RU2805798C1 - Endoscopy device and method of its use (options) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for endoscopy consisting of an endoscope, at least one hanging instrumental channel, clip holders, a tabletop holder; the endoscope contains a flexible working part with a controlled distal end, containing standard channels inside; hinged instrumental channels (HIC) are made in the form of tubes made of dielectric material, inert, elastic, tensile strength, the distal ends of the HIC are made atraumatic, and the proximal ends are made with the possibility of inserting endoscopic instruments into the HIC and are equipped with an elastic valve to prevent leakage of inflating gas, the HIC are fixed on clip holders around the circumference of the flexible working part with the possibility of providing access for an endoscopic instrument to the area of the organ being examined or operated on; clip-holders (CD) contain a leading CD, intermediate CDs and a trailing CD; the tabletop-holder is made of any shape with a U-shaped recess corresponding to the cross-section of the handle with the possibility of fixing the tabletop-holder to the handle; the elements of the claimed device are interconnected as follows: The HIC are fixed on the flexible working part of the endoscope using a leading CD, intermediate CDs and a trailing CD, the proximal ends of the HIC are fixed in the through holes of the table-top holder, which is fixed to the handle. A device for endoscopy, consisting of an endoscope, at least one hanging instrumental channel, clip holders, a tabletop holder; the endoscope contains a flexible working part with a controlled distal end, containing standard channels inside; a handle with handles for forced control of the drive mechanisms of the controlled distal end of the flexible working part, an air and water supply button, a connecting cable; hinged instrumental channels (HIC) are made in the form of tubes made of dielectric material, inert, elastic, tensile strength, the distal ends of the NIK are made atraumatic, and the proximal ends are made with the possibility of inserting endoscopic instruments into the HIC and are equipped with an elastic valve with the ability to prevent leakage of inflating gas; the NICs are fixed on clip holders around the circumference of the flexible working part with the possibility of providing access for an endoscopic instrument to the area of the organ being examined or operated on; clip-holders (CD) contain a leading CD, intermediate CDs and a trailing CD; the tabletop-holder is made of any shape with a U-shaped recess corresponding to the cross-section of the handle with the possibility of fixing the tabletop-holder to the handle; the elements of the claimed device are interconnected as follows: The HIC are fixed on the flexible working part of the endoscope using a leading CD, intermediate CDs and a trailing CD, the proximal ends of the HIC are fixed in the through holes of the table-top holder, which is fixed to the handle. The following is proposed: a method of using the first device for endoscopy, which consists in taking the claimed device by the handle and inserting a flexible working part into the patient’s hollow organ being examined or operated on; to carry out diagnostics, the patient’s organ being examined is examined and diagnosed using the standard equipment of an endoscope and at least one mounted instrumental channel; diagnostics is carried out and, based on its results, a treatment program is determined; to carry out treatment, air is insufflated through the standard channel for supplying air and water to inflate the lumen of the organ and create an internal operating space, then the distal end of the flexible working part is brought to the site of therapeutic actions, endoscopic instruments are inserted through the hanging instrumental channels in the amount of at least one, a regular worker the aspiration-instrumental/biopsy channel is either left free for water supply and aspiration of rinsing waters and biological fluids, or used for insertion of an endoscopic instrument; then therapeutic actions are performed with the inserted endoscopic instruments; upon completion of therapeutic actions, endoscopic instruments are alternately removed from the standard working aspiration-instrumental/biopsy channel and hanging instrumental channels, then air is removed from the internal surgical space, after which the declared device is removed and the medical intervention is completed. A method of using a second device for endoscopy, which consists in taking the claimed device by the handle and inserting a flexible working part into the patient’s hollow organ being examined or operated on; to carry out diagnostics, the patient’s organ being examined is examined and diagnosed using the standard equipment of an endoscope and at least one mounted instrumental channel; carry out diagnostics and, based on the diagnostic results, determine a treatment program; to carry out treatment, air is insufflated through the standard channel for supplying air and water to inflate the lumen of the organ and create an internal surgical space, then the distal end of the flexible working part is brought to the site of therapeutic actions, endoscopic instruments are introduced through the hinged instrumental channels in the amount of at least one, then with endoscopic instruments inserted into the hanging instrumental channels perform therapeutic actions; upon completion of the therapeutic actions, the endoscopic instruments are alternately removed from the hanging instrumental channels, then the air is removed from the internal surgical space, after which the declared device is removed, completing the medical intervention.

EFFECT: easier insertion of the flexible working part of the endoscope into hollow organs due to the smaller diameter of the flexible working part and the streamlined shape of the controlled distal end.

9 cl, 12 dwg

Description

The present invention relates to the field of satisfying human vital needs, specifically to endoscopy and can be used in medicine and veterinary medicine, in combination with endoscopic instruments for minimally invasive medical interventions.

Terms and abbreviations used in the description:

Gastrointestinal tract - gastrointestinal tract.

UES - upper esophageal sphincter.

Internal operating space - in the context of this description, the internal lumen (explored cavity) of any hollow organ, for example, the stomach or rectum, inflated with air or another gaseous medium under low pressure for subsequent diagnosis and/or therapeutic and surgical intervention.

The distal end of the endoscope is the controlled end of the flexible working part of the endoscope, farthest from the operator, inserted into the lumen of the internal organs (internal end).

The proximal end of the endoscope is the end of the flexible working part of the endoscope closest to the operator, located outside the patient (outer end).

Standard channels - channels located inside the flexible working part of the endoscope, the handle and in the connecting cable with the illuminator connector: standard working aspiration-instrumental/biopsy channel (hereinafter referred to as the standard working channel); lighting transmission channel; image transmission channel; combined channel for supplying air and water; channels for placing kinematics [Khatsevich T.N. Endoscopes: textbook. allowance / T.N. Khatsevich, I.O. Mikhailov. -2nd ed., add. and extension - Novosibirsk: SGGA, 2012. - P.81].

KD - clip-holder.

NIK - mounted instrument channel.

The angle of “attack” is the angle of inclination of the axis of the surgical action [http://www.redov.ru/medicina/sovety_molodomu_hirurgu/p10.php] or the angle of inclination of the instrument to the object of the operation.

Zip lock - a fastener made of two strips: the seam overlaps smoothly, it has no teeth. Fastening occurs as the guide elements are pressed against each other [https://vyvoz.org/blog/chto-takoe-zip-lock-pakety-i-upakovka /?ysclid=ldlqcysxr7376380077].

Arrangement of hinged instrumental channels (NIC) along the clock dial - depending on the situation, to ensure access of the endoscopic instrument to any part of the examined or operated organ, hinged instrumental channels are located around the perimeter (circumference) of the flexible working part of the endoscope with the possibility of their fixation along the clock dial, for example, at 3, 5, 6 and 8 o'clock.

The external dimensions of medical flexible endoscopes (length and diameter/cross-section of the flexible working part) are limited by natural factors - the location of the cavity being examined and directly depend on the size of the natural openings of the body of people and animals, the extensibility of biological tissues (skin, mucous membranes and sphincters) around the openings, for example , around the pharynx or around the anal canal, the passage section of the lumen of hollow organs. The chain of interrelated constraints is a key feature that introduces significant technical limitations into the design of all types of flexible endoscopes. This significantly limits the scope of application of endoscopes.

Diagnosis and most minimally invasive medical interventions are carried out in ordinary medical institutions (polyclinic, district hospital) using the most affordable serial endoscopes with one standard working channel, using a variety of endoscopic instruments, the range and number of which when carrying out endoscopic interventions exceeds the number of working channels of the endoscope .

In the process of work, as necessary, instruments are repeatedly replaced by inserting and removing them through the standard working channel of the endoscope, which increases the duration of medical intervention and is accompanied by a long stay of the patient in a state of discomfort, increasing fatigue of the operator and a decrease in the concentration of his attention.

To meet the need for simultaneous work with the number of instruments, it is necessary to increase the number of standard working channels of serial endoscopes, which is technically impossible due to the limited size - the outer and inner diameters of the flexible working part of the endoscope, determined by the flow section of the lumen of the internal organs. Compacting the installation of optical-mechanical parts placed inside the flexible working part of endoscopes in order to increase the number of working channels is impractical - this reduces the flexibility of endoscopes (their rigidity increases), which significantly worsens the controllability of the endoscope during the operator’s work and the quality of visualization of the object, causing pain to the patient during the examination. These disadvantages and limitations complicate the operator’s work and reduce the quality of the diagnostic and treatment process.

The applicant has identified analogues of the proposed invention from the researched prior art. When describing analogues, the terminology of their (analogous) descriptions is used.

From the studied level of technology, a flexible diagnostic endoscope is known [Khatsevich T.N. Endoscopes: textbook. allowance / T.N. Khatsevich, I.O. Mikhailov. - 2nd ed., add. and extension - Novosibirsk: SGGA, 2012. - P. 80]. The known endoscope has standard equipment: a flexible working part with a controlled distal end, containing standard channels inside: lighting, image transmission, combined air and water supply, standard working aspiration-instrumental/biopsy (hereinafter referred to as the working channel), placement of kinematics, and channels lighting and image transmission end at the end of the controlled distal end of the flexible working part with lenses, the working channel with an outlet, and the combined air and water supply channel with a nozzle; a handle with handles located on it for forced control of drive mechanisms for the controlled distal end of the flexible working part, an aspiration control button, an air and water supply button, an inlet hole into the working channel, drive mechanisms for the controlled distal end of the flexible working part located inside the handle; a connecting cable with a connector (hereinafter referred to as the connecting cable) for connecting the endoscope to an external light source, a pump for supplying air and water, and an aspirator; The outside of the endoscope is covered with an elastic sealed shell.

The disadvantages of the known endoscope are:

- limited number of working channels, which does not allow simultaneous manipulations the number of tools when such a need arises;

- the inability to change the angle of “attack” of the instruments without changing the position of the endoscope;

- the inability to transition from diagnostics to therapeutic manipulations without replacing the diagnostic endoscope with an operating one due to the limited number of working channels and, as a result, the instruments used, which is why they are forced and sequentially to use first a diagnostic endoscope, then an operating one. In this case, a time gap arises between the diagnostic processes and therapeutic manipulations, which can range from several minutes to several hours and even days;

- the need to replenish the inflating gas during medical intervention due to the fact that during operation there is a constant leakage of inflating gas from the cavity under study through the gap between the wall of the working channel and the tubular body of the instruments.

The invention is known under patent RU 2553499 “Device for fixing an external endoscope catheter.” The essence is a device for fixing an external catheter of an endoscope, containing fastening elements, characterized in that the fastening elements are made in the form of two mechanically coupled half-rings facing in opposite directions, the inner diameter of which corresponds to the outer diameter of the catheter and the outer diameter of the endoscope, and the diameter of the smaller half-ring is 2 - 6 catheter diameters, and the diameter half ring is 1-4 times the diameter of the endoscope.

The disadvantages of the known technical solution are:

- a device for fixing an external catheter allows you to attach only one additional catheter and/or one additional instrument to the endoscope, judging by Fig. 1 and Fig. 2 descriptions of patent RU 2553499;

- despite the presence of an additional catheter with an instrument on the endoscope and a free standard working channel, the simultaneous use of more than 2 instruments on one endoscope is excluded (if 3 or more instruments are needed);

- the increased (after equipping with half rings) cross-section of the controlled distal end of the flexible working part of the endoscope significantly complicates the insertion of such an endoscope into the lumen of a hollow organ, which is very uncomfortable and traumatic for the patient;

- inability to replace the endoscopic instrument without removing the endoscope from the hollow organ. Removal of the endoscope for the purpose of replacing the instrument during one endoscopic intervention is always accompanied by its (endoscope) re-insertion. Repeated re-insertion of a periodically re-equipped endoscope during surgery causes additional pain and discomfort to the patient, increases the risk of trauma to internal organs, prolongs the duration of the operation, causes inconvenience in work and increased fatigue to the operating team.

The invention is known under patent RU 2409305 “Device for multi-purpose endoscopy”.

The essence is a device for multi-purpose endoscopy, including a flexible frame, a lighting transmission channel, an air/water supply channel, an aspiration channel, characterized in that a cap is installed at the distal end of the endoscope, equipped with at least one groove with a tubular channel placed in it with the possibility of installation there is a tool in it, and the size of the gutter slot is 0.65-0.75 of the gutter diameter, the outer diameter of the tubular channel is 0.95-0.98 of the inner diameter of the gutter (prototype terminology).

