JP6997985B2 - Endoscopic snare - Google Patents

Description

The present invention relates to an endoscopic snare that is inserted into the body through a forceps channel of an endoscope and captures and excises tissues such as polyps with a wire formed in a loop shape.

The endoscope snare used to remove the polyp by inserting it into the forceps channel of the endoscope has a loop-shaped wire extending at the tip of the operation wire (cable) inserted into the sheath. By moving the cable forward and backward from the side, the wire moves back and forth from the tip of the sheath, and the wire protruding from the sheath expands in a loop shape by self-elastic force, catching the polyp in this loop, and looping. The polyp is excised by high-frequency ablation while closing the wire. The wire is closed and housed in a sheath having a small diameter, and is shaped so as to expand at the time of protrusion. It is formed as a polygon.

Since the vertical tendency of the loop is such that the wire is gradually extruded, the shorter the extruded length (protruding length), the more remarkable it is. There was a problem that the operability was not good especially for small polyps, such as the need to increase the extrusion length in order to secure a wide width.

On the other hand, when the wire is projected from the sheath to form a loop, even a small loop in the initial stage of protrusion can be easily and stably captured even with a small polyp by forming a wide annular ring. A snare for an endoscope has been proposed. (Patent Document 1) In this snare, one end of one wire is provided at the tip of the sheath without providing a protrusion formed by bending the wire at the tip of a loop provided in a conventional general snare. It is attached to the tip of the tip and the other end is connected to the tip of the cable that slides in the sheath. It is configured to be expanded.

Japanese Unexamined Patent Publication No. 2017-136188

According to the endoscopic snare of the above configuration, the loop formed by the wire does not become an ellipse long in the axial direction even in the initial stage of protrusion, but exhibits an annular shape having a width that is easy for the polyp to catch. As expected, the shape retention at the loop formation stage is unstable because there is no special machined part on the wire, and in particular, the wire is twisted and the loop is inverted at the initial stage of wire protrusion, and the position of the loop is expected. There remains a problem that it is difficult to expand the loop shape at a stable position such as changing the direction.

Therefore, according to the present invention, in an endoscopic snare that excises a tissue such as a polyp via an endoscope, the loop shape is circular regardless of the size of the loop when the wire is projected from the sheath to be expanded and closed. The challenge is to provide an endoscope snare that can be held in an annular shape, the wire will not be twisted even in the initial stage of wire protrusion, and the loop can be expanded and contracted in an annular shape at a stable position and orientation at all times. did.

The endoscope snare of the present invention includes a flexible sheath, two parallel cables sliding in the sheath, and an elastic wire connecting both ends to each of the distal ends of the two cables. It is composed of a hand operation unit that operates a wire via a cable, and the operation of the hand operation unit causes the wire to move in and out of the sheath and the loop to be expanded or contracted by the wire. Then, the wire on which the loop is formed has a predetermined position in the vicinity of the sheath tip when the loop is formed and in the region near the proximal end of the wire extending from the connection portion with the cable on one side. Two bends, one on the distal side and one on the proximal side, are habituated at intervals, of which the bends habituated on the proximal side are approximately perpendicular to the outward direction of the loop to be formed. It is formed by bending. Further , the hand operation portion is provided with a first sliding means for sliding parallel cables together to move the wire out of the sheath , and a bent portion in a region near the proximal end of the wire extending from the connection portion with the cable. A second sliding means is provided to slide only the cable to which the end of the wire on the side not connected is connected to expand or contract the loop by the wire.

Further, it is preferable that each part is configured or formed as follows.
The distal bent portion habituated to the wire is set at a position that becomes the tip of the wire when projected from the sheath by the first sliding means.
The slide width of the first sliding means is set to be slightly longer than the length between the bent portions on the distal side and the proximal side.
-The wire is formed of a stranded metal wire, and the surface is blasted as necessary.
-The wire may be formed of a superelastic alloy, and the cross section at that time may be formed into a triangular shape.
-The distal bent portion habituated to the wire is formed as an outward protrusion of the loop to be formed .
The hand operation unit constitutes the first slide means for connecting the operation unit main body to which the sheath is connected and the wire end on the side where the bent portion is formed in the region near the proximal end of the wire via a cable. The first slider is provided, and the second slider constituting the second sliding means for connecting to the wire end on the side where the bent portion is not provided in the region near the proximal end of the wire via a cable is provided. The slider is set with the specified movable range as the slide range with the main body of the operation unit as the axis.
-The first slider is urged to the distal side of the slide range of the slider by an elastic member.
-Any of the first slider and the proximal end of the main body of the operation unit, and the second slider are provided with an operation ring for operation by fingers.

