JP4349850B2 - Endoscope anchor remote guidance system - Google Patents

Description

[0001]
【Technical field】
The present invention relates to an endoscopic anchor remote guidance system used when excising a lesion under endoscopic observation.
[0002]
[Prior art and its problems]
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.
[0003]
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.
[0004]
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 was required.
[0005]
Therefore, in order to solve these problems, the applicant of the present invention has a gripping member for gripping a lesioned part inside a human organ, a magnetic anchor made of a magnetic material, and a connecting member for connecting the gripping member and the magnetic anchor. And a magnetic anchor guiding device that is arranged 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 by the gripping member A magnetic anchor remote guidance system characterized by lifting the lesioned part is proposed and a patent application has been filed (Japanese Patent Application No. 2002-268239).
[0006]
OBJECT OF THE INVENTION
The object of the present invention is to improve the invention of the above-mentioned patent application so that not only can the target site be excised quickly and easily, but also the distance between the anchor and the gripping member can be adjusted. An object of the present invention is to provide an endoscope anchor remote guidance system in which a connecting member is always tensioned when an anchor is moved in a predetermined direction inside an object.
[0007]
Summary of the Invention
An endoscope anchor remote guidance system according to the present invention includes a gripping member capable of gripping a target portion inside a target, a magnetic anchor made of a magnetic material, and a deformable wire connecting the gripping member and the magnetic anchor. And a magnetic anchor guide device that is arranged outside the object and generates a magnetic field, and moves the magnetic anchor by the magnetic force generated by the magnetic field generated by the magnetic anchor guide device, An endoscope anchor remote guidance system for moving a target part gripped by the gripping member in a predetermined direction, wherein a connecting member having one end coupled to the gripping member has a plurality of holes along its longitudinal direction. The magnetic anchor includes an engaging member that selectively engages with any one of these holes.
[0008]
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.
[0009]
According to another aspect, an endoscope anchor remote guidance system according to the present invention includes a gripping member capable of gripping a target portion inside a target object, a gravitational anchor made of a nonmagnetic material, the gripping member, and the gravitational anchor. A deformable linear connecting member that connects the two, and remotely moving the gravitational anchor according to gravity to move the target portion gripped by the gripping member in a predetermined direction A connecting member, one end of which is coupled to the gripping member, has a plurality of holes along its longitudinal direction, and the magnetic anchor selectively engages any of these holes. An engaging member is provided.
[0010]
In any aspect, it is practical that the connecting member is a flexible connecting string, and the hole is a ring formed by connecting the connecting strings.
[0011]
In any aspect, the connecting member may be a chain, and the hole may be a ring constituting the chain.
[0012]
In any aspect, the engagement member is substantially C-shaped, and is pivotally attached to the base portion that can be engaged with the hole portion from one end side thereof and to the other end portion of the base portion. And an opening / closing piece that opens and closes a gap formed between both ends of the base.
[0013]
Furthermore, in any aspect, it is practical that the engaging member includes a biasing means that constantly biases the opening / closing piece in the closing direction to close the gap of the base portion.
[0014]
In any aspect, a cylindrical sheath having a fitting groove in which the tip is open and the base of the engaging member can be fitted, and the sheath can be relatively moved in the longitudinal direction of the sheath. When the base portion of the engagement member is inserted and is moved relative to the sheath in a state where the base portion of the engagement member is engaged with the fitting groove, the distal end portion protruding from the distal end opening of the sheath It is practical to have a changing device provided with a rod-like pressing and changing member that rotates in the opening direction to open the gap.
[0015]
Further, the pressing and switching member is pressed against the connecting member while pressing the opening / closing piece in the opening direction by the tip portion in a state where the base portion of the engaging member is engaged with the fitting groove. It is preferable that the hole engaged with the base can be removed from the base by relatively moving the engaging member.
[0016]
Further, in the state in which the hole portion engaged with the base portion is pulled out from the base portion and the base portion of the engagement member is engaged with the fitting groove, The opening / closing piece is pressed in the opening direction by the tip portion and the hole portion is engaged with the base portion of the engaging member while engaging the hole portion different from the hole portion that has come out of the base portion with the portion. Is preferably possible.
[0027]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. The anchor remote guidance system of the present embodiment includes a magnetic anchor device 10 (consisting of a gripping member 11, a magnetic anchor 12, a connecting string 13, a traction separating member 14, and a cylindrical fastening member 15) and an internal view of the magnetic anchor device 10. The operation device 30 performs a separation operation from the mirror 20 and the like, and the magnetic anchor guide device 40 that controls the magnetic anchor device 10 to be attracted outside the body (applies a magnetic force to the magnetic anchor 12).
