Endoscopic treatment tools

Abstract

To provide an endoscope treatment instrument capable of sufficiently and stably securing lifting force of an internal tissue and holding force of a state of the tissue, by easy endoscope operation.SOLUTION: An endoscope treatment instrument comprises a sheath 11, an operation wire 13 inserted thereinto, a tool 12 disposed on a distal end 11a side of the sheath 11, a handle body 15 connected to a proximal end 11d side, and an operation member 14 for sliding the operation wire 13 connected to the tool 12 in an axial direction of the sheath 11 with respect to the handle body 15. The tool 12 includes a plurality of claw members 21 and 22 being movable between a storage position stored in the distal end 11a side and a use position projecting outward from the distal end 11a of the sheath 11, where each of the claw members 21 and 22 has a needle shape capable of puncturing into an internal tissue, and at least one thereof has an uneven shape.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to an endoscopic treatment tool, and more particularly to an endoscopic treatment tool suitable for lifting body tissue under an endoscope. [Background technology]

[0002] When a tumor develops in the digestive tract, such as the stomach, rigid laparoscopes have traditionally been used to perform minimally invasive surgery that leaves smaller scars on the body surface than open surgery. However, in recent years, medical technology has been proposed that enables even less invasive surgery by using flexible endoscopes with bendable insertion sections that can be inserted orally. Hereinafter, flexible endoscopes will also be simply referred to as endoscopes.

[0003] For example, in recent years, laparoscopic-endoscopic combined surgery (LECS), which uses both a laparoscope and an endoscope, has been used in place of the traditional open or laparoscopic surgery used to remove tumors. However, advanced medical techniques such as endoscopic full-thickness resection (EFTR), which uses only an endoscope, have been proposed to make this procedure even less invasive.

[0004] EFTR uses an endoscope to transorally resect and retrieve tumors, enabling pathological diagnosis. If the tumor has invaded the proper muscularis of the gastrointestinal tissue, an electric scalpel inserted through the forceps port of the endoscope is used to resect the mucosa around the lesion, after which the tumor's attachment to the muscularis is exposed, the muscularis is incised, and a full-thickness resection of the gastrointestinal tissue is performed to remove the lesion.

[0005] Furthermore, when performing EFTR, a surgical procedure has been proposed in which the gastrointestinal tissue containing the lesion is lifted up into the lumen under endoscopy, the gastrointestinal tissue is inverted at its base, and then the gastrointestinal tissue containing the lesion is resected. This procedure has the advantage that the lesion can be resected without causing communication between the inside and outside of the gastrointestinal tract, preventing leakage of gastrointestinal contents such as digestive fluids into the peritoneum and reducing the postoperative risk of peritonitis.

[0006] As an endoscopic treatment tool suitable for this procedure, for example, Patent Document 1 discloses a suturing device that includes a front arm with a storage space, a rear arm with a pair of needle-like members, arm moving means for moving the arms closer to or farther apart, and when the arms move closer to each other, the needle-like members engage with an engaging member with a suture thread stored in the storage space, thereby suturing tissue located between the arms. This suturing device makes it possible to suitably suture the base portion of digestive tract tissue that has been lifted into the lumen.

[0007] Patent Document 1 also discloses a method for suspending the gastrointestinal tissue containing the lesion inside the lumen in advance, in which the gastrointestinal tissue containing the lesion and the opposing gastrointestinal tissue are connected with a suture. Patent Document 1 also discloses that another suturing device described in Patent Document 2 can be used for this connection. [Prior art documents] [Patent documents]

[0008] [Patent Document 1] International Publication No. 2017 / 164359 [Patent Document 2] Patent No. 5294181 Summary of the Invention [Problem to be solved by the invention]

[0009] However, the method of using a suturing device to connect opposing pieces of digestive tract tissue with suture thread and thereby lifting the digestive tract tissue into the lumen has the problem that a relatively difficult procedure is required to connect the digestive tract tissue. In addition, it requires the use of separate suturing instruments attached to the endoscope for both lifting the digestive tract tissue and suturing its base, which makes it necessary to remove and reinsert the endoscope between lifting and suturing the base, which is cumbersome.

[0010] The present invention is intended to solve such conventional unresolved problems, and has as its object to provide an endoscopic treatment tool that can lift up internal body tissue with a relatively simple operation. [Means for solving the problem]

[0011] (1) To achieve the above-mentioned object, the endoscopic treatment instrument of the present invention is an endoscopic treatment instrument comprising a tubular sheath, an operating wire inserted into the sheath, a tool arranged on the tip side of the sheath, a handle body connected to the base end side of the sheath, and an operating member operably connected to the tool via the operating wire and sliding the operating wire relative to the handle body at least in the axial direction of the sheath, wherein the tool has a plurality of claw members that can be moved between a storage position stored in the tip side of the sheath and a use position protruding outward from the tip of the sheath, each of the plurality of claw members having a needle shape that can be punctured into body tissue, and at least one of the plurality of claw members having a concave-convex shape.

[0012] With this configuration, in the present invention, the multiple claw members extending in the axial direction of the sheath of the tool can puncture internal tissue at a usage position protruding from the distal end of the sheath, and at least one of the multiple claw members has an uneven shape, which prevents the tool from slipping out of the internal tissue once punctured, making it possible to lift and hold the internal tissue. Moreover, in the present invention, since the endoscopic treatment tool can be easily configured to be insertable through the treatment tool passage of the endoscope, by using an endoscope equipped with a suturing device for suturing the base of the lifted internal tissue and inserting the endoscopic treatment tool through the treatment tool passage, it is possible to complete the lifting of the internal tissue and the suturing of the base without removing and reinserting the endoscope, thereby simplifying operation.

[0013] (2) In a preferred embodiment of the present invention, each of the plurality of claw members may have a concave or convex shape, which further strengthens the tool's ability to prevent slipping out and allows the tool to more fully exert its lifting force on the internal tissue and its ability to maintain the lifted state.

