Endoscopic treatment tool

Abstract

To provide an endoscopic treatment tool used in cooperation with plural persons.SOLUTION: An endoscopic treatment tool 20 used by introducing into a treatment tool inlet port 112 of an endoscope 1 includes: a distal end portion 21 that includes a treatment part 210; a connector part 22 provided on a proximal end; an operation handle 23 that is provided between the distal end portion 21 and the connector part 22 and is mechanically connected to the treatment part 210; a first sheath 24 for connecting the distal end portion 21 and the operation handle 23; and a second sheath 25 for connecting the operation handle 23 and the connector part 22. The operation handle 23 is configured to be rotatable in a circumferential direction of the endoscopic treatment tool 20, and the treatment part 210 is configured to be rotatable in the circumferential direction by rotations of the operation handle 23.SELECTED DRAWING: Figure 2

Description

Technical Field

[0001] The technology of the present disclosure relates to an endoscopic treatment instrument.

Background Art

[0002] Patent Document 1 describes a treatment instrument inserter attached to an insertion part of an insertion device inserted into a subject, for inserting a treatment instrument into the insertion part. The treatment instrument inserter includes a main body part through which the treatment instrument is inserted, a mounting part for mounting the main body part to the insertion part, a guiding part connectable to a treatment instrument insertion port of the insertion device and guiding the treatment instrument extending from the main body part into the insertion part through the treatment instrument insertion port, and an operation member provided on the main body part and capable of fixing the treatment instrument inserted into the main body part by at least partial elastic deformation, and performing operations of advancing and retreating along the axial direction of the treatment instrument and rotating around the axis in a fixed state where the treatment instrument is fixed.

[0003] Patent Document 2 describes an endoscopic treatment instrument including a treatment instrument insertion part insertable into a channel of an endoscope, a treatment part connected to a distal end of the treatment instrument insertion part, and a treatment instrument operation part integrally having a rotation operation part capable of rotating the treatment instrument insertion part around an axis and an advance / retreat operation part capable of advancing and retreating the treatment instrument insertion part in the axial direction and being detachable from the endoscope.

[0004] Patent Document 3 describes an endoscopic treatment instrument having a movable part and a fixed part for treating a living body, a single-wire coil sheath in which a single wire is spirally wound, a braided sheath formed by braiding a plurality of thin wires and impregnated with resin at the braids and covering the single-wire coil sheath, an operation shaft member formed to extend longitudinally and having a distal end connected to the movable part, and an operation part for advancing and retreating the operation shaft member, wherein a distal end of the braided sheath is connected to the fixed part and a proximal end is connected to the operation part.

[0005] Patent Document 4 describes a high-frequency treatment device that injects saline to lift a lesion tissue for separating the lesion tissue from normal tissue and then picks and removes it using high frequency. In the device, a tubular body provided with a saline injection port at the front moves back and forth along the body, and a push rod is coupled in front of an operating tool having a high-frequency port so as to be located inside the body. At the front end of the push rod of the operating tool, an auxiliary push rod having a locking surface on the outer peripheral surface is rotatably coupled. A handle having a locking corresponding hole locked to the locking surface of the auxiliary push rod is non-removably engaged with the front side portion of the body. A wire connected to the front end of the auxiliary push rod is configured to be exposed through a tube coupled to the front of the body to form an operating portion. An arc-shaped knife is coupled to the end of the wire of the operating portion. The high-frequency treatment device is configured such that the push rod, the auxiliary push rod, the wire, and the knife move back and forth by the forward and backward movement of the operating tool and the wire and the knife rotate by the rotation of the handle.

[0006] Patent Document 5 describes a flexible tube-shaped member that is inserted and removed freely within the treatment tool insertion channel of an endoscope, characterized in that the portion protruding outward from the tip of the treatment tool insertion channel is formed to be curved in an arc shape.

[0007] Patent Document 6 describes an endoscope treatment tool in which a treatment function portion operable by the operation of an operation handle portion whose rear end side is connected to a flexible cord is provided at the tip of a flexible cord having a length that can be led out from the treatment tool introduction portion of the endoscope through the treatment tool insertion channel and out from the treatment tool outlet. In the endoscope treatment tool having a directionality in the rotational direction, the flexible cord has a length that is located on the proximal side of the treatment tool introduction portion in a state where the treatment function portion is led out from the treatment tool outlet. A rotation operation member is fixedly provided on the outer peripheral portion of the position where the flexible cord is led out from the treatment tool introduction portion to the outside, and the direction of the treatment function portion can be adjusted by rotating the rotation operation member to rotate the flexible cord.

Prior Art Documents

Patent Documents

[0008] Patent Document 1 International Publication No. 2017 / 86107 Patent Document 2 Japanese Unexamined Patent Application Publication No. 2005-198868 Patent Document 3 Japanese Unexamined Patent Application Publication No. 2008-148738 Patent Document 4 Japanese Unexamined Patent Application Publication No. 2014-4333 Patent Document 5 Japanese Unexamined Patent Application Publication No. Hei 9-299323 Patent Document 6 Japanese Unexamined Patent Application Publication No. 2010-22619 Summary of the Invention Problems to be Solved by the Invention

[0009] The present disclosure provides an endoscopic treatment instrument that can be used jointly by multiple people (used together at the same timing). Means for Solving the Problems

[0010] An endoscopic treatment instrument according to one aspect of the technology of the present disclosure is an endoscopic treatment instrument that is introduced into a treatment instrument insertion port of an endoscope and used, and includes a distal end portion including a treatment portion, a proximal end portion provided at the proximal end, an operation member provided between the distal end portion and the proximal end portion and mechanically connected to the treatment portion, a first connection member connecting the distal end portion and the operation member, and a second connection member different from the first connection member connecting the operation member and the proximal end portion. The operation member is configured to be rotatable in a first direction around the axis of the endoscopic treatment instrument, and the treatment portion is configured to be rotatable in the first direction by the rotation of the operation member.

[0011] An endoscopic treatment instrument according to one aspect of the technology of the present disclosure is an endoscopic treatment instrument that is introduced into the treatment instrument insertion port of an endoscope and used, and includes a distal end portion including a treatment portion, a proximal end portion provided at the proximal end, a first member extending along the axial direction of the endoscopic treatment instrument from the distal end portion to the proximal end portion, and a tubular member provided inside a part of the first member and extending from the distal end portion to a position between the distal end portion and the proximal end portion. The treatment portion is configured to be rotatable in the first direction by rotation of the tubular member in the first direction around the axis of the endoscopic treatment instrument.

Advantages of the Invention

[0012] According to the technology of the present disclosure, the operator performs the operations that require proficiency, and the assistant performs the other simple operations, so that the treatment can be performed efficiently and accurately.

Brief Description of the Drawings

[0013]

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DETAILED DESCRIPTION OF THE INVENTION

[0014] FIG. 1 is a diagram showing a schematic configuration of an endoscope apparatus 100 which is one aspect of the technology of the present disclosure. The endoscope apparatus 100 includes an endoscope 1, a main body unit 2 including a light source device 4 and a processor device 5 to which the endoscope 1 is connected, and a display device 7 for displaying a captured image or the like obtained by imaging with the endoscope 1.

[0015] The endoscope 1 is a long, elongated instrument extending in one direction and includes an insertion portion 10 that is inserted into a subject, an operation portion 11 provided at the proximal end of the insertion portion 10 and provided with operation members for performing observation mode switching operations, imaging and storage operations, forceps operations, air and water supply operations, suction operations, or electrosurgical knife operations, etc., an angle knob 12 provided adjacent to the operation portion 11, and a universal cord 13 including a connector portion 13A that detachably connects the endoscope 1 to the connection portion 4A of the light source device 4.

[0016] The operation portion 11 is provided with a treatment tool inlet 112 for introducing an endoscope treatment tool. The endoscope treatment tool is a long, elongated instrument longer than the insertion portion 10 of the endoscope 1, and a treatment portion is provided at its tip. The technology of the present disclosure can be preferably applied to those in which the treatment portion can be rotated around the axis of the endoscope treatment tool. The endoscope treatment tool is, for example, a biopsy forceps, a grasping forceps, a hemostatic clip, a scissors-type knife, a snare, an injection needle, or a high-frequency knife, etc. Although omitted in FIG. 1, inside the operation portion 11 and the insertion portion 10, various channels such as a treatment tool channel, an air and water supply channel, and a suction channel through which the endoscope treatment tool introduced from the treatment tool inlet 112 is inserted are provided. The operation portion 11 includes a suction button 11A, an air and water supply button 11B, etc.

[0017] The insertion portion 10 is composed of a flexible soft portion 10A, a bending portion 10B provided at the tip of the soft portion 10A, and a tip portion 10C harder than the soft portion 10A provided at the tip of the bending portion 10B. A imaging element and an imaging optical system are built into the tip portion 10C.

