JP2002360583A - Stitching tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a stitching tool capable of reducing a time for medical operation by easily performing stitching operation though there is not a sufficient space in the periphery of a stitching part. SOLUTION: The stitching tool 1 is provided with a coat pipe 3 which can be inserted to a lumen in a body, a stitching needle 9 inserted into the channel 4 of the pipe 3 in the state of being movable forward and backward, a grasping part 2 provided on the hand side of the pipe 3 and having an operation means 13 for forward/backward moving operation of the needle 9, and a stitching thread guiding part 12 for guiding the stitching thread 11 held at the tip of the needle 9 to the part 2. The needle 9 consists of a piercing part 6 at a tip which can project and sink from the tip opening 5 of the channel 4 of the pipe 3, an elastic part 7 which is connected to the base end of this part 6 and can be curved in a prescribed direction and a lengthy axis part 8 connected to the base end of this part 7.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a suturing tool used for suturing a living tissue.

[0002]

2. Description of the Related Art Conventionally, as a technique for suturing luminal organs,
A device using metal staples is known. However, in the case of suturing a hollow organ having a small inner diameter, a tissue staple to be sewn is relatively large, so that it is not possible to easily sew the staple using metal staples.

[0003] Therefore, an operator performs a manual suturing operation using a suture needle, a suture, or the like.
For example, in the pelvic cavity, since the surrounding space is narrow and the suturing operation is difficult, there is a problem that the operation time is lengthened, the burden on the patient's body is increased, and the operator's fatigue is also increased.

For this reason, US Pat. No. 5,308,353 has proposed a suturing tool which can sew in a narrow place. The suturing tool disclosed in U.S. Pat. No. 5,308,353 is configured such that a hook-shaped (arc-shaped) suturing needle is rotatably attached to a long shaft member.

[0005]

However, US Pat.
No. 8353 proposes a suturing tool in which a suture needle is simply attached to a long shaft member, and the suture needle itself cannot move independently with respect to the long shaft member. Move together). So, like the pelvic cavity,
In the case where the approach from the body cavity side can be obtained from only one direction, if the long shaft member interferes with the surrounding tissue and the movement is restricted, it is difficult to move the suture needle at the tip as desired . Therefore, it is difficult to perform a suturing operation for anastomosis that requires complicated movement.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances. It is an object of the present invention to easily perform a suturing operation even if there is not enough space around a suturing portion, and to reduce operation time. It is to provide a suturing tool that can be used.

[0007]

In order to solve the above-mentioned problems, a suturing instrument according to the present invention has an outer tube which can be inserted into a body lumen, and is inserted and retracted into a channel of the outer tube. A suturing needle, a grasping portion provided on the proximal side of the mantle tube and having operating means for performing an operation of moving the suturing needle forward and backward, and a suture thread for guiding a suture held at the tip of the puncture needle to the grasping portion A guide portion, wherein the suture needle has a puncture portion at a distal end which can protrude and retract from a distal end opening of the channel of the mantle tube, and an elastic portion connected to a base end of the puncture portion and capable of bending in a predetermined direction. And an elongated shaft portion connected to the base end of the elastic portion.

[0008]

Embodiments of the present invention will be described below with reference to the drawings.

FIGS. 1 to 5 show a first embodiment of the present invention. As shown in FIGS. 1 to 3, the suturing tool 1 of the present embodiment includes a grip portion 2 for holding by an operator, and a channel 4 connected to the grip portion 2 and extending over the entire length thereof.
And a suture needle 9 inserted into the channel 4 of the mantle tube 3. Suture needle 9
Is a puncture portion 6 protruding from the distal end opening 5 of the channel 4 of the mantle tube 3, an elastic portion 7 connected to the proximal end side of the puncture portion 6, and a long elongate extending from the proximal end of the elastic portion 7. And a shaft portion 8.

The puncture portion 6 of the suture needle 9 is provided with a through hole 10 through which a suture 11 passes. The elastic portion 7 of the suturing needle 9 has a bending tendency in one direction. In the channel 4, the elastic portion 7 is pressed by the inner surface of the channel 4 and held in a substantially linear shape. In the state in which is not acting, it bends in one direction. The portion of the channel 4 between the inner surface of the mantle tube 3 and the shaft portion 8 of the suture needle 9 extends from the hole 10 of the puncture portion 6 to the grip portion 2.
The suture guide portion 12 guides the suture 11 toward.

The grip 2 is provided with an operation knob (operation means) 13 slidable along the longitudinal axis direction of the mantle tube 3. In this case, the operation knob 13 is engaged with a slit 50 provided in the grip portion 2, and the sliding movement is guided by the slit 50.

