Electrode unit and method of operating an electrode unit

Abstract

Provided is an electrode unit (30) for easily performing bulk resection of biological tissue in a body cavity, which uses high-frequency current to treat tissue in the body cavity, and which includes: an electrode (35) having rigidity, formed to have a free end, and to which high-frequency current is applied; an electrode support portion (32) that supports one end of the electrode, has an outer surface composed of a material having electrical insulation, is overall rod-shaped, and allows the electrode to slide in a direction parallel to a direction along an axis connecting a distal end side and a base end side; and a tissue pressing portion (40) that has an outer surface composed of a material having electrical insulation, presses a surface of the tissue, and allows the electrode, to which high-frequency current is applied, to slide from the distal end side toward the base end side by the electrode support portion, and the electrode cuts the tissue.

Description

TECHNICAL FIELD

[0001] The present application relates to an electrode unit and an operation method of an electrode unit, and more particularly, to an electrode unit and an operation method of an electrode unit for performing treatment on a biological tissue in a body cavity using high-frequency current. BACKGROUND

[0002] In the past, in the medical field, an endoscope system as a medical device for performing treatment such as resection or coagulation of a biological tissue in a body cavity of an object such as a human body using an energy device such as an electrosurgical knife using high-frequency current under observation based on an endoscope is known. The endoscope system including such an energy device is widely used when performing treatment such as resection of a biological tissue in an organ such as a bladder.

[0003] For example, in Japanese Patent No. 4495493, Japanese Patent No. 3730796, and the like, an endoscope system for performing treatment such as resection or coagulation of a biological tissue in a body cavity of an object using an energy device using high-frequency current under observation based on an endoscope is disclosed.

[0004] The endoscope system disclosed in the above-described Japanese Patent No. 4495493 has an electrode unit having an electrode formed in a hook shape, and performs treatment such as resection or coagulation of a desired biological tissue by flowing high-frequency current through the hook-shaped electrode. Further, the hook-shaped electrode disclosed in the publication is configured to be able to arbitrarily set the following two states: a first state in which the electrode is freely rotated with respect to the sheath around the axis of the sheath in a state in which the entire electrode protrudes from the front end of the sheath; and a second state in which the electrode is rotationally fixed in a state in which the electrode protrudes from the front end of the sheath by an arbitrary length, and the rotation of the electrode with respect to the sheath around the axis of the sheath is restricted.

[0005] According to this structure, in the endoscope system disclosed in the publication, the rotation of the hook-shaped electrode around the axis of the sheath is restricted during treatment such as resection of a biological tissue, and the electrode can be maintained in a stable posture. Therefore, the user can more stably perform a desired operation.

[0006] However, in the existing endoscope system including the electrode unit of the type having a hook-shaped electrode, in order to perform resection of an entire lesion site as desired, for example, a plurality of different operations such as an operation of continuously marking the periphery of the lesion site, an operation of cutting the periphery of the lesion site, and an operation of peeling the site after cutting are required, and there are problems in that the operations are complicated and require skilled operation.

[0007] In addition, in the endoscope system disclosed in the above-mentioned Japanese Patent No. 4495493, even if the rotation of the electrode in treatment is suppressed to achieve an improvement in operability, the control of the depth direction in which the electrode enters from the wall surface of the biological tissue is not considered, and the thickness of the biological tissue to be resected can be deviated.

[0008] Generally, in a case where the resected biological tissue is used for biopsy, a tissue of a prescribed thickness is required, and thus it is preferable that the thickness of the resected tissue, that is, the resection depth be constant.

[0009] On the other hand, the device disclosed in the above-mentioned Japanese Patent No. 3730796 is provided with an electrode unit having an electrode formed in a ring shape, and performs treatment such as resection or coagulation of a biological tissue by flowing a high-frequency current through the ring-shaped electrode. The electrode unit of the ring-shaped electrode type has an advantage that the operability is excellent.

[0010] However, in the existing endoscope system including the electrode unit having the ring-shaped electrode, the size of the electrode in the width direction is limited by the diameter of a sheath through which the electrode is inserted, or the channel diameter of an endoscope through which the sheath is inserted, and the like, and thus there is a problem that the resection width becomes narrow and the bulk resection of a lesion site desired cannot be performed.

[0011] Generally, the size of the electrode that can pass through the channel of a resectoscope, a cystoscope, or the like is less than 1 cm. On the other hand, the size of the biological tissue that is desired to be bulk resected is about 4 cm at the maximum in a normal case.

[0012] The present application is achieved in view of the above-mentioned points, and aims to provide an electrode unit that performs treatment on a tissue in a body cavity using a high-frequency current, and an operation method of the electrode unit, which are capable of easily performing bulk resection of a biological tissue in the body cavity. SUMMARY

[0013] Means for solving the problem

[0014] To achieve the above object, an electrode unit of one embodiment of the present application uses high-frequency current to treat tissue in a body lumen, and includes an electrode having rigidity, formed to have a free end, and to which high-frequency current is applied; an electrode support portion that supports one end of the electrode, whose outer surface is composed of a material having electrical insulation, and that is entirely in a rod shape, and that allows the electrode to slide in a direction parallel to a direction along an axis connecting a distal end side and a base end side; and a tissue pressing portion whose outer surface is composed of a material having electrical insulation, and that presses a surface of the tissue, and that allows the electrode to which high-frequency current is applied to slide from the distal end side toward the base end side by the electrode support portion, and that allows the electrode to incise the tissue.

[0015] An operation method of an electrode unit of one embodiment of the present application uses high-frequency current to treat tissue in a body lumen, and includes the steps of pressing a part of a peeling target region with a tissue pressing portion arranged apart from the electrode while making a peeling sheet in a state in which a part is attached to the inside of the body lumen with the electrode; abutting the electrode against a position apart from a part of the peeling sheet attached to the inside of the body lumen by the amount of one electrode in a state in which an electrode support portion that supports the electrode is arranged below the peeling sheet; pressing a part of the peeling target region with the tissue pressing portion while giving energy to the electrode to make a peeling sheet in a state in which a part is attached to the inside of the body lumen; abutting the electrode against a part of the peeling sheet attached to the inside of the body lumen in a state in which a part of the electrode unit is arranged below the peeling sheet; and giving energy to the electrode to detach the peeling sheet from the inside of the body lumen.

[0016] According to the present application, an electrode unit that uses high-frequency current to treat tissue in a body lumen and that is configured to easily perform en bloc resection of biological tissue in the body lumen, and an operation method of the electrode unit can be provided. BRIEF DESCRIPTION OF DRAWINGS

[0017] Figure 1 is a schematic diagram illustrating the structure of an endoscope system including an electrode unit of a first embodiment of the present application.

[0018] Figure 2 is a top view of the electrode unit of the first embodiment of the present application as viewed from above.

[0019] Figure 3 is a left view as viewed in the direction of arrow [3] of Figure 2 .

[0020] Figure 4 is a right view as viewed in the direction of arrow [4] of Figure 2 .

[0021] Figure 5 From Figure 2 The main view is viewed in the direction of the arrow [5].

[0022] Figure 6 It is along Figure 2 A cross-sectional view of line [6]-[6].

[0023] Figure 7 It is along Figure 6 A cross-sectional view of line [7]-[7].

[0024] Figure 8 This is a schematic diagram showing the state in which the electrode unit of the first embodiment of the present invention is inserted through the device channel of the resection endoscope.

[0025] Figure 9 This is a schematic diagram showing the state in which a resection scope with an electrode unit of the first embodiment of the present invention is inserted into the body cavity of the subject.

[0026] Figure 10 Viewed from the side Figure 9 A schematic diagram of the electrode unit.

[0027] Figure 11 This diagram illustrates the function of the electrode unit according to the first embodiment of the present invention, and is a schematic diagram showing the state of the electrode entering the tissue of a living organism from the side.

[0028] Figure 12 From Figure 11 A schematic diagram of the direction of the arrow

[12] .

[0029] Figure 13 It shows along Figure 12 A schematic diagram of the cross section of line

[13] -

[13] .

[0030] Figure 14 This is a schematic diagram showing the state when pressure is applied to the front end of the electrode unit in the first embodiment of the present invention, with the electrode inserted into the tissue of a living organism.

[0031] Figure 15 It is along Figure 14 A cross-sectional view of the

[15] -

[15] line.

[0032] Figure 16 It is shown in Figure 14 , Figure 15 This is a diagram illustrating the state after the shown state when the cutting operation is performed.

[0033] Figure 17 Viewed from the right diagonal side of the front Figure 16 A schematic diagram of the electrode unit in its state.

[0034] Figure 18 is a schematic view showing a state in which the electrodes reach the incision terminal position after the operation of Figure 16 , Figure 17 is a schematic view showing a state in which the electrodes reach the incision terminal position after the operation of

[0035] Figure 19 is a schematic view showing a state in which the electrodes reach the incision terminal position after the operation of Figure 18 is a schematic view showing a configuration of the electrodes at the time of the next second round of incision operation after the state shown in

[0036] Figure 20 is a schematic view showing a state in which the electrodes reach the incision terminal position after the operation of the second round from the state shown in Figure 19 is a schematic view showing a state in which the electrodes reach the incision terminal position after the operation of the second round from the state shown in

[0037] Figure 21 is a schematic view showing a configuration of the electrodes at the time of the next third round of incision operation (final incision operation) after the state shown in Figure 20 is a schematic view showing a configuration of the electrodes at the time of the next third round of incision operation (final incision operation) after the state shown in

[0038] Figure 22 is a schematic view of the electrode unit at the time of the final incision operation after the state shown in Figure 21 is a schematic view of the electrode unit at the time of the final incision operation after the state shown in

[0039] Figure 23 is a schematic view showing a state in which the electrodes reach the incision terminal position and cut off the biological tissue section in the final incision operation after the state shown in Figure 22 is a schematic view showing a state in which the electrodes reach the incision terminal position and cut off the biological tissue section in the final incision operation after the state shown in

[0040] Figure 24 is a plan view of the electrode unit of the first modification of the first embodiment of the present application as viewed from above.

[0041] Figure 25 is a schematic view showing a state of the final incision operation at the time of cutting off the biological tissue in the body cavity in one piece using the electrode unit of Figure 24 is a schematic view showing a state of the final incision operation at the time of cutting off the biological tissue in the body cavity in one piece using the electrode unit of

[0042] Figure 26 is a plan view of the electrode unit of the second modification of the first embodiment of the present application as viewed from above.

[0043] Figure 27 is a front view as viewed in the direction of the arrow

[27] of Figure 26 is a front view as viewed in the direction of the arrow

[27] of

[0044] Figure 28 is a plan view of the electrode unit of the third modification of the first embodiment of the present application as viewed from above.

[0045] Figure 29 is a plan view of the electrode unit of the third modification of the first embodiment of the present application as viewed from above. Figure 28A schematic diagram of the final cutting operation when the electrode unit completely removes biological tissue within the body cavity.

[0046] Figure 30 This is a top view of the electrode unit of the fourth modified example of the first embodiment of the present invention.

[0047] Figure 31 From Figure 30 The main view is viewed in the direction of the arrow

[31] .

[0048] Figure 32 It shows the use Figure 30 A cross-sectional view of the state when the electrode unit is completely removed from the biological tissue within the body cavity.

[0049] Figure 33 This is a front view of the electrode unit of the fifth variation of the first embodiment of the present invention, viewed from the direction along the length axis L.

[0050] Figure 34 It shows the use Figure 33 A cross-sectional view of the state when the electrode unit is completely removed from the biological tissue inside the body cavity.

[0051] Figure 35 This is a front view of the electrode unit of the sixth variation of the first embodiment of the present invention, viewed from the direction along the length axis L.

[0052] Figure 36 It shows the use Figure 35 A cross-sectional view of the state when the electrode unit is completely removed from the biological tissue within the body cavity.

[0053] Figure 37 This is a top view of the electrode unit of the seventh modified example of the first embodiment of the present invention.

[0054] Figure 38 Viewed from the direction along the length axis L Figure 37 Front view of the electrode unit.

[0055] Figure 39 This is a top view of the electrode unit according to the second embodiment of the present invention.

[0056] Figure 40 From Figure 39 The arrow in the

[40] direction is the left view.

[0057] Figure 41 From Figure 39 The arrow in the

[41] direction is the right view.

[0058] Figure 42is a schematic view showing steps when performing the en bloc resection process using the resection scope to which the electrode unit of the first embodiment of the present application is applied.

[0059] Figure 43 is a schematic view showing a cross section along the arrow

[43] -

[43] line of Figure 42 .

[0060] Figure 44 is a schematic view showing a state at the time when the first edge circumferential incision operation is completed after the operation of .

[0061] Figure 45 is a schematic view showing a state at the time when the first edge circumferential incision operation is completed after the operation of Figure 44 .

[0062] Figure 46 is a schematic view showing a cross section along the arrow

[46] -

[46] line of Figure 45 .

[0063] Figure 47 is a schematic view showing a state at the time when the second edge circumferential incision operation is completed.

[0064] Figure 48 is a schematic view showing a state at the time when the third edge circumferential incision operation is completed.

[0065] Figure 49 is a schematic view showing a resection groove corresponding to an outer circumferential edge of a resection scheduled region of a biological tissue.

[0066] Figure 50 is a schematic view showing a configuration of the electrode unit at the time when the first round of the slice peeling operation is started.

[0067] Figure 51 is a schematic view showing a cross section along the arrow

[51] -

[51] line of Figure 50 .

[0068] Figure 52 is a schematic view showing a positional relationship between the electrode and the biological tissue in the state of Figure 51 .

