JP4389618B2 - Electric treatment instrument - Google Patents

Description

  The present invention relates to an electrical treatment instrument equipped with an incision electrode capable of performing incision of a living tissue by flowing a high-frequency current, and more specifically, the protruding length of the incision electrode is kept constant during operation, The present invention relates to an easy-to-handle electrical treatment instrument.

  As a medical electrical treatment instrument, a treatment instrument using high-frequency electrical energy is known, and a living tissue can be electrically incised without damaging the living body, thereby reducing bleeding during surgery. Therefore, it has come to be widely used in recent years. The electrical treatment instrument utilizes the action of high-frequency electrical energy between the electrode provided at the distal end of the treatment instrument and the living tissue.

  Among such electric treatment instruments, the electric treatment instrument described in Patent Document 1 is known as one that is suitable for incision through a relatively narrow range of living tissue by being inserted into the body through an endoscope. It has been. This electric treatment instrument includes a sheath (catheter tube) having a counter electrode attached to the tip, a drive wire disposed inside the sheath, and an incision electrode attached to the tip of the drive wire. When a high-frequency current is passed between the two electrodes, the living tissue can be incised by the incision electrode.

  Further, in this electric treatment instrument, an operation main body is attached to the proximal end portion of the sheath, and an operation handle having a fixing screw is attached to the proximal end portion of the drive wire. By fixing the operating handle to the operating body with a fixing screw, it is possible to limit the axial movement of the drive wire relative to the sheath. Therefore, by operating the operating handle, the incision electrode protrudes from the sheath for a predetermined length or is pulled into the sheath, and then the operating handle is fixed to the operating body with the fixing screw. And that state can be maintained.

  When using this electric treatment instrument, first, the incision electrode is drawn into the sheath, and then inserted into the body through the endoscope. Then, after the distal end of the sheath is brought close to the living tissue to be incised, the operating handle is operated while viewing the endoscope image so that the incising electrode protrudes from the sheath to a desired length. . Then, after fixing the operating handle to the operating body with the fixing screws, a high frequency current is passed between the two electrodes to make a target incision.

  However, in the electric treatment instrument disclosed in Patent Document 1, the protruding length of the incision electrode is fixed to a predetermined length by fixing the sheath and the drive wire on the proximal end side with fixing screws. . Therefore, when the operator (operator) operates the sheath or the patient moves the body, the undulation state of the drive wire in the sheath changes, and the sheath and the drive wire on the distal end side change relative to each other. The position will change. Therefore, the protruding length of the incision electrode from the sheath may change.

For example, if the protruding length of the incision electrode suddenly increases during the mucosal incision, the electrode may reach the patient's muscle tissue and cause perforation. Further, when the protruding length of the incision electrode is shortened, the intended incision cannot be performed. Therefore, it is necessary to handle the electric treatment instrument of Patent Document 1 while considering that the protruding length of the incision electrode does not change, and further improvement has been desired.
JP 2002-224135 A

  The present invention has been made in view of the above circumstances, and an object thereof is to provide an easy-to-handle electric treatment instrument in which the protruding length of the incision electrode is kept constant during operation.

In order to achieve the above object, an electrical treatment instrument according to the present invention comprises:
A sheath that can be inserted into the body,
A drive wire disposed inside the sheath so as to be axially movable;
An incision electrode mounted on the distal end of the drive wire, and having an incision electrode that can be protruded and retracted from the distal end of the sheath in accordance with the axial movement of the drive wire. There,
Provided at the proximal end of the incision electrode, a stopper convex portion larger than the outer diameter of the incision electrode,
Stopper means provided in the distal end portion of the sheath, through which the incision electrode is passed, and an electrode insertion hole that does not pass the stopper convex portion is formed;
And an urging means for urging the drive wire toward the distal end with respect to the sheath.

Preferably, the proximal end of the sheath comprises an operating body,
The operation main body is connected to the proximal end portion of the drive wire, and an operation handle for moving the drive wire in the axial direction inside the sheath is provided in the axial direction with respect to the operation main body. It is equipped to move freely,
A spring for urging the manipulation handle axially in the distal end direction with respect to the manipulation main body constitutes the urging means.

Preferably, a spacer member is mounted on the proximal end side of the operation handle so as to be axially movable with respect to the operation main body.
The spring presses the spacer member in the direction of the operation handle.

