JP4338441B2 - Endoscope guidance means guidance system and endoscope guidance device - Google Patents

Description

[0001]
【Technical field】
The present invention relates to an endoscope guidance means guidance system and an endoscope guidance device used when excising a lesioned part under endoscopic observation.
[0002]
[Prior art and its problems]
Conventionally, when excising a lesion inside a human body in a normal operation, the distance between the lesion and the adjacent normal tissue is widened by lifting the lesion using a grasping forceps, and the lesion and the normal tissue are in that state. It is excised between. However, for example, in endoscopic mucosal resection (EMR), since only one endoscope can be inserted into the body, the lesion cannot be lifted, and physiological saline is applied to the normal mucosa around the lesion with an injection needle. The lesion was lifted by injecting, and in that state, excision between the lesion and the normal mucous membrane was performed using a high-frequency knife or snare.
[0003]
However, in such a conventional method, the lesioned part could not be lifted to a sufficient position, and thus a sufficient excision part at the boundary between the lesioned part and the normal tissue could not be secured.
In addition, when the lesioned part has a flat shape, it may not be possible to create an excised part.
[0004]
Further, during the excision work, the already excised lesioned part may fall on the normal tissue, thereby obstructing the field of view by the endoscope, particularly when the lesioned part is large. For this reason, the excised part cannot be seen, and in order to remove it blindly, the normal part is damaged and complications such as perforation occur, blood vessels are damaged and major bleeding occurs. Since it could not be confirmed and hemostasis could not be achieved, serious complications could occur, and a safer device and treatment method were required.
[0005]
Therefore, in order to solve these problems, the present applicant arranges a clip for gripping a lesion in the human body, a magnetic guiding means (magnetic anchor) made of a magnetic material connected to the clip, and a human body. is provided with a magnetic induction means guiding device to power the magnetic induction means to generate a magnetic field, and power the magnetic induction means by a magnetic field magnetic induction means guiding device occurs, lesions that are gripped by the clip Proposed a magnetic guidance means guidance system characterized by lifting and lifting a patent (Japanese Patent Application No. 2002-268239).
[0006]
However, since the gripping force by the clip used in this patent application is not so large, when the power applied to the magnetic guiding means is large, the clip may be detached from the lesion. If the clip is detached from the lesioned part in this way, it becomes necessary to grip the clip again on the lesioned part, so that it takes a long time to treat the lesioned part, which increases the burden on the operator and the patient. End up.
[0007]
OBJECT OF THE INVENTION
An object of the present invention, the concatenated piercing fitting and guiding means, after piercing the target site within the object, which can be stopped reliably escape, guide means guiding system for an endoscope, and the endoscope The object is to provide a mirror guidance device .
[0008]
Summary of the Invention
In the endoscope guiding means guiding system according to the present invention, a piercing fixture that can be pierced, a magnetic guiding means made of a magnetic material, and the magnetic guiding means and the piercing fixture are connected to a target portion inside an object. An endoscope comprising: a flexible coupling string; and a magnetic guidance means guidance device that is disposed outside the object, generates a magnetic field, and moves the magnetic guidance means in a predetermined direction by a magnetic force generated from the magnetic field. The guiding means guiding system for use, wherein the piercing fixture has a piercing member having a needle portion at a tip portion thereof, and a return member which becomes a resistance when trying to move in the removal direction when the piercing to the target site is completed It is characterized by having.
[0009]
The return member has a needle member at a tip portion thereof, a retaining member made of a member different from the piercing member, a needle portion of the retaining member contacting the needle portion of the piercing member, and a rear end portion of the piercing member. It is preferable to include an urging means for urging the separation member and the piercing member to be urged away from the member.
[0010]
[0011]
[0012]
According to another aspect, guide means guiding system for endoscopes according to the present invention, the target site within the object, and piercing fixture pierceable, moves by gravity, and gravity guide means made of a nonmagnetic material , a guide means guiding system for an endoscope comprising a flexible connection cord for connecting the heavy force guidance means and the piercing fitment, the said piercing fitment, barbs having a needle portion at its distal end It is characterized by comprising a member and a return member that becomes a resistance when attempting to move in the removal direction in a state where the puncture to the target site has been completed.
