Endoscope cap, endoscope treatment instrument, and endoscope system

Abstract

An endoscope cap (1) includes: a cover portion (2) which is cylindrical, which is attached to an outer peripheral surface of a front end portion of an endoscope (10); a cap portion (3) which projects from a front end of the cover portion (2) in a length direction of the cover portion (2), which has an abutting surface (6) for an end (10a) of the endoscope (10) to abut in a state in which the front end portion of the endoscope (10) is inserted into the cover portion (2); a channel tube (4) whose front end portion is fixed to a base end portion of the cover portion (2), which extends substantially in parallel with the cover portion (2); and a connecting member (5) which is linear, which is supported to the cover portion (2), which is used to connect a device (30) in the tube (4) to the cover portion (2), the cover portion (2) has a pair of support holes (7) which are separated from each other in a circumferential direction of the cover portion (2), which are formed at positions which are on a base end side from the abutting surface (6) and on a front end side from a front end of the channel tube (4), the connecting member (5) is inserted into the pair of support holes (7), and the connecting member (5) is able to swing with each of the support holes (7) as a fulcrum.

Description

TECHNICAL FIELD

[0001] The present application relates to an endoscope cap, an endoscope treatment instrument, and an endoscope system. BACKGROUND

[0002] As one of treatment means for early-stage cancer, there is ESD (Endoscopic Submucosal Dissection) in which a mucosa including cancer is peeled off a submucosa. A traction device for applying tension to the submucosa is used at the time of peeling (see Patent Documents 1 and 2, for example).

[0003] The traction device described in Patent Documents 1 and 2 is a cap type mounted to a distal end portion of an endoscope, and a gripping device is supported so as to be movable in a longitudinal direction. By advancing and retreating in the longitudinal direction of the gripping device, a gripping portion at a distal end of the gripping device is lowered and raised in front of the endoscope. Thus, it is possible to grip and lift a mucosa with the gripping device within a field of view of the endoscope.

[0004] Prior art documents

[0005] Patent documents

[0006] Patent Document 1: International Publication No. 2014 / 199759

[0007] Patent Document 2: Japanese Patent Application Publication No. 2008-253597 SUMMARY

[0008] PROBLEMS TO BE SOLVED BY THE INVENTION

[0009] In the case of the traction device of Patent Documents 1 and 2, the lowered position of the gripping portion is far from the distal end of the endoscope, away from the focal position of the endoscope. In order to observe the gripping portion more clearly with the endoscope, it is desirable that the lowered position of the gripping portion be close to the distal end of the endoscope.

[0010] Further, by retreating of the gripping device, a mucosa lifted by the gripping portion is pulled toward the proximal end side of the endoscope. At this time, it is desirable that the mucosa be pulled in to a position closer to the proximal end side.

[0011] The present application was made in view of the above circumstances, and aims to provide an endoscope cap, an endoscope treatment instrument, and an endoscope system that can lower a gripping portion to a position close to a distal end of an endoscope, and that can secure an amount of pull-in of a biological tissue gripped by the gripping portion.

[0012] MEANS FOR SOLVING THE PROBLEMS

[0013] In order to achieve the above object, the present application provides the following means.

[0014] A technical solution of the present application is a cap for an endoscope, which includes: a cover portion that is cylindrical, and is attached to an outer peripheral surface of a front end portion of an endoscope; a cap portion that is connected to a front end of the cover portion, has an abutting surface for the front end portion of the endoscope to abut in a state where the front end portion is inserted into the cover portion, and protrudes from the front end of the cover portion in a length direction of the cover portion; a channel tube for insertion of an elongated device, a front end portion of the channel tube being fixed to a base end portion of the cover portion, the channel tube extending substantially in parallel with a length axis of the cover portion; and a connecting member that is linear, and is used to connect the device to the cover portion, the connecting member being supported by the cover portion, extending along an outer peripheral surface of the cover portion, a front end of the channel tube being located at a position closer to the base end side of the cover portion than the abutting surface, the cover portion having a pair of support holes provided at positions separated from each other in a circumferential direction of the cover portion, the connecting member being inserted into the pair of support holes from an outer side toward an inner side of the cover portion, the connecting member being able to swing with respect to the cover portion with each of the support holes as a fulcrum, the pair of support holes being formed at positions closer to the base end side of the cover portion than the abutting surface and closer to the front end side of the cover portion than the front end of the channel tube.

[0015] According to the technical solution, the device is inserted into the channel tube, and the device is connected to the cover portion by the connecting member extending between the pair of support holes of the cover portion. Moreover, the cover portion is oriented so that the pair of support holes are arranged in a left-right direction of the endoscope and the channel tube and the device are disposed on an upper side of the endoscope, and the front end of the endoscope attached to the front end portion and abutting against the abutting surface is positioned at a predetermined position with respect to the cover portion.

[0016] In this state, when the device is moved forward in the length direction with respect to the cover portion and the endoscope, the device swings with the connecting member as a fulcrum with the support holes, and a grip portion of the front end of the device descends in front of the front end of the endoscope. In addition, when the device is moved rearward in the length direction with respect to the cover portion and the endoscope, the device swings with the connecting member as a fulcrum with the support holes, and the grip portion ascends in front of the front end of the endoscope. Thus, by simply pushing the device forward, it is possible to bring the grip portion close to a target portion of a biological tissue located on a lower side portion in a field of view of the endoscope and grip the target portion with the grip portion. In addition, by simply pulling the device rearward, it is possible to lift the target portion gripped by the grip portion and pull the target portion into a position closer to the base end side of the cover portion than the front end of the cover portion.

