JP2002253562A - Medical treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical treatment instrument capable of easily and surely holding, fixing, releasing, pulling, and collecting a tissue and an organ. SOLUTION: This endoscopic treatment instrument is provided with a flexible sheath, an operation wire having a treatment part opened when the tip side projects from the sheath, and an operation means for driving the operation wire. In this instrument a ratchet mechanism of the operation means can mechanically hold and fix the organ and the treatment part plane of the operation wire has an appropriate angle so as to fasten and release it, while observing the treatment part loop from the frontal view on the endoscope screen.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an operating means and an operating wire for a medical treatment tool used in endoscopic and endoscopic surgery.

[0002]

2. Description of the Related Art In recent years, endoscopic surgery and endoscopic surgery have been widely performed. The operation under the endoscope is a method of performing an operation by remote control while watching an image viewed from the endoscope on a screen. The operator who actually performs the surgery performs the surgery by remote control while exchanging a plurality of treatment tools while watching the video projected on the endoscope on the screen. Tissues and organs excised by surgery are collected using a general snare, a collection tool with a bag, forceps, or the like. A general snare burns and collects the tissue by high frequency. However, when the organ is grasped and collected outside the body, the handle is closed and the loop of the treatment section is closed, and the organ is grasped and taken out of the body. However, since there is no mechanism for fixing the slide portion, if the grip is loosened during collection, the organ may fall into the body. In addition, it has been pointed out that in general snares, when the endoscope is positioned almost parallel because the plane of the tip opening is on the wire axis, the wire opening is difficult to see from the endoscope. Improvements have been required.

As for the ratchet mechanism, Japanese Utility Model Publication No.
As disclosed in Japanese Patent Publication No. 21436 and Japanese Utility Model Publication No. 5-111842, a ratchet portion including a plurality of saw-tooth-shaped locking claws whose blades face in the direction of the rear end of the operation portion is provided on the operation portion.
There has been proposed an operation member in which a claw and a release button are provided on an operation member so that a distal end forceps portion or the like is immobile unless a release button is pressed. These require a separate button member for release, precise processing,
There is a problem that the mold processing and the forming processing are difficult and the cost is greatly increased.

Further, Japanese Patent Application Laid-Open No. H11-332870 discloses an endoscope treatment tool in which a stopper with a ratchet mechanism is variably provided for adjusting a sliding length of a slide portion in an operation portion. However, since the stopper and the slide portion are separate members, the fixing mechanism is not considered for the slide portion, and there is a problem in the gripping force at the time of collection, like a general snare.

Japanese Patent Application Laid-Open No. H11-226024 discloses that the plane of the opening of the distal end of the wire is bent at a shallow angle with respect to the plane of the distal end of the tube by the expanding direction restricting means, so that the living tissue can be securely grasped, resected and removed. Something that can be sucked and discharged has been proposed. However, since the wire tip opening is located along the outer diameter of the tube, gripping of a larger organ is not assumed. In addition, since the wire is inserted through the forceps hole of the endoscope, the position of the wire opening is difficult to see, and it is difficult to confirm the position of the distal end of the tube.

[0006]

SUMMARY OF THE INVENTION The present invention solves such a drawback of the conventional endoscopic surgery, and an object of the present invention is to easily and reliably grasp and fix tissues and organs. -To provide a medical treatment tool that can be released, towed, and collected.

[0007]

That is, the present invention provides:
(1) A flexible sheath, an operation wire inserted in the sheath and provided with a treatment section on the distal end side, and an operation section having a first finger hook and a second finger hook, and In an endoscope treatment tool provided with an operation means including a fixed slide portion, a ratchet groove is provided in the operation portion along a tightening direction, and the slide portion is slidable with respect to the operation portion, and the slide portion is provided with a ratchet groove. A medical treatment tool provided with a fixing / releasing means in a ratchet groove, (2) a treatment section plane of the operation wire is 1 mm away from the axis of the wire.
The medical treatment tool according to (1), which has an angle of 5 to 60 degrees,
(3) The medical treatment tool according to (1) or (2), wherein a slide groove for sliding the slide portion is provided in the operation portion, and (4) the fixing / releasing means of the slide portion is integrally formed with the slide portion. ) To any one of the medical treatment tools according to (3), (5).
The medical treatment tool according to any one of (1) to (4), wherein the direction in which the plane of the treatment portion of the operation wire has an angle is opposite to the direction of the fixing / releasing means side of the slide portion of the operation means.

