Endoscope treatment instrument, endoscope device, and treatment method

Abstract

The present application provides an endoscope treatment instrument, an endoscope device and a treatment method which are easy to operate even if the holding manner of the operation part of the operator is deviated. An endoscope treatment instrument (20) includes: a front end part (23) provided with an openable and closable holding part (24); a bending part (25) provided adjacent to the front end part and capable of bending; an operation part (22) inputted with an operation of closing the holding part and an operation of bending the bending part; and an operation wire (27) transmitting the operation of the operation part to the holding part and the bending part, the operation wire being linear, when the operation part is observed toward the front end part along the axial direction of the operation wire, the position of the bending action surface of the bending part is located in a range of more than 180 degrees and less than 270 degrees in the clockwise direction in the circumferential direction of the axis, starting from the position where the operation handle (51) for making the bending part act is provided on the operation part.

Description

Technical Field

[0001] This invention relates to an endoscopic treatment device, an endoscopic apparatus, and a treatment method. Background Technology

[0002] Traditionally, endoscopic devices and endoscopic treatment instruments have been combined to perform various treatments on living organisms. One known example of this treatment is endoscopic submucosal dissection (ESD). The lining of organs suitable for ESD, such as the esophagus, stomach, and large intestine, consists of three layers: the mucosa, submucosa, and muscularis propria. In ESD, lesions in the mucosa, including the submucosa, are dissected. For example, larger lesions exceeding 2 cm can also be removed.

[0003] As an example of an endoscopic treatment device, Patent Document 1 discloses an endoscopic treatment device comprising: an insertion portion capable of being inserted into a body; an operating portion; and an operating line extending from the operating portion to the insertion portion, which is pulled toward the operating portion side by operation of the operating portion. The insertion portion includes: a front end having an openable and closable grip portion; a bending portion adjacent to the operating portion side of the front end and capable of bending; and a connecting portion connecting the bending portion and the operating portion. In this endoscopic treatment device, the connecting portion moves forward or backward along the longitudinal axis of the connecting portion or rotates about the longitudinal axis of the connecting portion by operation of the operating portion. By moving forward or backward or rotating the connecting portion, the grip portion moves forward or backward or rotates, and is pulled by the operating line, closing the grip portion, and bending the bending portion in the closed state.

[0004] Previous technical documents

[0005] Patent documents

[0006] Patent Document 1: International Publication No. 2019 / 172318 Summary of the Invention

[0007] The technical problem to be solved by the invention

[0008] In the endoscopic procedure device disclosed in Patent Document 1, deviations in the way the operating part is held can sometimes become a problem. For example, when the operating part is equipped with an operating handle, the operating orientation of the operating handle and the direction of movement of the front end (the movement of the bending part) are not always configured in a way that is easy for the operator to operate. In short, the way the operating part is held varies depending on the operator, and the operating orientation of the operating handle deviates from the orientation of the operator's body. Therefore, the direction of movement of the front end feels awkward relative to the operating orientation of the operating handle, which impairs operability.

[0009] The present invention was made in view of the above circumstances, and proposes an endoscopic treatment instrument, endoscopic device and treatment method that are easy to operate even if the operator's grip of the operating part is incorrect.

[0010] means for solving technical problems

[0011] The endoscopic treatment device of the present invention comprises: a front end portion having an openable and closable grip portion; a bending portion being disposed adjacent to the front end portion and capable of bending; an operation portion being input with an operation to close the grip portion and an operation to bend the bending portion; and an operation line transmitting the operation of the operation portion to the grip portion and the bending portion, such that the operation line is straight. When the operation portion is observed toward the front end portion along the axial direction of the operation line, the bending action surface of the bending portion is located within a range greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the axis, starting from the position of the operation handle on the operation portion that enables the bending portion to operate.

[0012] The endoscope device of the present invention comprises: a first treatment device as an endoscope treatment device; a second treatment device; and an endoscope having a first treatment device channel through which the first treatment device can be inserted and a second treatment device channel through which the second treatment device can be inserted.

[0013] In the treatment method of the present invention, using the aforementioned endoscope device, the front end of the first treatment device is positioned at the lesion site in the body through the first treatment device channel of the endoscope, the lesion site is held by the holding portion of the first treatment device, and while holding the lesion site, the bending portion of the first treatment device is bent to lift the lesion site, and while the lesion site is lifted, the lower part of the lesion site is treated by inserting the second treatment device that penetrates the second treatment device channel of the endoscope.

[0014] Invention Effects

[0015] According to the present invention, an endoscope treatment device, endoscope apparatus and treatment method can be provided that are easy to operate even if the operator's gripping method is incorrect. Attached Figure Description

[0016] Figure 1 This is a diagram illustrating an example of an endoscope system used to explain embodiments of the present invention.

[0017] Figure 2 This is a diagram illustrating an example of an endoscopic treatment device used to explain embodiments of the present invention.

[0018] Figure 3 It means Figure 2 A diagram showing the structure of the gripping part at the front end of an endoscopic treatment instrument.

[0019] Figure 4 It means Figure 3 A diagram illustrating the action of the gripping part.

[0020] Figure 5 It means Figure 2 A diagram showing the structure of the curved and connecting parts of an endoscopic procedure device.

[0021] Figure 6 It means Figure 5 A diagram showing the movement of the curved part.

[0022] Figure 7 It means Figure 5 A diagram of the internal structure of the curved section.

[0023] Figure 8 It means Figure 5 A diagram of the internal structure of the curved section.

[0024] Figure 9 It means Figure 5 A diagram showing the internal movement of the curved section.

[0025] Figure 10 It means Figure 2 A diagram showing the structure of the operating section of an endoscopic procedure device.

[0026] Figure 11 yes Figure 2 A cross-sectional view of the operating section of an endoscopic treatment device.

[0027] Figure 12 yes Figure 2 A cross-sectional view of the closed operating section of an endoscopic procedure device.

[0028] Figure 13 yes Figure 11 An enlarged 3D view of the friction adjustment mechanism shown.

[0029] Figure 14 yes Figure 11 The exploded perspective view of the connecting rod component is shown.

[0030] Figure 15 yes Figure 11 An exploded perspective view of the wire holding section is shown.

[0031] Figure 16 This is a cross-sectional view of another example of a friction adjustment mechanism in the operating section of an endoscopic procedure.

[0032] Figure 17This is an exploded perspective view showing the friction mechanism that generates friction between the fixed part and the main body of the operating part in the operating part of an endoscopic procedure.

[0033] Figure 18 yes Figure 17 A cross-sectional view of the portion along line XX.

[0034] Figure 19 It is used for explanation Figure 18 An enlarged cross-sectional view of the contact state during rotation in the friction mechanism shown.

[0035] Figure 20 This is a cross-sectional perspective view showing another example of a friction mechanism that generates friction between the fixed part and the main body of the operating part in the operating part of an endoscopic procedure.

[0036] Figure 21 yes Figure 20 An enlarged cross-sectional perspective view of the main parts of the friction mechanism shown.

[0037] Figure 22 This is a schematic diagram illustrating the direction of operation of the control handle and the orientation of the grip.

[0038] Figure 23 It is a perspective view used to illustrate the relationship between the operating moving surface of the operating handle of the operating part and the bending action surface of the bending part.

[0039] Figure 24 Viewed from above Figure 23 An enlarged perspective view of the operating handle in the endoscopic procedure apparatus shown.

[0040] Figure 25 Viewed from the front side along the axial direction of the main body of the operating unit. Figure 23 A diagram of the main body of the operating section in the endoscopic procedure apparatus shown.

[0041] Figure 26 It means to utilize Figure 2 An example of a method for handling endoscopic instruments.

[0042] Figure 27 It means to utilize Figure 2 An example of a method for handling endoscopic instruments.

[0043] Figure 28 It means to utilize Figure 2 An example of a method for handling endoscopic instruments.

[0044] Figure 29 It indicates combined use. Figure 2A diagram illustrating an example of a method of handling endoscopic instruments and other endoscopic instruments.

[0045] Figure 30 It indicates combined use. Figure 2 A diagram illustrating an example of a method of handling endoscopic instruments and other endoscopic instruments.

[0046] Figure 31 It indicates combined use. Figure 2 A diagram illustrating an example of a method of handling endoscopic instruments and other endoscopic instruments.

