Endoscopic treatment tool and endoscope device

Abstract

Provided are: an endoscope treatment tool which can be easily operated regardless of how an operator holds the operation part; an endoscope device; and a treatment method.　An endoscope treatment tool 20 comprises: a tip part 23 provided with a openable / closable holding part 24; a bendable bending part 25 adjacent to the tip part; an operation part 22 into which operation to close the holding part and operation to bend the bending part are input; and an operation wire 27 for transmitting the operation on the operation part to the holding part and the bending part. When the operation wire is made linear and the operation part is viewed along the direction of the axis line of the operation wire toward the tip part, the position of a bending operation face of the bending part is located within a range larger than 180 degrees in the clockwise direction and less than 270 degrees in the clockwise direction in the circumferential direction of the axis line from the position at which an operation handle 51 that causes the bending part to operate is provided on the operation part.

Description

[Technical Field]

[0001] The present invention relates to an endoscopic treatment tool, an endoscopic device, and a treatment method. [Background technology]

[0002] Conventionally, various treatments have been performed on living organisms using a combination of an endoscopic device and an endoscopic treatment tool. One example of such treatment is endoscopic submucosal dissection (ESD). ESD is applied to the inner walls of the esophagus, stomach, large intestine, and other organs, which consist of three layers: the mucosal layer, the submucosal layer, and the muscular layer. In ESD, the lesion in the mucosal layer is dissected together with the submucosal layer, making it possible to remove even relatively large lesions, e.g., those exceeding 2 cm, en bloc.

[0003] As an example of an endoscopic treatment tool, for example, Patent Document 1 discloses an endoscopic treatment tool including an insertion portion insertable into a body, an operation portion, and a single operation wire extending from the operation portion to the insertion portion and pulled toward the operation portion by operation of the operation portion, the insertion portion including a tip portion having an openable and closable grip portion, a bendable bending portion provided adjacent to the tip portion on the operation portion side, and a connecting portion connecting the bending portion to the operation portion. In this endoscopic treatment tool, the connecting portion is advanced and retracted along the longitudinal axis of the connecting portion by operation of the operation portion, and is rotated around the longitudinal axis of the connecting portion, so that the grip portion advances and retracts or rotates as the connecting portion advances and retracts, and the operation wire is pulled, so that the grip portion closes, and the bending portion is bent when the grip portion is closed. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] International Publication No. 2019 / 172318 Summary of the Invention [Problem to be solved by the invention]

[0005] In the endoscopic treatment tool disclosed in Patent Document 1, variations in the way the operating unit is held can sometimes be a problem. For example, in the case of an operating unit equipped with an operating handle, the operating direction of the operating handle and the direction of movement of the tip end (movement of the bending section) are not always arranged in a way that is easy for the operator to operate. In short, the way the operating unit is held varies depending on the operator, and the operating direction of the operating handle varies relative to the direction of the operator's body, causing an uncomfortable feeling in the direction of movement of the tip end relative to the operating direction of the operating handle, which has led to a problem of impaired operability.

[0006] The present invention has been made in view of the above-mentioned circumstances, and proposes an endoscopic treatment tool, an endoscopic device, and a treatment method that are easy to operate even if there is variation in the way operators hold the operation unit. [Means for solving the problem]

[0007] The endoscopic treatment tool of the present invention comprises a tip portion provided with an openable and closable gripping portion, a bendable bending portion provided adjacent to the tip portion, an operation portion to which an operation to close the gripping portion and an operation to bend the bending portion are input, and an operation wire for transmitting the operation of the operation portion to the gripping portion and the bending portion, wherein when the operation wire is made straight and the operation portion is viewed toward the tip portion along the axial direction of the operation wire, the position of the bending operation surface of the bending portion is located in a range greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the axial line, starting from the position where an operation handle for operating the bending portion is provided on the operation portion.

[0008] The endoscopic device of the present invention comprises a first treatment tool which is the endoscopic treatment tool, a second treatment tool, a first treatment tool channel through which the first treatment tool can be inserted, and an endoscope having a second treatment tool channel through which the second treatment tool can be inserted.

[0009] The treatment method of the present invention uses the endoscopic device, positions the tip of the first treatment tool at a lesion site inside the body through the first treatment tool channel of the endoscope, grasps the lesion site with the grasping portion of the first treatment tool, lifts the lesion site by bending the bending portion of the first treatment tool while the lesion site is grasped, and treats a portion below the lesion site with the second treatment tool inserted through the second treatment tool channel of the endoscope while the lesion site is lifted. [Effects of the Invention]

[0010] According to the present invention, it is possible to provide an endoscopic treatment tool, an endoscopic device, and a treatment method that are easy to operate even if there is variation in the way operators hold the operation section. [Brief explanation of the drawings]

[0011] [Figure 1] 1 is a diagram illustrating an example of an endoscope system for explaining an embodiment of the present invention. [Figure 2] 1A and 1B are diagrams illustrating an example of an endoscopic treatment tool for explaining an embodiment of the present invention. [Figure 3] 3 is a diagram showing the configuration of a grip portion at the distal end of the endoscopic treatment tool of FIG. 2. FIG. [Figure 4] 4A to 4C are diagrams illustrating the operation of the gripping portion of FIG. 3. [Figure 5] 3 is a diagram showing the configuration of a bending portion and a connecting portion of the endoscopic treatment tool of FIG. 2. FIG. [Figure 6] 6A and 6B are diagrams illustrating the operation of the bending portion of FIG. 5. [Figure 7] 6 is a diagram showing the internal configuration of the bending portion of FIG. 5. FIG. [Figure 8] 6 is a diagram showing the internal configuration of the bending portion of FIG. 5. FIG. [Figure 9] 6A and 6B are diagrams illustrating the internal operation of the bending portion of FIG. 5. [Figure 10] 3 is a diagram showing the configuration of an operation section of the endoscopic treatment tool of FIG. 2. FIG. [Figure 11] 3 is a cross-sectional view of an operation portion of the endoscopic treatment tool of FIG. 2. FIG. [Figure 12] 3 is a cross-sectional view of the operation part of the endoscopic treatment tool of FIG. 2 in a closed state. [Figure 13] FIG. 12 is an enlarged perspective view of the friction adjustment mechanism shown in FIG. [Figure 14] FIG. 12 is an exploded perspective view of the link member shown in FIG. [Figure 15] FIG. 12 is an exploded perspective view of the wire holding portion shown in FIG. [Figure 16] 10 is a cross-sectional view of another example of a friction adjustment mechanism of the operation portion of the endoscopic treatment instrument. FIG. [Figure 17] 10 is an exploded perspective view showing a friction mechanism that generates a friction force between a fixed portion and an operation portion main body in the operation portion of the endoscopic treatment tool. FIG. [Figure 18] 18 is a cross-sectional view taken along line XX in FIG. 17. [Figure 19] 19 is an enlarged cross-sectional view for explaining a contact state during rotation in the friction mechanism shown in FIG. 18. FIG. [Figure 20] FIG. 10 is a cross-sectional perspective view showing another example of a friction mechanism that generates a friction force between a fixed portion and an operation portion main body in the operation portion of an endoscopic treatment tool. [Figure 21] FIG. 21 is an enlarged cross-sectional perspective view of a main part of the friction mechanism shown in FIG. 20. [Figure 22] 10A and 10B are explanatory schematic diagrams for explaining the operating direction of the operating handle of the operating unit and the operating direction of the grip unit. [Figure 23] 10 is a perspective view for explaining the relationship between an operation movement surface of an operation handle of the operation portion and a bending action surface of the bending portion. FIG. [Figure 24] 24 is an enlarged perspective view of the operation section handle of the endoscopic treatment tool shown in FIG. 23, seen from above. FIG. [Figure 25] 24 is a view of the operation portion main body in the endoscopic treatment tool shown in FIG. 23, viewed from the distal end side in the axial direction thereof. FIG. [Figure 26] 3A to 3C are diagrams showing an example of a treatment method using the endoscopic treatment tool of FIG. 2. [Figure 27] 3A to 3C are diagrams showing an example of a treatment method using the endoscopic treatment tool of FIG. 2. [Figure 28]3A to 3C are diagrams showing an example of a treatment method using the endoscopic treatment tool of FIG. 2. [Figure 29] 3 is a diagram showing an example of a treatment method using the endoscopic treatment tool of FIG. 2 in combination with another endoscopic treatment tool. [Figure 30] 3 is a diagram showing an example of a treatment method using the endoscopic treatment tool of FIG. 2 in combination with another endoscopic treatment tool. [Figure 31] 3 is a diagram showing an example of a treatment method using the endoscopic treatment tool of FIG. 2 in combination with another endoscopic treatment tool. [Figure 32] 11 is a diagram showing another example of the configuration of the operation unit in FIG. 10. FIG. DETAILED DESCRIPTION OF THE INVENTION

[0012] An endoscopic treatment tool according to one embodiment of the present invention will now be described with reference to Figures 1 to 25. Figure 1 shows an example of an endoscopic system for explaining an embodiment of the present invention.