(Action)
According to the endoscopic snare of the means, when the wire is projected from the sheath to form a loop, the two bends of the wire are made by the first slide means prior to expanding the loop by the second slide means. By projecting from the sheath, the two bent portions are at the base end portion on one side of the wire at the stage where the wire on the side without the bent portion is projected by the second sliding means to form and expand the loop. By stably holding the position and direction of the wire, the entire ring-shaped loop formed can also be stably maintained, and the twisting of the wire seen in the initial stage of conventional loop formation is prevented, resulting in a stable circle. The loop diameter can be expanded or contracted while maintaining the ring shape.

Further, by making the protruding tip of the wire by the first sliding means a bent portion on the distal side, the bent portion also serves as a tip when the bent portion is housed in the sheath, and the slide for storing or protruding. Can be made smooth. In addition, the slide width of the first sliding means is set to be slightly longer than the distance between the bent portions on the distal side and the proximal side, so that the base end portion of the loop formed (proximal protrusion on one side of the wire) is formed. The end portion) becomes a bent portion on the proximal side, and it is easy to maintain the loop shape formed by retaining the shape at the proximal end portion (proximal end portion) as described above.

Further, by using a stranded wire or a superelastic alloy for the wire, it is possible to deform the shape into a loop without giving an unintended bending habit, and it is possible to easily form a bent portion. Then, by blasting the stranded wire and making the cross section of the superelastic alloy triangular, it is possible to hold the polyp securely while preventing slipping.

In addition, by forming the bent portion on the distal side of the wire as a protrusion, the bending of the wire at the protruding portion is suppressed, and a more stable loop-shaped shape retention is expected, and the wire is simply bent at a right angle or the like. Compared to the case, both sides of the portion are opened at a wider angle (more linearly), so that the wire forms a loop that is closer to an annular shape.

Further, by urging the first slider to the distal side of the slide range by the elastic member, the operation of the first slider to the distal side is not necessary because the operation to the distal side is naturally performed by the urging of the elastic member. The operation to the proximal side can be integrated with the operation of the second slider provided on the distal side of the first slider, and even if two sliding means are provided, one-handed operation is possible. .. Further, by providing the operation ring at a predetermined position, stable operation with three or four fingers becomes possible.

According to the means and actions of the present invention, when the wire is projected from the sheath to be expanded and closed, the loop shape can be maintained in an annular shape regardless of the size of the loop, and it is an initial stage of wire protrusion. To provide an endoscopic snare that enables easy and stable capture of various sizes, especially small polyps, by allowing the loop to expand and contract in a stable position without twisting the wire. Can be done.

An overall configuration diagram showing an endoscopic snare according to the first embodiment of the present invention, in which the maximum loop is formed. The enlarged view which shows the internal structure of the wire and the tip part of the said form. The enlarged view which shows the internal structure of the hand operation part of the said form. The side view from the opening side of the hand operation part. The whole block diagram which shows the state which the 1st slide means is arranged in the distal end in the initial state of the said form, and the bent part of a wire protrudes from a sheath. An enlarged view showing a wire portion in a state where the bent portion of the wire is projected. The whole block diagram which shows the state which the whole wire is housed in the sheath of the said form. An enlarged view showing an internal configuration of a tip portion in a state where the wire is housed. The whole block diagram which shows the state which the wire formed a loop by sliding the 2nd slide means of the said form halfway. It is an overall block diagram which shows the snare for an endoscope of the 2nd Embodiment of this invention, and the state which the whole wire is housed in the sheath. The whole block diagram which shows the state which the wire of the said form formed the maximum loop. The enlarged view which shows the internal structure of the wire and the tip part of the said form.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is an overall configuration diagram showing an endoscope snare of the present embodiment, showing a state in which a wire forms a maximum loop, FIG. 2 shows the wire and the tip portion thereof, and FIGS. 3 and 4 show the wire and the tip portion thereof. The hand operation unit is shown, FIG. 3 shows a front view showing an internal configuration, and FIG. 4 shows a side view from the opening side. The hand operation unit shows the state where the second sliding means is slid halfway so that the overall configuration can be easily understood, and the elastic member (spring) is drawn with a hidden line (dotted line) for easy understanding. It is shown by a solid line.

