Treatment tool for endoscope

Abstract

The invention provides a treatment tool for an endoscope. This treatment tool for an endoscope is provided with: a sheath; a conductive rod protruding from the front end of the sheath; the electrode is connected with the front end of the rod; an insulator provided further toward the distal end side than the electrode; and an insulating member covering at least a portion of an outer peripheral surface of the rod.

Description

Technical Field

[0001] The present disclosure relates to a treatment instrument for an endoscope. This application claims the benefit of U.S. Provisional Application No. 63 / 620,006, filed on January 11, 2024, the entire text of which is incorporated herein by reference. Background Art

[0002] Conventionally, in endoscopic treatments such as ESD (endoscopic submucosal dissection), an endoscopic treatment instrument such as a high-frequency knife has been used as shown in Patent Document 1 etc. An operator can easily perform incisions of biological tissues using an endoscopic treatment instrument such as a high-frequency knife.

[0003] Prior Art Documents

[0004] Patent Documents

[0005] Patent Document 1: International Publication No. 2014 / 061701 Summary of the Invention

[0006] Problems to be Solved by the Invention

[0007] However, the conventional high-frequency knives described in Patent Document 1 etc. are suitable for large-scale incisions, but it is difficult to perform incisions limited to a narrow range.

[0008] In view of the above circumstances, an object of the present disclosure is to provide an endoscopic treatment instrument capable of performing incisions of biological tissues etc. well.

[0009] Solutions to the Problems

[0010] To solve the above technical problems, the present invention proposes the following technical solutions.

[0011] The endoscopic treatment instrument of the first technical solution of the present disclosure includes: a sheath; a conductive rod protruding from the front end of the sheath; an electrode connected to the front end of the rod; an insulator provided at a position more distal than the electrode; and an insulating member covering at least a part of the outer peripheral surface of the rod.

[0012] Effects of the Invention

[0013] The endoscopic treatment instrument of the present disclosure can perform incisions of biological tissues etc. well. Brief Description of the Drawings

[0014] Figure 1 is an overall view of an endoscopic treatment system according to the first embodiment.

[0015] Figure 2 is a view showing the overall treatment instrument.

[0016] Figure 3It is a perspective view of the front end portion of the treatment instrument.

[0017] Figure 4 It is a side view of the front end portion of the treatment instrument.

[0018] Figure 5 It is a side view of the front end portion of the treatment instrument.

[0019] Figure 6 It is a cross-sectional view along Figure 4 the X1-X1 line shown.

[0020] Figure 7 It is a cross-sectional view along Figure 6 the X2-X2 line shown.

[0021] Figure 8 It is a perspective view of the front end portion of the treatment instrument observed from the proximal end side.

[0022] Figure 9 It is a diagram showing a modified example of the insulating member.

[0023] Figure 10 It is a cross-sectional view of the modified example of the insulating member.

[0024] Figure 11 It is a cross-sectional view along Figure 10 the X3-X3 line shown.

[0025] Figure 12 It is a diagram showing another modified example of the insulating member.

[0026] Figure 13 It is a cross-sectional view of the modified example of the insulating member.

[0027] Figure 14 It is a cross-sectional view along Figure 13 the X4-X4 line shown.

[0028] Figure 15 It is a cross-sectional view along Figure 13 the X5-X5 line shown.

[0029] Figure 16 It is a diagram showing a modified example of the insulating head.

[0030] Figure 17 It is a side view of the front end portion of the treatment instrument of the second embodiment.

[0031] Figure 18 It is a cross-sectional view of the front end portion of the treatment instrument.

[0032] Figure 19 It is a cross-sectional view showing a modified example of the insulating member.

[0033] Figure 20 It is an overall view of the treatment instrument showing the third embodiment.

[0034] Figure 21 It is a cross-sectional view of the front end portion of the treatment instrument.

[0035] Figure 22 It is a cross-sectional view of the front end portion of the treatment instrument.

[0036] Figure 23 It is a cross-sectional view of the front end portion of the treatment instrument.

[0037] Figure 24 It is along Figure 21 The cross-sectional view taken along the line Y1 - Y1 shown.

[0038] Figure 25 It is along Figure 21 The cross-sectional view taken along the line Y2 - Y2 shown.

[0039] Figure 26 It is along Figure 21 The cross-sectional view taken along the line Y3 - Y3 shown.

[0040] Figure 27 It is along Figure 21 The cross-sectional view taken along the line Y4 - Y4 shown.

[0041] Figure 28 It is a figure showing the movement of the blade by the operation of the operation unit.

