WO2013132861A1

WO2013132861A1 - Region ensuring tool and endoscope comprising region ensuring tool

Info

Publication number: WO2013132861A1
Application number: PCT/JP2013/001455
Authority: WO
Inventors: 宏仁森
Original assignee: 国立大学法人香川大学
Priority date: 2012-03-08
Filing date: 2013-03-07
Publication date: 2013-09-12
Also published as: JP5975257B2; JP2013183895A

Abstract

Provided are a region ensuring tool with which it is possible to ensure a field of view of a part to be operated on and a field of operation in a NOTES, and an endoscope which comprises the region ensuring tool. A region ensuring tool (10) which is used in natural orifice translumenal endoscopic surgery (NOTES) comprises a cylindrical main body part (11) having a hollow space. The hollow space of the main body part (11) is formed such that the cross-section area thereof gets bigger than the cross-section area of a shaft (2) of an endoscope (1), and it is possible for the main body part (11) to expand and contract in the direction which intersects the central axis (CL) of the hollow space. By making the main body part (11) protrude and expand from the leading end part of an outer cylinder (5), it is possible to ensure a field of view of an endoscope by the main body part (11) and a field of operation for an operation by the endoscope (1). By forming the main body part (11) to a size which can be housed in the outer cylinder (5) when contracted, it is possible to move the main body part (11) in the state of being housed in the outer cylinder (5) to a site where the operation, etc., is carried out, thus simplifying the positioning of the main body part (11) at the site where the operation, etc., is carried out.

Description

Area securing instrument and endoscope provided with area securing instrument

The present invention relates to an area securing instrument and an endoscope including the area securing instrument. More specifically, it is used for transluminal endoscopic surgery in which a through-hole is formed in the digestive tract by an endoscope inserted into the digestive tract cavity such as the mouth, anus, or vagina, or in the abdominal cavity. The present invention relates to a region securing instrument and an endoscope provided with the instrument.

Transluminal endoscopic surgery (hereinafter referred to as NOTES) is a procedure that removes lesions in the digestive tract cavity or abdominal cavity using an endoscope inserted into the digestive tract cavity such as the mouth, anus, or vagina. Surgery to perform.

For example, surgery to remove the stomach wall in which a hole that penetrates the stomach wall is formed, specifically a tumor deeper than the submucosa formed in the stomach wall, that is, a tumor that has reached the intrinsic muscle layer Surgery to remove with an endoscope corresponds to NOTES.
Further, as shown in FIG. 5, an endoscope S is inserted from the mouth, a hole h is formed in the stomach wall by the tip of the endoscope S, and the tip of the endoscope S enters the abdominal cavity from the hole h. In addition, surgery for removing a tumor or the like formed in the pancreas, liver or the like with the endoscope S also corresponds to NOTES.

Compared to conventional surgical operations, these NOTES can be performed without leaving scars on the abdomen, and the burden on the patient (reduction of immune response, early rehabilitation, etc.) can be reduced. There is.

On the other hand, in NOTES, as with conventional endoscopic surgery, surgery must be performed while confirming the affected area and the status of the surgery using the camera provided at the distal end of the endoscope. It is important to secure a field (Non-Patent Document 1).

Conventionally, when endoscopic surgery is performed in the stomach, a through-hole is not formed in the stomach, so even if the stomach is expanded by blowing air into the stomach, the visual field is expanded and the surgical field is opened. It is possible to secure.
However, as described above, in NOTES, a hole that penetrates the stomach wall is formed by surgery, and at the same time, the air in the stomach flows into the abdominal cavity and the stomach bag is deflated. Then, in the operation of excising the stomach wall, the endoscope tip is covered with the stomach wall, and the field of view is lost or the field of view is extremely limited, making it difficult to perform the operation.

In laparoscopic surgery, a plurality of ports (citrus) are inserted into the abdominal cavity from the hole provided in the abdomen, and the collapsed and collapsed stomach is lifted and deployed to remove the visual field and the lesion. The method of ensuring is adopted. Therefore, even in NOTES, it is conceivable to adopt a method of inserting a plurality of endoscopes and lifting the stomach.
However, at most two endoscopes can be inserted into the stomach or the like. With the two endoscopes, it is difficult to lift and collapse the collapsed stomach, so that it is impossible to secure a sufficient visual field by the method described above.

Also in NOTES, it is possible to develop a sufficient field of view by adopting a lifting method in which the stomach wall is fixed to the abdominal wall before excision of the stomach wall with an endoscope. However, in order to fix the abdominal wall and the stomach wall, the needle must be penetrated not only to the stomach wall but also to the abdominal wall, so that the body surface is damaged. In other words, the advantage of NOTES that the body surface is not damaged is lost.

Various methods for securing the field of view of the endoscope have been studied so far, and a hood with an open tip that is attached to the tip of the endoscope and used as an instrument for surgery that does not allow a through-hole in the stomach. Have also been developed (Patent Documents 1 and 2).
When such a hood is provided, a space can be formed between the distal end of the endoscope and the stomach wall by the hood, so that the stomach wall and the like can be easily observed. Further, if the affected part or the like is positioned in the distal end opening of the hood, the affected part can be separated from the distal end of the endoscope to some extent, so that the affected part can be easily treated with the endoscope.

However, the hoods disclosed in

Patent Documents

1 and 2 are used by being fixed to the tip of the endoscope, and the visual field that can be secured by such a hood is at most about the diameter of the endoscope, that is, The diameter and depth are only about 2 cm. For this reason, it is difficult to secure a sufficient visual field and operative field for NOTES.
Moreover, even if a hood for the endoscope is provided, if the stomach wall becomes deflated during surgery to remove the stomach wall, the stomach wall on the front of the hood will be folded even if there is a hood. It is difficult to secure a sufficient visual field and surgical field for surgery.
And, when performing surgery by invading the distal end of the endoscope into the abdominal cavity from the hole formed in the stomach wall, a larger visual field and surgical field are required, so just providing a hood as described above, It is impossible to perform surgery.

As described above, at present, NOTES does not use a lifting method that fixes the stomach wall to the abdominal wall, in other words, a method for securing a visual field and an operating field for surgery without forming a wound on the body surface. Has not been developed, and there is a strong demand for the development of such technology.

Japanese Patent Laid-Open No. 10-323323 Japanese Patent Laid-Open No. 11-299725

In view of the above circumstances, an object of the present invention is to provide an area securing instrument and an endoscope provided with an area securing instrument capable of securing a visual field and a surgical field of a surgical site in NOTES.

