JP4465179B2 - Anoscope - Google Patents

Description

  The present invention relates to a medical spectroscopic device, which can access a treatment unit in the rectum, and particularly relates to an anoscope that can be used for the treatment of hemorrhoids.

  “Diseases of the Colon and Rectum” described by Blaisdell in 1963 is famous as a technique related to the treatment of hemorrhoids by rubber band ligation. The technique involves placing a rubber band on the rectal tissue over an area of hemorrhoids that has little sensation. Tissue trapped within the band is disconnected from its blood supply, denatured and rotted. The rubber band is then passed by intestinal movement together with the tissue that caused the carrion. More importantly, however, the resulting healing process fixes nearby tissue and the escape of the heel tissue is minimized. Furthermore, it was found that the rubber band ligation technique gives relief (sedation, relief) to the symptoms of hemorrhoids.

Currently, many devices that use rubber band ligation technology are on the market. For example, Patent Document 1, Patent Document 2, and Patent Document 3. The devices disclosed in these patents are generally designed to be used with instruments such as a rectoscope or an anoscope to directly view the banded area. In some cases, an assistant is needed to hold the rectoscope or anoscope, and using these observation devices, which are approximately larger in diameter than the banding device, may cause symptoms in the patient, especially hemorrhoids There is considerable pain in those who are sick. An anoscope typically includes a hollow tubular member that is inserted into the anus and colon. The tubular body is adapted to expand the anus and cover the skin of the anal canal. The inner or distal end of the brace is adapted to enter the rectum and colon. A gap, a notch, or a slot is formed at the end portion to be positioned over the entire affected area. The interior of the tubular member is examined by a physician and provides an observation and access passage for performing treatment at the affected area. An anoscope is particularly useful for examination and treatment of hemorrhoids. The tissue of the fold is collected in a single notch at the distal end, and the tissue typically bulges inside the anoscope tube for quick access by the physician. A large-diameter anus that was previously painful for patients to provide ample space for operation of the rubber band ligation device, or any other examination or treatment device, within the anoscope It was chosen to use a mirror. Surgery generally entrusted to the general anesthetic with increased risk and cost of treatment using an anoscope with a diameter greater than 2 inches (5.08 cm) to (2 + 1/2) inches (6.35 cm) depending on the patient Treatment needs to be done in the room. The cost of the anesthetic, operating room and recovery room is approximately $ 1000 per procedure. Therefore, for improved access to the affected area at the notch at the end of the anoscope, while being designed to have a sufficiently small diameter that can be used without the need for general anesthetics, There is a need for an anoscope that allows operation of a rubber band ligation device that is inserted into the anoscope.
US Pat. No. 5,203,863 US Pat. No. 5,122,149 US Pat. No. 5,158,563

  However, it is also an object of the present invention to provide suction that is incorporated therein to draw the heel tissue into the banding opening without requiring a connection to an auxiliary operator or aspirator. It is to provide a rubber band ligating apparatus having the apparatus. The suction device incorporates a locking mechanism to maintain the suction force, thus allowing the physician to perform banding techniques that operate with both hands, which means that only one operator is required Means. Accordingly, the present invention comprises a tubular member having a longitudinal axis and a proximal end and a distal end, a first longitudinal slot extending from the distal end toward the proximal end, and extending from the proximal end to the distal end. The first longitudinal slot and the second longitudinal slot are separated by about 180 ° at the surface of the tubular member, and the first longitudinal slot is treated. Configured to allow access to the site and configured to allow the second longitudinal slot to accommodate a change in direction of the rubber band ligating device at an angle to the longitudinal axis of the tubular member An anoscope is provided for use with a rubber band ligation device that is insertable into the anoscope.

  The present invention has been made in view of such circumstances, and the object thereof is an anoscope having an appropriate diameter to be inserted without pain into the patient's anus including a proximal notch in addition to a distal notch. I will provide a. A proximal notch is external to the anus and a rubber band ligation inserted into the anoscope's longitudinal axis away from the longitudinal axis of the anoscope to improve access to the affected area with the distal notch It can adapt to the direction change of the device.

