Endoscopic treatment tool

Abstract

To enhance convenience.SOLUTION: An endoscopic treatment tool 6 comprises a sheath 9 comprising a first hole 922 in a tip part, and an incision part 11 inserted into the first hole 922 so as to freely advance and retreat, and comprising a second hole 120 extending between a tip and a base end, and is constituted so as to be capable of switching between a first mode in which fluid is passed by establishing communication between a main flow passage M1 and the first hole 922, and a second mode in which the fluid is passed by establishing communication between the main flow passage M1 and the second hole 120, in accordance with the advance and retreat of the incision part 11.SELECTED DRAWING: Figure 2

Description

Technical Field

[0001] The present invention relates to an endoscopic treatment instrument.

Background Art

[0002] Conventionally, an endoscopic treatment instrument has been known which includes an insertion portion inserted into a body cavity via an endoscope and cuts a site to be treated in a living tissue (hereinafter referred to as a target site) by a high-frequency current (see, for example, Patent Document 1). In the endoscopic treatment instrument described in Patent Document 1, the insertion portion includes a sheath having a first hole communicating inside and outside at the tip, and a cutting portion that protrudes from the first hole to the outside of the sheath and cuts the target site when a high-frequency current is applied. A second hole penetrating from the base end side to the tip is provided in this cutting portion. And in this endoscopic treatment instrument, it is configured to be switchable between a first mode in which a liquid is circulated into the body cavity from a gap between the inner surface of the first hole and the outer surface of the cutting portion, and a second mode in which the liquid is circulated into the body cavity from the second hole.

Prior Art Documents

Patent Documents

[0003]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] However, in the endoscopic treatment instrument described in Patent Document 1, the insertion section is provided with two independent first and second flow channels. The first flow channel communicates with the first of the two holes and is a flow channel that allows liquid to flow into the first hole. The second flow channel communicates with the second of the two holes and is a flow channel that allows liquid to flow into the second hole. The two flow channels, the first and second, are connected to independent water sources. In other words, the configuration of the operating section that allows liquid to flow through the two flow channels, the first and second, becomes complex, making operation cumbersome.

[0005] The present invention has been made in view of the above, and aims to provide an endoscopic treatment instrument that can improve convenience. [Means for solving the problem]

[0006] To solve the above-mentioned problems and achieve the objective, the endoscopic treatment instrument according to the present invention comprises a sheath having a first hole at its tip, and an incision portion that is inserted into the first hole so as to be able to move back and forth and has a second hole extending between the tip and the base, and is configured to be switchable between a first mode in which fluid is circulated by communication between the main flow path and the first hole, and a second mode in which fluid is circulated by communication between the main flow path and the second hole, depending on the movement of the incision portion. [Effects of the Invention]

[0007] The endoscopic treatment instrument according to the present invention can improve convenience. [Brief explanation of the drawing]

[0008] [Figure 1] Figure 1 is a diagram showing an endoscope system according to Embodiment 1. [Figure 2] Figure 2 is a diagram illustrating the configuration of the instrument insertion section. [Figure 3] Figure 3 is a diagram illustrating the configuration of the instrument insertion section. [Figure 4] Figure 4 is a diagram illustrating the configuration of the instrument insertion section. [Figure 5] Figure 5 is a diagram illustrating the configuration of the instrument insertion section. [Figure 6] Figure 6 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 7] Figure 7 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 8] Figure 8 is a diagram illustrating the operation of an endoscopic instrument. [Figure 9] Figure 9 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 10] Figure 10 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 2. [Figure 11] Figure 11 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 2. [Figure 12] Figure 12 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 13] Figure 13 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 14] Figure 14 illustrates a modified example of Embodiment 2. [Figure 15] Figure 15 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 3. [Figure 16] Figure 16 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 3. [Figure 17] Figure 17 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 18] Figure 18 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 19] Figure 19 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 4. [Figure 20] Figure 20 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 4. [Figure 21] Figure 21 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 4. [Figure 22] Figure 22 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 4. [Figure 23]FIG. 23 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 4. [Figure 24] FIG. 24 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 25] FIG. 25 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 26] FIG. 26 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 5. [Figure 27] FIG. 27 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 5. [Figure 28] FIG. 28 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 5. [Figure 29] FIG. 29 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 5. [Figure 30] FIG. 30 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 5. [Figure 31] FIG. 31 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 5. [Figure 32] FIG. 32 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 33] FIG. 33 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 34] FIG. 34 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 6. [Figure 35] FIG. 35 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 6. [Figure 36] FIG. 36 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 37] FIG. 37 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 38] FIG. 38 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 7. [Figure 39] FIG. 39 is a diagram for explaining the configuration of the treatment tool insertion part according to Embodiment 7. [Figure 40] FIG. 40 is a diagram for explaining the operation of the endoscope treatment tool. [Figure 41] Figure 41 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 42] Figure 42 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 8. [Figure 43] Figure 43 is a diagram illustrating the configuration of the instrument insertion section according to Embodiment 8. [Figure 44] Figure 44 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 45] Figure 45 is a diagram illustrating the operation of an endoscopic treatment instrument. [Figure 46A] Figure 46A shows an example of the shape of the protrusion. [Figure 46B] Figure 46B shows an example of the shape of the protrusion. [Modes for carrying out the invention]

[0009] The embodiments for carrying out the present invention (hereinafter referred to as "embodiments") will be described below with reference to the drawings. However, the present invention is not limited to the embodiments described below. Furthermore, in the drawings, the same parts are denoted by the same reference numerals.

[0010] (Embodiment 1) [Configuration of the Endoscopy System] Figure 1 is a diagram showing an endoscope system 1 according to Embodiment 1. The Endoscope System 1 is a system used in the medical field that, while observing the inside of a body cavity, applies high-frequency energy to a target area (hereinafter referred to as the target area) in the biological tissue within the body cavity to treat the target area. The procedures that can be performed with the Endoscope System 1 according to this embodiment 1 include procedures such as coagulation (sealing) of the target area or incision of the target area. As shown in Figure 1, this Endoscope System 1 comprises an endoscope 2, a display device 3, a light source device 4, a control device 5, and an endoscopic treatment instrument 6.

[0011] The endoscope 2 is partially inserted into a body cavity, captures an image of the subject reflected from within the body cavity, and outputs an image signal generated by the capture. As shown in Figure 1, the endoscope 2 comprises an endoscope insertion section 21, an endoscope operation section 22, a universal cord 23, and a connector section 24. The endoscope insertion section 21 is the part that is inserted into the body cavity and is at least partially flexible. As shown in Figure 1, this endoscope insertion section 21 comprises a tip unit 211, a bending section 212, and a flexible tube 213.

[0012] The tip unit 211 is located at the tip of the endoscope insertion section 21. Although not shown in detail in the illustration, this tip unit 211 includes an illumination optical system, an imaging optical system, and an imaging unit. The illumination optical system is positioned opposite one end of a light guide (not shown) routed within the endoscope insertion section 21, and the light transmitted by the light guide is irradiated into the body cavity from the tip of the endoscope insertion section 21. The imaging optical system captures light (the image of the subject) that is irradiated into the body cavity from the illumination optical system and reflected from within the body cavity, and forms an image on the imaging surface of the image sensor that constitutes the imaging unit. The imaging unit is composed of an image sensor such as a CCD (Charge Coupled Device) or CMOS (Complementary Metal Oxide Semiconductor), captures an image of a subject formed by the imaging optical system, and outputs an image signal generated by the imaging.

[0013] The bending section 212 is connected to the proximal end (endoscope operating section 22 side) of the tip unit 211. Although not shown in detail in the illustration, this bending section 212 has a configuration in which multiple bending pieces are connected, making it bendable. The flexible tube 213 is connected to the proximal end (endoscope operating section 22 side) of the curved section 212, and is elongated and flexible.

[0014] The endoscope control unit 22 is connected to the proximal end portion of the endoscope insertion unit 21. The endoscope control unit 22 receives various operations on the endoscope 2. As shown in Figure 1, the endoscope control unit 22 is provided with a plurality of operating members 221, a bending knob 222, and an insertion port 223. The multiple operating members 221 are composed of buttons and the like that accept various operations. The bending knob 222 is configured to be rotatable in response to user operation. By rotating the bending knob 222, a bending mechanism (not shown) made of metal or resin wire, etc., disposed within the endoscope insertion section 21 is activated. As a result, the bending section 212 bends. The insertion port 223 communicates with a conduit (not shown) that extends from the tip to the proximal end (endoscope operating section 22 side) of the endoscope insertion section 21, and is an insertion port for inserting the treatment instrument insertion section 7 of the endoscope treatment instrument 6 into the conduit from the outside.

[0015] The universal code 23 extends from the endoscope operating section 22 in a direction different from the direction of extension of the endoscope insertion section 21, and is a code on which the aforementioned light guide and signal lines for transmitting the aforementioned image signals are arranged. The connector section 24 is provided at the end of the universal cord 23 and is detachably connected to the light source device 4 and the control device 5.

[0016] The display device 3 is an LCD (Liquid Crystal Display) or an EL (Electro Luminescence) display, etc., and displays a predetermined image under the control of the control device 5. The light source device 4 emits illumination light. The illumination light emitted from the light source device 4 passes through the connector section 24, the universal cord 23, the endoscope operating section 22, and the light guide and illumination optical system routed to the endoscope insertion section 21, before being irradiated into the body cavity from the tip of the endoscope insertion section 21.

[0017] The control device 5 is configured to include a CPU (Central Processing Unit) or FPGA (Field-Programmable Gate Array), and comprehensively controls the operation of the display device 3 and the light source device 4. For example, the control device 5 processes the image signal input from the imaging unit through the signal line described above to generate an endoscopic image. The control device 5 then controls the operation of the display device 3 to display the endoscopic image on the display device 3. In this embodiment 1, the light source device 4 and the control device 5 are configured as separate components, but they may also be integrated into a single housing.

[0018] [Composition of Endoscopic Treatment Instruments] The endoscopic instrument 6 is, for example, an instrument used in ESD (Endoscopic Submucosal Dissection). As shown in Figure 1, the endoscopic instrument 6 comprises an instrument insertion section 7 and an instrument operating section 8. As shown in Figure 1, the instrument insertion section 7 is the part that protrudes from the tip of the endoscope insertion section 21 via a conduit inside the endoscope insertion section 21 from the insertion opening 223 and is inserted into the body cavity, and corresponds to the insertion section according to the present invention. The detailed configuration of the instrument insertion section 7 will be explained later in the section titled "Configuration of the Instrument Insertion Section". Furthermore, the term "tip" as used below refers to one end of the instrument insertion section 7 in the direction of insertion, and the term "base" as used below refers to the other end of the instrument insertion section 7 opposite to the direction of insertion.

[0019] The instrument operating unit 8 is connected to the proximal end portion of the instrument insertion section 7 (the portion of the instrument insertion section 7 that is on the proximal end side with respect to the insertion direction). The instrument operating unit 8 receives input for the endoscopic instrument 6. As shown in Figure 1, the instrument operating unit 8 comprises an operating unit body 81 and a slider 82. The operating unit body 81 has an elongated shape, and the base end portion of the sheath 9, which will be described later and constitutes the instrument insertion section 7, is fixed to it. In addition, as shown in Figure 1, a ring 811 is provided at the base end portion of the operating unit body 81 for the operator, such as a surgeon, to grip with their finger. Furthermore, the operating unit body 81 is provided with a water supply port 812 to which a tube TU is connected. Physiological saline solution is supplied to the water supply port 812 from a water source 200, such as a pump, via the tube TU. Here, physiological saline corresponds to the fluid according to the present invention. However, the fluid according to the present invention is not limited to physiological saline; other liquids, gases such as air, etc., may also be used.

