WO2011024900A1

WO2011024900A1 - Endoscope aid

Info

Publication number: WO2011024900A1
Application number: PCT/JP2010/064491
Authority: WO
Inventors: 清一中島; 大人相馬; 安晃宮嵜; 裕也伊藤; 裕太青木
Original assignee: 国立大学法人大阪大学; 株式会社トップ
Priority date: 2009-08-26
Filing date: 2010-08-26
Publication date: 2011-03-03
Also published as: JP5787244B2; JP2011067597A

Abstract

Disclosed is an endoscope aid that enables the elimination of smoke and regulation of pressure in the portion that is being arranged by an endoscope. The endoscope aid (1) is an aid that can be used in various procedures, and is provided with an outer tube (20) that is inserted into a body, an inner tube (30) inserted into the outer tube (20), a holder unit (40), and a de-aeration prevention unit (50). The outer tube (20) has auxiliary tubes (23, 24), and the de-aeration prevention unit (50) is provided with a vent valve (57), and these are appropriately connected to an automatic air supply device or air removal device, maintaining the air pressure in the body and eliminating smoke generated by surgery.

Description

Endoscope aids

The present invention relates to an auxiliary tool used for using an endoscope in the body.

In recent years, in order to reduce the burden on the patient at the time of surgery, it has been widely performed to perform a procedure for minimizing the incision of the body surface using an endoscope. At that time, for reasons such as securing a visual field in the treatment section, a procedure such as sending a gas such as carbon dioxide from the outside into the body cavity where the treatment section is located and increasing the pressure in the body cavity is performed. . Usually, in such a procedure, air is supplied through a channel provided in the endoscope.

On the other hand, auxiliary tools such as overtubes are used to introduce the endoscope into the body cavity. For example, in the overtube, a deaeration prevention valve is provided so that gas in the body cavity does not leak from a gap between the endoscope and the overtube.

However, when the endoscope is moved during the procedure, gas leaks from the gap between the endoscope and the deaeration prevention valve, and the pressure in the body cavity may decrease. Conventionally, when the pressure in the body cavity drops in this way, it is necessary to increase the amount of gas introduced through the endoscope and to adjust on the endoscope side so that the internal pressure does not rise too much. there were.

Such adjustments must be performed by a surgeon or assistant who performs a procedure with an endoscope. When the surgeon performs the adjustment, the surgeon may not be able to concentrate on the original procedure.

Also, when a cautery device such as an electric knife is used in the procedure, smoke may be generated when the treatment section is burned out with the electric knife, and the visibility around the treatment section may deteriorate. In this case, the operator needs to wait until the smoke has settled, or to suck the smoke from inside the body cavity through the channel of the endoscope.

However, when smoke is sucked from the body cavity through the endoscope channel, the atmospheric pressure in the body cavity is lowered, which disadvantageously narrows the field of view of the endoscope. Therefore, after sucking the smoke, it is necessary to supply the gas into the body cavity again through the channel of the endoscope to increase the atmospheric pressure in the body cavity.

Thus, in the conventional procedure using an electric knife, the original procedure is interrupted every time smoke is generated, resulting in a longer procedure time and a burden on the operator and patient.

JP 2007-301364 A

In order to reduce the burden on the patient in endoscopic surgery, the inventors of the present application have invented an invention that eliminates the inconvenience caused by the means for making a hole in the stomach wall disclosed in Patent Document 1, and as Japanese Patent Application No. 2009-195605 I have applied.

In the prior application, as an auxiliary tool used in a so-called NOTES (Natural Orifice Translumenal Endoscopic Surgery) procedure (transluminal endoscopic surgery), an overtube through which an endoscope can be inserted and inserted into the overtube Proposed inventions such as a hard inner cylinder and a holder that is fixed to a patient's body surface and holds an overtube and an endoscope.

The inventors of the present application have found that the overtube and the holder proposed in the previous application are effective for solving the above disadvantages. Furthermore, these aids should be used not only for NOTES procedures but also widely for procedures such as EMR (Endoscopic Mucosal Resection) and ESD (Endoscopic Submucosal Dssection / endoscopic submucosal dissection). I found out that I can do it.

An object of the present invention is to improve an insertion aid for an endoscope. More specifically, in order to eliminate the inconvenience, an internal pressure can be easily adjusted and a cautery device such as an electric knife is used. An object of the present invention is to provide an endoscope auxiliary tool that can ventilate the body while maintaining the pressure inside the body. Another object of the present invention is to provide an endoscope auxiliary tool that can be used not only in a NOTES technique but also in a technique such as EMR or ESD.

In order to achieve the above object, an endoscope auxiliary tool according to the present invention is an auxiliary tool used when an endoscope is used in a body through a body cavity, and includes an endoscope having an objective lens at a tip. An inner cylinder having an insertable internal passage, and an overtube through which the inner cylinder can be inserted. The overtube and the inner cylinder are formed of flexible synthetic resin, and the tip of the inner cylinder Is provided with a tip portion formed in a tapered shape, at least a front portion of the objective lens is formed transparently, and provided with a tip portion formed so that the outside can be visually observed by the objective lens. The tip portion protrudes from the front end of the overtube and the rear end portion of the inner cylinder protrudes from the rear end portion of the overtube when inserted into the overtube. Cube along its axial direction, characterized in that at least the gas to be supplied auxiliary passage is provided in the body.

