Treatment instrument

Abstract

A treatment instrument is provided. The treatment instrument includes a tube having a tube lumen extending along a length axis, a wire that is threaded through the tube lumen and extends along the length axis of the tube, a handle body that is mounted to a proximal end portion of the tube, and a rotation handle that is coupled to a proximal end portion of the wire, the rotation handle having a first mode in which the rotation handle is rotatable about a rotation axis relative to the handle body and a second mode in which a rotation amount of the rotation handle is limited when a force applied to the rotation handle in a rotation direction of the rotation handle is equal to or less than a predetermined amount and the rotation handle is rotatable when the applied force exceeds the predetermined amount.

Description

Technical Field

[0001] This invention relates to treatment apparatus and methods of operating the treatment apparatus. Background Technology

[0002] When removing bile duct stones endoscopically, the duodenal papilla, which is the outlet of the bile duct, is narrow, sometimes preventing the stones from being directly expelled. In such cases, endoscopic instruments capable of incising tissue, such as the mastoidectomy knife disclosed in U.S. Patent 7635363, are used. Specifically, the endoscopic instrument, such as the mastoidectomy knife, is inserted through the endoscope to incise the duodenal papilla and sphincter muscle, thereby widening the bile duct outlet before removing the stone. The position of the fold generally aligns with the direction of bile duct extension around the duodenal papilla. Since there are fewer blood vessels and less bleeding in the direction of bile duct extension around the duodenal papilla, the sphincter muscle is usually incised in the direction of the fold.

[0003] When the mastoidectomy knife used for cutting the sphincter of the biliary and pancreatic endoscope protrudes from the tip of the endoscope, the direction of the knife portion (the pre-bent portion located at the front end of the sheath body, protruding from the outer peripheral surface of the sheath) is expected to automatically align with the approximate 12 o'clock position of the endoscope image.

[0004] The endoscope insertion section is inserted through the patient's mouth until it reaches the duodenal papilla, and the mastoidectomy knife is inserted into the channel of the endoscope insertion section, protruding from the front end of the endoscope insertion section. At this time, the insertion section of the mastoidectomy knife passively bends at multiple points between the operating section and the treatment section. Because conventional mastoidectomy knives with rotational function about the axis of the treatment section have rotational torque that can transmit the rotational operation of the operating section to the front end of the knife section, with the passive bending at multiple points as described above, there are cases where the knife section is oriented in a direction different from the 12 o'clock direction, requiring the knife section to be aligned with the desired direction. In particular, the operation of aligning the pre-bent section with the desired direction during the operation is cumbersome. Summary of the Invention

[0005] The problem the invention aims to solve

[0006] In conventional mastoidectomies with a pre-curved section, it is difficult to align the catheter with the bile duct and the blade with the desired incision direction. Furthermore, in the case of a mastoidectomy with a rotating function, the distal end of the mastoidectomy blade can easily change direction due to the rotation of the catheter during endoscope insertion, making it difficult to align the catheter with the bile duct to be inserted and the blade with the desired incision direction.

[0007] Based on the above, the object of the present invention is to provide a treatment device and a method of operating the treatment device that enables the direction of the treatment section to be easily aligned with the desired direction.

[0008] Solution for solving the problem

[0009] A processing device includes: a tube having a lumen extending along a length axis; a line passing through the lumen and extending along the length axis of the tube; a handle body mounted on a proximal end of the tube; and a rotating handle connected to a proximal end of the line, the rotating handle having: a first configuration in which the rotating handle is rotatable about a rotation axis relative to the handle body; and a second configuration in which the rotation amount of the rotating handle is limited when the force applied to the rotating handle in the rotation direction is less than a predetermined amount, and the rotating handle is capable of rotation when the applied force exceeds the predetermined amount.

[0010] A treatment device includes: a tube having a lumen extending along a length axis; a line passing through the lumen and extending along the length axis of the tube; a handle body mounted on a proximal end of the tube; and a rotating handle capable of moving forward and backward relative to the handle body and connected to a proximal end of the line, the rotating handle being configured to move between a first position where the handle body and the rotating handle are engaged in the rotational direction of the rotating handle and a second position where the engagement between the handle body and the rotating handle is released.

[0011] A method of operating a treatment device includes the following steps: advancing the treatment device, which has a wire connected to the distal end of a longitudinal tube and housed within the tube, to the treatment site within the body; operating a first handle connected to the proximal end of the wire relative to a second handle connected to the proximal end of the tube, so that the wire rotates about the length axis of the tube; generating first user feedback from the first handle during the rotation of the wire; and engaging the first handle with the second handle during the rotation of the wire, thereby enabling second user feedback from the first handle. Attached Figure Description

[0012] Figure 1 This is an overall diagram of the endoscopic treatment system according to the first embodiment.

[0013] Figure 2 This is an overall diagram of the treatment apparatus according to the first embodiment.

[0014] Figure 3 This is a partial cross-sectional view along the length of the treatment device according to the first embodiment.

[0015] Figure 4This is an overall diagram of the treatment apparatus according to the first embodiment.

[0016] Figure 5 This is a cross-sectional view along the length of the rotating handle in the first embodiment.

[0017] Figure 6 This is a cross-sectional view along the length of the rotating handle in the first embodiment.

[0018] Figure 7 This is a perspective view of the rotating handle according to the first embodiment.

[0019] Figure 8 yes Figure 5 Sectional view along line A8-A8.

[0020] Figure 9 This is a cross-sectional view along the length of the rotating handle of the handling device in Modified Example 1.

[0021] Figure 10 This is a perspective view of the rotating handle of the treatment device in Modified Example 1.

[0022] Figure 11 This is a cross-sectional view along the length of the rotating handle of the handling device in Modified Example 1.

[0023] Figure 12 yes Figure 11 Sectional view along line A12-A12.

[0024] Figure 13 yes Figure 9 Sectional view along line A11-A11.

[0025] Figure 14 yes Figure 9 The sectional view along line A11-A11 is from... Figure 13 The image shows the state of the rotating handle during operation.

[0026] Figure 15 This is a partial sectional view of the rotating handle of a modified processing device.

[0027] Figure 16 yes Figure 15 Sectional view along line A16-A16.

[0028] Figure 17 A partial sectional view of the rotating handle of the modified processing device.

[0029] Figure 18 yes Figure 15 The sectional view along line A16-A16 is from... Figure 16 The image shows the state of the rotating handle during operation.

[0030] Figure 19This is a cross-sectional view along the length of the handle of the treatment device according to the second embodiment.

[0031] Figure 20 This is a cross-sectional view along the length of the handle of the treatment device according to the second embodiment.

[0032] Figure 21 This is a side view of the handle of the treatment device according to the second embodiment.

[0033] Figure 22 This is a side view of the handle of the treatment device according to the second embodiment.

[0034] Figure 23 This is a side view of the handle of the treatment device in a modified embodiment of the second embodiment.

[0035] Figure 24 This is a side view of the handle of the treatment device in a modified embodiment of the second embodiment.

[0036] Figure 25 This is a partial cross-sectional view of the handle of the treatment device in a modified example of the second embodiment.

[0037] Figure 26 This is a partial cross-sectional view of the handle of the treatment device in a modified example of the second embodiment.

[0038] Figure 27 This is a partial cross-sectional view of the handle of the treatment device in a modified example of the second embodiment.

[0039] Figure 28 This is a schematic diagram illustrating the usage of the processing device in the implementation method.