  Preferably, a forward movement restricting member is mounted on the distal end side of the operation handle so as to be axially movable with respect to the operation main body and to be fixed at a predetermined axial position.

  Preferably, the forward movement restricting member is screwed to the operation main body.

  Preferably, a counter electrode paired with the incision electrode is attached to the distal end portion of the sheath.

  Preferably, the counter electrode has a ring shape, and an insulating tube is attached to an inner periphery of the counter electrode so as to protrude from a distal end portion of the counter electrode.

  ADVANTAGE OF THE INVENTION According to this invention, the protrusion length of the electrode for an incision is kept constant during operation, and the electric treatment instrument which is easy to handle is provided.

The electrical treatment instrument of the present invention is
A sheath that can be inserted into the body,
A drive wire disposed inside the sheath so as to be axially movable;
An incision electrode mounted on the distal end of the drive wire, and having an incision electrode that can be protruded and retracted from the distal end of the sheath in accordance with the axial movement of the drive wire. There,
Provided at the proximal end of the incision electrode, a stopper convex portion larger than the outer diameter of the incision electrode,
Stopper means provided in the distal end portion of the sheath, through which the incision electrode is passed, and an electrode insertion hole that does not pass through the stopper convex portion is formed;
And an urging means for urging the drive wire toward the distal end with respect to the sheath.

  In the electric treatment instrument of the present invention, in a state where the incision electrode protrudes from the distal end portion of the sheath, the drive wire is urged toward the distal end by the urging means, and the convex portion for stopper is pressed against the stopper means. Maintained. For this reason, the protruding length of the incision electrode is kept constant during the operation.

  That is, even if the surgeon operates the sheath, etc., even if the undulation state of the drive wire in the sheath changes, the movement of the distal end portion of the drive wire toward the distal end is prohibited by the stopper means. . In addition, since the movement of the distal end portion of the drive wire toward the proximal end is also prohibited by the biasing means, the relative position between the distal end portion of the drive wire and the distal end portion of the sheath becomes constant, and the operation The protruding length of the incision electrode does not change. Therefore, the electric treatment instrument of the present invention is easy to handle because it is not necessary to consider the change in the protruding length of the incision electrode during the operation.

  In the electric treatment instrument of the present invention, the proximal end portion of the sheath has an operation main body, and the operation main body is connected to the proximal end portion of the drive wire so that the drive wire is connected to the sheath. It is preferable that an operation handle for moving in the axial direction is provided so as to be movable in the axial direction with respect to the operation main body.

  It is preferable that a forward movement restricting member is mounted on the distal end side of the operation handle so as to be axially movable with respect to the operation main body and to be fixed at a predetermined axial position.

  In the electric treatment instrument of the present invention, when the operating handle is operated and the incision electrode is pulled into the sheath, a repulsive force is exerted by the urging means, and when the hand is released from the operating handle, the incising electrode is It will return to the state which protruded from the sheath. By providing the forward movement restricting member as described above and fixing it to the operation main body, it is possible to inhibit the movement of the operation handle forward (distal end side). Therefore, even when the hand is released from the operation handle, the state in which the incision electrode is drawn into the sheath can be maintained.

  In particular, the forward movement restricting member is preferably screwed to the operation main body. By setting it as such a structure, operation which fixes a forward movement restriction member to the operation main body can be easily performed, without requiring another member for fixation like a screw.

  In the electric treatment instrument of the present invention, it is preferable that a distal electrode of the sheath has a counter electrode that is paired with an incision electrode. The electrical treatment instrument including the incision electrode and the counter electrode is called a bipolar type, and can perform an incision by supplying a low-output high-frequency current only to a target incision. A minimally invasive treatment can be performed. However, the present invention is not necessarily limited thereto. For example, the present invention may be a so-called monopolar type in which only an incision electrode is provided and an incision is performed by flowing a high-frequency current between a counter electrode provided outside the body. .

  Hereinafter, the present invention will be described based on embodiments shown in the drawings.

FIG. 1 is an overall configuration diagram of a bipolar electric treatment instrument according to an embodiment of the present invention,
2 is a side view of the operation main body shown in FIG.
FIG. 3 is a cross-sectional view of an essential part of the distal end portion of the sheath shown in FIG.
FIG. 4 is a schematic view showing a use state of the electric treatment instrument shown in FIG.

