Endoscopic treatment tools

Abstract

To provide a treatment tool for an endoscope according to the present invention that enables water supply from a distal end of a high-frequency knife or sheath to be performed preferably.SOLUTION: A treatment tool for an endoscope according to the present invention includes: a sheath 1 extending in a longitudinal direction; an insulation distal end member 11 provided in a distal end of the sheath 1 and having a through hole 12 penetrating in a longitudinal direction; a metal electrode 2 that is inserted to the through hole 12, advances or retreats in the longitudinal direction, and includes a first pipe line 22 for water supply extending in the longitudinal direction; and a rod 3 extending in the longitudinal direction and arranged at least in the first pipe line 22.SELECTED DRAWING: Figure 4

Description

[Technical field]

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

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

[0003] The endoscopic treatment tools described in Patent Documents 1 and 2 are configured to enable incision, cauterization, and ablation treatment using a high-frequency knife and hemostasis treatment, and also to enable local injection treatment in which a liquid (local injection liquid) is fed from the tip of a sheath. Patent Documents 1 and 2 also describe an endoscopic treatment tool (a so-called dual knife) that can feed water from a water feed port provided at the tip of the high-frequency knife in addition to feeding water from a water feed port of a sheath formed on the side of the high-frequency knife. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] US Patent Application Publication No. 2021 / 0113260 [Patent Document 2] US Patent Application Publication No. 2022 / 0096154 Summary of the Invention [Problem to be solved by the invention]

[0005] In the endoscopic treatment tools described in Patent Documents 1 and 2, the tip of the high-frequency knife is applied to the treatment area during incision, cauterization, ablation, and hemostasis treatment, so tissue adheres to the tip of the high-frequency knife or gets into the water supply port at the tip and becomes clogged. This can weaken the water supply force of the fluid to the treatment area when the surgeon performs local injection treatment, or can cause the water supply to become unstable. In addition, if high-frequency energy is supplied while the tissue is attached to the high-frequency knife, the tissue will be burned. The burnt tissue adheres to the tip of the high-frequency knife, so it is difficult to remove the burnt tissue even if the water supply force is increased.

[0006] The present invention has been made in consideration of the above circumstances, and has an object to provide an endoscopic treatment tool that allows water to be appropriately supplied from the tip of a high-frequency knife or a sheath. [Means for solving the problem]

[0007] In order to solve the above problems, the present invention proposes the following means. The endoscopic treatment tool according to a first aspect of the present invention comprises a sheath extending in a longitudinal direction, an insulating tip member provided at a tip of the sheath and having a through hole penetrating in the longitudinal direction, a metal electrode inserted into the through hole and advancing and retreating in the longitudinal direction, the metal electrode having a first pipeline for water supply extending in the longitudinal direction, and a rod extending in the longitudinal direction and disposed in at least the first pipeline, the rod being With respect to the electrode The device has a scorched part removal section that can remove scorched part adhering to the first pipe line by moving back and forth. Effect of the Invention

[0008] According to the endoscopic treatment tool of the present invention, water can be suitably supplied from the tip of the high-frequency knife or the sheath. [Brief description of the drawings]

[0009] [Figure 1] 1 is a diagram showing an overall configuration of an endoscopic treatment system according to a first embodiment of the present invention. [Diagram 2] 2 is an overall view showing a treatment tool of the endoscope treatment system. FIG. [Diagram 3] FIG. [Figure 4] 4 is a cross-sectional view of the distal end of the treatment tool. FIG. [Diagram 5] FIG. 4 is a perspective view showing a distal end portion of the treatment tool in a pre-treatment state. [Figure 6] FIG. 4 is a cross-sectional view showing the distal end of the treatment tool in a pre-treatment state. [Figure 7] FIG. 4 is a perspective view showing the distal end of the treatment tool in a water supplying state. [Figure 8] FIG. 4 is a cross-sectional view showing the distal end of the treatment tool in a water supplying state. [Figure 9] 13 is a cross-sectional view showing a sealing member of a treatment tool which is a modified example of the rod of the treatment tool. FIG. [Figure 10] 13 is a cross-sectional view showing a modified example of the rod of the treatment tool. FIG. [Figure 11] FIG. 4 is a cross-sectional view showing the rod in an advanced state. [Figure 12] 13 is a cross-sectional view showing a modified example of the rod of the treatment tool. FIG. [Figure 13] FIG. 4 is a cross-sectional view showing a state in which the knife of the treatment tool has been moved. [Figure 14] FIG. 11 is a perspective view showing a modified example of the knife. [Figure 15] FIG. 11 is a perspective view showing a modified example of the knife. [Figure 16] 13A and 13B are diagrams showing a modified example of the operation section of the treatment tool in a closed state. [Figure 17] 13A and 13B are diagrams showing an open state of a modified example of the operation section of the treatment tool. [Figure 18] 13A and 13B are diagrams showing a modified example of the operation section of the treatment tool in a closed state. [Figure 19] FIG. 11 is a cross-sectional view showing a modified example of the rod. [Figure 20] 13 is a cross-sectional view showing a rod slider positioned in a first region in a modified example of the operating portion. FIG. [Figure 21]13 is a cross-sectional view showing a rod slider positioned in a second region in a modified example of the operating portion. FIG. [Figure 22] 13 is a cross-sectional view showing a rod slider positioned in a third region in a modified example of the operating portion. FIG. [Figure 23] FIG. 11 is a cross-sectional view showing a modified example of the operation unit. [Figure 24] FIG. 11 is a cross-sectional view showing a modified example of the operation unit. [Diagram 25] 13 is a diagram showing the connection between the lever and the rod of the operating unit. FIG. [Figure 26] 26 is a cross-sectional view of the lever and the tubular member taken along line XX shown in FIG. 25. [Figure 27] 13 is a cross-sectional view showing a modified example of the lever and the tubular member. FIG. [Figure 28] 13 is a cross-sectional view showing a modified example of the lever and the tubular member. FIG. [Figure 29] FIG. 11 is a perspective view of a distal end portion of a treatment tool according to a second embodiment. [Diagram 30] 4 is a cross-sectional view of the distal end of the treatment tool. FIG. [Diagram 31] 13 is a cross-sectional view showing a modified insulating tip of a sheath of the treatment instrument. FIG. [Diagram 32] 13 is a cross-sectional view showing the insulating tip in a state in which the knife of the treatment instrument is retracted toward the base end side. FIG. [Diagram 33] 13 is a perspective view showing a modified example of the protrusion of the insulating tip. FIG. [Diagram 34] 13 is a perspective view showing a modified example of the protrusion of the insulating tip. FIG. [Diagram 35] 13 is a cross-sectional view showing a modified example of the protrusion of the insulating tip. FIG. [Diagram 36] 13 is a cross-sectional view showing a modified insulating tip of a sheath of the treatment instrument. FIG. [Figure 37] FIG. 4 is a cross-sectional view showing a state in which the knife of the treatment tool has been moved. [Figure 38] FIG. 11 is a cross-sectional view showing a modified example of the treatment tool. [Figure 39]FIG. 11 is a cross-sectional view showing a modified example of the treatment tool. [Diagram 40] FIG. 13 is a diagram showing an endoscopic treatment system according to a third embodiment of the present invention. [Diagram 41] FIG. 2 is a schematic configuration diagram illustrating an example of the endoscope treatment system. [Diagram 42] 4 is a flow chart illustrating the operation of the endoscope treatment system. FIG. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] First embodiment An endoscopic treatment system 300 according to a first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 8. Fig. 1 is a diagram showing the overall configuration of the endoscopic treatment system 300 according to the first embodiment of the present invention.

[0011] [Endoscopic treatment system 300] An endoscopic treatment system (treatment system) 300 is used for surgery on the digestive tract, etc. As shown in Fig. 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment tool (endoscopic treatment tool) 100. The treatment tool 100 is inserted into the endoscope 200 for use.

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

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

[0014] The imaging unit 203 includes an imaging element such as a CCD or a CMOS, and can capture an image of a site to be treated. The imaging unit 203 can capture an image of the knife 2 of the treatment tool 100 in a state in which the treatment tool 100 protrudes from the distal end opening 206a of the channel 206.

[0015] The bending section 204 bends in response to an operator's operation of the operating section 207. The flexible section 205 is a tubular section having flexibility.

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

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

[0018] [Sheath 1] The sheath 1 extends in a longitudinal direction A. The sheath 1 is a long, flexible, and insulating resin member extending from a distal end 1a to a proximal end 1b. The sheath 1 has an outer diameter that allows it to be inserted into a channel 206 of an endoscope 200, and it can advance and retract through the channel 206. As shown in FIG. 1, when the sheath 1 is inserted into the channel 206, the distal end 1a of the sheath 1 can protrude and retract from a distal end opening 206a of the channel 206.

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

[0020] [Knife (high frequency knife) 2] FIG. 4 is a cross-sectional view of the distal end of the treatment tool 100. As shown in FIG. The knife (high-frequency knife) 2 is, for example, a high-frequency dual knife capable of incising, cauterizing, and dissecting by water supply and high-frequency current. The knife 2 is a roughly round bar-shaped metallic member inserted into the sheath 1 and moving back and forth in the longitudinal direction A. The knife 2 is provided so as to be able to protrude from the distal end opening 12a of the insulating tip 11 of the sheath 1 to the distal end side A1. The knife 2 is formed of a material such as stainless steel. The knife 2 is conductive and a high-frequency current is passed through it. The knife 2 has a knife body 20 and a flange 21.