[0014] (3) In a preferred embodiment of the present invention, the sheath may include a flexible tube slidably inserted into the endoscope. This allows the endoscope and the sheath holding a tool disposed at the distal end thereof to be freely displaced relative to each other in the axial direction and rotational direction about the axis, allowing the tool to be manipulated together with the sheath in the direction of puncturing and / or retracting the internal tissue, thereby enabling reliable manipulation and support of the tool.

[0015] (4) In a preferred embodiment of the present invention, the tool may be configured to displace in the axial direction of the sheath in response to axial operation input of the operating member relative to the handle body, and to rotate about the axis in response to rotational operation input from the operating member or the proximal end of the handle body. In this case, the amount of protrusion of the tool from the sheath tip can be adjusted, the tool can be operated in the puncture direction relative to the internal tissue independently of the sheath, and the tool can be rotated in the retraction direction together with the sheath or independently of the sheath, making it easy to adjust the position of the tool in the axial and rotational directions.

[0016] (5) In a preferred embodiment of the present invention, the handle body may be engaged with the operating member so as to be displaceable relative to the operating member in the axial direction but restrict relative rotation about the axis. In this case, the operating member of the tool and the handle body connected to the sheath are displaceable relative to each other in the axial direction, so that the tool can be operated in the puncture direction of internal tissue independently of the sheath. On the other hand, the relative rotation about the axis of the operating member with respect to the handle body is restricted by the handle body, so that the tool can be rotated together with the sheath by rotating the operating member about the axis, thereby facilitating operation.

[0017] (6) In a preferred embodiment of the present invention, a displacement restriction mechanism can be provided that can restrict axial displacement of the operating member relative to the handle body at a position where the multiple claw members protrude a predetermined amount from the distal end of the sheath. In this way, when the axial displacement of the operating member relative to the handle body is restricted by the displacement restriction mechanism, the amount of protrusion of the multiple claw members of the tool from the distal end of the sheath is fixed, and operation can be facilitated by setting the amount of protrusion appropriate for puncturing, lifting, and wrapping body tissue.

[0018] (7) In a preferred embodiment of the present invention, a guide member that is slidable on the inner surface of the distal end side of the sheath may be integrally provided on the proximal end side of the plurality of claw members of the tool. In this way, the guide member is slidably held on the inner surface of the distal end side of the sheath, so that the plurality of claw members of the tool can be retracted into or protruded from the sheath in a suitable position.

[0019] (8) In a preferred embodiment of the present invention, the guide member may be arranged around the plurality of claw members at a predetermined distance from the distal end toward the proximal end of the plurality of claw members and fixed to at least one of the plurality of claw members. In this way, the guide member, which is a predetermined distance from the tip of the tool, is fixed to at least one of the plurality of claw members, and can be used as a stopper during puncture.

[0020] (9) In a preferred embodiment of the present invention, the plurality of claw members are strip-shaped and face each other in the radial direction of the sheath, and at least one of the plurality of claw members corresponding to one side in the axial direction may have a notch having the concave and convex shape formed on one side in the plate width direction, and a hook-shaped portion may be formed adjacent to the notch. In this way, the bending rigidity of the plurality of claw members is increased in the plate width direction, which is the direction in which the internal tissue is engaged with and wrapped around the hook-shaped portions of the plurality of claw members, and the force with which the internal tissue is lifted and the force with which the lifted state is maintained can be sufficiently increased.

[0021] (10) The plurality of claw members may have a smaller diameter toward the tip of the at least one claw member than the portion having the concave-convex shape. This makes it easier for the plurality of claw members to puncture the body tissue and makes it less likely for them to come off after puncturing. [Effects of the Invention]

[0022] According to the present invention, an endoscopic treatment tool can be provided that can perform a procedure of lifting up internal tissue in the digestive tract and suturing its base with a suturing device or the like through relatively easy endoscopic manipulation, and that can fully exert the force of lifting internal tissue and the force of maintaining that lifted state. [Brief explanation of the drawings]

