WO2016068204A1 - 内視鏡用鋏及び内視鏡用高周波処置具 - Google Patents
内視鏡用鋏及び内視鏡用高周波処置具 Download PDFInfo
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- WO2016068204A1 WO2016068204A1 PCT/JP2015/080429 JP2015080429W WO2016068204A1 WO 2016068204 A1 WO2016068204 A1 WO 2016068204A1 JP 2015080429 W JP2015080429 W JP 2015080429W WO 2016068204 A1 WO2016068204 A1 WO 2016068204A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00101—Insertion part of the endoscope body characterised by distal tip features the distal tip features being detachable
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Definitions
- the grasping forceps is a device that strongly grasps a living tissue and excises it by scavenging it. That is, as shown in FIG. 7 of Patent Document 1, the grasping forceps is an instrument that grasps a region having a predetermined area including a part to be excised such as a diseased tissue and scrapes the entire region.
- an endoscope scissors is an instrument that applies a high-frequency voltage to cauterize a living tissue and applies an incision by applying a shearing force to the living tissue with a pair of overlapped scissors, if necessary. Distinguishable from grasping forceps.
- Patent Document 3 describes another example of an endoscope cage.
- a depression is formed in the blade part (blade surface) of the flange (blade) of the endoscope cage.
- Such a depression is formed with a shallow depth that does not penetrate the heel piece in the thickness direction, and is supposed to function as a slip stopper when incising the living tissue.
- Patent Document 4 includes a pair of hooks that are pivotally supported by a support pin so as to rotate and displace between an open state and a closed state, and the hook pieces are opened and closed by advancing and retracting an operation wire.
- An endoscopic high-frequency treatment instrument (hereinafter also referred to as “Prior Art 1”) is disclosed.
- the prior art 1 has a connection terminal for applying a high frequency power source to the blade provided on the collar piece.
- the endoscope scissors of Patent Document 2 may incise the living tissue at an excessive depth.
- the endoscope scissors of Patent Document 2 may have a nail portion and a plurality of saw blades that bite into the mucosal tissue and make an incision with the gripped, so that when the scissors bite too deeply into the mucosal tissue May be incised up to the muscle layer.
- the endoscope scissors described in Patent Document 3 have a dent formed in the blade portion, and the living tissue is locally released to the dent, so that it functions as a slipper when incising.
- the living tissue is only released within the depth of the depression, the function of the slip prevention by the depression is extremely limited, except when incising the living tissue that deforms flexibly within such a minute range. Is done.
- the present invention has been made in view of the above-described problems, and it is possible to accurately incise a target living tissue without slipping of a heel piece. For example, an excessive depth reaches a muscle layer. It is an object of the present invention to provide an endoscope scissors that allows a minimally invasive procedure without incision.
- the prior art 1 has stabilized arrangement
- the insulating coating may be peeled off by rubbing the surface of the flange that operates inside the slit when the pair of flanges are opened and closed due to contact with the inner surface of the holding frame.
- the conductive part other than the blade part may come into contact with the living tissue because the part where the insulating coating is peeled off is exposed to the outside of the holding frame by the opening / closing operation of the pair of scissors. there were.
- FIG. 15 is a side view of the distal end portion of a conventional endoscopic high-frequency treatment instrument 1900 showing a pair of scissors 1212 and 1222 in an open state.
- FIG. 16 is a side view of the distal end portion of a conventional endoscope high-frequency treatment instrument 1900 and shows a pair of collar pieces 1212 and 1222 in a closed state.
- the high-frequency treatment instrument for endoscope 1900 shown in FIG. 15 and FIG. 16 has a stepped portion 1110 on the proximal end side from the portion pivotally supported by the rotation shaft 1029 of the collar pieces 1212 and 1222.
- the thickness on the base end side with respect to the portion 1110 is formed smaller than the thickness on the tip end side with respect to the stepped portion 1110.
- link pieces 1017 and 1027 having thicknesses equal to or less than the height of the stepped portion 1110 and hook pieces 1212 and 1222 are pivotally supported by shafts 1170 and 1270, and at least the hook piece 1212. , 1222 and the inner surface of the arm portion 1910 are in contact with each other. Therefore, the pair of flange pieces 1212 and 1222 is stably disposed between the arm portions 1910 facing each other.
- inner side rather than the collar piece 1212 is abbreviate
- the opposing two arm portions 1910 constitute a holding frame 1914 together with the base end portion 1912.
- the endoscopic high-frequency treatment instrument 1900 operates from the closed state to the open state, so that a part of the collar pieces 1212 and 1222 included in the holding frame 1914 in the closed state is exposed region as shown in FIG. It appears as 1920 outside the holding frame 1914. Further, the endoscope high-frequency treatment instrument 1900 operates from the open state to the closed state, so that part of the collar pieces 1212 and 1222 included in the holding frame 1914 in the open state is as shown in FIG.
- the exposed area 1940 appears outside the holding frame 1914.
- the portions accommodated in the holding frame 1914 of the flange pieces 1212 and 1222 are rubbed in contact with the inner surface of the holding frame 1914 by operating in an open state and a closed state, and are formed on the surface.
- the coatings 1018 and 1028 were peeled off. Therefore, the exposed regions 1920 and 1940 from which the insulating coatings 1018 and 1028 are peeled off become conductive regions, and there is a possibility that an unscheduled portion of the living tissue may be cauterized.
- the present invention has been made in view of the above problems. That is, the present invention provides a high-frequency endoscope for which a treatment portion including a pair of gripping pieces is supported by a holding frame, but the insulating coating is prevented from peeling off when the treatment portion comes into contact with the holding frame. Providing a treatment tool.
- an endoscopic scissor that is inserted into a forceps hole of an endoscope and used to incise a living tissue, is overlapped with each other and is rotated by a rotating shaft that extends in the overlapping direction.
- a pair of scissors that are pivotally supported so as to be openable and closable, and each have a blade portion for grasping and incising the living tissue, and applying a driving force to the base end side of the scissors to provide a distal end
- an operation wire for opening and closing the part, and a claw part for gripping the living tissue is formed in the tip part of at least one of the pair of collar pieces so as to protrude in the closing direction from the blade part.
- the blade portion of the one or other flange piece is locally formed with a recessed portion penetrating in the thickness direction, and the blade portion excluding the claw portion and the recessed portion extends in the proximal direction.
- An endoscopic cage characterized by being formed in a linear shape is provided.
- the claw portion is formed to protrude in the closing direction at the distal end portion of the heel piece, and the claw portion can be incised by biting the living tissue and gripping it.
- the target tissue can be accurately incised without slipping on the living tissue.
- the recessed part formed in the blade part has penetrated in the thickness direction, compared with patent document 3, many biological tissues can escape to a recessed part, and a blade part can be digged in.
- the blade portion is formed in a flat linear shape extending in the proximal direction, so that the blade portion has a sawtooth shape as in Patent Document 2.
- the bite of the blade part with respect to a biological tissue is suppressed moderately. For this reason, for example, even when the sepals are deeply bitten into the mucosal tissue, by pulling the sepals and pulling up the mucosal tissue, the muscle layer falls off between the sepals due to the elastic restoring force, so that the Only the layer and the submucosa are incised by the blade. For this reason, it is possible to cut the mucosal tissue without damaging the muscle layer.
- an endoscope scissors capable of accurately and minimally incising a target living tissue without slipping the scissors pieces.
- the treatment portion is supported by the holding frame in a state where the outer side surface of the treatment portion including the pair of grip pieces and the inner side surface of the holding frame are separated from each other. Therefore, even when the pair of gripping pieces are opened and closed, the insulating coating formed on the surface of the treatment portion is prevented from peeling off due to contact with the inner side surface of the holding frame.
- the endoscope scissor 100 has a scissor-shaped tip treatment section 10 that opens and closes the thin scissors 12 and 22 that are superposed on each other and applies a shearing force to the living tissue 200 to grasp it.
- the flanges 12 and 22 open and close each other in the in-plane direction around the rotation shaft 29.
- the extending direction (axial direction) of the rotation shaft 29 is the overlapping direction of the flange pieces 12 and 22, in other words, the thickness direction of the flange pieces 12 and 22.
- the distal treatment section 10 is driven to open and close by the operation wire 30.
- the operation wire 30 is made of a conductive metal material such as stainless steel.
- the holding frame 20 is attached to the tip of the sheath 40.
- the proximal end portion of the holding frame 20 is inserted into the sheath 40 and fixed, and the distal end portion of the holding frame 20 protrudes from the sheath 40 and accommodates the link pieces 17 and 27.