[0020] The slider 82 is attached to the main body 81 of the operating unit so as to be movable along the longitudinal direction of the operating unit body 81 in response to operation by an operator such as a surgeon. As shown in Figure 1, the slider 82 is provided with a pair of rings 821 for the operator to grip with their fingers. The slider 82 is also provided with a plug 822 to which the power cord CO is connected. The plug 822 is electrically connected to the power supply 100 via the power cord CO.

[0021] [Configuration of the instrument insertion section] Figures 2 to 5 illustrate the configuration of the instrument insertion section 7. Specifically, Figure 2 is a cross-sectional view of the tip portion of the instrument insertion section 7, cut by a plane containing the central axis of the instrument insertion section 7. Figure 3 is a cross-sectional view of the instrument insertion section 7 at the position of line III-III shown in Figure 2. Figure 4 is a cross-sectional view of the instrument insertion section 7 at the position of line IV-IV shown in Figure 2. Figure 5 is a cross-sectional view of the instrument insertion section 7 at the position of line VV shown in Figure 2. As shown in Figures 1 to 5, the instrument insertion section 7 comprises a sheath 9, a wire 10 (Figure 2), and an incision section 11 (Figure 2).

[0022] The sheath 9 is the outer surface of the instrument insertion section 7. As shown in Figures 1 and 2, the sheath 9 comprises a sheath body 91 and a tip member 92. The sheath body 91 is a cylindrical member made of resin material or the like, possessing insulating and flexible properties. The base end of the sheath body 91 is fixed to the operating unit body 81. The inside of the sheath body 91 is in communication with the water supply port 812.

[0023] The tip member 92 has a bottomed cylindrical shape, and closes the tip portion of the sheath body 91 with its bottom portion 920 facing the tip side (left side in Figure 2). The tip member 92 may be made of an electrically insulating material such as ceramic, resin material, or rubber, or it may be made of a material such as metal with an insulating coating applied to its surface. The tip member 92 may be made of a single part, or it may be made by combining multiple parts.

[0024] As shown in Figures 2 and 5, the inner circumferential surface 921 of the tip member 92 is provided with first and second wall portions 9211 and 9212. As shown in Figures 2 and 5, the first wall portion 9211 is a wall that protrudes from the inner circumferential surface 921 toward the central axis of the tip member 92 and extends along the said central axis. As shown in Figures 2 and 5, the second wall portion 9212 protrudes from the inner circumferential surface 921 toward the central axis of the tip member 92 and extends along the central axis to the bottom portion 920 of the tip member 92. Also, as shown in Figures 2 and 5, the second wall portion 9212 is provided with a groove portion 9213 that extends along the entire length of the second wall portion 9212.

[0025] The inside of the sheath body 91 and the tip member 92 described above function as the main flow path M1 (Figure 2) according to the present invention, through which physiological saline supplied from the water source 200 flows via the tube TU and the water supply port 812.

[0026] Furthermore, as shown in Figures 2 to 4, the bottom portion 920 of the tip member 92 is provided with a first hole 922 that connects the bottom portion 920 and the tip of the tip member 92, and the first hole 922 opens to both the bottom portion 920 and the tip of the tip member 92, respectively. The bottom portion 920 corresponds to the tip of the sheath according to the present invention. The first hole 922 has a circular cross-section and extends linearly along the central axis of the tip member 92. Here, the inner diameter of the first hole 922 is set to be smaller than the inner diameter of the inner circumferential surface 921, as shown in Figure 2. The first hole 922 may preferably be located on the central axis of the tip member 92.

[0027] The wire 10 is made of a conductive material such as metal and is inserted into the sheath 9. The base end of the wire 10 is fixed to the slider 82. That is, the wire 10 moves forward and backward within the sheath 9 in response to the operation of the slider 82 by an operator such as a surgeon. The wire 10 is also electrically connected to the plug 822.

[0028] The incision section 11 is made of a conductive material such as metal and is fixed to the tip of the wire 10. The incision section 11 is also inserted through the first hole 922. That is, the incision section 11 moves back and forth within the sheath 9 (first hole 922) in response to the operation of the slider 82 by the operator, such as a surgeon, together with the wire 10. The tip of the incision section 11 protrudes from the first hole 922 to the outside of the tip member 92. The incision section 11 is energized by a high-frequency current from the power supply 100 via the power cord CO, plug 822, and wire 10, and incises the target area within the body cavity. As shown in Figures 2 to 5, the incision section 11 is equipped with a knife 12.

[0029] The knife 12 protrudes from the first hole 922 to the tip member 92 and is the part that cuts the target area. As shown in Figure 2, it is composed of a so-called hook knife. This knife 12 comprises a knife body 121 and a projection 122. The knife body 121 is located on the central axis of the tip member 92 and is composed of a cylindrical member that extends linearly along the central axis. Here, the outer diameter of the knife body 121 is set to be smaller than the inner diameter of the first hole 922, as shown in Figures 2 and 4. The projection 122 is provided at the tip of the knife body 121 and is bent at approximately 90° relative to the knife body 121, upward in Figure 2.

[0030] As shown in Figure 2, the knife 12 described above is provided with a knife hole 123 that extends from the base end to the tip. This knife hole 123 is composed of an inlet hole 1231 and an outlet hole 1232. The inlet hole 1231 is a hole located at the base end of the knife body 121, extending from the upper side toward the central axis of the knife body 121 in Figures 2 and 5. The outflow hole 1232 is located on the central axis of the knife body 121 and extends linearly along that central axis. The outflow hole 1232 communicates with the outside of the knife 12 through the projection 122 at the tip end and with the base end.

[0031] Furthermore, a connecting member 13 is provided at the base end of the knife 12, as shown in Figures 2 to 5. The connecting member 13 is a member that connects the knife 12 and the wire 10. This connecting member 13 comprises a cylindrical portion 131 and a rotation restricting portion 132. The cylindrical portion 131 is composed of a cylindrical member that extends linearly along the central axis of the tip member 92. Here, as shown in Figure 5, the outer diameter of the cylindrical portion 131 is set to be slightly smaller than the distance between the first wall portion 9211 and the second wall portion 9212, and larger than the inner diameter of the first hole 922. Preferably, the cylindrical portion 131 may be located on the central axis of the tip member 92.

[0032] Furthermore, as shown in Figure 2, the cylindrical portion 131 is provided with a fitting hole 133 that extends from the tip end face towards the base end (right side in Figure 2) and into which the knife body 121 is fitted. In addition, as shown in Figures 2 and 5, the cylindrical portion 131 is provided with a communication hole 134 that extends from the outer circumferential surface of the cylindrical portion 131 toward the central axis of the cylindrical portion 131 and communicates with the inlet hole 1231. The knife hole 123, fitting hole 133, and communication hole 134 described above open to the outer circumferential surface on the base end side of the incision portion 11 and correspond to the second hole 120 (Figure 2) according to the present invention.

[0033] As shown in Figures 2 and 5, the rotation restricting portion 132 is a projection that protrudes from the outer circumferential surface of the cylindrical portion 131, and this projection is inserted into the groove portion 9213. The rotation restricting portion 132 is always inserted into the groove portion 9213 when the cutting portion 11 moves back and forth within the sheath 9 in response to the operation of the slider 82 by the operator, such as the surgeon. The rotation restricting portion 132 restricts the rotation of the knife 12 and the wire 10 about their central axes. The second wall portion 9212 (groove portion 9213) and the rotation restricting portion 132 described above correspond to the rotation restricting structure according to the present invention.

[0034] [Operation of endoscopic instruments] Next, we will explain the operation of the endoscopic treatment instrument 6 mentioned above. For the sake of clarity, we will use the ESD procedure as an example. Figures 6 to 9 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figure 6 illustrates the marking process in ESD. Figure 7 illustrates the local injection process in ESD. Figures 8 and 9 are cross-sectional views corresponding to Figure 2.

[0035] First, the operator inserts the endoscope insertion section 21 into the body cavity and moves the tip of the endoscope insertion section 21 to the vicinity of the target site T1 (Figure 6). Next, the operator performs a first operation by retracting the slider 82 towards the front (towards the ring 811). This causes the projection 122 to come into contact with the tip of the tip member 92, and only the projection 122 protrudes from the first hole 922 to the outside of the tip member 92. Then, the operator inserts the treatment instrument insertion part 7 from the insertion port 223 into the conduit inside the endoscope insertion part 21, and allows it to protrude from the tip of the endoscope insertion part 21.

[0036] Next, the operator or other person performing the procedure will carry out the marking process as shown below. In other words, the operator, such as a surgeon, operates a foot switch or other control unit (not shown) to supply high-frequency current from the power supply 100 to the knife 12 while maintaining a state in which only the projection 122 protrudes from the first hole 922 to the tip member 92 by the first operation on the slider 82. Then, as shown in Figure 6(a), the operator, such as a surgeon, presses the projection 122 against the biological tissue surrounding the target site T1. As a result, the biological tissue that comes into contact with the projection 122 is cauterized. That is, a marking mark T2 is formed in the cauterized area, as shown in Figures 6(a) and 6(b). The operator then repeats the above procedure multiple times to form a number of marking marks T2 that allow them to identify the outer edge of the target area T1, as shown in Figure 6(c). After this, the operator terminates the supply of high-frequency current from the power supply 100 to the knife 12.

[0037] Next, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as the surgeon, performs a second operation to advance the slider 82. As a result, the knife 12 protrudes from the tip of the sheath 9 (tip member 92) by its maximum protrusion length, as shown in Figure 8. In this state, the connecting member 13 comes into contact with the bottom portion 920 (opening peripheral portion) of the tip member 92. As a result, the base end opening of the first hole 922 is closed by the connecting member 13, as indicated by the "×" mark in Figure 8. In other words, the connecting member 13 corresponds to the second closing member according to the present invention, which can close the base end opening of the first hole 922. On the other hand, the communication hole 134 is positioned at a location offset from the position opposite the first wall portion 9211. That is, the position of the communication hole 134 is offset from the position of the first wall portion 9211 in the longitudinal axis direction of the sheath 9. As a result, the communication hole 134 communicates with the main flow path M1.

[0038] Furthermore, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200 while maintaining the state in which the knife 12 protrudes to its maximum length from the tip of the sheath 9 by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main channel M1, through the communication hole 134, the inlet hole 1231, and the outlet hole 1232, as shown by the arrows in Figure 8, and is then discharged from the tip of the knife 12. The discharged saline solution SL is injected below the target site T1 by its water pressure (Figure 7). Then, the target site T1 is lifted away from other tissues below, such as the submucosa.

