Endoscopic treatment implement

Abstract

This endoscopic treatment implement comprises: a sheath having a longitudinal axis; an electrode at least a portion of which protrudes from the distal-end section of the sheath toward the distal end side; and a tube supported by the distal-end section of the sheath and having a suction conduit passing in the longitudinal direction of the longitudinal axis. A distal-end opening of the suction conduit is positioned at the distal-end section of the sheath, and a proximal-end opening of the suction conduit is opened to the outside of the sheath at a position between the distal end and proximal end of the sheath.

Description

Endoscopic treatment tools

[0001] The present invention relates to an endoscopic treatment tool.

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

[0003] When performing hemostasis using an endoscopic treatment tool, the surgeon supplies water to identify the location where hemostasis is to be performed. When performing hemostasis after identifying the location, it is desirable that there is no electrolyte liquid around the location. Therefore, before performing hemostasis, the surgeon performs a procedure to aspirate the liquid around the tissue to be stopped. Patent Documents 1 and 2 describe endoscopic treatment tools with a suction function.

[0004] US Patent Application Publication No. 2007 / 0038213 Japanese Patent Application Publication No. 2009-233269

[0005] However, in the endoscopic treatment tools described in Patent Documents 1 and 2, the suction conduit is provided along the entire length of the sheath, and therefore, in order to improve suction efficiency, the conduit diameter must be increased, which increases the outer diameter of the sheath along its entire length. If the outer diameter of the sheath is increased along its entire length, the suction performance of the endoscope may be reduced.

[0006] In view of the above circumstances, an object of the present invention is to provide an endoscopic treatment tool that can perform suction from the distal end of the sheath without significantly reducing the suction performance of the endoscope.

[0007] In order to solve the above problems, the present invention proposes the following means: An endoscopic treatment tool according to a first aspect of the present invention comprises a sheath having a longitudinal axis, an electrode at least a portion of which protrudes distally from a distal end portion of the sheath, and a tube supported by the distal end portion of the sheath and having a suction conduit passing through in the longitudinal direction of the longitudinal axis, wherein a distal opening of the suction conduit is located at the distal end portion of the sheath and a proximal opening of the suction conduit opens to the outside of the sheath at a position between the distal end and proximal end of the sheath.

[0008] The endoscopic treatment instrument of the present invention can perform suction from the distal end of the sheath without significantly reducing the suction performance of the endoscope.

[0009] 5 is an overall view of an endoscopic treatment system according to a first embodiment. FIG. 5 is an overall view showing a treatment tool of the endoscopic treatment system. FIG. 5 is a perspective view of a distal opening of a channel of an endoscope of the endoscopic treatment system. FIG. 5 is a perspective view of a distal end portion of the treatment tool. FIG. 5 is a view showing the distal end portion of the treatment tool when the distal end of the knife is in a second position. FIG. 5 is a cross-sectional view taken along line X1-X1 of FIG. 5. FIG. 5 is a cross-sectional view taken along line X2-X2 of FIG. 5. FIG. 5 is a view showing the distal end portion of the treatment tool when the distal end of the knife is in a first position. FIG. 5 is a cross-sectional view of the distal end portion of the treatment tool. FIG. 5 is a view showing a modified example of a suction hole. FIG. 5 is a view showing another modified example of the suction hole. FIG. 5 is a view showing a modified example of the knife. FIG. 5 is a cross-sectional view of a modified example of the treatment tool. FIG. 5 is a cross-sectional view of a modified example of the channel. FIG. 5 is a perspective view of a distal end portion of a treatment tool according to a second embodiment. FIG. 5 is a cross-sectional view of the distal end portion of the treatment tool when the distal end of the knife is in a second position. FIG. 5 is a cross-sectional view of the distal end portion of the treatment tool when the distal end of the knife is in a first position. FIG. 5 is a perspective view of a treatment tool according to a third embodiment. FIG. 5 is a cross-sectional view of the distal end portion of the treatment tool.

[0010] First Embodiment An endoscopic treatment system 300 according to a first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 9. Fig. 1 is an overall view of the endoscopic treatment system 300 according to this embodiment.

[0011] 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment tool 100. The treatment tool 100 is inserted into the endoscope 200 when in use.

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

[0013] The insertion section 202 has an imaging section 203, a bending section 204, and a flexible section 205. The imaging section 203, the bending section 204, and the flexible section 205 are arranged in this order from the tip of the insertion section 202. A channel 206 for inserting the treatment tool 100 is provided inside the insertion section 202. A tip opening 206a of the channel 206 is provided at the tip of the insertion section 202.

[0014] The imaging unit 203 includes an imaging element such as a CCD or CMOS, and is capable of capturing an image of the site to be treated. The imaging unit 203 can capture an image of the knife 3 of the treatment tool 100 when the treatment tool 100 protrudes from the distal end opening 206 a of the channel 206.

[0015] The bending portion 204 bends in accordance with the operator's operation of the operating portion 207. The flexible portion 205 is a flexible tubular portion.

[0016] The operation section 207 is connected to the flexible section 205. The operation section 207 has a grip 208, an input section 209, a proximal end opening (forceps opening) 206b of the channel 206, and a universal cord 210. The grip 208 is a portion that is held by the operator.

[0017] The input unit 209 has an angle knob 209a, an air / water supply button 209b, and a suction button 209c. The angle knob 209a accepts operation inputs for bending the bending portion 204. The air / water supply button 209b is a push button used to input an operation to supply air or water from the distal end opening 206a. The suction button 209c is a push button used to input a suction operation from the distal end opening 206a, and pressing the suction button 209c starts suction within the channel.