According to the description, the known technical solution is used as follows. At the distal end of the endoscope, a cap is installed, equipped with one to four grooves with additional tubular channels placed in them. The tubular channel is fixed with a special clamp (not shown). However, the description does not contain information about the configuration and dimensions of the special clamp (or clamps). A loop for electroexcision, a coagulator, a forceptor are placed in each tubular channel, or irrigation is carried out through one of the channels. Using the control mechanism of the distal end of the endoscope, the patient’s organ being examined is examined and diagnosed, the distal part of the endoscope with the cap installed on it is brought to the site of therapeutic actions and therapeutic actions are carried out using instruments fixed in 4 tubular channels of the cap - a loop for electroexcision, a coagulator, forecept and an irrigator installed in one of the 4 channels.

The disadvantages of the known technical solution are:

- difficult insertion of the endoscope into the examined cavity of the patient, even in a state of deep endotracheal anesthesia and muscle relaxation, since after installing the cap, the cross-section of the controlled distal end of the flexible endoscope frame introduced into the examined/operated cavity increases significantly;

- the limited number of working channels and, as a result, simultaneously used tools (no more than 4) does not allow simultaneous manipulation of a large number of tools when such a need arises;

- inability to change the angle of “attack” of the tools;

- inability to ensure interchangeability and rotation of instruments among themselves without removing the endoscope from the patient’s body;

- the impossibility of transition from diagnostics to therapeutic manipulations without replacing the diagnostic endoscope with an operating one due to the limited number of working channels used and, as a result, instruments, which is why they are forced and sequentially to use first a diagnostic endoscope, then an operating one. In this case, a time gap arises between the diagnostic processes and therapeutic manipulations, which can range from several minutes to several hours and even days;

- inability to replace instruments in tubular channels without removing the endoscope from the cavity being examined/operated due to uncontrolled displacement of the tubular channels up to their kinks and/or interweaving with each other and the flexible frame as a result of the only place of fixation of the tubular channels of the prototype - on the cap, and the lack of fixation of the tubular channels channels along the flexible frame of the endoscope;

- the possibility of intertwining of the handles of endoscopic instruments inserted into tubular channels;

- increased risk of injury, pain, complications for the patient and increased operator fatigue due to repeatedly performed (repeated) insertions of a re-equipped endoscope;

- the need to replenish the inflating gas during medical intervention due to the fact that during operation there is a constant leakage of inflating gas from the cavity being examined/operated through the gap between the wall of the working channel and the tubular body of the instruments.

The identified analogues coincide with the declared technical solution according to individual matching features, therefore the prototype has not been identified and the claims are drawn up without a restrictive part.

The technical result of the claimed technical solution is to eliminate the disadvantages of analogues by developing a device for endoscopy and a method of its use (options), namely, providing:

– facilitated insertion of the flexible working part of the endoscope into hollow organs due to the smaller diameter of the flexible working part and the streamlined shape of the controlled distal end;

– an increase in the number of working channels and, as a result, simultaneously used tools, which allows simultaneous manipulation of a larger number of tools when such a need arises;

– the ability to change the angle of “attack” of the instruments to the operated object without changing the position of the endoscope due to the location of the working channels around the circumference of the endoscope;

– the possibility of interchangeability and rotation of instruments among themselves without removing the endoscope from the patient’s body;

– the possibility of transition from diagnostics to therapeutic manipulations without replacing the diagnostic endoscope with an operating one due to an increase in the number of working channels and the instruments used in them. In this case there is no time gap between diagnostic processes and therapeutic manipulations;

– stable fixation of hinged instrumental channels along the flexible working part and on the endoscope handle due to clip holders and a table-top holder;

– reliable placement of endoscopic instruments in hinged instrument channels along the flexible working part of the endoscope;

– eliminating the possibility of intertwining of the outer handles of endoscopic instruments due to their fixation on the tabletop holder;

– reducing the risk of injury to internal organs and the risk of possible complications;

– reduction of operator fatigue due to the absence of repeated insertions of the endoscope;

– reduction of leakage of inflation gas from a hollow organ due to the presence of a valve.

The essence of the claimed technical solution is a device for endoscopy, consisting of an endoscope, at least one mounted instrumental channel, clip holders, a tabletop holder; wherein the endoscope contains a flexible working part with a controlled distal end, containing standard channels inside: lighting, image transmission, combined air and water supply, kinematics placement, standard working aspiration-instrumental/biopsy channel; a handle with handles for forced control of the drive mechanisms of the controlled distal end of the flexible working part, buttons for controlling aspiration and supplying air and water, and a connecting cable; in this case, the hinged instrumental channels are made in the form of tubes made of dielectric material, approved for use in medicine, inert, not destroyed during disinfection, elastic-elastic, tensile strength, while the distal ends of the hinged instrumental channels are made atraumatic - beveled or rounded, and the proximal ends the ends are made in the form of a funnel with the possibility of insertion into the hinged instrumental channels of endoscopic instruments and are equipped with an elastic valve with the ability to prevent leakage of the inflating gas, in the form of two oppositely placed elastic membranes, with each of the membranes with one edge attached to the edge of the proximal end of the hinged instrumental channel, and the free the edges of the membranes fit tightly and overlap each other, extending one after another with the possibility of blocking the lumen of the hinged instrumental channel and preventing the leakage of inflating gas from the operated cavity, as well as with the possibility of passing the endoscopic instrument by enveloping it in the form of a cuff; along the entire length of the outer surface of each hinged instrumental channel, a longitudinal tenon in the form of a protrusion is made monolithically with it in such a way that the junction of the hinged instrumental channel and the longitudinal tenon is made narrowed in the form of a “waist” with the possibility of fixing the hinged instrumental channel in clip-holders; in this case, the length of the hanging instrumental channels is made not exceeding the length of the longest of the endoscopic instruments intended for use; hinged instrumental channels are fixed on clip-holders around the circumference of the flexible working part along the clock dial with the possibility of providing access for an endoscopic instrument to the area of the organ being examined or operated on; in this case, the clip-holders contain a leading clip-holder, intermediate clip-holders and a closing clip-holder, while the outer surface of all clip-holders is made with longitudinal grooves with the possibility of attaching hinged tool channels, while the shape and dimensions of the longitudinal grooves are made according to the type zip lock with the ability to cover the waist with a longitudinal spike; in this case, the leading clip-holder is made in the form of a tube with the possibility of its tension on the controlled distal end; the end of the leading clip-holder, facing the organ cavity, is made in the form of a skirt without longitudinal grooves, while the diameter and length of the skirt depends on the throughput of the patient’s anal sphincter or upper esophageal sphincter and on the type of endoscopic intervention; wherein the intermediate clip-holders are made in the form of twisted springs in the amount of at least two, with the number of turns from 1.5 to 3.5, while the intermediate clip-holders are located on the flexible working part at an equal distance from each other; in this case, the closing clip-holder is made in the form of a horseshoe-shaped groove with the possibility of reliable fixation at the proximal end of the flexible working part close to the handle; the tabletop-holder is made of any shape with a U-shaped recess, through holes and fitted grooves, while the U-shaped recess is made corresponding to the cross-section of the handle with the possibility of fixing the tabletop-holder to the handle, while through holes and fitted grooves are made along the perimeter of the tabletop-holder with the possibility of fixing hinged instrumental channels, while the dimensions of the through holes correspond to the outer diameter of the hinged instrumental channels; in this case, the elements of the claimed device are interconnected as follows: the hinged instrumental channels are fixed on the flexible working part of the endoscope using a leading clip-holder, intermediate clip-holders and a trailing clip-holder, the proximal ends of the hinged instrumental channels are fixed in the through holes of the table-top holder, which is attached to the handle. A device for endoscopy, consisting of an endoscope, at least one hanging instrumental channel, clip holders, a tabletop holder; wherein the endoscope contains a flexible working part with a controlled distal end, containing standard channels inside: lighting, image transmission, combined air and water supply, kinematics placement; a handle with handles for forced control of the drive mechanisms of the controlled distal end of the flexible working part, an air and water supply button, a connecting cable; in this case, the hinged instrumental channels are made in the form of tubes made of dielectric material, approved for use in medicine, inert, not destroyed during disinfection, elastic-elastic, tensile strength, while the distal ends of the hinged instrumental channels are made atraumatic - beveled or rounded, and the proximal ends the ends are made in the form of a funnel with the possibility of insertion into the hinged instrumental channels of endoscopic instruments and are equipped with an elastic valve with the ability to prevent leakage of the inflating gas, in the form of two oppositely placed elastic membranes, with each of the membranes with one edge attached to the edge of the proximal end of the hinged instrumental channel, and the free the edges of the membranes fit tightly and overlap each other, extending one after another with the possibility of blocking the lumen of the hinged instrumental channel and preventing the leakage of inflating gas from the operated cavity, as well as with the possibility of passing the endoscopic instrument by enveloping it in the form of a cuff; along the entire length of the outer surface of each hinged instrumental channel, a longitudinal tenon in the form of a protrusion is made monolithically with it in such a way that the junction of the hinged instrumental channel and the longitudinal tenon is made narrowed in the form of a “waist” with the possibility of fixing the hinged instrumental channel in clip-holders; in this case, the length of the hanging instrumental channels is made not exceeding the length of the longest of the endoscopic instruments intended for use; hinged instrumental channels are fixed on clip-holders around the circumference of the flexible working part along the clock dial with the possibility of providing access for an endoscopic instrument to the area of the organ being examined or operated on; in this case, the clip-holders contain a leading clip-holder, intermediate clip-holders and a closing clip-holder, while the outer surface of all clip-holders is made with longitudinal grooves with the possibility of attaching hinged tool channels, while the shape and dimensions of the longitudinal grooves are made according to the type zip lock with the ability to cover the waist with a longitudinal spike; in this case, the leading clip-holder is made in the form of a tube with the possibility of its tension on the controlled distal end; the end of the leading clip-holder, facing the organ cavity, is made in the form of a skirt without longitudinal grooves, while the diameter and length of the skirt depends on the throughput of the patient’s anal sphincter or upper esophageal sphincter and on the type of endoscopic intervention; wherein the intermediate clip-holders are made in the form of twisted springs in the amount of at least two, with the number of turns from 1.5 to 3.5, while the intermediate clip-holders are located on the flexible working part at an equal distance from each other; in this case, the closing clip-holder is made in the form of a horseshoe-shaped groove with the possibility of reliable fixation at the proximal end of the flexible working part close to the handle; the tabletop-holder is made of any shape with a U-shaped recess, through holes and fitted grooves, while the U-shaped recess is made corresponding to the cross-section of the handle with the possibility of fixing the tabletop-holder to the handle, while through holes and fitted grooves are made along the perimeter of the tabletop-holder with the possibility of fixing hinged instrumental channels, while the dimensions of the through holes correspond to the outer diameter of the hinged instrumental channels; in this case, the elements of the claimed device are interconnected as follows: the hinged instrumental channels are fixed on the flexible working part of the endoscope using a leading clip-holder, intermediate clip-holders and a trailing clip-holder, the proximal ends of the hinged instrumental channels are fixed in the through holes of the table-top holder, which is attached to the handle. The device for endoscopy according to claim 1 and claim 2, characterized in that the longitudinal spike is made reaching the tip of the distal end and not reaching the edge of the proximal end of the hinged instrumental channel. The device for endoscopy according to claim 1 and claim 2, characterized in that the longitudinal spike is made not reaching the tip of the distal and the edge of the proximal ends of the hinged instrumental channel. The device for endoscopy according to claim 1 and claim 2, characterized in that the skirt of the leading clip-holder is made with one circular groove along the edge of the outer surface of the skirt with the possibility of fixing an endoscopic instrument. The device for endoscopy according to claim 1 and claim 2, characterized in that the skirt of the leading clip-holder is made without a circular groove. The method of using the device for endoscopy according to claim 1, which consists in taking the claimed device by the handle and inserting into the patient’s hollow organ being examined or operated on a flexible working part equipped with hinged instrumental channels mounted on clip-holders and a table-top holder; To carry out diagnostics, the patient’s organ being examined is examined and diagnosed using the standard equipment of the endoscope and at least one hanging instrumental channel, for which first air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then the hanging instrumental channel is connected to an aquapurator for supplying water under pressure, water is supplied and the mucous membrane is washed from biological contaminants, and through a standard working aspiration-instrumental/biopsy channel, aspiration of washing water and biological fluids is carried out; carry out diagnostics and, based on its results, determine a treatment program; to carry out treatment, air is insufflated through the standard channel for supplying air and water to inflate the lumen of the organ and create an internal operating space, then the distal end of the flexible working part is brought to the site of therapeutic actions, endoscopic instruments are introduced through hanging instrumental channels in the amount of at least one, in case using two or more hanging instrumental channels, they are either used completely, or some are left free for reserve; the standard working aspiration-instrumental/biopsy channel is either left free for water supply and aspiration of washing water and biological fluids, or used for insertion of an endoscopic instrument; then therapeutic actions are performed with the inserted endoscopic instruments; when the need arises, the used endoscopic instrument is removed from the hinged instrumental channels and the standard working aspiration-instrumental/biopsy channel and a situationally necessary endoscopic instrument is inserted instead, without removing the flexible working part from the patient’s hollow organ, the endoscopic instruments are mutually moved among themselves, and the angle of “attack” is changed. endoscopic instruments, work with endoscopic instruments simultaneously; upon completion of therapeutic actions, endoscopic instruments are alternately removed from the standard working aspiration-instrumental/biopsy channel and hanging instrumental channels, then air is removed from the internal surgical space, after which the declared device is removed, completing the medical intervention. The method of using the device for endoscopy according to claim 2, which consists in taking the claimed device by the handle and inserting a flexible working part equipped with hinged instrumental channels mounted on clip-holders and a table-top holder into the patient’s examined or operated hollow organ; To carry out diagnostics, the patient’s organ being examined is examined and diagnosed using the standard equipment of the endoscope and at least one hanging instrumental channel, for which first air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then the hanging instrumental channel is connected to to the aquapurator for supplying water under pressure, water is supplied and the mucous membrane is washed from biological contaminants, then the aquapurator is disconnected from the hinged instrumental channel and an aspirator is connected, and aspiration of washing water and biological fluids is carried out through the hinged instrumental channel; carry out diagnostics and, based on the diagnostic results, determine a treatment program; to carry out treatment, air is insufflated through the standard channel for supplying air and water to inflate the lumen of the organ and create an internal operating space, then the distal end of the flexible working part is brought to the site of therapeutic actions, endoscopic instruments are introduced through hanging instrumental channels in the amount of at least one, in case using two or more hanging instrumental channels, they are either used completely, or some are left free for reserve, then therapeutic actions are performed with endoscopic instruments inserted into the hanging instrumental channels; when a need arises, the used endoscopic instrument is removed from the hinged instrumental channels and a situationally necessary endoscopic instrument is inserted instead, without removing the flexible working part from the patient’s hollow organ, the endoscopic instruments are mutually moved among themselves, the angle of “attack” of the endoscopic instruments is changed, and the endoscopic instruments are operated simultaneously; upon completion of the therapeutic actions, endoscopic instruments are alternately removed from the hanging instrumental channels, then air is removed from the internal operating space, after which the claimed device is removed, completing the medical intervention. The method of using the device for endoscopy according to any of points 7, 8, characterized in that it is situationally necessary the endoscopic instrument is selected from at least the following: biopsy forceps, injector, electrosurgical loop, rat tooth forceps, clipper.

