WO2020105253A1 - Outil de traitement d'endoscope - Google Patents

Outil de traitement d'endoscope

Info

Publication number
WO2020105253A1
WO2020105253A1 PCT/JP2019/036081 JP2019036081W WO2020105253A1 WO 2020105253 A1 WO2020105253 A1 WO 2020105253A1 JP 2019036081 W JP2019036081 W JP 2019036081W WO 2020105253 A1 WO2020105253 A1 WO 2020105253A1
Authority
WO
WIPO (PCT)
Prior art keywords
slider
clip
tubular body
proximal
handle
Prior art date
Application number
PCT/JP2019/036081
Other languages
English (en)
Japanese (ja)
Inventor
尚武 前久保
岸田　学
Original Assignee
株式会社カネカ
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 株式会社カネカ filed Critical 株式会社カネカ
Priority to JP2020558114A priority Critical patent/JP7348204B2/ja
Publication of WO2020105253A1 publication Critical patent/WO2020105253A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips

Definitions

  • the present invention relates to an endoscopic treatment tool used for grasping an object to be treated such as a lesion under an endoscope.
  • ESD endoscopic submucosal dissection
  • EMR Mucosal resection
  • a clip is used for hemostasis of a wound after excising a lesion or for ligating to pinch and close the wound.
  • the opening and closing of the clip arranged on the distal side of the endoscopic treatment instrument is controlled by the operation of the handle arranged on the proximal side of the endoscopic treatment instrument.
  • Patent Document 1 discloses an instrument for operating a clip by pushing a handle and returning it.
  • a clip attached to the distal end of the treatment object is grasped by operating a handle on the proximal side, and then the clip is detached from the endoscopic treatment instrument to grasp the treatment object.
  • the clip can be placed in the body. Conventionally, such an operation has been performed by the surgeon sensing a subtle difference in resistance caused by movement of the clip with a hand holding a handle. Therefore, it may be difficult for the surgeon to properly operate the clip. For example, the grip position of the clip may deviate from the intended position, or the clip may be unintentionally released. In addition, when hemostasis is performed, speed is required, so it is necessary to perform an accurate clip operation.
  • the present invention has been made in view of the above circumstances, and an object thereof is to provide an endoscopic treatment tool that can appropriately control the position in the perspective direction of a connecting portion to which a clip is attached by operating a handle on the hand side. To provide.
  • the endoscopic treatment tool of the present invention which has been able to solve the above-mentioned problems includes a tubular body, and a wire rod which is disposed in the inner cavity of the tubular body and has a connecting portion at a distal end portion for connecting a clip.
  • An endoscope treatment tool having a tubular body and a handle provided on the proximal side of the wire rod, wherein the handle includes a handle body to which a proximal end portion of the tubular body is connected, and a proximal portion of the wire rod. It has a slider that is connected to the end and can move in the perspective direction with respect to the handle body, and the connector can be housed in the cylinder by pulling the slider from the distal side to the proximal side.
  • the endoscopic treatment instrument of the present invention preferably further satisfies the following [Condition 3] and [Condition 4].
  • [Condition 3] With the 0th stop point located distal to the 1st stop point, and with no clip attached to the connecting portion of the endoscopic treatment tool, the slider should be directed toward the proximal side. By pulling with the slider, at least a part of the slider abuts at least a part of the handle body at the 0th stop position within the movable range of the slider to stop the movement of the slider in the proximal direction. The traction force is applied to release the stop and the slider moves in the proximal direction.
  • the connecting portion When the slider is located at the 0th stop position, the connecting portion is located on the distal side of the distal end of the tubular body.
  • the endoscopic treatment tool of the present invention preferably further satisfies the following [Condition 5] and [Condition 6].
  • the slider is directed to the proximal side in the state where the third stop point is located closer to the proximal side than the second stop point and no clip is attached to the connecting portion of the endoscopic treatment tool.
  • the slider By pulling the slider, at least a part of the slider abuts at least a part of the handle body at the third stop position within the movable range of the slider, and the movement of the slider in the proximal direction is stopped.
  • the entire connecting portion is housed in the cylinder.
  • an opening / closing adjustment section in which the clip is opened / closed by adjusting the perspective position of the slider on the proximal side of the secondary stop position.
  • the proximal end of the clip is inside the tubular body, and the distal end of the clip is distal to the distal end of the tubular body.
  • a connection release position where the connection between the clip and the connection portion is released by pulling the slider is present on the proximal side of the opening / closing adjustment section.
  • the endoscopic treatment tool further includes an outer cylindrical body having a cylindrical body arranged in the inner cavity.
  • the outer cylinder is slidable in a specific range with respect to the cylinder, the slider is arranged between the primary stop position and the secondary stop position, and the outer cylinder is farthest from the cylinder.
  • the outer tube body contains the clip when moved to the position, and the distal end of the clip is exposed from the outer tube body when the outer tube is moved to the most proximal position with respect to the tube body. ..
  • Each stop point described above can be realized by providing a convex portion or a concave portion on the surfaces where the handle body and the slider face each other.
  • a handle body side convex portion is provided on a surface of the handle body facing the slider
  • a slider side convex portion is provided on a surface of the handle body facing the handle body. It is preferable that the contact portion and the slider-side protrusion contact each other. Further, at least one of the handle body-side protrusions may be replaced with a recess, or at least one of the slider-side protrusions may be replaced with a recess.
  • the endoscopic treatment tool of the present invention includes a tubular body, a wire arranged in an inner cavity of the tubular body, and having a connecting portion for connecting a clip at a distal end, and a tubular body and a proximal side of the wire.
  • An endoscopic treatment tool having a handle provided, wherein the handle has a handle body to which a proximal end portion of a tubular body is connected and a handle body to which a proximal end portion of a wire is connected.
  • the handle has a slider that can move in the perspective direction, a first locking portion and a second locking portion that restrict movement of the slider in the perspective direction, and the slider is locked by the first locking portion.