[0008]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be specifically described below with reference to the drawings. FIG. 1 is a plan view of a medical treatment tool according to an embodiment of the present invention, FIG. 2 is a side view of the medical treatment tool when it is protruded, FIG. 3 is a cross-sectional view of operation means, and FIG. The mechanism sectional view is shown. FIG. 5 is a plan view of the operating means of the medical treatment tool according to another embodiment, FIG. 6 is a side view of the operating means, FIG. 7 is a sectional view of the operating means, FIG. The ratchet mechanism sectional drawing is shown. FIG. 9 is a plan view of an operation means of a medical treatment tool according to another embodiment of the present invention, and FIG. 10 is a side view of the operation means.
FIG. 11 is a sectional view of the operating means, and FIG. 12 is a sectional view of the ratchet mechanism. FIG. 13 is a schematic view showing an example of an operation representing a procedure using a medical treatment tool. FIGS. 14A and 14B are schematic diagrams when the medical treatment tool is observed from the endoscope. FIG. 14A shows a state in which the operation wire treatment unit has a certain angle, and FIG. FIG. 15 is a schematic view showing an operation method of releasing the ratchet mechanism by the operation means.

The structure of the medical treatment tool according to the present invention comprises an operating means (1), a sheath (8), and an operating wire (9), and the operating means (1) comprises an operating part (2) and a slide part (6). ) And a connector (11), and a slide part (6) can be moved forward and backward on the operation part (2). The sheath (8) is connected between the operation part (2) and the connector (11), and the operation wire (9) is inserted therein. The operation wire (9) is fixed in the slide part (6) of the operation means (1), and enters the sheath (8) from the tip of the operation part (2). When the slide section (6) is moved to the front side of the operation section (2), when the treatment section (10) of the operation wire (9) protrudes from the distal end of the sheath (8) and opens and moves to the rear side. Is in a state where the treatment section (10) is housed in the sheath (8). When the slide part (6) is moved to the rear side of the operation part (2), the fixing release means (7) of the slide part (6) and the ratchet groove (3) of the operation part (2) are fitted. They move together and do not return in the projecting direction unless they are released using the fixing release means (7).

(Operation unit) Operation unit (2) of operation means (1)
Is usually produced by injection molding. A first finger hook (4) is provided on the hand side of the operation unit (2), and a ratchet groove (3) is formed in at least a part of the entire length. The first finger hook (4) is not particularly limited as long as the operator's thumb can be fixed.
It is preferable to set it to ３０30 mm. Further, the ratchet groove (3) is formed in a shape to be fitted to the fixing releasing means of the slide portion (6), and is usually formed inside the operation portion (2) as shown in FIG. 1, FIG. 5 or FIG. .

There is no problem if the ratchet groove (3) is formed on the entire length of the slide portion (6). However, in order to improve the operability, the ratchet groove (3) is formed around the portion to be tightened to the extent that the organ is tightened. It only has to be manufactured in the part. The maximum slide length of the slide unit (6) moving on the operation unit (2) is when the palm of the operator is fully extended, and is usually 75.
It is set between １００100 mm. Therefore, the total length of the operation unit (2) is set to about 120 to 250 mm.
The length of the ratchet groove is preferably set to about 1 to 5 mm, and if it is smaller than 1 mm, it takes time to tighten to the required size. If it is larger than 5 mm, the width of the force for tightening the organ is widened, and only one tightening is required There is a danger that the organs will be torn.

To prevent the tip of the slide portion (6) from rising when the slide portion (6) is moved, FIG.
A slide groove (12) may be provided as shown in FIG. The material of the operation section (2) is preferably a hard and slippery material, and a metal such as a vinyl chloride resin, a polycarbonate resin, an ABS resin, a polyacetal resin, a polyamide resin, a polypropylene resin, a polyethylene resin, or a stainless steel is used. You.

