Medical manipulator, medical manipulator system, and treatment method performed by means of medical system

Abstract

This medical manipulator comprises: a manipulator flexible section that extends in the longitudinal direction; and two arms disposed at the tip end of the manipulator flexible section. The two arms are arranged in a left-right direction perpendicular to the longitudinal direction. Each of the two arms includes a second bending part. As a result of the second bending parts bending, the tip ends of the second bending parts of the two arms are separated in the left-right direction.

Description

Medical manipulator, medical manipulator system, and treatment method using the medical system

[0001] The present invention relates to a medical manipulator, a medical manipulator system, and a treatment method using the medical system. This application is based on 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 / 669,306 provisionally filed in the United States on July 10, 2024, U.S. Provisional Patent Application No. 63 / 669,306 provisionally filed in the United States on August 30, 2024, and U.S. Provisional Patent Application No. 63 / 669,306 provisionally filed in the United States on August 30, 2024. Priority is claimed to U.S. Provisional Patent Application No. 63 / 688,972 provisionally filed in the United States on September 5, 2024, U.S. Provisional Patent Application No. 63 / 691,009 provisionally filed in the United States on September 17, 2024, U.S. Provisional Patent Application No. 63 / 695,602 provisionally filed in the United States on December 20, 2024, U.S. Provisional Patent Application No. 63 / 737,339 provisionally filed in the United States on February 26, 2025, 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, a medical manipulator system, and a treatment method using a medical 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 extending in a longitudinal direction and two arms arranged at the tip of the manipulator flexible section, the two arms being arranged in a left-right direction perpendicular to the longitudinal direction, each of the two arms having a second curved section, and the tips of the second curved sections of the two arms being spaced apart in the left-right direction by bending the second curved sections.

[0008] According to the medical manipulator, the medical manipulator system, and the treatment method using the medical 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 for marking. FIG. 18 is a diagram showing a local injection needle. FIG. 19 is a diagram showing the local injection needle for local injection. FIG. 19 is a diagram showing the high-frequency knife for incision. FIG. 19 is a diagram showing the high-frequency knife for incision. FIG. 20 is a diagram showing a basket. FIG. 21 is a diagram showing the basket for retrieving a target portion. FIG. 21 is a cross-sectional view of the manipulator tool. FIG. 22 is a diagram showing a modified example of the manipulator tool. FIG. 23 is a diagram showing the artificial muscle arranged at another position. FIG. 24 is a diagram showing the artificial muscle arranged at another position. FIG. 25 is a diagram showing another modified example of the manipulator tool. FIG. 26 is a diagram showing the artificial muscle arranged at another position. FIG. 27 is a diagram showing another modified example of the manipulator tool. FIG. 28 is an overall view of an electric endoscope system according to a fifth embodiment. FIG. 29 is a perspective view of the tip of the insertion manipulator of the electric endoscope system. 1A and 1B are a cross-sectional view of an insertion portion of the insertion manipulator, a view showing the insertion portion, a view showing a bending portion of the insertion manipulator, a view showing a ring member, and a view showing the ring member as viewed from the longitudinal direction.1 is a diagram showing a first channel tube; a diagram showing a treatment manipulator protruding from a first opening; a diagram showing the treatment manipulator; a diagram showing the treatment manipulator. Same as above. A perspective view of a bending tube; a developed view of the bending tube unfolded in the circumferential direction; a diagram showing the bending tube compressed; a diagram showing the bending tube bent; a diagram showing an artificial muscle; a diagram showing a bending piece; a diagram showing a modified example of the bending piece; a diagram showing another modified example of the bending piece; a diagram showing another modified example of the bending piece; a diagram showing another modified example of the bending piece; a diagram showing a connecting piece; a diagram showing a treatment instrument arm with a second bending portion bent; a functional block diagram of a drive device; a diagram showing an insertion drive unit; a diagram showing a drive unit; a diagram showing the operation of the drive unit; Same as above. A cross-sectional view of the first motor unit from which the first adapter has been separated; a cross-sectional view of the first motor unit to which the first adapter has been attached; an exploded view of the second drive unit. Same as above. Same as above. A cross-sectional view of the second motor unit to which the second adapter has been attached. FIG. 1 is a cross-sectional view of a second motor unit to which a third adapter and a fourth adapter are attached. FIG. 2 is a diagram showing an example of operation of the drive unit. FIG. 3 is a diagram showing a rack as a modified example of the cart. FIG. 4 is a diagram showing a scope protruding from the tip. FIG. 5 is a diagram explaining operation of a scope operating wire.

[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 (camera) 201 is equipped with a stereo lens and an imaging element such as 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 in an S-shape 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 in the left-right direction and move away from each other. 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 An electric endoscope system 1000F according to a fifth embodiment of the present disclosure will be described with reference to Fig. 50 to Fig. 60. In the following description, components common to those already described will be assigned the same reference numerals, and duplicate description will be omitted.

[0144] 50 is an overall view of an electric endoscope system 1000F according to this embodiment. The electric endoscope system 1000F is an example of a medical manipulator system. The medical manipulator includes an insertion manipulator 100F to be inserted into a body, an electrically driven endoscope, a catheter, a treatment tool, an endoluminal device, etc.

[0145] [Electric Endoscope System 1000F] The electric endoscope system 1000F is a medical system for observing and treating the inside of the body of a patient P lying on an operating table OT. The electric endoscope system 1000F includes an insertion manipulator 100F, a treatment manipulator 400F (see FIG. 58 ), a drive unit 500F, an image control device 600, an operation device 800, and a display device 900. The drive unit 500F and the image control device 600 constitute a control device 700F that controls the electric endoscope system 1000F.

[0146] [Insertion manipulator 100F] Fig. 51 is a perspective view of the tip of the insertion manipulator 100F. Fig. 52 is a cross-sectional view of the insertion section 110F. The insertion manipulator 100F includes an insertion section 110F, a detachable section 150, a bending wire 160F, a built-in member 170F, and a scope 200.

[0147] An internal passage (lumen) 101 is formed inside the insertion manipulator 100F, extending along the longitudinal direction (longitudinal axis direction, axial direction) A of the insertion manipulator 100F from the tip of the insertion section 110F to the base end of the detachable section 150. The bending wire 160F and the built-in object 170F are inserted into the internal passage 101.

[0148] The insertion section 110F is a thin, elongated member that can be inserted into a lumen. The insertion section 110F has a distal end section 111, a bending section 112F, and a flexible section 119. The distal end section 111, the bending section 112F, 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 110F has an outer sheath 118F, which is the outermost layer.

[0149] As in the first embodiment, the tip portion 111 is provided at the tip of the insertion section 110F. The scope 200 is attached so as to be able to protrude from the tip portion 111 to the tip side A1 and to be bendable. The scope 200 is operated by a scope operating wire 178. The notch 111n of the tip portion 111 illustrated in Figure 51 is formed on the inner circumferential surface of the first opening 111a and does not penetrate in a direction perpendicular to the longitudinal direction A.

[0150] 52, the built-in part 170F passes through the internal path 101. The built-in part 170F has a first channel tube 171F, a second channel tube 172, an imaging cable 173, a light guide 174, a water supply tube 175, an air supply tube 176, a suction tube 177, and a scope operation wire 178.

