Surgical device, outer tube, endoscope, and treatment tool

Abstract

A surgical device, an outer tube, an endoscope, and a treatment tool that have a compact configuration and achieve high durability are provided. The outer tube includes a slider in an outer tube body. When the endoscope and the treatment tool are inserted into the outer tube, and are held by an endoscope holding part and a treatment tool holding part each being provided in the slider, and are combined into a single unit. Consequently, when the treatment tool is moved in the axial direction, the endoscope is moved in the axial direction in interlock with the movement. Because the outer tube is configured such that the endoscope exit port has an inner diameter that is smaller than the inner diameter of the elastic member provided to hold the endoscope at the endoscope holding part, the strength of the endoscope can be secured while preventing interference with the treatment tool.

Claims

1. A surgical device comprising: a first medical instrument that includes an insertion part; a second medical instrument that includes an insertion part; and an outer tube into which the insertion part of the first medical instrument and the insertion part of the second medical instrument are inserted, and is configured to guide the insertion part of the first medical instrument and the insertion part of the second medical instrument into a body cavity, wherein the outer tube comprises: a cylindrical outer tube body into which the insertion part of the first medical instrument and the insertion part of the second medical instrument are inserted; a first entry port provided at a proximal end part of the outer tube body; a second entry port provided at the proximal end part of the outer tube body; a first exit port provided at a distal end part of the outer tube body; a second exit port provided at the distal end part of the outer tube body; a movable object which is arranged in the outer tube body and is configured to be movable in the outer tube body in an axial direction; a first holding part which is provided at the movable object and configured to hold the insertion part of the first medical instrument inserted into the outer tube body; and a second holding part which is provided at the movable object and configured to hold the insertion part of the second medical instrument inserted into the outer tube body, wherein the first holding part includes a first annular elastic member through which the insertion part of the first medical instrument is inserted, and the second holding part includes a second annular elastic member through which the insertion part of the second medical instrument is inserted, wherein the first and second entry and exit ports are within the outer tube body, and the first medical instrument passes through the first entry and exit ports, while the second medical instrument passes through the second entry and exit ports, wherein the insertion part of the first medical instrument comprises: a part which is to be held by the first holding part and has a first diameter A1; and a part which is disposed closer to a distal end than the part having the first diameter A1, and is configured to be delivered to protrude out of the first exit port, and has a second diameter A2 smaller than the first diameter A1.

2. The surgical device according to claim 1, wherein the insertion part of the second medical instrument comprises: a part which is to be held by the second holding part and has a first diameter B1; and a part which is disposed closer to a distal end than the part having the first diameter B1, and is configured to be delivered to protrude out of the second exit port, and has a second diameter B2 smaller than the first diameter B1.

3. The surgical device according to claim 2, wherein the outer tube further includes a second sealing member which is provided at the second entry port and configured to slidably seal the insertion part of the second medical instrument, and the insertion part of the second medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter B1, and is configured to maintain hermeticity with the second sealing member, and has a third diameter B3 larger than the first diameter B1.

4. The surgical device according to claim 2, wherein the outer tube further includes a second sealing member which is provided at the second entry port and configured to slidably seal the insertion part of the second medical instrument, and the insertion part of the second medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter B1, and is configured to maintain hermeticity with the second sealing member, and has a third diameter B3 smaller than the first diameter B1.

5. The surgical device according to claim 1, wherein the first medical instrument is an endoscope.

6. The surgical device according to claim 1, wherein the first holding part includes an annular elastic member through which the insertion part of the first medical instrument is inserted, and which is configured to hold the insertion part of the first medical instrument by means of an elastic force, and the first exit port has an inner diameter smaller than an inner diameter of the elastic member.

7. The surgical device according to claim 1, wherein the movable object comprises: a movable object main body configured to be movable with respect to the outer tube body in the axial direction; and a movable part configured to be movable with respect to the movable object main body in the axial direction, and one of the first holding part and the second holding part is provided in the movable part, and another one of the first holding part and the second holding part is provided in the movable object main body.

8. The surgical device according to claim 1, wherein the outer tube further includes a first sealing member which is provided at the first entry port and configured to slidably seal the insertion part of the first medical instrument, and the insertion part of the first medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter A1, and is configured to maintain hermeticity with the first sealing member, and has a third diameter A3 smaller than the first diameter A1.

9. The surgical device according to claim 1, wherein the outer tube further includes a first sealing member which is provided at the first entry port and configured to slidably seal the insertion part of the first medical instrument, and the insertion part of the first medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter A1, and is configured to maintain hermeticity with the first sealing member, and has a third diameter A3 larger than the first diameter A1.

10. An outer tube adapted to guide an insertion part of a first medical instrument and an insertion part of a second medical instrument into a body cavity, the outer tube comprising: a cylindrical outer tube body into which the insertion part of the first medical instrument and the insertion part of the second medical instrument are configured to be inserted; a first entry port provided at a proximal end part of the outer tube body; a second entry port provided at the proximal end part of the outer tube body; a first exit port provided at a distal end part of the outer tube body; a second exit port provided at the distal end part of the outer tube body; a movable object which is arranged in the outer tube body and is configured to be movable in the outer tube body in an axial direction; a first holding part which is provided at the movable object and configured to hold the insertion part of the first medical instrument inserted into the outer tube body; and a second holding part which is provided at the movable object and configured to hold the insertion part of the second medical instrument inserted into the outer tube body, wherein the first holding part includes a first annular elastic member through which the insertion part of the first medical instrument is inserted, and the second holding part includes a second annular elastic member through which the insertion part of the second medical instrument is inserted, wherein the first and second entry and exit ports are within the outer tube body, and the first medical instrument passes through the first entry and exit ports, while the second medical instrument passes through the second entry and exit ports, wherein the insertion part of the first medical instrument comprises: a part which is to be held by the first holding part and has a first diameter A1; and a part which is disposed closer to a distal end than the part having the first diameter A1, and is configured to be delivered to protrude out of the first exit port, and has a second diameter A2 smaller than the first diameter A1.

11. The outer tube according to claim 10, wherein the insertion part of the second medical instrument comprises: a part which is to be held by the second holding part and has a first diameter B1; and a part which is disposed closer to a distal end side than the part having the first diameter B1, and is delivered to protrude out of the second exit port, and has a second diameter B2 smaller than the first diameter B1.

12. The outer tube according to claim 11, further comprising a second sealing member which is provided at the second entry port, and is configured to slidably seal the insertion part of the second medical instrument, wherein the insertion part of the second medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter B1, and is configured to maintain hermeticity with the second sealing member, and has a third diameter B3 smaller than the first diameter B1.

13. The outer tube according to claim 11, further comprising a second sealing member which is provided at the second entry port, and is configured to slidably seal the insertion part of the second medical instrument, wherein the insertion part of the second medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter B1, and is configured to maintain hermeticity with the second sealing member, and has a third diameter B3 larger than the first diameter B1.

14. The outer tube according to claim 10, wherein the movable object comprises: a movable object main body configured to be movable with respect to the outer tube body in the axial direction; and a movable part configured to be movable with respect to the movable object main body in the axial direction, and one of the first holding part and the second holding part is provided in the movable part, and another one of the first holding part and the second holding part is provided in the movable object main body.

15. The outer tube according to claim 10, further comprising a first sealing member which is provided at the first entry port, and is configured to slidably seal the insertion part of the first medical instrument, wherein the insertion part of the first medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter A1, and is configured to maintain hermeticity with the first sealing member, and has a third diameter A3 smaller than the first diameter A1.