[0023] [Figure 1] 1 is a schematic perspective view of a main portion of an endoscopic treatment tool according to an embodiment of the present invention. [Figure 2] FIG. 2(A) is an explanatory diagram of the use state of an endoscopic treatment instrument according to one embodiment of the present invention, at the stage of inserting the instrument into a treatment instrument passage of an endoscope equipped with a suturing device and puncturing tissue, and FIG. 2(B) is an explanatory diagram of the use state of the endoscopic treatment instrument, at the stage of holding the tissue in a lifted state. [Figure 3] Figure 3(A) is an explanatory diagram linking a side view of the essential parts showing the operating direction of an endoscopic treatment tool according to one embodiment of the present invention in the stage of puncturing the tissue of the digestive tract with a diagram of the state of the surgical field under the endoscope at that stage; Figure 3(B) is an explanatory diagram linking a side view of the essential parts showing the operating direction of an endoscopic treatment tool according to one embodiment of the present invention in the stage of puncturing the tissue of the digestive tract and then rolling it up with a diagram of the state of the surgical field under the endoscope at that stage; and Figure 3(C) is an explanatory diagram linking a side view of the essential parts showing the operating direction of an endoscopic treatment tool according to one embodiment of the present invention in the stage of puncturing the tissue of the digestive tract and then rolling it up with a diagram of the state of the surgical field under the endoscope at that stage. [Figure 4]4(A) is a view taken in the direction of the arrow IVA in FIG. 1 showing one side of a tool (a main part of the treatment tool) during use in an endoscopic treatment tool according to one embodiment of the present invention, FIG. 4(B) is a view taken in the direction of the arrow IVB in FIG. 1 with the multiple claw members shown in FIG. 4(A) facing forward, and FIG. 4(C) is a view taken in the direction of the arrow IVC in FIG. 1 showing the other side of the tool having the multiple claw members shown in FIG. 4(B). [Figure 5] Figure 5(A) is an explanatory diagram of the operation at the stage where the suturing device attached to the endoscope is positioned near the suturing position on one side of the circumferential direction of the lumen of the tissue in a suspended state, Figure 5(B) is an explanatory diagram of the operation at the stage where the needle member of the suturing device shown in Figure 5(A) is advanced while puncturing the tissue in a suspended state and fitted into the engaging member on the rear side, and Figure 5(C) is an explanatory diagram of the operation at the stage where the needle member of the suturing device shown in Figure 5(B) is retracted to remove it from the tissue and pull out the suture together with the engaging member. [Figure 6] This is an explanatory diagram of the state as viewed from the tip side of the stage where a suturing device attached to an endoscope is placed near a predetermined suturing position on suspended tissue and suturing is performed. The suturing device shown in solid lines on the left side of the figure illustrates an example of the state of use corresponding to the leftmost suturing position of three adjacent suturing positions on the left side of the figure, and the suturing device shown in virtual lines on the right side of the figure illustrates an example of the state of use corresponding to the central leftmost suturing position of the three suturing positions. [Figure 7] 10A and 10B are explanatory views of an example of a stage in which a suture is ligated by a suture ligating device inserted into a treatment tool passage of an endoscope. [Figure 8] Figure 8(A) is an explanatory diagram of an example of a stage in which tissue above the sutured site is incised with an incising treatment instrument inserted into another treatment instrument passage of the endoscope, and Figure 8(B) is an explanatory diagram of an example of a stage in which tissue above the sutured site is incised with the incising treatment instrument shown in Figure 8(A) and then the tissue is retrieved with a grasping treatment instrument inserted into the treatment instrument passage of the endoscope. [Figure 9] 9(A) is a top view of the essential parts showing a deformed form in which the tip sides of multiple claw members protruding from the tip of a sheath in an endoscopic treatment tool according to one embodiment of the present invention are expanded into a free shape, and FIG. 9(B) is a top view of the essential parts showing a state in which the expansion width of the multiple claw members shown in FIG. 9(A) is limited by the inner edge of the tip of the sheath when the tip portions of the multiple claw members are retracted. DETAILED DESCRIPTION OF THE INVENTION

[0024] Hereinafter, embodiments of the present invention will be described with reference to the drawings.

[0025] (One embodiment) 1 to 4 show an endoscopic treatment tool according to one embodiment of the present invention, and FIGS. 5 to 8 show an example of treatment performed after lifting internal body tissue with the endoscopic treatment tool.

[0026] First, the overall configuration of the endoscopic treatment tool of this embodiment will be described.

[0027] The endoscopic treatment tool 1 of this embodiment shown in Figure 1 is used, for example, in non-exposed endoscopic full-thickness resection, or so-called non-exposed EFTR, and is a treatment tool that is inserted through an endoscope 2, which is a flexible endoscope, and inserted into the digestive tract DT, as shown in Figure 2, to lift up tissue PP having a lesion in the digestive tract DT toward the inside of the lumen and maintain that lifted state.

[0028] 1 to 4, the endoscopic treatment tool 1 has a tubular flexible sheath 11 that can be inserted into the treatment tool passage 2b of the endoscope 2, a lifting tool 12 arranged on the distal end 11a side of the sheath 11, an operating wire 13 such as an operating / driving wire inserted into the sheath 11, an operating member 14 arranged on the proximal end 11d side of the sheath 11 and operably connected to the lifting tool 12 via the operating wire 13, and a handle body 15 that is connected to the proximal end 11d side of the sheath 11 and supports the operating member 14 so that it can be relatively displaced in the axial direction. Note that Fig. 1 shows only the vicinity of the distal end of the endoscopic treatment tool 1 in an enlarged manner, and the other parts are shown in a reduced schematic view.

[0029] Although the detailed structure of the endoscope 2 is not shown, it has an operating section outside the body and an insertion section that is inserted into the body, and the tip side of the insertion section can be freely bent by operating the proximal side. In addition, the tip section 2a of the endoscope 2 is provided with, for example, a light guide with an illumination lens that illuminates the inside of the lumen, a CCD camera with an objective lens, a nozzle that can supply fluids such as water or air into the lumen, and a tip side opening of a treatment tool passage 2b, which is a lumen provided in the endoscope 2 for inserting endoscopic treatment tools, etc.

[0030] A suturing device 3 having a fitting tubular portion 3a for mounting the endoscope and integrally joined to an outer cover 3b is attached to the tip portion 2a of the endoscope 2, and the tip portion 2a of the endoscope 2 is inserted into, fitted and fixed to the fitting tubular portion 3a of the suturing device 3. The endoscope 2 with this suturing device 3 attached is adapted to be inserted orally into the digestive tract DT from the tip portion 2a side.

[0031] As shown in Figures 2, 5 and 6, the suturing device 3 has a front arm 31 in which stepped hole-shaped suture needle accommodating spaces 31a, 31b are formed, a rear arm 32 in which suturing needle members 32a, 32b are provided, and an arm moving mechanism 33 that moves the arms 31, 32 closer to or farther apart.

[0032] In the illustrated example of the suturing device 3, when the front arm 31 and rear arm 32, which are positioned in the digestive tract DT so as to sandwich the tissue PP having a diseased area therebetween, are brought closer together, the needle members 32a, 32b of the rear arm 32 are inserted into the suture target area ST1 of the tissue PP, and then pushed into the engaging members 35a, 35b, which are elastic rings with suture thread 34 that have been previously stored in the storage spaces 31a, 31b of the front arm 31, so that the engaging members 35a, 35b are held in the narrowed portions 32c, 32d of the needle members 32a, 32b.

[0033] Furthermore, when the front arm 31 and the rear arm 32 are moved away from each other, the ends 34a, 34b of the suture 34 connected to the engaging members 35a, 35b are pulled out together with the engaging members 35a, 35b in the direction of penetrating the tissue of the suture target area ST1 as the needle members 32a, 32b are retracted, and the suture target area ST1 can be sutured simply by ligating the ends 34a, 34b of the suture 34.