[0017] In this case, the pair of support holes, which are the center of swinging of the grip portion, are provided at positions closer to the base end side of the endoscope than the abutting surface. Thus, compared to a case where the pair of support holes are provided in the cap portion, it is possible to bring the grip portion to descend to a position close to the front end of the endoscope, and it is possible to ensure the amount of pulling of the biological tissue gripped by the grip portion.

[0018] In the above technical solution, the inner peripheral surface of the cover portion can have a tapered surface that gradually increases in inner diameter from the front end toward the base end.

[0019] In the above technical solution, either the cover portion or the cap portion can have a pair of fixing holes provided at positions separated from each other in the circumferential direction and different from the pair of support holes, and the both end portions of the connecting member can be fixed in the pair of fixing holes.

[0020] According to this structure, by additionally providing the fixing holes for fixing the end portions of the connecting member with respect to the support holes, it is possible to prevent the end portions of the connecting member from being subjected to force when the connecting member swings.

[0021] In the above technical solution, the pair of fixing holes can be provided in either the cap portion or the cover portion.

[0022] In the above technical solution, the both end portions of the connecting member can have knobs with outer diameters larger than the diameters of the support holes, and the both end portions of the connecting member can be fixed in the pair of support holes.

[0023] In the above technical solution, the connecting member can be a flexible wire.

[0024] According to this structure, compared with the case where a member with high bending stiffness such as a wire is used as the connecting member, it is possible to improve the degree of freedom of movement of the holding portion.

[0025] Another technical solution of the present application is an endoscope treatment instrument including: a long holding device; and the above-described cap for endoscope, the holding device having a long flexible elongated member that penetrates the channel tube in a manner capable of moving in the longitudinal direction, a holding portion that holds a biological tissue and is connected to the front end of the elongated member, and a connector that is provided on the base end side of the holding portion and is disposed at a position closer to the front end side than the channel tube, the connector having a through hole that penetrates in a direction intersecting the longitudinal direction of the elongated member, and the connecting member extending between the pair of support holes via the through hole inside the connector.

[0026] Another technical solution of the present application is an endoscope system including: an endoscope; and the above-described endoscope treatment instrument.

[0027] In the above technical solution, the cap for endoscope can have a pair of support holes provided at positions separated from each other in the circumferential direction and different from the pair of support holes, and the both end portions of the connecting member can be fixed in the pair of support holes.

[0028] In the above another aspect, the connector can be disposed on the side opposite to the cover portion with respect to the elongated member in the radial direction of the cover portion.

[0029] According to this structure, interference of the oscillating connector with the surface of the cover portion can be prevented.

[0030] In the above another aspect, the connector can be disposed between the elongated member and the cover portion in the radial direction of the cover portion.

[0031] According to this structure, entanglement of the connector with the gripping means can be prevented.

[0032] In the above another aspect, the edge of the front end of the cap portion can have a protrusion extending in a direction from the base end toward the front end of the cap portion and a recess extending in a direction from the front end toward the base end of the cap portion, and the connector can be configured to be able to oscillate from a first position extending along the outer peripheral surface of the cover portion to a second position in contact with the protrusion of the cap portion.

[0033] In the above another aspect, the edge of the front end of the cap portion can have a protrusion extending in a direction from the base end toward the front end of the cap portion and a recess extending in a direction from the front end toward the base end of the cap portion, and a portion of the connector can be in contact with the protrusion when a portion of the gripping means passes through the recess.

[0034] Effects of the Invention

[0035] According to the present application, the following effects are obtained: the holding portion can be lowered to a position close to the front end of the endoscope, and the amount of the biological tissue held by the holding portion can be ensured. BRIEF DESCRIPTION OF DRAWINGS

[0036] Figure 1A is a side view showing the structure of the cap for endoscope, the treatment instrument for endoscope, and the endoscope system according to an embodiment of the present application.

[0037] Figure 1B is a diagram illustrating Figure 1A the operation of the treatment instrument for endoscope, and is a diagram showing a state in which the holding portion is lowered to a lowered position.

[0038] Figure 2A is a diagram showing an example of a fixing band for fixing the cover portion to the endoscope.

[0039] Figure 2B is a diagram showing a state in which the cover portion is fixed to the endoscope using the fixing band of Figure 2A

[0040] Figure 2C ​is a view showing an example of a fixing band for fixing a channel tube to an endoscope.

[0041] Figure 2D is a view showing a state in which a channel tube is fixed to an endoscope using a fixing band of Figure 2C .

[0042] Figure 3A is a plan view of an endoscope cap viewed from the upper side.

[0043] Figure 3B is a perspective view of an endoscope cap, and is a view showing a state in which the holding portion is lowered to a lowered position.

[0044] Figure 4A is a view showing an example of a method of using an endoscope system, and is a view showing a case in which a biological tissue is held by the holding portion in the lowered position.

[0045] Figure 4B is a view showing an example of a method of using an endoscope system, and is a view showing a case in which a biological tissue is lifted up and pulled in by the holding portion.

[0046] Figure 5 is a view showing a design parameter of an endoscope cap.

[0047] Figure 6A is a view showing another design parameter of an endoscope cap, and is a view showing an action of a holding device in a case where a pair of support holes are located at a position higher than a length axis of a cover portion.

