WO2017134757A1 - 内視鏡処置具 - Google Patents
内視鏡処置具 Download PDFInfo
- Publication number
- WO2017134757A1 WO2017134757A1 PCT/JP2016/053117 JP2016053117W WO2017134757A1 WO 2017134757 A1 WO2017134757 A1 WO 2017134757A1 JP 2016053117 W JP2016053117 W JP 2016053117W WO 2017134757 A1 WO2017134757 A1 WO 2017134757A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- forceps
- sheath
- flow path
- liquid
- operation member
- Prior art date
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3478—Endoscopic needles, e.g. for infusion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00269—Type of minimally invasive operation endoscopic mucosal resection EMR
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/0034—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means adapted to be inserted through a working channel of an endoscope
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/002—Irrigation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
Definitions
- the present invention relates to an endoscope treatment tool.
- a forceps that is opened and closed by a wire is provided at the distal end of the sheath that is inserted into the channel of the endoscope, and water that is guided through a flow path in the sheath is offset to the side of the forceps.
- There is an endoscope treatment tool that sends liquid from a liquid lumen toward a target site see, for example, Patent Document 1).
- the present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide an endoscopic treatment tool capable of switching a liquid feeding state according to an open / close state of a forceps.
- One embodiment of the present invention has a conduit capable of feeding a liquid, and is disposed so as to protrude from a sheath that can be inserted into a channel of an endoscope and a distal end cover provided at the distal end of the sheath, and can be opened and closed.
- a forceps part including a pair of forceps pieces, and a forceps part connected to a proximal end of the forceps part and opened in the longitudinal direction in the duct of the distal end cover to open and retract the forceps part.
- An operation member that closes the piece, and a through hole that allows the operation member to pass therethrough.
- a gap between the through hole and the operation member constitutes a first liquid feeding hole, and a gap between the inner peripheral surface of the tip cover And a flow path forming member that constitutes a second liquid feeding hole, and abuts against the flow path forming member when the operating member is advanced to the operating member, and the first liquid feeding hole is
- An endoscopic treatment tool provided with a large-diameter portion to be closed .
- the sheath is inserted into the channel of the endoscope, and the forceps portion protruding from the distal end cover provided at the distal end of the sheath is protruded from the distal end of the endoscope, and the proximal end side of the sheath
- the pair of forceps pieces of the forceps portion can be opened and closed to treat the target site.
- the forceps piece is opened by advancing the operating member in the sheath, the large diameter portion provided in the operating member closes the first liquid feeding hole, so that the liquid flowing in the sheath
- the liquid is fed forward only from the second liquid feeding hole between the flow path forming member and the flow path forming member. That is, when the forceps piece is opened, the flow area is reduced, and the liquid can be fed at a high flow rate, so that body fluids such as blood can be efficiently washed.
- the large diameter portion provided in the operation member opens the first liquid feeding hole, so that the liquid flowing in the sheath Liquid is fed from both the first liquid feeding hole and the second liquid feeding hole. That is, when the forceps piece is closed, the flow area is increased and the liquid can be fed at a large flow rate. Moreover, even when the viscosity of the liquid is increased, for example, when local injection into the submucosa layer is performed, the liquid can be easily fed.
- the forceps portion may include a bracket that supports the forceps piece so as to be opened and closed, and the bracket may be fixed to the flow path forming member.
- the pair of forceps pieces can be easily swung by moving the operating member back and forth in the longitudinal direction of the sheath with respect to the bracket fixed to the flow path forming member.
- the operation member is disposed along the central axis of the sheath, and the flow path forming member is provided to be rotatable about the longitudinal axis of the sheath with respect to the sheath, On at least one side in a direction orthogonal to the opening / closing direction of the forceps piece, there may be a recess that is recessed inward in the radial direction and constitutes the second liquid feeding hole.
- the swing plane of the pair of forceps pieces can be rotated around the longitudinal axis of the sheath by rotating the bracket around the longitudinal axis of the sheath.
- part can be adjusted easily.
- the relative position of the second liquid feeding hole with respect to the forceps piece does not change.
