JP7716088B2 - Endoscopic treatment tools - Google Patents

Description

This disclosure relates to an endoscopic treatment tool.

Traditionally, in the treatment of early-stage malignant tumors and other conditions, procedures such as EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) have been used to endoscopically remove lesions that have developed on the mucosa of hollow organs such as the digestive tract. High-frequency knives and high-frequency snares are used as endoscopic treatment tools for removing diseased tissue.

In endoscopic colon polypectomy, a distending agent such as saline is injected into the intestinal wall with a syringe (local injection needle) to lift the polyp, then the syringe needle is replaced with a snare, which is placed around the polyp and the snare is tightened to remove the polyp. Therefore, the syringe needle and snare wire must be changed depending on the number of polyps to be removed, which complicates the procedure, lengthens the surgery time, and places an increased burden on the surgeon and patient.

To solve the above-mentioned problems, endoscopic treatment tools that integrate an injection needle and a snare have been proposed and developed. For example, Patent Document 1 discloses a medical device that includes a combined snare and needle, in which the needle is movably positioned within the snare's elongated lumen-type control member.

Special table 2019-518484 publication

However, in conventional endoscopic treatment tools disclosed in Patent Document 1 and elsewhere, the injection needle and snare are inserted through a single catheter, and are arranged coaxially. Therefore, if a malfunction occurs in either the injection needle or the snare, for example, when protruding it from the tip of the catheter or when transporting it through the catheter, both treatment tools may become unusable. Furthermore, the snare disclosed in Patent Document 1 is plate-shaped, which presents a problem in that it is not possible to resect diseased tissue with high precision.

In order to solve the above-mentioned problems, the present disclosure aims to provide an endoscopic treatment tool that, when the injection needle and snare are integrated, allows the injection needle and snare to be smoothly transported within the catheter and inserted and removed from the tip of the catheter.

In order to solve the above-mentioned problems, the endoscopic treatment tool according to the present disclosure comprises a catheter that can be inserted into a channel of an endoscopic device, an injection needle that is inserted into the catheter so as to be able to advance and retreat in the longitudinal axis direction, a wire portion that is inserted into the catheter so as to be able to advance and retreat in the longitudinal axis direction, and a guide member that is provided in the catheter at a position that is a predetermined distance inward from the tip portion of the catheter , the guide member being provided with a first guide portion that guides the injection needle so as to be able to protrude and retract from the tip portion of the catheter, and a second guide portion that guides the wire portion so as to be able to protrude and retract from the tip portion of the catheter, the wire portion being provided on the tip side and having a snare that is elastically deformable into an annular shape, and the second guide portion of the guide member having side grooves that accommodate each of the opposing wires of the snare that is contracted inside the catheter .
an injection needle inserted into the catheter so as to be able to advance and retract in the longitudinal axis direction; a guide member provided with: a first guide portion that guides the injection needle so as to be able to advance and retract in the longitudinal axis direction of the catheter; and a second guide portion that guides the wire portion so as to be able to advance and retract in the tip portion of the catheter; the guide member having a main body and a head portion connected to the main body, the main body being provided within the catheter, the head portion being provided so as to protrude from the tip portion of the catheter, the wire portion being provided on the tip side and having a snare that is elastically deformable into an annular shape; and the second guide portion of the guide member being provided in the main body, and having side grooves that accommodate each of the opposing wires of the snare that is contracted within the catheter .

According to the present disclosure, by providing a guide member having a first guide portion and a second guide portion at the tip portion inside the catheter, it is possible to provide independent transport paths for the injection needle and the wire portion within a single catheter. This allows the injection needle and the wire portion to be advanced and retracted within the catheter without interfering with each other, enabling the injection needle and the wire portion to be smoothly inserted and removed from the tip opening of the catheter.

1 is an overall view of an endoscopic treatment tool according to a first embodiment; 1 is a cross-sectional view of an endoscopic treatment tool according to a first embodiment. 1 is a cross-sectional view of a catheter according to a first embodiment. 2B is a cross-sectional view of the catheter shown in FIG. 2A taken along line AA. 2B is a cross-sectional view of the catheter shown in FIG. 2A taken along line BB. 5A to 5C are diagrams illustrating the operation of a first slider according to the first embodiment. 10A to 10C are diagrams illustrating the movement of the injection needle based on the operation of the first slider according to the first embodiment. 6A to 6C are diagrams illustrating the operation of a second slider according to the first embodiment. 10A to 10C are diagrams illustrating the movement of the wire portion based on the operation of the second slider according to the first embodiment. FIG. 2 is a diagram schematically illustrating a wire portion according to the first embodiment. 10A and 10B are diagrams schematically showing modified examples of the wire portion. 10A to 10C are diagrams illustrating the operation of the endoscopic treatment tool when removing a lesion according to the first embodiment. 10A to 10C are diagrams illustrating the operation of the endoscopic treatment tool when removing a lesion according to the first embodiment. 10A to 10C are diagrams illustrating the operation of the endoscopic treatment tool when removing a lesion according to the first embodiment. FIG. 10 is an overall view of an endoscopic treatment tool according to a second embodiment. FIG. 10 is a cross-sectional view of an endoscopic treatment tool according to a second embodiment. FIG. 10 is a cross-sectional view of a catheter according to a second embodiment. FIG. 10 is a plan view of a guide member according to a second embodiment. FIG. 10 is a side view of a guide member according to a second embodiment. FIG. 10 is a cross-sectional view of a guide member according to a second embodiment. FIG. 10 is a front view of a guide member according to a second embodiment. FIG. 10 is a rear view of the guide member according to the second embodiment. 10A to 10C are diagrams illustrating the movement of the injection needle based on the operation of the first slider according to the second embodiment. 10A to 10C are diagrams illustrating the movement of the injection needle based on the operation of the first slider according to the second embodiment. 10A to 10C are diagrams illustrating the movement of the snare wires based on the operation of the second slider according to the second embodiment. 10A to 10C are diagrams illustrating the movement of the snare wires based on the operation of the second slider according to the second embodiment. FIG. 10 is an overall view of an endoscopic treatment tool according to a third embodiment. FIG. 10 is a cross-sectional view of an endoscopic treatment tool according to a third embodiment. 13B is a cross-sectional view showing the distal end side of the catheter of the endoscopic treatment tool shown in FIG. 13A. 13A to 13C are diagrams showing the movement of the injection needle based on the operation of the syringe operation unit 320 according to the third embodiment. 13A to 13C are diagrams showing the movement of the injection needle based on the operation of the syringe operation unit 320 according to the third embodiment. 13A to 13C are diagrams illustrating the movement of the wire portion based on the operation of the snare operating portion 330 according to the third embodiment.

