Endoscopic instruments and endoscopic systems
The endoscopic treatment instrument improves operability by using a flexible insertion part with a single operating wire to control gripping and bending, facilitating easier and safer procedures like endoscopic submucosal dissection.
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 treatment instruments have rigid tip portions that hinder operability and ease of use.
The endoscopic treatment instrument features a flexible insertion part with a rotating shaft and link member, allowing for a single operating wire to control both the opening and closing of the gripping section and the bending of the tip, with a friction adjustment mechanism to maintain curvature and reduce operational resistance.
This design enhances operability by simplifying the operation of the gripping and bending functions, enabling safer and more efficient procedures such as endoscopic submucosal dissection with reduced need for re-grasping and improved visibility of the treatment site.
Smart Images
Figure 2026086366000001_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 grasping forceps including a metal sheath inserted into a body cavity, a grasping part provided at the tip of the sheath, an operation part provided at the base end of the sheath for opening and closing the grasping part, a fixing screw for fixing the operation part to the sheath, and an electrode pin provided integrally with the fixing screw for energizing a high-frequency current through the sheath to the grasping part.
[0003] Patent Document 2 connects the rear end of an insertion member inserted into the body through an endoscope to an operation mechanism, rotatably supports an opening / closing body at the front end of an operation member, provides an interlocking member in the insertion member, drives and connects the rear end of the interlocking member to the operation mechanism, drives and connects the front end of the interlocking member to the opening / closing body through a linear member, operates the opening / closing body based on remote operation of the operation mechanism, uses a single linear member, and biases the opening / closing body in the opening direction by the elastic force of the linear member, and describes an endoscopic treatment instrument.
[0004] Patent Document 3 includes a base material formed in a sheet shape from an insulating material and having a through portion penetrating in the thickness direction, an electrode having a conductive application portion attached to one surface of the base material, and an electrode operation treatment instrument with the electrode detachably attached to the tip, and the electrode operation treatment instrument has a drawing means for drawing the pericardium on one surface side of the base material into the through portion in a state where the electrode is attached to the tip, and the electrode has a locking member protruding into the through portion along one surface, and describes a cardiac stimulation device system. [[ID=二十一]] [[ID=二十二]]
[0005] [[ID=二十三]] Patent Document 4 describes a high-frequency treatment device comprising an insertion part that can be inserted into the body, a pair of gripping parts positioned at the tip of the insertion part for grasping and coagulating or cutting biological tissue, and an operating part connected to the base end of the insertion part for opening and closing the gripping parts. A high-frequency current is passed through electrodes provided on the gripping surfaces of the gripping parts to coagulate and cut the biological tissue grasped by the gripping parts, and an electrically insulating part is provided on the gripping surface of at least one of the gripping parts. When the gripping parts are completely closed, the electrically insulating part abuts against the gripping surface of the other gripping part, thereby creating a predetermined gap between the gripping surfaces of each gripping part and preventing short circuits between the electrodes of each gripping part. [Prior art documents] [Patent Documents]
[0006] [Patent Document 1] Japanese Patent Application Publication No. 05-285147 [Patent Document 2] Japanese Patent Application Publication No. 10-118089 [Patent Document 3] Japanese Patent Publication No. 2013-042921 [Patent Document 4] Japanese Patent Publication No. 2000-070280 [Overview of the project]
[0007] One embodiment of the technology described herein provides an endoscopic treatment instrument and an endoscopic system that can improve operability by shortening the rigid tip portion. [Means for solving the problem]
[0008] (1) An insertion part including a tip that can be inserted into the body and has an opening and closing treatment section, An operating section is located on the base end side of the insertion section, Connected to the above-mentioned operating unit, at least one operating wire is provided to operate the opening and closing of the above-mentioned treatment unit, Equipped with, The above-mentioned treatment unit includes a tip operating unit, a link member rotatably connected to the base end side of the tip operating unit, and a connecting member rotatably connected to the base end side of the link member. The above operating wire is fixed to the above connecting member. In the longitudinal axis direction of the insertion portion, at least a portion of the operating wire and the link member overlap. Endoscopic instruments.
