Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
• • 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
  • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
  • A61B2017/00296—Surgical instruments, devices or methods 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
  • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
  • A61B2017/0034—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means adapted to be inserted through a working channel of an endoscope
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00053—Mechanical features of the instrument of device
  • A61B2018/00172—Connectors and adapters therefor
  • A61B2018/00178—Electrical connectors
• • 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
  • A61B2018/00053—Mechanical features of the instrument of device
  • A61B2018/00184—Moving parts
• • 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
  • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
  • A61B2018/00482—Digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
  • A61B2018/00601—Cutting
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/0091—Handpieces of the surgical instrument or device
• • 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
  • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• • 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
  • A61B2018/1475—Electrodes retractable in or deployable from a housing

Definitions

• the present invention relates to an endoscopic treatment device.
• This application claims the benefit of U.S. Provisional Application No. 63/564,938, filed March 13, 2024, the entire text of which is incorporated herein by reference.
• endoscopic treatments such as ESD (endoscopic submucosal dissection) have used endoscopic treatment instruments for incision and dissection, such as high-frequency knives, and endoscopic treatment instruments for local injection.
• ESD endoscopic submucosal dissection
• the endoscopic treatment tool described in Patent Document 1 is equipped with a rod that can be freely advanced and retracted relative to the electrode, and can perform incision and ablation procedures and local injection procedures.
• Patent Document 1 requires the surgeon to intentionally change the operation of advancing and retracting the electrode and the rod depending on the treatment situation, and these operations need to be made easier.
• the present invention aims to provide an endoscopic treatment tool that allows for easy operation of electrodes and rods depending on the treatment situation, such as incision/dissection treatment and local injection treatment.
• the endoscopic treatment tool of the present invention allows for easy operation of the electrodes and rods depending on the treatment situation, such as incision/dissection treatment and local injection treatment.
• FIG. 1 is an overall view of an endoscopic treatment system according to a first embodiment.
• FIG. 2 is an overall view showing a treatment tool of the endoscope treatment system.
• FIG. FIG. 2 is a cross-sectional view of the distal end of the treatment tool.
• 10 is a cross-sectional view of the distal end of the treatment tool when the rod is in a third position.
• FIG. 7 is a cross-sectional view taken along line X1-X1 shown in FIG. 6.
• FIG. 2 is a cross-sectional view of an operating member and an operating portion.
• 10A and 10B are diagrams illustrating the operation of the treatment tool. Same as above. Same as above. Same as above.
• FIG. 10 shows the rod piercing tissue.
• FIG. 10 shows the rod piercing tissue.
• FIG. 10 shows a knife for delivering liquid into tissue.
• 10A and 10B are diagrams illustrating modified examples of the elastic body.
• FIG. 10 is a diagram showing a modified example of the lever. 17 is a cross-sectional view taken along line X2-X2 shown in FIG. 16.
• FIG. 10 is a diagram showing a modified example of the operation unit. Same as above.
• FIG. 10 is a diagram showing a modified example of the rod.
• 10A and 10B are diagrams showing a modified example of the first connector of the treatment tool.
• 10A and 10B are diagrams showing another modified example of the first connector.
• 10A and 10B are diagrams showing another modified example of the first connector.
• 10A and 10B are diagrams showing another modified example of the first connector.
• FIG. 10 is a view showing a distal end portion of a modified example of the treatment tool.
• 10A and 10B are diagrams illustrating the operation of the treatment tool according to the second embodiment. Same as above. Same as above. Same as above. Same as above. Same as above. 10A and 10B are diagrams illustrating the operation of the treatment tool according to the third embodiment. Same as above. 10A and 10B are diagrams showing a modified example of the first connector of the treatment tool. 10A and 10B are diagrams showing another modified example of the first connector. 10A and 10B are diagrams illustrating modified examples of the elastic body.
• FIG. 1 is an overall view of the endoscopic treatment system 300 according to this embodiment.
• the endoscopic treatment system 300 includes an endoscope 200 and a treatment tool 100.
• the treatment tool 100 is inserted into the endoscope 200 when in use.
• the endoscope 200 is a known flexible endoscope and comprises an insertion section 202 that is inserted into the body from the tip, an operating section 207 attached to the base end of the insertion section 202, and a universal cord 210 attached to the operating section 207.
• the insertion section 202 is a long, slender member that can be inserted into a lumen.
• the insertion section 202 has a tip section 201, a bending section 204, and a flexible section 205.
• the tip section 201, bending section 204, and flexible section 205 are connected in this order from the tip side.
• a channel 206 for inserting the treatment tool 100 is provided inside the insertion section 202.
• the tip section 201 is provided with a tip opening 206a of the channel 206 and an imaging section 203.
• the imaging unit 203 is equipped with an imaging element such as a CCD or CMOS, and is capable of capturing an image of the area to be treated.
• the imaging unit 203 can capture an image of the tip of the treatment tool 100 when the treatment tool 100 protrudes from the tip opening 206a of the channel 206.
• the bending portion 204 bends in response to the operator's operation of the operating unit 207.
• the flexible portion 205 is a flexible tubular portion.
• the operation unit 207 is connected to the flexible section 205.
• the operation unit 207 has a grip 208, an input unit 209, and a proximal end opening 206b of the channel 206.
• the grip 208 is the part that is held by the operator.
• the input unit 209 accepts operation input for bending the bending section 204.
• the universal cord 210 connects the endoscope 200 to external devices.