[0013] The endoscope system 1 includes an endoscope 2, a light source device 3, and a processor 4. The endoscope 2 has an endoscope insertion section 6 for insertion into a subject, an endoscope operation section 7 connected to the endoscope insertion section 6, and a universal cord 8 extending from the endoscope operation section 7, and the endoscope insertion section 6 is composed of an endoscope tip section 10, an endoscope bending section 11 connected to the endoscope tip section 10, and an endoscope connection section 12 connecting the endoscope bending section 11 and the endoscope operation section 7.

[0014] An imaging device including an imaging element is mounted on the endoscope tip 10. The endoscope bending section 11 is configured to be bendable, and the bending of the endoscope bending section 11 is controlled by the endoscope control section 7. In addition, the endoscope connection section 12 is configured to be flexible enough to be deformable to follow the shape of the insertion path inside the subject.

[0015] The endoscope operation section 7 is provided with operation buttons for operating image capture using the imaging device and an operation knob for operating the bending of the endoscope bending section 11. The endoscope operation section 7 is also provided with a first treatment tool insertion port 13 and a second treatment tool insertion port 15 into which an endoscopic treatment tool 20 (see FIG. 2) can be inserted, and the endoscope insertion section 6 is provided with a first treatment tool channel 14 that extends from the first treatment tool insertion port 13 to the endoscope tip section 10 and opens at the end face of the endoscope tip section 10, and a second treatment tool channel 16 that extends from the second treatment tool insertion port 15 to the endoscope tip section 10 and opens at the end face of the endoscope tip section 10.

[0016] A light guide and a cable are provided inside the endoscope insertion portion 6, the endoscope operation portion 7, and the universal cord 8, and a connector 9 is provided at the end of the universal cord 8. The endoscope 2 is connected to the light source device 3 and the processor 4 via the connector 9.

[0017] The illumination light generated by the light source device 3 is guided to the endoscope tip 10 via the light guide and emitted from the endoscope tip 10. In addition, the operating power of the image sensor, a control signal for driving the image sensor, and an image signal output from the image sensor are transmitted between the processor 4 and the image sensor via the cable. The processor 4 processes the input image signal to generate image data of the observation site within the subject, and displays and records the generated image data on the monitor 5.

[0018] FIG. 2 shows an example of an endoscopic treatment tool 20 for explaining an embodiment of the present invention.

[0019] The endoscopic treatment tool 20 includes an insertion section 21 that can be inserted into the first treatment tool channel 14 (see FIG. 1), a treatment tool operating section 22 (hereinafter simply referred to as the "operating section 22"), and a fixing section 52 that is attached and fixed to the endoscope operating section 7. The insertion section 21 includes a tip section 23 that has a gripping section 24 that is opened and closed by the operating section 22, a bending section 25 that is provided adjacent to the operating section side of the tip section 23, and a connecting section 26 that connects the bending section 25 and the operating section 22.

[0020] When the insertion section 21 is inserted into the first treatment instrument channel 14, the connection section 26 is housed in the first treatment instrument channel 14, and the tip section 23 and the bending section 25 protrude from the end face of the endoscope tip section 10 (see FIG. 1). The connection section 26 housed in the first treatment instrument channel 14 is configured to be flexible enough to be deformable to follow the shape of the insertion path inside the subject, similar to the endoscope connection section 12. The connection section 26 is an example of a flexible section of the present invention.

[0021] 3 and 4 show the configuration and operation of the grip portion 24 of the distal end portion 23 of the endoscopic treatment tool 20. FIG.

[0022] In the example shown in Fig. 3, the gripping portion 24 has a pair of gripping claws 30 and a pair of link members 31. The tip portion 23 has a support body 32 that rotatably supports the pair of gripping claws 30. The pair of gripping claws 30 are arranged crosswise, and a pin 33 is provided so as to pass through the intersection of the pair of gripping claws 30. The pin 33 is fixed to the support body 32. The gripping claws 30 are supported by the support body 32 so as to be rotatable about the pin 33 as a rotation axis.

[0023] The distal end of a link member 31 is rotatably connected to the proximal end of the gripping claw 30, and an operation wire 27 is connected to the proximal end of the link member 31. The operation wire 27 extends from the distal end 23 through the curved portion 25 and the connecting portion 26 to reach the operation unit 22, and is pulled toward the operation unit 22 or pushed toward the distal end 23 in response to an operation at the operation unit 22.

[0024] 3 shows a state in which the operating wire 27 is pushed out toward the distal end portion 23, and the distal ends of the pair of gripping claws 30 are open. When the operating wire 27 is pulled toward the operating unit 22, the distal ends of the pair of gripping claws 30 are closed, as shown in FIG. 4. The treatment site of the living body is grasped by the distal ends of the closed pair of gripping claws 30.

[0025] 5 and 6 show the configuration and operation of the bending portion 25 and the connecting portion 26 in the endoscopic treatment tool 20. FIG.

[0026] The connecting portion 26 is flexible and also rigid enough to transmit translational and rotational power from the operating portion 22 to the bending portion 25. Such a connecting portion 26 may be configured, for example, by covering the outer periphery of a spiral tube formed by spirally winding a metal strip with a braided metal wire, and then covering the outer periphery of the braided tube with a resin outer cover. As shown in FIG. 6 , the bending portion 25, which is bent by the operating portion 22, can be bent in a direction approximately perpendicular to a plane including the opening and closing directions of the pair of gripping jaws 30. In other words, the bending motion plane including the bending motion direction of the bending portion 25 is approximately perpendicular to the opening and closing motion plane of the pair of gripping jaws 30.

[0027] 7 to 9 show the internal configuration and operation of the bending portion 25. FIG.

[0028] The bending portion 25 has a plurality of bending pieces 42 and a resin outer cover 43. The plurality of bending pieces 42 are arranged side by side in the longitudinal direction of the insertion portion 21 including the bending portion 25. Two adjacent bending pieces 42 are connected via a pair of pins 46 arranged to face each other in the radial direction of the bending portion 25. As shown in FIG. 8, the pair of pins 46 are arranged on an axis X that is substantially parallel to the opening and closing direction of the pair of gripping jaws 30. Therefore, the adjacent bending pieces 42 connected by the pair of pins 46 can rotate around the axis X as a rotation axis. By adding up the rotations of the plurality of bending pieces 42 around the axis X as a rotation axis, the bending portion 25 is bent along a direction (bending operation plane) that is substantially perpendicular to the opening and closing direction (direction of the axis X) of the pair of gripping jaws 30, as shown in FIG. 9.

[0029] The bending portion 25 is bent by an operation wire 27 for opening and closing the pair of gripping claws 30. As shown in Fig. 8, each of the multiple bending pieces 42 has a wire guide 47 that holds the operation wire 27 so that it can be pushed and pulled. When the bending piece 42 is divided into a first side A and an opposite second side B with the axis X as the boundary, the wire guide 47 is provided on one of the second sides B. Therefore, by pulling the operation wire 27 toward the operation unit 22, the bending portion 25 is bent so that the first side A is located on the outer side of the bending and the second side B is located on the inner side of the bending.

[0030] In this way, the closing operation of the gripping portion 24 and the bending operation of the bending portion 25 are performed by pulling the single operation wire 27. This makes it easy to operate the operation unit 22. Here, when the operation wire 27 is pulled toward the operation unit 22, the gripping portion 24 closes first, and the bending portion 25 is bent when the gripping portion 24 is closed. The order of the closing operation of the gripping portion 24 and the bending operation of the bending portion 25 can be set based on the magnitude relationship between the operating resistance when the gripping portion 24 closes and the operating resistance when the bending portion 25 bends. In other words, when the operating resistance of the bending portion 25 is relatively large, the closing operation of the gripping portion 24 comes first, and the bending operation of the bending portion 25 comes later.

