JP2007089690A - Conductive traction device for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To make a conductive traction device for endoscope effective in a treatment such as cutting, to enable the using frequencies of forceps, pinching utensils and the like to be reduced in such a manner that a fibrous tissue or the like which becomes an obstacle for an endoscopic observation at the time of surgery is moved or cut by using a traction section, and thus, to reduce burden on a patient, to enable the operation time to be shortened, and also, to enable a frictional stimulation or a damage to a skin incision section to be reduced, and thus, to enable the patient to go home on the same the day without being hospitalized for a long time after the surgery. <P>SOLUTION: This conductive traction device is used by insertion of an endoscope, and has a traction section and an electrode on the distal end part of a cylindrical section. An optical lens section of the endoscope which is inserted into the conductive traction device can be protruded from the distal end part of the conductive traction device. The endoscope is made movable in the axial direction of the conductive traction device. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an energized traction device for an endoscope capable of performing endoscopic surgery with a single skin incision, and particularly suitable for nerve fiber blocking techniques such as sympathetic nerves and parasympathetic nerves, particularly thoracoscopic chest sympathetic nerve blockade The present invention relates to an energization pulling apparatus suitable for surgery, and further to an energization instrument for an endoscope that can move and cut and remove a fibrous tissue that hinders the operation or obstructs its visual field.

In so-called endoscopic surgery using an endoscope, conventionally, treatment instruments such as an electric knife and a coagulation electrode and the endoscope are inserted through different skin incisions. For this reason, at least two skin incisions are necessary in these operations, and in some cases, it is necessary to provide three or more incisions in order to ensure treatment and a visual field. Moreover, in order to prevent contamination and complete sterilization, treatment instruments such as electric scalpels and coagulation electrodes have been used in the form of rods that are solid to the inside, and cylindrical ones have not been used.
However, in order to reduce the burden on the patient and achieve early recovery after surgery, the smaller the number of skin incisions, the better the smaller the size of the incision. In order to have a single skin incision, it is necessary to insert the endoscope and the energizing traction device from the same incision. In order to reduce the size of the incision portion, it is necessary to make the endoscope and the energizing traction device as thin as possible. As a solution to this problem, an endoscope and a treatment instrument can be inserted into the body through the same skin incision, and treatment such as electrocautery, electrocoagulation, and incision can be performed while observing the surgical site with the endoscope. An endoscope energization device is known (for example, see Patent Document 1). That is, the energization device for an endoscope of Patent Document 1 is a cylindrical instrument that has an electrode at the tip, and performs electrocoagulation and incision, and the endoscope can be inserted into the cylinder, The endoscope can be finely moved along the cylinder. By adopting such a configuration, it is possible to perform treatment using a cylinder having an inner diameter through which an endoscope can pass, and by making the cylinder wall thin, an unprecedented thin cylinder can be used. It was possible to reduce the thickness. In addition, a window is provided at the distal end of the tube so that the surrounding tissue can be observed from the lumen of the endoscope, and the target portion can be electrocoagulated and incised more safely.
International Publication Number WO00 / 16707

  However, when treatment is performed with such a device, fibrous tissue or a lump of fat or the like may cover the treatment site on or near the treatment site to obstruct the field of view or make the treatment difficult. In such a case, even with the above-mentioned apparatus, it is possible to cope with electrocautery to some extent. However, it is usually necessary to insert tweezers or a scalpel to remove such tissue, and there is a risk of damaging the treatment site or wasting time. If the fibrous tissue or the like can be removed or moved out of sight more easily and quickly, it becomes safer and the treatment time can be shortened.

  In order to solve the above-described problems, the present invention relates to an endoscope energizing traction device characterized in that a traction portion is provided at a distal end portion of a cylinder.

  The energized traction device according to the present invention is an energized traction device that is used by inserting an endoscope, and includes an operation unit, a tube unit, a traction unit, and an electrode unit. The tube portion has a traction portion and an electrode at the distal end portion, and an operation portion at the proximal end, and the endoscope inserted into the energization traction device is movable in the axial direction of the energization traction device, The optical lens portion of the endoscope can protrude from the distal end portion of the energization pulling device. Such an endoscope is composed of a rod-shaped insertion portion having a diameter of 2 mm to 3 mm having an optical lens at a tip portion thereof, and a display device such as a television monitor which is usually connected to the insertion portion. Can be used. The insertion portion of the endoscope having an optical lens to be inserted into the energization pulling device of the present invention needs to be inserted almost closely into the inside of the hard energization pulling device, and fine movement adjustment is possible in the axial direction of the cylinder portion. As possible, it is linear with a constant cross-sectional shape or curved with a constant radius. The cross-sectional shape of the insertion portion is arbitrary depending on the endoscope optical system, but is usually circular.

