WO2022190939A1 - 内視鏡用処置具 - Google Patents
内視鏡用処置具 Download PDFInfo
- Publication number
- WO2022190939A1 WO2022190939A1 PCT/JP2022/008379 JP2022008379W WO2022190939A1 WO 2022190939 A1 WO2022190939 A1 WO 2022190939A1 JP 2022008379 W JP2022008379 W JP 2022008379W WO 2022190939 A1 WO2022190939 A1 WO 2022190939A1
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- WO
- WIPO (PCT)
- Prior art keywords
- shaped member
- distal end
- tubular portion
- tip
- opening
- Prior art date
Links
- 238000012277 endoscopic treatment Methods 0.000 title claims abstract description 46
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 claims abstract description 40
- 238000011282 treatment Methods 0.000 claims description 32
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- 239000008280 blood Substances 0.000 description 13
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- 230000000740 bleeding effect Effects 0.000 description 7
- 238000002347 injection Methods 0.000 description 7
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- 206010040844 Skin exfoliation Diseases 0.000 description 5
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- 239000004696 Poly ether ether ketone Substances 0.000 description 3
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Images
Classifications
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
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- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
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Definitions
- the present invention relates to an endoscopic treatment instrument.
- Endoscopic Submucosal Dissection is a method that enables reliable en bloc resection of a wide range of lesions such as early esophageal cancer, early gastric cancer, and early colon cancer using an endoscope. , abbreviated as “ESD”)).
- ESD Endoscopic Submucosal Dissection
- marking was applied to the excision range of the lesion (marking treatment)
- a drug solution was locally injected into the submucosa to raise the mucosal lesion (local injection treatment)
- an incision was made around the mucosal lesion according to the marking.
- the submucosal layer is peeled off (incision/exfoliation treatment), and bleeding that occurs during the peeled ulcer surface, incision, or peeling is stopped (hemostatic treatment).
- an endoscopic treatment instrument having a nozzle or the like for applying a high-frequency current to excise a mucous membrane or the like is used (see, for example, Patent Document 1).
- the present invention has been made in view of the above circumstances, and its object is to provide an endoscopic treatment instrument capable of improving the efficiency of procedures.
- a treatment instrument for an endoscope includes a tubular portion, and a rod-shaped member arranged so as to protrude from the distal end surface of the tubular portion, the amount of protrusion from the distal end surface being variable according to the operation of the operation portion.
- a first connection port to which a device for water supply or suction can be connected; a first tip opening formed in the tip surface of the rod-shaped member; a first conduit whose distal end communicates with the first distal opening and whose proximal end communicates with the first connection port; a second connection port to which an instrument can be connected; and a distal end surface of the tubular portion. and a second conduit extending axially within the tubular portion and having a distal end communicating with the second distal opening and a proximal end communicating with the second connection port.
- the endoscopic treatment instrument may further include a tube that communicates with the through passage formed in the rod-shaped member.
- the first tip opening is an opening of a through passage formed in the tip surface of the rod-shaped member.
- the first conduit includes a through passage and a tube.
- the endoscopic treatment instrument may have a configuration in which the proximal end of the rod-shaped member is inserted into the distal end of the tube so that the through passage and the tube communicate with each other.
- the rod-shaped member also advances and retreats in the axial direction, and the amount of protrusion of the rod-shaped member from the tip surface of the tubular portion changes.
- the rod-shaped member is positioned in the central region of the distal end surface of the tubular portion, and the second distal opening is located in the peripheral region of the distal end surface of the tubular portion positioned outside the central region. It is good also as composition located.
- a plurality of second tip openings may be formed on the tip surface of the tubular portion.
- the plurality of second tip openings are arranged around the rod-shaped member at equal pitches when viewed from the front.
- the tubular part may be configured to include a sheath and a cap-shaped member attached to the sheath so as to close the tip opening of the sheath.
- the cap-shaped member supports the rod-shaped member so as to be slidable in the axial direction
- the opening on the proximal side communicates with the sheath
- the opening on the distal side is formed on the distal end surface of the cap-shaped member. It has a first through-passage penetrating the cap-shaped member and a second through-passage penetrating through the cap-shaped member, the second through-passage being formed around the first through-passage in the axial direction.
- the second through passage forms part of the second conduit.
- the opening on the distal end side of the second through passage is the second distal opening and is formed in the distal end surface of the cap-shaped member.
- tubular portion may be configured to include a support path that supports the rod-shaped member so as to be slidable in the axial direction.
- the support channel forms part of the second conduit.
- the tubular part may be configured to include a sheath and a cap-shaped member attached to the sheath so as to close the tip opening of the sheath.