[0151] Figure 53 is a diagram showing the insertion section 110F. The insertion section 110F has a spring 113. The spring 113 is formed by winding a wire-shaped metal member in a spiral shape. The spring 113 is, for example, a flat wire spring or a round wire spring. By using a flat wire spring instead of a round wire spring formed from a round wire-shaped metal member, the diameter of the insertion section 110F can be made thinner. On the other hand, by using a round wire spring, it is expected that the insertion section 110F will be easier to bend. Note that the bending wire 160F and the built-in object 170F are not shown in Figure 53.

[0152] The spring 113 is disposed from the distal end to the proximal end of the insertion section 110F, so that the insertion section 110F has good torque transmission properties.

[0153] The spring 113 is arranged in the internal passage 101 of the insertion section 110F in a preloaded state with a compressive force of, for example, 20 N to 25 N. Because the spring 113 is preloaded, it has good kink resistance and is unlikely to buckle.

[0154] The outer sheath 118F is a cylindrical member disposed on the outside of the spring 113. The outer sheath 118F has a braided tube 118b and coatings 118c disposed on both the inner and outer circumferential sides of the braided tube 118b. The coating 118c disposed on the inner circumferential side is also referred to as an inner coating. The coating 118c disposed on the outer circumferential side is also referred to as an outer coating. The coating 118c may be either the inner coating or the outer coating.

[0155] The braided tube 118b is a tube made of braided metal wires, resin wires, etc. The braided tube 118b is made of, for example, aramid or UHMW-PE (Ultra High Molecular Weight Polyethylene).

[0156] The coating 118c is sandwiched between the inner and outer peripheries of the braided tube 118b, encapsulating the braided tube 118b. The coating 118c is attached to the braided tube 118b by coating, co-extrusion, over-casting, or over-molding. The coating 118c is made of a low-friction, low-durometer resin or the like.

[0157] The outer sheath 118F has the braided tube 118b encapsulated by the coating 118c, which provides the braided tube 118b with good rigidity without increasing its diameter. The low friction and low durometer of the coating 118c provides the outer sheath 118F with a suitable elasticity, allowing it to be both durable and flexible.

[0158] Markings 118m that can be observed under X-ray fluoroscopy are provided on the outer peripheral surface of the outer sheath 118F. By checking the markings 118m, the surgeon S can easily grasp the insertion position and insertion distance of the insertion section 110F.

[0159] 54 is a diagram showing a bending portion 112F. The bending portion 112F has a spring 113, a plurality of ring members 115F, and an outer sheath 118F that is the outermost layer. A bending wire 160F and an internal object 170F are inserted through an internal passage 101 formed in the bending portion 112F.

[0160] 55 is a view showing a ring member 115F. Multiple ring members 115F are arranged in an internal passage 101 formed in a bending portion 112F. The multiple ring members 115F are arranged in the axial direction A. The multiple ring members 115F are not connected to each other, and adjacent ring members 115F are arranged spaced apart in the axial direction A. An internal structure 170F including a first channel tube 171F passes through the multiple ring members 115A. A bending wire 160F passes through a wire guide 115Fg formed in the ring member 115F.

[0161] The ring member 115F has a slit 115s formed therein, into which the spring 113 is fitted. The ring member 115F is attached to the spring 113 by fitting the spring 113 into the slit 115s.

[0162] 56 is a diagram showing a ring member 115F as viewed from the longitudinal direction A. Three wire guides 115Fg are provided on the inner circumferential surface of the ring member 115F. The three wire guides 115Fg are arranged at equal intervals along the circumferential direction C. The three wire guides 115Fg are arranged at intervals of 120 degrees with respect to the central axis O1 in the longitudinal direction A.

[0163] The bending wires 160F are wires that bend the bending portion 112F. The bending wires 160F extend through the internal path 101 to the detachable portion 150. The bending wires 160F include a first bending wire 161F, a second bending wire 162F, and a third bending wire 163F. The number of bending wires 160F is three, not four. In other words, the bending wires 160F are composed of three wires: the first bending wire 161F, the second bending wire 162F, and the third bending wire 163F.

[0164] The direction perpendicular to the longitudinal axis of the first bending wire 161F inserted through the wire guide 115Fg and the central axis O1 of the longitudinal direction A is defined as the up-down direction (also referred to as the "UD direction"). The direction perpendicular to the longitudinal direction A and the up-down direction is defined as the left-right direction (also referred to as the "LR direction"). Although there are three bending wires 160F, the bending wires 160F can bend the bending portion 112F in all directions, including the up-down direction and the left-right direction.

[0165] 55, the bending wire 160F may be inserted through a coil sheath 160c. However, the distal end of the bending wire 160F that is inserted through multiple ring members 115F does not have to be inserted through the coil sheath 160c. Since the bending section 112F in which the ring members 115F are arranged does not have a coil sheath 160c, the coil sheath does not suppress compressive deformation due to wire pulling, and the outer sheath 118F can be smoothly bent.

[0166] Figure 57 is a diagram showing a first channel tube 171F. The first channel tube 171F is a tube having a large-diameter first treatment instrument lumen 171r. 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 can be three to five times the inner diameter D2 of the second treatment instrument lumen 172r. As shown in Figure 3, two treatment manipulators 400 can be inserted through the first treatment instrument lumen 171r.

[0167] The inner diameter D1 of the first treatment instrument lumen 171r can be set to 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 100F 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 400F can be inserted into the first treatment instrument lumen 171r, expanding the range of procedures.

[0168] The first channel tube 171F includes a braided tube 171g and a coating 171h disposed on both the inner and outer circumferential sides of the braided tube 171g. The coating 171h disposed on the outer circumferential side is also referred to as an outer coating. The coating 171h may be either an inner coating or an outer coating.

[0169] The braided tube 171g is a tube made of braided metal wires, resin wires, etc. The braided tube 171g is made of, for example, aramid or UHMW-PE (Ultra High Molecular Weight Polyethylene).

[0170] The coating 171h is sandwiched between the inner and outer circumferential sides of the braided tube 171g, encapsulating the braided tube 171g. The coating 171h is attached to the braided tube 171g by coating, co-extrusion, over-casting, or over-molding. The coating 171h is made of a low-friction, low-durometer resin or the like.

[0171] The first channel tube 171F has a braided tube 171g encapsulated by a coating 171h. This provides the first channel tube 171F with good rigidity without increasing its diameter. The low friction and low durometer of the coating 171h provides the first channel tube 171F with suitable elasticity, ensuring both durability and flexibility.

[0172] [Treatment manipulator 400F] Figure 58 is a diagram showing the treatment manipulator 400F protruding from the first opening 111a. The treatment manipulator 400F is a device that is inserted, for example, through the first channel tube 171F of the insertion manipulator 100F to protrude from the first opening 111a and inserted into a patient's lumen to treat an affected area. An end effector (treatment unit) that treats the affected area may be disposed at the tip of the treatment manipulator 400F, and a treatment tool equipped with the end effector may be insertable into a channel provided in the treatment manipulator 400F. The treatment manipulator 400F is driven by a drive unit (actuator) 550 or the like.

[0173] 59, 60, and 61 are diagrams showing a treatment manipulator 400F. The treatment manipulator 400F includes a manipulator flexible section 417, a bendable treatment instrument arm 410F, and treatment instruments (forceps 420, high-frequency knife 430, local injection needle 440, basket 450, etc.) that are inserted through the treatment instrument arm 410F. Note that the covering member that covers the treatment instrument arm 410F is not shown in Figure 59 etc.

