JP4075310B2 - Intracavity TV camera - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a body cavity observation television camera that is directly inserted into a body cavity by an operator's hand, for example, in the abdominal cavity.
[0002]
[Prior art]
As endoscopes used for medical purposes, endoscopes for the upper gastrointestinal tract and the like inserted into the body cavity from the oral cavity and the like, endoscopes for the lower gastrointestinal tract inserted from the anus and the like are generally used. Furthermore, endoscopes that are inserted percutaneously are also widespread. Here, examinations and treatments performed using a percutaneously inserted endoscope do not require a large-scale operation such as a laparotomy, and can directly perform treatment such as excision of the affected part. In recent years, this type of procedure has made significant progress.
[0003]
Accordingly, FIG. 8 shows an example of a state in which examination and treatment using a laparoscope are performed as an example of an endoscope inserted percutaneously. In the figure, reference numeral 1 denotes a laparoscope. The laparoscope 1 is guided into the abdominal cavity using a trocar 2 inserted from the body epidermis as a guide. Accordingly, the insertion portion 1a of the laparoscope 1 is inserted into the trocar 2 that penetrates the abdominal wall. At the distal end of the insertion portion 1a of the laparoscope 1, there are provided illumination means for illuminating at least the body cavity and observation means for observing the body cavity under illumination by the illumination means. The laparoscope 1 is mainly used for observing the inside of a body cavity, and generally does not include a path for inserting a treatment tool such as forceps, that is, a treatment tool insertion channel.
[0004]
As described above, the laparoscope 1 normally does not include a treatment instrument insertion channel. However, when an affected part is found as a result of endoscopic examination or the like, sampling of tissue cells is necessary, or the like. In order to introduce a treatment instrument comprising forceps and a high-frequency treatment instrument into the abdominal cavity, in addition to the trocar 2 into which the insertion portion 1a of the laparoscope 1 is inserted, one or more trocars 3 (drawings). A single trocar 3 is shown above) and is inserted into the abdominal cavity from the abdominal wall. A predetermined treatment instrument 4 is inserted into the other trocar 3.
[0005]
In performing the above-described intraperitoneal treatment, it is necessary to minimize damage to healthy tissue cells. For this purpose, the outer diameter dimensions of the trocars 2, 3 and the like inserted into the abdominal wall are made the minimum necessary. Here, the thing with the largest outer diameter as what is inserted into the trocar is usually the insertion part 1a of the laparoscope 1. On the other hand, the treatment instrument guided into the abdominal cavity through the trocar is small. Moreover, since the operation of the treatment tool must be performed remotely from outside the body, the operability is poor, for example, an operation of moving a large organ or a delicate operation, for example, removal of an affected part located near a blood vessel. It is extremely difficult to perform operations such as.
[0006]
Based on the above, in recent years, the body epidermis is incised by a predetermined length, and the operator's hand is inserted into the abdominal cavity through this incision, so that the organ can be directly touched or grasped by the hand. In other words, a so-called hand assist technique has been clinically used. Here, when performing hand assist, the operator cannot directly observe the hand and the surroundings where the hand is inserted, and thus requires monitoring by an endoscope. As described above, since the laparoscope is inserted into the body cavity via the trocar, the operation is usually performed using the image captured by the laparoscope as a clue.
[0007]
In this regard, an endoscope used for hand assist, that is, a television camera for observation inside a body cavity has been developed and put into practical use. This television camera includes a camera body incorporating at least a body cavity observation means including a solid-state imaging means and an illumination means including a light guide in a casing, and a cable and a light connected to the camera body and connected to the solid-state imaging means. The other end of the flexible cord is a connector portion that is detachably connected to the video signal processing device and the light source device.
[0008]
[Problems to be solved by the invention]
Incidentally, the above-described endoscope for hand assist is generally provided by connecting the camera body to a surgical glove or the like and is fixed to a finger. Therefore, in a state where the hand is inserted into the body cavity, at least the finger on which the camera body is mounted cannot be used, and thus the operation of the finger is greatly restricted. As a result, there are significant restrictions on the operation by hand assist.
