TREATMENT TOOL FOR ENDOSCOPE AND ENDOSCOPE SYSTEM

Abstract

A treatment tool for an endoscope and an endoscope system are provided that are able to facilitate treatment at a target part. An endoscope treatment tool comprises an insertable part that can be inserted into a body and an actuating part located on a base end of the insertable part. The insertable part includes a distal end having a handle that can be opened and closed, a flexible part that is adjacent to an actuating end of the distal end, and a connecting part that joins the flexible part and the actuating part. The insertable part can be moved forward and backward along a longitudinal axis of the connecting part and rotated about the longitudinal axis by actuating the actuating part. The handle is closed by actuating the actuating part, and the flexible part is bent when the handle is closed. The maximum bending angle of the flexible part with respect to the longitudinal axis of the connecting part is greater than 90 degrees.

Description

BACKGROUND OF THE INVENTION 1. Field of the invention

[0001] The present invention relates to a treatment tool for an endoscope and an endoscope system. 2. Description of the state of the art

[0002] JP1999-299793A (JP-H11-299793A) discloses an insertion tool for an examinee, in which a flexible element with a hollow tubular shape and an opening section on one side is arranged within a distal end part of a hollow coil forming an insertion part, a pull wire is inserted through the hollow coil in such a way that it is movable forwards and backwards, the pull wire is pre-tensioned to one side of the opening section of the flexible element and is attached to a distal end side of the flexible element, and the flexible element is bent in an opening section direction by a pulling action.

[0003] JP1997-299323A (JP-H9-299323A) discloses a treatment tool guide for an endoscope, which is a flexible tubular element that can be inserted and removed through a treatment tool insertion channel of the endoscope, and wherein a section projecting outwards from a distal end of the treatment tool insertion channel is formed in an arc shape.

[0004] JP2007-151595A discloses an endoscope treatment device which is provided with an observation unit which observes a body cavity and is used in combination with an endoscope which can be inserted into the cavity, wherein the endoscope treatment device comprises a flexible insertion part which has a bendable part and a channel through which a treatment tool is inserted, an actuating part which is connected to the insertion part and is used to actuate bending of the bendable part, and a treatment tool actuating unit which actuates the treatment tool.

[0005] JP2022-152489A discloses an endoscope in which an observation window is arranged transversely to a vertical axis in a distal end-surface region located above a horizontal axis, a first treatment tool outlet port is arranged transversely to the vertical axis in a distal end-surface region located below the horizontal axis, a second treatment tool outlet port is arranged transversely to the horizontal axis in a distal end-surface region located below a line passing through the center of the observation window and parallel to the horizontal axis, and in a distal end-surface region located on a left side of the vertical axis, and a water supply port is located mainly in the distal end-surface region located below the line passing through the center of the observation window and parallel to the horizontal axis.and in a distal end-surface area located on a side opposite the second treatment tool outlet port with respect to a line passing through the center of the first treatment tool outlet port and parallel to the vertical axis. SUMMARY OF THE INVENTION

[0006] An embodiment according to the technology of the present disclosure provides a treatment tool for an endoscope and an endoscope system that are able to facilitate treatment on a target part. (1) Treatment tool for an endoscope, comprising: an insertable part that can be inserted into a body; and an actuating part that is arranged on a base end face of the insertion part, the introductory part contains: a distal end part which has a handle part which can be opened and closed, a flexible part which is flexible and which is designed to be adjacent to the distal end part on one side of the actuating part, and a connecting part that connects the flexible part and the actuating part, the insertion part can be moved forwards and backwards along a longitudinal axis of the connecting part and can be rotated around the longitudinal axis by actuating the actuating part, by actuating the actuating part, the handle part is closed and the flexible part is bent in a state in which the handle part is closed, and a maximum bending angle of the flexible part with respect to the longitudinal axis is greater than 90 degrees. (2) Treatment tool for an endoscope according to (1), further comprising: at least one actuating wire connected to the actuating part, which actuates at least one of the opening and closing of the handle part and bending of the flexible part. (3) Treatment tool for an endoscope according to (1) or (2), wherein the insertion part is used by inserting it into a treatment tool channel of the endoscope, and The inner diameter of an arc, when drawn in a case where the flexible part is bent to its maximum extent, is greater than 1 / 2 of the outer diameter of the endoscope. (4) Treatment tool for an endoscope according to a procedure of (1) to (3), wherein the insertion part is used by inserting it into a treatment tool channel of the endoscope, and In a case where the flexible part is maximally bent, the distal end part extending from the treatment tool channel is not in contact with the endoscope. (5) Treatment tool for an endoscope according to (4), in a case where the flexible part is maximally bent, the distal end part extending from the treatment tool channel is not in contact with the endoscope regardless of the rotational state of the insertion part. (6) Endoscope system, comprising: the treatment tool for an endoscope according to one of (1) to (5); and an endoscope that has a treatment tool channel through which the insertion part can be inserted. (7) Endoscope system according to (6), further comprising: a first treatment tool, which is the treatment tool for an endoscope; a second treatment tool; and the endoscope wherein the endoscope has a first treatment tool channel through which the insertion part of the first treatment tool can be inserted, and a second treatment tool channel through which the second treatment tool can be inserted.