[0174] The manipulator flexible portion 417 is an elongated member extending in the longitudinal direction A that can be inserted into the first channel tube 171F or the like. Two treatment instrument arms 410F are provided on a distal end surface 417a of the manipulator flexible portion 417. The two treatment instrument arms 410F extend from the distal end surface 417a toward the distal end side A1.

[0175] The two treatment instrument arms 410F protrude from the first opening 111a of the distal end 111 of the insertion manipulator 100F while aligned in the left-right direction (LR direction). At least a portion of the two treatment instrument arms 410F can be inserted through the cutout portions 111n and can spread outward in the left-right direction. Therefore, by spreading the two treatment instrument arms 410F in the left-right direction, the surgeon can easily treat an affected area located near the scope 200 with treatment instruments.

[0176] By moving or rotating the insertion manipulator 100F with the two treatment instrument arms 410F in contact with the cutout portions 111n, the two treatment instrument arms 410F move or rotate in accordance with the movement while their relative positions with respect to the scope 200 are fixed. Therefore, even when the insertion manipulator 100F is moved or rotated, the surgeon can easily grasp the position of the treatment instrument inserted through the treatment instrument arm 410F. Note that if the cutout portions 111n are grooves into which the treatment instrument arms 410F fit, the relative position of the treatment instrument arms 410F with respect to the scope 200 is fixed, which has the effect that the position of the treatment instrument arm 410F imaged in the field of view does not change even when the insertion manipulator 100F is moved or rotated.

[0177] The treatment instrument arm 410F is a hollow, elongated member having an insertion path (channel) through which a treatment instrument is inserted. The treatment instrument arm 410F has a first bending portion 411F provided on the distal end side A1 and a second bending portion 412F provided on the proximal end side A2. When the treatment manipulator 400F is in use as shown in Fig. 60 , the first bending portion 411F can be positioned on the distal end side A1 from the distal end surface of the distal end portion 111. A portion of the second bending portion 412F can protrude from the distal end portion 111 toward the distal end side A1.

[0178] The first bending portion 411F has a tip end 411a, a base end 411b, a bendable bending tube 460, and four artificial muscles 470. The first bending portion 411F can be bent in the up-down and left-right directions by being driven by the artificial muscles 470. The bending tube 460 and the artificial muscles 470 extend along the longitudinal direction A and are arranged side by side. Note that the tip end 411a, the base end 411b, and the artificial muscles 470 are not shown in Figure 61.

[0179] 62 is a perspective view of the bending tube 460. The bending tube 460 is a bendable tubular member. The internal space of the bending tube 460 is an insertion path (channel) through which a treatment tool is inserted. The bending tube 460 has a distal end portion 460a connected to the distal end portion 411a, a proximal end portion 460b connected to the proximal end portion 411b, and a bending tube main body 460d sandwiched between the distal end portion 460a and the proximal end portion 460b.

[0180] The bending tube main body 460d is a tubular member made of metal, resin, or the like, and has a plurality of grooves 461 formed along the circumferential direction C. The length of the grooves 461 in the circumferential direction C may be 70% to 80% of the entire circumference of the bending tube main body 460d. The grooves 461 penetrate the bending tube main body 460d in the radial direction. The bending tube main body 460d is bent as the grooves 461 widen or narrow.

[0181] 63 is a development view of the bending tube 460 developed in the circumferential direction C. The grooves (cuts) 461 have a first groove 462 and a second groove 463. The first grooves 462 and the second grooves 463 are both grooves that extend along the circumferential direction C. The first grooves 462 and the second grooves 463 are alternately arranged along the longitudinal direction A. A set of adjacent first grooves 462 and second grooves 463 is also referred to as a "pair of grooves 461p." In the pair of adjacent grooves 461p, the pair of grooves 461p on the distal end side A1 is positioned at a position rotated 90 degrees with respect to one side C1 in the circumferential direction C compared to the pair of grooves 461p on the proximal end side A2.

[0182] The first groove 462 and the second groove 463 are symmetrical with respect to a plane perpendicular to the longitudinal direction A, and are disposed at positions rotated 180 degrees with respect to the circumferential direction C. The first groove 462 is a groove that bulges toward the distal end side A1. The second groove 463 is a groove that bulges toward the proximal end side A2.

[0183] The first groove 462 and the second groove 463 may have a first gap 464 in the center in the circumferential direction C, second gaps 465 on both sides of the first gap 464 in the circumferential direction C, and a third gap 466 on the outer side of the second gap 465. The length G1 of the first gap 464 in the longitudinal direction A may be longer than the length G2 of the second gap 465 in the longitudinal direction A and the length G3 of the third gap 466 in the longitudinal direction A. Furthermore, the length G2 of the second gap 465 in the longitudinal direction A may be shorter than the length G1 of the first gap 464 in the longitudinal direction A and the length G3 of the third gap 466 in the longitudinal direction A (G1 > G3 > G2).

[0184] In a pair of grooves 461p (first groove 462 and second groove 463), the position of the second gap 465 of the first groove 462 and the position of the second gap 465 of the second groove 463 in the circumferential direction C may be substantially the same. In a pair of grooves 461p (first groove 462 and second groove 463), the second gap 465 of the first groove 462 and the second gap 465 of the second groove 463 may be arranged adjacent to each other along the longitudinal direction A. Adjacent second gaps 465 in a pair of grooves 461p are also referred to as a "pair of second gaps 465p." The pair of second gaps 465p of a pair of grooves 461p and the first gaps 464 of the grooves 461 of the adjacent pair of grooves 461p may be arranged alternately in the longitudinal direction A.

[0185] Figure 64 is a diagram showing the bending tube 460 compressed at the start of treatment. As shown in Figure 64, treatment begins with the bending tube 460 compressed in the longitudinal direction A until both ends of the second gap 465 in the longitudinal direction A nearly touch. At this time, both ends of the first gap 464 in the longitudinal direction A do not come into contact. This state is called the "initial state." By starting treatment from a state in which the surrounding artificial muscle 470 is moderately compressed, it is possible to further compress the artificial muscle 470 during treatment, and it is also possible to further stretch the artificial muscle 470 during treatment. Note that the bending tube 460 does not need to be compressed when attached to the first bending section 411F, and the ends of the first gap 464 and the second gap 465 may not come into contact.

[0186] Figure 65 is a diagram showing a curved bending tube 460. The pair of second gaps 465p function as hinges, allowing the bending tube 460 to bend smoothly. The first gap 464 located on the outer side of the bending widens, while the first gap 464 located on the inner side of the bending narrows. Because the first gap 464 and the pair of second gaps 465p are evenly spaced in the circumferential direction C, the bending tube 460 can bend in all directions, including up, down, left, and right. When the groove 461 has third gaps 466 at both ends in the circumferential direction C, the bending tube 460 has the effect of dispersing stress when bent.

[0187] The bending tube 460 is a tubular member made up of a combination of thin struts and thick struts. The thin struts are, for example, the portions sandwiched between a pair of second gaps 465p. The thick struts are, for example, the portions sandwiched between a pair of second gaps 465p and a first gap 464. The thin struts function as springs in the compression direction of the artificial muscle 470. The thick struts function as joints when bending.