- a rotation shaft 29 that rotatably connects the first collar piece 12 and the second collar piece 22 is fixed to the holding frame 20.
- the hook pieces 12 and 22 have a substantially L-shape, that is, a sickle shape, which is shallowly bent in the direction of the rotation plane in the vicinity of the rotation shaft 29.
- the shape of the pair of flanges 12 and 22 may be a symmetric shape or an asymmetric shape.
- the hook pieces 12 and 22 and the link pieces 17 and 27 constitute a four-bar linkage mechanism that opens and closes the distal treatment section 10 with the rotation shaft 29 as a fulcrum.
- the operation wire 30 applies a driving force to the proximal end portions of the collar pieces 12 and 22 via the advancing / retreating portion 26 and the link pieces 17 and 27, and opens and closes the distal ends of the collar pieces 12 and 22.
- edges of the blades 13 and 23 may be formed so sharp that the living tissue 200 can be incised by the shearing force, or formed at an angle that is so blunt that the living tissue 200 is not incised by the shearing force. Also good.
- the edges of the blade portions 13 and 23 are formed at a blunt angle so that the living tissue 200 is not substantially incised only by the shearing force generated by pulling the slider 56. It is configured. Then, in a state where the living tissue 200 is held by the sepals 12 and 22, the living tissue 200 is cauterized and incised by applying a high-frequency voltage described later between the sepals 12 and 22. As a result, the biological tissue 200 is not inadvertently incised while the biological tissue 200 is grasped by the collars 12 and 22 and the biological tissue 200 is stretched and extended with a predetermined tension.
- a claw portion 14 for gripping the living tissue 200 is formed at least at one tip of the collar piece 12 or 22 so as to protrude from the blade portion 13 or 23 in the closing direction.
- the closing direction is a direction from one collar piece 12, 22 toward the other collar piece 22, 12, and the opposite direction is referred to as an opening direction.
- a concave portion 15 penetrating in the thickness direction is locally formed in the blade portion 13 of the first collar piece 12, and the blade portion 13 excluding the claw portion 14 and the concave portion 15 is in the proximal direction (the left-right direction in FIG. 2). It is formed in the shape of a flat line extending.
- a concave portion 25 penetrating in the thickness direction is also locally formed in the blade portion 23 of the second flange piece 22, and the blade portion 23 excluding the concave portion 25 is in the distal end direction (left-right direction in FIG. 2). It is formed in the shape of a flat line extending.
- the blades 13 and 23 are flat and linear.
- the edges of the inner surfaces of the scissors 12 and 22 that are overlapped with each other have a linear shape or a smooth curved shape.
- the blade portions 13 and 23 of the present embodiment are not formed with sharp protrusions such as toothed teeth.
- the blade portion 13 has a linear shape except for the formation region of the claw portion 14 and the recessed portion 15.
- the blade portion 23 has a linear shape except for the formation region of the recess 25.
- one or both of the blade portions 13, 23 may be smoothly curved into a convex arc shape protruding in the closing direction or a concave arc shape recessed in the opening direction.
- the recesses 15 and 25 penetrating in the thickness direction are locally formed in at least one of the blades 12 and 22 (both in the present embodiment) of the blades 13 and 23. That the recessed parts 15 and 25 are formed in the blade parts 13 and 23 means that the recessed parts 15 and 25 are formed so that it may be depressed in the opening direction from the edge which cut
- the endoscope collar 100 of this embodiment although the aspect in which the recessed parts 15 and 25 are formed in both the blade parts 13 and 23 is illustrated, the blade part 13 or 23 like 2nd embodiment mentioned later is mentioned. You may form the recessed part 15 only in one (for example, blade part 13).
- the concave portions 15 and 25 of the present embodiment each have a substantially semicircular shape.
- the substantially semicircular shape means a concave shape composed of smooth curved lines.
- the concave portion 15 is formed so as to be connected to the claw portion 14 formed at the distal end portion of the collar piece 12. That is, the claw portion 14 is formed so as to protrude from the inner peripheral surface of the recess 15 in the closing direction.
- the blade portion 13 of the collar piece 12 is formed in a linear shape so as to extend to the proximal end side with respect to the concave portion 15.
- the substantially semicircular recesses 15 and 25 are formed so as to face the positions corresponding to each other of the blade portions 13 and 23 of the pair of scissors pieces 12 and 22, respectively. Then, by closing the flanges 12 and 22, the recesses 15 and 25 are joined together to form a substantially circular through hole 16 (see FIG. 2).
- the living tissue 200 can be gripped by the collar pieces 12 and 22 so as to be wrapped in the cylindrical shape by the through-holes 16. For this reason, the biological tissue 200 can be gripped at a plurality of locations of the claw portion 14 and the through-hole 16 in combination with the claw portion 14 that has bitten into the biological tissue 200. Thereby, even when a force is applied from the living tissue 200 to the distal treatment section 10 not only in the proximal direction but also in the crossing direction, the biological tissue 200 is preferably prevented from being grasped from the distal treatment section 10.
- an example is a mucosal tissue in which a submucosal layer 204 is laminated on the upper surface of the muscle layer 206 and the mucosal layer 202 is further laminated on the upper surface thereof.
- the living tissue 200 include an inner wall of a body cavity of the digestive system such as the inner wall of the stomach.
- a lesion tissue 203 is locally formed in the mucosa layer 202.
- a bulging portion 210 into which physiological saline, hyaluronic acid, or the like is injected is formed in advance in a region corresponding to the lower portion of the diseased tissue 203 in the submucosa 204.
- the nail portion 14 and the concave portions 15 and 25 are bitten into the mucous membrane layer 202 of the living tissue 200.
- the linear blade portions 13 and 23 come into contact with the mucous membrane layer 202. For this reason, it is suppressed that the mucous membrane layer 202 bites into the collar pieces 12 and 22 excessively.
- the blade portions 13 and 23 are pressed flat against the mucous membrane layer 202, so that the depth at which the mucosal layer 202 bites into the claw portion 14 and the through hole 16 is moderately suppressed.
- the distal treatment section 10 holding the living tissue 200 is pulled upward, the living tissue 200 is advanced along the flat blade portions 13 and 23 with the mucous membrane layer 202 hooked to the nail portion 14. Can slide down slightly in the direction. As a result, the mucous membrane layer 202 and the submucosal layer 204 are gripped and stretched by the distal treatment section 10 and are stretched with a predetermined tension, while the muscle layer 206 is detached from the distal treatment section 10.
- the slider 56 (see FIG. 1) is further pulled to close the flanges 12 and 22, and a high frequency voltage is applied as described later, whereby the mucosa layer 202 (or the mucosa layer 202 and the submucosa 204) is applied.
- the recessed parts 15 and 25 were formed facing each other and the flanges 12 and 22 were closed, the substantially circular through-hole 16 was formed, but the recessed parts 15 and 25 are restricted to this. Absent.
- the concave portions 15 and 25 may be formed at different positions in the front end direction of the flange pieces 12 and 22, respectively. In this case, the recesses 15 and 25 may be formed at positions where some of the recesses 15 and 25 are continuous, or the recesses 15 and 25 may be formed at positions completely separated from each other.
- the insulating coatings 18 and 28 can be formed by coating an insulating material such as, for example, a fluororesin; diamond-like carbon (DLC); a ceramic material such as titanium oxide or silicon.
- an insulating coating that is particularly excellent in insulation, durability against electric conduction and adhesion can be obtained by selecting a silicon-based ceramic material as an insulating material. Yes. Insulating properties and durability are achieved by increasing the film thickness of the insulating coating. However, when the film thickness is increased, there is a problem that the adhesiveness with the strip decreases.
- a silicon-based ceramic as the insulating material, it is possible to improve the balance of insulation, durability against electric current and adhesion as compared with other ceramic materials, fluororesin, and DLC. it can.
- the thickness of the insulating coatings 18 and 28 is not particularly limited, but is 20 ⁇ m or more and 80 ⁇ m or less when a fluororesin is used as the insulating material, 1 ⁇ m or more and 5 ⁇ m or less when DLC is used, and 5 ⁇ m or more when a silicon ceramic material is used.
- the thickness is preferably 40 ⁇ m or less.
- the blade portions 13 and 23 exposed from the insulating coatings 18 and 28 are linear electrodes.
- the saddle pieces 12 and 22 are applied with a high-frequency voltage having the same phase from the power supply unit 52 to become monopolar high-frequency electrodes.
- the following steps can be performed. That is, an insulating material is coated on the whole of the collar pieces 12 and 22 in advance, and then the coating of the bent linear regions corresponding to the inner peripheral surfaces of the blade portions 13 and 23 and the concave portions 15 and 25 is polished or chemically treated. Can be peeled off.
