Shrinking device

Abstract

To provide a plication device which can improve operability in sewing body tissue around the separation face of a lesion part.SOLUTION: A plication device includes a loop wire, a cable, and a sheath. The loop wire is provided with a first end and a second end that is the end of the opposite side of the first end. The loop wire is provided with an annular loop part in which mutually separated two parts of the loop wire between the first end and the second end are made a starting point and an end point respectively. The cable is attached at least to the first end. The sheath is provided with a third end and a fourth end that is the end on the opposite side of the third end. Inside the sheath, there are arranged the loop wire and the cable so that the loop part protrudes from the third end side while the cable partly protrudes from the fourth end side. The loop part is reduced in the diameter by drawing out the cable from the fourth end side.SELECTED DRAWING: Figure 2

Description

Technical Field

[0001] The present invention relates to a constriction device.

Background Art

[0002] Endoscopic submucosal dissection (ESD) is a treatment method for excising a lesion inside the stomach or the like using a high-frequency scalpel or the like. As a technique for preventing bleeding from the cut surface of the lesion, Patent Document 1 (Japanese Patent No. 6233147) describes a detachable snare and a detachable snare ligation device.

[0003] The detachable snare described in Patent Document 1 has a nylon wire and a tightening ring. The nylon wire on one side of the tightening ring forms a first loop. The nylon wire on the other side of the tightening ring forms a second loop. The first loop is larger than the second loop. The detachable snare described in Patent Document 1 is arranged such that the first loop surrounds the cut surface of the lesion. The first loop is clipped to the body tissue around the cut surface of the lesion.

[0004] The detachable snare ligation device described in Patent Document 1 is inserted into a guide tube for an endoscope. After insertion into the guide tube for an endoscope, the detachable snare ligation device described in Patent Document 1 moves the tightening ring from the second loop side toward the first loop side to reduce the diameter of the first loop. As the diameter of the first loop is reduced, the body tissue around the cut surface of the lesion is also constricted, so that bleeding from the cut surface of the lesion is prevented.

Prior Art Documents

Patent Documents

[0005]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0006] However, in the constriction using the indwelling snare and the indwelling snare ligation device described in Patent Document 1, after the indwelling snare described in Patent Document 1 is placed near the resection surface of the lesion, in order to slide the tightening ring, it is necessary to hook the hook of the indwelling snare ligation device described in Patent Document 1 on the second loop. Therefore, there is room for improvement in the operability when constricting the body tissue around the resection surface of the lesion.

[0007] The present invention has been made in view of the problems of the prior art as described above. More specifically, the present invention provides a constriction device with improved operability when constricting body tissue around the resection surface of a lesion.

Means for Solving the Problems

[0008] The constriction device of the present invention includes a loop wire, a cable, and a sheath. The loop wire has a first end and a second end that is opposite to the first end. The loop wire has an annular loop portion with two mutually separated portions of the loop wire between the first end and the second end as the starting point and the ending point, respectively. The cable is attached to at least the first end. The sheath has a third end and a fourth end that is opposite to the third end. The loop wire and the cable are arranged in the sheath such that the loop portion protrudes from the third end side and the cable partially protrudes from the fourth end side. The loop portion is reduced in diameter by pulling out the cable from the fourth end side.

[0009] The above constriction device may further include a stopper. By slidably attaching the stopper to two mutually separated portions of the loop wire between the first end and the second end, the loop wire may be provided with a loop portion. The stopper may be arranged between the loop portion and the third end. The stopper may be non-insertable into the sheath from the third end side. The loop portion may be reduced in diameter by pulling out the cable from the fourth end side with the stopper in contact with the third end.

[0010] In the above-described suturing device, the cable may be attached to the first end and the second end. In the above-described suturing device, the length of the loop wire between the stopper and the cable may be 100 mm or more.

[0011] In the above-described suturing device, the stopper may have a resin layer around the loop wire and a cylindrical member covering the resin layer. The cylindrical member may be caulked to the loop wire with the resin layer interposed therebetween.

[0012] In the above-described suturing device, the loop wire may be formed of nylon, polyester, polypropylene, polytetrafluoroethylene, polybutester, or polyethylene. In the above-described suturing device, the cable may be formed of a material having a higher Young's modulus than the material constituting the loop wire. In the above-described suturing device, the cable may be formed of stainless steel.

Advantages of the Invention

[0013] According to the above-described suturing device, the operability when suturing the body tissue around the cut surface of the lesion can be improved.