[0013]
Also in this aspect, the return member has a needle member at the tip thereof, a retaining member made of a member different from the piercing member, and the needle member of the retaining member is in contact with the needle member of the piercing member, and the rear end The return member preferably includes an urging means for urging the portion so as to be separated from the piercing member, and connecting the retaining member and the piercing member. A retaining member made of a member different from the piercing member, and the retaining member that urges the needle portion of the retaining member to contact the needle portion of the piercing member and the rear end portion away from the piercing member. Biasing means for coupling the piercing member.
[0014]
[0015]
Further, in any aspect, it is preferable to include a grasping forceps that can be inserted into and removed from the forceps channel of the endoscope and that pierces the target portion while grasping the piercing fixture.
[0016]
An endoscope guidance device according to the present invention includes a piercing fixture that can be pierced into a target portion inside a target object, a magnetic guiding means that is attracted by a magnetic force generated outside the target object, A flexible coupling string for connecting the magnetic guiding means and the puncture attachment, and the puncture attachment is removed in a state where a puncture member having a needle portion at a tip portion thereof and a puncture to the target site is completed And a return member that becomes a resistance when trying to move in the direction .
[0017]
The return member is provided with a stopper member having a needle portion at the tip thereof, which is a separate member from the piercing member, the needle portion of the stopper member is in contact with the needle portion of the piercing member, and the rear end portion is the piercing member. It is preferable to include an urging means for urging the separation member and the piercing member to be urged away from the member.
[0018]
[0019]
[0020]
[0021]
[0022]
[0023]
[0024]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, a first embodiment of the present invention will be described with reference to FIGS.
The guiding means guiding system of the present embodiment includes a magnetic guiding device 10 (magnetic guiding means 11, puncture fitting 12, and connecting string 16), an endoscope 20, and a puncture of the puncture attachment 12 to the tongue-like mucous membrane Y. and the grasping forceps 30 for operation or the like, the magnetic induction device 10 for suction control in vitro (on the magnetic force on the magnetic induction means 11) is made of a magnetic induction means guiding device 40.
[0025]
First, the configuration of the magnetic induction device 10 will be described with reference to FIG.
The magnetic induction means 11 includes a front part 11a having a substantially cylindrical shape and a rear part 11b having a substantially triangular pyramid shape, and is entirely formed of a ferromagnetic material. Specific examples of the magnetic material include magnets such as platinum magnets, rare earth magnets, terbium / dysprosium / iron alloys, in addition to pure iron and iron alloys.
[0026]
The piercing fixture 12 has a long piercing member 13 having a sharp needle portion 13a at its tip, and a retaining member (return member) 14 having a sharp needle portion 14a at its tip and shorter than the piercing member 13. And a compression spring (return member) (biasing means) 15 that couples the piercing member 13 and the retaining member 14. The compression spring 15 constantly urges the retaining member 14 so that the needle portion 14 a of the retaining member 14 contacts the needle portion 13 a of the piercing member 13 and the rear end portion is separated from the piercing member 13.
[0027]
One end of a flexible connecting string 16 is fixed to the rear part 11 b of the magnetic guiding means 11, and the other end of the connecting string 16 is firmly connected to the base end of the piercing member 13. The piercing fixture 12 and the magnetic guiding means 11 are connected via the. As the connecting string 16, for example, a surgical suture, a fishing line, or a metal wire can be used.
[0028]
FIG. 2 shows an endoscope 20 used for performing a resection using a guiding means guiding system.
Since the structure of the endoscope 20 is well known, detailed description thereof is omitted. However, an air / water supply nozzle (not shown) for sending air and cleaning water to the distal end surface 22 of the insertion portion 21 to be inserted into the body, an excision portion. And an illumination window for illuminating the periphery thereof (not shown), an observation window (not shown) in which an objective lens is disposed immediately after observing the excision and the periphery thereof, and an outlet 23 of the forceps channel C (not shown) 7 and 8). The forceps channel C is formed in the insertion portion 21, and its inlet 24 a is formed on the end surface of the forceps insertion port protrusion 24.
