Treatment system

Abstract

Provided are a treatment system and a treatment method that improve the efficiency of endoscopic examination and treatment.　A treatment system (20) comprises a tubular member (31) which has a hollow part (31S) formed therein and which is provided with, at the leading end (31A) thereof, a treatment part (32) on the outer circumference of the hollow part (31S). Between a base-end surface (311) on the base end (31B) side and a leading-end surface (312) on the leading end (31A) side of the tubular member (31) in the axial direction, at least the base-end surface (311) has formed therein a base-end opening (3(1)1A) that is connected to the hollow part (31S).

Description

Treatment System

[0001] The technology of the present disclosure relates to a treatment system used in an endoscope.

[0002] Patent document 1 describes a transseptal insertion device that includes a sheath defining at least one hollow portion therein, one or more positioning balloons connected to the distal end of the sheath, and a piercing portion movably disposed within the hollow portion.

[0003] Patent document 2 describes a medical device for inducing controlled necrosis at a target location within the body, the medical device comprising an elongated member having a base end portion, a distal end portion, and at least one hollow portion therein that is fluidly connected to a cooling fluid, a plurality of ablation tips connected to the distal end of the elongated member and configured to contact and ablate tissue, and an ultrasonic probe for controlling the transmural depth of the plurality of ablation tips into the tissue.

[0004] US Patent No. 5,949,999 describes a system that includes a probe that deploys at least one needle into tissue.

[0005] US Patent No. 6,299,949 describes an imaging component that includes a shaft having a proximal end, a distal end, and a cavity, and an imaging transducer coupled to the distal end of the shaft.

[0006] Patent document 5 describes a treatment probe including a handle, a probe body, an imaging source coupled to the probe body, and an ablation element coupled to the probe body and configured to ablate target tissue.

[0007] Patent document 6 describes a system having an imaging component including an imaging handle segment, an imaging shaft having a proximal end and a distal end, and an imaging transducer at the distal end of the imaging shaft, and a needle component including a needle handle segment, a needle shaft having a distal end and a proximal end, and a needle structure reciprocally disposed on or within the needle shaft.

[0008] Japanese Patent Publication No. 2022-548739 Publication Japanese Patent No. 4653734 Publication Japanese Patent No. 6674432 Publication Japanese Special Publication Publication No. 2021-525124 Publication Japanese Special Publication Publication No. 2020-518385 Publication Japanese Patent No. 6243910

[0009] The present disclosure provides a technique that can improve the efficiency of examinations and treatments using endoscopes.

[0010] A treatment system according to one aspect of the disclosed technology comprises a tubular member having a hollow portion therein and a treatment portion provided on the outer periphery of the hollow portion at one end, and the tubular member has a first opening connected to the hollow portion at at least the first end face of the tubular member, out of a first end face on the other end side in the axial direction and a second end face on the one end side.

[0011] A treatment method according to one aspect of the technology disclosed herein includes the following steps: a first step of inserting an ultrasonic probe into a tubular member having a hollow portion therein, a treatment portion provided at one end on the outer periphery of the hollow portion, and an opening connected to the hollow portion on an end face on the other end side in the axial direction; a second step of inserting the tubular member and the ultrasonic probe into a subject, with an ultrasonic vibrator of the ultrasonic probe disposed in a position adjacent to the treatment portion in the axial direction of the tubular member; a third step of aligning the ultrasonic vibrator with a target site of the subject based on an output of the ultrasonic vibrator obtained by moving the tubular member and the ultrasonic probe inside the subject; a fourth step of moving the treatment portion to the position of the ultrasonic vibrator with the target site and the treatment portion aligned; and a fifth step of driving the treatment portion with the target site and the treatment portion aligned.

[0012] According to the techniques of the present disclosure, it is possible to improve the efficiency of examinations and treatments using endoscopes.

[0013] FIG. 1 is a diagram showing a schematic configuration of an endoscopic device 100 according to one aspect of the technology disclosed herein. FIG. 2 is a cross-sectional schematic diagram showing a schematic configuration of a treatment system 20 that is used by being inserted into a treatment instrument channel of the endoscope 1 from a treatment instrument introduction port 112 of the endoscope 1 shown in FIG. 1. FIG. 3 is an enlarged view of range X in FIG. 2. FIG. 4 is a cross-sectional view taken along arrows CC shown in FIG. 3. FIG. 5 is an enlarged view of range Y in FIG. 2. FIG. 6 is a diagram showing a state in which the tubular member 31 has moved toward its distal end from the state shown in FIG. 3. FIG. 7 is a diagram showing a state in which the ultrasonic probe 40 has moved toward the proximal end from the state shown in FIG. 6. FIG. 8 is a schematic diagram showing a first modified example of the treatment system 20. FIG. 9 is a schematic diagram showing a state in which the ultrasonic probe 40 and the treatment probe 30 are arranged at the endoscope distal end portion 10C. FIG. 10 is a schematic diagram for explaining a treatment method. FIG. 11 is a schematic diagram for explaining the treatment method. FIG. 12 is a schematic diagram for explaining the treatment method. FIG. 13 is a schematic diagram showing a second modified example of the treatment system 20. As shown in FIG.

