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WO2012096280A1 - Système de suture et système endoscopique - Google Patents

Système de suture et système endoscopique Download PDF

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Publication number
WO2012096280A1
WO2012096280A1 PCT/JP2012/050329 JP2012050329W WO2012096280A1 WO 2012096280 A1 WO2012096280 A1 WO 2012096280A1 JP 2012050329 W JP2012050329 W JP 2012050329W WO 2012096280 A1 WO2012096280 A1 WO 2012096280A1
Authority
WO
WIPO (PCT)
Prior art keywords
tissue
suturing
thread
tissue penetrating
suturing system
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2012/050329
Other languages
English (en)
Japanese (ja)
Inventor
山本　哲也
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Medical Systems Corp
Original Assignee
Olympus Medical Systems Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Medical Systems Corp filed Critical Olympus Medical Systems Corp
Publication of WO2012096280A1 publication Critical patent/WO2012096280A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • A61B2017/00646—Type of implements
    • A61B2017/00663—Type of implements the implement being a suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0409—Instruments for applying suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0419—H-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06004—Means for attaching suture to needle
    • A61B2017/06009—Means for attaching suture to needle having additional means for releasably clamping the suture to the needle, e.g. actuating rod slideable within the needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066—Needles, e.g. needle tip configurations
    • A61B2017/06104—Needles, e.g. needle tip configurations interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/2833—Locking means
    • A61B2017/2837—Locking means with a locking ratchet

Definitions

  • the present invention relates to a suturing system and an endoscope system for suturing tissue.
  • This application is the application which claimed the priority based on provisional application 61/431580 for which it applied to the United States on January 11, 2011, and uses the content of the said US provisional application here.
  • the automatic suturing device described in Patent Document 1 has a structure in which needles (36, slender thread-like members) formed with pointed ends are alternately moved to the tip portions (34a, 34b) of a pair of jaws. ing.
  • the surgical needle (12) having both ends formed at the tip is a pair of jaws (18, 20), as in the automatic suturing device described in Patent Document 1 above. It has a structure that can be changed alternately.
  • the pair of arms (24a, 24b) formed in the shape of a hollow needle having a curved tip are opened and closed with respect to the tubular member (12). It has a configuration that can.
  • the thread-like suture material (30) disposed in the lumen of one arm is used as the lumen of the other arm. Sent out.
  • This structure allows the suture material to pass through the tissue. Thereafter, the device is removed from the body, and two suture materials coming out of the mouth and the like are tied outside the body to form a knot, and the suture site is ligated and sutured by a device (70) having a knot pusher function.
  • the present invention has been made in view of the above circumstances, and a suturing system and an endoscope system capable of preventing a needle-like member from dropping and damaging surrounding tissue and continuously suturing the tissue.
  • the purpose is to provide.
  • a suturing system is a suturing system comprising: an elongated thread-like member; and a suturing device that allows the elongated thread-like member to be detachable and sutures tissue using the elongated thread-like member.
  • the elongated thread-like member has a tip member, a thread-like main body portion whose one end is connected to the tip member, and whose outer diameter is set smaller than the outer diameter of the tip member, and the other end of the thread-like main body portion.
  • a tissue fixing member having one end connected to the mediation unit and disposed on the opposite side of the filamentous main body, and having an outer diameter set larger than the outer diameter of the filamentous main body.
  • the suturing device has a pair of tissue penetrating members having a lumen capable of accommodating the tip member and an opening communicating with the lumen, and the pair of tissue penetrating members is one of the tissue penetrating members. A portion of the other tissue A communicating position where the lumen of each other are made to communicate with each enters into the lumen of the member, and a separated position in which the pair of the tissue-piercing member is spaced apart from each other, the provided movable relative.
  • the tissue penetrating members are respectively fixed to a pair of jaw members that approach and separate from each other.
  • the tissue penetrating member has a slit into which the thread-like main body portion can be inserted.
  • a pair of detaching members that are disposed so as to be able to advance and retreat in the lumen of the tissue penetrating member and push out the tip member housed in the tissue penetrating member from the opening. It has.
  • the inner peripheral surface of the tissue penetrating member is locked from protruding from the inner peripheral surface and moving the distal end member of the elongated thread-like member toward the opening side.
  • the protrusion is deformed by pushing out the tip member by the removing member, and a convex portion is formed on which the tip member can get over.
  • the suturing device includes a switching mechanism for alternately moving the pair of detaching members forward and backward along the lumen of the tissue penetrating member.
  • the switching mechanism is rotated around a predetermined axis, whereby the position of the removal member in the lumen of the tissue penetrating member is set along the lumen.
  • the suturing system further includes a rotation assist mechanism that restricts the rotating member to rotate about the same direction of the predetermined axis.
  • the tissue penetrating member has the pair of tissue penetrating members positioned at the communicating position with the tissue sandwiched between the openings.
  • a blade portion capable of incising a portion of the tissue sandwiched between the openings is provided.
  • the thread main body is formed of a material having a higher tensile strength than the tissue fixing member.
  • the thread-like main body portion of the elongated thread-like member is made of metal.
  • the tissue fixing member of the elongated thread-like member is formed of resin.
  • the tip member of the elongated thread-like member is formed in a substantially spherical shape.
  • At least a part of the tip member of the elongated thread-like member is pointed like a needle.
  • the elongated thread-like member has a thread locking member that can be fixed to the tissue fixing member.
  • An endoscope system includes the suturing system and an endoscope in which a forceps channel into which the suturing device can be inserted is formed and which can observe a predetermined visual field range. Prepare.
  • the suturing device is provided with an index capable of confirming that the pair of tissue penetrating members are in the communication position.
  • the index is set so as to be positioned within the visual field range of the endoscope when the suture instrument is inserted into the forceps channel and the suture instrument is attached to the endoscope.
  • the indicator moves in conjunction with movement of the tissue penetrating member between the communication position and the separation position.
  • the treatment portion and the insertion portion of the suturing device can be substantially reduced in size and diameter. Further, it is possible to prevent the needle-like member from falling off and damaging the surrounding tissue, which can occur with a conventional suture instrument. In addition, the tissue can be continuously sutured. Furthermore, according to the endoscope system of the present invention, since the suture instrument and the endoscope are provided, the tissue can be sutured with the suture instrument while observing the front with the observation unit of the endoscope.
  • 1 is an overall view of an endoscope system according to a first embodiment of the present invention.
