CN112584784A - Endoscope treatment instrument and working method thereof - Google Patents
Endoscope treatment instrument and working method thereof Download PDFInfo
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- CN112584784A CN112584784A CN201980053086.5A CN201980053086A CN112584784A CN 112584784 A CN112584784 A CN 112584784A CN 201980053086 A CN201980053086 A CN 201980053086A CN 112584784 A CN112584784 A CN 112584784A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
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- Surgery (AREA)
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- Endoscopes (AREA)
Abstract
The invention provides an endoscopic treatment instrument capable of limiting the position of a treatment tool in an outer cylinder and a working method thereof. The endoscopic treatment instrument includes: an outer cylinder (10) having a distance direction; an inner cylinder (20) disposed in the inner cavity of the outer cylinder (10); and a wire (30) which is disposed in the lumen of the inner tube (20) and has a connection section (31) at the distal end thereof, which is connected to the treatment instrument, wherein the outer tube (10) has a small diameter section (11) which is a section having a small inner diameter in a partial section in the distal direction, wherein the inner tube (20) has a large diameter section (21) which is a section having a large outer diameter in a partial section in the distal direction, wherein the outer tube (10) is movable in the distal direction relative to the inner tube (20), and wherein the section having the smallest inner diameter of the small diameter section (11) is located closer to the end side than the section having the largest outer diameter of the large diameter section (21) in the movable region of the outer tube (.
Description
Technical Field
The present invention relates to an endoscopic treatment instrument used for hemostasis, extraction or resection of a body tissue, injection of a drug solution into the body tissue, and the like in an operation or treatment using an endoscope.
Background
Conventionally, in a treatment using an endoscope such as submucosal dissection (ESD) in an endoscope or mucosal resection (EMR) in an endoscope, an endoscopic treatment instrument such as a clip for stopping bleeding or suturing a lesion when bleeding occurs due to excision of the lesion, a snare or a knife for excising the lesion, a forceps for taking out a body tissue, or a local injection needle for injecting a drug solution into the body tissue has been used.
For example, patent document 1 describes a medical endoscope apparatus which is an insertion tube having an inner tube and an outer tube, and in which a manipulation wire is bundled and which is capable of accurately facing a distal end surface of the insertion tube to an observation target portion without damaging a tissue of a subject when the insertion tube is inserted into the body. Patent document 2 describes an endoscopic treatment instrument including a tube for accommodating a sample extractor at the distal end of an endoscope so as to be movable forward and backward, the tube including a sheath large-diameter portion and a sheath small-diameter portion. Patent document 3 describes an endoscopic puncture needle device in which the outer tube and the inner tube are made of a material having a small friction coefficient, and the endoscopic puncture needle attached to the distal end of the treatment instrument is prevented from buckling, so that the endoscopic puncture needle smoothly exits from the distal end of the outer tube. Patent document 4 describes an endoscopic treatment instrument in which a locking gear is provided on the inner side of an outer tube portion, and an engaging protrusion is provided on the side surface of an inner tube portion, whereby the endoscopic treatment instrument can be advanced and retracted, and the protruding length from the distal end portion of the outer tube to the outside can be changed in multiple stages.
Patent document 1: japanese patent laid-open publication No. 2016-83270
Patent document 2: international publication No. 2013/168498
Patent document 3: japanese patent laid-open publication No. 2013-172842
Patent document 4: japanese patent laid-open No. 2000-37455
A treatment instrument such as a clip is attached to the distal end side of the endoscopic treatment instrument, and is inserted into the endoscope while being housed in the outer tube. In the endoscopic treatment instruments as in patent documents 1 to 4, there is a problem that the position of the treatment instrument in the outer tube is unclear. If the position of the treatment instrument in the outer tube is not appropriate, the treatment instrument may not be projected from the outer tube when the treatment instrument is inserted into the body from the treatment instrument hole of the endoscope disposed in the body, or the outer tube may be excessively projected from the treatment instrument hole to damage the tissue in the body.
Disclosure of Invention
The present invention has been made in view of the above circumstances, and an object thereof is to provide an endoscopic treatment instrument and an operation method thereof, which can restrict the position of a treatment instrument in an outer tube.
The present inventors have conducted intensive studies to solve the above problems, and have completed the present invention. That is, the gist of the present invention is as follows.
[1] An endoscopic treatment instrument comprising: an outer cylinder having a proximal direction; an inner cylinder configured in the inner cavity of the outer cylinder; and a wire which is disposed in the inner cavity of the inner tube and has a connection portion at a distal end thereof to be connected to a treatment instrument, wherein the outer tube has a small diameter portion, which is a portion having a small inner diameter, in a partial section in the distal direction, and the inner tube has a large diameter portion, which is a portion having a large outer diameter, in a partial section in the distal direction, and the outer tube is movable in the distal direction with respect to the inner tube, and wherein a portion having a minimum inner diameter of the small diameter portion is located closer to an end side than a portion having a maximum outer diameter of the large diameter portion in a movable region.
[2] Preferably, the outer cylinder is not fixed to another member.
[3] Preferably, the inner diameter of the small diameter portion is larger than the outer diameter of the inner cylinder disposed inside the small diameter portion and smaller than the outer diameter of the large diameter portion.
[4] Preferably, the small diameter portion is located closer to the end than a midpoint in the distal-proximal direction of the outer cylinder, and the large diameter portion is located closer to the end than the midpoint in the distal-proximal direction of the inner cylinder.
[5] Preferably, the tapered portion is provided on at least one of a distal end side from a midpoint in the distal-proximal direction of the small diameter portion and an end side from the midpoint in the distal-proximal direction of the large diameter portion.
[6] Preferably, the outer diameter of the portion of the outer cylinder where the small diameter portion exists has a smaller outer diameter than the portion of the outer cylinder on the distal end side of the small diameter portion.
[7] Preferably, in the movable region of the outer cylinder, a distal end of the small diameter portion is located closer to an end side than a proximal end of the large diameter portion.
[8] Preferably, the outer tube has a grip portion on an outer surface thereof, and the grip portion is disposed closer to an end side than a midpoint in a distal-proximal direction of the outer tube.
[9] Preferably, the grip portion has a portion protruding from an outer surface of the outer cylinder.
[10] Preferably, the handle is connected to the proximal end of the inner cylinder, and the handle has a receiving portion that contacts the proximal end of the outer cylinder.
[11] Preferably, the receiving portion is disposed inside the handle.
[12] Preferably, the inner cylinder has a handle connected to a proximal end of the inner cylinder, and the inner cylinder is attached to the handle so as to be rotatable about a longitudinal axis of the inner cylinder as a rotation axis.
[13] Preferably, the suture thread comprises a handle connected to the proximal end of the thread, and the portion of the handle connected to the thread is movable in the proximal and distal directions with respect to the handle body.
[14] Preferably, in the movable region of the outer cylinder with respect to the inner cylinder, when the outer cylinder is disposed at the farthest end side in the movable region with respect to the inner cylinder, the distal end of the small diameter portion is disposed at a position in contact with the proximal end of the large diameter portion, and when the outer cylinder is disposed at the nearest end side in the movable region with respect to the inner cylinder, the proximal end of the small diameter portion is disposed at a position in contact with the receiving portion.
[15] An operating method of an endoscopic treatment instrument according to any one of [1] to [14], preferably comprising: moving the outer cylinder to the near end side; connecting a treatment instrument to the connection part; moving the outer tube to the distal end side to dispose the treatment instrument in the lumen of the outer tube; inserting an endoscopic treatment instrument into an endoscope and delivering a treatment instrument to a target site; and a step of moving the outer tube to the proximal end side to expose the treatment instrument from the outer tube.
According to the endoscopic treatment instrument of the present invention, the small diameter portion of the outer tube and the large diameter portion of the inner tube restrict the movable region of the outer tube that is movable in the proximal and distal directions with respect to the inner tube, thereby making it possible to restrict the position of the treatment instrument within the outer tube. Therefore, when the treatment instrument is inserted into the body from the treatment instrument hole of the endoscope disposed in the body, it is possible to prevent the treatment instrument from failing to protrude from the outer tube in the body, or the outer tube from protruding excessively from the treatment instrument hole of the endoscope in the body to damage the tissue in the body.