- the second liquid feeding hole is constituted by a gap between the concave portion provided on at least one side in a direction orthogonal to the opening / closing direction of the forceps piece and the inner surface of the sheath, the second liquid feeding hole is obstructed by the forceps piece to be opened / closed. The liquid can be fed forward.
- the said flow-path formation member may be equipped with the said recessed part on both sides on both sides of the said through-hole.
- the forceps piece and the said operation member may consist of an electroconductive material which can flow a high frequency current.
- a forceps part can be used as a high frequency knife with the high frequency current supplied via the operation member. It is possible to switch between treatments involving gripping with forceps, cleaning with liquid feeding, local injection, or treatments involving cutting with a high-frequency knife while the endoscope treatment tool remains inserted into the endoscope channel. it can.
- the width dimension of the said opening / closing direction of the forceps piece may be smaller than the said bracket.
- the width dimension of the direction orthogonal to the said opening / closing direction of the said forceps piece may be smaller than the said bracket.
- the liquid feeding state can be switched according to the open / close state of the forceps.
- FIG. 1 is an overall configuration diagram illustrating an enlarged distal end portion of an endoscope treatment tool according to an embodiment of the present invention, with a part thereof omitted.
- FIG. 2 is an enlarged longitudinal sectional view showing a state in which a forceps piece of the endoscope treatment tool in FIG. 1 is closed.
- FIG. 2 is an enlarged longitudinal sectional view showing a state in which a forceps piece of the endoscope treatment tool in FIG. 1 is opened.
- FIG. 2 is an enlarged longitudinal sectional view showing a cross section in a direction orthogonal to an opening / closing direction of a forceps piece of the endoscope treatment tool of FIG. 1. It is a perspective view which shows the flow-path formation member with which the endoscope treatment tool of FIG. 1 is equipped.
- FIG. 7 is a front view showing a state in which the forceps portion of the endoscope treatment tool in FIG. 6 is rotated around the central axis of the sheath. It is a cross-sectional view which shows the relationship between the butting part, the flow-path formation member, and the operation member which were provided in the sheath of the endoscope treatment tool of FIG.
- An endoscope treatment tool 1 is a treatment tool in which a distal end is introduced into a body through a channel provided in an insertion portion of an endoscope, for example, as shown in FIG.
- the sheath 2 is formed into an elongated cylindrical shape that can be inserted into the channel and has flexibility, and a pair of forceps pieces 3a disposed in a state of projecting from an opening of a distal end cover 30 described later at the distal end of the sheath 2.
- a liquid feeding means 5 for feeding a liquid from the tip of the tip cover 30 via a flow path (pipe) 2a formed by the inner hole of the coil sheath 21.
- the sheath 2 includes a sheath body 20 and a distal end cover 30 fixed to the distal end of the sheath body 20.
- the sheath body 20 includes a coil sheath 21 having an inner diameter larger than the diameter of the operation member 4d, and a cylindrical resin sheath 22 that covers the outer surface of the coil sheath 21.
- the tip cover 30 is a hard member such as metal and has an outer diameter that is substantially the same as the outer diameter of the resin sheath 22.
- the tip of the tip cover 30 is provided with a hook-like portion 2b extending inward in the radial direction and reducing the diameter of the flow path 2a.
- the inner surface of the distal end cover 30 is provided with an abutting portion 2c that protrudes inward in the radial direction at a position spaced a predetermined distance from the flange portion 2b to the base end.
- the forceps portion 3 includes a bracket 3 c that supports a pair of forceps pieces 3 a by a swing shaft 3 b so as to be swingable.
- the pair of forceps pieces 3a is connected to the operation member 4d via a link mechanism 6 provided on the base end side thereof.
- the pair of forceps pieces 3a are swung around the swing shaft 3b in the opening direction.
- the width dimension in the opening / closing direction of the forceps piece 3a and the width dimension in the direction orthogonal to the opening / closing direction are both set smaller than those of the bracket 3c.
- a flow path forming member 7 having a central hole (through hole) 7a through which the operation member 4d passes is fixed integrally to the proximal end of the bracket 3c of the forceps portion 3.
- the flow path forming member 7 is formed in a disk shape having a diameter slightly smaller than the outer diameter of the resin sheath 22 and larger than the inner diameter of the flange-shaped portion 2b, and the flange-shaped portion 2b is formed on both sides of the central hole 7a.