[0047] Figure 32 It means Figure 10 Another structural example of the operating part is shown in the figure. Detailed Implementation

[0048] The following is for reference. Figures 1 to 25 An endoscopic procedure apparatus according to one embodiment of the present invention will be described. Furthermore, Figure 1 This illustrates an example of an endoscope system used to explain embodiments of the present invention.

[0049] The endoscope system 1 includes an endoscope 2, a light source device 3, and a processor 4. The endoscope 2 has: an endoscope insertion part 6 for insertion into the body of the patient; an endoscope operation part 7 connected to the endoscope insertion part 6; and a universal plug 8 extending from the endoscope operation part 7. The endoscope insertion part 6 is composed of an endoscope front end 10, an endoscope bend 11 connected to the endoscope front end 10, and an endoscope connection part 12 connecting the endoscope bend 11 and the endoscope operation part 7.

[0050] An imaging device including an imaging element is mounted on the front end 10 of the endoscope. The endoscope bending section 11 is configured to be flexible, and the bending of the endoscope bending section 11 is operated by the endoscope operation section 7. Furthermore, the endoscope connecting section 12 is configured to have flexibility that can mimic the shape deformation of the insertion path inside the patient's body.

[0051] The endoscope operation section 7 is equipped with operation buttons for operating the imaging device and operation knobs for bending the endoscope bending section 11. Furthermore, the endoscope operation section 7 is equipped with an endoscope handling device 20 (see reference) that can be inserted. Figure 2 The endoscope insertion part 6 has a first treatment device insertion port 13 and a second treatment device insertion port 15. Inside the endoscope insertion part 6, there is a first treatment device channel 14 that extends from the first treatment device insertion port 13 to the end end portion 10 of the endoscope and opens to the end face of the end end portion 10 of the endoscope, and a second treatment device channel 16 that extends from the second treatment device insertion port 15 to the end end portion 10 of the endoscope and opens to the end face of the end end portion 10 of the endoscope.

[0052] Light guides and cables are installed inside the endoscope insertion section 6, the endoscope operation section 7, and the universal plug 8. A connector 9 is installed at the end of the universal plug 8. The endoscope 2 is connected to the light source device 3 and the processor 4 via the connector 9.

[0053] The illumination light generated by the light source device 3 is guided to the front end of the endoscope 10 via the aforementioned light guide and exits from the front end of the endoscope 10. Furthermore, the operating power of the aforementioned camera element, the control signal driving the camera element, and the image signal output from the camera element are transmitted between the processor 4 and the camera device via the aforementioned cable. The processor 4 processes the input image signal to generate image data of the observation area within the subject body, displays the generated image data on the display 5, and records it.

[0054] Figure 2 This illustrates an example of an endoscopic treatment device 20 used to illustrate embodiments of the present invention.

[0055] Endoscopic treatment device 20 includes: an insertion part 21, capable of being inserted into the first treatment device channel 14 (reference). Figure 1 The endoscope 21 includes: a front end portion 23 having a gripping portion 24 for opening and closing via the operation portion 22; a bending portion 25 disposed adjacent to the operation portion side of the front end portion 23; and a connecting portion 26 connecting the bending portion 25 and the operation portion 22.

[0056] When the insertion portion 21 is inserted through the first treatment instrument channel 14, the connecting portion 26 is accommodated in the first treatment instrument channel 14, and the front end portion 23 and the curved portion 25 extend from the front end portion 10 of the endoscope (see reference). Figure 1 The end face of the end face protrudes. The connecting portion 26, which is accommodated in the first treatment instrument channel 14, is configured similarly to the endoscope connecting portion 12 to have a degree of flexibility that can conform to the shape deformation of the insertion path inside the subject. The connecting portion 26 is an example of the flexible portion of the present invention.

[0057] Figure 3 and Figure 4 This describes the structure and operation of the gripping part 24 of the front end 23 of the endoscope treatment device 20.

[0058] exist Figure 3 In the example shown, the gripping part 24 has a pair of gripping claws 30 and a pair of connecting rod members 31. The front end 23 has a support body 32 that rotatably supports the pair of gripping claws 30. The pair of gripping claws 30 are arranged crosswise, and a pin 33 is provided through the crosswise portion of the pair of gripping claws 30. The pin 33 is fixed to the support body 32. The gripping claws 30 are supported by the support body 32 so that they can rotate about the pin 33 as a rotation axis.

[0059] The front end of the connecting rod member 31 is rotatably connected to the base end of the gripper 30, and an operation line 27 is connected to the base end of the connecting rod member 31. The operation line 27 extends from the front end 23 through the bend 25 and the connecting part 26 to the operation part 22, and is pulled toward the operation part 22 side or extruded toward the front end 23 side according to the operation in the operation part 22.

[0060] Figure 3 This indicates that the operating line 27 is being extruded towards the forward end 23, and the front ends of the pair of gripping claws 30 are open. They are being pulled towards the operating section 22 via the operating line 27, as... Figure 4 As shown, the front ends of a pair of gripping claws 30 are closed. The handling area of ​​the live animal is gripped by the front ends of the closed pair of gripping claws 30.

[0061] Figure 5 and Figure 6 This describes the structure and operation of the curved portion 25 and the connecting portion 26 in the endoscopic treatment device 20.

[0062] The connecting portion 26 is flexible, yet also rigid enough to transmit both forward and rotational power from the operating portion 22 side to the bending portion 25 side. This connecting portion 26 can be configured, for example, by covering the outer periphery of a spiral tube obtained by winding a metal sheet into a helical shape with a braided metal wire mesh tube, and then covering the outer periphery of the mesh tube with a resin outer sheath. For example... Figure 6 As shown, the bending section 25, which is bent by the operating section 22, can be bent in a direction that is substantially perpendicular to the opening and closing direction of the pair of gripping claws 30. In short, the bending action surface including the bending action direction of the bending section 25 is in a direction that is substantially perpendicular to the opening and closing action surface of the pair of gripping claws 30.

[0063] Figures 7 to 9 This describes the internal structure and operation of the curved section 25.

[0064] The curved portion 25 has a plurality of curved elements 42 and a resin outer skin 43. The plurality of curved elements 42 are arranged along the long side of the insertion portion 21 including the curved portion 25. Adjacent curved elements 42 are connected by a pair of pins 46 arranged radially opposite each other in the curved portion 25. Figure 8 As shown, a pair of pins 46 are positioned on an axis X that is substantially parallel to the opening and closing direction of a pair of gripping claws 30. Therefore, adjacent bent members 42 connected by the pair of pins 46 can rotate about the axis X. The sum of the rotations of the multiple bent members 42 about the axis X results in... Figure 9 As shown, the curved portion 25 is curved in a direction that is approximately perpendicular to the opening and closing direction (direction of axis X) of the pair of gripping claws 30 (bending action surface).

[0065] The curved portion 25 bends through the operating line 27 for opening and closing a pair of gripping claws 30. For example... Figure 8 As shown, each of the multiple bent members 42 has a guide 47 that can be pushed and pulled to hold the operation line 27. When the bent member 42 is divided into a first side A and a second side B on the opposite side by the axis X, the guide 47 is provided on the second side B. Therefore, the bent part 25 is bent such that the first side A is on the outside of the bend and the second side B is on the inside of the bend when it is pulled towards the operation part 22 by the operation line 27.

[0066] Thus, the closing action of the gripping part 24 and the bending action of the bending part 25 are performed by the traction of the operating line 27. This makes operation in the operating part 22 easier. Here, the configuration is such that when the operating line 27 is pulled towards the operating part 22, the gripping part 24 closes first, and the bending part 25 bends while the gripping part 24 is closed. The sequence of the closing action of the gripping part 24 and the bending action of the bending part 25 can be set according to the relationship between the resistance to closing the gripping part 24 and the resistance to bending the bending part 25. In general, when the resistance to bending the part 25 is relatively large, the closing action of the gripping part 24 is performed first, followed by the bending action of the bending part 25.