The claimed technical solution is illustrated in Figure 1 - Figure 12.

In FIG. Figure 1 shows the appearance of the claimed endoscopy device prepared for use: 1A – according to option, 1B – according to option 2.

In FIG. Figure 2 shows the flexible working part of the endoscope according to option 1.

In FIG. Figure 3 shows the flexible working part of the endoscope according to option 2.

In FIG. Figure 4 shows hinged instrumental channels (hereinafter referred to as NIK) with a longitudinal spike 18 made reaching the tip of the distal end 14 NIK (position A) and not reaching the tip of the distal end 14 NIK (pos. B and C), and also not reaching to the edge of the proximal end 15 NIK, while at pos. A, B, the distal ends of 14 NIK are made beveled, at pos. B – rounded.

In FIG. Figure 5 shows an elastic valve.

In FIG. Figure 6 shows a cross section of the NIK.

In FIG. Figure 7 shows the varieties of the leading clip-holder CD: 7A – without a circular groove, 7B – with a circular groove).

In FIG. Figure 8 shows the intermediate clip-holder CD in working condition.

In FIG. Figure 9 shows the intermediate clip-holder CD in a non-working (unfolded) state.

In FIG. Figure 10 shows the closing CD.

In FIG. 11 shows the circumference of the waist of the longitudinal tenon with longitudinal grooves like a zip lock.

In FIG. 12 shows a tabletop holder in the shape of a circle and a triangular shape.

Positions in Figure 1 - Figure 12 indicate:

1 - mounted instrumental channels (hereinafter referred to as NIK),

2 - leading clip-holder CD,

3 - intermediate clips - CD holders,

4 - closing clip-holder CD,

5 - tabletop-holder,

6 - flexible working part,

7 - controlled distal end of the flexible working part,

8 - standard working aspiration-instrumental/biopsy channel (hereinafter referred to as the standard working channel),

8a - entrance hole of the standard working aspiration-instrumental/biopsy channel,

8b - exit hole of the standard working aspiration-instrumental/biopsy channel,

9 - nozzle of the standard air and water supply channel,

10 - lenses of standard lighting transmission channels,

11 - lens of the standard image transmission channel,

12 - handle,

13 - connecting cable with illuminator connector,

14 - distal end of the NIK,

15 - proximal end of the NIK,

16 - elastic valve,

16.1 and 16.2 - membranes,

17 - endoscopic instrument,

18 - longitudinal spike,

19 - waist of the longitudinal spike (hereinafter referred to as the waist),

20 - longitudinal grooves CD,

21 - skirt,

22 - circulation groove,

23 - U-shaped recess of the tabletop-holder,

24 - through holes,

25 - fitted grooves.

Next, the applicant provides a description of the claimed technical solution with examples of specific implementation.

The declared technical result is achieved by developing the claimed device for endoscopy (variants) and the method of its use.

The applicant eliminates the identified design and functional shortcomings of the prototype by placing (on top of the elastic sealed shell) along the entire length of the flexible working part 6 of the endoscope, hanging instrumental channels (NIC) 1, additional to the standard working channel 8 (Fig. 1, Fig. 2). NIK 1 ensures that the endoscope is equipped with a larger number of endoscopic instruments, 17 compared to its analogues, in order to achieve the stated technical result.

Next, the applicant provides a description of the claimed device.

The claimed device for endoscopy includes (Fig. 1):

- endoscope (not indicated by a position in the Fig.) (according to option 1 and option 2),

- at least one mounted instrumental channel NIK 1;

- CD holder clips, including leading CD 2, intermediate CD 3 and trailing CD 4;

- table top holder 5.

Next, the applicant provides a detailed description of the components of the claimed device.

Options 1 and 2 of the claimed device differ in the design of the endoscope.

Endoscope according to option 1 (Fig. 1A).

The endoscope according to option 1 contains: a flexible working part 6 (Fig. 2) with a controlled distal end 7, containing standard channels inside (not indicated in Fig. by positions): lighting, image transmission, combined supply of air and water, placement of kinematics, as well as standard working channel 8, while the lighting and image transmission channels end at the end of the controlled distal end of the flexible working part with lenses 10 and 11, the standard working channel with outlet 8b, the combined air and water supply channel with nozzle 9, with outlet 8b of the working channel located, for example, at 7 o'clock on the hour dial (if you look at it in a mirror); handle 12 with handles located on it for forced control of the drive mechanisms of the controlled distal end of the flexible working part, aspiration control button, air and water supply button (positions not indicated in Fig.), inlet hole 8a into the standard working channel 8, drive mechanisms of the controlled distal end flexible working part located inside the handle; connecting cable 13 for connecting the endoscope with an external light source, a pump for supplying air and water, and an aspirator (not indicated in Fig.); The endoscope is covered with an elastic sealed sheath.

Endoscope according to option 2 (Fig. 1B).

The endoscope according to option 2 contains: a flexible working part 6 (Fig. 3) with a controlled distal end 7, containing standard channels inside (not indicated in Fig. by positions): lighting, image transmission, combined supply of air and water, placement of kinematics, while the lighting and image transmission channels end at the end of the controlled distal end of the flexible working part with lenses 10 and 11, combined with a nozzle 9; handle 12 with handles for forced control of drive mechanisms for the controlled distal end of the flexible working part, an aspiration control button, an air and water supply button, drive mechanisms for the controlled distal end of the flexible working part located inside the handle; connecting cable 13 for connecting the endoscope with an external light source, a pump for supplying air and water, and an aspirator (not indicated in Fig.); The endoscope is covered with an elastic sealed sheath.

The applicant explains that the difference between endoscopes in options 1 and 2 is the number of standard working channels in the flexible working part 6: in option 2 there is no standard working channel 8 (Figure 3), due to which the flexible working part 6 has a smaller cross-sectional diameter, which facilitates access to the patient's hollow organs and reduces the risk of injury. In this case, endoscopic instruments 17 in option 1 are inserted through the standard working channel 8 and hinged instrumental channels 1, in option 2 they are inserted only through hinged instrumental channels 1, which in both options helps to achieve the stated technical result.

Options 1 and 2 are alternative options in terms of purpose and achieved technical result and expand the arsenal of means for the specified purpose.

Mounted instrument channels NIK 1.

NIK 1 (Fig. 4) are made in the form of tubes made of dielectric material, approved for use in medicine, inert, not destroyed during high-level disinfection, elastic-elastic (collapses under load and restores its shape after removing the load), with a low coefficient of sliding friction between the inner walls of the NIK and the material of endoscopic instruments, high tensile strength, for example, silicone or silicone rubber [https://arthouse96.ru/informatsiya/stati_o_produktsii/vyibiraem_tverdost_silikona],

[http://elmica.ru/nashaprodukciya/rezinotehnicheskieizda/silikonovaya-rezina-plastiny-shnury-trubki.html].

In this case, the distal ends 14 of the NIK 1 are made atraumatic - beveled (Fig. 4, pos. A, B) or rounded (Fig. 4, pos. B), and the proximal ends 15 are made in the form of a funnel with the ability to provide convenient insertion of endoscopic instruments into the NIK instruments and are equipped with an elastic valve 16 (Fig. 5), preventing the leakage of inflation gas, in the form of two oppositely placed elastic membranes 16.1 and 16.2, each of the membranes with one edge attached to the edge of the proximal end 15, for example, by gluing, and the free edges of the membranes 16.1 and 16.2 fit tightly and overlap each other, extending one after the other with the possibility of blocking the lumen of the NIK 1 and preventing the leakage of inflating gas from the operated cavity, as well as with the possibility of passing the endoscopic instrument 17 (Figure 1) by enveloping it in the form of a cuff.

The applicant explains that:

- making the distal ends 14 of the NIK 1 beveled (Fig. 4, pos. A, B) allows for the safe introduction of the controlled distal end 7 of the flexible working part 6 with the CD and NIK fixed on it, for example, through the IPS into the esophagus and stomach. In this case, the fixation of several NIKs along the perimeter of the leading CD gives the controlled distal end 7 of the flexible working part a streamlined wedge-shaped (cone-shaped) shape, gradually increasing in diameter in the direction from the skirt 21 to the flexible working part 6 (Fig. 2, Fig. 3), which allows taking into account the crushability of the NIK, overcome the tone and small diameter of the opening of the IPS and safely pass into the lumen of the esophagus, smoothly and evenly spreading the muscles of the IPS along the entire perimeter;

- making the distal ends 14 of the NIK 1 rounded (Fig. 4, pos. B) allows for the safe insertion of the flexible working part 6 with the CD and NIK fixed on it, for example, through the anal canal into the rectum. At the same time, the fixation of several NIKs along the perimeter of the leading CD gives the controlled distal end 7 of the flexible working part a streamlined shape (Fig. 2, Fig. 3), which allows, taking into account the crushability of the NIK, to overcome the tone of the anal sphincter and safely pass into the lumen of the rectum, smoothly and evenly spreading the anal sphincter muscles around the entire perimeter.

Along the entire length of the outer surface of each NIK 1, a longitudinal tenon 18 is made monolithically with it (Fig. 4, 5, 6) in the form of a protrusion so that the junction of the NIK 1 and the longitudinal tenon 18 is made narrowed in the form of a “waist” 19 with the possibility of reliable fixing NIK 1 in clip holders 2, 3, 4.

In a particular case, the longitudinal spike 18 is made to reach the tip of the distal end 14 and not reach the edge of the proximal end 15 of the NIK (Fig. 4, position A). This design of the longitudinal spike 18 does not allow the distal end 14 of the NIK (Fig. 4, pos. A) to reach the skirt 21 of the leading CD 2 when mounting the device on the controlled distal end 7 of the flexible working part 6 (Fig. 2, Fig. 3, Fig. 7A, 7B), thereby achieving a gradual increase in the outer diameter of the controlled distal end 7 from the skirt to the flexible working part 6.

In another particular case of implementation, the longitudinal spike 18 is made not reaching the tip of the distal and the edge of the proximal ends of the NIK (Fig. 4, pos. B and C). This design of the longitudinal tenon 18 allows the distal end 14 of the NIK (Fig. 4, pos. A) to reach the length of the skirt 21 of the leading CD 2 and beyond, when mounting the device on the controlled distal end 7 of the flexible working part 6 (Fig. 2, Fig. .3, Figs. 7A, 7B), thereby achieving visualization of the instruments leaving the NIK, observation and control of their trajectory of movement.

