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 first rod protruding from the front end of the sheath; an insulator fixed to a distal end of the first rod; and an electrically conductive second rod extending from the insulator to a distal end side, the second rod being fixed in position with respect to the insulator on a longitudinal axis of the first 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 and the like. A surgical operator uses an endoscopic treatment instrument such as a high-frequency knife to perform incisions of biological tissues well.

[0003] Prior Art Documents

[0004] Patent Documents

[0005] Patent Document 1: WO 2014 / 061701 Summary of the Invention

[0006] Problems to be Solved by the Invention

[0007] When performing an ESD operation, it is necessary to frequently replace the treatment instrument according to the treatment purpose. Therefore, the conventional high-frequency knives described in Patent Document 1 and the like seek to be multifunctional, that is, without replacing the treatment instrument, it is possible to easily perform operations such as marking tissues in addition to incising tissues.

[0008] In view of the above circumstances, an object of the present disclosure is to provide an endoscopic treatment instrument capable of performing various treatments without replacing the treatment instrument.

[0009] Means for Solving the Problems

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

[0011] The endoscopic treatment instrument according to the first aspect of the present disclosure includes: a sheath; a conductive first rod protruding from the front end of the sheath; an insulator fixed to the distal end of the first rod; and a conductive second rod extending distally from the insulator, the second rod being fixed in position on the length axis of the first rod with respect to the insulator.

[0012] Effects of the Invention

[0013] The endoscopic treatment instrument of the present disclosure can perform various treatments without replacing the treatment instrument. Brief Description of the Drawings

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

[0015] Figure 2 It is an overall view of the treatment instrument of the endoscope treatment system.

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

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

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

[0019] Figure 6 It is a cross-sectional view of the front end of the treatment instrument.

[0020] Figure 7 It is a view showing the operation part of the treatment instrument.

[0021] Figure 8 It is a view showing the switch of the operation part.

[0022] Figure 9 It is a view showing the cutting and peeling step.

[0023] Figure 10 It is a view showing the cutting and peeling step.

[0024] Figure 11 It is a view showing a modified example of the first rod of the treatment instrument.

[0025] Figure 12 It is a view showing a modified example of the first electrode and a modified example of the insulating head of the treatment instrument.

[0026] Figure 13 It is a view showing the modified example of the first electrode and the modified example of the insulating head of the treatment instrument.

[0027] Figure 14 It is a cross-sectional view showing a modified example of the switch.

[0028] Figure 15 It is a cross-sectional view showing a modified example of the operation wire and a modified example of the connector of the treatment instrument.

[0029] Figure 16 It is a cross-sectional view showing the modified example of the operation wire and the modified example of the connector.

[0030] Figure 17 It is a cross-sectional view showing another modified example of the operation wire.

[0031] Figure 18 It is a cross-sectional view showing the modified example of the operation wire.

[0032] Figure 19 This is a view showing the operation unit of the treatment instrument according to the second embodiment.

[0033] Figure 20 This is a cross-sectional view when the first rod of the treatment instrument is inserted.

[0034] Figure 21 This is a cross-sectional view when the first rod of the treatment instrument protrudes.

[0035] Figure 22 This is a view showing a modified example of the receiving part of the operation unit and a modified example of the movable part of the operation unit.

[0036] Figure 23 This is a view showing the modified example of the receiving part and the modified example of the movable part.

[0037] Figure 24 This is a view showing another modified example of the receiving part.

[0038] Figure 25 This is a view showing another modified example of the receiving part and a modified example of the movable part.

[0039] Figure 26 This is a view showing another modified example of the receiving part and another modified example of the movable part.

[0040] Figure 27 This is a view showing the modified example of the receiving part and the modified example of the movable part.

[0041] Figure 28 This is a view showing the modified example of the receiving part and the modified example of the movable part.

[0042] Figure 29 This is a view showing another modified example of the receiving part.

[0043] Explanation of reference numerals

[0044] 300, Endoscopic treatment system; 200, Endoscope; 100, 100C, Treatment instrument (treatment instrument for endoscope, high-frequency treatment instrument); 110, 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, Knife (electrode); 20, 20A, First rod (blade body, electrode body); 20i, Insulating member; 20s, Internal space; 21, 21A, First electrode (flange, enlarged diameter part); 21b, Base end face (back face); 21p, Protrusion; 22, 22A, Connector (connecting member); 22b, Through-hole; 22c, Through-hole; 23, Second rod (second electrode); 23a, Front end part (flange, enlarged diameter part); 23b, Base end part; 3, 3A, Insulating head (insulator); 30, Main body part; 31, Outer side face; 32, Front end part; 33, 33A, Base end part; 33t, Tapered face; 41, 41A, Operating wire; 41e, Conductive wire; 41b, Most base end part; 41B, Operating member; 41c, Insulating member; 41f, Outer side face; 41s, Internal space; 42, Conductive wire; 42a, Insulating coating; 42b, Front end part; 43, Metal tube; 43s, Internal space; 44, Conductive wire; 44a, Insulating coating; 5, 5C, Operating part; 51, Operating part main body; 52, Sliding member (handle); 53, Power supply connector; 55, 55A, 55C, Switch; 55p, Connection pad; 56, 56A, 56B, 56C, 56D, 56E, Receiving part; 56a, Concave part; 56b, Bottom face; 56c, Insulating member; 56d, Plug receiving part; 56e, Leaf spring; 56f, Insulating member; 56p, Plug; 56s, Inner side face; 56t, Protrusion; 56u, Support part; 57, 57A, 57C, 57D, Movable part; 57a, Plug receiving part; 57b, Insulating member; 57p, Plug; 58, Spring; A, Length axis direction (length direction, axis direction); A1, Front end side (distal side); A2, Base end side (proximal side); C, Circumferential direction; P1, First position; P2, Second position; R, Radial direction; S1, First position; S2, Second position; SF, Front space; SR, Rear space. Detailed implementation mode