In the procedure using the endoscope, first, it is necessary to insert the overtube into the body through an incision provided on the surface of the body or the body cavity, but the tip shape of the inner cylinder is a tapered shape, Furthermore, since the outside can be visually observed by the objective lens, the inner tube and the endoscope are attached to the overtube, and the situation is confirmed by the endoscope when the overtube is inserted into the body through the incision. Treatment can be performed.

Here, in a conventional technique using an endoscope and an overtube, first, an overtube is attached around the endoscope, only the endoscope is inserted into the body cavity, and then the overtube is inserted into the endoscope. It was the procedure of inserting it toward the body cavity along. At this time, the overtube is inserted into the body cavity while the outer tube slides on the outer peripheral surface of the endoscope that has been inserted first, but since the endoscope has already been inserted into the body cavity, the tip of the overtube is The overtube cannot be inserted with visual inspection. Therefore, in the conventional procedure, the surface of the pharynx and the esophagus is caught between the endoscope and the overtube, which may cause a burden on the patient.

In the present invention, the inner cylinder and the overtube can be inserted into the body cavity while the endoscope is mounted in the inner cylinder. Further, in the present invention, the tip portion at the tip of the inner cylinder is transparent, and the front can be seen with an endoscope attached inside. Therefore, according to the present invention, since the procedure can be performed while confirming the insertion state of the overtube with an endoscope, the pharynx, the esophagus and the like can be prevented from being involved, and a smooth procedure can be performed.

Also, since the auxiliary passage is provided in the overtube, gas can be supplied into the body from the auxiliary passage. When a procedure is performed with an endoscope, the inner cylinder is removed from the overtube, and the endoscope is directly inserted into the body through the overtube. In this state, gas can be supplied into the body from the auxiliary passage, and gas can be discharged from the body through the gap between the overtube and the endoscope, so that the atmospheric pressure in the body can be easily adjusted. be able to.

In addition, by supplying gas from the auxiliary passage to the body using the endoscope auxiliary tool of the present invention, the gas in the body near the treatment section is also received when a procedure using an electric knife or the like is performed. Since ventilation is performed, it is possible to prevent the visual field near the treatment area from being deteriorated.

Also, in the endoscope auxiliary tool of the present invention, it is preferable that a plurality of the auxiliary passages are provided to supply gas into the body and to suck the gas from the body. With this configuration, gas supply and suction can be freely controlled, so that the pressure inside the body can be easily controlled.

Further, in the endoscope auxiliary tool of the present invention, it is preferable that a stopcock for opening and closing the auxiliary passage is provided at a position exposed on the body surface side of the auxiliary passage. With this configuration, by appropriately opening and closing the stopcock, the pressure inside the body can be easily controlled by the surgeon or assistant.

The endoscopic auxiliary tool of the present invention further includes holding means for holding the overtube held on the surface of the body cavity of the patient or on the surface of the body, and the holding means is inserted through the overtube. A cylindrical portion that is attached to a patient and holds the cylindrical portion, and holds the overtube against the inner peripheral surface of the cylindrical portion by pressing the overtube against the inner peripheral surface of the cylindrical portion. A possible inflatable balloon is preferably provided.

According to this configuration, the overtube is held by the holding means by inflating the balloon with the overtube inserted into the cylindrical portion of the holding means. For this reason, the position of the endoscope inserted into the overtube is also stabilized. Therefore, the operator can perform a procedure with the endoscope or the like being stable without holding the overtube or the endoscope by an assistant or the like.

Further, when the endoscopic auxiliary tool is an auxiliary tool for performing a procedure via the vagina or anus, the mounting portion is made of cloth and is formed in a pants shape, and the cylindrical portion is the mounting portion. It may be attached to the mounting portion so as to be placed at a position in front of the vagina or anus when mounted on a patient.

Thus, when the cylindrical part is attached to the pant-shaped attachment part, it is easy to attach the cylindrical part to the patient in the NOTES procedure, and the position of the cylindrical part is stabilized even during attachment. Various materials can be used for the pant-shaped mounting part as long as they are made of cloth, but a stretchable part such as a knit or non-woven fabric is preferable. When the mounting portion is formed of such a material, it can be adapted to many patients, and is preferable from the aspect of fixing the cylindrical portion.

Further, the endoscope auxiliary tool of the present invention further includes a deaeration prevention valve unit that is detachably attached to a rear end portion of the overtube, and the deaeration prevention valve unit is a progression of the endoscope. A valve body having a pair of inclined surfaces with a ridgeline at the tip, and having a slit provided along the ridgeline, and a slit provided inside the valve body. It is preferable to provide a restraining member that restrains deformation of the valve body side walls on both ends.

According to this configuration, airtightness between the overtube and the endoscope is maintained by the valve body. Further, the valve body having a pair of tapered inclined surfaces has a resistance to pulling the endoscope back when the endoscope is pulled out due to friction with the endoscope surface when the endoscope is pulled out. In many cases, however, in the present invention, the valve member is prevented from being turned over by the restraining member, so that the resistance when the endoscope is pulled out from the overtube is smaller than that of the conventional one.

