JP7535690B2 - Medical Traction Device - Google Patents

Description

The present invention relates to a medical traction device for traction of lesions, etc., mainly during treatment using an endoscope.

Conventionally, there are two known techniques for using an endoscope to remove diseased areas of the esophagus, stomach, large intestine, etc.: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Of these, EMR is a technique in which the diseased area is constricted with a metal snare and then removed by passing a high-frequency current through it. ESD is a technique in which an incision is first made around the diseased area with a high-frequency knife or the like, and then the submucosal layer below the diseased area is dissected to remove the diseased area.

Although EMR can be completed in a relatively short time, the size of the lesion that can be resected is limited by the size of the snare. Therefore, ESD is used when the lesion is relatively widespread, but when the submucosal layer is dissected over a wide area, the resected lesion may block the endoscopic field of view during the dissection. For this reason, in recent years, a method has been used in which the resected lesion is grasped with a hemostatic clip or the like, and the clip is pulled from outside the patient's body to lift the resected lesion and ensure the endoscopic field of view.

There are various methods for traction of clips, but a simple method is to attach a weight to a string or thread of an appropriate length tied to the clip and hang this weight outside the patient's body to perform traction (the Sinker system method) (see, for example, Non-Patent Document 1).

Naoto Sakamoto and 6 others, "A new traction method for colonic endoscopic submucosal dissection", Journal of the Japanese Society of Gastroenterological Endoscopy, Japan Gastroenterological Endoscopy Society, July 20, 2017, Vol. 59, No. 7, pp. 1514-1523

However, for the method using weights, since no dedicated thread or weights are available, it is performed by connecting an appropriate pair of forceps to the silk thread as a weight. This means that it is necessary to cut the silk thread to the appropriate length during the procedure and tie it to the clip, or to clamp the affected area with a clip and then clamp the silk thread with forceps to use as a weight, which is a problem in that it is time-consuming despite being a simple method.

In view of the above circumstances, the present invention aims to provide a medical traction device that can easily perform traction of lesions, etc.

The medical traction device of the present invention comprises a string-like member having a tip side connected to a clip that grasps an object to be grasped, a rotating member having a base end side of the string-like member wound around a predetermined rotation center, and a holding member that holds the rotating member and has an insertion hole through which a portion of the string-like member extending from the rotating member is inserted so as to be able to advance and retreat, wherein the holding member has a first holding portion that is configured to freely move the rotating member in a direction approaching and moving away from the insertion hole and holds the rotating member non-rotatably around the rotation center relative to the holding member, and a second holding portion that is provided on an extension of the moving direction in which the rotating member moves away from the insertion hole in the first holding portion and holds the rotating member rotatably around the rotation center relative to the holding member, and wherein the rotating member is configured to be freely moveable between the first holding portion and the second holding portion.

According to the medical traction device of the present invention, preparation for traction of the lesion, etc. is completed simply by connecting the tip end of the string-like member to the clip, positioning the rotating member in the second holding part, unwinding the string-like member to an appropriate length, and then positioning the rotating member in the first holding part. After that, the lesion, etc. can be tractioned simply by gripping the lesion, etc. with the clip and then hanging the holding member and rotating member as weights. In other words, the lesion, etc. can be tractioned very easily.

In the medical traction device of the present invention, it is preferable that the string-like member has a loop-shaped connection portion formed by connecting its own tip portion at a portion closer to the base end than the tip portion so as to be freely movable along the string-like member.

As a result, after the connection portion is hooked onto the clip, the loop of the connection portion can be reduced and fastened to the clip simply by moving the rotating member in the first holding portion in a direction away from the insertion hole, so that the string-like member can be easily and reliably connected to the clip.

This allows the operation of fastening the connection part to the clip and the operation of making the rotating member rotatable (i.e., the operation of making the string-like member capable of being unwound) to be performed consecutively in a single operation, making it possible to easily and quickly prepare for traction of the affected area, etc.

In addition, in the medical traction device of the present invention, it is preferable that the rotating member has a pair of extending portions that extend in different centrifugal directions from the center of rotation, and the first holding portion is configured to hold the rotating member with the extending portions extending in a direction intersecting the moving direction of the rotating member.

This allows the operation of fastening the connection part to the clip and the operation of making the rotating member rotatable to be performed by placing two fingers on the rotating member, making it easy and quick to prepare for traction of the affected area, etc.