[0009] (2) (1) The endoscopic treatment instrument described above, The above-mentioned connecting member has a rotating shaft portion that rotatably connects the above-mentioned link member and the above-mentioned connecting member. Endoscopic instruments.
[0010] (3) (2) Endoscopic treatment instrument as described above, The above-mentioned connecting member has the above-mentioned rotating shaft portion and an insertion hole through which the above-mentioned operating wire can be inserted and which intersects with the rotating shaft of the above-mentioned rotating shaft portion, The above operating wire is fixed to the inner surface of the above insertion hole. Endoscopic instruments.
[0011] (4) (3) Endoscopic treatment instrument as described above, In the longitudinal axis direction described above, the insertion hole is longer than the rotating shaft portion. Endoscopic instruments.
[0012] (5) (4) Endoscopic treatment instrument, In the longitudinal axis direction described above, the portion in contact with the inner surface of the insertion hole and the operating wire is longer than the rotating shaft portion. Endoscopic instruments.
[0013] (6) An endoscopic instrument described in any one of (2) to (5), The housing includes the above-mentioned connecting member and has a guide groove that guides the movement of the above-mentioned rotating shaft portion in the longitudinal axis direction, Endoscopic instruments.
[0014] (7) (1) to (6) any one of the endoscope treatment devices described, The insertion portion includes a bendable bending portion adjacent to the operation portion side of the tip portion. Endoscope treatment device.
[0015] (8) (7) The endoscope treatment device described, By the operation of the operation portion, the bending portion bends. Endoscope treatment device.
[0016] (9) (1) The endoscope treatment device described, The connecting member and the operation wire are fixed by laser welding. Endoscope treatment device.
[0017] (10) (9) The endoscope treatment device described, The connecting member and the operation wire are laser welded other than the rear end surface of the connecting member. Endoscope treatment device.
[0018] (11) (1) to (10) any one of the endoscope treatment devices described, An endoscope having a treatment tool channel through which the insertion portion can be inserted, Endoscope system including.
Effect of the Invention
[0019] According to the present invention, it is possible to provide an endoscope treatment device and an endoscope system capable of improving the operability by shortening the rigid portion at the tip.
Brief Explanation of Drawings
[0020] [Figure 1] It is a figure which shows an example of the endoscope system of embodiment of this invention. [Figure 2]This figure shows an example of an endoscopic treatment instrument 20 according to an embodiment of the present invention. [Figure 3] This diagram shows the configuration of the gripping portion 24 of the tip portion 23 of the endoscopic treatment instrument 20. [Figure 4] This diagram shows the operation of the gripping part 24 in Figure 3. [Figure 5] This figure shows the configuration of the bending portion 25 and the connecting portion 26 of the endoscopic treatment instrument 20. [Figure 6] This figure shows the operation of the curved section 25. [Figure 7] This diagram shows the internal structure of the curved section 25. [Figure 8] Figure 7 shows a cross-sectional view of the curved portion 25 along line aa. [Figure 9] This diagram shows the internal workings of the curved section 25. [Figure 10] This diagram shows the configuration of the operating section 22 of the endoscopic treatment instrument 20. [Figure 11] This is a cross-sectional view of the operating section 22 of the endoscopic treatment instrument 20. [Figure 12] This is a cross-sectional view showing the closed state of the operating section 22 of the endoscopic treatment instrument 20. [Figure 13] This figure shows the first example (part 1) of a treatment method using the endoscopic treatment instrument 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 is a perspective view illustrating the configuration of the tip 23 to which the operating wire 27 is connected. [Figure 24] Figure 23 is a plan view of the tip portion 23 and the operating wire 27. [Figure 25] This is a perspective view illustrating the configuration of the connecting member 83 that connects the operating wire 27 and the link members 81a and 81b. [Figure 26] This is a cross-sectional view of the tip portion 23 and the operating wire 27 along the longitudinal direction of the insertion portion 21. [Figure 27] This is a view of the tip portion 23 and the operating wire 27 as seen from the direction of the rotation axis Y of the rotating shaft portion 84. [Figure 28] Figure 27 shows a cross-sectional view of the tip portion 23 along the bb line. [Figure 29] This figure shows another example of the operating handle 51. [Modes for carrying out the invention]
[0021] 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.