An area securing instrument according to a first aspect of the present invention is an area securing instrument used for transluminal endoscopic surgery, and has a cylindrical main body having a hollow space. The hollow space of the main body can be expanded and contracted in a direction intersecting the central axis of the hollow space. In the expanded state, the cross-sectional area of the hollow space of the main body portion is larger than the cross-sectional area of the shaft of the endoscope. It is formed so that it may become large.
According to a second aspect of the present invention, there is provided the region securing instrument according to the first aspect, wherein the main body portion is substantially cylindrical when contracted, and in a magnified state, the cross-sectional area of the hollow space at the proximal end portion is internally viewed. The cross-sectional area of the mirror shaft is larger, and the cross-sectional area of the hollow space at the distal end is larger than the cross-sectional area of the hollow space at the proximal end. And
The region securing instrument of the third invention is the first or second invention, when a force of a certain level or more is applied in a direction from the direction in which the main body portion intersects the central axis of the hollow space toward the central axis. It is characterized in that it is contracted so that its cross-sectional area becomes small and is adjusted so that it can return to its original shape when the force is removed.
A region securing device according to a fourth aspect of the present invention is a region securing device used for transluminal endoscopic surgery, and includes a main body portion formed so that a cross-sectional area of a distal end portion thereof can expand and contract. The main body portion includes a cylindrical support portion having a hollow space, and a region holding portion having a base end coupled to the support portion, and the support portion has an internal cross-sectional area. It is formed so as to be larger than the cross-sectional area of the shaft of the endoscope, and the region holding portion has a plurality of region holding pieces provided along the circumferential direction of the support portion. The tip of the piece is provided so as to be able to approach and separate from the central axis direction of the support portion, and is formed by the tips of the plurality of region holding pieces in a state of being separated from the central axis of the support portion. The cross-sectional area of the space is formed so as to be larger than the cross-sectional area of the support portion. And features.
The region securing device according to a fifth aspect of the present invention is the region securing tool according to the fourth aspect, wherein each region holding piece has a certain force in a direction from the direction intersecting the central axis of the support portion toward the central axis with respect to the tip. When applied, the tip is deformed so as to approach the central axis of the support, and is adjusted so that it can return to its original shape when the force is removed.
The area securing device according to a sixth aspect of the present invention is the invention according to any one of the first to fifth aspects, wherein the region securing device includes a cylindrical connecting pipe having a hollow space, and the connecting pipe is the hollow The cross-sectional area of the space is larger than the cross-sectional area of the shaft of the endoscope, and the tip of the space is communicated with the hollow space of the main body. It is connected with the base end of this main-body part, It is characterized by the above-mentioned.
The area securing instrument according to a seventh aspect of the present invention is the invention according to any one of the first to sixth aspects, wherein an extension portion is provided in the main body portion so as to be able to protrude and retract from the tip of the main body portion. The main body of the first, second, third, fourth or fifth invention has substantially the same shape and is accommodated in the main body so as to be movable along the central axis direction of the main body. It is characterized by.
According to an eighth aspect of the present invention, there is provided the region securing instrument according to the seventh aspect, wherein a plurality of the extension portions are provided in the main body portion, and the plurality of extension portions have different cross-sectional areas at the distal end portion in the contracted state. An extension portion having a smaller cross-sectional area of the tip portion in a contracted state than the one extension portion is accommodated in the one extension portion, and is provided so as to be movable along the axial direction. The extension portion accommodated in the extension portion is provided so as to be able to protrude and retract from the tip of the one extension portion.
The region securing instrument according to a ninth aspect of the present invention is the seventh or eighth aspect of the invention, wherein the extension portion has a cross-sectional area of the tip portion in an enlarged state, and the extension portion that accommodates the main body portion and the extension portion is enlarged. In this state, the cross-sectional area of the tip portion is formed to be small.
A region securing instrument according to a tenth aspect of the present invention is the tube having a hollow space provided in the connecting pipe and movably along the axial direction of the connecting pipe in the seventh, eighth or ninth invention. The extension connecting pipe is formed such that the cross-sectional area of the hollow space is larger than the cross-sectional area of the shaft of the endoscope, and the hollow space is the extension pipe. The tip is connected to the base end of the main body so as to communicate with the hollow space of the part.
An endoscope provided with a region securing instrument according to an eleventh aspect of the invention is an endoscope used for transluminal endoscopic surgery, and the endoscope has a shaft inserted through the endoscope. The area securing instrument according to any one of the first to tenth aspects of the invention is provided, and the area securing instrument is inserted into the outer cylinder and the outer cylinder. The main body portion is disposed so as to be able to protrude from the distal end of the outer tube along the axial direction of the shaft of the endoscope. It is characterized by.
An endoscope having a region securing instrument according to a twelfth aspect of the present invention is the endoscope according to the eleventh aspect, wherein the connecting tube and / or the extended connecting tube is connected to the main body portion and / or the extended portion. The length from the distal end of the main body and / or the extension in the axial direction of the connecting pipe and / or the extended connecting pipe to the base end of the connecting pipe and / or the extended connecting pipe is the axial direction of the outer cylinder It is characterized by being formed so as to be longer than the length.

