WO2011001996A1 - Forceps pour endoscope - Google Patents

Forceps pour endoscope Download PDF

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Publication number
WO2011001996A1
WO2011001996A1 PCT/JP2010/061101 JP2010061101W WO2011001996A1 WO 2011001996 A1 WO2011001996 A1 WO 2011001996A1 JP 2010061101 W JP2010061101 W JP 2010061101W WO 2011001996 A1 WO2011001996 A1 WO 2011001996A1
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WO
WIPO (PCT)
Prior art keywords
forceps
pair
insertion member
state
annular member
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2010/061101
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English (en)
Japanese (ja)
Inventor
鈴木一郎
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Suzuken Co Ltd
Original Assignee
Suzuken Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Suzuken Co Ltd filed Critical Suzuken Co Ltd
Publication of WO2011001996A1 publication Critical patent/WO2011001996A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/06—Biopsy forceps, e.g. with cup-shaped jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/04—Endoscopic instruments, e.g. catheter-type instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible

Definitions

  • the present invention relates to an endoscopic forceps used for endoscopic tissue collection, treatment, hemostasis, treatment site marking, and the like.
  • an endoscopic forceps for performing various treatments on a living tissue in a body cavity has been provided (see, for example, Patent Document 1).
  • An endoscopic forceps is a medical device that is inserted into a body cavity through a forceps channel of an endoscope.
  • a general endoscope forceps includes a coil 92 having a cup holding portion 91 at the tip, a pair of forceps pieces 93 rotatably supported by the cup holding portion 91, and a coil 92.
  • an endoscopic forceps 9 including two operation wires 94 inserted through and an operation unit (not shown) operated by an operator.
  • a pair of forceps pieces 93 are rotatably supported by the pins 910 of the cup holding portion 91 like scissors.
  • the distal end of the operation wire 94 is locked to each of the arm portions 931 corresponding to the rear end portion of the forceps piece 93.
  • a cup shape 930 that is depressed leaving the outer peripheral edge portion 932 is formed. After the biological tissue is positioned in the gap between the pair of forceps pieces 93, the biological tissue can be cut according to the engagement of the outer peripheral edge portion 932 by closing the forceps piece 93. The cut biological tissue is accommodated in the cup shape 930 and can be collected as it is.
  • an endoscopic hemostatic clip (not shown) is known as an instrument for performing hemostasis, marking, and the like after collection or treatment of living tissue using endoscopic forceps.
  • a clip that exhibits an expanded shape in a freely deformed state like tweezers a clip closing member that opens and closes in response to axial advancement and retraction, and an insertion of the clip closing member
  • an endoscopic hemostatic clip provided with a possible cylindrical sheath (see, for example, Patent Document 2).
  • the clip and the clip closing member are supported in a detachable state.
  • the clip closed by elastic deformation is inserted and arranged in the sheath together with the clip closing member.
  • the clip closing member is retracted so that the clip protrudes, so that the clip is opened by free deformation.
  • the clip closing member is advanced to close the clip and perform hemostasis or the like.
  • the sheath can be extracted from the forceps channel by separating the clip and the clip closing member.
  • the internal tissue is quickly extracted from the forceps channel after the biological tissue is collected. It is necessary to remove the forceps for endoscope and insert a hemostatic clip for endoscope instead. Furthermore, it is necessary to promptly execute a series of operations in which the hemostatic clip for endoscope is inserted into the body cavity, the clip is opened, and then the clip is closed to stop bleeding.
  • the present invention has been made in view of the above-described conventional problems, and an object of the present invention is to provide an endoscopic forceps that can perform hemostasis, marking, and the like without being extracted from the forceps channel.
  • the present invention is a flexible cross-sectional structure composed of a first insertion member located on the inner peripheral side and a cylindrical second insertion member that can advance and retract in the axial direction relative to the first insertion member.
  • An elongated insertion part exhibiting sex;
  • An operation unit coupled to the rear end side of the first and second insertion members;
  • the first insertion member and the pair of forceps pieces can be extrapolated and moved forward in the axial direction in accordance with the advancement of the second insertion member facing the first insertion member.
  • An annular member configured to be separable by being pushed to the distal end side through a state of being extrapolated to the forceps piece
  • the second insertion member is capable of advancing and retreating in the axial direction relative to the first insertion member between a position where the pair of forceps pieces is accommodated and a position where the second insertion member protrudes toward the distal end side. While the pair of forceps pieces are in an open state in a free deformation state, the pair of forceps pieces are deformed according to a force acting from the second insertion member side when housed on the inner peripheral side of the second insertion member.
  • An endoscope forceps is configured such that when the insertion member advances in the axial direction, a state in which the living tissue is completely closed is set to such an extent that the living tissue can be cut.
