The present invention relates to scissors for an endoscope for poking out of a distal end of an insertion part of an endoscope and performing treatment.
As a device for an endoscope (treatment tool), various devices are prepared. There are known, for example, forceps that grip and press or pick up tissue, and scissors that cut tissue. In addition, a monopolar electrode type electric knife, bipolar electrode type forceps, and the like are known as devices that cut tissue and fuse tissue to stop bleeding by causing a high-frequency current to flow.
For example, Patent Literature 1 describes a multifunction device for endoscopic surgery with forceps or a clamp that is also formed as a jaw part capable of grasping and holding tissue as a bipolar electrode, and incorporates a circular disc-like monopolar electrode in a solid jaw part.
Further, Patent Literature 2 describes bipolar forceps including, in one of a pair of jaw members facing each other, a monopolar extension part housing a monopolar element selectively extending.
Patent Literature 1: Japanese Translation of PCT International Application Publication No. 2009-533109 Patent Literature 2: Japanese Patent Laid-Open No. 2011-212449
In the conventional forceps for an endoscope described in each of Patent Literatures 1 and 2, the monopolar electrode is thus provided in the forceps, and therefore it is possible to cut tissue with the monopolar electrode while gripping the tissue, or stop bleeding.
However, in a case where tissue is cut extensively and quickly, it is necessary to pull out the conventional forceps for an endoscope having the monopolar electrode from a port of an endoscope, and replace the scissors for the endoscope. Further, in a case where a target site to be cut is fibrotic tissue of little moisture content, it is difficult to cut the target site with a high-frequency current from the monopolar electrode, and it is required for replacement of the scissors for an endoscope similarly, and therefore treatment requires labor and time.
An object of the present invention is to provide scissors for an endoscope enabling reduction in labor during treatment and reduction in time required for the treatment.
Scissors for an endoscope of the present invention include: a scissor mechanism part that includes a pair of scissor members connected to each other by a spindle, and cuts a target site by opening and closing of the pair of scissor members with the spindle as a fulcrum; and an electrode part on which a monopolar electrode is formed on a distal end part of one scissor member of the pair of scissor members.
According to the scissors for an endoscope of the present invention, an operator can quickly and extensively cut the target site by using the scissor mechanism part by the pair of scissor members, or can stop bleeding at the target site or cut the target site by using the monopolar electrode. Therefore, it is possible to perform various treatments without replacement of the scissors for an endoscope of the present invention.
The electrode part can be formed at such a position that a center line of the scissor mechanism part, which passes through the spindle, and a center line along a protruding direction of the monopolar electrode coincide with each other when the pair of scissor members are closed.
Even when an insertion part of the endoscope is rotated around the axis, and the scissors for an endoscope of the present invention is rotated around the axis, the monopolar electrode is formed at such a position that the center line of the scissor mechanism part and the center line along the protruding direction of the monopolar electrode coincide with each other. Therefore, it is possible to prevent the direction of the monopolar electrode toward the target site from being displaced from the target site, and therefore the treatment can be performed in a stable state.
The electrode part can include a base that has the same thickness as a thickness of the one scissor member, and can be provided on a thickness surface of the one scissor member.
The one scissor member and the monopolar electrode can be formed from a single metal plate by punching, and the one scissor member and the monopolar electrode can be cut out integrally. Therefore, the manufacturing is easy.
The electrode part can be formed such that the distal end part has a shorter width direction thickness direction orthogonal to a thickness direction protruding direction while maintaining a thickness.
The distal end part of the monopolar electrode can be formed into a sharp shape, and therefore arc discharge can be reliably dissipated toward the target site from the distal end part, and the target site can be treated.
The electrode part can include a base formed of a rod-like body, and a block part formed on a distal end of the base. The block part is provided on the base formed of the rod-like body, so that the block part can be a semispherical body, a cylindrical body, a polygonal columnar body, a body with an elliptical cross section, a conical body, or the like.
The block part can be formed in a polygonal columnar shape. The block part is formed in a polygonal columnar shape, so that a high-frequency current is more concentrated when the distal end is sharp, and the arc discharge is more likely to dissipate. Therefore, the block part is formed in the polygonal shape, so that the arc discharge can dissipate from a corner closest to the tissue.
