JP2005095564A - Surgical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical instrument with which blood vessels can be accurately anastomosed through an easy operation. <P>SOLUTION: This surgical instrument 1 includes an instrument main body 6, ring supporting parts 71 and 72 provided near the distal end of the instrument main body 6 for detachably supporting rings 2 and 3 to be respectively inserted into the blood vessels from incisions formed in the two blood vessels to be anastomosed, shafts 78 and 79 with hooks as a thread pulling means for pulling threads 4 and 5 spanningly laid between the rings 2 and 3 to connect them, and a clip supporting part 73 provided near the distal end of the instrument main body 6 for detachably supporting a clip 9. In this surgical instrument, by inserting the rings 2 and 3 supported by the ring supporting parts 71 and 72 into the respective blood vessels and pulling the threads 4 and 5 from the exterior of the blood vessels, the rings 2 and 3 are drawn closer to each other, and after clamping the edge portions of the incisions in both blood vessels between the rings 2 and 3, by mounting the clip 9 and holding the condition where the rings 2 and 3 are drawn close to each other, both blood vessels are anastomosed. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a surgical instrument used for blood vessel anastomosis.

  In vascular anastomosis procedures such as coronary artery bypass surgery, for example, when bypassing the internal thoracic artery and the left coronary artery, the left coronary artery incised and the end of the internal thoracic artery are anastomosed with a thread. The procedure for passing the needle through the coronary artery for anastomosis depends on the arm of the doctor, but it is a very difficult procedure in situations where the coronary artery has a narrow blood vessel diameter and a narrow field of view, particularly under heartbeat.

  Therefore, a vascular anastomosis device using two rings has been proposed for the purpose of easily forming an anastomosis without performing suturing (see, for example, Patent Document 1). The blood vessel anastomosis instrument described in FIG. 14 of Patent Document 1 is used for anastomosing the side portions of blood vessels, and the rings inserted inside the incised portions of each blood vessel are attracted to each other by magnetic force. It is comprised so that both blood vessels may be joined by. In the anastomosis formed in this way, blood is intended to flow between the two blood vessels through an incision formed on the inside of the ring and on the side of the blood vessel.

  However, the conventional vascular anastomosis device has the following problems. As a first problem, when two rings are joined by magnetic force, it is difficult to align the two rings so that they are exactly overlapped with each other, and the two rings are likely to be attracted in a shifted state. As a result, there is a possibility that the joint between both blood vessels is disengaged. As a second problem, even if both blood vessels are joined, there is nothing to hold the incision formed on the side of the blood vessel in an expanded state, so the incision (incision) is closed by the elasticity of the blood vessel wall. There is a problem that it is likely to be in a state, and the blood flow between both blood vessels cannot be sufficiently secured.

US Pat. No. 6,352,543 (FIG. 14)

  An object of the present invention is to provide a surgical instrument capable of accurately anastomosing blood vessels with a simple operation.

Such an object is achieved by the present inventions (1) to (25) below.
(1) the instrument body,
A pair of ring support portions that are provided near the distal end of the instrument body and removably support a pair of rings respectively inserted into the blood vessels from incisions formed in the two blood vessels to be anastomosed;
Thread pulling means that pulls the thread that is spanned between the rings and connects them;
A clip support portion provided near the tip of the instrument body, and removably supporting a clip that sandwiches the outer peripheral portion of the ring via the vessel wall of the blood vessel,
The rings supported by the ring support portions are inserted into the blood vessels, and the yarn is pulled from the outside of the blood vessel by the yarn pulling means to pull the rings toward each other. A surgical instrument for anastomosing the blood vessels by attaching the clip and holding the state in which the two rings are approached after the edge of the incision is sandwiched between the two rings.

  (2) Each said ring support part is comprised by the two wires which have the elasticity hold | maintained by aligning a base end part, The said ring is pinched | interposed between both said wires as described in said (1). Surgical instruments.

  (3) The surgical instrument according to (2), wherein the two wires in each of the ring support portions sandwich the ring between the two wires with one of the wires inserted through the inside of the ring. .

  (4) The surgical instrument according to (2) or (3), wherein the two wires in each of the ring support portions have different lengths.

  (5) The surgical instrument according to (4), in which the longer one of the two wires in each of the ring support portions has higher flexibility than the shorter one.

  (6) Out of the two wires in each of the ring support portions, the outer diameter of the longer wire is smaller than or substantially equal to the outer diameter of the shorter wire, as described in (4) or (5) above Surgical instruments.

(7) It further comprises a moving mechanism for moving the ring support part forward and backward with respect to the instrument body,
The surgical instrument according to any one of (1) to (6), wherein after inserting the ring supported by the ring support portion into the blood vessel, the ring support portion is retracted by operation of the moving mechanism.

  (8) After inserting the ring supported by the ring support portion into the blood vessel, the ring support portion is removed from the incision portion of the blood vessel when the ring support portion is retracted by operation of the moving mechanism. The surgical instrument according to (7), wherein the ring is detached from the ring support portion and remains in the blood vessel.

  (9) The surgical instrument according to (7) or (8), wherein the thread pulling unit is capable of pulling the thread independently of advancement and retreat of the ring support portion.

  (10) The surgical instrument according to (7) or (8), wherein the thread pulling unit is configured to pull the thread in conjunction with the retraction of the ring support portion.

  (11) The surgical instrument according to any one of (1) to (10), wherein the thread pulling unit pulls the two sets of threads coming out of the rings substantially symmetrically through the rings.

  (12) The surgical instrument according to any one of (1) to (11), wherein the surgical instrument includes a guide portion that guides the thread so that the pulling amounts of the plurality of threads exiting from both the rings are substantially equal.

  (13) The surgical instrument according to any one of (1) to (12), wherein the clip support portion supports the clip in an opened state.

  (14) The surgical instrument according to any one of (1) to (13), further including a holding unit that holds the clip supported by the clip support portion and can release the held state.

  (15) The instrument main body includes a gripping part that is gripped by a hand, a thread operation part that operates the thread pulling means, and a ring operation part that advances and retracts the ring support part relative to the instrument main body. Or the surgical instrument in any one of (14).

