US20050228224A1 - Endoscope therapeutic device - Google Patents

Abstract

In an endoscope therapeutic device having a plurality of introduction guide tubes for introducing a treatment tool into a body cavity, the introduction guide tubes are mutually joined at a position more proximal than bending portions thereof. Accordingly, the effects caused by the movement of the plurality of the introduction guide tubes are mutually invalidated at a joint portion as a fulcrum, so that the position of the introduction guide tube is relatively stabilized in the body cavity. As joining methods, there are integration, usage of a joint tool, and usage of an over tube. The operability is improved when the introduction guide tube is provided at the distal end thereof with a mechanism for retaining and/or rotating a distal end of a treatment tool inserted therethrough.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application is based upon and claims the benefit of priority from prior Japanese Patent Application No.2004-118182, filed Apr. 13, 2004, the entire contents of which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to an endoscope therapeutic device for performing treatment under observation via an endoscope by introducing a treatment tool through an introduction guide tube with a bending function into a body cavity, and an introduction guide tube thereof.
• 2. Description of the Related Art
• An endoscope therapeutic device for performing treatment using a treatment tool under observation via an endoscope by introducing the treatment tool through a soft introduction guide tube into a body cavity is known in the related art. The introduction guide tube used in the endoscope therapeutic device of this type is referred also as a “channel tube”. Recently, as an introduction guide tube of this type, an introduction guide tube with a bending function, in which a bending portion is provided in the vicinity of the distal end of the tube, and the bending portion is capable of being bent by a proximal final operating element is proposed (See JP-A-2000-33071). This endoscope therapeutic device is configured in such a manner that treatment tools are guided via a plurality of introduction guide tubes with a bending function, respectively, into a body cavity, and the directions of the treatment tools in the body cavity are adjusted by bending the bending portions of the introduction guide tubes.
BRIEF SUMMARY OF THE INVENTION
• An endoscope therapeutic device according to the present invention includes a plurality of introduction guide tubes for introducing treatment tools into a body cavity, wherein the plurality of introduction guide tubes are joined to each other at portions proximal to the bending portions thereof. In a case where there are a plurality of bending portions on the introduction guide tube, a joint portion is placed in a more proximal position than the distal-most bending portion.
• In this manner, the effects caused by the movement of a plurality of the introduction guide tubes are mutually invalidated at a joint portion as a fulcrum, so that the position of the introduction guide tube is relatively stabilized in the body cavity. Therefore, the operability is improved. Also, since the bending portions are located on the more distal side than the joint portion, good operability can be maintained even when they are joined.
• The form of joint may be such that a part of the insertion portion that is located on a more proximal side than the bending portion of the introduction guide tube is integrally joined with other introduction guide tubes. In this case, a stable connection is achieved. It is also possible to join the introduction guide tubes with a joint tool. In this case, since the introduction guide tubes can be replaced, it is applicable to various embodiments. It is also possible to provide a connecting function to an over tube through which the introduction guide tubes are inserted.
• When the joint tool is resiliently deformed to tighten the introduction guide tubes to be inserted, a stable joint is achieved.
• In addition to the introduction guide tubes, the positions of the endoscope, a suction tube, and the like in the body cavity are also stabilized by being joined as a matter of course. Further, an operating mechanism for operating the distal end of the treatment tool to be inserted therethrough may preferably be provided at the distal end of the introduction guide tube. Since the introduction guide tube is provided with a function to operate the treatment tool in addition to the function to receive the treatment tool inserted therethrough, operability is improved. Since the treating portion and the operating portion are located close to each other, a delicate operation can be performed.
• The operator can operate the treatment tools inserted through the guide tubes without unlinking his/her hand from the guide tube by operating on the proximal side of the guide tube, and hence good operability is achieved. The operation of the treatment tool includes, for example, the fore-and-aft movement or the rotation of the treatment tool.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
• These and other features, aspects, and advantages of the apparatus and methods of the present invention will become better understood with regard to the following description, appended claims, and accompanying drawings where:
• FIG. 1A is a perspective view of an endoscope therapeutic device according to a first embodiment of the present invention;
• FIG. 1B is a perspective view of a distal portion of an endoscope for use with the endoscope therapeutic device ofFIG. 1A;
• FIG. 2 is a lateral cross-sectional view of a joint portion in the endoscope therapeutic device ofFIG. 1A as taken along line2-2 thereof;
• FIG. 3 is an explanatory drawing showing the state of usage of the endoscope therapeutic device according to the first embodiment;
• FIG. 4 is a perspective view showing the joint in an enlarged manner in a state in which a treatment tool introduction guide tube unit is built in the endoscope in the endoscope therapeutic device according to the first embodiment;
• FIG. 5 is a perspective view showing the joint for assembling the treatment tool introduction guide tube unit to the endoscope in the endoscope therapeutic device according to the first embodiment;
• FIG. 6 is a perspective view showing the introduction guide tube in the treatment tool introduction guide tube unit of the endoscope therapeutic device according to the first embodiment;
• FIG. 7 is a cross-sectional view of a distal end portion of the introduction guide tube in the treatment tool introduction guide tube unit of the endoscope therapeutic device according to the first embodiment;
• FIG. 8 is a partial perspective view of the endoscope therapeutic device according to a second embodiment of the present invention;
• FIG. 9 is a perspective view showing an over tube of the endoscope therapeutic device according to the second embodiment;
• FIG. 10 is a cross-sectional view of a fixed portion of the endoscope therapeutic device ofFIG. 8 as taken along line10-10 thereof;
• FIG. 11 is an explanatory drawing showing the state of usage of the endoscope therapeutic device according to the second embodiment;
• FIG. 12 is an exploded perspective view of the endoscope therapeutic device according to a third embodiment of the present invention;
• FIG. 13 is an explanatory drawing showing the state of usage of the endoscope therapeutic device according to the third embodiment;
• FIG. 14 is a perspective view showing a distal end of the endoscope therapeutic device according to a fourth embodiment of the present invention;
• FIG. 15 is a perspective view showing the distal end of the endoscope therapeutic device according to a fifth embodiment of the present invention;
