JP2005519650A - 非円形型切除装置及び内視鏡 - Google Patents

非円形型切除装置及び内視鏡 Download PDF

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JP2005519650A
JP2005519650A JP2003513434A JP2003513434A JP2005519650A JP 2005519650 A JP2005519650 A JP 2005519650A JP 2003513434 A JP2003513434 A JP 2003513434A JP 2003513434 A JP2003513434 A JP 2003513434A JP 2005519650 A JP2005519650 A JP 2005519650A
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ディー アダムス ロナルド
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Abstract

全層切除装置(FTRD)のためのプロキシマル・ハウジングが、ファスナーが貫通して、切除する組織部へ導入される複数のチャンバー(34)を伴い提供される。プロキシマル・ハウジングは、内視鏡(8)を受け入れるための複数のチャンバーの反対側のプロキシマル・ハウジングに形成される非円形の切り取り器(13)を有する。またプロキシマル・ハウジングには、切除された組織を受け入れるための切除キャビティ(37)が提供される。更に、少なくとも1つの軸開口部が提供され、取り付け軸が貫通して挿入される。また、切り取り器(13)へ挿入するための非円形の内視鏡(8)が開示され、該内視鏡は遠視、照射、吸入、洗浄機能を収容するための通路を有する。

Description

(発明の分野)
本発明は一般的には管状臓器、特に大腸の病班の局部切除を行うための全層切除装置(FTRD)に関する。本発明には、経肛門的外科的処置及び経口的外科的処置といった特定用途があるが、これらに限定されない。
(関連技術の記載)
切除処置には、臓器の一部を摘出する、摘出によってできた穴を塞ぐために周囲の組織を接近させ、余分な組織を除去することが伴う。何種類もの従来の装置及び処置で管状臓器の病班の切除が可能である。
例えば、いくつかの切除装置及び処置は、病班又は治療部位にアクセスするために、臓器の摘出箇所の近くに少なくとも1つの切開を必要とする(なぜなら切除装置には、操縦及び/又は視認能力がないからである)。
従って切開では、医師が切除し、装置を導くために臓器部分にアクセスすることを可能とすることが求められる。代わりに、摘出される臓器部が、外科装置が届く範囲を越えるか、摘出される部位へ到達するために臓器を通して曲がることに対して、該外科装置が十分に柔軟ではないとき、切開は処置に用いる装置の位置を決めるために求められる。
切開から回復することに加え、管状切除処置から回復する間、当然これら切開は苦痛であり、部分的又は全ての可動性を損なうことがある。更に、そのような処置から回復するのに必要な時間は、切開を必要としない処置に比べて長い。
従来の切除処置の1つは円形のステープリング器具を利用する。該ステープリング器具は管状の臓器の管状部位を切除し、該管状の臓器は第1切片と第2切片に分離される。次に該第1切片及び第2切片の端面は、個別にすぼめる用にして結ばれ、近接し、止められ、「すぼめられた」端面は切除される。
この一連の円形の切除処置において、少なくとも1つの分離した浸潤的な切開は、臓器を切断し、分離した切断面を個別に結ぶために、切除される部位の近くで行わなければならない。また、分離した切開は、第1切片において切除装置の第1部分、及び第2切片において装置が対応する第2部分で行うことが必要である。装置は第1及び第2切片を共に元の臓器部位へ再度取り付けることができるようにする。
通常これら分離した第1部分は、ステープル綴じ込み構造を含み、一方第2部分はステープルを形成する台を含む。従ってこのタイプの切除処置には、浸潤的な切開を必要とする処置に関して上記の欠点が伴う。
更に、臓器の2つの切片への分離は、無菌ではない腸の内容物を無菌の体腔へ流出する危険性が生じる。該流出は深刻な感染及び死亡する可能性を生じる。
他の切除装置は軸にステープリング部及び切断部を含み、該軸は望んだ形状へ湾曲又は形成され患者の体腔へ挿入される。一度軸が望んだ形状へ湾曲されると、軸の剛性は、作動中該形状を確実に維持する。
