JP4338438B2 - Endoscope gripping device - Google Patents

Description

[0001]
【Technical field】
The present invention relates to an endoscope gripping device for gripping a lesioned part of a patient using a magnetic guiding means that can be guided by a magnetic field when the lesioned part is excised under endoscopic observation.
[0002]
[Prior art and its problems]
When excising a lesion using magnetic guidance means (magnetic anchor) that can be guided by a magnetic field, an endoscopic grasping device in which a grasping member for grasping the lesion and a magnetic guidance means are connected by a connector is used. ing. In this apparatus, the lesioned part is lifted by attracting the magnetic guiding means in accordance with the state of excision.
[0003]
However, in the conventional apparatus, since the length of the coupler cannot be easily adjusted, when the magnetic guiding means is gradually moved to a higher position and reaches the inner wall of the patient, the magnetic guiding means is Sometimes it was impossible to tow further.
[0004]
[Patent Literature]
Japanese Patent Application No. 2002-268239 Specification
OBJECT OF THE INVENTION
SUMMARY OF THE INVENTION An object of the present invention is to provide an endoscope gripping device that can easily adjust the length of a connector and that can always sufficiently pull the guiding means .
[0006]
Summary of the Invention
In order to solve the above-described problems, the endoscope gripping apparatus of the present invention includes a gripping member that grips a target portion inside a target object and a magnetic body, and is attracted by a magnetic force generated outside the target object. Guiding means, and a connecting member that connects the gripping member and the guiding means, and the guiding means is provided at a through hole into which the connecting member can be inserted, and at one outlet of the through hole, And a connecting member holding portion having a gap portion into which the connecting member can be pushed.
[0007]
It is preferable that the connecting member holding portion has elasticity, and the gap portion is a slit penetrating the connecting member holding portion.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments according to the present invention will be described in detail with reference to the drawings. Endoscopic grasping device 1 according to this embodiment, the clip 10, connector 20, has a magnetic induction unit 30.
[0009]
(1) Configuration A clip (gripping member) 10 shown in FIG. 1 is a grasping member for grasping and lifting a lesioned part (target site) 130 (FIG. 6) in a patient (target) body. This clip 10 is provided with a pair of tip portions 10b having variable intervals at the tip of a main body portion 10a which is a pair of bent plate-like members. The main body portion 10a can be adjusted in the interval by a ratchet portion (interval adjusting portion) 10c fixed to the central portion thereof, and is fixed at the position after the interval adjustment by the ratchet mechanism. The ratchet portion 10c has a function of preventing the deformation when the paired main body portions 10a are elastically deformed in the direction of reducing the interval, and holding the narrow interval after the interval adjustment. A hole 10d for connecting the connector 20 to the clip 10 is formed by the ratchet portion 10c and the U-shaped portion of the main body portion 10a. The clip 10 in the initial state is open at the tip 10b due to its elasticity.
[0010]
The magnetic induction means ( induction means ) 30 is made of a substantially cylindrical ferromagnetic body, and includes a through hole 30b through which the connector 20 is inserted. A connector holding portion (connecting member holding portion) 30c as shown in FIG. 2 is disposed at one outlet of the through hole 30b. The connector holding part 30c is a member (for example, rubber) having a circular cross-sectional shape, and a connector insertion part (gap part) 30d provided in the center with a part cut out in a slit shape in the radial direction. It has. The coupling tool 20 can be pushed into the coupling tool insertion part 30d, and the pushed coupling tool 20 is pressed and held by the inner wall of the coupling tool insertion part 30d by the elasticity of the coupling tool holding part 30c. Examples of the magnetic material used in the magnetic induction means 30 include magnets such as platinum magnets, rare earth magnets, terbium / dysprosium / iron alloys, in addition to pure iron and iron alloys. Moreover, the connector insertion part 30d can be made into arbitrary shapes other than slit shape, and can be provided in arbitrary positions other than the center of the connector holding part 30c.
[0011]
The position of the magnetic guiding means 30 is controlled by a magnetic guiding means guiding device 110 having a magnetic guiding member 112 that controls the magnetic guiding means 30 outside the body of the patient 101 (powers the magnetic guiding means 30). In the magnetic induction member 112, an electromagnet 112c having a structure in which a coil is wound around an iron core is disposed on a base body 112a (FIG. 3).
[0012]
As shown in FIG. 3, the magnetic induction member 112 is slidable on a frame / rail (in-plane moving mechanism) 114 arranged so as to surround the bed 116 on which the patient 101 lies. It is placed so as to face each other. This frame / rail 114 is composed of two U-shaped rails 114a and 114b arranged in parallel in one plane, and two XY stages (one-way moving mechanism) are parallel to the width direction of the floor plate 116a of the bed 116. ) Between 118 and 119. The two XY stages 118 and 119 are relatively movable in a direction perpendicular to the plane on which the frame / rail 114 is provided. With the above configuration, the magnetic guiding member 112 can move between the two XY stages 118 and 119 by the base 112a sliding on the frame / rail 114. The magnetic guiding member 112 is disposed on the rail 114a on the side close to the patient 101 of the two parallel rails 114a and 114b of the frame / rail 114.