[0039] Next, the operator or other person performing the procedure will carry out the incision as shown below. In other words, the operator, such as a surgeon, operates a foot switch or other control unit (not shown) to supply high-frequency current from the power supply 100 to the knife 12 while maintaining the state in which the knife 12 protrudes by its maximum protrusion length from the tip of the sheath 9 (tip member 92) by a second operation on the slider 82. Then, while confirming the marking mark T2, the operator, such as a surgeon, moves the projection 122 along the periphery of the target site T1 with the projection 122 embedded in the living tissue, and incises the entire circumference of the target site T1. After this, the target site T1 is removed by dissecting the submucosa and performing other procedures on the mucosal layer including the target site T1, which has been incised all around.

[0040] The ESD procedure is completed through the above steps. During each of the ESD steps described above, when cleaning the operating room, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122 protrudes from the first hole 922 to the outside of the tip member 92, that is, the projection 122 protrudes from the first hole 921 and the knife body 111 is positioned within the first hole 921. In this state, as shown in Figures 5 and 9, the communication hole 134 is positioned opposite the first wall portion 9211. That is, the position of the communication hole 134 coincides with the position of the first wall portion 9211 in the longitudinal axis direction of the sheath 9. In this state, the first wall portion 9211 abuts against the outer circumferential surface (opening edge portion) of the cylindrical portion 131, and the communication hole 134 (the opening on the base end side of the second hole 120) is closed by the first wall portion 9211, as shown by the "×" mark in Figure 9. In other words, the first wall portion 9211 is positioned inside the sheath 9 and corresponds to the first closing member according to the present invention, which can close the opening on the base end side of the incision portion 11. On the other hand, the first hole 922 is released from the blockage by the connecting member 13 and communicates with the main flow path M1.

[0041] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the first hole 922, as indicated by the arrows in Figure 9, and is then discharged from the tip of the sheath 9 (tip member 92) and supplied to the operating room in the body cavity. Here, the opening area between the inner surface of the first hole 922 and the outer surface of the knife body 121 is larger than the opening area of ​​the outflow hole 1232. Therefore, the operating room is cleansed by the saline solution discharged from the tip of the sheath 9 (tip member 92).

[0042] As described above, in this embodiment 1, the main channel M1 is capable of communicating with the first hole 922 and the second hole 120, respectively, at the tip side of the sheath 9 (tip member 92). Furthermore, the device is configured to allow switching between a first mode and a second mode by moving the incision section 11 forward and backward in response to the operation of the slider 82 by an operator such as a surgeon. The first mode is set by moving the incision section 11 to the proximal end side of the sheath 9, and is a mode in which physiological saline solution is circulated into the body cavity by communicating the main channel M1 and the first hole 922. More specifically, the first mode is a state in which the main channel M1 and the first hole 922 are in communication, and the opening on the proximal end side of the incision section 11 is closed by the first wall section 9211. The second mode is set by moving the incision portion 11 towards the tip of the sheath 9, and is a mode in which physiological saline solution is circulated into the body cavity by connecting the main channel M1 and the second hole 120. More specifically, the second mode is a state in which the main channel M1 and the second hole 120 are in communication, and the proximal opening of the first hole 922 is closed by the connecting member 13.

[0043] According to the first embodiment described above, the following effects are achieved. In the endoscopic treatment instrument 6 according to this embodiment 1, the main flow path M1 is capable of communicating with the first and second holes 922 and 120, respectively, at the tip side of the sheath 9 (tip member 92). In other words, the flow path for physiological saline in the treatment instrument insertion section 7 is composed of a single flow path (main flow path M1) from the base end to the tip end of the treatment instrument insertion section 7, and branches into two (first and second holes 922 and 120) at the tip side of the sheath 9 (tip member 92). Furthermore, in the endoscopic treatment instrument 6 according to this embodiment 1, the operator, such as a surgeon, can switch between the first and second modes by performing first and second operations on the slider 82, which are simple operations. Therefore, in ESD, the local injection step and other steps can be performed using a single endoscopic treatment instrument 6 without having to change the treatment instrument between the local injection step and other steps. Therefore, the endoscopic treatment instrument 6 according to this embodiment 1 can improve convenience.

[0044] Furthermore, in the endoscopic treatment instrument 6 according to this embodiment 1, a rotation restricting structure (second wall portion 9212 (groove portion 9213) and rotation restricting portion 132) is provided between the incision portion 11 and the sheath 9 to restrict rotation about the central axis of the incision portion 11. For this reason, a so-called hook knife, which needs to avoid rotation about the central axis, can be used as the knife 12.

[0045] (Embodiment 2) Next, we will describe Embodiment 2. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this second embodiment, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the first embodiment described above. For the sake of explanation, the treatment instrument insertion section according to this second embodiment will be referred to as the treatment instrument insertion section 7A below.

[0046] Figures 10 and 11 illustrate the configuration of the instrument insertion section 7A according to Embodiment 2. Specifically, Figure 10 is a cross-sectional view corresponding to Figure 2. Figure 11 is a cross-sectional view of the instrument insertion section 7A at the position of line XI-XI shown in Figure 10. In the instrument insertion section 7A, as shown in Figures 10 and 11, the configuration of the sheath 9 and the incision section 11 differs from that of the instrument insertion section 7 described in Embodiment 1 above. For the sake of explanation, the sheath and incision section in this Embodiment 2 will be referred to as sheath 9A and incision section 11A, respectively.

[0047] In sheath 9A, as shown in Figures 10 and 11, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For convenience of explanation, the tip member according to Embodiment 2 will be referred to as tip member 92A below. The tip component 92A may be composed of a single component, or it may be composed of a combination of multiple components. In the tip member 92A, as shown in Figures 10 and 11, a third wall portion 9214 is provided instead of the first and second wall portions 9211 and 9212 compared to the tip member 92 described in the above-described embodiment 1.

[0048] As shown in Figures 10 and 11, the third wall portion 9214 comprises a pair of support portions 9215 and an annular portion 9216. As shown in Figures 10 and 11, the pair of support portions 9215 each project linearly from the inner circumferential surface 921 toward the central axis of the tip member 92A. As shown in Figure 11, the annular portion 9216 has an annular shape that is coaxial with the central axis of the tip member 92A, and its outer surface is connected to the protruding ends of the pair of support portions 9215.

[0049] Furthermore, as shown in Figure 10, the shape of the first hole 922 in the tip member 92A differs from that of the tip member 92 described in Embodiment 1 above. For the sake of explanation, the first hole in Embodiment 2 will be referred to as the first hole 922A below. The first hole 922A has a circular cross-section and extends linearly along the central axis of the tip member 92A. Furthermore, as shown in Figure 10, the tip portion of the first hole 922A widens towards the tip. Here, the inner diameter of the base portion of the first hole 922A is set to be smaller than the inner diameter of the inner circumferential surface 921. Also, the inner diameter of the first hole 922A is set to be larger than the outer diameter of the knife body 121. Preferably, the first hole 922A may be located on the central axis of the tip member 92A.

[0050] In the incision section 11A, as shown in Figures 10 and 11, the shapes of the knife 12 and connecting member 13 differ from those of the incision section 11 described in Embodiment 1 above. For convenience of explanation, the knife and connecting member in this Embodiment 2 will be referred to as knife 12A and connecting member 13A, respectively. As shown in Figure 10, the shape of the projection 122 in knife 12A differs from that of knife 12 described in Embodiment 1 above. For convenience of explanation, the treatment part according to Embodiment 2 will be referred to as projection 122A below. The projection 122A has a disc shape that is coaxial with the central axis of the knife body 121. Here, the outer diameter of the projection 122A is set to be smaller than the inner diameter of the tip portion of the first hole 922A, as shown in Figure 10.

[0051] Furthermore, as shown in Figure 10, the shape of the knife hole 123 in knife 12A differs from that of knife 12 described in Embodiment 1 above. For the sake of explanation, the knife hole according to Embodiment 2 will be referred to as knife hole 123A below. As shown in Figure 10, the knife hole 123A is located on the central axis of the knife body 121 and extends linearly along the central axis from the base end of the knife body 121 to the end face on the tip side of the projection 122A.

[0052] The connecting member 13A is composed of a cylindrical member that extends linearly along the central axis of the tip member 92A. Here, the outer diameter of the connecting member 13A is set to be slightly smaller than the inner diameter of the annular portion 9216 (Figure 11) and larger than the inner diameter of the base end portion of the first hole 922A. In addition, the connecting member 13A is provided with first and second communication holes 135 and 136, as shown in Figures 10 and 11. The connecting member 13A may preferably be located on the central axis of the tip member 92A. As shown in Figure 10, the first communication hole 135 extends linearly along the central axis of the connecting member 13A from the tip towards the base end. When the connecting member 13A and the knife body 121 are connected, the first communication hole 135 communicates with the knife hole 123A. Preferably, the first communication hole 135 may be located on the central axis of the connecting member 13A. The second communication hole 136 is a cross-shaped hole that communicates with the first communication hole 135 and also with an opening on the outer circumferential surface of the connecting member 13A. The knife hole 123A and the first and second communication holes 135 and 136 described above open to the outer circumferential surface on the proximal end side of the incision portion 11A and correspond to the second hole 120A (Figure 10) according to the present invention.

[0053] Next, the operation of the endoscopic treatment instrument 6 according to this second embodiment will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the first embodiment described above. Figures 12 and 13 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 12 and 13 are cross-sectional views corresponding to Figure 10. In this second embodiment, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, sets the knife 12A to protrude by its maximum protrusion length from the tip of the sheath 9A (tip member 92A) by a second operation on the slider 82. In this state, the connecting member 13A abuts against the bottom portion 920 (opening peripheral portion) of the tip member 92A. As a result, the base end opening of the first hole 922A is closed by the connecting member 13A, as shown by the "×" mark in Figure 12. In other words, the connecting member 13A corresponds to the second closing member according to the present invention, which can close the base end opening of the first hole 922A. Furthermore, the connecting member 13A is positioned on the tip side of the annular portion 9216. That is, the second communication hole 136 is not closed by the inner circumferential surface of the annular portion 9216 and communicates with the main flow path M1.

[0054] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12A is protruding from the tip of the sheath 9A by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main channel M1, the first and second communication holes 135, 136 and the knife hole 123A, and is discharged from the tip of the knife 12A, as shown by the arrows in Figure 12. The discharged saline solution is injected below the target site T1. Then, the target site T1 rises above other tissues such as the submucosa below it.

[0055] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0056] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922A to the outside of the tip member 92A. In this state, as shown in Figures 11 and 13, the connecting member 13A is inserted into the annular portion 9216, and the second communication hole 136 is positioned opposite the inner circumferential surface of the annular portion 9216. That is, the inner circumferential surface of the annular portion 9216 comes into contact with the outer circumferential surface (opening edge portion) of the connecting member 13A, and the second communication hole 136 (the opening on the base end side of the second hole 120A) is closed by the inner circumferential surface of the annular portion 9216, as shown by the "×" mark in Figure 13. In other words, the annular portion 9216 corresponds to the first closing member according to the present invention, which is positioned inside the sheath 9A and can close the opening on the base end side of the incision portion 11A. Meanwhile, the blockage of the first hole 922A by the connecting member 13A is released, and it comes into communication with the main flow path M1.

