JP4462482B2 - Magnetic anchor remote guidance system - Google Patents

Description

The present invention relates to a magnetic anchor remote guidance system for grasping a patient's lesion using an anchor when the lesion is excised under endoscopic observation.

An example of a conventional magnetic anchor remote guidance system is described in Japanese Patent Application No. 2002-268239. In this system, a hooking member for hooking a target portion inside the target object, a magnetic anchor made of a magnetic material connected to the hooking member, and a magnetic anchor disposed outside the target object to generate a magnetic field to the magnetic anchor. A magnetic anchor guiding device for applying power, and applying power to the magnetic anchor by a magnetic field generated by the magnetic anchor guiding device to lift a target portion that is hooked on the hooking member.
Japanese Patent Application No. 2002-268239

However, in the magnetic anchor remote guidance system described above, when the traction direction is changed, it is necessary to guide a large magnetic anchor guidance device arranged outside the object even if the change amount is small. is there. For this reason, in order to change the pulling direction during the treatment, it may be necessary to interrupt the treatment and check the operation status of the magnetic anchor remote guidance system. In addition, it may be difficult to change the direction with a large magnetic anchor guiding device, and if the direction is changed more than necessary, the treatment may fail.

In order to solve the above problems, a magnetic anchor remote guidance system according to the present invention includes a gripping member that grips a target portion inside a target object , and a magnetized magnetic anchor portion that pulls the gripping member via a connecting member. A control means for controlling a pulling direction by the magnetic anchor part; and a magnetic induction member that is arranged outside the object and that can move the magnetic anchor part by generating a magnetic field. A pulling direction change anchor having therein a moving chamber extending in a direction different from the magnetization direction, and made of a magnetic material and magnetized in the same direction as the magnetization direction by the control means , and in the moving chamber The pulling direction of the gripping member is changed by moving the arranged moving member.

  The control means includes two springs made of a shape memory alloy, and an energization device that energizes and heats the two springs, and one of the two springs is one of two opposing side surfaces of the moving member, Both ends abut against one of the two opposing inner walls of the moving chamber, the other of the two springs is the other of the two opposing side surfaces of the moving member, the other of the two opposing inner walls of the moving chamber, It is preferable that both ends are in contact with each other, and the moving member is arranged at a predetermined position in the moving chamber by energizing and heating one of the two springs.

  The control means includes an air cylinder having two pressure suction tubes, and one of the two pressure suction tubes is one of two opposite side surfaces of the moving member and the opposite of the moving chamber. The other of the two pressurized suction tubes communicates with the space between one of the two inner walls, and the other of the two opposing side surfaces of the moving member and the two inner walls of the moving chamber facing each other. The moving member can be disposed at a predetermined position in the moving chamber by supplying or sucking air through one of the two pressurized suction tubes.

  The anchor portion preferably has a traction anchor connected to a traction direction change anchor by a connecting member.

  According to the present invention, by providing the traction direction change anchor, the traction direction can be changed by a desired amount in the direction desired by the operator without interrupting the treatment.

Hereinafter, embodiments according to the present invention will be described in detail with reference to the drawings.
An endoscope grasping apparatus 1 according to an embodiment includes a clip (gripping member) 10, a magnetic anchor part (anchor part) 30 that pulls the clip 10, a connecting member 20 that connects the clip 10 and the magnetic anchor part 30, and a magnetic anchor. An energization device 25 that controls the pulling direction by the unit 30 is provided.

(1) Configuration As shown in FIGS. 1 to 3, the clip (gripping member) 10 has a plate-shaped member 11, 12, 13 having the same shape with respect to the outer diameter of the substantially circular base end portion 10 a. It is an elastic member formed by fixing one end in the longitudinal direction. The plate-like members 11, 12, and 13 are arranged at intervals of 120 degrees on the outer diameter of the base end portion 10a, and extend in parallel with each other with the bottom face inward. Note that the number of plate-like members may be two or three or more as long as the clip 10 can grip the lesioned part.

On the other hand, claw portions 11a, 12a, and 13a bent inward are formed at the other end portion that is not fixed to the base end portion 10a. For this reason, if the plate-shaped members 11, 12, and 13 are energized so as to approach each other, the object can be held between the claw portions 11a, 12a, and 13a.

Further, at the same position in the longitudinal direction of each of the plate-like members 11, 12, 13, the convex portions 11 b, 12 b, 13 b projecting outward from the front and rear portions by bending the plate-like members 11, 12, 13. And the inclined portions 11c, 12c, 13c that spread outward again from the front ends of the convex portions 11b, 12b, 13b narrowed inward, and the claw portions 11a, 12a, 13a from the front ends of the inclined portions 11c, 12c, 13c. Leading end portions 11d, 12d, and 13d are provided.

