WO2008026689A1 - Outil de traitement pour endoscope - Google Patents
Outil de traitement pour endoscope Download PDFInfo
- Publication number
- WO2008026689A1 WO2008026689A1 PCT/JP2007/066894 JP2007066894W WO2008026689A1 WO 2008026689 A1 WO2008026689 A1 WO 2008026689A1 JP 2007066894 W JP2007066894 W JP 2007066894W WO 2008026689 A1 WO2008026689 A1 WO 2008026689A1
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- Prior art keywords
- conductor
- treatment
- frequency current
- conductor portion
- endoscope
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00059—Material properties
- A61B2018/00071—Electrical conductivity
- A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00482—Digestive system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1497—Electrodes covering only part of the probe circumference
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
- A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
Definitions
- the present invention relates to an endoscopic treatment instrument, and particularly to an endoscopic treatment instrument used in endoscopic submucosal dissection (ESD).
- ESD endoscopic submucosal dissection
- Endoscopic mucosal resection is recognized as a minimally invasive and reliable therapeutic method for radical treatment of tumorous mucosal lesions such as early gastric cancer and early colorectal cancer.
- ESD endoscopic submucosal dissection
- the mucous membrane around the tumor is incised and then the submucosa between the mucous membrane and the intrinsic muscle layer is cut to remove the tumor mucosa at once.
- this method can draw the incision line as intended and can reliably remove the tumor, it has a problem in that it requires skill in a technically difficult procedure and requires a long treatment time.
- the endoscope treatment tool described in Patent Document 1 is a hook knife in which a high-frequency electrode at the tip is formed by a bending rod, and the tip of the hook knife is hooked on a mucosal tissue and pulled into the sheath. By this, the mucosal tissue is excised.
- the endoscope treatment tool described in Patent Document 2 is an IT knife in which an insulator is attached to the tip of a needle-like knife, and it is possible to prevent the intrinsic muscle layer from being pierced by the insulator. Attempts have been made to alleviate the technical difficulty of endoscopic submucosal dissection by using these endoscopic treatment tools.
- Patent Document 1 JP 2004-275641 A
- Patent Document 2 JP-A-8-299355
- the endoscope treatment tool of Patent Document 2 is a treatment tool that cuts mucous membranes, and has a viscous function. Not suitable for cutting (peeling) of the submucosa after membrane cutting.
- the endoscopic treatment tool of Patent Document 1 has a problem that, when cutting the submucosal layer, there is a risk of damaging the inherent muscle layer depending on the angle and posture of the distal end portion, which makes it difficult to operate.
- Patent Document 1 approaches and cuts the digestive tract wall (mucous membrane or intrinsic muscle layer) in parallel with the treatment instrument, so that the lesion on the digestive tract wall is cut.
- the endoscope treatment instrument of Patent Document 1 has a problem that the position of the endoscope must be changed when performing the approach of the treatment section and the cutting process, and the lesion cannot be observed.
- the endoscopic treatment tool of Patent Document 1 may be accompanied by a large amount of bleeding when the submucosa is cut.
- heat coagulation is performed by applying a high-frequency current for coagulation! /, But it is necessary to cut while it is difficult to adjust the coagulation depth! /, And! /
- the conventional endoscopic treatment tool has a problem that it is difficult to quickly and safely cut (peel) the submucosal layer!
- the present invention has been made in view of such circumstances, and an object thereof is to provide an endoscopic treatment tool suitable for endoscopic submucosal dissection.
- the first aspect of the present invention is for an endoscope in which a treatment portion provided at a distal end of a insertion portion inserted into the body has a conductor portion connected to a high-frequency power source.
- the treatment portion is formed in a sandwich structure including the conductor portion and a non-conductor portion provided on the distal end side and the proximal end side of the conductor portion, and the conductor portion is formed on a side surface of the treatment portion. It is characterized by being formed in a strip shape.
- the side surface of the treatment portion has a sandwich structure in which the strip-like conductor portion is sandwiched between the non-conductor portions, the distal end of the treatment portion is brought into contact with the intrinsic muscle layer. At this time, the non-conductive portion comes into contact with the proper muscle layer, and the conductor portion does not come into contact with the proper muscle layer. Therefore, cutting of the proper muscle layer can be surely prevented. Furthermore, according to the first aspect of the present invention, By moving the treatment part to the side, the submucosal layer comes into contact with the side surface of the treatment part, and the submucosal layer in contact with the strip-shaped conductor part is cut. Therefore, according to the first aspect of the present invention,
- the submucosa can be cut without damaging the intrinsic muscle layer.
- the treatment portion is cut by approaching the digestive tract wall (mucous membrane or intrinsic muscle layer) in the vertical direction, so that the digestive tract wall is frontally viewed with an endoscope.
- the treatment part can be approached easily while viewing.
- the treatment portion is moved to the side to perform the cutting, so that the cutting can be performed with the digestive tract wall viewed from the front with an endoscope.
- a second aspect of the present invention is the first aspect of the present invention, characterized in that the strip-shaped conductor portion is formed so as to go around the side surface of the treatment portion.
- the conductor portion since the conductor portion is formed so as to go around the side surface of the treatment portion, the treatment portion has cutting performance on all side surfaces. Therefore, the force S can be used to cut the submucosa even if the treatment part is moved in any direction.
- a third aspect of the present invention is the first or second aspect of the present invention, wherein the treatment section is formed in a substantially gear shape in which crests and troughs are alternately arranged in the circumferential direction.
- the treatment portion is formed in a substantially gear shape, so that when the treatment portion is moved to the side, the fibrous submucosal layer is easily caught on the peak portion of the treatment portion, The submucosa can be cut efficiently.
- a fourth aspect of the present invention is the force according to any one of the first to third aspects of the present invention.
- the treatment part is supported via a swing mechanism that adjusts the posture of the treatment part.
- the posture of the treatment portion can be freely adjusted, and the cutting process can be easily performed.
- any one of the first to fourth aspects of the present invention at least three of the strip-shaped conductor portions are provided in parallel and sandwiching a non-conductor portion, and the at least The two conductor parts including the most distal conductor part are selected from the forces of the three conductor parts, and the coagulating high-frequency current is applied with the selected two conductor parts as a pair of electrodes. Selecting two conductor portions excluding the most distal end conductor portion from among the at least three conductor portions, and applying a cutting high-frequency current with the selected two conductor portions as a pair of electrodes. A high-frequency current supply device is provided.
- the portion for supplying the high-frequency current for solidification is provided on the tip side of the portion for supplying the high-frequency current for cutting. Coagulated tissue remains on the proper muscle layer side, and the amount of bleeding can be greatly reduced. Further, according to the fifth aspect of the present invention, since the coagulation position and the cutting position are changed, adjustment of the coagulation depth is easy, and hemostasis is reliably performed while preventing excessive tissue damage due to coagulation. be able to.