  • the endoscope forceps of the present invention has the annular member that can be separated by being pushed out as the second insertion member advances. Before the annular member is separated, the pair of forceps pieces can be set only in an incompletely closed state in which the biological tissue is grasped without being cut. On the other hand, when the annular member is pushed out and separated from the distal end side of the pair of forceps pieces, the pair of forceps pieces are in the completely closed state capable of cutting the living tissue.
  • the annular member pushed through the pair of forceps pieces in the state of grasping the living tissue and pushed to the distal end side is extrapolated to the root of the cut living tissue. According to the said annular member, it fixes to a biological tissue, maintaining the state extrapolated by the cut
  • the forceps for endoscope of the present invention treatments such as collection and treatment of living tissue and treatments such as hemostasis and marking after treatment can be performed almost simultaneously. Therefore, it is not necessary to remove the forceps from the endoscope after a procedure such as collection of a living tissue and reinsert another instrument for hemostasis into the endoscope. According to the forceps for endoscope, the necessary number of insertions of the treatment tool into the endoscope can be reduced, and the treatment can be executed relatively efficiently and relatively easily.
  • the forceps piece and the annular member in the present invention can be formed of various materials such as an elastic metal such as elastic stainless steel, a shape memory alloy, a shape memory resin, and a biodegradable resin.
  • an elastic metal such as elastic stainless steel
  • a shape memory alloy such as stainless steel
  • a shape memory resin such as polymethyl methacrylate
  • a biodegradable resin such as polymethyl methacrylate
  • a configuration for heating the forceps piece is preferably provided. In this case, it becomes possible to enhance the hemostatic effect by heating the annular member with the forceps piece to exhibit the shape memory effect.
  • the second insertion member is preferably formed so as to ensure a load resistance in the compression direction. If the load resistance in the compression direction is ensured, the reliability of the operation of moving the second insertion member forward relative to the first insertion member can be increased.
  • the second insertion member can be formed of carbon fiber or a resin material alone, but may be formed of a combination of carbon fiber and a resin material. Furthermore, a metal may be disposed at the tip portion of the second insertion member, that is, the portion in contact with the annular member.
  • the pair of forceps pieces are connected to each other via an elastically deformable connecting portion, and the incompletely closed state and the completely closed state according to the elastic deformation of the connecting portion. It is preferable that a closed state can be set.
  • the opening / closing structure of the pair of forceps pieces can be simplified compared to an opening / closing structure including a shaft that supports the forceps pieces in a rotatable state. If the mechanical structure can be configured simply, the possibility of trouble occurring during use can be suppressed and the reliability can be improved.
  • the pair of forceps pieces and the connecting portion may be integrally formed of a metal material, a resin material, or the like.
  • the pair of forceps pieces, the connecting portion, and the first insertion member may be integrally formed. For example, if molding is integrally performed with a resin material, a resin composite material, or the like, assembly work is not necessary, and production efficiency can be improved.
  • the pair of forceps pieces is formed with a convex portion protruding toward the outer peripheral side in the radial direction, and the pair of forceps pieces is formed by the second insertion member. It is preferable that the completely closed state is set in accordance with the contact load that acts on the convex portion from the inner peripheral surface.
  • the pair of forceps pieces can be completely closed according to the contact between the convex portion and the inner peripheral surface of the second insertion member. According to the convex portion formed at the distal end portion of the forceps piece, the contact load from the inner peripheral surface of the second insertion member is directly applied to the meshing position located at the distal end portion of the pair of forceps pieces. And can work efficiently.
  • the said annular member is provided with elasticity, and the inner peripheral cross-sectional area in a free deformation state is smaller than the inner peripheral cross-sectional area in the extrapolation state with respect to a pair of forceps piece.
  • the diameter of the living tissue corresponding to the root is often the same as the diameter of a circumscribed circle formed by the pair of forceps pieces at that time. Therefore, when configured as described above, the annular member is firmly fixed to the living tissue by the elastic restoring force of the annular member and the living tissue that is to return to the original shape.
  • a drop-off preventing structure for preventing drop-out from the living tissue is formed on the inner peripheral surface of the annular member.
  • dropping from the living tissue can be prevented in advance, and treatments such as hemostasis and marking can be realized with higher certainty.
  • the drop-off preventing structure for example, a structure including a protrusion having a sharp shape in a certain direction like a saw tooth can be considered.
  • the annular member provided with the protrusion may be formed of a shape memory alloy or the like, and the protrusion may be configured to stand depending on the shape memory effect. In this case, a high dropout prevention effect can be exhibited according to the shape memory effect.
  • the forceps for endoscope of the present invention in a series of actions such as hemostasis and marking after collecting or treating a living tissue, the forceps for endoscope from the forceps channel of the endoscope, etc.