In this configuration, when a force that biases the convex portions 11b, 12b, and 13b inward is applied, the bending angle before and after the change changes, so that the inclined portions 11c, 12c, and 13c and the tip portions 11d, 12d, and 13d are Spread outward (Fig. 3). When a force for urging the inclined portions 11c, 12c, 13c and the tip end portions 11d, 12d, 13d inward is applied in a state where the convex portions 11b, 12b, 13b are urged inward, this time, the inclined portions The bending angles of 11c, 12c, and 13c and tip portions 11d, 12d, and 13d change so that the interval between them is narrowed.

Inside the clip 10, a connecting member 20 having flexibility for connecting the clip 10 and the magnetic anchor part 30 is inserted. As the connecting member 20, for example, a surgical suture, a fishing line, or a metal wire can be used.

The magnetic anchor portion 30 coupled to the coupling member 20 includes a traction direction change anchor 32 and a traction anchor 33 that are coupled to each other by the coupling member 34.

The traction direction change anchor 32 shown in FIG. 4 is made of a ferromagnetic material, and can be attracted and controlled by using a magnetic induction member such as an electromagnet or a permanent magnet. As the magnetic material used for the pulling direction changing anchor 32, magnets such as platinum magnet, rare earth magnet, terbium / dysprosium / iron alloy can be used in addition to pure iron and iron alloy.

From the end surface 32a, a hole 32f is formed in the small diameter portion 32c, and a fixed hole 32g having a larger inner diameter than the hole 32f is formed inward from the hole 32f to the small diameter portion 32c. The connecting member 20 is inserted into the hole 32f, and the tip of the connecting member 20 is tied in the fixed hole 32g, whereby the connecting member 20 and the pulling direction changing anchor 32 are connected. Adhering the connecting member 20 to the inner surface of the hole 32f and / or the fixed hole 32g is preferable because the connecting strength between the connecting member 20 and the traction direction change anchor 32 increases.

On the other hand, a hole 32h is formed in the large diameter portion 32d from the end face 32b, and a fixed hole 32i having a larger inner diameter than the hole 32h is formed from the hole 32h to the inside of the large diameter portion 32d. The connecting member 34 is inserted into the hole 32h, and the leading end thereof is tied in the fixed hole 32i, whereby the pulling direction changing anchor 32 and the connecting member 34 are connected. Adhering the connecting member 34 to the inner surface of the hole 32h and / or the fixed hole 32i is preferable because the connection strength between the traction direction change anchor 32 and the connecting member 34 is increased.

The pulling direction change anchor 32 is magnetized so that the end face 32a side is N-pole and the end face 32b side is S-pole, or the end face 32a side is S-pole and the end face 32b side is N-pole. That is, the magnetization direction of the traction direction change anchor 32 is a direction from the end surface 32a toward the end surface 32b, or a direction from the end surface 32b toward the end surface 32a. Inside the pulling direction changing anchor 32 is provided a moving chamber 35 extending in a direction perpendicular to the magnetization direction and drilled in a substantially rectangular parallelepiped shape. The moving chamber 35 may extend in a direction other than the vertical direction as long as it is not the same as the magnetization direction.

In the moving chamber 35, shape memory alloys (for example, Ti (titanium) -Ni (nickel) alloy, Cu (copper) -Zn (zinc)) having the same shape and the same characteristics (elasticity and shape memory characteristics) are provided. Two coil springs (elastic members) 36a and 36b made of -Al (aluminum) alloy or Cu-Al-Ni alloy are disposed. Between these coil springs 36a and 36b, a moving member 37 having a substantially cubic shape is arranged. The moving member 37 is made of a ferromagnetic material, and in addition to pure iron and an iron alloy, a magnet such as a platinum magnet, a rare earth magnet, and terbium / dysprosium / iron alloy can be used. The moving member 37 is accommodated in the moving chamber 35 so that the magnetization direction thereof is the same as the magnetization direction of the traction direction change anchor 32.

The coil spring 36 a has end portions 36 a 1 and 36 a 2 in contact with the inner wall 35 a of the moving chamber 35 and the side surface 37 a of the moving member 37. On the other hand, the end portions 36b1 and 36b2 of the coil spring 36b are in contact with the inner wall 35b facing the inner wall 35a and the side surface 37b facing the side surface 37a, respectively.

The pulling direction change anchor 32 is provided with an introduction passage 38a for inserting the pair of conductor groups 23 into the moving chamber 35 from the outside of the pulling direction change anchor 32 toward the step portion 32e from the inner wall 35a. Yes. Similarly, an introduction passage 38b is formed in the moving chamber 35 from the outside of the pulling direction changing anchor 32 toward the step portion 32e from the inner wall 35b. The conducting wire group 23 and the conducting wire group 24 are connected to an energization device 25 arranged outside the traction direction change anchor 32. The conductor group 23, the conductor group 24, the energization device 25, the coil spring 36a, and the coil spring 36b constitute a control means.