The endoscope snare of this embodiment includes a flexible and long sheath 1 having a diameter and a length that can be inserted into the forceps channel of the endoscope.
Two cables 21 and a second cable 22 arranged in the sheath 1 and sliding in parallel with the sheath 1 in the axial direction, and a second cable 22
A wire 3 forming a series of loops connecting both ends of the first and second cables 21 and 22 via connection tips 23 and 24, and a wire 3
The hand operation unit 4 is configured to move the wire 3 out of the sheath 1 and to form and expand / contract the loop via the cables 21 and 22.

The sheath 1 is made of, for example, polypropylene or fluororesin, which is relatively hard even if it is flexible and has low axial stretchability and surface frictional resistance in consideration of insertion into the forceps channel and operability of the snare. It is sufficient to select an outer cylinder tube made of such a resin and having a size suitable for the forceps channel of the endoscope. In this example, the outer diameter 2 that can be reasonably used for a general forceps channel. A fluororesin tube having a length of 1.6 mm and a length of 1600 mm (effective length) was used. The proximal end of the sheath 1 is connected to the tip of the hand operating portion 4 by the sheath base 42.

Two cables 21 and 22 are provided in parallel in the sheath 1, have appropriate flexibility and rigidity in consideration of operability in the forceps channel, have low axial stretchability, and further. It is formed from a metal stranded wire formed by twisting a plurality of metal wires such as stainless steel so as to have a followability capable of reliably transmitting the operation by hand operation to the tip. Its size is formed to fit the sheath 1 and have an outer diameter (0.6 mm in this example) in which two of the sheath lumens slide comfortably.

Then, the wire ends 31 and 32 are connected to the respective distal ends, but the first cable 21 and the bent portion 33 connected to the end on the side having the bent portions 33 and 34 of the wire described later. The second cable 22 connected to the end on the side without the, 34 is connected via the connection chips 23 and 24, respectively. On the other hand, at the proximal end, the first cable 21 is attached to the first slider 5 which is the first sliding means of the hand operation unit 4, which will be described later, and the second cable 22 is the second sliding means which is the second sliding means. It is connected to the slider 6, but the base portion of each is energized to prevent buckling of the sheath 1 and wire 3 and to cover the first and second cables 21 and 22 for smooth sliding operation. Reinforcing pipes 25 and 26 are provided, and their proximal ends are connected to cable connection portions 71 and 81 provided on the first and second sliders 5 and 6.

The wire 3 is a stranded wire obtained by twisting a plurality of fine metal wires such as stainless steel having a smaller diameter than the cables 21 and 22, or a loop shape developed in a naturally state, for example, a Ni—Ti alloy. It is made of a conductive metal wire that is not easily crushed or bent due to aging even if it is housed in a small diameter sheath 1, such as a superelastic alloy such as, and when it protrudes from the sheath 1, it expands naturally. It is formed as an annular shape. In addition, if the wire 3 formed of stranded wire is blasted as needed, or if the cross section of the wire formed of superelastic alloy is triangular, it will not slip easily when the polyp is captured. can do. In this example, a metal stranded wire formed by twisting seven 0.1 mm fine stainless steel wires, which are less likely to change in shape, was used.

Further, when the wire 3 is provided with a predetermined distance from the wire end 31 on the side connected to the first cable 21, that is, when the first cable 21 is slid to the distal end. A second bent portion 34 obtained by bending the wire 3 at a substantially right angle is provided at a position slightly protruding from the sheath 1, and a predetermined interval (7 mm in this example) is provided on the distal side of the second bent portion 34. The loop is located at the provided position, that is, at the position where the tip of the wire 3 is projected from the sheath 1 (see FIGS. 5 and 6) when the first cable 21 is slid to the distal end. A spire-shaped protrusion (first bent portion) 33 protruding outward is formed by habituation.

