Conveying device

Abstract

A delivery device is provided. The delivery device includes a handle, a first sheath connected to the handle at a proximal end, a second sheath through which the first sheath is threaded and which is relatively movable in a lengthwise direction with respect to the handle, a third sheath through which the second sheath is threaded, and an adjuster provided to the handle and configured to change a distance in the lengthwise direction between the proximal end of the first sheath and a distal end of the third sheath between a first distance and a second distance that is longer than the first distance.

Description

Technical Field

[0001] This invention relates to a method for retaining conveying devices and supports. Background Technology

[0002] Stent delivery devices are used when placing a self-expanding stent within a body cavity (e.g., U.S. Patent 6302893). Conventional stent delivery devices house the stent in the gap between an inner and outer sheath. By retracting the outer sheath relative to the inner sheath, the stent is exposed and expanded in diameter. The stent is then placed within the body cavity by pulling it out of the inner sheath. Summary of the Invention

[0003] A delivery device of one technical solution includes: a handle; a first sheath, the proximal end of which is connected to the handle; a second sheath through which the first sheath passes and which is movable relative to the handle in a length direction; a third sheath through which the second sheath passes; and an adjuster disposed on the handle, configured to change the distance in the length direction between the proximal end of the first sheath and the distal end of the third sheath between a first distance and a second distance longer than the first distance.

[0004] A conveying device of one technical solution includes: a first sheath; a second sheath through which the first sheath passes and which moves relative to the first sheath along a length direction; a third sheath having a path for the second sheath to move forward and backward, and through which the second sheath passes; and an adjuster configured to change the insertion length of the second sheath through the path between a first length and a second length longer than the first length.

[0005] A method for placing a stent includes the following steps: inserting the sheath body of a delivery device having a sheath body into the channel of an endoscope, the sheath body including a first sheath, a second sheath for relative movement of the first sheath along its length, and a third sheath having a path for the second sheath to move forward and backward and passing through the second sheath in the path; fixing the position of the sheath body relative to the channel of the endoscope in the length direction; causing a portion of the stent housed at the distal end of the sheath body to protrude from the delivery device by retracting the second sheath; changing the insertion length of the second sheath through the path to a second length longer than a first length by advancing the second sheath; and housing the stent within the sheath body by advancing the second sheath.

[0006] According to one technical solution, the method of placing the stent can also be that the distal end of the first sheath is retracted by changing the insertion length from the first length to the second length.

[0007] According to one technical solution, the method for placing a stent can also involve changing the insertion length from the second length to the first length.

[0008] According to one technical solution, the method of placing the stent can also be that the distal end of the second sheath is advanced by changing the insertion length from the second length to the first length. Attached Figure Description

[0009] Figure 1 This is an overall diagram of the conveying system according to the first embodiment.

[0010] Figure 2 This is a cross-sectional view of the conveying device according to the first embodiment.

[0011] Figure 3 This is a cross-sectional view of the conveying device according to the first embodiment.

[0012] Figure 4 This is a side view of the bracket.

[0013] Figure 5 This is a flowchart of the stent delivery method according to the first embodiment.

[0014] Figure 6 It is a diagram showing the process of conveying.

[0015] Figure 7 It is a diagram showing the process of conveying.

[0016] Figure 8 It is a diagram showing the process of conveying.

[0017] Figure 9 This is a cross-sectional view of the conveying device of a modified embodiment of the first embodiment.

[0018] Figure 10 This is a cross-sectional view of the conveying device according to the second embodiment.

[0019] Figure 11 This is a cross-sectional view of the conveying device according to the third embodiment. Detailed Implementation

[0020] (First Implementation)

[0021] Reference Figures 1-3 The conveying system 300 of the first embodiment is described. Figure 1 This is an overall view of the conveying system 300 of this embodiment.

[0022] [Staff Delivery System 300]

[0023] like Figure 1As shown, the stent delivery system 300 includes an endoscope 200 and a delivery device 1. The delivery device 1 is inserted into the endoscope 200 for use. Figure 1 The distal portion of the transmission device 1 is shown in a magnified view.

[0024] [Endoscope 200]

[0025] Endoscope 200 is a known side-viewing flexible endoscope. It includes a longitudinally elongated insertion section 210, an operating section 220, a treatment instrument channel 230 (hereinafter referred to as "channel 230"), and a gripping section 240. The operating section 220 is located at the proximal end of the insertion section 210. In the following description, the operating section 220 side of the endoscope 200 is referred to as the proximal side L2. The side of the insertion section 210 opposite to the operating section 220 in the longitudinal direction is referred to as the distal side of the endoscope 200. The channel 230 allows a treatment instrument such as a delivery device 1 to pass through. Endoscope 200 can also be a direct-viewing flexible endoscope.

[0026] The insertion portion 210 has a front rigid portion 211, a bending portion 212, and a flexible tube portion 213. The front rigid portion 211 is provided at the front end of the insertion portion 210. The bending portion 212 is installed on the proximal side of the front rigid portion 211 and is configured to be able to bend. The flexible tube portion 213 is installed on the proximal side L2 of the bending portion 212.