[0067] The resistance to closing the grip 24 includes friction between the intersecting portions of the pair of grippers 30 and friction between the grippers 30 and the connecting portion of the linkage member 31. Similarly, the resistance to bending the bending portion 25 includes friction between the connecting portions of two adjacent bending members 42. Furthermore, the outer skin 43 of the bending portion 25 is an elastic member that straightens the bending portion 25 into a straight line, and the resistance to bending the bending portion 25 includes the elasticity of the outer skin 43. Similarly, the operating line 27 is also an elastic member that straightens the bending portion 25 into a straight line, and the resistance to bending the bending portion 25 includes the elasticity of the operating line 27. Additionally, the elastic member that straightens the bending portion 25 into a straight line is not limited to the outer skin 43 or the operating line 27; it can also be a wire spring, a leaf spring, or the like.

[0068] Thus, the outer skin 43 of the bent portion 25, which is bent by the traction of the operating line 27, is made of an elastic component, thereby generating an elastic force in the direction of restoring from the bent state to the straight state through the outer skin 43.

[0069] Furthermore, the outer skin 43 of the bent portion 25 is made of an elastic member, thus generating an elastic force in the return direction when deformed by the operating line 27, and the elastic force of the bent portion 25 increases according to the amount of bending. By using the friction adjustment mechanisms 70 and 73 (described later) that can cope with this elastic force, the friction force is increased according to the amount (angle) of bending of the bent portion 25, thereby maintaining the bending state of the bent portion 25 well.

[0070] Here, the greater the amount of movement of the operating line 27 under traction, the greater the force (extending in a straight line) pulling the operating line 27 in the return direction. Furthermore, in this embodiment, the friction adjustment mechanisms 70 and 73, described later, can increase the friction force in accordance with the amount of traction of the operating line 27, thereby maintaining the traction state effectively. These friction adjustment mechanisms 70 and 73 can cope with changes in the force (elastic restoring force) pulling the operating line 27 in the return direction.

[0071] Furthermore, the bend 25 can also be formed using a flexible tube made of an elastic material such as an elastomer, instead of the multiple bends 42 rotatably connected as the inner components of the outer skin 43. When the bend 25 is made of a flexible tube, the resistance (elastic restoring force) during bending includes the elasticity of the tube, resulting in a stronger elastic force. Thus, by using an elastic material for the inner components of the outer skin 43, the bend 25 can generate a force in the return direction while being deformed by the operating line 27.

[0072] Figure 10 and Figure 11 This indicates the structure of the operation unit 22.

[0073] The operating unit 22 has a gripping unit 24 (see reference) Figure 3 The main body 50 of the input mechanism for forward and backward rotation operations, and the bending part 25 for opening and closing the gripping part 24 (see reference). Figure 2 The operating handle 51 of the input mechanism for the bending opening and closing bending operation and the endoscope operating part 7 are detachably mounted (see reference). Figure 1 The mounting part, namely the fixing part 52.

[0074] The fixing part 52 has a connecting fitting 52a. The connecting fitting 52a connects to the first treatment instrument insertion port 13 (see reference) provided in the endoscope operating part 7. Figure 1 With the interface connection of the connector 52a connected, the operating unit 22 is supported by the endoscope operating unit 7.

[0075] The operating unit body 50 is rod-shaped and supported by the fixing part 52, enabling it to move along the central axis indicated by arrow E and in the rotational direction around the central axis indicated by arrow F. The connecting part 26 is connected to the operating unit body 50 via the fixing part 52 and moves forward and backward along the longitudinal axis of the connecting part 26 according to the movement of the operating unit body 50 in the direction of arrow E. Furthermore, the connecting part 26 rotates about its longitudinal axis according to the movement of the operating unit body 50 in the direction of arrow F. The forward movement and rotation of the connecting part 26 are transmitted to the gripping part 24, which also moves forward, backward, and rotates integrally with the connecting part 26.

[0076] The operating handle 51 is supported by the main body 50 of the operating unit and is swingable. More specifically, as... Figure 11 As shown, the operating handle 51 is supported by the rotation support 55a (55), and the free end 51a can swing in the opening direction C, which is separate from the operating part body 50, and in the closing direction D, which is close to the operating part body 50. In summary, the operating handle 51 is supported to move on a fan-shaped operating movement surface centered on the rotation support 55a.

[0077] Figure 12 This indicates the state when the operating handle 51 is operated in the closing direction D. When the operating handle 51 swings in the closing direction D, it pulls (in the direction of arrow G) the operating cable 27, and when it swings in the opening direction C, it presses the operating cable 27 in (opposite direction of arrow G). The operating cable 27 is fixed to the cable holding part 56, which is provided within the operating part body 50 and is slidably movable along its axis. The cable holding part 56 is connected to the operating handle 51 via a connecting rod member 57 that is rotatably connected to the rotating support part 55c (55). The connecting rod member 57 and the operating handle 51 are rotatably connected via the rotating support part 55b (55).

[0078] Here, as described above, as the traction amount (movement in the direction of arrow G) of the operating line 27 increases, the force (elastic restoring force) pulling the wire holding part 56 in the return direction increases. Furthermore, when the lesion is grasped and pulled, the restoring force strengthens with the amount of pulling (traction). Therefore, the increased restoring force, which increases with the increase in traction, acts on the operating handle 51. To cope with this change in restoring force, a friction adjustment mechanism 70 is provided on the rotating support part 55c. This friction adjustment mechanism 70 increases the friction force of the wire holding part 56 based on the traction amount of the operating line 27, which is linked to the operation of the operating handle 51.

[0079] As the operating handle 51 swings in the opening direction C, the operating cable 27 is pushed forward to the front end 23. As the operating handle 51 swings in the closing direction D, the operating cable 27 is pulled towards the operating part 22. In this case, by swinging the operating handle 51 in the closing direction D, the gripping part 24 closes and the bending part 25 bends.

[0080] The operating handle 51 has a friction adjustment mechanism 70 that maintains its operating state, thereby enabling the bending angle of the bending portion 25 to be maintained at any angle below the maximum bending angle. The friction adjustment mechanism 70 increases the friction force of the wire holding portion 56 that holds the operating wire 27 as the amount of traction on the wire increases with the swing of the operating handle 51.

[0081] Thus, the friction adjustment mechanism 70 can increase the friction as the traction of the operating line 27 increases. Therefore, even if the wire recovery force becomes stronger due to the increased traction of the operating line 27, the return of the operating handle 51 is prevented. No matter what position the operating handle 51 is in, the hand can be removed from the operating handle 51. Moreover, the operating force required for rotation is small, and stable operation can be performed.

[0082] The operating handle 51 is slidably connected to the cable holding part 56 via the linkage member 57, thereby increasing the portion that moves relative to the cable holding part as the operating handle 51 is operated. This increases the option to install the friction adjustment mechanism 70. Furthermore, as the traction force on the cable holding part 56 increases, the linkage member 57 tilts such that the tilt angle of the front end 23 side relative to the cable holding part 56 decreases, thereby increasing the force resisting the restoring force of the operating cable 27 and improving the operability of the handle.

[0083] Figures 13-15 This is a perspective view showing an example of the friction adjustment mechanism 70. (Example) Figure 13 As shown, the friction adjustment mechanism 70 is fastened by a fastening member 58m passing through a through hole 55h in the rotating support portion 55c, such that the connecting rod member 57 is clamped between a pair of wire holding portions 56 (the internal thread side of the fastening member 58m is omitted in the figure). Here, the portion surrounding the shaft of the rotating support portion 55c of the wire holding portion 56 and the connecting rod member 57 is configured as a cylinder. Then, a cam portion 70c is provided that contacts the components in the thickness direction of the cylindrical portion and is capable of adjusting the friction force. As described later, this cam portion 70c can change the contact pressure between the components by corresponding to the rotation angle of the rotating support portion 55c.

[0084] In the connecting rod component 57, such as Figure 14 As shown, in the cylindrical portion 57b with the through hole 57h of the connecting rod portion having the rotating support portion 55c, cam portions 57c (70c) are provided on both end faces of the watch back when viewed from the axis CL direction. The cam portions 57c are formed to divide the two end faces of the watch back of the cylindrical portion 57b into semi-circular regions. In general, on the two end faces of the watch back of the cylindrical portion 57b, a cam surface inclined in the circumferential direction is formed in each of its semi-circular regions. More specifically, it becomes an inclined structure in which the thickness (W1) of one end side 57ct and the thickness (W2) of the other end side 57ce of the semi-circular region of the cylindrical portion 57b decreases. That is, the thickness of the cylindrical portion 57b is greatest at one end side 57ct (W1), and in Figure 14 The structure gradually thins in the counterclockwise direction.