- a concave portion 7b that is recessed to a radial position sufficiently smaller than the inner diameter is provided.
- the recess 7b has a shape in which the outer peripheral surface of the flow path forming member 7 is cut out by two planes parallel to the axis of the central hole 7a. Further, as shown in FIGS. 6 and 7, the recesses 7 b are arranged at both side positions sandwiching the bracket 3 c in a direction perpendicular to the opening / closing direction of the pair of forceps pieces 3 a supported by the bracket 3 c. Accordingly, the second liquid feed hole 8 (shown by hatching in FIGS. 6 to 8) for feeding the liquid guided through the sheath 2 forward by the gap between the inner peripheral surface of the tip cover 30 and the recess 7b. Part).
- the abutting portion 2 c protrudes to a radial position where the entire circumference is smaller than the maximum diameter of the flow path forming member 7 and larger than the concave portion 7 b.
- the flow path forming member 7 has a thickness dimension slightly smaller than the distance dimension between the flange-shaped part 2b and the abutting part 2c, and is disposed at a position sandwiched between the flange-shaped part 2b and the abutting part 2c. Has been. Thereby, the flow path forming member 7 is provided to be rotatable around the central axis of the sheath 2.
- the operation member 4d is disposed on the proximal end side with respect to the small-diameter portion 4d1 that can pass through the central hole 7a of the flow path forming member 7, and the central hole 7a. And a large-diameter portion 4d2 having a larger outer diameter.
- the 1st liquid feeding hole 9 is comprised by the clearance gap between the small diameter part 4d1 of the operation member 4d, and the center hole 7a.
- the operation member 4d, the flow path forming member 7, the link mechanism 6 and the forceps piece 3a, the coil sheath 21, the tip cover 30, the bracket 3c, and the flow path forming member 7 are electrically conductive. It is comprised with the property material.
- the operation unit 4 includes a handle 4b having a finger hooking hole 4a attached to the proximal end side of the sheath 2, and a movable unit 4c provided to be movable in the longitudinal axis direction of the sheath 2 with respect to the handle 4b.
- reference numeral 4e denotes a finger hole provided in the movable portion 4c.
- a connection port 10 that communicates with the flow path 2a of the sheath 2 is provided in the handle 4b.
- the liquid feeding means 5 is a syringe or a pump connected to the connection port 10, and a liquid such as physiological saline can be fed into the flow path 2 a of the sheath 2 by the operation of the liquid feeding means 5. Yes.
- the operation unit 4 is operated to close the forceps piece 3a as shown in FIG.
- the sheath 2 is introduced into the body from the distal end side through the channel of the insertion portion of the endoscope, and the distal end of the sheath 2 is projected from the distal end of the insertion portion of the endoscope.
- the forceps piece 3a arranged at the distal end of the sheath 2 enters the field of view of the endoscope, the operator performs the treatment while confirming the image acquired by the endoscope on the monitor.
- the forceps piece 3a can be used as a high-frequency knife.
- Such an endoscopic submucosal dissection using the endoscope treatment tool 1 according to the present embodiment will be described along the flow of the procedure as follows.
- a closed forceps piece 3a is inserted into the submucosal layer of a site that is considered to be a lesion to be excised in the endoscopic image displayed on the monitor, and a liquid such as physiological saline is injected by the liquid feeding means 5. To raise the lesion.
- the large diameter portion 4d2 of the operation member 4d opens the first liquid feeding hole 9, and the coil sheath 21 flows.
- the liquid guided to the tip in the path 2a is fed forward from both the first liquid feeding hole 9 and the second liquid feeding hole 8.
- the cross-sectional area of the flow path 2a can be widened, and a large flow rate of liquid can be fed.
- a highly viscous liquid such as hyaluronic acid is used as a liquid for raising the lesion site, the liquid can be easily fed by ensuring a wide cross-sectional area of the flow path 2a. There is an advantage.
- an initial incision is made in which holes are made in a plurality of places spaced in the circumferential direction in a part of the mucous membrane around the lesion site. Then, the forceps piece 3a in a closed state is inserted into the hole formed in the initial incision, and a high-frequency current is supplied to the forceps piece 3a through the operation member 4d, while the forceps piece a intersects the longitudinal axis. By moving in the incision direction, the mucosa around the lesion can be excised.