[0018] The bending portion 10B is configured to be bendable by the rotation operation of the angle knob 12. The bending portion 10B can be bent in any direction and at any angle according to the site of the subject where the endoscope 1 is used, etc., and the tip portion 10C can be directed in a desired direction.

[0019] Inside the endoscope 1, a light guide formed by bundling a plurality of optical fibers is provided from the tip 10C of the insertion section 10 to the connector section 13A. The light generated by the light source device 4 is introduced into this light guide from the connector section 13A and travels to the tip 10C, and is irradiated onto the subject from the illumination window provided at the tip 10C. Inside the endoscope 1, a treatment tool channel is provided from the tip 10C of the insertion section 10 to the treatment tool inlet 112. The tip of the endoscope treatment tool introduced into the treatment tool inlet 112 can protrude from the treatment tool opening provided on the front end surface 10E (see FIG. 3) of the tip 10C.

[0020] FIG. 2 is a schematic diagram showing a schematic configuration of an endoscope treatment tool 20 which is an embodiment of an endoscope treatment tool inserted into the treatment tool inlet 112 of the endoscope 1. The endoscope treatment tool 20 includes a tip 21 including a treatment section 210, a connector section 22 provided at the proximal end, an operation handle 23 provided between the tip 21 and the connector section 22 and mechanically connected to the treatment section 210, a first sheath 24 connecting the tip 21 and the operation handle 23, and a second sheath 25 different from the first sheath 24 connecting the operation handle 23 and the connector section 22. The connector section 22 constitutes the proximal end portion. The operation handle 23 constitutes an operation member. The first sheath 24 constitutes a first connecting member. The second sheath 25 constitutes a second connecting member.

[0021] The connector section 22 has a slider 223 movable in the axial direction of the endoscope treatment tool 20 (hereinafter, when simply described as the axial direction, it means the axial direction (in other words, the longitudinal direction) of the endoscope treatment tool 20). The connector section 22 is provided, for example, inside the slider 223, with a connector for making an electrical connection with the endoscope treatment tool 20. The treatment section 210 has a pair of forceps pieces 210A, and this pair of forceps pieces 210A is configured to be openable and closable.

[0022] The first sheath 24 and the second sheath 25 each have a long columnar outer shape. The first sheath 24 and the second sheath 25 each preferably form a long tubular shape and have flexibility. The length of the first sheath 24 is preferably longer than the distance from the tip surface 10E of the insertion portion 10 to the entrance of the treatment tool inlet 112.

[0023] The operation handle 23 has a cylindrical shape. The first sheath 24 is connected to one end side in the axial direction thereof, and the second sheath 25 is connected to the other end side in the axial direction thereof. In this way, the internal spaces of the first sheath 24 and the second sheath 25 are configured to be connected via the operation handle 23. Since the operation handle 23 is a part that is operated by an operator who operates the endoscope 1, it is preferably configured to have higher rigidity than the first sheath 24 and the second sheath 25 in consideration of its operability and durability. Also, the outer diameter of the operation handle 23 is preferably larger than the inner diameter of the treatment tool inlet 112 so that the operation handle 23 is not inserted into the treatment tool inlet 112 and is easy to operate. In order to make it easier to operate, a configuration in which unevenness or the like is provided on the outer peripheral surface of the operation handle 23 to make it non-slip is also effective.

[0024] An operation wire 20W is provided in the internal spaces of the first sheath 24, the operation handle 23, and the second sheath 25. The operation wire 20W extends from the connector portion 22 to the treatment portion 210 and mechanically connects the slider 223 of the connector portion 22 and the treatment portion 210. The operation wire 20W is configured to be movable in the axial direction in accordance with the movement of the slider 223. In the endoscope treatment tool 20, by performing an operation of moving the slider 223 in the axial direction, a pair of forceps pieces 210A provided in the treatment portion 210 can be opened and closed via the operation wire 20W. The operation wire 20W constitutes a transmission element (hereinafter, also referred to as a power transmission element) that transmits power corresponding to the movement of the slider 223 to the treatment portion 210.

[0025] The operation handle 23 is fixed in the axial direction with respect to the first sheath 24 and the second sheath 25. That is, when the operation handle 23 is gripped and moved in the axial direction, the first sheath 24 and the second sheath 25 move in the axial direction together with the operation handle 23.

[0026] On the other hand, the operation handle 23 is configured to be rotatable with respect to the first sheath 24 and the second sheath 25 in a first direction around the axis of the endoscope treatment instrument 20. The operation wire 20W is configured to be movable in the axial direction with respect to the operation handle 23 and non-rotatable in the first direction. That is, when the operation handle 23 is rotated in the first direction with respect to the first sheath 24 and the second sheath 25, the operation wire 20W also rotates in the first direction in conjunction with the rotation of the operation handle 23. In this way, by rotating the operation handle 23, the treatment portion 210 connected to the tip of the operation wire 20W can be rotated in the first direction in conjunction with the rotation.

[0027] FIG. 3 is a diagram showing a state in which the endoscope treatment instrument 20 shown in FIG. 2 is introduced into the treatment instrument introduction port 112 of the endoscope 1. The endoscope treatment instrument 20 is introduced from the treatment instrument introduction port 112 and led out from the distal end surface 10E through a treatment instrument insertion channel (not shown). In the state shown in FIG. 3, in the axial direction, the positions of the tip of the treatment portion 210 and the distal end surface 10E coincide, and a part of the proximal end side of the first sheath 24 is exposed outside the treatment instrument introduction port 112. In the state shown in FIG. 3, the length of the exposed portion of the first sheath 24 (the distance between the treatment instrument introduction port 112 and the operation handle 23) is the distance L1.

[0028] The endoscope treatment instrument 20 can be operated independently by an operator who operates the endoscope 1, or can be jointly operated by two persons, namely, the operator and an assistant who assists in operating the endoscope treatment instrument 20. Specifically, the operator grips the operation unit 11 with the left hand and pinches the operation handle 23 with the fingers of the right hand, and performs the forward and backward operation (movement in the axial direction) of the operation handle 23 and the rotation operation (rotation in the first direction) of the operation handle 23.

[0029] By the operator performing the forward and backward operation of the operation handle 23, the treatment portion 210 can be protruded from the distal end surface 10E by a maximum distance L1. Further, by the operator performing the rotation operation of the operation handle 23, the direction of the forceps piece 210A can be adjusted. The assistant moves the slider 223 of the connector portion 22 to perform the opening and closing operation of the forceps piece 210A.

[0030] In this way, according to the endoscope treatment instrument 20, for operations that require skill (such as determining the direction and position of the forceps piece 210A with respect to the treatment target site), the operator can perform them, and for simple operations that do not require much skill (such as treating the treatment target site by opening and closing the forceps piece 210A), the assistant can perform them. In this way, by dividing the roles, it becomes possible to perform the treatment efficiently and accurately. By using the endoscope treatment instrument 20, the assistant only needs to move the slider 223 according to the instructions of the operator. Therefore, an efficient treatment can be performed regardless of the combination of the operator and the assistant.

[0031] The distance L2 from the operation handle 23 to the connector portion 22 is preferably, for example, 50 cm or more in order to appropriately ensure the distance between the operator and the assistant. The distance L1 may be a distance that is easy for the operator to operate, and its upper limit value is preferably, for example, 30 cm. Since many endoscope treatment instruments have the protruding length from the distal end surface 10E within the range of 5 cm or more and 10 cm or less at maximum, the distance L1 is preferably set within this range.

[0032] FIG. 4 is an enlarged perspective view of the vicinity of the connector portion 22 in the endoscope treatment instrument 20. The connector portion 22 includes a cylindrical sheath support portion 221 that supports the proximal end portion by fixing the proximal end portion of the second sheath 25 inside, a slider shaft 222 having its tip fixed to the sheath support portion 221, a slider 223 slidably supported in the axial direction on the outer periphery of the slider shaft 222, a ring 224 provided at the proximal end of the slider shaft 222, and a cord connection portion 223B provided on the slider 223.

[0033] A cord is connected to the cord connection part 223B and is connected to the control device of the endoscopic treatment instrument 20. When the endoscopic treatment instrument 20 can be energized in the treatment part 210, an electrical connection to the treatment part 210 is made through this cord connection part 223B. In this case, inside the first sheath 24, the operation handle 23, and the second sheath 25, an electric wire electrically connected to the treatment part 210 extends to the inside of the slider shaft 222 and is provided, and this electric wire is connected to a connector inside the cord connection part 223B. This electric wire constitutes a transmission element (hereinafter, also referred to as a current transmission element) that transmits a high-frequency current from the connector part 22 to the treatment part 210. When the endoscopic treatment instrument 20 cannot be energized in the treatment part 210, this electric wire and the cord connection part 223B can be omitted.

