Treatment tool for endoscope and medical procedure

A treatment tool for an endoscope according to the present invention includes: an outer sheath to be inserted into a channel of an endoscope; a forcep sheath which is movably arranged in the outer sheath along an axial direction; a plurality of forcep cups which are attached to a distal end of the forcep sheath, at least one of which is formed with a sharp needle-shaped portion on a distal end, and which cooperate with each other to be openable/closable as a whole; an operation wire which is movably arranged in the forcep sheath along an axial direction, and is connected to the forcep cups, and which opens/closes the forcep cups when moved in its axial direction; a first operation portion which is movably attached along an axial direction of a proximal end of the outer sheath, and is connected to a proximal end of the forcep sheath; and a second operation portion which is movably attached to the first operation portion along an axial direction of the proximal end of the forcep sheath, and is connected to a proximal end of the operation wire.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to a treatment tool for an endoscope and a medical procedure using this.

2. Description of Related Art

Recently, there is a demand for biopsy of the inside of a human parenchymatous organ and diagnosis of the tissue under an endoscope.

To meet such a demand, there is disclosed in Japanese Unexamined Patent Application, First Publication No. H05-237120 and Japanese Unexamined Patent Application, First Publication No. 2000-201939, a treatment tool for an endoscope which is used by being inserted into a channel of an endoscope, and has distal ends of a pair of openable/closable forcep cups formed into sharp needle-shapes.

In such a treatment tool for an endoscope, while being set into the channel of the endoscope, the pair of forcep cups are piercingly poked to the diagnosis site inside the parenchymatous organ using the sharp needle-shaped portion on the distal ends, and the forcep cups are further pushed forward while being opened so that the forcep cups reach the diagnosis site. Then, by closing the forcep cups, the biopsy tissue of the diagnosis site is collected.

SUMMARY OF THE INVENTION

An object of the present invention is to provide a treatment tool for an endoscope and a medical procedure which enable even only one operator to extremely readily perform two operations of opening forcep cups and pushing the forcep cups forward, which have to be performed at the same time, for collecting a biopsy tissue inside the parenchymatous organ.

The treatment tool for an endoscope according to the present invention includes: an outer sheath to be inserted into a channel of an endoscope; a forcep sheath which is movably arranged in the outer sheath along an axial direction; a plurality of forcep cups which are attached to a distal end of the forcep sheath, at least one of which is formed with a sharp needle-shaped portion on a distal end, and which cooperate with each other to be openable/closable as a whole; an operation wire which is movably arranged in the forcep sheath along an axial direction, and is connected to the forcep cups, and which opens/closes the forcep cups when moved in its axial direction; a first operation portion which is movably attached along an axial direction of a proximal end of the outer sheath, and is connected to a proximal end of the forcep sheath; and a second operation portion which is movably attached to the first operation portion along an axial direction of the proximal end of the forcep sheath, and is connected to a proximal end of the operation wire.

The medical procedure according to an aspect of the present invention includes: a step of inserting and setting a forcep mainbody including: an outer sheath to be inserted into a channel of an endoscope; a forcep sheath which is movably arranged in the outer sheath along an axial direction; a plurality of forcep cups which are openably/closably attached to a distal end of the forcep sheath, and at least one of which is formed with a sharp tapered portion on a distal end; and a forcep wire which is movably arranged in the forcep sheath along an axial direction, and is connected to the forcep cups, and which opens/closes the forcep cups when moved in the axial direction, into the channel of the endoscope; a step of inserting the insertion portion of the endoscope having the forcep mainbody inserted and set into the channel, into a body cavity of an examinee; a step of moving the first operation portion connected to the proximal side of the forcep sheath, to a distal side along an axial direction of a proximal side of the outer sheath, and piercing a parenchymatous organ of an examinee with the distal end of the forcep cups; a step of moving the first operation portion to the distal side along the axial direction of the proximal side of the outer sheath, moving the second operation portion that is movably attached to the first operation portion along an axial direction of a proximal end of the forcep sheath, and is connected to the proximal end of the operation wire, to the distal side along the axial direction of the proximal side of the outer sheath, and thereby moving the plurality of forcep cups forward while opening them; and a step of moving the second operation portion to the proximal side along the axial direction of the proximal side of the outer sheath, so as to close the forcep cups, and thereby correcting a biopsy tissue from the parenchymatous organ of the examinee.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Hereunder is a detailed description of an embodiment.