According to the first invention, if the main body is disposed at the distal end of the outer cylinder through which the endoscope is inserted, and the main body protrudes from the distal end of the outer cylinder and is enlarged, It is possible to secure a field of view for an endoscope and a surgical field for an operation using an endoscope. In addition, if the main body portion is formed to a size that can be accommodated in the outer cylinder when contracted, the main body portion can be moved to a place where surgery or the like is performed while being accommodated in the outer cylinder. It becomes easy to arrange the main body at a place where surgery is performed.
According to the second invention, if the main body is in an enlarged state, a space that expands from the base end toward the tip can be formed in the main body. Then, counter traction and triangulation can be performed on the collapsed stomach and the like. In addition, since a wide surgical field can be ensured at a position close to the outer cylinder, an effect of facilitating the operation in the near field can be obtained.
According to the third invention, when the contracted main body is accommodated in the distal end of the outer cylinder through which the endoscope is inserted, the main body can be simply projected from the distal end of the outer cylinder. The portion can be enlarged. On the contrary, if the main body portion is pushed into or pulled into the inside from the tip of the outer cylinder, the main body portion contracts, so that the main body portion can be accommodated in the outer cylinder. That is, the main body can be expanded and contracted simply by projecting the main body from the front end of the outer cylinder or by pushing or pulling the main body from the front end of the outer cylinder. Therefore, since a special mechanism for expanding and contracting the main body is not necessary, the structure of the instrument can be simplified.
According to the fourth aspect of the present invention, if the main body portion is arranged at the distal end portion of the outer cylinder through which the endoscope is inserted, and the main body portion is projected and enlarged from the distal end portion of the outer cylinder, the region holding portion The field of view of the endoscope and the surgical field for the operation by the endoscope can be secured. In addition, if the main body is formed in a size that can be accommodated in the outer cylinder when the distal end of the region holding portion is brought close to the central axis of the support section, the main body is operated in a state of being accommodated in the outer cylinder. Therefore, it is easy to place the main body at the place where surgery is performed. And if the front-end | tip part of an area | region holding part shall be in the state spaced apart from the center axis | shaft of a support part, the space which spreads toward a front-end | tip part from a base end part can be formed in a main-body part. Then, counter traction and triangulation can be performed on the collapsed stomach and the like. In addition, since a wide surgical field can be ensured at a position close to the outer cylinder, an effect of facilitating the operation in the near field can be obtained.
According to the fifth aspect of the present invention, if the main body with the distal end of the region holding portion approaching the central axis of the support is accommodated in the distal end of the outer cylinder through which the endoscope is inserted, the main body By merely projecting from the tip of the outer cylinder, the tip of the region holding part can be separated from the central axis of the support part. On the contrary, if the main body is pushed into or retracted from the front end of the outer cylinder, the front end of the region holding section can be brought closer to the central axis of the support section, so that the main body is accommodated in the outer cylinder. can do. That is, the front end portion of the region holding portion is moved closer to and away from the central axis of the support portion simply by projecting the main body portion from the front end portion of the outer cylinder or by pushing or pulling in the inner end from the front end portion of the outer cylinder be able to. This eliminates the need for a special mechanism for moving the distal end portion of the region holding portion toward and away from the central axis of the support portion, thereby making the structure of the instrument simple.
According to the sixth aspect of the present invention, if the area securing instrument is placed in the outer cylinder so that the main body is positioned at the distal end of the outer cylinder through which the endoscope is inserted, the proximal end of the connecting pipe is operated. Thus, the main body portion can be moved along the axial direction of the outer cylinder, and the main body section can be projected and retracted from the tip of the outer cylinder. This eliminates the need for a special mechanism for causing the main body portion to protrude from the tip of the outer cylinder, so that the structure of the instrument can be simplified.
According to the seventh aspect of the present invention, if the extension part protrudes from the main body part, the stomach wall, the organ, etc. hanging from the front surface of the main body part can be lifted. Then, compared with the case where the area is secured only by the main body, a wider area can be secured in the axial direction of the outer cylinder, that is, in the depth direction of the field of view of the endoscope. In addition, if the expansion and contraction of the main body portion and the extension portion are alternately repeated, the visual field region can be moved in the axial direction of the outer cylinder while securing a visual field region of a certain level or more. Then, when the endoscope is moved while searching for an affected part in a deflated stomach or abdominal cavity, the affected part can be easily found.
According to the eighth invention, since there are a plurality of extensions, it becomes easier to secure a wider area in the depth direction of the field of view of the endoscope, and the endoscope can be used while searching for the affected part in a deflated stomach or abdominal cavity. When moving, the endoscope is easily moved.
According to the ninth aspect, since the extension portion having the smallest cross-sectional area is located at the tip, it is easy to enter the organ or the deflated stomach. And if it is an area | region ensured with the extension part with a small cross-sectional area, an area | region can be easily expanded also with an extension part and a main-body part with a larger cross-sectional area. Therefore, the endoscope can be easily guided into the organ or the stomach that is deflated.
According to the tenth aspect, by operating the base end of the extension connecting pipe, the extension portion can be projected and retracted from the distal end of the main body portion or another extension portion. This eliminates the need for a special mechanism for causing the extension part to protrude from the tip of the main body part or the other extension part, so that the structure of the instrument can be simplified.
(Endoscope with area securing device)
According to the eleventh aspect of the present invention, if the main body and / or the extension is projected from the distal end portion of the outer cylinder and enlarged, the visual field and the surgical field for surgery can be secured by the main body and / or the extension. it can. In addition, since the main body and / or the extension can be moved to a place where surgery or the like is performed while being accommodated in the outer cylinder, the arrangement of the main body and / or extension at the place where surgery or the like is performed is facilitated. .
According to the twelfth aspect of the present invention, if the area securing instrument is placed in the outer cylinder so that the main body part and / or the extension part is located at the tip of the outer cylinder, the connecting pipe and / or the extension connecting pipe By manipulating the base end, the main body part and / or the extension part can be moved along the axial direction of the outer cylinder, and the main body part and / or the extension part can be projected and retracted from the distal end of the outer cylinder. This eliminates the need for a special mechanism for causing the main body part and / or the extension part to protrude from the tip of the outer cylinder, so that the structure of the instrument can be simplified.

It is a schematic explanatory drawing of the endoscope 1 provided with the instrument 10 for area | region ensuring of this embodiment. 2A is a sectional view taken along line IIA-IIA in FIG. 1, and FIG. 2B is a partial cross-sectional view taken along line BB in FIG. It is a schematic explanatory drawing of the state by which the main-body part 11 of the instrument 10 for area | region ensuring of this embodiment is accommodated in the outer cylinder 5, Comprising: (A) It is the schematic explanatory drawing which looked at the front-end | tip of the outer cylinder 5 from the axial direction. , (B) is a partial cross-sectional view taken along line BB of (A). It is explanatory drawing of the condition which is using the endoscope 1 provided with the instrument 10 for area | region ensuring of this embodiment in the stomach, (A) is the state in which the main-body part 11 is accommodated in the outer cylinder 5. FIG. It is a schematic explanatory drawing of the condition arrange | positioned in the stomach, (B) is explanatory drawing of the state which made the main-body part 11 protrude from the outer cylinder 5 tip from the state of (A), and was expanded. (C) is a schematic explanatory drawing of the state which bent the endoscope 1 from the state of (B). It is the figure which showed an example of the operation by NOTES. It is a schematic explanatory drawing of the instrument 10 for area | region ensuring in other embodiment. It is the figure which showed an example of the surgery using the instrument 10 for area | region ensuring in other embodiment. It is a schematic explanatory drawing of the instrument 30 for area | region ensuring of other embodiment. It is a schematic explanatory drawing of the instrument 10 for area | region ensuring of this embodiment in the state in which the extension part 21 protrudes from the main-body part 11, Comprising: (A) It is the schematic explanatory drawing which looked at the front-end | tip of the outer cylinder 5 from the axial direction. B) is a partial sectional view taken along line BB in FIG. FIG. 3 is a schematic explanatory view of the region securing instrument 10 of the present embodiment in a state where the extension portion 21 is accommodated in the main body portion 11, and (A) a schematic explanatory view of the outer cylinder 5 viewed from the axial direction. , (B) is a partial cross-sectional view taken along line BB of (A). It is a schematic explanatory drawing of the state which has lifted stomach wall ST by the main-body part 11 and the extension part 21. FIG.

Next, an embodiment of the present invention will be described with reference to the drawings.
The region securing instrument of the present invention is an instrument used in transluminal endoscopic surgery (hereinafter referred to as NOTES) using an endoscope, without complicating the structure of the endoscope. It is characterized by the fact that the field of view and the surgical field for surgery can be secured.

(Endoscope with area securing device)
In FIG. 1, the code | symbol 1 has shown the endoscope provided with the instrument 10 for area | region ensuring of this embodiment.
The endoscope 1 is a flexible endoscope used for general endoscopic surgery, and includes a shaft 2 inserted into a digestive tract of a living body, an operation unit 3 for operating the shaft 2, and a shaft 2. A portion connected to a light source body that supplies light to the tip is provided.

As long as the endoscope 1 is used by being inserted into a digestive tract of a living body, the diameter, length, material, and the like of the tube are not particularly limited.
For example, the diameter of the tube 2 is about 10 mm in a general endoscope, but may be about 5 to 15 mm. The length of the tube 2 is about 1200 mm in a general endoscope, but may be about 1200 to 3000 mm.
In particular, when performing surgery on an organ in the abdominal cavity, the endoscope 1 preferably has a narrow-band light observation (NBI) function or a water jet function.

(About the outer cylinder 5)
In FIG. 1, the code | symbol 5 has shown the outer cylinder in which the shaft 2 of the endoscope 1 is penetrated. The outer cylinder 5 guides the movement of the shaft 2 when the shaft 2 of the endoscope 1 is inserted into and removed from the living body, and is formed by a hollow cylindrical member that is long in the axial direction. The length of the outer cylinder 5 is shorter than the length of the shaft 2.
That is, if the shaft 2 of the endoscope 1 is inserted into the hollow space from one end (base end) of the outer cylinder 5, the tip of the shaft 2 can be projected from the other end (tip). The shaft 2 is formed so that the tip of the shaft 2 can be projected and retracted from the tip of the outer cylinder 5 by moving the shaft 2 in the axial direction in a state of being disposed in a hollow space.