[0034] In addition, for example, when applying the technology of the present disclosure to a snare, in the endoscopic treatment instrument 20, the treatment part 210 is configured to be replaced with an annular or bag-shaped snare wire whose shape changes according to the movement of the slider 223.

[0035] Also, for example, when applying the technology of the present disclosure to an injection needle, in the endoscopic treatment instrument 20, the treatment part 210 is replaced with a cylindrical needle, and a connecting part of a cylinder for supplying a chemical solution is added to the connector part 22, and a flow path for passing the chemical solution is provided inside the connector part 22, the second sheath 25, the operation handle 23, the first sheath 24, and the tip part 21. This flow path constitutes a transmission element (hereinafter, also referred to as a chemical solution transmission element) for transmitting the chemical solution. For example, when the treatment part 210 is a curved needle, the operator can change the direction of the needle by rotating the operation handle 23. In this case, the assistant only needs to perform the operation of injecting the chemical solution by operating the cylinder according to the instructions of the operator.

[0036] Inside the slider shaft 222, a space in which the operation wire 20W can move in the axial direction is provided, and in this space, a wire support member (not shown) that supports the proximal end of the operation wire 20W is provided. This wire support member is fixed to the slider 223 and is interlocked with the slider 223.

[0037] For example, the assistant hooks the thumb on the ring 224 and hooks the index finger and middle finger between the two flange portions 223A provided on the slider 223, and then pulls the index finger and middle finger toward the thumb side to move the slider 223 in the axial direction. In conjunction with this movement, the above-described wire support member moves in the axial direction, so that the operating wire 20W moves in the axial direction.

[0038] The above-described wire support member built in the slider shaft 222 preferably supports the operating wire 20W so as to be rotatable in the first direction. That is, it is preferable that the operating wire 20W and the connector portion 22 are connected so as to be relatively rotatable in the first direction. By doing so, it is possible to prevent the rotational force of the operation handle 23 from being transmitted to the connector portion 22 via the operating wire 20W. Even when the assistant holds the connector portion 22, the operation handle 23 can be rotated without problems, so that the workability of the surgeon and the assistant can be improved.

[0039] In the configuration in which the above-described wire support member supports the operating wire 20W so as not to be rotatable, when the operation handle 23 is rotated, a rotational force is transmitted to the connector portion 22 via the operating wire 20W. However, even in this case, it is possible to rotate the operation handle 23 without problems by changing the way the assistant holds the connector portion 22 or by twisting the operating wire 20W without resisting the rotational force. As will be described later, at least a part of the range connecting the operation handle 23 and the connector portion 22 of the operating wire 20W is made to have low rigidity in the rotational direction, so that the rotational force transmitted to the connector portion 22 can be reduced.

[0040] FIG. 5 is an enlarged perspective view of the vicinity of the distal end portion 21 of the endoscope treatment instrument 20. FIG. 6 is a cross-sectional view of the vicinity of the distal end portion 21 shown in FIG. 5. The distal end portion 21 includes a distal end support member 211 and a treatment portion 210. The distal end support member 211 has a cylindrical shape and supports the distal end portion of the first sheath 24 inside the proximal end side.

[0041] The treatment unit 210 includes a wire support member 210B that supports the tip of the operation wire 20W, which is provided so as to be movable in the axial direction inside the tip side of the tip support member 211, a link mechanism 210C that connects the wire support member 210B and the forceps piece 210A, and a link mechanism support member 210D that supports the link mechanism 210C. The wire support member 210B and the link mechanism support member 210D are supported by the tip support member 211 so as to be rotatable in the first direction.

[0042] When the operation wire 20W rotates and the wire support member 210B rotates, the link mechanism 210C, the forceps piece 210A, and the link mechanism support member 210D rotate with respect to the tip support member 211 in conjunction with the wire support member 210B. Thus, in the endoscope treatment tool 20, the operation handle 23 and the treatment unit 210 are mechanically connected by the operation wire 20W, and the rotational force when the operation handle 23 is rotated in the first direction can be transmitted to the treatment unit 210 via the operation wire 20W.

[0043] As shown in FIG. 6, the first sheath 24 preferably has a two-layer structure including a first tubular member 241 and a second tubular member 242 provided on the outer periphery of the first tubular member 241. The operation wire 20W is provided inside the first tubular member 241 so as to be movable in the axial direction and rotatable in the first direction. The first tubular member 241 is constituted by, for example, a close-coil spring. The second tubular member 242 is constituted by, for example, a wire-wound blade tube, a multi-layer coil, or a resin tube formed by extrusion molding. In the first sheath 24, the second tubular member 242 may be omitted.

[0044] When closing the forceps blades, relatively strong wire traction force is generated in grasping forceps and hemostatic forceps. On the other hand, the tip of the treatment portion 210 needs to be accurately positioned with respect to the lesion. For this reason, for the first sheath 24, a sheath characteristic in which a change in length hardly occurs with respect to compression (axial force) is required. Further, since the first sheath 24 is a portion inserted into the insertion portion 10, durability and insertability are also required. For the second sheath 25, different from the first sheath 24, it is sufficient if the operation wire 20W can be accommodated at least movably in the axial direction. For this reason, even if the second sheath 25 has a characteristic in which a large change in length occurs with respect to compression, there is no problem, and durability and insertability are not so much required. Therefore, the second sheath 25 may be composed of only an inexpensive single member such as a resin tube formed by extrusion molding. Thus, by separating the first sheath 24 and the second sheath 25, it is easy to change the mechanical physical properties between the first sheath 24 and the second sheath 25.

[0045] For example, it is preferable that the first sheath 24 has a greater rigidity with respect to the axial force than the second sheath 25. By doing so, while ensuring the positioning accuracy of the treatment portion 210, the manufacturing cost of the second sheath 25 can be reduced.

[0046] Further, when the first sheath 24 has a two-layer structure, for example, by making the rigidity of the first tubular member 241 with respect to the axial force greater than the rigidity of the second tubular member 242 with respect to the axial force, while reducing the manufacturing cost of the first sheath 24, accurate positioning of the tip of the treatment portion 210 becomes possible.

[0047] Also, it is preferable that the first sheath 24 has a greater rigidity with respect to the force in the first direction than the second sheath 25. By doing so, the manufacturing cost of the second sheath 25 can be reduced.

[0048] In this way, by making the mechanical properties of the first sheath 24 and the second sheath 25 different, it is possible to improve the positioning accuracy of the treatment section 210 and optimize the manufacturing cost. When insulation is required for the endoscope treatment instrument 20, an insulating member such as a heat shrinkable tube may be further provided on the outer periphery of the first sheath 24 and the second sheath 25.

[0049] FIG. 7 is a schematic cross-sectional view of the vicinity of the operation handle 23 in the endoscope treatment instrument 20. The operation handle 23 includes a cylindrical support member 231 that rotatably supports the first sheath 24 and the second sheath 25 in the first direction and forms an internal space SP1 in which the operation wire 20W is disposed. In the example of the figure, the operation handle 23 further includes a flat pipe 234 that is fixed to the operation wire 20W in the internal space SP1 and is configured to be rotatable in the first direction in conjunction with the rotation of the support member 231 in the first direction. The flat pipe 234 is fixed to the operation wire 20W by being clamped with the operation wire 20W inserted therein or by brazing or the like. The flat pipe 234 constitutes a fixing member.

[0050] The base end portion of the first sheath 24 is fixed inside a cylindrical first sheath holder 232 with a flange. The support member 231 rotatably supports the first sheath holder 232 in the first direction in the internal space SP1, thereby rotatably supporting the first sheath 24 in the first direction.

[0051] The tip end portion of the second sheath 25 is fixed inside a cylindrical second sheath holder 233 with a flange. The support member 231 rotatably supports the second sheath holder 233 in the first direction in the internal space SP1, thereby rotatably supporting the second sheath 25 in the first direction.

[0052] The operation wire 20W inserted into the second sheath 25 from the connector portion 22 is inserted from the tip end of the second sheath 25 into the second sheath holder 233, inserted from the second sheath holder 233 into the flat pipe 234, and inserted from the flat pipe 234 through the first sheath holder 232 into the first sheath 24, and extends to the tip end portion 21.

[0053] Among the internal spaces SP1, the portion between the first sheath holder 232 and the second sheath holder 233 has a rectangular cross-section perpendicular to the axial direction. FIG. 8 is a schematic diagram of a cross-section perpendicular to the axial direction of the operation handle 23 and is a schematic diagram of a cross-section passing through the flat pipe 234. As shown in FIG. 8, the flat pipe 234 is disposed in the internal space SP1 having a rectangular cross-section. The outer shape of the cross-section of the flat pipe 234 is the same as that of the internal space SP1, and the gap between the flat pipe 234 and the support member 231 is very small. For this reason, as shown in FIG. 9, when the support member 231 rotates in the first direction, the flat pipe 234 also rotates in conjunction with the support member 231.