Moreover, in the endoscope auxiliary tool of the present invention, the deaeration prevention valve unit is opened on an inner peripheral surface at a front position of the valve body and communicates with one or two or more vents communicating the inside and the outside. A valve is preferably provided. With this configuration, the atmospheric pressure in the body can be adjusted via the ventilation valve. For this reason, the auxiliary passage provided in the overtube can be inserted with a liquid such as a chemical solution or physiological saline, a treatment instrument for an endoscope, or the like in addition to air supply or inhalation. As a result, the endoscope auxiliary tool of the present invention can introduce liquids, treatment tools, and the like desired by the operator into the treatment section in response to various procedures.

Further, in the endoscope auxiliary tool of the present invention, the tip portion is formed with a polygonal pyramid ridge line by a rod-shaped member, and includes an opening portion that opens in communication with the internal passage of the inner cylinder. It may be. According to the shape, when the incision portion provided on the surface of the body cavity is expanded and entered, the rod-shaped member has a stronger pressing force per unit area than the plate-shaped member, so that the procedure can be quickly performed. Can be done. Moreover, since it has the said opening part, an incision part can be confirmed with an endoscope directly.

In the endoscope auxiliary tool of the present invention, the tip portion may be provided with a spiral protrusion on the surface of the tip formed in the tapered shape. According to this configuration, the tip portion can easily spread the incision portion provided on the body cavity surface.

In the endoscope auxiliary tool of the present invention, the shape of the overtube may be an arc shape that gently curves in a side view. According to this configuration, the operator can operate the direction of the distal end of the overtube in an arbitrary direction by rotating the proximal end portion of the overtube. As a result, the range in which the endoscope can enter is widened, so that a wide range of organs can be treated.

Moreover, in the endoscope auxiliary tool of the present invention, the auxiliary passage may be an auxiliary tube provided on a surface of the outer peripheral surface of the overtube that has a smaller radius of curvature in a side view. . According to the configuration, the auxiliary passage can be easily provided in the overtube, and the body cavity surface is not so much contacted and pressed against the body cavity surface as compared with the case where the auxiliary passage is provided on the outer peripheral surface having the larger curvature radius. Since there is not much, the burden on the patient can be reduced as much as possible.

In the endoscope auxiliary tool of the present invention, the auxiliary passage may be provided through the wall surface of the overtube. According to the said structure, since an auxiliary | assistant channel | path does not contact a body cavity surface, it can prevent applying a burden to a patient by this contact.

In the endoscope auxiliary tool of the present invention, the auxiliary passage may be provided on the inner surface of the overtube. Even with this configuration, the auxiliary passage does not contact the surface of the body cavity, so that it is possible to prevent the patient from being burdened by the contact.

Further, in the endoscope auxiliary tool of the present invention, when the inner cylinder is inserted into the overtube, a connector portion for coupling the rear end portion of the inner cylinder to the rear end portion of the overtube is provided. You may provide in the rear-end part of an inner cylinder, and the rear-end part of this overtube, respectively. According to this configuration, by connecting the rear end portion of the inner cylinder to the rear end portion of the overtube, the amount of protrusion of the tip portion from the tip of the overtube is kept constant, while the overtube of the overtube to the treatment portion is maintained. Insertion can be performed.

When the deaeration prevention valve unit is provided, when the inner cylinder is inserted into the overtube, a connector portion for connecting the rear end portion of the inner cylinder to the rear end portion of the overtube is provided. The deaeration prevention valve unit includes a connector portion connectable to a connector portion at a rear end portion of the overtube, and is provided at a rear end portion of the inner tube and a rear end portion of the overtube. Then, it may be detachably attached to the rear end of the overtube.

According to this configuration, the connector portion at the rear end portion of the overtube can be used for both the connection with the rear end portion of the inner cylinder and the connection with the deaeration prevention valve unit.

In addition, when the shape of the overtube is an arc shape, a mark for confirming the bending direction of the overtube is provided on the surface of the rear end portion of the overtube having a smaller radius of curvature of the overtube. You may have. According to the said structure, since an operator can confirm the curve direction of an overtube with a mark by hand, a procedure becomes easy.

Further, in the endoscope auxiliary tool of the present invention, there are a plurality of the auxiliary passages, injecting the cleaning liquid from one auxiliary passage, and sucking out the cleaning liquid after cleaning from the other auxiliary passage, The treatment portion may be cleaned by the endoscope. According to this configuration, even when the endoscope does not have a water supply function, the treatment section can be cleaned.

Further, in the endoscope auxiliary tool of the present invention, the ventilation valve and the auxiliary passage perform air supply through one of them, and suction through the other, thereby allowing the treatment portion to be used by the endoscope. It may be possible to discharge the generated smoke. According to this configuration, even when there is no ventilation channel in the endoscope, air is supplied from one of the ventilation valve or the auxiliary passage, and the gas is sucked from the other, which is generated in the treatment section. Smoke can be discharged to the outside.

In the endoscope auxiliary tool of the present invention, the auxiliary passage may be capable of inserting a treatment tool used for a procedure. According to this configuration, the auxiliary passage can be used in many ways.

Further, in the endoscope auxiliary tool of the present invention, a male connector is provided at one rear end of the auxiliary passage for injecting and sucking out the cleaning liquid, and a female connector is provided at the other rear end. Also good. According to this configuration, the cleaning liquid inlet and the suction port can be easily distinguished.

