Patent Application
20220087513
This application claims priority under 35 U.S.C ยง 119(a) to Japanese Patent Application No. 2020-158526 filed on 23 Sep. 2020. The above application is hereby expressly incorporated by reference, in its entirety, into the present application.
The present invention relates to a treatment tool device for an endoscope and an endoscope system that are used by being inserted through a forceps channel of an endoscope.
In the medical field, an insertion part of an endoscope is inserted into the body of a subject to perform not only observation of an inside of the body but also various treatments on an observation site. Specifically, various treatment tools, such as forceps and an incision tool, are inserted through a forceps channel in the insertion part from a forceps port provided in an operation part of the endoscope, and are led out from a forceps outlet that is open at a distal end of the insertion part, whereby various treatments, such as resection and collection of the observation site, are performed.
JP4663345B (corresponding to US2009/105534A1) discloses a treatment tool for an endoscope comprising a flexible sheath, a treatment tool main body, and an attachment part for attaching the flexible sheath to an operation part of the endoscope. The flexible sheath is inserted into a body cavity through a forceps channel of the endoscope. The treatment tool main body is formed of a flexible operation wire, a treatment part provided at a distal end of the operation wire, and a hard pipe connected to a base end of the operation wire. The operation wire and the pipe are supported by the flexible sheath so as to advance and retreat. The treatment part is a snare wire that contracts in a case of being housed inside the flexible sheath and expands in a case of protruding from a distal end of the flexible sheath. Thus, an operation of expanding the treatment part by causing the treatment part to protrude from the distal end of the flexible sheath inserted into the body cavity can be performed near the operation part of the endoscope.
In the medical field, further preventive measures against infectious diseases are desired. Therefore, it is required to reduce the risk of infection by performing various treatments using an endoscope and a treatment tool with as few people as possible. In addition, due to problems such as a shortage of medical personnel and an increase in burden of medical expenses, it is desired to perform a treatment with a small number of people. In a case where there is an assistant who operates the treatment tool in addition to a doctor who operates the endoscope, there is a problem that the treatment cannot be performed smoothly unless the cooperation between the doctor and the assistant is good.
However, in the treatment tool for an endoscope disclosed in JP4663345B, in a case where the doctor operates the endoscope, an operation of the treatment tool for an endoscope that can be performed by the doctor is only an operation of advancing and retreating the treatment tool to and from the forceps channel. That is, operations other than the operation of advancing and retreating the treatment tool to and from the forceps channel, for example, an operation of expanding or contracting the treatment part or an operation of rotating the treatment tool around a central axis with respect to the forceps channel, require assistance from the assistant, and the doctor needs cooperation of the operations, such as issuing instructions to the assistant. Moreover, the number of people who perform a treatment cannot be reduced.
An object of the present invention is to provide a treatment tool device for an endoscope and an endoscope system capable of increasing the number of the types of treatment tool operations that can be performed by either a doctor who operates an endoscope or an assistant, to perform the treatment tool operations without the need for cooperation, and capable of reducing the number of people who perform the treatment in a case where the doctor is a main operator.
A treatment tool device for an endoscope according to an aspect of the present invention comprises a treatment tool main body and an oversheath. The treatment tool main body comprises a flexible sheath having a tubular shape and inserted into a forceps channel of an endoscope, an operation wire inserted through the flexible sheath, a hard part provided at a base end portion of the flexible sheath and harder than the flexible sheath, and an operation part continuously provided at the hard part. The oversheath is inserted into a forceps channel in a state where the flexible sheath and the hard part are inserted into the oversheath.
It is preferable that the oversheath has a fitting part that is fitted to the hard part, and that the treatment tool main body is slidable and rotatable with respect to the oversheath within a range in which the hard part and the fitting part are fitted to each other.
It is preferable that a length of the oversheath is shorter than a length of the flexible sheath. It is preferable that the oversheath is provided with a seal member filling a gap between the oversheath and the treatment tool main body at a base end portion. It is preferable that the seal member is an annular elastic member housed inside the oversheath.