  The present invention is a complete one with all the necessary elements to complete the ligation of the internal hemorrhoidal tissue, including the ability to suck the hemorrhoidal tissue into the cylinder and place a rubber band around the tissue A rubber band ligation device is provided which operates at a. The rubber band is stretched, and using an incremental step that allows the user to easily stretch the rubber band over the inner tubular member, and a loading cone incorporating ribs, Positioned around the front end of the tubular member. In the case of a conventional loading cone, the rubber band tends to slide back down the cone. The band is released by advancing the outer sleeve over the inner tubular member, thus placing the rubber band over the entire tissue of the fold that is aspirated into the inner tubular member.

  In one embodiment, the ligating device and anoscope are disposable after use.

  The present invention is a plastic inner tubular member for retaining a stretched rubber band over the entire front end, the inner tubular member extending to a length sufficient for insertion into a patient's rectum, and Having a tubular member plunger with handle means extending away from the front end, the handle means having a suction force for drawing the tissue of the fold into the inner tubular member through an opening in the front end A plastic inner tubular member that slides the plunger away from the front end of the inner tubular member to provide, an outer end of the outer tubular sleeve proximate to the stretched rubber band, and fits across the inner tubular member; and Fit the limited friction across the inner tubular member, and the operator can Thumb push means for releasing the rubber band from the front end of the inner tubular member to push the outer tubular pusher sleeve toward the end and to fit the heel tissue through the opening of the inner tubular member A rubber band ligating device operated by a single operator for the treatment of heel tissue comprising an outer tubular sleeve having a plastic outer tubular pusher sleeve having an opposite end.

  The disposable rubber band ligation device can be used in a doctor's office and generally does not require any form of anesthetic. One to three bands are typically placed on each patient visit, and a total of as many as six bands may be needed, especially for advanced cases. In one embodiment, the ligating device and anoscope are made of plastic and are disposable, so once it is used, it does not need to be discarded and sterilized. In another embodiment, the ligation device and anoscope can be made of metal and sterilized after use.

  1-3, various views of a preferred embodiment of an anoscope according to the present invention are shown. The anoscope includes a tubular member 4 that is long enough to be inserted into the patient's rectum. Tubular member 4 defines a hollow body having a longitudinal axis 6 having a proximal end 8 and a distal end 10 at opposite ends. The first longitudinal slot 12 extends from the distal end 10 toward the proximal end 8 by a distance along the tubular member. The first longitudinal slot 12 and the second longitudinal slot 14 are offset by about 180 ° on the surface of the tubular member.

  Formed on the tubular member 4 is a generally frustoconical flange 20 extending in a fringe shape outwardly adjacent to the proximal end 8 traversed by the second longitudinal slot 14. The tubular member 4 has a shape that tapers inwardly toward the distal end 10 in order to facilitate the insertion of the tubular member 4 into the patient's anus and rectum. In the illustrated embodiment, the tapered shape includes a first conical portion 21 formed in a generally conical shape near the proximal end of the tubular member and a second conical portion 23 proximate the distal end. It is formed in two shapes. The body of the tubular member 4 is preferably formed from a transparent medical grade plastic that can be easily discarded after use.

  Obturator 24 (FIG. 7) is used with an anoscope to provide a single composite structure during insertion. The obturator 24 is adapted to slide lengthwise in order to extend through the anoscope along the longitudinal axis 6. The obturator 24 has a dome-shaped or warhead-shaped front portion 24 a protruding from the base end portion 10. The obturator 24 has a body that is generally conical in shape to conform to the internal shape of the tubular member to close the first longitudinal slot 12 and the second longitudinal slot 14. The obturator 24 is somewhat longer than the tubular member 4 so that the flange 24b protrudes from the flange 20 to act as a gripping surface 24b for removing the obturator 24 when the anoscope is inserted. It has become.