[0042] Figure 29 It is a figure showing the movement of the blade by the operation of the operation unit.

[0043] Figure 30 It is a figure showing the movement of the blade by the operation of the operation unit.

[0044] Figure 31 It is a figure showing the movement of the blade by the operation of the operation unit.

[0045] Explanation of reference numerals

[0046] 300, Endoscopic treatment system; 200, endoscope; 100, 100C, 100E, treatment instrument (treatment instrument for endoscope, high-frequency treatment instrument); 110, 110C, 110E, treatment part; 1, sheath; 10, outer tube; 11, front-end member; 12, through-hole; 12a, first opening; 14, front-end face; 19, internal space (pipe, lumen); 2, 2C, 2E, knife (electrode); 20, rod (blade body, electrode body); 20c, energization area; 20e, outer cylinder of rod; 20i, core part of rod; 21, 21E, electrode (flange, enlarged diameter part); 21b, base end face (back face); 21p, protrusion; 22, 22E, connector (connecting member); 22b, through-path; 23, 23A, 23B, insulating member (second insulating member); 23C, 23D, 23E, insulating member (second insulating member, insulating tube); 23a, front end; 23b, base end; 24, power transmission member; 3, 3A, insulating head (insulator, first insulating member); 30, main body part; 31, outer side face; 32, front-end part; 33, 33A, base-end part; 33t, conical face; 4, operating wire; 5, 5E, operating part; 51, main body of operating part; 52, sliding member; 53, power supply connector; 56, operating rod (sliding operating rod); A, length axis direction (length direction, axial direction); A1, front-end side (distal side); A2, base-end side (proximal side); C, circumferential direction; R, radial direction. Detailed implementation mode

[0047] (First implementation mode)

[0048] For the endoscopic treatment system 300 of the first implementation mode of the present disclosure, refer to Figures 1 to 9 for description. Figure 1 is an overall view of the endoscopic treatment system 300 of this implementation mode.

[0049] [Endoscopic treatment system 300]

[0050] As Figure 1 shown, the endoscopic treatment system 300 includes an endoscope 200 and a treatment instrument 100. The treatment instrument 100 is inserted into the endoscope 200 for use.

[0051] [Endoscope 200]

[0052] The endoscope 200 is a well-known flexible endoscope, and includes an insertion part 202 inserted into the body from the front end and an operation part 207 installed at the base end of the insertion part 202.

[0053] The insertion portion 202 has an imaging unit 203, a bending portion 204, and a flexible portion 205. Starting from the front end of the insertion portion 202, the imaging unit 203, the bending portion 204, and the flexible portion 205 are arranged in sequence. Inside the insertion portion 202, there is a channel 206 for inserting the treatment instrument 100. At the front end of the insertion portion 202, there is a front end opening 206a of the channel 206.

[0054] The imaging unit 203 includes imaging elements such as a CCD, a CMOS, etc., and can image the part to be treated. In a state where the treatment instrument 100 protrudes from the front end opening 206a of the channel 206, the imaging unit 203 can image the front end portion of the treatment instrument 100.

[0055] The bending portion 204 bends according to the operation of the operation unit 207 by the operator. The flexible portion 205 is a flexible tubular part.

[0056] The operation unit 207 is connected to the flexible portion 205. The operation unit 207 has a handle 208, an input unit 209, a proximal end opening 206b of the channel 206, and a general cable 210. The handle 208 is the part held by the operator. The input unit 209 receives an operation input for causing the bending portion 204 to perform a bending operation.

[0057] The general cable 210 includes an image signal line for outputting the image captured by the imaging unit 203a to the outside. The image signal line is connected to a display device such as a liquid crystal display via an image processing device having a processor, etc.

[0058] [Treatment instrument 100]

[0059] Figure 2 It is an overall view showing the treatment instrument 100.

[0060] The treatment instrument (endoscope treatment instrument, high-frequency treatment instrument) 100 is an ESD knife. The treatment instrument 100 includes a sheath 1, a knife 2, an insulating head 3, an operation wire 4 (refer to Figure 4 ) and an operation unit 5. The knife 2 and the insulating head 3 constitute a "treatment portion 110" for treating the affected part. In the following description, the side inserted into the patient's body in the length axis direction (length direction, axial direction) A of the treatment instrument 100 is called the "front end side (distal side) A1", and the operation unit 5 side is called the "proximal end side (proximal side) A2".

