JP5543733B2 - Endoscope insertion tool - Google Patents

Description

  The present invention relates to an endoscope treatment tool insertion tool for inserting a treatment tool such as forceps.

A treatment instrument channel through which a treatment instrument such as forceps is inserted is provided in an insertion portion of a general endoscope (a tubular portion inserted into a body cavity of a patient).
In endoscopic treatment, various treatment tools are inserted into the treatment tool channel of the endoscope, this treatment tool is projected from the distal end portion of the endoscope, and the treatment tool is operated while confirming the endoscopic image to obtain the desired treatment tool. Take action. At this time, the treatment instrument is operated while ensuring a visual field in the vicinity of the site to be treated, but in order to perform appropriate treatment, the position of the endoscope tip and the position of the treatment tool tip may be finely adjusted according to the situation. Necessary.
Usually, the operator rotates the operation handle provided on the operation part of the endoscope with the left hand to perform the angle operation of the endoscope. Therefore, the forward / backward operation of the endoscope insertion part and the forward / backward operation of the treatment tool are performed with the right hand. Done in

By the way, the forward / backward operation of the endoscope is performed by holding the insertion portion of the endoscope with the right hand and moving it forward or backward so that the distal end of the endoscope is at a desired position in the body cavity.
On the other hand, the advancement / retraction operation of the treatment instrument of the endoscope is normally performed by the operator near the treatment instrument insertion port because the treatment instrument insertion port of the treatment instrument channel is provided in the vicinity of the operation part of the endoscope. You must take this in and out.
Therefore, when the endoscope and the treatment tool are advanced and retracted during the operation, the left hand of the surgeon is closed for the angle operation of the endoscope, so both must be performed only with the right hand. After securing the field of view once by advancing and retracting the insertion portion, the right hand must be removed from the endoscope insertion portion and replaced with a treatment tool in the vicinity of the treatment instrument insertion port to perform the advance / retreat operation of the treatment instrument.
That is, since the right hand must be once removed from the endoscope insertion portion for the advancement / retraction operation of the treatment instrument, not only the operability is bad, but also the problem that the field of view once secured shifts during the advancement / retraction operation of the treatment instrument. is there.
JP 2008-200098 A

Although some treatment instrument channels can be externally attached to the endoscope insertion section, the treatment instrument insertion port of the treatment instrument channel externally attached to the endoscope is also provided on the endoscope operation section side. It is normal.
Therefore, as in the case where the treatment instrument channel is provided in the endoscope insertion portion, when performing the advancement / retraction operation of the endoscope insertion portion and the advancement / retraction operation of the treatment instrument during the operation, hold the endoscope insertion portion with the right hand. After performing the advance / retreat operation of the endoscope, the right hand must be released and moved to the treatment instrument near the treatment instrument insertion port to perform the advance / retreat operation of the treatment instrument. There is a problem that shifts.
JP 2008-253597 A

  The present invention enables the advancement / retraction operation of the treatment instrument while maintaining the visual field once secured by the advance / retreat operation of the endoscope, that is, the endoscope capable of performing the advancement / retraction operation of the treatment instrument while holding the endoscope with one hand. It is an object to obtain a treatment instrument insertion tool for a mirror.

Endoscopic treatment instrument insertion device of the invention, the treatment instrument such as forceps is inserted, Ri Do a flexible tube, the peripheral wall of the processing置具channel provided in an endoscope insertion portion to be inserted into a body cavity In addition, an axial slit that is attached to the treatment instrument and into which the advance / retreat operation assisting tool that assists the advance / retreat operation of the treatment instrument is inserted is formed.

  The treatment instrument channel of the endoscope is a concept including a so-called external treatment instrument channel as well as the one provided in the endoscope insertion section inserted into the body cavity, and the endoscope insertion section and Alternatively, a separate flexible tube may be detachably attached to the peripheral edge of the endoscope insertion portion (claim 2).

When the treatment instrument channel is configured by a flexible tube, the attachment of the treatment instrument channel to the endoscope insertion portion may be performed using a known attachment means such as a strap, an attachment, or a medical tape, Preferably, a transparent hood that can be attached to the distal end of the endoscope insertion portion is provided at the distal end of the flexible tube, and this transparent hood is attached to the distal end of the endoscope insertion portion.
If this hood is attached to the distal end of the endoscope insertion portion, the distal end portion of the flexible tube is securely fixed to the endoscope insertion portion, so that when the flexible tube is inserted into the body cavity, It can be inserted safely and smoothly together with the mirror insertion part. In addition, when performing a treatment by operating the treatment tool, it is possible to secure a working space for the treatment tool inside the hood while securing a field of view outside the hood with the transparent hood.
The hood may be fixed to the tip of the flexible tube or may be detachably attached.

