JP2005021561A - Endoscope anchor teleguiding system and endoscopic treatment method using anchor teleguiding system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope anchor teleguiding system and an endoscopic treatment method using the anchor teleguiding system quickly and easily treating an object part, and constantly tensioning a connecting member when moving the anchor in a prescribed direction. <P>SOLUTION: The endoscope anchor teleguiding system is provided with a retaining member 3 retaining the object part Z1; a magnetic anchor 2; a string-shaped connecting member 4 connecting the magnetic anchor to the retaining member; a length adjuster 31 having a pair of fixing pieces 32 contacting with the string-shaped connecting member, and an energizing piece 33 which can take an elastically deformed state of contacting with the string-shape connecting member between the pair of fixing pieces and facing in approximately parallel to a plane connecting the pair of fixing pieces, and a free state of moving in the separating direction; and a magnetic anchor teleguiding device. This system applies a power to the magnetic anchor between the pair of fixing pieces and the energizing piece of the length adjuster in a state where the effective length of the string connecting member is made to reduce in the free state of the energizing piece so as to lift the retained object part. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an endoscope remote anchor guidance system and an endoscopic treatment method using an anchor remote guidance system used when excising a lesion under endoscopic observation.

  Conventionally, when excising a lesion inside a human body in a normal operation, the distance between the lesion and the adjacent normal tissue is widened by lifting the lesion using a grasping forceps, and the lesion and the normal tissue are in that state. It is excised between. However, for example, in endoscopic mucosal resection (EMR), since only one endoscope can be inserted into the body, the lesion cannot be lifted, and the normal mucous membrane around the lesion cannot be lifted with an injection needle. Saline was injected to raise the lesion, and in that state, a high-frequency knife or snare was used to perform excision between the lesion and the normal mucosa.

However, in such a conventional method, the lesioned part could not be lifted to a sufficient position, and thus a sufficient excision part at the boundary between the lesioned part and the normal tissue could not be secured.
In addition, when the lesioned part has a flat shape, it may not be possible to create an excised part.

  Further, during the excision work, the already excised lesioned part may fall on the normal tissue, thereby obstructing the field of view by the endoscope, particularly when the lesioned part is large. For this reason, the excised part cannot be seen, and in order to remove it blindly, the normal part is damaged and complications such as perforation occur, blood vessels are damaged, and major bleeding occurs. Since it could not be confirmed and hemostasis could not be achieved, serious complications could occur, and a safer device and treatment method were required.

  Therefore, in order to solve these problems, the applicant of the present invention has a gripping member that grips a lesion in a human organ, a magnetic anchor made of a magnetic material, and a string-like shape that connects the gripping member and the magnetic anchor. And a magnetic anchor guiding device that is disposed outside the human body and generates a magnetic field to power the magnetic anchor, and the magnetic anchor is powered by the magnetic field generated by the magnetic anchor guiding device and gripped. An anchor remote guidance system characterized by lifting a lesioned part grasped by a member has been proposed and a patent application has been filed (Japanese Patent Application No. 2002-268239).

  The object of the present invention is to further improve the above-mentioned patent application, so that the target site can be treated quickly and easily, and the anchor length can be adjusted within the object by adjusting the effective length of the string-like connecting member according to the situation. An object of the present invention is to provide an endoscopic anchor remote guidance system in which a connecting member is always tensioned when moved in a predetermined direction, and an endoscopic treatment method using the anchor remote guidance system.

  The remote anchor guidance system for an endoscope of the present invention includes a gripping member that grips a target portion inside a target object, a magnetic anchor made of a magnetic material, and a flexible string-like connection that connects the magnetic anchor and the gripping member. A member, a pair of fixed pieces that contact the string-like connecting member, and an elastic member that is between the pair of fixed pieces and that is also in contact with the string-like connecting member and that is substantially parallel to a plane connecting the pair of fixed pieces. A length adjuster having a deformed state and a biasing piece capable of moving in a direction away from the plane connecting the pair of fixed pieces, and a length adjusting tool disposed outside the object to generate a magnetic field And an effective length of the string-like connecting member in a free state of the biasing piece between the pair of fixed pieces and the biasing piece of the length adjuster. The string-like connection so as to reduce In a state where the wound around the timber, by a magnetic field the magnetic anchor induction device is generated powered on the magnetic anchor is characterized in that lifting the target region which is gripped in the gripping member.

  The magnetic anchor guide device generates a magnetic force by a generated magnetic field, and moves the magnetic anchor in a predetermined direction by the magnetic force, and a U-shape in which the magnetic guide member is arranged in a specific plane. It is practical to have an in-plane moving mechanism that moves along the frame member and a unidirectional moving mechanism that relatively moves the U-shaped frame member in a direction perpendicular to the one plane.

  According to another aspect, an endoscope anchor remote guidance system according to the present invention includes a gripping member that grips a target site inside a target, a gravity anchor made of a nonmagnetic material, the gravity anchor, and the gripping member. A flexible string-like connecting member that connects the pair of fixing pieces, a pair of fixed pieces that contact the string-like connecting member, and a pair of fixed pieces that are between the pair of fixed pieces and that also contact the string-like connecting member and connect the pair of fixed pieces A length adjuster having an elastically deformed state facing a plane substantially parallel to the plane and a biasing piece capable of taking a free state of moving in a direction away from the plane connecting the pair of fixed pieces, Between the pair of fixed pieces and the urging piece of the length adjuster, in a state where the string-like connecting member is hung so that the effective length of the string-like connecting member is reduced in the free state of the urging piece, Move the gravity anchor according to gravity, and The target region that are gripped by the support member is characterized by moving in the direction of gravity.

