JP5699392B2 - Area securing instrument and endoscope provided with area securing instrument - Google Patents

Description

  The present invention relates to an area securing instrument and an endoscope including the area securing instrument. More specifically, it is used for transluminal endoscopic surgery in which a through-hole is formed in the digestive tract by an endoscope inserted into the digestive tract cavity such as the mouth, anus, or vagina, or in the abdominal cavity. The present invention relates to a region securing instrument and an endoscope provided with the instrument.

  Transluminal endoscopic surgery (hereinafter referred to as NOTES) is a procedure that removes lesions in the digestive tract cavity or abdominal cavity using an endoscope inserted into the digestive tract cavity such as the mouth, anus, or vagina. Surgery to perform.

For example, surgery to remove the stomach wall in which a hole that penetrates the stomach wall is formed, specifically a tumor deeper than the submucosa formed in the stomach wall, that is, a tumor that has reached the intrinsic muscle layer Surgery to remove with an endoscope corresponds to NOTES.
Further, as shown in FIG. 5, an endoscope S is inserted from the mouth, a hole h is formed in the stomach wall by the tip of the endoscope S, and the tip of the endoscope S enters the abdominal cavity from the hole h. In addition, surgery for removing a tumor or the like formed in the pancreas, liver or the like with the endoscope S also corresponds to NOTES.

  Compared to conventional surgical operations, these NOTES can be performed without leaving scars on the abdomen, and the burden on the patient (reduction of immune response, early rehabilitation, etc.) can be reduced. There is.

  On the other hand, in NOTES, as with conventional endoscopic surgery, surgery must be performed while confirming the affected area and the status of the surgery using the camera provided at the distal end of the endoscope. It is important to secure a field (Non-Patent Document 1).

Conventionally, when endoscopic surgery is performed in the stomach, a through-hole is not formed in the stomach, so even if the stomach is expanded by blowing air into the stomach, the visual field is expanded and the surgical field is opened. It is possible to secure.
However, as described above, in NOTES, a hole that penetrates the stomach wall is formed by surgery, and at the same time, the air in the stomach flows into the abdominal cavity and the stomach bag is deflated. Then, in the operation of excising the stomach wall, the endoscope tip is covered with the stomach wall, and the field of view is lost or the field of view is extremely limited, making it difficult to perform the operation.

In laparoscopic surgery, a plurality of ports (citrus) are inserted into the abdominal cavity from the hole provided in the abdomen, and the collapsed and collapsed stomach is lifted and deployed to remove the visual field and the lesion. The method of ensuring is adopted. Therefore, even in NOTES, it is conceivable to adopt a method of inserting a plurality of endoscopes and lifting the stomach.
However, at most two endoscopes can be inserted into the stomach or the like. With the two endoscopes, it is difficult to lift and collapse the collapsed stomach, so that it is impossible to secure a sufficient visual field by the method described above.

  Also in NOTES, it is possible to develop a sufficient field of view by adopting a lifting method in which the stomach wall is fixed to the abdominal wall before the stomach wall is resected by an endoscope. However, in order to fix the abdominal wall and the stomach wall, the needle must be penetrated not only to the stomach wall but also to the abdominal wall, so that the body surface is damaged. In other words, the advantage of NOTES that the body surface is not damaged is lost.

Various methods for securing the field of view of the endoscope have been studied so far, and a hood with an open tip that is attached to the tip of the endoscope and used as an instrument for surgery that does not allow a through-hole in the stomach. Have also been developed (Patent Documents 1 and 2).
When such a hood is provided, a space can be formed between the distal end of the endoscope and the stomach wall by the hood, so that the stomach wall and the like can be easily observed. Further, if the affected part or the like is positioned in the distal end opening of the hood, the affected part can be separated from the distal end of the endoscope to some extent, so that the affected part can be easily treated with the endoscope.

However, the hoods disclosed in Patent Documents 1 and 2 are used by being fixed to the tip of the endoscope, and the visual field that can be secured by such a hood is at most about the diameter of the endoscope, that is, The diameter and depth are only about 2 cm. For this reason, it is difficult to secure a sufficient visual field and operative field for NOTES.
Moreover, even if a hood for the endoscope is provided, if the stomach wall becomes deflated during surgery to remove the stomach wall, the stomach wall on the front of the hood will be folded even if there is a hood. It is difficult to secure a sufficient visual field and surgical field for surgery.
And, when performing surgery by invading the distal end of the endoscope into the abdominal cavity from the hole formed in the stomach wall, a larger visual field and surgical field are required, so just providing a hood as described above, It is impossible to perform surgery.