[0085] like Figure 15As shown, the cylindrical portion 56b of the wire holding portion 56 has a boss portion 56d, which has a through hole 55h and can be inserted into the through hole 57h of the connecting rod portion. Around the boss portion 56d, a cam portion 56c is provided on one end face side (inner side) when viewed from the axis CL direction. The cam portion 56c is divided into a semi-circular region of the cylindrical portion 56b, and this semi-circular region has a cam surface whose thickness is inclined in the circumferential direction. The thickness of the cylindrical portion 56b is greatest at one end side 56ct (W3). Figure 15 The thickness (W4) of the cam surface gradually decreases from the middle to the other end 56ce in the clockwise direction.

[0086] The cam portion 56c of the wire holding part 56 and the cam portion 57c of the connecting rod part 57 are thus configured as follows: Figure 13 By combining the components as shown and securing them with fastening member 58m, the contact pressure of the cam surfaces can be changed. Specifically, if the connecting rod member 57 is rotated in a direction where the angle between it and the wire holding portion 56 decreases (if the traction amount increases), the cam portion 57c of the connecting rod member 57 functions to expand the cam portion 56c of the wire holding portion 56. As a result, the contact pressure between the cam surfaces gradually increases as the traction amount of the operating wire 27 increases, and the frictional force gradually increases as well.

[0087] Thus, the friction adjustment mechanism 70 is provided on the rotating support shaft 55c that rotatably supports the operating handle 51. The rotating support shaft 55c has a cam portion 70c around its shaft that changes the contact pressure in accordance with the rotation angle. Therefore, the structure of the friction adjustment mechanism 70 is not large and can be made compact.

[0088] Thus, the cam portion 70c of the friction adjustment mechanism 70 is provided in the wire holding portion 56 within the operating unit body 50. That is, by means of the rotating support portion 55c provided between the connecting rod member 57 and the wire holding portion 56, liquid can be prevented from seeping into the cam portion 70c even if the operator's hand is wet, thus preventing fluctuations in friction.

[0089] Furthermore, a fastening member 58m is provided through the rotating support shaft portion 55c, which is configured to adjust the fastening force of the rotating support shaft portion 55c. Thus, by adjusting the fastening of the fastening member 58m, the fastening force can be adjusted, thereby changing the contact pressure of the cam surface. As a result, the friction force of the friction adjustment mechanism 70 can be easily adjusted. Moreover, by clamping an elastic member between the fastening member 58m and the wire holding portion 56, the contact pressure between the cam surfaces can also be adjusted. For example, by clamping a spring washer with a small spring constant between the fastening member 58m and the wire holding portion 56, the increase in contact pressure can be mitigated.

[0090] The friction adjustment mechanism 70 is designed to be located at the rotating support portion 55c, but it can also be located at other rotating support portions 55a and 55b. In short, any rotating support portion 55 involved in the swinging of the operating handle 51 can be located in any position, and the friction adjustment mechanism 70 can be located in multiple positions. Furthermore, it can be designed with one position as the friction adjustment mechanism 70, while other positions are configured with friction components, such as those made of rubber, that generate constant friction regardless of the operating position of the operating handle 51.

[0091] The connecting rod component 57 and the wire holding portion 56 constituting the cam portion 70c are preferably made of materials that generate appropriate friction and are not prone to stick-slip. Furthermore, since the wire holding portion 56 slides against the operating portion body 50, it is preferably made of a material with a low coefficient of friction. From the above perspective, the wire holding portion 56 is preferably made of a low-friction resin material such as polypropylene, polyethylene, or PTFE (polytetrafluoroethylene), and the connecting rod component 57 is preferably made of a material with an appropriate coefficient of friction such as ABS (acrylonitrile butadiene styrene).

[0092] Furthermore, during handling and storage, the rods are fixed in a state where the contact pressure between the cams is low. This avoids applying prolonged compressive forces to the components constituting the cams, suppressing dimensional changes and reductions in contact pressure caused by creep.

[0093] Figure 16 This is a cross-sectional view of an example of another friction adjustment mechanism 73 of the operating section 22. (See example...) Figure 16 As shown, the friction adjustment mechanism 73 includes a first sliding portion 71 and a second sliding portion 72, which are sliding portions capable of slidingly contacting the wire holding portion 56 as it slides relative to the operating part body 50. The first sliding portion 71, for example, has a flat sliding wall surface 56s that slidably holds the axial wire holding portion 56. The second sliding portion 72 has an inclined wall surface 73t that increases the holding force of the wire holding portion 56 as the amount of traction of the operating wire (the amount of movement of the wire holding portion 56) increases.

[0094] Thus, the system includes a wire holding portion 56 that slides relative to the main body 50 of the operating unit, and first and second sliding portions 71 and 72 that slidably contact the wire holding portion 56 as it moves. The first and second sliding portions 71 and 72 have an inclined structure in which at least a portion increases the contact pressure on the wire holding portion 56 in response to an increase in the traction of the operating wire 27. Therefore, the frictional force increases as the traction of the operating wire 27 increases. Thus, even if the traction of the operating wire 27 increases and the wire restoring force becomes stronger, the contact force can be gradually increased by the inclined wall surface 73t to cope with the magnitude of the force that the operating handle 51 wants to return. As a result, the operating handle 51 is held regardless of its operating position, enabling stable operation.

[0095] The first sliding portion 71 is configured, for example, as an annular member 73a such as an O-ring, to contact a sliding wall surface 56s formed by a cylindrical inner wall surface along the sliding direction. Therefore, the sliding wall surface 56s and the annular member 73a are always in contact with a constant contact force, and thus the first sliding portion 71 can generate a constant frictional force on the wire holding portion 56.

[0096] Thus, the sliding portion includes a first sliding portion 71 with a substantially constant contact pressure on the wire holding portion 56 and a second sliding portion 72 with an inclined structure that increases in response to an increase in the contact pressure on the wire holding portion 56 and the traction amount of the operating wire 27. Therefore, the friction force can be adjusted separately by the two sliding portions, making it easy to adjust the friction force. As a result, a stable friction force can be generated, and even if the wire restoring force increases due to an increase in the traction amount of the operating wire 27, the operating handle 51 can be reliably held, and stable operation can be performed regardless of the operating position of the operating handle 51.

[0097] The second sliding part 72 includes a cylindrical cylinder 73c, for example, disposed at one end 50e of the operating part body 50, and a piston 73p disposed at one end of the wire holding part 56 and slidably disposed within the cylinder 73c. ​​An annular elastic member 73o, such as an O-ring, is disposed on the outer periphery of the piston 73p and contacts an inclined wall surface 73t constituting the inner wall surface of the cylinder 73c. ​​The inclined wall surface 73t is inclined such that the inner diameter of the cylinder decreases as the piston 73p moves in the traction direction (in the figure, in the direction of arrow G).

[0098] Here, the friction force of the first sliding part 71 is set to be smaller than that of the second sliding part 72. Therefore, the first sliding part 71 can generate a minimum friction force, and the second sliding part 72 can be used for friction force adjustment. As a result, friction force adjustment is easy, and stable friction force can be obtained.

[0099] Furthermore, the frictional force can be adjusted by the contact force between the inclined wall 73t of the second sliding part 72 and the elastic member 73o. Moreover, the elastic member 73o is made of an O-ring, so it can be easily formed into an elastic deformation structure and can be manufactured inexpensively.

[0100] Figure 17 This is an exploded perspective view of the friction mechanism 80 that generates friction between the fixed part 52 and the main body 50 of the operating part. Furthermore, Figure 18 This indicates the internal structure of the fixing part 52. Figure 17 A cross-sectional view of the portion along line XX. And, Figure 19 This is an enlarged sectional view used to illustrate the contact state during rotation in the friction mechanism 80.