[0022] 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 that is inserted into a subject, an endoscope operating section 7 connected to the endoscope insertion section 6, and a universal cord 8 extending from the endoscope operating 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 that connects the endoscope bending section 11 and the endoscope operating section 7.
[0023] 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.
[0024] 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.
[0025] 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.
[0026] 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.
[0027] 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.
[0028] The insertion section 21 includes a tip section 23 having a gripping section 24 that can be opened and closed by operation of 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 that connects the curved section 25 and the operating section 22. The gripping section 24 is an example of the "treatment section" of the present invention. When the insertion section 21 is inserted through the first treatment instrument channel 14, the connecting section 26 is housed in 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 in 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.
[0029] 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.
[0030] 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 support body 32 is an example of the "housing" of the present invention. 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.
[0031] The tip of a link member 31 is rotatably connected to the base end of the gripping claw 30. An operating wire 27 is connected to the base end of the link member 31. The operating wire 27 reaches the operating section 22 from its tip 23 through a curved section 25 and a 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.
[0032] 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.
[0033] 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.
[0034] 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.
[0035] 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.
[0036] 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.
[0037] 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.
[0038] 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.
[0039] 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.
[0040] 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.
[0041] 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.
[0042] 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.
[0043] 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.
[0044] 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.
[0045] 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.
[0046] 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).
[0047] 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.
[0048] 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.
[0049] 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.
[0050] 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).
[0051] 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).
[0052] 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.
[0053] 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.
[0054] 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.
[0055] 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.
[0056] 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.
[0057] 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.
[0058] 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.
[0059] 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.
[0060] 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.
[0061] 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.
[0062] 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.
[0063] 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.
[0064] 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.
[0065] 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.
[0066] 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.
[0067] 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.
[0068] 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.
[0069] 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.
[0070] 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.
[0071] 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.
[0072] By making the maximum curvature angle of the curved portion 25 greater than 90 degrees, it becomes possible to continuously pull the lesion site LA grasped by the gripping claw 30 over a wide area. Therefore, 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 claw 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.
[0073] The configuration of the tip section 23 to which the operating wire 27 is connected will be explained with reference to Figures 23 to 28. Figure 23 is a perspective view illustrating the configuration of the tip section 23 to which the operating wire 27 is connected. Figure 24 is a plan view of the tip section 23 and operating wire 27 shown in Figure 23. Note that the support 32 of the tip section 23 is omitted in Figures 23 and 24 for clarity.
[0074] As shown in Figures 23 and 24, the operating wire 27 is connected to the gripping portion 24 (treatment portion) of the tip portion 23. The gripping portion 24 includes gripping claws 30a and 30b, link members 81a and 81b rotatably connected to the base ends of the gripping claws 30a and 30b, and a connecting member 83 rotatably connected to the base ends of the link members 81a and 81b. The gripping claws 30a and 30b are examples of the "tip operating portion" of the present invention.
[0075] The pair of gripping claws 30a and 30b are arranged in a cross shape, similar to the gripping claw 30 described in Figure 3 above, and are rotatable using a pin 33 that passes through the cross portion as the pivot axis.
[0076] Link member 81a is connected to gripping claw 30a. Link member 81b is connected to gripping claw 30b. Link member 81b and gripping claw 30b are arranged so that their ends intersect, and are rotatably connected using a pin 82b, which is provided through the intersection, as the pivot axis. Similarly, link member 81a and gripping claw 30a are arranged so that their ends intersect, and are rotatably connected using a pin (not shown) that is provided through the intersection as the pivot axis.