  As described above, at present, NOTES does not use a lifting method that fixes the stomach wall to the abdominal wall, in other words, a method for securing a visual field and an operating field for surgery without forming a wound on the body surface. Has not been developed, and there is a strong demand for the development of such technology.

Japanese Patent Laid-Open No. 10-323323 JP-A-11-299725

Xu No. et al., “Natural Orifice Translumenal Endoscopic Surgery (NOTES) Current Status and Future Prospects-Endoscopic Surgery without Scars on the Body Surface”, Fukuoka Medical Journal 100 (2), p43-50, 2009

  In view of the above circumstances, an object of the present invention is to provide an area securing instrument and an endoscope provided with an area securing instrument capable of securing a visual field and a surgical field of a surgical site in NOTES.

An area securing instrument according to a first aspect of the present invention is an area securing instrument used for transluminal endoscopic surgery, and has a cylindrical main body having a hollow space. In the direction intersecting the central axis of the hollow space formed by the shape memory material, it can expand and contract,
In the expanded state, the hollow space of the main body is formed such that the cross-sectional area of its tip is larger than the cross-sectional area of the shaft of the endoscope, and the direction intersecting the central axis of the hollow space When a force of a certain level or more is applied in the direction from the center to the center axis, the tip is contracted so that the cross-sectional area is reduced, and when the force is removed, it is adjusted so that it can return to the original shape. It is characterized by being.
According to a second aspect of the present invention, there is provided the region securing instrument according to the first aspect, wherein the main body portion is substantially cylindrical in a contracted state, and in an enlarged state, the hollow space at the tip portion in the axial direction of the main body portion. The cross-sectional area is formed so as to be larger than the cross-sectional area of the hollow space at the axial end portion of the main body.
The area securing device according to a third aspect of the present invention is the first or second invention, wherein the region securing tool includes a cylindrical connecting pipe having a hollow space, and the connecting pipe is formed in the hollow space. The cross-sectional area is formed so as to be larger than the cross-sectional area of the shaft of the endoscope, and the tip of the main body portion is arranged so that the hollow space is in communication with the hollow space of the main body portion. It is connected with the base end of this.
(Endoscope with area securing device)
A region securing instrument according to a fourth aspect of the present invention is an endoscope used for transluminal endoscopic surgery, and the endoscope is a cylindrical outer tube through which a shaft of the endoscope is inserted. And the region securing instrument of the first, second or third invention, wherein the region securing instrument includes the outer tube and the shaft of the endoscope in a state of being inserted into the outer tube. In the meantime, the endoscope is characterized in that it can be projected and retracted from the tip of the outer cylinder along the axial direction of the shaft of the endoscope.
A region securing instrument according to a fifth aspect of the present invention is the region securing instrument according to the fourth aspect, wherein the region securing instrument includes a cylindrical connecting pipe having a hollow space, and the connecting section is configured so that the hollow space is the main body portion. The distal end of the tube is connected to the base end of the main body so as to be in communication with the hollow space of the body, and the connecting tube has a cross-sectional area of the hollow space of the shaft of the endoscope. In a state of being connected to the main body portion, the length from the distal end of the main body portion to the proximal end of the connecting tube in the axial direction of the connecting tube is longer than the axial length of the outer tube. It is formed so that it becomes long.