[0007] According to the present invention, it is possible to provide a treatment tool for an endoscope and an endoscope system that are able to facilitate treatment on a target part. BRIEF DESCRIPTION OF THE DRAWINGS Fig. Figure 1 is a diagram showing an example of an endoscope system according to an embodiment of the present invention. Fig. Figure 2 is a diagram showing an example of a treatment tool 20 for an endoscope according to the embodiment of the present invention. Fig. Figure 3 is a diagram showing a configuration of a handle part 24 of a distal end part 23 in the treatment tool 20 for an endoscope. Fig. 4 is a diagram showing the operation of the handle part 24 of Fig. 3 shows. Fig. Figure 5 is a diagram showing a configuration of a flexible part 25 and a connecting part 26 of the treatment tool 20 for an endoscope. Fig. Figure 6 is a diagram showing the actuation of the flexible part 25 of Fig. 5 shows. Fig. Figure 7 is a diagram showing an internal configuration of the flexible part 25. Fig. 8 is a cross-sectional view along line aa of the in Fig. 7 flexible part shown 25. Fig. Figure 9 is a diagram showing an internal actuation of the flexible part 25. Fig. Figure 10 is a diagram showing a configuration of an actuating part 22 of the treatment tool 20 for an endoscope. Fig. Figure 11 is a cross-sectional view of the actuating part 22 of the treatment tool 20 for an endoscope. Fig. Figure 12 is a cross-sectional view showing a closed state of the actuating part 22 of the treatment tool 20 for an endoscope. Fig. Figure 13 is a diagram showing a first example (part 1) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 14 is a diagram showing a first example (part 2) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 15 is a diagram showing a first example (part 3) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 16 is a diagram showing a first example (part 1) of a treatment procedure using a combination of the treatment tool 20 for an endoscope and another treatment tool for an endoscope. Fig. Figure 17 is a diagram showing a first example (part 2) of a treatment procedure using a combination of the treatment tool 20 for an endoscope and another treatment tool for an endoscope. Fig. Figure 18 is a diagram showing a first example (part 3) of a treatment procedure using a combination of the treatment tool 20 for an endoscope and another treatment tool for an endoscope. Fig. Figure 19 is a diagram showing a state in which the treatment tool 20 for an endoscope is attached to a first treatment tool insertion port 13 of an endoscope actuating part 7. Fig. Figure 20 is a diagram showing the flexible part 25 in an insertion part 21 in an undistracted state. Fig. Figure 21 is a perspective view showing the flexible part 25 in a bent state. Fig. 22 is a top view of the in Fig. 21 shown flexible part 25. Fig. Figure 23 is a diagram showing a second example (part 1) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 24 is a diagram showing a second example (part 2) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 25 is a diagram showing a second example (part 3) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 26 is a diagram showing a positional relationship between the distal end part 23 and an endoscope 2 in a case where the flexible part 25 is maximally bent. Fig. Figure 27 is a diagram showing an example of an end surface 10a of a distal end part 10 of an endoscope. Fig. Figure 28 is a diagram showing another example of an operating handle 51. DESCRIPTION OF PREFERRED EXECUTION FORMS

[0008] A treatment tool for an endoscope and an endoscope system according to an embodiment of the present invention are described below with reference to the accompanying drawings.

[0009] Fig. Figure 1 is a diagram showing an example of an endoscope system according to an embodiment of the present invention. As shown in Fig. As shown in Figure 1, an endoscope system 1 comprises an endoscope 2, a light source device 3, and a processor 4. The endoscope 2 has an endoscope introducer 6 for insertion into a patient, an endoscope actuating part 7 connected to the endoscope introducer 6, and a universal cable 8 extending from the endoscope actuating part 7. The endoscope introducer 6 consists of a distal end 10 of the endoscope, a flexible endoscope part 11 connected to the distal end 10 of the endoscope, and an endoscope connector 12 connecting the flexible endoscope part 11 and the endoscope actuating part 7.

[0010] An imaging device containing an imaging element is mounted on the distal end 10 of the endoscope. The flexible endoscope section 11 is configured to be bendable. Bending of the flexible endoscope section 11 is actuated by the endoscope actuator 7. Furthermore, the endoscope connector 12 is configured to be flexible enough to conform to the shape of an insertion channel in the patient.

[0011] The endoscope actuating part 7 is provided with an actuation button for initiating imaging using the imaging device and an actuation knob for initiating the bending of the flexible endoscope part 11. Furthermore, the endoscope actuating part 7 is provided with a first treatment tool insertion port 13 into which a treatment tool 20 for an endoscope (see Fig. 2) can be inserted, and is provided with a second treatment tool insertion port 15. Within the endoscope insertion part 6, a first treatment tool channel 14 is provided, which extends from the first treatment tool insertion port 13 to the distal end part 10 of the endoscope and which is open to an end surface of the distal end part 10 of the endoscope, and a second treatment tool channel 16 is provided, which extends from the second treatment tool insertion port 15 to the distal end part 10 of the endoscope and which is open to the end surface of the distal end part 10 of the endoscope.

[0012] A light guide and a cable are provided within the endoscope insertion part 6, the endoscope actuation part 7, and the universal cable 8. A connector 9 is provided at one end of the universal cable 8. The endoscope 2 is connected to the light source device 3 and the processor 4 via the connector 9.

[0013] Illumination light generated by the light source device 3 is guided via the light guide to the distal end 10 of the endoscope and is emitted from the distal end 10 of the endoscope. In addition, operating power for the imaging element, a control signal to drive the imaging element, and an image signal output by the imaging element are transmitted between the processor 4 and the imaging device via the cable. The processor 4 processes the input image signal to generate image data of an observation point on the subject, displays the generated image data on a monitor 5, and records the generated image data in a storage unit.

[0014] Fig. Figure 2 is a view showing an example of the treatment tool 20 for an endoscope according to the embodiment of the present invention. As shown in Fig. As shown in Figure 2, the treatment tool 20 for an endoscope comprises an insertion part 21, an actuating part 22 of the treatment tool, and a fastening part 52. The insertion part 21 is a section that can be inserted through the first treatment tool channel 14 (see Figure 2). Fig. 1) The actuating part 22 is a section arranged on a base end face of the insertion part 21. The fastening part 52 is a section attached to and fastened to the endoscope actuating part 7.

[0015] The insertion part 21 comprises a distal end part 23, which has a handle part 24 that can be opened and closed by actuating the actuating part 22, a flexible part 25 provided on the side of the actuating part 22 of the distal end part 23, and a connecting part 26 that connects the flexible part 25 and the actuating part 22. When the insertion part 21 is inserted through the first treatment tool channel 14, the connecting part 26 is housed in the first treatment tool channel 14. However, when the insertion part 21 is inserted through the first treatment tool channel 14, the distal end part 23 and the flexible part 25 protrude from the end face of the distal end part 10 of the endoscope (see Fig. 1) As with the endoscope connecting part 12, the connecting part 26 received in the first treatment tool channel 14 is configured to be flexible enough to be deformable in order to follow the shape of the insertion channel in the subject.