[0061] The sheath 1 is a longitudinally long tubular member extending from the front end 1a to the base end 1b. The sheath 1 can be inserted into the channel 206 of the endoscope and can advance and retreat in the channel 206. As Figure 1 shown, in a state where the sheath 1 is inserted into the channel 206, the front end 1a of the sheath 1 can protrude from and retract into the front end opening 206a of the channel 206.

[0062] Figure 3 is a perspective view of the distal end portion of the treatment instrument 100.

[0063] The sheath 1 has an outer tube 10 extending in the longitudinal axis direction A and a distal end member 11 provided at the distal end of the outer tube 10. Additionally, the sheath 1 may be formed by integrally molding the outer tube 10 and the distal end member 11.

[0064] The distal end member 11 is formed in a cylindrical shape. Additionally, the "cylindrical shape" includes shapes close to the cylindrical shape in addition to the strict cylindrical shape. The distal end member 11 is preferably formed of an insulating material such as resin. A through hole 12 is formed in the distal end member 11.

[0065] The through hole 12 is provided in the distal end member 11 and is a hole that penetrates the distal end member 11 in the longitudinal axis direction A. The distal end of the through hole 12 communicates with a first opening 12a formed in the distal end surface 14 of the distal end member 11. The proximal end of the through hole 12 communicates with the internal space 19 of the outer tube 10.

[0066] Figure 4 and Figure 5 is a side view of the distal end portion of the treatment instrument 100.

[0067] The knife (electrode) 2 is a metal member. The knife 2 is formed of a raw material such as stainless steel, for example. The knife 2 has conductivity and is supplied with high-frequency current. The knife 2 has a rod 20, an electrode 21, a connector 22, and an insulating member 23.

[0068] The rod (blade body, electrode body) 20 is a metal rod-shaped member. Additionally, the "rod shape" includes shapes close to the rod shape in addition to the strict rod shape. The rod 20 is disposed on the distal end side A1 of the sheath 1. An operation wire 4 is attached to the proximal end of the rod 20.

[0069] The rod 20 penetrates the through hole 12 of the distal end member 11 of the sheath 1 along the longitudinal axis direction A and can project and retract freely from the first opening 12a toward the distal end side A1. Additionally, the rod 20 may be fixed in a state of projecting from the first opening 12a toward the distal end side A1 so as not to be able to advance or retreat.

[0070] The central axis O2 in the longitudinal axis direction A of the rod 20 preferably coincides with the central axis O1 in the longitudinal axis direction A of the sheath 1. Additionally, "coincide" includes forms that are almost coincident in addition to the strictly coincident form.

[0071] Figure 6 is a cross-sectional view along Figure 4 the X1-X1 line shown. Figure 7 is along Figure 6A cross-sectional view of the X2-X2 line shown. The outer peripheral surface of the rod 20 is covered with an insulating member (second insulating member) 2.

[0072] Figure 8 It is a perspective view of the front end portion of the treatment instrument 100 as viewed from the proximal end side A2.

[0073] The electrode (diameter-expanded portion) 21 is connected to the front end of the rod 20 and is a plate-shaped conductive member extending from the outer peripheral surface of the rod 20. The electrode 21 extends in the radial direction of the length axis of the rod 20. A planar base end surface (back surface) 21b is formed on the proximal end side A2 of the electrode 21. The base end surface 21 is not limited to a planar surface and may be, for example, a surface with unevenness.

[0074] A plurality of electrodes 21 project outward from the outer peripheral surface of the rod in the radial direction R. The electrodes 21 extend at equal intervals along the circumferential direction C around the length axis of the rod 20. When viewed from the front in the direction along the length axis direction A, the electrode 21 is formed in a three-pronged shape. In addition, the electrode 21 may be formed in a four-pronged shape or a five-pronged shape. That is, the electrode 21 may be formed in a radial shape extending radially outward in a plurality of directions from the central axis O2 of the rod 20. In addition, the electrode 21 may be formed in a flange shape such as a disk shape or a polygonal shape.

[0075] The insulating member 23 covers the entire outer peripheral surface of the rod 20. In addition, the base end surface 21b of the electrode 21 and the front end of the insulating member 23 coincide. That is, the insulating member 23 covers at least the outer peripheral surface of the portion of the rod 20 from the base end of the electrode 21 to the front end of the sheath 1. The insulating member 23 is, for example, an insulating coating formed of PTFE, PEEK, etc.

[0076] The connector (connecting member) 22 is a metal cylindrical member. In addition, the "cylindrical shape" includes shapes close to a cylindrical shape in addition to a strict cylindrical shape. The connector 22 connects the rod 20 and the operating wire 4.