[0027] The camera unit 216 is disposed on the side of the front rigid part 211 in an exposed state. The camera unit 216 includes a light guide and a CCD.

[0028] A lifting platform 214 is provided at the front rigid part 211. The proximal end of the lifting platform 214 is rotatably supported on the front rigid part 211. A lifting platform operation line (not shown) is fixed at the front end of the lifting platform 214. The lifting platform operation line (not shown) extends through the insertion part 210 toward the proximal side L2.

[0029] The bending portion 212 is configured to be flexible in both the vertical and horizontal directions. The tip of the operating line is fixed to the distal side of the bending portion 212. The operating line extends through the insertion portion 210 to the operating portion 220. The vertical direction is the vertical direction of the endoscope's field of view, which is an orthogonal direction from the insertion portion 210 extending straight outwards towards the direction intersecting the axis. The horizontal direction is the horizontal direction of the endoscope's field of view, which is an orthogonal direction from the insertion portion 210 extending straight outwards towards the direction intersecting the axis. The bending direction of the bending portion 212 is not limited to the vertical and horizontal directions; it can also be flexible in directions intersecting the axis of the insertion portion 210. The bending portion 212 bends according to the operations performed on the operating portion 220 by the surgical operator.

[0030] The distal opening 231 of the channel 230 opens to the side of the front rigid portion 211. The proximal end of the channel 230 extends to the grip portion 240. The grip portion 240 is the part for the surgeon P1 of the endoscope 200 to hold. A forceps jaw 232 communicating with the channel 230 is provided in the grip portion 240. The surgeon can insert endoscopic instruments such as the delivery device 1 through the forceps jaw 232. A forceps latch 225 is installed in the forceps jaw 232 to prevent leakage of bodily fluids.

[0031] The operation unit 220 is connected to the insertion unit 210. The operation unit 220 has an input unit 229. The input unit 229 accepts operation inputs for bending the bending unit 212, operation inputs for the camera unit 216, etc. A general-purpose cable (not shown) is connected to the operation unit 220. The general-purpose cable is connected to a display device such as a liquid crystal display via an image processing device equipped with a processor, etc. Images captured by the camera unit 203 are output externally via the general-purpose cable.

[0032] [Transmission Device 1]

[0033] Figure 2 and Figure 3 This is a cross-sectional view along the length L of the conveying device 1. The conveying device 1 has an elongated shape overall. Figure 2 and Figure 3 The delivery device 1 is described in detail along its length, with a partial break. It includes a first sheath 7, a second sheath 8, a third sheath 9, a handle 3, and an adjuster 6. The first sheath 7, the second sheath 8, and the third sheath 9 constitute the sheath body 10. In the following description, the side of the delivery device 1 that is inserted into the patient's body along its length L will be referred to as the "distal side L1," and the side with the handle 3 will be referred to as the "proximal side L2."

[0034] The sheath body 10 is flexible and extends from a distal end to a proximal end. The sheath body 10 has, sequentially from the inside, a first sheath 7, a second sheath 8, and a third sheath 9. The first sheath 7, the second sheath 8, and the third sheath 9 are arranged in a generally concentric shape. The first sheath 7, the second sheath 8, and the third sheath 9 are all longitudinally elongated resin components. The first sheath 7 penetrates the lumen 83 of the second sheath 8, and the second sheath 8 penetrates the lumen 93 of the third sheath 9. The sheath body 10 has the ability to... Figure 1 The outer diameter of the channel 230 of the endoscope 200 shown is inserted. The sheath body 10 is configured to be able to move in and out of the channel 230. Figure 1 As shown, with the sheath body 10 inserted into the channel 230, the distal ends of the first sheath 7 and the second sheath 8 can protrude and retract relative to the distal opening 231 of the channel 230.

[0035] A front end head 5 is installed at the distal end 71 of the first sheath 7. The diameter of the front end head 5 is larger than the inner diameter of the lumen 83 of the second sheath 8, but smaller than the outer diameter of the second sheath 8. The front end head 5 abuts against the distal end 81 of the second sheath 8 at the maximum retraction position of the first sheath 7. The proximal end 72 of the first sheath 7 is connected to the handle 3. Specifically, the proximal end 72 of the first sheath 7 is fixed to the fixing part 34 of the proximal end 32 of the handle 3. Multiple X-ray heads 731 and 732 are provided at the distal end of the first sheath 7, separated in the length direction L. The X-ray heads 731 and 732 indicate the storage positions of the front end and base end of the stent 100 in the body cavity when the stent is placed.

[0036] The second sheath 8 has a distal end 81 on the distal side of the conveying device 1 and a proximal end 82 on the proximal side L2 of the conveying device 1. For example... Figure 2 and Figure 3 As shown, a cavity 83 is formed in the second sheath 8 from the distal end 81 to the proximal end 82. The proximal end 82 of the second sheath 8 is fixed to the operating part 4. The first sheath 7 passes through the cavity 83. The second sheath 8 can be a tube formed of resin or the like, or it can be a coil sheath.