- the liquid feeding means 5 is operated to supply liquid into the flow path 2a of the coil sheath 21, and the bleeding site is washed away. Can be clarified to facilitate the treatment of hemostasis.
- the operator moves the movable portion 4c toward the distal end side with respect to the handle 4b of the operation portion 4 to thereby push the pressing force via the operation member 4d. Is supplied to the link mechanism 6 and is swung in a direction to open the pair of forceps pieces 3a. Then, by applying a twisting force to the operation member 4d, the flow path forming member 7, the bracket 3c, and the forceps piece 3a are rotated around the central axis of the sheath 2 with respect to the sheath 2, and the opening / closing direction of the forceps piece 3a is adjusted. be able to.
- the forceps piece 3a is rotated around the central axis of the sheath 2 while being supported by the sheath 2, the forceps piece 3a is rotated by the sheath 2 as compared with the case where the sheath 2 is rotated together.
- the opening and closing direction can be changed stably without greatly changing the position of the forceps piece 3a.
- the traction force is applied to the link mechanism 6 via the operation member 4d by moving the movable portion 4c to the proximal side with respect to the handle 4b. Then, the pair of forceps pieces 3a are swung in the closing direction. Thereby, a treatment such as grasping and removing the mucous membrane between the pair of forceps pieces 3a can be performed.
- the liquid feeding means 5 is operated to feed a liquid such as physiological saline through the flow path 2a of the coil sheath 21.
- the second liquid feeding hole 8 is formed by a gap between the concave portion 7b of the flow path forming member 7 and the inner surface of the tip cover 30, and the concave portion 7b is perpendicular to the opening / closing direction of the forceps piece 3a. Since it is arranged at a position sandwiched in the direction, the liquid fed from the second liquid feeding hole 8 is fed straight forward without being obstructed by the open forceps piece 3a. Thereby, the liquid of the target part can be more reliably washed.
- the position of the recess 7b is always arranged at a position sandwiching the bracket 3c in a direction perpendicular to the opening / closing direction of the forceps piece 3a, as shown in FIG.
- the liquid fed from the second liquid feeding hole 8 can be fed straight forward.
- the width dimension in the opening / closing direction of the forceps piece 3a and the width dimension in the direction orthogonal to the opening / closing direction are both smaller than the width dimension of the bracket 3c. Therefore, in a state where the forceps piece 3a is closed, the forceps piece 3a does not interfere with the liquid fed from the second liquid feeding hole 8, and the current density of the supplied high-frequency current is set to the forceps piece 3a. There is an advantage that the efficiency of incision can be improved when used as a high-frequency knife because it can be raised in position.
- the forceps piece 3a can be used as a high-frequency knife and a grasping forceps, and the forceps piece 3a is in a closed state or an open state. Also, it can be used for cleaning or local injection by feeding liquid forward. Therefore, in the above endoscopic submucosal dissection, it is not necessary to insert / remove a plurality of treatment tools into / from the endoscope channel, with the endoscope treatment tool 1 according to the present embodiment being inserted, There is also the advantage that treatment can be performed from beginning to end.
- the second liquid supply holes 8 are provided on both sides of the bracket 3c in a direction perpendicular to the opening / closing direction of the forceps piece 3a. Instead, only one side is provided. May be provided.