[0101] like Figure 17 and Figure 18 As shown, the operating unit 22 is installed on the endoscope operating unit 7 (reference). Figure 1 The fixing part 52 has a front end side that can be slidably and movable to accommodate the main body 50 of the operating part. Figure 17 The insertion end 50t (on the left side of the image) has a generally cylindrical receiving space SS with a small diameter. A protrusion 52d protruding radially inward toward the inner wall of the receiving space SS is provided. The protrusion 52d is formed along the length direction of the receiving space SS, i.e., the forward and backward direction of the insertion end 50t (the traction direction and pressing direction of the operating line 27). Furthermore, multiple (four) protrusions 52d are provided at predetermined intervals along the circumferential direction of the inner wall. An annular friction member 59 is provided at the insertion end 50t to contact the protrusion 52d with a predetermined contact pressure, along the rotation direction of the insertion end 50t (arrow F direction). The friction member 59 is, for example, a component with predetermined elasticity, such as an O-ring.

[0102] Thus, the operation unit 22 includes a fixing part 52 for mounting the operation unit 22 and an operation unit body 50 that can move forward and backward relative to the fixing part 52 along the operation line 27 and can rotate along a plane orthogonal to the forward and backward direction. Furthermore, it includes a friction mechanism 80 that generates a first frictional force (rotational direction frictional force) in the rotational direction of the fixing part 52 and the operation unit body 50, and a second frictional force (forward and backward direction frictional force) different from the first frictional force in the forward and backward direction of the fixing part 52 and the operation unit body 50.

[0103] In summary, the friction mechanism 80 generates a first frictional force (frictional force in the rotational direction) on the fixed part 52 in the rotational direction (arrow F direction) of the operating part body 50. Furthermore, it generates a second frictional force (frictional force in the forward / backward direction) on the fixed part 52 in the forward / backward direction (arrow E direction), which is different from the first frictional force.

[0104] Thus, the frictional force in the rotational direction during rotation and the frictional force in the forward and backward direction during movement are different between the fixed part 52 and the main body 50 of the operating part. This allows for easy setting of the force in the rotational direction and the force in the forward and backward direction of the operating part 22. Consequently, the situation where prioritizing either rotation or forward / backward movement degrades the operability of the other, as was the case previously, can be avoided. As a result, an operating part 22 that allows for easy operation of both rotation and forward / backward movement of the main body 50 of the operating part is provided.

[0105] like Figure 19 As shown, the first frictional force generated by the relative movement of the friction member 59 and the protrusion 52d in the direction of rotation is increased by the formation of a deformation portion 59t in the friction member 59. The conditions for forming the deformation portion 59t are as follows: when the friction member 59 rotates relative to the protrusion 52d, the surface of the friction member 59 is slightly concave due to the contact pressure with the protrusion 52d; the friction member 59 is easily deformed (easily stretched) in the circumferential direction due to friction from the protrusion 52d; the friction member 59 is elongated during rotation, thus easily stretching in the direction of rotation, etc. By forming this deformation portion 59t, the contact pressure of the friction member 59 relative to the protrusion 52d increases, and the frictional resistance increases.

[0106] On the other hand, in the forward and backward direction, the surface of the friction member 59 is recessed relative to the protrusion 52d, but the recessed state is maintained in the radial (thickness direction) direction of the friction member 59, and a portion like the deformed portion 59t is not formed, so the second frictional force does not increase. That is, the first frictional force is set to be greater than the second frictional force.

[0107] In this way, the first friction force, which is the friction force in the direction of rotation, is set to be greater than the second friction force, which is the friction force in the direction of forward and backward movement. This allows the force required for the rotation and forward / backward movement of the operating unit 22 to be adjusted to be close, thereby improving the operability of the operating unit 22.

[0108] In the friction mechanism 80, the friction member 59 extends along the rotational direction, and the protrusion 52d extends along the forward and backward direction. With this structure, the contact between the friction member 59 and the protrusion 52d is such that, in the rotational direction, the protrusion 52d deforms and moves the friction member 59, thus increasing the resistance in the rotational direction. In contrast, in the forward and backward direction, the friction member 59 is in a partial contact state where only a predetermined portion contacts the protrusion 52d, thus reducing the resistance during forward and backward movement. As a result, the resistance in both the rotational and forward / backward directions can be optimized, improving the operability of the operating part body 50.

[0109] like Figure 18As shown, the friction member 59 is configured in an annular shape, and the protrusions 52d are composed of a plurality of protrusions 52d arranged at predetermined intervals along the circumference of the friction member 59 and extending in the forward and backward direction. Therefore, in the forward and backward direction, the contact between the protrusions 52d and the friction member 59 is partial, avoiding an increase in frictional resistance. On the other hand, in the rotational direction, the contact between the protrusions 52d and the friction member 59 is accompanied by deformation of the friction member 59 at the position of each protrusion 52d, thus increasing the frictional resistance.

[0110] Conversely, to increase the frictional resistance in the forward and backward direction, the width of the protrusion 52d can be increased. The frictional resistance in the forward and backward direction is approximately proportional to the contact area of ​​the friction component 59 and the protrusion 52d, so the frictional resistance can be freely adjusted by changing the shape of the protrusion 52d.

[0111] With the structure described above, the frictional forces in both the rotational and forward / reverse directions can be freely designed, thus eliminating the need for lubricants. Lubricants are complex to manage during manufacturing and can cause various problems, such as deviations in coating amount or adverse effects on resin materials. Therefore, in terms of quality and cost, the benefits of eliminating the need for lubricants can be expected.

[0112] Figure 20 This is a cross-sectional perspective view showing another example of a friction mechanism 80 that generates friction between the fixed part 52 in the operation part 22 and the main body 50 of the operation part. Figure 21 yes Figure 20 An enlarged cross-sectional perspective view of the main part of the friction mechanism 80 shown.

[0113] Figure 20 In the friction mechanism 80 of the operating part 22 shown, a sliding ring 75 is provided between the fixing part 52 and the operating part body 50, that is, between the fixing part 52 and the insertion end 50t of the operating part body 50, to restrict movement in the forward and backward direction. The sliding ring 75 allows movement of the operating part body 50 in the forward and backward direction on the side that engages with the protrusion 50td. On the other hand, on the opposite side of the side that engages with the protrusion 50td, the operating part body 50 allows rotational movement (in the direction of arrow F) of the friction member 76.

[0114] Furthermore, the friction mechanism 80 is composed of two parts: a first friction part 81 and a second friction part 82. The part with the sliding ring 75 is the first friction part 81, and the second friction part 82, which generates frictional force in the rotational and forward / backward directions, is located at a different part from the first friction part 81.

[0115] The second friction part 82 is, for example, an O-ring 77 located at the front end of the insertion end 50t that contacts the cylindrical inner peripheral wall 52w of the fixing part 52. Therefore, a predetermined friction is generated by the rotational movement of the operating part body 50 (in the direction of arrow F). Furthermore, a predetermined friction is generated by the forward and backward movement of the operating part body 50 (in the direction of arrow E).

[0116] like Figure 21 As shown, in the sliding ring 75 constituting the first friction part 81, an annular groove 75g is formed on the outer side in the radial direction of the ring, and a friction member 76 made of an O-ring is fitted into the annular groove 75g. Furthermore, the sliding ring 75 is fitted into an annular guide groove 52g formed along the circumferential direction of the inner surface of the fixing part 52. Therefore, the bottom wall 52gw of the annular guide groove 52g contacts the friction member 76. Additionally, a longitudinal groove 75k along the advancing / retreating direction is provided on the inner circumferential side of the sliding ring 75, and the protrusion 50td is slidably fitted into the longitudinal groove 75k. With this configuration, the first friction part 81 can generate almost no frictional resistance in the advancing / retreating direction, but generate a large frictional force in the rotational direction.

[0117] Thus, by providing a sliding ring 75 between the fixing part 52 and the insertion end 50t of the operating part body 50, and by providing a friction member 76 on one end of the sliding ring 75, the frictional force on the side in contact with the sliding ring 75 and the side in contact with the friction member 76 can be changed. As a result, the friction in the rotational direction (arrow F direction) and the forward / reverse direction (arrow E direction) between the fixing part 52 and the operating part body 50 can be separated respectively.

[0118] Furthermore, by setting multiple friction points, including the first friction point 81 and the second friction point 82, the friction force can be adjusted at multiple points, making it easy to adjust.

