1. Field of the Invention
The present invention relates to a medical device.
2. Description of Related Art
In the related art, in order to accurately excise an excision target site in a widely-used surgical operation by which a lesion site on the mucous membrane of a hollow organ is excised, an operator confirms the lesion site from the inside of the hollow organ, forms a marking at an excising position, and incises the site at a marking position from an abdominal cavity side. Marking using an ink dot, marking by indwelling a clip, marking by cauterizing, and the like are known as methods of forming a marking on an excision target site from the inside of a hollow organ. For example, Japanese Unexamined Patent Application, First Publication No. 2009-153828 discloses a living body observation apparatus including means for forming a marking on a target using a dyeing colorant. Japanese Unexamined Patent Application, First Publication No. 2009-153828 discloses a technique in which a marking is formed by transmuting the surface of a target using heat or high-frequency waves instead of using a dyeing colorant.
According to a first aspect of the present invention, a medical device includes: an insertion portion that includes a distal end, a proximal end, and a longitudinal axis which connects the distal end and the proximal end together, and that is capable of being inserted into a body; a marking portion that is disposed at the distal end of the insertion portion and that is configured to form a marking on a biological tissue; an inner region that is disposed at the distal end of the insertion portion and that is surrounded by the marking portion in a surface perpendicular to the longitudinal axis; and a light-emitting portion that is disposed at the inner region and that is configured to emit light containing a wavelength capable of passing through the biological tissue.
According to a second aspect of the present invention, in the medical device according to the first aspect, the marking portion and the light-emitting portion may be capable of being coaxially positioned.
According to a third aspect of the present invention, in the medical device according to the first aspect, the marking portion may include an electrode capable of being energized with high-frequency current to cauterize the biological tissue.
A medical device 1 according to a first embodiment of the present invention will be described.
As illustrated in
As illustrated in
The distal configuration portion 3 is provided in a distal portion of the insertion portion 2. The distal configuration portion 3 includes a light-emitting portion 4 and a marking portion 5.
The light-emitting portion 4 is disposed at a distal end of the light guide 10. Light transmitted via the light guide 10 to the distal end of the light guide 10 is emitted from the light-emitting portion 4. The light-emitting portion 4 is disposed in a central portion of the insertion portion 2 in a cross-sectional surface perpendicular to a longitudinal axis of the insertion portion 2 that connects the distal end and the proximal end of the insertion portion 2 together.
As illustrated in
In the embodiment, a position of the light-emitting portion 4 and a position of the marking portion 5 have a fixed relationship with each other.
The wiring 7 is a conductor that electrically connects the annular electrode 6 with a connector 26 (to be described later).
The tubular portion 8 is a flexible cylindrical member connected to a proximal end of the distal configuration portion 3. In the embodiment, at least a distal portion of the tubular portion 8 is an elastic member having resilience such that the elastic member is maintained straight when external force is not applied thereto. The light guide 10 and the wiring 7 are inserted into the tubular portion 8. A proximal end of the tubular portion 8 is fixed to the body portion 20. In the embodiment, a stopper 9 that can be engaged with a forceps port provided at a proximal end of a treatment tool channel of a flexible endoscope is mounted on the tubular portion 8.
As illustrated in
The body portion 20 includes an exterior body 21 to which the proximal end of the tubular portion 8 is fixed, a light source unit 22 disposed inside the exterior body 21, and the connector 26 fixed to the exterior body 21.
The light source unit 22 includes a light emitter 23, a power supply unit 24, and a switch 25.
The positional relationship of the light emitter 23 relative to the light guide 10 is determined such that light is incident to the proximal end of the light guide 10. For example, a light-emitting diode, a laser diode, lamps such as an incandescent lamp, or the like may be appropriately selected and adopted as the light emitter 23. In the embodiment, a light-emitting diode having advantages in terms of the amount of light, heat generation, and power consumption is adopted as the light emitter 23. The wavelength of light emitted from the light emitter 23 is set such that the wavelength of light emitted from the light-emitting portion 4 is from 600 nm to 800 nm. Accordingly, the light emitted from the light-emitting portion 4 becomes a visible light beam suitably passing through a biological tissue. In the embodiment, light emitted from the light-emitting portion 4 preferably contains a small number of wavelength components having wavelengths greater than or equal to those in the infrared region. The reason for this is that in the embodiment, only visible light components of the light emitted from the light-emitting portion 4 are used, and wavelength components in the infrared region are deemed to adversely affect the biological tissue by heating the biological tissue. In the embodiment, light emitted from the light-emitting portion 4 preferably contain almost no wavelength components in the ultraviolet region. In the embodiment, the wavelength of light emitted from the light emitter 23 is set to be from 600 nm to 800 nm. Means for changing the length of the wavelength of the light is not provided on a path from the proximal end of the light guide 10 to the light-emitting portion 4. In the embodiment, output power of the light emitter 23 is less than or equal to 5 mW.
