JP2009125344A - High frequency snare device for endoscope, high frequency snare for endoscope and its drive unit - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To improve operability for performing coagulation hemostasis relating to a high frequency snare device for an endoscope, a high frequency snare for an endoscope and its drive unit. <P>SOLUTION: The high frequency snare includes a sheath 15, an operation wire 16 inserted into the through-hole 15a of the sheath 15, a snare loop 17 provided on the distal end of the operation wire 16, an electrode 18 for hemostasis attached to the distal end of the snare loop 17, a hand operation part for operating the snare loop 17 through the operation wire 16, and a pressure sensor 24 attached to the distal end part of the sheath 15. When performing the hemostasis on a bleeding site, by the operation of the hand operation part, the hand operation part is operated and the operation wire 16 is pulled. By the pulling, the electrode 18 for the hemostasis is abutted on the distal end of the sheath 15. When the electrode 18 for the hemostasis is abutted on the distal end of the sheath 15, contact detection signals are output from the pressure sensor 24 to a current switching part. In response to the contact detection signals, the current switching part switches to a high frequency current for the hemostasis. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an endoscopic high-frequency snare device, an endoscopic high-frequency snare device, and a driving device for the endoscopic high-frequency snare device that are inserted into a subject through a transendoscope and excise a raised lesion by energizing a high-frequency current.

  In a medical examination using an electronic endoscope, various treatments such as collection and excision of a living tissue are performed using an endoscope treatment tool. As an endoscope treatment tool, for example, a high-frequency snare for excising a raised lesion (so-called polyp) is known. The high-frequency snare includes a sheath that is inserted into the forceps channel of the electronic endoscope, a snare loop provided at the distal end of the sheath, and a hand operation unit provided at the proximal end of the sheath.

  When excising a raised lesion using a high-frequency snare, first, the operator manipulated the hand manipulator and pushed the maneuver inserted through the sheath toward the tip, thereby being connected to the tip of the maneuver. The snare loop is pushed out from the tip of the sheath and inflated in a loop shape, and the raised lesion is surrounded by the snare loop. Next, by operating the hand operation unit again and pulling the operation wire to the proximal end, the snare loop is drawn into the distal end of the sheath, and the raised lesion is bound by the snare loop. In this state, a high-frequency current is applied to the snare loop to remove the raised lesion.

  After removing the raised lesion, it is necessary to immediately stop bleeding from the excised part. Conventionally, when hemostasis is performed, a high-frequency snare is pulled out from the forceps channel, and a hemostatic treatment tool (hemostatic forceps) different from the high-frequency snare is inserted into the forceps channel. For this reason, it took time and effort to pull out and insert the treatment tool, and in some cases, the amount of bleeding was increased, and the patient was burdened.

In order to solve this problem, there are two types: a snare loop that can be projected and retracted from the distal end of the sheath, and a sleeve-shaped coagulation and hemostasis electrode that is formed so as to cover the outer peripheral surface inserted from the distal end of the sheath A high-frequency snare provided with these electrodes has been proposed (Patent Document 1). According to this, since excision and hemostasis can be performed with one high-frequency snare, there is no need to replace the treatment tool. Further, in this high-frequency snare, the coagulation hemostasis electrode is shifted from the distal end of the sheath to the proximal end side, and an insulating portion for preventing a short circuit between the snare loop and the coagulation hemostasis electrode is provided at the sheath distal end. Is formed. In addition, a separate connection terminal is prepared for the snare loop and the coagulation hemostasis electrode, and after switching the raised lesion with the snare loop, the terminal is replaced to switch to the coagulation hemostasis electrode.
JP 05-337130 A

  In the invention described in Patent Document 1, when switching from the snare loop to the electrode for coagulation and hemostasis, the terminal has to be exchanged, which is troublesome. In addition, since it relies on the manual operation of the surgeon, the terminal may be mistaken or the replacement of the terminal may be forgotten, which may cause a serious medical error.

  The present invention has been made in view of the above problems, and provides an endoscopic high-frequency snare device, an endoscopic high-frequency snare device, and a driving device thereof that can improve operability when performing coagulation hemostasis. For the purpose.