Note that in the modified examples explained later, the same reference symbols are used for the same components, and duplicate descriptions are omitted.

FIG. 1shows the whole of a treatment tool for an endoscope that is used by being inserted into a channel of an endoscope. The treatment tool for an endoscope1comprises: a forcep mainbody2for performing an actual treatment by being inserted into the channel of the endoscope; and an operation portion mainbody3for performing the positional adjustment of the forcep mainbody2with respect to the channel, and an opening/closing operation of the forcep cups.

The forcep mainbody2includes: an outer sheath10that is inserted into the channel of the endoscope; a coil sheath (forcep sheath)11movably arranged along the axial direction of the outer sheath10inside the outer sheath10; a pair of forcep cups13attached to the distal end of the coil sheath11in a mutually openable/closable manner; and an operation wire14movably arranged along the axial direction of the coil sheath11inside the coil sheath11, and connected to the forcep cups13so as to open/close the forcep cups13when the wire itself is moved in the axial direction.

In this specification, assuming that the treatment tool for an endoscope is inserted into the channel of the endoscope, then for the respective components of the treatment tool for an endoscope, the left side inFIG. 1is referred to as the distal side and the right side is referred to as the proximal side.

The outer sheath10is made from a flexible pipe material, for example a tube of polytetrafluoroethylene or the like, so as to be deformable to follow the curvature of the insertion portion of the endoscope.

The coil sheath11is flexible, and for example, a closely coiled stainless steel wire is used, so that the pushing force from the proximal side can be transferred to the distal end.

As shown inFIG. 5, the pair of forcep cups13are formed into a cup-shape having a semicircular cross-section from the center to the distal end. The distal end of one forcep cup13of the pair of forcep cups13(here the top forcep cup inFIG. 5) is formed with a needle-shaped portion12which is sharp in a conical shape. The needle-shaped portion12is formed to project from one forcep cup to the other forcep cup side so as to project from the forcep cup main body to the distal side but within a range not interfering with the opening/closing operation of the forcep cups. Moreover, the distal center12aof the needle-shaped portion12is arranged on the abutted portion positioned in the center of the pair of forcep cups13.

The intermediate portions of the forcep cups13are rotatably attached via a pin16to a base plate15that is attached to the distal end of the coil sheath11. Moreover, the proximal ends of the forcep cups13are respectively linked to the distal ends of link members18in a pair via pins17. The proximal ends of the link members18are linked to a coupling rod20via a pin19. The coupling rod20is linked to the distal end of the operation wire14.

Moreover, the forcep cups13, the link members18, and the coupling rod20constitute a link mechanism21. By this link mechanism21, the pair of forcep cups13are opened when the operation wire14is moved to the distal side with respect to the coil sheath11as shown inFIG. 16andFIG. 17, and the pair of forcep cups13are closed when the operation wire14is moved to the proximal side with respect to the coil sheath11as shown inFIG. 18.

The operation portion mainbody3has main components of: an endoscope coupling tool30which is fixed to an insertion port of the channel of the endoscope, and is connected to the proximal end of the outer sheath10; a slider (first operation portion)31which is movably attached to the endoscope coupling tool30along the axial direction of the proximal end of the outer sheath10, and is connected to the proximal end of the coil sheath11; and a button (second operation portion)32which is movably attached to this slider31along the axial direction of the proximal end of the coil sheath11, and is connected to the proximal end of the operation wire14.

