Patent Application
20210007788
The present invention relates to an end effector that enables grasping of tissue and plasma irradiation to tissue, and an endoscopic system comprising the end effector.
A low temperature plasma generation apparatus has been conventionally known (see, for example, Non Patent Literature 1). Aside from surface processing, low temperature plasma can obtain effects such as sterilization, blood coagulation (hemostasis) and wound healing in the medical field. In particular, application to hemostasis is expected because low temperature plasma can coagulate blood in a short time period without damaging tissue.
[NPL 1] Mynavi Corporation, “Tokodai nado, −90 ˜+150° C. de ondo wo seimitsu seigyo kanou na taikiatsu purazuma souchi wo kaihatsu (Tokyo Institute of Technology and others developed an atmospheric pressure plasma apparatus that can precisely control temperature between −90 and +150° C.)”, [online], [searched on Jan. 31, 2018], internet, <URL:https://news.mynavi.jp/article/20111026-a080/>
However, low temperature plasma was limited in terms of hemostasis effect against an exposed blood vessel or spurting bleeding.
The present invention was invented in view of the problem discussed above, wherein the purpose is to provide an improved end effector for hemostasis and an endoscopic system comprising the end effector.
In one aspect of the present invention, the end effector of the present invention comprises: a grasping member for grasping tissue; and a plasma generation mechanism that can generate plasma.
In one embodiment of the present invention, the end effector may further comprise a hinge part, wherein: the grasping member and the plasma generation mechanism may be connected to each other at the hinge part; and the grasping member may be configured to be able to rotate around the hinge part.
In one embodiment of the present invention, the end effector may further comprise a connection part that can connect with a pulling means that can pull the plasma generation mechanism, wherein activation of the pulling means that has been connected may achieve grasping of the tissue with the grasping member.
In one embodiment of the present invention, the connection part may be configured so that the puling means would be detachable.
In one embodiment of the present invention, the grasping member may be configured to be able to be electrically controlled.
In one embodiment of the present invention, the plasma generation mechanism may be configured so that the plasma can be irradiated to a position where the grasping member grasps the tissue.
In one embodiment of the present invention, the grasping member may comprise a plurality of grasping pieces.
In one embodiment of the present invention: the plasma generation configuration may have a housing shape having a hollow part; the housing may comprise a first electrode and a second electrode that is different from the first electrode; and the plasma generation mechanism may turn gas that passes through the hollow part into plasma by electric release between the first electrode and the second electrode.
In one aspect of the present invention, the endoscopic system of the present invention comprises the end effector of any one of claims 1 to 8.
In one embodiment of the present invention, the endoscopic system may further comprise: a gas supply source that can supply gas that is to be turned into plasma with the plasma generation mechanism, wherein the gas supply source can supply one or more types of gas; a power source that can switch among a plurality of modes; and a pulling means that can be connected to the connection part of the end effector.
In one embodiment of the present invention, the plurality of modes may include at least two of a low temperature plasma mode, an APC (argon plasma coagulation) mode and a high frequency coagulation mode.
In one embodiment of the present invention, the endoscopic system may further comprise a pulse gas system for enabling pulse-like supply of gas that is to be turned into plasma to the hollow part.
According to the present invention, it is possible to provide an improved end effector for hemostasis and an endoscopic system comprising the end effector.
Herein, the term “distal” refers to a portion that is farther away from a user (operator) and the term “proximal” refers to a portion that is closer to the user. Herein, “about” refers to the concept of being in the range of ±10% of the number that follows thereafter.
The embodiment of the present invention is explained below while referring to the drawings. Furthermore, the same reference number is used for the same component throughout herein.
The present invention is characterized by an end effector that enables grasping of tissue and plasma irradiation to tissue and an endoscopic system comprising the end effector and an operation part. Movement of an end effector (for example, grasping of tissue or plasma irradiation to tissue) can be controlled by the operation part.
A power source having one or more modes and a supply source for supplying a supply can be connected to the operation part as needed. In a preferable embodiment, the power source can have a plurality of modes. While these plurality of modes may typically include two or preferably three of a low temperature plasma mode, an APC (argon plasma coagulation) mode and a high frequency coagulation mode, the present invention is not limited thereto. One example of the supply source is a gas supply source for supplying gas that is to be turned into plasma. Gas is supplied from a gas supply source to an end effector through an operation part. The type of gas to be supplied can be differentiated in accordance with one or more mode of the power source. The gas supplied to the end effector will be turned into plasma in the end effector and will be irradiated to tissue. This leads to treatment (for example, hemostasis or sterilization) of the tissue. In a preferable embodiment, a gas supply source may comprise a pulse gas system for enabling pulse-like supply of gas. A pulse gas system can clarify a target for hemostasis by pulse-like firing of gas. Furthermore, treatment (for example, hemostasis or ligation) of tissue is carried out by the end effector grasping the tissue.