The outer cylinder 5 may have an inner diameter, a thickness, a length, a material, etc., as long as it is generally used when the endoscope 2 is inserted into the digestive tract of a living body to perform inspection or surgery. Is not particularly limited.
For example, the inner diameter of the outer cylinder 5 is generally about 20 mm, but any shaft can be used as long as the shaft 2 can be inserted and the shaft 2 can be smoothly moved along the axial direction. The inner diameter of the outer cylinder 5 may be about 10 to 30 mm. The thickness of the outer cylinder 5 is generally several mm if the inner diameter of the outer cylinder 5 is about 20 mm, but is thick enough to insert the outer diameter of the outer cylinder 5 into the digestive tract. If it can form in this, the thickness of the outer cylinder 5 will not be specifically limited. Further, the length of the outer cylinder 5 only needs to be shorter than the length of the shaft 2. That is, when the shaft 2 is inserted from one end of the outer cylinder 5, the tip of the shaft 2 can be projected from one end of the outer cylinder 5 by a predetermined length (for example, about 10 to 500 mm). Well, not particularly limited.

In particular, when the distal end of the endoscope 1 is inserted into the abdominal cavity through a hole formed in the wall of the stomach or the like to perform an operation on an organ in the abdominal cavity, the outer diameter of the outer tube 5 is 15 to 25 mm. It is preferable that the length is about 500 to 1000 mm and that the tube 2 of the endoscope 1 is formed of a material that can be smoothly inserted, removed, and rotated.

(Equipment for securing area 10)
Next, the area securing instrument 10 will be described.
First, the area securing instrument 10 is a cylindrical member having a hollow passage that passes through the axial direction thereof, and is disposed between the outer cylinder 5 and the shaft 2 of the endoscope 1. Specifically, the area securing instrument 10 is inserted into the outer cylinder 5, and the shaft 2 of the endoscope 1 is inserted into the hollow passage.

The area securing instrument 10 includes a hollow cylindrical connecting pipe 15 and a hollow main body 11 attached to the tip (left end in FIG. 1) of the connecting pipe 15. The region securing instrument 10 is inserted into the outer cylinder 5 such that the main body 11 is located on the distal end side of the outer cylinder 5 and the distal end of the main body 11 does not protrude from the distal end of the outer cylinder 5. Has been.
The area securing instrument 10 is formed such that its axial length (that is, the length from the proximal end of the connecting tube 15 to the distal end of the main body 11) is longer than that of the outer cylinder 5. That is, when it arrange | positions in the outer cylinder 5 so that it may be in the said state, it forms so that the base end of the connecting pipe 15 may protrude from the base end of the outer cylinder 5. FIG.
For this reason, when the proximal end of the connecting pipe 15 is operated to move the area securing instrument 10 along the axial direction of the outer cylinder 5, the distal end of the main body 11 can be projected and retracted from the distal end of the outer cylinder 5. It is.

Further, the main body portion 11 of the area securing instrument 10 is contracted in a state where it is accommodated in the outer cylinder 5, but when the tip portion protrudes outside from the tip of the outer tube 5, the tip portion expands. It has such a structure.
Specifically, when the tip of the main body 11 protrudes from the tip of the outer cylinder 5 to the outside, the tip of the main body 11 can be expanded (expanded), and the opening area of the tip can be increased. It has a structure that can be larger than the cross-sectional area.

(Operational effect of the endoscope 1 provided with the area securing instrument 10)
Since the structure is as described above, in the endoscope 1 provided with the area securing instrument 10 of the present embodiment, the area securing instrument 10 functions as follows, and therefore the field of view of the endoscope 1 is secured. It is possible to secure a surgical field.
In the following, a case where a field of view or the like is secured by the region securing instrument 10 in the collapsed stomach will be described as a representative.

First, the outer cylinder 5 is inserted from the patient's mouth, and the distal end of the outer cylinder 5 is placed in the collapsed stomach. Then, the endoscope 1 and the area securing instrument 10 are inserted through the outer cylinder 5 (FIG. 4A).

Next, the area securing instrument 10 is moved along the axial direction of the outer cylinder 5 so that the main body portion 11 protrudes from the distal end of the outer cylinder 5 and the distal end is enlarged (expanded). When the distal end of the main body 11 is enlarged (expanded), the opening area of the distal end becomes larger than the cross-sectional area of the outer cylinder 5, so that the stomach wall ST is pushed outward by the outer edge of the distal end of the main body 11. The stomach can be expanded (deployed) (FIG. 4B).
That is, by pressing the stomach wall ST outwardly by the distal outer edge of the main body part 11, tension is applied to the gastric wall ST surrounded by the distal outer edge of the main body part 11 so that the stomach wall ST is stretched. is there.

In addition, as described above, when the distal end is enlarged (expanded), the opening area at the distal end of the main body portion 11 becomes larger than the cross-sectional area of the outer cylinder 5, so that the gastric wall developed through the space in the main body portion 11. Confirmation of the inner surface of ST becomes easy. And since the space in the main-body part 11 becomes large compared with the diameter of an endoscope, etc., it becomes easy to perform treatments, such as excision of the stomach wall ST.

And in endoscope 1 provided with region securing instrument 10 of this embodiment, since stomach wall ST is supported by the tip of body part 11, part of stomach wall ST is excised and a penetration hole is formed in stomach wall ST. Even if formed, the stomach will not collapse. In other words, the portion of the stomach wall ST disposed in the opening at the tip of the main body 11 is maintained in a deployed state (a stretched state, so-called counter traction, triangulation).
Then, since the field of view of the endoscope can be secured at all times in the portion surrounded by the opening at the distal end of the main body 11, the operation of the endoscope 1 can be continued in a stable state.

Further, in the endoscope 1 including the region securing instrument 10 according to the present embodiment, if the body part 11 of the region securing tool 10 is moved along the axial direction of the outer cylinder 5, the body part 11 is moved to the outer cylinder. 5 can be accommodated.
Then, when changing the place where the examination or treatment is performed, if the outer cylinder 5 is moved in a state where the main body 11 is accommodated in the outer cylinder 5, the main body 11 can also be moved together. It is easy to change the place where the operation is performed and to arrange the main body 11 at the place.

In addition, when changing the place where the operation or the like is performed in the stomach, the place where the operation or the like is performed may be changed while the main body 11 is projected from the outer cylinder 5. That is, the place where the operation or the like is performed may be changed by moving the distal edge 11a along the stomach wall ST while the distal edge 11a of the main body 11 is in contact with the stomach wall ST (see FIG. 4C). ). In this case, even when the stomach collapses when the main body 11 is accommodated in the outer cylinder 5, the portion of the stomach wall ST surrounded by the opening at the tip of the main body 11 is expanded. Can do. Then, since the location can be changed while confirming the stomach wall ST, it is preferable in that the incision of the stomach wall ST can be performed safely. Further, since the state of the stomach wall ST can be confirmed even while moving, it is also preferable in that the possibility of missing a lesion or the like can be reduced.

When the distal edge 11a of the main body 11 is moved while being in contact with the stomach wall ST, the distal edge 11a in contact with the stomach wall ST is coated with a hydrophilic substance, or only the distal edge 11a is hydrophilic. It is preferable that the main body 11 is entirely formed of a hydrophilic substance.
Then, since the hydrophilic substance has a small resistance to the stomach wall ST, when the distal end edge 11a of the main body 11 is in contact with the stomach wall ST and is slid and moved on the inner surface of the stomach wall ST, the resistance is reduced. Therefore, the main body 11 can be moved smoothly.

