WO2021251738A1

WO2021251738A1 - Polypectomy snare device having ligating instrument

Info

Publication number: WO2021251738A1
Application number: PCT/KR2021/007182
Authority: WO
Inventors: 정성훈
Original assignee: 가톨릭대학교 산학협력단
Priority date: 2020-06-12
Filing date: 2021-06-09
Publication date: 2021-12-16
Also published as: KR20210154353A; KR102358347B1

Abstract

The present invention relates to a polypectomy snare device having a ligating instrument, wherein a ligating instrument for hemostasis is provided, and thus the snare device itself can successively perform hemostasis and polyp removal without a separate clip or endo-loop and accordingly can make the procedure convenient. Further, the distance between the snare and the ligature is very short, and thus the ligation and polypectomy can be performed without spatial difficulty even when a polyp has a short neck portion.

Description

Snare device for polypectomy with ligation device

The present invention relates to a snare device for removing polyps in the body, and more particularly, since the ligation mechanism for bleeding prevention is provided by itself, it can be effectively used for resection of ductal polyps. It relates to the snare device for the dragon.

When a polyp is found during an in vivo endoscopy, a technique for excising the polyp by inserting a snare device into the body through a working channel of the endoscope device is known.

The snare device is for cutting protruding tissues such as polyps that have been discovered, and it is a flexible tube that passes through a working channel, a snare located at the tip of the flexible tube, and a snare that is built into the flexible tube and uses a high-frequency current applied from the outside to snare it. It is provided with a power line that transmits to the

The method of removing a polyp using a snare device includes a process of applying a high-frequency current to the snare while the polyp is captured by bringing the snare close to the polyp. The polyp is excised by high-frequency heat, the polyp falls off, and the remaining part is sintered.

However, in pedicle polyps, blood vessels are more developed than other types of polyps, so there is a high risk of bleeding when the polyp is removed. For this reason, in order to excise a pedicle polyp, using a clip or an endo loop for bleeding prevention, the neck of the polyp is first ligated and then the polyp excision is performed. (Even if it is not a ductal polyp, if bleeding is expected, a clip or endoloop is often filled to prevent bleeding.)

As such, the conventional method for removing ductal polyps includes two steps: a ligation process for bleeding prevention and a polyp removal process, so the procedure is cumbersome, and in particular, depending on the shape of the polyp, it is difficult to capture the polyp after ligation.

In this regard, a double snare device for removing living tissue has been disclosed through Korean Patent Registration No. 10-2038589.

The disclosed snare device includes: a tube having a hole formed along its length; an imaging unit installed at the end of the tube and imaging a region around the tube; an operation wire inserted into the hole; Formed at the tip of the manipulation wire and as the manipulation wire moves, when one side of the tip of the tube presses the outer diameter side, the inner diameter is reduced and the tissue is brought into contact with one side of the living tissue and heat generated by the electric current supplied from the outside to remove the living tissue a snare for removal; It is disposed inside the tube and arranged in a straight line with the tissue removal snare, and the rear end is detachably coupled to the front end of the tissue removal snare, and the inner diameter of the tip exposed to the outside of the tube is reduced. lasso; and a bleeding-preventing snare for fixing the biological tissue while the front end is exposed to the outside of the tube and the inner diameter of the rear end is reduced. And it is installed on one side of the hemorrhage prevention snare, and as the operation wire moves, it is supported by the tip of the tube and moved in the direction of the bleeding prevention snare. It includes a band portion that maintains the shape of the noose for bleeding prevention.

[Prior art literature]

(Patent Document 1) Domestic Registered Patent Publication No. 10-2038589 (Double snare device for removing biological tissue)

(Patent Document 2) Domestic Registered Patent Publication No. 10-1768660 (medical snare device)

The present invention was created to solve the above problems, and it is possible to sequentially perform hemostasis and polyp removal by itself without the need for a separate clip or endoloop, thus enabling a more convenient operation, even when the neck of the polyp is short An object of the present invention is to provide a snare device for polyp resection equipped with a ligation mechanism, which can proceed with ligation and polyp resection without spatial difficulties.

The snare device for polyp resection provided with the ligation mechanism of the present invention as a means of solving the problems for achieving the above object, the body extending in the longitudinal direction and laterally opened through the side slit; a flexible extension tube mounted to an end of the body; a power line capable of being positioned in the longitudinal direction while being accommodated in the body and the extension tube and receiving external power; a snare fixed to the tip of the power line and exposed to the outside of the extension tube when in use to capture and excise polyps; It is accommodated in the body and the extension tube, and captures the polyp together with the snare, and includes a ligation mechanism for performing ligation before the snare excises the polyp.