  • the endoscope treatment tool configured as described above further includes an outer cylindrical body in which the cylindrical body is arranged in the inner cavity.
  • the outer cylinder is slidable in a specific range with respect to the cylinder, and has a position when the slider is locked by the first locking portion and a position when the slider is locked by the second locking portion. Position and the outer cylinder is moved most distally with respect to the cylinder, the outer cylinder contains the clip and the outer cylinder is positioned most proximally with respect to the cylinder. When moved to, the clip is preferably exposed from the outer cylinder.
  • the handle on the proximal side is composed of the handle body and the slider, and by moving the slider in the perspective direction with respect to the handle body, the perspective position of the connecting portion for connecting the clip. Can be adjusted. Since the handle is provided with a predetermined stop position within the movable range of the slider, depending on the position of the connection part in the perspective direction, the operator can use the stop position when operating the slider as a guide. The position in the perspective direction can be controlled appropriately. Therefore, the clipping operation of the clip attached to the connecting portion becomes easy.
  • FIG. 1 shows an example of an overall view of an endoscopic treatment tool according to an embodiment of the present invention, showing a state in which a clip is attached to a connecting portion of a wire and exposed from a distal end of a tubular body.
  • a clip is not attached to the connecting portion of the wire and the connecting portion is arranged inside the cylinder.
  • FIG. 6 illustrates an example of a side view of the distal end of a clip and wire.
  • 4 represents a perspective view of the distal end of the wire shown in FIG. 3.
  • 5A shows an example of a side view of the handle
  • FIG. 5A shows a state where the slider is at the primary stop point
  • FIG. 5B shows a state where the slider is at the secondary stop point.
  • FIG. 6A shows an example of a side view of the distal end portion of the endoscopic treatment tool when the slider is at the primary stop point
  • FIG. 6B shows that the slider is at the secondary stop point
  • FIG. 3A shows an example of a side view of the distal end portion of the endoscopic treatment tool when in FIG.
  • FIG. 7A shows an example of a distal end portion of an endoscopic treatment instrument having an outer tubular body
  • FIG. 7A shows a cross-sectional view of a state where a clip is arranged in the outer tubular body
  • FIG. 7B shows an outer tubular body.
  • FIG. 3 is a side view of the clip exposed from the body.
  • FIG. 8A shows an example of a side view of the handle
  • FIG. 8A shows an example of a side view of the handle
  • FIG. 8A shows a state where the slider is at the 0th stop point
  • FIG. 8B shows a state where the slider is at the third stop point
  • FIG. 9A shows an example of a side view of the distal end portion of the endoscopic treatment tool when the slider is at the 0th stop position
  • FIG. 9B shows the slider at the 3rd stop position
  • FIG. 3A shows an example of a side view of the distal end portion of the endoscopic treatment tool when in FIG.
  • FIG. 6 illustrates an example of a cross-sectional view taken along the perspective direction of the handle. In the handle shown in FIG. 10, a sectional view showing the handle body and the slider separately is shown.
  • the endoscopic treatment tool of the present invention includes a tubular body, a wire arranged in an inner cavity of the tubular body, and having a connecting portion for connecting a clip at a distal end, and a tubular body and a proximal side of the wire. And a handle provided.
  • the handle has a handle body and a slider. By moving the slider in the perspective direction with respect to the handle body, the wire can be moved in the perspective direction with respect to the tubular body.
  • the slider can be moved in the proximal direction to operate the clip tightening mechanism to clip the treatment target.
  • the endoscopic treatment tool of the present invention is provided with a stop position of the slider when the slider is pulled proximally with respect to the handle body as described above, whereby the clip operation by the endoscopic treatment tool is performed. Can be performed easily and appropriately.
  • the endoscopic treatment tool 1 includes a tubular body 2, a wire rod 3 disposed in an inner cavity of the tubular body 2, and having a connecting portion 4 at a distal end portion for connecting the clip 21, a tubular body 2, and a wire rod 3. And a handle 7 provided on the proximal side of the.
  • the handle 7 has a handle body 8 and a slider 9 that is movable in the perspective direction with respect to the handle body 8.
  • the perspective direction refers to the long axis direction of the tubular body 2 or the wire 3
  • the proximal side in the perspective direction refers to the direction toward the user, that is, the operator's hand side
  • the distal side refers to the proximal side.
  • the opposite direction that is, the direction toward the treatment target side.
  • the clip 21 When performing the operation with the endoscopic treatment tool 1, as shown in FIG. 3, the clip 21 is connected to the connection portion 4 provided at the distal end portion of the wire rod 3 to move the wire rod 3 inside the tubular body 2.
  • the endoscopic treatment tool 1 placed in the cavity is inserted into the forceps channel of the endoscope.
  • the clip 21 When inserting the endoscopic treatment tool 1 into the forceps channel, it is preferable that the clip 21 is in a non-clipping state.
  • the wire 3 to which the clip 21 is connected is conveyed to near the object to be treated through the forceps channel, and then the slider 9 of the handle 7 on the proximal side is operated to control opening / closing of the clip 21 provided on the distal side.
  • the treatment target can be gripped by the clip 21.
  • the clip 21 is used for sealing an object during endoscopic treatment, and for pinching the object for hemostasis, suturing, ligation, and marking.
  • the clip 21 is preferably formed such that the distal portion can be opened and closed with the proximal portion as a fulcrum.
  • the proximal end portion of the clip 21 preferably has a shape capable of being connected to the connecting portion 4 at the distal end portion of the wire 3.
  • the cylindrical body 2 has the wire 3 arranged inside, and the proximal end is connected to the handle body 8.
  • the cylinder 2 and the handle body 8 may be connected so as not to move or may be connected rotatably. It is desirable that the tubular body 2 has both a flexibility that bends along the shape of the body cavity and a rigidity that surely reaches the treatment target portion in a well-balanced manner.
  • the barrel 2 is preferably made of a biocompatible material.
  • the tubular body 2 is formed of, for example, a tubular body formed of a coil-shaped metal or synthetic resin, a tubular body in which a plurality of short tubular joint pieces are connected in a perspective direction to be rotatable, and a synthetic resin. A cylinder is mentioned.
  • the wire 3 has a connecting portion 4 for connecting the clip 21 at the distal end, and the proximal end of the wire 3 is connected to the slider 9 of the handle 7.