A proximal end of the suture needle 9 is connected to the operation knob 13. Therefore, when the operation knob 13 is slid in the axial direction with respect to the grip portion 2, the suturing needle 9
Move in the front-rear direction (the longitudinal axis direction of the mantle tube 3).

Next, FIG. 4 for explaining the operation of the suturing device 1 having the above-described configuration shows an arrangement state of each device when the human urethra is anastomosed by using the suturing device 1. As shown,
The mantle tube 3 of the suture instrument 1 is inserted into the urethra 16 from the perineum 14 through the external urethral opening 15. Further, a pair of trocars 18 is placed so as to penetrate the abdominal wall 17.
An endoscope 19 is inserted into the abdominal cavity 21 via one trocar 18, and a laparoscopic surgical treatment tool 20 such as forceps is inserted into the abdominal cavity 21 via the other trocar 18. The endoscope 19 is connected to a television camera device (not shown) via the camera head 24, so that the image of the endoscope 19 can be observed on a television screen.

FIG. 5 shows an enlarged procedure for performing an anastomosis operation in the arrangement state of FIG. First, FIG.
As shown in (1), the distal end of the mantle tube 3 of the suture instrument 1 is positioned at one cut end 23a of the cut portion 23 of the urethra 16.
Then, in this state, the operation knob 13 is slid forward to cause the puncture portion 6 of the suture needle 9 to protrude from the outer tube 3. At this time, the puncture needle 6 is directed toward the wall portion 25 of the urethra 16 by the action of the curved elastic portion 7 as the elastic portion 7 having a curl in one direction protrudes from the mantle tube 3, and the puncture is performed. The first puncture by the part 6 is performed. That is, the puncture portion 6 penetrates the wall portion 25 of the urethra 16, and the tip of the suture 11 passed through the hole 10 of the puncture portion 6 is introduced to the outside of the urethra 16, that is, into the abdominal cavity 21. In addition, at this time, the suture 11 is
Will be observed.

When the suture 11 is introduced into the abdominal cavity 21,
The suture 11 is grasped and pulled using the laparoscopic surgical treatment tool 20, and the suture 11 having a sufficient length is introduced into the abdominal cavity 21. In this manner, the suture needle 9 is thereafter moved to the urethra 16
, The distal end of the suture 11 can remain in the abdominal cavity 21.

After the suture 11 having a sufficient length is introduced into the abdominal cavity 21, the suture needle 9 is once housed in the channel 4 of the mantle tube 3. And the mantle tube 3 in the urethra 16
Is pushed in the distal direction to position the distal end of the mantle tube 3 at the other cut end 23 b of the cut portion 23 of the urethra 16. Then, in this state, the operating knob 13 is again slid forward to cause the puncture portion 6 of the suture needle 9 to protrude from the mantle tube 3, and the puncture portion 6 is moved to the urethral wall as shown in FIG. A second puncture is performed to penetrate the portion 25 from inside to outside.
Thereafter, as in the case of the first puncture, the suture 11 having a sufficient length is passed through the abdominal cavity 21 using the laparoscopic surgical treatment tool 20.
And cut the suture 11 to the appropriate length.

In this state, as shown in FIG. 5C, both ends 26 of the suture 11 are in the abdominal cavity 21. In other words, the suture 11 reaches the urethra 16 from the inside of the abdominal cavity 21 through the one cut end 23a of the urethra cutting portion 23, and reaches the inside of the abdominal cavity 21 again through the other cut end 23b. Therefore, the urethra 16 can be ligated with the suture 11 by grasping the ends 26 of the suture 11 in the abdominal cavity 21 and forming a knot. By repeating this procedure and forming a ligature over the entire circumference of the urethra wall 25, the anastomosis of the urethra 16 is completed. The operation in the abdominal cavity 21 may be performed using the laparoscope 19, or may be performed under the direct view of the operator by making a large incision in the abdominal wall.

As described above, the suturing tool 1 according to the present embodiment includes the mantle tube 3 that can be inserted into a body lumen and the mantle tube 3.
Needle 9, which is inserted into the channel so as to be able to advance and retreat, a grip portion 2 provided on the proximal side of the mantle tube 3 and has an operation knob 13 for performing the operation of moving the suture needle 9, and is held at the tip of the puncture needle 9. A suture guide portion 12 for guiding the obtained suture 11 to the grip portion 2, and the suture needle 9 is provided with a puncture portion 6 at a distal end capable of protruding and retracting from a distal end opening of a channel of the outer tube 3, and the puncture portion 6. An elastic portion 7 connected to the base end of the elastic portion 7 and bendable in a predetermined direction, and an elongated shaft portion 8 connected to the base end of the elastic portion 7. Moreover, the elastic portion 7 has a bending tendency in one direction, and is directed toward the wall portion 25 of the urethra 16 as it protrudes from the mantle tube 3.