  (16) The instrument body has a pair of projecting portions projecting substantially in the distal end direction at a distal end portion thereof, and the thread is inserted through a slit formed in the projecting portion. ). The surgical instrument according to any one of

  (17) The yarn according to any one of (1) to (16), wherein when the yarn is pulled by the yarn pulling means, the yarn acts to widen an incision formed in a side surface of the two blood vessels. Surgical instruments.

  (18) The ring according to any one of (1) to (17), wherein the ring has a substantially rectangular shape and is inserted into the blood vessel so that a longitudinal direction thereof substantially coincides with an incision direction of the incision portion. Surgical instruments.

  (19) The surgical instrument according to any one of (1) to (18), wherein at least one of the pair of rings is provided with a thread insertion portion through which the thread passes when the thread is pulled. .

  (20) The surgical instrument according to any one of (1) to (19), wherein the thread connects the pair of rings at two or more locations.

  (21) The surgical instrument according to any one of (1) to (20), wherein the thread connects the inner peripheral portions of the pair of rings.

  (22) Any one of the above (1) to (21), wherein the clip includes a pair of holding portions that can approach and separate from each other, and a tightening force generation portion that urges the both holding portions in an approaching direction by elasticity. The surgical instrument described in 1.

  (23) The surgical instrument according to (22), wherein the tightening force generation unit includes a pair of arms that are connected at their base ends and support the clamping unit at a distal end thereof.

  (24) The both arm portions intersect each other in the middle thereof, and when the portion closer to the base end side than the intersecting portion is pressed from the outside against the elastic force of the tightening force generating portion, the both arms are closed. The surgical instrument according to (23), wherein the sandwiching portion is configured to open.

  (25) The surgical instrument according to any one of (22) to (24), wherein the clamping unit includes a hole through which the thread is inserted.

  According to the present invention, after inserting a pair of rings into the inside of the incision formed in the two blood vessels to be anastomosed, pulling the thread connecting both rings, and then attaching the clip, Can be anastomosed. In particular, the operation of inserting both rings into the blood vessel, the pulling operation of both rings (thread pulling operation), and the mounting operation of the clip can be performed with a single instrument. It can be performed reliably and each operation is simple.

  In addition, since the pair of rings are attracted to each other while being automatically aligned by the tension of the yarn, it is possible to reliably obtain a state where the pair of rings are accurately overlapped without being displaced.

Further, the interval between the two rings when the two blood vessels are joined can be freely adjusted by the tension of the yarn. Therefore, since the interval between both rings can be adjusted according to the thickness of the blood vessel, an anastomosis can be reliably formed according to each case.
Because of this, blood vessels can be anastomosed quickly, easily and reliably.

Hereinafter, the surgical instrument of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.
<First Embodiment>
1 is a perspective view showing a first embodiment of the surgical instrument of the present invention, FIGS. 2 and 3 are enlarged perspective views showing the vicinity of the distal end of the surgical instrument shown in FIG. 1, and FIG. 1 is a perspective view of a blood vessel anastomosis formed using the surgical instrument shown in FIG. In the following, for convenience of explanation, the left side in FIGS. 1 to 3 is referred to as a “tip” and the right side is referred to as a “base end”.

  A surgical instrument 1 shown in FIG. 1 is used for anastomosing the side portions of two blood vessels 10 and 20. As shown in FIGS. 2 and 3, a blood vessel anastomosis instrument 50 is attached to the distal end portion of the instrument body 6 of the surgical instrument 1. As shown in FIG. 4, after anastomosing blood vessels 10 and 20 using this surgical instrument 1, a blood vessel anastomosis instrument 50 is attached to the anastomosis portion.

  Hereinafter, the vascular anastomosis instrument 50 will be described first, and then the surgical instrument 1 of the present invention will be described.

  FIG. 5 is a perspective view showing an embodiment of a vascular anastomosis instrument used with the surgical instrument of the present invention, FIG. 6 is a perspective view showing a ring and a thread in the vascular anastomosis instrument shown in FIG. 5, and FIGS. FIG. 9 is a perspective view showing a state in which the ring in the blood vessel anastomosis instrument shown in FIG. 5 is inserted into the blood vessel, FIG. 10 is a plan view showing the incision portion in the state shown in FIG. 9, and FIG. 11 is a longitudinal sectional view showing the anastomosis portion in a state in which the anastomosis technique is completed.

  5 to 9 and 11, the posture of the vascular anastomosis instrument 50 is turned upside down as compared with the posture in FIGS.

  As shown in FIG. 5, the vascular anastomosis device 50 includes a pair of rings (annular bodies) 2 and 3, threads 4 and 5 that are stretched between the rings 2 and 3, and a clip 9. And have.

  The ring 2 is inserted inside an incision (cut) 101 formed in one blood vessel 10 to be anastomosed.

  As shown in FIG. 6, the schematic shape of the ring 2 has a substantially rectangular frame shape. The “substantially rectangular” referred to here includes not only a quadrangle such as a substantially rectangular shape but also a hexagonal shape or a polygon having more corners (for example, a boat-shaped hexagon).

  In the vicinity of both ends of the inner peripheral portion of one long side 25 of the ring 2, thread insertion portions 21 and 22 for inserting the yarn 4 are provided, and in the vicinity of both ends of the inner peripheral portion of the other long side 26. Are provided with thread insertion portions 23 and 24 through which the thread 5 is inserted.

  The ring 3 is inserted inside an incision (cut) 201 formed in the blood vessel 20 that anastomoses with the blood vessel 10. The approximate shape of the ring 3 is substantially the same as that of the ring 2 and forms a rectangular frame. Holes 31 and 32 for inserting the thread 4 are formed in the vicinity of both ends of one long side 35 of the ring 3, and holes 33 and 32 for inserting the thread 5 are formed in the vicinity of both ends of the other long side 36. 34 are formed. These holes 31 to 34 are formed so as to penetrate from the outer peripheral surface of the ring 3 to the inner peripheral surface.

  The constituent materials of the rings 2 and 3 are not particularly limited. For example, various metal materials such as stainless steel, aluminum or aluminum alloy, titanium or titanium alloy, nickel titanium alloy, polypropylene, polycarbonate, nylon, polyester, PTFE, Various resin materials such as polystyrene, biodegradable resins (for example, PLLA, PLA, PGA, etc.), acrylic, silicon, polyurethane, polyvinyl chloride, and copolymers thereof can be used.