[0037] The second sheath 8 has a stent-accommodating region E1 for accommodating the stent 100. The stent-accommodating region E1 is the area within the lumen 83 of the second sheath 8 where the stent 100, fitted over the outside of the first sheath 7, is accommodated. The stent 100 is accommodated within the stent-accommodating region E1 between the inner wall of the lumen 83 of the second sheath 8 and the first sheath 7. The stent-accommodating region E1 extends from the distal end 81 of the second sheath 8 towards the proximal side L2 by a distance greater than the length of the stent 100. The stent-accommodating region E1 is located distally to the distal end 91 of the third sheath 9.

[0038] The third sheath 9 forms the outermost layer of the sheath body 10. The second sheath 8 passes through the lumen 93 of the third sheath 9. The proximal end 92 of the third sheath 9 is fixed to the adjuster 6. The third sheath 9 is mounted to the handle 3 via the adjuster 6. The length of the third sheath 9 is shorter than that of the first sheath 7 and the second sheath 8. The length of the third sheath 9 is such that when the delivery device 1 is inserted into the channel 230 of the endoscope 200, the distal end 91 of the third sheath 9 can be positioned distally from the jaws 232. The length of the third sheath 9 is such that the distal end 91 of the third sheath 9 can be inserted into the jaws 232 and positioned closer to the base of the support receiving area E1 of the second sheath 8. The distal end 91 of the third sheath 9 is located at the midpoint of the length direction L of the first sheath 7 and the second sheath 8. The third sheath 9 can be a tube formed of resin or the like, or a coil sheath.

[0039] The adjuster 6 is configured to change the distance D1 in the length direction L between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9 between a first distance and a second distance. In other words, the adjuster 6 is configured to change the insertion length of the second sheath 8, which passes through the lumen 93 (path) of the third sheath 9, between a first length and a second length longer than the first length. The insertion length of the second sheath 8 refers to the length by which the second sheath 8 is inserted into the lumen 93 of the third sheath 9. The inner diameter of the lumen 93 of the third sheath 9 is sufficiently large compared to the outer diameter of the second sheath 8. Therefore, within the lumen 93, the central axis of the second sheath 8 does not necessarily have to be aligned with the central axis of the lumen 93 of the third sheath 9; the second sheath 8 moves slightly within the lumen 93. The insertion length of the second sheath 8 moving within the lumen 93 is longer than the total length of the lumen 93 of the third sheath 9. The adjuster 6 is mounted on the handle 3. The adjuster 6 is located between the proximal end 92 of the third sheath 9 and the handle 3. The adjuster 6 is, for example, a cylindrical force-applying member. For example, the adjuster 6 is a spring with an initial tension of 3N or less. In this embodiment, an example of the adjuster 6 being a helical spring is shown.

[0040] Handle 3 is the part of the delivery device 1 that is held by the surgical operator P2. Handle 3 has a distal end 31, a proximal end 32, and a middle portion 33. The distal end 31 and the proximal end 32 are flat plates that are approximately orthogonal to the length direction L and are arranged parallel to each other. The middle portion 33 extends along the length direction L and connects the distal end 31 and the proximal end 32. The proximal end 32 has a fixing portion 34 for the proximal end 32 of the first sheath 7. An opening 35 is formed on the distal side L1 of the fixing portion 34 in the distal end 31. The opening 35 extends through the distal end 31 along the length direction L and is an opening of a size that allows the second sheath 8 to move in and out.

[0041] The proximal end of the first sheath 7 passes through the opening 35 of the handle 3, and the proximal end 72 is fixed to the fixing part 34. The proximal end of the second sheath 8 passes through the opening 35 of the handle 3 and is designed to move forward and backward relative to the handle 3. The operating part 4, fixed to the proximal end 82 of the second sheath 8, is designed to move along the length direction L between the distal end 31 and the proximal end 32 of the handle 3. The proximal end 62 of the adjuster 6 is fixed to the distal end 31 of the handle 3. The proximal end 62 of the third sheath 9 is mounted to the handle 3 by means of the adjuster 6. Therefore, when the operating part 4 moves forward and backward relative to the handle 3 along the length direction L, the second sheath 8 moves forward and backward relative to the first sheath 7 and the third sheath 9. The distance D1 in the length direction L between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9 changes according to the extension and retraction of the adjuster 6 in the length direction L. Therefore, the path length of the first sheath 7 and the second sheath 8 within the lumen 93 of the third sheath 9 varies according to the extension and retraction of the regulator 6 in the length direction L.

[0042] The support 100 is a cylindrical, self-expanding support. The support 100 is formed, for example, by weaving in wires. The wires forming the support 100 are, for example, a superelastic alloy with NiTi as the main material. The superelastic alloy with NiTi as the main material retains its woven shape in the woven state. Figure 4 An example of the main components of the support 100 is shown. For example... Figure 4 As shown, a plurality of annular lines 100a, 100b, and 100c are arranged in the length direction L. Each line 100a, 100b, and 100c has a first curved portion 110a, 110b, and 110c that bends in a first direction toward the length direction L, and a second curved portion 120a, 120b, and 120c that bends in a second direction opposite to the first direction. In each line 100a, 100b, and 100c, the plurality of first curved portions 110a, 110b, and 110c and the plurality of second curved portions 120a, 120b, and 120c that bend in the second direction are alternately arranged in the circumferential direction. By interlacing the plurality of first curved portions 110a, 110b, and 110c with the plurality of second curved portions 120a, 120b, and 120c that bend in the second direction, the plurality of lines 100a, 100b, and 100c have a cylindrical shape extending in the length direction L. The intersection of the plurality of first bends 110a, 110b, 110c and the plurality of second bends 120a, 120b, 120c bending in the second direction is called the interlacing portion. The support 100 has the ability to reduce its diameter under load compared to its natural state and to maintain the strength of the lumen without blocking the narrow portion.