[0028]
First, the configuration of the magnetic anchor device 10 will be described with reference to FIGS. 1 to 3.
The gripping member 11 having a symmetric shape is an elastic member obtained by bending a metal plate, and in a free state, a C-ring-shaped base portion 11a with which the tip ends of both sides come into contact with each other, and extending while extending forward from the tip end of the base portion 11a. A pair of inclined pieces 11b, 11b to be opened, opening / closing pieces 11c, 11c extending in parallel with each other from the tips of both inclined pieces 11b, 11b, and a claw portion 11d formed by bending the tip portions of both opening / closing pieces 11c, 11c. 11d. Further, an insertion hole 11a1 is formed in the rear end portion of the base portion 11a.
[0029]
The magnetic anchor 12 includes a substantially cylindrical main body 12a, a protrusion 12b protruding from the main body 12a, and an engaging member 12c provided at the protrusion 12b. The main body 12a and the protrusion 12b are formed of a ferromagnetic material. Specific examples of the ferromagnetic material include pure iron, iron alloy, platinum magnet, rare earth magnet, terbium / dysprosium / iron alloy, etc. There are magnets.
The engaging member 12c is pivotally attached to one end of the base portion 12c1 and a base portion 12c1 having a substantially C shape, and comes into contact with the other end of the base portion 12c1, thereby forming a gap formed between both ends of the base portion 12c1. An opening / closing piece 12c2 that closes and opens the gap by being separated from the other end is provided. Furthermore, the engaging member 12c has a biasing spring (biasing means) (not shown) that constantly biases the opening / closing piece 12c2 in the closing direction to close the gap. As shown, the opening / closing piece 12c2 normally closes the gap.
[0030]
A base end of a flexible connecting string (connecting member) 13 is connected to the base portion 11a of the gripping member 11 so as to be slidable with respect to the base portion 11a. A plurality of ring portions (hole portions) 13 a are formed along the longitudinal direction of the connecting string 13 by connecting the intermediate portions thereof. In FIG. 1 to FIG. 3, the base portion 12 c 1 of the engaging member 12 c of the magnetic anchor 12 is inserted into the ring portion 13 a formed at the distal end of the connecting cord 13, and thus the connecting strap 13 and the magnetic anchor 12 are connected. The holding member 11 is connected.
[0031]
The pulling / separating member 14 is a rod-shaped member, and at the tip thereof is engaged with a pair of insertion pieces 14a penetrating the insertion hole 11a1 of the gripping member 11 and the inner surface of the base portion 11a provided at the tip of the insertion piece 14a. Thus, a retaining portion 14b that prevents the insertion piece 14a from slipping out of the base portion 11a is provided. Furthermore, a flange portion 14 c is formed at the proximal end portion of the traction separation member 14. The pulling / separating member 14 is formed from a metal material such as plastic or SUS, and has such a strength that it can be cut when receiving a strong force exceeding a predetermined cutting force.
[0032]
The cylindrical fastening member 15 having both ends opened as shown in FIGS. 1 to 3 and the like is made of a flexible material. The cylindrical fastening member 15 is formed with a pair of slits 15 a that face in the same direction as the cylindrical fastening member 15. The front end of the slit 15a is open and the rear end is closed. Further, the inner diameter of the cylindrical fastening member 15 is such that the base 11a of the gripping member 11 and the inclined piece 11b can be fitted.
[0033]
From the state shown in FIG. 1 (the state in which the gripping member 11 is not fitted in the cylindrical fastening member 15), when the traction separation member 14 is pulled backward relative to the cylindrical fastening member 15, As shown in FIG. 2, the base 11a of the gripping member 11 is drawn into the cylindrical fastening member 15 while being elastically deformed inward. Then, the diameter of the base portion 11a is reduced, and the both inclined pieces 11b and the both open / close pieces 11c are in an open state in which they are separated from each other.
As shown in FIG. 3, when the traction separating member 14 is pulled further rearward relative to the cylindrical fastening member 15, the gripping member 11 is elastically deformed inward and enters the inside of the cylindrical fastening member 15. Further, the inclined piece 11b comes into contact with the tip opening of the cylindrical fastening member 15, and the open / close pieces 11c and the claws 11d come close to each other.
[0034]
FIG. 4 shows an endoscope 20 used to perform a resection using an anchor remote guidance system.
As is well known, the endoscope 20 has an insertion portion 21 that is soft and flexible and is inserted into the body, and the distal end surface 22 is supplied with air and water for supplying air and cleaning water. A nozzle (not shown), an illumination window (not shown) for illuminating the excision part and its periphery, an observation window for observing the excision part and its periphery where the objective lens and the image sensor are arranged immediately thereafter, and FIG. An outlet 23 of the forceps channel C shown in FIG. The forceps channel C is formed in the insertion portion 21, the inlet 24 a is formed on the end face of the forceps opening 24, and the outlet 23 is tapered so that the diameter of the distal end is increased.