  The yarn 4 is stretched between the long side 25 of the ring 2 and the long side 35 of the ring 3. Specifically, the thread 4 passes through the thread insertion part 21 from the inside to the outside, then crosses the ring 3 and passes from the inside to the outside through the hole 31 at a position corresponding to the thread insertion part 21. Further, the thread 4 that has passed through the hole 31 reaches the hole 32 along the outer surface of the long side 35, passes through the hole 32 from the outside to the inside, then crosses the ring 2, and passes the thread insertion part 22 from the outside to the inside. I go to. The yarn 4 extends from the yarn insertion portions 21 and 22 beyond the opposite long side 26 and further outward.

  Similarly, the yarn 5 is stretched between the long side 26 of the ring 2 and the long side 36 of the ring 3. Specifically, the thread 5 passes through the thread insertion part 23 from the inside to the outside, then crosses the ring 3 and passes through the hole 33 located at a position corresponding to the thread insertion part 23 from the inside to the outside. Further, the thread 5 that has passed through the hole 33 travels along the outer surface of the long side 36 to reach the hole 34, passes through the hole 34 from the outside to the inside, then crosses the ring 2, and passes the thread insertion portion 24 from the outside to the inside. I go to. The thread 5 extends from the thread insertion portions 23 and 24 beyond the opposite long side 25 and further outward.

  With such a configuration, the ring 2 and the ring 3 are formed by connecting the portions 44 and 45 of the yarn 4 between the rings 2 and 3 and the portions 54 and 55 of the yarn 5 between the rings 2 and 3. Connected at points.

  The spanning portions 44, 45, 54 and 55 of the yarns 4 and 5 connect the inner peripheral portions of the rings 2 and 3 to each other.

  In such a vascular anastomosis instrument 50, after the rings 2 and 3 are inserted inside the blood vessels 10 and 20, the portions 41 and 42 that extend outward beyond the long side 26 of the thread 4, and the long side 25 of the thread 5 When the outwardly extending portions 51 and 52 are pulled from outside the blood vessels 10 and 20, the rings 2 and 3 are pulled together, and the edges 102 and 202 of the incisions 101 and 201 are between the rings 2 and 3 It is pinched.

  The constituent materials of the yarns 4 and 5 are not particularly limited. For example, various synthetic resin materials such as polypropylene, polyester, nylon (polyamide), polyethylene, rayon, expanded PTFE, various metal materials such as stainless wire, silk, etc. Various natural materials can be used.

  In addition, the arrangement | positioning path | route of the thread | yarns 4 and 5 is not restricted to said structure, What kind of arrangement | positioning method may be sufficient if the function which draws the rings 2 and 3 near each other can be exhibited.

  In addition, as described above, in the present embodiment, the rings 2 and 3 are connected at the four portions of the spanning portions 44, 45, 54, and 55, but in the present invention, the connecting portion between the pair of rings by the thread is There should be at least two places. For example, in the rings 2 and 3, a configuration may be adopted in which the intermediate points of the long sides 25 and 35 and the intermediate points of the long sides 26 and 36 are connected by a thread at two locations. Further, there may be five or more connecting points.

  As shown in FIG. 5, the clip 9 includes a pair of sandwiching portions 91 and 92 that can be approached and separated from each other (openable and closable), and a tightening force generating portion 93 that biases the sandwiching portions 91 and 92 toward each other. It consists of

  The clip 9 holds the state in which the rings 2 and 3 are attracted to each other by tightening the outer peripheral portions of the rings 2 and 3 through the tube walls 103 and 203 of the blood vessels 10 and 20 by the sandwiching portions 91 and 92. It has a function.

  The holding portions 91 and 92 have a rod shape, and the length thereof is substantially the same as or slightly longer than the long sides 25, 26, 35 and 36 of the rings 2 and 3. Although the length of the clamping parts 91 and 92 is set according to the magnitude | size of the rings 2 and 3, it is preferable normally that it is about 3-20 mm.

  As shown in FIG. 11, the width of the sandwiching portions 91 and 92 in the thickness direction of the rings 2 and 3 is such that the edges 102 and 202 of the incisions 101 and 201 are sandwiched between the rings 2 and 3. At this time, the tube walls 103 and 203 of the blood vessels 10 and 20 are sandwiched between the long sides 25, 26, 35 and 36 of the rings 2 and 3, and are wide enough to be tightened. This width is set according to the thickness of the rings 2 and 3, but is usually preferably about 0.5 to 10 mm.

  Further, the thicknesses of the sandwiching portions 91 and 92 are not particularly limited, but usually about 0.1 to 2 mm is preferable.

  As shown in FIG. 5, the holding portion 91 is formed with two thread insertion holes 911 through which the portions 41 and 42 of the thread 4 extending outward are inserted. The portions 41 and 42 extending to the outside of the yarn 4 are inserted through the respective yarn insertion holes 911 and connected to each other outside the pinching portion 91 to form a loop.

  Similarly, the holding portion 92 is formed with two thread insertion holes 921 through which the outwardly extending portions 51 and 52 of the thread 5 are inserted. The portions 51 and 52 extending to the outside of the yarn 5 are inserted into the respective yarn insertion holes 921 and connected to each other outside the pinching portion 91 to form a loop.

  As shown in FIG. 9, the thread insertion holes 911 and 921 are formed so as to penetrate from the inner surface to the outer surface in the vicinity of the center in the width direction (the thickness direction of the rings 2 and 3) of the holding portions 91 and 92. Yes.

  As shown in FIG. 5, the tightening force generating portion 93 includes a pair of arm portions 94 and 95 and a U-shaped connecting portion 96 that connects the base end portions of both arm portions 94 and 95. . The distal end portion of the arm portion 94 is connected to and supports the proximal end portion of the clamping portion 91. The distal end portion of the arm portion 95 is connected to and supports the proximal end portion of the clamping portion 92.