In addition, in the medical traction device of the present invention, the holding member has a tubular portion in which the insertion hole is provided and a pair of arm-like portions extending from the tubular portion, the rotating member has a pair of protrusions that protrude in opposite directions along the rotation center and is disposed between the pair of arm-like portions, the first holding portion is formed of an elongated hole or groove provided in each of the pair of arm-like portions and accommodating at least a part of the protrusion, the second holding portion is formed of a circular hole or a recess having an inner surface that is circumferential about the rotation center and that is provided in each of the pair of arm-like portions so as to be continuous with the elongated hole and accommodating at least a part of the protrusion, and the protrusion is formed in a shape whose cross-sectional shape with respect to the rotation center has a longitudinal direction, and it is preferable that the longitudinal dimension of the cross-sectional shape of the protrusion is greater than the width of the elongated hole or groove that constitutes the first holding portion and smaller than the inner diameter of the circular hole or recess that constitutes the second holding portion.

This allows the holding member and the rotating member to be integrally molded, for example from resin, and the arm-shaped portion to be elastically deformed so that the rotating member can be attached to the holding member, thereby increasing the productivity of the medical traction device and reducing production costs.

The medical traction device of the present invention has the excellent effect of making it possible to easily perform traction of lesions, etc.

FIG. 1 is a front view of a medical traction tool according to an embodiment of the present invention. 1A is a left side view of the medical traction tool 1. FIG. 1B is a cross-sectional view taken along line II in FIG. 1A is a front view of the rotating member, and FIG. 1A to 1C are schematic diagrams showing an example of a method of using the medical traction device. 1A and 1B are schematic diagrams showing an example of a method of using a medical traction device. 1A and 1B are schematic diagrams showing an example of a method of using a medical traction device. FIG. 13 is a front view showing a modified example of the medical traction tool.

Hereinafter, an embodiment of the present invention will be described with reference to the attached drawings. FIG. 1 is a front view of a medical traction tool 1 according to one embodiment of the present invention. FIG. 2A is a left side view of the medical traction tool 1, and FIG. 2B is a cross-sectional view taken along line I-I in FIG. 1. As shown in these drawings, the medical traction tool 1 includes a string-like member 10 whose tip side is connected to a clip for grasping a lesion or the like, a rotating member 20 around which the base end side of the string-like member 10 is wound, and a holding member 30 through which the tip side of the string-like member 10 is inserted and which holds the rotating member 20. In other words, the medical traction tool 1 is designed so that the rotating member 20 and the holding member 30 function as a weight suspended outside the body of a living body undergoing treatment such as ESD.

The string-like member 10 is made of a thread of an appropriate thickness. The material of the string-like member 10 is not particularly limited, and for example, polyamide, polypropylene, polyester, silk, etc. can be used. The string-like member 10 may be made of a single thread, may be made of a braided yarn, or may be made of other string-like materials. The length of the string-like member 10 is not particularly limited, but it is preferably about 1 to 2 m in order to properly suspend the rotating member 20 and the holding member 30 outside the body of a living body lying on an operating table, etc.

A loop-shaped connection part 11 is provided on the tip side of the string-like member 10. This connection part 11 is configured in a loop (ring shape) by tying the tip of the string-like member 10 to the string-like member 10 at a position closer to the base end than the tip. In addition, the knot 11a at the tip of the string-like member 10 is tied so as to be movable along the string-like member 10, and the size of the loop of the connection part 11 can be freely changed. Therefore, the connection part 11 can be fastened to a clip or the like by pulling the string-like member 10 with the clip or the like inserted into the connection part 11, and is configured so that the string-like member 10 can be easily connected to the clip or the like.

The rotating member 20 rotates around the center of rotation C relative to the holding member 30 to unwind and wind the string-like member 10. FIG. 3A is a front view of the rotating member 20, and FIG. 3B is a plan view of the rotating member 20. As shown in these figures, the rotating member 20 includes a winding section 21 around which the string-like member 10 is wound around the center of rotation C, four (two pairs) of extension sections 22 that extend in the centrifugal direction from the center of rotation C on both sides of the axial direction of the winding section 21, a pair of cylindrical sections 23 provided on both sides of the axial direction of the winding section 21, and a pair of protruding sections 24 that protrude along the center of rotation C from each of the pair of cylindrical sections 23.

The winding section 21 is composed of a column with an oval cross section with the center of rotation C as its central axis, and the string-like member 10 is wound around the outer circumferential surface. The winding section 21 is provided with a through hole 21a that penetrates in a direction perpendicular to the center of rotation C, and a reduced diameter section 21b with a reduced inner diameter is provided midway through the through hole 21a (see FIG. 2B). The string-like member 10 is inserted into the through hole 21a, and a locking section 12 such as a knot provided at the base end locks onto the reduced diameter section 21b, thereby fixing the string-like member 10 to the winding section 21 so that it cannot rotate (see FIG. 2B).

