Endoscopic treatment tool

Abstract

To provide an endoscopic treatment tool in which water supply from a distal end of a high-frequency knife or sheath can be suitably performed.SOLUTION: An endoscopic treatment may include a sheath 1 extending in a longitudinal direction, a distal end member 11 having insulation and the distal end member provided at a distal end of the sheath 1 and having a through-hole 12 penetrating in the longitudinal direction. The treatment tool may further include a metal electrode 2 having a conduit 22 passing through the through-hole 12 and extending in the longitudinal direction and a rod 3 having an outside surface being configured to advance and retract into the conduit 22 relative to the electrode 2 so as to be capable of removing internal burn from the conduit 22.SELECTED DRAWING: Figure 4

Description

Technical Field

[0001] The present invention relates to an endoscopic treatment instrument. This application claims priority based on U.S. Provisional Patent Application No. 63 / 387,401 filed in the United States on December 14, 2022, the content of which is incorporated herein by reference.

Background Art

[0002] Conventionally, in endoscopic treatments such as ESD (endoscopic submucosal dissection), endoscopic treatment instruments for incision, cauterization, and dissection such as a high-frequency knife, endoscopic treatment instruments for local injection, and endoscopic treatment instruments for hemostasis have been used.

[0003] Endoscopic treatment instruments as described in Patent Document 1 and Patent Document 2 are configured to be capable of performing incision, cauterization, and dissection procedures and hemostasis procedures using a high-frequency knife, and also capable of performing a local injection procedure for delivering a liquid (local injection liquid) from the tip of the sheath. Further, Patent Document 1 and Patent Document 2 describe an endoscopic treatment instrument (so-called dual knife) that enables water delivery from a water delivery port provided at the tip of the high-frequency knife in addition to water delivery from the water delivery port of the sheath formed on the side surface of the high-frequency knife.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Patent Document 2

Summary of the Invention

Problems to be Solved by the Invention

[0005] In the endoscopic treatment instruments described in Patent Document 1 and Patent Document 2, in incision, cauterization, peeling treatment, and hemostasis treatment, since the tip of the high-frequency knife is applied to the treatment part, tissue adheres to the tip of the high-frequency knife or enters and clogs the water supply port provided at the tip. Then, when the operator performs local injection treatment, there is a risk that the water supply force of the fluid to the treatment part weakens or the water supply becomes unstable. In addition, when high-frequency energy is supplied with the tissue adhering to the high-frequency knife, the tissue burns. Since the burned tissue adheres to the tip of the high-frequency knife, it is difficult to remove the burned tissue even if the water supply force is increased to a high pressure.

[0006] The present invention has been made in consideration of such circumstances, and an object thereof is to provide an endoscopic treatment instrument capable of suitably performing water supply from the tip of a high-frequency knife or a sheath.

Means for Solving the Problems

[0007] In order to solve the above problems, the present invention proposes the following means. An endoscopic treatment instrument according to a first aspect of the present invention includes a sheath extending in a longitudinal direction, an insulating tip member provided at the tip of the sheath and having a through hole extending in the longitudinal direction, a metal electrode having a pipe line passing through the through hole and extending in the longitudinal direction, and a rod having an outer surface capable of removing the burn in the pipe line by advancing and retreating with respect to the electrode in the pipe line.

Effects of the Invention

[0008] According to the endoscopic treatment instrument of the present invention, water supply from the tip of a high-frequency knife or a sheath can be suitably performed.

Brief Description of the Drawings

[0009]

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Embodiments for Carrying Out the Invention

[0010] (First Embodiment) The endoscopic treatment system 300 according to the first embodiment of the present invention will be described with reference to FIGS. 1 to 8. FIG. 1 is a diagram showing the overall configuration of the endoscopic treatment system 300 according to the first embodiment of the present invention.

[0011] [Endoscopic Treatment System 300] The endoscopic treatment system (treatment system) 300 is used for surgeries such as those on the digestive tract. As shown in FIG. 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment tool (treatment tool for endoscope) 100. The treatment tool 100 is inserted into the endoscope 200 for use.

[0012] [Endoscope 200] The endoscope 200 is a known flexible endoscope and includes a long insertion portion 202 inserted into the body from the tip and an operation portion 207 provided at the proximal end of the insertion portion 202.

[0013] The insertion portion 202 has an imaging portion 203, a bending portion 204, and a flexible portion 205. The imaging portion 203, the bending portion 204, and the flexible portion 205 are arranged in this order from the tip of the insertion portion 202. A treatment tool channel 206 through which the treatment tool 100 is inserted is formed in the insertion portion 202. A distal opening 206a of the treatment tool channel 206 is provided at the distal end 202a of the insertion portion 202. The treatment tool channel 206 extends from the distal end 202a of the insertion portion 202 to the operation portion 207.

[0014] The imaging unit 203 includes an imaging device such as a CCD or a CMOS, and is capable of imaging a site to be treated. The imaging unit 203 can image the knife 2 of the treatment instrument 100 in a state where the treatment instrument 100 protrudes from the distal opening 206a of the channel 206.

[0015] The bending portion 204 bends according to the operation of the operation unit 207 by the operator. The flexible portion 205 is a tubular portion having flexibility.

[0016] The operation unit 207 is connected to the flexible portion 205. The operation unit 207 includes a grip 208, an input unit 209, a proximal opening 206b of the channel 206, and a universal code 210. The grip 208 is a portion gripped by the operator. The input unit 209 receives an operation input for bending the bending portion 204. The universal code 210 outputs an image captured by the imaging unit 203 to the outside. The universal code 210 is connected to a display device such as a liquid crystal display via an image processing device including a processor or the like.

[0017] [Treatment instrument 100] FIG. 2 is an overall view showing the treatment instrument 100. The treatment instrument (treatment instrument for endoscope) 100 includes a sheath 1, a knife (high-frequency knife, electrode) 2, a rod-shaped member (rod) 3, a connecting joint 23, an operation wire 4 (see FIG. 4), and an operation unit 5. In the following description, in the longitudinal direction A of the treatment instrument 100, the side inserted into the patient's body is referred to as the "tip side A1", and the operation unit 5 side is referred to as the "base end side A2". Also, the width direction of the treatment instrument 100 orthogonal to the longitudinal direction A (the left-right direction of the treatment instrument 100 viewed from the front) is referred to as the "width direction Y (see FIG. 3)".

[0018] [Sheath 1] The sheath 1 extends in the longitudinal direction A. The sheath 1 is a long resin member having flexibility and insulation property, and extends from the distal end 1a to the proximal end 1b. The sheath 1 has an outer diameter that can be inserted into the channel 206 of the endoscope 200 and can advance and retreat in the channel 206. As shown in FIG. 1, in the state where the sheath 1 is inserted into the channel 206, the distal end 1a of the sheath 1 can protrude from and retract into the distal end opening 206a of the channel 206.

[0019] FIG. 3 is a perspective view of the distal end portion of the treatment instrument 100. An insulating insulating tip (tip member) 11 having a through hole 12 penetrating in the longitudinal direction A is attached to the distal end 1a of the sheath 1. The through hole 12 has a tip conduit 12h (see FIG. 4) extending along the longitudinal direction A. A tip opening 12a is formed at the tip of the tip conduit 12h. A knife 2 and a rod (rod-shaped member) 3 are inserted into the through hole 12. The knife 2 and the rod 3 are provided so as to be able to advance and retreat in the longitudinal direction A within the tip conduit 12h.

[0020] [Knife (high-frequency knife) 2] FIG. 4 is a cross-sectional view of the distal end portion of the treatment instrument 100. The knife (high-frequency knife) 2 is, for example, a high-frequency dual knife capable of cutting, cauterizing, and peeling by water supply and high-frequency current. The knife 2 is a substantially round bar-shaped member made of metal that is inserted into the sheath 1 and advances and retreats in the longitudinal direction A. The knife 2 is provided so as to be able to protrude from the tip opening 12a of the insulating tip 11 of the sheath 1 toward the tip side A1. The knife 2 is formed of a material such as stainless steel, for example. The knife 2 has conductivity and is energized with high-frequency current. The knife 2 has a knife body 20 and a flange 21.

[0021] The knife 2 is movable relative to the rod 3 described later. The central axis O2 of the knife 2 in the longitudinal direction A substantially coincides with the central axis O1 of the sheath 1 in the longitudinal direction A.

[0022] The knife body 20 is a metal round bar-shaped member. An operating wire 4 is attached to the proximal end of the knife body 20. The knife body 20 supplies the high-frequency current supplied from the operating wire 4 connected to the operating unit 5 to the flange 21. When a high-frequency current is supplied from the operating wire 4 to the knife 2, the knife body 20 and the flange 21 function as a monopolar electrode that outputs the high-frequency current to the biological tissue.

[0023] The flange (tip portion) 21 is an annular plate-shaped conductive member provided at the tip of the knife body 20. In a front view seen from the direction along the longitudinal direction A, the outer periphery of the flange 21 is formed concentrically with the outer periphery of the knife body 20. As shown in FIG. 4, the radial width L1 of the flange 21 in the direction perpendicular to the longitudinal direction A is longer than the radial width L2 of the knife body 20.

[0024] Here, the tip opening 12a of the chip conduit 12h is formed to have a size that engages with the flange 21 which is the tip portion of the knife 2. Further, the inner diameter L3 of the chip conduit 12h is smaller than the radial width L1 of the flange 21. Therefore, the flange 21 is locked at the tip opening 12a and does not move from the tip opening 12a to the proximal end side A2.

[0025] The knife body 20 and the flange 21 have a first water supply conduit (first conduit) 22 that extends along the longitudinal direction A. A liquid flows through the first water supply conduit 22. The first water supply conduit 22 communicates with a tip opening (water supply port or first opening) 22a formed in the flange 21. In other words, the first water supply conduit 22 has the tip opening 22a on the tip side A1.

[0026] [Rod (bar-shaped member) 3] The rod (bar-shaped member) 3 extends in the longitudinal direction A and is a flexible round bar-shaped member formed of a resin material, a metal material, or the like. The rod 3 has the central axis O2 as its central axis, similar to the knife 2. The rod 3 is inserted into the tubular knife 2 and the operating wire 4 along the longitudinal direction A and can move forward and backward relative to the knife 2 and the operating wire 4. Specifically, the rod 3 is inserted into the first water supply pipe 22 of the knife 2 and the second water supply pipe (second pipe) 42 of the operating wire 4 described later.

[0027] The rod 3 has an outer diameter such that at least the tip 3a of the tip side A1 is slightly smaller than the inner diameter of the tip opening 22a. The tip 3a can function as a plug for the first water supply pipe 22 and the second water supply pipe (second pipe) 42 of the operating wire 4 described later. In the present embodiment, the outer diameter of the rod 3 is the same at any position in the longitudinal direction A. The base end portion of the rod 3 is connected to the lever 55 of the operating portion 5 described later.

[0028] [Connection joint 23] As shown in FIG. 4, the connection joint 23 is attached to the circumferential direction of the base end side A2 of the knife 2 and the circumferential direction of the tip side A1 of the operating wire 4, and connects the base end of the knife 2 and the tip of the operating wire 4.

[0029] [Operating wire 4] As shown in FIG. 4, the operating wire 4 is a shaft that passes through the internal space 1s of the sheath 1 and has a coil shaft 40 and a tube 41. The tip of the operating wire 4 is connected to the knife 2 by the connection joint 23, and the base end of the operating wire 4 is connected to the operating portion 5. Note that the operating wire 4 may be in other forms as long as it is a hollow shaft.

[0030] The coil shaft 40 is a metal coil wire. The coil shaft 40 is formed of a material such as stainless steel, for example. A second water supply pipe 42 is formed inside the coil shaft 40. The second water supply pipe 42 is connected (communicates) to the base end of the first water supply pipe 22.

[0031] The tube 41 is a tube provided on the outer peripheral portion of the coil shaft 40, and is, for example, a heat shrinkable tube. By covering the outer peripheral portion of the coil shaft 40 with the tube 41, liquid does not leak from the second water supply pipe 42.

[0032] [Operation unit 5] As shown in FIGS. 1 and 2, the operation unit 5 includes an operation unit main body 51, a slider 52, a power supply connector 53, a liquid supply port 54, and a lever (slide lever) 55.

[0033] The tip of the operation unit main body 51 is connected to the proximal end 1b of the sheath 1. The operation unit main body 51 has an internal space through which the operation wire 4 can be inserted. The rod 3 and the operation wire 4 extend to the slider 52 through the internal space 1s (see FIG. 4) of the sheath 1 and the internal space of the operation unit main body 51.

[0034] The slider 52 is attached to the operation unit main body 51 so as to be movable along the longitudinal direction A. The slider 52 is attached to the sheath 1 connected to the operation unit main body 51 via an O-ring or the like. The proximal end of the operation wire 4 is attached to the slider 52. By the operator moving the slider 52 forward and backward relative to the operation unit main body 51, the operation wire 4 and the knife 2 move forward and backward.

[0035] The power supply connector 53 is fixed to the slider 52. The power supply connector 53 can be connected to a high-frequency power supply device (not shown), and is connected to the proximal end portion of the operation wire 4 via a conductive wire or the like. The power supply connector 53 can supply the high-frequency current supplied from the high-frequency power supply device to the knife 2 via the operation wire 4.

[0036] The liquid supply port 54 is provided on the slider 52. The liquid supply port 54 is connected to the proximal end of the second water supply pipe 42 via a water supply pipe line (not shown) formed in the slider 52. A liquid delivery device such as a pump is connected to the liquid supply port 54. The pump delivers (sends) liquid to the liquid supply port 54. The liquid supplied from the liquid supply port 54 passes through the water supply pipe line formed in the slider 52, the second water supply pipe 42, and the first water supply pipe 22 and is discharged from the tip opening 22a.

[0037] The proximal end of the rod 3 is attached to the lever (slide lever) 55. Also, the lever (slide lever) 55 is attached to the slider 52 so as to be movable along the longitudinal direction A. The operator can move the rod-shaped member 3 forward and backward in the longitudinal direction A by moving the lever 55 along the longitudinal direction A.