  • 1 is an overall view of an elongated thread-like member attached to a suture instrument of an endoscope system according to a first embodiment of the present invention. It is a plane sectional view of a treatment part of a suture instrument of a 1st embodiment of the present invention. It is side surface sectional drawing of the treatment part of the suturing device of 1st Embodiment of this invention.
  • It is a disassembled perspective view of a front-end
  • FIG. It is a principal part enlarged view of FIG. It is a side view of the principal part of the treatment part of 1st Embodiment of this invention. It is side surface sectional drawing of the principal part of the treatment part of 1st Embodiment of this invention. It is side surface sectional drawing of the operation part of the suturing device of 1st Embodiment of this invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention. It is a figure explaining the procedure using the endoscope system of a 1st embodiment of the present invention.
  • FIGS. 1 to 20 This endoscope system is a system that performs a treatment of suturing tissue with a suture instrument while observing the inside of a body cavity with an endoscope.
  • FIGS. 3, 12, 14 to 18, 29, and 31 to 34 are conceptual diagrams, and are partially different in shape from other detailed views.
  • the endoscope system 1 includes an endoscope 3, an insertion portion 4, a suture device 5, and an elongated thread-like member 24.
  • the endoscope 3 has a forceps channel 2 formed therein.
  • the suturing device 5 is configured such that a long insertion portion 4 provided on the distal end side can be inserted into the forceps channel 2.
  • the elongated thread-like member 24 is detachable from the suturing device 5 and is used for suturing tissue.
  • the suture device 5 can be used not only for a flexible endoscope but also for a surgical operation in combination with a rigid endoscope. In this case, you may make the above-mentioned insertion part 4 rigid.
  • the endoscope 3 has a long endoscope insertion portion 8 and an endoscope operation portion 9 connected to the proximal end portion of the endoscope insertion portion 8.
  • An endoscope having a known configuration is used as the endoscope 3.
  • the endoscope insertion portion 8 includes a distal end hard portion 10, a bending portion 11, and a flexible tube portion 12.
  • the tip hard portion 10 is provided at the tip.
  • the bending portion 11 can be bent and is connected to the proximal end side of the distal end hard portion 10.
  • the flexible tube portion 12 is connected to the proximal end side of the bending portion 11.
  • An illumination unit 13 that emits illumination light and an observation unit 14 that detects reflected illumination light are provided on the front surface of the distal end hard portion 10.
  • a glass fiber, an LED, or the like is used for example.
  • the observation unit 14 a member having a plurality of optical lenses and a CCD is used. Moreover, the observation unit 14 is set so that the inside of the predetermined visual field range R ahead can be observed.
  • the endoscope operation section 9 is provided with an operation dial 17 for operating the bending state of the bending section 11.
  • One end of a universal cable 18 is connected to the endoscope operation unit 9.
  • the other end of the universal cable 18 is connected to a display unit (not shown). On the display unit, an image within the field of view acquired by the observation unit 14 can be displayed.
  • the aforementioned forceps channel 2 communicates with an opening formed in the front surface of the distal end hard portion 10 and extends through the endoscope insertion portion 8 to the endoscope operation portion 9.
  • the forceps channel 2 further communicates with an opening of a forceps plug 19 provided in the endoscope operation unit 9.
  • the suturing device 5 includes the above-described insertion portion 4, a treatment portion 22, and an operation portion 23.
  • the treatment portion 22 is provided at the distal end portion of the insertion portion 4.
  • the operation unit 23 is connected to the proximal end portion of the insertion unit 4.
  • An elongated thread-like member 24 that is sutured to the tissue by the suture device 5 is detachably attached to the treatment portion 22.
  • the suturing system according to this embodiment includes a suturing device 5 and an elongated thread-like member 24.
  • the elongate thread-like member 24 has a linear main body portion 28 and a tip member 27 attached to one end portion of the main body portion 28.
  • the tip member 27 is formed in a substantially spherical shape having an outer diameter larger than that of the main body portion 28.
  • the main body portion 28 includes a thread-like main body portion 29, an intermediary portion 30, and a tissue fixing portion 31.
  • One end of the thread-like main body 29 is connected to the tip member 27, and the mediation part 30 is connected to the other end of the thread-like main body 29.
  • the tissue fixing member 31 is disposed on the opposite side of the filamentous main body 29 with the mediation portion 30 interposed therebetween, and one end thereof is connected to the mediation portion 30.
  • the thread-like main body portion 29 is formed with an outer diameter smaller than that of the tip member 27.
  • the filamentous main body 29 is formed of a material having a higher tensile strength than the tissue fixing member 31.
  • the thread-like main body 29 is made of a material having flexibility and characteristics that are harder to cut than a general suture.
  • the material is, for example, metal, and specifically, stainless steel, titanium, Ni—Ti, rubber metal ( ⁇ -type titanium alloy), gold, or composite fiber liquid crystal polymer combined with resin, carbon fiber, and the like are suitable. Can be used.
  • the filamentous main body 29 may be in any form such as a monofilament form or a multifilament form, but the multifilament form has a lower resistance during stitching.
  • the mediation part 30 has a narrow width in a cross section in a plane orthogonal to the axial direction of the thread-like main body part 29 and the tissue fixing member 31 so that the tissue can pass smoothly.
  • the tissue fixing member 31 has an outer diameter that is set to be larger than the outer diameter of the filamentous main body 29 and is configured to be long.
  • the tissue fixing member 31 is made of resin.
  • a non-absorbable thread and a suture material including an absorbent thread can also be used as a material of the tissue fixing member 31 as a material of the tissue fixing member 31, a non-absorbable thread and a suture material including an absorbent thread can also be used.
  • the other end of the tissue fixing member 31 is provided with a bar 32 disposed so as to be orthogonal to the tissue fixing member 31.
  • the bar 32 may not be provided on the elongated thread-like member 24 depending on the contents of the procedure performed using the endoscope system of the present embodiment.
  • the tip holding portion 35 is formed in a substantially cylindrical shape extending along the central axis C ⁇ b> 1 of the insertion portion 4, and is disposed on the tip side of the insertion portion 4.
  • the distal end side of the forceps operation wire 36 extending along the central axis C1 is inserted.
  • a hole 35a is provided in the vicinity of the tip of the tip holding portion 35, and a slit 35b is provided on the inner peripheral surface of the tip holding portion 35.
  • the base end portion of the slit 35b extends to the base end side from the hole 35a.
  • a pin 37 that is a first locking member (tip locking member) is disposed in the hole 35a. A part of the pin 37 protrudes into the tip holding portion 35 in a state of being inserted into the hole 35a.