The length of NIK 1 is made not exceeding the length of the longest of the flexible endoscopic instruments 17 intended for use.

The NIKs are fixed on CD 2, 3, 4 around the circumference of the flexible working part 6 (along the clock dial) (Fig. 1, Fig. 2, Fig. 3) with the ability to provide access for the endoscopic instrument 17 to any part of the organ being examined or operated on.

The number of NIK 1 depends on the type and purpose of endoscopic intervention, but at least one according to option 1 and at least one according to option 2.

Clip-holders (CD) for NIK mounted instrument channels.

Clip holders (CD) include leading CD 2 (Fig. 7), intermediate CD 3 (Fig. 8, 9) and trailing CD 4 (Fig. 10), while the outer surface of all CDs is made with longitudinal grooves 20 with the possibility of fastening NIK 1, while the shape and dimensions of the longitudinal grooves 20 are made like a zip lock with the possibility of covering the waist 19 of the longitudinal tenon 18 (Fig. 11).

The leading CD 2 is made in the form of a tube with the possibility of tensioning it on the controlled distal end 7. The end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves 20, while the diameter and length of the skirt 21 depends on the throughput of the sphincter the patient's device and the type of endoscopic intervention.

In one particular case, the skirt 21 of the leading CD 2 is made with one circular groove 22 along the edge of the outer surface of the skirt with the possibility of fixing an endoscopic instrument (Fig. 7B).

In another particular case, the skirt 21 of the leading CD 2 is made without a circular groove 22 (Fig. 7A).

Intermediate CD 3 are made in the form of twisted springs in the amount of at least two (Fig. 8, Fig. 9), with the number of turns from 1.5 to 3.5. In this case, the intermediate CDs 3 are located on the flexible working part 6 at an equal distance from each other (Fig. 1, Fig. 2, Fig. 3).

The closing CD 4 (Fig. 10) is made in the form of a horseshoe-shaped groove with the possibility of reliable fixation by the joint at the proximal end 15 of the flexible working part 6 close to the handle 12 (Fig. 1, Fig. 2, Fig. 3).

The table-top holder 5 (Fig. 1, Fig. 2, Fig. 3, Fig. 12) is made of any shape (for example, in the shape of a circle, triangular shape, star shape, etc.) with a U-shaped recess 23, through holes 24 and fitted grooves 25. In this case, the U-shaped recess 23 is made corresponding to the cross-section of the handle 12 with the possibility of fixing the table-top holder 5 to the handle 12 with an articulation. In this case, through holes 24 and fitted grooves 25 are made along the perimeter of the table-top holder 5 with the possibility of fixing the NIK 1 joint, while the dimensions of the through holes 24 correspond to the outer diameter of the NIK 1.

In this case, the elements of the claimed device are connected to each other as follows (Fig. 1, Fig. 2): hinged instrumental channels 1 are fixed on the flexible working part 6 of the endoscope using the leading CD 2, intermediate CD 3 and trailing CD 4, proximal ends 15 NIK 1 are fixed in the through holes 24 of the table-top holder 5, which is fixed to the handle 12. All elements are connected, for example, by an articulation.

Next, the applicant provides a description of the assembly of the claimed device.

NIKs, CD holder clips and a tabletop are manufactured in accordance with the design described above, for example, by casting from an inert, non-destructive during high-level disinfection, approved for medical use, elastic-elastic (crinkles under load and restores its shape after removing the load), with a low coefficient of sliding friction between the internal walls of hinged instrumental channels (NIC) and the material of endoscopic instruments, high tensile strength dielectric material, for example, silicone or silicone rubber [https://arthouse96.ru/informatsiya/stati_o_produktsii/vyibiraem_tverdost_silikona] and [http: //elmica.ru/nashaprodukciya/rezinotehnicheskieizda/silikonovaya-rezina-plastiny-shnury-trubki.html].

Take an endoscope made according to option 1 or option 2, fix the tabletop holder 5 on the handle 12 (Fig. 1, Fig. 2, Fig. 3) using a U-shaped recess 23 (Fig. 12), for example, with a joint. In this case, the tabletop-holder 5 is taken with the number and dimensions of through holes 24, corresponding to the number and dimensions of NIK 1.

Next, the controlled distal end 7 of the flexible working part 6 is connected to the leading CD 2, for example, by pulling the CD 2 onto the controlled distal end 7 using the elasticity of the CD material (Fig. 1, Fig. 2, Fig. 3).

Then, on the flexible working part 6, close to the handle 12, the closing clip-holder 4 is fixed (Fig. 1, Fig. 2, Fig. 3) by enveloping the flexible working part 6 with the clip-holder 4.

Then, at least two intermediate clip holders 3 (Fig. 1, Fig. 2, Fig. 3) are fixed on the flexible working part 6 at an equal distance from each other by wrapping coils of the spiral CD 3 around the flexible working part 6, using the elasticity of the CD material. The number of intermediate CDs 3 and the distance between them depends on the purpose of the endoscopic intervention.

Then the longitudinal grooves 20 are oriented first at the trailing CD 4, then at the intermediate CDs 3, then at the leading CD 2, for example - turning the CD around the flexible working part 6 so that the longitudinal grooves 20 of all CDs are lined up in one line as a continuation of each other and coincided with each other and were oriented with the through holes of the tabletop-holder 5 in one projection (Fig. 1, Fig. 2, Fig. 3).

Next, take the NIK and position them in such a way that the distal ends 14 are located next to the leading CD 2 (Fig. 1, Fig. 2, Fig. 3, Fig. 4), and the proximal ends 15 of the NIK are located at the table-top holder 5. Next fix the NIK, starting from their distal end 14, on CD 2, 3, CD 4, connecting the longitudinal grooves 20 of the clip holders and the longitudinal tenons 18 of the NIK. In this case, the spikes 18 are brought to the longitudinal grooves 20 (Fig. 11) and by pressing the fingers, the spikes are pressed into the longitudinal grooves 20, starting from the leading CD 2 at the controlled distal end 7, then sequentially into the intermediate CDs 3 on the flexible working part 6, moving in direction to the handle 12, and end with the closing CD 4, thereby tightly fastening the NIK along the entire length of the flexible working part 6 to all CDs using the zip lock type. After this, the proximal ends 15 of the NIK are fixed in the through holes 24 of the tabletop-holder 5 by articulating through the fitted grooves 25, using the elasticity of the material.

Next, the applicant provides a description of the claimed method of operation of the claimed device (variants) as a whole.

Take the claimed device, made according to option 1 or option 2, assembled according to the algorithm described above.

The patient is placed on the operating table, the claimed device is taken by the handle 12 and a flexible working part 6, equipped with NIKs 1, attached to the CD 2, CD 3, CD 4 and the table-top holder 5, is inserted into the patient’s hollow organ being examined or operated on.

Moreover, due to the manufacture of the NIK from an elastic-elastic material with walls tenths of a millimeter thick and a low coefficient of friction, the NIKs are crushed during the passage of the sphincter apparatus and, thanks to the streamlined configuration of the distal ends and clip holders, do not cause difficulties for inserting the flexible working part 6 into the test or the operated cavity of internal organs, for example, through the congenital heart into the esophagus and stomach. In the crumpled state, the NIKs slightly increase the outer diameter of the flexible working part 6, which creates insignificant, in comparison with analogues, resistance when inserting it through the patient’s sphincter apparatus, which is overcome due to the extensibility of biological tissues. The combination of elastic elasticity and crushability of the NIK with the extensibility of biological tissues helps to reduce, in comparison with analogues, the pain and trauma of the process of inserting the flexible working part 6 into the examined or operated hollow organ, which at the same time facilitates the operator’s work during diagnosis and subsequent therapeutic manipulations.

To carry out diagnostics, the organ being examined is examined and diagnosed using the standard equipment of the endoscope and at least one mounted instrumental channel, for which:

- according to option 1, first, air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then the NIK is connected, for example, to an aquapurator to supply water under pressure, water is supplied and the mucous membrane is washed from biological contaminants, and through The standard working channel 8 carries out aspiration of washing water and biological fluids. Conduct diagnostics and, based on the diagnostic results, determine a treatment program;

- according to option 2, first, air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then the NIK is connected to an aquapurator to supply water under pressure, water is supplied and the mucous membrane is washed from biological contaminants, then the aquapurator is disconnected from the NIK and connect an aspirator, and aspiration of washing water and biological fluids is carried out through the NIK. Diagnostics are carried out and a treatment program is determined based on the diagnostic results.

To carry out treatment, air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then:

- according to option 1, the distal end 7 of the flexible working part 6 is brought to the site of therapeutic actions, endoscopic instruments are inserted through the NIK 1 in an amount of at least one, in the case of using two or more NIK, part of the NIK is left free (reserve), for example, to change the angle “attack” or insertion of other instruments as needed, the standard working channel 8 is left free, for example, for supplying water and aspiration of rinsing water and biological fluids, or for inserting an endoscopic instrument. Then, with the instruments inserted into NIKi 1 and the standard working channel 8, therapeutic actions are performed;

- according to option 2, the distal end 7 of the flexible working part 6 is brought to the site of therapeutic actions, endoscopic instruments are inserted through the NIK 1 in an amount of at least one, if two or more NIKs are used, part of the NIK is left free (reserve), for example, for water supply and aspiration of rinsing waters and biological fluids, or to change the angle of “attack” or introduce other endoscopic instruments as needed. Then, therapeutic actions are performed with endoscopic instruments inserted into NIKi 1.

If a need arises, the used endoscopic instrument is removed from the NIK and a situationally necessary endoscopic instrument is inserted instead, without removing the flexible working part 6 from the hollow organ, the endoscopic instruments are mutually moved among themselves, the angle of “attack” of the instruments is changed, and several endoscopic instruments are operated simultaneously.

Upon completion of the therapeutic actions, endoscopic instruments are alternately removed from NIK 1, then air is removed from the internal surgical space, after which the claimed device is removed, completing the medical intervention.

Next, the applicant provides examples of the implementation of the claimed technical solution.

The given examples illustrate the claimed technical solution, but do not limit the scope of patent claims.

To carry out experiments in examples 1 - 6, carcasses of slaughtered pigs weighing 70 - 80 kg, obtained in a subsidiary farm, were used. The experiments were carried out immediately after the pigs were slaughtered for 1 hour.

EXAMPLE 1 according to option 1. Carrying out an endoscopic diagnostic examination and therapeutic intervention on a hollow organ of the upper gastrointestinal tract, for example, the stomach, with the claimed device with one NIK and an endoscope according to option 1 with one standard working channel (Fig. 1A, Fig. 2).

Take the declared device according to option 1, assembled according to the algorithm described above.

When choosing the number of NIKs, the variety of their distal end 14, the design options for the longitudinal spike 18 (Fig. 4, pos. A, pos. B, pos. C), the number of CDs and their location on the flexible working part of the endoscope, we took into account the structural features of the upper gastrointestinal tract , for example, the small diameter of the opening of the UHL, as well as the purpose of endoscopic intervention.

According to example 1 for taking a biopsy:

- on the endoscope, using a CD, we recorded, for example, one NIK at 5 o’clock on the hour dial, in such a way that the beveled distal end of the NIK (Fig. 4, pos. A) does not extend onto the skirt 21 of the leading CD 2 (Fig. 7 );

- the distal end 14 of NIK 1 is made beveled (Fig. 4, pos. A);

- longitudinal spike 18 on the NIK is made reaching the tip of the distal beveled end and not reaching the edge of the proximal end of the NIK (Fig. 4, pos. A);

- the end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves and without a circular groove 22 (Fig. 7A);

- intermediate CD 3 are made in the form of two coiled springs with 1.5 turns around the flexible working part of the endoscope 6 (Fig. 8, Fig. 9);

- the tabletop holder 5 is made in the shape of a circle (Fig. 12).

The pig carcass was placed on a manipulation table, the pig's mouth was parted, the mouth was fixed in an open state, the claimed device was taken by the handle 12, and then sequentially - first into the pharynx, then into the esophagus and into the stomach, a flexible working part 6, equipped with one NIK 1 by 5, was inserted - three (five) hours on the dial, mounted on the leading CD 2, on two intermediate CDs 3, trailing CD 4 and tabletop holder 5. Introduction of a flexible working part 6, equipped with a leading CD 2, two intermediate CDs 3, one trailing CD 4 and one NIK 1 passed unhindered due to the streamlined wedge-shaped shape of the controlled distal end 7 of the flexible working part together with CD 2 and the crushability of the NIK when passing the upper esophageal sphincter.