According to the first invention, if the main body is disposed at the distal end of the outer cylinder through which the endoscope is inserted, and the main body protrudes from the distal end of the outer cylinder and is enlarged, It is possible to secure a field of view for an endoscope and a surgical field for an operation using an endoscope. In addition, if the main body portion is formed to a size that can be accommodated in the outer cylinder when contracted, the main body portion can be moved to a place where surgery or the like is performed while being accommodated in the outer cylinder. It becomes easy to arrange the main body at a place where surgery is performed. And, if the main body part in the contracted state is accommodated in the distal end part of the outer cylinder through which the endoscope is inserted, the main body part is expanded from the distal end part of the outer cylinder. It can be. On the contrary, if the main body portion is pushed into or pulled into the inside from the tip of the outer cylinder, the main body portion contracts, so that the main body portion can be accommodated in the outer cylinder. That is, the main body can be expanded and contracted simply by projecting the main body from the front end of the outer cylinder or by pushing or pulling the main body from the front end of the outer cylinder. Therefore, since a special mechanism for expanding and contracting the main body is not necessary, the structure of the instrument can be simplified.
According to the second invention, if the main body is in an enlarged state, a space that expands from the base end toward the tip can be formed in the main body. Then, counter traction and triangulation can be performed on the collapsed stomach and the like. In addition, since a wide surgical field can be ensured at a position close to the outer cylinder, an effect of facilitating the operation in the near field can be obtained.
According to the third aspect of the present invention, if the area securing instrument is placed in the outer cylinder so that the main body is positioned at the distal end of the outer cylinder through which the endoscope is inserted, the proximal end of the connecting pipe can be operated. For example, the main body portion can be moved along the axial direction of the outer cylinder, and the main body section can be projected and retracted from the tip of the outer cylinder. This eliminates the need for a special mechanism for causing the main body portion to protrude from the tip of the outer cylinder, so that the structure of the instrument can be simplified.
(Endoscope with area securing device)
According to the 4th invention , if a main-body part is protruded and expanded from the front-end | tip part of an outer cylinder, a visual field and the surgical field for an operation can be ensured by a main-body part. In addition, since the main body can be moved to a place where surgery or the like is performed while being housed in the outer cylinder, it is easy to arrange the main body at a place where surgery or the like is performed.
According to the fifth aspect of the present invention , if the area securing instrument is placed in the outer cylinder so that the main body is positioned at the distal end of the outer cylinder, the main body is By moving along the axial direction of the outer cylinder, the main body can be projected and retracted from the tip of the outer cylinder. This eliminates the need for a special mechanism for causing the main body portion to protrude from the tip of the outer cylinder, so that the structure of the instrument can be simplified.

It is a schematic explanatory drawing of the endoscope 1 provided with the instrument 10 for area | region ensuring of this embodiment. (A) is the IIA-IIA arrow directional view of FIG. 1, (B) is the BB partial sectional view of (A). It is a schematic explanatory drawing of the state by which the main-body part 11 of the instrument 10 for area | region ensuring of this embodiment is accommodated in the outer cylinder 5, Comprising: (A) It is the schematic explanatory drawing which looked at the front-end | tip of the outer cylinder 5 from the axial direction. (B) is a BB line partial sectional view of (A). It is explanatory drawing of the condition which is using the endoscope 1 provided with the instrument 10 for area | region ensuring of this embodiment in the stomach, (A) is the state in which the main-body part 11 is accommodated in the outer cylinder 5. FIG. It is a schematic explanatory drawing of the condition arrange | positioned in the stomach, (B) is explanatory drawing of the state which made the main-body part 11 protrude from the outer cylinder 5 tip from the state of (A), and was expanded. (C) is a schematic explanatory drawing of the state which bent the endoscope 1 from the state of (B). It is the figure which showed an example of the operation by NOTES. It is a schematic explanatory drawing of the instrument 10 for area | region ensuring in other embodiment. It is the figure which showed an example of the surgery using the instrument 10 for area | region ensuring in other embodiment.

Next, an embodiment of the present invention will be described with reference to the drawings.
The region securing instrument of the present invention is an instrument used in transluminal endoscopic surgery (hereinafter referred to as NOTES) using an endoscope, without complicating the structure of the endoscope. It is characterized by the fact that the field of view and the surgical field for surgery can be secured.

(Endoscope with area securing device)
In FIG. 1, the code | symbol 1 has shown the endoscope provided with the instrument 10 for area | region ensuring of this embodiment.
The endoscope 1 is a flexible endoscope used for general endoscopic surgery, and includes a shaft 2 inserted into a digestive tract of a living body, an operation unit 3 for operating the shaft 2, and a shaft 2. A portion connected to a light source body that supplies light to the tip is provided.

As long as the endoscope 1 is used by being inserted into a digestive tract of a living body, the diameter, length, material, and the like of the tube are not particularly limited.
For example, the diameter of the tube 2 is about 10 mm in a general endoscope, but may be about 5 to 15 mm. The length of the tube 2 is about 1200 mm in a general endoscope, but may be about 1200 to 3000 mm.
In particular, when performing surgery on an organ in the abdominal cavity, the endoscope 1 preferably has a narrow-band light observation (NBI) function or a water jet function.

