Detachable multi-ring traction device

Abstract

A detachable multi-loop traction device for insertion into a body through a forceps tube of an endoscope, in which when a diseased mucous membrane in the body is resected by an extracorporeal operation, the traction device is provided with a plurality of loops for traction of the diseased mucous membrane. The detachable multi-ring traction device is configured to be fixed to the lesion mucous membrane and a normal mucous membrane opposite to the lesion mucous membrane through clamps. The detachable multi-ring traction device is provided with a plurality of annular rings having a large circle and a small circle, and two adjacent rings are connected with each other in a manner of being connected with each other in the diameter direction of the large circle in a state that outer edge parts of the two adjacent rings are connected with each other.

Description

[0001] This application is a divisional application of the following application:

[0002] Title of the Invention: Detachable Multi-Ring Traction Device Filing Date: July 9, 2019 Application Number: 201980098220.3 Technical Field

[0003] The present disclosure relates to a detachable multi-ring traction device for medical use. Background Art

[0004] In recent years, early cancers originating from the inner mucosa of the gastrointestinal tract can be efficiently resected minimally invasively by endoscopic submucosal dissection (ESD). A therapist performing ESD, for example, uses an endoscope, a grasping instrument, and a high-frequency scalpel, and performs the surgery in the following order.

[0005] First, the therapist accurately identifies the position of the lesion on the mucosa and makes a full-circumference incision of the mucosa surrounding the lesion. Next, the therapist clamps the mucosa that has been incised in a full circumference with a clamp, pulls the traction device connected to the clamp to lift the mucosa, and at the same time, makes an incision and dissection of the submucosa.

[0006] In ESD, the treatment must be performed under the limited field of view of the endoscope. Therefore, when making an incision of the submucosa and dissecting the mucosa, there may be a situation where the mucosa being resected covers the field of view or the treatment range of the endoscope. When such a state occurs, there may be a risk of obstructing the treatment, increasing the risk of perforation, and prolonging the treatment time.

[0007] For example, Patent Document 1 discloses a technique for solving such problems.

[0008] Prior Art Documents

[0009] Patent Documents

[0010] Patent Document 1: Japanese Unexamined Patent Application Publication No. 2008-62004 Summary of the Invention

[0011] Problems to be Solved by the Invention

[0012] In the technique of Patent Document 1, it cannot be said that the resection of the mucosa is performed efficiently enough, and there is room for further improvement.

[0013] An object of the present disclosure is to provide a traction device that enables efficient incision and dissection of the mucosa in ESD.

[0014] Solutions to the Problems

[0015] The content recorded herein is provided to introduce in a simplified form the content that will be further described in the following detailed description. This summary of the invention is not intended to identify the main features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter.

[0016] A detachable multi - loop traction device according to one aspect of the present disclosure is inserted into the body through the forceps channel of an endoscope. When excising a diseased mucosa in the body by an operation outside the body, in order to traction the diseased mucosa, the detachable multi - loop traction device is configured to be fixed to the diseased mucosa and the normal mucosa opposed to the diseased mucosa by a clamp. The detachable multi - loop traction device includes a plurality of annular loops each having a large circle and a small circle. Adjacent two of the loops are connected to each other in a state where their outer edge portions are in contact with each other and are connected to each other in a manner of being connected in the diameter direction of the large circle. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] Figure 1 (A) of is a front view of a detachable multi - loop traction device according to an embodiment. Figure 1 (B) of is Figure 1 (A) of is a top view. Figure 1 (C) of is Figure 1 (A) of is a right view.

[0018] Figure 2 is a component Figure 1 (A) of is a front view of one loop of the detachable multi - loop traction device.

[0019] Figure 3 is a schematic diagram showing Figure 1 (A) of is a schematic diagram of the first usage method of the detachable multi - loop traction device.

[0020] Figure 4 is a schematic diagram showing Figure 1 (A) of is a schematic diagram of the second usage method of the detachable multi - loop traction device.

[0021] Figure 5 (A) to Figure 5 (C) of is a photograph for explaining the method of introducing the detachable multi - loop traction device of (A) of into the body with a grasping forceps. Figure 1 (A) of is a photograph for explaining the method of introducing the detachable multi - loop traction device of (A) of into the body with a grasping forceps.