- the fifth aspect of the present invention is a bipolar endoscope treatment tool.
- a sixth aspect of the present invention is the invention according to the fifth aspect of the present invention, wherein the number of the conductor portions is three, and the high-frequency current supply device includes It is characterized in that a high frequency current for solidification is selected by selecting the conductor portion on the end side, and a high frequency current for cutting is selected by selecting the central conductor portion and the conductor portion on the most proximal side.
- a seventh aspect of the present invention is the fifth aspect of the present invention, wherein the number of the conductor portions is four, and the high-frequency current supply device includes: a conductor portion on the most distal side and a conductor portion on the most proximal side. A pair of or two pairs of conductor parts including a metal is selected and a high frequency current for solidification is applied, and two central conductor parts are selected and a high frequency current for cutting is supplied.
- the seventh aspect of the present invention since the coagulated tissue remains on the proximal side (mucosal side) of the cutting position, the amount of bleeding can be further reduced. That is, according to the seventh aspect of the present invention, the amount of bleeding due to the cutting can be greatly reduced since the distal side solidified tissue and the proximal side solidified tissue are cut.
- At least two of the strip-shaped conductor portions are provided in parallel and sandwiching a non-conductor portion, and the at least At least one conductor portion including the most distal end conductor portion is selected from the two conductor portions, and a high frequency current for solidification is passed so that the selected conductor portion forms one of a pair of electrodes.
- a high-frequency current for cutting so that at least one conductor part is selected from the force of the at least two conductor parts, excluding the most distal conductor part, and the selected conductor part forms one of a pair of electrodes.
- a high-frequency current supply device for supplying current.
- the portion through which the high-frequency current for solidification is passed is a high-cutting portion. Since it is provided on the tip side of the portion where the high-frequency current is applied, the coagulated tissue remains on the tip side (the intrinsic muscle layer side) of the cutting position, and the amount of bleeding can be greatly reduced. Further, according to the eighth aspect of the present invention, since the coagulation position and the cutting position are changed, adjustment of the coagulation depth is easy, and hemostasis can be reliably performed while preventing tissue damage due to coagulation. it can.
- the eighth aspect of the present invention is a monopolar endoscope treatment tool.
- a ninth aspect of the present invention is the eighth aspect of the present invention, wherein the number of the conductor portions is two, and the high-frequency current supply device selects the two conductor portions to select a high-frequency for solidification. It is characterized in that a current is applied and a high-frequency current for cutting is supplied by selecting a conductor portion on the base end side.
- a tenth aspect of the present invention is the eighth aspect of the present invention, wherein the number of the conductor portions is three, and the high-frequency current supply device includes: a conductor portion on the most distal side and a conductor on the most proximal side.
- the high-frequency current supply device includes: a conductor portion on the most distal side and a conductor on the most proximal side.
- a high-frequency current for solidification is selected and a high-frequency current for solidification is selected
- a high-frequency current for cutting is selected and a central conductor is selected.
- An eleventh aspect of the present invention is the force of any one of the first to tenth aspects of the present invention.
- the distal end portion of the wire connecting the conductor portion and the high-frequency power source or the wire is connected to the treatment portion.
- the wire is provided so as to be able to advance and retreat with respect to the insulating sheath through which the wire is passed, and the tip of the wire or the shaft electrode is exposed. And can be adjusted to a non-exposed state.
- the eleventh aspect of the present invention since the wire or the axial electrode is exposed by advancing the sheath relative to the sheath, only the conductor portion on the side surface of the treatment portion can be obtained by flowing a high-frequency current through the wire. Cutting can also be performed with a wire or a shaft electrode. Therefore, according to the present invention, incision of the mucous membrane can be performed using the exposed wire or the axial electrode.
- the twelfth aspect of the present invention is the invention according to any one of the first to eleventh aspects of the present invention! /, And the non-conductor portion is formed on the base end surface of the treatment portion. And a non-continuous convex part integral with the protrusion. According to the twelfth aspect of the present invention, a convex portion is formed on the proximal end surface of the treatment portion. Thus, the submucosa can be hooked or gathered using the convex portion, and an effective peeling operation of the submucosa can be performed.
- the thirteenth aspect of the present invention is the force of any one of the first to twelve aspects of the present invention, wherein the conductor portion is exposed to the proximal end surface of the treatment portion. .
- the proximal end surface of the treatment portion can be cut only by the side surface of the treatment portion by flowing a high-frequency current through the conductor portion. Therefore, according to the present invention, the submucosal layer can be cut with the conductor portion on the side surface of the treatment portion, and the mucosa can be cut with the conductor portion on the proximal end surface of the treatment portion.
- the side surface of the treatment portion has a San German structure in which a strip-like conductor portion is sandwiched between non-conductor portions, the submucosal layer without damaging the intrinsic muscle layer can be cut. it can. Therefore, according to the present invention, the endoscopic submucosal dissection is quickly and safely performed with the force S.
- FIG. 1 is a perspective view showing a first embodiment of an endoscope treatment tool according to the present invention.
- FIG. 2 Front view of treatment section of Fig. 1 as viewed from the direction of arrow A
- FIG. 3 is a cross-sectional view of the treatment section showing a cross section taken along line 3-3 in FIG.
- FIG. 4 is an explanatory view showing the operation method of the endoscope treatment tool
- FIG. 4A shows a state where marking is performed around the lesioned part
- FIG. 4B shows a state where the lesioned part is expanded.
- 4C shows the state during mucosal incision
- FIG. 4D shows the state after incision of the mucosa
- FIG. 4E shows the state during cutting of the submucosa
- FIG. 4F shows the state after cutting of the submucosa. Show.
- FIG. 5 is a cross-sectional view showing a cut state by the treatment section
- FIG. 6 is a cross-sectional view showing a bipolar endoscope treatment tool.
- FIG. 7 is a side view showing a second embodiment of the endoscope treatment tool according to the present invention.
- FIG. 8 is a sectional view showing the treatment section of FIG.
- FIG. 9 is a side view showing a state where the posture of the treatment section in FIG. 7 is changed.
- FIG. 11 is a plan view showing a treatment section having a swing mechanism having a configuration different from that of FIG. [Fig. 12] Sectional view of treatment section of Fig. 10
- FIG. 13 is a cross-sectional view showing an endoscopic treatment instrument having a swing mechanism different in configuration from FIG.
- FIG. 14 is a cross-sectional view showing an endoscopic treatment instrument having a swing mechanism different in configuration from FIG.
- FIG. 15 is a side view showing the treatment portion of the third embodiment of the treatment tool for endoscope according to the present invention.
- FIG. 16 is a perspective view showing the treatment tool for endoscope having a conductor portion provided on the sheath.
- FIG. 17 is a cross-sectional view showing an endoscopic treatment instrument having a function of a high-frequency knife.