Therefore, if the operation from the outside of the abdominal wall 17 and the operation from the inside of the urethra 16 by the suture tool 1 are made to cooperate, the cut end 23 generated in the urethra 16 at the distal part of the bladder 22 can be easily formed. It can be sutured and anastomotic. That is, the suturing device 1 of the present embodiment is inserted inside a luminal organ and assists the endoscopic surgical instrument 20 located outside, thereby facilitating suturing under an endoscope. A living body part having a small diameter and a small space around it is sutured by only rotating and moving the mantle tube 3 and moving the puncture part 6 into and out of the mantle tube 3 without any complicated operation. be able to. In other words, it is a case where the approach from the body cavity side can be obtained from only one direction, such as the pelvic cavity, and it is assumed that the mantle tube 3 interferes with the surrounding tissue and the movement is restricted. Even if there is, the suturing needle 9 can be advanced and retracted with respect to the mantle tube 3 and the puncture portion 6 can be easily directed to the wall portion 25 of the urethra 16 by the action of the elastic portion 7. A suturing operation for an anastomosis that requires movement is easy. In other words, even if there is not enough space around the suturing part, the suturing operation can be performed easily,
Operation time can be reduced.

FIG. 6 shows a second embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in the figure, in the suturing tool 1A of the present embodiment, a holder 27 for winding the long suture 11 guided from the puncture portion 6 of the suture needle 9 to the grasping portion 2 is provided on the grasping portion 2. Is provided. The other configuration is the same as that of the first embodiment.

Therefore, according to this embodiment, the same operation and effect as those of the first embodiment can be obtained, and the suture 11 can be hardly entangled.

FIGS. 7 and 8 show a third embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in the figure, in the suturing tool 1B of the present embodiment, as shown in FIG. 7, the distal end of the mantle tube 3 is closed, and instead, the distal end opening 5 communicating with the channel 4 is provided with a mantle. It is formed on the side of the tube 3.

In the suturing tool 1B of the present embodiment, the elastic portion 7 has no bending habit.
As shown in FIG. 3A, a guide surface 51 for guiding the puncture portion 6 to the distal end opening 5 is formed in the distal end closing portion of the outer tube 3.

Therefore, as shown in FIG. 8B, when the suture needle 9 is slid in the distal direction using the operation knob 13, the distal end side of the suture needle 9 deforms the elastic portion 7 and the guide surface. With the guidance by 51, the puncture portion 6 advances while bending toward the distal end opening portion 5 of the channel 4, and the puncture portion 6
Of the urethra 16 and is directed toward the wall 25 of the urethra 16, for example. The other configuration is the same as that of the first embodiment.

Therefore, according to the present embodiment, the same operation and effect as those of the first embodiment can be obtained, and it is not necessary to add a bending habit to the elastic portion 7, so that the sewing needle 9 can be easily formed.

FIG. 9 shows a fourth embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in the figure, in the suturing tool 1C of the present embodiment, a wire fixing portion 29 is provided on the distal end side of the elastic portion 7 of the suturing needle 9, and the wire 30 is fixed to the wire fixing portion 29. The wire 30 extends to the grip 2 through the channel 4 in the mantle tube 3, and its end is connected to an angle knob 31 provided on the grip 2. The angle knob 31 is provided, for example, concentrically and integrally with the operation knob 13, and is rotated to operate the wire 3.
0 can be pushed and pulled.

In such a configuration, when the angle knob 31 is rotated and the wire 30 is pulled toward the grip portion 2, the elastic portion 7 is curved as shown in FIG. 6 are oriented in one direction (eg, the wall 25 of the urethra 16). On the other hand, when the angle knob 31 is rotated in the reverse direction to release the pulling of the wire 30, the elastic portion 7 returns to the original linear shape, and the puncture portion 6 is oriented in the axial direction of the outer tube 3. Become. The other configuration is the same as that of the first embodiment.

Therefore, according to this embodiment, the same operation and effect as those of the first embodiment can be obtained, and the degree of curvature of the suturing needle 9 can be easily adjusted.

FIGS. 10 and 11 show a fifth embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in FIG. 10, in the suturing tool 1D of the present embodiment, the suturing needle 9 is formed hollow. Further, as clearly shown in FIG. 11, the suture 11 is guided from the grasping portion 2 to the puncture portion 6 of the suture needle 9 through the insertion hole 32 of the hollow suture needle 9, and is formed in the puncture portion 6. The hole 10 extends outside the suture needle 9. The hole 10
May be located near the tip of the puncture unit 6. Further, the shape of the hole 10 is desirably a smooth shape with corners so as not to damage the suture 11 at its edge. The other configuration is the same as that of the first embodiment.