  • the number of times of inserting and removing can be reduced and efficient work is possible. Therefore, with this endoscopic forceps, the required skill level of the procedure can be suppressed, and the safety of the procedure can be improved.
  • FIG. 3 is a top view illustrating a forceps piece housing structure according to the first embodiment. Explanatory drawing which shows the endoscope and forceps for endoscopes in Example 1.
  • FIG. The front view which shows the cyclic
  • FIG. Sectional drawing which shows the cross-sectional structure of the annular member in Example 1 (AA arrow cross section.).
  • the perspective view which shows the accommodation structure of the forceps piece in Example 1.
  • FIG. 3 is a perspective view illustrating an operation unit in the first embodiment. Sectional drawing which shows the cross-section of the operation part in the unused state in Example 1.
  • FIG. 3 is a top view showing a forceps piece in an open state according to the first embodiment.
  • Explanatory drawing which shows a mode that the forceps piece of the state closed incompletely in Example 1 hold
  • Explanatory drawing which shows the cross-section of an operation part when the forceps piece is in the incompletely closed state in Example 1.
  • FIG. Explanatory drawing which shows the moment in which the forceps piece of the completely closed state cut
  • FIG. 3 is an explanatory diagram for explaining the mechanical superiority over the conventional forceps in the first embodiment.
  • the front view which shows the other annular member in Example 1.
  • FIG. The side view which shows the other annular member in Example 1.
  • FIG. The figure which shows the other outer sheath in Example 1.
  • FIG. The side view which shows the forceps for endoscopes in a prior art example.
  • Example 1 This example is an example relating to an endoscopic forceps 1 having a hemostatic function. The contents will be described with reference to FIGS. As shown in FIGS. 1 to 3, the endoscope forceps 1 of this example is advanced and retracted in the axial direction relative to the first insertion member 11 located on the inner peripheral side and the first insertion member 11.
  • the first and second insertion members 11 and 12 can be extrapolated with respect to the operation portion 4 to which the rear ends of the first and second insertion members 11 and 12 are connected, and the first insertion member 11 and the pair of forceps pieces 21.
  • an annular member 30 that can be separated by being pushed forward through the pair of forceps pieces 21 after being advanced in the axial direction in accordance with the advancement of the second insertion member 12 opposite to the first insertion member 12. .
  • the second insertion member 12 can advance and retreat in the axial direction relative to the first insertion member 11 between a position where the pair of forceps pieces 21 are accommodated and a position where the second insertion member 12 protrudes toward the distal end side.
  • the pair of forceps pieces 21 are in an open state in a freely deformed state, while the force acting from the inner peripheral surface of the second insertion member 12 is accommodated in the second insertion member 12 on the inner peripheral side. Accordingly, it is deformed and closed. Further, the pair of forceps pieces 21 can be set only in an incompletely closed state in which the living tissue is grasped without being cut until the annular member 30 is separated, while the annular member 30 is separated.
  • the second insertion member 12 moves forward in the axial direction to a position where the living tissue is located, the living tissue is completely closed to the extent that it can be cut. This will be described in detail below.
  • the endoscopic forceps 1 of this example is a medical device used in combination with the endoscope 100 as shown in FIG.
  • the endoscope 100 includes a tubular insertion tube 102 having flexibility, and an operation unit 103 connected to the rear end of the insertion tube 102.
  • An imaging element (not shown) for capturing an endoscopic image is disposed at the distal end of the insertion tube 102.
  • the insertion tube 102 is inserted with a control line of the imaging device, a tube for sending and sucking air and water, and a tube called a forceps channel 101 for inserting the forceps for endoscope 1. It is inserted.
  • the endoscopic forceps 1 of this example is a medical device that is inserted into a body cavity through the forceps channel 101.
  • the endoscopic forceps 1 of this example has a hemostatic function. Therefore, if this endoscopic forceps 1 is used, hemostasis can be performed without removing the forceps from the forceps channel 101 after the biological tissue is cut. That is, it is possible to treat biological tissue cutting and hemostasis after cutting almost simultaneously.
  • the endoscopic forceps 1 includes an insertion portion 10 to be inserted into the forceps channel 101 and an operation portion 4 connected to the rear end of the insertion portion 10.
  • the insertion part 10 has a double cross-sectional structure of an inner sheath that is the first insertion member 11 and an outer sheath that is the second insertion member 12.
  • the inner sheath 11 is a cylindrical elongated tube made of a resin material.
  • the outer sheath 12 is a thin, cylindrical, elongated tube made of a carbon composite material.
  • the insertion portion 10 in which the inner sheath 11 is inserted and disposed with respect to the outer sheath 12 has flexibility.