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

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

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

[0024] Here, the tip opening 12a of the tip conduit 12h is formed to a size that allows it to engage with the flange 21, which is the tip of the knife 2. Also, the inner diameter L3 of the tip conduit 12h is smaller than the radial width L1 of the flange 21. Therefore, the flange 21 is locked by the tip opening 12a and does not move from the tip opening 12a to the base end side A2.

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

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

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

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

[0029] [Operation wire 4] 4, the operation wire 4 is a shaft that passes through the internal space 1s of the sheath 1, and includes a coil shaft 40 and a tube 41. The tip of the operation wire 4 is connected to the knife 2 by a connecting joint 23, and the base end of the operation wire 4 is connected to the operation section 5. Note that the operation wire 4 may be in other forms as long as it is a hollow shaft.

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

[0031] The tube 41 is, for example, a heat shrink tube, provided on the outer periphery of the coil shaft 40. By covering the outer periphery of the coil shaft 40 with the tube 41, liquid does not leak from the second water supply pipeline .

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

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

[0034] The slider 52 is attached to the operation unit body 51 so as to be movable along the longitudinal direction A. The slider 52 is attached to the sheath 1 connected to the operation unit body 51 via an O-ring or the like. The base end of the operation wire 4 is attached to the slider 52. When the surgeon advances or retreats the slider 52 relatively to the operation unit body 51, the operation wire 4 and the knife 2 advance or retreat.

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

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

[0037] The base end of the rod 3 is attached to the lever (slide lever) 55. The lever (slide lever) 55 is attached to the slider 52 so as to be movable along the longitudinal direction A. The surgeon can move the lever 55 along the longitudinal direction A to advance or retract the rod-shaped member 3 in the longitudinal direction A.

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

[0039] As shown in FIG. 3 and FIG. 4, when the slider 52 and the lever 55 are moved to the distal side A1, the knife 2 and the rod 3 protrude from the distal end 1a of the sheath 1. The state of the knife 2 and the rod 3 at this time is called a treatment state. In the treatment state, the surgeon can perform incision, cauterization, and dissection treatment. At this time, the distal end 3a of the rod 3 is located at the distal end opening 22a in the longitudinal direction A. In the following description, the position at which the distal end 3a is located at the distal end opening 22a in the longitudinal direction A is called a first position P1. At the first position P1, the distal end 3a overlaps with the distal end opening 22a when viewed from the width direction Y. That is, when the distal end 3a is located at the first position P1, the position of the distal end 3a coincides with the position of the distal end of the knife 2 in the longitudinal direction A. When the distal end 3a of the rod 3 is located at the first position P1, the distal end opening 22a is sealed by the distal end 3a of the rod 3. The form of the rod 3 in which the tip opening 22a is sealed with the tip 3a disposed at the first position P1 is referred to as a first form.

[0040] Fig. 5 is a perspective view showing the distal end of the treatment tool 100 in a pre-treatment state. Fig. 6 is a cross-sectional view showing the distal end of the treatment tool 100 in a pre-treatment state.

[0041] 5 and 6, when the slider 52 and the lever 55 are moved to the base end side A2, the knife 2 and the rod 3 are brought into a state where they do not protrude from the distal end opening 12a of the through hole 12 of the insulating tip 11 provided at the distal end 1a of the sheath 1. The knife 2 and the rod 3 are retracted and stored in the base end side A2 from the distal end opening 12a of the through hole 12.

[0042] At this time, the state of the knife 2 and the rod 3 is a pre-treatment state. Specifically, when the knife 2 is retracted to the base end side A2, the flange 21 provided at the tip of the knife body 20 is disposed near the tip opening 12a. In this state, the flange 21 overlaps the tip opening 12a when viewed from the width direction Y. That is, the flange 21 is accommodated in the recess of the insulating tip 11. Note that, when the flange 21 is accommodated in the recess of the insulating tip 11, the tip of the knife 2 may slightly protrude from the tip opening 12a. In addition, as the knife 2 retracts, the rod 3 also retracts to the base end side A2, and the tip 3a of the rod 3 is located at the tip opening 22a of the knife 2 in the longitudinal direction A. That is, the tip 3a is located at the first position P1, and the position of the tip 3a coincides with the position of the tip of the knife 2 in the longitudinal direction A. Furthermore, when the tip position of the flange 21 in the longitudinal direction A coincides with the position of the tip surface of the insulating tip 11, the position of the tip 3a in the longitudinal direction A coincides with the positions of the tip surface of the knife 2 and the tip surface of the insulating tip 11.

[0043] Fig. 7 is a perspective view showing the distal end of the treatment tool 100 in a water supplying state. Fig. 8 is a cross-sectional view showing the distal end of the treatment tool 100 in a water supplying state.

[0044] As shown in FIG. 7 and FIG. 8, when the slider 52 is moved to the distal end side A1, the knife 2 protrudes from the distal end 1a of the sheath 1 (i.e., the distal end opening 12a of the insulating tip 11). In addition, the distal end 3a of the rod 3 is arranged at a second position P2, which is retreated from the first position P1 to the proximal end side A2, by further moving the lever 55 to the proximal end side A2, and the distal end opening 22a is opened. At this time, the state of the knife 2 and the rod 3 is called a water supply state. In the water supply state, the rod 3 is not inserted in the first water supply pipe 22, and a sufficient space is provided, and the first water supply pipe 22 can supply water. Therefore, even when water is supplied, the rod 3 does not interfere, and the distal end 3a of the rod 3 does not block the distal end opening 22a of the first water supply pipe 22, so that the surgeon can smoothly supply water and perform local injection treatment. The form of the rod 3 in which the distal end 3a is arranged at the second position P2 and the distal end opening 22a is opened to allow water to be supplied to the first pipe 22 is called a second form.

[0045] [Method of using the endoscopic treatment system 300] Next, a procedure (a method of using the endoscopic treatment system 300) using the endoscopic treatment system 300 of this embodiment will be described. Specifically, a local injection treatment, an incision / cauterization / exfoliation treatment, and a hemostatic treatment of a lesion (treatment site) in an endoscopic treatment such as ESD (endoscopic submucosal dissection) will be described.

[0046] As a preparatory step, the surgeon identifies the lesion by a known method. Specifically, the surgeon inserts the insertion section 202 of the endoscope 200 into the digestive tract (e.g., the esophagus, stomach, duodenum, and large intestine) and identifies the lesion while observing an image obtained by the imaging section 203 of the endoscope.

[0047] <insertion step> The surgeon inserts the treatment tool 100 into the channel 206, and causes the tip 1a of the sheath 1 to protrude from the tip opening 206a of the insertion section 202. The surgeon advances the slider 52 of the operation section 5 relatively to the operation section body 51, and causes the knife 2 and rod 3 to protrude and enter a treatment state (see Figures 3 and 4).

[0048] <Local injection step> The surgeon moves the lever 55 to the base end side A2 relative to the slider 52, thereby moving the rod 3 to the base end side A2 relative to the knife 2. The surgeon also moves the slider 52 to the tip end side A1 to project the knife 2 from the tip end 1a of the sheath 1. As a result, the tip end 3a of the rod 3 is located at the second position P2, and the knife 2 and the rod 3 are in a water supply state (see Figs. 7 and 8). The surgeon punctures the knife 2 into the site in the lesion where the liquid for local injection (local injection liquid) is to be injected, and supplies water with the tip end opening 22a of the tip of the knife 2 in the submucosal layer (local injection step). At this time, the first water supply conduit 22 has a sufficient space for the liquid for water supply to flow, so the liquid flows smoothly through the first water supply conduit 22 and flows out from the tip end opening 22a.

[0049] <Incision, cauterization, and peeling steps> The surgeon performs incision, cauterization, and dissection treatment. With the knife 2 advanced, the surgeon moves the lever 55 to the distal end side A1 relative to the slider 52, thereby causing the rod-shaped member 3 to protrude from the distal end 1a of the sheath 1 and enter a treatment state (see Figs. 3 and 4). The distal end 3a of the rod-shaped member 3 is located at the distal end opening 22a in the longitudinal direction A and is disposed at the first position P1. With a high-frequency current being applied to the knife 2, the surgeon moves the flange 21 to cauterize or incise the mucosa of the lesion. In addition, the surgeon advances the knife 2, and with a high-frequency current being applied, lifts the mucosa of the cauterized or incised lesion to expose the submucosa, while dissecting the submucosa of the cauterized or incised lesion. At this time, a part of the tissue in the digestive tract adheres to the distal end of the knife 2. This tissue becomes charred during cauterization and adheres to the distal end of the knife 2. However, the distal end 3a is disposed at the distal end opening 22a of the knife 2. Moreover, the distal end opening 22a is covered and closed by the distal end 3a of the rod 3 when viewed from the distal end side A1 in the longitudinal direction A. Therefore, the rod 3 can reduce the risk of tissue adhering to the flange 21 or tissue entering the first water supply pipeline 22 from the distal end opening 22a and clogging the pipeline 22. Furthermore, the rod 3 can prevent the attached tissue from being burned and fixed during cauterization treatment.

[0050] <Removal Step> 4 and 8, the surgeon moves the lever 55 toward and away from the distal end side A1 and the proximal end side A2 relative to the slider 52, thereby moving the rod 3 toward and away from the knife 2. As a result, even if tissue enters the first water supply pipeline 22 from the flange 21 or distal end opening 22a of the knife 2 during the above-mentioned incision, cauterization, and dissection treatment, and charred tissue adheres to the distal end opening 22a or the knife body 20, the distal end 3a of the rod 3 can peel off and remove the charred tissue.

