WO2010087330A1

WO2010087330A1 - Retractor for flexible endoscope

Info

Publication number: WO2010087330A1
Application number: PCT/JP2010/050963
Authority: WO
Inventors: 清一中島; 俊朗西田; 大人相馬
Original assignee: 国立大学法人大阪大学
Priority date: 2009-01-29
Filing date: 2010-01-26
Publication date: 2010-08-05
Also published as: JP2012080902A

Abstract

Disclosed is a retractor (1) equipped with a retraction part (10) with a dull-shaped distal end, an introduction part (20) extending from the retraction part, and a handle (30) attached to the proximal end of the introduction part. In this retractor, the retraction part and the introduction part each has an outer diameter allowing the insertion thereof into an instrument channel (42) of a flexible endoscope (40) that is to be inserted from the natural orifice of a hollow organ into the lumen. When protruded from the instrument channel into the inside of the lumen, the retraction part changes the shape thereof into a definite shape and shows smooth surface. The introduction part comprises a flexible material. The handle can be manipulated so as to change the shape of the retraction part. In a preferable embodiment, the retraction part comprises a shape-memory material. Because of requiring no insertion pathway from the body surface, the aforesaid retractor is useful in minimally invasive surgical operations such as endoscopic surgeries and NOTES.

Description

Flexible endoscope retractor

The present invention, in an endoscopic surgical operation, moves an operation target organ to an appropriate visual field, and controls an organ that obstructs the surgical field by squeezing out and pulling to secure an intraoperative visual field (surgical field). The present invention relates to a retractor for a flexible endoscope.

In clinical departments, direct observation and treatment of body cavities are performed for the purpose of diagnosis for various disease states, determination of therapeutic effects, determination of therapeutic strategies, and the like. Conventionally, these have been performed by a large invasive approach called test laparotomy or test thoracotomy. However, with the spread of endoscopic surgery in recent years, it has come to be performed with a test laparoscope or a test thoracoscope with a smaller incision.

For example, Patent Documents 1 and 2 describe a trocar system that can provide a passage through which a larger diameter surgical instrument can be easily expanded after penetrating the skin with a small diameter and inserting it into a body cavity. Is disclosed. According to this system, compared with the conventional case where a large incision corresponding to the diameter of the surgical instrument is made, the trauma of the patient is small, and the recovery time is very short.

Meanwhile, new minimally invasive techniques have been developed to minimize patient trauma. This technique, known as Natural Orifice Translumenal Endoscopic Surgery (NOTES), is performed through the body surface opening of a luminal organ (natural orifice: mouth, anus, vagina, etc.) This is a completely new technique in which a flexible endoscope is inserted, a wall of a luminal organ is incised to reach a body cavity, and diagnosis, treatment, and treatment are performed. Theoretically, since no incision on the surface of the body is required (incisionless), it is expected to be less invasive than endoscopic surgery. Overseas, cases of clinical success of laparoscopic-assisted transvaginal or transgastric “partial NOTES” have been reported and are attracting great interest. In the near future, clinical introduction of “complete NOTES” using only a flexible endoscope, which does not require laparoscopic assistance, is also expected.

In such endoscopic surgery, there is a drawback that it is difficult to secure an optimum visual field compared to open surgery, because the surgical space is limited or the direction of the visual field cannot be freely changed. is there. This problem contributes to the difficulty of endoscopic surgery. For example, in vaginal NOTES gastric surgery, how to raise the stomach wall and obtain a stable surgical field around the stomach is one of the technical problems. In gastrectomy, for example, prior to gastrectomy with a stapler, it is necessary to widely dissect the mesenchyme around the stomach and to fully activate the stomach. At this time, since it is necessary to give moderate tension (or traction) to the mesenchyme to be separated, the treatment instrument is inserted through a channel of 1.2 mm to 3.0 mm provided in the flexible endoscope, The operation of grasping and pulling the mesenchyme is performed. However, at present, assistance with laparoscopic forceps is performed, and therefore, only partial NOTES can be performed instead of complete NOTES.

