U.S. patent application number 17/586390 was filed with the patent office on 2022-08-04 for endoscopic treatment device.
This patent application is currently assigned to OLYMPUS MEDICAL SYSTEMS CORP.. The applicant listed for this patent is OLYMPUS MEDICAL SYSTEMS CORP.. Invention is credited to Hiromasa KATO, Chika MIYAJIMA, Yusuke SHIOTA, Tomohiro TSUJI, Kotaro YAMADA.
Application Number | 20220241002 17/586390 |
Document ID | / |
Family ID | |
Filed Date | 2022-08-04 |
United States Patent
Application |
20220241002 |
Kind Code |
A1 |
SHIOTA; Yusuke ; et
al. |
August 4, 2022 |
ENDOSCOPIC TREATMENT DEVICE
Abstract
An endoscopic treatment device includes a sheath formed from a
resin; a tubular hollow needle inserted into the sheath and having
a sharp distal end; a rod formed from a metal and having a conduit;
a shaft attached to a proximal end of the rod and having an
internal space communicating with the conduit of the rod; and an
operation portion including (i) a slider attached to a proximal end
of the shaft, and (ii) and a lever attached to a proximal end of
the hollow needle.
Inventors: |
SHIOTA; Yusuke;
(Machida-shi, JP) ; MIYAJIMA; Chika;
(Hachioji-shi, JP) ; KATO; Hiromasa; (Tokyo,
JP) ; YAMADA; Kotaro; (Tachikawa-shi, JP) ;
TSUJI; Tomohiro; (Hino-shi, JP) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
OLYMPUS MEDICAL SYSTEMS CORP. |
Tokyo |
|
JP |
|
|
Assignee: |
OLYMPUS MEDICAL SYSTEMS
CORP.
Tokyo
JP
|
Appl. No.: |
17/586390 |
Filed: |
January 27, 2022 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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63143141 |
Jan 29, 2021 |
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International
Class: |
A61B 18/14 20060101
A61B018/14 |
Claims
1. An endoscopic treatment device comprising: a sheath; a tubular
hollow needle inserted into the sheath and having a sharp distal
end; a rod inserted into the sheath and having a conduit; a shaft
attached to a proximal end of the rod and having an internal space
communicating with the conduit of the rod; and an operation portion
comprising: a slider attached to a proximal end of the shaft; and a
lever attached to a proximal end of the hollow needle.
2. The endoscopic treatment device according to claim 1, wherein
the slider and the lever are connected by a ratchet mechanism.
3. The endoscopic treatment device according to claim 1, wherein
the rod is inserted into the hollow needle.
4. The endoscopic treatment device according to claim 1, further
comprising: a distal end cover provided in a distal end portion of
the sheath, wherein: a protrusion is provided on an outer
circumferential surface of a distal end portion of the hollow
needle, and the protrusion engages with a proximal end of the
distal end cover due to an operation of the lever.
5. The endoscopic treatment device according to claim 4, further
comprising: a connection portion configured to connect the rod and
the shaft, wherein: the connection portion protrudes from the rod
in a radial direction, and the connection portion engages with the
proximal end of the distal end cover due to an operation of the
slider.
6. The endoscopic treatment device according to claim 5, further
comprising: a flange at a distal end of the rod, wherein: a distal
end of the rod is positioned at a first position being at a distal
end side of a needle tip of the hollow needle when the connection
portion is engaged with a proximal end of the distal end cover, and
the distal end of the rod is positioned at a second position being
at a proximal end side of the needle tip of the hollow needle when
the flange is engaged with a distal end of the distal end
cover.
7. The endoscopic treatment device according to claim 1, wherein
the hollow needle is inserted into the conduit of the rod.
8. The endoscopic treatment device according to claim 7, further
comprising: a groove extending along a longitudinal axis in a
distal end portion of the rod, wherein: a protrusion is provided on
an outer circumferential surface of the hollow needle, and a
movement range of the hollow needle with respect to the rod is
restricted by the protrusion entering the groove and being engaged
with the groove so as to be freely slidable along the longitudinal
axis.
9. The endoscopic treatment device according to claim 1, wherein
the sheath is formed from a resin.
10. The endoscopic treatment device according to claim 1, wherein
the rod is formed from a metal.
11. A treatment method comprising: inserting an endoscopic
treatment device into a body cavity, the treatment device
comprising: an electrode having a hole; and a needle positioned at
a distal end side of the electrode and being freely movable with
respect to the electrode; forming an incision from a mucosal
surface to a submucosa layer by the needle tip; inflating the
mucosal surface by injecting fluid until the submucosa layer from
the hole of the electrode via the incision; and peeling the
submucosa layer while energizing the electrode with a
high-frequency current in a state in which the needle is positioned
at a proximal end side of a distal end of the electrode.
12. The treatment method according to claim 11, wherein the fluid
is injected until the submucosa layer via the incision in a state
in which the needle is stuck in the incision.
13. The treatment method according to claim 11, wherein the liquid
is supplied toward the incision from the hole.
14. The treatment method according to claim 11, wherein the hole
opens at a distal end of the electrode, and the liquid is supplied
toward the incision from the hole in a state in which the distal
end of the electrode is pressed on the incision.
15. The treatment method according to claim 11, wherein movement of
a distal end of the needle is restricted in a state in which the
distal end of the electrode is positioned at the distal end side of
the distal end of the needle.