  In order to achieve the above object, the present invention provides an endoscopic high-frequency snare inserted through a forceps channel of an endoscope, and a driving device that is driven by energizing the high-frequency snare for endoscope. In the high-frequency mirror snare device, the endoscopic high-frequency snare bulges from the distal end of the sheath so that it swells in a loop when pushed out from the distal end of the sheath and squeezes when pulled into the sheath from the distal end. A snare loop for ablating excision of a raised lesion by energization of a first high-frequency current, and a snare loop provided at the tip of the snare loop, and when the snare loop is drawn into the sheath The second high-frequency current is energized after the excision of the raised lesion by the snare loop is configured to contact the distal end of the sheath and to be positioned immediately before the sheath. A coagulation hemostasis electrode for coagulation and hemostasis bleeding after resection of the raised lesion, and a detection means for detecting whether or not the coagulation hemostasis electrode is immediately before the sheath tip, The drive device supplies the first and second currents to the snare loop and the coagulation hemostasis electrode, and the first and second high frequency currents according to the detection result of the detection means. And switching means for switching between.

  It is preferable that the detection means is a contact pressure detection sensor that detects a pressure when the electrode for coagulation and hemostasis contacts the distal end of the sheath. It is preferable that the detection means is a pull-in amount detection sensor that detects a pull-in amount of the snare loop into the sheath. The endoscopic high-frequency snare has an operation wire inserted into the sheath and provided at a proximal end portion of the snare loop, and the operation wire has a mark when the hemostasis electrode contacts the sheath. It is preferable that the mark is a mark detection sensor for detecting the mark of the operation wire. The endoscopic high-frequency snare has a hand operation part for pushing or pulling the snare loop out of the sheath, and the hand operation part includes a main body shaft attached to a proximal end portion of the sheath, and the main body shaft And a slider that is slidable with respect to the main body shaft, and the detection means is provided on the main body shaft, and contacts the slider when the coagulation hemostasis electrode contacts the tip of the sheath. It is preferable that the microswitch is in contact. The detection means is preferably a contact current detection sensor that detects a current when the coagulation hemostasis electrode contacts a bleeding site.

  The endoscopic high-frequency snare preferably satisfies D> d, where d is the inner diameter of the sheath and D is the size of the coagulation hemostasis electrode. The coagulation hemostasis electrode preferably has a cylindrical shape. The coagulation hemostasis electrode preferably has a tapered shape.

  The snare loop and the coagulation hemostasis electrode are preferably bipolar. Preferably, the coagulation hemostasis electrode is divided into bipolar by an insulator, and a wiring through which the second high-frequency current flows is connected to each pole. The snare loop and the coagulation hemostasis electrode are preferably monopolar.

  The endoscope high-frequency snare according to the present invention has a sheath inserted into the forceps channel of the endoscope, and expands in a loop shape when pushed out from the distal end of the sheath, and squeezes when pulled into the sheath from the distal end. The snare loop is provided so as to be able to protrude from the distal end of the sheath, and is disposed at the distal end of the snare loop for ablating and excising a raised lesion by energization of the first high-frequency current, and the snare loop is When drawn into the sheath, it is configured to be in contact with and immediately before the distal end of the sheath, and when the second high-frequency current is energized after excision of the raised lesion by the snare loop, A coagulation hemostasis electrode for coagulation and hemostasis of bleeding after excision of a raised lesion, and detection for detecting whether or not the coagulation hemostasis electrode is located immediately before the distal end of the sheath Characterized in that it comprises a stage.

  The endoscope high-frequency snare driving device of the present invention is connected to the endoscope high-frequency snare of the present invention described above, and the first and second high-frequency currents are applied to the snare loop and the coagulation hemostasis electrode. An endoscope high-frequency snare drive device comprising: a high-frequency power supply to be supplied; and a switching unit that switches between the first and second high-frequency currents according to a detection result of the detection unit.

  According to the present invention, when the hemostasis electrode for hemostasis detects that the distal end portion of the sheath is in contact, the first high-frequency current for excising the raised lesion is changed to the second high-frequency current for hemostasis. By switching, it is possible to save the trouble of replacing the terminals as in the prior art and prevent medical errors due to erroneous operations. Thereby, the operativity at the time of performing coagulation hemostasis can be improved.