  In any aspect, it is preferable that the length adjusting tool is entirely formed of a leaf spring material, and the pair of fixing pieces and the urging pieces extend from a common fixing portion.

  Furthermore, in any aspect, a rod-shaped holding member that enters between the pair of fixed pieces and the urging piece of the length adjuster and holds the urging piece in the elastically deformed state is provided. Is preferred.

  Further, the holding member has a linear main body portion and a tip portion sandwiched between the pair of fixing pieces and the biasing piece, and the holding member is relatively disposed within the cylindrical pressing member. It is practical that it is supported so that it can move and the front-end | tip part protrudes.

  Further, the cylindrical pressing member has a distal end surface that is orthogonal to the longitudinal direction of the cylindrical pressing member and abuts against the length adjusting tool that sandwiches the distal end portion, thereby the cylindrical pressing member of the length adjusting tool. It is preferable that the contact surface adjusts the direction with respect to the member.

  Further, it is practical that the cylindrical pressing member and the holding member can be inserted into and removed from the forceps channel of the endoscope.

  Furthermore, it is preferable that at least one of the surfaces of the fixing piece and the urging piece is provided with a plurality of engaging grooves that can be engaged with the connecting member at different positions in the longitudinal direction.

  Furthermore, it is preferable to provide a holding portion for holding the string-like connecting member on at least one of the surfaces of the fixed piece and the urging piece.

  Furthermore, it is preferable that a plurality of the holding portions are provided on at least one of the surfaces of the fixed piece and the urging piece with the positions being different in the longitudinal direction.

  Furthermore, it is practical that the holding portion is an engagement groove with which the string-like connecting member can be engaged.

  An endoscopic treatment method using the anchor remote guidance system according to the present invention includes a step of preparing a connection body in which a magnetic anchor made of a magnetic material and a gripping member are connected by a flexible string-like connection member, A pair of fixed pieces in contact with the connection member, and an elastically deformed state between the pair of fixed pieces and also in contact with the string-like connection member and in a direction substantially parallel to a plane connecting the pair of fixed pieces; Preparing a length adjuster having a biasing piece capable of taking a free state of moving in a direction away from a plane connecting a pair of fixed pieces, disposing the connection body inside the object, A step of gripping a target portion inside the target by the gripping member, generating a magnetic field from a magnetic anchor guiding device disposed outside the target, moving the magnetic anchor, and A moving step of lifting the object part held in a predetermined direction, and after the moving step, the string in a free state of the urging piece between the pair of fixed pieces and the urging piece of the length adjuster. And a length adjusting step for winding the string-like connecting member so that the effective length of the connecting member is shortened.

  According to another aspect, an endoscopic treatment method using the anchor remote guidance system of the present invention is a connection in which a gravity anchor made of a nonmagnetic material and a gripping member are connected by a flexible string-like connecting member. A step of preparing a body, a pair of fixed pieces that contact the string-like connecting member, and a direction that is between the pair of fixed pieces and that also contacts the string-like connecting member and connects the pair of fixed pieces in a substantially parallel direction Preparing a length adjuster having an elastically deformed state facing the surface and a biasing piece capable of moving in a free state moving away from a plane connecting the pair of fixed pieces; A step of arranging the object within the object, a step of grasping the object part inside the object by the grasping member, and moving the gravity anchor according to gravity to move the object part grasped by the grasping member in a predetermined direction. The effective length of the string-like connecting member is shortened in a free state of the biasing piece between the pair of fixed pieces and the biasing piece of the length adjusting tool after the lifting step and the moving step. Thus, it has a length adjusting step for winding the string-like connecting member.

  In any aspect, the length adjuster is entirely formed of a leaf spring material, and the pair of fixing pieces and the urging pieces extend from a common fixing portion. It is preferable that the elastic member is rotatable about the center, and the tip is always in a free state away from the plane connecting the two fixing pieces.

  Further, the length adjustment step includes a holding step of inserting a rod-shaped holding member between the pair of fixed pieces and the biasing piece of the length adjuster and holding the elastically deformed state, and a pair of elastically deformed states. An insertion step of inserting the string-like connecting member between the fixed piece and the urging piece, and the holding member is extracted from between the two fixed pieces and the urging piece, and the urging piece is freed to form a string-like connecting member. It is practical to have an effective length shortening step for shortening the effective length.

  The holding member has a linear main body portion and a tip portion sandwiched between both the fixing pieces and the biasing piece, and the holding member is relatively movable in the cylindrical pressing member. And the front-end | tip part is supported so that it may protrude, and it is preferable that the said holding | maintenance step is a step which clamps the front-end | tip part of the said holding member between the said urging | biasing piece and both fixed pieces.

  The distal end surface of the cylindrical pressing member is a contact surface orthogonal to the longitudinal direction, and the cylindrical pressing member is moved to the distal end side between the holding step and the inserting step. It is preferable to have a direction adjusting step of adjusting the direction of the length adjusting tool relative to the cylindrical pressing member by bringing the contact surface into contact with the length adjusting tool.

  It is practical that the cylindrical pressing member and the holding member can be inserted into and removed from the forceps channel of the endoscope.