[0045] (First implementation mode)

[0046] Regarding the endoscopic treatment system 300 of the first implementation mode of the present disclosure, refer to Figures 1 to 10 for description. Figure 1 is the overall view of the endoscopic treatment system 300 of this implementation mode.

[0047] [Endoscopic treatment system 300]

[0048] As Figure 1As 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.

[0049] [Endoscope 200]

[0050] The endoscope 200 is a well-known flexible endoscope, and includes an insertion portion 202 that is inserted into the body from the front end and an operation portion 207 that is attached to the proximal end of the insertion portion 202.

[0051] 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 respectively 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.

[0052] The imaging unit 203 includes an imaging element such as a CCD or a CMOS, and is capable of imaging a 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.

[0053] The bending portion 204 bends according to the operation of the operator on the operation portion 207. The flexible portion 205 is a flexible tubular portion.

[0054] The operation portion 207 is connected to the flexible portion 205. The operation portion 207 has a handle 208, an input portion 209, a proximal end opening 206b of the channel 206, and a general cable 210. The handle 208 is a part held by the operator. The input portion 209 receives an operation input for causing the bending portion 204 to perform a bending operation.

[0055] The general cable 210 includes an image signal line that outputs the image captured by the imaging unit 203 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 and the like.

[0056] [Treatment instrument 100]

[0057] Figure 2 It is an overall view showing the treatment instrument 100.

[0058] The treatment instrument (endoscopic 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 (first wire member) 41 (refer to Figure 4 ), a current-carrying wire (second wire member) 42 (refer to Figure 6) and the operation unit 5. The blade 2 and the insulating head 3 constitute a "treatment unit 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 referred to as the "front end side (distal side) A1", and the operation unit 5 side is referred to as the "base end side (proximal side) A2".

[0059] The sheath 1 is a longitudinally extending 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 200 and can move forward and backward in the channel 206. As Figure 1 shown, in the 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.

[0060] Figure 3 is a perspective view of the front end portion of the treatment instrument 100.

[0061] The sheath 1 has an outer tube 10 extending in the length axis direction A and a front end member 11 provided at the front end of the outer tube 10. In addition, the sheath 1 may be formed by integrally molding the outer tube 10 and the front end member 11.

[0062] The front end member 11 is formed in a cylindrical shape. In addition, the "cylindrical shape" includes shapes close to the cylindrical shape in addition to the strict cylindrical shape. The front end member 11 is preferably formed of an insulating material such as resin. The front end member 11 is preferably formed of an insulating material such as resin. The resin forming the front end member 11 is, for example, ceramics such as PTFE, PEEK, and zirconia-based. A through hole 12 is formed in the front end member 11.

[0063] The through hole 12 is provided in the front end member 11 and is a hole penetrating the front end member 11 in the length axis direction A. The front end of the through hole 12 communicates with a first opening 12a formed on the front end face 14 of the front end member 11. The base end of the through hole 12 communicates with the internal space 19 of the outer tube 10.

[0064] Figure 4 and Figure 5 is a side view of the front end portion of the treatment instrument 100.

[0065] The blade (electrode) 2 is a metal member. The blade 2 is formed of a raw material such as stainless steel, for example. The blade 2 has conductivity and is supplied with high-frequency current. The blade 2 has a first rod 20, a first electrode 21, a connector 22, and a second rod 23.

[0066] Preferably, the central axis O2 in the length axis direction A of the blade 2 coincides with the central axis O1 in the length axis direction A of the sheath 1. In addition, "coincide" includes forms that are almost coincident in addition to the strictly coincident form.

[0067] Figure 6 It is a cross-sectional view of the front end of the treatment instrument 100.

[0068] The first rod (blade body, electrode main body) 20 is a rod-shaped member made of conductive metal. In addition, the "rod shape" includes shapes close to the rod shape in addition to the strict rod shape. The first rod 20 is hollow and has an internal space 20s that penetrates the inside of the first rod 20 along the length axis direction A. The first rod 20 is arranged on the front end side A1 of the sheath 1. An operating wire 41 is installed at the proximal end of the first rod 20.

[0069] The first rod 20 penetrates the through-hole 12 of the front end member 11 of the sheath 1 along the length axis direction A and can protrude and retract freely from the first opening 12a to the front end side A1. In addition, the first rod 20 can also be fixed in a state of protruding from the first opening 12a to the front end side A1 in a non-retractable manner.