A preferable embodiment of the end effector and the endoscopic system of the present invention is explained below.
An endoscopic system 10 comprises an insertion part 11, an operation part 12 connected to a proximal end part of the insertion part 11 and a power source 13 and a gas supply source 14 connected to the operation part 12.
The gas supply source 14 is for supplying gas that is to be turned into plasma. The gas supply source 14 is interconnected with the operation part 12 as shown in
The gas storage part 14a is configured so as to enable storage of a plurality of types of gas and extraction of stored gas. The form of storage of a plurality of types of gas is arbitrary. For example, a plurality of types of gas may be stored by comprising a plurality of gas tanks that each can store one type of gas, each type of gas may be stored within each interior space of a housing that has a plurality of divided spaces inside, or a plurality of types of gas may be stored so as to enable extraction of each type of gas as needed in a state in which a plurality of types of gas are mixed. In addition, the gas stored in the gas storage part 14a is, for example, but not limited to, argon, carbon dioxide, oxygen, nitrogen, helium and air.
The pulse gas system 14b is for enabling pulse-like supply of gas that is to be turned into plasma which is supplied from the gas supply source 14 to the insertion part 11 through the operation part 12. The pulse gas system 14b is configured to be able to provide a high-speed air stream with a predetermined pressure to gas that is to be turned into plasma in a predetermined time interval, and thereby enables pulse-like gas supply to the insertion part 11 through the operation part 12. The pulse gas system 14b is configured so as to enable addition of a high-speed air stream to gas that is to be turned into plasma. The pressure, interval between additions and number of irradiations of the air stream that is to be added by the pulse gas system 14b can be appropriately adjusted in accordance with a condition required for treatment of tissue or the like. The pressure of the air stream is, for example, about 0.3 to about 0.9 MPa. In addition, the interval between additions is, for example, about 0.1 to about 5 seconds. Furthermore, the number of irradiations is, for example, about 5 to about 20 times. In one embodiment, a high-speed air stream may be added 5 times, 10 times, or times, under the condition of being a high-speed air stream with the pressure of 0.3 MPa with the interval of 0.1 second. In other embodiment, a high-speed air stream may be added 5 times, 10 times, or 20 times, under the condition of being a high-speed air stream with the pressure of 0.6 MPa with the interval of 0.1 second. In yet other embodiment, a high-speed air stream may be added 5 times, 10 times, or 20 times, under the condition of being a high-speed air stream with the pressure of 0.9 MPa with the interval of 0.1 second. However, the present invention is not limited thereto. As such, the technique of using gas that is to be turned into plasma in a form of a pulse to irradiate the plasma to a lesion enables the pulse-like plasma to treat the lesion while a high-speed air stream blows off obstructive blood, foreign objects and the like.
Thus, pulse-like gas irradiation contributes to improvement of visibility and high-speed hemostasis of a lesion.
While the number of the gas supply source 14 is one in the example shown in
Furthermore, a supply source (not shown) for supplying a supply other than gas may be further connected to the operation part 12. The supply supplied from the supply source (not shown) may be, for example, an illumination light that illuminates the periphery of a therapy site or an examination site, a laser light source for guiding an irradiation position of plasma irradiated from the end effector, or a cooling water that cleans a therapy site and cools the endoscope or the like.
The power source 13 is for supplying necessary power to the operation part 12 and eventually to a device incorporated in the insertion part 11. The power source 13 is configured be switchable among a plurality of modes. In the example shown in
The low temperature plasma mode 13a is a mode for carrying out plasma irradiation at a low temperature (for example, about −90 to about 160° C., more preferably, about to about 100° C.). The use of plasma at 40° C. to about 100° C. is preferable in terms of being able to dehydrate blood or the like with heat while reducing thermal damage in addition to the chemical blood coagulation effect. An end effector 100 can turn gas supplied from the gas supply source 14 into plasma at a low temperature and irradiate the plasma to a lesion at a low temperature as discussed below by switching the power source 13 to the low temperature plasma mode 13a. One example of the gas that is to be turned into plasma at a low temperature is as previously mentioned as an example of gas stored in the gas storage part 14a. The safety of low temperature plasma is high. In addition, high hemostasis effect is obtained for gushing bleeding. However, effect on hemostasis of spurting bleeding, exposed blood vessel, or the like is limited.
The APC mode 13b is a mode for realizing treatment of a lesion using APC. The power source 13 applies high frequency current to argon supplied from the gas supply source 14 by switching the power source 13 to the APC mode 13b. This enables treatment of the lesion using APC. APC achieves high hemostasis effect on gushing bleeding. This is because APC treats gushing bleeding by cauterizing a wide range with large surface area cauterized by plasma gas and not by carrying out a local cauterization with a small cauterization surface area. However, since APC does not have a grasping structure that can seal a bleeding part of a blood vessel with thermal denaturation, the hemostasis effect on spurting bleeding and an exposed blood vessel is low.