It is preferable that in a case where a distal end of the operation part is made to abut on a base end of the oversheath, a length of the flexible sheath protruding from a distal end of the oversheath is 40 cm or more and 270 cm or less.
It is preferable that the oversheath is provided with an index indicating an insertion length of the oversheath inserted into the forceps channel. It is preferable that a mark is used as the index indicating the insertion length, and that a dimension from a distal end of the oversheath to the mark is 4 cm. Alternatively, it is preferable that gradations indicating a dimension from a distal end of the oversheath are used as the index indicating the insertion length.
It is preferable that the oversheath has an oversheath main body that is inserted into the forceps channel and a stopper provided on the oversheath main body to regulate insertion of the oversheath, and it is more preferable that a dimension from a distal end of the oversheath main body to the stopper is 4 cm.
An endoscope system according to an aspect of the present invention comprises an endoscope provided with a forceps channel and a forceps valve, and the treatment tool device for an endoscope.
An endoscope system according to an aspect of the present invention comprises an endoscope provided with a forceps channel, a forceps valve, and a suction channel connected to the forceps channel, and the treatment tool device for an endoscope, in which the treatment tool device for an endoscope is inserted into the forceps channel in a state where the oversheath does not reach a branch part between the forceps channel and the suction channel.
It is preferable that the endoscope is provided with an attaching/detaching member that makes the oversheath attachable and detachable. It is preferable that a first resistance force in a case where the oversheath is advanced and retreated to and from the forceps valve is greater than a second resistance force in a case where the treatment tool main body is advanced and retreated to and from the oversheath.
According to the aspects of the present invention, it is possible to increase the number of the types of treatment tool operations that can be performed by either a doctor who operates an endoscope or an assistant, to perform the treatment tool operations without the need for cooperation, and is possible to reduce the number of people who perform the treatment in a case where the doctor is a main operator.
As shown in
The universal cord 5 is connected to an external device such as the processor device 11 or the light source device 12 via a connector 5A. The processor device 11 is electrically connected to the display 13 and the UI 14. The UI 14 has a keyboard, a mouse, a touch pad, a microphone, and the like, and accepts an input operation of a doctor D who is a user.
As shown in
In a case where the insertion part 3 of the endoscope 2 is inserted from a mouth M of the patient P, a mouthpiece 15 for an endoscope is mounted on the mouth of the patient P. The mouthpiece 15 for an endoscope has a pipe line (not shown) through which the insertion part 3 is inserted. The mouthpiece 15 for an endoscope is mounted on the mouth M of the patient P by inserting a part of the mouthpiece into the mouth M of the patient P and holding the inserted portion by the patient P. Thus, the insertion part 3 can be introduced into the body through the pipe line.
A forceps channel 8 through which a treatment tool main body 21 and an oversheath 22, which will be described below, are inserted is disposed in the insertion part 3. One end of the forceps channel 8 is connected to a forceps outlet 7, and the other end thereof is connected to a forceps port 9 provided in the operation part 4. The forceps port 9 is provided with a forceps valve 16. The forceps channel 8 is also used as a route for feeding a cleaning liquid such as water from the forceps outlet 7 and a route for sucking a body fluid such as blood and contents such as body waste materials. A suction channel 17 branched from the forceps channel 8 is disposed in the operation part 4, and one end of the suction channel 17 is connected to the forceps channel 8 and the other end thereof is connected to an operation button 4A provided on the operation part 4.
The operation button 4A comprises a suction valve (not shown) provided inside. The suction valve is connected to the suction channel 17 in the operation part 4, and is connected to the external suction device 18 via a pipe line (not shown) disposed in the operation part 4, the universal cord 5, and the connector 5A. The suction device 18 is, for example, a suction pump that generates a negative pressure. By pressing a pressing portion of the operation button 4A, the suction channel 17 communicates with a pipe line of the suction device 18. As a result, a body fluid or the like can be sucked from the forceps outlet 7 of the insertion part 3 inserted into the subject. In addition, by releasing the pressing operation of the pressing portion, the communication between the suction channel 17 and the pipe line of the suction device 18 is interrupted, and the suction from the forceps outlet 7 can be stopped.