Drawings
Fig. 1 is a plan view of an entire endoscopic treatment instrument according to an embodiment of the present invention.
Fig. 2 is a schematic cross-sectional view along the proximal-distal direction of the endoscopic treatment instrument shown in fig. 1, in which the outer tube is disposed on the proximal end side of the movable region.
Fig. 3 is a schematic cross-sectional view along the proximal-distal direction of the endoscopic treatment instrument shown in fig. 1, in which the outer tube is disposed on the distal-most side of the movable region.
Fig. 4 is a partially enlarged cross-sectional view along the distal-proximal direction of the endoscopic treatment instrument shown in fig. 1.
Fig. 5 is a partially enlarged cross-sectional view along the distal-proximal direction of an endoscopic treatment instrument according to another embodiment of the present invention.
Fig. 6 is a schematic cross-sectional view along the distal-proximal direction of an endoscopic treatment instrument according to another embodiment of the present invention.
Fig. 7 is a schematic cross-sectional view along the distal-proximal direction of an endoscopic treatment instrument according to another embodiment of the present invention.
Detailed Description
The present invention will be described more specifically below based on the following embodiments, but the present invention is not limited to the following embodiments, and can be modified and implemented as appropriate within a scope conforming to the gist of the foregoing and the following, and these technical means are included in the technical scope of the present invention. Note that, in each drawing, hatching, component reference numerals, and the like may be omitted for convenience, and in the above case, the description and other drawings are referred to. In addition, the dimensions of the various components in the drawings are premised on an understanding of the features of the invention, and therefore, may differ from actual dimensions.
Fig. 1 is a plan view of an entire endoscopic treatment instrument according to an embodiment of the present invention, fig. 2, 3, 6, and 7 are schematic cross-sectional views of the endoscopic treatment instrument along a distal-proximal direction, and fig. 4 and 5 are partial enlarged cross-sectional views of the endoscopic treatment instrument along the distal-proximal direction.
As shown in fig. 1 to 3, an endoscopic treatment instrument 1 of the present invention includes: an outer cylinder 10 having a proximal direction; an inner cylinder 20 disposed in the inner cavity of the outer cylinder 10; and a wire 30 disposed in the lumen of the inner cylinder 20 and having a connecting portion 31 at a distal end thereof to be connected to a treatment instrument. The outer cylinder 10 has a small diameter portion 11, which is a portion having a small inner diameter, in a partial region in the distal direction, and the inner cylinder 20 has a large diameter portion 21, which is a portion having a large outer diameter, in a partial region in the distal direction.
In the present invention, the proximal end side is the side of the user's hand with respect to the direction in which the outer cylinder 10 or the inner cylinder 20 extends, and the distal end side is the side opposite to the proximal end side, i.e., the treatment target side. The extending direction of the outer cylinder 10 or the inner cylinder 20 is referred to as a proximal-distal direction. The radial direction refers to a radial direction of the outer cylinder 10 or the inner cylinder 20, the radially inner side refers to a direction toward the axial center side of the outer cylinder 10 or the inner cylinder 20, and the radially outer side refers to a direction toward the side opposite to the inner side. In fig. 1 to 7, the right side of the drawing is the proximal side, and the left side of the drawing is the distal side.
In the endoscopic treatment instrument 1, a treatment instrument is connected to a connection unit 31 connected to the treatment instrument in a treatment using an endoscope such as ESD or EMR. The treatment instrument is used for cutting a lesion, stopping bleeding, suturing the lesion, extracting a body tissue, injecting a drug solution into the body tissue, and the like. Specific examples of the treatment instrument include a clip for stopping bleeding or suturing a lesion, a local injection needle for injecting a drug solution into a body tissue, a forceps for extracting a body tissue, a snare or a knife for cutting a lesion, and the like.
The outer cylinder 10 is movable in the proximal and distal directions with respect to the inner cylinder 20. That is, the positional relationship between the outer tube 10 and the inner tube 20 can be changed by moving the outer tube 10 relative to the entire endoscopic treatment instrument 1. For example, the outer cylinder 10 can be moved in the proximal-distal direction without moving the inner cylinder 20, and the inner cylinder 20 can be moved in the proximal-distal direction without moving the outer cylinder 10.
As shown in fig. 2, the endoscopic treatment instrument 1 of the present invention is characterized in that, in the movable region of the outer tube 10, the portion of the outer tube 10 having the smallest inner diameter of the small diameter portion 11 is located closer to the end side than the portion of the inner tube 20 having the largest outer diameter of the large diameter portion 21. In the endoscopic treatment instrument 1, the portion of the outer tube 10 having the smallest inner diameter of the small diameter portion 11 is positioned closer to the end side than the portion of the inner tube 20 having the largest outer diameter of the large diameter portion 21, whereby the movable region of the outer tube 10 in the distal and proximal directions with respect to the endoscopic treatment instrument 1 can be controlled, and the position of the connection portion 31 connected to the treatment instrument in the outer tube 10 can be restricted. As a result, it is possible to prevent the treatment instrument from failing to protrude from the outer tube 10 in the body or the outer tube 10 from protruding excessively from the treatment instrument hole of the endoscope in the body to damage the tissue in the body when the treatment instrument is inserted into the body from the treatment instrument hole of the endoscope disposed in the body. The contact portion between the large diameter portion 21 and the small diameter portion 11 is one end of the movable region, and the contact portion between the proximal end of the outer cylinder 10 and the handle 50 is the other end of the movable region, thereby determining the movable region of the outer cylinder 10.
The outer cylinder 10 has a proximal-distal direction and has an inner cavity extending in the proximal-distal direction. Further, an inner cylinder 20 is disposed in the inner cavity of the outer cylinder 10. Further, the outer cylinder 10 can have a connection portion 31 disposed in the inner cavity. The outer tube 10 can dispose the connection portion 31 in the lumen, and thereby at least a part of the treatment instrument connected to the connection portion 31 can be disposed in the outer tube 10. Therefore, the outer tube 10 can prevent the treatment instrument from damaging the jaw opening in the endoscope, the inside of the forceps channel, the body tissue other than the treatment target portion, and the like, before the treatment instrument is conveyed from the jaw opening of the endoscope, which is preferably not fixed to another member, through the forceps channel to the vicinity of the treatment target portion.
The inner cylinder 20 has a proximal-distal direction and has an inner cavity extending in the proximal-distal direction. Preferably, the wire 30 is disposed in the inner cavity of the inner tube 20, and the wire 30 is movable in the proximal and distal directions with respect to the inner tube 20. The wire 30 can move in the proximal and distal directions with respect to the inner tube 20, and thus the treatment instrument connected to the connection portion 31 can be easily operated. Specifically, when the treatment instrument is a clip, the clip can be opened and closed or the degree of opening and closing of the clip can be adjusted by moving the linear object 30 in the proximal and distal directions with respect to the inner tube 20. When the treatment instrument is a forceps, the linear member 30 is moved in the proximal and distal directions with respect to the inner cylinder 20, and thereby the forceps mouth can be opened and closed or the opening and closing degree of the forceps mouth can be adjusted in the same manner as the clip. When the treatment instrument is a snare, the size and the degree of expansion of the loop portion of the snare can be adjusted by moving the wire 30 in the proximal and distal directions with respect to the inner tube 20.
The outer cylinder 10 and the inner cylinder 20 may include, for example, a coil-shaped cylinder formed by spirally winding a metal wire or a plate material, a rotatable cylinder formed by axially connecting a plurality of short cylindrical joint blocks made of metal or synthetic resin, or a cylinder made of synthetic resin.