[0016] Fig. Figure 3 is a diagram showing a configuration of the handle part 24 of the distal end part 23 of the treatment tool 20 for an endoscope. Fig. 4 is a diagram showing the operation of the handle part 24 of Fig. 3 shows.

[0017] As in Fig. As shown in Figure 3, the handle part 24 has a pair of gripping claws 30 and a pair of connecting elements 31. The distal end part 23 has a bearing 32 that rotatably supports the pair of gripping claws 30. The pair of gripping claws 30 are arranged so that they intersect, and a pin 33 is provided to penetrate an intersecting section of the pair of gripping claws 30. The pin 33 is attached to the bearing 32. The pair of gripping claws 30 is supported by the bearing 32 in such a way that it is rotatable about the pin 33 as a rotary shaft.

[0018] A distal end part of the connecting element 31 is rotatably connected to a base end part of the gripping claw 30. At least one actuating wire 27 is connected to a base end part of the connecting element 31. The actuating wire 27 extends from the distal end part 23 through the flexible part 25 and the connecting part 26 to the actuating part 22 and is pulled towards the side of the actuating part 22 or pushed out towards the side of the distal end part 23 in response to actuation of the actuating part 22.

[0019] Fig. Figure 3 shows a state in which the actuating wire 27 is extended to the side of distal end part 23 and the distal end parts of the pair of gripping claws 30 are open. Conversely, in a case where the actuating wire 27 is pulled to the side of actuating part 22, the distal end parts of the pair of gripping claws 30 are closed, as shown in Figure 3. Fig. Figure 4 shows that a treatment site of a living body is grasped by the distal end parts of the pair of closed grasping claws 30.

[0020] Fig. Figure 5 is a diagram showing a configuration of the flexible part 25 and the connecting part 26 of the treatment tool 20 for an endoscope. Fig. Figure 6 is a diagram showing the actuation of the flexible part 25 of Fig. 5 shows.

[0021] As in Fig. As shown in Figure 5, the insertion part 21 of the treatment tool 20 for an endoscope has a flexible part 25 on the side of the actuating part 22 of the distal end part 23, which has the handle part 24, and a connecting part 26 on the side of the actuating part 22 of the flexible part 25. The connecting part 26 has flexibility and also stiffness, which allows translational and rotational forces to be transmitted from the side of the actuating part 22 to the side of the flexible part 25. The connecting part 26 can, for example, be configured such that an outer circumference of a spiral tube, formed by spiral winding of a strip material made of metal, is covered with a mesh-like tube formed by braiding a wire made of metal, and an outer circumference of the mesh-like tube is covered with an outer sheath made of resin.

[0022] As in Fig. As shown in Figure 6, the flexible part 25, which is actuated by the actuating part 22, is flexible in a direction that is substantially perpendicular to a plane containing an opening and closing direction of the pair of gripping claws 30. A bending actuation plane containing a bending actuation direction of the flexible part 25 is arranged in a direction that is substantially perpendicular to an opening and closing actuation plane of the pair of gripping claws 30.

[0023] Fig. Figure 7 is a diagram showing an internal configuration of the flexible part 25. Fig. 8 is a cross-sectional view along line aa of the in Fig. 7 flexible part shown 25. Fig. Figure 9 is a diagram showing an internal actuation of the flexible part 25.

[0024] As in Fig. As shown in Figure 7, the flexible part 25 has several bending pieces 42 and an outer shell 43 made of resin. The several bending pieces 42 are arranged in a longitudinal direction of the insertion part 21, which contains the flexible part 25. Two bending pieces 42 that are adjacent to each other are connected to each other via a pair of pins 46, which are arranged so that they face each other in a radial direction of the flexible part 25.

[0025] As in Fig. As shown in Figure 8, the pair of pins 46 are arranged on an axis X. The axis X is a direction that is essentially parallel to the opening and closing direction of the pair of gripping claws 30. The adjacent bending pieces 42, which are connected by the pair of pins 46, are rotatable about the axis X as an axis of rotation.

[0026] As in Fig. As shown in Figure 9, the flexible part 25 is bent along a direction (bending actuation plane) that is essentially perpendicular to the opening and closing direction (direction of axis X) of the pair of gripping claws 30 by adding rotary movements of the several bending pieces 42 with axis X as the axis of rotary movement.

[0027] The flexible part 25 is bent by the actuating wire 27 to open and close the pair of gripping claws 30. As shown in Fig. As shown in Figure 8, each of the several bendable sections 42 has a wire guide 47 that allows the actuating wire 27 to be pushed and pulled. In a case where the bendable section 42 is divided into a first side A and a second side B, which is an opposite side, with axis X as a boundary, the wire guide 47 is provided on the side that is the second side B. Therefore, when the actuating wire 27 is pulled towards the side of the actuating part 22, the flexible part 25 is bent such that the first side A is positioned outside the curve and the second side B is positioned inside the curve.

[0028] As described above, in the endoscope treatment tool 20, the closing action of the handle 24 and the bending action of the flexible part 25 are performed by pulling an actuating wire 27. This facilitates actuation of the actuating part 22. Here, when the actuating wire 27 is pulled towards the side of the actuating part 22, the handle 24 is first closed, and the flexible part 25 is bent while the handle 24 is closed. An actuation sequence of closing the handle 24 and bending the flexible part 25 can be set based on the relationship between the actuating resistance when closing the handle 24 and the actuating resistance when bending the flexible part 25.For example, in a case where the actuation resistance of the flexible part 25 is relatively large, the closing process of the handle part 24 is carried out first, and the bending process of the flexible part 25 is carried out later.