[0029]
The grasping forceps 30 shown in FIGS. 3 and 4 are inserted into and removed from the forceps channel C of the endoscope 20.
The grasping forceps 30 includes a pair of grasping claws 31 and 32 that can be opened and closed at the distal end thereof. By operating an operation unit (not shown) provided at the base end, the grasping claws 31 and 32 are It can be changed between the fully closed state shown in FIG. 3 and the fully opened state shown in FIG.
[0030]
Next, with reference to FIGS. 5 and 6, description will be given of a configuration of the magnetic induction means guiding device 40 for sucking controls the magnetic guiding device 11 in the outside of the patient's body A.
A pair of XY stages (one-way moving mechanisms) 42 and 42 are disposed on both sides of the bed 41 having a floor plate 41a on which the patient A is placed. The pair of XY stages 42 reciprocate linearly along the longitudinal direction of the bed 41 so that the longitudinal positions of the both 42 and 42 are always the same. Further, above the bed 41, a frame / rail (two-plane moving mechanism) composed of two rails 44 and 45 that are substantially U-shaped in front view and are parallel to each other in a plane orthogonal to the longitudinal direction of the bed 41. 43, and both ends of the frame / rail 43 are fixed to the left and right XY stages 42, respectively. Inside the rail 44, (on a magnetic force to the magnetic induction means 11) for the magnetic induction means 11 for suction control in vitro of the magnetic induction apparatus 10 magnetic induction member 46 is mounted slidably, magnetic induction member 46 Can move along the rail 45 between the left and right XY stages 42. The magnetic induction member 46 is obtained by fixing an electromagnet 47 having a structure in which a coil is wound around an iron core on a base 48, and the electromagnet 47 always faces the patient A side (see FIG. 5). The magnetic induction member 46 may be a combination of a permanent magnet and an electromagnet, or a combination of two or more permanent magnets and electromagnets.
[0031]
A counterweight 49 for maintaining the weight balance of the entire frame / rail 43 is slidably mounted on the rail 45 on the rail 45 outside the frame / rail 43. The counterweight 49 changes its position according to the position of the magnetic induction member 46. For example, when the magnetic guide member 46 is located on the front side of the patient A, the counterweight 49 is located on the back side of the patient A, and when the magnetic guide member 46 is on the back side of the patient A, the counterweight 49 is Located on the front side of the patient A, the entire frame / rail 43 is balanced in weight.
The above magnetic induction member 46, XY stage 42 described, the magnetic induction means guiding device 40 by a frame / rail 43 is constituted.
[0032]
Next, the excision procedure of the lesion X using the guidance means guidance system will be described.
Prior to performing excision using the guiding means guiding system, first, the patient A subjected to local anesthesia is laid on the floor plate 41a of the bed 41 as shown in FIGS. At this time, the XY stage 42 is operated so that the longitudinal direction position of the bed 41 of the frame / rail 43 is substantially the same position as the head A1 of the patient A, and the magnetic induction member 46 and the counterweight 49 are set to a predetermined position. Keep it in the place.
Next, the XY stage 42 is operated to place the frame / rail 43 on the front side of the patient A, and the magnetic guiding device 46 is moved along the frame / rail 43 to start excision of the magnetic guiding member 46. Position at the hour position (see FIG. 6).
[0033]
Next, a flexible overtube (not shown) is inserted into the body from the mouth of the patient A, and the tip of the overtube is inserted into the organ B (see FIG. 9 to FIG. 12) (target). Close to the lesion X. Then, the endoscope 20 is inserted into the overtube, the distal end portion of the insertion portion 21 is projected from the distal end of the overtube, and is brought close to the lesioned portion X (not shown). As described above, when the distal end of the insertion portion 21 of the endoscope 20 is inserted into the organ B, an observation image in the organ B obtained from the observation window of the endoscope 20 is displayed on a television monitor (not shown). .