- FIG. 18 is a cross-sectional view showing the endoscope treatment tool with the high-frequency knife function of FIG. 17 turned off.
- FIG. 19 is a cross-sectional view showing a fourth embodiment of an endoscope treatment tool according to the present invention.
- FIG. 20 is a cross-sectional view showing the treatment section 20 of FIG.
- FIG. 21 is a perspective view showing a treatment portion of a fifth embodiment of the endoscope treatment tool according to the present invention.
- FIG. 23 Sectional view of the treatment section along line 23-23 in FIG.
- FIG. 24 is a cross-sectional view of the treatment portion of FIG.
- FIG. 25 is a cross-sectional view of a treatment portion showing a convex portion having a shape different from that in FIG.
- FIG. 26 is a cross-sectional view of the treatment portion showing a convex portion having a shape different from that in FIG.
- FIG. 27 is a cross-sectional view of a treatment portion having a conductor portion different in shape from FIG.
- FIG. 28 is a sectional view showing a sixth embodiment of the treatment instrument for endoscope according to the present invention.
- FIG. 29 is a perspective view showing the treatment section of FIG.
- Non-conductive part 120 ... Treatment part, 120 mm ... Convex part, 122 ... Non-conductive part, 124 ... Conductor part, 124C- Base end exposed surface, 126 ... Non-conductive part, 130 ...
- Treatment part 130 mm ... Convex part, 132 ... Non-conductor part, 134 ... Conductor part, 134 mm ... Axial electrode, 136 ... Non-conductor part, 138 ... Connection Pipe, 140 ⁇ Power Luller
- FIG. 1 is a perspective view showing an endoscope treatment tool 10 according to the first embodiment.
- the endoscopic treatment instrument 10 mainly comprises an insertion part 12 inserted into the body and a hand operating part 14 connected to the insertion part 12, and the insertion part 12 is non-conductive.
- the distal end of the wire 18 is connected to the treatment section 20, and the proximal end of the wire 18 is connected to the connector 22 of the hand operation section 14.
- the connector 22 is electrically connected to a high-frequency current supply device (not shown) that supplies a high-frequency current.
- an operation button 26 is provided on the grip portion 24 of the hand operation unit 14, and a high frequency current is passed through the wire 18 by pressing the operation button 26.
- the endoscope treatment tool 10 configured as described above is operated by grasping the grasping portion 24 of the hand operation portion 14 and pulling the insertion portion 12 into the forceps channel (not shown) of the endoscope. .
- FIG. 2 is a front view showing the distal end surface of the treatment section 20 of FIG. 1 as viewed from the direction of arrow A
- FIG. 3 is a cross-sectional view of the treatment section 20 taken along line 3-3 of FIG.
- the treatment portion 20 is formed in a substantially gear shape.
- the treatment section 20 has a plurality of peak portions 20 ⁇ , 20 ⁇ ... And valley portions 20 B, 20 B therebetween are alternately arranged in the circumferential direction.
- the tip of the ridge 20A has a rounded shape, and is configured so as not to cut the proper muscle layer 36 even when pressed against the later-described proper muscle layer 36 (see FIG. 5).
- the treatment section 20 is composed of a conductor section 30 made of a metal plate and the like, and non-conductor sections (insulator sections) 28 and 32 made of a non-conductive material such as ceramic or plastic. It has been.
- the conductor portion 30 and the non-conductor portions 28 and 32 are formed in the same gear shape, and the side surfaces of the conductor portion 30 and the non-conductor portions 28 and 32 form the same surface when they are overlapped.
- the side surface of the treatment portion 20 has a sandwich structure in which the belt-like conductor portion 30 is sandwiched between the non-conductor portions 28 and 32, and the belt-like conductor portion 30 is formed so as to go around the side surface of the treatment portion 20. Is done.
- the thickness of the non-conductor portion 28 on the distal end side reliably prevents the conductor portion 30 from coming into contact with the intrinsic muscle layer 36 (see Fig. 4), and the conductor portion 30 is connected to the submucosa 38.
- the thickness of the non-conductor portion 32 on the proximal end side is preferably from 0.;! To 2 mm force S, and more preferably from 0.5 to 1 mm in order to prevent the mucous membrane 34 from being burned.
- the diameter (maximum diameter) of the treatment section 20 is preferably 1.5 to 3 mm, and is preferably about 2.5 mm when the forceps channel of the endoscope has an inner diameter of 2.8 mm.
- the thickness of the conductor portion 30 is preferably 0.2 to 1 mm, more preferably 0.3 to 0.7 mm, and particularly preferably 0.5 mm.
- cutting becomes impossible when the thickness exceeds the range of 0.2 to 1 mm, and the sharpness becomes dull when the thickness is less than 0.3 mm. This is because the tissue was scorched when the thickness exceeded 0.7 mm.
- a wire 18 is electrically connected to the conductor portion 30 described above. As described above, the wire 18 is electrically connected to the connector 22 shown in FIG. 1. By connecting the connector 22 to a high-frequency current supply device (not shown), a high-frequency current can flow through the conductor portion 30.
- the endoscope treatment tool 10 of the first embodiment is a monopolar type in which only one electrode is provided in the treatment section 20, and the other electrode (counter electrode plate) is attached to the subject.
- a lesion 34 A is present in the mucous membrane 34, and this lesion 34 A is removed without damaging the intrinsic muscle layer 36.
- the lesioned part 34A is confirmed by an observation optical system (not shown) provided in the endoscope insertion part 41. At that time, spray a pigment such as indigo carmine from the injection port of the endoscope insertion part 41 to stain the lesion 34A! /.
- the method of marking 43 is not particularly limited.
- a high-frequency knife 45 having a needle-like tip is used.
- the high-frequency knife 45 has a thin metal conductor threaded inside the insulating tube, and the tip of the metal conductor protrudes from the tip of the insulating tube by a predetermined length.
- the protruding portion of the metal conductor serves as an electrode.
- the body wall is incised or excised by the flow of high-frequency current.
- the injection needle 47 is passed through the forceps channel of the endoscope insertion portion 41 and led out from the tip. And with this injection needle 47, the area around the lesion 34A
- the drug solution 37 (see Fig. 5) is locally injected (local injection) into the submucosa 38 of the mucosa 34.
- physiological saline is generally used.
- the strength of viscosity is high! / Sodium hyaluronate may be used! /. In this way, by locally injecting the entire periphery of the lesion 34A, the entire lesion 34A is greatly expanded.
- the injection needle 47 is pulled out from the forceps channel of the endoscope insertion part 41, and the high-frequency knife 45 is passed through. Then, as shown in FIG. 4 (c), the mucous membrane 34 on the outer periphery of the lesion 34A is incised with a high-frequency knife 45 along the positions of the markings 43, 43.
- FIG. 4 (d) the mucosa 34 of the lesion 34A contracts and the submucosa 38 becomes visible.