[0014] Fig. 1 is a diagram showing a schematic configuration of an endoscopic device 100 according to one aspect of the technology of the present disclosure. The endoscopic device 100 includes an endoscope 1, a main body 2 connected to the endoscope 1 and including a light source device 4 and a processor device 5, and a display device 7 that displays captured images and the like obtained by capturing images with the endoscope 1. In the example shown in Fig. 1, the endoscope 1 is a bronchoscope, but is not limited to this.

[0015] The endoscope 1 includes an insertion section 10, which is a long instrument extending in one direction and is inserted into a subject; an operation section 11 provided at the base end of the insertion section 10 and equipped with operation members for performing observation mode switching operations, image capture storage operations, forceps operations, suction operations, etc.; an angle lever 12 provided adjacent to the operation section 11; and a universal cord 13 including a connector section 13A that detachably connects the endoscope 1 to a connector connection section 4A of the light source device 4.

[0016] The operation unit 11 is provided with a treatment tool introduction port 112 through which a treatment tool for collecting biological tissue such as cells or polyps is introduced. Although not shown in FIG. 1 , various channels such as a treatment tool channel through which the treatment tool introduced from the treatment tool introduction port 112 is inserted and a suction channel are provided inside the operation unit 11 and the insertion unit 10. The operation unit 11 includes a suction button 11A and the like. A suction tube (not shown) is connected to the suction button 11A, and this suction tube is connected to a suction device. When the suction button 11A is operated, a fluid or the like is sucked into the suction tube from the tip of the endoscope 1 and collected by the suction device.

[0017] The insertion section 10 is composed of a flexible flexible section 10A, a bending section 10B provided at the tip of the flexible section 10A, and an endoscope tip section 10C that is harder than the flexible section 10A and provided at the tip of the bending section 10B. An imaging element and an imaging optical system are built into the endoscope tip section 10C.

[0018] The bending portion 10B is adapted to bend in the vertical direction (A2 direction) by rotating the angle lever 12 of the operating unit 11 in the A1 direction, and by bending the bending portion 10B, the endoscope tip portion 10C can be directed in the desired direction.

[0019] A light guide made up of a bundle of optical fibers is provided inside the endoscope 1, extending from the endoscope tip 10C of the insertion section 10 to the connector section 13A. Light generated by the light source device 4 is introduced into this light guide from the connector section 13A and travels to the endoscope tip 10C, where it is irradiated onto the subject through an illumination window provided in the endoscope tip 10C.

[0020] The configuration of the endoscope 1 is an example and is not limited to that shown in FIG.

[0021] Fig. 2 is a cross-sectional schematic diagram showing the general configuration of a treatment system 20 that is used by being inserted into a treatment tool channel of the endoscope 1 from the treatment tool introduction port 112 of the endoscope 1 shown in Fig. 1. Fig. 3 is an enlarged view of range X in Fig. 2. Fig. 4 is a cross-sectional view taken along arrows CC shown in Fig. 3. Fig. 5 is an enlarged view of range Y in Fig. 2.

[0022] The treatment system 20 comprises a treatment probe 30, which is an elongated treatment tool that extends in one direction, an ultrasonic probe 40, which is an elongated instrument that extends in one direction, and an operating handle 50 configured to support the treatment probe 30 and the ultrasonic probe 40.

[0023] The treatment probe 30 has a tubular member 31 that includes, for example, a cylindrical hollow portion 31S (see FIGS. 3 and 5) therein. The treatment probe 30 has a treatment section 32 that is provided circumferentially at a tip end 31A (see FIG. 3), which is an end portion on one side of the axial direction of the tubular member 31, and is a treatment tool that can freeze tissue of a subject using the treatment section 32. The treatment probe 30 preferably has a treatment section 32 made of, for example, metal that cools the treatment section 32 using the Joule-Thomson effect.

[0024] A first space SP1 having, for example, a circular cross section and a second space SP2 surrounding the first space SP1 are provided in the wall of the tubular member 31. An opening 31K connecting the first space SP1 and the second space SP2 is provided in the tubular member 31 at the treatment section 32. The portions of the tubular member 31 other than the treatment section 32 are made of, for example, resin or elastomer.

[0025] As shown in Fig. 5, the first space SP1 is connected to a gas supply pipe 34 for cooling the treatment unit 32. As shown in Fig. 2, a substantially T-shaped gripping portion 33 is fixed to a base end portion 31B, which is the other axial end of the tubular member 31, and the supply pipe 34 is provided inside the gripping portion 33. The supply pipe 34 is connected to a treatment probe control device 300. The treatment probe control device 300 performs various controls such as driving the treatment unit 32 (injecting gas for cooling).

[0026] The gas supplied from the supply pipe 34 passes through the first space SP1 and is supplied from the opening 31K to the second space SP2. As the gas flows from the first space SP1 to the second space SP2, the treatment unit 32 is cooled by the Joule-Thomson effect. The gas that flows into the second space SP2 is exhausted to an exhaust pipe (not shown). Because the treatment unit 32 is provided in an annular shape around the hollow portion 31S, the treatment unit 32 can freeze tissue within a 360-degree range around the tip 31A of the treatment probe 30.

[0027] As shown in Fig. 3, a distal end opening 312A connected to the hollow portion 31S is provided in a distal end surface 312, which is an end surface on one end side in the axial direction of the tubular member 31. As shown in Fig. 5, a proximal end opening 311A ​​connected to the hollow portion 31S is provided in a proximal end surface 311, which is an end surface on the other end side in the axial direction of the tubular member 31.