  • a treatment portion 20 including a pair of forceps pieces 21 is integrally formed at the distal end of the inner sheath 11.
  • the outer sheath 12 is formed so that the inner sheath 11 and the treatment portion 20 can be inserted.
  • the inner diameter of the outer sheath 12 is set larger than the outer diameter of the inner sheath 11 so that the outer sheath 12 can smoothly advance and retreat in an extrapolated state with respect to the inner sheath 11.
  • the outer sheath 12 of this example made of a carbon composite material, it is easy to set a high load resistance in the compression direction, and an operation force for advancing in the axial direction relative to the inner sheath 11 can be efficiently transmitted.
  • the outer sheath 12 of this example has a convex portion 121 that protrudes to the inner peripheral side on the inner peripheral surface that is a predetermined distance from the tip.
  • the annular member 30 is a component that is placed in the body cavity for hemostasis at the cut site.
  • the annular member 30 is an annular component having elasticity made of a resin material. As shown in FIG. 4, the annular member 30 in a freely deformed state has a shape such that a circular ring is crushed sideways, and its inner peripheral shape has a slit shape.
  • the annular member 30 extrapolated to the living tissue is elastically deformed so as to approach a circular shape, and is fixed to the living tissue with high certainty by an elastic restoring force for returning to the original shape.
  • a drop-off preventing structure is formed on the inner peripheral surface of the annular member 30.
  • the drop-off prevention structure of this example is a structure in which a plurality of protrusions 31 having a sharp shape in a certain direction like saw teeth are formed.
  • the protrusion 31 bites into the living tissue, and the effect of preventing the dropout is effectively exhibited.
  • a T bar 251 for retracting the annular member 30 is engaged with the distal end surface of the annular member 30.
  • the T bar 251 is connected to the operation unit 4 via an operation wire 252 inserted and disposed in the inner sheath 11.
  • the T bar 251 is formed of a resin material having appropriate flexibility so that it can be bent. Note that an insertion hole (not shown) is drilled in the outer peripheral wall corresponding to the middle in the axial direction of the inner sheath 11. The operation wire 252 is taken out into the gap between the outer sheath 12 and the inner sheath 11 through the insertion hole.
  • the treatment unit 20 is a part that cuts a living tissue. Similar to the inner sheath 11, the treatment portion 20 of this example is made of a resin material and is integrally formed at the tip of the inner sheath 11. The treatment portion 20 is shaped such that a pair of forceps pieces 21 are connected via a connecting portion 23.
  • the forceps piece 21 has a cup shape 215 that is obtained by vertically dividing a hollow cylindrical shape along the axial direction into two parts. The outer peripheral edge of the cup shape 215 in the forceps piece 21 forms a cutting tooth 210.
  • the connecting portion 23 has a shape that is obtained by bending a substantially rectangular flat plate.
  • the forceps pieces 21 are connected so as to extend from the portions corresponding to both ends of the connecting portion 23.
  • the distal end of the inner sheath 11 is coupled to the coupling portion 23.
  • the pair of forceps pieces 21 are opened at an angle of about 90 degrees.
  • the connecting portion 23 made of a resin material can be elastically deformed so that the opening angle of the bent portion varies. If the opening angle of the bent portion is elastically deformed until it becomes substantially zero, the pair of forceps pieces 21 face each other with a substantially constant gap therebetween, and the gap is closed incompletely so that the living tissue can be grasped. Can be set (to be described later with reference to FIG. 11).
  • the connecting portion 23 in the incompletely closed state can be further elastically deformed so as to bring the forceps pieces 21 closer to each other.
  • a completely closed state in which the living tissue can be cut by the engagement of the cutting teeth 210 can be set (described later with reference to FIG. 13).
  • a convex portion 211 protruding toward the outer peripheral side in the radial direction is formed on a portion located in the opening / closing direction (vertical direction in FIG. 1).
  • the connecting portion 23 is formed with a slope 232 that smoothly extends to the outer peripheral surface of the forceps piece 21 as the width corresponding to the opening and closing direction gradually approaches the forceps piece 21 side.
  • the convex portion 211 is formed so as to come into contact with the inner peripheral surface when the outer sheath 12 advances to a predetermined position.
  • the inclined surface 232 is formed so as to contact the convex portion 121 disposed on the inner peripheral surface of the outer sheath 12 when the convex portion 211 contacts the inner peripheral surface of the outer sheath 12.
  • the operation unit 4 includes a substantially cylindrical shaft portion 41, and a bottomed substantially cylindrical slider that is extrapolated in a state in which the shaft portion 41 can advance and retreat in the axial direction. 42 and a biasing spring 43 that biases the slider 42 toward the forward side so as to push the slider 42 against the shaft portion 41.
  • an operation ring 410 on which an operator places a finger is extended.