[0031] The motion resistance when the gripping portion 24 is closed includes friction at the intersection of the pair of gripping claws 30 and friction at the connection portion between the gripping claws 30 and the link member 31. Similarly, the motion resistance when the bending portion 25 is bent includes friction at the connection portion between two adjacent bending pieces 42. Furthermore, the outer cover 43 of the bending portion 25 is an elastic member that linearly extends the bending portion 25, and the motion resistance when the bending portion 25 is bent includes the elasticity of the outer cover 43. The operation wire 27 is also an elastic member that linearly extends the bending portion 25, and the motion resistance when the bending portion 25 is bent includes the elasticity of the operation wire 27. Note that the elastic member that linearly extends the bending portion 25 is not limited to the outer cover 43, the operation wire 27, etc., but may be a wire spring, a leaf spring, etc.

[0032] In this way, the bending portion 25 that bends when the operating wire 27 is pulled has the outer cover 43 made of an elastic material, and the outer cover 43 generates an elastic force in the direction of returning the bending portion 25 from a bent state to a straight state.

[0033] Furthermore, because the outer skin 43 of the bending portion 25 is made of an elastic material, an elastic force is generated in the return direction when the bending portion 25 is pulled and deformed by the operating wire 27, and the elastic force of the bending portion 25 increases according to the amount of bending. The friction adjustment mechanisms 70, 73, which will be described later, which can accommodate this elastic force, increase the friction force according to the amount of bending (angle) of the bending portion 25, thereby maintaining the bending state of the bending portion 25 in a good condition.

[0034] Here, the greater the amount of movement by which the operation wire 27 is pulled, the greater the force pulling the operation wire 27 in the return direction (the force stretching it linearly). Note that in this embodiment, the friction adjustment mechanisms 70 and 73, which will be described later, are capable of responding to changes in the force pulling the operation wire 27 in the return direction (elastic return force), and the friction force can be increased in accordance with the amount of pulling of the operation wire 27, making it possible to maintain a good pulling state.

[0035] Furthermore, the bending portion 25 may be formed of a flexible tubular material made of an elastic material such as an elastomer, instead of the plurality of rotatably connected bending pieces 42 that are members inside the outer skin 43. When the bending portion 25 is made of a flexible tubular material, the operating resistance (elastic return force) when the bending portion 25 is bent includes the elasticity of the tubular material, and a stronger elastic force is generated. In this way, since the member inside the outer skin 43 is made of an elastic material, the bending portion 25 can generate a biasing force in the return direction when it is pulled and deformed by the operating wire 27.

[0036] 10 and 11 show the configuration of the operation unit 22. FIG.

[0037] The operation unit 22 has an operation unit main body 50 as an input means for advancing / retracting and rotating the gripping portion 24 (see Figure 3), an operation handle 51 as an input means for opening / closing and bending operations for opening / closing the gripping portion 24 and bending the bending portion 25 (see Figure 2), and a fixing portion 52 which is an attachment part that can be detachably attached to the endoscope operation unit 7 (see Figure 1).

[0038] The fixing portion 52 has a connecting fitting 52a. The connecting fitting 52a is connected to a mouthpiece provided in the first treatment tool insertion port 13 (see FIG. 1) of the endoscope operation section 7, and the operation section 22 is supported by the endoscope operation section 7 when the connecting fitting 52a is connected.

[0039] The operation unit main body 50 is formed in a rod shape and is supported by a fixed part 52 so as to be movable in the direction of its central axis indicated by arrow E and in a rotational direction around the central axis indicated by arrow F. The connection part 26 is connected to the operation unit main body 50 through the fixed part 52, and is advanced and retreated along the longitudinal axis of the connection part 26 in response to movement of the operation unit main body 50 in the direction of arrow E. Furthermore, the connection part 26 is rotated about the longitudinal axis of the connection part 26 in response to movement of the operation unit main body 50 in the direction of arrow F. The advancement and retreat and rotation of the connection part 26 are transmitted to the grip part 24, and the grip part 24 is also advanced and retreated and rotated integrally with the connection part 26.

[0040] The operating handle 51 is swingably supported by the operating unit main body 50. In detail, as shown in Fig. 11, the operating handle 51 is supported by a rotation support shaft portion 55a (55), and can swing in an opening direction C in which the free end portion 51a moves away from the operating unit main body 50, and in a closing direction D in which the free end portion 51a moves toward the operating unit main body 50. In short, the operating handle 51 is supported so as to move on a fan-shaped operation movement plane centered on the rotation support shaft portion 55a.

[0041] 12 shows the state when the operating handle 51 is operated in the closing direction D. When the operating handle 51 is swung in the closing direction D, it pulls the operating wire 27 (in the direction of arrow G), and when it is swung in the opening direction C, it pushes the operating wire 27 (in the opposite direction to arrow G). The operating wire 27 is fixed to a wire holding portion 56 that is provided inside the operating unit main body 50 so as to be slidable along its axis. The wire holding portion 56 is connected to the operating handle 51 via a link member 57 that is rotatably coupled to the rotation support shaft portion 55c (55). The link member 57 and the operating handle 51 are rotatably connected via the rotation support shaft portion 55b (55).

[0042] Here, as described above, as the pulling amount (amount of movement in the direction of arrow G) of the operation wire 27 increases, the force pulling the wire holding portion 56 in the return direction (elastic return force) also increases. Furthermore, when grasping and pulling up the lesion site, the return force increases with the amount of pulling (pulling amount). Therefore, a returning force that increases with an increase in the pulling amount acts on the operation handle 51. To accommodate this change in return force, a friction adjustment mechanism 70 is provided on the rotation support shaft portion 55c, which increases the frictional force that locks the wire holding portion 56 in accordance with the pulling amount of the operation wire 27, which is linked to the operation of the operation handle 51.

[0043] The operating wire 27 is pushed out toward the distal end portion 23 when the operating handle 51 is swung in the opening direction C, and is pulled toward the operating portion 22 when the operating handle 51 is swung in the closing direction D. In this case, when the operating handle 51 is swung in the closing direction D, the grip portion 24 is closed and the bending portion 25 is bent.

[0044] The operating handle 51 has a friction adjustment mechanism 70 that maintains its operating state, and is configured to be able to maintain the bending angle of the bending portion 25 at any angle up to the maximum bending angle. The friction adjustment mechanism 70 increases the friction force that locks the wire holding portion 56 in response to an increase in the amount of pulling of the operating wire 27 by the wire holding portion 56, which is linked to the swinging of the operating handle 51.

[0045] In this way, the friction adjustment mechanism 70 can increase the frictional force as the pulling amount of the operating wire 27 increases, so even if the wire return force becomes stronger as the pulling amount of the operating wire 27 increases, the operating handle 51 is prevented from returning, and the hands can be released from the operating handle 51 regardless of the operating position of the operating handle 51. Furthermore, only a small operating force is required when rotating, allowing for stable operation.

[0046] The operating handle 51 is slidably connected to the wire holding portion 56 via the link member 57, which increases the number of portions that move relatively as the operating handle 51 is operated. This increases the number of options for the portion where the friction adjustment mechanism 70 can be installed. Furthermore, as the amount of traction force on the wire holding portion 56 increases, the link member 57 can be tilted so that the angle of inclination on the tip end portion 23 side relative to the wire holding portion 56 decreases, thereby increasing the force that resists the return force of the operating wire 27, which can be used to improve handle operability.

[0047] 13 to 15 are perspective views showing an example of a friction adjustment mechanism 70. As shown in FIG. 13, the friction adjustment mechanism 70 is configured such that a link member 57 is sandwiched between a pair of wire holding portions 56 by fastening members 58m that pass through through holes 55h in the pivot support shaft portions 55c (the female threads of the fastening members 58m are omitted in the drawing). Here, the wire holding portion 56 and the pivot support shaft portions 55c of the link member 57 have cylindrical peripheral portions around their axes. Cam portions 70c are provided that face each other in the thickness direction of the cylindrical portions and come into contact with each other, thereby adjusting the frictional force. As will be described later, the cam portions 70c can change the contact pressure between the members in accordance with the rotation angle of the pivot support shaft portions 55c.

