WO2021167224A1 - Dispositif de capuchon à configuration variable pour dissection sous-mucosale endoscopique - Google Patents

Dispositif de capuchon à configuration variable pour dissection sous-mucosale endoscopique Download PDF

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Publication number
WO2021167224A1
WO2021167224A1 PCT/KR2020/018731 KR2020018731W WO2021167224A1 WO 2021167224 A1 WO2021167224 A1 WO 2021167224A1 KR 2020018731 W KR2020018731 W KR 2020018731W WO 2021167224 A1 WO2021167224 A1 WO 2021167224A1
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Prior art keywords
cap
variable
cauterizer
variable cap
endoscope tube
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PCT/KR2020/018731
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English (en)
Korean (ko)
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정성훈
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가톨릭대학교 산학협력단
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Publication of WO2021167224A1 publication Critical patent/WO2021167224A1/fr

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    • 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
    • A61B17/3494—Trocars; Puncturing needles with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors
    • A61B17/3496—Protecting sleeves or inner probes; Retractable tips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • 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
    • A61B17/3476—Powered trocars, e.g. electrosurgical cutting, lasers, powered knives
    • 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
    • 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
    • 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
    • A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
    • 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
    • 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
    • A61B90/04—Protection of tissue around surgical sites against effects of non-mechanical surgery, e.g. laser surgery
    • 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
    • A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on 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
    • A61B17/00234—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
    • A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
    • 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
    • A61B2018/00595—Cauterization
    • 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
    • A61B90/04—Protection of tissue around surgical sites against effects of non-mechanical surgery, e.g. laser surgery
    • A61B2090/0409—Specification of type of protection measures
    • A61B2090/0427—Prevention of contact