  Further, in the length adjusting step, the connecting member is engaged with any one of a plurality of engaging grooves provided in different positions in the longitudinal direction on at least one of the surfaces of the fixed piece and the biasing piece. It is preferable to have a step.

  Furthermore, it is preferable that the length adjusting step includes a holding step for holding the string-like connecting member in a holding portion provided on at least one of the surfaces of the fixed piece and the biasing piece.

  Furthermore, a plurality of the holding portions are provided in different positions in the longitudinal direction of the fixed piece and the urging piece, and the holding step is a step of holding the string-like connecting member in any holding portion. Preferably there is.

  Furthermore, it is practical that the holding portion is an engagement groove with which the string-like connecting member can be engaged.

  According to the present invention, the target part can be quickly and easily treated, and the connecting member is adjusted when the anchor is moved in a predetermined direction inside the object by adjusting the effective length of the string-like connecting member according to the situation. Always get nervous.

Hereinafter, a first embodiment of the present invention will be described in detail with reference to FIGS.
The anchor remote guidance system of this embodiment includes a magnetic anchor device 1 (consisting of a magnetic anchor 2, a clip 3 and a string-like connecting member 4) and suction control of the magnetic anchor device 1 outside the body (applying a magnetic force to the magnetic anchor 2). ) The magnetic anchor guiding device 10 and the length adjusting device 30 capable of adjusting the length of the string-like connecting member 4 are provided.

First, the configuration of the magnetic anchor device 1 will be described with reference to FIGS. 1 to 3.
The magnetic anchor 2 includes a substantially cylindrical main body 2a and a mounting portion 2b that is smaller than the main body 2a. Both the main body 2a and the mounting portion 2b are made of a ferromagnetic material. Specific examples of the ferromagnetic material include magnets such as platinum magnet, rare earth magnet, terbium / dysprosium / iron alloy in addition to pure iron and iron alloy.

  The clip (gripping member) 3 shown in detail in FIGS. 2 and 3 is a member for grasping and lifting the lesion X in the organ B (object) of the patient A. The clip 3 is made of an elastic material bent in a U-shape, and includes a pair of opening / closing pieces 3a urged away from each other by the elasticity thereof. A distal end portion 3b capable of gripping the lesioned portion X is formed, and the base end portions of the both opening and closing pieces 3a are connected by a connecting portion 3c. The relative distance between the two opening / closing pieces 3a is variable, and the both opening / closing pieces 3a are provided with a ratchet member 3d for fixing the position after adjusting the distance between the two opening / closing pieces 3a. As shown in FIG. 3, the ratchet member 3d includes a pair of engagement pieces 3d1, and engagement teeth 3d2 that can be engaged and disengaged with each other are formed on opposing surfaces of both engagement pieces 3d1. . The ratchet member 3d has a function of preventing the deformation when the pair of opening / closing pieces 3a is elastically deformed in the direction of reducing the distance and holding the distance after adjusting the distance between the opening / closing pieces 3a.

  One end of the string-like connecting member 4 is fixed to the attachment portion 2b of the magnetic anchor 2, and the other end is fixed to the connecting portion 3c of the clip 3. The string-like connecting member 4 allows the magnetic anchor 2 and the clip 3 to be connected. It is connected.

Next, the configuration of the magnetic anchor guide device 10 will be described with reference to FIGS. 4 and 5.
A pair of XY stages (one-way moving mechanisms) 12 and 12 are disposed on both sides of the bed 11 including the floor plate 11a on which the patient A is placed. The pair of XY stages 12 reciprocate linearly along the longitudinal direction of the bed 11 so that the longitudinal positions of the both 12 and 12 are always the same. Further, above the bed 11, a frame / rail (two-plane moving mechanism) comprising two rails 14 and 15 that are substantially U-shaped in front view and are parallel to each other in a plane orthogonal to the longitudinal direction of the bed 11. 13 is disposed, and both end portions of the frame / rail 13 are fixed to the left and right XY stages 12, respectively. The inner rail 14 is slidably mounted with a magnetic induction member 16 that controls the magnetic anchor 2 of the magnetic anchor device 1 outside of the body (which exerts a magnetic force on the magnetic anchor 2). The XY stage 12 can be moved along the rail 14. The magnetic induction member 16 is configured such that an electromagnet 17 having a structure in which a coil is wound around an iron core is disposed on a base 18, and the electromagnet 17 always faces the patient A side (see FIG. 4). The magnetic induction member 16 may be a combination of a permanent magnet and an electromagnet, or a combination of two or more permanent magnets and electromagnets.

A counterweight 19 for maintaining the weight balance of the entire frame / rail 13 is slidably mounted on the rail 15 on the rail 15 outside the frame / rail 13. The counterweight 19 changes its position according to the position of the magnetic induction member 16. For example, when the magnetic guide member 16 is located on the front side of the patient A, the counterweight 19 is located on the back side of the patient A, and when the magnetic guide member 16 is on the back side of the patient A, the counterweight 19 is Located on the front side of patient A, the entire frame / rail 13 is weight balanced.
The magnetic guide member 10, the XY stage 12, and the frame / rail 13 described above constitute the magnetic anchor guide device 10.

FIG. 6 shows an endoscope 20 used to perform an ablation using an anchor remote guidance system.
Since the structure of the endoscope 20 is well-known, detailed description thereof is omitted. However, as shown in FIG. 13 and FIG. 14, air and cleaning water are fed to the distal end surface 21 a of the insertion portion 21 inserted into the body. An air supply nozzle 22, an illumination window 23 for illuminating the excision part and its periphery, an observation window 24 for observing the excision part and the periphery where the objective lens is arranged behind the excision part, and a forceps channel (not shown) An outlet 25 is provided. The forceps channel is provided in the insertion portion 21, and the inlet 26 a is formed on the end surface of the forceps opening 26.