- the living tissue 200 can be cauterized in the blade portions 13 and 23 and the recesses 15 and 25.
- a quick incision procedure is possible.
- the insulating coatings 18 and 28 on the inner peripheral surfaces of the recesses 15 and 25, it is possible to prevent the solidified tissue from adhering to the inside of the recesses 15 and 25 when the living tissue 200 is cauterized.
- a high gripping force for the living tissue 200 (see FIG. 5) can be obtained.
- a claw portion 14 is formed on the collar piece 12 so as to protrude in the closing direction from the blade portion 13.
- a plurality of recesses 15a to 15c are formed on the blade portion 13 or 23 on the side where the claw portion 14 is formed (blade portion 13).
- the formation depth of the recess 15 formed in the flange 12 is equal to or greater than the protrusion height at which the claw portion 14 protrudes from the blade portion 13 in the closing direction. Thereby, many biological tissues 200 (refer FIG. 5) can escape to the through-hole 16, and the collar pieces 12 and 22 can be made to bite into the biological tissue 200. FIG. For this reason, when the distal treatment section 10 is pulled up while holding the living tissue 200, between the claw 14 at the distal end of the heel piece 12 and the recesses 15 and 25 formed on the proximal end side with respect to the intermediate portion, Tension can be applied to the living tissue 200 (mucosal layer 202).
- FIG. 8A is a plan view showing a closed state of the distal treatment section 10 in the endoscope scissors 100 of the fourth embodiment
- FIG. 8B is a side view of the distal treatment section 10.
- FIG. 9 is a side view showing an open state of the distal treatment section 10 in the endoscope scissor 100 of the fourth embodiment. Description overlapping with any of the first to third embodiments described above will be omitted as appropriate.
- the bent protrusion 66 is brought into contact with the mucosal layer 202 when the distal treatment section 10 is advanced along the mucosal layer 202 (see FIG. 4). Since the distal end 64 of the distal treatment section 10 faces away from the mucosal layer 202, the distal end 64 is prevented from interfering with the mucosal layer 202.
- the flanges 12 and 22 are arranged along the extension line L of the operation wire 30 at the most proximal end portion 67 accommodated in the holding frame 20 and parallel to the advance / retreat portion 26.
- a part of the most proximal end portion 67 protrudes from the holding frame 20 toward the distal end side.
- the proximal end bending portion 62 is connected to the distal end side of the most proximal end portion 67.
- a plurality of recesses 15 are formed in at least one of the blade portions 13 and 23 of one or the other of the pair of flanges 12 and 22 so as to be spaced apart from each other in the proximal direction.
- four concave portions 15 (15a to 15d) and 25 are formed at positions corresponding to each other with respect to the blade portions 13 and 23 of the pair of collar pieces 12 and 22, respectively.
- the recesses 15 and 25 are formed on the base end side with respect to the intermediate portion in the front base end direction of the flange pieces 12 and 22.
- the recessed portion 15 is formed in the proximal curved portion 62 of the blade portion 13, and the recessed portion 25 is formed in the proximal curved portion 62 of the blade portion 23.
- the mucous membrane layer 202 and the submucosal layer 204 can be incised shallowly by the distal bending portion 60 while being gripped by the distal treatment section 10 (see FIG. 5). Thereby, incision of the muscle layer 206 by the distal treatment section 10 is preferably avoided.
- the various components of the endoscope cage 100 of the present invention do not have to be individually independent.
- a plurality of components are formed as one member, a component is formed of a plurality of members, one component is a part of another component, and one component is And a part of other components are allowed to overlap.
- FIG. 10 is an overall side view of an endoscope high-frequency treatment instrument 1100 according to a fifth embodiment of the present invention.
- FIG. 11 is a side view of the distal end portion of the endoscope high-frequency treatment instrument 1100 in the closed state.
- FIG. 12 is a side view of the distal end portion of the endoscope high-frequency treatment instrument 1100 in the opened state.
- FIG. 13A is a partial top view of the treatment section 1010 and the holding frame 1020 before being combined, and FIG.
- the endoscopic high-frequency treatment instrument 1100 is held by a holding frame 1020 in a state in which a treatment portion 1010 including a grip piece (piece piece 1012, 1022) is housed inside a pair of arm portions 1016.
- the spacer portion 1015 is arranged, so that the inner side surface 1152 of the arm portion 1016 and the facing surface 1154 of the treatment portion 1010 are prevented from coming into direct contact with each other.
- the insulating coatings 1018 and 1028 provided on the surface of the opposing surface 1154 are rubbed by rubbing the inner surface 1152 of the arm portion 1016 and the opposing surface 1154 of the treatment portion 1010 by the opening and closing operation of the gripping pieces (saddle pieces 1012, 1022). There is no peeling.
- the insulating film on the outer surface of the treatment portion 1010 is peeled off, and the region exposed to the outside of the arm portion 1016 by the opening / closing operation of the grip pieces (hook pieces 1012, 1022). It is prevented from becoming conductive.
- the spacer portion 1015 in the present embodiment has a gap between the facing surface 1154 of the flange pieces 1012,1022, which are gripping pieces accommodated in the arm portion 1016, and the inner side surface 1152 of the arm portion 1016. It is sandwiched without any problems.
- “there is no gap” means that at least a part of the inner side surface 1152, the spacer portion 1015, and the opposing surface 1154 are continuous to the extent that the collar pieces 1012, 1022 do not shake in the axial direction inside the arm portion 1016. Means.
- such a configuration does not exclude an aspect having a microscopic gap between the inner surface 1152 and the spacer portion 1015 or between the spacer portion 1015 and the facing surface 1154.
- the disposition position of the scissors pieces 1012, 1022 accommodated in the arm portion 1016 does not shake in the axial direction of the rotation shaft 1029, and the scissors pieces 1012, 1022
- the placement position of is stable. Due to the stable arrangement position, the operability of the hook pieces 1012, 1022 is good.
- the pair of gripping pieces are a pair of scissors pieces 1012, 1022 each having thin plate-like blade portions 1013, 1023.
- the blade edges of the thin plate-like blade portions 1013 and 1023 are directed in the closing direction, and a shearing force is applied to the living tissue (not shown) by the operation in the closing direction of the pair of saddle pieces 1012, 1022.
- the living tissue can be cauterized and incised (removed) by applying a high frequency voltage to the blade portions 1013 and 1023.
- the pair of flange pieces 1012, 1022 is pivotally supported on the rotating shaft 1029 in a region where they are overlapped with each other at the intermediate portion.
- the blade portions 1013 and 1023 of the collar pieces 1012, 1022 operate in a direction (closed direction) that overlaps each other with a portion pivotally supported by the rotation shaft 1029 as a fulcrum, and sandwich the living tissue in a closed state or a state close to the closed state. obtain.
- the blade portions 1013 and 1023 can sandwich the living tissue satisfactorily.
- the spacer portion 1015 has no gap between the facing surface 1154 of the hook pieces 1012, 1022 and the inner side surface 1152 of the arm portion 1016 as described above. It is preferable that the arrangement position of the hook piece 1012 is stabilized by being sandwiched.
- An endoscopic high-frequency treatment instrument 1100 is used by being inserted into a forceps hole (not shown) of an endoscope, applies a shearing force to a living tissue (not shown) and applies a high-frequency voltage to make an incision. It is an instrument.
- the endoscopic high-frequency treatment instrument 1100 includes a pair of collars 1012, 1022 and an operation wire 1030.
- the pair of flange pieces 1012, 1022 have blade portions 1013, 1023 that are pivotally supported so as to be openable and closable with each other and apply a shearing force to the living tissue.
- a treatment portion 1010 including a pair of scissors pieces 1012, 1022 is provided at the distal end portion of the endoscope high-frequency treatment instrument 1100.
- the treatment unit 1010 is driven to open and close by the operation wire 1030.
- the operation wire 1030 is made of, for example, a conductive metal material such as stainless steel.
- the operation wire 1030 is a member that applies a driving force to the proximal end side of the flange pieces 1012, 1022, and opens and closes the distal end portion of the flange pieces 1012, 1022.
- the blades 1012 and 1022 have a thin plate shape in which the blade portions 1013 and 1023 are thin plates, and the regions other than the blade portions 1013 and 1023 are also slightly thicker than the blade portion 1023.
- the flange pieces 1012, 1022 are overlapped with each other at an intermediate portion and are pivotally supported by a rotating shaft 1029 so as to be opened and closed.
- the rotation shaft 1029 is a fixed shaft that is held and fixed by the holding frame 1020.