The high frequency coagulation mode 13c is a mode for realizing cauterization of a lesion using a high frequency current. A high frequency current can be applied to the end effector 100 to flow to a lesion and coagulate the lesion with heat caused by the high frequency current by switching the power source 13 to the high frequency coagulation mode 13c. The frequency of the high frequency applied in the high frequency coagulation mode 13c may be, for example, 10 kHz to 5 MHz, preferably, 10 kHz to 1 MHz, more preferably, 10 kHz to 500 kHz. High frequency coagulation achieves high hemostasis effect on various states of bleeding such as spurting bleeding. However, high frequency coagulation may cause damage to tissue.
The operation part 12 is for operating the insertion part 11 and a device incorporated in the insertion part 11. The operation part 12 is interconnected with the supply source 13 as shown in
The insertion part 11 is a portion inserted in a body. The insertion part 11 is configured to be controlled by the operation part 12 and to be able to bend to change the direction of the insertion part 11 in accordance with the input in the operation part 12. The insertion part 11 comprises the end effector 100 that can project from a distal end part 11′ of the insertion part 11. The size of the diameter of the insertion part 11 can be any size, preferably as small as possible so as to be movable inside a very small space (for example, inside intestines or inside digestive organs). For example, when an endoscope 10 is an endoscope for a large intestine, the size would be about 13 mm. However, the present invention is not limited thereto. In addition, the size of the diameter of the end effector can be any size, preferably as small as possible so as to be movable inside a very small space (for example, inside intestines or inside digestive organs). For example, when the end effector is provided in a forceps channel of an endoscope for large intestines, the size would be about 3 mm. However, the present invention is not limited thereto.
The insertion part 11 comprises a channel for forceps and the end effector 100 is configured to be capable of going through the channel for forceps in accordance with the circumstance and projecting from an open end part of the channel for forceps on the distal end part 11′ of the insertion part 11. For example, the end effector will project when applying therapy to a therapy site using the end effector, and the end effector will be stored in the insertion part 11 when moving the endoscope 10 itself or the like.
The device incorporated in the insertion part 11 may comprise, for example, an imaging unit (for example, a camera lens) and a device for illumination (for example, a light) in addition to the end effector 100. The device incorporated in the insertion part 11 may be one or more. Furthermore, a nozzle for releasing a supply from the supply source 13 may be provided in the insertion part 11.
The end effector 100 of the present invention comprises a grasping member 110 for grasping tissue and a plasma generation mechanism 120 that can generate plasma.
In the example shown in
In a preferable example shown in
The plasma generation mechanism 120 has a housing shape having a hollow part. The hollow part is defined between a release hole 130 on the distal end part of the plasma generation mechanism 120 and an inflow hole 140 on a proximal end part of the plasma generation mechanism 120. Gas supplied from the gas supply source 14 enters into the hollow part from the inflow hole 140 and passes through the hollow part to be released from the release hole 130. Since there may be a case in which high frequency is generated when the housing or the grasping member touches plasma, it is preferable that a portion where high frequency flow is not intended is insulative (for example, said portion may be configured with an insulative member, or may be coated with an insulative member such as resin or ceramic).
The plasma generation mechanism 120 comprises a first electrode 150a and a second electrode 150b as means for generating plasma. The first electrode 150a and the second electrode 150b are disposed, for example, along the interior wall of the hollow part so as not to interfere with the flow of gas. In the example shown in
When voltage is applied between the first electrode 150a and the second electrode 150b by a power source (not shown), electric discharge is generated between the first electrode 150a and the second electrode 150b. Therefore, gas that entered inside through the inflow hole 140 passes through the hollow part of the end effector 100 to be turned into plasma between the first electrode 150a and the second electrode 150b by the electric release between the first electrode 150a and the second electrode 150b to be released from the release hole 130. This causes the plasma to be ejected from the release hole 130, and irradiation of the plasma to an irradiation target (for example, bleeding site) causes blood coagulation and sterilization effect. The flow rate of the plasma generated by electric release between the first electrode 150a and the second electrode 150b is about over 0 to about 15 L/min, more preferably about over 0 to about 3 L/min. A low dose such as about over 0 to about 3 L/min may be preferable in terms of reducing generation of submucosal emphysema. Furthermore, the inflow hole 140 and the release hole 130 will have any shape as long as plasma can pass through. For example, the shape of the inflow hole 140 and the release hole 130 may be a circle, may be a square, or may be a polygon. The first electrode 150a and the second electrode 150b may be used in combination in the low temperature plasma mode, the APC mode and the high frequency coagulation mode, or different electrodes may be used for each mode.