[0070] The first electrode (flange, enlarged diameter part) 21 is a disc-shaped conductive member provided at the front end of the first rod 20. In addition, the first electrode 21 is not limited to the disc shape and can also be formed in a radial shape that extends radially outward from the central axis O2 of the rod 20 in multiple directions. A planar base end surface (back surface) 21b is formed on the proximal end side A2 of the first electrode 21. In addition, the base end surface 21 is not limited to a planar surface and can be, for example, a surface with unevenness. In addition, the knife 2 may not have the first electrode 21.

[0071] The connector (connecting member) 22 is a cylindrical member made of metal. In addition, the "cylindrical shape" includes shapes close to the cylindrical shape in addition to the strict cylindrical shape. A through-hole 22b that penetrates in the radial direction R is provided in the connector 22. The connector 22 connects the first rod 20 and the operating wire 41. For example, the first rod 20 and the operating wire 41 are connected by brazing using solder inserted through the through-hole 22b.

[0072] The second rod (second electrode) 23 is a conductive metal member. The second rod 23 extends from the insulating head 3 to the distal end side A1. The proximal end of the proximal end portion 23b of the second rod 23 is fixed to the insulating head 3 by bonding or press-fitting in a state of being connected to the energizing wire 42. The second rod 23 cannot move forward or backward relative to the insulating head 3, and its position on the length axis of the first rod 20 is fixed. As Figure 4 shown, the length L2 from the front end of the insulating head 3 to the front end of the second rod 23 is smaller than the protruding length L1 of the first rod 20 protruding from the sheath 1 when the first rod 20 protrudes to the front end side A1 to the maximum extent.

[0073] The second rod 23 has a front end portion (flange, enlarged diameter portion) 23a disposed on the front end side A1 and a base end portion 23b disposed on the base end side A2. The front end portion 23a and the base end portion 23b are connected in an array in the longitudinal axis direction A. The front end portion 23a and the base end portion 23b are formed in a cylindrical shape. The outer diameter of the front end portion 23a is larger than the outer diameter of the base end portion 23b. The front end portion 23a is in a flange shape (circular plate shape). In addition, the shape of the front end portion 23a is not limited to the flange shape, and may be, for example, a triangular shape or a hook shape.

[0074] The outer diameter of at least a part of the second rod 23 is equal to or less than the outer diameter of the first rod 20. In the present embodiment, the outer diameter of the base end portion 23b of the second rod 23 is smaller than the outer diameter of the first rod 20. In addition, it may be that the outer diameter of the front end portion 23a of the second rod 23 is smaller than the outer diameter of the first rod 20.

[0075] The first rod 20 and the first electrode 21 are provided on both sides of the second rod 23 with an insulating head 3 therebetween in the longitudinal axis direction A, and are electrically separated.

[0076] High-frequency current is supplied from an operating wire (first wire) 41 connected to the operation unit 5 to the first rod 20 and the first electrode 21. When high-frequency current is supplied from the operating wire 41 to the first rod 20 and the first electrode 21, the first rod 20 and the first electrode 21 function as monopolar electrodes for outputting high-frequency current to the biological tissue.

[0077] High-frequency current is supplied from a conducting wire (second wire) 42 connected to the operation unit 5 to the second rod 23. When high-frequency current is supplied from the conducting wire 42 to the second rod 23, the second rod 23 functions as a monopolar electrode for outputting high-frequency current to the biological tissue.

[0078] 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, i.e., the first position P1.

[0079] As Figure 5 shown, when the knife 2 is retracted relative to the sheath 1, the base end face 21b of the first electrode 21 contacts the front end face 14 of the front end member 11. By the base end face 21b of the first electrode 21 contacting the front end member 11, the knife 2 is positioned at the most base end side A2 position, i.e., the second position P2.

[0080] By advancing and retracting the operating wire 41, the knife 2 can advance and retract within the range from the first position P1 to the second position P2. In addition, the knife 2 may be fixed in a state of protruding from the first opening 12a toward the front end side A1 so as not to be able to advance and retract.

[0081] As Figure 4As shown, by bringing the blade 2 closer to the first position P1, a rear space SR can be ensured on the proximal side A2 of the proximal end of the first electrode 21. By ensuring the rear space SR of the first electrode 21, the surgical operator can perform incision treatment using the first electrode 21 well.

[0082] The insulating head (insulator) 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 side A1 than the first electrode 21. In the present embodiment, the proximal end of the insulating head 3 is fixed in contact with the first electrode 21 at the distal end of the first rod 20. When viewed from the front in the direction along the longitudinal axis direction A, the outer peripheral portion of the first 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. The insulating head 3, the first rod 20, and the second rod 23 are integrally movable forward and backward with respect to the sheath 1.

[0083] 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.

[0084] 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 series in the longitudinal axis direction A.

[0085] 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.

[0086] 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 tapers toward the front end side A1.

[0087] 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 tapers toward the base end side A2.

[0088] The operating wire 41 is a metal wire member that penetrates the internal space (pipe, lumen) 19 of the outer tube 10. The operating wire 41 is formed of a raw material such as stainless steel, for example. The operating wire 41 is hollow and has an internal space 41s that penetrates the operating wire 41 in the longitudinal axis direction A. The front end of the operating wire 41 is connected to the first rod 20, and the internal space 41s of the operating wire 41 communicates with the internal space 20s of the first rod 20. The base end of the operating wire 41 is connected to the operating portion 5.