[0038] Next, the relationship between the operation of the operation unit 5 and the knife 2 and the rod 3 will be described.

[0039] As shown in FIGS. 3 and 4, when the slider 52 and the lever 55 are moved to the tip side A1, the knife 2 and the rod 3 protrude from the tip 1a of the sheath 1. At this time, the states of the knife 2 and the rod 3 are set as the treatment states. In the treatment state, the operator can perform incision, cauterization, and peeling treatments. Also, at this time, the tip 3a of the rod 3 is located at the tip opening 22a in the longitudinal direction A. In the following description, the position where the tip 3a is arranged at the tip opening 22a in the longitudinal direction A is referred to as the first position P1. The tip 3a overlaps the tip opening 22a when viewed from the width direction Y at the first position P1. That is, when the tip 3a is located at the first position P1, the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. When the tip 3a of the rod 3 is located at the first position P1, the tip opening 22a is sealed by the tip 3a of the rod 3. The form of the rod 3 that seals the tip opening 22a with the tip 3a arranged at the first position P1 is referred to as the first form.

[0040] FIG. 5 is a perspective view showing the tip of the treatment instrument 100 in the pre-treatment state. FIG. 6 is a cross-sectional view showing the tip of the treatment instrument 100 in the pre-treatment state.

[0041] As shown in FIGS. 5 and 6, when the slider 52 and the lever 55 are moved to the proximal end side A2, the knife 2 and the rod 3 do not protrude from the tip opening 12a of the through hole 12 of the insulating tip 11 provided at the tip 1a of the sheath 1. By retracting the knife 2 and the rod 3, they are housed in the proximal end side A2 from the tip opening 12a of the through hole 12.

[0042] At this time, the states of the knife 2 and the rod 3 are set as the pre-treatment state. Specifically, when the knife 2 is retracted to the proximal end side A2, the flange 21 provided at the tip of the knife body 20 is disposed near the tip opening 12a. In this state, the flange 21 overlaps the tip opening 12a when viewed from the width direction Y. That is, the flange 21 is accommodated in the recess of the insulating tip 11. Note that even if the tip of the knife 2 slightly protrudes from the tip opening 12a in a state where the flange 21 is accommodated in the recess of the insulating tip 11, it is acceptable. Further, as the knife 2 retracts, the rod 3 also retracts to the proximal end side A2, and the tip 3a of the rod 3 is positioned at the tip opening 22a of the knife 2 in the longitudinal direction A. That is, the tip 3a is in a state of being positioned at the first position P1, and the position of the tip 3a coincides with the position of the tip of the knife 2 in the longitudinal direction A. When the tip position of the flange 21 coincides with the tip surface position of the insulating tip 11 in the longitudinal direction A, the position of the tip 3a coincides with the tip surface positions of the knife 2 and the insulating tip 11 in the longitudinal direction A.

[0043] FIG. 7 is a perspective view showing the tip of the treatment instrument 100 in the water supply state. FIG. 8 is a cross-sectional view showing the tip of the treatment instrument 100 in the water supply state.

[0044] As shown in FIGS. 7 and 8, when the slider 52 is moved to the tip side A1, the knife 2 projects from the tip 1a of the sheath 1 (i.e., the tip opening 12a of the insulating tip 11). Further, the tip 3a of the rod 3 is disposed at the second position P2 retracted from the first position P1 to the proximal end side A2 by moving the lever 55 further to the proximal end side A2, and the tip opening 22a is opened. At this time, the states of the knife 2 and the rod 3 are set as the water supply state. In the water supply state, the rod 3 is not inserted into the first water supply pipe 22 and sufficient space is provided, so that the first water supply pipe 22 can supply water. Therefore, even when water is supplied, the rod 3 does not interfere and the tip 3a of the rod 3 does not block the tip opening 22a of the first water supply pipe 22, so that the operator can smoothly supply water and perform local injection treatment. The form of the rod 3 in which the tip 3a is disposed at the second position P2, the tip opening 22a is opened, and the first pipe 22 can supply water is defined as the second form.

[0045] [Method of using the endoscope treatment system 300] Next, a procedure using the endoscope treatment system 300 of the present embodiment (method of using the endoscope treatment system 300) will be described. Specifically, local injection treatment, incision / burning / excision treatment, and hemostasis treatment of a lesion part (treatment part) in endoscopic treatment such as ESD (endoscopic submucosal dissection) will be described.

[0046] As a preparatory work, the operator identifies the lesion part by a known method. Specifically, the operator inserts the insertion portion 202 of the endoscope 200 into the digestive tract (for example, esophagus, stomach, duodenum, large intestine), and identifies the lesion part while observing the image obtained by the imaging portion 203 of the endoscope.

[0047] [Insertion step] The operator inserts the treatment instrument 100 into the channel 206 and projects the tip 1a of the sheath 1 from the tip opening 206a of the insertion portion 202. The operator advances the slider 52 of the operation portion 5 relative to the operation portion main body 51, projects the knife 2 and the rod 3, and sets the treatment state (see FIGS. 3 and 4).

[0048] [Local injection step] The operator moves the lever 55 towards the proximal end A2 with respect to the slider 52, thereby moving the rod 3 towards the proximal end A2 with respect to the knife 2. Further, the operator moves the slider 52 towards the distal end A1 to project the knife 2 from the distal end 1a of the sheath 1. As a result, the distal end 3a of the rod 3 is disposed at the second position P2, and the knife 2 and the rod 3 are in a water supply state (see FIGS. 7 and 8). The operator punctures the knife 2 at the location where the local injection liquid (local injection solution) is to be injected at the lesion site, and performs water supply with the distal end opening 22a of the distal end of the knife 2 inserted into the submucosa (local injection step). At this time, since there is sufficient space for the liquid for water supply to flow in the first water supply pipe 22, the liquid smoothly flows through the first water supply pipe 22 and flows out from the distal end opening 22a.

[0049] <Cutting, cauterizing, and peeling step> The operator performs a cutting, cauterizing, and peeling procedure. The operator moves the lever 55 towards the distal end A1 with respect to the slider 52 while advancing the knife 2, thereby projecting the rod-shaped member 3 from the distal end 1a of the sheath 1 to bring it into a treatment state (see FIGS. 3 and 4). The distal end 3a of the rod-shaped member 3 is located at the distal end opening 22a in the longitudinal direction A and is disposed at the first position P1. The operator moves the flange 21 while passing a high-frequency current through the knife 2 to cauterize or cut the mucosa of the lesion site. Further, the operator advances the knife 2 and, while passing a high-frequency current through it, lifts the cauterized or cut mucosa of the lesion site to expose the submucosa, and peels the submucosa of the cauterized or cut mucosa of the lesion site. At this time, a part of the tissue in the digestive tract adheres to the distal end of the knife 2. Then, this tissue burns and adheres firmly to the distal end of the knife 2 during cauterization. However, the distal end 3a is disposed at the distal end opening 22a of the knife 2. Further, the distal end opening 22a is covered and blocked by the distal end 3a of the rod 3 when viewed from the distal end side A1 in the longitudinal direction A. Therefore, the rod 3 can reduce the risk of tissue adhering to the flange 21 or entering the first water supply pipe 22 from the distal end opening 22a and clogging. Further, the rod 3 can prevent the tissue adhering during the cauterization procedure from burning and adhering firmly.

[0050] <Removal step> As shown in FIGS. 4 and 8, the operator moves the lever 55 forward and backward with respect to the slider 52 on the tip side A1 and the base end side A2, thereby moving the rod 3 forward and backward with respect to the knife 2. As a result, even if tissue enters the first water supply pipe 22 from the flange 21 of the knife 2 or the tip opening 22a due to the above-described incision, cauterization, and peeling procedures, and charring of the tissue adheres to the tip opening 22a or the knife body 20, the charring of the tissue can be peeled off and removed.

[0051] <Additional local injection step> The operator performs an additional local injection procedure as needed. The operator retracts the rod 3 with respect to the knife 2 to the base end side A2 to bring it into a water supply state (see FIGS. 7 and 8). At the location where the liquid for local injection (local injection liquid) is to be additionally injected, the operator inserts the tip opening 22a at the tip of the knife 2 into the submucosa and supplies water (additional local injection step). At this time, the tip 3a of the rod 3 is disposed at the second position P2, and there is sufficient space for the water supply liquid to flow in the first water supply pipe 22. Therefore, the liquid flows smoothly in the first water supply pipe 22 and flows out from the tip opening 22a.

[0052] <Hemostasis step> When bleeding occurs during the incision, cauterization, and peeling procedures, the operator performs a hemostasis procedure. The operator brings the knife 2 and the rod 3 into a treatment state, and while pressing the knife body 20 and the flange 21, cauterizes the bleeding point with energization using a high-frequency current to stop the bleeding (hemostasis step).

[0053] The operator continues the above-described operations (procedures) as needed, finally excises the lesion, and ends the ESD procedure.

[0054] According to the treatment instrument 100 according to the present embodiment, a plurality of treatments such as a local injection treatment, an incision, cauterization, and peeling treatment, and a hemostasis treatment can be performed.

[0055] In addition, the treatment instrument 100 according to the present embodiment includes a rod-shaped member 3. Therefore, even if charring of tissue that has entered the tip of the knife 2 or the first water supply pipeline 22 due to incision, cauterization, or dissection adheres to the first water supply pipeline 22, the charring of the tissue can be peeled off and removed. Furthermore, the rod 3 can physically remove the charring of the tissue. Therefore, it is no longer necessary for the operator to perform the operation (treatment) of removing the charring of the tissue by high-pressure water supply as in the past.

[0056] In addition, the rod 3 according to the present embodiment advances and retracts in the longitudinal direction A. Therefore, when performing a regional injection treatment, the operator retracts the lever 55 with respect to the slider 52 to the proximal end side A2, moves the rod-shaped member 3 to the proximal end side A2, and arranges it at the second position, thereby providing sufficient space in the first water supply pipeline 22 through which the liquid for water supply flows, and the liquid can flow out smoothly from the tip opening 22a.

[0057] In addition, the rod 3 according to the present embodiment closes the tip opening 22a at the tip side A1 of the first water supply pipeline 22. Therefore, the rod 3 can prevent tissue from entering the first water supply pipeline 22 from the tip opening 22a during the incision, cauterization, or dissection treatment.

[0058] (Modification 1-1) In the above embodiment, the rod 3 passes through the knife 2 and the operation wire 4. However, the form of the rod-shaped member 3 is not limited to this. FIG. 9 is a diagram showing a sealing member (plug) 3A of a treatment instrument 100A which is a modification of the rod 3 of the treatment instrument 100. The sealing member 3A has a shorter length in the longitudinal direction A compared to the rod 3 of the first embodiment. Specifically, the length of the sealing member 3A is shorter than the length of the knife 2 in the longitudinal direction A. In the present embodiment, as shown in FIG. 9, the sealing member 3A is an insulating plug that is inserted into the first water supply pipeline (first pipeline) 22 of the knife 2 and closes the tip opening 22a at the tip of the knife 2. The sealing member 3A is removable.

[0059] In this case, the sealing member 3A closes the tip opening 22a at the tip of the knife 2. Therefore, in the above-described incision, cauterization, and peeling steps, it is possible to prevent tissue and tissue char from adhering to the tip of the knife 2. Even if tissue adheres to the tip of the knife 2, since the sealing member 3A is removable, the operator can remove the tissue and tissue char by removing the sealing member 3A from the tip opening 22a.

[0060] Note that the sealing member 3A may further be provided with a through hole penetrating in the longitudinal direction A near the center. With this configuration, the treatment instrument 100A can send water from the through hole of the sealing member 3A in a state where the sealing member 3A is attached to the tip opening 22a. Therefore, the treatment instrument 100A can send water while preventing the adhesion of tissue and tissue char.

[0061] (Modification 1-2) Also, in the above embodiment, the rod 3 is a round bar-shaped member extending along the longitudinal direction A. However, the form of the rod 3 is not limited to this. FIG. 10 is a diagram showing a rod 3B of a treatment instrument 100B which is a modification of the rod 3 of the treatment instrument 100. FIG. 11 is a diagram showing a state where the rod 3B has advanced.

[0062] As shown in FIG. 10, the rod 3B includes a support column portion 3Bb extending in the longitudinal direction A with the central axis O2 as the central axis, and a tip portion (sealing member) 3Ba provided on the tip side A1 of the support column portion 3Bb and having an outer diameter larger than that of the support column portion 3Bb. The base end side A2 of the support column portion 3Bb is connected to a lever 55 of an operation unit 5 described later. The outer diameter of the tip portion 3Ba is slightly smaller than the inner diameter of the tip opening 22a. The tip portion 3Ba of the rod 3B covers and closes (seals) the tip opening 22a at the first position P1 where it is disposed in the tip opening 22a. In this state, the operator can perform an incision, cauterization, and peeling treatment. Also in this case, since the tip opening 22a is closed (sealed) by the tip portion 3Ba of the rod 3B, it is possible to prevent tissue from entering the first water supply passage 22 from the flange 21 or the tip opening 22a and adhering to the knife body 20, or the char of the tissue from sticking.

[0063] In addition, as shown in FIG. 11, when the operator advances the lever 55 of the operation unit 5, the support part 3Bb advances toward the distal end side A1. The distal end part 3Ba moves to the distal end side A1 beyond the distal end opening 22a on the distal end side A1 of the first water supply pipeline 22. Then, the distal end opening 22a that was covered and blocked by the distal end part 3Ba of the rod 3B opens. Therefore, in this state, the operator can smoothly supply water with the liquid and perform a local injection treatment.

[0064] (Modification Example 1-3) In addition, FIG. 12 is a diagram showing a rod 3C of a treatment instrument 100C which is a modification of the rod 3 of the treatment instrument 100. FIG. 13 is a diagram showing a state where the knife 2 of the treatment instrument 100C is moved.