Various retractors have been developed to alleviate the problem of intraoperative visual field (operating field). A retractor is an instrument mainly used to secure a surgical field by moving the position of a tissue to be operated into an appropriate surgical field or by excluding or pulling a tissue that obstructs the surgical field. As a basic function, the retractor is required to be able to insert a device through a small opening passage such as a trocar (outer tube) or a small incision as an insertion passage when the retractor is inserted into the body. Therefore, it is necessary to have a small diameter at least at the time of insertion (for example, 10 mm or less for a trocar, and preferably 20 mm or less for a small incision) and a rod-like form. In order to exclude objects widely and safely, it is required that the excluding portion be deformable into a shape having a certain large area.

In response to the above conflicting requirements, various retractors have been proposed or marketed. For example, there is one in which the exclusion portion expands in a fan shape (for example, Patent Document 3). When the trocar is inserted into the abdominal cavity, the fan-shaped exclusion portion is folded and stored in the rod-shaped tube, and is pushed out from the rod-shaped tube in the body cavity and spreads in a fan shape. There are structures that can expand the fan-shaped exclusion part to an arbitrary size by hand operation, and those that can change the angle between the exclusion part and the base, etc. It is suitable for. Note that the shape is not limited to a fan shape, and many shapes having various shapes such as rhombus have been proposed.

As another type, there is a snake retractor in which the rod-like body of the exclusion part bends in the body cavity (for example, Patent Documents 4 and 5). When the trocar is inserted, the bent extruding part is linearly housed inside the rod-shaped tube, and when it is pushed out from the rod-shaped tube in the body cavity, it returns to the bent shape, or when inserted, the rod-shaped one has various shapes in the body cavity. Can be bent and the bent shape can be fixed. These are particularly effective for pulling an object so as to be sandwiched between bent portions, and are widely used in laparoscopic surgery.

Alternatively, there is a tip portion having a loop shape (for example, Patent Document 6). This is a type in which a small-diameter loop is taken out from the distal end of the tube, and the tissue is clamped and pulled by the loop. Although it can be inserted from a small-sized trocar and is extremely minimally invasive, it cannot be adapted to exclusion. On the other hand, as a retractor for evacuating and pulling internal organs and the like, an evacuation portion comprising a sheet of rubber elastic thin film and a frame that substantially surrounds and surrounds the periphery of the sheet is extended to the evacuation portion. By using a super elastic alloy or shape memory alloy for the frame, the exclusion part can be reduced in diameter to be inserted from a trocar or a small incision when inserted into a body cavity. There are also instruments having a function of restoring the original shape having a large exclusion area inside the body cavity (Patent Documents 7 and 8).

Also disclosed is a snake retractor that is flexible and allows manipulation of organ and tissue structures as a tool arm that is inserted through a lumen provided in an endoscope insertion tube. (Patent Document 9). This is also a multi-node type like the snake retractor inserted via the trocar, and has a complicated structure.

All of these are inserted into the body cavity through the incision on the body surface or from the body surface opening of the hollow organ, and the organ is evacuated under the observation of the endoscope in the inserted cavity. It is.

US Pat. No. 5,320,611 JP-T 8-507238 JP-A-6-154152 JP 7-502914 A US Patent Application Publication No. 2002/011536 JP 2000-23989 A JP 2003-16459 A JP 2005-237398 A Special table 2007-511247 gazette

As described above, in the current laparoscopic surgery, in addition to the insertion path of the laparoscope, an open passage from the body surface for excluding the organ is necessary. Moreover, the necessity of a device for facilitating organ elevation and exclusion has not been widely recognized among NOTES researchers. Therefore, an object of the present invention is to provide a retractor that does not require an insertion path from the body surface in minimally invasive surgery such as laparoscopic surgery or NOTES. It is another object of the present invention to provide a method for eliminating a luminal organ and securing a surgical field within the abdominal cavity using a retractor that does not require an insertion path from the body surface.

The present inventors, when performing resection of the stomach with transvaginal NOTES in pigs, separate from the flexible endoscope inserted into the abdominal cavity transvaginally, another flexible endoscope inserted into the stomach ( A gastric camera is used to raise the stomach wall from the luminal side and develop a technique for obtaining appropriate traction on the mesenchyme (Non-Patent Document 1). However, this method has a drawback in that the field of view of the endoscope is lost because the endoscope itself is used as a retractor. In order to secure a visual field, it is possible to raise the stomach wall using an endoscope with a transparent cap or hood attached to the tip, but this also restricts the visual field.