[0018] The universal cord 210 outputs the image captured by the imaging unit 203 to the outside. The universal cord 210 is connected to a display device such as a liquid crystal display via an image processing device including a processor, etc. The endoscope 200 is connected to a suction pump 400 via the universal cord 210, and suction within the channel 206 begins when a suction button 209c is pressed.

[0019] 2 is an overall view showing the treatment tool 100. The treatment tool (endoscopic treatment tool, high-frequency treatment tool) 100 includes a sheath 1, a suction tube 2, a knife 3, a manipulation wire 4 (see FIG. 4), and an operation unit 5. In the following description, in the longitudinal direction A of the treatment tool 100, the side that is inserted into the patient's body will be referred to as the "tip side (distal side) A1," and the side of the operation unit 5 will be referred to as the "base side (proximal side) A2."

[0020] 3 is a perspective view of the distal opening 206a of the channel 206. The sheath 1 is a long tubular member extending in a longitudinal direction A along the longitudinal axis from the distal end 1a to the proximal end 1b. The sheath 1 is insertable into the channel 206 of the endoscope 200 and is capable of advancing and retreating through the channel 206. When the sheath 1 is inserted into the channel 206, the distal end 1a of the sheath 1 can protrude and retract from the distal opening 206a of the channel 206.

[0021] 4 is a perspective view of the distal end portion of the treatment tool 100. The sheath 1 has an outer tube 10 extending in the longitudinal direction A and a distal end member 11 provided at the distal end of the outer tube 10. Note that the sheath 1 may be formed by integrally molding the outer tube 10 and the distal end member 11, or may be made of the same material.

[0022] 5 is a diagram showing the distal end of the treatment instrument 100 with the distal end of the knife 3 at the second position P2. The sheath 1 is inserted into the internal space 23 (hereinafter also referred to as the "suction line 23") of the suction tube 2. A portion of the knife 3 is inserted into the internal space 19 of the sheath 1. That is, the outer diameter of the sheath 1 is smaller than the outer diameter of the suction tube 2 and larger than the outer diameter of the knife 3.

[0023] The outer tube 10 is a long, flexible, and insulating tubular member made of, for example, resin. In this embodiment, the inner space 19 of the outer tube 10 is a space into which a portion of the knife 3 can be inserted.

[0024] FIG. 6 is a cross-sectional view taken along line X1-X1 in FIG. 5. FIG. 7 is a cross-sectional view taken along line X2-X2 in FIG. 5. The tip member 11 is formed in a cylindrical shape. Note that "cylindrical" includes not only a strictly cylindrical shape but also a shape close to a cylindrical shape. The tip member 11 is preferably formed of an insulating material such as resin. The length from the tip to the base end of the tip member 11 is, for example, 10 mm to 20 mm. As shown in FIG. 4, the tip member 11 is formed with a through-hole 12 and a suction hole 13. The through-hole 12 and the suction hole 13 are not directly connected. The tip member 11 has a first portion 15 and a second portion 16.

[0025] The first portion 15 is provided on the distal end side A1 of the distal end member 11 and is formed in a disk shape. Note that "disk shape" includes not only a strict disk shape but also a shape close to a cylindrical shape. At least a portion of the first portion 15 protrudes from the outer tube 10 toward the distal end side A1. As shown in FIG. 4 , the first portion 15 has a distal end surface 14 on the distal end side A1. At least a portion of the first portion 15 is inserted into the suction tube 2 and is fixed by fitting into a distal end opening 21 of the suction tube 2. The first portion 15 protrudes from the distal end of the suction tube 2 toward the distal end side A1. The outer diameter of the first portion 15 is larger than the outer diameter of the outer tube 10.

[0026] The second portion 16 is provided on the proximal end side A2 of the distal end member 11 and is formed in a cylindrical shape. Note that "cylindrical" includes not only a strict disk shape but also a shape close to a cylindrical shape. The second portion 16 is provided on the proximal end side A2 of the first portion 15. The second portion 16 is inserted into the outer tube 10 and fixed by fitting into the distal end opening of the outer tube 10. For example, the second portion 16 of the distal end member 11 and the outer tube 10 may be joined by press-fitting the outer tube 10 into a tapping screw provided on the distal end member 11. Alternatively, the second portion 16 of the distal end member 11 and the outer tube 10 may be joined by adhesive.

[0027] The through hole 12 is a hole provided in the first portion 15 and the second portion 16 of the tip member 11 and passes through the tip member 11 in the longitudinal direction A. The tip of the through hole 12 communicates with a first opening 12a formed in the tip surface 14 of the tip member 11. The base end of the through hole 12 communicates with the internal space 19 of the outer tube 10.

[0028] The suction holes 13 are provided in the first portion 15 of the tip member 11, are holes that penetrate the first portion 15 of the tip member 11 in the longitudinal direction A, and form at least a part of the suction flow path SR. Three suction holes 13 are formed in the first portion 15 of the tip member 11. The three suction holes 13 are respectively connected to three tip openings 13a formed in the tip surface 14 of the tip member 11. The base ends of the suction holes 13 are connected to the suction pipeline 23 of the suction tube 2. An inner circumferential surface 13s of the suction holes 13 is located inward in the radial direction R from an inner circumferential surface 2s of the suction tube 2.

[0029] The tip openings 13a of the suction holes 13 are arranged to be spaced apart in the radial direction R from the first openings 12a of the through holes 12. The three tip openings 13a are evenly arranged along the circumferential direction C with respect to the longitudinal direction A. The tip openings 13a are formed in the shape of an elongated hole along the circumferential direction C.