The endoscope coupling tool30is described here. Reference symbol41denotes a cylindrical coupling member installed coaxially with the insertion port43of the channel of the endoscope (refer toFIG. 8). As shown inFIG. 4, the distal end of this coupling member41is provided and arranged with a lock member42in a slidable manner in a direction orthogonal to the axis of the coupling member. As shown inFIG. 8, the coupling member41is fixed to the channel insertion port43of the endoscope via an adaptor forceps plug44in a fluid-tight condition, by sliding the lock member42downward inFIG. 10while the adaptor forceps plug44to be fitted to the channel insertion port43of the endoscope is fitted inside.

The coupling member41is attached with an operation portion supporting pipe member45along the axis. This operation portion supporting pipe member45is fitted to the outside of the outer sheath10.

Into the proximal side of the coupling member41, the distal end of a pipe fixing member46is movably inserted along the axis of the coupling member41. The fixed position of the pipe fixing member46with respect to the coupling member41can be optionally set by tightening a screw47with the coupling member41interposed therebetween.

The distal end of the pipe fixing member46is connected with the proximal end of the outer sheath10via a sheath fixing member48. The proximal side of the pipe fixing member46is linked with a slider receiver49coaxially with the pipe fixing member46. The coil sheath11is inserted respectively into through holes49aand46aformed along the axes of the slider receiver49and the pipe fixing member46.

Here, the coupling member41, the pipe fixing member46, the slider receiver49, and the like constitute the endoscope coupling tool30. Moreover, the pipe fixing member46, the screw47, and the sheath fixing member48constitute a sheath fixed position adjustment mechanism50which adjusts the fixed position of the proximal end of the outer sheath10with respect to the coupling member41.

Around the outer circumference on the proximal side of the slider receiver49, the slider31is fitted to the outside of a slide groove49bthat is formed on the outer circumference of the slider receiver49, and thereby the slider31is attached coaxially and movably in the axial direction with respect to the slider receiver49. The slider31comprises: a slider mainbody52which is fitted to the outside of the slider receiver49; a retaining member54attached to the distal side of the slider mainbody52; and a coil sheath coupling member55attached to the proximal side of the slider mainbody52.

The slider mainbody52is formed with a through hole52aalong the axis. Into this through hole52a, the coil sheath11is inserted. As shown inFIG. 15, here, the slider mainbody52is constituted by a pipe-shaped handle that can be grasped by an operator with one hand.

The movement limit position of the slider mainbody52to the distal side with respect to the slider receiver49is determined by a stopper (first operation portion stopper)56that is movable in the axial direction and is fixed to the outer circumference of the slider receiver49in an optional position by means of a screw56a. Moreover, the movement limit position of the slider mainbody52on the proximal side with respect to the slider receiver49is determined by the retaining member54abutted against an outer flange46bformed on the proximal end of the slider receiver49.

Here, when the slider mainbody52is moved to the distal side, the coil sheath coupling member55, the coil sheath11, and the forcep cups13are integrally moved in the same direction. Moreover, conversely, when the slider mainbody52is moved to the proximal side, the coil sheath coupling member55, the coil sheath11, and the forcep cups13are integrally moved in the same direction.

The outer circumference of the approximate central portion of the slider receiver49is formed with a ring-like groove. As shown inFIG. 3, by means of a C ring57attached to this ring groove, the stopper56is restricted from being moved further to the distal side.

As shown inFIG. 6, the coil sheath coupling member55is formed in a cylindrical shape overall, having a small diameter portion58on the distal side and a large diameter portion59on the proximal side. The small diameter portion58is inserted into the through hole formed in the proximal end of the slider mainbody52, and fixed thereto. Moreover, with the proximal end of the coil sheath11inserted into the small diameter portion58, this is fixed by an appropriate fixing means such as an adhesive.

Inside of the large diameter portion59of the coil sheath coupling member, from the distal side to the proximal side, a spring receiver (elastic member stopper)60, a coil spring (elastic member)61, and a part of the button32are stored. Moreover, the operation wire14is inserted into the large diameter portion59of the coil sheath coupling member, and the proximal end of the operation wire14is fixed to the button32as mentioned above.

