JP4958393B2 - Soft bipolar forceps for endoscope - Google Patents

Description

  The present invention relates to an endoscope flexible bipolar forceps used by being inserted into an endoscope.

2. Description of the Related Art Treatment tools that perform treatments in the stomach, the esophagus, the duodenum, and the like include a flexible bipolar forceps that includes a pair of electrodes that sandwich biological tissue at the tip and is used for hemostasis. This bipolar forceps is supported in a state where each electrode is electrically insulated in order to give each electrode a different polarity (see, for example, Patent Document 1, Patent Document 2, and Patent Document 3).
In the bipolar forceps disclosed in Patent Document 1, two slits are formed in parallel in the longitudinal direction of a support made of an insulating member, and one electrode is inserted into each of the slits, and is supported rotatably.
The bipolar forceps disclosed in Patent Document 2 has a flat washer having non-conductivity, and supports the electrode rotatably on each of the sleeve portions protruding from both sides of the washer. It is inserted and supported on a non-conductive support.
In the bipolar forceps disclosed in Patent Document 3, a pair of electrodes is supported so as to sandwich an insulating support, and the base end side of each electrode is connected to an operation wire for opening and closing the electrodes via a link mechanism. Connected. The support has a flat shape from the tip side that rotatably supports each electrode to the link mechanism.
JP 2004-113328 A Japanese National Patent Publication No. 8-509623 US Pat. No. 5,603,711

However, the bipolar forceps as disclosed in Patent Documents 1 and 2 have a laminated structure in which the inner surface side and the outer surface side of the pair of electrodes are each covered with an insulating material. It was difficult to reduce the size.
Moreover, in the bipolar forceps as disclosed in Patent Document 3, since the support sandwiched between the pair of electrodes is plate-shaped, it is difficult to reduce the size while ensuring the strength of the support. Further, with such a support on a flat plate, it is difficult to ensure a sufficient creepage distance when a high frequency power source is connected to a pair of electrodes.
The present invention has been made in view of such circumstances, and an object of the present invention is to prevent an increase in the size of the flexible bipolar forceps and to ensure treatment such as hemostasis.

The invention according to claim 1 of the present invention that solves the above-described problems includes an insulating support member at the tip of a flexible insertion portion that is inserted through an endoscope, and the width direction of the support member A pair of forceps members are disposed so as to sandwich the support member, and the pair of forceps members are rotatably supported around a reference line parallel to the width direction so that the distal ends of the pair of forceps members can be opened and closed. pin is disposed, each clamp member, a soft of the operation wire is connected directly to the rear end than the pin, a pair of operation wires, endoscopes which are connected to the positive pole of the high-frequency power source, to the negative electrode, respectively in soft bipolar forceps for mirror, wherein the support member comprises a flat base portion sandwiched from the width direction to the pair of forceps members and a projecting portion which projects in each of the width direction from the base portion, the butt parts are Oite the rear end side of the pin, Hirakijo Wherein with leaving pivoting region of the rear end portion when closing forceps members, soft bipolar forceps for an endoscope, characterized in that it is formed at a position to be rotationally symmetrical from the central axis of the base in It was.
The flexible bipolar forceps for endoscope has a protrusion protruding in the width direction from the base, and the protrusion is provided at a position that is rotationally symmetric about an axis parallel to the longitudinal direction. The strength of the entire support member can be maintained while the size of the treatment portion including is increased.

The invention according to claim 2 is the flexible bipolar forceps for an endoscope according to claim 1, wherein the back end portion of the forceps member in a closed state is opposite to the base portion in the width direction. A protrusion is formed.
In this flexible bipolar forceps for endoscope, the creeping distance from the rear end portion of one forceps member to the rear end portion of the other forceps member in a state where the forceps member is closed is only a flat base portion. It becomes larger than the case.