[0048] Figure 6B is a view showing another design parameter of an endoscope cap, and is a view showing an action of a holding device in a case where a pair of support holes are located at a position lower than a length axis of a cover portion.

[0049] Figure 7A is a side view of an example of an endoscope cover in which end portions of a link member are fixed in support holes.

[0050] Figure 7B is a side view of an example of an endoscope cover having fixing holes.

[0051] Figure 7C is a side view of another example of an endoscope cover having fixing holes.

[0052] Figure 8A is a side view of another example of an endoscope cover having fixing holes.

[0053] Figure 8B is a partial sectional view of a cover portion along a D-D line of a link member passing through a support hole and a fixing hole, and is a view showing a treatment of end portions of the link member in the fixing hole. Figure 8A ​

[0054] Figure 9A is a side view of another example of the cap for endoscope having a fixing hole.

[0055] Figure 9B is a partial cross-sectional view of the cap portion along the E-E line of Figure 9A is a partial cross-sectional view of the cap portion along the E-E line of

[0056] Figure 10A is a side view of another example of the cap for endoscope having a fixing hole.

[0057] Figure 10B is a partial cross-sectional view of the cap portion along the E-E line of Figure 10A is a partial cross-sectional view of the cap portion along the E-E line of

[0058] Figure 11A is a side view of a modification example of the treatment instrument for endoscope.

[0059] Figure 11B is a side view of another modification example of the treatment instrument for endoscope. DETAILED DESCRIPTION

[0060] Hereinafter, an endoscope cap 1, a treatment instrument for endoscope 20, and an endoscope system 100 of an embodiment of the present application will be described with reference to the drawings.

[0061] As shown in Figure 1A , the endoscope system 100 of the present embodiment includes an endoscope 10 and the treatment instrument for endoscope 20.

[0062] The treatment instrument for endoscope 20 includes the holding device 30 and the endoscope cap 1 that supports the holding device 30 and is attached to the front end portion of the endoscope 10.

[0063] The holding device 30 includes an elongated member 31 that is a long, flexible, and slender member, a holding portion 32 that is connected to the front end of the elongated member 31 and holds a living tissue, and a connector 33 that is provided on the base end side of the holding portion 32. The elongated member 31 is, for example, a coil sheath. The holding portion 32 has a pair of holding pieces that can be opened and closed, and a living tissue can be held between the pair of holding pieces. The connector 33 is provided, for example, between the elongated member 31 and the holding portion 32, and has a through-hole 33a that penetrates in a direction orthogonal to the longitudinal direction of the elongated member 31.

[0064] The endoscope cap 1 includes a generally cylindrical cover 2 mounted on the outer peripheral surface of the front end of the endoscope 10, a cap 3 connected to the front end of the cover 2, a channel tube 4 fixed to the base end of the cover 2, a connecting member 5 supported on the cover 2 and connecting the cover 2 and the holding device 30, and an abutment surface 6 that positions the front end 10a of the endoscope 10 at a predetermined position at or near the front end of the cover 2.

[0065] The endoscope cap 1 has mutually orthogonal vertical and horizontal directions. The vertical and horizontal directions are the radial directions of the cover 2, and the alignment direction of the longitudinal axis of the cover 2 and the longitudinal axis of the channel tube 4 is vertical. The vertical and horizontal directions of the endoscope cap 1 correspond to the vertical and horizontal directions of the endoscope 10, respectively.

[0066] The cover 2 has openings on its front end face and base end face, allowing the front end of the endoscope 10 to be inserted from the base end side. The cover 2 fits into the outer peripheral surface of the front end of the endoscope 10, and is fixed to the front end of the endoscope 10 by friction between the inner peripheral surface of the cover 2 and the outer peripheral surface of the front end of the endoscope 10. The inner peripheral surface of the cover 2 has a tapered surface 2a that gradually increases in inner diameter from the front end towards the base end.

[0067] If necessary, the endoscope 10 can also be fixed to the cover 2. Figure 2A The fixing strap 11a is shown in the shape. By connecting the endoscope 10 and the cover 2 as shown... Figure 2B They are fixed together as shown, thereby increasing the fixation strength. Figure 2B This is a bottom view of the cover 2 and endoscope 10 observed from below. Alternatively, it can also be used... Figure 2C The fixing band 11b of the shape shown is as follows Figure 2D The endoscope 10 and the channel tube 4 are fixed together as shown.

[0068] Specifically, the cover 2 has a notch 2b, which is a portion that is significantly lacking from the base end toward the front end. The edge of the notch 2b and the outer peripheral surface of the endoscope 10 exposed from the notch 2b are covered by a fixing strap 11a. This ensures a large bonding range (the length of the edge of the cover 2) between the endoscope 10 and the cover 2, thereby firmly bonding the cover 2 and the outer peripheral surface of the endoscope 10. Therefore, even if the curved portion of the endoscope 10 is bent, for example, the cover 2 is unlikely to detach from the endoscope 10. Furthermore, the bonding method of using the fixing strap 11a to bond the endoscope 10 and the cover 2 is not limited to this embodiment; for example, it can also be used when the holding device 30 is replaced with a snare or a knife.

[0069] Further, the cover portion 2 has a pair of support holes 7 for supporting the connecting member 5. The pair of support holes 7 are provided at positions separated from each other in the circumferential direction of the cover portion 2 and opposed to each other in the left-right direction. Each of the support holes 7 penetrates from the outer peripheral surface to the inner peripheral surface of the cover portion 2 in the radial direction of the cover portion 2.