[0119] Furthermore, the second friction part 82 is configured to generate a smaller frictional force than the first friction part 81.

[0120] exist Figure 20 , Figure 21The structure of the protrusion 50td being provided on the operating part body 50 has been described, but the protrusion 50td can also be provided on the fixing part 52. In this case, the annular guide groove 52g is provided on the operating part body 50. Furthermore, the longitudinal groove 75k is provided on the outer peripheral side of the sliding ring 75, and the annular groove 75g and the friction member 76 are provided on the inner peripheral side of the sliding ring 75. That is, the protrusion 50td is provided on one of the fixing part 52 and the operating part body 50, and protrudes to the other side of the fixing part 52 and the operating part body 50. Specifically, the protrusion 50td is provided on one of the fixing parts 52 and protrudes to the operating part body 50 side, or the protrusion 50td is provided on one of the operating part body 50 and protrudes to the fixing part 52 side.

[0121] Thus, by generating a small frictional force in the second friction part 82, a minimum frictional force can be generated through the second friction part 82. As a result, the frictional force of the first friction part 81 can be easily adjusted.

[0122] Back Figure 10 The outer surface of the operating part body 50 is provided with a recess 50c and a protrusion 50d that can engage a finger when the operating part body 50 is operated in the forward and backward direction.

[0123] Thus, by providing a recess 50c and a protrusion 50d on the outer surface of the operating part body 50, when operating the operating part body 50 in the forward and backward direction, the fingers can be hooked onto the engaging recess 50c and protrusion 50d, thereby improving operability in the forward and backward direction.

[0124] Furthermore, in the state where the main body 50 of the operating part is closest to the fixed part 52 ( Figure 10 In the state shown, the gap between the end face 52m of the fixing part 52 and the end face 50m of the operating part body 50 opposite to the end face 52m is an inclined surface that widens toward the outer surface of the operating part body 50.

[0125] Thus, the distance between the end face 52m of the fixing part 52 and the end face 50m of the operating part body 50 when they are closest is an inclined surface that widens toward the outer surface of the operating part body 50, thereby avoiding the trouble of fingers being pinched between the end faces of the two parts during the forward and backward operation of the operating part body 50.

[0126] Figure 22 This is an explanatory diagram used to explain the operating direction of the operating handle 51 of the operating unit 22 and the orientation of the movement direction of the gripping unit 24.

[0127] like Figure 22 As shown, when the operation line 27 is made straight, and the operation section 22 is observed along the axial direction of the operation line 27 towards the front end 23 ( Figure 22In the middle, when viewed from the direction of the main body 50 towards the front end 23, the bending action surface MS of the bending part 25 (refer to) Figure 23 ) position ( Figure 22 In the middle, at the same position as the front end 23, it is located at the position where the operating handle 51 for actuating the bending part 25 is provided on the operating part 22. Figure 22 Starting from the position at 0 degrees, on the axis ( Figure 22 In the circumferential direction of the axis represented by the operation line 27, the range OE is greater than 180 degrees and less than 270 degrees clockwise.

[0128] If configured in this way, for example, when the endoscope treatment device 20 is installed on the endoscope operating unit 7 for use, the operating direction of the operator operating the operating handle 51 ( Figure 22 In the relationship between the curved section 25 (including the front end 23) of the monitor 5 displayed on the endoscope screen and the curved action surface MS, it is set so that the top of the monitor 5 screen is aligned with the operating direction directly in front of the operator. Figure 22 In the case where the direction of a straight line (representing 180 degrees) is consistent with the operation direction where the top of the monitor 5 screen is 90 degrees to the right relative to the operator's direct front direction (the direction of operation). Figure 22 In the case where the center position CP (225 degrees clockwise from the 0-degree position) is consistent with the straight line direction of 270 degrees, the position OE within a circle of less than 90 degrees in the circumferential direction becomes the top of the screen of monitor 5.

[0129] Thus, the bending action surface MS of the bending section 25, which is operated by the operating unit 22, is located within a range OE, greater than 180 degrees and less than 270 degrees clockwise, starting from the position where the operating handle 51 is located (0 degrees). Therefore, when operating the operating unit 22, the direction of the bending action surface MS of the bending section 25 and the direction of the operation screen are accepted without causing any incongruity to the operator's feel. As a result, the operability of the operating unit 22 is improved.

[0130] Figure 23 This is a perspective view used to explain the relationship between the operating movement surface OS of the operating handle 51 of the operating unit 22 and the bending action surface MS of the bending unit 25.

[0131] like Figure 23 As shown, the operating movement surface OS is a virtual plane that includes the fan-shaped movement surface depicted by the operating handle 51 of the operating unit 22. Furthermore, the bending action surface MS is a virtual plane that includes the fan-shaped movement surface of the bending portion 25, which performs a bending action in a direction orthogonal to the virtual plane opened and closed by the gripper 30.

[0132] Furthermore, the bending action surface MS, which is bent by the traction of the bending part 25 through the operation line 27, is preferably set at a point 225 degrees clockwise from the operation movement surface OS when the operation handle 51 is operated. Figure 22 The position of CP in the middle.

[0133] Thus, the bending action surface MS is set at the intermediate position CP, 225 degrees clockwise, starting from the operation movement surface OS when the operating handle 51 is operated. This allows for a range of variation in the relationship between the operating direction of the operating handle 51 and the bending direction of the bending portion 25, within which the gripping method of the operating portion 22 can change according to the operator. Consequently, even if the gripping method (operating direction) changes according to the operator, the discomfort caused by extreme changes in the movement direction of the bending portion 25 can be avoided, achieving stabilization of endoscopic technology.

[0134] Furthermore, the operation unit 22 includes: an operation unit body 50, which can rotate relative to the fixing part 52 on which the operation unit is mounted to a predetermined position so that the orientation of the front end 23 can be rotated; and an operation handle 51, which moves the operation line 27 by opening and closing relative to the operation unit body 50 with the rotation fulcrum as the center.

[0135] Thus, the operating part 22 can rotate relative to the fixed part 52, so the front part 23 can be rotated by the operating part body 50, and the operating handle 51 can perform opening and closing actions centered on the rotation pivot point (rotation pivot part 55a) relative to the operating part body 50. Therefore, the rotation of the operating part body 50 and the opening and closing of the operating handle 51 can be easily performed.

[0136] Figure 24 This is a magnified perspective view of the operating handle 51 in the endoscopic procedure device 20, viewed from above. (See image below.) Figure 24 As shown, the operating handle 51 has a first protrusion 51f, which can be bent simultaneously with at least the side 51w on the closed side and the side 51u on the open side relative to the finger Hf that operates the operating handle 51.

[0137] Thus, by providing a first protrusion 51f, and with sides 51u and 51w arranged on the inside and outside of the finger Hf relative to the finger Hf that operates the operating handle 51, the operating handle 51 can be freely opened and closed by moving the finger Hf placed on the inside of the first protrusion 51f in the closing direction (arrow D direction) or the opening direction (arrow C direction).

[0138] Furthermore, the first protrusion 51f has one side having a direction at least orthogonal to the opening and closing direction of the operating handle 51. Figure 24The hook shape of the open part 51s (in the middle, on the right side).

[0139] Thus, the side orthogonal to the opening and closing direction of the operating handle 51 is set as the hook shape of the opening part 51s, thereby allowing, for example, the finger Hf that operates the operating handle 51 to slide and move orthogonally laterally (in the direction of arrow J) from the operating handle 51.

[0140] The operating handle 51 has a second protrusion 51b that protrudes in a direction orthogonal to the opening and closing direction of the operating handle 51.

[0141] Thus, having a second protrusion 51b protruding in a direction orthogonal to the opening and closing direction of the operating handle 51, the fingers can be placed on the operating handle 51 even when the fingers are moved laterally relative to it. As a result, even if the gripping method relative to the operating part 22 changes in the circumferential direction of the operating part 22, the operating handle 51 can still be operated via the second protrusion 51b. For example, if finger Hf is a right-hand finger and the right hand is twisted in the direction of arrow C, operation based on the first protrusion 51f of finger Hf becomes difficult, but by moving finger Hf from the first protrusion 51f to the second protrusion 51b, and operating the second protrusion 51b by finger Hf, the operating handle 51 can be easily operated.