• FIG. 16 is a perspective view showing a final operating element of the introduction guide tube in the endoscope therapeutic device according to a sixth embodiment of the present invention;
• FIG. 17 is a plan view of the final operating element of the introduction guide tube in the endoscope therapeutic device according to the sixth embodiment;
• FIG. 18A andFIG. 18B are vertical cross-sectional views of the distal end of the introduction guide tube in the endoscope therapeutic apparatus according to the sixth embodiment;
• FIG. 19A andFIG. 19B are perspective views showing the distal end of the introduction guide tube in the endoscope therapeutic device according to a seventh embodiment of the present invention;
• FIG. 20 is a perspective view showing the final operating element of the introduction guide tube in the endoscope therapeutic device according to an eighth embodiment of the present invention;
• FIG. 21 is a perspective view showing a treatment tool rotating mechanism built in the distal end of the introduction guide tube in the endoscope therapeutic device according to the eighth embodiment of the present invention;
• FIG. 22 is a vertical cross-sectional view of the treatment tool rotating mechanism built in the distal end of the introduction guide tube in the endoscope therapeutic device according to the eighth embodiment;
• FIG. 23 is a plan view showing a gear train of the treatment tool rotating mechanism built in the distal end of the introduction guide tube in the endoscope therapeutic device according to the eighth embodiment;
• FIG. 24 is a perspective view showing the gear train of the treatment rotating mechanism built in the distal end of the introduction guide tube in the endoscope therapeutic device according to the eighth embodiment;
• FIG. 25 is a perspective view of the distal end when the introduction guide tube of the endoscope therapeutic device according to the eighth embodiment is in use;
• FIG. 26 is a vertical cross-sectional view of the distal end of the introduction guide tube of the endoscope therapeutic device according to the eighth embodiment when in use;
• FIG. 27 is a perspective view showing the treatment tool rotating mechanism built in the distal end of the introduction guide tube in the endoscope therapeutic device according to a ninth embodiment of the present invention; and
• FIG. 28 is a side view of the final operating element of the introduction guide tube in the endoscope therapeutic device according to the ninth embodiment.
DETAILED DESCRIPTION OF THE INVENTION
• Embodiments of the invention will be described below with reference to the accompanying drawings.
• Referring now toFIG. 1 toFIG. 7, an endoscope therapeutic device according to a first embodiment of the present invention will be described.FIG. 1A is a perspective view of an endoscope therapeutic device according to the first embodiment of the present invention. A treatment tool introductionguide tube unit1 is shown inFIG. 1A.FIG. 1B shows aninsertion portion3 of anendoscope2. In the endoscope therapeutic device according to the first embodiment, the treatment tool introductionguide tube unit1 is joined to theinsertion portion3 of theendoscope2 by the joint tool described above.
• The treatment tool introductionguide tube unit1 includes a plurality of treatment toolintroduction guide tubes4a,4bas manipulators for operating the surgical operation tools including the treatment tools such as forceps or the like. Thetreatment guide tubes4a,4bare joined at a midsection of an insertion portion S thereof by ajoint portion6, and is fixed and joined integrally. Ajoint hood26, which constitutes thejoint portion6 is formed of a soft material. A mode for joining the two treatment toolintroduction guide tubes4a,4bby thejoint hood26 is shown inFIG. 2. It is also possible to form at least part of theinsertion portions5 of the two treatment toolintroduction guide tubes4a,4bas a single flexible tube of oval shape in lateral cross-section without using thejoint hood26 as described above. For example, at least thejoint portion6 can be configured in such a manner. In this case as well, a fixed structure in which theinsertion portions5 of a plurality of theintroduction guide tubes4a,4bare connected integrally to each other is provided.
• FIG. 6 is a perspective view of the treatment toolintroduction guide tube4a(4b). As shown inFIG. 6, theinsertion portions5 of the treatment toolintroduction guide tubes4a,4beach include adistal portion10 located at a distal extremity thereof, afirst bending portion11 is located on the proximal side of thedistal portion10, asecond bending portion12 is located on the proximal side of thefirst bending portion11, and asoft portion13 is provided behind thesecond bending portion12. A proximalfinal operating element20 is provided at the proximal end of theinsertion portion5 of each of theintroduction guide tubes4aor4b. The proximalfinal operating elements20 each include agrip portion21, aninsertion port22 which communicates with a treatment tool guiding channel14 (seeFIG. 7), and a plurality of operating members for bending the bendingportions11,12 respectively. The operating member for bending includes twoangle knobs23a,23bfor operating thefirst bending portion11 in two directions and one angle handle24 for operating thesecond bending portion12 in a single (e.g., vertical) direction.
• FIG. 7 is a vertical cross-sectional view of theinsertion portion5 of the introduction guide tube in the treatment tool introduction guide tube unit. As shown inFIG. 7, aflexible tube15 forming the treatmenttool guiding channel14 is disposed over the entire length in theinsertion portion5 of each of theintroduction guide tubes4a,4b. The treatmenttool guiding channel14 opens toward the outside at the distal extremity of theinsertion portion5 via achannel hole16 at thedistal portion10 and at the final operating element at the insertion port.
• Thefirst bending portion11 includes a plurality ofcurved pieces17 joined so as to be capable of rotating freely to allow bending in the vertical and lateral directions, and is bent in the pulling direction of anoperating wire18 by pulling a plurality of the operatingwires18. Although the second bending portion12 (seeFIG. 6) also has the same configuration to be bent by means of a plurality of the bending pieces, thesecond bending portion12 is configured so as to be bent only in the vertical direction.
• As shown inFIG. 1A, thesecond bending portion12 is provided so as to extend or project from the distal end of thejoint portion6. In other words, in the respective treatment toolintroduction guide tubes4a,4b, the proximal portions in the movable sections including the bendingportions11,12 are fixedly supported by thejoint hood26. In the first embodiment in this configuration, a fixing portion (fixing means) for fixing the portions of theintroduction guide tubes4a,4bin the vicinity of the proximal ends of the bendingportions11,12 respectively, and then fixing the same to each other is provided. Also, thejoint hood26 constitutes a therapeutic instrument joint tool for joining a plurality of theintroduction guide tubes4a,4b.
• Then, the distal end of thejoint hood26 which supports both of the movable sections of the respective treatment toolintroduction guide tubes4a,4bserves as acommon fulcrum27. Therefore, the movable sections including the bendingportions11,12 can move respectively on the basis of thecommon fulcrum27. Thefulcrum27 is also a common fixed point for the movable sections of the respectiveintroduction guide tubes4a,4b.
• Subsequently, referring toFIG. 1B, theendoscope2 will be described.FIG. 1B is a perspective view of theinsertion portion3 of theendoscope2. As shown inFIG. 1B, theinsertion portion3 of theendoscope2 includes adistal portion31 located at a distal extremity thereof, a bendingportion32 located on the proximal side of thedistal portion31, and asoft portion33 located on the proximal side of the bendingportion32. Theendoscope2 has an observation function by the provision of an inspection window34, anillumination window35, and achannel port36 at the distal end surface of thedistal portion31. The bendingportion32 is bent by a final operating element (not shown) provided at a proximal end of theinsertion portion3.