  • the rear end of the inner sheath 11 is fixed to the shaft portion 41, while the rear end of the outer sheath 12 is fixed to the slider 42.
  • the outer sheath 12 can be advanced and retracted in the axial direction relative to the inner sheath 11. If the outer sheath 12 is retracted relative to the inner sheath 11, the treatment portion 20 can be projected to open the pair of forceps pieces 21. If the outer sheath 12 is advanced relative to the inner sheath 11, the treatment portion 20 can be accommodated in the outer sheath 12 and the pair of forceps pieces 21 can be closed.
  • the urging spring 43 is disposed in a compressed state in the gap between the bottom 427 of the slider 42 and the tip end surface 411 of the shaft portion 41.
  • the biasing spring 43 is arranged in a state of being extrapolated to the inner sheath 11.
  • the urging spring 43 urges the slider 42 forward with respect to the shaft portion 41.
  • This urging force is a reaction force against the backward operation of the slider 42 that attempts to open the forceps piece 21.
  • an appropriate operating force can be set when the forceps piece 21 is opened by the backward operation of the slider 42.
  • the rear end of the inner sheath 11 is fixed to a front end surface 411 that is opposite to the operation ring 410 in the end surface of the shaft portion 41.
  • a groove 415 having a rectangular cross section extends along the axial direction. The groove 415 opens on the rear end surface 412 on the operation ring 410 side, but does not reach the opposite end surface 411, and the groove end 416 is positioned in front of the groove 415.
  • a pair of two operation rings 420 are installed on the outer peripheral surface of the slider 42 so as to protrude on both sides in the radial direction.
  • a through hole 426 for inserting the inner sheath 11 is formed in the bottom 427 of the slider 42.
  • the rear end of the outer sheath 12 and the rear end of the operation wire 252 extending from the T bar 251 are fixed.
  • the operation wire 252 is taken out to the outer peripheral side of the inner sheath 11 from an insertion hole (not shown) drilled in the outer peripheral surface of the inner sheath 11.
  • convex portions 421 and 422 that engage with the groove 415 of the shaft portion 41 are formed at two locations along the axial direction.
  • the convex portion 421 is a convex portion that always engages with the groove portion 415 regardless of the advance / retreat position of the slider 42.
  • the slider 42 is restricted from rotating relative to the shaft portion 41 in accordance with the engagement between the convex portion 421 and the groove 415.
  • the convex portion 422 is a convex portion for separating from the groove 415 when the slider 42 is advanced with respect to the shaft portion 41 and positioned at the tip side of the shaft portion 41, and then restricting the slider 42 from retreating. is there.
  • the convex portion 422 is formed at the tip of a rectangular piece 423 that forms part of the outer peripheral wall of the slider 42.
  • the rectangular piece 423 is a portion connected to the main body side of the slider 42 through only one side of the root like a diving plate.
  • the rectangular piece 423 is separated from the surroundings by a substantially U-shaped slit 424 formed in the outer peripheral wall of the slider 42.
  • the rectangular piece 423 can be rotated by elastic deformation around one side of the base located on the bottom 427 side.
  • the convex portion 422 has a protruding shape formed by an inclined surface 422T located on the front end surface 411 side and a right-angle surface 422V located on the rear end surface 412 side.
  • the rectangular piece 423 is formed with a protruding portion 425 that protrudes in a dome shape toward the inner peripheral side, similar to the protruding portion 422.
  • the protruding portion 425 is arranged closer to the base side of the rectangular piece 423 than the convex portion 422.
  • the position where the protruding portion 425 engages with the groove end 416 is the urging position of the slider 42 by the urging spring 43.
  • the urging spring 43 is set so as to urge the slider 42 until the protruding portion 425 reaches the groove end 416 in an unused state, and to generate an urging force such that the protruding portion 425 does not exceed the groove end 416.
  • the state in which the protrusion 425 is positioned at the groove end 416 as shown in FIG. 8 corresponds to the unused state shown in FIGS. 1, 2, and 6.
  • the distal end surface of the outer sheath 12 is located deeper on the retreat side by the width of the annular member 30 than the convex portion 211.
  • the T bar 251 connected to the distal end of the operation wire 252 is locked to the distal end surface of the annular member 30.
  • the state where the convex portion 422 is positioned at the groove end 416 corresponds to a state where the living tissue is incompletely closed to the extent that the living tissue can be grasped, as will be described later with reference to FIG.
  • the state in which the convex portion 422 is positioned on the distal end side of the shaft portion 41 beyond the groove end 416 corresponds to a state in which the living tissue is completely closed to the extent that it can be cut as described later with reference to FIG. is doing.
  • the unused endoscope forceps 1 can be inserted into a body cavity through the forceps channel 101 of the endoscope 100.
