Endoscopic instruments and endoscopic systems
The endoscopic treatment instrument addresses flexibility and maneuverability issues by incorporating a flexible, rotatable, and longitudinally movable design with adjustable friction, enhancing the ease and precision of procedures like ESD.
Patent Information
- Authority / Receiving Office
- JP · JP
- Patent Type
- Applications
- Current Assignee / Owner
- FUJIFILM CORP
- Filing Date
- 2025-10-31
- Publication Date
- 2026-05-26
AI Technical Summary
Existing endoscopic instruments face challenges in efficiently maneuvering and treating target sites due to limitations in flexibility and maneuverability, particularly in bending and gripping mechanisms, which complicate procedures like endoscopic submucosal dissection (ESD).
An endoscopic treatment instrument with a flexible, rotatable, and longitudinally movable insertion part featuring a gripping section and a curved portion that can bend beyond 90 degrees, allowing for enhanced maneuverability and ease of operation, including a mechanism to adjust friction based on curvature angle for stable control.
The instrument facilitates easier grasping, lifting, and incising of target sites, improving the safety and efficiency of procedures like ESD by allowing for precise control and reduced operational complexity.
Smart Images
Figure 2026086365000001_ABST
Abstract
Description
Technical Field
[0001] The present invention relates to an endoscopic treatment instrument and an endoscopic system.
Background Art
[0002] Patent Document 1 describes a subject insertion instrument in which a curved member that is hollow tubular and has an opening on the side is disposed inside the tip of a hollow coil forming an insertion portion, a traction wire is inserted into and withdrawn from the hollow coil in a freely advancing and retreating manner, the traction wire is biased toward the opening side of the curved member and fixed to the tip side of the curved member, and the curved member is curved in the direction of the opening by a traction operation.
[0003] Patent Document 2 describes a flexible tube-shaped member that is inserted into and removed from an instrument insertion channel of an endoscope, and a portion that protrudes outward from the tip of the instrument insertion channel is formed to be curved in an arc shape.
[0004] Patent Document 3 describes an endoscopic treatment device that includes an observation means for observing the inside of a body cavity, is used in combination with an endoscope that can be inserted into the body cavity, includes a flexible insertion portion having a curved portion and a channel through which a treatment instrument is inserted, an operation portion connected to the insertion portion for performing a bending operation of the curved portion, and a treatment instrument operation means for operating the treatment instrument.
[0005] Patent Document 4 describes an endoscope in which an observation window is disposed across a vertical axis in a tip surface area above a horizontal axis, a first treatment instrument outlet is disposed across a vertical axis in a tip surface area below the horizontal axis, a second treatment instrument outlet is in a tip surface area below a line passing through the center of the observation window and parallel to the horizontal axis, and on the left side of the vertical axis, and is disposed across the horizontal axis, and a water supply port is in a tip surface area below a line passing through the center of the observation window and parallel to the horizontal axis, and on the opposite side of the tip surface area from the second treatment instrument outlet with respect to a line passing through the center of the first treatment instrument outlet and parallel to the vertical axis.
Prior Art Documents
Patent Documents
[0006] [Patent Document 1] Japanese Patent Application Publication No. 11-299793 [Patent Document 2] Japanese Patent Application Publication No. 9-299323 [Patent Document 3] Japanese Patent Publication No. 2007-151595 [Patent Document 4] Japanese Patent Publication No. 2022-152489 [Overview of the Initiative]
[0007] One embodiment of the technology relating to the present disclosure provides an endoscopic treatment instrument and an endoscopic system that can improve the ease of treatment of a target site. [Means for solving the problem]
[0008] (1) An insertable part that can be inserted into the body, An operating section is located on the base end side of the insertion section, Equipped with, The above insertion part is, A tip having an opening and closing gripping section, A flexible curved portion is provided adjacent to the operating portion side of the tip mentioned above, The connecting part that connects the curved part and the operating part, Includes, The insertion portion can be moved forward and backward along the longitudinal axis of the connection portion and rotated about the longitudinal axis by operating the operating portion. By operating the above-mentioned operating part, the gripping part closes, and with the gripping part closed, the curved part curves. The maximum curvature angle of the curved portion with respect to the longitudinal axis is greater than 90 degrees. Endoscopic instruments.
[0009] (2) (1) The endoscopic treatment instrument described above, Comprising at least one operating wire connected to the above operating part and operating at least one of the opening and closing of the above gripping part and the bending of the above bending part. Endoscopic treatment instrument.
[0010] (3) The endoscopic treatment instrument according to (1) or (2), The above insertion part is inserted and used in the treatment tool channel of the endoscope, The inner diameter of the arc drawn when the above bending part is bent maximally is larger than half of the outer diameter of the above endoscope. Endoscopic treatment instrument.
[0011] (4) The endoscopic treatment instrument according to any one of (1) to (3), The above insertion part is inserted and used in the treatment tool channel of the endoscope, When the above bending part is bent maximally, the above tip part extending from the above treatment tool channel is non-contact with the above endoscope. Endoscopic treatment instrument.
[0012] (5) The endoscopic treatment instrument according to (4), When the above bending part is bent maximally, regardless of the rotational state of the above insertion part, the above tip part extending from the above treatment tool channel is non-contact with the above endoscope. Endoscopic treatment instrument.
[0013] (6) The endoscopic treatment instrument according to any one of (1) to (5), and An endoscope having a treatment tool channel through which the above insertion part can be inserted, An endoscopic system including.
[0014] (7) The endoscopic system according to (6), The first treatment tool which is the above endoscopic treatment instrument, The second treatment tool, The above endoscope, Including, The endoscope has a first treatment tool channel through which the insertion portion of the first treatment tool can be inserted, and a second treatment tool channel through which the second treatment tool can be inserted. Endoscope system.