Examples of the metal constituting the outer cylinder 10 and the inner cylinder 20 include stainless steel such as SUS304 and SUS316, platinum, nickel, cobalt, chromium, titanium, tungsten, gold, Ni — Ti alloy, Co — Cr alloy, and a combination thereof. The metal constituting the outer cylinder 10 and the inner cylinder 20 is particularly preferably an Ni — Ti alloy. The metal constituting the outer cylinder 10 or the inner cylinder 20 is a Ni — Ti alloy, and thus the outer cylinder 10 or the inner cylinder 20 can be formed to have excellent shape memory properties or high elasticity.
Examples of the resin constituting the outer tube 10 and the inner tube 20 include polyamide resins such as nylon, polyolefin resins such as polyethylene and polypropylene, polyester resins such as polyethylene terephthalate (PET), aromatic polyether ketone resins such as polyether ether ketone (PEEK), polyimide resins, fluorine resins such as Polytetrafluoroethylene (PTFE), tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer (PFA), and ethylene-tetrafluoroethylene copolymer (ETFE), and the like.
The material constituting the outer cylinder 10 is, for example, preferably a fluororesin, and more preferably PTFE. Since the material constituting the outer cylinder 10 is a fluororesin, the slidability between the outer cylinder 10 and the inner cylinder 20 disposed in the inner cavity of the outer cylinder 10 is improved, and the outer cylinder 10 can be easily moved in the distance direction with respect to the inner cylinder 20. The material constituting the inner cylinder 20 is preferably different from the material constituting the outer cylinder 10, and for example, when the material constituting the outer cylinder 10 is a fluorine-based resin, the material constituting the inner cylinder 20 is preferably a polyolefin-based resin, and more preferably polyethylene. Since the material of the inner cylinder 20 is different from the material of the outer cylinder 10, the slidability between the inner cylinder 20 and the outer cylinder 10 can be improved, and the movement in the distance direction between the outer cylinder 10 and the inner cylinder 20 can be facilitated.
The material constituting the outer tub 10 is preferably transparent or translucent. Since the material constituting the outer cylinder 10 is transparent or translucent, the positional relationship between the inner cylinder 20 disposed in the inner cavity of the outer cylinder 10 and the outer cylinder 10 can be visually confirmed, and the operability of the endoscopic treatment instrument 1 can be improved.
The inner tube 20 may be a metallic coil-shaped tube. Since the inner tube 20 is a metallic coiled tube, the inner tube 20 having a balanced rigidity and flexibility can be formed, and the endoscopic treatment instrument 1 can be easily inserted from the forceps opening of the endoscope to the treatment target site, and the outer tube 10 and the inner tube 20 can be easily moved in the distal and proximal directions, or the inner tube 20 and the wire 30 can be easily moved in the distal and proximal directions.
The length of the outer tube 10 and the inner tube 20 in the proximal and distal directions can be selected appropriately in consideration of the distance from the jaw opening of the endoscope to the treatment target site, and the like, and in accordance with the length of the wire 30, the outer tube 10, and the inner tube 20 in the proximal and distal directions, and the like. The length of the outer cylinder 10 and the inner cylinder 20 in the near-far direction can be set to, for example, 1000mm to 3000 mm.
The length of the inner tube 20 in the proximal-distal direction is preferably longer than the length of the outer tube 10 in the proximal-distal direction. The length of the inner tube 20 in the distal-proximal direction is longer than the length of the outer tube 10 in the distal-proximal direction, so that the outer tube 10 can be easily moved in the distal-proximal direction with respect to the inner tube 20, and the outer tube 10 can be prevented from protruding excessively in the body and damaging the body tissues other than the treatment target site. The length of the inner tube 20 in the proximal-distal direction is preferably 1.2 times or less, more preferably 1.1 times or less, and still more preferably 1.05 times or less the length of the outer tube 10 in the proximal-distal direction. By setting the upper limit of the ratio of the length in the proximal-distal direction of the inner tube 20 to the length in the proximal-distal direction of the outer tube 10 within the above range, the inner tube 20 and the connection portion 31 can be sufficiently accommodated in the inner cavity of the outer tube 10. As a result, the treatment instrument can hardly damage the forceps opening or the forceps channel in the endoscope, the body tissue other than the treatment target portion, and the like, while the treatment instrument is being conveyed to the treatment target portion.
The dimensions of the outer tube 10 and the inner tube 20 can be appropriately selected according to the dimensions of the forceps hole of the endoscope and the dimensions of other components of the endoscopic treatment instrument 1 such as the connection portion 31. For example, the thickness of the outer cylinder 10 and the inner cylinder 20 is preferably 100 μm or more, more preferably 150 μm or more, and further preferably 200 μm or more. By setting the lower limit of the thickness of the outer cylinder 10 and the inner cylinder 20 within the above range, the rigidity of the outer cylinder 10 and the inner cylinder 20 can be made appropriate, and the outer cylinder 10 can be easily moved in the distance direction with respect to the inner cylinder 20. The thickness of the outer cylinder 10 and the inner cylinder 20 is preferably 500 μm or less, more preferably 400 μm or less, and still more preferably 300 μm or less. By setting the upper limit value of the thickness of the outer cylinder 10 and the inner cylinder 20 within the above range, the flexibility of the outer cylinder 10 and the inner cylinder 20 can be increased, and the endoscopic treatment instrument 1 can be easily delivered from the forceps opening of the endoscope to the treatment target site.
The outer cylinder 10 has a small diameter portion 11, which is a portion having a small inner diameter, in a partial region in the distal direction. That is, the inner diameter of the small diameter portion 11 is smaller than the inner diameter of the portion of the outer cylinder 10 other than the small diameter portion 11. Since the outer cylinder 10 has the small diameter portion 11 and the inner cylinder 20 has the large diameter portion 21, when the outer cylinder 10 is moved toward the distal end side with respect to the inner cylinder 20, the small diameter portion 11 comes into contact with the large diameter portion 21, and the movable region of the outer cylinder 10 toward the distal end side can be restricted. The outer diameter of the section of the outer cylinder 10 in which the small diameter portion 11 is provided may be the same as or different from the section in which the small diameter portion 11 is not provided.
Examples of the method of forming the small diameter portion 11 in the outer cylinder 10 include the following methods: a cylindrical member is inserted into the inner cavity of the outer tube 10 at an arbitrary portion of the outer tube 10, and the outer tube 10 and the cylindrical member are fixed by using an adhesive or the like; an outer tube 10 made of heat-shrinkable resin, and heating an arbitrary portion of the outer tube 10 to reduce the diameter thereof; the outer cylinder 10 is reduced in diameter by covering an arbitrary portion of the outer cylinder 10 with a cylindrical member and caulking or the like. In particular, it is preferable to heat and reduce the diameter of the outer cylinder 10 to form the small diameter portion 11. By forming the small diameter portion 11 by heating and reducing the diameter of the outer cylinder 10, the small diameter portion 11 can be easily formed in the outer cylinder 10, and the production efficiency of the endoscopic treatment instrument 1 can be improved.
The inner cylinder 20 has a large diameter portion 21, which is a portion having a large outer diameter, in a partial section in the distal direction. That is, the outer diameter of the large diameter portion 21 is larger than the outer diameter of the portion of the inner tube 20 other than the large diameter portion 21. As described above, when the outer cylinder 10 having the small diameter portion 11 is moved toward the proximal end side with respect to the inner cylinder 20 having the large diameter portion 21, the small diameter portion 11 and the large diameter portion 21 come into contact with each other, whereby the movable region of the outer cylinder 10 toward the proximal end side can be restricted.
Examples of the method of forming the large diameter portion 21 in the inner tube 20 include the following methods: covering the cylindrical member at an arbitrary position of the inner tube 20, and fixing the inner tube 20 and the cylindrical member with an adhesive or the like; inserting the inner tube 20 into the inner cavity of the tubular member and caulking the tubular member to bring the inner tube 20 into close contact with the tubular member; the inner tube 20 is covered with a heat shrinkable tube, and the heat shrinkable tube is heated to be closely attached to the inner tube 20. In particular, it is preferable that the large diameter portion 21 is formed by covering the cylindrical member with the inner tube 20 and fixing the inner tube 20 and the cylindrical member with an adhesive or the like. By forming the large diameter portion 21 by covering the cylindrical member with the inner cylinder 20 and fixing the inner cylinder 20 and the cylindrical member, the large diameter portion 21 can be easily formed, and the production efficiency of the endoscopic treatment instrument 1 can be improved.