  A bipolar electric treatment instrument 2 according to this embodiment shown in FIGS. 1 to 3 is an instrument called a so-called endoscopic electric knife, and has a sheath 4 in which a lumen 3 is formed. A drive wire 8 is disposed in the lumen 3 of the sheath 4 so as to be movable forward and backward along its axial direction.

  A ring-shaped counter electrode 6 is fixed to the distal end portion of the sheath 4. The material of the counter electrode 6 is not particularly limited as long as it is a conductive material. Examples of such a conductive material include gold, silver, platinum, nickel, iron, aluminum, tin, and zinc. Examples thereof include single metals, and alloys such as stainless steel and nichrome.

  As shown in FIG. 3, the sheath 4 includes an outer tube 16, an insulating tube 14 disposed inside the outer tube 16, and a reinforcing coil 18 disposed between these tubes 14 and 16. Become. The distal end of the insulating tube 14 protrudes in the axial direction with a predetermined length L1 from the distal end of the electrode 6 through the internal through hole of the counter electrode 6. The predetermined length L1 is not particularly limited, but is usually 0.1 to 1 mm, preferably 0.3 to 0.7 mm. The counter electrode 6 and the distal end of the insulating tube 14 are fixed by an adhesive or the like. Further, the counter electrode 6 and the distal end of the outer tube 16 are also fixed by an adhesive or the like.

  The reinforcing coil 18 has conductivity, and the distal end thereof is inserted into the ring-shaped recess on the rear end side of the counter electrode 6, where it is connected to the counter electrode 6. The connection is performed by brazing, for example. The material of the reinforcing coil is not particularly limited, and is made of the same metal or alloy as the counter electrode 6.

  A stopper tube (stopper means) 20 is fixed to the inner peripheral portion of the distal end portion of the insulating tube 14 by means such as heat fusion or adhesion. An electrode insertion hole 21 is formed in the stopper tube 20 along the axial direction. The axial length L2 of the stopper tube 20 is not particularly limited, but is usually 5 to 15 mm, preferably 7 to 12 mm.

  A proximal end portion of a linear incision electrode 10 is connected to the distal end portion of the drive wire 8. The incision electrode 10 is paired with the counter electrode 6 so that high-frequency current can be discharged between both electrodes. A stopper ring 12 serving as a stopper convex portion having an outer diameter larger than the outer diameter of the incision electrode 10 is fixed to the proximal end portion of the incision electrode 10 (connection portion between the drive wire 8 and the incision electrode 10). It is.

  The material of the drive wire 8, the stopper ring 12 and the incision electrode 10 is not particularly limited as long as it is a conductive material. The drive wire 8 may be either a single wire or a stranded wire, and the stranded wire includes a core wire made of a single wire and a coil surrounding the core wire.

  The outer diameter of the incision electrode 10 is not particularly limited, but is preferably 0.2 to 0.6 mm, and more preferably 0.3 to 0.5 mm. In the case of such an outer diameter, the sharpness is particularly improved. In addition, the shape of the incision electrode 10 is not particularly limited, and examples thereof include a rod shape and a spatula shape other than the illustrated linear shape, and each may be curved. The outer diameter of the stopper ring 12 is not particularly limited, but is preferably 0.9 to 1.0 mm. The outer diameter of the drive wire 8 is not particularly limited, but is preferably 0.7 to 0.85 mm.

  The material of the outer tube 16, the insulating tube 14, and the stopper tube 20 is not particularly limited as long as it is an electrically insulating material, such as polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyethersulfone, and fluororesin. Plastics can be used, and a material having an appropriate elastic modulus can be selected according to the purpose.

  The outer diameter of the outer tube 16 is not particularly limited, but is preferably 1.5 to 3.0 mm. The thickness of the outer tube 16 is not particularly limited, but is about 0.1 to 0.5 mm. The outer diameter of the insulating tube 14 is not particularly limited, but is preferably 1.0 to 2.0 mm. The thickness of the insulating tube 14 is not particularly limited, but is about 0.1 to 0.5 mm. The inner diameter of the stopper tube 20 (the hole diameter of the electrode insertion hole 21) is determined so that the incision electrode 10 can be inserted and the stopper ring 12 cannot be inserted, and is, for example, 0.7 to 0.9 mm.