[0013]
A counterweight 120 for maintaining the weight balance of the entire frame / rail 114 is disposed on the rail 114b on the side far from the patient 101 of the frame / rail 114 so as to be slidable on the rail 114b. The counterweight 120 changes its position according to the position of the magnetic induction member 112. For example, when the magnetic guiding member 112 is in front of the patient 101, the counterweight 120 is disposed on the back of the patient 101, and when the magnetic guiding member 112 is on the back of the patient 101, the counterweight 120 is on the front of the patient 101. To balance the weight of the entire frame / rail 114.
[0014]
A connecting tool (connecting member) 20 shown in FIG. 1 connects the clip 10 and the magnetic guiding means 30, and a hook portion 20b and a retaining member 20c are provided at both ends of the main body portion 20a. . The main body 20a may be a rigid body, an elastic material, or a flexible material, and a spring, rubber, or the like can be used.
[0015]
The clip 10 and the connector 20 are connected by hooking the hook portion 20b to the hole portion 10d of the clip 10. On the other hand, the coupling tool 20 and the magnetic guiding means 30 are coupled with each other by holding the coupling tool after the main body portion 20a is inserted into the through hole 30b and the coupling tool holding section 30c is inserted without the retaining member 20c attached. The retaining member 20c is bonded and fixed to the tip of the main body 20a protruding from the portion 30c.
[0016]
The retaining member 20c includes a base portion 20d having a circular cross section disposed on the connector holding portion 30c side and a flange portion 20e having a larger outer diameter than the base portion 20d. The base portion 20d and the flange portion 20e are connected to the connector insertion portion 30d. Has a sufficiently large outer diameter. Therefore, even if the main body portion 20a is pulled in the direction in which it is pulled out from the magnetic guiding means 30, the retaining member 20c cannot be inserted into the coupling tool insertion portion 30d, so that the coupling tool 20 is prevented from falling off from the magnetic guiding means 30. Furthermore, the connector holding part 30c has elasticity, and the connector insertion part 30d is set to a length that will finally pass when the connector 20 is strongly pressed, so that the connector 20 that has been pressed is inserted. Is pressed against the inner wall of the connector insertion portion 30d and held in that position.
Note that the clip 10 and the connector 20 may be integrally formed.
[0017]
As described above, by arranging the magnetic guiding member 112, the XY stages 118 and 119, the frame / rail 114, and the like, the magnetic guiding member 112 can be disposed at an optimum position for excision of the lesion (target site) 130. it can. Therefore, in order to lift the lesioned part so as to be easily excised, the magnetic guiding means 30 is sucked (powered), and the clip 10 connected to the magnetic guiding means 30 via the connector 20 is moved in a desired direction. Can be towed.
[0018]
(2) Preparation for Execution of Resection As shown in FIG. 3, prior to performing resection using the endoscope grasping apparatus 1 according to the present invention, first, a patient 101 that has undergone local anesthesia is placed on a bed 116. Lay on top. At this time, the frame / rail 114 is retracted to the side where the head 101a of the patient 101 comes by the XY stages 118 and 119, and the magnetic guiding member 112 and the counterweight 120 are arranged at predetermined positions.
[0019]
When the patient 101 lies on the bed 116, the XY stages 118, 119 are operated to place the frame / rail 114 in front of the patient's lesion and then rubbed on the frame / rail 114. 112 is placed in the position at the start of the resection.
[0020]
(3) Operation of introducing the clip 10 and the magnetic guiding means 30 into the body (FIGS. 4 and 5)
The clip 10 and the magnetic guiding means 30 are introduced into the patient (target object) 101 using an introduction tube 70 inserted through the distal end rigid portion 60 of the endoscope 90.
[0021]
At the time of introduction, the magnetic guiding means 30, the connector 20, and the clip 10 are already connected, and the connector 20 and the clip 10 are inserted into a flexible hollow pipe-shaped introduction tube 70. The main body part 30 a and the connector holding part 30 c of the magnetic guiding means 30 are exposed to the outside of the introduction pipe 70. The distal end portion 10 b of the clip 10 is in contact with the flexible pushing rod 71 in the introduction tube 70. 71 extends over the entire length of the introduction pipe 70 to which the rear end portion 70a is welded. The introduction tube 70 is longer than the length from the distal end 90 a of the endoscope 90 to the forceps insertion port 91. Therefore, even if the introduction tube 70 is set on the endoscope 90 with the main body portion 30a of the magnetic guiding means 30 protruding from the distal end portion 90a of the endoscope 90, the rear end portion 70a of the introduction tube 70 is inserted with forceps. Located outside the mouth 91.