9 to 12 show a length adjusting device 30 for adjusting the length of the string-like connecting member 4, and includes an adjusting tool (length adjusting tool) 31, a holding member 35, and a cylindrical pressing member 36. .
An adjustment tool 31 integrally formed of an elastic material such as plastic or stainless steel includes a pair of fixing pieces 32 and 32 that are parallel to each other, and an urging piece 33 that is positioned between the fixing pieces 32 and parallel to the fixing pieces 32. Both fixing pieces 32 and a fixing portion 34 for joining the base end portions of the urging pieces 33 are provided.
Both the fixing pieces 32 are located on the same plane, and the urging piece 33 is rotatable around its base end portion, and the tip of the urging piece 33 always has the both fixing pieces 32 as shown in FIG. It is in a free state away from the connecting plane.
Further, a plurality of engaging grooves (holding portions) 32a that can be engaged with the string-like connecting member 4 on one surface of both the fixing pieces 32 and the opposite surface of the biasing piece 33 in the longitudinal direction. 33a is provided.

The holding member 35 is a metal bar-like member, and includes a linear main body portion 35a and an inclined portion (front end portion) 35b that forms a distal end portion thereof and is inclined with respect to the main body portion 35a.
The cylindrical pressing member 36 is a cylindrical member that is open at both ends, and the tip end surface thereof is an abutting surface 36a that is orthogonal to the longitudinal direction. The main body 35 a of the holding member 35 can be inserted into and removed from the cylindrical pressing member 36. When the holding member 35 is inserted into the cylindrical pressing member 36, the inclined portion 35b protrudes from the distal end of the cylindrical pressing member 36, and the base end portion of the main body portion 35 protrudes from the proximal end of the cylindrical pressing member 36 (illustrated). Abbreviation). Further, the cylindrical pressing member 36 and the holding member 35 inserted therein can be inserted into and removed from the forceps channel of the endoscope 20.

  11 and 12, when the urging piece 33 of the adjustment tool 31 is rotationally moved from the free state to the opposite side of the plane connecting both the fixing pieces 32 (elastically deformed state), both the fixing pieces 32 and The inclined piece 35b of the holding member 35 can be inserted between the urging pieces 33. The inserted inclined piece 35b includes both the fixed pieces 32 and the urging piece 33 that is to be elastically restored toward the free state. The adjustment tool 31 is held in this elastically deformed state.

Next, the excision procedure of the lesion X using the anchor remote guidance system will be described.
Prior to performing excision using the anchor remote guidance system, first, as shown in FIGS. 4 and 5, the patient A subjected to local anesthesia is laid on the bed 11. At this time, the XY stage 12 is operated so that the longitudinal direction position of the bed 11 of the frame / rail 13 is substantially the same position as the head A1 of the patient A, and the magnetic induction member 16 and the counterweight 19 are set to a predetermined position. Keep it in the place.
Next, the XY stage 12 is operated to place the frame / rail 13 on the front side of the affected area of the patient A, and the magnetic guidance device 16 is moved along the frame / rail 13 to cut out the magnetic guidance member 16. It is located at the position at the start of surgery (see FIG. 5).

  Next, the overtube OT shown in FIGS. 13 and 14 is inserted into the body from the mouth of the patient A. Subsequently, the insertion portion 21 of the endoscope 20 is inserted into the overtube OT, the distal end portion of the insertion portion 21 is protruded from the distal end of the overtube OT, and an organ (target) B (see FIGS. 13 and 14 etc.) It is made to approach to the lesioned part X. As described above, when the distal end of the insertion portion 21 of the endoscope 20 is inserted into the organ B, an observation image in the organ B obtained from the observation window 24 is displayed on a television monitor (not shown).

  In this state, a tube-like treatment instrument (not shown) having an injection needle at its distal end is inserted from the inlet 26a of the forceps port 26, and the injection needle is protruded from the outlet 25 of the insertion portion 21. Is inserted into the submucosa B1 of the organ B from the periphery of the lesion X, and physiological saline is injected, so that the lesion X is lifted from the proper muscle layer B2.

Next, the magnetic anchor device 1 is inserted into the organ B of the patient A in the manner described below.
When inserting the magnetic anchor device 1 into the organ B, the endoscope 20 is pulled out of the body of the patient A, and the rear end portion 40a is welded to the forceps channel of the endoscope 20. The hollow tubular guide sheath 40 is inserted in advance, and the distal end portion of the guide sheath 40 is inserted into the insertion portion 21 (see FIG. 8). It protrudes from the front end surface 21a.
Thereafter, the magnetic anchor device 1 is inserted into the distal end portion 40b of the guide sheath 40 so as to be in the state of FIG. 7A so that the magnetic anchor device 1 does not unexpectedly come off from the distal end portion 40b of the guide sheath 40. In this state, the insertion portion 21 of the endoscope 20 is inserted into the patient A's body.

  Since the total length of the guide sheath 40 is longer than the distance from the entrance 26a of the forceps port 26 of the endoscope 20 to the distal end surface 21a of the insertion portion 21, as shown in FIG. When the guide sheath 40 is set on the endoscope 20 with the main body portion 2a of the anchor 2 protruding, the rear end portion 40a of the guide sheath 40 is positioned outside the forceps opening 26.