- the operation unit 1050 by operating the operation unit 1050, the distance between the blade parts 1013 and 1023 provided on each of the pair of hooks 1012 and 1022 is operated in a decreasing direction, and the hooks 1012 and 1022 are rotated in the closing direction. By making it move, a pair of collar pieces 1012,1022 will be in a closed state.
- a holding frame 1020 is attached to the distal end of the sheath 1040.
- the holding frame 1020 has a base end portion 1019 and an arm portion 1016.
- the proximal end portion 1019 is inserted into the distal end side of the sheath 1040, whereby the holding frame 1020 is fixed and attached to the distal end of the sheath 1040.
- the holding frame 1020 includes two arm portions 1016 that protrude from the proximal end portion 1019 toward the distal end of the endoscope high-frequency treatment instrument 1100 and face each other.
- the two arm portions 1016 are opposed to each other with a predetermined interval, the treatment portion 1010 is accommodated between the two arm portions 1016, and the rotation axis extends over the two arm portions 1016. 1029 is extended. Both ends of the rotation shaft 1029 are held by two arm portions 1016, whereby the rotation shaft 1029 is a fixed shaft whose position is fixed relative to the endoscope high-frequency treatment instrument 1100. It has become.
- the holding frame 1020 may be formed of the same or different metal material as the flange pieces 1012, 1022, and an insulating film may be formed on the surface thereof.
- the holding frame 1020 may be formed of an insulating material such as ceramic or a resin material.
- the endoscope high-frequency treatment instrument 1100 has a spacer portion 1015.
- two spacer portions 1015 are arranged to face each other with the treatment portion 1010 interposed therebetween. Therefore, the treatment unit 1010 is stably placed inside the arm unit 1016.
- the spacer portion 1015 in this embodiment is completely accommodated in the holding frame 1020, and the entire spacer portion 1015 is covered with two arm portions 1016 in a side view.
- the spacer portion 1015 may be formed of the same or different metal material as the flanges 1012, 1022, and an insulating film may be formed on the surface.
- the holding frame 1020 may be formed of an insulating material such as ceramic or a resin material.
- two spacer portions 1015 are arranged so as to face each other with a pair of collars 1012, 1022.
- the collar pieces 1012, 1022 are continuous with the arm portion 1016 via the spacer portion 1015. Therefore, the arrangement state of the collar pieces 1012, 1022 is stable inside the arm portion 1016.
- the term “continuous” means that the collars 1012, 1022 and the spacer part 1015, and the spacer part 1015 and the arm part 1016 are arranged so that the arrangement state of the collars 1012, 1022 is stabilized between the opposing arm parts 1016. Means next to each other.
- the spacer portion 1015 is provided around the rotation shaft 1029. Therefore, the arrangement stability of the pair of flange pieces 1012, 1022 supported by the rotation shaft 1029 is good. That is, the spacer portion 1015 in the present embodiment may be provided at a place other than the periphery of the rotating shaft 1029, for example, on the facing surface 1156 (see FIGS. 13A and 13B) of the link piece 1017.
- the collar pieces 1012, 1022 and the arm portion 1016 are separated from each other, but when the collar pieces 1012, 1022 are operated by the operation unit 1050, the collar pieces 1012, 1022 are in the direction of the arm portion 1016. There is a possibility of slight blurring.
- the spacer portion 1015 is provided on the opposing surface 1154 (see FIGS. 13A and 13B) of the flange pieces 1012, 1022, in particular, an aspect in which the spacer portion 1015 is provided around the rotation shaft 1029. Then, the possibility of shaking of the above-mentioned hook pieces 1012, 1022 is remarkably reduced. This is because the flange pieces 1012, 1022 accommodated in the holding frame 1020 are substantially continuous with the inner side surface 1152 of the arm portion 1016 via the spacer portion 1015.
- the endoscope high-frequency treatment instrument 1100 in which the spacer portion 1015 is fixed to the collar pieces 1012, 1022, it is preferable to pay attention to the following points.
- the endoscope high-frequency treatment instrument 1100 has an arm portion 1016 that is visually observed (that is, viewed from the side) in the axial direction of the rotation shaft 1029 under the opening / closing operation of the pair of gripping pieces (hook pieces 1012, 1022).
- a spacer portion 1015 is included inside the outer edge.
- Such a configuration is particularly effective in an aspect in which an insulating film is provided on the surface of the spacer portion 1015 formed of a conductive material.
- the spacer portion 1015 including the peeled portion is This is because there is no possibility of cauterizing the living tissue because it does not appear outside the portion 1016.
- the endoscopic high-frequency treatment instrument 1100 in which the spacer portion 1015 is fixed to the collar pieces 1012, 1022 further has the following configuration. That is, as shown in FIGS. 13A and 13B, the endoscope high-frequency treatment instrument 1100 has two spacer portions 1015 that are flat plate-like bodies facing each other with a pair of gripping pieces (gutter pieces 1012, 1022) interposed therebetween. Are arranged.
- the maximum dimension of the treatment section in the axial direction of the rotation shaft 1029 is configured to be smaller than the facing width dimension of the two spacer sections 1015 facing each other.
- spacer portions 1015 are arranged and fixed on the opposing surfaces 1154 of the flange pieces 1012, 1022, respectively, at positions facing each other. Therefore, the spacer portion 1015 forms a protruding portion that protrudes from the facing surface 1154.
- a stepped portion 1110 is provided on the base end side of a portion supported by the pivot shaft 1029 of the hook pieces 1012, 1022, and the facing surface 1154 of the hook pieces 1012, 1022 is inwardly at a predetermined height. Just going down.
- the flange pieces 1012, 1022 have a substantially uniform thickness dimension on the front end side from the stepped portion 1110 and a substantially uniform thickness dimension on the rear end side from the stepped portion 1110.
- the endoscope high-frequency treatment instrument 1100 includes a flexible sheath 1040 and an operation unit 1050 provided on the proximal side of the sheath 1040.
- the sheath 1040 is an insulating flexible tube, and an operation wire 1030 is inserted through the sheath 1040.
- Blade portions 1013 and 1022 are formed on the flange pieces 1012 and 1022 along opposite edges of the inner surfaces that are overlapped with each other.
- the blade portions 1013 and 1023 of the present embodiment are formed in a partial region of the hook pieces 1012, 1022 on the tip side of the rotation shaft 1029.
- the blade portions 1013 and 1023 are portions that apply a shearing force to a living tissue (not shown). Specifically, by pulling the slider 1056 (see FIG. 10) of the operation unit 1050 and rotating the collar pieces 1012, 1022 around the rotation shaft 1029 as shown in FIG. A shearing force is generated between the blade portions 1013 and 1023.
- the high-frequency endoscope treatment instrument 1200 of this embodiment is different from the fifth embodiment in that the spacer portion 1015 is fixed to the inner surface of the arm portion 1016.
- the description overlapping with the fifth embodiment will be omitted as appropriate.