  • the wire 3 is configured, for example, by providing the connecting portion 4 on the distal side of the linear object 5. It is desirable that the linear object 5 has both a flexibility that bends along the shape of the body cavity and a rigidity that surely reaches the treatment target portion in a well-balanced manner.
  • the linear object 5 is preferably composed of a material having biocompatibility, for example, a metal wire material such as stainless steel or carbon steel, a polyamide resin (for example, nylon), a polyolefin resin (for example, polyethylene or polypropylene).
  • a thread formed from a synthetic resin such as a polyester resin (for example, PET), an aromatic polyether ketone resin (for example, PEEK), a polyimide resin, a fluororesin (for example, PTFE, PFA, ETFE) can be used.
  • the wire 3 may be a composite of a plurality of materials.
  • the linear object 5 may be a composite of metal and synthetic resin. Further, the linear object 5 may have a configuration in which a wire-shaped base material is coated.
  • the connection part 4 is a part of the wire 3 to which the clip 21 is connected.
  • the connecting portion 4 may be provided as a separate body from the linear object 5, or the distal end portion of the linear object 5 may be formed as the connecting portion 4.
  • the connecting portion 4 has a shape that can be connected to the clip 21, and various shapes can be selected as long as the clip 21 and the connecting portion 4 can be connected to each other. For example, as shown in FIGS. 3 and 4, by providing a claw at the proximal end of the clip 21 and an opening at the connecting portion 4, the claw provided at one side and the other opening can be engaged with each other, or both It is possible to connect the claws so that the claws are engaged with each other.
  • the connecting portion 4 is preferably made of a biocompatible material, for example, stainless steel such as SUS303, SUS304, SUS631, or a Ni—Ti alloy.
  • a biocompatible material for example, stainless steel such as SUS303, SUS304, SUS631, or a Ni—Ti alloy.
  • polyamide resin for example, nylon
  • polyolefin resin for example, polyethylene or polypropylene
  • polyester resin for example, PET
  • aromatic polyetherketone resin for example, PEEK
  • polyimide resin for example, fluororesin (for example, PTFE, It may be formed of a synthetic resin such as PFA or ETFE).
  • the size of the connecting portion 4 can be appropriately set according to the size of the clip 21 connected to the connecting portion 4, the outer diameter of the wire 3, the inner diameter of the tubular body 2, and the like.
  • the outer diameter of the connecting portion 4 can be set in the range of 0.3 mm or more and 2.0 mm or less, and the length in the perspective direction of the connecting portion 4 is set in the range of 3.0 mm or more and 6.0 mm or less. be able to.
  • the clip 21 is preferably composed of a clip body 22 and a tightening ring 23.
  • the clip body 22 is configured such that the distal side thereof can be opened and closed with the proximal side as a fulcrum, and the tightening ring 23 is provided so as to surround the periphery of the proximal portion of the clip body 22.
  • the wire 21 is further moved to the proximal side with respect to the tubular body 2 to disengage the clip 21 from the connection portion 4, and the clip 21 is inserted in the body while the treatment target is clipped. Can be placed in.
  • the clip body 22 is formed, for example, by bending a single metal plate into a U-shape or a V-shape, or by connecting two metal plates facing each other.
  • the clip body 22 and the tightening ring 23 are preferably made of a material having high elasticity and biocompatibility.
  • stainless steel such as SUS301, SUS303, SUS304, and SUS631 or a metal such as Ni—Ti alloy or a synthetic material. It is preferably composed of a resin.
  • the sizes of the clip body 22 and the tightening ring 23 may be appropriately set according to the size of the connecting portion 4 to which the clip 21 is connected, the inner diameter of the tubular body 2, and the like.
  • the clip body 22 preferably has a length in the perspective direction of, for example, 7.0 mm or more and 20.0 mm or less in the closed state of the clip 21, and at least one of the clip body 22 in the closed state of the clip 21. It is preferable that the portion is formed so as to be accommodated in the tubular body 2.
  • the fastening ring 23 preferably has a length in the perspective direction of, for example, 0.5 mm or more and 3.0 mm or less.
  • the outer diameter of the tightening ring 23 is preferably larger than the inner diameter of the tubular body 2, and the inner diameter of the tightening ring 23 is preferably smaller than the outer diameter of the tubular body 2.
  • the endoscopic treatment instrument 1 further includes an outer cylindrical body 6.
  • the tubular body 2 is arranged in the inner cavity of the outer tubular body 6 and that the outer tubular body 6 is slidable with respect to the tubular body 2 in a specific range.
  • the outer tubular body 6 is located at a position where the distal end of the outer tubular body 6 is on the distal side of the distal end of the tubular body 2 and on the proximal side of the distal end of the tubular body 2. It is preferable to be formed so as to be movable in a perspective direction between the position and the position. Further, in order to allow such a moving operation to be performed on the proximal side of the endoscopic treatment instrument 1, it is preferable that the outer tubular body 6 extends to the proximal portion of the tubular body 2.
  • the outer tube body 6 is preferably formed so that the clip 21 can be inserted into and taken out from the outer tube body 6 in a state where the clip 21 is connected to the connecting portion 4 at the distal end of the wire 3.
  • This allows the endoscope treatment tool 1 to be inserted into the forceps channel from the forceps opening of the endoscope with the clip 21 housed in the outer cylinder 6.
  • the clip 21 cannot be clipped, and while the clip 21 is transported to the vicinity of the treatment target portion, the clip 21 is moved by the outer cylindrical body 6 to a forceps channel in the endoscope or a body tissue other than the lesioned portion. It is possible to prevent damage to the etc.
  • the outer cylindrical body 6 has both a flexibility that bends along the shape of the body cavity and a rigidity that surely reaches the tissue to be treated in a well-balanced manner.
  • the outer tubular body 6 is preferably made of a biocompatible material.
  • a tubular body formed of synthetic resin a tubular body formed of coil-shaped metal or synthetic resin, or a short tubular joint. It can be configured by a cylindrical body in which a plurality of pieces are connected in the axial direction so as to be rotatable.
  • a tubular body made of synthetic resin is preferably used, and the outer tubular body 6 can be visually checked by the user so that the positional relationship between the outer tubular body 6 and the tubular body 2 can be visually confirmed.
  • Examples of the synthetic resin forming the tubular body 2 and the outer tubular body 6 include polyamide resin such as nylon, polyolefin resin such as polypropylene (PP) and polyethylene (PE), polyester resin such as polyethylene terephthalate (PET), and polyether.