[0009]
Since the laparoscope is inserted into the body cavity via the trocar, it is possible to perform a predetermined operation with the hand inserted into the body cavity by observing the image of the laparoscope. However, in that case, the trocar inserted through the laparoscope cannot be used for other purposes, and it is necessary when operating multiple treatment tools at the same time. A number of trocars into which a number of treatment tools can be inserted must be inserted into the body cavity, which causes a problem that damage to healthy tissue is increased accordingly.
[0010]
The present invention has been made in view of the above points, and an object of the present invention is to minimize the number of trocars to be inserted into a body cavity and ensure smoothness and certainty of operation by hand assist. There is to do.
[0011]
[Means for Solving the Problems]
In order to achieve the above-described object, the present invention includes at least a solid-state imaging unit mounted in a casing, and the solid-state imaging unit has an observation unit that can be adjusted in angle to change the observation field of view . A camera body, a flexible cord connected to the camera body, through which a cable from the solid-state imaging means is inserted, and detachably connected to the video signal processing device; and a trocar or trocar provided on the camera body And a fastening portion that is detachably attached to an attachment shaft that is inserted through the attachment shaft.
[0012]
Here, in addition to the observation means described above, it is desirable to provide illumination means at a position close to the observation means in the casing of the camera body. The illuminating means includes an illuminating lens and a light guide provided so as to face the illuminating lens, and the light guide is inserted into the cord together with the signal cable. The observation means is configured to be able to change the observation visual field as desired, that is, to be able to swing . As an example for remotely changing the field of view by adjusting the angle of the observation means, the observation means is attached to the casing via a spherical bearing, and an operation wire inserted through a flexible cord is used. The observation means can be directed in a desired direction by the push-pull operation. The structure of the fastening portion provided in the camera body may depend on, for example, an elastic ring that engages the outer surface of the trocar, although it depends on the other member to be attached, and the mounting shaft that is inserted into the trocar. A screw portion is provided at the tip, and a screw hole screwed into the screw portion of the mounting shaft can be used as a fastening portion in the casing of the camera body.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 shows a state in which an intra-abdominal examination and treatment are performed using a hand-assist technique. Note that the in-vivo observation TV camera of the present invention is not limited to the intra-abdominal cavity, but in general, the in-vivo observation TV camera or the trocar for inserting and guiding the treatment tool is used to perform inspection and treatment in the body cavity in general. Applicable.
[0014]
Thus, in FIG. 1, 10 and 11 are trocars, 12 is a laparoscope, and 13 is a treatment instrument. The trocars 10 and 11 are inserted from the body skin S into the abdominal cavity C, thereby securing an insertion path into the abdominal cavity C. The laparoscope 12 is formed by connecting an insertion portion 12b to a main body operation portion 12a. The insertion portion 12b is inserted into a body cavity using the trocar 10 as a guide means. The treatment tool 13 is composed of, for example, forceps, a high-frequency treatment tool, and the like, and is inserted into the abdominal cavity C through the trocar 11 to perform treatment such as collection of a tissue sample, excision of an affected part, and coagulation.
[0015]
An incision having a predetermined width is made in the body surface skin S, and an operator's hand H is inserted through the incision. Thus, when inserting the hand H into the abdominal cavity C, the television camera 14 for observation inside the body cavity is carried. As shown in FIG. 2, the television camera 14 includes a camera body 15, a flexible cord 16 connected to the camera body 15, an operation unit 17 coupled to the flexible cord 16, and the operation unit. The connector 18 is connected to the control unit 19 in an detachable manner at the end of the connection cord 18.
[0016]
FIG. 3 shows a cross section of the camera body 15. In these drawings, reference numeral 20 denotes an objective optical system provided in the lens barrel 20a. A solid-state image pickup device 21 is provided at an image forming position of the objective optical system 20, and the solid-state image pickup device 21 is a circuit board 22. Is attached. The objective optical system 20, the solid-state image sensor 21 and the like constitute a television camera as observation means. The lens barrel 20a constituting the objective optical system 20 is attached to the holding cylinder 23 so that the position of the lens barrel 20a can be adjusted in the optical axis direction, and a cover glass 25 attached to a holder 24 is provided in front of the objective optical system 20. It has been. The solid-state imaging device 21, the holding cylinder 23, and the holder 24 are provided in a housing 26 whose outer peripheral surface 26S has a spherical shape, and this housing 26 slides on an inner peripheral surface 27S of a casing 27 that has a concave spherical shape. It is installed as possible. Accordingly, the angle of the housing 26 can be adjusted with respect to the casing 27.