[0054] Since the flat pipe 234 is fixed to the operation wire 20W, when the support member 231 rotates, the operation wire 20W rotates, and the treatment portion 210 connected to the tip of the operation wire 20W rotates. The support member 231 rotatably supports the first sheath holder 232 and the second sheath holder 233. For this reason, even when the support member 231 is rotated, the first sheath 24 and the second sheath 25 are not twisted, and the influence on the treatment is prevented.

[0055] The flat pipe 234 is movable in the axial direction between the first sheath holder 232 and the second sheath holder 233. Therefore, when the slider 223 of the connector portion 22 moves in the axial direction, the flat pipe 234 also moves together with the operation wire 20W between the first sheath holder 232 and the second sheath holder 233. The distance between the first sheath holder 232 and the second sheath holder 233 is set to a value required for opening and closing the pair of forceps pieces 210A.

[0056] According to the endoscope treatment instrument 20 configured as described above, since the first sheath 24 and the second sheath 25 are separated and in a non-contact state, the space between them can be utilized to enable a mechanical connection between the operation wire 20W and the operation handle 23 without passing through the sheath. As a result, it becomes possible to rotate the operation wire 20W at a location different from the connector portion 22, and it becomes possible to adjust the orientation of the treatment portion 210 and perform the treatment by the treatment portion 210 at different positions. Consequently, it can be used jointly by two people, an operator and an assistant. Also, since the operation by the operator and the operation by the assistant can be made independent, the work efficiency and accuracy can be enhanced.

[0057] Note that the operation wire 20W may be divided into a first wire provided inside the first sheath 24 and a second wire provided inside the second sheath 25, and the first wire and the second wire may be connected by a flat pipe 234 at the operation handle 23. The first wire constitutes a first component member, and the second wire constitutes a second component member.

[0058] In such a case, it is preferable to make the rigidity of the first wire with respect to the force in the first direction different from the rigidity of the second wire with respect to the force in the first direction. Specifically, the rigidity of the second wire with respect to the force in the first direction is made smaller than the rigidity of the first wire with respect to the force in the first direction. By doing so, even if the second wire and the connector portion 22 are fixedly configured so as not to be relatively rotatable in the first direction, the rotational force of the operation handle 23 is less likely to be transmitted from the second wire to the connector portion 22, and it is possible to prevent the connector portion 22 from rotating due to the rotation of the operation handle 23. Also, by increasing the rigidity of the first wire with respect to the force in the first direction, the rotational force of the operation handle 23 can be efficiently transmitted to the treatment portion 210, and the followability of the rotation of the treatment portion 210 with respect to the rotation operation of the operation handle 23 can be enhanced.

[0059] FIG. 10 is a perspective view showing the configuration of an operation handle 23A which is a first modification of the operation handle 23. FIG. 11 is a schematic cross-sectional view of the operation handle 23A shown in FIG. 10.

[0060] The operation handle 23A has a support member 231A formed by joining a pair of members having the same shape and a flat shape. An internal space SP2 capable of accommodating a first sheath holder 232, a second sheath holder 233, and an operation wire 20W exposed from the first sheath holder 232 and the second sheath holder 233 is formed between the pair of members constituting the support member 231A. The support member 231A supports the first sheath holder 232 so as to be rotatable in the first direction and supports the second sheath holder 233 so as to be rotatable in the first direction. A pair of elastically displaceable pressing portions 231B are provided opposite to each other on the support member 231A.

[0061] The operation wire 20W is exposed between the first sheath holder 232 and the second sheath holder 233, and the exposed portion of the operation wire 20W is disposed between the pair of pressing portions 231B. A gap is provided between the pair of pressing portions 231B such that the operation wire 20W can move in the axial direction when the pressing portions 231B are in a steady state. In the pressed state where each pressing portion 231B is pressed in a direction approaching the operation wire 20W, this gap disappears, the operation wire 20W is clamped by the pair of pressing portions 231B, and the operation wire 20W becomes non-movable in the axial direction.

[0062] By rotating the support member 231A in the first direction while maintaining the above-mentioned pressing state, the operation wire 20W can be rotated in the first direction to rotate the treatment portion 210. In the above-mentioned steady state, as the slider 223 moves, the operation wire 20W moves within the support member 231A, so that the opening and closing operation of the forceps blade 210A becomes possible. Further, in this steady state, the support member 231A is rotatable in the first direction with respect to the operation wire 20W. Since the axial positions of the first sheath holder 232 and the second sheath holder 233 are fixed with respect to the support member 231A, regardless of whether it is in the above-mentioned steady state or pressing state, by moving the support member 231A in the axial direction, the operation wire 20W, the first sheath holder 232, the first sheath 24, the second sheath holder 233, and the second sheath 25 can be integrally moved in the axial direction to move the treatment portion 210 in the axial direction. Thus, the support member 231A is configured to be able to switch between a state in which the rotation of the operation wire 20W is interlocked with the rotation of the support member 231A and a state in which the support member 231A is rotated with respect to the operation wire 20W.

[0063] According to the operation handle 23A shown in FIGS. 10 and 11, since a fixing member (flat pipe) is unnecessary, it is possible to eliminate the limitation on the axial movement distance of the operation wire 20W according to the operation of the slider 223. In the operation handle 23A, the distance between the first sheath holder 232 and the second sheath holder 233 can be set to the minimum necessary extent that a part of the pressing portion 231B can be arranged. For this reason, even in an endoscope treatment instrument in which the axial movement distance of the operation wire 20W becomes large when the slider 223 is operated, such as when the treatment portion 210 is composed of a snare wire, it is possible to prevent the axial size of the operation handle 23A from becoming large. Thereby, it is possible to reduce the manufacturing cost of the endoscope treatment instrument 20 and improve the operability of the operation handle 23A.

[0064] FIG. 12 is a schematic cross-sectional view showing the configuration of an operation handle 23B which is a second modification of the operation handle 23. FIG. 13 is a schematic cross-sectional view taken along line A-A of FIG. 12.

[0065] The operation handle 23B has a support member 231C formed by joining a pair of members having the same shape and a flat shape. An internal space SP3 is formed between the pair of members constituting the support member 231C, and houses a first sheath holder 232, a second sheath holder 233, an operation wire 20W positioned between the first sheath holder 232 and the second sheath holder 233, and a deformed tube 235.

[0066] The support member 231C rotatably supports the first sheath holder 232 in the first direction and rotatably supports the second sheath holder 233 in the first direction. The deformed tube 235 has the operation wire 20W inserted therein and is fixed to the operation wire 20W. The deformed tube 235 constitutes a tubular housing member for housing the operation wire 20W.

[0067] The deformed tube 235 is provided so as to extend from the inside of the first sheath 24 to the inside of the second sheath 25. The deformed tube 235 is sized to be rotatable in the first direction within the first sheath 24 and the second sheath 25.

[0068] Among the deformed tube 235, the portion between the first sheath holder 232 and the second sheath holder 233 is disposed between the pair of members constituting the support member 231C. The distance between the pair of members is sized such that the deformed tube 235 can move in the axial direction, but the deformed tube 235 is sized such that it cannot rotate in the first direction.

[0069] With such a configuration, as shown in FIG. 14, when the support member 231C rotates in the first direction, the deformed tube 235 and the operation wire 20W rotate in the first direction in conjunction with the rotation. Since the deformed tube 235 is rotatable within the first sheath 24 and the second sheath 25, the rotation of the support member 231C is not hindered. Further, when the slider 223 is moved in the axial direction, the operation wire 20W and the deformed tube 235 housing the same move integrally in the axial direction, thereby opening and closing the forceps piece 210A.

[0070] The deformed tube 235 only needs to ensure a sufficient axial length so that it can be arranged between the pair of members constituting the support member 231C regardless of the axial position of the slider 223. In the operation handle 23B, even when the distance between the first sheath 24 and the second sheath 25 is shortened, there is no limit to the length of the deformed tube 235, and its length can be made sufficiently large. Therefore, while enabling the operation wire 20W to be interlocked with the rotation of the support member 231C, similar to the operation handle 23A, the limitation on the axial movement distance of the operation wire 20W corresponding to the operation of the slider 223 can be eliminated.

[0071] In addition, in FIG. 12, the deformed tube 235 may not be inserted inside the first sheath 24. Alternatively, the deformed tube 235 may not be inserted inside the second sheath 25.