- the support path is a third through path that penetrates the cap-shaped member, has a proximal opening that communicates with the sheath, and has a distal opening that is formed in the distal end surface of the cap-shaped member.
- the third through passage forms part of the second conduit.
- An endoscopic treatment instrument has at least a portion of the first conduit passing through the second conduit, and the airtightness of the second conduit inside the tubular portion is improved.
- a sealing member for ensuring the above may be arranged on the outer periphery of a portion of the first pipeline that passes through the inside of the second pipeline.
- An endoscopic treatment instrument further includes: a contact portion to which a high-frequency power supply for applying a high-frequency current can be connected; and a conductive wire disposed within the tubular portion. good too.
- the rod-like member is electrically conductive.
- the wire has a distal end electrically connected to the rod-shaped member and a proximal end electrically connected to the contact portion.
- an endoscopic treatment instrument capable of improving the efficiency of procedures.
- FIG. 1 is a perspective view showing the configuration of an endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 1 is a side sectional view showing the configuration of an endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 1 is a side sectional view showing the configuration of an endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is an enlarged view showing an enlarged part of an endoscopic treatment instrument according to an embodiment of the present invention
- FIG. 1 is a perspective view of a distal end of a tubular portion of an endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 1 is a perspective view of a distal end of a tubular portion of an endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 1 is a front view of a distal end surface of a tubular portion of an endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 2 is a cross-sectional view showing a water supply pipeline provided in the endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 2 is a cross-sectional view showing a suction channel provided in the endoscopic treatment instrument according to one embodiment of the present invention
- FIG. 11 is a perspective view of a distal end of a tubular portion of an endoscopic treatment instrument according to a modified example of the present invention
- FIG. 11 is a perspective view of a distal end of a tubular portion of an endoscopic treatment instrument according to a modified example of the present invention
- FIG. 11 is a front view of the distal end surface of the tubular portion of the endoscopic treatment instrument according to the modified example of the present invention
- FIG. 11 is a cross-sectional view showing a water supply line provided in the endoscopic treatment instrument according to the modified example of the present invention
- FIG. 11 is a cross-sectional view showing a suction channel provided in a treatment instrument for an endoscope according to a modified example of the present invention
- FIG. 1 is a perspective view showing the configuration of an endoscopic treatment instrument 1 according to one embodiment of the present invention.
- the endoscopic treatment instrument 1 includes a first conduit and a second conduit. For example, by connecting a water supply pump to one conduit and a suction pump to the other conduit, the pumps can be replaced. One or both of water supply and suction can be performed at the same time.
- the endoscopic treatment instrument 1 includes a water supply conduit 60 and a suction conduit 70 as examples of the first conduit and the second conduit.
- a water pump for example, is connected to the proximal end of the water pipe 60 .
- the cleaning liquid is supplied by the water pump, the cleaning liquid is ejected to the outside from the distal end of the endoscopic treatment instrument 1 through the water supply pipe line 60 .
- a suction pump for example, is connected to the proximal end of the suction line 70 . When the suction pump is driven, the adherents in the body cavity are sucked into the suction conduit 70 and put into a container or the like provided with the suction pump.
- the endoscopic treatment instrument 1 includes a tubular portion 10.
- the axial direction (longitudinal direction) of the tubular portion 10 is defined as the Z direction
- the two directions orthogonal to the Z direction and mutually orthogonal are defined as the X direction and the Y direction.
- X-, Y-, and Z-directions that are orthogonal to each other form a right-handed system.
- the positive side in the Z direction is also called the front side
- the negative side in the Z direction is also called the rear side
- the positive side in the Y direction is also called the upper side
- the negative side in the Y direction is also called the lower side. It is a name used for convenience to explain the relative positional relationship between the two, and does not indicate an absolute direction.
- FIG. 2 and 3 are side cross-sectional views showing the configuration of the endoscopic treatment instrument 1 according to one embodiment of the present invention.
- FIG. 2 shows a YZ cross section including the central axis of tubular portion 10 .
- FIG. 3 shows an XZ cross-section including the central axis of tubular portion 10 .
- 4 is an enlarged view showing an enlarged portion PA of FIG. 2.
- FIG. 5A and 5B are enlarged views showing an enlarged portion PB of FIG. 2.
- FIG. 6 is an enlarged view showing an enlarged portion PC of FIG. 3.
- FIG. 7 is an enlarged view showing an enlarged portion PD of FIG. 8A and 8B are perspective views of the distal end of tubular portion 10.
- FIG. FIG. 9 is a view of the distal end surface 10A of the tubular portion 10 when viewed from the Z-direction positive side (in other words, a front view of the distal end surface 10A).