[0051] <Additional local injection steps> The surgeon performs additional local injection procedure as necessary. The surgeon moves the rod 3 back toward the base end side A2 relative to the knife 2 to set the water supply state (see Figs. 7 and 8). The surgeon places the tip opening 22a of the tip of the knife 2 into the submucosa at the location where the local injection liquid (local injection liquid) is to be additionally injected, and supplies water (additional local injection step). At this time, the tip 3a of the rod 3 is positioned at the second position P2, and the first water supply pipe 22 has sufficient space for the water supply liquid to flow. Therefore, the liquid flows smoothly through the first water supply pipe 22 and flows out from the tip opening 22a.

[0052] <Hemostasis step> If bleeding occurs during incision, cauterization, and dissection treatment, the surgeon performs hemostasis treatment. The surgeon sets the knife 2 and rod 3 to the treatment state, and while pressing the knife body 20 and flange 21 against the bleeding point, cauterizes the bleeding point by passing a high-frequency current to stop the bleeding (hemostasis step).

[0053] The surgeon continues the above-mentioned operations (treatments) as necessary, and finally excises the lesion, completing the ESD procedure.

[0054] The treatment tool 100 according to this embodiment can perform a variety of treatments, such as local injection treatment, incision / cauterization / excision treatment, and hemostatic treatment.

[0055] Moreover, the treatment tool 100 according to this embodiment includes a rod-shaped member 3. Therefore, even if charred tissue that has entered the tip of the knife 2 or the first water supply pipeline 22 during incision, cauterization, or ablation treatment adheres to the first water supply pipeline 22, the rod 3 can peel off and remove the charred tissue. Furthermore, the rod 3 can physically remove the charred tissue. Therefore, the surgeon does not need to perform the operation (treatment) of removing the charred tissue by supplying high-pressure water, which was previously performed.

[0056] Moreover, the rod 3 according to this embodiment advances and retreats in the longitudinal direction A. Therefore, when performing a local injection procedure, the surgeon retreats the lever 55 to the base end side A2 relative to the slider 52, and moves the rod-shaped member 3 to the base end side A2 to place it in the second position, thereby providing a sufficient space in the first water supply pipeline 22 through which the liquid for water supply flows, and allowing the liquid to smoothly flow out from the distal end opening 22a.

[0057] Moreover, the rod 3 according to this embodiment closes the tip opening 22a on the tip side A1 of the first water supply pipeline 22. Therefore, the rod 3 can prevent tissue from entering the first water supply pipeline 22 from the tip opening 22a during incision, cauterization, and ablation treatment.

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

[0059] In this case, the sealing member 3A closes the distal end opening 22a at the distal end of the knife 2. Therefore, in the above-mentioned incision, cauterization, and dissection steps, it is possible to prevent tissue or charred tissue from adhering to the distal end of the knife 2. Even if tissue adheres to the distal end of the knife 2, the sealing member 3A is removable, so the surgeon can peel off and remove the tissue or charred tissue by removing the sealing member 3A from the distal end opening 22a.

[0060] The sealing member 3A may further have a through hole near the center penetrating in the longitudinal direction A. With this configuration, the treatment tool 100A can deliver liquid from the through hole of the sealing member 3A in a state in which the sealing member 3A is attached to the distal end opening 22a. Therefore, the treatment tool 100A can deliver water while preventing adhesion of tissue or charred tissue.

[0061] (Variation 1-2) In the above embodiment, the rod 3 is a round bar-shaped member extending along the longitudinal direction A. However, the form of the rod 3 is not limited thereto. Fig. 10 is a diagram showing a rod 3B of a treatment tool 100B which is a modified example of the rod 3 of the treatment tool 100. Fig. 11 is a diagram showing a state in which the rod 3B is advanced forward.

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

[0063] 11, when the surgeon advances the lever 55 of the operation unit 5, the support portion 3Bb advances to the tip side A1. The tip portion 3Ba moves from the tip opening 22a of the tip side A1 of the first water supply pipeline 22 to the tip side A1. Then, the tip opening 22a, which was covered and closed by the tip portion 3Ba of the rod 3B, opens. Therefore, in this state, the surgeon can smoothly supply the liquid and perform the local injection procedure.

[0064] (Variation 1-3) Moreover, Fig. 12 is a diagram showing a rod 3C of a treatment tool 100C which is a modified example of the rod 3 of the treatment tool 100. Fig. 13 is a diagram showing a state in which the knife 2 of the treatment tool 100C has been moved.

[0065] The tip 3Ca of the rod 3C has a tapered surface that is sharp at the tip, and is formed so that the outer diameter decreases from the base end of the tapered surface toward the tip. As shown in FIG. 12, the tip 3Ca of the rod 3C is arranged so as to protrude slightly toward the tip side A1 from the tip opening 12a of the tip channel 12h. Here, in this embodiment, the operation unit 5 does not need to include a lever 55. The rod 3C does not advance or retreat in the longitudinal direction A, and the base end side of the rod 3C is fixed to a part of the operation unit main body 51.

[0066] In order to perform incision, cauterization, and dissection, the surgeon moves the slider 52 to the distal end side A1 and causes the knife 2 to protrude from the distal opening 12a, as shown in Fig. 12. When the surgeon performs incision, cauterization, and dissection in this state, some tissue in the digestive tract adheres and adheres to the tip of the knife 2. However, as shown in Fig. 13, when the surgeon moves the slider 52 to the proximal end side A2 and retracts the knife 2 to the vicinity of the distal opening 12a, the tip portion 3Ca, which protrudes slightly beyond the distal opening 12a toward the distal end side A1, penetrates the charred tissue adhered to the tip of the knife 2, and can be peeled off and dropped.

[0067] The operating unit 5 may include a lever 55. In this case, the surgeon moves the lever 55 to the tip side A1 in the longitudinal direction A to project the rod 3C from the tip opening 12a and the tip opening 22a of the knife 2. In this state, the rod 3C can easily insert the tip opening 22a at the tip of the knife 2 into the submucosal layer by puncturing with the tip portion 3Ca at the site where the liquid for local injection is to be injected.

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

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

[0070] (Variation 1-5) In the above embodiment, the operating unit 5 may further include a removable stopper that locks the lever 55. In this case as well, the lever 55 can be locked to the stopper to stop the forward and backward movement, and the rod 3 can be prevented from unintentionally advancing and retracting relative to the knife 2.

[0071] (Variation 1-6) In the above embodiment, the tip of the knife 2 is provided with a disk-shaped flange 21. However, the aspect of the knife 2 is not limited to this. Fig. 14 is a diagram showing a knife 2A which is a modified example of the knife 2. The flange 21A of the knife 2A is formed in a triangular shape when viewed from the front end side A1. With this configuration, the surgeon can hook each apex of the triangle and cut the tissue without slipping, without rotating the knife 2 in the circumferential direction.

[0072] (Variation 1-7) In the above embodiment, the tip of the knife 2 is provided with a flange 21. However, the aspect of the knife 2 is not limited to this. FIG. 15 is a diagram showing a knife 2B, which is a modified example of the knife 2. The tip 21B of the knife 2B has a different shape from the flange 21 and is formed in a spherical shape. With this configuration, the tip 21B of the knife 2B can easily penetrate into the submucosal layer, allowing the surgeon to perform an efficient procedure. In addition, by using the tip 21B of the knife 2B, the surgeon can perform a mucosal incision operation while suppressing invasion of deep tissue.

[0073] (Variation 1-8) In the above embodiment, the treatment tool 100 is provided with the distal end opening 22a of the knife 2 as a water supply port, but the aspect of the treatment tool 100 is not limited thereto. The treatment tool 100 may further include a through hole (first conduit) for water supply in the insulating tip 11 of the sheath 1. The treatment tool 100 may further include a water supply tube for water supply in the internal space 1s of the sheath 1.

[0074] (Variation 1-9) In the above embodiment, the operation unit 5 may include a regulating member (stopper) that regulates the advancement and retreat range of the lever 55.

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

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

[0077] The operation unit 5 may further include a restricting protrusion 57 capable of restricting movement of the lever 55 toward the base end side A2. As shown in Fig. 16, 17, and 18, the restricting protrusion 57 is a protrusion provided on the operation unit main body 51 closer to the base end side A2 than the lever 55.

[0078] 16, in the operation unit 5, a state in which the regulating member 56 regulates the movement of the lever 55 toward the tip side A1 is referred to as a "closed state." In the operation unit 5 in the closed state, the movement of the tip side A1 of the lever 55 is regulated by the regulating member 56. In addition, the movement of the base side A2 of the lever 55 is regulated by the regulating protrusion 57. In other words, the regulating member 56 and the regulating protrusion 57 are stoppers that regulate the advancement and retreat range of the lever 55.

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

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

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

[0082] For example, the operator can easily advance and retract the tip 3a of the rod 3 in the range from the first position P1 to the second position P2 by advancing and retracting the lever 55 in the range from the restricting member 56 to the restricting protrusion 57. Therefore, when tissue enters the first water supply conduit 22 and charred tissue adheres to the inside of the first water supply conduit 22, the operator can easily peel off and remove the charred tissue by the rod 3 by advancing and retracting the lever 55 in the range from the restricting member 56 to the restricting protrusion 57 and advancing and retracting the rod 3 in the range from the first position P1 to the second position P2. The operator can peel off and remove the charred tissue adhered to the inside of the first water supply conduit 22 by using the tip 3a of the rod 3 in the above embodiment or the tip portion 3Ba shown in FIG. 10.

[0083] 17, the restriction on movement of lever 55 by restricting member 56 can be released by removing restricting member 56 from operation unit body 51. Here, the state of operation unit 5 in which movement of lever 55 toward tip side A1 is not restricted by restricting member 56 is referred to as the "open state."