The block part can be formed in an octagonal columnar shape. When the block part is octagonal columnar, it is easy to aim, and it is easier to dissipate a high-frequency current to a desired site.
Another scissor member of the pair of scissor members can be a cutter having a blade part, and the one scissor member of the pair of scissor members can be a die having a first surface receiving the target site, and a second surface facing a flank face of the cutter when the cutter moves in a cutting direction.
Scissors for an endoscope of the present invention can perform various treatments without replacement, and therefore it is possible to reduce labor during treatment and shorten time required for the treatment.
Scissors for an endoscope according to an embodiment of the present invention will be described with reference to the drawings.
In this specification, the description will be made while the scissors side is defined as the distal end side or the front side, and the wire side is defined as the proximal end side or the back side. In addition, the description will be made while the direction of pushing a wire to open the scissors is defined as the advancing direction, and the direction of pulling the wire to close the scissors is defined as the retreating direction.
Scissors 10 for an endoscope illustrated in
The scissors 10 for an endoscope includes a scissor mechanism part 20, a link mechanism part 30, and an electrode part 40. For example, the scissor mechanism part 20 according to this embodiment is formed such that the length from a proximal end part to a distal end part is about 6 mm. The scissor mechanism part 20 is formed so as to have a thickness of about 0.5 mm. The electrode part 40 is formed so as to have about 1.5 mm.
The scissor mechanism part 20 includes a pair of scissor members (one scissor member 22, the other scissor member 21), and a first spindle S1 (spindle) connecting the pair of scissor members 21 and 22 openably and closably, and is formed in an X-shape.
In the scissor member 21, a cut side 21p from a distal end part 21x to a central part 21y in which a through hole 21t is formed into which the first spindle S1 is inserted is formed in a substantially V-shape, and an operation side 21q from the central part 21y to a proximal end part 21z is formed so as to have a gradually narrowed width.
A through hole 21u for connecting the link mechanism part 30 and the scissor member 21 is formed in the proximal end part 21z of the scissor member 21.
An inner surface of the cut side 21p of the scissor member 21 has a blade surface whose thickness gradually decreases formed therein, so that the scissor member 21 functions as a cutter having a blade part 21b. In this embodiment, as illustrated in
In the one scissor members 22 illustrated in
A through hole 22u for connecting the link mechanism part 30 and the scissor member 22 is formed in the proximal end part 22z of the scissor member 22.
An inner surface of the cut side 22p of the scissor member 22 functions as a die having a first surface 22m that receives a target site, and a second surface 22n facing the flank face 21d (see
In this embodiment, the second surface 22n is a surface parallel to the cutting direction F1.
The scissor members 21 and 22 are formed to have the same length from the through holes 21t and 22t into which the first spindle S1 of the scissor members 21 and 22 is inserted to the through holes 21u and 22u into which a second spindle described below is inserted.
As illustrated in
The second spindle S21 integrally formed in a first end 31e of the link 31 is rotatably inserted into and fixed to the through hole 21u (see
The second spindle S22 integrally formed in a first end 32e of the link 32 is rotatably inserted into and fixed to the through hole 22u (see
A third spindle S3 is integrally formed with the link 31 in a second end 31o of the link 31. A through hole 32t into which the third spindle S3 is inserted is formed in a second end 32o of the link 32 in order to connect a wire (not illustrated) together in a state in which the second ends 31o and 32o are overlapped on each other.
Further, thin wall parts 31m and 32m are formed in the second ends 31o and 32o of the links 31 and 32, respectively, such that even when a connecting part for connecting the wire is disposed between the second ends 31o and 32o, the overlapped thickness of the links 31 and 32 is not changed.
The third spindle S3 is formed at such a length as to protrude from the link 32.
As illustrated in
As illustrated in
The electrode part 40 is formed on a discharge surface 40s where a part of a thickness surface 41s on the distal end part 42 side in the base 41 and a thickness surface 42s of the distal end part 42 are exposed from an insulating film. Accordingly, a surface of the scissors 10 for an endoscope other than the discharge surface 40s of the electrode part 40 is formed on an insulating surface 20s covered with the insulating film.
A use state of the thus configured scissors for an endoscope according to the embodiment of the present invention will be described with reference to the drawings.