[0043] like Figure 2 As shown, the support 100 is housed in the support receiving area E1 of the second sheath 8. Specifically, the first sheath 7 passes through the interior of the support 100, and the reduced-diameter support 100 is housed in the gap between the inner walls of the lumen 83 of the first sheath 7 and the second sheath 8. The support 100 is locked in a locking portion (not shown) formed on the outer peripheral surface of the first sheath 7. Thus, the support 100 is positioned relative to the first sheath 7 in a reduced-diameter state and does not move relative to it along the length direction L of the first sheath 7. The configuration is such that by pulling the operating part 4 relative to the handle 3 towards the proximal side L2, the second sheath 8 moves towards the proximal side L2 of the delivery device 1, and the support 100 is released from the distal end of the delivery device 1. Furthermore, when the first sheath 7 is retracted while a portion of the support 100 is housed in the support receiving area E1, the front end 5 retracts while pushing the support 100 towards the proximal side L2, and the support 100 can be housed back in the support receiving area E1 while its diameter is reduced.

[0044] Since the delivery device 1 passes through the insertion portion 210 of the endoscope 200, which snakes within the body cavity, the first sheath 7 and the second sheath 8 also snake. During this snakening motion, the path length of the first sheath 7 within the lumen 83 of the second sheath 8 changes, and the protrusion length of the first sheath 7 extending from the distal end 81 of the second sheath 8 changes. In the delivery device 1, sometimes, with a portion of the sheath body 10 protruding from the distal opening 231 of the channel 230, it bends considerably through the active bending portion of the insertion portion 210 of the endoscope 200, thereby causing the first sheath 7 and the second sheath 8 to bend considerably. In this case, the protrusion length of the first sheath 7 also changes. Because the inner diameter of the lumen 83 of the second sheath 8 is larger than the outer diameter of the first sheath 7, when the sheath body 10 bends or serpentine to a large extent, the first sheath 7 bends and serpentine within the lumen 83 of the second sheath 8, causing a change in the path length of the first sheath 7 within the lumen 83. Conversely, the path length of the first sheath 7 within the lumen 83 can be adjusted using the adjuster 6 to prevent misalignment of the front end 5 caused by changes in path length. That is, misalignment of the support 100's position during the deployment operation of the support 100 can be eliminated.

[0045] [Stent placement method]

[0046] Next, refer to Figures 5-8 This section describes an example of the method for placing a stent and the method of using the delivery system 300. Specifically, it will be described as an example of placing a stent 100 in a narrow section T1 within a body cavity using the delivery system 300. The surgeon determines the placement position of the stent 100 using known methods. For example, while confirming the position of the narrow section T1 of the lumen under X-ray fluoroscopy, the surgeon inserts the insertion portion 210 of the endoscope 200 near the narrow section T1. The surgeon inserts the insertion portion 210 of the endoscope 200 into the digestive tract (e.g., esophagus, stomach, duodenum, large intestine) and identifies the narrow section while observing the images obtained by the imaging unit 216 of the endoscope 200.

[0047] Next, the surgical operator inserts the delivery device 1 from the forceps opening 232 into the channel 230, as follows: Figure 6 As shown, the distal end of the sheath body 10 protrudes from the distal opening 231 of the insertion portion 210 (step S1). The delivery system 300 is operated by a surgeon P1 operating the endoscope 200 and a surgeon P2 operating the delivery device 1. After the surgeon P1 positions the delivery device 1 near the narrow portion T1, the surgeon P1 grasps the delivery device 1 near the forceps jaw 232, fixing the position of the delivery device 1 relative to the insertion portion 210 in the length direction (step S2). At this time, the distal end 91 of the third sheath 9 is positioned within the channel 230 at a position distal to the forceps jaw 232. Figure 6 In this example, the distal end 91 of the third sheath 9 is positioned at the grip portion 240 within the channel 230. The surgical operator P2 holds the handle 3 with one hand and the operating portion 4 with the other. The position of the tip 5 in step S2 relative to the distal opening 231 of the insertion portion 210 of the endoscope 200 is referred to as the advance position A1.

[0048] Next, as Figure 7 As shown, the surgical operator P2 holds the handle 3 while retracting the operating part 4 proximally towards L2, causing a portion of the stent 100 to protrude from the second sheath 8 (step S3). Specifically, when the operating part 4 is retracted relative to the handle 3, the second sheath 8 is retracted relative to the first sheath 7. As a result, the distal end 71 of the first sheath 7 protrudes from the distal end 81 of the second sheath 8, exposing the distal portion of the stent 100. Since the proximal end of the third sheath 9 is connected to the handle 3, the third sheath 9 remains in position relative to the forceps jaw 232 and the channel 230 when the handle 3 is held in position. Therefore, the front end 5 of the first sheath 7, connected to the third sheath 9 by the handle 3, remains in the forward position A1, maintaining its protruding length from the channel 230. At this time, the static and dynamic friction between the reduced diameter portion of the stent 100 and the outer peripheral surface of the first sheath 7 is sufficiently greater than the dynamic friction between the stent 100 and the inner wall of the lumen 83 of the second sheath 8. Therefore, the support 100 remains positioned at the front end of the first sheath 7. The sheath body 10, between the position where the surgical operator P1 holds the delivery device 1 and the handle 3, can bend freely depending on the position of the handle 3, etc. The relative positions of the first sheath 7, the second sheath 8, and the third sheath 9 of the sheath body 10 differ when the sheath body 10 extends straight along its length axis and when it is bent. When straight, the lengths (path lengths) of the first sheath 7 and the second sheath 8 within the third sheath 9 are approximately equal. When the sheath body 10 is bent to a greater extent, the central axes of the first sheath 7 and the second sheath 8 within the third sheath 9 are offset from each other, and the path lengths of the first sheath 7 and the second sheath 8 within the third sheath 9 change. Figure 6 and Figure 7 As shown, when the proximal end 82 of the second sheath 8 is pulled towards the proximal side L2 while the sheath body 10 is bent and the positions of the first sheath 7 and the third sheath 9 are maintained, the second sheath 8 will be pulled towards the inner side of the sheath body 10 that is bent, i.e. Figure 7 The forces act in the directions indicated by arrows B81, B83, and B84. As a result, the third sheath 9 acts with a linearized force within the lumen 93 from the second sheath 8 in the direction of arrow B83. However, in Figure 7In the state shown, the regulator 6 is in a compressed state and will not contract further along the length direction L. Therefore, even if a linearizing force is applied to the third sheath 9, it will not deform in the direction of arrow B83 under the reaction force of the compressed regulator 6, thus limiting the linearization of the third sheath 9. As a result, it prevents the forward position A1 of the front end head 5 from retracting due to the operation of retracting the second sheath 8 to retain the support 100, thereby preventing the retention position of the support 100 from being misaligned from the desired position.

[0049] Next, a recapture operation can be performed while adjusting the placement position of the stent 100. Specifically, while maintaining the position of the delivery device 1 relative to the insertion portion 210 of the endoscope 200, the second sheath 8 is advanced, with the distal end 81 of the second sheath 8 advancing relative to the first sheath 7, and the stent 100 is housed within the stent receiving area E1 (step S4). The surgical operator P2, while holding the handle 3, advances the operating part 4 distally to the L1. According to this operation, as the second sheath 8 advances, the third sheath 9 bends outward toward the sheath body 10, that is, at the outer side, where it bends. Figure 8 The force is applied in the directions indicated by arrows B81, B82, and B83. Since the handle 3 is held in position, when a force is applied to the third sheath 9 in the directions of arrows B81, B82, and B83, the adjuster 6 extends along its length, and the proximal end 92 of the third sheath 9 advances. As a result, the path length from the proximal end 32 of the handle 3 to the distal end 91 of the third sheath 9 becomes longer, and the path length of the first sheath 7 within the sheath body 10 also becomes longer. While the stent 100 is housed within the stent receiving area E1, the first sheath 7 slightly retracts relative to the second sheath 8. In this state, when the surgical operator P2 releases the state of holding the handle 3 in the predetermined position, the adjuster 6 retracts to its original length. As a result, the path lengths of the first sheath 7 and the second sheath 8 relative to the third sheath 9 within the sheath body 10 return to their original lengths, the first sheath 7 and the second sheath 8 advance from the distal opening 231, the stent 100 is housed within the stent receiving area E1, and the recapture operation is completed. When the recapture operation is complete, the system will return to the state it was in before the stent was released.

[0050] The adjuster 6 uses, for example, a spring with an initial tension of 3N or less. By using a spring with an initial tension of 3N or less as the adjuster 6, the spring extends as the third sheath 9 moves distally to L1 during the recapture operation. As a result, during the recapture operation of the stent 100, the path length is adjusted by the force applied by the adjuster 6 instead of the surgeon P2 adjusting the movement of the third sheath 9 proximally to L2, allowing the first sheath 7 to retract smoothly. When a spring with an initial tension greater than 3N is used as the adjuster 6, the spring is difficult to extend, and the spring cannot function effectively in the delivery device 1 that places the stent 100 within the body cavity. It is not necessary to use a spring with an initial tension of 3N or less as the adjuster; the setting can be adjusted according to the stiffness of the stent, etc. Furthermore, a tightly wound spring is more preferable. A tightly wound spring is formed by winding the coiled wires that constitute the spring close together with almost no gaps between them. This is because, when a tightly wound spring is used, misalignment can be prevented during stent placement.

[0051] Next, the stent 100 is placed. After the surgeon P1 positions the tip 5 in the placement position of the stent 100, while maintaining the position of the delivery device 1 relative to the insertion portion 210 of the endoscope 200, similar to step S3 above, the surgeon P2, while holding the handle 3, retracts the operating part 4 proximally to L2, causing the stent 100 to protrude from the second sheath 8 (step S5). Specifically, when the operating part 4 is retracted relative to the handle 3, the second sheath 8 retracts relative to the first sheath 7. As a result, the stent 100 protrudes from the distal end 81 of the second sheath 8 and expands in diameter. When the proximal end of the stent 100 is exposed at a position more distal than the distal end of the second sheath 8, the stent 100 expands in diameter beyond the tip 5. Figure 3 As shown, in the retention position, the bracket 100 expands the narrow portion T1. When the handle 3 is retracted, causing the front end 5 to retract from the inside of the expanded bracket 100, the retention of the bracket 100 is completed (step S5). After the bracket 100 is retained, the conveying device 1 is pulled out from the channel 230, completing the retention of the bracket 100. Steps S3 and S4 are repeated until the position of the front end 5 is positioned as desired. On the other hand, if the position of the front end 5 can be positioned as desired during the initial execution of step S3, step S4 is unnecessary.

[0052] The placement method of the conveying device 1, the conveying system 300 and the bracket according to this embodiment can accurately and smoothly place the treatment device on the treatment object.

[0053] The stent placement method of this embodiment enables the stent 100 to be positioned in the narrow portion with high precision and smoothness. The stent placement method of this embodiment also enables the smooth re-capture operation of the stent 100.

[0054] The conveying device 1 of this embodiment, by having an adjuster 6, can change the distance D1 in the length direction L between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9 between a first distance and a second distance. As a result, during the advance and retraction operation of the second sheath 8, it is possible to prevent the distal end of the first sheath 7 from being misaligned and the position of the support 100 from shifting.

[0055] Using the conveying device 1 of this embodiment, a self-expanding type support 100 with an interlacing portion can be disposed within the support receiving area E1. That is, during the recapture operation of the self-expanding type support 100, the first sheath 7 can be smoothly retracted relative to the second sheath 8. As a result, the situation where the interlacing portion bends relative to the length direction L, causing the exposed and expanded lines 100a, 100b, 100c to stack between the lumen 83 of the tube and the second sheath 8, can be prevented.

[0056] The conveying device 1 of this embodiment allows for easy adjustment of the distance L in the length direction between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9, since the adjuster 6 is located between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9. Specifically, because the adjuster 6, capable of changing the path length, is provided between the proximal end 72 of the first sheath 7 and the distal end of the third sheath 9, the relative position of the third sheath 9 caused by changes in the path length between the first sheath 7 and the second sheath 8 can be automatically adjusted using the adjuster 6. Therefore, even if the path length between the first sheath 7 and the second sheath 8 changes during placement, the process can be carried out smoothly.

[0057] In the conveying device 1 of this embodiment, the length of the third sheath 9 is shorter than the lengths of the first sheath 7 and the second sheath 8. As a result, even with a three-layer sheath structure, the third sheath 9 is positioned closer to the positioning side than the distal ends of the first sheath 7 and the second sheath 8, allowing for smooth movement of the first sheath 7 and the second sheath 8 when the support 100 is in place. Furthermore, the conveying device 1 can perform smooth forward and backward movement and bending operations of the sheath body 10.

[0058] In this embodiment, an example is shown where the adjuster 6 is a cylindrical helical spring through which the second sheath 8 can pass, but the shape of the adjuster 6 is not limited to a cylindrical shape. The adjuster 6 is configured to change the distance in the length direction L between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9 between a first distance and a second distance. For example, it could also be a plate spring, a corrugated cylinder, an elastic member, or other telescopic member fixed to the distal end 91 of the third sheath 9 and the distal end 31 of the handle 3. For example, it could also be a plate spring, a corrugated cylinder, an elastic member, or other telescopic member. Figure 9The diagram shows the use of multiple tightly fitted helical springs as the adjuster 6. Figure 9 The example shown is an example of an adjuster 6 in which multiple tightly sealed coils are arranged separately in the circumferential direction of the third sheath 9. When using multiple helical springs as adjusters, the initial tension, elastic modulus, and other characteristics of each coil can be the same or different.

[0059] (Second Implementation)

[0060] Reference Figure 10 The conveying device 1A of the second embodiment will be described. In the following description, the same reference numerals will be used for structures that are common to the structures already described, and repeated descriptions will be omitted. Figure 10 This is a cross-sectional view of the conveying device 1A in this embodiment.

[0061] The shape of the handle and the structure of the adjuster of the conveying device 1A differ from those of the first embodiment. The proximal end 92 of the third sheath 9 is fixed to the distal end 31 of the handle 3A. The handle 3A includes a first member 3a and a second member 3b arranged in the longitudinal direction L. A portion of the circumferential part of the middle portion 33 of the handle 3A is open. The handle 3A may also have a generally U-shaped cross-section. The adjuster 6A is provided between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9. The distal end 61 of the adjuster 6A is fixed to the proximal end 332 of the first member 3a, and the proximal end 62 of the adjuster 6A is fixed to the distal end 331 of the second member 3b. Similar to the first embodiment, the adjuster 6A may be, for example, a plate spring, an elastic member, or a helical spring with its central axis arranged along the middle portion 33.