16. The treatment method according to claim 11, wherein: when the
electrode is advanced, movement of the position of the distal end
of the needle is restricted in a state in which the distal end of
the electrode is positioned at the distal end side of the distal
end of the needle, and when the electrode is retracted, movement of
the position of the distal end of the needle is restricted in a
state in which the distal end of the electrode is positioned at the
proximal end side of the distal end of the needle while the
electrode abuts on a distal end of the sheath.
17. An endoscopic treatment device comprising: a sheath; an
electrode provided at a distal end side of the sheath and having a
conduit extending along a longitudinal axis; and a needle having a
needle tip and being freely advanceable and retractable with
respect to the electrode, wherein: the needle tip is movable to a
first position at a distal end side of the electrode by advancing
the needle with respect to the electrode, the needle tip is movable
to a second position at a proximal end side of the electrode by
retracting the needle with respect to the electrode, the endoscopic
treatment device is configured to supply liquid from the conduit in
a state in which the needle tip is moved to the first position, and
the endoscopic treatment device is configured to energize tissues
in a state in which the needle tip is moved to the second position.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This nonprovisional application claims the benefit of U.S.
Provisional Application No. 63/143,141, filed Jan. 29, 2021. The
disclosure of the prior application is hereby incorporated by
reference herein in its entirety.
TECHNICAL FIELD
[0002] The present disclosure relates to an endoscopic treatment
device.
BACKGROUND
[0003] Conventionally, during an endoscopic treatment such as
Endoscopic Submucosal Dissection (ESD) or the like, the endoscopic
treatment device for dissection and peeling procedures (such as the
high-frequency knife and the like), the endoscopic treatment device
for local injection procedures, and the endoscopic treatment device
for hemostasis procedures are used.
[0004] The endoscopic treatment devices can be configured to be
capable of performing several procedures among the dissection and
the peeling procedures, the local injection procedures, and the
hemostasis procedures. For example, the endoscopic high-frequency
treatment device can be capable of performing the dissection
procedures, the peeling procedures, and the hemostasis procedures.
Or it can be capable of performing the dissection procedures, the
peeling procedures, and the local injection procedures.
SUMMARY
[0005] In some embodiments of the present disclosure, an endoscopic
treatment device includes a sheath formed from a resin; a tubular
hollow needle inserted into the sheath and having a sharp distal
end; a rod formed from a metal and having a conduit; a shaft
attached to a proximal end of the rod and having an internal space
communicating with the conduit of the rod; and an operation portion
including (i) a slider attached to a proximal end of the shaft, and
(ii) a lever attached to a proximal end of the hollow needle.
BRIEF DESCRIPTION OF THE DRAWINGS
[0006] FIG. 1 is an overall view showing an endoscopic treatment
system according to an exemplary embodiment.
[0007] FIG. 2 is an overall view showing a treatment device of the
endoscopic treatment system.
[0008] FIG. 3 is a perspective view showing a distal end portion of
the treatment device.
[0009] FIG. 4 is a side view showing the distal end portion of the
treatment device.
[0010] FIG. 5 is a cross-sectional view showing the distal end
portion of the treatment device.
[0011] FIG. 6 is a cross-sectional view showing the distal end
portion of the treatment device.
[0012] FIG. 7 is a cross-sectional view showing an operation
portion of the treatment device.
[0013] FIG. 8 is a view showing a connection between a lever of the
operation portion and a sharp member.
[0014] FIG. 9 is a cross-sectional view of the operation portion
along line X-X shown in FIG. 8.
[0015] FIG. 10 is a view showing the treatment device when the
lever is moved to a distal end side with respect to a slider of the
operation portion.
[0016] FIG. 11 is a view showing the treatment device when the
lever is moved to a proximal end side with respect to the slider of
the operation portion.
[0017] FIG. 12 is a cross-sectional view showing a modification
example of the operation portion.
[0018] FIG. 13 is a view showing a modification example of a flange
of the treatment device.
[0019] FIG. 14 is a view showing a modification example of a rod of
the treatment device.
[0020] FIG. 15 is a view showing a modification example of the
treatment device.
[0021] FIG. 16 is a cross-sectional view of the modification
example.
[0022] FIG. 17 is a cross-sectional view of the modification
example.
[0023] FIG. 18 is an overall view showing a treatment device
according to an exemplary embodiment.
[0024] FIG. 19 is a perspective view showing a distal end portion
of the treatment device.
[0025] FIG. 20 is a side view showing the distal end portion of the
treatment device.
[0026] FIG. 21 is a cross-sectional view showing the distal end
portion of the treatment device.
[0027] FIG. 22 is a cross-sectional view showing the distal end
portion of the treatment device.
[0028] FIG. 23 is a cross-sectional view showing an operation
portion of the treatment device.
[0029] FIG. 24 is a cross-sectional view showing the operation
portion of the treatment device.
[0030] FIG. 25 is a view showing a modification example of a flange
of the treatment device.
[0031] FIG. 26 is a view showing a modification example of a rod of
the treatment device.
[0032] FIG. 27 is a view showing another modification example of
the rod of the treatment device.
[0033] FIG. 28 is a cross-sectional view showing a modification
example of the treatment device.
[0034] FIG. 29 is a cross-sectional view showing a modification
example of the treatment device.
DESCRIPTION OF EMBODIMENTS
[0035] An endoscopic treatment system 300 according to an exemplary
embodiment of the present disclosure will be described by referring
to FIG. 1 to FIG. 17. FIG. 1 is an overall view of the endoscopic
treatment system 300 according to the present embodiment.
[Endoscopic Treatment System 300]
[0036] As shown in FIG. 1, the endoscopic treatment system 300
includes an endoscope 200 and a treatment device 100. The treatment
device 100 is inserted into the endoscope 200 to be used.
