WO2018220818A1

WO2018220818A1 - Ligature aid

Info

Publication number: WO2018220818A1
Application number: PCT/JP2017/020598
Authority: WO
Inventors: 孝侑畠中
Original assignee: オリンパス株式会社
Priority date: 2017-06-02
Filing date: 2017-06-02
Publication date: 2018-12-06

Abstract

This ligature aid comprises: a mounting part that can be attached to and detached from the distal end of an endoscope; and a pair of protrusions that are formed extending from the mounting part and include, in the distal ends thereof, through-holes into which a thread can be inserted. At least one of the pair of protrusions is configured such that the distal end thereof is capable of elastically deforming to approach the distal end of the other protrusion.

Description

Ligation aid

The present invention relates to a ligation aid, and more particularly, to a ligation aid used when ligating a suture thread hung on a tissue.

Conventionally, various treatments have been performed using a flexible endoscope inserted into a luminal organ such as the digestive tract. In general, these treatments are performed by inserting an endoscope treatment tool through a channel provided in the endoscope insertion portion and projecting the distal end of the treatment tool from the distal end of the endoscope insertion portion.

One of the difficult treatments is ligation using sutures. A series of procedures of ligation includes an operation of applying a yarn to the tissue and an operation of forming a knot on the yarn so that the yarn applied to the tissue keeps applying a predetermined tension to the tissue. In general, when performing single ligation with only one knot, the end of the thread hung on the tissue is pulled out of the body and the knot is made outside the body. After that, move the knot you made into the body and ligate.

As a conventional technique related to ligation performed under an endoscope, a thread guide device attached to the distal end of the endoscope is disclosed (for example, see Patent Document 1). This yarn guide device has a pair of yarn guide means formed in a tubular shape and extending into a tube wall. Both ends of the knotted thread are passed through each thread guiding means, and the thread guiding device is attached to the distal end of the endoscope. Thereafter, when the endoscope is advanced while holding both ends of the yarn, the knot can be moved to the vicinity of the portion where the yarn is hung.

Japanese National Table No. 8-501001

In the technique described in Patent Document 1, when a knot is brought close to a tissue and temporarily ligated and then the endoscope is retracted for the main ligation, the knot may be loosened. If this ligation is performed with the knot loosened, the suture site may not be ligated properly.

In view of the above circumstances, an object of the present invention is to provide a ligation assisting tool that can be attached to an endoscope and that does not loosen the knot even if the endoscope is retracted after approaching the knot.

The present invention comprises a mounting portion that can be attached to and detached from the distal end portion of the endoscope, and a pair of projecting portions that are provided so as to protrude forward from the mounting portion and have a through-hole through which a thread can be inserted. At least one of the pair of protrusions is a ligation aid in which the tip is configured to be accessible to the tip of the other protrusion by elastic deformation.

The mounting portion may be formed in a cylindrical shape or an annular shape having a central axis, and the pair of protrusions may extend in parallel with the central axis.
At this time, the pair of protrusions may be formed so as to face each other with the central axis therebetween.

The pair of projecting portions may be configured such that the distal end portion is more easily elastically deformed than a region closer to the proximal end than the distal end portion.

The pair of protrusions may have a shape that gradually decreases in size as it approaches the tip.
At this time, the mounting portion is formed in a cylindrical shape or an annular shape having a central axis, and in the pair of projecting portions, an edge located on one side in the circumferential direction of the mounting portion is inclined with respect to the central axis. It may be located on a plane.

The ligation aid according to the present invention may further include a support member provided between the pair of protrusions.

The protrusion may have a groove extending from the through hole to the periphery of the protrusion.

The ligation aid according to the present invention may further include a threading member inserted into the through hole.

The ligation aid of the present invention can be attached to an endoscope, and even if the endoscope is retracted after the knot is brought close to the tissue, the knot is difficult to loosen.