(About outer cylinder 5)
In FIG. 1, the code | symbol 5 has shown the outer cylinder in which the shaft 2 of the endoscope 1 is penetrated. The outer cylinder 5 guides the movement of the shaft 2 when the shaft 2 of the endoscope 1 is inserted into and removed from the living body, and is formed by a hollow cylindrical member that is long in the axial direction. The length of the outer cylinder 5 is shorter than the length of the shaft 2.
That is, if the shaft 2 of the endoscope 1 is inserted into the hollow space from one end (base end) of the outer cylinder 5, the tip of the shaft 2 can be projected from the other end (tip). The shaft 2 is formed so that the tip of the shaft 2 can be projected and retracted from the tip of the outer cylinder 5 by moving the shaft 2 in the axial direction in a state of being disposed in a hollow space.

The outer cylinder 5 may have an inner diameter, a thickness, a length, a material, etc., as long as it is generally used when the endoscope 2 is inserted into the digestive tract of a living body to perform inspection or surgery. Is not particularly limited.
For example, the inner diameter of the outer cylinder 5 is generally about 20 mm, but any shaft can be used as long as the shaft 2 can be inserted and the shaft 2 can be smoothly moved along the axial direction. The inner diameter of the outer cylinder 5 may be about 10 to 30 mm. The thickness of the outer cylinder 5 is generally several mm if the inner diameter of the outer cylinder 5 is about 20 mm, but is thick enough to insert the outer diameter of the outer cylinder 5 into the digestive tract. If it can form in this, the thickness of the outer cylinder 5 will not be specifically limited. Further, the length of the outer cylinder 5 only needs to be shorter than the length of the shaft 2. That is, when the shaft 2 is inserted from one end of the outer cylinder 5, the tip of the shaft 2 can be projected from one end of the outer cylinder 5 by a predetermined length (for example, about 10 to 500 mm) or more. Well, not particularly limited.

  In particular, when the distal end of the endoscope 1 is inserted into the abdominal cavity through a hole formed in the wall of the stomach or the like to perform an operation on an organ in the abdominal cavity, the outer diameter of the outer tube 5 is 15 to 25 mm. It is preferable that the length is about 500 to 1000 mm and that the tube 2 of the endoscope 1 is formed of a material that can be smoothly inserted, removed, and rotated.

(Equipment for securing area 10)
Next, the area securing instrument 10 will be described.
First, the area securing instrument 10 is a cylindrical member having a hollow passage that passes through the axial direction thereof, and is disposed between the outer cylinder 5 and the shaft 2 of the endoscope 1. Specifically, the area securing instrument 10 is inserted into the outer cylinder 5, and the shaft 2 of the endoscope 1 is inserted into the hollow passage.

The area securing instrument 10 includes a hollow cylindrical connecting pipe 15 and a hollow main body 11 attached to the tip (left end in FIG. 1) of the connecting pipe 15. The region securing instrument 10 is inserted into the outer cylinder 5 such that the main body 11 is located on the distal end side of the outer cylinder 5 and the distal end of the main body 11 does not protrude from the distal end of the outer cylinder 5. Has been.
The area securing instrument 10 is formed such that its axial length (that is, the length from the proximal end of the connecting tube 15 to the distal end of the main body 11) is longer than that of the outer cylinder 5. That is, when it arrange | positions in the outer cylinder 5 so that it may be in the said state, it forms so that the base end of the connecting pipe 15 may protrude from the base end of the outer cylinder 5. FIG.
For this reason, when the proximal end of the connecting pipe 15 is operated to move the area securing instrument 10 along the axial direction of the outer cylinder 5, the distal end of the main body 11 can be projected and retracted from the distal end of the outer cylinder 5. It is.

Further, the main body portion 11 of the area securing instrument 10 is contracted in a state where it is accommodated in the outer cylinder 5, but when the tip portion protrudes outside from the tip of the outer tube 5, the tip portion expands. It has such a structure.
Specifically, when the tip of the main body 11 protrudes from the tip of the outer cylinder 5 to the outside, the tip of the main body 11 can be expanded (expanded), and the opening area of the tip can be increased. It has a structure that can be larger than the cross-sectional area.

(Operational effect of the endoscope 1 provided with the area securing instrument 10)
Since the structure is as described above, in the endoscope 1 provided with the area securing instrument 10 of the present embodiment, the area securing instrument 10 functions as follows, and therefore the field of view of the endoscope 1 is secured. It is possible to secure a surgical field.
In the following, a case where a field of view or the like is secured by the region securing instrument 10 in the collapsed stomach will be described as a representative.