  A cut string 41 is provided at the rear end portion 40 a of the guide sheath 40, and the cut string 41 is bonded to the outer peripheral surface of the guide sheath 40 along the circumferential direction. Further, the end 41a of the cut string 41 floats from the guide sheath 40 so that the surgeon can easily pull the cut string 41, and the other part than the end 41a is integrated with the guide sheath 40. When the surgeon pulls the cut string 41, the cut string 41 is removed along the circumferential direction of the guide sheath 40, so that the guide sheath 40 is divided into two parts at the front and rear at the portion where the cut string 41 is removed (see FIG. 7B). ).

  When the rear end portion 40a is pulled out after the guide sheath 40 is divided into the front and the rear, the flexible pushing rod L provided inside the guide sheath 40 appears. By moving the flexible pushing rod L forward in the axial direction, the magnetic anchor device 1 is pushed out from the distal end of the guide sheath 40 into the organ B of the patient A (see FIG. 7C), and FIG. As shown, the magnetic anchor device 1 is placed in the organ B.

When the magnetic anchor device 1 is thus arranged in the organ B, the guide sheath 40 is pulled out from the forceps channel, and instead, the grasping forceps 50 shown in FIGS. 13 and 14 are inserted into the forceps channel, and the distal end is inserted into the insertion portion. It protrudes from the tip surface 21a of 21.
The gripping forceps 50 includes a metal gripping member 51 that can be opened and closed at the distal end of the flexible tube 50a, and an operation portion (not shown) at the base end of the flexible tube 50a. Yes, when this operation unit is operated, the gripping member 51 opens and closes.
Then, by operating the grasping forceps 50 and tightening the ratchet member 3d of the clip 3, both the open / close pieces 3a of the clip 3 are closed, and the end portion (target site) X1 of the lesioned portion X is grasped by the both end portions 3b. (See FIG. 13).

  As shown in FIG. 14, the magnetic guiding device 16 is disposed outside the patient A in a state of being close to the organ B. Therefore, when a magnetic field is generated from the magnetic guiding device 16, the magnetic force generated from the magnetic field is used. The magnetic anchor 2 is attracted toward the magnetic guidance device 16. When the string-like connecting member 4 is strained, the clip 3 lifts the end X1 of the lesion X in a desired direction by a desired distance.

As shown in FIG. 14, when a magnetic field is generated from the magnetic induction device 16, if the magnetic anchor 2 comes into contact with the inner wall of the organ B with the string-like connecting member 4 slackened, the magnetic anchor 2 Is not transmitted to the lesioned part X through the string-like connecting member 4.
For this reason, in such a case, after the endoscope 20 is taken out of the body, the grasping forceps 50 is extracted from the forceps channel of the endoscope 20, and the holding member 35 is inserted into the forceps channel. The pressing member 36 is inserted. And the front-end | tip part of the holding member 35 and the cylindrical press member 36 is protruded from the front end surface 21a of the insertion part 21, and the adjustment tool 31 is mounted | worn with the inclination part 35b of the holding member 35, as shown in FIG.

Then, the endoscope 20 in this state is inserted into the body again, and the distal end portion thereof is positioned in the organ B.
Next, as shown in FIG. 15, the cylindrical pressing member 36 is moved relative to the distal end side with respect to the holding member 35, and the side surface of the adjustment tool 31 is pressed by the contact surface 36 a, and the cylindrical pressing member 36 is pressed against the cylindrical pressing member 36. The adjustment tool 31 is made orthogonal.
If the orientation of the adjustment tool 31 is changed in this way, the orientation of the insertion portion 21 is adjusted, and the connecting string 13 is positioned in the gap formed between the two fixing pieces 32 and the biasing piece 33 of the adjustment tool 31. The holding member 35 is moved relative to the cylindrical pressing member 36 toward the proximal end side, and the holding member 35 is pulled out from the gap. Then, as shown in FIGS. 16 and 17, the urging piece 33 elastically returns to the free state while being in contact with the string-like connecting member 4, so that the contact portion of the string-like connecting member 4 with the urging piece 33 is both The effective length of the string-like connecting member 4 (distance from the fixing point with the magnetic anchor 2 to the fixing point with the clip 3 when the string-like connecting member 4 is in tension) is short from the plane connecting the fixed pieces 32. Become. At this time, the cord-like connecting member 4 is engaged with the engaging grooves 32 a, 33 a of the fixing piece 32 and the biasing piece 33 facing each other, so that the adjustment tool 31 is securely attached to the cord-like connecting member 4. Is preferred.

  If the effective length of the string-like connecting member 4 is shortened in this way, the adjustment tool 31 of the string-like connecting member 4 is attached when the magnetic anchor 2 is attracted toward the magnetic induction device 16 as shown in FIG. Since the entire non-exposed portion is tensioned and the traction force of the magnetic anchor 2 is transmitted to the clip 3, the end portion X1 of the lesion X can be lifted in a desired direction by a desired distance.