[Endoscope 200]
[0037] The endoscope 200 is a conventional flexible endoscope, and
includes an insertion portion 202 being inserted into the body from
a distal end, and an operation portion 207 attached to a proximal
end of the insertion portion 202.
[0038] The insertion portion 202 includes an imaging portion 203, a
bending portion 204, and a flexible portion 205. The imaging
portion 203, the bending portion 204, and the flexible portion 205
are disposed from the distal end of the insertion portion 202 in
this sequence. Inside the insertion portion 202, a channel 206 for
inserting the treatment device 100 is provided. A distal end
opening portion 206a of the channel 206 is provided at the distal
end of the insertion portion 202.
[0039] The imaging portion 203 includes, for example, the imaging
element such as CCD or CMOS, and is configured to be able to image
the site of the treatment target. The imaging portion 203 is able
to image the rod 2 of the treatment device 100 in a state in which
the treatment device 100 protrudes from the distal end opening
portion 206a of the channel 206.
[0040] The bending portion 204 is bent according to operations by
an operator to the operation portion 207. The flexible portion 205
is a tubular portion having flexibility.
[0041] The operation portion 207 is connected to the flexible
portion 205. The operation portion 207 includes a grip 208, an
input portion 209, a proximal end opening portion 206b of the
channel 206, and a universal cord 210. The grip 208 is a portion
for the operator to grasp. The input portion 209 receives the
operation input for the bending operations of the bending portion
204. The universal cord 210 is configured to output the image
captured by the imaging portion 203 to the external device. The
universal cord 210 is connected to a display device such as an LCD
display or the like via an image processing device that includes a
processor and the like.
[Treatment Device 100]
[0042] FIG. 2 is an overall view of the treatment device 100C.
[0043] The treatment device (endoscopic treatment device) 100
includes a sheath 1, a rod 2, a sharp member (hollow needle) 3, an
operation wire 4 (see FIG. 5), and an operation portion 5. In the
following description, along a longitudinal direction A of the
treatment device 100, the side being inserted into the body of the
patient is referred to as the "distal end side A1", and the side of
the operation portion 5 is referred to as the "proximal end side
A2".
[0044] The sheath 1 having flexibility and insulation properties is
an elongated member extending from a distal end 1a to a proximal
end 1b and the sheath 1 is made from a resin material. The sheath 1
has an outer diameter so as to be insertable into the channel 206
of the endoscope 200, and is advanceable and retractable in the
channel 206. As shown in FIG. 1, in a state in which the sheath 1
is inserted into the channel 206, the distal end 1a of the sheath 1
is able to protrude from the distal end opening portion 206a of the
channel 206.
[0045] FIG. 3 is a cross-sectional view of a distal end of the
treatment device 100.
[0046] An insulation tip (distal end cover) 11 including a
penetration hole 12 penetrating along the longitudinal direction A
is attached to the distal end 1a of the sheath 1. The rod 2 and the
sharp member 3 are inserted into the penetration hole 12.
[0047] FIG. 4 is a side view of the distal end of the treatment
device 100.
[0048] The rod 2 is a member formed from a metal material and has
an approximately round bar shape. The rod 2 is provided to be able
to protrude from the penetration hole 12 of the insulation tip 11
of the sheath 1 toward the distal end side (A1). For example, the
rod 2 is formed from a material such as stainless steel or the
like. The rod 2 has conductivity to be energized by a
high-frequency current. The rod 2 includes a rod main body 20 and a
flange 21.
[0049] The rod 2 is inserted through the tubular sharp member 3
along the longitudinal direction A, and the rod 2 is relatively
movable with respect to the sharp member 3. A central axis O2 along
the longitudinal direction A of the rod 2 is substantially
coincided with the central axis O1 along the longitudinal direction
A of the sheath 1.
[0050] FIG. 5 is a cross-sectional view showing a distal end
portion of the treatment device 100.
[0051] The rod main body 20 is a member formed from the metal
material and in a round bar shape. The rod main body 20 is
configured to supply the high-frequency current supplied from the
operation wire 4 connected to the operation portion 5 to the flange
21. When the high-frequency current is supplied from the operation
wire 4 to the rod 2, the rod main body 20 and the flange 21
function as the monopolar electrode configured to output the
high-frequency current to the living tissues.
[0052] The flange 21 is a disk-shaped conductive member provided at
the distal end of the rod main body 20. In a front view seen from
the direction along the longitudinal direction A, the outer
circumference of the flange 21 is formed in a concentric circular
shape with the outer circumference of the rod main body 20. As
shown in FIG. 4, a length L1 of the flange 21 in a radial direction
R orthogonal to the longitudinal direction A is longer than a
length L2 of the rod main body 20 in the radial direction R.
[0053] The rod 20 and the flange 21 include a first water-supply
pipeline 22 extending along the longitudinal direction A. The first
water-supply pipeline 22 communicates with the distal end opening
22a formed at the flange 21. The distal end opening 22a opens at
the distal end side (A1).
[0054] The sharp member (hollow needle) 3 is a tubular member
formed from the resin material, the metal material or the like. The
rod 2 and the operation wire 4 are inserted through the internal
space 3s of the sharp member 3 to be advanceable and retractable.
The sharp member 3 includes a tubular main body portion 31, a
distal end portion 32 and a sharp portion 33.
[0055] The tubular main body portion 31 is a cylindrical member
having a proximal end connected to the operation portion 5. The
distal end portion 32 is provided at the distal end of the tubular
main body portion 31.