The side wall of the large diameter portion59of the coil sheath coupling member55is formed with crank shape grooves59ashifted through 180 degrees so as to be symmetrical to each other. In these crank shape grooves59aare fitted neck portions60aof the spring receiver60. Moreover, depending on whether the neck portions60aof the spring receiver60are latched on the longitudinal grooves59aaof the crank shape grooves59aor on the transverse grooves59abthereof, it can be alternatively selected whether the spring receiver60is in a position where it is always abutted against the coil spring61, or is in a free position where it is not always abutted against the coil spring61. That is, together with the neck portions60aof the spring receiver60, the crank shape grooves59aof the large diameter portion59constitute a positioning mechanism which determines the position of the spring receiver60.

Moreover, when the spring receiver60is latched on the transverse grooves59abof the crank shape grooves59, to be in a position where it is always abutted against the coil spring61, that is in a condition shown inFIG. 7, then the button32is always pressed to the proximal side by the coil spring61. In this condition, if the operator presses the button32to the distal side, the operation wire14is pushed to the distal side so as to open the forcep cups13, and if the pressing on the button32is released, the operation wire14is pushed back to the proximal side due to the urging force of the coil spring61, so as to close the forcep cups13.

Onto the proximal end of the large diameter portion59of the coil sheath coupling member is fitted a cap62. By latching this cap62on a large diameter portion32aprovided on the distal side of the button32, the button32is prevented from dropping off.

Next is a description of a method of collecting a tissue of a parenchymatous organ of an examinee, using the treatment tool for an endoscope.

The previously sterilized treatment tool for an endoscope is taken out from a sterilized package. As shown inFIG. 7, the latched position of the neck portions60aof the spring receiver60with respect to the crank shape grooves59aof the large diameter portion is shifted from the longitudinal grooves59aato the transverse grooves59ab, so as to set the spring receiver60to the position where it is always abutted against the coil spring61. As a result, the coil spring61always urges the button32to the proximal side (right side inFIG. 7).

At the time of sterilization, the spring receiver60is in a position where its neck portions60aare latched in the longitudinal grooves59aa, in a free state where it is not always abutted against the coil spring61. Therefore, the parts can be prevented from being abutted against each other, and the sterilization can be smoothly performed.

As described above, the treatment tool for an endoscope1having the spring receiver60set in the position where it is always abutted against the coil spring61, is inserted from the insertion port43into the channel of the endoscope.

Specifically, the outer sheath10having the coil sheath11, the forcep cups13, and the like inserted and set therein, is inserted into the channel. As shown inFIG. 8, the adaptor forceps plug44is fitted on the channel insertion port43. Furthermore, the coupling member41is moved to the channel insertion port43side to fit to the adaptor forceps plug44(refer toFIG. 9). In this condition, as shown inFIG. 10, the lock member42is moved in the direction orthogonal to the axis of the coupling member41to lock. As a result, the treatment tool for an endoscope1is fixed so as not to drop from the endoscope accidentally.

Next, the insertion portion of the endoscope having the treatment tool for an endoscope1set therein, is inserted from a natural orifice such as the mouth or the anus of the examinee into the body cavity, so that its distal end reaches the vicinity of a diagnosis site Aa of a parenchymatous organ A.

Next, as shown inFIG. 11, the screw47of the sheath fixed position adjustment mechanism50is loosened, and the pipe fixing member46is moved to the distal side of the coupling member41, to adjust the position so that the distal end of the outer sheath10slightly projects from the exit of the channel opened in the distal end of the endoscope insertion portion. In this condition, the screw47is tightened. The position of the distal end of the outer sheath10at this time is a position which allows an appropriate observation respectively in an optical observation system and an ultrasonic observation system attached to the distal end of the endoscope insertion portion.

Next, as shown inFIG. 12, the screw56ais loosened, and the stopper56is moved to the distal side along the axial direction of the slider receiver49so as to reach a position slightly before the C ring57. This position of the stopper56serves as a guidance for moving the slider mainbody52to the distal side. As a result, as described later, the operator can operate to move the slider mainbody52with a sense of security.