• FIG. 3 is an explanatory drawing showing the state of usage of the endoscopetherapeutic device1 including the treatment toolintroduction guide tubes4a,4band theendoscope2 assembled together according to the first embodiment. As shown inFIG. 3, the treatment tool introductionguide tube unit1 is joined to theinsertion portion3 of theendoscope2 by ajoint tool40 in a state of being placed along theinsertion portion3 of theendoscope2. Thejoint tool40 is disposed in the vicinity of the distal end of thesoft portion33 averting the bendingportion32 of theendoscope2. Since the portion of the introductionguide tube unit1 in the vicinity of the distal end is joined by thejoint tool40, the movable sections of the respective treatment toolintroduction guide tubes4a,4bincluding the bendingportions11,12 are disposed corresponding to the bendingportion32 of theendoscope2, and are configured to be movable with respect to each other.
• As shown inFIG. 4 andFIG. 5, thejoint tool40 includes aband member43 having aninsertion hole41 for allowing thejoint portion6 of the introductionguide tube unit1 to be inserted therethrough and aninsertion hole42 for allowing theinsertion portion3 of theendoscope2 to be inserted therethrough, and theband member43 is capable of opening and closing so that one end can be opened about ahinge44 on the other end. Aprojection45 is formed on one of the edges at the openable end of theband member43 and a correspondinghole46 for receiving theprojection45 for engagement is formed on the other edge.
• Subsequently, a case of using the endoscope therapeutic device will be described. As shown inFIG. 3, the operator assembles the introductionguide tube unit1 to theinsertion portion3 of theendoscope2 and guides the same into a body cavity as one unit. When guiding the unit assembled into one piece into the body cavity as described above, it is also possible to guide it into the body cavity using a trocar or an over tube (not shown) as a guiding member as is known in the art.
• Then, the operator introduces the various treatment tools (including a suction tool) into the body cavity via the respectiveintroduction guide tubes4a,4bof the introductionguide tube unit1, which are joined to theinsertion portion3 of theendoscope2, while observing the body cavity by theendoscope2 to perform a required treatment. It is also possible to introduce another treatment tool through thechannel port36 and corresponding channel provided on theendoscope2 to perform a treatment simultaneously.
• FIG. 3 shows a state in which ananatomy47 is pulled upward. In this example of treatment, the operator pulls up theanatomy47 using grippingforceps48 introduced through one of theintroduction guide tubes4a, holds theanatomy47 using the grippingforceps49 introduced through the otherintroduction guide tube4b, and moves the respective treatment tools in the opposite direction. In other words, the operator bends the bendingportions11,12 of theintroduction guide tubes4a,4brespectively, and provides the opposite movements to the two pairs offorceps48,49 to pull theanatomy47.
• Here, since the movable sections of the respectiveintroduction guide tubes4a,4bwhich guide the respective grippingforceps48,49 move in the opposite directions with reference to thefulcrum27, supporting forces exerted to the fulcrum27 are mutually invalidated (canceled), and the movable sections of the respectiveintroduction guide tubes4a,4bmove with reference to thefulcrum27. Thefulcrum27 is approximately considered as a fixed point. Therefore, a force to be exerted to the grippingforceps48,49 does deviate and can be exerted to theanatomy47 as is. Such behavior is not limited to the case of puling up theanatomy47, but may be the same in the surgical operation such as to expand theanatomy47.
• In general, in case of using the single soft introduction guide tube or the soft endoscope independently, the soft portion of the insertion portion is suspended in a space of the body cavity by the reaction received from the gripping forceps so as to be capable of moving freely. Therefore, a force exerted to the anatomy can become extremely small because the force generated by the reaction is absorbed in the soft insertion portion.
• However, in the first embodiment, since the movable sections of the respectiveintroduction guide tubes4a,4bwhich guide the grippingforceps48,49 is fixedly supported by thecommon fulcrum27, the supporting forces generated by the reaction and exerted to the fulcrum27 are mutually invalidated at thefulcrum27, whereby relatively stable support of the movable sections of theintroduction guide tubes4a,4bis achieved. In other words, there is less possibility that theintroduction guide tubes4a,4bmove by themselves and hence the force is dissipated. The fulcrum27 can be regarded as a fixed point, and hence thegrip forceps48,49 can be guided as intended with reference to the fulcrum27 to perform a quick operation of treatment. In this manner, even when the two portions of the anatomy are gripped by the two treatment tools and the two portions are moved in the opposite directions as in the case of pulling up of the anatomy or expanding the anatomy, treatment can be performed with a strong force without any undesirable movement of theintroduction guide tubes4a,4band/or theendoscope2.
• In the first embodiment described above, the case in which the introductionguide tube unit1 is used by being joined to theinsertion portion3 of theendoscope2 has been described. However, the same advantages can be achieved in the case in which the introductionguide tube unit1 having a plurality of the introduction guide tubes joined to each other is used independently. However, when the introductionguide tube unit1 is used by being joined to theinsertion portion3 of theendoscope2, the positional relation with respect to theendoscope2 is established during use, and hence the surgical situation can be observed easily, and the stable supporting balance is provided to the entire unit, whereby stability of operation is increased, thereby improving usability.
• In the case in which the treatment tool is used via the channel provided in theendoscope2, the form of usage in which the supporting function is provided as described above is also conceivable as well as other various forms of usage.
• Referring now toFIG. 8 toFIG. 11, the endoscope therapeutic device according to a second embodiment of the present invention will be described. The same parts to those in the embodiment described above will be represented by the same reference numerals in the description.
• FIG. 8 is a partial perspective view of the endoscope therapeutic device according to the second embodiment of the present invention. As shown inFIG. 8, the treatment tool introductionguide tube unit1 according to the second embodiment is an assembly of the two treatment toolintroduction guide tubes4a,4bintegrally inserted through an overtube61 formed of soft material. The treatment toolintroduction guide tubes4a,4bare the same as those in the first embodiment.
• FIG. 9 is a perspective view showing the overtube61 of the endoscope therapeutic device according to the second embodiment, andFIG. 10 is a lateral cross-sectional view of a fixed portion of the introduction guide tube built in the overtube61. As shown inFIG. 9, the overtube61 is formed with twoinsertion holes62a,62bfor inserting the respective two treatment toolintroduction guide tubes4a,4bseparately in a juxtaposed manner. As shown inFIG. 10, although the respective insertion holes62a,62bare partitioned by apartitioning wall63 for guiding theintroduction guide tubes4a,4bseparately, the insertion holes62a,62bpartly communicate with each other and are formed close to each other.