[0017]
Further, a light guide 28 constituting an illuminating means is provided in the housing 26. The light guide 28 is composed of an optical fiber bundle, and is inserted into a through hole 26a provided in the housing 26. Is an emission part of illumination light. Two light guides 28 are arranged at positions on both sides of the objective optical system 20. Further, a protective glass 29 is fitted between the inner peripheral portion of the housing 26 and the outer peripheral portion of the holder 24 to which the cover glass 25 is attached, and the light guide 28 exit portion faces the protective glass 29. The position to be turned is a diverging lens portion 29a.
[0018]
A predetermined number of wires are connected to the circuit board 22 to which the solid-state image pickup device 21 is connected. These wires are bundled as a signal cable 30 and extend from the proximal end opening 26 b of the housing 26 into the casing 27. Further, the flexible cord 16 is inserted. Further, the light guide 28 whose front end is branched into two extends from the base end opening 26 b into the casing 27, and is integrated into the casing 27. Is inserted. The signal cable 30 and the light guide 27 are extended from the flexible cord 16 through the operation portion 17 into the connection cord 18 and are connected to the control unit 19 via the connector 18a. Therefore, the control unit 19 includes a light source unit facing the incident end of the light guide 27 and a video signal processing circuit to which the signal cable 30 is connected.
[0019]
As described above, the joint portion between the housing 26 and the casing 27 in which the observation unit including the objective optical system 20 and the solid-state imaging device 21 and the illumination unit including the light guide 28 are mounted has a spherical shape. 26 can be rotated in an arbitrary direction, whereby the visual field of the observation means can be directed in a desired direction. The observation visual field is changed by the observation means by turning the operation knobs 31a and 31b (see FIG. 2) provided in the operation unit 17 remotely. For this purpose, as shown in FIG. 4, pulleys 32a and 32b are connected to the operation knobs 31a and 31b, respectively, and a pair of operation wires 33 are wound around the pulleys 32a and 32b. ing. The four operation wires 33 are inserted into the close contact coil 34 in the flexible cord 16, and the front end portion of the close contact coil 34 is fixed to a mounting plate 35 provided in the casing 27. Further, cross arms 36 projecting every 90 ° are attached to the base end portion of the housing 26, and the four operation wires 33 are led out from the tips of the contact coils 34, and each arm of the cross arm 36 is provided. It is connected to the pieces 36U, 36D, 36R, 36L.
[0020]
For example, the other ends of the two operation wires 33 wound around the pulley 32a of the operation knob 31a are connected to the arm pieces 36U and 36D of the cross arm 36, respectively, and the two wound around the pulley 32b of the operation knob 31b. The other end of the operation wire 33 is connected to the arm pieces 36R and 36L, respectively. Accordingly, when the operation knob 31a is rotated in the forward / reverse direction, the housing 26 is rotated in the vertical direction with respect to the casing 27, and when the operation knob 31b is rotated in the forward / reverse direction, the housing 26 is moved in the left / right direction. When the operation knobs 31a and 31b are combined and operated, the housing 26 is rotated in an arbitrary direction. As a result, the observation visual field of the observation means comprising the objective optical system 20 and the solid-state imaging device 21 provided in the housing 26 can be changed in an arbitrary direction.
[0021]
Here, as is apparent from FIG. 3, the casing 27 is connected to the main body portion 27a having a substantially cylindrical shape, and to the base end side of the main body portion 27a, and the front end of the flexible cord 16 is fixed. It is composed of three members: a portion 27b and a locking portion 27c that is connected to the distal end side of the main body portion 27a and spherically joins the outer surface of the housing 26 together with the main body portion 27a. And as shown in FIG. 6, the fastening part 37 is attached to the outer surface of the main-body part 27a. The fastening portion 37 has an elastic ring portion 38 formed of an elastic plate piece having a substantially C shape, and a screw hole 39 is provided on the inner surface of the elastic ring portion 38. As will be described later, the elastic ring portion 38 can be detachably fastened so as to hold the outer surface of the trocar 10, and the screw hole 39 is screwed into a screw portion 40 a provided at the tip of the mounting shaft 40. Thus, the attachment shaft 40 can be detachably fastened.