[0188] Figure 66 is a diagram showing an artificial muscle 470. As in the fourth embodiment, the artificial muscle 470 is, for example, a McKibben artificial muscle. A tube 471 is attached to the artificial muscle 470, which supplies a fluid for operating the artificial muscle 470. The artificial muscle 470 contracts due to the fluid supplied from the tube 471. The artificial muscle 470 shown as an example in Figure 66 has a silicone tube 474 and a braided tube 475 arranged on the outside of the silicone tube 474. A fluid is supplied to the silicone tube 474 from the tube 471. In the artificial muscle 470, the outer periphery of the braided tube 475 may be silicone coated.

[0189] The four artificial muscles 470 are arranged around the bent tube 460 along the longitudinal direction of the bent tube 460. The tip of the bent tube 460 and the tip of the artificial muscle 470 are connected to the tip end portion 411a. The base end of the bent tube 460 and the base end of the artificial muscle 470 are connected to the base end portion 411b. The bent tube 460 is passively bent by the artificial muscles 470 bending. Note that the number of artificial muscles 470 is not limited to four. For example, as shown in FIG. 43 , the number of artificial muscles 470 may be three.

[0190] The distal end portion 411a and the proximal end portion 411b may be formed in a rectangular shape extending in the up-down direction when viewed from the longitudinal direction A. Two artificial muscles 470 may be arranged on the upper side (U side) of the bending tube 460, and two artificial muscles 470 may be arranged on the lower side (D side) of the bending tube 460. Therefore, the dimension of the first bending portion 411F in the left-right direction may be shorter than the dimension in the up-down direction. This makes it easy to arrange the two first bending portions 411F side by side in the left-right direction. Furthermore, the bending tube 460 is less likely to interfere with the artificial muscles 470 when bent in the left-right direction compared to when bent in the up-down direction. Therefore, the movable range of the two first bending portions 411F in the left-right direction can be widened.

[0191] The artificial muscle 470 may be silicone coated. In this case, even if there is bias or variation in the structure of the braid tube 475, the silicone coating absorbs the variation in deformation, achieving uniform deformation throughout the entire artificial muscle 470. Furthermore, even if the artificial muscle 470 repeatedly contracts and relaxes, deviation of the braid tube 475 can be suppressed, improving the ability to restore the original shape, thereby improving the reproducibility and stability of the behavior of the artificial muscle 470. This makes it easier for the surgeon to control the bending behavior of the artificial muscle 470 in the up, down, left, and right directions.

[0192] The operation of the artificial muscle 470 is divided into a "nonlinear region," where the amount of deformation relative to the amount of pressurization of the fluid is nonlinear, and a "linear region," where the amount of change relative to the amount of pressurization of the fluid is linear, or where the control of the manipulator can be treated as approximately linear. When the fluid is pressurized from an unpressurized state, the operation of the artificial muscle 470 transitions through the nonlinear region to the linear region. Therefore, the artificial muscle 470 sets the state in which the fluid is pressurized and compressed until it transitions to the linear region as its "initial state." The responsiveness of the artificial muscle 470 improves, and the controllability of the first curved section 411F improves.

[0193] The first bending section 411F is driven by the artificial muscle 470, not by a wire. Therefore, there is no need to insert a wire into the internal space of the bending tube 460, and sufficient space can be secured for inserting a treatment tool. Furthermore, there is no need to provide a path for inserting a wire in the bending tube 460, and the structure of the bending tube 460 can be simplified. Furthermore, since wire breakage and the like do not occur, maintenance is easy.

[0194] As shown in Fig. 60 , the second bending portion 412F has a shoulder joint 416F that greatly bends the treatment instrument arm 410F in the left-right direction (LR direction), and a wire 480. The shoulder joint 416F bends the second bending portion 412F into an S-shape when viewed in the up-down direction (UD direction). As shown in Fig. 59 , the tips of the second bending portions 412F of the two treatment instrument arms 410F are bent left and right and move away from each other.

[0195] 61 , the wires 480 are attached to the second bending portion 412F. The second bending portion 412F is bent by pulling the second bending portion 412F from the proximal end side A2. Two wires 480 are attached to one second bending portion 412F.

[0196] As shown in FIG. 61, the shoulder joint 416F has a first shoulder joint 418 provided on the distal end side A1 and a second shoulder joint 419 provided on the proximal end side A2.

[0197] The first shoulder joint 418 is connected to the distal end of the second shoulder joint 419 and extends to the distal end side A1. The first shoulder joints 418 of the two treatment instrument arms 410F are curved in a direction approaching each other (inward) in the left-right direction (LR direction).

[0198] The second shoulder joint 419 extends to the distal end side A1 and is connected to the distal end surface 417a of the manipulator flexible portion 417. Each of the second shoulder joints 419 of the two treatment instrument arms 410F curves in a direction away from each other (outward) in the left-right direction (LR direction).

[0199] The first shoulder joint 418 and the second shoulder joint 419 are bent in opposite directions in the left-right direction, so that the second bending portion 412F is bent in an S-shape.

[0200] As shown in Fig. 61 , the shoulder joint 416F has a bending piece 415F and a connecting piece 415G. The first shoulder joint 418 and the second shoulder joint 419 have connecting pieces 415G arranged at the distal end and proximal end, and a plurality of bending pieces 415F are arranged between the two connecting pieces 415G. When the wire 480 is pulled, adjacent bending pieces 415F come into contact with each other.

[0201] FIG. 67 is a diagram showing a bending piece 415F. The bending piece 415F may be formed in a substantially rectangular parallelepiped shape, or may be a rectangular shape extending in the up-down direction when viewed from the longitudinal direction A. The bending piece 415F has an insertion hole 415h penetrating in the longitudinal direction A at its center. The insertion hole 415h is an insertion path (channel) for a treatment tool. The bending piece 415F has a wire hole 415w at one left-right end and a spacer 415s at the other left-right end. The wire hole 415w is formed along the longitudinal direction A and is a wire guide through which the wire 480 is inserted. The spacer 415s protrudes on both sides in the longitudinal direction A. Connection holes 415d are provided on the upper and lower sides of the insertion hole 415h, through which connection members 415c (see FIG. 59) that connect the bending piece 415F and the connection piece 415G are inserted.

[0202] When adjacent bending pieces 415F come into contact, the wire holes 415w come into contact with each other and the spacers 415s come into contact with each other. The length S1 of the wire hole 415w in the longitudinal direction A is longer than the length S2 of the spacer 415s in the longitudinal direction A (S1 > S2). Therefore, when the wire 480 is pulled, the adjacent bending pieces 415F come into contact with each other and are bent in the left-right direction.

[0203] 68 is a diagram showing a bending piece 415Fa which is a modified example of the bending piece 415F. The bending piece 415Fa has a spacer 415sa which is a modified example of the spacer 415s. The spacer 415sa is formed in a cylindrical shape. The spacer 415sa is provided in the center in the up-down direction (UD direction).

[0204] 69 is a diagram showing a bending piece 415Fb that is a modified example of the bending piece 415F. The bending piece 415Fb has a wire hole 415wb that is a modified example of the wire hole 415w. The wire hole 415wb is formed in a rectangular shape extending in the up-down direction (UD direction) when viewed from the longitudinal direction A. In the wire hole 415wb, a hole through which the wire 480 is inserted is provided in the center in the up-down direction. Because the wire hole 415wb extends in the up-down direction, it is possible to prevent the bending piece 415Fb from wobbling in the up-down direction.