The wire 30 has a proximal-distal direction and has a connecting portion 31 at a distal end. The wire 30 may be cylindrical having a lumen extending in the proximal-distal direction, but is preferably solid. Since the wire 30 is solid, the rigidity of the wire 30 can be improved without excessively increasing the outer diameter of the wire 30, and the outer diameter of the endoscopic treatment instrument 1 can be reduced and the insertion property of the endoscopic treatment instrument 1 can be improved.
Examples of the material constituting the string-like member 30 include metal wires such as stainless steel and carbon steel, polyamide resins such as nylon, polyolefin resins such as PP and PE, polyester resins such as PET, aromatic polyether ketone resins such as PEEK, polyimide resins, and synthetic resin fibers such as fluorine resins such as PTFE, PFA, and ETFE. The material constituting the wire 30 is particularly preferably a stainless steel wire. The wire 30 is made of stainless steel wire, and thus has a required strength and improved biocompatibility.
Although not shown, the wire 30 may have a coating layer on the surface of the wire 30. The wire 30 has a coating layer, and thus the friction between the wire 30 and the inner tube 20 can be reduced to improve the sliding property, or the strength of the wire 30 can be improved. Examples of the coating layer include fluorine-based resins such as PTFE, PFA, ETFE, tetrafluoroethylene-hexafluoropropylene copolymer (FEP), and the like.
As a method for forming a coating layer on the wire 30, for example, a material for forming a coating layer may be coated on the wire 30, and for example, a dipping method, a spraying method, a fluidized bed method, a kneading coating method, or the like can be used.
The length of the wire 30 in the proximal-distal direction can be selected as appropriate in accordance with the length of the outer tube 10 or the inner tube 20 in the proximal-distal direction, taking into consideration the distance from the jaw opening of the endoscope to the treatment target site, and the like, similarly to the length of the outer tube 10 or the inner tube 20 in the proximal-distal direction. The length of the wire 30 in the near-far direction may be, for example, 1000mm to 3000 mm.
The length of the wire 30 in the proximal-distal direction is preferably longer than both the length of the outer tube 10 in the proximal-distal direction and the length of the inner tube 20 in the proximal-distal direction. Since the length of the wire 30 in the distal-proximal direction is longer than both the length of the outer tube 10 in the distal-proximal direction and the length of the inner tube 20 in the distal-proximal direction, the outer tube 10 can be easily moved in the distal-proximal direction with respect to the inner tube 20, and the outer tube 10 can be prevented from protruding excessively in the body to damage the body tissue and the like other than the treatment target region. The length of the thread 30 in the near-far direction can be set according to the movable region of the slider 52, and is, for example, preferably 1.15 times or less, more preferably 1.1 times or less, and still more preferably 1.05 times or less the length of the inner tube 20 in the near-far direction. By setting the upper limit of the ratio of the length of the wire 30 in the proximal-distal direction to the length of the inner tube 20 in the proximal-distal direction within the above range, the wire 30 can be easily moved in the proximal-distal direction, and the treatment instrument connected to the connection portion 31 can be easily operated.
The outer diameter of the wire 30 is preferably 100 μm or more, more preferably 200 μm or more, and further preferably 300 μm or more. By setting the lower limit of the outer diameter of the wire 30 within the above range, the rigidity of the wire 30 can be improved, and the insertion property of the endoscopic treatment instrument 1 can be improved. The outer diameter of the wire 30 is preferably 0.8 times or less, more preferably 0.5 times or less, and further preferably 0.15 times or more, more preferably 0.3 times or more the inner diameter of the inner tube 20. That is, the outer diameter of the wire 30 is preferably in the range of 0.8 to 0.15 times, and more preferably in the range of 0.5 to 0.3 times the inner diameter of the inner tube 20. By setting the upper limit value of the outer diameter of the wire 30 within the above range, the outer diameter can be reduced while maintaining the rigidity of the wire 30, and the diameter of the endoscopic treatment instrument 1 can be reduced. The outer diameter of the wire 30 may be the same or different over the entire length. For example, a portion of the wire 30 disposed inside the handle 50 or a portion on the proximal end side may be thickened for reinforcement. As the reinforcing member, a tube may be disposed on the outer side surface of the thread 30.
The connecting portion 31 is provided at the distal end of the wire 30. The connection portion 31 is a portion for connecting a treatment instrument to the endoscopic treatment instrument 1. The connecting portion 31 may be a part of the wire 30, or may be another member for connecting a treatment tool to the distal end of the wire 30. By providing the connection portion 31 at the distal end portion of the wire 30, it is possible to facilitate connection between the treatment instrument and the wire 30 or removal of the treatment instrument from the wire 30, to facilitate treatment using the endoscopic treatment instrument 1, and to shorten the treatment time.
When the connection portion 31 is a member disposed at the distal end of the wire 30 and different from the wire 30, examples of the material constituting the connection portion 31, that is, the other member for connecting the treatment instrument include metals such as stainless steel and carbon steel, polyamide resins such as nylon, polyolefin resins such as PP and PE, polyester resins such as PET, aromatic polyether ketone resins such as PEEK, polyimide resins, and synthetic resins such as fluorine resins such as PTFE, PFA, and ETFE. The material constituting the other members for connecting the treatment instrument is particularly preferably the same as the material constituting the wire 30. In the case where the connection portion 31 is a member different from the wire 30, the connection portion 31 and the wire 30 can be firmly joined by using the same material as the material constituting the wire 30. Therefore, the connection portion 31 is less likely to fall off from the wire 30, and the durability of the endoscopic treatment instrument 1 can be improved.
In the case where the connection portion 31 is a member disposed at the distal end of the wire 30 and different from the wire 30, the method of fixing another member for connecting the treatment instrument to the wire 30 may be, for example, mechanical fixing by a connection member such as screwing, caulking, fitting, or pressing, welding by laser or heat, or adhesion by an adhesive or a tape. The connection portion 31 serving as a member for connecting other members of the treatment instrument is particularly preferably fixed to the thread 30 by welding. By fixing other members for connecting a treatment instrument to the wire 30 by welding, the bonding strength between the connection portion 31 and the wire 30 can be easily increased, and the possibility of damage to the endoscopic treatment instrument 1 can be reduced.
The outer diameter of the connecting portion 31 is preferably smaller than the inner diameter of the inner cylinder 20. That is, the connection portion 31 is preferably disposed in the inner cavity of the inner tube 20. Since the outer diameter of the connecting portion 31 is smaller than the inner diameter of the inner tube 20, the connecting portion 31 can be accommodated in the inner cavity of the inner tube 20 when the endoscopic treatment instrument 1 is delivered from the jaw opening of the endoscope to the treatment target site. As a result, the connection portion 31 is housed in the lumen of the outer tube 10, and the connection portion 31 and the treatment instrument can be prevented from damaging the jaw opening or the forceps channel in the endoscope, the body tissue other than the treatment target portion, and the like. In order to dispose the treatment instrument in the outer tube 10, the outer diameter of the connection portion 31 is preferably smaller than the inner diameter of the outer tube 10.
As shown in fig. 4 and 5, the inner diameter of the small diameter portion 11 of the outer cylinder 10 is preferably larger than the outer diameter of the inner cylinder 20 disposed inside the small diameter portion 11 and smaller than the outer diameter of the large diameter portion 21 of the inner cylinder 20. In the endoscopic treatment instrument 1, the inner diameter of the small diameter portion 11 of the outer cylinder 10 is larger than the outer diameter of the inner cylinder 20 disposed inside the small diameter portion 11 and is smaller than the outer diameter of the large diameter portion 21 of the inner cylinder 20, so that the movement of the outer cylinder 10 in the proximal and distal directions with respect to the inner cylinder 20 is not hindered and the outer cylinder 10 can be prevented from excessively moving to the distal end side. Therefore, the position of the treatment instrument in the outer tube 10 can be limited to an appropriate position, and it is possible to prevent the treatment instrument from failing to protrude from the outer tube 10 in the body or the outer tube 10 from protruding excessively from the endoscope and damaging the tissue in the body.