[0048] As shown in FIG. 14, the link member 57 has a cylindrical portion 57b having a link portion through-hole 57h of the pivot support shaft portion 55c, and cam portions 57c (70c) are provided on both front and back end surfaces of the cylindrical portion 57b when viewed from the direction of the axis CL. The cam portions 57c are formed so as to divide both front and back end surfaces of the cylindrical portion 57b into semicircular regions. In other words, cam surfaces that are inclined in the circumferential direction are formed on both front and back end surfaces of the cylindrical portion 57b for each semicircular region. More specifically, the semicircular region of the cylindrical portion 57b has an inclined structure in which the thickness (W2) of the other end side 57ce is thinner than the thickness (W1) of one end side 57ct. In other words, the thickness of the cylindrical portion 57b is greatest at the thickness (W1) of the one end side 57ct and gradually becomes thinner counterclockwise in FIG. 14.

[0049] As shown in Fig. 15, the cylindrical portion 56b of the wire holding portion 56 has a boss portion 56d having a through hole 55h and capable of fitting into the link portion through hole 57h, and a cam portion 56c is provided around the boss portion 56d on one end face side (inner side) when viewed from the direction of the axis CL. The cam portion 56c is divided into semicircular regions of the cylindrical portion 56b, and the semicircular regions are provided with a cam surface whose thickness slopes in the circumferential direction. The thickness of the cylindrical portion 56b is greatest at a thickness (W3) at one end side 56ct and gradually becomes thinner toward a thickness (W4) at the other end 56ce in the clockwise direction in Fig. 15, forming a cam surface.

[0050] The cam portion 56c of the wire holding portion 56 and the cam portion 57c of the link member 57 configured in this manner are combined as shown in Fig. 13 and fastened together with a fastening member 58m, thereby making it possible to change the contact pressure of the cam surfaces. That is, when the link member 57 rotates around the pivot shaft portion 55c in a direction that reduces the angle with respect to the wire holding portion 56 (when the pulling amount increases), the cam portion 57c of the link member 57 acts to push apart the cam portion 56c of the wire holding portion 56. As a result, the contact pressure between the cam surfaces can be gradually increased as the pulling amount of the operation wire 27 increases, and the frictional force can be gradually increased.

[0051] In this way, the friction adjustment mechanism 70 is provided on the pivotal support shaft 55c that rotatably supports the operating handle 51, and the pivotal support shaft 55c is equipped with a cam portion 70c that can change the contact pressure around its axis in accordance with the rotation angle, so the structure of the friction adjustment mechanism 70 can be made compact without becoming large.

[0052] In this way, cam portion 70c of friction adjustment mechanism 70 is provided on wire holding portion 56 inside operation unit main body 50. In other words, by providing cam portion 70c on rotation support shaft portion 55c between link member 57 and wire holding portion 56, it is possible to prevent liquid from entering cam portion 70c even when the operator's hands are wet, for example, and to prevent fluctuations in frictional force.

[0053] Furthermore, the pivot shaft 55c is provided with a fastening member 58m that penetrates the pivot shaft 55c, allowing the fastening force of the pivot shaft 55c to be adjusted. The fastening force can be adjusted by adjusting the tightening of the fastening member 58m, thereby changing the contact pressure of the cam surfaces. This facilitates adjustment of the frictional force of the friction adjustment mechanism 70. The contact pressure between the cam surfaces can also be adjusted by inserting an elastic member between the fastening member 58m and the wire holding portion 56. For example, inserting a spring washer with a small spring constant between the fastening member 58m and the wire holding portion 56 can slow down the increase in contact pressure.

[0054] Although the friction adjustment mechanism 70 is configured to be provided on the rotation support shaft portion 55c, it may also be configured to be provided on the other rotation support shaft portions 55a and 55b. In short, it may be provided at any location on the rotation support shaft portion 55 that is involved in the swing of the operating handle 51, and the friction adjustment mechanism 70 may also be provided at multiple locations. Furthermore, a structure may be adopted in which the friction adjustment mechanism 70 is provided at one location, while friction members made of, for example, rubber or the like that generate a constant friction force regardless of the operating position of the operating handle 51 are disposed at other locations.

[0055] The materials for link member 57 and wire holding portion 56 that make up cam portion 70c are preferably those that generate appropriate friction but are less likely to cause stick-slip. Also, since wire holding portion 56 slides against operation unit main body 50, a material with a low coefficient of friction is desirable. From the above perspectives, it is preferable that wire holding portion 56 be made of a low-friction resin material such as polypropylene, polyethylene, or PTFE (Poly Tetra Fluoro Ethylene), and that link member 57 be made of a material with an appropriate coefficient of friction such as ABS (Acrylonitrile Butadiene Styrene).

[0056] During transportation and storage, the levers are fixed in a state where the contact pressure between the cams is small, which prevents the components that make up the cam from being subjected to compressive force for a long period of time and prevents dimensional changes and a decrease in contact pressure due to creep.

[0057] Fig. 16 is a cross-sectional view of another example of a friction adjustment mechanism 73 for the operation unit 22. As shown in Fig. 16, the friction adjustment mechanism 73 includes a first sliding portion 71 and a second sliding portion 72 as sliding portions that can come into sliding contact with the wire holding portion 56 as the wire holding portion 56 slides relative to the operation unit body 50. The first sliding portion 71 has, for example, a flat sliding wall surface 56s that slidably holds the shaft-shaped wire holding portion 56. The second sliding portion 72 has an inclined wall surface 73t that can increase the holding force of the wire holding portion 56 as the pulling amount of the operation wire (the movement amount of the wire holding portion 56) increases.

[0058] As described above, the operation handle 51 includes the wire holding portion 56, which slides relative to the operation unit main body 50, and the first and second sliding portions 71, 72, which are capable of sliding contact with each other as the wire holding portion 56 moves. At least a portion of the first and second sliding portions 71, 72 has an inclined structure that increases the contact pressure with the wire holding portion 56 in response to an increase in the pulling amount of the operation wire 27. This makes it possible to increase the frictional force as the pulling amount of the operation wire 27 increases. Therefore, even if the pulling amount of the operation wire 27 increases and the wire return force becomes stronger, the inclined wall surface 73t gradually increases the contact force, thereby making it possible to respond to the magnitude of the force that tries to return the operation handle 51. As a result, the operation handle 51 is held in place regardless of its operating position, enabling stable operation.

[0059] The first sliding portion 71 is configured such that a ring-shaped member 73a, such as an O-ring, comes into contact with a sliding wall surface 56s, which is formed of a cylindrical inner wall surface along the sliding direction. Therefore, the sliding wall surface 56s and the ring-shaped member 73a are always in contact with each other with a constant contact force, so that the first sliding portion 71 can generate a constant frictional force against the wire holding portion 56.

[0060] As described above, the sliding portion includes the first sliding portion 71, which has a substantially constant contact pressure with the wire holding portion 56, and the second sliding portion 72, which has an inclined structure and whose contact pressure with the wire holding portion 56 increases in response to an increase in the amount of pulling of the operation wire 27, so that the frictional force can be adjusted separately by the two sliding portions, making it easy to adjust the frictional force. Therefore, a stable frictional force can be generated, and even if the wire return force becomes stronger as the amount of pulling of the operation wire 27 increases, the operation handle 51 can be held securely, and stable operation becomes possible regardless of the operating position of the operation handle 51.

[0061] The second sliding portion 72 includes, for example, a cylindrical cylinder 73c provided at one end side 50e of the operation portion main body 50, and a piston 73p provided at one end of the wire holding portion 56 and slidably provided within the cylinder 73c. ​​A ring-shaped elastic member 73o, for example, an O-ring, is provided on the outer periphery of the piston 73p and comes into contact with an inclined wall surface 73t that constitutes the inner wall surface of the cylinder 73c. ​​The inclined wall surface 73t is inclined so as to reduce the cylinder inner diameter as the piston 73p moves in the pulling direction (movement in the direction of arrow G in the figure).

[0062] Here, the first sliding portion 71 is set to have a smaller frictional force than the second sliding portion 72. This allows the first sliding portion 71 to generate a minimum amount of frictional force, and the adjustment of the frictional force can be performed by the second sliding portion 72. As a result, the frictional force can be easily adjusted, and a stable frictional force can be obtained.

[0063] The frictional force can be adjusted by adjusting the contact force between the inclined wall surface 73t of the second sliding portion 72 and the elastic member 73o. Furthermore, since the elastic member 73o is made of an O-ring, an elastically deformable structure can be easily achieved and the structure can be manufactured inexpensively.