16. The outer tube according to claim 10, further comprising a first sealing member which is provided at the first entry port, and is configured to slidably seal the insertion part of the first medical instrument, wherein the insertion part of the first medical instrument further includes a part which is disposed closer to a proximal end than the part having the first diameter A1, and is configured to maintain hermeticity with the first sealing member, and has a third diameter A3 larger than the first diameter A1.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 is a schematic configuration diagram of an endoscopic surgical device.

(2) FIG. 2 is a schematic configuration diagram of an endoscope system.

(3) FIG. 3 is a sectional view showing a schematic configuration of the inside of a distal end part of an insertion part of an endoscope.

(4) FIG. 4 is a schematic configuration diagram showing an example of a needle light.

(5) FIG. 5 is a schematic configuration diagram showing an example of a treatment tool.

(6) FIG. 6 is a side sectional view of an outer tube.

(7) FIG. 7 is a front view of the outer tube.

(8) FIG. 8 is a rear view of the outer tube.

(9) FIG. 9 is an enlarged sectional view of a proximal end part of the outer tube.

(10) FIG. 10 is an enlarged sectional view of a distal end part of the outer tube.

(11) FIG. 11 is a sectional view taken along 11-11 of FIG. 9.

(12) FIG. 12 is an exploded perspective view showing a schematic configuration of a valve member.

(13) FIG. 13 is a side sectional view of the valve member.

(14) FIG. 14 is a schematic diagram showing an example of an operation method using the endoscopic surgical device.

(15) FIG. 15 is a side sectional view of an outer tube of a second embodiment.

(16) FIG. 16 is an enlarged sectional view of a proximal end part of the outer tube of the second embodiment.

(17) FIG. 17 is a sectional view taken along 17-17 of FIG. 16.

(18) FIG. 18 is a side sectional view of an outer tube of another embodiment.

(19) FIG. 19 is an enlarged sectional view of the proximal end parts of an outer tube, an endoscope and a treatment tool of another embodiment.

(20) FIG. 20 is an enlarged sectional view of the proximal end parts of an outer tube, an endoscope and a treatment tool of another embodiment.

(21) FIG. 21 is an enlarged sectional view of the proximal end parts of an outer tube, an endoscope and a treatment tool of another embodiment.

(22) FIG. 22 is a schematic configuration diagram of a main part of an endoscope of another embodiment.

DETAILED DESCRIPTION OF THE EMBODIMENTS

(23) Hereinafter, preferred embodiments of the present invention are described with reference to the accompanying drawings.

(24) <<Configuration of Endoscopic Surgical Device>>

(25) FIG. 1 is a schematic configuration diagram of an endoscopic surgical device.

(26) The endoscopic surgical device 1 as a surgical device is configured to include: an endoscope 10 that is to be inserted into a body cavity of a patient and is for observing the inside of the body cavity; a treatment tool 60 that is to be inserted into the body cavity of the patient and is for performing necessary treatment; and an outer tube 100 for guiding the endoscope 10 and the treatment tool 60 into the body cavity of the patient.

(27) <Endoscope>

(28) FIG. 2 is a schematic configuration diagram of an endoscope system.

(29) The endoscope 10 as a medical instrument is an electronic endoscope, and configures the endoscope system together with a processor device 30, and a monitor 32.

(30) The endoscope 10 used in the endoscopic surgical device 1 of this embodiment is a rigid endoscope, such as a laparoscope. The endoscope 10 includes a linear-rod-shaped insertion part 12.

(31) The insertion part 12 includes an observation window 14 (see FIG. 3) at its distal end. The endoscope 10 allows observation in the body cavity through the observation window 14 at a distal end of the insertion part 12.

(32) FIG. 3 is a sectional view showing a schematic configuration of the inside of a distal end part of the insertion part of the endoscope.

(33) As shown in FIG. 3, the insertion part 12 internally includes an imaging device 20, which is imaging means, at the distal end part. An image observed through the observation window 14 is taken by the imaging device 20.

(34) The imaging device 20 is configured to include a lens group 22, a prism 24, an image pickup element 26 (CCD (Charge Coupled Device), a CMOS (Complementary Metal Oxide Semiconductor), etc.) and the like.

(35) Subject light entering from the observation window 14 passes through the lens group 22, is subsequently reflected by the prism 24 at a substantially right angle, and is incident on the light receiving surface of the image pickup element 26. Consequently, an image observed through the observation window 14 is taken by the image pickup element 26.

(36) Various signal lines 28 connected to the imaging device 20 are arranged inside the insertion part 12, and extracted from a proximal end part of the insertion part 12 through a cable 16 for the endoscope.

(37) The processor device 30 is a device that integrally controls the entire endoscope system. The processor device 30 is connected to the endoscope 10 through the cable 16 for the endoscope extending from the proximal end of the insertion part 12. This device is also connected to the monitor 32 through a cable 34 for the monitor.

(38) Electric power and control signals for operating the imaging device 20 are transmitted from the processor device 30 to the endoscope 10. On the other hand, an image signal output from the imaging device 20 is transmitted from the endoscope 10 to the processor device 30.

(39) The processor device 30 processes the image signal obtained from the endoscope 10, and outputs the processed signal to the monitor 32. Consequently, the image of the inside of the body cavity observed through the observation window 14 of the endoscope 10 is displayed on the monitor 32.

(40) Note that the endoscope 10 of this example includes no illumination means. Illumination is provided through another piece of means, for example a needle light. Omission of the illumination means that is to be embedded in the endoscope allows the diameter of the insertion part of the endoscope to be narrowed. Consequently, the diameter of the outer tube 100 can also be narrowed, and the invasiveness applied to a body wall of the patient can be reduced.

(41) The endoscope 10 of this example has the configuration including the imaging device 20 at the distal end part of the insertion part 12. Alternatively, a configuration that includes the imaging device 20 at the proximal end part of the insertion part 12 may be adopted. That is, a configuration where an image observed through the observation window 14 is transmitted by a relay lens and the like and taken by the imaging device provided at the proximal end part of the insertion part 12 may be adopted.

(42) The endoscope 10 requires use of the outer tube 100 as a precondition. Consequently, the external shape of the endoscope is made suitable for the structure of the outer tube 100. In particular, the endoscope 10 of this embodiment is configured to have an outer diameter with two steps, and the distal end part (the part (part having a second diameter A2) to be delivered to protrude out of the outer tube 100) is narrowed so as not to interfere with the treatment tool 60. This point will be described later in detail.

(43) <Needle Light>

(44) FIG. 4 is a schematic configuration diagram showing an example of a needle light.

(45) The needle light 40 as a medical instrument is inserted into the body cavity of the patient and illuminates the body cavity with illumination light.

(46) The needle light 40 includes a linear-rod-shaped insertion part 42. An illumination window (not shown) is provided at the distal end of the insertion part 42. Through the illumination window, the illumination light is emitted in the axial direction. An optical fiber bundle that transmits illumination light emitted from the illumination window is contained inside the insertion part 42.

(47) A connection part 44 is provided at the proximal end of the needle light 40. A flexible cable 46 for the needle light is connected to the connection part 44. A light source device 48 is connected through this cable 46 for the needle light. The illumination light caused to be emitted through the illumination window is supplied from the light source device 48. The light source device 48 is connected to the processor device 30 through a cable. The light intensity and the like are thus controlled.

(48) As an example, the needle light 40 is inserted into the body cavity through an outer tube 50 for the needle light.