Definitions

  • the present invention relates to a variable cap device inserted into the distal end of an endoscope tube for endoscopic submucosal dissection. It relates to the cap device.
  • Endoscopic surgery is much simpler than conventional open surgery, reduces the patient's pain, and allows for a faster recovery.
  • endoscopic mucosal resection or endoscopic submucosal dissection is performed using various treatment instruments inserted into the body through a working channel formed in an endoscope tube.
  • treatment instruments for example, a cauterizer for excising the mucous membrane of a tissue, a core regulator for hemostasis, a needle injecting saline, etc. to swell the mucosal tissue, a snare for grabbing a tumor, etc.
  • endoscopic submucosal dissection is a method of treating early cancer occurring in the stomach, esophagus, or colon. It is a surgical method in which the periphery of the tumor attached to the mucous membrane is excised using a cautery protruding from the tip of the endoscope and the tumor is removed from the submucosal layer.
  • 1 is a view for explaining the process of a general endoscopic submucosal dissection.
  • a marking is made around the tumor tissue (hereinafter referred to as cancer). That is, the area to be excised is marked in advance along the periphery of the cancer using the cauterizer 13 .
  • physiological saline is injected into the submucosal layer around the cancer to swell the inner region of the marked portion.
  • the cancer part swells by injection of physiological saline.
  • the submucosal layer is peeled off and cauterized using a cauterizer. That is, after cauterizing the submucosal tissue, the process of lifting the cauterized part, cutting the tissue below the lifted part again, and lifting the cut tissue again is repeated. (See FIGS. 1D and 1E) Through the above process, cancer is separated from normal tissue as shown in FIG. 1F.
  • the cauterizer 13 does not damage normal tissue, and in order to grasp the boundary between the portion to be removed and the submucosal layer, the endoscope A transparent cylindrical cap (not shown) is fitted at the distal end of the tube 11 .
  • the cap accommodates the cauterizer 13 in a state of being fixed to the endoscope tube 11 as a cylindrical member of a transparent material.
  • the cap when penetrating the cauterizer into the lower part of the tissue, the tip part was caught in other tissues, there were many cases that interfered with the entry of the cauterizer. This inconvenience is more severe when the incision is not sufficiently widened due to severe fibrosis of the submucosal layer.
  • Patent Document 1 Domestic Registered Patent Publication No. 10-1565958 (Endoscope)
  • Patent Document 2 Domestic Registered Patent Publication No. 10-2046712 (Cap unit for endoscope capable of measuring impedance)
  • the present invention was created to solve the above problems, and since it contracts when entering the lower part of the submucosal layer and widens when tissue incision is made to secure a field of view, endoscopic submucosal dissection can be performed more efficiently to dissociate the submucosal layer
  • An object of the present invention is to provide a variable cap device for use.
  • variable cap device for endoscopic submucosal dissection of the present invention as a means of solving the problem for achieving the above object is mounted on the tip of an endoscope tube to be inserted into the body, and accommodates a cauterizer exposed to the front of the tip of the endoscope tube, A transparent fixing cap that exposes the cauterizer only when cauterizing the object with the cauterizer, and accommodates the cauterizer when not cauterized, enclosing the tip of the endoscope tube and providing an accommodation space between the endoscope tube and the outer circumferential surface; an elastic part installed in the receiving space of the transparent fixing cap and outputting an elastic force; A variable cap is included to be slidably installed in the accommodation space, to move forward by the action of the elastic part to accommodate the cauterizer, or to move backward by an external force to expose the cauterizer.
  • variable cap It has a sliding part that is slidably surfaced on the outer peripheral surface of the endoscope tube, and is integral with the sliding part, and has a tapered part having a concave shape toward the front.
  • the tapered portion is divided by a plurality of division slits and consists of a plurality of elastic pieces inclined inward.
  • variable cap support part for fixing the variable cap in a state of being pushed to the rear while covering the cauterizer is provided in the transparent fixed cap.
  • variable cap support portion a circulation groove having a first locking groove portion and a second locking groove portion is formed, the variable cap support portion;
  • variable cap is caught in the first locking groove in a state inserted into the transparent fixing cap, protrudes to the outside of the transparent fixing cap, and is caught in the second locking portion in a state that covers the cauterizer.
  • variable cap device for endoscopic submucosal dissection of the present invention as a means of solving the problem for achieving the above object is mounted on the tip of the endoscope tube to be inserted into the body, and accommodates the cauterizer exposed in front of the tip of the endoscope tube.
  • the cauterizer is exposed only when the object is cauterized with the cauterizer, and when not cauterized, the cauterizer is accommodated, and a transparent fixing cap that surrounds the tip of the endoscope tube and provides an accommodation space between the endoscope tube and the outer circumferential surface; a variable cap which is slidably installed in the receiving space and accommodates the cauterizer by moving forward or exposing the cauterizer by moving backward; and a variable cap driving unit for reciprocating the variable cap.
  • variable cap driving unit A permanent magnet fixed to the rear end of the variable cap, is mounted inside the transparent fixed cap, is opposite to the permanent magnet, and is magnetized by electric power applied from the outside through a power line to apply attractive or repulsive force to the permanent magnet
  • an electromagnet that applies
  • variable cap It has a sliding part that is slidably surfaced on the outer peripheral surface of the endoscope tube, and is integral with the sliding part, and has a tapered part having a concave shape toward the front.
  • the tapered portion is divided by a plurality of division slits and consists of a plurality of elastic pieces inclined inward.
  • variable cap device for endoscopic submucosal dissection of the present invention as described above is constricted when entering the lower part of the submucosal layer and widened when tissue incision is made to secure a field of view, so that the detachment of the submucosal layer can be performed more efficiently do.
  • 1 is a view for explaining the process of a general endoscopic submucosal dissection.
  • FIGS 2 and 3 are cross-sectional views showing the structure of the variable cap device for endoscopic submucosal dissection according to the first embodiment of the present invention.
  • variable cap support unit applied to the variable cap device for endoscopic submucosal dissection according to the first embodiment of the present invention.
  • variable cap device 6 and 7 are cross-sectional views for explaining the structure and operating principle of the variable cap device for endoscopic submucosal dissection according to the second embodiment of the present invention.
  • variable cap device of the present invention is a tool used for endoscopic submucosal dissection, mounted on the tip of an endoscope tube to be inserted into the body, and accommodates a cauterizer exposed to the front of the tip of the endoscope tube, but the cauterizer is used. It has a structure that is exposed only when it is not in use and accommodated inside when not in use.
  • the endoscope tube is a flexible tube extending long in the longitudinal direction, and has a plurality of working channels therein.
  • the working channel is a passage that guides the tools necessary for surgery into the body.
  • a cauterizer is one of the tools necessary for surgery.
  • FIGS. 2 and 3 are cross-sectional views showing the structure of the variable cap device 20 for endoscopic submucosal dissection according to the first embodiment of the present invention
  • FIGS. 4 and 5 are the variable cap device 20 applied to the variable cap device 20 of the present invention. It is a view for explaining the structure and operation method of the cap support portion (45).
  • variable cap device 20 includes a transparent fixed cap 30 , an elastic part, a variable cap 50 , and a variable cap support part 45 .