  • the pin 37 is attached to the outer peripheral surface of the tip holding portion 35 by a leaf spring 38 that is an urging member. By this leaf spring 38, the pin 37 is urged in a direction to be accommodated in the hole 35a.
  • an elongated release member 39 is inserted into the slit 35b.
  • the release member 39 is a second release member (forceps release member) fixed to the tip holding portion 35 by laser welding or an adhesive.
  • the release member 39 is cut obliquely on the central axis C1 side on the base end side.
  • a cylinder portion 40a of the tip cover 40 is inserted from the tip opening side.
  • the tip cover 40 has the above-described tube portion 40a and a cover main body 40b.
  • the cylindrical portion 40 a has an outer diameter that is substantially equal to or slightly smaller than the inner diameter of the tip holding portion 35.
  • the cover main body 40b is disposed on the distal end side of the cylindrical portion 40a and is formed integrally with the cylindrical portion 40a.
  • a coil spring 41 is disposed outside the cylindrical portion 40a and urges the tip cover 40 away from the tip holding portion 35 in the direction of the central axis C1.
  • slits 40c and 40d are formed in the cylindrical portion 40a along the direction of the central axis C1.
  • the slit 40c is formed around the axis of the cylindrical portion 40a in accordance with the position where the hole 35a of the tip holding portion 35 is formed (see FIG. 4).
  • the width of the slit 40c is such that the pin 37 cannot enter (see FIG. 6), but only the base end portion 40f of the slit 40c is widened so that the tip of the pin 37 can enter.
  • the slit 40d is formed around the axis of the cylindrical portion 40a in accordance with the formation position of the slit 35b of the tip holding portion 35.
  • the width of the slit 40d is such that the release member 39 can be disposed (see FIG. 7).
  • the base end of the slit 40d extends to the base end side from the base end portion 40f of the slit 40c. Further, at the base end of the slit 40d, the inner diameter of the through-hole is increased with respect to the width of the slit 40d, and a large-diameter portion 40g communicating with the slit 40d is formed (see FIG. 7).
  • a rod 44 constituting an opening / closing mechanism is inserted into the tip cover 40 so as to be movable forward and backward in the direction of the central axis C1.
  • the distal end portion of the forceps operation wire 36 is fixed to the proximal end portion of the rod 44.
  • a concave portion 44 a extending in the radial direction is formed at a position near the proximal end of the rod 44.
  • a ball 45 as a second locking member (forceps locking member) is inserted into the recess 44a.
  • the second locking member (forceps locking member) is formed in a spherical shape, but may be formed in any shape such as a columnar shape or a prismatic shape.
  • the ball 45 is urged radially outward by a coil spring 46 disposed in the recess 44a. As shown in FIG. 7, the ball 45 is formed in such a size that it can enter the large diameter portion 40g provided at the base end portion of the slit 40d of the cylindrical portion 40a but cannot enter the slit 40d.
  • the first release member (at the tip side of the position where the ball 45 is disposed and at a position which is symmetrical with respect to the central axis C1 from the position where the ball 45 is disposed).
  • a release member 47 which is a tip release member is attached to the rod 44.
  • the release member 47 is fixed to the outer surface of the rod 44 in a state where a part protrudes radially outward.
  • a tapered surface is provided on the outer peripheral surface of the base end portion of the release member 47 so that the pin 37 can easily ride on the release member 47 when the release member 47 moves to the base end side.
  • Two link members 49 and 50 are attached to the tip of the rod 44 through pins 48 so that one end portions of each of the link members 49 and 50 are rotatable.
  • the other end of the link member 49 and the one end 52 a of the jaw member 52 are connected to each other via a pin 51 so as to be freely rotatable.
  • the jaw member 52 has a through-hole formed at a predetermined position from one end 52a to the other end 52b (see FIG. 3).
  • the jaw member 52 is pivotally supported by the tip cover 40 by allowing the through hole to engage with a pin (pivot shaft) 53 fixed to the tip cover 40.
  • the other end of the link member 50 is rotatably connected to one end 55a of the jaw member 55 by a pin 54.
  • the jaw member 55 is pivotally supported by the tip cover 40 by a pin 53.
  • the treatment portion 22 configured as described above pulls the forceps operation wire 36 to rotate the other end portion 52b of the jaw member 52 and the other end portion 55b of the jaw member 55 around the axis of the pin 53. , Can be closed close to each other. Further, by pushing the forceps operation wire 36, the other end 52b of the jaw member 52 and the other end 55b of the jaw member 55 can be opened apart from each other.
  • the tissue penetrating member 58 is formed in a curved tubular shape with a hollow structure.
  • a through hole 52 c is formed in the other end 52 b of the jaw member 52.
  • the tissue penetrating member 58 is attached to the outside of the jaw member 52 in the opening / closing direction so as to extend substantially parallel to the central axis C1.
  • the distal end side of the tissue penetrating member 58 is curved toward the other end 55b side of the jaw member 55 through the through hole 52c.
  • the lumen of the tissue penetrating member 58 is set to a size that can accommodate the distal end member 27 of the elongated thread-like member 24.
  • the tissue penetrating member 58 has a slit 58a extending from a distal end opening to a predetermined length in the axial direction of the tissue penetrating member 58.
  • the width of the slit 58a is set such that the thread-like main body 29 of the elongated thread-like member 24 can be inserted.
  • a cutting edge 59 for penetrating tissue is provided at the edge of the distal end portion of the tissue penetrating member 58 over the entire circumference except the portion where the slit 58a is formed.
  • a pusher (detaching member) 60 that is disposed so as to be able to advance and retreat in the lumen and pushes the distal end member 27 accommodated in the tissue penetrating member 58 from the opening.
  • the pusher 60 is made of a material that is flexible enough to advance and retreat along the lumen of the curved tissue penetrating member 58 and at the same time has little expansion and contraction in the axial direction of the pusher 60.
  • the proximal end side of the pusher 60 extends toward the distal end holding portion 35 side together with the proximal end side of the tissue penetrating member 58.
  • a convex portion 58 b protruding from the inner peripheral surface is formed on the inner peripheral surface on the distal end side of the tissue penetrating member 58.
  • the convex portion 58b is formed so that the tip member 27 can be moved over the opening side, and the tip member 27 deformed by pushing the tip member 27 by the pusher 60 can be overcome.
  • the convex portion 58b is formed by deforming the tissue penetrating member 58 formed in a tubular shape, but another component is attached to the tissue penetrating member 58 with an adhesive, brazing, soldering, laser processing, or the like. You may form a convex part by joining.