- the shape of the concave portion 7b constituting the second liquid feeding hole 8 is not limited to a shape in which the outer peripheral surface of the disk-shaped flow path forming member 7 is cut out by a flat surface, and other arbitrary shapes are adopted. Can do.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Medical Informatics (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Plasma & Fusion (AREA)
- Otolaryngology (AREA)
- Physics & Mathematics (AREA)
- Ophthalmology & Optometry (AREA)
- Cardiology (AREA)
- Surgical Instruments (AREA)
Abstract
Description
本発明は、上述した事情に鑑みてなされたものであって、鉗子の開閉状態に応じて送液状態を切り替えることができる内視鏡処置具を提供することを目的としている。
このようにすることで、流路形成部材に固定されたブラケットに対して操作部材をシースの長手方向に進退させることにより、一対の鉗子片を容易に揺動させることができる。
このようにすることで、ブラケットをシースの長手軸回りに回転させることにより、一対の鉗子片の揺動平面をシースの長手軸回りに回転させることができる。これにより、目的部位を把持する方向を容易に調節することができる。この場合に、ブラケットに固定されている流路形成部材もブラケット同時にシースの長手軸回りに回転するので、鉗子片に対する第2の送液孔の相対位置は変化しない。特に、第2の送液孔が、鉗子片の開閉方向に直交する方向の少なくとも一側に設けられた凹部とシースの内面との隙間により構成されるので、開閉される鉗子片によって妨げられることなく前方に送液を行うことができる。
このようにすることで、鉗子部を挟んだ両側からバランスよく液体を送液することができる。
このようにすることで、操作部材を介して供給した高周波電流によって鉗子部を高周波ナイフとして使用することができる。鉗子部による把持を伴う処置、送液による洗浄や局注あるいは、高周波ナイフによる切断を伴う処置を内視鏡のチャネルに対して内視鏡処置具を挿入したままの状態で切り替えて行うことができる。
また、上記態様においては、前記鉗子片の前記開閉方向に直交する方向の幅寸法が、前記ブラケットより小さくてもよい。
このようにすることで、鉗子部における高周波電流の密度を増大させることができ、切断作業を容易に行うことができる。
本実施形態に係る内視鏡処置具1は、例えば、内視鏡の挿入部に設けられたチャネルを介して先端が体内に導入される処置具であって、図1に示されるように、チャネル内に挿入可能な細長い円筒状に形成され、可撓性を有するシース2と、該シース2の先端の後述する先端カバー30の開口から突出した状態に配置された一対の鉗子片3aを有する鉗子部3と、シース2の基端側において押し引きすることにより鉗子片3aを開閉動作させる操作部4と、該操作部4により発生した張力を鉗子片3aまで伝達するワイヤ4f、操作部材4dと、コイルシース21の内孔により構成された流路(管路)2aを経由して先端カバー30の先端から液体を送液させる送液手段5とを備えている。
先端カバー30は、金属等の硬質な部材で、外径が樹脂シース22の外径と略同径に形成されている。
鉗子片3aの開閉方向の幅寸法および開閉方向に直交する方向の幅寸法は、いずれもブラケット3cよりも小さく設定されている。
そして、流路形成部材7は、鍔状部2bと突き当て部2cとの間隔寸法より若干小さい厚さ寸法を有し、鍔状部2bと突き当て部2cとの間に挟まれる位置に配置されている。これにより、流路形成部材7は、シース2の中心軸回りに回転可能に設けられている。
ワイヤ4fの基端側には図示しない電源が接続されており、操作部材4dを介して鉗子片3aに高周波電流を供給することができるようになっている。
送液手段5は、接続口10に接続されるシリンジあるいはポンプ等であり、送液手段5の作動によって生理食塩水のような液体をシース2の流路2aに送り込むことができるようになっている。
本実施形態に係る内視鏡処置具1を使用して、内視鏡的粘膜下層剥離術を行うには、操作部4を操作して、図2に示されるように、鉗子片3aを閉じた状態で、内視鏡の挿入部のチャネルを介してシース2を先端側から体内に導入していき、内視鏡の挿入部の先端からシース2の先端を突出させる。
最初に、モニタに表示された内視鏡画像において切除すべき病変と思われる部位の粘膜下層に閉じた状態の鉗子片3aを刺して、送液手段5によって生理食塩水等の液体を注入して病変部位を隆起させる。
そして、初期切開において形成しておいた穴内に閉じた状態の鉗子片3aを挿入し、操作部材4dを介して鉗子片3aに高周波電流を供給しながら、鉗子片aを長手軸に交差する所定の切開方向に移動させることにより、病変部位の周囲の粘膜を切除していくことができる。
また、病変部位の周囲の粘膜を切開する際に出血が発生した場合には、送液手段5を作動させて、コイルシース21の流路2a内に液体を供給し、出血を洗い流して出血した部位を明確にし、止血の処置を行い易くすることができる。
これにより、粘膜を把持するために鉗子片3aを開いた待機状態のままで、液体を送液して粘膜を洗浄し、確認された粘膜を、鉗子片3aによって即座に把持することができる。
また、第2の送液孔8を構成する凹部7bの形状は、円板状の流路形成部材7の外周面を平面によって切り欠いた形状のみならず、他の任意の形状を採用することができる。