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

[0085] 18, the operation unit 5 may be configured so that the lever 55 cannot advance or retreat by a restricting member 56 and a restricting protrusion 57. The lever 55 shown in Fig. 18 is restricted in its movement toward the tip side A1 by the restricting member 56, and restricted in its movement toward the base side A2 by the restricting protrusion 57, and is provided so as to be unable to advance or retreat in the longitudinal direction A. The restricting member 56 shown in Fig. 18 is provided, for example, closer to the base side A2 than the restricting member 56 shown in Fig. 16.

[0086] When the lever 55 is restricted so as not to be able to move forward or backward by the restricting member 56 and the restricting protrusion 57, the tip 3a of the rod 3 is located at the first position P1. That is, the tip opening 22a of the knife 2 is covered and closed by the tip 3a of the rod 3, so that it is possible to prevent tissue from entering the first water supply pipeline 22 through the tip opening 22a and causing clogging.

[0087] The state of the rod 3 in which the tip 3a is positioned at the first position P1 by restricting the advancement and retreat of the lever 55 by the restricting member 56 and the restricting protrusion 57 is referred to as a "positioned state." By restricting the advancement and retreat of the lever 55 by the restricting member 56 and the restricting protrusion 57, the surgeon can easily maintain the rod 3 in the positioned state.

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

[0089] A restricting protrusion 57 that restricts the movement of the lever 55 toward the base end side A2 may be detachably provided on the operation unit main body 51. In the examples shown in Fig. 16, Fig. 17, and Fig. 18, the operation unit 5 is provided with two restricting protrusions 57, but it is sufficient that the restricting protrusion 57 is capable of restricting the movement of the lever 55 toward the base end side A2, and for example, the movement of the lever 55 toward the base end side A2 may be restricted by one restricting protrusion 57.

[0090] (Variation 1-10) In the above embodiment, the rod 3 may have a protrusion (burnt removal portion) protruding from the outer circumferential surface of the rod 3.

[0091] Fig. 19 is a cross-sectional view showing a modified example of the rod 3. The rod 3 shown in Fig. 19 is provided with a helical projection 31 that is provided on the outer circumferential surface of the rod 3 and protrudes outward in the radial direction of the rod 3. Here, the outer side in the radial direction of the rod 3 refers to the direction away from the central axis O2 of the rod 3 in the radial direction of the rod 3.

[0092] 19, the helical projection 31 is provided in a helical shape in a predetermined range in the longitudinal direction A on the outer circumferential surface of the rod 3. The outer diameter of the helical projection 31 is slightly smaller than the inner diameter of the tip opening 22a.

[0093] The surgeon can move the lever 55 back and forth, for example, by moving the rod 3 back and forth in the range from the first position P1 to the second position P2, thereby using the helical protrusion 31 to peel off and remove the charred matter that has adhered to the inside of the first water supply pipeline 22. The projections are not limited to a spiral shape, and projections of any shape, such as flaps or wings, may be provided on the outer circumferential surface of the rod 3. It is sufficient that the outer circumferential surface of the rod 3 has the function of removing burnt parts.

[0094] (Variation 1-11) In the above embodiment, the rod 3 can be advanced and retreated in the longitudinal direction A by advancing and retreating the lever 55, but the form of the rod 3 is not limited to this.

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

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

[0097] The knife slider (first slider) 52Aa, like the slider 52 in the above embodiment, is attached to the base end of the operating wire 4, and is configured to be able to advance and retreat the operating wire 4 and the knife 2 by moving it forward and backward relative to the operating unit main body 51.

[0098] The rod slider 52Ab (second slider) is attached to the base end of the rod 3, and is configured to be able to advance and retract the rod 3 by advancing and retracting it relative to the operation unit body 51 and the knife slider 52Aa. That is, the surgeon can advance and retract the operation wire 4 and the knife 2 by advancing and retracting the knife slider 52Aa, and can advance and retract the rod 3 by advancing and retracting the rod slider 52Ab.

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

[0100] The positioning portion 521 may be provided on the entire circumference of the rod slider 52Ab or only on a part of the circumference. When the positioning portion 521 is provided on only a part of the circumference of the rod slider 52Ab, it is preferable that the positioning portion 521 is provided at a plurality of positions on the circumference of the rod slider 52Ab.

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

[0102] A slider recess 522Aa is provided on the inner circumference of the slider restricting portion 522A (stopper), the inner circumference surface of which is recessed from the base end portion 522Ab and the tip end portion 522Ac of the slider restricting portion 522A. The slider recess 522Aa is, for example, a portion of the inner circumference of the slider restricting portion 522A that is recessed all around.

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

[0104] When the positioning portion 521 is located in the second region R2, the convex positioning portion 521 and the concave slider recess 522Aa fit together, and the advancement and retreat of the rod slider 52Ab in the longitudinal direction A is restricted by the slider restricting portion 522A. The inner diameters of the base end 522Ab and the tip end 522Ac of the slider restricting portion 522A are smaller than the outer diameter of the positioning portion 521. Therefore, the positioning portion 521 is sandwiched between the base end 522Ab and the tip end 522Ac of the slider restricting portion 522A in the longitudinal direction A, and the advancement and retreat in the longitudinal direction A is restricted.

[0105] Further, the tip side A1 from the slider restricting portion 522A is referred to as the "third region R3." In the rod slider 52Ab shown in FIG. 22, the positioning portion 521 is located in the third region R3. In the rod slider 52Ab shown in FIG. 22, since the positioning portion 521 is located in the third region R3, the positioning portion 521 and the slider recess 522Aa are not engaged. Therefore, the rod slider 52Ab can advance and retreat within the range where the positioning portion 521 is located in the third region R3.

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

[0107] Therefore, when the positioning portion 521 is located in the first region R1, the surgeon can advance and retreat the rod slider 52Ab within a predetermined range where the positioning portion 521 is located in the first region R1. At this time, the surgeon can use the rod 3 to peel off and remove the scorched matter adhering to the inside of the first water supply conduit 22. The rod 3 may have a protrusion (scorched matter removal portion) such as the spiral protrusion 31 shown in Fig. 19, and in that case, the surgeon can use the scorched matter removal portion to peel off and remove the scorched matter adhering to the inside of the first water supply conduit 22.

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

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

[0110] When the positioning portion 521 is located in the first region R1, the rod 3 is in a state (restricted state) in which the range in which the tip 3a can advance and retreat is restricted to a range from the first position P1 located at the tip opening 22a to the base end of the knife 2 (for example, the second position P2). In addition, the range in which the rod slider 52Ab can advance and retreat is restricted on the base end side A2 from the slider restriction portion 522A. In addition, the tip of the rod 3 is restricted to a range from the first position P1 to the base end (second position P2) of the knife 2 when the positioning portion 521 is fitted into the slider recess 522Aa, and the tip of the rod 3 may be configured to be located at the first position P1 when the positioning portion 521 is fitted into the slider recess 522Aa, and to be located at the second position P2 when the rod slider 52Ab is moved backward to the maximum. In addition, the movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be restricted to any range within the first water supply pipe 22 of the knife 2.

[0111] When the positioning portion 521 of the rod slider 52Ab is located in the second region R2, the tip 3a of the rod 3 is located in the first position P1. Therefore, the tip opening 22a of the knife 2 is covered and closed by the tip 3a of the rod 3, so that it is possible to prevent tissue from entering the first water supply pipeline 22 through the tip opening 22a and causing clogging.

[0112] When the positioning portion 521 is located in the second region R2, the positioning portion 521 and the slider recess 522Aa are fitted together, and the forward and backward movement of the rod slider 52Ab in the longitudinal direction A is restricted by the base end portion 522Ab and the tip end portion 522Ac of the slider restricting portion 522A. Therefore, the rod 3 is maintained in a state in which the tip end 3a is positioned at the first position P1 (positioned state), that is, in the longitudinal direction A, the position of the tip end 3a is aligned with the position of the tip end of the knife 2. The surgeon can release the engagement between the positioning portion 521 and the slider recess 522Aa by advancing and retracting the rod slider 52Ab with a predetermined force relative to the slider 52. In a state in which the engagement between the positioning portion 521 and the slider recess 522Aa is released, the surgeon can move the rod slider 52Ab forward and backward relative to the slider 52 to move the rod 3 forward and backward relative to the knife 2. When the surgeon advances the rod slider 52Ab relative to the slider 52, the engagement between the positioning portion 521 and the slider recess 522Aa is released and the positioning portion 521 moves to the third region R3. When the tip of the rod 3 is projected from the tip opening 22a of the first pipeline 22, the positioning portion 521 and the slider recess 522Aa are engaged with each other, generating a resistance force (user feedback) against the rod slider 52Ab.

[0113] When the positioning portion 521 is located in the third region R3, the rod 3 is in a state (protruding state) in which the tip 3a protrudes from the tip opening 22a of the knife 2 to the tip side A1. When the rod 3 is in the protruding state, the tip opening 22a of the knife 2 is not covered by the tip 3a of the rod 3, so the surgeon can perform a local injection procedure.

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

[0115] In this way, the surgeon advances and retreats the rod slider 52Ab with a predetermined force, and advances and retreats the positioning portion 521 to the first region R1, the second region R2, and the third region R3, thereby easily switching between the restricted state, the positioned state, and the protruding state of the rod 3. Because a predetermined force is required to switch between the restricted state, the positioned state, and the protruding state, the surgeon can easily grasp that the state (position) of the rod 3 is switching, and can move the rod 3 to a desired position.