  The arm portions 94 and 95 intersect each other in the middle (intersection portion 931). The arm portion 94 has a narrow portion 941 whose width is narrower than other portions in the vicinity of the intersecting portion 931. Further, the arm portion 95 has a long hole 951 through which the narrow portion 941 is inserted in the vicinity of the intersecting portion 931.

  Due to the elastic force of the tightening force generating portion 93, the sandwiching portions 91 and 92 are urged in a direction (close direction) approaching each other. In other words, the tightening force generation part 93 functions as a spring that brings the clamping parts 91 and 92 close to each other.

  In such a clip 9, the pressed portions 942 and 952, which are proximal portions of the intersecting portions 931 of the arm portions 94 and 95, are pressed from the outside against the elastic force of the tightening force generating portion 93. By closing, the clamping portions 91 and 92 can be separated (opened) from each other.

  Although it does not specifically limit as a constituent material of the clip 9, For example, various metal materials, such as stainless steel, aluminum or aluminum alloy, titanium or titanium alloy, nickel titanium alloy, cobalt chromium alloy, polypropylene, polycarbonate, nylon, polyester, Various resin materials such as PTFE, polystyrene, biodegradable resins (for example, PLLA, PLA, PGA, etc.), acrylic, silicon, polyurethane, polyvinyl chloride, and copolymers thereof can be used.

  Moreover, although it is preferable that each part (the clamping parts 91 and 92 and the clamping force generation | occurrence | production part 93) of the clip 9 is integrally formed, you may be comprised combining several components.

  Next, based on FIG. 7 thru | or FIG. 11, the process of anastomosing the blood vessels 10 and 20 using such a blood vessel anastomosis instrument 50 is demonstrated in detail.

  [1] As shown in FIG. 7, an incision is made on the side surface of the blood vessel 10 along the longitudinal direction of the blood vessel 10 to form an incision 101. Next, the ring 2 is inserted into the blood vessel 10 from the incision 101. At this time, the ring 2 is inserted such that the longitudinal direction thereof substantially coincides with the incision direction of the incision portion 101.

  [2] As shown in FIG. 8, an incision is made on the side surface of the blood vessel 20 along the longitudinal direction of the blood vessel 20 to form an incision 201. Next, the ring 3 is inserted into the blood vessel 20 from the incision 201. At this time, the ring 3 is inserted such that the longitudinal direction thereof substantially coincides with the incision direction of the incision portion 201.

  7 and 8, the clip 9 is not shown, but the clip 9 is held by pressing the pressed portions 942 and 952 by a surgical instrument 1 to be described later. 91 and 92 are held in the vicinity of rings 2 and 3 in an open state.

  [3] When the portions 41 and 42 extending to the outside of the yarn 4 and the portions 51 and 52 extending to the outside of the yarn 5 are pulled from the outside of the holding portions 91 and 92 of the clip 9 in the state shown in FIG. When the yarns 4 and 5 pass through the yarn insertion portions 21 to 24 and the yarn insertion holes 911 and 921, the lengths of the spanning portions 44 and 45 of the yarn 4 and the spanning portions 54 and 55 of the yarn 5 are reduced. As it shortens, rings 2 and 3 are drawn toward each other. As a result, as shown in FIG. 9, the edge 102 of the incision 101 and the edge 202 of the incision 201 are sandwiched between the rings 2 and 3.

  At this time, in this embodiment, since the thread insertion holes 911 and 921 are provided, the alignment between the rings 2 and 3 and the holding portions 91 and 92 is automatically performed by pulling the threads 4 and 5. This alignment does not require skill or time, and can be performed very easily and quickly.

  When the threads 4 and 5 are pulled from the state shown in FIG. 8, the spanning portions 44, 45, 54, and 55 act to widen the incisions 101 and 201 (see FIG. 10). As a result, the edges 102 and 202 are sandwiched between the rings 2 and 3 in a state where the incisions 101 and 201 are surely spread (opened), so that the blood between the blood vessels 10 and 20 A sufficient flow can be secured. In addition, although the incision part 201 is shown in FIG. 10, the incision part 101 is also expanded similarly.

  In particular, in the present embodiment, since the incisions 101 and 201 are expanded at the four portions of the spanning portions 44, 45, 54, and 55, a wider opening area can be ensured.

  Also, since the spanning portions 44, 45, 54 and 55 connect the inner peripheral portions of the rings 2 and 3, the edge portions 102 and 202 of the incisions 101 and 201 are more accurately located between the rings 2 and 3. And it can pinch reliably.

  In the present embodiment, as can be seen from FIG. 10, since the rings 2 and 3 are substantially rectangular, the opening area of the incisions 101 and 201 can be secured particularly large. A sufficient blood flow between 20 and 20 can be secured.

  [4] When the pressing to the pressed parts 942 and 952 by the surgical instrument 1 is released from the state shown in FIG. 9, the holding parts 91 and 92 are close to each other due to the elastic force of the clip 9. As a result, as shown in FIG. 11, the tube walls 103 and 203 of the blood vessels 10 and 20 are disposed between the outer peripheral portions of the long sides 25, 26, 35 and 36 of the rings 2 and 3 and the sandwiching portions 91 and 92. Is pinched. As a result, the outer peripheral portions of the rings 2 and 3 are clamped by the sandwiching portions 91 and 92 via the tube walls 103 and 203 of the blood vessels 10 and 20, and the state in which the rings 2 and 3 are pulled toward each other is maintained. Thus, the anastomosis forming procedure between the blood vessel 10 and the blood vessel 20 is completed.

  As described above, in the vascular anastomosis instrument 50, when the operation of pulling the threads 4 and 5 described in [3] is performed, the ring 2 and the ring 3 are automatically aligned by the tension of the threads 4 and 5. Thus, the ring 2 and the ring 3 can be accurately brought together without being displaced by a simple operation.

  In the vascular anastomosis instrument 50, the distance between the ring 2 and the ring 3 in the state of FIG. 9 can be freely adjusted by the tension of the threads 4 and 5. Therefore, since the space | interval of the ring 2 and the ring 3 can be adjusted according to the thickness of the blood vessels 10 and 20 (edge part 102, 202), an anastomosis can be formed reliably according to each case.

  Further, when the operation [3] is completed, the rings 2 and 3 can be easily separated by loosening the threads 4 and 5, so that if the operation is re-executed for some reason, it can be easily re-executed. .