• A fixingscrew64 is screwed into a sidewall of one of the insertion holes62b, and theintroduction guide tube4binserted through theinsertion hole62bis tightened by thescrew64, so that theintroduction guide tube4bcan be fixed. Theintroduction guide tube4ainserted through theother insertion hole62ais tightened by resilient deformation of theover tube61, which occurs when theintroduction guide tube4bis tightened by thescrew64, and is fixed to theinsertion hole62bthereby.
• In other words, in the second embodiment in this configuration, the fixing portion (fixing means) for fixing the portions of theintroduction guide tube61 in the vicinity of the proximal ends of the bendingportions11,12 respectively and then fixing the same to each other is provided. Also, the overtube61 itself constitutes the treatment equipment joint tool for joining a plurality of theintroduction guide tubes4a,4b.
• As shown inFIG. 8, when the two treatment toolintroduction guide tubes4a,4brespectively are mounted to the overtube61, thedistal portion10 and the sections of the bendingportions11,12 are exposed from the distal end of theover tube61 and project forward (distally). Normally, the distal ends of thesoft portions13 are also projected at least slightly when mounted.
• Subsequently, the case where this endoscope therapeutic device is used will be described.FIG. 11 is an explanatory drawing showing the state of usage of the endoscope therapeutic device. As shown inFIG. 11, the operator mounts the two treatment toolintroduction guide tubes4a,4bto the overtube61 respectively to form a single unit, and guides the same into the body cavity using the guide means such as trocar. Here, since theintroduction guide tubes4a,4bprojecting from the distal end of theover tube61 are retained with the distal end of theover tube61 as thefulcrum27, the movement of theintroduction guide tubes4a,4bis stable and smooth. In a case where the grippingforceps48,49 as the treatment tools are operated in the opposite directions by theintroduction guide tubes4a,4b, the components of the force in the opposite directions exerted to the fulcrum27 are mutually invalidated. Therefore, the movable operating sections of theintroduction guide tubes4a,4bmove with reference to thefulcrum27, and hence the force exerted to the grippingforceps48,49 can be exerted to theanatomy47 without dissipation.
• Alternatively, the operator can fix the portion in the vicinity of the boundary between thefirst bending portion11 and thesecond bending portion12 onto the overtube61 by means of thescrew64 or the like with the sections of thesecond bending portions12 of the respectiveintroduction guide tubes4a,4bpositioned within the overtube61 and with only thefirst bending portion11 projected from the overtube61. In this case, only thefirst bending portion11 is bent about the portion in the vicinity of the boundary between thefirst bending portion11 and thesecond bending portion12 is set as a fulcrum. In other words, the present invention is not limited to the portion in the vicinity of the proximal end of the proximal-mostsecond bending portion12, but may take a form in which the portion located at the midsection of the bending portion is fixed.
• In the second embodiment, theendoscope2 is provided separately from the unit, and as shown inFIG. 11, theendoscope2 can be guided in thebody cavity65 along the overtube61 of the unit for observing the state of treatment, or can guide a treatment tool such as a separate high-frequency knife66.FIG. 11 shows a state of incising theanatomy47, which is pulled up by the grippingforceps48,49, by means of the high-frequency knife66 introduced through theendoscope2.
• Referring now toFIG. 12 andFIG. 13, the endoscope therapeutic device according to a third embodiment of the present invention will be described. The same parts as in the embodiments described above are represented by the same reference numerals.
• The third embodiment is configured in such a manner that the above-described two treatment toolintroduction guide tubes4a,4band theendoscope2 are joined by ajoint tool71. As shown inFIG. 12, thejoint tool71 includes aresilient member75 having ahole portion72 for fitting theinsertion portion5 of theintroduction guide tube4a, ahole portion73 for fitting the insertion portion S of theintroduction guide tube4b, and ahole portion74 for fitting theinsertion portion3 of theendoscope2 disposed radially. Thehole portions72,73,74 of thejoint tool71 each are formed with aslit76 for allowing the member to be put in or removed at the midsection thereof by deforming the portions of theresilient member75 proximate to theslits76 to insert the respective insertion portions of theintroduction guide tubes4a,4bandendoscope2.
• FIG. 13 shows the state of usage of the third embodiment. Theinsertion portion5 of theintroduction guide tube4a, theinsertion portion5 of theintroduction guide tube4b, and theinsertion portion3 of theendoscope2 are mounted by being fitted to thehole portions72,73,74 of thejoint tool71 corresponding thereto, respectively. Thejoint tool71 is mounted and fixed to thedistal portion31 of theendoscope2. In order to fixedly retain thesoft portions13 of theintroduction guide tubes4a,4bin the vicinity of the distal ends in this position, the supporting portion serves as thefulcrum27 of theintroduction guide tubes4a,4b. Therefore, as shown inFIG. 13, when theintroduction guide tubes4a,4band theendoscope2 are connected by thejoint tool71, theintroduction guide tubes4a,4bare disposed at the position surrounding, and in the vicinity of, theinsertion portion3 of theendoscope2. Consequently, the same usage as the second embodiment described above is enabled. Thejoint tool71 may also be disposed at other positions of theendoscope2 and/orintroduction guide tubes4a,4b.
• Subsequently, referring toFIG. 14, the endoscope therapeutic device according to a fourth embodiment of the present invention will be described. The same parts as in the embodiments described above are represented by the same reference numerals in the description.
• A soft overtube80 having a bending function is employed in the fourth embodiment. The distal portion of theover tube80 includes a bendingportion81, and the bendingportion81 is bent by the final operating element (not shown) disposed on a proximal side of theover tube80. The overtube80 is formed with ahole83 for receiving anintroduction guide tube82 inserted therethrough, twoholes85 for receiving tworespective suction tubes84a,84bseparately and ahole86 for receiving theinsertion portion3 of theendoscope2 in a sectional manner.
• Then, when theintroduction guide tube82, thesuction tubes84a,84b, and theinsertion portion3 of theendoscope2 are inserted through the correspondingholes83,85,86 of theover tube80 respectively, these members are unitized. The overtube80 includes a fixed portion in the vicinity of the distal portion thereof, so that the inserted tools can be supported so that the relative position between theover tube80 and the inserted tools does not change in the radial direction. Theintroduction guide tube82 and thesuction tubes84a,84bare mounted to the overtube80 so as to be capable of moving in the fore-and-aft direction without wobbling in the radial direction. The movable sections of theintroduction guide tube82 and thesuction tubes84a,84bprojecting from the distal end of theover tube80 are formed with bendingportions87 which are similar to that described above with regard to theintroduction guide tubes4a,4b. The proximal portions of the bendingportions87 projecting from the distal end of theover tube80 are supported by the overtube80, and the portions of theover tube80 in the vicinity of the distal end serves as a fulcrum of the movable sections projecting forward therefrom.
