool 400G can be inserted through the channel 420E simultaneously. For example, the thread pulling tool 400G has a hook-shaped or helical coil-shaped catch portion at its tip. The surgeon S hooks the thread TH onto the catch portion of the thread pulling tool 400G and pulls it toward the base end side A2, moving the thread TH from the tip end space S1 to the base end space S2.

[0163] As shown in Fig. 58 , the surgeon S pulls the plug 413F toward the proximal side A2 to remove the plug 413F from the first anchor 411F and the second anchor 412F. The proximal space S2 of the first anchor 411F narrows, sandwiching the suture TH. The first anchor 411F is fixed to the first fixing portion of the suture TH that is inserted through the proximal space S2. Furthermore, the proximal space S2 of the second anchor 412F narrows, sandwiching the suture TH. The second anchor 412F is fixed to the second fixing portion of the suture TH that is inserted through the proximal space S2.

[0164] As shown in FIG. 59 , the surgeon S pulls the blade 414F toward the proximal side A2 to cut the thread TH. The blade 414F cuts the thread TH between the first fixing portion and the second fixing portion. One of the cut threads TH, the thread TH on the defect portion D side, is designated as the first thread TH1. The other of the cut threads TH, the thread TH on the needle 414E side, is designated as the second thread TH2. The first anchor 411F is attached to the first thread TH1. The second anchor 412F is attached to the second thread TH2. The surgeon S removes the anchor applier 400F and the thread pulling tool 400G from the channel 420E.

[0165] 60 , the first anchor 411F attached to the first thread TH1 functions as a thread stopper for the ligation (terminal end) of the first thread TH1 that has sutured the defect D. The second anchor 412F attached to the second thread TH2 functions as a thread stopper for the start end of the next suture. Note that the surgeon S can adjust the length of the second thread TH2 to be used in the next suture by adjusting the amount of pulling of the thread TH with the thread pulling tool 400G to adjust the length of the thread TH between the first fixing part and the second fixing part.

[0166] The suturing device 400E according to this embodiment allows for more efficient observation and treatment. The surgeon S can place the first anchor 411F, which serves as the end of the suture, pull the thread TH, and place the second anchor 412F, which serves as the start of the next suture, all in one continuous operation within the lumen. This eliminates the need for preparation for thread fastening outside the body or complex operations using a knot pusher, etc., allowing for easy suturing and shortening the suturing time.

[0167] Although five embodiments of the present invention have been described above in detail with reference to the drawings, the specific configuration is not limited to these embodiments and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above-described embodiments and modifications can be appropriately combined to form a configuration.

[0168] The programs in each embodiment may be recorded on a computer-readable recording medium, and then read and executed by a computer system. The term "computer system" includes hardware such as an OS and peripheral devices. The term "computer-readable recording medium" refers to portable media such as flexible disks, optical magnetic disks, ROMs, and CD-ROMs, as well as storage devices such as hard disks built into a computer system. The term "computer-readable recording medium" may also include media that dynamically store programs for a short period of time, such as communication lines used when transmitting programs via networks such as the Internet or telephone lines, or media that store programs for a fixed period of time, such as volatile memory within a computer system serving as a server or client. The program may also be designed to implement some of the functions described above, or may be capable of implementing the functions described above in combination with a program already stored in the computer system.

[0169] The present invention can be applied to a medical system for observing and treating the inside of a hollow organ or the like.