[0029] The actuation resistance in a case where the handle part 24 is closed includes friction at the cutting edge of the pair of gripping claws 30 and friction at a connecting section between the gripping claw 30 and the linking element 31. The actuation resistance in a case where the flexible part 25 is bent includes friction at a connecting section between the two adjacent bending pieces 42. Furthermore, the outer sheath 43 of the flexible part 25 is an elastic element that linearly extends the flexible part 25. Therefore, the actuation resistance in a case where the flexible part 25 is bent includes the elasticity of the outer sheath 43. Additionally, the actuating wire 27 is also an elastic element that linearly extends the flexible part 25. Therefore, the actuating resistance in a case where the flexible part 25 is bent includes the elasticity of the actuating wire 27.The elastic element that linearly extends the flexible part 25 is not limited to the outer sheath 43, the actuating wire 27 and the like, and can be a wire spring, a leaf spring or the like.

[0030] As described above, in the flexible part 25, which is bent by pulling the actuating wire 27, an elastic force is generated by the outer sheath 43 in a direction that returns from a bent state to a linear state, since the outer sheath 43 consists of an elastic element. Furthermore, the elastic force increases according to the degree of bending of the flexible part 25. A friction adjustment mechanism 70 (in Fig. 12 described below) is provided which can react to a change in the elastic force, can increase a frictional force according to the bending amount (angle) of the flexible part 25 and can maintain the bent state of the flexible part 25 in a stable state.

[0031] As the amount of movement by which the actuating wire 27 is pulled increases, a force pulling in the direction of the actuating wire 27's return (a linearly extending force) also increases. In the present embodiment, the friction adjustment mechanism 70, described below, which can respond to a change in the force (elastic restoring force) pulling in the direction of the actuating wire 27's return, can increase a frictional force to correspond to the amount of movement of the actuating wire 27 and can maintain a pulled state in a stable condition.

[0032] Fig. Figure 10 is a diagram showing a configuration of the actuating part 22 of the treatment tool for an endoscope 20. Fig. Figure 11 is a cross-sectional view of the actuating part 22 of the treatment tool 20 for an endoscope.

[0033] As in Fig. As shown in Figure 10, the actuating part 22 comprises an actuating part main body 50, an actuating handle 51, and a fastening part 52. The actuating part main body 50 serves as a means for inputting a forward and reverse rotary actuation to move the handle part 24 (see Figure 10). Fig. 3) forwards and backwards and for rotating the handle part 24. The actuating handle 51 serves as a means for inputting an opening and closing bending actuation of the opening and closing of the handle part 24 and of bending the flexible part 25 (see Fig. 2) The fastening part 52 is a fastening section that can be attached to and removed from the endoscope actuation part 7 (see Fig. 1).

[0034] The fastening part 52 has a connecting fitting 52a. The connecting fitting 52a is connected to a base that is attached to the first treatment tool insertion port 13 (see Fig. 1) of the endoscope actuating part 7. The actuating part 22 is supported by the endoscope actuating part 7 in a state in which the connecting fitting 52a is connected to the base.

[0035] The actuator body 50 is formed in a rod shape and can be actuated in a direction along its central axis, indicated by arrow E, and in a direction of rotation about a central axis, indicated by arrow F. The actuator body 50 is supported by the mounting part 52. The connecting part 26 of the insertion part 21 is connected to the actuator body 50 by the mounting part 52. In response to the actuation of the actuator body 50, the connecting part 26 moves forward and backward along a longitudinal axis of the connecting part 26 in the direction of arrow E. Furthermore, in response to the actuation of the actuator body 50, the connecting part 26 rotates about its longitudinal axis in the direction of arrow F.The forward and backward movement and rotation of the connecting part 26 are transferred to the handle part 24, and the handle part 24 is also moved forward and backward and is rotated integrally with the connecting part 26.

[0036] The operating handle 51 is pivotally mounted on the main body 50 of the operating element. For example, as shown in Fig. As shown in Figure 11, the actuating handle 51 is mounted by a rotary motion bearing shaft part 55a (55) and can oscillate in an opening direction C, in which a free end part 51a moves away from the actuating part main body 50, and in a closing direction D, which approaches the actuating part main body 50. The actuating handle 51 is mounted such that it moves on a fan-shaped actuating motion surface that is centered on the rotary motion bearing shaft part 55a.

[0037] Fig. Figure 12 is a cross-sectional view showing the closed state of the actuating part 22 of the treatment tool for an endoscope 20. The closed state of the actuating part 22 is a state in which the actuating handle 51 is actuated in the closing direction D. Meanwhile, the open state of the actuating part 22 is a state ( Fig. 11) in a case where the operating handle 51 is actuated in the opening direction C.

[0038] The actuating handle 51 pulls (direction of arrow G) the actuating wire 27 in the closing direction D when oscillating and pushes (direction opposite to arrow G) the actuating wire 27 in the opening direction C when oscillating. The actuating wire 27 is attached to a wire holder 56, which is designed to be slidably movable along its axis in the actuating handle main body 50. The wire holder 56 is connected to the actuating handle 51 via a connecting element 57, which is rotatably connected to the rotary motion bearing shaft part 55c (55). The connecting element 57 and the actuating handle 51 are rotatably connected to each other via the rotary motion bearing shaft part 55b (55).

[0039] As described above, when the pull-out force (the amount of movement in the direction of arrow G) of the actuating wire 27 increases, a force (elastic restoring force) acting in the direction of return of the wire retaining part 56 also increases. Furthermore, in a case where a lesion part is grasped and lifted, the restoring force increases with the lifting force (the amount of pull). Therefore, a restoring force acting on the actuating handle 51 increases as the pull-out force increases. To respond to a change in the restoring force, the friction adjustment mechanism 70, which increases a frictional force for locking the wire retaining part 56 to correspond to the pull-out force of the actuating wire 27 coupled to an actuation of the actuating handle 51, is provided on the rotary motion bearing shaft part 55c.

[0040] The actuating wire 27 is pushed out towards the side of distal end part 23 in response to the actuating handle 51 swinging in the opening direction C, and is pulled in towards the side of actuating part 22 in response to the actuating handle 51 swinging in the closing direction D. In this case, when the actuating handle 51 swings in the closing direction D, the handle part 24 is closed and the flexible part 25 is bent.