[0057] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which only the projection 122A protrudes from the first hole 922A to the outside of the tip member 92A by performing a first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the first hole 922A, as shown by the arrow in Figure 13, and is then discharged from the tip of the sheath 9A and supplied to the operating room in the body cavity. Here, the opening area between the inner surface of the first hole 922A and the outer surface of the knife body 121 is larger than the opening area of ​​the knife hole 123A. Therefore, the operating room is cleansed by the saline solution discharged from the tip of the sheath 9A (tip member 92A).

[0058] As described above, in this embodiment 2, similar to embodiment 1 described above, the main channel M1 is able to communicate with the first hole 922A and the second hole 120A at the tip side of the sheath 9A (tip member 92A). Furthermore, the device is configured to allow switching between the first mode and the second mode by moving the incision portion 11A forward and backward in response to the operation of the slider 82 by an operator such as a surgeon. The first mode is set by moving the incision portion 11A to the proximal end side of the sheath 9A, and is a mode in which physiological saline solution is circulated into the body cavity by communicating the main channel M1 and the first hole 922A. More specifically, the first mode is a state in which the main channel M1 and the first hole 922A are in communication, and the opening on the proximal end side of the incision portion 11A is closed by the annular portion 9216. The second mode is set by moving the incision 11A towards the tip of the sheath 9A, and is a mode in which saline solution is circulated into the body cavity by connecting the main channel M1 and the second hole 120A. More specifically, the second mode is a state in which the main channel M1 and the second hole 120A are in communication, and the proximal opening of the first hole 922A is closed by the connecting member 13A.

[0059] Even when the instrument insertion part 7A according to Embodiment 2 described above is used, the same effects as those of Embodiment 1 described above are achieved.

[0060] (Modified version of Embodiment 2) Figure 14 illustrates a modified example of Embodiment 2. Specifically, Figure 14 is a cross-sectional view corresponding to Figure 10. In the second embodiment described above, the shape of the tip portion of the first hole 922A may be configured as shown in Figure 14. Specifically, the tip portion of the first hole 922A according to this modified example shown in Figure 14 expands in diameter toward the tip, and then extends linearly toward the tip along the central axis of the tip member 92A while maintaining the same diameter dimension.

[0061] (Embodiment 3) Next, Embodiment 3 will be described. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this third embodiment, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the first embodiment described above. For the sake of explanation, the treatment instrument insertion section according to this third embodiment will be referred to as the treatment instrument insertion section 7B below.

[0062] Figures 15 and 16 illustrate the configuration of the instrument insertion section 7B according to Embodiment 3. Specifically, Figure 15 is a cross-sectional view corresponding to Figure 2. Figure 16 is a cross-sectional view of the instrument insertion section 7B at the position shown by line XVI-XVI in Figure 15. As shown in Figures 15 and 16, the configuration of the sheath 9, wire 10, and incision section 11 in the instrument insertion section 7 described in Embodiment 1 above differs. For convenience of explanation, the sheath, wire, and incision section in Embodiment 3 will be referred to as sheath 9B, wire 10B, and incision section 11B, respectively.

[0063] In sheath 9B, as shown in Figures 15 and 16, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For convenience of explanation, the tip member according to Embodiment 3 will be referred to as tip member 92B below. The tip component 92B may be composed of a single component, or it may be composed of a combination of multiple components. As shown in Figure 15, the first and second wall portions 9211 and 9212 are omitted in the tip member 92B compared to the tip member 92 described in the above-described embodiment 1.

[0064] Furthermore, as shown in Figures 15 and 16, the tip member 92B has a different shape for the first hole 922 compared to the tip member 92 described in Embodiment 1 above. For convenience of explanation, the first hole in this Embodiment 3 will be referred to as the first hole 922B below. The first hole 922B has a circular cross-section and extends linearly along the central axis of the tip member 92B. Furthermore, as shown in Figure 15, the tip portion of the first hole 922B widens towards the tip. Here, the inner diameter of the base portion of the first hole 922B is smaller than the inner diameter of the inner circumferential surface 921. The inner diameter of the tip portion of the first hole 922B is larger than the outer diameter of the projection 122A. Additionally, the inner diameter of the first hole 922B is larger than the outer diameter of the knife body 121. The first hole 922B may preferably be located on the central axis of the tip member 92B.

[0065] Furthermore, a pair of fourth walls 9221 (Figures 15 and 16) and a fifth wall 9222 (Figure 15) are provided on the inner surface of the first hole 922B. As shown in Figures 15 and 16, the pair of fourth wall portions 9221 are walls that project toward the central axis of the first hole 922B from portions on the inner surface of the first hole 922B that are opposite each other in the vertical direction in Figures 15 and 16. Here, the distance between the protruding ends of the pair of fourth wall portions 9221 is set to be slightly larger than the outer diameter of the knife body 121. The fifth wall portion 9222 is an annular wall coaxial with the central axis of the first hole 922B. Here, the inner diameter of the fifth wall portion 9222 is set to be slightly larger than the outer diameter of the knife body 121.

[0066] As shown in Figure 15, wire 10B differs in shape from wire 10 described in Embodiment 1 above, having a cylindrical shape. Furthermore, the through-hole 101 in wire 10B communicates with the water supply port 812. The through-hole 101 functions as the main flow path M1 according to the present invention, through which physiological saline supplied from the water supply source 200 flows via tube TU and water supply port 812.

[0067] In the incision section 11B, as shown in Figures 15 and 16, the connecting member 13 is omitted compared to the incision section 11 described in Embodiment 1 above, and the shape of the knife 12 is different. For the sake of explanation, the knife according to Embodiment 3 will be referred to as knife 12B below. As shown in Figure 15, knife 12B has the same external shape as knife 12A described in Embodiment 2 above. That is, knife 12B comprises a knife body 121 and a projection 122A. The knife body 121 is directly connected to the wire 10B. In Embodiment 3, the outer circumferential surface of the knife body 121 is provided with an annular contact portion 1211 that protrudes from the base end and extends over the entire circumference in the circumferential direction centered on the central axis of the knife body 121.

[0068] Furthermore, as shown in Figure 15, the shape of the knife hole 123A in knife 12B differs from that of knife 12A described in Embodiment 2 above. For the sake of explanation, the knife hole in Embodiment 3 will be referred to as knife hole 123B below. The knife hole 123B comprises a second hole body 1233 (Figure 15) and a communication hole 1234 (Figures 15 and 16).

[0069] As shown in Figure 15, the second hole body 1233 is located on the central axis of the knife body 121 and extends linearly along the central axis from the base end of the knife body 121 to the end face on the tip side of the projection 122A. When the knife body 121 and the wire 10B are connected, the second hole body 1233 communicates with the through hole 101. The communication hole 1234 is located approximately in the center of the longitudinal direction of the knife body 121, communicates with the second hole body 1233, and extends vertically (radially in the direction of the knife body 121) in Figures 15 and 16, and is an I-shaped hole that opens to the outer circumferential surface of the knife body 121. The knife hole 123B described above corresponds to the second hole 120B (Figure 15) according to the present invention.

[0070] Next, the operation of the endoscopic treatment instrument 6 according to this third embodiment will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the first embodiment described above. Figures 17 and 18 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 17 and 18 are cross-sectional views corresponding to Figure 15. In this third embodiment, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, sets the knife 12B to protrude by its maximum protrusion length from the tip of the sheath 9B (tip member 92B) by a second operation on the slider 82. In this state, the contact portion 1211 abuts against the bottom portion 920 (opening periphery portion) of the tip member 92B. This restricts the movement of the knife 12B toward the tip. The communication hole 1234 is positioned opposite the pair of fourth wall portions 9221. In this state, the pair of fourth wall portions 9221 abut against the outer circumferential surface (opening periphery portion) of the knife body 121, and the flow path between the first hole 922B and the communication hole 1234 is blocked by the pair of fourth wall portions 9221, as shown by the "×" mark in Figure 17.

[0071] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12B is protruding to its maximum length from the tip of the sheath 9B by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main channel M1 and the knife hole 123B, as shown by the arrow in Figure 17, and is then discharged from the tip of the knife 12B. The discharged saline solution is injected below the target site T1 by its water pressure. Then, the target site T1 is lifted away from other tissues below, such as the submucosa.

[0072] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0073] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922B and out of the tip member 92B. In this state, the communication hole 1234 is positioned offset from the position facing the pair of fourth wall portions 9221, as shown in Figure 18. As a result, the communication hole 1234 communicates with the first hole 922B.

[0074] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining a state in which only the projection 122A protrudes from the first hole 922B outside the tip member 92B by the first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the knife hole 123B and is discharged from the tip of the knife 12B, as shown by the arrows in Figure 18, and also travels from the main flow path M1 through the knife hole 123B, the communication hole 1234, and the first hole 922B and is discharged from the tip of the sheath 9B, and supplied to the operating room. Here, the saline solution that travels through the main flow path M1 is discharged from both the knife hole 123B and the first hole 922B. Therefore, the operating room is cleansed by the saline solution discharged from both the knife hole 123B and the first hole 922B.

[0075] As described above, in this embodiment 3, similar to embodiment 1 described above, the main channel M1 is capable of communicating with the first hole 922B and the second hole 120B, respectively, at the tip side of the sheath 9B (tip member 92B). Furthermore, the device is configured to allow switching between a first mode and a second mode by moving the incision portion 11B forward and backward in response to the operation of the slider 82 by an operator such as a surgeon. The first mode is set by moving the incision portion 11B towards the proximal end of the sheath 9B, and is a mode in which saline solution is circulated into the body cavity by communicating the main channel M1 with the first hole 922B and the second hole 120B. The second mode is set by moving the incision portion 11B towards the tip side of the sheath 9B, and is a mode in which saline solution is circulated into the body cavity by communicating the main channel M1 with the second hole 120B.

[0076] Even when the instrument insertion section 7B according to Embodiment 3 described above is used, the same effects as those of Embodiment 1 described above are achieved.

[0077] (Embodiment 4) Next, we will describe Embodiment 4. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this fourth embodiment, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the first embodiment described above. For the sake of convenience of explanation, the treatment instrument insertion section according to this fourth embodiment will be referred to as the treatment instrument insertion section 7C below.

[0078] Figures 19 to 23 illustrate the configuration of the instrument insertion section 7C according to Embodiment 4. Specifically, Figure 19 is a cross-sectional view corresponding to Figure 2. Figure 20 is a cross-sectional view of the instrument insertion section 7C at the position of the XX-XX line shown in Figure 19. Figure 21 is a cross-sectional view of the instrument insertion section 7C at the position of the XXI-XXI line shown in Figure 19. Figure 22 is a cross-sectional view of the instrument insertion section 7C at the position of the XXII-XXII line shown in Figure 19. Figure 23 is a cross-sectional view of the instrument insertion section 7C at the position of the XXIII-XXIII line shown in Figure 19. In the instrument insertion section 7C, as shown in Figures 19 to 23, the configuration of the sheath 9 and the incision section 11 differs from that of the instrument insertion section 7 described in Embodiment 1 above. For convenience of explanation, the sheath and incision section in this Embodiment 4 will be referred to as sheath 9C and incision section 11C, respectively.

[0079] In sheath 9C, as shown in Figures 19 to 23, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For convenience of explanation, the tip member according to Embodiment 3 will be referred to as tip member 92C below. The tip component 92C may be composed of a single component, or it may be composed of a combination of multiple components. In the tip member 92C, as shown in Figure 19, the first wall portion 9211 is omitted compared to the tip member 92 described in the above-described embodiment 1.