• An imaging cable, optical fiber cable, or the like is inserted into the universal cord 210, and outputs the imaging signal captured by the imaging unit 203 to the outside.
• FIG. 2 is an overall view showing the treatment tool 100.
• the treatment tool (endoscopic treatment tool) 100 includes an outer sheath 1, a knife 2, a rod 3, an operating member 4 (see FIG. 4 ), and an operating section 5.
• the longitudinal direction (longitudinal axis direction, axial direction) A of the treatment tool 100 the side that is inserted into the patient's body is referred to as the "tip side (distal side) A1," and the side of the operating section 5 is referred to as the "base side (proximal side) A2.”
• the outer sheath 1 is a long tubular member extending from the distal end 1a to the proximal end 1b.
• the outer sheath 1 can be inserted into the channel 206 of the endoscope 200 and can be advanced and retracted through the channel 206. As shown in Figure 1, when the outer sheath 1 is inserted into the channel 206, the distal end 1a of the outer sheath 1 can be protruded and retracted from the distal end opening 206a of the channel 206.
• FIG. 3 is a perspective view of the distal end of the treatment tool 100.
• the outer sheath 1 has a tube 10 extending in a longitudinal direction A and a tip member 11 provided at the tip of the tube 10.
• the outer sheath 1 may be formed by integrally molding the tube 10 and the tip member 11.
• the tube 10 is a long, flexible, and insulating tubular member.
• the tube 10 is made of, for example, resin.
• the tip member 11 is fitted and attached to the inside of the tube 10.
• the tip member 11 may also be adhered to the tube 10 with an adhesive or the like.
• the tip member 11 is formed in a cylindrical shape. Note that “cylindrical” includes not only a strictly cylindrical shape but also a shape that is close to a cylindrical shape.
• the tip member 11 is preferably formed from an insulating material such as resin.
• a first through hole 12 is formed in the tip member 11.
• the first through hole 12 is a hole provided in the tip member 11 and passes through the tip member 11 in the longitudinal direction A.
• the tip of the first through hole 12 communicates with a tip opening 12a formed in the tip surface 14 of the tip member 11.
• the base end of the first through hole 12 communicates with the internal space 19 of the tube 10.
• the knife 2 is inserted through the first through hole 12.
• FIG. 4 and 5 are cross-sectional views of the distal end portion of the treatment tool 100.
• the knife (electrode, knife electrode) 2 is a metal rod-shaped member. Note that "rod-shaped” includes not only a strict round bar shape but also a shape close to a round bar shape.
• the knife 2 is formed from a material such as stainless steel.
• the knife 2 is conductive and is energized with high-frequency current.
• the knife 2 has a knife body 20, a flange 21, and a first connector 22.
• the knife 2 is inserted through the first through-hole 12 of the distal end member 11 of the outer sheath 1 along the longitudinal direction A, and can freely protrude and retract from the distal end opening 12a to the distal end side A1.
• the knife 2 may also be fixed in a state where it cannot move forward or backward while protruding from the distal end opening 12a to the distal end side A1.
• the central axis O2 of the knife 2 in the longitudinal direction A preferably coincides with the central axis O1 of the outer sheath 1 in the longitudinal direction A. Note that “coincidence” includes not only exact coincidence but also near coincidence.
• the knife body 20 is a round bar-shaped member made of metal.
• the outer diameter of the knife body 20 is smaller than the inner diameter of the first through hole 12.
• the knife body 20 can move forward and backward through the first through hole 12 in the longitudinal direction A.
• the flange (tip enlarged diameter portion) 21 is a disc-shaped conductive member provided at the tip of the knife body 20.
• the length D2 of the flange 21 in the radial direction R perpendicular to the longitudinal direction A is longer than the length D1 of the knife body 20 in the radial direction R.
• a flat base end surface 21b is formed on the base end side A2 of the flange 21. Note that the flange 21 is not limited to a disc shape, and may also be triangular or hook-shaped.
• the knife body 20 and flange 21 have a first duct 23 extending along the longitudinal direction A.
• the first duct 23 is connected to a tip opening 23a formed in the flange 21.
• the tip opening 23a is an opening provided on the tip side A1 of the flange 21.
• the first connector (butting member) 22 is a cylindrical member made of metal. Note that "cylindrical” includes not only a strictly cylindrical shape but also a shape close to a cylindrical shape.
• the first connector 22 connects the knife body 20 and the inner tube 41. Specifically, the outer peripheral surface of the knife body 20 and the inner peripheral surface of the first connector 22 are fixed by welding or the like, and the outer peripheral surface of the first connector 22 and the inner peripheral surface of the inner tube 41 are fixed by welding or the like.
• the first connector 22 cannot be inserted through the first through-hole 12 in the longitudinal direction A.
• the first conduit 23 is in communication with the internal space 43 formed in the inner tube 41.
• An inner tube 41 is attached to the base end of the knife body 20 via a first connector 22. High-frequency current is supplied to the knife 2 via the inner tube 41, which is connected to the operating unit 5. When high-frequency current is supplied to the knife 2 from the inner tube 41, the knife body 20 and flange 21 function as active electrodes that output high-frequency current to biological tissue.
• the knife 2 when the knife 2 is advanced relative to the outer sheath 1, the distal end 22a of the first connector 22 or the distal end 41a of the inner tube 41 comes into contact with the proximal end surface 15 of the distal end member 11.
• the knife 2 When the distal end 22a of the first connector 22 comes into contact with the proximal end surface 15 of the distal end member 11, the knife 2 is positioned at a first position P1, which is the position on the distal end side A1.