[0077] As Figure 4 shown, when the knife 2 is advanced relative to the sheath 1, the front end of the connector 22 contacts the front end member 11. By the front end of the connector 22 contacting the front end member 11, the knife 2 is positioned at the most front end side A1 position, that is, the first position P1.

[0078] As Figure 5 shown, when the knife 2 is retracted relative to the sheath 1, the base end surface 21b of the electrode 21 contacts the front end surface 14 of the front end member 11. By the base end surface 21b of the electrode 21 contacting the front end member 11, the knife 2 is positioned at the most proximal end side A2 position, that is, the second position P2.

[0079] By operating the operating wire 4 to move forward and backward, the blade 2 can move forward and backward within the range from the first position P1 to the second position P2. In addition, the blade 2 can also be fixed in a state of protruding from the first opening 12a toward the distal end side A1 in a non-retractable manner.

[0080] High-frequency current is supplied from the operating wire 4 connected to the operating portion 5 to the blade 2. When high-frequency current is supplied from the operating wire 4 to the blade 2, the electrode 21 functions as a monopolar electrode that outputs high-frequency current to the biological tissue. In the present embodiment, since the outer peripheral surface of the rod 20 is covered with the insulating member 23, high-frequency current is not supplied from the outer peripheral surface of the rod 20 to the biological tissue.

[0081] The insulating head (insulator, first insulating member) 3 is formed of an insulating material such as ceramic or resin. The insulating head 3 is provided at a position closer to the distal end side A1 than the electrode 21. In the present embodiment, the proximal end of the insulating head 3 is fixed to the rod 20 in a state of being in contact with the electrode 21. In the direction orthogonal to the longitudinal axis direction A, the electrode 21 is disposed at a position radially R inward of the outer side surface 31 of the insulating head 3 within the entire circumference.

[0082] Preferably, the central axis O3 in the longitudinal axis direction A of the insulating head 3 coincides with the central axis O1 in the longitudinal axis direction A of the sheath 1. In addition, "coincide" includes not only a strictly coincident form but also a nearly coincident form.

[0083] The insulating head 3 has a main body portion 30, a front end portion 32 disposed on the front end side A1 of the main body portion 30, and a base end portion 33 disposed on the base end side A2 of the main body portion 30. The front end portion 32, the main body portion 30, and the base end portion 33 are connected in an array in the longitudinal axis direction A. The front end portion 32 and the base end portion 33 may be integrally formed with the main body portion 30 or may be formed by connecting different members to the main body portion 30.

[0084] The main body portion 30 is formed in a cylindrical shape. The central axis in the longitudinal axis direction A of the front end portion 32 coincides with the central axis O3.

[0085] The front end portion 32 is provided at the front end of the main body portion 30. The front end portion 32 is formed in a hemispherical (dome) shape and has a reduced diameter toward the front end side A1. In addition, the shape of the front end portion 32 is not limited to the hemispherical shape and may also be a cylindrical shape.

[0086] The base end portion 33 is provided at the base end of the main body portion 30. The base end portion 33 is formed in a hemispherical (dome) shape and has a reduced diameter toward the base end side A2. In addition, the shape of the base end portion 33 is not limited to the hemispherical shape and may also be a cylindrical shape.

[0087] The electrode 21 is located between the insulating head (first insulating member) 3 and the insulating member (second insulating member) 23 in the longitudinal axis direction A. At least a part of the electrode 21 protrudes radially outward beyond the outer diameter R of the outer circumferential rod 20 of the insulating member 23. The outer diameter of the insulating member (second insulating member) 23 is smaller than at least a part of the outer diameter of the insulating head (first insulating member) 3.

[0088] The operating wire 4 is a metallic wire member that penetrates the internal space (pipe, lumen) 19 of the outer tube 10. The operating wire 4 is formed of a raw material such as stainless steel, for example. The front end of the operating wire 4 is connected to the rod 20, and the base end of the operating wire 4 is connected to the operating portion 5.

[0089] As Figure 1 And Figure 2 shown, the operating portion 5 has an operating portion main body 51, a slider 52, and a power supply connector 53.

[0090] The front end portion of the operating portion main body 51 is connected to the base end 1b of the sheath 1. The operating portion main body 51 has an internal space through which the operating wire 4 can pass. The operating wire 4 extends through the internal space 19 of the outer tube 10 and the internal space of the operating portion main body 51 to the slider 52.