[0064] Fig. 17 is an exploded perspective view showing a friction mechanism 80 that generates a friction force between the fixed part 52 and the operation unit main body 50. Fig. 18 is a cross-sectional view taken along line XX in Fig. 17, showing the internal structure of the fixed part 52. Fig. 19 is an enlarged cross-sectional view illustrating the contact state of the friction mechanism 80 during rotation.

[0065] As shown in FIGS. 17 and 18 , the fixing part 52 that attaches the control section 22 to the endoscope control section 7 (see FIG. 1 ) has a substantially cylindrical storage space SS that slidably accommodates the small-diameter insertion end 50t at the distal end (left side in FIG. 17 ) of the control section main body 50. The inner wall surface that defines the storage space SS is provided with a protrusion 52d that protrudes radially inward of the storage space SS. The protrusion 52d is formed along the longitudinal direction of the storage space SS, i.e., along the advancing and retreating directions of the insertion end 50t (the pulling and pushing directions of the control wire 27). A plurality of protrusions 52d (four in total) are provided at predetermined intervals in the circumferential direction of the inner wall surface. The insertion end 50t is provided with an annular friction member 59 that contacts the protrusion 52d with a predetermined contact pressure and moves along the direction of rotation of the insertion end 50t (the direction of arrow F). The friction member 59 is formed of a member having a predetermined elasticity, such as an O-ring.

[0066] Thus, the operation unit 22 includes a fixed part 52 to which the operation unit 22 is attached, and an operation unit main body 50 that is movable back and forth along the operation wire 27 relative to the fixed part 52 and that is rotatable along a plane perpendicular to the direction of the movement of the operation unit 22. The operation unit 22 is provided with a friction mechanism 80 that generates a first friction force (rotational direction friction force) in the direction of rotation between the fixed part 52 and the operation unit main body 50, and generates a second friction force (advancement / retraction direction friction force) different from the first friction force in the direction of the movement of the operation unit 22 back and forth between the fixed part 52 and the operation unit main body 50.

[0067] In other words, the friction mechanism 80 generates a first friction force (friction force in the rotational direction) relative to the fixed part 52 in the direction of rotation (direction of arrow F) of the operation unit body 50. Also, a second friction force (friction force in the advance / retract direction) different from the first friction force is generated relative to the fixed part 52 in the direction of advance / retraction of the operation unit body 50 (direction of arrow E).

[0068] In this way, the rotational friction force during rotation and the forward / backward friction force during forward / backward movement are different between the fixed part 52 and the operation unit main body 50, making it easy to set the rotational force and the forward / backward force separately for the operation unit 22. This makes it possible to avoid a situation where prioritizing one of rotation or forward / backward movement makes the operability of the other movement poor, as in the past. As a result, it is possible to provide an operation unit 22 that makes it easy to operate both the rotation and forward / backward movement of the operation unit main body 50.

[0069] 19, the first friction force generated by the relative movement between friction member 59 and protrusion 52d in the rotational direction is increased by the generation of deformed portions 59t in friction member 59. This is because, when friction member 59 rotates relative to protrusion 52d, the surface of friction member 59 is slightly recessed due to contact pressure with protrusion 52d, friction member 59 is easily deformed (easily stretched) in the circumferential direction due to rubbing against protrusion 52d, and friction member 59 is easily stretched in the rotational direction due to its long length. The formation of deformed portions 59t increases the contact pressure of friction member 59 with protrusion 52d, and increases frictional resistance.

[0070] On the other hand, in the forward / backward direction, the surface of friction member 59 is recessed relative to protrusion 52d, but the friction member 59 remains recessed in the radial direction (thickness direction), so no portion such as deformed portion 59t is formed, and the second friction force does not become large. In other words, the first friction force is set to be larger than the second friction force.

[0071] In this way, by setting the first friction force, which is the friction force in the rotational direction, to be greater than the second friction force, which is the friction force in the forward / backward direction, it becomes possible to adjust the forces required for rotating the operating unit 22 and for moving it forward / backward so that they are closer to each other, thereby improving the operability of the operating unit 22.

[0072] In the friction mechanism 80, the friction member 59 extends in the direction of rotation, and the protrusion 52d extends in the direction of advancement and retraction. With this configuration, contact between the friction member 59 and the protrusion 52d in the direction of rotation causes the protrusion 52d to deform the friction member 59 as it moves, thereby increasing the resistance in the rotational direction. In contrast, in the direction of advancement and retraction, the friction member 59 is in partial contact with the protrusion 52d only at a predetermined portion, thereby reducing the resistance during advancement and retraction. As a result, the resistance in the direction of rotation and the direction of advancement and retraction can be optimized, thereby improving the operability of the operation unit main body 50.

[0073] 18, the friction member 59 is configured in an annular shape, and is configured with a plurality of protrusions 52d, four of which are arranged at predetermined intervals around the circumference of the friction member 59 and extend in the forward / backward direction. As a result, in the forward / backward direction, the contact between the protrusions 52d and the friction member 59 is partial, preventing an increase in frictional resistance. On the other hand, in the rotational direction, the contact between the protrusions 52d and the friction member 59 is accompanied by deformation of the friction member 59 at the locations of the protrusions 52d, thereby increasing the frictional resistance.

[0074] Conversely, if you want to increase the frictional resistance in the forward / backward direction, you can simply widen the protrusion 52d. Because the frictional resistance in the forward / backward direction is roughly proportional to the contact area between the friction member 59 and the protrusion 52d, you can freely adjust the frictional resistance by changing the shape of the protrusion 52d.

[0075] The above configuration allows for the free design of friction in both the rotational and forward / backward directions, eliminating the need for lubricants. Lubricants are difficult to manage during manufacturing and can cause various problems, such as variations in the amount applied and adverse effects on resin materials, so eliminating the need for lubricants is expected to have benefits in terms of quality and cost.

[0076] Fig. 20 is a cross-sectional perspective view showing another example of a friction mechanism 80 that generates a friction force between the fixed portion 52 in the operation unit 22 and the operation unit body 50. Fig. 21 is an enlarged cross-sectional perspective view of a main portion of the friction mechanism 80 shown in Fig. 20.

[0077] 20, a friction mechanism 80 of the operation unit 22 is provided with a slide ring 75 whose movement in the forward and backward directions is restricted between the fixed portion 52 and the operation unit main body 50, i.e., between the fixed portion 52 and the insertion end 50t of the operation unit main body 50. The slide ring 75 allows the operation unit main body 50 to move forward and backward on the side that fits with the protrusion 50td. On the other hand, on the side opposite to the side that fits with the protrusion 50td, a friction member 76 is interposed between the slide ring 75 and the operation unit main body 50, allowing rotational movement (in the direction of arrow F).

[0078] The friction mechanism 80 is also composed of two parts: a first friction part 81 which has the slide ring 75, and a second friction part 82 which is located at a part separate from the first friction part 81 and generates friction forces in the rotational direction and the forward / backward direction.

[0079] The second friction portion 82 has a structure in which, for example, an O-ring 77 provided at the tip of the insertion end portion 50t comes into contact with the cylindrical inner peripheral wall surface 52w of the fixing portion 52. Therefore, a predetermined friction is generated by the rotational movement (in the direction of arrow F) of the operation portion body 50. Also, a predetermined friction is generated by the forward and backward movement (in the direction of arrow E) of the operation portion body 50.

[0080] As shown in FIG. 21 , the slide ring 75 constituting the first friction region 81 has a ring groove 75g formed on its outer side in the ring radial direction, and a friction member 76 made of an O-ring is fitted into this ring groove 75g. The slide ring 75 is fitted into a ring guide groove 52g formed along the circumferential direction of the inner surface of the fixed portion 52. Therefore, the bottom wall 52gw of the ring guide groove 52g comes into contact with the friction member 76. A vertical groove 75k is formed on the inner circumferential side of the slide ring 75 along the forward / backward direction, and the protrusion 50td is slidably fitted into this vertical groove 75k. With this configuration, the first friction region 81 generates almost no frictional resistance in the forward / backward direction, but can generate a large frictional force in the rotational direction.