While
The end effector 100 further comprises a hinge part 160. In the example shown in
The endoscopic system 10 further comprises a pulling means 170 that can pull the plasma generation mechanism 120, wherein the pulling means 170 and the end effector 100 are configured to be able to be connected to each other. In other words, the end effector 100 plays a role of a connection part to connect with the pulling means 170.
Furthermore, the end effector 100 is configured to be detachable from the pulling means 170. In the preferable example shown in
The pulling means 170 is configured to pull in the end effector 100 towards the direction of being pulled inside the insertion part 11 with a force equal to or stronger than the fitting strength of the convex part of the pulling means 170 and the concave part of the end effector 100 so that the fitting of the convex part of the pulling means 170 and the concave part of the end effector 100 would come undone to enable removal from the end effector 100.
In the preferable example shown in
The insertion part 11 is configured to pull in the insertion part towards the direction of being pulled inside the insertion part 11 with a force equal to or stronger than the fitting strength of the convex part of the distal end part 11′ of the insertion part and the concave part 181 of lock mechanism 180 so that the fitting of the convex part and the concave part would come undone to enable the insertion part 11 to be removed from the lock mechanism 180.
The lock mechanism 180 is configured to be able to maintain a closed state of the grasping member 110. In the example shown in
The grasping member 110 is in an open state as shown in
The present embodiment explained a case in which the grasping member 110 is released in a normal state due to a spring or the like and the movement of the pulling means closes the grasping member 110. However, the present invention is not limited thereto. For example, the grasping member 110 may be closed in a normal state due to the force of a compression spring or the like, and the grasping member 110 may be opened by the movement of the pulling means.
Since hemostasis processing using plasma can be carried out while directly grasping a blood vessel, a mucous membrane, or the like with the grasping member 110, hemostasis can also be effectively performed to spurting bleeding or an exposed blood vessel, on which conventional plasma had a limited hemostasis effect. In addition, since a blood vessel or the like is directly grasped by the grasping member 110, it is possible to carry out safe hemostasis with little tissue damage. Furthermore, the end effector 100 can be handled in the same manner as a hemostasis clip by having the end effector 100 comprising the grasping member 110 be detachable with respect to the pulling means 170, which enables a certain hemostasis effect to be obtained for a long time. It may be preferable to use the APC mode 13B or the high frequency coagulation mode 13C especially when carrying out hemostasis of a treatment part with high blood pressure using plasma while grasping using the grasping member 110 in such a manner.
As shown in
The Example shown in
In addition, the Example shown in
In addition, in the example shown in
In addition, in the example shown in
As such, according to the endoscopic system 10 of the present invention, plasma irradiation to tissue, grasping of tissue with the grasping member 110, switching among the low temperature plasma mode, the APC mode and the high frequency coagulation mode and pulse-like gas irradiation can all be practiced with one end effector of the present invention. Conventionally, it was necessary to replace the hemostasis tool (for example, grasping member, APC apparatus, high frequency coagulation apparatus and low temperature plasma apparatus) which is to be inserted in the insertion part of the endoscope each time in accordance with the situation of the bleeding, which thereby caused a therapy to take a long time and caused large burden to a patient.
Meanwhile, according to the endoscopic system 10 comprised by the end effector 100 of the present invention, various hemostasis methods can be selected or combined for therapy by switching the mode or the like in accordance with the situation without going through the trouble of replacing the hemostasis tool, which is thereby significant in terms of being able to accurately perform therapy in a secure/safe and prompt manner.
For example, for gushing bleeding that was unable to be treated with conventional low temperature plasma, the combination of the low temperature plasma and the pulse-like gas irradiation or the grasping member enables hemostasis of the gushing bleeding in high speed and without damaging tissue. In addition, for spurting bleeding that was unable to be treated with conventional low temperature plasma, the combination of the grasping of tissue with the grasping member 110 and the APC or the high frequency coagulation enables hemostasis of the spurting bleeding. Furthermore, hemostasis of an exposed blood vessel can be carried out by utilizing high frequency coagulation.
In addition, it can be considered that the endoscopic system 10 of the present invention which can handle the low temperature plasma and the grasping member 110 is significant in that irradiation of low temperature plasma and grasping of tissue with the grasping member both have high safety.
Although the present invention has been exemplified using a preferable embodiment of the present invention as described above, the interpretation of the present invention should not be limited to this embodiment. It is understood that the scope of the present invention should be interpreted by the Claims alone. It is understood that those skilled in the art can practice an equivalent scope based on the description of the present invention and common general knowledge from the description of the specific and preferable embodiment of the present application.
The present invention is useful as an invention providing an improved end effector for hemostasis, an endoscopic system comprising the end effector and the like.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2018-057947 | Mar 2018 | JP | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/JP2019/012448 | 3/25/2019 | WO | 00 |