[0040] Figure 29 This is a schematic diagram showing the state of the processing device in use according to the embodiment. Detailed Implementation

[0041] (First Implementation)

[0042] [Disposal System 100]

[0043] Reference Figure 1 The processing system 100 of the first embodiment is described. Figure 1 This is an overall view of the treatment system 100 equipped with the treatment appliance 1 of this embodiment. Figure 1 As shown, the treatment system 100 includes a flexible endoscope 200 and a treatment device 1. The treatment device 1 is inserted into the flexible endoscope 200 for use.

[0044] [Flexible endoscope 200]

[0045] like Figure 1As shown, the flexible endoscope 200 (hereinafter referred to as "endoscope 200") includes an insertion portion 202 that is inserted into the body and an endoscope operating portion 207 mounted on the insertion portion 202. In the following description, the insertion end side of the insertion portion 202 that is inserted into the body will be referred to as the distal side, and the endoscope operating portion 207 side will be referred to as the proximal side.

[0046] The insertion part 202 includes a camera part 203, an active bending part 204, a flexible part 205, and a front rigid part 211. Starting from the distal end of the insertion part 202, the front rigid part 211, camera part 203, active bending part 204, and flexible part 205 are arranged in the following order: front rigid part 211, camera part 203, active bending part 204, and flexible part 205. A channel 206 for inserting the treatment device 1 is provided inside the insertion part 202. A distal opening 206a of the channel 206 is formed at the distal end of the insertion part 202.

[0047] A lifting platform 212 is provided in the channel 206 near the distal opening 206a of the rigid front section 211. The lifting platform 212 lifts the treatment instrument 1 that passes through the channel 206. An operating cable 213 is connected to the front end of the lifting platform 212, and the proximal end of the operating cable 213 is connected to the endoscope operating section 207 via the insertion section 202. Only Figure 1 Operation line 213 is shown in the figure.

[0048] The camera unit 203, for example, is equipped with a CCD or CMOS sensor, and is capable of capturing images of the area to be treated. The camera unit 203 can capture images of the cutting portion 3 of the treatment instrument 1 (described later) when the treatment instrument 1 protrudes from the distal opening 206a of the channel 206. The active bending portion 204 can be actively bent according to the operation performed by the operator on the endoscope operating section 207. The flexible portion 205 is a flexible, tubular portion.

[0049] The endoscope operating unit 207 is connected to the flexible part 205. The endoscope operating unit 207 includes a handle 208, an input part 209, a forceps jaw 206b, and a universal cable 210. The handle 208 is the part held by the operator. The input part 209 receives operational input for bending the active bending part 204. The forceps jaw 206b communicates with the channel 206 and is an opening for inserting or removing the instrument relative to the channel 206. The universal cable 210 outputs images captured by the camera unit 203 to the outside. The universal cable 210 can be connected to a display device such as a liquid crystal display via an image processing device such as a processor.

[0050] [Treatment Equipment 1]

[0051] Figures 2-4 This is an overall diagram showing the treatment device 1. Figure 3A section of the treatment device 1 is shown. The treatment device 1 is inserted into the endoscope 200 for use. (Example) Figures 2-4 As shown, the treatment device 1 has a sheath 4 (tube), an operating part 20, and a torque line 7 (wire, see reference). Figure 3 ) and the cut part 3.

[0052] The sheath 4 is an elongated member having a lumen 41 extending along its length axis. The sheath 4 has an outer diameter capable of being inserted into the channel 206. The sheath 4 is a soft sheath made of resin. The sheath 4 is a multi-lumen tube with multiple lumens. Among the multiple lumens 41 are lumens for liquid delivery and lumens for wire passing through, such as torque wire 7 and conductive wire 72. Figure 3 The diagram only shows the first cavity 411 (cavity) through which the torque line 7 passes and the second cavity 412 through which the conductive line 72 passes.

[0053] The sheath 4 has a distal sheath 42, a proximal sheath 43, and a plurality of connecting tubes 44. The distal sheath 42 and the proximal sheath 43 are arranged in a row separately along the longitudinal axis. A plurality of connecting tubes 44 are provided between the distal sheath 42 and the proximal sheath 43. The connecting tubes 44 are tubes that connect the lumens of the distal sheath 42 and the lumens of the proximal sheath 43.

[0054] like Figure 3 As shown, a webbing 421 is provided at the base end of the distal sheath 42. The webbing 421 is fixed to the distal sheath 42 using adhesive materials, heat shrink tubing, etc. The webbing 421 is, for example, a component made by bundling multiple thin stainless steel wires into a grid pattern to form a tube, winding stainless steel wire or stainless steel strip into one or more coils to form a tube, or winding one or more coils interlaced in the winding direction into multiple layers to form a tube.

[0055] The distal sheath 42 may also include a pre-bent portion 45. The pre-bent portion 45 has a restoring force to recover from a bent shape, which is the shape in which the distal sheath 42 bends in a predetermined direction. Figure 4 As shown, the pre-bent portion 45 is bent in such a way that the outer peripheral surface of the through holes 423, 424 for leading the cut portion 3 outward to the outside of the distal sheath 42 becomes the inner side of the bend.

[0056] Torque line 7 extends through the first cavity 411 of the proximal sheath 43, with its central axis C extending along the length axis of the sheath 4. Torque line 7 transmits the rotational torque input to the operating part 20 to the distal sheath 42, causing the distal sheath 42 to rotate about the central axis C. The distal end of torque line 7 extends to a position further distal than the distal end of the proximal sheath 43 and is fixed to the proximal end of webbing 421. The distal end of torque line 7 has a flat portion that abuts against webbing 421 for fixation (see reference). Figure 3The near end 7b of the torque line 7 has a flat portion, which is inserted into and fixed to the rotary handle 6 (first handle) (see reference). Figure 7 Torque wire 7 can be a single wire, for example. Torque wire 7 can also be a wire formed by bundling multiple wires together. Torque wire 7 can be formed, for example, from stainless steel wire or nickel-titanium alloy.

[0057] The torque line 7 passes through the first cavity 411 in such a way that by rotating the rotary handle 6 about the central axis C (rotation axis), the torque line 7 can rotate relative to the first cavity 411 about the central axis C. On the other hand, since the front end of the torque line 7 is fixed to the distal sheath 42, when the rotary handle 6 is rotated about the central axis C, rotational torque is transmitted through the torque line 7, and the distal sheath 42 can rotate relative to the proximal sheath 43 about the length axis.

[0058] The cutting portion 3 protrudes from the outer peripheral surface of the distal sheath 42 and extends along the longitudinal axis of the sheath 4. The cutting portion 3 is constituted by a portion of the conductive wire 72. Specifically, the conductive core of the conductive wire 72 is covered with an insulating film (not shown) formed of a suitable synthetic resin. The conductive wire 72 protrudes from the second cavity 412 outward from the through-hole 423 of the distal sheath 42, extends distally along the longitudinal axis of the sheath 4, and enters the second cavity 412 through the through-hole 424 on the distal side. The front end of the conductive wire 72 is fixed within the second cavity 412. The portion of the conductive wire 72 exposed to the outside of the sheath 4 from the through-holes 423 and 424 is not covered with the insulating film, exposing the core wire, thus forming a linear cutting portion 3 capable of cutting tissue. The cutting portion 3 is an example of an electrode.