  • tissue penetrating member 61 is attached to the outside of the jaw member 55 in the opening / closing direction so as to extend substantially parallel to the central axis C1.
  • a tissue penetrating member 61 formed in a tubular shape is fixed to the other end portion 55 b of the jaw member 55.
  • the distal end side of the tissue penetrating member 61 is curved toward the other end 52b of the jaw member 52, and the opening at the distal end of the tissue penetrating member 61 and the opening at the distal end of the tissue penetrating member 58 are configured to face each other.
  • the tissue penetrating member 61 can accommodate the distal end member 27 of the elongated thread-like member 24 in the lumen, and the inner diameter is set to be approximately equal to the outer diameter of the tissue penetrating member 58.
  • the tissue penetrating member 61 has a slit 61 a extending from the opening at the tip to a predetermined length in the axial direction of the tissue penetrating member 61.
  • the width of the slit 61a is set in the same manner as the slit 58a.
  • a cutting edge 62 for penetrating the tissue is provided at the edge of the distal end portion of the tissue penetrating member 61 over the entire circumference except the portion where the slit 61a is formed.
  • a pusher 63 is provided in the lumen of the tissue penetrating member 61.
  • the pusher 63 is disposed so as to be able to advance and retreat in the lumen of the tissue penetrating member 61, and pushes the distal end member 27 accommodated in the tissue penetrating member 61 from the opening.
  • a convex portion 61b having the same configuration as the convex portion 58b is formed on the inner peripheral surface on the distal end side of the tissue penetrating member 61.
  • the tissue penetrating member 58 configured in this manner pulls the forceps operation wire 36 to close the jaw members 52 and 55, so that the tip of the tissue penetrating member 58 enters the lumen of the tissue penetrating member 61, and the tissue The lumen of the penetrating member 58 and the lumen of the tissue penetrating member 61 can be moved to a communicating position (see FIG. 8). Further, the tissue penetrating member 61 can be moved to a spaced position (see FIG. 13) where the openings of the tissue penetrating members 58 and 61 are separated from each other by pushing the forceps operation wire 36 to open the jaw members 52 and 55. .
  • tissue penetrating members 58 and 61 When the tissue penetrating members 58 and 61 are disposed at the communication position in a state where the tissue is sandwiched between the openings of the tissue penetrating members 58 and 61, a portion of the tissue sandwiched between the openings by the cutting blades 59 and 62 An incision can be made.
  • the switching member (rotating member) 67 is formed in a substantially cylindrical shape and is rotatably disposed on the outer peripheral surface of the tip holding portion 35.
  • the position of the pin 68 attached to the outer peripheral surface of the tip cover 40 is shifted by 90 ° around the central axis C1 with respect to the position of the pin 68 in FIG. Is written.
  • the switching member 67 is configured to be attachable to and detachable from the tip holding portion 35.
  • Contact surface 69a, 69b, 69c which the base end parts 60a and 63a of pusher 60 and 63 contact
  • the contact surface which is not shown in figure is formed also in the part on the opposite side of the front-end
  • a cam groove 70 is formed on the inner peripheral surface of the switching member 67, and the pin 68 engages with the cam groove 70 so as to be slidable within the cam groove 70.
  • the cam groove 70 includes a parallel cam groove 70a formed substantially parallel to the central axis C1 and an inclined cam groove 70b that moves toward the proximal end as it rotates in the direction D1 with respect to the central axis C1 around the central axis C1. It is configured to be connected alternately. In the present embodiment, for example, four parallel cam grooves 70a and four inclined cam grooves 70b arranged at equal angles around the central axis C1 are alternately connected.
  • a plurality of mountain-shaped bodies 71 and 72 are provided integrally with the switching member 67 on the distal end side and the proximal end side of the switching member 67.
  • the mountain-shaped bodies 71 and 72 are continuously formed in a mountain shape around the central axis C1 at equal angles.
  • four parallel cam grooves 70 a are formed in the switching member 67. Therefore, the mountain-shaped bodies 71 and 72 are provided, for example, at equal angles around the central axis C1 by 12 that is a multiple of 4. For this reason, the angle which the top part 72a of the adjacent mountain-shaped body 72 makes around the central axis C1 is 30 °.
  • the mountain-like bodies 73 and 74 formed in a mountain shape corresponding to the mountain-like bodies 71 and 72 at positions opposite to the mountain-like bodies 71 and 72 are equiangularly around the central axis C1.
  • the valley 74a of the mountain 74 that engages the top 72a of the mountain 72 is around the direction D1 of the central axis C1 from the position moved from the top 72a of the mountain 72 to the proximal end in the direction of the central axis C1. It is arranged at a position moved by a predetermined angle. Since the mountain-shaped body 74 is also provided around the central axis C1 every 30 °, the predetermined angle can be 8 °, which is a value smaller than half of 30 °, for example.
  • the mountain-like body 73 is also disposed at a position where the position in the direction of the central axis C1 relative to the mountain-like body 71 is moved by a predetermined angle around the central axis C1. Then, as the pin 68 moves in the cam groove 70, the switching member 67 is formed to rotate intermittently around the direction D1.
  • the switching member 67 does not rotate around the central axis C1, but the pin 68 side rotates.
  • the switching member 67 does not rotate when the pin 68 moves to the proximal end side as indicated by the arrow A1 in the parallel cam groove 70a. Then, when the pin 68 reaches the position Q1 in the parallel cam groove 70a and moves to the base end side together with the switching member 67 as will be described later, the mountain body 72 and the mountain body 74 are engaged, The switch member 67 is rotated by 8 ° around the direction D2 opposite to the direction D1 with respect to the central axis C1, and reaches the position Q2. Actually, the switching member 67 rotates in the direction D1. Thereafter, when the pin 68 moves to the tip end side as indicated by the arrow A2, the switching member 67 rotates in the direction D1 by the pin 68 coming into contact with the inclined cam groove 70b.
  • the cam groove 70 and the pin 68 constitute a cam mechanism that rotates the switching member 67 around the central axis C1.
  • the switching member 67 and the cam mechanism constitute a switching mechanism for alternately moving the pushers 60 and 63 back and forth.
  • the mountain-like bodies 71 to 74 constitute a rotation assist mechanism that restricts the switching member 67 to rotate around the same direction of the central axis C1.
  • the insertion portion 4 has a sheath 80 that is flexible and formed in a tubular shape.
  • the aforementioned distal end holding portion 35 is attached to the distal end of the sheath 80.