Explanatory drawing which shows an example of embodiment of the auxiliary tool for endoscopes of this invention. Explanatory perspective view which shows the state which inserted the endoscope in the inner cylinder in this embodiment. Explanatory sectional drawing which shows the state of the front-end | tip part at the time of attaching an inner cylinder and an endoscope to the overtube in this embodiment. Explanatory drawing which shows an example of the holder unit of this embodiment. (A) is explanatory sectional drawing which shows the deaeration prevention unit of this embodiment, (b) is explanatory drawing which shows the support ring provided in the deaeration prevention unit. Explanatory drawing which shows the chip | tip part of the other example of this embodiment. Explanatory drawing which shows the front-end | tip part of the other overtube of this embodiment. Explanatory drawing which shows the holder unit of the other example of this embodiment. Explanatory drawing which shows a mode that the three-way cock was connected to the auxiliary channel | path in this embodiment.

Next, an example of an embodiment of the endoscope auxiliary tool of the present invention will be described with reference to FIGS.

The endoscope auxiliary tool 1 of this embodiment is used for performing a procedure by inserting an endoscope into a body from a body cavity such as a vagina or an incision provided in the abdomen. As shown, an overtube 20 that is inserted into the body through a body cavity or an incision, an inner cylinder 30 that is inserted into the overtube 20, a holder unit 40 (see FIG. 4) and an anti-aeration unit 50 (see FIG. 4). 5).

In the overtube 20, the main body 21 is formed of a flexible synthetic resin tube, and a stainless steel reinforcing core member 22 is integrally formed therein to give a certain degree of rigidity. The vicinity of the distal end portion of the main body 21 is in a state where there is no reinforcing core member 22 and is softer than a portion where the reinforcing core member 22 is present.

The shape of the overtube 20 is an arc shape that curves gently in a side view. Moreover, the outer diameter of the overtube 20 is formed to a thickness suitable for various procedures. In the present embodiment, those having a diameter of about 2 cm to 6 cm are appropriately selected and used depending on the application location and the patient.

A pair of

auxiliary tubes

23 and 24 are fixed to the surface of the overtube 20 having a smaller radius of curvature. The

auxiliary tubes

23 and 24 are flexible synthetic resin tubes, and the tip ends are inclined obliquely along the tip shape of the overtube 20, and the

connectors

25 and 26 are provided at the rear ends. Is provided. In the

connectors

25 and 26, one connector 25 is a male connector and the other connector 26 is a female connector.

As shown in FIGS. 1 to 3, the

auxiliary tubes

23 and 24 are fixed so that the distal end portion is located slightly rearward from the distal end portion of the overtube 20, and rearward along the surface of the overtube 20. It extends to the vicinity of the front end position of the connector portion 27 provided at the rear end portion of the overtube 20. Further, it is divided in the circumferential direction from the vicinity of the tip position of the connector portion 27 and extends to the opposite side of the overtube 20, and is separated from the overtube 20 and connected to the

connectors

25 and 26.

Also, the connector portion 27 is provided with an engagement groove 28 that engages with an engagement protrusion 34 provided on the connector portion 33 of the inner cylinder 30. In addition, the connector portion 27 is provided with a display mark 29 on the surface of the overtube 20 on the side having a small curvature radius so that the bending direction of the overtube 20 can be confirmed at hand.

The inner cylinder 30 includes a cylindrical main body 31, a tip portion 32 provided at the front end portion of the main body 31, and a connector portion 33 provided at the rear end portion of the main body 31. The main body 31 and the chip part 32 are formed of a transparent synthetic resin, and a flexible synthetic resin is used in this embodiment. Further, the inside of the main body 31 is an internal passage 31a through which the endoscope 60 is inserted (see FIG. 3).

Further, the tip portion 32 has a substantially conical shape, and the tip portion is small and provided with a radius. Further, the rear end portion of the chip portion 32 is formed so as to have substantially the same size as the outer diameter of the main body 31.

As shown in FIG. 3, the outer diameter of the inner cylinder 30 (main body 31) is slightly smaller than the inner diameter of the main body 21 of the overtube 20, and the inner cylinder 30 is inside the main body 21 of the overtube 20. Can be moved easily. On the other hand, the gap between the surface of the inner cylinder 30 and the inner peripheral surface of the main body 21 of the overtube 20 is small, and the inner cylinder 30 and the overtube 20 are placed in the stomach via the patient's mouth and esophagus. It is formed so that the surface of the throat or esophagus is not pinched when inserted.

The connector portion 33 of the inner cylinder 30 is provided with an engagement protrusion 34, and is attached to the connector portion 27 of the overtube 20, and the engagement protrusion 34 is engaged with the engagement groove 28, so that the overtube 20 and the inner cylinder 30 can be connected to each other.

In addition, as shown in FIG. 3, the endoscope 60 is inserted into the inside of the inner cylinder 30 up to the vicinity of the distal end portion, so that the endoscope 60 having a diameter generally used can be inserted into the inner passage 31a. Has an inner diameter. The outer diameter of the inner cylinder 30 has a plurality of types of thickness according to the inner diameter of the overtube 20, and is appropriately selected depending on the application location and the patient.

The endoscope auxiliary tool 1 of the present embodiment includes a holder unit 40 shown in FIG. 4 and a deaeration prevention unit 50 shown in FIG. 5 in addition to the above configuration.

Referring to FIG. 4, the holder unit 40 holds the overtube 20 and the endoscope 60 in a predetermined position at the time of surgery. As shown in FIG. 4, the holder unit 40 includes a flange portion 41 arranged in the vicinity of the opening of the patient's body cavity or on the body surface where the incision portion is provided, and a cylindrical portion 42 protruding from the flange portion 41 to one side. And a belt fixing portion 43 provided on the flange portion 41 and a polyurethane fixing belt 44 (mounting portion).