  Since the stopper ring 12 cannot be inserted into the insertion hole 21 of the stopper tube 20, the distal end of the incision electrode 10 protrudes from the distal end of the insulating tube 14 beyond a predetermined maximum protruding length L3. Can not be. The maximum protrusion length L3 is determined according to the application and the like, but is preferably 5 to 10 mm.

  As shown in FIG. 1, an operation main body 30 is attached to the proximal end portion of the sheath 4. An operation handle 32 is attached to the operation main body 30 so as to be movable in the axial direction. A spacer (spacer member) 36 is mounted on the proximal end side of the operation handle 32 so as to be movable along the axial direction of the operation main body 30. The spacer 36 adjusts the tension of the coil spring 38 described below and prevents the coil spring 38 from coming into contact with the rear end portion of the driving wire 8 extended to the proximal end side of the operation handle 32. Electric leakage from the drive wire 8 is prevented.

  The proximal end of the drive wire 8 shown in FIGS. 1 and 3 is connected to the operating handle 32. An incision connected to the distal end portion of the drive wire 8 by moving the operation handle 32 in the axial direction with respect to the operation main body 30 to move the drive wire 8 in the axial direction with respect to the sheath 4. The working electrode 10 can be projected and retracted from the distal end of the sheath 4.

  As shown in FIG. 1, the spacer 36 is urged by a coil spring (biasing means) 38 so as to be pressed against the operation handle 32, and the operation handle 32 is moved to a socket (forward movement limiting member) described below. ) Press against 60 side.

  As shown in FIG. 2, a male screw 33 is formed on the outer periphery of the distal end (distal end) of the operation main body 30. A fixed handle 35 is formed at the rear end of the operation main body 30. The operation main body 30 has two rails 31, and the operation handle 32 shown in FIG. 1 can move in the axial direction with respect to the rails 31. A locking projection 37 that locks the proximal end of the coil spring 38 is formed at the proximal end of the rail 31.

  In the operation main body 30, a socket 60 having a screw groove (not shown) on the inside is screwed to the male screw 33 on the distal end (tip) side of the operation handle 32 as shown in FIG. 1. It is. The socket 60 is movable in the axial direction with respect to the operation main body 30 in a range where the male screw 33 is formed, and is fixed to the operation main body 30 if the rotation of the socket 60 is stopped. .

  When the socket 60 is moved in the proximal end direction, the operation handle 32 is pressed by the socket 60 and moved in the proximal end direction. If the socket 60 is moved in the proximal end direction until the incision electrode 10 is pulled into the sheath 4 and then the socket 60 is fixed to the operation main body 30, the front of the operation handle 32 ( Movement to the distal end side) is prohibited, and the state in which the incision electrode 10 is drawn from the distal end portion of the sheath 4 can be maintained. Further, if the socket 60 is moved in the distal end direction, the operation handle 32 is also moved in the distal end direction, so that the incision electrode 10 can be protruded from the distal end portion of the sheath 4. it can.

  When the distal end portion of the sheath 4 in the bipolar electric treatment instrument 2 is guided into the patient's body using an endoscope, the incision electrode 10 is pulled from the distal end portion of the sheath 4. To maintain. Thereafter, when the distal end of the sheath 4 is positioned near the living tissue to be incised in the patient's body, as shown in FIG. 4, the incising electrode 10 is protruded from the distal end of the sheath 4, An incision is made in the living tissue.

  As shown in FIG. 1, the wiring cord 42 is connected to the operation handle 32. The wiring cord 42 is electrically connected to the proximal end portion of the drive wire 8 connected to the operation handle 32, and supplies a high-frequency current to the incision electrode 10 through the drive wire 8. A wiring cord 40 is connected to the proximal end of the sheath 4. The wiring cord 40 is electrically connected to the proximal end of the reinforcing coil 18 shown in FIG. 2 and supplies a high-frequency current to the counter electrode 6 through the reinforcing coil 18. These wiring cords 40 and 42 are connected to the connection connector 44. The connection connector 44 is connected to a high-frequency current generator not shown.

