JP5787244B2 - Endoscope aids - Google Patents

Description

  The present invention relates to an auxiliary tool used for using an endoscope in a body.

  In recent years, in order to reduce the burden on the patient at the time of surgery, it has been widely performed to perform a procedure for minimizing the incision of the body surface using an endoscope. At that time, for reasons such as securing a visual field in the treatment section, a procedure such as sending a gas such as carbon dioxide from the outside into the body cavity where the treatment section is located and increasing the pressure in the body cavity is performed. . Usually, in such a procedure, air is supplied through a channel provided in the endoscope.

  On the other hand, auxiliary tools such as an overtube are used to introduce an endoscope into a body cavity. For example, in the overtube, a deaeration prevention valve is provided so that gas in the body cavity does not leak from a gap between the endoscope and the overtube.

  However, when the endoscope is moved during the procedure, gas may leak from the gap between the endoscope and the deaeration prevention valve, and the pressure in the body cavity may decrease. Conventionally, when the pressure in the body cavity drops in this way, it is necessary to increase the amount of gas introduced through the endoscope and to adjust on the endoscope side so that the internal pressure does not rise too much. there were.

  Such an adjustment must be performed by an operator or an assistant who performs a procedure with an endoscope. When the operator performs the adjustment, the operator may not be able to concentrate on the original procedure.

  Further, when using a cautery device such as an electric knife in the procedure, smoke may be generated when the treatment section is burned out with the electric knife, and the visibility around the treatment section may deteriorate. In this case, the operator needs to wait until the smoke has settled, or to suck the smoke from inside the body cavity through the channel of the endoscope.

  However, when smoke is sucked from the body cavity through the endoscope channel, the atmospheric pressure in the body cavity is lowered, which disadvantageously narrows the field of view of the endoscope. Therefore, after sucking the smoke, it is necessary to supply the gas into the body cavity again through the channel of the endoscope to increase the atmospheric pressure in the body cavity.

  As described above, in the procedure using the conventional electric knife, the original procedure is interrupted every time smoke is generated. As a result, the procedure takes a long time and becomes a burden on the operator and the patient.

JP 2007-301364 A

  In order to reduce the burden on the patient in endoscopic surgery, the inventors of the present application invented an invention that eliminates the inconvenience caused by the means for making a hole in the stomach wall disclosed in Patent Document 1, and as Japanese Patent Application No. 2009-195605 I have applied.

  In the prior application, as an auxiliary tool used in a so-called NOTES (Natural Orifice Translumenal Endoscopic Surgery) procedure (transluminal endoscopic surgery), an overtube through which an endoscope can be inserted and inserted into the overtube Proposed inventions such as a hard inner cylinder and a holder that is fixed to a patient's body surface and holds an overtube and an endoscope.

  The inventors of the present application have found that the overtube and the holder proposed in the previous application are effective for solving the above disadvantages. Furthermore, these aids should be used not only for NOTES procedures but also for procedures such as EMR (Endoscopic Mucosal Resection) and ESD (Endoscopic Submucosal Dssection). I found out that I can do it.

  An object of the present invention is to improve an insertion aid for an endoscope. More specifically, in order to eliminate the inconvenience, an internal pressure can be easily adjusted and a cautery device such as an electric knife is used. An object of the present invention is to provide an endoscope auxiliary tool that can ventilate the body while maintaining the pressure inside the body. Another object of the present invention is to provide an endoscope auxiliary tool that can be used not only in a NOTES technique but also in a technique such as EMR or ESD.