[0072] In each of the endoscope treatment tools 20 including the operation handle 23, the endoscope treatment tool 20 including the operation handle 23A, and the endoscope treatment tool 20 including the operation handle 23B, the second sheath 25 may be fixed to the operation handles 23, 23A, 23B, and the second sheath 25 and the sheath support portion 221 of the connector portion 22 may be connected so as to be relatively rotatable in the first direction.

[0073] In this case, when the operation handles 23, 23A, 23B are rotated, the second sheath 25 will rotate following this. However, since the second sheath 25 and the sheath support portion 221 are connected so as to be relatively rotatable, the rotational force of the operation handles 23, 23A, 23B can be prevented from being transmitted to the connector portion 22.

[0074] FIG. 15 is a schematic diagram showing the configuration of an endoscopic treatment instrument 20A which is a first modification of the endoscopic treatment instrument 20. The endoscopic treatment instrument 20A is obtained by modifying the endoscopic treatment instrument 20 shown in FIG. 2 such that the operation handle 23 is changed to an operation handle 23C, the connector portion 22 is changed to a connector portion 22A, the treatment portion 210 is changed to a treatment portion constituted by a blade-shaped high-frequency knife 210K, and the operation wire 20W is deleted. The distal end portion 21 of the endoscopic treatment instrument 20A has a configuration in which, for example, in FIG. 6, the high-frequency knife 210K is rotatably supported in a first direction by a distal end support member 211.

[0075] The operation handle 23C has the same configuration as the operation handle 23 shown in FIG. 7, but a wire support portion 23T is provided instead of the flat pipe 234. The operation handle 23C rotatably supports the proximal end portion of the first sheath 24 in a first direction and rotatably supports the distal end portion of the second sheath 25 in a first direction. In the axial direction, the position of the operation handle 23C is fixed with respect to the first sheath 24 and the second sheath 25.

[0076] In the endoscopic treatment instrument 20A, inside the first sheath 24, a rotation operation wire T1 is provided, the distal end of which is fixed to the high-frequency knife 210K and the proximal end of which is fixed to the wire support portion 23T inside the operation handle 23C. The rotation operation wire T1 is a power transmission element that mechanically connects the operation handle 23C and the high-frequency knife 210K. The rotation operation wire T1 is rotatably provided in the first direction inside the first sheath 24.

[0077] When the operation handle 23C is rotated in the first direction, the wire support portion 23T integrally formed with the operation handle 23C rotates in the first direction, and in conjunction with this, the rotation operation wire T1 rotates. As a result, the high-frequency knife 210K fixed to the rotation operation wire T1 rotates in the first direction.

[0078] Thus, in the endoscopic treatment instrument 20A, when the operation handle 23C is rotated, the rotational force is configured to be transmitted to the high-frequency knife 210K that constitutes the treatment section 210 via the rotation operation wire T1 provided only inside the first sheath 24 out of the first sheath 24 and the second sheath 25.

[0079] The connector section 22A has a configuration in which, for example, the slider 223 and the ring 224 are removed from the configuration of the connector section 22 shown in FIG. 4, and instead, an operation button 225 for turning on and off the supply of high-frequency current to the high-frequency knife 210K is provided. In the endoscopic treatment instrument 20A, inside the first sheath 24, the operation handle 23C, and the second sheath 25, an electric wire T2 is provided that extends from the connector section 22A to the high-frequency knife 210K and electrically connects the connector section 22A and the high-frequency knife 210K. The electric wire T2 is a current transmission element provided to extend from the connector section 22A to the high-frequency knife 210K. The electric wire T2 is electrically connected to a cord connected to the cord connection section 223B. In response to the operation of the operation button 225, high-frequency current is supplied to the high-frequency knife 210K through the electric wire T2.

[0080] Thus, according to the endoscopic treatment instrument 20A, even in a configuration where the treatment section 210 that only rotates without requiring a movable section (such as forceps pieces or snare wires) at the distal end 21 is provided, the operator can perform the rotation operation and the forward and backward movement operation of the treatment section 210 (high-frequency knife 210K) using the operation handle 23C. Regarding the supply of high-frequency current to the high-frequency knife 210K, an assistant can operate the connector section 22A to perform it. It becomes possible to rotate the high-frequency knife 210K at a location different from the connector section 22A, and it becomes possible to adjust the direction of the high-frequency knife 210K and perform the treatment with the high-frequency knife 210K at different positions. As a result, it can be used jointly by two people, an operator and an assistant. Also, since the operation by the operator and the operation by the assistant can be made independent, the work efficiency and accuracy can be improved.

[0081] In the endoscopic treatment instrument 20A, the operation handle 23C is configured to support the second sheath 25 so as to be rotatable in the first direction, but it is not limited to this. For example, the operation handle 23C and the second sheath 25 may be fixed. However, according to the configuration in which the operation handle 23C and the second sheath 25 are connected so as to be relatively rotatable, it is possible to prevent the second sheath 25 from being twisted by the rotation operation of the operation handle 23C.

[0082] In the endoscopic treatment instrument 20A, it is preferable that the second sheath 25 and the connector portion 22A are connected so as to be relatively rotatable in the first direction. By doing so, for example, even when the operation handle 23C and the second sheath 25 are fixed, since the second sheath 25 can rotate with respect to the connector portion 22A, it is possible to prevent the rotation operation of the operation handle 23C from being transmitted to the connector portion 22A.

[0083] In the endoscopic treatment instrument 20A, since the first sheath 24 needs to rotatably accommodate the rotation operation wire T1, it is preferably tubular with a hollow portion large enough for the rotation operation wire T1 to rotate. However, since the second sheath 25 only needs to accommodate the electric wire T2 that does not need to be moved in the axial direction and the first direction, it does not need to be tubular. The second sheath 25 may be configured, for example, as a solid structure in which the electric wire T2 is coated with an insulating material and integrally formed. This can reduce costs.

[0084] Also in the endoscopic treatment instrument 20A, similar to the endoscopic treatment instrument 20, by making the mechanical physical properties (rigidity against forces in the first direction and the axial direction) different between the first sheath 24 and the second sheath 25, it is possible to optimize the manufacturing cost and improve the operability.

[0085] For example, by making the rigidity of the first sheath 24 with respect to the force in the first direction greater than the rigidity of the second sheath 25 with respect to the force in the first direction, when the operation handle 23C and the second sheath 25 are fixed, the reaction force due to the torsion of the second sheath 25 can be suppressed. Further, when the operation handle 23C and the second sheath 25 are fixed and the second sheath 25 and the connector portion 22A are fixed, it is possible to prevent the rotational force of the operation handle 23C from being transmitted to the connector portion 22A. Also, the cost of the second sheath 25 can be reduced.

[0086] Further, by making the rigidity of the first sheath 24 with respect to the axial force smaller than the rigidity of the second sheath 25 with respect to the axial force, it is possible to perform the positioning of the high-frequency knife 210K with high precision while reducing the cost of the second sheath 25.

[0087] In the endoscopic treatment instrument 20A, the high-frequency knife 210K may be replaced with, for example, an injection needle. In this case, instead of the electric wire T2, a chemical solution transmission element may be provided, and a cylinder for chemical solution injection may be provided in the connector portion 22A. Also, depending on the treatment instrument, both the chemical solution transmission element and the current transmission element (electric wire T2) may be provided extending from the connector portion 22A to the treatment portion 210. In this case, for example, the operation button 225 may be eliminated from the connector portion 22A in FIG. 15, and only the cord connection portion 223B and the chemical solution injection port may be provided. The assistant may perform only the chemical solution injection operation, and the energization operation may be performed by the operator using a foot switch or the like (not shown). In a treatment instrument having a plurality of degrees of freedom of operation like this, various combinations are possible as to which operation means is arranged in the connector portion. The above examples do not limit these combinations. Also, in FIG. 15, when the electric wire T2 is constituted by at least one of the chemical solution transmission element and the current transmission element, the second sheath 25 does not need to be a tubular shape having a hollow portion, and the cost can be reduced by making it a solid structure.

[0088] FIG. 16 is a schematic cross-sectional view showing the configuration of an operation handle 23D, which is a third modification of the operation handle 23 of the endoscopic treatment instrument 20. The operation handle 23D is different from the configuration of the operation handle 23 shown in FIG. 7 in that the flat pipe 234 and the first sheath holder 232 are deleted, and the support member 231 and the first sheath 24 are fixed by adhesion or the like so that the first sheath 24 and the support member 231 cannot rotate relative to each other. Further, in the endoscopic treatment instrument 20 (hereinafter referred to as the endoscopic treatment instrument 20D) in which the operation handle 23 is replaced with the operation handle 23D, the link mechanism support member 210D and the distal end support member 211 shown in FIG. 6 are integrated.