[0069] Figure 53 is a schematic view showing a state at the time when the first round of the slice peeling operation is performed and the electrode reaches a peeling terminal position.

[0070] Figure 54 is a schematic view showing a state at the time when the electrode is moved from the peeling terminal position of the first round of the slice peeling operation to a start position of the second round of the slice peeling operation in a partial cross section of the biological tissue.

[0071] Figure 55 is a schematic view showing a configuration of an electrode unit at the time of starting a second round of slice peeling operation.

[0072] Figure 56 is a plan view showing a configuration of an electrode unit at the time of starting a last slice peeling operation from above.

[0073] Figure 57 is a partial sectional view of a biological tissue in a state of Figure 56

[0074] Figure 58 is a flowchart showing steps of a treatment performed using a resectoscope to which an electrode unit of the first embodiment of the present application is applied.

[0075] Figure 59 is a flowchart showing steps of a treatment performed using a resectoscope to which an electrode unit of the second embodiment of the present application is applied. DETAILED DESCRIPTION

[0076] Hereinafter, the present application will be described through an illustrated embodiment. Each drawing used in the following description is schematic, and in order to show each structural element in a size recognizable on the drawing, each structural element is sometimes shown in a manner different in size relationship, scale, etc. of each component. Therefore, in the present application, the number of each structural element, the shape of each structural element, the ratio of the size of each structural element, the relative positional relationship of each structural element, etc. are not limited only to the illustrated manner.

[0077] [First Embodiment]

[0078] An endoscope system including the electrode unit of the first embodiment of the present application is a medical device for performing a desired treatment such as resection or coagulation of a biological tissue under endoscope observation in a subject.

[0079] Therefore, first, before a detailed description of the electrode unit of the first embodiment of the present application is performed, the Figure 1 The following description is made of the overall outline structure of the endoscope system including the electrode unit of the present embodiment.

[0080] Figure 1 is a diagram schematically showing the structure of the endoscope system including the electrode unit of the first embodiment of the present application.

[0081] As shown in Figure 1 , the endoscope system 1 including the electrode unit 30 of the present embodiment is configured to include a resectoscope 10 as an endoscope, the electrode unit 30 of the present embodiment, and an external device 50, etc.

[0082] ​The endoscope system 1 including the electrode unit 30 of the present embodiment is an example of an endoscope system that takes a human body as an object to be examined. Also, in the endoscope system 1 of the structural example shown in FIG. 1, an endoscope of a form generally called a resectoscope is applied. However, the electrode unit of the present application is not limited to application to this structural example, and can be applied to, for example, a flexible endoscope. Figure 1 In the endoscope system 1 of the structural example shown in FIG. 1, a resectoscope 10 is configured to include a sheath 11, a slider 20, a telescope 21, and the like.

[0083] In the endoscope system 1 including the electrode unit 30 of the present embodiment, the resectoscope 10 is configured to include the sheath 11, the slider 20, the telescope 21, and the like.

[0084] The sheath 11 is formed in a straight line along the length axis L and is composed of a hollow tubular member. Also, the sheath 11 is formed to be open at both ends in the direction of the length axis L. This sheath 11 is a site that is inserted into an object to be examined from the outside of the object to be examined when the resectoscope 10 is used. Also, the telescope 21 and the electrode unit 30 are inserted into this sheath 11 when the resectoscope 10 is used.

[0085] Also, an outer sheath for introducing a perfusion fluid into the object to be examined is arranged on the outer periphery of the sheath 11. The structure of the outer sheath and the like provided for the purpose of introducing the perfusion fluid into the object to be examined is known, and thus the description thereof is omitted. In the present embodiment, the perfusion fluid is, for example, a physiological saline or the like, which is an electrolyte solution having conductivity.

[0086] One end of the sheath 11 on the side of insertion into the object to be examined among both ends in the direction of the length axis L is referred to as a front end 11a, and the other end on the side opposite to the front end 11a is referred to as a base end 11b. The base end 11b of the sheath 11 becomes a site that is placed outside the object to be examined when the resectoscope 10 is used.

[0087] Here, a pair of axes orthogonal to the length axis L and orthogonal to each other, that is, a first axis X and a second axis Y are determined. Also, one of the directions along the first axis X is set as a right direction, and the other is set as a left direction. In this case, the right side when the front end side (distal end side) is observed from the base end side is set as the right direction, and the left side is set as the left direction (). Figure 3 Also, one of the directions along the second axis Y is set as an upper direction, and the other is set as a lower direction.

[0088] In this case, in an image captured using the telescope 21, the horizontal direction of the image is substantially parallel to the first axis X, and the vertical direction is substantially parallel to the second axis Y. Also, the upper direction and the lower direction of the second axis Y of the image correspond to the upper side and the right side of the image in the image captured using the telescope 21.

[0089] The recovery electrode 11c composed of a material having conductivity is provided to the surface of the sheath 11 in the vicinity of at least the front end 11a in such a manner as to be exposed to the outside.

[0090] Further, the sheath 11 is integrally made of a conductive material such as metal. Therefore, the surface of the sheath 11 as a whole can function as a recovery electrode instead of the recovery electrode 11c.

[0091] A sheath connector 11d is provided near the base end 11b of the sheath 11. The sheath connector 11d is electrically connected to the recovery electrode 11c. A cable 56 is connected to the sheath connector 11d. The cable 56 electrically connects the sheath connector 11d and a high-frequency power supply control device 55 (described later) included in the external device 50.

[0092] The slider 20 is an operation member disposed on the base end 11b side of the sheath 11. The slider 20 is configured to be relatively movable in the direction along the length axis L with respect to the sheath 11. A handle 20a is provided on the slider 20. By the user applying a force in the direction along the length axis L to the handle 20a with a finger or the like, the slider 20 is relatively moved in the direction along the length axis L with respect to the sheath 11.

[0093] In addition, as for a mechanism for guiding the relative movement of the slider 20 with respect to the sheath 11, substantially the same structure as that of the existing resectoscope is applied. Therefore, detailed illustrations and descriptions of the mechanism (the movement mechanism of the slider 20) are omitted.

[0094] The slider 20 is configured to include a scope holding portion 22, an electrode unit holding portion 23, an electrode connector 24, and the like. Here, the scope holding portion 22 is a structural portion provided to hold the telescope 21.

[0095] The telescope 21 is a structural unit for optically observing the inside of the subject. The telescope 21 is a structural unit configured to include an elongated insertion portion 21a, an eyepiece portion 21b, a light source connection portion 21c, and the like.

[0096] The insertion portion 21a is a structural portion inserted into the sheath 11 in a state where the telescope 21 is fixed to the scope holding portion 22.

[0097] An observation window and an illumination light exit window, which are not shown, are provided at a front end portion 21al of the insertion portion 21a. In addition, the eyepiece portion 21b and the light source connection portion 21c of the telescope 21, and the like are provided at a base end portion 21a2 of the insertion portion 21a.

[0098] A camera unit 52 included in the external device 50 is attached to the eyepiece portion 21b. The camera unit 52 is electrically connected to a video processor 51 included in the external device 50. The video processor 51 is electrically connected to an image display device 53 included in the external device 50.

[0099] Further, one end of an optical fiber cable 54a is connected to the light source connecting portion 21c. The other end of the optical fiber cable 54a is connected to a light source device 54 included in the external device 50.

[0100] Light from the subject that is incident on an observation window provided at the front end portion 21al of the insertion portion 21a is captured by the imaging unit 52, and as a result, an image based on image data generated by the imaging unit 52 is displayed by the image display device 53 in a manner that can be visually recognized.

[0101] Further, illumination light emitted from the light source device 54 is emitted toward the subject from an illumination light exit window provided at the front end portion 21al of the insertion portion 21a.

[0102] Further, the telescope 21 and the external device 50 (the video processor 51, the imaging unit 52, the image display device 53, the light source device 54, and the like) connected to the telescope 21 have the same structure as the existing resectoscope 10. Therefore, detailed descriptions of these devices are omitted.

[0103] In the slider 20, the electrode unit holding portion 23 is a structural portion provided to hold the electrode unit 30 of the present embodiment. Further, the electrode connector 24 is electrically connected to the base end portion of the electrode unit 30. One end of a cable 56 is connected to the electrode connector 24. The other end of the cable 56 is electrically connected to the high-frequency power supply control device 55 of the external device 50. Thereby, by interposing the electrode connector 24 and the cable 56 between the electrode unit 30 and the high-frequency power supply control device 55, electrical connection is ensured.

[0104] In the present embodiment, a mode in which the electrode connector 24 is separately constituted from the sheath connector lid is exemplified, but is not limited to this structural example. For example, a mode in which the electrode connector 24 and the sheath connector lid are integrally formed can also be employed.

[0105] The base end portion of the electrode unit 30 of the present embodiment is fixed to the electrode unit holding portion 23, and the other portion is inserted and arranged within a device passage (not shown) provided within the sheath 11.

[0106] Here, as described above, the slider 20 is configured to be able to relatively move the telescope 21 and the electrode unit 30 together in the direction along the length axis L with respect to the sheath 11.

[0107] Therefore, when the slider 20 is moved in the direction along the length axis L with respect to the sheath 11, a portion of the electrode unit 30 on the front end side is configured to protrude toward the outside from the front end 11a of the sheath 11. Also, the electrode unit 30 is provided with the electrode 35 described later at the portion protruding from the front end 11a of the sheath 11.

[0108] The electrode unit 30, the recovery electrode 11c, and the high-frequency power supply control device 55 constitute a so-called bipolar electric surgical device. The electric surgical device is not limited to the bipolar type, and can constitute a monopolar type electric surgical device.

[0109] Here, the high-frequency power supply control device 55 is provided with a switch 55a. The switch 55a is a structural unit including a switching member for performing on-off operation of the high-frequency power supply control device 55. As a specific structure example of the switch 55a, for example, a so-called foot switch or the like configured to be capable of performing on-off operation of the switching member by a user stepping with a foot is applied. Further, the high-frequency power supply control device 55 switches the presence or absence of output of the high-frequency current in response to on-off operation of the switch 55a.

[0110] The high-frequency current output from the high-frequency power supply control device 55 flows among the electrode 35, the perfusion solution, and the recovery electrode 11c in the subject. In a state in which the high-frequency power supply control device 55 outputs the high-frequency current, if the electrode 35 is brought into contact with the biological tissue of the subject, the biological tissue is heated. Thus, the biological tissue is configured to be capable of being resected or coagulated or the like.

[0111] The above is a schematic structure of the endoscope system 1 including the electrode unit 30 of the present embodiment. In addition, other structures of the endoscope system 1 are the same as those of a conventional endoscope system, and detailed description is omitted.

[0112] Next, the structure of the electrode unit 30 of the present embodiment is described below in detail.

[0113] The electrode unit 30 of the present embodiment is a high-frequency energy device that applies a desired treatment to a biological tissue in a body lumen of a subject using a high-frequency current. In a state in which the electrode unit 30 is inserted through a device channel (not shown, refer to a later-described reference numeral 10a) of the resectoscope 10 or a treatment instrument channel of an endoscope or the like, the electrode unit 30 is used in such a manner that the slider 20 provided at the proximal end side as an operation member is advanced and retracted with respect to the sheath 11 in a direction along the length axis L. Figure 8

[0114] Here, Figures 2-8 is a drawing showing the electrode unit of the present embodiment. Herein, Figure 2 is a plan view of the electrode unit of the present embodiment as viewed from above. Further, in a direction along the first axis X of Figure 2 , the upper side of the drawing is referred to as the right direction of the electrode unit, and the lower side of the drawing is referred to as the left direction of the electrode unit.

[0115] Figure 3 is a left view of the electrode unit of the present embodiment. That is, Figure 3 is a view of the electrode unit of the present embodiment as viewed from Figure 2 ​The arrows [3] indicate the direction of observation in the diagram. Figure 4 This is a right view of the electrode unit in this embodiment. That is, Figure 4 From Figure 2 The diagram viewed in the direction indicated by the arrow [4]. Furthermore, along... Figure 3 , Figure 4 In the direction of the second axis Y, the upper side of the figure is called the upper direction of the electrode unit, and the lower side of the figure is called the lower direction of the electrode unit.

[0116] Figure 5 This is a front view of the electrode unit, viewed from a position opposite the front end of the electrode unit in this embodiment. That is, Figure 5 From Figure 2 The diagram is viewed in the direction of the arrow [5]. Figure 6 It is along Figure 2 A cross-sectional view along line [6]-[6]. Therefore, along [6]... Figure 5 , Figure 6 Along the first axis X, the right side of the figure represents the left direction of the electrode unit, and the left side represents the right direction of the electrode unit. Additionally, along... Figure 5 , Figure 6 In the direction of the second axis Y, the upper side of the figure is taken as the upper direction of the electrode unit, and the lower side of the figure is taken as the lower direction of the electrode unit. Figure 7 It is along Figure 6 A cross-sectional view of line [7]-[7].

[0117] Figure 8 This is a schematic diagram showing the state in which the electrode unit of this embodiment is inserted through the device channel of the resection scope. Additionally, in Figure 8 The image shows the front end of the electrode unit protruding outward from the front end face of the resection mirror's device channel.

[0118] like Figures 2-4 As shown, the electrode unit 30 of this embodiment is formed into an elongated shape with its length direction along the length axis L. The electrode unit 30 is mainly composed of a base end rigid part 31, an electrode support part 32, an electrode wire 33, an electrode 35, a tissue pressing part 40, etc.