  • the operation portion 4 is operated so as to retract the slider 42 with respect to the shaft portion 41.
  • the relative position between the slider 42 and the shaft portion 41 in the unoperated state is such that the convex portion 422 is accommodated in the groove 415 as shown in FIG. Since the projecting portion 422 can be retracted along the groove 415, the retracting of the slider 42 with respect to the shaft portion 41 is allowed.
  • the slider 42 is connected to the rear end of the outer sheath 12 and the operation wire 252. Therefore, if the slider 42 is retracted as described above, the outer sheath 12 and the operation wire 252 can be retracted with respect to the inner sheath 11. If the operation wire 252 is retracted, the annular member 30 can be retracted by the T bar 251 connected to the tip.
  • the pair of forceps pieces 21 can be protruded.
  • the pair of forceps pieces 21 protruding from the annular member 30 and the outer sheath 12 are opened according to the free deformation of the connecting portion 23 as shown in FIGS.
  • the T bar 251 is accommodated so as to be bent and deformed and dragged into the inner sheath 11. Thereby, the locking relationship between the annular member 30 and the T bar is released.
  • the slider 42 is advanced with respect to the shaft portion 41 in a state where the living tissue is positioned in the gap between the pair of forceps pieces 21. Accordingly, the outer sheath 12 can be advanced relative to the inner sheath 11 and the forceps piece 21 can be closed. If the outer sheath 12 is advanced to the front of the convex portion 211, as shown in FIG. 11, the pair of forceps pieces 21 returns to the incompletely closed state. In the incompletely closed state, the living tissue can be grasped with high reliability by the pair of forceps pieces 21. At this time, in the operation part 4, as shown in FIG. 12, the convex part 422 contacts the groove end 416, and an axial reaction force is generated. The operator of the operation unit 4 can grasp with high certainty that the incompletely closed state is set according to the reaction force in the axial direction.
  • the operation wire 252 does not have axial rigidity. Therefore, the operation wire 252 sags as the slider 42 advances with respect to the shaft portion 41. The T bar 251 connected to the distal end of the operation wire 252 is left as it is inside the inner sheath 11.
  • the annular member 30 When the incompletely closed state is reached, the annular member 30 is positioned on the outer periphery of the living tissue grasped by the forceps piece 21. If the slider 42 is further advanced, the outer sheath 12 can be advanced beyond the convex portion 211.
  • the convex portion 121 comes into contact with the inclined surface 232 of the treatment portion 20 at the same time as the distal end of the outer sheath 12 gets over the convex portion 211. Yes.
  • a contact load that acts on the convex portion 211 from the inner peripheral surface of the outer sheath 12 and a contact load that acts on the slope 232 from the convex portion 121 are generated. These contact loads act as a force for bringing the pair of forceps pieces 21 closer to each other. With these forces, the pair of forceps pieces 21 are completely closed, and the living tissue is cut.
  • the operation unit 4 is in a state in which the convex portion 422 has moved forward over the groove end 416.
  • the right-angle surface 422V of the convex portion 422 is engaged with the tip surface 411 of the shaft portion 41, the retreat of the slider 42 is restricted.
  • the state in which the pair of forceps pieces 21 are completely closed is firmly maintained, and the cut biological tissue can be held with high reliability.
  • the separated annular member 30 is extrapolated to the living tissue corresponding to the root portion of the cut living tissue.
  • the living tissue that hits the root portion is bound by the annular member 30.
  • a drop-off preventing structure including the protrusion 31 (FIG. 5) is formed as described above.
  • the protrusion 31 bites into the living tissue, and the annular member 30 can be fixed with high reliability.
  • the inner peripheral shape of the annular member 30 in a state where the root portion is tightly bound is close to a circular shape with respect to the slit-shaped inner peripheral shape (FIG. 4) in a freely deformed state.
  • an elastic force is generated in the annular member 30 to return to the original shape.
  • an elastic force is generated to return the bound biological tissue to its original state.
  • the elastic force of the annular member 30 and the elastic force of the biological tissue work effectively because the annular member 30 is firmly fixed to the biological tissue.
  • the endoscopic forceps 1 accommodates a living tissue in a cup shape 215 inside a pair of forceps pieces 21. If the insertion part 10 of the forceps 1 for endoscope is extracted from the forceps channel 101, the cut biological tissue can be collected. On the other hand, the annular member 30 is firmly fixed to the cut portion in the body cavity as described above. Therefore, bleeding from the cut surface of the living tissue can be suppressed with high certainty.
