Overtube and natural opening medical procedures using the same

Abstract

An overtube according to the present invention has an insertion portion having a distal end portion and a proximal end portion, at least the distal end portion being inserted into an examination subject; a first lumen formed in the insertion portion and in which a device for carrying out medical procedures in the examination subject is freely inserted and removed; a tissue cutting portion that is to be disposed at the distal end portion of the insertion portion traversing the first lumen and that cuts the tissue of the examination subject; and a holding portion that holds the tissue cutting portion at a position removed from a position traversing the first lumen.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic diagram showing the entire overtube according to a first embodiment.

FIG. 2 is a drawing showing the essential components of the overtube according to a first embodiment.

FIG. 3 is a perspective view showing the distal end portion of the overtube according to a first embodiment.

FIG. 4A is a cross-sectional view along III-III in FIG. 3.

FIG. 4B is a cross-sectional view along IV-IV in FIG. 3.

FIG. 5 is an enlarged partial cross-sectional view showing the electrode controlling portion of the overtube according to a first embodiment.

FIG. 6A is an overall view showing the double T bar used in the present embodiment.

FIG. 6B is a cross-sectional view showing the state in which the double T bar is mounted on a puncture needle of the overtube according to a first embodiment.

FIG. 7 is a partial cross-sectional view showing the needle control portion of the overtube according to a first embodiment.

FIG. 8 is a cross-sectional view in the vicinity of the endoscope lock button of the overtube according to a first embodiment.

FIG. 9 is an overall schematic drawing of the endoscope showing an example of the device used in the overtube according to a first embodiment.

FIG. 10 is a flowchart of a medical procedure according to a first embodiment.

FIG. 11 is a drawing for explaining the state in which the endoscope has been inserted into the overtube in a medical procedure according to a first embodiment.

FIG. 12 is a drawing for explaining the state in which the overtube is introduced to the targeted incision cite in the medical procedure according to a first embodiment.

FIG. 13 is a drawing for explaining the state in which a portion of the stomach wall is sucked into the overtube in a medical procedure according to a first embodiment.

FIG. 14 is a drawing for explaining the state in which the abdomen has been insufflated by supplying air from an injection needle in a medical procedure according to a first embodiment.

FIG. 15 is a drawing for explaining the state in which the sucked stomach wall has been punctured by a puncture needle of the overtube in a medical procedure according to a first embodiment.

FIG. 16 is a drawing for explaining the state in which the anchors of the double T bar have been ejected from the puncture needles in a medical procedure according to a first embodiment.

FIG. 17 is a drawing for explaining the state in which the sucked stomach wall has been cut by the cutting electrode of the overtube in a medical procedure according to a first embodiment.

FIG. 18 is a view of FIG. 17 after being rotated 90°.

FIG. 19 is a drawing for explaining the state in which the endoscope has been inserted into the abdominal cavity.

FIG. 20 is a drawing for explaining the state in which the thread of the retained double T bar has been pulled and bound in a medical procedure according to a first embodiment.

FIG. 21 is a fontal view of the distal end portion showing a modified example.

FIG. 22 is a cross-sectional view along line V-V in FIG. 21.

FIG. 23 is a drawing for explaining another method in which the cutting electrode is exposed during cutting, and is a cross-sectional view through a plane that crosses the axial line of the distal end portion.

FIG. 24 is a drawing in which the electrode tube has been detached and the electric controlling wires have been exposed.

FIG. 25 is a drawing in which the electrode controlling wires and the electrode tube have been moved relative to each other.

FIG. 26 is a drawing in which one electrode controlling wire has been pulled by the action of FIG. 25.

FIG. 27 is a drawing in which the cutting electrode is drawn into the electrode tube.

FIG. 28 is a drawing showing the essential components of the overtube according to a second embodiment.

FIG. 29 is a cross-sectional view along A-A in FIG. 28.

FIG. 30 is a flowchart of a medical procedure according to a second embodiment.

FIG. 31A is a drawing for explaining the state in which the endoscope insertion portion projects from the overtube in a medical procedure.

FIG. 31B is a drawing for explaining the state in which the overtube has been moved from the state shown in FIG. 31A into the abdominal cavity by using a second magnet of the overtube while the endoscope insertion portion serves as a guide.

FIG. 32A is a drawing for explaining the state in which both the endoscope insertion portion and the overtube project from the opening in a medical procedure.

FIG. 32B is a drawing for explaining the state in which the endoscope insertion portion and the overtube have been moved from the state shown in FIG. 32A into the abdominal cavity by using a second magnet of the overtube.

FIG. 33 is a drawing for explaining the state in which the overtube is supported in the abdominal cavity by using the first magnet of the overtube in a medical procedure according to a second embodiment.

FIG. 34 is a drawing for explaining the state in which the overtube has been rotated in the abdominal cavity by using a first magnet and a third magnet of the overtube in a medical procedure according to a second embodiment.

FIG. 35 is a perspective view in which a scale and a scale detecting member have been provided on the proximal handle.

FIG. 36 is a drawing for explaining the operation of the scale detecting member.