The high-frequency power supply 19 causes a high-frequency current to flow through a snare wire 25, which will be described below, of the treatment tool device 20 for an endoscope. As a result, the lesion portion can be resected.
As shown in
The hard part 26 is provided at a base end portion of the flexible sheath 23 and is formed of a material harder than that of the flexible sheath 23, for example, a hard resin. The hard part 26 is disposed coaxially with the flexible sheath 23, that is, on a central axis parallel to an insertion direction Z into the forceps channel 8. The hard part 26 is formed in a cylindrical shape and is fitted to fitting portions 31B and 32B to be described below.
The operation part 27 comprises an operation part main body 28 and a slider 29 supported by the operation part main body 28 to be slidable. As described above, the hard part 26 is provided at the base end portion of the flexible sheath 23, and the operation part main body 28 is continuously provided at a base end portion of the hard part 26.
The operation part main body 28 is provided with a finger hook portion 28A and a cylindrical portion 28B parallel to the insertion direction Z. The slider 29 is engaged with the cylindrical portion 28B and slides along the cylindrical portion 28B in an axial direction of the flexible sheath 23. In a case where the patient P is treated, a thumb of the user is hooked on the finger hook portion 28A, and an index finger and a middle finger of the same user are hooked on the slider 29. A base end of the operation wire 24 is fixed to the slider 29. Therefore, the operation wire 24 is pushed and pulled in the flexible sheath 23 in the axial direction with the sliding movement of the slider 29.
As shown in
As shown in
The oversheath main body 31 has a pipe line 31A and a fitting portion 31B. The flexible sheath 23 of the treatment tool main body 21 is inserted into the pipe line 31A. The fitting portion 31B communicates with the pipe line 31A and has an inner diameter larger than that of the pipe line 31A. The fitting portion 31B is fitted to the hard part 26 of the treatment tool main body 21 to be slidable and rotatable. In the oversheath 22, except for the seal member 33, the oversheath main body 31, the seal holding member 32, and the lid member 34, are formed of a soft material such as a soft resin.
The seal holding member 32 is fixed to a base end portion of the oversheath main body 31 in the insertion direction Z, and protrudes from an outer peripheral surface of the oversheath main body 31. The seal holding member 32 has a pair of recess portions 32A, the fitting portion 32B, an opening portion 32C, and an engaging projection portion 32D. The pair of recess portions 32A is a concave portion in an outer shape of the seal holding member 32, and is constricted in a direction orthogonal to the insertion direction Z. The recess portion 32A is engaged with an attaching/detaching member 40 to be described below. The fitting portion 32B communicates with the fitting portion 31B of the oversheath main body 31. The fitting portion 32B is fitted to the hard part 26 of the treatment tool main body 21 to be slidable and rotatable in the same manner as the fitting portion 31B.
As shown in
An edge surface shape of a base end portion of the seal holding member 32 in the insertion direction Z is circular or elliptical. The engaging projection portion 32D is a cylindrical projection portion disposed around the opening portion 32C and protruding toward the base end side in the insertion direction Z.
The lid member 34 is formed in a shape that is the same as or one size larger than the base end portion of the seal holding member 32. The lid member 34 has a through-hole 34A and an engaging recess portion 34B. The through-hole 34A is a circular through-hole located at the center of the lid member 34. The through-hole 34A has the same inner diameter as the fitting portions 31B and 32B.