[0056] The distal end portion 32 is provided at the distal end of
the tubular main body portion 31, and the distal end portion 32 is
formed in a semi-cylindrical shape by dividing the cylindrical
member along the longitudinal direction A. In other words, the
distal end portion 32 includes a slit formation portion 32a formed
in the semi-cylindrical shape. A portion of the flange 21 protrudes
outwardly in the radial direction from the outer circumferential
surface and/or the inner circumferential surface of the tubular
main body portion 31. The flange 21 is configured to be freely
slidable at the distal end side of the proximal end 32b of the slit
formation portion 32a. It is not necessary for the slit formation
portion 32a to be in the semi-cylindrical shape, and for example,
the slit formation portion 32a may be configured as the groove with
a width smaller than the inner diameter of the tubular main body
portion 31 that is formed along the longitudinal axis. In this
case, the flange 21 is formed to have the dimension capable of
entering the groove so as to be slidable inside the groove.
[0057] The sharp portion 33 is provided at the distal end of the
distal end portion 32, and the distal end side (A1) of the sharp
portion 33 is sharp (configured to incise or penetrate a living
tissue). The sharp portion 33, as shown in FIG. 3 and FIG. 4, is
formed to have a shape that an edge 33a at the distal end side (A)
of the semi-cylindrical shape is inclined with respect to the
longitudinal direction A. The distal end (needle tip) 33b of the
sharp portion 33 is formed to be sharp toward the distal end side
(A1).
[0058] FIG. 6 is a cross-sectional view showing the distal end
portion of the treatment device 100.
[0059] The rod 2 and the sharp member 3 can be accommodated in the
proximal end side (A2) from the penetration hole 12 of the
insulation tip 11 of the sheath 1 by being retracted.
[0060] The operation wire 4 is a shaft inserting through the
internal space 3s of the sharp member 3, and the operation wire 4
includes a coil shaft 40 and a tube 41. The distal end of the
operation wire 4 is connected to the rod 2, and the proximal end of
the operation wire 4 is connected to the operation portion 5. The
operation wire 4 only has to be a hollow shaft, but can otherwise
be configured in other configurations.
[0061] The coil shaft 40 is a coil wire made from a metal material.
For example, the coil shaft 40 is made from a material such as
stainless steel or the like. Inside the coil shaft 40, a second
water-supply pipeline 42 is formed. The second water-supply
pipeline 42 is connected to the proximal end of the first
water-supply pipeline 22.
[0062] The tube 41 is a tube provided in the outer circumferential
portion of the coil shaft 40, and for example, the tube 41 is a
heat shrinkable tube. By covering the tube 41 on the outer
circumferential portion of the coil shaft 40, there is no liquid
leakage from the second water-supply pipeline 42.
[0063] As shown in FIG. 1 and FIG. 2, the operation portion 5
includes an operation portion main body 51, a slider 52, a
power-supply connector 53, a liquid-supply port 54, and a lever
(second slider) 55.
[0064] FIG. 7 is a cross-sectional view showing the operation
portion 5.
[0065] The distal end portion of the operation portion main body 51
is connected to the proximal end 1b of the sheath 1. The operation
portion main body 51 has an internal space into which the operation
wire 4 can be inserted. The sharp member 3 and the operation wire 4
extend until the slider 52 through the internal space 1s of the
sheath 1 and the internal space 5s of the operation portion main
body 51.
[0066] The slider 52 is attached thereto to be movable along the
longitudinal direction A with respect to the operation portion main
body 51. The slider 52 is attached to the sheath 1 connected to the
operation portion main body 51 via the O-ring 52a. The proximal end
4b of the operation wire 4 is attached to the slider 52. The
operation wire 4 and the rod 2 advance and retract by the surgeon
relatively advancing and retracting the slider 52 with respect to
the operation portion main body 51.
[0067] The power-supply connector 53 is fixed to the slider 52. The
power-supply connector 53 is connectable with the high-frequency
power supply device which is not shown in the figures, and the
power-supply connector 53 is connected to the proximal end portion
of the operation wire 4 via a conductive wire 53w. The power-supply
connector 53 is configured to be able to supply the high-frequency
current supplied from the high-frequency power supply device to the
rod 2 via the operation wire 4.
[0068] The liquid-supply port 54 is provided on the slider 52. The
liquid-supply port 54 is connected to the proximal end of the
second water-supply pipeline 42 via a third water-supply pipeline
56 formed in the slider 52. The liquid supplied from the
liquid-supply port 54 passes through the third water-supply
pipeline 56, the second water-supply pipeline 42, and the first
water-supply pipeline 22 and is drained from the distal end opening
22a.
[0069] FIG. 8 is a view showing a connection between the lever 55
and the sharp member 3.
[0070] The proximal end of the sharp member 3 is attached to the
lever (second slider) 55. The lever (second slider) 55 is attached
to the slider 52 to be movable along the longitudinal direction A.
The lever 55 includes a handle portion 55a in a convex shape and
operated by the surgeon, and an engagement portion 55b connected to
the sharp member 3. An engagement convex portion 55c is provided in
the distal end of the engagement portion 55b.
[0071] As shown in FIG. 8, a penetration hole 13 extending along
the longitudinal direction A is formed in the sheath 1. The lever
55 passes through the penetration hole 13 and is connected to the
sharp member 3.
[0072] FIG. 9 is a cross-sectional view of the operation portion 5
along the line X-X shown in FIG. 8.
[0073] As shown in FIG. 8 and FIG. 9, an engaged portion 34
engaging with the engaging portion 55b is formed in the proximal
end portion of the sharp member 3. An engaging concave portion 34a
that engages with the engaging convex portion 55c is formed in the
engaged portion 34.