(Sliding Part) The sliding part (6) of the operating means (1) is formed so as to surround the operating part (2) and is attached so as to move back and forth on the operating part (2). Usually, it is produced by injection molding or the like. Slide part (6)
The second finger hook (5) is installed at the hand side of the device.
(5) is not particularly limited as long as the index part and the middle finger of the operator can be inserted and the slide part (6) can be slid, but when it is formed in a circular shape, the inner diameter is 15 to 3
Preferably, it is set to 0 mm.

A fixing release means (7) is provided at the tip side of the slide portion (6), and may be made of the same molded product as the slide portion (6), or attached to the slide portion (6) as a separate member. Alternatively, insert molding may be used. The positional relationship between the fixing release means (7) and the ratchet groove (3) of the operation unit (2) is as follows: when the fixing release means (7) is formed as shown in FIG.
When the sliding portion (6) is pulled toward the hand, the fixing releasing means (7) is bent by the slit extending toward the hand side from the fixing releasing means (7) at the tip of the sliding portion (6), and the fixing releasing means (7)
The fixing part (13) of the ratchet groove (3) of the operation part (2)
Although it slides while being fitted to the, it slides toward the hand side, but is fixed to the distal end side and does not return.

When moving to the distal end side, the fitting with the ratchet groove (3) is released while pressing the button (14) of the fixing releasing means (7), and the slide is made toward the distal end side. When the fixing releasing means is formed as shown in FIG. 8, it is slid to the hand side as in FIG. 4, but is fixed to the tip side and does not return. When moving to the distal end side, the button (14) of the fixing release means (7) is pulled to release the engagement with the ratchet groove (3), and then slide to the distal end side. Fixed part (1
When 3) is fitted, the fixing strength is more likely to be higher than the specification shown in FIG.

Further, as shown in FIG. 12, when the fixing release means (7) is formed by reversing the direction of the button (14) and the slit from that of FIG. 8, when the sliding portion (6) is pulled toward the hand, the sliding portion ( 6) The fixing part (1) of the fixing releasing means (7)
Since 3) slides while being fitted into the ratchet groove (3) of the operation section (2), it slides toward the hand side but is fixed to the distal end side and does not return. When moving to the distal end side, the fitting with the ratchet groove (3) is released while pressing the button (14) of the fixing releasing means (7), and the distal end side is slid. This method facilitates one-handed operation.

When performing a one-handed operation, a button is provided near the second finger hook (5) so that the index finger can be hooked on the button (14) with the middle finger inserted in the second finger hook (5). It is necessary to arrange (14). In this case, the position of the button (14) is preferably 1 to 5 cm from the center line of the second finger hook (5). Further, by moving the slide member (15) of the slide part (6) by fitting the slide member (15) into the slide groove (12) of the operation part (2), the floating in front of the slide part (6) can be prevented, and the fixing part ( 13) It is possible to prevent the detachment and improve the ratchet fitting sound. The material of the sliding part (6) and the fixing releasing means (7) is preferably a hard and slippery material, such as vinyl chloride resin, polycarbonate resin, ABS resin, polyacetal resin, polyamide resin, polypropylene resin, polyethylene resin, and stainless steel. Etc. are used.

(Sheet) The sheath (8) has a hand side attached to the operation section (2), and an operation wire (9) inside.
Is inserted. Usually, it is formed by extrusion or the like. The length of the sheath (8) is about 500 to 3000 mm when put into an endoscope or a trocar with a forceps hole, and the outer diameter is about 1 to 3 mm in consideration of the inner diameter of the forceps hole such as an endoscope. It is appropriate that the thickness is about 0.5 to 2.8 mm. The method of attaching the sheath (8) and the operation unit (2) is welding, bonding,
Any method such as fitting may be used. In general, a method is used in which the end of the sheath (8) is flanged and fastened and fixed between the connector (11) and the operation section (2).

