Medical treatment method and apparatus

• US 20030135091A1
• Filed: 12/31/2002
• Published: 07/17/2003
• Est. Priority Date: 01/11/2002
• Status: Active Grant

• Current Assignee: Olympus Corporation
• Original Assignee: Olympus Corporation
• Inventors: Yabe, Hisao, Yamaya, Koji, Furukawa, Tatsuya, Nakazawa, Masaaki, Nakamura, Toshio, Matsuura, Nobuyuki, Kimura, Hidenobu
• Granted Patent: US 6,991,602 B2
• Time in Patent Office: Days
• US Class Current: 600/113
• CPC Class Codes: A61B 1/00073 with externally grooved shaft
• CPC Class Codes: A61B 1/0014 Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
• CPC Class Codes: A61B 1/00149 using articulated arms
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/01 Guiding arrangements therefore
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/31 for the rectum, e.g. proctoscopes, sigmoidoscopes , colonoscopes
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• CPC Class Codes: A61B 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 2017/00269 endoscopic mucosal resection EMR
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2018/1407 Loop
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

A medical treatment method comprises orally inserting a first endoscope having a first treatment tool provided thereto into a body cavity, inserting a first insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity, inserting a second endoscope having a second treatment tool provided thereto into the body cavity through the first insertion member insertion support tool, grasping a lesioned part by the second treatment tool inserted into the body cavity by the second endoscope, cutting the lesioned part by the first treatment tool inserted into the body cavity by the first endoscope, and collecting the lesioned part.

Claims

1. A medical treatment method comprising:

orally inserting a first endoscope having a first treatment tool provided thereto into a body cavity;

inserting a first insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting a second endoscope having a second treatment tool provided thereto into the body cavity through the first insertion member insertion support tool;

grasping a lesioned part by the second treatment tool inserted into the body cavity by the second endoscope;

cutting the lesioned part by the first treatment tool inserted into the body cavity by the first endoscope; and

removing the lesioned part.

2. The medical treatment method according to claim 1, wherein the second endoscope is inserted into the body cavity while supplying air into the body cavity from between the first insertion member insertion support tool and the second endoscope.

3. The medical treatment method according to claim 2, further comprising:

detecting sliding of the second endoscope with respect to the first insertion member insertion support tool; and

controlling air supply and stop of air supply into the body cavity in accordance with the detected sliding of the second endoscope.

4. The medical treatment method according to claim 1, further comprising supplying air into the body cavity through the first insertion member insertion support tool.

5. The medical treatment method according to claim 1, further comprising:

inserting a third treatment tool into the body cavity through the first insertion member insertion support tool; and

grasping the lesioned part by the third treatment tool.

6. The medical treatment method according to claim 5, further comprising leading the first endoscope toward the lesioned part by the third treatment tool.

7. The medical treatment method according to claim 4, further comprising leading an end portion of the second endoscope toward the lesioned part by the first endoscope.

8. The medical treatment method according to claim 7, wherein the operation to lead the end portion of the second endoscope toward the lesioned part further includes an operation to grasp a grasping portion provided at the end portion of the second endoscope by the first treatment tool.

9. The medical treatment method according to claim 1, further comprising:

inserting the second insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting the third treatment tool into the body cavity through the second insertion member insertion support tool; and

grasping the lesioned part by the third treatment tool.

10. The medical treatment method according to claim 9, wherein the third treatment tool is inserted into the body cavity through a treatment tube having a plurality of lumens provided in an inner hole of the second insertion member insertion support tool.

11. The medical treatment method according to claim 1, further comprising:

inserting the second insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting a third endoscope having a third treatment tool provided thereto into the body cavity by the second insertion member insertion support tool; and

grasping the lesioned part by the third treatment tool.

12. The medical treatment method according to claim 1, further comprising discharging accumulated matter in the body cavity to the outside of the body.

13. The medical treatment method according to claim 12, wherein an aspirator, which discharges the accumulated matter to the outside of the body, is inserted from at least one of abdominal and transdermal cavities into the body cavity by the inserted second insertion member insertion support tool.

14. A medical treatment method comprising:

orally inserting a first endoscope having a first treatment tool provided thereto into a body cavity;

inserting an insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting a tubular member into the body cavity through an inner hole of the insertion member insertion support tool;

inserting a second treatment tool having a polyarticular arm and a second endoscope into the body cavity through an inner hole of the tubular member;

grasping a lesioned part by the second treatment tool inserted into the body cavity by the tubular member;

cutting the lesioned part by the first treatment tool inserted into the body cavity by the first endoscope; and

removing the lesioned part.

15. A medical treatment method comprising:

orally inserting a first endoscope into a body cavity;

inserting an insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting a cover tube into the body cavity through an inner hole of the insertion member insertion support tool;

inserting a treatment tool and a second endoscope into the body cavity through an inner hole of the cover tube;

bringing an end portion of the cover tube into contact with the circumference of a lesioned part;

sucking the lesioned part by a suction apparatus connected to the cover tube;

cutting a lesioned part by the treatment tool; and

removing the lesioned part.

16. A medical treatment method comprising:

orally inserting a first endoscope having a first treatment tool provided thereto into a body cavity;

inserting from at least one of abdominal and transdermal cavities into the body cavity an insertion member insertion support tool having a leading portion which leads to a lesioned part;

providing a second treatment tool and inserting into the body cavity a second endoscope which is led to an abdominal side where the lesioned part exists by the insertion member insertion support tool;

grasping the lesioned part by the second treatment tool inserted into the body cavity by the second endoscope;

cutting the lesioned part by the first treatment tool inserted into the body cavity by the first endoscope; and

removing the lesioned part.

17. A medical treatment method comprising:

orally inserting a first endoscope having a first treatment tool provided thereto into a body cavity;

inserting a first insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting a second insertion member insertion support tool from at least one of abdominal and transdermal cavities into the body cavity;

inserting a second endoscope having a second treatment tool provided thereto into the body cavity by the first insertion member insertion support tool;

grasping a lesioned part by the second treatment tool inserted into the body cavity by the second endoscope;

leading to the lesioned part a third treatment tool inserted into the body cavity by the second insertion member insertion support tool by the first treatment tool inserted into the body cavity by the first endoscope;

grasping the lesioned part by the third treatment tool;

cutting the lesioned part by a fourth treatment tool inserted into the body cavity by the first endoscope; and

removing the lesioned part.

18. The medical treatment method according to claim 17, wherein the third treatment tool is fixed to the second insertion portion insertion support tool after grasping the lesioned part by the third treatment tool.

19. The medical treatment method according to claim 17, wherein the first endoscope has a plurality of treatment tool channels.

20. A fluid control apparatus for an insertion member insertion support tool, comprising:

a main body having a hole through which an insertion member is inserted into a body cavity, an inside diameter of the hole being larger than an outside diameter of the insertion member, a seal member which seals a gap formed between the insertion member and the hole with the insertion member being inserted, and closes the body cavity and a duct communicating with the hole;

a fluid supply mechanism which supplies a fluid to the duct; and

a control mechanism which controls a quantity of fluid supplied to the duct by the fluid supply mechanism and controls a frictional force between the insertion member and the hole.

21. The fluid control apparatus according to claim 20, wherein the control mechanism includes, between the fluid lead-in duct and the fluid supply mechanism, a pressure detection mechanism that detects a pressure in an organ, and an operation control mechanism that controls an operation of the fluid supply mechanism by the pressure detected by the pressure detection mechanism.

22. The fluid control apparatus according to claim 20, wherein an insertion member insertion support tool which connects the inside of the organ and the outside of the body with at least one of abdominal and transdermal cavities is provided between the main body and the organ, and the main body is connected to the insertion member insertion support tool.

23. A fluid control apparatus for an insertion member insertion support tool which inserts at least one of an endoscope and a treatment tool from at least one of abdominal and transdermal cavities into an organ, comprising:

a main body which is caused to communicate with the inside of an organ and includes a through hole having a larger diameter than an outside diameter of the endoscope and an insertion portion of the treatment tool, a seal member which receives the insertion portion in the through hole and seals the atmosphere in the organ, and an air lead-in duct which communicates with the through hole; and

an air supply pump which supplies air to the air lead-in duct between the insertion portion and the through hole and inflates the organ by reducing a coefficient of friction between the insertion portion and the through hole and causing the air to flow into the organ.

24. The fluid control apparatus according to claim 23, further comprising, between the air lead-in duct and the air supply pump, a pressure control valve having a pressure detection mechanism which detects a pressure in the organ and an operation control mechanism which controls an operation of the air supply pump by the detected pressure.

25. The fluid control apparatus according to claim 23, further comprising, between the main body and the organ, an insertion member insertion support tool that connects the inside of the organ and the outside of the body with at least one of abdominal and transdermal cavities, the main body being connected to the insertion member insertion support tool.

26. A fluid control apparatus for an insertion member insertion support tool of an insertion member having an elongated insertion portion which is inserted from at least one of abdominal and transdermal cavities into an organ, comprising:

a main body which communicates with the inside of an organ and includes a through hole having a larger diameter than an outside diameter of the insertion portion, a seal member which receives the insertion portion in the through hole and seals the inside of the organ, and a fluid lead-in duct which communicates with the through hole; and

a fluid feed mechanism which causes a fluid to flow through the fluid lead-in duct and lowers a coefficient of friction between the insertion portion and the through hole by causing the fluid to flow between the insertion portion and the through hole.

27. The fluid control apparatus according to claim 26, further comprising, between the fluid lead-in duct and the fluid supply mechanism, a pressure control mechanism having a pressure detection mechanism which detects a pressure in the organ and an operation control mechanism which controls an operation of the fluid supply mechanism.

28. The fluid control apparatus according to claim 26, further comprising an insertion member insertion support tool which is provided between the main body and the organ, connects the inside of the organ and the outside of the body with at least one of abdominal and transdermal cavities, and is connected to the main body.

29. The fluid control apparatus according to claim 27, further comprising an insertion member insertion support tool which is provided between the main body and the organ, and which connects the inside of the organ and the outside of the body with at least one of abdominal and transdermal cavities, and is connected to the main body.

30. A medical treatment apparatus capable of giving a treatment to a lesioned part in an organ, comprising:

a first flexible endoscope having an insertion portion which is orally inserted into the organ; and

a second flexible endoscope which has an insertion portion which is inserted from at least one of abdominal and transdermal cavities into the organ and gives a medical treatment to the lesioned part in cooperation with the first flexible endoscope.

31. The medical treatment apparatus according to claim 30, further comprising a third flexible endoscope which has an insertion portion which is inserted from at least one of abdominal and transdermal cavities into the organ and gives a medical treatment to the lesioned part in cooperation with the first and second flexible endoscope.

32. The medical treatment apparatus according to claim 30, wherein an observation optical system is eliminated from the insertion portion of the second flexible endoscope.

33. The medical treatment apparatus according to claim 31, wherein an observation optical system is eliminated from the insertion portion of the second flexible endoscope.

34. The medical treatment apparatus according to claim 30, wherein the organ is a stomach.

35. The medical treatment apparatus according to claim 34, wherein there is provided a first insertion member insertion support tool which connects the inside of the stomach and the outside of the living body with at lest one of abdominal and transdermal cavities.

36. The medical treatment apparatus according to claim 35, wherein a catheter that the second flexible endoscope is inserted into the stomach through an inner hole of the catheter is provided to the first insertion member insertion support tool.

37. The medical treatment apparatus according to claim 36, wherein the catheter is formed of any of a chloroethene material, a PTFE-based material and a silicon material.

38. The medical treatment apparatus according to claim 37, wherein a treatment tool is provided in the catheter of the first insertion member insertion support tool.

39. The medical treatment apparatus according to claim 38, wherein there is provided a holding portion which is provided so as to protrude from the insertion portion of the second flexible endoscope and holds the treatment tool.

40. The medical treatment apparatus according to claim 35, wherein there is provided a second insertion member insertion support tool which causes the inside of the organ to communicate with the outside of the living body with at least one of abdominal and transdermal cavities and is provided at a position different from that of the first insertion member insertion support tool.

41. The medical treatment apparatus according to claim 40, wherein a catheter that at least one of the third flexible endoscope and the treatment tool is inserted into the stomach through an inner hole of the catheter is provided to the second insertion member insertion support tool.

42. The medical treatment apparatus according to claim 41, wherein at least one of the third flexible endoscope and the vicinity of an end of the insertion portion of the treatment tool includes at least one grasping portion which is held by a treatment tool provided to the first flexible endoscope.

43. The medical treatment apparatus according to claim 41, wherein the treatment tool includes at least two polyarticular arms, grasping portions provided at end portions of the polyarticular arms, and an operation portion which operates the polyarticular arms and the grasping portions.

44. The medical treatment apparatus according to claim 36, wherein an opening of at least one of the insertion portion of the second flexible endoscope and the treatment tool includes a seal member which seals the inside of the organ at an end portion of the catheter outside the body.

45. The medical treatment apparatus according to claim 44, wherein an air supply path is caused to communicate with a lead-in duct of at least one of the flexible endoscope and the treatment tool at the end portion of the catheter outside the body, and an insertion member insertion support tool having a seal member is detachably provided on the front side.

46. The medical treatment apparatus according to claim 36, further comprising a holding mechanism which is inserted into the stomach through the catheter and can hold the first flexible endoscope.

47. The medical treatment apparatus according to claim 45, further comprising a holding mechanism which is inserted into the organ through the catheter and can hold the first flexible endoscope.

48. The medical treatment apparatus according to claim 30, wherein at least one of the first and second flexible endoscopes includes a first curved portion which is bent in two directions and a second flexible portion which is bent in at least two directions.

49. The medical treatment apparatus according to claim 30, wherein a direction identification label which is observed by the first flexible endoscope and lead the curved portions of the second flexible endoscope to a desired direction is provided on an outer surface in the vicinity of the end portion of the insertion portion of the second flexible endoscope.

50. The medical treatment apparatus according to claim 30, wherein the insertion portion of at least one of the first and second flexible endoscopes has a treatment tool which protrudes from the end of the insertion portion and whose end is bent.

51. The medical treatment apparatus according to claim 50, wherein a direction identification label which is observed by the first flexible endoscope and lead the curved portion of the second treatment tool to a desired direction is provided on the outer surface in the vicinity of the end portion of the insertion portion of the treatment tool.

52. A medical treatment apparatus capable of giving a medical treatment to a lesioned part in an organ, comprising:

a first endoscope having a flexible insertion portion which is orally inserted into an organ in a living body;

at least one insertion member having an insertion portion which is inserted from at least one of abdominal and transdermal cavities into the organ; and

at least one second endoscope which has a flexible insertion portion which is inserted from at least one of abdominal and transdermal cavities into the organ and gives a medical treatment to a lesioned part in the organ in cooperation with the first endoscope and the insertion member.

53. The medical treatment apparatus according to claim 52, wherein the insertion member is formed of any of an endoscope having a flexible insertion portion, a treatment tool having a flexible insertion portion and a treatment tool having a rigid insertion portion.

54. The medical treatment apparatus according to claim 52, wherein a treatment tool which gives a medical treatment to the lesioned part along the insertion portion is provided to at least one of the first and second endoscopes.

55. A medical treatment method for a lesioned part existing in an organ of a living body, comprising:

orally inserting an insertion portion of a first flexible endoscope which is inserted into an organ;

inserting an insertion portion of a second flexible endoscope which is inserted from at least one of abdominal and transdermal cavities into the organ; and

giving a medical treatment to a lesioned part in the organ in cooperation with the first and second flexible endoscopes.

56. The medical treatment method according to claim 55, wherein an insertion portion of a first flexible endoscope is inserted from at least one of abdominal and transdermal cavities into the organ.

57. The medical treatment method according to claim 55, wherein a medical treatment is given to the inside of the organ by endoscopic mucosal resection (EMR).

58. The medical treatment method according to claim 56, wherein a medical treatment is given to the inside of the organ by endoscopic mucosal resection.

59. The medical treatment method according to claim 55, wherein the lesioned part is lifted up by the second flexible endoscope and the lesioned part is cut by the first flexible endoscope.

60. The medical treatment method according to claim 55, wherein the lesioned part is lifted up by the second and third flexible endoscopes, and the lesioned part is cut by the first flexible endoscope.

61. The medical treatment method according to claim 55, wherein the second flexible endoscope, an observation optical system of which has been eliminated from an insertion portion thereof, is led to a desired position by the first flexible endoscope.

62. The medical treatment method according to claim 55, wherein the organ is a stomach.

63. The medical treatment method according to claim 62, wherein the second flexible endoscope is inserted through a first insertion member insertion support tool which connects the stomach and the outside of the body.

64. The medical treatment method according to claim 63, wherein the first insertion member insertion support tool is formed by percutaneous endoscopic gastrostomy (PEG).

65. The medical treatment method according to claim 64, wherein a catheter is set in an inner hole of the first insertion member insertion support tool and the second flexible endoscope is inserted through this catheter.

66. The medical treatment method according to claim 64, wherein a treatment tool is inserted through a second insertion member insertion support tool provided at a position different from that of the first insertion member insertion support tool.

67. The medical treatment method according to claim 55, wherein the first flexible endoscope orally inserted into the organ is used to observe the lesioned part, and

a medical treatment is given by a plurality of flexible endoscopes which are inserted from at least one of abdominal and transdermal cavities.

68. The medical treatment method according to claim 56, wherein the first flexible endoscope orally inserted into the organ is used to observe the lesioned part, and

a medical treatment is given by a plurality of flexible endoscopes which are inserted from at least one of abdominal and transdermal cavities.