In order to achieve the above object, an endoscope auxiliary tool of the present invention is an auxiliary tool that has an overtube through which an inner cylinder can be inserted, and is used when the endoscope is used in a body through a body cavity. And holding means for holding the overtube held on the body cavity surface or body surface incision part of the patient, the holding means being attached to the patient and the cylindrical part through which the overtube is inserted and a mounting portion for holding the tubular portion, characterized in that the inner peripheral surface of the cylindrical portion, the overtube can hold against the said inner peripheral surface of the expansion deflatable balloon is provided And
In addition, the endoscope auxiliary tool of the present invention is an auxiliary tool used when the endoscope is used in the body through a body cavity, and has an internal passage through which an endoscope having an objective lens at the tip can be inserted. And an overtube through which the inner cylinder can be inserted. The overtube and the inner cylinder are made of a synthetic resin having flexibility. Formed in a tapered shape, at least the front portion of the objective lens is formed transparently, provided with a tip portion formed so that the outside can be visually observed by the objective lens, and when the inner cylinder is inserted into the overtube, The tip portion protrudes from the front end of the overtube and the rear end portion of the inner cylinder protrudes from the rear end portion of the overtube. Along with this, an auxiliary passage capable of supplying at least gas into the body is provided, and includes holding means for holding the overtube held on the surface of the body cavity of the patient or on the body surface incision, and the holding means includes the overtube has a tubular portion to be inserted, and a mounting portion for holding the cylindrical portion is attached to the patient, the inner peripheral surface of the cylindrical portion, capable of holding the overtube against on the inner peripheral surface It is characterized in that a balloon that can be freely expanded and contracted is provided.
Further, the endoscope auxiliary tool of the present invention is an auxiliary tool for performing an operation via the vagina or anus, and the mounting portion is made of cloth and is formed in a pants shape. The tubular part may be attached to the attachment part so that the attachment part is disposed at a position in front of the vagina or anus when the attachment part is attached to a patient.
An endoscope auxiliary tool according to the present invention has an overtube through which an inner cylinder can be inserted, and is an auxiliary tool used when the endoscope is used in the body through a cavity. A deaeration prevention valve unit that is detachably attached to an end portion, and the deaeration prevention valve unit is tapered toward the advancing direction of the endoscope, and a pair of inclined surfaces having a ridge line at the distal end portion And a valve body having a slit provided along the ridgeline, and a shape of the inclined surface so as to suppress deformation of the valve body side wall provided at the both ends of the slit provided inside the valve body. And a cylindrical restraining member having a pair of mountain-shaped protrusions that taper in the direction of travel of the endoscope in side view.

  In the procedure using the endoscope, first, it is necessary to insert the overtube into the body through an incision provided on the surface of the body or the body cavity, but the tip shape of the inner cylinder is a tapered shape, Furthermore, since the outside can be visually observed by the objective lens, the inner tube and the endoscope are attached to the overtube, and the situation is confirmed by the endoscope when the overtube is inserted into the body through the incision. Treatment can be performed.

  Here, in a conventional technique using an endoscope and an overtube, first, an overtube is attached around the endoscope, only the endoscope is inserted into the body cavity, and then the overtube is inserted into the endoscope. It was the procedure of inserting it toward the body cavity along. At this time, the overtube is inserted into the body cavity while the outer tube slides on the outer peripheral surface of the endoscope that has been inserted first, but since the endoscope has already been inserted into the body cavity, the tip of the overtube is The overtube cannot be inserted with visual inspection. Therefore, in the conventional procedure, the surface of the pharynx and the esophagus is caught between the endoscope and the overtube, which may cause a burden on the patient.

  In the present invention, the inner cylinder and the overtube can be inserted into the body cavity in a state where the endoscope is mounted in the inner cylinder. Further, in the present invention, the tip portion at the tip of the inner cylinder is transparent, and the front can be seen with an endoscope attached inside. Therefore, according to the present invention, since the procedure can be performed while confirming the insertion state of the overtube with an endoscope, the pharynx, the esophagus and the like can be prevented from being involved, and a smooth procedure can be performed.

  Moreover, since the auxiliary passage is provided in the overtube, gas can be supplied into the body from the auxiliary passage. When a procedure is performed with an endoscope, the inner cylinder is removed from the overtube, and the endoscope is directly inserted into the body through the overtube. In this state, gas can be supplied into the body from the auxiliary passage, and gas can be discharged from the body through the gap between the overtube and the endoscope, so that the atmospheric pressure in the body can be easily adjusted. be able to.

  In addition, by supplying gas from the auxiliary passage to the body using the endoscope auxiliary tool of the present invention, the gas in the body near the treatment section is also received when a procedure using an electric knife or the like is performed. Since ventilation is performed, it is possible to prevent the visual field near the treatment area from being deteriorated.

  In the endoscope auxiliary tool of the present invention, it is preferable that a plurality of the auxiliary passages are provided to supply gas into the body and to suck the gas from the body. With this configuration, gas supply and suction can be freely controlled, so that the pressure inside the body can be easily controlled.

  Moreover, in the endoscope auxiliary tool of the present invention, it is preferable that a stopcock for opening and closing the auxiliary passage is provided at a location exposed on the body surface side of the auxiliary passage. With this configuration, by appropriately opening and closing the stopcock, the pressure inside the body can be easily controlled by the surgeon or assistant.

