An instrument for removing flat adenoma in duodenum

Abstract

The invention discloses an intraduodenal flat adenoma removal instrument, which comprises an operating instrument, which enters into the position of the intraduodenal flat adenoma through the operating channel of an endoscope, and the operating instrument comprises a marking instrument, a protrusion injection instrument, a cutting instrument, an electrocoagulation instrument, and a hemostasis instrument; the operating instrument itself comprises: a functional unit part, which operates the intraduodenal flat adenoma; and an angle adjustment part, the functional unit part is combined with the angle adjustment part, and the functional unit part does not rotate relative to the angle adjustment part and does not change its relative position, the angle adjustment part comprises: a working part, which is combined with the functional unit part; a control part, which is combined with the working part, and the bending angle of the working part is adjusted by operating the control part so that the working part enters the operation area; and a connecting part, which is used to connect the working part and the control part, and different functional unit parts enter into the duodenum with the working part, and the accurate angle is adjusted by the control part to operate the flat adenoma.

Description

Technical Field

[0001] The present invention belongs to the technical field of medical devices, and more specifically relates to a device for removing tissue in the duodenum in the field of digestion, and specifically is a device for removing flat adenomas in the duodenum. Background Art

[0002] Duodenal adenomas are mostly solitary. Single pedunculated adenomas are prone to pyloric obstruction, while multiple adenomas are rare. Therefore, it is clinically necessary to remove adenomas in the duodenum.

[0003] Duodenal flat adenoma is a type of duodenal adenoma. Due to its non-prominent shape, it is difficult and complicated to remove flat adenomas growing in the duodenum using existing technologies in clinical practice. Existing instruments that can enter the duodenum include duodenoscopes, but using duodenoscopes for resection will cause the operating instrument to change direction to a large extent, as a lifting forceps is provided at the opening of the channel. The lifting forceps can easily cause the operating instrument to bend and change direction, making it impossible to move forward and backward flexibly and effectively, thereby failing to complete the surgical operation in the duodenum.

[0004] Therefore, a cutting instrument capable of effectively removing flat adenomas in the duodenum is needed. Summary of the invention

[0005] In view of the technical difficulties in removing flat adenomas in the duodenum, the present invention combines the existing side-view duodenoscope with the relevant instruments of ESD (endoscopic submucosal dissection) surgery, hoping to mark the location of the flat adenoma first, then cut the marked location, then electrocoagulate and dissect the exposed adenoma, and finally stop the bleeding with a hemostatic device. The specific instrument includes an observation endoscope facing sideways, a handling instrument channel is set next to the endoscope, a forward blocking structure is set in front of the operating instrument channel, and the instrument in the operating channel is controlled by the rear control structure to realize the bending of the front operating part to ensure that the flat adenoma can be operated in the surgical operation area of ​​the observation endoscope.

[0006] The specific technical solution is: an intraduodenal flat adenoma removal device, which includes:

[0007] The operating instruments are inserted into the location of the flat adenoma in the duodenum through the channel of the endoscope. The operating instruments include marking instruments, elevating injection instruments, cutting instruments, electrocoagulation instruments, and hemostatic instruments. The operating instruments themselves include:

[0008] The functional unit parts are the unit parts that perform marking function, elevating injection function, cutting function, electrocoagulation function or hemostasis function; the functional unit parts operate on the flat adenoma in the duodenum; and

[0009] The angle adjustment part, the functional unit part is combined with the angle adjustment part, and the functional unit part does not rotate relative to the angle adjustment part and the relative position does not change. The angle adjustment part includes:

[0010] The working part is combined with the functional unit part;

[0011] The control part is combined with the working part, and the bending angle of the working part is adjusted by operating the control part so that the working part enters the surgical area;

[0012] A connecting part, used to connect the working part and the control part;

[0013] The control part adjusts the angle of the working part through the connecting part, and the functional unit part changes its angle along with the working part. A plurality of different functional unit parts operate the flat adenoma in the duodenum at a suitable angle.

[0014] Furthermore, a control unit controls the working unit to perform bending and rotation operations, and the control unit is arranged on the soft endoscope and / or each operating instrument.

[0015] Furthermore, the control unit is arranged on each operating device to independently operate each operating device; a bending structure for connecting the control unit and the working unit is arranged in the connecting unit; the bending structure includes a pulling rope, and the working unit is a deformable structure that can be deformed. The pulling rope is pulled or loosened by operating the control unit, thereby adjusting the angle of the working unit.