[0035]
Next, the operation device 30 inserted into the forceps channel C of the endoscope 20 will be described with reference to FIG.
The insertion tube 31 is a flexible cylindrical member and can be inserted into the forceps channel C from the entrance 24 a of the forceps port 24 of the endoscope 20. Further, the inner diameter is such that the gripping member 11 and the cylindrical fastening member 15 in the state of FIG. 1 can be inserted. A cylindrical insertion coil 32 that is movable relative to the insertion tube 31 is inserted into the insertion tube 31. A small-diameter portion 33b of a regulation tube 33 composed of a large-diameter portion 33a and a small-diameter portion 33b is fitted to the distal end portion of the insertion coil 32, and the small-diameter portion 33b is distal to the distal end of the insertion coil 32 by an adhesive, solder, brazing, or the like. It is fixed to the part.
[0036]
The outer diameter of the large diameter portion 33 a is smaller than the inner diameter of the insertion tube 31 and is set to be substantially the same as the outer diameter of the insertion coil 32. Furthermore, the inner diameter of the large-diameter portion 33a is larger than the inner diameter of the small-diameter portion 33b and is set to be substantially the same as the outer shape of the cylindrical fastening member 15, and the inner surface of the large-diameter portion 33a is connected to the inner surface of the small-diameter portion 33b. An annular step 33a1 perpendicular to the axis of the restriction tube 33 is formed (see FIG. 7 and the like).
[0037]
Inside the insertion coil 32 inserted into the forceps channel C, an operation wire 35 provided with a hook portion 34 at the tip is inserted so as to be movable relative to the insertion coil 32 and the regulation tube 33. The hook portion 34 has a proximal end portion fixed to the distal end portion of the operation wire 35 by an adhesive, solder, brazing, or the like.
Furthermore, each base end part of the insertion tube 31, the insertion coil 32, and the operation wire 35 is connected with the operation part (not shown) of the operating device 30, and is mutually movable to an axial direction.
The operation device 30 is configured by the insertion tube 31, the insertion coil 32, the restriction tube 33, the hook portion 34, the operation wire 35, and the operation portion described above.
[0038]
Next, the configuration of the magnetic anchor guidance device 40 that controls the magnetic anchor 12 outside the body of the patient A will be described with reference to FIGS. 5 and 6.
A pair of XY stages (one-way moving mechanisms) 42 and 42 are disposed on both sides of the bed 41 having a floor plate 41a on which the patient A is placed. The pair of XY stages 42 reciprocate linearly along the longitudinal direction of the bed 41 so that the longitudinal positions of the both 42 and 42 are always the same. Further, above the bed 41, a frame / rail (two-plane moving mechanism) composed of two rails 44 and 45 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 41. 43, and both ends of the frame / rail 43 are fixed to the left and right XY stages 42, respectively. The inner rail 44 is slidably mounted with a magnetic induction member 46 for attracting and controlling the magnetic anchor 12 outside the body (which exerts a magnetic force on the magnetic anchor 12). The magnetic induction member 46 is attached to the left and right XY stages 42. It is possible to move along the rail 45. The magnetic induction member 46 is obtained by fixing an electromagnet 47 having a structure in which a coil is wound around an iron core on a base 48, and the electromagnet 47 always faces the patient A side (see FIG. 5). The magnetic induction member 46 may be a combination of a permanent magnet and an electromagnet, or a combination of two or more permanent magnets and electromagnets.
[0039]
A counterweight 49 for maintaining the weight balance of the entire frame / rail 43 is slidably mounted on the rail 45 on the rail 45 outside the frame / rail 43. The position of the counterweight 49 changes depending on the position of the magnetic induction member 46. For example, when the magnetic guide member 46 is located on the front side of the patient A, the counterweight 49 is located on the back side of the patient A, and when the magnetic guide member 46 is on the back side of the patient A, the counterweight 49 is Located on the front side of the patient A, the entire frame / rail 43 is balanced in weight.
The magnetic guide member 40, the XY stage 42, and the frame / rail 43 described above constitute the magnetic anchor guide device 40.
[0040]
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. 5 and 6, the patient A subjected to local anesthesia is laid on the floor plate 41 a of the bed 41. At this time, the XY stage 42 is operated so that the longitudinal direction position of the bed 41 of the frame / rail 43 is substantially the same position as the head A1 of the patient A, and the magnetic induction member 46 and the counterweight 49 are set to a predetermined position. Keep it in the place.