[0119] The rigid base portion 31 is the electrode unit holding portion 23 fixed to the resection endoscope 10 (see reference). Figure 1 ) structural component. At the front end 31a of the rigid portion 31 at the base (refer to Figure 2 , Figure 4 The electrode support portion 32 is connected to the base end 31b of the base end hard portion 31 (see reference). Figures 2-4 The electrode is equipped with an electrical connection part 31c. When the base end rigid part 31 is fixed to the electrode unit holding part 23 (see reference 23), the electrode is equipped with an electrical connection part 31c. Figure 1The electrical connection portion 31c is electrically connected to the electrode connector 24 of the resection endoscope 10. In addition, the electrical connection portion 31c is electrically connected to the electrode 35 via a conductive electrode wire 33 that passes through and is inserted into the electrode unit 30.

[0120] The electrode wire 33 is a conductive wire that penetrates and is inserted into the interior of the base end rigid portion 31 and the electrode support portion 32 disposed in the electrode unit 30. The electrode wire 33 electrically connects the electrical connection portion 31c provided at the base end 31b of the electrode unit 30 to the electrode 35. Furthermore, the electrode wire 33 is a structural component that ensures the electrical connection between the high-frequency power control device 55 and the electrode 35 when using the resection scope 10.

[0121] The electrode support portion 32 is the base end 35a of the counter electrode 35 (see reference). Figure 4 , Figure 5 The electrode support portion 32 is a structural part that provides fixed support. In addition, the electrode support portion 32 is generally formed in a straight line and is arranged parallel to the tissue pressing portion 40 described later.

[0122] The electrode support 32 is located at the front end 11a of the sheath 11 when using the resection scope 10 (see reference). Figure 1 The portion protrudes in a roughly straight line towards the outside front. The electrode support portion 32 is configured to have a front hard portion 36 and an elastic region 37.

[0123] The front-end rigid portion 36 is a structural part with a hollow columnar shape, the length of which is along the length axis L. In this embodiment, the front-end rigid portion 36 is illustrated with a generally circular cross-section, but it is not limited to this shape. For example, the cross-sectional shape of the front-end rigid portion 36 may be formed as a polygon or the like.

[0124] like Figure 6 , Figure 7 As shown, the front rigid part 36 is composed of a ceramic tube 32a and a covering part 38. The ceramic tube 32a and the covering part 38 are made of an electrically insulating material.

[0125] The ceramic tube 32a is an elongated tubular component with a through hole 32d on its inner side for inserting an electrode wire 33. The covering portion 38 is a tubular component made of, for example, a resin material. This covering portion 38 covers the ceramic tube 32a.

[0126] Near the front end of the ceramic tube 32a and the covering portion 38, a through hole 32c for holding the base end 35a of the electrode 35 opens downward. Furthermore, this through hole 32c communicates with a through hole 32d in the ceramic tube 32a.

[0127] Electrode 35 is a structural part that, when using electrode unit 30, performs the function of removing biological tissue and coagulating tissue to stop bleeding by flowing a high-frequency current. For example, electrode 35 is formed using a wire-like or rod-like component (e.g., metal wire) made of a conductive and rigid material. The base end 35a of electrode 35 is fixedly supported at a predetermined position near the front end 36e of the front end rigid portion 36. Furthermore, the electrode 35 applied to electrode unit 30 in this embodiment uses, for example, a rod-like component with a diameter of approximately 0.5 mm.

[0128] In this embodiment, the electrode 35 is made of the same material as the conductive (e.g., metallic) electrode wire 33 that is inserted through the electrode unit 30. Furthermore, in this embodiment, the electrode 35 and the electrode wire 33 are integrated and formed from a single metal wire component. Additionally, the electrode 35 is not limited to the configuration shown in this embodiment; for example, the electrode 35 can also be configured by separating the electrode and the electrode wire and then continuously arranging them to ensure electrical connection.

[0129] The electrode 35 is configured such that the base end 35a protrudes from the surface of the front end hard portion 36. More specifically, as... Figure 5 , Figure 6 As shown, the base end 35a of the electrode 35 protrudes outward from a portion near the front end 36e of the front end hard portion 36, and extends downward along the second axis Y for a predetermined length. Here, as... Figure 5 As shown, the base 35a is more than the containment line C (refer to...) Figure 5 The surface of the front hard part 36 extends further downward, and the line C connects the lower end surface 36c of the front hard part 36 with the lower end surface 40c of the tissue pressing part 40.

[0130] A beam portion 35b is provided at the end of the base end 35a, and the beam portion 35b is formed by bending in a manner that extends to the left along the first axis X.

[0131] Here, along the first axis X of electrode 35 to the left of electrode unit 30 (in Figure 5 , Figure 6 The length A of the beam extending 35b from the center (to the right of the attached diagram) (refer to...) Figure 5 The area (referred to as S) is configured to be accommodated in the space between the electrode support 32 and the tissue pressing part 40. Figure 2 The length within ).

[0132] Additionally, when viewed from the direction along the length axis L (refer to...) Figure 5 , Figure 6 The beam portion 35b of electrode 35 is formed in a roughly L-shape. Furthermore, when viewed from the direction along the first axis X (see reference...), Figures 2-4The beam 35b extends in a direction approximately orthogonal to the length axis L.

[0133] Furthermore, electrode 35 is electrically connected to electrode wire 33 inside the front hard portion 36. Here, electrode 35 and electrode wire 33 are formed from the same metal wire as described above.

[0134] Thus, the beam portion 35b of the electrode 35 is a free end, and the electrode 35 is formed as a cantilever beam. In addition, the configuration ensures electrical connection by placing the electrode wire 33, the electrical connection portion 31c, the electrode unit holding portion 23, the electrode connector 24, and the cable 56 between the electrode 35 and the high-frequency power control device 55, thereby applying a high-frequency current to the electrode 35.

[0135] The elastic region 37 of the electrode support portion 32 is a component that connects the base end of the front end hard portion 36 and the front end 31a of the base end hard portion 31. The elastic region 37 is formed to be elastic in the bending direction. Furthermore, the bending stiffness of the elastic region 37 is set to be lower than that of the front end hard portion 36 and the base end hard portion 31. In addition, in this embodiment, the bending stiffness of the elastic region 37 can be set arbitrarily by, for example, by using different materials for the elastic region 37, the front end hard portion 36, and the base end hard portion 31.

[0136] Furthermore, the elastic region 37 is composed of a resin tube, i.e., a covering portion 38. In this embodiment, an example is shown where the covering portion 38 of the front rigid portion 36 and the covering portion 38 of the elastic region 37 are composed of the same component that is continuous in the direction along the length axis L.

[0137] An electrode wire 33 is inserted through the covering portion 38 of the elastic region 37. That is, in this embodiment, the ceramic tube 32a inserted into the covering portion 38 has the effect of further improving the bending rigidity of the front end rigid portion 36 compared with the elastic region 37.

[0138] And, as Figure 7 As shown, the rigid base portion 31 of this embodiment is composed of a covering portion 38 and a metal tube 31d, and the covering portion 38 is a tube made of resin. In this embodiment, an example is shown where the covering portion 38 of the rigid base portion 31 and the covering portion 38 of the elastic region 37 are composed of the same component that is continuous in the direction along the length axis L.

[0139] An electrode wire 33 is inserted through the covering portion 38 of the rigid base portion 31. A metal tube 31d covers the outer periphery of the covering portion 38. That is, in this embodiment, the metal tube 31d has the effect of further improving the bending rigidity of the rigid base portion 31 compared with the elastic region 37.

[0140] Further, the structure in which the bending rigidity of the elastic region 37 is lower than that of the front-end rigid portion 36 and the base-end rigid portion 31 is not limited to the manner in which the material of the structural member is made different as exemplified in the present embodiment. As another manner, for example, by making the outer diameter of the elastic region 37 thinner than that of the front-end rigid portion 36 and the base-end rigid portion 31, the bending rigidity of the elastic region 37 can also be set lower than that of the front-end rigid portion 36 and the base-end rigid portion 31.

[0141] On the other hand, the tissue pressing portion 40 has a function of pressing the surface of the living tissue when resection of a desired site (a prescribed region including a lesion) of the living tissue is performed using the electrode unit 30 in the case of using the resectoscope 10. Further, the tissue pressing portion 40 is a structure provided to maintain the distance of the electrode 35 from the living tissue as an object of treatment constant in order to suppress the electrode 35 from entering too deeply from the surface of the living tissue (stop function).

[0142] The tissue pressing portion 40 is a substantially straight rod-shaped member that is elastic as a whole and is formed of a non-conductive material. The tissue pressing portion 40 has the front end 40e as a free end, and the base end is fixedly supported to the side surface portion of the base-end rigid portion 31 near the front end, thereby being formed in a cantilever beam shape.

[0143] In detail, the tissue pressing portion 40 is arranged in a state of being substantially parallel to the electrode support portion 32 in a manner of extending along the length axis L. In this case, the electrode support portion 32 and the tissue pressing portion 40 are arranged so as to be separated by a prescribed interval in the direction along the first axis X (the left-right direction of the electrode unit 30) (see reference sign S in Figure 2 ).

[0144] That is, the electrode support portion 32 and the tissue pressing portion 40 are arranged in a manner of overlapping each other when viewed in the direction along the first axis X (see Figure 3 , Figure 4 ). Figure 7

[0145] Further, here, the "opposed surfaces opposing each other" refer to the surface (reference sign 36a in Figure 7 ) of the front-end rigid portion 36 of the electrode support portion 32 arranged on the right side of the electrode unit 30 (when viewed from the base-end side to the front-end side) facing the substantially left direction and the surface (reference sign 40a in Figure 7 ) of the tissue pressing portion 40 arranged on the left side of the electrode unit 30 (when viewed from the base-end side to the front-end side) facing the substantially right direction.

[0146] ​That is, the opposing surfaces 36a, 40a refer to surfaces of the electrode support portion 32 and the tissue pressing portion 40, respectively, that oppose each other in a space sandwiched by the electrode support portion 32 and the tissue pressing portion 40. Thus, the opposing surface 36a of the electrode support portion 32 is arranged in parallel with the opposing surface 40a of the tissue pressing portion 40, but can not necessarily be arranged in parallel.

[0147] In the electrode unit 30 configured by such a structure, as shown in FIG. 1, the electrode 35 is exposed to the outside in a region of a space S sandwiched by the front end hard portion 36 of the electrode support portion 32 and the front end portion of the tissue pressing portion 40, when viewed in a direction along the second axis Y. Figure 2

[0148] In addition, as shown in FIG. 2, the electrode 35 is exposed to the outside in a region of the space S sandwiched by the front end hard portion 36 of the electrode support portion 32 and the front end portion of the tissue pressing portion 40, when viewed in a direction along the length axis L, for example, from the front end side (front surface). Figure 5

[0149] Further, in the electrode unit 30 of the present embodiment configured by such a structure, as shown in FIG. 3, a virtual plane P (rectangle indicated by a double-dotted line in FIG. 3) containing the central axes of the electrode support portion 32 and the tissue pressing portion 40, respectively, is formed. Figure 8 Figure 8 The virtual plane P corresponds to a contact surface when the electrode unit 30 is brought into contact with a wall surface of a biological tissue when the resectoscope 10 is used.

[0150] Here, the electrode portion 35 is arranged so as to protrude further in a lower direction along the second axis Y than a virtual line connecting the central axes of the electrode support portion 32 and the tissue pressing portion 40, respectively, and along the first axis X. Here, the virtual line is a parallel line included in the virtual plane P described above.

[0151] Thus, in the electrode unit 30 of the present embodiment, the virtual plane P described above is formed by the electrode support portion 32 and the tissue pressing portion 40, and the electrode 35 is arranged at a position further in a lower direction along the second axis Y than the virtual plane P. With such a structure, in the electrode unit 30 of the present embodiment, the electrode support portion 32 and the tissue pressing portion 40 suppress the electrode 35 from excessively entering the inside of a biological tissue from the surface thereof during treatment.

[0152] The electrode unit 30 of the present embodiment is configured as described above. Hereinafter, the electrode unit 30 of the present embodiment will be described using FIGS. 4 to 6. Figures 9-23 Figure 58 ​​​​The procedure of the operation and the steps of the treatment when the electrode unit 30 of the present embodiment is used to perform the resection treatment of the biological tissue of the prescribed region including the lesion in the organ 100 of the subject will be described below.

[0153] Figures 9-23 is a diagram schematically showing the steps of the treatment when the resection mirror to which the electrode unit of the present embodiment is applied is used to perform the treatment of the biological tissue in the body cavity (organ) of the subject such as a human body. In this diagram, Figure 9 is a diagram showing the state in which the resection mirror to which the electrode unit of the present embodiment is applied is inserted into the body cavity (organ) of the subject such as a human body. Also, Figure 58 is a flowchart showing the steps of the treatment performed using the resection mirror to which the electrode unit of the present embodiment is applied.

[0154] In addition, the example of the treatment steps described below is an example of the resection in which the biological tissue (for example, the biological tissue including the lesion such as cancer) as the treatment target is resected in a concentrated block shape.

[0155] In the case where the resection treatment of the biological tissue in the organ 100 is performed using the electrode unit 30 of the present embodiment, first, the user inserts the resection mirror 10 into the organ 100 in accordance with the prescribed procedure. In addition, the procedure of inserting the resection mirror 10 into the organ 100, the method of filling the organ 100 with the perfusate, and the like are the same as those in the case of operating the existing resection mirror, and thus the description thereof will be omitted.