Then, as described above, the wire end portion 31 on the side provided with the first and second bent portions 33, 34 is connected to the first cable 21 extended to the first slide means via the connection tip 23. , The wire end portion 32 on the side where the first and second bent portions 33 and 34 are not provided is connected to the second cable 22 extended to the second slide means via the connection tip 24. ..

The hand operation unit 4 has an operation unit main body 41 provided with a sheath base 42 connecting the sheath 1 to the distal end and an end cap 43 having a gripping ring 44 at the proximal end, and the operation unit main body 41 as an axis in the front-rear direction. A first slider 5 that is a first sliding means to which the first cable 21 (reinforcing pipe 25) is connected, and a second cable 22 that is arranged distal to the first slider 5. It is composed of a second slider 6 which is a second sliding means connected to the (reinforcing pipe 26).

The operation unit main body 41 is a tubular body having a slide length capable of covering the length of the wire 3 protruding from the sheath 1, and holds the sheath base 42 on the distal side and the spring 52 described later on the proximal side as described above. The end cap 43 to be slid and the grip ring 43 to be the operation grip portion for inserting the thumb mainly when the sliding means is slid are provided. Then, in this example, the intermediate portion (the portion excluding the sheath base 42 and the end cap 43) of the tubular body is formed as a quadrangular tubular slide area, and one surface thereof is used as an opening surface to form an internal structure such as a wire. It was used as a connecting surface with the part. Further, a stopper 45 for restricting the slide of the first slider 5 to the distal side is formed as a protrusion on the inner surface at a predetermined position on the inner surface of the slide area. The structure of the opening surface may be a slit or the like provided relative to the main body of the operation unit depending on the structure of the sliding means or the like.

The first slider 5 is provided on the proximal side of the slide area of the operation unit main body 41, and slides a length that allows the first and second bent portions 33 and 34 of the wire 3 to move back and forth from the sheath 1. As a range, it can be moved back and forth around the operation unit main body 4 (slide width 10 mm in this example). Then, when the first slider 5 abuts on the stopper 45 and is located on the distal side of the slide range, the first and second bent portions 33 and 34 of the wire 3 protrude from the sheath 1 and are close to each other. When located on the position side, the entire wire 3 including the bent portions 33 and 34 is housed in the sheath 1. A metal connection rod 7 for connecting to the proximal end of the first cable 21 (reinforcing vibe 25) inside the operation unit main body 4 is inserted into the first slider 5 in this embodiment from the side surface. The cable connection portion 71 is connected and fixed to the first cable 21 by brazing or the like.

Further, an end cap 43 which is a proximal end of the operation unit main body 4 is provided on the proximal side of the first slider 5, and the first slider 5 is far from the inside of the end cap 43. A spring 52 for urging the position side is provided, and in a natural state (a state in which the spring is extended), the first slider 5 is held on the distal side of the slide range, and the bent portions 33 and 34 of the wire 3 are held. Is held in a state of protruding from the sheath 1. In this way, by urging the first slider 5 to the distal side by the spring 52, it is possible to slide in the distal direction without providing a grip portion on the first slider 5, and the first slider 5 can be slid in the distal direction. Using the slide to the proximal side of the second slider 6, the first slider 5 can be simultaneously slid to the proximal side while compressing the spring 52. As a result, even if two first and second sliders 5 and 6 are provided separately, one-handed operation is possible.

The second slider 6 is provided on the distal side of the first slider 5 in the slide area of the operation unit main body 41, and the range in which the entire loop forming portion of the wire 3 moves out of the sheath 1 is set as the slide range of the operation unit main body 41. Is movable back and forth around the axis (slide width 100 mm in this example). Then, when the second slider 6 is located on the proximal side of the slide range in which the spring 52 is compressed together with the first slider 5, the entire wire 3 is housed in the sheath 1, and from this state, the second slider When 6 is slid to the distal side, the side of the wire 3 not provided with the bent portions 33 and 34 protrudes from the sheath 1 via the second cable 22 and the loop is expanded. The second slider 6 of the present embodiment is used to connect to the proximal end of the second cable 22 (reinforcing pipe 26) inside the operation unit main body 4 and to energize the wire 3 at the tip. A connection lot 8 of a conductive metal for serving as a terminal connection portion of the high frequency generator is inserted and provided from the side surface, and is connected and fixed to the second cable 22 by brazing or the like at the cable connection portion 81. On the other hand, the protrusion from the side surface of the second slider 6 of the connection lot 8 to the outside serves as a connection portion with the terminal of the high frequency generator.