[0089] The energizing wire 42 is a metal wire. The energizing wire 42 passes through the internal space 41s of the operating wire 41 and the internal space 20s of the first rod 20. An insulating coating 42a is provided on the outer periphery of the energizing wire 42, and the energizing wire 42 is insulated from the operating wire 41 and the first rod 20. The front end portion 42b of the energizing wire 42 is stripped of the insulating coating 42a and is connected to the second rod 23 by soldering or the like.

[0090] It is also possible to increase the stiffness by thickening the energizing wire 42 so as to form a structure that can advance and retreat, and the second rod 23 can advance and retreat relative to the insulating head 3 and the first rod 20 according to the advancement and retreat of the energizing wire 42.

[0091] Figure 7 It is a diagram showing the operation unit 5.

[0092] The operation unit 5 includes an operation unit main body 51, a slider 52, a power supply connector 53, and a switch 55.

[0093] The front end portion of the operation unit main body 51 is connected to the base end 1b of the sheath 1. The operation unit main body 51 has an internal space through which the operating wire 41 can pass. The operating wire 41 extends through the internal space 19 of the outer tube 10 and the internal space of the operation unit main body 51 to the slider 52.

[0094] The slider (handle) 52 is mounted on the operation unit main body 51 so as to be movable relative to the operation unit main body 51 along the length axis direction A. The base end portion of the operating wire 41 is mounted on the slider 52. The surgical operator advances and retreats the slider 52 relative to the operation unit main body 51, thereby advancing and retreating the operating wire 41, the knife 2, and the insulating head 3.

[0095] 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) via a cable. The power supply connector 53 can supply the high-frequency current supplied from the high-frequency power supply device to the first rod 20 and the first electrode 21 via the operating wire 41. In addition, the power supply connector 53 can supply the high-frequency current supplied from the high-frequency power supply device to the second rod 23 via the energizing wire 42. Alternatively, the power supply connector 53 may be fixed to the operation unit main body 51 instead of being fixed to the slider 52.

[0096] Figure 8 It is a diagram showing the switch 55.

[0097] The switch 55 is provided on the slider 52. The switch 55 is a switch that alternatively selects one of the operating wire 41 and the energizing wire 42 as the conduction path, and a connection pad 55p is mounted. The connection pad 55p and the power supply connector 53 are connected by a metal wire or the like. That is, the high-frequency current supplied from the power supply connector 53 is only conducted to one of the wire members selected by the switch 55.

[0098] The switch 55 has a connection pad 55p electrically connected to the power supply connector 53. The switch 55 is capable of sliding movement between a first position S1 where the connection pad 55p is electrically connected to the conductive wire 41e and a second position S2 where the connection pad 55p is electrically connected to the through wire 42. The conductive wire 41e is a wire member electrically connected to the operation wire 41. Additionally, the conductive wire 41e is not necessary, and it is also possible that the operation wire 41 extends to the connection pad 55p. In this case, when the switch 55 is in the first position S1, the operation wire 41 is directly electrically connected to the connection pad 55p.

[0099] When the switch 55 is in the first position S1, the high-frequency current supplied from the power supply connector 53 is supplied to the first rod 20 and the first electrode 21 via the operation wire 41. When the switch 55 is in the second position S2, the high-frequency current supplied from the power supply connector 53 is supplied to the second rod 23 via the through wire 42.

[0100] [Method of using the endoscopic treatment system 300]

[0101] Next, the operation of using the endoscopic treatment system 300 of the present embodiment (method of using the endoscopic treatment system 300) will be described. Specifically, the incision and dissection treatment of the lesion part in endoscopic treatments such as ESD (endoscopic submucosal dissection) will be described.

[0102] As a preparatory operation, the surgical operator determines the lesion part by a known method. Specifically, the surgical operator inserts the insertion portion 202 of the endoscope 200 into the digestive tract (for example, esophagus, stomach, duodenum, large intestine), and while observing the image obtained by the imaging unit 203 of the endoscope, determines the lesion part.

[0103] <Insertion step>

[0104] The surgical operator inserts the treatment instrument 100 into the channel 206, and causes the front end 1a of the sheath 1 to protrude from the front end opening 206a of the insertion portion 202. The surgical operator relatively advances the slider 52 of the operation portion 5 with respect to the operation portion main body 51, and causes the knife 2 and the insulating head 3 to protrude.

[0105] <Marking application step>

[0106] Figure 9 This is a diagram showing the marking application step.

[0107] The surgeon relatively retracts the slider 52 of the operation section 5 with respect to the operation section main body 51, and disposes the knife 2 at the proximal end side A2 position (for example, the second position P2). The surgeon energizes the second rod 23 by moving the switch 55 to the second position S2 in a state where the second rod 23 is in contact with the mucosal surface, thereby cauterizing the biological tissue (mucosal surface) around the lesion to coagulate it. As a result, the marker M is applied to the mucosal surface. The surgeon can also use the first electrode 21 to cauterize the biological tissue (mucosal surface) to coagulate it. In addition, the marker M applied to the biological tissue only modifies the tissue by coagulating the biological tissue (mucosal surface), which is different from cutting.

[0108] <Cutting and Dissecting Step>

[0109] Figure 10 It is a diagram showing the cutting and dissecting step.