Next, the XY stage 42 is operated to place the frame / rail 43 on the front side of the patient A, and the magnetic guiding device 46 is moved along the frame / rail 43 to start excision of the magnetic guiding member 46. Position at the hour position (see FIG. 6).
[0041]
Next, a flexible overtube (not shown) is inserted from the mouth of patient A into the body. Subsequently, the insertion portion 21 of the endoscope 20 is inserted into the overtube, the distal end portion of the insertion portion 21 is protruded from the distal end of the overtube, and the organ B (target) (see FIGS. 8 to 10, etc.) It is made to approach the lesioned part (target site) X (not shown). Thus, when the distal end of the insertion portion 21 of the endoscope 20 is inserted into the organ B, the observation image in the organ B obtained from the observation window provided on the distal end surface 22 of the insertion portion 21 of the endoscope 20. Is displayed on a television monitor (not shown).
[0042]
Next, a tube-like treatment tool (not shown) having an injection needle at the tip is inserted into the forceps channel C from the inlet 24 a of the forceps port 24, and the injection needle protrudes from the outlet 23 of the forceps channel C. Then, an injection needle is inserted from the periphery of the lesion X into the submucosa B1 of the organ wall and physiological saline or the like is injected, and the lesion X is lifted from the proper muscle layer B2 (FIGS. 8 to 11, FIG. 21 and FIG. 22).
[0043]
Subsequently, the treatment tool is taken out from the forceps channel C. Next, the operation device 30 in which the insertion tube 31, the insertion coil 32, the restriction tube 33, the hook portion 34, the operation wire 35, and the operation portion are integrated is inserted into the forceps channel C from the forceps port 24.
At this time, when the operation device 30 is inserted into the forceps channel C, the operation portion of the operation device 30 and the proximal end portions of the insertion tube 31, the insertion coil 32, and the operation wire 35 protrude to the rear of the forceps port 24 (not shown). .
Further, since the cylindrical fastening member 15 is formed from a flexible material and the insertion coil 32 is bendable, these members can be retained in the forceps channel C even when the insertion portion 21 is bent. It can move smoothly.
[0044]
When the distal end of the operation device 30 reaches the distal end portion of the forceps channel C, the proximal end portion of the operation wire 35 protruding from the forceps opening 24 is grasped, and the operation wire 35 is operated so that only the hook portion 34 is endoscope 20. The operation wire 35 is pulled toward the operation portion side by engaging the hook portion 34 with the hook portion 14 c of the pulling separation member 14. Then, as shown in FIG. 7, the proximal end portion of the cylindrical fastening member 15 is fitted to the large diameter portion 33 a of the restriction tube 33, and the gripping member 11, the connecting cord 13, the pulling connecting member 14, and the magnetic anchor 12 are used. The protrusion 12b is pulled into the forceps channel C, the end surface of the main body 12a of the magnetic anchor 12 comes into contact with the distal end surface 22 of the insertion portion 21, and the magnetic anchor device 10 and the operating device 30 are integrated.
[0045]
When the magnetic anchor device 10 and the operating device 30 are set in the endoscope 20 as described above, as shown in FIG. 8, the proximal end portion of the insertion tube 31 protruding rearward from the forceps port 24 is grasped, and the insertion tube 31 is gripped. Is moved to the distal end side of the insertion portion 21, the distal end portion protrudes from the distal end surface 22, and the magnetic anchor 12 is pushed out from the forceps channel C.
Next, the insertion coil 32 is moved to the distal end side of the insertion portion 21, the gripping member 11 is protruded from the distal end of the insertion tube 31, and the gripping member 11 is brought close to the lesioned part X. When the operation wire 35 is pulled backward relative to the endoscope 20 in this state, the base 11a of the gripping member 11 is pulled into the cylindrical fastening member 15, and the gripping member 11 is in the open state shown in FIG. It becomes.
[0046]
When the operation wire 35 is further pulled rearward, the base 11 a of the gripping member 11 is further pulled rearward inside the cylindrical fastening member 15, and the inclined piece 11 b comes into contact with the distal end opening of the cylindrical fastening member 15. Therefore, the opening / closing piece 11c of the grasping member 11 is closed, and the lesioned part X is reliably grasped by the both claws 11d (see FIG. 9).
[0047]
In this state, when the operation wire 35 is pulled backward with a force greater than the above cutting force, the traction separating member 14 engaged with the hook portion 34 is cut at the intermediate portion, and as a result, the magnetic anchor device 10 Is separated from the operation wire 35 (see FIG. 10).