[0022]
A cut string 80 is provided at the rear portion of the introduction tube 70 that has come out of the forceps insertion port 91. The cut string 80 is provided along the circumferential direction of the introduction pipe 70, and its end 80a floats from the introduction pipe 70 so that the operator can easily pull the cut string 80, but the portions other than the end 80a are the introduction pipe. 70 and one. When the operator pulls the cut string 80, the cut string 80 is removed along the circumferential direction of the introduction pipe 70, so that the introduction pipe 70 is divided into two parts at the part where the cut string 80 is removed. Here, when the rear end portion 70a is pulled out, the flexible pushing rod 71 provided inside the introduction pipe appears. By moving the flexible pushing rod 71 in the axial direction, the magnetic guiding means 30, the connector 20, and the clip 10 are pushed out from the distal end portion of the introduction tube 70 into the body of the patient.
[0023]
Of the clip 10, the connector 20, and the magnetic guiding means 30 pushed out into the body, the clip 10 is grasped by the grasping forceps 100 (FIGS. 8 and 9) with the distal end portion 10 b opened and the lesioned portion 130. After being arranged at a predetermined position, the tip 10b is closed by tightening the ratchet portion 10c with the grasping forceps 100, and a part of the lesioned portion 130 is grasped and fixed at that position. At this time, the magnetic field generated by the magnetic induction member 112 is set weak. Next, by increasing the current flowing through the coil of the magnetic induction member 112 and strengthening the generated magnetic field, the magnetic induction means 30 is attracted to raise the lesioned part 130 to a desired height.
[0024]
In the above configuration, the lesioned part 130 can be lifted sufficiently high by attracting the magnetic guiding means 30 with the magnetic guiding member 112, so that a sufficient excised portion of the boundary between the lesioned part 130 and the normal tissue can be taken. Even if the lesioned part 130 has a flat shape, an excised part can be created. Further, since the clip 10 can be disposed at an arbitrary position, the view of the endoscope is not hindered by the excised lesion part 130.
[0025]
In addition, the clip 10 and the connection body of the connector 20 and the magnetic induction means 30 can also be introduced into the body separately. In this case, after introducing them into the body, they may be connected using the grasping forceps 100.
[0026]
(4) Step of excision The excision process of the lesioned part 130 using the magnetic guiding means guiding device 110 configured as described above will be described with reference to FIGS. 6 and 7.
[0027]
First, physiological saline is injected from the periphery of the lesioned part 130 with an injection needle inserted into the submucosal layer (not shown), and the lesioned part 130 is lifted from the proper muscle layer (not shown).
[0028]
On the other hand, the magnetic guiding member 112 is arranged at a preset position near the lesioned part 130. When set in this way, the lesioned part 130 is lifted by the attractive force between the magnetic guiding member 112 and the magnetic guiding means 30. When the amount of lifting of the lesioned part 130 is insufficient or too large, adjustment is performed by shifting the position of the magnetic guiding member 112 or weakening the magnetic field generated by the magnetic guiding member 112.
[0029]
Subsequently, an incision tool 62 such as a high-frequency knife is introduced into the body from the forceps channel 61 and the lesioned part 130 is excised together with the mucous membrane from the end. At this time, since the lesioned part 130 is lifted by the clip 10, the excised part can be taken sufficiently, and the already excised lesioned part 130 can also be prevented from falling on the intrinsic muscle layer. Moreover, since the excised lesioned part 130 can be further lifted by gradually shifting the position of the magnetic guiding member 112, the position of the distal end of the incision tool 62 can be easily confirmed, and the excision work can be performed smoothly.
[0030]
During resection, the clip 10 may not be pulled sufficiently. For example, when the excision of the lesioned part 130 proceeds and the lesioned part 130 is lifted higher, the magnetic guiding means 30 reaches the inner wall of the patient 101 so that the position of the clip 10 cannot be further increased. This is the case. In the present embodiment, since the distance between the clip 10 and the magnetic guiding means 30 can be adjusted, the position of the clip 10 can be further increased even in such a case.