In this embodiment, the cross-sectional shape of the winding portion 21 is an ellipse, but the cross-sectional shape of the winding portion 21 is not particularly limited as long as it is a shape that allows the string-like member to be wound around it, and may be, for example, a circle, an ellipse, a polygon, or the like.

The extension portion 22 is a portion on which the user's fingers are hooked when operating the medical traction device 1. In this embodiment, a pair of extension portions 22 extending in opposite directions are provided on both sides of the axial direction of the winding portion 21. The extension portion 22 is configured in a generally trapezoidal flat plate shape, and in this embodiment, a thick portion 22a that is thicker than the base end side is provided on the tip side of the extension portion 22, and recesses 22b that are formed to be the deepest recess in the thick portion 22a are provided on both end faces of the extension portion 22 in the width direction, making it easier for the user to hook their fingers.

In addition, by providing a thick portion 22a at the tip side of the extension portion 22, the moment of inertia of the rotating member 20 is increased, and the rotation of the rotating member 20 can be stabilized. In this embodiment, the extension portion 22 is configured to have a flange shape relative to the winding portion 21, so that it also functions as a fall prevention portion that prevents the string-like member 10 wound around the winding portion 21 from falling off from the winding portion 21.

The thick portion 22a is formed by partially expanding the outer surfaces 22c of the extension portion 22 that are not opposed to each other. In addition, the inner surfaces 22d of the extension portion 22 that are opposed to each other are formed in flat surfaces that are approximately parallel to each other so as not to impede the unwinding and winding of the string-like member 10.

The cylindrical portion 23 is configured in a cylindrical shape with the center of rotation C as its central axis, and is provided so as to protrude along the center of rotation C from the extensions 22 on both sides of the winding portion 21. The corners between the top surface 23a and the outer circumferential surface 23b of the cylindrical portion 23 are appropriately rounded.

The protruding portion 24 is configured in the shape of a rounded rectangular prism with the center of rotation C as its central axis, and is provided so as to protrude along the center of rotation C from the top surface 23a of the cylindrical portion 23. More specifically, the cross-sectional shape of the protruding portion 24 with respect to the center of rotation C (perpendicular to the center of rotation C) is configured in a shape in which the four corners of a rectangle having a longitudinal direction are rounded, and the central portions of the short sides at both ends in the longitudinal direction are smoothly bulged.

The protrusion 24 is disposed in such a position that the longitudinal direction of the cross-sectional shape is perpendicular to the extension direction of the extension portion 22. The longitudinal dimension of the cross-sectional shape of the protrusion 24 is set to be smaller than the outer diameter of the cylindrical portion 23. The corners between the top surface 24a and the side surface 24b of the protrusion 24 are appropriately rounded. Furthermore, the side surface 24b of the protrusion 24 is smoothly continuous because the corners are rounded as in the cross-sectional shape described above.

Returning to Fig. 1 and Figs. 2A and B, the holding member 30 comprises a tubular portion 31 through which the tip side of the string-like member 10 (the portion extending from the rotating member 20) is inserted so as to be freely movable forward and backward, and a pair of arm-like portions 32 that hold the rotating member 20. The tubular portion 31 is formed with an insertion hole 31a inside, and is configured in a cylindrical shape whose outer diameter is reduced in two stages toward the tip side (the opposite side of the arm-like portions 32).

The insertion hole 31a is composed of a first tapered section 31a1 whose inner diameter gradually decreases from the base end side (arm section 32 side) toward the tip end side, a constant diameter section 31a2 whose minimum diameter of the first tapered section 31a1 is maintained in the axial direction, a second tapered section 31a3 whose inner diameter gradually decreases from the inner diameter of the constant diameter section 31a2 toward the tip end side, and a small diameter section 31a4 whose minimum diameter of the second tapered section 31a3 is maintained in the axial direction.

The inner diameter of the small diameter portion 31a4 of the insertion hole 31a is set to a diameter slightly larger than the outer diameter of the string-like member 10. In this embodiment, the small diameter portion 31a4 is provided, and the knot 11a of the connection portion 11 is set to a size that does not allow it to pass through the small diameter portion 31a4. As a result, in this embodiment, by simply pulling the string-like member 10 toward the base end with the connection portion 11 protruding from the tip of the tubular portion 31, the knot 11a can be engaged with the tip surface 31b of the tubular portion 31, thereby reducing the size of the loop of the connection portion 11. In addition, in this embodiment, the first tapered portion 31a1 and the second tapered portion 31a3 are provided to expand the diameter of the base end side of the insertion hole 31a, making it easier to insert the string-like member 10 when assembling the medical traction device 1.