To simulate a diagnostic biopsy, air was insufflated through the standard air and water supply channel 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, then NIK 1 was connected to an aquapurator and a stream of water under pressure was supplied into the organ cavity, the mucous membrane was washed from mucus and residues food, through the standard working channel 8, aspiration of washing liquids was performed, and the mucous membrane was examined. The need for a biopsy of the mucous membrane was conditionally determined. To simulate a biopsy of the mucous membrane, biopsy forceps were inserted through NIK1 and a piece of the mucous membrane was pinched off and then removed.

The insertion and removal of the endoscopic instrument from the lumen of the organ went smoothly. During the diagnostic process, no collapse of the cavity under study was observed.

To simulate polypectomy, air was insufflated through the standard channel for supplying air and water 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, the controlled distal end 7 of the flexible working part 6 was brought to the site of a conditional polypectomy of the stomach, and an injector was inserted through the standard working channel 8 of the endoscope. , injected into the submucosal layer of the stomach, injected the required amount of saline to create an infiltration “cushion” - a conditional polyp, after which the injector was removed.

An electrosurgical loop was inserted into the lumen of the organ through NIK1, opened and placed over a conditional polyp. To ensure radical resection of the conditional polyp, a second instrument, forceps, was inserted through the standard working channel 8, grabbed the conditional polyp by the apex and pulled to the end of the endoscope so that the electrosurgical loop dropped closer to the gastric wall and covered the conditional polyp and its pseudopod. After this, the loop was tightened on the pseudopod of the conditional polyp and an electric current was applied to the loop, the conditional polyp was cut off, a wound surface with an exposed submucosal layer was formed at the resection site, the removed conditional polyp was fragmented with a loop, then with forceps inserted through the standard working channel 8, fragments of the conditional polyp were removed outward, the electrosurgical loop was removed from NIK 1, then an aquapurator was connected to NIK 1. A jet of water under pressure was applied to the organ cavity on the wound surface, the wound surface was washed, and the washing liquid was simultaneously aspirated through the standard working channel 8. Then the location of the wound surface in the surgical space was assessed on the monitor screen. The wound surface is located at 7 o'clock on the dial on the front wall of the lower third of the body of the stomach, closer to the greater curvature. After this, the optimal angle of “attack” was selected for bringing the “rat tooth” forceps in order to bring the edges of the wound together. In this case, the NIK, located at 5 o'clock on the dial (on the contralateral side of the wound) turned out to be the most optimal for capturing and bringing together the edges of the wound. To do this, the aquapurator was disconnected from the NIK at 5 o'clock on the dial, rat-tooth forceps were inserted, and the edges of the wound were grasped and brought together. A clipper with a clip was inserted through the standard working channel 8 and the edges of the wound were fixed together. To completely close the wound, it was necessary to apply a second clip from the contralateral side - at a different angle of “attack”. To do this, “rat tooth” type forceps were removed from the NIK, located at 5 o’clock on the dial. Then a clipper was inserted into it and the edges of the wound were completely clipped, applying a second clip. In this case, the clipper was freely removed to reload the clips, and its location and angle of “attack” were changed, without changing the position of the controlled distal end 7 of the flexible working part 6 of the endoscope.

Upon completion of the conditional therapeutic and diagnostic actions, endoscopic instruments 17 were removed from the NIK 1 and from the standard working channel 8 (Fig. 1), then air was aspirated from the internal operating space through the standard working channel 8, after which the claimed device was removed and the conditional medical intervention was completed.

All manipulations, from diagnosis to therapeutic intervention, were performed without removing the endoscope from the pig carcass and without changing the position of its controlled distal end 7 of the flexible working part in relation to the conditionally pathological formation and to the wound surface. The insertion and removal of the endoscopic instrument through the NIK went smoothly. During the operation, no collapse of the internal operating space was observed. The presence of a multichannel endoscope contributed to the simultaneous use of min two instruments (an electrosurgical loop and forceps, a clipper and “rat tooth” forceps), rotation of instruments with a change in their angle of “attack”, and optimized access by instruments to hard-to-reach areas of the surgical field, and also facilitated separate connecting an aquapurator and an aspirator (each into its own channel), providing the possibility of their simultaneous use when washing a wound defect.

EXAMPLE 2 according to option 1. Carrying out an endoscopic diagnostic examination and therapeutic intervention on a hollow organ of the upper gastrointestinal tract, for example, the stomach, with the claimed device with three NIK and an endoscope according to option 1 with one standard working channel (Fig. 1A, Fig. 2).

Take the declared device according to option 1, assembled according to the algorithm described above.

The choice of the type of NIK (the shape of the distal end 14, the design options for the longitudinal spike 18 (Fig. 4, pos. A, pos. B, pos. C), the number of NIK and the number of CDs, their location on the flexible working part of the endoscope is influenced by the structural features of the upper section of the gastrointestinal tract, for example, the small diameter of the opening of the UHL, as well as the purpose of endoscopic intervention.

According to example 2 for taking a biopsy:

- on an endoscope using a CD, for example, three NIKs were recorded along the lower-right semicircle of the flexible working part at 3, 5 and 8 o’clock on the hour dial, in such a way that the beveled distal ends of all NIKs (Fig. 4 , pos. B) extend onto the skirt 21 of the leading CD 2 (Fig. 7) and are tightly adjacent to its surface;

- the distal ends 14 of NIK 1 are made beveled (Fig. 4, pos. B);

- longitudinal spike 18 on the NIK is made not reaching the tip of the distal beveled end and not reaching the edge of the proximal end of the NIK (Fig. 4, pos. B);

- the end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves, with a circular groove 22 along the edge of the outer surface (Fig. 7B);

- The NIK, located at 5 o’clock on the dial, was pre-equipped with an electrosurgical loop. The loop was opened and fixed on the circular groove 22 of the skirt 21 of the leading CD 2 by tightening the loop so that the latter was completely immersed in the circular groove 21.

- intermediate CDs 3 are made in the form of three twisted springs with 2.5 turns around the flexible working part of the endoscope 6 (Fig. 8, Fig. 9);

- the table-top holder 5 is made in the shape of a triangle (Fig. 12).

The pig carcass was placed on a manipulation table, the claimed device was taken by the handle 12, the pig's mouth was parted, the mouth was fixed in an open state, and then sequentially - first into the pharynx, then into the esophagus and into the stomach, a flexible working part 6, equipped with three NIKs 1, secured on KD 2, KD 3, KD 4, and tabletop holder 5, and with one tool in NIK.

The passage of the flexible working part 6, equipped with a leading CD 2, three intermediate CDs 3, one trailing CD 4, three NIKs 1 and with one instrument in the NIK, passed through the IPS without hindrance, due to the location of all NIKs within one semicircle, the streamlining of the wedge-shaped controlled distal the end 7 of the flexible working part together with CD 2 and the crushing of two free NIK.

To simulate a diagnostic biopsy, air was insufflated through the standard air and water supply channel 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, then NIK 1, located at 3 o’clock on the dial, was connected to an aquapurator and a stream of water was supplied into the organ cavity under pressure, washed the mucous membrane from mucus and food debris, performed simultaneous aspiration of washing liquids through the standard working channel 8, and examined the mucous membrane. The need for a biopsy of the mucous membrane was conditionally determined. To simulate a biopsy of the mucous membrane through NIK 1, located at 8 o'clock on the dial, biopsy forceps were inserted and a piece of the mucous membrane was pinched off and then removed.

The insertion and removal of the endoscopic instrument from the lumen of the organ went smoothly. During the diagnostic process, no collapse of the cavity under study was observed.

To simulate polypectomy, air was insufflated through the standard channel for supplying air and water 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, the controlled distal end 7 of the flexible working part 6 was brought to the place of conditional polypectomy, through the NIK at 8 o'clock on the dial , an injector was introduced, the submucosal layer of the stomach was injected with the injector, the required amount of saline was injected to create an infiltration “cushion” - a conditional polyp, after which the injector was removed.

To ensure radical resection, biopsy forceps were inserted into the standard working channel 8, grabbed the conditional polyp by the apex and pulled it to the end of the flexible working part, and released the electrosurgical loop located in the NIK at 5 o’clock on the dial from the circular groove 22 of the skirt 21 of the leading clip 2 , and sliding the loop along the biopsy forceps, as if along a guide, brought the loop to the conditional polyp, continuing to hold the conditional polyp with forceps, they threw an electrosurgical loop over it so that the electrosurgical loop dropped closer to the gastric wall and covered the conditional polyp and its pseudopod. After this, the loop was tightened on the pseudopod of the conditional polyp and an electric current was applied to the loop, the conditional polyp was cut off, a wound surface with an exposed submucosal layer was formed at the resection site, the removed conditional polyp was fragmented with a loop, then with forceps inserted through the standard working channel 8, fragments of the conditional polyp were removed outward, the forceps were removed, and the electrosurgical loop was removed from the IEC. Then, at 3 o'clock, an aquapurator was connected to NIK1, a stream of water under pressure was applied to the organ cavity on the wound surface, the wound surface was washed, and the washing liquid was aspirated through the standard working channel 8. Then the location of the wound surface in the surgical space was assessed on the monitor screen. The wound surface is located at 7 o'clock on the dial on the front wall of the lower third of the body of the stomach, closer to the greater curvature. After this, the optimal angle of “attack” was selected for bringing “rat tooth” forceps to bring the edges of the wound together. In this case, the NIK, located at 3 o'clock on the dial (on the contralateral side of the wound) turned out to be the most optimal for capturing and bringing together the edges of the wound.

To do this, the aquapurator was disconnected from the NIK at 3 o'clock on the dial, rat-tooth forceps were inserted, and the edges of the wound were grasped and brought together. Through the NIK, located at 5 o'clock on the dial, a clipper with a clip was inserted and the edges of the wound were fixed together. To completely close the wound, it was necessary to apply a second clip also on the contralateral side, but at a different angle of “attack”. To do this, “rat tooth” type forceps were removed from the NIK, located at 3 o’clock on the dial. Then a clipper was inserted into it and the edges of the wound were completely clipped, applying a second clip. In this case, the clipper was freely removed twice to reload the clips, and its location and angle of “attack” were changed without changing the position of the controlled distal end 7 of the flexible working part 6 of the endoscope.

Upon completion of the conditional therapeutic and diagnostic actions, endoscopic instruments 17 were removed from NIK 1 (Fig. 1), then air was aspirated from the internal operating space through the standard working channel 8, after which the declared device was removed and the conditional medical intervention was completed.

All manipulations, from diagnosis to therapeutic intervention, were performed without removing the endoscope from the pig carcass and without changing the position of its controlled distal end 7 of the flexible working part in relation to the conditionally pathological formation and to the wound surface. The insertion and removal of the endoscopic instrument through the NICI went smoothly. During the operation, no collapse of the internal operating space was observed. The presence of a multichannel endoscope contributed to the simultaneous use of min two instruments (an electrosurgical loop and forceps, a clipper and “rat tooth” forceps), rotation of instruments with a change in their angle of “attack”, and optimized access by instruments to hard-to-reach areas of the surgical field, and also facilitated separate connecting an aquapurator and an aspirator (each into its own channel), providing the possibility of their simultaneous use when washing a wound defect.

EXAMPLE 3 according to option 1. Carrying out an endoscopic diagnostic examination and therapeutic intervention on a hollow organ of the lower gastrointestinal tract, for example, the rectum, with the claimed device with five NIK and an endoscope according to option 1 with one standard working channel (Fig. 1A, Fig. 2) .

Take the declared device according to option 1, assembled according to the algorithm described above.

The choice of the type of NIK (the shape of the distal end 14, the design options for the longitudinal spike 18 (Fig. 4, pos. A, pos. B, pos. C), the number of NIK and the number of CDs, their location on the flexible working part of the endoscope is influenced by the structural features of the lower section Gastrointestinal tract, for example, greater opening of the anal sphincter, as well as the purpose of endoscopic intervention.

According to example 3 for taking a biopsy:

- on the endoscope using a CD, for example, five NIKs are fixed around the entire circumference of the flexible working part at 3, 5, 8, 9 and 12 o’clock on the hour dial, such that the distal ends of all NIK (Fig. 4, pos. B) extend onto the skirt 21 of the leading CD 2 (Fig. 7) and are tightly adjacent to its surface;

- the distal ends of the hinged instrumental channels are made rounded (Fig. 4, pos. B);

- the longitudinal spike 18 on the NIKs is made not reaching the tip of the distal end and not reaching the edge of the proximal end of the NIKs (Fig. 4, pos. B and C);

- the end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves and without a circular groove 22 (Fig. 7A);

- intermediate CDs 3 are made in the form of five twisted springs with 3.5 turns around the endoscope 6 (Fig. 8, Fig. 9);

- table top-holder 5 is star-shaped.