[0030] The suction tube (suction conduit member) 2 is formed in a cylindrical shape. Note that "cylindrical" includes not only a strictly cylindrical shape but also a shape close to a cylindrical shape. The suction tube 2 has a suction conduit 23 that forms at least a part of the suction flow path SR. The suction conduit 23 is a conduit that penetrates in the longitudinal direction A. The suction tube 2 covers the entire circumference of the outer tube 10 along the circumferential direction C and at least a part of the outer peripheral surface of the distal end portion 1a of the sheath 1. The suction flow path SR in the suction conduit 23 is formed between the inner peripheral surface of the suction tube 2 and at least a part of the outer peripheral surface of the distal end portion 1a of the sheath 1.

[0031] 8 is a diagram showing the distal end portion of the treatment tool 100 with the distal end of the knife 3 at the first position P1. The distal end opening 21 of the suction tube 2 is located at the distal end portion 1a of the sheath 1. The distal end opening 21 of the suction tube 2 is fitted into and fixed to the first portion 15. For example, the first portion 15 of the distal end member 11 and the suction tube 2 may be joined by adhesive.

[0032] The first portion 15 of the distal end member 11 is connected to the suction tube 2 at a position on the distal end side A1 and outside in the radial direction R of the connection position between the second portion 16 and the outer tube 10 .

[0033] The fitting diameter D4 between the suction tube 2 and the first portion 15 is larger than the fitting diameter D3 between the outer tube 10 and the second portion 16 (D4>D3). The fitting diameter D4 between the suction tube 2 and the first portion 15 is smaller than the maximum outer diameter D5 of the tip member 11 (D5>D4).

[0034] The proximal end opening 22 of the suction tube 2 opens to the outside of the sheath 1 at a position between the distal end and proximal end of the sheath 1. As shown in FIG. 5 , when the surgeon performs suction treatment or hemostasis treatment using the knife 3 or the like while observing the image captured by the imaging unit 203, the distal end opening 21 of the suction tube 2 protrudes from the distal end opening 206a of the channel 206, and a protrusion length L1 by which the tip of the knife 3 protrudes from the distal end opening 206a of the channel 206 is 5 mm to 10 mm. At this time, the proximal end opening 22 of the suction tube 2 is disposed inside the channel 206 of the endoscope 200. For example, the proximal end opening 22 of the suction tube 2 may be disposed inside the channel 206 in the bending portion 204 of the endoscope 200. The length L2 of the suction tube 2 is shorter than the length along the longitudinal axis of the bending portion 204 of the endoscope 200, and is, for example, 10 mm to 20 mm. Because the suction tube 2 is prone to buckling if it is too long, it is desirable that the length L2 of the suction tube 2 be, for example, 20 mm or less.

[0035] As shown in Figure 5, the suction conduit 23 communicates with the suction hole 13 via the distal opening 21 on the distal side A1. The suction conduit 23 also communicates with the channel 206 via the proximal opening 22 on the proximal side A2. That is, the suction hole 13, the suction conduit 23, and the channel 206 form the suction channel SR. The distal opening 13a is the suction opening of the suction channel SR. Liquid aspirated through the distal opening 13a passes through the suction channel SR (suction hole 13, suction conduit 23, channel 206) and is discharged outside the body. From the viewpoint of suction efficiency, it is desirable that the gap between the distal opening 206a of the channel 206 and the suction tube 2 be small.

[0036] The connection between the first portion 15 and the suction tube 2 is not limited to the above-described fitting connection. The first portion 15 and the suction tube 2 may be connected so that the suction hole 13 and the suction pipe line 23 communicate with each other.

[0037] The knife (electrode) 3 is a thin, elongated metal member. The knife 3 is made of a material such as stainless steel. The knife 3 is electrically conductive and is energized with high-frequency current. The knife 3 includes a knife body 30, a flange 31, and a connector 32.

[0038] The knife 3 is inserted through the through-hole 12 of the distal end member 11 of the sheath 1 along the longitudinal direction A and can freely protrude and retract from the first opening 12a to the distal end side A1. Note that the knife 3 may be fixed in a state where it cannot advance or retreat while protruding from the first opening 12a to the distal end side A1.

[0039] The central axis O3 of the knife 3 in the longitudinal direction A preferably coincides with the central axis O1 of the sheath 1 in the longitudinal direction A. Note that "coinciding" includes not only a state in which they coincide exactly but also a state in which they almost coincide.

[0040] The knife body 30 is a round bar-shaped member made of metal. The outer diameter of the knife body 30 is smaller than the inner diameter of the through hole 12. The knife body 30 is movable in the longitudinal direction A through the through hole 12 and the first opening 12a.

[0041] The flange (tip enlarged diameter portion) 31 is a flange-shaped conductive member provided at the tip of the knife body 30. In a front view along the longitudinal direction A, the outer periphery of the flange 31 is formed concentrically with the outer periphery of the knife body 30. A length D2 of the flange 31 in a radial direction R perpendicular to the longitudinal direction A is longer than a length D1 of the knife body 30 in the radial direction R. The flange 31 cannot be inserted through the through-hole 12 or the first opening 12a. A flat base end surface 31b is formed on the base end side A2 of the flange 31. The flange 31 is not limited to a disk shape, and may be triangular or hook-shaped. An insulating resin member may be fixed to the tip of the knife body 30.

[0042] 5, when the knife 3 is advanced relative to the sheath 1, the tip of the connector 32 comes into contact with the tip member 11 (second portion 16). The contact between the tip of the connector 32 and the tip member 11 positions the tip of the knife 3 at the second position P2, which is the position on the tip-most side A1.