  When the diseased tissue generated in the mucous membrane is excised using the bipolar electric treatment instrument 2 of the present embodiment, the distal end of the sheath 4 is positioned on the muscular tissue layer 54 shown in FIG. To the vicinity of the lesion 50. For this purpose, first, the socket 60 is operated, and the incision electrode 10 is drawn into the electrode insertion hole 21 from the distal end of the sheath 4 to maintain the state. In this state, for example, the distal end portion of the sheath 4 is introduced into the body through the channel of the endoscope.

  When the distal end of the sheath 4 is positioned near the lesioned part 50, the socket 60 located outside the body is moved toward the distal end. When the socket 60 is moved in the direction of the distal end, the operation handle 32 biased by the coil spring 38 is also moved in the direction of the distal end, so that the cutting electrode 10 is moved from the distal end of the sheath 4. The distal end of the can be delivered. When the socket 60 is moved toward the distal end until the movement of the operation handle 32 accompanying the movement of the socket 60 stops and a gap is generated between the socket 60 and the operation handle 32, the operation main body 30 is moved to that position. On the other hand, the socket 60 is fixed. In this state, the operating handle 32 and the drive wire 8 are pushed toward the distal end by the coil spring 38, and the stopper ring 12 comes into contact with the proximal end of the stopper tube 20 as shown in FIG. The electrode 10 is kept protruding from the distal end of the insulating tube 14 with a predetermined maximum protruding length L3.

  Next, as shown in FIG. 4, the distal end portion of the incision electrode 10 is inserted into the mucosal layer 52 located below the lesioned portion 50, and a high frequency is provided between the counter electrode 6 and the incision electrode 10. By moving the incision electrode 10 while passing an electric current, the lesioned part 50 is excised with electrical energy.

  In the bipolar electric treatment instrument 2 according to the present embodiment, a high frequency is generated between the counter electrode 6 attached to the distal end portion of the sheath 4 and the incision electrode 10 protruding from the distal end portion of the sheath 4. The living tissue is incised and excised by passing an electric current and moving the incision electrode 10 to be an electric knife. As described above, the bipolar electric treatment instrument 2 according to the present embodiment does not need to provide a counter electrode outside the patient's body, and can flow a high-frequency current only to a necessary lesion portion, so that it is compared with a monopolar type device. Thus, the output is low, and there are few perforations that reach the muscle tissue layer 54 due to thermal denaturation. Therefore, the bipolar electric treatment instrument 2 of the present embodiment is a device that realizes a less invasive treatment for a patient.

  Moreover, in this embodiment, in the state where the incision electrode 10 protrudes from the distal end portion of the sheath 4, the drive wire 8 is urged toward the distal end by the coil spring 38, and the stopper ring 12 becomes the stopper tube. It remains pressed against the proximal end of 20. For this reason, the protrusion length L3 of the incision electrode 10 is kept constant during operation.

  That is, even if the operator operates the sheath 4 or the like, even if the undulation state of the drive wire 8 in the sheath 4 changes, the movement of the distal end portion of the drive wire 8 toward the distal end is prohibited. The This is because the stopper ring 12 is pressed against the proximal end of the stopper tube 20. In addition, since the movement of the distal end portion of the drive wire 8 toward the proximal end is also prohibited by the coil spring 38, the relative position between the distal end portion of the drive wire 8 and the distal end portion of the sheath 4 is constant. Thus, the protrusion length L3 of the incision electrode 10 does not change during the operation. Therefore, the electric treatment instrument 2 of this embodiment is easy to handle because it is not necessary to consider the change in the protruding length L3 of the incision electrode 10 during the operation.

  The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.

  For example, the biasing means in the present invention is not limited to the illustrated coil spring 38, and a metal spring such as a leaf spring or a wire spring or a spring such as a rubber spring can be used.

  Further, the position where the urging means such as the coil spring 38 is provided is not limited to the illustrated embodiment. For example, the biasing means may be mounted inside the sheath 4 without necessarily being attached to the operation main body 30.

  Further, the forward movement restricting member is not limited to the socket 60 in which a screw groove is formed on the inner side, and other members may be used. For example, an axially movable ring may be used, and this ring may be fixed with screws.