  The cylinder part of the energizing traction device is made of a hard and non-breakable material such as a metal such as stainless steel or ceramics, and has a traction part and an electrode at its distal end, and this electrode is electrically connected to the control part. Connected. When the cylindrical treatment instrument is formed of a conductive material such as metal, the inner and outer surfaces of the cylinder, excluding the electrodes, are insulated so that electricity does not leak outside or energize the endoscope. To do. The insulation treatment can be achieved by coating an insulating material, applying and curing, baking, or the like. The electrode may be a monopolar or a bipolar, but a monopolar capable of concentrating current in a relatively narrow portion is suitable for performing fine surgery.

  When the distal end portion of the energizing traction device is used for incision, it is preferable to form a sharp blade. Further, it is preferable that the endoscope optical lens portion and the distal end portion are as close as possible so that a large gap is not generated. If there is a large gap, body fluids such as blood, fat, and excised body tissue fragments may enter the gap during surgery, contaminating another part of the body or narrowing the field of view, hindering endoscopic observation. May occur.

  The endoscope optical lens part of the energization pulling device for endoscopes of the present invention can protrude from the distal end portion of the energization pulling device, and can finely set the endoscope at a specific position in the axial direction of the cylinder. is there. By projecting the endoscope first from the distal end portion of the energized pulling device, the visual field can be observed by the endoscope without being obstructed by the energized pulling device. Furthermore, since the endoscope can be moved to a specific position in the axial direction of the cylinder, when searching for the target site of surgery, the endoscope is projected from the distal end of the energizing traction device, and the inside of the body is observed with a wide field of view. When a site is specified and treated, it is possible to focus on both the target site and the electrode by retracting the endoscope. This moving distance is extremely short, and usually 5 to 7 mm is sufficient. By adopting such a configuration, the electrode and the endoscope move on the same axis, so when performing treatment with the electrode, the electrode can always be placed in the field of view, and the surgical site identified by further search It is possible to perform treatment such as cauterization by bringing the electrodes close to each other accurately. The endoscope may be moved manually or electrically by a DC motor or the like. In the case of electric operation, the direct current motor can be operated with a dial, lever or the like provided in the operation unit, and can be moved to a desired position with a single touch and can be easily operated during an operation. . Then, it is not necessary to take out the endoscope every time the endoscope is moved during the operation, and the burden on the patient can be reduced. Furthermore, since the direction of movement of the endoscope, the direction of movement of the energizing traction device, and the visual field direction to be observed with the endoscope are coaxial, the visual field direction can be confirmed each time it moves, and the focus is aligned. Therefore, the operation is simplified and the operation can be performed quickly.

  The shape of the electrode at the distal end of the tubular part is such that the endoscope is energized at the distal end of the energizing traction device so that the distal end of the tubular part or the electrode does not obstruct the visual field of the endoscope when observing the surgical site with the endoscope It must have a shape that does not obstruct the course of the endoscope so that it can exit the part. Therefore, when the endoscope insertion portion has a circular cross section, it is preferable that the electrodes also have a circular shape that conforms to the cross sectional shape of the endoscope or an arc that forms a part of the circular shape. In particular, in the case of bipolar, it is preferable that the arc is used. The electrode shape may be a cylindrical shape cut at right angles to the axial direction, may be a shape cut obliquely with respect to the axial direction, and may further have a needle shape or a linear shape by projecting the tip portion. . By making it needle-shaped or linear, operations such as electrical stimulation, cauterization, and coagulation for searching for a minute portion by an electrode can be performed. For example, when identifying a nerve fiber to be blocked from the nerve bundle, a weak electrical stimulus can be given to each nerve fiber at the tip of the needle-like electrode, and the response to that stimulus shows where the nerve fiber communicates. It can be confirmed. Further, even in nerve blockage, it is possible to block only specific nerve fibers, which has been difficult in the past, by the needle-like electrode.

  The endoscopic electrification pulling device of the present invention is also effective for the treatment of microscopic blood vessel coagulation performed under an endoscope, and particularly the thoracic sympathetic nerve blocking operation performed under an endoscope is performed at a minimum of one place. Can be performed by skin incision. And during surgery, there is no need to insert / remove instruments to / from the patient's body, so frictional stimulation to the incision is only at the time of instrument insertion and at the time of extraction of the instrument after completion of surgery, with minimal damage to the incision. Can be stopped. Therefore, the patient does not need to be hospitalized for a long time after the operation, and can return home on the day of the operation.