Then, the magnetic anchor 12 is attracted | sucked to the magnetic induction member 46 side by strengthening the magnetic field generated of the magnetic induction member 46 arrange | positioned outside the patient's A body. At this time, if the connecting string 13 is tensed, the lesion X gripped by the gripping member 11 can be lifted to the magnetic induction member 46 side.
[0048]
As shown in FIG. 11, when the magnetic anchor 12 comes into contact with the inner wall of the organ B while the connecting cord 13 is not tensioned, the lesion X gripped by the gripping member 11 is removed from the magnetic induction member 46. In such a case, the connecting device 13 shown in FIG. 12 is used to move the connecting string 13 from the fixing portion with the gripping member 11 to the engaging portion with the engaging member 12c. Adjust the length.
[0049]
The changing device 50 includes a flexible sheath 51 having both ends opened, and a rod-like pressing and changing member 52 inserted into the sheath 51 so as to be relatively movable. A fitting groove 51a into which the base portion 12c1 of the engaging member 12c can be fitted is formed at the distal end surface of the sheath 51, and an operation piece (vertical) with respect to the main body is formed at the distal end of the pressing and switching member 52. A tip 52) is formed. The operation piece 52 always protrudes from the distal end of the sheath 51, and the proximal end portion of the pressing and changing member 52 protrudes from the proximal end of the sheath 51 (not shown).
[0050]
In order to adjust the length, the switching device 50 is inserted into the forceps channel C of the endoscope 20, and the distal end portion thereof protrudes from the distal end surface 22 of the insertion portion 21. Is protruded from the forceps port 24 (not shown).
Then, as shown in FIG. 13, the base portion 12c1 of the engaging member 12c is fitted into the fitting groove 51a of the sheath 51, and in this state, the base end portion of the pressing and changing member 52 is grasped and the base end side thereof is moved to the base end side. When pulled, the operation piece 52a presses the opening / closing piece 12c2 of the engaging member 12c in the opening direction against the urging force of the urging spring, and moves the opening / closing piece 12c2 to the opening position shown in FIG.
In this state, by operating the pressing and switching member 52 while grasping the base end portion and moving the magnetic anchor 12 in a predetermined direction, the base portion 12c1 of the engaging member 12c is moved from the ring portion 13a of the connecting string 13. Escape to separate the magnetic anchor 12 and the connecting cord 13 (see FIG. 15).
[0051]
Subsequently, as shown in FIG. 16, the pressing and changing member 52 is moved to cause the fitting groove 51a to escape from the base portion 12c1 of the engaging member 12c, and thereafter, as shown in FIG. The adjustment member 50 is moved to the connection string 13 side, and the operation piece 52 a is engaged with the ring portion 13 a located on the proximal side from the distal end of the connection string 13.
Next, the magnetic field generated by the magnetic induction member 46 is temporarily weakened to bring the magnetic anchor 12 closer to the lesion X (not shown).
[0052]
Subsequently, while maintaining this state, as shown in FIG. 18, the switching device 50 is brought closer to the magnetic anchor 12 side, and the base portion 12 c 1 of the engaging member 12 c is fitted into the fitting groove 51 a of the sheath 51.
In this state, when the pressing / replacement member 52 is pulled toward the base end side, as shown in FIG. 19, the operation piece 52a opposes the opening / closing piece 12c2 of the engagement member 12c against the urging force of the urging spring. The ring portion 13a engaged with the operation piece 52a is moved to the base portion 12c1 side and engaged with the base portion 12c1 from one end of the base portion 12c1.
[0053]
In this way, when the length of the connecting string 13 from the fixing portion with the gripping member 11 to the engaging portion with the engaging member 12c is shortened, the magnetic field generated by the magnetic induction member 46 is strengthened again, and the magnetic anchor 12 is moved. It attracts | sucks to the magnetic induction member 46 side. Then, as shown in FIG. 20, the connecting string 13 is tensioned between the magnetic anchor 12 and the gripping member 11, and the lesioned part X gripped by the gripping member 11 is lifted by a sufficient distance upward in FIG. .
[0054]
Thus, when the lesioned part X is moved by a desired distance in the desired direction, a sufficiently large excision part is formed at the boundary between the lesioned part X and the normal tissue. Then, the operation wire 35 is taken out from the endoscope 20, and as shown in FIG. 20, an incision tool such as a high-frequency knife 60 is inserted into the organ B using the forceps channel C of the endoscope 20 (not shown in FIG. 20). The lesioned part X is excised together with the mucous membrane from one end side.
When the lesioned part X is excised from one end side to the opposite end side, the entire lesioned part X is eventually completely excised (see FIG. 21).
In the excision work with the high-frequency knife 60, the position of the tip 60a of the high-frequency knife 60 can be confirmed more easily as the excision area increases.