  • Aromatic polyether ketone resin such as ether ketone (PEEK), polyimide resin, polytetrafluoroethylene (PTFE), tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer (PFA), ethylene-tetrafluoroethylene copolymer (ETFE)
  • PEEK ether ketone
  • PEEK polyimide resin
  • PTFE polytetrafluoroethylene
  • PFA tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer
  • ETFE ethylene-tetrafluoroethylene copolymer
  • fluororesins can be used. From the viewpoint of slipperiness, it is preferable that the synthetic
  • the handle 7 has a handle body 8 and a slider 9 movable in a perspective direction with respect to the handle body 8.
  • the handle body 8 and the slider 9 can be composed of one or more members.
  • the constituent materials of the handle body 8 and the slider 9 include polyolefin resins such as polypropylene (PP) and polyethylene (PE), polyester resins such as polyethylene terephthalate (PET), synthetic resins such as polycarbonate resins, ABS resins and polyurethane resins. Can be used.
  • the handle body 8 is connected to the proximal end portion of the tubular body 2, the slider 9 is connected to the proximal end portion of the wire rod 3, and the slider 9 is moved in the perspective direction with respect to the handle body 8 to move the wire rod.
  • 3 can be moved in the perspective direction with respect to the tubular body 2. Specifically, by moving the slider 9 proximally with respect to the handle body 8, the wire 3 can be moved in the proximal direction with respect to the tubular body 2, and the slider 9 with respect to the handle body 8.
  • the wire 3 can be moved in the distal direction with respect to the tubular body 2 by moving the wire 3 toward the distal side.
  • the endoscope treatment tool 1 can accommodate the connecting portion 4 provided at the distal end portion of the wire 3 in the tubular body 2 by pulling the slider 9 from the distal side toward the proximal side.
  • the fact that the slider 9 can move in the perspective direction with respect to the handle body 8 includes that the positions of the slider 9 and the handle body 8 in the perspective direction can be relatively changed.
  • the slider 9 is preferably slidable in the perspective direction with respect to the handle body 8.
  • the position of the connecting portion 4 in the perspective direction is appropriately controlled before or after gripping the treatment target with the clip 21.
  • the clip 21 is positioned at the distal end of the tubular body 2 or in the vicinity thereof. Is preferred.
  • the gripping operation of the treatment target can be started immediately after the clip 21 is transported to the treatment target.
  • the distance for pulling the wire 3 toward the proximal side does not become excessively long before the operation of closing the clip 21 is performed, so that the position of the clip 21 in the perspective direction can be prevented from largely deviating from the treatment object. it can. Therefore, it becomes easy to grip a desired portion of the treatment target with the clip 21.
  • the operator can sense that the clip 21 is at or near the point where the clip 21 starts to close while operating the handle 7. This facilitates careful pulling of the slider 9 proximally when closing the clip 21 and gripping the treatment target.
  • the endoscopic treatment tool 1 is configured such that when the slider 9 of the handle 7 is pulled proximally, the movement of the slider 9 in the proximal direction stops at a predetermined stop position.
  • the predetermined stop point corresponds to the clip 21 being located at the distal end of the tubular body 2 or in the vicinity thereof in a state where the clip 21 is attached to the connecting portion 4 of the wire rod 3.
  • the endoscopic treatment tool 1 is preferably configured to satisfy the following conditions 1 and 2, which will be described with reference to FIGS. 5 and 6.
  • FIG. 5 (a) shows a state where the slider 9 is stopped at the first stop position of the following condition 1
  • FIG. 5 (b) shows that the slider 9 is stopped at the second stop position of the following condition 1.
  • the state is shown.
  • the stopping position of the slider 9 is represented by the position of the proximal end of the slider 9 in the perspective direction.
  • FIG. 6A shows the positional relationship between the connecting portion 4 and the cylindrical body 2 when the slider 9 is at the primary stop position, together with the state of the clip 21, and FIG. The positional relationship between the connecting portion 4 and the tubular body 2 when the slider 9 is at the secondary stop position is shown together with the state of the clip 21.
  • the slider 9 is stopped from moving in the proximal direction by coming into contact with at least a part of the slider 9, and the slider 9 is moved in the proximal direction by releasing the stop by applying a pulling force of a predetermined amount or more to the slider 9.
  • the primary stopping point 11 and the secondary stopping point 12 can function as a signal notifying that the clip 21 is in the proper position when the operator performs the treatment with the endoscopic treatment tool 1.
  • the operator pulls the slider 9 to the proximal side the operator can detect the primary stop point 11 and the secondary stop point 12 by hand while operating the handle 7, and thus the clip 21 can be properly adjusted. It can be set to a proper position and the clip 21 can be operated appropriately.
  • the operation of pulling the slider 9 to the proximal side can be regarded as the operation of pushing the handle body 8 to the distal side.
  • the primary stop point 11 can be made to function as a signal notifying that the clip 21 is in the position suitable for the standby state before performing the gripping operation by the clip 21.
  • the standby state is a state in which the grip operation with the clip 21 can be performed immediately.
  • the clip 21 is removed from the tubular body 2. It can be located at or near the end.
  • the entire connecting portion 4 may be housed in the tubular body 2, and in this case, the distal end of the connecting portion 4 is, for example, the proximal side from the distal end of the tubular body 2.
  • all of the clip 21 is on the distal side of the distal end of the tubular body 2, or It is preferable that only a part of 21 is accommodated in the cylindrical body 2.
  • the position of the clip 21 in the standby state may be the primary stop point 11 or a section between the primary stop point 11 and the secondary stop point 12.
  • the slider 9 can be pulled toward the proximal side to bring the clip 21 into the standby state when the slider 9 stops at the primary stop point 11, and in the latter case, the slider 9 can be further moved. Can be pulled toward the proximal side, and the clip 21 can be in the standby state in the range from the primary stop point 11 to the secondary stop point 12.