[0070] The cap portion 3 is a substantially circular ring-shaped member coaxial with the cover portion 2 and projects from the front end of the cover portion 2 in the length direction of the cover portion 2. The cap portion 3 has a length in the length direction smaller than the focal point distance of the endoscope 10, and the focal point position of the endoscope 10 is disposed in the vicinity of the front end of the cap portion 3. In one example of the design of the endoscope system 100, the focal point distance of the endoscope 10 is 10 mm, and the length of the cap portion 3 is 5 mm.

[0071] The abutting surface 6 is disposed at the front end or in the vicinity of the front end of the cover portion 2 and is used for the front end 10a of the endoscope 10 to abut in a state in which the front end portion of the endoscope 10 is inserted into the cover portion 2. The abutting surface 6 is provided, for example, at the base end portion of the cap portion 3. The cylindrical base end portion of the cap portion 3 is fitted inside the front end portion of the cover portion 2 and is fixed to the front end portion of the cover portion 2 with an adhesive. The abutting surface 6 projects from the inner peripheral surface of the base end portion of the cap portion 3 toward the radial direction inner side. By abutting the front end surface of the endoscope 10 to the abutting surface 6, it is possible to position the front end 10a of the endoscope 10 at the position of the abutting surface 6 as a predetermined position.

[0072] The cover portion 2 and the cap portion 3 can also be manufactured by two-color molding. In the case of two-color molding, it is preferable that the front end of the cover portion 2 abut against a portion of the cap portion 3. Further, in the case of two-color molding, the cap portion 3 is preferably formed of polycarbonate, and the cover portion 2 is preferably formed of a polyester-based elastomer.

[0073] A portion of the cap portion 3 is molded so as to have a larger outer diameter than the front end of the cover portion 2, and the front end of the cover portion 2 abuts against this portion. Further, the front end of the tapered surface 2a abuts against the most base end portion of the cap portion 3, and the inner diameter of the front end of the tapered surface 2a is larger than the inner diameter of the cylindrical base end portion of the cap portion 3 at a position on the base end side from the abutting surface 6.

[0074] In order to assume a role of securing a space in front of the endoscope 10 for lifting the peripheral tissue in front of the endoscope 10 in the body, the cap portion 3 preferably has rigidity capable of maintaining a shape against a force from the peripheral tissue. On the other hand, from the viewpoint of easiness of mounting to the front end portion of the endoscope 10, the cover portion 2 is preferably formed of an elastic material. By providing the abutting surface 6 at the cap portion 3 having higher rigidity than the cover portion 2, it is possible to make the position of the front end 10a of the endoscope 10 more stable.

[0075] The cover portion 2 has a protrusion 2c on the upper side of the base end portion of the cover portion 2. A passage 2d (see FIG. 2) that penetrates the protrusion 2c in the length direction of the cover portion 2 is formed in the protrusion 2c. Figure 1AThe front end of the passage 2d and the base end of the passage 2d communicate with each other. The front end portion of the passage pipe 4 is fixed to the protrusion 2c in a state of being inserted into the passage 2d. The method of fixing the passage pipe 4 in the passage 2d can be either adhesion using an adhesive or heat fusion. The passage pipe 4 extends substantially in parallel with the length direction of the cover portion 2. The front end of the passage pipe 4 is located at a position closer to the base end side of the cover portion 2 than the front end of the cover portion 2. The passage pipe 4 has a passage 4a that penetrates the passage pipe 4 in the length direction. The elongated member 31 of the gripping device 30 penetrates the passage 4a in a manner capable of moving in the length direction, and the gripping portion 32 and the connector 33 are disposed at a position closer to the front end side of the passage pipe 4. Each of the support holes 7 is formed at a position closer to the base end side of the cover portion 2 than the abutting surface 6 and at a position closer to the front end side of the cover portion 2 than the front end of the passage pipe 4.

[0076] The connection member 5 is an elongated linear member such as a wire. The connection member 5 is disposed on the outside of the cover portion 2 and extends between the pair of support holes 7 via the through hole 33a of the connector 33. The outer diameter of the connection member 5 is preferably smaller than the inner diameter of each of the support holes 7. However, the outer diameter of the connection member 5 can be larger than the inner diameter of each of the support holes 7 as long as the connection member 5 can be inserted into the support holes 7.

[0077] The both end portions of the connection member 5 are inserted into the support holes 7 from the outside toward the inside, and the both ends of the connection member 5 disposed in the cover portion 2 are fixed in the support holes 7, for example, by using the knots formed at the both ends. The knots have a width larger than the inner diameter of each of the support holes 7. Thus, the connection member 5 is supported in a manner capable of oscillating with respect to the cover portion 2 with the pair of support holes 7 as a fulcrum.

[0078] The connection member 5 is preferably a member having flexibility and being hardly or completely inextensible in the length direction, and is preferably a soft wire, for example. The connection member 5 can be a metal wire instead of a wire.

[0079] By connecting the gripping device 30 and the cover portion 2 with the connection member 5, the gripping portion 32 is moved between Figure 1A the maximum pull-in position shown in FIG. 6 and Figure 1B the lowered position shown in FIG. 7 in accordance with the push-pull operation in the length direction of the gripping device 30. The maximum pull-in position is a position at which the gripping portion 32 or the connector 33 abuts against the front end of the passage pipe 4 and the further movement of the gripping portion 32 to the base end side is prevented by the front end of the passage pipe 4.