[0043] 8, when the knife 3 is retracted relative to the sheath 1, the proximal end surface 31b of the flange 31 comes into contact with the distal end member 11 (first portion 15). The contact between the proximal end surface 31b of the flange 31 and the distal end member 11 positions the distal end of the knife 3 at a first position P1, which is the position closest to the proximal end side A2.

[0044] 9 is a cross-sectional view of the distal end portion of the treatment tool 100. As shown in Fig. 9, the knife body 30 and the flange 31 have a first duct 33 extending along the longitudinal direction A. The first duct 33 communicates with a distal opening 33a formed in the flange 31. The distal opening 33a is an opening provided on the distal side A1 of the flange 31.

[0045] The connector (connecting member) 32 is a cylindrical member made of metal. Note that the term "cylindrical" includes not only a strictly cylindrical shape but also a shape close to a cylindrical shape. The connector 32 connects the knife body 30 and the operating wire 4.

[0046] 9, when the distal end of the knife 3 is positioned at the first position P1, the proximal end opening 22 of the suction tube 2 is located on the distal side A1 relative to the proximal end 32p of the connector 32. Therefore, buckling of the suction tube 2 can be prevented.

[0047] The connector 32 has a second conduit 34 extending along the longitudinal direction A. The second conduit 34 communicates with the first conduit 33 and a third conduit 43 formed in the operating wire 4. The second conduit 34 is formed in a tapered shape whose diameter decreases from the base end side A2 toward the tip end side A1.

[0048] An operating wire 4 is attached to the proximal end of the connector 32. A high-frequency current is supplied to the knife 3 via the operating wire 4 connected to the operating unit 5. When a high-frequency current is supplied from the operating wire 4 to the knife 3, the knife body 30 and the flange 31 function as active electrodes that output the high-frequency current to biological tissue.

[0049] The operating wire 4 is a wire that passes through the internal space (duct, lumen) 19 of the outer tube 10 of the sheath 1. The operating wire 4 is a wire that operates the knife 3. The operating wire 4 has a coil shaft 44. The distal end of the operating wire 4 is connected to the connector 32 of the knife 3, and the proximal end of the operating wire 4 is connected to the slider 52 of the operating unit 5. Note that the operating wire 4 may have other configurations as long as it is a hollow shaft.

[0050] The coil shaft 44 is a hollow metallic coil wire. The coil shaft 44 is formed of a material such as stainless steel. A third conduit 43 is formed inside the coil shaft 44. The third conduit 43 is connected to the base end of the second conduit 34. The first conduit 33, the second conduit 34, and the third conduit 43 form a water supply flow path WR. The fluid supplied from the liquid supply port 54 passes through the water supply flow path WR (the third conduit 43, the second conduit 34, and the first conduit 33) and is released from the distal end opening 33a.

[0051] The outer periphery of the coil shaft 44 may be covered with a heat shrink tube, etc. By covering the outer periphery of the coil shaft 44 with a heat shrink tube, it becomes more difficult for liquid to leak from the third pipeline 43.

[0052] As shown in FIGS. 1 and 2, the operation unit 5 has an operation unit main body 51, a slider 52, a power supply connector 53, and a liquid supply port 54.

[0053] The distal end of the operation portion main body 51 is connected to the proximal end 1b of the sheath 1 (the proximal end of the outer tube 10). The operation portion main body 51 has an internal space through which the operation wire 4 can be inserted. The operation wire 4 passes through the internal space 19 of the outer tube 10 and the internal space of the operation portion main body 51 and extends to the slider 52.

[0054] The slider 52 is attached to the operation unit main body 51 so as to be movable along the longitudinal direction A. The proximal end of the operation wire 4 is attached to the slider 52. When the surgeon moves the slider 52 forward or backward relative to the operation unit main body 51, the operation wire 4 and the knife 3 move forward or backward.

[0055] The power supply connector 53 is fixed to the slider 52. The power supply connector 53 is connectable to a high-frequency power supply device (not shown) and is connected to the proximal end of the operation wire 4 via a conductive wire. The power supply connector 53 is capable of supplying high-frequency current supplied from the high-frequency power supply device to the knife 3 via the operation wire 4. The power supply connector 53 may be fixed to the operation unit main body 51 instead of the slider 52.

[0056] The liquid supply port 54 is provided in the slider 52. The liquid supply port 54 is connected to the base end of the third conduit 43 via a conduit formed in the slider 52. As shown in Fig. 9, the liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (the third conduit 43, the second conduit 34, and the first conduit 33) and is released from the distal end opening 33a. Note that the liquid supply port 54 may be provided in the operation unit main body 51 instead of the slider 52.

[0057] According to the above configuration, the treatment tool 100 has the effect of being able to perform suction from the distal end of the sheath 1 without significantly reducing the suction performance of the endoscope 200. In other words, the endoscopic treatment system 300 can achieve both the suction efficiency of the channel 206 of the endoscope 200 and the suction efficiency of the suction tube 2 of the treatment tool 100.

[0058] [Method of Using the Endoscopic Treatment System 300] Next, a procedure (method of using the endoscopic treatment system 300) using the endoscopic treatment system 300 of this embodiment will be described. Specifically, a local injection treatment and an incision / excision treatment of a lesion in an endoscopic treatment such as ESD (endoscopic submucosal dissection) will be described.