[0028] The ultrasonic probe 40 is used in a state where it is inserted through the proximal end opening 311A ​​into the hollow portion 31S of the treatment probe 30. The inner diameter of the tubular member 31 is preferably larger than the outer diameter of the ultrasonic probe 40.

[0029] 3, an ultrasonic transmitting / receiving unit 42 is provided on a part of the outer circumferential surface of a substantially cylindrical tip portion 41, which is an end portion on one side of the ultrasonic probe 40. The ultrasonic transmitting / receiving unit 42 is configured, for example, by an array of multiple ultrasonic vibrators, and can transmit ultrasonic waves in a specific range in the radial direction of the tip portion 41. The ultrasonic transmitting / receiving unit 42 may be configured by a single ultrasonic vibrator.

[0030] A rotating shaft 43 is provided inside the ultrasonic probe 40, one end of which is connected to the ultrasonic transmitter / receiver unit 42. The rotating shaft 43 extends in a direction (the axial direction of the ultrasonic probe 40) that intersects (preferably orthogonal to) the direction of ultrasonic transmission from the ultrasonic transmitter / receiver unit 42, and the other end of the rotating shaft 43 is connected to a rotating member (not shown). Rotation of this rotating member rotates the rotating shaft 43, and the transmission range of ultrasonic waves from the ultrasonic transmitter / receiver unit 42 can be rotated and switched along the circumferential direction of the tip portion 41. As such, the ultrasonic transmitter / receiver unit 42 is configured to be rotatable, so that ultrasonic images of the inside of the subject within a 360-degree range around the tip portion 41 can be obtained based on echoes received by the ultrasonic transmitter / receiver unit 42.

[0031] The ultrasonic transmitter / receiver 42 may be provided in a ring shape when viewed in the axial direction of the tubular member 31. By providing the ultrasonic transmitter / receiver 42 in a ring shape, it is possible to easily obtain an ultrasonic image of the inside of the subject within a 360-degree range around the tip 41 based on echoes received by the ultrasonic transmitter / receiver 42. When the ultrasonic transmitter / receiver 42 is provided in a ring shape, the rotating shaft 43 and the rotating member are not necessary.

[0032] The ultrasonic probe 40 is provided with a group of wires electrically connected to the ultrasonic transmitter / receiver unit 42. This group of wires is connected to an ultrasonic probe control device 400 that controls the ultrasonic transmitter / receiver unit 42 and generates and displays ultrasonic images.

[0033] The operating handle 50 has an elongated cylindrical shape having an accommodation space capable of accommodating a portion of the treatment probe 30. The operating handle 50 has a cylindrical connecting portion 51 at its tip that can be connected by fitting or the like to a mouthpiece 112A provided at the treatment tool introduction port 112 of the endoscope 1.

[0034] The operating handle 50 further has a cylindrical shaft member 52, one end of which is supported by the connection portion 51 and which extends away from the connection portion 51. The shaft member 52 has a flange portion 52a at the end on the connection portion 51 side and a flange portion 52b at the end opposite the connection portion 51 side. The flange portion 52a is inserted into and fixed to the inside of the connection portion 51. A tubular member 31 is inserted throughout the shaft member 52. The part of the tubular member 31 on the tip side of the flange portion 52a of the shaft member 52 passes through the inside of the connection portion 51 and is inserted into a base 112A that is connected to the connection portion 51.

[0035] When the treatment system 20 is in use, the treatment probe 30, which has been led out of the connection part 51, is inserted from its tip end 31A through the mouthpiece 112A into the treatment tool channel 1A of the endoscope 1, and in this state, the connection part 51 is connected to the mouthpiece 112A. The connection part 51 is configured to be connectable to the treatment tool introduction port 112 when the tubular member 31 is inserted into the treatment tool introduction port 112 of the endoscope 1 from the tip end 31A side.

[0036] The operating handle 50 further includes a cylindrical slider 53 that is slidably connected to the outer peripheral surface of the shaft member 52 between the flange portions 52a and 52b so as to be axially movable along the shaft member 52. An opening is provided on the outer peripheral surface of the slider 53 at the end on the connection portion 51 side. A fixing member 57 such as a screw is inserted into this opening to fix (lock) the relative position of the slider 53 with respect to the shaft member 52. When the lock by the fixing member 57 is released, the slider 53 is configured to be movable within a range of a distance L1 between the position shown in FIG. 2 where its inner wall abuts against the flange portion 52b, and the position where its end face on the connection portion 51 side abuts against the connection portion 51.

[0037] The slider 53 has an opening 53K on its outer peripheral surface, closer to the base end than the position where the flange portion 52b is located when the end face on the connection portion 51 side is in contact with the flange portion 52a (the position of the shaft member 52 in this state is shown by the dashed line in the figure). The grip portion 33 is located at the position where this opening 53K is located. A portion of the grip portion 33 protrudes to the outside through the opening 53K. The grip portion 33 is fixed to the tubular member 31.

[0038] A support mechanism 55 that supports the base end 31B of the tubular member 31 is provided inside the slider 53, next to the distal end side (left side in FIG. 2) of the gripping portion 33. The support mechanism 55 includes a latch mechanism and the like, and supports the treatment probe 30 so that it can move a predetermined distance in the axial direction of the tubular member 31. For example, by an operator gripping the gripping portion 33 and moving it leftward in FIG. 3, the tubular member 31 (i.e., the treatment probe 30) can be moved a predetermined distance toward the distal end and maintained in that state.