[0080] That is, as shown in Figure 1BAs shown, when the holding device 30 is pushed forward in the longitudinal direction, the connector 33 and the connecting member 5 swing together with the support hole 7 as the fulcrum in front of the cap 3 from top to bottom, thereby causing the holding part 32 to descend from top to bottom in front of the cap 3. Furthermore, when the holding device 30 is pulled backward in the longitudinal direction, the connector 33 and the connecting member 5 swing together with the support hole 7 as the fulcrum in front of the cap 3 from bottom to top, thereby causing the holding part 32 to rise from bottom to top in front of the cap 3.

[0081] The connecting member 5 is preferably movable relative to the connector 33 along its length direction within the through hole 33a. The movement of the connecting member 5 within the through hole 33a allows for relative left-right movement of the holding device 30 and the cover 2, enabling independent left-right movement of the holding device 30 and the front end of the endoscope 10. For example, while holding the holding portion 32 and the biological tissue held by the holding portion 32 in the same position, the front end of the endoscope 10 can be moved left-right by bending the curved portion of the endoscope 10 in the left-right direction.

[0082] The length of the connecting member 5 is preferably such that the connecting member 5 does not loosen when the gripping part 32 is positioned in the maximum pull-in position. If the length of the connecting member 5 is such that the connecting member 5 is loose when the gripping part 32 is positioned in the maximum pull-in position, there is a possibility that the gripping part 32 in the maximum pull-in position may move against the intention of the surgical operator.

[0083] like Figure 3A and Figure 3B As shown, the edge 3a of the front end of the cap 3 has a protrusion 3b extending in the direction from the base end of the cap 3 toward the front end and a recess 3c extending in the direction from the front end of the cap 3 toward the base end.

[0084] When viewed from above, orthogonal to the central axis of each support hole 7 (through hole 33a) and the length axis A of the cover 2, a recess 3c is provided in the upper part through which the holding device 30 passes. When viewed from the side, along the direction of the central axis of each support hole 7 (through hole 33a), a protrusion 3b extends in a convex shape, gently curving from the recess 3c toward the length axis A.

[0085] In the top view, the recess 3c and the channel tube 4 are positioned such that the central axis of the channel tube 4 passes through the recess 3c. The channel tube 4 is fixed to the cover 2 in this positional relationship. Therefore, by advancing only the holding device 30 protruding from the front end of the channel tube 4, the holding device 30 will pass through the recess 3c of the cap 3. As a result, the holding part 32 can be brought closer to the front end of the endoscope 10.

[0086] When the holding portion 32 descends from the upper side to the lower side in front of the cap portion 3, since the edge 3a is gently curved in the range from the recess 3c to the protrusion 3b, the link member 5 can smoothly slide on the edge 3a. It is preferable that the link member 5 be in contact with the protrusion 3b in a state where the holding portion 32 descends in front of the cap portion 3. That is, the link member 5 is configured to be in contact with the protrusion 3b when the holding device 30 passes through the recess 3c. Further, the link member 5 is configured to be able to swing from a first position extending along the outer circumferential surface of the cover portion 2 to a second position in contact with the protrusion 3b of the cap portion 3.

[0087] Next, the operation of the cap 1 for an endoscope, the treatment instrument 20 for an endoscope, and the endoscope system 100 will be described.

[0088] In order to perform treatment on the diseased tissue S in the patient's body using the endoscope system 100 of the present embodiment, as shown in FIG. 1, the cap 1 for an endoscope is attached to the cover portion 2 of the endoscope 10. Then, as shown in FIG. 2, the treatment instrument 20 for an endoscope is attached to the cap 1 for an endoscope. Figure 1A As shown in FIG. 3, by fitting the distal end portion of the endoscope 10 into the cap portion 3, the treatment instrument 20 for an endoscope is attached to the distal end portion of the endoscope 10. At this time, the distal end 10a of the endoscope 10 is positioned at a predetermined position by the abutting surface 6. Further, the channel tube 4 and the holding device 30 are arranged on the upper side of the endoscope 10, and the relative positions of the cap portion 3 and the distal end portion of the endoscope 10 about the length axis are adjusted so that the up-down direction and the left-right direction of the cap portion 3 coincide with the up-down direction and the left-right direction of the endoscope 10, respectively.

[0089] Next, the assembly of the endoscope 10 and the treatment instrument 20 for an endoscope is inserted into the body, and the distal end portion of the endoscope 10 is arranged so that the diseased tissue S is positioned at the lower side portion in the field of view of the endoscope 10. Then, the proximal end portion of the elongated member 31 arranged outside the body is pushed toward the distal end side, and the holding portion 32 is moved in the length direction forward with respect to the cap 1 for an endoscope and the endoscope 10.

[0090] By the movement of the holding portion 32 forward, the link member 5 swings about the support hole 7, and as shown in FIG. 4, the holding portion 32 descends from the upper side to the lower side in front of the distal end 10a of the endoscope 10. Thus, in the endoscope image, the holding portion 32 appears from the upper side and moves toward the diseased tissue S to the lower side. Therefore, by moving only the holding device 30 forward, the holding portion 32 can reach the diseased tissue S. Figure 1B

[0091] Next, as shown in FIG. 5, the diseased tissue S is held by the holding portion 32, and next, as shown in FIG. 6, the proximal end portion of the elongated member 31 is pulled, and thus the held diseased tissue S is lifted. At this time, as shown in FIG. 7, the holding portion 32 is positioned in the vicinity of the distal end 10a of the endoscope 10. Figure 4A Figure 4B Figure 4B ​​​The holding portion 32 is pulled toward the proximal end side in the direction of the arrow shown in FIG. 1, toward the channel tube 4, so that the raised tissue S can be pulled in from the front end of the cap portion 3 toward the proximal end side. The cap portion 3 ensures a distance between the raised tissue S and the front end face of the endoscope 10. Next, a treatment instrument such as an electrotome is introduced to the tissue S via an instrument channel (not shown) provided in the endoscope 10, and the raised tissue S is dissected using the treatment instrument.