  The handle 22 is formed so as to extend from the flange 20 of the proximal end portion 8, and is used by a doctor when the anoscope is inserted. The handle 22 is preferably located on the same side of the tubular member 4 as the first longitudinal slot 12 to ensure that the anoscope tubular body is as strong and rigid as possible.

  As best shown in FIG. 5, the handle 22 is preferably hollow so that a lighting fixture such as a penlight can be inserted into the handle. The penlight works to illuminate the transparent plastic wall of the anoscope by internal reflection of light, and is improved to illuminate the tissue expanded by the anoscope, allowing the doctor to observe it. ing. Such illumination means are conventionally part of an anoscope for examination and surgery.

  Referring to FIG. 4, the first longitudinal slot 12 and the second longitudinal slot 14 are preferably sized to overlap in a region 30 intermediate the ends of the tubular member 4. This arrangement maintains the structural rigidity of the tubular body 4 against contraction of the patient's involuntary muscles and is at an angle with respect to the longitudinal axis 6 of the tubular member 4 within the anoscope. The direction of the medical device to be inserted can be easily changed.

  FIGS. 4, 5 and 6 illustrate the ligating device 40 inserted into the anoscope and changed direction at an angle with respect to the longitudinal axis 6 of the anoscope. FIG. 5 is a cross-sectional view of FIG. 4, and FIG. 6 is a side view of the apparatus shown in FIG. The ligating apparatus 40 shown is a rubber band ligating apparatus described and claimed in US Pat. No. 5,741,273. This rubber band ligation device is particularly suitable for use with the anoscope according to the present invention, with the working tip 42 of the device located in the hemorrhoid in the second longitudinal slot 14 and the next banding The hemorrhoid is inhaled into the working tip 42 for surgery. The anoscope of the present invention is guided through the interior of the anoscope and is redirected away from the longitudinal axis 6 of the anoscope through the second longitudinal slot 14 and the first longitudinal slot. It will be apparent to those skilled in the art that other medical devices that require optimal access to the affected area at 12 locations will be applied.

  The anoscope of the present invention is sufficiently small in diameter that it can be inserted without relying on general anesthetics. Reducing the internal space within the anoscope for manipulating the medical device is substantially offset by extending longitudinally to a second longitudinal slot 14 that cooperates with the first longitudinal slot 12. The operability of the device is allowed by converting the direction of the device to an angle with respect to the longitudinal axis 6 of the anoscope. For example, FIGS. 4 and 5 show that, despite the small diameter of the anoscope tubular body 4, the working tip of the instrument 42 is accurately positioned at the location of the affected area in the first longitudinal slot 12. A device 40 is shown being redirected to an angle of approximately 35 ° relative to the longitudinal axis 6 of the anoscope, which significantly improves the physician's ability.

  In use, the anoscope will be inserted into the patient's anus and rectum. During insertion, the obturator 24 occludes the proximal end 10 of the anoscope, the first longitudinal slot 12 and the second longitudinal slot 14. A frustoconical flange 20 is positioned proximate and protects the patient's anus. The anoscope tubular body 4 expands the anus and covers the skin of the anal canal. The proximal end 10 enters the rectum. After insertion of the anoscope, the obturator 24 is removed from the proximal end 8 and passes through the first longitudinal slot 12 and the second longitudinal slot 14. The tubular member 4 keeps the anus firmly open despite the contracting sphincter movement. In particular, this movement of the contracting anus is strong when no anesthetic is used. The transparent tubular member 4 can ensure observation of hemorrhoids. When the first longitudinal slot 12 of the proximal end 10 is gathered at a point in the hemorrhoid, the tissue is raised into the space provided by the slot so that the tissue can be examined and / or treated by rubber band ligation. Positioned for. Despite any involuntary stenosis, the tubular member 4 keeps the anal canal open and properly observing the rectum. Furthermore, the flange 20 and the tubular body act as an anus and anal canal shield for the equipment used in the procedure. This is especially important for conscious patients who do not use anesthesia or only have partial anesthesia.