Brief Description of the Drawings

[0014]

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Best Mode for Carrying Out the Invention

[0015] Details of embodiments of the present invention will be described with reference to the drawings. In the following drawings, the same or corresponding parts are denoted by the same reference numerals, and redundant descriptions will not be repeated.

[0016] (Configuration of the Shrinking Device According to the Embodiment) Hereinafter, the configuration of a shrinking device (referred to as "shrinking device 100") according to an embodiment will be described.

[0017] FIG. 1 is a plan view of the shrinking device 100. FIG. 2 is a plan view of the shrinking device 100 with the sheath 40 omitted. FIG. 3 is a cross-sectional view taken along line III-III in FIG. 2. As shown in FIGS. 1 and 2, the shrinking device 100 includes a loop wire 10, a cable 20, a stopper 30, and a sheath 40.

[0018] The loop wire 10 is a linear member. The loop wire 10 is a thread formed of a flexible material. Specific examples of the material constituting the loop wire 10 include nylon, polyester, polypropylene, polytetrafluoroethylene, polybutester, and polyethylene. The outer diameter of the loop wire 10 is, for example, 0.4 mm. The loop wire 10 has a first end 10a and a second end 10b. The second end 10b is the end on the opposite side of the first end 10a.

[0019] The cable 20 is a linear member. The cable 20 is formed of a material having a higher Young's modulus than the material constituting the loop wire 10. The cable 20 is, for example, a stranded wire formed of a metal material. A specific example of the material constituting the cable 20 is stainless steel.

[0020] One end of the cable 20 is attached to the first end 10a of the loop wire 10. More specifically, one end side of the cable 20 and the first end 10a side of the loop wire 10 are arranged inside the cylindrical member 21 and the cylindrical member 21 is caulked, whereby one end of the cable 20 is attached to the first end 10a of the loop wire 10. The cylindrical member 21 is formed of, for example, a metal material. A specific example of the metal material constituting the cylindrical member 21 is stainless steel.

[0021] The stopper 30 is slidably attached to two separated portions of the loop wire 10 between the first end 10a and the second end 10b. Let these two portions be the first portion 11 and the second portion 12, respectively. The second portion 12 is closer to the second end 10b than the first portion 11. The second portion 12 is away from the second end 10b. A knot is provided in the portion of the loop wire 10 between the second portion 12 and the second end 10b. This knot prevents the loop wire 10 from coming off the stopper 30.

[0022] The loop wire 10 has a loop portion 13. The loop portion 13 is annular with the first portion 11 and the second portion 12 as the starting point and the ending point, respectively.

[0023] The stopper 30 has a resin layer 31 and a cylindrical member 32. The resin layer 31 is around the loop wire 10 (the first portion 11, the second portion 12). The resin layer 31 is a layer formed of a resin material. A specific example of the resin material constituting the resin layer 31 is silicone rubber. The cylindrical member 32 covers the resin layer 31. From another perspective, the loop wire 10 (the first portion 11, the second portion 12) and the resin layer 31 are inside the cylindrical member 32. The cylindrical member 32 is formed of, for example, a metal material. A specific example of the metal material constituting the cylindrical member 32 is stainless steel. The cylindrical member 32 is caulked to the loop wire 10 (the first portion 11, the second portion 12) with the resin layer 31 interposed therebetween.

[0024] Let the length of the loop wire 10 between the stopper 30 and the cable 20 be length L. The length L is, for example, 100 mm or more. The length L may be 150 mm or more. The length L is measured in a state where the diameter of the loop portion 13 (the width in the longitudinal direction of the loop portion 13) is 35 mm.

[0025] The sheath 40 is a tubular member. The sheath 40 is formed of, for example, a resin material. Specific examples of the resin material constituting the sheath 40 include fluororesin. The sheath 40 has a third end 40a and a fourth end 40b. The fourth end 40b is the end on the opposite side of the third end 40a.

[0026] The loop wire 10 and the cable 20 are disposed within the sheath 40. However, the loop portion 13 protrudes from the third end 40a side of the sheath 40, and a part of the cable 20 protrudes from the fourth end 40b side of the sheath 40.

[0027] The stopper 30 is disposed between the third end 40a of the sheath 40 and the loop portion 13. The stopper 30 cannot be inserted into the interior of the sheath 40 from the third end 40a side. More specifically, the outer diameter of the stopper 30 on the third end 40a side of the sheath 40 is larger than the inner diameter of the sheath 40. The outer diameter of the sheath 40 is smaller than the inner diameter of the forceps channel of the endoscope, for example. The sheath 40 has a length that can be inserted into the forceps channel of the endoscope.