2 シース
2a 流路(管路)
3 鉗子部
3a 鉗子片
3c ブラケット
4d 操作部材
4d2 大径部
7 流路形成部材
7a 中央孔(貫通孔)
7b 凹部
8 第2の送液孔
9 第1の送液孔
30 先端カバー
Claims (7)
- 送液可能な管路を有し、内視鏡のチャネル内に挿入可能なシースと、
該シースの先端に設けられた先端カバーより突出状態に配置され、開閉可能な一対の鉗子片を備える鉗子部と、
該鉗子部の基端に接続され、前記先端カバーの前記管路内において長手方向に前進させられることにより前記鉗子片を開き、後退させられることにより前記鉗子片を閉じる操作部材と、
該操作部材を貫通させる貫通孔を有し、該貫通孔と前記操作部材との隙間により第1の送液孔を構成し、前記先端カバーの内周面との隙間により第2の送液孔を構成する流路形成部材とを備え、
前記操作部材に、該操作部材が前進させられたときに前記流路形成部材に突き当たって、前記第1の送液孔を閉塞する大径部が設けられている内視鏡処置具。 - 前記鉗子部が、前記鉗子片を開閉可能に支持するブラケットを備え、
該ブラケットが、前記流路形成部材に固定されている請求項1に記載の内視鏡処置具。 - 前記操作部材が、前記シースの中心軸に沿って配置され、
前記流路形成部材が、前記シースに対して、該シースの長手軸回りに回転可能に設けられ、前記鉗子片の開閉方向に直交する方向の少なくとも一側に、径方向内方に窪み前記第2の送液孔を構成する凹部を有する請求項2に記載の内視鏡処置具。 - 前記流路形成部材が、前記貫通孔を挟んで両側に前記凹部を備える請求項3に記載の内視鏡処置具。
- 前記鉗子片および前記操作部材が、高周波電流を流すことのできる導電性材料からなる請求項1から請求項4のいずれかに記載の内視鏡処置具。
- 前記鉗子片の前記開閉方向の幅寸法が、前記ブラケットより小さい請求項1から請求項5のいずれかに記載の内視鏡処置具。
- 前記鉗子片の前記開閉方向に直交する方向の幅寸法が、前記ブラケットより小さい請求項1から請求項6のいずれかに記載の内視鏡処置具。
Priority Applications (6)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CN201680080674.4A CN108601602B (zh) | 2016-02-02 | 2016-02-02 | 内窥镜处置器具 |
PCT/JP2016/053117 WO2017134757A1 (ja) | 2016-02-02 | 2016-02-02 | 内視鏡処置具 |
EP16889247.9A EP3412227A4 (en) | 2016-02-02 | 2016-02-02 | ENDOSCOPE TREATMENT TOOL |
JP2017526712A JP6227204B1 (ja) | 2016-02-02 | 2016-02-02 | 内視鏡処置具 |
US16/046,593 US11207088B2 (en) | 2016-02-02 | 2018-07-26 | Endoscopic surgical device |
US17/529,680 US20220071649A1 (en) | 2016-02-02 | 2021-11-18 | Endoscopic surgical device |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/JP2016/053117 WO2017134757A1 (ja) | 2016-02-02 | 2016-02-02 | 内視鏡処置具 |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US16/046,593 Continuation US11207088B2 (en) | 2016-02-02 | 2018-07-26 | Endoscopic surgical device |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2017134757A1 true WO2017134757A1 (ja) | 2017-08-10 |
Family
ID=59500363
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/JP2016/053117 WO2017134757A1 (ja) | 2016-02-02 | 2016-02-02 | 内視鏡処置具 |
Country Status (5)
Country | Link |
---|---|
US (2) | US11207088B2 (ja) |
EP (1) | EP3412227A4 (ja) |
JP (1) | JP6227204B1 (ja) |
CN (1) | CN108601602B (ja) |
WO (1) | WO2017134757A1 (ja) |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2021005670A1 (ja) * | 2019-07-08 | 2021-01-14 | オリンパス株式会社 | 内視鏡用処置具 |
WO2022250002A1 (ja) | 2021-05-25 | 2022-12-01 | 清明 本間 | 内視鏡用処置具 |
JP7491720B2 (ja) | 2020-04-10 | 2024-05-28 | 清明 本間 | 内視鏡用処置具 |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN112617970B (zh) * | 2020-12-02 | 2022-03-22 | 苏州贝诺医疗器械有限公司 | 一种腹腔镜输卵管复通钳具 |