The inner diameter of the small diameter portion 11 of the outer cylinder 10 is preferably 1.05 times or more, more preferably 1.1 times or more, and still more preferably 1.2 times or more the outer diameter of the inner cylinder 20 disposed inside the small diameter portion 11. By setting the lower limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the inner tube 20 disposed inside the small diameter portion 11 within the above range, the outer tube 10 can be smoothly moved in the proximal and distal directions with respect to the inner tube 20, and the treatment using the endoscopic treatment instrument 1 can be easily performed. The inner diameter of the small diameter portion 11 is preferably 1.2 times or less, more preferably 1.1 times or less, and still more preferably 1.05 times or less the outer diameter of the inner tube 20 disposed inside the small diameter portion 11. By setting the upper limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the inner tube 20 disposed inside the small diameter portion 11 within the above range, the outer diameter of the outer tube 10 can be prevented from becoming excessively large, and the endoscopic treatment instrument 1 having good insertion performance can be formed.
The inner diameter of the small diameter portion 11 is preferably 0.9 times or less, more preferably 0.85 times or less, and still more preferably 0.8 times or less the outer diameter of the large diameter portion 21. By setting the upper limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the large diameter portion 21 within the above range, the small diameter portion 11 of the outer cylinder 10 can be prevented from moving to the distal end side beyond the large diameter portion 21 of the inner cylinder 20, and the body tissue and the like can be prevented from being damaged by the outer cylinder 10 protruding excessively in the body. The inner diameter of the small diameter portion 11 is preferably 0.5 times or more, more preferably 0.6 times or more, and still more preferably 0.7 times or more the outer diameter of the large diameter portion 21. By setting the lower limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the large diameter portion 21 within the above range, the flexibility of the small diameter portion 11 of the outer cylinder 10 can be made sufficient, and even in a state where the transport path is curved when the endoscopic treatment instrument 1 is transported to the vicinity of the treatment target site, the outer cylinder 10 can be smoothly moved in the distal and proximal directions with respect to the inner cylinder 20.
The small diameter portion 11 may be provided at any position in the distal/proximal direction of the outer tube 10, but is preferably located on the end side of the midpoint in the distal/proximal direction of the outer tube 10. The small diameter portion 11 is located closer to the end side than the midpoint of the outer cylinder 10 in the distal and proximal directions, and thus the small diameter portion 11 can be easily formed in the outer cylinder 10, and the endoscopic treatment instrument 1 can be easily manufactured. In addition, a tapered portion 12 of the small diameter portion 11, which will be described later, is easily formed in the small diameter portion 11.
The small diameter portion 11 is preferably located on the end side of the midpoint in the distal/proximal direction of the outer tube 10, more preferably located on the end side of the midpoint in the distal/proximal direction of the outer tube 10 and the midpoint of the proximal end of the outer tube 10, and still more preferably located at the proximal end of the outer tube 10. The small diameter portion 11 is located closer to the end side than the midpoint of the outer tube 10 in the distal-proximal direction and the midpoint of the proximal end of the outer tube 10, so that the small diameter portion 11 can be formed more easily in the outer tube 10, and the manufacturing efficiency of the endoscopic treatment instrument 1 can be improved.
The large diameter portion 21 may be provided at any position in the distal and proximal direction of the inner tube 20, but is preferably located closer to the end side than the midpoint in the distal and proximal direction of the inner tube 20. The large diameter portion 21 is located closer to the end side than the midpoint in the distal-proximal direction of the inner tube 20, and thus the large diameter portion 21 can be easily formed in the inner tube 20, and the endoscopic treatment instrument 1 can be easily manufactured. Further, the tapered portion 22 of the large diameter portion 21, which will be described later, can be easily formed in the large diameter portion 21.
The large diameter portion 21 is preferably located on the end side of the midpoint in the distal/proximal direction of the inner tube 20, but more preferably located on the end side of the midpoint in the distal/proximal direction of the inner tube 20 and the midpoint of the proximal end of the inner tube 20. The large diameter portion 21 is located closer to the end side than the midpoint of the inner tube 20 in the distal-proximal direction and the midpoint of the proximal end of the inner tube 20, and thus the large diameter portion 21 can be easily formed in the inner tube 20, and the manufacturing efficiency of the endoscopic treatment instrument 1 can be easily improved.
As shown in fig. 5 and 6, the outer tube 10 preferably has tapered portions 12 and 22 on at least one of the distal end side from the midpoint P1 in the distal direction of the small diameter portion 11 and the end side from the midpoint P2 in the distal direction of the large diameter portion 21. The endoscopic treatment instrument 1 has the tapered portions 12 and 22 on at least one of the distal end side of the outer tube 10 relative to the distal-to-proximal direction midpoint P1 of the small diameter portion 11 and the end side of the large diameter portion 21 relative to the distal-to-proximal direction midpoint P2, and thus can prevent the small diameter portion 11 and the large diameter portion 21 from being damaged when the small diameter portion 11 and the large diameter portion 21 come into contact with each other by moving the outer tube 10 in the distal-to-proximal direction relative to the inner tube 20. For example, the tapered portion 12 provided on the distal end side of the small diameter portion 11 of the outer cylinder 10 is preferably tapered such that the inner diameter of the outer cylinder 10 increases toward the distal end side. In this case, the inner diameter of the distal end of the tapered portion 12 may be the same as or different from the inner diameter of the portion of the outer cylinder 10 where the tapered portion 12 or the small diameter portion 11 is not provided. The movable region of the outer cylinder 10 may be determined by the end of the large diameter portion 21 of the inner cylinder 20 contacting the middle portion of the tapered portion 12.
As shown in fig. 5 and 6, the small diameter portion 11 preferably has a tapered portion 12 on the distal end side of a midpoint P1 in the distal and proximal direction of the small diameter portion 11, and when the outer cylinder 10 is disposed on the most distal end side with respect to the movable region of the inner cylinder 20, the surface of the tapered portion 12 of the small diameter portion 11 is in contact with the surface of the large diameter portion 21 of the inner cylinder 20. Preferably, the large diameter portion 21 has a tapered portion 22 on the end side of the midpoint P2 in the distal and proximal direction of the large diameter portion 21, and when the outer cylinder 10 is disposed on the farthest end side with respect to the movable region of the inner cylinder 20, the surface of the tapered portion 22 of the large diameter portion 21 contacts the surface of the small diameter portion 11 of the outer cylinder 10. In the endoscopic treatment instrument 1, when the outer tube 10 is disposed at the most distal end side with respect to the movable region of the inner tube 20, the surface of the tapered portion 12 of the small diameter portion 11 is in contact with the surface of the large diameter portion 21 of the inner tube 20, and the surface of the tapered portion 22 of the large diameter portion 21 is in contact with the surface of the small diameter portion 11 of the outer tube 10, whereby the outer tube 10 and the inner tube 20 are fixed to each other, and excessive movement of the distal end 10a of the outer tube 10 to the distal end side can be more effectively prevented.
The tapered portions 12 and 22 are preferably provided on at least one of the distal end side from the midpoint P1 in the distal direction of the small diameter portion 11 and the end side from the midpoint P2 in the distal direction of the large diameter portion 21, and more preferably, the tapered portions 12 and 22 are provided on both the distal end side from the midpoint P1 in the distal direction of the small diameter portion 11 and the end side from the midpoint P2 in the distal direction of the large diameter portion 21. More specifically, the tapered portion 12 is preferably provided on the distal end side of the midpoint P1 in the distal-proximal direction of the small diameter portion 11, and the tapered portion 22 is preferably provided on the end side of the midpoint P2 in the distal-proximal direction of the large diameter portion 21. In the endoscopic treatment instrument 1, since the tapered portions 12 and 22 are provided on both the distal end side of the midpoint P1 in the distal and proximal directions of the small diameter portion 11 and the end side of the midpoint P2 in the distal and proximal directions of the large diameter portion 21, when the outer tube 10 is disposed on the distal end side in the movable region thereof, the tapered portion 12 of the small diameter portion 11 and the tapered portion 22 of the large diameter portion 21 come into contact with each other, the outer tube 10 and the inner tube 20 can be more firmly fixed, and excessive movement of the distal end 10a of the outer tube 10 to the distal end side can be further prevented.