  First, the outer cylinder 5 is inserted from the patient's mouth, and the distal end of the outer cylinder 5 is placed in the stomach in a collapsed state. Then, the endoscope 1 and the area securing instrument 10 are inserted through the outer cylinder 5 (FIG. 4A).

Next, the area securing instrument 10 is moved along the axial direction of the outer cylinder 5 so that the main body portion 11 protrudes from the distal end of the outer cylinder 5 and the distal end is enlarged (expanded). When the distal end of the main body 11 is enlarged (expanded), the opening area of the distal end becomes larger than the cross-sectional area of the outer cylinder 5, so that the stomach wall ST is pushed outward by the outer edge of the distal end of the main body 11. The stomach can be expanded (deployed) (FIG. 4B).
That is, by pressing the stomach wall ST outwardly by the distal outer edge of the main body part 11, tension is applied to the gastric wall ST surrounded by the distal outer edge of the main body part 11 so that the stomach wall ST is stretched. is there.

  In addition, as described above, when the distal end is enlarged (expanded), the opening area at the distal end of the main body portion 11 becomes larger than the cross-sectional area of the outer cylinder 5, so that the gastric wall developed through the space in the main body portion 11. Confirmation of the inner surface of ST becomes easy. And since the space in the main-body part 11 becomes large compared with the diameter etc. of an endoscope, it becomes easy to perform treatments, such as excision of the stomach wall ST.

And in endoscope 1 provided with region securing instrument 10 of this embodiment, since stomach wall ST is supported by the tip of body part 11, part of stomach wall ST is excised and a penetration hole is formed in stomach wall ST. Even if formed, the stomach will not collapse. In other words, the portion of the stomach wall ST disposed in the opening at the tip of the main body 11 is maintained in a deployed state (a stretched state, so-called counter traction, triangulation).
Then, since the field of view of the endoscope can be secured at all times in the portion surrounded by the opening at the distal end of the main body 11, the operation of the endoscope 1 can be continued in a stable state.

Further, in the endoscope 1 including the region securing instrument 10 according to the present embodiment, if the body part 11 of the region securing tool 10 is moved along the axial direction of the outer cylinder 5, the body part 11 is moved to the outer cylinder. 5 can be accommodated.
Then, when changing the place where the examination or treatment is performed, if the outer cylinder 5 is moved in a state where the main body 11 is accommodated in the outer cylinder 5, the main body 11 can also be moved together. It is easy to change the place where the operation is performed and to arrange the main body 11 at the place.

  In addition, when changing the place where surgery etc. are performed in the stomach, you may change the place where surgery etc. are performed with the main body part 11 protruding from the outer cylinder 5. That is, the place where the operation or the like is performed may be changed by moving the distal edge 11a along the stomach wall ST while the distal edge 11a of the main body 11 is in contact with the stomach wall ST. In this case, even when the stomach collapses when the main body 11 is accommodated in the outer cylinder 5, the portion of the stomach wall ST surrounded by the opening at the tip of the main body 11 is expanded. Can do. Then, since the location can be changed while confirming the stomach wall ST, it is preferable in that the incision of the stomach wall ST can be performed safely. Further, since the state of the stomach wall ST can be confirmed even while moving, it is also preferable in that the possibility of missing a lesion or the like can be reduced.

When the distal edge 11a of the main body 11 is moved while being in contact with the stomach wall ST, the distal edge 11a in contact with the stomach wall ST is coated with a hydrophilic substance, or only the distal edge 11a is hydrophilic. It is preferable that the main body 11 is entirely formed of a hydrophilic substance.
Then, since the hydrophilic substance has a small resistance to the stomach wall ST, when the distal end edge 11a of the main body 11 is in contact with the stomach wall ST and is slid and moved on the inner surface of the stomach wall ST, the resistance is reduced. Therefore, the main body 11 can be moved smoothly.

(Detailed description of the area securing instrument 10 of the present embodiment)
Below, each part of the instrument 10 for area | region ensuring of this embodiment is demonstrated in detail.

(About the main body 11)
Next, the main body 11 will be described.
As shown in FIG. 2, the main body 11 is a member formed in a cylindrical shape, and has one end (the right end in FIGS. 2 and 3, hereinafter referred to as a base end) and the other end (in FIGS. 2 and 3). A space communicating with the left end (hereinafter referred to as the tip) is formed. The main body 11 is formed in such a size that the hollow space can be inserted through the shaft 2 of the endoscope 1. Specifically, the cross-sectional area of the hollow space in the main body 11 is formed to be larger than the cross-sectional area of the shaft 2 of the endoscope 1.