[0039] A support member 56 that supports the ultrasonic probe 40 is provided on the slider 53 closer to the proximal end than the grip portion 33. The support member 56 is made of a circular rubber or the like that fits into an opening provided in the proximal end surface of the slider 53, and allows the ultrasonic probe 40 to be inserted therethrough. The support member 56 can be fixed to and support the inserted ultrasonic probe 40 by tightening a screw or the like (not shown) to narrow the hollow portion. The ultrasonic probe 40 inserted into the support member 56 is inserted into the hollow portion 31S of the tubular member 31 supported by the support mechanism 55, and is inserted all the way to the tip of the tubular member 31.

[0040] A support mechanism 58 that supports the ultrasonic probe 40 is provided between the grip portion 33 of the slider 53 and the support member 56. The support mechanism 58 includes a latch mechanism and the like, and supports the ultrasonic probe 40 so that it can move a predetermined distance in its axial direction. For example, by the operator moving the support mechanism 58 rightward in Figure 3, the ultrasonic probe 40 can be moved a predetermined distance toward its base end.

[0041] In the treatment system 20, it is preferable that the treatment probe 30 and the grip portion 33 are configured to be detachable from the operating handle 50. When using the treatment system 20, first, an assembly including the treatment probe 30 and the grip portion 33 fixed thereto is prepared, and this assembly is inserted into the slider 53 through the opening 53K. At this time, the treatment probe 30 is inserted from its distal end through the slider 53, shaft member 52, and connecting portion 51 in that order, until most of the treatment probe 30 is exposed to the outside from the connecting portion 51. The treatment system 20 may also be configured such that the operating handle 50, the treatment probe 30, and the grip portion 33 are integrated, and only the ultrasound probe 40 is detachable.

[0042] Next, the ultrasonic probe 40 is inserted into the support member 56 from the tip end 41 side, and the ultrasonic probe 40 is inserted into the hollow portion 31S of the tubular member 31 supported by the support mechanism 55. Then, the tip of the ultrasonic probe 40 is inserted all the way to the tip of the tubular member 31 so as to achieve the positional relationship shown in FIG.

[0043] 3, the ultrasonic transmitting / receiving unit 42 is located on the opposite side of the treatment unit 32 from the base end surface 311 in the axial direction of the tubular member 31. In this manner, the ultrasonic probe 40 is supported by the support member 56 and the support mechanism 58 in a state in which the ultrasonic transmitting / receiving unit 42 can protrude from the distal end opening 312A to the outside of the hollow portion 31S. The treatment probe 30 can be moved in the axial direction within the slider 53 by the support mechanism 55. Therefore, when the gripping portion 33 is operated, the treatment probe 30 can be moved a predetermined distance toward the distal end without changing the position of the ultrasonic probe 40.

[0044] Fig. 6 is a diagram showing a state in which the gripping portion 33 has moved toward the distal end of the tubular member 31 from the state shown in Fig. 3. By moving the gripping portion 33 toward the distal end by a distance L2 from the position shown in Fig. 2, it is possible to obtain a state in which the ultrasonic transmitting / receiving unit 42 is retracted from the distal opening 312A into the hollow portion 31S, as shown in Fig. 6. In addition, in the state shown in Fig. 6, when viewed in the radial direction of the tubular member 31, the treatment portion 32 and the ultrasonic transmitting / receiving unit 42 overlap, and the positions of the treatment portion 32 and the ultrasonic transmitting / receiving unit 42 in the axial direction of the tubular member 31 are approximately the same.

[0045] In the state shown in Figure 6, a portion of the tip portion 41 protrudes from the tip opening 312A, but the tubular member 31 may be movably supported by the support mechanism 55 so that the entire tip portion 41 is retracted into the hollow portion 31S.

[0046] The ultrasonic probe 40 can be moved in the axial direction within the slider 53 by the support mechanism 58. Therefore, when the support mechanism 58 is operated, the ultrasonic probe 40 can be moved toward the proximal end by a distance L3 (see FIG. 7) relative to the treatment probe 30.

[0047] Fig. 7 is a diagram showing a state in which the ultrasonic probe 40 has been moved toward the proximal end from the state shown in Fig. 6. By operating the support mechanism 58 and moving the ultrasonic probe 40 toward the proximal end by a distance L3, it is possible to obtain a state in which the ultrasonic transmitter / receiver unit 42 is positioned closer to the proximal end surface 311 than the treatment unit 32, as shown in Fig. 7. In the state shown in Fig. 7, it is preferable that the ultrasonic probe 40 be movably supported by the support mechanism 58 so that the treatment unit 32 and the ultrasonic transmitter / receiver unit 42 do not overlap when viewed in the radial direction of the tubular member 31.

[0048] In this way, the support mechanism 55, the support member 56, and the support mechanism 58 support the tubular member 31 and the ultrasonic probe 40 so that the relative positions of the ultrasonic transmitter / receiver unit 42 of the ultrasonic probe 40 and the treatment unit 32 of the treatment probe 30 can be changed.