The invention according to claim 3 is the flexible bipolar forceps for endoscope according to claim 1 or 2 , wherein the base, the protrusion, and the rear end have a substantially circular outer shape. It is formed.
In this endoscopic soft bipolar forceps, when the entire treatment portion in the closed state is substantially cylindrical, the diameter of the treatment portion becomes small.

  According to the present invention, since the strength can be maintained by projecting the protrusion from the base portion that rotatably supports the pair of forceps members, the support member having a complicated configuration and the forceps member can be multiplexed. There is no need to form a laminated structure, and the structure of the support member can be simplified and downsized. Further, if the protrusion is disposed so that the creepage distance at the rear end portion of the forceps member is increased, a short circuit between the rear end portions can be prevented.

The best mode for carrying out the present invention will be described with reference to the drawings.
FIG. 1 shows the overall configuration of the soft bipolar forceps according to the present embodiment, and FIG. 2 shows an enlarged view of the distal end portion of the soft bipolar forceps.
The flexible bipolar forceps 1 has a treatment portion 2 at the distal end, and a flexible insertion portion 3 extends at the proximal end of the treatment portion 2. Further, an operation unit 4 that is operated by an operator or the like is provided at the proximal end of the insertion unit 3.

  The treatment section 2 is configured such that a pair of forceps members 6 and 7 are disposed so as to sandwich the support member 5 from the width direction orthogonal to the longitudinal direction of the support member 5 and are rotatably supported by the support member 5. It has become. As shown in FIG. 2, the support member 5 has a flat plate-like base portion 12 having an insertion hole 11 formed on the distal end side, and a first protrusion is formed on the proximal end side of the base portion 12 in each of the width directions. Portions 13 and 14 and second protrusions 15 and 16 are projected. As shown in FIG. 3, which is a side view of the support member viewed from the direction of arrow A in FIG. 2, the distal end portion of the base portion 12 is cut out in an arc shape centering on the insertion hole 11. The arc-shaped wing 18 extends so as to protrude in the width direction from the tip of the edge 17 to slightly beyond the center. In addition, the lower edge part 17 is one circular-arc-shaped part in the position orthogonal to the width direction.

  As shown in FIG. 4, the protruding width of the wing portion 18 gradually increases from the lower edge portion 17 toward the center. Further, as shown in FIGS. 3 and 4, in the vicinity of the center in the longitudinal direction of the support member 5, the slit 19 starts from the lower edge 17 of the base 12 and reaches the base end 20 of the support member 5. It is formed diagonally. As shown in FIG. 3, the slit 19 has the widest starting width facing the lower edge 17 of the base 12, and a relief groove 21 is formed here to further reduce the width of the base 12. Yes. Further, the upper side of the slit 19 is a first protrusion 13, and the lower side of the slit 19 is a second protrusion 15. The upper edge of the first protrusion 13 is smoothly connected to the upper edge 22 of the base 12, and the tip surface 23 has an upward slope so as to open toward the tip of the support member 5. The lower edge of the second protrusion 15 is smoothly connected to the lower edge 17 of the base 12.

  On the other hand, when the support member 5 is viewed from the direction of the arrow C in FIG. 2, the base 12 is arranged symmetrically with respect to the longitudinal axis with respect to the shape on the one surface 12a side shown in FIG. It has become. That is, as shown in FIG. 5, an arc-shaped wing portion 25 extends in the width direction from the upper edge portion 22 to slightly beyond the center at the tip of the base portion 12. Further, near the center in the longitudinal direction of the support member 5, the slit 26 is formed obliquely from the upper edge portion 22 of the base portion 12 to the base end portion 20 of the support member 5. The slit 26 has the largest width at the starting end facing the upper edge 22 of the base 12, and an escape groove 27 is formed here to further reduce the width of the base 12. Further, the upper side of the slit 26 becomes the second protrusion 16, and the lower side of the slit 26 becomes the first protrusion 14. The lower edge of the first protrusion 14 is smoothly connected to the lower edge 17 of the base 12, and the tip surface 28 has a downward slope so as to open toward the tip of the support member 5. The upper edge of the second protrusion 16 is smoothly connected to the upper edge 22 of the base 12.