Advantages of the Invention
[0015] According to the present invention, it is possible to provide an endoscopic treatment tool and an endoscope system that can improve the ease of treatment for a target site.
Brief Description of the Drawings
[0016] [Figure 1] It is a diagram showing an example of an endoscope system according to an embodiment of the present invention. [Figure 2] It is a diagram showing an example of an endoscopic treatment tool 20 according to an embodiment of the present invention. [Figure 3] It is a diagram showing the configuration of a gripping portion 24 of a distal end portion 23 in the endoscopic treatment tool 20. [Figure 4] It is a diagram showing the operation of the gripping portion 24 in FIG. 3. [Figure 5] It is a diagram showing the configuration of a bending portion 25 and a connecting portion 26 of the endoscopic treatment tool 20. [Figure 6] It is a diagram showing the operation of the bending portion 25 in FIG. 5. [Figure 7] It is a diagram showing the internal configuration of the bending portion 25. [Figure 8] It is a cross-sectional view taken along line a-a of the bending portion 25 shown in FIG. 7. [Figure 9] It is a diagram showing the internal operation of the bending portion 25. [Figure 10] It is a diagram showing the configuration of an operation portion 22 of the endoscopic treatment tool 20. [Figure 11] It is a cross-sectional view of the operation portion 22 of the endoscopic treatment tool 20. [Figure 12] It is a cross-sectional view showing a closed state of the operation portion 22 of the endoscopic treatment tool 20. [Figure 13] It is a diagram showing a first example (part 1) of a treatment method using the endoscopic treatment tool 20. [Figure 14]This figure shows the first example (part 2) of a treatment method using the endoscopic treatment instrument 20. [Figure 15] This figure shows the first example (part 3) of a treatment method using the endoscopic treatment instrument 20. [Figure 16] This figure shows the first example (part 1) of a treatment method using endoscopic treatment instrument 20 in combination with other endoscopic treatment instruments. [Figure 17] This figure shows the first example (part 2) of a treatment method using endoscopic treatment instrument 20 in combination with other endoscopic treatment instruments. [Figure 18] This figure shows the first example (part 3) of a treatment method using endoscopic treatment instrument 20 in combination with other endoscopic treatment instruments. [Figure 19] This diagram shows the state in which the endoscopic treatment instrument 20 is attached to the first treatment instrument insertion port 13 of the endoscope control unit 7. [Figure 20] This figure shows the uncurved state of the curved portion 25 in the insertion portion 21. [Figure 21] This is a perspective view showing the curvature of the curved portion 25. [Figure 22] Figure 21 is a plan view of the curved section 25. [Figure 23] This figure shows a second example (part 1) of a treatment method using the endoscopic treatment instrument 20. [Figure 24] This figure shows a second example (part 2) of a treatment method using the endoscopic treatment instrument 20. [Figure 25] This figure shows a second example (part 3) of a treatment method using the endoscopic treatment instrument 20. [Figure 26] This figure shows the positional relationship between the tip portion 23 and the endoscope 2 when the curved portion 25 is at its maximum curvature. [Figure 27] This figure shows an example of the end face 10a of the tip portion 10 of the endoscope. [Figure 28] This figure shows another example of the operating handle 51. [Modes for carrying out the invention]
[0017] Hereinafter, an endoscopic treatment instrument and an endoscopic system according to one embodiment of the present invention will be described with reference to the drawings.
[0018] Figure 1 shows an example of an endoscope system according to an embodiment of the present invention. As shown in Figure 1, the endoscope system 1 comprises an endoscope 2, a light source device 3, and a processor 4. The endoscope 2 has an endoscope insertion section 6 for insertion into a subject, an endoscope operation section 7 connected to the endoscope insertion section 6, and a universal cord 8 extending from the endoscope operation section 7. The endoscope insertion section 6 consists of an endoscope tip section 10, an endoscope bending section 11 connected to the endoscope tip section 10, and an endoscope connection section 12 connecting the endoscope bending section 11 and the endoscope operation section 7.
[0019] The endoscope tip 10 is equipped with an imaging device including an image sensor. The endoscope bending section 11 is configured to bend. The bending of the endoscope bending section 11 is controlled by the endoscope operating section 7. The endoscope connection section 12 is also configured to be flexible enough to conform to the shape of the insertion path within the patient.
[0020] The endoscope control unit 7 is provided with an operation button for operating imaging using the imaging device described above, and an operation knob for operating the bending of the endoscope bending section 11. The endoscope control unit 7 is also provided with a first treatment instrument insertion port 13 and a second treatment instrument insertion port 15 into which an endoscopic treatment instrument 20 (see Figure 2) can be inserted. Inside the endoscope insertion section 6, there is a first treatment instrument channel 14 that extends from the first treatment instrument insertion port 13 to the endoscope tip 10 and opens to the end face of the endoscope tip 10, and a second treatment instrument channel 16 that extends from the second treatment instrument insertion port 15 to the endoscope tip 10 and opens to the end face of the endoscope tip 10.
[0021] A light guide and cable are provided inside the endoscope insertion section 6, the endoscope operating section 7, and the universal cord 8. A connector 9 is provided at the end of the universal cord 8. The endoscope 2 is connected to the light source device 3 and the processor 4 via the connector 9.
[0022] The illumination light generated by the light source device 3 is guided to the endoscope tip 10 via the light guide and emitted from the endoscope tip 10. The operating power of the image sensor, the control signal that drives the image sensor, and the image signal output from the image sensor are transmitted between the processor 4 and the imaging device via the cable. The processor 4 processes the input image signal to generate image data of the observation area within the subject, displays the generated image data on the monitor 5, and also records it in the storage unit.