  The vascular anastomosis tool 50 has been described above. Next, returning to FIGS. 1 to 3, the surgical instrument 1 will be described.

  As shown in FIG. 1, the surgical instrument 1 has an instrument body 6. The instrument body 6 has a pair of elongated arms 61 and 62, and the base ends of the arms 61 and 62 are connected to each other. About half of the proximal end side of the arms 61 and 62 constitutes a grasping portion 63 for the operator to grasp the surgical instrument 1 by hand. The arms 61 and 62 can be closed by gripping the grip portion 63 so that the arms 61 and 62 are brought close to each other. Further, when the hand holding the grip 63 is loosened, the arms 61 and 62 can be opened by the elasticity of the arms 61 and 62. That is, the arms 61 and 62 can be opened and closed by grasping the grip 63 and operating it like tweezers.

  A joint 64 that can be bent in a direction substantially perpendicular to a direction in which the arms 61 and 62 open and close is provided at a position near the longitudinal ends of the arms 61 and 62. Accordingly, the bending angle of the joint 64 can be changed according to the posture at the time of performing the procedure, the orientation of the blood vessels 10 and 20, and the like so that the operation can be easily performed.

  A crank portion 65 bent in a crank shape is formed near the center of the arms 61 and 62 in the longitudinal direction, and a step is provided between the distal end portion and the proximal end portion of the crank portion 65. ing.

  A fastener 66 that can fix the arms 61 and 62 in a closed state is provided in the middle (approximately the center) of the arms 61 and 62 in the longitudinal direction. As shown in FIG. 12, the fastener 66 includes a plate piece 661 installed on the arm 61 and a plate piece 662 installed on the arm 62. Each of the plate pieces 661 and 662 is formed by forming a thin plate cut out in a predetermined shape. The plate piece 662 is provided with a hook portion 663 formed by bending the plate so that the plate is folded back. An engaging portion 664 having a shape that can be inserted into the hook portion 663 is provided at 661.

  When the arms 61 and 62 are closed by grasping the grip portion 63, the engaging portions 664 are inserted into the hook portion 663 and hooked, whereby the arms 61 and 62 can be held closed. When releasing the holding state, the arms 61 and 62 are further brought closer to each other until the engaging portion 664 passes the hook portion 663 to the opposite side, whereby the engaging portion 664 is detached from the hook portion 663 and the arms 61 and 62 are moved. Can be opened.

  As shown in FIG. 2, a pair of ring support portions 71 and 72 for detachably supporting the rings 2 and 3 of the blood vessel anastomosis tool 50 are provided near the tips of the arms 61 and 62 of the instrument body 6, and the blood vessel anastomosis tool. A clip support portion 73 that detachably supports 50 clips 9 is provided.

  The clip support portion 73 is composed of pressing portions 731 and 732 formed at the distal ends of the arms 61 and 62, respectively. A state in which the arms 61 and 62 of the instrument main body 6 are closed with the arm portions 94 and 95 (the pressed portions 952 and 942) of the clip 9 being sandwiched between the pressing portions 731 and 732 and the arms 61 and 62 are closed by the fastener 66 The clip 9 can be held by being fixed to. That is, the fastener 66 functions as a holding unit that holds the clip 9 supported by the clip support portion 73.

  In a state where the clip 9 is supported by the clip support portion 73, the pressing portions 731 and 732 press the pressed portions 952 and 942 from both sides, so that the sandwiching portions 91 and 92 are opened (see FIG. 2). Moreover, the holding state with respect to the clip 9 of the clip support part 73 can be cancelled | released by releasing the fixing state of the fastener 66 as mentioned above, and opening the arms 61 and 62 (pressing parts 731 and 732). When the holding state of the clip support portion 73 with respect to the clip 9 is released, the holding portions 91 and 92 of the clip 9 are closed by elasticity (see FIG. 3).

  The ring support portion 71 is composed of two parallel wires of a short wire 711 and a long wire 712. The proximal ends (fixed ends) of the short wire 711 and the long wire 712 are aligned and connected to and held by the distal end portion of another wire 74, and the distal ends of the short wire 711 and the long wire 712 are connected to the free end. It has become. The ring support portion 71 can hold (clamp) the ring 2 inserted between the short wire 711 and the long wire 712 by the elasticity of both wires.

  The ring support part 72 is the same as the ring support part 71 except that the posture is reversed, and is composed of two parallel wires of a short wire 721 and a long wire 722. The proximal ends (fixed ends) of the short wire 721 and the long wire 722 are aligned and connected to and held by the distal end of another wire 75, and the distal ends of the short wire 721 and the long wire 722 are connected to the free end. It has become. The ring support 72 can hold (clamp) the ring 3 inserted between the short wire 721 and the long wire 722 by the elasticity of both wires.

  The short wires 711 and 721 are located outside the long wires 712 and 722. The ring support portions 71 and 72 sandwich the short sides of the rings 2 and 3 in a state where the short wires 711 and 721 are inserted inside the rings 2 and 3.

  According to such ring support portions 71 and 72, the rings 2 and 3 can be supported so as to be easily inserted into the blood vessels 10 and 20. Further, after the rings 2 and 3 are inserted into the blood vessels 10 and 20, it is easy to remove the rings 2 and 3 from the ring support portions 71 and 72.

  In a state where the rings 2 and 3 are supported by the ring support portions 71 and 72, the ring 2 and the ring 3 are supported at a predetermined distance in the thickness direction thereof. Thereby, the rings 2 and 3 can be more easily inserted into the blood vessels 10 and 20.

  As shown in FIG. 1, the wires 74 and 75 connected to the base end portions of the ring support portions 71 and 72 extend to the base end side along the instrument body 6 and reach the vicinity of the crank portion 65. A plurality of cylindrical wire insertion portions 67 through which the wires 74 and 75 are slidably inserted are provided in the instrument main body 6 at intervals. A ring-shaped ring operation unit 76 is fixed to the base ends of the wires 74 and 75 so as to be easily pinched with fingers.