As shown in FIG. 6 which is a cross-sectional view taken along the line D-D of FIG. 3, the support member 5 is provided with wings 18 and 25 at the front end so as to be orthogonal to the longitudinal direction. The base portion 12 extends to the base end portion 20, and a portion 12 c reduced in width by the insertion hole 11 and the slits 19 and 26 is formed in the middle. Furthermore, from the one surface 12a side of the base part 12, the 1st protrusion 13 is extended in the longitudinal direction, gradually expanding from the vicinity of the formation position of the insertion hole 11 in the longitudinal direction. The width of the first protrusion 13 is the maximum when it comes into contact with the slit 19, and reaches the base end 20 while gradually reducing the width. As shown in FIG. 7, which is a cross-sectional view taken along the line EE in FIG. 3, the first protrusion 14, which is axially symmetric with respect to the first protrusion 13, is in relation to the other surface 12 b of the base 12. It has the same shape.
As shown in FIG. 6, the second protrusion 15 is formed by the slit 26, extends along the longitudinal direction while gradually widening from the other surface 12 b of the base 12, and reaches the base end 20. The second protrusion 15 (see FIG. 3) that is axially symmetric with respect to the second protrusion 16 has the same shape as the one surface 12 a of the base 12. And in each protrusion 13, 14, 15, 16, the distance (width | variety) from the most protruding part to the axis line of the supporting member 5 is substantially equal. Further, this distance is substantially equal to the length from the axis of the support member 5 to the ends of the wing portions 18 and 25.
As shown in FIG. 7, the support member 5 is reduced in width by forming slits 19 and 26 and relief grooves 21 and 27 in the base 12, but as shown in FIGS. 3 to 5, The protrusions 13, 14, 15, and 16 extend while shifting their positions in the width direction and the vertical direction perpendicular to the width direction, thereby ensuring the rigidity of the support member 5 as a whole.

  As shown in FIG. 6, the base end portion 20 is a cylindrical portion having an outer diameter slightly smaller than the outer diameter of the substantially circular shape formed by the base portion 12 and the four protrusions 13, 14, 15, and 16. Two holes 30 penetrating in a direction orthogonal to the width direction of the base 12 are provided. Further, the ends of the slits 19 and 26 formed in the base 12 reach the base end 20, and the ends are holes 31 that penetrate the base end 20 from the outside to the inside.

  Examples of the material of the support member 5 include polyether ether ketone resin, zirconia, and ceramics such as alumina. Moreover, as a manufacturing method of the support member 5, shaping | molding or cutting is mention | raise | lifted. In the case of cutting, the tip of a substantially cylindrical member made of an insulating material is cut out in an arc shape when viewed from the side, leaving the wings 18 and 25 in the width direction, and reducing the width into a plate shape. In this way, the base portion 12 is formed, and subsequently, slits 19 and 26 are formed obliquely from the lower edge toward the base end portion 20 in the vicinity of the approximate center in the longitudinal direction, and escape grooves 21 and 27 are further formed.

As shown in FIGS. 2 and 8, the forceps member 6 has a cup-shaped jaw portion 35 at the distal end, and an arm portion 36 extends from the proximal end of the jaw portion 35 and one side. The arm portion 36 is formed so that a through hole 37 penetrates the arm portion 36 in the width direction at substantially the center in the longitudinal direction. The through-hole 37 has a tapered surface 37a having a reduced diameter between the opening on the outer surface side of the arm portion 36 and the opening on the inner surface side. As a result, the opening diameter on the outer surface side is larger than the opening diameter on the inner surface side. It has become. As shown in FIG. 2, the opening diameter on the inner surface side of the through hole 37 is substantially equal to the diameter of the insertion hole 11 of the support member 5. As shown in FIG. 8, in the arm portion 36, the base end side of the through hole 37 is tapered such that the height in the vertical direction decreases toward the base end, and the rear end portion 38. The outer surface side is cut off to form a thin plate-like portion. In such a rear end portion 38, a through hole 39 penetrating in the width direction is formed.
The forceps member 7 shown in FIG. 2 has the same shape as the forceps member 6 except that a through-hole 40 is formed at the approximate center in the longitudinal direction of the arm portion 36. The through hole 40 has the same diameter regardless of the position in the width direction, and the diameter is smaller than the insertion hole 11 of the base portion 12.