[0074] FIG. 10 is a view showing the treatment device 100 in which
the lever 55 is moved to the distal end side (A1) with respect to
the slider 52. By moving the lever 55 to the distal end side (A1)
with respect to the slider 52, the sharp portion 33 of the sharp
member 3 is moved to the distal end side (A1) with respect to the
rod 2 connected to the operation wire 4 fixed to the slider 52.
[0075] FIG. 11 is a view showing the treatment device 100 in which
the lever 55 is moved to the proximal end side (A2) with respect to
the slider 52. By moving the lever 55 to the proximal end side (A2)
with respect to the slider 52, the sharp portion 33 of the sharp
member 3 is moved to the proximal end side (A2) with respect to the
rod 2 connected to the operation wire 4 fixed to the slider 52.
[0076] As shown in FIG. 7, the operation wire 4 is embedded in the
sharp member 3. Accordingly, when the operation wire 4 and the rod
2 advance and retract by the surgeon relatively advancing and
retracting the slider 52 with respect to the operation portion main
body 51, the sharp member 3 also advances and retracts due to the
friction.
[Usage Method of Treatment Device 100C]
[0077] Next, the procedures using the endoscopic treatment system
300 (usage method of the endoscopic treatment system 300) according
to the present embodiment will be described. More specifically, the
dissection and the peeling procedures, the local injection
procedures, and the hemostasis procedures such as the ESD
(Endoscopic Submucosal Dissection) procedures or the like with
respect to the lesion site during the endoscopic treatment will be
described.
[0078] As a preparation operation, the surgeon uses the
conventional method to specify the lesion site. More specifically,
the surgeon inserts the insertion portion 202 of the endoscope 200
into the gastrointestinal tract (such as the esophagus, the
stomach, the duodenum, and the large intestine) to specify the
lesion site while observing the image captured by the imaging
portion 203 of the endoscope.
<Insertion Step>
[0079] The surgeon inserts the treatment device 100 into the
channel 206 and protrudes the distal end 1a of the sheath 1 from
the distal end opening portion 206a of the insertion portion 202.
The surgeon relatively advances the slider 52 of the operation
portion 5 with respect to the operation portion main body 51 to
protrude the rod 2 and the sharp member 3.
<Local Injection Step>
[0080] As shown in FIG. 10, the surgeon moves the lever 55 to the
distal end side (A1) with respect to the slider 52 to move the
sharp member 3 to the distal end side (A1) with respect to the rod
2. As a result, the sharp portion 33 of the sharp member 3
protrudes toward the distal end side (A1) with respect to the rod
2. The surgeon sticks and penetrates the location where the liquid
for the local injection (local injection solution) at the lesion
site using the sharp portion 33 of the sharp member 3. More
specifically, the surgeon forms an incision from the mucosa surface
until the submucosa layer by the distal end (needle tip) 33b of the
sharp portion 33. The surgeon supplies liquid to the submucosa
layer in a state of putting the distal end opening 22a at the
distal end of the rod 2 into the submucosa layer (local injection
step). More specifically, the surgeon supplies the liquid from the
distal end opening (hole) 22a toward the incision in a state in
which the sharp portion 33 of the sharp member 3 is stuck into the
incision. The surgeon inflates the mucosa surface by injecting the
liquid until the submucosa layer from the distal end opening 22a
via the incision. The surgeon may supply the liquid from the distal
end opening 22a toward the incision in a state in which the distal
end of the rod 2 is pressed on the incision.
<Dissection and the Peeling Step>
[0081] The surgeon performs the dissection and peeling procedures.
As shown in FIG. 11, the surgeon advances the rod 2 to move the
flange 21 in an energized state by the high-frequency current to
dissect the mucosa on the lesion site. Otherwise, the surgeon
advances the rod 2 to lift the dissected mucosa at the lesion site
to expose the submucosa layer and peels off the submucosa layer in
the dissected lesion site. During the dissection and peeling
procedures, it is desirable that the sharp member 3 is completely
accommodated in the sheath 1.
<Additional Local Injection Step>
[0082] The surgeon performs the additional local injection
procedures as needed. As shown in FIG. 10, the surgeon protrudes
the sharp portion 33 of the sharp member 3 toward the distal end
side (A1) with respect to the rod 2. The surgeon sticks and
penetrates the location where the liquid for the local injection
(local injection solution) at the lesion site using the sharp
portion 33 of the sharp member 3 (additional local injection
step).
<Hemostasis Procedures>
[0083] In a case in which bleeding occurs during the dissection and
peeling procedures, the surgeon performs the hemostasis procedures.
The surgeon presses the rod main body 20 and the flange 21 on the
bleeding point while cauterizing the bleeding point by energization
with the high-frequency current to stop the bleeding (hemostasis
step).
[0084] The surgeon continues the above-described operations
(procedures) as needed so as to finally dissect the lesion site and
finish the ESD procedures.
[0085] According to the treatment device 100 disclosed in the
present embodiment, it is possible to perform various procedures
such as the local injection procedures, the dissection and the
peeling procedures, and the hemostasis procedures.
[0086] An exemplary embodiment of the present disclosure has been
described above; however, the specific configuration thereof is not
limited to this specific configuration, and modifications within
the scope of the claims and not departing from the spirit of the
present disclosure may be included. Also, the configuration may be
made by appropriately combining the configurations disclosed in the
above-described embodiment and modification examples.
