WO2012042920A1

WO2012042920A1 - Therapeutic instrument

Info

Publication number: WO2012042920A1
Application number: PCT/JP2011/053528
Authority: WO
Inventors: 悟菊池; 雅之小林
Original assignee: オリンパス株式会社
Priority date: 2010-09-30
Filing date: 2011-02-18
Publication date: 2012-04-05
Also published as: JP2012075604A

Abstract

To introduce a guidewire into the pericardial space while keeping the tip of the guidewire from contacting the heart, a therapeutic instrument (1) is provided that has forceps (3) to grasp living tissue, a main body provided on the forceps (3), an actuator (5) that is provided on the main body (2) and operates the forceps (3), a channel (10) for delivering the guidewire (9) to be introduced into the living tissue, and an articulated mechanism (4) that swings the forceps (3) in a direction orthogonal to the longitudinal direction of the main body (2).

Description

Treatment tool

The present invention relates to a treatment instrument.

Conventionally, there has been known a treatment instrument that introduces a guide wire into a pericardial cavity by puncturing the pericardium in a pinched state (for example, see Patent Document 1).

US Pat. No. 5,931,810

However, in the case of Patent Document 1, when the guide wire is penetrated through the pericardium, there is a problem that the tip of the guide wire may come into contact with the heart adjacent to the pericardium.
The present invention has been made in view of the above-described circumstances, and provides a treatment instrument capable of introducing a guide wire into the pericardial cavity while preventing the tip of the guide wire from contacting the heart. With the goal.

In order to achieve the above object, the present invention provides the following means.
The present invention provides a forceps part for gripping a living tissue, a main body part provided on the forceps part, an operation part provided on the main body part for operating the forceps part, and a guide wire introduced into the living tissue. There is provided a treatment instrument including a channel portion to be led out and a joint mechanism that is provided in the main body portion and swings the forceps portion in a direction intersecting a longitudinal axis direction of the main body portion.

According to the present invention, the main body is inserted into the body, the forceps part reaches the pericardium, and the guide wire inserted into the channel part in a state where the pericardium is gripped by the forceps, It can be introduced into the pericardial cavity through the pericardium.
In this case, the forceps unit is swung by the joint mechanism while the pericardium is gripped by the forceps unit, and the guide wire is pushed out with the forceps unit tilted along the pericardium. As a result, the distal end of the forceps part is directed in a substantially tangential direction of the heart surface, and the guide wire is projected along the substantially tangential direction. Therefore, when the guide wire is introduced into the pericardial cavity, the distal end of the forceps part becomes the heart. Can be prevented from touching.

In the said invention, it is good also as providing the restriction | limiting mechanism provided in the said joint mechanism and restrict | limits the rocking | fluctuation direction of the said forceps part.
By doing so, the swinging direction of the forceps portion can be known in advance, so that the positional relationship between the guide wire and the pericardium when the forceps portion is swung can be grasped and the guide wire can be more securely penetrated into the pericardium. Can be made.

In the said invention, the structure provided with the fixing mechanism which is provided in the said joint mechanism and fixes rocking | fluctuation of the said forceps part may be sufficient.
In this way, when the pericardium does not need to be grasped by the forceps part, the forceps part is operated in a closed state, thereby preventing the forceps part from unintentionally swinging and hindering the operation. The operability can be improved.

In the above configuration, a gripping force transmission member that is connected to the forceps portion and transmits a gripping operation of the operation portion to the forceps portion, and a fitting portion that is provided on the main body portion and engages the gripping force transmission member. The fixing mechanism may fix the swinging direction of the forceps portion via the fitting portion.
By doing so, the gripping force transmission member is fitted into the fitting portion in accordance with the gripping operation of the operation portion by the operator, so that the swinging of the forceps portion is fixed. It can be prevented from moving and obstructing operation.

In the said invention, the said forceps part is good also as being formed in the shape along the biological tissue surface.
By doing so, since the forceps portion is arranged along the shape of the pericardium when the forceps portion is tilted on the pericardium, the posture of the forceps portion can be stabilized.