[0205] The vertical length S3 of the wire hole 415wb is preferably shorter than the vertical length S4 of the spacer 415s (S3<S4). The vertical length S3 of the wire hole 415wb on the force application side of the wire 480 is short, and the vertical length S4 of the spacer 415s on the side farther from the force application side of the wire 480 is long, thereby stabilizing the bending motion.

[0206] 70 is a diagram showing a bending piece 415Fc, which is a modified example of the bending piece 415F. The bending piece 415Fc has a wire hole 415wc, which is a modified example of the wire hole 415w. The wire hole 415wc is formed in an elliptical shape extending in the up-down direction (UD direction) when viewed from the longitudinal direction A. The hole in the wire hole 415wc through which the wire 480 is inserted is provided in the center in the up-down direction. Because the wire hole 415wc extends in the up-down direction, it is possible to prevent the bending piece 415Fc from wobbling in the up-down direction.

[0207] The bending piece 415Fc has spacers 415sc, which are modified versions of the spacers 415s. The spacers 415sc are formed in a cylindrical shape and are provided on both sides in the up-down direction.

[0208] The vertical length S3 of the wire hole 415wc is preferably shorter than the vertical length S4 of the spacer 415sc (S3<S4). The vertical length S3 of the wire hole 415wc on the force point side of the wire 480 is short, and the vertical length S4 of the spacer 415sc on the side farther from the force point side of the wire 480 is long, thereby stabilizing the bending motion.

[0209] 71 is a diagram showing a bending piece 415Fd which is a modified example of the bending piece 415F. The bending piece 415Fd has a spacer 415sc which is a modified example of the spacer 415s. The spacer 415sc is formed in a cylindrical shape and is provided on both sides in the up-down direction.

[0210] Figure 72 is a diagram showing a connecting piece 415G. The connecting piece 415G may be formed in a substantially rectangular parallelepiped shape, or may be a rectangle extending in the up-down direction when viewed from the longitudinal direction A. The bending piece 415F has an insertion hole 415h penetrating through the center in the longitudinal direction A. The insertion hole 415h is an insertion path (channel) for a treatment tool. Connecting holes 415d are provided on the upper and lower sides of the insertion hole 415h, through which connecting members 415c (see Figure 59) that connect the bending piece 415F and the connecting piece 415G are inserted.

[0211] 61 , the bending pieces 415F are provided in the first shoulder joints 418 of the two treatment instrument arms 410F so that the wire holes 415w are located on the outer side in the left-right direction. The length S1 in the longitudinal direction A of the wire holes 415w located on the outer side is longer than the length S2 in the longitudinal direction A of the spacers 415s located on the inner side (S1>S2). Therefore, when the wire 480 is pulled, the first shoulder joints 418 of the two treatment instrument arms 410F are bent inwardly toward each other in the left-right direction (LR direction).

[0212] 61 , the bending pieces 415F are provided in the second shoulder joints 419 of the two treatment instrument arms 410F so that the wire holes 415w are located on the inside in the left-right direction. The length S1 in the longitudinal direction A of the wire holes 415w located on the inside is longer than the length S2 in the longitudinal direction A of the spacers 415s located on the outside (S1 > S2). Therefore, when the wire 480 is pulled, the second shoulder joints 419 of the two treatment instrument arms 410F are bent in directions away from each other (outside) in the left-right direction (LR direction).

[0213] 73 is a diagram showing a treatment instrument arm 410F with a curved second bending portion 412F. The first shoulder joint 418 and the second shoulder joint 419 are curved in opposite directions in the left-right direction, resulting in an S-shaped curve of the second bending portion 412F. This allows the distance L (shoulder width) between the central axes at the tips of the second bending portions 412F of the two treatment instrument arms 410F to be increased. When treating a target site using two treatment instrument arms 410F, by appropriately separating the proximal ends of the two first bending portions 411F, the surgeon S can secure sufficient space for treatment, making it easier to treat the target site. Furthermore, the configuration that allows the artificial muscle 470 to be driven while protruding from the insertion manipulator 100F has the advantage of allowing the artificial muscle 470 to be driven without being limited by the outer diameter of the insertion manipulator 100F. The configuration in which the tip portion 111 has the cutout portion 111n has the advantage that the treatment tool protruding from the tip of the treatment manipulator 400F can maintain a positional relationship that does not interfere with the treatment tool protruding from the second opening 111b, and that a positional relationship that does not obstruct the field of view can be maintained. Furthermore, by arranging the artificial muscle 470 at the tip, there is the advantage that the treatment manipulator 400F is less susceptible to changes in shape over the entire length of the insertion manipulator 100F. Furthermore, by selecting a fluid-driven artificial muscle 470, there is a high degree of freedom in the arrangement of the ducts inside the treatment manipulator 400F.

[0214] Because the first bending portion 411F is bent by the artificial muscle 470, the bending angle may be smaller than other bending portions driven by wires or the like. However, as shown in FIG. 73 , when the second bending portion 412F is bent into an S-shape, the two first bending portions 411F can be arranged substantially parallel along the longitudinal direction A while being spaced apart in the left-right direction. Therefore, even a treatment manipulator 400F including a first bending portion 411F with a relatively small bending angle can easily treat an affected area located on the central axis O4 of the treatment manipulator 400F. Furthermore, because the bending angle is relatively small but delicate driving is possible, the treatment manipulator 400F is also suitable for treatment in deep areas such as the right colon.

[0215] In the treatment manipulator 400F, the treatment instrument does not have a bending mechanism, but the treatment instrument arm 410F through which the treatment instrument is inserted has a bending mechanism. Because the treatment instrument advances and retreats relative to the bending treatment instrument arm 410F, the treatment manipulator 400F has a wider approachable range than when other treatment instruments with bending mechanisms advance and retreat. Even the treatment manipulator 400F, which includes a first bending portion 411F with a small bending angle, can approach a wide range. Furthermore, because the treatment instrument of the treatment manipulator 400F does not have a bending mechanism, the mechanism can be simplified and maintenance is easy.

[0216] [Driver 500F] Figure 74 is a functional block diagram of the driver 500F. The driver 500F includes an operation receiving unit 520, a drive controller 560, an insertion drive unit 540, and a drive unit 570. The operation receiving unit 520 and the drive controller 560 are mounted on the driver main body 500b. The insertion drive unit 540 and the drive unit 570 are devices separate from the driver main body 500b. The drive controller 560 controls the insertion drive unit 540 and the drive unit 570. The insertion drive unit 540 and the drive unit 570 are mounted on the cart 500W.

[0217] In comparison with the drive device 500 of the first embodiment, the drive device 500F is configured such that the air supply / suction drive section 530 and the drive section 550 are incorporated into a separate "drive unit 570."

[0218] [Insertion Drive Unit 540] Figure 75 is a diagram showing the insertion drive unit 540. The insertion drive unit 540 assists in the operation of inserting the insertion manipulator 100F into the body of the patient P. The insertion drive unit 540 is mounted on an arm 500a that deformably extends from the cart 500W. By operating the arm 500a, the surgeon S can position the insertion drive unit 540 at a position that makes it easier to insert the insertion manipulator 100F into the body of the patient P. Furthermore, when the position of the insertion manipulator 100F needs to be readjusted (repositioned) during treatment, the insertion drive unit 540 can be used to readjust the position, which has the effect of preventing buckling of the insertion manipulator 100F.