[0022] Figure 6 (A) to Figure 6 (D) of is a photograph for explaining the method of introducing the detachable multi - loop traction device of (A) of into the body with a hemostatic clip. Figure 1 (A) of is a photograph for explaining the method of introducing the detachable multi - loop traction device of (A) of into the body with a hemostatic clip.

[0023] Figure 7 (A) to Figure 7(C) shows the situation in a photo when using Figure 1 the detachable multi - loop traction device of (A) to excise the diseased mucosa.

[0024] Figure 8 from (A) to Figure 8 (C) shows the situation in a photo when using Figure 1 the detachable multi - loop traction device of (A) to excise the diseased mucosa.

[0025] Figure 9 from (A) to Figure 9 (C) shows the situation in a photo when using Figure 1 the detachable multi - loop traction device of (A) to excise the diseased mucosa. Detailed implementation mode

[0026] Next, with reference to the drawings, the detachable multi - loop traction device of the implementation mode will be described. The scope of the technology of the present disclosure is not limited to these implementation modes and can be implemented in various ways without changing the gist of the invention.

[0027] <Configuration of the detachable multi - loop traction device>

[0028] In Figure 1 from (A) to Figure 1 (C), the detachable multi - loop traction device 1 (hereinafter, simply referred to as "device 1") of the present implementation mode is shown. Figure 1 (A) represents the front view, Figure 1 (B) represents the top view, Figure 1 (C) represents the right view. It should be noted that the rear view is the same as the front view, the bottom view is the same as the top view, and the left view is the same as the right view.

[0029] The device 1 is configured to be inserted into the body through the forceps channel of a well - known endoscope (not shown), and when excising the diseased mucosa in the body by an operation at the outside of the body, in order to traction the diseased mucosa, it is fixed to the diseased mucosa and the normal mucosa opposed to the diseased mucosa by a clamp.

[0030] The device 1 includes a plurality of (for example, three to five) circular rings 2 having a large circle and a small circle. These rings 2 are connected to each other in a state where the outer edge portions of two adjacent rings 2 are in contact with each other and are connected to each other in the diameter direction of the large circle.

[0031] These rings 2 do not necessarily have to be circular, and can also be, for example, a slightly distorted circle or an ellipse.

[0032] In the embodiment where the device 1 includes three rings 2, the ring 2 at one end is called the first ring 2, the ring 2 at the other end is called the third ring 2, and the ring 2 in the middle is called the second ring 2.

[0033] A plurality of rings 2 can be formed from the same raw material. The raw material of these rings 2 is preferably a synthetic resin that does not contain rubber. The synthetic resin is preferably at least one selected from polyethylene, polypropylene, and polyvinyl chloride.

[0034] The device 1, that is, a plurality of rings 2 connected in a row, can be integrally formed by injection molding a synthetic resin, such as polyethylene, into a mold. Alternatively, the device 1 can be formed by the following method: a linear material having the diameter of the small circle of the ring 2 is formed into a circular ring so as to have the diameter of the large circle, and ultrasonic welding is performed in such a manner that a specified number of rings are connected.

[0035] In addition, it is also possible that after forming a plurality of circular rings from a linear material having the diameter of the small circle of the ring 2 so as to have the diameter of the large circle, these plurality of rings are arranged in a row in the direction of the diameter of the large circle, and adjacent rings are welded to each other by ultrasonic waves.

[0036] Preferably, compared with actively pulling the diseased mucosa by elasticity like rubber, the device 1 pulls the diseased mucosa by the pulling strength between the mucosae. Therefore, the device 1 is not formed of elastic rubber, but is formed of plastic (synthetic resin). This plastic is not elastic and can be deformed to such an extent that it can be inserted into the forceps channel of the endoscope together with a hemostatic clip or a grasping forceps. It is sufficient that the large circle of the ring 2 can be deformed in the folding direction so as to overlap.

[0037] Figure 2 One of the rings 2 constituting the device 1 is shown enlarged. However, in Figure 2 In, in order to highlight the small circle (the thickness of the ring 2), the scale is changed.

[0038] The diameter A of the large circle of one ring 2 is, for example, 5 mm to 10 mm, preferably 6 mm to 8 mm. The diameter B of the small circle of one ring 2 is, for example, 0.1 mm to 0.5 mm, preferably 0.2 mm to 0.4 mm.