[0016] Furthermore, two symmetrical pulling ropes are provided to adjust the angle changes in two symmetrical directions respectively, and the control unit controls the symmetrically provided pulling ropes to perform opposite pulling actions of pulling or loosening. In this way, the angle adjustment in two different directions can be achieved, and the appropriate bending direction can be selected according to the needs during the specific operation, which increases the selection and reduces the difficulty of operation.

[0017] Furthermore, two control structures are provided to control the change of the length of the pulling rope, and when one of the control structures changes, the other does not change;

[0018] Alternatively, two threaded pulling rods are provided to respectively control the pulling ropes, namely threaded pulling rod 1 and threaded pulling rod 2, threaded pulling rod 1 is connected to pulling rope 1, and threaded pulling rod 2 is connected to pulling rope 2; threaded pulling rod 1 and threaded pulling rod 2 control pulling rope 1 and pulling rope 2 to perform opposite actions of pulling and bending and loosening and returning the working part, so as to ensure that no bending conflict occurs in two symmetrical directions.

[0019] Furthermore, gears 1 and 2 are arranged outside the threaded pulling rod 1 and threaded pulling rod 2, and threaded holes are arranged inside the gears 1 and 2 respectively, which are adapted to the threads of the threaded pulling rod 1 and threaded pulling rod 2, and the gears 1 and 2 rotate in the same direction, driving the threaded rod 1 and threaded rod 2 to move in opposite directions, thereby causing the working part to perform opposite actions of pulling and bending and loosening and returning, and a rotation control structure is arranged to control the simultaneous rotation of the gears 1 and 2. In this way, the control of the pulling rope is effectively achieved.

[0020] Furthermore, the rotation control structure includes a gear hole partially meshing with the gear 1 and the gear 2, and the bending angle of the front end working part can be adjusted by rotating and adjusting the rotation control structure.

[0021] Furthermore, the control part also includes a holding part, which is controlled to remain stationary. When the rotation control structure rotates relative to the holding part, the bending angle of the working part is adjusted; simply rotating the holding part drives the entire operating device to rotate. This method can achieve rotational swinging operations in addition to mutual bending operations, making the control of the working part more convenient.

[0022] Furthermore, the working part of the raised injection device adopts a puncture injection needle with a certain elasticity; the material is similar to the relevant material of the ultrasonic puncture needle.

[0023] Furthermore, the working part is a shape-variable structure with a centrally arranged functional unit part, such as a hose, or a movable part composed of movable joints connected to each other with adjustable angles.

[0024] The beneficial effects of the present invention are:

[0025] 1) By setting a variety of operating instruments and corresponding functional unit parts, and the functional unit parts and the angle adjustment part realize angle adjustment, the angle of entering the flat adenoma in the duodenum is accurate and effective; it can ensure that the flat adenoma in the duodenum can be effectively removed through a series of actions such as marking, protruding, removing, and stopping bleeding in the duodenum.

[0026] 2) By setting up symmetrical double pulling ropes and opposite operating modes, the entry angle selection of the operating instrument can be effectively reduced, ensuring that the operating instrument bends in two directions after being extended. In addition, through the effective cooperation of threaded pulling rod 1, threaded pulling rod 2 and the rotation control structure, the control of the two pulling ropes in opposite directions can be effectively achieved, and the bending state can be effectively maintained, making the operation of the operating instrument entering the duodenal flat adenoma position more stable and smooth. BRIEF DESCRIPTION OF THE DRAWINGS

[0027] Figure 1 The overall structure of the operating device of the present invention is shown in FIG.

[0028] Figure 2It is a schematic diagram of a partially enlarged structure of the front end of the soft endoscope of the present invention with the operating instrument extended;

[0029] Figure 3 It is a partial enlarged structural schematic diagram of the front end of the soft endoscope of the present invention with the operating instrument not extended;

[0030] Figure 4 It is a partial enlarged structural schematic diagram of the operating device of the present invention, in which the front end is a hose;

[0031] Figure 5 It is a partial enlarged structural schematic diagram of the operating device of the present invention, in which the front end is a movable part formed by a movable joint and is in a straightened state;

[0032] Figure 6 It is a schematic diagram of a partially enlarged structure of the operating device of the present invention, in which the front end is a working part formed by a movable joint and is in a bent state;