[0034] Then, after the endoscopic treatment tool 1 is pulled out and removed from the treatment tool passage 2b of the endoscope 2, a suture ligation device 82 with a connecting hook 82a to which a suture ligation tool 81 is attached is inserted into the treatment tool passage 2b of the endoscope 2 as shown in Figure 7, and both ends 34a, 34b of the suture 34 that has passed through the tissue of the suture target site ST1 with the suturing device 3 are tightened and fixed in a tangled state, i.e., ligated, thereby suturing the suture target site ST1. The suture ligation tool 81 and the suture ligation device 82 are similar to the suture ligation tool and ligation device described in, for example, JP 2020-163011 A. Then, once ligation of the suture 34 is complete, the suture ligating device 82 is removed from the treatment tool passage 2b of the endoscope 2, and instead a suture cutting tool capable of cutting the suture 34, such as an endoscopic electric scalpel, is inserted into the treatment tool passage 2b of the endoscope 2, thereby cutting the suture 34 located between the suture device 3 and the suture ligating tool 81, thereby separating the suture device 3 from the suture.

[0035] By repeating the above-described procedure from suturing to cutting the suture thread as many times as necessary while changing the suture position, the base of the tissue PP can be sutured so as to be liquid-tight. When suturing three suture target sites ST1, ST2, and ST3 as shown in Fig. 6, the suture position can be changed by changing the positions and postures of the endoscope 2 and the front arm 31 and rear arm 32 of the suturing device 3, or by operating the suturing device 3, the suture ligature tool 81, and the suture ligature device 82, as shown in Figs. 2 and 6. The detailed structure of the arm movement mechanism 33 of the suturing device 3 is the same as that described in Patent Document 1.

[0036] The area to be sutured (for example, the positions ST1 to ST3 shown in Figure 6) is located in advance by endoscopic examination, and when the tissue PP containing the marked lesion is lifted into the lumen of the digestive tract DT with the endoscopic treatment tool 1, it is set so that it is located closer to the base of the markings.

[0037] After the suturing and ligation of the multiple suture target sites are completed, as shown in Fig. 8(A), the tissue PP is severed from the digestive tract DT by incising the base of the tissue PP above the suture target sites ST1 to ST3 with an incision treatment instrument 71 such as an endoscopic electric scalpel inserted through the treatment instrument passage 2b of the endoscope 2. Then, the incision treatment instrument 71 is pulled out and removed from the treatment instrument passage 2b of the endoscope 2, and as shown in Fig. 8(B), the severed tissue PP is grasped with a retrieval treatment instrument 72 such as endoscopic grasping forceps inserted through the treatment instrument passage 2b of the endoscope 2, and the retrieval treatment instrument 72 is pulled out of the body via the treatment instrument passage 2b of the endoscope 2 or together with the endoscope 2 while still inserted through the treatment instrument passage 2b, thereby allowing the tissue PP to be removed and retrieved from the body.

[0038] Next, the configuration of the endoscopic treatment tool 1 of this embodiment will be described.

[0039] The sheath 11 of the endoscopic treatment tool 1 includes, as its main part, a flexible tube 11c that is slidably inserted into the endoscope 2, and a substantially annular mouthpiece member 11b having a chamfered outer periphery and / or inner periphery at the tip of the flexible tube 11c is attached.

[0040] The flexible tube 11c of the sheath 11 may be a tube made of resin or the like, but in this embodiment it is made of a coil tube made of metal such as stainless steel, for example, a flat wire coil tube made by spirally winding a strip-shaped metal material, or a round wire coil tube.

[0041] The endoscopic treatment tool 1 is configured so that the lifting tool 12 is retracted and stored within the sheath 11 so as not to be exposed, and the relative axial displacement of the two is restricted before being inserted into the endoscope 2 from the distal end 11a side of the sheath 11. Therefore, the flexibility and bending rigidity of the coil tube of the flexible tube 11c are optimally set so as to achieve both flexibility that can sufficiently follow the free deformation of the distal end portion 2a of the endoscope 2 inserted orally into the digestive tract DT, and the bending rigidity required when using the lifting tool 12 to lift the tissue PP, which will be described later, and maintain that lifted state.

[0042] The lifting tool 12 is connected to the distal end 13a of the operating wire 13 located on the distal end side of the endoscope 2 via a connecting member 24, and the proximal end 13b of the operating wire 13 located on the operating section side not shown of the endoscope 2 is fixed to a metal sliding member (not shown) that is slidably disposed in the substantially cylindrical handle body 15. The connecting member 24 may be connected in any manner as long as it restrains the lifting tool 12 and the distal end 13a of the operating wire 13 substantially integrally in the axial direction, and is not limited to welding or mechanical connection, and may also be connected in a rubber elastic manner.

[0043] The operating member 14 has finger holes 14a and 14b on both sides of a central cylindrical portion 14c through which the handle body 15 slidably passes, and the operating member 14 is provided with a screw-type movement restriction member 16, which is a displacement restriction mechanism, that passes through a portion of the central cylindrical portion 14c in the radial direction.

[0044] As shown in Figure 1, the operating member 14 is slidably engaged with a stepped elongated hole portion 15b formed in the handle body 15 at an inner convex portion (not shown) on the inner periphery of the central cylindrical portion 14c, and by tightening a movement restricting member 16 that is screwed to the aforementioned sliding member through the stepped elongated hole portion 15b, it is possible to selectively restrict or restrict the axial displacement of the operating member 14 relative to the handle body 15, or to allow relative displacement of the operating member 14 and the handle body 15 by releasing the restriction or restriction.

[0045] The lifting tool 12 is made of metal, for example, stainless steel, and has a fork shape extending in the axial direction of the sheath 11. The lifting tool 12 is interconnected at the base end connected to the operating wire 13, and has a plurality of claw members 21, 22 spaced apart at a predetermined radial interval at the tip end.