Therefore, according to the present embodiment, the same operation and effect as those of the first embodiment can be obtained, and the suture 11 can be prevented from being entangled in the channel 4 of the mantle tube 3 where the suture needle 9 advances and retreats. .

FIGS. 12 and 13 show a sixth embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in FIG. 12, the suturing tool 1E of the present embodiment has a falling-off prevention mechanism for preventing the suture 11 from falling off from the suture guiding portion 12. That is, a fixing member 33 for bringing the suture thread 11 into close contact with the suture needle 9 is provided at the distal end portion of the suture needle 9. FIG.
3 (a) and 3 (b), the fixing member 3
A narrow gap 34 is formed between the needle 3 and the suture needle 9, and the suture 11 passes through the gap 34
It is designed to receive great resistance due to friction when it is pulled back and forth. Further, as shown in FIG. 13B, the left and right ends of the fixing member 33 are in close contact with the suture needle 9 so that the suture 11 does not move in the lateral direction.
The other configuration is the same as that of the first embodiment.

Therefore, according to the present embodiment, the same operation and effect as those of the first embodiment can be obtained, and the suture 11 can be prevented from falling off from the suture needle 9.

When the suturing needle 9 has a hollow shape as in the fifth embodiment, the fixing member 33 is provided inside the suturing needle 9 as shown in FIG. In the example of FIG. 14, the fixing member 33 is formed by cutting out the wall of the shaft portion 8 of the suture needle 9 and dropping it into the insertion hole 32. As another embodiment of a drop-off prevention mechanism for preventing the suture 11 from falling off from the suture guide section 12, as shown in FIG.
Screw 2 into the holder 2 for the suture 11
It is conceivable to hinder the rotation of 7.

FIGS. 16 to 18 show a seventh embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in FIG. 16, in the suturing tool 1F of this embodiment, the outer tube 3 is formed of an opaque material, and a suture needle protrusion hole 35 is provided on the side surface of the outer tube 3. As clearly shown in FIG. 17, a light source channel 36 for introducing a light source is formed in the mantle tube 3 in addition to the channel 4 for inserting the suture needle 9. Partition wall 3 between channel 4 and light source channel 36
Reference numeral 7 denotes a portion that is cut off at the position of the suturing needle protrusion hole 35, or a portion facing the suturing needle protrusion hole 35 is formed of a transparent material so that light transmission is not blocked. The distal ends of the channel 4 through which the suture needle 9 is inserted and the light source channel 36 may be open or closed. Other configurations are the same as those of the first embodiment.

FIG. 18 shows a state in which an anastomosis of the urethra 16 is performed using the suturing instrument 1F having such a configuration.
As shown, the suture 1F is inserted into the urethra 16,
The distal end of the mantle tube 3 reaches the distal cut end 23 of the urethra 16. In addition, strong light from the light source device is introduced to the distal end of the light source channel 36 of the suture tool 1F using the light guide 38 or the like made of an optical fiber, and leaks out of the outer tube 3 from the suture needle protrusion hole 35. Is out. In this state, when observed from the abdominal cavity side, a light spot 39 penetrating through the urethral wall 25 can be observed, and as a result, the suture needle protrusion hole
Can be confirmed.

As the light source, in addition to using a light source device outside the body, a light source such as a lamp or an LED may be attached to the end of the channel as long as light can be introduced into the end of the channel. Observation from the abdominal cavity side is facilitated by reducing the amount of light illuminating the abdominal cavity side. Further, the channel of the mantle tube 3 may be a single channel having a size that allows the suture needle 9 and the light source to be inserted at the same time.

Therefore, according to this embodiment, the same operation and effect as those of the first embodiment can be obtained, and the puncturing position of the suture needle 9 can be accurately grasped. In the present embodiment, a suturing needle and a light source may be inserted into the channel of the suturing tool, or the suturing operation may be performed while an endoscope is inserted and observed from inside the urethra. When using an endoscope, the light source of the endoscope may be used for confirming the puncturing position without inserting only the light source independently. Further, the suturing tool itself may be provided in the endoscope device. That is, the suturing tool is configured to be used in combination with the channel provided in the endoscope. Further, the suturing tool may have a mechanism for rotating the suturing needle about the axis.

According to the technical contents described above, the following various configurations can be obtained.