  • a forceps operation wire 36 is inserted into the sheath 80 so as to be able to advance and retreat.
  • the proximal end portion of the sheath 80 is connected to the distal end side of the substantially rod-shaped operation portion body 84.
  • a wire operation slider 86 is attached to the operation portion body 84 so as to be able to advance and retract.
  • a proximal end portion of the forceps operation wire 36 is attached to the wire operation slider 86.
  • the operation unit 23 has a ratchet mechanism.
  • the button 87 When the button 87 is pushed in as shown in FIG. 11, the ratchet mechanism is released. Then, the locking portion 87 a formed on the button 87 is separated from the notch member 91 formed on the operation portion body 84, and the wire operation slider 86 can be freely advanced and retracted with respect to the operation portion body 84.
  • the stopper 88 formed on the button 87 is removed from the engaging portion 89 formed on the wire operation slider 86, and the button 87 is slid into the pulled-out state. Then, the locking portion 87a urged in the radial direction by the spring 90 moves in the radial direction, the locking portion 87a engages with the notch member 91 of the operation portion body 84, and the wire operation slider 86 is It can move only to the base end side with respect to the body 84. Thereby, the jaw members 52 and 55 cannot move in the opening direction.
  • the target site is not limited to this, and may be a luminal organ such as the esophagus, duodenum, small intestine, large intestine, uterus, and bladder.
  • the natural opening into which the endoscope 3 is inserted is not limited to the mouth but may be the nose or the anus.
  • it may be used for the treatment of hemorrhage such as perforation due to ulcer, mucosal defect part, digestive tract diverticulum and the like.
  • the surgeon inserts the insertion unit 4 of the suture device 5 into the forceps channel 2 of the endoscope 3 and attaches the suture device 5 to the endoscope 3. Then, the suture device 5 is inserted into the stomach through the patient's mouth together with the endoscope 3.
  • the suturing device 5 is directly fixed to the endoscope 3 and used. Also good.
  • the jaw members 52 and 55 are opened in the stomach prior to suturing.
  • the surgeon pushes the wire operation slider 86 of the operation unit 23 shown in FIG.
  • the forceps operation wire 36 moves forward, and the link members 49 and 50 connected to the rod 44 rotate the jaw members 52 and 55 around the pin 53.
  • the jaw members 52 and 55 are opened, and the openings of the tissue penetrating members 58 and 61 are arranged at spaced apart positions.
  • the position and orientation of the operation unit 23 are adjusted, and the opened jaw members 52 and 55 are brought close to the opening W1 of the patient P that is the evening-getting part.
  • the wire operation slider 86 is pulled back so as to squeeze the tissue W2 on one side with respect to the opening W1 by the jaw members 52 and 55.
  • the forceps operation wire 36 is retracted together with the link members 49 and 50, and the jaw members 52 and 55 are rotated around the pin 53 and closed. Then, the tissue penetrating members 58 and 61 fixed to the jaw members 52 and 55 are moved to the communication position with the tissue W2 sandwiched between the respective openings and inserted into the tissue W2, and the tissue penetrating member 58, 61 lumens communicate with each other. It should be noted that puncture can be performed with the same operation even when the suture target is not an opening shape but a flat portion.
  • the distal end member 27 moves from the tissue penetrating member 61 to the tissue penetrating member 58, and the filamentous main body 29 passes through the tissue W2.
  • the proximal end portion 60a of the pusher 60 does not contact the contact surfaces 69a, 69b, 69c, the pusher 60 is at the same position inside the tissue penetrating member 58.
  • the switching member 67 does not rotate around the central axis C1 when the pin 68 moves in the direction of the arrow A1, but when the pin 68 reaches the proximal end of the cam groove 70, the pin 68 is engaged with the cam groove 70.
  • the pin 68 and the switching member 67 are integrally moved to the proximal end side.
  • the mountain-shaped body 72 and the mountain-shaped body 74 come into contact with each other, and the switching member 67 rotates by a predetermined angle in the direction D1 of FIG. Thereafter, the moving direction of the pin 68 is switched from the arrow A1 to the arrow A2.
  • FIG. 4 shows a state in which the cylindrical portion 40a and the rod 44 are connected.
  • the operation of opening the jaw members 52 and 55 will be described.
  • the integrated tip cover 40 and rod 44 move to the tip side.
  • the switching member 67 rotates in the direction D1 in FIG. 9, and the contact surface of the proximal end portion 63a of the pusher 63 is changed from the contact surface 69a to the contact surface 69c by the rotation. , Switching through the contact surface 69b.
  • the angle at which the switching member 67 rotates about the central axis C1 is generally 90 ° rotation, but may be other than 90 ° depending on use conditions.
  • the pin 68 reaches the distal end side of the cam groove 70, whereby the pin 68 and the switching member 67 move together to the distal end side. Due to this movement, the mountain-shaped body 73 and the mountain-shaped body 71 come into contact with each other, the switching member 67 rotates by a predetermined angle in the direction D1, and the pin 68 engages with a portion (not shown) of the cam groove 70.
  • the ball 45 is pushed up by the release member 39, the engagement between the rod 44 and the tip cover 40 is released, and the jaw members 52 and 55 are opened.
  • the release member 47 moves to the proximal end side in parallel to the central axis C1.
  • the pin 37 enters the proximal end portion 40f of the slit 40c formed in the tip cover 40 through the hole 35a of the tip holding portion 35, and the tip cover 40 and the tip holding portion 35 are integrated.
  • the protrusions of the pusher 60 and the pusher 63 are repeatedly switched alternately so that the distal end member 27 moves alternately between the tissue penetrating member 58 and the tissue penetrating member 61.
  • the tissue W2 on one side and the tissue W3 on the other side with respect to the opening W1 can be alternately sutured by the elongated thread-like member 24.
  • the opening 5 may be closed by moving the suturing device 5 to the proximal end side.
  • the tip member 27 has a substantially spherical shape. Therefore, for example, even if the distal end member 27 falls off, it is possible to prevent the needle-like member from dropping off and damaging the surrounding tissue as in a conventional suture instrument. Further, the tissue can be continuously sutured by repeatedly delivering the tip member 27 between the tissue penetrating members 58 and 61.
  • the elongated thread-like member 24 has a tip member 27 and a thread-like main body portion 29 having an outer diameter smaller than that of the tip member 27. Therefore, the thread-like main body portion 29 is formed in a hole formed by penetrating the tip member 27 into the tissue. Can be reliably inserted.
