WO2018189775A1

WO2018189775A1 - Medical overtube and medical system

Info

Publication number: WO2018189775A1
Application number: PCT/JP2017/014635
Authority: WO
Inventors: 紘介甕
Original assignee: オリンパス株式会社
Priority date: 2017-04-10
Filing date: 2017-04-10
Publication date: 2018-10-18

Abstract

This medical overtube is provided with a tubular body section. The body section comprises a collection lumen into which a capture device for capturing biological tissue is inserted. The collection lumen comprises a small diameter section on the tip side and a large diameter section having a larger inner diameter than the small diameter section.

Description

Medical overtube and medical system

The present invention relates to a medical overtube and a medical system including the medical overtube.

As one of the procedures using an endoscope, necrotic tissue removal for the pancreas (necrosectomy) is known.
When necrosectomy is performed by accessing the pancreas from the stomach, an endoscope is projected from a hole formed in the stomach wall and introduced into a lumen such as a cyst formed in the pancreas. Next, the necrotic tissue is captured by various treatment tools such as grasping forceps, snare, and net protruding from the treatment tool channel of the endoscope. The captured tissue is carried into the stomach, discarded into the stomach, and discharged out of the body through the digestive tract.

To throw away the supplemented tissue into the stomach, it is necessary to move the tip of the endoscope into the stomach, so to remove all necrotic tissue, the endoscope should be placed between the stomach and pancreas. Need to move again. Furthermore, since the treatment instrument has a size that can be inserted into the treatment instrument channel, the amount of necrotic tissue that can be captured by the treatment instrument in one operation is small. Therefore, it is often necessary to perform a reciprocating motion between the stomach and the pancreas extremely many times before the procedure is completed.

Although endoscopic necrosectomy has the advantage of being less invasive than necrosectomy by laparotomy, the procedure is cumbersome for the reasons described above and can be as long as 1-2 hours to remove all necrotic tissue. It often takes time.

Patent Document 1 discloses a biological tissue collection device including a hollow duct having a distal end portion having a collection portion for collecting a biological tissue and a proximal end portion having a suction mechanism for sucking the tissue collected by the collection portion. Is disclosed. Since the tissue collected by the collection unit is collected through the duct, necrosectomy is performed by combining the collection device described in Patent Document 1 with an endoscope, and the endoscope is placed between the stomach and pancreas. There is a possibility that the removal work of the necrotic tissue can be continued without being moved.

International Publication No. 2006-030596

However, even if the collection instrument described in Patent Document 1 is used, the amount of necrotic tissue that can be captured in one operation is still small because the point that it must be introduced into the target site via the endoscope channel remains the same. . Furthermore, when the supplemented necrotic tissue is large, there is a possibility that the tube is clogged and cannot be recovered. When this happens, the endoscope must eventually be moved between the stomach and pancreas.

In view of the above circumstances, an object of the present invention is to provide a medical overtube and a medical system that can efficiently collect captured tissue and the like.

A first aspect of the present invention is a medical overtube including a tubular main body, and the main body includes a recovery lumen through which a capture device that captures biological tissue is inserted, and the recovery lumen includes: A small-diameter portion on the distal end side and a large-diameter portion having an inner diameter dimension larger than that of the small-diameter portion.

The recovery lumen may further include a tapered portion that connects the small diameter portion and the large diameter portion, and is formed so that the diameter decreases as the small diameter portion is approached.

The main body may further include a water supply lumen extending along the recovery lumen, and the water supply lumen and the recovery lumen may communicate with each other at the tapered portion.

A second aspect of the present invention is a medical system including the medical overtube of the present invention and a capture device inserted through the recovery lumen.

The inner diameter of the large diameter portion may be equal to or greater than the maximum opening width of the tip portion of the capture device.

The medical system of the present invention may further include a suction mechanism connected to the proximal end portion of the recovery lumen.

According to the medical overtube and the medical system of the present invention, it is possible to efficiently collect the captured tissue and the like.