1. A puncture portion that is inserted into a channel inserted into a luminal organ in a body and protrudes from a distal end opening of the channel, and an elastic portion connected to a proximal end side of the puncture portion, A suturing needle having an elongated shaft portion connected to a side thereof, a grip portion protruding proximally from a proximal opening of the channel and provided on a proximal end side of the suturing needle, and a puncture portion. A suture guide portion for guiding a suture from the provided hole to the grip portion. 2. The suturing device according to claim 1, wherein the suture needle is capable of gripping a suture drawn out from the inside of the luminal organ by a forceps inserted outside the luminal organ. 3. The suturing tool according to claim 1, wherein the elastic portion has a bending tendency in one direction. 4. The suturing tool according to claim 1, wherein the suture guide portion is a groove provided in the elastic portion and the shaft portion. 5. The suturing tool according to claim 1, wherein the grip has a holder for winding the suture.

6. A wire having a distal end joined to the distal end of the elastic portion and a base end connected to an angle knob provided on the grip portion is pushed and pulled by the rotation of the angle knob to bend the elastic portion. The suturing tool according to claim 1.

[0047]

As described above, according to the suturing tool of the present invention, the suturing operation can be easily performed even if there is not enough space around the suturing portion, and the operation time can be reduced.

[Brief description of the drawings]

FIG. 1 is a side view of a suturing tool according to a first embodiment of the present invention when a puncture portion is projected.

FIG. 2 is a cross-sectional view of the suture tool of FIG. 1 when the puncture portion is stored.

FIG. 3 is an enlarged cross-sectional view of a distal end portion of a mantle tube of the suture instrument of FIG.

FIG. 4 is a cross-sectional view showing an arrangement state of each device when anastomosis is performed on a human urethra using the suturing device of FIG. 1;

5A and 5B are enlarged views showing a procedure for performing an anastomosis operation in the arrangement state of FIG. 4, wherein FIG. 5A shows a state at the time of the first puncture, FIG. 5B shows a state at the time of the second puncture, and FIG. Each is shown.

6A is a side view of the suturing tool according to the second embodiment of the present invention when the puncture portion is projected, and FIG. 6B is a cross-sectional view of the suturing tool of FIG.

FIG. 7 is a side view of a suturing tool according to a third embodiment of the present invention when a puncture portion is stored.

8A and 8B are enlarged cross-sectional views of the distal end portion of the outer tube of the suturing device of FIG. 7, in which FIG. 8A shows a state where the puncture portion is stored, and FIG.

9A is a side view of a suturing tool according to a fourth embodiment of the present invention when a puncture portion is projected, and FIG. 9B is a cross-sectional view of the suturing tool of FIG.

FIG. 10 is a side view of a suturing tool according to a fifth embodiment of the present invention when a puncture portion is projected.

FIG. 11 is an enlarged cross-sectional view of a distal end portion of a mantle tube of the suture instrument of FIG.

FIG. 12 is a side view of a suturing tool according to a sixth embodiment of the present invention when a puncture portion is projected.

13A is an enlarged cross-sectional view of the distal end portion of the outer tube of the suture tool of FIG. 12, and FIG. 13B is a cross-sectional view taken along line AA of FIG.

14A is a perspective view of a distal end portion of a suture tool according to a first modification of the sixth embodiment of the present invention, and FIG. 14B is a cross-sectional view of the suture tool of FIG.

FIG. 15 is a side view of a suturing tool according to a second modification of the sixth embodiment of the present invention.

FIG. 16 is a perspective view of a suturing tool according to a seventh embodiment of the present invention.

FIG. 17 is a sectional view of the suturing tool of FIG. 16;

FIG. 18 is a schematic view showing the operation of the suturing tool of FIG.

[Explanation of symbols]

 1, 1A, 1B, 1C, 1D, 1E, 1F ... suture tool 2 ... gripping part 3 ... mantle tube 4 ... channel 5 ... tip opening 6 ... puncture part 7 ... elastic part 8 ... shaft part 9 ... suture needle 11 ... suture Thread 12: suture guide unit 13: operation knob (operation means)

Claims (1)

[Claims] 1. An outer tube that can be inserted into a body lumen, a suture needle that is inserted into a channel of the outer tube so as to be able to advance and retreat, and a suture needle that is provided on the proximal side of the outer tube and that advances and retracts the suture needle. A grip having operating means for performing an operation, and a suture guide for guiding a suture held at the tip of the puncture needle to the grip, wherein the suture needle has a tip of a channel of the mantle tube. It comprises a puncturing portion at the tip that can protrude and retract from the opening, an elastic portion connected to the base end of the puncturing portion and bendable in a predetermined direction, and a long shaft portion connected to the base end of the elastic portion. A suturing tool characterized in that: