JP2005000294A

JP2005000294A - Suturing device

Info

Publication number: JP2005000294A
Application number: JP2003164954A
Authority: JP
Inventors: Takayasu Mikkaichi; ▲高▼康三日市; Keita Suzuki; 啓太鈴木
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 2003-06-10
Filing date: 2003-06-10
Publication date: 2005-01-06

Abstract

<P>PROBLEM TO BE SOLVED: To continuously pass a suture through a plurality of places by one suction to shorten a suturing time. <P>SOLUTION: This suturing device 1 is equipped with a treatment body 3 brought into contact with living body tissue 2 to apply suturing treatment thereto, the suction mechanism 4 connected to the treatment body 3 and a hollow puncture needle 6 permitting the suture 5 to pass through the inside of the same and puncturing the living body tissue 2 to pass the suture 5. The treatment body 3 is connected to the leading end part of a unidirectionally extending soft shaft member not shown in the drawing and formed into a long rectangular parallelopiped shape in the extending direction of the shaft member. One surface of the rectangular parallelopiped shape is set as a treatment surface 8 capable of closely coming into contact with the living body tissue 2 and equipped with a plurality of recessed parts 9 formed side by side in the length direction of the treatment surface 8 and an insertion hole passage 10 in which the hollow puncture needle 6 is inserted so as to be capable of continuously passing through the recessed parts 9 unidirectionally. A hole part 11 permitting the hollow puncture needle 6 to pass through is formed to the leading end part 3a of the treatment body 3. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

【０００１】
【発明の属する技術分野】
本発明は、外科的処置として生体組織を糸で縫合する際に用いられる縫合装置に関する。
【０００２】
【従来の技術】
外科手術等の外科的処置の際に生体組織を切開した後でこの切開部を再び接合させたり、組織に薬剤を浸透させるために組織表面に薬剤を載置して埋設させたりする場合、生体組織に糸を通して組織同士を縫合する処置が行われる。このような縫合処置を行うため、例えば、開腹によって腸管等を縫合する場合、一対のジョーによって腸管等を挟んだ状態で糸のついた針をこの組織内に穿刺して縫合する縫合装置が提案されている（例えば、特許文献１参照。）。