Therefore, the inventors raised the stomach wall from the stomach lumen side by deploying a retractor in the stomach via the treatment instrument channel of the flexible endoscope, not the flexible endoscope itself. As a result, it was found that appropriate traction to the intermesentery was obtained, and the present invention was completed. That is, the present invention is characterized in that the retraction required in the abdominal cavity is performed not from the outside of the organ but from the digestive tract lumen side.

The present invention provides a retractor including an exclusion portion having a blunt-shaped distal end, an introduction portion extending to the exclusion portion, and a handle portion provided at a proximal end of the introduction portion. In the tractor,
The exclusion part and the introduction part have an outer diameter that can be inserted into a treatment instrument channel of a flexible endoscope that is inserted into the lumen from a body surface opening of a hollow organ,
The exclusion portion expresses a predetermined shape when projected from the treatment instrument channel into the lumen, and has a smooth surface;
The introduction portion is made of a flexible material, and the handle portion is operable to change the shape of the exclusion portion.

In one embodiment, the exclusion part is made of a shape memory material.

In one embodiment, the shape memory material is a shape memory alloy.

In one embodiment, the exclusion portion is surface-coated.

In one embodiment, the exclusion part has a length of 15 to 20 cm.

In one embodiment, the retractor can be used in surgery selected from the group consisting of laparoscopic surgery and NOTES.

The present invention also provides a method for excluding a luminal organ, the method comprising:
Inserting a flexible endoscope having a treatment instrument channel into a lumen from a body surface opening of a luminal organ;
Inserting a retractor into the treatment instrument channel, wherein the retractor is any of the above retractors;
Projecting the retraction part of the retractor into the lumen of the luminal organ to express an arbitrary shape; and bringing the retraction part into contact with the inner wall of the luminal organ to relieve the inner wall. Include.

In one embodiment, the method is performed in a surgery selected from the group consisting of laparoscopic surgery and NOTES.

The present invention further provides a method for securing a surgical field in intraperitoneal or intraluminal surgery,
Inserting a flexible endoscope having a treatment instrument channel into a lumen from a body surface opening of a luminal organ;
Inserting a retractor into the treatment instrument channel, wherein the retractor is any of the above retractors;
Allowing the retractor of the retractor to project into the lumen of the luminal organ to develop an arbitrary shape; and contacting the evacuation part with the inner wall of the luminal organ to squeeze the inner wall, A step of securing a surgical field in the abdominal cavity or in the lumen is included.

In one embodiment, the intraperitoneal surgery is selected from the group consisting of laparoscopic surgery and NOTES.

The retractor of the present invention is inserted into the lumen of the luminal organ via the treatment instrument channel of the flexible endoscope, and quickly develops the shape designed in advance by the hand operation in the lumen. Due to the developed tip shape, the luminal organ can be evacuated / opened from the lumen side, and for example, a surgical operation in the abdominal cavity by NOTES can be assisted.

Using the retractor of the present invention, the surgical field can be secured without requiring an open passage from the body surface for excluding the organ other than the insertion path of the laparoscope. Further, since the exclusion operation can be performed while securing the visual field, for example, when there is a small lesion in the digestive tract cavity, the operation can be performed without damaging the lesion. Furthermore, there is no tissue pinching or damage caused by the instrument during use.

According to the method of the present invention, the retraction required in the abdominal cavity is performed not from the outside of the lumen organ but from the lumen side of the lumen organ by inserting the retractor into the lumen organ. be able to.

It is a schematic diagram which shows one embodiment of the structure of the retractor of this invention. It is a partial schematic diagram which shows one embodiment at the time of exposing the retractor of this invention through the treatment tool channel of an endoscope. It is a schematic diagram which shows the various forms of the front-end | tip part of the retractor of this invention, (a) Triangle type | mold, (b) Circle type, and (c) Angled triangle type | mold, respectively. The retractor of the present invention is inserted into the stomach through the treatment instrument channel of the gastroscope, (a) a state in which the exclusion portion expressing the memory shape is pressed against the stomach wall, and (b) operation of the gastroscope It is explanatory drawing which shows the state which raised the stomach wall from the lumen side by the exclusion part by each. It is a schematic diagram which shows the state which inserted the retractor of this invention in the large intestine through the treatment tool channel of the large intestine endoscope. It is explanatory drawing at the time of inserting the retractor of this invention into the large intestine through the treatment tool channel of a large intestine endoscope, (a) When the polyp in the large intestine is seen from the large intestine endoscope, the base of the polyp is the large intestine A state in which it is partially hidden by a wall fold, (b) a state in which the retractor of the present invention is disposed near a polyp in the large intestine through the treatment instrument channel of the large intestine endoscope, The tractor's retraction part is pressed against the colon wall around the polyp to relieve the sputum, and the entire polyp, especially the base, is visible, and (d) a polyp with an electric knife inserted through the treatment instrument channel of the large intestine endoscope The state of processing the base of each is shown.