[0091] The slider 52 is mounted on the operating portion main body 51 so as to be movable relative to the operating portion main body 51 in the longitudinal axis direction A. The base end portion of the operating wire 4 is mounted on the slider 52. The surgical operator moves the slider 52 relative to the operating portion main body 51 forward and backward, thereby moving the operating wire 4 and the knife 2 forward and backward.

[0092] The power supply connector 53 is fixed to the slider 52. The power supply connector 53 can be connected to a high-frequency power supply device (not shown), and is connected to the base end portion of the operating wire 4 via a conductive wire. The power supply connector 53 can supply high-frequency current supplied from the high-frequency power supply device to the rod 20 via the operating wire 4. In addition, the power supply connector 53 may be fixed to the operating portion main body 51 instead of being fixed to the slider 52.

[0093] In the treatment instrument 100 according to the present embodiment, since the rod 20 is covered with the insulating member 23, the conductive portion that can conduct electricity to the tissue can be reduced. Therefore, it is possible to limit the cutting of the biological tissue of the cutting target and perform the cutting of the biological tissue well. By enabling cutting to be performed only by the electrode 21 disposed between the insulating head 3 and the insulating member 23, thermal invasion of the tissue can be suppressed.

[0094] As described above, the first embodiment of the present disclosure has been described in detail with reference to the drawings, but the specific structure is not limited to this embodiment, and also includes design changes and the like within the scope not exceeding the gist of the present disclosure. In addition, the constituent elements shown in the above-described embodiment and modification examples can be appropriately combined.

[0095] (Modification Example 1)

[0096] Figure 9 It is a view showing an insulating member 23A which is a modification example of the insulating member 23. Figure 10 It is a cross-sectional view of the rod 20 and the insulating member 23A. Figure 11 It is along Figure 10 The cross-sectional view taken along the line X3-X3 shown. The insulating member 23A is provided inside the rod 20 of the conductor. The rod 20 has a rod core portion 20i and a rod outer cylinder 20e, and the insulating member 23A is provided between the rod core portion 20i and the rod outer cylinder 20e. The rod core portion 20i is connected to the electrode 21 and supplies high-frequency current to the electrode 21. The rod outer cylinder 20e is formed of a conductor, but is electrically separated from the rod core portion 20i by the insulating member 23A and does not supply high-frequency current. Therefore, high-frequency current is not supplied from the rod outer cylinder 20e to the biological tissue.

[0097] (Modification Example 2)

[0098] Figure 12 It is a view showing an insulating member 23B which is a modification example of the insulating member 23. Figure 13 It is a cross-sectional view of the rod 20 and the insulating member 23B. Figure 14 It is along Figure 13 The cross-sectional view taken along the line X4-X4 shown. Figure 15 It is along Figure 13 The cross-sectional view taken along the line X5-X5 shown. The insulating member 23B covers a part of the circumferential direction C of the outer peripheral surface of the rod 20. Specifically, the insulating member 23B intermittently covers a part of the circumferential direction C of the outer peripheral surface of the rod 20, and the insulating member 23B and the energization region 20c are alternately arranged in the circumferential direction C. The insulating member 23B separates the outer peripheral surface of the rod 20 into three energization regions 20c arranged. The energization region 20c extends along the longitudinal axis direction A and is rectangular in shape. Alternatively, the insulating member 23B and the energization region 20c may be arranged along each half circumference of the outer peripheral surface of the rod 20.

[0099] (Modification Example 3)

[0100] Figure 16 It is a view showing an insulating head 3A which is a modification example of the insulating head 3.

[0101] The insulating head 3A has a main body portion 30, a front end portion 32, and a base end portion 33A which is a modified example of the base end portion 33. The base end portion 33A has a tapered surface 33t that tapers toward the electrode 21 (toward the base end side A2). The base end of the tapered surface 33t abuts against the root of the electrode 21. The electrode 21 has a protruding portion 21p that extends outward in the radial direction R of the rod 20 relative to the base end of the tapered surface 33t. Since the tapered surface 33t is separated from the protruding portion 21p and the front end surfaces of the tapered surface 33t and the protruding portion 21p face each other with a gap therebetween, a front space (gap) SF is formed between the tapered surface 33t and the protruding portion 21p. By ensuring the front space (gap) SF of the protruding portion 21p of the electrode 21, the surgical operator can perform incision treatment using the electrode 21 well.

[0102] (Second Embodiment)

[0103] Refer to Figures 17 to 19 , the treatment instrument 100C of the second embodiment of the present disclosure will be described. In the following description, the same reference numerals are assigned to the same structures as those already described, and repeated descriptions are omitted.