[0077] The end of link member 81a opposite to the end connected to the gripping claw 30a is connected to the connecting member 83. Similarly, the end of link member 81b opposite to the end connected to the gripping claw 30b is connected to the connecting member 83. Link member 81a is connected to the rotating shaft portion 84 of the connecting member 83. Similarly, link member 81b is connected to the rotating shaft portion 84 of the connecting member 83.
[0078] The operating wire 27 is fixed to the connecting member 83 of the gripping section 24. The connecting member 83 is a sleeve member that connects the operating wire 27 to the link members 81a and 81b. In the longitudinal axis direction of the insertion section 21, at least a portion of the operating wire 27 overlaps with the link members 81a and 81b connected to the rotating shaft section 84 and is fixed to the connecting member 83. Laser welding, soldering, brazing, crimping, etc., can be used to fix the connecting member 83 and the operating wire 27, but soldering and brazing may cause solder or solder to penetrate to the base end of the wire, in which case the wire in the penetrated area may harden and hinder the curvature of the curved section 25. Therefore, a method of welding a controlled area using laser welding is preferred. Furthermore, by avoiding the rear end face of the connecting member 83 (the end face on the operating section 22 side) in the laser welding area, the influence of the change in wire stiffness due to welding on the curvature can be minimized. For example, by aligning the tip surface of the connecting member 83 (the end surface on the gripping portion 24 side) with the tip surface of the operating wire 27 and laser welding these tip surfaces, it becomes possible to weld a limited area including the tip surfaces.
[0079] Figure 25 is a perspective view illustrating the configuration of a connecting member 83 that connects the operating wire 27 to the link members 81a and 81b. The connecting member 83 has a rotating shaft portion 84 that rotatably connects the link members 81a and 81b to the connecting member 83, and an insertion hole 85 through which the operating wire 27 can be inserted. The rotating shaft portion 84 is configured, for example, in a cylindrical shape. The insertion hole 85 is formed so as to intersect with the rotation axis Y of the rotating shaft portion 84. The insertion hole 85 is formed to penetrate the rotating shaft portion 84 in a direction perpendicular to the rotation axis Y direction of the rotating shaft portion 84. The operating wire 27 inserted through the insertion hole 85 is fixed to the inner surface of the insertion hole 85. The "rotation axis Y of the rotating shaft portion 84" is a hypothetical rotation axis (straight line).
[0080] The central part of the rotating shaft portion 84 in the direction of the rotation axis Y is provided with an extension portion 86, for example, a rectangular shape, that extends in the direction through which the operating wire 27 is inserted. The insertion hole 85 of the connecting member 83 is formed to penetrate both the rotating shaft portion 84 and the extension portion 86. Therefore, in the longitudinal axis direction of the insertion portion 21, the length of the insertion hole 85 is longer than the length (diameter) of the rotating shaft portion 84. As a result, in the longitudinal axis direction of the insertion portion 21, the length of the portion in contact between the inner surface of the insertion hole 85 and the operating wire 27 is longer than the length (diameter) of the rotating shaft portion 84. For example, the connecting member 83 is integrally molded including the rotating shaft portion 84, the extension portion 86, and the insertion hole 85.
[0081] Figure 26 is a cross-sectional view of the tip portion 23 and operating wire 27 along the longitudinal direction of the insertion portion 21. Figure 27 is a view of the tip portion 23 and operating wire 27 from the direction of the rotation axis Y of the rotating shaft portion 84. Figure 28 is a cross-sectional view of the tip portion 23 shown in Figure 27 along line bb. Figures 26 to 28 show the support 32 of the tip portion 23.
[0082] As shown in Figure 26, link members 81a and 81b are each connected to the rotating shaft portion 84 of the connecting member 83. Link members 81a and 81b are connected to one side and the other side (upper and lower sides in Figure 26) of the rotating shaft portion 84, with an extension portion 86 formed on the rotating shaft portion 84 in between. The operating wire 27, which is inserted through the insertion hole 85 formed in the rotating shaft portion 84 and the extension portion 86, has its end overlapping with the link members 81a and 81b and is fixed to the connecting member 83.