[0089] In the endoscopic treatment instrument 20D, the first tubular member 241 constituting the inner layer of the first sheath 24 protrudes from the proximal end edge of the second tubular member 242, and this protruding portion is adhered to the inner peripheral surface of the support member 231, for example. Further, the second tubular member 242 constituting the outer layer of the first sheath 24 has its proximal end portion adhered to the inner peripheral surface of the support member 231, for example.

[0090] Thus, in the endoscopic treatment instrument 20D, since the support member 231 and the first sheath 24 are fixed, when the support member 231 is rotated in the first direction, the first sheath 24 rotates in conjunction with the rotation. As a result, the distal end support member 211 that supports the distal end portion of the first sheath 24 and the treatment portion 210 supported thereby rotate. Thus, in the endoscopic treatment instrument 20D including the operation handle 23D, the support member 231 and the treatment portion 210 are mechanically connected by the first sheath 24, and the rotational force when the support member 231 is rotated can be transmitted to the treatment portion 210 via the first sheath 24.

[0091] In the endoscopic treatment instrument 20D, it is the first sheath 24 that transmits the rotational force of the support member 231 to the treatment section 210. Therefore, it is preferable that the first sheath 24 has high rigidity against the force in the first direction. For example, it is preferable that the first sheath 24 has higher rigidity against the force in the first direction than the second sheath 25. Thereby, while making the second sheath 25 inexpensive, the followability of the rotation of the treatment section 210 due to the rotational operation of the operation handle 23D can be improved. Further, it is preferable that the first sheath 24 has higher rigidity against the axial force than the second sheath 25. Thereby, while making the second sheath 25 inexpensive, the positioning accuracy of the treatment section 210 and the gripping force of the forceps piece 210A can be sufficiently ensured.

[0092] Also in the endoscopic treatment instrument 20D, it is preferable that the second sheath 25 and the connector section 22 are connected so as to be relatively rotatable in the first direction. Although the support member 231 is rotatable with respect to the second sheath 25, since the second sheath 25 is also rotatable with respect to the connector section 22, it is possible to more strongly prevent the operation of the connector section 22 from affecting the operation of the operation handle 23D.

[0093] In the endoscopic treatment instrument 20D, in addition to the operation wire 20W, one or both of the current transmission element and the chemical solution transmission element extending from the connector section 22 to the treatment section 210 may be provided inside the first sheath 24, the operation handle 23D, and the second sheath 25.

[0094] In the endoscopic treatment instrument 20D, when the treatment section 210 has no movable part and requires energization (for example, in the case of the high-frequency knife 210K shown in FIG. 15), instead of the operation wire 20W, for example, a current transmission element may be provided. Further, in the endoscopic treatment instrument 20D, when the treatment section 210 is an injection needle, instead of the operation wire 20W, for example, a chemical solution transmission element may be provided. In the endoscopic treatment instrument 20D, when the operation wire 20W is replaced by one or both of the current transmission element and the chemical solution transmission element, at least one of the first sheath 24 and the second sheath 25 does not need to be a hollow tubular shape inside, and may be a solid structure in which the current transmission element and the chemical solution transmission element are integrally provided inside.

[0095] FIG. 17 is a schematic diagram showing the configuration of an endoscopic treatment instrument 20E, which is a second modification of the endoscopic treatment instrument 20. The endoscopic treatment instrument 20E is the endoscopic treatment instrument 20 shown in FIG. 2, in which the operation handle 23 is changed to an operation handle 23E, the second sheath 25 is deleted, and instead of the deleted second sheath 25, the first tubular member 241 constituting the inner layer of the first sheath 24 is extended to the position of the connector section 22.

[0096] FIG. 18 is a schematic diagram showing a cross section near the operation handle 23E of the endoscopic treatment instrument 20E shown in FIG. 17. The left side in FIG. 18 is the proximal end side of the endoscopic treatment instrument 20E, and the right side is the distal end side of the endoscopic treatment instrument 20E. In the endoscopic treatment instrument 20E, the link mechanism support member 210D and the distal end support member 211 shown in FIG. 6 are integrated.

[0097] The operation handle 23E includes a cylindrical support member 231C. A second tubular member 242 is fixed to the inner peripheral surface of the support member 231C by adhesion or the like. In the first sheath 24, the first tubular member 241 and the second tubular member 242 are configured to be relatively rotatable in the first direction. The first tubular member 241 and the second tubular member 242 are configured to be non-relatively movable in the axial direction at least at the tip portion 21. That is, the position of the second tubular member 242 in the axial direction is fixed with respect to the first tubular member 241. As shown in FIG. 6, the tip portion of the second tubular member 242 of the first sheath 24 is fixed to the tip support member 211.

[0098] The first sheath 24 changes from a two-layer structure to a one-layer structure with the inside of the support member 231C as a boundary. Specifically, the second tubular member 242 extends from the tip portion 21 to the inside of the support member 231C, and the first tubular member 241 protrudes from the base end edge of the second tubular member 242. The first tubular member 241 extends to the inside of the sheath support portion 221 of the connector portion 22 shown in FIG. 4 and is supported by the sheath support portion 221. When the endoscope treatment instrument 20E requires insulation, the second tubular member 242 exposed on the proximal end side of the operation handle 23E is covered with an insulating member such as a heat shrinkable tube.

[0099] In the endoscopic treatment instrument 20E, since the support member 231C and the second tubular member 242 are fixed, when the support member 231C is rotated in the first direction, the second tubular member 242 rotates. As a result, the distal end support member 211 that supports the distal end of the second tubular member 242 and the treatment portion 210 supported thereby rotate. Thus, in the endoscopic treatment instrument 20E, the support member 231C and the treatment portion 210 are mechanically connected by the first sheath 24, and the rotational force when the support member 231C is rotated can be transmitted to the treatment portion 210 via the first sheath 24. When the support member 231 is moved in the axial direction, the first sheath 24 and the operation handle 23E move integrally in the axial direction, so that the axial position of the treatment portion 210 can be changed. In the endoscopic treatment instrument 20E, the first tubular member 241 constitutes the first member. The second tubular member 242 constitutes the tubular member.

[0100] Thus, according to the endoscopic treatment instrument 20E, the operator can perform the rotation operation and the forward / backward movement operation of the treatment portion 210 using the operation handle 23E. Therefore, the same effect as that of the endoscopic treatment instrument 20 can be obtained. According to the operation handle 23E, since the second sheath 25 is not required, the manufacturing cost can be reduced.

[0101] In the endoscopic treatment instrument 20E, it is preferable that the first tubular member 241 and the second tubular member 242 have different mechanical physical properties. For example, it is preferable that the second tubular member 242 has a greater rigidity with respect to the force in the first direction than the first tubular member 241. By doing so, while reducing the manufacturing cost of the first sheath 24, the followability of the rotation of the treatment portion 210 with respect to the rotation operation of the operation handle 23E can be enhanced. Further, it is preferable that the first tubular member 241 has a greater rigidity with respect to the axial force than the second tubular member 242. By doing so, the positioning accuracy of the treatment portion 210 and the gripping force of the forceps piece 210A can be sufficiently ensured.

[0102] In the endoscopic treatment instrument 20E, the operation handle 23E is not essential and can be omitted. When the operation handle 23E is omitted, the operator can pinch the proximal end portion of the second tubular member 242 with a finger and rotate it in the first direction or move it in the axial direction, so that the treatment portion 210 can be rotated and advanced / retreated.

[0103] In the endoscopic treatment instrument 20E, the first tubular member 241 may be fixed to the inner peripheral surface of the support member 231C so that the second tubular member 242 and the first tubular member 241 cannot relatively rotate in the first direction. In this case, when the operation handle 23E is rotated, the entire first sheath 24 rotates with respect to the operation wire 20W, so that the treatment portion 210 can be rotated. In this case, the rotational force when the operation handle 23E rotates can also be transmitted to the connector portion 22 via the first tubular member 241. However, by making the rigidity of the first tubular member 241 against the force in the first direction smaller than the rigidity of the second tubular member 242 against the force in the first direction, the rotational force of the support member 231C can be made less likely to be transmitted to the connector portion 22. As a result, the reaction force due to the twist of the exposed first tubular member 241 is suppressed, and it is possible to prevent the rotational operation of the operation handle 23E by the operator from affecting the operation of the connector portion 22 by the assistant.

[0104] Also, in a configuration where the second tubular member 242 and the first tubular member 241 cannot relatively rotate in the support member 231C, for example, even if the mechanical physical properties of the first tubular member 241 and the second tubular member 242 are the same, the first sheath 24 changes from a two-layer structure to a one-layer structure with the operation handle 23E as a boundary, so that the transmission performance of the rotational force of the operation handle 23E changes between the two-layer structure portion and the one-layer structure portion. Therefore, it is possible to prevent the rotational operation of the operation handle 23E by the operator from affecting the operation of the connector portion 22 by the assistant. Also, by connecting the first tubular member 241 and the sheath support portion 221 so as to be relatively rotatable in the first direction, such an influence can be eliminated.