[0049] In an initial state in which the support mechanisms 55 and 58 are not operated, the ultrasonic transmitter / receiver 42 protrudes from the distal end opening 312A of the tubular member 31. The treatment system 20 may be provided with a restricting unit that restricts the amount of protrusion of the ultrasonic transmitter / receiver 42 from the distal end opening 312A in this initial state.

[0050] For example, as shown in Fig. 8, an annular protrusion 31T is provided on the inner peripheral surface of the distal end 31A of the tubular member 31, and a protrusion 40T that can abut against the protrusion 31T is provided on the outer peripheral surface of the ultrasonic probe 40 near the distal end 41. When the ultrasonic probe 40 is inserted into the hollow portion 31S of the tubular member 31, the protrusion 31T and the protrusion 40T abut against each other, maximizing the amount of protrusion of the ultrasonic transmitting / receiving unit 42 from the hollow portion 31S, and thus restricting this protrusion. By fixing the ultrasonic probe 40 with a support member 56 in the state shown in Fig. 8, the positional relationship between the treatment probe 30 and the ultrasonic probe 40 can be controlled to a desired position. In the configuration shown in Fig. 8, the protrusion 31T and the protrusion 40T constitute a first restricting unit.

[0051] Note that the operating handle 50 may be configured such that the support position of the tubular member 31 is fixed (the support mechanism 55 supports the tubular member 31 so that it cannot move in the axial direction), and only the ultrasonic probe 40 is supported so that it can move in the axial direction of the tubular member 31. Even with this configuration, by moving the ultrasonic probe 40 relative to the treatment probe 30, it is possible to transition from the state shown in Figure 3 to the state shown in Figure 6, and from the state shown in Figure 6 to the state shown in Figure 7.

[0052] 3 (a state in which the ultrasonic transmitting / receiving unit 42 protrudes from the distal end opening 312A), the treatment probe 30 with the ultrasonic probe 40 inserted therethrough is inserted distally into the treatment tool introduction port 112, and then the connecting portion 51 is connected to the treatment tool introduction port 112. In this state, as shown in FIG. 9, the treatment probe 30 and the ultrasonic probe 40 are retracted further inside the endoscope distal end portion 10C than the treatment tool outlet 10Ca formed on the end face of the endoscope distal end portion 10C. Note that the structure of the operating handle 50 can also be modified so that the treatment probe 30 is inserted distally into the treatment tool introduction port 112 with the distal end of the ultrasonic probe 40 inserted up to the distal end of the tubular member 31 to achieve the positional relationship shown in FIG. 6.

[0053] The support mechanism 55 and the support mechanism 58 are supported by the slider 53. Therefore, when the slider 53 is moved along the shaft member 52 while the support mechanism 55 and the support mechanism 58 are not being operated, the treatment probe 30 and the ultrasonic probe 40 can be simultaneously moved from the state shown in Fig. 9. As a result, the treatment probe 30 and the ultrasonic probe 40 can be protruded from the treatment instrument outlet 10Ca, or the treatment probe 30 and the ultrasonic probe 40 can be retracted into the treatment instrument outlet 10Ca.

[0054] In this way, the shaft member 52, slider 53, support mechanism 55, support member 56, and support mechanism 58 constitute a moving mechanism that moves the tubular member 31 and the ultrasonic probe 40 in the axial direction of the tubular member 31 while maintaining the relative positions of the ultrasonic transmission / reception unit 42 and the treatment unit 32.

[0055] The slider 53 can only move between a position where it abuts against the connecting portion 51 and a position where it abuts against the flange portion 52b. Therefore, the amount of protrusion of the tubular member 31 and the ultrasonic probe 40 from the treatment tool outlet 10Ca is regulated by the shaft member 52, the slider 53, and the connecting portion 51. The shaft member 52, the slider 53, and the connecting portion 51 constitute a second regulating portion.

[0056] An example of a treatment method using the endoscope 1 and treatment system 20 configured as described above will be described below. First, the surgeon inserts the insertion section 10 of the endoscope 1 into the bronchi of the subject and moves the endoscope tip section 10C to the desired site. Then, the surgeon inserts the treatment probe 30 and the ultrasonic probe 40 of the treatment system 20 prepared as described above into the treatment tool introduction port 112 and connects the connection section 51 to the treatment tool introduction port 112. Note that the treatment system 20 may be attached to the endoscope 1 before inserting the endoscope 1 into the subject.

[0057] Next, the operator slides the slider 53 to project the treatment probe 30 and the ultrasonic probe 40 from the treatment instrument outlet 10Ca and advances them within the bronchus. While checking the ultrasound image generated based on the output of each ultrasonic transducer of the ultrasonic transmitter / receiver 42, the operator aligns the ultrasonic transmitter / receiver 42 with the target site P of the bronchus OS (see FIG. 10 ). In the state shown in FIG. 10 , the target site P and the ultrasonic transducers are aligned. Note that the treatment probe 30 and the ultrasonic probe 40 may be moved within the bronchus after projecting them from the treatment instrument outlet 10Ca in the state shown in FIG. 6 , and after reaching the desired position, they may be changed to the state shown in FIG. 3 , and the ultrasonic transmitter / receiver 42 may be aligned with the target site P of the bronchus OS.