• When using this unit, as shown inFIG. 14, the operator causes theintroduction guide tube82, thesuction tubes84a,84b, and theinsertion portion3 of theendoscope2 to project from the distal end of theover tube80. Then, for example, the distal ends of the twosuction tubes84a,84bare placed on theanatomy47 to adsorb theanatomy47. The operator can also bend the bendingportion87 of thesuction tubes84a,84bwhich are projected from the distal end of theover tubes80 as needed and pull theanatomy47 upward. The operator can also expand theanatomy47 by bending the bendingportions87 of thesuction tubes84a,84b, which are projected from the distal end of theover tube80, as needed in the directions away from each other.
• In the usage thereof, since the movable sections of therespective suction tubes84a,84bare fixedly supported at the common fulcrum, the reaction forces exerted to thesuction tubes84a,84bare mutually invalidated, so that thesuction tubes84a,84bcan be operated reliably with a strong force as intended about the distal end of theover tube80 as the fulcrum. The treatment tools may be projected from theintroduction guide tube82 for treatment.
• Theintroduction guide tube82 may be used as the suction tube. Alternatively, thesuction tubes84a,84bmay be replaced by the treatment tool introduction guide tubes, which are similar to that described above.
• Referring now toFIG. 15, the endoscope therapeutic device according to a fifth embodiment of the present invention will be described. The same parts as in the embodiments described above are represented by the same reference numerals for description.
• In the fifth embodiment, a soft overtube90 is employed. The soft overtube90 is formed integrally with a plurality ofmanipulators91a,91bat the distal end of the soft overtube90. One of themanipulators91ais provided with adistal operating section92 having flexibility, which is similar to the movement of the fingers of a human being, and theother manipulator91bis provided with a bendingportion93 with the bending function having flexibility which is similar to the movement of the wrist of a human being. Therespective manipulators91a,91bare separately and remotely operated by an operation input means (not shown). The operation input means may be, for example, a glove-type input device to which the movement of the hand of the human being is input and mimicked by themanipulators91a,91b.
• The soft overtube90 is formed with aninsertion channel95 to which theinsertion portion3 of theendoscope2 is introduced. Theendoscope2 used here has an extrathin insertion portion3 having only an observing function.
• When using the endoscope therapeutic device, as shown inFIG. 15, the operator performs treatment by gripping the treatment tool or by nipping the anatomy directly using the left andright manipulators91a,91bwhich have flexibility similar to the movement of the fingers of the human being. In this treatment form, since the movement similar to the wrist of the human being is achieved and hence it can be used with the similar feelings as a human hand, the operability can further be improved, and the usage can be acquired easily.
• The left andright manipulators91a,91bare mounted to the distal end of the soft overtube90, and fixedly and integrally supported. Accordingly, this supporting portion serves as the fulcrum of themanipulators91a,91bas the movable sections. Therefore, in the case of operating in the opposite directions using therespective manipulators91a,91b, the forces exerted to therespective manipulators91a,91bare mutually invalidated so that therespective manipulators91a,91bcan be operated reliably with a strong force as intended about the distal end of theover tube90 as the fulcrum.
• Referring now toFIG. 16 toFIG. 18, another therapeutic device in which the introduction guide tube as described above is modified will be described as a sixth embodiment of the present invention. As shown inFIG. 16 andFIG. 17, anintroduction guide tube100 in this therapeutic device includes asoft insertion portion101 and afinal operating element102, and thefinal operating element102 includes agrip portion103, a plurality ofangle knobs105 for bending the bending portion of theinsertion portion101, aninsertion port107 that communicates with a channel of theinsertion portion101, and a treatmenttool operating lever109 for operating a treatment tool operating mechanism, described later. Theangle knob105 is provided with abrake knob105afor locking the operating position thereof. The brake knob may be provided also on the treatmenttool operating lever109.
• FIG. 18A andFIG. 18B are vertical cross-sectional views of a distal end of the introduction guide tube in the endoscope therapeutic device according to the sixth embodiment. As shown inFIG. 18A andFIG. 18B, aninsertion portion110aof atreatment tool110, such as gripping forceps, is inserted from theinsertion port107 of thefinal operating element102 of theintroduction guide tube100 through achannel106, so as to be projected into the body cavity from an opening106aat the distal end of thechannel106.
• A treatmenttool operating mechanism108 is built in the distal portion of theinsertion portion101. The treatmenttool operating mechanism108 here includes a ring-shapedmovable element115 which allows insertion of theinsertion portion110aof thetreatment tool110 in the distal portion of theinsertion portion101 so as to be capable of linear movement in the fore-and-aft axial direction. The distal end of anoperating wire116 inserted through theinsertion portion110 is connected to themovable element115. Accordingly, a movement control mechanism in which theoperating wire116 is moved in the fore-and-aft axial direction when the treatmenttool operating lever109 of the above-describedfinal operating element102 is operated, whereby themovable element115 of the treatmenttool operating mechanism108 is moved in the fore-and-aft direction and thedistal end110aof thetreatment tool110 is moved in the fore-and-aft direction, is configured. Themovable element115 constitutes a mechanism for selectively engaging and disengaginggrip arms117 as engaging members that engage part of theinsertion portion110aof thetreatment tool110 by theoperating wire116, which is operated on the proximal side.
• As shown inFIG. 18A andFIG. 18B, a plurality of thegrip arms117 as engaging members that engage part of theinsertion portion110aof thetreatment tool110 project forward from themovable element115. The distal portions of therespective grip arms117 are resiliently biased so as to open outwardly in the free state shown inFIG. 18B. Eachgrip arm117 is integrally formed with a holdingportion118 at the distal end thereof. A tighteningmember121 is attached on the outside of eachgrip arm117, and the tighteningmember121 is capable of sliding freely in the range between themovable element115 and the holdingportion118. Theinsertion portion101 is formed with aguide rail122 in the distal portion so as to guide the tighteningmember121 linearly in the fore-and-aft direction. Positioning stoppers (stepped portions)123a,123bformed of walls extending vertically upward are formed at the front end and the rear end of theguide rail122, so that front and rear terminal positions of movement of the tighteningmember121 are defined respectively.
• The tighteningmember121 includes a slidingportion124 to be guided by theguide rail122 and afastening ring portion125 that slides on the outer periphery of thegrip arm117. As shown inFIG. 18A, when the tighteningmember121 is retracted, therespective grip arms117 are tightened by the tighteningmember121, and the holdingportions118 of therespective grip arms117 are pressed against the outer periphery of theinsertion portion110aof thetreatment member110 to grip thetreatment tool110 by themovable element115.