[0046] Furthermore, lifting tool 12 is movable between a storage position where multiple claw members 21, 22 are stored within sheath 11 without protruding from distal end 11a of sheath 11, and a use position where multiple claw members 21, 22 protrude outward from distal end 11a of sheath 11, as shown in Figure 1. This movement can be controlled by loosening movement restricting member 16 and displacing operating member 14, which is connected to lifting tool 12 via operating wire 13, in the axial direction relative to handle body 15, which is connected to sheath 11. For example, the surgeon can operate the lifting tool by inserting his index finger and middle finger into finger holes 14a, 14b of operating member 14 and, for example, inserting his thumb into finger hole 15a provided at the base end of handle body 15.

[0047] Furthermore, the plurality of claw members 21, 22 have a needle shape that can puncture internal body tissue such as tissue PP of the digestive tract DT, and have an uneven shape in part in the longitudinal direction.

[0048] Specifically, the multiple claw members 21, 22 form a pair of strip-shaped plates facing each other in the radial direction of the sheath 11, and each of the multiple claw members 21, 22 has a concave-shaped notch 21c or 22c formed on one side of the plate width direction of the lifting tool 12.

[0049] For example, recessed notches 21c, 22c are formed on one side of the plurality of claw members 21, 22 in the plate width direction within a predetermined range in the longitudinal direction thereof so as to open to one side in the plate width direction of the lifting tool 12. As a result, the plurality of claw members 21, 22 have hook-shaped portions 21b, 22b, respectively, which are adjacent to the notches 21c, 22c on one side of the plate width of the lifting tool 12 and have an edge shape in the form of a substantially L-shaped hook.

[0050] Furthermore, the outer diameter of each of the plurality of claw members 21, 22 becomes smaller toward the tips 21a, 22a of the concave-convex portions having the respective notches 21c, 22c and hook-shaped portions 21b, 22b.

[0051] More specifically, the multiple claw members 21, 22 have a needle-like shape with a rectangular cross section, with flat inclined surfaces on both sides of their tip ends in the width direction of the plate, and a flat inclined surface only on the outer surface side in the thickness direction of the plate.

[0052] Therefore, when the multiple claw members 21, 22 are punctured from the tip 21a, 22a side until the hook-shaped portions 21b, 22b enter the internal tissue such as the tissue PP of the digestive tract DT, the hook-shaped portions 21b, 22b can hold the tissue PP in a non-slip state through the internal tissue that enters the notches 21c, 22c.

[0053] In addition, when the lifting tool 12 is rotated around its axis via the operating wire 13 by the operating member 14, which engages integrally with the handle body 15 in the rotational direction, the internal body tissue, such as tissue PP, which is held in a non-slip state, is wrapped around the multiple claw members 21, 22, thereby enhancing the function of holding the non-slip state.

[0054] Furthermore, a metal, for example, stainless steel guide member 23 that can slide on the inner surface of the tip 11a side of the sheath 11 is integrally provided on the proximal end side of the multiple claw members 21, 22 of the lifting tool 12. Taking into consideration the curvature of the sheath 11 that is inserted into the endoscope 2, this guide member 23 has a short cylindrical shape with an axial length that is relatively short compared to its outer diameter.

[0055] As shown in Fig. 4(A), guide member 23 is disposed around both claw members 21, 22 at a predetermined distance L2 from tips 21a, 22a of the claw members 21, 22 toward base ends 21d, 22d, and is fixed integrally to the claw members 21, 22 by welding or the like. Guide member 23 may be chamfered at either one end in the axial direction as shown in Fig. 4, or at both ends. The predetermined distance L2 is a length that does not penetrate tissue when punctured.

[0056] As described above, the handle body 15 is capable of relative axial displacement with respect to the operating member 14, but is engaged in a manner that restricts relative rotation about the axis. Therefore, the lifting tool 12 is displaced axially within the sheath 11 in response to an axial operation input of the operating member 14 relative to the handle body 15, or an axial operation input of the handle body 15 relative to the operating member 14, but rotates integrally with the sheath 11 in the axial direction in response to a rotation operation input from the base end side of the operating member 14 or the handle body 15.

[0057] Of course, if the operating member 14 or the handle body 15 is engaged with each other so that they can rotate about their axis, the lifting tool 12 can be relatively rotationally displaced within the sheath 11 in response to an operation input of the operating member 14 relative to the handle body 15 in the axial direction, or an operation input of the handle body 15 relative to the operating member 14 in the axial direction.

[0058] For example, such an engaged state can be achieved by forming multiple circumferential grooves or spiral grooves that open radially outward rather than axial grooves in the handle body 15, or by simply fitting the operating member 14 and the handle body 15 together via cylindrical surfaces and restricting movement in any direction with a threaded movement restricting member 16. Also, instead of the sheath 11, a sheath with a double structure having an outer sheath connected to the handle body 15 and an inner sheath connected to the operating member 14 can be used.

[0059] The displacement of the operating member 14 relative to the handle body 15 is restricted by a screw-type movement restricting member 16 at a position where the tips 21a, 22a of the multiple claw members 21, 22 protrude from the tip 11a of the sheath 11 by a predetermined protrusion amount L1 shown in Figure 4(A), thereby restricting the relative displacement of the sheath 11 and the lifting tool 12 in the axial direction.

[0060] Therefore, the lifting tool 12 can be fixed in the storage position by tightening the screw-type movement-restricting member 16 to prevent axial displacement relative to the sheath 11, and can be moved to the usage position by releasing the tightening of the movement-restricting member 16.

[0061] In this embodiment, the operating member 14 and the handle body 15 are engaged and can slide axially, so the position of use of the lifting tool 12 depends on the manual operation of the relative position of the operating member 14 and the handle body 15, and is fixed by tightening the movement restricting member 16. However, by providing a feed screw mechanism or the like that can finely adjust the axial position of the operating member 14 and the handle body 15, the movement restricting member 16 can be eliminated or reduced to a simple locking mechanism.

