WO2007072767A1

WO2007072767A1 - Instrument for incising and dissecting tissue

Info

Publication number: WO2007072767A1
Application number: PCT/JP2006/325151
Authority: WO
Inventors: Nobuyuki Sakurazawa
Original assignee: Nobuyuki Sakurazawa
Priority date: 2005-12-19
Filing date: 2006-12-18
Publication date: 2007-06-28
Also published as: JP2009055927A

Abstract

It is intended to provide an instrument for incising and dissecting a tissue without resorting to unnecessary perforation of the tissue by cauterization so that the onset of a complication can be prevented. Namely, an instrument for incising and dissecting a tissue comprising: a pair of grasping members each of which has one end and the other end and the other ends of which are opened and closed so as to grasp a tissue; a pair of operating line members each being connected to one end of a grasping member as described above and extending toward the operator’s side along the longitudinal direction; and flexible pipe members enclosing the respective operating line members therein; wherein each of the grasping members extends in the longitudinal direction so that incision can be made when current is applied and is provided with a blade for holding the other end as described above an outer insulating member located outside the blade to thereby coat the same.

Description

Tissue dissection tool

Technical field

[0001] The present invention relates to an endoscopic processing tool used together with an endoscope when incising and peeling a mucous membrane of a tissue such as an organ such as the stomach, esophagus and large intestine, in particular, lifting the epithelium of the mucosa from the lower layer, The present invention relates to a tissue incision remover that directly or indirectly performs mucosal dissection.

Background art

[0002] Conventionally, there are various types of knives for incision and separation in comparison with mucosal incision and exfoliation for incision and exfoliation of the mucous membrane of tissues such as organs (for example, see Non-Patent Documents 1 to 6).

[0003] Non-Patent Document 1: Rotary Disposal Frequency Knife KD620LR> (Olinos, Hookknife TM, medical device approval number 21400BZZ00490000)

Non-Patent Document 2: Dissipator Endoscope (0915-3217) No.17-6 Page905- 907 (2005.06) (Koyama Tsuneo)

Non-patent document 3: Disposal frequency knife KD630L> (Olympus, Flexknif e TM, medical device approval number 21500BZZ00488000)

Non-Patent Document 4: Disposable Endoscope (0915-3217) No.17-6 Page909-912 (June 2005) (Naohisa Yahagi)

Non-patent document 5: Disposal frequency knife <KD610L> (Olympus, ITknife TM, medical device approval number 21400BZZ00142000)

Non-Patent Document 6: Disposable Endoscope (0915-3217) No.17-6 Page — 903 (06.2005) (Noriaki Hasuike, Yuya Ono, Tetsuya Inui)

[0004] By the way, in conventional hook knives, flex knives, and IT knives, blades that are energized parts to be incised are exposed. Even the IT knife has an insulating ceramic sphere at the tip, but the blade is exposed at the energized part. In particular, incision and removal of lesions of organs that do not have a thick muscle layer, such as the large intestine and the small intestinal muscle layer, are often accompanied by perforation due to unnecessary cauterization, which may cause complications.

Disclosure of the invention [0005] In view of the above drawbacks, an object of the present invention is to provide a tissue incision / peeling tool that can prevent complications without causing unnecessary perforation due to cauterization of tissue.

[0006] The tissue incision / peeling tool of the present invention each has one end and the other end, and is connected to the one end along the longitudinal direction and a pair of grasping members that open and close the other end so as to grasp the tissue. A tissue incision / peeling tool having a pair of operation line members extending to the operator side and a flexible tube member for accommodating these operation line members, each of the gripping members being incised when energized. A blade having the one end extending in the longitudinal direction as possible, and an outer insulator portion disposed outside the blade so as to cover the blade.

[0007] According to the tissue incision / peeling tool of the present invention, the grasping member can be used as a heel member. As a result, the outer insulator portion of the grasping member is not energized and the desired tissue is sandwiched. The surrounding tissue is not thermally damaged. Only the desired tissue is incised with a blade, which acts to expand the operating range.

[0008] According to the tissue incision / peeling tool of the present invention, the outer insulator of the grasping portion has a structure including a heel member that prevents energization, and therefore, the tissue does not cause perforation due to unnecessary cauterization and causes complications. The effect of providing a tissue incision / peeling tool that can prevent this can be expected.