[0156] After the distal end portion of the resection mirror 10 is disposed at the prescribed position in the organ 100 (the position at which the lesion or the like is present), the user performs the operation of inserting the electrode unit 30 through the device channel 10a of the resection mirror 10 so that the distal end of the electrode unit 30H protrudes outward in the front direction by a prescribed amount from the distal end portion of the device channel. This operation is also the same as that of the existing resection mirror.

[0157] Next, the user brings the distal end hard portion 36 of the electrode support portion 32 and each of the lower end surfaces of the tissue pressing portions 40 into a posture in which they face the biological tissue as the treatment target in the organ 100.

[0158] Next, the user brings the imaginary plane P of the electrode support portion 32 and the tissue pressing portions 40 into a posture in which they face the wall surface 101 of the organ 100, and positions and abuts the electrode 35 against the biological tissue (the biological tissue including the lesion) of the prescribed region as the treatment target Figure 58 (S1) of the present embodiment. The state at this time is as shown in Figure 9 , Figure 10 .

[0159] That is,Figure 9 , Figure 10 shows a state in which the electrode support portion 32 of the electrode unit 30 and the imaginary plane P of the tissue pressing portion 40 are disposed in opposition to the wall surface 101 of the biological tissue in a state in which the electrode unit 30 protrudes from the front end portion of the resectoscope 10 by a prescribed amount, and the front end of the electrode 35 is brought into contact with the wall surface 101 of the biological tissue. In this case, Figure 9 is a schematic view of the appearance, Figure 10 is a schematic view as viewed from the side.

[0160] Next, the user operates the switch 55a to start the output of the high-frequency current from the high-frequency power source control device 55. As a result, the high-frequency current flows from the electrode 35 to the recovery electrode 11c through the perfusion solution, and thus the biological tissue in contact with the electrode 35 is heated, and the biological tissue is incised. Then, as the electrode 35 starts to incise the biological tissue by starting the output of the high-frequency current, as shown in Figures 11-13 , the electrode 35 enters the inside of the biological tissue (step S2 of Figure 58 ).

[0161] Figures 11-13 shows a state in which the electrode 10 has entered the biological tissue. In this case, Figure 11 is a schematic view as viewed from the side, Figure 12 is a schematic view as viewed from the direction of the arrow

[12] of Figure 11 , and Figure 13 is a schematic view showing a cross section along the line of reference numerals

[13] -

[13] of Figure 12 .

[0162] In this state, the electrode 35 cauterizes the biological tissue and enters the tissue. In Figure 12 , Figure 13 , the portion shown by the cross-hatched portion and the reference numeral 101a shows a state in which a portion of the biological tissue is cauterized. Hereinafter, such a portion will be referred to as a cauterized portion. In addition, in Figure 12 , the reference numeral 102 indicates a lesion portion such as a cancer.

[0163] In this state, when the electrode 35 enters the living body tissue to a prescribed depth, the tip hard portion 36 abuts against the tissue surface which is not incised by the electrode 35. Here, the cauterized region by the electrode 35 depends on the thickness dimension (width dimension) of the electrode 35. In the electrode unit 30 of the present embodiment, the thickness dimension (width dimension) of the tip hard portion 36 is set to be larger (wider) than the thickness dimension (width dimension) of the electrode 35, and therefore, when the electrode 35 enters the living body tissue by the length of the base end 35a, the tip hard portion 36 abuts against the tissue surface which is not cauterized by the electrode 35. At the same time, the tissue surface which is abutted by the tissue pressing portion 40 which is arranged in parallel with the tip hard portion 36 on the same plane and forms the imaginary plane P is not cauterized, and therefore the tissue pressing portion 40 does not enter the living body tissue. Thus, the tip hard portion 36 and the tissue pressing portion 40 function as stoppers which restrict the electrode 35 from entering the living body tissue to a prescribed depth or more.

[0164] In this state, the imaginary plane P of the tip end of the electrode unit 30 is pressed toward the wall surface 101 of the living body tissue with a prescribed force. Then, the electrode support portion 32 and the tissue pressing portion 40 of the electrode unit 30 are pressed toward the living body tissue, and therefore the living body tissue which contacts the electrode support portion 32 and the tissue pressing portion 40 sinks toward the inside. On the other hand, the living body tissue in the region between the electrode support portion 32 and the tissue pressing portion 40 is deformed as shown by the reference numeral 101b, to a convex shape which protrudes toward the outside from the tissue surface. At this time, as described above, since the electrode support portion 32 and the tissue pressing portion 40 restrict the entry into the living body tissue to a prescribed depth or more, the convex portion formed by the living body tissue always maintains a constant shape. Also, by this pressing operation, the depth (thickness) dimension of the living body tissue which is to be resected is defined. Figure 14 , Figure 15

[0165] In addition, Figure 14 , Figure 15 is a schematic view showing the state when a pressing force is applied to the tip end of the electrode unit in the state where the electrode 10 enters the living body tissue. In this view, Figure 14 is a schematic view corresponding to Figure 12 Figure 15 corresponds to Figure 13 is a cross-sectional view along the

[15] -

[15] line of Figure 14

[0166] When the resectoscope 10 is in the state shown by Figure 14 , Figure 15 , the user operates the resectoscope 10 to perform the operation of moving the electrode unit 30 toward the hand side (base end side, proximal side, left side in the view) in the direction along the length axis L. At this time, the electrode 35 of the electrode unit 30 enters the living body tissue. In this state, the user operates the resectoscope 10 to perform the operation of pressing the imaginary plane P of the tip end of the electrode unit 30 toward the wall surface 101 of the living body tissue. Then, the electrode support portion 32 and the tissue pressing portion 40 of the electrode unit 30 are pressed toward the living body tissue, and therefore the living body tissue which contacts the electrode support portion 32 and the tissue pressing portion 40 sinks toward the inside. On the other hand, the living body tissue in the region between the electrode support portion 32 and the tissue pressing portion 40 is deformed as shown by the reference numeral 101b, to a convex shape which protrudes toward the outside from the tissue surface. At this time, as described above, since the electrode support portion 32 and the tissue pressing portion 40 restrict the entry into the living body tissue to a prescribed depth or more, the convex portion formed by the living body tissue always maintains a constant shape. Also, by this pressing operation, the depth (thickness) dimension of the living body tissue which is to be resected is defined. Figure 16 ​​​The pulling operation (in the direction of arrow L1) causes the electrode support 32 to move along the wall 101 of the organ 100. Thus, within the biological tissue, the electrode 35 moves in the direction along the wall 101. Figure 58 Step S3). At this point, electrode 35 is in a state where it has entered the tissue at a specified depth, so a tissue slice of a specified thickness is removed.

[0167] Here, Figure 16 , Figure 17 It is shown in Figure 14 , Figure 15 This diagram illustrates the state after the state shown (electrode 10 has entered the biological tissue and pressure has been applied to the tip of the electrode unit) is reached, followed by a cutting operation in which the electrode unit 30 is pulled in the direction of arrow L1. Figure 16 It is equivalent to Figure 12 , Figure 14 A schematic diagram. Additionally... Figure 17 Viewed from the right diagonal side of the front Figure 16 A schematic diagram of the electrode unit in its state.

[0168] In this situation, as described above, the user presses the front end portion (electrode support portion 32 and tissue pressing portion 40) of the electrode unit 30 against the wall surface 101 of the organ 100. Even if the pressing force changes during the pulling operation of the electrode unit 30, the depth of the electrode 35 into the tissue remains constant due to the imaginary plane P. Furthermore, even if the user's pressing force changes, the force exerted on the electrode 35 towards the biological tissue remains approximately constant due to the appropriate bending caused by the elastic force of the elastic region 37. Therefore, the force by which the rigid front end portion 36 and the tissue pressing portion 40 deform the biological tissue remains approximately constant, and thus the depth of the electrode 35 into the tissue also remains approximately constant.

[0169] Therefore, in Figure 16 , Figure 17 In the illustrated situation, when the electrode unit 30 is pulled along the length axis L, the electrode 35, having penetrated to a predetermined depth within the biological tissue, cuts the biological tissue of the convex-shaped portion 101b to a predetermined depth. Here, Figure 16 The designation 101c indicates the incision line when the biological tissue is cut by moving the electrode 35 in the direction of the length axis L1 (the first round of operation).

[0170] At this time, since the electrode unit 30 is pulled along the length axis L while the tissue surface is pressed with a certain force, the position of the convex part 101b also moves as the electrode unit 30 moves in the same direction.

[0171] Furthermore, in the electrode unit 30 of this embodiment, the electrode 35 is only disposed on the electrode support portion 32 side, so the tissue pressing portion 40 side only presses and moves the surface of the biological tissue. As a result, the biological tissue is cut by the electrode 35 on the electrode support portion 32 side but not on the tissue pressing portion 40 side.

[0172] Then, in Figure 18 The following states are shown: In Figure 16 , Figure 17 After the operation shown (the operation of pulling electrode 35 along the length axis L1 to cut the biological tissue), electrode 35 reaches the target cutting terminal position in the designated area of ​​the treatment object. When it becomes this Figure 18 After reaching the indicated state, the user lifts electrode 35 toward the surface of the biological tissue. Figure 58 Step S4).

[0173] At this time, in the biological tissue, a channel-shaped (U-shaped) cutting line 101c (hereinafter referred to as the channel cutting line) is formed, consisting of two continuous cutting edges and one long cutting edge. The two cutting edges are parallel to the axis of the electrode 35 and have a length dimension approximately equal to that of the electrode 35. The long cutting edge has a predetermined length dimension along the length axis L. Furthermore, when observing a generally rectangular area of ​​the biological tissue surface formed by the channel cutting line 101c, the other long edge (hereinafter referred to as the non-cutting long edge) opposite the long cutting edge included in the channel cutting line 101c is not cut by the electrode 35. In other words, a peeling sheet is created that is attached to the surface of the biological tissue via the non-cutting long edge. Figure 58 Step S4).

[0174] In Figure 18 After the state shown, the second round of cutting operation is performed. The user operates switch 55a to stop the output of high-frequency current from the high-frequency power supply control device 55. Then, the release tab is lifted, causing the electrode unit 30 to... Figure 18 The electrode support 32 is moved in the direction of arrow L2 and positioned so that it is submerged below the release liner. That is, the electrode support 32 is positioned above the portion that was first burned, and the release liner is placed above the electrode support 32. In this state, the electrode 35 at the front end of the electrode support 32 is positioned near the initial burned portion 101a, offset from the non-cut long side by approximately one electrode 35 length. Figure 58 Step S5).

[0175] Next, the user operates the switch 55a to start the output of the high-frequency current from the high-frequency power source control device 55, and incises the living body in contact with the electrode 35. At this time, the electrode 35 is disposed as shown in FIG. 10A. In this state, the incised site 101a by the first round of operation is shown. In this case, the incised site 101a is shown by the reference numeral 101b. Figure 19 Figure 19 In this state, the living body tissue in the vicinity of the incised site 101a by the first round of operation is shown to be incised by the second round of operation by the electrode 35. In this case, the incised site 101a by the second round of operation is shown by the reference numeral 101d (the step S6 of FIG. 9). Figure 58

[0176] From the state shown in FIG. 10A, the second round of incision operation is performed. The second round of incision operation itself is the same as the first round of incision operation (refer to FIG. 9). That is, the user operates the resectoscope 10 to perform the operation of pulling the electrode unit 30 toward the proximal side (the distal side, the arrow LI direction of FIG. 10B) in the direction along the length axis LI, and moves the electrode support portion 32 along the wall surface 101 of the organ 100 (the step S3 of FIG. 9). After that, when the state where the electrode 35 reaches the target incision terminal position in the prescribed region as the treatment object is reached, the user performs the operation of lifting the electrode 35 toward the living body tissue surface side. By this, the peeled piece in the state of being attached to the living body tissue surface with the non-incision long side is made in a size further shifted by substantially the length of one electrode 35 from the peeled piece made in the first round (the step S4 of FIG. 9). Further, the detailed contents of each incision operation of the second round are the same as the operation of the first round. Therefore, the explanation thereof is omitted. Figure 19 Figures 14-18 Figure 16 Figure 58 Figure 58

[0177] Then, the state where, after the second round of operation (the operation of pulling the electrode 35 toward the length axis LI direction to incise the living body tissue) from the state shown in FIG. 10A is performed, the electrode 35 reaches the target incision terminal position in the prescribed region as the treatment object is shown in FIG. 10D. When the state shown in FIG. 10D is reached, the user performs the operation of lifting the electrode 35 toward the living body tissue surface side, and operates the switch 55a to end the output of the high-frequency current from the high-frequency power source control device 55. Then, the peeled piece is lifted, the electrode unit 30 is moved toward the arrow L2 direction of FIG. 10E, and the electrode support portion 32 is disposed in the state of being submerged in the lower side of the peeled piece, to become the state shown in FIG. 10E. Figure 20 Figure 19 Figure 20 Figure 20 Figure 21

[0178] ​​​​​​​​​​​​Thus, the channel cutting line 101c of the aforementioned channel shape (ko-shaped) formed in the biological tissue becomes a form in which two cutting edges extend parallel to the axis of the electrode 35. Even in this state, the non-cutting long edge at the position opposite to the cutting long edge of the channel cutting line 101c is not cut by the electrode 35.

[0179] Next, from Figure 21 The process begins in the nth round of incision. In other words, during a surgical procedure involving the en bloc removal of biological tissue using the electrode unit 30 of this embodiment, the aforementioned series of operations (the first round of incision, see...) is repeated multiple times (n times). Figures 14-18 ()( Figure 58 (In the cyclic processing of steps S3 to S6), when the cutting area in the axial (length direction) direction of electrode 35 reaches the designated area (the area to be cut) within the organ 100 of the subject containing the lesion, the final cutting operation described below is performed. Figure 58 Step S7). Here, the final cutting operation refers to the operation of removing the entire block of biological tissue slice by cutting the non-cut long side. In addition, in one example of the treatment steps described here, the third round of cutting operation is described as the final cutting operation.