It is a figure which shows the ligation assistance tool which concerns on 1st embodiment of this invention. It is a figure which shows one form at the time of use of the ligation aid. It is a figure which shows one form at the time of use of the ligation aid. It is a figure which shows one form at the time of use of the ligation aid. It is a figure which shows one form at the time of use of the ligation aid. It is a figure which shows the protrusion part in the modification of the ligation aid. It is a figure which shows the protrusion part in the modification of the ligation aid. It is the elements on larger scale which show the modification of the ligation aid. It is a figure which shows the protrusion part in the modification of the ligation aid. It is a figure which shows the protrusion part in the modification of the ligation aid. It is a front view which shows the ligation auxiliary tool which concerns on 2nd embodiment of this invention. It is sectional drawing in the II line | wire of FIG. It is a figure which shows one form at the time of use of the ligation aid. It is a figure which shows the modification of the ligation auxiliary tool. It is a figure which shows the modification of the ligation auxiliary tool. It is sectional drawing in the II-II line | wire of FIG. It is a figure which shows the ligation assistance tool which concerns on 3rd embodiment of this invention. It is a figure which shows one form at the time of use of the ligation aid. It is a front view which shows the ligation assistance tool in the modification of this invention. It is a figure which shows an example of the usage method of the ligation auxiliary tool which concerns on 1st embodiment.

A first embodiment of the present invention will be described with reference to FIGS. 1 to 9B.
Drawing 1 is a figure showing ligation auxiliary tool 1 of this embodiment, the left side is a front view and the right side is a side view. As shown in FIG. 1, the thread fixing device 1 includes a tubular mounting portion 10 and a pair of projecting

portions

21 and 22 extending forward from the mounting portion 10.
In the following description, the direction in which the pair of protrusions extend from the mounting portion 30 is referred to as the distal end side of the ligation aid 1, and the side opposite to the direction in which the protrusion extends is referred to as the proximal end side of the ligation aid 1.

The mounting portion 10 is formed in a tubular shape or an annular shape with resin or the like, and is configured to be detachable from the distal end portion of the endoscope. The inner diameter of the mounting portion 10 can be set as appropriate in consideration of the dimensions of the endoscope to be mounted. The mounting portion 10 does not necessarily have to be tubular or annular as long as it can be securely mounted to such an extent that it does not fall off from the endoscope by an operation in use, which will be described later. For example, it may be a C-shape or U-shape that contacts only a part of the outer periphery of the insertion portion of the endoscope.

The

protrusions

21 and 22 in the present embodiment have the same shape and size, and extend from the tip of the mounting part 10 in parallel with the central axis X1 of the mounting part 10. The dimension D1 of the

protrusions

21 and 22 in the circumferential direction of the mounting part 10 is the same from the base end connected to the mounting part 10 to the tip.

Through

holes

21a and 22a are formed at the tip portions of the

protrusions

21 and 22, respectively. Each of the

through holes

21 a and 22 a extends in a direction crossing the circumferential direction of the mounting portion 10. Since the

through holes

21a and 22a face each other across the central axis X1, the line connecting the through hole 21a and the through hole 22a passes through the central axis X1. The

protrusions

21 and 22 in which the through

holes

21a and 22a are formed also face each other across the central axis X1.

In the present embodiment, the mounting portion 10 and the projecting

portions

21 and 22 are all integrally formed of an elastically deformable resin material. Examples of the resin material include silicone and polytetrafluoroethylene (PTFE). The forming method can be exemplified by integral molding using a resin material, but the attachment portion and the protruding portion are formed separately and joined together by adhesion, welding, or the like to produce the ligation aid 1. Good.
In the ligation aid 1 of the present embodiment, both the mounting portion 10 and the protruding

portions

21 and 22 are formed to be transparent, but the mounting portion 10 is not necessarily transparent.