(49) <Treatment Tool>

(50) FIG. 5 is a schematic configuration diagram showing an example of the treatment tool.

(51) The treatment tool 60 as a medical instrument includes: a linear-rod-shaped insertion part 62 that is inserted into the body cavity; a treatment part 64 that is arranged at the proximal end of the insertion part 62; and a handle part (operation part) 66 that is arranged at the distal end of the insertion part 62. The treatment part 64 shown in FIG. 5 has a structure of scissors. The treatment part 64 is operated to open and close by an open and close operation of the handle part 66.

(52) Note that the treatment tool 60 is not limited to this example. Alternatively, forceps, a laser probe, a suture instrument, an electric scalpel, a needle holder, an ultrasonic aspirator or the like may be used as the treatment tool.

(53) <Outer Tube>

(54) The body cavity wall of the patient is punctured with the outer tube 100. The endoscope 10 and the treatment tool 60 are inserted along the inner circumference part of the outer tube, which allows the endoscope 10 and the treatment tool 60 to be guided into the body cavity of the patient.

(55) FIG. 6 is a side sectional view of the outer tube. FIG. 7 is a front view of the outer tube. FIG. 8 is a rear view of the outer tube. FIG. 9 is an enlarged sectional view of a proximal end part of the outer tube. FIG. 10 is an enlarged sectional view of a distal end part of the outer tube. FIG. 11 is a sectional view taken along 11-11 of FIG. 9.

(56) The outer tube 100 includes a cylindrical outer tube body 102. The outer tube body 102 has a cylindrical shape, and the proximal end part is formed to have a flange shape with an enlarged diameter.

(57) A proximal end cap 104 is attached to the proximal end part of the outer tube body 102. An opening part of the outer tube body 102 at the proximal end is blocked with the proximal end cap 104. A distal end cap 106 is attached to the distal end part of the outer tube body 102. An opening part of the outer tube body 102 at the distal end is blocked with the distal end cap 106.

(58) As shown in FIG. 8, the proximal end cap 104 is provided with an endoscope entry port 110 as a first entry port for allowing the insertion part 12 of the endoscope 10 to be inserted into the outer tube body 102, and a treatment tool entry port 108 as a second entry port for allowing the insertion part 62 of the treatment tool 60 to be inserted into the outer tube body 102.

(59) The treatment tool entry port 108 has a circular shape, and is formed to have a size allowing the insertion part 62 of the treatment tool 60 to be inserted through the port. That is, the port is formed to have a size which makes the thickest portion of the insertion part 62 of the treatment tool 60 to be inserted into the outer tube 100 insertable into the port.

(60) The endoscope entry port 110 has a circular shape, and is formed to have a size allowing the insertion part 12 of the endoscope 10 to be inserted through the port. That is, the port is formed to have a size which makes the thickest portion of the insertion part 12 of the endoscope 10 to be inserted into the outer tube 100 insertable into the port.

(61) As shown in FIG. 6, the distal end cap 106 is provided with an endoscope exit port 116 as a first exit port from which the insertion part 12 of the endoscope 10 inserted from the endoscope entry port 110 into the outer tube body 102 is delivered to protrude, and a treatment tool exit port 114 as a second exit port from which the insertion part 62 of the treatment tool 60 inserted into the outer tube body 102 is delivered to protrude.

(62) The treatment tool exit port 114 has a circular shape, and is formed to have a size allowing the distal end part of the insertion part 62 of the treatment tool 60 to be inserted into the port. Preferably, the treatment tool exit port 114 has a diameter substantially identical to the outer diameter of the distal end part of the insertion part 62 of the treatment tool 60.

(63) The endoscope exit port 116 has a circular shape in conformity with the distal end part of the insertion part 12 of the endoscope 10, and is formed to have a size allowing the distal end part of the insertion part 12 of the endoscope 10 to be inserted into the port. In particular, in the outer tube 100 of this embodiment, the endoscope exit port 116 has an inner diameter that is substantially identical to an outer diameter of the distal end part of the insertion part 12 of the endoscope 10, and is configured to allow the distal end part of the insertion part 12 of the endoscope 10 to be inserted with substantially no gap.

(64) Here, as described above, in the endoscope 10 of this embodiment, the distal end part of the insertion part 12 is narrowed. This configuration is for preventing the part from interfering with the treatment tool 60 when the part is delivered to protrude out of the endoscope exit port 116. Thus, in the endoscope 10, at least the part to be delivered to protrude out of the endoscope exit port 116 (the part having the second diameter A2) is narrowed.

(65) The endoscope exit port 116 is formed in conformity with the outer diameter of the narrowed distal end part of the insertion part 12 of the endoscope 10. That is, the endoscope exit port 116 is configured so that the narrowed distal end part is insertable thereinto with substantially no gap. Consequently, the inner diameter ID0 of the endoscope exit port 116 is formed to be slightly larger than the outer diameter OD0 (second diameter A2) of the distal end part (the part (the part having the second diameter A2) to be delivered to protrude out of the endoscope exit port 116) of the insertion part 12 of the endoscope 10.

(66) The treatment tool entry port 108 and the treatment tool exit port 114 are coaxially arranged, and arranged on an axis parallel to the axis of the outer tube body 102. Consequently, the treatment tool 60 inserted through the treatment tool entry port 108 is delivered along the axis of the outer tube body 102 and protrudes out of the treatment tool exit port 114.

(67) The endoscope entry port 110 and the endoscope exit port 116 are coaxially arranged, and arranged on an axis parallel to the axis of the outer tube body 102. Consequently, the endoscope 10 inserted through the endoscope entry port 110 is delivered along the axis of the outer tube body 102 and protrudes out of the endoscope exit port 116.

(68) The proximal end cap 104 is provided with a valve member 120. The valve member 120 seals the treatment tool entry port 108 and the endoscope entry port 110.

(69) FIG. 12 is an exploded perspective view showing a schematic configuration of the valve member. FIG. 13 is a side sectional view of the valve member.

(70) The valve member 120 is configured to include a first valve body 122, an intermediate member 124, and a second valve body 126.

(71) The first valve body 122, the intermediate member 124 and the second valve body 126 are circular plate members (disk-shaped members) having the same outer diameter, and coaxially overlaid so as to be integrated, thus configuring the valve member 120.

(72) The first valve body 122 and the second valve body 126 are made of an elastic material, such as natural rubber, synthetic rubber, or silicone rubber, and formed to be elastically deformable.

(73) The intermediate member 124 is made of a material having stiffness, which is metal, such as stainless steel or aluminum, or rigid plastic or the like. The intermediate member 124 plays a role of reinforcing the first valve body 122 and the second valve body 126 which are overlaid on the front and rear of this member 124.

(74) The intermediate member 124 has a treatment tool insertion hole 128 into which the insertion part 62 of the treatment tool 60 is inserted, and an endoscope insertion hole 130 into which the insertion part 12 of the endoscope 10 is inserted.

(75) The treatment tool insertion hole 128 has a circular shape, and is formed to have a size allowing the insertion part 62 of the treatment tool 60 to be inserted into this hole. That is, this hole is formed to have a size which makes the thickest portion of the insertion part 62 of the treatment tool 60 to be inserted into the outer tube 100 insertable into the port.

(76) The endoscope insertion hole 130 has a circular shape, is formed to have a size allowing the insertion part 12 of the endoscope 10 to be inserted into this hole. That is, this hole is formed to have a size which makes the thickest portion of the insertion part 12 of the endoscope 10 to be inserted into the outer tube 100 insertable into the port.

(77) The treatment tool insertion hole 128 is arranged coaxially with the treatment tool entry port 108. The endoscope insertion hole 130 is arranged coaxially with the endoscope entry port 110. Consequently, when the insertion part 62 of the treatment tool 60 is inserted through the treatment tool entry port 108, the insertion part 62 of the treatment tool 60 is, in turn, inserted into the treatment tool insertion hole 128. When the insertion part 12 of the endoscope 10 is inserted through the endoscope entry port 110, the insertion part 12 of the endoscope 10 is, in turn, inserted into the endoscope insertion hole 130.

(78) The first valve body 122 arranged on the proximal end side is provided with an opening type hermetic valve part 132 for the treatment tool, and a slit type hermetic valve part 134 for the endoscope.

(79) The opening type hermetic valve part 132 for the treatment tool is formed as a circular opening in the first valve body 122. The opening type hermetic valve part 132 for the treatment tool functions as a sealing member (treatment tool sealing member) that seals a gap formed between the insertion part 62 of the treatment tool 60 and the treatment tool entry port 108 when the insertion part 62 of the treatment tool 60 is inserted into the outer tube 100. The opening type hermetic valve part 132 for the treatment tool is arranged coaxially with the treatment tool insertion hole 128. This portion is formed to have an inner diameter ID1 that is slightly smaller than the outer diameter (the outer diameter of a part in contact with the opening type hermetic valve part 132 for the treatment tool) OD1 of the insertion part 62 of the treatment tool 60. Consequently, when the insertion part 62 of the treatment tool 60 is fitted into the opening type hermetic valve part 132 for the treatment tool, the inner peripheral surface of the opening is brought into close contact with the outer peripheral surface of the insertion part 62 of the treatment tool 60. Consequently, when the insertion part 62 of the treatment tool 60 is inserted into the outer tube 100, the gap formed between the insertion part 62 of the treatment tool 60 and the treatment tool entry port 108 is sealed.

(80) The slit type hermetic valve part 134 for the endoscope is formed as a single linear slit with a predetermined length in the first valve body 122. After the insertion part 12 of the endoscope 10 is extracted out of the outer tube 100, the slit type hermetic valve part 134 for the endoscope blocks the endoscope entry port 110.

(81) The second valve body 126, which is arranged on the distal end side, is provided with an opening type hermetic valve part 138 for the endoscope, and a slit type hermetic valve part 136 for the treatment tool.

(82) The opening type hermetic valve part 138 for the endoscope is formed as a circular opening in the second valve body 126. When the insertion part 12 of the endoscope 10 is inserted into the outer tube 100, the opening type hermetic valve part 138 for the endoscope functions as a sealing member (endoscope sealing member) that seals the gap formed between the insertion part 12 of the endoscope 10 and the endoscope entry port 110. The opening type hermetic valve part 138 for the endoscope is arranged coaxially with the endoscope insertion hole 130. This opening type hermetic valve part 138 is formed to have an inner diameter ID2 that is slightly smaller than the outer diameter OD2 of the insertion part 12 of the endoscope 10. Consequently, when the insertion part 12 of the endoscope 10 is fitted into the opening type hermetic valve part 138 for the endoscope, the inner peripheral surface of the opening is brought into close contact with the outer peripheral surface of the insertion part 12 of the endoscope 10. Consequently, when the insertion part 12 of the endoscope 10 is inserted into the outer tube 100, the gap formed between the insertion part 12 of the endoscope 10 and the endoscope entry port 110 is sealed.

(83) The slit type hermetic valve part 136 for the treatment tool is formed as a single linear slit with a predetermined length in the second valve body 126. After the insertion part 62 of the treatment tool 60 is extracted out of the outer tube 100, the slit type hermetic valve part 136 for the treatment tool, which is formed as the slit, blocks the treatment tool entry port 108.

(84) According to the valve member 120 configured as described above, after the insertion part 62 of the treatment tool 60 and the insertion part 12 of the endoscope 10 are inserted into the outer tube 100, the hermeticity of the outer tube 100 is secured by the opening type hermetic valve part 132 for the treatment tool and the opening type hermetic valve part 138 for the endoscope. When the insertion part 62 of the treatment tool 60 and the insertion part 12 of the endoscope 10 are not inserted into the outer tube 100, the hermeticity of the outer tube 100 is secured by the slit type hermetic valve part 136 for the treatment tool and the slit type hermetic valve part 134 for the endoscope.

(85) Inside the outer tube body 102, a slider (movable object) 140 that is movable in a direction parallel to the axis of the outer tube body 102 is provided.

(86) The slider 140 is configured as a block that is movable in the outer tube body 102. In this embodiment, the slider is configured as a cylindrical block.

(87) The slider 140 is configured to be movable inside the outer tube body 102 along the axis of the outer tube body 102 guided by a pair of slider guide shafts 142. The slider guide shafts 142 are each formed into a linear rod shape, and are arranged parallel to each other along the axis of the outer tube body 102. The slider guide shafts 142 are each supported by the proximal end cap 104 at the proximal end, and supported by the distal end cap 106 at the distal end, and are arranged in parallel to the axis of the outer tube body 102.

(88) The slider 140 is provided with a pair of slider guide holes 144 into which the pair of slider guide shafts 142 can be inserted. In the pair of slider guide holes 144, the slider guide holes 144 are arranged so that the interval therebetween becomes the same as the arrangement interval of the pair of slider guide shafts 142, and are arranged in parallel to each other. The slider guide shafts 142 are inserted into the respective slider guide holes 144, thereby allowing the slider 140 to be slidably supported by the slider guide shafts 142.

(89) The slider 140 is provided with an endoscope holding part (first holding part) 148 that holds the insertion part 12 of the endoscope 10 inserted into the outer tube body 102, and a treatment tool holding part (second holding part) 146 that holds the insertion part 62 of the treatment tool 60 inserted into the outer tube body 102.

(90) The treatment tool holding part 146 includes a treatment tool holding hole 150 through which the insertion part 62 of the treatment tool 60 is inserted, and a cylindrical (annular) elastic member 152 that is arranged in the treatment tool holding hole 150.

(91) The treatment tool holding hole 150 is formed to penetrate through the slider 140, and formed in parallel to the axis of the outer tube body 102. The treatment tool holding hole 150 is provided for the slider 140 so as to be arranged coaxially with the treatment tool entry port 108 and the treatment tool exit port 114.

(92) The cylindrical elastic member 152 is coaxially fixed and attached to the inner circumference part of the treatment tool holding hole 150. The cylindrical elastic member 152 is formed to have an inner diameter ID3 that is slightly smaller than the outer diameter (the outer diameter of a part held by the treatment tool holding part 146) OD3 of the insertion part 62 of the treatment tool 60.

(93) In the treatment tool 60 of this embodiment, the insertion part 62 has the constant outer diameter. Consequently, the outer diameter OD3 of the part held by the treatment tool holding part 146 is the same as the outer diameter OD1 of the part which is in contact with the opening type hermetic valve part 132 for the treatment tool (OD1=OD3). Accordingly, the inner diameter ID3 of the elastic member 152 is identical to or substantially identical to the inner diameter ID1 of the opening type hermetic valve part 132 for the treatment tool (ID1=ID3).

(94) The insertion part 62 of the treatment tool 60, which is inserted from the treatment tool entry port 108 into the outer tube body 102, passes through the treatment tool holding hole 150 and is delivered to protrude out of the treatment tool exit port 114. When the insertion part 62 of the treatment tool 60 passes through the treatment tool holding hole 150, this part passes through the elastic member 152. As described above, the elastic member 152 is formed to have the inner diameter that is slightly smaller than the outer diameter (the outer diameter of the part held by the treatment tool holding part 146) of the insertion part 62 of the treatment tool 60. Consequently, when the insertion part 62 of the treatment tool 60 passes through the treatment tool holding hole 150, this part is held by the treatment tool holding hole 150 by means of the elastic force of the elastic member 152.

(95) Note that the portion is thus held by means of the elastic force of the elastic member 152. Consequently, the holding position of the treatment tool 60 can be arbitrarily adjusted with respect to the slider 140.

(96) The treatment tool 60 is held by the elastic force of the elastic member 152. However, the frictional force between the elastic member 152 and the insertion part 62 of the treatment tool 60 is configured to be higher than the frictional force between the slider guide shaft 142 and the slider guide hole 144 (=the frictional force between the outer tube body 102 and the slider 140). Consequently, when the treatment tool 60 is moved in the axial direction, the slider 140 and the treatment tool 60 are integrally moved with respect to the outer tube body 102.

(97) The endoscope holding part 148 includes an endoscope holding hole 154 through which the insertion part 12 of the endoscope 10 is inserted, and a cylindrical (annular) elastic member 156 that is arranged in the endoscope holding hole 154.

(98) The endoscope holding hole 154 is formed to penetrate through the slider 140, and formed in parallel to the axis of the outer tube body 102. The endoscope holding hole 154 is provided for the slider 140 so as to be arranged coaxially with the endoscope entry port 110 and the endoscope exit port 116.

(99) The cylindrical elastic member 156 is coaxially fixed and attached to the inner circumference part of the endoscope holding hole 154. The cylindrical elastic member 156 is formed to have an inner diameter ID4 that is slightly smaller than the outer diameter OD4 of the insertion part 12 of the endoscope 10.

(100) Note that the outer diameter OD4 (first diameter A1) of the insertion part 12 of the endoscope 10 is the outer diameter of the part having an enlarged diameter on the proximal end part side. That is, the endoscope 10 is held by the endoscope holding part 148 at the part having the enlarged diameter on the proximal end part side. Consequently, the strength of the insertion part 12 of the endoscope 10 can be secured, and the durability can be improved.

(101) The part (the part having the second diameter) (narrowed-diameter part) having a narrowed diameter of the endoscope 10 is a part to be delivered to protrude out of the endoscope exit port 116 of the outer tube 100 when the endoscope 10 is inserted into the outer tube 100 and used. If the holding position of the endoscope 10 by means of the endoscope holding part 148 is made adjustable, the narrowed-diameter part is configured in consideration of the adjustment margin.

(102) As a result, the insertion part 12 of the endoscope 10 is configured to have an external shape in which the distal end part has a narrowed diameter.

(103) The outer tube 100 is configured in conformity with the external shape of the insertion part 12 of the endoscope 10 such that the endoscope exit port 116 is formed to have the inner diameter ID0 that is smaller than the inner diameter ID4 of the annular elastic member 156 provided at the endoscope holding part 148.

(104) In the endoscope 10 of this embodiment, only the distal end part of the insertion part 12 is narrowed. Accordingly, the outer diameter OD4 of the part held by the endoscope holding part 148 is the same as the outer diameter OD2 of the part to be in contact with the opening type hermetic valve part 138 for the endoscope (OD2=OD4). Consequently, the inner diameter ID4 of the elastic member 156 is also identical to or substantially identical to the inner diameter ID2 of the opening type hermetic valve part 138 for the endoscope.

(105) The insertion part 12 of the endoscope 10 inserted from the endoscope entry port 110 into the outer tube body 102 passes through the endoscope holding hole 154, and is delivered to protrude out of the endoscope exit port 116. When the endoscope 10 passes through the endoscope holding hole 154, this endoscope passes through the elastic member 156. As described above, the elastic member 156 is formed to have the inner diameter that is slightly smaller than the outer diameter of the insertion part 12 of the endoscope 10. Consequently, after the insertion part 12 of the endoscope 10 passes through the endoscope holding hole 154, the insertion part 12 is held by the endoscope holding hole 154 by means of the elastic force of the elastic member 156.

(106) Note that the endoscope 10 is thus held by means of the elastic force of the elastic member 156. Consequently, the holding position of the endoscope 10 can be arbitrarily adjusted with respect to the slider 140.

(107) The endoscope 10 is held by the elastic force of the elastic member 156. However, the frictional force between the elastic member 156 and the insertion part 12 of the endoscope 10 is configured to be higher than the frictional force between the slider guide shaft 142 and the slider guide hole 144 (=the frictional force between the outer tube body 102 and the slider 140). Consequently, when the endoscope 10 is moved in the axial direction, the slider 140 and the endoscope 10 are integrally moved with respect to the outer tube body 102.

(108) <<Operation of Endoscopic Surgical Device>>

(109) First, the insertion part 12 of the endoscope 10 is inserted from the endoscope entry port 110. The insertion part 12 inserted into the endoscope entry port 110 passes through the outer tube body 102, and delivered to protrude out of the endoscope exit port 116. In this case, the insertion part 12 passes through the endoscope holding hole 154 provided in the slider 140 in the outer tube body 102, and is delivered to protrude out of the endoscope exit port 116. The endoscope holding hole 154 is provided with the elastic member 156. The insertion part 12 passing through the endoscope holding hole 154 is held by the slider 140 by means of the elastic force of the elastic member 156.

(110) Next, the insertion part 62 of the treatment tool 60 is inserted from the treatment tool entry port 108. The insertion part 62 inserted into the treatment tool entry port 108 passes through the outer tube body 102, and is delivered to protrude out of the treatment tool exit port 114. In this case, the insertion part 62 passes through the treatment tool holding hole 150 provided in the slider 140 in the outer tube body 102, and is delivered to protrude out of the treatment tool exit port 114. The treatment tool holding hole 150 is provided with the elastic member 152. The insertion part 62 passing through the treatment tool holding hole 150 is held by the slider 140 by means of the elastic force of the elastic member 152.

(111) Both the insertion part 12 of the endoscope 10 inserted into the outer tube 100 and the insertion part 62 of the treatment tool 60 are held by the slider 140. Consequently, when the treatment tool 60 is moved in the axial direction, the endoscope 10 is moved in the axial direction in interlock with the movement.

(112) As described above, the endoscopic surgical device 1 of this embodiment can move the endoscope 10 in interlock with the treatment tool 60. Consequently, the visual field (imaging region) of the endoscope 10 can be caused to follow the treatment portion, and an image optimal to treatment can be always provided for the operator.

(113) Note that the movement (to-and-fro movement) in the forward and rear direction of the endoscope visual field is performed by the movement in the axial direction of the treatment tool 60. Meanwhile, the movement in the vertical and horizontal directions is performed by the inclination movement of the treatment tool 60. That is, all the parts including the outer tube 100 are inclined to move the visual field.

(114) Typically, laparoscopic surgery is performed by supplying gas into the abdominal cavity to expand the abdominal cavity. However, the outer tube 100 is provided with the valve member 120. Consequently, the hermeticity can be secured.