[0092] Here, the focal point position of the endoscope 10 is located near the front end of the cap portion 3. Thus, in order to clearly observe the holding portion 32 using the endoscope 10, it is desirable that the lowered position of the holding portion 32 be closer to the front end 10a of the endoscope 10. According to the present embodiment, the support holes 7, which are the pivot points of the swing of the link member 5, are provided at positions closer to the proximal end side than a predetermined position at which the front end of the endoscope 10 is positioned by the abutting face 6. Thus, compared to a case in which the support holes 7 are provided in the cap portion 3, the lowered position of the holding portion 32 can be made closer to the front end 10a of the endoscope 10.

[0093] Further, by providing the support holes 7 at positions closer to the proximal end side than the predetermined position, compared to a case in which the support holes 7 are provided in the cap portion 3, the holding portion 32 can be disposed at a position closer to the proximal end side. Thus, the holding portion 32 can be disposed at a position that does not interfere with the surrounding tissue of the front end of the endoscope cap 1. Further, as shown in FIG. 1, the amount of pull-in of the raised tissue S held by the holding portion 32 can be ensured, so that the range of the raised tissue can be expanded. Figure 4B

[0094] The positions of the support holes 7 in the length direction of the cover portion 2 are described. As shown in FIG. 2, each support hole 7 is preferably formed at a position closer to the front end side of the cover portion 2 than the center in the length direction of the cover portion 2. Figure 5 Figure 5 The positions of the support holes 7 in the up-down direction of the cover portion 2 are described. As shown in FIG. 3, each support hole 7 is preferably formed at a position closer to the front end side of the cover portion 2 than the center in the length direction of the cover portion 2.

[0095] In FIG. 4, the distance B1 is the distance in the length direction of the cover portion 2 from the front end of the cap portion 3 to each support hole 7. The greater the distance B1, the greater the amount of pull-in of the biological tissue, and the farther the lowered position of the holding portion 32 from the front end 10a of the endoscope 10. On the other hand, the smaller the distance B1, the smaller the amount of pull-in of the biological tissue, and the closer the lowered position of the holding portion 32 to the front end 10a of the endoscope 10. Figure 5 By forming each support hole 7 at a position closer to the front end side of the cover portion 2 than the center in the length direction of the cover portion 2, the lowered position of the holding portion 32 closer to the front end 10a of the endoscope 10 and the ensuring of the amount of pull-in of the biological tissue can be taken into account.

[0096]

[0097] The positions of the support holes 7 in the up-down direction of the cover portion 2 are described. As shown in FIG. 3, each support hole 7 is preferably formed at a position closer to the front end side of the cover portion 2 than the center in the length direction of the cover portion 2. Figure 6A Figure 6B The positions of the support holes 7 in the up-down direction of the cover portion 2 are described. As shown in FIG. 3, each support hole 7 is preferably formed at a position closer to the front end side of the cover portion 2 than the center in the length direction of the cover portion 2.​​Figure 6A and Figure 6B As shown, when viewing the endoscope cap 1 from the side in the left-right direction, the distance C1 is preferably less than half of the distance C2. The distance C1 is the distance from the length axis A of the cover 2 to each support hole 7 in the vertical direction, and the distance C2 is the distance from the length axis A of the cover 2 to the outer peripheral surface of the cover 2 in the vertical direction, that is, the outer radius of the cover 2.

[0098] When viewed from the side in the left-right direction, each support hole 7 is more preferably located on the length axis A of the cover 2. In other words, the support hole 7 is provided on the outer peripheral surface of the cover 2 at a position intersecting a plane that includes the length axis of the cover 2 and intersects a plane perpendicular to the line segment connecting the length axis of the channel tube 4 and the length axis of the cover 2.

[0099] Figure 6A This shows the case where the support hole 7 is located on the upper side of the length axis A. Figure 6B This shows the case where the support hole 7 is located lower than the length axis A.

[0100] like Figure 6A As shown, when the offset of the support hole 7 from the length axis A upward is too large, the lowering position of the holding part 32 is close to the front end 10a of the endoscope 10 due to the short length of the connecting member 5. However, the front end portion of the elongated member 31 protrudes upward. This is because the connecting member 5, which swings downward from the upper side, makes strong contact with the front end of the cap 3. Due to the friction between the connecting member 5 and the cap 3, the force of the swinging connecting member 5 is transformed into a force that compresses the elongated member 31 between the channel tube 4 and the connector 33.

[0101] like Figure 6B As shown, when the offset of the support hole 7 from the length axis A to the downward side is too large, the lowering position of the holding part 32 is far away from the front end 10a of the endoscope 10 due to the long length of the connecting member 5, which is not ideal.

[0102] In the above embodiments, the two ends of the connecting member 5 can also be fixed to either the cover part 2 or the cap part 3.

[0103] For example, it can also be like Figure 7A As shown, the two ends of the connecting member 5 are fixed in the support holes 7 of the cover portion 2 by means of joints 5a formed at both ends of the connecting member 5 and having an outer diameter larger than the diameter of the support hole 7. The joints 5a are disposed on the inner side of the cover portion 2, so that the connecting member 5 does not detach from the support hole 7.