[0110] The surgeon then performs a cutting and dissecting procedure. The surgeon energizes the second rod 23 by moving the switch 55 to the second position S2 in a state where the second rod 23 is inserted under the mucosal layer, so that a pre-cutting part (the entry point where cutting starts) P can be formed in the mucosal layer and / or submucosal layer.

[0111] The surgeon relatively advances the slider 52 of the operation section 5 with respect to the operation section main body 51, and disposes the knife 2 at the front end side A1 position (for example, the first position P1). The surgeon moves the first rod 20 from the pre-cutting part P while applying high-frequency current to the first rod 20 by moving the switch 55 to the first position S1 to cut the mucosa of the lesion. Figure 10 As shown, while applying high-frequency current to the first rod 20, the surgeon lifts the cut mucosa of the lesion to expose the submucosal layer, and at the same time peels off the submucosal layer of the cut lesion. At this time, since the second rod 23 is not energized with high-frequency current, tissues such as the mucosa and submucosal layer will not be cut by the second rod 23.

[0112] The surgeon continues the above actions (procedures) as needed, and finally removes the lesion, ending the ESD operation.

[0113] According to the treatment instrument 100 of the present embodiment, without replacing the treatment instrument, in addition to cutting biological tissue, it is also possible to easily apply a marker to the biological tissue, etc. The surgeon can supply high-frequency current only to either the first rod 20 or the second rod 23 by operating the switch 55 in cooperation with the implemented treatment.

[0114] As described above, the first 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 disclosure. In addition, the constituent elements shown in the above-described embodiment and modification examples may be appropriately combined.

[0115] (Modification Example 1)

[0116] Figure 11 FIG. is a view showing a first rod 20A as a modification of the first rod 20.

[0117] The proximal end side of the portion of the first rod 20A protruding from the sheath 1 is covered with an insulating member 20i. The insulating member 20i is, for example, an insulating coating or an insulating tube. Since electricity is not conducted to the biological tissue from at least a part of the outer peripheral surface of the first rod 20A, heat invasion to the biological tissue can be suppressed.

[0118] (Modification Example 2)

[0119] Figure 12 and Figure 13 FIG. is a view showing a first electrode 21A as a modification of the first electrode 21 and an insulating head 3A as a modification of the insulating head 3. The first electrode 21A is a plate-shaped conductive member provided at the tip of the first rod 20. The first electrode 21A has a protruding portion 21p extending in a direction crossing the length axis of the first rod 20. For example, the protruding portion 21p protrudes outward in the radial direction R of the first rod 20 compared to the outer side surface of the proximal end of the insulating head 3A (the proximal end of the conical surface 33t described later). A planar base end surface (rear surface) 21b is formed on the proximal end side A2 of the first electrode 21A. The base end surface 21b is not limited to a planar surface and may be, for example, a surface with unevenness.

[0120] The first electrode 21A has three protruding portions 21p. The three protruding portions 21p are arranged at equal intervals in the circumferential direction C with respect to the length axis direction A. When viewed from the front in the direction along the length axis direction A, the first electrode 21A is formed in a trident shape. In addition, the first electrode 21A may be formed in a four-pronged shape or a five-pronged shape. That is, the first electrode 21A 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 first electrode 21A may be formed in a flange shape such as a disc shape or a polygonal shape.

[0121] The insulating head (insulator) 3A is formed of an insulating material such as ceramic or resin. The insulating head 3A is provided at a position on the distal end side A1 with respect to the first electrode 21A. The proximal end of the insulating head 3A is fixed to the first rod 20 in a state of being in contact with the first electrode 21A. At least the protruding portion 21p of the first electrode 21A protrudes outward in the radial direction R compared to the outer peripheral surface of the proximal end of the insulating head 3A (the proximal end of the conical surface 33t described later).

[0122] When viewed from the front in the direction of the longitudinal axis A, the maximum distance D1 from the central axis of the second rod 23 to the outer side surface of the second rod 23 is smaller than the distance D2 from the central axis of the first rod 20 to the top 21t of the protruding portion 21p of the first electrode 21A.

[0123] 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 first electrode 21A (toward the base end side A2). The tapered surface 33t is spaced apart from the protruding portion 21p with a gap, and a front space (gap) SF is formed between the tapered surface 33t and the protruding portion 21p. That is, in the longitudinal axis direction A of the first rod 20, the tapered surface 33t and the protruding portion 21p are spaced apart with a gap, and the tapered surface 33t and the front end surface of the protruding portion 21p are arranged to face each other. By ensuring the front space (gap) SF of the first electrode 21A, the surgical operator can perform incision treatment using the first electrode 21A well.

[0124] (Modified Example 3)

[0125] Figure 14 It is a cross-sectional view showing a switch 55A which is a modified example of the switch 55.

[0126] The switch 55A can move to a first position S1 where the connection pad 55p is connected to the conductive wire 41e and a second position S2 where the connection pad 55p is connected to the through wire 42 not by sliding movement but by rotating around the rotation axis RO.

[0127] (Modified Example 4)

[0128] Figure 15 and Figure 16 It is a cross-sectional view showing an operating wire 41A which is a modified example of the operating wire 41 and a connector 22A which is a modified example of the connector 22. The operating wire 41A is solid, unlike the hollow operating wire 41. A through hole 22c penetrating in the radial direction R is provided in the connector 22A. The through wire 42 passing through the internal space 20s of the first rod 20 passes through the through hole 22c of the connector 22A and penetrates the internal space 19 of the outer tube 10.