The material of the sheath (8) is an operation wire (9)
It should be made of a material that slides easily with the forceps hole of the endoscope, etc., and that does not easily break or break, such as vinyl chloride resin, urethane resin, fluorine resin, polyamide resin, polypropylene resin, polyethylene resin, and other resins. However, a composite material of a metal coil, a metal mesh, or the like for providing rigidity is not limited.

(Operation Wire) The operation wire (9) is formed by metal working. The treatment section (10) has a loop diameter of 10 to 35 mm, which is about the same size as a commonly used loop for a high-frequency snare, and has an outer diameter of 0.1 to 2 mm to be inserted into and taken out of the sheath (8). The stainless steel wire or mini rope is suitable, but the material is not particularly limited as long as it has a rigidity that can maintain the loop shape and does not easily affect the body.

The operating wire (9) may be rod-shaped in the operating means (1) in order to improve linear operability in the operating means (1), and the operation wire (9) is connected to the slide portion (6). Alternatively, the caulked portion may be inserted into the slide portion (6) or fitted to a metal plate embedded in the slide portion.

As shown in the side view of FIG. 2, the operating wire (9) further includes a treatment section (1) at the tip of the operating wire (9).
0) is at an angle of 15 to 60 degrees with respect to the plane of the normal treatment unit (10). In the case of endoscopic surgery, as shown in FIG. When the medical treatment instrument of the present invention is inserted, the treatment section (10) has an angle, so that the treatment section loop of the medical treatment instrument can be directly viewed in the field of view of the laparoscope as shown in FIG.
Compared to the case where no angle is provided as in FIG.
The operation of inserting the organ into the treatment section loop becomes easy.

FIGS. 2 and 10 show the positional relationship between the unlocking means (7) of the operating means (1) and the operating wire (9).
When the operation wire (9) and the treatment section (10) are angled in the opposite direction to the button (14), the treatment section (10) is inserted into a trocar with a forceps hole and viewed through an endoscope. ) Can be operated with one hand. FIG. 15 shows an operation of releasing the fixation with the index finger.

(Connector) The connector (11) is used for fixing the sheath (8) to the operation unit (2).
Usually, it is formed by injection molding. The attachment to the operation unit (2) may be performed by bonding, welding, screwing, or the like. The material used for the connector (11) is a metal such as vinyl chloride resin, polycarbonate resin, ABS resin, polyacetal resin, polyamide resin, polypropylene resin, polyethylene resin, or stainless steel.

(Method of Use) Next, the actual method of using the medical treatment tool according to the present invention will be described with reference to FIGS.
5, the effect of the present invention will be clarified. In the case of endoscopic surgery, as shown in FIG. 13, a laparoscope is inserted into a trocar having a forceps hole, and the inside of the abdominal cavity is observed to confirm the removed organ. The slide part (6) of the medical treatment tool of the present invention is moved in the tightening direction on the hand side, and the treatment part (10) is stored in the sheath (8). Insert the sheath tip into the forceps hole of the trocar with the forceps hole, and confirm with a laparoscope that the sheath tip has reached the abdominal cavity.

At this time, the fixing releasing means (7) of the operating means (1) is operated by the first finger hook (4) and the second finger hook (5).
When the operator's thumb, index finger, and middle finger are held so that they come to the back of the hand, the angle of the operation part wire (9) is set so that the plane of the operation part wire (9) is inside, so that the operation wire (9 14), the loop of the treatment section (10) can be seen in front of the laparoscope as shown in FIG. 14 (a), and the organs can be displaced as compared with the case where no angle is formed as shown in FIG. 14 (b). The operation of inserting the inside of the treatment section loop becomes easy, and the release (projection) operation can be performed with one hand.

As shown in FIG. 13, a grasping forceps inserted from another trocar is inserted into the loop of the treatment section (10) to grasp the organ, and is drawn into the loop of the treatment section (10). With the organ retracted, the slide part (6) is moved in the tightening direction on the hand side to firmly grasp the organ. At this time, the operation means (1) has a ratchet mechanism, and the slide portion (6) does not move to the release side. At the same time as the trocar, the medical treatment tool is pulled out of the body together with the organ, and the organ is collected.