The power supply unit 24 is provided inside the exterior body 21 so as to supply the light emitter 23 with electric power required to emit light by the light emitter 23. In the embodiment, a battery B is provided at the power supply unit 24.
In order for an operator to manually turn on an off the supply of electric power from the power supply unit 24 to the light emitter 23, the switch 25 is provided in the exterior body 21 while being exposed from the external surface of the exterior body 21.
A plug cord connected to a well-known high-frequency power supply device can be attached to and detached from the connector 26.
Next, a method of using the medical device 1 according to the embodiment and an operation thereof will be described.
As an example of the usage of the medical device 1, an example of forming markings 201 and 202 on the stomach of a patient having a lesion 200 in the stomach so as to indicate the position of the lesion 200 in the stomach is illustrated.
As illustrated in
The insertion portion 2 of the medical device 1 is pushed toward a distal side through the treatment tool channel 102 such that a distal end of the insertion portion 2 of the medical device 1 protrudes from a distal end of the treatment tool channel 102. When the distal end of the insertion portion 2 of the medical device 1 protrudes from the distal end of the treatment tool channel 102, an image of the distal end of the insertion portion 2 is captured in an endoscopic image acquired by the flexible endoscope 100.
As illustrated in
When the distal end of the insertion portion 2 is brought into contact with the internal surface S2 of the stomach, the annular electrode 6 of the marking portion 5 is brought into contact with the internal surface S2 of the stomach.
The annular electrode 6 is energized with high-frequency current from the high-frequency power supply device via the connector 26 without changing the position of the annular electrode 6 in contact with the internal surface S2 of the stomach. As illustrated in
Subsequently, the operator turns on the switch 25 of the body portion 20 to allow the light emitter 23 to emit light in a state where the annular electrode 6 is in contact with the internal surface S2 of the stomach. As illustrated in
As illustrated in
As illustrated in
In the embodiment, the operator may form the marking 201 on the external surface S1 of the stomach prior to forming the marking 202 on the internal surface S2 of the stomach using the annular electrode 6. In this case, the position of the light acquired from the outside of the stomach in a laparascopic image is coincident with a predetermined forming position at which the marking 202 is formed on the internal surface S2 of the stomach by the medical device 1.
The operator forms the markings 201 on the external surface S1 of the stomach and the markings 202 on the internal surface S2 of the stomach at multiple locations around a circumference of the lesion 200 by the aforementioned same sequence. Thereafter, the operator excises the lesion 200 with reference to the positions of the markings 201 and 202 using a well-known technique.
The medical device 1 according to the embodiment is capable of consecutively or simultaneously performing both the transmission of the predetermined forming position of the marking 202 to the external surface S1 of the stomach, and the formation of a marking on the internal surface S2 of the stomach in a state where the annular electrode 6 of the marking portion 5 is in contact with the internal surface S2 of the stomach.
For this reason, the operator can accurately form markings on both the internal surface S2 and the external surface S1 of the stomach within a short period of time compared to a method in the related art.
Since the annular electrode 6 has an annular shape and the light-emitting portion 4 is disposed in the central portion of the annular electrode 6, even if light is dispersed by the stomach wall, light emitted from the light-emitting portion 4 and observed on the external surface S1 of the stomach is positioned at substantially the center of the annular electrode 6. For this reason, the operator observes the external surface S1 of the stomach and forms a marking at the position of light so that the position of the marking on the external surface S1 of the stomach is easily placed in a marking region formed in an annular shape on the internal surface S2 of the stomach.
In the embodiment, an example, in which the stomach has a lesion to be excised, is described; however, an organ having a lesion is not limited to the stomach. The medical device 1 according to the embodiment can be used in a case where markings are formed on a pair of opposite surfaces of a hollow tissue or other tissues into which an endoscope can be inserted.
The light guide 10 may be advanced and retracted relative to the annular electrode 6. For example, the light guide 10 may be configured such that the light guide 10 can be pulled into the tubular portion 8 when cauterizing is performed using the annular electrode 6. When the light guide 10 can be pulled into the tubular portion 8, thermal damage to the light guide 10 can be prevented.