[0041] Since the actuating handle 51 has the friction adjustment mechanism 70, which maintains its actuated state, the actuating handle 51 is configured to maintain a bending angle of the flexible part 25 at any angle equal to or less than a maximum bending angle. The friction adjustment mechanism 70 increases a frictional force to lock the wire retaining part 56 to correspond to an increase in the amount of pull of the actuating wire 27 caused by the wire retaining part 56 coupled to the oscillation of the actuating handle 51. Therefore, even in a case where the amount of pull of the actuating wire 27 is increased and the wire return force is increased, the actuating handle 51 is prevented from retracting.Accordingly, a hand can be released from the operating handle 51 regardless of its operating position, and furthermore, the actuating force required for the rotational movement is small, so that stable actuation is possible.

[0042] A first example of a treatment procedure using the treatment tool for an endoscope 20 is given with reference to Fig. 13, Fig. 14, Fig. 15, Fig. 16, Fig. 17 to Fig. 18 described. This example describes a treatment procedure of endoscopic submucosal dissection (ESD). Fig. Figure 13 is a diagram showing a first example (part 1) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 14 is a diagram showing a first example (part 2) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 15 is a diagram showing a first example (part 3) of a treatment procedure using the treatment tool 20 for an endoscope. Furthermore, Fig. 16 a diagram showing a first example (part 1) of a treatment procedure using a combination of the treatment tool for an endoscope 20 and another treatment tool for an endoscope. Fig. Figure 17 is a diagram showing a first example (part 2) of a treatment procedure using a combination of the treatment tool 20 for an endoscope and another treatment tool for an endoscope. Fig. Figure 18 is a diagram showing a first example (part 3) of a treatment procedure using a combination of the treatment tool 20 for an endoscope and another treatment tool for an endoscope.

[0043] The actuating wire 27 is pulled towards the side of the actuating part 22 in response to the oscillation of the actuating handle 51 in the closing direction D. Furthermore, another treatment tool for an endoscope, used in combination with the treatment tool for an endoscope 20, is an incision tool and a high-frequency forceps 60, which has a pair of openable and closable claws 61 on a distal end part (see Fig. 16) The pair of claws 61 is opened and closed by actuating an actuating part of the high-frequency forceps 60. In a state where the pair of claws 61 is closed and living body tissue is grasped by the pair of claws 61, a high-frequency current flows between the pair of claws 61 and a feedback electrode plate via the living body tissue, or a high-frequency current flows between the pair of claws 61, thereby cauterizing and incising the living body tissue. The treatment tool for an endoscope 20 is an example of a “first treatment tool” of the present invention. The high-frequency forceps 60 is an example of a “second treatment tool” of the present invention.

[0044] As in Fig. As shown in Figure 13, the distal end 10 of the endoscope 2, which has been inserted into the body, is positioned on one side of a lesion LA of a mucosal layer. The treatment tool for the endoscope 20 is inserted through the first treatment tool channel 14 of the endoscope 2, and the distal end 23 and the flexible part 25 of the treatment tool for the endoscope 20 protrude from the end face of the distal end 10 of the endoscope. The lesion LA is then grasped by the actuating part 22 of the treatment tool for the endoscope 20 via the handle 24 of the distal end 23.

[0045] In a case where the lesion part LA is grasped by the handle part 24, the actuating handle 51 is first (see Fig. 10) of the actuating part 22 in the opening direction C. As in Fig. As shown in Figure 13, actuating the actuating handle 51 in the opening direction C pushes the actuating wire 27 to the side of the distal end part 23, and pushing the actuating wire 27 linearly extends the flexible part 25 and positions it along the longitudinal axis of the connecting part 26. Furthermore, when the actuating wire 27 is pushed out, the pair of gripping claws 30 of the handle part 24 opens. Then, the lesion part LA is positioned between the pair of gripping claws 30 by appropriately pushing and pulling the actuating part main body 50.

[0046] Next, the actuating handle 51 is actuated in the closing direction D in a state where the lesion part LA is positioned between the pair of gripping claws 30. Accordingly, the actuating wire 27 is pulled to the side of the actuating part 22. When the actuating wire 27 is pulled, initially, as described in Fig. As shown in Figure 14, the pair of grasping claws 30 is closed and the lesion part LA is grasped by the handle part 24. Then, after the lesion part LA has been grasped by the handle part 24, the flexible part 25 is moved as shown in Figure 14. Fig. 15 shown bent. Accordingly, the handle part 24 is erected from a state in which it is arranged along the longitudinal axis of the connecting part 26, and the lesion part LA gripped by the handle part 24 is lifted.

[0047] In a state where the lesion portion LA is elevated, the forceps 60, inserted through the second treatment tool channel 16 of the endoscope 2, are used for high-frequency applications as described in Fig. Figure 16 shows a peripheral surface of the distal end portion 10 of the endoscope. The pair of claws 61 of the high-frequency forceps 60 is positioned on a lower portion of the lesion portion LA, and the lower portion of the lesion portion LA is cut by the pair of claws 61. As the incision progresses, the lifted lesion portion LA can be released once, grasped again, and then lifted. In a case where the once-cut lesion portion LA is lifted, the lower portion can be exposed for easier viewing. The incision progresses as the high-frequency forceps 60 are appropriately pushed and pulled, and the lesion portion LA, which contains a submucosal layer, is gradually removed.

[0048] In this way, the lesion part LA can be grasped from the side, and the grasped lesion part LA can be lifted by actuating the actuating handle 51 of the treatment tool for an endoscope 20, thus simplifying operation. Furthermore, lifting the lesion part LA exposes its lower portion for easier visualization, and treatment of the lower portion of the lifted lesion part LA can be performed safely, reliably, and easily.

