Instruments for endoscopy, and endoscopes having the same.

Abstract

The treatment instrument is moved to the position desired by the user. [Solution] The treatment instrument 10 is used by inserting it into the passage 72a of the insertion section 72 of the endoscope 70. The treatment instrument 10 comprises a grip 20, a sheath 30, and a treatment instrument body 40. The grip 20 has a first movable part 22. The first movable part 22 is operated by the user. The sheath 30 is cylindrical. The sheath 30 has a sheath end 36 and a sheath tip 35. The sheath end 36 is connected to the grip 20. The sheath tip 35 is on the opposite side of the sheath end 36. The sheath 30 curves in accordance with the movement of the first movable part 22. The treatment instrument body 40 has an end effector 41. The end effector 41 is inserted into the sheath 30. The end effector 41 is for excising or manipulating the patient's internal tissue on the side of the sheath tip 35.

Description

[Technical Field]

[0001] The present disclosure relates to a treatment instrument for an endoscope, and specifically to a treatment instrument used by being inserted into a channel of an insertion portion of an endoscope. The present disclosure further relates to an endoscope including such a treatment instrument. [Background Art]

[0002] The endoscope disclosed in Patent Document 1 (Japanese Patent No. 5285122) includes an insertion portion. The insertion portion is a long member to be inserted into a patient's body, and a camera is provided at the distal end thereof. A doctor who is a user of the endoscope can bend the insertion portion by operating an operation portion connected to the proximal end of the insertion portion, and move the camera according to his / her own intention.

[0003] Such an endoscope is often used together with a treatment instrument for performing some kind of treatment on affected tissue in the body. The treatment instrument is also a long member similar to the insertion portion. The insertion portion of the endoscope is formed in a tubular shape, and the treatment instrument can be inserted into an internal channel thereof.

[0004] The insertion portion is thicker than the treatment instrument, and the distal end thereof is less likely to approach the affected area. For this reason, when a doctor performs treatment using the treatment instrument, the distal end of the treatment instrument may be protruded from the distal end of the insertion portion. [Prior Art Documents] [Patent Documents]

[0005] [Patent Document 1] Patent No. 5285122 [Summary of the Invention] [Problem to be Solved by the Invention]

[0006] When a physician wants to move the tip of a medical instrument to a desired position, they can use the curvature of the insertion tube. However, if the instrument protrudes from the tip of the insertion tube, it is difficult for the physician to move the tip of the instrument precisely to the desired position.

[0007] One of the purposes of this disclosure is to provide a treatment instrument that allows the tip to be easily moved to the desired position by the physician. [Means for solving the problem]

[0008] The following describes several elements as means to solve the problem. These elements can be combined as needed.

[0009] In one aspect of this disclosure, the instrument is used by being inserted into the passage of the insertion section of an endoscope. The instrument comprises a grip, a sheath, and an instrument body. The grip has a first movable part, which is operated by the user. The sheath is cylindrical, and has a sheath end and a sheath tip. The sheath end is connected to the grip, and the sheath tip is opposite the sheath end. The sheath curves in accordance with the movement of the first movable part. The instrument body has an end effector, which is inserted into the sheath. The end effector is for excising or manipulating patient tissue located on the side of the sheath tip.

[0010] Preferably, the instrument body further includes an electric wire, which is connected to an end effector. The end effector further functions as an energy device that receives power from a power supply connected to the electric wire to perform incision or coagulation of internal tissue. The instrument further includes a smoke exhaust channel, which is connected to a suction device. The smoke exhaust channel is for guiding smoke generated near the end effector from the tip of the sheath to the end of the sheath.

[0011] Preferably, the treatment device body further includes a protective tube. The protective tube covers the wire.

[0012] Preferably, the exhaust gas flow path is formed by the inner circumferential surface of the sheath and the outer circumferential surface of the protective tube.

[0013] Preferably, the grip further has a second movable part, which is operated by the user. The instrument body further has a wire, which is positioned inside a protective tube to transmit the movement of the second movable part to the end effector.

[0014] Preferably, the end effector is a forceps. The wire opens and closes the forceps.

[0015] Preferably, the sheath has a bendable outer cylinder and a bendable inner cylinder. The inner cylinder is inserted into the outer cylinder and joined to the outer cylinder at the joint at the tip of the sheath. The first movable part moves the relative position of the inner cylinder with respect to the outer cylinder at the end of the sheath in order to bend the sheath.

[0016] Preferably, the outer cylinder has an outer cylinder first portion and an outer cylinder second portion. The outer cylinder first portion and the outer cylinder second portion are in contact with each other at their contact surfaces. The contact surfaces extend in the direction of the sheath axis. The inner cylinder has an inner cylinder first portion and an inner cylinder second portion. The inner cylinder first portion and the inner cylinder second portion are in contact with each other at their contact surfaces. The contact surfaces extend in the direction of the sheath axis. The inner cylinder first portion is positioned close to the outer cylinder first portion. The inner cylinder second portion is positioned close to the outer cylinder second portion. When a force is applied to shorten the length of the outer cylinder from the outer cylinder end corresponding to the sheath end to the outer cylinder tip corresponding to the sheath tip, the outer cylinder second portion is more easily shortened than the outer cylinder first portion. When a force is applied to shorten the length of the inner cylinder from the inner cylinder end corresponding to the sheath end to the inner cylinder tip corresponding to the sheath tip, the inner cylinder first portion is more easily shortened than the inner cylinder second portion.

[0017] Preferably, each of the first outer cylinder portion, the second outer cylinder portion, the first inner cylinder portion, and the second inner cylinder portion is made from a single material.

[0018] Preferably, the material constituting each of the first outer cylinder portion, the second outer cylinder portion, the first inner cylinder portion, and the second inner cylinder portion is 50,000 (N / mm 2 ) has a longitudinal elastic modulus exceeding

[0019] Preferably, the second outer cylinder portion has a plurality of outer cylinder slits. The plurality of outer cylinder slits are formed in a direction perpendicular to the axis. The first inner cylinder portion has a plurality of inner cylinder slits. The plurality of inner cylinder slits are formed in a direction perpendicular to the axis.

[0020] Preferably, in the sheath, each of the plurality of outer cylinder slits does not communicate with any of the plurality of inner cylinder slits, whereby the outer cylinder and the inner cylinder cooperate to isolate the outer space and the inner space of the sheath from each other.