Preferred embodiments of the present disclosure are described in detail below with reference to the accompanying drawings.

First Embodiment
[Operation example of the endoscopic treatment tool 100]
FIG. 1 is an overall view of an endoscopic treatment tool 100 according to a first embodiment. FIG. 2A is a cross-sectional view of the endoscopic treatment tool 100 according to the first embodiment, FIG. 2B is a cross-sectional view of a catheter 118, FIG. 2C is a cross-sectional view taken along line A-A, and FIG. 2D is a cross-sectional view taken along line B-B. FIG. 3A is a diagram showing the operation of a first slider 120, and FIG. 3B is a diagram showing the operation of an injection needle 150 based on the operation of the first slider 120. FIG. 4A is a diagram showing the operation of a second slider 130, and FIG. 4B is a diagram showing the operation of a wire portion 160 based on the operation of the second slider 130. FIG. 5A is a diagram schematically showing a wire portion 160A, and FIG. 5B is a diagram schematically showing a wire portion 160B as a modified example.

The endoscopic treatment tool 100 is used by being inserted into a treatment tool channel formed in the endoscope insertion portion of an endoscopic device. As shown in Figures 1 and 2A, the endoscopic treatment tool 100 comprises an operation unit 110, a catheter 118, an injection needle 150, a wire portion 160A, and a guide member 170. The operation unit 110 has an operation unit main body 112, a first slider 120, a syringe port 122, a second slider 130, and an electric current-carrying electrode 102. The injection needle 150 and the wire portion 160A are each inserted into the catheter 118 so as to be able to advance and retract in the direction of the longitudinal axis X.

The first slider 120 is attached to the tip side of the operating unit body 112 in the longitudinal axis X direction and is movable forward and backward relative to the operating unit body 112. As shown in Figures 3A and 3B, when the first slider 120 moves forward relative to the operating unit body 112, it causes the injection needle 150 to protrude from the tip side of the catheter 118, and when it moves backward relative to the operating unit body 112, it retracts the injection needle 150 into the catheter 118 and stores it therein.

The syringe port 122 is a connection port for detachably attaching the tip (syringe barrel) of a syringe into which a swelling agent such as saline has been injected. The syringe port 122 is provided on the first slider 120 and moves integrally with the first slider 120. As shown in FIG. 2A , the base end of the syringe conduit 123 is connected to the syringe port 122. The syringe conduit 123 merges with the catheter 118 and is inserted into the catheter 118, extending, for example, to the tip side of the catheter 118. The syringe conduit 123 is inserted into and fixed to the base end of the injection needle 150, allowing the swelling agent in the syringe attached to the syringe port 122 to be supplied to the injection needle 150 via the syringe conduit 123.

The second slider 130 is located behind the first slider 120 and at the rear of the operating unit body 112, and is attached so as to be movable forward and backward relative to the operating unit body 112. As shown in Figures 4A and 4B, when the second slider 130 advances relative to the operating unit body 112, it causes the wire portion 160 to protrude from the tip opening 119 of the catheter 118, and when it retreats relative to the operating unit body 112, as shown in Figure 2B, it retracts the wire portion 160A into the catheter 118. The second slider 130 is configured as a gripping portion with an annular hole through which a finger can be inserted, but is not limited to this shape. The positions of the first slider 120 and second slider 130 may be reversed.

The current-carrying electrode 102 is attached to the second slider 130 and operates integrally with the second slider 130. One end of the current-carrying electrode 102 protrudes outward from the second slider 130, allowing connection to a high-frequency power supply (not shown). A wire attachment portion 136 is provided at the other end of the current-carrying electrode 102. The base end of the wire portion 160A is attached to the wire attachment portion 136, allowing high-frequency current from the high-frequency power supply to be passed through the current-carrying electrode 102 to the wire portion 160A.

The catheter 118 is a long member that can be inserted into and removed from the endoscope's treatment instrument channel 530 (see Figure 6A). It extends a predetermined length from the distal end of the control unit main body 112 via the cap 114. While the length of the catheter 118 in the longitudinal axis X direction is omitted in Figure 1A and other figures, the actual length of the catheter 118 in the longitudinal axis X direction is, for example, 180 to 240 cm. The catheter 118 is made of an insulating material, such as a fluororesin such as PTFE (polytetrafluoroethylene). The catheter 118 is flexible and can be inserted into and removed from the endoscope's treatment instrument channel, which meanders along the curved shape of luminal tissue within the body cavity. As shown in Figure 2A, the catheter 118 has a distal opening 119 at the distal end and a lumen 118a formed along its entire length. In this embodiment, the base end of the catheter 118 is attached to the tip end of the operation unit main body 112 via the cap 114, but the catheter 118 may also be extended along the inside of the operation unit main body 112 and its base end attached to the base end of the operation unit main body 112.