In the above invention, the joint mechanism may include a plurality of joints.
In this way, when the forceps part is tilted, each joint swings along the pericardium shape and the joint mechanism is arranged along the pericardium, so that the posture of the forceps part can be stabilized. it can.

According to the present invention, the guide wire can be introduced into the pericardial space while preventing the tip of the guide wire from contacting the heart.

It is a whole block diagram of the treatment tool which concerns on one Embodiment of this invention, and has shown the state which opened the forceps part. It is a figure which shows the state which closed the forceps part of the treatment tool of FIG. It is the side view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which closed the forceps part. It is the top view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which closed the forceps part. It is the side view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which opened the forceps part. It is a figure explaining rocking | fluctuation operation | movement of the forceps part by a joint part. It is a figure explaining the usage method of the treatment tool of FIG. 1, and has shown the state which inserted the forceps part to the pericardium. It is a figure explaining the usage method of the treatment tool of FIG. 1, and has shown the state which hold | gripped the pericardium with the forceps part and pulled this pericardium. It is a figure explaining the usage method of the treatment tool of FIG. 1, and has shown the state which penetrated the pericardium. It is a figure which shows the modification of a forceps part. It is a figure which shows the modification of a joint part.

Hereinafter, a treatment tool 1 according to an embodiment of the present invention will be described with reference to the drawings.
As shown in FIGS. 1 and 2, the treatment instrument 1 according to the present embodiment includes a rigid insertion portion (main body portion) 2 that is inserted into the body and a forceps portion that is disposed on the distal end side of the insertion portion 2. 3, a joint part (joint mechanism) 4 that pivotally connects the forceps part 3 to the distal end of the insertion part 2, and an operation part 5 that opens and closes the forceps part 3 when operated by an operator. ing. FIG. 1 shows a state in which the forceps portion 3 is opened, and FIG. 2 shows a state in which the forceps portion 3 is closed.

The insertion portion 2 has an elongated cylindrical shape and is made of a hard material such as metal. In the insertion portion 2, a lumen (fitting portion) 2a having both ends opened is formed along the longitudinal direction.
As shown in FIGS. 3 and 4, the forceps portion 3 includes a pair of

gripping pieces

6 a and 6 b, and the

gripping pieces

6 a and 6 b are connected to each other by a link mechanism 7 on the base end side. As shown in FIG. 3, the link mechanism 7 closes the

gripping pieces

6 a and 6 b when a gripping force transmission member 8, which will be described later, retreats, and the gripping force transmission member 8 moves forward as shown in FIG. 5. The

gripping pieces

6a and 6b are sometimes opened. A channel (channel portion) 10 into which a guide wire 9 can be inserted is formed on one gripping piece 6a. The channel 10 opens at the tip and outer surface of the gripping piece 6a.

The joint part 4 connects the forceps part 3 to the insertion part 2 via a connecting member 11. The connecting member 11 has a distal end side attached to the

gripping pieces

6 a and 6 b so as to be swingable at a position of a node on the distal end side of the link mechanism 7, and a proximal end side connected to the distal end of the insertion portion 2 by the joint portion 4. As shown in FIG. 6, the joint portion 4 has the forceps portion 3 inserted into the insertion portion so that the joint portion 4 can swing in the substantially same direction as the direction in which the

gripping pieces

6 a and 6 b open and close. 2 is connected. The connecting member 11 is provided with a stopper (restricting mechanism) 11a that restricts the swinging direction of the forceps portion 3 by the joint portion 4 only in the direction in which the grip piece 6a on the side having the channel 9 is directed outward.

The operation unit 5 includes a fixed handle 12a fixed to the insertion unit 2 and a movable handle 12a. The movable handle 12 a is connected to the forceps portion 3 through the gripping force transmission member 8. The gripping force transmission member 8 is inserted into the lumen 2a so as to be movable in the forward / backward direction, penetrates the joint portion 4, and is connected to the base ends of the

gripping pieces

6a, 6b.