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Abstract
Description
本願は、2014年10月29日に、日本に出願された特願2014-219976号、2014年10月30日に、日本に出願された特願2014-221892号、2015年10月19日に、日本に出願された特願2015-205864号、及び2015年10月19日に、日本に出願された特願2015-205865号に基づき優先権を主張し、その内容をここに援用する。
即ち、一対の鋏片の開閉時にスリット内部で動作する鋏片の表面は、保持枠の内側面との接触により擦れて絶縁性被膜が剥離する場合があった。ここで、一対の鋏片の開閉動作により、絶縁性被膜が剥離した箇所が、保持枠の外部に表出することによって、刃部以外の導電性部分が生体組織に接触する虞が生じ問題であった。
図15および図16に示す内視鏡用高周波処置具1900は、鋏片1212、1222の回動軸1029に軸支された箇所よりも基端側において、段差部1110を有しており、段差部1110よりも基端側の厚みが、段差部1110よりも先端側の厚みよりも小さく形成されている。内視鏡用高周波処置具1900は、段差部1110の高さ寸法以下の厚みのリンク片1017、1027と鋏片1212、1222とが軸1170、1270により互いに軸支されており、少なくとも鋏片1212、1222の外側面と、腕部1910の内側面とが当接する関係にある。そのため、一対の鋏片1212、1222が対向する腕部1910の間で安定に配置されている。尚、鋏片1212よりも紙面奥側に設けられた腕部1910は図示省略している。対抗する二本の腕部1910は、基端部1912とともに保持枠1914を構成している。
図1は、本発明の第一実施形態の内視鏡用鋏100の全体構造を示す模式図である。図2は閉鎖状態の内視鏡用鋏100における先端部の縦断面図であり、図3は開放状態の内視鏡用鋏100における先端部の縦断面図である。図4は、鋏片12、22を開放した状態を示す説明図である。図5は、鋏片12、22を閉鎖して生体組織200を切開する状態を示す説明図である。
図6は、本発明の第二実施形態の内視鏡用鋏100における先端処置部10の側面図である。同図は閉鎖状態の先端処置部10を示している。
図7は、本発明の第三実施形態の内視鏡用鋏100における先端処置部10の側面図である。同図は閉鎖状態の先端処置部10を示している。
図8Aは第四実施形態の内視鏡用鋏100における先端処置部10の閉鎖状態を示す平面図であり、図8Bは当該先端処置部10の側面図である。図9は、第四実施形態の内視鏡用鋏100における先端処置部10の開放状態を示す側面図である。上述した第一から第三実施形態のいずれかと重複する説明は適宜省略する。
先端湾曲部60は、板状の鋏片12、22を面直方向に曲げ形成することにより作成することができる。より具体的には、鋏片12、22の中間部を面直方向に曲げ形成して曲折突部66を形成することで、鋏片12、22の先端64は、操作ワイヤ30の延長線Lに対して斜め方向を向くこととなる。延長線Lは内視鏡用鋏100における仮想線であり、図8Aにおいて二点鎖線で図示する。
曲折突部66は、鋏片12、22のうち、先端湾曲部60の湾曲方向と反対側(図8Aにおける下側)に形成される凸領域である。曲折突部66における鋏片12、22の曲率半径は特に限定されないが、曲折突部66において先端湾曲部60と基端湾曲部62とが滑らかに連続形成されていることが好ましい。本実施形態のように先端湾曲部60を形成することで、先端処置部10を粘膜層202(図4参照)に沿って前進させる際に曲折突部66を粘膜層202と当接させることで、先端処置部10の先端64が粘膜層202とは反対側を向くため、当該先端64が粘膜層202と干渉することが抑制される。
凹部15、25が形成されている長さ領域よりも先端側において鋏片12、22に先端湾曲部60を湾曲形成することで、凹部15、25を粘膜層202に食い込ませて生体組織200を先端処置部10で把持した状態(図5参照)で、先端湾曲部60によって粘膜層202や粘膜下層204を浅く切開することができる。これにより、先端処置部10によって筋層206を切開してしまうことが好適に回避される。
たとえば上記実施形態において、シース40を導電性ワイヤのコイルで形成することを例示したが、これに限られない。また、上記実施形態では鋏片12、22に同位相の高周波電圧を印加するモノポーラ型の内視鏡用鋏100を例示したが、これに限られない。鋏片12、22の一方をアクティブ電極とし、他方をリターン電極とするバイポーラ型の内視鏡用鋏100としてもよい。
また以下の実施形態に関し、一対の把持片とは、操作部の操作により開閉動作可能な部分を意味し、閉じ方向に動作することによって生体組織を挟むことが可能な部分を意味する。本発明における把持片は、たとえば、薄板状の刃部を備える鋏片、開口部が対向する椀状のカップ片を包含する。
また以下の実施形態において、側面視とは、特段の断りがない場合には、回動軸1029の軸心方向に腕部1016を目視することを意味する。
以下に、本発明の第五実施形態にかかる内視鏡用高周波処置具1100について図10から図13Bを用いて説明する。また比較のために従来技術である内視鏡用高周波処置具を図15、図16に示す。
図10は、本発明の第五実施形態にかかる内視鏡用高周波処置具1100の全体側面図である。図11は、内視鏡用高周波処置具1100の閉鎖状態における先端部の側面図である。図12は、内視鏡用高周波処置具1100の開放状態における先端部の側面図である。図13Aは組み合わせる前の処置部1010および保持枠1020の部分上面図であり、図13Bは内視鏡用高周波処置具1100の処置部1010および保持枠1020の部分上面図である。
図15は、従来の内視鏡用高周波処置具1900の先端部の側面図であり、開放状態である一対の鋏片1212、1222を示す。図16は、従来の内視鏡用高周波処置具1900の先端部の側面図であって、閉鎖状態である一対の鋏片1212、1222を示す。
尚、図11、12、14A、14B、15において、コイル1041、絶縁性被膜1042、および基端部1019は、理解容易のために、縦断面を示している。
内視鏡用高周波処置具1100は、操作ワイヤ1030と、処置部1010と、接続端子1052と、操作部1050と、保持枠1020と、を有している。
操作ワイヤ1030は、体内に挿入される可撓管(シース1040)に進退自在に挿通された導電性のワイヤである。
処置部1010は、把持片(鋏片1012、1022)を備え、把持片(鋏片1012、1022)は、回動軸1029により互いに開閉動作可能に軸支され導電性の刃部1013、1023を備えるとともに刃部1013、1023を除いた周面の略全面が絶縁性被膜1018、1028で被覆されている。接続端子1052は、刃部1013、1023に高周波電圧を印加する端子である。
操作部1050は、可撓管(シース1040)の基端部に付設され操作ワイヤ1030を進退操作して処置部1010を操作し、把持片(鋏片1012、1022)を開閉させる。保持枠1020は、対向する一対の腕部1016の内側に処置部1010の一部を収容するとともに回動軸1029の両端を保持している。
かかる構成を備える内視鏡用高周波処置具1100は、腕部1016に収容された鋏片1012、1022の配置位置が、回動軸1029の軸心方向にぶれることがなく、鋏片1012、1022の配置位置が安定している。配置位置が安定していることにより、鋏片1012、1022の操作性は良好である。
即ち、内視鏡用高周波処置具1100は、一対の把持片が、薄板状の刃部1013、1023をそれぞれ有する一対の鋏片1012、1022である。薄板状の刃部1013、1023の刃先は、それぞれ閉じ方向に向かっており、一対の鋏片1012、1022の閉じ方向の動作によって生体組織(図示省略)に剪断力を付与する。生体組織に刃部1013、1023に剪断力を付与した状態で、刃部1013、1023に高周波電圧を印加することによって当該生体組織を焼灼して切開(切除)することができる。
内視鏡用高周波処置具1100は、内視鏡の鉗子孔(図示せず)に挿入して用いられ、生体組織(図示せず)に剪断力を付与するとともに高周波電圧を印加して切開する器具である。内視鏡用高周波処置具1100は、一対の鋏片1012、1022と、操作ワイヤ1030と、を備えている。一対の鋏片1012、1022には、互いに開閉可能に軸支され生体組織に剪断力を付与する刃部1013、1023をそれぞれ有している。一対の鋏片1012、1022を備える処置部1010が、内視鏡用高周波処置具1100の先端部に設けられている。処置部1010は操作ワイヤ1030により開閉駆動される。操作ワイヤ1030は、たとえば、ステンレス鋼などの導電性の金属材料で作成されている。操作ワイヤ1030は、鋏片1012、1022の基端部側に駆動力を付与して、鋏片1012、1022の先端部を開閉操作する部材である。
本実施形態におけるスペーサ部1015は、保持枠1020に完全に収容されており、側面視にてスペーサ部1015の全体が2本の腕部1016に覆われている。