The cylindrical portion 42 is provided with a groove 42a formed in a shape in which the pair of

auxiliary tubes

23 and 24 are accommodated, and a balloon 45 positioned on the opposite side of the groove 42a. The inside of the balloon 45 communicates with the connection tube 46, and a connector 47 is attached to the distal end portion of the connection tube 46.

A syringe (not shown) having no injection needle can be connected to the connector 47, and air can be fed with the syringe to inflate the balloon 45. Further, a check valve (not shown) is provided inside the connector 47 so that air inside the balloon 45 does not leak outside even when the syringe is removed. When the air in the balloon 45 is evacuated, the air is evacuated by inserting a syringe into the connector 47 and pulling the plunger of the syringe.

Referring to FIG. 5A, the deaeration preventing unit 50 is made of rubber having a hole having a diameter smaller than the diameter of the endoscope at the center so that the endoscope 60 can be inserted into the main body 51. A first deaeration prevention valve 52, a rubber second deaeration prevention valve 53 (valve element) formed in a tapered shape toward the advancing direction of the endoscope (left side in FIG. 5A), 2 A support ring 54 (suppressing member) mounted inside the deaeration prevention valve 53 and a spacer 55 for positioning and holding these members in the main body 51 are provided.

Further, the deaeration preventing unit 50 is provided with a ventilation valve 57 that communicates the inside and the outside. The ventilation valve 57 has a passage 57a formed therein, and in the deaeration prevention unit 50, an opening 57b is formed in front of the second deaeration prevention valve 53 (on the left side in FIG. 5A), and the communication between the passage 57a is blocked. And a switching valve 57c for switching between the two.

The first deaeration prevention valve 52 is formed in a ring shape that tapers in the traveling direction of the endoscope 60, and a radial protrusion 52a is formed on the surface thereof to reduce resistance when the endoscope 60 is inserted. Is provided.

The second deaeration prevention valve 53 is a valve formed in a mountain shape in a side view, and has a pair of inclined surfaces 53b provided with a ridge line 53a at the tip, and has a slit 53c provided along the ridge line 53a. is doing. In the second deaeration prevention valve 53, when the air pressure on the left side in FIG. 5A increases, the slit 53c is closely closed by the pressure applied to the inclined surface 53b. Is prevented.

Referring to FIG. 5B, the support ring 54 is formed of a rigid synthetic resin, and is formed in a mountain shape in a side view in accordance with the shape of the side walls on both ends of the slit 53c of the second deaeration prevention valve 53. Has been. In addition, the support ring 54 is provided with an engaging protrusion 54 a so as to be held by a spacer 55 mounted in the main body 51 of the deaeration preventing unit 50.

Further, the deaeration prevention unit 50 is provided with a connector portion 56 that can be detachably attached to the connector portion 27 of the overtube 20. The connector portion 56 is also provided with an engagement protrusion 56 a that can be engaged with the engagement groove 28 of the connector portion 27 of the overtube 20.

Next, a usage example of the endoscope auxiliary tool 1 of the present embodiment will be described. In the following description, a method of using the technique by inserting an endoscope into the stomach using the overtube 20 and the inner cylinder 30 from an incision provided on the patient's abdominal surface will be described. Note that the endoscope 60 used for the procedure is an endoscope that is generally widely used, and includes an objective lens 61 at the tip.

When the incision portion is pushed out by the inner cylinder 30, the endoscope 60 is inserted into the inner cylinder 30, and the distal end portion of the endoscope 60 is positioned near the rear end portion of the tip portion 32 as shown in FIG. Insert until The endoscope 60 is provided with an objective lens 61, and the objective lens 61 makes it possible to visually recognize what is in front of the tip portion 32. At this time, a lubricant is applied to the surfaces of the overtube 20, the inner cylinder 30, and the endoscope 60.

After setting the endoscope 60 in the inner cylinder 30, the inner cylinder 30 and the endoscope 60 are inserted into the overtube 20, and the connector part 27 of the overtube 20 and the connector part 33 of the inner cylinder 30 are connected. . At this time, the engagement protrusion 34 of the connector portion 33 is engaged with the engagement groove 28 of the connector portion 27. In the present embodiment, in this state, as shown in FIG. 2, the tip portion 32 of the inner cylinder 30 protrudes from the distal end portion of the overtube 20.

On the other hand, the holder unit 40 is fixed to the patient side. The holder unit 40 is fixed such that the cylindrical portion 42 is positioned outside the patient with the flange portion 41 facing the patient, the fixing belt 44 is wound around the patient's waist, and the holder unit 40 is fixed to the patient's body surface. To do. At this time, the balloon 45 is deflated.

Next, in a state where the endoscope auxiliary tool 1 and the endoscope 60 are set, these are inserted into the stomach from the incision portion of the patient through the cylindrical portion 42 of the holder unit 40. At this time, the overtube 20 and the inner cylinder 30 are inserted into the body cavity while visually confirming the inside of the body cavity with the objective lens 61 of the endoscope 60.