  As shown in FIG. 1, the high-frequency snare 10 of the present invention is inserted into a body cavity of a patient P together with an endoscope 11 to excise an affected area such as a tumor (raised lesion) or to stop hemostasis after the affected area is excised. Used to do. The high-frequency snare 10 is provided at the sheath 15 inserted into the forceps channel 11 a of the endoscope 11, the operation wire 16 inserted through the through hole 15 a (see FIG. 2) in the sheath 15, and the distal end of the operation wire 16. A snare loop 17, a hemostatic electrode 18 attached to the tip of the snare loop 17, a hand operating section 19 for operating the snare loop 17 via the operating wire 16, an operating wire 16 and a high frequency power source 20. And a connection cord 21 to be connected. The snare loop 17 is formed of a conductive wire and functions as an electrode for excision of the affected area. The high-frequency snare 10 is used together with a counter electrode plate 22, and this counter electrode plate 22 is attached in the vicinity of the position of the affected part of the patient P. The counter electrode plate 22 is connected to the high frequency power supply 20 by a connection cord 23.

  The high frequency power supply 20 includes a snare connection portion 20a to which the connection cord 21 of the high frequency snare 10 is connected, and a counter electrode plate connection portion 20b to which the connection cord 23 of the counter electrode plate 22 is connected. The high-frequency current of the high-frequency power supply 20 is a switching current that alternately turns on and off the power supply. The switching current includes a high-frequency current for excision of a low-voltage affected part whose ON time is 100%, and ON There is a high voltage high frequency current for hemostasis with a time of 6% and an OFF time of 94%. Switching between the high frequency current for excision of the affected part and the high frequency current for hemostasis is performed by the current switching unit 26 in the high frequency power supply 20. The high frequency power supply 20 is connected to a foot switch 27 for flowing a high frequency current to the snare loop 17 and the hemostasis electrode 18. The ratio of the ON and OFF times in the high frequency current for excision of the affected area and the high frequency current for hemostasis need not be limited to the above percentage.

  The operation wire 16 is a conductive wire and sends a high-frequency current from the high-frequency power source 20 to the snare loop 17 and the hemostasis electrode 18. The snare loop 17 is also formed of a conductive wire and is used as a conducting wire for the hemostatic electrode 18. For this reason, there is no need to provide separate wires for each of the snare loop 17 and the hemostasis electrode 18, so that the wire passing through the sheath 15 is compared with the conventional example in which the hemostasis electrode is provided at the distal end of the sheath. The number is small, which is advantageous when the sheath is made thin.

  The high-frequency current flows through the human body of the patient P between the snare loop 17 and the hemostatic electrode 18 and the counter electrode plate 22 to generate a microwave. The affected part is dielectrically heated by this microwave, and excision and hemostasis are performed.

  As shown in FIG. 2A, when the operation wire 16 is pushed out from the through hole 15a of the sheath 15 by the operation of the hand operation unit 19, the snare loop 17 swells in a loop shape due to its own elasticity. Further, as shown in FIG. 2B, the snare loop 17 is housed in the through hole 15a while being narrowed when the operation wire 16 is pulled into the sheath 15 by the operation of the hand operation unit 19. The hemostasis electrode 18 advances and retreats along the axial direction of the sheath 15 as the snare loop 17 advances and retreats.

  As shown in FIG. 3, the hemostatic electrode 18 has, for example, a substantially cylindrical shape, and the corners are rounded so that the inner wall of the digestive tract is not inadvertently damaged. As shown in FIG. 2A, the outer diameter D of the hemostatic electrode 18 is formed larger than the inner diameter d of the through hole 15a of the sheath 15. In this way, when the hemostasis electrode 18 retracts toward the distal end of the sheath 15 as the snare loop 17 is retracted, the rear end surface of the hemostasis electrode 18 comes into contact with the distal end of the sheath 15, The hemostatic electrode 18 stops at the immediately preceding position. As long as the operation wire 16 is pulled, the hemostatic electrode 18 is pulled backward, so that the contact state with the tip of the sheath 15 is maintained, and the position and posture of the hemostatic electrode 18 are stabilized.