(Detailed description of the area securing instrument 10 of the present embodiment)
Below, each part of the instrument 10 for area | region ensuring of this embodiment is demonstrated in detail.

(About the main body 11)
Next, the main body 11 will be described.
As shown in FIG. 2, the main body 11 is a member formed in a cylindrical shape, and has one end (the right end in FIGS. 2 and 3, hereinafter referred to as a base end) and the other end (in FIGS. 2 and 3). A space communicating with the left end (hereinafter referred to as the tip) is formed. The main body 11 is formed in such a size that the hollow space can be inserted through the shaft 2 of the endoscope 1. Specifically, the cross-sectional area of the hollow space in the main body 11 is formed to be larger than the cross-sectional area of the shaft 2 of the endoscope 1.

The main body 11 is formed such that the opening area of the hollow space is gradually increased from the base end toward the tip, and the opening area of the tip is larger than the cross-sectional area of the outer cylinder 5. . That is, the main body 11 is formed so that the appearance thereof is a trumpet shape.
For example, as shown in FIG. 2, when the cross section of the hollow space of the main body 11 is circular, the length L of the main body 11 is about 300 to 1000 mm, the inner diameter of the opening at the proximal end is about 15 to 25 mm, and If the inner diameter D of the opening is formed to be about 15 to 70 mm, a visual field suitable for cholecystectomy, gastrojejunostomy, fallopian tube ligation, etc., and a surgical field for surgery can be secured.

In addition, the main body 11 is formed so as to be able to expand and contract in a direction intersecting with the central axis CL of the hollow space. Specifically, the main body 11 is formed of a shape memory material such as a material or an elastic material such as a metal, and in a state where no force is applied to the outer surface, the main body 11 has a trumpet shape as described above. However, when a force is applied to the outer surface, the cross-sectional area of the distal end and the proximal end is adjusted so as to be a substantially cylindrical shape.

Specifically, the main body 11 maintains the trumpet shape (original shape) even when a force below a certain level is applied in the direction toward the center axis CL from the trumpet shape state, and moves toward the center axis CL. When a force of a certain level or more is applied in the direction, the hollow space is formed to shrink so that the cross-sectional area becomes small. For example, when the hollow space of the main body part 11 is circular, when a force of a certain level or more is applied along the direction from the outer surface of the main body part 11 toward the central axis, the main body part 11 has a cross-sectional shape of the hollow space. Is adjusted to shrink while maintaining a substantially circular state (in other words, a shape similar to the opening cross-sectional shape of the tip in the original shape).

When the main body 11 is inserted into the outer cylinder 5 from the opening (for example, the front end), the main body 11 is inserted into the main body 11 from the outer surface thereof in the direction intersecting the central axis CL of the hollow space. A certain force or more can be applied along the direction toward CL. Then, since the main body part 11 contracts, the main body part 11 can be inserted into the outer cylinder 5.
On the other hand, when the front end of the main body 11 is protruded from the outer cylinder 5, the portion protruding from the main body 11 is released from the above force, so that the entire main body 11 is protruded from the outer cylinder 5. The main body 11 can be automatically brought into the original shape. Then, since the opening area of the front-end | tip of the main-body part 11 becomes larger than the cross-sectional area of the outer cylinder 5, the stomach wall ST can be pushed outward by a front-end | tip outer edge, and the stomach can be expanded (deployed). is there. And since the special mechanism for expanding and contracting the main-body part 11 is unnecessary, the structure of the instrument 10 for area | region ensuring can be made into a simple structure.

If the structure as described above is used, the opening area at the front end of the main body 11 when the entire main body 11 is protruded from the outer cylinder 5 is almost automatically determined by the protruding amount of the main body 11 from the front end of the outer cylinder 5. To be determined.
However, if the main body 11 is provided with a mechanism capable of adjusting the opening area of the distal end regardless of the amount of protrusion from the distal end of the outer cylinder 5, a field of view and a surgical field suitable for a site to be observed or treated can be formed. ,preferable.
For example, a wire is arranged in a ring shape along the distal end edge 11a of the main body 11, and one end thereof is fixed to the distal end edge 11a, and the other end is a hand of the area securing instrument 10, that is, an internal view. It is arranged near the operation unit 3 of the mirror 1. In addition, the ring | wheel formed with a wire is provided so that a ring | wheel may become small if the other end is pulled. Then, if the wire at hand is adjusted, the front-end | tip of the main-body part 11 can be squeezed. That is, the opening area at the tip of the main body 11 can be adjusted regardless of the amount of protrusion of the main body 11 from the outer cylinder 5.

Moreover, the main-body part 11 should just be made into the shape suitable according to the place to use, a treatment, etc., and it cannot be overemphasized that it is not limited to said size and shape.
For example, when the appearance is a trumpet shape, even if the length L of the main body 11 is the same, a wide field of view can be secured by increasing the angle θ formed between the central axis CL of the hollow space and the inner surface. If it is made smaller, the distance from the stomach wall ST or the like can be made larger, so the length L and the angle θ of the main body 11 may be set appropriately according to the place and treatment used.
The appearance may not necessarily be a trumpet shape, and may be a columnar shape, an elliptical shape in a side view, a radial shape, or the like.

For example, as shown in FIG. 6 (A), a main body 11 having a cylindrical shape having an inner diameter larger than that of the outer cylinder 5 when protruding from the outer cylinder 5 can be employed. In this case, since the digestive tract can be maintained in a cylindrical shape, the large intestine and the like can be formed in a cylindrical shape, and the inner wall and the like can be easily inspected. Further, there is an advantage that the distance between the tip of the tube 2 and the inner wall of the digestive tract can be taken by the length of the main body 11 in the axial direction. In particular, if a through-hole is formed in the side wall of the main body 11, the part disposed in the through-hole can be inspected by the endoscope 1.

Also, as shown in FIG. 6B, the main body 11 has a shape that has an elliptical shape in a side view when projected from the outer cylinder 5, in other words, a portion 11d that swells between the distal end and the proximal end. If it makes it, the advantage that it becomes easy to perform the operation | movement (operation by a double scope) using the two endoscopes 1 is also acquired.
For example, as shown in FIG. 7B, the shaft 1B of one endoscope 1B is used for observing blood vessels and the like on the outer surface of the stomach wall ST through the stomach wall ST, and the shaft of the other endoscope 1A. Surgery may be performed with 1A. In such a case, if the shaft 1A is arranged in the main body part 11, the stomach wall ST in a state of being developed by the main body part 11 can be operated, and the distal end portion of the main body part 11 penetrates the stomach wall ST through the shaft 1B. It is preferable because it does not get in the way.

Furthermore, as shown in FIG. 6C, a dividing plate 10p that divides the inside of the communicating pipe 15 and the inside of the main body 11 into two spaces along the axial direction of the main body 11 and the communicating pipe 15 may be provided. . In this case, it is preferable that the shaft 2A and the shaft 2B are passed through the spaces of the communication pipe 15 during the operation with the double scope, because problems such as the

shafts

2A and 2B entangled do not occur. And when employ | adopting this structure, the one where the opening area of the main-body part 11 is large is preferable since the place which penetrates the stomach wall ST can be ensured, taking a large surgical field.