  The wires 74 and 75 and the ring operation part 76 function as a moving mechanism for moving the ring support parts 71 and 72 forward and backward with respect to the instrument body 6. That is, by holding the ring operation unit 76 with a finger and moving it forward and backward with respect to the instrument body 6, the ring support parts 71 and 72 are advanced in the distal direction with respect to the instrument body 6 via the wires 74 and 75, or in the proximal direction. Can be retracted (retracted).

  After the rings 2 and 3 supported by the ring support portions 71 and 72 are inserted from the incisions 101 and 201 of the blood vessels 10 and 20, the ring operation portion 76 is pulled to retract the ring support portions 71 and 72 in the proximal direction. Then, the ring support portions 71 and 72 are removed from the incision portions 101 and 201, and the rings 2 and 3 are separated from the ring support portions 71 and 72 by being caught by the incision portions 101 and 201, and enter the blood vessels 10 and 20. Remains.

  The long wires 712 and 722 are longer than the short wires 711 and 721. As a result, when the rings 2 and 3 are inserted from the incisions 101 and 201 of the blood vessels 10 and 20, the incisions 101 and 201 can be easily opened by the tips of the protruding long wires 712 and 722. 3 can be easily inserted into the blood vessels 10 and 20. In addition, it is preferable that the lengths of the long wires 712 and 722 are such that their tips protrude from the tips of the rings 2 and 3 by about 1 to 30 mm.

  Moreover, it is preferable that the lengths of the short wires 711 and 721 are such that their tips hardly protrude from the tips of the rings 2 and 3. Accordingly, the rings 2 and 3 can be easily inserted into the blood vessels 10 and 20, and when the ring support portions 71 and 72 are retracted in the proximal direction after the insertion, the rings 2 and 3 are connected to the ring support portion 71. , 72 can be reliably separated from the blood vessels 10 and 20.

  Although it does not specifically limit as a constituent material of the short wires 711 and 721 and the long wires 712 and 722, Super elastic alloys, such as Ni-Ti alloy and Ni-Co-Cr alloy, various elasticity which have stainless steel, a piano wire, etc. A metal material or the like is preferably used. Moreover, hydrophilic coating etc. may be given to the outer peripheral surface of the short wires 711 and 721 and the long wires 712 and 722 so that the insertion resistance in the blood vessels 10 and 20 may be reduced.

  The long wires 712 and 722 are preferably more flexible than the short wires 711 and 721. Thereby, when it inserts in the blood vessels 10 and 20, damage to the vascular endothelium can be further reduced.

  The outer diameters of the short wires 711 and 721 and the long wires 712 and 722 are preferably about 0.1 to 2.0 mm. Moreover, it is preferable that the outer diameters of the long wires 712 and 722 are smaller than or substantially equal to the outer diameters of the short wires 711 and 721.

  As shown in FIG. 2, the surgical instrument 1 includes hook-attached shafts (hook-attached wires) 78 and 79 as thread pulling means for pulling the threads 4 and 5 of the vascular anastomosis instrument 50. The hooked shafts 78 and 79 are disposed along the outside of the arms 61 and 62 of the instrument body 6. As shown in FIG. 1, the base end portions of the hook-attached shafts 78 and 79 reaching the vicinity of the crank portion 65 are connected to each other to form a loop, and this loop portion constitutes a yarn operation portion 80. A plurality of cylindrical shaft insertion portions 68 through which the hook-attached shafts 78 and 79 are slidably inserted are provided in the instrument main body 6 at intervals.

  Hooks 781 and 791 are provided at the tip ends of the shafts 78 and 79 with hooks. The hooks 781 and 791 are hooked with portions 41 and 42 extending outward of the yarn 4 and portions 51 and 52 extending outward of the yarn 5, respectively.

  When the yarn operating portion 80 is pulled in the proximal direction, the yarns 4 and 5 can be pulled through the shafts 78 and 79 with hooks.

  The constituent materials of the hooked shafts 78 and 79 are not particularly limited. For example, superelastic alloys such as Ni—Ti alloy and Ni—Co—Cr alloy, various metal materials such as stainless steel and piano wire are preferably used.

  As shown in FIG. 2, the distal end portion of the instrument body 6 is provided with projecting portions 81 and 82 that project further from the distal ends of the arms 61 and 62 in the distal direction. Slits 811 and 821 are formed in the projecting portions 81 and 82, and the slits 811 and 821 include portions 41 and 42 extending to the outside of the yarn 4 and portions 51 and 52 extending to the outside of the yarn 5. Each is inserted.

  When the yarn operating portion 80 is pulled in the proximal direction, the yarns 4 and 5 are pulled in the proximal direction via the shafts 78 and 79 with hooks.

  When the shafts 78 and 79 with hooks pull the yarns 4 and 5 in the proximal direction, the pulling directions of the yarns 4 and 5 are corrected in the slits 811 and 812, so that the yarns 4 and 5 near the rings 2 and 3 are corrected. The pulling direction is substantially symmetric on both sides via the rings 2 and 3 in plan view. As a result, the forces exerted by the pulled threads 4 and 5 cancel each other, so that it is possible to reliably prevent the position of the vascular anastomosis tool 50 from being shifted when the threads 4 and 5 are pulled.

  Further, by passing the threads 4 and 5 through the slits 811 and 821, the pulling direction of the threads 4 and 5 by the hooked shafts 78 and 79 can be set to the longitudinal direction of the instrument body 6. Even when the working space is small, the yarn drawing operation can be performed without hindrance.

  The base end portion of the slit 811 is located at the approximate center of the two thread insertion holes 911 of the holding portion 91 of the clip 9. Accordingly, the slit 811 functions as a guide portion that guides the yarn 4 so that the towing amounts of the portions 41 and 42 extending outward are substantially equal when the yarn 4 is pulled. Similarly, when the yarn 5 is pulled, the slit 821 functions as a guide portion that guides the yarn 5 so that the pulling amounts of the portions 51 and 52 extending outward are substantially equal. Since the slits 811 and 821 function in this way, the rings 2 and 3 can be evenly drawn without tilting.

  Next, an example of how to use the surgical instrument 1 will be described, but the description of the same matters as described in the description of the vascular anastomosis device 50 will be omitted.