  • the endoscopic treatment tool 1 When performing an operation with the endoscopic treatment tool 1, it is possible to insert the endoscopic treatment tool 1 into the forceps channel of the endoscope while the clip 21 is in the standby state and convey the clip 21 to the vicinity of the treatment object. preferable. At this time, it is preferable that the clip 21 be transported to the vicinity of the treatment target while maintaining the position in the standby state. As a result, the gripping operation of the treatment target can be started immediately after the clip 21 is transported to the treatment target. From such a point of view, it is preferable that the clip 21 is in a standby state in a range beyond the primary stop point 11 and reaches the secondary stop point 12. This makes it easier to maintain the clip 21 in the standby state until the clip 21 is transported near the treatment target.
  • the length in the perspective direction from the primary stop point 11 to the secondary stop point 12 can be appropriately set according to the length and shape of the clip 21 in the perspective direction, and is preferably 1.0 mm or more, for example. It is more preferably 0.5 mm or more, preferably 5.0 mm or less, and more preferably 4.0 mm or less.
  • the clip 21 can be put in and taken out from the distal end of the outer tubular body 6. This will be described with reference to FIG. 7.
  • the body 6 contains the clip 21 and the outer cylinder 6 is moved to the most proximal position with respect to the cylinder 2, the distal end of the clip 21 is separated from the outer cylinder 6 as shown in FIG. 7B. It is preferable to expose.
  • the clip 21 is protected by the outer tubular body 6 while being transported through the forceps channel of the endoscope to the vicinity of the treatment target portion, and the clip 21 is also protected by the forceps channel in the endoscope. It is possible to prevent damage to internal tissues other than the lesion.
  • the outer cylinder 6 is pulled toward the proximal side of the endoscopic treatment tool 1 to expose the clip 21 from the outer cylinder 6, and the operation by the clip 21 is performed. It can be performed.
  • the clip 21 may be removable at the primary stop point 11 from the distal end of the outer tubular body 6 as described above, and may be disposed between the primary stop point 11 and the secondary stop point 12. Then, it may be possible to take it in and out from the distal end of the outer tubular body 6. Further, when the slider 9 is arranged on the distal side of the primary stop location 11, the clip 21 may be able to be taken in and out from the distal end of the outer tubular body 6.
  • the secondary stop point 12 can be made to function as a signal notifying that the clip 21 is in a position suitable for starting a gripping operation.
  • the entire connecting portion 4 is housed in the tubular body 2.
  • the proximal portion of the clip 21 is moved to the tubular body 2. It can be accommodated inside and the distal portion can be extended distally from the distal end of the barrel 2. That is, when the slider 9 is located at the secondary stop point 12, it is preferable that only a part of the clip 21 is accommodated in the tubular body 2 with the clip 21 attached to the connecting portion 4. .
  • the proximal end of the tightening ring 23 is the distal end of the tube body 2 when the slider 9 is located at the secondary stop point 12. It is preferably in contact with the end.
  • the distal end of the connecting portion 4 is preferably positioned within 5.0 mm proximally from the distal end of the tubular body 2, for example.
  • the secondary stop point 12 preferably functions as a standard position at which the clip 21 starts to close when the slider 9 is pulled proximally. As a result, the operator can carefully pull the slider 9 to the proximal side on the proximal side of the secondary stop point 12, and it is possible to more appropriately perform the grasping operation of the treatment target. ..
  • the traction force F 1 required to tow the slider 9 on the proximal side of the first pause position 11, the traction force F 2 required to drive the slider 9 on the proximal side of the second pause position 12 May be the same as or different from each other.
  • the traction force F 0-1 required to tow the slider 9 proximally in a section adjacent the distal side of the first pause position 11 is preferably the less than tractive force F 1
  • the traction force F 1-2 required to pull the slider 9 proximally in the section that is proximal to the next stop point 11 and is adjacent to the distal side of the second stop point 12 is the traction force. It is preferably smaller than F 2 .
  • the traction force F 1-2 is preferably smaller than the traction force F 1 .
  • the clip 21 is opened and closed by adjusting the perspective position of the slider 9 to the proximal side of the secondary stop point 12. It is preferable that there is an opening / closing adjustment section. In the opening / closing adjustment section, since the opening degree of the clip 21 can be reversibly adjusted, it is possible to set the gripping position of the treatment target by the clip 21 more accurately. In addition, in the opening / closing adjustment section, it is preferable that the proximal end of the clip 21 exists inside the tube body 2 and the distal end of the clip 21 exists on the distal side of the distal end of the tube body 2. Accordingly, by adjusting the perspective position of the slider 9, the opening degree of the clip 21 can be adjusted.
  • connection release position where the connection between the clip 21 and the connection portion 4 is released by pulling the slider 9 is present on the proximal side of the opening / closing adjustment section.
  • FIG. 8A shows a state in which the slider 9 is stopped at the 0th stop position under the following condition 3, and FIG. 9A shows a connecting portion when the slider 9 is at the 0th stop position.
  • the positional relationship between 4 and the cylindrical body 2 is shown together with the state of the clip 21.
  • the stopping position of the slider 9 is represented by the position of the proximal end of the slider 9 in the perspective direction.
  • the 0th stop 10 is present on the distal side of the 1st stop 11, and the slider 9 is not attached to the connecting portion 4 of the endoscopic treatment instrument 1 when the clip 21 is attached.
  • the slider 9 By pulling toward the proximal side, at least part of the slider 9 abuts at least part of the handle body 8 at the 0th stop point 10 within the movable range of the slider 9 so that the slider 9 moves in the proximal direction. Is stopped, and the slider 9 is moved in the proximal direction by releasing the stop by applying a traction force of a predetermined amount or more to the slider 9.
  • the 0th stop portion 10 When the clip 21 is attached to the connecting portion 4 before the endoscopic treatment tool 1 is inserted into the forceps channel of the endoscope, the 0th stop portion 10 is suitable for the connecting portion 4. It can act as a signal that you are in position.
  • the 0th stop point 10 also functions as a stopper that prevents the wire rod 3 from moving in the proximal direction when the clip 21 is attached to the connection portion 4, and facilitates the work of attaching the clip 21 to the connection portion 4.
  • the connecting portion 4 is present on the distal side of the distal end of the tubular body 2.
  • the entire connecting portion 4 may be present on the distal side of the distal end of the tubular body 2, and only a part of the connecting portion 4 may be placed on the distal side of the distal end of the tubular body 2.
  • the former aspect is preferred.