[0142] Furthermore, the first protrusion 51f and the second protrusion 51b are formed continuously. As a result, the operable surface of the operating handle 51 is widened as a continuous plane, and even when rotating in conjunction with the opening and closing operation of the operating handle 51, the operable range is widened, and the finger Hf can perform the rotation operation and the opening and closing operation without leaving the operating handle 51.

[0143] Figure 25 This is a diagram showing the operating body of the endoscope treatment device 20 viewed from the front side along the axial direction of the operating body 50. (See diagram below.) Figure 25 As shown, the operating part 22 has a length direction and a width direction in a cross-section orthogonal to the axial direction of the operating part body 50 and the operating part 22. Furthermore, the length direction is approximately parallel to the operating movement surface OS that includes the operating handle 51.

[0144] Thus, in the operating unit 22, in a cross-section orthogonal to the axial direction of the operating unit 22, the length direction is approximately parallel to the surface containing the operating handle 51's operating movement surface OS, therefore... Figure 25 As shown, when the operator holds the control unit 22, the fingers Hf placed on the control handle 51 fit snugly against the palm holding the control unit body 50, resulting in excellent operability. Furthermore, even without visually inspecting the control handle 51, the operator can easily determine the direction of the control handle 51 by holding it.

[0145] Figures 26 to 31 In this example, a treatment method in ESD is shown as an example of treatment using the endoscopic treatment device 20. Furthermore, the operating line 27 is pulled towards the operating section 22 as it swings relative to the closing direction D of the operating handle 51. The endoscopic treatment device used in conjunction with the endoscopic treatment device 20 is a cutting instrument, specifically a high-frequency scissor 60 with a pair of openable and closable claws 61 at its front end (see reference). Figure 29 A pair of claws 61 are opened and closed via the operating part of the high-frequency scissor clamps 60. When the pair of claws 61 are closed and the living tissue is held by the pair of claws 61, a high-frequency current flows through the living tissue between the pair of claws 61 and the counter electrode plate or between the pair of claws 61, thereby cauterizing and cutting the living tissue.

[0146] like Figure 26 As shown, endoscope 2 is inserted into the body, with the endoscope tip 10 positioned laterally to the lesion site LA in the mucosal layer. Endoscopic treatment device 20 is inserted through the first treatment device channel 14 of endoscope 2, with the endoscope tip 23 and curved portion 25 protruding from the end face of the endoscope tip 10. Furthermore, the lesion site LA is held by the gripping portion 24 of the endoscope tip 23 through the operation of the operating part 22 of the endoscope treatment device 20.

[0147] When holding the lesion site LA by the holding part 24, firstly, move the operating handle 51 of the operating part 22 in the opening direction C (refer to...). Figure 10 To perform the operation, such as... Figure 26 As shown, with the operation of the operating handle 51, the operating line 27 is extruded towards the forward end 23. Through the extrusion of the operating line 27, the curved portion 25 is straightened into a straight line and lies flat along the longitudinal axis of the connecting portion 26. Furthermore, through the extrusion of the operating line 27, the pair of gripping claws 30 of the gripping portion 24 open. Additionally, the operating portion body 50 is appropriately pushed or pulled, and the lesion site LA is positioned between the pair of gripping claws 30.

[0148] With the lesion site LA positioned between a pair of gripping claws 30, the operating handle 51 is operated in the closing direction D. This pulls the operating line 27 towards the operating section 22. By pulling the operating line 27, firstly, as... Figure 27 As shown, a pair of gripping claws 30 are closed, and the lesion site LA is gripped by the gripping part 24. Furthermore, after the lesion site LA is gripped by the gripping part 24, as... Figure 28 As shown, the curved portion 25 is curved. As a result, the holding portion 24 is raised from a flat position along the longitudinal axis of the connecting portion 26, and the lesion site LA held by the holding portion 24 is lifted.

[0149] When the LA at the lesion site is raised, such as Figure 29As shown, a high-frequency scissor forceps 60, inserted through the second treatment instrument channel 16 of the endoscope 2, protrudes from the end face of the anterior end portion 10 of the endoscope. A pair of claws 61 of the high-frequency scissor forceps 60 are positioned below the lesion site LA, and the lower portion of the lesion site LA is cut by the claws 61. As the cutting is performed, the raised lesion site LA can be temporarily released and then repositioned and raised again. Once the cut lesion site LA is raised, the lower portion is easily exposed visually, allowing for safe, reliable, and easy resection. By appropriately pushing and pulling the high-frequency scissor forceps 60, the lesion site LA, including the submucosa, is gradually peeled away.

[0150] Thus, by simply operating the handle 51 of the endoscopic treatment instrument 20, the lesion site LA can be grasped from the side and lifted, making the operation simple. This allows for safe, reliable, and easy lifting of the lesion site LA, making the area below the lesion site easily visible and allowing for safe, reliable, and easy treatment of the area below the lifted lesion site LA. Furthermore, in this example, the operating handle 51 can be maintained in its operating state via the friction adjustment mechanisms 70 and 73, so the lesion site LA remains lifted even after the operator's hand leaves the handle 51. This allows for focused operation of the high-frequency scissor forceps 60 during incision, further simplifying the operation and facilitating easier treatment of the area below the lesion site LA.

[0151] When cutting, the main body 50 of the operating part 22 can also be along... Figure 10 The arrow E direction is pushed or pulled and / or the main body 50 of the operating part is along Figure 10 Rotate in the direction of arrow F. As described above, the connecting part 26 has rigidity that can transmit and rotate power from the operating part 22 side to the bending part 25 side, and the pushing, pulling and rotation of the operating part body 50 are transmitted to the bending part 25 via the connecting part 26.

[0152] Figure 30 This indicates that the main body 50 of the operating unit has rotated. Corresponding to the rotation of the main body 50 of the operating unit, the connecting part 26 rotates about the longitudinal axis of the connecting part 26. With the bending part 25 bent, the holding part 24 rotates while remaining upright relative to the longitudinal axis of the connecting part 26, and the lesion site LA held by the holding part 24 shakes about the longitudinal axis of the connecting part 26.

[0153] Figure 31This indicates that the main body 50 of the operating part is being pushed or pulled. Corresponding to the pushing or pulling of the main body 50 of the operating part, the connecting part 26 moves forward and backward along the longitudinal axis of the connecting part 26. When the bending part 25 is bent, the holding part 24 moves forward and backward while remaining upright relative to the longitudinal axis of the connecting part 26, and the lesion LA held by the holding part 24 is pushed or pulled along the longitudinal axis of the connecting part 26.

[0154] By appropriately shaking and / or pushing / pulling the lesion site LA, the incision can be enlarged, for example. This makes it easier to treat the area below the lesion site LA. Furthermore, the friction mechanism 80 maintains the operating state of the operating unit body 50, so that the incision can remain open even after the operator's hand leaves the operating unit body 50. This makes it easier to treat the area below the lesion site LA.

[0155] The embodiments of the present invention have been described above, but the present invention is not limited to the above embodiments and can be appropriately modified or improved.

[0156] For example, in the friction adjustment mechanism 70 of the above embodiment, it is configured to have a structure in which a pair of wire holding portions 56 clamp the connecting rod member 57 and there are two pairs of cam surfaces, but it is not limited to this. For example, the opposing cam surfaces can be a pair.

[0157] Furthermore, in the sliding friction adjustment mechanism 73 of the above embodiment, an O-ring is used as an elastic member 73o, but it may not be an O-ring.

[0158] Furthermore, in the friction mechanism 80 of the above embodiment, it is provided with a structure having four protrusions 52d, but it is not limited to four; the number can be more or less.

[0159] Furthermore, in the friction mechanism 80 of the above embodiment, a recess 50c and a protrusion 50d that can engage a finger are provided, but both the recess 50c and the protrusion 50d may not be provided, as long as at least one of them is provided.

[0160] Furthermore, in the operation unit 22 of the above embodiment, a structure has been described in which the operation handle 51 protrudes relative to the operation unit body 50 and is configured to be swingable, and the wire holding part 56 is moved by swinging, but it is not limited to this structure. For example, such as Figure 32 As shown, the operating handle 51 can be a component provided on a flat portion 50b provided in the operating unit body 50, capable of moving along the flat portion 50b in the direction of arrow E. The operating handle 51 can be operated, for example, by the thumb of an operator holding the operating unit body 50.