2B and 2C, a partition member 104 is disposed within the catheter 118 to separate the space through which the injection needle 150 passes from the space through which the wire portion 160A passes. The partition member 104 is composed of a flat plate member having a predetermined length extending in the longitudinal axis X direction, and divides the interior of the catheter 118, which has a circular cross section, into two sections. The partition member 104 is made of an insulating material, for example, a fluororesin such as PTFE (polytetrafluoroethylene). In this embodiment, multiple partition members 104 are provided and arranged at predetermined intervals, but a single elongated partition member 104 may also be disposed within the catheter 118. The space through which the wire portion 160A passes may also be further divided into two sections by the partition member 104. The partition member 104 may be molded integrally with the catheter 118 using a mold, for example, or may be attached later by forming a cut or hole in the catheter 118 in the direction of the longitudinal axis X and inserting the partition member 104 through the cut or hole.

The wire portion 160A is made of a conductive material such as stainless steel, nickel-titanium alloy, or tungsten, and extends within the control unit main body 112 and catheter 118, as shown in FIG. 2A. As shown in FIGS. 2A and 5A, the wire portion 160A includes a control wire 161 and a snare wire (snare) 163.

The operating wire 161 is composed of a single twisted wire, for example, two metallic wires twisted together. The outer surface of the operating wire 161 may be covered with a non-conductive material (not shown). The operating wire 161 is inserted into a cylindrical lead pipe 165 arranged along the longitudinal axis X inside the operating unit main body 112, and its base end is attached to the second slider 130. The tip of the operating wire 161 is connected to the snare wire 163.

The snare wire 163 is a part used to surround and incise the lesion P (see Figure 6A) and is provided so that it can be extended and retracted from the distal opening 119 of the catheter 118. As shown in Figures 2D and 4B, the snare wire 163 is composed of two wires 163a, 163b that are curved outward and connected at the distal end, forming a circular ring (loop) in plan view. In other words, the ring shape is formed by bending a single wire from the distal end toward the proximal end. The snare wire 163 is elastically deformable, and as shown in Figure 4B, when it protrudes outward from the distal opening 119 of the catheter 118, it expands and deforms into a loop shape due to elastic force, and when it is retracted into the distal opening 119 of the catheter 118, it contracts and narrows due to elastic force. Note that, although the snare wire 163 is configured as a circular ring in plan view in this embodiment, this is not limited thereto, and the snare wire 163 may be formed into a polygonal shape in plan view by providing multiple bends in the snare wire 163.

Note that other configurations can also be used for the wire portion 160A. A modified wire portion 160B has a first operating wire 161, a second operating wire 162, and a snare wire 163, as shown in Figure 5B.

The first operating wire 161 is composed of two wires 161a and 161b made of, for example, metal. The distal end of the first operating wire 161 is connected to the proximal end of a snare wire 163, the proximal end of which is connected to the distal end of a second operating wire 162. The second operating wire 162 is inserted into a lead pipe 165 arranged along the longitudinal axis X within the operating unit main body 112 and twisted together, converging into a single wire. The proximal end of the second operating wire 162 is attached to the second slider 130. The snare wire 163 is provided so that it can be inserted and withdrawn from the distal opening 119 of the catheter 118. The snare wire 163 is elastically deformable into a ring shape and surrounds and incises the lesion P (see Figure 6A).

2A and 2B, the guide member 170 is a member for guiding the injection needle 150 and snare wire 163 through the catheter 118 while keeping them spaced apart so as not to interfere with each other. The guide member 170 is made of a material such as ceramic or plastic. The guide member 170 is a substantially cylindrical body with a diameter smaller than the inner diameter of the catheter 118, and is attached inside the catheter 118 at a position a predetermined distance Y inward from the distal opening 119. The guide member 170 can be fixed inside the catheter 118 using a fixing member such as an adhesive. The distance Y is, for example, approximately 5 to 20 mm. As a result, when the snare wire 163, which has a lesion P such as a polyp sandwiched between it, is pulled into the catheter 118, any lesion P larger than the diameter of the distal opening 119 of the catheter 118 will hit the edge of the distal opening 119 and be obstructed, allowing the lesion P to be torn off.

As shown in FIG. 2D , the guide member 170 has a first groove 172 that guides the injection needle 150 so that it can be inserted and removed from the distal end opening 119 of the catheter 118, and second grooves 174a and 174b that guide the wires 163a, 163b, etc. so that they can be inserted and removed from the distal end opening 119 of the catheter 118. The first groove 172 is formed by cutting out a concave cross section from the circumferential surface and extends over the entire length in the direction of the longitudinal axis X. The concave shape of the first groove 172 has a diameter slightly larger than the diameter of the injection needle 150, and may be formed as, for example, a U-shaped groove that follows the external shape of the injection needle 150. The first groove 172 constitutes an example of a first guide portion.

The second grooves 174a and 174b are formed by cutting out the peripheral surface to form a concave cross section, and are formed over the entire length in the direction of the longitudinal axis X. The concave shape of the second grooves 174a and 174b has a diameter slightly larger than the diameter of the wires 163a and 163b, etc., and may be formed as, for example, a U-shaped groove that follows the outer shape of the wire portion 160A. The second grooves 174a and 174b constitute an example of a second guide portion.