It is a figure showing the whole medical system composition concerning a first embodiment of the present invention. It is a front view which shows the main-body part of a medical overtube. FIG. 3 is a cross-sectional view taken along line II in FIG. 2. It is a figure showing a process of operation at the time of use of the medical system. It is a figure showing a process of operation at the time of use of the medical system. It is a figure showing a process of operation at the time of use of the medical system. It is a figure showing a process of operation at the time of use of the medical system. It is a figure which shows the overtube in the modification of the medical system. It is a figure which shows the front-end | tip part of the grasping forceps in the modification of the medical system. It is a figure showing a process of operation at the time of use of the modification. It is a front view which shows the main-body part of the medical overtube which concerns on 2nd embodiment of this invention. FIG. 13 is a cross-sectional view taken along line III-III in FIG. 11. It is sectional drawing in the IV-IV line of FIG. It is sectional drawing in the VV line | wire of FIG. It is sectional drawing which shows the modification of the medical overtube. It is sectional drawing which shows the medical overtube which concerns on the modification of this invention. It is a figure which shows the capture device which concerns on the modification of this invention. It is a figure which shows the medical overtube which concerns on the modification of this invention.

A first embodiment of the present invention will be described with reference to FIGS.
FIG. 1 is a diagram illustrating an example of a medical system 1 according to the present embodiment using a medical overtube (hereinafter, simply referred to as “overtube”) 10 according to the present embodiment. The medical system 1 includes an overtube 10, an endoscope 50 and a grasping forceps (capturing device) 60 inserted through the overtube 10, and a suction mechanism 70 connected to the overtube 10.

The endoscope 50 and the grasping forceps 60 are a so-called flexible endoscope and a flexible treatment instrument provided with a flexible insertion portion. An image in the visual field captured by the endoscope 50 is displayed on the monitor 51. The grasping forceps 60 is configured to open and close the forceps member at the distal end by operating the slider 61.
The endoscope 50 and the grasping forceps 60 can be appropriately selected and used from known soft endoscopes and soft forceps in consideration of the outer diameter size and the like.

The overtube 10 includes a tubular main body 20 having flexibility and an operation unit 40 attached to the main body 20.
The main body 20 has an outer diameter that can be introduced into the body from the esophagus. The external dimension of the main body 20 is, for example, about 15 mm to 20 mm.

The main body 20 is made of a flexible material such as resin, and has an active bending portion 21 provided on the distal end side and a flexible tube portion 22 provided on the proximal end side.
The active bending portion 21 has a known configuration including a plurality of node rings and is connected to the operation portion 40 via a transmission member (not shown) such as a wire. The active bending portion 21 can be bent in a desired direction by operating the operation portion 40 to advance and retract the transmission member in the longitudinal direction. In the active bending portion 21, the bendable directions (one direction, two directions, four directions) and the like may be determined as appropriate, and the number of transmission members and the specific configuration of the operation unit 40 are also in accordance with the known configuration. You may select suitably.
The flexible tube portion 22 has such flexibility that it can follow the running or shape change of a hollow organ.

FIG. 2 is a front view of the main body 20, and FIG. 3 is a cross-sectional view taken along the line II of FIG. As shown in FIGS. 2 and 3, the main body 20 is provided with a first lumen 25 through which the endoscope 50 is inserted and a second lumen (recovery lumen) 30 through which the grasping forceps 60 is inserted over the entire length. ing.
The cross-sectional shape of the first lumen 25 is circular, and the inner diameter dimension is the same over the entire length. The inner diameter dimension is a value that allows the endoscope 50 to be inserted with a predetermined clearance.

The cross-sectional shape of the second lumen 30 is also circular, but the inner diameter differs depending on the position in the longitudinal direction. The second lumen 30 has a small diameter portion 31 on the distal end side, a large diameter portion 33 on the proximal end side, and a tapered portion 32 between the small diameter portion 31 and the large diameter portion 33.
The inner diameter dimension of the small diameter portion 31 is a value through which the grasping forceps 60 can be inserted with a predetermined clearance. The inner diameter of the small diameter portion 31 is substantially the same as that of a general treatment instrument channel.
The inner diameter dimension D1 of the large diameter portion 33 is larger than the maximum opening width W1 of the forceps member at the tip of the grasping forceps 60. Therefore, the grasping forceps 60 can be opened to the maximum opening in the large diameter portion 33. The inner diameter dimension D1 is, for example, about 2 to 3 times the inner diameter dimension of the small diameter portion.
The taper portion 32 is gradually reduced in diameter as it approaches the small diameter portion 31, and smoothly connects the small diameter portion 31 and the large diameter portion 33 so as not to cause a large step.

The suction mechanism 70 is connected to the proximal end opening of the second lumen 30 in a watertight manner. The suction mechanism includes a pump 71 configured to be capable of suction and air supply, and a bottle 72 for storing solids and liquids collected by suction. A water supply source 73 and a port 74 for introducing the grasping forceps 60 are provided in a pipe line connecting the second lumen 30 and the bottle. Air supply and suction by the pump 71 and water supply by the water supply source 73 can be switched by a known three-way stopcock or the like.