[0028] When the cable 20 is pulled out from the fourth end 40b side of the sheath 40, the stopper 30 moves toward the third end 40a of the sheath 40 and contacts the third end 40a of the sheath 40. Since the stopper 30 cannot be inserted into the interior of the sheath 40 from the third end 40a side, when the cable 20 is further pulled out with the stopper 30 in contact with the third end 40a of the sheath 40, the loop wire 10 is drawn into the interior of the sheath 40 and the loop portion 13 is reduced in diameter.

[0029] (Method of using the suture constriction device according to the embodiment) The method of using the suture constriction device 100 will be described below.

[0030] When using the suturing device 100, first, a guide sheath is prepared. A loop portion 13 is inserted into the guide sheath. Note that the other parts of the suturing device 100 do not need to be disposed within the guide sheath.

[0031] When using the suturing device 100, second, the guide sheath with the loop portion 13 inserted is disposed at the entrance of the forceps channel of the endoscope. By pushing the suturing device 100 in this state, the suturing device 100 is inserted into the forceps channel of the endoscope. Since the loop wire 10 is highly flexible, it is difficult to directly insert the loop portion 13 from the entrance of the forceps channel of the endoscope. However, by using the guide sheath, the loop portion 13 can be easily inserted into the forceps channel of the endoscope. The suturing device 100 is moved within the forceps channel of the endoscope until the loop portion 13 is disposed on the body tissue (e.g., gastric mucosa) around the cut surface of the lesion.

[0032] When using the suturing device 100, third, the loop portion 13 is fixed to the body tissue around the cut surface of the lesion by using endoscope clips. This fixation is performed, for example, at a plurality of locations.

[0033] When using the suturing device 100, fourth, while gripping the sheath 40, the cable 20 is pulled out from the fourth end 40b side of the sheath 40. Thereby, the loop portion 13 is reduced in diameter. As the loop portion 13 is reduced in diameter, the body tissue around the cut surface of the lesion is confined and sutured by the loop portion 13.

[0034] After the body tissue around the resection surface of the lesion is sutured and contracted by the loop portion 13, the portion of the loop wire 10 on the side of the first end 10a rather than the loop portion 13 is cut by the scissors forceps, and the loop portion 13 and the stopper 30 are left in the body. The other parts of the suture device 100 are then removed outside the body. Note that the endoscope clip that fixed the loop portion 13 to the body tissue around the resection surface of the lesion naturally comes off over time and is discharged outside the body together with the loop portion 13 and the stopper 30 left in the body.

[0035] (Effect of the suture device according to the embodiment) The effects of the suture device 100 will be described below.

[0036] In the suture device 100, after the loop portion 13 is clipped to the body tissue around the resection surface of the lesion, by performing a simple operation of pulling out the cable 20 from the fourth end 40b side of the sheath 40 as it is, the loop portion 13 is reduced in diameter, and the body tissue around the resection surface of the lesion is sutured and contracted. Therefore, the operability when suturing and contracting the body tissue around the resection surface of the lesion is improved.

[0037] In the suture device 100, another device (for example, a device having a hook for reducing the diameter of the loop portion) is not required to reduce the diameter of the loop portion 13, and the device configuration for suturing and contracting the body tissue around the resection surface of the lesion can be simplified.

[0038] In the suture device 100, although the loop wire 10 is connected to the user's hand via the cable 20, the loop wire 10 is formed of a flexible material and has a length L of, for example, 100 mm or more. Therefore, the loop portion 13 is independent of the movement of the endoscope. Therefore, the endoscope can be moved without changing the position of the loop portion 13, and the endoscope can be moved to a position with a good view to proceed with the procedure.

[0039] In the suture device 100, since the loop wire 10 is caulked by the cylindrical member 32 via the resin layer 31, an appropriate frictional force acts between the stopper 30 and the loop wire 10. Therefore, when the cable 20 is pulled out from the fourth end 40b side of the sheath 40 with the stopper 30 in contact with the third end 40a of the sheath 40, the loop wire 10 slides relative to the stopper 30, but in other cases, it is difficult for the loop wire 10 to move relative to the stopper 30. Therefore, according to the suture device 100, it is possible to achieve both the operability during suturing and the prevention of loosening of the loop portion 13 (the shape holding force of the loop portion 13).

[0040] In the suture device 100, the cable 20 is formed of a material having a higher Young's modulus than the material constituting the loop wire 10. As a result, when the loop portion 13 sutures the body tissue around the cut surface of the lesion, the total elongation of the loop wire 10 and the cable 20 is suppressed, so that the tightening load by the loop portion 13 can be reduced.