[0055]
When the excision work is completed as described above, the lesioned part X separated from the normal tissue remains in the state of being gripped by the gripping member 11 (magnetic anchor device 10), and thus the lesioned part X is prevented from being lost.
In order to collect the excised lesion part X, as shown in FIG. 21, the forceps channel C of the endoscope 20 is provided with a pair of gripping pieces 71 that can be opened and closed at its distal end, and further, its proximal end A grasping forceps 70 having an operation unit (not shown) is inserted into the. Then, by operating this operation portion, the gripping piece 71 is brought into the open state to be brought close to the traction separation member 14, and then both the gripping pieces 71 are closed so that the traction separation member 14 is reliably secured by the both gripping pieces 71. Hold it. Then, the endoscope 20 is removed from the body as it is, the lesioned part X is taken out of the body together with the magnetic anchor device 10, and thereafter, the excised part is sutured and disinfected.
[0056]
As described above, when the anchor remote guidance system of the present embodiment is used, the length of the connecting string 13 from the fixing portion with the grasping member 11 to the engaging portion with the engaging member 12c is adjusted, thereby organs Regardless of the size of B, it is possible to lift the lesioned part X by always tensioning the connecting string 13.
[0057]
Further, since the lesioned part X can be moved in a desired direction by a sufficient distance, the excised part at the boundary between the lesioned part X and the normal tissue can be easily and reliably secured with a sufficient size. Even if the lesioned part X has a flat shape, a sufficiently large excision part can be created. Even in such a case, the lesioned part X can be easily excised. .
[0058]
Furthermore, since the lesioned part X is lifted by the gripping member 11, a sufficiently excised part can be secured, and the already excised lesioned part X can be prevented from falling on the proper muscle layer B2.
In addition, since the gripping member 11 can be arranged at an arbitrary position, the view of the endoscope 20 is not hindered by the excised lesioned part X.
[0059]
Next, a second embodiment of the present invention will be described with reference to FIG.
The same members as those in the first embodiment are designated by the same reference numerals, and detailed description thereof is omitted.
[0060]
The anchor remote guidance system of this embodiment includes a magnetic anchor device 80 (consisting of a gripping member 11, a magnetic anchor 12, a chain 81, a traction separating member 14, and a cylindrical fastening member 15), an operating device 30, and a magnetic anchor guidance. The apparatus 40 is comprised.
[0061]
In this embodiment, the grip member 11 and the magnetic anchor 12 are connected using a chain (connecting member) 81 instead of the connecting string 13. The chain 81 is configured by connecting a large number of rings 82. In the state shown in FIG. 22, the ring 82 located at the proximal end engages with the base 11 c of the gripping member 11, and the ring 82 located at the distal end engages with the engaging member 12 c of the magnetic anchor 12. .
[0062]
The magnetic anchor device 80 is inserted into the organ B while being attached to the endoscope 20 in the same manner as in the first embodiment, and then the holding member 11 holds the lesion X.
If the chain 81 is not tensioned even when the magnetic anchor 12 is moved by generating a magnetic field from the magnetic induction member 46, the engagement member 12c is used by using the changing device 50 as in the first embodiment. The ring 82 positioned on the base end side is engaged with the base portion 12c1 (not shown).
[0063]
In this way, by adjusting the length from the base end of the chain 81 to the engaging portion of the chain 81 with the engaging member 12c, a magnetic field is applied from the magnetic induction member 46 regardless of the size of the organ B. If generated, the chain 81 can always be tensioned to lift the lesion X.
[0064]
Finally, a third embodiment of the present invention will be described with reference to FIG. The same members as those in the first embodiment are designated by the same reference numerals, and detailed description thereof is omitted.
[0065]
The anchor remote guidance system of this embodiment includes a gravity anchor device 90 (consisting of a gripping member 11, a gravity anchor 91, a connecting string 13, a traction separating member 14, and a cylindrical fastening member 15) and an operation device 30. It is.
The gravity anchor 91 of this embodiment includes a main body 91a, a protrusion 91b, and an engaging member 12c having the same shape as the magnetic anchor 12, and the main body 91a and the protrusion 91b are formed of a nonmagnetic material. Yes. Specific examples of the nonmagnetic material include gold, copper, aluminum, stainless steel (austenite), brass, ceramic, glass, and the like.
[0066]
The gravitational anchor device 90 is inserted into the organ B while being attached to the endoscope 20 in the same manner as in the first embodiment, and then the gripping member 11 grips the lesion X.
