Patent Application
20210259529
The present invention relates to a guide tube, a treatment system and a guide-tube attachment method, and particularly relates to a guide tube for a treatment tool used in combination with an endoscope.
In the related art, there is a known treatment-tool tube that is attached to the outside of an endoscope (for example, see Patent Literature 1).
An aspect of the present invention is a guide tube including an elongated sheath into which an elongated treatment tool is inserted so as to be movable in a longitudinal direction and that is arranged so as to be parallel to an endoscope, wherein: the sheath has a first end having a projection port from which the treatment tool projects and a second end having an insertion port into which the treatment tool is inserted and is divided, in the longitudinal direction, into a first region including the first end and having flexibility and a second region including the second end; the second region has a high-rigidity portion having higher rigidity than a rigidity of the first region; and a lengths of the first region is not greater than a length of the second region.
Another aspect of the present invention is a guide tube including an elongated sheath into which an elongated treatment tool is inserted in a longitudinal direction and that is arranged so as to be parallel to an endoscope, wherein: the sheath has a first end from which the treatment tool projects and a second end into which the treatment tool is inserted and is divided, in the longitudinal direction, into a first region including the first end and having flexibility and a second region including the second end; the second region has a high-rigidity portion having higher rigidity than a rigidity of the first region; and the high-rigidity portion includes a length adjusting mechanism.
Another aspect of the present invention is a treatment method using a guide tube including an elongated sheath into which an elongated treatment tool is inserted in a longitudinal direction and that is arranged so as to be parallel to an endoscope, the sheath being divided, in the longitudinal direction, into a first region including a first end from which the treatment tool projects and having flexibility, and a second region including a second end into which the treatment tool is inserted and having a high-rigidity portion having higher rigidity than a rigidity of the first region, the method including: inserting only the first region into a body cavity; and rotationally operating the treatment tool after the inserting.
A guide tube 1 and a treatment system 100 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in
The endoscope 10 is a flexible endoscope that is inserted into a body cavity such as the large intestine. The endoscope 10 includes an elongated insertion portion 11 and an operating portion 12 that is connected to the proximal end of the insertion portion 11. The insertion portion 11 has an elongated flexible portion 13 having flexibility and a bending portion 14 that is connected to the distal end of the flexible portion 13. A scopist A can control a bending operation of the bending portion 14 by operating the operating portion 12.
The treatment tools 20 each include: an elongated insertion portion 21 having flexibility; an end effector 22 that is connected to the distal end of the insertion portion 21; and a manipulating portion 23 that is connected to the proximal end of the insertion portion 21. The end effector 22 is a portion that applies treatment to biological tissue and is, for example, an electrode or forceps.
As shown in
The guide tube 1 includes: the two elongated, tubular sheaths 2 that are parallel to each other; a cap 3 that is fixed to distal ends 2a of the two sheaths 2; a fixing portion 4 that is attached to intermediate positions of the sheaths 2 in the longitudinal direction and that is for fixing the two sheaths 2 to the insertion portion 11; and cylindrical rigid holders 5 that are connected to proximal ends 2b of the respective sheaths 2. In addition, the guide tube 1 has two channels 1a that penetrate from a distal end surface of the cap 3 to proximal end surfaces of the holders 5 through the interiors of the respective sheaths 2 and into which the insertion portions 21 and the end effectors 22 of the treatment tools 20 are inserted. The inner diameter of each of the channels 1a is larger than the outer diameters of the insertion portion 21 and the end effector 22, and the insertion portion 21 can advance and retract in the longitudinal direction and can also rotate about the longitudinal axis in the channel 1a.
The cap 3 has three holes 3a, 3b, 3c that penetrate in a direction along the longitudinal axis of the sheath 2. One hole 3a is for the endoscope 10 and can be fitted with a distal end portion of the endoscope 10. The other two holes 3b, 3c respectively communicate with the interiors of the two sheaths 2 and constitute distal end portions of the channels 1a.