• the knife 2 may also be positioned at the first position P1 when the slider 52 of the operating unit 5, described below, comes into contact with a distal end stopper 51s (see Figure 8).
• the base end surface 21b of the flange 21 comes into contact with the tip surface 14 of the tip member 11.
• the contact between the base end surface 21b of the knife 2 and the tip surface 14 of the tip member 11 positions the knife 2 at the second position P2, which is the position closest to the base end A2.
• the knife 2 may also be positioned at the second position P2 by the slider 52 of the operating unit 5, which will be described later, coming into contact with the base end stopper 51t (see Figure 8).
• FIG. 6 is a cross-sectional view of the distal end of the treatment tool 100 when the rod 3 is in the third position P3.
• the rod (solid needle) 3 is a rod-shaped member, and is preferably made of a non-conductive material such as a resin or ceramic material so as not to conduct electricity against the surgeon's intention, but may also be made of a metal material.
• the rod 3 has a main body 31, a tip 32, and a second connector 33.
• the rod 3 is inserted through the first duct 23 of the knife 2 in the longitudinal direction A and can be freely extended and retracted from the tip opening 23a to the tip side A1.
• the main body 31 and the tip 32 are long, round-rod-shaped members.
• round-rod-shaped includes not only a strict round-rod shape, but also a shape close to a round-rod shape.
• the outer diameters of the main body 31 and the tip 32 are smaller than the inner diameter of the first pipeline 23.
• the main body 31 and the tip 32 can move forward and backward in the longitudinal direction A through the first pipeline 23.
• the tip side A1 of the tip 32 may be formed in a tapered shape.
• the second connector 33 connects the rod 3 and the operating wire 42. Specifically, the base end of the rod 3 and the tip of the operating wire 42 are fixed by welding or the like. The second connector 33 cannot be inserted through the first conduit 23 in the longitudinal direction A.
• FIG. 7 is a cross-sectional view taken along the line X1-X1 shown in FIG.
• the second connector 33 does not have a circular cross section perpendicular to the longitudinal axis A, but has a shape with a portion of the circle cut out (e.g., a D-cut shape). That is, in a cross section at least at the distal end of the second connector 33, at least a portion of the outer shape of the second connector 33 is formed by an outer surface 33s extending in a direction perpendicular to the longitudinal axis of the rod 3.
• the number of outer surfaces 33s is not limited to one, and may be multiple.
• the shape with a portion of the circle cut out may also be a shape with a concave outer surface.
• the outer surface 33s may be formed over the entire length of the second connector 33, from the distal end to the proximal end. With this configuration, as shown in FIG. 6 , even when the second connector 33 abuts against the proximal end of the knife body 20, the internal space 43 of the inner tube 41 communicates with the first conduit 23.
• the shape of the second connector 33 is not limited to this, as long as it can form a flow path that connects the internal space 43 and the first conduit 23 when the second connector 33 abuts against the proximal end of the knife body 20.
• the tip of the second connector 33 is not limited to a circular shape with a part cut out, but may be rectangular or oval.
• FIG. 8 is a cross-sectional view of the operating member 4 and the operating portion 5.
• the operating member 4 has an inner tube 41 that passes through the internal space (duct, lumen) 19 of the outer sheath 1 , and an operating wire 42 that passes through the internal space 43 of the inner tube 41 .
• the inner tube (first operating member) 41 is a conductive tube that operates the knife 2.
• the tip of the inner tube 41 is connected to the knife 2 via the first connector 22.
• the base end of the inner tube 41 is connected to the slider 52 of the operating unit 5.
• the inner tube 41 may be in other forms as long as it is a hollow conductive tube, and may be, for example, a hollow metal coil.
• the operating wire (second operating member) 42 is a wire that operates the rod 3.
• the tip of the operating wire 42 is connected to the rod 3 via the second connector 33.
• the base end of the operating wire 42 passes through a through-hole 41b provided at the base end of the inner tube 41 and is connected to the lever 56 of the operating unit 5.
• the operating wire 42 may be of other types as long as it is a member that can move the rod 3 back and forth.
• the rod 3 and the operating wire 42 may be formed as a single unit.
• the rod 3 and the operating wire 42 may be a single wire or a stranded wire that is processed so that the distal end has a smaller diameter than the proximal end.
• the operating unit (handle) 5 has a handle body 51, a slider 52, a power supply plug 53, a liquid delivery port 54, a suction port 55, a lever 56, and an elastic body 57.
• the distal end of the handle body 51 is connected to the proximal end 1b of the outer sheath 1.
• the handle body 51 has an internal space 59 through which the inner tube 41 can be inserted.
• the inner tube 41 passes through the internal space 19 of the tube 10 and the internal space 59 of the handle body 51, extending to the slider 52.
• the operating wire 42 passes through the internal space 43 of the inner tube 41 and the internal space 59 of the handle body 51, extending to the lever 56.
• the slider (second slider) 52 is attached to the handle body 51 so that it can move along the longitudinal direction A.
• the base end of the inner tube 41 is attached to the slider 52.
• the power supply plug 53 is fixed to the slider 52.
• the power supply plug 53 can be connected to a high-frequency power supply device (not shown) and is connected to the base end of the inner tube 41.
• the power supply plug 53 can supply high-frequency current supplied from the high-frequency power supply device to the knife 2 via the inner tube 41.
• the power supply plug 53 may also be fixed to the handle body 51 instead of the slider 52.