  The forceps members 6 and 7 are disposed so as to sandwich the base portion 12 of the support member 5 from the width direction, and are fastened by pins 42 into which spacers 41 are inserted. The spacer 41 is a substantially cylindrical member made of an insulating material such as zirconia. The pin 42 is a metal member having a head portion 42b whose diameter is increased in a tapered shape at the proximal end portion of the cylindrical pin body 42a. The spacer 41 and the pin 42 are inserted in this order from the outer surface side of the forceps member 6, and the tip portion of the pin 42 is substantially flush with the outer surface of the forceps member 7, and the pin 42, the support member 5, and The forceps member 7 is insulated by the spacer 41. When the distal end of the pin 42 is welded to the forceps member 7 by laser welding or the like while the pin 42 is pushed in, the forceps members 6 and 7 are rotatably supported by the base portion 12 of the support member 5. The head portion 42b of the pin 42 is sealed with a lid 43 made of an insulating material.

  At this time, the jaw portion 35 of the forceps member 6 protrudes from the distal end surface of the support member 5 so as to avoid the wing portion 25 of the support member 5, so that the arm portion 36 of the other forceps member 7 is supported by the wing portion 25. Insulation is ensured. Further, as shown in FIG. 8, the arm portion 36 extends along the base portion 12 and reaches the start end portion of the slit 19 so as to avoid the first protrusion 13. And the front-end | tip part of the operation wire 50 which is an operation member is latched by the rear-end part 38 of the arm part 36. FIG. The operation wire 50 is formed by coating a conductive member with an insulating material, leaving the tip, and the exposed tip passes through the through hole 39 of the arm 36 and reaches the escape groove 21. It is crushed by caulking or the like to prevent extraction from the through hole 39.

  As shown in FIG. 2, the forceps member 7 has the same shape. That is, in the forceps member 7, the rear end portion 38 of the arm portion 36 reaches the start end portion of the slit 26, and the distal end portion of the operation member 51 is locked to the rear end portion 38. The operation wires 50 and 51 pass through the slits 19 and 26, respectively, enter the inside of the support member 5 from the hole 31 (see FIGS. 3 and 5) of the base end portion 20 of the support member 5, and then be flexible. The insertion portion 3 is inserted through the insertion portion 3 so as to freely advance and retract.

  As shown in FIG. 9, in the insertion portion 3, the outer periphery of the closely wound coil sheath 55 is covered with an insulating tube 56. The tip of the densely wound coil sheath 55 is provided with a small diameter portion 55a whose outer diameter is slightly reduced by scraping off the wire of the closely wound coil sheath 55. A connecting member 57 is attached. Further, the distal end portion of the insulating tube 56 is engaged with a protrusion 54a on the outer peripheral surface of the base portion 54 that is provided so as to be rotatable with respect to the small diameter portion 55a. That is, the insulating tube 56 is rotatable with respect to the closely wound coil sheath 55 by the cap portion 54. The connecting member 57 has an annular portion that covers the outer periphery of the base end portion 20 of the support member 5, and two holes 58 are formed on the annular portion on one diameter. These holes 58 are formed so as to coincide with the holes 30 on the support member 5 side, and the pins 59 are inserted in a state where these holes 30 and 58 coincide with each other, and the pins 59 are welded from the outside by laser welding or the like. Thus, the support member 5 is fixed to the connecting member 57. And as shown in FIG. 1, the operation part 4 is being fixed to the base end part of the insertion part 3. As shown in FIG.