[0065] The distal end part 3Ca of the rod 3C has a tapered surface such that the distal end is sharp, and is formed such that the outer diameter becomes smaller from the proximal end to the distal end of the tapered surface. The distal end part 3Ca of the rod 3C is arranged to protrude slightly toward the distal end side A1 beyond the distal end opening 12a of the chip pipeline 12h as shown in FIG. 12. Here, in the present embodiment, the operation unit 5 may not include the lever 55. The rod 3C does not advance and retreat in the longitudinal direction A, and the proximal end side of the rod 3C is fixed to a part of the operation unit main body 51.

[0066] In order to perform an incision, cauterization, and dissection treatment, the operator moves the slider 52 toward the distal end side A1 as shown in FIG. 12 to project the knife 2 from the distal end opening 12a. When performing the incision, cauterization, and dissection treatment in this state, a part of the tissue in the digestive tract adheres and adheres to the distal end of the knife 2. However, as shown in FIG. 13, when the operator moves the slider 52 toward the proximal end side A2 to retract the knife 2 to the vicinity of the distal end opening 12a, the distal end part 3Ca that protrudes slightly toward the distal end side A1 beyond the distal end opening 12a pierces into the charred tissue fixed to the distal end of the knife 2 and can be peeled off and dropped.

[0067] Note that the operation unit 5 may include a lever 55. In this case, the operator moves the lever 55 to the tip side A1 in the longitudinal direction A to project the rod 3C from the tip opening 12a and the tip opening 22a of the knife 2. In this state, at the location where the liquid for local injection is to be injected, the rod 3C can be punctured with the tip portion 3Ca and the tip opening 22a at the tip of the knife 2 can be easily inserted into the submucosal layer.

[0068] Also, the tip portion 3Ca may not be inclined toward the central axis O2. For example, the tip portion 3Ca may be formed in a shape inclined toward the axis in the longitudinal direction A passing through one end of the periphery of the rod 3 from the base end side A2 toward the tip side A1.

[0069] (Modification 1-4) In the above embodiment, the slider 52 and the lever 55 are not directly connected in the operation unit 5, but the mode of the operation unit 5 is not limited to this. In the operation unit 5, the slider 52 and the lever 55 may be directly connected. In this case, due to the friction between the slider 52 and the lever 55, etc., when the slider 52 is advanced or retracted, the rod 3, the operation wire 4, and the knife 2 can be operated in conjunction.

[0070] (Modification 1-5) In the above embodiment, the operation unit 5 may further include a removable stopper for locking the lever 55. Also in this case, the lever 55 can be locked to the stopper to stop the forward and backward movement, and the rod 3 can be prevented from moving forward and backward with respect to the knife 2 unintentionally.

[0071] (Modification 1-6) In the above-described embodiment, a disc-shaped flange 21 is provided at the tip of the knife 2. However, the form of the knife 2 is not limited to this. FIG. 14 is a diagram showing a knife 2A which is a modified example of the knife 2. The flange 21A of the knife 2A is formed in a triangular shape in a front view seen from the tip side A1. According to this configuration, the operator can hook each vertex of the triangular shape and incise the tissue smoothly without performing a rotational operation in the circumferential direction of the knife 2.

[0072] (Modification Example 1-7) In the above-described embodiment, a flange 21 is provided at the tip of the knife 2. However, the form of the knife 2 is not limited to this. FIG. 15 is a diagram showing a knife 2B which is a modified example of the knife 2. The tip portion 21B of the knife 2B is formed in a spherical shape, which is different in shape from the flange 21. With this configuration, the tip portion 21B of the knife 2B can easily penetrate into the submucosa, and the operator can perform an efficient procedure. Further, the operator can perform a mucosal incision operation while suppressing the invasion of the deep tissue by using the tip portion 21B of the knife 2B.

[0073] (Modification Example 1-8) In the above-described embodiment, the treatment instrument 100 is provided with the tip opening 22a of the knife 2 as a water supply port. However, the form of the treatment instrument 100 is not limited to this. The treatment instrument 100 may further be provided with a through hole for water supply (first pipeline) in the insulating tip 11 of the sheath 1. Further, the treatment instrument 100 may further be provided with a water supply tube for water supply in the internal space 1s of the sheath 1.

[0074] (Modification Example 1-9) In the above-described embodiment, the operation unit 5 may include a regulating member (stopper) that regulates the advancing and retreating range of the lever 55.

[0075] FIG. 16 is a diagram showing a closed state in a modified example of the operation unit 5 including the regulating member 56. FIG. 17 is a diagram showing an open state in a modified example of the operation unit 5 including the regulating member 56. FIG. 18 is a diagram showing a closed state in a modified example of the operation unit 5 including the regulating member 56.

[0076] The restricting member 56 (stopper) is detachably provided on the operation unit main body 51. Further, the restricting member 56 is provided on the tip side A1 with respect to the lever 55 and can restrict the movement of the lever 55 to the tip side A1.

[0077] The operation unit 5 may further include a restricting projection 57 that can restrict the movement of the lever 55 to the base end side A2. As shown in FIGS. 16, 17, and 18, the restricting projection 57 is in a projection shape provided on the base end side A2 with respect to the lever 55 in the operation unit main body 51.

[0078] Here, as shown in FIG. 16, in the operation unit 5, the state in which the restricting member 56 restricts the movement of the lever 55 to the tip side A1 is referred to as the "closed state". In the operation unit 5 in the closed state, the movement of the tip side A1 of the lever 55 is restricted by the restricting member 56. Further, the movement of the base end side A2 of the lever 55 is restricted by the restricting projection 57. That is, the restricting member 56 and the restricting projection 57 are stoppers that restrict the advancing and retreating ranges of the lever 55.

[0079] In the operation unit 5 in the closed state shown in FIG. 16, the lever 55 can advance and retreat within a predetermined range in the longitudinal direction A. The range in which the lever 55 can advance and retreat is the range sandwiched between the restricting member 56 and the restricting projection 57 in the longitudinal direction A.

[0080] Since the base end of the rod 3 is connected to the lever 55, by limiting the advancing and retreating range of the lever 55 by the restricting member 56 and the restricting projection 57, the advancing and retreating range of the rod 3 in the longitudinal direction A is also limited.

[0081] When the advancing and retreating range of the lever 55 is limited by the restricting member 56 and the restricting projection 57, the advancing and retreating range of the tip 3a of the rod 3 in the longitudinal direction A is limited to the range from the first position P1 (see FIGS. 4 and 6) where the tip 3a is located at the tip opening 22a to the base end portion of the knife 2 (for example, the second position P2 shown in FIG. 8). Here, the state of the rod 3 in which the range in which the tip 3a can advance and retreat is restricted to the range from the first position P1 to the position of the base end portion of the knife 2 is referred to as the "restricted state".

[0082] For example, the operator can easily move the tip 3a of the rod 3 back and forth within the range from the first position P1 to the second position P2 by moving the lever 55 back and forth within the range from the regulating member 56 to the regulating projection 57. Therefore, when tissue enters the first water supply pipeline 22 and tissue charring adheres to the inside of the first water supply pipeline 22, the operator can move the lever 55 back and forth within the range from the regulating member 56 to the regulating projection 57 and move the rod 3 back and forth within the range from the first position P1 to the second position P2, so that the tissue charring can be easily peeled off and dropped by the rod 3. The operator can peel off and drop the charring adhering to the inside of the first water supply pipeline 22 by using the tip 3a of the rod 3 in the above-described embodiment or the tip portion 3Ba shown in FIG. 10.

[0083] Further, as shown in FIG. 17, by removing the regulating member 56 from the operation unit main body 51, the regulation of the movement of the lever 55 by the regulating member 56 can be released. Here, the state of the operation unit 5 in which the movement of the lever 55 to the tip side A1 is not restricted by the regulating member 56 is referred to as an "open state".

[0084] When the operation unit 5 is in the open state, as shown in FIG. 17, the lever 55 can move to the tip side A1 without being inhibited by the regulating member 56. Therefore, the operator can move the tip 3a of the rod 3 to the tip side A1 beyond the first position P1 by moving the lever 55 of the operation unit 5 forward. Here, the state of the rod 3 in which the tip 3a protrudes to the tip side A1 beyond the first position P1 is referred to as a "protruding state". When the operation unit 5 is in the open state and the rod 3 is in the protruding state, for example, the tip portion 3Ba of the rod 3B shown in FIG. 11 can be moved to the tip side A1 beyond the tip opening 22a on the tip side A1 of the first water supply pipeline 22, and a local injection treatment can be performed.

[0085] Also, as shown in FIG. 18, the operation unit 5 may be configured such that the lever 55 is prevented from moving forward and backward by the restricting member 56 and the restricting projection 57. The lever 55 shown in FIG. 18 is restricted from moving to the tip side A1 by the restricting member 56 and restricted from moving to the base end side A2 by the restricting projection 57, and is provided so as not to be able to move forward and backward in the longitudinal direction A. The restricting member 56 shown in FIG. 18 is provided, for example, on the base end side A2 rather than the restricting member 56 shown in FIG. 16.

[0086] Here, when the lever 55 is restricted from moving forward and backward by the restricting member 56 and the restricting projection 57, the tip 3a of the rod 3 is disposed at the first position P1. That is, since the tip opening 22a of the knife 2 is covered and blocked by the tip 3a of the rod 3, it is possible to prevent tissue from entering and clogging the first water supply passage 22 from the tip opening 22a.

[0087] The state of the rod 3 in which the tip 3a is positioned at the first position P1 by restricting the forward and backward movement of the lever 55 by the restricting member 56 and the restricting projection 57 is referred to as the "positioned state". The operator can easily maintain the rod 3 in the positioned state by restricting the forward and backward movement of the lever 55 by the restricting member 56 and the restricting projection 57.

[0088] The restricting member 56 that is detachable from the operation unit main body 51 may not be separated from the operation unit main body 51 in the open operation unit 5. For example, the first end of the restricting member 56 may be rotatably attached to the operation unit main body 51, and the second end of the restricting member 56 may be detachably provided on the operation unit main body 51. In that case, the operation unit 5 may be switched between the open state and the closed state by rotating the restricting member 56 with respect to the operation unit main body 51.

[0089] Further, the restricting projection 57 that restricts the movement of the lever 55 to the base end side A2 may be detachably provided on the operation unit main body 51. Also, in the examples shown in FIGS. 16, 17, and 18, two restricting projections 57 are provided on the operation unit 5, but the restricting projection 57 only needs to be able to restrict the movement of the lever 55 to the base end side A2. For example, the movement of the lever 55 to the base end side A2 may be restricted by one restricting projection 57.

[0090] (Modification Example 1-10) In the above embodiment, the rod 3 may be provided with a protrusion (char removal portion) protruding from the outer peripheral surface of the rod 3.

[0091] FIG. 19 is a cross-sectional view showing a modification of the rod 3. The rod 3 shown in FIG. 19 is provided with a spiral protrusion 31 provided on the outer peripheral surface of the rod 3 and protruding outward in the radial direction of the rod 3. Here, the outer side in the radial direction of the rod 3 indicates the direction away from the central axis O2 of the rod 3 in the radial direction of the rod 3.

[0092] As shown in FIG. 19, the spiral protrusion 31 is provided in a spiral shape in a predetermined range in the longitudinal direction A on the outer peripheral surface of the rod 3. The outer diameter of the spiral protrusion 31 is slightly smaller than the inner diameter of the tip opening 22a.

[0093] The operator can move the lever 55 forward and backward, and for example, move the rod 3 forward and backward within the range from the first position P1 to the second position P2, and use the spiral protrusion 31 to peel off and drop the char fixed inside the first water supply pipe 22. Note that the protrusion is not limited to a spiral shape, and protrusions of any shape such as flaps and wings may be provided on the outer peripheral surface of the rod 3. It is only necessary that the outer peripheral surface of the rod 3 has a function of removing char.

[0094] (Modification Example 1-11) In the above embodiment, the rod 3 can move forward and backward in the longitudinal direction A by moving the lever 55 forward and backward, but the mode of the rod 3 is not limited to this.

[0095] FIG. 20 is a cross-sectional view showing the rod slider 52Ab located in the first region R1 in a modification of the operation unit 5. FIG. 21 is a cross-sectional view showing the rod slider 52Ab located in the second region R2. FIG. 22 is a cross-sectional view showing the rod slider 52Ab located in the third region R3.

[0096] In the modification examples shown in FIGS. 20, 21, and 22, the slider 52A has a knife slider (first slider) 52Aa and a rod slider (second slider, slide lever) 52Ab.

[0097] The knife slider (first slider) 52Aa is attached to the proximal end of the operation wire 4, similarly to the slider 52 in the above-described embodiment, and is configured to be able to move forward and backward relative to the operation unit main body 51, so that the operation wire 4 and the knife 2 can move forward and backward.

[0098] The rod slider 52Ab (second slider) is attached to the proximal end of the rod 3 and is configured to be able to move forward and backward relative to the operation unit main body 51 and the knife slider 52Aa, so that the rod 3 can move forward and backward. That is, the operator can move the operation wire 4 and the knife 2 forward and backward by moving the knife slider 52Aa forward and backward, and can move the rod 3 forward and backward by moving the rod slider 52Ab forward and backward.

[0099] The rod slider 52Ab is a cylindrical member through which the operation unit main body 51 is inserted. Note that the cylindrical shape does not necessarily have to be a strict cylinder. A positioning portion 521 that protrudes outward from the outer peripheral surface is provided at the tip of the rod slider 52Ab.

[0100] The positioning portion 521 may be provided on the entire circumference of the outer periphery of the rod slider 52Ab, or may be provided only on a part thereof. When the positioning portion 521 is provided only on a part of the outer periphery of the rod slider 52Ab, it is preferably provided at a plurality of locations on the outer periphery of the rod slider 52Ab.

[0101] Further, as shown in FIG. 20, a cylindrical slider regulating portion (stopper) 522A through which the operation unit main body 51 is inserted is provided at the proximal end of the knife slider 52Aa. Note that the cylindrical shape does not necessarily have to be a strict cylinder.