  If the outer diameter D of the hemostasis electrode 18 is smaller than the inner diameter d of the through-hole 15a, not only the hemostasis electrode 18 may be immersed in the sheath 15 but also the contact state with the sheath 15 is difficult to maintain. . If the hemostatic electrode 18 is not supported by contact with the sheath 15, the hemostasis electrode 18 hangs down near the distal end of the sheath 15, and the position and posture are not stable. The position of the hemostasis electrode 18 is adjusted by a technique and applied to a bleeding site that requires hemostasis. Therefore, if the position and posture are not stable, the position adjustment by the technique is difficult. By making the outer diameter D larger than the inner diameter d, the contact state between the hemostatic electrode 18 and the distal end of the sheath 15 can be easily maintained, and the position and posture of the hemostatic electrode 18 are stabilized. Improved operability.

  As shown in FIG. 2, the pressure sensor 24 is attached to the distal end portion of the sheath 15, and detects the contact pressure when the hemostatic electrode 18 contacts the distal end of the sheath 15. Further, the wiring (not shown) of the pressure sensor is fixed to the inner wall of the sheath 15, and this wiring is connected to the high frequency power supply 20 via the connection cord 21. When the pressure sensor 24 detects the contact pressure of the hemostatic electrode 18, the pressure sensor 24 transmits a contact detection signal to the high frequency power supply 20. The current switching unit 26 of the high frequency power supply 20 switches the current of the high frequency power supply 20 to a high frequency current for hemostasis in response to the contact detection signal from the pressure sensor 24.

  The position of the hemostatic electrode from the time of excision of the affected area to the time of subsequent hemostasis changes as follows. The excision of the affected part is performed while the snare loop 17 is drawn into the sheath 15, and the hemostatic electrode 18 is retracted toward the distal end of the sheath 15 along with this drawing. During excision of the affected area, the snare loop 17 surrounds the affected area, so that the hemostatic electrode 18 and the tip of the sheath 15 do not contact each other. When the affected part is excised, the snare loop 17 is drawn into the sheath 15, and the hemostasis electrode 18 is retracted by the momentum to come into contact with the distal end of the sheath 15, and hemostasis is performed in this state.

  In this way, the position of the hemostatic electrode 18 changes between the excision of the affected part and the hemostasis, but the position of the hemostatic electrode 18 is detected by the pressure sensor 24, and the high frequency current for hemostasis is automatically detected according to the position detection. Can be switched automatically. Conventionally, since switching of the high-frequency current is entrusted to the operator's operation such as switching by foot pedal operation, there has been a concern that switching of the high-frequency current may be forgotten. In response, automatic switching of the high-frequency current eliminates such concerns. In addition, it is possible to prevent selection mistakes such as a high frequency current for hemostasis flowing during the excision of the affected part by mistaken operation and a high frequency current for excision of the affected part during the hemostasis. Furthermore, the automatic switching allows the operator to smoothly shift from the excision procedure to the hemostasis procedure without being aware of the switching of the high-frequency current, and can concentrate on the procedure.

  Next, the operation procedure of the procedure using the high frequency snare will be described. First, the inside of the body cavity of the patient P is observed with the endoscope 11, and when an affected part such as a lesion or a foreign body is found during the observation, the high-frequency snare 10 is inserted into the forceps channel 11a of the endoscope 11, The sheath 15 is protruded from the distal end portion of the endoscope 11. When the high-frequency snare 10 is inserted, the snare loop 17 is housed in the through hole 15a of the sheath 15 so that the snare loop 17 is not caught inside the forceps channel 11a.

  When the distal end of the sheath 15 reaches the vicinity of the affected area, the snare loop 17 is pushed out from the distal end of the sheath 15 and is expanded in a substantially elliptical shape. Then, as shown in FIG. 4, after surrounding the affected area 30 with the snare loop 17 swelled in a substantially elliptical shape, the operation wire 16 is drawn into the sheath 15, and the affected area 30 is tightened with the snare loop 17 and the hemostatic electrode 18. . In this state, the operator steps on the foot switch 27. As a result, as shown in FIG. 5, the high frequency current for excision of the affected area flows through the snare loop 17 and the hemostatic electrode 18, and the affected area 30 is excised.