- the high-frequency knife 45 is pulled out from the forceps channel of the endoscope insertion part 41, the endoscope treatment tool 10 of this embodiment is passed through the forceps channel, and the treatment part 20 is led out. Then, the treatment section 20 is also pushed into the incision position force into the submucosal layer 38, and the distal end of the treatment section 20 is pressed against the proper muscle layer 36 as shown in FIG. At that time, the treatment section 20 can be approached in a direction perpendicular to the digestive tract wall. Therefore, the treatment section 20 can be approached without changing the posture of the endoscope insertion section 41.
- the side surface of the treatment portion 20 is configured with a sandwich structure in which the strip-shaped conductor portion 30 is sandwiched between the non-conductor portions 28 and 32. Only the submucosa 38 that is not cut can be cut reliably.
- the treatment portion 20 is formed in a gear shape in which the crest portions 20A and the trough portions 20B are alternately arranged in a circumferential shape, so that the treatment portion 20 is moved to the side.
- the membrane lower layer 38 is easily caught by the treatment part 20 and can be cut easily.
- the strip-shaped conductor portion 30 is formed so as to go around the side surface of the treatment portion 20, it has cutting performance on all sides of the treatment portion 20.
- the submucosa 38 can be cut when the treatment section 20 is moved in any direction.
- the treatment section 20 is approached in the vertical direction with respect to the digestive tract wall, so that the treatment section 20 can be approached while viewing the lesioned part in front. Furthermore, according to the present embodiment, the treatment section 20 is moved to the side to perform the cutting, so that the cutting can be performed while the lesioned part is viewed from the front.
- the embodiment described above is an example in which the treatment section 20 has six peaks 20A and six valleys 20B, but the number of peaks 20A and valleys 20B is not limited to this. It may be ⁇ 5 or 7 or more.
- the shape of the treatment section 20 is not limited to a gear shape, but is a circular plate shape, an elliptical plate shape, a polygonal plate shape such as a triangle, a sphere or a shape obtained by cutting a sphere into a star shape, etc. There may be.
- FIG. 6 is a side cross-sectional view showing a nopolar-type endoscope treatment tool.
- the treatment section 20 shown in the figure is configured by superposing a non-conductor section 28, a conductor section 29, a non-conductor section 31, a conductor section 30 and a non-conductor section 32 from the front end side.
- Each conductor part 29, 30 and each non-conductor part 28, 31, 32 are formed in the same plane shape, and form the same side surface when they are overlapped.
- the side surface of the treatment portion 20 has a sandwich structure of a plurality of layers in which the strip-shaped conductor portion 29 is sandwiched between the non-conductor portions 28 and 31 and the strip-shaped conductor portion 30 is sandwiched between the non-conductor portions 31 and 32.
- the conductor portions 29 and 31 are connected to wires 18 and 18, respectively, and are connected to the high-frequency current supply device via the wires 18 and 18.
- the wires 18 and 18 are covered so as not to contact each other and short-circuit.
- the bipolar endoscopic treatment tool configured as described above has a high frequency between the conductor portions 29 and 30 through the lower mucosa layer 38 when the lower mucosa layer 38 contacts the side surface of the treatment portion 20. Current Flows and the submucosa 38 is cut.
- the first embodiment described above is an example in which the treatment portion 20 is fixed to the distal end of the insertion portion 12 (sheath 16). However, as shown below, the treatment portion 20 is provided with a swing mechanism. You may be able to change the posture of the treatment unit 20! /.
- FIG. 7 is a side view showing a distal end portion of the treatment instrument for endoscope according to the second embodiment
- FIG. 8 is a side cross-sectional view showing a cross section of
- FIG. 9 is a side view showing a state in which the posture of the treatment section in FIG. 7 is changed
- FIG. 10 is a view as seen from the direction of arrow B in FIG.
- a pair of bearing portions 42, 42 project from the base end surface 20C of the treatment portion 20, and the bearing portions 42, 42 have shafts. 44 is supported.
- the distal end portion of the first sleeve 46 is rotatably connected to the shaft 44, and the distal end portion of the second sleeve 48 is engaged with the proximal end portion of the first sleeve 46.
- the first sleeve 46 and the second sleeve 48 are coaxially arranged and connected to each other, and are connected so as to rotate around their central axes.
- a sheath 16 is connected to the proximal end of the second sleeve 48.
- the treatment section 20 is rotatably supported via two different rotation shafts, and the posture of the treatment section 20 can be freely changed. Can do. In other words, by rotating the treatment portion 20 with respect to the first sleeve 46, the posture of the treatment portion 20 can be tilted with respect to the insertion direction, and the first sleeve 46 is further changed to the second sleeve 48.
- the treatment section 20 can be turned around in the insertion direction by turning it. Therefore, according to the second embodiment, the posture of the treatment section 20 can be freely changed.
- the distal end surface 20D of the treatment section 20 can follow the shape of the proper muscle layer 36, and the distal end face 20D of the treatment section 20 is always brought into contact with the proper muscle layer 36.
- This force S is possible. Therefore, it is possible to more reliably prevent the conductor portion 30 of the treatment portion 20 from coming into contact with the proper muscle layer 36.
- the second embodiment described above is an example in which the posture of the treatment unit 20 is passively changed, and the force may be actively changed without being limited to this.
- the tip of a wire (not shown) is connected to the non-conductive portion 32 of the treatment section 20, and the wire is extended to the hand operation section 14 so that the treatment section 20 is rotated by pushing and pulling the wire. Good.
- FIG. 11 and FIG. 12 show an endoscope treatment section having a configuration different from that of the second embodiment described above.
- the treatment portion 50 is cut out from one side surface to form a groove 50E.
- a shaft 52 is provided in the groove 50E, and the first sleeve 46 is rotatably supported by the shaft 52.
- the width of the groove 50E is slightly larger than the outer diameter of the first sleeve 46.
- the shaft 52 is made of a conductive material such as metal.
- the shaft 52 is connected to the conductor portion 30, and the wire 18 is connected to the shaft 52.
- the first sleeve 46 is arranged inside the groove 50E of the treatment portion 50 by rotating the treatment portion 50 with respect to the sleeve 46. I can do it. Therefore, the thickness of the treatment section 50 can be reduced, and the permeability to the forceps channel of the endoscope can be improved.
- the configuration of the swing mechanism of the treatment sections 20 and 50 is not limited to the above-described embodiment, and various modes are possible.
- the treatment section 20 may be supported via a curved section 62 having a plurality of cup members 60, 60.
- a hole 60A is formed in the cup member 60 of FIG. 13, and the wire 18 is passed through the hole 60A.
- the wire 18 has a distal end connected to the treatment section 20 and a proximal end connected to the slider 64 of the hand operating section 14.
- the slider 64 is slidably supported on the main body 66 of the hand operation unit 14, and the lock 64 of the slider 64 and the main body 66 are locked and unlocked by operating a lock screw 68 provided on the slider 64.