[0102] On the inner circumference of the slider regulating portion 522A (stopper), there is provided a slider recessed portion 522Aa whose inner circumferential surface is recessed more than the base end portion 522Ab and the tip end portion 522Ac of the slider regulating portion 522A. The slider recessed portion 522Aa is, for example, a portion where the entire circumference is recessed on the inner circumference of the slider regulating portion 522A.

[0103] Here, the base end side A2 of the slider regulating portion 522A is referred to as the "first region R1". That is, the rod slider 52Ab shown in FIG. 20 is located in the first region R1. Also, in the longitudinal direction A, the region where the slider regulating portion 522A is provided is referred to as the "second region R2". The rod slider 52Ab shown in FIG. 21 has the positioning portion 521 located in the second region R2.

[0104] When the positioning portion 521 is located in the second region R2, the convex positioning portion 521 and the concave slider recessed portion 522Aa are fitted together, and the forward and backward movement of the rod slider 52Ab in the longitudinal direction A is regulated by the slider regulating portion 522A. The inner diameters of the base end portion 522Ab and the tip end portion 522Ac of the slider regulating portion 522A are smaller than the outer diameter of the positioning portion 521. Therefore, the positioning portion 521 is sandwiched between the base end portion 522Ab and the tip end portion 522Ac of the slider regulating portion 522A in the longitudinal direction A, and the forward and backward movement in the longitudinal direction A is regulated.

[0105] Also, the tip end side A1 of the slider regulating portion 522A is referred to as the "third region R3". The rod slider 52Ab shown in FIG. 22 has the positioning portion 521 located in the third region R3. Since the positioning portion 521 of the rod slider 52Ab shown in FIG. 22 is located in the third region R3, the positioning portion 521 and the slider recessed portion 522Aa are not fitted together. Therefore, the rod slider 52Ab can move forward and backward within the range where the positioning portion 521 is located in the third region R3.

[0106] Here, when the positioning portion 521 of the rod slider 52Ab is located in the first region R1, the tip 3a of the rod 3 is located on the base end side A2 with respect to the tip opening 22a of the first water supply pipe 22. That is, the tip 3a of the rod 3 is located on the base end side A2 with respect to the first position P1.

[0107] Therefore, when the positioning portion 521 is located in the first region R1, the operator can move the rod slider 52Ab forward and backward within a predetermined range where the positioning portion 521 is located in the first region R1. At this time, the operator can use the rod 3 to remove and drop the burnt matter adhered to the inside of the first water supply pipe 22. The rod 3 may have a protrusion (burnt matter removing portion) such as the spiral protrusion 31 shown in FIG. 19. In that case, the operator can use the burnt matter removing portion to remove and drop the burnt matter adhered to the inside of the first water supply pipe 22.

[0108] For example, in the rod slider 52Ab located in the first region R1, the movement of the rod slider 52Ab toward the base end side A2 is restricted by the contact between the base end portion 523 of the rod slider 52Ab and the base end portion 511 of the operation unit main body 51 in the longitudinal direction A.

[0109] Also, the movement of the rod slider 52Ab toward the tip side A1 is restricted by the contact between the positioning portion 521 and the base end portion 522Ab of the slider restricting portion 522A in the longitudinal direction A. Therefore, the range within which the rod slider 52Ab located in the first region R1 with the positioning portion 521 can move forward and backward is limited to a predetermined range.

[0110] When the positioning portion 521 is located in the first region R1, the rod 3 is in a state (restricted state) where the range of advancement and retraction of the tip 3a is restricted to the range from the first position P1 located at the tip opening 22a to the base end portion of the knife 2 (for example, the second position P2). Also, the range of advancement and retraction of the slider 52Ab for the rod is restricted on the base end side A2 with respect to the slider restricting portion 522A. Further, the tip of the rod 3 is restricted to the range from the first position P1 to the base end portion of the knife 2 (the second position P2). When the positioning portion 521 is fitted into the slider recess 522Aa, the tip of the rod 3 is located at the first position P1, and when the slider 52Ab for the rod is retracted to the maximum extent, the tip of the rod 3 may be configured to be located at the second position P2. Note that the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be restricted within an arbitrary range in the first water supply pipe 22 of the knife 2.

[0111] When the positioning portion 521 of the slider 52Ab for the rod is located in the second region R2, the tip 3a of the rod 3 is arranged at the first position P1. Therefore, since the tip opening 22a of the knife 2 is covered and blocked by the tip 3a of the rod 3, it is possible to prevent tissue from entering and clogging the first water supply pipe 22 from the tip opening 22a.

[0112] When the positioning portion 521 is located in the second region R2, the positioning portion 521 and the slider recess 522Aa are fitted together, and the advancement and retraction of the slider 52Ab for the rod in the longitudinal direction A are restricted by the base end portion 522Ab and the tip end portion 522Ac of the slider restricting portion 522A. Therefore, the rod 3 is maintained in a state where the tip 3a is positioned at the first position P1 (positioning state), that is, a state where the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. By advancing and retracting the slider 52Ab for the rod with a predetermined force with respect to the slider 52, the operator can release the engagement between the positioning portion 521 and the slider recess 522Aa. In a state where the engagement between the positioning portion 521 and the slider recess 522Aa is released, the operator can advance and retract the rod 3 relative to the knife 2 by advancing and retracting the slider 52Ab with respect to the slider 52. When the operator advances the slider 52Ab for the rod with respect to the slider 52, the engagement between the positioning portion 521 and the slider recess 522Aa is released and the positioning portion 521 moves to the third region R3. When the tip of the rod 3 protrudes from the tip opening 22a of the first conduit 22, the engagement between the positioning portion 521 and the slider recess 522Aa generates a resistance force (user feedback) with respect to the slider 52Ab for the rod.

[0113] When the positioning portion 521 is located in the third region R3, the rod 3 is in a state (protruding state) where the tip 3a protrudes from the tip opening 22a of the knife 2 toward the tip side A1. When the rod 3 is in the protruding state, since the tip opening 22a of the knife 2 is not covered by the tip 3a of the rod 3, the operator can perform a regional injection treatment.

[0114] Here, the slider regulating portion 522A is formed of an elastic member such as rubber. Therefore, when the positioning portion 521 is located in the first region R1, the operator can move the positioning portion 521 to the second region R2 by pushing the slider 52Ab for the rod into the tip side A1 with a predetermined force. Further, when the positioning portion 521 is located in the second region R2, the operator can move the positioning portion 521 to the third region R3 by pushing the slider 52Ab for the rod into the tip side A1 with a predetermined force.

[0115] In this way, the operator can easily switch the restriction state, positioning state, and protruding state of the rod 3 by advancing and retracting the slider 52Ab for the rod with a predetermined force and advancing and retracting the positioning portion 521 to the first region R1, the second region R2, and the third region R3. Since the operator requires a predetermined force to switch between the restriction state, the positioning state, and the protruding state, the operator can easily grasp that the state (position) of the rod 3 has changed, and the rod 3 can be moved to a desired position.

[0116] (Modification Example 1-12) The above-described slider restriction portion 522A only needs to be configured so that the operator can grasp the position of the rod 3. For example, it does not necessarily have to have the slider recess 522Aa. The above-described slider restriction portion 522A enables the switching of the restriction state, the positioning state, and the protruding state of the rod 3 by switching the position of the positioning portion 521 to the first region R1, the second region R2, and the third region R3. However, the slider restriction portion may be configured so that the operator can grasp the switching between the restriction state and the protruding state of the rod 3. FIG. 23 is a cross-sectional view showing the slider 52B in a modification of the operation portion 5.

[0117] The slider 52B includes a slider 52Ba for the knife (first slider) and a slider 52Bb for the rod (second slider, slide lever). The slider 52Ba for the knife is attached to the proximal end of the knife 2 and is configured to be able to advance and retract the knife 2 in the longitudinal direction A by advancing and retracting with respect to the operation portion main body 51. Further, the slider 52Bb for the rod is attached to the proximal end of the rod 3 and is configured to be able to advance and retract the rod 3 in the longitudinal direction A by advancing and retracting with respect to the operation portion main body 51.

[0118] As shown in FIG. 23, the slider 52Ba for the knife has a cylindrical slider restriction portion (stopper) 522B through which the operation portion main body 51 is inserted. Note that the cylindrical shape does not necessarily have to be a strict cylinder. The slider restriction portion 522B extends toward the tip side A1 as compared with the above-described slider restriction portion 522A and does not have the slider recess 522Aa.

[0119] As shown in Fig. 23, the rod slider 52Bb is a cylindrical member through which the operation unit main body 51 is inserted, and does not have the positioning portion 521 as compared with the above-described rod slider 52Ab. Note that the cylindrical shape does not necessarily have to be a strict cylinder.

[0120] Here, the rod slider 52Bb and the slider regulating portion 522B are formed of different materials. For example, the rod slider 52Bb is formed of resin, and the slider regulating portion 522B is formed of a rubber material.

[0121] Further, the inner diameter of the slider regulating portion 522B and the outer diameter of the tip of the rod slider 52Bb are equal. Therefore, when the tip of the rod slider 52Bb is inserted into the slider regulating portion 522B, when the rod slider 52Bb is moved forward and backward relative to the slider regulating portion 522B, the forward and backward movement of the rod slider 52Bb is inhibited to some extent by the frictional force generated between the rod slider 52Bb and the slider regulating portion 522B. Since a frictional force is generated between the rod slider 52Bb and the slider regulating portion 522B, a predetermined force is required when the operator moves the rod slider 52Bb inserted into the slider regulating portion 522B forward and backward. Note that the inner diameter of the slider regulating portion 522B and the outer diameter of the tip of the rod slider 52Bb do not necessarily have to be exactly equal.

[0122] Therefore, the operator can easily grasp whether the rod slider 52Bb is inserted into the slider regulating portion 522B. For example, when the rod slider 52Bb is located on the proximal end side A2 with respect to the slider regulating portion 522B and the rod slider 52Bb is not inserted into the slider regulating portion 522B, the tip 3a of the rod 3 is located at the first position P1 or on the proximal end side A2 with respect to the first position P1. That is, the rod 3 is in the above-described regulated state.

[0123] When the tip of the rod slider 52Bb is inserted into the slider regulating portion 522B, the tip 3a of the rod 3 is located on the distal end side A1 with respect to the first position P1 and protrudes from the tip opening 22a of the knife 2 to the distal end side A1. That is, the rod 3 is in the above-described protruding state.

[0124] In this way, by imparting a sense of resistance to the operator due to the friction between the rod slider 52Bb and the slider regulating portion 522B, the operator can easily grasp the position of the tip 3a of the rod 3. On the other hand, when the rod slider 52Bb abuts against the end portion of the slider regulating portion 522B, the tip of the rod 3 is at the first position P1, that is, the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. Also, the base end side A2 of the end portion of the slider regulating portion 522B is substantially regulated as a range in which the rod slider 52Bb can advance and retreat. When the tip of the rod 3 is projected from the tip opening 22a of the first conduit 22, the rod slider 52Bb abuts against the end portion of the slider regulating portion 522B, thereby generating a resistance force (user feedback) against the rod slider 52Bb. Further, the tip of the rod 3 is regulated within a range from the first position P1 to the base end portion (second position P2) of the knife 2, and when the rod slider 52Bb is brought into contact with the end portion of the slider regulating portion 522B, the tip of the rod 3 is located at the first position P1, and when the rod slider 52Bb is retracted to the maximum extent, the tip of the rod 3 may be configured to be located at the second position P2. Note that the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be regulated within an arbitrary range in the first water supply conduit 22 of the knife 2.

[0125] (Modification Example 1-13) FIG. 24 is a cross-sectional view showing a slider 52C in a modification of the operation unit 5. The slider 52C includes a knife slider (first slider) 52Ca and a rod slider (second slider, slide lever) 52Cb.

[0126] The knife slider 52Ca is attached to the base end of the knife 2 and is configured to be able to advance and retreat the knife 2 in the longitudinal direction A by advancing and retreating with respect to the operation unit main body 51. Also, the rod slider 52Cb is attached to the base end of the rod 3 and is configured to be able to advance and retreat the rod 3 in the longitudinal direction A by advancing and retreating with respect to the operation unit main body 51.

[0127] The slider 52Ca for the knife is a cylindrical member through which the operation unit main body 51 is inserted. Note that the cylindrical shape does not necessarily have to be a precise cylinder. At the proximal end of the slider 52Ca for the knife, a slider regulating portion (stopper) 522C that protrudes toward the operation unit main body 51 is provided on the inner peripheral surface surrounding the operation unit main body 51. The slider regulating portion 522C may be provided on the entire circumference of the inner peripheral surface of the slider 52Ca for the knife, or may be provided only on a part of the inner peripheral surface.

[0128] The slider 52Cb for the rod is a cylindrical member through which the operation unit main body 51 is inserted. Note that the cylindrical shape does not necessarily have to be a precise cylinder. The slider 52Cb for the rod has a second slider main body 524 and a positioning portion 521C provided at the tip of the second slider main body 524.

[0129] The positioning portion 521C has a small-diameter portion 521Ca having an outer diameter smaller than that of the second slider main body 524, and a large-diameter portion 521Cb provided on the tip side A1 of the small-diameter portion 521Ca and having an outer diameter larger than that of the small-diameter portion 521Ca. That is, on the outer peripheral surface of the slider 52Cb for the rod, the portion where the small-diameter portion 521Ca is provided is recessed compared to the portions where the second slider main body 524 and the large-diameter portion 521Cb are provided. The small-diameter portion 521Ca is, for example, a portion where the entire circumference is recessed on the outer peripheral surface of the slider 52Cb for the rod.

[0130] The outer diameters of the second slider main body 524 and the large-diameter portion 521Cb are slightly larger than the inner diameter of the slider regulating portion 522C in the slider 52Ca for the knife. Also, the outer diameter of the small-diameter portion 521Ca is slightly smaller than the inner diameter of the slider regulating portion 522C.

[0131] Here, when the slider 52Cb for the rod is located in the region (first region) on the proximal side A2 of the slider regulating portion 522C, the operator can insert the slider 52Cb for the rod through the slider regulating portion 522C by pushing the slider 52Cb for the rod toward the tip side A1 with a predetermined force.