[0062] The operation of the conveying device 1A, the conveying system, and the method for retaining the support using the conveying device 1A is the same as in the first embodiment. That is, in step S3 of the above-described method for retaining the support, the regulator 6 retracts to maintain the distance D1 at the first distance, and in step S4, when the force caused by the bending or serpentine movement of the second sheath 8 within the lumen 93 of the third sheath 9 acts on the third sheath 9, or when the path length of the first sheath 7 becomes longer, the regulator 6A extends, and the first member 3a moves distally to the second member 3b by L1, thereby changing the distance D1 to the second distance.

[0063] The conveying device 1A of this embodiment, like that of the first embodiment, can accurately and smoothly place the treatment device on the treatment object.

[0064] The conveying device 1A of this embodiment, by having an adjuster 6A, allows the distance D1 in the length direction L between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9 to be varied between a first distance and a second distance. As a result, during the forward and backward movement of the second sheath 8, it is possible to prevent the distal end of the first sheath 7 from being misaligned and the position of the support 100 from shifting.

[0065] The stent placement method of this embodiment enables the stent 100 to be positioned in the narrow portion with high precision and smoothness. The stent placement method of this embodiment also enables the smooth re-capture operation of the stent 100.

[0066] The shape of the handle is not limited to Figure 10 In the example shown, any handle connected in the length direction L by means of an adjuster 6A is acceptable. Alternatively, it can be structured similarly to the first embodiment: a handle with a hollow rectangular cross-section is split in the middle portion in the length direction L, with an adjuster provided in the middle portion 33.

[0067] (Third Implementation)

[0068] Reference Figure 11 The conveying device 1B of the third embodiment will be described. In the following description, the same reference numerals will be used for structures that are common to those already described, and repeated descriptions will be omitted. The conveying device 1B of this embodiment differs from that of the first embodiment in that it includes a protective sleeve 64 and a locking mechanism 65. The structure of the adjuster 6 is the same as that of the first embodiment. A portion of the circumferential part of the middle portion 33 of the handle 3B is open. The handle 3B may also have a generally U-shaped cross-section. For example, it may have a distal end 31 at the distal end of the plate-shaped middle portion 33. Proximal ends 32 are arranged opposite each other at the proximal ends.

[0069] The protective sleeve 64 is, for example, a resin sleeve. The proximal end 641 of the protective sleeve 64 contacts the distal end 31 of the handle 3. The protective sleeve 64 covers the proximal end 92 of the third sleeve 9 and the adjuster 6. The protective sleeve 64 is radially separated from the adjuster 6 to a degree that does not impede the extension and retraction of the adjuster 6.

[0070] A locking mechanism 65 is located at the distal portion of the protective sleeve 64. Specifically, a receiving portion 66 is formed that communicates with both the inside and outside of the protective sleeve 64, and a locking body 651 is housed within the receiving portion 66. A switching portion 652 is integrally formed with the locking body 651 and protrudes radially outward from the receiving portion 66. The locking body 651 has a locking surface that can be sealed against the outer surface of the third sleeve 9 and a non-locking surface that is separated from the outer peripheral surface of the third sleeve 9. By moving the switching portion 652, the locking body 651 rotates within the receiving portion 66, and the locking surface or the non-locking surface faces the outer surface of the third sleeve 9. When the switching portion 652 is positioned in a first position, the locking surface is sealed against the outer surface of the third sleeve 9, and the relative position of the third sleeve 9 and the protective sleeve 64 is fixed. When the switching portion 652 is positioned in a second position different from the first position, the locking body 651 rotates, and the non-locking surface faces the outer surface of the third sleeve 9 at a position separated from it. In this state, the third sheath 9 can move forward and backward relative to the protective sheath 64.

[0071] The operation of the conveying device 1B, the conveying system, and the method for retaining the support using the conveying device 1B is the same as in the first embodiment. That is, in step S3 of the above-described method for retaining the support, the regulator 6 retracts to maintain the distance D1 at the first distance. In step S4, when the force caused by the bending or serpentine movement of the second sheath 8 within the lumen 93 of the third sheath 9 acts on the third sheath 9, or when the path length of the first sheath 7 increases, the regulator 6 extends along the length direction, the proximal end 92 of the third sheath 9 advances, and the distance D1 can be changed to the second distance.

[0072] When positioning the distal ends of the first sheath 7 and the second sheath 8, or when it is desired to fix the position of the handle 3B relative to the third sheath 9, the conveying device 1B can operate the switching part 652 to the first position and use the locking mechanism 65 to maintain the relative position of the protective sheath 64 and the third sheath 9. When using the conveying device 1B to perform a recapture operation of the bracket 100, the switching part 652 can be positioned to the second position to release the locking mechanism 65, thereby allowing the regulator 6 and the proximal end 92 of the third sheath 9 to move forward and backward.

[0073] The conveying device 1B of this embodiment, like that of the first embodiment, can accurately and smoothly place the treatment device on the treatment object.