- the slider 64 is formed with a flange 64A for placing the index finger and middle finger of the surgeon, and a ring portion 66A for placing the surgeon's thumb is formed at the base end of the main body 66. Yes.
- the base end of the sheath 16 is fixed to the main body 66 of the hand operating portion 14, and the distal end of the sheath 16 is fixed to the cup member 60 on the most base end side.
- the sheath 16 has an appropriate rigidity so that when the slider 64 is slid to the proximal end side and the tension of the wire 18 is increased, the sheath 16 is not broken or crushed.
- the bending portion 62 is covered with a covering tube 70 made of a soft material such as rubber. .
- the distal end of the coated tube 70 is fixed to the treatment section 20, and the proximal end of the coated tube 70 is attached to the proximal end of the sheath 16.
- the tension of the wire 18 is lowered by sliding the slider 64 of the hand operation unit 14 toward the distal end side with respect to the main body 66, and each cup member 60 is moved.
- the friction between 60 is reduced. Therefore, the bending portion 62 can be freely bent.
- FIG. 14 is a schematic diagram showing an endoscopic treatment tool having another configuration of a swing mechanism.
- the curved portion 72 that supports the treatment portion 20 has a plurality of cylindrical nodal rings 74, 74, and the nodal rings 74, 74 are rotated by pins 76. It is connected freely.
- the node ring 74 at the distal end is fixed to the treatment section 20, and the distal ends of the operation wires 78 and 78 are fixed to the node ring 74.
- the operation wires 78 and 78 are passed through the sheath 16 and are wound around the pulley 80 of the hand operation unit 14.
- the operation wires 78 and 78 are pushed and pulled, and the node rings 74 and 74 are rotated and the bending portion 72 is bent.
- the bending portion 72 can be freely bent, and the force S for freely adjusting the posture of the treatment portion 20 can be achieved. Therefore, the treatment section 20 can easily approach the submucosa 38 and can easily cut the submucosa 38.
- FIG. 14 shows a force S showing a bending structure that bends only in two directions (up and down), and the bending direction is not limited to this, and may be a structure that bends in four directions, up, down, left, and right. .
- the posture of the treatment section 20 is changed using a rack and a pinion, or the treatment section 20 is supported by a linear member made of a shape memory material, and the linear member is heated by energization.
- the posture of the treatment section 20 may be changed by deforming it.
- FIG. 15 is a side view showing the characteristic part of the treatment instrument for endoscope according to the third embodiment.
- the treatment section 90 is configured by superposing four conductor sections 91, 92, 93, 94 and five non-conductor sections 95, 96, 97, 98, 99.
- the treatment section 90 includes, from the distal end, the non-conductor section 95, the conductor section 91, the non-conductor section 96, the conductor section 92, the non-conductor section 97, the conductor section 93, the non-conductor section 98, the conductor section 94, and the non-conductor section.
- each conductor part 9;! ⁇ 94 and each non-conductor part 95 ⁇ 99 are formed in the same shape (for example, a gear shape) when viewed from the A direction, and are combined so that they completely coincide. . Therefore, the side surface of the treatment section 90 has a multi-layer sandwich structure in which the strip-shaped conductor portions 9;! -94 are sandwiched between the non-conductor portions 95-99.
- the non-conductive portion 97 disposed between the central conductive portions 92 and 93 is formed thinner than the other non-conductive portions 96 and 98. Therefore, the distance between the central conductors 92 and 93 is the same as the conductors 9 on both sides.
- Each conductor portion 9;! -94 is connected to a conducting wire 101-; 104, and this conducting wire 10;!-104 is connected to an external high-frequency current supply device via a connector 22 of the hand operating portion 14. (Not shown).
- the high-frequency current supply device selects the two conductive wires 101 to 104 energized from the force of the four conductive wires 10;! To 104, and the different high-frequency currents depending on the selected conductive wires 101 to 104 Energize.
- the conductor portions 91 and 92 are selected, and a high-frequency current for solidification is applied using the conductor portions 91 and 92 as a pair of electrodes.
- the high-frequency current supply device includes a solidification process for selecting the conductor portions 91 and 92 and the conductor portions 93 and 94, and the conductor portion 9.
- the endoscopic treatment tool configured as described above has the distal-side conductor portion 91 when the treatment portion 90 is moved to the side and the submucosal layer 38 is pressed against the side surface of the treatment portion 90.
- the lower mucosa layer 38 in contact with 92 and the lower mucosa layer 38 in contact with the conductors 93 and 94 on the proximal end side are solidified,
- the submucosal layer 38 in contact between the central conductors 92 and 93 is cut. Therefore, the amount of bleeding can be greatly reduced because the coagulated parts are cut.
- the coagulated tissue remains not only on the intrinsic muscle layer 36 side but also on the mucosa 34 side, the amount of bleeding can be greatly reduced.
- the third embodiment is a bipolar treatment instrument, and only the tissue sandwiched between the electrodes (between the conductor portions) is coagulated, so that the coagulation range can be controlled to be narrow. Therefore, tissue damage due to coagulation with a narrow range of tissue damage can be minimized.
- the coagulation position is not limited to this.
- a high-frequency current for coagulation is applied between conductor parts 91 and 94 to coagulate the whole. Also good.
- only the conductors 91 and 92 may be fed with a high-frequency current for solidification to solidify only the tip side of the cutting position! /.
- the four conductor portions 9;! To 94 are provided.
- the number of conductor portions is not limited to this. In the case of a bipolar type, the number is three or more. I just need it.
- the two conductor parts including the most distal conductor part are selected and energized with a high frequency current for solidification, and the two conductor parts excluding the most distal conductor part are selected and used for cutting.
- a high-frequency current may be applied.
- the most distal conductor portion and the most proximal conductor portion are selected and a high-frequency current for solidification is applied, and the most proximal conductor portion is connected. It is preferable to select a central conductor portion and apply a cutting high-frequency current.
- the number of conductor portions should be two or more! /.
- at least one conductor portion including the most distal end conductor portion is selected and a high frequency current for solidification is applied, and one conductor portion excluding the most distal end conductor portion is selected and a cutting high frequency current is selected.
- What is necessary is just to supply an electric current.
- the conductor part on the distal end side and the base end side are selected and a high frequency current for solidification is applied, and the central conductor part is selected and the high frequency current for cutting is selected. Should be energized.
- For the high-frequency current for solidification you can select all three conductors! /, Or you can select only the conductor on the tip! /.
- both conductor parts are provided in a monopolar type.
- both conductor parts are provided.
- only the conductor portion may be selected and a high frequency current for solidification may be applied, and a conductor portion on the base end side may be selected and a high frequency current for cutting may be supplied.