Then, when the incision portion is pushed and spread by the tip portion 32 of the inner cylinder 30 and passed through the incision portion, the respective states can be visually recognized by the objective lens 61 through the transparent tip portion 32. Therefore, the surgeon can easily grasp that the distal end portion of the inner cylinder 30 has passed through the incision portion. Further, since there is only a small gap between the outer peripheral surface of the inner cylinder 30 and the inner peripheral surface of the overtube 20, the procedure can be performed smoothly without sandwiching an incision portion or the like.

During the above procedure, when there is bleeding or the like from the treatment section and the visibility of the endoscope 60 becomes poor, the treatment section can be cleaned by the

auxiliary tubes

23 and 24. Specifically, the treatment portion can be washed by injecting a cleaning solution such as physiological saline from one auxiliary tube 23 to wash the treatment portion, and sucking out the washing solution after washing from the other auxiliary tube 24. it can. In the present embodiment, the

connectors

25 and 26 provided at the rear ends of the

auxiliary tubes

23 and 24 are distinguished from male connectors and female connectors, so that it is easy to distinguish between injection and suction of the cleaning liquid.

After the above procedure is performed and a hole through which the overtube 20 can be inserted is formed on the body cavity surface, the inner cylinder 30 is removed from the overtube 20 and the deaeration prevention unit 50 is attached to the connector portion 27 of the overtube 20. Then, the endoscope 60 is caused to enter the overtube 20 through the deaeration prevention unit 50. Then, while observing the state of the body with the endoscope 60, the tip of the endoscope 60 is advanced to the vicinity of the affected part.

During the above procedure, the procedure is facilitated by keeping the stomach at a pressure higher than atmospheric pressure. In the present embodiment, the venting valve 57 is provided in the deaeration preventing unit 50, and by connecting an automatic air feeding device to the venting valve 57, the body cavity is automatically maintained at a predetermined pressure. It is. As a result, air supply that has been conventionally performed manually from the air supply channel of the endoscope can be automatically performed via the overtube 20, and the labor of the operator is greatly reduced.

Further, since the overtube 20 is curved in an arc shape, the operator can operate the direction of the tip of the overtube 20 in an arbitrary direction by rotating the connector portion 27. As a result, the range in which the endoscope 60 can enter is widened, so that a wide range of organs can be treated. In addition, since the operator can confirm the bending direction of the overtube 20 with the display mark 29, the procedure is facilitated.

Next, when the overtube 20 is advanced to a predetermined position, the balloon 45 of the holder unit 40 is inflated to hold the overtube 20 in the holder unit 40. At that time, the balloon 45 is inflated after the pair of

auxiliary tubes

23 and 24 are positioned in the groove 42 a of the cylindrical portion 42. Thereby, since the

auxiliary tubes

23 and 24 are not compressed even by the expansion of the balloon 45, the

auxiliary tubes

23 and 24 are not crushed and the internal passage is not blocked.

After that, the surgeon performs a desired procedure using a treatment tool such as an endoscope and an electric knife. For example, when the endoscope 60 has a treatment instrument channel and a ventilation channel (not shown), the affected part is excised using an electric knife, and smoke generated at that time is discharged to the outside through the ventilation channel. Can do.

At this time, air pressure in the stomach can be kept constant by supplying air into the stomach through the overtube 20 from the automatic air supply device connected to the ventilation valve 57 of the deaeration preventing unit 50.

On the other hand, when there is no ventilation channel in the endoscope 60, for example, air is supplied through the overtube 20 from an automatic air supply device connected to the ventilation valve 57 of the deaeration prevention unit 50, and any of the

auxiliary tubes

23, 24 is supplied. By sucking gas from one or both, the smoke in the stomach can be discharged to the outside. Conversely, an automatic air supply device may be connected to the

auxiliary tubes

23 and 24 to suck smoke from the ventilation valve 57 to the outside.

Even if it is necessary to remove the endoscope 60 from the overtube 20 during the procedure, the deaeration prevention unit 50 of the present embodiment has a support ring inside the second deaeration prevention valve 53. Since 54 is provided, when the endoscope 60 is pulled out, the second deaeration prevention valve 53 is not turned over and does not press the surface of the endoscope 60, so that the endoscope 60 can be pulled out easily.

In addition, in the said embodiment, although the

auxiliary tubes

23 and 24 provided in the overtube 20 are two, it is good also as only one and it is good also as three or more multiple. The

auxiliary tubes

23 and 24 may be used to insert a treatment tool such as forceps in addition to injecting and suctioning the cleaning liquid.

Moreover, in the said embodiment, although the

auxiliary tubes

23 and 24 are provided in the outer peripheral surface of the overtube 20, as shown to Fig.7 (a), it is good also as the auxiliary channel | path 23a which penetrates the wall surface of the overtube 20. FIG. . Further, as shown in FIG. 7B, an auxiliary tube 23 b may be provided on the inner surface of the overtube 20. Moreover, about the overtube 20, it is not restricted to what has the reinforcement core material 22, It is good also as a thing without the reinforcement core material 22 depending on a material.

Further, the fixing belt 44 of the holder unit 40 can be made of any material such as silicone rubber or a hook-and-loop fastener other than the polyurethane belt as in the above embodiment.

Moreover, in this embodiment, each structure of the balloon 45 of the holder unit 40, the connection tube 46, and the connector 47 is applied to the mouthpiece conventionally used, and the overtube 20 and the inner cylinder 30 are taken from a patient's mouth. You may use for the procedure inserted in a stomach.