  At the time of excision of the affected part, since the operation wire 16 is pulled, when the affected part 30 is excised, the snare loop 17 is drawn into the sheath 15 with the momentum. Along with this, the hemostatic electrode 18 also moves backward toward the distal end of the sheath 15 and stops when it comes into contact with the distal end. When the hemostatic electrode 18 comes into contact with the tip of the sheath 15, a contact detection signal is transmitted from the pressure sensor 24 to the high frequency power supply 20. In response to the contact detection signal, the current switching unit 26 switches to a high frequency current for hemostasis.

  After removing the affected part, as shown in FIG. 6, the position of the sheath 15 is adjusted by a procedure in order to apply the hemostatic electrode 18 to the bleeding site 32. Since the position and posture of the hemostatic electrode 18 are stable due to contact with the sheath 15, it is easy to adjust the position by a technique. Further, the hemostasis electrode 18 stops immediately before the distal end of the sheath 15 immediately after excision of the affected area, and therefore is located in the vicinity of the position immediately above the bleeding site 32. This position is closer to the bleeding site 32 as compared to the conventional example in which a hemostatic electrode is provided at the sheath tip. Therefore, the position adjustment amount for applying the hemostatic electrode 18 to the bleeding site 32 is small, and the operability is improved as compared with the conventional case. When the hemostasis electrode 18 comes into contact with the bleeding site 32, the operator steps on the foot switch 27 to flow a hemostasis high-frequency current to the hemostasis electrode 18. As a result, the bleeding site 32 is coagulated and stopped.

  In the present embodiment, a switching current is used as the high-frequency current of the high-frequency power source. A high-frequency current that is continuously turned ON is supplied when the affected part is excised, and a high-frequency current that is repeatedly turned ON is supplied when hemostasis is performed. There is no need. For example, the current value of the high-frequency current may be different between the excision of the affected part and the hemostasis.

  In the present embodiment, a monopolar high-frequency snare using a counter electrode plate is used as the high-frequency snare. However, the present invention is not limited to this, and a bipolar high-frequency snare that does not use a counter electrode plate may be used. In this case, as shown in FIG. 7, the operation wire 16 is composed of a pair of conductive wires 16a and 16b, one base end portion 17a of the snare loop 17 is used as the operation wire 16a, and the other snare loop 17 is used. The base end portion 17b is connected to the operation wire 16b. The conductive wires 16a and 16b are insulated so as not to be short-circuited. Then, an insulator 35 is provided on the hemostasis electrode 18, and the hemostasis electrode 18 and the snare loop 17 are divided into two electrodes 36 and 37 with the insulator 35 as a boundary. When a high frequency current flows through the electrodes 36 and 37 and the snare loop 17, a microwave is generated in the loop of the snare loop 17.

  In this embodiment, the outer diameter of the hemostasis electrode is made larger than the inner diameter of the through hole of the sheath so that the hemostasis electrode abuts against the distal end of the sheath, but as shown in FIG. If a regulating member 40 that contacts the rear end surface of the hemostatic electrode 43 is provided near the opening of the through hole 42a of the sheath 42, the outer diameter D1 of the hemostatic electrode 43 may be made smaller than the inner diameter d1 of the through hole. . The regulating member 40 has, for example, a donut shape, and the snare loop 17 can be inserted through an opening 40a formed at the center. If the outer diameter D1 of the hemostatic electrode 43 is larger than the diameter d2 of the opening 40a, the rear end surface of the hemostatic electrode 43 comes into contact with the regulating member 40, so that the hemostatic electrode 43 is placed at a position immediately before the distal end of the sheath 15. Can be stopped. Further, a pressure sensor 44 similar to that of the present embodiment is attached to the regulating member 40, and a contact pressure when the hemostatic electrode 43 contacts the regulating member 40 is detected.

  In the present embodiment, the shape of the hemostatic electrode has been described as a substantially cylindrical shape. However, the shape is not limited to this, and other shapes such as a warhead shape having a tapered tip, such as the hemostatic electrode 45 shown in FIG. Shape may be sufficient. In addition, since the hemostatic electrode generates heat when energized, a heat insulating material may be provided at the distal end of the sheath in order to prevent the sheath from melting due to contact with the hemostatic electrode.