[0104] Or, it can be like Figure 7B and Figure 7C As shown, either the cover part 2 or the cap part 3 has a pair of fixing holes 8 for fixing the two ends of the connecting member 5.

[0105] A pair of fixing holes 8 are provided at positions which are separated from each other in the circumferential direction of the cover portion 2 and which are opposed to each other in the left-right direction, and which are different from the supporting hole 7. Figure 7B An example in which the fixing holes 8 are provided in the cap portion 3 is shown, Figure 7C An example in which the fixing holes 8 are provided in the cover portion 2 is shown. Each of the fixing holes 8, like the supporting hole 7, penetrates from the outer peripheral surface to the inner peripheral surface of the cover portion 2 or the cap portion 3 in the radial direction.

[0106] The end portion of the connecting member 5 penetrates the fixing hole 8 from the inside to the outside, and the knot 5a formed at the end of the connecting member 5 is fixed in the fixing hole 8. Thus, as shown in Figure 7B and Figure 7C in the case where a single fixing hole 8 for each end portion of the connecting member 5 is provided, the knot 5a is disposed on the outside of the cover portion 2 or the cap portion 3.

[0107] In the case where the end portion of the connecting member 5 is fixed in the supporting hole 7, it is easy to apply a force to the end portion of the connecting member 5 when the connecting member 5 is swung. By fixing the end portion of the connecting member 5 in the fixing hole 8 which is different from the supporting hole 7, it is possible to prevent the force from being applied to the end portion when the connecting member 5 is swung, thereby preventing the end portion of the connecting member 5 from being detached from the cover portion 2.

[0108] As shown in Figure 8A and Figure 9A , two fixing holes 8 for one end portion of the connecting member 5 can be provided in the right portion of the cover portion 2 or the cap portion 3, and two fixing holes 8 for the other end portion of the connecting member 5 can be provided in the left portion of the cover portion 2 or the cap portion 3. Figure 8A An example in which the fixing holes 8 are provided in the cover portion 2 is shown, Figure 9A An example in which the fixing holes 8 are provided in the cap portion 3 is shown.

[0109] By thus providing two fixing holes 8 with respect to each end portion of the connecting member 5, it is possible to dispose the knots 5a of both ends of the connecting member 5 on the inside of the cover portion 2, whereby it is possible to prevent the knots 5a from contacting the surrounding tissue.

[0110] Specifically, as shown in Figure 8B and Figure 9B , the connecting member 5 penetrates the supporting hole 7 from the outside O to the inside I, penetrates one of the fixing holes 8 from the inside I to the outside O, penetrates the other of the fixing holes 8 from the outside O to the inside I, and the knot 5a of the end of the connecting member 5 is disposed on the inside I. In Figure 8B and Figure 9B , the upper side is the inside I of the cover portion 2 or the cap portion 3, and the lower side is the outside O of the cover portion 2 or the cap portion 3.

[0111] In Figure 8A and Figure 9AIn the example shown in FIG. 1, the two fixing holes 8 are arranged in the length direction of the cover portion 2, but the two fixing holes 8 can be arranged in any direction. For example, as shown in FIG. 2, the two fixing holes 8 can be arranged in the up-down direction. Figure 10A

[0112] Further, as shown in FIG. 3 and FIG. 4, a recess 9 can be formed around the fixing hole 8. The recess 9 is formed in the outer peripheral surface of the cover portion 2 or the cap portion 3, and is recessed toward the radial inner side. By providing the recess 9, the connecting member 5 can be arranged inside the outer diameter of the cover portion 2 or the cap portion 3 as shown in FIG. 5, and contact of the connecting member 5 with the biological tissue can be prevented. An adhesive can be filled in the recess 9. Figure 10A Figure 10B Figure 10B Figure 10B In FIG. 5, the left side is the outer side O of the cover portion 2 or the cap portion 3, and the right side is the inner side I of the cover portion 2 or the cap portion 3.

[0113] In the above-described embodiment, the through-hole 33a can be located at a position higher than the elongated member 31. For example, as shown in FIG. 6, the connector 33 can be provided at a position higher than the elongated member 31 in the radial direction of the cover portion 2, that is, on the side opposite to the cover portion 2 with respect to the elongated member 31. According to this structure, when the holding device 30 is moved in the length direction with respect to the cover portion 2, interference of the connector 33 with the outer peripheral surface of the cover portion 2 can be prevented. Figure 11A

[0114] Alternatively, as shown in FIG. 7, the connector 33 can be arranged between the cover portion 2 and the elongated member 31 in the radial direction of the cover portion 2, and the through-hole 33a can be located at a position lower than the elongated member 31. According to this structure, entanglement of the connecting member 5 with the holding device 30 against the intention of the operator of the surgery can be prevented. Figure 11B

[0115] Reference Signs

[0116] 1, cap for endoscope; 2, cover portion; 3, cap portion; 3b, protruding portion; 3c, dimple; 4, channel tube; 5, connecting member; 5a, knot; 6, abutting surface; 7, support hole; 8, fixing hole; 9, recess; 10, endoscope; 10a, distal end; 20, endoscope treatment instrument; 30, holding device (instrument); 31, elongated member; 32, holding portion; 33, connector; 33a, through-hole; 100, endoscope system; A, length axis; S, diseased tissue, biological tissue.​​​​​​