  The operation unit 4 has an elongated operation unit main body 60, and a finger hanging ring 61 is provided at the base end of the operation unit main body 60. Further, a slit 62 is formed on the tip side of the ring 61 in parallel with the longitudinal direction, and a slider 63 is attached to the slit 62 so as to be able to advance and retract. A pair of electrical terminals 64 is embedded in the slider 63. The electrical terminals 64 are connected to the end portions of the operation wires 50 and 51 that are inserted into the operation unit main body 60 so as to freely advance and retract. In addition, a power cord 65 is electrically connected to the electrical terminal 64. The power cord 65 is pulled out from the slit 62, and a plug 66 connected to a high-frequency power source (not shown) is attached to an end portion thereof. It has been.

Next, the operation of this embodiment will be described.
First, an endoscope (not shown) is inserted into the patient's body, and the distal end thereof is exposed to the affected area. Further, the flexible bipolar forceps 1 is inserted from the distal end side into the forceps channel of the endoscope, and the treatment portion 2 is projected from the distal end of the endoscope. At this time, since the operation unit 4 remains outside the body, the surgeon connects the power cord 65 to the high frequency power source. Thereby, the operation wire 50 is connected to the positive electrode, for example, and the operation wire 51 is connected to the negative electrode.

In performing the treatment, first, the pair of forceps members 6 and 7 are opened and closed, and the affected part is sandwiched between the jaws 35. Specifically, a finger is put on the ring 61 and the slider 63 of the operation unit main body 60, the slider 63 is advanced, and the pair of operation wires 50, 51 are advanced. Since the operation wires 50 and 51 are rotatably locked to the rear end portions 38 of the arm portions 36 of the forceps members 6 and 7, when the operation wires 50 and 51 are advanced, the forceps members 6 and 7 are moved to the pins 42. Rotate around the center. At this time, as shown in FIG. 10, the rear end portion 38 of the arm portion 36 is centered on the pin 42, on the extension line of the start end of the slits 19 and 26 of the support member 5, and the first protrusion on the same side surface. It rotates so that it may leave | separate from the parts 13 and 14, and, as a result, it opens so that the jaw parts 35 may leave | separate. In this state, the entire endoscope or the entire soft bipolar forceps 1 is advanced to press the affected part against the open jaw 35 and then the slider 63 is retracted. Accordingly, the pair of operation wires 50 and 51 are retracted, the rear end portion 38 of the arm portion 36 is rotated so as to be close to the first protrusions 13 and 14 on the same side surface, and the jaw portion 35 is closed. . Here, when the high frequency power supply is turned on, electric energy is supplied from the operation wires 50 and 51 to the forceps members 6 and 7, and the grasped affected part is treated, for example, hemostatic, by this electric energy.
When the treatment is completed, the high frequency power supply is turned off, and then the slider 63 is operated to release the grip of the affected area. Thereafter, the flexible bipolar forceps 1 is pulled out of the body together with the endoscope.

In this embodiment, the support member 5 that supports the pair of forceps members 6, 7 has a planar base portion 12, and the protrusions 13, 14, 15, 16 projecting from the base portion 12 are arranged in the longitudinal direction. Since it extended along, it can ensure sufficient intensity | strength in the support member 5 reduced in diameter. In particular, since the first protrusions 13 and 14 are provided at positions that are axially symmetric with respect to the longitudinal axis of the support member 5, the opening and closing regions of the forceps members 6 and 7 are secured, but the diameter and strength are small. The treatment part 2 having a high height can be formed.
Further, since the first protrusions 13 and 14 are provided symmetrically with respect to the longitudinal axis of the base portion 12, the creeping distance on the rear end portion 38 side of the arm portion 36 of each forceps member 6 and 7 is increased. be able to. Therefore, even when the diameter of the treatment portion 2 is reduced, a short circuit on the rear end portion 38 side of the arm portion 36 can be prevented. Moreover, since the treatment part 2 becomes a tapered substantially cylindrical shape as a whole, it can be easily inserted into and removed from the forceps channel of the endoscope.