The operation at the time of use of the ligation aid 1 configured as described above will be described using an example of ligating a target site in the stomach.
Before using the ligation aid 1, the operator observes the target site with an endoscope using grasping forceps or the like passed through the treatment instrument channel of the endoscope and a curved needle to which a thread is connected. While threading the target part. After applying the thread, the operator removes the endoscope and the grasping forceps outside the body while holding the end of the thread that is not connected to the needle while holding the curved needle with the grasping forceps. Thereby, both ends of the thread hung on the target part are pulled out of the body.

Next, the surgeon cuts the curved needle from the thread, holds the both ends of the thread, and forms it loose enough not to tighten the desired knot. Thereafter, as shown in FIG. 2, the

end portions

101 and 102 of the thread 100 are passed through the through

holes

21a and 22a from the lumen side of the attachment portion 10, respectively.

The surgeon attaches the ligation aid 1 through the thread 100 to the tip of the endoscope. The mounting is performed by causing the endoscope to enter the mounting unit 10 from the proximal end side of the mounting unit 10. The thread 100 may be passed through the ligation aid 1 after the ligation aid 1 has been attached to the endoscope in advance.

The surgeon inserts the endoscope into the patient's body while the

end portions

101 and 102 are held so as not to move into the body, and as shown in FIG. Introduced until near. The holding of the

ends

101 and 102 may be performed by an operator or an assistant different from the operator.
When the surgeon pulls the

end portions

101 and 102, the knot approaches the target site T, and the target site is bound. Thereafter, when an operator or the like increases the pulling of the

end portions

101 and 102 to increase the tension related to the thread 100, the protruding

portions

21 and 22 through which the thread 100 is passed are elastically deformed by the tension applied to the thread 100. . As a result, as shown in FIG. 4, the tips of the

protrusions

21 and 22 are deformed so as to approach the central axis X1. By this elastic deformation, the tip portions of the

protrusions

21 and 22 provided with the through

holes

21a and 22a approach the knot 110 while approaching each other, and the target site T is suitably temporarily ligated.

The surgeon performs this ligation while maintaining the temporarily ligated state. There is no restriction | limiting in particular in the method of this ligation, A well-known method can be selected suitably. For example, once the endoscope 200 is removed, the thread 100 is removed from the ligation aid 1, a knot for the main ligation is loosely formed on the thread 100, and then the end of the thread 100 is passed through the ligation aid 1 again. Then, what is necessary is just to move the knot for this ligation to the vicinity of the object site | part T in the procedure similar to the above-mentioned. As another method, this ligation may be performed using a grasping forceps or the like protruding from the endoscope 200.
After the main ligation, when the remaining part of the thread 100 is separated from the knot and removed from the body, the single ligation of the target part T using the thread 100 is completed. Repeat the same procedure for multiple single ligations.

According to the ligation aid 1 of the present embodiment, since the pair of elastically

deformable protrusions

21 and 22 are provided, the

protrusions

21 and 22 are parallel to the central axis X1 when the thread 100 is not tensioned. The visual field of the endoscope 200 is not obstructed while maintaining the state. On the other hand, when tension is applied to the thread 100 with the knot 110 moved to the vicinity of the target site T, the pair of

protrusions

21 and 22 are elastically deformed, and through

holes

21a and 22a are formed in the

protrusions

21 and 22. The distal end is sufficiently close to the knot 110. As a result, the

protrusions

21 and 22 suitably hold the thread 100 extending from the knot 110 near the knot 110, and the knot 110 is less likely to loosen.
Further, when the endoscope 200 is retracted for the main ligation, the state in which the tip portions of the projecting

portions

21 and 22 are close to each other is maintained. For this reason, as shown in FIG. 5, the thread 100 is between the knot 110 and the

protrusions

21 and 22 and is almost parallel to the axis X <b> 1 of the insertion portion of the endoscope 200. The direction in which the thread 100 moves backward substantially coincides with the direction in which the thread 100 is pulled. With these actions, it is possible to suitably prevent the knot 110 from being loosened when the endoscope 200 is removed.