[0105] In the endoscopic treatment instrument 20E, rather than configuring the first tubular member 241 as a single member, it may be configured to be divided into two members in the axial direction and the two members are connected at the support member 231C. For example, inside the proximal end side of the support member 231C, a connection portion of the two members constituting the first tubular member 241 is provided, and the member on the proximal end side of this connection portion may be a resin tube or the like, thereby reducing costs.

[0106] In the endoscopic treatment instrument 20E, in addition to the operation wire 20W, at least one of a current transmission element and a chemical solution transmission element may be further provided. Further, instead of the operation wire 20W, at least one of a current transmission element and a chemical solution transmission element may be provided. When at least one of a current transmission element and a chemical solution transmission element is provided instead of the operation wire 20W, the first tubular member 241 does not necessarily need to be a tube having a hollow portion, and may be a solid structure in which at least one of the transmission element and the chemical solution transmission element is integrally provided inside.

[0107] As described above, at least the following matters are described in this specification.

[0108] (1) An endoscopic treatment instrument introduced into the treatment instrument inlet of an endoscope, a distal end portion including a treatment portion, a proximal end portion provided at the proximal end, an operation member provided between the distal end portion and the proximal end portion and mechanically connected to the treatment portion, a first connection member connecting the distal end portion and the operation member, a second connection member different from the first connection member connecting the operation member and the proximal end portion, and the operation member is configured to be rotatable in a first direction around the axis of the endoscopic treatment instrument, An endoscopic treatment instrument in which the treatment portion is configured to be rotatable in the first direction by rotation of the operation member.

[0109] (2) The endoscopic treatment instrument according to (1), The operation member is an endoscope treatment instrument in which the axial position of the endoscope treatment instrument is fixed with respect to the first connection member and the second connection member.

[0110] (3) The endoscope treatment instrument according to (2), comprising a power transmission element that mechanically connects at least the operation member and the treatment portion, the operation member is configured to be rotatable in the first direction with respect to the first connection member, an endoscope treatment instrument configured to be able to transmit the rotational force when the operation member is rotated to the treatment portion via the power transmission element.

[0111] (4) The endoscope treatment instrument according to (3), the first connection member is a tubular member in which the power transmission element is provided inside.

[0112] (5) The endoscope treatment instrument according to (4), the power transmission element further extends from the operation member to the proximal end portion and mechanically connects the proximal end portion and the treatment portion, the second connection member is a tubular member in which the power transmission element is provided inside.

[0113] (6) The endoscope treatment instrument according to (5), the power transmission element is provided inside the first connection member, the operation member, and the second connection member so as to be movable in the axial direction.

[0114] (7) The endoscope treatment instrument according to (6), the operation member is configured to be rotatable in the first direction with respect to the first connection member and the second connection member.

[0115] (8) The endoscope treatment instrument according to (7), The operation member includes a support member that rotatably supports the first connection member and the second connection member and forms an internal space in which the power transmission element is disposed, and a fixing member that is fixed to the power transmission element in the internal space and is configured to be rotatable in conjunction with the rotation of the support member. An endoscopic treatment instrument.

[0116] (9) The endoscopic treatment instrument according to (7), The operation member includes a support member that rotatably supports the first connection member and the second connection member and forms an internal space in which the power transmission element is disposed. The support member is configured to be switchable between a state in which the rotation of the power transmission element is interlocked with the rotation of the support member and a state in which the support member is rotated with respect to the power transmission element. An endoscopic treatment instrument.

[0117] (10) The endoscopic treatment instrument according to (7), The operation member includes a support member that rotatably supports the first connection member and the second connection member and forms an internal space in which the power transmission element is disposed, and a tubular housing member that houses the power transmission element. The housing member is configured to be rotatable in conjunction with the rotation of the support member, and a part of the housing member is provided in at least one of the first connection member and the second connection member so as to be rotatable and movable in the axial direction. An endoscopic treatment instrument.

[0118] (11) The endoscopic treatment instrument according to (7), The power transmission element and the base end portion are connected so as to be relatively rotatable in the first direction. An endoscopic treatment instrument.

[0119] (12) The endoscopic treatment instrument according to (7), The power transmission element has a configuration in which a first component provided inside the first connection member and a second component provided inside the second connection member are connected in the operation member. The second component member is an endoscopic treatment instrument having a rigidity against the force in the first direction smaller than that of the first component member.

[0120] (13) The endoscopic treatment instrument according to (4), comprising a transmission element provided to extend from the proximal end portion to the treatment portion, The second connection member is an endoscopic treatment instrument which is a solid structure body having the transmission element provided therein.

[0121] (14) The endoscopic treatment instrument according to (2), wherein the operation member is configured to be rotatable in the first direction with respect to the second connection member.

[0122] (15) The endoscopic treatment instrument according to (2), wherein the operation member is fixed to the first connection member, and the endoscopic treatment instrument is configured such that a rotational force when the operation member is rotated can be transmitted to the treatment portion via the first connection member.

[0123] (16) The endoscopic treatment instrument according to (15), comprising a transmission element provided to extend from the proximal end portion to the treatment portion, wherein the first connection member and the second connection member are columnar with the transmission element provided therein.

[0124] (17) The endoscopic treatment instrument according to (16), wherein the transmission element includes a power transmission element that mechanically connects the proximal end portion and the treatment portion, the first connection member has a first tubular member and a second tubular member provided on the outer periphery of the first tubular member, the power transmission element is provided inside the first tubular member so as to be movable in the axial direction, The first tubular member is an endoscopic treatment instrument having a greater rigidity against the axial force than the second tubular member.

[0125] (18) An endoscopic treatment instrument according to any one of (1) to (17), wherein the first connecting member and the second connecting member are endoscopic treatment instruments having different mechanical physical properties.

[0126] (19) An endoscopic treatment instrument according to (18), wherein the first connecting member and the second connecting member are endoscopic treatment instruments having different rigidities against the force in the first direction.

[0127] (20) An endoscopic treatment instrument according to (19), wherein the first connecting member is an endoscopic treatment instrument having a greater rigidity against the force in the first direction than the second connecting member.

[0128] (21) An endoscopic treatment instrument according to (18), wherein the first connecting member and the second connecting member are endoscopic treatment instruments having different rigidities against the axial force of the endoscopic treatment instrument.

[0129] (22) An endoscopic treatment instrument according to (21), wherein the first connecting member is an endoscopic treatment instrument having a greater rigidity against the axial force than the second connecting member.

[0130] (23) An endoscopic treatment instrument according to any one of (1) to (17), wherein the proximal end portion and the second connecting member are connected so as to be relatively rotatable.

[0131] (24) An endoscopic treatment instrument that is introduced into the treatment instrument insertion port of an endoscope and used, having a distal end portion including a treatment portion, and a proximal end portion provided at the proximal end, A first member extending along the axial direction of the endoscopic treatment instrument from the tip end portion to the base end portion; A tubular member provided with a part of the first member inside and extending from the tip end portion to a position between the tip end portion and the base end portion; and An endoscopic treatment instrument configured such that the treatment portion can be rotated in the first direction by rotation of the tubular member in the first direction around the axis of the endoscopic treatment instrument.

[0132] (25) The endoscopic treatment instrument according to (24), wherein the tubular member is configured to be rotatable in the first direction with respect to the first member.

[0133] (26) The endoscopic treatment instrument according to (24), wherein the tubular member is fixed in position in the axial direction of the endoscopic treatment instrument with respect to the first member, at least at the tip end portion.

[0134] (27) The endoscopic treatment instrument according to any one of (24) to (26), further comprising an operating member fixed to the tubular member.

[0135] (28) The endoscopic treatment instrument according to any one of (24) to (26), further comprising a transmission element extending from the base end portion to the treatment portion.

[0136] (29) The endoscopic treatment instrument according to (28), wherein the first member is tubular, and the transmission element is provided inside the first member so as to be movable in the axial direction.

[0137] (30) The endoscopic treatment instrument according to (28), wherein The first member is an endoscopic treatment instrument which is a solid structure with the transmission element provided inside.

[0138] (31) The endoscopic treatment instrument according to any one of (24) to (26), wherein the first member and the tubular member have different mechanical properties.

[0139] (32) The endoscopic treatment instrument according to (31), wherein the first member and the tubular member have different rigidities with respect to the force in the first direction.

[0140] (33) The endoscopic treatment instrument according to (32), wherein the tubular member has a rigidity with respect to the force in the first direction greater than that of the first member.

[0141] (34) The endoscopic treatment instrument according to any one of (24) to (26), wherein the first member and the tubular member have different rigidities with respect to the axial force of the endoscopic treatment instrument.