[0059] The operating unit 20 is mounted on the proximal end of the sheath 4. The operating unit 20 includes a handle body 2 (second handle), a rotating handle 6, and a knife handle 8. The handle body 2 is connected to the proximal end of the sheath 4. The rotating handle 6 and the knife handle 8 are configured to move forward and backward relative to the handle body 2.

[0060] The proximal portion of the handle body 2 branches into a connecting part 21 for rotating the handle 6 and a connecting part 22 for the knife handle 8. For example... Figure 3As shown, the connecting portion 21 of the rotary handle 6 is coaxially arranged with the sheath 4 along its length. A torque line cavity 2a is formed in the handle body 2, extending coaxially with the central axis C of the first cavity 411 of the sheath 4. The connecting portion 22 of the knife handle 8 extends in a direction intersecting the length direction of the sheath 4. A conductive line cavity 2b is formed in the handle body 2, communicating with the second cavity 412 of the sheath 4. The conductive line cavity 2b extends coaxially with the central axis C of the sheath 4 at the distal end of the handle body 2, and extends in a curved direction intersecting the length axis of the second cavity 412 at the proximal end. Considering operability, the connecting portion 22 of the knife handle 8 only needs to be in a position that does not interfere with the operation of the rotary handle 6; the structure of the connecting portion 22 intersecting the length direction of the sheath 4 is not necessary.

[0061] The handle body 2 is provided with a delivery tube head 29 that communicates with the delivery tube cavity. A syringe (not shown) can be attached to and detached from the delivery tube head 29. Figure 3 In the example shown, the second lumen 412 is connected to the liquid delivery head 29, and the second lumen 412 also functions as a liquid delivery lumen.

[0062] The knife handle 8 is the operating part for advancing and retracting the conductive wire 72 and bending the distal sheath 42. The knife handle 8 includes a handle shaft 81, a slider 82, and a terminal port 83. The distal end of the handle shaft 81 is a component mounted to the connecting part 22 of the handle body 2. The slider 82 is configured to slide relative to the handle shaft 81. The terminal port 83 is located on the slider 82. The proximal end of the conductive wire 72 passes through the conductive wire cavity 2b of the handle body 2, passes through the handle shaft 81, and extends to the vicinity of the terminal port 83, connecting to a terminal 74. The terminal 74 is located within the terminal port 83 and fixed to the slider 82. The terminal 74 can be connected to an external high-frequency power supply. High-frequency current supplied from the high-frequency power supply device is supplied to the conductive wire 72 via the terminal 74. When the slider 82 is advanced relative to the handle shaft 81, it can be configured to make the cutting portion 3 straight and to align the cutting portion 3 with the outer peripheral surface of the distal sheath 42. When the slider 82 is retracted relative to the handle shaft 81, the distal sheath 42 bends relative to it, which can be set to a state where the cut portion 3 is tensioned (see reference). Figure 2 ).

[0063] The handle body 2 has a socket 5. The socket 5 is located at the connection part 21 of the rotary handle 6. The socket 5 is configured to allow the rotary handle 6 to be inserted. Figure 5 and Figure 6 This is a partial cross-sectional view along the length of the socket 5 and the rotary handle 6. Figure 5 This shows the state where the rotating handle 6 is embedded in the socket 5. Figure 6 This shows the state where the rotating handle 6 has been pulled out from the socket 5. Figure 8 It is Figure 5The section view is indicated by the arrow A8-A8 line. (Example) Figure 5 and Figure 6 As shown, an insertion port 51 is formed in the socket 5, which communicates with the proximal opening of the torque line cavity 2a. The insertion port 51 is a generally cylindrical opening of a size that allows the insertion part of the rotating handle 6 to be inserted.

[0064] A locking portion 53 is formed on the inner circumferential surface 511 of the socket 5. For example... Figure 8 As shown, the locking portion 53 has a plurality of protrusions and recesses 531 and 532. The plurality of protrusions and recesses 531 and 532 of the locking portion 53 are arranged circumferentially in the insertion port 51 of the socket 5. The plurality of protrusions and recesses 531 and 532 are provided at equal intervals in the circumferential direction on the inner circumferential surface 511. The number of protrusions and recesses 531 and 532 is not limited to the example shown in the figure. The locking portion 53 extends from the proximal opening 52 of the insertion port 51 to the distal end and is provided to the middle portion in the length direction. The locking portion 53 is configured such that a plurality of recesses 532 are formed in the proximal portion of the inner circumferential surface 511 of the insertion port 51. Therefore, in the radial direction of the insertion port 51, the protruding end of the protrusion 531 is the same as or located outside the inner circumferential surface 511 on the distal side of the insertion port 51.

[0065] In this embodiment, an example is shown where the socket 5 and the handle body 2 are integrally formed, but the connection portion 21 between the socket 5 and the handle body 2 can also be independent of each other. An example is shown where a pair of protrusions are provided on the rotary handle 6, but the number of protrusions is not limited to the example shown in the figure. The protrusions are any concave-convex structures that can be locked into the locking portion 53, and one or more protrusions are sufficient.

[0066] The rotary handle 6 is connected to the proximal end 7b of the torque line 7. The rotary handle 6 is configured to rotate about the central axis C relative to the handle body 2. Figure 7 This is a perspective view of the rotary handle 6. The rotary handle 6 has a handle 61, an insertion part 62, and a protrusion 63. The handle 61 is a rigid part for the user to grip and rotate. The handle 61 only needs to be shaped to facilitate rotation around the central axis C.

[0067] The insertion portion 62 protrudes from the distal end of the handle 61 along the central axis C. The insertion portion 62 has a generally cylindrical shape. The insertion portion 62 is sized to be inserted into the insertion port 51. A circular base 64 is provided between the insertion portion 62 and the handle 61. A cavity for the torque line 7 to pass through is formed in the base 64 and the insertion portion 62. A planar portion of the proximal end 7b of the torque line 7 is inserted into the distal end face of the insertion portion 62.

[0068] The protrusion 63 protrudes from the outer peripheral surface of the insertion portion 62. In this embodiment, the protrusion 63 extends longitudinally from the base 64 toward the distal end and is located at the proximal end of the insertion portion 62. Figure 7 and Figure 8 As shown, the protrusion 63 is a protruding piece with a roughly triangular cross-sectional shape in a direction orthogonal to the length axis. It is positioned such that the apex 631 of the protrusion 63 extends parallel to the length axis. A slit 65 is formed at the boundary between the protrusion 63 and the outer peripheral surface of the insertion portion 62, communicating with the inner peripheral surface 511 of the insertion port 51. The slit 65 is continuously formed at the distal end and both circumferential sides of the protrusion 63. The protrusion 63 elastically deforms radially when an external force is applied, and in its natural state without an external force applied, it remains as... Figure 8 As shown, the protrusion 63 remains protruding from the outer peripheral surface of the insertion portion 62. When an external force is applied from the radially outer side, the protrusion 63 deflects radially inward. When an external force is applied to the protrusion 63 in the circumferential direction, the protrusion 63 deflects slightly. Compared to when an external force is applied in the circumferential direction, the radial elastic deformation of the protrusion 63 is larger when an external force is applied in the radial direction.

[0069] like Figure 8 As shown, in this example, two protrusions 63 are provided at a position 180 degrees circumferentially separated from the insertion portion 62. Figure 8 As shown, when viewed from the length direction, the protrusion 63 protrudes in a direction orthogonal to the flat surface at the end of the torque line 7. The protrusion 63 may also protrude in a direction along the flat surface.

[0070] The protrusion 63 is configured to engage with the locking portion 53 within the recess 532 of the locking portion 53 of the socket 5. By engaging the multiple protrusions and recesses of the locking portion 53 with the protrusion 63 of the rotary handle 6, the rotation of the rotary handle 6 relative to the handle body 2 is controlled. The control mode for the rotation of the rotary handle 6 relative to the handle body 2 will be described later.

[0071] As described above, the proximal end 7b of the torque line 7 is fixed to the rotating handle 6, and the distal end 7a of the torque line 7 is fixed to the webbing 421 of the distal sheath 42. When the treatment device 1 is arranged in a straight line along its length axis, the planar portions of the distal end 7a and proximal end 7b of the torque line 7 face the same direction. When the rotating handle 6 is rotated about the central axis C, the rotational force of the rotating handle 6 is transmitted via the torque line 7, causing the webbing 421 to rotate, the distal sheath 42 to rotate about the central axis C, and the direction of the cutting portion 3 to change. The direction of the cutting portion 3 can be changed by rotating the rotating handle 6 about the central axis C.

[0072] The treatment device 1 is configured to switch between a first mode and a second mode. The first mode is a mode in which the rotating handle 6 can rotate freely about the central axis C relative to the handle body 2. The second mode is a mode in which the rotation of the rotating handle 6 is limited when the force applied to the rotating handle 6 in the direction of rotation is less than a predetermined amount, and the rotating handle 6 can rotate when the applied force exceeds the predetermined amount.

[0073] Figure 2 , Figure 3 and Figure 6 The first configuration of the handling device 1 is shown. When the rotating handle 6 is positioned in a position retracted relative to the handle body 2 (second position), the protrusion 63 is exposed closer to the end side than the insertion port 51 of the socket 5, thus releasing its engagement with the locking part 53 in the first configuration. When the locking part 53 is released from engagement with the protrusion 63, the rotating handle 6 becomes freely rotatable.

[0074] Figure 4 , Figure 5 and Figure 8 The second embodiment of the treatment device 1 is shown. When the rotating handle 6 is positioned in a position advanced relative to the handle body 2 (first position), the protrusion 63 and the locking part 53 are aligned in the direction of the central axis C of the rotating handle, thereby locking the protrusion 63 and the locking part 53. At this time, the insertion part 62 is disposed in the insertion port 51 of the socket 5, forming a second embodiment where the protrusion 63 and the locking part 53 are engaged. In the second embodiment, the insertion part 62 enters into the distal end of the insertion port 51, the protrusion 63 is disposed in the recess 532, and the base 64 contacts the base end face of the protrusion 531. That is, in the second embodiment, the protrusion 63 is engaged with the locking part 53.

[0075] In the second configuration, the rotation of the rotary handle 6 around the central axis C is restricted, but the rotary handle 6 can rotate when a predetermined amount of force is applied in the rotational direction. Specifically, when a predetermined amount of force is applied to the rotary handle 6 in the rotational direction, a circumferential force is applied to the protrusion 63, and the inclined surface of the protrusion 63 is pushed circumferentially by the convex portion 531, thereby causing the protrusion 63 to elastically deform and flex radially toward the central axis C. When the protrusion 63 flexes by a predetermined amount, the apex 631 of the protrusion 63 can move past the convex portion 531 toward the adjacent circumferential recess 532. That is, in the second configuration, when a predetermined amount of force in the rotational direction is applied to the rotary handle 6, it can move to the adjacent recess 532 in stages. In the second configuration, the rotation amount of the rotary handle 6 can be adjusted by a predetermined amount each time in stages.

[0076] In the second configuration, a locking sensation is provided to the user holding the rotary handle 6 (user feedback, second user feedback). Specifically, when the user holds the rotary handle 6 and rotates it around the central axis C, the vibration of the protrusion 63 passing over the protrusion 531 is transmitted to the user's hand as a locking sensation, providing feedback to the user that a predetermined amount of rotation has been achieved. An audible sound is generated when the protrusion 63 passes over the protrusion 531 during rotary operation. Thus, when the handling device 1 rotates the rotary handle 6 with a force greater than a predetermined amount in the second configuration, the user can identify the rotation of the rotary handle 6 based on the audible sound.

[0077] The treatment device 1 can switch between a first mode and a second mode. In the treatment device 1, the first mode and the second mode can be switched by moving the rotating handle 6 forward or backward relative to the handle body 2. In this embodiment, when the rotating handle 6 is moved forward relative to the handle body 2, it is in the second mode; when the rotating handle 6 is moved backward relative to the handle body 2 from the second mode, it switches back to the first mode. When the rotating handle 6 is moved forward in the first mode, it switches back to the second mode.

[0078] [Instructions for using treatment equipment]

[0079] The operation and usage of the treatment device 1 will be explained using a surgery performed with the treatment device 1 as an example.

[0080] In the following procedure, two surgical operators, U1 and U2, use the treatment system 100 as users. Surgical operator U1 holds the operating part 20 of the treatment instrument 1, while surgical operator U2 holds the endoscope operating part 207 and a portion of the sheath 4 of the treatment instrument 1. While reviewing the image displayed on the monitor, surgical operator U2 operates the input part 209 as needed, inserting the insertion part 202 into the patient P's mouth while bending the flexible part 205. At this time, as... Figure 29 As shown, patient P lies prone on examination table 300 with his face to the right.

[0081] Although not illustrated, a guide wire is inserted from the forceps orifice 206b into the channel 206 and guided through the duodenum into the bile duct. The guide wire, exposed from the forceps orifice 206b, extends from the distal end of the treatment device 1 through the guide wire lumen and is exposed from the proximal side of the treatment device 1. The guide wire extends along the entire length of the treatment device 1.

[0082] As the insertion part 202 moves from the patient P's mouth to the vicinity of the bile duct P3, the site of treatment, the sheath 4 of the treatment instrument 1 and the flexible part 205 of the insertion part 202 bend at multiple points. For example, the part of the treatment instrument 1 that is inserted into the forceps mouth 206b and held by the surgeon U2, the part of the insertion part 202 that bends towards the patient P's mouth as it reaches the vicinity of the upper surface of the examination table 300 from the holding position of the endoscope operation part 207 held by the surgeon U2, the part that bends along the patient P's throat, the part that bends when passing through the patient P's stomach, and the part that bends when the front end of the treatment instrument 1 is lifted by the lifting platform 212 of the endoscope 200.

[0083] The surgical operator U2 advances by inserting the sheath 4 into the channel 206, thereby causing the sheath 4 to protrude from the distal opening 206a.

[0084] Here, during the process of advancing the treatment instrument 1 towards the treatment site, the torque line 7, as described above, bends and twists at multiple points. Therefore, by retracting the rotating handle 6, transitioning from the second configuration to the first configuration, the rotating handle 6 can rotate freely, thus eliminating the twisting of the torque line 7. The surgical operator U2 adjusts the insertion depth of the sheath 4 into the channel 206, causing the distal end of the sheath 4 to protrude from the channel 206.