[0023] Figure 2 shows an example of an endoscopic treatment instrument 20 according to an embodiment of the present invention. As shown in Figure 2, the endoscopic treatment instrument 20 comprises an insertion portion 21, an operating portion 22, and a fixing portion 52. The insertion portion 21 is a portion that can be inserted into the first treatment instrument channel 14 (see Figure 1). The operating portion 22 is a portion located on the proximal end side of the insertion portion 21. The fixing portion 52 is a portion that is attached to and fixed to the endoscopic operating portion 7.
[0024] The insertion section 21 includes a tip section 23 having a gripping section 24 that can be opened and closed by operating the operating section 22, a curved section 25 adjacent to the operating section 22 side of the tip section 23, and a connecting section 26 connecting the curved section 25 and the operating section 22. When the insertion section 21 is inserted through the first treatment instrument channel 14, the connecting section 26 is housed within the first treatment instrument channel 14. Conversely, when the insertion section 21 is inserted through the first treatment instrument channel 14, the tip section 23 and the curved section 25 protrude from the end face of the endoscope tip section 10 (see Figure 1). The connecting section 26 housed within the first treatment instrument channel 14 is configured to be flexible enough to conform to the shape of the insertion path within the patient, similar to the endoscope connecting section 12.
[0025] Figure 3 shows the configuration of the gripping portion 24 at the tip 23 of the endoscopic treatment instrument 20. Figure 4 shows the operation of the gripping portion 24 in Figure 3.
[0026] As shown in Figure 3, the gripping portion 24 has a pair of gripping claws 30 and a pair of link members 31. The tip portion 23 has a support body 32 that rotatably supports the pair of gripping claws 30. The pair of gripping claws 30 are arranged to intersect, and a pin 33 is provided passing through the intersection of the pair of gripping claws 30. The pin 33 is fixed to the support body 32. The pair of gripping claws 30 are supported by the support body 32 so as to be rotatable with the pin 33 as the pivot axis.
[0027] The tip of a link member 31 is rotatably connected to the base end of the gripping claw 30. At least one operating wire 27 is connected to the base end of the link member 31. The operating wire 27 reaches the operating section 22 from the tip 23 through the curved section 25 and the connecting section 26, and is pulled towards the operating section 22 or pushed out towards the tip 23 in response to operations at the operating section 22.
[0028] Figure 3 shows the operating wire 27 being pushed out toward the tip 23, with the tips of the pair of gripping claws 30 open. Conversely, when the operating wire 27 is pulled toward the operating section 22, the tips of the pair of gripping claws 30 close, as shown in Figure 4. The treatment site of the living organism is grasped by the closed tips of the pair of gripping claws 30.
[0029] Figure 5 shows the configuration of the bending section 25 and the connecting section 26 of the endoscopic treatment instrument 20. Figure 6 shows the operation of the bending section 25 in Figure 5.
[0030] As shown in Figure 5, the insertion portion 21 of the endoscopic instrument 20 has a curved portion 25 on the operating portion 22 side of the tip portion 23 which has a gripping portion 24, and a connecting portion 26 on the operating portion 22 side of the curved portion 25. The connecting portion 26 is flexible and also has rigidity that allows translational and rotational power to be transmitted from the operating portion 22 side to the curved portion 25 side. The connecting portion 26 can be constructed, for example, by covering the outer circumference of a spiral tube made of metal strip material with a mesh tube made of braided metal wire material, and covering the outer circumference of the mesh tube with a resin outer sheath.
[0031] As shown in Figure 6, the curved portion 25, which is bent by the operating portion 22, can be bent in a direction substantially perpendicular to the plane including the opening and closing direction of the pair of gripping claws 30. The bending operation plane of the curved portion 25, which includes the bending operation direction, is in a direction substantially perpendicular to the opening and closing operation plane of the pair of gripping claws 30.
[0032] Figure 7 shows the internal structure of the curved section 25. Figure 8 is a cross-sectional view of the curved section 25 shown in Figure 7 along line aa. Figure 9 shows the internal operation of the curved section 25.
[0033] As shown in Figure 7, the curved section 25 has a plurality of curved pieces 42 and a resin outer shell 43. The plurality of curved pieces 42 are arranged in a line along the longitudinal direction of the insertion section 21, which includes the curved section 25. Two adjacent curved pieces 42 are connected via a pair of pins 46 that are positioned facing each other in the radial direction of the curved section 25.
[0034] As shown in Figure 8, the pair of pins 46 are positioned on axis X. Axis X is approximately parallel to the opening and closing direction of the pair of gripping claws 30. Adjacent curved pieces 42 connected by the pair of pins 46 are rotatable around axis X as the pivot axis.
[0035] As shown in Figure 9, the curved portion 25 is curved along a direction (curving surface) substantially perpendicular to the opening and closing direction (direction of axis X) of the pair of gripping claws 30 by the summation of the rotations of multiple curved pieces 42 with axis X as the pivot axis.
[0036] The curved section 25 is curved by an operating wire 27 for opening and closing a pair of gripping claws 30. As shown in Figure 8, each of the curved sections 42 has a wire guide 47 that holds the operating wire 27 in a pushable and pullable manner. The wire guide 47 is provided on one of the second sides B when the curved section 42 is divided into a first side A and a second side B on the opposite side with respect to the axis X. Therefore, when the operating wire 27 is pulled toward the operating section 22, the curved section 25 is curved such that the first side A is located on the outside of the curve and the second side B is located on the inside of the curve.