  The slit may be formed by cutting the peripheral wall in the axial direction of the treatment instrument channel, or may be formed as a long hole extending in the axial direction. Further, the slit can be configured to be opened and closed with a wire fastener or the like. In short, the advance / retreat operation assisting tool can be taken in and out from the outside, and the inserted advance / retreat operation assisting tool can be moved in the axial direction. When the slit is constituted by a wire fastener or the like, it is possible to close a slit other than the range necessary for the attachment and advance / retreat operation of the treatment instrument advance / retreat tool.

  The slit may be formed in a part of the treatment instrument channel. However, if the slit is formed over almost the entire length of the treatment instrument channel, the advance / retreat operation assisting tool can be attached at an arbitrary position. The movement range in the axial direction is not limited (Claim 3).

  Further, the slit may be formed by intermittently forming a plurality of slits having a length of about several centimeters in the axial direction. In this case, the slits are prevented from opening and the treatment instrument is prevented from coming out of the treatment instrument channel in use. can do. (Claim 4).

The endoscope treatment tool insertion tool of the reference example is for the user to form the slit at an arbitrary position, and on the treatment tool channel peripheral wall of the endoscope through which a treatment tool such as forceps is inserted, A planned opening portion for forming an axial slit into which the advance / retreat operation assisting tool for assisting the advance / retreat operation of the treatment instrument is inserted is provided.
It is sufficient that the planned opening portion serves as a mark for the user to form a slit and can be more easily torn than other portions of the treatment instrument channel peripheral wall.For example, an axial groove is provided in the treatment instrument channel peripheral wall. For example, it may be formed and configured.
According to this, the user can cut the planned opening portion to form a slit at an arbitrary position in the axial direction of the treatment instrument channel only in a range necessary for the advancement / retraction operation of the treatment instrument. Since the occlusion state can be maintained outside the necessary range, the backflow of body fluid can be prevented as much as possible.

The advance / retreat operation assisting tool is for assisting the advance / retreat operation of the treatment instrument inserted into the treatment instrument channel, and it is sufficient that the advance / retreat operation assisting instrument can be attached to the treatment instrument in the treatment instrument channel via the slit. For example, a clip-like instrument having a grip portion that can be inserted into the treatment instrument channel is conceivable.
Further, in the present invention, the treatment instrument refers to an instrument that is inserted into a treatment instrument channel of an endoscope such as various forceps and used for various endoscopic treatments.

According to the present invention, since the axial slit for inserting the advance / retreat operation assisting tool for assisting the advance / retreat operation of the treatment instrument is formed on the peripheral wall of the treatment instrument channel of the endoscope, the advance / retreat operation of the treatment instrument is performed via the slit. An operation aid can be attached.
Therefore, the surgeon attaches an advance / retreat operation assisting tool to the treatment instrument in the treatment instrument channel via the slit in the vicinity of the hand holding the insertion part of the endoscope, and performs the treatment with the hand holding the endoscope insertion part. The advancement / retraction operation of the treatment instrument in the instrument channel can be performed.
However, there is no need to change hands one by one with the advance / retreat operation of the endoscope and the advance / retreat operation of the treatment tool, and since it can be performed simultaneously with one hand, the operability is improved and once secured by the advance / retreat operation of the endoscope. The treatment instrument can be advanced and retracted while maintaining the visual field.

  According to the invention of claim 2, since the treatment instrument channel is configured to be detachable from the peripheral edge of the endoscope insertion portion with a flexible tube separate from the endoscope insertion portion, Can be installed and used.

  According to the invention of claim 3, since the slit is formed over almost the entire length of the treatment instrument channel, the advance / retreat operation assisting tool can be attached at an arbitrary position of the treatment instrument channel. The moving range in the direction is not limited.

  According to the invention of claim 4, since a plurality of slits are formed intermittently in the axial direction of the treatment instrument channel, it is possible to prevent the slit from being opened during use and the internal treatment instrument from slipping out of the treatment instrument channel. can do.

  According to the fifth aspect of the present invention, since the distal end of the flexible tube is provided with the transparent hood that can be attached to the distal end of the endoscope insertion portion, the distal end portion of the flexible tube is surely secured to the endoscope insertion portion. It is fixed to the tip and can be inserted safely and smoothly together with the endoscope insertion part when inserting the flexible tube into the body cavity. A work space for the treatment tool can be secured inside the hood while securing.