• the liquid supply port 54 is provided on the slider 52.
• the liquid supply port 54 is connected to the base end of the inner tube 41 and communicates with the internal space 43. Liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (internal space 43, first pipeline 23) and is released from the tip opening 23a. Note that the liquid supply port 54 may also be provided on the handle body 51 instead of the slider 52.
• the suction port 55 is provided in the handle body 51.
• the suction port 55 is connected to the tip of the handle body 51 and is connected to the internal space 59.
• the suction port 55 can be connected to a pump device (not shown). By suctioning through the suction port 55, liquid sucked from the tip opening 12a passes through the suction flow path SR (internal space 19, internal space 59) and is discharged outside the body.
• the lever (first slider) 56 is attached to the slider 52 so that it can move along the longitudinal direction A.
• the base end of the operating wire 42 is attached to the lever 56.
• the elastic body 57 is located between the handle body 51 and the lever 56, and connects the handle body 51 and the lever 56.
• the tip of the elastic body 57 is attached to the handle body 51, and the base end of the elastic body 57 is attached to the lever 56.
• the elastic body 57 is connected to the operating wire 42 via the lever 56.
• the elastic body 57 biases the lever 56 toward the base end side A2 so that the tip 3a of the rod 3 is housed in the internal space 43 of the inner tube 41.
• the tip 3a of the rod 3 is located inside the inner tube 41, and when the rod 3 is advanced against the elastic force of the elastic body 57, the rod 3 is biased by the elastic body 57 in the direction toward the base end side A2.
• the tip 3a of the rod 3 is located closer to the base end side A2 than the tip of the outer sheath 1.
• the elastic body 57 may bias the tip of the rod 3 so that it is housed closer to the base end A2 than the tip of the knife 2.
• the elastic body 57 may specifically be a spring, or may be made of rubber instead.
• the lever 56 may be composed of two or more parts.
• the lever 56 may be composed of a first member connected to the operating wire 42 and the elastic body 57, and a second member that the surgeon touches and operates.
• FIGS. 9 to 12 are diagrams illustrating the operation of the treatment tool 100.
• the surgeon advances the knife 2 relative to the outer sheath 1 by advancing the slider 52 relative to the handle body 51.
• the knife 2 is positioned at the first position P1. Because the elastic body 57 biases the lever 56 toward the proximal end A2, the tip 3a of the rod 3 remains in a position (fourth position P4) where it is housed in the internal space 43 of the inner tube 41. At this time, the tip 3a of the rod 3 is positioned closer to the proximal end A2 than the tip of the outer sheath 1.
• the surgeon advances the lever 56 relative to the slider 52, thereby advancing the rod 3 relative to the knife 2.
• the rod 3 is positioned at the third position P3, with the tip 32 protruding from the tip opening 23a toward the tip side A1.
• the lever 56 moves toward the base side A2 due to the elastic force of the elastic body 57.
• the tip 3a of the rod 3 returns to the fourth position P4, where it is housed within the internal space 43 of the inner tube 41.
• the surgeon retracts the slider 52 relative to the handle body 51, thereby retracting the knife 2 relative to the outer sheath 1.
• the knife 2 is positioned at the second position P2.
• the elastic body 57 biases the lever 56 toward the proximal side A2, causing the tip 3a of the rod 3 to move to the fourth position P4, where it is housed in the internal space 43 of the inner tube 41.
• the tip 3a of the rod 3 is positioned closer to the proximal side A2 than the tip of the outer sheath 1.
• the surgeon advances the lever 56 relative to the slider 52, thereby advancing the rod 3 relative to the knife 2.
• the rod 3 is positioned at the third position P3, with the tip 32 protruding from the tip opening 23a toward the tip side A1.
• the lever 56 moves toward the base side A2 due to the elastic force of the elastic body 57.
• the tip 3a of the rod 3 moves to the fourth position P4, where it is housed in the internal space 43 of the inner tube 41.
• the surgeon identifies the lesion using a known method. Specifically, the surgeon inserts the insertion section 202 of the endoscope 200 into the digestive tract (e.g., esophagus, stomach, duodenum, or large intestine) and identifies the lesion while observing the image obtained by the imaging section 203 of the endoscope.
• the digestive tract e.g., esophagus, stomach, duodenum, or large intestine
• ⁇ Insertion step> The operator inserts the treatment tool 100 into the channel 206 and causes the distal end 1 a of the outer sheath 1 to protrude from the distal end opening 206 a of the insertion section 202 .
• ⁇ Marking step> 11 the surgeon moves the slider 52 back relative to the handle body 51 to place the knife 2 in the second position P2. Using the flange 21 protruding from the distal end surface 14 of the distal end member 11, the surgeon cauterizes and marks the living tissue around the lesion.
• FIG. 13 shows the rod 3 puncturing the tissue. 10
• the surgeon advances the slider 52 relative to the handle body 51 to place the knife 2 in a first position P1.
• the surgeon also advances the lever 56 relative to the slider 52 to place the rod 3 in a third position P3.
• the surgeon punctures and penetrates the site in the lesion where a local injection liquid (local injection liquid) is to be injected with the rod 3.
• a local injection liquid local injection liquid
• FIG. 14 shows a knife 2 for delivering liquid into tissue.
• the surgeon releases the lever 56, causing the rod 3 to retract and move to the fourth position P4.
• This ensures a wide water supply flow path WR (internal space 43, first conduit 23).