The operation unit 5 is configured such that when the operator grips the fixed handle 12a and the movable handle 12b, the movable handle 12b approaches the fixed handle 12a and the gripping force transmission member 8 is pulled to the proximal end side. . Thereby, the operator can close the

gripping pieces

6a and 6b by grasping both the

handles

12a and 12b. On the other hand, the operation unit 5 is configured such that when the operator releases his hands from both the

handles

12a and 12b, the gripping force transmission member 8 moves forward to open the

gripping pieces

6a and 6b. A fixing portion (not shown) that holds the opening angle of the

gripping pieces

6a and 6b constant by fixing the relative positions of both the

handles

12a and 12b may be provided in the operation portion 5.

The gripping force transmitting member 8 includes a hard shaft portion (fixing mechanism) 8a having a diameter that forms a sufficiently narrow gap with the inner surface of the lumen 2a, and a movable shaft 8a provided on the distal end side of the shaft portion 8a. And a flexible wire portion (flexible portion) 8b. When the shaft portion 8a is advanced, the shaft portion 8a penetrates the joint portion 4 and the tip thereof is disposed forward of the joint portion 4. On the other hand, when the shaft portion 8a is retracted, the shaft portion 8a is disposed rearward of the joint portion 4. It is provided as follows.

Here, a groove (fitting portion, fixing mechanism) 13 into which the tip of the shaft portion 6a disposed in front of the joint portion 4 is fitted is formed in the connecting member 11. Thereby, in a state where the

gripping pieces

6a and 6b are opened, the shaft portion 8a is fitted into both the groove 13 of the connecting member 11 and the lumen 2a of the insertion portion 2 with the joint portion 4 interposed therebetween. Thus, the angle of the forceps portion 3 with respect to the insertion portion 2 is fixed in a direction along the longitudinal direction of the insertion portion 2. On the other hand, in the state where the

gripping pieces

6a and 6b are closed, the wire portion 8b is disposed at the position of the joint portion 4, and the forceps portion 3 can swing.

Next, the operation of the treatment instrument 1 configured as described above will be described.
In order to introduce the guide wire 9 into the pericardial cavity A using the treatment instrument 1 according to the present embodiment, the insertion portion 2 is inserted into the body while the distal end portion of the guide wire 9 is housed in the channel 10. Then, the forceps 3 is disposed outside the pericardium B. At this time, as shown in FIG. 7, by inserting the treatment instrument 1 into the body with the grasping

pieces

6a and 6b opened, the shaft portion 8a is fitted into the groove 13, so that the forceps portion 3 is not necessary. Thus, the insertion portion 2 can be smoothly run without being swung or being caught by tissue in the body.

After the forceps portion 3 reaches the outside of the pericardium B, as shown in FIG. 8, the pericardium B is gripped by the gripping

pieces

6a and 6b, and the insertion portion 2 is pulled back slightly to pull the pericardium B. . In this state, since the shaft portion 8 a is disengaged from the fitting with the groove 13, the forceps portion 3 is rocked and tilted by the joint portion 4 and is tilted on the pericardium B. As a result, as shown in FIG. 9, the grip piece 6a on the side having the guide wire 9 is sandwiched between the pericardium B folded, and the opening of the channel 10 provided at the tip of the grip piece 6a is opened. , Directed tangential to the surface of the heart A. In this state, the guide wire 9 is pushed on the proximal end side so as to protrude from the channel 10 so that the distal end of the guide wire 9 is easily penetrated into the pericardium B in a tensioned state, and the guide wire 9 is inserted into the pericardial cavity. A can be introduced into A.

Before pushing out the guide wire 9 from the channel 10, a puncture needle (not shown) is inserted into the pericardium B along the guide wire 9, and the puncture needle is pushed out from the channel 10 to puncture the pericardium B. Perforation for penetrating the pericardium may be formed in the pericardium B in advance.
After the guide wire 9 is inserted to a desired position in the pericardial cavity A, the treatment instrument 1 is pulled out from the body along the guide wire 9 while the guide wire 9 remains in place. Thereby, a device such as an endoscope can be easily inserted and removed along the guide wire 9 between the outside of the body and the pericardial cavity A.