[0049] In a case of incision, the actuator main body 50 of the actuator 22 can be cut in the direction of arrow E from Fig. 10 can be pushed and pulled and / or the actuator main body 50 can be moved in the direction of arrow F from Fig. 10 can be rotated. As described above, the connecting part 26 has a stiffness that allows translational and rotational force to be transmitted from the side of the actuating part 22 to the side of the flexible part 25, and pushing, pulling and rotating the actuating part main body 50 are transmitted via the connecting part 26 to the flexible part 25.

[0050] Fig. Figure 17 shows a movement of the handle part 24 in a case where the actuator main body 50 is rotated. The connecting part 26 is rotated about its longitudinal axis in response to the rotation of the actuator main body 50. In a state where the flexible part 25 is bent, the handle part 24 is rotated while maintaining an upright position with respect to the longitudinal axis of the connecting part 26. As the handle part 24 is rotated, the lesion part LA, gripped by the handle part 24, is swung about the longitudinal axis of the connecting part 26.

[0051] Fig. Figure 18 shows a movement of the handle part 24 in a case where the actuator part main body 50 is pushed and pulled. The connecting part 26 is moved forward and backward in an axial direction along the longitudinal axis of the connecting part 26 in response to the pushing and pulling of the actuator part main body 50. In a state where the flexible part 25 is bent, the handle part 24 is moved forward and backward while maintaining an upright position with respect to the longitudinal axis of the connecting part 26. As the handle part 24 moves forward and backward, the lesion part LA gripped by the handle part 24 is pushed and pulled in the axial direction along the longitudinal axis of the connecting part 26.

[0052] By swinging and / or pushing and pulling the lesion portion LA as needed, a cut wound, for example, can be widened. Accordingly, treatment of the lower part of the lesion portion LA can be performed more easily.

[0053] Fig. Figure 19 is a diagram showing a state in which the treatment tool for an endoscope 20 is attached to the first treatment tool insertion port 13 of the endoscope actuator 7. As described above, the treatment tool for an endoscope 20 is attached to the endoscope actuator 7 by connecting the connecting fitting 52a of the mounting part 52 to the base of the first treatment tool insertion port 13 of the endoscope actuator 7. With the treatment tool for an endoscope 20 attached to the endoscope actuator 7, the insertion part 21, which consists of the distal end part 23, the flexible section 25, and the connecting part 26, is inserted into the first treatment tool channel 14, which extends from the first treatment tool insertion port 13 to the distal end part 10 of the endoscope.

[0054] The bent state of the flexible part 25 in the insertion part 21 of the treatment tool for an endoscope 20 is described with reference to Fig. 20, Fig. 21 to Fig. 22 described. Fig. Figure 20 is a diagram showing the flexible part 25 in the insertion part 21 in an undistracted state. Fig. Figure 21 is a perspective view showing the flexible part 25 in a bent state. Fig. 22 is a top view of the in Fig. 21 shown flexible part 25.

[0055] As in Fig. As shown in Figure 20, the undistracted state of the flexible part 25 signifies a state in which the flexible part 25 is straight relative to an end part of the connecting part 26 on the side of the flexible part 25. As described above, the flexible part 25 is bent by actuating the actuating wire 27, which extends from the distal end part 23 through the flexible part 25 and the connecting part 26 to the actuating part 22. Furthermore, the pair of gripping claws 30 on the distal end part 23 is opened and closed by actuating the actuating wire 27.

[0056] For example, in a case where the actuating wire 27 is pushed out to the side of distal end part 23, as in Fig. 20 shows the flexible part 25 brought into an unbent state in which the flexible part 25 is linearly extended and is positioned along the longitudinal axis of the connecting part 26, and the pair of gripping claws 30 of the handle part 24 is in an open state.

[0057] On the other hand, in a case where the actuating wire 27 is pulled to the side of actuating part 22, as in Fig. 21 and Fig. As shown in Figure 22, the pair of gripping claws 30 of the handle part 24 is brought into a closed position, and the flexible part 25 is bent so that it bulges outwards and is bent upwards with respect to the longitudinal axis of the connecting part 26. In this case, when the actuating wire 27 is pulled to the side of the actuating part 22, the pair of gripping claws 30 is first brought into a closed position, and after the pair of gripping claws 30 has been closed, the flexible part 25 is bent into a bent position.

[0058] As in Fig. As shown in Figure 22, the maximum bending angle θ of the flexible part 25 with respect to the longitudinal axis of the connecting part 26 is configured to be greater than 90 degrees. The term "maximum bending angle" refers to the angle of the distal end of the flexible part 25 when the flexible part 25 is maximally bent relative to the distal end of the flexible part 25 in an unbent state. The term "maximally bent" refers to a state in which the flexible part 25 is bent to the greatest extent within a range that can be actuated by actuating the actuating part 22. For example, the maximum bending angle θ is preferably 100 degrees to 180 degrees.

[0059] A second example of an ESD treatment procedure using the treatment tool for an endoscope 20 is given with reference to Fig. 23, Fig. 24 to Fig. 25 described. Fig. Figure 23 is a diagram showing a second example (part 1) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 24 is a diagram showing a second example (part 2) of a treatment procedure using the treatment tool 20 for an endoscope. Fig. Figure 25 is a diagram showing a second example (part 3) of a treatment procedure using the treatment tool 20 for an endoscope.

[0060] As in Fig. As shown in Figure 23, an injection cannula 80 protruding from the end face of the distal end part 10 of the endoscope is used to inject a drug (for example, physiological saline solution) into a submucosal layer SU, thereby elevating the lesion portion LA together with a mucosal MU. The injection cannula 80 is inserted through the second treatment tool channel 16 of the endoscope 2.

[0061] Next, the mucosa MU around the raised lesion portion LA is incised. The lesion portion LA is gradually peeled away from the incised portion. For example, as shown in Fig. As shown in Figure 24, the distal end 23 and the flexible part 25 of the treatment tool for an endoscope 20, which is inserted through the first treatment tool channel 14 of the endoscope 2, and the high-frequency forceps 60, which are inserted through the second treatment tool channel 16, protrude from the end face of the distal end 10 of the endoscope. After the lesion part LA has been grasped by the pair of grasping claws 30 of the distal end 23 of the treatment tool for an endoscope 20, the flexible part 25 is bent to lift the lesion part LA grasped by the grasping claws 30. Then, with the lesion part LA lifted, the lower part of the lesion part LA is cut by the pair of claws 61 of the high-frequency forceps 60.