[0058] Next, in the state shown in Figure 10, the surgeon slides the gripping portion 33 toward the tip, thereby moving the tubular member 31 toward the tip portion 31A while maintaining the position of the ultrasonic transmission / reception unit 42, as shown in Figure 11, and aligning the ultrasonic transmission / reception unit 42 with the treatment unit 32.

[0059] Next, the operator operates the support mechanism 58 to move the ultrasonic probe 40 toward its proximal end, as shown in FIG.

[0060] Next, the surgeon drives the treatment unit 32 to treat the target site P. That is, the treatment unit 32 is cooled to freeze the target site P. Thereafter, while maintaining the positional relationship between the treatment probe 30 and the ultrasonic probe 40 shown in FIG. 12 , the surgeon detaches the connection unit 51 from the treatment tool introduction port 112 and pulls out the treatment probe 30 and the ultrasonic probe 40 from the treatment tool introduction port 112 to collect the frozen tissue. Note that after freezing the target site P, the insertion unit 10 of the endoscope 1 may be pulled out from inside the subject, and the insertion unit 10, treatment probe 30, and ultrasonic probe 40 may be pulled out simultaneously.

[0061] In this way, with the treatment system 20, even in narrow areas such as the bronchi that cannot be observed with the endoscope 1, the target area P can be searched for using the ultrasound probe 40, and the target area P can be treated (tissue extracted) using the treatment unit 32 without removing the ultrasound probe 40 from the endoscope 1.

[0062] For example, after inserting an ultrasonic probe into the treatment instrument channel of the endoscope 1 to search for the target site P, the ultrasonic probe is removed from the treatment instrument channel, and a treatment probe is inserted into the treatment instrument channel to advance the treatment unit to the position of the target site P, and then treatment is performed in that state (the task of switching the ultrasonic probe and treatment probe) is no longer necessary. Therefore, treatment can be performed easily and efficiently.

[0063] 11, in which the tubular member 31 is slid by the support mechanism 55, the ultrasonic transmission / reception unit 42 and the treatment unit 32 are positioned at approximately the same position. This allows the treatment unit 32 to be accurately positioned with respect to the target site P, and allows treatment to be performed accurately on the target site P confirmed by the ultrasonic image. Furthermore, compared to methods that use radiation to locate the target site, the use of ultrasonic waves reduces the impact on the subject and reduces the cost of treatment.

[0064] 12, the treatment system 20 can drive the treatment unit 32 without disposing the ultrasonic transmitter / receiver unit 42 inside the treatment unit 32. This prevents the cooling heat of the treatment unit 32 from affecting the ultrasonic transmitter / receiver unit 42, thereby improving the durability of the ultrasonic probe 40.

[0065] Furthermore, according to the treatment system 20, the ultrasonic probe 40 can be inserted into and removed from the treatment probe 30, so that an ultrasonic probe already on the market can be used as the ultrasonic probe 40, thereby reducing the introduction cost of the system. In the treatment system 20, the operating handle 50 and the ultrasonic probe 40 may be washed and reused, while the treatment probe 30 may be a single-use product. Alternatively, the ultrasonic probe 40 may be washed and disinfected and reused, while the operating handle 50 and the treatment probe 30 may be a single-use product.

[0066] It is not essential that the relative positions of the treatment probe 30 and the ultrasonic probe 40 be changeable in the treatment system 20. The treatment probe 30 and the ultrasonic probe 40 may be fixed in a positional relationship, such as that shown in FIG. 3 . In this configuration, after aligning the ultrasonic transmitter / receiver 42 with the target site P, the slider 53 is slid to move the treatment probe 30 and the ultrasonic probe 40 to the left in FIG. 3 , moving the treatment unit 32 to the position where the ultrasonic transmitter / receiver 42 was located. In this state, the treatment unit 32 is driven to freeze the target site P. In this configuration, providing a mechanism for moving the slider 53 distally by the same distance as the distance between the treatment unit 32 and the ultrasonic transmitter / receiver 42 (e.g., adding a scale or the like to the slider 53) enables more accurate treatment of the target site P. Furthermore, in this configuration, the distal opening 312A may be blocked by a distal member 44 made of a material capable of propagating ultrasonic waves, as shown in FIG. 13 . The tip portion 41 shown in FIG. 13 is inserted into the hollow portion of the tip member 44 and fixed to the tip member 44 by fitting or bonding.

[0067] 13, it is assumed that the treatment system 20 will be sold in an assembled state of the treatment probe 30, the operating handle 50, and the ultrasonic probe 40. However, the tip member 44 may be configured as an independent part, and after the ultrasonic probe 40 is inserted into the treatment probe 30 as shown in FIG. 3, this part may be fitted into the tip portion 41, thereby obtaining the configuration shown in FIG.

[0068] The treatment probe 30 described above is not limited to one that can freeze and collect tissue, and other methods of collecting tissue may also be used. For example, the treatment portion 32 may be changed to a brush-shaped treatment portion. In this case, for example, the brush may be configured to be folded under normal conditions and to open and expand to a position where it can contact the target site P during treatment.

[0069] Furthermore, the treatment section 32 may be a pair of forceps. In this case, for example, the forceps may be folded in normal operation and may be opened to a position where they can come into contact with the target site P during treatment.

[0070] In the above description, the ultrasonic wave transmitting / receiving unit 42 is configured to be rotatable inside the ultrasonic probe 40, but this is not limiting. For example, the entire ultrasonic probe 40 may be configured to be rotatable around its axis.