[0104] Figure 17 is a side view of the front end portion of the treatment instrument 100C.

[0105] The treatment instrument (endoscopic treatment instrument, high-frequency treatment instrument) 100C is an ESD knife. The treatment instrument 100C includes a sheath 1, a knife 2C, an insulating head 3, an operating wire 4, and an operating portion 5. The knife 2C and the insulating head 3 constitute a "treatment portion 110C" for treating the affected part.

[0106] The knife (electrode) 2C is a metal member. The knife 2C is formed of a raw material such as stainless steel, for example. The knife 2C has conductivity and is supplied with high-frequency current. The knife 2C has a rod 20, an electrode 21, a connector 22, and an insulating member 23C.

[0107] Figure 18 is a cross-sectional view of the front end portion of the treatment instrument 100C.

[0108] The insulating member 23C is an insulating tube that covers the outer peripheral portion of the rod 20. The insulating member 23C is, for example, an insulating tube formed of PTFE, PEEK, or the like. The insulating member 23C is attached to the rod 20 by fitting or heat shrinkage. The front end 23a of the insulating member 23C is disposed in the rod 20 at a position closer to the proximal end side A2 than the electrode 21, and a gap is provided between the proximal end surface 21b of the electrode 21 and the front end 23a of the insulating member 23C. The proximal end 23b of the insulating member 23C is disposed at a position closer to the front end side A1 than the connector 22 that connects the rod 20 and the operating wire 4. Thus, the front end portion of the rod 20 is exposed from the insulating member 23C. The insulating member 23C covers the proximal end side of the portion of the rod 20 that protrudes from the sheath 1. The blade 2C is configured not to energize the living tissue from at least a partial outer peripheral surface of the rod 20.

[0109] As Figure 18 shown, even when the blade 2 is disposed at the first position P1, the proximal end 23b of the insulating member 23C is disposed at a position closer to the proximal end side A2 than the first opening 12a of the sheath 1 and does not protrude from the first opening 12a.

[0110] With the treatment instrument 100C according to the present embodiment, incision of living tissue can be satisfactorily performed. By enabling incision with the exposed front end portion of the electrode 21 and the rod 20, heat invasion to the tissue can be suppressed.

[0111] As described above, the second embodiment of the present disclosure has been described in detail with reference to the drawings. However, the specific structure is not limited to this embodiment and also includes design changes and the like within the scope not exceeding the gist of the present invention. In addition, the constituent elements shown in the above-described embodiment and modification examples may be appropriately combined.

[0112] (Modification Example 2-1)

[0113] Figure 19 is a cross-sectional view showing an insulating member 23D as a modification example of the insulating member 23C.

[0114] The proximal end 23b of the insulating member 23D may also extend to the connector 22. In this case, the proximal end 23b of the insulating member 23D is caulked and fixed at the connector 22.

[0115] In addition, the insulating head 3 of the treatment instrument 100C may also have a tapered surface 33t like the Figure 16 insulating head 3A shown. A front space (gap) SF is formed between the tapered surface 33t and the protruding portion 21p of the electrode 21.

[0116] (Third Embodiment)

[0117] Refer to Figures 20 to 27, the treatment instrument 100E of the third embodiment of the present disclosure will be described. In the following description, the same reference numerals are given to the same structures as those already described, and repeated descriptions are omitted.

[0118] Figure 20 It is an overall view showing the treatment instrument 100E.

[0119] The treatment instrument (endoscope treatment instrument, high-frequency treatment instrument) 100E is an ESD knife. The treatment instrument 100C includes a sheath 1, a knife 2E, an insulating head 3, an operating wire 4, and an operating portion 5E. The knife 2E and the insulating head 3 constitute a "treatment portion 110E" for treating the affected part.

[0120] Figures 21 to 23 It is a cross-sectional view of the front end portion of the treatment instrument 100E. Figure 24 It is along Figure 21 The cross-sectional view taken along the Y1 - Y1 line shown. Figure 25 It is along Figure 21 The cross-sectional view taken along the Y2 - Y2 line shown. Figure 26 It is along Figure 21 The cross-sectional view taken along the Y3 - Y3 line shown. Figure 27 It is along Figure 21 The cross-sectional view taken along the Y4 - Y4 line shown. The knife (electrode) 2E is a metal member. The knife 2E is formed of a raw material such as stainless steel, for example. The knife 2E has conductivity and is supplied with high-frequency current. The knife 2E has a rod 20, an electrode 21E, a connector 22E, an insulating member 23E, and a power transmission member 24.