In addition, since the

protrusions

21 and 22 are formed transparently, even when the protrusions are elastically deformed and move into the field of view of the endoscope 200, the state in front of the protrusions can be grasped through the protrusions. Can be performed smoothly.

In the present embodiment, the shape of the protruding portion can be variously changed.
For example, the base end portion 21b may be formed narrower than the tip end portion provided with the through hole 21a, as in the protruding portion 21A of the modification shown in FIG. In the protruding portion 21A formed in this way, the proximal end side is more easily elastically deformed than the distal end side.

FIG. 7 shows another modification example in which the base end side is more easily elastically deformed than the distal end side. The protruding portion 21B of the modification shown in FIG. 7 has a base end portion 21b thinner than the distal end portion by reducing the dimension in the direction orthogonal to the circumferential direction of the mounting portion 10. Also in this case, in the protruding portion, the base end side is more easily elastically deformed than the distal end side.
The modification examples shown in FIGS. 6 and 7 can be appropriately used alone or in combination when it is desired to adjust the easiness (rigidity) of the elastic deformation of the protrusion to a desired value for each part. In order to make the distal end side more easily elastically deformed, the distal end side may be made thinner or thinner than the proximal end side.

Moreover, the through-hole provided in the protrusion part may be configured to facilitate threading.
In the modification shown in FIG. 8, the threading member 40 is passed through the through hole 21a. When an operator or the like passes the thread 100 through the threading member 40 and pulls out the threading member 40 from the through hole 21a, the thread 100 can be easily passed through the through hole 21a.

In the modification shown in FIGS. 9A and 9B, the through hole 21a is provided with a groove 21c extending to the periphery of the protruding portion. If it does in this way, the thread | yarn 100 can be easily passed through the through-hole 21a by approaching the thread | yarn 100 to the groove | channel 21c, and moving it in a through-hole.
It is preferable to make the width of the groove 21c slightly smaller than the diameter of the thread 100 because the thread 100 that has passed through the through hole 21a is prevented from unintentionally coming off the through hole 21a. Since the protruding portion 21 can be elastically deformed, the yarn 100 can be passed even if the width of the groove 21 c is narrower than the diameter of the yarn 100. Although the direction in which the groove 21c extends is not particularly limited, as shown in FIG. 9B, when the groove 21c extends toward the tip of the protruding portion 21, the thread is detached from the through hole 21a when the endoscope 200 is retracted. there is a possibility. Therefore, as shown in FIG. 9A, if the groove 21c extends in the circumferential direction of the mounting portion 10 or extends toward the proximal end side of the protrusion, such as extending toward the distal end, the passage through the through hole It is preferable because both ease and suppression of the yarn from coming off the through hole can be achieved.

Next, a second embodiment of the present invention will be described with reference to FIGS. The ligation aid of the present embodiment is different from the ligation aid 1 of the first embodiment in that it includes a support member that supports the knot. In the following description, components that are the same as those already described are assigned the same reference numerals and redundant description is omitted.

FIG. 10 is a front view of the ligation aid 51 of this embodiment, and FIG. 11 is a cross-sectional view taken along the line II of FIG. The ligation aid 51 includes a support member 52 provided between the protrusion 21 and the protrusion 22.

The support member 52 is a V-shaped member that is transparently formed of a resin material, glass, or the like. As shown in FIG. 11, the support member 52 is provided at the proximal end of each

protrusion

21, 22 so as to protrude toward the distal end side of the

protrusion

21, 22, that is, in the extending direction of the

protrusion

21, 22. It is fixed. Of the support member, the convex bent portion 52a is located between the through hole 21a and the through hole 22a.