[0021] Preferably, the outer diameter of the sheath is 1.5 mm or less.

[0022] In one aspect of the present disclosure, an endoscope includes an operation section, an operation mechanism, an insertion section, a camera, and a treatment tool. The operation section is connected to a display device. The operation mechanism is provided on the operation section and receives a user's operation. The insertion section extends from the operation section and bends according to the movement of the operation mechanism. The camera is disposed at a distal end of the insertion section. The treatment tool is inserted into a passage of the insertion section. The treatment tool is any one of those described above. Effects of the Invention

[0023] According to the treatment tool of the present disclosure, the sheath can be bent according to a user's operation without depending on the bending of the insertion portion of the endoscope, and the user's intention can be accurately reflected in the operation of the end effector. Brief Description of the Drawings

[0024] [Figure 1] It is a schematic diagram showing an endoscope 70 and a treatment tool 10 according to the first embodiment. [Figure 2] It is a schematic diagram showing an external device connected to the endoscope 70 or the treatment tool 10. [Figure 3] This is a schematic cross-sectional view of the treatment instrument 10 at the side of the sheath tip 35. [Figure 4] This is a schematic cross-sectional view of the treatment instrument 10 at the end of the sheath 36. [Figure 5] This is a cross-sectional view of the sheath 30 according to the first embodiment. [Figure 6] This is a schematic diagram showing the outer cylinder 31 and inner cylinder 32 according to the first embodiment. [Figure 7] This is a schematic diagram showing the shrinkage characteristics of each part that makes up the sheath 30. [Figure 8] This figure shows the bending motion of the sheath 30 in the first direction DR1. [Figure 9] This figure shows the bending motion of the sheath 30 in the second direction DR2. [Figure 10] This is a cross-sectional view of the sheath 30 according to the first embodiment. [Figure 11] This is a schematic diagram showing the outer cylinder 31 and inner cylinder 32 according to the first embodiment. [Figure 12] This is a cross-sectional view of the sheath 30 according to a first modified example of the first embodiment. [Figure 13] This is a schematic diagram showing an outer cylinder 31 and an inner cylinder 32 according to a first modified example of the first embodiment. [Figure 14] This is a cross-sectional view of the sheath 30 according to a first modified example of the first embodiment. [Figure 15] This is a schematic diagram showing an outer cylinder 31 and an inner cylinder 32 according to a first modified example of the first embodiment. [Figure 16] This is a schematic diagram showing the endoscope 70 and treatment instrument 10 according to the second embodiment. [Figure 17] This is a schematic cross-sectional view of the treatment tool 10 in the vicinity of the branching unit 50. [Figure 18] This is a schematic diagram showing the endoscope 70 and treatment instrument 10 according to the third embodiment. [Figure 19] This is a schematic diagram showing the treatment device 10 according to the third embodiment. [Figure 20] This is a schematic cross-sectional view of the treatment tool 10 near the communication hole 38. [Figure 21] This is a schematic cross-sectional view showing the insertion of the treatment instrument 10 into the endoscope passage 70a. [Figure 22] This is a schematic cross-sectional view of the sheath tip 35 side of the treatment instrument 10 according to the fourth embodiment. [Figure 23] This is a schematic cross-sectional view of the end 36 of the sheath of the treatment instrument 10 according to the fourth embodiment. [Figure 24] This is a cross-sectional view of the sheath 30 according to the fourth embodiment. [Modes for carrying out the invention]

[0025] <First Embodiment> (1) Schematic configuration (1-1) Endoscope 70 Figure 1 shows an endoscope 70 and treatment instrument 10 according to the first embodiment. The endoscope 70 is used to acquire images or videos of tissue from a diseased area inside the patient's body. The endoscope 70 has an operating unit 71, an insertion unit 72, a camera 73, a cable 74, and a connector 75. The operating unit 71 serves as the interface with the physician, who is the user of the endoscope 70. The operating unit 71 is equipped with an angle knob 71p and various buttons 71q. The angle knob 71p and the various buttons 71q are operating mechanisms that accept input from the physician. The insertion unit 72 is a long part that is inserted into the patient's body. The end of the insertion unit 72 is connected to the operating unit 71. The camera 73 is used to photograph the diseased area. The camera 73 is located at the tip of the insertion unit 72. The cable 74 connects the operating unit 71 and the connector 75. The connector 75 is used to connect the cable 74 to an external display device.

[0026] The insertion section 72 bends in response to the doctor's operation of the angle knob 71p. This allows the doctor to move the position of the camera 73. The various buttons 71q are for the doctor to control the endoscope 70 or external devices.

[0027] The operating section 71 is provided with an operating section passage 71a. The insertion section 72 is provided with an insertion section passage 72a. The operating section passage 71a and the insertion section passage 72a are connected to each other to form an endoscope passage 70a. The endoscope passage 70a is for inserting the treatment instrument 10.

[0028] (1-2) Treatment tool 10 The instrument 10 shown in Figure 1 is for performing treatment on the tissue of an affected area. The instrument 10 has a grip 20, a sheath 30, and an instrument body 40. The grip 20 is held by the physician, who is the user of the instrument 10. The sheath 30 is a flexible, bendable component with a long cylindrical shape. The sheath 30 extends from the tip 35 to the end 36. The tip 35 is located on the opposite side of the end 36. The end 36 is connected to the grip 20. The instrument body 40 has an end effector 41 for performing treatment on the affected area. The end effector 41 is exposed from the tip 35 of the sheath. The instrument body 40 also has a mechanism that transmits the physician's operations on the grip 20 to the end effector 41, and this mechanism is located inside the sheath 30.

[0029] By gripping the grip 20 and pushing the sheath 30 into the endoscope passage 70a, the physician can cause the tip of the instrument 10 to protrude from the tip of the insertion section 72, thereby separating the end effector 41 from the tip of the insertion section 72. The physician can also pull the end effector 41 back to the tip of the insertion section 72 by pulling the grip 20 away from the endoscope passage 70a.

[0030] (1-3) Various operations Figure 2 shows external equipment connected to the endoscope 70 or treatment instrument 10. The connector 75 of the endoscope 70 is connected to a display device 95. The display device 95 is for the physician to view images or videos of the affected area.

[0031] The treatment device 10 is connected to a power supply unit 91 and a suction device 93.