The pair of arm-like portions 32 are provided so as to extend along the axial direction of the cylindrical portion 31 from the front side and back side of the base end of the cylindrical portion 31, respectively. The outer surface 32a of the arm-like portion 32 is provided so as to be continuous with the outer peripheral surface of the cylindrical portion 31. In addition, the opposing inner surfaces 32b of the arm-like portion 32 are configured as flat surfaces that are approximately parallel to each other, and are provided with a tip-side inner surface 32b1 on the tip side of the holding member 30 (the base end side of the arm-like portion 32), a base-side inner surface 32b2 that is closer to each other than the tip-side inner surface 32b1, and a stepped portion 32b3 that is inclined relative to both the tip-side inner surface 32b1 and the base-side inner surface 32b2.

The distance between the opposing tip side inner surfaces 32b1 is set to be slightly smaller than the distance between the top surfaces 23a of the cylindrical portion 23 of the rotating member 20. The distance between the opposing base side inner surfaces 32b2 is set to be slightly larger than the distance between the outer surfaces 22c of the extension portions 22 on both sides of the axial direction of the winding portion 21 of the rotating member 20.

The tip of the arm 32 (the base end of the holding member 30) has a bulge 32c that bulges outward (to the front or back) in a generally truncated pyramid shape, and the end surface 32d on the tip side of the arm 32 (the base end side of the holding member 30) is where the user places, for example, their thumb when operating the medical traction device 1.

The pair of arm-shaped portions 32 are each provided with a first retaining portion 33 having an elongated hole shape and a second retaining portion 34 having a circular hole shape. The rotating member 20 is retained by the retaining member 30 by inserting (accommodating) the protrusion 24 into the first retaining portion 33 or the second retaining portion 34. Specifically, the first retaining portion 33 is a portion that retains the rotating member 20 so that it cannot rotate around the rotation center C relative to the retaining member 30, and the second retaining portion 34 is a portion that retains the rotating member 20 so that it can rotate around the rotation center C relative to the retaining member 30. In FIG. 1 and FIGS. 2A and B, the rotating member 20 retained by the second retaining portion 34 is shown by a two-dot chain line.

The first holding portion 33 is configured as an elongated hole extending in the axial direction of the holding member 30, i.e., approximately parallel to the insertion hole 31a. The width of the elongated hole constituting the first holding portion 33 is set to be smaller than the longitudinal dimension of the cross-sectional shape of the protruding portion 24 of the rotating member 20, and slightly larger than the width dimension (short dimension) of the cross-sectional shape of the protruding portion 24. As a result, when the protruding portion 24 is inserted into the first holding portion 33 and held by the first holding portion 33, the rotating member 20 cannot rotate around the rotation center C relative to the holding member 30. Furthermore, when the rotating member 20 is held by the first holding portion 33, it is freely movable in a direction approaching or moving away from the insertion hole 31a.

As described above, the distance between the tip side inner surfaces 32b1 of the arm-shaped portions 32 is slightly smaller than the distance between the top surfaces 23a of the cylindrical portions 23 of the rotating member 20. Therefore, when the protruding portion 24 of the rotating member 20 is inserted into the first holding portion 33 and held by the first holding portion 33, the top surface 23a comes into contact with the tip side inner surface 32b1, pushing the two arm-shaped portions 32 apart, resulting in the arm-shaped portions 32 and the cylindrical portions 23 being elastically deformed. In other words, when held by the first holding portion 33, the rotating member 20 is sandwiched between the two arm-shaped portions 32, and the frictional force between the top surface 23a and the tip side inner surface 32b1 prevents the rotating member 20 from moving inadvertently.

In addition, when the rotating member 20 is held by the first holding portion 33, the extension portion 22 extends in a direction perpendicular to the direction of movement of the rotating member 20. Therefore, the user can place, for example, the thumb on the end surface 32d of the arm portion 32 and hook, for example, the index finger and middle finger on the extension portion 22 to move the rotating member 20 in a direction away from the insertion hole 31a.

The second holding portion 34 is provided so as to be continuous (integrally) with the first holding portion 33 on the tip side of the arm portion 32, i.e., on the opposite side to the insertion hole 31a. In other words, the rotating member 20 is freely movable between the first holding portion 33 and the second holding portion 34. The inner diameter of the circular hole constituting the second holding portion 34 is set to be slightly larger than the outer diameter of the cylindrical portion 23 of the rotating member 20 and the longitudinal dimension of the cross-sectional shape of the protruding portion 24. In addition, the second holding portion 34 is provided at a position corresponding to the stepped portion 32b3 and the base end side inner surface 32b2.