(115) Furthermore, because the distal end part of the endoscope 10 that is to be delivered to protrude out of the endoscope exit port 116 is narrowed, even if the outer tube 100 is narrowed, the endoscope can be used without interference with the treatment tool 60. That is, in order to perform a low-invasive operation, the endoscope 10 and the treatment tool 60 should be arranged as close as possible and the diameter of the outer tube 100 is required to be reduced. However, too close arrangement of both the elements causes situations where the visual field of the endoscope 10 is blocked by the treatment tool 60 and reduced, or the treatment portion 64 of the treatment tool 60 is brought into contact with the endoscope 10. However, as with this embodiment, the distance between the centers of axes of both the elements can be secured by narrowing the diameter of the distal end of the endoscope 10. Consequently, reduction in the visual field of the endoscope 10 and contact with the treatment portion 64 can be prevented.

(116) On the other hand, reduction in the diameter of the insertion part 12 of the endoscope 10 reduces the strength of the insertion part 12. However, in this embodiment, only the distal end is narrowly formed, but the holding part (the part held by the endoscope holding part 148) that requires strength is formed to have a large diameter. Consequently, sufficient strength can be secured. Therefore, durability can be secured.

(117) Since the endoscope 10 has the narrowed distal end part of the insertion part 12, the sliding friction applied from the valve member 120 during insertion into and extraction from the outer tube 100 can be eliminated at the distal end part. Accordingly, insertion and extraction can be smoothly performed without unnecessary force.

(118) <<Example of Use of Endoscopic Surgical Device>>

(119) FIG. 14 is a schematic diagram showing an example of an operation method using the endoscopic surgical device.

(120) This example indicates an example of the case where a single operator performs treatment.

(121) The endoscope 10 and the treatment tool 60 are inserted into the body cavity 3 through the outer tube 100 that is punctured into the body cavity wall 2 of the patient. The endoscope 10 moves in interlock with the movement of the treatment tool 60. Consequently, the video image of the treatment portion is always displayed on the monitor 32, and the movement of the treatment tool 60 can, in turn, move the visual field.

(122) The endoscope 10 is provided with no illumination means. Consequently, the needle light 40 is used as the illumination means. The needle light 40 is inserted into the body cavity 3 through the outer tube 50 for the needle light. The body cavity 3 is illuminated with illumination light emitted from the distal end of the needle light 40. This example exemplifies the case of using the single needle light 40. Alternatively, multiple needle lights 40 may be used as necessary.

(123) According to the endoscopic surgical device 1 of this embodiment, the operation of the treatment tool 60 also operates the endoscope 10. Consequently, treatment can be performed by a single operator. That is, laparoscopist is unnecessary.

(124) Furthermore, the endoscope 10 and the treatment tool 60 are inserted into the body cavity 3 through the outer tube 100. Consequently, only one site to be punctured is required to allow the endoscope 10 and the treatment tool 60 to be inserted into the body cavity. Therefore, a low-invasive operation can be performed.

(125) <<Second Embodiment of Outer Tube>>

(126) FIG. 15 is a side sectional view of an outer tube of a second embodiment. FIG. 16 is an enlarged sectional view of a proximal end part of the outer tube of the second embodiment. FIG. 17 is a sectional view taken along 17-17 of FIG. 16.

(127) The outer tube 200 of this embodiment is different from the outer tube 100 of the embodiment described above in that a slider 210 arranged inside an outer tube body includes a movable part. Except for the difference in the configuration of the slider 210, the configuration is the same as the configuration of the outer tube 100 of the embodiment described above. Consequently, only the configuration of the slider 210 is herein described (the same signs are assigned to other configurations, and the explanation about them is omitted).

(128) <Configuration>

(129) The slider 210 is configured to include a slider body (movable object main body) 212, and a sleeve (movable part) 214 that is configured to be movable in the axial direction with respect to the slider body.

(130) The slider body 212 is configured as a block that is movable in the outer tube body 102. In this embodiment, this body is configured as a cylindrical block.

(131) The slider body 212 is configured to be movable inside the outer tube body 102 along the axis of the outer tube body 102 guided by the pair of slider guide shafts 142. The slider body 212 is provided with a pair of slider guide holes 216 through which the pair of slider guide shafts 142 can be inserted. The pair of slider guide holes 216 is arranged so that the interval between the slider guide holes 216 is the same as the arrangement interval of the pair of slider guide shafts 142, and the slider guide holes 216 are arranged parallel to each other. The slider guide shafts 142 are inserted into the respective slider guide holes 216, thereby allowing the slider body 212 to be slidably supported by the slider guide shafts 142.

(132) The slider body 212 is provided with a sleeve guide hole 218. The sleeve guide hole 218 is formed to be a hole having as a round-shaped cross-section and to penetrate through the slider body 212. The sleeve guide hole 218 is formed in parallel to the axis of the outer tube body 102, and provided for the slider body 212 so as to be arranged coaxially with the treatment tool entry port 108 and the treatment tool exit port 114.

(133) The sleeve 214 is formed to have a shape (a cylindrical body in this example) that is slidable in the sleeve guide hole 218. The sleeve 214 is contained in the sleeve guide hole 218, and arranged movable in the sleeve guide hole 218. In the sleeve guide hole 218, stopper parts 220 for restricting the movement of the sleeve 214 are provided at both the ends thereof so as to protrude in radial directions. The movable range of the sleeve 214 is restricted by the stopper parts 220. Furthermore, the sleeve 214 is prevented from dropping off the sleeve guide hole 218 by the stopper parts 220.

(134) The slider 210 is provided with a treatment tool holding part 222 that holds the insertion part 62 of the treatment tool 60 inserted into the outer tube body 102, and an endoscope holding part 224 that holds the insertion part 12 of the endoscope 10 inserted into the outer tube body 102. The treatment tool holding part 222 is provided in the sleeve 214. The endoscope holding part 224 is provided in the slider body 212.

(135) The treatment tool holding part 222 includes a treatment tool holding hole 226 through which the insertion part 62 of the treatment tool 60 is inserted, and a cylindrical (annular) elastic member 228 arranged in the treatment tool holding hole 226.

(136) The treatment tool holding hole 226 is configured by the inner circumference part of the sleeve 214, which is configured to be a cylindrical body. As described above, the sleeve guide hole 218 that guides the sleeve 214 is formed in parallel to the axis of the outer tube body 102, and arranged coaxially with the treatment tool entry port 108 and the treatment tool exit port 114. Consequently, the treatment tool holding hole 226, which is the inner circumference part of the sleeve 214, is also arranged in parallel to the axis of the outer tube body 102, and arranged coaxially with the treatment tool entry port 108 and the treatment tool exit port 114.

(137) The cylindrical elastic member 228 is coaxially fixed and attached to the inner circumference part of the treatment tool holding hole 226. The cylindrical elastic member 228 is formed to have the inner diameter ID3 that is slightly smaller than the outer diameter (the outer diameter of the part held by treatment tool holding part 222) OD3 of the insertion part 62 of the treatment tool 60.

(138) The insertion part 62 of the treatment tool 60 inserted from the treatment tool entry port 108 into the outer tube body 102 passes through the treatment tool holding hole 226, and is delivered to protrude out of the treatment tool exit port 114. When the insertion part 62 of the treatment tool 60 passes through the treatment tool holding hole 226, this part passes through the elastic member 228. As described above, the elastic member 228 is formed to have the inner diameter that is slightly smaller than the outer diameter (the outer diameter of the part held by the treatment tool holding part 222) of the insertion part 62 of the treatment tool 60. Consequently, after the insertion part 62 of the treatment tool 60 passes through the treatment tool holding hole 226, this part is held by the treatment tool holding hole 226 by means of the elastic force of the elastic member 228.