  • the transparent fixing cap 30 is a member made of a transparent synthetic resin, and surrounds the distal end of the endoscope tube 11 and provides an accommodation space 30a between the endoscope tube and the outer circumferential surface.
  • the spring 40 as an elastic part, the variable cap support part 45, and the variable cap 50 are accommodated in the accommodation space 30a.
  • the transparent fixing cap 30 is stably fixed to the endoscope tube 11 and does not move forward or backward during use.
  • the front in this description means the front end of the endoscope tube, that is, the direction in which the cauterizer 13 is located.
  • the inside of the transparent fixing cap 30 is provided with a spring support jaw 32 and a separation preventing projection 34 .
  • the spring support jaw 32 supports one end of the spring 40 so that the spring 40 can elastically support the variable cap 50 forward.
  • the departure preventing sill 34 hangs the engaging protrusion 53a of the variable cap 50 so that the variable cap 50 does not fall forward.
  • the spring 40 is an example of an elastic part, and elastically supports the variable cap 50 while being sandwiched between the sliding part 53 of the variable cap 50 and the spring support jaw 32 .
  • variable cap 50 is partially accommodated in the accommodating space 30a of the transparent fixing cap 30 in a state that the distal end of the endoscope tube 11 is wrapped, and is slidable in the longitudinal direction of the endoscope tube. For example, it protrudes in the direction of arrow a by the action of the spring 40 or enters the inside of the transparent fixing cap 30 by an external force in the direction of arrow b.
  • the external force in the direction of arrow b is a reaction force generated when the endoscope tube 11 is pushed, for example, to an appropriate point (thick portion) of the colon wall or stomach wall.
  • variable cap 50 moves in the arrow b direction to expose the cauterizer 13, or moves in the arrow a direction to accommodate the cauterizer 13 therein.
  • the reason for exposing the cauterizer 13 is to allow the cauterizer 13 to cut the submucosal tissue.
  • covering the cauterizer 13 with the variable cap 50 is to prevent the cauterizer 13 from damaging surrounding normal tissues.
  • the variable cap 50 is made of a transparent and flexible synthetic resin, and has a sliding part 53 and a plurality of elastic pieces 51 .
  • the sliding part 53 is accommodated in the transparent fixing cap 30 as a part that is slidably surfaced on the outer peripheral surface of the endoscope tube 11 .
  • the elastic piece 51 is integrally formed with the sliding part 53, and has a plurality of elastic pieces 51 as a tapered portion having a concave shape toward the front.
  • a locking protrusion 53a is formed on the outer circumferential surface of the sliding part 53 .
  • the locking jaw (53a) is a portion caught on the departure preventing projection (31).
  • the elastic piece 51 is integral with the sliding part 53, is a part divided by a plurality of division slits 52, and takes a concave shape toward the front. Four to ten elastic pieces 51 may be applied.
  • the dividing slit 52 separates the elastic piece 51 from each other, for example, when the elastic piece 51 is pushed to the rear of the endoscope tube 11, a reaction from the edge of the front end surface of the endoscope tube 11 take power and make it open.
  • the elastic piece 51 is retracted in a state in which the cauterizer 13 is accommodated. Since the elastic piece 51 is concave, when the endoscope tube 11 is pushed into the submucosa, it can easily enter under the incision of the submucosa without being caught in other tissues. In a state in which the elastic piece 51 enters the submucosal layer, the incision portion can be raised higher by moving the endoscope tube 11 .
  • the elastic piece 51 After the incision is lifted, if the endoscope tube 11 is further pushed into the submucosal layer, the elastic piece 51 receives a reaction force from the submucosal layer and is pushed backward to expose the cauterizer 13 .
  • the exposed cauterizer 13 cuts the submucosal layer and allows the elastic piece 51 to re-enter the submucosal layer. Resection of the submucosal layer is completed by repeating the above process.
  • variable cap support part 45 serves to support the variable cap 50 .
  • the variable cap in a state of being pushed and moved backward is maintained in the transparent fixing cap 30 .
  • variable cap support part 45 under the action of the spring 40, allows the variable cap 50 to maintain a retracted state as shown in FIG. 2 or to maintain a forward state as shown in FIG.
  • variable cap 50 when the variable cap 50 is pressed backward in the state of FIG. 2 and released, the variable cap 50 moves forward by the spring to become the state of FIG. 3 , and in the state of FIG. 3 , the variable cap 50 is moved backward When it is completely pushed and released, the variable cap 50 is in a state accommodated in the transparent fixing cap 30 .
  • a circulation groove 33 is formed on the inner circumferential surface of the transparent fixing cap 30 for the variable cap support 45 .
  • the circulation groove 33 forms a substantially heart-shaped closed circuit as shown in FIG. 4 , and has a first locking groove portion 33a , a second locking groove portion 33b , and a connection groove portion 33c .
  • the first locking groove portion 33a and the second locking groove portion 33b are grooves through which a locking pin 55b, which will be described later, is engaged.
  • the connecting groove portion (33c) is a linear space connecting the second locking groove portion (33b) and the first locking groove portion (33a).
  • the locking pin 55b passes through the connection groove 33c along the arrow m direction (when an external force is applied) in a state in which the locking pin 55b is hooked and supported by the first locking groove part 33a and then the second locking groove part It is possible to move to (33b).
  • the locking pin 55b which was caught by the second locking groove portion 33b and waiting, moves in the arrow n direction of FIG. 5 and moves in the direction of the arrow n of FIG. It moves to the groove (33a).
  • the first locking groove portion (33a) is positioned relatively rearward compared to the second locking groove portion (33b).
  • the variable cap support part 45 includes a connecting rod 55 and a locking pin 55b.
  • the connecting rod 55 is a rod-shaped member that is connected to the variable cap 50 through the support pin 55a and is rotatable around the support pin 55 and extends in the longitudinal direction.
  • the locking pin (55b) is fixed to the extended end of the connecting rod (55) and fitted into the circulation groove (33).
  • the locking pin 55b is alternately hooked on the first locking groove portion 33a and the second locking groove portion 33b during the sliding movement of the variable cap 50 .
  • the locking pin 55b is caught in the first locking groove 33a in a state in which the variable cap 50 is inserted into the transparent fixing cap 30 as shown in FIG. As shown, it protrudes to the outside of the transparent fixing cap 30 and is caught by the second locking part 33b in a state that covers the cauterizer.
  • the operator can determine the position of the variable cap 50 by pushing the variable cap 50 to an appropriate point on the colon wall or the stomach wall while cauterizing the submucosal layer.
  • variable cap device 8 and 9 are cross-sectional views for explaining the structure and operating principle of the variable cap device for endoscopic submucosal dissection according to the second embodiment of the present invention.
  • variable cap device 20 includes a transparent fixed cap 30 , a variable cap 50 , and a variable cap driving unit.
  • a permanent magnet 61 and an electromagnet 63 are disposed inside the transparent fixing cap 30 .
  • the permanent magnet 61 and the electromagnet 63 are variable cap driving parts for reciprocating the variable cap 50 in front and rear.
  • the permanent magnet 61 is fixed to the rear end of the variable cap 50 and takes the form of a ring.
  • the polarity of the permanent magnet 61, the half in contact with the variable cap 50 is an S pole or an N pole, and the half facing the electromagnet 63 is an N pole or an S pole.
  • the electromagnet 63 is mounted inside the transparent fixing cap 30 and faces the permanent magnet 61, and is magnetized by electric power applied from the outside through the power line 64, and applies an attractive or repulsive force to the permanent magnet. .
  • the power line 64 is wired in a working channel (not shown) formed in the endoscope tube 11 and connects the electromagnet 64 to an external power source. The current applied to the electromagnet 64 is controlled through an external controller (not shown).
  • variable cap 50 moves forward, and accommodates the cauterizer 13 as shown in FIG. 8 .
  • variable cap 50 retreats to open the cauterizer 13 .