[0032] The power supply unit 91 is a high-frequency power supply for supplying power to the end effector 41 of the treatment instrument 10 in the form of a high-frequency current. The power supply unit 91 is connected to the grip 20 by a high-frequency cable 45. The physician operates the power supply unit 91 using a high-frequency foot switch 92.

[0033] The suction device 93 is for aspirating smoke generated from the affected area and, for example, has a vacuum pump. The suction device 93 is connected to the grip 20 by a smoke exhaust tube 46. The physician operates the suction device 93 using a smoke exhaust foot switch 94.

[0034] The grip 20 is provided with a first movable part 22 and a second movable part 23. By moving the first movable part 22, the physician can adjust the degree of curvature of the sheath 30 of the instrument 10. This allows the physician to move the position of the end effector 41, especially when the end effector 41 protrudes from the tip of the insertion part 72 of the endoscope 70. Furthermore, the physician can operate the end effector 41 by moving the second movable part 23.

[0035] (2) Detailed configuration of the treatment device 10 (2-1) Sheath tip 35 Figure 3 shows the configuration of the treatment instrument 10 at the sheath tip 35. A cylindrical sheath 30 is located at the outermost part of the treatment instrument 10. The sheath 30 consists of an outer cylinder 31 and an inner cylinder 32. The inner cylinder 32 is inserted into the outer cylinder 31. Both the outer cylinder 31 and the inner cylinder 32 are flexible and can bend in response to applied external force. At the joint 37 of the sheath tip 35, the outer cylinder 31 and the inner cylinder 32 are joined to each other. Even at locations other than the joint 37, the inner circumferential surface of the outer cylinder 31 and the outer circumferential surface of the inner cylinder 32 are in substantial contact with each other.

[0036] The treatment instrument body 40 is inserted into the inner cylinder 32 of the sheath 30. The treatment instrument body 40 includes an end effector 41, a wire 42, an electric wire 43, and a protective tube 44.

[0037] As mentioned above, the end effector 41 is for treating the affected area and is exposed from the tip 35 of the sheath. The end effector 41 of this embodiment has two functions. The first function is a forceps. The forceps are for excising a portion of the tissue inside the patient's body, holding the excised tissue, or performing other operations on the tissue. The second function is an energy device. The energy device is for cutting or coagulating tissue by burning the tissue using high-frequency current.

[0038] The end effector 41 has a pair of cup members 41a, 41b, a base 41c, and a pivot axis 41d. The pivot axis 41d is provided on the base 41c. The pair of cup members 41a, 41b are rotatable about the pivot axis 41d so that the end effector 41 can function as forceps, thereby allowing the pair of cup members 41a, 41b to open and close. By closing the cup members 41a, 41b, the end effector 41, functioning as forceps, can excise or hold the tissue from the affected area. Furthermore, the pair of cup members 41a, 41b are made of conductors so that the end effector 41 can function as an energy device.

[0039] The wire 42 is used to allow the end effector 41 to function as forceps. The wire 42 is used to apply force to the cup members 41a and 41b to rotate them. The wire 42 is connected to the second movable part 23 (Figure 2), as will be described later.

[0040] The electric wire 43 is for enabling the end effector 41 to function as an energy device. At one end, the electric wire 43 is electrically connected to each of the pair of cup members 41a and 41b of the end effector 41. At the other end, the electric wire 43 is electrically connected to the power supply unit 91 (Figure 2). The end effector 41 functions as an energy device by receiving power from the power supply unit 91 via the electric wire 43.

[0041] The protective tube 44 is a cylindrical member for protecting the wire 42 and the electric wire 43. The protective tube 44 is provided so as to cover the wire 42 and the electric wire 43. The opening at the end of the protective tube 44 is closed by the base 41c. The protective tube 44 protects the wire 42 and the electric wire 43 from smoke emitted from the affected area.

[0042] The sheath 30 has an outer circumferential surface 30a and an inner circumferential surface 30b. The protective tube 44 has an outer circumferential surface 44a and an inner circumferential surface 44b. A smoke exhaust passage 11 is formed between the inner circumferential surface 30b of the sheath and the outer circumferential surface 44a of the protective tube.

[0043] (2-2) Sheath end 36 Figure 4 shows the configuration of the instrument 10 at the end of the sheath 36. The sheath 30 is connected to the grip 20 at the end of the sheath 36. The sheath 30 and the instrument body 40 are inserted into the grip 20.

[0044] The grip 20 has a grip body 21, a first movable part 22, and a second movable part 23. The physician, who is the user of the endoscope 70, operates the parts of the treatment instrument 10 by gripping the grip body 21 and manipulating the first movable part 22 and the second movable part 23.

[0045] The outer casing 31 of the sheath 30 is fixed to the grip body 21. The electric wire 43 passes through an opening in the grip body 21 and is connected to the high-frequency cable 45. The smoke exhaust channel 11 communicates with the smoke exhaust tube 46 by being connected to another opening in the grip body 21. The smoke exhaust channel 11 guides the smoke generated by the end effector 41, which functions as an energy device, from the tip 35 of the sheath to the end 36 of the sheath, thereby enabling the suction device 93 to suck up the smoke.

[0046] The first movable part 22 is movable relative to the grip body 21. The inner cylinder 32 of the sheath 30 is fixed to the first movable part 22. The sheath 30 curves in accordance with the movement of the first movable part 22. By moving the first movable part 22, the physician can shift the relative position of the inner cylinder 32 with respect to the outer cylinder 31 at the end 36 of the sheath. This relative positional shift causes the sheath 30 to curve.

[0047] The second movable part 23 is also movable relative to the grip body 21. A wire 42 is fixed to the second movable part 23. The wire 42 transmits the movement of the second movable part 23 to the end effector 41. The pair of cup members 41a and 41b of the end effector 41 rotate in accordance with the movement of the second movable part 23. The doctor can open and close the pair of cup members 41a and 41b of the end effector 41 by moving the second movable part 23.

[0048] (3) Detailed configuration of Sheath 30 (3-1) Each part that makes up the sheath 30 Figure 5 shows a cross-section perpendicular to the axis X of the sheath 30. The outer cylinder 31 and inner cylinder 32 are substantially concentric with respect to the axis X of the sheath 30. The outer cylinder 31 and inner cylinder 32 work together to isolate the external space Q1 and the internal space Q2 of the sheath 30. The outer diameter D of the sheath 30 is, for example, 1.5 mm or less.