Further, since the wing portions 18 and 25 are provided at the distal end of the support member 5, it is possible to prevent a short circuit between the jaw portion 35 and the arm portion 36 of the different forceps members 6 and 7. The wing portions 18 and 25 also have an effect of increasing the rigidity of the distal end portion of the support member 5.
Further, when the pair of forceps members 6 and 7 are supported by the support member 5, the pin 42 insulated by the spacer 41 is rotatably inserted from the forceps member 6 side, and the tip of the pin 42 is fixed to the forceps member 7. It is possible to use a high-strength material such as metal for the pin 42 for the support mechanism of the forceps members 6 and 7. Further, when the head of the pin 42 is covered with the insulating lid 43, it is possible to prevent the arm portions 36 of the pair of forceps members 6 and 7 from being short-circuited via the pin 42.
In connecting the support member 5 made of an insulating material and the insertion portion 3, a plurality of pins 59 are inserted and the pins 59 are welded in a state where they are arranged so as to overlap each other. The connection structure can be easily and reliably formed.

Note that the present invention can be widely applied without being limited to the above-described embodiment.
For example, the flexible bipolar forceps 1 is not limited to hemostasis but may be for incision.
Moreover, the external shape of the treatment part 2 is not limited to a substantially cylindrical shape, and may be an ellipse or the like. Furthermore, the support member 5 may not have the second protrusions 15 and 16, and the second protrusions 15 and 16 extend to the distal end side in the same manner as the first protrusions 13 and 14. Alternatively, the rear end portion 38 of the arm portion 36 may be sandwiched between the protrusions 15 and 16.

It is a figure which shows the structure of the flexible bipolar forceps concerning embodiment of this invention, Comprising: It is the figure which expanded the front-end | tip part. It is a figure which shows the structure of the treatment part of flexible bipolar forceps. It is the side view which looked at the supporting member from the arrow A direction of FIG. FIG. 4 is a view taken in the direction of arrow B in FIG. 3. It is the side view which looked at the supporting member from the arrow C direction of FIG. It is sectional drawing along the DD line of FIG. It is sectional drawing along the EE line of FIG. FIG. 3 is a view as seen from an arrow A in FIG. 2. FIG. 5 is a cross-sectional view taken along line FF in FIG. 2. It is a side view of a treatment part, and is a figure showing the state where a pair of forceps members was opened.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Soft bipolar forceps 2 Treatment part 3 Insertion part 5 Support member 6,7 Forceps member 12 Base part 13,14 1st protrusion 15,16 2nd protrusion 38 Rear end part 50,51 Operation wire

Claims (3)

An insulating support member is provided at the distal end of the flexible insertion portion that is inserted through the endoscope, and a pair of forceps members are disposed so as to sandwich the support member from the width direction of the support member . Pins that support the forceps members so as to be rotatable around a reference line parallel to the width direction and that can open and close the front ends of the pair of forceps members are arranged , and each forceps member has a rear end portion than the pins. soft of the operation wire is connected directly to a pair of operating wires, the positive electrode of the high-frequency power source, the soft bipolar forceps for an endoscope which is connected to the negative electrode,
Wherein the support member comprises a flat base portion sandwiched from the width direction to the pair of forceps members and a projecting portion which projects in each of the width direction from the base portion,
The projection is Oite the rear end side of the pin, with leaving a pivoting region of the rear end when closing the forceps member in the open state, the rotational symmetry from the central axis of the base position A flexible bipolar forceps for an endoscope, characterized in that the endoscope is formed as described above.   2. The flexible endoscope according to claim 1, wherein the protruding portion is formed on the opposite side of the base portion in the width direction with respect to the rear end portion of the forceps member in a closed state. Bipolar forceps. The flexible bipolar forceps for endoscope according to claim 1 or 2 , wherein a substantially circular outer shape is formed by the base portion, the protrusion, and the rear end portion.

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