[0062] 1 to 4, the multiple claw members 21, 22 have radially opposing inner surfaces parallel to each other, but as shown in Fig. 9(A), the multiple claw members 21, 22 may have a free shape that expands toward the tip side of the guide member 23 so that the spacing between the multiple claw members 21, 22 becomes wider toward the tip when the lifting tool 12 is in use. In this case, when the lifting tool 12 is retracted to the storage position, as shown in Fig. 9(B), the spacing between the multiple claw members 21, 22 becomes approximately the same and parallel along the axial direction, and at the start of use, they return to the expanded shape shown in Fig. 9(A).

[0063] Next, the operation of the endoscope 2 when using the endoscopic treatment tool 1 will be described.

[0064] In this embodiment, the endoscopic treatment tool 1 can rotate around its axis relative to the endoscope 2, and the endoscope 2 can be rotated around its axis within the digestive tract DT, so that the relative heights and radial positions of the suturing device 3 supported on the tip 2a of the endoscope 2 and the sheath 11 and lifting tool 12 of the endoscopic treatment tool 1 within the digestive tract DT can be changed by rotating the endoscope 2.

[0065] Furthermore, the postures of the endoscopic treatment tool 1 and the suturing device 3 can be changed by operating them in the axial direction or rotating them around their axes.

[0066] Furthermore, in this embodiment, a predetermined bending rigidity is set on the tip 11a side of the sheath 11, so that the multiple claw members 21, 22 can lift up the punctured tissue PP or other internal body tissue into the lumen and maintain that lifted state in response to changes in the radial tilt attitude of the tip 2a of the endoscope 2 and changes in the rotational opening position.

[0067] Figures 2, 3 and 6 illustrate examples of changes in the attitude and height of the lifting tool 12 in response to changes in the radial tilt attitude and rotational angle position of the tip 2a of the endoscope 2, but it goes without saying that the lifting attitude and lifting height of internal tissue such as tissue PP by the lifting tool 12 can also be changed by raising the tip 2a of the endoscope 2.

[0068] In addition, in order to change the lifting posture and lifting height of internal tissue such as tissue PP by the lifting tool 12 while keeping the posture of the endoscope 2 fixed, it is also possible to use a means for raising the tip 11a side of the sheath 11 of the endoscopic treatment tool 1 by wire drive or the like.

[0069] Next, the operation will be described.

[0070] In the endoscopic treatment tool 1 of this embodiment, which is configured and operated as described above, the multiple claw members 21, 22 of the lifting tool 12 extending in the axial direction of the sheath 11 can puncture internal tissue such as tissue PP at a use position protruding from the tip 11a of the sheath 11, and since the multiple claw members 21, 22 have an uneven shape, they can prevent the fork-shaped lifting tool 12 punctured into the tissue PP from slipping out, allowing the tissue PP to be lifted and held.

[0071] Furthermore, when the lifting tool 12 is rotated around the axis, the anti-slip action can be strengthened while also generating a catching action for the tissue PP, so that the lifting force for the tissue PP and the force for maintaining the lifted state can be fully exerted.

[0072] Furthermore, in this embodiment, each of the multiple claw members 21, 22 has an uneven shape on one side of the plate width direction of the lifting tool 12 when lifting the tissue PP, so that the uneven shape creates a slip-out prevention effect at multiple locations, and the respective slip-out prevention effects can be strengthened when the lifting tool 12 is rotated to one side around the axis, making it possible to more fully exert the lifting force for the tissue PP and the force for maintaining the lifted state.

[0073] Furthermore, in this embodiment, the sheath 11 includes a flexible tube 11c that is slidably inserted into the endoscope 2, so that the endoscope 2 and the sheath 11 that holds the lifting tool 12 arranged at its tip side can be freely displaced relative to each other in the axial direction and the rotational direction around the axis, and the lifting tool 12 can be appropriately and accurately operated together with the sheath 11 in the puncture direction and / or the winding direction relative to the tissue PP, thereby enabling reliable operation and support of the lifting tool 12.

[0074] Additionally, in this embodiment, the lifting tool 12 is displaced in the axial direction of the sheath 11 in response to an axial operation input of the operating member 14 relative to the handle body 15, while rotating about its axis in response to a rotational operation input from the proximal end side of the operating member 14 or the handle body 15, making it possible to appropriately adjust the amount L1 of protrusion of the lifting tool 12 from the distal end 11a of the sheath 11. Furthermore, since the lifting tool 12 can be operated in the puncture direction relative to the tissue PP independently of the sheath 11, and furthermore, the lifting tool 12 can be rotated in the retraction direction together with the sheath 11, it is possible to easily adjust the position of the lifting tool 12 in the axial and rotational directions.

[0075] That is, the handle body 15 is displaceable relative to the operating member 14 in the axial direction, but restricts the relative rotation of the operating member 14 about the axis. Therefore, the handle body 15 is displaceable relative to the operating member 14 of the lifting tool 12 in the axial direction, and the lifting tool 12 can be operated in the puncture direction relative to the tissue PP independently of the sheath 11. On the other hand, since the relative rotation of the operating member 14 about the axis with respect to the handle body 15 is restricted by the handle body 15, the lifting tool 12 can be rotated together with the sheath 11 when the operating member 14 is rotated about the axis, making the operation easy and stable.

[0076] Of course, instead of the sheath 11, a double-structure sheath having an outer sheath connected to the handle body 15 and an inner sheath connected to the operating member 14 may be used so that the lifting tool 12 can be rotated in the retracting direction independently of the sheath 11.