[0129] The base end of the operating wire 41A is connected to the hollow metal tube 43 by the connector 22A. The high-frequency current supplied to the conductive wire 41e is supplied to the first rod 20 and the first electrode 21 via the metal tube 43 and the operating wire 41A.

[0130] The base end of the through wire 42 passes through the through hole 22c of the connector 22A and penetrates the internal space 43s of the metal tube 43. The through wire 42 extends to the slider 52 through the internal space 43s of the metal tube 43.

[0131] Alternatively, instead of the through hole 22c of the connector 22A, the current-carrying wire 42 may be passed through the through hole 22b for brazing. The through hole 22b is blocked by injecting solder into the through hole 22b with the current-carrying wire 42 passed through it. In this case, the internal space 19 of the sheath 1 and the internal space 20s of the rod 20 are not connected.

[0132] (Modification 5)

[0133] Figure 17 and Figure 18 FIG. is a cross-sectional view showing an operating member 41B as a modification of the operating wire 41. The operating member 41B is a longitudinally extended solid member made of resin or the like and having no conductivity. The connector 22A on the front end side A1 and the connector 22A on the base end side A2 are electrically connected by a conductive wire 44. An insulating coating 44a is provided on the outer periphery of the conductive wire 44. The high-frequency current supplied to the conductive wire 41e is supplied to the first rod 20 and the first electrode 21 via the metal tube 43 and the conductive wire 44.

[0134] (Second Embodiment)

[0135] Refer to Figures 19 to 21 , the treatment instrument 100C of the second embodiment of the present disclosure will be described. In the following description, the same structural components as those already described are denoted by the same reference numerals and redundant description is omitted.

[0136] The treatment instrument (endoscopic treatment instrument, high-frequency treatment instrument) 100C is an ESD knife. The treatment instrument 100 includes a sheath 1, a knife 2, an insulating head 3, an operating wire 41, a current-carrying wire 42, and an operating portion 5C.

[0137] Figure 19 FIG. is a view showing the operating portion 5C.

[0138] The operating portion 5C has an operating portion main body 51, a slider 52, a power supply connector 53, and a switch 55C.

[0139] The switch 55C is a switch that alternatively selects one of the operating wire 41 and the current-carrying wire 42 as a conduction path according to the advancement and retraction of the slider 52. The switch 55C has a receiving portion 56 and a movable portion 57.

[0140] The receiving portion 56 is a conductive member fixedly provided on the operation portion main body 51 and is electrically connected to the power supply connector 53. A recess 56a for receiving the movable portion 57 is formed in the receiving portion 56. The recess 56a opens toward the front end side A1 and receives the movable portion 57 that has retreated to the base end side A2. A plug 56p protruding toward the front end side A1 is provided on the bottom surface 56b of the recess 56a formed on the base end side A2. The plug 56p is formed in a conical shape. An insulating member 56c is provided on the bottom surface 56b of the recess 56a except for the portion where the plug 56p is located and on the inner side surface 56s of the recess 56a on the base end side A2.

[0141] The movable portion 57 is a conductive member fixed to the base end of the operation wire 41 and moves forward and backward along the longitudinal axis direction A according to the forward and backward movement of the slider 52. A plug receiving portion 57a is formed at the end of the movable portion 57 on the base end side A2. The plug receiving portion 57a is electrically connected to the current-carrying wire 42. The plug receiving portion 57a is formed with a conical recess that can engage with the plug 56p. By housing the movable portion 57 in the receiving portion 56, the plug 56p engages with the plug receiving portion 57a. The plug receiving portion 57a is covered with an insulating member 57b except for the portion electrically connected to the current-carrying wire 42 and the portion engaging with the plug 56p.

[0142] An insulating member 41c is provided on the outer side surface 41f of the operation wire 41 at the base end portion except for the most base end portion 41b. Here, the most base end portion 41b is the portion closest to the base end side A2 among the base end portions of the outer side surface 41f of the operation wire 41.

[0143] Figure 20 It is a cross-sectional view when the first rod 20 of the treatment instrument 100C is inserted.

[0144] The surgical operator moves the slider 52 to the base end side A2, thereby inserting the first rod 20 into the sheath 1. By housing the movable portion 57 in the receiving portion 56, the plug 56p engages with the plug receiving portion 57a. The high-frequency current supplied from the power supply connector 53 is supplied to the second rod 23 via the plug 56p, the plug receiving portion 57a, and the current-carrying wire 42.

[0145] Figure 21 It is a cross-sectional view when the first rod 20 of the treatment instrument 100C protrudes.

[0146] The surgical operator moves the slider 52 to the front end side A1, thereby causing the first rod 20 to protrude from the sheath 1. The most base end portion 41b of the operation wire 41 contacts the non-insulated inner side surface 56s. The high-frequency current supplied from the power supply connector 53 is supplied to the first rod 20 and the first electrode 21 via the inner side surface 56s, the most base end portion 41b, and the operation wire 41.