【０００３】
しかし、特許文献１に示す縫合装置の場合、一対のジョーでは胃壁等のような面状の処置部位を挟み込むことができない。また、ジョーの操作時に２方向からの操作が必要となるため、開腹手術若しくは腹腔鏡手術においてしか用いることができない。そこで、面状の処置部位に対して、及び、内視鏡下手術においても患者の負担の小さい縫合処置を可能とするため、被縫合物を吸引して凸状部とした部位に中空針を穿刺し、この中空針の内部をとおして糸を挿通することによって、一方向からの操作で縫合を可能とする縫合装置が提案されている（例えば、特許文献２参照。）。
【０００４】
【特許文献１】
特開平０６−１４２１０７号公報
【特許文献２】
特表平１０−５００３１８号公報
【０００５】
【発明が解決しようとする課題】
しかしながら、上記従来の縫合装置においては、１回の吸引に対して１箇所しか吸引できないので糸を１箇所にしか挿通できない。そのため、例えば、巾着縫合のように隣接する複数箇所に糸を連通して縫合するような場合では、吸引及び挿通操作を複数回繰り返して実施しなければならず、処置時間が多大なものとなっていた。
本発明は上記事情に鑑みて成されたものであり、１回の吸引に対して複数箇所に糸を連続的に挿通することを可能として縫合時間の短縮化を図ることを目的とする。
【０００６】
【課題を解決するための手段】
本発明は、上記課題を解決するため、以下の手段を採用する。
本発明は、被縫合物に接触して縫合処置を施す処置本体と、該処置本体に接続された吸引機構と、内部に縫合用の糸が挿通可能で前記被縫合物に穿刺して糸を挿通させる中空穿刺針とを備え、前記処置本体が、前記被縫合物と密着可能な処置面と、該処置面に並んで形成された複数の凹部と、これらの凹部内に前記中空穿刺針が連続して貫通可能に挿入される挿通孔路とを備え、前記吸引機構が、前記各凹部に接続されて各凹部内を吸引可能とされていることを特徴とする。
【０００７】
この縫合装置は、処置本体が、処置面に並んで形成された複数の凹部を備え、吸引機構が、各凹部に接続されて各凹部内を吸引可能とされているので、吸引機構による１回の吸引によって被縫合物を処置本体の各凹部に取り込むことによって複数の凸状部を１回で形成することができる。
さらに、この中空穿刺針が各凹部内に連続して貫通可能に挿入される挿通孔路を備えているので、挿通孔路を通して中空穿刺針を凸状部に連続して貫通させることによって各凸状部に糸を挿通でき、被縫合物の複数箇所を一度に縫合することができる。
【０００８】
本発明は、前記縫合装置であって、前記処置本体が、基端側から先端側に向けて一対の前記挿通孔路を並んで有していると共に、これらの挿通孔路が先端側の折返し部で接続されていることを特徴とする。
この縫合装置は、基端側から先端側に向けて一対の前記挿通孔路を並んで有しているので、１回の吸引で形成された複数の凸状部分に対して２列に糸を挿通させることができる。また、これらの挿通孔路が先端側の折返し部で接続されているので、挿通孔路に挿通させた糸を折返し部を利用して結合することによって、１本の新たな糸を一対の挿通孔路内に形成することができ、この糸を引き寄せることによって被縫合物を巾着縫合することができる。
【０００９】
本発明は、前記縫合装置であって、前記処置本体が、前記吸引機構に接続された主吸引孔と、該主吸引孔から分岐され前記各凹部に接続された分岐吸引孔とを備えていることが好ましい。
この縫合装置は、吸引機構に接続された主吸引孔とこの主吸引孔から分岐された分岐吸引孔とが各凹部に設けられているので、被縫合物を凹部内に吸引することによって何れかの分岐吸引孔が被縫合物によって塞がれてしまっても、残りの分岐吸引孔から吸引することができる。
【００１０】
【発明の実施の形態】
本発明の第１の実施形態について、図１から図４を参照して説明する。
本実施形態に係る縫合装置１は、図１に示すように、内視鏡Ｓの挿入部に沿って先端部に取り付けられており、被縫合物である生体組織２を巾着縫合する際に使用する。