[0219] The insertion drive unit 540 has two rings 541 through which the flexible portion 119 of the insertion manipulator 100F is inserted, and a drive unit 542 disposed between the two rings 541.

[0220] The drive unit 542 can clamp and fix the flexible portion 119. The drive unit 542 can advance and retreat between the two rings 541, and can advance and retreat the clamped and fixed flexible portion 119. The drive unit 542 can rotate in the circumferential direction, and can rotate the clamped and fixed flexible portion 119. The insertion drive unit 540 is not limited to a mode in which the drive unit 542 clamps and fixes the flexible portion 119. For example, the insertion drive unit 540 may be provided with rollers, and the flexible portion 119 may be fixed by pressing the rollers against the flexible portion 119, and the flexible portion 119 may advance and retreat or rotate by the rotation of the rollers.

[0221] [Drive unit 570] Figure 76 is a diagram showing the drive unit 570. The drive unit 570 is a device that drives the insertion manipulator 100F and the treatment manipulator 400F. The drive unit 570 is mounted on the top of the cart 500W. The base unit 571 and the drive unit 570 have a first drive unit 580 and a second drive unit 590.

[0222] 77 and 78 are diagrams showing the operation of the drive unit 570. The drive unit 570 has a generally cylindrical shape extending in the longitudinal direction A. A first drive unit 580 is disposed on the distal end side A1, and a second drive unit 590 is disposed on the proximal end side A2. A base unit 571 supports the first drive unit 580 and the second drive unit 590 so that they can be driven. The base unit 571 has a motor 571a that drives the first drive unit 580 and the second drive unit 590.

[0223] The first drive unit 580 is a device that drives the insertion manipulator 100F. The first drive unit 580 is supported by the base unit 571 so as to be movable forward and backward in the longitudinal direction A and rotatable around a central axis O5 along the longitudinal direction A. The first drive unit 580 has a first insertion passage 580h that passes through in the longitudinal direction A and through which the treatment manipulator 400F or the hardness variable device 300 can be inserted.

[0224] 79 is an exploded view of the first drive unit 580. The first drive unit 580 has a first motor unit 581 on the base end side A2 and a first adapter 582 on the tip end side A1.

[0225] 80 is a cross-sectional view of the first motor unit 581 from which the first adapter 582 has been separated. The first motor unit 581 is a unit to which the first adapter 582 can be attached from the distal end side A1. The first motor unit 581 drives a first driven part 584 of the attached first adapter 582. The first motor unit 581 has a first driving part 583.

[0226] The first driving unit (first actuator) 583 includes a first motor 583 m, a first shaft 583 s driven by the first motor 583 m, and a first coupled unit 583 c connected to the first shaft 583 s. The first coupled unit 583 c is exposed on the distal end side A1 of the first motor unit 581.

[0227] The first adapter 582 is an adapter that can be attached to and detached from the tip side A1 of the first motor unit 581. A detachable portion 150 provided at the base end of the flexible portion 119 of the insertion manipulator 100F is connected to the tip side A1 of the first adapter 582. The first adapter 582 communicates with a first insertion passage 580h that is the internal path 101 of the insertion manipulator 100F. The first adapter 582 has a first driven portion 584.

[0228] The first driven part (driving force transmission part) 584 is a member to which a driving force that drives the bending wire 160F and the scope operation wire 178 is input. The first driven part 584 is, for example, a rotating drum that rotates about a central axis along the longitudinal direction A. The first driven part 584 has a first coupling part 584c. The first coupling part 584c is exposed on the base end side A2 of the first adapter 582. Note that the first driven part 584 is not limited to a rotating drum. For example, the first driven part 584 may be a ball screw. Alternatively, an artificial muscle may be used for the bending part 112F, and the first driven part 584 may be a cylinder. The cylinder may be a hydraulic cylinder, a water pressure cylinder, or a pneumatic cylinder.

[0229] 81 is a cross-sectional view of the first motor unit 581 to which the first adapter 582 is attached. Attaching the first adapter 582 to the first motor unit 581 couples the first coupled portion 583c and the first coupling portion 584c. As a result, the rotation of the first shaft 583s by the first motor 583m is transmitted to the first driven portion 584. This enables the first driving portion 583 to drive the bending wire 160F and the scope manipulation wire 178.

[0230] The second drive unit 590 is a device that drives the treatment manipulator 400F and the hardness variable device 300. The second drive unit 590 is supported by the base unit 571 so as to be rotatable about a central axis O5. The second drive unit 590 has a second insertion passage 590h that passes through in the longitudinal direction A and through which the treatment manipulator 400F and the hardness variable device 300 can be inserted.

[0231] 82 to 84 are exploded views of the second drive unit 590. The second drive unit 590 has a second motor unit 591 on the distal end side A1, and a second adapter 592, a third adapter 592A, and a fourth adapter 592B on the proximal end side A2.

[0232] When the first drive unit 580 moves to the base end side A2, the first drive unit 580 comes into contact with the second drive unit 590. As shown in Figure 77, when the first drive unit 580 and the second drive unit 590 come into contact with each other, the first insertion passage 580h and the second insertion passage 590h communicate with each other.

[0233] 82 to 84 , the second motor unit 591 is a unit to which a second adapter 592, a third adapter 592A, and a fourth adapter 592B can be attached from the base end side A2. The second motor unit 591 drives second driven portions 594 of the attached second adapter 592, third adapter 592A, and fourth adapter 592B. The second motor unit 591 has a second driving portion 593.

[0234] 81 , the second drive unit (second actuator) 593 has a second motor 593 m, a second shaft 593 s driven by the second motor 593 m, and a second coupled portion 593 c connected to the second shaft 593 s. The second coupled portion 593 c is exposed on the base end side A2 of the second motor unit 591.

[0235] 85 is a cross-sectional view of the second motor unit 591 to which the second adapter 592 is attached. The second adapter 592 is an adapter that can be attached and detached to the base end side A2 of the second motor unit 591. The treatment manipulator 400F and the stiffness variable device 300 are connected to the tip end side A1 of the second adapter 592. The treatment manipulator 400F and the stiffness variable device 300 are inserted into the internal path 101 of the insertion manipulator 100F via the first insertion passage 580h and the second insertion passage 590h. The second adapter 592 has a second driven part 594.

[0236] The second driven part (driving force transmission part) 594 is a member to which a driving force is input to drive the tube 471 and wire 480 of the treatment manipulator 400F, the wire 312 of the hardness variable device 300, etc. The second driven part 594 is, for example, a rotary drum, a cylinder, or a ball screw. The second driven part 594 has a second coupling part 594c. The second coupling part 594c is exposed on the distal end side A1 of the second adapter 592.

[0237] When the second adapter 592 is attached to the second motor unit 591, the second coupled portion 593c and the second coupling portion 594c are coupled together. As a result, the rotation of the second shaft 593s caused by the second motor 593m is transmitted to the second driven portion 594. This allows the second driving portion 593 to drive the tube 471, the wire 480, the wire 312, and the like.