  In this embodiment, the example in which the wiring for the hemostasis electrode is shared with the snare loop has been described. However, the wiring for the hemostasis electrode and the wiring for the snare loop may be provided separately. In this case, for example, a wiring covered with an insulating material is disposed along the snare loop and connected to the hemostatic electrode. The snare loop and the hemostatic electrode are also insulated. In this way, the high frequency current for hemostasis flows only to the hemostatic electrode, and the high frequency current for excision of the affected area flows only to the snare loop.

  In the present embodiment, the pressure sensor is used to detect that the hemostatic electrode is in contact with the distal end of the sheath, but the detection sensor is not limited to this. For example, as shown in FIG. 10, a photosensor 51 may be used instead of the pressure sensor. The photosensor 51 is, for example, a reflection type photosensor, is provided inside the sheath 15, and is arranged so that the light projecting portion and the light receiving portion face the operation wire 16. The operation wire 16 is provided with a mark 50 near the proximal end of the snare loop 17. The mark 50 is disposed so as to come to a position facing the photosensor 51 when the hemostatic electrode 18 comes into contact with the distal end of the sheath 15. The photosensor 51 outputs a mark detection signal to the current switching unit 26 when the mark 50 is detected. The current switching unit 26 switches the current of the high frequency power supply 20 to a high frequency current for hemostasis in response to the mark detection signal.

  Further, as shown in FIG. 11, a micro switch 56 is provided on the main body shaft 55 of the hand operation unit 19. Then, the microswitch 56 may detect that the hemostatic electrode 18 is in contact with the distal end of the sheath 15. The body shaft 55 of the hand operation unit 19 is attached to the proximal end portion of the sheath 15 via the connecting portion 54. A slider 57 is slidably attached to the main body shaft 55, and the operation wire 16 is connected to the slider 57. The microswitch 56 is provided so as to contact the slider 57 when the hemostatic electrode 18 contacts the tip of the sheath 15. When the micro switch 56 comes into contact with the slider 57, a contact detection signal is output to the current switching unit 26. In response to this detection signal, the current switching unit 26 switches to a high frequency current for hemostasis.

  In the present embodiment, the pressure sensor is provided at the distal end portion of the sheath. However, the present invention is not limited to this. For example, the pressure sensor may be provided on the main body shaft of the hand operation portion. In this case, the pressure sensor is provided so as to contact the slider when the hemostatic electrode contacts the distal end of the sheath. Further, the above-described microswitch may be provided at the distal end portion of the sheath instead of the hand operation portion. In this case, when the hemostatic electrode contacts the distal end of the sheath, the micro switch outputs a contact detection signal to the current switching unit according to the contact.

  Alternatively, the contact of the hemostatic electrode may be detected by providing a circuit through which a current flows when the hemostatic electrode contacts the distal end of the sheath, and detecting the current.

It is the schematic which shows the high frequency snare of this invention. (A) is the front view which shows the snare loop and the hemostatic electrode in the state which protruded from the front-end | tip of a sheath, and sectional drawing which shows the sheath front-end | tip, (B) is the snare loop and the hemostasis state in the state accommodated in the sheath It is sectional drawing which shows the front view which shows an electrode, and the sheath front-end | tip vicinity. It is a perspective view which shows the shape of the electrode for hemostasis. It is the schematic of the snare loop and the hemostatic electrode which show the state which clamped the affected part. It is the schematic of the snare loop and the hemostatic electrode which show the state which resected the affected part. It is explanatory drawing which shows the state which is bleeding and coagulating the bleeding part with the electrode for hemostasis. It is the schematic which shows a bipolar type high frequency snare. It is explanatory drawing which shows the state which block | closed the opening of the through-hole of a sheath with the control member. It is a top view which shows the electrode for hemostasis of a shape different from the shape of the electrode for hemostasis of this embodiment. It is explanatory drawing showing the mark of the operation wire for detecting contact | abutting of the electrode for hemostasis, and a photo sensor. It is explanatory drawing showing the microswitch for detecting contact | abutting of the electrode for hemostasis.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 High frequency snare 15, 42 Sheath 15a, 42a Through-hole 17 Snare loop 18, 43, 45 Hemostatic electrode 19 Hand operation part 22 Counter electrode 24, 44 Pressure sensor 35 Insulator 50 Mark 51 Photo sensor 56 Main body axis | shaft 57 Slider