  In the embodiment described above, the surface of the incision electrode 10 is not provided with an insulating coating. However, as shown in FIG. 3, the insulating coating is applied in a region having a predetermined range length L4 from the tip of the incision electrode 10. A film may be coated. The range of the predetermined range length L4 is not particularly limited, and is a range larger than 0 and shorter than the length L2 + L3. By adjusting the length, the heat generation range in the incision electrode 10 can be adjusted. it can.

  The material of the insulating coating film is not particularly limited, and for example, a fluororesin, a polyimide resin, a ceramic, or the like is used. Examples of ceramics include metal oxides, metal nitrides, and metal carbides. The insulating coating film is preferably a film to which the tissue after energization is difficult to adhere or from which the deposit is easily peeled off. From such a viewpoint, a slippery film is preferable.

  Although the film thickness of an insulating coating film is not specifically limited, About 5-50 micrometers is preferable. The method for forming the insulating coating film is not particularly limited, and examples thereof include a baking method, a spray spraying method, and an immersion method.

  By applying an insulating coating film to a predetermined range from the tip of the incision electrode 10 and adjusting the coating range, heat generation at the tip of the incision electrode 10 can be suppressed and contribution to prevention of perforation can be achieved. When the insulating coating is applied over the entire area of the incision electrode 10, the entire surface of the incision electrode 10 can be made smooth, and the movement of the incision electrode 10 as an electric knife can be made smooth. At the same time, the adhesion of the tissue can be effectively prevented.

  Moreover, the risk of perforating the muscle tissue layer can be further reduced by providing an electrical insulating tip having a diameter larger than the outer diameter of the incising electrode 10 at the distal end portion of the incising electrode 10. Examples of the shape of the electrically insulating chip include a spherical shape and a disk shape.

FIG. 1 is an overall configuration diagram of a bipolar electric treatment instrument according to an embodiment of the present invention. FIG. 2 is a side view of the operation main body shown in FIG. FIG. 3 is a cross-sectional view of the main part of the distal end portion of the sheath shown in FIG. FIG. 4 is a schematic view showing a use state of the electric treatment instrument shown in FIG.

Explanation of symbols

2 ... Bipolar electrical treatment instrument 4 ... Sheath 6 ... Counter electrode 8 ... Drive wire 10 ... Incision electrode 12 ... Stopper ring (protrusion for stopper)
14 ... Insulating tube 16 ... Outer tube 18 ... Reinforcing coil 20 ... Stopper tube (stopper means)
30 ... Operation body 32 ... Operation handle 36 ... Spacer (Spacer member)
38 ... Coil spring (biasing means)
60 ... Socket (forward movement limiting member)

Claims (3)

A sheath that can be inserted into the body,
A drive wire disposed inside the sheath so as to be axially movable;
An incision electrode mounted on the distal end of the drive wire, and having an incision electrode that can be protruded and retracted from the distal end of the sheath in accordance with the axial movement of the drive wire. There,
Provided at the proximal end of the incision electrode, a stopper projection larger than the outer diameter of the incision electrode,
Stopper means provided in the distal end portion of the sheath, through which the incision electrode is passed, and an electrode insertion hole that does not pass through the stopper convex portion is formed;
Biasing means for biasing the drive wire toward the distal end with respect to the sheath ;
A proximal end of the sheath is provided with an operating body,
The operation main body is connected to the proximal end portion of the drive wire, and an operation handle for moving the drive wire in the axial direction inside the sheath is provided in the axial direction with respect to the operation main body. It is equipped to move freely,
A spring for axially urging the operating handle toward the distal end with respect to the operating body constitutes the urging means, and a spacer member is provided on the proximal end side of the operating handle. It is attached to the operation main body so as to be movable in the axial direction, and the spring presses the spacer member in the direction of the operation handle,
On the distal end side of the operation handle, a forward movement limiting member is attached to the operation main body so as to be axially movable and fixed at a predetermined axial position,
The electric treatment instrument according to claim 1, wherein the forward movement restricting member is screwed to the operation main body . The electrosurgical instrument according to claim 1 , wherein a counter electrode paired with the incision electrode is attached to a distal end portion of the sheath. The bipolar electric treatment instrument according to claim 2, wherein the counter electrode has a ring shape, and an insulating tube is attached to an inner periphery of the counter electrode so as to protrude from a distal end portion of the counter electrode. .

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