• the surgeon inserts the tip of the knife 2 (including the tip opening 23a) into the submucosal layer through the hole formed by puncturing with the rod 3, or with the tip of the knife 2 in contact with the tissue surface, delivers liquid (local injection liquid) into the tissue from the liquid supply port 54.
• the liquid (local injection liquid) is released from the tip opening 23a and injected into the tissue.
• ⁇ Incision and peeling step> the surgeon performs the incision and dissection procedure. As shown in Figure 9, the surgeon advances the knife 2 and moves the flange 21 while high-frequency current is being applied to incise the mucosa at the lesion. The surgeon also advances the knife 2 and, while high-frequency current is being applied, lifts the mucosa at the incised lesion to expose the submucosal layer, and dissects the submucosal layer at the incised lesion.
• the treatment tool 100 allows for easy operation of the knife 2 and rod 3 depending on the treatment situation, such as incision/dissection treatment or local injection treatment.
• the surgeon does not need to operate the lever 56 backward, and the rod 3 is automatically stored in the internal space 43 of the inner tube 41 when the surgeon releases the lever 56, simplifying the procedure. It also prevents the surgeon from unintentionally operating the knife 2 with the rod 3 protruding.
• FIG. 15 shows an elastic body 57A, which is a modified example of the elastic body 57.
• the distal end of the elastic body 57A is attached to the lever 56, and the proximal end of the elastic body 57A is attached to the handle main body 51.
• a restoring force (elastic force) acts on the elastic body 57A as the elastic body 57A deforms, causing the lever 56 to move toward the proximal end side A2.
• the elastic body 57A biases the lever 56 toward the proximal end side A2 so that the distal end 3a of the rod 3 is accommodated in the internal space 43 of the inner tube 41.
• the elastic body 57A when the elastic body 57A has restored its original shape, the distal end 3a of the rod 3 is located inside the inner tube 41.
• the rod 3 advances against the elastic force of the elastic body 57A, the rod 3 is biased by the elastic body 57A in the direction toward the proximal end side A2.
• the tip 3a of the rod 3 is located on the proximal side A2 relative to the tip of the outer sheath 1.
• the elastic body 57A may be a spring, or may be made of rubber.
• FIG. 16 shows a lever 56A, which is a modified version of the lever 56.
• FIG. 17 is a cross-sectional view taken along line X2-X2 in FIG. 16.
• the lever 56A is attached to the outer periphery of the handle body 51, not to the slider 52, and is movably attached to the handle body 51 along the longitudinal direction A.
• a hollow pipe 58 is provided in the internal space 59 of the handle body 51.
• the pipe 58 connects the inner tube 41 and the slider 52.
• the operating wire 42 is inserted through the pipe 58 and connected to the lever 56A.
• An elastic body 57 is inserted through the pipe 58 and connects the handle body 51 and the lever 56A.
• the surgeon can operate the lever 56A independently of the slider 52. That is, moving the slider 52 along the longitudinal direction A does not move the lever 56A, and moving the lever 56A along the longitudinal direction A does not move the slider 52.
• the operation unit 5A has a sheath slider 50, a handle main body 51, a power supply plug 53, a liquid supply port 54, a suction port 55, a lever 56A, and an elastic body 57. Note that the power supply plug 53, the liquid supply port 54, and the suction port 55 are not shown.
• the sheath slider 50 is connected to the proximal end 1b of the outer sheath 1 and is movable forward and backward relative to the handle main body 51.
• the proximal end 41d of the inner tube 41 is attached to the handle main body 51 so as to be immovable. The surgeon can move the outer sheath 1 forward and backward relative to the knife 2 by moving the sheath slider 50 forward and backward relative to the handle main body 51. Note that the inner tube 41 may be movable forward and backward in conjunction with the outer sheath 1.
• (Variation 4) 20 is a diagram showing a rod 3A, which is a modified example of the rod 3.
• the rod 3A moves to a position where the tip 3a is housed in the first channel 23 of the knife 2.
• the tip 3a of the rod 3A may be located between the tip and base ends of the tip member 11 in the longitudinal axis direction A.
• FIG. 21 is a diagram showing a first connector 22A that is a modified example of the first connector 22.
• the tip 41a of the inner tube 41 attached to the first connector 22 is exposed at the tip 22a of the first connector 22 and can come into contact with the base end surface 15 of the tip member 11.
• the first connector 22A shown in Figure 21 has a step 22s on its outer surface that engages with the tip 41a of the inner tube 41.
• the tip 41a of the inner tube 41 is not exposed at the tip 22a of the first connector 22.
• the tip 22a of the first connector 22A abuts against the base end surface 15 of the tip member 11 and is reliably positioned.
• the tip 41a of the inner tube 41 can be easily connected to the step 22s of the first connector 22A, facilitating assembly.
• FIG. 22 shows a first connector 22B, which is a modified example of the first connector 22.
• the first connector 22B has a protrusion 22b extending radially inward on the inner surface at the proximal end, and the knife body 20 is fixed by welding or the like in a state where the protrusion 22b abuts against the protrusion 22b.
• the protrusion 22b of the first connector 22B is located on the proximal side A2 of the knife body 20.
• the proximal side A2 of the protrusion 22b is formed with a slope (tapered surface) 22c so as to come into contact with the second connector 33.
• the slope 22c is tapered, with its diameter decreasing from the proximal side A2 to the distal side A1. Therefore, when the lever 56 is advanced relative to the slider 52 with the distal end 3a of the rod 3 positioned within the internal space 43, the distal end 3a of the rod 3 can be smoothly inserted into the knife body 20 without getting caught on the first connector 22B.