In this case, in the conventional treatment tool, the guide wire 9 is pushed out in a direction substantially perpendicular to the surface of the heart C and penetrated into the pericardium B. In other words, since the guide wire 9 is introduced into the pericardial cavity A with the distal end directed toward the heart C, the guide wire 9 easily contacts the heart C after passing through the pericardium B. On the other hand, according to the present embodiment, the guide wire 9 is penetrated through the pericardium B along the substantially tangential direction of the surface of the heart C, that is, with the tip directed away from the heart C. Accordingly, there is an advantage that the guide wire 9 can be introduced into the pericardial cavity A without bringing the tip of the guide wire 9 into contact with the heart C.

In the present embodiment, the channel 10 into which the guide wire 9 is inserted is provided only in one gripping piece 6a. Alternatively, the channel 10 may be provided in both gripping

pieces

6a and 6b. . In this case, the stopper 11a is not necessary.
When using the treatment instrument 1 configured as described above, for example, forceps in which the insertion portion 2 is inserted into the body without attaching the guide wire 9 to the channel 10 and the pericardium B is grasped by the grasping

pieces

6a and 6b. After tilting the part 3 on the pericardium B, the channel 10 of the

gripping pieces

6 a and 6 b arranged on the side adjacent to the pericardium B may be selected and the guide wire 9 may be inserted into the channel 10.

Further, in the present embodiment, as shown in FIG. 10, the outer surface of the gripping piece 6 a having the channel 10 may be formed in a curved shape that is recessed along the surface shape of the pericardium B. By doing in this way, when the forceps part 3 is fallen on the pericardium B, the outer surface of the gripping piece 6a is arranged along the shape of the pericardium B, so that the gripping piece 6a with respect to the pericardium B is arranged. , 6b can be stabilized.
Even in the configuration in which the channel 10 is provided only on the one gripping piece 6a, the stopper 11a may not be provided.

Further, in the present embodiment, as shown in FIG. 11, in addition to the position where the forceps portion 3 is connected to the insertion portion 2, a plurality of joint portions 4 are spaced apart in the longitudinal direction of the insertion portion 2 (shown). In this example, two joints 4a may be provided.
Even if it does in this way, when the forceps part 3 is fallen on the pericardium B, since each joint 4a bends and the joint part 4 is arrange | positioned along the shape of the pericardium B, the attitude | position of the forceps part 3 is made. It can be stabilized.

1 treatment tool 2 insertion part (main part)
2a Lumen (Fitting part)
3 Forceps part 4 Joint part (joint mechanism)
4a joint 5

operation section

6a, 6b gripping piece 7 link mechanism 8 gripping force transmitting member 8a shaft section (fixing mechanism)
8b Wire part (flexible part)
9 Guide wire 10 Channel (channel part)
11 Connecting member 11a Stopper (limitation mechanism)
12a Fixed handle 12b Movable handle 13 Groove (fitting part, fixing mechanism)
A Pericardial cavity B Pericardium (living tissue)
C heart

Claims

Forceps for gripping the living tissue;
A main body provided in the forceps portion;
An operation unit provided on the main body unit for operating the forceps unit;
A channel portion for deriving a guide wire to be introduced into the living tissue;
A treatment instrument comprising: a joint mechanism provided on the main body portion and configured to swing the forceps portion in a direction intersecting a longitudinal axis direction of the main body portion.
The treatment instrument according to claim 1, further comprising a restriction mechanism provided in the joint mechanism for restricting a swinging direction of the forceps portion.
The treatment instrument according to claim 1, further comprising a fixing mechanism provided in the joint mechanism and configured to fix swinging of the forceps portion.
A gripping force transmission member that is connected to the forceps portion and transmits a gripping operation of the operation portion to the forceps portion;
A fitting portion provided on the main body portion and fitted with the gripping force transmission member;
The treatment tool according to claim 3, wherein the fixing mechanism fixes the swinging direction of the forceps portion via the fitting portion.
The treatment instrument according to claim 1, wherein the forceps portion is formed in a shape along a biological tissue surface.
The treatment instrument according to claim 1, wherein the joint mechanism includes a plurality of joints.