The pig carcass was placed on a manipulation table, the claimed device was taken by the handle 12 and a flexible working part 6, equipped with five NIKs 1, was inserted through the sphincter of the anal canal at 3, 5, 8, 9 and 12 o'clock along the dial, mounted on the leading CD 2, on five intermediate CDs 3, the trailing CD 4 and the table-top holder 5, into the rectum.

The introduction of the flexible working part 6, equipped with a leading CD 2, five intermediate CDs 3, one trailing CD 4 and five NIKs 1, passed through the anal sphincter without hindrance, due to the streamlined shape of the controlled distal end 7 of the flexible working part together with CD 2 and the crushability of all NIKs when passage of the anal sphincter.

To simulate a diagnostic biopsy, air was insufflated through the standard air and water supply channel 9 into the lumen of the rectum to inflate the lumen of the organ and create an internal operating space, then the NIK, located at 3 o’clock on the dial, was connected to the aquapurator, the standard working channel 8 was connected to the aspirator, at the same time A stream of water under pressure was applied into the lumen of the organ and aspiration of washing liquids was performed, thus washing the mucous membrane from mucus and remnants of intestinal contents and examining it. The need for a biopsy of the mucous membrane was conditionally determined. To simulate a biopsy of the mucous membrane, biopsy forceps were inserted into NIK 1, located at 9 o’clock on the dial, and a piece of the mucous membrane was pinched off and then removed.

The insertion and removal of the endoscopic instrument from the lumen of the organ went smoothly. During the diagnostic process, no collapse of the cavity under study was observed.

To simulate polypectomy, air was insufflated through the standard channel for supplying air and water 9 into the lumen of the rectum to inflate the lumen of the organ and create an internal operating space; the controlled distal end 7 of the flexible working part 6 was brought to the site of the conditional polypectomy.

An electrosurgical loop was inserted through the NIK at 5 o'clock on the dial, an injector was inserted through the NIK at 9 o'clock on the dial, and a clipper was inserted through the NIK at 12 o'clock on the dial. The NIK at 8 o'clock on the dial was left in reserve for introducing another instrument or changing the angle of "attack". Then the injector was injected into the submucosal layer of the rectum, the required amount of saline was injected to create an infiltration “cushion” - a conditional polyp, after which the injector was removed.

They opened the electrosurgical loop, brought the loop to the conditional polyp, and threw it on it. To ensure radical resection through the NIK, at 9 o'clock, biopsy forceps were inserted, grabbed the conditional polyp by the apex and pulled it closer to the end of the flexible working part, so that the electrosurgical loop dropped closer to the intestinal wall, covering the polyp and its pseudopod, then the loop was tightened and applied an electric current to it, the conditional polyp was cut off, a wound surface with a bare submucosal layer was formed at the resection site, the conditional polyp was fragmented with an electrosurgical loop, fragments of the conditional polyp were removed with forceps, then the forceps and the electrosurgical loop were removed as unnecessary, through the NIK for 3 At about 10 o'clock, a jet of water under pressure was applied into the organ cavity, the wound surface was washed, the washing liquid was aspirated through the standard working channel 8. The localization of the wound surface in the surgical space was assessed - on the monitor screen the wound surface was located at 3 o'clock on the dial. After this, the optimal location of the NIK was selected for bringing “rat tooth” forceps in order to bring the edges of the wound together, i.e. NIKs located on the contralateral side of the wound at 8 and 9 o'clock on the dial. We inserted “rat tooth” forceps through the NIK at 9 o’clock, grabbed the edges of the wound defect and brought them close to each other, then clipped the edges of the wound defect using a clipper located at 12 o’clock on the dial. The rat tooth forceps were removed. Clipping of the edges of the wound defect turned out to be incomplete, and the location of the wound edges also turned out to be not very convenient for subsequent capture with clips, so the clipper with the clip was inserted through the NIK, located at 8 o’clock on the dial, changing the angle of “attack” of the instrument and finally fixing the edges of the wound to each other, placing two more clips. In this case, the clipper was freely removed twice to reload the clips.

During the clipping process, the location and angle of “attack” of the instrument were optimal - the position of the controlled distal end 7 of the flexible working part 6 of the endoscope was not changed.

Through the NIK, located at 3 o'clock on the dial, the surgical field was washed with water, followed by aspiration of the washing water through the standard working channel 8. The result of clipping was assessed.

Upon completion of the conditional therapeutic and diagnostic actions, all instruments 17 were removed from NIK 1 (Fig. 1), then air was aspirated from the internal operating space through the standard working channel 8, after which the declared device was removed and the conditional medical intervention was completed.

All manipulations, from diagnosis to therapeutic intervention, were performed without removing the endoscope from the pig carcass and without changing the position of its controlled distal end 7 of the flexible working part in relation to the conditionally pathological formation and to the wound surface. The insertion and removal of the endoscopic instrument through the NICI went smoothly. During the operation, no collapse of the internal operating space was observed. The presence of a multichannel endoscope contributed to the simultaneous use of min two instruments (an electrosurgical loop and forceps, a clipper and “rat tooth” forceps), rotation of instruments with a change in their angle of “attack”, and optimized access by instruments to hard-to-reach areas of the surgical field, and also facilitated separate connecting an aquapurator and an aspirator (each into its own channel), providing the possibility of their simultaneous use when washing a wound defect.

EXAMPLE 4 according to option 2. Carrying out an endoscopic diagnostic examination and therapeutic intervention on a hollow organ of the upper gastrointestinal tract, for example, the stomach, with the claimed device with one NIK and an endoscope according to option 2 without a standard working channel (Fig. 1B, Fig. 3).

Take the declared device according to option 2, assembled according to the algorithm described above.

When choosing the number of NIKs, the variety of their distal end 14, the design options for the longitudinal spike 18 (Fig. 4, pos. A, pos. B, pos. C), the number of CDs and their location on the flexible working part of the endoscope, we took into account the structural features of the upper gastrointestinal tract, for example, the small diameter of the opening of the UHL, as well as the purpose of endoscopic intervention.

According to example 4 for taking a biopsy:

- on the endoscope, using a CD, we recorded, for example, one NIK at 5 o’clock on the hour dial, in such a way that the beveled distal end of the NIK (Fig. 4, pos. A) does not extend onto the skirt 21 of the leading CD 2 (Fig. 7 );

- the distal end 14 of NIK 1 is made beveled (Fig. 4, pos. A);

- longitudinal spike 18 on the NIK is made reaching the tip of the distal beveled end and not reaching the edge of the proximal end of the NIK (Fig. 4, pos. A);

- the end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves and without a circular groove 22 (Fig. 7A);

- intermediate CD 3 are made in the form of two twisted springs with 1.5 turns around the flexible working part of the endoscope 6 (Fig. 8, Fig. 9),

- tabletop-holder 5 is made in the shape of a circle (Fig. 12),

The pig carcass was placed on a manipulation table, the pig's mouth was parted, the mouth was fixed in an open state, the claimed device was taken by the handle 12, and then sequentially - first into the pharynx, then into the esophagus and into the stomach, a flexible working part 6, equipped with one NIK 1 by 5, was inserted - three hours on the dial, mounted on the leading CD 2, on two intermediate CDs 3, the trailing CD 4 and the table-top holder 5.

The introduction of the flexible working part 6, equipped with a leading CD 2, two intermediate CDs 3, one trailing CD 4 and one NIK 1, passed without hindrance due to the small diameter and streamlined wedge-shaped shape of the controlled distal end 7 of the flexible working part together with CD 2, and the crushability of the NIK during passage upper esophageal sphincter.

To simulate a diagnostic biopsy, air was insufflated through the standard air and water supply channel 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, then NIK 1 was connected to an aquapurator and a stream of water under pressure was supplied into the organ cavity, the mucous membrane was washed from mucus and residues food, NIK 1 was disconnected from the aquapurator and connected to an aspirator, aspiration of washing liquids was performed, and the mucous membrane was examined. The need for a biopsy of the mucous membrane was conditionally determined. To simulate a biopsy of the mucous membrane, biopsy forceps were inserted through NIK1 and a piece of the mucous membrane was pinched off and then removed.

The insertion and removal of the endoscopic instrument from the lumen of the organ went smoothly. During the diagnostic process, no collapse of the cavity under study was observed.

To simulate polypectomy, air was insufflated through the standard channel for supplying air and water 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, the controlled distal end 7 of the flexible working part 6 was brought to the place of conditional polypectomy, an injector was inserted into the lumen of the organ through the NIK, and the injection was made. into the submucosal layer of the stomach, the required amount of saline was injected to create an infiltration “cushion” - a conditional polyp, after which the injector was removed.

Through NIK1, an electrosurgical loop was introduced into the lumen of the organ, opened and draped over the conditional polyp, the loop was tightened on the pseudopod of the conditional polyp and an electric current was applied to the loop, the polyp was cut off, a wound surface with a bare submucosal layer was formed at the resection site, the removed conditional polyp was fragmented with a loop, then the electrosurgical loop was removed from the IEC. Forceps were inserted through the NIK and fragments of the conditional polyp were removed. An aquapurator was connected to the NIK, a stream of water under pressure was applied to the organ cavity on the wound surface, the wound surface was washed, NIK 1 was disconnected from the aquapurator and connected to an aspirator, and the washing liquid was aspirated. Then the location of the wound surface in the operating space was assessed on the monitor screen. The wound surface is located at 7 o'clock on the dial on the front wall of the lower third of the body of the stomach, closer to the greater curvature. After this, a clipper with a clip was inserted through the NIK, located at 5 o’clock on the dial, and the edges of the wound were connected. For complete and final closure of the wound, it was necessary to apply a second clip - at a different angle of “attack”, changing the position of the controlled distal end 7 of the flexible working part 6. In this case, the clipper was freely removed twice to reload the clips.

Upon completion of the conditional therapeutic and diagnostic actions, the endoscopic instrument was removed from NIK 1, air was aspirated through it from the internal surgical space, after which the declared device was removed, and the conditional medical intervention was completed.

All manipulations, from diagnosis to therapeutic intervention, were performed without removing the endoscope from the pig carcass, but at the same time the position of the controlled distal end 7 of the flexible working part 6 was changed in relation to the conditionally pathological formation and to the wound surface. The insertion and removal of the endoscopic instrument through the NIK went smoothly. During the operation, no collapse of the internal operating space was observed. The presence of a multi-channel endoscope contributed to the alternate rotation of instruments (electrosurgical loop, forceps and clipper), as needed, and changing their angle of “attack” was achieved by changing the position of the controlled distal end 7 of the flexible working part 6 and optimized access for instruments to hard-to-reach areas of the surgical field , and also contributed to the alternate connection of the aquapurator and aspirator, providing the possibility of their alternate use when washing the wound defect. The endoscope according to option 2 coped with the task. NIK works similarly to the standard working channel 8 according to option 1.

EXAMPLE 5 according to option 2. Carrying out an endoscopic diagnostic examination and therapeutic intervention on a hollow organ of the upper gastrointestinal tract, for example, the stomach, with the claimed device with three NIKs and an endoscope according to option 2 without a standard working channel (Fig. 1B, Fig. 3).

Take the declared device according to option 2, assembled according to the algorithm described above.

The choice of the type of NIK (the shape of the distal end 14, the design options for the longitudinal spike 18 (Fig. 4, pos. A, pos. B, pos. C), the number of NIK and the number of CDs, their location on the flexible working part of the endoscope is influenced by the structural features of the upper section Gastrointestinal tract, for example, the small diameter of the opening of the UHL, as well as the target of endoscopic intervention.

According to example 5 for taking a biopsy:

- on an endoscope using a CD, for example, three NIKs were recorded along the lower-right semicircle of the flexible working part at 3, 5 and 8 o’clock on the hour dial, in such a way that the beveled distal ends of all NIKs (Fig. 4 , pos. B) extend onto the skirt 21 of the leading CD 2 (Fig. 7) and are tightly adjacent to its surface;

- the distal ends 14 of NIK 1 are made beveled (Fig. 4, pos. B);

- longitudinal spike 18 on the NIK is made not reaching the tip of the distal beveled end and not reaching the edge of the proximal end of the NIK (Fig. 4, pos. B);

- the end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves, with a circular groove 22 along the edge of the outer surface (Fig. 7B);

- The NIK, located at 5 o’clock on the dial, was pre-equipped with an electrosurgical loop. The loop was opened and fixed on the circular groove 22 of the skirt 21 of the leading CD 2 by tightening the loop so that the latter was completely immersed in the circular groove 21;

- intermediate CDs 3 are made in the form of three twisted springs with 2.5 turns around the flexible working part of the endoscope 6 (Fig. 8, Fig. 9);

- tabletop-holder 5 is made in the shape of a triangle.