  The endoscopic auxiliary tool of the present invention further includes holding means for holding the overtube held on the surface of the body cavity of the patient or on the surface of the body, and the holding means is inserted through the overtube. A cylindrical portion that is attached to a patient and holds the cylindrical portion, and the overtube can be pressed against the inner peripheral surface of the passage and held on the inner peripheral surface of the cylindrical portion It is preferable that an inflatable and contractible balloon is provided.

  According to the said structure, the said overtube is hold | maintained at the said holding means by inflating the said balloon in the state which inserted the said overtube in the cylindrical part of the said holding means. For this reason, the position of the endoscope inserted into the overtube is also stabilized. Therefore, the operator can perform a procedure with the endoscope or the like being stable without holding the overtube or the endoscope by an assistant or the like.

  Further, when the endoscopic auxiliary tool is an auxiliary tool for performing a procedure via the vagina or anus, the mounting portion is made of cloth and is formed in a pants shape, and the cylindrical portion is the mounting portion. It may be attached to the mounting portion so as to be placed at a position in front of the vagina or anus when mounted on a patient.

  Thus, when the cylindrical part is attached to the pant-shaped mounting part, the cylindrical part can be easily mounted on the patient in the NOTES procedure, and the position of the cylindrical part is stabilized even during the mounting. Various materials can be used for the pant-shaped mounting part as long as they are made of cloth, but a stretchable part such as a knit or non-woven fabric is preferable. When the mounting portion is formed of such a material, it can be adapted to many patients, and is preferable from the aspect of fixing the cylindrical portion.

  Further, the endoscope auxiliary tool of the present invention further includes a deaeration prevention valve unit that is detachably attached to a rear end portion of the overtube, and the deaeration prevention valve unit is a progression of the endoscope. A valve body having a pair of inclined surfaces with a ridgeline at the tip, and having a slit provided along the ridgeline, and a slit provided inside the valve body. It is preferable to provide a restraining member that restrains deformation of the valve body side walls on both ends.

  According to this configuration, airtightness between the overtube and the endoscope is maintained by the valve body. Further, the valve body having a pair of tapered inclined surfaces has a resistance to pulling the endoscope back when the endoscope is pulled out due to friction with the endoscope surface when the endoscope is pulled out. In many cases, however, in the present invention, the valve member is prevented from being turned over by the restraining member, so that the resistance when the endoscope is pulled out from the overtube is smaller than that of the conventional one.

  Moreover, in the endoscope auxiliary tool of the present invention, the deaeration prevention valve unit is opened on an inner peripheral surface at a front position of the valve body and communicates with one or two or more vents communicating the inside and the outside. A valve is preferably provided. With this configuration, the atmospheric pressure in the body can be adjusted via the ventilation valve. For this reason, the auxiliary passage provided in the overtube can be inserted with a liquid such as a chemical solution or physiological saline, a treatment instrument for an endoscope, or the like in addition to air supply or inhalation. As a result, the endoscope auxiliary tool of the present invention can introduce liquids, treatment tools, and the like desired by the operator into the treatment section in response to various procedures.

Explanatory drawing which shows an example of embodiment of the auxiliary tool for endoscopes of this invention. Explanatory sectional drawing which shows the state which inserted the endoscope in the inner cylinder in this embodiment. Explanatory sectional drawing which shows the state of the front-end | tip part at the time of attaching an inner cylinder and an endoscope to the overtube in this embodiment. Explanatory drawing which shows an example of the holder unit of this embodiment. (A) is explanatory sectional drawing which shows the deaeration prevention unit of this embodiment, (b) is explanatory drawing which shows the support ring provided in the deaeration prevention unit. Explanatory drawing which shows the chip | tip part of the other example of this embodiment. Explanatory drawing which shows the front-end | tip part of the other overtube of this embodiment. Explanatory drawing which shows the holder unit of the other example of this embodiment.

  Next, an example of an embodiment of the endoscope auxiliary tool of the present invention will be described with reference to FIGS.

  The endoscope auxiliary tool 1 of this embodiment is used for performing a procedure by inserting an endoscope into a body from a body cavity such as a vagina or an incision provided in the abdomen. As shown, an overtube 20 inserted into the body through a body cavity or incision, an inner cylinder 30 inserted into the overtube 20, a holder 40 (see FIG. 4) and an anti-aeration unit 50 (see FIG. 5) described later. Reference).