Referring to FIG. 1, a retractor 1 according to the present invention is provided at an exclusion part 10 having a blunt-shaped distal end, an introduction part 20 extending to the exclusion part 10, and a proximal end of the introduction part 20. The excluding portion 10 and the introducing portion 20 have an outer diameter that can be inserted into a treatment instrument channel of a flexible endoscope that is inserted into the lumen from a body surface opening of a hollow organ. Have The exclusion part 10 is corresponded to the movable part in FIG.

In the present specification, the term “retractor” refers to an object that shifts the position of an object (for example, a luminal organ) in the medical field, or that excludes, opens, pulls, or lifts an object that obstructs the field of view. Medical equipment for securing and performing surgery. In addition, the operations of exclusion, opening / extraction, traction, or elevation may be collectively referred to as “retraction” or “retraction”. In the present specification, the term “exclusion” may include not only an exclusion operation but also an operation of opening, pulling, or raising (that is, retraction).

Target luminal organs include stomach, small intestine, large intestine, vagina and the like. The retractor of the present invention is preferably used for the stomach, small intestine, and large intestine.

In this specification, the flexible endoscope refers to a medical flexible endoscope. Such a flexible endoscope uses a flexible material, and there are a built-in observation optical system using a glass fiber and a CCD using a CCD. In general, an illumination optical system is provided with a light source on the side of a control device outside the body, and the light is guided by an optical fiber and irradiated from the tip. There is also a type in which an LED is built in the endoscope tip. In general, an endoscope has a treatment instrument channel (sublumen) separate from these optical systems, and performs local cleaning, gas or liquid injection, drug spraying, suction, treatment by a dedicated device (gripping, Cutting, puncture, etc.). In addition, the direction of the distal end of the endoscope can be freely changed by an operation at hand. As the flexible endoscope, an endoscope having an appropriate size is selected according to a target lumen. The exclusion part and the introduction part of the retractor of the present invention have an outer diameter that can be inserted into the treatment instrument channel of such a flexible endoscope. The inner diameter of the treatment instrument channel is usually about 3 mm. Therefore, the outer diameter of the exclusion part and the introduction part of the retractor of the present invention can be less than 3 mm when inserted into the treatment instrument channel.

The retractor of the retractor of the present invention has a blunt-shaped distal end, and develops a predetermined shape when projected from the treatment instrument channel into the lumen. In the expressed shape, the exclusion portion has a smooth surface so as not to damage the interior of the lumen.

As used herein, the term “distal” refers to the part of the instrument furthest from the operator of the instrument, and the term “proximal” refers to the part of the instrument that is closest to the operator.

The retractor of the retractor according to the present invention has an outer diameter that can be inserted into the treatment instrument channel of the flexible endoscope, but can protrude from the treatment instrument channel into the lumen to express a predetermined shape. Any structure may be used as long as it has a sufficient strength to eliminate the pressure. For example, a wire, tube, or rod-shaped configuration made of a shape memory material may be used. Or you may be comprised with the close_contact | adherence coil and the mesh, and the structure with which the several segment continued may be sufficient. In the present invention, it is preferably composed of a shape memory material.

When the exclusion part of the retractor of the present invention is made of a shape memory material, the shape memory material is not particularly limited as long as it is a material having sufficient strength to exclude an organ with a predetermined shape, as long as it is not harmful to the living body. Not. The shape memory material is preferably a shape memory alloy, more preferably a shape memory alloy commonly used in medical devices. Such shape memory alloys have been developed in various ways and are used in endoscopes, guide wires, catheters, stents, orthodontic wires, implant materials, osteosynthesis staples, and the like. For example, a nickel-titanium alloy (typically nitinol), a copper-zinc-aluminum alloy, and the like can be given. For example, a shape memory alloy having a shape transformation temperature in the range of 32 ° C. to 40 ° C. is preferably used.