When the end X1 of the lesioned part X is moved in this way, a sufficiently large excision part is secured at the boundary between the lesioned part X and the normal tissue, so that the grasping forceps 50 is taken out from the endoscope 20 Thereafter, as shown in FIG. 18, an incision tool such as a high-frequency knife 60 is inserted into the organ B through the forceps channel, and the lesioned part X is excised together with the mucous membrane from the end X1 to completely excise the entire lesioned part X. (Not shown). In the excision work with the high-frequency knife 60, the position of the tip 60a of the high-frequency knife 60 becomes easier to confirm as the excision area expands.
When the excision work is completed as described above, the lesioned part X is attached to the clip 3, so that the lesioned part X is prevented from being lost. In order to collect the excised lesion X, the clip 3 is grasped by the grasping forceps 50, and the endoscope 20 is removed from the body in the state as it is. After that, treatments such as suturing and disinfection of the excised part are performed.

As described above, by using the anchor remote guidance system of the present embodiment, by adjusting the effective length of the string-like connecting member 4, the string-like connecting member 4 is always tensioned regardless of the size of the organ B. It is possible to lift the lesion X.
As a result, the magnetic anchor 2 can be moved in a desired direction by a desired distance, so that a sufficiently large excision portion can be secured at the boundary between the lesion X and the normal tissue. Even if the part X has a flat shape, a sufficiently large excision part can be created, so that the lesion part X can be excised easily.
Furthermore, since the lesioned part X is moved to the magnetic induction device 16 side by the clip 3, it is possible to secure a sufficient excised part and prevent the already excised lesioned part X from falling on the proper muscle layer B2.
Further, since the clip 3 can be arranged at an arbitrary position, the view of the endoscope is not hindered by the excised lesion part X.

Furthermore, the effective length of the string-like connecting member 4 can be further finely adjusted by changing the engagement position of the urging piece 33 and both fixed pieces 32 of the string-like connecting member 4. That is, if the string-like connecting member 4 is engaged with the engagement grooves 32a, 33a on the proximal end side of the fixed piece 32 and the urging piece 33, the adjustment amount (shortening amount) of the string-like connecting member 4 is not so large. On the other hand, if the string-like connecting member 4 is engaged with the engaging grooves 32a and 33a on the distal end side of the fixed piece 32 and the biasing piece 33, the adjustment amount of the string-like connecting member 4 increases.
Further, since the connecting cord 13 is inserted into the gap formed in the adjusting tool 31 after the orientation of the adjusting tool 31 is adjusted, and the connecting string 13 is held between the adjusting tools 31, the connecting of the adjusting tool 31 is performed. The attachment work to the string 13 can be performed easily and accurately.

Next, a second embodiment of the present invention will be described with reference to FIG.
Note that the same members as those in the first embodiment are given the same reference numerals, and detailed descriptions thereof are omitted.

  The gravity anchor device 70 according to this embodiment includes a gravity anchor 71, a string-like connecting member 4, and a clip 3. The shape of the gravity anchor 71 is the same as that of the magnetic anchor 2 except that the gravity anchor 71 is entirely formed of a nonmagnetic material. Specific examples of the nonmagnetic material include gold, copper, aluminum, stainless steel (austenite), brass, ceramic, glass, and the like.

Such a gravity anchor device 70 is inserted into the organ B in the same manner as in the first embodiment, and the clip 3 can hold the end X1 of the lesion X. In other words, the gravity anchor 71 is moved in the direction of gravity P.
As in the first embodiment, when the gravity anchor 71 contacts the inner wall of the organ B with the string-like connecting member 4 slackened, the length adjusting device 30 is used as in the first embodiment. The length of the string-like connecting member 4 is adjusted.
If it does in this way, since the string-like connection member 4 comes to become tense, the edge part X1 of the lesioned part X can be moved to the gravity P direction.

Thus, the present embodiment can provide the same effects as those of the first embodiment.
Furthermore, in this embodiment, the magnetic anchor guiding device 40, which is an expensive device that was necessary in the first embodiment, is unnecessary, which is advantageous in terms of cost compared to the first embodiment.

  The present invention has been described above with reference to each embodiment. However, the present invention is not limited to the above embodiment, and can be improved or changed within the scope of the purpose of the improvement or the idea of the present invention. For example, instead of the clip 3, it is also possible to prepare a fishing hook-like needle member (not shown) that can pierce the lesioned part X and pierce the end X1 of the lesioned part X. is there.