The two conducting wires 23a and 23b constituting the conducting wire group 23 are connected to the end portion 36a1 and the end portion 36a2 of the coil spring 36a, respectively. Similarly, the two conducting wires 24a and 24b constituting the conducting wire group 24 are connected to the end portion 36b1 and the end portion 36b2 of the coil spring 36b, respectively. The energization device 25 can energize each of the conducting wire group 23 and the conducting wire group 24 by a user's operation. When the conducting wire 25 is energized by the energizing device 25, the coil spring 36a connected thereto is also energized and can be heated. Similarly, when the conducting wire group 24 is energized, the coil spring 36b connected thereto is also energized and can be heated.

The coil spring 36a and the coil spring 36b have the same characteristics as described above, and can be expanded and contracted at room temperature (temperature that is neither heated nor cooled). For this reason, when the moving chamber 35 extends in the horizontal direction at room temperature, the coil spring 36a and the coil spring 36b are in an equilibrium state with the moving member 37 as the center. At this time, the moving member 37 is arranged at the center position 35c in the longitudinal direction (left and right direction in FIG. 5) of the moving chamber 35, and the magnetic force is the strongest at the center position 35c as the distribution of the magnetic force of the entire pulling direction change anchor 32. (FIG. 5B).

On the other hand, the coil spring 36a and the coil spring 36b have a predetermined length stored in advance by being energized and heated. In the present embodiment, when only the coil spring 36a is energized and heated among the coil spring 36a and the coil spring 36b, the coil spring 36a is shifted to the inner wall 35b side from the center position 35c regardless of the state before the energization heating. Returning to such a length that the moving member 37 is disposed at (5). At this time, as the distribution of the magnetic force of the entire pulling direction changing anchor 32, the position of the moving member 37 approaching the inner wall 35b has the strongest magnetic force. On the other hand, when only the coil spring 36b is energized and heated, the coil spring 36b is disposed at a position where the moving member 37 is offset from the center position 35c toward the inner wall 35a regardless of the state before the energization heating. Return to the length (FIG. 5C). At this time, as the distribution of the magnetic force of the entire pulling direction changing anchor 32, the position of the moving member 37 approaching the inner wall 35a has the strongest magnetic force.

  The magnetization of the pulling direction changing anchor 32 and the moving member 37 is set in the moving chamber 35 in consideration of the difficulty of placing the premagnetized moving member 37 into the moving chamber 35 of the premagnetized pulling direction changing anchor 32. This is preferably performed after introducing the moving member 37.

The pulling anchor 33 shown in FIG. 4B is made of a ferromagnetic material, and can be attracted and controlled by using a magnetic induction member such as an electromagnet or a permanent magnet. As the magnetic material used for the traction anchor 33, magnets such as platinum magnets, rare earth magnets, terbium / dysprosium / iron alloys as well as pure iron and iron alloys can be used.

From the end surface 33a of the traction anchor 33, a hole 33h is formed in the traction anchor 33, and a fixed hole 33i having a larger inner diameter than the hole 33h is formed inward from the hole 33h. The connecting member 34 is inserted into the hole 33h, and the tip of the connecting member 34 is tied in the fixed hole 33i, whereby the traction direction changing anchor 32 and the traction anchor 33 are connected. Bonding the connecting member 34 to the inner surface of the hole 33h and / or the fixed hole 33i is preferable because the connection strength between the traction direction changing anchor 32 and the traction anchor 33 is increased.

As described above, the clip 10 and the traction direction change anchor 32 are connected via the connection member 20, and the traction direction change anchor 32 and the traction anchor 33 are connected via the connection member 34. The clip 10 can be pulled in a desired direction by controlling the suction of the traction anchor 32 and the traction anchor 33.

In the vicinity of the base end portion 10a, the plate-like members 11, 12, 13 are inserted into a substantially cylindrical clip receiving tube (gripping member receiving tube) 40 having an inner diameter with which the outer surface can abut. (FIGS. 1 and 2). Here, at least a part of the rear portions 11 e, 12 e, 13 e of the plate-like members 11, 12, 13 is received in the large-diameter portion 46. The clip receiving tube 40 can be formed of, for example, a stainless steel pipe, a plastic tube, or a superelastic alloy, and a pair of slits 41 and 42 are provided at positions facing each other in the radial direction. The slits 41 and 42 are arranged on the anchor side with a predetermined position 43 shifted to the insertion side of the clip 10 in the direction parallel to the center line of the clip receiving tube 40 (a line connecting the centers of the substantially circular cross sections) as the front end. It extends to the end 44 and its rear end is open. There may be one slit.

The connecting member 20 connected to the magnetic anchor portion 30 is introduced into the clip receiving tube 40 through the slits 41 and 42 and passed through the proximal end portion 10a (FIGS. 1 and 2). With this configuration, the clip 10 and the magnetic anchor portion 30 are connected via the clip receiving tube 40.