• the second connector 33 of the rod 3 comes into contact with the inclined surface 22c of the first connector 22B. This contact between the second connector 33 of the rod 3 and the first connector 22B positions the rod 3 at a third position P3, which is the most distal end A1 position.
• the protrusion 22b may have a reduced diameter.
• the shape of the second connector 33 is not limited as long as it can form a flow path that connects the internal space 43 to the first conduit 23 when the first connector 22B and the second connector 33 come into contact.
• the distal end of the second connector 33 is not limited to a circular shape with a partially cut-out portion, and may be rectangular or elliptical.
• a slit that can become a flow path when the first connector 22B and the second connector 33 abut may be formed on the tapered surface 22c.
• Figure 23 shows a first connector 22Ba, which is a modified example of the first connector 22B.
• the first connector 22Ba has a protrusion 22p extending radially outward on the outer surface of the tip side A1 of the first connector 22Ba, and the outer surface of the base end side of the first connector 22Ba is covered by the tip portion 41s of the inner tube 41.
• the tip 41a of the inner tube 41 is fixed by welding or the like in a state where it abuts against the protrusion 22p. Therefore, the tip 41a of the inner tube 41 is not exposed at the tip 22a of the first connector 22Ba. With this configuration, the tip 22a of the first connector 22Ba abuts against the base end surface 15 of the tip member 11 and is reliably positioned.
• the tip 41a of the inner tube 41 can be easily connected to the step 22s of the first connector 22Ba, facilitating assembly. Even when the second connector 33 and the first connector 22Ba come into contact, the internal space 43 of the inner tube 41 communicates with the first pipeline 23.
• the shape of the second connector 33 is not limited as long as it can form a flow path that connects the internal space 43 and the first pipeline 23 when the first connector 22Ba and the second connector 33 come into contact.
• the tip of the second connector 33 is not limited to a partially cut-out circular shape, and may also be rectangular or oval.
• a slit that can become a flow path when the first connector 22Ba and the second connector 33 come into contact may be formed on the tapered surface 22c.
• Figure 24 shows a first connector 22Bb, which is a modified example of the first connector 22B.
• the second connector 33B has a larger outer diameter than the second connector 33B.
• the inclined surface 22c of the first connector 22Bb extends further outward in the radial direction R than the inclined surface 22c of the first connector 22B.
• the inclined surface 22c of the first connector 22Bb has a length in the radial direction R (outer diameter) longer than the outer diameter of the knife body 20, allowing for sufficient contact with the second connector 33B.
• the second connector 33B abuts against the inclined surface 22c of the first connector 22Bb, but does not abut against the knife body 20.
• the tip 22a of the first connector 22Bb abuts against the base end surface 15 of the tip member 11, ensuring reliable positioning. Even when the second connector 33B and the first connector 22Bb come into contact, the internal space 43 of the inner tube 41 is connected to the first pipeline 23.
• the shape of the second connector 33B is not limited as long as it can form a flow path connecting the internal space 43 and the first pipeline 23 when the first connector 22Bb and the second connector 33B come into contact.
• the tip of the second connector 33B is not limited to a partially cut-out circular shape, and can also be rectangular or oval.
• a slit that can become a flow path when the first connector 22Bb and the second connector 33B come into contact may be formed on the tapered surface 22c.
• FIG. 25 shows a first connector 22C, a modified example of the first connector 22.
• the first connector 22C has an inclined conduit 22d located closer to the proximal end A2 than the proximal end 20b of the knife body 20.
• the inclined conduit 22d is a conduit through which the rod 3 is inserted.
• the inner circumferential surface of the inclined conduit 22d is tapered, decreasing in diameter from the proximal end A2 to the distal end A1. Therefore, when the lever 56 is advanced relative to the slider 52 with the distal end 3a of the rod 3 positioned within the internal space 43, the distal end 3a of the rod 3 can be smoothly inserted into the knife body 20 without being caught on the first connector 22C.
• the second connector 33 of the rod 3 comes into contact with the inner circumferential surface of the inclined conduit 22d of the first connector 22C.
• the second connector 33 comes into contact with the inner circumferential surface of the inclined conduit 22d, the second connector 33 is positioned inside the inclined conduit 22d.
• the cross section of at least the tip of the second connector 33 has an outer surface 33s, at least a portion of which extends in a direction perpendicular to the longitudinal axis of the rod 3. Therefore, even when the second connector 33 and the first connector 22C come into contact with each other, the internal space 43 of the inner tube 41 is more reliably in communication with the first conduit 23.
• the shape of the second connector 33 is not limited as long as it can form a flow path connecting the internal space 43 and the first conduit 23 when the first connector 22C and the second connector 33 come into contact with each other.
• the tip of the second connector 33 is not limited to a partially cut-out circular shape, and may be rectangular or elliptical.
• a slit that can become a flow path when the first connector 22C and the second connector 33 come into contact with each other may be formed on the inner circumferential surface of the inclined conduit 22d.
• FIG. 8 is a diagram showing the distal end of a treatment tool 100A, which is a modified example of treatment tool 100.
• Treatment tool 100A further includes an insulating member 7.
• Insulating member 7 is a non-conductive member such as a resin or ceramic material. Insulating member 7 is provided at the distal end of knife body 20. Insulating member 7 has a through hole 71 penetrating in the longitudinal axis direction A. Through hole 71 communicates with first duct 23. Distal end 32 of rod 3 is inserted through first duct 23 and through hole 71 and can protrude from through hole 71 to distal end side A1.