  In the overtube 20, the main body 21 is formed of a flexible synthetic resin tube, and a stainless steel reinforcing core member 22 is integrally formed therein to give a certain degree of rigidity. The vicinity of the distal end portion of the main body 21 is in a state where there is no reinforcing core member 22 and is softer than a portion where the reinforcing core member 22 is present.

  The shape of the overtube 20 is an arc shape that gently curves in a side view. Moreover, the outer diameter of the overtube 20 is formed to a thickness suitable for various procedures. In the present embodiment, those having a diameter of about 2 cm to 6 cm are appropriately selected and used depending on the application location and the patient.

  A pair of auxiliary tubes 23 and 24 are fixed to the surface of the overtube 20 on the side with the smaller radius of curvature. The auxiliary tubes 23 and 24 are flexible synthetic resin tubes, and the tip ends are inclined obliquely along the tip shape of the overtube 20, and the connectors 25 and 26 are provided at the rear ends. Is provided. In the connectors 25 and 26, one connector 25 is a male connector and the other connector 26 is a female connector.

  As shown in FIGS. 1 to 3, the auxiliary tubes 23 and 24 are fixed so that the distal end portion is located slightly rearward from the distal end portion of the overtube 20, and rearward along the surface of the overtube 20. It extends to the vicinity of the front end position of the connector portion 27 provided at the rear end portion of the overtube 20. Further, it is divided in the circumferential direction from the vicinity of the tip position of the connector portion 27 and extends to the opposite side of the overtube 20, and is separated from the overtube 20 and connected to the connectors 25 and 26.

  Further, the connector portion 27 is provided with an engagement groove 28 that engages with an engagement protrusion 34 provided on the connector portion 33 of the inner cylinder 30. In addition, the connector portion 27 is provided with a display mark 29 on the surface of the overtube 20 on the side having a small curvature radius so that the bending direction of the overtube 20 can be confirmed at hand.

  The inner cylinder 30 includes a cylindrical main body 31, a tip portion 32 provided at the front end portion of the main body 31, and a connector portion 33 provided at the rear end portion of the main body 31. The main body 31 and the chip part 32 are formed of a transparent synthetic resin, and a flexible synthetic resin is used in this embodiment. Further, the inside of the main body 31 is an internal passage 31a through which the endoscope 60 is inserted (see FIG. 3).

  The tip portion 32 has a substantially conical shape, and the tip portion is small and provided with a rounded shape. Further, the rear end portion of the chip portion 32 is formed so as to have substantially the same size as the outer diameter of the main body 31.

  Further, as shown in FIG. 3, the outer diameter of the inner cylinder 30 is slightly smaller than the inner diameter of the main body 21 of the overtube 20, and the inner cylinder 30 easily moves inside the main body 21 of the overtube 20. It is possible. On the other hand, the gap between the surface of the inner cylinder 30 and the inner peripheral surface of the main body 21 of the overtube 20 is made small, and the inner cylinder 30 and the overtube 20 are inserted into the stomach via the patient's mouth and esophagus. In such a case, the surface of the throat or esophagus is formed so as not to be caught.

  An engagement protrusion 34 is provided on the connector portion 33 of the inner cylinder 30. The engagement protrusion 34 is attached to the connector portion 27 of the overtube 20, and the engagement protrusion 34 is engaged with the engagement groove 28. 30 can be connected to each other.

  In addition, as shown in FIG. 3, the endoscope 60 is inserted into the inside of the inner cylinder 30 up to the vicinity of the distal end portion, so that the endoscope 60 having a diameter generally used can be inserted into the inner passage 31a. Has an inner diameter. The outer diameter of the inner cylinder 30 has a plurality of types of thickness according to the inner diameter of the overtube 20, and is appropriately selected depending on the application location and the patient.

  The endoscope auxiliary tool 1 according to the present embodiment includes a holder unit 40 shown in FIG. 4 and a deaeration preventing unit 50 shown in FIG. 5 in addition to the above configuration.

  With reference to FIG. 4, the holder unit 40 holds the overtube 20 and the endoscope 60 at predetermined positions at the time of surgery. As shown in FIG. 4, the holder unit 40 includes a flange portion 41 arranged in the vicinity of the opening of the patient's body cavity or on the body surface where the incision portion is provided, and a cylindrical portion 42 protruding from the flange portion 41 to one side. And a belt fixing portion 43 provided on the flange portion 41 and a polyurethane fixing belt 44 (mounting portion).