[0238] 86 is a cross-sectional view of the second motor unit 591 to which a third adapter 592A and a fourth adapter 592B are attached. The third adapter 592A and the fourth adapter 592B are detachable from the proximal end side A2 of the second motor unit 591. Treatment instruments (such as forceps 420, high-frequency knife 430, local injection needle 440, and basket 450) are connected to the distal end side A1 of the third adapter 592A and the fourth adapter 592B. The treatment instruments are inserted through the treatment instrument arm 410F via the manipulator flexible portion 417 of the treatment manipulator 400F. The third adapter 592A and the fourth adapter 592B have a third driven portion 595.

[0239] The third driven part (driving force transmission part) 595 is a member to which a driving force that drives the treatment tool (such as the forceps 420, the high-frequency knife 430, the local injection needle 440, and the basket 450) is input. The third driven part 595 is, for example, a rotating drum. The third driven part 595 has a third coupling part 595c. The third coupling part 595c is exposed on the distal end side A1 of the third adaptor 592A and the fourth adaptor 592B.

[0240] When the third adapter 592A and the fourth adapter 592B are attached to the second motor unit 591, the second coupled portion 593c and the third coupling portion 595c are coupled together. As a result, the rotation of the second shaft 593s caused by the second motor 593m is transmitted to the third driven portion 595. This enables the second driving portion 593 to drive the treatment tools (such as the forceps 420, the high-frequency knife 430, the local injection needle 440, and the basket 450).

[0241] The second motor unit 591 has a plurality of second drive units 593 which are allocated to the second adapter 592, the third adapter 592A, and the fourth adapter 592B. The number of second drive units 593 to which the second adapter 592, the third adapter 592A, and the fourth adapter 592B are connected is determined by the number of drive systems for driving treatment tools and the like.

[0242] The second adapter 592, the third adapter 592A, and the fourth adapter 592B have identifiers such as RFID etc. The drive controller 560 can recognize the type of adapter attached to the second motor unit 591.

[0243] 87 to 91 are diagrams showing an example of the operation of the drive unit 570. The surgeon S inserts the insertion section 110F of the insertion manipulator 100F into the large intestine of the patient. The variable stiffness device 300 is connected to the second adapter 592 of the second drive unit 590.

[0244] 87 , the surgeon S inserts the distal end of the insertion section 110F of the insertion manipulator 100F into the large intestine from the patient's anus. At this time, the surgeon S provides slack SL in the flexible section 119 between the part holding the flexible section 119 and the drive unit 570. The advancement and retraction of the insertion section 110F may be performed manually by the surgeon S, or may be performed by the insertion drive unit 540.

[0245] 88 , the surgeon S places the bending portion 112F at a large curved portion in the large intestine. The surgeon S advances the shape-variable stiffness portion 310 to place the shape-variable stiffness portion 310 in the bending portion 112F. The surgeon S fixes the shape of the stiffness variable portion 310 that is inserted through the bending portion 112F.

[0246] 89 , the surgeon S advances the first drive unit 580 toward the distal end side A1 to advance the insertion section 110F. The bending section 112F advances along the hardness variable section 310, the shape of which is fixed. The insertion manipulator 100F can smoothly pass through large curves in the large intestine.

[0247] As shown in FIG. 90, the surgeon S releases the wire of the hardness variable section 310 to soften the hardness variable section 310 .

[0248] 91 , the surgeon S holds and fixes the flexible section 119. Fixing of the insertion section 110F may be performed by the surgeon S's hand, or may be performed by the insertion drive unit 540. The surgeon S retracts the first drive unit 580 to the proximal side A2. This reduces the slack SL of the flexible section 119, and the hardness variable section 310 moves forward.

[0249] As described above, by moving the first drive unit 580 forward and backward while operating the insertion section 110F, the insertion manipulator 100F can be advanced. Because it is not necessary to continue advancing the first drive unit 580 to advance the insertion manipulator 100F, the movable range of the first drive unit 580 can be limited. The cart 500W on which the drive unit 570 is mounted can be made smaller.

[0250] 92 is a diagram showing a rack 500R which is a modified example of the cart 500W. A drive unit 570 is mounted on an arm 500a which extends deformably from the rack 500R. A drive device main body 500b and a video control device 600 can be mounted on the rack 500R.

[0251] 93 is a diagram showing the scope 200 protruding from the distal end portion 111. The scope (camera unit) 200 is attached so as to be able to protrude from the distal end portion 111 to the distal end side A1 and bendable. The scope 200 is operated by a scope operation wire 178. The scope (camera unit) 200 includes an imaging unit (camera) 201 and a support unit 220 that supports the imaging unit 201. The imaging unit 201 is provided on the distal end side A1 of the support unit 220.

[0252] The support part 220 of the scope 200 has a leaf spring 210 on the upper side (U side). The leaf spring 210 is formed in a flat plate shape extending in the longitudinal direction A. When the scope operation wire 178 is not driven, the leaf spring allows the scope 200 to maintain a linear shape extending in the longitudinal direction A.

[0253] 94 is a diagram illustrating the operation of the scope manipulation wire 178. The scope manipulation wire 178 has a first scope manipulation wire 178a and a second scope manipulation wire 178b.

[0254] The first scope manipulation wire 178a is connected to the proximal side A2 of the scope 200 via a pulley 178p. The pulley 178p is located on the distal side A1 of a connection portion 178c where the first scope manipulation wire 178a is connected to the scope 200. The pulley 178p reverses the direction of advancement and retreat of the first scope manipulation wire 178a in the longitudinal direction A.

[0255] The tip of the second scope operating wire 178 b is connected to the lower side (D side) of the imaging unit (camera) 201 provided on the tip side A1 of the scope 200 .

[0256] The scope 200 transitions between a first state in which the scope 200 advances relative to the tip 111, a second state in which the scope 200 retreats relative to the tip 111, and a third state in which the scope 200 bends downward.

[0257] When the first scope manipulation wire 178a is pulled, the first scope manipulation wire 178a pulls the connection portion 178c toward the distal end side A1, and the scope 200 moves forward relative to the distal end portion 111 (first state).

[0258] When the second scope operating wire 178b is pulled, the scope 200 moves back relative to the distal end portion 111 (second state).

[0259] When the first scope operating wire 178a and the second scope operating wire 178b are pulled, the force pulling the second scope operating wire 178b becomes greater than the holding force of the leaf spring, causing the leaf spring 210 to bend downward and the scope 200 to bend downward (third state).

[0260] The two scope control wires 178 allow the advancement, retreat, and bending of the scope 200 to be controlled, and the distal end portion 111 can be simplified and made thinner.

[0261] According to the electric endoscope system 1000F of this embodiment, observation and treatment can be performed more efficiently.

[0262] Although the fifth 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.

[0263] The present invention can be applied to a medical system for observing and treating the inside of a hollow organ or the like.