[0049] The outer cylinder 31 has two parts: a first outer cylinder portion 31a and a second outer cylinder portion 31b. In the cross-section of the sheath 30, both the first outer cylinder portion 31a and the second outer cylinder portion 31b form circular arcs. In this embodiment, the central angle θa of the arc formed by the first outer cylinder portion 31a and the central angle θb of the arc formed by the second outer cylinder portion 31b are both 180°. However, the values ​​of the two central angles θa and θb are not limited to this.

[0050] The inner cylinder 32 has two parts: an inner cylinder first part 32a and an inner cylinder second part 32b. In the cross-section of the sheath 30, both the inner cylinder first part 32a and the inner cylinder second part 32b form an arc. The inner cylinder first part 32a is positioned close to the outer cylinder first part 31a in a cross-section perpendicular to the axis X, and preferably overlaps with the outer cylinder first part 31a in its entirety. To enable this, it is preferable that the arc of the inner cylinder first part 32a has the aforementioned central angle θa. The inner cylinder second part 32b is positioned close to the outer cylinder second part 31b in a cross-section perpendicular to the axis X, and preferably overlaps with the outer cylinder second part 31b in its entirety. To enable this, it is preferable that the arc of the inner cylinder second part 32b has the aforementioned central angle θb.

[0051] Figure 6 shows the outer cylinder 31 and inner cylinder 32 that constitute the sheath 30 separately. Both the outer cylinder 31 and the inner cylinder 32 extend along the axis X of the sheath 30. The first outer cylinder portion 31a and the second outer cylinder portion 31b that constitute the outer cylinder 31 are in contact with each other at contact surfaces that extend in the direction of the axis X of the sheath 30. The first inner cylinder portion 32a and the second inner cylinder portion 32b that constitute the inner cylinder 32 are in contact with each other at contact surfaces that extend in the direction of the axis X of the sheath 30.

[0052] Figure 7 shows the flexibility of each part constituting the sheath 30. The outer cylinder 31 has an outer cylinder tip 31c corresponding to the sheath tip 35 and an outer cylinder end 31d corresponding to the sheath end 36. The inner cylinder 32 has an inner cylinder tip 32c corresponding to the sheath tip 35 and an inner cylinder end 32d corresponding to the sheath end 36.

[0053] With the outer cylinder tip 31c supported by appropriate means, when a force F1 is applied to shorten the length of the outer cylinder 31 from the outer cylinder end 31d toward the outer cylinder tip 31c, the outer cylinder 31 is configured such that the second outer cylinder portion 31b is more easily shortened than the first outer cylinder portion 31a. Due to the difference in the ease with which the first outer cylinder portion 31a and the second outer cylinder portion 31b are shortened, the outer cylinder 31 bends so that the first outer cylinder portion 31a bulges out and the second outer cylinder portion 31b is indented.

[0054] Similarly, when the inner cylinder tip 32c is supported by appropriate means, and a force F2 is applied to shorten the length of the inner cylinder 32 from the inner cylinder end 32d toward the inner cylinder tip 32c, the inner cylinder 32 is configured such that the first part 32a is more easily shortened than the second part 32b. Due to the difference in the ease with which the first part 32a and the second part 32b are shortened, the outer cylinder 31 bends so that the first part 32a collapses and the second part 32b bulges out.

[0055] (3-2) Bending motion of sheath 30 Figure 8 shows the case where the physician manipulates the first movable part 22 of the grip 20, thereby shifting the relative position of the inner cylinder end 32d relative to the outer cylinder end 31d at the sheath end 36 in a direction away from the sheath tip 35. As mentioned above, the outer cylinder 31 and the inner cylinder 32 are joined to each other at the joint 37 of the sheath tip 35. Therefore, the outer cylinder tip 31c and the inner cylinder tip 32c support each other. At this time, a force F3 is applied to the outer cylinder 31, shortening its length from the outer cylinder end 31d toward the outer cylinder tip 31c. A force F4 is applied to the inner cylinder 32, extending its length so that the inner cylinder end 32d is pulled away from the inner cylinder tip 32c. As a result, the shortening of the second outer cylinder portion 31b becomes dominant, causing the sheath 30 to curve in the first direction DR1.

[0056] Figure 9 shows the case where the physician manipulates the first movable part 22 of the grip 20, thereby shifting the relative position of the inner cylinder end 32d relative to the outer cylinder end 31d at the sheath end 36 toward the sheath tip 35. At this time, a force F5 is applied to the outer cylinder 31, extending its length so that the outer cylinder end 31d is pulled away from the outer cylinder tip 31c. A force F6 is applied to the inner cylinder 32, shortening its length from the inner cylinder end 32d toward the inner cylinder tip 32c. As a result, the shortening of the first part 32a of the inner cylinder becomes dominant, causing the sheath 30 to curve in the second direction DR2, opposite to the first direction DR1.

[0057] (3-3) Setting the ease of shrinking In this embodiment, the ease with which each part of the sheath 30 shrinks is determined by providing slits. Figure 10 is a cross-sectional view of the sheath 30 according to this embodiment.

[0058] Multiple outer cylinder slits S1 are engraved in the second outer cylinder portion 31b. Each outer cylinder slit S1 runs perpendicular to the axis X of the sheath 30. The area of ​​the outer cylinder slits S1 corresponds to the entire central angle θb (Figure 5) of the second outer cylinder portion 31b.

[0059] Multiple inner cylinder slits S2 are engraved in the first inner cylinder portion 32a. Each inner cylinder slit S2 also runs in a direction perpendicular to the axis X of the sheath 30. The range of the inner cylinder slits S2 corresponds to the entire central angle θa (Figure 5) of the first inner cylinder portion 32a.

[0060] Figure 11 shows the outer cylinder 31 and the inner cylinder 32 separately. In this figure as well, it can be seen that each of the multiple outer cylinder slits S1 engraved in the second part 31b of the outer cylinder runs perpendicular to the axis X of the sheath 30. Similarly, each of the inner cylinder slits S2 engraved in the first part 32a of the inner cylinder runs perpendicular to the axis X of the sheath 30. In the outer cylinder slit S1, a portion of the material constituting the outer cylinder 31 is cut away. In the inner cylinder slit S2, a portion of the material constituting the inner cylinder 32 is cut away.