As illustrated in
Thus, the operation sides 21q and 22q of the scissor members 21 and 22 connected to the first ends 31e and 32e of the links 31 and 32 by the second spindles S21 and S22 move in the closing direction with the first spindle S1 as a fulcrum. With the movement of the operation sides 21q and 22q in the closing direction, the sides of the cut sides 21p and 22p of the scissor members 21 and 22 move in the closing direction.
At this time, as illustrated in
The target site that comes into contact with the scissor member 21 having the blade part 21b may start being cut at that point. In addition, the target site that comes into contact with a right-angled shoulder 22o formed by the first surface 22m and the second surface 22n of the scissor member 22 may also start being cut.
However, in many cases, an interval between the distal end parts of the cut sides 21p and 22p in the scissor members 21 and 22 becomes narrower, so that even when a target site such as a viscoelastic wall part or a fibrous and hard wall part comes into contact with the scissor members 21 and 22, the target site may slide on the blade part 21b and the first surface 22m, and escape while shifting. Further, an interval between the proximal end parts of the cut sides 21p and 22p becomes narrower, so that the target site may escape while shifting.
As illustrated in
Therefore, when the target site C is sandwiched between the distal end sides of the cut sides 21p and 22p in the scissor members 21 and 22, the target site C can be cut on the distal end side. Further, even when the target site C escapes while shifting on the distal end side, the target site C can be moved to the central sides of the blade part 21b and the first surface 22m as the scissor members 21 and 22 close.
When the target site C is sandwiched between the proximal end sides of the cut sides 21p and 22p in the scissor members 21 and 22, the target site C can be cut on the proximal end side. Even when the target site C escapes while sliding on the proximal end, the target site C can be moved on the central sides of the blade part 21b and the first surface 22m as the scissor members 21 and 22 close.
As illustrated in
Accordingly, the scissor members 21 and 22 can cut from both the distal end and proximal end sides of the cut sides 21p and 22p, and therefore even a wall part has elasticity and is likely to slide due to a mucous membrane or the like, the target site C can be cut without allowing the target to escape.
The blade part 21b is formed up to the distal end part 21x (blade edge) of the scissor member 21, and is sharp. Therefore, even when the wall part is located at the distal end part 21x, the distal end part 21x can bite into the wall part to be contacted and press the wall part against the first surface 22m of the scissor member 22. Accordingly, the wall part can be placed between the scissor members 21 and 22 and be cut without allowing the wall part to escape.
Thus, the blade part 21b by the rake face 21c and the flank face 21d is formed, so that the scissor member 21 functions as a cutter, and the scissor member 22 functions as a die having the first surface 22m and the second surface 22n.
For example, when the scissors includes the blade parts that are made by cutters formed in both scissor members, biting to the target site is improved, and excellent sharpness is obtained. However, the thickness of the blade edge (blade width) is thin and linear, and therefore it is difficult to secure high strength.
However, in the scissors 10 for an endoscope according to this embodiment, while the scissor members in the scissor mechanism part 20 securely receive and hold a wall part of a target site by the first surface 22m of the scissor member 22 illustrated in
Accordingly, the scissors 10 for an endoscope according to this embodiment can be excellent in sharpness, and be resistant to chipping and cracking of the blade part.
When both the scissor members are cutters, a sharp blade part needs to be formed on both the scissor members, which takes time to process. However, in the scissors 10 for an endoscope according to this embodiment, the scissor member 22 is formed as a die, and therefore it is possible to shorten processing time compared to a case where the scissor member 22 is formed as a cutter.
When the scissor members 21 and 22 are open again, the wire (not illustrated) is pushed in the advancing direction F22 as illustrated in
When bleeding occurs due to incision in a tissue serving as a target site, hemostasis is required. An operator points the electrode part 40 toward a portion requiring the hemostasis while keeping the scissor mechanism part 20 illustrated in
Then, a control device (not illustrated) is operated, and a high-frequency current adjusted for the hemostasis is output to the electrode part 40. The high-frequency current flows as arc discharge from the discharge surface 40s (see
When the tissue is cut, the operator operates the control device, and a high-frequency current adjusted for the cutting is output to the electrode part 40. Similarly to the case of hemostasis, the high-frequency current flows as arc discharge from the discharge surface 40s of the electrode part 40 to the tissue at the treatment site, so that the target site is burned off and separated.