When the retraction part of the retractor of the present invention is constituted by a contact coil or a mesh, the shape expression is controlled by operating means provided together with these. The operating means can be, for example, a wire. Further, in order to eliminate the possibility of organs being sandwiched between the gaps between the coils and the mesh at the time of shape development, the exclusion part is provided with a flexible mantle (for example, silicone rubber, polyurethane) that provides a smooth surface. .

When the retraction part of the retractor of the present invention is composed of a plurality of segments, preferably, each tubular segment is connected, and an operating means for controlling the shape expression is provided in the cylinder. Also in this case, in order to prevent organ damage due to being sandwiched between the segments, the exclusion portion includes the above-described mantle.

Referring to FIG. 2, when the retractor 10 of the retractor 1 of the present invention protrudes from the treatment instrument channel 42 of the endoscope 40 into the lumen, a predetermined shape is developed. The desired shape is not particularly limited as long as the desired shape can be eliminated in the target hollow organ. For example, it may be a fan type, a bent type, a loop type, a bar type, a curve type, or the like. In the retractor of the present invention, a bent shape in which one member is smoothly bent is particularly preferable. Examples of the bent shape include (a) triangle type, (b) circle type, and (c) angled triangle type shown in FIG. Such an exclusion part has a length corresponding to the intended exclusion or shape, and has a length of 15 to 20 cm, for example.

Also, the retractor of the retractor of the present invention has no joints or seams on the surface so as not to cause tissue pinching or damage by the instrument during use, in other words, it is not articulated or bellows type Is preferred. However, in the case where the exclusion portion is formed of a contact coil, a mesh, or a plurality of segments, it is only necessary to include a flexible mantle that provides a smooth surface as described above.

In addition, when an exclusion part is comprised from shape memory material, the shape is designed previously at the time of manufacture, and cannot be changed at the time of use. Accordingly, a retractor having various shapes, various lengths of movable parts, various bending angles, and the like should be provided according to the portion to be excluded and the exclusion range. There are a plurality of tip shapes depending on the part to be excluded and the exclusion range.

The retractor of the retractor of the present invention has a smooth surface so as not to damage the organ. Its distal end is dull (ie not sharp). Preferably, the vicinity of the distal end has a pigtail-like shape (ie, rounded) as shown in FIGS. The tip of the distal end is rounded and preferably spherical. Furthermore, the exclusion part may be surface-coated. For the coating, materials usually used for coating medical devices can be used. For example, the outer surface may be coated with a porous polytetrafluoroethylene (ePTFE) film, a silicone film, a polyurethane film, a polyethylene terephthalate (Dacron (registered trademark)) film, or the like.

When constructed of shape memory material, the retraction portion becomes a flexible rod when inserted into the treatment instrument channel, and when exposed to the lumen from the treatment instrument channel, the retraction portion (eg, bent) The shape of the mold). In the treatment instrument channel, the shape is memorized so as to be formed into a straight rod shape physically by the lumen of the channel, or a straight rod shape at a temperature higher or lower than the shape transformation temperature. The expression of the shape in the lumen can be performed at a temperature above or below the shape transformation temperature, or by being released from physical constraints.

The introduction part of the retractor of the present invention extends from the above-mentioned exclusion part, and connects the handle part and the exclusion part. The length of the introduction part is sufficient if it is long enough to protrude (or be exposed) into the lumen targeted for the exclusion part, and is usually a wire extending to the treatment instrument for a flexible endoscope Can be equivalent to The outer diameter of the introduction part is smaller than the inner diameter of the treatment instrument channel as described above, and is usually less than 3 mm.

The flexible material constituting the introduction portion of the retractor of the present invention allows the retraction portion to be delivered to the distal end of the endoscope via the treatment instrument channel and protruded (or exposed) into the lumen. As long as it has possible flexibility and strength, it is not particularly limited. For example, it may be a wire extending to a treatment instrument (for example, forceps) for a flexible endoscope. The material includes a flexible material used for a stent or the like. For example, 316L stainless steel, tantalum, cobalt alloy, nitinol (nickel-titanium alloy), etc., which are medical stainless steels. These wires may be, for example, coiled wires or wire meshes. The introduction portion can move together in the treatment instrument channel in accordance with the movement of the flexible endoscope without interfering with the movement of the flexible endoscope. Alternatively, the exclusion part can be further pushed out from the treatment instrument channel into the lumen through the introduction part, or the direction of the exclusion part can be changed in the lumen.