As a result, when the protruding portion 24 is inserted into the second holding portion 34 and the rotating member 20 is held by the second holding portion 34, the rotating member 20 is rotatable around the center of rotation C relative to the holding member 30. As described above, the distance between the base end side inner surfaces 32b2 of the arm-shaped portions 32 is slightly larger than the distance between the outer surfaces 22c of the extension portions 22 of the rotating member 20, so when the rotating member 20 is held by the second holding portion 34, the cylindrical portion 23 is inserted into the second holding portion 34 together with the protruding portion 24. As a result, the rotating member 20 held by the second holding portion 34 can rotate smoothly due to the sliding between the outer peripheral surface 23b of the cylindrical portion 23 and the inner peripheral surface of the second holding portion 34.

In FIG. 2A, the rotating member 20 is shown by a two-dot chain line in a state rotated 90 degrees from the state shown in FIG. 1. As shown in FIG. 2A, it goes without saying that the rotating member 20 and the arm portion 32 are configured not to interfere with each other when the rotating member 20 is rotated.

In addition, since the second holding portion 34 is disposed on the extension of the moving direction in which the rotating member 20 moves away from the insertion hole 31a in the first holding portion 33, the user can move the rotating member 20 to the second holding portion 34, i.e., transition the rotating member 20 to a state held by the second holding portion 34, by continuing the same operation after moving the rotating member 20 away from the insertion hole 31a in the first holding portion 33.

As shown in FIG. 1, when the rotating member 20 is held by the second holding portion 34 in a position where the extension portion 22 extends in a direction perpendicular to the axial direction of the holding member 30 (i.e., the movement direction of the rotating member 20 in the first holding portion 33), the end face 32d on the tip side of the arm portion 32 protrudes in the axial direction from the rotating member 20. In other words, the end face 32d on the opposite side of the arm portion 32 from the first holding portion 33 with respect to the second holding portion 34 protrudes in the movement direction of the rotating member 20 from the rotating member 20 in the position shown in FIG. 1 in the second holding portion 34.

Therefore, when the rotating member 20 is in the second holding portion 34 in the position shown in FIG. 1, the user's thumb, which is placed on the end surface 32d of the arm portion 32, is not in contact with the rotating member 20. This allows the user to move the rotating member 20 from the first holding portion 33 to the second holding portion 34 while placing, for example, the thumb on the end surface 32d of the arm portion 32 and, for example, the index finger and middle finger on the extension portion 22.

In addition, by moving the rotating member 20 to the second holding portion 34, the arm portion 32 releases the rotating member 20 from its grip, which the user can feel as a click. In other words, the user can tell by the touch of his or her fingertips that the rotating member 20 has moved from the first holding portion 33 to the second holding portion 34.

As described above, the rotating member 20 and the holding member 30 function as a weight, and the combined weight of the two provides a traction force for the affected area, etc. In this embodiment, the rotating member 20 is made of polypropylene, and the holding member 30 is made of acrylonitrile-butadiene-styrene copolymer synthetic resin (ABS resin), and the combined weight of the rotating member 20 and the holding member 30 is set to approximately 10 gw.

The total weight of the rotating member 20 and the holding member 30 (i.e., the traction force generated by the medical traction device 1) is preferably 5 to 15 gw (traction force of 5 to 15 gf) in ESD of the esophagus, stomach, large intestine, etc. However, the total weight of the rotating member 20 and the holding member 30 is not limited to this, and an appropriate weight can be adopted depending on the application of the medical traction device 1, etc.

The material of the rotating member 20 and the holding member 30 is not particularly limited, and in addition to polypropylene and ABS resin, various resins such as polyethylene, polycarbonate, or polyamide can be used, and various rubbers, metals, or ceramics may also be used. The rotating member 20 and the holding member 30 may be made of the same material. The rotating member 20 or the holding member 30 may have a portion made of a material different from the other portions, in which case the weight can be set more easily.

Although not shown in the figures, in assembling the medical traction device 1, first, the base end side of the string-like member 10 is connected to the rotating member 20 and wound around the winding portion 21. Next, the string-like member 10 extending from the winding portion 21 is inserted into the insertion hole 31a, and the rotating member 20 is inserted between the pair of elastically deformed arm portions 32, and the pair of protrusions 24 are inserted into the first holding portion 33 or the second holding portion 34 of the pair of arm portions 32. Then, the rotating member 20 is moved along the first holding portion 33 and positioned at the position closest to the insertion hole 31a.