即ち、本実施形態におけるスペーサ部1015は、回動軸1029の周囲以外の箇所、たとえば、リンク片1017における対向面1156(図13A、13B参照)に設けられてもよい。ただし、かかる構成では、鋏片1012、1022と腕部1016とは離間するものの、操作部1050によって操作されて鋏片1012、1022が動作したときに、鋏片1012、1022が腕部1016の方向に対して僅かにぶれる可能性がある。これに対し、スペーサ部1015が、鋏片1012、1022における対向面1154(図13A、13B参照)に設けられた態様、特には、スペーサ部1015が、回動軸1029の周囲に設けられた態様では、上述する鋏片1012、1022のぶれの可能性が顕著に低減する。保持枠1020に収容された鋏片1012、1022が、スペーサ部1015を介して腕部1016の内側面1152に実質的に連続するからである。
一対の鋏片1012、1022が操作部1050の操作により開閉方向に動作する際、固定軸である回動軸1029には一定の負荷がかかる。そのため、離間する腕部1016と鋏片1012、1022との間であって回動軸1029の周囲を連続的に取り囲む位置に厚みが略均一のスペーサ部1015が設けられることによって、回動軸1029の負荷を低減し保護することができる。
スペーサ部1015の形状は特に限定されるものではないが、円盤状をなすことによって、スペーサ部1015に回転対称性を付与することができる。これにより回動軸1029を中心にして回転方向に開閉動作する一対の鋏片1012、1022とスペーサ部1015との接触領域の面積を実質的に小さく抑えることができる。
また、例えばスペーサ部1015が鋏片1012、1022に固定された態様においてスペーサ部1015が回転対称性を有することにより、一対の鋏片1012、1022の回転方向の開閉動作下において、スペーサ部1015が腕部1016の外側に表出し難い。
このように鋏片1012の幅寸法1130に対し、充分に大きい形状のスペーサ部1015を設けることによって、単に鋏片1012、1022と腕部1016とを離間させるだけでなく、腕部1016の内側面1152とスペーサ部1015とを充分な面積で面接触させることができる。そのため鋏片1012、1022が厚み方向に揺動することが規制され、腕部1016と離間する鋏片1012、1022の配置安定性を良好に図ることができる。
一対の鋏片1012、1022の開閉動作下において、スペーサ部1015は、鋏片1012、1022と擦れることがない。そのため開閉動作する鋏片1012、1022は、スペーサ部15との接触によって鋏片1012、1022の表面に設けられた絶縁性被膜1018、1028が剥離するという虞がない。鋏片1012、1022に固定されたスペーサ部1015は、一対の鋏片1012、1022の開閉動作下において、腕部1016の内側面1152と接触する。しかし腕部1016の内側面1152は、生体組織と接触しないため、内側面1152に設けられた絶縁性被膜の一部が剥離しても、生体組織の予定されない箇所を焼灼する虞がない。もちろん、予め、内側面1152を絶縁性の材料で構成してもよい。
即ち、内視鏡用高周波処置具1100は、一対の把持片(鋏片1012、1022)の開閉動作下で、回動軸1029の軸心方向に目視(即ち側面視)される腕部1016の外縁よりも内側に、スペーサ部1015が包含されていることが好ましい。
特にかかる構成は、導電性材料で形成されたスペーサ部1015の表面に絶縁性被膜が設けられた態様において特に有効である。一対の鋏片1212、1222の開閉動作下において、スペーサ部1015と腕部1016とが擦れてスペーサ部1015の絶縁性被膜が剥離した場合であっても、剥離箇所を含むスペーサ部1015が、腕部1016の外部に表出しないため、生体組織を焼灼する虞が生じないからである。
即ち、内視鏡用高周波処置具1100は、図13A、13Bに示すように、扁平な板状体である2つのスペーサ部1015が、一対の把持片(鋏片1012、1022)を挟んで対向して配置されている。ここで回動軸1029の軸心方向における処置部の最大寸法は、対向する2つのスペーサ部1015の対向幅寸法よりも小さくなるよう構成されている。
一対の鋏片1012、1022の少なくとも一方の先端部には、生体組織を把持する爪部1014が、刃部1013、1023よりも閉じ方向に突出して形成されている。本実施形態にかかる内視鏡用高周波処置具1100は、図11、図12に示すとおり、鋏片1022の先端部に刃部1023よりも閉じ方向に突出して形成された爪部1014を有している。
次に、本発明の第六実施形態の内視鏡用高周波処置具1200について、図14A、14Bを用いて説明する。
図14Aは、組み合わせる前の第六実施形態にかかる内視鏡用高周波処置具1200における処置部1010および保持枠1020の上面図であり、(b)は第六実施形態にかかる内視鏡用高周波処置具1200の処置部1010および保持枠1020を部分的に示す上面図である。
本実施形態においてスペーサ部1015は、保持枠1020とは別体で製造されたスペーサ部1015を内側面1152の所定の位置に接着やレーザー溶接などの任意の手段で固定してもよいし、保持枠1020と一材で一体成形してもよい。
たとえば、刃部1013、1023に対し高周波電圧を印加する際、保持枠1020が導電経路に含まれない構造では、保持枠1020を樹脂など絶縁性部材で形成することができる。樹脂などの一体成形性に優れる材料で保持枠1020およびスペーサ部1015を一体形成することにより生産効率を向上させ得る。
ここで接触領域1158の軌跡が、回動軸1029の軸心方向に目視される腕部1016の外縁よりも内側に包含されることにより、絶縁性被膜1018、1028が形成された領域が保持枠1020から表出することを防止することができる。
図17Aは第七実施形態の内視鏡用鋏1100における先端処置部1010の閉鎖状態を示す平面図であり、図17Bは当該先端処置部1010の側面図である。図18は、第七実施形態の内視鏡用鋏1100における先端処置部1010の開放状態を示す側面図である。上述した第五または第六実施形態と重複する説明は適宜省略する。
先端湾曲部1060は、板状の鋏片1012、1022を面直方向に曲げ形成することにより作成することができる。より具体的には、鋏片1012、1022の中間部を面直方向に曲げ形成して曲折突部1066を形成することで、鋏片1012、1022の先端1064は、操作ワイヤ1030の延長線Lに対して斜め方向を向くこととなる。延長線Lは内視鏡用鋏1100における仮想線であり、図17Aにおいて二点鎖線で図示する。
曲折突部1066は、鋏片1012、1022のうち、先端湾曲部1060の湾曲方向と反対側(図17Aにおける下側)に形成される凸領域である。曲折突部1066における鋏片1012、1022の曲率半径は特に限定されないが、曲折突部1066において先端湾曲部1060と基端湾曲部1062とが滑らかに連続形成されていることが好ましい。本実施形態のように先端湾曲部1060を形成することで、体腔内で先端処置部1010を前進させる際に、曲折突部1066を生体組織と当接させることで、先端処置部1010の先端1064が当該生体組織と反対側を向くため、先端1064が生体組織と干渉することが抑制される。
また本実施形態では、スペーサ部1015は、鋏片1012、1022と腕部1016との間に配置された例を示した。しかし本実施形態は、鋏片1012、1022以外の処置部1010の任意の箇所(たとえばリンク片1017、1027の腕部1016の内側面1152に対向する対向面1156(図13A、13B参照)と腕部1016の内側面1152との間にスペーサ部1015が配置される態様を包含する。
また上記実施形態では、スペーサ部1015は、鋏片1012、1022における対向面1154または、腕部1016の内側面1152に固定されて配置された例を示した。しかしスペーサ部1015の態様はこれに限定されず、たとえば中央に回動軸1029が貫通するとともに処置部1010および腕部1016のいずれにも固定されない状態で、これらに挟持されてもよい。
また、本実施形態の説明では、回動軸1029の挿通する孔1029aを備え回動軸1029の周囲に連続的に配置されたスペーサ部1015の例を示した。しかし、かかる例は、スペーサ部1015の配置位置を限定するものではなく、たとえば、スペーサ部1015は、鋏片1012と腕部1016との間において回動軸1029の周囲に離散して複数設けられてもよい。
(1)内視鏡の鉗子孔に挿入して用いられて生体組織を切開する内視鏡用鋏であって、互いに対向して重ね合わされ、重ね方向に延在する回動軸により開閉可能に軸支されているとともに、前記生体組織を把持して切開する刃部をそれぞれ有する一対の鋏片と、前記鋏片の基端部側に駆動力を付与して前記鋏片の先端部を開閉操作する操作ワイヤと、を備え、一対の前記鋏片の少なくとも一方の前記先端部には、前記生体組織を把持する爪部が前記刃部よりも閉じ方向に突出して形成されており、前記一方および/または他方の前記鋏片の前記刃部には厚み方向に貫通する凹部が局所的に形成され、前記爪部および前記凹部を除く前記刃部が先基端方向に延在する平坦な線状に形成されていることを特徴とする内視鏡用鋏。