  The slits 41 and 42 have rear end portions that are open to the end portion 44 (open), but the front end portions are not extended to the front end of the clip receiving tube 40 and are stopped at a predetermined position 43 in the middle. Yes. With this configuration, the movement of the connecting member 20 inserted into the slits 41 and 42 from the end 44 side to the clip 10 side (front side) is regulated by the predetermined position 43. On the other hand, the movement of the connecting member 20 toward the end 44 (rear side) is regulated by the proximal end 10 a of the clip 10 inserted into the clip receiving tube 40.

  Further, the outer diameter of the clip receiving tube 40 differs before and after the step 45 provided at a position shifted to the rear side from the predetermined position 43. That is, the outer diameter of the large-diameter portion (front portion) 46 on the front side of the step portion 45 is set smaller than the outer diameter of the small-diameter portion (rear portion) 47 on the rear side of the step portion 45.

A metal loop wire (traction separation means) 50 is passed through the base end portion 10a (FIG. 1). The loop wire 50 may be made of a material other than metal as long as it is cut when pulled with a strong force of a predetermined level or more. The clip 10 having one end inserted into the clip receiving tube 40 is pulled into the clip receiving tube 40 while pulling the loop wire 50 rearward so that each portion abuts against the inner wall of the clip receiving tube 40 and is elastically deformed. Can be inserted.

Specifically, when the convex portions 11b, 12b, and 13b abut against the inner wall of the clip receiving tube 40 by pulling the loop wire 50 to the rear side, the convex portions 11b, 12b, and 13b are inward so as to approach each other. Bend. Thereby, the front end portions 11d, 12d, and 13d are separated from each other, and the clip 10 is opened. When the loop wire 50 is further pulled rearward, the inclined portions 11c, 12c, 13c abut against the inner wall of the clip receiving tube 40, and the inclined portions 11c, 12c, 13c bend inward so as to approach each other. Then, the tip portions 11d, 12d, and 13d approach each other, and the clip 10 is in a closed state.

The clip 10, the connecting member 20, the magnetic anchor portion 30, the clip receiving tube 40, and the loop wire 50 connected as described above are formed by using a hollow cylindrical introduction tube 70 and a forceps channel 61 as described below. To the patient (object) 101.

The introduction tube 70 is made of a flexible material, and is inserted from the forceps insertion port 91 of the endoscope 90 into the forceps channel 61 of the distal end rigid portion 60 as shown in FIGS. On the inner wall of the introduction pipe 70, an insertion coil 71 is disposed that can move relative to the introduction pipe 70 in the longitudinal direction of the introduction pipe 70. A restriction tube 72 is fixed to the distal end of the insertion coil 71 on the distal end hard portion 60 side by an adhesive, solder, solder, or the like. The regulation tube 72 is provided with a stepped portion 73, and the outer diameter of the front portion 74 of the stepped portion 73 is substantially the same as the inner diameter of the introduction tube 70. On the other hand, the outer diameter of the rear portion 75 whose outer diameter is smaller than that of the front portion 74 is substantially the same as the inner diameter of the hollow cylinder formed by the insertion coil 71. Therefore, when the insertion coil 71 is fixed to the outer periphery of the rear portion 75, the outer periphery of the hollow cylinder formed by the insertion coil 71 and the outer periphery of the front portion 74 are substantially on the same plane.

On the other hand, the inner diameter of the front portion 74 is set larger than the inner diameter of the rear portion 75. Furthermore, the inner diameter of the front portion 74 and the inner diameter of the rear portion 75 are substantially the same as the outer diameter of the large diameter portion 46 and the small diameter portion 47 of the clip receiving tube 40, respectively. For this reason, the clip receiving tube 40 can be inserted into the restricting tube 72, and the movement of the clip receiving tube 40 is restricted when the stepped portion 45 abuts against the distal end surface 76 of the restricting tube 72. Here, since the predetermined position 43 is disposed in front of the stepped portion 45 in the direction of the center line of the clip receiving tube 40, the clip receiving tube 40 is restricted until the stepped portion 45 and the stepped portion 73 come into contact with each other. Even if inserted, the slits 41 and 42 are not completely covered by the restriction tube 72. Accordingly, even in this state, the connecting member 20 can extend from the clip receiving tube 40 to the outside.

Inside the insertion coil 71 and the restriction tube 72, an operation wire 80 having a hook portion 81 provided at the tip is disposed so as to be movable relative to the insertion coil 71 and the restriction tube 72. The hook portion 81 has a rear end fixed to the operation wire 80 by an adhesive, solder, solder, or the like. The operation wire 80 is sufficiently longer than the introduction tube 70, and the rear end portion 80 a extends from the introduction tube 70 protruding outward from the forceps insertion port 91. A central portion of the hook portion 81 is a concave portion 82 (see FIGS. 12 and 13). By pulling the operation wire 80 by hooking the end portion of the loop wire 50 to the concave portion 82, the loop wire 50 is interposed. Thus, the clip 10 can be drawn into the clip receiving tube 40. The operation wire 80 is pulled by pulling the rear end 80a extending from the endoscope 90.