Further, the second slider 6 is provided with a slide ring 61 facing each other in a wing shape, and serves as an operation grip portion for mainly inserting the index finger and the middle finger or the middle finger and the ring finger during the slide operation.

Next, the operation and operation of the endoscope snare of the present embodiment will be described.
FIG. 5 shows an initial state before the snare operation of the present embodiment, and shows a state before forming a loop in which the sheath to the bent portion of the wire are projected, and FIG. 6 shows a protruding wire portion in that state. The enlarged view of is shown.
The hand operation unit 4 in the initial state before the operation is positioned in a state where the first slider 5 is pressed toward the distal side of the slide range of the slider 5 by the urging of the spring 52, and the second slider 6 is the slider. In this example, the first and second sliders 5 and 6 are located on the proximal side of the slide range of 6 and closer to the distal side from the proximal end by the amount of the slide by the first slider 5. Positioned in contact.

At this time, the wire 3 on the tip side of the snare is projected from the sheath 1 by the amount of sliding to the distal side of the first and second sliders 5 and 6, and as described above, this sliding amount is the first. Since the length up to the second bent portions 33 and 34 protrudes from the sheath 1, the length up to the second bent portion 34 protrudes from the sheath 1. Since the second slider 6 is also slid to the distal side by the same length as the first slider 5, the side of the wire 3 not provided with the bent portion is also projected by the same length at the same time. At this time, the first bent portion (projection) 33 is set to be the protruding tip portion of the wire 3.

FIG. 7 shows a state in which the entire wire of the snare of the present embodiment is housed in the sheath, and FIG. 8 shows an enlarged view of the internal structure of the tip portion thereof.
By sliding the first and second sliders 5 and 6 to the proximal end of the slide range from the initial state, the entire protruding wire 3 is accommodated in the sheath 1. In the operation from the initial state, the grip ring 43 provided at the proximal end of the operation unit main body 41 and the slide ring 61 provided on the second slider 6 are gripped by fingers, relatively close to each other, and the spring 52 is compressed and slid. At this time, since the same length of the first and second sliders 5 and 6 is slid backward and both ends of the wire 3 are retracted by the same amount, the first bent portion 33 becomes the tip portion of the wire 3 and the sheath is formed even in this state. It is in a form that is easy to accommodate in 1.
Then, the wire 3 is inserted into the forceps hole of the endoscope while maintaining the state of being housed in the sheath 1.

FIG. 9 shows a state in which the second sliding means of the above-described embodiment is slid to the middle of the sliding range to form a loop of wires.
When the wire 3 is projected from the state where all of the wire 3 is housed in the sheath 1, the grip ring 44 and the slide ring 61 are gripped by fingers, and the second slider 6 is distal to the operation unit main body 4. Although it slides to the side, both sides of the wire 3 protrude at the same time until the first slider 5 reaches the distal end of the slide range, and the bent portions 33 and 34 protrude (see FIGS. 5 and 6). After that, only the second slider 6 slides, and only the side of the wire 3 where the bent portions 33 and 34 are not provided is projected to form an annular loop, and the loop formed by the length of the slide. The diameter is scaled. The maximum loop (see FIGS. 1 and 2) is then formed when the second slider 6 is located at the distal end of the slide range.

Next, the method of using the snare of this embodiment will be described according to the procedure.
1. 1. An electrode extending from the high frequency generator is connected to a terminal connection portion of a connection rod 8 provided on the second slider 6.
2. 2. The grip ring 43 is gripped with the thumb and the slide ring 61 with the index finger and the middle finger or the middle finger and the ring finger, and the grip ring 43 is compressed against the elastic force of the spring 52. Positioned at the proximal end of the slide area, the sheath 1 is inserted into the forceps hole of the endoscope with the wire 3 completely contained in the sheath 1.
3. 3. After inserting the tip of the sheath 1 into the body, when the force of the grip is released and the spring 52 is in the natural state, the first slider 5 naturally moves to the distal side of the slide range, and the wire 3 bends from the sheath 1. The portions 33 and 34 are in a protruding state.
4. From this state, slide the second slider 6 to the distal side of the slide range and expand it to a loop that matches the size of the polyp to be excised.
5. The polyp is captured in the loop, and while energizing a high frequency, the second slider 6 is slid toward the proximal side of the slide range to contract the loop of the wire 3 to excise the polyp.