In addition, the ligation mechanism; It provides a ligation in the form of a snare, and has a ligation string extending parallel to the power line, and a tension means for pulling the ligation string in a state where the ligation unit captures the polyp so that the ligation unit maintains the ligation state.

In addition, the ligation part is connected to the snare through a connection member, and the connection member is separated from the snare when the ligation string is tensioned by a tensioning means.

In addition, the ligation string, as a non-stretch string, one end is bent to form the ligation portion, the other end is extended into the body is connected to the tension means.

In addition, the ligation string further includes a ligation string fixing portion for maintaining the shape of the ligation portion.

And, the ligation string fixing part; A first toothed tube fixed to one end of the ligation string, a second toothed tube fixed to the other part of the ligation string and meshed with the first toothed tube, and receiving the tensile force of the tensioning means from the first toothed tube include

In addition, the tension means; It is rotatably installed inside the body and includes a bobbin for winding a ligation string, and a ligation dial located outside the body and connected to the bobbin to rotate the bobbin.

In addition, a polygonal groove opened in the direction of the ligation dial is formed in the central axis of rotation of the bobbin, and the ligation dial includes; a polygonal plate accommodated in the polygonal groove, a shaft integral with the polygonal plate, and an operation dial fixed to the shaft and operated by a user, wherein the binding dial is linked to the bobbin and moves forward and backward relative to the bobbin do.

In addition, a plurality of protruding stoppers are formed on the operation dial, and a parking groove for accommodating the stoppers to prevent rotation of the operation dial is formed on the outer surface of the body.

The snare device for polyp resection provided with the ligation mechanism of the present invention as described above is provided with a ligation mechanism for hemostasis, so that hemostasis and polyp removal are sequentially performed by itself without the need for a separate clip or end loop. This allows for a more convenient operation.

In addition, since the distance between the snare and the ligation string is very close, even when the neck of the polyp is short, ligation and polyp resection can be performed without spatial difficulties.

1 is a perspective view of a snare device for polyp resection provided with a ligation mechanism according to an embodiment of the present invention.

FIG. 2 is a cross-sectional view of the snare device shown in FIG. 1 .

3 is a partial cross-sectional view for explaining the operation of the stair device shown in FIG.

4 is a perspective view separately showing the ligation dial of FIG.

5 is a cross-sectional view taken along line A-A of FIG. 3 .

6 is a view showing a ligation mechanism applied to the snare device according to an embodiment of the present invention.

7a to 7g are diagrams for explaining a polyp removal method using a snare device according to an embodiment of the present invention.

Hereinafter, one embodiment according to the present invention will be described in more detail with reference to the accompanying drawings.

The snare device of the present invention has a structure that can perform both ligation and excision for polyps by itself. It comprises: a body extending longitudinally and laterally open through side slits; a flexible extension tube mounted to an end of the body; a power line capable of being positioned in the longitudinal direction while being accommodated in the body and the extension tube and receiving external power; a snare fixed to the tip of the power line and exposed to the outside of the extension tube when in use to capture and excise polyps; It is accommodated in the body and the extension tube, and captures the polyp together with the snare, and includes a ligation mechanism for performing ligation before the snare excises the polyp.

1 is a perspective view of a polyp resection snare device 10 equipped with a ligation mechanism according to an embodiment of the present invention, and FIG. 2 is a side cross-sectional view of the snare device shown in FIG. 1 . Also, FIG. 3 is a partial plan sectional view for explaining the operation of the snare device shown in FIG. 1 .

As shown, the snare device 10 according to the present embodiment includes a body 11, a support tube 29, an extension tube 31, a power line 23, a snare 35, a ligation mechanism (in FIG. 6). 41) is provided.

The body 11 has an inner space 11g that extends in the longitudinal direction and is laterally opened through the side slits 11a. In the inner space 11g, the bobbin 17, the power line 23, and a part of the covering 25 are accommodated. In addition, a finger rest portion 11e is provided at the rear end of the body 11 . The finger rest portion 11e provides a through hole 11f through which the operator's thumb is fitted. The thumb is placed in the finger rest portion 11e, and the index and middle fingers are inserted into the through-holes 13c of the slider 13 to be described later, and the slider 13 can be pulled in the direction of the arrow a. By pulling the slider 13, the snare 35 tightens the polyp.