• FIG. 27 A treatment tool 100B according to a second embodiment of the present invention will be described with reference to Fig. 27 to Fig. 30.
• components common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.
• the treatment tool 100B includes an outer sheath 1, a knife 2, a rod 3, an operating member 4, and an operating portion 5B.
• the operating unit (handle) 5B has a handle body 51, a slider 52, a power supply plug 53, a liquid delivery port 54, a suction port 55, a lever 56, and an elastic body 57B.
• the elastic body 57B is located between the slider 52 and the lever 56, and connects the slider 52 and the lever 56.
• the tip of the elastic body 57B is attached to the slider 52, and the base end of the elastic body 57B is attached to the lever 56.
• the elastic body 57B is connected to the operating wire 42 via the lever 56.
• the elastic body 57B biases the lever 56 toward the base end side A2 so that the tip 3a of the rod 3 is housed in the internal space 43 of the inner tube 41.
• the tip 3a of the rod 3 is located inside the inner tube 41, and when the rod 3 is advanced against the elastic force of the elastic body 57B, the rod 3 is biased by the elastic body 57B in the direction toward the base end side A2.
• the tip 3a of the rod 3 is located closer to the base end side A2 than the tip of the outer sheath 1.
• the elastic body 57B may specifically be a spring, or may be made of rubber instead.
• the surgeon advances the knife 2 relative to the outer sheath 1 by advancing the slider 52 relative to the handle body 51.
• the knife 2 is positioned at the first position P1. Because the elastic body 57B biases the lever 56 toward the proximal end A2, the tip 3a of the rod 3 remains at the fourth position P4, where it is housed in the internal space 43 of the inner tube 41. At this time, the tip 3a of the rod 3 is positioned closer to the proximal end A2 than the tip of the outer sheath 1.
• the lever 56 engages with the first receiving surface 52a formed at the base end of the slider 52 and advances together with the slider 52 while being pushed by the first receiving surface 52a.
• the relative positional relationship between the knife 2 and rod 3 in the longitudinal axis direction A is maintained.
• the surgeon advances the lever 56 relative to the slider 52, thereby advancing the rod 3 relative to the knife 2.
• the rod 3 is positioned at the third position P3, with the tip 32 protruding from the tip opening 23a toward the tip side A1.
• the lever 56 moves toward the base side A2 due to the elastic force of the elastic body 57B.
• the tip 3a of the rod 3 moves to the fourth position P4, where it is housed in the internal space 43 of the inner tube 41.
• the surgeon retracts the slider 52 relative to the handle body 51, thereby retracting the knife 2 relative to the outer sheath 1.
• the knife 2 is positioned at the second position P2.
• the elastic body 57B biases the lever 56 toward the proximal side A2, causing the tip 3a of the rod 3 to move to the fourth position P4, where it is housed in the internal space 43 of the inner tube 41.
• the tip 3a of the rod 3 is positioned closer to the proximal side A2 than the tip of the outer sheath 1.
• the surgeon advances the lever 56 relative to the slider 52, thereby advancing the rod 3 relative to the knife 2.
• the rod 3 is positioned at the third position P3, with the tip 32 protruding from the tip opening 23a toward the tip side A1.
• the lever 56 moves toward the base side A2 due to the elastic force of the elastic body 57B.
• the tip 3a of the rod 3 moves to the fourth position P4, where it is housed in the internal space 43 of the inner tube 41.
• the treatment tool 100B allows for easy operation of the knife 2 and rod 3 depending on the treatment situation, such as incision/dissection treatment and local injection treatment.
• the surgeon does not need to operate the lever 56 backward; when the surgeon releases the lever 56, the rod 3 is automatically stored in the internal space 43 of the inner tube 41, simplifying the procedure. It also prevents the surgeon from unintentionally operating the knife 2 with the rod 3 protruding. Because the knife 2 and rod 3 can be moved forward and backward relatively in the longitudinal axis direction A, the stroke of the lever 56 relative to the slider 52 can be reduced.
• a treatment tool 100C according to a third embodiment of the present invention will be described with reference to Figures 31 and 32.
• components common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.
• the treatment tool (endoscopic treatment tool) 100C includes an outer sheath 1, a knife 2, a rod 3, an operating member 4, an operating portion 5C, and an elastic body 6.
• the knife 2 is similar to the first embodiment and includes a knife body 20, a flange 21, and a first connector 22.
• the knife body 20 and flange 21 have a first duct 23 extending along the longitudinal direction A.
• the first connector (butting member) 22 connects the knife body 20 to the inner tube 41.
• the first connector 22 cannot be inserted through the first through-hole 12 in the longitudinal direction A.
• the first duct 23 is connected to an internal space 43 formed in the inner tube 41.
• the rod 3 is similar to that in the first embodiment and has a main body 31, a tip 32, and a second connector 33.
• the rod 3 is inserted through the first duct 23 of the knife 2 in the longitudinal direction A and can freely protrude and retract from the tip opening 23a to the tip side A1.
• the second connector 33 connects the rod 3 to the operating wire 42.
• the second connector 33 cannot be inserted through the first duct 23 in the longitudinal direction A.
• the operating unit 5C has a handle body 51, a slider 52, a power supply plug 53, a liquid delivery port 54, a suction port 55, and a lever 56.
• the operating unit 5C does not have an elastic body.
• the elastic body 6 is located in the internal space 43 of the inner tube 41, between the base end 20b of the knife body 20 and the second connector 33 in the longitudinal axis direction A.