To release the fixing, as shown in FIG. 15, while pressing the button (14) of the fixing releasing means (7) of the slide part (6) with the index finger, the fitting between the fixing part (13) and the ratchet groove (3) is performed. Release and push the slide part (6) to the tip side,
The loop of the treatment section (10) is expanded, and the organ is removed.

Thus, "when the organ is grasped and collected from the inside of the body to the outside by the ratchet mechanism of the operation means, the organ can be mechanically grasped and fixed, and there is no need to retrieve while grasping." Is bent to an appropriate angle, so that the treatment section can be seen directly from the laparoscope,
The operation of passing the organ through the loop has become easier. "" The release button is set on the back of the hand, and the bending direction of the operation wire is set to the inner side. The release operation can be performed with one hand. "

[0030]

The medical treatment instrument of the present invention can be inserted into a forceps hole such as a trocar having a forceps hole, and the loop of the treatment section can be directly viewed with an endoscope, and the organ can be grasped and fixed simply and reliably by one-handed operation. Since it can be released, the operator's stress can be reduced, and the organ collection time can be speeded up.

[Brief description of the drawings]

FIG. 1 is a plan view of a medical treatment tool according to an embodiment of the present invention.

FIG. 2 is a side view of one embodiment at the time of protrusion.

FIG. 3 is a cross-sectional view of an operation unit according to one embodiment.

FIG. 4 is a schematic view of an unlocking means and a cross-sectional view of a ratchet mechanism according to one embodiment.

FIG. 5 is a plan view of an operation means of a medical treatment tool according to another embodiment.

FIG. 6 is a side view of an operation unit according to another embodiment.

FIG. 7 is a cross-sectional view of an operation means according to another embodiment.

FIG. 8 is a schematic view of a fixing releasing means and a cross-sectional view of a ratchet mechanism of another embodiment.

FIG. 9 is a plan view of the operation means of the medical treatment tool according to another embodiment.

FIG. 10 is a side view of the operation means of another embodiment.

FIG. 11 is a cross-sectional view of an operation unit according to another embodiment.

FIG. 12 is a sectional view of a ratchet mechanism according to another embodiment.

FIG. 13 is a schematic view showing an example of an operation representing a procedure using a medical treatment tool.

14A and 14B are schematic diagrams when a medical treatment tool is observed from an endoscope, in which FIG. 14A shows a state in which an operation wire treatment unit has a certain angle, and FIG. 14B shows a state in which the treatment unit is not bent. It is.

FIG. 15 is a schematic diagram showing a method of operating a ratchet mechanism release by operating means.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Operation means 2 Operation part 3 Ratchet groove 4 First finger part 5 Second finger part 6 Slide part 7 Fixation releasing means 8 Sheath 9 Operation wire 10 Treatment part 11 Connector 12 Slide groove 13 Fixed part 14 Button

Claims (5)

[Claims] 1. An operation wire having a flexible sheath, an operation wire inserted into the sheath and provided with a treatment section at a distal end, and an operation section having a first finger hook section and a second finger hook section. In an endoscope treatment tool provided with an operation means including a slide portion to which a wire is fixed, a ratchet groove is provided in the operation portion along a tightening direction, and the slide portion is slidable with respect to the operation portion, and slides. A medical treatment instrument characterized in that a means for fixing / releasing with a ratchet groove is provided in the portion. 2. The medical treatment tool according to claim 1, wherein the treatment section plane of the operation wire has an angle of 15 to 60 degrees with respect to the axis of the wire. 3. The medical treatment tool according to claim 1, wherein the operation portion has a slide groove for sliding the slide portion. 4. The medical treatment tool according to claim 1, wherein the means for fixing and releasing the slide portion is formed integrally with the slide portion. 5. The medical treatment tool according to claim 1, wherein the direction in which the operation wire has an angle with the plane of the treatment portion is opposite to the direction of the fixing / releasing means side of the slide portion of the operation means.