[0034]
Next, a tube-like treatment instrument (not shown) having an injection needle is inserted into the distal end portion from the inlet 24a of the forceps insertion port projection 24, and the injection needle is protruded from the outlet 23 of the insertion portion 21, so that the injection needle Is inserted into the submucosal layer B1 of the organ wall from around the lesioned part X, and physiological saline is injected, and the lesioned part X is lifted from the proper muscle layer B2.
Next, the treatment tool is taken out from the forceps channel C of the endoscope 20, and instead, a high-frequency knife 50 as shown in FIG. 9 (the illustration of the endoscope 20 is omitted in FIG. 9) is inserted, and its distal end 50a is used. Then, a cut is made in the mucous membrane in the vicinity of the lesion X, and a lingual mucosa (target site) Y is formed in the vicinity of the lesion X (see FIGS. 9 to 12).
[0035]
Next, the endoscope 20 is taken out from the body of the patient A, the high-frequency knife 50 is further removed from the forceps channel C, and the grasping forceps 30 and the magnetic guiding device 10 are next placed on the endoscope 20 outside the body of the patient A. Install according to the procedure.
[0036]
First, the operation part of the grasping forceps 30 is operated in advance so that the grasping claws 31 and 32 are fully closed, and the grasping forceps 30 is inserted into the forceps channel C from the inlet 24a of the forceps insertion port projection 24, as shown in FIG. As shown, both gripping claws 31 and 32 are projected from the distal end surface 22 of the endoscope 20.
[0037]
Next, the gripping claws 31 and 32 are opened by operating the operation unit, and then the piercing fixture 12 is brought close to the gripping claws 31 and 32 from the front of the endoscope 20, and the gripping claws are further operated by operating the operation unit. 31 and 32 are returned to a fully closed state, and the piercing member 13 of the piercing fixture 12 is gripped by both gripping claws 31 and 32 (see FIG. 7).
When the piercing fixture 12 is gripped by the gripping forceps 30 in this way, the proximal end portion (not shown) of the gripping forceps 30 protruding rearward from the forceps insertion port projection 24 is pulled backward to pierce the piercing fixture 12. And the connecting string 16 are completely accommodated in the forceps channel C, and a part of the rear part 11b of the magnetic guiding means 11 is accommodated in the forceps channel C, and the rear part 11b is brought into contact with the distal end surface 22 of the insertion part 21. The endoscope 20, the magnetic guidance device 10, and the grasping forceps 30 are integrated (see FIG. 8).
[0038]
Next, the endoscope 20 in such a state is inserted again into the organ B, the distal end portion of the insertion portion 21 is brought close to the tongue-like mucosa Y, and then grasping forceps (not shown in FIGS. 9 to 11). 30 is moved relative to the endoscope 20 toward the lingual mucosa Y side. Then, the magnetic guiding means 11 is detached from the endoscope 20, and the puncture fitting 12 is brought close to the tongue-like mucosa Y (see FIG. 9). Further, when the grasping forceps 30 are operated and the needle portions 13a and 14a of the piercing member 13 and the retaining member 14 are pierced into the tongue-shaped mucous membrane Y, as shown in FIG. Since resistance is received from Y, the retaining member 14 rotates toward the piercing member 13 around the needle portion 14a against the urging force of the compression spring 15. Thus, when the retaining member 14 approaches the piercing member 13 side, the resistance force that the piercing member 13 and the retaining member 14 receive from the tongue-shaped mucosa Y decreases, so that the piercing member 13 and the retaining member 14 become the tongue-shaped mucosa Y. It comes to pierce smoothly.
Then, as shown in FIG. 11, when the proximal end of the retaining member 14 penetrates the tongue-shaped mucous membrane Y, the retaining member 14 rotates in a direction in which the proximal end separates from the piercing member 13 by the biasing force of the compression spring 15. Therefore, the distance between the retaining member 14 and the piercing member 13 is widened, and the retaining member 14 completely prevents the piercing member 13 and the retaining member 14 from coming off the tongue-shaped mucosa Y.