• the elastic body 6 urges the rod 3 toward the base end side A2 so that the tip end 3a of the rod 3 is housed in the internal space 43 of the inner tube 41. That is, as in the first embodiment, when the elastic body 6 has restored to its original shape, the tip end 3a of the rod 3 is located inside the inner tube 41, and when the rod 3 is advanced against the elastic force of the elastic body 6, the rod 3 is urged by the elastic body 6 in the direction toward the base end side A2. Note that when the elastic body 6 has restored to its original shape, the tip end 3a of the rod 3 is located closer to the base end side A2 than the tip of the outer sheath 1.
• the elastic body 6 may specifically be a spring, or may be rubber.
• the surgeon advances the knife 2 relative to the outer sheath 1 by advancing the slider 52 relative to the handle body 51.
• the knife 2 is positioned at the first position P1.
• the elastic body 6 biases the second connector 33 toward the base end side A2, causing the tip 3a of the rod 3 to move to the fourth position P4 where it is housed in the internal space 43 of the inner tube 41.
• the tip 3a of the rod 3 is positioned closer to the base end side A2 than the tip of the outer sheath 1.
• the lever 56 engages with the first receiving surface 52a formed at the base end of the slider 52 and advances together with the slider 52 while being pushed by the first receiving surface 52a.
• the relative positional relationship between the knife 2 and rod 3 in the longitudinal axis direction A is maintained.
• the surgeon advances the lever 56 relative to the slider 52, thereby advancing the rod 3 relative to the knife 2.
• the rod 3 is positioned at the third position P3, with the tip 32 protruding from the tip opening 23a toward the tip side A1.
• the elastic force of the elastic body 6 causes the rod 3 to move toward the base side A2.
• the tip 3a of the rod 3 moves to the fourth position P4, where it is housed in the internal space 43 of the inner tube 41.
• the treatment tool 100C makes it easy to operate the knife 2 and rod 3 according to the treatment situation, such as incision/dissection treatment and local injection treatment. It also prevents the surgeon from unintentionally operating the knife 2 with the rod 3 protruding. Compared to treatment tool 100C with an elastic body 57 provided in the operating section 5, the stroke amount of the rod 3 is less affected by the curved shape of the insertion section 202 of the endoscope 200, making it easier to control the amount of puncture of the rod 3 into the tissue.
• (Variation 3-1) 33 is a diagram showing a first connector 22E that is a modified example of the first connector 22.
• the first connector 22E has a reduced diameter portion 22b that is located on the proximal side A2 relative to the proximal end 20b of the knife body 20.
• the elastic body 6 is located in the internal space 43 of the inner tube 41, and is located between the first connector 22E and the second connector 33 in the longitudinal axis direction A.
• FIG. 34 shows a first connector 22D, which is a modified example of the first connector 22.
• the first connector 22D has a guide duct 22g extending to the proximal side A2.
• the guide duct 22g is a duct that houses the elastic body 6.
• the elastic body 6 housed in the guide duct 22g is guided by the guide duct 22g, allowing the tip 3a of the rod 3 to smoothly expand and contract without getting caught on the wire of the elastic body 6. Note that, when the elastic body 6 is in its restored state, a portion of the second connector 33 may be inserted into the guide duct 22g of the first connector 22D.
• the tip of the operating wire 42 may be inserted into the guide duct 22g of the first connector 22D.
• the first connector 22D and the second connector 33 are less likely to get caught, allowing for smooth operation of the rod 3 relative to the knife body 20.
• (Other Modifications) 35 is a diagram showing elastic body 57C, which is a modification of elastic body 57B.
• Elastic body 57C is formed by forming the tip of lever 56 into a spring shape.
• elastic body 57C and lever 56 are molded integrally.
• Lever 56 and elastic body 57C exert the same effect as lever 56 and elastic body 57B, which are separate bodies. Note that a configuration in which multiple parts are molded integrally, such as molding elastic body 57B and lever 56 integrally, is applicable to all embodiments and modifications.
• the present invention can be applied to endoscopic treatment tools with water supply functions.
• Endoscope treatment system 200 Endoscope 100, 100A, 100B, 100C Treatment tool (endoscopic treatment tool) 1 Outer sheath 10 Tube 11 Distal end member 12 First through hole 12a Distal end opening 14 Distal end surface 15 Base end surface 19 Internal space (duct, lumen) 2.
• Knife (electrode, knife electrode) 20 Knife body 21 Flange (tip enlarged diameter portion) 21b: base end surface 22, 22A, 22B, 22Ba, 22Bb, 22C, 22D, 22E: first connector (butting member) 23 First conduit 23a Tip opening 3, 3A Rod (solid needle) 3a Tip 31 Main body 32 Tip portion 33 Second connector 4 Operation member 41 Inner tube (first operation member) 42 Operating wire (second operating member) 43 Internal space 5, 5A, 5B, 5C Operation part (handle) 50 Sheath slider 51 Handle body 51s Distal end stopper 51t Proximal end stopper 52 Slider (second slider) 53 Power supply plug 54 Liquid supply port 55 Suction port 56, 56A Lever (first slider) 57, 57A, 57B, 57C Elastic body 58 Pipe 59 Internal space 6 Elastic body 7 Insulating member P1 First position P2 Second position P3 Third position P4 Fourth position SR Suction flow path WR Water supply flow path

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  • 2025-01-26 CN CN202510124348.XA patent/CN120643260A/zh active Pending
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