[0116] (Variation 1-12) The slider restriction portion 522A described above may not have the slider recess 522Aa, as long as it is configured to allow the surgeon to grasp the position of the rod 3. The slider restriction portion 522A described above makes it possible to switch the restricted state, the positioned state, and the protruding state of the rod 3 by switching the position of the positioning portion 521 to the first region R1, the second region R2, and the third region R3, but the slider restriction portion may be configured to allow the surgeon to grasp the switching between the restricted state and the protruding state of the rod 3. FIG. 23 is a cross-sectional view showing a slider 52B in a modified example of the operation unit 5. As shown in FIG.

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

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

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

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

[0121] In addition, the inner diameter of the slider regulating portion 522B and the outer diameter of the tip of the rod slider 52Bb are equal. Therefore, when the tip of the rod slider 52Bb is inserted inside the slider regulating portion 522B, when the rod slider 52Bb is moved forward and backward relative to the slider regulating portion 522B, the movement of the rod slider 52Bb is hindered to some extent by the frictional force generated between the slider regulating portion 522B and the rod slider 52Bb. Since the frictional force is generated between the rod slider 52Bb and the slider regulating portion 522B, a certain amount of force is required when the surgeon moves the rod slider 52Bb inserted inside the slider regulating portion 522B forward and backward. Note that the inner diameter of the slider regulating portion 522B and the outer diameter of the tip of the rod slider 52Bb do not need to be strictly equal.

[0122] Therefore, the surgeon can easily grasp whether the rod slider 52Bb is inserted into the slider restricting portion 522B or not. For example, when the rod slider 52Bb is located on the base end side A2 from the slider restricting portion 522B and the rod slider 52Bb is not inserted into the slider restricting portion 522B, the tip 3a of the rod 3 is located at the first position P1 or on the base end side A2 from the first position P1. That is, the rod 3 is in the restricted state described above.

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

[0124] In this way, the friction between the rod slider 52Bb and the slider restriction portion 522B gives the surgeon a sense of resistance, so that the surgeon can easily grasp the position of the tip 3a of the rod 3. On the other hand, when the rod slider 52Bb and the end of the slider regulating portion 522B come into contact with each other, the tip of the rod 3 is at the first position P1, i.e., the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. Also, the base end side A2 from the end of the slider regulating portion 522B is substantially regulated as a range within which the rod slider 52Bb can advance and retreat. When the tip of the rod 3 is protruded from the tip opening 22a of the first pipeline 22, the rod slider 52Bb hits the end of the slider regulating portion 522B, generating a resistance force (user feedback) against the rod slider 52Bb. The tip of the rod 3 may be configured to be restricted within a range from the first position P1 to the base end (second position P2) of the knife 2, and when the rod slider 52Bb is brought into contact with the end of the slider restriction portion 522B, the tip of the rod 3 is located at the first position P1, and when the rod slider 52Bb is moved to the maximum extent, the tip of the rod 3 is located at the second position P2. The movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be restricted within any range within the first water supply pipe 22 of the knife 2.

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

[0126] The knife slider 52Ca is attached to the base end of the knife 2, and configured to be able to advance and retract the knife 2 in the longitudinal direction A by advancing and retracting relative to the operation unit body 51. In addition, the rod slider 52Cb is attached to the base end of the rod 3, and configured to be able to advance and retract the rod 3 in the longitudinal direction A by advancing and retracting relative to the operation unit body 51.

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

[0128] The rod slider 52Cb is a cylindrical member through which the operation portion main body 51 is inserted. The rod slider 52Cb has a second slider main body 524 and a positioning portion 521C provided at the tip of the second slider main body 524.

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

[0130] The outer diameter of the second slider body 524 and the large diameter portion 521Cb is slightly larger than the inner diameter of the slider regulating portion 522C of the knife slider 52Ca. The outer diameter of the small diameter portion 521Ca is slightly smaller than the inner diameter of the slider regulating portion 522C.

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

[0132] At this time, for example, the large diameter portion 521Cb or the slider restriction portion 522C is elastically deformed, so that the large diameter portion 521Cb climbs over the slider restriction portion 522C, and the slider restriction portion 522C having a convex shape and the small diameter portion 521Ca having a concave shape fit together.

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

[0134] When the positioning portion 521C is located in the second region, the surgeon can push the rod slider 52Cb toward the tip side A1 with a predetermined force to elastically deform the slider restriction portion 522C and move the positioning portion 521C to a region (third region) on the tip side A1 beyond the slider restriction portion 522C. At this time, the slider restriction portion 522C and the second slider body 524 maintain a state of contact with each other.

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

[0136] When the positioning portion 521C is located in the first region, the surgeon can advance and retreat the rod slider 52Cb within a predetermined range where the positioning portion 521C is located in the first region. At this time, the surgeon can use the rod 3 to peel off and remove the scorched matter adhering to the inside of the first water supply conduit 22. The rod 3 may have a protrusion (scorched matter removal portion) such as the spiral protrusion 31 shown in FIG. 19, and in that case, the surgeon can use the scorched matter removal portion to peel off and remove the scorched matter adhering to the inside of the first water supply conduit 22.

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

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

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

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

[0141] When the positioning portion 521C is located in the second region, the positioning portion 521C and the slider regulating portion 522C are engaged with each other, and the movement of the rod slider 52Cb in the longitudinal direction A is regulated by the slider regulating portion 522C. Therefore, the rod 3 is maintained in a state in which the tip 3a is positioned at the first position P1 (positioned state), that is, in the longitudinal direction A, the position of the tip 3a coincides with the position of the tip of the knife 2. The surgeon can release the engagement between the positioning portion 521C and the slider regulating portion 522C by advancing and retracting the rod slider 52Cb with a predetermined force relative to the slider 52. In a state in which the engagement between the positioning portion 521C and the slider regulating portion 522C is released, the surgeon can move the rod slider 52Cb forward and backward relative to the slider 52 to move the rod 3 forward and backward relative to the knife 2. When the surgeon advances the rod slider 52Cb relative to the slider 52, the engagement between the positioning portion 521C and the slider regulating portion 522C is released and the positioning portion 521C moves to the third region. When the tip of the rod 3 is projected from the tip opening 22a of the first pipeline 22, the positioning portion 521C and the slider regulating portion 522C are engaged with each other, generating a resistance force (user feedback) against the rod slider 52Cb.

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

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

[0144] In this case, it is preferable to provide a protruding shape (second large diameter portion) at the base end of the small diameter portion 521Ca for restricting movement of the rod slider 52Cb in the second region toward the tip side A1.

[0145] (Variation 1-14) In the above embodiment, a structure may be adopted in which a tubular member 43 is provided inside the operation unit 5, and the lever 55 can be positioned relative to the tubular member 43 connected to the base end of the operation wire 4. The base end of the tubular member 43 is connected to the slider 52.

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

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

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

[0149] 25, a through hole 4h is formed at the base end of the tubular member 43, penetrating in the radial direction and extending in the longitudinal direction A. The engagement portion 55b of the lever 55 is provided in the through hole 4h of the tubular member 43, and is provided so as to be movable in the longitudinal direction A within the range in which the through hole 4h is formed. When the surgeon moves the lever 55 forward or backward relative to the slider 52 in the longitudinal direction A, the rod 3 connected to the lever 55 moves forward or backward, but the operating wire 4 does not move forward or backward. In other words, when the lever 55 is moved forward or backward relative to the slider 52, the rod 3 moves forward or backward relative to the knife 2.

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

[0151] In addition, ball clicks 55d constituted by a spring member and a spherical member (spherical member) are provided on the engaging protrusion 55c of the lever 55. As shown in Fig. 26, the ball clicks 55d are provided on both sides in the width direction Y of the engaging portion 55b surrounded by the through hole 4h of the tubular member 43.

[0152] The ball click 55d has a spring member connected to the engagement portion 55b and a spherical member 55e connected to the tip of the spring member. The ball click 55d is expandable and contractable in the width direction Y by the elasticity of the spring member.

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

[0154] When the ball click 55d and the engagement recess 4a are engaged, the tip 3a of the rod 3 is located at the first position P1, that is, the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. The lever 55 is restricted in the range in which it can advance and retreat on the base end side A2 from the engagement recess 4a. The tip of the rod 3 is restricted to the range from the first position P1 to the base end (second position P2) of the knife 2, and may be configured such that when the ball click 55d is engaged with the engagement recess 4a, the tip of the rod 3 is located at the first position P1, and when the lever 55 is moved backward to the maximum, the tip of the rod 3 is located at the second position P2. The movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, and may be restricted to any range within the first water supply pipe 22 of the knife 2.

[0155] In addition, by moving the slider 52 back and forth while the ball click 55d and the engagement recess 4a are engaged with each other, the surgeon can move the knife 2 connected to the operating wire 4 and the rod 3 connected to the lever 55 back and forth while maintaining the tip 3a of the rod 3 positioned at the first position P1 (positioned state).

[0156] The surgeon can disengage the ball click 55d from the engagement recess 4a by advancing or retracting the lever 55 with a predetermined force relative to the slider 52. In a state in which the ball click 55d and the engagement recess 4a are disengaged, the surgeon can advance or retract the lever 55 relative to the slider 52, thereby advancing or retracting the rod 3 relative to the knife 2. When the tip of the rod 3 is projected from the tip opening 22a of the first pipeline 22, the ball click 55d engages with the engagement recess 4a, generating a resistance force (user feedback) against the lever 55.

[0157] (Variation 1-15) In the above embodiment, a structure may be adopted in which a tubular member 43 is provided inside the operation unit 5, and the lever 55 can be positioned relative to the tubular member 43 connected to the base end of the operation wire 4. The base end of the tubular member 43 is connected to the slider 52.