[0039]
Subsequently, the operation unit of the grasping forceps 30 is operated to open both the grasping claws 31 and 32 and release the piercing fixture 12 from the grasping forceps 30.
Subsequently, as shown in FIG. 12, when the magnetic induction means 11 is attracted to the upper side of FIG. 12 by increasing the magnetic field generated by the magnetic induction member 46 arranged outside the body of the patient A, the connecting string 16 is obtained. As the whole is tensed, the puncture attachment 12 moves in the direction of magnetic force (upward in FIG. 12), and the tongue-like mucosa Y integrated with the puncture attachment 12 moves in the same direction. Make sure to move a sufficient distance in the direction.
[0040]
As described above, when the lesioned part X is moved by a desired distance in a desired direction, a sufficiently large excision part is formed at the boundary between the lesioned part X and the normal tissue. The lesioned part X is excised together with the mucous membrane from one end side.
When the lesioned part X is excised from one end side to the opposite end side, the entire lesioned part X is eventually completely excised (not shown).
At the time of excision work with the high-frequency knife 50, the position of the tip 50a of the high-frequency knife 50 becomes easier to confirm as the excision area is expanded.
[0041]
When the excision work is completed as described above, the lesioned part X separated from the normal tissue maintains an integrated state with the puncture attachment 12 (magnetic guiding device 10), so that the lesioned part X is prevented from being lost. . In order to collect the excised lesion X, the high-frequency knife 50 is pulled out from the forceps channel C of the endoscope 20, the gripping forceps 30 are inserted into the forceps channel C again, and the piercing fixture 12 is gripped by the gripping forceps 30. In this state, the endoscope 20 is removed from the body, and the lesion X is taken out of the body together with the magnetic guidance device 10. Thereafter, treatments such as suturing and disinfection of the excised part are performed.
[0042]
As described above, by using the guiding means guiding system of the present embodiment, the piercing fixture 12 that forms part of the magnetic guiding device 10 can be smoothly pierced into the tongue-like mucous membrane Y, and the retaining member 14 The puncture attachment 12 can be reliably prevented from coming off the tongue-like mucosa Y. Therefore, even if the magnetic force applied to the magnetic guiding means 11 is large, the puncture fitting 12 does not come out of the tongue-shaped mucosa Y. For this reason, compared with the case where the lesioned part X is hold | gripped with a clip conventionally, the burden of an operator and a patient can be reduced.
[0043]
Further, since the lesioned part X can be moved in a desired direction by a sufficient distance, the excision part at the boundary between the lesioned part X and the normal tissue can be easily and reliably secured with a sufficient size. Even if the lesioned part X has a flat shape, a sufficiently large excision part can be created, so that the lesioned part X can be easily excised.
[0044]
Furthermore, since the lesioned part X is lifted by the piercing fixture 12, a sufficient excised part can be secured, and the already excised lesioned part X can be prevented from falling on the proper muscle layer B2.
Moreover, since the puncture attachment 12 can be arrange | positioned in arbitrary positions, the visual field of the endoscope 20 is not prevented by the excised lesioned part X.
[0045]
Next, a second embodiment of the present invention will be described with reference to FIG.
The same members as those in the first embodiment are designated by the same reference numerals, and detailed description thereof is omitted.
[0046]
The guiding means guiding system according to the present embodiment includes a gravity guiding device 60 (consisting of a gravity guiding means 61, a piercing fixture 12, and a connecting string 16), an endoscope 20, and a grasping forceps 30.
The outer shape of the gravity guiding means 61 is the same as that of the magnetic guiding means 11, and includes a front part 61a and a rear part 61b. The gravity guiding means 61 is entirely formed of a nonmagnetic material, and specific examples of the nonmagnetic material include gold, copper, aluminum, stainless steel (austenite), brass, ceramic, glass, and the like.