Claims

1. An endoscope cap, wherein, The endoscope cap includes: The cover, which is cylindrical, is installed on the outer peripheral surface of the front end of the endoscope; A cap portion, which is connected to the front end of the cover portion, has a contact surface for the front end of the endoscope to abut against when the front end of the endoscope is inserted into the cover portion, and the cap portion protrudes from the front end of the cover portion along the length direction of the cover portion; A channel tube for inserting a long strip of device, the front end of which is fixed to the base end of the cover, the channel tube extending substantially parallel to the length axis of the cover; and A connecting member, which is linear in shape, is used to connect the device to the cover portion. The connecting member is supported on the cover portion and extends along the outer peripheral surface of the cover portion. The front end of the channel tube is located on the base end side of the cover portion, which is closer to the abutment surface. The cover has a pair of support holes located circumferentially separated from each other and communicating from the outside to the inside of the cover. The connecting member is inserted into the pair of support holes. The connecting member can swing relative to the cover with each of the support holes as fulcrums. The pair of support holes are formed at a position that is closer to the base end of the cover than the abutment surface and closer to the front end of the cover than the front end of the channel tube.

2. The endoscope cap according to claim 1, wherein, The inner circumferential surface of the cover has a tapered surface whose inner diameter gradually increases from the front end toward the base end.

3. The endoscope cap according to claim 1, wherein, Either the cover or the cap has a pair of fixing holes located in a position that is circumferentially separated from the pair of support holes, and the two ends of the connecting member are fixed in the pair of fixing holes.

4. The endoscope cap according to claim 3, wherein, The pair of fixing holes are provided on the cap.

5. The endoscope cap according to claim 3, wherein, The pair of fixing holes are provided on the cover.

6. The endoscope cap according to claim 1, wherein, At both ends of the connecting member, joints with an outer diameter larger than that of the support hole are formed. The two ends of the connecting member are fixed in the pair of support holes.

7. The endoscope cap according to claim 1, wherein, The cover has two fixing holes at one end of the connecting member and two other fixing holes at the other end of the connecting member. The two fixing holes and the two other fixing holes are respectively located at positions that are separated from each other in the circumferential direction and are different from the pair of support holes. One end of the connecting member passes through the two fixing holes and is fixed, and the other end of the connecting member passes through the two other fixing holes and is fixed.

8. The endoscope cap according to claim 1, wherein, The cap has two fixing holes at one end of the connecting member and two other fixing holes at the other end of the connecting member. The two fixing holes and the two other fixing holes are respectively located in a position that is separated from each other in the circumferential direction and is different from the pair of support holes. One end of the connecting member passes through the two fixing holes and is fixed, and the other end of the connecting member passes through the two other fixing holes and is fixed.

9. The endoscope cap according to claim 7 or 8, wherein, A recess is formed around the fixing hole.

10. The endoscope cap according to claim 1, wherein, The pair of support holes are formed at a position closer to the front end of the cover than the center of the cover in the length direction.

11. The endoscope cap according to claim 1, wherein, The distance from the length axis of the cover to the pair of support holes is less than half the outer radius of the cover.

12. An endoscopic treatment device, wherein, The endoscopic handling apparatus includes: Long, narrow gripping device; and Endoscope cap as described in any one of claims 1 to 11, The holding device has a long, flexible, slender member that can move along the length direction through the channel tube, a holding portion connected to the front end of the slender member and holding biological tissue, and a connector provided at the base end of the holding portion and positioned closer to the front end of the channel tube. The connector has a through hole extending in a direction intersecting the length direction of the elongated member. The connecting member extends through the through hole between the pair of support holes.

13. The endoscopic treatment device according to claim 12, wherein, A notch is formed in a portion of the cover. The endoscopic treatment device includes a strap that adheres the cover and the endoscope along the edge of the notch.

14. The endoscopic treatment device according to claim 12, wherein, The connector is located radially on the side of the cover opposite to the elongated member.

15. The endoscopic treatment device according to claim 12, wherein, The connector is located radially between the elongated member and the cover.

16. The endoscopic treatment device according to claim 12, wherein, The edge of the front end of the cap has a protrusion extending in a direction from the base of the cap toward the front end and a recess extending in a direction from the front end of the cap toward the base. The connecting member is configured to swing from a first position extending along the outer peripheral surface of the cover to a second position contacting the protrusion of the cap.

17. An endoscope system, wherein, The endoscopic system includes: Endoscope; and The endoscopic treatment device according to any one of claims 12 to 16.

18. An endoscope cap, wherein, The endoscope cap includes: The cover, which is cylindrical, is installed on the outer peripheral surface of the front end of the endoscope; A cap portion, which is connected to the front end of the cover portion, has a contact surface for the front end of the endoscope to abut against when the front end of the endoscope is inserted into the cover portion, and the cap portion protrudes from the front end of the cover portion along the length direction of the cover portion; A channel tube for inserting a long strip of device, the front end of which is fixed to the base end of the cover, the channel tube extending substantially parallel to the length axis of the cover; and A connecting member, which is linear in shape, is used to connect the device to the cover portion. The connecting member is supported on the cover portion and extends along the outer peripheral surface of the cover portion. The cover has a pair of support holes located circumferentially separated from each other and communicating from the outside to the inside of the cover. The connecting member is inserted into the pair of support holes. The connecting member can swing relative to the cover with each of the support holes as fulcrums. The pair of support holes are formed at a position closer to the base end of the cover than the abutment surface.

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