In addition, a dial sheet 11b is formed on the side of the body 11 . The dial sheet 11b has an open central portion as a protrusion on which the ligation dial 21 is mounted. The inner space 11g is also opened to the outside through the dial seat 11b. A support groove 11d is formed on the inner surface of the dial seat 11b. The support groove 11d is a groove into which the receiving ring portion 17a of the bobbin 17 is fitted. The bobbin 17 is supported by the support groove 11d and is rotatable based on the rotation axis S.

In addition, a plurality of parking grooves 11c are provided on the outward surface of the dial seat 11b. The parking groove 11c is symmetrical with respect to the rotation axis S and accommodates a stopper 21b to be described later.

On the other hand, the slider 13 is supported by the body 11, is slidable in the longitudinal direction of the body, and further has a terminal passage 13e in addition to the through hole 13c described above. The terminal passage 13e is a hole through which the terminal 27 passes. The terminal 27 passes through the side slit 11a, enters the terminal passage 13e, is coupled with an external power supply means, and moves along the side slit 11a when the slider 13 moves in a straight line.

The power line 23 is connected to the terminal 27 and transmits power supplied through the terminal to the snare 35 . The power line 23 is covered by the sheath 25 . The sheath 25 accommodates the power line 23 and has a terminal fixing part 25a on one side. The terminal fixing part 25a receives a part of the force transmitted through the terminal 27 when the slider 13 slides, and prevents the stress from being concentrated at the joint between the power line 23 and the terminal 27 .

The support tube 29 is a straight tube fixed to the front end of the body 11 and passes the power line 23 . The support tube 29 prevents bending of the power line 23 extending to the outside of the body 11 .

The extension tube 31 is a flexible tube fixed to the front end of the body 11 and extending in the longitudinal direction. A connection portion between the extension tube 31 and the body 11 is supported by the support tube 29 . The support tube 29 prevents the extension tube 31 from being sharply bent while accommodating a part of the extension tube 31 . The extension tube 31 passes through the working channel of the endoscope and approaches the polyp.

The power line 23 is accommodated in the extension tube 31 , and is connected to the snare 35 through a coupler 33 . The coupler 33 is a conductive connecting member that physically connects the power line 23 and the snare 35 . Power applied to the terminal 27 is transmitted to the snare 35 through the power line 23 and the coupler 33 .

The snare 35 is tightened in a state surrounding the polyp in the body to cut the polyp, and its both ends are connected to the power line 23 in a state collected inside the coupler 33 . The high-frequency current supplied through the power line 23 is applied to the snare 35 to excise the polyp.

This snare 35 is accommodated inside the extension tube 31 before use, and after the tip of the extension tube 31 approaches the polyp, the slider 13 is moved in the direction of the arrow b. (31) It is exposed to the outside and spreads out to take the form of a noose.

In addition, when the slider 13 is pulled in the direction of the arrow a while the polyp is captured, as shown in FIG. 7d , the polyp acts to be tightened between the front end surfaces of the extension tube 31 . If power is supplied in this state, the polyp is excised.

On the other hand, the ligation mechanism 41, as shown in FIGS. 7A to 7G, captures the polyp together with the snare 35, and before the snare 35 excises the polyp, it is in the neck 101 of the polyp 100. It plays a role in performing ligation first.

6 is a view showing a ligation mechanism 41 applied to the snare device 10 according to an embodiment of the present invention.

As shown, the ligation mechanism 41 includes a ligation string 43 , a ligation string fixing part 45 , and a bobbin 17 and a ligation dial 21 as tension means.

The ligation string 43 is a non-stretch string, and one end is bent to form a snare-shaped ligation portion 43a and the other end is wound around the bobbin 17 inside the body 11 . As the bobbin 17 is wound, the ligation string 43 is pulled in the direction of the arrow c to bind the neck 101 . The ligation string 43 may be made of the same material as the existing endoloop.

A plurality of cut portions 43c are formed in the ligation string 43 . The cut portion 43c is a portion that is cut when the ligation string 43 is tensioned with a set force after the completion of the procedure. The set force above means a force greater than the force required for ligation. By applying the cut portion (43c), as shown in Figure 7g, after completion of the procedure, the neck portion 101 of the polyp can be maintained in a ligated state for some time.