[0033] Figure 7 It is a partial enlarged structural schematic diagram of two adjacent joints of the operating device of the present invention;

[0034] Figure 8 It is a partial enlarged structural schematic diagram of the movable ring with a short rotating rod of the present invention;

[0035] Fig. 9 It is a longitudinally cutaway structural schematic diagram of a control portion of an operating device with two pulling ropes according to an embodiment of the present invention;

[0036] Fig.10 It is a longitudinally cutaway structural schematic diagram of a control portion of a threadless pulling rod of an operating device with two pulling ropes according to an embodiment of the present invention;

[0037] Fig.11 It is a schematic diagram of a longitudinally cut structure of a cavity above a control portion of a threadless pulling rod of an operating device with two pulling ropes according to an embodiment of the present invention;

[0038] Description of main reference numerals

[0039] 1. Soft endoscope; 11. Observation mirror; 12. Channel opening; 13. Forward blocking structure; 21. Working part; 2111. Movable ring; 2112. Short rotating rod; 2113. Joint body; 2114. Accommodating pipeline; 22. Control part; 23. Connecting part; 241. Pull rope 1; 242. Pull rope 2; 251. Threaded pull rod 1; 252. Threaded pull rod 2; 261. Gear 1; 262. Gear 2; 27. Rotation control structure; 271. Gear hole; 28. Grip; 281. Upper cavity; 282. Lower cavity; 3. Functional unit part. DETAILED DESCRIPTION

[0040] refer to Figure 1-11A device for removing flat adenoma in the duodenum is provided, which improves the duodenoscope facing sideways and sets the inlet and outlet of the incision device for flat adenoma in the duodenum with reference to the ESD operation method. The specific technical scheme is as follows:

[0041] refer to Figure 1 —4. The intraduodenal flat adenoma removal instrument includes an operating instrument, which enters the intraduodenal flat adenoma position through the channel of the endoscope, and the operating instrument includes a marking instrument, a protrusion injection instrument, a cutting instrument, an electrocoagulation instrument, and a hemostatic instrument; the operating instrument itself includes: a functional unit part 3, which is a unit part that performs a marking function, a protrusion injection function, a cutting function, an electrocoagulation function, or a hemostatic function; the functional unit part 3 operates the intraduodenal flat adenoma; and an angle adjustment part, the functional unit part 3 is combined with the angle adjustment part, and the functional unit part 3 does not rotate relative to the angle adjustment part and the relative position does not change, the angle adjustment part includes: a working part 21, which is combined with the functional unit part 3; a control part 22, which is combined with the working part 21, and the bending angle of the working part 21 is adjusted by operating the control part 22, so that the working part 21 enters the surgical area; and a connecting part 23, which is used to connect the working part 21 with the control part 22;

[0042] refer to Figure 1 —4, the control unit 22 adjusts the angle of the working part 21 through the connecting part 23, and the functional unit part 3 changes its angle with the working part 21. Multiple different functional unit parts 3 operate the flat adenoma in the duodenum at a suitable angle. Except for the different functional unit parts 3, the setting methods of other parts of different operating instruments are the same as a whole; the corresponding parts of the functional unit parts 3 that play the corresponding marking, injection, incision, electrocoagulation stripping and hemostasis functions are set in the central position of the operating instrument, and move with the movement of the working part 21 of the operating instrument, and their relative positions relative to the working part 21 and the connecting part 23 change. This setting can ensure that the operating instruments can effectively play their respective functions.

[0043] When in use, the soft endoscope 1 is inserted into the duodenum, and then the entry speed is slowed down after observing the flat adenoma in the duodenum, and the position of the soft endoscope 1 in the duodenum is adjusted. It is best to make the observation mirror 11 face the position of the flat adenoma, and then stop and control the position of the soft endoscope 1; then each operating instrument is sent to the front end of the operating channel through the operating channel, and then the control unit 22 is operated in vitro to change the angle of the working part 21 in the body; and the working part 21 is adjusted to reach the surgical area by moving back and forth, and the surgical area is operated in turn. During the process, the control unit 22 can also be rotated at the rear end to drive the entire operating instrument to rotate, and finally the rotational motion is transmitted to the working part 21, causing it to swing, and at the same time driving the functional unit part 3 combined with the working part 21 to perform the corresponding function and complete the corresponding operation steps; completing the control of the front working part 21 by the control unit 22 at the rear end is a simpler implementation method with relatively easy preparation process. The specific steps of using different operating instruments are as follows: first, during the operation, the marking instrument is sent in to complete the marking operation of the corresponding surgical area of ​​the flat adenoma; after marking, the lifting injection instrument is sent in to complete the lifting operation of the flat adenoma; after lifting, the cutting instrument is sent in to complete the cutting operation of the flat adenoma; after cutting, the electrocoagulation instrument is sent in to complete the electrocoagulation stripping operation of the flat adenoma; after electrocoagulation stripping, the hemostasis instrument is sent in to complete the hemostasis operation of the flat adenoma; and then the removal of the flat adenoma is completed. The effect of removing the flat adenoma by using the new soft endoscope 1 and the corresponding operating instruments is achieved.