[0180] In Figure 20 After the state shown, in order to perform the next third (final) cutting operation, the electrode unit 30 is directed towards... Figure 20 The electrode 35 is moved in the direction of arrow L2, positioning it near the second cauterization area 101d. The electrode 35 is then configured as follows: Figure 21 As shown. In this Figure 21 The image shows the state of the biological tissue near the second-round cauterization site 101d after being cauterized by electrode 35 in this (third, final) operation. Here, the cauterized site after the third-round operation is illustrated by reference numeral 101e.

[0181] in addition, Figure 22 , Figure 23 This is a schematic diagram of the electrode unit during the third round of cutting operation, viewed from a right-angled position on the front. Figure 22 This is a diagram showing the state during the third round of cutting operations. Figure 23 The image shows the state when the electrode reaches the cutting terminal position and cuts off the biological tissue slice during the third round of cutting operation.

[0182] from Figure 21 The process begins in the initial state, and the third round of cutting is performed. As described above, this third round of cutting is the final cutting operation, which involves cutting the non-long side to remove the entire block of biological tissue.

[0183] As Figure 21 , Figure 22 shown in the third round of the incision operation, first, the front end portion of the beam portion 35b of the electrode 35 is brought into abutment against the vicinity of the intersection of one of the two incision edges and the non-incision long edge 101f (step S8 of FIG. 13). In this state, the user operates the switch 55a, starts the output of the high-frequency current from the high-frequency power source control device 55, and performs the operation of pulling the electrode unit 30 in the arrow LI direction (step S9 of FIG. 13). Thus, the non-incision long edge 101f is incised. Figure 58 Figure 58

[0184] In this case, if the electrode unit 30 is rotated by a certain amount in the arrow Rl direction of FIG. 14 about the length axis L so that the front end portion of the beam portion 35b of the electrode 35 becomes a state of being slightly separated from the biological tissue surface, and the pressing force of the electrode unit 30 toward the biological tissue surface is relaxed, the incision of the non-incision long edge 101f can be easily performed. At this time, the tissue pressing portion 40 can stably press the incised biological tissue slice by slightly pressing the biological tissue surface. Figure 22

[0185] Then, the final incision operation is started from the state shown in FIG. 15, and when the electrode 35 reaches the target incision terminal position in the region of the object of treatment, the state shown in FIG. 16 is reached. At this time, the incision of the non-incision long edge 101f is completed. Thus, the biological tissue slice that is the object of the resection treatment (the biological tissue including the lesion portion such as cancer) is cut from the wall surface 101 of the organ 100, and the entire resection process is completed (step S10 of FIG. 13). Figure 21 Figure 22 Figure 23 Figure 58

[0186] In the above description of the first embodiment, the third round of the incision operation is taken as the final incision operation, but it is not limited thereto. For example, the operation after the third round is also performed as the second round of the incision operation, and if the above-described final incision operation is performed as the last incision operation, a larger region of the biological tissue can be resected.

[0187] In the present embodiment, as the configuration of the electrode 35, a structure example in which the base end 35a extending in the downward direction along the second axis Y and the beam portion 35b extending in the left direction along the first axis X from the tip end of the base end 35a are provided is shown, but it is not limited to this configuration.

[0188] As a different configuration of the electrode 35, for example, the beam portion 35b extending in the left direction along the first axis X from the opposing surface 36a of the front end rigid portion 36 can be provided alone.

[0189] ​​​​​​​In the electrode unit 30 of the present embodiment, after the electrode supporting portion 32 and the tissue pressing portion 40 are brought into contact with the biological tissue, the same direction is pressed, whereby the biological tissue between the electrode supporting portion 32 and the tissue pressing portion 40 is deformed into a convex shape toward the outside. Therefore, even if the electrode 35 is formed in the first axis X direction (horizontal direction) from the opposing surface 36a of the front end hard portion 36, the biological tissue can be resected in a stable shape, which is not changed.

[0190] As explained above, according to the above-described first embodiment, in the electrode unit in which the biological tissue in the body cavity is treated using a high-frequency current, for example, specifically, the biological tissue including a lesion such as cancer is en bloc resected, by bringing the electrode supporting portion 32 and the tissue pressing portion 40 into contact with the biological tissue, it is possible to bring the electrode 35 supported by the electrode supporting portion 32 into a stable state with respect to the surface of the biological tissue, and it is possible to limit the depth of the electrode 35 into the depth direction from the surface of the biological tissue. Thereby, it is not worried that the electrode 35 perforates the wall surface of the biological tissue or the like.

[0191] In addition, in this state, by slidingly moving the electrode supporting portion 32 in the length axis L direction from the front end side (distal end side) to the base end side, it is possible to slide the electrode 35 in the same direction to cut the biological tissue. And at this time, the tissue pressing portion 40 is pressed against the surface of the biological tissue while moving in the same direction as the electrode 35, so it is possible to maintain the region of the resection object in a stable state. Therefore, it is also possible to stably and reliably perform the cutting operation of the electrode 35 to the biological tissue. And by repeatedly performing such a simple operation, it is possible to perform en bloc resection of the desired region of the biological tissue.

[0192] Thereby, the biological tissue after resection is en bloc. Therefore, by using the en bloc resection slice (pathological specimen), for example, it is possible to efficiently perform pathological diagnosis, and it is possible to contribute to more accurate diagnosis.

[0193] In addition, the structure of the electrode supporting portion and the electrode, the tissue pressing portion provided in the electrode unit of the present application is not limited to the structure example exemplified in the above-described first embodiment. Hereinafter, other various structure examples of the first embodiment of the present application will be described.

[0194] [First Modification Example]

[0195] Figure 24 、 Figure 25 is a view showing a first modification example of the first embodiment of the present application. Among them, Figure 24 is a plan view observed from the upper surface of the electrode unit of the present modification example. Figure 25 shows a state when the biological tissue in the body cavity is en bloc resected using the electrode unit of the present modification example. In addition, in theFigure 25 The image shows the state during the final cutting operation.

[0196] like Figure 24 As shown, in the electrode unit 30A of this modified example, the difference is that the length of the tissue pressing part 40A is set to be longer than the length of the electrode support part 32.

[0197] In other words, in this modified example, the tissue pressing portion 40A is formed to extend further distally than the front end of the electrode support portion 32. Figure 24 In the structural example shown, the tissue pressing portion 40A is formed to extend further distally than the front end of the electrode support portion 32 by the length indicated by reference numeral B. Other structures are the same as in the first embodiment described above.

[0198] When performing en bloc resection of biological tissue using the electrode unit 30A of the first modified example constructed with such a structure, such as Figure 25 As shown, the tissue pressing part 40A can more reliably press the cut biological tissue 101x.

[0199] Furthermore, in the electrode unit 30A of this modified example, since the length of the tissue pressing part 40A is set to be longer than the length indicated by the reference numeral B for the electrode support part 32, even when the electrode 35 reaches the cutting end position, the front end of the tissue pressing part 40A is in a state of being left inside the already cut biological tissue 101x.

[0200] Therefore, when performing the second round of cutting operations, in this state, by simply sliding the electrode unit 30A from the base side to the front side (distal side), it is not necessary to insert the tissue pressing part 40A into the cut biological tissue 101x, and the electrode 35 can be moved to the starting point of the next cutting operation.

[0201] Thus, in the electrode unit 40A of this modified example, the cut biological tissue 101x can be reliably and stably pressed, which also helps to improve operability.

[0202] [Second variation]

[0203] Figure 26 , Figure 27 This is a diagram illustrating a second variation of the first embodiment of the present invention. Wherein, Figure 26 This is a top view taken from above the electrode unit of this modified example. Figure 27 From Figure 26 The main view is viewed in the direction of the arrow

[27] .

[0204] like Figure 26 , Figure 27As shown, the configuration of the tissue pressing portion 40B of the electrode unit 30B of this modification example is different from that of the first embodiment described above.

[0205] That is, the tissue pressing portion 40B in the electrode unit 30B of this modification example is provided to the front-end rigid portion 36B of the electrode support portion 32B. In this case, the tissue pressing portion 40B is formed as a plate as a whole. One end of the plate-shaped tissue pressing portion 40B is supported by the electrode support portion. Also, the plate-shaped tissue pressing portion 40B extends in parallel to the same direction as the extending direction of the beam portion 35b of the electrode 35. In the structural example of this modification example, the plate-shaped tissue pressing portion 40B is provided on the front-end rigid portion 36B at a position closer to the base end than the electrode 35 in the length axis L direction.

[0206] The plate-shaped tissue pressing portion 40B has a function of limiting the depth of the electrode 35 from the surface of the biological tissue into the depth direction while maintaining the posture of the electrode 35 in the horizontal direction with respect to the surface of the biological tissue when the beam portion 35b of the electrode 35 enters from the surface of the biological tissue. The other structures are the same as those of the first embodiment described above.

[0207] When performing the en bloc resection of the biological tissue using the electrode unit 30B of the second modification example configured in this way, the tissue pressing portion 40B more reliably presses the biological tissue before being cut by the electrode 35 (not shown), so that the resection operation of the biological tissue can be stably performed.

[0208] [Third Modification Example]

[0209] Figure 28 、 Figure 29 is a view showing a third modification example of the first embodiment of the present application. In this drawing, Figure 28 is a plan view as seen from the top of the electrode unit of this modification example. Figure 29 A case where the electrode unit of this modification example is used to perform the en bloc resection of the biological tissue in the body cavity is shown. In addition, in Figure 29 , the state when the final cutting operation is performed is particularly shown.

[0210] As shown in Figure 28 、 Figure 29 , the electrode unit 30C of this modification example is different from the second modification example described above only in the configuration of the tissue pressing portion 40C.

[0211] The tissue pressing portion 40C in the electrode unit 30C of this modification example is provided to the front-end rigid portion 36C of the electrode support portion 32C, as in the second modification example described above.

[0212] In the configuration example of the present modification example, the plate-shaped tissue pressing portion 40C is provided on the front end hard portion 36C at a position closer to the distal end (front end) than the electrode 35 in the length axis L direction.

[0213] The plate-shaped tissue pressing portion 40C has the same function as that of the second modification example described above, which is to limit the depth of penetration of the electrode 35 into the depth direction from the surface of the biological tissue while maintaining the posture of the electrode 35 in the horizontal direction with respect to the surface of the biological tissue when the beam portion 35b of the electrode 35 enters from the surface of the biological tissue. The other structures are the same as those of the first embodiment described above.

[0214] When the entire piece resection of the biological tissue is performed using the electrode unit 30C configured by such a structure, as with the second modification example described above, the tissue pressing portion 40C more reliably presses the biological tissue 101x of the region immediately after being cut by the electrode 35, so that the resection operation of the biological tissue can be stably performed. In addition to this, according to the configuration of the present modification example, since the tissue pressing portion 40C is provided at a position closer to the front end than the electrode 35, the same effect as that of the first modification example described above can be obtained.

[0215] In addition, the shape and size (plate area) of the plate-shaped tissue pressing portion 40B, 40C shown in the second and third modification examples are not limited to the examples shown in the drawings, and can be appropriately set depending on the object of the treatment and the type of the treatment.

[0216] [Fourth Modification Example]

[0217] Figures 30-32 is a view showing a fourth modification example of the first embodiment of the present application. In this view, Figure 30 is a plan view as seen from the upper surface of the electrode unit of the present modification example. Figure 31 is a front view as seen from the arrow

[31] direction of Figure 30 . Figure 32 is a cross-sectional view showing a state when the entire piece resection of the biological tissue in the body cavity is performed using the electrode unit of the present modification example.

[0218] As shown in Figure 30 , Figure 31 , the shape of the electrode 35D of the electrode unit 30D of the present modification example is different from that of the first embodiment and each modification example described above.

[0219] The electrode 35D in the electrode unit 30D of the present modification example extends substantially horizontally from the opposing surface 36a in the front end hard portion 36D of the electrode support portion 32D toward the opposing surface 40a of the tissue pressing portion 40. The other structures are the same as those of the first embodiment described above.

[0220] When the electrode unit 30D using the structure of this fourth modification example is used for bulk resection of a biological tissue, first, after the electrode support portion 32D and the tissue pressing portion 40 in the electrode unit 30D are brought into abutment with the surface of the biological tissue, pressing is performed.

[0221] When pressing of the electrode unit 30D against the biological tissue is continued, eventually the electrode 35D comes into abutment with the surface of the biological tissue. At this time, if a high-frequency current flows in the electrode 35D, the electrode 35D cauterizes the biological tissue.

[0222] If a pressing force in the same direction is applied to the electrode unit 30D in this state, the electrode 35D enters the inside of the tissue while cauterizing the biological tissue. At the same time, as shown in FIG. 10B, the biological tissue between the electrode support portion 32D and the tissue pressing portion 40 deforms into a convex shape (refer to reference numeral 101b) from the surface of the tissue toward the outside. Figure 32

[0223] In this state, the electrode unit 30D is slid and moved from the tip end side toward the base end side. By this, the electrode 35D also slides and moves in the same direction. At this time, the electrode 35D cuts the biological tissue of the convex shape portion 101b.