The distal end (first end) 2a of each of the sheaths 2 has a projection port 2c from which the treatment tool 20 projects, and the proximal end (second end) 2b of each of the sheaths 2 has an insertion port 2d into which the treatment tool 20 is inserted. The sheaths 2 are each divided into two regions 61, 62 in the longitudinal direction.
The first region 61 including the distal end 2a is a portion inserted into a body cavity when the guide tube 1 is used and has flexibility so as to be bendable along the shape of the body cavity. In a state in which the insertion portion 21 is disposed in the first region 61, the first region 61 can bend in accordance with a force received from the bending portion 14.
The second region 62 including the proximal end 2b is a portion disposed outside of the body when the guide tube 1 is used. The second region 62 is a high-rigidity portion having higher rigidity than the rigidity of the first region 61 and can maintain the shape thereof against a force received from the insertion portion 21 disposed in the second region 62. In other words, in the second region 62, bending and twisting of the insertion portion 21 are suppressed by the rigidity of the second region 62. By doing so, the advancing/retracting and rotating movements applied to the proximal end of the insertion portion 21 from the manipulating portion 23 are efficiently transmitted in the second region 62 toward the distal end of the insertion portion 21. The rigidity of the second region 62 is preferably higher than the rigidity of the insertion portion 21.
The length of the first region 61 is greater than the length from the distal end of the insertion portion 11 to the proximal end of the bending portion 14, and the first region 61 is parallel to the bending portion 14 over the entire length of the bending portion 14.
In addition, the lengths of the first region 61 and the second region 62 are determined on the basis of the total length of the sheath 2 and the length of the sheath 2 inserted into a body cavity (the length of the body cavity from an entrance of the body cavity to an affected site). In the case of the guide tube 1 for the large intestine, the total length of the sheath 2 from the distal end 2a to the proximal end 2b is 1200-1900 mm. In this case, in consideration of the general length of the sheath 2 inserted into the large intestine, the length of the second region 62 is preferably 20-30% of the total length of the sheath 2.
The fixing portion 4 is provided at a boundary 2e between the first region 61 and the second region 62 or in the vicinity of the boundary 2e. In other words, the first region 61 is a region closer to the distal end than the fixing portion 4 is, and the second region 62 is a region closer to the proximal end than the fixing portion 4 is. As described above, the length of the first region 61 is greater than the length from the distal end of the endoscope 10 to the proximal end of the bending portion 14, and thus, the fixing portion 4 is fixed to the insertion portion 11 at a position closer to the proximal end than the bending portion 14 is.
As shown in
The distal end of the holder 5 is directly connected to the proximal end 2b of the sheath 2, and the second region 62 is continuous with the holder 5. The inner diameter of the holder 5 is larger than the inner diameter of the second region 62, and an annular abutment surface against which the distal end of the shaft 23a abuts is formed at the distal end of the holder 5.
The sheaths 2 in
The sheath 2 in
The outer tube 74 preferably has higher rigidity than the rigidity of the inner tube 73. For example, the tube 74 is a heat-shrinkable tube. Alternatively, the tube 74 may be a rigid tube, for example, a metal tube. As shown in
Next, the operation of the thus-configured guide tube 1 and treatment system 100 will be described by illustrating the case in which an affected site in the large intestine is treated.
As shown in
The scopist A inserts the insertion portion 11, together with the two sheaths 2, into the large intestine of the patient P from the anus to the affected site. Because the lengths of the first regions 61 are designed to be the lengths of the sheaths 2 inserted to the affected site, the fixing portion 4 is disposed in the vicinity of the anus in a state in which the sheaths 2 are inserted to the affected site. In other words, the first regions 61 having low rigidity are disposed in the large intestine and the second regions 62 having high rigidity are disposed outside of the body.
Next, the operator B inserts the treatment tools 20 through the channels 1a from the proximal ends of the holders 5 to the affected site. Next, the operator B treats the affected site with the end effectors 22 while observing the affected site and the end effectors 22 with the endoscope 10.
Here, the operator B can change the orientation of the distal end of the insertion portion 11 with respect to the affected site by operating the operating portion 12 to bend the bending portion 14 in the large intestine.