[0077] Furthermore, in this embodiment, a movement restricting member 16 is provided that can restrict the displacement of the operating member 14 relative to the handle body 15 at a usage position where the multiple claw members 21, 22 protrude a predetermined protrusion amount L1 from the tip 11a of the sheath 11. Therefore, when the displacement of the operating member 14 relative to the handle body 15 is restricted by the movement restricting member 16, the protrusion amount L1 of the multiple claw members 21, 22 of the lifting tool 12 from the tip 11a of the sheath 11 is fixed to a protrusion amount suitable for operations such as puncturing, lifting, and wrapping the tissue PP, thereby making these operations sufficiently easy.

[0078] In addition, in this embodiment, a guide member 23 that can slide on the inner surface of the tip 11a side of the sheath 11 is integrally provided on the base end side of the multiple claw members 21, 22 of the lifting tool 12.Since the guide member is slidably held on the inner surface 11e side of the tip 11a side of the sheath 11, the multiple claw members 21, 22 of the lifting tool 12 can be stored or protruded in a suitable position within the sheath 11.

[0079] Moreover, guide member 23 is disposed around the plurality of claw members 21, 22 at a predetermined distance L2 from tips 21 a, 22 a of the plurality of claw members 21, 22 toward base ends 21 d, 22 d, and is fixed to the plurality of claw members 21, 22 by welding or the like, so that it can also function as a stopper that limits the penetration depth to a predetermined depth when the plurality of claw members 21, 22 puncture internal tissue such as tissue PP. Note that when a guide member is provided, it is not necessary for the guide member to be fixed to all of the plurality of claw members, and it is sufficient that the guide member be fixed to at least one of the plurality of claw members.

[0080] In addition, in this embodiment, the multiple claw members 21, 22 of the lifting tool 12 are formed with notches 21c, 22c and hook-shaped portions 21b, 22b adjacent to these notches 21c, 22c so as to have an uneven shape on one side in the plate width direction.Therefore, the bending rigidity of the multiple claw members 21, 22 is increased in the plate width direction, which is the direction in which the tissue PP is engaged with the hook-shaped portions 21b, 22b of the multiple claw members 21, 22 and the direction in which the tissue PP is rolled up into the notches 21c, 22c, and the lifting force of the tissue PP and the force with which it is held in the lifted state can be sufficiently increased.

[0081] Furthermore, the diameter of the multiple claw members 21, 22 becomes smaller toward the tip 21a, 22a on the tip side of the portion having an uneven shape on one side of the plate width direction due to each hook-shaped portion 21b, 22b and notch 21c, 22c, making it easier for the multiple claw members 21, 22 to puncture the tissue of the tissue PP and making it less likely for them to come out after puncturing.

[0082] Thus, according to this embodiment, the task of lifting the tissue PP of the digestive tract DT into the lumen while excising the tissue PP above the suture point at its base, for example, the multiple suture target sites ST1 to ST3, can be performed with relatively easy endoscopic manipulation, and an endoscopic treatment tool 1 can be provided that can fully exert the force of lifting the tissue PP and the force of maintaining the lifted state.

[0083] (Other embodiments) FIG. 9 illustrates only the essential parts of an endoscopic treatment tool according to another embodiment of the present invention.

[0084] Although the shape of the distal end of the lifting tool 12 in this embodiment differs from that in the above-described embodiment, the other configurations are exactly the same as those in the above-described embodiment. Therefore, the differences between this embodiment and the above-described embodiment will be described below using the reference numerals of the corresponding components in the above-described embodiment shown in Figures 1 to 8.

[0085] As shown in Figure 9(A), in this embodiment, the multiple claw members 21, 22 of the lifting tool 12 have a free shape in which the distance between them increases as they approach the tips 21a, 22a on the side of the guide member 23 closer to the tips 21a, 22a.

[0086] For example, the multiple claw members 21, 22 have a free shape in which the radial separation distance d1 between the tips 21a, 22a is larger than the radial separation distance d2 inside the guide member 23 by a predetermined factor d1 / d2 (for example, approximately 1 to 1.5 times).

[0087] When the plurality of claw members 21, 22 of the lifting tool 12 store the guide member 23 inside the tip 11a of the sheath 11 and reduce the amount of protrusion L1 of the plurality of claw members 21, 22 from the tip 11a of the sheath 11 to less than the predetermined distance L2, the separation distance on the tip side of the plurality of claw members 21, 22 is narrowed to less than separation distance d1 by the sheath 11. Note that at this time, the tips 21a, 22a of the plurality of claw members 21, 22 do not come into contact with the inner circumferential surface of the sheath 11.

[0088] That is, as shown in FIG. 9(B), the distance between the tip ends of the multiple claw members 21, 22 is approximately the storage side distance d3, which is closer to the radial distance d2 inside the guide member 23 than the distance d1 between the tips 21a, 22a when the sheath 11 protrudes a predetermined amount L1 from the tip 11a.

[0089] Furthermore, when the multiple claw members 21, 22 of the lifting tool 12 again protrude from the tip 11a of the sheath 11 to a predetermined protrusion amount L1, the multiple claw members 21, 22 elastically recover to their free shape and return to the maximum separation distance d1.

[0090] In this embodiment, too, the multiple claw members 21, 22 of the lifting tool 12 extending in the axial direction of the sheath 11 can puncture internal tissue such as tissue PP at the use position protruding from the tip 11a of the sheath 11, and since the multiple claw members 21, 22 have an uneven shape, they can prevent the lifting tool 12 that has punctured the tissue PP from slipping out, allowing the tissue PP to be lifted and held.

[0091] Furthermore, when the lifting tool 12 is rotated around the axis, the anti-slip action can be strengthened while also generating a catching action for the tissue PP, so that the lifting force for the tissue PP and the force for maintaining the lifted state can be fully exerted.

[0092] Furthermore, in this embodiment, the plurality of claw members 21, 22 have a free shape that widens toward the tip end so that the distance between the plurality of claw members 21, 22 becomes larger toward the tip end 21a, 22a, and therefore the anti-slip effect of the notches 21c, 22c and the hook-shaped portions 21b, 22b can be further strengthened.