  According to the invention of claim 6, since the surgeon can cut the planned opening portion and form a slit at an arbitrary position in the axial direction of the treatment instrument channel only in a range necessary for the advancement / retraction operation of the treatment instrument. Except for the range necessary for the advancement and retreat operation of the device, the closed state is maintained, and the backflow of body fluid can be prevented as much as possible.

FIG. 1 is a view showing an embodiment in which a treatment instrument channel is formed of a flexible tube separate from an endoscope insertion portion, and FIG. 2 is a view showing a state in which the treatment instrument channel is mounted on an endoscope (implementation). Example 1).
In FIG. 1, a distal end hood 2 that can be attached to the distal end of an endoscope insertion portion is fixed to the distal end of a flexible tube 1 formed of an elastic material such as thin rubber. The tip hood 2 is made of a transparent elastic material and is formed in a shape that can be fitted and attached to the tip of the endoscope in a substantially cylindrical shape. A small protrusion 21 is provided on the inner wall of the hood 2 for restricting the protruding direction of the distal end of the treatment instrument 3.

  In the peripheral wall of the flexible tube 1, a single slit 11 is formed in the axial direction over almost the entire length. Since the flexible tube 1 is made of an elastic material, the slit 11 can be easily opened with a finger or the like.

Next, an operation of advancing / retreating the treatment tool using the endoscope treatment tool insertion tool of the present invention will be described.
When performing endoscopic treatment, an operator first attaches the hood 2 at the distal end of the flexible tube 1 to the distal end of the endoscope insertion portion 6 and attaches it to the endoscope insertion portion 6.
Next, the distal end portion of the endoscope insertion portion 6 to which the flexible tube 1 is attached is inserted into the body cavity of the patient. At this time, since the distal end of the flexible tube 1 is integrally attached to the endoscope insertion portion 6 by the distal end hood 2, the distal end of the flexible tube 1 and the endoscope are inserted when inserted into the body cavity of the patient. The distal end of the mirror insertion portion 6 is integrally inserted, and can be inserted into the body cavity together with the endoscope insertion portion 6 safely and reliably.

  The operator holds the endoscope insertion portion 6 until the endoscope tip reaches the vicinity of the treatment portion of the patient, and inserts it into the body cavity. Make fine adjustments to the position.

After securing the visual field, the operator inserts the treatment tool 3 from the insertion opening of the flexible tube 1 to which the forceps plug 4 is attached, and feeds the treatment tool 3 until it protrudes from the distal end of the tube 1.
When the treatment instrument 3 protrudes from the distal end of the tube 1, the rough insertion length of the endoscope insertion portion 6 and the treatment instrument 3 into the body cavity is determined and thereafter fine adjustment is performed. The advance / retreat operation assisting tool 5 is attached to the treatment tool 3 in the tube 1 through the slit 11 at a position where it can be easily performed.
That is, the advancing / retracting operation assisting tool 5 is configured in a clip shape having an arc-shaped gripping portion 51. When the knob 52 is picked, the gripper 51 is opened, and when the knob 52 is released, the gripper 51 is elastic spring force. Therefore, the slit 11 is opened, the grip portion 51 of the advance / retreat operation assisting tool 5 is inserted into the flexible tube 1, and the knob 52 is operated to grip the treatment instrument 3 (FIG. 3). And FIG. 4).

  Next, the surgeon operates the angle operation lever with the left hand to perform the angle operation of the endoscope, and performs the advance / retreat operation of the endoscope and the advance / retreat operation of the treatment instrument 3 with the right hand. That is, since the advance / retreat operation assisting tool 5 is attached to the treatment tool 3 through the slit 11 in the vicinity of the position where the endoscope insertion portion 6 is provided, the endoscope can be inserted with the middle finger, ring finger, little finger and palm of the right hand. Hold the unit 6 and move the advancing / retracting aid 5 back and forth in the axial direction with the thumb or index finger while performing the advancing / retreating operation of the endoscope (operation to maintain the secured visual field or perform fine adjustment again) Then, the advancement / retraction operation of the treatment instrument 3 is performed.

  Accordingly, the advance / retreat operation for fine adjustment of the position of the treatment instrument 3 can be performed with the same hand as the hand supporting the endoscope insertion portion 6, so it is necessary to release the hand from the endoscope insertion portion 5. Therefore, there is no possibility that the field of view is shifted as the treatment tool 3 advances and retracts (see FIG. 4).