  • the tissue penetrating member 58 is fixed to the jaw member 52, and the tissue penetrating member 61 is fixed to the jaw member 55. For this reason, by moving the jaw members 52 and 55 closer to and away from each other, the position of the tissue penetrating members 58 and 61 can be easily moved between the communication position and the separation position, and the elongated thread-like member 24 can be easily sutured. be able to.
  • the tissue penetrating member 58 has a slit 58a into which the thread-like main body portion 29 of the elongated thread-like member 24 can be inserted.
  • the tissue penetrating member 58 passes through the slit-like body portion 29 connected to the distal end member 27 accommodated in the lumen of the tissue penetrating member 58 through the slit 58a. Lead outside. As a result, it is possible to prevent the filamentous main body 29 from interfering with the movement of the distal end member 27 in the lumen of the tissue penetrating member 58.
  • the suture instrument 5 includes the pushers 60 and 63, the distal end member 27 in the tissue penetrating members 58 and 61 can be easily pushed out from the opening.
  • the distal end member 27 accommodated on the proximal end side from the convex portion 58 b in the lumen of the tissue penetrating member 58 is mistakenly inserted into the tissue penetrating member 58. Prevents falling off from the tip side of the. Then, if necessary, the distal end member 27 can be ejected from the distal end side of the tissue penetrating member 58 by pushing the distal end member 27 with the pusher 60.
  • the pushers 60 and 63 can be easily advanced and retracted along the lumens of the tissue penetrating members 58 and 61. Since the switching mechanism includes the switching member 67 and the cam mechanism, the pushers 60 and 63 can be advanced and retracted only by rotating the switching member 67 around the central axis C1 by the cam mechanism. Since the switching mechanism has a rotation assist mechanism that restricts the switching member 67 to rotate about the same direction of the central axis C1, the movement of the switching member 67 can be stabilized.
  • a cutting edge 59 is provided at the distal end portion of the tissue penetrating member 58, and a cutting edge 62 is provided at the distal end portion of the tissue penetrating member 61. Therefore, when the tissue penetrating members 58 and 61 are disposed at the communication position, the tissue sandwiched between the tissue penetrating member 58 and the tissue penetrating member 61 can be easily penetrated by the cutting blades 59 and 62.
  • the outer diameter can be set smaller than the outer diameter of the tissue fixing member 31.
  • the tip member 27 which is a member which moves back and forth between tissues at the time of suturing can be designed small. Therefore, the tissue penetrating members 58 and 61 that operate in cooperation with the distal end member 27 can also be reduced in size. As a result, the treatment portion 22 and the insertion portion 4 of the suturing device 5 can be substantially reduced in size and diameter.
  • the tissue penetrating members 58 and 61 can selectively grasp a site to be sutured in the tissue.
  • the tissue penetrating members 58 and 61 are configured so that the tissue does not fall off the tissue penetrating members 58 and 61.
  • the tissue can be reliably penetrated.
  • the thread-like main body 29 is made of metal, it is possible to prevent the thread-like main body 29 from being cut during the procedure.
  • the tissue fixing member 31 is made of resin, the tissue fixing member 31 can be bent along the shape of the sutured tissue. Since the tip member 27 is formed in a substantially spherical shape, it is possible to reduce the invasion given to surrounding tissues when the tip member 27 is accidentally dropped.
  • the endoscope system 1 includes the suturing device 5 and the endoscope 3, the tissue can be sutured with the suturing device 5 while observing the front with the observation unit 14 of the endoscope 3.
  • an elongated thread-like member 94 shown in FIG. 19 may be used instead of the elongated thread-like member 24.
  • the elongated thread-like member 94 includes a distal end member 95 instead of the distal end member 27 of the elongated thread-like member 24.
  • the tip member 95 is formed in a substantially cylindrical shape extending in a direction substantially orthogonal to the thread-like main body portion 29, and needle-pointed portions, more specifically conical pointed portions 95a and 95b, are formed at both ends of the tip member 95. ing.
  • the elongated thread-like member 94 is loaded into the suturing device 5 in the same manner as the elongated thread-like member 24.
  • the elongated thread-like member 94 By configuring the elongated thread-like member 94 in this way, when the tissue penetrating members 58 and 61 penetrate the tissue at the time of tissue puncture by the suturing device 5 and the lumens of the tissue penetrating members 58 and 61 communicate with each other, the apex It becomes easy to puncture the tissue by the portions 95a and 95b.
  • the pointed portion may be formed only at one end of the tip member 95.
  • the inner diameter of the tissue penetrating member 61 on the proximal side from the convex portion 61b may be substantially equal to the inner diameter of the tissue penetrating member 58 on the distal side from the convex portion 58b. With this configuration, the distal end member 27 can move between the tissue penetrating member 58 and the tissue penetrating member 61 more smoothly.
  • the endoscope system of this embodiment includes the endoscope 3 of the above embodiment, the elongated thread-like member 105 shown in FIG. 21, the suturing device 5 of the above embodiment, and the pusher tube 113 shown in FIG. Yes.
  • the elongated thread-like member 105 is detachably attached to the treatment portion 22 of the suturing device 5. As shown in FIG. 21, the elongated thread-like member 105 includes a mediating part 106 instead of the mediating part 30 of the elongated thread-like member 24, and a thread locking member 107 that can be fixed to the tissue fixing member 31.
  • a slit 106a having a predetermined length is formed along the longitudinal direction from the end on the tissue fixing member 31 side.
  • a plurality of slits 106 a are provided around the axis of the tissue fixing member 31.
  • a taper portion 106b whose outer diameter decreases toward the thread-like main body portion 29 side is formed in the portion on the thread-like main body portion 29 side in the mediation portion 106.
  • the thread locking member 107 has thread fixing parts 108 and 109 and a folding part 110.
  • the thread fixing portions 108 and 109 are formed in a cylindrical shape, are arranged at a predetermined distance from each other, and the tissue fixing member 31 is inserted therein. Both ends of the folding unit 110 are connected to the thread fixing units 108 and 109.
  • a plurality of folding sections 110 are provided around the axis of the tissue fixing member 31. 21 and 22, the folding part 110 is a bent part 110a formed near the center of the folding part 110.
  • the folding part 110 is wide in the axial direction and in the direction orthogonal to the axial direction. It can be folded so that
  • the thread fixing portion 108 is formed with a tongue-shaped stopper 108a bent toward the tissue fixing member 31 side. Then, the tip of the stopper 108a contacts the outer peripheral surface of the tissue fixing member 31, so that the thread fixing portion 108 can move from the tip member 27 side to the bar 32 side with respect to the tissue fixing member 31, It is configured not to move from the bar 32 side to the tip member 27 side.