[0071] As described above, this specification describes at least the following: Below, components corresponding to the above-described embodiment are shown in parentheses, but the present invention is not limited to these.

[0072] (1) A treatment system (treatment system 20) comprising a tubular member (tubular member 31) having a hollow portion (hollow portion 31S) therein and a treatment portion (treatment portion 32) provided on the outer periphery of the hollow portion at one end (tip end portion 31A), wherein the tubular member has a first opening (base end opening 311A) connected to the hollow portion at at least the first end face out of a first end face (base end face 311) on the other end (base end portion 31B) side in the axial direction and a second end face (tip end face 312) on the one end side.

[0073] (2) The treatment system according to (1), wherein the second end surface of the tubular member is provided with a second opening (tip opening 312A) that is connected to the hollow portion.

[0074] (3) A treatment system according to (1) or (2), comprising: a device (operating handle 50) including a first support portion (support mechanism 55) that supports the other end of the tubular member; and a connection portion (connection portion 51) that can be connected to a treatment tool introduction port (treatment tool introduction port 112) of an endoscope in a state in which the tubular member is inserted into the treatment tool introduction port from the one end side; wherein the device includes a second support portion (support member 56 and support mechanism 58) that supports an ultrasonic probe (ultrasonic probe 40) that is inserted into the hollow portion.

[0075] (4) A treatment system according to (3), wherein the first support portion and the second support portion support the tubular member and the ultrasonic probe so that the relative position between the treatment portion and an ultrasonic vibrator (ultrasonic transmitting / receiving portion 42) provided at the tip portion (tip portion 41) on the second end face side of the ultrasonic probe can be changed.

[0076] (5) The treatment system according to (4), wherein the relative position includes a first state (the state shown in FIG. 3) in which the ultrasonic transducer is positioned on the opposite side of the treatment section from the first end face side.

[0077] (6) The treatment system according to (5), wherein the second end surface of the tubular member is provided with a second opening (tip opening 312A) that is connected to the hollow portion, and the first state is a state in which the ultrasonic vibrator protrudes from the second opening.

[0078] (7) The treatment system according to (6), further comprising a first restricting portion that restricts the amount of protrusion of the ultrasonic transducer from the second opening.

[0079] (8) The treatment system according to (6), wherein the relative position includes a second state (the state shown in FIG. 6 or the state shown in FIG. 7) in which the ultrasonic transducer is positioned closer to the first end face than the second opening.

[0080] (9) The treatment system according to (8), wherein the second state is a state in which the ultrasonic vibrator is located closer to the first end face than the treatment section (the state shown in FIG. 7).

[0081] (10) A treatment system according to any one of (3) to (9), wherein the device includes a moving mechanism that moves the tubular member and the ultrasonic probe in the axial direction while the device is connected to the treatment tool introduction port and while the relative position between the ultrasonic vibrator (ultrasonic transmitting / receiving unit 42) provided at the tip end (tip end 41) on the second end face side of the ultrasonic probe and the treatment unit is maintained (the state shown in FIG. 3).

[0082] (11) The treatment system according to (10), wherein the moving mechanism includes a second restricting section that restricts the amount of protrusion of the tubular member and the ultrasonic probe from a treatment tool outlet (treatment tool outlet 10Ca) on the distal end surface of the endoscope.

[0083] (12) A treatment system according to any one of (1) to (11), comprising an ultrasonic probe (ultrasonic probe 40) inserted into the hollow portion with a tip end portion (tip end portion 41) on which an ultrasonic vibrator is provided facing the second end face side.

[0084] (13) A treatment system according to (12), wherein the ultrasonic transducer (ultrasonic transmitter / receiver 42) of the ultrasonic probe is configured to be rotatable around a rotation axis (rotation shaft 43) extending in a direction intersecting the ultrasonic wave transmission direction of the ultrasonic transducer.

[0085] (14) A treatment system according to (13), wherein the second end face of the tubular member is provided with a second opening (tip opening 312A) connected to the hollow portion, and the ultrasonic probe is configured to be switchable between a state in which the ultrasonic vibrator protrudes from the second opening (the state shown in Figure 3) and a state in which the ultrasonic vibrator retracts from the second opening into the hollow portion (the state shown in Figures 6 and 7).

[0086] (15) A tubular member (tubular member 31) having a hollow portion (hollow portion 31S) therein, a treatment portion (treatment portion 32) being provided on the outer periphery of the hollow portion at one end (distal end portion 31A), and an opening (proximal end opening 311A) connected to the hollow portion at an end face (proximal end face 311) on the other end (proximal end portion 31B) side in the axial direction, comprising: a first step of inserting an ultrasonic probe (ultrasonic probe 40) into the hollow portion of the tubular member; a second step of inserting the tubular member and the ultrasonic probe into a subject with an ultrasonic vibrator (ultrasonic transmitting / receiving unit 42) of the ultrasonic probe disposed in a position adjacent to the treatment portion in the axial direction of the tubular member; and a third step of aligning the ultrasonic vibrator with a target site (target site P) of the subject based on an output of the ultrasonic vibrator obtained by moving the tubular member and the ultrasonic probe inside the subject. a fourth step of aligning the target site and the treatment unit by moving the treatment unit to the position of the ultrasonic vibrator while the target site and the treatment unit are aligned; and a fifth step of treating the target site by driving the treatment unit while the target site and the treatment unit are aligned.