  [1] Before using the surgical instrument 1, the blood vessel anastomosis tool 50 is attached to the distal end portion of the instrument body 6 as shown in FIG. 2. In this state, the rings 2 and 3 supported by the ring support portions 71 and 72 are inserted into the blood vessels 10 and 20 from the incisions 101 and 201 of the blood vessels 10 and 20.

  [2] Next, the ring operation unit 76 is pulled in the proximal direction. As a result, the ring support portions 71 and 72 are retracted from the instrument body 6 in the proximal direction and removed from the incisions 101 and 201, and the rings 2 and 3 are connected to the incisions 101 and 201 of the blood vessels 10 and 20. By being hooked, it is detached from the ring support portions 71 and 72 and remains in the blood vessels 10 and 20.

  [3] Next, the thread operating portion 80 is pulled in the proximal direction. Thereby, the yarns 4 and 5 are pulled, and the rings 2 and 3 are pulled toward each other (see FIG. 3). In FIG. 3, the blood vessels 10 and 20 are not shown for easy viewing.

  [4] While maintaining the tension applied to the threads 4 and 5 so that the thread operating section 80 does not return, when the clip 66 is released and the holding state with respect to the clip 9 is released, the thread 9 is clamped by the elasticity of the clip 9 itself. The portions 91 and 92 are closed, and the clip 9 is attached to the anastomosis portion of the blood vessels 10 and 20. By this clip 9, the state in which the rings 2 and 3 are approached is maintained.

  [5] The threads 4 and 5 are removed from the hooks 781 and 791, and the surgical instrument 1 is retracted from the anastomosis portion. The anastomosis part of the blood vessels 10 and 20 formed as described above is as shown in FIG.

  As described above, in the surgical instrument 1, three operations including the insertion operation of the rings 2 and 3 into the blood vessel, the pulling operation of the rings 2 and 3 (traction operation of the threads 4 and 5), and the mounting operation of the clip 9 are performed. Since it can be performed with one instrument, anastomosis using the vascular anastomosis device 50 can be performed quickly and reliably, and the operation is also simple.

  Further, since the operation of pulling the threads 4 and 5 and the operation of detaching the rings 2 and 3 from the ring support portions 71 and 72 can be performed on the hand side of the instrument body 6, for example, a work space under an endoscope or the like. It can be suitably used even in the case of an operation method with little.

Second Embodiment
FIG. 13 is an enlarged perspective view showing the vicinity of the distal end of the surgical instrument according to the second embodiment of the present invention. Hereinafter, the second embodiment of the surgical instrument of the present invention will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.

  In the first embodiment, the yarns 4 and 5 can be pulled independently of the advance and retreat of the ring support portions 71 and 72. However, in the surgical instrument 1 ′ of the present embodiment, the ring support portions 71 and 72 are provided. The yarns 4 and 5 are configured to be pulled in conjunction with retreating in the proximal direction.

  As shown in FIG. 13, a hook 741 is provided at the distal end portion of the wire 74 in the surgical instrument 1 ′. Another yarn 83 is connected to the portions 41, 42, 51, 52 extending to the outside of the yarns 4, 5, and this yarn 83 is hooked on the hook 741.

  With such a configuration, when the ring operation portion 76 is pulled in the proximal direction, the yarns 4 and 5 are pulled through the yarn 83 as the ring support portions 71 and 72 are retracted. That is, in this embodiment, the rings 2 and 3 can be pulled together by pulling the threads 4 and 5 simultaneously with retracting the ring support portions 71 and 72 and detaching the rings 2 and 3. Therefore, the operation is further simplified, and the operation can be performed more quickly and easily.

  As described above, in this embodiment, the moving mechanism for moving the ring support portions 71 and 72 forward and backward functions as the yarn pulling means, and the ring operation portion 76 also functions as the yarn operation portion.

  The surgical instrument of the present invention has been described above with respect to the illustrated embodiment. However, the present invention is not limited to this, and each component constituting the surgical instrument has any configuration that can exhibit the same function. Can be substituted. Moreover, arbitrary components may be added.

  Further, the clip 9 is not limited to the illustrated configuration as long as the same effect (action) can be obtained, and for example, the clip 9 may not have the intersecting portion 931. That is, the clip may be such that both arms do not intersect and both arms and both clamping parts open and close simultaneously. Further, the connecting portion 96 may not be provided, and the pair of arm portions may be fixed with a member such as a pin. Further, the tightening force generation part is not limited to one that generates a tightening force by the elasticity of the arm part or the connecting part 96 itself, but may include an urging member made of an elastic body such as rubber that generates the tightening force. Good.

  Further, in the above-described embodiment, the case where the side-to-side anastomosis for performing anastomosis between the side portions of the blood vessels has been described. The present invention can also be applied to the case where an end-to-end anastomosis for anastomosing blood vessel ends is performed.

  The “incision” in the present specification is a concept including not only a notch formed on the side surface of a blood vessel but also an end portion (cut portion) of the blood vessel when performing end-side anastomosis or end-end anastomosis. is there.