[0062] When cutting the lesion part LA, if the lesion part LA to be cut is small or if the incision of the lesion part LA is in its initial stage, the required lifting distance to raise the lesion part LA grasped by the gripping claws 30 is small. Therefore, for example, as in Fig. Figure 24 shows one direction of the tensile force of the flexible part 25, which is generated by bending the flexible part 25, one direction (in Fig. 24 upward direction), in which the grasped lesion part LA is pulled away from the submucosal layer SU. Therefore, a bending angle of the flexible part 25 required to elevate the lesion part LA can be 90 degrees or less.

[0063] However, in a case where the lesion portion LA to be cut is large, or in a case where the incision of the lesion portion LA has already progressed to a certain degree, the lifting amount (distance) required to raise the lesion portion LA grasped by the gripping claws 30 becomes large. Therefore, for example, as in Fig. 25 shows a direction of the tensile force of the flexible part 25, which is generated by bending the flexible part 25, a direction in which the grasped lesion part LA is pulled away from the submucosal layer SU, and is also a direction (in Fig. 25 (direction to the right), in which the grasped lesion part LA is guided in a direction opposite to a cutting direction. Therefore, the maximum bending angle θ of the flexible part 25 for lifting the lesion part LA and then for sending the lifted lesion part LA in the direction opposite to the cutting direction must be an angle greater than 90 degrees.

[0064] Fig. Figure 26 is a diagram showing the positional relationship between the distal end part 23 and the endoscope 2 in a case where the flexible part 25 is maximally bent. As shown in Fig. As shown in Figure 26, the flexible part 25 and the distal end 23 of the treatment tool for an endoscope 20, which is inserted through the first treatment tool channel 14 of the endoscope 2, extend outwards from an end face 10a of the distal end 10 of the endoscope. In a case where the extended flexible part 25 is bent to the maximum bending angle (in a case where it is bent maximally), the inner diameter of an arc drawn by the flexible part 25 is greater than 1 / 2 of the outer diameter DE of the distal end 10 of the endoscope.

[0065] The "inner diameter of the arc" is twice the radius of curvature. In a case where the curvature is not constant, the radius of curvature is twice the radius of curvature of a section with the highest curvature (large bend). For example, as in this example, in a case where the curvature of the arc drawn by the flexible part 25 is not constant, an inner diameter Dbs is twice the radius of curvature of the section with the highest curvature (large bend), and an inner diameter Dbl is twice the radius of curvature of a section with the lowest curvature (small bend), and the inner diameter of the arc drawn by the flexible part 25 is the inner diameter Dbs.Since the shape of a section of the endoscope 2, in which the first treatment tool channel 14 is provided, is essentially circular when viewed along a longitudinal axis of the first treatment tool channel 14, the "outer diameter DE of the distal end part 10 of the endoscope" is an outer diameter (diameter) of the section. In a case where the shape of the distal end part 10 of the endoscope is elliptical, the diameter of a major axis of the ellipse is the outer diameter DE. Therefore, the relationship between the inner diameter Dbs of the arc drawn by the flexible part 25 and the outer diameter DE of the distal end part 10 of the endoscope is Dbs > DE / 2.

[0066] Furthermore, the flexible part 25 is configured such that the distal end part 23 (gripping claw 30), extending from the first treatment tool channel 14, does not come into contact with the distal end part 10 of the endoscope 2 when the flexible part 25 is maximally bent. That is, the flexible part 25 does not come into contact with the distal end part 10 of the endoscope regardless of the bent position or changes in the bending angle. Moreover, when the flexible part 25 is maximally bent, the distal end part 23, extending from the first treatment tool channel 14, does not come into contact with the distal end part 10 of the endoscope 2, regardless of the rotational state of the insertion part 21, which accompanies the actuation of the actuating part main body 50.

[0067] Fig. Figure 27 is a diagram showing an example of the end surface 10a of the distal end part 10 of an endoscope. As in Fig. As shown in Figure 27, the first treatment tool channel 14 of the endoscope 2 is designed such that position C1 in the middle of the first treatment tool channel 14 is a position that differs from position C0 in the middle of the distal end part 10 of the endoscope 2. Although in Fig. 27 not shown, in addition to the first treatment tool channel 14, the second treatment tool channel 16 and the like are formed in the distal end part 10 of the endoscope of the endoscope 2 (see, for example, Figure 27). Fig. 13), and the second treatment tool channel 16 is also provided such that a position in the middle of the second treatment tool channel 16 differs from position C0 in the middle of the distal end part 10 of the endoscope 2. The outer diameter DE of the distal end part 10 of the endoscope is, for example, 5 mm to 14 mm and preferably 9 mm to 12 mm. An inner diameter DC of the first treatment tool channel 14 is, for example, 2 mm to 6 mm and preferably 2.8 mm to 3.8 mm.

[0068] As described above, in the treatment tool 20 for an endoscope, the pair of gripping claws 30 of the handle part 24 can be closed by actuating the actuating handle 51. The flexible part 25 can be bent in a state where the gripping claws 30 are closed, and the maximum bending angle of the bent flexible part 25 can be set to be greater than 90 degrees. With this configuration, it is possible to continuously pull the lesion part LA, gripped by the gripping claws 30, over a wide range by bending the flexible part 25. Therefore, even in a case where the lesion part LA to be cut is a large part, or even in a case where the cutting process of the lesion part LA has progressed to a certain extent, the number of times the lesion part LA needs to be re-gripped by the gripping claws 30 can be reduced.As a result, the lower part of the lesion (LA) can be easily exposed for visualization, and treatment of the lower part of the lesion can be performed safely, reliably, and easily. Therefore, it is possible to improve the ease of treatment of the lesion (LA).