[0083] As shown in Figures 26 and 27, a pin 33, which penetrates the intersection of a pair of gripping claws 30a and 30b, is fixed to a support 32 that houses the connecting member 83. The support 32 is provided, for example, to cover the connecting member 83 from both sides in the direction of the rotation axis Y of the rotating shaft portion 84. The pin 33 rotatably fixes the support 32, the link members 81a and 81b, and the gripping claws 30a and 30b.
[0084] As shown in Figures 27 and 28, the support 32 has a guide groove 34 that guides the movement of the connecting member 83. The guide groove 34 is formed in the support 32 along the longitudinal axis direction of the insertion portion 21. Both ends of the rotating shaft portion 84 of the connecting member 83 in the direction of the rotation axis Y engage with the guide groove 34. For example, when the operating wire 27 is pulled towards the operating portion 22, the rotating shaft portion 84 of the connecting member 83 connected to the operating wire 27 is guided by the guide groove 34 of the support 32 and moves towards the operating portion 22 in the longitudinal axis direction of the insertion portion 21. Similarly, when the operating wire 27 is pushed out towards the tip portion 23, the rotating shaft portion 84 of the connecting member 83 is guided by the guide groove 34 and moves towards the tip portion 23 in the longitudinal axis direction of the insertion portion 21.
[0085] In Figures 23 to 28 above, the gripping portion 24 of the tip 23 of the endoscopic treatment instrument 20 is described as an example of the "treatment portion," but it is not limited to this. An example of the "treatment portion" may be the tip of a high-frequency scissor forceps 60, for example.
[0086] Thus, the endoscopic treatment instrument 20 comprises a gripping portion 24 including gripping claws 30a, 30b, link members 81a, 81b rotatably connected to the base ends of the gripping claws 30a, 30b, and a connecting member 83 rotatably connected to the base ends of the link members 81a, 81b, and at least one operating wire 27 fixed to the connecting member 83 for operating the opening and closing of the gripping claws 30a, 30b, and in the longitudinal axis direction of the insertion portion 21 that can be inserted into the body, at least a portion of the operating wire 27 fixed to the connecting member 83 and the link members 81a, 81b connected to the connecting member 83 are arranged to overlap. With this configuration, since the operating wire 27 and the link members 81a, 81b are connected to the connecting member 83 and the two connected members are arranged to overlap, the length of the gripping portion 24 in the longitudinal axis direction of the insertion portion 21 can be shortened. This allows the insertion portion 21 of the endoscopic treatment instrument 20 to be easily inserted into the first treatment instrument channel 14 of the endoscope operating section 7, even when the first treatment instrument channel 14 is curved. In addition, the gripping portion 24 extending from the endoscope tip 10 can be operated at a position close to the end face of the endoscope tip 10. Therefore, shortening the gripping portion 24 of the tip 23 improves operability.
[0087] Furthermore, according to the endoscopic treatment instrument 20, the connecting member 83 is provided with a rotating shaft portion 84 that rotatably connects the link members 81a, 81b and the connecting member 83, and an insertion hole 85 through which the operating wire 27 can be inserted and which intersects with the rotation axis Y of the rotating shaft portion 84, and the operating wire 27 is fixed to the inner surface of the insertion hole 85. As a result, the operating wire 27 inserted through the insertion hole 85 which intersects with the rotation axis Y of the rotating shaft portion 84 and the link members 81a, 81b are arranged to overlap, so the length of the gripping portion 24 in the longitudinal axis direction of the insertion portion 21 can be shortened, improving operability.