The operation at the time of use of the medical system 1 of the present embodiment configured as described above will be described by taking as an example the case of necrosectomy of the pancreas.
First, the operator confirms the position of the treatment target site in the pancreas with an endoscope capable of both optical observation and ultrasonic observation, and establishes an access path to the treatment target site by incising the stomach wall and pancreas. After the access path is established, the endoscope is removed.

Next, the surgeon inserts the endoscope 50 through the proximal end opening of the first lumen 25 of the overtube 10 and inserts the overtube 10 into the patient's body. While observing the inside of the body with the endoscope 50, the surgeon operates the operation unit 40 as necessary to pass the access path. As shown in FIG. 4, the operator finally introduces the tip of the overtube 10 to the vicinity of the treatment target site. In this example, the site to be treated is in the pancreas Pc, and there is necrotic tissue Nt to be removed.
In the introduction process, air supply or water supply using the second lumen 30 may be appropriately performed.

Next, the operator inserts the grasping forceps 60 into the second lumen 30 from the port 74 while fixing the position of the overtube 10. A known sealing material or the like is provided at the port 74, and the grasping forceps can be introduced into the second lumen 30 while maintaining the water tightness of the second lumen 30.
When the surgeon advances the grasping forceps 60 in the second lumen 30, the distal end portion of the grasping forceps 60 is guided by the tapered portion 32 to reach the small diameter portion 31 and protrudes from the distal end opening in the second lumen 30. .

As shown in FIG. 5, the operator operates the grasping forceps 60 to grasp and remove the necrotic tissue Nt while observing the treatment target site with the endoscope 50. The surgeon retracts the grasping forceps 60 that grasps the necrotic tissue Nt, and moves the distal end portion of the grasping forceps 60 into the overtube 10 as shown in FIG.

When the distal end portion of the grasping forceps 60 moves to the large diameter portion 33, the operator opens the distal end portion of the grasping forceps 60 and releases the necrotic tissue Nt that has been grasped as shown in FIG. When suction is performed with the pump 71 of the suction mechanism 70 in this state, the necrotic tissue Nt released by the negative pressure in the second lumen 30 moves to the proximal end side in the second lumen 30 and enters the bottle 72. drop down.
A marker or the like may be provided on the proximal side of the grasping forceps 60 so that it can be easily understood that the distal end portion of the grasping forceps 60 has moved to the large diameter portion 33.

Thereafter, the surgeon again causes the distal end portion of the grasping forceps 60 to protrude from the overtube 10 and grasps the necrotic tissue Nt. Thereafter, the same operation is repeated until all the necrotic tissue Nt is removed. The aspiration of the necrotic tissue Nt may be performed every time the grasping forceps 60 is retracted, or may be performed every several retreats and aspirated collectively.

According to the medical system 1 of the present embodiment, the necrotic tissue Nt grasped by the grasping forceps 60 can be collected by moving it into the second lumen 30 and sucking it. Therefore, the operation of removing the necrotic tissue Nt can be continued while the overtube 10 and the endoscope 50 are fixed. That is, unlike the conventional procedure, it is not necessary to move the overtube or endoscope from the pancreas into the stomach every time the necrotic tissue is grasped. As a result, the work efficiency of necrosectomy and the like can be significantly improved.

Further, since the second lumen 30 for tissue recovery has the large-diameter portion 33, a large necrotic tissue or the like can be preferably recovered without clogging in the middle.
Furthermore, since the inner diameter dimension D1 of the large-diameter portion 33 is larger than the maximum opening width W1 of the grasping forceps 60, the grasping forceps 60 can be sufficiently opened in the large-diameter portion 33 to reliably release the grasped necrotic tissue or the like. it can. As a result, it is possible to prevent the grasped necrotic tissue or the like from moving again out of the overtube.

In addition, since the distal end portion of the second lumen 30 is the small diameter portion 31, the protruding position of the grasping forceps 60 is stable, and it is easy to perform a tissue removal procedure under observation with the endoscope 50. Further, since the small diameter portion 31 is present, a sufficient negative pressure can be generated in the second lumen 30 during suction.
Further, since the tapered portion 32 is provided between the small diameter portion 31 and the large diameter portion 33, the grasping forceps that have passed through the large diameter portion 33 can be smoothly moved to the small diameter portion 31.