In this procedure, when the overtube 20 and the inner cylinder 30 are inserted from the patient's mouth, treatment can be performed while confirming the situation with an endoscope. Further, the tip portion 32 of the inner cylinder 30 has a substantially conical shape, and the tip portion has a spherical shape. Further, the gap between the inner cylinder 30 and the overtube 20 is narrowed. For this reason, when passing through the throat, esophagus, or piriform fossa, the overtube 20 or the like can be inserted without damaging these portions, mucous membranes, and the like.

In the above embodiment, the tip portion 32 of the inner cylinder 30 has a substantially conical shape. However, as shown in FIG. 6A, a configuration like the tip portion 32a may be used. A spiral protrusion 35 is provided on the surface of the tip portion 32a. The protrusion 35 makes it easy for the tip portion 32a to spread the incised portion provided on the body surface.

Further, as shown in FIG. 6B, a configuration like a chip portion 32b may be adopted. The tip portion 32b is formed in a quadrangular pyramid shape with a rod-shaped member 36, and an opening portion 37 that communicates with the inner passage 31a of the inner cylinder is provided. Although not shown, the rod-shaped member 36 may be formed into a triangular pyramid shape or another polygonal pyramid shape.

With this configuration, when the incision portion provided on the body surface is pushed and expanded by the tip portion 32b, the incision portion can be directly viewed with the objective lens 61 of the endoscope 60 through the opening portion 37. Can do. Further, when the treatment instrument channel is provided in the endoscope 60, it is possible to perform treatment by extending the treatment instrument forward through the opening 37.

Further, in the above-described embodiment, the description has been given of the single vent valve 57 of the deaeration preventing unit 50. However, the present invention is not limited to this, and a plurality of vent valves 57 may be provided as necessary. By providing a plurality of ventilation valves 57, the pressure inside the body can be adjusted only by the deaeration prevention unit 50. Therefore, the

auxiliary tubes

23 and 24 provided in the overtube 20 are used to eliminate smoke from the treatment section. Can be used. Further, only one of the auxiliary tubes can be used for smoke removal, and a treatment instrument or the like can be inserted into the other auxiliary tube, and an easy-to-use auxiliary tool can be provided according to various procedures.

In the above embodiment, the holder unit 40 has been described as being fixed to the patient by the fixing belt 44. However, as shown in FIG. 8, the holder unit 40 is used for a NOTES procedure in which a procedure is performed via the vagina or anus. It is good also as a structure like the simple holder unit 40a. The holder unit 40a uses a pant-shaped mounting portion 48 as a mounting portion. The mounting portion 48 is formed using a knit material used for ordinary clothes.

In FIG. 8, the holder unit 40a has a cylindrical portion 42 having the same configuration as that of the above embodiment, and the shape of the flange portion 41a is different from that of the flange portion 40 of the above embodiment. Specifically, the flange portion 41a is curved along the shape of the mounting portion 48, and the belt fixing portion 43 as in the above embodiment is not provided. Since the other structure of the holder unit 40a is the same as the holder unit 40 of the said embodiment, the same code | symbol is attached | subjected to the same structure and detailed description is abbreviate | omitted.

The holder unit 40a having the above configuration is easy to be mounted on the patient because the mounting portion 48 is in a pants shape, and the flange portion 41a and the cylindrical portion 42 can be reliably positioned with respect to the patient. In the

holder units

40 and 40a, when the overtube 20 is of the type shown in FIG. 7a or 7b, the groove 42a shown in FIG. 4 can be omitted.

Further, although not mentioned in the above embodiment, a stopcock for opening and closing the flow to the auxiliary passage 24 may be provided at a location exposed on the body surface side of the auxiliary passage 24. As the stopcock, for example, a three-way stopcock 80 that closes the connection port to which the handle 84 faces among the three connection ports 81 to 83 as shown in FIG. 9 can be used. The auxiliary passage 24 is connected to the connection port 81 via the female connector 26.

Injection lines

85 and 86 for supplying air, cleaning liquid, and the like are connected to the

connection ports

82 and 83, respectively.

By directing the handle 81 to the connection port 81 as shown in FIG. 9, the connection to the auxiliary passage 24 from both the

injection lines

85 and 86 can be blocked. Further, the direction of the handle 81 is directed to the

connection port

82 or 83, so that the connection destination to the auxiliary passage 24 can be switched between the injection line 86 and the injection line 85.

Furthermore, by connecting a similar three-way stopcock to the auxiliary passage 23 side, it is possible to appropriately switch the discharge destination of gas or the like from the auxiliary passage 23, or to prevent discharge. In this case, since the gas can be supplied to the auxiliary passage 24 and the gas can be discharged from the auxiliary passage 23 by operating the three-way stopcock, the pressure inside the body can be easily controlled by the operator or assistant. it can.

As described above, the endoscope auxiliary tool of the present invention is an auxiliary tool that can be used in various procedures such as EMR, ESD, or NOTES. In the above embodiment, in the NOTES procedure, the transvaginal NOTES procedure has been described as an example. However, the procedure is to widen the incision provided on the surface of the body cavity or to provide the incision on the surface of the body cavity. If the procedure is performed with an instrument formed in a straight line, the body cavity may be used for procedures such as the esophagus, rectum, and urethra.

DESCRIPTION OF SYMBOLS 1 ... Endoscope auxiliary tool, 20 ... Overtube, 30 ... Inner cylinder, 31a ... Internal passage, 32 ... Tip part, 40 ... Holder unit, 50 ... Deaeration prevention unit, 60 ... Endoscope, 61 ... Objective lens.

Claims

An auxiliary tool used when the endoscope is used in the body through a body cavity,
An inner cylinder having an internal passage through which an endoscope having an objective lens at the tip can be inserted, and an overtube through which the inner cylinder can be inserted,
The overtube and the inner cylinder are formed of flexible synthetic resin,
At the tip of the inner cylinder, the tip shape is formed in a tapered shape, at least the front part of the objective lens is formed transparently, and a tip portion is provided that is formed so that the outside can be visually observed by the objective lens,
When the inner cylinder is inserted into the overtube, the tip portion protrudes from the tip of the overtube and the rear end of the inner cylinder protrudes from the rear end of the overtube,
The overtube has an auxiliary passage capable of supplying at least gas into the body along the axial direction of the overtube.
The endoscope auxiliary tool according to claim 1, wherein a plurality of the auxiliary passages are provided to supply gas into the body and to suck gas from the body.
The endoscope auxiliary tool according to claim 1, wherein a stopcock for opening and closing the auxiliary passage is provided at a position exposed on the body surface side of the auxiliary passage.
A holding means for holding the overtube held on the surface of the body cavity of the patient or on the body surface incision;
The holding means includes a cylindrical portion through which the overtube is inserted, and an attachment portion that is attached to a patient and holds the cylindrical portion,
2. The internal view according to claim 1, wherein an inflatable and contractible balloon capable of pressing and holding the overtube against the inner peripheral surface of the cylindrical portion is provided on the inner peripheral surface of the cylindrical portion. Mirror aids.
The endoscopic auxiliary tool is an auxiliary tool for performing a procedure via the vagina or anus,
The attachment part is made of cloth and is formed in a pants shape, and the cylindrical part is attached to the attachment part so that the attachment part is disposed at a front position of the vagina or anus when the attachment part is attached to a patient. The endoscope auxiliary tool according to claim 4.
A deaeration prevention valve unit that is detachably attached to the rear end of the overtube;
The deaeration prevention valve unit is tapered toward the direction of travel of the endoscope, has a pair of inclined surfaces with a ridge line at the tip, and has a slit provided along the ridge line. When,
The endoscope auxiliary tool according to claim 1, further comprising a restraining member that is provided inside the valve body and suppresses deformation of a valve body side wall on both ends of the slit.
The said deaeration prevention valve unit is provided with the 1 or 2 or more ventilation valve which opens to the internal peripheral surface of the front position of the said valve body, and connects the inside and the exterior. The endoscope aid described.
2. The internal view according to claim 1, wherein the tip portion is formed by forming a polygonal pyramid ridge line with a rod-shaped member and includes an opening that communicates with an internal passage of the inner cylinder. Mirror aids.
The endoscope auxiliary tool according to claim 1, wherein the tip portion is provided with a spiral projection on a surface of the tip formed in the tapered shape.
The endoscope auxiliary tool according to claim 1, wherein the shape of the overtube is an arc shape that gently curves in a side view.
The endoscope auxiliary tool according to claim 10, wherein the auxiliary passage is an auxiliary tube provided on a surface on a side having a small curvature radius in a side view among outer peripheral surfaces of the overtube. .
The endoscope auxiliary tool according to claim 1, wherein the auxiliary passage is provided so as to penetrate the wall surface of the overtube.
The endoscope auxiliary tool according to claim 1, wherein the auxiliary passage is provided on an inner surface of the overtube.
When the inner cylinder is inserted into the overtube, a connector portion for connecting the rear end portion of the inner cylinder to the rear end portion of the overtube is provided as a rear end portion of the inner cylinder and a rear end portion of the overtube. The endoscope auxiliary tool according to claim 1, further comprising:
When the inner cylinder is inserted into the overtube, a connector portion for connecting the rear end portion of the inner cylinder to the rear end portion of the overtube is provided as a rear end portion of the inner cylinder and a rear end portion of the overtube. Prepared for each,
The deaeration prevention valve unit includes a connector portion connectable to a connector portion at a rear end portion of the overtube, and can be detachably attached to the rear end portion of the overtube via the connector portion. The endoscope auxiliary tool according to claim 6, wherein the endoscope auxiliary tool is provided.
11. The endoscope for an endoscope according to claim 10, wherein a mark for confirming a bending direction of the overtube is provided on a surface of the rear end portion of the overtube having a smaller radius of curvature of the overtube. Auxiliary tool.
A plurality of the auxiliary passages exist, and the treatment liquid can be washed by the endoscope by injecting the washing liquid from one auxiliary passage and sucking out the washing liquid after washing from the other auxiliary passage. The endoscope auxiliary tool according to claim 1, wherein:
The venting valve and the auxiliary passage allow air to be supplied through one of them and sucked through the other, thereby allowing the endoscope to discharge smoke generated in the treatment section. The endoscope auxiliary tool according to claim 1.
The endoscope auxiliary tool according to claim 1, wherein the auxiliary passage is capable of inserting a treatment tool used for a procedure.
2. The endoscope according to claim 1, wherein a male connector is provided at one rear end of the auxiliary passage for injecting and sucking the cleaning liquid, and a female connector is provided at the other rear end. Aids.