(139) Note that the portion is thus held by means of the elastic force of the elastic member 228. Consequently, the holding position of the treatment tool 60 can be arbitrarily adjusted with respect to the sleeve 214.

(140) The endoscope holding part 224 includes an endoscope holding hole 230 through which the insertion part 12 of the endoscope 10 is inserted, and a cylindrical (annular) elastic member 232 arranged in the endoscope holding hole 230.

(141) The endoscope holding hole 230 is formed to penetrate through the slider body 212, and formed in parallel to the axis of the outer tube body 102. The endoscope holding hole 230 is provided for the slider body 212 so as to be arranged coaxially with the endoscope entry port 110 and the endoscope exit port 116.

(142) The cylindrical elastic member 232 is coaxially fixed and attached to the inner circumference part of the endoscope holding hole 230. The cylindrical elastic member 232 is formed to have the inner diameter ID4 that is slightly smaller than the outer diameter OD4 of the insertion part 12 of the endoscope 10.

(143) Here, the outer diameter OD4 of the insertion part 12 of the endoscope 10 is the outer diameter of the part having the enlarged diameter on the proximal end part side. That is, the endoscope 10 is held by the endoscope holding part 224 at the part having the enlarged diameter on the proximal end part side.

(144) The insertion part 12 of the endoscope 10 inserted from the endoscope entry port 110 into the outer tube body 102 passes through the endoscope holding hole 230, and is delivered to protrude out of the endoscope exit port 116. When the endoscope 10 passes through the endoscope holding hole 230, the endoscope 10 passes through the elastic member 232. As described above, the elastic member 232 is formed to have the inner diameter that is slightly smaller than the outer diameter of the insertion part 12 of the endoscope 10. Consequently, after the insertion part 12 of the endoscope 10 passes through the endoscope holding hole 230, this part is held by the endoscope holding hole 230 by means of the elastic force of the elastic member 232.

(145) Note that the part is thus held by means of the elastic force of the elastic member 232. Consequently, the holding position of the endoscope 10 can be arbitrarily adjusted with respect to the slider body 212.

(146) The outer tube 200 of this embodiment is configured as described above.

(147) <Operation>

(148) First, the insertion part 12 of the endoscope 10 is inserted from the endoscope entry port 110. The insertion part 12 inserted into the endoscope entry port 110 passes through the outer tube body 102, and is delivered to protrude out of the endoscope exit port 116. In this case, the insertion part 12 passes through the endoscope holding hole 230 provided in the slider 210 in the outer tube body 102, and is delivered to protrude out of the endoscope exit port 116. The endoscope holding hole 230 is provided with the elastic member 232. The insertion part 12 passing through the endoscope holding hole 230 is held by the slider body 212 by means of the elastic force of the elastic member 232.

(149) Next, the insertion part 62 of the treatment tool 60 is inserted from the treatment tool entry port 108. The insertion part 62 inserted into the treatment tool entry port 108 passes through the outer tube body 102, and is delivered to protrude out of the treatment tool exit port 114. In this case, the insertion part 62 passes through the inner circumference part (treatment tool holding hole 226) of the sleeve 214 provided in the slider 210 in the outer tube body 102, and is delivered to protrude out of the treatment tool exit port 114. The inner circumference part (treatment tool holding hole 226) of the sleeve 214 is provided with the elastic member 228. The insertion part 62 passing through the inner circumference part (treatment tool holding hole 226) of the sleeve 214 is held by the sleeve 214 by means of the elastic force of the elastic member 228.

(150) After the insertion part 12 of the endoscope 10 and the insertion part 62 of the treatment tool 60 are thus inserted into the outer tube 200, the insertion part 12 of the endoscope 10 and the insertion part 62 of the treatment tool 60 are connected by the slider 210. As a result, when the treatment tool 60 is moved in the axial direction, the endoscope 10 is moved in the axial direction in interlock with the movement.

(151) Here, the sleeve 214 for holding the treatment tool 60 is configured to be movable in the axial direction with respect to the slider body 212 for holding the endoscope 10. As a result, only when the treatment tool 60 is moved by a predetermined amount or more, the endoscope 10 moves in interlock with the treatment tool 60. That is, even when the treatment tool 60 is moved, if the movement of the tool is within the movable range of the sleeve 214, the endoscope is not moved and its stationary state is maintained. On the other hand, when the treatment tool 60 is moved exceeding the movable range of the sleeve 214, the endoscope 10 is moved in interlock with the movement of the treatment tool 60. That is, the interlocked movement is not caused by minute and small movement. Instead, the interlocked movement is caused only by large movement.

(152) The movable range of the treatment tool 60 is restricted by the stopper parts 220 at both the ends of the sleeve guide hole 218. Consequently, when the sleeve 214 abuts on the stopper part 220, the treatment tool 60 and the endoscope 10 move in interlock with each other.

(153) Thus, the outer tube 200 of this embodiment thus has what is so-called a play (non-sensitive region) for the movement of the treatment tool 60, and is configured so as not to transmit small movement to the endoscope 10. Consequently, even when the insertion part 62 of the treatment tool 60 is minutely displaced in the axial direction (the case of performing to-and-fro movement with a small amplitude), the image on the screen can be prevented from swaying (a stable image can be provided).

(154) If the frictional force between the sleeve 214 and the sleeve guide hole 218 is greater than the frictional force between the slider guide shaft 142 and the slider guide hole 216 (=the frictional force between the outer tube body 102 and the slider body 212), the entire slider body 212 is moved by movement of the treatment tool 60 (the sleeve 214 does not slide against the slider body 212, but the entire slider body 212 moves). Thus, the slider 210 is configured to have the frictional force between the sleeve 214 and the sleeve guide hole 218 that is smaller than the frictional force between the slider guide shaft 142 and the slider guide hole 216.

(155) The treatment tool 60 is held by the treatment tool holding part 222 by means of the elastic force of the elastic member 228. However, the frictional force between the elastic member 228 and the insertion part 62 of the treatment tool 60 is configured to be greater than the frictional force between the sleeve 214 and the sleeve guide hole 218 and the frictional force between the slider guide shaft 142 and the slider guide hole 216 (=the frictional force between the outer tube body 102 and the slider body 212).

(156) Likewise, the endoscope 10 is held by the endoscope holding part 224 by means of the elastic force of the elastic member 232. However, the frictional force between the elastic member 232 and the insertion part 62 of the treatment tool 60 is configured to be greater than the frictional force between the sleeve 214 and the sleeve guide hole 218 and the frictional force between the slider guide shaft 142 and the slider guide hole 216 (=the frictional force between the outer tube body 102 and the slider body 212).

(157) <<Other Embodiments of Outer Tube>>

(158) The outer tube 200 of the second embodiment has the configuration where the movable part (sleeve 214) of the slider 210 is provided with the treatment tool holding part 222, and the slider body 212 is provided with the endoscope holding part 224. Alternatively, as shown in FIG. 18, the movable part (sleeve 214) of the slider 210 may be provided with the endoscope holding part 224, and the slider body 212 may be provided with the treatment tool holding part 222. In this case, the treatment tool holding hole 226 is formed in the slider body 212, and the inner circumference part of the sleeve 214 serves as the endoscope holding hole 230. Also with such a configuration, the treatment tool 60 and the endoscope 10 can move in interlock with each other, and minute vibrations are prevented from being transmitted.