[0061] Each of the outer cylinder first part 31a, outer cylinder second part 31b, inner cylinder first part 32a, and inner cylinder second part 32b is made of a single material. The materials of these four parts may be different, or they may all be the same. The materials that make up these four parts are, for example, metal or resin. This material has a strength of, for example, 50,000 (N / mm²). 2 It has a Young's modulus exceeding ). The ease with which the first outer cylinder portion 31a, the second outer cylinder portion 31b, the first inner cylinder portion 32a, and the second inner cylinder portion 32b can be compressed is adjusted by providing slits in at least a portion of these portions and cutting off a portion of their area. These portions can be compressed by bringing two opposing parts on either side of the slit closer together. On the other hand, because these four parts have a sufficiently large Young's modulus, the sheath 30 as a whole can easily maintain a stable curved shape.

[0062] As shown in Figure 11, the positions of the outer cylinder slit S1 and the inner cylinder slit S2 in the direction of the axis X of the sheath 30 are offset from each other. In addition, as mentioned above, the inner circumferential surface of the outer cylinder 31 and the outer circumferential surface of the inner cylinder 32 are substantially in contact with each other. As a result, at the position of the sheath 30 corresponding to the boundary between the first outer cylinder portion 31a and the second outer cylinder portion 31b, or the boundary between the first inner cylinder portion 32a and the second inner cylinder portion 32b, each of the multiple outer cylinder slits S1 is not in communication with any of the multiple inner cylinder slits S2. Therefore, whether the sheath 30 is extending in a straight line or curved, the external space Q1 and the internal space Q2 of the sheath 30 are isolated. This suppresses the leakage of smoke passing through the flue gas channel 11 into the external space Q1 of the sheath 30.

[0063] (4) Features (4-1) Since the sheath 30 of the treatment instrument 10 can bend in response to user operation, the user does not need to rely on the bending of the insertion section 72 of the endoscope 70 when operating the end effector 41. Therefore, the user's intentions can be accurately reflected in the operation of the end effector 41. This is particularly useful when the tip of the treatment instrument 10 protrudes from the tip of the insertion section 72 of the endoscope 70, and the end effector 41 is separated from the tip of the insertion section 72.

[0064] (4-2) When the end effector 41 is used as an energy device, the smoke generated is removed using the exhaust channel 11. Therefore, smoke emitted from bodily tissues near the end effector 41 can be removed.

[0065] (4-3) The electric wire 43 that supplies power to the energy device is protected by a protective tube 44. The smoke exhaust channel 11, formed by the inner surface 30b of the sheath and the outer surface 44a of the protective tube, is isolated from the electric wire 43. Therefore, since the electric wire 43 is protected from smoke, the smoke resistance of the treatment device 10 can be improved.

[0066] (4-4) The movement of the second movable part 23 is transmitted to the end effector 41. Therefore, the end effector 41 can be operated according to the user's will. The end effector 41 is a forceps, and the user can open and close the forceps by operating the second movable part 23.

[0067] (4-5) The sheath 30 has an outer cylinder 31 and an inner cylinder 32, and the curvature of the sheath 30 is achieved by the relative movement of the outer cylinder 31 and the inner cylinder 32. Therefore, no additional parts such as wires are required for the curvature of the sheath 30. As a result, the diameter of the sheath 30 can be made smaller than that of a sheath with a different configuration than that of this embodiment, for example, a sheath composed of a flexible tubular member and a wire for curvature.

[0068] (4-6) The outer cylinder 31 and the inner cylinder 32 each have two parts with different degrees of contraction, and the curvature of the sheath 30 is achieved by these differences in contraction. Therefore, because the structure of the sheath 30 is simple, damage to the sheath 30 is reduced even during long-term use.

[0069] (4-7) Each of the outer cylinder first part 31a, outer cylinder second part 31b, inner cylinder first part 32a, and inner cylinder second part 32b is made of a single material. Therefore, because the structure of the sheath 30 is simple, damage to the sheath 30 is reduced even during long-term use.

[0070] The materials constituting the first outer cylinder portion 31a, the second outer cylinder portion 31b, the first inner cylinder portion 32a, and the second inner cylinder portion 32b all have a large Young's modulus and are relatively hard materials. The Young's modulus is, for example, 50,000 (N / mm²). 2 ) exceeds. Therefore, compared to a sheath with a different configuration than that of this embodiment, for example, a sheath composed of a soft tubular material and a wire that transmits force for bending, the sheath 30 of this embodiment is more likely to stably maintain a curved shape as a whole.

[0071] (4-8) The ease with which the outer cylinder second portion 31b shrinks is achieved by the outer cylinder slit S1, and the ease with which the inner cylinder first portion 32a shrinks is achieved by the inner cylinder slit S2. The degree of shrinkability is determined by the size of the area cut off by the slit. Therefore, the degree of shrinkability of the outer cylinder second portion 31b and the inner cylinder first portion 32a can be easily adjusted.

[0072] (4-9) Regardless of whether the sheath 30 is curved or not, the outer cylinder slit S1 and the inner cylinder slit S2 do not communicate with each other, so the external space Q1 and the internal space Q2 of the sheath 30 are isolated. Therefore, leakage of gas or smoke from inside the sheath 30 to the outside of the sheath 30 is suppressed.

[0073] (4-10) The outer diameter D of the sheath 30 is a small value of 1.5 mm or less, and such a thin sheath 30 can be bent according to the user's wishes. Therefore, it is possible to perform precise surgery that cannot be achieved by using the bending function of the insertion section 72 of the endoscope 70 to manipulate the end effector 41.

[0074] (4-11) The treatment instrument 10 can bend in accordance with the movement of the first movable part 22 while protruding from the tip of the insertion part 72 of the endoscope 70. Therefore, the bending function of the treatment instrument 10 can be used to access small affected areas that cannot be accessed by the thick insertion part 72 of the endoscope 70.

[0075] (5) Variant Modifications of the first embodiment are described below. Multiple modifications may be combined.

[0076] (5-1) First variation In the embodiment described above, the range of the outer cylinder slit S1, which runs perpendicular to the axis X of the sheath 30, corresponds to the entire central angle θb of the second outer cylinder portion 31b. In addition, the range of the inner cylinder slit S2, which runs perpendicular to the axis X of the sheath 30, corresponds to the entire central angle θa of the first inner cylinder portion 32a. However, there may be a configuration in which the range of the outer cylinder slit S1 does not correspond to the central angle θb, and the range of the inner cylinder slit S2 does not correspond to the central angle θa.