[0037] Thus, in the endoscopic instrument 20, the closing operation of the gripping section 24 and the bending operation of the bending section 25 are performed by pulling a single operating wire 27. This makes operation at the operating section 22 easier. Here, when the operating wire 27 is pulled toward the operating section 22, the gripping section 24 closes first, and the bending section 25 bends while the gripping section 24 is closed. The order of operation between the closing operation of the gripping section 24 and the bending operation of the bending section 25 can be set by the relative magnitudes of the operating resistance when the gripping section 24 closes and the operating resistance when the bending section 25 bends. For example, if the operating resistance of the bending section 25 is relatively large, the closing operation of the gripping section 24 will occur first, followed by the bending operation of the bending section 25.
[0038] The operating resistance when the gripping portion 24 closes includes the friction at the intersection of the pair of gripping claws 30 and the friction at the connection between the gripping claws 30 and the link member 31. The operating resistance when the curved portion 25 bends includes the friction at the connection between two adjacent curved pieces 42. The outer sheath 43 of the curved portion 25 is an elastic member that extends the curved portion 25 in a straight line. Therefore, the operating resistance when the curved portion 25 bends includes the elasticity of the outer sheath 43. The operating wire 27 is also an elastic member that extends the curved portion 25 in a straight line. Therefore, the operating resistance when the curved portion 25 bends includes the elasticity of the operating wire 27. Note that the elastic member that extends the curved portion 25 in a straight line is not limited to the outer sheath 43 and the operating wire 27, but may also be a wire spring, a leaf spring, etc.
[0039] Thus, the curved section 25, which bends when pulled by the operating wire 27, has an outer sheath 43 made of an elastic material, which generates an elastic force that returns it from a curved state to a straight state. Furthermore, this elastic force increases in proportion to the amount of curvature of the curved section 25. A friction adjustment mechanism 70 (described later in Figure 12) is provided that can accommodate this change in elastic force and increases the frictional force according to the amount (angle) of curvature of the curved section 25, thereby maintaining the curved state of the curved section 25 in good condition.
[0040] The greater the amount of movement the operating wire 27 is pulled, the greater the force pulling the operating wire 27 in the return direction (the force that stretches it in a straight line). In this embodiment, the friction adjustment mechanism 70, described later, which can respond to changes in the force pulling the operating wire 27 in the return direction (elastic return force), can increase the frictional force in accordance with the amount of pulling the operating wire 27, thereby maintaining a good pulling state.
[0041] Figure 10 shows the configuration of the operating section 22 of the endoscopic treatment instrument 20. Figure 11 is a cross-sectional view of the operating section 22 of the endoscopic treatment instrument 20.
[0042] As shown in Figure 10, the operating unit 22 includes an operating unit body 50, an operating handle 51, and a fixing part 52. The operating unit body 50 functions as an input means for forward, backward, and rotational operations to advance and rotate the gripping part 24 (see Figure 3). The operating handle 51 functions as an input means for opening and closing operations to open and close the gripping part 24 and to curve the bending part 25 (see Figure 2). The fixing part 52 is a mounting part that is detachably attached to the endoscope operating unit 7 (see Figure 1).
[0043] The fixed part 52 has a connecting fitting 52a. The connecting fitting 52a is connected to a nozzle provided in the first treatment instrument insertion port 13 (see Figure 1) of the endoscope operating section 7. The operating section 22 is supported by the endoscope operating section 7 when the connecting fitting 52a is connected to the nozzle.
[0044] The operating unit body 50 is formed in a rod shape and is movable in the direction of the central axis indicated by arrow E and in the rotational direction about the central axis indicated by arrow F. The operating unit body 50 is supported by a fixed part 52. The connecting part 26 of the insertion part 21 is connected to the operating unit body 50 through the fixed part 52. The connecting part 26 moves forward and backward along its longitudinal axis in response to the movement of the operating unit body 50 in the direction of arrow E. The connecting part 26 also rotates about its longitudinal axis in response to the movement of the operating unit body 50 in the direction of arrow F. The movement and rotation of the connecting part 26 are transmitted to the gripping part 24, and the gripping part 24 also moves forward and backward and rotates together with the connecting part 26.
[0045] The operating handle 51 is pivotably supported on the operating unit body 50. For example, as shown in Figure 11, the operating handle 51 is supported on the pivot shaft portion 55a (55), and its free end 51a is pivotable in an opening direction C, away from the operating unit body 50, and in a closing direction D, approaching the operating unit body 50. The operating handle 51 is supported to move on a fan-shaped operating movement surface centered on the pivot shaft portion 55a.
[0046] Figure 12 is a cross-sectional view showing the closed state of the operating section 22 of the endoscopic treatment instrument 20. The closed state of the operating section 22 is the state when the operating handle 51 is operated in the closing direction D. In contrast, the open state of the operating section 22 is the state when the operating handle 51 is operated in the opening direction C (Figure 11).
[0047] When the operating handle 51 swings in the closing direction D, it pulls the operating wire 27 (in the direction of arrow G), and when it swings in the opening direction C, it pushes the operating wire 27 in (in the opposite direction of arrow G). The operating wire 27 is fixed to a wire holder 56 which is provided within the operating unit body 50 so as to be slidable along its axis. The wire holder 56 is connected to the operating handle 51 via a link member 57 which is rotatably connected to a pivot shaft portion 55c(55). The link member 57 and the operating handle 51 are rotatably connected via a pivot shaft portion 55b(55).