[0069] Furthermore, in the treatment tool 20 for an endoscope, when the flexible part 25 is maximally bent, the inner diameter Dbs of the arc formed by the flexible part 25 is greater than 1 / 2 the outer diameter DE of the distal end 10 of the endoscope. Therefore, even when the flexible part 25 is maximally bent, the distal end 23 extending from the first treatment tool channel 14 does not come into contact with the distal end 10 of the endoscope 2. Moreover, even when the flexible part 25 is maximally bent, the distal end 23 extending from the first treatment tool channel 14 does not come into contact with the distal end 10 of the endoscope, regardless of the rotational state of the insertion part 21.Accordingly, in a case where the lesion part LA is grasped and lifted by the gripping claws 30, it is possible to perform treatment on the lower part of the lesion part LA safely and reliably. Therefore, it is possible to improve the ease of treatment on the lesion part LA.

[0070] In the actuating part 22 of the above embodiment, the actuating handle 51 is provided such that it protrudes from the actuating part main body 50 and is pivotable, and the wire holding part 56 is moved by the vibration, but the present invention is not limited to this configuration. Fig. Figure 28 is a diagram showing another example of the operating handle 51. For example, as shown in Fig. Figure 28 shows that the actuating handle 51 is an element provided on a flat section 50b on the actuating part main body 50 and is movable in a direction E along the flat section 50b. The actuating handle 51 is actuated, for example, by the thumb of an operator grasping the actuating part main body 50.

[0071] In this case, the actuating handle 51 is connected to the wire retaining part 56, and in a case where the actuating handle 51 is directed to a distal end (an upper side of Fig. 28) of the actuating part main body 50 is moved, the wire retaining part 56 is also moved to the distal end side of the actuating part main body 50, and the actuating wire 27 is pulled. In addition, in a case where the actuating handle 51 is moved to a base end side (a lower side of Fig. 28) when the actuator main body 50 is moved, the wire retaining part 56 is also moved to the base end of the actuator main body 50, and the actuator wire 27 is loosened. That is, when the in Fig. In the configuration shown in 28, the same actuation as actuating the swinging of the in can be achieved by moving the actuating handle 51 up and down. Fig. The actuating handle 51 shown in 11 can be implemented. In the case of the Fig. In the configuration shown in Figure 28, the position or shape of the actuating handle 51 or the flat section 50b does not correspond to the configuration shown in Figure 28. Fig. The configuration shown is limited to 28. Reference symbol list 1 Endoscope system 2 Endoscope 3 Light source device 4 processors 5 Monitor 6 Endoscope insertion part 7 Endoscope actuation part 8 Universal cables 9 connectors 10 distal end of endoscope 10a End area 11 flexible endoscope part 12 Endoscope connector 13 First treatment tool insertion port 14 first treatment tool channel 15 second treatment tool insertion port 16 second treatment tool channel 20 Treatment tools for endoscopes 21 Introductory section 22 Actuating part 23 distal end part 24 Handle part 25 flexible part 26 Connecting part 27 Actuating wire 30 grasping claw 31 57 Linking element 32 storage areas 33, 46 pen 42 bending piece 43 Outer jacket 47 Wire guide 50 Actuator main body 50b level section 51 Operating handle 51a free end section 52 Fastening part 52a Connecting fitting 55a, 55b, 55c Rotary motion bearing shaft part 56 Wire holder part 60 pliers 61 Claw 70 Friction adjustment mechanism 80 injection cannulas C0, C1 Position QUOTES INCLUDED IN THE DESCRIPTION

[0000] This list of documents cited by the applicant was automatically generated and is included solely for the reader's convenience. The list is not part of the German patent or utility model application. The DPMA accepts no liability for any errors or omissions. Cited patent literature

[0000] JP 1999-299793A

[0002] JP-H11-299793A

[0002] JP 1997-299323A

[0003] JP-H9-299323A

[0003] JP 2007-151595A

[0004] JP 2022-152489A

[0005]

Claims

Treatment tool for an endoscope, comprising: an inserter that can be inserted into a body; and an actuating part arranged on a base end face of the inserter, wherein the inserter comprises: a distal end part having a handle that can be opened and closed, a flexible part that is flexible and is provided to be adjacent to the distal end part on one side of the actuating part, and a connecting part that connects the flexible part and the actuating part, the inserter being able to be moved forwards and backwards along a longitudinal axis of the connecting part and rotated about the longitudinal axis by actuation of the actuating part, the handle being closed by actuation of the actuating part and the flexible part being bent in a state in which the handle is closed, and the maximum bending angle of the flexible part with respect to the longitudinal axis being greater than 90 degrees. Treatment tool for an endoscope according to claim 1, further comprising: at least one actuating wire connected to the actuating part and which actuates at least one of opening and closing the handle part and bending the flexible part. Treatment tool for an endoscope according to claim 1 or 2, wherein the insertion part is used by being inserted into a treatment tool channel of the endoscope, and an inner diameter of an arc, which in a case is drawn in which the flexible part is bent to its maximum extent, is greater than 1 / 2 of an outer diameter of the endoscope. Treatment tool for an endoscope according to one of claims 1 to 3, wherein the insertion part is used by being inserted into a treatment tool channel of the endoscope, and in a case where the flexible part is maximally bent, the distal end part extending from the treatment tool channel does not come into contact with the endoscope. Treatment tool for an endoscope according to claim 4, wherein in a case where the flexible part is maximally bent, the distal end part extending from the treatment tool channel is not in contact with the endoscope regardless of a rotational state of the insertion part. Endoscope system comprising: the treatment tool for an endoscope according to any one of claims 1 to 5; and an endoscope having a treatment tool channel through which the insertion part can be inserted. Endoscope system according to claim 6, further comprising: a first treatment tool, which is the treatment tool for an endoscope; a second treatment tool; and the endoscope, wherein the endoscope has a first treatment tool channel through which the insertion part of the first treatment tool can be inserted, and a second treatment tool channel through which the second treatment tool can be inserted.

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