- the tubular portion 10 holds a sheath 11 that can be inserted into a treatment instrument insertion channel of an endoscope (not shown), a stopper 12 that is fitted into a distal end opening of the sheath 11, a proximal end of the sheath 11, and various components.
- a housing unit 13 is provided.
- the sheath 11 is a flexible resin insulating tube.
- the sheath 11 is made of, for example, PEEK (polyetheretherketone) or PTFE (polytetrafluoroethylene).
- the stopper 12 is a cap-shaped member having an outer diameter substantially equal to the inner diameter of the sheath 11, and has a retainer projection formed on its outer peripheral surface.
- the stopper 12 is press-fitted into the sheath 11 from the distal end opening of the sheath 11 and fitted to the inner surface of the sheath 11 . That is, the stopper 12 is attached to the sheath 11 so as to block the distal end opening of the sheath 11 .
- the stopper 12 is an insulating member made of, for example, ceramics.
- the distal end surface of the stopper 12 is the distal end surface 10A of the tubular portion 10. As shown in FIG. Therefore, the distal end surface 10A of the tubular portion 10 is sometimes referred to as the distal end surface 10A of the stopper 12. As shown in FIG.
- a through passage 121 is formed in the stopper 12 so as to extend through its central portion in the Z direction.
- a plurality of through passages 122 extending parallel to the through passage 121 and penetrating the stopper 12 are formed around the through passage 121 .
- four through-paths 122 are formed around the through-path 121 at equal pitches (specifically, at a pitch of 90 degrees), but the number of through-paths 122 is not limited to this.
- the number of through passages 122 may be one, two, three, or five or more.
- the opening on the tip side of the through-path 122 is referred to as "tip opening 122A (second tip opening)".
- a through passage 131 extending in the Z direction is formed through the housing portion 13 .
- the proximal end of the sheath 11 is inserted into the distal end of the through passage 131 .
- the proximal end of the sheath 11 inserted into the through-path 131 is fixed to the inner wall surface of the through-path 131 by an adhesive or the like.
- the endoscopic treatment instrument 1 includes a slider 20 (manipulation section).
- the distal end of the slider 20 is attached to the proximal end of the through passage 131 of the housing portion 13 .
- the tip outer diameter of the slider 20 is slightly smaller than the diameter (inner diameter) of the through passage 131 . Therefore, the slider 20 can slide in the through-path 131 in the Z direction.
- a retaining projection is formed on the outer peripheral surface of the leading end of the slider 20 . Therefore, the slider 20 does not come off the through passage 131 .
- a through passage 201 extending through the slider 20 in the Z direction is formed.
- a proximal end of the tube 30 is inserted into the distal end of the through passage 201 .
- the proximal end of the tube 30 inserted into the through-path 201 is fixed to the inner wall surface of the through-path 201 by an adhesive or the like.
- the tube 30 whose proximal end is inserted into the through passage 201 of the slider 20 is arranged to extend in the Z direction through the through passage 131 of the housing portion 13 to the vicinity of the distal end of the sheath 11 .
- the tube 30 is a flexible resin insulating tube.
- the tube 30 is made of PEEK or PTFE, for example.
- a plug 40 (contact portion) that can be connected to a high-frequency power source (not shown) is provided on the side of the housing portion 13 .
- a proximal end of a wire 41 that is a conductive member is electrically connected to the proximal end of the plug 40 .
- the wire 41 is wired inside the tubular portion 10 through the through passage 131 of the housing portion 13 to reach the vicinity of the distal end of the sheath 11 .
- the tip of the wire 41 arranged near the tip of the sheath 11 is electrically connected to the high-frequency knife 50 (rod-shaped member).
- the plug 40 and the wire 41 are joined by a joining material such as solder, brazing, laser welding, or the like.
- the wire 41 and the high-frequency knife 50 are also joined by a joining material such as solder, brazing, laser welding, or the like.
- a high-frequency knife 50 (rod-shaped member) is inserted through the through passage 121 of the stopper 12 .
- the high-frequency knife 50 is a rod-shaped metal member such as SUS.
- a high-frequency current is supplied to the high-frequency knife 50 via a plug 40 and a wire 41 from a high-frequency power supply.
- the high-frequency electric current applied to the high-frequency knife 50 enables incision and ablation of tissue in body cavities.
- the proximal end of the high-frequency knife 50 is inserted into the distal end of the tube 30 arranged near the distal end of the sheath 11 .
- the proximal outer diameter of high frequency knife 50 is slightly larger than the inner diameter of tube 30 . Therefore, the distal end of the tube 30 is elastically deformed so as to come into close contact with the outer peripheral surface of the proximal end of the high-frequency knife 50 , thereby airtightly covering the proximal end of the high-frequency knife 50 .