In particular, the ligation portion 43a is fixed to the snare 35 through a plurality of connecting members 49 . The connecting member 49 serves to maintain the interval of the ligation portion 43a with respect to the snare 35, and as shown in FIG. 7b, when the ligation string 43 is pulled in the arrow f direction, the snare 35 separated from

The ligation string fixing part 45, which serves to maintain the snare shape of the ligation part 43a, includes a first toothed tube 45a and a second toothed tube 45b. The first and second toothed tubes (45a, 45b) are tubular members that pass through the ligation string 43, and have teeth on their outer peripheral surfaces.

These first and second toothed tubes (45a, 45b) are accommodated in the toothed tube receiving portion (31a) of the extension tube (31), as shown in FIG. 5 is a cross-sectional view taken along line A-A of FIG. 3 .

5, a toothed tube accommodating part 31a is provided inside the extension tube 31, and the first and second

toothed tubes

45a and 45b are accommodated in the toothed tube accommodating part 31a in a meshed state. It can be seen that it has been The toothed tube accommodating portion 31a is a passage extending in the longitudinal direction of the extension tube 31, and supports the first and second

toothed tubes

45a and 45b so as to be capable of linear movement.

In any case, when the first toothed tube (45a) and the second toothed tube (45b) are engaged, when the ligation string (43) is pulled in the arrow c direction of FIG. 6, the first toothed tube (45a) is the second toothed tube It is towed to (45b) and moves in the same direction. The first and second

toothed tubes

45a and 45b are pulled in the direction of the arrow c at the same time in a state of being bitten by each other.

On the other hand, the bobbin 17 is a member rotatably installed inside the body 11, and has a polygonal groove 17c and a shaft hole 17e in the center of rotation. Of course, a support bracket (not shown) for rotatably supporting the bobbin 17 is provided inside the body 11 .

The polygonal groove (17c) is a groove made of a polygonal inner peripheral surface, and accommodates the polygonal plate (21e) of the ligation dial (21). The shaft hole 17e is a hole for laterally opening the polygonal groove 17c, and supports the shaft 21c.

The ligation dial 21 is used to wind or unwind the bobbin 17, and has the configuration shown in FIG.

4 is a perspective view showing the ligation dial 21.

As shown, the ligation dial 21 includes an operation disk 21a having a predetermined diameter, a shaft 21c fixed to the central axis of the operation disk 21a, and a polygonal plate coupled to the end of the shaft 21c ( 21e) is provided. In addition, a plurality of stoppers 21b are formed on the inward surface of the operation disk 21a.

The polygonal plate 21e serves to transmit the rotational force of the operating disk 21a to the bobbin 17 while being accommodated in the polygonal groove 17c. In addition, the stopper 21b is a protrusion disposed at an equal angle with respect to the shaft 21c, and is inserted and supported in the parking groove 11c as shown in FIG. 3 . The stopper 21b can be inserted into and separated from the parking groove 11c. In a state in which the stopper 21b is inserted into the parking groove 11c, the operation disk 21a cannot rotate.

The ligation dial 21 having the above configuration is linked to the bobbin 17 in a state opposite to the dial seat 11b, as shown in FIG. 3 . At this time, of course, the shaft 21c of the ligation dial 21 is supported by the shaft hole 17e, and the polygonal plate 21e is accommodated in the polygonal groove 17c.

The ligation dial 21, in a state in which the polygonal plate 21e is inserted into the polygonal groove 17c, can be positioned in the direction of the arrow e or the opposite direction. For example, it moves in the direction of the arrow e to be separated from the dial seat 11b, or moves in the opposite direction to be fixed to the dial seat 11b.

When the ligation dial 21 moves in the direction of the arrow e, the stopper 21b inserted into the parking groove 11c is released from the parking groove 11c, and the ligation dial 21 is in a rotatable state. In addition, when the ligation dial 21 is pressed and moved toward the bobbin 17 in a state where the stopper 21b is aligned with the parking groove 11c, the stopper 21b is fitted into the parking groove 11c and rotation of the ligation dial 21 This is prevented. That is, the bobbin 17 is fixed.

7a to 7g are views for explaining a method of removing the ductal polyp 100 using the snare device 10 according to an embodiment of the present invention. Since ductal polyps accompany a lot of bleeding during excision, the neck 101 must be tied up before excision.

As shown in Figures 7a and 7b, the snare 35 and the ligation string 43 are lowered in a state positioned on the upper part of the polyp 100, the neck 101 of the polyp 100 is the snare 35 and to be caught on the ligation string (43).