  The cylindrical portion 42 is provided with a groove 42a formed in a shape in which the pair of auxiliary tubes 23 and 24 are accommodated, and a balloon 45 positioned on the opposite side of the groove 42a. The inside of the balloon 45 communicates with the connection tube 46, and a connector 47 is attached to the distal end portion of the connection tube 46.

  A syringe (not shown) without an injection needle can be connected to the connector 47, and air can be fed with the syringe to inflate the balloon 45. Further, a check valve (not shown) is provided inside the connector 47 so that air inside the balloon 45 does not leak outside even when the syringe is removed. Further, when the air in the balloon 45 is removed, the syringe is inserted into the connector 47 and the plunger of the syringe is pulled.

  Referring to FIG. 5A, the deaeration preventing unit 50 is made of rubber having a hole having a diameter smaller than the diameter of the endoscope at the center so that the endoscope 60 can be inserted into the main body 51. A first deaeration prevention valve 52, a rubber second deaeration prevention valve 53 (valve element) formed in a tapered shape toward the advancing direction of the endoscope (left side in FIG. 5A), 2 A support ring 54 (suppressing member) mounted inside the deaeration prevention valve 53 and a spacer 55 for positioning and holding these members in the main body 51 are provided.

  Further, the deaeration preventing unit 50 is provided with a ventilation valve 57 that communicates the inside and the outside. The ventilation valve 57 has a passage 57a formed therein, and in the deaeration prevention unit 50, an opening 57b is formed in front of the second deaeration prevention valve 53 (on the left side in FIG. 5A), and the communication between the passage 57a is blocked. And a switching valve 57c for switching between the two.

  The first deaeration prevention valve 52 is formed in a ring shape that tapers in the traveling direction of the endoscope 60, and a radial protrusion 52a is formed on the surface thereof to reduce resistance when the endoscope 60 is inserted. Is provided.

  The second deaeration prevention valve 53 is a valve formed in a mountain shape in a side view, and has a pair of inclined surfaces 53b provided with a ridge line 53a at the tip, and has a slit 53c provided along the ridge line 53a. doing. In the second deaeration prevention valve 53, when the air pressure on the left side in FIG. 5A increases, the slit 53c is closely closed by the pressure applied to the inclined surface 53b. Is prevented.

  Referring to FIG. 5B, the support ring 54 is formed of a rigid synthetic resin, and is formed in a mountain shape in a side view according to the shape of the side walls on both ends of the slit 53c of the second deaeration prevention valve 53. Has been. In addition, the support ring 54 is provided with an engagement protrusion 54 a so as to be held by a spacer 55 mounted in the main body 51 of the deaeration prevention unit 50.

  The deaeration prevention unit 50 is provided with a connector portion 56 that can be detachably attached to the connector portion 27 of the overtube 20. The connector portion 56 is also provided with an engagement protrusion 56 a that can be engaged with the engagement groove 28 of the connector portion 27 of the overtube 20.

  Next, a usage example of the endoscope auxiliary tool 1 of the present embodiment will be described. In the following description, a method of using the technique by inserting an endoscope into the stomach using the overtube 20 and the inner cylinder 30 from an incision provided on the patient's abdominal surface will be described. Note that the endoscope 60 used for the procedure is an endoscope that is generally widely used, and includes an objective lens 61 at the tip.

  When the incision portion is pushed out by the inner cylinder 30, the endoscope 60 is inserted into the inner cylinder 30, and the distal end portion of the endoscope 60 is positioned near the rear end portion of the tip portion 32 as shown in FIG. Insert until The endoscope 60 is provided with an objective lens 61, and the objective lens 61 makes it possible to visually recognize what is in front of the tip portion 32. At this time, a lubricant is applied to the surfaces of the overtube 20, the inner cylinder 30, and the endoscope 60.

  After setting the endoscope 60 in the inner cylinder 30, the inner cylinder 30 and the endoscope 60 are inserted into the overtube 20, and the connector part 27 of the overtube 20 and the connector part 33 of the inner cylinder 30 are connected. . At this time, the engagement protrusion 34 of the connector portion 33 is engaged with the engagement groove 28 of the connector portion 27. In the present embodiment, in this state, as shown in FIG. 2, the tip portion 32 of the inner cylinder 30 protrudes from the distal end portion of the overtube 20.