[0081] In this way, by providing the slide ring 75 between the fixed part 52 and the insertion end 50t of the operation unit main body 50 and providing the friction member 76 on one end side of the slide ring 75, it is possible to change the friction force between the side in contact with the slide ring 75 and the side in contact with the friction member 76. As a result, it is possible to separate the friction in the rotational direction (arrow F direction) and the forward / backward direction (arrow E direction) between the fixed part 52 and the operation unit main body 50.

[0082] Furthermore, by providing a plurality of friction regions, namely the first friction region 81 and the second friction region 82, the friction force can be adjusted at a plurality of regions, making adjustment easier.

[0083] The second friction region 82 is set to generate a smaller friction force than the first friction region 81.

[0084] 20 and 21 have been described with reference to a configuration in which the protrusion 50td is provided on the operation unit main body 50, but the protrusion 50td may also be provided on the fixed part 52. In this case, the ring guide groove 52g is provided on the operation unit main body 50. The vertical groove 75k is provided on the outer periphery of the slide ring 75, and the ring groove 75g and the friction member 76 are provided on the inner periphery of the slide ring 75. That is, the protrusion 50td is provided on one of the fixed part 52 and the operation unit main body 50, and protrudes to the other side of the fixed part 52 and the operation unit main body 50. Specifically, the protrusion 50td is provided on (one side of) the fixed part 52 and protrudes to the side of the operation unit main body 50 (the other side), or the protrusion 50td is provided on (one side of) the operation unit main body 50 and protrudes to the side of the fixed part 52 (the other side).

[0085] In this way, by generating a small friction force in the second friction portion 82, it is possible to generate a minimum friction force by the second friction portion 82. This makes it easier to adjust the friction force of the first friction portion 81.

[0086] Returning to FIG. 10, the outer surface of the operation unit body 50 is provided with a recess 50c and a protrusion 50d that can be engaged with fingers when the operation unit body 50 is operated in the forward and backward directions.

[0087] In this way, by providing the recessed portion 50c and the protruding portion 50d on the outer surface of the operating unit main body 50, when operating the operating unit main body 50 in the forward / backward direction, the fingers can be hooked onto the engageable recessed portion 50c or the protruding portion 50d, thereby improving operability in the forward / backward direction.

[0088] Furthermore, when the operating unit main body 50 is closest to the fixed part 52 (the state shown in Figure 10), the distance between the end face 52m of the fixed part 52 and the end face 50m of the operating unit main body 50 facing the end face 52m is an inclined surface that widens toward the outer surface of the operating unit main body 50.

[0089] In this way, when the end face 52m of the fixing part 52 and the end face 50m of the operating part main body 50 are closest to each other, the distance between them is an inclined surface that widens toward the outer surface of the operating part main body 50, so that when moving the operating part main body 50 forward or backward, it is possible to avoid the trouble of getting fingers caught between the end faces of the two parts.

[0090] FIG. 22 is a schematic diagram for explaining the operating direction of the operating handle 51 of the operating unit 22 and the direction of movement of the grip unit 24. As shown in FIG.

[0091] As shown in FIG. 22, when the operation wire 27 is straightened and the operation unit 22 is viewed along the axial direction of the operation wire 27 toward the tip end 23 (in FIG. 22, when viewed from the direction of the operation unit main body 50 toward the tip end 23), the position of the bending operation surface MS (see FIG. 23) of the bending portion 25 (in FIG. 22, the same position as the position of the tip end 23) is located in a range OE greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the axis (in FIG. 22, the axis indicated by the operation wire 27) starting from the position (0 degree position in FIG. 22) where the operation handle 51 that operates the bending portion 25 is provided on the operation unit 22.

[0092] With this configuration, for example, when the endoscopic treatment tool 20 is attached to the endoscope operation section 7 and used, in relation to the operation direction of the operator operating the operation handle 51 (the linear direction indicating 0 degrees in FIG. 22) and the bending operation plane MS of the bending section 25 (including the tip section 23) displayed on the monitor 5 of the endoscope screen, the position of a range OE of less than 90 degrees in the circumferential direction about an intermediate position CP (a position of 225 degrees clockwise from the 0 degree position) between a case where the upper part of the screen of the monitor 5 coincides with the operation direction directly in front of the operator (the linear direction indicating 180 degrees in FIG. 22) and a case where the upper part of the screen of the monitor 5 coincides with the operation direction 90 degrees to the right of the directly in front of the operator (the linear direction indicating 270 degrees in FIG. 22) is set to be above the screen of the monitor 5.

[0093] In this way, the position of the bending action surface MS of the bending portion 25 operated by the operation unit 22 is located in a range OE that is greater than 180 degrees and less than 270 degrees clockwise, starting from the position where the operation handle 51 is arranged (0 degrees), so that when operating the operation unit 22, the direction of the bending action surface MS of the bending portion 25 and the direction of the operation screen are accepted by the operator without any sense of discomfort in operation. As a result, the operability of the operation unit 22 can be improved.

[0094] FIG. 23 is a perspective view for explaining the relationship between the operation movement plane OS of the operation handle 51 of the operation section 22 and the bending operation plane MS of the bending section 25. As shown in FIG.

[0095] 23, the operation movement plane OS is a virtual plane including a fan-shaped movement plane described by the operation handle 51 of the operation unit 22. The bending operation plane MS is a virtual plane including a fan-shaped movement plane of the bending unit 25 that performs a bending operation in a direction perpendicular to the virtual plane along which the gripping jaws 30 open and close.

[0096] Furthermore, it is most preferable that the bending operation plane MS, on which the bending portion 25 bends when the operating wire 27 is pulled, is set at a position 225 degrees clockwise (intermediate position CP in Figure 22) from the operating movement plane OS when operating the operating handle 51.

[0097] In this way, the bending operation plane MS is set at an intermediate position CP of 225 degrees clockwise from the operation movement plane OS when operating the operating handle 51 as the starting point, so that the bending operation plane MS can be oriented at an intermediate position within the range of variation in the way the operator holds the operating section 22, in relation to the operating direction of the operating handle 51 and the bending direction of the bending section 25. As a result, even if the way the operator holds the operating section 22 (operation direction) varies, it is possible to avoid discomfort that accompanies extreme variations in the operating direction of the bending section 25, and it is possible to stabilize the endoscopic procedure.

[0098] The operating unit 22 also has an operating unit main body 50 that can rotate relative to a fixed part 52 that attaches the operating unit to a predetermined location to rotate the direction of the tip part 23, and an operating handle 51 that moves the operating wire 27 by opening and closing it around a rotation fulcrum relative to the operating unit main body 50.

[0099] In this way, since the operating unit 22 is rotatable relative to the fixed unit 52, the tip 23 can be rotated by the operating unit main body 50, and since the operating handle 51 can be opened and closed around a rotation fulcrum (rotational support shaft portion 55a) relative to the operating unit main body 50, it is easy to rotate the operating unit main body 50 and open and close the operating handle 51.

[0100] Fig. 24 is an enlarged perspective view seen from above of the operating handle 51 of the endoscopic treatment tool 20. As shown in Fig. 24, the operating handle 51 has a first protruding portion 51f that is curved so that at least a side surface 51w on the closing side of the operating handle 51 and a side surface 51u on the opening side thereof can simultaneously face a finger Hf that operates the operating handle 51.

[0101] In this way, by providing the first protrusion 51f, the operating handle 51 has side surfaces 51u and 51w positioned on the inside and outside of the finger Hf that operates the operating handle 51, so that the operating handle 51 can be freely opened and closed by moving the finger Hf placed inside the first protrusion 51f in the closing direction (direction of arrow D) or the opening direction (direction of arrow C).

[0102] The first protrusion 51f is hook-shaped and has a release portion 51s that is open on at least one side (the right side in FIG. 24) in a direction perpendicular to the opening and closing direction of the operating handle 51.

[0103] In this way, since the operating handle 51 has a hook shape with an open portion 51s on one side in a direction perpendicular to the opening and closing direction, the finger Hf operating the operating handle 51 can slide, for example, in a lateral direction (direction of arrow J) perpendicular to the operating handle 51.

[0104] The operating handle 51 has a second protruding portion 51b that protrudes in a direction perpendicular to the opening and closing direction of the operating handle 51.