Modification Example 1-1
[0087] In the above-described embodiment, the slider 52 and the
lever 55 are not directly connected to each other in the operation
portion 5. However, the configuration of the operation portion 5 is
not limited thereto. FIG. 12 is a cross-sectional view showing an
operation portion 5A as a modification example of the operation
portion 5. The operation portion 5A includes the operation portion
main body 51, a slider 52A, the power-supply connection 53, the
liquid-supply port 54, and a lever 55A. The slider 52A and the
lever 55A are connected to each other by a ratchet mechanism.
[0088] Compared with the lever 55 according to the first
embodiment, the lever 55A further includes a spring 55s, an
engaging portion (claw) 55e, and a release button 55r. Compared
with the slider 52 according to the first embodiment, the slider
52A further includes an engaged portion (ratchet teeth) 52e.
[0089] The engaging portion 55e of the lever 55A engages with the
engaged portion (ratchet teeth) 52e provided in the slider 52A due
to the restoring force of the spring 55s. In the case in which the
engaging portion 55e is engaged with the engaged portion 52e, it is
impossible for the lever 55A to advance with respect to the slider
52A. On the other side, even in the case in which the engaging
portion 55e is engaged with the engaged portion 52e, it is possible
for the lever 55A to retract with respect to the slider 52A.
[0090] The release button 55r is configured to release the
engagement of the engaging portion 55e and the engaged portion 52e.
The release button 55r can move to two positions including a
standard position and a press position being pressed from the
standard position. The release button 55r includes a lock mechanism
such that the release button 55r moved to the press position is
kept in the press position until the release button is pressed next
time. The surgeon moves the release button 55r from the press
position to the standard position so as to make the lever 55A be
advanceable with respect to the slider 52A. In other words, the
engagement (catching) between the engaging portion 55e and the
engaged portion 52e is disengaged by moving the release button 55r
to the standard position such that the lever 55A is advanceable
with respect to the lever 55A.
[0091] According to the operation portion 5A, the slider 52A and
the lever 55A are connected to each other by the ratchet mechanism
such that it is possible to operate the sharp member 3 and the
operation wire 4 in conjunction except in the case in which the
connection is released. Accordingly, it is possible to prevent the
sharp member 3 from unintentionally protruding toward the rod
2.
Modification Example 1-2
[0092] In the above-described embodiment, the flange 21 in a disk
shape is provided at the distal end of the rod 2. However, the
configuration of the flange 21 is not limited thereto. FIG. 13 is a
view showing a flange 21A as a modification example of the flange
21. The flange 21A is formed in a triangle shape when viewed in a
front view from the distal end side (A1).
Modification Example 1-3
[0093] In the above-described embodiment, the flange 21 is provided
at the distal end of the rod 2. However, the configuration of the
rod 2 is not limited thereto. FIG. 14 is a view showing a rod 2A as
a modification example of the rod 2. A distal end portion 24 of the
rod 2A is formed in a hook shape. The distal end opening 22a that
opens toward the distal end side (A1) is formed in the distal end
portion 24.
Modification Example 1-4
[0094] FIG. 15 to FIG. 17 are views showing a treatment device 100E
as a modification example of the treatment device 100.
[0095] The treatment device 100E includes a sheath 1E, a rod 2E, a
sharp member (hollow needle) 3E, the operation wire 4, and the
operation portion 5.
[0096] Similar to the sheath 1, the sheath 1E is an elongated
member and formed from the resin, and the sheath 1E includes the
insulation tip (distal end cover) 11E as a modification example of
the insulation tip 11. Compared with the insulation tip (distal end
cover) 11, the insulation tip (distal end cover) 11E further
includes a restriction member 14. As shown in FIG. 15, the
restriction member 14 is a member configured to block part of the
penetration hole 12. As shown in FIG. 16, the flange 21 of the
retracting rod 2E comes into contact with the distal end of the
restriction member 14 of the insulation tip 11E such that it is
impossible for the distal end of the rod 2E to enter the inside
space 1s of the sheath 1E. The position of the distal end of the
rod 2E is determined to be at the second position P2 at the
proximal end side (A2, base end side) of the needle tip 33b of the
sharp member 3E.
[0097] Similar to the rod 2, the rod 2E is the member in the
substantially round bar shape and made from the metal material, and
the rod 2E further includes a connection portion 23 connecting with
the operation wire 4. The connection portion 23 is configured to
connect the proximal end of the rod 2E and the distal end of the
operation wire 4. The connection portion 23 protrudes from the rod
2E outwardly in the radial direction. As shown in FIG. 17, the
connection portion 23 of the advancing rod 2E comes into contact
with the proximal end of the restriction member 14 such that the
position of the distal end of the rod 2E is determined to be at the
first position P1 at the distal end (A1, front end side) of the
needle tip 22b of the sharp member 3E.
[0098] The sharp member (hollow needle) 3E is the tubular member
formed of the same resin material or the metal material as the same
with that of the sharp member 3, and the sharp member 3E further
includes a protrusion 36 protruding in the radial direction on the
outer circumferential surface of the distal end portion 32. As
shown in FIG. 16, the position of the distal end of the sharp
member 3E is determined by the protrusion 36 of the advancing sharp
member 3E comes into contact with the proximal end of the
insulation tip 11E.
[0099] A treatment device 100B according to another exemplary
embodiment of the present disclosure will be described by referring
to FIG. 18 to FIG. 24. In the following description, the described
common configurations will be designated with the same reference
signs and the duplicate description will be omitted.
[Treatment Device 100B]
[0100] FIG. 18 is an overall view showing the treatment device
100B.