In this embodiment, the first groove 172 and the second grooves 174a, 174b are spaced apart at approximately 120° intervals in the circumferential direction to prevent interference with each other, but this spacing is not limited to this. Also, while the first groove 172 and the second grooves 174a, 174b are shown as grooves in Figure 2D and other figures, at least one of the first groove 172 and the second grooves 174a, 174b may be configured as a hole penetrating in the longitudinal axis X direction.

[Operation example of the endoscopic treatment tool 100]
Next, an example of the operation of the endoscopic treatment tool 100 when excising a lesion P such as a polyp that bulges out from the epithelium of a living body will be described. Figures 6A to 6C are diagrams showing the operation of the endoscopic treatment tool 100 when removing the lesion P.

First, the surgeon inserts the endoscope insertion section 510 of the endoscope device 500 into the body cavity and identifies the lesion P while observing the image captured by the endoscope 520. The surgeon inserts the catheter 118 of the endoscopic treatment tool 100 into the treatment tool channel 530 provided in the endoscope insertion section 510, and positions the tip of the catheter 118 above the lesion P by protruding it from the treatment tool channel 530, as shown in Figure 6A.

Next, the first slider 120 of the endoscopic treatment tool 100 is advanced relative to the control unit body 112, causing the injection needle 150 to protrude from the distal opening 119 of the catheter 118, as shown in FIG. 6B. The protruding injection needle 150 is then inserted between the lesion P and the muscle layer W, and a swelling agent such as saline is injected to distend the lesion P. After the swelling agent is injected, the first slider 120 is retracted relative to the control unit body 112, causing the injection needle 150 to be retracted into the catheter 118 through the distal opening 119 of the catheter 118, and the injection needle 150 is stored in the first groove 172 of the guide member 170 (see FIGS. 2B and 2D).

Next, the second slider 130 of the endoscopic treatment tool 100 is advanced relative to the control unit main body 112, causing the snare wire 163 to protrude from the distal opening 119 of the catheter 118, as shown in Figure 6C. This causes the snare wire 163 to expand due to its elastic force, deforming into a loop, and unfolding. The surgeon then places the looped snare wire 163 around the lesion P, thereby surrounding the lesion P with the snare wire 163.

Next, the surgeon slightly retracts the second slider 130 of the endoscopic treatment tool 100 relative to the control unit main body 112, pulling the base end of the snare wire 163 into the catheter 118. This reduces the diameter of the annular shape of the snare wire 163, causing the snare wire 163 to wrap around the base of the lesion P.

Next, the surgeon operates the high-frequency power supply device to supply and energize the snare wire 163 of the wire portion 160A via the current-carrying electrode 102. This causes the lesion P wrapped around the snare wire 163 to be cauterized and incised. Finally, the surgeon further retracts the second slider 130 of the endoscopic treatment tool 100 relative to the control unit body 112, retracting the entire snare wire 163 into the catheter 118 and storing the wires 163a and 163b into the second grooves 174a and 174b, respectively (see Figures 2B and 2D).

In the above-described embodiment, a high-frequency current is passed through the snare wire 163, but this is not limiting. For example, the lesion P may be incised by so-called cold polypectomy, in which the snare wire 163 clamps and incises the base of the lesion P without passing a high-frequency current through the snare wire 163.

As described above, according to the first embodiment, by providing a guide member 170 having a first groove 172 and second grooves 174a, 174b at the distal end of the catheter 118, it is possible to provide independent transport paths for the injection needle 150 and the wire portion 160A within a single catheter 118. This allows the injection needle 150 and the wire portion 160A to be advanced and retracted within the catheter 118 without interfering with each other, enabling the injection needle 150 and the wire portion 160A to be smoothly inserted and removed from the distal opening 119 of the catheter 118. Furthermore, because the transport paths for the injection needle 150 and the wire portion 160A are provided separately, even if a malfunction occurs in one treatment tool, for example, the injection needle 150, the other treatment tool, for example, the wire portion 160A, can be used normally.

In addition, since the injection needle 150 is guided and conveyed along the first groove 172 of the guide member 170, and the snare wire 163 is guided and conveyed along the second grooves 172b and 172c of the guide member 170, positional deviation of the injection needle 150 and snare wire 163 in a direction intersecting (perpendicular to) the longitudinal axis X can be prevented. This allows the lesion P to be resected accurately and with high precision.

In addition, by providing the partition member 104 within the catheter 118, the transport path for the injection needle 150 and the transport path for the wire portion 160A can be separated within a single catheter 118, preventing interference between the injection needle 150 and the snare wire 163. This prevents problems such as entanglement between the injection needle 150 and the snare wire 163, allowing for smooth transport of the injection needle 150 and the snare wire 163. Furthermore, for example, by supporting the wire portion 160A with the partition member 104 and narrowing the transport path, it is possible to prevent bending of the wire portion 160A.

Furthermore, according to this embodiment, the transport path for the injection needle 150 and the transport path for the snare wire 163 can be provided separately within the catheter 118, so the injection needle 150 and the snare wire 163 can be used in sequence without having to be swapped. Furthermore, the injection needle 150 and the snare wire 163 can be injected with the injection needle 150 and the snare wire 163 simultaneously protruding from the distal end opening 119 of the catheter 118, and the lesion P can be excised. This reduces the time required to swap the injection needle 150 and the snare wire 163, thereby significantly reducing the surgical time.