[0041] (Modification 1) Hereinafter, the suture device 100 (referred to as "suture device 100A") according to Modification 1 will be described. Here, mainly the points different from the suture device 100 will be described, and the overlapping descriptions will not be repeated.

[0042] FIG. 4 is a plan view of the suture device 100A with the illustration of the sheath 40 omitted. As shown in FIG. 4, the suture device 100A includes a loop wire 10, a cable 20, a stopper 30, and a sheath 40 (not shown). Since the stopper 30 is attached to two separated portions of the loop wire 10 between the first end 10a and the second end 10b, the portion of the loop wire 10 between the two portions forms the loop portion 13.

[0043] Inside the sheath 40, the loop wire 10 and the cable 20 are arranged such that the loop portion 13 protrudes from the third end 40a side of the sheath 40 and the cable 20 protrudes from the fourth end 40b side of the sheath 40. In this regard, the configuration of the constriction device 100A is common to the configuration of the constriction device 100.

[0044] However, in the constriction device 100A, both the first end 10a and the second end 10b of the loop wire 10 are attached to one end of the cable 20. That is, between the stopper 30 and one end of the cable 20, the two wires of the loop wire 10 are arranged in parallel. In this regard, the configuration of the constriction device 100A is different from the configuration of the constriction device 100. Also in this case, the first end 10a side and the second end 10b side of the loop wire 10 are attached to one end side of the cable 20 by caulking using the cylindrical member 21.

[0045] In the constriction device 100A, similar to the constriction device 100, by pulling out the cable 20 from the fourth end 40b side of the sheath 40, the loop portion 13 can be reduced in diameter and the body tissue around the cut surface of the lesion can be constricted. Therefore, the operability when constricting the body tissue around the cut surface of the lesion is improved.

[0046] Also, in the constriction device 100A, since both the first end 10a and the second end 10b of the loop wire 10 are connected to one end of the cable 20, even if the length of pulling out the cable 20 from the fourth end 40b side of the sheath 40 is the same as that of the constriction device 100, the loop portion 13 can be reduced in diameter more greatly.

[0047] (Modification 2) Hereinafter, a constriction device 100 (referred to as "constriction device 100B") according to Modification 2 will be described. Here, mainly the points different from the constriction device 100 will be described, and repeated descriptions will not be repeated.

[0048] FIG. 5 is a plan view of the suture device 100B with the sheath 40 omitted. As shown in FIG. 5, the suture device 100A has a loop wire 10, a cable 20, and a sheath 40 (not shown). The loop wire 10 has a loop portion 13 having two spaced-apart portions of the loop wire 10 between the first end 10a and the second end 10b as the starting point and the ending point, respectively. Inside the sheath 40, the loop wire 10 and the cable 20 are arranged such that the loop portion 13 protrudes from the third end 40a side of the sheath 40 and the cable 20 protrudes from the fourth end 40b side of the sheath 40. In this regard, the configuration of the suture device 100B is common to the configuration of the suture device 100.

[0049] However, in the suture device 100A, the loop portion 13 is formed by connecting the second end 10b side of the loop wire 10 to the other portion of the loop wire 10. In the suture device 100B, the second end 10b side of the loop wire 10 is connected to the other portion of the loop wire 10 such that the loop portion 13 is reduced in diameter by pulling out the cable 20 from the fourth end 40b side of the sheath 40. This knot is larger than the inner diameter of the sheath 40. Also, this knot allows the loop wire 10 to be slidable and fixable at a predetermined fixed position. A specific example of such a knot is a Roeder Knot. The suture device 100B does not have a stopper 30. In this regard, the configuration of the suture device 100B is different from the configuration of the suture device 100.

[0050] In the suture device 100B, similar to the suture device 100, by pulling out the cable 20 from the fourth end 40b side of the sheath 40, the loop portion 13 is reduced in diameter and the body tissue around the cut surface of the lesion can be sutured. Therefore, the operability when suturing the body tissue around the cut surface of the lesion is improved.

[0051] (Modification of the method of using the suture device according to the embodiment) In the above example, when using the suturing device 100, the suturing device 100 was inserted into the forceps channel of the endoscope. However, the suturing device 100 can be used by methods other than inserting it into the forceps channel of the endoscope.

[0052] FIG. 6 is a schematic diagram showing a method of using the suturing device 100 using the outer cylinder 200. As shown in FIG. 6, the suturing device 100 may be used by being inserted into the outer cylinder 200. The outer cylinder 200 is formed of, for example, a flexible material. Specific examples of the material constituting the outer cylinder 200 include vinyl chloride.