[0048] As described above, as the amount of traction of the operating wire 27 (amount of movement in the direction of arrow G) increases, the force pulling the wire holder 56 in the return direction (elastic return force) also increases. Furthermore, when grasping and lifting the lesion site, the return force increases with the amount of lifting (amount of traction). Therefore, the operating handle 51 is subjected to a return force that increases with the amount of traction. To accommodate this change in return force, a friction adjustment mechanism 70 is provided on the pivot shaft 55c that increases the frictional force that locks the wire holder 56 in accordance with the amount of traction of the operating wire 27 which is linked to the operation of the operating handle 51.
[0049] The operating wire 27 is pushed out toward the tip portion 23 when the operating handle 51 swings in the opening direction C, and pulled toward the operating portion 22 when the operating handle 51 swings in the closing direction D. In this case, when the operating handle 51 swings in the closing direction D, the gripping portion 24 is closed and the curved portion 25 is curved.
[0050] The operating handle 51 has a friction adjustment mechanism 70 that maintains its operating state, so that the curvature angle of the curved section 25 can be maintained at any angle below the maximum curvature angle. The friction adjustment mechanism 70 increases the frictional force that locks the wire holder 56 in response to the increase in the amount of pull of the operating wire 27 by the wire holder 56, which is linked to the swinging of the operating handle 51. As a result, even if the wire return force becomes strong due to an increase in the amount of pull of the operating wire 27, the operating handle 51 is prevented from returning to its original position. This allows the user to release their hand from the operating handle 51 regardless of its operating position, and furthermore, since the operating force required during rotation is small, stable operation is possible.
[0051] Referring to Figures 13 to 18, the first example of a procedure using the endoscopic instrument 20 will be explained. In this example, the procedure for endoscopic submucosal dissection (ESD) will be explained. Figure 13 is a diagram showing the first example (part 1) of a procedure using the endoscopic instrument 20. Figure 14 is a diagram showing the first example (part 2) of a procedure using the endoscopic instrument 20. Figure 15 is a diagram showing the first example (part 3) of a procedure using the endoscopic instrument 20. Furthermore, Figure 16 is a diagram showing the first example (part 1) of a procedure using the endoscopic instrument 20 in combination with other endoscopic instruments. Figure 17 is a diagram showing the first example (part 2) of a procedure using the endoscopic instrument 20 in combination with other endoscopic instruments. Figure 18 is a diagram showing the first example (part 3) of a procedure using the endoscopic instrument 20 in combination with other endoscopic instruments.
[0052] Furthermore, the operating wire 27 is pulled toward the operating section 22 when the operating handle 51 swings in the closing direction D. Another endoscopic instrument used in combination with the endoscopic instrument 20 is a cutting instrument, which is a high-frequency scissor forceps 60 having a pair of openable and closable claws 61 at its tip (see Figure 16). The pair of claws 61 are opened and closed by operating the operating section of the high-frequency scissor forceps 60. When the pair of claws 61 are closed and the biological tissue is grasped by the pair of claws 61, the biological tissue is cauterized and cut by passing a high-frequency current between the pair of claws 61 and the counter electrode plate via the biological tissue, or by passing a high-frequency current between the pair of claws 61. The endoscopic instrument 20 is an example of the "first treatment instrument" of the present invention. The high-frequency scissor forceps 60 is an example of the "second treatment instrument" of the present invention.
[0053] As shown in Figure 13, the endoscope tip 10 of the endoscope 2, which has been inserted into the body, is positioned laterally to the lesion site LA in the mucosal layer. The endoscopic treatment instrument 20 is inserted through the first treatment instrument channel 14 of the endoscope 2, and the tip 23 and bending portion 25 of the endoscopic treatment instrument 20 protrude from the end face of the endoscope tip 10. Then, by operating the operating portion 22 of the endoscopic treatment instrument 20, the lesion site LA is grasped by the gripping portion 24 of the tip 23.
[0054] When the lesion site LA is grasped by the gripping section 24, first, the operating handle 51 (see Figure 10) of the operating section 22 is operated in the opening direction C. As shown in Figure 13, by operating the operating handle 51 in the opening direction C, the operating wire 27 is pushed out toward the tip section 23, and as the operating wire 27 is pushed out, the curved section 25 is straightened and laid flat along the longitudinal axis of the connecting section 26. Also, as the operating wire 27 is pushed out, the pair of gripping claws 30 of the gripping section 24 are opened. Then, by appropriately pushing and pulling the operating section body 50, the lesion site LA is positioned between the pair of gripping claws 30.
[0055] Next, with the lesion site LA positioned between the pair of gripping claws 30, the operating handle 51 is operated in the closing direction D. This pulls the operating wire 27 towards the operating section 22. As the operating wire 27 is pulled, first, as shown in Figure 14, the pair of gripping claws 30 close, and the lesion site LA is gripped by the gripping section 24. Then, after the lesion site LA is gripped by the gripping section 24, the curved section 25 is curved, as shown in Figure 15. This causes the gripping section 24 to be raised from its lying position along the longitudinal axis of the connecting section 26, and the lesion site LA being gripped by the gripping section 24 is lifted.
[0056] Next, with the lesion site LA lifted, as shown in Figure 16, the high-frequency scissor forceps 60, which is inserted into the second treatment instrument channel 16 of the endoscope 2, protrudes from the end face of the endoscope tip 10. The pair of claws 61 of the high-frequency scissor forceps 60 are positioned on the lower part of the lesion site LA, and the lower part of the lesion site LA is incised by the pair of claws 61. As the incision progresses, the lifted lesion site LA may be released, grasped again, and then lifted. Once the lesion site LA has been incised, it is possible to lift it and expose the lower part for easier visualization. The incision is advanced by appropriately pushing and pulling the high-frequency scissor forceps 60, and the lesion site LA, including the submucosa, is gradually dissected.