[0085] Then, the rotating handle 6 is moved forward relative to the handle body 2 to switch to the second configuration, and the distal sheath 42 is inserted into the duodenal papilla P2. For example, as... Figure 28 As shown, when the incision 3 is aligned with the treatment site at a branch point of the bile duct or pancreatic duct, the direction of the incision 3 is adjusted by rotating the operating handle 6 around the central axis C. While the surgeon U1 is reviewing the image and applying force in the direction of rotation to the operating handle 6, the protrusion 63 moves past the protrusion 531 towards the adjacent recess 532. The rotation of the operating handle 6 is transmitted via the torque line 7, and the distal sheath 42 rotates a predetermined amount around the central axis C. At this time, a locking sensation (user feedback, second user feedback) is fed back to the surgeon U1. After adjusting the direction of the incision 3, the treatment instrument 1 remains in the second configuration, holding the incision 3 in the desired direction. In the second configuration, the torque line 7 is allowed to twist. That is, when rotating the operating handle 6 in the second configuration, it can be held in a state where the protrusion 63 engages with the locking part 53, thus allowing the torque line 7 to twist while maintaining the incision 3 aligned with the desired direction.

[0086] The surgeon U1 uses the image captured by the camera unit 203 to confirm the position of the wrapping fold P4 and determine the direction of the incision, and also confirms the direction of the current incision 3. Having determined the direction to be cut, the surgeon rotates the rotating handle 6, which conforms to the second configuration, around the central axis to adjust the direction of the incision 3 to the 12 o'clock position on the image. In this state, when the surgeon U2 moves the lifting platform 212, causing the distal sheath 42 to bend, the distal sheath 42 can protrude in a direction approximately similar to the direction to be cut.

[0087] If the position of the fold P4 of patient P deviates from the 12 o'clock position of the image, the surgeon U1 changes the direction of the incision 3 to the 11 o'clock position as described below.

[0088] The surgical operator U1 rotates the proximal end 7b of the torque line 7 by a predetermined amount in the circumferential direction by rotating the rotating handle 6 about the central axis C.

[0089] The rotational torque is transmitted to the webbing 421 via the torque line 7, and then to the distal sheath 42. Thus, the rotational torque input by the surgical operator U1 using the rotating handle 6 is transmitted to the distal sheath 42 via the torque line 7, and the incision 3 rotates around the central axis C.

[0090] While rotating the rotary handle 6 to apply rotational torque to the sheath 4 via the torque line 7, the surgical operator U1 observes the direction of the distal sheath 42 around the central axis C using an image, and aligns the incision 3 with the 11 o'clock position. This allows the surgical instrument 1 to adjust the direction of the incision 3 even if the desired incision direction differs from the 12 o'clock position due to individual patient differences. Furthermore, when operating the rotary handle 6 in the second configuration, the direction of the incision 3 can be changed gradually. Moreover, when operating the rotary handle 6 in the second configuration, the incision 3 can be kept aligned with the desired direction.

[0091] Next, terminal 74 of the treatment device 1 is connected to a high-frequency power supply. The surgeon U1 retracts the slider 82 of the scalpel handle 8 relative to the handle shaft 81, tensioning the incision section 3. A high-frequency current is supplied from the high-frequency power supply, causing the lifting platform 212 to rise or fall, thereby causing the distal sheath 42 to swing. The high-frequency current and pressure caused by the tension of the incision section 3 are applied to the tissue of the duodenal papilla P2 in contact with the incision section 3, cutting the duodenal papilla P2. For example, if it can be confirmed using imaging that the required incision amount has been achieved, the high-frequency current supply is stopped.

[0092] If the incision of the duodenal papilla P2 is completed, the slide 82 is pushed in so that the incision 3 follows the distal sheath 42, and then the treatment instrument 1 is withdrawn from the channel 206. In place of the treatment instrument 1, a stone retrieval basket forceps (not shown) is inserted into the channel 206 and inserted into the bile duct P3 through the incised duodenal papilla P2 to capture the stone. If the stone is expelled, the stone retrieval basket forceps and endoscope 200 are withdrawn from the body, ending the procedure.

[0093] In the second embodiment, the treatment device 1 can restrict the rotation of the rotating handle 6. Since the circumferential position of the rotating handle 6 relative to the handle body 2 can be maintained at a predetermined position, the direction of the cutting portion 3 can be kept in a predetermined direction. Therefore, even if the sleeve 4 and torque line 7 twist in the insertion path of the treatment device 1, causing an unexpected change in the direction of the cutting portion 3, it can still be maintained in a direction approximately equal to the desired position. Furthermore, in the second embodiment, when a predetermined amount or more of force is applied to the rotating handle 6 in the rotational direction, the rotating handle 6 rotates by a predetermined amount. Therefore, when adjusting the direction of the cutting portion 3, the direction of the cutting portion 3 can be adjusted while preventing significant changes in the direction of the cutting portion 3 caused by twisting of the sleeve 4 and torque line 7.

[0094] The processing device 1 of this embodiment can switch between a first mode and a second mode by simply moving the rotating handle 6 forward or backward relative to the handle body 2.

[0095] In the first embodiment of the processing device 1, since the rotating handle 6 rotates freely, when torsion occurs at the distal end of the torque line 7, the user holding the rotating handle 6 experiences a reaction force generated by the torsion of the torque line 7, and receives a tactile sensation that the rotation of the rotating handle 6 is pushed back in the opposite direction (first user feedback). Because the rotating handle 6 rotates freely, when torsion occurs at the distal end of the torque line 7, in the first embodiment, when the user releases their hand from the rotating handle 6, the rotating handle 6 rotates freely, eliminating the torsion of the torque line 7. Therefore, the torsion of the torque line 7 can be easily eliminated.

[0096] Hereinafter, a variation of the treatment device 1 will be described. The same reference numerals as those used in the above embodiments will be used in the accompanying drawings, and their descriptions will be omitted.

[0097] (Variation Example 1)

[0098] Reference Figures 9-14 The processing device of Modified Example 1 is described. The above embodiment shows an example of switching between a first mode and a second mode by rotating the handle 6 forward and backward relative to the handle body 2, but the structure for switching between the first mode and the second mode is not limited to the example described above. In this modified example, the structure of the handle body, the socket, and the rotating handle differs from that of the above embodiment. Figure 9 and Figure 11 This is a cross-sectional view along the length of the vicinity of the rotating handle 6A and the connecting part 21A of the handling device in Modified Example 1. Figure 9 The second form is shown. Figure 11 The first form is shown.

[0099] The socket 5A is a separate component from the connecting portion 21A of the handle body 2. The socket 5A is mounted to the handle body 2 in a manner that allows it to move forward and backward relative to the connecting portion 21A. A groove 26 extending along the length from the proximal end is formed on the outer peripheral surface of the connecting portion 21A. The socket 5A includes a through passage 562 and a sliding portion 561. The proximal end of the connecting portion 21A is inserted into the through passage 562. Figure 12 As shown, a portion of the circumferential direction of the inner circumferential surface of the through-passage 562 protrudes inward to form a sliding portion 561. The sliding portion 561 enters the groove 26 and can slide along its length within the groove 26. Figure 9 and Figure 11 As shown, a locking portion 53 is formed on the inner peripheral surface 511 at the distal end of the insertion port 51 of the socket 5A.

[0100] like Figure 10 As shown, the structure of the distal end of the rotary handle 6A differs from that in the embodiment described above. A protrusion 63A protrudes distally from the distal surface of the base 64, parallel to the central axis C. The cross-sectional shape of the protrusion 63A, orthogonal to the length direction, is the same as in the embodiment described above.