この処理は、挿入前に望んだ形状へ軸を湾曲すること及び一度湾曲された軸の剛性は、医師が挿入前に取り除く臓器部位の位置を確認すること、軸を再形成することを必要とするので装置の効果的な作業範囲を制限する。
更に軸の剛性は、臓器内の離れた領域、特に曲がっている及び/又は遠回りとなる経路(例えば、S字結腸)を通して到達する領域に到達することを難しくする。従って、装置を摘出される臓器部位の近くに位置付けるために、摘出のための切開は臓器部位の近くで行われることを必要とする。
現在、標準の内視鏡を組み込んだFTRDは、多くの製品から入手可能である。これら標準の内視鏡は形状が円形であり、円形の形状は、内視鏡が単独で用いられる場合、多くの従来の製品において望ましい。FTRDは円形の内視鏡であるが、例えば本体内にルーメン用にかなりのスペースを占める。
このことは、結果としてサンプルが望む以上に小さくなる。また円形の内視鏡は、望ましい位置へ湾曲するための十分な柔軟性を有さない。
(発明の要約)
本発明によると、全層切除装置(FTRD)のためのプロキシマル・ハウジングが、複数のチャンバーを備えて提供され、該チャンバーのファスナーが切除される組織部に導入される。
プロキシマル・ハウジングは、非円形の内視鏡を受け入れるために、複数のチャンバーの反対側に非円形の切り取り器を有する。また該プロキシマル・ハウジングは、切除する組織を受け入れるための切除キャビティを備えて提供される。更に軸開口部は、搭載軸が挿入されるようにして提供される。
本発明の他の側面によると、複数のチャンバーが、実質的に楕円形のファスナー・パターンを提供するために構成される。
本発明の更に他の側面によると、用いられるファスナーはステープルである。
本発明の更に他の側面によると、切り取り器に挿入するために実質的に切り取り器と同一形状であり、遠視、照射、吸入、洗浄機能を内蔵するための通路を有する。
本発明の他の側面によると、非円形の内視鏡は楕円形である。
本発明の更なる目的及び利点は、以下に記載され明らかとなる。或いは本発明の実施により理解される。本発明の目的及び利点は、特に請求項で指摘される要素との組み合わせにより理解することができる。前記一般的な記載及び以下の詳細な記載の両方は、例示及び説明のためのものであり、本発明を制限するものではない。
本文中に組み入れられ、本明細書の一部を構成する添付の図面は、本発明の実施形態の1つを示し、記載と共に本発明の本質を説明するためのものである。
本発明は、非円形の内視鏡及びこれに対応するFTRDである。これら非円形の装置は、既存の円形の装置よりも多くの利点を有する。例えば、非円形の形状は、装置が挿入される体内のルーメンに占めるスペースをより少なくすることを可能とする。
また非円形の内視鏡は、装置及び内視鏡の組み合わせのまとめ方のより効果的な方法を提供する。スペースのより効果的な利用は、装置が同等の円形の内視鏡が可能な大きさよりも大きな試験片サイズを捕らえることを可能とすることである。
更に、FTRDと共に用いるための非円形の内視鏡はより柔軟であり、従ってより容易に湾曲し望んだ位置、例えば内視鏡はより小さい領域へ進むことができる。好適な実施形態において、内視鏡は特定の使用のために全層切除又は同等の処置を行う装置と組み合わせて形成される。
更に、装置のステープル・カートリッジ及び台の形状は、より楕円形で非円形のステープル・パターンを有するため更に利点を提供する。
本発明の実施形態の詳細な説明を参照し、実施例が添付の図面で示される。各図面において、同じ参照番号は同じ部品を示す。
図1及び図2に示される通り、FTRDは、ワーキング・ヘッド・アセンブリ2からなり、該ヘッド・アセンブリは、覆い4の遠端部4aに接続される。覆い4の近端部は、制御ハンドル6に接続される。作動中、装置全体は内視鏡8に取り付けされ、制御ハンドル6、覆い4及びワーキング・ヘッド・アセンブリ2を貫通する、近端部8a、遠端部8bを有する。
内視鏡8は、管状臓器の病斑を目視観測するように位置するために体の開口部に挿入される(通常は臓器を吸入する)。一度病斑の位置を確認したならば、ワーキング・ヘッド・アセンブリ2及び覆い4は、病斑に隣接する望ましい場所に位置するまで、管状臓器内を内視鏡8に沿ってスライド可能なように前進する。
当業者は、他の実施形態において、ワーキング・ヘッド・アセンブリ2は取り外し可能なように内視鏡8の遠端に接続され、配列全体が、目視観測可能な体の開口部に挿入されることを理解する。