Modification examples of the present embodiment are shown in FIGS. FIG. 8 is a view showing the tip of an overtube 10A according to a modification, in which the left side is a front view and the right side is a cross-sectional view taken along the line II-II of the front view. In the overtube 10 </ b> A, a seal member 35 having a slit 35 a is attached to the distal end opening of the second lumen 30. Since the sealing member 35 hermetically seals the distal end opening of the second lumen 30, it is possible to generate a negative pressure in the second lumen 30 at the time of suction.

Since the grasping forceps 60 can be easily advanced and retracted through the slit 35a, the operation of removing necrotic tissue or the like is not hindered. Further, even when the grasping forceps 60 is projected, the periphery of the grasping forceps 60 is sealed by the seal member 35. Accordingly, it is possible to concurrently perform suction and collection of necrotic tissue or the like in the second lumen 30 while removing new necrotic tissue or the like with the grasping forceps 60.
The material of the seal member 35 is preferably an elastic body such as rubber, sponge, or elastomer.

A gripping forceps 60 </ b> A of another modification shown in FIG. 9 includes a disc-shaped seal flange 65. The seal flange 65 is formed of the same elastic body as the seal member 35. The maximum outer diameter dimension D2 of the seal flange 65 is set to be equal to or larger than the inner diameter dimension of the small-diameter portion 31, and is formed in a tapered shape in which the outer diameter is gradually reduced on both sides in the axial direction. Since both sides in the axial direction are tapered, the gripping forceps 60A can be prevented from being caught when passing through the small diameter portion 31, and the seal flange 65 can be easily positioned at the small diameter portion.

When the grasping forceps 60A is protruded from the second lumen 30, the small-diameter portion 31 around the grasping forceps 60A is sealed by the seal flange 65 as shown in FIG. Accordingly, similarly to the above-described modified example in which the seal member 35 is provided, the inside of the second lumen 30 can be appropriately set to a negative pressure, and suction and recovery during the removal operation by the grasping forceps 60A is also possible.

A second embodiment of the present invention will be described with reference to FIGS. This embodiment is different from the first embodiment in the structure of the overtube. In the following description, components that are the same as those already described are assigned the same reference numerals and redundant description is omitted.

FIG. 11 is a front view of the main body 120 in the overtube 110 of the present embodiment, and FIG. 12 is a cross-sectional view taken along the line III-III in FIG.
In the second lumen 130 of the overtube 110, as shown in FIG. 11, the small diameter portion 131 and the large diameter portion 133 are arranged coaxially.

Furthermore, the overtube 110 includes a third lumen (water supply lumen) 135 for supplying water to the second lumen 130.
13 is a sectional view taken along line IV-IV in FIG. 12, and FIG. 14 is a sectional view taken along line VV in FIG. As shown in FIG. 13 and FIG. 14, the third lumen 135 extends from the proximal end side opening to the distal end side in a state of non-communication with the second lumen, and at the taper portion 132 via the communication hole 135 a, Communicate.
In the present embodiment, the water supply source 73 is directly connected to the third lumen 135 and is not connected to the suction mechanism 70.

The operation at the time of use of this embodiment is almost the same as that of the first embodiment. When necrotic tissue or the like released in the second lumen 130 is difficult to be sucked due to high viscosity or the like, the surgeon sends water from the water supply source 73 to the third lumen 135. Since water flows into the second lumen 130 from the communication hole 135a of the tapered portion 132 and facilitates the flow of necrotic tissue and the like, suction and recovery of the necrotic tissue and the like are facilitated.

Also in the medical system of this embodiment provided with the overtube 110, work efficiency, such as a necrosectomy, can be improved remarkably similarly to 1st embodiment.
In addition, since the third lumen 135 communicated with the second lumen 130 at the tapered portion 132 is provided, the water supplied from the water supply source 73 is supplied from the distal end side to the necrotic tissue or the like released by the large diameter portion 133. Can do. As a result, necrotic tissue or the like can be easily pushed toward the proximal end side, and suction and recovery can be assisted by water supply.

In the present embodiment, as in the modification shown in FIG. 15, communication holes 135 b and 135 c between the second lumen 130 and the third lumen 135 may be provided in places other than the tapered portion 132. If it does in this way, since it can feed water to the wider range of the inner surface of the 2nd lumen | rumen 130, sticking to the inner surface of a necrotic tissue etc. can be prevented suitably.
In addition, before removing the necrotic tissue or the like, the water supplied to the third lumen 135 may be discharged from the distal end opening of the second lumen 130, and the front of the endoscope 50 may be cleaned or general water supply may be performed. . Further, after the operation of removing necrotic tissue or the like, water or air may be supplied from a gap around the endoscope 50 in the first lumen 25.