• By moving themovable element115 by theoperating wire116 in the fore-and-aft direction in the state in which the treatment tool is constrained as shown inFIG. 18A, thetreatment tool110 can be moved in the fore-and-aft direction together with theintroduction guide tube100. In this manner, complicated operation such as to operate with the hand unlinked from the final operating element of theintroduction guide tube100 or the endoscope as in a case where the operator grips the distal end of thetreatment tool110 directly and pulls and pushes the proximal end of thetreatment tool110 by hand to move the distal portion in the fore-and-aft direction is not necessary, and the fore-and-aft movement of thetreatment tool110 can be performed easily without unlinking the hand from the final operating element.
• When the tighteningmember121 is moved forward as shown inFIG. 18B, the distal portions of therespective grip arms117 open and release thetreatment tool110. In other words, the holdingportions118 of therespective grip arms117 retract from theinsertion portion110aof thetreatment tool110 and release thetreatment tool110 from the gripped state shown inFIG. 18A. Therefore, thetreatment tool110 can be moved in the fore-and-aft direction or in the rotational direction independently of theintroduction guide tube100, whereby the operability of thetreatment tool110 is improved.
• Theintroduction guide tube100 is used as the introduction guide tube in the device in the therapeutic system described above, and can be used for introduction of various treatment tools. It can also be applied to an unit form in which a plurality of theintroduction guide tubes100 are joined so that the supporting forces exerted to the movable sections of a plurality of theintroduction guide tubes100 are mutually invalidated at the common fulcrum. The general existing introduction guide tube is simply used for inserting the treatment tool therethrough. However, with theintroduction guide tube100 disclosed here, thetreatment tool110 can be rotated or moved in the fore-and-aft direction positively, and hence the reliable operation of thetreatment tool110 is achieved. Theintroduction guide tube100 guarantees beneficial effects also when using theintroduction guide tube100 independently and separately from theendoscope2.
• Subsequently, referring toFIG. 19A andFIG. 19B, a modification of the above-described introduction guide tube will be described as a seventh embodiment of the present invention. Anintroduction guide tube130 of this type differs from the above-describedintroduction guide tube100 in that there is provided a treatment tool advancing-retracting mechanism. In other words, the treatment tool advancing-retracting mechanism supports aseparate extremity member132 at thedistal portion131 of theintroduction guide tube130 via a plurality ofpush rods133 so as to be capable of moving in the fore-and-aft direction. Thepush rods133 are moved in the fore-and-aft direction by operating the treatmenttool operating lever109 provided on thefinal operating element102 of theintroduction guide tube130, so that theextremity member132 is moved in the fore-and-aft direction.
• FIG. 19A shows a state in which theextremity member132 is waiting at a normal position which is retracted backward, andFIG. 19B shows a state in which theextremity member132 is moved forward.
• As shown inFIG. 19A andFIG. 19B, a ring-shapedresilient member135 as the resilient member is disposed at the peripheral edge of the distal end opening of the channel formed on theextremity member132. The ring-shapedresilient member135 is used for gripping the insertion portion of thetreatment tool110 projected from the distal end opening of the channel by tightening the same with a resilient force. Thetreatment tool110 is retained by the resiliently tightening force of the ring-shapedresilient member135 and hence follows the movement of theextremity member132. However, the force that retainstreatment tool110 is such that when theinsertion portion110aof thetreatment tool110 is pushed and pulled from the proximal side, only thetreatment tool110 can move against the retaining force of the ring-shapedresilient member135. It is also possible to retain thetreatment tool110 with a force of a strength that cannot move thetreatment tool110.
• The above-describedintroduction guide tube130 can also be used as the above-described introduction guide tube and as a member for introducing the treatment tool as a matter of course, and it can also be applied to a unit form in which a plurality of theintroduction guide tubes130 are joined so that the supporting forces exerted to the movable sections of a plurality of theintroduction guide tubes130 are mutually invalidated at the common fulcrum.
• Referring now toFIG. 20 toFIG. 26, another modification of the aforementioned introduction guide tube will be described as an eighth embodiment of the present invention. As shown inFIG. 20, theintroduction guide tube140 includes asoft insertion portion141 and afinal operating element142. Thefinal operating element142 includes agrip portion143, a plurality ofangle knobs145 for bending a bending portion144 (seeFIG. 21) of theinsertion portion141, aninsertion port147 in communication with a channel146 (seeFIG. 22) of theinsertion portion141, a treatmenttool rotating knob149 for operating a treatment toolrotating mechanism148 described later. Theangle knob145 and the treatmenttool rotating lever149 are provided withbrake knobs145a,149afor locking the operating positions thereof. Thefinal operating element142 is provided with anoperating button137 for performing operations such as suction or air supply using thechannel146.
• As shown inFIG. 25 andFIG. 26, by inserting aninsertion portion150aof atreatment tool150 such as the grip forceps from theinsertion port147 of thefinal operating element142 of theintroduction guide tube140 through thechannel146, thetreatment tool150 is projected from a distal end opening of thechannel146 into the body cavity.
• The treatment toolrotating mechanism148 is assembled in the distal portion of theinsertion portion141, and is configured as shown inFIG. 21 toFIG. 26. In other words, a cylindrical connectingmouth ring153, to which the distal end of asoft tube152 defining thechannel146 is connected, is provided in adistal portion151 of theinsertion portion141 of theintroduction guide tube140, and the connectingmouth ring153 is fixed to a supportingmember154 fixed to thedistal portion151. As shown inFIG. 22, a cylindrical rotatingmember156 is disposed along the connectingmouth ring153 and adistal wall155 of thedistal portion151, and the rotatingmember156 is rotatably supported about an elongated shaft of thechannel146 or a shaft extending in parallel with the elongated shaft. The rotatingmember156 opens at the distal surface of thedistal portion151 of theintroduction guide tube140 and forms a distal end opening146aof thechannel146.
• As shown inFIG. 22, abevel gear157 as a driven gear is coaxially formed on the outer periphery of the rotatingmember156. Abevel gear158 as a drive gear engages thebevel gear157. The shaft center of thebevel gear158 is disposed orthogonally to the shaft center of thebevel gear157 as the driven gear. Thebevel gear158 as the drive gear is rotatably supported in the distal portion of theinsertion portion141. Apinion gear159 is coaxially and integrally formed with thebevel gear158. As shown inFIG. 23, a pair ofracks160a,160bare disposed on both sides of thepinion gear159 so as to engage therewith. Therespective racks160a,160bare configured to be guided linearly by a guide, not shown, in the distal portion of the insertion portion0.141 of theintroduction guide tube140.
• Distal ends of operatingwires161a,161bare connected to therespective racks160a,160bseparately, and when the operator pushes or pulls the operatingwires161a,161bfrom the proximal side, theracks160a,160bmove in the fore-and-aft direction, so that thepinion gear159 rotates.
• The operatingwires161a,161bare pulled by operating the treatmenttool rotating knob149 provided on thefinal operating element142 to move theracks160a,160b.