  Moreover, the conducting wire group 23 and the conducting wire group 24 extending from the pulling direction changing anchor 32 are inserted from the forceps insertion port 91 into the forceps channel 61 of the distal end rigid portion 60 (FIG. 7).

  On the other hand, the magnetic anchor part 30 is a magnetic anchor remote guidance system (anchor remote guidance system) 110 having a magnetic guiding member 112 that controls the magnetic anchor part 30 outside the body of the patient 101 (makes the magnetic anchor part 30 movable). The position is controlled by. 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. 8).

  As shown in FIG. 8, the magnetic induction member 112 is slidable on a frame / rail (a movement mechanism in one plane) 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.

  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.

  As described above, by arranging the magnetic guiding member 112, the XY stages 118 and 119, the frame / rail 114, etc., the magnetic guiding is performed at an optimum position for excision of the lesion (target site) 130 (FIGS. 12 and 13). The member 112 can be disposed.

Furthermore, the direction in which the traction direction change anchor 32 faces can be changed by energizing and heating the coil spring 36 a or the coil spring 36 b using the energization device 25. For this reason, the direction of the clip 10 with respect to the lesioned part 130 can be changed, and the lesioned part 130 can be lifted so as to be easily excised.

Specifically, when the coil spring 36a and the coil spring 36b are not energized and heated, both are in an equilibrium state with the moving member 37 as the center (FIG. 9B). On the other hand, when the coil spring 36a is energized and heated using the energization device 25, the coil spring 36a extends to a predetermined length and the moving member 37 moves to the inner wall 35b side. Then, since the position of the moving member 37 is the largest in the magnetic force of the pulling direction changing anchor 32 as a whole, this position is most strongly attracted to the magnetic guiding member 112 (FIG. 9A). On the other hand, when the coil spring 36b is energized and heated using the energization device 25, the coil spring 36b extends to a predetermined length and the moving member 37 moves to the inner wall 35a side. Then, since the position of the moving member 37 is the largest in the magnetic force of the pulling direction change anchor 32 as a whole, this position is most attracted to the magnetic guiding member 112 (FIG. 9C).

(2) Preparation for performing resection As shown in FIG. 8, 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. 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.

(3) Operation for introducing the magnetic anchor part 30 and the clip 10 into the body In the endoscope gripping apparatus 1 of the present invention, the clip 10 and the magnetic anchor part 30 are introduced into the body at the distal end of the endoscope. This is done by introducing the hard part 60. The distal rigid portion 60 can be repeatedly put in and out through an overtube 62 inserted in and out of the patient's body. In the distal end rigid portion 60, the lead wire group 23 extending from the introduction tube 70 having the magnetic anchor portion 30 disposed at the distal end and the pulling direction changing anchor 32 is inserted. The clip 10 is arranged with the claw portions 11a, 12a, and 13a facing the distal end side of the distal end rigid portion 60 (FIG. 10).

Arrangement of the clip 10 and the magnetic anchor portion 30 in the introduction tube 70 is performed as follows.
The clip 10 and the magnetic anchor portion 30 are inserted into the introduction tube 70 in a state where the clip 10 and the magnetic anchor portion 30 are connected to each other through the connection member 20 passed through the clip receiving tube 40 from the slit 41 and the slit 42. At this time, the lead wire group 23 and the lead wire group 24 are inserted through the pulling direction changing anchor 32 in advance. The leading ends of the conducting wire group 23 and the conducting wire group 24 are connected to the coil spring 36 a and the coil spring 36 b, respectively, and the other end is connected to the energization device 25.

At the time of insertion into the introduction tube 70, the loop wire 50 passed through the clip 10 in advance is hooked on the recess 82 of the hook portion 81 fixed to the tip of the operation wire 80 inserted through the introduction tube 70. . In this state, the clip receiving tube 40 linked to the clip 10 and the magnetic anchor portion 30 is inserted into the restriction tube 72 disposed in the introduction tube 70. This insertion operation ends when the step 45 of the clip receiving tube 40 abuts the step 73 of the restricting tube 72 and the movement of the clip receiving tube 40 is restricted.

As shown in FIG. 10, in the endoscope gripping apparatus 1 according to the present invention, the clip 10 is inserted after the clip receiving tube 40, and then the small diameter portion 32 c of the traction direction changing anchor 32 of the magnetic anchor portion 30. Is inserted. The outer diameters of the large diameter portion 32d and the introduction pipe 70 are the same. When the small diameter portion 32c is inserted into the introduction pipe 70, the stepped portion 32e is inserted into the introduction pipe with the conductor group 23 and the conductor group 24 sandwiched therebetween. It abuts against the end surface 70a of the tip of 70. The conducting wire group 23 and the conducting wire group 24 extending from the pulling direction changing anchor 32 are led out of the introduction pipe 70.