[0080] Furthermore, as shown in Figures 19 and 20, the shape of the first hole 922 in the tip member 92C differs from that of the tip member 92 described in Embodiment 1 above. For the sake of explanation, the first hole in this Embodiment 4 will be referred to as the first hole 922C below. The first hole 922C differs from the first hole 922 described in Embodiment 1 above in the shape of its upper side in Figures 19 and 20. Specifically, the upper side of the first hole 922C has a predetermined gap between it and the knife body 121, and the first hole 922C (the inner circumferential surface of the tip member 92C) expands radially and communicates with the main flow path M1.

[0081] In the incision section 11C, as shown in Figures 19 to 23, the shapes of the knife 12 and connecting member 13 differ from those of the incision section 11 described in Embodiment 1 above. For the sake of explanation, the knife and connecting member according to Embodiment 4 will be referred to as knife 12C and connecting member 13C, respectively. As shown in Figure 19, knife 12C has the same external shape as knife 12A described in Embodiment 2 above. That is, knife 12C comprises a knife body 121 and a projection 122A.

[0082] Furthermore, as shown in Figure 19, the shape of the knife hole 123A in knife 12C differs from that of knife 12A described in Embodiment 2 above. For the sake of explanation, the knife hole in Embodiment 4 will be referred to as knife hole 123C below. The knife hole 123C comprises a second hole body 1235 (Figures 19 and 20) and a communication hole 1236 (Figures 19 and 21).

[0083] As shown in Figure 19, the second hole body 1235 extends linearly along the central axis of the knife body 121 from the end face on the tip side of the projection 122A toward the base end side. Preferably, the second hole body 1235 may be located on the central axis of the knife body 121. As shown in Figures 19 and 21, the communication hole 1236 communicates with the base end portion of the second hole body 1233 and extends toward the outer circumferential surface of the knife body 121, opening toward the outer circumferential surface of the knife body 121. The knife hole 123C described above opens to the outer peripheral surface on the proximal end side of the incision portion 11C and corresponds to the second hole 120C (Figure 19) according to the present invention.

[0084] In the connecting member 13C, as shown in Figures 19 and 21 to 23, the communication hole 134 is omitted compared to the connecting member 13 described in Embodiment 1 above. Note that in Figures 19 and 21 to 23, the fitting hole 133 is omitted for the sake of clarity.

[0085] Next, the operation of the endoscopic treatment instrument 6 according to this embodiment 4 will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the first embodiment described above. Figures 24 and 25 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 24 and 25 are cross-sectional views corresponding to Figure 19. In this fourth embodiment, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922C to the outside of the tip member 92C, that is, the projection 122A protrudes from the first hole 922C and the knife body 121 is positioned inside the first hole 922C. In this state, the communication hole 1236 is positioned at a distance from the inner surface of the first hole 922C, as shown in Figure 24, creating a gap. As a result, the communication hole 1236 communicates with the main flow path M1 through this gap. On the other hand, the tip side of the first hole 922C is closed by the projection 122A because the projection 122A abuts against the tip of the sheath 9C (tip member 92C), as indicated by the "×" mark in Figure 24. In other words, the projection 122A corresponds to a second closing member according to the present invention that can close the opening on the tip side of the first hole 922C.

[0086] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which only the projection 122A protrudes from the first hole 922C to the outside of the tip member 92C by the first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main flow path M1, through the communication hole 1236 and the second hole body 1235, as shown by the arrow in Figure 24, and is then discharged from the tip of the knife 12C. The discharged saline solution is injected below the target site T1 by its water pressure. Then, the target site T1 floats up from other tissues below, such as the submucosa.

[0087] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0088] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a second operation on the slider 82 to set the knife 12C to a state where it protrudes from the tip of the sheath 9C by its maximum protrusion length. In this state, as shown in Figure 25, the communication hole 1236 is positioned to abut against the inner surface of the first hole 922C. As a result, the flow path between the communication hole 1236 and the main flow path M1 is blocked by the inner surface of the first hole 922C, as indicated by the "×" mark in Figure 25. That is, the inner surface of the first hole 922C corresponds to the first closure member according to the present invention, which is located inside the sheath 9C and can close the opening on the proximal end side of the incision portion 11C. On the other hand, in this state, the tip side of the first hole 922C is separated from the tip of the sheath 9C (tip member 92C), so the closure by the projection 122A is released.

[0089] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12C is extended to its maximum protrusion length from the tip of the sheath 9C by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the first hole 922C, as shown by the arrow in Figure 25, and is then discharged from the tip of the sheath 9C and supplied to the operating room. Here, the opening area between the inner surface of the first hole 922C and the outer surface of the knife body 121 is larger than the opening area of ​​the second hole body 1235. Therefore, the operating room is cleansed by the saline solution discharged from the tip of the sheath 9C (tip member 92C).

[0090] As described above, in this embodiment 4, similar to embodiment 1 described above, the main channel M1 is able to communicate with the first hole 922C and the second hole 120C, respectively, at the tip side of the sheath 9C (tip member 92C). Furthermore, the incision portion 11C is configured to move forward and backward in response to the operation of the slider 82 by an operator such as a surgeon, thereby enabling switching between the first mode and the second mode. The first mode is set by moving the incision portion 11C to the tip side of the sheath 9C, and is a mode in which saline solution is circulated into the body cavity by communicating the main channel M1 and the first hole 922C. More specifically, the first mode is a state in which the main channel M1 and the first hole 922C are in communication, and the opening on the proximal end side of the incision portion 11C is closed by the inner surface of the first hole 922C. The second mode is set by moving the incision portion 11C to the proximal end of the sheath 9C, and is a mode in which physiological saline solution is circulated into the body cavity by connecting the main channel M1 and the second hole 120C. More specifically, the second mode is a state in which the main channel M1 and the second hole 120C are in communication, and the tip-side opening of the first hole 922C is closed by the projection 122A.

[0091] Even when the instrument insertion section 7C according to Embodiment 4 described above is used, the same effects as those of Embodiment 1 described above are achieved.

[0092] (Embodiment 5) Next, Embodiment 5 will be described. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this 5th embodiment, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the 1st embodiment described above. For the sake of explanation, the treatment instrument insertion section according to this 5th embodiment will be referred to as the treatment instrument insertion section 7D below.

[0093] Figures 26 to 31 illustrate the configuration of the instrument insertion section 7D according to Embodiment 5. Specifically, Figure 26 is a cross-sectional view corresponding to Figure 2. Figure 27 is a cross-sectional view of the instrument insertion section 7D at the position of line XXVII-XXVII shown in Figure 26. Figure 28 is a cross-sectional view of the instrument insertion section 7D at the position of line XXVIII-XXVIII shown in Figure 26. Figure 29 is a cross-sectional view of the instrument insertion section 7D at the position of line XXIX-XXIX shown in Figure 26. Figure 30 is a cross-sectional view of the instrument insertion section 7D at the position of line XXX-XXX shown in Figure 26. Figure 31 is a cross-sectional view of the instrument insertion section 7D at the position of line XXXI-XXXI shown in Figure 26. In the instrument insertion section 7D, as shown in Figures 26 to 31, the configuration of the sheath 9 and the incision section 11 differs from that of the instrument insertion section 7 described in Embodiment 1 above. For convenience of explanation, the sheath and incision section in this Embodiment 5 will be referred to as sheath 9D and incision section 11D, respectively.

[0094] In sheath 9D, as shown in Figures 26 to 31, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For convenience of explanation, the tip member according to Embodiment 5 will be referred to as tip member 92D below. The tip component 92D may be composed of a single component, or it may be composed of a combination of multiple components. In the tip member 92D, as shown in Figures 26 and 31, a third wall portion 9214, as described in Embodiment 2, is provided instead of the first and second wall portions 9211 and 9212, as described in Embodiment 1, compared to the tip member 92 described above. In this Embodiment 5, as shown in Figure 31, a wire 10 is inserted through the annular portion 9216 that constitutes the third wall portion 9214.

[0095] In the incision section 11D, as shown in Figures 26 to 30, the knife 12A described in Embodiment 2 is used instead of the knife 12 in the incision section 11 described in Embodiment 1, and the shape of the connecting member 13 is different. For the sake of explanation, the connecting member according to Embodiment 5 will be referred to as the connecting member 13D below. The connecting member 13D is composed of a cylindrical member that extends linearly along the central axis of the tip member 92D. Here, the outer diameter of the connecting member 13D is set to be slightly smaller than the inner diameter of the first hole 922 and larger than the inner diameter of the annular portion 9216. Furthermore, as shown in Figures 26, 28, and 29, the connecting member 13D is provided with first and second communication holes 137 and 138, and a pair of third communication holes 139. The connecting member 13D may preferably be located on the central axis of the tip member 92D.

[0096] As shown in Figure 26, the first communication hole 137 extends linearly along the central axis of the connecting member 13D from the tip towards the base end. When the connecting member 13D and the knife body 121 are connected, the first communication hole 137 communicates with the knife hole 123A. Preferably, the first communication hole 137 may be located on the central axis of the connecting member 13D. The second communication hole 138 is located approximately in the center of the longitudinal direction of the connecting member 13D, communicates with the first communication hole 137, and extends vertically (radially in the direction of the connecting member 13D) in Figures 26 and 29, and is an I-shaped hole that opens to the outer circumferential surface of the connecting member 13D. The knife hole 123A and the first and second communication holes 137 and 138 described above open to the outer circumferential surface on the proximal end side of the incision portion 11D and correspond to the second hole 120D (Figure 26) according to the present invention.

[0097] As shown in Figure 28, the pair of third communication holes 139 are located on either side of the first communication hole 137 and are holes that penetrate linearly through the connecting member 13D from its tip to its base along the central axis of the connecting member 13D. Note that the pair of third communication holes 139 do not communicate with the first and second communication holes 137 and 138.

[0098] Next, the operation of the endoscopic treatment instrument 6 according to this embodiment 5 will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the first embodiment described above. Figures 32 and 33 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 32 and 33 are cross-sectional views corresponding to Figure 26. In this embodiment 5, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922 and the tip member 92D is outside the first hole 922, that is, the projection 122A protrudes from the first hole 922 and the knife body 121 is positioned inside the first hole 922. In this state, as shown in Figure 32, the tip end of the connecting member 13D is inserted into the first hole 922, while the base end abuts against the tip end face of the annular portion 9216. In this state, the tip end of the connecting member 13D is inserted into the first hole 922, and the pair of third communication holes 139 are closed by the annular portion 9216, so the flow path between the first hole 922 and the main flow path M1 is blocked by the connecting member 13D, as indicated by the "×" mark in Figure 32. In other words, the connecting member 13D corresponds to a third closing member according to the present invention that can close the opening on the base end side of the first hole 922. Also, the flow path between the pair of third communication holes 139 and the main flow path M1 is blocked by the annular portion 9216, as indicated by the "×" mark in Figure 32. On the other hand, the second communication hole 138 is positioned offset from the inner surface of the first hole 922. As a result, the second communication hole 138 communicates with the main flow path M1.