[0101] The sliding part 561 of the socket 5A is inserted into the slot 26, and the proximal end of the connecting part 21A is inserted into the through passage 562. While the sliding part 561 slides within the slot 26, the socket 5A moves forward and backward relative to the connecting part 21A. The position of the rotating handle 6A relative to the length of the handle body 2 is fixed. Figure 9 As shown, when the socket 5A is in the retracted position, the protrusion 63A is inserted into the insertion port 51 of the socket 5A, and the protrusion 63A is locked in the locking part 53. The rotating handle 6A is set to the second mode. In the second mode, as... Figure 13 and Figure 14 As shown, protrusion 63A is locked to locking portion 53. Similar to the first embodiment, when a force exceeding a predetermined amount in the rotational direction is applied to the rotating handle 6A, the rotating handle 6A rotates by a predetermined amount. At this time, similar to the first embodiment, the user experiences a locking sensation (user feedback, second user feedback). Figure 11 As shown, when the socket 5A is moved forward relative to the connecting part 21A, the rotating handle 6A switches to a first state. In the first state, the sliding part 561 of the socket 5A abuts against the far end of the groove 26, and the protrusion 63A is disposed in the insertion port 51 near the end side of the locking part 53. When the protrusion 63A is released from the locking part 53, the rotating handle 6A becomes freely rotatable. In the first state, the user holding the rotating handle 6A experiences a reaction force generated by the torsion of the torque line 7, etc., and obtains a tactile feeling that the rotation of the rotating handle 6A is pushed back in the opposite direction (first user feedback).

[0102] The handling device of this modified example switches between a first and a second form by moving the socket 5A forward and backward relative to the rotating handle 6A and the handle body 2 along the length direction.

[0103] (Variation Example 2)

[0104] Reference Figures 15-18 The processing device of modified example 2 is explained. The socket and rotating handle can be any structure that utilizes a locking part and a protrusion for locking. For example, it can also be like... Figure 15 and Figure 16As shown in the modified example, multiple protrusions and recesses are provided on the rotating handle 6B, and protrusions are provided on the inner circumferential surface of the socket 5B. The socket 5B of modified example 2, like that of modified example 1, is constructed independently of the connecting portion 21A, and is installed in a manner that allows it to move forward and backward along the length direction relative to the connecting portion 21A but cannot rotate. The socket 5B moves forward and backward along the length direction by sliding within the groove 26 via the sliding portion 561. Figure 16 As shown, a protrusion 58 is provided in the socket 5B. The protrusion 58 protrudes radially inward from the inner circumferential surface of the insertion port 51. Two slits 581 are formed circumferentially separated at the location of the protrusion 58 in the socket 5B. The slits 581 extend longitudinally from the proximal end to the distal end of the socket 5B. As a result of the formation of the slits 581, the protrusion 58 flexes radially when an external force is applied. Multiple protrusions and recesses are formed on the outer circumferential surface of the base 64 of the rotating handle 6B, forming a locking portion 66. The protrusion 58 is locked into the locking portion 66.

[0105] Figure 15 The area showing the rotating handle 6B and the connecting part 21A in the second configuration is illustrated. Figure 17 The area showing the rotary handle 6B and the connecting portion 21A in the first configuration is illustrated. In the second configuration, the socket 5B is positioned retracted relative to the connecting portion 21A. When the socket 5B is in the retracted position, the protrusion 58 is locked in place by the recess 662 of the locking portion 66. When the rotary handle 6B is rotated in the second configuration, as... Figure 18 As shown, the protrusion 58 contacts the protrusion 661 of the locking part 66, and the protrusion 58 flexes radially outward, moving relative to the adjacent recess 662 beyond the protrusion 661, and is locked again. At this time, the user experiences a locking sensation (user feedback, second user feedback). In the first configuration, the socket 5B is positioned at a position advanced relative to the connecting part 21A. In the first configuration, the locking part 66 is exposed at a position closer to the end side than the insertion port 51 of the socket 5B, releasing the engagement between the protrusion 58 and the locking part 66. In the first configuration, the rotating handle 6B rotates freely. In the first configuration, the reaction force generated by the torsion of the torque line 7, etc., is transmitted to the user (first user feedback).

[0106] (Second Implementation)

[0107] Reference Figures 19-23 The processing device 1C 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.

[0108] The processing device 1C in this embodiment is an example where the structure of the operating unit differs from that of the first embodiment. The operating unit 20C in this embodiment does not include the knife handle 8; rotation and cutting operations are performed using a handle 6C. The operating unit 20C includes a handle body 2C and a handle 6C.

[0109] The handle body 2C does not have the two connecting portions 21 and 22 of the branch of the handle body 2 in the first embodiment. The proximal end 23 of the handle body 2C extends in a straight line along its length. A connecting portion 861 for connecting to the handle 6C is provided on the outer periphery of the proximal end 23. A liquid delivery tube head 29 is provided on the proximal end 23 of the handle body 2C. A syringe (not shown) can be attached to and detached from the liquid delivery tube head 29. The liquid delivery tube head 29 communicates with the lumen 231 of the handle body 2C. An operating line 7C passes through the lumen 231 of the handle body 2C. The lumen 231 also functions as a liquid delivery lumen.

[0110] The handle 6C includes a handle shaft 61C, a slider 62C, a terminal port 68, and a socket 5C. The handle shaft 61C is mounted on the proximal end 23 of the handle body 2C. A connecting portion 862 is provided at the distal end of the handle shaft 61C. The handle shaft 61C is connected to the handle body 2C via the connecting portion 861 of the handle body 2C and the connecting portion 862, such that the handle shaft 61C cannot move along the length axis relative to the handle body 2C but can rotate about the central axis C. The handle shaft 61C is engaged with the handle body 2C in a manner that allows it to rotate about the central axis C relative to the handle body 2C. A locking portion 67 is provided on the outer peripheral surface of the handle shaft 61C near the end of the connecting portion 862. The locking portion 67 is composed of multiple protrusions and recesses. The locking portion 67 has a... Figure 15 The locking part 66 shown in the modified example 2 has the same structure.

[0111] The slider 62C is configured to move forward and backward along the length direction relative to the handle shaft 61C. The slider 62C is configured to slide freely relative to the handle shaft 61C. The slider 62C is engaged with the handle shaft 61C in a manner that allows it to move forward and backward relative to the handle shaft 61C but cannot rotate. It has the same structure as the slider 82 of the knife handle 8 in the first embodiment. A terminal port 68 is provided on the slider 62C.

[0112] The operating line 7C is a wire formed of a conductive material and has torque transmission capabilities. A cut-out portion 3 (electrode) is connected to the distal end of the conductive line 72. The cut-out portion 3 can protrude from the distal end of the sheath 4. For example, the portion of the operating line 7C other than the cut-out portion 3 at the distal end is covered with an insulating material. In other words, the operating line 7C has the functions of both the conductive line 72 and the torque line 7 of the first embodiment. The proximal end of the operating line 7C, like the conductive line 72 of the first embodiment, is provided with a terminal 74.

[0113] The proximal end of the operating line 7C passes through the cavity 231 of the handle body 2C, extends through the handle shaft 61C to the vicinity of the terminal port 68, and connects to the terminal 74. The terminal 74 is disposed within the terminal port 68 and fixed to the slider 62C. The terminal 74 can be connected to an external high-frequency power supply. Similar to the knife handle 8 of the first embodiment, when the slider 62C is moved forward relative to the handle shaft 61C, it can be configured such that the cutting portion 3 is straight and follows the outer peripheral surface of the distal sheath 42. When the slider 62C is moved backward relative to the handle shaft 61C, the distal sheath 42 bends relative to it, and the cutting portion 3 can be configured to be in a tensioned state.