Next, as shown inFIG. 13, the operator grasps the slider mainbody52with his/her hand and moves it to a position where its distal end is abutted against the stopper56.

As a result, the coil sheath11and the forcep cups13attached to the distal end of the coil sheath11are moved to the distal side, and the forcep cups13project from the outer sheath10. Then, the distal end of the forcep cups13pierces to the diagnosis site Aa of the parenchymatous organ A (refer toFIG. 14). At this time, since the forcep cups13have a sharp needle-shaped portion12formed on the distal end, the forcep cups13themselves can pierce to the diagnosis site Aa of the parenchymatous organ A, without using a treatment tool exclusively for piercing, nor a treatment tool for incision.

Next, as shown inFIG. 15andFIG. 16, while pushing the button32attached to the proximal side of the slider mainbody52against the urging force of the coil spring61with the thumb, the slider mainbody52is further moved to the distal side up to the position where the stopper56is abutted against the C ring57.

By pushing the button32, the operation wire14is relatively moved to the distal side with respect to the coil sheath11, and thereby the forcep cups13are opened. The slider mainbody52is further moved to the distal side, and thereby the forcep cups13are moved to the distal side via the coil sheath11. That is, the forcep cups13are opened and moved to the distal side at the same time, to be faced to the diagnosis site Aa inside the parenchymatous organ A (refer toFIG. 17).

Such an operation simply involves grasping the slider mainbody52with one hand, pushing the button32with the thumb as it is, and pushing the grasped slider mainbody52into the distal side. Therefore, it is extremely easy even for only one operator to perform.

Next, as shown inFIG. 18, the pressing on the button32is released. As a result, the operation wire14is moved to the proximal side due to the urging force of the coil spring61, and the forcep cups13are closed. That is, the biopsy tissue of the diagnosis site Aa is collected by the forcep cups13. In this operation also it is sufficient to merely release the pressing operation of the button by means of the thumb, and hence it is also a very easy operation.

Next, as shown inFIG. 19, the slider mainbody52and the stopper56are moved to the proximal side to respectively return to the original position.

Next, as shown inFIG. 20, the lock member42is moved in the direction orthogonal to the axis of the coupling member41to return to the original position.

Lastly, as shown inFIG. 21, the engagement of the coupling member41and the adaptor forceps plug44is released, after which the treatment tool for an endoscope1is withdrawn from the channel of the endoscope.

By the above operation, the biopsy tissue of the diagnosis site Aa can be collected from the inside of the parenchymatous organ A of the examinee.

Here is a description of modified examples of the embodiment.

First Modified Example

FIG. 22toFIG. 24show a first modified example of the forcep cups.

In the abovementioned forcep cups13, when the operation wire14is moved to the distal side to open, both forcep cups13respectively rotate about the pin16. However, in this modified example, only one forcep cup71aof a pair of forcep cups71(71aand71b) rotates, and the other forcep cup71bdoes not rotate.

That is, the other forcep cup71bis attached to the distal end of the coil sheath11in a manner where it is integrally fixed to the connection part to be connected with the coil sheath11. The intermediate portion of the one forcep cup71ais rotatably attached to the intermediate portion of the other forcep cup71b, via a pin73. The proximal end of the one forcep cup71ais linked to the distal end of a link member75via a pin74. The proximal end of the link member75is linked to a coupling rod77via a pin76. The coupling rod77is linked to the distal end of the operation wire14.

That is, the one forcep cup71a, the link member75, and the coupling rod77constitute the link mechanism78. By this link mechanism78, only one forcep cup71arotates to open when the operation wire14is moved to the distal side with respect to the coil sheath11as shown inFIG. 24, and only one forcep cup71arotates to close when the operation wire14is moved to the proximal side with respect to the coil sheath11as shown inFIG. 23.

Moreover, only the distal end of the other forcep cup71bis formed with a needle-shaped portion72which is sharp in a conical shape. The distal end of the one forcep cup71ais not formed with a needle-shaped portion.

Next a method of collecting the biopsy tissue from the inside of the parenchymatous organ A using these forcep cups71is described for only the points different from the abovementioned method.