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

[0159] As shown in FIG. 27, the through hole 4h of the tubular member 43 is provided with a restricting protrusion (lever positioning portion) 4Aa that protrudes from the inner circumferential surface of the through hole 4h in the width direction Y. When the tip of the lever 55 is brought into contact with the restricting protrusion 4Aa, the tip of the rod 3 is at a first position P1, that is, the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. In addition, the base end side A2 from the restricting protrusion 4Aa is restricted as a range in which the lever 55 can advance and retreat. In addition, the tip of the rod 3 is restricted to a range from the first position P1 to the base end (second position P2) of the knife 2, and the tip of the rod 3 may be configured to be located at the first position P1 when the lever 55 is brought into contact with the restricting protrusion 4Aa, and to be located at the second position P2 when the lever 55 is maximally retreated. The movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, but may be restricted to any range within the first water supply pipeline 22 of the knife 2.

[0160] Note that the lever 55 may be configured to move beyond the restricting protrusion 4Aa to the distal end side A1 by moving the lever 55 toward the distal end side A1 with a predetermined force. When the distal end of the rod 3 is protruded from the distal end opening 22a of the first pipeline 22, the lever 55 hits the restricting protrusion 4Aa, thereby generating a resistance force (user feedback) against the lever 55.

[0161] (Variation 1-16) In the above embodiment, the tubular member 43 may be provided with a restricting member 4b that restricts the advancement and retreat of the lever 55 to a certain extent.

[0162] Fig. 28 is a cross-sectional view showing a modified example of the lever 55 and the tubular member 43. The cross-section shown in Fig. 28 is a cross-sectional view of the lever 55 and the tubular member 43 taken along the line XX shown in Fig. 25, similar to Figs. 26 and 27.

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

[0164] When the lever 55 is moved toward the tip side A1 and at least a part of the lever 55 is located in the restriction area 4c, the engagement portion 55b of the lever 55 comes into contact with the restriction member 4b in the width direction Y. The restriction member 4b is formed of, for example, a rubber material.

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

[0166] When at least a part of the engaging portion 55b of the lever 55 is located in the restriction area 4c, for example, the tip 3a of the rod 3 is in a state (protruding state) protruding from the tip opening 22a of the knife 2 to the tip side A1. Therefore, the surgeon can easily know that the rod 3 is in the protruding state by the resistance felt from the lever 55 located in the restriction area 4c. On the other hand, when the engaging portion 55b of the lever 55 and the end of the regulating member 4b come into contact with each other, the tip of the rod 3 is at the first position P1, i.e., the position of the tip 3a in the longitudinal direction A coincides with the position of the tip of the knife 2. In addition, the base end side A2 from the end of the regulating member 4b is substantially restricted as a range in which the lever 55 can advance and retreat. When the tip of the rod 3 is protruded from the tip opening 22a of the first pipeline 22, the lever 55 hits the end of the regulating member 4b, generating a resistance force (user feedback) against the lever 55. In addition, the tip of the rod 3 is restricted within a range from the first position P1 to the base end (second position P2) of the knife 2, and the tip of the rod 3 may be configured to be located at the first position P1 when the lever 55 comes into contact with the end of the regulating member 4b, and to be located at the second position P2 when the lever 55 is fully retreated. The movement range of the tip of the rod 3 does not necessarily have to be between the first position P1 and the second position P2, but may be restricted to any range within the first water supply pipeline 22 of the knife 2.

[0167] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0168] Second Embodiment A treatment tool 100D according to a second embodiment of the present invention will be described with reference to Fig. 29 and Fig. 30. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted.

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

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

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

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

[0173] The first through hole 121 is a hole that penetrates the insulating tip body 111 in the longitudinal direction A. The central axis OB2 of the first through hole 121 in the longitudinal direction A is disposed at a position different from the central axis O1 of the sheath 1D in the longitudinal direction A in the height direction Z that intersects with the longitudinal direction A and the width direction Y. The first through hole 121 has a first tip pipe 121h therein. The first tip pipe 121h communicates with a first opening 112 formed in the distal end surface 111a. In other words, the first tip pipe 121h has a first opening 112 on the distal end side A1. The first opening 112 is slightly smaller than the flange 21, which is the distal end of the knife 2, and is formed to a size that allows the flange 21 to be engaged. Therefore, the flange 21 is engaged with the first opening 112 and does not move from the first opening 112 to the base end side A2.

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

[0175] 30, in the following description, the direction in which the central axis OB2 is disposed relative to the central axis O1 is referred to as the lower side Z2 in the height direction Z, and the direction in which the central axis OB3 is disposed relative to the central axis O1 is referred to as the upper side Z1 in the height direction Z. In this embodiment, the central axis OB2 is formed on the lower side Z2 of the central axis OB3. However, the central axis OB2 may be formed on the upper side Z1 of the central axis OB3. In addition, the central axis OB2 or the central axis OB3 may be formed on the same axis line as the central axis O1.

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

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

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

[0179] The opening area of ​​the second opening 113 is preferably smaller than the opening area of ​​the first opening 112. Here, the opening area refers to the area of ​​the opening in a plan view from the longitudinal direction A. By making the opening area of ​​the second opening 113 smaller than the opening area of ​​the first opening 112, it is possible to maintain the incision performance of the knife 2 while simultaneously supplying water sharply from the second opening 113.

[0180] The opening area of ​​the second opening 113 is preferably larger than the opening area of ​​the tip opening 22a of the first water supply pipeline 22. In addition, the knife 2 is preferably rotatable about the central axis OB2 in the longitudinal direction A relative to the sheath 1D and the insulating tip 11D.

[0181] According to this embodiment, the insulating tip 11D of the sheath 1D is provided with a first opening 112 and a second opening 113 provided at a position different from the first opening 112 and through which a fluid passing through a third water supply pipe (water supply pipe) 24h of the water supply tube 24 described later flows out on the distal end surface 111a of the insulating tip body 111. Therefore, even if charred tissue adhered to the distal end of the knife 2 due to an incision, cauterization, or ablation treatment clogs the distal end opening 22a and the fluid passing through the first water supply pipe 22 cannot be supplied, the surgeon can supply the fluid flowing through the third water supply pipe 24h of the water supply tube 24 by causing it to flow out from the second opening 113 where no tissue adheres and water supply is not obstructed.

[0182] Furthermore, by making the knife 2 rotatable about the longitudinal direction A relative to the sheath 1D and the insulating tip 11D, burnt tissue adhering to the flange 21 of the knife 2 can be washed away evenly by the fluid discharged from the second opening 113.

[0183] (Variation 2-1) According to this embodiment, the sheath 1D has an insulating tip 11D at its tip, but the form of the insulating tip 11D is not limited thereto. FIG. 31 is a cross-sectional view showing an insulating tip 11E of a sheath 1E, which is a modified example of the insulating tip 11D of the sheath 1D. The insulating tip body 111E of the insulating tip 11E has a protruding portion 13 protruding from a tip surface 111Ea to a tip side A1. The protruding portion 13 is formed in a cylindrical shape extending in the longitudinal direction A with a central axis OB3 as its central axis. The protruding portion 13 has a protruding portion duct 13h therein. In addition, the base end of the protruding portion 13 is attached to the tip surface 111Ea so as to cover the second opening 113, and the protruding portion duct 13h inside communicates with the second tip duct 122h. The protruding portion 13 has a protruding portion opening 13a at its tip. The fluid passing through the third water supply line 24h of the water supply tube 24 passes through the second tip line 122h and flows out from the second opening 113, and then passes through the protruding portion line 13h communicating with the second tip line 122h and flows out from the protruding portion opening 13a.

[0184] As shown in Fig. 31, the protrusion opening 13a of the protrusion 13 is disposed on the base end side A2 from the knife 2 when the knife 2 advances to the tip end side A1. Fig. 32 is a cross-sectional view showing the insulating tip 11E when the knife 2 retracts to the base end side A2. As shown in Fig. 32, the protrusion opening 13a of the protrusion 13 is disposed on the tip end side A1 from the knife 2 when the knife 2 retracts to the base end side A2 (when the flange 21 of the knife 2 abuts against the tip surface 111Ea of the insulating tip main body 111E). With this configuration, the surgeon can easily perform local injection treatment by disposing the protrusion 13 provided on the insulating tip 11E of the sheath 1E and having the protrusion opening 13a through which the delivered liquid flows out, near the lesion.

[0185] (Variation 2-2) Moreover, the protruding portion 13 is not limited to the above-mentioned embodiment. Fig. 33 is a perspective view showing a protruding portion 13A, which is a modified example of the protruding portion 13. The protruding portion 13A has a tapered surface 13p inclined toward the central axis OB3 from the base end side A2 toward the tip side A1 at the tip. In this case, since the tip of the protruding portion 13A having the protruding portion opening 13a from which the liquid flows out has the tapered surface 13p, the surgeon can easily insert the protruding portion opening 13a of the protruding portion 13A into the submucosal layer to perform a local injection procedure.

[0186] (Variation 2-3) Moreover, the protruding portion 13 is not limited to the above-mentioned embodiment. Fig. 34 is a perspective view showing a protruding portion 13B which is a modified example of the protruding portion 13 of the insulating tip 11E. The tip portion 13b of the protruding portion 13B is inclined from the base end side A2 toward the tip side A1 toward an axis passing through one end of the periphery of the protruding portion 13B in the longitudinal direction A. With this configuration, the tip portion of the protruding portion 13B has a sharp shape. Even in this case, the surgeon can easily insert the protruding portion opening 13a of the protruding portion 13B into the submucosal layer to perform a local injection procedure.