(159) In the above embodiment, only for the endoscope, the diameter of the distal end part (the part to be delivered to protrude out of the endoscope exit port 116) is narrowed (for the outer tubes 100 and 200, the inner diameters ID0 of the endoscope exit ports 116 are configured smaller than the inner diameters ID4 of the elastic members 156 and 232). Likewise, also for the treatment tool, the diameter of the distal end part (the part to be delivered to protrude out of the treatment tool exit port 114) may be narrowed.

(160) In this case, as shown in FIG. 19, the outer tube 200 is configured to have the inner diameter ID0 of the treatment tool exit port 114 that is smaller than the inner diameter ID3 of the elastic member 228.

(161) On the other hand, the treatment tool 60 is formed such that the part to be delivered to protrude out of the treatment tool exit port 114 has the outer diameter (second diameter B2) that is smaller than the outer diameter (first diameter B1) of the part to be held by the treatment tool holding part 222. That is, the distal end part side is narrowly formed. Consequently, also for the treatment tool 60, the strength as a whole can be secured while the diameter of the required part facilitated to be narrowed.

(162) Here, for both the endoscope and the treatment tool, their distal end parts may have narrowed diameters. Alternatively, for only one of the endoscope and the treatment tool, the distal end part may have a narrowed diameter.

(163) In the above embodiment, the outer diameter of the endoscope has a two-step configuration and the diameter of the distal end part is narrowed. Any configuration may be sufficient so long as a part to be delivered to protrude out of the endoscope exit port 116 is formed in conformity with the inner diameter of the endoscope exit port 116, and a part to be held by the endoscope holding part 148 or 224 is formed to have a diameter that can be held by the endoscope holding part 148 or 224.

(164) Accordingly, for example, as shown in FIG. 20, the part to be brought into contact with the opening type hermetic valve part 138 for the endoscope (the portion of the third diameter A3) may be formed to have the outer diameter OD2 (third diameter A3) that is smaller than the outer diameter OD4 (first diameter A1) of the part to be held by the endoscope holding part 148 (the portion of the first diameter A1). Therefore, when the endoscope 10 is moved in the axial direction, the sliding friction applied to the opening type hermetic valve part 138 for the endoscope can be reduced. Consequently, the force required when the treatment tool 60 and the endoscope 10 are moved in the axial direction can be reduced. Furthermore, the movement of the treatment tool 60 and the endoscope 10 in the axial direction can be smoothed. Note that in this case, the opening type hermetic valve part 138 for the endoscope of the outer tube 100 is formed to have the inner diameter ID2 that is smaller than the inner diameter ID4 of the elastic member 156 in conformity with the endoscope 10.

(165) Likewise, also for the treatment tool 60, the part to be brought into contact with the opening type hermetic valve part 132 for the treatment tool may be formed to have the outer diameter (third diameter B3) that is smaller than the outer diameter (first diameter B1) of the part to be held by the treatment tool holding part 146.

(166) Furthermore, for example, as shown in FIG. 21, the part to be brought into contact with the opening type hermetic valve part 138 for the endoscope (the portion of the third diameter A3) may be formed to have the outer diameter OD2 (third diameter A3) that is larger than the outer diameter OD4 (first diameter A1) of the part to be held by the endoscope holding part 148 (the portion of the first diameter A1). Consequently, the sliding friction applied to the endoscope by the opening type hermetic valve part 138 during insertion and extraction of the endoscope 10 can be reduced, and the insertion and extraction operation of the endoscope 10 can be smoothly performed without unnecessary force. Note that in this case, the opening type hermetic valve part 138 for the endoscope of the outer tube 100 is formed to have the inner diameter ID2 that is larger than the inner diameter ID4 of the elastic member 156 in conformity with the endoscope 10.

(167) Likewise, also for the treatment tool 60, the part to be brought into contact with the opening type hermetic valve part 132 for the treatment tool may be formed to have the outer diameter (third diameter B3) that is larger than the outer diameter (first diameter B1) of the part to be held by the treatment tool holding part 146.

(168) In the above embodiments, in the case of varying the diameter of the insertion part of the endoscope 10, the variation is stepwisely made. It is, however, preferable that the outer diameter be smoothly varied. For example, it is preferable the variation be performed in a tapered manner, or in a curved manner as shown in FIG. 22. Consequently, during insertion and extraction of the endoscope 10, the part with a varying diameter can be prevented from being caught by the valve member 120 or the like, and insertion and extraction operation can be further smoothed. The load onto the valve member 120 can be further reduced, thereby facilitating increase in the life-span of the valve member 120.

(169) In the above embodiments, in the endoscope holding part, the member for holding the endoscope is the cylindrical elastic member. However, in the endoscope holding part, the member for holding the endoscope is not limited to the case. Alternatively, for example, a configuration where a ring-shaped elastic member, such as an O-ring, is used to hold the endoscope may be adopted. In this case, a configuration where multiple ring-shaped elastic members are coaxially arranged to hold the endoscope may be adopted. This configuration is also applicable to the treatment tool holding part. The configuration where a ring-shaped elastic member, such as an O-ring, is used to hold the treatment tool may be adopted.

APPENDIX

(170) (A1) The surgical device, wherein the endoscope internally includes an imaging device at a distal end of the insertion part.

(171) (A2) The surgical device, wherein the first medical instrument is a treatment tool.

(172) (A3) The surgical device, wherein the first holding part can adjust a holding position of the insertion part of the first medical instrument.

(173) (A4) The surgical device, wherein the second holding part can adjust a holding position of the insertion part of the second medical instrument.

(174) (A5) The surgical device, wherein the movable object main body is configured to have a greater movement resistance to the outer tube body than a movement resistance of the movable part to the movable object main body.

(175) (B1) The outer tube wherein the first medical instrument is an endoscope.

(176) (B2) The outer tube, wherein the endoscope internally includes an imaging device at a distal end of the insertion part.

(177) (B3) The outer tube, wherein the first medical instrument is a treatment tool.

(178) (B4) The outer tube, wherein the first holding part can adjust a holding position of the insertion part of the first medical instrument.

(179) (B5) The outer tube, wherein the second holding part can adjust a holding position of the insertion part of the second medical instrument.

(180) (B6) The outer tube, wherein

(181) the first holding part includes an annular elastic member through which the insertion part of the first medical instrument is inserted, and which is configured to hold the insertion part of the first medical instrument by means of an elastic force, and

(182) the first exit port has an inner diameter smaller than an inner diameter of the elastic member.

(183) (B7) The outer tube, wherein the movable object main body is configured to have a greater movement resistance to the outer tube body than a movement resistance of the movable part to the movable object main body.

(184) (C1) The endoscope, wherein the endoscope internally includes an imaging device at a distal end of the insertion part.

(185) (D1) The treatment tool, wherein

(186) the outer tube further includes a treatment tool sealing member which is provided at the treatment tool entry port, and is configured to slidably seal the insertion part of the treatment tool, and

(187) the insertion part of the treatment tool further includes a part which is disposed closer to a proximal end than the part having the first diameter B1, and is configured to maintain hermeticity with the treatment tool sealing member, and has a third diameter B3 smaller than the first diameter B1.

(188) (D2) The treatment tool, wherein

(189) the outer tube further includes a treatment tool sealing member which is provided at the treatment tool entry port, and is configured to slidably seal the insertion part of the treatment tool, and

(190) the insertion part of the treatment tool further includes a part which is disposed closer to proximal end than the part having the first diameter B1, and is configured to maintain hermeticity with the treatment tool sealing member, and has a third diameter B3 larger than the first diameter B1.