[0170] 1000 Electric endoscope system 100 Insertion manipulator 101 Internal path (lumen) 110, 110A Insertion section 111, 111A Tip section 111a First opening 111b Second opening 111c Treatment camera 111d Water supply nozzle 111e Air supply nozzle 111f Suction nozzle 111g Cutout section 111n Cutout section 112, 112A Bending section 115 Nodal ring (bending piece) 115a First nodal ring 115b Second nodal ring 115A Ring member 116 Tip section 117 Expandable section 118 Outer sheath 119 Flexible section 120 Bending section 150 Detachable section 160 Bending wire 161d Downward bending wire 161l Left bending wire 161r Right bending wire 161u Up bending wire 170 Built-in object 171 First channel tube (lumen) 171a Coil sheath 171A Base end channel tube 171b Braid tube 171B Distal end channel tube 171c First fixing portion 171d Second fixing portion 171e Restriction wire 171r First treatment tool lumen 172 Second channel tube 172r Second treatment tool lumen 173 Imaging cable 174 Light guide 175 Water supply tube 176 Air supply tube 177 Suction tube 180 Spiral tube 181 Fin 200 Scope 201 Imaging unit 202 Illumination unit 300 Rigidity variable device (Rigidizer, introducer) 310, 310A, 310B, 310C, 310D Hardness variable section 311 Spine section 312 Wire 313 Tube 314 Wire rod 315 Outer tube 316 Inner tube 317 Cable 318 Shape memory alloy wire 320 Insertion section 340 Drive unit 400, 400B, 400C,400D Treatment manipulator 400E Suturing device 400F Anchor applier 400G Thread traction tool 410 Treatment tool arm 410A Large diameter treatment tool arm 410E Arm 410F Main body 411 First bending portion 411E Tip portion 411F First anchor 411s Internal space 412 Second bending portion 412a Rotating arm 412b Jaw main body 412E First jaw (upper jaw portion) 412F Second anchor 413a Needle receiving portion 413b Needle locking mechanism 413E Second jaw (lower jaw portion) 413F Plug 414a Blade 414E Needle 414F Blade 415 Nodal ring (bending piece) 415 Nodal ring 416 Shoulder joint 417 Manipulator flexible portion 420 Forceps 420E Channel 430 High-frequency knife 440 Local injection needle 450 Basket 470 Artificial muscle 471 Tube 472 Ring member 473 Tip wire 480 Wire 500 Drive device 510 Endoscope adapter 520 Operation receiving unit 530 Air supply and suction drive unit 550 Drive unit (actuator) 560 Drive controller 600 Image control device 610 Endoscope adapter 620 Image capture processing unit 630 Light source unit 660 Main controller 700 Control device 800 Operation device 801 Operation cable 900 Display device 901 Display cable CON Console A Longitudinal direction (longitudinal axis direction, axial direction) A1 Tip side (distal side) A2 Base end side (proximal side) E Non-curved region L1 Distance (shoulder width) L3 Distance M Marking O Central axis P Opening / closing direction RO Rotation axis S1 Tip space (needle insertion space) S2 Base space (thread insertion space) T Target area TH Thread TH1 First thread TH2 Second thread VS Field of view space (through space),

Claims

1. A medical manipulator comprising: a manipulator flexible section; an arm having a first bending section and a second bending section and disposed at the tip of the manipulator flexible section; an artificial muscle that drives the first bending section to bend; and a wire that drives the second bending section to bend.

2. The medical manipulator according to claim 1, wherein the first bending portion is provided on the distal end side of the arm, and the second bending portion is disposed on the proximal end side of the first bending portion.

3. The medical manipulator according to claim 1, comprising at least two arms.

4. The medical manipulator according to claim 1, wherein the artificial muscle is attached to the first bending portion.

5. The medical manipulator according to claim 1, wherein the artificial muscle is disposed in a non-bending region that is not driven to bend.

6. The medical manipulator according to claim 1, wherein the artificial muscle is disposed in the manipulator flexible section.

7. The medical manipulator according to claim 1, wherein the first bending portion is driven to bend by two or more of the artificial muscles, and the two or more artificial muscles are arranged side by side along the axial direction of the arm.

8. A medical manipulator according to claim 1, wherein the arm has a channel through which a treatment tool is inserted from the base end of the medical manipulator to the tip end of the arm.

9. The medical manipulator according to claim 1, wherein the arm is provided with an end effector at its tip.

10. The medical manipulator according to claim 1, wherein the second bending portion is bent twice in different directions.

11. A medical manipulator system comprising: a treatment manipulator; an insertion manipulator having a channel through which the treatment manipulator is inserted; and a control device having a drive device that drives the treatment manipulator and the insertion manipulator, wherein the treatment manipulator has: a manipulator flexible section, an arm having a first bending section and a second bending section and arranged at the tip of the manipulator flexible section, an artificial muscle that drives the first bending section to bend, and a wire that drives the second bending section to bend, and the drive device drives the artificial muscle and the wire.

12. The medical manipulator system according to claim 11, wherein a notch is formed in the distal opening of the channel of the insertion manipulator, and when the arm is bent, at least a portion of the arm can be inserted through the notch.

13. The medical manipulator system according to claim 11, wherein the first bending portion is provided on the distal end side of the arm, and the second bending portion is disposed on the proximal end side of the first bending portion.

14. The medical manipulator system according to claim 11, comprising at least two arms.

15. The medical manipulator system according to claim 11, wherein the artificial muscle is attached to the first bending portion.

16. The medical manipulator system according to claim 11, wherein the artificial muscle is arranged in a non-bending region that is not driven to bend.

17. The medical manipulator system according to claim 11, wherein the artificial muscle is disposed in the manipulator flexible section.

18. The medical manipulator system according to claim 11, wherein the first bending portion is driven to bend by two or more of the artificial muscles, and the two or more artificial muscles are arranged side by side along the axial direction of the arm.

19. The medical manipulator system according to claim 11, wherein the arm has a channel through which a treatment tool is inserted from the base end of the treatment manipulator to the tip end of the arm.

20. The medical manipulator system according to claim 11, wherein the second bending portion is bent twice in different directions.

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