  • the endoscopic forceps 1 of this example is an endoscopic forceps having a hemostatic function. If this endoscopic forceps 1 is used, cutting of a living tissue and hemostasis and hemostasis can be performed almost simultaneously, so that bleeding and the like can be suppressed to a minimum and the burden on the human body side can be suppressed. Furthermore, since it is not necessary to quickly remove the endoscopic forceps 1 from the forceps channel 101 after cutting the living tissue and immediately insert the hemostatic clip for endoscope to stop the hemostasis, it is possible to suppress the burden on the treatment side.
  • the mechanical superiority of the endoscopic forceps 1 of this example will be described in comparison with the conventional endoscopic forceps 9 with reference to FIG.
  • a fulcrum is set on the pin 910
  • an action point is set on the tip of the forceps piece 93
  • a force point is set on the arm portion 931. Due to the demand for a smaller diameter, it is difficult to ensure a long length between the pin 910 and the arm portion 931, and in general, there is a tendency to be shorter than the length between the forceps piece 93 and the pin 910. Therefore, it is necessary to apply a force larger than that required for the forceps piece 93 to the arm portion 931.
  • the load acting on the engagement structure between the operation wire 252 and the arm portion 931, the pin 910 that is a fulcrum, and the like is increased, causing a mechanical trouble.
  • the positional relationship among the force point set at the convex portion 211, the action point set at the tip of the forceps piece 21, and the fulcrum set at the connecting portion 23 is the same as in the conventional endoscope. It is completely different from the forceps for mirrors. That is, in the endoscopic forceps 1 of this example, the force point and the action point are arranged on the same side with respect to the fulcrum and at substantially the same position. Therefore, the force acting on the force point can be directly transmitted to the action point. Unlike the conventional case, since there is no possibility that an excessive load acts on the fulcrum or the like, the possibility of causing a mechanical trouble is extremely reduced.
  • the annular member 30 in which the inner peripheral shape in the free deformation state exhibits a linear slit shape is employed.
  • the annular member 30 in which the inner peripheral shape in the free deformation state exhibits a cross shape is used. It can also be adopted.
  • the annular member 30 provided with the side wall which exhibits the mesh structure like knitting is also employable.
  • the mesh structure is an effective structure for ensuring strength. If the annular member 30 has a mesh structure, it is possible to secure the strength that can withstand the pushing force when extrapolated into the living tissue while suppressing dimensions such as thickness.
  • the material of the annular member 30 various materials such as elastic stainless steel, shape memory alloy, shape memory resin, and biodegradable resin can be adopted.
  • a configuration for heating the forceps piece 21 is preferably provided.
  • the shape memory effect can be exhibited by heating the annular member with the forceps piece 21.
  • the protrusion 31 is configured to stand on the inner peripheral side due to the shape memory effect, the effect of the drop-off prevention mechanism is further enhanced.
  • the annular member 30 may be formed of a biodegradable resin. Since it is decomposed in nature after being discharged from the body, the impact on the environment can be suppressed.
  • a metal ring may be disposed at the tip of the outer sheath 12.
  • the strength of the distal end portion of the outer sheath 12 can be secured high. If the strength of the outer sheath 12 is ensured, a force can be applied to the forceps piece 21 more efficiently.
  • This example is an example in which the treatment portion 20 is integrally formed at the tip of the inner sheath 11.
  • the treatment portion may be formed separately from the inner sheath 11.
  • a method for fixing a separate treatment portion to the distal end of the inner sheath for example, there are a method for fixing via a support pin or the like, a method for bonding, and the like.
  • a method of joining there are various methods such as adhesive joining, welding joining, caulking joining, and fitting.
  • this example is an example in which the outer sheath 12 advances in accordance with the pushing operation of the slider 42 with respect to the shaft portion 41, that is, the advancement of the slider 42 with respect to the shaft portion 41.
  • the outer sheath 12 may be configured to advance in accordance with the pushing operation of the shaft portion 41 with respect to the slider 42, that is, with the advancement of the shaft portion 41 with respect to the slider 42. If the outer sheath 12 and the rear end of the operation wire 252 are connected to the shaft portion 41 and the rear end of the inner sheath 11 is connected to the slider 42, the outer sheath 12 is moved according to the pushing operation of the shaft portion 41 as described above. The annular member 30 can be pushed out and separated by being advanced.
  • the groove 120 may be disposed opposite to the inner peripheral surface of the outer sheath 12.
  • the groove 120 extends along the axial direction and opens at the distal end surface of the outer sheath 12.
  • the circumferential position of the groove 120 can be matched with the convex portion 211 of the forceps piece 21, and the convex portion 121 of the outer sheath 12 can be It can be located on both sides of the connecting portion 23.
  • the annular member 30 can be pushed out and separated while picking up without cutting the living tissue. It can be applied to treatments such as hemostasis and marking of a living body site where bleeding has occurred like a hemostatic forceps.