[0077] Figures 12 and 13 show a configuration in which the range of the outer cylinder slit S1 is smaller than the central angle θb, and the range of the inner cylinder slit S2 is smaller than the central angle θa. In this case, there is a region in the sheath 30 where there are no slits, corresponding to the boundary between the first outer cylinder portion 31a and the second outer cylinder portion 31b, or the boundary between the first inner cylinder portion 32a and the second inner cylinder portion 32b.

[0078] Figures 14 and 15 show a configuration in which the range of the outer cylinder slit S1 is greater than the central angle θb, and the range of the inner cylinder slit S2 is greater than the central angle θa. In this case, there is a region in the sheath 30 where both the outer cylinder slit S1 and the inner cylinder slit S2 are engraved, corresponding to the boundary between the first outer cylinder portion 31a and the second outer cylinder portion 31b, or the boundary between the first inner cylinder portion 32a and the second inner cylinder portion 32b.

[0079] These modified configurations can be adopted insofar as the provision of the outer cylinder slit S1 makes the second outer cylinder portion 31b more easily contracted than the first outer cylinder portion 31a, and the provision of the inner cylinder slit S2 makes the first inner cylinder portion 32a more easily contracted than the second inner cylinder portion 32b.

[0080] (5-2) Second variation In the above-described embodiment, the ease with which the outer cylinder first portion 31a, outer cylinder second portion 31b, inner cylinder first portion 32a, and inner cylinder second portion 32b can be contracted is adjusted by providing outer cylinder slits S1 and inner cylinder slits S2. Alternatively, the ease with which the outer cylinder first portion 31a, outer cylinder second portion 31b, inner cylinder first portion 32a, and inner cylinder second portion 32b can be contracted may be adjusted by constructing them from different materials.

[0081] For example, with respect to the outer cylinder 31 and inner cylinder 32 shown in Figure 6, the first outer cylinder portion 31a and the second inner cylinder portion 32b may be made of a hard material without providing slits, while the second outer cylinder portion 31b and the first inner cylinder portion 32a may be made of a softer material compared to the first outer cylinder portion 31a and the second inner cylinder portion 32b, respectively. For example, the Young's modulus of the soft material constituting the second outer cylinder portion 31b and the first inner cylinder portion 32a may be set to be significantly smaller than the Young's modulus of the hard material constituting the first outer cylinder portion 31a and the second inner cylinder portion 32b, respectively.

[0082] Even in this case, the sheath 30 can be bent in response to user operation.

[0083] (5-3) Third variation In the embodiment described above, the end effector 41 has the function of forceps. Alternatively, the end effector 41 may have a different function. For example, the end effector 41 may be a diathermy knife, another knife, an electrosurgical unit, a hypodermic needle, or a suturing instrument.

[0084] (5-4) Fourth variation In the embodiment described above, the end effector 41 has the function of an energy device. Alternatively, the end effector 41 does not have to have the function of an energy device.

[0085] The endoscope 70 may be provided with multiple endoscope passages 70a. In this case, the treatment instrument 10 according to the present invention may be inserted into one endoscope passage 70a, and another treatment instrument may be inserted into another endoscope passage 70a. If the other treatment instrument can function as an energy device, the smoke exhaust passage 11 of the treatment instrument 10 according to the present invention may be used to discharge smoke generated by the other treatment instrument, even if the treatment instrument 10 according to the present invention does not have the function of an energy device.

[0086] Even in this case, the sheath 30 of the treatment instrument 10 can bend according to the user's operation, so the user's intentions can be accurately reflected in the operation of the end effector 41.

[0087] (5-5) Fifth variation In the embodiment described above, the multiple outer cylinder slits S1 and the multiple inner cylinder slits S2 all run in a direction perpendicular to the axis X of the sheath 30. Alternatively, at least some of the multiple outer cylinder slits S1 and the multiple inner cylinder slits S2 may intersect the axis X at an angle other than perpendicular to the axis X.

[0088] Even in this case, the sheath 30 of the treatment instrument 10 can be bent in accordance with the user's operation.

[0089] <Second Embodiment> (1) Composition Figure 16 shows the endoscope 70 and treatment instrument 10 according to the second embodiment. The treatment instrument 10 differs from the treatment instrument 10 of the first embodiment in that it has a branching unit 50. The branching unit 50 is attached to the sheath 30. A smoke exhaust tube 46 extending from the suction device 93 is connected to the branching unit 50. Unlike the first embodiment, the smoke exhaust tube 46 is not connected to the grip 20.

[0090] Figure 17 schematically shows a cross-section of the treatment tool 10 near the branching unit 50. The branching unit 50 is a component separated from the grip 20. The branching unit 50 has a branching unit body 51 and a sealing member 52. The branching unit body 51 is a T-shaped pipe member and has a first port 55, a second port 56, and a third port 57. A main conduit for installing the sheath 30 is formed between the first port 55 and the second port 56. The first port 55 is on the side of the end effector 41. The second port 56 is on the side of the grip 20. The third port 57 constitutes a branch conduit that branches off from the main conduit, and a smoke exhaust tube 46 is connected to this branch conduit.

[0091] A communication hole 38 is provided in the sheath 30 at the location where the branching unit 50 is to be placed. The communication hole 38 is for connecting the smoke exhaust passage 11 provided in the sheath 30 to the smoke exhaust tube 46. The communication hole 38 is provided in both the outer cylinder 31 and the inner cylinder 32. On the other hand, the communication hole 38 is not provided in the protective tube 44. A sealing member 52 is provided between the second port 56 and the third port 57. The sealing member 52 blocks the smoke exhaust passage 11, thereby preventing smoke in the smoke exhaust passage 11 from leaking to the second port 56.

[0092] (2) Characteristics In this case as well, the sheath 30 can be bent according to the user's operation. When the end effector 41 is used as an energy device, the smoke generated passes through the smoke exhaust passage 11 of the sheath 30 and is drawn into the suction device 93 from the third port 57 of the branching unit 50.

[0093] As described with respect to the fourth modification of the first embodiment, the exhaust flue passage 11 of the treatment device 10 may be used to discharge smoke generated by another treatment device that can function as an energy device.

[0094] (3) Variant Modifications of the first embodiment may also be applied to this embodiment.