FIG. 37 is a drawing showing a structure in which an impedance measuring device is provided and the timing at which the cutting of the tissue has completed can be detected.

FIG. 38 is a drawing of another embodiment of the holding portion, and is a cross-sectional view showing the holding portion that extends from the distal end side.

FIG. 39 is a drawing showing another embodiment of the holding portion, and is a cross-sectional view showing the holding portion that extends from the proximal end side.

Claims

1. An overtube comprising: an insertion portion that has a distal end portion and a proximal end portion, at least the distal end portion being inserted into an examination subject;a first lumen that is formed in the insertion portion and into which a device for carrying out medical procedures in the examination subject is freely inserted and removed;a tissue cutting portion that is to be disposed in the distal end portion of the insertion portion so as to traverse the first lumen and that cuts the tissue of the examination subject; anda holding portion that holds the tissue cutting portion at a position that is removed from a position traversing the first lumen.

2. The overtube according to claim 1, wherein the holding portion includes puncture needles that are disposed so as to be freely advanced and retracted in the insertion portion and that are to puncture the tissue.

3. The overtube according to claim 2, wherein the distal end portion of the insertion portion has a groove provided therein, and the tissue cutting portion is engaged so as to be retained in the groove by the puncture needle that traverses the groove.

4. The overtube according to claim 3, wherein the puncture needles are structured to accommodate anchors that are to be retained in the tissue.

5. The overtube according to claim 1, further comprising an expanded portion, wherein the expanded portion has a groove that is provided in the distal end portion of the insertion portion, and the holding portion is formed by extending an inner peripheral side of the distal end portion of the insertion portion so as to cover a portion of the groove of the expanded portion.

6. The overtube according to claim 1, wherein the holding portion includes a tube that extends from one end side and the other end side of the tissue cutting portion and that passes through an operating member that extends toward the proximal end portion of the insertion portion by passing through the insertion portion.

7. A medical procedure in a natural opening, comprising: inserting an insertion portion of an overtube in which a lumen is formed that allows passage of a device into the insertion portion that has a distal end and a proximal end into an examination subject through a natural opening of the examination subject;moving a tissue cutting portion disposed in a distal end portion of the insertion portion from a first position removed from the position traversing the lumen to a second position traversing the lumen; andforming an opening by cutting tissue using the tissue cutting portion disposed at the second position traversing the lumen.

8. The medical procedure in a natural opening according to claim 7, wherein inserting the insertion portion into the examination subject includes inserting a device insertion portion into the lumen of the overtube, advancing a distal end of the device insertion portion relative to a distal end of the overtube, and inserting the insertion portion into the examination subject by using the device insertion portion as a guide.

9. The medical procedure in a natural opening according to claim 8, wherein the distal end of the device insertion portion is returned inside the lumen of the overtube before the tissue cutting portion is disposed in advance at the second position traversing the lumen.

10. The medical procedure in a natural opening according to claim 7, wherein moving the tissue cutting portion disposed at the removed first position to the second position traversing the lumen includes retracting in a direction of the proximal end of the insertion portion the puncture needle disposed at an inner surface side of the overtube defined by the lumen, and releasing the engagement of the tissue cutting portion disposed at the first position by the retraction of the puncture needle.

11. The medical procedure in a natural opening according to claim 7, wherein moving the tissue cutting portion disposed at the removed first position to the second position traversing the lumen includes disposing the tissue cutting portion accommodated in a tube to the second position traversing the lumen by advancing a controlling member with respect to the tube, the tissue cutting portion having been accommodated in the tube by advancing and retracting the controlling member that extends from one end and the other end of the tissue cutting portion and that passes through the tube passing through the insertion portion.

12. The medical procedure in a natural opening according to claim 8, wherein after the tissue cutting portion disposed in the removed first position is disposed at the second position traversing the lumen, the tissue is punctured by advancing the puncture needles in an insertion direction of the insertion portion, and the sutures are made to pass through the tissue.

13. The medical procedure for a natural opening according to claim 9, wherein forming the opening includes forming the opening in the tissue that has been sucked by using the lumen while the distal end of the overtube abuts the tissue.

14. The medical procedure in a natural opening according to claim 9, further comprising: pulling the tissue cutting portion out of the overtube after forming the opening in the tissue by the tissue cutting portion.

15. An overtube comprising: an insertion portion having a distal end portion and a proximal end portion and at least the distal end portion thereof is inserted into an examination subject;a pair of lumen tubes formed in the insertion portion, each of the pair of lumen tubes having a distal end opening and a proximal end opening formed therein, and disposed such that the distal end opening is separated at the distal end portion of the insertion portion;an activation part disposed between the respective distal end openings of the pair of lumen tubes so as to be usable;a device that extends from both ends of the activation part and has an operation part that passes through the pair of lumen tubes so as to freely advance and retract; anda fastening member that releasably fastens proximal end portions of the pair of lumen tubes that are pulled from the proximal end portion of the insertion portion, and while the operation part is exposed by releasing one of the pair of lumen tubes, the released lumen tube can be moved relative to the operation part.