Brief Description of Drawings

FIG. 1 is a plan view of a tissue incision / peeling tool according to a first embodiment of the present invention.

FIG. 2 is a view showing a side surface when the tissue incision / peeling device according to the second embodiment of the present invention is used in the large intestine.

FIG. 3 is a plan view of the distal ends of a pair of grasping members in a tissue incision / peeling device according to a third embodiment of the present invention.

[FIG. 4] A cross-sectional view of a diseased tissue, showing a wrinkled state with no epithelial mucosa covering the underlying tissue.

5 is a view showing a state in which the tip of the tissue incision / peeling tool in FIG. 3 is pressed into the lower layer tissue 1 in FIG. 4 and the epithelial mucosa covering the lower layer tissue is not shown.

FIG. 6 is a view showing a state in which the lower layer tissue is bluntly peeled using the tissue incision peeling tool of FIG. FIG. 7 is a view showing a state in which the lower layer tissue is bluntly peeled using the tissue incision and peeling tool of FIG. 3 twice, and the epithelial mucosa covering the lower layer tissue is not shown.

[FIG. 8] A view showing a use state in which the remaining affected area is incised by the tissue incision / removal tool of FIG. 3, and the epithelial mucosa covering the lower layer tissue 1 is not shown.

[Fig. 9] Fig. 9 is a diagram showing a state in which the tissue incision remover according to the first to third embodiments of the present invention is used.

BEST MODE FOR CARRYING OUT THE INVENTION

Hereinafter, the tissue incision / peeling tool of the present invention will be described in detail with reference to the drawings.

[0011] (First embodiment)

FIG. 1 is a view showing a tissue incision / peeling device according to a first embodiment of the present invention. FIG. 4 shows a cross section of the inner wall of human viscera (stomach), that is, mucosal tissue 1. FIG. 5 shows a state in which the spherical tip of the grasping member of the tissue cutting / peeling tool of FIG. 1 is pressed into the mucosal tissue. FIG. 9 is a view showing a state in which the tissue incision / peeling tool of FIG. 1 is inserted together with an endoscope.

[0012] The tissue incision / peeling tool of the present invention shown in Fig. 1 includes one and the other for incising and grasping the mucous membrane of tissue 1, that is, a pair of grasping members 111, 112, and the grasping members 111, 112. And a pair of operation line members 15-1 and 15-2 that are connected to the respective ends 17-1 and 17-2 and extend along the longitudinal direction to the operator 13 side. The pair of gripping members 11-1 and 11-2 constitutes an electric knife in a bowl shape and acts as a needle electrode, that is, a + electrode. On the other hand, the counter electrode (earth plate) 41 is attached to the trunk of the patient. A high-frequency current from the high-frequency generator 510 flows through the mucous membrane of the tissue 1 as a load, that is, a contact resistance, and acts to cut the tissue 1 with the generation of Joule heat.

[0013] Each of the grasping members 11-1 and 11 2 extends in the longitudinal direction so that a desired lesioned tissue can be incised when energized, and blades 19 1 and 19 2 having the one ends, Blades 19-1 and 19-2 are provided on the outside so as to cover them, and outer insulator portions 21-1 and 21-2 that prevent thermal damage of normal tissues (surroundings) are provided. Outer insulators 21-1 and 2 1-2 are made of insulating material such as fluorine resin, and one end 17-1 and 17-2 are connected to a pair of operation lines 15-1 and 15-2. By pulling the ring-shaped incision operation part 51-2, the other ends of the gripping members 11-1 and 11-2 can be closed (see FIG. 1). Incision control part 51 Press 2 to open. The other ends of outer insulators 21-1, 21-2, which will be described later in the third embodiment, that is, spherical tips 29-1, 29-2 are the innermost layers of tissue 1 in FIG. 4, that is, FIG. It can be pressed and inserted in a closed state with respect to the epithelium 3 of the skin, and can be detached bluntly even without energization.

The tissue incision / peeling tool includes a pivot member 23 that pivotally supports the grasping members 11 1 and 11 2 so as to cross each other and is rotatable about the longitudinal direction, the pivot member 23 and the pair of operation line members. And a helical spring 25 for winding 15-1 and 15-2 together to form a rotating assembly fixed together with the gripping members 11-1 and 11-2.