[0101] Similar to the treatment device 100 according to the above
embodiment, the treatment device (endoscopic treatment device) 100B
together with the endoscope 200 configure the endoscopic treatment
system. The treatment device 100B includes the sheath 1, a rod 2B,
a sharp member (hollow needle) 3B, an operation wire 4B, and an
operation portion 5B.
[0102] FIG. 19 is a perspective view showing the distal end portion
of the treatment device 100B.
[0103] The rod 2B and the sharp member 3B are inserted into the
penetration hole 12 formed in the insulation tip (distal end cover)
11 of the sheath 1.
[0104] FIG. 20 is a side view showing the distal end portion of the
treatment device 100B.
[0105] Similar to the rod 2 according to the above embodiment, the
rod 2B is a tubular member made from the metal material, and the
rod 2B is configured to be able to protrude toward the distal end
side (A1) from the penetration hole 12 of the insulation tip 11 of
the sheath 1. The rod 2B has conductivity and is energized by the
high-frequency current. The rod 2B includes the rod main body 10
and the flange 21.
[0106] When the high-frequency current is supplied from the
operation wire 4B to the rod 2B, the rod main body 20 and the
flange 21 function as a monopolar electrode configured to output
high-frequency current to the living tissues.
[0107] FIG. 21 is a cross-sectional view showing the distal end
portion of the treatment device 100B.
[0108] The rod 2B includes an internal space 2s extending along the
longitudinal direction A. The internal space 2s communicates with
the distal end opening 22a formed in the flange 21. The distal end
opening 22a opens toward the distal end side (A1).
[0109] Similar to the sharp member 3 according to the first
embodiment, the sharp member (hollow needle) 3B is the tubular
member formed from the resin material, the metal material or the
like. The sharp member 3B includes the tubular main body portion 31
and the sharp portion 33B.
[0110] The sharp member 3B includes the water-supply pipeline 35
extending along the longitudinal direction A. The water-supply
pipeline 35 communicates with the distal end opening 35a formed in
the sharp portion 33B. The distal end opening 35a opens toward the
distal end side (A1).
[0111] The sharp member 3B is inserted through the internal space
2s of the rod 2B along the longitudinal direction A, and the sharp
member 3B is relatively movable with respect to the rod 2B. The
central axis O2 along the longitudinal direction A of the rod 2B is
substantially coincided with the central axis O1 of the sheath 1
along the longitudinal direction A.
[0112] The sharp portion 33B is a sharp member provided at the
distal end of the tubular main body portion 31 and being sharp at
the distal end thereof. As shown in FIG. 19 and FIG. 20, the sharp
portion 33B is formed to have the edge 33a at the distal end side
with the cylindrical shape to be inclined with respect to the
longitudinal direction A. The distal end 33b of the sharp portion
33B is formed to be sharp toward the distal end side (A1).
[0113] FIG. 22 is a cross-sectional view showing the distal end
portion of the treatment device 100B.
[0114] The rod 2B and the sharp member 3B can be accommodated at
the proximal end side (A2) of the insulation tip 11 of the sheath 1
from the penetration hole 12 as being retracted.
[0115] The operation wire 4B is the shaft inserted through the
internal space 1s of the sheath 1, and the operation wire 4B has
the coil shaft 40. The sharp member 3B is inserted through the
internal space 4s of the operation wire 4B to be freely advanceable
and retractable. The distal end of the operation wire 4B is
connected to the rod 2B, and the proximal end of the operation wire
4B is connected to the operation portion 5B. The operation wire 4B
only has to be a hollow shaft, but may otherwise be configured
according to other configurations.
[0116] As shown in FIG. 18, the operation portion 5B includes the
operation portion main body 51, the slider 52, the power-supply
connector 53, the liquid-supply port 54, and the lever (second
slider) 55.
[0117] FIG. 23 is a cross-sectional view showing the operation
portion 5B.
[0118] The distal end portion of the operation portion main body 51
is connected to the proximal end 1b of the sheath 1. The operation
portion main body 51 has an internal space into which the operation
wire 4B can be inserted. The sharp member 3B and the operation wire
4B extend until the slider 52 through the internal space 1s of the
sheath 1 and the internal space 5s of the operation portion main
body 51.
[0119] The proximal end 4b of the operation wire 4B is attached to
the slider 52. The operation wire 4B and the rod 2B advance and
retract by the surgeon relatively advancing and retracting the
slider 52 with respect to the operation portion main body 51.
[0120] The power-supply connector 53 is fixed to the slider 52. The
power-supply connector 53 is connectable with the high-frequency
power supply device which is not shown in the figures, and the
power-supply connector 53 is connected to the proximal end portion
of the operation wire 4B via the conductive wire 53w. The
power-supply connector 53 is configured to be able to supply the
high-frequency current supplied from the high-frequency power
supply device to the rod 2B via the operation wire 4B.
[0121] The liquid-supply port 54 is provided on the slider 52. The
liquid-supply port 54 is connected to the proximal end of the
water-supply pipeline 35 via the third water-supply pipeline 56
formed in the slider 52. The liquid supplied from the liquid-supply
port 54 passes through the third water-supply pipeline 56 and the
water-supply pipeline 35 and is drained from the distal end opening
35a.
[0122] FIG. 24 is a cross-sectional view of the operation portion
5B.
[0123] The proximal end of the sharp member 3B is attached to the
lever (second slider) 55. The lever (second slider) 55 is attached
to the slider 52 to be movable along the longitudinal direction A.
The lever 55 is connected to the sharp member 3B through the
penetration hole 13.