It is a figure which shows the structure of the magnetic anchor apparatus of the 1st form of this invention. It is a figure which shows the shape of a clip. It is sectional drawing of a ratchet member. It is a front view which shows the state which mounted the patient on the bed surrounded by the magnetic guidance apparatus. It is a side view which shows the state which mounted the patient on the bed. It is a general view of the endoscope used when excising a lesion part. (A) is a figure which shows the state which set the magnetic anchor apparatus to the guide sheath, (b) is a figure which shows the state which removed the rear-end part side of the guide sheath by pulling a cut string, (c) FIG. 5 is a view showing a state in which the magnetic anchor device is pushed out by pushing a flexible pushing rod. It is a figure which shows the state which inserted the guide sheath and the magnetic anchor apparatus in the forceps channel of an endoscope. It is a top view of an adjustment tool. It is a side view of an adjustment tool. It is a side view which shows the state which pinched | interposed the holding member between the adjustment tools. It is a general view of the length adjustment apparatus when a holding member is pinched | interposed between adjustment tools. It is a figure which shows the state which inserted the magnetic anchor apparatus in the internal organ. It is a figure which shows the state which moves a lesion part using a magnetic anchor apparatus. It is a figure which shows a mode that the direction of an adjustment tool is changed with the cylindrical press member. It is a figure which shows a mode that the adjustment tool after direction change is mounted | worn with a connection string. It is a figure which shows the state which moves a lesioned part using a magnetic anchor apparatus, after adjusting the length of a connection string. It is a figure which shows the excision process of the lesioned part using a magnetic anchor apparatus. It is a figure which shows the state which moves a lesioned part after adjusting the length of a connection string using the gravity anchor apparatus of the 2nd form of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Magnetic anchor apparatus 2 Magnetic anchor 2a Main-body part 2b Attachment part 3 Clip (gripping member)
3a Open / close piece 3b Tip 3c Ratchet member 3c1 Engagement piece 3c2 Engagement tooth 4 String-like connecting member 10 Magnetic anchor guide device 11 Bed 11a Floor board 12 XY stage (unidirectional movement mechanism)
13 frame / rail (moving mechanism in one plane)
14 15 Rail 16 Magnetic induction member 17 Electromagnet 18 Base 19 Counterweight 20 Endoscope 21 Insertion portion 21a Tip surface 22 Air / water supply nozzle 23 Illumination window 24 Observation window 25 Forceps channel outlet 26 Forceps port 26a Inlet 30 Length adjusting device 31 Adjuster (Length adjuster)
32 fixed piece 32a engaging groove (holding part)
33 Energizing piece 33a Engaging groove (holding part)
34 fixing part 35 holding member 35a main body part 35b inclined part (tip part)
36 cylindrical pressing member 36a contact surface 40 guide sheath 40a rear end portion 40b distal end portion 41 cut string 50 gripping forceps 50a flexible tube 51 gripping member 60 high-frequency knife 60a distal end portion 70 gravity anchor device 71 gravity anchor 71a main body portion 71b Attachment A Patient A1 Head B Organ (object)
B1 Submucosa B2 Proper muscle layer L Flexible pushing rod L
OT Overtube P Gravity X Lesion X1 End (target site)

Claims (21)