10 to 12 show an endoscopic snare according to a second embodiment of the present invention, FIG. 10 shows a state in which the entire wire is housed in a sheath, and FIG. 11 shows a loop in which the wire has the maximum loop. The overall configuration of the formed state is shown, and FIG. 12 shows an enlarged view of the loop-formed wire portion.
Since the snare of this embodiment has the same basic configuration and functions of each part as the snare of the first embodiment described above, the snares of the present embodiment are briefly described except for the differences from the above-described embodiment.

The snare of this embodiment is the same as that of the first embodiment, the sheath 100, the first and second cables 210 and 220 provided in parallel in the sheath, and the connection tip 230 at the distal end of the cables 210 and 220. , A wire 300 connecting both ends 310 and 320 via 240, and a hand operation unit 400 for operating the exit and exit of the wire 300 from the sheath 100 and loop formation via the cables 210 and 220. .. The sheath 100 and the cables 210 and 220 are formed in the same manner as described above, and only the shape of the first bent portion 330 of the wire 300 and the hand operating portion 400 are different.

The bent portions 330 and 340 of the wire 300 of this example have the same positions as those in which the bent portions 330 and 340 are set, exit from the sheath 100, and have a loop forming function, but are the same as those in the first embodiment. One bent portion 330 is not the protrusion 33 of the above-mentioned form, but the first and second bent portions 330 and 340 are formed by bending the wire 300 at a substantially right angle, and the first and second bent portions 330 and 340 are formed. The second bent portion 340 is bent outward and the first bent portion 330 is bent inward with respect to the loop to be formed. The structure of the bent portions 330 and 340 is expected to have a weaker annular loop shape holding force due to habituation as compared with the case where the protrusion 33 is formed, and the vertical and horizontal directions of the formed annular loop. Although the ratio may be vertically long, there is an advantage that the second bent portion 340 can be easily formed.

The hand operation unit 400 of this example includes an operation unit main body 410 having a long tubular shape and forming a slide area by sliders 500 and 600, and a sheath base 420 connecting a sheath 1 provided on the distal side of the operation unit main body 410. , The end cap 430 which is the proximal end of the slide provided on the proximal side, and the first and second sliders 500 and 600, and the sheath 100 and the cables 210 and 220 are the same as in the first form. However, unlike the previous form, the first slider 5 is not operated in conjunction with the operation of the second slider 6, but the first slider 500 and the second slider 600 are slid independently. The first and second slide rings 510 and 610 that are operated and are formed into a wing shape that is mainly used by inserting the indicator finger and the middle finger or the middle finger and the ring finger, which are gripping parts for the slide operation, are attached to the sliders 500 and 600, respectively. It was provided and configured.

Then, the slide range of the first slider 500 is set to a length from the state where the wire 300 is housed in the sheath 100 (see FIG. 10) to the state where the bent portions 330 and 340 protrude from the sheath 100. The proximal side of the slide range is set to the position where it abuts on the end cap 430 which is the proximal end of the operation unit main body 410, and the stopper 450 for stopping the slide of the first slider 500 is provided at the position on the distal side. Formed.

The second slider 600 is set to the distal side of the first slider 500 and its slide range abuts on the proximal side to the first slider 500 when the first slider 500 is at the proximal end. The position (see FIG. 10) was set, and the distal side was set as the position (see FIG. 11) in contact with the sheath base 420, which is the distal end of the main body 410 of the hand operation unit.

In the endoscope snare of this embodiment, when the first and second sliders 500 and 600 are located on the proximal end side of the operation unit main body 410, the wire 300 is entirely housed in the sheath 100. When the operation of the first slider 500 slides to the distal side of the slide range, the second slider 600 is also slid forward by the same length with a stopper 440 at the distal end of the slide range of the first slider 500. When stopped, up to the second bent portion 340 of the wire 100 protrudes from the sheath 100. At that time, the first bent portion 330 is set to be the tip end portion of the sheath 100.