  On the other hand, the holder unit 40 is fixed to the patient side. The holder unit 40 is fixed such that the cylindrical portion 42 is positioned outside the patient with the flange portion 41 facing the patient, the fixing belt 44 is wound around the patient's waist, and the holder unit 40 is fixed to the patient's body surface. To do. At this time, the balloon 45 is deflated.

  Next, in a state where the endoscope auxiliary tool 1 and the endoscope 60 are set, these are inserted into the stomach from the incision portion of the patient through the cylindrical portion 42 of the holder unit 40. At this time, the overtube 20 and the inner cylinder 30 are inserted into the body cavity while visually confirming the inside of the body cavity with the objective lens 61 of the endoscope 60.

  Then, when the incision portion is pushed and spread by the tip portion 32 of the inner cylinder 30 and passes through the incision portion, the respective states can be visually recognized by the objective lens 61 through the transparent tip portion 32. Therefore, the surgeon can easily grasp that the distal end portion of the inner cylinder 30 has passed through the incision portion. Further, since there is only a small gap between the outer peripheral surface of the inner cylinder 30 and the inner peripheral surface of the overtube 20, the procedure can be performed smoothly without sandwiching an incision portion or the like.

  In the case of the above procedure, when there is bleeding or the like from the treatment section and the visibility of the endoscope 60 becomes poor, the treatment section can be cleaned by the auxiliary tubes 23 and 24. Specifically, the treatment portion can be washed by injecting a cleaning solution such as physiological saline from one auxiliary tube 23 to wash the treatment portion, and sucking out the washing solution after washing from the other auxiliary tube 24. it can. In the present embodiment, the connectors 25 and 26 provided at the rear ends of the auxiliary tubes 23 and 24 are distinguished from male connectors and female connectors, so that it is easy to distinguish between injection and suction of the cleaning liquid.

  After the above procedure is performed and a hole through which the overtube 20 can be inserted is formed on the body surface, the inner cylinder 30 is removed from the overtube 20, and the deaeration prevention unit 50 is attached to the connector portion 27 of the overtube 20. Then, the endoscope 60 is caused to enter the overtube 20 through the deaeration prevention unit 50. Then, while observing the state of the body with the endoscope 60, the tip of the endoscope 60 is advanced to the vicinity of the affected part.

  During the above procedure, the procedure is facilitated by keeping the stomach at a pressure higher than atmospheric pressure. In the present embodiment, the venting valve 57 is provided in the deaeration preventing unit 50, and by connecting an automatic air feeding device to the venting valve 57, the body cavity is automatically maintained at a predetermined pressure. It is. As a result, air supply that has been conventionally performed manually from the air supply channel of the endoscope can be automatically performed via the overtube 20, and the labor of the operator is greatly reduced.

  Further, since the overtube 20 is curved in an arc shape, the operator can operate the direction of the tip of the overtube 20 in an arbitrary direction by rotating the connector portion 27. As a result, the range in which the endoscope 60 can enter is widened, so that a wide range of organs can be treated. In addition, since the operator can confirm the bending direction of the overtube 20 with the display mark 29, the procedure is facilitated.

  Next, when the overtube 20 is advanced to a predetermined position, the balloon 45 of the holder unit 40 is inflated to hold the overtube 20 in the holder unit 40. At that time, the balloon 45 is inflated after the pair of auxiliary tubes 23 and 24 are positioned in the groove 42 a of the cylindrical portion 42. Thereby, since the auxiliary tubes 23 and 24 are not compressed even by the expansion of the balloon 45, the auxiliary tubes 23 and 24 are not crushed and the internal passage is not blocked.

  Thereafter, the surgeon performs a desired procedure using a treatment instrument such as an endoscope and an electric knife. For example, when the endoscope 60 has a treatment instrument channel and a ventilation channel (not shown), the affected part is excised using an electric knife, and smoke generated at that time is discharged to the outside through the ventilation channel. Can do.

  At this time, the gas pressure in the stomach can be kept constant by supplying air into the stomach through the overtube 20 from the automatic air supply device connected to the ventilation valve 57 of the deaeration preventing unit 50.

  On the other hand, when there is no ventilation channel in the endoscope 60, for example, air is supplied through the overtube 20 from an automatic air supply device connected to the ventilation valve 57 of the deaeration prevention unit 50, and any of the auxiliary tubes 23, 24 is supplied. By sucking gas from one or both, the smoke in the stomach can be discharged to the outside. Conversely, an automatic air supply device may be connected to the auxiliary tubes 23 and 24 to suck smoke from the ventilation valve 57 to the outside.