Furthermore, according to this embodiment, the guide member 170 is provided at a position a predetermined distance Y inward from the distal opening 119 of the catheter 118, making it possible to preferably perform cold pectomy, which removes the lesion P without using high-frequency current. That is, as the snare wire 163, which clamps the lesion P, is pulled into the catheter 118 and the snare wire 163 is moved the distance Y, the lesion P, which is larger than the distal opening 119, hits the edge of the distal opening of the catheter 118, allowing the lesion P to be torn off without applying current. By employing cold pectomy, the tiny blood vessels running through the stalk of the polyp can be bluntly torn off, causing spasm, which has the advantage of causing less bleeding than when the polyp is removed by cauterization with an electric scalpel.

Second Embodiment
The second embodiment differs from the configuration of the guide member 170 of the first embodiment in that the distal end portion of the guide member 270 protrudes from the distal end opening 219 of the catheter 218. In the endoscopic treatment tool 200 of the following embodiment, parts having the same configurations and functions as those of the endoscopic treatment tool 100 of the first embodiment will be designated by the same names, and redundant explanations will be omitted.

Figure 7 is an overall view of an endoscopic treatment tool 200 according to the second embodiment. Figure 8A is a cross-sectional view of the endoscopic treatment tool 200 according to the second embodiment, and Figure 8B is a cross-sectional view of a catheter 218. Figure 9A is a plan view of a guide member 270 according to the second embodiment, Figure 9B is a side view of the guide member 270, Figure 9C is a cross-sectional view of the guide member 270, Figure 9D is a front view of the guide member 270, and Figure 9E is a rear view of the guide member 270.

[Configuration example of the endoscopic treatment tool 200]
7 and 8A, the endoscopic treatment tool 200 according to this embodiment includes a manipulation section 210, a catheter 218, a partition member 204, an injection needle 250, a wire section 260, and a guide member 270. The manipulation section 210 includes a manipulation section main body 212, a first slider 220, a second slider 230, and a current-carrying electrode 202. While either the structure of the wire section 160B shown in FIG. 5A or the structure of the wire section 160A shown in FIG. 5B may be employed as the wire section 260, the following description will focus on the case where the wire section 160B is employed as the wire section 260. The wire section 260 includes a first manipulation wire 261, a second manipulation wire 262, and a snare wire 263.

The guide member 270 is a member for guiding the injection needle 250 and the wire portion 260 through the catheter 218 while keeping them separated so as not to interfere with each other. The guide member 270 is made of, for example, ceramic, plastic, etc. As shown in Figures 8B and 9A, the guide member 270 has a main body 270a and a head portion 270b connected to the main body 270a. In this embodiment, the main body 270a is provided inside the distal end of the catheter 118, and the head portion 270b is provided to protrude outward from the distal opening 219 of the catheter 218.

The main body 270a has a cylindrical shape with a diameter slightly smaller than or approximately the same as the inner diameter of the catheter 218, and is fixed to the distal end of the catheter 118 with a fixing member such as an adhesive. As shown in Figures 9C and 9D, side grooves 272a and 272b are formed on the left and right sides of the main body 270a to accommodate the opposing wires 263a and 263b (wire portion 260) contracted (compressed) within the catheter 218. The side grooves 272a and 272b are formed by cutting out the circumferential surface to form a concave cross section, and extend over the entire length in the direction of the longitudinal axis X. The concave shapes of the side grooves 272a and 272b may have a diameter slightly larger than the diameter of the wire portion 260 and may be formed, for example, as a U-shaped groove that follows the outer shape of the wire portion 260. The side grooves 272a and 272b constitute an example of a second guide portion.

As shown in Figures 9A and 9B, head 270b is generally bowl-shaped with a larger diameter than body 270a and is attached to the tip of body 270a. Head 270b is formed with a storage groove 272c for storing curved tip 263c (see Figure 11A) of snare wire 263 (wire portion 260). Storage groove 272c is formed by cutting out the circumferential surface to form a concave cross section and is formed in an arc shape to follow the circumferential shape, with both ends communicating with side grooves 272a and 272b. The concave shape of storage groove 272c may have a diameter slightly larger than that of wire portion 260 and may be formed as, for example, a U-shaped groove that follows the external shape of wire portion 260. Storage groove 272c constitutes an example of a second guide portion.

As shown in Figure 9B, in a side view of the guide member 270, the storage groove 272c is inclined obliquely upward at a predetermined angle relative to the side grooves 272a and 272b, which extend in the direction of the longitudinal axis X (horizontal direction). This allows the storage groove 272c to be positioned offset from the storage hole 272d formed in the axis of the guide member 270 when viewed from the front. Note that, from the perspective of cutting, it is preferable that the extension direction of the storage hole 272d in a side view be formed in a straight line, but it may also be curved. As shown in Figure 8B, the step portion 270c provided on the rear edge of the head portion 270b engages with the end surface of the tip opening 219 of the catheter 218, restricting movement of the guide member 270 into the catheter 218.

As shown in Figures 9C, 9D, and 9E, the guide member 270 is also formed with a storage hole 272d for guiding the injection needle 250 so that it can move forward and backward within the catheter 218. The storage hole 272d penetrates along the central axis (axial core) of the guide member 270 and has a diameter that is slightly larger than or approximately the same as the diameter of the injection needle 250. The base end of the storage hole 272d is connected to the inside of the catheter 218. The storage hole 272d constitutes an example of a first guide section.

[Operation example of the endoscopic treatment tool 200]
10A and 10B are diagrams showing the movement of the injection needle 250 based on the operation of the first slider 220.