[0044] refer to Figure 1 —2. A more preferred embodiment is that the control unit 22 can control the bending and rotation operations of the working part 21, and the control unit 22 is arranged on the soft endoscope 1 and / or on each operating instrument. It is preferred that the control unit 22 is arranged separately on each operating instrument, and the specific embodiment is as follows: the control unit 22 is arranged on each operating instrument, and each operating instrument is operated independently; a bending structure for connecting the control unit 22 and the working part 21 is arranged in the connecting part 23; the bending structure includes a pulling rope, and the pulling rope is a thin pulling rope; the working part 21 is a deformable structure that can be deformed. The pulling rope is pulled or loosened by operating the control unit 22, thereby adjusting the angle of the working part 21.

[0045] Various implementation methods are set according to the number of pulling ropes, wherein the first method is to set a pulling rope. When a pulling rope is set, the control part 22 includes a rotating rod, and the rotating rod is used to wind the pulling rope; the selection of different directions of the rotating rod realizes the winding of more pulling ropes, so as to achieve the purpose of pulling the working part 21 to bend by the pulling rope, and after the working part 21 reaches a suitable bending angle, the selected position of the rotating rod is locked (not shown in the drawings). Alternatively, the control part 22 includes a threaded rod, the threaded rod is connected to the pulling rope, and a rotating nut corresponding to the thread of the threaded rod is set on the control part 22. The rotating nut drives the threaded rod to move up and down, thereby realizing the pulling or loosening of the pulling rope, and achieving the control of the bending angle of the working part 21 (not shown in the drawings).

[0046] Alternatively, refer to Figure 4 —9, two pulling ropes are symmetrically arranged to adjust the bending angle changes in two symmetrical directions of the working part 21 respectively, and the control part 22 controls the symmetrically arranged pulling ropes to pull or release opposite pulling actions. In this way, the angle adjustment in two different directions can be achieved, and the appropriate bending direction can be selected according to the needs during the specific operation, which increases the selection and reduces the difficulty of operation. More specifically, the pulling ropes include a pulling rope 1 241 and a pulling rope 242, and two length control structures for controlling the length change of the pulling ropes are provided, namely, length control structure 1 and length control structure 2. The length control structure 1 controls the length change of the pulling rope 1 241, and the length control structure 2 controls the length change of the pulling rope 2 242. When the length control structure 1 controls the pulling rope 1 241 to be shortened, the working part 21 is bent at an angle; at the same time, the length control structure 2 controls the pulling rope 2 242 to be adaptively extended in an active or passive manner. On the contrary, when the length control structure 2 controls the pulling rope 2 242 to be shortened, the working part 21 is bent at an angle; at the same time, the length control structure 1 controls the extension of the pulling rope 1 241 in an active or passive manner.

[0047] The specific length control structure setting method is as follows: Figure 9-11; The length control structure is a threaded pulling rod; they are respectively a threaded pulling rod 251 and a threaded pulling rod 252, the threaded pulling rod 251 is connected to the pulling rope 241, and the threaded pulling rod 252 is connected to the pulling rope 242; the threaded pulling rod 251 and the threaded pulling rod 252 control the pulling rope 241 and the pulling rope 2 242 to perform opposite actions of pulling and bending and loosening and returning the working part 21, so as to ensure that no bending conflict occurs in the two symmetrical directions. In a more specific implementation, a gear 1 261 and a gear 2 262 are arranged outside the threaded pulling rod 1 251 and the threaded pulling rod 2 252, and threaded holes are arranged inside the gear 1 261 and the gear 2 262, respectively matching with the threads of the threaded pulling rod 1 251 and the threaded pulling rod 2 252, and the gear 1 261 and the gear 2 262 rotate in the same direction, driving the threaded rod 1 and the threaded rod 2 to move in opposite directions, thereby causing the working part 21 to perform opposite actions of pulling and bending and loosening and returning, and a rotation control structure 27 is arranged to control the gear 1 261 and the gear 2 262 to rotate simultaneously. In this way, the control of the pulling rope is effectively achieved.