In addition, the operator B can change the positions and orientations of the end effectors 22 in the large intestine by operating the manipulating portions 23. Specifically, the operator B can advance the end effectors 22 by advancing the manipulating portions 23 and can retract the end effectors 22 by retracting the manipulating portions 23. In addition, the operator B can rotate the end effectors 22 by rotating the manipulating portions 23 about the longitudinal axes.
As described above, with this embodiment, the first region 61 disposed in a body cavity has high flexibility. Therefore, the sheath 2 can be easily inserted into the body cavity along the curved shape of the body cavity. In addition, the first region 61 having high flexibility is disposed parallel to the bending portion 14 in the body cavity. Therefore, it is possible to bend the bending portion 14 together with the first region 61 and to realize good operability of the bending portion 14.
In addition, the second region 62 disposed outside of the body has higher rigidity than the first region 61. Therefore, the second region 62 is not bent or twisted due to the force received from the insertion portion 21 of the treatment tool 20, and bending and twisting of the insertion portion 21 in the second region 62 are suppressed by the rigidity of the second region 62. In other words, the advancing/retracting and rotating movements applied to the proximal end of the insertion portion 21 from the manipulating portion 23 are transmitted to the end effector 22 with high efficiency via the insertion portion 21. By doing so, it is possible to realize good operability of the treatment tool 20.
In this embodiment, the guide tube 1 may further include a length adjusting mechanism 8 for adjusting the length ratio between the first region 61 and the second region 62.
The tube 76, 77 is arranged coaxially with a flexible tube 75 and covers the tube 75 from the proximal end to an intermediate position in the longitudinal direction. The first region 61 is composed of the one tube 75 and the second region 62 is composed of the two tubes 75, 76 or 75, 77. The proximal end of the tube 76, 77 is fixed to the proximal end of the tube 75. As a result of extension and contraction of the tube 76, 77, the distal end of the tube 76, 77 moves in the longitudinal direction with respect to the tube 75, and thus, the length ratio between the first region 61 and the second region 62 changes.
The length of the sheath 2 inserted into a body cavity, that is, the optimum lengths of the first region 61 and the second region 62, differs according to the position of an affected site in the body cavity. With the guide tube 1 including the length adjusting mechanism 8, it is possible to easily adjust the length of the first region 61 to a length suitable for the length inserted into the body cavity. The adjustment of the length ratio between the first region 61 and the second region 62 is performed before or after the sheath 2 is inserted into the body cavity.
Although the rigidity of the second region 62 may be uniform over the entire length thereof in this embodiment, as shown in
There is a possibility that a distal end portion of the second region 62 is inserted into a body cavity depending on the situation. Therefore, for example, as shown in
In this embodiment, the boundary 2e between the first region 61 and the second region 62 is provided at such a position that the boundary 2e is disposed at an entrance (for example, the anus) of a body cavity of a patient P when the guide tube 1 is used, or is provided in the vicinity of said position. Alternatively, as shown in
With the guide tube 1 in
As shown in
Alternatively, as shown in
Although the guide tube 1 includes the cap 3 and the fixing portion 4 in this embodiment, alternatively, at least one of the cap 3 and the fixing portion 4 need not be provided.
For example, the insertion portion 11 of the endoscope 10 and the sheath 2 may be inserted into a body cavity in a state in which only the distal ends are fixed to each other by means of the cap 3. Alternatively, the insertion portion 11 of the endoscope 10 and the sheath 2 may be separately inserted into a body cavity, and the sheath 2 may be movable with respect to the insertion portion 11 in the body cavity.
The above-described embodiment also leads to the following aspects.
An aspect of the present invention is a guide tube including an elongated sheath into which an elongated treatment tool is inserted so as to be movable in a longitudinal direction and that is arranged so as to be parallel to an endoscope, wherein: the sheath has a first end having a projection port from which the treatment tool projects and a second end having an insertion port into which the treatment tool can be inserted and is divided, in the longitudinal direction, into a first region including the first end and having flexibility and a second region including the second end; and the second region has a high-rigidity portion having higher rigidity than a rigidity of the first region.