[0039] A string of rings 2 can be folded and deformed to such an extent that it can pass through the inside of the forceps channel, and can be extended and deformed in the direction of the diameter of the large circle. However, the ring 2 does not need to have elasticity like rubber.

[0040] <Method of using a detachable multi-ring traction device 1>

[0041] Figure 3 Method 1 of using the device 1 is shown. A side sectional view of the gastrointestinal tract (for example, the stomach or the large intestine, etc.) is shown at the lower part in the figure. The gastrointestinal tract has a surface mucosa layer S, a muscular layer M, and an inner serosa layer I arranged in sequence from the lumen side (the upper side in the figure). The lesion 10 in this example stays in the surface mucosa layer S.

[0042] The therapist uses a scalpel 5, such as a high-frequency scalpel, to make an incision in the surface mucosal layer S in such a way as to surround the diseased mucosa containing the lesion 10 to be excised. Typically, the incision is generally circular or oval in an appropriate size, and is usually set to be only appropriately wider than the lesion 10 by an appropriate width.

[0043] Thereafter, the therapist fixes the first ring 2 of the device 1 to the diseased mucosa containing the lesion 10, that is, the inner side of the incision, by means of the clamp 3. At this time, the therapist can use the forceps 4 to pull the second ring 2 or the third ring 2 with an appropriate force. The therapist pulls the diseased mucosa via the device 1 while cutting off the diseased mucosa with the scalpel 5.

[0044] <Method of using a detachable multi-ring traction device 2>

[0045] Figure 4 Method 2 of using the device 1 is shown. It should be noted that for the Figure 3 same constitution, the same reference numerals are marked and the description is omitted.

[0046] In this method of use 2, the therapist uses the scalpel 5 to make an incision of an appropriate size in the surface mucosal layer S of the diseased mucosa containing the lesion 10. Thereafter, the therapist fixes the first ring 2 of the device 1 to the diseased mucosa to be excised by means of the clamp 3. Then, the therapist fixes the third ring 2 of the device 1 to the normal mucosa S' (the mucosa not to be excised) opposed to the diseased mucosa by means of the clamp 3'.

[0047] Next, the therapist introduces air into the interior of the visceral organ (in this case, into the stomach) at an appropriate pressure and applies a prescribed pressure P. Thus, the clamps 3 and 3' are pulled apart from each other, the device 1 is pulled, and further, the lesion 10 is pulled via the device 1. In this state, the therapist cuts the lower layer side of the diseased mucosa with the high-frequency scalpel 5 and peels off the diseased mucosa.

[0048] In addition to pulling the device 1 with air pressure, or instead of this method, the therapist can also cut the lower layer side of the diseased mucosa with the high-frequency scalpel 5 while pulling the device 1 fixed by the clamps 3 and 3'.

[0049] After the therapist cuts off the diseased mucosa containing the lesion 10, the first ring 2 of the device 1 is cut off. For example, the device 1 can be cut off by the therapist pulling it strongly with forceps, or it can also be cut off using the high-frequency scalpel 5. Thereafter, the therapist recovers the diseased mucosa containing the lesion 10 and conducts a pathological examination, etc.

[0050] In the above treatment, the clamp 3' remaining on the normal mucosa will naturally fall off after a period of time and be discharged out of the body.

[0051] <Method of introducing a detachable multi-ring traction device into the body>

[0052] Next, the situation when the device 1 is inserted into the body through the forceps channel of the endoscope will be described.

[0053] 1. Method of using the grasping forceps

[0054] In Figure 5 from (A) to Figure 5 in (C) of, the sequence of attaching the device 1 to the grasping forceps is shown. The therapist folds the device 1 at the connecting part of the loop 2 in advance and grasps three loops 2 that become the size of one loop 2 with the grasping forceps (refer to Figure 5 in (A) of). The therapist inserts the grasping forceps through the forceps channel to move the device 1 (refer to Figure 5 in (B) of and Figure 5 in (C) of). The therapist can also insert the device 1 into the body through the forceps channel by grasping only one loop 2 (for example, the first loop 2) with the grasping forceps without folding the device 1.