[0099] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which only the projection 122A protrudes from the first hole 922 to the outside of the tip member 92D by the first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main flow path M1, the second communication hole 138, the first communication hole 137, and the knife hole 123A, as shown by the arrows in Figure 32, and is then discharged from the tip of the knife 12A. The discharged saline solution is injected below the target site T1 by its water pressure. Then, the target site T1 floats up from other tissues below, such as the submucosa.

[0100] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0101] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a second operation on the slider 82 to set the knife 12A to protrude from the tip of the sheath 9D by its maximum protrusion length. In this state, the base end of the connecting member 13D is separated from the annular portion 9216, as shown in Figure 33. The first hole 922 then communicates with the main flow path M1 via a pair of third communication holes 139. Meanwhile, the second communication hole 138 is positioned opposite the inner surface of the first hole 922. In this state, the inner surface of the first hole 922 abuts against the outer circumferential surface (opening edge portion) of the connecting member 13D, and the flow path between the second communication hole 138 and the main flow path M1 is blocked by the inner surface of the first hole 922, as indicated by the "×" mark in Figure 33. In other words, the inner surface of the first hole 922 corresponds to the first closing member according to the present invention, which is positioned inside the sheath 9D and can close the opening on the proximal end side of the incision portion 11D.

[0102] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12A protrudes to its maximum length from the tip of the sheath 9D by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the third communication hole 139 and the first hole 922, as shown by the arrows in Figure 33, and is then discharged from the tip of the sheath 9D and supplied to the operating room. Here, the opening area between the inner surface of the first hole 922 and the outer surface of the knife body 121 is larger than the opening area of ​​the knife hole 123A. Therefore, the operating room is cleansed by the saline solution discharged from the tip of the sheath 9D (tip member 92D).

[0103] As described above, in this embodiment 5, similar to embodiment 1 described above, the main channel M1 is able to communicate with the first hole 922 and the second hole 120D at the tip side of the sheath 9D (tip member 92D). Furthermore, the incision portion 11D is configured to move forward and backward in response to the operation of the slider 82 by an operator such as a surgeon, thereby enabling switching between the first mode and the second mode. The first mode is set by moving the incision portion 11D towards the tip side of the sheath 9D, and is a mode in which physiological saline solution is circulated into the body cavity by communicating the main channel M1 and the first hole 922. More specifically, the first mode is a state in which the main channel M1 and the first hole 922 are in communication, and the opening on the proximal end side of the incision portion 11D is closed by the inner surface of the first hole 922. The second mode is set by moving the incision portion 11D to the proximal end of the sheath 9D, and is a mode in which physiological saline solution is circulated into the body cavity by connecting the main channel M1 and the second hole 120D. More specifically, the second mode is a state in which the main channel M1 and the second hole 120D are in communication, and the proximal opening of the first hole 922 is closed by the connecting member 13D.

[0104] Even when the instrument insertion section 7D according to Embodiment 5 described above is used, the same effects as those of Embodiment 1 described above are achieved.

[0105] (Embodiment 6) Next, Embodiment 6 will be described. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this embodiment 6, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the above-described embodiment 1. For the sake of explanation, the treatment instrument insertion section according to this embodiment 6 will be referred to as the treatment instrument insertion section 7E below.

[0106] Figures 34 and 35 illustrate the configuration of the instrument insertion section 7E according to Embodiment 6. Specifically, Figure 34 is a cross-sectional view corresponding to Figure 2. Figure 35 is a cross-sectional view of the instrument insertion section 7E at the position of the line XXXV-XXXV shown in Figure 34. In the instrument insertion section 7E, as shown in Figures 34 and 35, the configuration of the sheath 9 and the incision section 11 differs from that of the instrument insertion section 7 described in Embodiment 1 above. For convenience of explanation, the sheath and incision section in this Embodiment 6 will be referred to as sheath 9E and incision section 11E, respectively.

[0107] In sheath 9E, as shown in Figures 34 and 35, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For convenience of explanation, the tip member according to Embodiment 6 will be referred to as tip member 92E below. The tip component 92E may be composed of a single component, or it may be composed of a combination of multiple components. In the tip member 92E, as shown in Figures 34 and 35, a third wall portion 9214, as described in Embodiment 2, is provided instead of the first and second wall portions 9211 and 9212, as described in Embodiment 1, compared to the tip member 92 described above.

[0108] In the incision section 11E, as shown in Figures 34 and 35, the shapes of the knife 12 and connecting member 13 differ from those of the incision section 11 described in Embodiment 1 above. For convenience of explanation, the knife and connecting member according to Embodiment 6 will be referred to as knife 12E and connecting member 13E, respectively. As shown in Figure 34, the knife 12E has the same external shape as the knife 12A described in Embodiment 2 above. That is, the knife 12E comprises a knife body 121 and a projection 122A. In this Embodiment 6, the outer diameter of the knife body 121 is set to be slightly smaller than the inner diameter of the annular portion 9216. The knife body 121 is inserted into the annular portion 9216.

[0109] Furthermore, as shown in Figure 34, the shape of the knife hole 123A in knife 12E differs from that of knife 12A described in Embodiment 2 above. For convenience of explanation, the knife hole in Embodiment 6 will be referred to as knife hole 123E below. The knife hole 123E comprises a second hole body 1237 (Figure 34) and a communication hole 1238 (Figures 34 and 35).

[0110] As shown in Figure 34, the second hole body 1237 extends linearly along the central axis of the knife body 121 from the end face on the tip side of the projection 122A toward the base end side. Preferably, the second hole body 1237 may be located on the central axis of the knife body 121. As shown in Figures 34 and 35, the communication hole 1238 is a cross-shaped hole that communicates with the base end portion of the second hole body 1237 and opens onto the outer circumferential surface of the knife body 121. The knife hole 123E described above opens to the outer circumferential surface on the proximal end side of the incision portion 11E and corresponds to the second hole 120E (Figure 34) according to the present invention.

[0111] The connecting member 13E is located on the central axis of the tip member 92E and is composed of a cylindrical member that extends linearly along the central axis. Here, the outer diameter of the connecting member 13E is set to be larger than the inner diameter of the annular portion 9216.

[0112] Next, the operation of the endoscopic treatment instrument 6 according to this embodiment 6 will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the explanation given in embodiment 1 above. Figures 36 and 37 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 36 and 37 are cross-sectional views corresponding to Figure 34. In this embodiment 6, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922 to the outside of the tip member 92E. In this state, the communication hole 1238 is positioned offset from the inner circumferential surface of the annular portion 9216, as shown in Figure 36. As a result, the communication hole 1238 communicates with the main flow path M1. On the other hand, the tip side of the first hole 922 is closed by the projection 122A because it abuts against the tip of the sheath 9E (tip member 92E), as indicated by the "×" mark in Figure 36. In other words, the projection 122A corresponds to the second closing member according to the present invention, which can close the opening on the tip side of the first hole 922.

[0113] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining a state in which only the projection 122A protrudes from the first hole 922 and the knife body 121 is positioned within the first hole 922, by performing a first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the communication hole 1238 and the second hole body 1237, as indicated by the arrows in Figure 36, and is discharged from the tip of the knife 12E. The discharged saline solution is injected below the target site T1 by its water pressure. The target site T1 then floats up from other tissues below, such as the submucosa.

[0114] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0115] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, sets the knife 12E to protrude from the tip of the sheath 9E by a second operation on the slider 82, so that it extends to its maximum protrusion length. In this state, the tip of the connecting member 13E abuts against the end face on the base side of the annular portion 9216. Also, as shown in Figure 37, the communication hole 1238 is positioned opposite the inner circumferential surface of the annular portion 9216. In this state, the inner circumferential surface of the annular portion 9216 abuts against the outer circumferential surface (opening edge portion) of the knife body 121, and the flow path between the communication hole 1238 and the main flow path M1 is blocked by the annular portion 9216, as indicated by the "×" mark in Figure 37. In other words, the annular portion 9216 is located inside the sheath 9E and corresponds to the first closure member according to the present invention, which can close the opening on the base side of the incision portion 11E. On the other hand, the tip side of the first hole 922 is released from blockage by the projection 122A.

[0116] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12E protrudes to its maximum length from the tip of the sheath 9E by performing a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the first hole 922, as shown by the arrow in Figure 37, and is then discharged from the tip of the sheath 9E and supplied to the operating room. Here, the opening area between the inner surface of the first hole 922 and the outer surface of the knife body 121 is larger than the opening area of ​​the second hole body 1237. Therefore, the operating room is cleansed by the saline solution discharged from the tip of the sheath 9E (tip member 92E).

[0117] As described above, in this embodiment 6, similar to embodiment 1 described above, the main channel M1 is able to communicate with the first hole 922 and the second hole 120E at the tip side of the sheath 9E (tip member 92E), respectively. Furthermore, the device is configured to allow switching between the first mode and the second mode by moving the incision portion 11E forward and backward in response to the operation of the slider 82 by an operator such as a surgeon. The first mode is set by moving the incision portion 11E to the tip side of the sheath 9E, and is a mode in which physiological saline solution is circulated into the body cavity by communicating the main channel M1 and the first hole 922. More specifically, the first mode is a state in which the main channel M1 and the first hole 922 are in communication, and the opening on the proximal end side of the incision portion 11E is closed by the annular portion 9216. The second mode is set by moving the incision portion 11E to the proximal end of the sheath 9E, and is a mode in which physiological saline solution is circulated into the body cavity by connecting the main channel M1 and the second hole 120E. More specifically, the second mode is a state in which the main channel M1 and the second hole 120E are in communication, and the tip-side opening of the first hole 922 is closed by the projection 122A.

[0118] Even when the instrument insertion section 7E according to Embodiment 6 described above is used, the same effects as those of Embodiment 1 described above are achieved.

[0119] (Embodiment 7) Next, we will describe Embodiment 7. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this embodiment 7, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the above-described embodiment 1. For the sake of explanation, the treatment instrument insertion section according to this embodiment 7 will be referred to as the treatment instrument insertion section 7F below.

[0120] Figures 38 and 39 illustrate the configuration of the instrument insertion section 7F according to Embodiment 7. Specifically, Figure 38 is a cross-sectional view corresponding to Figure 2. Figure 39 is a cross-sectional view of the instrument insertion section 7E at the position of the line XXXIX-XXXIX shown in Figure 38. In the instrument insertion section 7F, as shown in Figures 38 and 39, the configuration of the sheath 9 and the incision section 11 differs from that of the instrument insertion section 7 described in Embodiment 1 above. For the sake of explanation, the sheath and incision section in this Embodiment 7 will be referred to as sheath 9F and incision section 11F, respectively.

[0121] In sheath 9F, as shown in Figures 38 and 39, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For the sake of explanation, the tip member according to this Embodiment 7 will be referred to as tip member 92F below. The tip component 92F may be composed of a single component, or it may be composed of a combination of multiple components. In the tip member 92F, as shown in Figures 38 and 39, a third wall portion 9214F, which is substantially the same as the third wall portion 9214 described in Embodiment 2, is provided instead of the first and second wall portions 9211 and 9212 described in Embodiment 1 above for the tip member 92 described above.