[0057] Thus, by simply operating the operating handle 51 of the endoscopic treatment instrument 20, the lesion site LA can be grasped from the side of the lesion site LA and lifted, making the operation simple. Furthermore, by lifting the lesion site LA, the lower part of the lesion site LA can be easily visualized and exposed, allowing for safe, reliable, and easy treatment of the lower part of the lifted lesion site LA.
[0058] During incision, the operating unit body 50 of the operating unit 22 may be pushed and pulled in the direction of arrow E in Figure 10, and / or rotated in the direction of arrow F in Figure 10. As described above, the connecting part 26 has rigidity that allows translational and rotational power to be transmitted from the operating unit 22 side to the curved part 25 side, and the pushing, pulling and rotation of the operating unit body 50 are transmitted to the curved part 25 via the connecting part 26.
[0059] Figure 17 shows the movement of the gripping portion 24 when the operating portion body 50 is rotated. In response to the rotation of the operating portion body 50, the connecting portion 26 rotates around its longitudinal axis. When the curved portion 25 is curved, the gripping portion 24 rotates while maintaining an upright position relative to the longitudinal axis of the connecting portion 26. As the gripping portion 24 rotates, the lesion site LA gripped by the gripping portion 24 is swung around the longitudinal axis of the connecting portion 26.
[0060] Figure 18 shows the movement of the gripping portion 24 when the operating portion body 50 is pushed or pulled. In response to the pushing or pulling of the operating portion body 50, the connecting portion 26 moves forward and backward in the axial direction of the longitudinal axis of the connecting portion 26. When the curved portion 25 is curved, the gripping portion 24 moves forward and backward while maintaining an upright position relative to the longitudinal axis of the connecting portion 26. As the gripping portion 24 moves forward and backward, the lesion site LA gripped by the gripping portion 24 is pushed or pulled in the axial direction of the longitudinal axis of the connecting portion 26.
[0061] By appropriately shaking and / or pushing and pulling the lesion site LA, for example, the incision can be widened. This makes it easier to treat the lower part of the lesion site LA.
[0062] Figure 19 shows the state in which the endoscopic treatment instrument 20 is attached to the first treatment instrument insertion port 13 of the endoscope control unit 7. As described above, the endoscopic treatment instrument 20 is attached to the endoscope control unit 7 by connecting the fixing part 52a of the fixing part 52 to the mouthpiece of the first treatment instrument insertion port 13 of the endoscope control unit 7. The insertion part 21 of the endoscopic treatment instrument 20 attached to the endoscope control unit 7, consisting of a tip part 23, a bending part 25, and a connecting part 26, is inserted into the first treatment instrument channel 14 that reaches from the first treatment instrument insertion port 13 to the endoscope tip 10.
[0063] Referring to Figures 20 to 22, the curvature of the curved portion 25 in the insertion portion 21 of the endoscopic treatment instrument 20 will be explained. Figure 20 shows the uncurved state of the curved portion 25 in the insertion portion 21. Figure 21 is a perspective view showing the curved state of the curved portion 25. Figure 22 is a plan view of the curved portion 25 shown in Figure 21.
[0064] As shown in Figure 20, the uncurved state of the curved portion 25 is when the curved portion 25 is straight relative to the end of the connecting portion 26 on the curved portion 25 side. As described above, the curved portion 25 is curved by the operation of the operating wire 27, which runs from the tip portion 23 through the curved portion 25 and the connecting portion 26 to the operating portion 22. In addition, the pair of gripping claws 30 at the tip portion 23 are opened and closed by the operation of the operating wire 27.
[0065] For example, when the operating wire 27 is pushed out toward the tip portion 23, as shown in Figure 20, the curved portion 25 is straightened out and laid flat along the longitudinal axis of the connecting portion 26, resulting in an uncurved state, and the pair of gripping claws 30 of the gripping portion 24 are opened.
[0066] In contrast, when the operating wire 27 is pulled towards the operating section 22, as shown in Figures 21 and 22, the pair of gripping claws 30 of the gripping section 24 are closed, and the curved section 25 is bent so as to curve upwards relative to the longitudinal axis of the connecting section 26. In this case, when the operating wire 27 is pulled towards the operating section 22, first the pair of gripping claws 30 are closed, and only after the pair of gripping claws 30 are closed does the curved section 25 become curved.
[0067] As shown in Figure 22, the maximum curvature angle θ of the curved portion 25 with respect to the longitudinal axis of the connecting portion 26 is configured to be greater than 90 degrees. The "maximum curvature angle" is the angle between the direction of the tip of the curved portion 25 when it is at its maximum curvature and the direction of the tip of the curved portion 25 when it is at its maximum curvature. The "maximum curvature" is the most curved state within the range that can be operated by the operation of the operation portion 22. The maximum curvature angle θ is preferably, for example, 100 degrees to 180 degrees.
[0068] Referring to Figures 23 to 25, a second example of the ESD procedure using the endoscopic instrument 20 will be explained. Figure 23 is a diagram showing the second example (part 1) of the procedure using the endoscopic instrument 20. Figure 24 is a diagram showing the second example (part 2) of the procedure using the endoscopic instrument 20. Figure 25 is a diagram showing the second example (part 3) of the procedure using the endoscopic instrument 20.
[0069] As shown in Figure 23, a drug (e.g., physiological saline) is injected into the submucosal layer SU by an injection needle 80 protruding from the end face of the end of the endoscope tip 10, causing the lesion site LA to float together with the mucosa MU. The injection needle 80 is inserted into the second treatment instrument channel 16 of the endoscope 2.