The light-emitting portion 4 may be advanced and retracted relative to the annular electrode 6. For example, the light-emitting portion 4 may be configured such that the light-emitting portion 4 can pulled into the tubular portion 8 when cauterizing is performed using the annular electrode 6. When the light-emitting portion 4 can be pulled into the tubular portion 8, dirt generated during the cauterizing of a tissue is unlikely to get stuck to the light-emitting portion 4.
A second embodiment of the present invention will be described. In each embodiment to be described below, the same reference signs are assigned to elements having the same configurations as those of the medical device 1 described in the first embodiment, and duplicate description of the first embodiment will be omitted.
As illustrated in
The light emitter 23A is fixed to the distal configuration portion 3 such that light can be emitted from the light-emitting portion 4. A wiring 7A connected to the switch 25 and the power supply unit 24 is attached to the light emitter 23A. Accordingly, the light emitter 23A can be turned on and off by the operating of the switch 25.
Similar to the first embodiment, a position of the light-emitting portion 4 and a position of the marking portion 5 have a fixed relationship with each other in the medical device 1A according to the embodiment. The medical device 1A according to the embodiment achieves the same effects as in the first embodiment.
Part of light emitted from the light emitter 23 of the medical device 1 according to the first embodiment that uses the light guide 10 is attenuated until the emitted light reaches the light-emitting portion 4. In contrast, in the embodiment, since the light emitter 23A is provided in the distal portion of the insertion portion 2, the amount of light attenuation is small compared to when the light guide 10 is used. When the light emitter 23A is provided in the distal portion of the insertion portion 2, the total extension length of the wiring 7A for supplying electric power required to cause the light emitter 23A to emit light may be large compared to that in the first embodiment. However, when the attenuation of light energy induced by the light guide 10 is compared to an electric power loss induced by the wiring 7A, even if the occurrence of an electric energy loss is caused by the wiring 7A, an energy loss when the light emitter 23A is provided in the distal portion of the insertion portion 2 is small compared to that induced by the light guide 10.
Next, a modified example of the embodiment will be described.
In the modified example, a rod 27 having light transmittance is provided on a distal side of the light emitter 23A. For example, the rod 27 is made of glass, and has durability against heat generated when the annular electrode 6 is energized with high-frequency current. A distal end surface of the rod 27 is formed to have a proper shape, thereby allowing the controlling of the distribution of light emitted from a distal end of the rod 27.
Also, the same effects as in the embodiment are obtained in this configuration.
A medical device 1B according to a third embodiment of the present invention will be described.
As illustrated in
The plurality of bar-shaped electrodes 28 are disposed in the distal portion of the insertion portion 2 so as to surround the light-emitting portion 4. A distal end of each of the bar-shaped electrodes 28 is a portion that is brought into contact with a biological tissue when a marking is formed using the bar-shaped electrode 28. The shape of the distal end of each of the bar-shaped electrodes 28 is not limited to a specific shape. For example, the shape of the distal end of each of the bar-shaped electrodes 28 may be a curved surface or a flat surface perpendicular to a longitudinal axis of the bar-shaped electrode 28 such that the distal end of the bar-shaped electrode 28 does not pierce a biological tissue. The wiring 7 for electrically connecting the bar-shaped electrodes 28 to the connector 26 (refer to
The operating of the slider 30 of the body portion 20B causes the plurality of bar-shaped electrodes 28 to protrude from the distal end of the distal configuration portion 3B to the distal side, or causes the plurality of bar-shaped electrodes 28 to be accommodated in the distal configuration portion 3B such that a distal end surface of the distal configuration portion 3B is flush with the distal ends of the bar-shaped electrodes 28. In the embodiment, three bar-shaped electrodes 28 are provided in the distal end of the distal configuration portion 3B. The number of bar-shaped electrodes 28 may be one or two. In a case where three or more bar-shaped electrodes 28 surrounding the light-emitting portion 4 are provided in the distal configuration portion 3B, when markings are formed by the bar-shaped electrodes 28, the operator can easily recognize substantially the center of the markings as a marking position notified by the light-emitting portion 4 after the markings are formed. When four or more bar-shaped electrodes 28 are provided in the distal configuration portion 3B, for example, even if a marking formed by one of the bar-shaped electrodes 28 is unclear, the operator can easily recognize the position of substantially the center of markings.
In the embodiment, in the cross-sectional surface perpendicular to the longitudinal axis of the insertion portion 2, the light-emitting portion 4 is disposed in an inner region of an envelope of distal end portions of the plurality of bar-shaped electrodes 28 which are brought into contact with a biological tissue when markings are formed. That is, in the embodiment, a position of the light-emitting portion 4 and a position of the marking portion 5B have a fixed relationship with each other in the cross-sectional surface perpendicular to the longitudinal axis of the insertion portion 2, is fixed.