The embodiments of the present invention have been described above. However, the technical scope of the present invention is not limited to the above-described embodiments, and the configurations shown in the embodiments and the modified examples are within the scope of the present invention. It is possible to change the combination of elements, add various changes to each component, or delete them.

For example, in the method for forming the second lumen, as in the modification shown in FIG. 16, first, the basic lumen 230 having the inner diameter dimension of the large diameter portion 33 is formed over the entire length, and the reduced diameter member 38 is formed on the distal end side of the lumen. The second lumen 30 </ b> A having the small diameter portion 31 and the tapered portion 32 may be formed. In this case, when a material made of a flexible material such as sponge is used as the diameter reducing member 38, a capture device such as a grasping forceps having a tip portion larger than the inner diameter of the small diameter portion 31 is deformed while the diameter reducing member 38 is deformed. Since it can project, the amount of necrotic tissue etc. that can be captured in one operation can be increased to further improve the working efficiency.
In the modification shown in FIG. 16, a seal member 35 having an outer diameter comparable to the inner diameter of the basic lumen 230 is attached in front of the reduced diameter member 38. Since the reduced diameter member 38 and the seal member 35 are not fixed, even if the reduced diameter member 38 is not completely restored to the original shape by the capturing device accommodated in the second lumen 30A, the seal member 35 is not in the second lumen. The tip opening of 30A can be closed. As a result, a negative pressure can be suitably generated in the second lumen 30A.

Also, as the grasping forceps inserted through the second lumen, a single-opening one in which only one of the jaws at the distal end portion can move may be used as in the grasping forceps 67 shown in FIG. In this case as well, the same effect can be obtained by setting the inner diameter dimension of the large-diameter portion 133 to be equal to or greater than the maximum opening width W2. In addition to the grasping forceps, a treatment instrument having a net-like or basket-like tip may be used as the capturing device.

Furthermore, in the overtube, the first lumen and the second lumen may not open at the same position in the longitudinal direction.
In the overtube 10 </ b> B of the modification shown in FIG. 18, the distal end opening 25 a of the first lumen 25 is provided on the proximal end side with respect to the distal end opening 30 a of the second lumen 30. In this manner, even when the tip opening 30a of the second lumen 30 is brought into contact with the tissue to suck liquid or the like, it can be performed while preferably observing with the endoscope 50.

In addition, it is not essential to have flexibility in the overtube of the present invention. For example, when inserting into a body cavity such as the abdominal cavity or chest cavity via a trocar, etc., it is possible to form the main body part from a hard material and to make a rigid overtube in which only the active bending part can be bent. is there.
As an example of the procedure in the body cavity, for example, in laparoscopic uterine fibroid enucleation, collection and removal of a tissue piece scattered in the abdominal cavity after using a molcerator can be mentioned.

The present invention can be suitably applied to a procedure for removing a body tissue or the like.

1

Medical System

10, 10A, 10B, 110

Medical Overtube

20, 120

Main Body

30, 130 Second Lumen (Recovery Lumen)
31, 131

Small diameter portion

32, 132

Taper portion

33, 133

Large diameter portion

60, 60A, 67 Gripping forceps (capturing device)
70 Suction mechanism 135 Third lumen (water supply lumen)
D1 Inner diameter W1, W2 Maximum opening width

Claims

A medical overtube comprising a tubular body,
The main body has a recovery lumen through which a capture device for capturing biological tissue is inserted;
The recovery lumen is
A small diameter part on the tip side,
A large diameter portion having a larger inner diameter than the small diameter portion,
Medical overtube.
The recovery lumen further includes a tapered portion that connects the small-diameter portion and the large-diameter portion, and is formed so as to be reduced in diameter as it approaches the small-diameter portion.
The medical overtube according to claim 1.
The main body further has a water supply lumen extending along the recovery lumen;
The water supply lumen and the recovery lumen communicate with each other at the tapered portion.
The medical overtube according to claim 2.
The medical overtube according to any one of claims 1 to 3,
A capture device inserted through the recovery lumen;
A medical system comprising:
The inner diameter dimension of the large diameter portion is not less than the maximum opening width of the capturing device tip,
The medical system according to claim 4.
A suction mechanism connected to the proximal end of the recovery lumen;
The medical system according to claim 4.