図1に示される通り、ワーキング・ヘッド・アセンブリ2は、プロキシマル・ハウジング12の遠端12aに接続される台部材10からなる。台部材10は、遠端部16及び遠端面の反対側により大きな近端部を実質的に備える三日月形状の断面を有する(すなわち、台部材10の外縁18は、第1楕円部分と該第1楕円内に、より小さい第2楕円切り取り器13を実質的に形成する)。
台部材10の切り取り器13は、内視鏡8がワーキング・ヘッド・アセンブリ2を貫通してスライド可能とするために含まれ、内視鏡8は、体内を病斑に向けて進むことが可能である。更に切り取り器13は、内視鏡8を介し前方の視界も提供する。
従って、切り取り器13の大きさは内視鏡8を提供するのに十分な任意の形状が選択され、より大きな切り取り器はより大きな視界を提供する。台部材10の外面18は、実質的にワーキング・ヘッド・アセンブリ2の中心軸と平行して延長し、一方台部材10の近端面及び端面は、同一面内に延長し、中央軸に対し実質的に垂直である。
外面18は、傾斜部5により遠端面16と結合する。
図3に示されるように、台部材10の近端面は第1キャビティ37及び該第1キャビティを取り囲むリム41を含む。溝19を形成する複数のステープルは、台部材10のリム41上に2本のオフセット列に配列され、楕円形のガイドスリット21は、溝19の列内で放射状に延長する。
リム41は、近端面の残りから突出し、浅いキャビティが近端面に形成される。
台部材10は、実質的に円筒形の2本の取り付け軸20aと20bで軸プロキシマル・ハウジング12に接続される。取り付け軸20a、20bは、それぞれホーン22a、22bの内の1つにおいて、台部材10の近端面14に接続される。
図3に示されるように、台部材10は、取り付け軸20a、20bに固定して接続されているのが示されるが、当業者は内視鏡8を貫通して、より広い視界を提供するために、台部材10が取り付け軸20a、20bに旋回するように接続することができることを理解する。この旋回型の配列において、台部材10は第1配置で角度が決められ、ホーン22a、22bが、台部材10の後ろよりもプロキシマル・ハウジングの端面12aに接近するようにする。
次に台部材10がプロキシマル・ハウジング12の端面12aの方に引き寄せられるにつれ、台部材10は、ホーン22a、22bを発端にして端面12aに対して押され、台部材10の近端面14が端面12aと平行になるまで台部材10の旋回を生じる。
図1に示される通り、取り付け軸20a、20bはスライド可能なように取り付け穴26a、26bに受け入れられ、該取り付け穴26a、26bは、取り付け軸20a、20bのサイズと形状に実質的に対応するサイズと形状を有し、取り付け軸20a、20bはプロキシマル・ハウジング12を軸方向に貫通する。
取り付け軸20a、20bは、好ましくは最も近接する位置の間の取り付け穴26a、26b内で軸方向に近接して先端へ移動可能であり、第1所定幅の組織保持キャビティは、リム41とプロキシマル・ハウジング12の端部12aの間で形成され、より大きな第2所定幅の組織保持キャビティである最も離れた位置は、リム41とプロキシマル・ハウジング12の端部12aの間で形成される。
第2所定幅は好ましくは切除される臓器の壁の2倍以上の厚さであり、管状臓器の部位は、台部材10とプロキシマル・ハウジング12の間の切除位置へ引っ張られる。
図4に示される通り、取り付け軸20a、20bの少なくとも1つの近端部は、プロキシマル・ハウジング12内に提供される動力装置92に接続される。動力装置92は、ヨーク93及び軸95から構成される。ヨーク93は、プロキシマル・ハウジング12内に、該ハウジングの軸に沿って縦方向の移動でスライド可能なように入り、台部材10が最も近接する位置にある時、ヨーク93は対応して最も近接する位置にあり、台部材が最も離れた位置にある時、ヨーク93もまた対応して最も遠い位置となる。
ヨーク93は、実質的に楕円形であり、長方形の断面を有する。図4において楕円形に形成されるヨーク93は、実質的に楕円の4分の1の円弧を形成するが、ヨーク93は、プロキシマル・ハウジング12内での適応、取り付け軸20a、20bの位置に基づき、より大きな楕円を形成することも可能である。
取り付け軸20aは好ましくはヨーク93と該ヨーク93の第1端部93aに接続することができ、取り付け軸20bは、ヨーク93と該ヨーク93の第2端部93bに接続することができる。補完的に駆動軸95の貫通遠端部95aの直径に実質的に対応する直径を有する軸穴97は、実質的に第1端部93aと第2端部93bの中間点で、ヨーク93を貫通して延長する。
従って駆動軸95が回転するとき、貫通遠端部95aは、ヨーク93を近接するよう、又は離れるように(駆動軸95の回転の方向による)動かすために軸穴97に嵌め込まれる。
駆動軸95の遠端部95aは、好ましくは、実質的に少なくともヨークの最も近接する距離と最も離れる距離の間の長さに対応する第1セクション95tを越えて貫通し、一方残りの部分95rは貫通する箇所を有さない。
駆動軸95は、貫通する第1セクション95t(セクション95tに近接及び/又は離れる)に隣接する領域に増加した切断面を有することが可能であり、従ってヨーク93の第1セクション95tへの動きを制限する。当業者は、駆動軸95は回転可能なようにプロキシマル・ハウジング12内に取り付けされ、該駆動軸95は回転するだけであり、プロキシマル・ハウジング12に連動して動かないことを理解するであろう。
駆動軸95は近端部95bに延長し、該近端部は覆い4を貫通し、制御ハンドル6に延長する駆動ケーブル90に接続される。駆動ケーブル90は、覆い4の周辺内部に沿って軸方向に延び、当業者は覆い4が、覆い内での駆動ケーブルからのトルク力に耐えるための捻じれ耐性があることを理解するだろう。
しかしながら、覆い4は縦方向に柔軟であり、内視鏡8に沿ってスライド可能なように進み、内視鏡8の動作を最小化するように整合し、周囲の細胞への傷を最小限にする。
覆い4は他の既知の内視鏡挿入チューブと同様に構成され、該チューブは柔軟であり、更に複数の方向及び内視鏡の回転力を有する旋回において、内視鏡8の遠端部を旋回するための力の伝達を可能とする。
作動中、ユーザは、周りを支えるワーキング・ヘッド・アセンブリ2と共に内視鏡8を、ワーキング・ヘッド・アセンブリ2が切除される組織に隣接する、望んだ位置に着くまで、切除する組織の部分へ進ませる。
図4に示すように、ユーザは制御ハンドル6の力を、駆動ケーブル100を回転するために用い、ケーブル100は、プロキシマル・ハウジング12の遠端部12aから離れたヨーク93及び台部材10を進ませるために駆動軸95を回転させる。
図3に示す様に、台部材10が最も離れた位置に着くと、補足穴32と33の間の1つを介して台部材10と遠端部12aの間の隙間に入るために、既存の握り装置98が覆い4及びワーキング・ヘッド・アセンブリ2を貫通して進む。
図3の装置は、十二指腸スコープを内視鏡8として用いて示されるが、当業者は例えば、胃鏡、カラースコープ等、他の内視鏡も用いることができることを理解するだろう。
図1に示されるように、少なくともプロキシマル・ハウジング12の遠端部12aは、台部材10の近端面14のサイズ及び形状に対応する切断面を有し、該プロキシマル・ハウジング12は、実質的に台部材10の切り取り器13にサイズと形状が対応する切り取り器29を有する。
切り取り器29は、内視鏡8を受け入れ、該内視鏡8に沿ってプロキシマル・ハウジング12をスライド可能なように進ませることを可能とするために提供される。当然当業者は、ワーキング・ヘッド・アセンブリ2の外面の形状は、いくつもの切除形状に適応するために選択され、台部材10の形状は、ワーキング・ヘッド・アセンブリの体内の通路への前進及びそこからの除去を促進するためにプロキシマル・ハウジング12に隣接して位置した時に、好ましくは連続表面を形成するために選択されることを理解するであろう。
ワーキング・ヘッド・アセンブリは、15mmと40mmの間で最大直径を有することが好ましい。
キャビティ30を受け入れる組織は、管状臓器の部位の遠端部12aと台部材10の隙間への引っ張りを促進するために、プロキシマル・ハウジング12の遠端部12aの中心に実質的に形成される。
当業者は、キャビティ30の深さは該キャビティへ引っ張られる組織量及びプロキシマル・ハウジング12のサイズによって様々であることを理解するであろう。2つの補足穴32及び33は、軸方向に延長し、好ましくは、プロキシマル・ハウジング12の縦方向軸から僅かに中心を外れる。
補足穴32及び33は、覆い4を貫通し、補足穴32及び33の内の1つを貫通して制御ハンドル106から進む補足器108をそれぞれ受け入れる。
作動中、1つ又は2つの補足装置98は、台部材10及びプロキシマル・ハウジング12の遠端部12aの間の管状臓器の部位を引き抜き、キャビティ30へ入れる。第3補足装置98もまた台部材10とプロキシマル・ハウジング12の間の臓器部位の位置付けの他の処置を提供するために内視鏡8の作動チャンネルを貫通して挿入される。