Firstly, as shown inFIG. 23, the coil sheath11is moved to the distal side, and the vicinity of the diagnosis site Aa of the parenchymatous organ A is pierced with the forcep cups71using the needle-shaped portion72formed on the distal end of the forcep cups71. At this time, the needle-shaped portion72is formed on the other forcep cup71bserving as the non-movable forcep cup that is directly fixed to the coil sheath11. Therefore when the coil sheath11is pressed to move, the pressing force is directly transferred to the needle-shaped portion72, enabling smooth piercing by the forcep cups71.

Next, while the coil sheath11is further moved to the distal side, a button (not shown) is pressed at the same time, so as to move the operation wire14forward. As a result, as shown inFIG. 24, while the one forcep cup71ais being opened, the whole forcep cups71are moved to the distal side at the same time, so as to face the diagnosis site Aa inside the parenchymatous organ A.

Here, in the forcep cups71, both cups are not opened, but only the one forcep cup71anot having the needle-shaped portion72on the distal end is opened. As a result, at the time of the opening operation, less resisting force from the parenchymatous organ is received, so that a smooth opening operation is performed.

Incidentally, when the forcep cups each formed with needle-shaped portions on the distal ends are opened, the needle-shaped portions rotate respectively while piercing the parenchymatous organ, and as a result a greater resisting force is received from the parenchymatous organ.

Second Modified Example

FIG. 25andFIG. 26show a second modified example of the forcep cups.

In this modified example, a needle-shaped portion82formed on the distal end of forcep cups81(81aand81b) has the distal end formed in a triangular pyramid shape (trocar point). Moreover, the needle-shaped portion82is not formed on both forcep cups81aand81b, but is formed only on one forcep cup81b. In this modified example, both forcep cups81aand81brotate.

Third Modified Example

FIG. 27toFIG. 29show a third modified example of the forcep cups.

The difference of this modified example from the abovementioned forcep cups shown inFIG. 25andFIG. 26, is the point that the surfaces of the forcep cups91and a base plate92are respectively provided with a plurality of dimple portions93.

In this manner, by providing the surfaces of the forcep cups91and the base plate92with the dimple portions93, reflected waves from the dimple portions93are received, enabling the location of the forcep cups and the base plate to be accurately ascertained, and facilitating the collection operation of the diagnosis site inside the parenchymatous organ under an ultrasonic image.

Fourth Modified Example

FIG. 30andFIG. 31show a modified example of the forcep cups.

In this modified example, a needle-shaped portion102formed on the distal end of forcep cups101(101aand101b) has a shape where the distal end is cut slantwise from bottom to top inFIG. 30, and both sides of this cut portion are further cut slantwise (lancet point). Moreover, also in this modified example, the needle-shaped portion102is not formed on the both forcep cups101aand101b, but is formed only on one forcep cup101b. Also in this modified example, both forcep cups101aand101brotate.

The technical scope of the present invention is not limited to the above embodiments, and various modifications can be made without departing from the scope of the present invention.

For example, in the above embodiments, the description is for examples where there are two forcep cups13,71(71aand71b),81(81aand81b),91, and101(101aand101b). However it is not limited to this and there may be three forcep cups or more.

Moreover, in the above embodiments, the configuration is such that the button32which opens/closes the forcep cups is automatically returned by the coil spring61. However it is not limited to this and the button may be automatically returned by another elastic member such as a rubber member. Furthermore, the configuration may be such that the operator manually returns the button without using the elastic member.

Furthermore, in the above embodiments, only one forcep cup is formed with the needle-shaped portion. However it is not limited to this and a plurality of forcep cups may be respectively provided with needle-shaped portions.

Moreover, in the above embodiments, the insertion port43of the channel of the endoscope comprises the coupling member41and the lock member42for fixing the treatment tool for an endoscope. However these members41and42are not always necessary, and the present invention may be realized without them. Moreover, similarly, the present invention may be realized without the screw47for adjusting the position of the pipe fixing member46with respect to the coupling member41.