The predetermined position 43 which is the end position of the slits 41 and 42 is disposed at a position on the front side in the direction of the center line of the clip receiving tube 40 with respect to the stepped portion 45 of the clip receiving tube 40. Even if the clip receiving tube 40 is inserted into the restricting tube 72 until 45 and the stepped portion 73 abut each other, the slits 41 and 42 are not closed by the restricting tube 72 but are opened at the predetermined position 43. Therefore, the connecting member 20 that connects the clip 10 and the magnetic anchor portion 30 can extend from the slits 41 and 42 to the outside of the clip receiving tube 40 at the predetermined position 43. Further, since the connecting member 20 has a sufficient length so as not to prevent the magnetic anchor portion 30 from being disposed in front of the clip 10, the magnetic anchor portion 30, the clip 10, and the clip receiving portion are completed when the insertion operation is completed. Tube 40 is arranged in a straight line.

The clip 10 and the magnetic anchor part 30 are introduced into the patient 101 as follows (FIG. 11).
First, the distal end rigid portion 60 is introduced into the body, and then the control tube 72 is urged forward by operating the operation wire 80. As a result, the clip receiving tube 40 in which the step 45 is in contact with the step 73 is pushed forward, and the clip 10 whose one end is press-fitted into the clip receiving tube 40 also advances forward. The tip is in contact with the end face 32a. When the restriction pipe 72 is further urged forward from this state, the traction direction change anchor 32 is pushed out from the introduction pipe 70. When the restriction tube 72 is further urged forward, the clip 10, the clip receiving tube 40, and the restriction tube 72 are exposed from the distal end of the introduction tube 70 into the patient 101. At this time, the clip 10 and the clip receiving tube 40 are arranged in a straight line in the longitudinal direction of the introduction tube 70. Therefore, if the distal rigid portion 60 is disposed toward the lesioned portion 130, the introduction tube 70 disposed in the distal rigid portion 60 also faces the lesioned portion 130. Therefore, the tip of the clip 10 can be easily directed to the lesioned portion 130. it can.

  The clip 10 is attached to the lesioned part 130 as follows (FIGS. 12 to 15). In FIG. 13 and FIG. 14, the plate-like member 12 is omitted for convenience of explanation.

First, in order to open the distal end portions 11d, 12d, and 13d, the operation wire 80 is moved relative to the insertion coil 71 and the restriction tube 72 to pull the operation wire 80 so that the convex portions 11b, 12b, and 13b are moved. Pull into the clip receiving tube 40. Since the convex portions 11b, 12b, and 13b drawn into the restriction tube 72 abut against the inner wall of the clip receiving tube 40, they bend in a direction approaching each other. Since the protrusions 11b, 12b, and 13b are bent in this way, the tip portions 11d, 12d, and 13d are bent away from each other, and as a result, the tip end side of the clip 10 exposed from the clip receiving tube 40 is opened ( FIG. 12).

  The clip 10 opened in this way is moved toward the lesioned part 130 by moving the insertion coil 71, the restriction tube 72, and the operation wire 80 together. When the tip of the clip 10 reaches a desired position, the clip 10 is moved. By closing, the lesioned part 130 can be grasped by the clip 10. In order to close the clip 10, the operation wire 80 is moved relative to the insertion coil 71 and the restriction tube 72 to pull the operation wire 80 so that the inclined portions 11 c, 12 c, 13 c are moved into the clip receiving tube 40. Pull in. The inclined portions 11c, 12c, and 13c drawn into the clip receiving tube 40 are in contact with the inner wall of the clip receiving tube 40, so that they bend toward each other, and the tip portions 11d, 12d, and 13d approach each other accordingly. As a result, the distal end side of the clip 10 exposed from the clip receiving tube 40 is closed (FIG. 13).

  Next, the clip 10 and the magnetic anchor portion 30 connected via the clip receiving tube 40 and the connecting member 20, the introduction tube 70 including the insertion coil 71, the restriction tube 72, the operation wire 80, and the hook portion 81 therein, And the attachment of the clip 10 to the lesioned part 130 is completed. In this separation operation, the operation wire 80 is pulled strongly to cut the loop wire 50 hung on the hook portion 81 (FIG. 14), and then the insertion coil 71, the restriction tube 72, the operation wire 80 and the hook portion 81 are retracted. (FIG. 15).

(4) Step of excision The excision process of the lesioned part 130 using the magnetic anchor remote guidance system 110 configured as described above will be described.
First, physiological saline is injected from the periphery of the lesioned part 130 with an injection needle (not shown) inserted into the submucosal layer 131, and the lesioned part 130 is lifted from the proper muscle layer 132 (FIG. 16).

On the other hand, the magnetic guiding member 112 is arranged at a preset position near the lesioned part 130. When set in this manner, the clip 10 is pulled toward the magnetic induction member 112 by the attractive force between the magnetic induction member 112 and the magnetic anchor portion 30. When the amount of lifting of the lesioned part 130 is insufficient or too large, it can be adjusted by shifting the position of the magnetic guiding member 112 or weakening the magnetic field generated by the magnetic guiding member 112.