この縫合装置１は、図１及び図２に示すように、生体組織２に接触して縫合処置を施す処置本体３と、処置本体３に接続された吸引機構４と、内部に縫合用の糸５が挿通可能で生体組織２に穿刺して糸５を挿通させる中空穿刺針６と、糸５及び中空穿刺針６を進退操作させる操作部Ｈとを備えている。
【００１１】
処置本体３は、図３に示すように、軟性の軸部材７の先端部に接続されており、この軸部材７の延びる方向に長い直方体形状に形成されている。この長さ方向に沿った１面が生体組織２と密着可能な処置面８とされ、処置面８の長さ方向に並んで形成された複数の凹部９と、これらの凹部９内に中空穿刺針６が一方向から連続して貫通可能に挿入される挿通孔路１０とを備えている。この処置本体３の先端部３ａには、挿通孔路１０の一部として中空穿刺針６が貫通可能な孔部１１と、この孔部１１を介して凹部９に連通される空間部としてエア漏れ防止部１１Ａとが形成されている。
【００１２】
各凹部９は、処置面８の長さ方向に設けられた一つの基凹部９Ａに対して、処置面８の幅方向にある両側の側縁部８ａ側から処置本体中央側に向かって互いに対向するように延びて形成された一対の突状部１２毎に仕切られて形成されている。挿通孔路１０は、処置本体３の基端部３ｂ中央に設けられ、各凹部９と孔部１１とに連通されて構成されている。
孔部１１は、凹部９とエア漏れ防止部１１Ａとを仕切る壁部１１Ｂに設けられて両者を連通させており、この壁部１１Ｂには、エア漏れ防止部１１Ａ側から凹部９側に向かって孔部１１の大きさを徐々に小さくさせるテーパ部１１Ｃが形成されている。
【００１３】
吸引機構４は、図１及び図２に示すように、吸引ポンプＰと、吸引ポンプＰに連通される吸引チューブ１３とを備えている。この吸引チューブ１３は、処置本体３の基端部３ｂに形成された吸引孔１４に連通されて各凹部９に接続されており、吸引ポンプＰによって各凹部９内が吸引可能とされている。
糸５の先端部には、孔部１１の大きさよりも短く、かつ、中空穿刺針６の内径よりも長い棒状の留部材１５が留められている。
この留部材１５は、中空穿刺針６内にあるときは中空穿刺針６の軸方向に沿って収納されている。
【００１４】
次に、以上の構成からなる本実施形態に係る縫合装置１の使用方法について説明する。
まず、人体の自然開口から図１に示す内視鏡Ｓとともに体内へ縫合装置１を挿入する。そして、図２に示すように縫合すべき生体組織２上に処置面８を向けて配置した後、処置面８を生体組織２に密着させる。
続いて、吸引ポンプＰを駆動して、生体組織２と各凹部９とによって形成される空間内を吸引チューブ１３を介して吸引して負圧とする。このとき、図４（ａ）に示すように、突状部１２によって押し付けられた部位以外の生体組織２面が各凹部９内に吸引され、複数の凸状部２ａを同時に形成する。
【００１５】
そして、図４（ｂ）に示すように、糸５を内部に備えた中空穿刺針６を、処置本体３の基端部３ｂ側から挿入し、各凸状部２ａを連続的に貫通させ、先端が孔部１１を貫通してエア漏れ防止部１１Ａ内に飛び出す位置まで挿入する。
続いて、糸５を中空穿刺針６から図示しない押出し装置によって押出すと、糸５の先端部が留部材１５とともに中空穿刺針６の内部から外へ飛び出す。
その後、中空穿刺針６を再び後退させるとともに、吸引ポンプＰを停止して吸引を停止し、処置本体３を生体組織２から離す。
こうして、図４（ｃ）に示すように、糸５を複数の凸状部２ａに同時に挿通することができる。また、図４（ｄ）に示すように、糸５を引くと、凸状部２ａに留部材１５が引っ掛ることよって各凸状部２ａを引き寄せて縫合する。
【００１６】
上述の縫合装置１を用いた縫合例について、以下説明する。
図５に、切開部分を巾着縫合する場合を示す。
切開後では、切開部位１６からのエア漏れ等によってこの部分の吸引が困難であるので、図５（ａ）に示すように切開部位１６の周囲に縫合装置１によって糸５を予め縫合しておく。
次に、図５（ｂ）に示すように切開し、この切開部位１６から処置具１７を挿入して体腔内で様々な処置を行う。
そして、図５（ｃ）に示すように、糸５の両端部を引き寄せることによって切開部位１６を巾着縫合する。
次に、処置後の組織内に薬剤１８を埋設する場合を図６に示す。
この場合も、図６（ａ）に示すように、薬剤１８を埋設する周囲を縫合装置１によって予め糸５で縫合する。
そして、薬剤１８を載置した後、糸５の端部を引き寄せることによって、図６（ｂ）及び（ｃ）に示すように、薬剤１８が生体組織２の表面に包まれて埋設される。