The main body 11 is formed such that the opening area of the hollow space is gradually increased from the base end toward the tip, and the opening area of the tip is larger than the cross-sectional area of the outer cylinder 5. . That is, the main body 11 is formed so that the appearance thereof is a trumpet shape.
For example, as shown in FIG. 2, when the cross section of the hollow space of the main body 11 is circular, the length L of the main body 11 is about 300 to 1000 mm, the inner diameter of the opening at the proximal end is about 15 to 25 mm, and If the inner diameter D of the opening is formed to be about 15 to 70 mm, a visual field suitable for cholecystectomy, gastrojejunostomy, fallopian tube ligation, etc., and a surgical field for surgery can be secured.

  In addition, the main body 11 is formed so as to be able to expand and contract in the direction intersecting the central axis CL of the hollow space. Specifically, the main body 11 is formed using a shape memory material as a raw material, and has a trumpet shape as described above in a state where no force is applied to the outer surface, but a force is applied to the outer surface. And the cross-sectional area of the front-end | tip and a base end is adjusted so that it may become a cylinder shape of the substantially same magnitude | size.

  Specifically, the main body 11 maintains the trumpet shape (original shape) even when a force below a certain level is applied in the direction toward the center axis CL from the trumpet shape state, and moves toward the center axis CL. When a force of a certain level or more is applied in the direction, the hollow space is formed to shrink so that the cross-sectional area becomes small. For example, when the hollow space of the main body part 11 is circular, when a force of a certain level or more is applied along the direction from the outer surface of the main body part 11 toward the central axis, the main body part 11 has a cross-sectional shape of the hollow space. Is adjusted to shrink while maintaining a substantially circular state (in other words, a shape similar to the opening cross-sectional shape of the tip in the original shape).

When the main body 11 is inserted into the outer cylinder 5 from the opening (for example, the front end), the main body 11 is inserted into the main body 11 from the outer surface thereof in the direction intersecting the central axis CL of the hollow space. A certain force or more can be applied along the direction toward CL. Then, since the main body part 11 contracts, the main body part 11 can be inserted into the outer cylinder 5.
On the other hand, when the front end of the main body 11 is protruded from the outer cylinder 5, the portion protruding from the main body 11 is released from the above force, so that the entire main body 11 is protruded from the outer cylinder 5. The main body 11 can be automatically brought into the original shape. Then, since the opening area of the front-end | tip of the main-body part 11 becomes larger than the cross-sectional area of the outer cylinder 5, the stomach wall ST can be pushed outward by a front-end | tip outer edge, and the stomach can be expanded (deployed). is there. And since the special mechanism for expanding and contracting the main-body part 11 is unnecessary, the structure of the instrument 10 for area | region ensuring can be made into a simple structure.

If the structure as described above is used, the opening area at the front end of the main body 11 when the entire main body 11 is protruded from the outer cylinder 5 is almost automatically determined by the protruding amount of the main body 11 from the front end of the outer cylinder 5. To be determined.
However, if the main body 11 is provided with a mechanism capable of adjusting the opening area of the distal end regardless of the amount of protrusion from the distal end of the outer cylinder 5, a field of view and a surgical field suitable for a site to be observed or treated can be formed. ,preferable.
For example, a wire is arranged in a ring shape along the distal end edge 11a of the main body 11, and one end thereof is fixed to the distal end edge 11a, and the other end is a hand of the area securing instrument 10, that is, an internal view. It is arranged near the operation unit 3 of the mirror 1. In addition, the ring | wheel formed with a wire is provided so that a ring | wheel may become small if the other end is pulled. Then, if the wire at hand is adjusted, the front-end | tip of the main-body part 11 can be squeezed. That is, the opening area at the tip of the main body 11 can be adjusted regardless of the amount of protrusion of the main body 11 from the outer cylinder 5.

Moreover, the main-body part 11 should just be made into the shape suitable according to the place to use, a treatment, etc., and it cannot be overemphasized that it is not limited to said size and shape.
For example, when the appearance is a trumpet shape, even if the length L of the main body 11 is the same, a wide field of view can be secured by increasing the angle θ formed between the central axis CL of the hollow space and the inner surface. If it is made smaller, the distance from the stomach wall ST or the like can be made larger, so the length L and the angle θ of the main body 11 may be set appropriately according to the place and treatment used.
The appearance may not necessarily be a trumpet shape, and may be a columnar shape, an elliptical shape in a side view, a radial shape, or the like.