[0224] As described above, when bulk resection is performed using the electrode unit of the first embodiment and each modification example of the present application, a plurality of cutting operations are performed. In this case, the thickness of the resection slice (the depth at which the electrode enters the inside of the tissue) of each cutting operation depends on the pressing force of the user. Therefore, even for the same user, a step difference can occur in the joint portion between the cut regions of each cutting operation.

[0225] In the structure of this modification example, the bottom edge vicinity of the convex shape portion 101b is cut substantially horizontally, and thus bulk resection can be performed at a uniform depth without such a step difference, and thus a resection slice with a smooth cut surface can be obtained.

[0226] [Fifth Modification Example]

[0227] Figure 33 , Figure 34 is a view showing the fifth modification example of the first embodiment of the present application. In this view, Figure 30 is a front view as viewed from the direction along the length axis L (a direction corresponding to the direction of the arrow

[31] of the front view Figure 34 used in the fourth modification example). Figure 30 is a sectional view showing a state when bulk resection of a biological tissue in a body cavity is performed using the electrode unit of this modification example. Further, the plan view as viewed from above the electrode unit of this modification example is the same as Figure 33 used in the fourth modification example, and thus is omitted. ​

[0228] The electrode unit 30E of this modification example has substantially the same structure as the fourth modification example described above. In this modification example, as shown in FIG. 34, only the shape of the electrode 35E is slightly different. Figure 34

[0229] The electrode 35E in the electrode unit 30E of this modification example is formed so as to have a protruding curved portion 35Ea curved in a convex shape toward the upper direction after extending substantially horizontally from the opposing surface 36a in the rigid portion 36E of the front end of the electrode support portion 32E toward the opposing surface 40a of the tissue pressing portion 40.

[0230] In other words, when viewed from the direction along the length axis L (the front surface side), the protruding curved portion 35Ea of the electrode 35E is curved in a convex shape toward the upper direction. The other structures are the same as those of the first embodiment described above.

[0231] The effect of using the electrode unit 30E of the fifth modification example having such a structure for bulk resection of a biological tissue is the same as that of the fourth modification example described above. That is, first, similarly to the fourth modification example described above, after the electrode support portion 32E and the tissue pressing portion 40 in the electrode unit 30E are brought into abutment against the surface of a biological tissue, pressing is performed. When the pressing of the electrode unit 30E against the biological tissue is continued, eventually the electrode 35E comes into abutment against the surface of the biological tissue. At this time, if a high-frequency current flows through the electrode 35E, the electrode 35E cauterizes the biological tissue.

[0232] If a pressing force in the same direction is applied to the electrode unit 30E in this state, the electrode 35E enters the inside of the tissue while cauterizing the biological tissue. At the same time, the biological tissue between the electrode support portion 32E and the tissue pressing portion 40 is deformed into a convex shape (refer to reference numeral 101b in FIG. 34) toward the outside from the tissue surface. Figure 35

[0233] In this state, the electrode unit 30E is slid and moved from the front end side toward the base end side. By this, the electrode 35E is also slid and moved in the same direction. At this time, the electrode 35E cuts the biological tissue of the convex-shaped portion 101b. As described above, the electrode 35E in this modification example is formed so as to have the protruding curved portion 35Ea toward the upper direction. This protruding curved portion 35Ea cuts the biological tissue in such a manner as to follow the inner side surface of the convex-shaped portion 101b when the electrode 35E is slid and moved from the front end side toward the base end side.

[0234] Therefore, according to the structure of this modification example, bulk resection can also be performed without generating a step difference that is a step difference of a joint portion between cut regions generated at each of a plurality of cutting operations, and thus a resected slice having a smooth cut surface can be obtained.

[0235] [Sixth Modification Example]​​

[0236] Figure 36 、 Figure 35 is a front view as viewed from a direction along the length axis L (a direction corresponding to the arrow

[31] direction of the fourth modification example). Figure 30 is a front view as viewed from a direction along the length axis L (a direction corresponding to the arrow

[31] direction of the fourth modification example). Figure 36 is a front view as viewed from a direction along the length axis L (a direction corresponding to the arrow

[31] direction of the fourth modification example). Figure 30 is a sectional view showing a state when the biological tissue in the body cavity is en bloc resected using the electrode unit of the present modification example. Further, a plan view as viewed from above the electrode unit of the present modification example is the same as Figure 35 of the fourth modification example, and thus is omitted.

[0237] The structure of the electrode unit 30F of the present modification example is basically the same as that of the fourth and fifth modification examples described above. In the present modification example, as shown in Figure 36 , only the shape of the electrode 35F is slightly different.

[0238] The electrode 35F in the electrode unit 30F of the present modification example is formed so as to have a protruding curved portion 35Fa curved in a convex shape toward the lower direction after extending substantially horizontally from the opposing surface 36a in the front end hard portion 36F of the electrode support portion 32F toward the opposing surface 40a of the tissue pressing portion 40.

[0239] In other words, as viewed from the direction along the length axis L (the front side), the protruding curved portion 35Fa of the electrode 35F is curved in a convex shape toward the lower direction. The other structures are the same as those of the first embodiment described above.

[0240] The effect when the en bloc resection of the biological tissue is performed using the electrode unit 30F of the sixth modification example having such a structure is the same as that of the fifth modification example described above. That is, first, similarly to the fifth modification example described above, after the electrode support portion 32F and the tissue pressing portion 40 in the electrode unit 30F are brought into abutment with the biological tissue surface, pressing is performed. When the pressing of the electrode unit 30F against the biological tissue is continued, eventually the electrode 35F comes into abutment with the biological tissue surface. At this time, if a high-frequency current flows in the electrode 35F, the electrode 35F cauterizes the biological tissue.

[0241] If a pressing force in the same direction is applied to the electrode unit 30F in this state, the electrode 35F enters the inside of the tissue while cauterizing the biological tissue. At the same time, the biological tissue between the electrode support portion 32F and the tissue pressing portion 40 is deformed into a convex shape toward the outside from the tissue surface (refer to the reference numeral 101b of Figure 37 ).

[0242] In this state, the electrode unit 30F is slid from the tip end side to the base end side. By this, the electrode 35F is also slid in the same direction. At this time, the electrode 35F cuts the living body tissue of the convex shape portion 101b. As described above, the electrode 35F in this modified example is formed to have the protruding curved portion 35Fa toward the lower direction. This protruding curved portion 35Fa cuts the living body tissue along the curved surface which is separated from the inner side surface of the convex shape portion 101b when the electrode 35F is slid from the tip end side to the base end side.

[0243] Therefore, according to the structure of this modified example, it is also possible to perform the en bloc resection with a uniform depth without generating a step difference which is a step difference of a joint portion between cut regions generated when each of a plurality of cutting operations is performed, and it is possible to obtain a resection slice including a muscular layer having a smooth cut surface cut at a certain depth.

[0244] [Seventh Modified Example]

[0245] Figure 38 、 Figure 37 is a view showing a seventh modified example of the first embodiment of the present application. In this view, Figure 38 is a plan view observed from the upper surface of the electrode unit of this modified example. Figure 30 is a front view observed from the direction along the length axis L (a direction corresponding to the arrow

[31] direction of the front view of the fourth modified example). Figure 37

[0246] As shown in Figure 38 、 Figure 38 , the shape of the electrode 35G of the electrode unit 30G of this modified example is different from those of the above-described first embodiment and each modified example.

[0247] The electrode 35G in the electrode unit 30G of this modified example is constituted by a belt-like member which extends in a substantially horizontal direction from the opposing surface 36a in the tip end hard portion 36G of the electrode support portion 32G toward the opposing surface 40a of the tissue pressing portion 40 and has a width dimension.

[0248] The structure example in which the electrode in the above-described first embodiment and each modified example applies the linear member or the rod-like member which is continuously provided with the electrode wire 33 is exemplified, but the belt-like member is applied instead of them in the electrode 35G of this modified example. The electrode 35G in this modified example is formed to have the electric conductivity and to have the rigidity. In addition, as a setting for obtaining a prescribed rigidity, it is preferable that, for example, the width dimension of the electrode 35G constituted by this belt-like member is set to about 1 to 2 mm, and it is formed to have a prescribed thickness dimension (at least 0.5 mm or more).

[0249] ​This is because, since the electrode 35G is configured in the form of a cantilever beam, it is likely to bend when pressing the electrode 35G against the surface of the biological tissue. In this case, the ablation treatment based on the electrode 35G is unstable, and it is likely to cause a problem that the ablation of the desired depth (thickness) cannot be performed. The structure of the present modification is used to eliminate such a problem.

[0250] That is, in the present modification, the electrode 35G is configured using the conductive member composed of the belt-shaped member having rigidity, and the ablation treatment can be performed more reliably and stably. The other structures are the same as those of the above-described first embodiment.

[0251] In the structure of the present modification, the same effects as those of the above-described first embodiment and each modification can be obtained.

[0252] Further, in the present modification, an example in which the belt-shaped member having rigidity is applied as the electrode 35G is shown, but it is not limited to this structural example. For example, with respect to the electrode (diameter of about 0.5 mm) used in the above-described first embodiment and the like, the electrode 35G can be configured using a thick wire-shaped member or a rod-shaped member having a diameter of about 1 to 2 mm. In this case, the same effects as those of the above-described modification 7 can be obtained.

[0253] Further, the electrode 35G in the above-described seventh modification can be additionally provided with the following structure.

[0254] An example in which the electrode 35G in the above-described seventh modification is configured using a belt-shaped member or a thick wire-shaped member having rigidity is shown. In the electrode 35G of such a structure, the electrode 35G is formed by applying an insulating coating to a part of the surface of the electrode 35G.

[0255] The surface to which the insulating coating is applied of the electrode 35G is a surface (reference numeral 35d, upper surface) other than a surface (reference numeral 35c, lower surface) at which the electrode 35G directly abuts against the biological tissue to cut when performing the bulk ablation treatment using the electrode unit 30G. Figure 38 Figures 39-41

[0256] That is, when performing the bulk ablation treatment, first, the lower surface 35c is brought into abutment with the surface of the biological tissue in a state in which one surface (lower surface 35c) is disposed in opposition to the surface of the biological tissue. At this time, the lower surface 35c of the electrode 35G heats and cauterizes the biological tissue. Thus, the electrode 35G enters the inside of the tissue from the tissue surface while cauterizing the biological tissue. Therefore, the lower surface 35c of the surface of the electrode 35G, which comes into contact with the surface of the biological tissue, is not applied with the insulating coating.

[0257] ​​On the other hand, in a state where the lower surface 35c of the electrode 35G is in contact with the surface of the biological tissue, the other surface of the surface of the electrode 35G, that is, the upper surface 35d which is not in contact with the surface of the biological tissue is applied with an insulating coating.

[0258] According to this structure, in a case where the electrode unit 30G is used for a whole piece resection treatment, the upper surface 35d of the surface of the electrode 35G to which the insulating coating is applied is in contact with the inner side surface of the resection slice which is cut from the wall surface of the biological tissue. However, by the effect of the insulating coating applied to this surface 35d, the thermal invasion to the resection slice, that is, the pathological specimen can be suppressed.

[0259] [Second Embodiment]

[0260] Next, the second embodiment of the present application will be described below. The electrode unit 30H of the present embodiment is basically composed of the same structure as that of the above-described first embodiment. In the electrode unit 30H of the present embodiment, only the structure of the tip hard portion 36H in the electrode support portion 32H and the electrode 35H and the structure of the tissue pressing portion 40H are different. Therefore, as for the same structure as that of the above-described first embodiment, the same reference numerals are attached and the description thereof is omitted, and only the different portions will be described.

[0261] Figure 39 is a drawing showing the electrode unit of the second embodiment of the present application. In this drawing, Figure 40 is a plan view as seen from the upper surface of the electrode unit of the present embodiment. Figure 40 is a left side view of the electrode unit of the present embodiment. That is, Figure 39 is a drawing as seen from the direction of the arrow mark

[40] of Figure 41 . Figure 41 is a right side view of the electrode unit of the present embodiment. That is, Figure 39 is a drawing as seen from the direction of the arrow mark

[41] of Figures 39-41 .

[0262] As shown in Figure 41 , the electrode unit 30H of the present embodiment is formed to have an elongated shape having a length direction in the direction along the length axis L. The electrode unit 30H is mainly composed of a base end hard portion 31, an electrode support portion 32H, an electrode wire 33, an electrode 35H, a tissue pressing portion 40H, and the like.

[0263] The electrode support portion 32H is a structure portion which fixedly supports the base end 35a of the electrode 35H (refer to Figures 39-41 ). In this case, the electrode support portion 32H is formed in a substantially linear shape as a whole, and fixedly supports the base end 35a of the electrode 35H in the tip portion. Also, the electrode support portion 32H is arranged in parallel with the tissue pressing portion 40H.

[0264] The electrode support portion 32H is configured to have a front end hard portion 36H and an elastic region 37. The front end hard portion 36H is a structural portion formed to have a columnar outer shape with a hollow in a length direction along the length axis L. The front end hard portion 36H is formed of a material having electrical insulation. An electrode wire 33 is inserted through the front end hard portion 36H, and the electrode wire 33 is electrically connected to an electrode 35H fixedly supported in the vicinity of the front end.

[0265] The base end 35a of the electrode 35H protrudes from the surface of the front end hard portion 36H and is provided in a cantilever beam shape. In detail, the base end 35a of the electrode 35H protrudes outward from one portion of the front end hard portion 36H near the front end and is provided to extend in a prescribed length in a downward direction along the second axis Y. Further, as will be described later, the protruding length of the electrode 35H protruding from the surface of the front end hard portion 36H is defined in relation to the length of the tissue pressing portion 40H as a stopper (details will be described later).