  • An endoscopic forceps in which the convex portion 211 of the forceps piece 21 and the convex portion 121 of the outer sheath 12 are omitted and the right-angle surface 422V of the convex portion 422 of the slider 42 is changed to an inclined surface is also useful.
  • This endoscopic forceps is an instrument in which the cutting function is omitted from the endoscopic forceps of the present invention.
  • the living tissue is picked up by the pair of forceps pieces 41 by advancing the outer sheath 12 in the axial direction relative to the inner sheath 11 by the advancement of the slider 42 relative to the shaft portion 41.
  • the annular member 30 can be moved without being cut.
  • the slider 42 is allowed to move backward with respect to the shaft portion 41, and the pinched biological tissue can be released.
  • Such endoscopic forceps are useful for procedures such as hemostasis and marking.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Biodiversity & Conservation Biology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Ophthalmology & Optometry (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)

Abstract

La présente invention concerne un forceps pour endoscope qui présente une fonction d'arrêt de sang, ledit forceps étant capable de réaliser un traitement tel que l'arrêt de sang, sans être extrait d'un canal de forceps. Ledit forceps (1) pour endoscope comprend les éléments suivants : une section d'insertion allongée flexible (10) présentant une double structure dans une section transversale de celle-ci et comprenant un premier élément d'insertion (11) et un second élément d'insertion (12) ; une paire d'éléments de forceps (21) maintenue à la pointe du premier élément d'insertion (11) ; et un élément annulaire en forme d'anneau (30) qui peut être séparé lorsqu'on l'avance dans la direction axiale en réponse à l'avancée du second élément d'insertion (12), qui fait face au premier élément d'insertion (11), puis l'extrude sur le côté de pointe après l'avoir amené dans un état selon lequel l'élément annulaire (30) est adapté sur la paire des éléments de forceps (21). Dans un état précédant la séparation de l'élément annulaire (30), la paire d'éléments de forceps (21) peut être réglée uniquement dans un état selon lequel la paire se trouve dans un état incomplètement fermé, la paire pouvant maintenir un tissu d'organisme sans couper le tissu d'organisme ; par contre, dans un état selon lequel la seconde section d'insertion (12) est avancée dans la direction axiale jusqu'à une position selon laquelle l'élément annulaire (30) se sépare, la paire d'éléments de forceps (21) se trouve dans un état complètement fermé selon lequel la paire peut couper le tissu d'organisme.
PCT/JP2010/061101 2009-06-30 2010-06-30 Forceps pour endoscope Ceased WO2011001996A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2009-156412 2009-06-30
JP2009156412 2009-06-30

Publications (1)

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WO2011001996A1 true WO2011001996A1 (fr) 2011-01-06

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PCT/JP2010/061101 Ceased WO2011001996A1 (fr) 2009-06-30 2010-06-30 Forceps pour endoscope

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
TWI452974B (zh) * 2011-10-07 2014-09-21 Nat Univ Chung Hsing 電能供應裝置及具有電能供應裝置的鞋墊
CN113825457A (zh) * 2019-05-20 2021-12-21 株式会社钟化 内窥镜用钳子

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5922002A (en) * 1989-12-05 1999-07-13 Yoon; Inbae Surgical instrument with jaws and movable internal biopsy device and method for use thereof
JP2000014634A (ja) * 1998-07-02 2000-01-18 Olympus Optical Co Ltd 内視鏡システム
GB2375306A (en) * 2001-05-08 2002-11-13 Stephen Addison Hall Biopsy forceps
JP2005103140A (ja) * 2003-10-01 2005-04-21 Olympus Corp 大腸全層切除の処置用挿入補助具とその医療器具システム
JP2008149142A (ja) * 2006-12-14 2008-07-03 Ethicon Endo Surgery Inc 組織の管腔内局所切除のための組織クランプ

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5922002A (en) * 1989-12-05 1999-07-13 Yoon; Inbae Surgical instrument with jaws and movable internal biopsy device and method for use thereof
JP2000014634A (ja) * 1998-07-02 2000-01-18 Olympus Optical Co Ltd 内視鏡システム
GB2375306A (en) * 2001-05-08 2002-11-13 Stephen Addison Hall Biopsy forceps
JP2005103140A (ja) * 2003-10-01 2005-04-21 Olympus Corp 大腸全層切除の処置用挿入補助具とその医療器具システム
JP2008149142A (ja) * 2006-12-14 2008-07-03 Ethicon Endo Surgery Inc 組織の管腔内局所切除のための組織クランプ

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
TWI452974B (zh) * 2011-10-07 2014-09-21 Nat Univ Chung Hsing 電能供應裝置及具有電能供應裝置的鞋墊
CN113825457A (zh) * 2019-05-20 2021-12-21 株式会社钟化 内窥镜用钳子

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