[0114] Socket 5C has the same as Figure 15 The socket 5B of the modified example 2 shown has the same structure. The socket 5C is installed in a manner that allows it to move forward and backward along its length but cannot rotate relative to the proximal end 23 of the handle body 2C. The connection part 86 between the handle body 2C and the handle shaft 61C is disposed in the insertion port 51 of the socket 5C.

[0115] Figure 19 The second configuration of the operation unit 20C is shown. Figure 20 The first configuration of the operating unit 20C is shown. The first configuration occurs when the socket 5C is positioned forward relative to the handle body 2C, and the second configuration occurs when the socket 5C is positioned backward relative to the handle body 2C. Figure 20 In the first configuration shown, the engagement between the protrusion 58 and the locking part 67 is released, similar to the modified example 2 described above. In the first configuration, the handle shaft 61C can rotate about the central axis C relative to the handle body 2C. In the first configuration, the user holding the handle shaft 61C experiences a reaction force generated by the torsion of the torque line 7C, etc., and receives a tactile sensation (first user feedback) that the rotation of the handle shaft 61C is pushed back in the opposite direction. Figure 19 In the second embodiment shown, the protrusion 58 is locked into the locking portion 67 by the retraction of the socket 5C. In the second embodiment, the rotation of the handle shaft 61C relative to the handle body 2C is restricted. The structure in which the protrusion 58 of the socket 5C moves past the protrusion of the locking portion 67 toward the adjacent recess when a force of more than a predetermined amount in the rotational direction is applied to the handle shaft 61C is the same as in modified example 2. In the handling device 1C of this embodiment, also in the second embodiment, when the handle shaft 61C is rotated with a force of more than a predetermined amount, the user can obtain a locking sensation (user feedback, second user feedback).

[0116] The treatment device 1C of this embodiment allows the handle 6C to be switched between a first and a second configuration by a simple operation of moving the socket 5C forward and backward along its length. In the first configuration, the handle shaft 61C rotates freely relative to the handle body 2C. Therefore, during surgery using the treatment device 1C, even if the operating line 7C is twisted due to multiple bends in the path of the sheath 4, the handle shaft 61C can still rotate freely by moving the socket 5C to the first configuration, thus eliminating the twisting of the operating line 7C.

[0117] The second embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes are included without departing from the spirit of the present invention. Furthermore, the constituent elements shown in the above embodiments and variations can be appropriately combined to form a configuration.

[0118] (Variation Example 3)

[0119] In the second embodiment, an example is shown where the socket 5C and the handle shaft 61C are locked together using the protrusion 58 of the socket 5C and the locking portion 67 having multiple protrusions and recesses. However, the means of switching between the first and second embodiments is not limited to the above example. For example, it could also be... Figure 21 and Figure 22 The structure of variant example 3 shown. Figure 22 The handle 6C in its first form is shown. Figure 21 The second form of the handle 6C is shown. In this variation, similar to the second embodiment, the handle body 2C and the handle shaft 61C are connected by a connecting part 86 in a rotatable but non-retractable manner. The handle shaft 61C does not have a locking part at its distal end, and the socket 5D does not have a protrusion 58. Figure 21 and Figure 22 As shown, the outer peripheral surface of the proximal end 23D of the handle body 2C and the outer peripheral surface of the distal end 64D of the handle shaft 61C form a tapered surface that expands in diameter towards the proximal end. The socket 5D is an annular component with a cylindrical insertion port 51D having a shape similar to the tapered shape of the outer peripheral surfaces of the handle body 2C and the handle shaft 61C. The socket 5D is configured to be able to move forward and backward relative to the handle body 2C and the handle shaft 61C along the length direction.

[0120] Because the inner diameter of the insertion port 51 at the proximal end of the socket 5D is larger than the outer diameter of the distal end of the handle shaft 61C, when the socket 5D is offset to the distal end, as... Figure 22 As shown, a gap can be formed between the socket 5D and the handle shaft 61C. As a result, the handle shaft 61C is released from its circumferential locking relative to the handle body 2C, achieving a first state of free rotation. Figure 22As shown, if the structure is such that the distal end of the handle shaft 61C is exposed when the socket 5D is positioned on the distal side, the user can easily identify the state when switching to the first mode. Figure 21 As shown, when the socket 5D is positioned on the proximal side, the outer peripheral surface of the handle shaft 61C engages with the inner peripheral surface of the socket 5D through friction. Simultaneously, the outer peripheral surface of the handle body 2C engages with the inner peripheral surface of the socket 5D through friction. As a result, the handle body 2C and the handle shaft 61C are locked in a non-rotatable state by means of the socket 5D.

[0121] The method of switching the relative rotation of the handle body 2C and the handle shaft 61C using the socket 5D is not limited to the friction engagement example. For example, it can also be a structure in which the handle body 2C, the handle shaft 61C, and the socket 5D are engaged by providing locking parts composed of grooves and protrusions.

[0122] In addition, it can also be like Figure 23 and Figure 24 A locking portion 593 is provided on the outer periphery of the socket 5E. The socket 5E has a distal member 591 on the handle body 2C side and a proximal member 592 on the handle shaft 61C side. The distal member 591 and the proximal member 592 abut against each other in the longitudinal direction and have a generally truncated conical shape. A locking portion 593 composed of multiple protrusions and recesses is formed on the outer peripheral surface of the proximal member 592. A protrusion 594 is provided on the outer peripheral portion of the distal member 591. The protrusion 594 is mounted on the outer peripheral surface of the distal member 591 by means of an arm 595. The protrusion 594 is configured to be movable radially along the distal member 591.

[0123] Figure 23 The second configuration of the operating section 20E is shown. Figure 24 The operating section 20E in the first configuration is shown. (Example) Figure 23 As shown, in the second configuration, the protrusion 594 is locked to the locking part 593, and the rotation of the handle shaft 61C relative to the handle body 2C is restricted. Figure 24 As shown, in the first configuration, the arm 595 moves radially outward from the socket 5E, releasing the engagement between the protrusion 594 and the locking portion 593, allowing the handle shaft 61C to rotate freely relative to the handle body 2C. The arm 595 can be moved manually to engage and disengage the protrusion 594 and the locking portion 593. According to this modified example, switching between the first and second configurations is achieved by moving the protrusion 594 radially relative to the locking portion 593.

[0124] For example, the protrusion 594 may also be a structure that can move radially due to the elastic deformation of the arm 595. For example, the protrusion 594 may also be a structure that can be rotatably mounted on the distal member 591 via the arm 595 and move radially.

[0125] The example of socket 5E can also be applied to the operation unit 20 of the first embodiment. Figures 25-27 An example of a modified socket 5F is shown, in which the operation section 20 of the first embodiment is provided with a socket 5E. Figure 25 An example of the second form is shown. Figure 26 An example of the first form is shown. Figure 27 This is a schematic diagram showing the state of the rotating handle 6F in the second configuration.