• Then, by the movement of theracks160a,160b, thepinion gear159 rotates together with thebevel gear158, and thebevel gear158 rotates thebevel gear157 as the driven gear. When thebevel gear157 as the driven gear rotates, the rotatingmember156 rotates together.
• On the other hand, as shown inFIG. 22 andFIG. 25, aresilient member165 formed of rubber or the like is provided at the peripheral edge of the distal end of the rotatingmember156. Theresilient member165 is exposed outward from thedistal portion151 of theinsertion portion141 of theintroduction guide tube140. Theresilient member165 serves as anchoring member which abuts against the distal end of the treatment tool inserted through thechannel146, and anchors itself with respect to the distal end of the treatment tool by a frictional force against the treatment tool or deformation thereof, so as to cause the treatment tool to rotate with the rotatingmember156. The treatment tool inserted through theintroduction guide tube140 can be rotated by the treatment toolrotating mechanism148.
• When thetreatment tool150 such as the grip forceps is inserted through theintroduction guide tube140 for use, as shown inFIG. 25 andFIG. 26, the operator inserts aninsertion portion150aof thetreatment tool150 through thechannel146 and allows adistal grip member150bof thetreatment tool150 to project from the distal end of theintroduction guide tube140.
• Then, the operator opens thedistal grip member150bby operating alink mechanism168 for operating an openable andclosable link mechanism168, causes thedistal grip member150bto retract slightly in the opened state, and presses the member of thelink mechanism168 against theresilient member165 for anchoring. In other words, thedistal grip member150bof thetreatment tool150 is joined with the rotatingmember156 by a frictional force or an engaging force between theresilient member165 and thelink mechanism168, so as to rotate with the rotatingmember156.
• When changing the direction of thetreatment tool150 by rotating the same, thedistal grip member150bof thetreatment tool150 can be rotated with the rotatingmember156. In other words, since thedistal grip member150bof thetreatment tool150 is rotated directly, accurate relation with respect to the amount of rotation can be maintained, and thedistal grip member150bof thetreatment tool150 can be rotated quickly. It is also possible to twist theelongated insertion portion150aof thetreatment tool150 from the proximal side to assist the rotation of thedistal grip member150bof thetreatment tool150.
• Referring now toFIG. 27 andFIG. 28, still another modification of the introduction guide tube provided with the treatment tool rotating mechanism as described above will be described as a ninth embodiment of the invention.
• As shown inFIG. 27, in the treatment tool rotating mechanism of anintroduction guide tube170, the driven gear to be provided on the outer periphery of the rotatingmember156 is aspur gear171. Aspur gear172 as a drive gear engages thespur gear171. Thespur gear172 as the drive gear is supported in the distal portion of theinsertion portion141. A distal end of atorque transmission wire173, which is configured to transmit rotational torque, is connected to a shaft of thespur gear172.
• Then, the operator rotates thespur gear172 as the drive gear and thespur gear171 as the driven gear by twisting and rotating thetorque transmission wire173 from the proximal side. When thespur gear171 rotates, the rotatingmember156 rotates together therewith.
• As shown inFIG. 28, arotating lever175 is provided on thefinal operating element142 of theintroduction guide tube170 so that thetorque transmission wire173 is rotated by operating therotating lever175. The direction of operation of the operating mechanism on the proximal side by therotating lever175 is substantially parallel to the axis of rotation of the rotating mechanism at the distal end of the insertion portion.
• The structure of the treatment tool rotating mechanism other than those described here may be substantially the same as the above-described embodiments.
• In this case as well, as in the above-described embodiments, the treatment tool rotating mechanism can be used for changing the direction of rotation of thetreatment tool150. Since the driven gear is thespur gear171 and the drive gear is thespur gear172, and thespur gear172 is rotated by thetorque transmission wire173, a mechanism to be built in the distal portion of theintroduction guide tube170 can be simplified.
• Although the treatment tool operating mechanism for moving the treatment tool in the fore-and-aft direction or for rotating the same is such that the treatment tool is built in the distal portion of the introduction guide tube in the aforementioned description, it is also possible to combine both configurations to obtain a form in which the treatment tool operating mechanism for moving the treatment tool in the fore-and-aft direction and rotating the same.
• As described above, in the introduction guide tube in a form including the treatment tool operating mechanism which moves the treatment tool in the fore-and-aft direction or/and rotating the same, the following problems can be solved.
• In other words, when the direction or the position of the distal portion of the treatment tool introduced into the body cavity via the soft introduction guide tube is changed as in the related art, the proximal portion of the treatment tool is twisted or moved in the fore-and-aft direction on the proximal side of the introduction guide tube.
• However, the insertion portion of the treatment tool introduced via the interior of the introduction guide tube is elongated and flexible, and the insertion portion of the treatment tool comes into contact with the inner wall of the introduction guide tube at many points and often snakes its way therein. In particular, when the bending portion of the introduction guide tube is bent, the insertion portion of the treatment tool comes into a pressing contact with the inner wall of the introduction guide tube at the bending portion.
• Under such a circumstance, even when the operator pushes and pull s the insertion portion of the treatment tool positioned in the introduction guide tube from the proximal side, or adds the rotating operation, the operating force is apt to be absorbed en route by snaking or twisting of the insertion portion of the treatment tool, and hence the operating force from the proximal side is hardly transmitted to the distal portion of the treatment tool.
• However, as described above, in a form in which the operating mechanism for moving the treatment tool in the fore-and-aft direction or the operating mechanism for rotating the treatment tool is built in the distal portion of the introduction guide tube, such disadvantages can be eliminated, and quick operation is enabled while maintaining the accurate relation with respect to the operating amount. Also, a complicated operation such as to operate with an operator's hand removed from the final operating element of the introduction guide tube or the endoscope as in a case where the operator pushes or pulls the proximal portion of the treatment tool by hand is not necessary, and hence the operation of the treatment tool in the fore-and-aft direction can be performed easily without the operator removing his/her hand from the final operating element.
• While there has been shown and described what is considered to be preferred embodiments of the invention, it will, of course, be understood that various modifications and changes in form or detail could readily be made without departing from the spirit of the invention. It is therefore intended that the invention be not limited to the exact forms described and illustrated, but should be constructed to cover all modifications that may fall within the scope of the appended claims.