[0055] 2. Method of using the hemostatic clip

[0056] In Figure 6 from (A) to Figure 6 in (D) of, the situation where the device 1 is clamped to the tip of the hemostatic clip and inserted into the body is shown. The therapist hangs the first loop 2 of the device 1 on the root end of the hemostatic clip that comes out of the tip of the sheath (refer to Figure 6 in (A) of), and then, pulls the hemostatic clip into the sheath. Thereby, the device 1 is inserted into the sheath (refer to Figure 6 in (B) of, Figure 6 in (C) of, and Figure 6 in (D) of). The therapist can insert the device 1 into the patient's body by inserting the sheath into the forceps channel.

[0057] <Usage method of the detachable multi-loop traction device in actual ESD>

[0058] Next, referring to Figure 7 from (A) to Figure 9 in (C) of, the sequence of ESD using the device 1 will be described. This usage method is the Figure 4 method shown.

[0059] First, the therapist cuts the mucosa (lesion mucosa) around the lesion into a roughly oval shape with a high-frequency scalpel (refer to Figure 7 in (A) of). Next, the therapist hooks the first loop 2 of the device 1 to the fixture 3 and fixes the fixture 3 to the lesion mucosa 10 (refer to Figure 7(B)). Next, the therapist fixes the third ring 2 of the device 1 to the normal mucosa facing the diseased mucosa 10 with the clamp 3'. At this time, the device 1 is connected between the clamp 3 and the clamp 3' with an appropriate pulling force (see Figure 7 (C) of Figure 8 (A)).

[0060] Next, the therapist applies an appropriate internal pressure to the gastrointestinal tract to expand the gastrointestinal tract. In this way, the device 1 pulls the diseased mucosa 10 (see Figure 8 (B)). In this state, the therapist uses a high-frequency scalpel to excise the lower layer part of the exposed diseased mucosa 10 (see Figure 8 (C)). By excising the entire lower layer of the diseased mucosa 10, the diseased mucosa 10 is separated from the gastrointestinal tract (see Figure 9 (A)). Thereafter, the therapist uses a high-frequency scalpel to cut the third ring 2 fixed to the normal mucosa via the clamp 3' (see Figure 9 (B)). Thus, the device 1 and the diseased mucosa 10 are separated from the gastrointestinal tract (see Figure 9 (C)). It should be noted that the clamp 3' remaining in the gastrointestinal tract will be naturally discharged after an appropriate number of days.

[0061] According to this embodiment, in ESD, when incising the submucosa, the mucosa being excised does not cover the field of view and the treatment range of the endoscope. Therefore, it is possible to smoothly and efficiently excise the diseased mucosa while ensuring a large treatment range.

[0062] It should be noted that the device 1 of this embodiment has three rings 2, but the number of rings 2 can be changed. For example, the device 1 can have four or five rings 2. For example, in the case of performing ESD on the stomach, the device 1 with three to five rings 2 is easy to use.

[0063] In the case of excising the diseased mucosa 10 of the large intestine, sometimes one or two rings 2 can also ensure sufficient length. In this way, when the device 1 is longer than the diseased mucosa, it is also possible to fix the ring at an appropriate position to the clamp without using the entire ring length. For example, the first ring 2 can be fixed to the diseased mucosa 10 via the clamp 3, and the second ring 2 can be fixed to the normal mucosa via the clamp 3'.

Claims

1. A detachable multi-ring traction device inserted into the body through the forceps channel of an endoscope, wherein, when excising a diseased mucosa in the body by an operation outside the body, in order to traction the diseased mucosa, the detachable multi-ring traction device is configured to be fixed to the diseased mucosa and the normal mucosa opposed to the diseased mucosa by a clamp. The detachable multi-ring traction device includes a plurality of annular rings each having a large circle and a small circle. In a state where adjacent two of the rings are in contact with each other at their outer edge portions, they are connected to each other in a manner of being connected along the diameter direction of the large circle.

2. The detachable multi-ring traction device according to claim 1, wherein, the plurality of rings are formed of the same raw material, the raw material is a synthetic resin, and the synthetic resin does not contain rubber.

3. The detachable multi-ring traction device according to claim 2, wherein, the synthetic resin is at least one selected from polyethylene, polypropylene, and polyvinyl chloride.

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