  Even if it is necessary to remove the endoscope 60 from the overtube 20 during the procedure, the deaeration prevention unit 50 of the present embodiment has a support ring inside the second deaeration prevention valve 53. Since 54 is provided, when the endoscope 60 is pulled out, the second deaeration prevention valve 53 is not turned over and does not press the surface of the endoscope 60, so that the endoscope 60 can be pulled out easily.

  In addition, in the said embodiment, although the auxiliary tubes 23 and 24 provided in the overtube 20 are made into two pieces, it is good also as only one piece, and good also as three or more. The auxiliary tubes 23 and 24 may be used to insert a treatment tool such as forceps in addition to injecting and suctioning the cleaning liquid.

  Moreover, in the said embodiment, although the auxiliary tubes 23 and 24 are provided in the outer peripheral surface of the overtube 20, as shown to Fig.7 (a), it is good also as the auxiliary channel | path 23a which penetrates the wall surface of the overtube 20. FIG. . Further, as shown in FIG. 7B, an auxiliary tube 23 b may be provided on the inner surface of the overtube 20. Moreover, about the overtube 20, it is not restricted to what has the reinforcement core material 22, It is good also as a thing without the reinforcement core material 22 depending on a material.

  Further, the fixing belt 44 of the holder unit 40 can be made of any material such as silicone rubber or a hook-and-loop fastener other than the polyurethane belt as in the above embodiment.

  Moreover, in this embodiment, each structure of the balloon 45 of the holder unit 40, the connection tube 46, and the connector 47 is applied to the mouthpiece conventionally used, and the overtube 20 and the inner cylinder 30 are taken from a patient's mouth. You may use for the procedure inserted in a stomach.

  In the procedure, when the overtube 20 and the inner cylinder 30 are inserted from the patient's mouth, treatment can be performed while confirming the situation with an endoscope. Further, the tip portion 32 of the inner cylinder 30 has a substantially conical shape and the tip portion is spherical. Further, the gap between the inner cylinder 30 and the overtube 20 is narrowed. For this reason, when passing through the throat, esophagus, or piriform fossa, the overtube 20 or the like can be inserted without damaging these portions, mucous membranes, and the like.

  In the above embodiment, the tip portion 32 of the inner cylinder 30 has a substantially conical shape. However, as shown in FIG. 6A, a configuration like the tip portion 32a may be used. A spiral protrusion 35 is provided on the surface of the tip portion 32a. The protrusion 35 makes it easy to spread the incision portion provided on the body surface of the tip portion 32a.

  Further, as shown in FIG. 6B, a configuration like a chip portion 32b may be adopted. The tip portion 32b is formed in a quadrangular pyramid shape with a rod-shaped member 36, and an opening portion 37 that communicates with the inner passage 31a of the inner cylinder is provided. Although not shown, the rod-shaped member 36 may be formed into a triangular pyramid shape or another polygonal pyramid shape.

  With this configuration, when the incision portion provided on the body surface is pushed and expanded by the tip portion 32, the incision portion can be directly viewed with the objective lens 61 of the endoscope 60 through the opening portion 37. Can do. Further, when the treatment instrument channel is provided in the endoscope 60, it is possible to perform treatment by extending the treatment instrument forward through the opening 37.

  Moreover, in the said embodiment, although the thing with the valve | bulb 57 for ventilation | gas_flowing of the deaeration prevention unit 50 was demonstrated, it is not restricted to this, You may provide multiple ventilation | gas_flowing valve | bulb 57 as needed. By providing a plurality of ventilation valves 57, the pressure inside the body can be adjusted only by the deaeration prevention unit 50. Therefore, the auxiliary tubes 23 and 24 provided in the overtube 20 are used to eliminate smoke from the treatment section. Can be used. Further, only one of the auxiliary tubes can be used for smoke removal, and a treatment instrument or the like can be inserted into the other auxiliary tube, and an easy-to-use auxiliary tool can be provided according to various procedures.

  In the above embodiment, the holder unit 40 has been described as being fixed to the patient by the fixing belt 44. However, as shown in FIG. 8, the holder unit 40 is used for a NOTES procedure in which a procedure is performed via the vagina or anus. It is good also as a structure like the simple holder unit 40a. The holder unit 40a uses a pant-shaped mounting portion 48 as a mounting portion. The mounting portion 48 is formed using a knit material used for ordinary clothes.