  • a stopper 109a is also formed in the thread fixing portion 109 similarly to the thread fixing portion 108, and the movement of the thread fixing portion 109 with respect to the tissue fixing member 31 is similarly restricted. Further, as shown in FIGS. 24 and 25, a convex portion 109 b formed integrally or separately with the thread fixing portion 109 can be fitted into the slit 106 a formed in the mediating portion 106. .
  • a stopper (not shown) is used so that the mediating portion 106 and the thread locking member 107 are not easily detached, or a press-fitting is performed when the convex portion 109b is inserted into the slit 106a so that the slit 106a and the convex portion are not convex. Friction resistance is generated between the portion 109b and the like.
  • the suturing device 5 of the present embodiment includes a pusher tube 113 shown in FIG. 26 and an operation unit as shown in FIG. 23 is provided with a pusher tube operation section 85 arranged at 23.
  • the pusher tube 113 has a pusher main body 114 formed in a long tubular shape, and a ring-shaped pusher front end portion 115 fixed to the front end of the pusher main body 114.
  • the pusher tip portion 115 is provided with a pair of projecting portions 116 that project inward from the inner peripheral surface of the pusher tip portion 115 with a certain distance from each other.
  • a slit 117 is formed between the pair of protruding portions 116 along the central axis C1 and through which the thread-like main body 29 of the elongated thread-like member 105 can pass.
  • a plurality of convex portions 118 (three convex portions 118 in the present embodiment) are formed on the front surfaces of the pair of projecting portions 116 so as to be spaced apart from each other and project toward the distal end side.
  • the elongated thread-like member 105 and the pusher tube 113 configured as described above are, as shown in FIG. 28, the thread-like main body part with the thread locking member 107 fitted to the mediating part 106 of the elongated thread-like member 105. 29 is disposed in the slit 117, and the mediating portion 106 is disposed on the distal end side of the filamentous main body portion 29. Then, by pulling the thread-like main body portion 29 toward the proximal end with a predetermined strength, the mediating portion 106 can be automatically inserted between the pair of protruding portions 116 by the tapered portion 106b.
  • the thread locking member 107 is separated from the mediation portion 106 and the mediation portion 106 is pulled into the pusher tube 113 as shown in FIG. It is. Along with this, the protrusion 109 b is inserted between the protrusions 118, whereby the thread fixing portion 109 of the thread locking member 107 is locked to the pusher tip 115.
  • the fixing portion 108 moves to the proximal end side of the suture instrument 5 in a state where the yarn fixing portion 109 is fixed to the pusher tip portion 115.
  • the folding part 110 is folded, and the thread fixing part 108 comes into contact with the thread fixing part 109.
  • the pusher tube operation unit 85 is attached to the operation unit body 84 so as to be able to advance and retreat.
  • a proximal end portion of the pusher tube 113 is attached to the pusher tube operation portion 85.
  • the surgeon pulls the operation portion body 84 against the pusher tube operation portion 85 of the suturing device 5 of the present embodiment to push the treatment portion 22 into the pusher. It is accommodated in the tube 113.
  • the operator further operates the operation portion 23 to place the thread-like main body portion 29 of the elongated thread-like member 105 between the pair of protrusions 116 of the pusher tube 113.
  • the operation portion body 84 is further pulled to the proximal end side, the thread engaging member 107 is fitted to the mediation portion 106, and the mediation portion 106 is interposed between the pair of projecting portions 116. insert.
  • the mediation portion 106 is pulled into the pusher tube 113 as shown in FIG.
  • the thread locking member 107 is locked to the pusher tip portion 115, and the tissues W2 and W3 are tightly bound by the thread locking member 107 and the bar 32 in which the folded portion 110 is folded.
  • the position of the thread locking member 107 with respect to the tissue fixing member 31 is fixed by the thread fixing portions 108 and 109.
  • the pusher tube operation portion 85 is pulled to expose the treatment portion 22 from the pusher tube 113 as shown in FIG. 33, and the wire operation slider 86 is pushed in, so that the jaw members 52, 55 are shown in FIG. Open.
  • the distal end member 27 is removed from the tissue penetrating members 58 and 61, and the elongated thread-like member 105 to which the tissues W2 and W3 are bound is placed in the body of the patient P.
  • the tissue can be continuously sutured while preventing the tissue from being damaged.
  • stitch for convenience of explanation, only one stitch (seam) is described or illustrated, but it goes without saying that a plurality of stitches can be stitched at a time.
  • the elongated thread-like member 105 has a thread locking member 107 that can be fixed to the tissue fixing member 31, the tissue sutured by the tissue fixing member 31 can be fixed in a state of being tightly bound by the thread locking member 107. it can.
  • the thread fixing portions 108 and 109 may be formed integrally with the plurality of folding portions 110.
  • the index 121 may be provided on the jaw members 52 and 55, and the index 122 may be provided on the tip cover 40.
  • the jaw members 52 and 55 are closed and the openings of the tissue penetrating members 58 and 61 are in the communicating position with each other, the index 121 and the index 122 are aligned on the same straight line. You may comprise so that the position of 61 can be confirmed.
  • the index 121 can be provided by being stamped or printed on the jaw members 52 and 55, or can be provided by being integrally formed with the jaw members 52 and 55.
  • the index 122 is also provided on the tip cover 40 in the same manner. With this configuration, when the tissue penetrating members 58 and 61 move between the communication position and the separation position, the index 121 moves in conjunction with each other.
  • the index set that is a set of the index 121 and the index 122 is aligned on the same straight line when the tissue penetrating members 58 and 61 are in the communication position. For this reason, the tip member 27 is moved safely and reliably by moving the tip member 27 between the tissue penetrating member 58 and the tissue penetrating member 61 when the indicator 121 and the indicator 122 are aligned on the same straight line. be able to.
  • the suture instrument when used in a place where the treatment unit 22 of the suture instrument cannot be directly visually recognized, such as in a body cavity of a patient, the suture instrument is inserted into the forceps channel 2 and the suture instrument is inserted into the endoscope. 3 is set so that the index set is positioned within the field-of-view range R of the endoscope 3. With this configuration, the index set provided in the treatment unit 22 can be observed by the observation unit 14 of the endoscope 3.
  • index set may be provided in one place, or the index set may be provided in the operation unit body 84, the pusher tube operation unit 85, the wire operation slider 86, and the like of the operation unit 23.