[0122] In the third wall portion 9214, as shown in Figures 38 and 39, the shape of the inner circumferential surface of the annular portion 9216 differs from that of the third wall portion 9214 described in Embodiment 2 above. For the sake of explanation, the annular portion according to Embodiment 7 will be referred to as the annular portion 9216F below. As shown in Figures 38 and 39, the inner circumferential surface of the annular portion 9216F has a frustoconical shape in which the inner diameter decreases towards the tip.

[0123] In the incision section 11F, as shown in Figures 38 and 39, the knife 12A described in Embodiment 2 is used instead of the knife 12 in the incision section 11 described in Embodiment 1, and the shape of the connecting member 13 is different. For the sake of explanation, the connecting member according to Embodiment 7 will be referred to as the connecting member 13F below. The connecting member 13F extends along the central axis of the tip member 92F and has a frustoconical shape substantially identical to the inner circumferential surface of the annular portion 9216F. Furthermore, as shown in Figures 38 and 39, the connecting member 13F is provided with first and second communication holes 130F1 and 130F2. The connecting member 13F may preferably be located on the central axis of the tip member 92F.

[0124] As shown in Figure 38, the first communication hole 130F1 extends linearly along the central axis of the connecting member 13F from the tip towards the base end. When the connecting member 13F and the knife body 121 are connected, the first communication hole 130F1 communicates with the knife hole 123A. Preferably, the first communication hole 130F1 may be located on the central axis of the connecting member 13F. As shown in Figures 38 and 39, the second communication hole 130F2 is located approximately in the center of the longitudinal direction of the connecting member 13F, communicates with the first communication hole 130F1, and is a cross-shaped hole that opens onto the outer circumferential surface of the connecting member 13F. The knife hole 123A and the first and second communication holes 130F1 and 130F2 described above open to the outer circumferential surface of the proximal end of the incision portion 11F and correspond to the second hole 120F (Figure 38) according to the present invention.

[0125] Next, the operation of the endoscopic treatment instrument 6 according to this embodiment 7 will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the explanation given in embodiment 1 above. Figures 40 and 41 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 40 and 41 are cross-sectional views corresponding to Figure 38. In this embodiment 7, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922 to the outside of the tip member 92F. In this state, the connecting member 13F is positioned spaced apart from the inner circumferential surface of the annular portion 9216F toward the base end, as shown in Figure 40. As a result, the second communication hole 130F2 communicates with the main flow path M1. On the other hand, the tip side of the first hole 922 is closed by the projection 122A, as shown by the "×" mark in Figure 40, because the projection 122A abuts against the tip of the sheath 9F (tip member 92F). In other words, the projection 122A corresponds to the second closing member according to the present invention, which can close the opening on the tip side of the first hole 922.

[0126] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which only the projection 122A protrudes from the first hole 922 to the outside of the tip member 92F by the first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main flow path M1, the second communication hole 130F2, the first communication hole 130F1, and the knife hole 123A, as shown by the arrows in Figure 40, and is then discharged from the tip of the knife 12A. The discharged saline solution is injected below the target site T1 by its water pressure. Then, the target site T1 floats up from other tissues below, such as the submucosa.

[0127] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0128] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a second operation on the slider 82 to set the knife 12A to protrude from the tip of the sheath 9F by its maximum protrusion length. In this state, the connecting member 13F abuts against the inner circumferential surface of the annular portion 9216F, as shown in Figure 41. In this state, the flow path between the second communication hole 130F2 and the main flow path M1 is blocked by the annular portion 9216F, as indicated by the "×" arrow in Figure 41, due to the inner circumferential surface of the annular portion 9216F abutting against the outer circumferential surface (opening edge portion) of the connecting member 13F. In other words, the annular portion 9216 corresponds to the first closure member according to the present invention, which is positioned inside the sheath 9F and can close the opening on the proximal end side of the incision portion 11F. On the other hand, the closure by the projection 122A is released on the tip side of the first hole 922.

[0129] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12A protrudes to its maximum length from the tip of the sheath 9F by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the first hole 922, as shown by the arrow in Figure 41, and is then discharged from the tip of the sheath 9F and supplied to the operating room. Here, the opening area between the inner surface of the first hole 922 and the outer surface of the knife body 121 is larger than the opening area of ​​the knife hole 123A. Therefore, the operating room is cleaned by the saline solution discharged from the tip of the sheath 9F (tip member 92F).

[0130] As described above, in this embodiment 7, similar to embodiment 1 described above, the main channel M1 is able to communicate with the first hole 922 and the second hole 120F at the tip side of the sheath 9F (tip member 92F). Furthermore, the device is configured to allow switching between a first mode and a second mode by moving the incision section 11F forward and backward in response to the operation of the slider 82 by an operator such as a surgeon. The first mode is set by moving the incision section 11F to the tip side of the sheath 9F, and is a mode in which physiological saline solution is circulated into the body cavity by communicating the main channel M1 and the first hole 922. More specifically, the first mode is a state in which the main channel M1 and the first hole 922 are in communication, and the opening on the proximal end side of the incision section 11F is closed by the annular section 9216F. The second mode is set by moving the incision portion 11F to the proximal end of the sheath 9F, and is a mode in which physiological saline solution is circulated into the body cavity by connecting the main channel M1 and the second hole 120F. More specifically, the second mode is a state in which the main channel M1 and the second hole 120F are in communication, and the tip-side opening of the first hole 922 is closed by the projection 122A.

[0131] Even when the instrument insertion section 7F according to Embodiment 7 described above is used, the same effects as those of Embodiment 1 described above are achieved. In particular, because the inner circumferential surface of the annular portion 9216 and the connecting member 13F are frustoconical in shape, it is possible to suppress leakage of physiological saline into the second hole 120F in the first mode.

[0132] (Embodiment 8) Next, we will describe this embodiment 8. In the following description, components similar to those in Embodiment 1 described above are denoted by the same reference numerals, and their detailed descriptions are omitted or simplified. In the endoscopic treatment instrument 6 according to this embodiment 8, the configuration of the tip portion of the treatment instrument insertion section 7 differs from that of the endoscopic treatment instrument 6 described in the above-described embodiment 1. For the sake of explanation, the treatment instrument insertion section according to this embodiment 8 will be referred to as the treatment instrument insertion section 7G below.

[0133] Figures 42 and 43 illustrate the configuration of the instrument insertion section 7G according to Embodiment 8. Specifically, Figure 42 is a cross-sectional view corresponding to Figure 2. Figure 43 is a cross-sectional view of the instrument insertion section 7G at the position shown by the line XXXXIII-XXXXIII in Figure 42. In the instrument insertion section 7G, as shown in Figures 42 and 43, the wire 10B described in Embodiment 3 is used instead of the wire 10 compared to the instrument insertion section 7 described in Embodiment 1, and the configuration of the sheath 9 and incision section 11 is different. For convenience of explanation, the sheath and incision section in this Embodiment 5 will be referred to as sheath 9G and incision section 11G, respectively.

[0134] In sheath 9G, as shown in Figures 42 and 43, the shape of the tip member 92 differs from that of sheath 9 described in Embodiment 1 above. For convenience of explanation, the tip member according to Embodiment 8 will be referred to as tip member 92G below. The tip component 92G may be composed of a single component, or it may be composed of a combination of multiple components. In the tip member 92G, as shown in Figure 42, the first and second wall portions 9211 and 9212 are omitted compared to the tip member 92 described in the above-described embodiment 1.

[0135] Furthermore, as shown in Figure 42, the tip member 92G has a different shape for the first hole 922 compared to the tip member 92 described in Embodiment 1 above. For convenience of explanation, the first hole in this Embodiment 8 will be referred to as the first hole 922G below. As shown in Figure 42, the first hole 922G comprises a hole body 922G1 and an auxiliary hole 922G2. The hole body 922G1 has a circular cross-section and extends linearly along the central axis of the tip member 92G. Here, the inner diameter of the hole body 922G1 is set to be smaller than the outer diameter of the projection 122A and larger than the outer diameter of the knife body 121. Preferably, the hole body 922G1 may be located on the central axis of the tip member 92G. As shown in Figure 42, the auxiliary hole 922G2 is a portion of the hole body 922G1 that extends radially, and like the hole body 922G1, it extends linearly along the central axis of the tip member 92G.

[0136] In the incision section 11G, as shown in Figures 42 and 43, the knife 12A described in Embodiment 2 is used instead of the knife 12 in the incision section 11 described in Embodiment 1, and the shape of the connecting member 13 is different. For the sake of explanation, the connecting member according to Embodiment 8 will be referred to as the connecting member 13G below. The connecting member 13G is composed of a cylindrical member that extends linearly along the central axis of the tip member 92G. Here, the outer diameter of the connecting member 13G is set to be larger than the inner diameter of the hole body 922G1 and smaller than the inner diameter of the tip member 92G. In addition, as shown in Figures 42 and 43, the connecting member 13G is provided with first and second fitting holes 130G1 and 130G2, a storage hole 130G3, and a communication hole 130G4. The connecting member 13G may preferably be located on the central axis of the tip member 92G.

[0137] The first fitting hole 130G1 is a circular hole that extends linearly from the tip to the base end of the connecting member 15 along the central axis of the connecting member 13G. The knife body 121 is fixed in place by being inserted through the first fitting hole 130G1. Preferably, the first fitting hole 130G1 may be located on the central axis of the connecting member 13G. The second fitting hole 130G2 is a circular hole that extends linearly along the central axis of the connecting member 13G from the base end to the tip end. The wire 10B is fixed in place with the wire inserted through the second fitting hole 130G2. Preferably, the second fitting hole 130G2 may be located on the central axis of the connecting member 13G.

[0138] The storage hole 130G3 is a circular hole that extends linearly along the central axis of the connecting member 13G from the tip side to the base side of the connecting member 13G, and communicates with the first and second fitting holes 130G1 and 130G3. Here, the inner diameter of the storage hole 130G3 is set to be larger than the inner diameter of the first and second fitting holes 130G1 and 130G2. When the knife 12A and the wire 10B are connected by the connecting member 13G, the main flow path M1 communicates with the knife hole 123A by passing through the storage hole 130G3. That is, the knife hole 123A and the storage hole 130G3 correspond to the second hole 120G (Figure 42) according to the present invention. Preferably, the storage hole 130G3 may be located on the central axis of the connecting member 13G.

[0139] As shown in Figure 42, the communication hole 130G4 is an elongated hole that penetrates from the outer circumferential surface of the connecting member 13G to the storage hole 130G3 and extends in the longitudinal axis direction of the connecting member 13G.

[0140] In this embodiment 8, the connecting member 13G described above is fitted with a biasing member 14 and a flow path switching member 15, as shown in Figures 42 and 43. As shown in Figures 42 and 43, the biasing member 14 is made of a coil spring and is positioned within the storage hole 130G3. One end of the biasing member 14 is in contact with or fixed to the support portion 151 that constitutes the flow path switching member 15, and the other end is in contact with or fixed to the peripheral portion of the second fitting hole 130G2. The biasing member 14 then biases the flow path switching member 15 toward the tip side.

[0141] The flow path switching member 15 is a member that switches the flow path of physiological saline solution that has flowed through the main flow path M1. As shown in Figures 42 and 43, this flow path switching member 15 comprises a support portion 151 and a blocking portion 152. The support portion 151 is inserted into the storage hole 130G3 through the communication hole 130G4 and has a pin shape that is perpendicular to the central axis of the connecting member 13G and positioned on the said central axis. The closing portion 152 is fixed to one end of the support portion 151 that is located outside the connecting member 13G, and has a plate shape that extends along the central axis of the connecting member 13G. The closing portion 152 is set to a size that can close the communication hole 130G4.