When the second slider 600 is slid to the distal side while the first slider 500 is held to the distal side from the state where only the bent portion 330 and the 340 portion are projected, the bent portion 330 of the wire 300, The wire 300 on the side where the 340 is not provided is projected, and a loop having a size corresponding to the length of the slide is formed in the slide range of the second slider 600.

In the snare of this embodiment, slide rings 510 and 610 for slide operation are provided on the sliders 500 and 600, respectively, and it is necessary to replace the fingers with the slide rings 510 and 610 when sliding each of them. As a result, the operability is slightly inferior to that of the first embodiment, and one-handed operation becomes difficult. However, as in the above-described embodiment, the instrument configuration can be simplified such that the spring 52 is not used. .. It should be noted that the procedure of the usage method of this embodiment may be carried out in the same manner as the above-described embodiment except for the sliding method of the sliding means.

1.100. Sheath 21.210. First cable 22.220. Second cable 23.24.230.240. Connection chip 25.26. Reinforcing pipe 3.300. Wire 31.32.310.320. (Wire) End 33.330. First bent part (protrusion)
34.340. Second bent part 4.400. Hand operation unit 41.410. Operation unit body 42.420. Sheath group 43.430. End cap 44. Grip ring 45.450. Stopper 5.500. First slider 510. First slide ring 52. Spring 6.600. Second slider 61.610. (Second) slide ring 7.8. Connection lot 71.81. Cable connection

Claims (11)

With a flexible sheath,
Two parallel cables sliding in the sheath,
An elastic wire that connects both ends to the distal ends of each of the two cables and forms a loop as it exits and exits the sheath and protrudes.
It consists of a hand-operated unit that controls the entry and exit of the wire and the expansion and contraction of the loop via the cable.
The wire is located near the tip of the sheath when the wire forms a loop, and is distal to the wire in a region near the proximal end of the wire extending from the connection with the cable on one side. The two bends on the side and the proximal side are habituated and formed.
The bent portion habituated to the proximal side is formed by bending at a substantially right angle in the outward direction of the loop to be formed.
The first sliding means for sliding parallel cables together on the hand operation unit,
A second sliding means for sliding only the cable to which the wire end portion on the side not provided with the bent portion is connected is provided in the region near the wire proximal end extending from the connection portion with the cable. Snare for endoscopes. The endoscope snare according to claim 1, wherein when the wire is projected from the sheath by the first sliding means, the bent portion on the distal side provided in the wire is set at a position where it becomes the tip end portion of the wire. The endoscope snare according to claim 1 or 2, wherein the slide width of the first sliding means is set to be slightly longer than the distance between the bent portions on the distal side and the proximal side. The endoscope snare according to any one of claims 1 to 3, wherein the elastic wire is formed of a metal stranded wire. The wire made of the metal stranded wire is a blasted 4 endoscope snare. The endoscope snare according to any one of claims 1 to 3, wherein the wire is made of a superelastic alloy. The endoscope snare according to claim 6, wherein the wire made of the superelastic alloy has a triangular cross section. The endoscopic snare according to any one of claims 1 to 7, wherein the distal bent portion habituated to the wire is formed as an outward protrusion of the loop to be formed. The hand operation unit includes an operation unit body to which the sheath is connected and the operation unit body.
A first slider constituting the first sliding means, which is connected to the wire end on the side where the bent portion is formed in the region near the proximal end of the wire via a cable.
A second slider constituting a second sliding means for connecting to the wire end on the side where the bent portion is not provided in the region near the proximal end of the wire via a cable is provided.
Each slider is a snare for an endoscope according to any one of claims 1 to 8 , wherein a specified range of motion is set as a slide range with the operation unit main body as an axis. The endoscope snare according to claim 9 , wherein the first slider is urged to the distal side of the slide range by an elastic member. The endoscopic snare according to any one of claims 9 to 10 , wherein either the first slider or the proximal end of the operation unit body, and the second slider is provided with an operation ring for finger operation.

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