[0059] As a preparatory step, the surgeon identifies the lesion by a known method. Specifically, the surgeon inserts the insertion section 202 of the endoscope 200 into the digestive tract (e.g., the esophagus, stomach, duodenum, or large intestine) and identifies the lesion while observing an image obtained by the imaging section 203 of the endoscope.

[0060] <Insertion Step> The surgeon inserts the treatment tool 100 into the channel 206 and causes the distal end portion 1 a of the sheath 1 to protrude from the distal end opening 206 a of the insertion portion 202 .

[0061] 5, the surgeon moves the slider 52 of the operating unit 5 back relative to the operating unit body 51, and positions the tip of the knife 3 at the first position P1. Using the tip of the flange 31 protruding from the tip surface 14 of the tip member 11, the surgeon cauterizes the biological tissue around the lesion and performs marking.

[0062] <Local injection step> As shown in Figure 5, the surgeon advances the slider 52 of the operation unit 5 relative to the operation unit body 51, and positions the tip of the knife 3 at the second position P2. With the tip opening 33a of the tip of the knife 3 placed in the submucosal layer, the surgeon supplies liquid (local injection liquid) from the liquid supply port 54. The liquid (local injection liquid) passes through the water supply flow path WR (third conduit 43, second conduit 34, first conduit 33) and is released from the tip opening 33a.

[0063] <Incision and dissection step> Next, the surgeon performs the incision and dissection procedure. The surgeon advances the knife 3 and moves the flange 31 while high-frequency current is being applied to incise the mucosa at the lesion. The surgeon also advances the knife 3 and, while high-frequency current is being applied, lifts the mucosa at the incised lesion to expose the submucosal layer, and dissects the submucosal layer at the incised lesion.

[0064] <Hemostasis Step> If bleeding occurs during an incision or ablation procedure, the surgeon performs hemostasis. The surgeon supplies liquid from the liquid supply port 54 to wash the area around the hemostasis point and identify the hemostasis point. Next, to ensure reliable hemostasis, the surgeon aspirates the electrolyte liquid from the surgical site. The surgeon presses the suction button 209c to perform suction from the distal end opening 206a using the endoscope 200 (first step). Next, suction is performed from the suction conduit 23 of the treatment instrument 100 (second step). As a result, the liquid aspirated from the distal end opening 13a passes through the suction flow path SR (suction hole 13, suction conduit 23, channel 206) and is discharged outside the body. To perform suction efficiently, the surgeon may bring the distal end opening of the suction flow path SR into contact with the liquid.

[0065] Next, the surgeon cauterizes the bleeding point by applying high-frequency current while pressing the knife body 30 and flange 31 against the surgical site, thereby stopping the bleeding (third step). At this time, since there is no electrolyte liquid in the surgical site, the surgeon can quickly perform the hemostasis procedure. The surgeon may also bring the knife 3 into contact with the liquid to efficiently stop the bleeding.

[0066] Since the surgeon can perform hemostasis treatment and suction treatment using the same treatment tool 100, there is no need to replace the treatment tool or remove the treatment tool and then use the channel 206 of the endoscope 200 to suction blood, etc. The surgeon may perform the second step and the third step simultaneously.

[0067] The surgeon continues the above-mentioned operations (treatments) as necessary, and finally excises the lesion, completing the ESD procedure.

[0068] The treatment tool 100 according to this embodiment has the advantage of being able to perform suction from the tip of the sheath 1 without significantly reducing the suction performance of the endoscope 200. In other words, the endoscopic treatment system 300 can achieve both the suction efficiency of the channel 206 of the endoscope 200 and the suction efficiency of the suction tube 2 of the treatment tool 100. Therefore, the treatment tool 100 can also perform a suction treatment using the suction function of the endoscope 200 depending on the situation. Because the treatment tool 100 can perform a suction treatment and a hemostatic treatment, the surgeon can immediately identify the hemostatic point and perform hemostatic treatment after suctioning and recovering fluid accumulated at the surgical site.

[0069] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above-described embodiment and modifications can be configured by appropriately combining them.

[0070] (Variation 1) Fig. 10 is a diagram showing a suction hole 13A, which is a variation of the suction hole 13. Six suction holes 13A are formed in the first portion 15 of the tip member 11. The six suction holes 13 are respectively connected to six tip openings 13Aa formed in the tip surface 14 of the tip member 11. The base ends of the suction holes 13A are connected to the internal space 19 of the outer tube 10. The six tip openings 13Aa are evenly arranged along the circumferential direction C with respect to the longitudinal direction A. The tip openings 13Aa are formed in a circular shape when viewed from the longitudinal direction A. Note that the suction holes 13A are arranged symmetrically with respect to the central axis along the longitudinal direction A of the tip member 11, but they may also be arranged asymmetrically with respect to the central axis along the longitudinal direction A.

[0071] (Variation 2) Figure 11 is a diagram showing a suction hole 13B, which is a variation of the suction hole 13. The suction hole 13B is a side hole formed on the side of the first part 15 of the tip member 11. The suction hole 13B communicates with side openings 13Ba formed on the side of the tip member 11. The suction hole 13B communicates with the internal space 19 of the outer tube 10. The surgeon can suction liquid accumulated in the surgical field through the suction hole 13B formed on the side. Note that the tip member 11 may not have the suction hole 13 and may have only the suction hole 13B.

[0072] (Variation 3) Figure 12 shows a knife 3A, which is a variation of the knife 3. The knife 3A does not have a water supply channel WR and does not have a water supply function. Even if the knife 3A does not have a water supply function, hemostasis treatment and suction treatment can be performed appropriately. Because the knife 3A, connector 32, and operating wire 4 do not need to be provided with a water supply channel WR, the sheath diameter of the sheath 1 can be made thinner, and the suction efficiency of the suction channel SR can be improved.