Further, the cross-sectional shape of the hollow space in the main body 11 is not limited to a circle (see FIG. 2), and may be an elliptical shape or a polygonal shape such as a quadrangle. In particular, it is preferable to use a shape such as a circle or an ellipse that does not have an angular portion on the outer periphery because the force applied to the organ or the like can be reduced when it comes into contact with the organ or the like.

Furthermore, the main body 11 only needs to be formed so as to be able to expand and contract in the direction intersecting the central axis CL of the hollow space, and the material has elasticity such as the shape memory material and metal as described above. Not limited to materials.
For example, a sheet-shaped member may be stretched on a framework formed of an elastic material such as rubber or metal to form a trumpet. Even in this case, the main body 11 can be accommodated in the outer cylinder 5 by constricting the tip, and the main body 11 can be formed in a trumpet shape by protruding from the outer cylinder 5.
In the case of the above structure, it is preferable to use a stretchable material such as rubber as a sheet-like member stretched around the framework. If such a material is used, the sheet-like member contracts even if it is housed in the outer cylinder 5 when the tip is constricted, so that the sheet-like member does not hang down between the frames. This is preferable because it does not obstruct the movement of the shaft 2 of the endoscope 1 or obstruct the visual field.
In addition, even if the sheet-like member is not a stretchable material, it can be prevented that the sheet-like member hangs down between the frames if the structure is foldable in a bellows shape. You can get an effect.

Furthermore, a hole that communicates between the inside and the outside may be provided in the main body 11. Then, even if liquids such as gastric juice and blood enter the space in the main body 11, these liquids can be discharged to the outside through the holes. Then, it is possible to prevent the liquid from accumulating in the space in the main body 11 and obstructing the observation by the endoscope 1.

Moreover, you may form a main-body part in a shape as shown in FIG.
As shown in FIG. 8, the main body portion 30 includes a cylindrical support portion 31 having a hollow space, and a region holding portion 32 having a plurality of region holding pieces 33 having base ends connected to the support portion 31, It has.

The support portion 31 is a cylindrical member having a hollow space 31h penetrating along the axial direction. The support portion 31 is formed so that the cross-sectional area of the hollow space 31 h is larger than the cross-sectional area of the shaft 2 of the endoscope 1. That is, the support part 31 is formed so that the shaft 2 can be inserted through the hollow space 31h.

The base end of a plurality of area holding pieces 33 of the area holding part 32 is connected to the support part 31. The plurality of region holding pieces 33 are formed of an elastic material, and are provided at the tip of the support portion 31 along the circumferential direction as shown in FIG. For example, the plurality of region holding pieces 33 are provided so as to be rotationally symmetric with each other (in other words, every predetermined angle).

Each region holding piece 33 is provided so that its distal end can swing in the radial direction of the support portion 31 with its base end as a fulcrum. In other words, each region holding piece 33 is provided such that the tip thereof can approach and separate from the direction of the central axis 31 c of the support portion 31.

And each area | region holding piece 33 is normally formed so that the front-end | tip may be located outside the base end, In that state, it is the space enclosed by the front-end | tip of the several area | region holding piece 33 The cross-sectional area is formed to be larger than the cross-sectional area of the hollow space 31 h of the support portion 31 and the cross-sectional area of the outer cylinder 5. In FIG. 8B, the area of a circle e formed by connecting the tips of the plurality of region holding pieces 33 is formed to be larger than the cross-sectional area of the space 31 h and the cross-sectional area of the outer cylinder 5.

Since the structure as described above is formed, if a certain force is applied to the tip of the plurality of region holding pieces 33 in a direction from the direction intersecting the central axis of the support portion 31 toward the central axis, the region The distal end portion of the holding piece 33 can be deformed so as to approach the central axis of the support portion 31 (in other words, it can be swung inward). When the force is removed, the region holding piece 33 is deformed so as to be separated from the central axis of the support portion 31. That is, the region holding piece 33 is deformed so as to return to the original state. That is, the tip of the area holding piece 33 swings outward.

Therefore, when the main body 30 is inserted into the outer cylinder 5 and the tip of the main body 30 is protruded from the outer cylinder 5 in the stomach, the sectional area of the space surrounded by the tips of the plurality of region holding pieces 33 is increased. Since it becomes larger than the cross-sectional area of the outer cylinder 5, the stomach wall ST can be pushed outward by the distal end portion of the main body portion 30, that is, the distal end portions of the plurality of region holding pieces 33, and the stomach is expanded (deployed). Can do.

In addition, the front end of the region holding piece 33 can be used as the central axis of the support portion 31 simply by causing the main body 30 to protrude from the front end of the outer cylinder 5 or by pushing or pulling in from the front end of the outer cylinder 5. It can approach and separate. This eliminates the need for a special mechanism for moving the distal end portion of the region holding piece 33 toward and away from the central axis of the support portion 31, so that the structure of the instrument can be simplified.

The shape and material of the region holding piece 33 are not particularly limited. For example, a leaf spring or the like can be used, and a wire formed of an elastic material as shown in FIG. Thus, the region holding piece 33 may be formed.
Further, the region holding piece 33 may be structured such that the plurality of region holding pieces 33 can swing independently, or all the region holding pieces 33 may swing in the same manner. A sheet-like member may be stretched between the region holding pieces 33 so as to cover the region holding pieces 33.

(About connecting pipe 15)
Next, the connecting pipe 15 will be described.
The connecting pipe 15 is a cylindrical member extending along the axial direction, and a hollow space penetrating between one end and the other end is formed. The hollow space is formed in such a size that the shaft 2 of the endoscope 1 can be smoothly inserted therein, and is communicated with the hollow space of the main body 11 so as to be substantially coaxial.

As described above, the connecting tube 15 has a length in the axial direction that is a combined length from the base end of the connecting tube 15 to the tip of the main body 11 in the state where the main body 11 is provided at the front end. Is formed to be longer than the outer cylinder 5.
Then, if the base end of the connecting pipe 15 is operated, the tip of the main body 11 can be projected and retracted from the tip of the outer cylinder 5, so that a special mechanism for projecting and retracting the main body 11 from the distal end of the outer cylinder 5 is provided. Since it becomes unnecessary, the structure of the area securing instrument 10 can be made simple.

In addition, the material of the connecting tube 15 is not particularly limited, but when the outer tube 5 or the shaft 2 of the endoscope 1 is bent, the connecting tube 15 is flexible enough to follow its movement, Those having such a strength that the shape can be maintained even when a certain amount of force is applied from the radial direction are preferable. For example, polyethylene preparations, plastic preparations, urethane preparations, and the like, which are materials generally used for the outer cylinder 5, can be used, but are not particularly limited as long as the materials satisfy the above functions.

In addition, the area securing instrument 10 includes a mechanism that allows the main body portion 11 to appear and disappear from the outside of the outer cylinder 5 and that can maintain the position of the main body portion 11 in the outer cylinder 5. If so, the connecting pipe 15 may not be provided.
However, if the area securing instrument 10 includes the connecting pipe 15 as described above, the length of the main body 11 protruding from the outer cylinder 5 or the outer cylinder 5 can be adjusted by operating the proximal end of the connecting pipe 15. Since the position of the main body 11 in the stomach, stomach, and abdominal cavity can be adjusted, there is an advantage that these adjustments are easy. Further, the position of the main body 11 in the outer cylinder 5, the stomach, and the abdominal cavity can be fixed simply by fixing the movement of the proximal end of the connecting tube 15 to the shaft 2 itself of the endoscope 1. There is also an advantage that the position of the portion 11 can be easily fixed.