CN114795458A (zh) * | 2021-01-29 | 2022-07-29 | 奥林巴斯医疗株式会社 | 内窥镜用处置器具 |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH1147135A (ja) * | 1997-08-06 | 1999-02-23 | Olympus Optical Co Ltd | 内視鏡用処置具 |
JP2002505904A (ja) * | 1998-03-09 | 2002-02-26 | スペクトラサイエンス,インコーポレイティド | 光学的生検鉗子システム及び組織標本採取方法 |
JP2005224426A (ja) * | 2004-02-13 | 2005-08-25 | Olympus Corp | 内視鏡用処置具 |
WO2014109181A1 (ja) * | 2013-01-10 | 2014-07-17 | オリンパスメディカルシステムズ株式会社 | 手術用高周波電気外科用処置具と手術用高周波電気外科用システム |
Family Cites Families (17)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPS64888Y2 (ja) | 1984-12-26 | 1989-01-10 | ||
US6183469B1 (en) * | 1997-08-27 | 2001-02-06 | Arthrocare Corporation | Electrosurgical systems and methods for the removal of pacemaker leads |
US20050033278A1 (en) * | 2001-09-05 | 2005-02-10 | Mcclurken Michael | Fluid assisted medical devices, fluid delivery systems and controllers for such devices, and methods |
JP4068989B2 (ja) | 2003-02-20 | 2008-03-26 | オリンパス株式会社 | 高周波処置具 |
JP4315725B2 (ja) | 2003-04-17 | 2009-08-19 | オリンパス株式会社 | 高周波ナイフ |
JP2005296412A (ja) * | 2004-04-13 | 2005-10-27 | Olympus Corp | 内視鏡治療装置 |
JP4836492B2 (ja) * | 2005-05-25 | 2011-12-14 | 富士フイルム株式会社 | 高周波処置具及び高周波処置具を用いた粘膜剥離方法 |
JP4690410B2 (ja) * | 2005-08-11 | 2011-06-01 | オリンパス株式会社 | 内視鏡用処置具 |
US8372071B2 (en) | 2005-08-12 | 2013-02-12 | Fujinon Corporation | High-frequency treatment tool |
JP4692141B2 (ja) | 2005-08-12 | 2011-06-01 | 富士フイルム株式会社 | 高周波処置具 |
WO2009147605A1 (en) * | 2008-06-04 | 2009-12-10 | Koninklijke Philips Electronics N.V. | Reconstruction of dynamical cardiac spect for measuring tracer uptake and redistribution |
US20110282368A1 (en) * | 2010-05-12 | 2011-11-17 | Swayze Jeffrey S | Fistula Repair Device with Extendable Barbs and Therapeutic Cell Delivery |
JP5285122B2 (ja) * | 2011-06-09 | 2013-09-11 | オリンパス株式会社 | 内視鏡用処置具 |
EP2910212A4 (en) * | 2012-10-17 | 2016-06-22 | Olympus Corp | SCALPEL WITH HIGH FREQUENCY |
WO2014077238A1 (ja) | 2012-11-13 | 2014-05-22 | オリンパスメディカルシステムズ株式会社 | 内視鏡用処置具 |
EP3289994A4 (en) * | 2015-04-30 | 2018-12-19 | Olympus Corporation | Treatment instrument |
US10849680B2 (en) * | 2015-07-13 | 2020-12-01 | Titan Medical, Inc. | Bipolar end effector apparatus for a surgical instrument |
-
2016
- 2016-02-02 CN CN201680080674.4A patent/CN108601602B/zh active Active
- 2016-02-02 JP JP2017526712A patent/JP6227204B1/ja active Active
- 2016-02-02 EP EP16889247.9A patent/EP3412227A4/en not_active Withdrawn
- 2016-02-02 WO PCT/JP2016/053117 patent/WO2017134757A1/ja active Application Filing
-
2018
- 2018-07-26 US US16/046,593 patent/US11207088B2/en active Active
-
2021
- 2021-11-18 US US17/529,680 patent/US20220071649A1/en active Pending