[0073] (Variation 4) Figure 13 is a cross-sectional view of a treatment tool 100A, which is a variation of the treatment tool 100. The treatment tool 100A further includes a sharp member (rod) 6. The sharp member 6 is a rod-shaped member made of a resin material, a metal material, or the like. The sharp member 6 is inserted movably through the water supply flow path WR of the knife 3. The sharp member 6 is capable of freely protruding and retracting from the distal end opening 33a of the knife 3. A sharp portion 61 is formed at the tip of the sharp member 6. The surgeon can easily insert the knife 3 into the local injection site by puncturing the local injection site into the lesion with the sharp portion 61 of the sharp member 6. When the sharp member 6 is fully retracted, the tip of the sharp member 6 is located between the distal end and proximal end of the distal end member 11. Alternatively, when the sharp member 6 is retracted to its fullest extent, the tip of the sharp member 6 may be located between the base end of the tip member 11 and the base end opening 30b of the knife body 30. When the sharp member 6 is advanced, a stopper 6s provided on the sharp member 6 comes into contact with the tapered second duct 34, positioning the sharp member 6 at the most distal side A1. When the sharp member 6 is advanced to its fullest extent, the amount of protrusion of the sharp member 6 from the tip of the knife 3 may be shorter than the overall length of the suction tube 2. In this case, local injection and suction can be performed efficiently.

[0074] (Variation 5) FIG. 14 is a cross-sectional view of a channel 206A, which is a variation of the channel 206. The channel 206A has a tapered portion 206t formed in a tapered shape. The tapered portion 206t is formed at the distal end of the channel 206A, and the inner diameter narrows toward the distal end opening 206a. The tapered portion 206t is preferably provided within the sliding range of the suction tube 2. The length L3 of the tapered portion 206t in the longitudinal direction A is, for example, 10 mm to 15 mm. Since the gap between the distal end opening 206a of the channel 206A and the suction tube 2 is reduced, the suction efficiency of the channel 206A is improved. Note that a flap or the like may be provided on the endoscope 200 to fill the gap between the distal end opening 206a of the channel 206A and the suction tube 2.

[0075] Second Embodiment A treatment tool 100B according to a second embodiment of the present invention will be described with reference to Fig. 15 to Fig. 17. In the following description, components common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.

[0076] 15 is a perspective view of the distal end of the treatment tool 100B. The treatment tool (endoscopic treatment tool, high-frequency treatment tool) 100B includes a sheath 1B, a suction tube 2, a knife 3B, a control wire 4B, and a control section 5.

[0077] Fig. 16 is a cross-sectional view of the distal end portion of the treatment tool 100B when the distal end of the knife 3B is at the second position P2. Fig. 17 is a cross-sectional view of the distal end portion of the treatment tool 100B when the distal end of the knife 3B is at the first position P1. The sheath 1B has an outer tube 10B extending in the longitudinal direction A and a distal end member 11B provided at the distal end of the outer tube 10B. Note that the sheath 1B may be formed by integrally molding the outer tube 10B and the distal end member 11B.

[0078] The outer tube 10B is a long, flexible, and insulating tubular member made of, for example, resin. In this embodiment, the inner space 19 of the outer tube 10B is a space through which the knife 3B passes and also forms at least a part of the water supply flow path WR.

[0079] The outer tube 10B has an expanded diameter section 18 on the proximal end side A2, which is closer to the proximal end opening 22 of the suction tube 2. The expanded diameter section 18 is a section whose outer diameter increases from the distal end side A1 toward the proximal end side A2. The outer diameter of the outer tube 10B is larger on the proximal end side A2 than on the expanded diameter section 18. This allows the cross-sectional area of ​​the internal space 19 within the outer tube 10B to be increased, thereby improving the efficiency of water supply.

[0080] The tip member 11B is formed in the same shape as the tip member 11 of the first embodiment. A through hole 12B and a suction hole 13 are formed in the tip member 11B.

[0081] The through hole 12B is provided in the distal end member 11B and is a hole that penetrates the distal end member 11B in the longitudinal direction A. The distal end of the through hole 12B communicates with a first opening 12a and a water supply groove 12e formed in the distal end surface 14 of the distal end member 11B. The first opening 12a and the water supply groove 12e communicate with each other. Note that the first opening 12a and the water supply groove 12e do not necessarily have to communicate with each other. The base end of the through hole 12B communicates with the internal space 19 of the outer tube 10B.

[0082] In this embodiment, the through-hole 12B forms at least a part of the water supply flow path WR. The liquid passing through the through-hole 12B is discharged at least from the water supply groove 12e.

[0083] The knife (electrode) 3B has a knife body 30B, a flange 31B, and a connector 32B. The knife 3B is inserted through the through-hole 12B of the distal end member 11B of the sheath 1B along the longitudinal direction A, and can freely protrude and retract from the first opening 12a to the distal end side A1.

[0084] The knife body 30B is a round bar-shaped member made of metal. The outer diameter of the knife body 30B is smaller than the inner diameter of the through-hole 12B. The knife body 30B can move back and forth through the through-hole 12B and the first opening 12a in the longitudinal direction A. The knife body 30B cannot be inserted through the water supply groove 12e.

[0085] The flange (tip enlarged diameter portion) 31B is a disc-shaped conductive member provided at the tip of the knife body 30A. The flange 31B cannot be inserted through the through-hole 12B, the first opening 12a, and the water supply groove 12e.