FIG. 5 is a diagram showing a pattern example of the slit 11 in the present invention.
(A) is the slit 11 having the pattern described in the above embodiment, but the slit 11 is formed by slitting the peripheral wall of the flexible tube 1 in the axial direction. When attached to and used, the operation range of the advance / retreat operation assisting tool 5 is not limited.
(B) shows the slit 11 formed on the peripheral wall of the flexible tube 1 as a plurality of intermittent slits in the axial direction, and the operation range of the advance / retreat operation assisting tool 5 is limited to the length of each slit 11. The treatment tool 3 in the flexible tube 1 can be attached to the treatment tool 3 in the flexible tube 1 through the slit 11 at an arbitrary position during endoscopic treatment, while the treatment tool 3 in the flexible tube 1 is attached. It can be prevented from slipping out through the slit 11.
(C) makes the slit 11 of the above (b) a long hole in the axial direction so that the advance / retreat operation assisting tool 5 can be attached to the treatment tool 3 more easily.
(D) is formed by staggering the slits 11 of the above (b) so that both ends thereof overlap each other, and an operation impossible range (dead space) between adjacent slits when the slits 11 are provided intermittently. It is the structure for eliminating.

FIG. 6 is a view showing a reference example in which a groove-like opening planned portion 13 is provided on the peripheral wall of the flexible tube 1.
The planned opening 13 is formed on the peripheral wall of the flexible tube 1 as a groove in the axial direction over almost the entire length of the flexible tube 1. Since the planned opening portion 13 is thinner than other portions of the peripheral wall, it is easier to break than the other portions.
The surgeon can cut the planned opening 13 with a blade or the like to form the slit 11 at an arbitrary position in the axial direction of the flexible tube 1 (treatment instrument channel) only in a range necessary for the advance / retreat operation of the treatment instrument 3. it can. Then, the treatment tool advance / retreat assist tool 5 can be attached to the internal treatment tool 3 through the formed slit 11 to perform the advance / retreat operation of the treatment tool 3.
Since it is not necessary to form the slit 11 outside the range necessary for the advance / retreat operation of the treatment instrument 3, the closed state of the flexible tube 1 is maintained as much as possible, and the backflow of body fluid can be prevented.

7 and 8 are views showing another aspect of the advance / retreat operation assisting tool 5.
FIG. 7 shows an example in which the advance / retreat operation assisting tool 5 is configured in a ring shape. A screw hole 54 is provided in a ring 53 having a diameter slightly smaller than the inner diameter of the flexible tube 1, and a screw 55 is screwed into the screw hole 54. Thus, the advance / retreat operation assisting tool 5 is configured (FIG. 7A).
When the advance / retreat operation assisting tool 5 is used, it is inserted in advance into the tube 1 from the slit 11 before the treatment instrument 3 is inserted into the flexible tube 1, and the distal end of the treatment instrument 3 is attached to the ring 53. The treatment tool 3 is inserted into the body cavity and attached. Then, after the distal end of the treatment instrument 3 protrudes from the distal end portion of the endoscope and a rough position is determined, the screw 55 is tightened at an arbitrary position where it is easy to operate and the treatment instrument 3 is pressed against the inner wall of the ring 53 to fix it. The advance / retreat operation assisting tool 5 is operated by moving the screw 55 back and forth in the axial direction with a finger (FIG. 7B).

FIG. 8 shows an example in which the advance / retreat operation assisting tool 5 is formed in a C-shape, and the opening 53 is provided in the ring 53 so that it can be easily attached to and detached from the treatment tool 3. The point that the screw hole 54 is provided, the screw 55 is screwed into the screw hole 54, and the treatment tool 3 is fixed by tightening the screw 55 is the same as the ring-shaped advance / retreat operation assisting tool (FIG. 8A).
According to this advance / retreat operation assisting tool 5, the treatment tool 3 can be taken in and out from the opening 56, so that even after the treatment tool 3 is completely inserted into the flexible tube 1, the treatment tool 3 is inserted into the treatment tool 3 through the slit 1. It can be retrofitted (FIG. 8 (b)).