[0187] (Variation 2-4) Moreover, the protrusion 13 is not limited to the above-mentioned embodiment. FIG. 35 is a cross-sectional view showing a protrusion 13C which is a modified example of the protrusion 13. As shown in FIG. 35, the protrusion 13C is configured to be movable in the longitudinal direction A. Specifically, the protrusion 13C has a base end fixed to the tip of the water supply tube 24. The water supply tube 24 has, for example, an operation unit 5 equipped with a lever 55, and the base end is attached to the lever 55. Therefore, when the operator moves the lever 55 forward or backward in the longitudinal direction A, the water supply tube 24 and the protrusion 13C can be moved forward or backward in the longitudinal direction A. As shown in FIG. 35, the protrusion opening 13Ca of the protrusion 13C can be arranged so as not to protrude from the second opening 113 equipped in the insulating tip body 111 to the tip side A1. With this configuration, during incision, cauterization, and ablation treatment and hemostasis treatment, the surgeon can move the unused protruding portion 13C toward the base end side A2 from the second opening 113 and store it in the second through-hole 122. Note that the water supply tube 24 may not be moved back and forth, and only the protruding portion 13 may be configured to be able to move back and forth in the longitudinal direction A.

[0188] (Variation 2-5) In the above embodiment, the insulating tip 11D of the sheath 1D includes a first opening 112 and a second opening 113 provided at a position different from the first opening 112 on the distal end surface 111a of the insulating tip body 111. However, the aspect of the insulating tip 11D is not limited to this. FIG. 36 is a cross-sectional view showing the insulating tip 11F of the sheath 1F, which is a modified example of the insulating tip 11D of the sheath 1D. In addition, in this embodiment, the knife 2F inserted into the sheath 1F has a shorter radial width than the knife 2 of the above embodiment, and the flange 21F of the knife 2F can move to the base end side A2 from the first opening 112.

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

[0190] FIG. 37 is a cross-sectional view showing a state in which the knife 2F has been moved. As shown in FIG. 37, the operator moves the slider 52 to the base end side A2, so that the flange 21F of the knife 2F moves to the base end side A2 from the internal insertion opening 113F. Then, in the first tip pipe 121h, a sufficient space can be provided to allow the fluid to flow out from the flange 21F to the tip side A1. Therefore, the liquid flowing in the third water supply pipe 24h of the water supply tube 24 is supplied into the second tip pipe 122Fh, and then flows out from the internal insertion opening 113F. Then, the fluid passes through the first tip pipe 121h and flows out from the first opening 112. In other words, in a state in which the liquid flows in from the internal insertion opening 113F, the flange (tip portion) 21F of the knife 2F is disposed on the base end side A2 from the internal insertion opening 113F. With this configuration, the operator can smoothly supply the liquid and perform a local injection procedure. Furthermore, when the flange 21F of the knife 2F is positioned near the internal insertion opening 113F, even if tissue or charred tissue is attached to the flange 21F, the fluid flowing out from the internal insertion opening 113F can wash away the tissue or charred tissue and discharge it from the first opening 112.

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

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

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

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

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

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

[0197] 39, the second through hole 122J is a hole that penetrates the insulating tip body 111J such that a central axis OB4 of the second through hole 122J intersects with a central axis OB2 of the first through hole 121. In other words, the second through hole 122J is provided such that a central axis OB4 intersects with the central axis of the knife 2.

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

[0199] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0200] The present invention includes the following technical ideas. (Additional note 1) A sheath extending in a longitudinal direction and having a water supply pipe therein; A high-frequency knife made of metal is inserted into the sheath and moves forward and backward in the longitudinal direction; an insulating tip member provided at a tip of the sheath; Equipped with The tip member has a first opening through which the high-frequency knife is inserted on a tip surface thereof, and a second opening provided at a position different from the first opening and through which the fluid passing through the water supply pipeline flows out. Endoscopic treatment tools.

[0201] (Additional note 2) A high frequency current flows through the high frequency knife. Item 1. An endoscopic treatment instrument according to claim 1.

[0202] (Additional note 3) an operating wire extending in the longitudinal direction and having the high-frequency knife connected to a tip thereof; an operating section provided at a proximal end of the operating wire; Further equipped with The high-frequency knife advances and retreats in the longitudinal direction by operating the operating portion. 3. The endoscopic treatment instrument according to claim 1 or 2.

[0203] (Additional note 4) The liquid supply tube is inserted into the sheath and has the water supply pipe therein for supplying water. The fluid flowing through the liquid supply tube flows out from the second opening. 3. The endoscopic treatment instrument according to claim 1 or 2.

[0204] (Additional note 5) A sheath extending in a longitudinal direction and having a water supply pipe therein; A high-frequency knife made of metal is inserted into the sheath and moves forward and backward in the longitudinal direction; an insulating tip member provided at a tip of the sheath; Equipped with the distal end member includes a first distal end conduit having a first opening on a distal end surface through which the high-frequency knife is inserted, and a second distal end conduit having an internal insertion opening on a side surface of the first distal end conduit and through which the fluid is supplied from the water supply conduit; The fluid supplied to the second distal end conduit flows out from the first opening. Endoscopic treatment tools.

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

[0206] Third embodiment Next, a third embodiment of the present invention will be described with reference to Fig. 40 to Fig. 42. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted. Note that the following embodiments are all different from the first embodiment in the configuration of the endoscopic treatment system using the treatment tool. Therefore, the following description will focus on the differences from the first embodiment.

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

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

[0209] The switch 6 is, for example, a foot switch operated by the surgeon with his / her foot. The switch 6 communicates with the high frequency power supply device 7 by wired or wireless communication. The switch 6 transmits a power on / off signal to the high frequency power supply device 7 described later.

[0210] The high-frequency power supply device 7 supplies high-frequency energy to the treatment tool 100H. Specifically, the high-frequency power supply device 7 is electrically connected to a power supply connector 53 provided on the operation unit 5. The high-frequency power supply device 7 switches between outputting and not outputting high-frequency energy by receiving a power on / off signal generated by the operation of the switch 6 by the surgeon. The high-frequency power supply device 7 includes a switch detection unit 71, an output unit 72, a first communication unit 73, and a first control unit 74.

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

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

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

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

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

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

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

[0218] The first control unit 74 is not limited to a device provided in a single piece of hardware. For example, the first control unit 74 may be configured by separating the CPU, memory, and storage unit as separate hardware and connecting the hardware with a communication line. Alternatively, the first control unit 74 may be realized as a cloud system by separating the storage unit and similarly connecting it with a communication line. Furthermore, the first control unit 74 may further have things necessary for the operation of the first control unit 74 other than the CPU, memory, and storage unit.

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

[0220] The water supply unit 81 receives a water supply signal from the second control unit 83 and starts supplying water by supplying liquid to the treatment tool 100H. In addition, the water supply unit 81 receives a water supply stop signal from the second control unit 83 and stops supplying water to the treatment tool 100H.

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

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

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

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

[0225] The second control unit 83 is not limited to a device provided in a single piece of hardware. For example, the second control unit 83 may be configured by separating the CPU, memory, and storage unit as separate hardware and connecting the hardware with a communication line. Alternatively, the second control unit 83 may be realized as a cloud system by separating the storage unit and similarly connecting it with a communication line. Furthermore, the second control unit 83 may further include things necessary for the operation of the second control unit 83 other than the CPU, memory, and storage unit.

[0226] The abnormality detection unit 84 detects an abnormality such as a malfunction that occurs when water (liquid) is not sufficiently supplied from the water supply unit 81 to the treatment tool 100H, for example, when the distal end opening 22a is blocked by adhesion of burnt tissue or when the treatment tool 100H having a water supply pipe through which a fluid flows is buckled. When the abnormality detection unit 84 detects an abnormality, it transmits abnormality detection information to the second control unit 83.

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

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

[0229] [Function of the endoscopic treatment system 300H] Next, the operation of the endoscope treatment system 300H will be described with reference to Fig. 42. Fig. 42 is a flow chart for explaining the operation of the endoscope treatment system 300H.

[0230] <Switch-on detection step (first detection step) S1> First, the surgeon uses his / her foot to operate the foot switch which is the switch 6. When the switch 6 transmits a power-on (ON) signal to the high-frequency power supply device 7, the switch detection unit 71 of the high-frequency power supply device 7 detects the power-on signal from the switch 6.

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

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

[0233] In this way, the high-frequency power supply device 7 and the liquid delivery device 8 can work together to simultaneously supply high-frequency energy and fluid to the treatment tool 100H. In other words, the high-frequency power supply device 7 and the liquid delivery device 8 communicate with each other, and one controls the other to work together. Although high-frequency energy and fluid can be simultaneously supplied to the treatment tool 100H, it is preferable that the fluid is supplied to the treatment tool 100H before the high-frequency energy. The timing of supplying the high-frequency energy and fluid can be arbitrarily adjusted by the first control unit 74 of the high-frequency power supply device 7 and the second control unit 83 of the liquid delivery device 8. In this state, the surgeon can use the treatment tool 100H to perform the above-mentioned insertion step, local injection step, incision / cauterization / exfoliation step, removal step, additional local injection step, and hemostasis step. In addition, the surgeon can continue the above-mentioned steps as necessary. Here, the work between the high-frequency power supply device 7 and the liquid delivery device 8 is not limited to a state in which high-frequency energy or fluid is supplied, but includes a state in which the high-frequency power supply device 7 and the liquid delivery device 8 communicate with each other.

[0234] <Abnormality detection step S4> The abnormality detection unit 84 of the liquid delivery device 8 transmits abnormality detection information to the second control unit 83 when it detects an abnormality such as a malfunction occurring when the liquid delivery device 8 delivers water from the water delivery unit 81 to the treatment tool 100H.