Subsequently, an incision tool 140 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 part. At this time, as shown in FIG. 17, when the conducting wire group 25 is energized by the energizing device 25 and the coil spring 36 a to which the conducting wire group 23 is connected has a predetermined length, the magnetic force distribution of the pulling direction change anchor 32 as a whole. Therefore, the posture of the traction direction change anchor 32 attracted by the magnetic guide member 112 changes. As a result, the pulling direction of the clip 10 by the pulling direction changing anchor 32 also changes, and as a result, the clip 10 can lift the lesioned part 130. Thus, when 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. In addition, the excised lesioned part 130 can be further lifted by gradually shifting the position of the magnetic guiding member 112, and the tip position of the high-frequency knife 140 can be easily confirmed, so that the excision work can be performed smoothly.

(5) Collection of Endoscopic Gripping Device 1 and Lesion Part 130 When the excision work is completed, the magnetic anchor part 30 is pulled toward the magnetic guide member 112 with the clip 10 holding the lesion part 130, so the lesion part 130 Can be prevented from being lost. The collection is performed by removing the endoscope 90 in a state where the clip 10, the connecting member 20, and the clip receiving tube 40 holding the magnetic anchor portion 30 and the lesioned portion 130 are held by the holding forceps 100. Thereafter, treatments such as suturing and disinfection are performed.

Below, the modification of this embodiment is demonstrated.
In the present embodiment, the magnetic anchor portion 30 is configured by the traction direction change anchor 32 and the traction anchor 33, but may be configured by only the traction direction change anchor 32. In this case, the pulling direction change anchor 32 exhibits a function of pulling the clip 10 in addition to changing the pulling direction. If comprised in this way, the holding | grip apparatus 1 for endoscopes can be made compact.

  Further, as shown in FIG. 18, an air cylinder 125 is used, and two pressure suction tubes 123 and pressure suction tubes 124 having the same shape extending from the air cylinder 125 are connected to the introduction passage 38a and the introduction passage 38b, respectively. It can also be set as the structure to do. The pressure suction tube 123, the pressure suction tube 124, and the air cylinder 125 constitute a control means. In this configuration, when air is simultaneously introduced into the moving chamber 35 from the introducing passage 38a and the introducing passage 38b, the moving member 37 is disposed at the center position 35c of the moving chamber 35, and the magnetic force of the entire pulling direction changing anchor 32 is increased. As for the distribution, the magnetic force is strongest at the center position 35c (FIG. 19B). On the other hand, when air is introduced only from the pressurized suction tube 123 or sucked only from the pressurized suction tube 124, the moving member 37 moves to the inner wall 35b side according to the air pressure, and the pulling direction change anchor 32 as a whole. As for the distribution of the magnetic force, the position of the moving member 37 has the strongest magnetic force (FIG. 19A). Conversely, when air is introduced only from the pressure suction tube 124 or suction is performed only from the pressure suction tube 123, the moving member 37 moves to the inner wall 35a side according to the air pressure, and the magnetic force of the entire pulling direction change anchor 32 is increased. As for the distribution of, the position of the moving member 37 has the strongest magnetic force (FIG. 19C).

  As shown in FIG. 20, instead of the traction anchor 33, a traction anchor 133 having a recess 133 a that can accommodate the traction direction change anchor 32 and the connecting member 34 inside can be used. Further, a tubular suction member 63 is disposed in a passage formed in the distal end rigid portion 60, and the distal end surface 63 a 1 of 63 a fixed to the distal end of the suction member 63 is aligned with the distal end surface 60 a of the distal end rigid portion 60. Then, the traction anchor 133 is fixed to the distal end surface 60a in a state where the traction direction changing anchor 32 is accommodated in the recess 133a by the suction force acting between the distal end surface 63a1 and the end surface 133b of the traction anchor 133. The part 60 can be introduced into the patient 101 more safely.

  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.