Finally, the connection part 11 is formed on the part of the string-like member 10 protruding from the insertion hole 31a. The string-like member 10 is already extended from the winding part 21 by a sufficient length, and the connection part 11 is formed at a position where the connection part 11 does not at least hinder the movement of the rotating member 20 from the position closest to the insertion hole 31a of the first holding part 33 to the second holding part 34. In particular, in this embodiment, the connection part 11 is formed at a position where the loop of the connection part 11 is reduced to a size that is appropriately fastened to the clip 50 when the rotating member 20 is moved from the position closest to the insertion hole 31a of the first holding part 33 to the second holding part 34 with the knot 11a engaged with the tip surface 31b of the tubular part 31. The above procedure completes the assembly of the medical traction tool 1. The assembled medical traction tool 1 is sterilized by an appropriate method and then stored inside the package.

In this embodiment, by configuring the rotating member 20 and the holding member 30 as described above, the rotating member 20 and the holding member 30 are integrally molded from an elastically deformable material such as resin, and the arm-shaped portion 32 can be elastically deformed to assemble the rotating member 20 to the holding member 30. This not only minimizes the number of parts in the medical traction device 1, but also eliminates the need for gluing or welding during assembly, thereby increasing the productivity of the medical traction device 1 and reducing production costs. In addition, because the rotating member 20 and the holding member 30 are configured in a simple shape, it is possible to adopt a relatively low-cost sterilization method such as ethylene oxide gas sterilization.

Next, a method of using the medical traction device 1 will be described. Figures 4A to 4D, 5A and 5B, and 6A and 6B are schematic diagrams showing an example of a method of using the medical traction device 1.

When using the medical traction device 1, first, the connection portion 11 of the string-like member 10 is connected to the clip 50 that grips the affected area, etc. At this time, the clip 50 is attached in advance to the tip of the clip operating device 51 as shown in FIG. 4A, and the clip operating device 51 is inserted into the forceps channel of the endoscope 60 so as to protrude from the tip of the endoscope 60. In addition, when using a tip hood 61 that is attached to the tip of the endoscope 60, the tip hood 61 is attached to the endoscope 60 in advance.

When connecting the connection part 11 to the clip 50, first, as shown in FIG. 4A, for example, one claw of the clip 50 is inserted into the loop of the connection part 11. Next, as shown in FIG. 4B, the rotating member 20 is moved along the first holding part 33 in a direction away from the insertion hole 31a, thereby pulling the string-like member 10 relative to the clip 50, and the knot 11a is engaged with the tip surface 31b of the tubular part 31, thereby reducing the loop of the connection part 11. Then, as shown in FIG. 4C, the rotating member 20 is positioned in the second holding part 34.

At this time, the user can move the rotating member 20 by placing, for example, the index finger and middle finger in the recess 22b of the extension portion 22 of the rotating member 20 and placing, for example, the thumb on the end surface 32d of the arm portion 32 of the holding member 30, so that the connecting portion 11 can be quickly and easily connected to the clip 50.

As described above, in this embodiment, the length of the string-like member 10 that is extended in advance from the winding portion 21 and the size of the loop of the connection portion 11 are appropriately set so that when the rotating member 20 is positioned in the second holding portion 34, the connection portion 11 is connected to the clip 50 in an appropriately tightened state. Therefore, the user can easily and reliably connect the connection portion 11 to the clip 50 with just a single action of, for example, bringing the thumb, index finger, and middle finger close to each other, making the medical traction device 1 extremely easy to operate.

If the clip 50 is not tightly fastened by the connecting portion 11 even after the rotating member 20 is positioned in the second holding portion 34, the fastening can be strengthened by gently pulling the rotating member 20 together with the holding member 30, or by directly pinching and gently pulling the string-like member 10. Also, if the knot 11a does not engage with the tip surface 31b of the tubular portion 31 and sufficient fastening is obtained at the connecting portion 11 before the rotating member 20 is positioned in the second holding portion 34, the holding member 30 can be moved closer to the clip 50 to position the rotating member 20 in the second holding portion 34.

It goes without saying that the string-like member 10 can also be pulled directly, or the holding member 30 can be pulled together with the rotating member 20 in the first holding part 33, to connect the connection part 11 to the clip 50 in an appropriately tightened state, and then the rotating member 20 can be moved from the first holding part 33 to the second holding part 34.