1 is a perspective view showing a first embodiment of a surgical instrument of the present invention. It is a perspective view which expands and shows the front-end | tip vicinity of the surgical instrument shown in FIG. It is a perspective view which expands and shows the front-end | tip vicinity of the surgical instrument shown in FIG. It is a perspective view of the anastomosis part of the blood vessel formed using the surgical instrument shown in FIG. It is a perspective view which shows embodiment of the vascular anastomosis instrument used with the surgical instrument of this invention. It is a perspective view which shows the ring and thread | yarn in the vascular anastomosis instrument shown in FIG. It is a perspective view which shows a mode that the ring in the vascular anastomosis instrument shown in FIG. 5 is inserted in the blood vessel. It is a perspective view which shows a mode that the ring in the vascular anastomosis instrument shown in FIG. 5 is inserted in the blood vessel. It is a longitudinal cross-sectional view which shows the anastomosis part in the state when a thread | yarn is pulled from the state shown in FIG. It is a top view which shows the incision part in the state shown in FIG. It is a longitudinal cross-sectional view which shows the anastomosis part of the state which the anastomosis technique was completed. It is a top view which shows the fastener in the surgical instrument shown in FIG. It is a perspective view which expands and shows the tip vicinity of the surgical instrument of 2nd Embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1, 1 'Surgical instrument 2 Ring 21, 22, 23, 24 Thread insertion part 25, 26 Long side 3 Ring 31, 32, 33, 34 Hole 35, 36 Long side 4 Thread 41, 42 The part 44 extended outside, 45 Hanging portion 5 Thread 51, 52 Outwardly extending portion 54, 55 Hanging portion 6 Instrument body 61, 62 Arm 63 Holding portion 64 Joint 65 Crank portion 66 Fastener 661, 662 Plate piece 663 Hook portion 664 Engagement portion 67 Wire insertion part 68 Shaft insertion part 71, 72 Ring support part 711, 721 Short wire 712, 722 Long wire 73 Clip support part 731, 732 Press part 74, 75 Wire 741 Hook 76 Ring operation part 78, 79 Shaft 781 with hook 791 Hook 80 Yarn operation part 81, 82 Projection part 811, 821 Slit 83 Yarn 9 Clip 91, 92 Clamping part 911, 921 Thread insertion hole 93 Tightening force generating part 931 Intersection part 94, 95 Arm part 941 Narrow part 951 Long hole 942, 952 Pressed part 96 Connection part 10 Blood vessel 101 Incision part 102 Edge part DESCRIPTION OF SYMBOLS 103 Tube wall 20 Blood vessel 201 Incision part 202 Edge part 203 Tube wall 50 Blood vessel anastomosis instrument

Claims (25)

An instrument body;
A pair of ring support portions that are provided near the distal end of the instrument body and removably support a pair of rings respectively inserted into the blood vessels from incisions formed in the two blood vessels to be anastomosed;
Thread pulling means that pulls the thread that is spanned between the rings and connects them;
A clip support portion provided near the tip of the instrument body, and removably supporting a clip that sandwiches the outer peripheral portion of the ring via the vessel wall of the blood vessel,
The rings supported by the ring support portions are inserted into the blood vessels, and the yarn is pulled from the outside of the blood vessel by the yarn pulling means to pull the rings toward each other. A surgical instrument for anastomosing the blood vessels by attaching the clip and holding the state in which the two rings approach each other after the edge of the incision is sandwiched between the two rings.   2. The surgical instrument according to claim 1, wherein each of the ring support portions includes two wires having elasticity that are held with the base end portions aligned, and the ring is sandwiched between the wires.   The surgical instrument according to claim 2, wherein the two wires in each of the ring support portions sandwich the ring between the wires in a state where one of the wires is inserted through the inside of the ring.   The surgical instrument according to claim 2 or 3, wherein the two wires in each ring support portion have different lengths.   The surgical instrument according to claim 4, wherein the longer wire of the two wires in each ring support portion is higher in flexibility than the shorter wire.   The surgical instrument according to claim 4 or 5, wherein an outer diameter of a longer one of the two wires in each ring support portion is smaller than or substantially equal to an outer diameter of a shorter wire. A moving mechanism for moving the ring support part forward and backward with respect to the instrument body;
The surgical instrument according to any one of claims 1 to 6, wherein after the ring supported by the ring support portion is inserted into the blood vessel, the ring support portion is retracted by operation of the moving mechanism.   After inserting the ring supported by the ring support portion into the blood vessel and then retracting the ring support portion by operating the moving mechanism, the ring support portion is removed from the incision portion of the blood vessel and the The surgical instrument according to claim 7, wherein the ring is detached from the ring support portion and remains in the blood vessel.   The surgical instrument according to claim 7 or 8, wherein the thread pulling means is capable of pulling the thread independently of advancing and retreating of the ring support portion.   The surgical instrument according to claim 7 or 8, wherein the thread pulling means is configured to pull the thread in conjunction with retraction of the ring support portion.   The surgical instrument according to any one of claims 1 to 10, wherein the thread pulling unit pulls the two sets of the threads coming out of the rings substantially symmetrically through the rings.   The surgical instrument according to any one of claims 1 to 11, further comprising a guide portion that guides the yarn so that the pulling amounts of the plurality of yarns coming out of the rings are substantially equal.   The surgical instrument according to any one of claims 1 to 12, wherein the clip support portion supports the clip in an open state.   The surgical instrument according to any one of claims 1 to 13, further comprising holding means for holding the clip supported by the clip support portion and capable of releasing the held state.   The instrument body has a grip part to be gripped by hand, a thread operation part for operating the thread pulling means, and a ring operation part for advancing and retracting the ring support part relative to the instrument body. Surgical instrument according to crab.   The said instrument main body has a pair of protrusion part which protrudes in the front-end | tip direction at the front-end | tip part, The said thread | yarn has penetrated the slit formed in the said protrusion part. Surgical instruments.   The surgical instrument according to any one of claims 1 to 16, wherein when the thread is pulled by the thread pulling means, the thread acts to widen an incision formed in a side surface of the two blood vessels.   The surgical instrument according to any one of claims 1 to 17, wherein the ring has a substantially rectangular shape and is inserted into the blood vessel so that a longitudinal direction thereof substantially coincides with an incision direction of the incision portion.   The surgical instrument according to any one of claims 1 to 18, wherein at least one of the pair of rings is provided with a thread insertion portion through which the thread passes when the thread is pulled.   The surgical instrument according to any one of claims 1 to 19, wherein the thread connects the pair of rings at two or more locations.   The surgical instrument according to any one of claims 1 to 20, wherein the thread connects inner peripheral portions of the pair of rings.   The surgical instrument according to any one of claims 1 to 21, wherein the clip includes a pair of holding portions that can approach and separate from each other, and a tightening force generation portion that urges the both holding portions in an approaching direction by elasticity.   23. The surgical instrument according to claim 22, wherein the tightening force generating portion includes a pair of arms that are connected to each other at the base ends and support the clamping portion at a distal end thereof.   The both arm portions intersect each other in the middle, and when the portion closer to the proximal end than the intersecting portion is pressed against the elastic force of the tightening force generating portion and closed from the outside, the both sandwiching portions are The surgical instrument of claim 23, wherein the surgical instrument is configured to open. The surgical instrument according to any one of claims 22 to 24, wherein the clamping portion has a hole through which the thread is inserted.

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