  In such a case of blocking nerve fibers, if healthy nerve fibers other than the target nerve fibers are unnecessarily blocked, side effects may occur. Therefore, it is important to determine which nerve fiber in the nerve tissue that runs in parallel is blocked, and it may affect the success or failure of the operation. Specifically, in the instrument of the present invention, the endoscope inserted into the energized traction device is protruded from the energized traction device to such an extent that the energized traction device portion does not enter the field of view, and the affected area is visible with a wide field of view while being visually confirmed on the display device. When the nerve bundle is easily searched for and the target nerve bundle is put in the field of view, the endoscope is gradually moved into the energized traction device without being removed from the field of view. Then, the position of the endoscope is finely adjusted so that both the nerve bundle and the electrodes of the energization pulling device are in the field of view of the endoscope, thereby focusing. When the endoscope is set at such a position, a search for specifying a nerve fiber to be blocked is performed. That is, as described above, an electrode is brought close to a specific nerve fiber, a voltage is adjusted by a controller, and a weak current is passed through the electrode to stimulate the nerve. While observing the response of each part of the body at that time, the electrical stimulation to the nerve is sequentially repeated to identify the target nerve fiber. If the nerve can be identified, the target nerve can be blocked by increasing the current by the controller for blocking the nerve. In this way, the needle-like electrode can stimulate specific nerve fibers in the nerve bundle with a weak current. By examining the response of each part of the body to the stimulation, It can block only the nerves that do. Examples of cases in which such nerve fiber blocking is effective include, but are not limited to, hyperhidrosis, Raynaud's syndrome, and reflex sympathetic atrophy (RSD).

  The pulling portion in the energization pulling device for an endoscope of the present invention is a hook-like protrusion that protrudes in the circumferential direction, usually at the distal end of the device. The distal end can be provided with a convex portion directed toward the proximal end side so that it can be easily caught. The pulling unit supports and moves or cuts a tissue that obstructs the field of view of the endoscope or an unnecessary tissue or member. As a result, both ends are fixed to bones, muscles, ligaments, internal organs, etc., and the middle part of the tissue is free. In the past, when treating such tissue, forceps and clamps were introduced into the treatment section each time, but by providing a traction section, the troublesome work required only by the present apparatus was achieved. Operation becomes possible, and operation can be simplified and time can be shortened. If the traction part is not used for tissue cutting, it is not necessary to provide an incision blade on the proximal side of the traction part, but if it is also used for tissue incision, part or all of the proximal end Form a blade. Moreover, you may form a blade also in the far end side of a traction part.

  In the energizing traction device of the present invention, a window portion can be provided together with the traction portion on the tip side, particularly on the side thereof. The window part is an opening that penetrates the inside and outside of the cylinder part of the energizing traction device, and there is no particular limitation on the shape thereof, and it can be a circle, an ellipse, a polygon such as a quadrangle, etc. From the viewpoint of easiness of sterilization operation, a circular or elliptical shape is preferable. A single window or a plurality of windows may be provided. With this window portion, when performing an energization treatment by pulling the endoscope into the energization traction device at the time of surgery, the field of view can be expanded by the window portion. Also, white smoke generated in the cylinder when solidified and cauterized by energization can be eliminated from the front surface of the endoscope optical lens through the window portion, and the visual field is not hindered. If the electrode is needle-shaped, the window can be provided in front of the needle-shaped electrode. As a result, the periphery of the surgical part can be observed from the window part together with the visual field inside the cylinder.

1 to 8 show an example of an energization pulling device for an endoscope of the present invention.
FIG. 1 is a front view of the energizing traction device for an endoscope of the present invention viewed from the direction perpendicular to the axial direction. A traction unit 1 is provided at the distal end of the device. Although the apparatus of FIG. 1 is linear, it may be formed in an arc with an endoscope inserted into its lumen. The apparatus illustrated in FIG. 1 employs a monopolar electrode system. In this example, the electrode part 14 and the cylinder part 4 are integrally formed of stainless steel. The outer diameter of the cylindrical part to the operation part of the cylindrical electrode of the energization pulling device for an endoscope of the present invention in FIG. 1 is 2.6 mm, the inner diameter is 2.1 mm, and the overall length is about 25 cm.