Thus, the operator can quickly and extensively cut the target site by using the scissor mechanism part 20 of the scissors 10 for an endoscope, or can stop bleeding at the target site or cut the target site by using the electrode part 40 of the monopolar electrode. In addition, even when the target site that is fibrotic tissue is not able to be incised by applying arc discharge from electrode part 40, the fibrotic tissue can be cut as it is by the scissor mechanism part 20 without replacement of the scissors 10 for an endoscope.
Accordingly, various treatments can be performed without replacement of the scissors 10 for an endoscope, and therefore the scissors 10 for an endoscope enables reduction in labor during treatment and reduction in time required for the treatment.
At this time, even in a case where the insertion part of the endoscope is rotated around the axis, and the scissors 10 for an endoscope is rotated around the axis, when the pair of scissor members 21 and 22 are closed as illustrated in
As illustrated in
The electrode part 40 is formed such that the distal end part 42 has a shorter width direction Fw orthogonal to the thickness direction Ft while maintaining the thickness. Therefore, it is possible to make it easier to dissipate the arc discharge from the discharge surface 40s (thickness surface 42s) of the distal end part 42 toward the target site, not from other portion of the electrode part 40, and it is possible to perform treatment on the target site.
When the distal end parts 21x and 22x of the scissor members 21 and 22 in the scissor mechanism part 20 are directed upward as illustrated in
Therefore, when the electrode part 40 is pushed into the target site and disconnected, the distal end parts 21x and 22x of the scissor members 21 and 22 function as a stopper by coming into contact with a peripheral part of the target site. Thus, the distal end part 22x of the scissor member 22 extends beyond the position of the electrode part 40, and the distal end part 21x of the scissor member 21 extends beyond the position of the electrode part 40, so that the distal end parts 21x and 22x extend in the both directions around the electrode part 40. Consequently, it is possible to prevent the electrode part 40 from entering too much. The electrode part 40 is prevented from penetrating deeply into the target site, and therefore it is less likely to cause perforation and safety can be improved.
In the scissor mechanism part 20, the scissor member 21 is formed as a cutter, and the scissor member 22 is formed as a die, so that when the scissor member 21 and the scissor member 22 are overlapped on each other, the tissue as the target site can be cut out by cutting, not shearing, and therefore it is possible to obtain excellent sharpness.
In this embodiment, the electrode part 40 is formed by providing the semi-circular distal end part 42 in the square rod-like base 41 with the thickness T of the scissor member 22. However, the electrode part can be provided with a conical part, a sphere part, a triangular pyramid part, a disk part, or a polygonal columnar block part at the distal end part of the rod-like member.
For example, an electrode part 40A illustrated in
As illustrated in
A high-frequency current is more concentrated when the distal end is sharp, and the arc discharge is more likely to dissipate. For example, in the case of a square columnar (rectangular parallelopiped or cubic) block part, the square columnar block part has four corners on a top surface, but in the case of the octagonal columnar block part 40X, the octagonal columnar block part has eight corners. Therefore, the octagonal columnar block part can locate the eight corners closest to the tissue, and the arc discharge can be likely to dissipate from any of the eight corners. Therefore, the octagonal columnar shape is easier to aim than the square columnar shape, and it is easier to dissipate a high-frequency current to a desired site.
However, when the polygonal shape has more corners than the octagonal columnar shape, the internal angle is larger than 135° of an octagon, and therefore the corners become obtuse, so that the arc discharge is unlikely to dissipate.
Therefore, it is desirable that the block part 40X of the distal end of the electrode part 40 is octagonal columnar.
Thus, the block parts 43b to 46b illustrated in
The scissor mechanism part 20 of this embodiment is composed of a combination of the scissor member 21 that functions as a cutter and the scissor member 22 that functions as a die. However, as illustrated in
The present invention is suitable for scissors for an endoscope for poking out of a distal end of an insertion part of an endoscope and performing treatment.
Number | Date | Country | Kind |
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2021-011581 | Jan 2021 | JP | national |
Number | Date | Country | |
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Parent | PCT/JP2022/002026 | Jan 2022 | US |
Child | 17992499 | US |