In the state of Fig. 7b, the bobbin 17 is rotated through the ligation dial 21 to pull the ligation string 43 in the arrow f direction of Fig. 7c. At this time, the snare 35 maintains a fixed state. As the ligation string 43 moves in the direction of the arrow f, the connecting member 49 is separated from the snare 35, and the ligation string 43 hangs the neck 101 as shown in FIG. 7c and the extension tube (31) pull to the side.

When the neck 101 is completely tightened by the ligation string 43, the ligation dial 21 is moved to the dial seat 11b side so that the stopper 21b is fitted into the parking groove 11c. As the stopper 21b is fitted into the parking groove 11c, the ligation string 43 maintains a pulled state. Hemostatic preparations for polyp (100) excision are complete.

Next, the snare 35 is pulled in the direction of the arrow h in FIG. 7C using the slider 13 . 7D is a state in which the neck portion 101 is completely tightened by the snare 35 and the ligation portion 43a.

When a high-frequency current is applied to the terminal 27 in the state of FIG. 7D , the portion tightened by the snare 35 is excised and cauterized by the high-frequency. Even if the polyp 100 is excised, bleeding is prevented because the neck 101 is tied by the ligation portion 43a.

When the appropriate post-processing of the excision site is completed, the ligation dial 21 is pulled out in the direction of the arrow e of FIG. 3 , and then the snare 35 and the ligation part 43a are lifted as shown in FIG. 7F to take them out. 7g is a view after the excision operation of the polyp 100 is completed. It can be seen that the polyp 100 of the upper part of the neck 101 is removed, and the neck 101 is maintained in a ligated state by the ligation part 43a.

As mentioned above, although the present invention has been described in detail through specific embodiments, the present invention is not limited to the above embodiments, and various modifications are possible by those of ordinary skill within the scope of the technical spirit of the present invention.

Claims

a body extending in a longitudinal direction and laterally opened through a side slit;

a flexible extension tube mounted to an end of the body;

a power line capable of being positioned in the longitudinal direction while being accommodated in the body and the extension tube and receiving external power;

a snare fixed to the tip of the power line and exposed to the outside of the extension tube when in use to capture and excise polyps;

It is accommodated in the body and the extension tube, and includes a ligation mechanism that captures the polyp together with the snare, and performs ligation before the snare excises the polyp,

A snare device for resection of polyps equipped with a ligation mechanism.
According to claim 1,

The ligation mechanism;

To provide a ligation in the form of a snare, and a ligation string extending parallel to the power line,

Pulling the ligation string in the state where the ligation unit captures the polyp has a tension means for allowing the ligation unit to maintain the ligation state,

A snare device for resection of polyps equipped with a ligation mechanism.
3. The method of claim 2,

The ligation part is connected to the snare through a connecting member,

The connection member is separated from the snare when tensioning the ligation string with a tensioning means,

A snare device for resection of polyps equipped with a ligation mechanism.
4. The method of claim 3,

The ligation string,

A non-stretchable string, wherein one end is bent to form the ligation portion, and the other end is extended into the body and connected to the tensioning means,

A snare device for resection of polyps equipped with a ligation mechanism.
5. The method of claim 4,

In the ligation string,

A ligation string fixing part for maintaining the shape of the ligation part is further included,

A snare device for resection of polyps equipped with a ligation mechanism.
6. The method of claim 5,

The ligation string fixing part;

A first toothed tube fixed to one end of the ligation string,

It is fixed to the other part of the ligation string and meshes with the first toothed tube, including a second toothed tube receiving the tensile force of the tensioning means from the first toothed tube,

A snare device for resection of polyps equipped with a ligation mechanism.
5. The method of claim 4,

The tension means;

A bobbin which is rotatably installed inside the body and winds a ligation string;

It is located on the outside of the body and has a ligation dial connected to the bobbin to rotate the bobbin,

A snare device for resection of polyps equipped with a ligation mechanism.
8. The method of claim 7,

A polygonal groove opened in the direction of the ligation dial is formed in the central axis of rotation of the bobbin,

The ligation dial;

a polygonal plate accommodated in the polygonal groove, a shaft integral with the polygonal plate, and an operation dial fixed to the shaft and operated by a user,

The binding dial is capable of advancing and retreating with respect to the bobbin in a state linked to the bobbin,

A snare device for resection of polyps equipped with a ligation mechanism.
9. The method of claim 8,

A plurality of protruding stoppers are formed on the operation dial,

A parking groove is formed on the outer surface of the body to accommodate the stopper to prevent rotation of the operation dial,

A snare device for resection of polyps equipped with a ligation mechanism.