[0095] <Third Embodiment> (1) Composition Figure 18 shows the endoscope 70 and treatment instrument 10 according to the third embodiment. This configuration differs from the configuration of the first embodiment in that the smoke exhaust tube 46 extending from the suction device 93 is connected to the endoscope 70 rather than directly to the treatment instrument 10. The smoke exhaust tube 46 is connected to the connection port 71s of the operating section 71 of the endoscope 70.

[0096] Figure 19 shows the treatment tool 10 of this embodiment. The sheath 30 of the treatment tool 10 is provided with a communication hole 38. A pair of sealing members 39 are provided on both sides of the communication hole 38. A certain distance G is maintained between each sealing member 39 and the communication hole 38.

[0097] Figure 20 schematically shows a cross-section of the treatment tool 10 near the communication hole 38. The sheath 30 extends horizontally in the figure, with the left side being the end effector 41 side and the right side being the grip 20 side. The communication hole 38 is the same as that provided in the second embodiment and is for connecting the smoke exhaust passage 11 to the smoke exhaust tube 46. The communication hole 38 is provided in both the outer cylinder 31 and the inner cylinder 32. On the other hand, the communication hole 38 is not provided in the protective tube 44. The communication hole 38 provided in the outer cylinder 31 and the communication hole 38 provided in the inner cylinder 32 may have different areas to take into consideration the efficiency of smoke exhaust when the sheath 30 is curved.

[0098] A sealing member 61 is provided in the smoke exhaust passage 11 on the side closer to the grip 20 than the communication hole 38. The sealing member 61 blocks the smoke exhaust passage 11, thereby preventing smoke from leaking out of the smoke exhaust passage 11 towards the grip 20.

[0099] Figure 21 shows the treatment instrument 10 being inserted into the endoscopic passage 70a of the endoscope 70. The endoscopic passage 70a is for inserting the treatment instrument 10 and consists of an operating section passage 71a provided in the operating section 71 and an insertion section passage 72a provided in the insertion section 72.

[0100] Inside the operating section 71, the suction passage 71t extending from the connection port 71s is connected to the operating section passage 71a at the confluence section 71u. The exhaust gas passage 11 inside the sheath 30 communicates with the suction passage 71t via the communication hole 38. From the viewpoint of efficient exhaust gas, it is preferable that the area of ​​the communication hole 38 in the sheath 30 is larger than the area of ​​the confluence section 71u.

[0101] The pair of sealing members 39 are made of a material that exhibits adhesion to one of the operating section 71 and the sheath 30, while exhibiting sliding properties to the other.

[0102] The physician moves the position of the end effector 41 by gripping the grip 20 and pushing the sheath 30 into the endoscope passage 70a, or by pulling the grip 20 away from the operating unit 71 and withdrawing the sheath 30 from the endoscope passage 70a. In this case, since the sealing member 39 exhibits sliding properties with respect to either the operating unit 71 or the sheath 30, the movement of the sheath 30 is not hindered. As long as the user physician does not move the sheath 30 beyond the distance G, events such as the sealing member 39 blocking the junction 71u or the sealing member 39 blocking the communication hole 38 will not occur. Therefore, it is possible to suction the smoke in the smoke exhaust passage 11 with the suction device 93.

[0103] (2) Characteristics In this case as well, the sheath 30 can be bent according to the user's operation. When the end effector 41 is used as an energy device, the smoke generated is guided through the exhaust passage 11 of the sheath 30, then passes through the suction passage 71t of the operating unit 71 and is sucked into the suction device 93.

[0104] As described with respect to the fourth modification of the first embodiment, the exhaust flue passage 11 of the treatment device 10 may be used to discharge smoke generated by another treatment device that can function as an energy device.

[0105] (3) Variant (3-1) First variation In the embodiment described above, the communication holes 38 provided in the outer cylinder 31 and the communication holes 38 provided in the inner cylinder 32 are each formed as single circular holes. Alternatively, each communication hole 38 may have a shape other than a circle. For example, the shape of each communication hole 38 may be an ellipse, an oblong, a square, a rectangle, a polygon, etc. Alternatively, each communication hole 38 may be composed of multiple holes. For example, the shape of each communication hole 38 may be composed of multiple circular holes, a mesh, a slit, or the like.

[0106] (3-2) Second variation Modifications of the first or second embodiment may be applied to this embodiment.

[0107] <Fourth Embodiment> (1) Composition Figure 22 shows the treatment tool 10 according to the fourth embodiment. The treatment tool 10 of this embodiment differs from that of the first to third embodiments in the configuration of the sheath 30, but the other configurations are generally the same as those of the first to third embodiments.

[0108] The sheath 30 includes an outer cylinder 31 and an inner cylinder 32, as well as a first sheath wire 33 and a second sheath wire 34. The first sheath wire 33 and the second sheath wire 34 are arranged in the internal space of the outer cylinder 31 and the external space of the inner cylinder 32. At the joint 37 of the sheath tip 35, the outer cylinder 31 and the inner cylinder 32 are joined to each other. The tips of the first sheath wire 33 and the tips of the second sheath wire 34 are also joined to this joint 37.

[0109] Figure 23 shows the configuration of the treatment instrument 10 at the end 36 of the sheath. The sheath 30 is connected to the grip 20 at the end 36 of the sheath. Both the outer cylinder 31 and the inner cylinder 32 of the sheath 30 are fixed to the grip body 21. The first movable part 22 is fixed to the first sheath wire 33 and the second sheath wire 34 of the sheath 30. In accordance with the movement of the first movable part 22, one of the first sheath wire 33 and the second sheath wire 34 is pushed toward the end 35 of the sheath, and the other is pulled toward the end 36 of the sheath. As the first sheath wire 33 and the second sheath wire 34 move in opposite directions, the sheath 30 bends.

[0110] Figure 24 shows a cross-section of the sheath 30 perpendicular to the axis X. Preferably, the first sheath wire 33 and the second sheath wire 34 are arranged symmetrically with respect to the axis X. In this embodiment, neither the outer cylinder 31 nor the inner cylinder 32 has two parts with different degrees of shrinkage, and is homogeneous throughout the circumference. On the other hand, with respect to the direction of the axis X, the hardness of the material of the outer cylinder 31 and the inner cylinder 32 may change. For example, by making the outer cylinder 31 and the inner cylinder 32 of a softer material near the sheath tip 35, the sheath 30 may bend easily near the sheath tip 35.

[0111] (2) Characteristics In this configuration as well, the sheath 30 can be bent according to user operation. When the end effector 41 is used as an energy device, the smoke generated passes through the exhaust passage 11 of the sheath 30 and is drawn into the suction device 93 from the third port 57 of the branching unit 50.