The engaging recess portion 34B is formed on a side facing the seal holding member 32, that is, on an edge surface of the lid member 34 on the distal end side in the insertion direction Z. The engaging recess portion 34B is a circular recess portion that matches an outer shape of the engaging projection portion 32D of the seal holding member 32. The engaging recess portion 34B is engaged with the engaging projection portion 32D, thereby coupling the lid member 34 to the seal holding member 32. In this case, the seal member 33 is interposed between the lid member 34 and the seal holding member 32. Thus, the movement of the seal member 33 in the insertion direction Z is regulated, and the seal member 33 is fixed inside the seal holding member 32.
As shown in
An outer shape of the operation part 27 of the treatment tool main body 21 is larger than an outer shape of the hard part 26. Therefore, in a case where the treatment tool main body 21 is slid toward the distal end side in the insertion direction Z with respect to the oversheath 22, the operation part 27 abuts against the base end of the oversheath 22. Thus, the user can recognize that the treatment tool main body 21 cannot be slid further toward the distal end side in the insertion direction Z with respect to the oversheath 22.
A length L11 (see
As shown in
The attaching/detaching member 40 is provided on the operation part 4 of the endoscope 2. The attaching/detaching member 40 has a pair of projection portions 40A facing each other. The projection portion 40A is formed so as to match the recess portion 32A of the oversheath. By engaging the projection portion 40A with the recess portion 32A, the attaching/detaching member 40 can attach the oversheath 23 attachably and detachably.
In the endoscope system 1, in a case where a first resistance force in a case where the oversheath 22 is advanced and retreated to and from the forceps valve 16 is defined as R1 and a second resistance force in a case where the treatment tool main body 21 is advanced and retreated to and from the oversheath 22 is defined as R2, the first resistance force R1 is greater than the second resistance force R2. Here, the first resistance force R1 is a frictional force mainly generated between the forceps valve 16 and the oversheath main body 31, and the second resistance force R2 is a frictional force mainly generated between the seal member 33 of the oversheath 22 and the hard part 26 of the treatment tool main body 21. In order to make the first resistance force R1 greater than the second resistance force R2, for example, a material having a smooth surface (small friction) need only be selected as the seal member 33, or a dimensional difference between an outer diameter of the hard part 26 and an inner diameter of the seal member 33 need only be adjusted.
An operation using the endoscope system 1 in a case where the doctor D, who is the user, performs a treatment by the treatment tool device 20 for an endoscope will be described. First, the doctor D inserts the insertion part 3 of the endoscope 2 into the body of the patient P, observes an endoscope image captured by the image sensor 10, finds a region of interest such as a lesion portion 50 (see
As described above, the treatment tool main body 21 is slidable and rotatable with respect to the oversheath 22 within a range in which the hard part 26 and the fitting portions 31B and 32B are fitted to each other. That is, in a case where the oversheath 22 and the treatment tool main body 21 are inserted into the forceps channel 8, the treatment tool main body 21 can be slid and rotated within a certain range with respect to the forceps channel 8. Thus, the doctor D can slide the treatment tool main body 21 with respect to the oversheath 22 and align the distal end portion of the flexible sheath 23 with the position of the lesion portion 50, while observing the endoscope image captured by the image sensor 10 (state shown in
Next, the operation part 27 is operated by the other hand DH2 to cause the snare wire 25 to protrude, or the treatment tool main body 21 is rotated with respect to the oversheath 22 to align the snare wire 25 with the position of the lesion portion 50 (state shown in
As described above, in a case where the treatment tool device 20 for an endoscope and the endoscope system 1 including the treatment tool device 20 for an endoscope are used, the doctor D can perform, in addition to the operation of the endoscope 2, a plurality of types of treatments such as an operation of sliding and rotating the treatment tool main body 21 with respect to the forceps channel 8, and the contraction and expansion of the snare wire 25 by himself or herself. Thus, it is possible to operate the treatment tool without the need for cooperation, and in a case where the doctor is a main operator, the number of people who perform the treatment can be reduced.