Similarly to the above-described ligation assisting tool 1, the ligation assisting tool 51 of the present embodiment configured as described above is also capable of elastically deforming the protruding portion to suitably prevent loosening of the knot when the endoscope is retracted. Can do.
Further, by providing the support member 52, the knot can be pushed directly by the support member. As a result, the knot can be made sufficiently close to the tissue, and the knot can be pushed in with a smaller force, and the elastic deformation of the

protrusions

21 and 22 can be controlled more reliably.

Further, when the thread 100 is passed, the knot 110 positioned between the pair of

protrusions

21 and 22 is supported by the support member 52 so as not to be too close to the endoscope 200 as shown in FIG. . Therefore, even in a state before the protruding portion 21 is elastically deformed, it is possible to prevent a situation in which the knot is too close to the endoscope and difficult to observe.

Furthermore, since the support member 52 is formed to be transparent, it is possible to check the situation in front of the support member 52 while preventing access to the knot endoscope.

In this embodiment, the shape of the support member can be variously changed. For example, instead of the V-shape described above, a U-shape or a C-shape in which a convex portion is formed in a curved shape may be used.

Alternatively, as shown in FIG. 13, an L-shaped wire 53 may be used as a support member by disposing a part of the wire 53 between the through

holes

21a and 22a. In this case, since the wire 53 is sufficiently thin with respect to the visual field of the endoscope 200, even if the wire 53 itself is not transparent, the knot can be supported almost without obstructing the observation of the endoscope 200. The same effect as 52 is produced.

14 and 15 (FIG. 15 is a cross-sectional view taken along the line II-II in FIG. 14), and may have a shape having a window portion 54a. In this case, since the material of the support member 54 does not exist in the window portion 54a, the knot is supported by the peripheral portion of the window portion 54, and even if the support member 54 is not transparent, the endoscope 200 passes through the window portion 54a. Observation can be suitably performed.

Next, a third embodiment of the present invention will be described with reference to FIGS. The ligation aid of this embodiment differs from the ligation aid of each embodiment in the shape of the protrusions.

FIG. 16 is a side view showing the ligation aid 71 of the present embodiment. The pair of

protrusions

72 and 73 in the ligation assisting tool 71 are formed in a trapezoidal shape in a side view, and gradually become smaller as the dimension of the mounting portion 10 in the circumferential direction approaches the tip.

The

protrusions

72 and 73 are formed by cutting off one end of the cylindrical member along straight lines L1 and L2 that are inclined with respect to the central axis X1. Accordingly, in the

protrusions

72 and 73, one of the edges on both sides in the circumferential direction of the mounting portion 10 is located on the virtual plane P1 along the straight line L1, and the other is located on the virtual plane P2 along the straight line L2.

The operation when using the ligation aid 71 of the present embodiment configured as described above will be described. The ligation assisting tool 71 is mounted on the endoscope 200 and introduced to the vicinity of the target site, as in the above-described embodiments. Thereafter, by pressing one of the edges of the

protrusions

72 and 73 described above against the tissue, the

protrusions

72 and 73 are approached from an oblique direction inclined with respect to the normal line N1 of the tissue surface Ts as shown in FIG. Can be made. Since the edges of the

protrusions

72 and 73 are all on the same virtual plane, the posture after the ligation aid 71 is brought into contact with the tissue is stabilized.

Similarly to the ligation aid described in the above embodiments, the ligation aid 71 of the present embodiment can also prevent the knot from loosening when the projection is retracted by elastically deforming the protrusion. .

Further, the

protrusions

71 and 72 are gradually smaller as the circumferential dimension of the mounting portion 10 approaches the tip, that is, have a tapered shape. For this reason, the tip side of the protrusion is configured to be more easily deformed, and when tension is applied to the thread 100, the

protrusions

71 and 72 first start elastic deformation from the tip side. As a result, the base of the protrusion is prevented from being bent sharply, and the knot behavior is stabilized.