Once the connection part 11 of the string-like member 10 is connected to the clip 50, the string-like member 10 is unwound from the winding part 21 to a length necessary to hang the rotating member 20 and the holding member 30 as a weight. At this time, the user only needs to pinch the bulging part 32c of the holding member 30 with the index finger and thumb from the front and back sides, and move the rotating member 20 and the holding member 30 in a direction away from the clip 50. As a result, as shown in FIG. 5A, the string-like member 10 rotates relative to the holding member 30 as if pulled by the clip 50, and the string-like member 10 is unwound from the winding part 21.

The rotation speed of the rotating member 20 can be adjusted by adjusting the force with which the bulge 32c is pinched and adjusting the friction between the arm portion 32 and the rotating member 20. When the required length of the string-like member 10 has been unwound, the rotation of the rotating member 20 is stopped. Then, as shown in FIG. 5B, the rotating member 20 is moved from the second holding portion 34 to the position closest to the insertion hole 31a of the first holding portion 33. This fixes the length of the string-like member 10 unwound from the winding portion 21.

The user may pull the string-like member 10 with the hand opposite to the hand holding the holding member 30, thereby unwinding the string-like member 10 from the winding portion 21. Either method allows the user to quickly and easily unwind the required length of string-like member 10. The rotation member 20 can be moved from the second holding portion 34 to the first holding portion, for example, by pinching the tubular portion 31 between the index finger and middle finger and pressing the extension portion 22 of the rotation member 20 with the thumb and ring finger. In other words, the medical traction device 1 allows the rotation member 20 to be moved with only one hand.

Once the required length of the string-like member 10 has been unwound, the clip 50 is housed in the forceps channel of the endoscope 60, and the endoscope 60 is inserted into, for example, the digestive tract of the living body to be treated. Then, when the tip of the endoscope 60 reaches the vicinity of the lesion, the user operates the clip operating device 51 to grasp the lesion with the clip 50, and then detaches the clip 50 from the clip operating device 51 and leaves it in the living body. Thereafter, as shown in FIG. 6A, the rotating member 20 and the holding member 30 are suspended outside the living body, so that a traction force is applied to the lesion grasped by the clip 50.

The example shown in FIG. 6A shows a case where an endoscope 60 is inserted through the mouth of a living body lying on an operating table 70 to treat a lesion in the esophagus or stomach. With the medical traction device 1, it is possible to apply a traction force to a lesion or the like simply by hanging the rotating member 20 and the holding member 30, allowing the user to concentrate on operating treatment tools such as the endoscope 60 and the high-frequency knife 80. In addition, since a mouthpiece 90 is usually placed at the mouth of the living body, which is the insertion port for the endoscope 60, no load is placed on the living body due to contact with the string-like member 10.

Figure 6B shows the state inside a living body during ESD to remove a lesion 110 that has developed in the mucosa 100. In ESD, the mucosa 100 and submucosal layer 101 around the lesion 110 are incised in advance with a high-frequency knife 80, and after a certain amount of the submucosal layer 101 below the lesion 110 is removed, the removed portion is grasped with a clip 50 and pulled.

By pulling the resected portion of the lesion 110, the tip of the endoscope 60 can be inserted between the lesion 110 and the proper muscularis 102 without being obstructed by this portion, as shown in FIG. 6B. In addition, even if the submucosal layer 101 is resected with the high-frequency knife 80, the lesion 110 after resection can be prevented from sagging and blocking the view of the endoscope 60.

Next, a modified example of the medical traction tool 1 will be described. FIG. 7 is a front view showing a modified example of the medical traction tool 1. Note that FIG. 7 shows the state in which the rotating member 20 is held by the second holding portion 34.

In this example, a notch 32e having a substantially rectangular shape in front view is provided at the tip end of the arm-shaped portion 32 (the base end of the holding member 30), so that the rotating member 20 in the second holding portion 34 can be moved to the first holding portion 33 by, for example, pressing it with the thumb in a posture in which the extension portion 22 extends in a direction perpendicular to the axial direction of the holding member 30. More specifically, in this example, a notch 32e is provided by partially cutting out the end face 32d opposite the first holding portion 33 for the second holding portion 34 of the arm-shaped portion 32. By inserting, for example, the tip of the thumb into this notch 32e, it is possible to press the rotating member 20 in the posture shown in FIG. 1 in the second holding portion 34 toward the first holding portion 33. In addition, when moving the rotating member 20 from the first holding portion 33 to the second holding portion 34, the thumb or the like can be positioned so as to straddle the end faces 32d on both sides of the notch 32e, so that the thumb or the like does not come into contact with the rotating member 20.