(2)前記凹部が略半円形をなしている上記(1)に記載の内視鏡用鋏。
(3)一対の前記鋏片の前記刃部の互いに対応する位置に略半円形の前記凹部が対向してそれぞれ形成されており、前記鋏片を閉じることで前記凹部が合わさって略円形の貫通孔が形成されることを特徴とする上記(2)に記載の内視鏡用鋏。
(4)前記凹部が、前記鋏片の先基端方向の中間部よりも基端側に形成されている上記(1)から(3)のいずれか一項に記載の内視鏡用鋏。
(5)一対の前記鋏片の前記一方または前記他方のいずれかの前記刃部に複数の前記凹部が先基端方向に互いに離間して並んで形成されており、他の前記刃部が連続的な線状に形成されている上記(1)から(4)のいずれか一項に記載の内視鏡用鋏。
(6)前記操作ワイヤを通じて前記鋏片に高周波電圧を印加する給電部を更に備え、前記鋏片の表面に絶縁性被覆が設けられており、前記刃部および前記凹部の内周面が前記絶縁性被覆から露出していることを特徴とする上記(1)から(5)のいずれか一項に記載の内視鏡用鋏。
(7)一対の前記鋏片は、前記凹部の形成領域よりも先端側に、前記重ね方向の一方側に湾曲する先端湾曲部を有する上記の内視鏡用鋏。
(8)一対の前記鋏片は、前記先端湾曲部よりも基端側に、前記重ね方向の他方側に湾曲する基端湾曲部を有しており、一対の前記鋏片の先端が前記操作ワイヤの延長線上に位置している上記の内視鏡用鋏。
(9)一対の前記鋏片の前記一方または前記他方の少なくともいずれかの前記刃部に複数の前記凹部が先基端方向に互いに離間して並んで形成されており、当該刃部における前記凹部の形成領域を除く他の長さ領域が連続的な線状に形成されている上記の内視鏡用鋏。
(10)前記操作ワイヤを通じて前記鋏片に高周波電圧を印加する給電部を更に備え、一対の前記鋏片の表面にそれぞれ絶縁性被覆が設けられており、前記刃部および前記凹部の内周面が前記絶縁性被覆から露出していることを特徴とする上記の内視鏡用鋏。
(11)前記絶縁性被覆がシリコン系セラミックを含む上記の内視鏡用鋏。
(12)一対の前記鋏片の表面にそれぞれ設けられた前記絶縁性被覆が互いに異なる色に着色されている上記の内視鏡用鋏。
(13)体内に挿入される可撓管に進退自在に挿通された導電性の操作ワイヤと、
回動軸により互いに開閉動作可能に軸支され導電性の刃部を備えるとともに前記刃部を除いた周面の略全面が絶縁性被膜で被覆された一対の把持片を備え前記操作ワイヤの先端部に配置された処置部と、
前記刃部に高周波電圧を印加するための接続端子と、
前記可撓管の基端部に付設され前記操作ワイヤを進退操作して前記処置部を操作し、前記把持片を開閉させる操作部と、
対向する一対の腕部の内側に前記処置部の一部を収容するとともに前記回動軸の両端を保持する保持枠と、
を有し、
前記腕部の内側面と、前記腕部に収容された前記処置部の前記腕部の前記内側面に対向する対向面と、の間に配置され、前記腕部の前記内側面と前記処置部の前記対向面とを離間させるスペーサ部を備えることを特徴とする内視鏡用高周波処置具。
(14)前記スペーサ部が、前記腕部に収容された前記把持片の前記対向面と前記腕部の内側面との間に隙間なく挟まれている上記(13)に記載の内視鏡用高周波処置具。
(15)前記処置部を挟んで2つの前記スペーサ部が対向して配置されている上記(13)または(14)に記載の内視鏡用高周波処置具。
(16)前記スペーサ部が前記回動軸の周囲に設けられている上記(13)から(15)のいずれか一項に記載の内視鏡用高周波処置具。
(17)前記スペーサ部が、扁平な板状体であって厚み方向に貫通する孔を有しており、
前記孔に前記回動軸が挿通されている上記(13)から(16)のいずれか一項に記載の内視鏡用高周波処置具。
(18)前記スペーサ部が円盤状であって、略中央に前記孔が設けられている上記(17)に記載の内視鏡用高周波処置具。
(19)前記円盤状の前記スペーサ部の外径が、前記把持片の前記回動軸が貫通する箇所の幅寸法の2分の1以上である上記(18)に記載の内視鏡用高周波処置具。
(20)前記スペーサ部が前記把持片の外周面に固定されている上記(13)から(19)のいずれか一項に記載の内視鏡用高周波処置具。
(21)一対の前記把持片の開閉動作下で、前記回動軸の軸心方向に目視される前記腕部の外縁よりも内側に、前記スペーサ部が包含されている上記(20)に記載の内視鏡用高周波処置具。
(22)扁平な板状体である2つの前記スペーサ部が、一対の前記把持片を挟んで対向して配置され、
前記回動軸の軸心方向における前記処置部の最大寸法が、対向する2つの前記スペーサ部の対向幅寸法よりも小さい上記(20)または(21)に記載の内視鏡用高周波処置具。
(23)前記スペーサ部が前記腕部の前記内側面に固定されている上記(13)から(19)のいずれか一項に記載の内視鏡用高周波処置具。
(24)前記把持片は、前記スペーサ部と接触する接触領域を有し、
開放状態と閉鎖状態とに開閉する一対の前記把持片を構成する前記把持片の前記接触領域の軌跡が、前記回動軸の軸心方向に目視される前記腕部の外縁よりも内側に包含される上記(23)に記載の内視鏡用高周波処置具。
(25)前記把持片が、薄板状の刃部を有する鋏片である上記(13)から(24)のいずれか一項に記載の内視鏡用高周波処置具。
(26)一対の前記鋏片が、厚み方向の一方側に湾曲する先端湾曲部を有する上記の内視鏡用鋏。
(27)一対の前記鋏片は、前記先端湾曲部よりも基端側に、前記厚み方向の他方側に湾曲する基端湾曲部を有しており、一対の前記鋏片の先端が前記操作ワイヤの延長線上に位置している上記の内視鏡用鋏。
(28)前記絶縁性被覆がシリコン系セラミックを含む上記の内視鏡用鋏。
(29)一対の前記把持片の表面をそれぞれ被覆する前記絶縁性被覆が互いに異なる色に着色されている上記の内視鏡用鋏。
12 第一の鋏片
22 第二の鋏片
13、23 刃部
14 爪部
15、15a~15d、25 凹部
16 貫通孔
17、27 リンク片
18、28 絶縁性被覆
19 スペーサ部
20 保持枠
26 進退部
29 回動軸
30 操作ワイヤ
40 シース
42 絶縁性被覆
50 手元操作部
52 給電部
54 指掛リング
56 スライダ
58 軸部
60 先端湾曲部
62 基端湾曲部
64 先端
66 曲折突部
67 最基端部
100 内視鏡用鋏
200 生体組織
202 粘膜層
203 病変組織
204 粘膜下層
206 筋層
210 膨出部
L 延長線
1010・・・処置部
1012、1022・・・鋏片
1013、1023・・・刃部
1014・・・爪部
1015・・・スペーサ部
1016・・・腕部
1017、27・・・リンク片
1018、1028・・・絶縁性被膜
1019・・・基端部
1020・・・保持枠
1026・・・進退部
1029・・・回動軸
1029a・・・孔
1030・・・操作ワイヤ
1040・・・シース
1041・・・コイル
1042・・・絶縁性被膜
1050・・・操作部
1052・・・接続端子
1054・・・指掛リング
1056・・・スライダ
1057・・・回転操作部
1058・・・軸部
1060 先端湾曲部
1062 基端湾曲部
1064 先端
1066 曲折突部
1067 最基端部
1100、1200、1900・・・内視鏡用高周波処置具
1110・・・段差部
1130・・・幅寸法
1152・・・内側面
1154・・・対向面
1156・・・対向面
1158・・・接触領域
1170、1260、1270・・・軸
1212、1222・・・鋏片
1910・・・腕部
1912・・・基端部
1914・・・保持枠
1920、1940・・・露出領域
L・・・延長線
Claims (27)
- 内視鏡の鉗子孔に挿入して用いられて生体組織を切開する内視鏡用鋏であって、
互いに対向して重ね合わされ、重ね方向に延在する回動軸により開閉可能に軸支されているとともに、前記生体組織を把持して切開する刃部をそれぞれ有する一対の鋏片と、
前記鋏片の基端部側に駆動力を付与して前記鋏片の先端部を開閉操作する操作ワイヤと、を備え、
一対の前記鋏片の少なくとも一方の前記先端部には、前記生体組織を把持する爪部が前記刃部よりも閉じ方向に突出して形成されており、
前記一方および/または他方の前記鋏片の前記刃部には厚み方向に貫通する凹部が局所的に形成され、前記爪部および前記凹部を除く前記刃部が先基端方向に延在する平坦な線状に形成されていることを特徴とする内視鏡用鋏。 - 前記凹部が略半円形をなしている請求項1に記載の内視鏡用鋏。
- 一対の前記鋏片の前記刃部の互いに対応する位置に略半円形の前記凹部が対向してそれぞれ形成されており、前記鋏片を閉じることで前記凹部が合わさって略円形の貫通孔が形成されることを特徴とする請求項2に記載の内視鏡用鋏。
- 前記凹部が、前記鋏片の先基端方向の中間部よりも基端側に形成されている請求項1から3のいずれか一項に記載の内視鏡用鋏。
- 一対の前記鋏片は、前記凹部の形成領域よりも先端側に、前記重ね方向の一方側に湾曲する先端湾曲部を有する請求項4に記載の内視鏡用鋏。
- 一対の前記鋏片は、前記先端湾曲部よりも基端側に、前記重ね方向の他方側に湾曲する基端湾曲部を有しており、