Claims (13)

In an endoscope high-frequency snare device comprising an endoscope high-frequency snare inserted into a forceps channel of an endoscope and a drive device that is driven by energizing the endoscope high-frequency snare,
The endoscope high-frequency snare is:
Protruding from the distal end of the sheath so that it swells when it is pushed out from the distal end of the sheath and swells when pulled into the sheath from the distal end. A snare loop for excision of
A raised lesion caused by the snare loop, provided at the tip of the snare loop, and configured to be in contact with the tip of the sheath and positioned immediately before the snare loop is pulled into the sheath. An electrode for coagulation and hemostasis for coagulation and hemostasis of bleeding after excision of the raised lesion by applying a second high-frequency current after the excision of
Detecting means for detecting whether the electrode for coagulation and hemostasis is immediately before the tip of the sheath;
The driving device includes:
A high frequency power source for supplying the first and second currents to the snare loop and the coagulation hemostasis electrode;
An endoscopic high-frequency snare device comprising switching means for switching the first and second high-frequency currents according to a detection result of the detection means.   The high-frequency snare device for endoscope according to claim 1, wherein the detection means is a contact pressure detection sensor that detects a pressure when the electrode for coagulation and hemostasis contacts the distal end of the sheath. The endoscope high-frequency snare has an operation wire inserted into the sheath and provided at a proximal end portion of the snare loop,
The operation wire is provided with a mark as a mark when the hemostatic electrode contacts the sheath,
The endoscope high-frequency snare device according to claim 1, wherein the detection unit is a mark detection sensor that detects a mark of the operation wire. The endoscope high-frequency snare has a hand operation unit for pushing or pulling the snare loop out of the sheath,
The hand operation unit has a main body shaft attached to the proximal end portion of the sheath, and a slider attached to the main body shaft and slidable with respect to the main body shaft,
The endoscope according to any one of claims 1 to 3, wherein the detection means is a micro switch that is provided on the shaft of the main body and contacts the slider when the electrode for coagulation and hemostasis contacts the distal end of the sheath. High frequency snare device.   5. The endoscope according to claim 1, wherein the detection unit is a contact current detection sensor that detects a current when the electrode for coagulation and hemostasis contacts the distal end of the sheath. High frequency snare device.   6. The endoscope high-frequency snare satisfies D> d, where d is an inner diameter of the sheath and D is a size of the electrode for coagulation and hemostasis. High frequency snare device for endoscope.   The high-frequency snare device for endoscope according to any one of claims 1 to 6, wherein the electrode for coagulation and hemostasis has a cylindrical shape.   The high-frequency snare device for endoscope according to any one of claims 1 to 7, wherein the electrode for coagulation and hemostasis has a tapered shape.   The endoscopic high-frequency snare device according to any one of claims 1 to 8, wherein the snare loop and the coagulation hemostasis electrode are bipolar. The coagulation hemostasis electrode is divided into bipolar by an insulator,
10. The endoscope high-frequency snare device according to claim 9, wherein a wiring through which the second high-frequency current flows is connected to each pole.   The high-frequency snare device for endoscope according to any one of claims 1 to 8, wherein the snare loop and the coagulation hemostasis electrode are monopolar. A sheath inserted through the forceps channel of the endoscope;
It is provided so as to be able to protrude and retract from the distal end of the sheath so that it swells when it is pushed out from the distal end of the sheath, and swells when pulled into the sheath from the distal end. A snare loop to cauterize the lesion;
A raised lesion caused by the snare loop, provided at the distal end of the snare loop, and configured to be in contact with the distal end of the sheath and positioned immediately before the snare loop is drawn into the sheath. An electrode for coagulation and hemostasis for coagulation and hemostasis of bleeding after the excision of the raised lesion,
An endoscopic high-frequency snare comprising: detecting means for detecting whether or not the coagulation hemostasis electrode is immediately before the distal end of the sheath. Connected to the endoscope high-frequency snare according to claim 12,
A high-frequency power source for supplying the first and second high-frequency currents to the snare loop and the coagulation hemostasis electrode;
An endoscope high-frequency snare drive device comprising: switching means for switching between the first and second high-frequency currents according to a detection result of the detection means.

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