[0047]
The gravity guiding device 60 is inserted into the organ B in a state of being attached to the endoscope 20 in the same manner as in the first embodiment, and then the puncture attachment 12 is attached to the lingual mucosa Y by the grasping forceps 30. And then released from the grasping forceps 30.
As shown in FIG. 13, since the gravity guiding means 61 moves according to the gravity P, if the posture of the patient A is changed and the gravity guiding means 61 is moved downward in the direction of gravity, the string portion 16 is tensioned and the piercing is attached. The lesion Y to which the tool 12 is attached moves downward in the direction of gravity. For this reason, a sufficiently large excision part is formed at the boundary between the lesion X and the normal tissue. Therefore, the lesion X is excised with the high-frequency knife 50 (not shown in FIG. 13).
[0048]
As described above, also with the guiding means guiding system of the present embodiment, the piercing fixture 12 that forms a part of the gravity guiding device 60 can be smoothly pierced into the lingual mucosa Y as in the first embodiment. In addition, after the penetration, the retaining member 14 can surely prevent the retaining. Therefore, even if the mass of the gravity guiding means 61 is large, the puncture fitting 12 does not come out of the tongue-shaped mucosa Y.
Furthermore, in this embodiment, the magnetic guiding means guiding device 40, which is an expensive device necessary in the first embodiment, is unnecessary, which is advantageous in terms of cost compared to the first embodiment.
[0049]
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. For example, the piercing fixture 12 can include a plurality of retaining members 14 and compression springs 15.
Further, the piercing fixture may be configured such that the compression spring 15 is omitted and the needle portion 14a of the retaining member 14 is fixed to the needle portion 13a of the piercing portion 13. Such a piercing fixture is also reliably prevented from coming off the tongue-like mucous membrane Y by the retaining member 14 after penetrating the tongue-like mucosa Y.
[0050]
【The invention's effect】
As described above, according to the present invention, the piercing fixture connected to the guiding means can be surely prevented from coming off after piercing the target portion inside the target object.
[Brief description of the drawings]
FIG. 1 is an overall view of a magnetic induction device according to a first embodiment of the present invention.
FIG. 2 is an overall view of an endoscope.
FIG. 3 is a view showing a distal end portion of a grasping forceps in a state where a grasping claw is closed.
FIG. 4 is a view showing a distal end portion of a grasping forceps in a state where a grasping claw is opened.
FIG. 5 is a view of a bed on which a patient to be excised from a lesion is placed and a magnetic guidance means guidance device as seen from the patient's head side.
FIG. 6 is a side view of a bed on which a patient is placed and a magnetic guiding means guiding device.
FIG. 7 is a cross-sectional view of the endoscope showing a state in which the grasping forceps inserted into the forceps channel of the endoscope are gripping the magnetic guiding device outside the endoscope.
FIG. 8 is a cross-sectional view of the endoscope showing a state in which the grasping forceps inserted into the forceps channel of the endoscope are pulled into the forceps channel while holding the magnetic guidance device .
FIG. 9 is a view showing a state in which the puncture fitting is approaching a lingual mucosa formed in the vicinity of an affected part of an organ.
FIG. 10 is a view showing a state where the puncture fitting is penetrating the lingual mucosa.
FIG. 11 is a view showing a state after the retaining member of the puncture fitting has completely penetrated the lingual mucosa.
FIG. 12 is a view showing a state in which the magnetic guiding means is moved by using the magnetic guiding means guiding device after the puncture fitting is passed through the tongue-like mucosa and attached.