[0132] At this time, for example, the large-diameter portion 521Cb or the slider regulating portion 522C elastically deforms so that the large-diameter portion 521Cb overrides the slider regulating portion 522C, and the convex-shaped slider regulating portion 522C and the concave-shaped small-diameter portion 521Ca are fitted together.

[0133] In a state where the slider regulating portion 522C and the small-diameter portion 521Ca are fitted together, the small-diameter portion 521Ca is disposed at a position overlapping the slider regulating portion 522C in a direction orthogonal to the longitudinal direction A. Further, since the outer diameter of the second slider main body 524 is larger than the inner diameter of the slider regulating portion 522C, in the longitudinal direction A, the slider regulating portion 522C is sandwiched between the large-diameter portion 521Cb and the second slider main body 524. That is, in a state where the slider regulating portion 522C and the small-diameter portion 521Ca are fitted together, the positioning portion 521C is located in the second region.

[0134] When the positioning portion 521C of the rod slider 52Cb is located in the second region, the operator can elastically deform the slider regulating portion 522C by pushing the rod slider 52Cb toward the distal end side A1 with a predetermined force, and move the positioning portion 521C to a region (third region) on the distal end side A1 with respect to the slider regulating portion 522C. At this time, the slider regulating portion 522C and the second slider main body 524 maintain a state of being in contact with each other.

[0135] Here, when the positioning portion 521C of the rod slider 52Cb is located in the first region, the distal end 3a of the rod 3 is located on the proximal end side A2 with respect to the distal end opening 22a of the first water supply pipe 22. That is, the distal end 3a of the rod 3 is located on the proximal end side A2 with respect to the first position P1.

[0136] When the positioning part 521C is located in the first region, the operator can move the slider 52Cb for the rod forward and backward within a predetermined range where the positioning part 521C is located in the first region. At this time, the operator can use the rod 3 to scrape off and drop the burnt part adhered to the inside of the first water supply pipe 22. The rod 3 may have a protrusion (burnt part removing part) such as the spiral protrusion 31 shown in FIG. 19. In that case, the operator can use the burnt part removing part to scrape off and drop the burnt part adhered to the inside of the first water supply pipe 22.

[0137] For example, in the slider 52Cb for the rod located in the first region, the movement of the slider 52Cb for the rod toward the base end side A2 is restricted by the contact of the base end portion 523 of the slider 52Cb for the rod and the base end portion 511 of the operation unit main body 51 in the longitudinal direction A.

[0138] Also, the movement of the slider 52Cb for the rod toward the tip side A1 is restricted by the contact of the large diameter portion 521Cb of the positioning part 521C and the slider restricting part 522C in the longitudinal direction A. Therefore, the range in which the slider 52Cb for the rod located in the first region can move forward and backward is limited to a predetermined range.

[0139] When the positioning part 521C is located in the first region, the tip 3a of the rod 3 is in a restricted state (restricted state) within the range from the first position P1 located at the tip opening 22a to the base end portion of the knife 2 (for example, the second position P2). Also, the base end side A2 from the slider restricting part 522C is restricted as the range in which the slider 52Cb for the rod can move forward and backward. Also, the tip of the rod 3 is restricted within the range from the first position P1 to the base end portion of the knife 2 (the second position P2). When the positioning part 521C is fitted to the slider restricting part 522C, the tip of the rod 3 may be configured to be located at the first position P1, and when the slider 52Cb for the rod is retracted to the maximum, the tip of the rod 3 may be located at the second position P2. Note that the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be restricted within an arbitrary range within the first water supply pipe 22 of the knife 2.

[0140] When the positioning portion 521C of the slider 52Cb for the rod is located in the second region, the tip 3a of the rod 3 is disposed at the first position P1. Therefore, since the tip opening 22a of the knife 2 is covered and blocked by the tip 3a of the rod 3, it is possible to prevent tissue from entering and clogging the first water supply passage 22 through the tip opening 22a.

[0141] When the positioning portion 521C is located in the second region, the positioning portion 521C and the slider restricting portion 522C are fitted together, and the forward and backward movement of the slider 52Cb for the rod in the longitudinal direction A is restricted by the slider restricting portion 522C. Therefore, the rod 3 is maintained in a state where the tip 3a is positioned at the first position P1 (positioning state), that is, a state where the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. The operator can release the fitting between the positioning portion 521C and the slider restricting portion 522C by moving the slider 52Cb for the rod forward and backward with a predetermined force with respect to the slider 52. In a state where the fitting between the positioning portion 521C and the slider restricting portion 522C is released, the operator can move the rod 3 forward and backward relative to the knife 2 by moving the slider 52Cb for the rod forward and backward with respect to the slider 52. When the operator moves the slider 52Cb for the rod forward with respect to the slider 52, the fitting between the positioning portion 521C and the slider restricting portion 522C is released and the positioning portion 521C moves to the third region. When the tip of the rod 3 protrudes from the tip opening 22a of the first conduit 22, the engagement of the positioning portion 521C and the slider restricting portion 522C generates a resistance force (user feedback) against the slider 52Cb for the rod.

[0142] When the positioning portion 521C is located in the third region, the rod 3 is in a state where the tip 3a protrudes from the tip opening 22a of the knife 2 toward the tip side A1 (protruding state). When the rod 3 is in the protruding state, since the tip opening 22a of the knife 2 is not covered by the tip 3a of the rod 3, the operator can perform a local injection procedure.

[0143] Here, when the positioning portion 521C is located in the third region, the rod slider 52Cb and the slider regulating portion 522C may not be in contact with each other. For example, in the second slider body 524, by making the outer diameter of the portion on the proximal end side A2 of the small-diameter portion 521Ca smaller than the inner diameter of the slider regulating portion 522C, the rod slider 52Cb located in the third region can be advanced and retracted without the second slider body 524 and the slider regulating portion 522C coming into contact with each other.

[0144] In this case, it is preferable to provide a convex shape (second large-diameter portion) that restricts the movement of the rod slider 52Cb on the proximal end of the small-diameter portion 521Ca toward the distal end side A1 in the second region.

[0145] (Modification Example 1-14) In the above-described embodiment, the operation unit 5 may have a tubular member 43, and may have a structure in which the lever 55 can be positioned with respect to the tubular member 43 to which the proximal end of the operation wire 4 is connected. Note that the proximal end of the tubular member 43 is connected to the slider 52.

[0146] FIG. 25 is a diagram showing the connection between the lever 55 and the rod 3 in the operation unit 5. In FIG. 25, some components such as the sheath 1 are omitted.

[0147] The proximal end portion 32 of the rod 3 has, for example, a cylindrical shape as shown in FIG. 25. Note that the cylindrical shape does not necessarily have to be a strict cylinder. The lever 55 is attached to the engagement recess 32a in the proximal end portion 32 of the rod 3.

[0148] The lever 55 has a convex handle portion 55a operated by an operator and an engagement portion 55b connected to the rod 3. An engagement convex portion 55c is provided at the tip of the engagement portion 55b as shown in FIG. 25. The engagement convex portion 55c of the lever 55 engages with the engagement recess 32a of the rod 3, and the lever 55 and the rod 3 are connected.

[0149] Further, at the proximal end of the tubular member 43, as shown in Fig. 25, a through-hole 4h that penetrates in the radial direction and extends in the longitudinal direction A is formed. The engaging portion 55b of the lever 55 is provided in the through-hole 4h of the tubular member 43 and is provided so as to be able to advance and retreat in the longitudinal direction A within the range where the through-hole 4h is formed. When the operator advances and retreats the lever 55 in the longitudinal direction A with respect to the slider 52, the rod 3 connected to the lever 55 advances and retreats, and the operating wire 4 does not advance and retreat. That is, when the lever 55 is advanced and retreated with respect to the slider 52, the rod 3 advances and retreats relative to the knife 2.

[0150] Fig. 26 is a cross-sectional view of the lever 55 and the tubular member 43 along the line X-X shown in Fig. 25. As shown in Figs. 25 and 26, on the inner peripheral surface of the through-hole 4h of the tubular member 43, an engaging recess (lever positioning portion) 4a that is recessed in the width direction Y is formed.

[0151] Further, on the engaging convex portion 55c of the lever 55, a ball click 55d composed of a spring member and a spherical member (spherical member) is provided. As shown in Fig. 26, the ball click 55d is provided on both sides in the width direction Y of the engaging portion 55b surrounded by the through-hole 4h of the tubular member 43.

[0152] The ball click 55d has a spring member connected to the engaging portion 55b and a spherical member 55e connected to the tip of the spring member. The ball click 55d can expand and contract in the width direction Y due to the elasticity of the spring member.

[0153] When the lever 55 is advanced and retreated in the longitudinal direction A, the lever 55 advances and retreats in a state where the spherical member 55e provided at the tip of the ball click 55d is in contact with the inner peripheral surface of the through-hole 4h. When the lever 55 is disposed at a position where the engaging recess 4a and the ball click 55d overlap in the width direction Y, the spring member of the ball click 55d extends in the width direction Y, and the tip (spherical member 55e) of the ball click 55d engages with the engaging recess 4a.

[0154] When the ball click 55d is engaged with the engaging recess 4a, the tip 3a of the rod 3 is located at the first position P1, that is, in the longitudinal direction A, the position of the tip 3a coincides with the position of the tip of the knife 2. Further, the lever 55 is restricted in the range where it can move forward and backward on the base end side A2 with respect to the engaging recess 4a. Further, the tip of the rod 3 is restricted to the range from the first position P1 to the base end portion (second position P2) of the knife 2. When the ball click 55d is engaged with the engaging recess 4a, the tip of the rod 3 is located at the first position P1, and when the lever 55 is retracted to the maximum extent, the tip of the rod 3 may be configured to be located at the second position P2. Note that the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be restricted within an arbitrary range in the first water supply pipe 22 of the knife 2.

[0155] Further, the operator can move the knife 2 connected to the operation wire 4 and the rod 3 connected to the lever 55 forward and backward while maintaining the state (positioning state) in which the tip 3a of the rod 3 is positioned at the first position P1 by moving the slider 52 forward and backward in the state of being connected by the engagement between the ball click 55d and the engaging recess 4a.

[0156] The operator can release the engagement between the ball click 55d and the engaging recess 4a by moving the lever 55 forward and backward with a predetermined force with respect to the slider 52. In a state where the engagement between the ball click 55d and the engaging recess 4a is released, the operator can move the rod 3 forward and backward relative to the knife 2 by moving the lever 55 forward and backward with respect to the slider 52. When the tip of the rod 3 protrudes from the tip opening 22a of the first pipe 22, the engagement between the ball click 55d and the engaging recess 4a generates a resistance force (user feedback) with respect to the lever 55.

[0157] (Modification Example 1-15) In the above embodiment, the operation unit 5 may have a tubular member 43, and may have a structure in which the lever 55 can be positioned with respect to the tubular member 43 connected to the base end of the operation wire 4. Note that the base end of the tubular member 43 is connected to the slider 52.

[0158] FIG. 27 is a cross-sectional view showing a modified example of the lever 55 and the tubular member 43. The cross-section shown in FIG. 27 is, similarly to FIG. 26, a cross-sectional view of the lever 55 and the tubular member 43 along the line X-X shown in FIG. 25.

[0159] In the through-hole 4h of the tubular member 43, as shown in FIG. 27, a regulating convex portion (lever positioning portion) 4Aa that protrudes in the width direction Y from the inner peripheral surface of the through-hole 4h is provided. When the tip of the lever 55 is brought into contact with the regulating convex portion 4Aa, the tip of the rod 3 is at the first position P1, that is, in the longitudinal direction A, the position of the tip 3a coincides with the position of the tip of the knife 2. Also, the base end side A2 with respect to the regulating convex portion 4Aa is regulated as a range in which the lever 55 can advance and retreat. Further, the tip of the rod 3 is regulated within a range from the first position P1 to the base end portion (second position P2) of the knife 2, and when the lever 55 is brought into contact with the regulating convex portion 4Aa, the tip of the rod 3 is positioned at the first position P1, and when the lever 55 is retracted to the maximum extent, the tip of the rod 3 may be configured to be positioned at the second position P2. Note that the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be regulated within an arbitrary range in the first water supply pipe 22 of the knife 2.

[0160] In addition, the lever 55 may be configured to be able to move over the regulating convex portion 4Aa to the tip side A1 with respect to the regulating convex portion 4Aa by moving the lever 55 to the tip side A1 with a predetermined force. When the tip of the rod 3 protrudes from the tip opening 22a of the first pipe 22, the lever 55 abuts against the regulating convex portion 4Aa, thereby generating a resistance force (user feedback) with respect to the lever 55.

[0161] (Modification Example 1-16) In the above embodiment, the tubular member 43 may include a regulating member 4b that regulates the advance and retreat of the lever 55 to some extent.

[0162] FIG. 28 is a cross-sectional view showing a modified example of the lever 55 and the tubular member 43. The cross-section shown in FIG. 28 is, similarly to FIGS. 26 and 27, a cross-sectional view of the lever 55 and the tubular member 43 along the line X-X shown in FIG. 25.

[0163] As shown in FIG. 28, a restricting member 4b is provided at the tip of the through hole 4h of the tubular member 43 along the inner peripheral surface of the through hole 4h. In the opening of the through hole 4h, the region (restricting region 4c) where the restricting member 4b is provided has a smaller dimension in the width direction Y than other regions.

[0164] When the lever 55 is moved to the tip side A1 and at least a part of the lever 55 is located in the restricting region 4c, in the width direction Y, the engaging portion 55b of the lever 55 and the restricting member 4b come into contact with each other. The restricting member 4b is formed of, for example, a rubber material or the like.

[0165] Therefore, when the operator moves the lever 55 to the tip side A1 and the lever 55 and the restricting member 4b come into contact with each other, the operator feels a sense of resistance due to the friction between the engaging portion 55b of the lever 55 and the restricting member 4b.