[0015] The pivot member 23 includes a pair of fixing plates 23-1, 23-2 for fixing the gripping members with one end 17-1, 17-2 sandwiched therebetween, and the fixing plates 23-1, 23-. And a pivot pin 23A that pivotally supports the two. The pivot pin 23A is a hard wire material and acts as a fulcrum.

[0016] The rotary assembly of the helical spring 25 is loosely inserted into the flexible assembly tube member 27 that is rotatably covered. The flexible cladding tube member 27 is an insulating material such as fluorine resin.

The tissue incision / peeling tool further includes a holding member 31 that contacts the flexible sheath tube member 27 and holds the state where the epithelium 3 is peeled from the lower layer 5. The holding member 31 is arranged between the epithelium 3 and the muscular layer 7 around the flexible sheath tube member 27, and inflates the balloon 31-1, and supplies or degass the nolane 31-1. And an air conduit member 31-2 and a syringe 31-3. In Fig. 1, the balloon 31-1 in front of an endoscope (not shown in Fig. 2 33) is expanded to maintain a long distance to the lower layer of the mucosa to be incised and the muscle layer epithelium ( (See Figure 2 below).

Next, the operation of the operation unit of the tissue incision / peeling tool of the present invention will be described. The case of incising the affected part in the innermost layer of the stomach, that is, the mucous membrane layer will be described.

Referring to FIG. 9, the tissue dissection exfoliating tool of the present invention is inserted into the patient's stomach after being inserted into the forceps hole 33H of the camera.

[0020] Referring to Figs. 4 and 5, when removing the mucous membrane around the affected area of the stomach and performing the incision and exfoliation of the underlying tissue 1, one or the other grasping member 11 1, 11 2 of the tissue incision exfoliating tool In The spherical tips 29-1 and 29-2 of the outer insulators 21-1 and 21-2 are closed and pressed against the underlying tissue 1 through the mucosa (not shown) of the affected area to be incised, It is inserted. In FIGS. 4 and 5, the mucosa of the affected part (not shown) is coated on the lower layer tissue 1.

Referring to FIG. 2, by pulling ring-shaped incision operation part 51-2 between epithelium 3 and lower layer 5, the outer insulation of one and the other gripping members 11-1, 11-2 is isolated. Open bodies 21—1, 21-2. After grasping the target lower layer 5 tissue, turn it on. At that time, the deflated nolane 31-1 is placed on the muscle layer 7, the syringe 31-3 is operated to expand through the air conduit 31-2, and the counter traction is applied. In other words, the incision / peeling tool of the present invention is accidentally jumped to prevent the jumping operation that damages the surrounding normal tissue.

[0022] As a result, according to the tissue incision / peeling tool in the first embodiment of the present invention, it is provided with a heel insulator structure that securely holds only a desired diseased tissue, and has a flexible coated tube member. Since the internal rotating body structure that rotates the rotating body is provided, only the desired lesioned tissue can be incised and easily separated.

[0023] In addition, in the incision after the counter traction with the holding member 31 added, the balloon 31-1 is expanded to increase the distance between the layers of the tissue 1, and the normal lesion to be left with the desired diseased tissue. Since the inter-tissue distance from the surrounding tissue is secured and the incision and removal can be performed safely, it is possible to prevent perforation due to energization and to shorten the operation time.

[0024] (Second Embodiment)

FIG. 2 is a diagram showing a use state of the tissue incision remover in the large intestine according to the second embodiment of the present invention. The tissue dissection exfoliating tool according to the second embodiment of the present invention includes sharp outer insulators 21-1A and 21-IB that are optimal when used in the large intestine. As shown in FIG. 2, in the tissue 1, the visceral large intestine mucosa has the epithelium 3 and the lower layer 5 on the muscle layer 7. The balloon 31-1 placed on the flexible covering tube member 27 is expanded, and the tissue of the lower layer 5 is grasped and incised by the outer insulators 21-1A and 21-1B, thereby removing the epithelium 3 from the lower layer 5. It will be in a separated state.