A gripping member for gripping a target part inside the target;
A magnetic anchor made of a magnetic material;
A flexible string-like connecting member for connecting the magnetic anchor and the gripping member;
A pair of fixed pieces in contact with the string-like connecting member, and an elastically deformed state between the pair of fixed pieces and also in contact with the string-like connecting member and in a direction substantially parallel to a plane connecting the pair of fixed pieces. A length adjuster having a biasing piece capable of taking a free state of moving in a direction away from a plane connecting the pair of fixed pieces;
A magnetic anchor guiding device disposed outside the object and generating a magnetic field to power the magnetic anchor;
Between the pair of fixed pieces and the urging piece of the length adjuster, in a state where the string-like connecting member is hung so that the effective length of the string-like connecting member is reduced in the free state of the urging piece, An endoscopic anchor remote guidance system for lifting an object portion gripped by the gripping member by applying power to the magnetic anchor by a magnetic field generated by the magnetic anchor guide device. The endoscope anchor remote guidance system according to claim 1,
The magnetic anchor guiding device is
A magnetic induction member that generates a magnetic force by a generated magnetic field and moves the magnetic anchor in a predetermined direction by the magnetic force;
An in-plane movement mechanism for moving the magnetic induction member along a U-shaped frame member arranged in a specific plane;
A one-way moving mechanism for relatively moving the U-shaped frame member in a direction orthogonal to the one plane;
An endoscope remote guidance system for endoscope. A gripping member for gripping a target part inside the target;
A gravity anchor made of non-magnetic material;
A flexible string-like connecting member that connects the gravity anchor and the gripping member;
A pair of fixed pieces in contact with the string-like connecting member, and an elastically deformed state between the pair of fixed pieces and also in contact with the string-like connecting member and in a direction substantially parallel to a plane connecting the pair of fixed pieces. A length adjuster having a biasing piece capable of taking a free state of moving in a direction away from a plane connecting the pair of fixed pieces;
With
Between the pair of fixed pieces and the urging piece of the length adjuster, in a state where the string-like connecting member is hung so that the effective length of the string-like connecting member is reduced in the free state of the urging piece, An endoscope anchor remote guidance system, wherein the gravity anchor is moved according to gravity to move the target portion held by the holding member in the direction of gravity. The endoscope anchor remote guidance system according to any one of claims 1 to 3, wherein the length adjuster is entirely made of a leaf spring material, and the pair of fixing pieces and the biasing pieces are common. Endoscope anchor remote guidance system extending from the fixed part of the endoscope. The endoscope anchor remote guidance system according to claim 4, wherein the length adjusting tool enters between a pair of fixed pieces and a biasing piece to hold the biasing piece in the elastically deformed state. An endoscope remote guidance system for an endoscope comprising a rod-shaped holding member. The endoscope anchor remote guidance system according to claim 5,
The holding member has a linear main body portion and a tip portion sandwiched between the pair of fixed pieces and the biasing piece,
This holding member is an endoscopic anchor remote guidance system that is supported so as to be relatively movable in a cylindrical pressing member and its tip portion protrudes. The remote anchor guide system for an endoscope according to claim 6, wherein a distal end surface of the cylindrical pressing member is orthogonal to the longitudinal direction and abuts on the length adjusting tool sandwiching the distal end portion. Accordingly, the endoscope anchor remote guidance system is a contact surface that adjusts the direction of the length adjusting tool with respect to the cylindrical pressing member. The endoscope anchor remote guidance system according to claim 6 or 7, wherein the cylindrical pressing member and the holding member can be inserted into and removed from the forceps channel of the endoscope. The endoscope anchor remote guidance system according to any one of claims 1 to 8, wherein a holding portion that holds the string-like connecting member is provided on at least one of the surfaces of the fixed piece and the biasing piece. Remote anchor guidance system for endoscopes. The endoscope anchor remote guidance system according to claim 9, wherein a plurality of the holding portions are provided on at least one of the surfaces of the fixed piece and the urging piece in different positions in the longitudinal direction. Anchor remote guidance system. The remote anchor anchor guidance system for endoscope according to claim 9 or 10, wherein the holding portion is an engaging groove with which the string-like connecting member can be engaged. Preparing a connection body in which a magnetic anchor made of a magnetic material and a gripping member are connected by a flexible string-like connecting member;
A pair of fixed pieces in contact with the string-like connecting member, and an elastically deformed state between the pair of fixed pieces and also in contact with the string-like connecting member and in a direction substantially parallel to a plane connecting the pair of fixed pieces. A step of preparing a length adjuster having a biasing piece capable of taking a free state of moving in a direction away from a plane connecting the pair of fixed pieces;
Disposing the connection body inside the object;
Gripping a target part inside the target object by the gripping member;
A moving step of generating a magnetic field from a magnetic anchor guiding device disposed outside the object, moving the magnetic anchor, and lifting the target portion gripped by the gripping member in a predetermined direction; and Later, the string-like connecting member is hung between the pair of fixed pieces and the biasing piece of the length adjusting tool so that the effective length of the string-like connecting member is shortened in the free state of the biasing piece. Length adjustment step,
A treatment method using an endoscope using an anchor remote guidance system. Preparing a connection body in which a gravity anchor made of a non-magnetic material and a gripping member are connected by a flexible string-like connection member;
A pair of fixed pieces in contact with the string-like connecting member, and an elastically deformed state between the pair of fixed pieces and also in contact with the string-like connecting member and in a direction substantially parallel to a plane connecting the pair of fixed pieces. A step of preparing a length adjuster having a biasing piece capable of taking a free state of moving in a direction away from a plane connecting the pair of fixed pieces;
Disposing the connection body inside the object;
Gripping a target part inside the target object by the gripping member;
A moving step of moving the gravity anchor according to gravity to lift the target portion gripped by the gripping member in a predetermined direction; and after the moving step, a pair of fixed pieces and biasing pieces of the length adjuster; A length adjusting step of hanging the string-like connecting member so that the effective length of the string-like connecting member is shortened in a free state of the biasing piece,
A treatment method using an endoscope using an anchor remote guidance system. 14. The endoscopic treatment method using the anchor remote guidance system according to claim 12 or 13, wherein the length adjuster is entirely made of a leaf spring material, and the pair of fixing pieces and the biasing pieces are common. The urging piece extending from the fixed portion is an elastic member that can rotate around its base end, and the tip is always in a free state away from the plane connecting the two fixed pieces. Endoscopic treatment method using a remote guidance system. In the treatment method by an endoscope using the anchor remote guidance system according to claim 14,
The length adjustment step
A holding step of inserting a rod-like holding member between the pair of fixed pieces and the urging piece of the length adjuster and holding the elastically deformed state;
An insertion step of inserting the string-like connecting member between a pair of fixed pieces and an urging piece in an elastically deformed state, and removing the holding member from between the two fixed pieces and the urging piece, and freely moving the urging piece An effective length shortening step for shortening the effective length of the string-like connecting member in a state;
Endoscopic treatment method using anchor remote guidance system having In the treatment method by an endoscope using the anchor remote guidance system according to claim 15,
The holding member has a linear main body portion and a tip portion sandwiched between both the fixing pieces and the biasing piece, and the holding member is relatively movable in the cylindrical pressing member. And the tip is supported so that it protrudes,
A treatment method using an endoscope using an anchor remote guidance system, wherein the holding step is a step of clamping a distal end portion of the holding member between the biasing piece and both fixed pieces. An endoscopic treatment method using the anchor remote guidance system according to claim 16,
The front end surface of the cylindrical pressing member is a contact surface orthogonal to the longitudinal direction, and
By moving the cylindrical pressing member to the tip side between the holding step and the inserting step, the abutment surface is brought into contact with the length adjuster, and the tube of the length adjuster An endoscopic treatment method using an anchor remote guidance system having a direction adjustment step of adjusting a direction with respect to the shaped pressing member. An endoscopic treatment method using the anchor remote guidance system according to claim 16 or 17,
An endoscopic treatment method using an anchor remote guidance system in which the cylindrical pressing member and the holding member can be inserted into and removed from a forceps channel of an endoscope. The treatment method by an endoscope using the anchor remote guidance system according to any one of claims 12 to 18, further comprising:
Endoscopic treatment using an anchor remote guidance system, wherein the length adjusting step has a holding step of holding the string-like connecting member on a holding portion provided on at least one of the surfaces of the fixed piece and the urging piece Method. An endoscopic treatment method using the anchor remote guidance system according to claim 19,
A plurality of the holding portions are provided at different positions in the longitudinal direction of the fixed piece and the urging piece,
A treatment method using an endoscope using an anchor remote guidance system, wherein the holding step is a step of holding the string-like connecting member in any holding portion. 21. The endoscopic treatment method using the anchor remote guidance system according to claim 19 or 20, wherein the holding portion is an engagement groove into which the string-like connecting member can be engaged. Endoscopic treatment method.

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