The introduction part may be provided with means for changing the shape of the exclusion part by operating the handle part as necessary. For example, in the case where the memory shape is expressed by a change in the shape transformation temperature of the shape memory alloy constituting the exclusion portion, a heat transfer means is additionally provided. Examples of the heat transfer means include flexible heating wires that are insulated and heat-insulated.

The handle portion of the retractor of the present invention is provided at the proximal end of the introduction portion. By operating the handle part, the exclusion part and the introduction part are inserted into the treatment instrument channel of the endoscope, and the exclusion part is delivered to the distal end of the endoscope and protruded (or exposed) into the lumen. Can do. For example, a structure may be adopted in which a dial is provided in the handle portion, and the dial is moved into or out of the treatment instrument channel by operating the dial (for example, rotating around the axis of the endoscope). .

This handle part can be operated to change the shape of the exclusion part. The method of changing the shape of the exclusion portion is appropriately determined according to the configuration of the exclusion portion. For example, when the shape is expressed by the change in the shape transformation temperature of the shape memory alloy as described above, the heat transfer means is changed by the temperature adjusting means (for example, a heating device connected to the power source) provided in the handle portion. The shape of the exclusion part is changed by adjusting the exclusion part to a predetermined temperature.

The shape and structure of the handle part are not particularly limited as long as it has the above functions. It may be of a size and shape that is easy for the operator of the instrument to handle and is normally employed in the art.

The retractor of the present invention is inserted into a luminal organ from the treatment instrument channel of the flexible endoscope, and the exclusion part expresses a predetermined shape (for example, a memorized shape). While this exclusion part is monitored by an endoscope, the inner wall is pressed or pushed up by being brought into contact with the inner wall of the lumen by an operation with the handle part or an operation of the endoscope itself. By this operation, it is possible to realize the exclusion, opening, traction, or elevation required for the outer wall of the lumen in surgery or the like in the abdominal cavity. Appropriate traction can be obtained on the outer wall of the luminal organ, and a surgical field can be secured in the abdominal cavity. Alternatively, for example, by expanding the mucosal surface in the large intestine and expanding the fold, for example, by observing the entire polyp hidden in the fold, treatment with a normal endoscope becomes possible.

The method for excluding a luminal organ will be described in detail with reference to FIGS. 2 to 4, taking as an example the case of using the retractor and gastroscope of the present invention.

The stomach endoscope 40 is orally inserted into the stomach S, and the retractor 1 of the present invention is inserted into the stomach S from the treatment instrument channel 42. Next, the exclusion part 10 is completely exposed in the stomach S to develop a memory shape (see FIG. 2 and FIG. 4A). Under the monitoring by the observation optical system 41 of the gastroscope 40, the exclusion portion 10 is brought into contact with the stomach wall and pressed against the stomach wall (FIG. 4 (a)). Next, by performing an operation of moving or bending the stomach endoscope 40, the stomach wall is lifted from the inside by the exclusion unit 10 (FIG. 4B). A part of the stomach wall is raised in the abdominal cavity and tension is created between the stomach and the surroundings, making it easier to operate in the abdominal cavity. Therefore, by this operation, the stomach can be evacuated without incising the body surface.

Although the retractor of the present invention has been described mainly as a device for retracting the stomach wall from the lumen side, for example, when used in the colon cavity, it can also be applied to a colectomy. An example of use in the colon cavity will be described with reference to FIGS. 5 and 6 by taking as an example the case of removing a polyp in the colon.

First, the retractor 1 of the present invention is inserted in the vicinity of the polyp P existing in the large intestine C through the treatment instrument channel of the large intestine endoscope 40 (FIG. 5). Here, the polyp P in the large intestine C is partially hidden by wrinkles on the large intestine wall when viewed from the large intestine endoscope 40 (FIG. 6A). Therefore, the retractor 1 of the present invention is disposed around the polyp P through the treatment instrument channel of the colonoscope 40 (FIG. 6B), and then the exclusion part of the retractor 1 that expresses the memory shape is defined as the polyp P. By pressing against the surrounding large intestine wall, the entire large polyp P, in particular, the base portion thereof is crushed so that it can be seen (FIG. 6C). Since the surgical field can be secured in this way, the polyp P is reliably processed (for example, excised after ligating the whole blood vessel passing through the base) with the electric knife 50 inserted through the treatment instrument channel of the colonoscope 40. (FIG. 6D).