[0086] The knife body 30B and the flange 31B do not have the first duct 33 extending along the longitudinal direction A.

[0087] Compared to the connector 32 of the first embodiment, the connector (coupling member) 32B further has a notch 32b on its outer circumferential surface that forms at least a part of the water supply flow path WR. When the knife 3B is disposed at the first position P1, the space formed by the notch 32b communicates with the through-hole 12B to form the water supply flow path WR.

[0088] The operation wire 4B is a wire that passes through the internal space (duct, lumen) 19 of the outer tube 10 of the sheath 1B. The operation wire 4B is, for example, a solid wire. The operation wire 4B does not have the third duct 43.

[0089] The liquid supply port 54 is connected to the base end of the internal space 19 of the outer tube 10 via a conduit formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (internal space 19, through hole 12B) and is discharged from the water supply groove 12e, as shown in Fig. 16. Even when the knife 3B is disposed in the first position P1, the water supply groove 12e is not blocked by the flange 31B, and the liquid supplied to the through hole 12B is discharged from the water supply groove 12e.

[0090] The treatment tool 100B according to this embodiment, like the treatment tool 100 of the first embodiment, has the advantage of being able to perform suction from the distal end of the sheath 1B without significantly reducing the suction performance of the endoscope 200. In other words, it is possible to achieve both the suction efficiency of the channel 206 of the endoscope 200 and the suction efficiency of the suction tube 2 of the treatment tool 100B. Therefore, the treatment tool 100B can also perform a suction treatment using the suction function of the endoscope 200 depending on the situation. Because the treatment tool 100B can perform a suction treatment and a hemostatic treatment, the surgeon can immediately identify the hemostatic point and perform hemostatic treatment after suctioning and recovering fluid accumulated at the surgical site.

[0091] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and modified examples can be configured by appropriately combining them.

[0092] Third Embodiment A treatment tool 100C according to a third embodiment of the present invention will be described with reference to Figures 18 and 19. In the following description, components common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.

[0093] Fig. 18 is a perspective view of the distal end of the treatment tool 100C. Fig. 19 is a cross-sectional view of the distal end of the treatment tool 100C. The treatment tool (endoscopic treatment tool, high-frequency treatment tool) 100C includes a sheath 1C, a knife 3, a manipulation wire 4, and a manipulation section 5.

[0094] The sheath 1C is a long tubular member extending in a longitudinal direction A along the longitudinal axis from the distal end 1a to the proximal end 1b. The sheath 1C is insertable into a channel 206 of the endoscope 200 and is movable forward and backward through the channel 206. The sheath 1C is a multi-lumen tube. The sheath 1C has a knife channel 12C through which a knife is inserted so as to be able to advance and retreat, and a suction channel 13C which forms at least a part of the suction channel SR.

[0095] The distal opening 13Ca of the suction pipeline 13C is located at the distal end of the sheath 1C. The proximal opening 22C of the suction pipeline 13C opens to the outside of the sheath 1C at a position between the distal and proximal ends of the sheath 1C. The proximal opening 22C of the suction pipeline 13C is formed by cutting out at least one lumen of the multi-lumen tube.

[0096] When the surgeon performs suction treatment or hemostasis treatment using the knife 3 or the like while observing the image captured by the imaging unit 203, the distal end opening 13Ca of the suction conduit 13C protrudes from the distal end opening 206a, and the protrusion length L1 of the tip of the knife 3 protruding from the distal end opening 206a of the channel 206 is 5 mm to 10 mm. At this time, the proximal end opening 22C of the suction conduit 13C is disposed inside the channel 206 in the bending portion 204 of the endoscope 200.

[0097] As in the first embodiment, a positioning member (tip member) 12d for positioning the knife 3 at the first position P1 and the second position P2 is provided at the tip of the knife channel 12C.

[0098] As in the first embodiment, the connector (connecting member) 32 connects the knife body 30 and the operating wire 4. When the knife 3 is advanced relative to the sheath 1C, the distal end of the connector 32 comes into contact with the positioning member 12d. This contact between the distal end of the connector 32 and the positioning member 12d positions the distal end of the knife 3 at a second position P2, which is the position furthest to the distal end side A1. When the knife 3 is retracted relative to the sheath 1C, the proximal end surface 31b of the flange 31 comes into contact with the positioning member 12d. This contact between the proximal end surface 31b of the flange 31 and the positioning member 12d positions the distal end of the knife 3 at a first position P1, which is the position furthest to the proximal end side A2.

[0099] The treatment tool 100C according to this embodiment, like the treatment tool 100 of the first embodiment, has the advantage of being able to perform suction from the distal end of the sheath 1C without significantly reducing the suction performance of the endoscope 200. In other words, it is possible to achieve both the suction efficiency of the channel 206 of the endoscope 200 and the suction efficiency of the suction conduit 13C of the treatment tool 100C. Therefore, the treatment tool 100C can also perform a suction treatment using the suction function of the endoscope 200 depending on the situation. Because the treatment tool 100C can perform a suction treatment and a hemostatic treatment, the surgeon can immediately identify the hemostatic point and perform hemostatic treatment after suctioning and recovering fluid accumulated at the surgical site.

[0100] Although the third embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and modifications can be configured by appropriately combining them.

[0101] The present invention can be applied to an endoscopic treatment tool having a hemostatic function.