With this aspect, the sheath is inserted into a body cavity along with the endoscope from an entrance of the body cavity, and the distal end of the endoscope and the first end of the sheath are disposed in the vicinity of an affected site in the body cavity. Next, the treatment tool is inserted into the sheath from the insertion port at the second end disposed outside of the body, and a distal end portion of the treatment tool projects from the projection port at the first end. Next, treatment of the affected site is performed by the treatment tool while the affected site and the treatment tool are observed with the endoscope.
In this case, the first region that is a distal-end side portion of the sheath and that has flexibility is disposed parallel to a bending portion of the endoscope in the body cavity. Therefore, it is possible to bend the sheath together with the bending portion of the endoscope and to realize good operability of the bending portion of the endoscope.
In addition, the second region of the sheath, which is disposed closer to the proximal end than the first region is, is less likely to be deformed due to a force received from the treatment tool, and thus, an advancing/retracting or rotating movement applied to the proximal end of the treatment tool outside of the body is efficiently transmitted in the second region toward the distal end of the treatment tool. Therefore, it is possible to realize good operability of the treatment tool.
In the abovementioned aspect, a fixing portion that is attached to the sheath at a position between the first region and the second region may be provided, and the fixing portion may be fixed to the endoscope at a position closer to a proximal end than a bending portion of the endoscope is.
With this configuration, the sheath can be fixed to the endoscope by the fixing portion at such a position that bending of the bending portion and the first region is not hindered.
In the abovementioned aspect, a cylindrical holder that is connected to the second end and that has a larger inner diameter than an inner diameter of the sheath may be provided.
With this configuration, a manipulating portion of the treatment tool can be supported by the holder.
In the abovementioned aspect, the high-rigidity portion may be continuous with the holder.
With this configuration, the movement of the treatment tool in the holder is transmitted more efficiently to the distal-end side of the treatment tool. Therefore, it is possible to further enhance the operability of the treatment tool.
In the abovementioned aspect, a total length of the sheath from the first end to the second end may be 1200-1900 mm, and a length of the high-rigidity portion may be 20-30% of the total length of the sheath.
With this configuration, the respective lengths of the first region and the second region can be set to lengths suitable for practical use.
In the abovementioned aspect, the high-rigidity portion may include a first tube and a second tube that covers the first tube.
With this configuration, the high-rigidity portion is formed of a two-layer structure tube. Thus, it is possible to easily manufacture the high-rigidity portion.
In the abovementioned aspect, a rigidity of the second tube may be higher than a rigidity of the first tube.
With this configuration, it is possible to further increase the rigidity of the high-rigidity portion.
Another aspect of the present invention is a treatment system including: a guide tube described above; and an endoscope, wherein the second region of the sheath is movable with respect to the endoscope.
Another aspect of the present invention is a treatment system including: a guide tube described above; and a treatment tool having an insertion portion that can be inserted into the sheath of the guide tube, wherein a rigidity of the high-rigidity portion is higher than a rigidity of the insertion portion.
Another aspect of the present invention is a guide-tube attachment method for attaching a guide tube to an endoscope, wherein: the guide tube includes an elongated sheath into which an elongated treatment tool is inserted so as to be movable in a longitudinal direction and that is arranged so as to be parallel to the endoscope, the sheath has a first end having a projection port from which the treatment tool projects and a second end having an insertion port into which the treatment tool can be inserted and is divided, in the longitudinal direction, into a first region including the first end and having flexibility and a second region including the second end, and the second region has a high-rigidity portion having higher rigidity than a rigidity of the first region; and the method includes fixing a position between the first region and the second region of the sheath to the endoscope, at a position closer to a proximal end than a bending portion of the endoscope is and closer to a distal end than an operating portion of the endoscope is.
This is a continuation of International Application PCT/JP2018/043101 which is hereby incorporated by reference herein in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2018/043101 | Nov 2018 | US |
| Child | 17318385 | US |