[0112] As described with respect to the fourth modification of the first embodiment, the exhaust flue passage 11 of the treatment device 10 may be used to discharge smoke generated by another treatment device that can function as an energy device.

[0113] (3) Variant Modifications of the first to third embodiments may also be applied to this embodiment.

[0114] <Conclusion> While embodiments of this disclosure have been described above, it should be understood that various modifications to the form and details are possible without departing from the spirit and scope of this disclosure as described in the claims. [Explanation of Symbols]

[0115] 10: Treatment tools 11: Smoke exhaust flow path 20: Grip 21: Grip body 22: 1st movable part 23:Second movable part 30: Sheath 30a: Outer surface of the sheath 30b: Inner surface of the sheath ("inner surface") 31: Outer cylinder 31a: First part of the outer cylinder 31b: Second part of the outer cylinder 31c: Outer cylinder tip 31d: End of outer cylinder 32: Inner cylinder 32a: Inner cylinder first part 32b: Inner cylinder second part 32c: Inner cylinder tip 32d: Inner cylinder end 33: First sheath wire 34: Second sheath wire 35: Sheath tip 36: Sheath end 37: Joint 38:Communication hole 39: Sealing material 40: Treatment instrument body 41: End Effector 41a: Cup component 41b: Cup component 41c: Base 41d: Rotation axis 42: Wire 43:Electric wire 44: Protective tube 44a: Outer surface of protective tube ("outer surface") 45: High-frequency cables 46: Smoke exhaust tube 50: Branching Unit 51: Branching unit body 52: Sealing material 55: Port 1 56: Second port 57: Third Port 61: Sealing material 70: Endoscopy 70a: Endoscopy passage 71 :Operation section 71a: Operation section passage 71p: Angle knob ("Operating mechanism") 71q: Button 71s: Connection port 71t: Suction path 71u: Confluence 72: Insertion part 72a: Insertion passage ("passage") 73: Camera 74: Cable 75: Connector 91: Power supply 92: High-frequency foot switch 93:Suction device 94: Foot switch for smoke exhaust 95: Display equipment D:Outer diameter DR1: 1st direction DR2: 2nd direction F1~F6: Power G: distance Q1: External space Q2: Internal space S1: Outer cylinder slit S2: Inner cylinder slit X: Axis line θa: central angle θb: Central angle

Claims

1. A treatment instrument used by inserting it into the passage of the insertion part of an endoscope, A grip having a first movable part operated by the user, A cylindrical sheath having a sheath end connected to the grip and a sheath tip on the opposite side of the sheath end, which curves in accordance with the movement of the first movable part, A treatment instrument body inserted into the sheath and having an end effector for excising or manipulating patient tissue located on the tip side of the sheath, An endoscope instrument equipped with the necessary components.

2. The treatment device body further includes an electric wire connected to the end effector, The end effector further functions as an energy device that receives power from a power supply connected to the wire to perform cutting or coagulation of the internal tissue. A smoke exhaust channel connected to a suction device, for guiding smoke generated near the end effector in the direction from the tip of the sheath to the end of the sheath, Furthermore, The treatment device according to claim 1.

3. The treatment device body further comprises a protective tube that covers the electric wire. The treatment device according to claim 2.

4. The exhaust gas passage is formed by the inner circumferential surface of the sheath and the outer circumferential surface of the protective tube. The treatment device according to claim 3.

5. The grip further has a second movable part operated by the user, The treatment device body further includes a wire positioned inside the protective tube to transmit the movement of the second movable part to the end effector. The treatment device according to claim 3.

6. The end effector is a forceps, and the wire opens and closes the forceps. The treatment device according to claim 5.

7. The sheath has a bendable outer cylinder and a bendable inner cylinder. The inner cylinder is inserted into the outer cylinder and is joined to the outer cylinder at the joint at the tip of the sheath. The first movable part moves the relative position of the inner cylinder with respect to the outer cylinder at the end of the sheath in order to bend the sheath. The treatment device according to claim 1.

8. The outer cylinder has a first outer cylinder portion and a second outer cylinder portion that are in contact with each other at a contact surface extending in the direction of the axis of the sheath, The inner cylinder has a first inner cylinder portion and a second inner cylinder portion that are in contact with each other at a contact surface extending in the direction of the axis, The first portion of the inner cylinder is positioned in close proximity to the first portion of the outer cylinder. The inner cylinder second portion is positioned in close proximity to the outer cylinder second portion. When a force is applied to shorten the length of the outer cylinder from the outer cylinder end corresponding to the sheath end toward the outer cylinder tip corresponding to the sheath tip, the second outer cylinder portion is more easily shortened than the first outer cylinder portion. When a force is applied to shorten the length of the inner cylinder from the inner cylinder end corresponding to the sheath end toward the inner cylinder tip corresponding to the sheath tip, the first portion of the inner cylinder is more easily shortened than the second portion of the inner cylinder. The treatment device according to claim 7.

9. Each of the first outer cylinder portion, the second outer cylinder portion, the first inner cylinder portion, and the second inner cylinder portion is made from a single material. The treatment device according to claim 8.

10. The material constituting each of the first outer cylinder portion, the second outer cylinder portion, the first inner cylinder portion, and the second inner cylinder portion has a strength of 50,000 (N / mm²). ２ Having a Young's modulus exceeding ) The treatment device according to claim 9.

11. The second outer cylinder portion has a plurality of outer cylinder slits engraved in a direction perpendicular to the axis, The first portion of the inner cylinder has a plurality of inner cylinder slits engraved in a direction perpendicular to the axis, The treatment device according to claim 8.

12. In the sheath, each of the multiple outer cylinder slits does not communicate with any of the multiple inner cylinder slits, and thereby the outer cylinder and the inner cylinder cooperate to isolate the external space from the internal space of the sheath. The treatment device according to claim 11.

13. The outer diameter of the sheath is 1.5 mm or less. The treatment device according to any one of claims 1 to 12.

14. An operating unit connected to a display device, An operating mechanism provided in the operating section for receiving user operations, An insertion portion extending from the operating portion and curving in accordance with the movement of the operating mechanism, A camera positioned at the tip of the insertion part, A treatment device according to any one of claims 1 to 12, which is inserted into the passage of the insertion portion, An endoscope equipped with [a specific feature].

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