[0147] The treatment instrument 100C according to the present embodiment can easily apply a mark or the like to a biological tissue in addition to cutting the biological tissue without replacing the treatment instrument. The surgeon can supply high-frequency current only to either the first rod 20 or the second rod 23 according to the advancement and retraction of the insulating head 3, the first rod 20, and the second rod 23 relative to the sheath 1. As Figure 20 shown, the surgeon can supply high-frequency current only to the second rod 23 by moving the insulating head 3, the first rod 20, and the second rod 23 to the proximal end side A2. As Figure 21 shown, the surgeon can supply high-frequency current only to the first rod 20 and the first electrode 21 by moving the first rod 20 and the second rod 23 to the distal end side A1.

[0148] 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 can be appropriately combined.

[0149] (Modification Example 2-1)

[0150] Figure 22 and Figure 23 are diagrams showing a plug receiving portion 56A as a modification of the receiving portion 56 and a movable portion 57A as a modification of the movable portion 57. A plug receiving portion 56d recessed toward the proximal end side A2 is provided on the bottom surface 56b of the receiving portion 56A. A plug 57p is formed at the end of the proximal end side A2 of the movable portion 57A. By housing the movable portion 57A in the receiving portion 56A, the plug 57p is engaged with the plug receiving portion 56d.

[0151] A leaf spring 56e is provided in the plug receiving portion 56d. The plug 57p housed in the plug receiving portion 56d pushes open the leaf spring 56e and is inserted. Therefore, the electrical contact between the plug 57p and the plug receiving portion 56d is stabilized.

[0152] (Modification Example 2-2)

[0153] Figure 24 is a diagram showing a receiving portion 56B as a modification of the receiving portion 56A.

[0154] The receiving portion 56B has a protrusion 56t protruding radially inward R at a portion of the inner surface 56s where the insulating member 56c is not provided. The protrusion 56t is provided, for example, at the position closest to the distal end side A1 in the inner surface 56s. The support portion 56u provided with the protrusion 56t is formed in a cantilever shape and can be elastically deformed along the radial direction R. When the movable portion 57A is inserted into the receiving portion 56B, the movable portion 57A pushes open the protrusion 56t and is inserted. Therefore, the electrical contact between the most proximal end portion 41b and the inner surface 56s is stabilized. In addition, the protrusion 56t may be a ball plug.

[0155] (Variation 2-3)

[0156] Figure 25 1 is a diagram showing a receiving portion 56C as a modified example of the receiving portion 56 and a movable portion 57C as a modified example of the movable portion 57. The receiving portion 56C and the movable portion 57C do not have the plug 56p and the plug receiving portion 57a. The bottom surface 56b of the receiving portion 56C and the movable portion 57C are in contact with each other via the conductive spring 58. Since the contactable range is expanded, the electrical contact point between the bottom surface 56b of the receiving portion 56C and the movable portion 57C is stabilized.

[0157] (Variation 2-4)

[0158] Figures 26 to 28 1 is a diagram showing a receiving portion 56D as a modified example of the receiving portion 56 and a movable portion 57D as a modified example of the movable portion 57. The receiving portion 56D does not have a plug 56p. The movable portion 57D is formed in a cylindrical shape and does not have a plug receiving portion 57a ​​and an insulating member 57b. The movable portion 57D is electrically connected to the receiving portion 56D by contacting the inner side surface 56s and the bottom surface 56b of the receiving portion 56D. An insulating member 56f is provided on the inner side surface 56s of the receiving portion 56D and in the middle portion in the longitudinal axis direction A.

[0159] like Figure 27 As shown, by moving the slider 52 to the base end side A2, the movable part 57D is accommodated in the base end side A2 of the receiving part 56D, so that the movable part 57D engages with the inner side surface 56s and the bottom surface 56b. The high-frequency current supplied from the power supply connector 53 is supplied to the second rod 23 via the receiving part 56D, the movable part 57D and the conducting wire 42.

[0160] like Figure 28 As shown, by moving the slider 52 to the front end side A1, the movable part 57D moves to the front end side A1 of the receiving part 56D, so that the inner side surface 56s and the most proximal end 41b engage. The high-frequency current supplied from the power supply connector 53 is supplied to the first rod 20 and the first electrode 21 via the inner side surface 56s, the most proximal end 41b and the operation wire 41.

[0161] Since the receiving portion 56D and the movable portion 57D can ensure a long contact portion in the longitudinal axis direction A, the electrical contact between the receiving portion 56D and the movable portion 57D can be stabilized even when the length of the sheath 1 changes due to bending of the sheath 1.

[0162] (Variation 2-5)

[0163] Figure 29 It is a figure which shows the receiving portion 56E which is a modification of the receiving portion 56D.

[0164] The receiving portion 56E has two protrusions 56t that protrude radially inward R at a portion of the inner surface 56s where the insulating member 56f is not provided. One protrusion 56t is disposed on the front end side A1 of the insulating member 56f. The other protrusion 56t is disposed on the base end side A2 of the insulating member 56f. When viewed from the front in a direction along the longitudinal axis direction A, the two protrusions 56t are disposed on both sides with the central axis O5 of the recess 56a therebetween. Similar to the receiving portion 56B, the most proximal end portion 41b is stabilized in electrical contact with the inner surface 56s. Also, since the protrusion 56t on the base end side A2 contacts the movable portion 57D, the electrical contact between the movable portion 57D and the inner surface 56s is also stabilized. Additionally, the protrusion 56t may be a ball plug.