The configuration in which the plurality of bar-shaped electrodes 28 are used to form markings can allow an energy density when the plurality of bar-shaped electrodes 28 are energized with high-frequency current to be increased compared to the first embodiment in which the annular electrode 6 is used. For this reason, in the embodiment, the total amount of energy of high-frequency current required to form the markings can be reduced compared to the first embodiment.
As illustrated in
In the embodiment, the plurality of bar-shaped electrodes 28 are moved to the distal side, thereby allowing an increase in the distance between the light-emitting portion 4 and the distal ends of the bar-shaped electrodes 28 in contact with a tissue during formation of the markings 203. For this reason, even if the tissue generates heat when the bar-shaped electrodes 28 are energized with high-frequency current, the generated heat is unlikely to adversely affect the light guide 10 of the light-emitting portion 4.
Next, a medical device 1C according to a fourth embodiment of the present invention will be described.
As illustrated in
The movable electrode 31 of the distal configuration portion 3C has a wire shape. A proximal portion of the movable electrode 31 is electrically connected to the connector 26 of the body portion 20C, and is fixed to the slider 30C1. Accordingly, in the embodiment, high-frequency current supplied from the high-frequency power supply device can be transmitted to the movable electrode 31, and markings can be formed using a distal end of the movable electrode 31.
The movable fiber 32 of the distal configuration portion 3C has a structure in which the light guide 10 described in the first embodiment can be advanced and retracted in the longitudinal direction of the insertion portion 2. That is, a proximal end of the movable fiber 32 is disposed in the body portion 20C such that light from the light emitter 23 can be incident to the movable fiber 32. The movable fiber 32 can be advanced and retracted in the longitudinal direction of the insertion portion 2 by the slider 30C2 of the body portion 20C. In the embodiment, the movable fiber 32 and the light emitter may be configured such that the movable fiber 32 and the light emitter can be integrally moved in the body portion 20C.
The distal guide portion 33 is a hollow member which includes one distal opening into which the movable electrode 31 and the movable fiber 32 can be inserted, and the diameter of which is gradually reduced from the proximal side toward the distal side.
In the embodiment, when the movable fiber 32 is exposed from the distal opening of the distal guide portion 33, a tissue can be illuminated with light emitted from the light emitter 23. That is, when the movable fiber 32 is disposed at the distal opening, a distal end of the movable fiber 32 becomes a light-emitting portion 4C, and performs the same function as that of the light-emitting portion 4 described in the first embodiment when being positioned at the distal opening of the distal guide portion 33. When the movable electrode 31 is exposed from the distal opening of the distal guide portion 33, the distal end of the movable electrode 31 becomes a marking portion 5C, and performs the same function as that of the marking portion 5 described in the first embodiment when being positioned at the distal opening of the distal guide portion 33. That is, in the embodiment, the distal guide portion 33 guides each of the distal end of the movable electrode 31 and the distal end of the movable fiber 32 to the distal opening of the distal guide portion 33, and thus a position of the light-emitting portion 4C and a position of the marking portion 5C have a fixed relationship with each other when each of the light-emitting portion 4C and the marking portion 5C is used.
Also, the same effects as in the first embodiment are obtained in this configuration.
Next, a medical device 1D according to a fifth embodiment of the present invention will be described.
As illustrated in
The medical device 1D includes an insertion portion 2D, a body portion 20D, and the light guide 10.
The insertion portion 2D includes a distal configuration portion 3D and the tubular portion 8.
The distal configuration portion 3D is a portion to which the distal end of the light guide 10 is fixed. In the embodiment, similar to the first embodiment, the distal configuration portion 3D includes the light-emitting portion 4 configured to emit light from the distal end of the light guide 10. In the embodiment, the light-emitting portion 4 also serves as the marking portion 5 performing marking using light transmitted through the light guide 10.
In the embodiment, high-energy laser light is used as light for marking. That is, in the embodiment, unlike the first embodiment, a laser light source 35 is adopted as the light emitter 23 in the body portion 20D.
In the embodiment, the laser light source 35 has a power output to the extent that a biological tissue can be cauterized. For example, the laser light source 35 is a semiconductor laser device, and emits laser light having a wavelength in a range from 790 nm to 830 nm. For example, the laser light source 35 has the maximum power output of 60 W.