(Multi-stage counter)
In the above example, the case where the stomach wall ST and the like are lifted by only one main body has been described. However, an extension having substantially the same structure as the main body is provided, and an area is secured by the main body and the extension. It may be.

In the following, the case where the main body has the structure of FIG. 1 (that is, the case of the main body 11) will be described. However, the main body having the structure shown in FIG. 6 or the structure shown in FIG. Even if it is the main-body part 30 which has, an extension part can be provided by the same method.
Further, in the following, a case where the main body portion and the extension portion have a substantially equivalent structure, in other words, a case where both are substantially similar to each other will be described, but the main body portion and the extension portion do not necessarily have a substantially equivalent structure. Also good. For example, the main body part 11 and the main body part 30 may be a combination of extensions having a substantially equivalent structure, or vice versa. However, when the main body portion and the extension portion are substantially similar, the arrangement and combination of both are facilitated, and interference between the two can be prevented from occurring when enlarged and reduced.

9 and 10 show an example of the area securing tool 1 in which both the main body 11 and the extension 21 are provided.
As shown in FIG. 9, the extension portion 21 has a structure substantially equivalent to that of the main body portion 11. That is, the extension portion 21 is formed in a cylindrical shape, and has one end (right end portion in FIGS. 9 and 10, hereinafter referred to as a base end) and the other end (left end portion in FIGS. 9 and 10, hereinafter, A space communicating with the tip) is formed. The hollow space of the extension portion 21 is formed in a size that allows the shaft 2 of the endoscope 1 to be inserted, like the main body portion 11.

Similarly to the main body 11, the extension portion 21 is made of a shape memory material such as a material or an elastic material such as metal, and has an outer appearance with a trumpet shape. It is formed to be larger than the area. The extension portion 21 also has a trumpet shape as described above when no force is applied to the outer surface thereof, but when a force is applied to the outer surface, the cross-sectional areas of the distal end and the proximal end are approximately the same. (See FIG. 11).

The extension 21 is substantially the same shape and substantially similar to the main body 11, but is formed in a size that can be accommodated in the space inside the main body 11. Specifically, when the force is applied to the outer surface of the extension portion 21 and the cross-sectional area of the distal end and the proximal end becomes a substantially cylindrical shape, the outer diameter of the extension portion 21 is when the main body portion 11 becomes a cylindrical shape. Are formed so as to be smaller than the inner diameter of the space formed therein.

Moreover, the distal end of a hollow cylindrical extension connecting pipe 25 is connected to the base end of the extension portion 21. The extended connecting pipe 25 has substantially the same shape as the connecting pipe 15 that operates the main body 11, but can be accommodated in the connecting pipe 15 and can move along the axial direction of the connecting pipe 15. Is formed. That is, the extension connecting pipe 25 is formed so that its inner diameter is larger than the outer diameter of the shaft 2 of the endoscope 1 but its outer diameter is smaller than the inner diameter of the connecting pipe 15.
On the other hand, the extension connecting pipe 25 is formed so that the length from the base end to the tip of the extension portion 21 is longer than the connecting pipe 15.
For this reason, when the extension connecting pipe 25 is operated along the axial direction, the tip of the extension portion 21 accommodated in the main body portion 11 can appear and disappear from the tip end of the main body portion 11.

It should be noted that the method for causing the tip of the extension 21 to protrude from the tip of the main body 11 is not limited to the structure as described above. For example, even if the length of the extension connecting pipe 25 is the same as that of the connecting pipe 15, the extension connecting pipe 25 and the connecting pipe 15 can be provided by making the length of the extension 21 itself in the axial direction longer than that of the main body 11. Even when the same is moved by the same amount, the tip of the extension portion 21 can appear and disappear from the tip of the main body portion 11.

Since the extension part 21 has the structure as described above, the extension part 21 and the extension connection pipe 25 can be provided in the main body part 11 and the connection pipe 15. 11, the tip of the shaft 2 of the endoscope 1 can be arranged (see FIGS. 9 and 10).

When the extension portion 21 is provided, even if the stomach wall ST or the organ lifted by the main body portion 11 hangs down on the front surface of the main body portion 11, the extension portion 21 protrudes from the tip of the main body portion 11, thereby The stomach wall ST and the like that hangs down on the front surface can be lifted by the extension 21. Then, the axial direction of the outer cylinder 5, that is, the visual field or surgical field having a large depth can be secured in depth compared to the case where the visual field of the endoscope 1 or the surgical surgical field is secured only by the main body 11. (FIG. 11 (A)).

Further, as shown in FIGS. 11B to 11D, if the expansion and contraction (that is, indentation) of the main body portion 11 and the extension portion 21 are alternately repeated, the visual field region is ensured while ensuring a visual field region of a certain level or more. Can be moved in the axial direction of the outer cylinder 5.
For example, from the state of FIG. 11A, the outer cylinder 5 is moved so that the tip thereof reaches the position of the tip of the main body 11, and the main body 11 is accommodated in the outer cylinder 5. In this state, the area on the front surface of the endoscope is secured by the extension 21 (FIG. 11B). Next, the outer cylinder 5 is moved so that the tip thereof reaches the position of the tip of the extension portion 21, and the extension portion 21 is accommodated in the outer cylinder 5 (FIG. 11C). If it will be in this state, the area | region of the front surface of an endoscope will be crushed, but if the main-body part 11 is protruded from the outer cylinder 5, an area | region can be ensured by the main-body part 11 again (FIG.11 (D)). From this state, if the extension part 21 protrudes from the tip of the main body part 11, a region having a large depth can be secured again (FIG. 11A).
As described above, when the extension portion 21 and the main body portion 11 are repeatedly projected and retracted, the affected portion can be easily found when the endoscope 1 is moved while searching for the affected portion in a deflated stomach or abdominal cavity.

The extension portion 21 is not particularly limited in the cross-sectional area (in other words, the diameter D2) of the tip portion in an enlarged state. For example, as shown in FIGS. 9 and 11, the extension portion 21 has a cross-sectional area (in other words, a diameter D2) of the distal end portion in an enlarged state. In other words, it is preferably formed so as to be smaller than the diameter D1). In this case, since the extension portion 21 having a small cross-sectional area is located at the tip, it is easy to enter the organ or the deflated stomach. And if it is an area | region ensured with the extension part 21 with a small cross-sectional area, an area | region can be easily expanded also with a main-body part with a large cross-sectional area. Therefore, there is an advantage that it is easy to guide the shaft 2 of the endoscope 1 into the organ or the deflated stomach.

(Multiple extensions 21)
In the above example, the case where only one extension portion 21 is provided has been described. However, a plurality of extensions 21 may be provided.
Specifically, a plurality of extension portions 21 having different end areas in the contracted state, in other words, different in outer diameter and inner diameter when contracted into a cylindrical shape. Provide. Then, another extension portion 21 having an inner diameter smaller than that of the one extension portion 21 is disposed in the one extension portion 21. At this time, the other extension portion 21 can move in the axial direction of the one extension portion 21 in a state where the other extension portion 21 is disposed in the one extension portion 21. Then, if the other extension 21 is moved in the axial direction, the tip of the other extension 21 can be protruded from the tip of the one extension 21.