The pig carcass was placed on a manipulation table, the claimed device was taken by the handle 12, the pig's mouth was parted, the mouth was fixed in an open state, and then sequentially - first into the pharynx, then into the esophagus and into the stomach, a flexible working part 6, equipped with three NIKs 1, secured on KD 2, KD 3, KD 4, and tabletop holder 5, and one tool in NIK.

The passage of the flexible working part 6, equipped with a leading CD 2, three intermediate CDs 3, one trailing CD 4, three NIK 1 and with one instrument in the NIK, passed through the IPU without hindrance, due to the location of all NIK within one semicircle, the smaller diameter and streamlining of the wedge-shaped the shape of the controlled distal end 7 of the flexible working part together with CD 2 and the crushability of two free NIK.

To simulate a diagnostic biopsy, air was insufflated through the standard air and water supply channel 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, then NIK 1, located at 3 o’clock on the dial, was connected to an aquapurator and a stream of water was supplied into the organ cavity under pressure, washed the mucous membrane from mucus and food debris, performed simultaneous aspiration of washing liquids through the NIK located at 8 o’clock on the dial, and examined the mucous membrane. The need for a biopsy of the mucous membrane was conditionally determined. To simulate a biopsy of the mucous membrane, the NIK, located at 8 o'clock on the dial, was disconnected from the aspirator, biopsy forceps were inserted through the NIK and a piece of the mucous membrane was pinched off, followed by its removal.

The insertion and removal of the endoscopic instrument from the lumen of the organ went smoothly. During the diagnostic process, no collapse of the internal surgical space was observed.

To simulate polypectomy, air was insufflated through the standard channel for supplying air and water 9 into the lumen of the stomach to inflate the lumen of the organ and create an internal operating space, the controlled distal end 7 of the flexible working part 6 was brought to the place of conditional polypectomy, through the NIK at 8 o'clock on the dial , an injector was introduced, the injector was injected into the submucosal layer of the stomach, the required amount of saline was injected to create an infiltration “cushion” - a conditional polyp, after which the injector was removed.

For resection of the conditional polyp, an electrosurgical loop was released (in the NIK at 5 o'clock), from the circular groove 22 of the skirt 21 of the leading clip 2 and thrown onto the conditional polyp. To ensure radical resection through the NIK, at 8 o'clock on the dial, forceps were inserted, grabbed the conditional polyp and pulled it closer to the end of the controlled distal end 7 of the flexible working part, so that the electrosurgical loop dropped closer to the gastric wall and covered the conditional polyp and its pseudopod. After this, the loop was tightened on the pseudopod of the conditional polyp and an electric current was applied to the loop, the polyp was cut off, a wound surface with an exposed submucosal layer was formed at the resection site, the removed conditional polyp was fragmented with a loop, fragments of the conditional polyp were removed with forceps, and the forceps were removed from the NIK at 8 clock on the dial, the electrosurgical loop was removed from the NIK at 5 o'clock on the dial, an aspirator was connected to the NIK at 5 o'clock, an aquapurator was connected to the NIK at 3 o'clock, a stream of water under pressure was applied to the organ cavity on the wound surface, washing the wound surface, the washing liquid was aspirated through the NIK at 5 o'clock on the dial, the location of the wound surface in the surgical space was assessed - on the monitor screen the wound surface was located at 7 o'clock on the dial on the front wall of the lower third of the body of the stomach closer to the greater curvature. After this, the optimal angle of “attack” was selected for bringing “rat tooth” forceps to bring the edges of the wound together. In this case, the NIK, located at 3 o'clock on the dial (on the contralateral side of the wound) turned out to be the most optimal for capturing and bringing together the edges of the wound. To do this, the aquapurator was disconnected from the NIK at 3 o'clock on the dial, rat-tooth forceps were inserted, and the edges of the wound were grasped and brought together. Through the NIK, located at 5 o'clock on the dial, a clipper with a clip was inserted and the edges of the wound were fixed together. To completely close the wound, it was necessary to apply a second clip also on the contralateral side, but at a different angle of “attack”. To do this, “rat tooth” type forceps were removed from the NIK, located at 3 o’clock on the dial. Then a clipper was inserted into it and the edges of the wound were completely clipped, applying a second clip. In this case, the clipper was freely removed twice to reload the clips, and its location and angle of “attack” were changed without changing the position of the controlled distal end 7 of the flexible working part 6 of the endoscope.

Upon completion of the conditional therapeutic and diagnostic actions, endoscopic instruments 17 were removed from all NIK 1 (Fig. 1), then through the NIK at 5 o'clock on the dial, air was aspirated from the internal operating space, after which the declared device was removed and the conditional medical intervention was completed.

All manipulations, from diagnosis to therapeutic intervention, were performed without removing the endoscope from the pig carcass and without changing the position of its controlled distal end 7 of the flexible working part in relation to the conditionally pathological formation and to the wound surface. The insertion and removal of the endoscopic instrument through the NICI went smoothly. During the operation, no collapse of the internal operating space was observed. The presence of a multi-channel endoscope contributed to the simultaneous use of at least two instruments (an electrosurgical loop and forceps, a clipper and “rat tooth” forceps), rotation of instruments with a change in their angle of “attack”, and optimized access by instruments to hard-to-reach areas of the surgical field, and also contributed to separate connection of an aquapurator and an aspirator (each into its own channel), providing the possibility of their simultaneous use when washing a wound defect.

EXAMPLE 6 according to option 2. Carrying out an endoscopic diagnostic examination and therapeutic intervention on a hollow organ of the lower gastrointestinal tract, for example, the rectum, with the claimed device with five NIK and an endoscope according to option 2 without a standard working channel (Fig. 1B, Fig. 3).

Take the declared device according to option 2, assembled according to the algorithm described above.

The choice of the type of NIK (the shape of the distal end 14, the design options for the longitudinal spike 18 (Fig. 4, pos. A, pos. B, pos. C), the number of NIK and the number of CD, their location on the flexible working part of the endoscope is influenced by the structural features of the lower of the gastrointestinal tract, for example, greater opening of the anal sphincter, as well as the purpose of endoscopic intervention.

According to example 6 for taking a biopsy:

- on the endoscope using a CD, for example, five NIKs are fixed around the entire circumference of the flexible working part at 3, 5, 8, 9 and 12 o’clock on the hour dial, such that the distal ends of all NIK (Fig. 4, pos. B) extend onto the skirt 21 of the leading CD 2 (Fig. 7) and are tightly adjacent to its surface;

- the distal ends of the hinged instrumental channels are made rounded (Fig. 4, pos. B);

- the longitudinal spike 18 on the NIKs is made not reaching the tip of the distal end and not reaching the edge of the proximal end of the NIKs (Fig. 4, pos. B and C);

- the end of the leading CD 2, facing the organ cavity, is made in the form of a skirt 21 without longitudinal grooves and without a circular groove 22 (Fig. 7A);

- intermediate CDs 3 are made in the form of five twisted springs with 3.5 turns around the endoscope 6 (Fig. 8, Fig. 9);

- table top-holder 5 is star-shaped,

The pig carcass was placed on a manipulation table, the claimed device was taken by the handle 12 and a flexible working part 6, equipped with five NIKs 1, was inserted through the sphincter of the anal canal at 3, 5, 8, 9 and 12 o'clock along the dial, mounted on the leading CD 2, on five intermediate CDs 3, the trailing CD 4 and the table-top holder 5, into the rectum.

The introduction of the flexible working part 6, equipped with a leading CD 2, five intermediate CDs 3, one trailing CD 4 and five NIK 1 through the anal sphincter, passed unhindered, due to the small diameter and streamlined shape of the controlled distal end 7 of the flexible working part together with CD 2 and the crushability of all NIKs when passing the anal sphincter.

To simulate a diagnostic biopsy, air was insufflated through the standard air and water supply channel 9 into the lumen of the rectum to inflate the lumen of the organ and create an internal operating space, then the NIK located at 3 o’clock on the dial was connected to the aquapurator, the NIK at 5 o’clock the dial was connected to an aspirator, at the same time a stream of water under pressure was applied into the lumen of the organ and aspiration of washing liquids was performed, thus washing the mucous membrane from mucus and remnants of intestinal contents, and inspecting it. The need for a biopsy of the mucous membrane was conditionally determined. To simulate a biopsy of the mucous membrane, biopsy forceps were inserted into NIK 1, located at 9 o’clock on the dial, and a piece of the mucous membrane was pinched off and then removed.

The insertion and removal of the endoscopic instrument from the lumen of the organ went smoothly. During the diagnostic process, no collapse of the cavity under study was observed.

To simulate polypectomy, air was insufflated through the standard channel for supplying air and water 9 into the lumen of the rectum to inflate the lumen of the organ and create an internal operating space; the controlled distal end 7 of the flexible working part 6 was brought to the site of the conditional polypectomy.

An electrosurgical loop was inserted through the NIK at 5 o'clock on the dial, having previously disconnected the NIK from the aspirator; through the NIK at 9 o'clock on the dial, an injector was inserted; through the NIK at 12 o'clock on the dial, a clipper was inserted. The NIK at 8 o'clock on the dial was left in reserve for introducing another instrument or changing the angle of "attack". Then the injector was injected into the submucosal layer of the rectum, the required amount of saline was injected to create an infiltration “cushion” - a conditional polyp, after which the injector was removed.

They opened the electrosurgical loop, brought the loop to the conditional polyp, and threw it on it. To ensure radical resection through the NIK, at 9 o’clock, biopsy forceps were inserted, grabbed the conditional polyp and pulled it closer to the end of the flexible working part, so that the electrosurgical loop dropped closer to the intestinal wall, covering the polyp and its pseudopod, then the loop was tightened and applied an electric current was applied to it, the conditional polyp was cut off, a wound surface with a bare submucosal layer was formed at the resection site, the conditional polyp was fragmented with an electrosurgical loop, fragments of the conditional polyp were removed with forceps, then the forceps and electrosurgical loop were removed as unnecessary, through the NIK at 3 o'clock in The organ cavity was supplied with a jet of water under pressure, the wound surface was washed, the washing liquid was aspirated through the NIK located at 5 o'clock on the dial, connecting it to an aspirator. We assessed the localization of the wound surface in the surgical space - on the monitor screen the wound surface was located at 3 o'clock on the dial. After this, the optimal location of the NIK was selected for bringing “rat tooth” forceps in order to bring the edges of the wound together, i.e. NIKs located on the contralateral side of the wound at 8 and 9 o'clock on the dial. We inserted “rat tooth” forceps through the NIK at 9 o’clock, grabbed the edges of the wound defect and brought them close to each other, then clipped the edges of the wound defect using a clipper located at 12 o’clock on the dial. The rat tooth forceps were removed. Clipping of the edges of the wound defect turned out to be incomplete, and the location of the wound edges also turned out to be not very convenient for subsequent capture with clips, so the clipper with the clip was inserted through the NIK, located at 8 o’clock on the dial, changing the angle of “attack” of the instrument and finally fixing the edges of the wound to each other, placing two more clips. In this case, the clipper was freely removed twice to reload the clips. During the clipping process, the location and angle of “attack” of the instrument were optimal - the position of the controlled distal end 7 of the flexible working part 6 of the endoscope was not changed.

Through the NIK located at 3 o'clock on the dial, the surgical field was washed with water, followed by aspiration of the washing water through the NIK at 5 o'clock. The result of clipping was assessed.

Upon completion of the conditional therapeutic and diagnostic actions, all instruments 17 were removed from NIK 1 (Fig. 1), then air from the internal surgical space was aspirated through the NIK at 5 o'clock, after which the declared device was removed and the conditional medical intervention was completed.

All manipulations, from diagnosis to therapeutic intervention, were performed without removing the endoscope from the pig carcass and without changing the position of its controlled distal end 7 of the flexible working part in relation to the conditionally pathological formation and to the wound surface. The insertion and removal of the endoscopic instrument through the NICI went smoothly. During the operation, no collapse of the internal operating space was observed. The presence of a multichannel endoscope contributed to the simultaneous use of min two instruments (an electrosurgical loop and forceps, a clipper and “rat tooth” forceps), rotation of instruments with a change in their angle of “attack”, and optimized access by instruments to hard-to-reach areas of the surgical field, and also facilitated separate connecting an aquapurator and an aspirator (each into its own channel), providing the possibility of their simultaneous use when washing a wound defect.