[0093] In each of the above-described embodiments, the endoscopic treatment tool 1 is used in non-perforation endoscopic full-thickness resection, but it can also be used as a treatment tool for lifting tissue in other procedures within NOTES, which is a transluminal endoscopic surgery.

[0094] Furthermore, in the above-described embodiment, the lifting tool 12 has two claw members 21, 22, but the number of claw members may be any number equal to or greater than two.

[0095] Furthermore, the multiple claw members 21, 22 are each configured to position the uneven shapes on one side of the plate width direction within the same area within a predetermined axial distance L2 using the notches 21c, 22c and the hook-shaped portions 21b, 22b, but the uneven shapes may be positioned on both sides of the plate width direction, or may be positioned in different areas within the predetermined axial distance L2.

[0096] Of course, one of the claw members 21 may have not only the concave-convex shape formed by the notch 21c and the hook-shaped portion 21b but also a different concave-convex shape on one side at a different axial location. Similarly, the other claw member 22 may have not only the concave-convex shape formed by the notch 22c and the hook-shaped portion 22b at one location but also a different concave-convex shape on the other side at a different axial location. Furthermore, the depths and shapes of the multiple recesses and the heights and shapes of the protrusions formed on the same claw member 21 or 22 may be different or the same. Furthermore, the number, size, and shape of the concave-convex shapes may be different on one side and the other side in the rotational direction around the axis to vary the strength of the retention effect depending on the direction of rotation. Furthermore, when the claw members have concave-convex shapes, it is not necessary for all of the claw members to have concave-convex shapes; it is sufficient for at least one of the claw members to have concave-convex shapes.

[0097] Furthermore, each of the claw members 21, 22 is a plate-shaped member that is approximately straight at the tip side of the guide member 23, but it may be curved in the thickness direction, or the width of the plate may change so that both side surfaces in the width direction form curved surfaces.

[0098] As explained above, the present invention provides an endoscopic treatment tool that can sufficiently and stably ensure the lifting force of internal tissue and the force to maintain that lifted state with relatively easy endoscopic operation, and is useful as an endoscopic treatment tool for lifting internal tissue under endoscopy. [Explanation of symbols]

[0099] 1 Endoscopic treatment tools 2 Endoscopy 2a Tip 2b Treatment tool passage 3 Suturing device 3a Fitting cylinder part 3b Outer cover 11 Sheath 11a tip 11b mouthpiece member 11c Flexible Tube 11d proximal end 11e Inside 12 Lifting tools 13 Operation wire 13a Tip 13b Proximal end 14 Operating member 14a, 14b, 15a finger holes 14c Central cylinder part 15 Handle body 15b Stepped slot 16 Movement restriction member (displacement restriction mechanism) 21, 22 Claw member (plurality of claw members) 21a, 22a tip 21b, 22b hook-shaped part 21c, 22c notch 21d, 22d proximal end 23 Guide member 31 Front arm 31a, 31b Storage space 32 Rear arm 32a, 32b needle member 32c, 32d waist area 33 Arm movement mechanism 34 Sutures 34a, 34b both ends 35a, 35b Engagement members 71 Incision instruments 72 Recovery equipment 81 Suture ligature device 82 Suture ligation device d1, d2 separation distance d3 Storage side clearance DT gastrointestinal tract L1 protrusion amount L2 predetermined distance PP tissue (tissue with lesions, internal tissue) ST1, ST2, ST3 suture target areas

Claims

1. a tubular sheath; an operating wire inserted into the sheath; a tool disposed on the distal end side of the sheath; a handle body connected to a proximal end side of the sheath; an operating member operably connected to the tool via the operating wire and sliding the operating wire relative to the handle body at least in the axial direction of the sheath, the tool has a plurality of claw members that are movable between a storage position where the tool is stored at the distal end side of the sheath and a use position where the tool protrudes outward from the distal end of the sheath, Each of the plurality of claw members has a needle shape capable of puncturing body tissue, and at least one of the plurality of claw members has an uneven shape, an endoscopic treatment instrument, characterized in that the tool is displaced in the axial direction of the sheath in response to an axial operation input of the operating member relative to the handle body, and rotates in an axial direction in response to a rotation operation input from the operating member or the proximal end side of the handle body.

2. 2. The endoscopic treatment tool according to claim 1, wherein each of the plurality of claw members has an uneven shape.

3. 3. The endoscopic treatment tool according to claim 1, wherein the sheath includes a flexible tube that is slidably inserted into the endoscope.

4. An endoscopic treatment tool as described in any one of claims 1 to 3, characterized in that the multiple claw members are connected to each other on the base end side of the tool that is connected to the operating wire.

5. 5. The endoscopic treatment tool according to claim 1, wherein the handle body is engaged with the operating member so as to be displaceable relative to the operating member in the axial direction, but to restrict relative rotation about the axis.

6. 6. The endoscopic treatment tool according to claim 1, further comprising a displacement restriction mechanism that restricts axial displacement of the operating member relative to the handle body at a position where the plurality of claw members protrude a predetermined amount from the tip of the sheath.

7. 7. The endoscopic treatment tool according to claim 1, wherein a guide member slidable on an inner surface of the distal end side of the sheath is integrally provided on the proximal end side of the plurality of claw members of the tool.

8. The endoscopic treatment tool according to claim 7, wherein the guide member is arranged around the plurality of claw members at a predetermined distance from the distal ends of the plurality of claw members toward the proximal end, and is fixed to at least one of the plurality of claw members.

9. 9. The endoscopic treatment tool according to claim 1, wherein the plurality of claw members are strip-shaped and face each other in a radial direction of the sheath, and at least one of the plurality of claw members corresponding to one side in the axial direction has a notch formed in the concave-convex shape on one side in the plate width direction, and a hook-shaped portion is formed adjacent to the notch.

10. The endoscopic treatment tool according to any one of claims 1 to 9, wherein at least one of the plurality of claw members is located on the distal end side of the portion having the uneven shape, and the diameter of the claw members decreases as it approaches the distal end.

Images