当然当業者は、補足穴32、33及び内視鏡8の作動チャンネルのいずれかを貫通して、任意の望ましい器具を台部材10とプロキシマル・ハウジング12の間の隙間へ進ませることができることを理解するであろう。
好ましくは複数のステープル・スリット34が、プロキシマル・ハウジング12の遠端部12aの外周に沿って、実質的に楕円形の列である2本のオフセットに配される。ステープル・スリット34は、他の取り付け軸26bに隣接する取り付け軸26aに隣接する領域から延長する。
複数のステープル・スリット34は、台部材10が最も近接している時、各ステープル・スリット34がステープル形成溝19に対応して一直線となるように配列される。
装置を手術用に構成する時、複数のステープルは、各ステープルがステープル・スリット34の1つと協調して、ワーキング・ヘッド・アセンブリ2内に受け入れられる。次にステープルは、プロキシマル・ハウジング12に配される作動装置(図示せず)により、それぞれステープル・スリット34から順次発射される。
実質的に楕円のブレード・スリットは、ステープル・スリット34内を実質的に放射状に延長し、台が最も近接する時、ブレード・スリット36が台部材においてガイドスリット21と一列に配列されるようにする。図4で明確に示す通り、ブレード・スリット36の延長部84a及び84bは、それぞれブレード・ハウジング74a及び74bに延長し、延長部84a及び84bはプロキシマル・ハウジング12の遠端部12aから離れて突出する。
ブレード・ハウジング74a及び74bは好ましくは隣接し、台部材10が最も近接する時、ブレード・ハウジング74a及び74bは、台部材10のリム41の部品43a及び43bと接触するようにする。
プロキシマル・ハウジング12からのブレード・ハウジング74a及び74bの延長は好ましくは、該ブレード・ハウジング74a及び74bがリム41の残りの部品43a及び43bを嵌め込む時(従って、台部材10の近接する動きを止め、最も近接する位置を定義する)、台部材10が確実にプロキシマル・ハウジング12に対して、押し潰したり損傷を与えたりすることなく臓器部分を保持することを可能とするために十分な長さで、台部材10と遠端部12aの間に隙間が形成されるように選択される。
ブレード・スリット36の一端に位置するとき(すなわち、延長部84a及び84bの1つにおいて)、切断ブレード(図示せず)は好ましくはブレード・ハウジング装置74a及び74b及びガイドスリット21の内の1つの中に完全に囲まれ、該切断ブレードが、医師が意図的にブレードを操作するまでいかなる組織も切断しないようにする。
医師がブレードを操作する時、ブレードが他の延長部84a及び84bの内の1つに受け入れられるまで、ブレードは移動方向に向いた切刃を備えてブレード・スリット36の周りの延長部84a及び84b内に受け入れられた最初の位置から駆動する。
従って、切断作業が実行された後、ブレードは再度、不注意に患者を傷つけないように扱われる。
従来技術の円形の内視鏡を利用する装置に示されるように、内視鏡はFTRD内の重要なスペースを占め、また切除キャビティに入る。従来技術の装置において、望ましい外科的処置を実行するのに必要なサイズのキャビティを提供するために、FTRDの全体のサイズはより大きく作らなければならない。
図6はFTRDのプロキシマル・ハウジング112の断面図を示し、切り取り器129内に非円形の内視鏡を受け入れるために構成される。またプロキシマル・ハウジング112は、取り付け軸と同様に取り付け穴126a及び126bを含む。
図示される通り、切り取り器129は、従来技術と同様にキャビティ130へ延長せず、従ってプロキシマル・ハウジング112の全体の大きさを小さくすることを可能とする。更にヘッドの楕円形は、従来技術の装置の一部分が円形のパターン以上に好ましい、チャンバー134から排出されたステープルのための楕円形に形成されたステープル・パターンを提供する。
図7に示される通り、内視鏡108は切り取り器129内に適合させるための本発明の実施形態の内視鏡である。全層切除処置に必要とされる以上に多くのチャンバーを有する従来の装置の標準的な円形の内視鏡を用いるよりも、本発明は望ましい処置に必要とされるだけのチャンバーを提供する内視鏡に関する。
内視鏡108には、この処置を実行するために用いられる遠視、照射、吸入、洗浄の機能を収容するための、わずか4本のチャンバーだけが提供される。