The retractor of the present invention is inserted into the lumen of a luminal organ via a treatment instrument channel of a flexible endoscope, and quickly develops a predesigned shape in the lumen. The evacuation part having the expressed tip shape is used to evacuate and open the luminal organ from the lumen side, and for example, the surgical operation in the abdominal cavity by NOTES can be assisted.

More specifically, the retractor of the present invention is a gastric resection, an esophagectomy, a small intestine resection, a splenectomy (expanding between the stomach and the spleen by expanding the stomach from the lumen) Etc.) and can be applied via a gastroscope. Transgastric NOTES can be applied via an enteroscope in colectomy, rectal resection, small intestine resection, and the like. Alternatively, it can be applied to gynecology and urology.

Furthermore, the retractor of the present invention can be applied not only to NOTES but also to laparoscopic surgery, endoscopic surgery, or open surgery. For example, in order to obtain appropriate traction of the gastrointestinal tract in ordinary laparoscopic surgery, the gastrointestinal tract can be inserted into the lumen of the gastrointestinal tract via an endoscope and used. Such an operation eliminates the need for an organ repellent used under a laparoscope, thereby reducing the abdominal incision.

Also, the retractor of the present invention can be used as an auxiliary when performing complex operations in a normal gastrointestinal endoscope (stomach camera or colon camera). For example, a polyp present on the back side of a coral that is difficult to access can be viewed from the front by deploying a wall using the retractor of the present invention, and can be excised endoscopically.

DESCRIPTION OF SYMBOLS 1 Retractor 10 Exclusion part 20 Introduction part 30 Handle part 40 Endoscope 41 Observation optical system (camera lens)
42 treatment instrument channel 50 electric knife S stomach C large intestine P polyp

Claims

A retractor comprising an exclusion part having a blunt-shaped distal end, an introduction part extending to the exclusion part, and a handle part provided at the proximal end of the introduction part,
The exclusion portion and the introduction portion have an outer diameter that can be inserted into a treatment instrument channel of a flexible endoscope that is inserted into the lumen from a body surface opening of a hollow organ,
The exclusion portion develops a predetermined shape when projected from the treatment instrument channel into the lumen, and has a smooth surface;
The introducing portion is made of a flexible material, and the handle portion is operable to change the shape of the exclusion portion;
Retractor.
The retractor according to claim 1, wherein the exclusion portion is made of a shape memory material.
The retractor according to claim 2, wherein the shape memory material is a shape memory alloy.
The retractor according to any one of claims 1 to 3, wherein the exclusion portion is surface-coated.
The retractor according to any one of claims 1 to 4, wherein the exclusion portion has a length of 15 to 20 cm.
The retractor according to any one of claims 1 to 5, wherein the retractor can be used in a surgery selected from the group consisting of laparoscopic surgery and NOTES.
A method for excluding a luminal organ,
Inserting a flexible endoscope having a treatment instrument channel into a lumen from a body surface opening of a luminal organ;
Inserting the retractor into the treatment instrument channel, wherein the retractor is the retractor according to any one of claims 1 to 6;
Projecting the retraction part of the retractor into the lumen of the luminal organ to express an arbitrary shape; and bringing the retraction part into contact with the inner wall of the luminal organ to relieve the inner wall. The method of inclusion.
The method according to claim 7, wherein the method is performed in a surgery selected from the group consisting of laparoscopic surgery and NOTES.
A method for securing a surgical field in intraabdominal surgery or intraluminal surgery,
Inserting a flexible endoscope having a treatment instrument channel into a lumen from a body surface opening of a luminal organ;
Inserting the retractor into the treatment instrument channel, wherein the retractor is the retractor according to any one of claims 1 to 6;
Allowing the retractor of the retractor to project into the lumen of the luminal organ to develop an arbitrary shape; and contacting the evacuation part with the inner wall of the luminal organ to squeeze the inner wall, Securing a surgical field within the abdominal cavity or in the lumen.
10. The method of claim 9, wherein the intra-abdominal surgery is selected from the group consisting of laparoscopic surgery and NOTES.