Since the gravity anchor 91 moves according to the gravity P, the posture of the patient A is changed and the gravity anchor 91 is moved downward in the gravity direction. Then, when the gravity anchor 91 comes into contact with the inner wall of the organ B without the tension of the coupling string 13 being engaged from the fixing portion of the coupling string 13 with the grasping member 11 in the same manner as in the first embodiment. The length to the engaging part with the member 12c is adjusted. If such adjustment is performed, the lesioned part X can be moved by always tensioning the connecting string 13 regardless of the size of the organ B, as in the first embodiment.
Furthermore, in this embodiment, the magnetic anchor guiding device 40, which is an expensive device necessary in the first embodiment, is not necessary, which is advantageous in terms of cost compared to the first embodiment.
[0067]
Although the present invention has been described with reference to the above embodiment, 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, if the magnetic anchor 12 of the second embodiment is replaced with the gravity anchor 91 of the third embodiment and the magnetic anchor guide device 40 is omitted, a gravity anchor device using the chain 81 can be obtained.
[0068]
【The invention's effect】
As described above, according to the present invention, the target part can be excised quickly and easily, and the distance between the anchor and the gripping member can be adjusted, so that the anchor is placed in a predetermined direction inside the object. When moved to the position, the connecting member is always in tension.
[Brief description of the drawings]
FIG. 1 is an overall view of a magnetic anchor device according to a first embodiment of the present invention.
FIG. 2 is an overall view of the magnetic anchor device with a gripping member open.
FIG. 3 is an overall view of the magnetic anchor device in a state where a gripping member is closed.
FIG. 4 is an overall view of an endoscope.
FIG. 5 is a view of a bed on which a patient whose lesion is to be excised and a magnetic anchor guide device are viewed from the patient's head side.
FIG. 6 is a side view of a bed on which a patient is placed and a magnetic anchor guiding device.
FIG. 7 is an enlarged longitudinal side view of the distal end portion of the endoscope showing a state in which the operating device is inserted into the forceps channel in a state linked to the magnetic anchor device.
FIG. 8 is an enlarged longitudinal sectional side view showing a state immediately before the grasping member protruding from the distal end of the endoscope in the opened state grasps a lesioned portion.
FIG. 9 is an enlarged longitudinal sectional side view showing a state where a gripping member protruding from the distal end of the endoscope is closed and a lesioned part is gripped.
FIG. 10 is an enlarged longitudinal side view showing a state where the magnetic anchor device and the operating device are separated inside the endoscope.
FIG. 11 is an enlarged longitudinal sectional side view showing a state in which a lesioned part is lifted by using a magnetic anchor guiding device after the gripping member grips the lesioned part.
FIG. 12 is an enlarged cross-sectional view of the distal end portion of the switching device.
FIG. 13 is an enlarged view showing a state in which the base portion of the engaging portion of the magnetic anchor is fitted in the fitting groove of the sheath.
FIG. 14 is an enlarged view showing a state where the opening / closing piece is moved in the opening direction by the pressing and changing member.
FIG. 15 is an enlarged view showing a state in which the opening / closing piece is maintained in the open state by the pressing and changing member and the ring portion of the connecting string is escaped from the base portion.
FIG. 16 is an enlarged view showing a state in which the base portion of the engaging portion of the magnetic anchor is detached from the fitting groove of the sheath.
FIG. 17 is an enlarged view showing a state in which another ring portion of the connecting string is engaged by the pressing and changing member.
FIG. 18 is an enlarged view showing a state in which the base portion of the engaging portion of the magnetic anchor is fitted in the fitting groove of the sheath while the other ring portion of the connecting string is engaged by the pressing and changing member.
FIG. 19 is an enlarged view showing a state in which the opening / closing piece is rotated in the opening direction by the pressing and switching member and the other ring portion of the connecting string is fitted to the base portion of the engaging portion.
FIG. 20 is an enlarged vertical side view showing a state in which a lesion is being lifted using a magnetic anchor guiding device after adjusting the length of a connecting string.
FIG. 21 is a view showing a state in which a magnetic anchor that holds a lesioned part separated from an organ is held by holding forceps.
FIG. 22 is an overall view of a magnetic anchor device according to a second embodiment of the present invention.