[0053] The outer cylinder 200 has an inner diameter into which the suturing device 100 can be inserted. The outer cylinder 200 has a fifth end 200a and a sixth end 200b. The sixth end 200b is the end on the opposite side of the fifth end 200a. The suturing device 100 is inserted into the inside of the outer cylinder 200, for example, from the sixth end 200b side. The outer cylinder 200 is attached to the endoscope with, for example, tape and inserted into the body together with the endoscope. Therefore, the suturing device 100 can be used by methods other than inserting it into the forceps channel of the endoscope. At this time, the outer cylinder 200 is inserted into the body from the fifth end 200a side.

[0054] FIG. 7 is a cross-sectional view of the outer cylinder 200 in the vicinity of the fifth end 200a of the outer cylinder 200. As shown in FIG. 7, the end face at the fifth end 200a of the outer cylinder 200 is constituted by a curved surface. Therefore, when inserting the outer cylinder 200 into the body, it is possible to make it difficult for the end face of the outer cylinder 200 to damage the body tissue in the insertion path of the outer cylinder 200.

[0055] The embodiments disclosed this time should be considered as illustrative in all respects and not restrictive. The scope of the present invention is shown not by the above embodiments but by the claims, and it is intended that all modifications within the meaning and scope equivalent to the claims are included.

Industrial Applicability

[0056] The above-described embodiment is particularly advantageously applicable to a constriction device for constricting body tissue around the cut surface of a lesion site.

Explanation of Signs

[0057] 100, 100A, 100B constriction devices, 10 loop wire, 10a first end, 10b second end, 11 first part, 12 second part, 13 loop part, 20 cable, 21 cylindrical member, 30 stopper, 31 resin layer, 32 cylindrical member, 40 sheath, 40a third end, 40b fourth end, 200 outer cylinder, 200a fifth end, 200b sixth end, L length.

Claims

Claim 1. A constriction device comprising a loop wire formed of a flexible material, a cable, and a sheath, wherein the loop wire has a first end and a second end opposite to the first end, the loop wire has an annular loop portion having two spaced-apart portions of the loop wire between the first end and the second end as a starting point and an ending point, respectively, the cable is attached to at least the first end, the sheath has a third end and a fourth end opposite to the third end, the loop wire and the cable are disposed within the sheath such that the loop portion protrudes from the third end side and the cable partially protrudes from the fourth end side, and the loop portion is reduced in diameter by pulling out the cable from the fourth end side, further comprising a stopper, wherein the stopper is slidably attached to two spaced-apart portions of the loop wire between the first end and the second end, whereby the loop portion is provided on the loop wire, the stopper is disposed between the loop portion and the third end, the stopper is non-insertable into the sheath from the third end side, the loop portion is reduced in diameter by pulling out the cable from the fourth end side with the stopper in contact with the third end, the length of the loop wire between the stopper and the cable when the width of the loop portion is 35 mm is 100 mm or more. Claim 2. The constriction device according to claim 1, wherein the cable is attached to the first end and the second end. Claim 3. The stopper has a resin layer around the loop wire and a cylindrical member covering the resin layer, the constriction device according to claim 1 or claim 2, wherein the cylindrical member is caulked to the loop wire with the resin layer interposed therebetween. Claim 4. The loop wire is formed of nylon, polyester, polypropylene, polytetrafluoroethylene, polybutester or polyethylene, the constriction device according to any one of claims 1 to 3. Claim 5. The cable is formed of a material having a higher Young's modulus than the material constituting the loop wire, the constriction device according to any one of claims 1 to 3. Claim 6. The cable is made of stainless steel, and the constricting device according to claim 4 or claim 5.

7. A loop wire formed of a flexible material, A cable, And a sheath, The loop wire has a first end and a second end that is an end opposite to the first end, The loop wire has a knot at the second end, and is slidably coupled to a portion of the loop wire located between the first end and the second end at the knot, The loop wire has an annular loop portion having two mutually separated portions of the loop wire between the first end and the second end as a starting point and an ending point respectively, The cable is attached to at least the first end, The sheath has a third end and a fourth end that is an end opposite to the third end, In the sheath, the loop wire and the cable are arranged such that the loop portion protrudes from the third end side and the cable partially protrudes from the fourth end side, And, The knot cannot be inserted into the sheath from the third end side, The loop portion is reduced in diameter by pulling out the cable from the fourth end side, A constricting device, wherein the length of the loop wire between the knot and the cable when the width of the loop portion is 35 mm is 100 mm or more.

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