[0165] Industrial Applicability

[0166] The present disclosure can be applied to an endoscopic treatment instrument.

Claims

1. An endoscopic treatment instrument, characterized in that the endoscopic treatment instrument includes: a sheath; a conductive first rod protruding from the front end of the sheath; an insulator fixed to the front end of the first rod; and a conductive second rod extending from the insulator toward the front end side, wherein the position of the second rod with respect to the insulator is fixed on the longitudinal axis of the first rod.

2. The endoscopic treatment instrument according to claim 1, characterized in that at least a part of the outer diameter of the second rod is equal to or less than the outer diameter of the first rod.

3. The endoscopic treatment instrument according to claim 1, characterized in that the length from the front end of the insulator to the front end of the second rod is smaller than the protruding length of the first rod protruding from the sheath.

4. The endoscopic treatment instrument according to claim 1, characterized in that the second rod is fixed to the insulator.

5. The endoscopic treatment instrument according to claim 1, characterized in that the second rod is connected to a current-carrying wire passing through the inside of the first rod.

6. The endoscopic treatment instrument according to claim 1, characterized in that the endoscopic treatment instrument further has a switch that selects one of the first rod and the second rod as a current-carrying path.

7. The endoscopic treatment instrument according to claim 6, characterized in that a handle is provided at the proximal end portion of the sheath, and the switch is provided on the handle.

8. The endoscopic treatment instrument according to claim 6, characterized in that the insulator, the first rod, and the second rod are configured to be retractable and extendable integrally with respect to the sheath, and the switch can select one of the first rod and the second rod as the current-carrying path according to the advancement and retraction of the first rod.

9. The endoscopic treatment instrument according to claim 6, characterized in that the insulator, the first rod, and the second rod are configured to be retractable and extendable integrally with respect to the sheath, and the switch can independently select one of the first rod and the second rod as the current-carrying path with respect to the advancement and retraction of the first rod.

10. The endoscopic treatment instrument according to claim 1, characterized in that the proximal end side of the portion of the first rod protruding from the sheath is covered with an insulating member.

11. The endoscopic treatment instrument according to claim 1, characterized in that the endoscopic treatment instrument has an electrode connected to the front end of the first rod, the insulator is provided at a position closer to the front end than the electrode, and a part of the electrode protrudes radially outward of the first rod with respect to the outer side surface of the proximal end of the insulator.

12. The endoscopic treatment instrument according to claim 11, characterized in that the electrode has a protruding portion that protrudes radially outward of the first rod with respect to the outer side surface of the proximal end of the insulator, and when viewed from the direction of the longitudinal axis in a front view, the maximum distance from the central axis of the second rod to the outer side surface of the second rod is smaller than the distance from the central axis of the first rod to the top of the protruding portion of the electrode.

13. An endoscopic treatment instrument, characterized in that The endoscope treatment device comprises: jacket; a conductive first rod protruding from a front end of the sheath; an insulator disposed at a front end of the first rod; and a conductive second rod extending from the insulator toward the front end, The insulator, the first rod, and the second rod are configured to be able to move forward and backward integrally with respect to the sheath between a first position where the first rod is moved forward to the maximum extent and a second position where the first rod is moved backward to the maximum extent.

14. The endoscopic treatment instrument according to claim 13, characterized in that: The length from the front end of the insulator to the front end of the second rod is smaller than the maximum protrusion amount of the first rod from the sheath.

15. An endoscope treatment instrument, characterized in that: The endoscope treatment device comprises: jacket; a conductive first rod protruding from a front end of the sheath; an insulator, which is disposed at the front end of the first rod; a conductive second rod extending from the insulator toward a front end; and A switch selects one of the first rod and the second rod as a current path.

16. The endoscopic treatment instrument according to claim 15, characterized in that: The second rod is connected to a conducting wire passing through an interior of the first rod.

17. The endoscopic treatment instrument according to claim 15, characterized in that: The sheath has a handle at a base end portion thereof, and the switch is provided on the handle.

18. The treatment instrument for endoscope according to claim 15, characterized in that: The switch can select one of the first rod and the second rod as the energization path according to the advance and retreat of the first rod.

19. The endoscopic treatment instrument according to claim 15, characterized in that: The insulator, the first rod, and the second rod are configured to be able to move forward and backward integrally with respect to the sheath.

20. The endoscopic treatment instrument according to claim 15, characterized in that: The second rod is configured to be able to move forward and backward relative to the insulator and the first rod.

21. The endoscopic treatment instrument according to claim 15, characterized in that: The switch selects one of the first rod and the second rod as a current path by being rotated.

22. The endoscopic treatment instrument according to claim 15, characterized in that: The switch includes a receiving portion and a movable portion, and selects one of the first rod and the second rod as a current conduction path by switching a contact state between the receiving portion and the movable portion.

23. The endoscopic treatment instrument according to claim 22, characterized in that: The receiving portion has a protrusion on an inner side surface thereof that protrudes radially inward.

24. The endoscopic treatment instrument according to claim 22, characterized in that: The bottom surface of the receiving portion and the movable portion are in contact with each other via a conductive spring.

25. The endoscopic treatment instrument according to claim 22, wherein, A plug is provided at one of the receiving portion and the movable portion, and a plug receiving portion engageable with the plug is provided at the other of the receiving portion and the movable portion.

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