一対の前記鋏片の先端が前記操作ワイヤの延長線上に位置している請求項5に記載の内視鏡用鋏。 - 一対の前記鋏片の前記一方または前記他方の少なくともいずれかの前記刃部に複数の前記凹部が先基端方向に互いに離間して並んで形成されており、当該刃部における前記凹部の形成領域を除く他の長さ領域が連続的な線状に形成されている請求項1から6のいずれか一項に記載の内視鏡用鋏。
- 前記操作ワイヤを通じて前記鋏片に高周波電圧を印加する給電部を更に備え、
一対の前記鋏片の表面にそれぞれ絶縁性被覆が設けられており、
前記刃部および前記凹部の内周面が前記絶縁性被覆から露出していることを特徴とする請求項1から7のいずれか一項に記載の内視鏡用鋏。 - 前記絶縁性被覆がシリコン系セラミックを含む請求項8に記載の内視鏡用鋏。
- 一対の前記鋏片の表面にそれぞれ設けられた前記絶縁性被覆が互いに異なる色に着色されている請求項8または9に記載の内視鏡用鋏。
- 体内に挿入される可撓管に進退自在に挿通された導電性の操作ワイヤと、
回動軸により互いに開閉動作可能に軸支され導電性の刃部を備えるとともに前記刃部を除いた周面の略全面が絶縁性被膜で被覆された一対の把持片を備え前記操作ワイヤの先端部に配置された処置部と、
前記刃部に高周波電圧を印加するための接続端子と、
前記可撓管の基端部に付設され前記操作ワイヤを進退操作して前記処置部を操作し、前記把持片を開閉させる操作部と、
対向する一対の腕部の内側に前記処置部の一部を収容するとともに前記回動軸の両端を保持する保持枠と、
を有し、
前記腕部の内側面と、前記腕部に収容された前記処置部の前記腕部の前記内側面に対向する対向面と、の間に配置され、前記腕部の前記内側面と前記処置部の前記対向面とを離間させるスペーサ部を備えることを特徴とする内視鏡用高周波処置具。 - 前記スペーサ部が、前記腕部に収容された前記把持片の前記対向面と前記腕部の内側面との間に隙間なく挟まれている請求項11に記載の内視鏡用高周波処置具。
- 前記処置部を挟んで2つの前記スペーサ部が対向して配置されている請求項11または12に記載の内視鏡用高周波処置具。
- 前記スペーサ部が前記回動軸の周囲に設けられている請求項11から13のいずれか一項に記載の内視鏡用高周波処置具。
- 前記スペーサ部が、扁平な板状体であって厚み方向に貫通する孔を有しており、
前記孔に前記回動軸が挿通されている請求項11から14のいずれか一項に記載の内視鏡用高周波処置具。 - 前記スペーサ部が円盤状であって、略中央に前記孔が設けられている請求項15に記載の内視鏡用高周波処置具。
- 前記円盤状の前記スペーサ部の外径が、前記把持片の前記回動軸が貫通する箇所の幅寸法の2分の1以上である請求項16に記載の内視鏡用高周波処置具。
- 前記スペーサ部が前記把持片の外周面に固定されている請求項11から17のいずれか一項に記載の内視鏡用高周波処置具。
- 一対の前記把持片の開閉動作下で、前記回動軸の軸心方向に目視される前記腕部の外縁よりも内側に、前記スペーサ部が包含されている請求項18に記載の内視鏡用高周波処置具。
- 扁平な板状体である2つの前記スペーサ部が、一対の前記把持片を挟んで対向して配置され、
前記回動軸の軸心方向における前記処置部の最大寸法が、対向する2つの前記スペーサ部の対向幅寸法よりも小さい請求項18または19に記載の内視鏡用高周波処置具。 - 前記スペーサ部が前記腕部の前記内側面に固定されている請求項11から17のいずれか一項に記載の内視鏡用高周波処置具。
- 前記把持片は、前記スペーサ部と接触する接触領域を有し、
開放状態と閉鎖状態とに開閉する一対の前記把持片を構成する前記把持片の前記接触領域の軌跡が、前記回動軸の軸心方向に目視される前記腕部の外縁よりも内側に包含される請求項21に記載の内視鏡用高周波処置具。 - 一対の前記把持片が、薄板状の刃部をそれぞれ有する一対の鋏片である請求項11から22のいずれか一項に記載の内視鏡用高周波処置具。
- 一対の前記鋏片が、厚み方向の一方側に湾曲する先端湾曲部を有する請求項23に記載の内視鏡用鋏。
- 一対の前記鋏片は、前記先端湾曲部よりも基端側に、前記厚み方向の他方側に湾曲する基端湾曲部を有しており、
一対の前記鋏片の先端が前記操作ワイヤの延長線上に位置している請求項24に記載の内視鏡用鋏。 - 前記絶縁性被覆がシリコン系セラミックを含む請求項11から25のいずれか一項に記載の内視鏡用鋏。
- 一対の前記把持片の表面をそれぞれ被覆する前記絶縁性被覆が互いに異なる色に着色されている請求項11から26のいずれか一項に記載の内視鏡用鋏。
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US15/521,497 US20170303954A1 (en) | 2014-10-29 | 2015-10-28 | Endoscopic scissors and endoscopic high frequency treatment tool |
KR1020177010240A KR20170078616A (ko) | 2014-10-29 | 2015-10-28 | 내시경용 가위 및 내시경용 고주파 처치구 |
EP15853992.4A EP3213702A4 (en) | 2014-10-29 | 2015-10-28 | Endoscope scissors and endoscopic high-frequency treatment tool |
BR112017007856A BR112017007856A2 (pt) | 2014-10-29 | 2015-10-28 | tesouras endoscópicas e ferramenta endoscópica de tratamento de alta frequência |
CN201580057936.0A CN107106198B (zh) | 2014-10-29 | 2015-10-28 | 内窥镜用剪刀及内窥镜用高频处置器具 |
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JP2015-205864 | 2015-10-19 | ||
JP2015205865A JP6798100B2 (ja) | 2014-10-30 | 2015-10-19 | 内視鏡用高周波処置具 |
JP2015-205865 | 2015-10-19 | ||
JP2015205864A JP6763128B2 (ja) | 2014-10-29 | 2015-10-19 | 内視鏡用鋏 |
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CN111093546A (zh) * | 2017-09-11 | 2020-05-01 | 住友电木株式会社 | 高频处置器具、高频处置器具用刀及高频处置器具用前端处置器具 |
KR20200052877A (ko) * | 2017-09-11 | 2020-05-15 | 스미또모 베이크라이트 가부시키가이샤 | 고주파 처치구, 고주파 처치구용 나이프 및 고주파 처치구용 선단 처치구 |
KR102635005B1 (ko) | 2017-09-11 | 2024-02-07 | 스미또모 베이크라이트 가부시키가이샤 | 고주파 처치구, 고주파 처치구용 나이프 및 고주파 처치구용 선단 처치구 |
CN111093546B (zh) * | 2017-09-11 | 2024-05-24 | 住友电木株式会社 | 高频处置器具、高频处置器具用刀及高频处置器具用前端处置器具 |
JP2019180929A (ja) * | 2018-04-12 | 2019-10-24 | 住友ベークライト株式会社 | 高周波処置具 |
JP2019180928A (ja) * | 2018-04-12 | 2019-10-24 | 住友ベークライト株式会社 | 高周波処置具 |
JP7151143B2 (ja) | 2018-04-12 | 2022-10-12 | 住友ベークライト株式会社 | 高周波処置具 |
JP7151142B2 (ja) | 2018-04-12 | 2022-10-12 | 住友ベークライト株式会社 | 高周波処置具 |
CN111920480A (zh) * | 2018-11-01 | 2020-11-13 | 台州黄岩羽山综合门诊部 | 一种用于医疗美形的鼻骨膜剥离用仪器 |
CN111920480B (zh) * | 2018-11-01 | 2022-07-22 | 西安多来米生物科技有限公司 | 一种用于医疗美形的鼻骨膜剥离用仪器 |
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CN107106198B (zh) | 2020-05-08 |
EP3213702A1 (en) | 2017-09-06 |
EP3213702A4 (en) | 2018-07-04 |
US20170303954A1 (en) | 2017-10-26 |
KR20170078616A (ko) | 2017-07-07 |
CN107106198A (zh) | 2017-08-29 |
BR112017007856A2 (pt) | 2017-12-26 |
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