[0266] On the other hand, the tissue pressing portion 40H is formed to have a rod-shaped portion 41 having elasticity as a whole and formed of a non-conductive material, and to have a substantially straight shape as a whole, and a bent portion 42 bent from the vicinity of the front end of the rod-shaped portion 41 in a downward direction along the second axis Y and provided to extend in a prescribed length in the same direction. Further, the tissue pressing portion 40H has a free end including a front end region of the bent portion 42, and a base end fixedly supported to one side surface portion of the base end hard portion 31 near the front end. With this structure, the tissue pressing portion 40H is formed in a cantilever beam shape.

[0267] In detail, the rod-shaped portion 41 of the tissue pressing portion 40H is arranged in a state of extending along the length axis L in a state of being substantially parallel to the electrode support portion 32H. In this case, the extension length of the tissue pressing portion 40H in the direction along the length axis L is set to be longer than the extension length of the electrode support portion 32H in the same direction by a dimension amount D as shown in the drawing. Figure 41

[0268] Here, the length dimension difference D between the electrode support portion 32H and the tissue pressing portion 40H in the length axis L direction is set in the following manner. As will be described later, when performing a whole block resection treatment using the electrode unit 30H of the present embodiment, a method of use is performed in which a portion of a resection slice (a pathological specimen) as a treatment target is held between the electrode support portion 32H and the tissue pressing portion 40H. In this case, the length dimension difference D between the electrode support portion 32H and the tissue pressing portion 40H is set to a length such that the biological tissue does not come off between the electrode support portion 32H and the tissue pressing portion 40H.

[0269] ​Further, the electrode support portion 32H and the tissue pressing portion 40H are arranged apart from each other in the direction along the first axis X (left-right direction of the electrode unit 30) at a prescribed interval, in this respect being the same as the first embodiment described above. In this case, the interval in the direction along the first axis X of the electrode support portion 32H and the tissue pressing portion 40H is set to be longer than the thickness of the resected slice by about 1 to 2 mm. This is because, when the electrode unit 30H is used, the operation of sandwiching and holding the resected slice in the thickness direction between the electrode support portion 32H and the tissue pressing portion 40H is performed (details of the operation steps are described later).

[0270] Further, the protruding length of the electrode 35H from the surface of the front end hard portion 36H is set to be longer than the length of the bent portion 42 of the tissue pressing portion 40H by the dimension amount E of the reference symbol E. Figure 43

[0271] Here, the length dimension difference amount E of the electrode 35H and the bent portion 42 in the second axis Y direction is set in the following manner. As described later, when the resection treatment using the electrode unit 30H of the present embodiment is performed, the bent portion 42 of the tissue pressing portion 40H abuts against the surface of the biological tissue in the vicinity of the resected slice (pathological specimen) that is the treatment target, thereby preventing the electrode 35H from excessively entering the inside of the biological tissue (stop function). In this case, the length dimensions of the electrode 35H and the bent portion 42, that is, the length dimension difference amount E is set so that, in a state where the bent portion 42 abuts against the surface of the biological tissue and presses the bent portion 42 against the surface of the biological tissue with a prescribed force, the front end of the electrode 35H that has entered the inside of the biological tissue becomes a state of being inserted into the muscularis layer (refer to the description of the operation steps described later). Figures 42-57 ). The other structures are the same as the first embodiment described above.

[0272] Hereinafter, the effects and the steps of the surgical operation when the endoscope system 1 that includes the electrode unit 30H of the present embodiment configured in this manner is used to perform the en bloc resection treatment of the biological tissue of a prescribed region including a lesion portion in the organ 100 of the subject will be described using Figure 59 , Figures 42-57

[0273] Further, the example of the treatment steps described in the present embodiment is an example when the en bloc resection treatment of resecting the biological tissue that is the treatment target (for example, the biological tissue including a lesion portion such as cancer) in a manner of being concentrated into a block shape is performed. This is the same as the first embodiment described above.

[0274] Figure 42 is a diagram that schematically shows the steps when the resection scope that applies the electrode unit of the present embodiment is used to perform the treatment of the biological tissue in the body cavity (organ) of the subject such as a human body. In this diagram,​​Figure 43 is a schematic view showing a state in which the resectoscope to which the electrode unit of the present embodiment is applied is inserted into a body cavity (organ) of a subject such as a human body and the electrode is brought into abutment with a prescribed position. Figure 42 is a cross-sectional view showing a cross section along the arrow

[43] -

[43] line of Figure 59 . Also, Figure 43 is a flowchart showing steps of a procedure performed using the resectoscope to which the electrode unit of the present embodiment is applied.

[0275] In Figure 59 , a state is shown in which the electrode 35H is inserted into the inside of the biological tissue from the front end by a prescribed amount (length dimension difference E), and the front end of the bent portion 42 of the tissue pressing portion 40H, which presses the biological tissue surface, is in abutment with the surface of the biological tissue, thereby functioning as a stopper that limits the electrode 35H from further entering the inside of the biological tissue.

[0276] In the case where the entire piece resection procedure of the biological tissue in the organ 100 is performed using the electrode unit 30H of the present embodiment, first, the user inserts the resectoscope 10 into the organ 100 in accordance with prescribed steps. Also, the steps of inserting the resectoscope 10 into the organ 100, the method of filling the organ 100 with perfusate, and the like are the same as those when the existing resectoscope is operated, and thus the description thereof is omitted.

[0277] After the front end portion of the resectoscope 10 is disposed at a prescribed position in the organ 100 (a position where a lesion portion or the like is present), the user performs the following operation: the electrode unit 30H is inserted through the device channel 10a of the resectoscope 10, and the front end of the electrode unit 30H is caused to protrude a prescribed amount from the front end portion of the device channel toward the outside in the front direction. This operation is also the same as that of the existing resectoscope.

[0278] Next, the user brings the respective front ends of the electrode 35H and the bent portion 42 of the tissue pressing portion 40H into a posture in which they are opposed to the biological tissue that is the object of the procedure in the organ 100. Then, the user brings the electrode unit 30H close to the surface of the biological tissue while maintaining the posture of the electrode unit 30H, and brings the front end of the electrode 35H into abutment with the positioned position in the vicinity of the biological tissue that is the object of the procedure (including the biological tissue of the lesion portion) (step S11 of Figure 43 At this time, first, the front end of the electrode 35H is brought into abutment with the surface of the biological tissue in a posture in which the electrode 35H and the bent portion 42 of the tissue pressing portion 42H are as perpendicular as possible to the surface of the biological tissue.

[0279] Next, the user operates the switch 55a, and the output of the high-frequency current from the high-frequency power source control device 55 is started. As a result, the biological tissue in contact with the electrode 35H is heated, and the biological tissue is cauterized. In this way, when the electrode 35H starts the cauterization of the biological tissue, as shown in Figure 42 , Figure 43 , Figure 42 ,

[0280] Figure 43 , Figure 42 shows a state in which the electrode 35H of the electrode support portion 32H of the electrode unit 30H enters the biological tissue by a prescribed amount (length dimension difference E) from the front end of the electrode unit 30H protruding from the front end portion of the resectoscope 10, and the front end of the tissue pressing portion 40H presses the surface of the biological tissue. Figure 43 is a schematic view of the appearance, Figure 43 is a schematic view showing a cross section.

[0281] In the state shown in Figure 43 , the electrode 35H becomes a state in which the biological tissue is cauterized and enters the inside. In this case, the portion shown by the cross-hatched portion and the reference numeral 101a in Figure 43 is a cauterized portion.

[0282] Generally, as shown in Figure 43 , the biological tissue such as an organ is formed in order from the surface side with an epithelial layer O, a mucosal layer P, a muscular layer Q, and a serosal layer R. When performing the en bloc resection treatment of the biological tissue (for example, the biological tissue including a lesion portion such as cancer) using the electrode unit 30H of the present embodiment to obtain a desired resection slice as a pathological specimen, it is necessary to include the muscular layer Q directly below the lesion portion such as cancer in the resection. On the other hand, if the resection is performed to a portion deeper than the muscular layer Q, there is a possibility that a perforation is generated in the wall surface of the organ. Therefore, it is preferable to appropriately and accurately set the resection treatment of the electrode 35H to a stable state by limiting the depth dimension of the electrode 35H entering from the surface of the biological tissue to a prescribed amount.

[0283] Therefore, in the electrode unit 30H of the present embodiment, the length dimension of the electrode 35H is set to be longer than the length dimension of the bent portion 42 of the tissue pressing portion 40H by the length dimension difference E. According to this structure, in this electrode unit 30H, a structure is obtained in which the depth dimension of the electrode 35H entering from the surface of the biological tissue is limited, appropriate resection including the muscular layer Q can be performed, and resection without concern of a perforation can be performed.

[0284] This point will be described more specifically. As shown in Figure 43 , the electrode 35H cauterizes the biological tissue while entering Figure 44The material advances in the direction of arrow Y1, penetrating into the tissue. Finally, when the tip of electrode 35H reaches the predetermined depth, i.e., the muscle layer Q, the tip of the flexed portion 42 of the tissue pressing portion 42H abuts against the surface of the biological tissue. Here, the tissue pressing portion 42 abuts against a portion of the outer region outside the area burned by electrode 35H.

[0285] Therefore, in the electrode unit 30H of this embodiment, the extension length of the rod-shaped portion 41 of the tissue pressing portion 42 in the length axis L direction is set to be longer than the extension length of the front end hard portion 36H in the same direction by a length dimension difference D.

[0286] According to this structure, when the electrode 35H enters the biological tissue by burning it, the front end of the bent portion 42 of the tissue pressing portion 40H abuts against the tissue surface at a location separated from the burned area by the electrode 35H, and presses against this tissue surface. However, at this time, the tissue surface abutted by the tissue pressing portion 40H is not burned. Therefore, the tissue pressing portion 40H will not enter the biological tissue in this state. Thus, the tissue pressing portion 40H functions as a stopper that limits the electrode 35H from entering the biological tissue to a depth exceeding a predetermined amount.

[0287] exist ​ In the state shown, electrode 35H can be said to be in a stable state in the direction of arrow Y1. In this state, the user makes an incision along the periphery of a desired area within the biological tissue. In the following description, this operation will be referred to as a peripheral incision operation. Here, the desired area is the predetermined region of the excised section to be taken from the biological tissue.

[0288] ​ , ​ , Figure 46 This diagram illustrates the state during a peripheral incision operation on the first edge of a predetermined region of a biological tissue to be removed. Figure 44 This is a schematic diagram showing the state during the cutting operation of the first perimeter. Figure 45 This is a schematic diagram showing the state at the moment the first perimeter cutting operation ends. Additionally, in Figure 44 , Figure 45 In the diagram, a double-dotted line is used to indicate the outer periphery of the area to be excised, and the number 200 is used to indicate this. Figure 46 It shows along Figure 45 A schematic diagram of the cross section of the arrow

[46] -

[46] .

[0289] In the first peripheral cutting operation performed by the user, firstly, in the position of Figure 42 , Figure 43In the state shown, the resection mirror 10 and the electrode unit 30H are moved together toward the hand side (base side) in the direction along the length axis L. Figure 44 , Figure 45 The drag operation (in the direction of arrow L1) Figure 59 (Step S12). As a result, the electrode support 32H and the electrode 35H also move in the same direction. At this time, the electrode 35H is in a state where it has entered the tissue at a predetermined depth (see step S12). Figure 43 Furthermore, it is in a state where a high-frequency current flows. Therefore, electrode 35H cauters biological tissue, creating a resection groove 110 of a specified depth (refer to...). Figure 46 ).like Figure 46 As shown, the inner surface of the cutting groove 110 becomes the scorching area 101a. Furthermore, the cutting groove 110 in... Figure 44 , Figure 45 The solid line along the burned area 101a is used to represent it.

[0290] Thus, when becoming Figure 45 In this state, the user then performs a second peripheral cutting operation. Figure 59 Step S13). The second-side peripheral cutting operation is the operation of generating the second-side cutting groove 110, which is a continuous groove with the cutting groove 110 generated by the first-side peripheral cutting operation, and is in a predetermined direction that is approximately orthogonal to the first side (in this example, ...). Figure 45 Extends in the direction of the arrow X1.

[0291] Figure 47 This is a schematic diagram showing the state at the end of the peripheral incision operation on the second side of the predetermined region of the organism tissue to be removed.

[0292] During the second peripheral cutting operation performed by the user, when in the position Figure 45 In the state shown, the resection mirror 10 and the electrode unit 30H are aligned together in a predetermined direction orthogonal to the length axis L. Figure 45 , Figure 47 The operation involves moving the electrode support 32H and the electrode 35H in the same direction (in the direction of arrow X1). At this time, the electrode 35H is also in a state where it has entered the tissue at a predetermined depth and maintains a high-frequency current flow. Thus, the electrode 35H, through the ablation of the biological tissue, similarly forms a resection groove 110 of a predetermined depth.

[0293] Thus, when becoming Figure 47 In this state, the user then performs a third-side peripheral cutting operation. Figure 59Step S14). The third-side peripheral cutting operation is the operation of generating a third-side cutting groove 110, which is a groove continuous with the second-side cutting groove 110 generated by the second-side peripheral cutting operation, and is in a predetermined direction that is approximately orthogonal to the second side (in this example, ...). Figure 47 The arrow extends in the direction of L2. Additionally, the third side is located opposite the first side.

[0294] Figure 48 This is a schematic diagram showing the state at the end of the peripheral incision operation on the third side of the predetermined region of the organism tissue to be removed.