When the outer cylinder 10 is transparent or translucent, the small diameter portion 11 is preferably colored so that the small diameter portion 11 can be visually recognized from the outside of the outer cylinder 10. That is, the color of the small diameter portion 11 and the color of the outer cylinder 10 are preferably different from each other. The difference in color means that the color of the small diameter portion 11 and the color of the outer tube 10 differ from each other in at least one of hue, brightness, and chroma specified in JIS Z8721. Since the small diameter portion 11 can be visually recognized from the outside of the outer cylinder 10, the movable region of the outer cylinder 10 can be visually recognized.
It is preferable that the outer tub 10 is not fixed to other members. Since the outer tube 10 is not fixed to another member, when performing a treatment using the endoscopic treatment instrument 1, the treatment instrument is stored in the endoscopic treatment instrument 1 or exposed from the endoscopic treatment instrument 1 by moving the outer tube 10 disposed on the outermost surface in the radial direction of the endoscopic treatment instrument 1 in the distal-proximal direction, and thus the operability of the endoscopic treatment instrument 1 can be improved.
When the outer cylinder 10 is not fixed to another member, the inner cylinder 20 is preferably fixed to another member. As a member for fixing the inner tube 20, for example, as shown in fig. 1 to 3, a handle 50 of the endoscopic treatment instrument 1 and the like can be mentioned. In the endoscopic treatment instrument 1, since the outer tube 10 is not fixed to another member and the inner tube 20 is fixed to another member, the outer tube 10 can be easily moved in the proximal and distal directions with respect to the inner tube 20, and the treatment instrument can be easily stored in or exposed from the endoscopic treatment instrument 1. The handle 50 will be described in detail later.
As shown in fig. 5, the outer diameter of the portion of the outer cylinder 10 where the small diameter portion 11 exists is preferably smaller than the outer diameter of the portion of the outer cylinder 10 on the distal end side of the small diameter portion 11. Since the outer diameter of the portion of the outer cylinder 10 where the small diameter portion 11 exists is smaller than the outer diameter of the outer cylinder 10 on the distal end side of the small diameter portion 11, the outer cylinder 10 can be easily pulled into the lumen of another object such as the handle 50, and the length of the endoscopic treatment instrument 1 in the distal and proximal directions can be prevented from becoming excessively long.
More preferably, the entire outer diameter of the portion of the outer cylinder 10 where the small diameter portion 11 exists is smaller than the outer diameter of the portion of the outer cylinder 10 on the distal end side of the small diameter portion 11. Further, it is preferable that the outer diameter of the outer cylinder 10 from the portion where the small diameter portion 11 exists to the proximal end of the outer cylinder 10 is smaller than the outer diameter of the portion of the outer cylinder 10 on the distal end side of the small diameter portion 11. The outer diameter of the entire portion of the outer cylinder 10 where the small diameter portion 11 exists is smaller than the outer diameter of the portion of the outer cylinder 10 on the distal end side of the small diameter portion 11, whereby the outer diameter of the proximal end portion of the outer cylinder 10 can be made smaller, and the outer cylinder 10 can be more easily pulled into another object such as the handle 50.
As shown in fig. 2, 3, and 7, in the movable region of the outer cylinder 10, the distal end 11a of the small diameter portion 11 is preferably located closer to the end side than the proximal end 21b of the large diameter portion 21. In the movable region of the outer cylinder 10, the distal end 11a of the small diameter portion 11 is located closer to the end side than the proximal end 21b of the large diameter portion 21, and therefore the small diameter portion 11 of the outer cylinder 10 is less likely to move to the distal end side beyond the large diameter portion 21 of the inner cylinder 20, and the movable region in the distal and proximal directions of the outer cylinder 10 can be further restricted.
As shown in fig. 1 and 7, the outer cylinder 10 preferably has a grip 40 on the outer surface. Since the outer cylinder 10 has the grip portion 40 on the outer surface, when the outer cylinder 10 is moved in the proximal and distal directions with respect to the inner cylinder 20, the outer cylinder 10 can be easily gripped sufficiently, and the operability of the endoscopic treatment instrument 1 can be improved.
The grip 40 is preferably disposed on the end side of the midpoint in the distal/proximal direction of the outer tube 10. By disposing the grip portion 40 at a position closer to the end side than the midpoint in the distal and proximal directions of the outer tube 10, the outer tube 10 can be gripped more easily, and the operation of accommodating the connection portion 31 or the treatment instrument in the lumen of the outer tube 10 can be performed easily.
Examples of the material constituting the grip portion 40 include synthetic resins such as polyamide resins, polyolefin resins, polyester resins, aromatic polyether ketone resins, polyimide resins, and fluorine resins, and metals such as stainless steel and carbon steel. The material constituting the grip 40 is preferably the same as the material constituting the outer cylinder 10. Since the material constituting the grip portion 40 is the same as the material constituting the outer tube 10, the grip portion 40 can be easily and firmly fixed to the outer tube 10, and the grip portion 40 can be prevented from coming off the outer tube 10 in use of the endoscopic treatment instrument 1.
The color of the grip 40 and the color of the outer tube 10 are preferably different from each other. The different colors mean that at least one of the hue, brightness, and chroma specified in JIS Z8721 is different between the color of the grip 40 and the color of the outer tube 10. Since the color of the grip 40 and the color of the outer tube 10 are different from each other, the visibility of the grip 40 is improved, and the endoscopic treatment instrument 1 can be easily handled. When the outer cylinder 10 is transparent or translucent, the grip portion 40 is preferably opaque. Since the grip portion 40 is opaque, the visibility of the grip portion 40 can be further improved. The color of the grip portion 40 may be, for example, opaque black.
Examples of the method of fixing the grip portion 40 to the outer tube 10 include adhesion with an adhesive, fixing by heat welding, and mechanical fixing such as fitting, press-fitting, and caulking the grip portion 40 to the outer tube 10. The method of fixing the grip portion 40 to the outer tube 10 is particularly preferably fixing using an adhesive. By fixing the grip portion 40 to the outer tube 10 using an adhesive, the grip portion 40 can be easily and firmly fixed to the outer tube 10.
The grip 40 preferably has a portion protruding from the outer surface of the outer cylinder 10. Since the grip portion 40 has a portion protruding from the outer surface of the outer cylinder 10, when the outer cylinder 10 is moved in the proximal-distal direction with respect to the inner cylinder 20, the grip portion 40 is easily gripped, and the outer cylinder 10 is easily moved in the proximal-distal direction.
The number of the grip portions 40 may be one, but is preferably plural. The plurality of gripping portions 40 makes it easier to grip the outer tube 10. The number of the grip portions 40 is preferably 5 or less, more preferably 3 or less, and further preferably 2.
Preferably, the endoscopic treatment instrument 1 has a handle 50 connected to the proximal end of the inner barrel 20. The handle 50 is a member to be held by a user when the endoscopic treatment instrument 1 is operated. The endoscopic treatment instrument 1 has a handle 50, whereby the operation of the endoscopic treatment instrument 1 becomes easy.
The handle 50 preferably has a socket 51 that contacts the proximal end of the outer barrel 10. The handle 50 has a receiving portion 51 that contacts the proximal end of the outer cylinder 10, and thus can prevent the outer cylinder 10 from moving excessively toward the proximal end during movement of the outer cylinder 10 in the distal-proximal direction with respect to the inner cylinder 20, thereby improving operability of the endoscopic treatment instrument 1. By providing the receiving portion 51 in the handle 50, the movable region of the outer cylinder 10 toward the proximal end side can be restricted by the receiving portion 51. Further, when the large diameter portion that restricts the portion of the outer cylinder 10 where the small diameter portion 11 and the large diameter portion 21 contact each other in the movable region on the proximal end side is the first large diameter portion, the second large diameter portion is provided at the position on the end side of the inner cylinder 20 with respect to the first large diameter portion, and the movable region on the proximal end side of the outer cylinder 10 can be restricted by the portion where the small diameter portion 11 and the second large diameter portion contact each other.