FIG. 9 is a diagram showing a state in which the treatment instrument channel is mounted on the endoscope in an embodiment in which the treatment instrument channel is formed of a flexible tube that is separate from the endoscope insertion portion and does not include a hood (Example 2).
In this embodiment, attachment of the flexible tube 1 to the endoscope insertion portion 6 is performed using an attachment 7.
The attachment 7 is made of an elastic material such as synthetic resin, and includes an endoscope attachment portion 71 into which the distal end of the endoscope is inserted and a treatment instrument channel attachment portion 72 into which the distal end of the treatment instrument channel is inserted. The endoscope mounting portion 71 and the treatment instrument channel mounting portion 72 are provided with slits 71s and 72s, respectively, and can correspond to some extent to the diameter of the distal end of the endoscope to be inserted and the diameter of the flexible tube. (See FIG. 10).
On the other hand, the reinforcing tube 14 is attached to the inside of the distal end portion of the flexible tube 1 so that the distal end portion of the tube 1 is not elastically deformed, so that the distal end of the tube 1 is fitted to the treatment instrument channel attaching portion 72. When it is inserted and attached, it is securely fixed (see FIG. 11).
Other configurations are the same as those of the first embodiment, and any of the slits 11 and the advance / retreat operation assisting tool 5 described in the above embodiments can be applied. The advance / retreat operation of the treatment instrument 3 is the same as that in the first embodiment.

FIG. 12 shows an embodiment in which a treatment instrument channel is provided inside an insertion portion of an endoscope (Example 3).
The insertion portion 6 of the endoscope is made of an elastic material, and a treatment instrument channel 1 through which the treatment instrument 3 such as forceps is inserted is provided therein, and the distal end of the treatment instrument 3 is inserted through the insertion port 12. This can be protruded from the part.
The treatment instrument channel 1 is provided at a position biased toward the peripheral side of the insertion portion 6, and the peripheral side peripheral wall of the treatment instrument channel 1 is formed thin.
A slit 11 having a length almost covering the entire length of the insertion portion 6 of the endoscope is formed on the peripheral side peripheral wall of the treatment instrument channel 1, and this slit 11 can be easily opened with a finger or the like. An advance / retreat operation assisting tool 5 for assisting the advance / retreat operation of the treatment instrument 3 can be attached to the treatment instrument 3 inserted inside through the slit 11.
Also in this embodiment, the slit 11 and the advance / retreat operation assisting tool 5 can apply any of the modes described in the above embodiment, and the advance / retreat operation of the treatment instrument 3 is the same as in the above embodiment. .
According to this embodiment, since the treatment instrument channel 1 in which the slit 11 is formed is provided integrally with the insertion section 6 of the endoscope, there is no need to additionally attach the treatment instrument channel to the insertion section 6. The size of the diameter of the portion inserted into the body cavity can be suppressed.

  The present invention relates to an endoscope treatment tool insertion tool for inserting a treatment tool such as forceps, and has industrial applicability.

The figure which shows the outline | summary of 1st Example of this invention The figure which shows the state where it was similarly attached to the endoscope The figure which also shows advancing / retreating operation tool Similarly, a partially enlarged view of a state in which an advance / retreat operation assisting tool is attached. The figure which shows the example of a pattern of the slit applicable to this invention The figure which shows the cross section of the treatment tool channel which provided the opening plan part of a reference example The figure which shows another aspect of the advance / retreat operation assistance tool of 1st Example of this invention . The figure which similarly shows another aspect of an advance / retreat operation aid The figure which shows the state with which the 2nd Example of this invention was mounted | worn with the endoscope. Figure showing the attachment as well The figure which similarly shows the treatment tool channel tip The figure which shows the outline | summary of 3rd Example of this invention

1 Flexible tube (treatment instrument channel)
DESCRIPTION OF SYMBOLS 11 Slit 13 Planned opening part 2 Tip cover 3 Treatment tool 4 Forceps stopper 5 Advancement / retraction operation aid 6 Endoscope insertion part 7 Attachment

Claims (5)

Treatment tool such as forceps is inserted, Ri Do a flexible tube, the peripheral wall of the processing置具channel provided in an endoscope insertion portion to be inserted into a body cavity, attached to the treatment instrument, the treatment instrument A treatment instrument insertion tool for an endoscope having an axial slit into which an advance / retreat operation assist tool for assisting advance / retreat operation is inserted. The flexible tube is constituted by removably attached to the periphery of the endoscope insertion portion, the endoscope treatment instrument insertion instrument according to claim 1.   The endoscope treatment instrument insertion tool according to claim 1 or 2, wherein the slit is formed over substantially the entire length of the flexible tube.   The endoscopic treatment instrument insertion tool according to any one of claims 1 to 3, wherein a plurality of the slits are formed intermittently in the axial direction of the flexible tube. The flexibility at the distal end of the tube with a attachable transparent hood to the endoscope insertion portion distal end, the endoscopic treatment Gu挿 communication instrument according to any one of claims 2 to 4.

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