- the treatment portion is configured by superimposing the conductor portion and the non-conductor portion having the same planar shape, but the configuration of the treatment portion is not limited to this. Any sandwiched structure in which a strip-like conductor portion is formed on the side surface of the treatment portion and the conductor portion is sandwiched between non-conductor portions may be used. Therefore, the conductor part may be formed in a cylindrical shape (donut shape) so that it appears on the side.
- a conductor portion 30 may be provided on the outer peripheral surface of the non-conductor sheath 16.
- the conductor portion 30 is preferably formed in a band shape so as to be arranged at a predetermined distance from the distal end of the sheath 16 and to make one round in the circumferential direction. With this configuration, it is possible to improve the permeability of the endoscope to the forceps channel.
- FIGS. 17 and 18 are cross-sectional views of the endoscope treatment tool in which the conductor portion 30 is provided on the outer peripheral surface of the sheath 16 and the function of a high-frequency knife is provided as in FIG.
- a wire 18 is passed through the sheath 16, and a metal disk 110 is attached to the tip of the wire 18, and a metal needle knife 112 is attached to the disk 110. Is attached.
- the proximal end of the wire 18 is attached to a slider 64 (see FIG. 13) of the hand operation unit 14 so that the wire 18 can be pushed and pulled.
- a hole 16A is formed in the distal end surface of the sheath 16, and when the wire 18 is pushed to the distal end side, the needle knife 112 is protruded from the hole 16A as shown in FIG. At this time, the protruding amount of the needle knife 112 is restricted by the disk 110 coming into contact with the distal end surface of the sheath 16. Further, by pulling the wire 18 toward the proximal end, the needle knife 112 is inserted into the sheath 16 through the hole 16A as shown in FIG.
- a protrusion 16B is provided on the inner peripheral surface of the sheath 16, so that the disc 110 is brought into contact with the protrusion 16B when the needle knife 112 is completely stored in the sheath 16. It is summer.
- a conductor 114 connected to the conductor 30 provided on the outer peripheral surface of the sheath 16 is disposed on the protrusion 16B. When the disk 110 is brought into contact with the protrusion 16B, the conductor 30 is connected to the wire 18. To be electrically connected.
- the needle 18 is operated by pressing the wire 18. By projecting 112, it can be used as a high-frequency knife, and the marking process can cut the mucous membrane 34. Further, by pulling the wire 18, a high-frequency current can be applied to the conductor portion 30 on the outer peripheral surface of the sheath 16 and can be used as a cutting means for the submucosa 38.
- FIG. 19 is a cross-sectional view showing the treatment portion 20 of the endoscope treatment tool of the fourth embodiment
- FIG. 20 is a cross-sectional view showing the treatment portion of FIG.
- the treatment section 20 of the fourth embodiment shown in these drawings is formed in a substantially gear shape, similar to the treatment section 20 of the first embodiment shown in FIGS. Constructed in a sandwich shape with conductor part 30 sandwiched between non-conductor parts 28 and 32.
- a wire 18 for connection to a high-frequency power source (not shown) is connected to the conductor portion 30, and the wire 18 is configured to be movable back and forth with respect to the sheath 16. That is, the base 18 is connected to the slider 64 of the hand operating section 14 at the base end, and the slider 64 is slidably supported by the main body 66. On the other hand, the base end of the insulating sheath 16 is connected to the main body 66 of the hand operating section 14, and the slider 18 is slid with respect to the main body 66 so that the sheath 18 (that is, the treatment section 20) is sheathed. Advancing and retreating operation is performed on 16.
- the treatment section 20 can be retreated with respect to the sheath 16, and conversely, by sliding the slider 64 forward with respect to the main body 66.
- the treatment portion 20 can be advanced toward the distal end side with respect to the sheath 16.
- the distal end of the sheath 16 comes into contact with the proximal end surface of the treatment portion 20 as shown by a two-dot chain line in FIG. Unexposed state. Therefore, when a high frequency current is applied to the wire 18, the cutting can be performed only with the conductor portion 30 on the side surface of the treatment portion 20.
- the hand operation unit 14 shown in FIG. 19 has the same configuration as the hand operation unit 14 shown in FIG. 13, and a detailed description thereof will be omitted.
- the configuration in which the treatment portion 20 is advanced and retracted with respect to the sheath 16 is not limited to the above-described embodiment, and various correspondences are possible.
- the endoscope treatment tool configured as described above can be cut at the distal end portion 18A of the wire 18 by advancing the treatment portion 20 relative to the sheath 16, so The device can be used to incise mucosa 34. That is, during the incision work of the mucous membrane 34 shown in FIG. 4 (c), the mucosa 34 can be incised using the endoscope treatment tool of the fourth embodiment instead of the high-frequency knife 45.
- a window is formed in the mucous membrane 34 in advance by precut or the like, and the window is pushed into the window from the distal end surface of the treatment section 20. Then, with the distal end portion 18A of the wire 18 exposed, the treatment portion 20 is moved to the side while energizing the wire 18 with a high-frequency current. As a result, the mucous membrane 34 touches the exposed tip 18A of the wire 18, so that the mucous membrane 34 is incised. At that time, the mucous membrane 34 can be cut and the mucous membrane 34 can be easily cut simply by moving the treatment unit 20 to the side without changing the posture of the treatment unit 20.
- the mucosa 34 can be cut simultaneously with the incision of the mucosa 34. Furthermore, since the non-conductive portion 28 is provided on the distal end side of the treatment portion 20, the mucosa 34 and the submucosa 38 that do not damage the intrinsic muscle layer 36 can be safely cut.
- the treatment section 20 is retracted with respect to the sheath 16, and the wire 18 is accommodated in the sheath 16. Then, after the wire 18 is in an unexposed state, the treatment section 20 is moved to the side while a high-frequency current is applied to the conductor section 30, and the submucosa 38 is peeled off.
- this embodiment can cut the mucous membrane 34 and peel the submucosal layer 38 without changing the endoscopic treatment tool, so that the working efficiency can be greatly improved and the patient can be improved. Can be greatly reduced.
- FIG. 21 is a perspective view showing the treatment portion 120 of the endoscope treatment tool of the fifth embodiment
- FIG. 22 is a plan view of the treatment portion 120 as seen from the direction of arrow B
- FIG. 22 is a cross-sectional view taken along line 23-23 of FIG.
- FIG. 24 shows a state in which the treatment section 120 of FIG. 23 is advanced with respect to the sheath 16.
- the treatment section 120 shown in these drawings is formed in a substantially gear shape, similar to the treatment section 20 of the first embodiment shown in FIGS. 1 to 3, and includes a plurality of peak portions 120 ⁇ , 120 ⁇ ⁇ ⁇ And valleys 120B, 120 ⁇ ⁇ are alternately arranged in the circumferential direction.
- the treatment portion 120 is configured in a sandwich shape in which the conductor portion 124 is sandwiched between the non-conductor portions 122 and 126, and is formed on the side surface of the treatment portion 120 so that the belt-like conductor portion 124 goes around.