[0166] When at least a part of the engaging portion 55b of the lever 55 is located in the restricting region 4c, for example, the rod 3 is in a state where the tip 3a protrudes from the tip opening 22a of the knife 2 to the tip side A1 (protruding state). Therefore, the operator can easily grasp that the rod 3 is in the protruding state by the sense of resistance felt from the lever 55 located in the restricting region 4c. On the one hand, when the engaging portion 55b of the lever 55 abuts against the end portion of the regulating member 4b, the tip of the rod 3 is at the first position P1, that is, in the longitudinal direction A, the position of the tip 3a coincides with the position of the tip of the knife 2. Also, the base end side A2 of the end portion of the regulating member 4b is substantially regulated as the range in which the lever 55 can advance and retreat. When the tip of the rod 3 protrudes from the tip opening 22a of the first conduit 22, the lever 55 abuts against the end portion of the regulating member 4b, thereby generating a resistance force (user feedback) against the lever 55. Further, the tip of the rod 3 is regulated within the range from the first position P1 to the base end portion (second position P2) of the knife 2. When the lever 55 is brought into contact with the end portion of the regulating member 4b, the tip of the rod 3 is located at the first position P1, and when the lever 55 is retracted to the maximum extent, the tip of the rod 3 may be configured to be located at the second position P2. Note that the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be regulated within an arbitrary range within the first water supply conduit 22 of the knife 2.

[0167] As described above, the first embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and also includes design changes and the like within the scope not departing from the gist of the present invention. Further, the components shown in the above-described embodiment and modification examples can be combined as appropriate.

[0168] (Second Embodiment) The treatment instrument 100D according to the second embodiment of the present invention will be described with reference to FIGS. 29 to 30. In the following description, the same reference numerals are given to the configurations common to those already described, and the overlapping description is omitted.

[0169] FIG. 29 is a perspective view of the tip portion of the treatment instrument 100D according to the second embodiment. FIG. 30 is a cross-sectional view of the tip portion of the treatment instrument 100D. The treatment instrument 100D does not include the rod 3. As shown in FIGS. 29 and 30, the treatment instrument 100D includes a sheath 1D, a knife 2, a connecting joint 23, a water supply tube 24, an operating wire 4, and an operating portion (not shown).

[0170] The sheath 1D has the same configuration as the sheath 1 of the first embodiment, except that the insulating chip (tip member) 11D provided at the tip 1a of the sheath 1D is different.

[0171] The insulating chip 11D has two different through-holes. The insulating chip 11D includes an insulating chip body (tip member body) 111, a first through-hole 121, and a second through-hole 122.

[0172] The insulating chip body 111 is the main body portion of the insulating chip 11D. The insulating chip body 111 has a first opening 112 on the front end face 111a on the front end side A1, and a second opening 113 provided at a position different from the first opening 112, through which the fluid flowing through the third water supply pipeline (water supply pipeline) 24h of the water supply tube 24 described later flows out.

[0173] The first through-hole 121 is a hole penetrating the insulating chip body 111 in the longitudinal direction A. The central axis OB2 in the longitudinal direction A of the first through-hole 121 is arranged at a position different from the central axis O1 in the longitudinal direction A of the sheath 1D in the height direction Z intersecting the longitudinal direction A and the width direction Y. The first through-hole 121 includes a first tip pipeline 121h inside. The first tip pipeline 121h communicates with the first opening 112 formed on the front end face 111a. In other words, the first tip pipeline 121h has the first opening 112 on the front end side A1. The first opening 112 is slightly smaller than the flange 21 which is the tip portion of the knife 2, and is formed to have a size for the flange 21 to be locked. Therefore, the flange 21 is locked at the first opening 112 and does not move from the first opening 112 to the base end side A2.

[0174] The second through-hole 122 penetrates in the longitudinal direction A and is provided at a distance from the first through-hole 121 when viewed from the tip side A1 in the longitudinal direction A. The central axis OB3 of the second through-hole 122 in the longitudinal direction A is arranged at a position (offset position) different from the central axis O1 and the central axis OB2 of the sheath 1D in the longitudinal direction A in the height direction Z. The second through-hole 122 includes a second tip conduit 122h inside. The second tip conduit 122h communicates with a second opening 113 formed in the tip surface 111a. In other words, the second tip conduit 122h has the second opening 113 on the tip side A1.

[0175] Here, as shown in FIG. 30, in the following description, the direction in which the central axis OB2 is arranged with respect to the central axis O1 is defined as the lower side Z2 in the height direction Z, and the direction in which the central axis OB3 is arranged with respect to the central axis O1 is defined as the upper side Z1 in the height direction Z. In the present embodiment, the central axis OB2 is formed on the lower side Z2 than the central axis OB3. However, the central axis OB2 may be formed on the upper side Z1 than the central axis OB3. Further, the central axis OB2 or the central axis OB3 may be formed on the same axis as the central axis O1.

[0176] The knife 2 is inserted into the sheath 1D. The knife 2 is provided so as to be able to project from the first opening 112 of the first tip conduit 121h of the insulating tip 11D to the tip side A1. The central axis of the knife 2 in the longitudinal direction A substantially coincides with the central axis OB2 of the first through-hole 121 of the sheath 1D in the longitudinal direction A.

[0177] The water supply tube 24 is a tube-shaped member extending along the longitudinal direction A. Inside the water supply tube 24, a third water supply conduit (water supply conduit) 24h for water supply is formed. The third water supply conduit 24h communicates with the second tip conduit 122h of the second through-hole 122. Therefore, the fluid flowing through the third water supply conduit 24h of the water supply tube 24 passes through the second tip conduit 122h and flows out from the second opening 113. Note that the water supply tube 24 is not an essential component. In this case, the internal space 1s of the sheath 1D serves as a water supply conduit for the fluid.

[0178] In this embodiment, the operation unit (not shown) does not include the lever 55 as compared with the operation unit 5 of the first embodiment, and is provided with two liquid supply ports. One of the two liquid supply ports is connected to the proximal end of the water supply tube 24. The fluid supplied to the third water supply pipeline 24h of the water supply tube 24 is discharged from the second opening 113. The other of the two liquid supply ports is connected to the proximal end of the second water supply pipeline 42 of the operation wire 4 in the same manner as in the first embodiment, and the supplied fluid is discharged from the tip opening 22a of the first water supply pipeline 22 of the knife 2. Liquid feeding devices such as pumps are respectively connected to the two liquid supply ports. However, the pump may be controlled so as to be supplied to either of the two liquid supply ports by providing a switching valve or the like. Further, the pump may supply not only liquid but also gas.

[0179] The opening area of the second opening 113 is preferably smaller than the opening area of the first opening 112. Here, the opening area refers to the area of the opening in a plan view from the longitudinal direction A. By making the opening area of the second opening 113 smaller than the opening area of the first opening 112, it is possible to achieve both the maintenance of the cutting performance by the knife 2 and the sharp water supply from the second opening 113.

[0180] The opening area of the second opening 113 is preferably larger than the opening area of the tip opening 22a of the first water supply pipeline 22. Further, the knife 2 is preferably rotatable around the longitudinal direction A with the central axis OB2 as the rotation center with respect to the sheath 1D and the insulating chip 11D.

[0181] According to this embodiment, the insulating chip 11D of the sheath 1D is provided on the front end surface 111a of the insulating chip body 111 with the first opening 112 and the second opening 113 through which the fluid flowing through the third water supply pipeline (water supply pipeline) 24h of the water supply tube 24 provided at a position different from the first opening 112 flows out. Therefore, even if the charring of the tissue fixed to the tip of the knife 2 due to the cutting / ablation / dissection treatment causes the fluid passing through the first water supply pipeline 22, that is, the tip opening 22a, to be unable to supply water, the operator can supply water by discharging the fluid flowing through the third water supply pipeline 24h of the water supply tube 24 from the second opening 113 where the tissue does not adhere and the water supply is not hindered.

[0182] Also, by making the knife 2 rotatable around the longitudinal direction A with respect to the sheath 1D and the insulating chip 11D, the charred tissue adhered to the flange 21 of the knife 2 can be evenly washed away by the fluid discharged from the second opening 113.

[0183] (Modification Example 2-1) According to the present embodiment, the sheath 1D is provided with the insulating chip 11D at the tip, but the mode of the insulating chip 11D is not limited to this. FIG. 31 is a cross-sectional view showing the insulating chip 11E of the sheath 1E which is a modification example of the insulating chip 11D of the sheath 1D. The insulating chip main body 111E of the insulating chip 11E is provided with a protruding portion 13 protruding from the tip surface 111Ea toward the tip side A1. The protruding portion 13 is formed in a cylindrical shape extending in the longitudinal direction A with the central axis OB3 as the central axis. The protruding portion 13 is provided with a protruding portion pipeline 13h inside. Further, the base end of the protruding portion 13 is attached to the tip surface 111Ea so as to cover the second opening 113, and the internal protruding portion pipeline 13h communicates with the second tip pipeline 122h. The protruding portion 13 is provided with a protruding portion opening 13a at the tip. The fluid passing through the third water supply pipeline 24h of the water supply tube 24 flows out from the protruding portion opening 13a through the protruding portion pipeline 13h communicating with the second tip pipeline 122h after flowing out from the second opening 113 through the second tip pipeline 122h.

[0184] As shown in FIG. 31, the protruding portion opening 13a of the protruding portion 13 is disposed on the base end side A2 of the knife 2 in a state where the knife 2 has advanced toward the tip side A1. FIG. 32 is a cross-sectional view showing the insulating chip 11E in a state where the knife 2 has retreated to the base end side A2. As shown in FIG. 32, the protruding portion opening 13a of the protruding portion 13 is disposed on the tip side A1 of the knife 2 in a state where the knife 2 has retreated to the base end side A2 (a state where the flange 21 of the knife 2 is in contact with the tip surface 111Ea of the insulating chip main body 111E). With this configuration, the operator can easily perform a local injection treatment by disposing the protruding portion 13 provided with the protruding portion opening 13a through which the supplied liquid flows out, near the lesion, on the insulating chip 11E of the sheath 1E.

[0185] (Modification Example 2-2) Moreover, the protruding portion 13 is not limited to the above-described embodiment. FIG. 33 is a perspective view showing a modified protruding portion 13A of the protruding portion 13. The protruding portion 13A has a tapered surface 13p inclined toward the central axis OB3 from the base end side A2 to the tip end side A1 at the tip end portion. In this case, since the tip end portion of the protruding portion 13A provided with the protruding portion opening 13a through which the liquid flows out has the tapered surface 13p, the operator can easily insert the protruding portion opening 13a of the protruding portion 13A into the submucosal layer and perform a local injection treatment.

[0186] (Modification Example 2-3) Moreover, the protruding portion 13 is not limited to the above-described embodiment. FIG. 34 is a perspective view showing a modified protruding portion 13B of the protruding portion 13 of the insulating chip 11E. The tip end portion 13b of the protruding portion 13B is inclined toward the axis passing through one end of the periphery of the protruding portion 13B in the longitudinal direction A from the base end side A2 to the tip end side A1. With this configuration, the tip end portion of the protruding portion 13B has a sharp shape. Also in this case, the operator can easily insert the protruding portion opening 13a of the protruding portion 13B into the submucosal layer and perform a local injection treatment.

[0187] (Modification Example 2-4) Moreover, the protruding portion 13 is not limited to the above-described embodiment. FIG. 35 is a cross-sectional view showing a modified example of the protruding portion 13, which is a protruding portion 13C. As shown in FIG. 35, the protruding portion 13C is configured to be retractable in the longitudinal direction A. Specifically, the base end of the protruding portion 13C is fixed to the tip of the water supply tube 24. And the water supply tube 24 is, for example, provided with an operation unit 5 having a lever 55, and the base end is attached to the lever 55. Therefore, when the operator moves the lever 55 forward and backward in the longitudinal direction A, the water supply tube 24 and the protruding portion 13C can be moved forward and backward in the longitudinal direction A. The protruding portion opening 13Ca of the protruding portion 13C can be arranged so as not to protrude from the second opening 113 provided in the insulating chip body 111 to the tip side A1 as shown in FIG. 35. With this configuration, the operator can move the unused protruding portion 13C to the base end side A2 with respect to the second opening 113 and accommodate it in the second through hole 122 during the incision, cauterization, peeling treatment, and hemostasis treatment. Note that only the protruding portion 13 may be configured to be retractable in the longitudinal direction A without moving the water supply tube 24 forward and backward.

[0188] (Modification Example 2-5) In the above-described embodiment, the insulating chip 11D of the sheath 1D includes a first opening 112 and a second opening 113 provided at a position different from the first opening 112 on the front end surface 111a of the insulating chip body 111. However, the aspect of the insulating chip 11D is not limited to this. FIG. 36 is a cross-sectional view showing an insulating chip 11F of a sheath 1F, which is a modified example of the insulating chip 11D of the sheath 1D. Also, the knife 2F inserted into the sheath 1F has a shorter radial width compared to the knife 2 of the above-described embodiment in this embodiment, and the flange 21F of the knife 2F can be moved to the base end side A2 with respect to the first opening 112.

[0189] The insulating chip 11F includes only the first opening 112 at the tip surface 111Fa of the insulating chip body 111F as compared with the insulating chip 11D of the second embodiment. Further, the insulating chip 11F includes a second tip conduit 122Fh. The second tip conduit 122Fh is curved inside the insulating chip 11F so that the tip faces the lower side Z2, and an internal insertion opening (second opening) 113F provided at the tip is formed on the side surface of the first tip conduit 121h. The proximal end side A2 of the second tip conduit 122Fh communicates with the third water supply conduit 24h of the water supply tube 24.

[0190] FIG. 37 is a cross-sectional view showing a state where the knife 2F is moved. As shown in FIG. 37, when the operator moves the slider 52 to the proximal end side A2, the flange 21F of the knife 2F moves to the proximal end side A2 with respect to the internal insertion opening 113F. Then, in the first tip conduit 121h, a sufficient space can be provided for fluid to flow out from the flange 21F to the tip side A1. Therefore, the liquid flowing through the third water supply conduit 24h of the water supply tube 24 is supplied into the second tip conduit 122Fh and then flows out from the internal insertion opening 113F. Then, the fluid passes through the first tip conduit 121h and flows out from the first opening 112. In other words, in a state where liquid flows into the internal insertion opening 113F, the flange (tip portion) 21F of the knife 2F is disposed on the proximal end side A2 with respect to the internal insertion opening 113F. According to this configuration, the operator can smoothly supply water and perform a local injection treatment. Further, when the flange 21F of the knife 2F is disposed near the internal insertion opening 113F, even if tissue or charring of the tissue adheres to the flange 21F, the fluid flowing out from the internal insertion opening 113F can wash away the tissue or the charring of the tissue and discharge it from the first opening 112.