  In a preferred device suitable for use with the majority of patients, the anoscope of the present invention has a total length of (3 + 1/2) inches (8.89 cm) and an inner diameter of the proximal end 8 of (1 + 3/8) inches ( 3.49 cm), and the inner diameter of the end portion 10 is preferably 3/4 inch (1.91 cm). The first longitudinal slot 12 extends approximately (1 + 7/8) inches (4.76 cm) along the body, and the second longitudinal slot 14 extends approximately 2 along the body of the tubular member. Inches (5.08 cm) extend. Flange 20 is about (2 + 1/4) inches (5.72 cm) in diameter at the widest point.

FIG. 8 illustrates a ligation device 40, which is a rubber band ligation device operated alone for the treatment of heel tissue,
A plastic inner tubular member 5 for holding a stretched rubber band over the entire front end, the inner tubular member 5 being extended to a length sufficient for insertion into the rectum of a patient; and Having a plunger of a tubular member 36 with handle means extending away from the front end, the handle means for drawing the tissue of the fold into the inner tubular member through the opening 15 at the front end A plastic inner tubular member 5 that slides the plunger away from the front end of the inner tubular member 5 to provide the suction force of the inner tubular member 5 and the insertion end of the outer tubular sleeve 27 proximate to the stretched rubber band 17 Fits across the inner tubular member and provides limited friction throughout the inner tubular member. And the operator presses the outer tubular pusher sleeve 27 toward the front end of the inner tubular member and inserts the heel tissue through the opening 15 in the inner tubular member 5. A plastic outer tubular pusher sleeve 27 having an end opposite to the outer tubular sleeve having a thumb push means 26 for releasing the rubber band 17 from the front end of 5.

  The rubber band ligating apparatus 40 incorporates an inner tubular member 5 and an outer tubular pusher sleeve 27 having a taper that increases in diameter from the front end.

  The rubber band ligating device 40 has an inner tubular member 5 that includes a plunger housing 16, spaced from the front end of the inner tubular member 5 to provide a suction force therein, the plunger 18 is Slide in the plunger housing 16.

  The rubber band ligating device 40 has a conical shape with stepped ribs for insertion into the front end 15 of the inner tubular member 5 in order to load the rubber band 20 across the front end 15 of the inner tubular member 5. Loader (FIG. 9).

  The conical loader (FIG. 9) has a thin sleeve that overlaps the front end 15 of the inner tubular member 5.

  The rubber band ligating device 40 has a front end 15 of the inner tubular member 5 that is rounded.

  The rubber band ligating device 40 has a locking means 37 for holding the plunger in the retracted position of the tubular member 5 in order to keep the suction force in the inner tubular member 16.

  The locking means is at least one shoulder ring in the tubular member for preventing the plunger from moving.

  The locking means 37 has a second safety ring 38 to prevent the plunger 18 from being pulled back far outside the inner tubular member 16.

  While specific embodiments of the invention have been described and illustrated, such embodiments are merely illustrative of the invention and limit the invention as construed by the accompanying laws. It should be considered not to.

  In one embodiment, the rubber band ligating device 40 of the present invention is made of either a transparent plastic or an opaque plastic and is disposable. In another embodiment, the rubber band ligating device 40 is made of stainless steel and can be sterilized after each use. As shown in FIG. 8, the rubber band ligating device 40 has a hemispherical, chamfered, or rounded inner tubular end 19 having an opening 15 that is slightly smaller in diameter than the inner tubular member 5. A member 5 is provided. The inner tubular member 5 may be slightly tapered so that its diameter increases as it extends rearward from the front end 19. In another embodiment, the inner tubular member 5 is not tapered and may be cylindrical in shape. The length of the inner tubular member 5 is sufficient to be inserted into the patient's rectum for treatment of heel tissue. The inner tubular member 5 is integrated with a plunger housing 16 having a plunger 18 therein, so that when the plunger 18 is moved rearwardly within the plunger housing 16, suction force is applied to the opening 15 in the front end 19. It comes to occur in.