[0070] Next, the mucous membrane MU surrounding the floating lesion site LA is incised. The lesion site LA is then gradually dissected from the incised area. For example, as shown in Figure 24, the tip 23 and bending portion 25 of the endoscopic treatment instrument 20, which is inserted into the first treatment instrument channel 14 of the endoscope 2, and the high-frequency scissor forceps 60, which is inserted into the second treatment instrument channel 16, are made to protrude from the end face of the endoscope tip 10. After grasping the lesion site LA with the pair of gripping claws 30 of the tip 23 of the endoscopic treatment instrument 20, the bending portion 25 is bent to lift the lesion site LA that is grasped by the gripping claws 30. Then, with the lesion site LA lifted, the lower part of the lesion site LA is incised with the pair of claws 61 of the high-frequency scissor forceps 60.
[0071] When incising a lesion site LA, if the lesion site LA to be incised is small, or if it is the beginning of the incision, the amount (distance) required to lift the lesion site LA grasped by the gripping claw 30 is small. For this reason, as shown in Figure 24, for example, the direction of the tensile force of the curved portion 25 generated by bending the curved portion 25 is in the direction that pulls the grasped lesion site LA away from the submucosal layer SU (upward in Figure 24). Therefore, the curvature angle of the curved portion 25 required to lift the lesion site LA may be 90 degrees or less.
[0072] However, when the lesion site LA to be incised is large, or when the incision of the lesion site LA has progressed to a certain extent, the amount (distance) required to lift the lesion site LA grasped by the gripping claw 30 becomes large. For this reason, as shown in Figure 25, for example, the direction of the tensile force of the curved portion 25 generated by bending the curved portion 25 is in the direction that pulls the grasped lesion site LA away from the submucosa SU, and also in the direction that sends the grasped lesion site LA in the opposite direction to the incision (to the right in Figure 25). Therefore, the maximum bending angle θ of the curved portion 25 required to lift the lesion site LA and then send the lifted lesion site LA in the opposite direction to the incision needs to be greater than 90 degrees.
[0073] Figure 26 shows the positional relationship between the tip 23 and the endoscope 2 when the curved portion 25 is at its maximum curvature. As shown in Figure 26, the curved portion 25 and tip 23 of the endoscopic treatment instrument 20, which is inserted into the first treatment instrument channel 14 of the endoscope 2, extend outward from the end face 10a of the endoscope tip 10. When the extended curved portion 25 is curved to its maximum curvature angle (maximum curvature), the inner diameter of the arc traced by the curved portion 25 is greater than half the outer diameter DE of the endoscope tip 10.
[0074] The "inner diameter of the arc" is twice the radius of curvature. If the curvature is not constant, it is twice the radius of curvature of the part with the highest curvature (largest curvature). For example, as in this example, if the curvature of the arc drawn by the curved section 25 is not constant, and the inner diameter Dbs is twice the radius of curvature of the part with the highest curvature (largest curvature), and the inner diameter Dbl is twice the radius of curvature of the part with the lowest curvature (smallest curvature), then the inner diameter of the arc drawn by the curved section 25 is the inner diameter Dbs. The shape of the part of the endoscope 2 where the first treatment instrument channel 14 is provided is approximately circular when viewed along the longitudinal axis of the first treatment instrument channel 14, so the "outer diameter DE of the endoscope tip 10" is its outer diameter (diameter). If the shape of the endoscope tip 10 is elliptical, then the diameter of its major axis is the outer diameter DE. Therefore, the relationship between the inner diameter Dbs of the arc drawn by the curved section 25 and the outer diameter DE of the endoscope tip 10 is Dbs > DE / 2.
[0075] Furthermore, the bending section 25 is configured such that, at maximum bending, the tip portion 23 (gripping claw 30) extending from the first treatment instrument channel 14 does not come into contact with the endoscope tip 10 of the endoscope 2. In other words, the bending section 25 is non-contact with the endoscope tip 10 in any bending state where the bending angle is changed. Moreover, at maximum bending, the bending section 25 is non-contact with the endoscope tip 10 of the endoscope 2, regardless of the rotation state of the insertion section 21 due to the operation of the operating unit body 50.
[0076] Figure 27 shows an example of the end face 10a of the endoscope tip 10. As shown in Figure 27, the first treatment instrument channel 14 of the endoscope 2 is provided such that its center position C1 is offset from the center position C0 of the endoscope tip 10 of the endoscope 2. Although not shown in Figure 27, in addition to the first treatment instrument channel 14, a second treatment instrument channel 16 is also formed inside the endoscope tip 10 of the endoscope 2 (see, for example, Figure 13), and the center position of the second treatment instrument channel 16 is also provided such that it is offset from the center position C0 of the endoscope tip 10 of the endoscope 2. The outer diameter DE of the endoscope tip 10 is, for example, 5 mm to 14 mm, preferably 9 mm to 12 mm. The inner diameter DC of the first treatment instrument channel 14 is, for example, 2 mm to 6 mm, preferably 2.8 mm to 3.8 mm.
[0077] In this way, the endoscopic treatment instrument 20 can be configured such that, by operating the operating handle 51, the pair of gripping claws 30 of the gripping section 24 are closed, and the bending section 25 is bent while the gripping claws 30 are closed, making the maximum bending angle of the bent bending section 25 greater than 90 degrees. With this configuration, by bending the bending section 25, it is possible to continuously pull the lesion site LA grasped by the gripping claws 30 over a wide area. For this reason, even if the lesion site LA to be incised is large, or even if the incision of the lesion site LA has progressed to a certain extent, the number of times the lesion site LA needs to be re-gripped by the gripping claws 30 can be reduced. As a result, the lower part of the lesion site LA can be easily seen and exposed, and treatment of the lower part of the lesion site LA can be performed safely, reliably, and easily. Thus, the ease of treatment of the lesion site LA can be improved.