[0124] By moving the lever 55 to the distal end side (A1) with
respect to the slider 52, the sharp portion 33B of the sharp member
3B is moved to the distal end side (A1) with respect to the rod 2B
connected to the operation wire 4B fixed to the slider 52.
[0125] By moving the lever 55 to the proximal end side (A2) with
respect to the slider 52, the sharp portion 33B of the sharp member
3B is moved to the proximal end side (A2) with respect to the rod
2B connected to the operation wire 4B fixed to the slider 52.
[0126] As shown in FIG. 23, the sharp member 3B is embedded in the
operation wire 4B. Accordingly, when the operation wire 4B and the
rod 2B advance and retract by the surgeon relatively advancing and
retracting the slider 52 with respect to the operation portion main
body 51, the sharp member 3B also advances and retracts due to the
friction. Similar to the modification example 1-1 of the first
embodiment, the slider 52 and the lever 55 may be engaged with each
other to be relatively slidable with each other by the ratchet
mechanism or the like. Accordingly, the slider 52 and the lever 55
are able to be advanced and retracted simultaneously.
[0127] According to the treatment device 100B disclosed in the
present embodiment, it is possible to perform various procedures
such as the local injection procedures, the dissection and the
peeling procedures, and the hemostasis procedures by the same usage
method of the treatment device 100 according to the present
embodiment.
[0128] Another embodiment of the present disclosure has been
described above; however, the specific configuration thereof is not
limited to this specific configuration, and modifications within
the scope of the claims and not departing from the spirit of the
present disclosure may be included. Also, the configuration may be
made by appropriately combining the configurations disclosed in
this embodiment and modification examples.
Modification Example 2-1
[0129] In the above-described embodiment, the flange 21 in the disk
shape is provided at the distal end of the rod 2B. However, the
configuration of the flange 21 is not limited thereto. FIG. 25 is a
view showing the flange 21A as a modification example of the flange
21. The flange 21A is formed in a triangle shape when viewed in a
front view from the distal end side (A1).
Modification Example 2-2
[0130] In the above-described embodiment, the flange 21 is provided
at the distal end of the rod 2B. However, the configuration of the
rod 2B is not limited thereto. FIG. 26 is a view showing a rod 2Ba
as a modification example of the rod 2B. The distal end portion 24
of the rod 2Ba is formed in a hook shape. The distal end opening
22a that opens toward the distal end side (A1) is formed in the
distal end portion 24.
Modification Example 2-3
[0131] In the above-described embodiment, the flange 21 is provided
at the distal end of the rod 2B. However, the configuration of the
rod 2B is not limited thereto. FIG. 27 is a view showing a rod 2Bb
as a modification example of the rod 2B. The distal end portion 25
of the rod 2Bb is formed in a hemisphere shape. The distal end
opening 22a that opens toward the distal end side (A1) is formed in
the distal end portion 25.
Modification Example 2-4
[0132] FIG. 28 to FIG. 29 are views showing a treatment device 100F
as a modification example of the treatment device 100.
[0133] The treatment device 100F includes the sheath 1, a rod 2F, a
sharp member (hollow needle) 3F, the operation wire 4B, and the
operation portion 5B.
[0134] Similar to the rod 2B, the rod 2F has a substantially round
bar shape and is made from the metal material, and the rod 2F
includes a rod main body 20F, a flange 21F, and the connection
portion 23. Similar to the rod main body 20, the rod main body 20F
has a round bar shape and is made from the metal material, and the
rod main body 20F further includes a groove 24 extending along the
longitudinal direction A. The groove 24 is configured to penetrate
the rod main body 20F from the internal circumferential surface to
the outer circumferential surface of the rod main body 20F. The
flange 21F has a larger outer diameter than that of the flange 21.
As shown in FIG. 28, since the flange 21F of the retracting rod 2F
comes into contact with the distal end of the insulation tip 11,
the distal end of the rod 2F is impossible to enter the internal
space 1s of the sheath 1. The connection portion 23 protrudes
outwardly from the rod 2F in the radial direction. As shown in FIG.
29, the connection portion 23 of the advancing rod 2F comes into
contact with the proximal end of the insulation tip 11 so as to
determine the position of the distal end of the rod 2F.
[0135] Similar to the sharp member 3, the sharp member (hollow
needle) 3F is a tubular member formed from the resin material, the
metal material or the like, and the sharp member 3F further
includes the protrusion 36 protruding from the outer
circumferential surface of the distal end portion 32 in the radial
direction. As shown in FIG. 28 and FIG. 29, the protrusion 36
penetrates the groove 24 of the rod 2F to further protrude
outwardly in the radial direction with respect to the rod 2F. The
protrusion 36 enters the groove 24 to be engaged therewith so as to
be freely slidable along the longitudinal direction A, and the
moveable range of the sharp member (hollow needle) 3F in the
longitudinal direction A with respect to the rod 2F is restricted.
The protrusion 36 of the advancing sharp member 3F comes into
contact with the proximal end of the insulation tip 11 so as to
determine the position of the distal end of the sharp member
3F.
[0136] Although the respective embodiments and modifications of the
present disclosure have been described above, the technical scope
of the present disclosure is not limited to the above-described
embodiments, and includes configurations in the respective
embodiments and modifications within the scope of the claims not
departing from the spirit of the present disclosure. It is possible
to change the combination of elements, make various changes to each
configuration element, or delete each configuration element. For
example, the configuration according to any one of above-described
embodiments and modifications of the present disclosure may be
appropriately combined with each modification of the operation
section. The present disclosure is not limited by the above
description, but only by the appended claims.
* * * * *