[0022]
The television camera 14 for in-body cavity observation is configured as described above, and this television camera 14 uses the hand H of the surgeon for the abdominal cavity C at the time of intra-abdominal examination, treatment, treatment, etc. performed by hand assist. It can be carried when inserted inside. As is clear from FIG. 1, a path for inserting the laparoscope 12, the treatment tool 13, and the like from the outside is secured inside the abdominal cavity C by the trocars 10, 11. Insert it so that the inside of the abdominal cavity C can be observed. As a result, the state of the abdominal cavity C can be observed from the stage before the operator's hand H is inserted, and the safety of the operation is ensured.
[0023]
The camera body 15 of the television camera 14 is held by the hand inserted into the abdominal cavity C, and the camera body 15 can observe the abdominal cavity C by itself, so that the hand moves as desired. By directing the observation field of view of the camera body 15 to the site of interest, the inside of the abdominal cavity C, the organ, and the like can be further examined. However, since the camera body 15 is gripped, hand movement is restricted. Therefore, if necessary, as shown in FIG. 5, if the elastic ring portion 38 constituting the fastening portion 37 provided in the camera body 15 is fixed to the outer surface of the trocar 10, The camera body 15 can be released. Further, as shown in FIG. 6, the mounting shaft 40 provided with the threaded portion 40 a at the tip is inserted into the other trocar 11, and the tip of the mounting shaft 40 is a screw hole forming the fastening portion 37 of the camera body 15. By screwing it into 39, the camera body 15 can be fixed to the mounting shaft 40, and the hand for performing hand assist can be freed.
[0024]
As described above, when the camera body 15 is fixed to the outer surface of the trocar 10 or the mounting shaft 40 inserted into the trocar 11, the inside of the abdominal cavity C can be observed by the camera body 15. Moreover, the camera body 15 can direct the observation field of view in an arbitrary direction by operating the operation knobs 31a and 31b provided on the operation unit 17 located outside the body. When the camera body 15 is attached to the attachment shaft 40, the observation field of view can also be changed by rotating the attachment shaft 40 around the axis within the trocar 11. As a result, it is not necessary to observe the abdominal cavity C with the laparoscope 12 inserted into the trocar 10, and the laparoscope 12 can be extracted. Therefore, the trocar 10 can be used as a guide means for other members.
[0025]
Here, since the trocar 10 into which the laparoscope 12 is inserted has a large inner diameter, for example, as shown in FIG. 5, a treatment instrument such as a large forceps 41 can be inserted. As a result, treatment and treatment inside the abdominal cavity C can be performed more smoothly. In addition, by using the trocar 10 as an insertion path for the treatment instrument, the number of trocars to be inserted can be reduced, and damage to healthy tissue is minimized. In addition, since the hand performing the hand assist is completely released, the hand can be freely moved, and a procedure requiring a delicate and careful operation such as grasping an organ in the abdominal cavity C. Can be performed smoothly and reliably.
[0026]
When the hand is taken out from the abdominal cavity C, the camera body 15 fixed to the trocar 10 or the mounting shaft 40 is detached, and the camera body 15 is gripped by hand and taken out from the abdominal cavity C to the outside. It will be.
[0027]
Note that it is only necessary that an observation means including at least an objective optical system and a solid-state imaging device is attached to the camera body of the television camera, and the illumination means is not necessarily attached. However, since it is necessary to illuminate the body cavity because it is a dark place, the illumination means may be configured to be guided directly into the body cavity or through another trocar, and the field of view of the observation means can be changed. For example, in the case where the camera body is fixed to a trocar having a so-called angle mechanism in which the tip portion can be bent in an arbitrary direction, the angle of the observation means may not be changed with respect to the camera body.