When the surgeon advances the first slider 220 relative to the operating unit main body 212, as shown in Figure 10A, the injection needle 250 advances along the storage hole 272d of the guide member 270 inside the catheter 218 and protrudes outward from the tip opening 219 and head 270b of the catheter 218. Then, in this state, the injection needle 250 protruding from the head 270b is inserted between the lesion P and the muscle layer W, and a bulging agent is injected.

Next, when the surgeon moves the first slider 220 backward relative to the operation unit main body 212, the injection needle 250 is retracted into the catheter 218, as shown in Figure 10B. This causes the injection needle 250 to be stored in the storage hole 272d of the guide member 270.

Figures 11A and 11B show the movement of the wire portion 260 based on the operation of the second slider 230.

Next, when the surgeon advances the second slider 230 relative to the control unit main body 212, the snare wire 263 advances along the side grooves 272a, 272b of the guide member 270 inside the catheter 218, and as shown in Figure 11A, protrudes outward from the distal opening 219 and head portion 270b of the catheter 218. The snare wire 263 protruding from the head portion 270b is deformed and slightly expanded due to elastic force.

Next, the snare wire 263 is placed around the lesion P from the head 270b. The surgeon then retracts the second slider 230 relative to the control unit body 212, causing the rear end of the snare wire 263 to be pulled into the catheter 218. Next, a high-frequency current is applied to the snare wire 263 by the high-frequency power supply, and the lesion P is excised.

Next, when the surgeon retracts the second slider 230 relative to the operation unit main body 212, the entire snare wire 263 is pulled into the catheter 218. As a result, as shown in FIG. 11B, the tip 263c of the snare wire 263 is stored in the storage groove 272c of the guide member 270, and the wires 263a and 263b of the snare wire 263 are stored in the side grooves 272a and 272b, respectively. Because the opening diameter of the snare wire 263 is configured to be approximately the same as the diameter of the guide member 270, the snare wire 263 can be stored in the catheter 218 without placing much strain on the snare wire 263.

As described above, the second embodiment can achieve the same effects as the first embodiment. For example, by providing a guide member 270 having side grooves 272a, 272b, storage groove 272c, and storage hole 272d at the distal end of the catheter 218, it is possible to provide independent transport paths for the injection needle 250 and the wire portion 260 within a single catheter 218. This allows the injection needle 250 and the wire portion 260 to be advanced and retracted within the catheter 218 without interfering with each other, enabling the injection needle 250 and the wire portion 260 to be smoothly inserted and removed from the distal opening 219 of the catheter 218. Furthermore, because the transport paths for the injection needle 250 and the wire portion 260 are provided separately, even if a malfunction occurs in one treatment tool, such as the injection needle 250, the other treatment tool, such as the wire portion 260, can be used normally.

Third Embodiment
The endoscopic treatment tool 300 of the third embodiment differs from the operation sections 110, 210 of the endoscopic treatment tools 100, 200 of the first and second embodiments in that the operation section 310 is configured in a pistol shape. Note that in the endoscopic treatment tool 300 of the following embodiments, parts having the same configurations and functions as those in the endoscopic treatment tool 100 of the first embodiment will be designated by the same names, and redundant explanations will be omitted.

Figure 12 is an overall view of an endoscopic treatment tool 300 according to a third embodiment. Figure 13A is a cross-sectional view of the endoscopic treatment tool 300 according to the third embodiment, and Figure 13B is a cross-sectional view showing the distal end side of the catheter 318 of the endoscopic treatment tool 300 shown in Figure 2A.

[Configuration example of endoscopic treatment tool 300]
12 and 13A, the endoscopic treatment tool 300 includes an operation section 310, a catheter 318, a syringe operation section 320, a snare operation section 330, an injection needle 350, a wire section 360, a guide member 370, and a drive mechanism 380. Note that although the guide member 170 of the first embodiment described above is applied to the guide member 370, the guide member 270 of the second embodiment may also be applied.

As shown in FIG. 12, the operation unit 310 has an operation unit main body 312 and a current-carrying electrode 302. As shown in FIG. 13A, the wire unit 360 has a first operation wire 361, a second operation wire 362, and a snare wire 363.

The operating unit main body 312 is provided with a handle portion 313 extending downward from the rear underside of the operating unit main body 312. In this embodiment, the operating unit main body 312 and the handle portion 313 form a pistol shape. As shown in FIG. 13A, the handle portion 313 has a built-in tank 390 for storing a swelling agent such as saline. The lower end of the handle portion 313 is provided with a connection port 391 to which a syringe (not shown) can be connected. The tank 390 is connected to the connection port 391, so that the swelling agent can be filled into the tank 390 via the connection port 391.

As shown in Figure 13A, a cylinder 315 is provided within the operating unit main body 312, which is movable along the longitudinal axis X and rotatable around the longitudinal axis X. The base end of a wire portion 360 is attached to the cylinder 315, and the wire portion 360 is movable back and forth as the cylinder 315 moves forward and backward. The rear end of the cylinder 315 protrudes outward from the rear end of the operating unit main body 312, and the protruding cylinder 315 is provided with a ring 315a for rotating the cylinder 315 and the snare wire 363. This allows the angle of the snare wire 363 to be adjusted by rotating the ring 315a. However, in this embodiment, the guide member 370 is fixed at the tip end inside the catheter 318, so the rotation function is not used.

A slide mechanism 316 is attached to the tip side of the cylinder 315. The shaft 317 of the slide mechanism 316 is inserted through the elongated hole 312a of the operation unit body 312 and the elongated hole 331a of the first grip 331. The elongated hole 312a of the operation unit body 312 is formed along the longitudinal axis X of the operation unit body 312. The slide mechanism 316 moves along the elongated hole 312a by rotating the first grip 331 and the second grip 332, moving the cylinder 315 forward and backward relative to the operation unit body 312.

The current-carrying electrode 302 is attached to the upper rear part of the operating unit main body 312. The tip of the current-carrying electrode 302 is adapted to be able to abut against the cylinder 315, and the base end of the current-carrying electrode 302 is adapted to be able to be connected to a high-frequency power supply device (not shown). This allows high-frequency current supplied from the high-frequency power supply device to be transmitted to the wire portion 360 via the cylinder 315. The tip of the current-carrying electrode 302 may also be attached to the rear end side of the cylinder 315.

The syringe operating unit 320 has a first trigger 321 and a second trigger 322. The first trigger 321 is an operating unit for protruding the injection needle 350 from the tip of the catheter 318 and for retracting the injection needle 350 into the catheter 318. The first trigger 321 is provided below the operating unit main body 312 and is configured to be pulled by the surgeon. When pulled, the first trigger 321 activates the drive mechanism 380, causing the injection needle 350 inserted into the catheter 318 to advance. The first trigger 321 is biased forward by an elastic member such as a spring (not shown).

The second trigger 322 is an operating part for supplying and injecting the swelling agent into the injection needle 350. The second trigger 322 is located below the operation part main body 312, behind the first trigger 321. The second trigger 322 is pressed rearward by the first trigger 321 when the first trigger 321 is pulled. As shown in FIG. 13A, a rubber stopper 323 is attached to the rear end of the second trigger 322, and the rubber stopper 323 is attached to a tank pipe 392 that communicates with the tank 390. When the rubber stopper 323 moves rearward within the tank pipe 392 as the second trigger 322 retracts, the swelling agent filled in the tank 390 is pushed out and injected into the injection needle 350.

As shown in FIG. 13A, the drive mechanism 380 has a first slide portion 381, a second slide 382, and a rotation shaft 383. The first slide portion 381 is attached to the upper side of the first trigger 321 and moves integrally with the first trigger 321 when the first trigger 321 is pulled. The first slide portion 381 is made of a long, thin, flat plate member with multiple teeth formed on its upper surface, which mesh with the teeth of the rotation shaft 383 located above.

The rotation shaft 383 is a gear with an axis perpendicular to the longitudinal axis X, and is rotatably attached to the operation unit main body 312. The rotation shaft 383 rotates in conjunction with the forward and backward movement of the first slide portion 381.

The second slide 382 is composed of a long, thin, flat plate member with multiple teeth formed on its underside, and is positioned opposite the upper side of the first slide portion 381. The second slide 382 engages with the teeth of the rotating shaft 383 positioned below, and moves forward and backward relative to the operating unit main body 312 as the rotating shaft 383 rotates.

A holding portion 384 for holding and fixing the syringe tube 394 is provided on the upper surface of the second slide 382. The holding portion 384 moves integrally with the second slide 382 as it moves, moving the syringe tube 394 and injection needle 350 forward and backward. The holding portion 384 may be configured, for example, to clamp the syringe tube 394, or may be configured using a fixing member such as an adhesive.

The snare operating section 330 has a first grip 331 and a second grip 332, which are made of elongated flat members. The first grip 331 and the second grip 332 are members that the surgeon grasps and tilts forward to advance the wire section 360 within the catheter 318.

One end of the first grip 331 is rotatably attached to a shaft 334 provided at the lower end of the handle portion 313. The other end of the first grip 331 protrudes from the top surface of the operation unit main body 312 and functions as a part to be held by the surgeon. A shaft 335 is provided at approximately the center of the first grip 331 in the longitudinal direction, and the shaft 335 is inserted into an elongated hole 332a of the second grip 332. A elongated hole 331a is formed in the first grip 331, and the shaft 317 of the slide mechanism 316 is inserted into the elongated hole 331a.

One end of the second grip 332 is rotatably attached to a shaft 336 provided on the upper rear side of the operation unit main body 312. A long hole 332a is formed in the second grip 332, and the shaft 335 of the first grip 331 is inserted into the long hole 332a. The other end of the second grip 332 protrudes from the underside of the handle portion 313 and functions as a gripping portion for the surgeon to hold.

As a result, when the first grip 331 and second grip 332 are tilted forward by the surgeon, the slide mechanism 316 advances along the elongated hole 312a of the operation unit main body 312, and the cylinder 315 and wire portion 360 advance accordingly. At least one of the first grip 331 and second grip 332 is biased rearward by an elastic member such as a spring (not shown). In this embodiment, the first grip 331 and second grip 332 are held in the initial position shown in Figure 12 by the elastic member.

[Operation example of the endoscopic treatment tool 300]
14A and 14B are diagrams for explaining the movement of the injection needle 350 based on the operation of the first trigger 321 and the second trigger 322.

As shown in Figure 14A, when the surgeon pulls the first trigger 321 in the direction of arrow D1, the first slide portion 381 retracts relative to the operation unit main body 312, causing the rotation shaft 383 to rotate counterclockwise and the second slide 382 to advance. As a result, the holding portion 384 and syringe tube 394 advance relative to the operation unit main body 312, and the injection needle 350 attached to the syringe tube 394 protrudes from the tip opening 319 of the catheter 318. Then, in this state, the injection needle 350 protruding from the tip of the catheter 318 is inserted between the lesion P and the muscle layer W.

As shown in Figure 14B, when the surgeon further pulls the first trigger 321 in the direction of arrow D1, the second trigger 322 is pressed backward by the first trigger 321. This causes the rubber stopper 323 to retract, and the swelling agent in the tank 390 is supplied to the injection needle 350 via the syringe tube 394, and the liquid is injected from the injection needle 350 into the vicinity of the lesion P.

When injection using the injection needle 350 is completed, the fingers are released from the first trigger 321 and the second trigger 322, and the first trigger 321 and the second trigger 322 return to their original positions due to the elastic force of a spring or the like (not shown). Accordingly, the first slide portion 381 advances relative to the operation unit main body 312, and the rotation shaft 383 rotates clockwise, causing the second slide 382 and the holding portion 384 to retract. This causes the syringe tube 394 and the injection needle 350 connected thereto to retract, and the injection needle 350 is retracted and stored within the catheter 318.

Figure 15 is a diagram illustrating the movement of the wire portion 360 of the injection needle 350 based on the operation of the first grip 331 and the second grip 332.

When the surgeon grasps the first grip 331 and the second grip 332 and tilts them forward in the directions of arrows D2 and D3, the slide mechanism 316 advances along the elongated hole 312a, causing the cylinder 315 to advance relative to the operating unit main body 312. As a result, the wire portion 360 attached to the cylinder 315 advances within the catheter 318, causing the snare wire 363 at the tip end, protruding from the tip opening 319 of the catheter 318, to deform into a circular shape due to elastic force.

Next, after the snare wire 363 is placed around the lesion P, the first grip 331 and the second grip 332 are moved slightly backward to tighten the snare wire 363, and a high-frequency current is passed through the snare wire 363 using the high-frequency power supply. This causes the lesion P to be resected.

Next, when the surgeon's fingers move away from the first grip 331 and the second grip 332, the elastic force of a spring or the like (not shown) causes the first grip 331 and the second grip 332 to move backward and return to their original positions. The slide mechanism 316 retracts along the elongated hole 312a, and the cylinder 315 and the wire portion 360 attached to the cylinder 315 retract. As a result, the snare wire 363 is retracted and stored within the catheter 318.

As described above, according to the third embodiment, by making the operating unit 310 pistol-shaped, from an ergonomic standpoint, the force required to resect a lesion P, such as a polyp, during cold polypectomy can be transmitted more directly to the snare operating unit 330. This allows the lesion P to be resected accurately and with high precision.

Furthermore, according to the third embodiment, it is possible to achieve the same effects as the first embodiment described above. For example, by providing a guide member 370 at the distal end side within the catheter 318, the injection needle 350 and the wire portion 360 can be advanced and retracted within the catheter 318 without interference, thereby realizing smooth insertion and removal of the injection needle 350 and the wire portion 360 from the distal opening 319 of the catheter 318. Furthermore, because separate transport paths are provided for the injection needle 350 and the wire portion 360, even if a malfunction occurs in one treatment tool, for example, the injection needle 350, the other treatment tool, for example, the wire portion 360, can be used normally.

100, 200, 300 Endoscopic treatment tool 118, 218, 318 Catheter 150, 250, 350 Injection needle 160A, 160B, 260, 360 Wire portion 163, 263, 363 Snare wire 170, 270, 370 Guide member 172 First groove (first guide portion)
174a, 174b Second groove (second guide part)
270a Main body (guide member)
270b Head (guide member)
272a, 272b gutter (second guide portion)
272c Storage groove (second guide portion)
272d Storage hole (first guide part)

Claims (4)

a catheter insertable into a channel of an endoscope device;
an injection needle inserted into the catheter so as to be able to advance and retreat in the longitudinal axis direction;
a wire portion inserted through the catheter so as to be able to advance and retreat in the longitudinal axis direction;
a guide member provided in the catheter at a position located a predetermined distance inward from the distal end of the catheter ,
The guide member has:
a first guide portion that guides the injection needle so that it can be projected and retracted from the tip end portion of the catheter;
a second guide portion that guides the wire portion so that it can be projected and retracted from the distal end portion of the catheter,
the wire portion has a snare provided at a distal end thereof and elastically deformable into an annular shape;
the second guide portion of the guide member has side grooves for receiving opposing wires of the snare when the snare is contracted within the catheter;
Endoscopic treatment tools. a catheter insertable into a channel of an endoscope device;
an injection needle inserted into the catheter so as to be able to advance and retreat in the longitudinal axis direction;
a wire portion inserted through the catheter so as to be able to advance and retreat in the longitudinal axis direction ;
a first guide portion that guides the injection needle so that it can be projected and retracted from the distal end portion of the catheter;
a guide member provided with a second guide portion that guides the wire portion so that it can be projected and retracted from the distal end portion of the catheter,
The guide member has a main body and a head portion connected to the main body ,
the main body is disposed within the catheter;
the head portion is provided to protrude from the distal end portion of the catheter,
the wire portion has a snare provided at a distal end thereof and elastically deformable into an annular shape;
The second guide portion of the guide member is
a side groove provided in the main body for accommodating each of the opposing wires of the snare when contracted within the catheter;
Endoscopic treatment tools. The second guide portion of the guide member is
A storage groove is provided in the head portion and stores the curved tip portion of the snare.
The endoscopic treatment tool according to claim 2 . The first guide portion is a through hole penetrating in the longitudinal axis direction or a groove formed along the longitudinal axis direction.
The endoscopic treatment tool according to claim 1 .