[0121] The electrode 21E is a disc-shaped conductive member provided at the front end of the rod 20. When viewed in the front view along the direction of the length axis A, the outer peripheral portion of the electrode 21E is disposed at a position radially R inside the outer side surface 31 of the insulating head 3A within the entire circumference.

[0122] The connector 22E is a substantially cylindrical member made of metal. The connector 22E connects the rod 20 and the operating wire 4. By advancing and retracting the operating wire 4, the connector 22E and the rod 20 advance and retract. As Figure 26 Shown, in the connector 22E, a through path 22b having a concave cross-section is provided on both sides in the radial direction R with the rod 20 interposed therebetween.

[0123] The insulating member (insulating tube) 23E is an insulating tube covering the outer peripheral portion of the rod 20. The insulating member 23E is mounted on the rod 20 along the outer peripheral portion of the rod 20 so as to be able to advance and retract in the direction of the length axis A.

[0124] The power transmission member 24 is a member that advances and retreats along the length axis direction A through the through path 22b. The front end of the power transmission member 24 is mounted on the insulating member 23E. The base end of the power transmission member 24 is connected to the operating rod 56 of the operating portion 5E. By advancing and retreating the power transmission member 24 relative to the operating wire 4, the insulating member 23E advances and retreats relative to the rod 20. As Figure 21 shown, the power transmission member 24 can advance relative to the operating wire 4 and the sheath 1 until the front end of the insulating member 23E abuts against the electrode 21E. In addition, it can also be as Figure 23 shown, configured such that in the state where the knife 2E advances to the maximum extent, the power transmission member 24 advances until it abuts against the front end member 11. In this case, it is configured such that in the state where the knife 2E advances to the maximum extent, when the front end of the power transmission member 24 advances until it abuts against the front end member 11, a gap is provided between the base end surface of the electrode 21E and the front end of the insulating tube 23E.

[0125] The operating portion 5E includes an operating portion main body 51, a slider 52, a power supply connector 53, and an operating rod 56.

[0126] The operating rod (sliding operating rod) 56 is mounted on the slider 52 so as to be able to advance and retreat. The base end of the power transmission member 24 is mounted on the operating rod 56. By advancing and retreating the operating rod 56, the power transmission member 24 advances and retreats.

[0127] Figures 28 to 31 is a diagram showing the movement of the knife 2E by the operation of the operating portion 5E.

[0128] As Figure 28 shown, when the slider 52 and the operating rod 56 are retracted, the front end of the insulating member 23E is disposed in the inner space 19 of the sheath 1. By retracting the operating rod 56 to the maximum extent, the insulating member 23E can be retracted to a position where the front end of the insulating member 23E is located within the sheath 1.

[0129] As Figure 29 and Figure 30 shown, the surgical operator can advance the rod 20 and the insulating member 23E together by advancing the slider 52 relative to the operating portion main body 51 so that the slider 52 and the operating rod 56 advance together.

[0130] As Figures 28 to 31 shown, the surgical operator can advance and retreat the insulating member 23E relative to the rod 20 by advancing and retreating the operating rod 56 relative to the slider 52. As Figure 30 shown, in the state where the rod 20 advances to the maximum extent, by advancing the operating rod 56 to the maximum extent, the insulating member 23E can advance relative to the rod 20 until the front end of the insulating member 23E abuts against the electrode 21E. As Figure 31As shown, in a state where the rod 20 is advanced to the maximum extent, by retracting the operating lever 56 to the maximum extent, the insulating member 23E can be retracted relative to the rod 20 to a position where the front end of the insulating member 23E is located within the sheath 1. That is, the insulating member 23E can move forward and backward between a position where the front end of the insulating member 23E abuts against the electrode 21E and a position where the front end of the insulating member 23E is located within the sheath 1. Alternatively, in a state where the rod 20 is advanced to the maximum extent, the insulating member 23E can move forward and backward between a position where the front end of the insulating member 23E abuts against the electrode 21E and a position where the front end of the insulating member 23E is located between the electrode 21E and the front end of the sheath 1. Further alternatively, in a state where the rod 20 is advanced to the maximum extent, the insulating member 23E can move forward and backward between a position where the front end of the insulating member 23E is disposed within the sheath 1 and a position where the front end of the insulating member 23E is disposed between the electrode 21E and the front end of the sheath 1.