[0028]
Furthermore, in the case of configuring the housing in which the observation means is mounted on the casing of the camera body so that the housing can be rotated, for example, a configuration as shown in FIG. In this figure, members that are the same as or equivalent to those in FIG. 7, the mounting ring 50 is screwed into the base end portion of the housing 26, and the distal end of the operation wire 51 is connected to the mounting ring 50 (see FIG. The two operation wires 51 are connected, but two more operation wires can be connected to the left and right). The operation wire 51 is once extended obliquely forward, is engaged with a direction changing guide portion 52 provided on the inner surface of the casing 27, and extends rearward from the guide portion 52. A mounting portion 53 is provided at a rear position of the guide portion 52 provided in the casing 27, and a base 54 a provided at the tip of the close contact coil 54 is fixed to the mounting portion 53. The operation wire 51 whose direction has been changed by the guide portion 52 is introduced into the close contact coil 54 from the base 54a. Accordingly, the two to four operation wires 51 are individually inserted into the contact coil 54 and extended to the operation unit.
[0029]
With this configuration, a force for rotating the spherical joint between the housing 26 and the casing 27 in a substantially tangential direction can be exerted, so that the casing 27 of the housing 26 is pushed and pulled by the operation wire 51. Since the rotation operation can be performed with a light load and the rotation angle with respect to the operation amount of the operation knob can be increased, the operability of the observation visual field changing operation is further improved.
[0030]
Here, since the housing 26 slides with respect to the casing 27, in order to prevent dirt from adhering to the sliding portion, the sealing member 55 made of a cylindrical elastic film is covered from the housing 26 to the casing 27. It can also be made to wear.
[0031]
【The invention's effect】
Since the present invention is configured as described above, the number of trocars to be inserted into the body cavity can be minimized, and the smoothness and certainty of operation by hand assist can be ensured.
[Brief description of the drawings]
FIG. 1 illustrates an embodiment of the present invention and is an explanatory diagram of a state in which an intra-abdominal examination and treatment are performed using a hand-assist technique.
FIG. 2 is an overall configuration diagram showing an embodiment of a television camera for observation inside a body cavity according to the present invention.
3 is a cross-sectional view of a main part of the television camera in FIG. 2;
FIG. 4 is an explanatory diagram of a configuration of a visual field changing mechanism of observation means of a television camera.
FIG. 5 is an explanatory view showing a state in which a camera body is detachably fixed to a trocar.
FIG. 6 is a configuration explanatory view showing a state in which a camera body is mounted on a mounting shaft.
FIG. 7 is a cross-sectional view of an essential part of a television camera showing a second embodiment of the present invention.
FIG. 8 is a configuration explanatory view showing a state in which examination and treatment are performed using a laparoscope as a general percutaneous endoscope;
[Explanation of symbols]
10, 11 trocar 12 laparoscope 13 treatment tool 14 TV camera 15 camera body 16 flexible cord 17 operation unit 18 connection cord 19 control unit 20 objective optical system 21 solid-state imaging device 26 housing 27 casing 31a, 31b operation knob 33, 51 Operation wires 34 and 54 Adhering coil 37 Fastening portion 38 Elastic ring portion 39 Screw hole 40 Mounting shaft 40a Screw portion

Claims (5)

At least a solid-state imaging unit is mounted in the casing, and the solid-state imaging unit has a camera body in which the observation unit whose angle is adjustable to change the observation field of view is mounted in the casing;
A flexible cord connected to the camera body, inserted through a cable from the solid-state imaging means, and detachably connected to the video signal processing device;
A television camera for intra-body-cavity observation, comprising: a trocar or a fastening portion that is detachably attached to an attachment shaft that is inserted through the trocar.   In the casing of the camera body, an illuminating unit is provided at a position close to the observation unit. The illuminating unit includes an illuminating lens and a light guide provided to face the illuminating lens. 2. The in-body-cavity observation television camera according to claim 1, wherein a light guide is inserted into the flexible cord.   The observation means is attached to the casing via a spherical bearing, and the observation means is configured to be capable of adjusting the angle by remote operation of an operation wire inserted into the flexible cord. Item 3. The television camera for in-vivo observation according to item 1 or 2.   The in-vivo observation television camera according to claim 1, wherein the fastening portion is formed of an elastic ring that is detachably engaged with an outer surface of the trocar.   The in-vivo observation television according to claim 1, wherein a screw portion is provided at a tip of the mounting shaft inserted through the trocar, and the fixing portion is a screw hole screwed into the mounting shaft. camera.

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