[0142] Next, the operation of the endoscopic treatment instrument 6 according to this embodiment 8 will be described. For the sake of explanation, the flow of ESD will be used as an example, similar to the first embodiment described above. Figures 44 and 45 illustrate the operation of the endoscopic treatment instrument 6. Specifically, Figures 44 and 45 are cross-sectional views corresponding to Figure 42. In this embodiment 8, the operator, such as the surgeon, performs the local injection process as shown below. In other words, the operator, such as a surgeon, performs a first operation on the slider 82 to set the device so that only the projection 122A protrudes from the first hole 922G to the outside of the tip member 92G. In this state, the connecting member 13G is positioned on the base end side of the tip member 92G, as shown in Figure 44. The flow path switching member 15 is also moved towards the tip side relative to the connecting member 13G by the biasing force of the biasing member 14. In this state, the closure portion 152 comes into contact with the outer circumferential surface (opening edge portion) of the connecting member 13G, and the communication hole 130G4 is closed by the closure portion 152.

[0143] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which only the projection 122A protrudes from the first hole 922G to the outside of the tip member 92G by the first operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels through the main flow path M1, the storage hole 130G3, and the knife hole 123A, as shown by the arrows in Figure 44, and is then discharged from the tip of the knife 12A. The discharged saline solution is injected below the target site T1 by its water pressure. Then, the target site T1 floats up from other tissues below, such as the submucosa.

[0144] The marking and cutting processes are the same as in Embodiment 1 described above, so their explanation will be omitted.

[0145] Furthermore, when cleaning the operating room during each step of ESD, the operator or other personnel should perform the following actions. The operator, such as a surgeon, performs a second operation on the slider 82 to set the knife 12A to protrude from the tip of the sheath 9G by its maximum protrusion length. During this second operation, the connecting member 13G moves into the tip member 92G from the base end. Meanwhile, the flow path switching member 15 catches on the base end of the tip member 92G and moves relative to the base end side with respect to the connecting member 13G, against the biasing force of the biasing member 14. As a result, as shown in Figure 45, the blockage of the communication hole 130G4 by the closure part 152 is released.

[0146] Next, the operator, such as the surgeon, operates a foot switch or other control unit (not shown) to supply saline solution from the water source 200, while maintaining the state in which the knife 12A is extended to its maximum protrusion length from the tip of the sheath 9G by a second operation on the slider 82. As a result, the saline solution supplied from the water source 200 travels from the main flow path M1 through the storage hole 130G3 and the knife hole 123A, as shown by the arrows in Figure 45, and is discharged from the tip of the knife 12A. It also travels from the main flow path M1 through the storage hole 130G3, the communication hole 130G4, inside the tip member 9G, and the auxiliary hole 922G2, and is discharged from the tip of the sheath 9G and supplied to the operating room. Here, the saline solution that travels through the main flow path M1 is discharged from both the knife hole 123A and the auxiliary hole 922G2. Therefore, the surgical field is cleansed by saline solution discharged from both the knife hole 123A and the auxiliary hole 922G2.

[0147] As described above, in this embodiment 8, similar to embodiment 1 described above, the main channel M1 is able to communicate with the first hole 922G and the second hole 120G at the tip side of the sheath 9G (tip member 92G). Furthermore, the incision section 11G moves forward and backward in response to the operation of the slider 82 by an operator such as a surgeon, making it possible to switch between the first mode and the second mode. The first mode is a mode in which saline solution is circulated into the body cavity by connecting the main channel M1 with the first hole 922G and the second hole 120G. The second mode is a mode in which saline solution is circulated into the body cavity by connecting the main channel M1 with the second hole 120G.

[0148] Even when the instrument insertion section 7G according to Embodiment 4 described above is used, the same effects as those of Embodiment 1 described above are achieved.

[0149] (Other embodiments) While embodiments for carrying out the present invention have been described so far, the present invention should not be limited to the embodiments 1 to 8 described above. In embodiments 1 to 8 described above, the surgical field was cleaned in the first mode and the local injection process was performed in the second mode, but this is not limited to this. For example, the surgical field may be cleaned in both the first and second modes. In all of the embodiments 1 to 8 described above, the rotation restricting structure according to the present invention (second wall portion 9212 (groove portion 9213) and rotation restricting portion 132) may be adopted.

[0150] In embodiments 1 to 8 described above, the shape of the projection 122 (122A) is not limited to the shape described in embodiments 1 to 8 described above, but other shapes may be adopted. Figures 46A and 46B show examples of the shape of the projection 122 (122A). Specifically, the projection 122 (122A) may have a flange shape such as a hemispherical shape (Figure 46A) or a triangular shape (Figure 46B), as shown in Figure 46A or Figure 46B, or it may have a needle shape without such a flange shape. [Explanation of Symbols]

[0151] 1 Endoscopy System 2 Endoscope 3 Display device 4 Light source device 5 Control device 6 Endoscopic treatment instruments 7,7A~7G Instrument insertion section 8. Treatment tool operating section 9,9A~9G Sheath 10,10B wire 11,11A~11G Incision 12, 12A~12C, 12E Knife 13, 13A, 13C~13G Connecting Members 14. Biasing member 15 Flow path switching member 21 Endoscope insertion site 22 Endoscope Operating Section 23 Universal Code 24 Connector section 81 Control Unit 82 Slider 91 Sheath body 92, 92A~92G Tip members 100 power supply 101 Through hole 120, 120A~120G Second hole 121 Knife body 122,122A protrusion 123, 123A~123C, 123E Knife holes 130G1 First mating hole 130G2 Second fitting hole 130G3 Storage Hole 130G4 Communication hole 131 Cylindrical section 132 Rotation restricting section 133 Fitting hole 134 Communication hole 135, 137, 130F1 First communication hole 136, 138, 130F2 Second communication hole 139 Third communication hole 151 Support part 152 Occlusion 200 Water source 211 Advanced Unit 212 Curved section 213 Flexible tube 221 Operating member 222 Curved Knob 223 Insertion port 811 Ring 812 Water supply port 821 Ring 822 Plug 920 bottom part 921 Inner surface 922, 922A~922C, 922G First hole 922G1 Hole body 922G2 Auxiliary hole 1211 Contact part 1231 Inflow hole 1232 Outflow hole 1233, 1235, 1237 Second hole body 1234,1236,1238 Communication hole 9211 First wall section 9212 Second wall section 9213 Groove 9214, 9214F Third wall section 9215 Support part 9216, 9216F Annular section 9221 Fourth Wall 9222 Fifth Wall Section CO power cord M1 main flow path SL physiological saline T1 Target area T2 markings TU tube

Claims

1. a sheath having a first hole at a distal end; a cutting portion having a second hole that is inserted into the first hole so as to be able to move back and forth and that extends between a distal end and a proximal end, The endoscopic treatment tool is configured to be switchable between a first mode in which a main flow path in the sheath communicates with the first hole to allow fluid to circulate, and a second mode in which the main flow path communicates with the second hole to allow fluid to circulate, depending on the advancement and retreat of the incision portion.

2. The first mode is the incision is set by moving the incision toward the distal end of the sheath; The second mode is The endoscopic treatment tool according to claim 1, wherein the incision portion is set by moving the sheath toward the proximal end.

3. The second hole is An opening is provided on the outer peripheral surface of the base end side of the incision portion, The sheath a first closure member disposed within the sheath and capable of closing an opening on a proximal end side of the incision part; The first mode is 3. The endoscopic treatment tool according to claim 2, wherein the main flow path and the first hole are in communication with each other, and the opening on the proximal end side of the incision portion is closed by the first closing member.

4. The incision is a second closing member that can close an opening on the tip side of the first hole; The second mode is 3. The endoscopic treatment tool according to claim 2, wherein the main flow path and the second hole are in communication with each other, and the opening of the first hole on the distal end side is closed by the second closing member.

5. The second hole is An opening is provided on the outer peripheral surface of the base end side of the incision portion, The sheath a first closure member disposed within the sheath and capable of closing an opening on a proximal end side of the incision part; The incision is a second closing member that can close an opening on the tip side of the first hole; The first mode is the main channel and the first hole are in communication with each other, and an opening on the proximal end side of the incision portion is closed by the first closing member; The second mode is 3. The endoscopic treatment tool according to claim 2, wherein the main flow path and the second hole are in communication with each other, and the opening of the first hole on the distal end side is closed by the second closing member.

6. a wire inserted into the sheath; a connecting member that connects the incision portion and the wire, The connecting member is a third closing member that can close an opening on a base end side of the first hole; The second mode is 3. The endoscopic treatment tool according to claim 2, wherein the opening on the base end side of the first hole is closed by the third closing member.

7. The second hole is An opening is provided on the outer peripheral surface of the base end side of the incision portion, The sheath a first closure member disposed within the sheath and capable of closing an opening on a proximal end side of the incision part; The endoscopic treatment tool includes: a wire inserted into the sheath; a connecting member that connects the incision portion and the wire, The connecting member is a third closing member that can close an opening on a base end side of the first hole; The first mode is the main channel and the first hole are in communication with each other, and an opening on the proximal end side of the incision portion is closed by the first closing member; The second mode is 3. The endoscopic treatment tool according to claim 2, wherein the main flow path and the second hole are in communication with each other, and the opening of the first hole on the base end side is closed by the third closing member.

8. Between the incision portion and the sheath, The endoscopic treatment tool according to claim 1, further comprising a rotation restriction structure for restricting rotation about a central axis of the incision portion.

9. The first mode is the incision is set by moving the sheath proximally; The second mode is The endoscopic treatment tool according to claim 1, wherein the incision portion is set by moving the sheath toward the distal end.

10. The second hole is An opening is provided on the outer peripheral surface of the base end side of the incision portion, The sheath a first closure member disposed within the sheath and capable of closing an opening on a proximal end side of the incision part; The first mode is The endoscopic treatment tool according to claim 9, wherein the main flow path and the first hole are in communication with each other, and the opening on the proximal end side of the incision portion is closed by the first closing member.

11. a wire inserted into the sheath; a connecting member that connects the incision portion and the wire, The connecting member is a second closing member that can close an opening on a base end side of the first hole; The second mode is The endoscopic treatment tool according to claim 9, wherein the main flow path and the second hole are in communication with each other, and the opening of the first hole on the base end side is closed by the second closing member.

12. The second hole is An opening is provided on the outer peripheral surface of the base end side of the incision portion, The sheath a first closure member disposed within the sheath and capable of closing an opening on a proximal end side of the incision part; The endoscopic treatment tool includes: a wire inserted into the sheath; a connecting member that is movable forward and backward relative to the first blocking member and that connects the incision portion and the wire, The connecting member is a second closing member that can close an opening on a base end side of the first hole; The first mode is the main channel and the first hole are in communication with each other, and an opening on the proximal end side of the incision portion is closed by the first closing member; The second mode is The endoscopic treatment tool according to claim 9, wherein the main flow path and the second hole are in communication with each other, and the opening of the first hole on the base end side is closed by the second closing member.

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