As a result, according to the tissue incision / peeling tool in the second embodiment of the present invention, the Only the desired lesioned tissue can be securely grasped, incised and removed. In addition, incision after countertraction with balloons is performed, the balloon is expanded to increase the distance between the layers of tissue, and the interstitial distance between the desired lesioned tissue and the normal surrounding tissue to be left behind. As a result, the incision and removal can be performed safely, so that the operation time can be shortened.

(Third embodiment of the present invention)

FIG. 3 is a view showing a tissue dissection exfoliating tool according to a third embodiment of the present invention, and is configured to be optimal for blunt dissection. In the tissue incision / peeling tool according to the third embodiment, the outer insulators 21-1 and 21-2 of the pair of gripping portions 11-1 and 11-2 push the above lower tissue 1 to incise and peel. It has the tip 29-1 and 29-2 as the other end. As shown in Fig. 5, the spherical tips 29-1, 29-2 of outer insulators 21-1, 21-2 are pushed into tissue 1, and as shown in Fig. 6, one end 17-1, 17-2 is When pulled, the spherical tips 29-1, 29-2 at the other end open. As a result, the blunt detachment of the lower layer structure 1 is performed.

[0027] To reiterate, when blunt dissection is performed twice, as shown in Fig. 7 for the first time and the second time, the underlying tissue of the affected area to be incised is the grasping member 111, 11 2 Outer insulators 21—1, 21—2 Spherical tips 29-1, 1, 29-2 are opened, pulled out, and after the second blunt dissection, they will sink under the mucous membrane of the affected area. As shown in Fig. 8, the affected tissue remaining in blades 19-1 and 19-2 is excised.

As a result, according to the third embodiment of the present invention, the underlying tissue 1 covered with the mucous membrane of the affected tissue to be incised is the spherical tip 29-1 of the outer insulators 21-1, 21-2. , 29-2 can be opened to perform blunt dissection.

[0029] The tissue incision / peeling tool of the present invention is not limited to the above description, and can be appropriately changed without departing from the gist of the present invention. Needless to say, incision and detachment of lesions in the small intestine and pharynx can be performed not only by the mucous membrane of the tissue in the stomach, large intestine, and internal organs of the esophagus.

Claims

The scope of the claims

[1] A pair of gripping members each having an end and an other end and opening and closing the other end so as to grasp tissue.

A pair of operating wire members connected to the one end and extending to the operator side along the longitudinal direction;

A flexible tube member for storing these operation line members;

A tissue incision peeler having

Each of the gripping members

A blade extending in the longitudinal direction so as to be incisable when energized and having the one end;

An outer insulator part disposed on the outer side of the blade so as to cover the blade.

[2] In the tissue incision peeler according to claim 1,

A pivot member that pivotally supports the gripping member so as to be crossable and is rotatable about the longitudinal direction;

A helical spring for winding the pivot member and the pair of operation line members together to form a rotating assembly fixed together with the gripping member;

A tissue incision exfoliating tool comprising:

[3] In the tissue dissection tool according to claim 2,

The pivot member is

A pair of fixing plates that fix the gripping member across one end; and

A pivot that pivotally supports the fixed plates;

A tissue incision exfoliating tool comprising:

[4] In the tissue incision peeling device according to claim 1,

A flexible coated tube member that is rotatably inserted into the rotating assembly of the helical spring and is rotatably covered.

A tissue incision exfoliating tool comprising:

[5] The tissue dissection exfoliation device according to claim 1, The tissue is a mucous membrane of an organ having a lower layer and its epithelium,

The grasping part grasps the lower layer, then energizes to incise, and the pair of grasping parts open to perform blunt peeling of the lower layer.

[6] In the tissue incision remover according to claim 4,

A holding member that contacts the flexible coated tube member and holds the state where the epithelium is peeled from the lower layer

A tissue incision exfoliating tool further comprising:

[7] The tissue dissection exfoliation device according to claim 5,

The organ has a muscle layer below the lower layer;

The holding member is

A balloon which is disposed between the epithelium and the muscle layer and expands around the flexible coated tube member

A tissue incision exfoliating tool comprising:

[8] In the tissue incision remover according to claim 6,

The holding member is

Air conduit member for supplying or degassing the balloon

And the air conduit member is used to extend together with the flexible sheath member.