  The stretched rubber band 17 or the rubber band cited in some cases is positioned over the entire inner tubular member 5 close to the front end 19. The outer tubular pusher sleeve 27 fits over the inner tubular member 5 and fits on the inner tubular member 5 with limited friction. When the outer tubular pusher sleeve 27 is pushed forward toward the front end 19 of the inner tubular member 5, the rubber band 17 is pushed away from the front end 19 of the inner tubular member 5, and the inner tubular The heel tissue sucked into the opening 15 at the front end of the member 5 is inserted.

  On one side of the outer tubular pusher sleeve 27, a partial pusher flange 26 extending from the end of the outer tubular pusher sleeve 27 is provided. The pusher flange 26 allows the pusher sleeve 27 to be pushed by the surgeon's thumb so that the rubber band 17 is released from the front end 19 of the inner tubular member 5. It has become. A first raised step 28 and a second raised step 30 are shown on one side of the pusher sleeve 22 proximate to the pusher flange 26. These stepped portions 28 and 30 are marks provided for the operator to position the rubber band ligating device 40 either visually or by touch.

  The plunger housing 16 is generally cylindrical and is not a tapered shape, and the outer shoulder 32 allows the housing 16 to be tightly gripped when the plunger 18 is pulled rearward. The plunger 18 is attached to a stem 34. The stem 34 has a cross-sectional shape as shown in FIG. 8, and has a shoulder 36 that acts as a grip. The plunger 18 can be pulled from the housing 16 for suction through the opening 15 in the front end 19 of the inner tubular member 5.

  The first shoulder ring 37 is located on the end side of the housing 16 and acts as a locking system so that the plunger 18 is pulled rearward and the first shoulder ring 37. Is held in that position, and maintains a vacuum in the housing 16 and the inner tubular member 5. In the absence of a locking system, the plunger 18 immediately returns to its original position and there is no vacuum to draw the heel tissue into the inner tubular member 5. The second shoulder ring 38 is positioned outside the first shoulder ring 37 and acts as a stop to prevent the plunger 18 from being pulled out of the housing 16.

  The first and second shoulder rings 37, 38 are shown to lock the plunger 18 in the housing 16, while other ones are used to stop the plunger 18 from returning into the housing 16. It will be apparent to those skilled in the art that a type of fastening system can be provided.

  In operation, when the physician examines the patient's rectum using the anoscope of FIGS. 1-3 and finds the location of the banded fold tissue, the physician then turns to FIG. Insert the ligation device shown. The opening 15 at the front end 19 of the inner tubular member 5 is positioned as close as possible to the heel tissue, and the operator holds the housing 16 and the thumb is positioned on the flange 32. The plunger 18 is pulled backwards past the first shoulder ring 37 so that a vacuum is created in the housing 16, and the tissue of the fold is drawn into the inner tubular member 5 through the opening 15. When this is complete, the physician releases the shoulder 36 of the plunger 18 and advances the thumb pusher 26 to push the outer plastic pusher sleeve 27 forward, and the stretched rubber band 17 is attached to the inner tubular member 5. It is pushed away from the front end 19 and captures the tissue of the eyelid. The rubber band ligation device 40 can then be removed and the procedure can be performed up to three times during a single patient visit to the doctor's office. The built-in plunger mechanism sucks the heel tissue into the inner tubular member 5 and holds it there for the physician to place the rubber band 17 so that the aspirator, or other device, It is not necessary to be attached to the rubber band ligating device 40.

  A conical loading device 41 is shown in FIG. 9 and has a thin sleeve 45 that overlaps the front end 19 of the inner tubular member 5. The rubber band 17 is pushed over the entire loading device 41 and becomes stretched as it advances each stepped portion, or the entire rib. It is moved until the rubber band 17 is pulled away from the sleeve onto the front end 19 of the inner tubular member 5. The loading device 41 is then removed and the rubber band will be moved to the position shown in FIG.