In this way, if an extension set in which another extension 21 is arranged in one extension 21 is arranged in the main body 11, the plurality of extensions 21 can be used in the depth direction of the field of view of the endoscope. It becomes easy to secure a wider area. Further, if the main body 11 and the plurality of extensions 21 are moved while being expanded and contracted (see FIG. 11), the shaft 2 of the endoscope 1 is moved while searching for the affected part in a deflated stomach or abdominal cavity. Sometimes, the shaft 2 becomes easy to move.

In the extension set, all the extensions 21 do not necessarily have a substantially equivalent structure, and extensions having different structures may be combined. However, when all the extension portions 21 have substantially the same structure and are substantially similar, the arrangement of the plurality of extension portions 21 is facilitated, and interference between the extension portions 21 occurs when enlarged or reduced. It can be made difficult to occur.

Further, the method for moving each extension 21 is not particularly limited. For example, what is necessary is just to set it as the structure which each provides the extended connection pipe | tube 25 corresponding to each extension part 21. FIG. In this case, the inner diameter of the extension connecting pipe 25 connected to one extension 21 is larger than the outer diameter of the extension connecting pipe 25 connected to the other extension 21 accommodated in the one extension 21. As long as it is larger.

As a matter of course, in the extension set, the extension 21 having the smallest inner diameter (that is, the extension 21 having the smallest cross-sectional area of the tip in the contracted state) and the extension connecting pipe 25 connected to the extension 21 are provided. Is formed to be larger than the outer diameter of the shaft 2 of the endoscope 1 (in other words, larger than the cross-sectional area of the shaft 2 of the endoscope 1).

In addition, the method of making the tip of the other extension part 21 accommodated in the one extension part 21 protrude from the tip of the one extension part 12 is not particularly limited. For example, the extension connection pipe 25 of the other extension part 21 may be made longer than the extension connection pipe 25 of the one extension part 21, or the length of the extension connection pipe 25 may be the same and the axis of the other extension part 21 may be the same. The length in the direction may be longer than the length in the axial direction of one extension portion 21.

The region securing device according to the present invention is a transluminal intraluminal operation for performing a procedure for forming a through-hole in the digestive tract or an operation in the abdominal cavity with an endoscope inserted in a digestive tract cavity such as the mouth, anus, or vagina. Suitable for instruments that secure the field of view and surgical field of endoscopic surgery.

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Shaft 5 Outer cylinder 10 Area | region securing instrument 11 Main body part 11a Outer edge 15 Connection pipe 21 Extension part 25 Extension connection pipe 30 Main body part 31 Support part 32 Area | region holding | maintenance part 33 Area | region holding piece ST Gastric wall

Claims

An instrument for securing a region used for transluminal endoscopic surgery,
It has a cylindrical main body with a hollow space,
The body part is
In a direction intersecting with the central axis of the hollow space, it can expand and contract,
In the expanded state, the hollow space of the main body is formed so that the cross-sectional area thereof is larger than the cross-sectional area of the shaft of the endoscope.
The body part is
In the contracted state, it becomes almost cylindrical,
In the expanded state, the cross-sectional area of the hollow space at the proximal end portion is larger than the cross-sectional area of the shaft of the endoscope, and the cross-sectional area of the hollow space at the distal end portion is at the proximal end portion. The region securing device according to claim 1, wherein the region securing device is formed to be larger than a cross-sectional area of the hollow space.
The main body is
When a force of a certain level or more is applied in a direction from the direction intersecting the central axis of the hollow space toward the central axis, the cross-sectional area shrinks so that the original shape is removed when the force is removed. The area securing instrument according to claim 1, wherein the area securing instrument is adjusted so as to be able to return to the position.
An instrument for securing a region used for transluminal endoscopic surgery,
It has a main body formed so that its cross-sectional area can expand and contract,
The main body is
A cylindrical support having a hollow space;
A region holding portion having a base end coupled to the support portion,
The support part is
The cross-sectional area is formed to be larger than the cross-sectional area of the endoscope shaft,
The region holding unit is
It has a plurality of area holding pieces provided along the circumferential direction of the support part,
Each area holding piece
The tip portion is provided so as to be able to approach and separate from the central axis direction of the support portion,
In a state of being separated from the central axis of the support portion, the cross-sectional area of the space formed by the tips of the plurality of region holding pieces is formed to be larger than the cross-sectional area of the support portion. Area securing device.
Each area holding piece
When a force of a certain level or more is applied to the tip portion in a direction from the direction intersecting the center axis of the support portion toward the center axis, the tip portion is deformed so as to approach the center axis of the support portion, and 5. The region securing device according to claim 4, wherein the region securing device is adjusted so that it can return to its original shape when the force is removed.
The area securing instrument is:
It has a cylindrical connecting pipe with a hollow space,
The connecting pipe is
The hollow space has a cross-sectional area that is larger than the cross-sectional area of the endoscope shaft,
The tip of the hollow space is connected to the base end of the main body so that the hollow space is in communication with the hollow space of the main body. Equipment for securing the stated area.
In the main body part, an extension part provided so as to be able to protrude from the tip of the main body part is provided,
The extension is
It is a shape substantially equivalent to the main-body part of Claim 1, 2, 3, 4 or 5, Comprising: It is accommodated in the said main-body part so that a movement is possible along the center axis direction of this main-body part. The region securing instrument according to any one of claims 1 to 6.
A plurality of the extension portions are provided in the main body portion,
The plurality of extensions are
The cross-sectional areas of the tip portions in the contracted state are different, and the extension portions having a smaller cross-sectional area of the tip portion in the contracted state than the one extension portion are accommodated in the one extension portion, and are mutually along the axial direction. It is provided to be movable,
8. The region securing device according to claim 7, wherein the extension portion accommodated in the one extension portion is provided so as to be able to protrude from the tip of the one extension portion.
The extension is
The cross-sectional area of the distal end portion in an enlarged state is formed so that the cross-sectional area of the distal end portion in an expanded state of the main body portion and the extension portion that accommodates the extension portion is also reduced. Item 7. The area securing device according to Item 7 or 8.
Provided with a cylindrical extension connecting pipe having a hollow space provided in the connecting pipe and provided movably along the axial direction of the connecting pipe;
The extended connecting pipe is
The hollow space has a cross-sectional area that is larger than the cross-sectional area of the endoscope shaft,
The distal end of the hollow space is connected to the base end of the main body so that the hollow space is in communication with the hollow space of the extension. Area securing device.
An endoscope used for transluminal endoscopic surgery,
The endoscope
A cylindrical outer tube through which the shaft of the endoscope is inserted;
A device for securing an area according to any one of claims 1 to 10,
The area securing instrument is:
Disposed between the outer tube and the shaft of the endoscope in a state of being inserted into the outer tube;
An endoscope provided with a region securing instrument, characterized in that the main body portion is provided so as to be able to protrude and retract from the tip of the outer cylinder along the axial direction of the shaft of the endoscope.
The connecting pipe and / or the extended connecting pipe are:
In a state of being connected to the main body part and / or the extension part, the connection pipe and / or the extension connection from the distal end of the main body part and / or the extension part in the axial direction of the connection pipe and / or the extension connection pipe. 12. The endoscope provided with the region securing instrument according to claim 11, wherein a length to a proximal end of the tube is shorter than a length in an axial direction of the outer cylinder.