[0191] (Modification 2-6) In the above embodiment, the treatment instrument 100D according to the second embodiment includes a water supply tube 24. However, the treatment instrument 100D is not limited to the above-described embodiment. FIG. 38 is a cross-sectional view showing a treatment instrument 100G which is a modified example of the treatment instrument 100D. The treatment instrument 100G does not include a water supply tube 24. In this case, the fluid water supply pipeline is formed in the internal space 1s of the sheath 1D. Also in this configuration, the treatment instrument 100G can supply water of the fluid from the second opening 113 provided in the insulating chip body 111 of the insulating chip 11D.

[0192] (Modification 2-7) In the above embodiment, the central axis OB3 in the longitudinal direction A of the second through hole 122 extends parallel to the longitudinal direction A, but the aspect of the second through hole is not limited thereto.

[0193] FIG. 39 is a cross-sectional view showing a treatment instrument 100J which is a modified example of the treatment instrument 100D. The treatment instrument 100J includes a sheath 1J, a knife 2, a connecting joint 23, an operating wire 4, and an operating portion (not shown).

[0194] An insulating chip (tip member) 11J is provided at the tip 1a of the sheath 1J. The insulating chip 11J has two different through holes. The insulating chip 11J includes an insulating chip body (tip member body) 111J, a first through hole 121, and a second through hole 122J.

[0195] The insulating chip body 111J is the main body portion of the insulating chip 11J. The insulating chip body 111J has a first opening 112 on the front end surface 111Ja on the front end side A1, and a second opening 113J which is provided at a position different from the first opening 112 and through which the fluid passing through the internal space 1s of the sheath 1J flows out.

[0196] The first through hole 121 is a hole that penetrates the insulating chip body 111J in the longitudinal direction A, similar to the above embodiment.

[0197] As shown in Fig. 39, the second through-hole 122J is a hole that penetrates the insulating chip body 111J such that the central axis OB4 of the second through-hole 122J intersects the central axis OB2 of the first through-hole 121. That is, the second through-hole 122J is provided such that the central axis OB4 intersects the central axis of the knife 2.

[0198] Therefore, the fluid passing through the internal space 1s of the sheath 1J is discharged from the second opening 113J toward the knife 2. As a result, the fluid discharged from the second opening 113J can efficiently wash away the charred tissue adhering to the knife 2.

[0199] As described above, the second embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. In addition, the components shown in the above-described embodiments and modifications can be configured by being appropriately combined.

[0200] The present invention includes the following technical ideas. (Appended Claim 1) A sheath extending in the longitudinal direction and having a water supply pipe line inside, A metal high-frequency knife inserted into the sheath and advancing and retreating in the longitudinal direction, An insulating tip member provided at the tip of the sheath, Comprising, The tip member has a first opening through which the high-frequency knife penetrates on the tip surface, and a second opening provided at a position different from the first opening through which the fluid passing through the water supply pipe line flows out. An endoscopic treatment instrument.

[0201] (Appended Claim 2) A high-frequency current flows through the high-frequency knife. The endoscopic treatment instrument according to Appended Claim 1.

[0202] (Appended Claim 3) An operation wire extending in the longitudinal direction and connected to the high-frequency knife at the tip, An operating part provided at the proximal end of the operating wire; further comprising The high-frequency knife advances and retracts in the longitudinal direction when the operating part is operated. The endoscopic treatment instrument according to claim 1 or claim 2.

[0203] (Additional item 4) further comprising a liquid delivery tube inserted into the sheath and having the water supply pipe line for water supply inside; The fluid flowing through the liquid delivery tube flows out from the second opening. The endoscopic treatment instrument according to claim 1 or claim 2.

[0204] (Additional item 5) a sheath extending in the longitudinal direction and having a water supply pipe line for water supply inside; a metal high-frequency knife inserted into the sheath and advancing and retracting in the longitudinal direction; an insulating tip member provided at the tip of the sheath; comprising The tip member includes a first tip pipe line provided with a first opening through which the high-frequency knife is inserted on the tip surface, and a second tip pipe line provided with an internal insertion opening on the side surface of the first tip pipe line and supplied with fluid from the water supply pipe line. The fluid supplied to the second tip pipe line flows out from the first opening. Endoscopic treatment instrument.

[0205] (Additional item 6) In a state where liquid flows out from the second opening, the tip of the high-frequency knife is disposed on the proximal end side of the internal insertion opening. The endoscopic treatment instrument according to claim 5.

[0206] (Third Embodiment) Next, a third embodiment of the present invention will be described with reference to FIGS. 40 to 42. In the following description, for components that are the same as those already described, the same reference numerals will be used and redundant descriptions will be omitted. Note that in all of the following embodiments, the configuration of the endoscopic treatment system using the treatment instrument is different from that of the first embodiment. Therefore, in the following description, the differences from the first embodiment will be mainly described.

[0207] [Endoscopic treatment system (treatment system, high-frequency knife system) 300H] FIG. 40 is a diagram showing an endoscopic treatment system 300H according to a third embodiment of the present invention. FIG. 40 is a schematic configuration diagram for explaining an example of the endoscopic treatment system 300H.

[0208] As shown in FIG. 40, an endoscopic treatment system (treatment system, high-frequency knife system) 300H using a treatment instrument according to a third embodiment of the present invention includes an endoscope (not shown), a treatment instrument 100H, a switch (foot switch) 6, a high-frequency power supply device 7, and a liquid supply device 8. Here, the treatment instrument 100H has the same configuration as the treatment instrument 100, except that it does not include a rod (rod-shaped member) 3 and a lever 55 of the operation unit 5 as compared with the first embodiment.

[0209] The switch 6 is, for example, a foot switch operated by the operator's foot. The switch 6 communicates with the high-frequency power supply device 7 by wire or wirelessly. The switch 6 transmits a power-on / off signal to the high-frequency power supply device 7 described later.

[0210] The high-frequency power supply device 7 supplies high-frequency energy to the treatment instrument 100H. Specifically, the high-frequency power supply device 7 is electrically connected to a power supply connector 53 provided in the operation unit 5. The high-frequency power supply device 7 switches the presence or absence of the output of high-frequency energy by receiving a power-on / off signal by the operation of the switch 6 by the operator. The high-frequency power supply device 7 includes a switch detection unit 71, an output unit 72, a first communication unit 73, and a first control unit 74.

[0211] The switch detection unit 71 detects the on / off signal of the power supply of the switch 6. When the switch detection unit 71 detects the on / off signal of the power supply, it transmits the on / off detection information of the power supply to the first control unit 74. The switch detection unit 71 is, for example, a current detection sensor.

[0212] The output unit 72 acquires an output signal from the first control unit 74 and starts outputting high-frequency energy to the treatment tool 100H. Also, when the output unit 72 acquires an output stop signal from the first control unit 74, it stops outputting high-frequency energy to the treatment tool 100H.

[0213] The first communication unit 73 is a communication interface. The first communication unit 73 communicates with the liquid delivery device 8 and other devices, for example, via a wired cable. The first communication unit 73 may be, for example, a device that performs wireless communication. Also, the first communication unit 73 may be a device that communicates with an access point connected to the Internet using a predetermined protocol such as a wireless LAN (Local Area Network).

[0214] When the first communication unit 73 acquires the on / off information of the power supply from the first control unit 74, it transmits the on / off information of the power supply to the liquid delivery device 8. Also, when the first communication unit 73 acquires abnormality detection information from the liquid delivery device 8, it transmits it to the first control unit 74.

[0215] The first control unit 74 is a device (computer) capable of executing a program having a CPU (Central Processing Unit), a memory capable of reading a program, a storage unit (not shown), etc. The functions of the first control unit 74 are realized by the CPU executing the program provided to the first control unit 74. Note that at least some of the functions of the first control unit 74 may be configured by a dedicated logic circuit or the like. The storage unit is a non-volatile recording medium that stores programs and necessary data. The storage unit is composed of, for example, a ROM or a hard disk. The program recorded in the storage unit is read into the memory and executed by the CPU.

[0216] When the first control unit 74 acquires the on / off detection information (input state) of the power supply from the switch detection unit 71, it generates an output signal or an output stop signal and transmits it to the output unit 72. Further, when the first control unit 74 acquires abnormality detection information from the liquid feeding device 8 via the first communication unit 73, it generates an output stop signal and transmits it to the output unit 72.

[0217] Also, when the first control unit 74 acquires the on / off detection information of the power supply from the switch detection unit 71, it generates on / off information of the power supply and transmits an instruction to the first communication unit 73.

[0218] Note that the first control unit 74 is not limited to a device provided in one piece of hardware. For example, the first control unit 74 may be configured by separating a CPU, a memory, and a storage unit as separate pieces of hardware and connecting the hardware to each other via a communication line. Alternatively, the first control unit 74 may separate the storage unit and connect it in the same way via a communication line to realize the first control unit as a cloud system. Furthermore, the first control unit 74 may further include components other than the CPU, the memory, and the storage unit, as long as they are necessary for the operation of the first control unit 74.

[0219] The liquid feeding device 8 feeds (delivers water) liquid to the treatment instrument 100H. Specifically, the liquid feeding device 8 is connected to a liquid supply port 54 provided in the operation unit 5. The liquid feeding device 8 operates the on / off of the power supply of the high-frequency power supply device by the switch 6 and feeds liquid to the treatment instrument 100H by acquiring the on / off information of the power supply from the high-frequency power supply device 7. The liquid feeding device 8 includes a water feeding unit 81, a second communication unit 82, a second control unit 83, and an abnormality detection unit 84. The liquid feeding device 8 is, for example, a pressure pump for liquid feeding.

[0220] The water feeding unit 81 acquires a water feeding signal from the second control unit 83 and starts feeding water by feeding liquid to the treatment instrument 100H. Also, the water feeding unit 81 acquires a water feeding stop signal from the second control unit 83 and stops the water feeding to the treatment instrument 100H.

[0221] The second communication unit 82 is a communication interface. The second communication unit 82 communicates with the high-frequency power supply device 7 and other devices, for example, via a wired cable. The second communication unit 82 may be, for example, a device for wireless communication. Also, the second communication unit 82 may be a device that communicates with an access point connected to the Internet, for example, according to a predetermined protocol such as a wireless LAN (Local Area Network).

[0222] The second communication unit 82 communicates with the first communication unit 73 of the high-frequency power supply device 7. When the second communication unit 82 acquires the on / off information of the power supply of the high-frequency power supply device 7 from the first communication unit 73, it transmits the on / off information of the power supply to the second control unit 83.

[0223] The second control unit 83 is a device (computer) capable of executing a program having a CPU (Central Processing Unit), a memory capable of reading a program, a storage unit (not shown), and the like. The functions of the second control unit 83 are realized by the CPU executing the program provided to the second control unit 83. Note that at least some of the functions of the second control unit 83 may be configured by a dedicated logic circuit or the like. The storage unit is a non-volatile recording medium that stores programs and necessary data. The storage unit is composed of, for example, a ROM or a hard disk. The program recorded in the storage unit is read into the memory and executed by the CPU.

[0224] When the second control unit 83 acquires the on / off information of the power supply from the second communication unit 82, it generates a water supply signal and transmits an instruction to the water supply unit 81.

[0225] Note that the second control unit 83 is not limited to a device provided in one piece of hardware. For example, the second control unit 83 may be configured by separating a CPU, a memory, and a storage unit as separate pieces of hardware and then connecting the pieces of hardware to each other via a communication line. Alternatively, the second control unit 83 may be realized as a cloud system by separating the storage unit and connecting it in the same way via a communication line. Furthermore, the second control unit 83 may further include components other than the CPU, the memory, and the storage unit, as long as they are necessary for the operation of the second control unit 83.

[0226] When the water supply unit 81 supplies water (liquid) to the treatment instrument 100H, the abnormality detection unit 84 detects an abnormality in the occurrence of a problem when, for example, the tip opening 22a is blocked due to sticking of tissue burn or the like, or when the treatment instrument 100H having a water supply pipe through which fluid flows buckles and water supply is not sufficient. When the abnormality detection unit 84 detects an abnormality, it transmits abnormality detection information to the second control unit 83.

[0227] When the second control unit 83 acquires the abnormality detection information from the abnormality detection unit 84, it transmits a water supply stop signal to the water supply unit 81. Further, the second control unit 83 transmits the abnormality detection information to the high-frequency power supply device 7 via the second communication unit 82.

[0228] Here, the endoscope treatment system 300H may further include a warning output unit (not shown). By providing the warning output unit, when the abnormality detection unit 84 detects an abnormality, it transmits the abnormality detection information to the warning output unit, and the warning output unit can acquire the abnormality detection information and generate a warning sound or a warning light.

[0229] [Operation of the endoscope treatment system 300H] Next, the operation of the endoscope treatment system 300H will be described with reference to FIG. 42. FIG. 42 is a flowchart for explaining the operation of the endoscope treatment system 300H.

[0230] <Switch-on detection step (first detection step) S1> First, the operator operates the foot switch, which is switch 6, using the foot. When switch 6 transmits a power-on signal to the high-frequency power supply device 7, the switch detection unit 71 of the high-frequency power supply device 7 detects the power-on signal of switch 6.

[0231] <Water supply start step (first supply step) S2> The switch detection unit 71 transmits the power-on detection information to the first control unit 74. When the first control unit 74 acquires the power-on detection information from the switch detection unit 71, it generates power-on information and transmits an instruction to the first communication unit 73. When the first communication unit 73 acquires the power-on information from the first control unit 74, it transmits the power-on information to the liquid delivery device 8. When the second communication unit 82 of the liquid delivery device 8 acquires the power-on information, it transmits the power-on information to the second control unit 83. When the second control unit 83 acquires the power-on information from the second communication unit 82, it generates a water supply signal and transmits an instruction to the water supply unit 81. The water supply unit 81 acquires the water supply signal and starts water supply by delivering liquid to the treatment tool 100H.