As shown in fig. 2 and 3, the receiving portion 51 may be disposed at the distal end of the handle 50, but is preferably disposed inside the handle 50 as shown in fig. 7. By disposing the receiving portion 51 inside the handle 50, the proximal end side of the outer tube 10 can be accommodated in the handle 50 when the outer tube 10 is moved to the proximal end side with respect to the inner tube 20, such as when a treatment instrument is connected to the connection portion 31 or when the treatment instrument is exposed from the outer tube 10 to operate the treatment instrument. Therefore, the endoscopic treatment instrument 1 can be prevented from becoming excessively long in the distal-proximal direction, and the endoscopic treatment instrument 1 can be easily handled.
Preferably, the endoscopic treatment instrument 1 is provided with a handle 50, and when the handle 50 is connected to the proximal end portion of the inner tube 20, the inner tube 20 is attached to the handle 50 so as to be rotatable about the longitudinal axis of the inner tube 20. The inner tube 20 is rotatably attached to the handle 50 with the long axis of the inner tube 20 as a rotation axis, and thus operability can be ensured even when the endoscopic treatment instrument 1 is rotated in a forceps hole of an endoscope or when a twist or a torsion is applied to the endoscopic treatment instrument 1. In particular, when the wire 30 is attached to the handle 50 so as to be movable in the proximal-distal direction and not independently rotatable, and the inner tube 20 is attached to the handle so as to be rotatable without being movable in the proximal-distal direction, operability can be ensured, and the endoscopic treatment instrument 1 having high followability of the treatment instrument with respect to the operation of the handle 50 can be formed. In this case, the wire 30 is preferably rotated in accordance with the rotation of the handle 50.
The handle 50 may also have a slider 52 attached to the proximal end of the wire 30 and capable of moving in the proximal-distal direction. The handle 50 has the slider 52, and thus, when the treatment instrument is connected to the connection portion 31 or when the treatment instrument connected to the connection portion 31 is operated, the wire 30 can be easily moved in the proximal and distal directions, and the operability of the endoscopic treatment instrument 1 can be improved.
As shown in fig. 3, when the outer cylinder 10 is disposed at the farthest end side in the movable region with respect to the inner cylinder 20, the distal end 11a of the small diameter portion 11 is preferably disposed at a position in contact with the proximal end 21b of the large diameter portion 21. By disposing the outer cylinder 10 at the distal end side and disposing the distal end 11a of the small diameter portion 11 at a position in contact with the proximal end 21b of the large diameter portion 21, the small diameter portion 11 and the large diameter portion 21 can restrict the movable region on the distal end side of the outer cylinder 10, and it is possible to prevent the outer cylinder 10 from moving more than necessary to the distal end side, failing to protrude the treatment tool from the outer cylinder 10 in the body, or excessively protruding the outer cylinder 10 to damage the tissue in the body.
As shown in fig. 2, when the outer cylinder 10 is disposed on the proximal end side with respect to the movable region of the inner cylinder 20, the proximal end 11b of the small diameter portion 11 is preferably disposed at a position in contact with the receiving portion 51. When the outer cylinder 10 is disposed on the proximal end side, the proximal end 11b of the small diameter portion 11 is disposed in contact with the receiving portion 51, whereby the small diameter portion 11 and the receiving portion 51 can restrict the movable region on the proximal end side of the outer cylinder 10. Therefore, the outer tube 10 can be prevented from moving excessively to the proximal end side, and the operation of storing the treatment instrument connected to the connection portion 31 in the outer tube 10 can be prevented from being difficult.
The operation method of the endoscopic treatment instrument 1 of the present invention includes the steps of: a step of moving the outer cylinder 10 to the proximal end side; a step of connecting the treatment instrument to the connection portion 31; a step of moving the outer tube 10 to the distal end side to dispose the treatment instrument in the lumen of the outer tube 10; a step of inserting the endoscopic treatment instrument 1 into an endoscope and delivering a treatment tool to a target site; and a step of moving the outer tube 10 to the proximal end side to expose the treatment instrument from the outer tube 10.
First, in order to easily specify the position of a target region such as a lesion, a step of scattering a pigment to the target region or a step of marking the periphery of the target region may be performed. The marking can be performed by cauterizing the periphery of the target site using a high-frequency instrument, for example. In the case of excising the lesion, a step of injecting physiological saline or hyaluronic acid between the muscular layer and the submucosa of the lesion to raise the lesion may be performed. By performing the step of raising the lesion, the lesion can be easily removed.
First, the outer cylinder 10 is moved to the proximal end side, and the inner cylinder 20 is exposed from the outer cylinder 10. At this time, it is preferable to move the wire 30 to the distal end side to expose the connection portion 31 from the inner tube 20. By exposing the connection portion 31 from the inner tube 20, the process of attaching the treatment instrument to the connection portion 31 can be easily performed.
Then, a treatment instrument is connected to the connection portion 31. The treatment instrument includes a snare, a knife, a clip, a forceps, a local injection needle, and the like, and is selected according to the treatment to be performed. After the treatment instrument is connected to the connection portion 31, the outer tube 10 is moved to the distal end side, and the treatment instrument is disposed in the lumen of the outer tube 10. By disposing the treatment instrument in the lumen of the outer tube 10 after the treatment instrument is connected to the connection portion 31, it is possible to prevent the injury of the jaw opening or the forceps channel in the endoscope, the body tissue other than the target site, and the like while the treatment instrument is being conveyed to the target site.
Then, the endoscopic treatment instrument 1 is inserted into an endoscope, and a treatment instrument is sent to a target site. Specifically, the distal end of the endoscopic treatment instrument 1 is inserted into a forceps channel from a forceps port of an endoscope, and the treatment instrument is delivered to a target site through the inside of the forceps channel. At this time, the operator moves the endoscopic treatment instrument 1 while observing the position, state, and the like of the target site using the image acquired from the endoscope.
After the treatment instrument is conveyed to the target site, the outer tube 10 is moved to the proximal end side, and the treatment instrument is exposed from the outer tube 10. Since the treatment instrument is stored in the outer tube 10 before the treatment instrument is delivered to the target site by exposing the treatment instrument from the outer tube 10 after the treatment instrument is delivered to the target site, damage to the jaw opening of the endoscope, the tissue in the body other than the target site, and the like can be prevented, and the treatment instrument is exposed from the outer tube 10 after the treatment instrument reaches the target site, so that the operation of the treatment instrument is not hindered. Then, the treatment instrument is operated by, for example, moving the wire 30 to the proximal end side as necessary.
As described above, an endoscopic treatment instrument according to the present invention includes: an outer cylinder having a proximal direction; an inner cylinder configured in the inner cavity of the outer cylinder; and a wire which is disposed in the inner cavity of the inner tube and has a connection portion at a distal end thereof to be connected to a treatment instrument, wherein the outer tube has a small diameter portion, which is a portion having a small inner diameter, in a partial section in the distal direction, and the inner tube has a large diameter portion, which is a portion having a large outer diameter, in a partial section in the distal direction, and the outer tube is movable in the distal direction with respect to the inner tube, and wherein a portion having the smallest inner diameter of the small diameter portion is located closer to the end side than a portion having the largest outer diameter of the large diameter portion in a movable region. The endoscopic treatment instrument of the present invention is configured such that the small diameter portion of the outer tube and the large diameter portion of the inner tube restrict the movable region of the outer tube that is movable in the proximal and distal directions with respect to the inner tube, and therefore the position of the treatment instrument within the outer tube can be restricted, and it is possible to prevent the treatment instrument from failing to protrude from the outer tube within the body or the outer tube from excessively protruding from the treatment instrument hole of the endoscope within the body and damaging the tissue within the body when the treatment instrument is inserted into the body from the treatment instrument hole of the endoscope disposed within the body.