- the high-frequency knife 50 and the slider 20 are mechanically connected via the tube 30 inserted through the through-path 131 of the housing 13 and the sheath 11 .
- the tube 30 attached to the through-path 201 of the slider 20 and the high-frequency knife 50 attached to the tip of the tube 30 are integrated into a Z direction. direction.
- the high-frequency knife 50 slides in the through-path 121 of the stopper 12 in the Z direction, and the protrusion amount of the stopper 12 from the distal end surface 10A changes according to the operation of the slider 20 by the operator.
- the high frequency knife 50 also advances and retreats in the Z direction, and the high frequency knife 50 protrudes from the distal end surface 10A of the tubular portion 10. quantity changes.
- the stopper 12 which is an example of a cap-shaped member, has a through-path 121 that supports the high-frequency knife 50, which is an example of a rod-shaped member, slidably in the Z direction.
- the through path 121 is an example of a first through path, and supports the high-frequency knife 50 slidably in the Z direction.
- the through passage 121 penetrates the stopper 12 in the Z direction, and has an opening on the proximal end side communicating with the sheath 11 and an opening on the distal end side formed in the distal end surface 10A of the stopper 12 .
- the through passage 122 is an example of a second through passage that penetrates the stopper 12 in the Z direction, and is formed around the through passage 121 so as to extend in the Z direction.
- the through passage 122 forms part of a suction conduit 70, which is an example of a second conduit.
- An opening on the distal end side of the through-path 122 is a distal opening 122A, which is an example of a second distal opening, and is formed in the distal end surface 10A of the stopper 12 .
- the high frequency knife 50 When the slider 20 is moved to the negative side in the Z direction, the high frequency knife 50 also moves to the negative side in the Z direction.
- a protrusion member 501 is formed on the tip side surface of the high-frequency knife 50 so as to protrude sideways over the entire circumference.
- the outer diameter of the projecting member 501 is larger than the diameter (inner diameter) of the through passage 121 of the stopper 12 . Therefore, when the high-frequency knife 50 is moved to the negative side in the Z direction, the projecting member 501 hits the distal end surface 10A of the tubular portion 10 (see FIGS. 5A and 8A). This restricts the movement of the high-frequency knife 50 to the negative side in the Z direction. At this time, the amount of protrusion of the high-frequency knife 50 from the tip surface 10A is minimized.
- the high frequency knife 50 When the slider 20 is moved to the Z direction positive side, the high frequency knife 50 also moves to the Z direction positive side.
- the stepped portion 502 formed on the outer peripheral surface of the high-frequency knife 50 hits the base end surface 12A of the stopper 12 (see FIG. 5B). As a result, movement of the high-frequency knife 50 toward the positive side in the Z direction is restricted. At this time, the amount of protrusion of the high-frequency knife 50 from the distal end surface 10A of the tubular portion 10 is maximized.
- the high-frequency knife 50 has a configuration in which the proximal end of an inner cylinder having a through passage 503 (to be described later) formed therein is covered with an outer cylinder and welded together. One end of this outer cylinder forms a stepped portion 502 .
- the operator can change the amount of protrusion of the high-frequency knife 50, which is arranged to protrude from the distal end surface 10A of the tubular portion 10, from the distal end surface 10A.
- the operator operates the slider 20 according to the procedure (marking, local injection, incision, peeling, hemostasis, etc.) to cause the high-frequency knife 50 to protrude from the distal end surface 10A by an appropriate amount.
- the operator presses the tip surface 10A against the mucous membrane around the lesion, and the high-frequency knife 50 High-frequency current is applied. As a result, a marking trace is formed around the lesion.
- the operator aspirates blood or mucus from the distal opening 503A formed in the high-frequency knife 50 (or the distal opening 122A formed in the distal surface 10A of the tubular portion 10) to secure the surgical field. can be done.
- a specific configuration of the suction channel (one of the first channel and the second channel) provided in the endoscope treatment instrument 1 will be described later.
- Local injection is a procedure in which a liquid is locally injected into the submucosal layer of the lesion to be incised to lift the mucous membrane of the lesion to be incised.
- the operator advances the high-frequency knife 50 to the knife advance position (see FIGS. 5B and 8B) and energizes the high-frequency current. pierce the The operator then inserts the high-frequency knife 50 into the submucosa and injects the drug solution into the submucosa through the tip opening 503A (first tip opening) of the high-frequency knife 50 .
- the operator advances the high-frequency knife 50 to the knife forward position (see FIGS. 5B and 8B) and energizes the high-frequency current, and inserts the distal end surface 10A of the tubular portion 10 into the submucosal layer. pierce the The operator then retracts the high-frequency knife 50 to the knife retracted position (see FIGS. 5A and 8A) and inserts the tip surface 10A into the submucosal layer.