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Abstract

La présente invention concerne un dispositif de capuchon à configuration variable pour une dissection sous-muqueuse endoscopique. Ce dispositif, tout en étant monté sur la partie pointe d'un tube d'endoscope inséré dans le corps, reçoit une cautérisation exposée vers l'avant de la partie de pointe du tube d'endoscope, et expose uniquement la cautérisation lorsque la cautérisation est utilisée pour cautériser une cible, et peut autrement recevoir la cautérisation. Le dispositif comprend : un capuchon de maintien transparent qui entoure la partie pointe du tube d'endoscope et fournit un espace de logement entre le capuchon de maintien transparent et la surface circonférentielle externe du tube d'endoscope ; une partie élastique qui est installée à l'intérieur de l'espace de réception du capuchon de maintien transparent et délivre une force élastiqu e; et un capuchon variable qui est installé de manière coulissante à l'intérieur de l'espace de réception, et est déplacé vers l'avant par l'action de la partie élastique pour recevoir la cautérisation, ou déplacé vers l'arrière par une force externe pour exposer la cautérisation.
PCT/KR2020/018731 2020-02-18 2020-12-21 Dispositif de capuchon à configuration variable pour dissection sous-mucosale endoscopique WO2021167224A1 (fr)

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KR10-2020-0019356 2020-02-18
KR1020200019356A KR102294046B1 (ko) 2020-02-18 2020-02-18 내시경 점막하박리술용 가변형 캡장치

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