  The thin sleeve 45 of the loading device 41 prevents the rubber band from being caught at the joint portion between the loading device 41 and the inner tubular member 39.

  As shown in FIG. 8, the front end 19 of the inner tubular member 5 is hemispherical or rounded, snagged, or without causing pain to the patient, allowing the physician to The rubber band ligating device 40 can be rotated or reciprocated to increase or control the size of the grip. The rubber band ligating device 40 can be made in different sizes. The inner tubular member 12 preferably has an inner diameter of 8 mm, 10 mm, and 12 mm. The size of the opening 15 is approximately about 0.5 mm to 1 mm, less than the inner diameter of the inner tubular member, to allow a rounded hemispherical edge at the front end 19.

  Various changes may be made to the embodiments shown herein without departing from the scope of the invention, which is limited only by the following claims.

1 is a front perspective view of an embodiment of an anoscope according to the present invention. FIG. 1b is a rear perspective view of the anoscope of FIG. FIG. 6 is an additional posterior perspective view from different angles to clearly show the distal and proximal notches of the anoscope. FIG. 6 is a side view of an anoscope with an inserted ligation tool. It is sectional drawing about FIG. FIG. 5 is a rear elevation view of the combined anoscope and ligation tool of FIG. 4 with the plunger removed. 1 is an elevation view of an obturator device used with an anoscope of the present invention to allow insertion into a patient's anus. FIG. 1 is a sectional elevation view showing a rubber band ligating apparatus according to an embodiment of the present invention. FIG. 2 is a detailed view of a loading cone from various angles.

Explanation of symbols

DESCRIPTION OF SYMBOLS 4 Tubular member 5 Inner tubular member 6 Longitudinal axis 8 Base end part 10 Terminal part 12 First longitudinal slot 14 Second longitudinal slot 15 Opening Front end part of inner tubular member 5 16 Plunger housing 16 Inner tubular member 18 Plunger 17 Rubber band Stretched rubber band 19 Front end portion of inner tubular member 20 Almost frustoconical flange that spreads out in a morning glory shape 21 First substantially conical portion 22 Handle Pusher sleeve 23 Second conical portion 24 Obturator 24a Dome-shaped or warhead-shaped front portion 24b Flange grip, grasping and gripping surface 26 Thumb push means Pusher flange Partial pusher flange 27 Plastic outer tubular pusher sleeve 28 First higher stepped portion First step shape Part 30 Tubular member 2nd stepped portion 1st step portion 32 Outer shoulder portion 34 Stem 36 Tubular member Shoulder portion 37 Locking means First shoulder ring 38 Second dark line ring 40 Rubber band ligating device Equipment 41 Loading device 42 Working tip 45 Thin sleeve

Claims (13)