- the operator injects the drug solution into the submucosa through the tip opening 122A.
- the operator advances the high-frequency knife 50 to the knife advance position (see FIGS. 5B and 8B) while confirming the positions of the high-frequency knife 50 and the marking marks on the endoscopic image.
- the operator energizes the high-frequency knife 50 with high-frequency current, moves the high-frequency knife 50 along the marking trace, and makes a circumferential incision.
- the protruding member 501 fits into the mucous membrane and functions as a kind of retainer. Therefore, the high-frequency knife 50 does not inadvertently come off from the mucous membrane during incision.
- the operator advances the high-frequency knife 50 to the knife advance position (see FIGS. 5B and 8B) to apply a high-frequency current, and lifts the incised lesion.
- the submucosal layer is cauterized and exfoliated.
- the protruding member 501 is appropriately caught in the mucous membrane during the peeling treatment as well as during the incision treatment. Therefore, the high-frequency knife 50 is prevented from slipping and accidentally falling out of the mucous membrane.
- the operator presses the high-frequency knife 50 against the bleeding ulcer or mucous membrane while retracting the high-frequency knife 50 to the knife retraction position (see FIGS. 5A and 8A). It is cauterized by passing an electric current through it.
- Hemostasis treatment is not limited to stopping bleeding from the ulcer after the lesion has been exfoliated, but is also used to stop bleeding at a site that bleeds during incision or exfoliation. Since blood and mucus adhering to the high-frequency knife 50 are removed by such a hemostatic treatment, the operator can clean the high-frequency knife 50 by injecting cleaning liquid from the tip opening 122A. In addition, it may be difficult to visually recognize the bleeding site due to blood or mucus adhering to the body cavity. In this case, the operator can remove blood and mucus by spraying liquid into the body cavity from the tip opening 503A and sucking the blood and mucus from the tip opening 122A. This makes it easier for the operator to visually recognize the bleeding site. Instead of the above, the blood and mucus may be removed from the body cavity by spraying liquid from the tip opening 122A into the body cavity and sucking the blood and mucus from the tip opening 503A.
- FIG. 10 is a cross-sectional view of the endoscopic treatment instrument 1 showing the water supply conduit 60.
- the hatched area is the water pipe 60 .
- the water supply pipe 60 is composed of a through-passage 201 formed in the slider 20 , the tube 30 and a through-passage 503 formed in the high-frequency knife 50 .
- the through path 503 is a through path extending through the high-frequency knife 50 in the Z direction.
- connection port 201A (first connection port) to which an instrument can be connected.
- Instruments that can be connected to the connection port 201A are instruments for water supply or suction, such as a water supply pump, a suction pump, and a syringe.
- the through passage 201 of the slider 20 communicates with the tube 30, and the tube 30 communicates with the through passage 503 of the high-frequency knife 50. Therefore, for example, when a water pump is connected to the connection port 201A, the cleaning liquid or the like supplied to the through-path 201 through the connection port 201A flows through the tube 30 and the through-path 503, and is formed on the tip surface of the high-frequency knife 50. It is jetted to the outside from the tip opening 503A (opening on the tip side of the through passage 503). As a result, it is possible to inject a drug solution into the submucosal layer and remove adherents (blood and mucus).
- the water supply pipe line 60 can be made to function as a suction pipe line.
- adherents such as blood and mucus adhering to the inside of the body cavity are sucked into the through passage 503 through the tip opening 503A.
- the deposits sucked into the through-path 503 are put into a container or the like provided in the suction pump via the tube 30 and the through-path 201 .
- FIG. 11 is a cross-sectional view of the endoscopic treatment instrument 1 showing the suction channel 70. As shown in FIG. In FIG. 11 , the hatched area is the suction pipe line 70 .
- a through passage 132 that branches the through passage 131 obliquely upward is formed in the housing portion 13 .
- a proximal end of the through-path 132 branched from the through-path 131 serves as a connection port 132A (second connection port) to which an instrument can be connected. Similar to the connection port 201A of the slider 20, the connection port 132A can be connected to a device for water supply or suction.
- the suction channel 70 is composed of through channels 131 and 132 , the sheath 11 , and a plurality of through channels 122 formed in the stopper 12 . More specifically, the tube 30 forming part of the water supply conduit 60 passes through the through passage 131 and the sheath 11 . Therefore, of the through-path 131 , the duct defined by the inner wall surface of the through-path 131 and the outer peripheral surface of the tube 30 forms a part of the suction duct 70 . In the sheath 11 , a channel defined by the inner peripheral surface of the sheath 11 and the outer peripheral surface of the tube 30 forms part of the suction channel 70 .