Since the oversheath 22 can be attached to the operation part 4 via the attaching/detaching member 40, the operation performed by the doctor D is concentrated near the operation part 4, and the operation of the treatment tool main body 21 can be stably performed. Furthermore, since the first resistance force R1 in a case where the oversheath 22 is advanced and retreated to and from the forceps valve 16 is greater than the second resistance force R2 in a case where the treatment tool main body 21 is advanced and retreated to and from the oversheath 22, the movement of the oversheath 22 can be regulated in a case where the treatment tool main body 21 is operated. Thus, the operation of the treatment tool main body 21 can be performed more stably.
In a second embodiment to be described below, in addition to the configuration of the first embodiment, a length of the flexible sheath 23 protruding from the distal end of the oversheath 22 is specified. As shown in
The length L21 described above is determined based on a length L22 from the forceps outlet 7 of the forceps channel 8 to a branch part 8A. That is, in a case where the distal end of the operation part 27 of the treatment tool main body 21 is made to abut on the base end of the oversheath 22, the length L21 of the flexible sheath 23 protruding from the distal end of the oversheath 22 is preferably longer than the length L22 from the forceps outlet 7 of the forceps channel 8 to the branch part 8A. The branch part 8A is a position where the forceps channel 8 and the suction channel 17 are joined together. Thus, it is possible to prevent the oversheath 22 inserted into the forceps channel 8 from reaching the position of the branch part 8A. Therefore, an outer diameter of the treatment tool main body 21 in the forceps channel 8 is smaller than a portion covered with the oversheath 22. Accordingly, the suction from the forceps channel 8 is not hindered.
In a case where the oversheath 22 inserted into the forceps channel 8 reaches the position of the branch part 8A, the suction from the forceps channel 8 is hindered because the oversheath 22 having a larger outer diameter than the flexible sheath 23 blocks the forceps channel 8. However, in the present embodiment, as described above, in a case where the distal end of the operation part 27 of the treatment tool main body 21 is made to abut on the base end of the oversheath 22, the length L21 of the flexible sheath 23 protruding from the distal end of the oversheath 22 is specified, so that the suction from the forceps channel 8 is not hindered.
As a modification example of the second embodiment, as shown in
As shown in
The index indicating the insertion length of the oversheath 22 inserted into the forceps channel 8 is not limited to the above modification example, and as shown in
As shown in
In the first and second embodiments, the example in which the doctor D performs a plurality of types of treatments by himself or herself is given, but the present invention is not limited to this, and the treatment may be performed by the doctor D and the assistant H. For example, as shown in
As shown in
In each of the above embodiments, as the treatment tool main body 21, a high-frequency snare comprising the snare wire 25 serving as a treatment part and expanding in a loop shape in a case of protruding from the distal end of the flexible sheath 23 by the push-pull operation of the operation wire 24 is exemplified. However, the treatment tool main body 21 is not limited thereto, and need only comprise at least the flexible sheath 23, the operation wire 24 inserted through the flexible sheath 23, the hard part 26 provided at the base end portion of the flexible sheath 23, and the operation part 27 continuously provided at the hard part 26, and may be, for example, a puncture needle or a treatment tool comprising an ultrasound oscillator. Further, it is preferable to comprise a treatment part that expands by the push-pull operation of the operation wire 24, and for example, forceps for holding biological tissue in the body, a clutch cutter for energizing the forceps with a high-frequency current, or the like may be applied as the treatment tool main body 21. In addition, in each of the above embodiments, as the endoscope, an upper digestive tract endoscope is exemplified. However, the endoscope is not limited thereto, and need only be an endoscope comprising a forceps valve, and may be, for example, a bronchoscope or a lower digestive tract endoscope.
A method of mounting a treatment tool device for an endoscope, the method comprising: setting, by a doctor or an assistant, the treatment tool device for an endoscope to be connected to the endoscope in a state where an oversheath does not reach a branch part between a forceps channel and a suction channel while viewing an index indicating an insertion length.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2020-158526 | Sep 2020 | JP | national |