Claims (23)

1. An endoscope therapeutic device for introducing a treatment tool into a body cavity and performing treatment by the treatment tool under observation by an endoscope, the endoscope therapeutic device comprising:

a plurality of introduction guide tubes for introducing the treatment tool into a body cavity, each of the plurality of introduction guide tubes comprise an insertion portion, one or more bending portions provided at a distal side of the insertion portion and being bendable by a bending operation; and

a mutual joint for joining at least two of the plurality of introduction guide tubes disposed at a position proximal to the distal-most bending portions of each of the at least two introducing guide tubes.

2. An endoscope therapeutic device according toclaim 1, wherein all of the plurality of the introduction guide tubes are joined at the position proximal to the distal-most bending portion of each of the introduction guide tubes.

3. An endoscope therapeutic device according toclaim 1, wherein the mutual joint of the at least two introduction guide tubes is achieved by a configuration in which at least part of the respective insertion portions of the at least two introduction guide tubes are integrally joined.

4. An endoscope therapeutic device according toclaim 1, wherein the mutual joint of the at least two introduction guide tubes comprises a joint tool.

5. An endoscope therapeutic device according toclaim 4, wherein the joint tool comprises a mechanism for resiliently deforming at least part of the joint tool for joining the at least two introduction guide tubes.

6. An endoscope therapeutic device according toclaim 1, wherein the mutual joint comprises an over tube for receiving introduction guide tubes to be joined inserted therethrough and tightening a member inserted through the distal part.

7. An endoscope therapeutic device according toclaim 1, wherein at least one of the plurality of introduction guide tubes is provided at the distal portion thereof with an operating mechanism for retaining a distal portion of a treatment tool inserted through the introduction guide tube and for moving the treatment tool.

8. An endoscope therapeutic device for introducing a treatment tool into a body cavity and performing treatment by the treatment tool under observation by an endoscope, the endoscope therapeutic device comprising:

the endoscope comprising an insertion portion and a bending portion;

at least one introduction guide tube for introducing the treatment tool into a body cavity, the introduction guide tube comprising an insertion portion and at least one bending portion provided at a distal side of the insertion portion of the at least one introduction guide tube, the bending portion of the introduction guide tube being bendable by a bending operation; and

a joint tool for detachably joining the insertion portion of the endoscope and a portion of the at least one introduction guide tube at a position proximal to the distal-most bending portion of the at least one introduction guide tube.

9. An endoscope therapeutic device according toclaim 8, wherein the at least one introduction guide tube comprises a plurality of introduction guide tubes, wherein the plurality of the introduction guide tubes are mutually joined at the position proximal to the distal most bending portion of each of the introduction guide tubes.

10. An endoscope therapeutic device according toclaim 9, wherein the joint tool also achieves a mutual joint between the plurality of introduction guide tubes.

11. An endoscope therapeutic device according toclaim 8, wherein the joint tool comprises an over tube for receiving the endoscope and the at least one introduction guide tube inserted therethrough, and the over tube is mounted so that a relative position of the introduction guide tube in a radial direction does not change at a fixed portion in the vicinity of a distal portion of the over tube.

12. An endoscope therapeutic device according toclaim 11, further comprising at least one suction tube inserted through the over tube, wherein the over tube is further mounted so that the relative position of the at least one suction tube in the radial direction does not change at the fixed portion.

13. A therapeutic instrument joint tool for mutually joining therapeutic instruments each having at least one bending portion and being configured for introduction into a body cavity, the therapeutic instrument joint tool being configured to mutually join the therapeutic instruments at a position proximal to the distal-most bending portions of each of the therapeutic instruments to be joined.

14. An over tube comprising:

a bending portion being bendable by a bending operation;

an insertion portion for inserting a plurality of introduction guide tubes therein; and,

a fixed portion for mutually fixing the plurality of introduction guide tubes at a position in the vicinity of and proximal to the bending portions of each of the plurality of introduction guide tubes.

15. An over tube according toclaim 14, wherein the insertion portion has a plurality of insertion guide openings, corresponding to the plurality of introduction guide tubes so that the plurality of the introduction guide tubes can be respectively inserted therein.

16. An introduction guide tube for receiving a treatment tool used for treatment in a body cavity inserted therethrough, the introduction guide tube comprising:

an operating mechanism provided at a distal portion of the introduction guide tube for retaining a distal end of the treatment tool inserted through the introduction guide tube and for moving the distal end of the treatment tool.

17. An introduction guide tube according toclaim 16, wherein the operating mechanism comprises an engaging member that engages part of an insertion portion of the treatment tool.

18. An introduction guide tube according toclaim 17, further comprising a mechanism for selectively engaging and disengaging the engaging member, the mechanism being actuated from a proximal side of the introduction guide tool.

19. An introduction guide tube according toclaim 16, wherein the operating mechanism is a moving mechanism for moving the distal end of the treatment tool in a fore-and-aft direction.

20. An introduction guide tube according toclaim 16, wherein the operating mechanism is a rotating mechanism for rotating the distal end of the treatment tool.

21. An introduction guide tube according toclaim 20, wherein the rotating mechanism rotates in a direction about an axis of rotation corresponding to a longitudinal axis of a treatment tool insertion channel of the introduction guide tube or an axis extending in parallel with the longitudinal axis.

22. An introduction guide tube according toclaim 20, wherein the rotating mechanism rotates in a same direction as an operating direction of the operating mechanism on the proximal side of the introduction guide tube.

23. An introduction guide tube according toclaim 20, wherein the rotating mechanism is operated such that an operating direction of the operating mechanism on a proximal side of the introduction guide tube is substantially parallel with an axis of rotation of the rotating mechanism.

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