- the through passages 132 communicate with the through passages 131, the through passages 131 communicate with the sheath 11, and the sheath 11 communicates with each through passage 122. Therefore, for example, when a suction pump is connected to the connection port 132A, deposits in the body cavity are sucked into the through passage 122 through the tip opening 122A formed on the tip surface 10A of the stopper 12. FIG. The deposit sucked into the through passage 122 is put into a container or the like provided in the suction pump through the sheath 11 and the through passages 131 and 132 .
- the suction conduit 70 By connecting a water supply pump to the connection port 132A, the suction conduit 70 can be made to function as a water supply conduit.
- the cleaning liquid or the like supplied to the through-path 132 through the connection port 132A flows through the through-path 131, the sheath 11, and the through-path 122, and is jetted to the outside from each tip opening 122A.
- water supply or suction can be performed without replacing the pump.
- both water supply and suction can be performed at the same time.
- various treatments such as local injection can be performed while always operating the suction pump to constantly suck blood and mucus. That is, by adopting a configuration in which water supply and suction can be performed at the same time, a good field of view can always be secured during ESD treatment.
- an O-ring 80 (sealing member) is fitted around the outer periphery of the tube 30 to hermetically seal this gap.
- the O-ring 80 that secures the airtightness of the suction pipe 70 inside the tubular portion 10 is positioned on the outer circumference of the portion of the water supply pipe 60 that passes through the suction pipe 70 (the outer circumference of the tube 30 that passes through the through passage 131). part of the circumference).
- Frictional resistance is generated between the outer peripheral surface of the tube 30 and the O-ring 80 by fitting the O-ring 80 .
- This frictional resistance causes the slider 20 to move in the Z direction with an appropriate load when operated. Therefore, the operator can easily move the slider 20 by a small amount, and easily adjust the amount of projection of the high-frequency knife 50 .
- the high-frequency knife 50 is positioned in the central region of the distal end surface 10A.
- four tip openings 122A are arranged at equal pitches in a peripheral area (in other words, around the high-frequency knife 50) of the tip face 10A located outside this central area. In this way, the high-frequency knife 50 and the tip opening 122A are positioned so as not to overlap when viewed from the front. The opening 122A is not blocked by the high frequency knife 50. - ⁇ Therefore, both water supply and suction can be performed at all times.
- the outer circumference of the protruding member 501 and the tip opening 122A are in contact with each other when viewed from the front.
- a large diameter of 122A (and through passage 122) can be ensured.
- both water supply and suction can be performed at the same time.
- a portion of the tip opening 122A overlaps the high-frequency knife 50 when viewed from the front (in other words, a portion of the tip opening 122A overlaps the projection member 501 when viewed from the front). hidden) arrangement configuration.
- the through passage 122 of the stopper 12 and the through passage 503 of the high-frequency knife 50 have a substantially perfect circular cross-sectional shape in the direction perpendicular to the axis, but the shape of the through passages 122 and 503 is not limited to this.
- the through-paths 122 and 503 may have a cross-sectional shape in the direction perpendicular to the axis, such as an ellipse or prism.
- FIG. 12A and 12B An endoscope treatment instrument 1 according to a modification of the present invention will be described with reference to FIGS. 12A and 12B and FIGS. 13 to 15.
- FIG. 12A and 12B An endoscope treatment instrument 1 according to a modification of the present invention will be described with reference to FIGS. 12A and 12B and FIGS. 13 to 15.
- FIG. 12A and 12B An endoscope treatment instrument 1 according to a modification of the present invention will be described with reference to FIGS. 12A and 12B and FIGS. 13 to 15.
- FIG. 12A and 12B An endoscope treatment instrument 1 according to a modification of the present invention will be described with reference to FIGS. 12A and 12B and FIGS. 13 to 15.
- FIG. 12A and 12B An endoscope treatment instrument 1 according to a modification of the present invention will be described with reference to FIGS. 12A and 12B and FIGS. 13 to 15.
- FIG. 12A and 12B An endoscope treatment instrument 1 according to a modification of the present invention will
- FIGS. 8A and 8B are views similar to FIGS. 8A and 8B, respectively, and are perspective views of the distal end of the tubular portion 10 according to this modification.
- FIG. 13 is a view similar to FIG. 9, and is a view of the distal end surface 10A of the tubular portion 10 according to this modification when viewed from the Z-direction positive side (in other words, a front view of the distal end surface 10A).
- FIG. 14 is similar to FIG. 10 and is a cross-sectional view of the endoscopic treatment instrument 1 showing the water supply conduit 60 according to this modification.