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

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

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

[0238] <High frequency energy output stopping step (second stopping step) S52> Furthermore, when the first control unit 74 acquires detection information of the power being turned off from the switch detection unit 71, it generates an output stop signal and transmits it to the output unit 72. The output unit 72 acquires the output stop signal from the first control unit 74 and stops the output of high-frequency energy to the treatment tool 100H. That is, when the first control unit 74 acquires detection information of the power being turned off of the switch 6 from the switch detection unit 71, it causes the liquid delivery device 8 to stop the supply of fluid from the water delivery unit 81 and causes the output unit 72 to stop the output of high-frequency energy. The high-frequency power supply device 7 and the liquid delivery device 8 can work together to stop the supply of high-frequency energy and fluid to the treatment tool 100H. The surgeon performs the above-mentioned steps as necessary to end (complete) the ESD procedure.

[0239] According to the endoscopic treatment system (treatment system) 300H of this embodiment, the high-frequency power supply device 7 and the fluid supply device 8 work together to simultaneously supply high-frequency energy and fluid to the treatment tool 100H. This allows the surgeon to simultaneously perform incision, cauterization, and ablation treatment, and hemostasis treatment, while supplying fluid to perform local injection treatment by operating the switch 6. Therefore, tissue does not enter the distal end opening (water supply port) 22a of the knife 2 of the treatment tool 100H, and does not clog the distal end opening 22a or cause tissue scorching.

[0240] (Variation 3-1) The liquid delivery device 8 according to the above embodiment is not limited to supplying liquid, and may also supply (deliver) gas.

[0241] (Variation 3-2) The switch 6 according to the above embodiment communicates with the high frequency power supply device 7 by wired or wireless communication, but is not particularly limited thereto. The switch 6 may communicate with the liquid delivery device 8 by wired or wireless communication. In this case, the liquid delivery device 8 is provided with a switch detection unit, so that the above-mentioned endoscopic treatment system 300H can be operated. Furthermore, the switch 6 may communicate with both the high frequency power supply device 7 and the liquid delivery device 8 by wired or wireless communication.

[0242] (Variation 3-3) Furthermore, the switch 6 is not limited to the foot switch described above, and can be, for example, a touch panel, various switches such as a mouse, a keyboard, or a switch of any device that can be operated, such as a lever or a remote controller.

[0243] (Variation 3-4) In the treatment system 300H according to the embodiment described above, the high-frequency power supply device 7 and the liquid supply device 8 work together to simultaneously supply high-frequency energy and fluid to the treatment tool 100H, but the aspect of the treatment system is not limited to this. For example, in the treatment system, the switch detection unit 71 of the high-frequency power supply device 7 detects a power-on signal of the switch 6, and starts outputting high-frequency energy to the treatment tool 100H. Furthermore, the treatment system may start sending water by sending liquid to the treatment tool 100H after detecting the stop of the supply of high-frequency energy by the high-frequency power supply device 7. In this way, by serially outputting the high-frequency energy and the fluid, the charred tissue stuck to the knife 2 can be washed away by the fluid after the incision, cauterization, and dissection steps are performed.

[0244] Although the third embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0245] The present invention includes the following technical ideas. (Additional note 7) an endoscopic treatment tool including a high-frequency knife that is inserted into a channel of an endoscope and extends in a longitudinal direction so as to be movable forward and backward, a first duct that extends in the longitudinal direction and through which a liquid flows, and a first opening through which the liquid flows out; A high frequency power supply device for supplying high frequency energy to the high frequency knife; A switch for starting or stopping the supply of the high frequency energy; A liquid delivery device for supplying a fluid to the first pipeline; Equipped with The high frequency power supply device and the liquid delivery device are linked together. High frequency knife system.

[0246] (Additional note 8) The high-frequency knife has the first opening at a tip and the first duct inside. 8. The high frequency knife system according to claim 7.

[0247] (Additional note 9) The endoscopic treatment tool further includes a sheath extending in the longitudinal direction and into which the high-frequency knife can be inserted, and an insulating tip member provided at a tip of the sheath, The tip member includes a first through hole penetrating in the longitudinal direction and into which the high-frequency knife can be inserted, and a second through hole having the first opening provided on a tip side and penetrating in the longitudinal direction. 8. The high frequency knife system according to claim 7.

[0248] (Additional note 10) The liquid delivery device delivers air or water. 9. The high frequency knife system according to claim 7 or 8.

[0249] (Additional note 11) The liquid delivery device and the high-frequency power supply device communicate with each other, and at least one of them controls the other. 9. The high frequency knife system according to claim 7 or 8.

[0250] (Additional note 12) When the high frequency power supply device supplies the high frequency energy, The liquid delivery device supplies the fluid. 9. The high frequency knife system according to claim 7 or 8.

[0251] (Additional note 13) A detection unit that detects an operational abnormality of the liquid delivery device is further provided, When the detection unit detects an operational abnormality of the liquid delivery device, the high frequency power supply device stops outputting. 9. The high frequency knife system according to claim 7 or 8.

[0252] (Additional note 14) A method for controlling a high frequency knife in which supply of high frequency energy and fluid is controlled by a switch, comprising: a first detection step of detecting that the switch is on; a first supply step of starting to supply the fluid; a second supply step of starting the supply of the high-frequency energy at the same time as starting the supply of the fluid; a second detection step of detecting the switch being turned off; a first stopping step of stopping the supply of the fluid; a second stopping step of stopping the supply of the high-frequency energy together with stopping the supply of the fluid; A method for controlling a high frequency knife comprising:

[0253] (Additional note 15) an abnormality detection step of detecting an abnormality in the supply of the fluid; an abnormality stopping step of stopping the supply of the fluid and the supply of the high-frequency energy; The method for controlling a high-frequency knife according to claim 14, further comprising:

[0254] In any of the above-described embodiments, the endoscopic treatment tool of the present invention can suitably supply water from the tip of the high-frequency knife or the sheath. [Explanation of symbols]

[0255] 300, 300H...Endoscopic treatment system (treatment system, high frequency knife system) 100, 100A, 100B, 100C, 100D, 100G, 100H...Treatment tools (endoscopic treatment tools) 200...Endoscope 1, 1D, 1E, 1F...Sheath 11, 11D, 11E, 11F...insulating tip (tip member) 12...Through hole 13, 13A, 13B, 13C...Protrusion 12a…Tip opening 2, 2A, 2B, 2F...Knife (high frequency knife, electrode) 20…Knife body 21, 21A, 21F...Flanges 21B...Tip 22…First water pipeline (first pipeline) 22a...Tip opening (water supply port or first opening) 24…Water supply tube 24h…Third water pipeline (water pipeline) 3, 3B, 3C...Rod (rod-shaped member) 3A...Sealing member 4…Operation wire 42...Second water pipeline (second pipeline) 5...Operation unit 52...Slider 55...Lever (slide lever) 6...Switch (foot switch) 7…High frequency power supply device 71 Switch detection unit 72...Output section 73…First Communications Department 74...First control section 8...Liquid delivery device 81…Water supply section 82…Second Communications Department 83...Second control section 84…Abnormality detection unit A…Longitudinal direction

Claims

1. a longitudinally extending sheath; an insulating tip member provided at a tip of the sheath and having a through hole passing through in the longitudinal direction; a metal electrode that is inserted into the through hole and moves back and forth in the longitudinal direction and has a first pipe for supplying water that extends in the longitudinal direction; a rod extending in the longitudinal direction and disposed in at least the first conduit; Equipped with The rod has a scorch removal portion capable of removing scorch adhered to the first pipe by moving the rod forward and backward relative to the electrode. Endoscopic treatment tools.

2. The charred part removal part has an outer peripheral surface capable of removing charred parts in the first pipeline by moving the rod back and forth. The endoscopic treatment tool according to claim 1 .

3. a hollow operation wire having a second conduit communicating with the first conduit in the longitudinal direction and a tip connected to the electrode; an operation unit that advances and retreats the operation wire along the longitudinal direction; Further comprising: The endoscopic treatment tool according to claim 1 or 2.

4. The operation unit includes: a slider connected to a proximal end of the operation wire and configured to move the electrode forward and backward in the longitudinal direction; a slide lever that moves the rod forward and backward relative to the electrode in the longitudinal direction; Equipped with The endoscopic treatment tool according to claim 3 .

5. the operation portion has a stopper capable of restricting the advancement and retreat of the slide lever along the longitudinal direction, When the advancement and retreat of the slide lever is restricted by the stopper, the range in which the rod can advance and retreat is restricted to a range in which the tip of the rod is from the tip opening of the first conduit to the base end of the electrode. The endoscopic treatment tool according to claim 4.

6. When the slide lever is located on the base end side relative to the stopper, the tip of the rod is located within the first pipeline. The endoscopic treatment tool according to claim 5 .

7. The rod is When the stopper is attached to the operation portion, the range in which the tip of the rod can advance and retreat is restricted to a range from the tip opening to a base end of the electrode, When the stopper is removed from the operation portion, the tip of the rod is in a protruding state capable of protruding further toward the tip side than the tip opening. The endoscopic treatment tool according to claim 6.

8. the operation portion has a stopper capable of restricting the advancement and retreat of the slide lever along the longitudinal direction, When the advancement and retreat of the slide lever is restricted by the stopper, the rod cannot advance and retreat in the longitudinal direction. The endoscopic treatment tool according to claim 4.

9. When the rod is restricted by the stopper so as not to be able to advance or retreat in the longitudinal direction, the tip of the rod is in a positioned state in which it is maintained at a tip opening of the first pipeline. The endoscopic treatment tool according to claim 8.

10. The operation unit has a positioning unit that generates user feedback for the slide lever when the tip end of the rod protrudes from the tip opening of the first pipeline. The endoscopic treatment tool according to claim 4.

Images