[0078] Furthermore, when the bending section 25 of the endoscopic treatment instrument 20 is at its maximum bending point, the inner diameter Dbs of the arc traced by the bending section 25 is greater than half the outer diameter DE of the endoscope tip 10. Therefore, even when the bending section 25 is at its maximum bending point, the tip 23 extending from the first treatment instrument channel 14 does not come into contact with the endoscope tip 10 of the endoscope 2. Also, even when the bending section 25 is at its maximum bending point, regardless of the rotational state of the insertion section 21, the tip 23 extending from the first treatment instrument channel 14 does not come into contact with the endoscope tip 10 of the endoscope 2. As a result, when the lesion site LA is grasped and lifted with the gripping claw 30, treatment of the lower part of the lesion site LA can be performed safely and reliably. Thus, the ease of treatment of the lesion site LA can be improved.
[0079] In the above embodiment, the operating handle 51 is described as being mounted to extend outwards from the operating unit body 50 and swingable, and moving the wire holding part 56 by the swing. However, the configuration is not limited to this. Figure 28 shows another example of the operating handle 51. For example, as shown in Figure 28, the operating handle 51 may be mounted on a flat portion 50b provided on the operating unit body 50 and be a member that can move in the direction E along this flat portion 50b. The operating handle 51 is operated, for example, by the thumb of an operator who is gripping the operating unit body 50.
[0080] In this case, the operating handle 51 is connected to the wire holder 56, and when the operating handle 51 is moved to the front end side of the operating unit body 50 (upper side in Figure 28), the wire holder 56 also moves to the front end side of the operating unit body 50, and the operating wire 27 is pulled. Also, when the operating handle 51 is moved to the base end side of the operating unit body 50 (lower side in Figure 28), the wire holder 56 also moves to the base end side of the operating unit body 50, and the operating wire 27 is loosened. In other words, in the configuration shown in Figure 28, the operation of moving the operating handle 51 up and down can achieve the same operation as the operation of swinging the operating handle 51 shown in Figure 11, etc. In the configuration shown in Figure 28, the position and shape of the operating handle 51 and the flat part 50b are not limited to the configuration shown in Figure 28. [Explanation of Symbols]
[0081] 1 Endoscopy System 2 Endoscope 3 Light source device 4 processors 5 monitors 6. Endoscope insertion area 7 Endoscope Control Section 8 Universal Code 9 connectors 10 Endoscope tip 10a end face 11 Endoscope bending section 12 Endoscope connection section 13 First treatment instrument insertion port 14. First treatment tool channel 15. Second instrument insertion port 16. Second treatment instrument channel 20 Endoscopic treatment instruments 21 Insertion part 22 Control section 23 Tip 24 Gripping part 25 Curved section 26 Connection part 27 Operating wire 30 Gripping claw 31,57 Link members 32 Support 33,46 pins 42 Curved pieces 43 Hull 47 Wire guide 50 Control Unit 50b Flat part 51 Operating handle 51a Free end 52 Fixed part 52a Connecting fittings 55a,55b,55c Rotating shaft part 56 Wire holding section 60 forceps 61 Nails 70 Friction adjustment mechanism 80 Syringe needle C0,C1 position
Claims
1. An insertable part that can be inserted into the body, An operating section is located on the base end side of the insertion portion, Equipped with, The aforementioned insertion portion is A tip having an opening and closing gripping section, A flexible curved portion adjacent to the operating portion side of the aforementioned tip, A connecting portion that connects the curved portion and the operating portion, Includes, The insertion portion can be moved forward and backward along the longitudinal axis of the connecting portion and rotated about the longitudinal axis by operating the operating portion. By operating the aforementioned operating part, the gripping part closes, and the curved part curves while the gripping part is closed. The maximum curvature angle of the curved portion with respect to the longitudinal axis is greater than 90 degrees. Endoscopic instruments.
2. An endoscopic treatment instrument according to claim 1, It is equipped with at least one operating wire connected to the operating section, which operates at least one of the following: opening and closing of the gripping section and bending of the curved section. Endoscopic instruments.
3. An endoscopic treatment instrument according to claim 1, The aforementioned insertion portion is inserted into the instrument channel of the endoscope for use. The inner diameter of the arc traced by the curved portion at its maximum curvature is greater than half the outer diameter of the endoscope. Endoscopic instruments.
4. An endoscopic treatment instrument according to claim 1, The aforementioned insertion portion is inserted into the instrument channel of the endoscope for use. When the curved portion is at its maximum curvature, the tip portion extending from the treatment instrument channel is not in contact with the endoscope. Endoscopic instruments.
5. The endoscopic treatment instrument according to claim 4, When the curved portion is at its maximum curvature, the tip portion extending from the treatment instrument channel is not in contact with the endoscope, regardless of the rotational state of the insertion portion. Endoscopic instruments.
6. An endoscopic treatment instrument according to any one of claims 1 to 5, An endoscope having a treatment instrument channel through which the insertion portion can be inserted, Endoscopic systems including...
7. The endoscopic system according to claim 6, The first treatment instrument, which is an endoscopic treatment instrument, The second treatment instrument, The endoscope and, Includes, The endoscope has a first treatment instrument channel through which the insertion portion of the first treatment instrument can be inserted, and a second treatment instrument channel through which the second treatment instrument can be inserted. Endoscopic system.