[0102] 300 Endoscopic treatment system 200 Endoscope 206, 206A Channel 206a Distal opening 206b Base end opening (forceps port) 206t Tapered portion 209c Suction button 100, 100B, 100C Treatment tool (endoscopic treatment tool) 1, 1B, 1C Sheath 1a Distal portion 1b Base end portion 10, 10B Outer tube 11, 11B Distal member 12, 12B Through hole 12a First opening 12C Knife channel 13, 13A, 13B Suction hole 13a, 13Aa Distal opening (suction opening) 13Ba Side opening (suction opening) 13C Suction channel 13Ca Distal opening 14 Distal surface 15 First portion 16 Second portion 18 Enlarged diameter portion 19 DESCRIPTION OF SYMBOLS 2 Inner space (duct, lumen) 2 Suction tube (suction duct member) 21 Tip opening 22, 22C Base end opening 23 Inner space, suction duct 24 Second duct 3, 3A, 3B Knife (electrode) 30, 30A, 30B Knife body 31, 31B Flange (tip enlarged diameter portion) 32, 32B Connector (connecting member) 33 First duct 33a Tip opening 4, 4B Operation wire 43 Third duct 44 Coil shaft 5 Operation unit 51 Operation unit body 52 Slider 53 Power supply connector 54 Liquid supply port 6 Sharp member (rod) 61 Sharp portion SR Suction flow path WR Water supply flow path

Claims

1. An endoscopic treatment instrument comprising: a sheath having a longitudinal axis; an electrode at least a portion of which protrudes distally from the distal end of the sheath; and a tube supported on the distal end of the sheath and having a suction conduit passing through in the longitudinal direction of the longitudinal axis, wherein the distal opening of the suction conduit is located at the distal end of the sheath, and the proximal opening of the suction conduit opens to the outside of the sheath at a position between the distal and proximal ends of the sheath.

2. The endoscopic treatment instrument according to claim 1, wherein the tube covers at least a portion of the outer circumferential surface of the distal end of the sheath, and the suction channel is formed between the distal end of the sheath and the tube.

3. The endoscopic treatment tool according to claim 1, wherein the sheath includes an insulating tip member attached to the tip of the sheath, and the tip of the tube is fixed to the sheath by the tip member.

4. An endoscopic treatment tool according to claim 3, wherein the tip member has a suction hole extending along the longitudinal direction, and the suction hole communicates with the suction duct via the tip opening.

5. The endoscopic treatment tool according to claim 1, wherein the outer diameter of the sheath is smaller than the outer diameter of the tube and larger than the outer diameter of the electrode.

6. An endoscopic treatment instrument according to claim 3, wherein the tip member has a first portion protruding from the tip of the sheath and a second portion inserted into the sheath, and the tip of the tube is fixed to the first portion.

7. The endoscopic treatment tool according to claim 3, wherein the length from the tip to the base end of the distal end member is 10 mm to 20 mm.

8. An endoscopic treatment instrument according to claim 3, wherein the tip member has a first portion protruding from the tip of the sheath and a second portion inserted into the sheath, and the tip opening of the suction channel is formed in the first portion.

9. The endoscopic treatment tool according to claim 4, wherein the inner peripheral surface of the suction hole is located radially inward of the inner peripheral surface of the tube.

10. An endoscopic treatment instrument as described in claim 3, wherein the sheath contains a wire that can be freely advanced and retracted along the longitudinal direction, a connector that connects the base end of the electrode to the wire, the tip end of the electrode is flange-shaped, and the position of the base end opening of the tube is located further distal than the base end of the connector when the tip end of the electrode is abutted against the tip member.

11. A treatment system comprising: an endoscope having a suction channel; and a treatment tool arranged to be able to freely advance and retreat through said suction channel, wherein said treatment tool has a tube arranged to be able to freely extend and retract from the tip of said suction channel, said tube having a suction conduit, and a base end opening of said suction conduit being located within said suction channel.

12. The treatment system according to claim 11, wherein, when the distal opening of the suction conduit protrudes from the distal end of the endoscope, the proximal opening of the suction conduit is located within the suction channel in the curved portion of the endoscope.

13. The treatment system according to claim 11, wherein the length from the distal end to the proximal end of the tube is shorter than the length along the longitudinal axis of the bending portion of the endoscope.

14. The treatment system according to claim 11, wherein, when the distal opening of the suction conduit protrudes from the distal end of the endoscope, the proximal opening of the suction conduit and the suction channel are in communication at a position within the suction channel in the bending portion of the endoscope.

15. The treatment system according to claim 11, wherein the endoscope has a tapered portion at the distal end of the suction channel, the inner diameter of which narrows toward the distal end.

16. A method of stopping bleeding, comprising: a first step of aspirating blood through a suction channel of an endoscope; a second step of aspirating blood through a suction conduit of a high-frequency treatment instrument; and a third step of stopping bleeding by passing electricity through an electrode protruding from the high-frequency treatment instrument.

17. The method for stopping bleeding according to claim 16, wherein the second step includes contacting the tip of the suction line of the high-frequency treatment instrument with blood, and the third step includes contacting the electrode with blood.

18. The hemostasis method according to claim 16, wherein in the first step, the high-frequency treatment tool is placed in the suction channel of the endoscope.

19. The method for stopping bleeding according to claim 16, comprising performing the second step and the third step simultaneously.

20. A method for stopping bleeding as described in claim 16, wherein the high-frequency treatment instrument has a tube arranged so as to be freely protruded and retracted from the tip of the suction channel, the tube having a suction conduit, and the second step involves suction with the base end opening of the suction conduit positioned within the suction channel.

21. The hemostasis method according to claim 16, wherein in the second step, the proximal opening of the suction conduit is positioned within the suction channel in the curved portion of the endoscope.

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