  • the position of the distal end of the connection portion 4 at the 0th stop portion 10 can be appropriately set in consideration of the ease of the work of attaching the clip 21 to the connection portion 4, for example, the 0th stop portion.
  • the distal end of the connecting portion 4 is preferably located on the distal side of 5.0 mm or more and 25.0 mm or less with respect to the distal end of the tubular body 2. In the state where the clip 21 is attached to the connecting portion 4, when the slider 9 is located at the 0th stop position 10, all of the clip 21 exists on the distal side of the distal end of the tubular body 2. Preferably.
  • the perspective length from the 0th stop point 10 to the 1st stop point 11 is preferably longer than the perspective length from the 1st stop point 11 to the 2nd stop point 12.
  • the length in the perspective direction from the 0th stop point 10 to the primary stop point 11 is preferably twice or more the length in the perspective direction from the primary stop point 11 to the secondary stop point 12. 3 times or more is more preferable, 4 times or more is still more preferable.
  • Tractive force required to drive the slider 9 on the proximal side than the zero-order stop portion 10 F 0 is the traction force F 1 and the slider required to tow the slider 9 on the proximal side of the first pause position 11
  • the pulling force F 2 required for pulling 9 closer to the proximal side than the second stop point 12 may be the same or different.
  • the slider 9 is pulled proximally on the section adjacent to the distal side of the 0th stop point 10. It is preferable that the traction force F D-0 required to do so is smaller than the traction force F 0 .
  • a pulling force F 0-1 required to pull the slider 9 proximally in a section that is proximal to the 0th stop point 10 and is adjacent to the distal side of the 1st stop point 11. Is preferably smaller than the traction force F 0 .
  • the distal end of the movable range of the slider 9 exists on the distal side of the 0th stop point 10.
  • the length from the distal end of the movable range of the slider 9 to the 0th stop point 10 is preferably 3.0 mm or less from the viewpoint of facilitating the work of attaching the clip 21 to the connecting portion 4. , 1.5 mm or less is more preferable.
  • the perspective length from the distal end of the movable range of the slider 9 to the 0th stop point 10 is preferably shorter than the perspective length from the 0th stop point 10 to the 1st stop point 11. ..
  • the length in the perspective direction from the 0th stop point 10 to the primary stop point 11 is twice the length in the perspective direction from the distal end of the movable range of the slider 9 to the 0th stop point 10.
  • the above is preferable, 3 times or more is more preferable, and 4 times or more is further preferable.
  • the distal end of the movable range of the slider 9 is represented by the position of the proximal end of the slider 9 when the slider 9 is at the most distal side in FIG. 8A.
  • the endoscopic treatment tool 1 is configured to satisfy the following conditions 5 and 6, which will be described with reference to FIGS. 8B and 9B.
  • FIG. 8B shows a state where the slider 9 is stopped at the third stop position under the following condition 5, and
  • FIG. 9B shows a connection portion when the slider 9 is at the third stop position. 4 and the positional relationship between the cylindrical body 2 are shown.
  • the slider 9 is provided in the state where the third stop point 13 is present on the proximal side of the second stop point 12 and the clip 21 is not attached to the connecting portion 4 of the endoscopic treatment instrument 1. By pulling toward the proximal side, at least a part of the slider 9 abuts at least a part of the handle body 8 at the third stop position 13 within the movable range of the slider 9 so that the slider 9 moves in the proximal direction. Stop moving to.
  • the slider 9 is further pulled toward the proximal side, so that the connection between the clip 21 and the connection portion 4 is released, and the connection portion 4 is connected to the clip 21. It can be used as a signal to notify you that you are far away.
  • the third stop point 13 is located closer to the proximal side than the disconnection position described above. By pulling the slider 9 to the third stop position 13, the operator can detect by hand that the gripping operation by the clip 21 and the indwelling operation of the clip 21 are completed.
  • the entire connecting portion 4 is housed in the tubular body 2.
  • the distal end of the connecting portion 4 is located on the proximal side of the distal end of the tubular body 2 by the length in the perspective direction of the clip 21 attached to the connecting portion 4 or more.
  • it is located at least 7.0 mm or more proximal from the distal end of the tubular body 2, and more preferably 10.0 mm or more proximally.
  • the position of the distal end of the connecting portion 4 at the third stop position 13 may be within 50.0 mm on the proximal side of the distal end of the tubular body 2. preferable.
  • the third stop point 13 may coincide with the proximal end of the movable range of the slider 9, and the proximal end of the moveable range of the slider 9 exists on the proximal side of the third stop point 13. Good.
  • the condition 5 is that by pulling the slider 9 toward the proximal side, at least a part of the slider 9 is at least a part of the handle body 8 at the third stop position 13 within the movable range of the slider 9.
  • the slider 9 is stopped from moving in the proximal direction by applying a pulling force of a predetermined value or more to the slider 9, and the slider 9 is moved in the proximal direction.
  • the proximal end of the movable range of the slider 9 is represented by the position of the proximal end of the slider 9 when the slider 9 is on the most proximal side.
  • the perspective length from the secondary stop point 12 to the tertiary stop point 13 is preferably longer than the perspective length from the primary stop point 11 to the secondary stop point 12.
  • the length in the perspective direction from the secondary stop point 12 to the third stop point 13 is preferably twice or more the length in the perspective direction from the primary stop point 11 to the secondary stop point 12. 3 times or more is more preferable, 4 times or more is still more preferable.
  • a pulling force F 3 required to pull the slider 9 from the third stop point 13 to the proximal side Is a traction force F 1 required to pull the slider 9 proximally from the first stop point 11 and a traction force F 2 required to pull the slider 9 proximally from the second stop point 12. , May be the same or different.
  • the traction force F 3 may be the same as or different from the traction force F 0 required to pull the slider 9 proximally from the 0th stop point 10.
  • the traction force F 2-3 required to pull the slider 9 proximally in a section that is proximal to the secondary stop location 12 and adjacent to the distal side of the tertiary stop location 13 is provided. Is preferably smaller than the traction force F 3 . Further, the traction force F 2-3 is preferably smaller than the traction force F 2 .