[0131] With the treatment instrument 100E according to the present embodiment, by adjusting the position of the insulating member 23E in accordance with the type of treatment and the condition of the affected part, the exposed degree of the rod 20 can be adjusted.

[0132] As described above, the third embodiment of the present disclosure has been described in detail with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and also includes design changes and the like within the scope not exceeding the gist of the present invention. In addition, the constituent elements shown in the above embodiments and modified examples can be appropriately combined.

[0133] In addition, the insulating head 3 of the treatment instrument 100E may also be like Figure 16 the insulating head 3A shown, which has a tapered surface 33t. A front space (gap) SF is formed between the tapered surface 33t and the electrode 21E.

[0134] Industrial Applicability

[0135] The present disclosure can be applied to endoscopic treatment instruments.

Claims

1. An endoscopic treatment instrument, characterized in that the endoscopic treatment instrument includes: a sheath; a conductive rod protruding from the front end of the sheath; an electrode connected to the front end of the rod; an insulator provided at a position closer to the front end than the electrode; and an insulating member covering at least a part of the outer peripheral surface of the portion of the rod protruding from the sheath.

2. The endoscopic treatment instrument according to claim 1, wherein The insulating member is an insulating coating.

3. The endoscopic treatment instrument according to claim 1, wherein The insulating member is a tube having insulating properties.

4. The endoscopic treatment instrument according to claim 3, characterized in that The tube is fixed relative to the rod.

5. The endoscopic treatment instrument according to claim 1, wherein The front end of the insulating member coincides with the base end of the electrode, and the base end of the insulating member is located inside the sheath or at the front end of the sheath.

6. The endoscopic treatment instrument according to claim 1, wherein The front end of the insulating member contacts the base end of the electrode, and the base end of the insulating member is located inside the sheath or at the front end of the sheath.

7. The endoscopic treatment instrument according to claim 1, wherein At least a part of the insulating member extends from the electrode to the front end of the sheath.

8. The endoscopic treatment instrument according to claim 1, wherein The insulating member covers the base end side of the portion of the rod protruding from the sheath.

9. The endoscopic treatment instrument according to claim 3, wherein The tube is configured to be movable forward and backward relative to the rod.

10. The endoscopic treatment instrument according to claim 9, wherein The tube is movable forward and backward between a position where the front end of the tube abuts against the electrode and a position where the front end of the tube is located between the electrode and the front end of the sheath.

11. The endoscopic treatment instrument according to claim 9, characterized in that the tube is movable forward and backward between a position where the front end of the tube abuts against the electrode and a position where the front end of the tube is located inside the sheath.

12. The endoscopic treatment instrument according to claim 2, characterized in that the insulating coating covers the entire outer peripheral surface of the rod.

13. The endoscopic treatment instrument according to claim 2, characterized in that the insulating coating covers a circumferential part of the outer peripheral surface of the rod.

14. The endoscopic treatment instrument according to claim 1, characterized in that the base end portion of the insulator has a tapered surface that tapers toward the electrode, and in the longitudinal axis direction of the rod, the tapered surface is spaced apart from the electrode with a gap.

15. An endoscopic treatment instrument, characterized in that the endoscopic treatment instrument includes: a sheath; and a treatment portion protruding from the front end of the sheath, wherein the treatment portion has: a first insulating member; a second insulating member disposed at a position closer to the base end than the first insulating member, and the outer diameter of the second insulating member is smaller than at least a part of the outer diameter of the first insulating member; and an electrode located between the first insulating member and the second insulating member in the longitudinal axis direction of the treatment portion.

16. The endoscopic treatment instrument according to claim 15, characterized in that the second insulating member is an insulating coating.

17. The endoscopic treatment instrument according to claim 15, characterized in that the second insulating member is a tube having insulating properties.

18. The endoscopic treatment instrument according to claim 15, characterized in that the second insulating member is movable forward and backward between a position where the front end of the second insulating member abuts against the electrode and a position where the front end of the second insulating member is located between the electrode and the front end of the sheath.

19. The endoscopic treatment instrument according to claim 15, characterized in that The second insulating member is movable back and forth between a position where the front end of the second insulating member abuts against the electrode and a position where the front end of the second insulating member is located within the sheath.

20. A treatment instrument for an endoscope, characterized in that the treatment instrument for an endoscope includes: a sheath; a conductive rod protruding from the front end of the sheath; an electrode connected to the front end of the rod; and an insulator provided at a position closer to the front end side than the electrode, the treatment instrument for an endoscope is configured such that at least a part of the outer peripheral surface of the portion of the rod protruding from the sheath has insulation properties.

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