Furthermore, since the projecting

portions

72 and 73 have a tapered shape, as described above, it is easy to approach the tissue from an oblique direction. This makes it possible to tighten the knot sufficiently close to the tissue even when it is difficult to approach the tissue from the normal direction due to the narrow internal space, such as the intestine. .

In the present embodiment, as shown in FIG. 16, an example has been described in which the angle formed by the straight line L2 with respect to the central axis X1 and the angle formed by the straight line L3 with respect to the central axis X1 are substantially the same. The two angles may be different. When the two angles are made different, the angle at which the ligation assisting tool is attached to the endoscope can be changed to change the stable angle with respect to the tissue in accordance with the position of the target site. Alternatively, one edge of the protruding portion may be parallel to the central axis as in the first embodiment, and only the other edge may be formed as in the present embodiment.

The embodiments of the present invention have been described above. However, the technical scope of the present invention is not limited to the above-described embodiments, and the combination of components is changed beyond the embodiments without departing from the spirit of the present invention. It is possible to make various changes to each component or delete them.

For example, it is not always necessary to arrange the pair of projecting portions so as to sandwich the central axis of the mounting portion. Therefore, like the

protrusion parts

81 and 82 of the modification shown in FIG. 18, you may arrange | position so that it may oppose on both sides of the internal space of a mounting part.

In addition, since it is only necessary for the protruding portion to be elastically deformable at least only at the distal end side where the through hole is provided, the proximal end side is made to be rigid by, for example, forming the proximal end side from another material, so that the central axis is substantially You may comprise the base end part of a protrusion part so that it may not elastically deform so that it may approach.

Furthermore, both of the pair of protrusions do not necessarily have to be elastically deformable. If at least one of the protrusions can be elastically deformed, the distal end side of the elastically deformed projecting portion approaches the other projecting portion, thereby providing the above-described effects.

In addition, when the ligation aid of the present invention does not include the support member described in the second embodiment, the knot 110 is supported by the grasping forceps 205 or the like projected from the endoscope 200 as shown in FIG. May be.

The present invention can be applied to a ligation aid.

DESCRIPTION OF

SYMBOLS

1, 51, 71 Ligation assist tool 10 Mounting

part

21, 21A, 21B, 22, 72, 73, 81, 82

Protrusion part

21a, 22a Through- hole 21c Groove 40 Threading member
52, 54 Support member 53 Wire (support member)
40 Operation wire (operation member)
45 Control sheath (connection holding member)
200 Endoscope P1, P2 Virtual plane X1 Central axis

Claims

A mounting part detachable from the distal end of the endoscope;
A pair of projecting portions provided to project forward from the mounting portion, and having a through-hole through which a thread can be inserted at the tip portion;
With
At least one of the pair of projecting portions is configured such that the distal end portion can approach the distal end portion of the other projecting portion by elastic deformation.
Ligation aid.
The mounting portion is formed in a cylindrical or annular shape having a central axis,
The pair of protrusions extend in parallel with the central axis.
The ligation aid according to claim 1.
The ligation assisting tool according to claim 1, wherein the pair of projecting portions are configured such that the distal end portion is more easily elastically deformed than a region closer to the proximal end than the distal end portion.
The ligation assisting tool according to claim 1, wherein the pair of protrusions has a shape that gradually decreases in size as it approaches the tip.
The mounting portion is formed in a cylindrical or annular shape having a central axis,
The ligation assisting tool according to claim 4, wherein, in the pair of projecting portions, an edge located on one side in the circumferential direction of the mounting portion is located on a virtual plane inclined with respect to the central axis.
The ligation aid according to claim 2, wherein the pair of projecting portions are formed so as to face each other with the central axis therebetween.
The ligation aid according to claim 1, further comprising a support member provided between the pair of protrusions.
The ligation aid according to claim 1, wherein the protrusion has a groove extending from the through hole to a peripheral edge of the protrusion.
The ligation aid according to claim 1, further comprising a threading member inserted through the through hole.