[0031]
The distance between the clip 10 and the magnetic guiding means 30 is adjusted by gripping the retaining member 20c with gripping forceps 100 introduced into the body from the forceps channel 61, as shown in FIGS. When the grasping forceps 100 is pulled back into the forceps channel 61 in a state where the retaining member 20c is gripped by hooking the distal end portion 100a to the flange portion 20e, the retaining member whose outer diameter is set smaller than the inner diameter of the forceps channel 61. Although 20c is drawn into the forceps channel 61, the connector holding portion 30c having an outer diameter larger than the inner diameter of the forceps channel 61 abuts against the distal outer wall 60a of the distal rigid portion 60 and does not enter the forceps channel 61 (FIG. 8). . When the grasping forceps 100 is further pulled back into the forceps channel 61 in this state, only the main body portion 20a is pulled into the forceps channel 61 while the connector holding portion 30c is in contact with the distal end outer wall 60a (FIG. 9). Here, when the movement of pulling back the grasping forceps 100 is stopped, the main body portion 20a is held at that position by the connector holding portion 30c, and the distance between the magnetic guiding means 30 and the clip 10 is increased by the amount drawn into the forceps channel 61. Can be shortened.
[0032]
After adjusting the magnetic guiding means 30 and the clip 10 to a desired distance, the retaining member 20c can be returned to the body by removing the distal end portion 100a from the retaining member 20c and retracting the distal end rigid portion 60, The resection can be resumed (FIG. 10).
[0033]
When the excision operation is completed while adjusting the distance between the clip 10 and the magnetic guiding means 30 according to the situation, the magnetic guiding means 30 is attracted to the magnetic guiding member 112 in a state where the clip 10 holds the lesioned part 130, so It is possible to prevent 130 from being lost. When recovering the excised lesion part 130, the current supply to the magnetic induction member 112 is stopped while the magnetic guiding means 30, the clip 10, the connector 20, and a part of the lesion part 130 are held by the grasping forceps 100. Then, it is recovered by removing the endoscope as it is. Thereafter, treatments such as suturing and disinfection are performed.
[0034]
The magnetic guiding means 30 may be pulled using gravity.
[0035]
Although the present invention has been described with reference to the above embodiment, the present invention is not limited to the above embodiment, and can be improved or changed within the scope of the purpose of the improvement or the idea of the present invention.
[0036]
【The invention's effect】
As described above, according to the present invention, the adjustment provided with a through hole capable of inserting the connector into the induction unit, by providing a connector holding member for holding the connector, the length of the coupler to easily and optionally Therefore, it is possible to provide an endoscope gripping device that can always sufficiently pull the guiding means .
[Brief description of the drawings]
FIG. 1 is a partial cross-sectional view showing a configuration of an endoscope gripping apparatus according to an embodiment of the present invention.
2A is a plan view showing a configuration of a connector holding part according to an embodiment of the present invention, and FIG. 2B is a diagram illustrating a case where the main body of the connector is pushed into the connector insertion part of the connector holding part. It is a top view which shows the state.
FIG. 3 is a side view showing the configuration of the magnetic guiding means guiding device according to the embodiment of the present invention.
FIG. 4 is a side view showing the configuration of the endoscope according to the embodiment of the present invention.
FIG. 5 is a partial cross-sectional view illustrating a process of introducing the endoscope gripping apparatus according to the embodiment of the present invention into the body using an introduction tube, and (a) introduces the endoscope gripping apparatus. (B) shows a state in which the rear end side of the introduction tube is removed, and (c) shows a state in which the endoscope gripping device is pushed out from the introduction tube.
FIG. 6 is a diagram showing a state where the endoscope gripping apparatus according to the embodiment of the present invention is attached to a lesioned part.
FIG. 7 is a diagram showing a state in which a lesion is lifted by an endoscope gripping apparatus according to an embodiment of the present invention.
FIG. 8 is a view showing a state in which the retaining member of the endoscope gripping apparatus according to the embodiment of the present invention is gripped by gripping forceps.
FIG. 9 is a view showing a state in which the coupler of the endoscope gripping apparatus according to the embodiment of the present invention is pulled into the forceps channel.
FIG. 10 is a diagram showing a state of excision after adjusting the interval between the magnetic guiding means and the clip according to the embodiment of the present invention.
[Explanation of symbols]
1 Endoscopic grasping device 10 Clip (gripping member)
20 connector (connecting member)
30 Magnetic guidance means (guidance means)
30b Through-hole 30c Connector holding part (connecting member holding part)
30d Connector insertion part (gap part)
101 Patient (object)
130 Lesions (target site)

Claims (2)

A gripping member for gripping a target part inside the target;
A guiding means made of a magnetic material and attracted by a magnetic force generated outside the object ;
A connecting member that connects the gripping member and the guiding means ;
With
The guiding means includes a through-hole into which the connecting member can be inserted,
A connecting member holding portion provided at one outlet of the through hole, and having a gap portion into which the connecting member can be pushed,
An endoscope gripping device comprising: The endoscope gripping apparatus according to claim 1, wherein the connecting member holding portion has elasticity, and the gap portion is a slit penetrating the connecting member holding portion.

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