In the embodiment, the laser light source 35 can change a power output in at least two stages. That is, the laser light source 35 can switch between a state in which the laser light source 35 emits laser light at the same power output of light emitted from a light-emitting diode described in the first embodiment and a state in which the laser light source 35 emits laser light having a power output required to form markings. As an example, the laser light source 35 in the embodiment includes a low-output light source and a high-output light source. The low-output light source emits laser light which is unlikely to heat a biological tissue and is easily seen through the biological tissue. The high-output light source emits laser light which easily heats a biological tissue. An example of the low-output light source is a light source emitting red laser light containing a small number of infrared components. An example of the high-output light source is a light source emitting red laser light or laser light having a wavelength greater than or equal to that of near-infrared light.
In addition to the configuration described in the first embodiment, the body portion 20D further includes a switch 25D for changing the power output of laser light. For example, laser light having a relatively low power output for transmitting marking positions from the internal surface S2 of the stomach to the external surface S1 of the stomach and laser light having a relatively high power output for forming markings on the internal surface S2 of the stomach are switched to each other by the operator's operation of the switch 25D.
As necessary, the power supply unit 24 and the switch 25D may be disposed outside the exterior body 21, and the power supply unit 24 and the laser light source 35 may be connected to each other by a cable or the like.
Unlike the first embodiment, in the embodiment, the electrode and the wiring 7 are not required, and it is not necessary to connect the medical device to the high-frequency power supply device. Since the power output of laser light is variable, light for the notification of marking positions and light for the formation of markings can be generated by the same light source. For this reason, the device configuration of the medical device 1D according to the embodiment is simplified.
In the embodiment, the distal end of the light guide 10 is the light-emitting portion 4 and also serves as the marking portion 5, and thus, a positional relationship between the light-emitting portion 4 and the marking portion 5 is always fixed.
The laser light source 35 may be configured to emit pulsed laser light for the notification of marking positions from the internal surface S2 of the stomach to the external surface S1 of the stomach, and to continuously emit laser light for the formation of markings on the internal surface S2 of the stomach. Accordingly, energy absorbed by a tissue can be differentiated.
When laser light is emitted to notify marking positions from the internal surface S2 of the stomach to the external surface S1 of the stomach, an ND filter may be interposed on an optical path so that energy absorbed by the tissue is decreased. Instead of the ND filter, a filter configured to cut off infrared region light may be interposed on the optical path.
Next, a sixth embodiment of the present invention will be described.
The configuration of a medical device 1E according to the embodiment is different from the configurations in the aforementioned embodiments in that markings are formed using a heat generator which includes an electrical resistor and is energized to generate heat.
Specifically, the medical device 1E includes a heat generator 6E instead of the annular electrode 6 described in the first embodiment. The medical device 1E does not include the connector 26 described in the first embodiment. Instead of the switch 25 described in the first embodiment, the medical device 1E includes a triple-pole switch 25E connected to the light emitter 23, the power supply unit 24, and the wiring 7.
The triple-pole switch 25E is fixed to an exterior body 21E which is provided in a body portion 20E having the same exterior shape as that of the body portion 20 described in the first embodiment. The triple-pole switch 25E is disposed such that the heat generator 6E is energized when the triple-pole switch 25E is moved to a proximal side (hand side) of the body portion 20E, and the light emitter 23 is energized when the triple-pole switch 25E is moved to a distal side of the body portion 20E.
The configuration of the heat generator 6E is not limited to a specific configuration. For example, the heat generator 6E includes a high-resistance conductive member such as a nichrome wire, and an insulator that coats the conductive member. The conductive member is connected to the wiring 7.
The same effects as in the aforementioned embodiments are obtained in the medical device 1E according to this embodiment.
The medical device 1E according to the embodiment does not require the plug cord that connects the high-frequency power supply device and the medical device 1 together in the first embodiment. As a result, a treatment can be performed in a cordless manner.
The preferred embodiments of the present invention have been described; however, the present invention is not limited to these embodiments and the modified example. Additions, omissions, replacements, other modifications can be made to the configurations without departing from the spirit and scope of the present invention.
The present invention is not limited to the aforementioned description, and is only limited by the scope of the appended claims.
This application is a continuation application based on PCT Patent Application No. PCT/JP2014/077394, filed Oct. 15, 2014, whose priority is claimed on U.S. Provisional Patent Application No. 61/891,137, filed Oct. 15, 2013. The contents of both the PCT patent application and the US Provisional patent application are incorporated herein by reference.
Number | Date | Country | |
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61891137 | Oct 2013 | US |
Number | Date | Country | |
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Parent | PCT/JP2014/077394 | Oct 2014 | US |
Child | 15068045 | US |