本発明の実施形態によると、内視鏡108は、プロキシマル・ハウジング112の切り取り器129内に適合させるために楕円形状を有する。当業者は、楕円形状により提供されるのと同様の目立たない形状を提供する、他の非円形の形状の内視鏡を利用することができることを理解するであろう。
5本のチャンバー108aから108eが内視鏡108内に提供される。チャンバー108cは好ましくは内視鏡の光学部材を収容する。チャンバー108b及び108dは、前記処置が実行される領域を照射するための光源を含む。
チャンバー108a及び108eは、それぞれ内視鏡の吸入及び洗浄機能を提供するが、当業者はこれら機能を無効にすることができることを理解する。プロキシマル・ハウジング112を利用するFTRDの作動において、従来技術のFTRDと同様に機能する。
本発明の他の実施形態は、明細書及び開示されている本発明の実施を検討することにより、当業者に明らかとなる。明細書及び実施例は例示の目的のみであり、本発明の正確な範囲及び精神は請求項で示されることが意図される。
本発明の実施形態の全層切除装置を示す斜視図である。 本発明の実施形態の内視鏡を取り付けた図1の装置を示す透視図である。 前記装置を貫通する補足装置を備える図1の装置を示す透視図である。 図1の動力装置を示す斜視図である。 挿入を行い易くするために傾斜が付けられた端部を備える図1の装置を示す斜視図である。 本発明の実施形態の全層切除装置のプロキシマル・ハウジングの断面図である。 図6の装置と共に用いられる内視鏡を示す断面図である。

Claims (14)

  1. ファスナーが切除する組織部へ導入される複数のチャンバーと、
    内視鏡を受け入れるための複数のチャンバーの反対側のプロキシマル・ハウジングに形成される非円形の切り取り器と、
    切除された組織を受け入れるための切除キャビティと、
    取り付け軸が貫通して挿入される、少なくとも1つの軸開口部と、
    前記非円形の切り取り器に挿入される非円形の切り取り器と実質的に同形状の非円形の内視鏡と、
    からなる全層切除装置のためのプロキシマル・ハウジング。
  2. 複数のチャンバーが原則的に楕円形のファスナー・パターンを形成するために構成されることを特徴とする請求項1のプロキシマル・ハウジング。
  3. 非円形の内視鏡がオプティカル・ソース、光源、吸入通路、洗浄通路の少なくとも1つを含むことを特徴とする請求項1のプロキシマル・ハウジング。
  4. ファスナーがステープルであることを特徴とする請求項1のプロキシマル・ハウジング。
  5. 前記少なくとも1つの軸開口部が2つの軸開口部であることを特徴とする請求項1のプロキシマル・ハウジング。
  6. 非円形の内視鏡が楕円形であることを特徴とする請求項1のプロキシマル・ハウジング。
  7. ファスナーが切除する組織部へ導入される複数のチャンバーと、
    内視鏡を受け入れるための複数のチャンバーの反対側のプロキシマル・ハウジングに形成される非円形の切り取り器と、
    切除された組織を受け入れるための切除キャビティと、
    取り付け軸が貫通して挿入される、少なくとも1つの軸開口部と、
    からなる全層切除装置のためのプロキシマル・ハウジング。
  8. 前記複数のチャンバーが本質的に楕円形のファスナー・パターンを形成するために構成されることを特徴とする請求項7のプロキシマル・ハウジング。
  9. 前記ファスナーがステープルであることを特徴とする請求項7のプロキシマル・ハウジング。
  10. 前記少なくとも1つの軸開口部が2つの軸開口部であることを特徴とする請求項7のプロキシマル・ハウジング。
  11. 前記非円形の切り取り器が楕円形であることを特徴とする請求項7のプロキシマル・ハウジング。
  12. 非円形ハウジングと、
    吸入、洗浄、照射及び遠視機能を有する複数のチャンバーと、
    からなる全層切除装置で用いるための内視鏡。
  13. 前記ハウジングが4本のチャンバーを有し、それぞれのチャンバーが吸入、洗浄、照射及び遠視機能を有することを特徴とする請求項12の内視鏡。
  14. 前記非円形の内視鏡が楕円形であることを特徴とする請求項12の内視鏡。
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US6629630B2 (en) 2003-10-07
US6820791B2 (en) 2004-11-23
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