  For example, as shown in FIG. 6 (A), a main body 11 that protrudes from the outer cylinder 5 and has a cylindrical shape having an inner diameter larger than that of the outer cylinder 5 can be employed. In this case, since the digestive tract can be maintained in a cylindrical shape, the large intestine and the like can be formed in a cylindrical shape, and the inner wall and the like can be easily examined. Further, there is an advantage that the distance between the tip of the tube 2 and the inner wall of the digestive tract can be taken by the length of the main body 11 in the axial direction. In particular, if a through-hole is formed in the side wall of the main body 11, the part disposed in the through-hole can be inspected by the endoscope 1.

Also, as shown in FIG. 6B, the main body 11 has a shape that has an elliptical shape in a side view when projected from the outer cylinder 5, in other words, a portion 11d that swells between the distal end and the proximal end. If it makes it, the advantage that it becomes easy to perform the operation | movement (operation by a double scope) using the two endoscopes 1 is also acquired.
For example, as shown in FIG. 7B, the shaft 1B of one endoscope 1B is used for observing blood vessels and the like on the outer surface of the stomach wall ST through the stomach wall ST, and the shaft of the other endoscope 1A. Surgery may be performed with 1A. In such a case, if the shaft 1A is arranged in the main body part 11, the stomach wall ST in a state of being developed by the main body part 11 can be operated, and the distal end portion of the main body part 11 penetrates the stomach wall ST through the shaft 1B. It is preferable because it does not get in the way.

  Furthermore, as shown in FIG. 6C, a dividing plate 10p that divides the inside of the communicating pipe 15 and the inside of the main body 11 into two spaces along the axial direction of the main body 11 and the communicating pipe 15 may be provided. . In this case, it is preferable that the shaft 2A and the shaft 2B are passed through the spaces of the communication pipe 15 during the operation with the double scope, because problems such as the shafts 2A and 2B entangled do not occur. And when employ | adopting this structure, the one where the opening area of the main-body part 11 is large is preferable since the place which penetrates the stomach wall ST can be ensured, taking a large surgical field.

  Moreover, the cross-sectional shape of the hollow space in the main body 11 is not limited to a circle (see FIG. 2), and may be an elliptical shape or a polygonal shape such as a quadrangle. In particular, it is preferable to use a shape such as a circle or an ellipse that does not have an angular portion on the outer periphery because the force applied to the organ or the like can be reduced when it comes into contact with the organ or the like.

Furthermore, the main body 11 only needs to be formed so as to be able to expand and contract in a direction intersecting the central axis CL of the hollow space, and may not necessarily be formed of the shape memory material as described above.
For example, a sheet-like member may be stretched around a skeleton formed of an elastic material such as rubber to form a trumpet. Even in this case, the main body 11 can be accommodated in the outer cylinder 5 by constricting the tip, and the main body 11 can be formed in a trumpet shape by protruding from the outer cylinder 5.
In the case of the above structure, it is preferable to use a stretchable material such as rubber as a sheet-like member stretched around the framework. If such a material is used, the sheet-like member contracts even if it is housed in the outer cylinder 5 when the tip is constricted, so that the sheet-like member does not hang down between the frames. This is preferable because it does not obstruct the movement of the shaft 2 of the endoscope 1 or obstruct the visual field.
In addition, even if the sheet-like member is not a stretchable material, it can be prevented that the sheet-like member hangs down between the frames if the structure is foldable in a bellows shape. You can get an effect.

  Furthermore, you may provide the main-body part 11 with the hole which connects between the inside and the exterior. Then, even if liquids such as gastric juice and blood enter the space in the main body 11, these liquids can be discharged to the outside through the holes. Then, it is possible to prevent the liquid from accumulating in the space in the main body 11 and obstructing the observation by the endoscope 1.

(About connecting pipe 15)
Next, the connecting pipe 15 will be described.
The connecting pipe 15 is a cylindrical member extending along the axial direction, and a hollow space penetrating between one end and the other end is formed. The hollow space is formed in such a size that the shaft 2 of the endoscope 1 can be smoothly inserted therein, and is communicated with the hollow space of the main body 11 so as to be substantially coaxial.