And a base end portion 8 and the distal portion 10 on the axis of the longitudinal axis, comprising a tubular member 4 having a length sufficient for insertion into a patient's rectum, the said tubular member 4,
A first longitudinal slot 12 extending along the tubular member 4 from the distal end 10 toward the proximal end 8 ;
A second longitudinal slot 14 extending along the tubular member 4 from the proximal end 8 toward the distal end 10 ;
The first longitudinal slot 12 and the second longitudinal slot 14 are offset by about 180 ° on the surface of the tubular member 4 ;
The first longitudinal slot 12 and the second longitudinal slot 14 are sized to overlap in a region in the middle of the ends of the tubular member 4;
The tubular member 4 has an inwardly tapered shape toward the distal end portion 10, and the tapered shape is a first conical portion 21 formed in a substantially conical shape near the proximal end portion 8. And an anoscope formed in two shapes, a second conical portion 23 proximate to the distal end 10 . The anoscope according to claim 1, wherein the tubular member 4 tapers inwardly toward the distal end for easy insertion of the tubular member 4 into the rectum. The anoscope according to claim 2, wherein the base end portion 8 of the tubular member 4 spreads in a morning glory shape toward the outside. The anoscope according to claim 3, wherein the base end portion 8 of the tubular member 4 spreads in a frustoconical shape. The anoscope according to claim 3, wherein a handle is disposed at the proximal end portion of the tubular member . The anoscope according to claim 5, wherein a handle is disposed on the same side of the tubular member as the first longitudinal slot 12 .   6. The anoscope according to claim 5, wherein the anoscope is made of transparent plastic.   The anoscope according to claim 7, wherein the handle is hollow so that a lighting device can be inserted into the handle. An obturator has a hemispherical front portion to close the first and second longitudinal slots 14 of the tubular member 4 to aid insertion into the rectum and is inserted into the tubular member 4 The anoscope according to claim 1, wherein the anoscope is capable of protruding from the end portion and the flange . A tubular member 4 having a proximal end 8 and a distal end 10 ;
A first longitudinal slot 12 extending from the distal end 10 to a portion spaced along the tubular member 4 ;
A second longitudinal slot 14 extending from the proximal end 8 to a portion spaced along the tubular member 4 ;
The first longitudinal slot 12 and the second longitudinal slot 14 are offset by about 180 ° on the surface of the tubular member 4 ;
The first longitudinal slot 12 and the second longitudinal slot 14 are sized to overlap in a region intermediate the ends of the tubular member 4;
The tubular member 4 has an inwardly tapered shape toward the distal end portion 10, and the tapered shape is a first conical portion 21 formed in a substantially conical shape near the proximal end portion 8. And an anoscope formed in two shapes, a second conical portion 23 proximate to the distal end 10 . An anoscope used with a rubber band ligation device 40 insertable into the anoscope,
Comprises a tubular member 4 having a proximal end 8 and a distal portion 10 on the axis of the longitudinal axis, the first longitudinal to the tubular member 4 that extends toward the base end portion 8 from the distal end 10 Slot 12 ;
A second longitudinal slot 14 extending from the proximal end 8 to the distal end 10 ;
The first longitudinal slot 12 and the second longitudinal slot 14 are offset from the surface of the tubular member 4 by about 180 °, and the first longitudinal slot 12 is further treated. Configured to allow access to a site, and the second longitudinal slot 14 is angled with respect to the longitudinal axis of the tubular member 4 so that the rubber band ligating device 40 is redirected. It is configured to allow,
The first longitudinal slot 12 and the second longitudinal slot 14 are sized to overlap in a region intermediate the ends of the tubular member 4;
The tubular member 4 has an inwardly tapered shape toward the distal end portion 10, and the tapered shape is a first conical portion 21 formed in a substantially conical shape near the proximal end portion 8. And an anoscope formed in two shapes, a second conical portion 23 proximate to the distal end 10 . And a base end portion 8 and the distal portion 10 on the axis of the longitudinal axis, comprising a tubular member 4 having a length sufficient for insertion into a patient's rectum, the said tubular member 4,
A first longitudinal slot 12 extending along the tubular member 4 from the proximal end 8 toward the distal end 10 ;
A second longitudinal slot 14 extending along the tubular member 4 from the proximal end 8 toward the distal end 10 ;
The rubber band ligating device 40 can be redirected at an angle with respect to the longitudinal axis of the tubular member 4 ;
The first longitudinal slot 12 and the second longitudinal slot 14 are sized to overlap in a region in the middle of the ends of the tubular member 4;
The tubular member 4 has an inwardly tapered shape toward the distal end portion 10, and the tapered shape is a first conical portion 21 formed in a substantially conical shape near the proximal end portion 8. And an anoscope formed in two shapes, a second conical portion 23 proximate to the distal end 10 . The anoscope according to claim 12 , wherein the first three-handed slot (12) and the second longitudinal slot (14) are offset from the surface of the tubular member (4) by about 180 ° .

Images