- FIG. 15 is similar to FIG. 11 and is a cross-sectional view of the endoscopic treatment instrument 1 showing the suction channel 70 according to this modification.
- FIGS. 14 and 15 show only the water supply conduit 60 and the suction conduit 70 at the distal end portion of the tubular portion 10, respectively.
- the through passage 121' of the stopper 12 is an example of a support passage for slidably supporting the high-frequency knife 50, which is an example of a rod-shaped member, in the Z direction, and is an example of a second conduit. It forms part of a certain suction line 70 (see FIGS. 12B, 14, 15, etc.).
- the through-path 121′ is also an example of a third through-path that penetrates the stopper 12 in the Z direction.
- An opening is formed in the tip surface 10A of the stopper 12 .
- An opening on the tip side of the through-path 121' is referred to as a "tip opening 121A'".
- the through path 121' is a single through path formed in a plus shape (in other words, a shape like +) in the XY cross section.
- the high-frequency knife 50 penetrates the through-path 121' in the Z-direction at the intersection of the portion extending in the X-direction and the portion extending in the Y-direction in the XY cross-section (in other words, the central region of the through-path 121' in the XY cross-section). are arranged to
- the water supply pipe 60 is composed of a through-path 201 formed in the slider 20, the tube 30, and a through-path 503 formed in the high-frequency knife 50, as in the above embodiment.
- the configuration of the suction pipeline 70 is different from that of the above embodiment.
- the suction channel 70 is configured by the through channels 131 and 132 of the housing portion 13, the sheath 11, and the through channel 121'. Therefore, for example, when a suction pump is connected to the connection port 132A, deposits in the body cavity are sucked into the through passage 121' through the distal end opening 121A' formed in the distal end surface 10A of the stopper 12. The deposit sucked into the through passage 121 ′ is put into a container or the like provided in the suction pump through the sheath 11 and the through passages 131 and 132 .
- the through-path 121' that supports the high-frequency knife 50 so as to be slidable in the Z direction also serves as a part of the suction pipe 70.
- the outer diameter of the tubular portion 10 can be kept small compared to the structure in which the through passage 122 is formed around.
- the volume of the suction channel 70 at the distal end portion of the tubular portion 10 can be increased. By increasing the volume of the suction conduit 70, for example, the amount of adherents that can be sucked per unit time can be increased.
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Abstract
Description
ストッパ12は、絶縁性部材であり、例えばセラミックスで構成される。なお、ストッパ12の先端面が管状部10の先端面10Aである。そのため、管状部10の先端面10Aは、ストッパ12の先端面10Aと呼ぶこともある。
Claims (10)
- 管状部と、
前記管状部の先端面から突出して配置され、操作部の操作に応じて前記先端面からの突出量が可変するロッド状部材と、
送水又は吸引のための器具を接続可能な第1の接続口と、
前記ロッド状部材の先端面に形成された第1の先端開口と、
前記管状部内に、前記管状部の軸線方向に延びて形成され、先端が前記第1の先端開口と連通し基端が前記第1の接続口と連通する第1の管路と、
前記器具を接続可能な第2の接続口と、
前記管状部の先端面に形成された第2の先端開口と、
前記管状部内に前記軸線方向に延びて形成され、先端が前記第2の先端開口と連通し基端が前記第2の接続口と連通する第2の管路と、
を備える、
内視鏡用処置具。 - 前記ロッド状部材に形成された貫通路と連通するチューブを更に備え、