It is a partial cross section figure showing the composition of the grasping device for endoscopes concerning the embodiment of the present invention. It is a side view showing the composition of the grasping device for endoscopes concerning the embodiment of the present invention. It is a front view showing the composition of the clip of the grasping device for endoscopes concerning the embodiment of the present invention. (A) is a partial cross section figure which shows the structure of the traction direction change anchor which concerns on embodiment of this invention, (b) is a partial cross section figure which shows the structure of the traction anchor which concerns on embodiment of this invention. It is a figure which shows the relationship between the position of the moving member in the traction direction change anchor which concerns on embodiment of this invention, and distribution of the magnetic force of the whole traction direction change anchor, (a) is one inner wall side in a movement chamber. (B) when the moving member is at the center position in the moving chamber, (c) is the state when the moving member is at the other inner wall side in the moving chamber and the distribution of magnetic force. Indicates. It is a partial cross section figure showing composition of an introduction pipe concerning an embodiment of the present invention, an insertion coil, a coil control pipe, a hook part, and an operation wire. 1 is an overview diagram showing an overall configuration of an endoscope according to an embodiment of the present invention. It is the general | schematic figure which looked at arrangement | positioning of the bed, the magnetic induction member, etc. which mounted the patient when excising the lesion part which concerns on embodiment of this invention from the patient's head side. It is a figure which shows the relationship between the position of the moving member in the traction direction change anchor which concerns on embodiment of this invention, and the attitude | positions of a traction direction change anchor and a clip, (a) is the one side of the inner wall in a movement chamber. (B) when the moving member is at the center position in the moving chamber, (c) when the moving member is at a position offset toward the other inner wall in the moving chamber Shows the attitude. It is a figure showing the state where the grasping device for endoscopes concerning the embodiment of the present invention was stored in the introduction tube. It is a figure which shows the state by which the magnetic anchor part, clip, clip receiving tube, and regulation tube which concern on embodiment of this invention were exposed in the patient's body. It is a partial sectional view showing the state where the clip concerning the embodiment of the present invention opened. It is a partial sectional view showing the state where the clip concerning the embodiment of the present invention was closed. It is a side view showing the state where a part of loop wire concerning an embodiment of the present invention was cut. It is a side view showing the state where the clip concerning an embodiment of the present invention, the introduction pipe, the coil control pipe, and the hook part were separated. It is a general-view figure which shows the state in the patient body which attached the endoscope holding apparatus which concerns on embodiment of this invention to the lesioned part. It is a general-view figure which shows the state which has changed the attitude | position of the pulling direction change anchor and clip which concerns on embodiment of this invention, and has raised the lesioned part. It is a partial cross section figure which shows the structure of the traction direction change anchor which concerns on the modification of embodiment of this invention. It is a figure which shows the relationship between the position of the moving member in the traction direction change anchor which concerns on the modification of embodiment of this invention, and distribution of the magnetic force of the whole traction direction change anchor, (a) is one of the movement members in a movement chamber. When the movable member is at a position offset toward the inner wall side, (b) is when the moving member is at the center position in the moving chamber, (c) is when the moving member is at a position offset toward the other inner wall side within the moving chamber, and The distribution of magnetic force is shown. It is a partial cross section figure which shows the state which accommodated the traction direction change anchor in the traction anchor which concerns on the modification of embodiment of this invention.

Explanation of symbols

10 clips (gripping members)
20 connecting member 23 conducting wire group (control means)
24 Conductor group (control means)
25 Energizing device (control means)
30 Magnetic anchor part (anchor part)
32 Towing direction changing anchor 33 Towing anchor 34 Connecting member 35 Moving chamber 36a Coil spring (control means)
36b Coil spring (control means)
37 Moving member 101 Patient (object)
110 Magnetic Anchor Remote Guidance System 123 Pressurized Suction Tube (Control Unit)
124 Pressurized suction tube (control means)
125 Air cylinder (control means)
130 Lesions (target site)

Claims (4)

A gripping member for gripping a target part inside the target;
A magnetized magnetic anchor portion for pulling the gripping member via a connecting member;
Control means for controlling the pulling direction by the magnetic anchor part;
A magnetic induction member disposed outside the object and capable of moving the magnetic anchor portion by generating a magnetic field;
With
The magnetic anchor portion includes a pulling direction change anchor provided therein with a moving chamber extending in a direction different from the direction of the magnetization,
The pulling direction of the gripping member is changed by moving a moving member made of a magnetic material and magnetized in the same direction as the magnetization direction and disposed in the moving chamber by the control means. Magnetic anchor remote guidance system. The control means includes two springs made of a shape memory alloy and an energization device that energizes and heats the two springs, and one of the two springs is one of two opposing side surfaces of the moving member. And both ends of the two opposing inner walls of the moving chamber are in contact with each other, and the other of the two springs is connected to the other of the two opposing side surfaces of the moving member and two of the moving chambers facing each other. 2. The magnetic anchor remote induction according to claim 1 , wherein both end portions are in contact with the other one of the inner walls, and the moving member is disposed at a predetermined position in the moving chamber by energizing and heating one of the two springs. system. The control means includes an air cylinder including two pressure suction tubes, and one of the two pressure suction tubes is one of the two side surfaces of the moving member facing each other in the moving chamber, The other of the two pressurized suction tubes communicates with a space between one of the two inner walls facing each other of the moving chamber, and the other of the two facing side surfaces of the moving member of the moving chamber, The movable member communicates with a space between the other two opposing inner walls of the moving chamber, and the moving member is moved to a predetermined position in the moving chamber by supplying or sucking air through one of the two pressurized suction tubes. The magnetic anchor remote guidance system according to claim 1, which is disposed in The magnetic anchor remote guidance system according to claim 1 , wherein the anchor portion has a traction anchor connected to the traction direction change anchor by a connection member.

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