[0126] like Figures 25-27 As shown, the rotary handle 6F has a flange 641 and a locking portion 642 at the distal end of the base 64. An annular flange 641 is formed at a position distal to the base 64, and a generally cylindrical locking portion 642 is formed from the distal end of the flange 641 toward the distal end. Multiple protrusions and recesses are formed on the outer peripheral surface of the locking portion 642. The handle body 61, base 64, flange 641, and locking portion 642 are coaxially arranged.

[0127] A socket 5F is located at the proximal end 23F of the connecting portion 21 of the handle body 2. The socket 5F has an insertion port 51F, a retaining portion 571, an arm 573, a protrusion 574, and a handle 575. The distal end of the rotating handle 6F is inserted into the insertion port 51F. The retaining portion 571 is located at the proximal opening of the insertion port 51F. The retaining portion 571 surrounds and retains the outer periphery of the flange 641. Because the flange 641 is held by the retaining portion 571, the rotating handle 6F is held in a manner that allows it to rotate relative to the socket 5E but prevents it from moving forward or backward.

[0128] Arm 573 is a portion of the outer peripheral wall of socket 5F that can rotate. The distal end of arm 573 is continuous with connecting part 21, and its proximal end is openable and closable. A claw 576 is provided at the proximal end of arm 573. A handle 575 protrudes outward from the outer peripheral surface of arm 573. The handle 575 is a part for the user to grasp when opening and closing operating arm 573. A protrusion 574 is integrally provided on arm 573. The protrusion 574 protrudes radially inward toward insertion port 51F. A recess 577 is provided on the distal end surface of retaining part 571. When claw 576 is engaged in recess 577, arm 573 is held in the closed state. When arm 573 is closed, protrusion 574 is engaged in locking part 642, becoming a second form.

[0129] When the user grips the handle 575 and tilts it to the distal end, the arm 573 flexes, the claw 576 disengages from the recess 577, and the arm 573 opens. When the arm 573 opens, the protrusion 574 releases its engagement with the locking part 642, resulting in the first configuration. In the first configuration, the rotating handle 6F can rotate freely relative to the handle body 2.

[0130] In the second configuration, the rotation of the rotary handle 6F is restricted by the engagement of the protrusion 574 with the locking portion 642. When a force less than a predetermined amount is applied in the direction of rotation, the rotary handle 6F does not rotate. When a rotational force greater than the predetermined amount is applied, the protrusion 574 moves past the protrusion of the locking portion 642 towards the adjacent recess. At this time, a locking sensation is provided to the user (user feedback, second user feedback). Figure 27 As shown, when arm 573 flexes, handle 575 also moves. The user can also visually recognize that the rotating handle 6F has rotated a predetermined amount.

[0131] exist Figures 23-24 In the example shown, a socket is provided at the connection between the rotary handle and the handle body, and a protrusion and a locking part are provided on the outer side of the socket. The protrusion is supported by the arm and protrudes from the outside of the socket toward the outer peripheral surface of the socket. With the movement of the arm, the user switches between a first state where the protrusion and the locking part are released, and a second state where the protrusion and the locking part are locked. Based on this structure, the user switches between the first and second states by rotating the arm of the socket. Furthermore, since the user can visually identify the positional relationship between the protrusion and the locking part, it is possible to visually determine whether the rotary handle is in the first or second state.

[0132] In the above embodiments, it is possible to switch between a first mode in which the rotary handle can rotate freely and a second mode in which the rotation of the rotary handle is restricted and the rotary handle rotates a predetermined amount each time when a predetermined amount of force is applied.

Claims

1. A treatment device, wherein, The treatment apparatus includes: A tube having a lumen extending along its length axis; A wire that passes through the lumen and extends along the length axis of the tube, the front end of which is attached to the tube; A handle body, which is mounted on the proximal end of the tube; and Rotate the handle, which is connected to the proximal end of the line. The rotary handle has: In the first embodiment, the rotating handle is freely rotatable relative to the handle body about the length axis of the line; and In the second embodiment, the rotation of the rotary handle is limited when the force applied to the rotary handle in the direction of rotation is less than a predetermined amount, and the rotary handle can rotate when the applied force exceeds the predetermined amount.

2. The treatment apparatus according to claim 1, wherein, The rotary handle has a handle shaft and a sliding member that is slidably disposed on the handle shaft. The handle shaft is rotatably engaged with the handle body, and the slider is engaged with the handle shaft in a manner that prevents rotation relative to the handle shaft but allows it to move forward and backward. An electrode that can protrude from the tube is provided at the distal end of the tube. The electrode is connected to the distal end of the wire. The slider is connected to the near end of the line.

3. The treatment apparatus according to claim 1, wherein, It can switch between the first form and the second form.

4. The treatment apparatus according to claim 1, wherein, The first and second modes can be switched by moving the rotating handle relative to the handle body along the length axis of the line.

5. The treatment apparatus according to claim 1, wherein, The handle body has a socket into which the rotating handle can be inserted. The inner circumferential surface of the socket has multiple protrusions and recesses. The outer peripheral surface of the rotary handle has a protrusion. The rotation of the rotary handle relative to the handle body is controlled by the engagement of the plurality of protrusions and recesses with the protrusions.

6. The treatment apparatus according to claim 5, wherein, In the second configuration, the protrusion engages with the plurality of concave and convex surfaces.

7. The treatment apparatus according to claim 5, wherein, In the first configuration, the engagement between the protrusion and the plurality of protrusions and recesses is released.

8. The treatment apparatus according to claim 5, wherein, The engagement between the protrusion and the plurality of protrusions is released by retracting the rotary handle relative to the handle body from the state of engagement between the protrusion and the plurality of protrusions, and the engagement between the protrusion and the plurality of protrusions is achieved by advancing the rotary handle relative to the handle body from the state of disengagement between the protrusion and the plurality of protrusions.

9. The treatment apparatus according to claim 5, wherein, The engagement between the protrusion and the plurality of protrusions and recesses is disengaged by moving the socket from a state where the protrusion is engaged with the plurality of protrusions and recesses, and the engagement between the protrusion and the plurality of protrusions and recesses is re-engaged by moving the socket from a state where the protrusion is not engaged with the plurality of protrusions and recesses.

10. The treatment apparatus according to claim 1, wherein, The distal end of the tube has a linear cut that protrudes from the outer circumferential surface of the tube.

11. The treatment apparatus according to claim 5, wherein, The first configuration releases the locking state of the protrusion and the plurality of protrusions and concaves by offsetting the positions of the protrusion and the plurality of concaves and convexes relative to each other in the axial direction of the rotating handle. The second configuration is a state in which the protrusion and the plurality of protrusions are locked together by aligning their positions with those of the rotating handle along the axial direction.

12. The treatment apparatus according to claim 1, wherein, In the first configuration, the twist of the line is eliminated; in the second configuration, the twist of the line is permitted.

13. The treatment apparatus according to claim 1, wherein, The twisting of the line is eliminated by transitioning from the second form to the first form.

14. The treatment apparatus according to claim 1, wherein, In the second configuration, a locking sensation is provided to the surgical operator holding the rotating handle.

15. The treatment apparatus according to claim 1, wherein, The handle body has a socket into which the rotating handle can be inserted. A portion of the outer peripheral wall of the socket is designed to rotate as an arm, and a protrusion is provided on the arm. The outer peripheral surface of the rotary handle has multiple protrusions and recesses. The rotation of the rotary handle relative to the handle body is controlled by the protrusions and the plurality of interlocking grooves. The protrusion can be moved radially by rotating the arm, thereby switching between the first and second configurations.

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