前記第1の先端開口は、前記ロッド状部材の先端面に形成された前記貫通路の開口であり、
前記第1の管路は、前記貫通路と前記チューブを含む、
請求項1に記載の内視鏡用処置具。 - 前記貫通路と前記チューブとが連通するように、前記ロッド状部材の基端が前記チューブの先端に差し込まれており、
前記操作部の操作に応じて前記チューブが前記管状部内を前記軸線方向に進退することに伴って前記ロッド状部材も前記軸線方向に進退し、前記管状部の先端面からの前記ロッド状部材の突出量が変わる、
請求項2に記載の内視鏡用処置具。 - 前記管状部の先端面の正面視において、前記ロッド状部材は、前記管状部の先端面の中央領域に位置し、前記第2の先端開口は、前記中央領域の外側に位置する前記管状部の先端面の周辺領域に位置する、
請求項1から請求項3の何れか一項に記載の内視鏡用処置具。 - 前記第2の先端開口は、前記管状部の先端面に複数形成され、
複数の前記第2の先端開口は、前記正面視において前記ロッド状部材の周囲に等ピッチに並んで位置する、
請求項4に記載の内視鏡用処置具。 - 前記管状部は、
シースと、
前記シースの先端開口を塞ぐように前記シースに取り付けられたキャップ状部材と、を含み、
前記キャップ状部材は、
前記ロッド状部材を前記軸線方向に摺動可能に支持し、かつ基端側の開口が前記シースと連通し、先端側の開口が前記キャップ状部材の先端面に形成された、前記キャップ状部材を貫通する第1の貫通路と、
前記第1の貫通路の周囲に前記軸線方向に延びて形成された、前記キャップ状部材を貫通する第2の貫通路と、を有し、
前記第2の貫通路は、前記第2の管路の一部をなし、
前記第2の貫通路の先端側の開口は、前記第2の先端開口であり、前記キャップ状部材の先端面に形成されている、
請求項4又は請求項5に記載の内視鏡用処置具。 - 前記管状部は、前記ロッド状部材を前記軸線方向に摺動可能に支持する支持路を含み、
前記支持路は、前記第2の管路の一部をなす、
請求項1から請求項3の何れか一項に記載の内視鏡用処置具。 - 前記管状部は、
シースと、
前記シースの先端開口を塞ぐように前記シースに取り付けられたキャップ状部材と、を含み、
前記支持路は、前記キャップ状部材を貫通し、かつ基端側の開口が前記シースと連通し、先端側の開口が前記キャップ状部材の先端面に形成された、第3の貫通路であり、
前記第3の貫通路は、前記第2の管路の一部をなす、
請求項7に記載の内視鏡用処置具。 - 前記第1の管路の少なくとも一部が前記第2の管路内を通っており、
前記管状部内部での前記第2の管路の気密性を確保するシール部材が、前記第1の管路のうち、前記第2の管路内を通る部分の外周に配置される、
請求項1から請求項8の何れか一項に記載の内視鏡用処置具。 - 高周波電流を流すための高周波電源を接続可能な接点部と、
前記管状部内に配置された導電性を有するワイヤと、
を更に備え、
前記ロッド状部材は導電性を有し、
前記ワイヤは、先端が前記ロッド状部材と電気的に接続され、基端が前記接点部と電気的に接続される、
請求項1から請求項9の何れか一項に記載の内視鏡用処置具。
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US18/271,788 US20240058054A1 (en) | 2021-03-12 | 2022-02-28 | Endoscopic treatment implement |
EP22766898.5A EP4260827A1 (en) | 2021-03-12 | 2022-02-28 | Endoscopic treatment implement |
CN202280009723.0A CN116710010A (zh) | 2021-03-12 | 2022-02-28 | 内窥镜用处理器具 |
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Citations (5)
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JP2000287992A (ja) * | 1999-04-01 | 2000-10-17 | Olympus Optical Co Ltd | 高周波焼灼装置 |
JP2009233269A (ja) * | 2008-03-28 | 2009-10-15 | Fujinon Corp | 内視鏡用高周波処置具 |
JP2012523863A (ja) * | 2009-04-16 | 2012-10-11 | エルベ エレクトロメディジン ゲーエムベーハー | 内視鏡外科器具 |
WO2019169843A1 (en) * | 2018-03-07 | 2019-09-12 | Micro-Tech (Nanjing) Co., Ltd. | Dual-channel injection bipolar high frequency electrosurgical knife |
JP2019213883A (ja) | 2013-04-04 | 2019-12-19 | ボストン サイエンティフィック リミテッド | 2つの摺動するシースを備える二重機能カテーテル |
-
2022
- 2022-02-28 JP JP2023505309A patent/JP7497515B2/ja active Active
- 2022-02-28 EP EP22766898.5A patent/EP4260827A1/en active Pending
- 2022-02-28 WO PCT/JP2022/008379 patent/WO2022190939A1/ja active Application Filing
- 2022-02-28 CN CN202280009723.0A patent/CN116710010A/zh active Pending
- 2022-02-28 US US18/271,788 patent/US20240058054A1/en active Pending
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2000287992A (ja) * | 1999-04-01 | 2000-10-17 | Olympus Optical Co Ltd | 高周波焼灼装置 |
JP2009233269A (ja) * | 2008-03-28 | 2009-10-15 | Fujinon Corp | 内視鏡用高周波処置具 |
JP2012523863A (ja) * | 2009-04-16 | 2012-10-11 | エルベ エレクトロメディジン ゲーエムベーハー | 内視鏡外科器具 |
JP2019213883A (ja) | 2013-04-04 | 2019-12-19 | ボストン サイエンティフィック リミテッド | 2つの摺動するシースを備える二重機能カテーテル |
WO2019169843A1 (en) * | 2018-03-07 | 2019-09-12 | Micro-Tech (Nanjing) Co., Ltd. | Dual-channel injection bipolar high frequency electrosurgical knife |
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