  FIG. 2 is a conceptual diagram showing a state where the energizing traction device for endoscope of the present invention is used in surgery. The device of the present invention is inserted into the body through the skin incision 5 between the ribs 11. In FIG. 2, since the electrocoagulation is about to be performed, the endoscope is pulled into the cylinder and placed at a position where the electrode and the target portion of electrocoagulation can be observed. The treatment portion 7 in the patient's body is a site where electrocoagulation is performed, and is brought close to a position where the electrodes are almost in contact. Here, laser treatment, ultrasonic treatment, and other treatments can be performed on the affected area together with or in place of electrocoagulation, and the apparatus can be introduced separately at that time. Alternatively, the endoscope may be pulled out and the device inserted from the tube portion. In this case, the energizing traction device itself does not have to be pulled out from the incision, so that the incision is not damaged and the patient is less irritating, so the burden on the patient is reduced, and various treatments are performed safely and reliably. Can do. In FIG. 2, the mouth clip 6 is used to energize the electrodes for convenience. The distal end is not insulated and forms an electrode. A rectangular window 3 is opened in a direction substantially perpendicular to the tip of the electrode.

  FIG. 3 is a perspective view of the tip portion and the traction portion of the apparatus. An endoscope objective lens 9 is shown, and the endoscope 2 can observe the periphery of the treatment section from the inside of the cylinder through the window portion 3 and the traction portion 1.

FIG. 4 shows a state where a part of the fibrous body tissue 8 is about to be hooked on the traction part through the opening of the traction part.
FIG. 5 shows a state in which one fibrous body tissue is gripped from the state of FIG.
FIG. 6 shows a state where power is applied to perform electrocautery and traction incision.
FIG. 7 shows a state after pulling and cutting the fibrous tissue 8.

  FIG. 8 is a front view of an embodiment of the traction unit 1, where the traction unit 1 is located on the near side, and the window 3 is located on the opposite side. The traction unit 1 can capture a fibrous tissue or the like through the opening 10 of the traction unit, and is provided with a traction unit protrusion 12 at the end of the traction unit 1 so that the fibrous tissue or the like captured at the time of traction can be easily removed. There is no such thing.

  It is effective for coagulation and cutting of fine blood vessels and nerve fibers such as nerve fibers performed under the endoscope, and moves the fibrous tissue that obstructs endoscopic observation and treatment during surgery using the traction unit. Alternatively, it can be cut, and the frequency of use of forceps, clamps, etc. can be reduced, reducing the burden on the patient and shortening the operation time. Some operations can be performed with a minimal skin incision in one location, minimizing the need to insert and remove the device from the patient's body during the operation, so that frictional stimulation and damage to the incision can be inserted into the device. Only when the device is removed at the time and after the operation is completed, so that the patient can return home during the operation day without being hospitalized for a long time after the operation.

It is a front view of the energization pulling device for endoscopes of the present invention seen from the direction perpendicular to the axial direction. It is a conceptual diagram which shows the use condition of this invention apparatus at the time of an operation. It is a perspective view of the front-end | tip part of this invention apparatus. It is a perspective view which shows the use condition of this invention apparatus. It is sectional drawing of the operation part of the electricity supply traction apparatus of FIG. It is an enlarged view of the front-end | tip part A of the electricity supply traction apparatus of FIG. It is a top view of an operation part. It is a front view of one Example of the traction part in this invention apparatus.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Traction part, 2 ... Endoscope, 3 ... Window part, 4 ... Tube part, 5 ... Skin incision part, 6 ... Mouth clip, 7 ... Treatment Body tissue to perform, 8 ... Fibrous tissue, 9 ... Endoscope objective lens, 10 ... Opening of pulling part, 11 ... Rib, 12 ... Protrusion protrusion, 13 ... Operation Part, 14 ... electrode part

Claims (2)

An energizing traction device having an operation portion, a cylinder portion, a traction portion, and an electrode portion, which is used by inserting an endoscope, wherein the traction portion, the electrode portion, and the proximal end side are disposed at a distal end side of the cylinder portion. The endoscope has an operating portion, the endoscope inserted in the energizing traction device is movable in the axial direction of the energizing traction device, and the optical lens portion of the endoscope is connected to the distal end portion of the cylindrical portion An energizing traction device for an endoscope that can protrude from an endoscope. The energized traction device for an endoscope according to claim 1, wherein an opening end of the traction portion has a traction portion protrusion protruding toward a proximal end side.

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