The present application claims priority from japanese patent application No. 2018-219669, filed on 11/22/2018. For reference, the entire contents of the specification of japanese patent application No. 2018-219669, applied 11/22/2018, are incorporated into the present application.
Description of the reference numerals
1 … endoscopic treatment instrument; 10 … an outer barrel; 10a … distal end of outer barrel; 11 … minor diameter portion; 11a … distal end of the small diameter portion; 11b … proximal end of the small diameter portion; 12 … taper of small diameter; 20 … inner cylinder; 20a … distal end of inner barrel; 21 … large diameter section; 21b … proximal end of the major diameter; 22 … taper of large diameter; 30 … a wire; a 31 … connection; 40 … a handle; 50 … a handle; 51 … a socket; 52 … sliders; the midpoint in the proximal direction of the P1 … small diameter portion; the midpoint of the large diameter portion P2 … in the proximal and distal directions.
Claims (15)
1. An endoscopic treatment instrument comprising:
an outer cylinder having a proximal direction;
an inner cylinder disposed in an inner cavity of the outer cylinder; and
a wire which is disposed in the inner cavity of the inner cylinder and has a connection part connected to a treatment instrument at a distal end part,
the outer cylinder has a small diameter portion, which is a portion having a small inner diameter, in a partial region in the distal direction,
the inner cylinder has a large diameter portion, which is a portion having a larger outer diameter, in a partial region in the distal direction,
the outer cylinder is movable in the proximal and distal directions with respect to the inner cylinder,
in the movable region of the outer cylinder, a portion of the small diameter portion having the smallest inner diameter is located closer to an end side than a portion of the large diameter portion having the largest outer diameter.
2. The endoscopic procedure instrument of claim 1,
the outer cylinder is not fixed to other members.
3. The endoscopic procedure instrument of claim 1 or 2,
the inner diameter of the small diameter portion is larger than the outer diameter of the inner cylinder disposed inside the small diameter portion, and is smaller than the outer diameter of the large diameter portion.
4. An endoscopic treatment instrument as defined in any one of claims 1 to 3,
the small diameter portion is located closer to the end side than the midpoint of the outer cylinder in the distal and proximal directions,
the large diameter portion is located closer to an end side than a midpoint in a far and near direction of the inner tube.
5. An endoscopic treatment instrument as defined in any one of claims 1 to 4,
the tapered portion is provided on at least one of a distal end side from a midpoint in a distal-proximal direction of the small diameter portion and an end side from the midpoint in the distal-proximal direction of the large diameter portion.
6. An endoscopic treatment instrument as defined in any one of claims 1 to 5,
the outer diameter of the portion of the outer cylinder where the small diameter portion exists has a smaller outer diameter than the portion of the outer cylinder on the distal end side of the small diameter portion.
7. An endoscopic treatment instrument as defined in any one of claims 1 to 6,
in the movable region of the outer cylinder, a distal end of the small diameter portion is located closer to an end side than a proximal end of the large diameter portion.
8. An endoscopic treatment instrument as defined in any one of claims 1 to 7,
the outer cylinder has a grip portion on an outer surface,
the grip portion is disposed closer to an end side than a midpoint in a distal-proximal direction of the outer tube.
9. The endoscopic procedure instrument of claim 8,
the grip portion has a portion protruding from an outer surface of the outer cylinder.
10. An endoscopic treatment instrument as defined in any one of claims 1 to 9,
having a handle connected to the proximal end of the inner barrel,
the handle has a bolster in contact with the proximal end of the outer barrel.
11. The endoscopic procedure instrument of claim 10,
the receiving part is arranged in the handle.
12. An endoscopic treatment instrument as defined in any one of claims 1 to 11,
having a handle connected to the proximal end of the inner barrel,
the inner cylinder is rotatably attached to the handle with a long axis of the inner cylinder as a rotation axis.
13. An endoscopic treatment instrument as defined in any one of claims 1 to 12,
having a handle connected to the proximal end of the wire,
the portion of the handle connected to the wire is movable in the proximal-distal direction with respect to the handle body.
14. The endoscopic procedure instrument of claim 10 or 11,
in a movable region of the outer cylinder with respect to the inner cylinder, when the outer cylinder is disposed on a farthest end side in the movable region with respect to the inner cylinder, a distal end of the small diameter portion is disposed at a position in contact with a proximal end of the large diameter portion, and when the outer cylinder is disposed on a closest end side in the movable region with respect to the inner cylinder, a proximal end of the small diameter portion is disposed at a position in contact with the receiving portion.
15. An operating method of an endoscopic treatment instrument according to any one of claims 1 to 14,
the method for operating the endoscopic treatment instrument is characterized by comprising the following steps:
moving the outer cylinder to a proximal end side;
connecting the treatment instrument to the connection part;
moving the outer tube to a distal end side to dispose the treatment instrument in an inner cavity of the outer tube;
inserting the endoscopic treatment instrument into an endoscope and delivering the treatment instrument to a target site; and
and a step of moving the outer tube to a proximal end side to expose the treatment instrument from the outer tube.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2018-219669 | 2018-11-22 | ||
| JP2018219669 | 2018-11-22 | ||
| PCT/JP2019/040419 WO2020105315A1 (en) | 2018-11-22 | 2019-10-15 | Endoscope treatment tool and method for operating same |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN112584784A true CN112584784A (en) | 2021-03-30 |
Family
ID=70774198
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201980053086.5A Pending CN112584784A (en) | 2018-11-22 | 2019-10-15 | Endoscope treatment instrument and working method thereof |
Country Status (3)
| Country | Link |
|---|---|
| JP (1) | JP7445604B2 (en) |
| CN (1) | CN112584784A (en) |
| WO (1) | WO2020105315A1 (en) |
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| JP4334736B2 (en) * | 2000-04-26 | 2009-09-30 | オリンパス株式会社 | Endoscopic needle |
| JP4512724B2 (en) | 2006-03-16 | 2010-07-28 | 有限会社リバー精工 | Endoscopic treatment tool |
| JP2011206228A (en) * | 2010-03-29 | 2011-10-20 | Fujifilm Corp | Endoscope treatment tool |
| JP5781347B2 (en) * | 2011-03-28 | 2015-09-24 | 日本ゼオン株式会社 | Endoscopic treatment tool |
| WO2018011847A1 (en) * | 2016-07-11 | 2018-01-18 | オリンパス株式会社 | Endoscope treatment tool |
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2019
- 2019-10-15 JP JP2020558155A patent/JP7445604B2/en active Active
- 2019-10-15 WO PCT/JP2019/040419 patent/WO2020105315A1/en active Application Filing
- 2019-10-15 CN CN201980053086.5A patent/CN112584784A/en active Pending
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| JPH08280701A (en) * | 1995-04-13 | 1996-10-29 | Olympus Optical Co Ltd | Ligature device |
| JP2000037455A (en) * | 1998-07-23 | 2000-02-08 | Clinical Supply:Kk | Treatment implement for endoscope |
| JP2006180938A (en) * | 2004-12-24 | 2006-07-13 | Olympus Corp | Injection needle for endoscope |
| JP2010221059A (en) * | 2010-06-09 | 2010-10-07 | Olympus Corp | Ligation apparatus |
| JP2013183960A (en) * | 2012-03-09 | 2013-09-19 | Hoya Corp | Flexible endoscope with insertion shape detection function |
| CN104349734A (en) * | 2012-05-25 | 2015-02-11 | 富士胶片株式会社 | Endoscopic surgery device and outer sleeve tube |
| CN203524629U (en) * | 2012-10-09 | 2014-04-09 | 富士胶片株式会社 | Optical fiber maintaining device and endoscope system |
Also Published As
| Publication number | Publication date |
|---|---|
| JP7445604B2 (en) | 2024-03-07 |
| JPWO2020105315A1 (en) | 2021-10-21 |
| WO2020105315A1 (en) | 2020-05-28 |
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