[0048] In a more specific embodiment, the rotation control structure 27 includes a gear hole 271 in which a portion of the gear 1 261 is meshed with the gear 2 262 , and the bending angle of the front end working portion 21 is adjusted by the rotation control structure 27 .

[0049] A more specific implementation method is to refer to Figure 9-11 The control portion 22 also includes a grip portion 28, which is controlled to remain stationary. When the rotation control structure 27 rotates relative to the grip portion 28, the bending angle of the working portion 21 is adjusted. Simply rotating the grip portion 28 drives the entire operating device to rotate. This method can achieve a rotational swinging operation in addition to the mutual bending operation, making the control of the working portion 21 more convenient.

[0050] In a more specific embodiment, the grip 28 and the functional unit part 3 of the operating device are integrally connected or combined without relative position change. The rotation control structure 27 is arranged in the middle of the grip 28, and relative rotation occurs with respect to the grip 28 but relative position movement does not occur. A bearing platform for bearing the rotation control structure 27, gear 1 261 and gear 2 262 is arranged in the middle of the grip 28; the bearing platform divides the cavity in the grip 28 into two parts, gear 1 261 and gear 2 262 are both arranged in the upper cavity, and the upper cavity and the lower cavity are both provided with a length space that can ensure the vertical movement length of the threaded pull rod 1 251 and the threaded pull rod 2 252, and a cap is arranged on the top of the cavity to ensure that the internal structure is not exposed during operation.

[0051] More specifically, the threaded pulling rod 1 251 and the threaded pulling rod 252 both have a limiting section, wherein at least two limiting plates are provided in the lower cavity, wherein the two limiting plates are respectively located on one side of the threaded pulling rod 1 251 and the threaded pulling rod 252, and the limiting section fits with the limiting plate. When the rotation control structure 27 rotates, the threaded pulling rod 1 251 and the threaded pulling rod 252 are limited by the limiting plate, so that one of the threaded pulling rod 1 251 and the threaded pulling rod 252 gradually moves from the lower cavity toward the upper cavity; the other threaded pulling rod moves from the upper cavity toward the lower cavity.

[0052] Specifically, the endoscope is a soft endoscope 1, which can be a duodenoscope, and includes an observation mirror 11 arranged at the front end of the soft endoscope 1 and facing the side of the soft endoscope 1; the soft endoscope 1 includes an operation channel, the channel opening 12 faces the side, the channel opening 12 is parallel to the direction of the observation mirror 11, and a forward blocking structure 13 is arranged at the front end of the channel; Figure 3 ; The implementation method of the forward blocking structure 13 is explained. The forward blocking structure 13 is provided with an inclined guide slope. When the operating device enters and feels the forward pressure increase, it indicates that it has reached the position of the forward blocking structure 13. The purpose of setting the cleaning guide slope is to reduce the difficulty of directly operating the control part 22. The cleaning guide slope initially completes the bending of the working part 21 of the operating device. In addition, it can also reduce the interference of the forward blocking structure 13 on the working part 21 of the operating device.

[0053] When in use, first extend the operating instrument into the operating channel to the position of the forward blocking structure 13 of the channel opening 12, and then continue to move forward for a distance or directly bend and then move forward for a distance to ensure that the working part 21 enters the surgical area visible to the observation mirror 11. When adjusting the angle, hold the holding part 28 of the control part 22, and then rotate the rotation control structure 27 to adjust the angle. When rotating forward, the control gear 261 rotates forward to drive the threaded pulling rod 251 to move upward, and then drives the pulling rope 241 to retract. The pulling rope 241 drives the working part 21 to bend at an angle and enter the surgical area at a suitable angle. When the position needs to be adjusted, the forward and backward movement can be adjusted by continuing to push the operating instrument forward or pushing the soft endoscope 1 forward. The rotation of the working part 21 can also be adjusted by rotating the holding part 28 at the rear end through the rotation conduction effect, and finally the 3D direction adjustment of the working part 21 in the duodenum is achieved, effectively completing the removal of the flat adenoma.