As described above, the connecting tube 15 has a length in the axial direction that is a combined length from the base end of the connecting tube 15 to the tip of the main body 11 in the state where the main body 11 is provided at the front end. Is formed to be longer than the outer cylinder 5.
Then, if the base end of the connecting pipe 15 is operated, the tip of the main body 11 can be projected and retracted from the tip of the outer cylinder 5, so that a special mechanism for projecting and retracting the main body 11 from the distal end of the outer cylinder 5 is provided. Since it becomes unnecessary, the structure of the area securing instrument 10 can be made simple.

  In addition, the material of the connecting tube 15 is not particularly limited, but when the outer tube 5 or the shaft 2 of the endoscope 1 is bent, the connecting tube 15 is flexible enough to follow its movement, Those having such a strength that the shape can be maintained even when a certain amount of force is applied from the radial direction are preferable. For example, polyethylene preparations, plastic preparations, urethane preparations, and the like, which are materials generally used for the outer cylinder 5, can be used, but are not particularly limited as long as the materials satisfy the above functions.

In addition, the area securing instrument 10 includes a mechanism that allows the main body portion 11 to appear and disappear from the outside of the outer cylinder 5 and that can maintain the position of the main body portion 11 in the outer cylinder 5. If so, the connecting pipe 15 may not be provided.
However, if the area securing instrument 10 includes the connecting pipe 15 as described above, the length of the main body 11 protruding from the outer cylinder 5 or the outer cylinder 5 can be adjusted by operating the proximal end of the connecting pipe 15. Since the position of the main body 11 in the stomach, stomach, and abdominal cavity can be adjusted, there is an advantage that these adjustments are easy. Further, the position of the main body 11 in the outer cylinder 5, the stomach, and the abdominal cavity can be fixed simply by fixing the movement of the proximal end of the connecting tube 15 to the shaft 2 itself of the endoscope 1. There is also an advantage that the position of the portion 11 can be easily fixed.

  The region securing device according to the present invention is a transluminal intraluminal operation for performing a procedure for forming a through-hole in the digestive tract or an operation in the abdominal cavity with an endoscope inserted in a digestive tract cavity such as the mouth, anus, or vagina. Suitable for instruments that secure the field of view and surgical field of endoscopic surgery.

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Shaft 5 Outer cylinder 10 Area | region securing instrument 11 Main-body part 11a Outer edge 15 Connection pipe ST Gastric wall

Claims (5)

An instrument for securing a region used for transluminal endoscopic surgery,
It has a cylindrical main body with a hollow space,
The main body is
In a direction intersecting with the central axis of the hollow space formed by the shape memory material, it can expand and contract,
In the expanded state, the hollow space of the main body is formed such that the cross-sectional area of its tip is larger than the cross-sectional area of the shaft of the endoscope,
When a force of a certain level or more is applied in a direction from the direction intersecting the central axis of the hollow space toward the central axis, the tip is contracted so that the cross-sectional area becomes small, and when the force is removed, A region securing device, wherein the region securing device is adjusted so that it can be restored to its shape. The main body is
In the contracted state, it becomes almost cylindrical,
In the expanded state, the cross-sectional area of the hollow space at the axial tip of the main body is formed to be larger than the cross-sectional area of the hollow space at the axial tip of the main body. The instrument for securing an area according to claim 1. The area securing instrument is:
It has a cylindrical connecting pipe with a hollow space,
The connecting pipe is
The hollow space has a cross-sectional area that is larger than the cross-sectional area of the endoscope shaft,
The region securing according to claim 1 or 2, wherein a distal end of the hollow space is connected to a proximal end of the main body so that the hollow space is in communication with the hollow space of the main body. Appliances. An endoscope used for transluminal endoscopic surgery,
The endoscope
A cylindrical outer tube through which the shaft of the endoscope is inserted;
A region securing device according to claim 1, 2 or 3,
The area securing instrument is:
Between the outer cylinder and the shaft of the endoscope in a state of being inserted into the outer cylinder, so as to be able to protrude from the tip of the outer cylinder along the axial direction of the shaft of the endoscope An endoscope provided with an area securing instrument, which is provided. The area securing instrument is:
It has a cylindrical connecting pipe with a hollow space,
The connecting pipe is
The tip of the hollow space is connected to the base end of the main body so that the hollow space is in communication with the hollow space of the main body.
The connecting pipe is
The cross-sectional area of the hollow space is larger than the cross-sectional area of the endoscope shaft,
In a state connected to the main body, the length from the distal end of the main body to the base end of the connecting pipe in the axial direction of the connecting pipe is shorter than the axial length of the outer cylinder. The endoscope provided with the instrument for area | region ensuring of Claim 4 characterized by the above-mentioned.

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