[0088] Furthermore, in the endoscopic instrument 20, the rotating shaft portion 84 is provided with an extension portion 86 that extends in the direction through which the operating wire 27 is inserted, and an insertion hole 85 for inserting the operating wire 27 is provided in the extension portion 86. Therefore, in the longitudinal axis direction of the insertion portion 21, the length of the insertion hole 85 can be made longer than the length (diameter) of the rotating shaft portion 84, so that the portion in contact between the inner surface of the insertion hole 85 and the operating wire 27 can be made longer than the diameter of the rotating shaft portion 84. This makes it possible to increase the fixing strength of the operating wire 27 fixed to the inner surface of the insertion hole 85.
[0089] Furthermore, in the endoscopic treatment instrument 20, the support body 32 that houses the connecting member 83 is provided with a guide groove 34 that guides the movement of the rotation shaft portion 84 in the longitudinal axis direction of the insertion portion 21. Therefore, when the operating wire 27 is pulled or pushed, the rotation shaft portion 84 can be guided along the guide groove 34, allowing it to move along the longitudinal axis direction of the insertion portion 21. This allows the link members 81a, 81b connected to the rotation shaft portion 84 and the pair of gripping claws 30a, 30b connected to the link members 81a, 81b to operate symmetrically around the longitudinal axis of the insertion portion 21. Thus, the operability of the endoscopic treatment instrument 20 can be improved.
[0090] 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 29 shows another example of the operating handle 51. For example, as shown in Figure 29, 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.
[0091] 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 29), 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 29), 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 29, 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 29, the position and shape of the operating handle 51 and the flat part 50b are not limited to the configuration shown in Figure 29. [Explanation of Symbols]
[0092] 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 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 30,30a,30b Gripping claw 31, 57, 81a, 81b Link members 32 Support 33,46,82b pins 34 Guide grooves 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 83 Connecting member 84 Rotating shaft section 85 Through hole 86 Extension
Claims
1. An insertion part including a tip that can be inserted into the body and has an opening and closing treatment section, An operating section is located on the base end side of the insertion portion, At least one operating wire connected to the operating unit for operating the opening and closing of the treatment unit, Equipped with, The treatment unit includes a tip operating unit, a link member rotatably connected to the base end of the tip operating unit, and a connecting member rotatably connected to the base end of the link member. The operating wire is fixed to the connecting member. In the longitudinal axis direction of the insertion portion, at least a portion of the operating wire and the link member overlap. Endoscopic instruments.
2. An endoscopic treatment instrument according to claim 1, The connecting member has a rotating shaft portion that rotatably connects the link member and the connecting member. Endoscopic instruments.
3. The endoscopic treatment instrument according to claim 2, The connecting member has the rotating shaft portion and an insertion hole through which the operating wire can be inserted and which intersects with the rotating shaft portion of the rotating shaft portion. The operating wire is fixed to the inner surface of the insertion hole. Endoscopic instruments.
4. The endoscopic treatment instrument according to claim 3, In the longitudinal axis direction, the insertion hole is longer than the rotating shaft portion. Endoscopic instruments.
5. The endoscopic treatment instrument according to claim 4, In the longitudinal axis direction, the portion in contact with the inner surface of the insertion hole and the operating wire is longer than the rotating shaft portion. Endoscopic instruments.
6. The endoscopic treatment instrument according to claim 2, The housing includes a connecting member and a guide groove that guides the movement of the rotating shaft portion in the longitudinal direction, Endoscopic instruments.
7. An endoscopic treatment instrument according to claim 1, The insertion portion includes a bendable curved portion adjacent to the tip portion on the operating portion side, Endoscopic instruments.
8. An endoscopic treatment instrument according to claim 7, The curved portion bends as a result of the operation of the control unit. Endoscopic instruments.
9. An endoscopic treatment instrument according to claim 1, The connecting member and the operating wire are fixed together by laser welding. Endoscopic instruments.
10. An endoscopic treatment instrument according to claim 9, The connecting member and the operating wire are laser-welded to a surface other than the rear end surface of the connecting member. Endoscopic instruments.
11. An endoscopic treatment instrument according to any one of claims 1 to 10, An endoscope having a treatment instrument channel through which the insertion portion can be inserted, Endoscopic systems including...