[0232] <High-frequency energy output start step (second supply step) S3> Also, when the first control unit 74 acquires the power-on detection information from the switch detection unit 71, it generates an output signal and transmits it to the output unit 72. The output unit 72 starts outputting high-frequency energy to the treatment tool 100H after acquiring the output signal from the first control unit 74. That is, when the first control unit 74 acquires the power-on detection information of switch 6 from the switch detection unit 71, it causes the water supply unit 81 to start supplying fluid by the liquid delivery device 8 and causes the output unit 72 to start outputting high-frequency energy.

[0233] In this way, the high-frequency power supply device 7 and the liquid supply device 8 can supply high-frequency energy and fluid to the treatment instrument 100H simultaneously. In other words, the high-frequency power supply device 7 and the liquid supply device 8 communicate with each other, and one controls the other to operate in conjunction. Although the treatment instrument 100H can supply high-frequency energy and fluid simultaneously, it is preferable that the fluid is supplied to the treatment instrument 100H prior to the high-frequency energy. The timing of supplying the high-frequency energy and the fluid can be arbitrarily adjusted by the first control unit 74 of the high-frequency power supply device 7 and the second control unit 83 of the liquid supply device 8. In this state, the operator can perform the above-described insertion step, local injection step, incision / cauterization / dissection step, removal step, additional local injection step, and hemostasis step using the treatment instrument 100H. Further, the operator can continue the above steps as necessary. Here, the interlocking of the high-frequency power supply device 7 and the liquid supply device 8 includes not only the state in which high-frequency energy or fluid is being supplied, but also the state in which the high-frequency power supply device 7 and the liquid supply device 8 are communicating with each other.

[0234] <Abnormality detection step S4> When the abnormality detection unit 84 of the liquid supply device 8 detects an abnormality indicating a malfunction during the liquid supply device 8 supplying water from the water supply unit 81 to the treatment instrument 100H, it transmits abnormality detection information to the second control unit 83.

[0235] <Abnormality stop steps S41, S42> When the second control unit 83 acquires the abnormality detection information from the abnormality detection unit 84, it transmits a water supply stop signal to the water supply unit 81. When the water supply unit 81 acquires the water supply stop signal from the second control unit 83, it stops the water supply to the treatment tool 100H. Also, the second control unit 83 transmits the abnormality detection information to the high-frequency power supply device 7 via the second communication unit 82. When the first communication unit 73 of the high-frequency power supply device 7 acquires the abnormality detection information from the liquid supply device 8, it transmits it to the first control unit 74. When the first control unit 74 acquires the abnormality detection information, it generates an output stop signal and transmits it to the output unit 72, and the output unit 72 stops the output of high-frequency energy to the treatment tool 100H. When the abnormality detection unit 84 does not detect an abnormality, the high-frequency power supply device 7 and the liquid supply device 8 continue to supply high-frequency energy and fluid to the treatment tool 100H.

[0236] <Switch-off detection step (second detection step) S5> The operator operates the switch 6 with the foot and transmits a power-off (OFF) signal to the high-frequency power supply device 7. The switch detection unit 71 of the high-frequency power supply device 7 detects the power-on signal of the switch 6.

[0237] <Water supply stop step (first stop step) S51> The switch detection unit 71 transmits the power-off detection information to the first control unit 74. When the first control unit 74 acquires the power-off detection information from the switch detection unit 71, it generates power-off information and transmits an instruction to the first communication unit 73. When the first communication unit 73 acquires the power-off information from the first control unit 74, it transmits the power-off information to the liquid supply device 8. When the second communication unit 82 of the liquid supply device 8 acquires the power-off information, it transmits the power-off information to the second control unit 83. When the second control unit 83 acquires the power-off information from the second communication unit 82, it generates a water supply stop signal and transmits an instruction to the water supply unit 81. The water supply unit 81 acquires the water supply stop signal and stops the water supply to the treatment tool 100H.

[0238] <High-frequency energy output stop step (second stop step) S52> Further, when the first control unit 74 acquires the power-off detection information from the switch detection unit 71, it generates an output stop signal and transmits it to the output unit 72. The output unit 72 acquires the output stop signal from the first control unit 74 and stops the output of high-frequency energy to the treatment tool 100H. That is, when the first control unit 74 acquires the power-off detection information of the switch 6 from the switch detection unit 71, it stops the supply of the fluid from the water supply unit 81 by the liquid feeding device 8 and stops the output of high-frequency energy by the output unit 72. The high-frequency power supply device 7 and the liquid feeding device 8 can stop the supply of high-frequency energy and the fluid to the treatment tool 100H in conjunction with each other. The operator can, if necessary, perform the above steps to end (complete) the ESD procedure.

[0239] According to the endoscope treatment system (treatment system) 300H according to the present embodiment, the high-frequency power supply device 7 and the liquid feeding device 8 can supply high-frequency energy and fluid to the treatment tool 100H simultaneously in conjunction with each other. Thereby, the operator can, by operating the switch 6, perform a local injection treatment while supplying water to the fluid, and simultaneously perform an incision, cauterization, peeling treatment, and hemostasis treatment. Therefore, the tissue does not enter the tip opening (water supply port) 22a of the knife 2 of the treatment tool 100H, and the tip opening 22a is not clogged, and tissue burning does not occur.

[0240] (Modification 3-1) The liquid feeding device 8 according to the above-described embodiment is not limited to a liquid, and may supply (inject) a gas.

[0241] (Modification 3-2) The switch 6 according to the above-described embodiment communicates with the high-frequency power supply device 7 by wire or wirelessly, but is not particularly limited. The switch 6 may communicate with the liquid feeding device 8 by wire or wirelessly. In this case, by providing the liquid feeding device 8 with a switch detection unit, the above-described endoscope treatment system 300H can be operated. Further, the switch 6 may communicate with both the high-frequency power supply device 7 and the liquid feeding device 8 by wire or wirelessly.

[0242] (Modification 3-3) Further, the switch 6 is not limited to the above-described foot switch. For example, a touch panel, various switches such as a mouse and a keyboard, or a switch using any device capable of performing operations such as a lever and a remote controller can be used.

[0243] (Modification Example 3-4) In the treatment system 300H according to the above-described embodiment, the high-frequency power supply device 7 and the liquid feeding device 8 cooperate to simultaneously supply high-frequency energy and fluid to the treatment instrument 100H. However, the mode of the treatment system is not limited to this. For example, in the treatment system, the switch detection unit 71 of the high-frequency power supply device 7 detects the power-on signal of the switch 6 and starts the output of high-frequency energy to the treatment instrument 100H. Further, the treatment system may start the water supply by feeding liquid to the treatment instrument 100H after detecting the stop of the supply of high-frequency energy by the high-frequency power supply device 7. In this way, by outputting high-frequency energy and fluid serially, after performing the incision, cauterization, and peeling steps, the charred tissue attached to the knife 2 can be washed away by the fluid.

[0244] As described above, the third embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. Further, the components shown in the above-described embodiments and modification examples can be combined as appropriate.

[0245] The present invention includes the following technical ideas. (Supplementary Claim 7) An endoscopic treatment instrument having a high-frequency knife that can be inserted into the channel of an endoscope and extend longitudinally in a retractable manner, a first pipeline that extends longitudinally and through which liquid flows, and a first opening through which the liquid flows out. A high-frequency power supply device that supplies high-frequency energy to the high-frequency knife. A switch that starts or stops the supply of the high-frequency energy. A liquid feeding device that supplies fluid to the first pipeline. Comprising The high-frequency power supply device and the liquid feeding device are interlocked. High-frequency knife system.

[0246] (Supplementary Note 8) The high-frequency knife is provided with the first opening at its tip and the first pipeline inside. The high-frequency knife system according to Supplementary Note 7.

[0247] (Supplementary Note 9) The endoscopic treatment instrument further includes a sheath extending in the longitudinal direction and into which the high-frequency knife can be inserted, and an insulating tip member provided at the tip of the sheath. The tip member is provided with a first through hole penetrating in the longitudinal direction and into which the high-frequency knife can be inserted, and a second through hole provided at the tip side of the first opening and penetrating in the longitudinal direction. The high-frequency knife system according to Supplementary Note 7.

[0248] (Supplementary Note 10) The liquid feeding device performs air supply or water supply. The high-frequency knife system according to Supplementary Note 7 or Supplementary Note 8.

[0249] (Supplementary Note 11) The liquid feeding device and the high-frequency power supply device communicate with each other, and at least one of them controls the other. The high-frequency knife system according to Supplementary Note 7 or Supplementary Note 8.

[0250] (Supplementary Note 12) When the high-frequency power supply device supplies the high-frequency energy, The liquid feeding device supplies the fluid. The high-frequency knife system according to Supplementary Note 7 or Supplementary Note 8.

[0251] (Supplementary Note 13) The device further includes a detection unit for detecting an abnormal operation of the liquid feeding device. When the detection unit detects an abnormal operation of the liquid feeding device, the high-frequency power supply device stops output. The high-frequency knife system according to supplementary note 7 or supplementary note 8.

[0252] (Supplementary note 14) A control method for a high-frequency knife, in which the supply of high-frequency energy and fluid is controlled by a switch, A first detection step of detecting the turning on of the switch, A first supply step of starting the supply of the fluid, A second supply step of starting the supply of the high-frequency energy simultaneously with the start of the supply of the fluid, A second detection step of detecting the turning off of the switch, A first stop step of stopping the supply of the fluid, A second stop step of stopping the supply of the high-frequency energy simultaneously with the stop of the supply of the fluid, A control method for a high-frequency knife comprising the above.

[0253] (Supplementary note 15) An abnormality detection step of detecting an abnormality in the supply of the fluid, An abnormal stop step of stopping the supply of the fluid and the supply of the high-frequency energy, The control method for a high-frequency knife according to supplementary note 14, further comprising the above.

[0254] In any of the above embodiments, according to the endoscopic treatment instrument of the present invention, water can be suitably supplied from the tip of the high-frequency knife or the sheath.

Explanation of reference numerals

[0255] 300, 300H... Endoscopic treatment system (treatment system, high-frequency knife system) 100, 100A, 100B, 100C, 100D, 100G, 100H... Treatment instrument (endoscopic treatment instrument) 200... Endoscope 1, 1D, 1E, 1F... Sheath 11, 11D, 11E, 11F... Insulating tip (tip member) 12... Through hole 13, 13A, 13B, 13C... Protrusion 12a… tip opening 2, 2A, 2B, 2F… knife (high-frequency knife, electrode) 20… knife body 21, 21A, 21F… flange 21B… tip part 22… first water supply pipeline (first pipeline) 22a… tip opening (water supply port or first opening) 24… water supply tube 24h… third water supply pipeline (water supply pipeline) 3, 3B, 3C… rod (rod-shaped member) 3A… sealing member 4… operating wire 42… second water supply pipeline (second pipeline) 5… operating part 52… slider 55… lever (slide lever) 6… switch (foot switch) 7… high-frequency power supply device 71 switch detection part 72… output part 73… first communication part 74… first control part 8… liquid supply device 81… water supply part 82… second communication part 83… second control part 84… abnormality detection part A… longitudinal direction

Claims

1. A sheath extending in the longitudinal direction, an insulating tip member provided at the tip of the sheath and having a through hole extending in the longitudinal direction, a metal electrode having a pipe line passing through the through hole and extending in the longitudinal direction, and a rod having an outer surface capable of removing charring in the pipe line by advancing and retreating with respect to the electrode in the pipe line. The endoscope treatment instrument is provided with: An endoscope treatment instrument.

2. A second pipe line communicating with the pipe line in the longitudinal direction, a hollow operation wire having a tip connected to the electrode, and an operation unit for advancing and retreating the operation wire along the longitudinal direction. The endoscope treatment instrument according to claim 1, further comprising: The endoscope treatment instrument according to claim 1.

3. The operation unit includes: a slider connected to the proximal end of the operation wire and advancing and retreating the electrode in the longitudinal direction, and a slide lever for relatively advancing and retreating the rod with respect to the electrode in the longitudinal direction. The endoscope treatment instrument according to claim 2, further comprising: The endoscope treatment instrument according to claim 2.

4. The operation unit has a stopper capable of restricting the advance and retreat of the slide lever along the longitudinal direction, when the advance and retreat of the slide lever is restricted by the stopper, the range in which the rod can advance and retreat is restricted to the range from the tip opening of the pipe line to the proximal end portion of the electrode. The endoscope treatment instrument according to claim 3.

5. When the slide lever is located on the proximal end side of the stopper, the tip of the rod is located inside the pipe line. The endoscope treatment instrument according to claim 4.

6. The rod is in a restricted state where when the stopper is attached to the operation unit, the range in which the tip of the rod can advance and retreat is restricted to the range from the tip opening to the proximal end portion of the electrode, and when the stopper is removed from the operation unit, the tip of the rod is in a protruding state where it can protrude to the tip side of the tip opening. The endoscope treatment instrument according to claim 4.

7. The operation unit has a stopper capable of restricting the advance and retreat of the slide lever along the longitudinal direction, when the advance and retreat of the slide lever is restricted by the stopper, the rod cannot advance and retreat in the longitudinal direction. The endoscope treatment instrument according to claim 3.

8. When the rod is restricted from advancing and retreating in the longitudinal direction by the stopper, the tip of the rod is in a positioned state maintained at the tip opening of the pipe line. The endoscope treatment instrument according to claim 7.

9. ​ When the distal end of the rod protrudes from the distal opening of the conduit, the operation unit has a positioning unit that generates user feedback with respect to the slide lever. The endoscopic treatment instrument according to claim 3.

10. The rod has a protrusion extending in the radial direction of the rod from the outer surface. The endoscopic treatment instrument according to claim 1.

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