  In FIG. 8, the holder unit 40a has a cylindrical portion 42 having the same configuration as that of the above embodiment, and the shape of the flange portion 41a is different from that of the flange portion 41 of the above embodiment. Specifically, the flange portion 41a is curved along the shape of the mounting portion 48, and the belt fixing portion 43 as in the above embodiment is not provided. Since the other structure of the holder unit 40a is the same as the holder unit 40 of the said embodiment, the same code | symbol is attached | subjected to the same structure and detailed description is abbreviate | omitted.

  The holder unit 40a having this configuration is easy to be attached to the patient because the attachment portion 48 is in a pant shape, and the flange portion 41a and the cylindrical portion 42 can be reliably positioned with respect to the patient.

  In the holder units 40 and 40a, when the overtube 20 is of the type shown in FIG. 7a or 7b, the groove 42a shown in FIG. 4 can be omitted.

  As described above, the endoscope auxiliary tool of the present invention is an auxiliary tool that can be used in various procedures such as EMR, ESD, or NOTES. In the above embodiment, in the NOTES procedure, the transvaginal NOTES procedure has been described as an example. However, the procedure is to widen the incision provided on the surface of the body cavity or to provide the incision on the surface of the body cavity. If the procedure is performed with an instrument formed in a straight line, the body cavity may be used for procedures such as the esophagus, rectum, and urethra.

DESCRIPTION OF SYMBOLS 1 ... Endoscope auxiliary tool, 20 ... Overtube, 30 ... Inner cylinder, 31a ... Internal channel | path, 32 ... Tip part, 50 ... Deaeration prevention unit, 60 ... Endoscope, 61 ... Objective lens.

Claims (4)

An inner cylinder having an internal passage through which an endoscope having an objective lens at the distal end can be inserted, and an overtube through which the inner cylinder can be inserted, are used when the endoscope is used in the body through a body cavity. An auxiliary tool,
Holding means for holding the overtube held on the surface of the patient's body cavity or body surface incision,
The holding means has a cylindrical portion through which the overtube is inserted, and an attachment portion that is attached to a patient and holds the cylindrical portion,
The inner peripheral surface of the tubular portion, endoscopic aid, wherein the overtube allows the retention against the said inner peripheral surface of the expansion deflatable balloon is provided. An auxiliary tool used when the endoscope is used in the body through a body cavity,
An inner cylinder having an internal passage through which an endoscope having an objective lens at the tip can be inserted, and an overtube through which the inner cylinder can be inserted,
The overtube and the inner cylinder are formed of flexible synthetic resin,
At the tip of the inner cylinder, the tip shape is formed in a tapered shape, at least the front part of the objective lens is formed transparently, and a tip portion is provided that is formed so that the outside can be visually observed by the objective lens,
When the inner cylinder is inserted into the overtube, the tip portion protrudes from the tip of the overtube and the rear end of the inner cylinder protrudes from the rear end of the overtube,
The overtube is provided with an auxiliary passage capable of supplying at least gas into the body along the axial direction thereof,
Holding means for holding the overtube held on the surface of the patient's body cavity or body surface incision,
The holding means has a cylindrical portion through which the overtube is inserted, and an attachment portion that is attached to a patient and holds the cylindrical portion,
The inner peripheral surface of the tubular portion, endoscopic aid, wherein the overtube allows the retention against the said inner peripheral surface of the expansion deflatable balloon is provided. The endoscopic auxiliary tool is an auxiliary tool for performing a procedure via the vagina or anus,
The attachment part is made of cloth and is formed in a pants shape, and the cylindrical part is attached to the attachment part so that the attachment part is disposed at a front position of the vagina or anus when the attachment part is attached to a patient. The endoscope auxiliary tool according to claim 2 . An inner cylinder having an internal passage through which an endoscope having an objective lens at the distal end can be inserted, and an overtube through which the inner cylinder can be inserted, are used when the endoscope is used in the body through a body cavity. An auxiliary tool,
A deaeration prevention valve unit detachably attached to the rear end of the overtube;
The deaeration prevention valve unit is tapered toward the direction of travel of the endoscope, has a pair of inclined surfaces with a ridge line at the tip, and has a slit provided along the ridge line. When,
A pair provided inside the valve body and tapered toward the advancing direction of the endoscope in a side view along the shape of the inclined surface so as to suppress deformation of the valve body side walls on both ends of the slit. An endoscopic auxiliary tool comprising: a cylindrical restraining member having a mountain-shaped protrusion .

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