[0105] In this way, since the second protrusion 51b is provided in a direction perpendicular to the opening / closing direction of the operating handle 51, the finger can be hooked on the operating handle 51 even if the finger is shifted laterally relative to the operating handle 51. As a result, the operating handle 51 can be operated using the second protrusion 51b even if the way in which the operating unit 22 is held relative to the hand changes in the circumferential direction of the operating unit 22. For example, if the finger Hf is a finger on the right hand and the right hand is twisted so as to rotate in the direction of arrow C, it becomes difficult to operate the first protrusion 51f with the finger Hf. However, by moving the finger Hf from the first protrusion 51f to the second protrusion 51b and operating the second protrusion 51b with the finger Hf, the operating handle 51 can be easily operated.

[0106] In addition, the first protrusion 51f and the second protrusion 51b are formed continuously, which widens the operable surface of the operating handle 51 as a continuous surface, and therefore, even when rotating the operating handle 51 while opening and closing it, the operable range is widened, allowing the operating handle 51 to be rotated and opened and closed without removing the finger Hf from the operating handle 51.

[0107] Figure 25 is a view of the operation portion main body 50 of the endoscopic treatment tool 20 as seen from the distal end side in the axial direction thereof. As shown in Figure 25, the operation portion 22 has a longitudinal direction and a lateral direction in a cross section of the operation portion main body 50 perpendicular to the axial direction of the operation portion 22. The longitudinal direction is approximately parallel to a plane including the operation movement plane OS of the operation handle 51.

[0108] In this way, the longitudinal direction of the operation unit 22 is approximately parallel to the plane including the operation movement plane OS of the operation handle 51 in a cross section perpendicular to the axial direction of the operation unit 22, so that when the operation unit 22 is held in the hand, the fingers Hf that are placed on the operation handle 51 and the palm that holds the operation unit main body 50 fit comfortably, providing excellent operability, as shown in Fig. 25. In addition, the operator can easily determine the direction of the operation handle 51 by gripping the operation handle 51, even without visually checking the operation handle 51.

[0109] 26 to 31 show a treatment method in ESD as an example of a treatment method using the endoscopic treatment tool 20. Note that the operation wire 27 is pulled toward the operation section 22 when the operation handle 51 is swung in the closing direction D. The endoscopic treatment tool used in combination with the endoscopic treatment tool 20 is an incision tool, and is a high-frequency scissors forceps 60 having a pair of openable and closable claws 61 at the tip (see FIG. 29). The pair of claws 61 are opened and closed by the operation section of the high-frequency scissors forceps 60. When the pair of claws 61 are closed and biological tissue is grasped by the pair of claws 61, a high-frequency current is passed between the pair of claws 61 and the return electrode plate via the biological tissue, or a high-frequency current is passed between the pair of claws 61, thereby cauterizing and incising the biological tissue.

[0110] 26, the endoscope 2 is inserted into the body, and the endoscope tip portion 10 is positioned to the side of the lesion LA in the mucosal layer. The endoscopic treatment tool 20 is inserted into the first treatment tool channel 14 of the endoscope 2, and the tip portion 23 and bending portion 25 of the endoscopic treatment tool 20 protrude from the end face of the endoscope tip portion 10. Then, by operating the operating portion 22 of the endoscopic treatment tool 20, the lesion LA is grasped by the grasping portion 24 of the tip portion 23.

[0111] When the lesion area LA is grasped by the grasping unit 24, first, the operating handle 51 (see FIG. 10) of the operating unit 22 is manipulated in the opening direction C. As shown in FIG. 26, the manipulation of the operating handle 51 pushes the operating wire 27 toward the distal end portion 23, and by pushing the operating wire 27, the bending portion 25 is extended linearly and laid down along the longitudinal axis of the connecting portion 26. Furthermore, by pushing the operating wire 27, the pair of grasping claws 30 of the grasping unit 24 are opened. Then, the operating unit main body 50 is pushed and pulled as appropriate, and the lesion area LA is positioned between the pair of grasping claws 30.

[0112] With the lesion area LA positioned between the pair of gripping jaws 30, the operating handle 51 is operated in the closing direction D. As a result, the operating wire 27 is pulled toward the operating unit 22. By pulling the operating wire 27, first, as shown in FIG. 27, the pair of gripping jaws 30 are closed, and the lesion area LA is gripped by the gripping portion 24. Then, after the lesion area LA is gripped by the gripping portion 24, the bending portion 25 is bent, as shown in FIG. 28. As a result, the gripping portion 24 is raised from its lying state along the longitudinal axis of the connecting portion 26, and the lesion area LA gripped by the gripping portion 24 is lifted up.

[0113] With the lesion LA lifted, as shown in FIG. 29 , a high-frequency scissors forceps 60 inserted through the second treatment instrument channel 16 of the endoscope 2 is protruded from the end face of the endoscope distal end portion 10. A pair of claws 61 of the high-frequency scissors forceps 60 is positioned below the lesion LA, and the lower portion of the lesion LA is incised by the pair of claws 61. As the incision progresses, the lifted lesion LA may be released, re-grasped, and then lifted. Once the incised lesion LA is lifted, the lower portion is exposed and easily visible, allowing for safe, reliable, and easy resection. The incision progresses by appropriately pushing and pulling the high-frequency scissors forceps 60, and the lesion LA, including the submucosal layer, is gradually dissected.

[0114] Thus, the lesion LA can be grasped at the side of the lesion LA and the grasped lesion LA can be lifted simply by operating the operating handle 51 of the endoscopic treatment tool 20, simplifying the operation. This allows the lesion LA to be lifted, and by lifting the lesion LA, the area below the lesion LA is exposed for easy viewing, thereby enabling safe, reliable, and easy treatment of the area below the lifted lesion LA. Furthermore, in this example, the friction adjustment mechanisms 70 and 73 allow the operating handle 51 to be maintained in an operated state, so that the lesion LA can be maintained in a lifted state even after the operator's hand has released the operating handle 51. This allows the operator to concentrate on operating the high-frequency scissors forceps 60 during incision, further simplifying the operation and making it even easier to treat the area below the lesion LA.

[0115] During incision, the operation unit main body 50 of the operation unit 22 may be pushed and pulled in the direction of arrow E in Fig. 10, and / or the operation unit main body 50 may be rotated in the direction of arrow F in Fig. 10. As described above, the connection part 26 has rigidity that allows translational and rotational power to be transmitted from the operation unit 22 side to the bending part 25 side, and the pushing, pulling, and rotation of the operation unit main body 50 are transmitted to the bending part 25 via the connection part 26.

[0116] 30 shows a case where operation unit main body 50 is rotated. In response to the rotation of operation unit main body 50, connecting portion 26 is rotated around the longitudinal axis of connecting portion 26. With bending portion 25 bent, gripping portion 24 is rotated while remaining upright relative to the longitudinal axis of connecting portion 26, and lesion area LA gripped by gripping portion 24 is swung around the longitudinal axis of connecting portion 26.

[0117] 31 shows a case where operation unit main body 50 is pushed and pulled. In response to the pushing and pulling of operation unit main body 50, connecting portion 26 is advanced and retreated in the axial direction of the longitudinal axis of connecting portion 26. When bending portion 25 is bent, gripping portion 24 is advanced and retreated while remaining upright relative to the longitudinal axis of connecting portion 26, and lesion area LA gripped by gripping portion 24 is pushed and pulled in the axial direction of the longitudinal axis of connecting portion 26.

[0118] By appropriately rocking and / or pushing and pulling the lesion LA, for example, the incision can be widened. This makes it easier to treat the area below the lesion LA. Furthermore, by maintaining the operation state of the operation unit main body 50 using the friction mechanism 80, the incision can be kept widened even after the operator's hand has left the operation unit main body 50. This makes it easier to treat the area below the lesion LA.

[0119] Although the embodiments of the present invention have been described above, the present invention is not limited to the above-described embodiments, and modifications, improvements, etc. are possible as appropriate.

[0120] For example, in the friction adjustment mechanism 70 of the above embodiment, the link member 57 is sandwiched between a pair of wire holding portions 56, and two pairs of cam surfaces are used, but this is not limited to this, and for example, there may be only one pair of opposing cam surfaces.

[0121] Furthermore, in the sliding friction adjustment mechanism 73 of the above embodiment, an O-ring is used as the elastic member 73o, but it is not limited to an O-ring.

[0122] Furthermore, in the friction mechanism 80 of the above embodiment, four protrusions 52d are provided, but the number is not limited to four, and a greater or lesser number may be provided.