[0161] In this case, the operating handle 51 is connected to the wire holding part 56. If the operating handle 51 is moved to the front end of the operating part body 50 ( Figure 32 If the operating handle 51 is moved to the upper side of the operating unit body 50, the wire holding part 56 also moves to the front end side of the operating unit body 50, thereby pulling the operating wire 27. Furthermore, if the operating handle 51 is moved to the base end side of the operating unit body 50 (…), the wire holding part 56 also moves to the front end side of the operating unit body 50, thereby pulling the operating wire 27. Figure 32 If the wire holding part 56 moves to the base end side of the operating part body 50 (on the lower side), the operating wire 27 will slacken. That is, in Figure 32 In the structure shown, by operating the handle 51 up and down, it is possible to achieve [the desired effect]. Figure 11 The same action as the operation of swinging the operating handle 51 shown in the figure.

[0162] In addition, Figure 32 In the structure shown, the position and shape of the operating handle 51 and the planar surface 50b are not limited to those of the components shown. Figure 32 The structure shown. For example, the planar portion 50b can be located in a position greater than... Figure 32 The example shown is located closer to the front end of the main body 50 of the operating section.

[0163] This instruction manual contains at least the following information.

[0164] (1) An endoscope processing device, comprising:

[0165] The front end is provided with an openable and closable handle;

[0166] A curved portion is provided adjacent to the aforementioned front end portion and is capable of bending;

[0167] The operating unit is input to close the aforementioned gripping part and to bend the aforementioned bending part; and

[0168] The operating line transmits the operation of the aforementioned operating unit to the aforementioned gripping unit and the bending unit.

[0169] When the aforementioned operating line is made straight, and the operating part is observed along the axial direction of the aforementioned operating line towards the aforementioned front end,

[0170] The bending action surface of the aforementioned bending portion is located within a range of greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the aforementioned axis, starting from the position where the operating handle for actuating the aforementioned bending portion is provided on the aforementioned operating part.

[0171] (2) The endoscopic treatment apparatus according to (1), wherein,

[0172] When the bending part is bent by the traction of the above-mentioned operating line, the bending action surface is set at a position 225 degrees clockwise, starting from the operating movement surface when the operating handle is operated.

[0173] (3) The endoscopic treatment apparatus according to (1) or (2), wherein,

[0174] The aforementioned operating unit includes: an operating unit body that can rotate relative to a fixing part on which the operating unit is mounted to a predetermined location to rotate the orientation of the aforementioned front end; and an operating handle that moves the aforementioned operating line by opening and closing relative to the aforementioned operating unit body around a pivot point.

[0175] (4) The endoscopic treatment apparatus according to (3), wherein,

[0176] The aforementioned operating handle has a first protrusion, which can be bent simultaneously on at least one side of the operating handle that is closed and one side that is open relative to the finger that operates the operating handle.

[0177] (5) The endoscopic treatment apparatus according to (4), wherein,

[0178] The first protrusion is a hook shape that opens on at least one side in a direction orthogonal to the opening and closing direction of the operating handle.

[0179] (6) The endoscopic treatment apparatus according to (4) or (5), wherein,

[0180] The aforementioned operating handle has a second protrusion that protrudes in a direction orthogonal to the opening and closing direction of the operating handle.

[0181] (7) The endoscopic treatment apparatus according to (6), wherein,

[0182] The first protrusion and the second protrusion are formed continuously.

[0183] (8) The endoscopic treatment apparatus according to any one of (3) to (7), wherein,

[0184] The aforementioned operating part has a length direction and a width direction in a cross section orthogonal to the axial direction of the operating part body and the operating part.

[0185] The aforementioned length direction is approximately parallel to the surface containing the operating movement surface of the aforementioned operating handle.

[0186] (9) An endoscope device comprising:

[0187] The first treatment device is any one of (1) to (8) of the endoscope treatment devices;

[0188] Second treatment equipment; and

[0189] An endoscope having a first treatment instrument channel through which the first treatment instrument can be inserted and a second treatment instrument channel through which the second treatment instrument can be inserted.

[0190] (10) A disposal method, wherein,

[0191] Using the endoscope device described in (9),

[0192] Through the first treatment instrument channel of the endoscope, the proximal end of the first treatment instrument is positioned at the lesion site within the body.

[0193] The lesion site is held by the holding part of the first treatment device.

[0194] While holding the lesion site, the curved portion of the first treatment device is bent, thereby lifting the lesion site.

[0195] With the lesion site lifted, the lower part of the lesion site is treated by inserting the second treatment instrument through the second treatment instrument channel of the endoscope.

[0196] Various embodiments have been described above with reference to the accompanying drawings, but it is self-evident that the present invention is not limited to these examples. Those skilled in the art will understand that various modifications or alterations can be conceived within the scope of the technical solutions described herein, and these modifications or alterations naturally fall within the technical scope of the present invention. Furthermore, the constituent elements of the above embodiments can be arbitrarily combined without departing from the spirit of the invention.

[0197] Additionally, this application is based on U.S. Provisional Application No. 63 / 118,975, filed November 30, 2020, the contents of which are incorporated herein by reference.

[0198] Symbol Explanation

[0199] 20-Endoscope handling instrument, 22-Operating part, 23-Front end, 25-Bending part, 26-Connecting part, 27-Operating cable, 50-Operating part body, 50b-Flat part, 51-Operating handle, 52-Fixing part, 52d-Protrusion, 55-Rotating support shaft, 56-Cable holding part, 57-Linkage assembly, 58m-Fastening component, 59-Friction component, 70, 73-Friction adjustment mechanism, 71-First sliding part (sliding part), 72-Second sliding part (sliding part), 73c-Cylinder, 73o-Elastic component, 73p-Piston, 75-Sliding ring, 76-Friction component, 77-O-ring, 80-Friction mechanism, 81-First friction part, 82-Second friction part, MS-Bending action surface, OS-Operating movement surface.

Claims

1. An endoscopic procedure device, comprising: The front end is provided with an openable and closable handle; A curved portion is disposed adjacent to the front end portion and is capable of bending; The operating unit is input to close the gripping part and to bend the bending part; and The operating line transmits the operation of the operating unit to the gripping part and the bending part. When the operating line is straightened and the operating part is viewed along the axial direction of the operating line towards the front end, The bending action surface of the bending part is located within a range of greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the axis, starting from the position where the operating handle for actuating the bending part is provided on the operating part. The operating handle has a first protrusion, which, relative to a finger operating the operating handle, can be simultaneously bent at least on one side of the operating handle that is closed and on the other side that is open. The operating handle has a second protrusion that protrudes in a direction orthogonal to the opening and closing direction of the operating handle. When operation based on the first protrusion of the finger becomes difficult, the operation of the second protrusion is performed by moving the finger from the first protrusion to the second protrusion.

2. The endoscopic procedure apparatus according to claim 1, wherein, When the bending part is bent by the traction of the operation line, the bending action surface is set at a position 225 degrees clockwise from the operation movement surface when the operation handle is operated.

3. The endoscopic procedure apparatus according to claim 1 or 2, wherein, The operating unit includes: an operating unit body that can rotate relative to a fixing part on which the operating unit is mounted to a predetermined position to rotate the orientation of the front end; and an operating handle that moves the operating line by opening and closing relative to the operating unit body around a pivot point.

4. The endoscopic procedure apparatus according to claim 1, wherein, The first protrusion is a hook shape that is open on at least one side in a direction orthogonal to the opening and closing direction of the operating handle.

5. The endoscopic procedure apparatus according to claim 1, wherein, The first protrusion and the second protrusion are formed continuously.

6. The endoscopic procedure apparatus according to claim 3, wherein, The operating part has a length direction and a width direction in a cross section orthogonal to the axial direction of the operating part body and the operating part. The length direction is approximately parallel to the surface containing the operating movement surface of the operating handle.

7. An endoscope device comprising: The first treatment device is the endoscopic treatment device according to any one of claims 1, 2, 4, 5, and 6; Second treatment equipment; and An endoscope having a first treatment instrument that can be inserted through a first treatment instrument channel and a second treatment instrument that can be inserted through a second treatment instrument channel.

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