By providing such a notch 32e, it is possible to further facilitate the movement of the rotating member 20 from the second holding portion 34 to the first holding portion 33, so that the adjustment of the payout length of the string-like member 10 can be performed more quickly and easily.

In addition, although not shown in the figures, the connection part 11 is not limited to being configured in a loop shape by the knot 11a, but may be configured in a loop shape by, for example, connecting a separate ring-shaped member provided at the tip of the string-like member 10 to the base end side of the tip. Also, for example, a snap hook or hook may be provided as the connection part. Also, the locking part 12 on the base end side of the string-like member 10 may be configured as a separate member.

The rotating member 20 may also have a single pair of extensions 22 instead of two pairs of extensions 22. The two pairs of extensions 22 may also extend in different directions, such as a direction in which the rotating member 20 has a cross shape when viewed from the front. The pair of extensions 22 of the rotating member 20 may also extend in a direction in which the rotating member 20 has a V shape when viewed from the front.

The rotating member 20 may not have the cylindrical portion 23, but may only have the protruding portion 24. The cross-sectional shape of the protruding portion 24 is not particularly limited as long as it has a longitudinal direction, and may be, for example, a shape of a circle cut at two chords, an ellipse, or other shapes. It goes without saying that the shapes and arrangements of the other parts of the rotating member 20 are not limited to those shown in this embodiment.

The first holding portion 33 of the holding member 30 may be configured as a groove that accommodates at least a portion of the protrusion 24 of the rotating member 20. Similarly, the second holding portion 34 may be configured as a recess that accommodates at least a portion of the protrusion 24 and has an inner surface that is circumferential about the center of rotation C. Needless to say, the shapes and arrangements of the other parts of the holding member 30 are not limited to those shown in this embodiment.

The above describes an embodiment of the present invention, but the medical traction device of the present invention is not limited to the above-mentioned embodiment, and various modifications can be made without departing from the spirit of the present invention.

Furthermore, the actions and effects shown in the above-mentioned embodiments are merely a list of the most preferable actions and effects resulting from the present invention, and the actions and effects of the present invention are not limited to these.

REFERENCE SIGNS LIST 1 medical traction tool 10 string-like member 11 connection portion 20 rotation member 22 extension portion 24 protrusion portion 30 holding member 31 tubular portion 31a insertion hole 32 arm portion 33 first holding portion 34 second holding portion 50 clip C rotation center

Claims (4)

A string-like member having a tip side connected to a clip that grips an object to be gripped;
a rotating member around which a base end side of the string-like member is wound around a predetermined rotation center;
a holding member for holding the rotating member and having an insertion hole through which a portion of the string-like member extending from the rotating member is inserted so as to be capable of advancing and retreating;
The holding member has a first holding portion configured to move the rotating member in a direction toward and away from the insertion hole, and holds the rotating member non-rotatably about the rotation center relative to the holding member, and a second holding portion provided on an extension of the moving direction in which the rotating member moves away from the insertion hole in the first holding portion, and holds the rotating member rotatably about the rotation center relative to the holding member,
The medical traction tool, wherein the rotating member is configured to be freely movable between the first holding portion and the second holding portion. The medical traction device according to claim 1,
The medical traction device, characterized in that the string-like member has a loop-shaped connection portion formed by connecting its own tip portion at a portion closer to the base end than the tip portion so that it can be freely moved along the string-like member. The medical traction device according to claim 1 or 2 ,
the rotating member has a pair of extending portions extending in different centrifugal directions relative to the rotation center,
The medical traction tool, wherein the first holding portion is configured to hold the rotating member in a state in which the extension portion extends in a direction intersecting a moving direction of the rotating member. The medical traction device according to any one of claims 1 to 3 ,
the holding member has a cylindrical portion in which the insertion hole is provided and a pair of arm portions extending from the cylindrical portion,
the rotating member has a pair of protruding portions protruding in opposite directions along the rotation center, and is disposed between the pair of arm portions;
the first holding portion is formed of a long hole or a groove provided in each of the pair of arm portions and configured to accommodate at least a part of the protrusion,
the second holding portion is formed of a circular hole provided in each of the pair of arm-shaped portions so as to be continuous with the long hole and accommodating at least a part of the protrusion, or a recess having an inner surface that is circumferentially shaped about the rotation center,
The protrusion is configured so that a cross-sectional shape with respect to the rotation center has a longitudinal direction,
A medical traction device, characterized in that the longitudinal dimension of the cross-sectional shape of the protrusion is larger than the width of the long hole or the groove that constitutes the first retaining portion and smaller than the inner diameter of the circular hole or the recess that constitutes the second retaining portion.

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