  • the 0th stop position to the 3rd stop position described above represent the relative positions of the slider 9 with respect to the handle body 8, and each stop position moves the slider 9 from the distal side to the proximal side within the movable range of the slider 9. It is defined as a position where at least a part of the slider 9 comes into contact with at least a part of the handle body 8 and the movement of the slider 9 to the proximal side is stopped when the slider 9 is pulled by a predetermined pulling force. Such contact can be simply realized by providing a convex portion or a concave portion on the surface where the slider 9 faces the handle body 8 and the surface where the handle body 8 faces the slider 9.
  • FIG. 10 shows a cross-sectional view of the handle 7 in the perspective direction
  • FIG. 11 shows a cross-sectional view showing the handle 7 shown in FIG. 10 separated into a handle body 8 and a slider 9.
  • the position in the perspective direction which gives the primary stop position and the secondary stop position when the slider 9 is pulled to the proximal side, is indicated by a chain line.
  • the handle main body 8 is provided with the handle main body side convex portion 14 on the surface facing the slider 9, and the slider main body 8 is provided with the slider side convex portion 15 on the surface facing the handle main body 8.
  • the position where the handle main body side convex portion 14 and the slider side convex portion 15 contact when the slider 9 is pulled from the distal side to the proximal side can be set as the above-mentioned stop point.
  • the position where the surface on the distal side of the handle body-side convex portion 14 and the surface on the proximal side of the slider-side convex portion 15 contact is the above-mentioned stop position.
  • the 0th stop position, the 1st stop position, and the 2nd stop position are realized by the contact between the handle main body side convex portion 14 and the slider side convex portion 15.
  • the third stop position is realized by the proximal end of the slider 9 contacting the proximal end of the movable range of the slider 9, that is, a part of the handle body 8.
  • the slider-side convex portion 15 is provided at one position and the handle main-body-side convex portion 14 is provided at three positions as positions in the perspective direction, but the slider-side convex portion 15 may be provided at two or more positions.
  • the main body side convex portion 14 may be provided at only one place or two places, or may be provided at four or more places. Further, at least one of the handle main body side convex portions 14 is replaced with a concave portion, and the position where the handle main body side concave portion and the slider side convex portion 15 contact each other is set as the above stopping point, or at least one of the slider side convex portion 15 is used.
  • the position where the handle main body side convex portion 14 and the slider side concave portion abut can be set as the above stop point. It is preferable to adopt such a structure and to set the opening / closing adjustment section above the convex portion of the secondary stop point 12.
  • the shape of the handle body-side convex portion 14, the handle body-side concave portion, the slider-side convex portion 15, and the slider-side concave portion can be appropriately selected according to the shapes of the handle body 8 and the slider 9.
  • a convex portion or a concave portion can be provided on the circumference of a cross section of the handle 7 which is perpendicular to the perspective direction.
  • the protrusions and recesses may have a continuous shape on the circumference, or one or more protrusions or recesses may be provided intermittently on the circumference.
  • handle body side convex portion or the concave portion may be continuously provided on the circumference, and the slider side convex portion or the concave portion may be provided as one or a plurality of projections or depressions on the circumference, or vice versa. It can be provided.
  • the 0th stop position is defined as the position where the movement of the slider 9 in the proximal direction stops.
  • the movable range of the slider 9 may be divided by each stop position to define the first locking part and the second locking part as follows. That is, the section between the distal end of the movable range of the slider 9 and the 0th stop point 10 is the first locking portion, and the section between the primary stop point 11 and the secondary stop point 12 is the second. It can be defined as a locking part. The details of the positional relationship between the first locking portion and the second locking portion can be appropriately read based on the above description of the 0th stop position to the 3rd stop position.
  • the handle 7 has a first locking portion and a second locking portion that restrict the movement of the slider 9 in the perspective direction.
  • the handle 7 When the slider 9 is locked by the first locking portion, the handle 7 When the distal end projects from the distal end of the tubular body 2 and the slider 9 is locked by the second locking portion, the distal end of the connecting portion 4 is arranged in the inner cavity of the tubular body 2. Is preferred.
  • the state in which the distal end of the connecting portion 4 projects from the distal end of the tubular body 2 is equivalent to the distal end of the connecting portion 4 being located on the distal side of the distal end of the tubular body 2.
  • the state in which the distal end of the connection portion 4 is arranged in the inner cavity of the tubular body 2 means that the distal end of the connection portion 4 is located closer to the proximal side than the distal end of the tubular body 2. Equivalent to. In this case, by attaching the slider 9 to the first engaging portion, the work of attaching the clip 21 to the connecting portion 4 becomes easy. By locking the slider 9 to the second locking portion, preparation for gripping an object to be treated by the clip 21 is started, and by pulling the slider 9 to the proximal side of the second locking portion, the clip 21 The actual gripping operation by can be started.
  • the endoscope treatment tool 1 includes the outer cylindrical body 6, the position when the slider 9 is locked by the first locking portion and the position when the slider 9 is locked by the second locking portion. It is preferable that the clip 21 can be put in and taken out from the distal end of the outer tubular body 6 in a state in which it is arranged between the two.
  • the outer tubular body 6 Is moved to the most distal end with respect to the tubular body 2, the outer tubular body 6 encloses the clip 21, and by moving the outer tubular body 6 to the most proximal position with respect to the tubular body 2, the clip 21 is moved to the outer tubular body. It is preferable that it is formed so as to be exposed from 6. Further, it is preferable that the clip 21 can be taken in and out from the distal end of the outer tubular body 6 in this manner when the slider 9 is locked by the second locking portion.
  • Endoscopic treatment tool 2 Cylindrical body 3: Wire material 4: Connection part 5: Linear object 6: Outer cylinder body 7: Handle 8: Handle body 9: Slider 10: Zeroth stop point 11: First order Stop location 12: Secondary stop location 13: Third stop location 14: Handle body side convex portion 15: Slider side convex portion 21: Clip 22: Clip body 23: Tightening ring