[0264] 1000, 1000F Electric endoscope system 100, 100F Insertion manipulator 101 Internal path (lumen) 110, 110A, 110F 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, 112F Bending section 113 Spring 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 118b Braid tube 118c Coating 118F Outer sheath 118m Marking 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 Upward bending wire 161F First bending wire 162F Second bending wire 163F Third bending wire 170, 170F Built-in parts 171, 171F First channel tube (lumen) 171a Coil sheath 171A Base end channel tube 171b Braided tube 171B Distal end channel tube 171c First fixing section 171d Second fixing section 171e Restriction wire 171g Braided tube 171h Coating 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 (camera unit) 201 Imaging unit (camera) 202 Illumination unit 210 Leaf spring 220 Support unit 300 Rigidity variable device (Rigidizer, introducer) 310, 310A, 310B, 310C, 310D Rigidity variable unit 311 Spine unit 312 Wire 313 Tube 314 Wire rod 315 Outer tube 316 Inner tube 317 Cable 318 Shape memory alloy wire 320 Insertion unit 340 Drive unit 400, 400B, 400C, 400D, 400F Treatment manipulator 410,410F Treatment instrument arm 410A Large diameter treatment instrument arm 411, 411F First bending portion 412, 412F Second bending portion 415, 415F, 415Fa, 415Fb, 415Fc, 415Fd Nodal ring (bending piece) 415c Connecting member 415d Connecting hole 415G Connecting piece 415h Insertion hole 415s, 415sa, 415sc Spacer 415w, 415wb, 415wc Wire hole 416, 416F Shoulder joint 417 Manipulator flexible portion 417a Tip surface 418 First shoulder joint 419 Second shoulder joint 420 Forceps 430 High frequency knife 440 Local injection needle 450 Basket 460 Bending tube 460a Distance portion 460b Base end portion 460d Bending tube main body 461 Groove (cut) 462 First groove 463 Second groove 464 First gap 465 Second gap 466 Third gap 470 Artificial muscle 471 Tube 472 Ring member 473 Distance wire 474 Silicon tube 475 Braided tube 480 Wire 500, 500F Drive device 500R Rack 500W Cart 500a Arm 500b Drive device main body 510 Endoscope adapter 520 Operation receiving unit 530 Air supply / suction drive unit 550 Drive unit (actuator) 560 Drive controller 570 Drive unit 571 Base unit 571a Motor 580 First drive unit 580h First insertion passage 581 First motor unit 582 First adapter 583 First driving section (first actuator) 583c First coupled section 583m First motor 583s First shaft 584 First driven section (driving force transmission section) 584c First coupling section 590 Second drive unit 590h Second insertion passage 591 Second motor unit 592 Second adapter 592A Third adapter 592B Fourth adapter 593 Second driving section (second actuator) 593c Second coupled section 593m Second motor 593s Second shaft 594 Second driven section (driving force transmission section) 594c Second coupling section 595 Third driven section (driving force transmission section) 595c Third coupling section 600 Image control device 610 Endoscope adapter 620 Imaging processing section 630 Light source section 660 Main controller 700700F 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 side (proximal side),

Claims

1. A medical manipulator comprising: a manipulator flexible section extending in the longitudinal direction; and two arms arranged at the tips of the manipulator flexible section, wherein the two arms are arranged in a left-right direction perpendicular to the longitudinal direction, and each of the two arms has a second curved section, and when the second curved section is curved, the tips of the second curved sections of the two arms are spaced apart in the left-right direction.

2. The medical manipulator according to claim 1, wherein the second bending portion further comprises a first shoulder joint provided at the tip end side and a second shoulder joint provided at the base end side, and when the first shoulder joint and the second shoulder joint are bent, the tips of the second bending portions of the two arms are separated in the left-right direction.

3. The medical manipulator according to claim 2, wherein the first shoulder joints of the two arms are each capable of bending in a direction toward each other in the left-right direction, and the second shoulder joints of the two arms are each capable of bending in a direction away from each other in the left-right direction.

4. The medical manipulator according to claim 2, wherein the second bending portion is provided with a wire that bends the second bending portion.

5. The medical manipulator according to claim 4, wherein the wires include a first wire for bending the first shoulder joint and a second wire for bending the second shoulder joint.

6. The medical manipulator according to claim 1, wherein the arm has a channel for inserting a treatment tool.

7. The medical manipulator according to claim 4, wherein the second bending portion has a plurality of bending pieces arranged along the longitudinal direction, and each of the plurality of bending pieces has an insertion hole through which a treatment tool is inserted, a wire hole through which the wire is inserted, and a spacer protruding in the longitudinal direction.

8. The medical manipulator according to claim 7, wherein the longitudinal length of the wire hole is longer than the longitudinal length of the spacer, and in the first shoulder joints of the two arms, the multiple bending pieces are provided so that the wire hole is located on the outside in the left-right direction, and in the second shoulder joints of the two arms, the multiple bending pieces are provided so that the wire hole is located on the inside in the left-right direction.

9. The medical manipulator according to claim 1, wherein each of the two arms has a first bending portion through which a treatment tool can be inserted, the first bending portion is connected to the distal end side of the second bending portion, and the first bending portion has an artificial muscle.

10. A medical manipulator system comprising: a medical manipulator having a manipulator flexible section extending in the longitudinal direction and two arms arranged at the tips of the manipulator flexible section; a drive unit that drives the medical manipulator; and a control device for controlling the drive unit, wherein the two arms are arranged in a left-right direction perpendicular to the longitudinal direction, and each of the two arms has a second bending section, and when the second bending section is bent, the tips of the second bending sections of the two arms are spaced apart in the left-right direction.

11. The medical manipulator system according to claim 10, wherein the second bending portion further comprises a first shoulder joint provided on the tip end side and a second shoulder joint provided on the base end side, and the first shoulder joint and the second shoulder joint are bent so that the tips of the second bending portions of the two arms are spaced apart in the left-right direction.

12. The medical manipulator system according to claim 11, wherein the first shoulder joints of the two arms are each capable of bending in a direction toward each other in the left-right direction, and the second shoulder joints of the two arms are each capable of bending in a direction away from each other in the left-right direction.

13. The medical manipulator system according to claim 11, further comprising an insertion manipulator through which the medical manipulator is inserted, the insertion manipulator having a notch on its tip surface, and the second shoulder joint fitting into the notch when bent.

14. The medical manipulator system according to claim 11, wherein the second bending portion includes a wire that bends the second bending portion.

15. The medical manipulator system according to claim 14, wherein the wires include a first wire for bending the first shoulder joint and a second wire for bending the second shoulder joint.

16. The medical manipulator system according to claim 10, further comprising a treatment tool that is inserted into the medical manipulator, and the arm has a channel through which the treatment tool is inserted.

17. The medical manipulator system according to claim 14, wherein the second bending portion has a plurality of bending pieces arranged along the longitudinal direction, and each of the plurality of bending pieces has an insertion hole through which a treatment tool is inserted, a wire hole through which the wire is inserted, and a spacer protruding in the longitudinal direction.

18. The medical manipulator system according to claim 17, wherein the longitudinal length of the wire hole is longer than the longitudinal length of the spacer, and in the first shoulder joints of the two arms, the multiple bending pieces are arranged so that the wire hole is located on the outside in the left-right direction, and in the second shoulder joints of the two arms, the multiple bending pieces are arranged so that the wire hole is located on the inside in the left-right direction.

19. The medical manipulator system according to claim 10, wherein each of the two arms has a first bending portion through which a treatment tool can be inserted, the first bending portion is connected to the distal end side of the second bending portion, and the first bending portion has an artificial muscle.

20. A treatment method using a medical system comprising a medical manipulator having two arms with a first shoulder joint and a second shoulder joint arranged in the left-right direction, and an insertion manipulator through which the medical manipulator is inserted, wherein each of the first shoulder joints of the two arms can be bent in a direction toward each other in the left-right direction, and each of the second shoulder joints of the two arms can be bent in a direction away from each other in the left-right direction, and with the second shoulder joints bent, the second shoulder joints are fitted into notches in the insertion manipulator to perform treatment.

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