[0142] (35) The endoscopic treatment instrument according to (34), wherein the first member has a rigidity with respect to the axial force greater than that of the tubular member.

Explanation of reference numerals

[0143] 1 Endoscope 2 Main body part 2 Electric wire T 4 Light source device 4A Connection part 5 Processor device 7 Display device 10 Insertion part 10A Flexible part 10B Bending part 10C, 21 Tip part 10E Tip surface 11 Operation section 11A Suction button 12 Angle knob 13 Universal code 13A, 22, 22A Connector section 20, 20A, 20D, 20E Endoscopic treatment instrument 20W Operation wire 23, 23A, 23B, 23C, 23D, 23E Operation handle 23T Wire support section 24 First sheath 25 Second sheath 100 Endoscope device 112 Treatment instrument insertion port 210 Treatment section 210A Forceps blade 210B Wire support member 210C Link mechanism 210D Link mechanism support member 210K High-frequency knife 211 Tip support member 221 Sheath support section 222 Slider shaft 223 Slider 223A Flange section 223B Cable connection section 224 Ring 225 Operation button 231, 231A, 231C Support member 231B Pressing section 232 First sheath holder 233 Second sheath holder 234 Flat pipe 235 Shaped tube 241 First tubular member 242 Second tubular member SP1, SP2, SP3 Internal space L1, L2 Distance T1 Rotation operation wire

Claims

1. An endoscope treatment instrument that is introduced into the treatment instrument insertion port of an endoscope and used, a distal end portion including a treatment portion, a proximal end portion provided at the proximal end, an operating member provided between the distal end portion and the proximal end portion and mechanically connected to the treatment portion, a first connecting member connecting the distal end portion and the operating member, a second connecting member different from the first connecting member that connects the operating member and the proximal end portion, and comprising: the operating member is configured to be rotatable in a first direction around the axis of the endoscope treatment instrument, An endoscope treatment instrument in which the treatment portion is configured to be rotatable in the first direction by rotation of the operating member.

2. The endoscope treatment instrument according to claim 1, wherein the position of the operating member in the axial direction of the endoscope treatment instrument is fixed with respect to the first connecting member and the second connecting member.

3. The endoscope treatment instrument according to claim 2, comprising a power transmission element that mechanically connects at least the operating member and the treatment portion, the operating member is configured to be rotatable in the first direction with respect to the first connecting member, An endoscope treatment instrument configured to transmit the rotational force when the operating member is rotated to the treatment portion via the power transmission element.

4. The endoscope treatment instrument according to claim 3, wherein the first connecting member is tubular with the power transmission element provided inside.

5. The endoscope treatment instrument according to claim 4, the power transmission element further extends from the operating member to the proximal end portion and mechanically connects the proximal end portion and the treatment portion, wherein the second connecting member is tubular with the power transmission element provided inside.

6. The endoscope treatment instrument according to claim 5, wherein the power transmission element is provided inside the first connecting member, the operating member, and the second connecting member so as to be movable in the axial direction.

7. The endoscope treatment instrument according to claim 6, wherein the operating member is configured to be rotatable in the first direction with respect to the first connecting member and the second connecting member.

8. The endoscope treatment instrument according to claim 7, The operating member includes a support member that rotatably supports the first connection member and the second connection member and forms an internal space in which the power transmission element is disposed, and a fixing member fixed to the power transmission element in the internal space and configured to be rotatable in conjunction with the rotation of the support member. An endoscopic treatment instrument.

9. The endoscopic treatment instrument according to claim 7, wherein the operating member includes a support member that rotatably supports the first connection member and the second connection member and forms an internal space in which the power transmission element is disposed, and the support member is configured to be switchable between a state in which the rotation of the power transmission element is interlocked with the rotation of the support member and a state in which the support member is rotated with respect to the power transmission element. An endoscopic treatment instrument.

10. The endoscopic treatment instrument according to claim 7, wherein the operating member includes a support member that rotatably supports the first connection member and the second connection member and forms an internal space in which the power transmission element is disposed, and a tubular housing member that houses the power transmission element, and the housing member is configured to be rotatable in conjunction with the rotation of the support member, and a part of the housing member is provided inside at least one of the first connection member and the second connection member so as to be rotatable and movable in the axial direction. An endoscopic treatment instrument.

11. The endoscopic treatment instrument according to claim 7, wherein the power transmission element and the proximal end portion are connected so as to be relatively rotatable in the first direction. An endoscopic treatment instrument.

12. The endoscopic treatment instrument according to claim 7, wherein the power transmission element has a configuration in which a first component provided inside the first connection member and a second component provided inside the second connection member are connected in the operating member, and the second component has a lower rigidity with respect to the force in the first direction than the first component. An endoscopic treatment instrument.

13. The endoscopic treatment instrument according to claim 4, comprising a transmission element provided to extend from the proximal end portion to the treatment portion, and the second connection member is a solid structure body having the transmission element provided inside. An endoscopic treatment instrument.

14. The endoscopic treatment instrument according to claim 2, wherein the operating member is configured to be rotatable in the first direction with respect to the second connection member. An endoscopic treatment instrument.

15. The endoscopic treatment instrument according to claim 2, wherein the operating member is fixed to the first connection member, An endoscope treatment instrument configured to be able to transmit the rotational force when the operation member is rotated to the treatment portion via the first connection member.

16. The endoscope treatment instrument according to claim 15, comprising a transmission element provided to extend from the proximal end portion to the treatment portion, wherein the first connection member and the second connection member are columnar with the transmission element provided inside thereof.

17. The endoscope treatment instrument according to claim 16, wherein the transmission element includes a power transmission element that mechanically connects the proximal end portion and the treatment portion, the first connection member having a first tubular member and a second tubular member provided on the outer periphery of the first tubular member, wherein the power transmission element is provided inside the first tubular member so as to be movable in the axial direction, the first tubular member having a greater rigidity against the axial force than the second tubular member.

18. The endoscope treatment instrument according to any one of claims 1 to 17, wherein the first connection member and the second connection member have different mechanical physical properties.

19. The endoscope treatment instrument according to claim 18, wherein the first connection member and the second connection member have different rigidities against the force in the first direction.

20. The endoscope treatment instrument according to claim 19, wherein the first connection member has a greater rigidity against the force in the first direction than the second connection member.

21. The endoscope treatment instrument according to claim 18, wherein the first connection member and the second connection member have different rigidities against the axial force of the endoscope treatment instrument.

22. The endoscope treatment instrument according to claim 21, wherein the first connection member has a greater rigidity against the axial force than the second connection member.

23. The endoscope treatment instrument according to any one of claims 1 to 17, wherein the proximal end portion and the second connection member are connected so as to be relatively rotatable.

24. An endoscope treatment instrument used by being introduced into the treatment instrument insertion port of an endoscope, comprising a distal end portion including a treatment portion, a proximal end portion provided at the proximal end, a first member extending along the axial direction of the endoscope treatment instrument from the distal end portion to the proximal end portion, and a tubular member provided with a part of the first member inside and extending from the distal end portion to a position between the distal end portion and the proximal end portion. An endoscope treatment instrument in which the treatment portion is configured to be rotatable in the first direction by rotation of the tubular member in the first direction around the axis of the endoscope treatment instrument.

25. The endoscope treatment instrument according to claim 24, wherein the tubular member is configured to be rotatable in the first direction with respect to the first member.

26. The endoscope treatment instrument according to claim 24, wherein the tubular member is fixed in position in the axial direction of the endoscope treatment instrument with respect to the first member, at least at the tip portion.

27. The endoscope treatment instrument according to any one of claims 24 to 26, further comprising an operating member fixed to the tubular member.

28. The endoscope treatment instrument according to any one of claims 24 to 26, further comprising a transmission element provided to extend from the base end portion to the treatment portion.

29. The endoscope treatment instrument according to claim 28, wherein the first member is tubular, and the transmission element is provided inside the first member so as to be movable in the axial direction.

30. The endoscope treatment instrument according to claim 28, wherein the first member is a solid structure body having the transmission element provided therein.

31. The endoscope treatment instrument according to any one of claims 24 to 26, wherein the first member and the tubular member have different mechanical physical properties.

32. The endoscope treatment instrument according to claim 31, wherein the first member and the tubular member have different rigidities with respect to the force in the first direction.

33. The endoscope treatment instrument according to claim 32, wherein the tubular member has a greater rigidity with respect to the force in the first direction than the first member.

34. The endoscope treatment instrument according to any one of claims 24 to 26, wherein the first member and the tubular member have different rigidities with respect to the axial force of the endoscope treatment instrument.

35. The endoscope treatment instrument according to claim 34, wherein the first member has a greater rigidity with respect to the axial force than the tubular member.

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