[0054] Alternatively, another embodiment is: the functional unit part 3 of each operating instrument can be set separately, and the angle adjustment part of the operating instrument can be set separately, and the angle adjustment part of the operating instrument includes the above-mentioned working part 21, connecting part 23 and control part 22; after the angle adjustment part of the operating instrument is combined with the functional unit part 3, no relative rotation and relative position movement occur. When in use, the working part 21 and the control part 22 of the operating instrument are first sent to the appropriate position, and then the functional unit part 3 of each operating instrument is set separately. This setting can effectively reduce the preparation cost of each operating instrument, and the time for each instrument to pass through the long soft endoscope 1 tube can be effectively reduced by setting the inserted operating instrument shell.

[0055] A more preferred embodiment is to illustrate the functional unit part 3 of the marking device and the uplift injection device. The functional unit part 3 of the marking device and the uplift injection device adopts a puncture injection needle with a certain elasticity; the material is similar to the relevant material of the ultrasonic puncture needle; it ensures that it can maintain a bent state to move forward and backward, and can effectively complete the marking and uplift injection actions.

[0056] A more preferred implementation is to set the functional unit parts 3 corresponding to the marking instrument, lifting injection instrument, cutting instrument, electrocoagulation instrument and hemostatic instrument and the angle adjustment part of the operating instrument, or to set the angle adjustment part of the operating instrument according to the existing marking instrument, lifting injection instrument, cutting instrument, electrocoagulation instrument and hemostatic instrument, among which the first method is the main one.

[0057] A more preferred embodiment is that the working portion 21 is a structure with a variable shape in which the functional unit portion 3 is centrally arranged, as shown in FIG. Figure 1 and Figure 4 , the working part 21 includes a hose; or, refer to 5-8; the working part 21 includes an active part formed by mutually connected angle-adjustable active joints. A more preferred embodiment is that a single active joint includes: a hollow active ring 2111 in the middle; a joint body 2113 and a rotating shaft, the joint body 2113 is combined with the active ring 2111 through the rotating shaft; a rotating shaft combined with the current active joint and a rotating shaft combined with the previous active joint are extended from the active ring 2111, and the rotating shaft of the current active joint is perpendicular to the rotating shaft of the previous active joint; the rotating shaft for completing the rotation of an active joint includes two short rotating rods 2112 symmetrically arranged on the active ring 2111. By setting the hollow ring, it can be ensured that the working part 21 can provide an entry channel for the functional unit part 3, and the convenience of setting the functional unit part 3 is ensured. In addition, by setting mutually perpendicular rotating shafts on the active ring 2111 to realize the rotation of the two joint bodies, the arbitrary adjustment of the angle can be well achieved. The shaft can be set as a damping shaft to ensure the stability of the overall structure after the angle is adjusted through damping.

[0058] In a more preferred embodiment, the pulling rope is arranged outside the angle adjustment part, and the pulling rope is confined beside the outer wall of the angle adjustment part by a continuous or discontinuous accommodating pipeline 2114. More specifically, a discontinuous accommodating pipeline 2114 is arranged outside each joint body 2113.

[0059] The technical solutions in the embodiments of the present invention are clearly and completely described above through specific embodiments. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Those skilled in the art can easily understand other advantages and effects of the present invention from the contents disclosed in this specification. The present invention can also be implemented or applied through other different specific implementation methods. In the absence of conflict, the above embodiments and features in the embodiments can be combined with each other. Based on the embodiments in the present invention, all other embodiments obtained by ordinary technicians in this field without making creative work are within the scope of protection of the present invention.