[0295] During the third-sided peripheral cutting operation performed by the user, in the position Figure 47 In the state shown, the resection mirror 10 and the electrode unit 30H are moved together from the hand side (base side) towards the front side (end side) along the length axis L. Figure 47 The operation involves pushing the electrode (in the direction of arrow L2). As a result, the electrode support 32H and the electrode 35H move in the same direction. At this time, the electrode 35H is also in a state where it has entered the tissue to a predetermined depth, and a high-frequency current flow is maintained. Thus, the electrode 35H, through the burning of the biological tissue, similarly forms a resection groove 110 of a predetermined depth.

[0296] Thus, when becoming Figure 48 In this state, the user then performs a fourth-sided peripheral cutting operation. Figure 59 Step S15). The fourth side perimeter cutting operation is the operation of generating a cutting groove 110 on the fourth side, which is a groove continuous with the cutting groove 110 generated by the third side perimeter cutting operation, and it is in a predetermined direction that is approximately orthogonal to the third side (in this example, ). Figure 48 The arrow extends in the X2 direction. Additionally, here, the fourth side is the side located opposite the second side.

[0297] Thus, when the resection mirror 10 and the electrode unit 30H are moved together to Figure 45 When the position is shown, as Figure 49 As shown, a roughly rectangular cutting groove 110 is generated. The cutting groove 110 shows the outer periphery of the predetermined area to be cut. Figure 49 This is a schematic diagram showing a resection groove corresponding to the outer periphery of the predetermined area to be removed from a biological tissue.

[0298] Furthermore, in this embodiment, the outer periphery of the predetermined area to be cut is formed into a generally rectangular shape consisting of the first to fourth sides (cutting groove 110), but it is not limited to this method. By repeatedly performing the same operation described above, the outer periphery of the predetermined area to be cut can be set to any shape.

[0299] Thus, in the bulk resection processing performed using the electrode unit 30H of the present embodiment, first, a substantially rectangular resection groove 110 corresponding to the outer periphery of the resection scheduled region of the biological tissue is initially generated. Thus, the generation of the substantially rectangular resection groove 110 is a preliminary preparation work for enabling the slice peeling operation (an operation of peeling the resection scheduled site (resection slice) in the biological tissue from the organ wall surface) to be performed next to be performed reliably and easily.

[0300] In short, the depth of the substantially rectangular resection groove 110 generated by the periphery incision operation (the operation described in Figures 44-49 ) described above becomes an index of the thickness of the resection slice, and thus the generation of the wall surface perforation can be suppressed when the slice peeling operation is performed, and the slice peeling can be performed at a substantially uniform thickness. Also, by generating the resection groove 110 having a prescribed depth dimension in advance, the operation of sandwiching the resection slice peeled off between the electrode support portion 32H and the tissue pressing portion 40H (described later) can be easily performed when the slice peeling operation is performed later.

[0301] Here, the process of the slice peeling operation performed after the periphery incision operation is described below. Figure 50 、 Figure 51 、 Figure 52 is a view showing a state at the time when the slice peeling operation of the scheduled region of the biological tissue desired to be resected is started to be performed. In this view, Figure 50 is a schematic view showing the arrangement of the electrode unit at the time when the slice peeling operation of the first round is started to be performed. Figure 51 is a schematic view showing a cross section along the line of the reference numerals

[51] -

[51] of Figure 50 . Figure 52 is a schematic view showing the positional relationship between the electrode and the biological tissue at the time of the state of Figure 51 .

[0302] The user arranges the front end rigid portion 36H of the electrode support portion 32H and the electrode 35H of the electrode unit 30H with respect to the biological tissue in the state shown in Figure 49 at the position shown in Figures 50-52 . In this case, the electrode 35H and the bent portion 42 are arranged to become horizontal with respect to the surface of the biological tissue. Specifically, the resection scope 10 in which the electrode unit 30H is inserted through is rotated by approximately 90 degrees with respect to the state shown in Figure 44 . At this time, the electrode 35H and the bent portion 42 are arranged to extend toward the direction of the arrow X1 of Figure 45 .

[0303] In addition, the front end hard portion 36H of the electrode support portion 32H is aligned with the cutaway groove 110 extending in the long axis direction L, and the electrode 35H is aligned with the cutaway groove 110 extending in a direction orthogonal to the long axis direction L, so as to be disposed at the depth direction bottom of the cutaway groove 110. In short, the front end hard portion 36H and the electrode 35H are aligned with the upper right corner of the cutaway groove 110 so as to be disposed at the groove inner bottom (step S16 of FIG. 10). In this state, a high frequency current is caused to flow in the electrode 35H. Figure 49 Figure 59

[0304] Then, the user performs an operation of pulling the cutaway mirror 10 and the electrode unit 30H together in the direction along the length axis L toward the hand side (the base end side, the arrow LI direction of FIG. 11) (step S17 of FIG. 11). By this, the electrode 35H also moves in the same direction. Then, the electrode 35H peels the biological tissue as a prescribed certain thickness of a tissue piece only in an area of a size corresponding to the width dimension of the electrode 35H itself. The operation at this time is substantially the same as the first round incision operation in the function, operation sequence in the above-described first embodiment. Figure 50 Figure 59

[0305] Figure 53 is a schematic view showing a state in which the electrode reaches the peeling terminal position by the first round slice peeling operation. In this state, a peeled piece 110a in a state of being partially attached to the surface of the biological tissue is produced (step S18 of FIG. 12). In addition, in Figure 59 , the double-dotted line indicated by the reference numeral 200a indicates a cutaway straight line of the slice 110a peeled by the first round slice peeling operation. Figure 53

[0306] Figure 54 is a schematic view showing a state at the time of moving the electrode from the peeling terminal position of the first round slice peeling operation to the start position of the second round slice peeling operation of Figure 53 Figure 55 is a schematic view showing the disposition of the electrode unit at the time of starting the second round slice peeling operation.

[0307] Thus, as shown in Figure 53 , when the electrode 35 reaches the peeling terminal position, the energization of the high frequency current to the electrode 35H is stopped, and thereafter, as shown in Figure 54 , the electrode 35H is caused to move away from the cauterized surface, and the electrode 35H is caused to return to the position shown in Figure 50 while lifting the peeled portion upward with the electrode 35H not energized.

[0308] ​​​​​​Then, electrode 35H is moved in the direction of arrow X1 within the excision trench 110, and electrode 35H is positioned at the beginning of the next second round of stripping operation. Figure 55 (The location shown) Figure 59 (Step S19). At this time, the slice 110a, which has been peeled off by the first round of slice peeling operation, remains sandwiched between the electrode 35H, the hard tip 36H, and the tissue pressing part 40H. Furthermore, in the next slice peeling operation, the peeled slice 110a is always sandwiched between the electrode 35H, the hard tip 36H, and the tissue pressing part 40H. Therefore, the tissue pressing part 40H can prevent the peeled slice 110a from curling up during the peeling operation, allowing for smooth peeling.

[0309] Thus, returning to Figure 55 A high-frequency current is then applied again to electrode 35H in its current state. Then, the same procedure as the first round of slicing and peeling is repeated until the tissue slice is removed from the tissue. Figure 59 (Steps S17-20 are repeated).

[0310] After repeatedly performing the slicing and peeling operation described above, such as Figure 56 , Figure 57 As shown, electrode 35H is positioned at the beginning of the final slicing and peeling operation. Figure 56 , Figure 57 This is a schematic diagram showing the configuration of the electrode unit when the final slicing and stripping operation begins. Furthermore, Figure 56 This is a top view taken from above the electrode unit. Figure 57 It is a partial sectional view of a biological tissue.

[0311] like Figure 56 As shown, in the final slicing and peeling operation, the tip of electrode 35H is configured to protrude into the resection groove 110. In this state, electrode 35H, to which a high-frequency current is applied, is moved in the direction of arrow L1. Then, when electrode 35H reaches the peeling terminal position, the biological tissue slice (containing biological tissue with lesions such as cancer) to be removed is cut off from the wall 101 of organ 100. Figure 59 Step S20). Thus, the whole-piece removal process performed by the electrode unit 30H of this embodiment is completed.

[0312] Here, when performing the operation of peeling off the final slice 110a, the peeled slice 110a is maintained in a state between the electrode 35H, the front hard part 36H, and the tissue pressing part 40H until the peeling is completed.

[0313] In this case, since the length of the tissue pressing portion 42H in the length axis L direction is set to be longer than the length of the front end hard portion 36H in the length axis L direction by the length difference D, when the peeling operation in the arrow L direction reaches the terminal position, the electrode 35H and the front end hard portion 36H are disposed at a position separated from the peeled slice 101a, but the tissue pressing portion 42H always maintains the state of pressing the peeled slice 101a. Therefore, it is not necessary to spend the effort of re-clamping the peeled slice 101a between the electrode 35H and the front end hard portion 36H and the tissue pressing portion 42H.

[0314] As explained above, according to the above-described second embodiment, the resection groove 110 having a prescribed depth dimension is generated in advance, and therefore, when the operation of performing the bulk resection process of the biological tissue is performed, the treatment can be completed without performing the difficult operation of rolling up the peeled slice 101a.

[0315] Further, in the structure of the present embodiment, the tissue pressing portion 40H always presses the peeled slice 101a during the bulk resection process of the biological tissue, and therefore, it is possible to suppress the problem of the peeled slice 101a being rolled up around the device and the like during the operation of the treatment, and it is possible to easily obtain the resection slice as a pathological specimen always in the desired form.

[0316] The present application is not limited to the above-described embodiments, and of course, various modifications and applications can be implemented within the scope of the gist of the present application. Also, the present application includes various stages in the above-described embodiments, and various applications can be extracted by appropriate combination of the disclosed plurality of structural elements. For example, even if several structural elements are deleted from all the structural elements shown in the above-described embodiments, the problem to be solved by the present application can be solved, and in the case where the effect of the present application is obtained, the structure in which the structural element is deleted can be extracted as the present application. Furthermore, the structural elements in different embodiments can be appropriately combined. The present application is not limited by the specific embodiments except for the appended claims.

Claims

1. An electrode unit, characterized by Possessing: an electrode having rigidity, formed to have a free end, and to which a high-frequency current is applied; an electrode support portion that supports one end of the electrode, whose outer surface is composed of a material having electrical insulation, the electrode support portion as a whole is rod-shaped, and the electrode is slidably moved from the distal end side toward the base end side in a direction parallel to the direction along the axis connecting the distal end side and the base end side; and a tissue pressing portion whose outer surface is composed of a material having electrical insulation, and which presses the surface of the tissue, the electrode is slidably moved from the distal end side toward the base end side in a state where a high-frequency current is applied to the electrode by the electrode support portion, the electrode incises the tissue, the electrode is disposed on a second face different from a first face in which the electrode support portion is slidably moved, the electrode is supported by the electrode support portion through a bent portion protruding from the first face toward the second face, the electrode has: a base end protruding from the surface of the hard portion of the front end of the electrode support portion in a direction pointing from the first face toward the second face; and a beam portion provided at the tip of the base end, and formed in a bent manner so as to extend in a direction pointing from the electrode support portion toward the tissue pressing portion, the beam portion being the free end.

2. The electrode unit according to claim 1, wherein the tissue pressing portion is rod-shaped as a whole, and is disposed at a position opposite to the electrode support portion in a manner separating the electrode, the front end of the electrode support portion is disposed in parallel with the front end of the tissue pressing portion.

3. The electrode unit according to claim 2, wherein the tissue pressing portion further extends toward the distal end side than the front end of the electrode support portion.

4. The electrode unit according to any one of claims 1 to 3, wherein the electrode extends in a direction substantially orthogonal to the long axis direction of the electrode support portion.

5. The electrode unit according to claim 4, wherein the electrode is bent.

6. The electrode unit according to claim 5, wherein the bending of the electrode is a bending in a convex shape upward or a concave shape downward with respect to the surface of the tissue.

7. The electrode unit according to claim 1 or 2, wherein a face of the electrode on the side abutting against the sliced tissue after incision is applied with an insulating coating when the tissue is incised.

8. The electrode unit according to claim 1, wherein the tissue pressing portion is plate-shaped as a whole, one end thereof is supported by the electrode support portion, and the tissue pressing portion extends in parallel with the direction identical to the extension direction of the electrode.

9. An endoscope system, comprising: an endoscope having a sheath; and an electrode unit protruding from the front end of the sheath, and performing treatment on a tissue, the electrode unit comprises an electrode having one end and the other end, the other end being a free end, and an electrode support portion supporting the one end of the electrode, ​ The electrode is configured at a second face different from a first face, the first face being a face through which the electrode support portion is moved when the electrode support portion is moved in a direction along a length axis of the electrode support portion, the electrode being supported to the electrode support portion by a bent portion protruding from the first face toward the second face, The electrode has: a base end protruding from a surface of a front end rigid portion of the electrode support portion in a direction from the first face toward the second face; and a beam portion provided at a distal end of the base end, the beam portion being formed in a bent manner so as to extend in a direction perpendicular to the direction from the first face toward the second face and perpendicular to the direction of the length axis of the electrode support portion, the beam portion being the free end.

10. The endoscope system according to claim 9, wherein the electrode unit further includes an arm portion, the arm portion passing through a point on a face including a front end of the electrode support portion and perpendicular to a central axis of the electrode support portion, outer surfaces of the electrode support portion and the arm portion are composed of a material having electrical insulating properties, the electrode is configured at a position apart from the arm portion by a gap with respect to the arm portion in parallel to a line connecting the front end of the electrode support portion and the point of the arm portion. ​

Images