[0087] (16) The treatment method according to (15), wherein the fifth step includes a step of moving the ultrasonic vibrator toward the other end side of the treatment unit with the target site and the treatment unit aligned, and after that step, driving the treatment unit.

[0088] (17) The treatment method according to (15), wherein the position adjacent to the treatment portion in the second step is an adjacent position on the opposite side to the other end portion side.

[0089] (18) The treatment method according to any one of (15) to (17), wherein the treatment unit is capable of freezing tissue, and the treatment method includes a sixth step of, after the fifth step, moving the ultrasonic probe and the tubular member to collect the frozen tissue.

[0090] Although various embodiments have been described above, it goes without saying that the present invention is not limited to such examples. It is clear that a person skilled in the art can conceive of various modifications or alterations within the scope of the claims, and it is understood that these also naturally fall within the technical scope of the present invention. Furthermore, the components of the above embodiments may be combined in any manner as long as they do not deviate from the spirit of the invention.

[0091] This application is based on a Japanese patent application (Patent Application No. 2023-169863) filed on September 29, 2023, the contents of which are incorporated herein by reference.

[0092] DESCRIPTION OF SYMBOLS 1 Endoscope SP1 First space SP2 Second space 1A Treatment tool channel 2 Main body 4 Light source device 4A Connector connection section 5 Processor device 7 Display device 10 Insertion section 10A Flexible section 10B Bending section 10C Endoscope tip section 10Ca Treatment tool outlet 11 Operation section 11A Suction button 12 Angle lever 13 Universal cord 13A Connector section 20 Treatment system 30 Treatment probe 31 Tubular member 31A Tip section 31B Base end section 31K, 53K Opening 31S Hollow section 31T, 40T Convex section 32 Treatment section 33 Grip section 34 Supply tube 40 Ultrasonic probe 41 Tip section 42 Ultrasonic wave transmitting / receiving section 43 Rotating shaft 44 Tip member 50 Operation handle 51 Connection section 52 Shaft member 52a, 52b Flange portion 53 Slider 55, 58 Support mechanism 56 Support member 57 Fixing member 100 Endoscope device 112 Treatment tool introduction port 112A Base 300 Treatment probe control device 311 Base end surface 311A ​​Base end opening 312 Distal end surface 312A Distal end opening 400 Ultrasonic probe control device

Claims

1. A treatment system comprising a tubular member having a hollow portion therein and a treatment portion provided on the outer periphery of the hollow portion at one end, wherein the tubular member has a first opening connected to the hollow portion in at least the first end face of a first end face on the other end side in the axial direction and a second end face on the one end side.

2. A treatment system according to claim 1, wherein the second end face of the tubular member is provided with a second opening that is connected to the hollow portion.

3. A treatment system as described in claim 1 or 2, comprising a device including a first support part that supports the other end of the tubular member, and a connection part that can be connected to the treatment tool introduction port of an endoscope when the tubular member is inserted into the treatment tool introduction port from the one end side, the device including a second support part that supports an ultrasonic probe that is inserted into the hollow portion.

4. A treatment system as described in claim 3, wherein the first support part and the second support part support the tubular member and the ultrasonic probe so as to change the relative position between the treatment part and an ultrasonic transducer provided at the tip part on the second end face side of the ultrasonic probe.

5. A treatment system according to claim 4, wherein the relative position includes a first state in which the ultrasonic transducer is positioned on the opposite side of the treatment section from the first end face side.

6. A treatment system as described in claim 5, wherein the second end face of the tubular member is provided with a second opening connected to the hollow portion, and the first state is a state in which the ultrasonic transducer protrudes from the second opening.

7. A treatment system according to claim 6, comprising a first restricting portion that restricts the amount of protrusion of the ultrasonic transducer from the second opening.

8. A treatment system according to claim 6, wherein the relative position includes a second state in which the ultrasonic transducer is located closer to the first end face than the second opening.

9. A treatment system according to claim 8, wherein the second state is a state in which the ultrasonic transducer is located closer to the first end face side than the treatment section.

10. A treatment system as described in claim 3, wherein the device includes a moving mechanism that moves the tubular member and the ultrasonic probe in the axial direction while the device is connected to the treatment tool introduction port and while the relative position between an ultrasonic transducer provided at the tip portion on the second end face side of the ultrasonic probe and the treatment section is maintained.

11. A treatment system as described in claim 10, wherein the moving mechanism is provided with a second regulating part that regulates the amount of protrusion of the tubular member and the ultrasonic probe from the treatment tool outlet port on the distal end surface of the endoscope.

12. A treatment system according to claim 1 or 2, comprising an ultrasonic probe inserted into the hollow portion with a tip end provided with an ultrasonic transducer facing the second end face side.

13. A treatment system according to claim 12, wherein the ultrasonic transducer of the ultrasonic probe is configured to be rotatable about a rotation axis extending in a direction intersecting the ultrasonic transmission direction of the ultrasonic transducer.

14. A treatment system as described in claim 13, wherein the second end face of the tubular member is provided with a second opening connected to the hollow portion, and the ultrasonic probe is configured to be switchable between a state in which the ultrasonic transducer protrudes from the second opening and a state in which the ultrasonic transducer retracts from the second opening into the hollow portion.

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