- each peak 120A On the base end face 120C (that is, the non-conductive portion 126) of each peak 120A, a protruding portion 120E is formed to protrude.
- Each convex portion 120E is disposed on the outermost peripheral side of the treatment portion 120 and is formed so as to protrude in a substantially hemispherical shape so that the submucosal layer 38 can be hooked on the convex portion 120E.
- the treatment section 120 is provided so as to be able to advance and retreat with respect to the sheath 16, and may be retracted with respect to the sheath 16 as shown in FIG. 23, or as shown in FIG. It can be moved forward with respect to the sheath 16 as shown in FIG.
- the conductor portion 124 is exposed in a band shape on the side surface of the treatment portion 120, and is also exposed on the base end surface 120C side of the treatment portion 120 to form a base end side exposed surface 124C.
- the proximal-side exposed surface 124C is disposed on the center side of the treatment portion 120, and is exposed when the treatment portion 120 is advanced with respect to the sheath 16 as shown in FIG. 24.
- the treatment portion 120C is exposed. When 120 is retracted with respect to the sheath 16, it is placed in the sheath 16 and becomes unexposed.
- the convex portion 120E is formed on the proximal end surface 120C of the treatment portion 120. Therefore, by moving the treatment portion 120 to the proximal end side, Can be hooked on the convex 120E.
- the hooked submucosal layer 38 is collected on the center side of the processing section 120 and is cut by contacting the proximal end exposed surface 124C and the distal end 18A of the wire 18. That is, it is possible to perform “stripping” that cuts the submucosal layer 38 while moving the treatment portion 120 to the proximal end side. This increases the peeling efficiency of the submucosa 38. And the burden on the patient can be reduced by shortening the time required for the peeling operation.
- the convex portion 120E is formed only on the outer peripheral side of the treatment portion 120.
- the convex portion protruding to the entire portion outside the sheath 16 is formed.
- Part 120E may be formed.
- the shape of the convex portion 120E is not limited to a hemispherical shape, and may be any shape that can hook the lower mucosal layer 38.
- the convex portion 120E protrudes into a substantially cylindrical shape or protrudes into a substantially conical shape. May be.
- a convex portion 120E having a shape that protrudes most at the outer position and gradually decreases toward the inner side may be formed.
- the convex portion 120E may be formed by forming a groove or a concave portion on the base end face 120C of the treatment portion 120.
- the proximal end exposed surface 124 is configured such that the proximal end exposed surface 124 of the conductor portion 124 is exposed by advancing the treatment portion 120 with respect to the sheath 16. 1 24 may always be exposed.
- the conductor portion 124 is formed larger than the sheath 16, and the proximal-side exposed surface of the conductor portion 124 is always exposed outside the sheath 16. Therefore, it is possible to always cut the submucosal layer 38 without moving the treatment section 120 back and forth.
- a mode in which the treatment section 120 is fixed to the sheath 16 is also possible.
- FIG. 28 is a cross-sectional view showing the treatment instrument for endoscope according to the sixth embodiment
- FIG. 29 is a perspective view showing the treatment portion 130 thereof.
- the treatment section 130 of the sixth embodiment shown in these drawings is formed in a gear shape when viewed from the front side (left side of FIG. 28), and has four peak portions 130 ⁇ , 130 ⁇ ⁇ And four valleys 130B and 13OB are alternately arranged.
- the treatment section 130 is configured in a sandwich shape in which the conductor section 134 is sandwiched between the non-conductor sections 132 and 136.
- the non-conductor portion 132 is formed in a substantially semi-spherical shape (specifically, a shape obtained by cutting the hemisphere into a gear shape) on the tip side. Therefore, when the treatment portion 130 is moved to the side while pressing the non-conductive portion 132 against the proper muscle layer 36, the friction between the non-conductor portion 132 and the proper muscle layer 36 is reduced, and the treatment portion 130 is smoothly moved. Can be moved.
- the non-conductor portion 136 on the base end side is the same as the treatment portion 120 of the fifth embodiment shown in Figs.
- a protrusion 130E is provided on the base end face 130C.
- the convex portion 130E is formed so that the outermost peripheral side of the peak portion 130A protrudes to the proximal end side, and the submucosa 38 can be hooked on the convex portion 130E.
- the conductor portion 134 is exposed in a band shape on the side surface of the treatment portion 130, and protrudes in a shaft shape from the base end surface 130C of the treatment portion 130 to form a shaft-like electrode 134A.
- the tip of the axial electrode 134A is fitted into the connection pipe 138 and fixed by welding, brazing, or the like.
- the tip of the wire 18 is inserted into the connection pipe 138 from the opposite side and fixed by welding, brazing, or the like. Thereby, the axial electrode 134A is connected to the tip of the wire 18.
- the base end of the wire 18 is connected to the slider 64 of the hand operation unit 14, and the slider 64 is slidably supported by the main body 66 of the hand operation unit 14.
- the base end of the sheath 16 is connected to the main body 66, and the wire 18 (that is, the treatment portion 130) is moved forward and backward with respect to the sheath 16 by sliding the slider 64 with respect to the main body 66. That is, by sliding the slider 64 backward with respect to the main body 66, the force S can be retracted with respect to the sheath 16, and conversely, by sliding the slider 64 forward with respect to the main body 66.
- the treatment section 130 can be advanced toward the distal end side with respect to the sheath 16.
- the axial electrode 134A is exposed, and cutting can be performed with the axial electrode 134A by applying a high-frequency current. Therefore, the incision of the mucous membrane 34 can be performed using the endoscope treatment tool of the sixth embodiment.
- a collar member 140 is provided inside the distal end portion of the sheath 16.
- the collar member 140 is made of a heat insulating material such as ceramic, and the collar member 140 prevents heat from the axial electrode 134A from being transmitted to the sheath 16.
- the collar member 140 is formed in a cylindrical shape having an inner diameter slightly larger than the outer diameter of the shaft-shaped electrode 134A, and the collar member 140 guides the shaft-shaped electrode 1 34A, so that the straightness of the treatment section 20 is improved. Is secured.
- the collar member 140 also serves to regulate the protrusion amount (advance amount) of the treatment portion 130.
- the maximum outer diameter of the treatment section 130 is substantially equal to the outer diameter of the sheath 16.
- the treatment section 130 is provided so as to be able to advance and retreat with respect to the sheath 16, so that the axial electrode 134A is exposed and the mucosa 34 is incised. S can. Further, according to the sixth embodiment, since the convex portion 130E protrudes from the proximal end surface 130C of the treatment portion 130 (that is, the non-conductive portion 136), the submucosal layer 38 is hooked on the convex portion 130E so that the central side And can be cut with the axial electrode 134A, and the peeling efficiency of the submucosa 38 can be increased.