Claims

1. An instrument for removing flat adenoma in the duodenum, characterized in that: These include, The operating instruments are inserted into the location of the flat adenoma in the duodenum through the operating channel of the endoscope. The operating instruments include marking instruments, elevating injection instruments, incision instruments, electrocoagulation instruments, and hemostatic instruments. The operating instruments themselves include: The functional unit parts are the unit parts that perform marking function, elevating injection function, cutting function, electrocoagulation function or hemostasis function; the functional unit parts operate on the flat adenoma in the duodenum; and The angle adjustment part, the functional unit part is combined with the angle adjustment part, and the functional unit part does not rotate relative to the angle adjustment part and the relative position does not change. The angle adjustment part includes: The working part is combined with the functional unit part; The control part is combined with the working part, and the bending angle of the working part is adjusted by operating the control part so that the working part enters the surgical area; A connecting part, used to connect the working part and the control part; The control part adjusts the angle of the working part through the connecting part, and the functional unit part changes its angle along with the working part, and a plurality of different functional unit parts enter the duodenum along with the working part to operate the flat adenoma; The control part is arranged on each operating device, and the working part of each operating device is adjusted independently; a bending structure for connecting the control part and the working part is arranged in the connecting part; the bending structure includes a pulling rope, and the pulling rope is a thin pulling rope; the working part is a deformable structure that can be deformed; Two pulling ropes are symmetrically arranged to adjust the bending angle changes of the working part in two symmetrical directions respectively, and the control part controls the symmetrically arranged pulling ropes to perform opposite pulling actions of pulling or loosening; The pulling rope is a pulling rope 1 and a pulling rope 2, and two length control structures for controlling the length change of the pulling rope are set, namely, the length control structure 1 and the length control structure 2. The length control structure 1 controls the length change of the pulling rope 1, and the length control structure 2 controls the length change of the pulling rope 2; the length control structure 1 controls the working part to bend at an angle when the pulling rope 1 is shortened; at the same time, the length control structure 2 controls the pulling rope 2 to extend adaptively in an active or passive manner; on the contrary, the length control structure 2 controls the working part to bend at an angle when the pulling rope 2 is shortened; at the same time, the length control structure 1 controls the extension of the pulling rope 1 in an active or passive manner; The length control structure is a threaded pulling rod; threaded pulling rod 1 and threaded pulling rod 2 respectively, threaded pulling rod 1 is connected to pulling rope 1, and threaded pulling rod 2 is connected to pulling rope 2; threaded pulling rod 1 and threaded pulling rod 2 control pulling rope 1 and pulling rope 2 to make the working part perform opposite actions of pulling and bending and loosening and returning; Gear 1 and gear 2 are arranged outside the threaded pulling rod 1 and the threaded pulling rod 2, and threaded holes are arranged inside the gear 1 and the gear 2 respectively, which are adapted to the threads of the threaded pulling rod 1 and the threaded pulling rod 2, and the gear 1 and the gear 2 rotate in the same direction, driving the threaded rod 1 and the threaded rod 2 to move in opposite directions, thereby causing the working part to perform opposite actions of pulling and bending and loosening and returning, and a rotation control structure is provided to control the simultaneous rotation of the gear 1 and the gear 2; The rotation control structure includes a gear hole partially meshing with the first gear and the second gear; The control part also includes a gripping part, which is controlled to remain stationary. When the rotation control structure rotates relative to the gripping part, the bending angle of the working part is adjusted; simply rotating the gripping part drives the entire operating device to rotate; The gripping part and the functional unit part of the operating device are integrally connected or combined without any relative position change; The rotation control structure is arranged in the middle of the gripping part, and rotates relative to the gripping part but does not move in relative position. A bearing platform for the rotation control structure, gear one and gear two is arranged in the middle of the interior of the gripping part; the bearing platform divides the cavity in the gripping part into two parts, namely an upper cavity and a lower cavity; gear one and gear two are both arranged in the upper cavity, and the upper cavity and the lower cavity are both provided with a length space that can ensure the vertical movement length of the threaded pulling rod one and the threaded pulling rod two.

2. The flat adenoma removal instrument according to claim 1, characterized in that: The functional unit part of each operating device is separately provided, and the angle adjustment part of the operating device is separately provided; or one angle adjustment part is provided, and a plurality of functional unit parts with corresponding functions are provided.

3. The flat adenoma removal instrument according to claim 1, characterized in that: The working part includes a shape-variable structure with a centrally arranged functional unit part.

4. The flat adenoma removal instrument according to claim 3, characterized in that: The working part includes a hose, or includes a movable part composed of movable joints that are connected to each other and have adjustable angles.

5. The flat adenoma removal instrument according to claim 4, characterized in that: The individual movable joints include: A movable ring, the middle of which is hollow; Joint body; A rotating shaft, through which the joint body is combined with a movable ring; A rotating shaft combined with the current movable joint and a rotating shaft combined with the previous movable joint extend from the movable ring, and the rotating shaft of the current movable joint is perpendicular to the rotating shaft of the previous movable joint; the rotating shaft that completes the rotation of an movable joint includes two short rotating rods symmetrically arranged on the movable ring.

Images