[0123] Furthermore, in the friction mechanism 80 of the above embodiment, a recess 50c and a protrusion 50d are provided that can be engaged with fingers, but it is not necessary to provide both the recess 50c and the protrusion 50d; it is sufficient to provide at least one of them.

[0124] Furthermore, in the operation unit 22 of the above embodiment, the operation handle 51 is configured to be swingable and protrude from the operation unit main body 50, and to move the wire holding unit 56 by swinging, but the present invention is not limited to this configuration. For example, as shown in FIG. 32 , the operation handle 51 may be provided on a flat surface 50b provided on the operation unit main body 50, and may be a member that is movable in the E direction along this flat surface 50b. The operation handle 51 is operated, for example, by the thumb of an operator holding the operation unit main body 50.

[0125] In this case, the operating handle 51 is connected to the wire holding portion 56, and when the operating handle 51 is moved toward the tip side of the operating unit main body 50 (upper side in FIG. 32), the wire holding portion 56 also moves toward the tip side of the operating unit main body 50, pulling the operating wire 27. Furthermore, when the operating handle 51 is moved toward the base end side of the operating unit main body 50 (lower side in FIG. 32), the wire holding portion 56 also moves toward the base end side of the operating unit main body 50, loosening the operating wire 27. That is, in the configuration shown in FIG. 32, by moving the operating handle 51 up and down, it is possible to achieve the same operation as the operation of swinging the operating handle 51 shown in FIG. 11 etc.

[0126] In the configuration shown in Fig. 32, the positions and shapes of the operation handle 51 and the flat portion 50b are not limited to the configuration shown in Fig. 32. For example, the flat portion 50b may be positioned closer to the tip of the operation unit main body 50 than in the example shown in Fig. 32.

[0127] This specification describes at least the following:

[0128] (1) a tip end portion provided with an openable and closable gripping portion; a bendable bending portion adjacent to the tip portion; an operation unit to which an operation for closing the gripping portion and an operation for bending the bending portion are input; an operation wire that transmits an operation of the operation unit to the grip unit and the bending unit; Equipped with When the operation wire is made straight and the operation section is viewed toward the tip end along the axial direction of the operation wire, The position of the bending operation surface of the bending portion is located in a range greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the axis, starting from a position where an operation handle for operating the bending portion is provided on the operation portion. Endoscopic treatment tools.

[0129] (2) The endoscopic treatment tool according to (1), The bending operation plane when the bending portion is bent by pulling the operation wire is set at a position of 225 degrees in a clockwise direction from an operation movement plane when the operation handle is operated as a starting point. Endoscopic treatment tools.

[0130] (3) The endoscopic treatment tool according to (1) or (2), The operation unit has an operation unit main body that can rotate relative to a fixing part that attaches the operation unit to a predetermined position to rotate the direction of the tip end, and an operation handle that moves the operation wire by opening and closing around a rotation fulcrum relative to the operation unit main body. Endoscopic treatment tools.

[0131] (4) (3) The endoscopic treatment tool according to the present invention, The operating handle has a first protrusion curved so that at least a side surface on a closing side and a side surface on an opening side of the operating handle can simultaneously face a finger operating the operating handle. Endoscopic treatment tools.

[0132] (5) (4) The endoscopic treatment tool according to the present invention, The first protrusion has a hook shape with at least one side open in a direction perpendicular to the opening and closing direction of the operating handle. Endoscopic treatment tools.

[0133] (6) The endoscopic treatment tool according to (4) or (5), The operating handle has a second protruding portion protruding in a direction perpendicular to the opening and closing direction of the operating handle. Endoscopic treatment tools.

[0134] (7) (6) The endoscopic treatment tool according to The first protrusion and the second protrusion are formed continuously. Endoscopic treatment tools.

[0135] (8) The endoscopic treatment tool according to any one of (3) to (7), The operation unit has a longitudinal direction and a lateral direction in a cross section of the operation unit body that is perpendicular to an axial direction of the operation unit, The longitudinal direction is approximately parallel to a plane including an operation movement surface of the operating handle. Endoscopic treatment tools.

[0136] (9) A first treatment tool which is an endoscopic treatment tool according to any one of (1) to (8), a second treatment tool; an endoscope having a first treatment tool channel through which the first treatment tool can be inserted and a second treatment tool channel through which the second treatment tool can be inserted; An endoscope apparatus comprising:

[0137] (10) (9) Using the endoscope device described above, The distal end of the first treatment tool is placed at a lesion site in the body through the first treatment tool channel of the endoscope; The lesion site is grasped by the grasping portion of the first treatment tool, In a state where the lesion site is grasped, the bending portion of the first treatment tool is bent to lift the lesion site; With the lesion site lifted, a lower portion of the lesion site is treated with the second treatment tool inserted into the second treatment tool channel of the endoscope. Treatment method.

[0138] Although various embodiments have been described above with reference to the drawings, it goes without saying that the present invention is not limited to such examples. It is clear that a person skilled in the art can conceive of various modifications or alterations within the scope of the claims, and it is understood that these also naturally fall within the technical scope of the present invention. Furthermore, the components of the above-described embodiments may be combined in any manner without departing from the spirit of the invention.

[0139] This application is based on a U.S. provisional application (63 / 118,975) filed on November 30, 2020, the contents of which are incorporated herein by reference. [Explanation of symbols]

[0140] 20 Endoscopic treatment tools 22 Control section 23 Tip 25 Curved section 26 Connection 27 Control wire 50 Operation unit body 50b Flat part 51 Operating handle 52 Fixed part 52d protrusion 55 Rotating shaft part 56 Wire holder 57 Link member 58m fastening member 59 Friction materials 70,73 Friction adjustment mechanism 71 First sliding part (sliding part) 72 Second sliding part (sliding part) 73c cylinder 73o Elastic member 73p Piston 75 Slide Ring 76 Friction materials 77 O-ring 80 Friction mechanism 81 1st friction part 82 2nd friction part MS curved operating surface OS operation movement surface

Claims

1. a tip end portion provided with an openable and closable gripping portion; a bendable bending portion adjacent to the tip portion; an operation unit to which an operation to close the gripping portion and an operation to bend the bending portion are input; an operation wire that transmits the operation of the operation unit to the gripping unit and the bending unit; Equipped with When the operation wire is made straight and the operation section is viewed toward the distal end along the axial direction of the operation wire, The position of the bending operation surface of the bending portion is located in a range greater than 180 degrees and less than 270 degrees clockwise in the circumferential direction of the axis, with the operation direction of the operating handle that causes the operating portion to operate being 0 degrees. Endoscopic treatment tools.

2. The endoscopic treatment tool according to claim 1, The bending operation plane when the bending portion is bent by pulling the operation wire is set at a position of 225 degrees in a clockwise direction from an operation movement plane when the operation handle is operated as a starting point. Endoscopic treatment tools.

3. The endoscopic treatment tool according to claim 1 or 2, The operation unit includes an operation unit main body that can rotate relative to a fixing part that attaches the operation unit to a predetermined position to rotate the direction of the tip end, and the operation handle that moves the operation wire by opening and closing around a rotation fulcrum relative to the operation unit main body. Endoscopic treatment tools.

4. The endoscopic treatment tool according to claim 3, the operating handle has a first protrusion curved so that at least a side surface on a closing side and a side surface on an opening side of the operating handle can simultaneously face a finger operating the operating handle, Endoscopic treatment tools.

5. The endoscopic treatment tool according to claim 4, the first protrusion has a hook shape with at least one side open in a direction perpendicular to the opening and closing direction of the operating handle; Endoscopic treatment tools.

6. The endoscopic treatment tool according to claim 4 or 5, The operating handle has a second protruding portion protruding in a direction perpendicular to the opening and closing direction of the operating handle. Endoscopic treatment tools.

7. The endoscopic treatment tool according to claim 6, The first protrusion and the second protrusion are formed continuously. Endoscopic treatment tools.

8. The endoscopic treatment tool according to any one of claims 3 to 7, When viewed from the axial direction of the operation unit, the length of the operation handle in a direction along an operation movement surface is longer than the length in a direction perpendicular to the direction along the operation movement surface. Endoscopic treatment tools.

9. a first treatment tool which is the endoscopic treatment tool according to any one of claims 1 to 8; a second treatment tool; an endoscope having a first treatment tool channel through which the first treatment tool can be inserted and a second treatment tool channel through which the second treatment tool can be inserted; An endoscope apparatus comprising:

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