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Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP07806371.6A EP2057953B1 (en) | 2006-08-30 | 2007-08-30 | Treatment tool for endoscope |
KR1020097003773A KR101413542B1 (ko) | 2006-08-30 | 2007-08-30 | 내시경용 처치구 |
JP2008532115A JP5180081B2 (ja) | 2006-08-30 | 2007-08-30 | 内視鏡用処置具 |
US12/439,476 US20090254085A1 (en) | 2006-08-30 | 2007-08-30 | Treatment instrument for endoscope |
CN2007800325603A CN101511294B (zh) | 2006-08-30 | 2007-08-30 | 内窥镜用治疗器具 |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2006-234159 | 2006-08-30 | ||
JP2006234159 | 2006-08-30 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2008026689A1 true WO2008026689A1 (fr) | 2008-03-06 |
Family
ID=39135971
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/JP2007/066894 WO2008026689A1 (fr) | 2006-08-30 | 2007-08-30 | Outil de traitement pour endoscope |
Country Status (6)
Country | Link |
---|---|
US (1) | US20090254085A1 (ja) |
EP (1) | EP2057953B1 (ja) |
JP (1) | JP5180081B2 (ja) |
KR (1) | KR101413542B1 (ja) |
CN (1) | CN101511294B (ja) |
WO (1) | WO2008026689A1 (ja) |
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JP2009254651A (ja) * | 2008-04-18 | 2009-11-05 | Fujinon Corp | 高周波処置具 |
JP2009254650A (ja) * | 2008-04-18 | 2009-11-05 | Fujinon Corp | 高周波処置具 |
JP2010046199A (ja) * | 2008-08-20 | 2010-03-04 | Fujinon Corp | 高周波処置具 |
EP2168516A1 (en) | 2008-09-30 | 2010-03-31 | Jichi Medical University | Treatment instrument for endoscope |
JP2010268845A (ja) * | 2009-05-19 | 2010-12-02 | Hoya Corp | 内視鏡用高周波ナイフ |
JP2011078549A (ja) * | 2009-10-07 | 2011-04-21 | Hoya Corp | 内視鏡用高周波ナイフ |
EP2322109A1 (en) * | 2008-08-13 | 2011-05-18 | Olympus Medical Systems Corp. | Treatment instrument for endoscope |
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US10076381B2 (en) | 2014-09-08 | 2018-09-18 | Olympus Corporation | Method of marking lesion in tubular organ of an object |
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KR101051323B1 (ko) * | 2010-03-29 | 2011-07-22 | 한양대학교 산학협력단 | 용종 절제 의료기기 |
JP2011212315A (ja) * | 2010-03-31 | 2011-10-27 | Fujifilm Corp | 内視鏡用高周波処置具 |
EP3138504B1 (en) * | 2014-05-02 | 2019-06-05 | Olympus Corporation | Mucous membrane elevation instrument for endoscope and endoscope treatment system |
JP6205529B2 (ja) * | 2015-06-18 | 2017-09-27 | オリンパス株式会社 | 高周波処置具 |
CN106214247B (zh) * | 2016-07-04 | 2018-08-14 | 南京微创医学科技股份有限公司 | 一种双极高频电刀 |
CN112971965A (zh) * | 2019-12-17 | 2021-06-18 | 波士顿科学国际有限公司 | 医疗装置以及相关的方法 |
US20210386472A1 (en) * | 2020-06-10 | 2021-12-16 | Boston Scientific Scimed Inc. | Medical devices and related methods |
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- 2007-08-30 JP JP2008532115A patent/JP5180081B2/ja active Active
- 2007-08-30 US US12/439,476 patent/US20090254085A1/en not_active Abandoned
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JP2009112794A (ja) * | 2007-10-17 | 2009-05-28 | Takashi Toyonaga | 高周波処置具 |
JP2009254651A (ja) * | 2008-04-18 | 2009-11-05 | Fujinon Corp | 高周波処置具 |
JP2009254650A (ja) * | 2008-04-18 | 2009-11-05 | Fujinon Corp | 高周波処置具 |
EP2322109A1 (en) * | 2008-08-13 | 2011-05-18 | Olympus Medical Systems Corp. | Treatment instrument for endoscope |
EP4212119A1 (en) * | 2008-08-13 | 2023-07-19 | Olympus Corporation | Endoscopic treatment tool |
US9301800B2 (en) | 2008-08-13 | 2016-04-05 | Olympus Corporation | Endoscopic treatment tool |
EP2322109A4 (en) * | 2008-08-13 | 2013-05-01 | Olympus Medical Systems Corp | ENDOSCOPE TREATMENT INSTRUMENT |
JP2010046199A (ja) * | 2008-08-20 | 2010-03-04 | Fujinon Corp | 高周波処置具 |
JP2010104776A (ja) * | 2008-09-30 | 2010-05-13 | Jichi Medical Univ | 内視鏡用処置具 |
US8425510B2 (en) | 2008-09-30 | 2013-04-23 | Jichi Medical University | Treatment instrument for endoscope including a sheath having a tapered portion at a distal end portion thereof |
CN101711704A (zh) * | 2008-09-30 | 2010-05-26 | 学校法人自治医科大学 | 内窥镜用处理器具 |
EP2168516A1 (en) | 2008-09-30 | 2010-03-31 | Jichi Medical University | Treatment instrument for endoscope |
JP2010268845A (ja) * | 2009-05-19 | 2010-12-02 | Hoya Corp | 内視鏡用高周波ナイフ |
JP2011078549A (ja) * | 2009-10-07 | 2011-04-21 | Hoya Corp | 内視鏡用高周波ナイフ |
WO2015107802A1 (ja) * | 2014-01-14 | 2015-07-23 | オリンパス株式会社 | 切開具 |
JP5801022B1 (ja) * | 2014-01-14 | 2015-10-28 | オリンパス株式会社 | 切開具 |
CN105228543A (zh) * | 2014-01-14 | 2016-01-06 | 奥林巴斯株式会社 | 切开器具 |
US9795438B2 (en) | 2014-01-14 | 2017-10-24 | Olympus Corporation | Incision instrument |
CN105228543B (zh) * | 2014-01-14 | 2018-02-16 | 奥林巴斯株式会社 | 切开器具 |
US10076381B2 (en) | 2014-09-08 | 2018-09-18 | Olympus Corporation | Method of marking lesion in tubular organ of an object |
Also Published As
Publication number | Publication date |
---|---|
CN101511294A (zh) | 2009-08-19 |
EP2057953B1 (en) | 2020-05-06 |
CN101511294B (zh) | 2013-09-18 |
EP2057953A1 (en) | 2009-05-13 |
KR101413542B1 (ko) | 2014-07-01 |
KR20090056992A (ko) | 2009-06-03 |
JPWO2008026689A1 (ja) | 2010-01-21 |
JP5180081B2 (ja) | 2013-04-10 |
US20090254085A1 (en) | 2009-10-08 |
EP2057953A4 (en) | 2012-11-14 |
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