[0074] The conveying device 1B of this embodiment, by having an adjuster 6, allows the distance D1 in the length direction L between the proximal end 72 of the first sheath 7 and the distal end 91 of the third sheath 9 to be varied between a first distance and a second distance. As a result, during the forward and backward movement of the second sheath 8, it is possible to prevent the distal end of the first sheath 7 from being misaligned and the position of the support 100 from shifting.

[0075] The structure of the locking mechanism 65 is not limited to the example described above. The locking mechanism can be any structure capable of fixing and releasing the position of the protective sleeve 64 relative to the third sleeve 9. For example, it could be a structure where, by operating the switching part, a portion of the inner wall of the protective sleeve 64 is reduced in diameter and tightly fixed to the outer surface of the third sleeve 9; and by operating the switching part, a portion of the inner wall of the protective sleeve 64 is expanded in diameter and separated from the outer surface of the third sleeve 9, thereby releasing the fixation.

[0076] In the conveying device 1B of the above embodiment, an example is shown in which the protective sheath has a locking mechanism, but for purposes such as the cover adjuster 6, the locking mechanism is not a necessary structure.

[0077] In the above embodiments, examples of self-expanding stents have been described. However, for the purpose of accurately placing the stent in the desired position using a delivery device, stent 100 is not limited to a self-expanding stent. Stent 100 may also be a non-self-expanding stent. Examples include stents made of CoCr alloys, biodegradable stents made of polylactic acid, polyglycolic acid, and copolymers thereof. Stent 100 may also be a fluid-expanding stent. Examples of fluid-expanding stents include non-self-expanding stents that expand using balloons or other treatment devices.

[0078] In the above embodiments, an example of a delivery device 1 for an indwelling stent 100 is shown, but the use of the delivery device is not limited to the indwelling of the stent 100. For example, the delivery device can be applied to a treatment instrument having a guide wire, pliers, etc., that can be inserted into the first sheath in a retractable manner, or to a delivery device 1 for delivering liquid by providing a delivery lumen in the first sheath.

[0079] The embodiments have been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to these embodiments, and design changes are included without departing from the spirit of the invention. Furthermore, the constituent elements shown in the above embodiments and variations can be appropriately combined to form a configuration.

Claims

1. A conveying device, wherein, The conveying device includes: handle; The first sheath, the proximal end of which is connected to the handle; A second sheath passes through the first sheath and moves relative to the handle along its length. A third sheath, through which the second sheath passes; and The regulator is configured to automatically change the distance in the longitudinal direction between the proximal end of the first sheath and the distal end of the third sheath between a first distance and a second distance longer than the first distance.

2. The conveying device according to claim 1, wherein, The adjuster is a force-applying member that applies force to the third sheath along the length direction in a manner that can change the relative position of the third sheath with respect to the first sheath in the length direction.

3. The conveying device according to claim 1, wherein, The regulator is located between the proximal end of the first sheath and the distal end of the third sheath.

4. The conveying device according to claim 1, wherein, The regulator is located on the handle.

5. The conveying device according to claim 1, wherein, The length of the third sheath is shorter than the lengths of the first sheath and the second sheath.

6. The conveying device according to claim 1, wherein, The first sheath, the second sheath, and the third sheath are configured to be inserted into the channel of the endoscope insertion part.

7. The conveying device according to claim 1, wherein, The delivery device includes a support disposed between the outer peripheral surface of the first sheath and the inner wall of the lumen of the second sheath. The bracket is located on the distal side of the distal end of the third sheath in the longitudinal direction.

8. The conveying device according to claim 7, wherein, The support has: The first curved portion is formed by bending a line in a first direction; The second curved portion is formed by bending a line in a second direction opposite to the first direction; as well as The first bend and the second bend intersect at the interlacing section.

9. The conveying device according to claim 1, wherein, The regulator is composed of a spring with an initial tension of less than 3N.

10. The conveying device according to claim 1, wherein, The distal end of the regulator is fixed to the proximal end of the third sheath, and the proximal end of the regulator is fixed to the handle.

11. The conveying device according to claim 1, wherein, The handle includes a first component and a second component arranged in the length direction. The distal end of the regulator is fixed to the proximal end of the first component, and the proximal end of the regulator is fixed to the distal end of the second component.

12. The conveying device according to claim 10, wherein, The delivery device includes a protective sheath covering the third sheath and the regulator.

13. The conveying device according to claim 12, wherein, The delivery device includes a locking mechanism capable of fixing and releasing the position of the protective sheath relative to the third sheath.

14. A conveying device, wherein, The conveying device includes: First sheath; The second sheath passes through the first sheath and moves relative to the first sheath along its length. A third sheath, having a path for the second sheath to move in and out, and having the second sheath passing through the path; and An adjuster configured to automatically change the insertion length of the second sheath through the path between a first length and a second length longer than the first length.

15. The conveying device according to claim 14, wherein, The adjuster is a force-applying member that applies force to the third sheath along the length direction in a manner that can change the relative position of the third sheath with respect to the first sheath in the length direction.

16. The conveying device according to claim 14, wherein, The regulator is located between the proximal end of the first sheath and the distal end of the third sheath.

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