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  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Reproductive Health (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)

Abstract

La présente invention concerne un outil de traitement d'endoscope (1) comprenant : un corps tubulaire (2) ; un matériau de fil (3) disposé dans une lumière du corps tubulaire (2) et ayant, à son extrémité distale, une partie de connexion (4) pour la connexion avec une attache (21) ; et une poignée (7). La poignée (7) comprend : un corps de poignée (8) auquel une extrémité proximale du corps tubulaire (2) est reliée ; et un curseur (9) auquel une extrémité proximale du matériau de fil (3) est reliée, le curseur étant mobile dans le sens distal-proximal par rapport au corps de poignée (8). En tirant le curseur (9) vers le côté proximal, le mouvement du curseur (9) dans le sens proximal est arrêté à un emplacement prédéterminé d'arrêt à l'intérieur de la plage mobile du curseur (9), et en appliquant, au curseur (9), une force de traction qui est supérieure ou égale à une valeur prédéterminée, l'arrêt est relâché et le curseur (9) se déplace dans le sens proximal, et la partie de connexion (4) est logée à l'intérieur du corps tubulaire (2).
PCT/JP2019/036081 2018-11-21 2019-09-13 Outil de traitement d'endoscope WO2020105253A1 (fr)

Priority Applications (1)

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JP2020558114A JP7348204B2 (ja) 2018-11-21 2019-09-13 内視鏡処置具

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JP2018218601 2018-11-21
JP2018-218601 2018-11-21

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WO2020105253A1 true WO2020105253A1 (fr) 2020-05-28

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007244826A (ja) * 2006-03-16 2007-09-27 River Seiko:Kk 内視鏡用処置具
US20110054498A1 (en) * 2008-05-05 2011-03-03 Niti Surgical Solutions Ltd. Endoscopic compression clip and system and method for use thereof
JP2012200518A (ja) * 2011-03-28 2012-10-22 Nippon Zeon Co Ltd 内視鏡用処置具

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2007244826A (ja) * 2006-03-16 2007-09-27 River Seiko:Kk 内視鏡用処置具
US20110054498A1 (en) * 2008-05-05 2011-03-03 Niti Surgical Solutions Ltd. Endoscopic compression clip and system and method for use thereof
JP2012200518A (ja) * 2011-03-28 2012-10-22 Nippon Zeon Co Ltd 内視鏡用処置具

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