FIG. 13 is a view showing a state in which the gravity guiding means is moved according to gravity after the piercing fixture of the second embodiment of the present invention is attached to penetrate the tongue-like mucosa.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 10 Magnetic guidance apparatus 11 Magnetic guidance means 11a Front part 11b Rear part 12 Puncture attachment tool 13 Puncture member 13a Needle part 14 Stopping member (return member)
14a Needle portion 15 Compression spring (return member) (biasing means)
16 Connecting string 20 Endoscope 21 Insertion section 22 End face 23 Forceps channel outlet 24 Forceps insertion port protrusion 24a Inlet 30 Grip forceps 31 Grip claw 32 Grip claw 40 Magnetic guiding means guiding device 41 Bed 41a Floor plate 42 XY stage (one direction Moving mechanism)
43 Frame / rail (moving mechanism in one plane)
44 rail 45 rail 46 magnetic guiding member 47 electromagnet 48 base 49 counterweight 50 high frequency knife 50a tip 60 gravity guiding device 61 gravity guiding means 61a front 61b rear A patient A1 head B organ (object)
B1 Submucosal layer B2 Intrinsic muscle layer C Forceps channel P Gravity X Lesions Y Tongue mucosa (target site)

Claims (8)

A piercing fixture that can be pierced into a target part inside the target object,
Magnetic induction means made of a magnetic material;
A flexible coupling string connecting the magnetic guiding means and the piercing fixture;
Disposed above the object outside, and generates a magnetic field, a magnetic induction unit guiding device for moving the magnetic induction means in a predetermined direction by magnetic force generated from the magnetic field,
An endoscope guidance means guidance system comprising:
The piercing fixture is
A piercing member having a needle portion at its tip,
A return member that becomes a resistance when trying to move in the removal direction in the state where the puncture to the target site is completed,
An endoscope guidance means guidance system comprising: The endoscope guiding means guiding system according to claim 1,
The return member is
A retaining member made of a member different from the piercing member, which has a needle portion at its tip,
An urging means for coupling the retaining member and the piercing member to urge the needle portion of the retaining member to contact the needle portion of the piercing member and to separate the rear end portion from the piercing member;
An endoscope guidance means guidance system comprising: The endoscope guiding means guiding system according to claim 1 or 2,
The magnetic guiding means guiding device is:
A magnetic induction member that generates a magnetic force by a generated magnetic field and moves the magnetic induction means in a predetermined direction by the magnetic force;
An in-plane movement mechanism for moving the magnetic induction member along a U-shaped frame member arranged in a specific plane;
A one-way moving mechanism for relatively moving the U-shaped frame member in a direction orthogonal to the one plane;
An endoscope guidance means guidance system comprising: A piercing fixture that can be pierced into a target part inside the target object,
Gravity guiding means made of non-magnetic material that moves according to gravity,
A flexible connecting string connecting the gravity guiding means and the piercing fixture;
A guide means guiding system for an endoscope having a,
The piercing fixture is
A piercing member having a needle portion at its tip,
A return member that becomes a resistance when trying to move in the removal direction in the state where the puncture to the target site is completed,
An endoscope guidance means guidance system comprising: The endoscope guiding means guiding system according to claim 4 ,
The return member is
A retaining member made of a member different from the piercing member, which has a needle portion at its tip,
An urging means for coupling the retaining member and the piercing member to urge the needle portion of the retaining member to contact the needle portion of the piercing member and to separate the rear end portion from the piercing member;
An endoscope guidance means guidance system comprising: The endoscope guiding means guiding system according to any one of claims 1 to 5 ,
further,
It can be inserted into and removed from the forceps channel of the endoscope,
An endoscope guiding means guiding system comprising grasping forceps for piercing the target portion while grasping the piercing fixture . A piercing fixture that can be pierced into a target part inside the target object,
Magnetic induction means made of a magnetic material and attracted by a magnetic force generated outside the object;
A flexible coupling string connecting the magnetic guiding means and the piercing fixture;
Comprising
The piercing fixture is
A piercing member having a needle portion at its tip,
A return member that becomes a resistance when trying to move in the removal direction in the state where the puncture to the target site is completed,
An endoscope guidance device comprising: In the endoscope guidance device according to claim 7 ,
The return member is
A retaining member having a needle portion at the tip thereof, which is a separate member from the piercing member, the needle portion of the retaining member being in contact with the needle portion of the piercing member, and the rear end portion being separated from the piercing member An endoscopic guidance device comprising: an urging means for urging the urging member to couple the retaining member and the piercing member.

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