From the above, we can conclude that the applicant has achieved the stated technical result, namely, the disadvantages of analogues have been eliminated by developing a device for endoscopy and a method for its use (options), namely, it has provided:

- facilitated insertion of the flexible working part of the endoscope into hollow organs due to the smaller diameter of the flexible working part and the streamlined shape of the controlled distal end;

- increase in the number of working channels and, as a result, simultaneously used instruments, which allows simultaneous manipulations the number of tools when such a need arises;

- the ability to change the angle of “attack” of the instruments to the operated object without changing the position of the endoscope due to the location of the working channels around the circumference of the endoscope;

- the possibility of interchangeability and rotation of instruments among themselves without removing the endoscope from the patient’s body;

- the possibility of transition from diagnostics to therapeutic manipulations without replacing the diagnostic endoscope with an operating one due to an increase in the number of working channels and the instruments used in them. In this case, there is no time gap between the diagnostic processes and therapeutic manipulations;

- stable fixation of hinged instrumental channels along the flexible working part and on the endoscope handle due to clip holders and a table-top holder;

- reliable placement of endoscopic instruments in hinged instrument channels along the flexible working part of the endoscope;

- eliminating the possibility of intertwining of the outer handles of endoscopic instruments due to their fixation on the tabletop holder;

- reducing the risk of injury to internal organs and the risk of possible complications;

- reduction of operator fatigue due to the absence of repeated insertions of the endoscope;

- reduction of leakage of inflating gas from the hollow organ due to the presence of a valve.

Claims (43)

1. A device for endoscopy, consisting of an endoscope, at least one hanging instrumental channel, clip holders, a tabletop holder; wherein the endoscope contains a flexible working part with a controlled distal end, containing standard channels inside: lighting, image transmission, combined air and water supply, kinematics placement, standard working aspiration-instrumental/biopsy channel; a handle with handles for forced control of the drive mechanisms of the controlled distal end of the flexible working part, buttons for controlling aspiration and supplying air and water, and a connecting cable; in this case, the hinged instrumental channels are made in the form of tubes made of dielectric material, approved for use in medicine, inert, not destroyed during disinfection, elastic, tensile strength, in this case, the distal ends of the hinged instrumental channels are made atraumatic - beveled or rounded, and the proximal ends are made in the form of a funnel with the possibility of inserting endoscopic instruments into the hinged instrumental channels and are equipped with an elastic valve with the ability to prevent leakage of inflating gas, in the form of two oppositely placed elastic membranes, and each of the membranes is attached with one edge to the edge of the proximal end of the hinged instrumental channel, and the free edges of the membranes fit tightly and overlap each other, overlapping one after the other with the possibility of blocking the lumen of the hinged instrumental channel and preventing leakage of inflation gas from the operated cavity, as well as with the possibility passing the endoscopic instrument by wrapping it in the form of a cuff; along the entire length of the outer surface of each hinged instrumental channel, a longitudinal tenon in the form of a protrusion is made monolithically with it in such a way that the junction of the hinged instrumental channel and the longitudinal tenon is made narrowed in the form of a “waist” with the possibility of fixing the hinged instrumental channel in clip-holders; in this case, the length of the hanging instrumental channels is made not exceeding the length of the longest of the endoscopic instruments intended for use; hinged instrumental channels are fixed on clip holders around the circumference of the flexible working part along the clock dial with the ability to provide access for an endoscopic instrument to the area of the organ being examined or operated on; in this case, the clip-holders contain a leading clip-holder, intermediate clip-holders and a closing clip-holder, while the outer surface of all clip-holders is made with longitudinal grooves with the possibility of attaching hinged tool channels, while the shape and dimensions of the longitudinal grooves are made according to the type zip lock with the ability to cover the “waist” of the longitudinal spike; in this case, the leading clip-holder is made in the form of a tube with the possibility of its tension on the controlled distal end; the end of the leading clip-holder, facing the organ cavity, is made in the form of a skirt without longitudinal grooves, while the diameter and length of the skirt depends on the throughput of the patient’s anal sphincter or upper esophageal sphincter and on the type of endoscopic intervention; wherein the intermediate clip-holders are made in the form of twisted springs in the amount of at least two with the number of turns from 1.5 to 3.5, while the intermediate clip-holders are located on the flexible working part at an equal distance from each other; wherein the closing clip-holder is made in the form of a horseshoe-shaped groove with the possibility of fixing at the proximal end of the flexible working part close to the handle; the tabletop-holder is made of any shape with a U-shaped recess, through holes and fitted grooves, while the U-shaped recess is made corresponding to the cross-section of the handle with the possibility of fixing the tabletop-holder to the handle, while through holes and fitted grooves are made along the perimeter of the tabletop-holder with the possibility of fixing hinged instrumental channels, while the dimensions of the through holes correspond to the outer diameter of the hinged instrumental channels; in this case, the elements of the claimed device are interconnected as follows: the hinged instrumental channels are fixed on the flexible working part of the endoscope using a leading clip-holder, intermediate clip-holders and a trailing clip-holder, the proximal ends of the hinged instrumental channels are fixed in the through holes of the table-top holder, which is attached to the handle. 2. A device for endoscopy, consisting of an endoscope, at least one hanging instrumental channel, clip holders, and a tabletop holder; wherein the endoscope contains a flexible working part with a controlled distal end, containing standard channels inside: lighting, image transmission, combined air and water supply, kinematics placement; a handle with handles for forced control of the drive mechanisms of the controlled distal end of the flexible working part, an air and water supply button, a connecting cable; in this case, the hinged instrumental channels are made in the form of tubes made of dielectric material, approved for use in medicine, inert, not destroyed during disinfection, elastic, tensile strength, in this case, the distal ends of the hinged instrumental channels are made atraumatic - beveled or rounded, and the proximal ends are made in the form of a funnel with the possibility of inserting endoscopic instruments into the hinged instrumental channels and are equipped with an elastic valve with the ability to prevent leakage of inflating gas in the form of two oppositely placed elastic membranes, each of membranes, one edge is attached to the edge of the proximal end of the hinged instrumental channel, and the free edges of the membranes fit tightly and overlap each other, overlapping one after the other with the possibility of blocking the lumen of the hinged instrumental channel and preventing the leakage of inflation gas from the operated cavity, as well as with the possibility of passage endoscopic instrument by wrapping it in the form of a cuff; along the entire length of the outer surface of each hinged instrumental channel, a longitudinal tenon in the form of a protrusion is made monolithically with it in such a way that the junction of the hinged instrumental channel and the longitudinal tenon is made narrowed in the form of a “waist” with the possibility of fixing the hinged instrumental channel in clip-holders; in this case, the length of the hanging instrumental channels is made not exceeding the length of the longest of the endoscopic instruments intended for use; hinged instrumental channels are fixed on clip-holders around the circumference of the flexible working part along the clock dial with the possibility of providing access for an endoscopic instrument to the area of the organ being examined or operated on; in this case, the clip-holders contain a leading clip-holder, intermediate clip-holders and a closing clip-holder, while the outer surface of all clip-holders is made with longitudinal grooves with the possibility of attaching hinged tool channels, while the shape and dimensions of the longitudinal grooves are made according to the type zip lock with the ability to cover the “waist” of the longitudinal spike; in this case, the leading clip-holder is made in the form of a tube with the possibility of its tension on the controlled distal end; the end of the leading clip-holder, facing the organ cavity, is made in the form of a skirt without longitudinal grooves, while the diameter and length of the skirt depends on the throughput of the patient’s anal sphincter or upper esophageal sphincter and on the type of endoscopic intervention; wherein the intermediate clip-holders are made in the form of twisted springs in the amount of at least two with the number of turns from 1.5 to 3.5, while the intermediate clip-holders are located on the flexible working part at an equal distance from each other; wherein the closing clip-holder is made in the form of a horseshoe-shaped groove with the possibility of fixing at the proximal end of the flexible working part close to the handle; the tabletop-holder is made of any shape with a U-shaped recess, through holes and fitted grooves, while the U-shaped recess is made corresponding to the cross-section of the handle with the possibility of fixing the tabletop-holder to the handle, while through holes and fitted grooves are made along the perimeter of the tabletop-holder with the possibility of fixing hinged instrumental channels, while the dimensions of the through holes correspond to the outer diameter of the hinged instrumental channels; in this case, the elements of the claimed device are interconnected as follows: the hinged instrumental channels are fixed on the flexible working part of the endoscope using a leading clip-holder, intermediate clip-holders and a trailing clip-holder, the proximal ends of the hinged instrumental channels are fixed in the through holes of the table-top holder, which is attached to the handle. 3. A device for endoscopy according to claims 1 and 2, characterized in that the longitudinal spike is made reaching the tip of the distal end and not reaching the edge proximal end of the hinged instrumental channel. 4. A device for endoscopy according to claim 1 and 2, characterized in that the longitudinal spike is made not reaching the tip of the distal and the edge of the proximal ends of the hinged instrumental channel. 5. A device for endoscopy according to claims 1 and 2, characterized in that the skirt of the leading clip-holder is made with one circular groove along the edge of the outer surface of the skirt with the possibility of fixing an endoscopic instrument. 6. A device for endoscopy according to claims 1 and 2, characterized in that the skirt of the leading clip-holder is made without a circular groove. 7. The method of using the endoscopy device according to claim 1, which consists in the fact that take the declared device by the handle and insert it into the test or the patient's hollow organ to be operated on; a flexible working part equipped with hinged instrumental channels mounted on clip-on holders and a table-top holder; To carry out diagnostics, the patient’s organ being examined is examined and diagnosed using the standard equipment of the endoscope and at least one hanging instrumental channel, for which first air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then the hanging instrumental channel is connected to an aquapurator for supplying water under pressure, water is supplied and the mucous membrane is washed from biological contaminants, and through a standard working aspiration-instrumental/biopsy channel, aspiration of washing water and biological fluids is carried out; carry out diagnostics and, based on its results, determine a treatment program; to carry out treatment, air is insufflated through the standard channel for supplying air and water to inflate the lumen of the organ and create an internal operating space, then the distal end of the flexible working part is brought to the site of therapeutic actions, endoscopic instruments are introduced through hanging instrumental channels in the amount of at least one, in case using two or more hanging instrumental channels, they are either used completely, or some are left free for reserve; the standard working aspiration-instrumental/biopsy channel is either left free for water supply and aspiration of washing water and biological fluids, or used for insertion of an endoscopic instrument; then therapeutic actions are performed with the inserted endoscopic instruments; when the need arises, the used endoscopic instrument is removed from the hinged instrumental channels and the standard working aspiration-instrumental/biopsy channel and a situationally necessary endoscopic instrument is inserted instead, without removing the flexible working part from the patient’s hollow organ, the endoscopic instruments are mutually moved among themselves, and the angle of “attack” is changed. endoscopic instruments, work with endoscopic instruments simultaneously; upon completion of therapeutic actions, endoscopic instruments are alternately removed from the standard working aspiration-instrumental/biopsy channel and hanging instrumental channels, then air is removed from the internal surgical space, after which the declared device is removed, completing the medical intervention. 8. The method of using the endoscopy device according to claim 2, which consists in the fact that take the declared device by the handle and insert it into the test or the patient's hollow organ to be operated on; a flexible working part equipped with hinged instrumental channels mounted on clip-on holders and a table-top holder; To carry out diagnostics, the patient’s organ being examined is examined and diagnosed using the standard equipment of the endoscope and at least one hanging instrumental channel, for which first air is insufflated through the standard air and water supply channel to inflate the lumen of the organ and create an internal operating space, then the hanging instrumental channel is connected to to the aquapurator for supplying water under pressure, water is supplied and the mucous membrane is washed from biological contaminants, then the aquapurator is disconnected from the hinged instrumental channel and an aspirator is connected and aspiration of washing water and biological fluids is carried out through the hinged instrumental channel; carry out diagnostics and, based on the diagnostic results, determine a treatment program; to carry out treatment, air is insufflated through the standard channel for supplying air and water to inflate the lumen of the organ and create an internal operating space, then the distal end of the flexible working part is brought to the site of therapeutic actions, endoscopic instruments are introduced through hanging instrumental channels in the amount of at least one, in case using two or more hanging instrumental channels, they are either used completely, or some are left free for reserve, then therapeutic actions are performed with endoscopic instruments inserted into the hanging instrumental channels; when a need arises, the used endoscopic instrument is removed from the hinged instrumental channels and a situationally necessary endoscopic instrument is inserted instead, without removing the flexible working part from the patient’s hollow organ, the endoscopic instruments are mutually moved among themselves, the angle of “attack” of the endoscopic instruments is changed, and the endoscopic instruments are operated simultaneously; upon completion of the therapeutic actions, the endoscopic instruments are alternately removed from the hanging instrumental channels, then the air is removed from the internal surgical space, after which the declared device is removed, completing the medical intervention. 9. Method of using the device for endoscopy according to any one of paragraphs. 7, 8, characterized in that the situationally necessary endoscopic instrument is selected from at least the following range: biopsy forceps, injector, electrosurgical loop, “rat tooth” forceps, clipper.