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JPH1147135A (ja) * | 1997-08-06 | 1999-02-23 | Olympus Optical Co Ltd | 内視鏡用処置具 |
JP2002505904A (ja) * | 1998-03-09 | 2002-02-26 | スペクトラサイエンス,インコーポレイティド | 光学的生検鉗子システム及び組織標本採取方法 |
JP2005224426A (ja) * | 2004-02-13 | 2005-08-25 | Olympus Corp | 内視鏡用処置具 |
WO2014109181A1 (ja) * | 2013-01-10 | 2014-07-17 | オリンパスメディカルシステムズ株式会社 | 手術用高周波電気外科用処置具と手術用高周波電気外科用システム |
Non-Patent Citations (1)
Title |
---|
See also references of EP3412227A4 * |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2021005670A1 (ja) * | 2019-07-08 | 2021-01-14 | オリンパス株式会社 | 内視鏡用処置具 |
JPWO2021005670A1 (ja) * | 2019-07-08 | 2021-01-14 | ||
JP7175396B2 (ja) | 2019-07-08 | 2022-11-18 | オリンパス株式会社 | 内視鏡用処置具 |
JP7491720B2 (ja) | 2020-04-10 | 2024-05-28 | 清明 本間 | 内視鏡用処置具 |
WO2022250002A1 (ja) | 2021-05-25 | 2022-12-01 | 清明 本間 | 内視鏡用処置具 |
KR20240007259A (ko) | 2021-05-25 | 2024-01-16 | 키요아키 홈마 | 내시경용 처치구 |
Also Published As
Publication number | Publication date |
---|---|
JP6227204B1 (ja) | 2017-11-08 |
US20220071649A1 (en) | 2022-03-10 |
CN108601602A (zh) | 2018-09-28 |
CN108601602B (zh) | 2021-04-13 |
US11207088B2 (en) | 2021-12-28 |
JPWO2017134757A1 (ja) | 2018-02-08 |
EP3412227A4 (en) | 2019-09-04 |
US20180325541A1 (en) | 2018-11-15 |
EP3412227A1 (en) | 2018-12-12 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
JP6216482B1 (ja) | 内視鏡処置具 | |
JP6848025B2 (ja) | 流体移送用及び電子的外科手術用の医療装置 | |
JP6227204B1 (ja) | 内視鏡処置具 | |
JP2004275548A (ja) | 内視鏡用嘴状処置具 | |
JP5981646B2 (ja) | 2つのハーフチューブ電極を有する双極型手術器具 | |
US9526562B2 (en) | High-frequency treatment tool | |
JP4690410B2 (ja) | 内視鏡用処置具 | |
EP1948027B1 (en) | Tissue cutting devices having hemostasis capability | |
JP4965416B2 (ja) | 高周波処置具 | |
US10631924B2 (en) | High-frequency treatment tool | |
JP4624692B2 (ja) | 内視鏡用処置具 | |
JP6841029B2 (ja) | 医療用高周波処置具 | |
KR101557008B1 (ko) | 인체 내강 시술용 처치 장치 | |
WO2016013255A1 (ja) | 高周波処置具 |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
ENP | Entry into the national phase |
Ref document number: 2017526712 Country of ref document: JP Kind code of ref document: A |
|
121 | Ep: the epo has been informed by wipo that ep was designated in this application |
Ref document number: 16889247 Country of ref document: EP Kind code of ref document: A1 |
|
NENP | Non-entry into the national phase |
Ref country code: DE |
|
WWE | Wipo information: entry into national phase |
Ref document number: 2016889247 Country of ref document: EP |
|
ENP | Entry into the national phase |
Ref document number: 2016889247 Country of ref document: EP Effective date: 20180903 |