  • an elongated thread member 125 as shown in FIG. 37 may be used instead of the elongated thread member 24.
  • the elongated thread-like member 125 includes a mediating part 126 in place of the mediating part 30 of the elongated thread-like member 24, and a tissue fixing member 127 that is a commercially available suture instead of the tissue fixing member 31.
  • the mediation portion 126 has a hole 126a through which the tissue fixing member 127 is passed.
  • the end portion of the tissue fixing member 127 is fixed to the mediation portion 126 with a knot 127a or the like.
  • At least one step 126b is formed in the mediation portion 126, and the puncture resistance of the tissue fixing member 127 fixed to the mediation portion 126 can be reduced by the step 126b.
  • the mediation portion 126 is formed with tapered portions 126c and 126d whose outer diameters become thinner toward the end portion for the purpose of reducing tissue resistance during puncturing.
  • tissue fixing member 127 which is a commercially available thread, as a part of the elongated thread-like member 125, so that versatility can be improved and cost can be reduced.
  • the materials of the component parts of the suturing device 5 and the elongated thread-like member described above are made of generally known materials. That is, as long as it is a metal material, it is made of stainless steel, titanium, titanium alloy, Ni—Ti metal, ⁇ titanium alloy, aluminum, gold, copper, brass, or the like. If it is a resin material, it is comprised with biocompatible resin, for example, a polyimide, polyetheretherketone, polysulfone, a liquid crystal polymer, and polyamide. In the case of a ceramic material, it is composed of biocompatible alumina, silicon nitride or the like.
  • the present invention it is possible to prevent the needle-like member from falling off and damaging the surrounding tissue like a conventional suture instrument.
  • the tissue can be continuously sutured.

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Abstract

La présente invention concerne un système de suture comprenant une partie en forme de filament fin (24) et un instrument de suture (5) auquel la partie en forme de filament fin (24) peut être attachée et détachée et qui sert à suturer un tissu en utilisant la partie en forme de filament fin (24), la partie en forme de filament fin (24) comprenant : une partie d'extrémité avant (27) ; une partie en forme de filament principale (29), dont une extrémité est raccordée à la partie d'extrémité avant (27) et le diamètre externe est plus petit que le diamètre externe de la partie d'extrémité avant (27) ; une partie de médiateur (30) raccordée à l'autre extrémité de la partie principale en forme de filament (29) ; et une partie de fixation de tissu (31), dont une extrémité est raccordée à la partie de médiateur (30) et est disposée sur le côté opposé à la partie principale en forme de filament (29) et dont le diamètre externe est plus grand que le diamètre externe de la partie principale en forme de filament (29). L'instrument de suture (5) a une paire de parties de perçage de tissu (58) avec des lumières capables de loger la partie d'extrémité avant (27) et des ouvertures qui communiquent avec lesdites lumières.
PCT/JP2012/050329 2011-01-11 2012-01-11 Système de suture et système endoscopique Ceased WO2012096280A1 (fr)

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Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2829240A1 (fr) * 2013-07-26 2015-01-28 Landanger Dispositif chirurgical
CN105358075A (zh) * 2014-01-14 2016-02-24 奥林巴斯株式会社 保持装置
US9775710B2 (en) 2015-01-27 2017-10-03 Landanger Surgical device
US11304691B2 (en) 2016-11-13 2022-04-19 Anchora Medical Ltd. Minimally-invasive tissue suturing device
CN114767189A (zh) * 2022-05-13 2022-07-22 中南大学 内镜下负压连续缝合器
WO2022232157A1 (fr) * 2021-04-26 2022-11-03 Boston Scientific Scimed, Inc. Dispositif de fermeture à base de suture

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4236470A (en) * 1979-01-17 1980-12-02 Stenson Thomas K Portable stitching device
JPH0336897U (fr) * 1989-08-21 1991-04-10
JPH05237123A (ja) * 1991-09-30 1993-09-17 Margaret Pamela Richardson 縫合装置
JPH07155332A (ja) * 1993-10-08 1995-06-20 United States Surgical Corp 装填機構を備えた手術用縫合装置
JPH09313495A (ja) * 1996-02-09 1997-12-09 Ethicon Inc 縫合装置において用いるための剛性化縫合糸
JP2001500765A (ja) * 1996-09-23 2001-01-23 シンバイオシス コーポレイション 自動針受渡し縫合器
JP2010036034A (ja) * 2008-07-31 2010-02-18 Olympus Medical Systems Corp 縫合器

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4236470A (en) * 1979-01-17 1980-12-02 Stenson Thomas K Portable stitching device
JPH0336897U (fr) * 1989-08-21 1991-04-10
JPH05237123A (ja) * 1991-09-30 1993-09-17 Margaret Pamela Richardson 縫合装置
JPH07155332A (ja) * 1993-10-08 1995-06-20 United States Surgical Corp 装填機構を備えた手術用縫合装置
JPH09313495A (ja) * 1996-02-09 1997-12-09 Ethicon Inc 縫合装置において用いるための剛性化縫合糸
JP2001500765A (ja) * 1996-09-23 2001-01-23 シンバイオシス コーポレイション 自動針受渡し縫合器
JP2010036034A (ja) * 2008-07-31 2010-02-18 Olympus Medical Systems Corp 縫合器

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2829240A1 (fr) * 2013-07-26 2015-01-28 Landanger Dispositif chirurgical
FR3008885A1 (fr) * 2013-07-26 2015-01-30 Landanger Dispositif chirurgical notamment pour la pose de prothese de cordage mitrale
CN105358075A (zh) * 2014-01-14 2016-02-24 奥林巴斯株式会社 保持装置
US9775710B2 (en) 2015-01-27 2017-10-03 Landanger Surgical device
US11304691B2 (en) 2016-11-13 2022-04-19 Anchora Medical Ltd. Minimally-invasive tissue suturing device
US12011160B2 (en) 2016-11-13 2024-06-18 Anchora Medical Ltd. Minimally-invasive tissue suturing device
WO2022232157A1 (fr) * 2021-04-26 2022-11-03 Boston Scientific Scimed, Inc. Dispositif de fermeture à base de suture
US12251098B2 (en) 2021-04-26 2025-03-18 Boston Scientific Scimed, Inc. Suture based closure device
EP4649896A3 (fr) * 2021-04-26 2025-12-10 Boston Scientific Scimed, Inc. Dispositif de fermeture à base de suture
CN114767189A (zh) * 2022-05-13 2022-07-22 中南大学 内镜下负压连续缝合器

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