FIG. 23 is an enlarged vertical cross-sectional view showing a state in which a lesion is moved downward in the gravity direction using the gravity anchor device after adjusting the chain length of the gravity anchor device according to the third embodiment of the present invention. It is a side view.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 10 Magnetic anchor apparatus 11 Grasp member 11a Base part 11a1 Insertion hole 11b Inclined piece 11c Opening / closing piece 11d Claw part 12 Magnetic anchor 12a Main body part 12b Projection part 12c Engagement member 12c1 Base part 12c2 Opening / closing piece 13 Connection string (connection member)
13a Ring (hole)
14 Pulling / separating member 14a Insertion piece 14b Retaining prevention part 14c Ridge part 15 Cylindrical clamping member 20 Endoscope 21 Insertion part 22 End face 23 Forceps channel outlet 24 Forceps port 24a Inlet 30 Operating device 31 Insertion tube 32 Insertion coil 33 Restriction tube 33a Large diameter portion 33a1 Annular step portion 33b Small diameter portion 34 Hook portion 35 Operation wire 40 Magnetic anchor guide device 41 Bed 41a Floor plate 42 XY stage (unidirectional movement mechanism)
43 Frame / rail (moving mechanism in one plane)
44 45 Rail 46 Magnetic induction member 47 Electromagnet 48 Base 49 Counterweight 50 Replacement device 51 Sheath 51a Fitting groove 52 Pressing and switching member 52a Operation piece (front end)
60 High-frequency knife 60a Tip 70 Grasping forceps 71 Grasping piece 80 Gravity anchor device 81 Chain (connection member)
82 Ring (hole)
90 Gravity Anchor Device 91 Gravity Anchor 91a Main Body 91b Projection A Patient (Subject)
A1 head B organ B1 submucosa B2 proper muscle layer C forceps channel P gravity X lesion (target site)

Claims (10)

A gripping member capable of gripping a target portion inside the target object;
A magnetic anchor made of a magnetic material;
A deformable linear coupling member connecting the gripping member and the magnetic anchor;
A magnetic anchor guiding device that is arranged outside the object and generates a magnetic field,
An endoscopic anchor remote guidance system for moving an object site gripped by the gripping member in a predetermined direction by moving the magnetic anchor by a magnetic force from a magnetic field generated by the magnetic anchor guide device,
A connecting member having one end coupled to the gripping member has a plurality of holes along its longitudinal direction,
The remote anchor guidance system for an endoscope, wherein the magnetic anchor includes an engagement member that selectively engages any one of the holes. 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 capable of gripping a target portion inside the target object;
A gravity anchor made of non-magnetic material,
A deformable linear connecting member that connects the gripping member and the gravity anchor;
An endoscope anchor remote guidance system that moves the gravity anchor according to gravity and moves a target portion gripped by the gripping member in a predetermined direction,
A connecting member having one end coupled to the gripping member has a plurality of holes along its longitudinal direction,
The remote anchor guidance system for an endoscope, wherein the magnetic anchor includes an engagement member that selectively engages any one of the holes. The endoscope anchor remote guidance system according to any one of claims 1 to 3, wherein the connecting member is a flexible connecting string, and the hole portion is formed by connecting the connecting string. Is an endoscope remote guidance system for endoscopes. The endoscope anchor remote guidance system according to any one of claims 1 to 3, wherein the connecting member is a chain, and the hole portion is a ring constituting the chain. system. The endoscope anchor remote guidance system according to any one of claims 1 to 5,
The engaging member is
A substantially C-shape, a base that can be engaged with the hole from one end thereof;
An opening / closing piece pivotally attached to the other end of the base and opening / closing a gap formed between both ends of the base;
An anchor remote guidance system for endoscopes comprising: The endoscope anchor remote guidance system according to claim 6,
An endoscope anchor remote guidance system, wherein the engagement member includes an urging unit that constantly urges the opening and closing piece in a closing direction to close the gap of the base. The endoscope anchor remote guidance system according to claim 7, further comprising:
A cylindrical sheath having a fitting groove that is open at the tip and into which the base of the engaging member can be fitted;
When the sheath is inserted into the sheath so as to be relatively movable in the longitudinal direction of the sheath and the base of the engaging member is engaged with the fitting groove, the distal end of the sheath is moved. A remote anchor anchor guidance system for an endoscope, comprising: a switching device including a rod-shaped pressing and switching member that has a tip protruding from the opening to rotate the opening / closing piece in an opening direction that opens the gap. The endoscope anchor remote guidance system according to claim 8,
In the state where the base part of the engaging member is engaged with the fitting groove, the pressing and switching member is engaged with the connecting member while pressing the opening / closing piece in the opening direction by the tip part. An anchor remote guidance system for an endoscope which can cause a hole engaged with the base to come out of the base by moving the joint member relative to each other. The endoscope anchor remote guidance system according to claim 9,
In the state in which the hole portion engaged with the base portion is pulled out from the base portion and the base portion of the engagement member is engaged with the fitting groove, It is possible to engage the hole with the base of the engaging member by pressing the opening / closing piece in the opening direction with the tip while engaging a hole different from the hole that has come out of the base. Remote anchor anchor guidance system.

Images