【００１７】
この縫合装置１によれば、吸引機構４による１回の吸引によって生体組織２を処置本体３の各凹部９に取り込むことによって複数の凸状部２ａを形成することができる。また、挿通孔路１０を通して中空穿刺針６を凸状部２ａに連続して貫通させることによって各凸状部２ａに糸５を挿通でき、複数箇所を同時に縫合することができる。
【００１８】
次に、本発明に係る第２の実施形態について、図７から図２１を参照して説明する。なお、以下の説明において、上記実施形態において説明した構成要素には同一符号を付し、その説明は省略する。
第２の実施形態が上記第１の実施形態と異なる点は、第１の実施形態では処置本体３に１つの挿通孔路１０が形成されているのに対して、第２の実施形態では処置本体１９に一対の挿通孔路２０、２１が並んで形成されている点である。
【００１９】
本実施形態に係る縫合装置２２は、図７（ａ）に示すように、上記実施形態に係る縫合装置１と同様の構成を有し、処置本体１９の処置面１９Ａには、各凹部９が一対の突状部１２毎に仕切られて形成されている。さらに、処置本体１９には、基端部１９ｂ側から先端部１９ａ側に向けて一対の挿通孔路２０、２１が並んで設けられていると共に、これらの挿通孔路２０、２１が先端部１９ａ側に設けられた折返し部２３で接続されている。
また、縫合装置２２は、第１の中空穿刺針２４及び第２の中空穿刺針２５の２本の中空穿刺針を備えており、それぞれ挿通孔路２０、２１に挿入されるように配設されている。
第１の中空穿刺針２４は、図８（ａ）に示すように、線状に形成されて柔軟性を有する糸誘導部材２６を内部に備えている。この糸誘導部材２６は、さらに、線状本体２７と、この線状本体２７の先端部に取り付けられた糸把持部材２８とを備えており、操作部Ｈによって第１の中空穿刺針２４内を押出し或いは引き込み可能とされている。
第２の中空穿刺針２５は、内部に糸５を有しており、この糸５の先端部には、糸把持部材２８に把持され結合可能な被把持部材２９が備えられている。
この第２の中空穿刺針２５は、図８（ｂ）に示すように、内部に被把持部材２９を押出す押出部材２５Ａを備えており、この押出部材２５Ａは、操作部Ｈによって第２の中空穿刺針２５内を押出し或いは引き込み可能とされている。
【００２０】
次に、以上の構成からなる本実施形態に係る縫合装置２２の使用方法について説明する。
まず、人体の自然開口から図１に示す内視鏡Ｓとともに体内へ縫合装置２２を挿入する。そして、第１の実施形態と同様に処置面１９Ａに接触させた生体組織２を各凹部９内に吸引して複数の凸状部２ａを同時に形成する。
そして、図７（ｂ）に示すように、第１の中空穿刺針２４及び第２の中空穿刺針２５をそれぞれ処置本体１９の基端部１９ｂ側から処置本体１９内に挿入し、それぞれの先端を折返し部２３の位置に到達させる。
【００２１】
続いて、第１の中空穿刺針２４の内部から操作部Ｈによって、図８（ａ）（ｂ）に示すように、糸誘導部材２６を外部へ押出すとともに、第２の中空穿刺針２５の内部から押出部材２５Ａを操作して被把持部材２９とともに糸５を外へ押し出す。
押出した糸誘導部材２６を、折返し部２３内を挿通させて第２の中空穿刺針２５の先端位置まで到達させ、図８（ｃ）に示すように、糸把持部材２８を押出部材２５Ａで支持された被把持部材２９に押し込んで結合する。
【００２２】
次に、図８（ｄ）に示すように、糸誘導部材２６を第１の中空穿刺針２４のほうへ引き込む。このとき、糸５は糸誘導部材２６とともに折返し部２３内を第１の中空穿刺針２４のほうに移動する。
こうして、図８（ｅ）及び図９（ａ）に示すように、折返し部２３を経由して１本の糸が挿通される。
その後は、図９（ｂ）に示すように、第１の中空穿刺針２４及び第２の中空穿刺針２５を再び後退させるとともに、吸引ポンプＰを停止して吸引を停止した後、縫合装置２２を生体組織から離す。
こうして、図１０に示すように、生体組織２の周囲が１本の糸５で縫合される。
なお、図８（ｅ）のＡ−Ａ断面である図８（ｆ）に示すように、折返し部２３の内側側面には、糸５が出入可能なスリット２３ａが設けられている。
また、糸把持部材２８と被把持部材２９との結合の際、図８（ｆ）に示すように、押出部材２５Ａの代わりに第２の中空穿刺針２５の内壁に段部２５ａを設け、この段部２５ａで被把持部材２９を支持することにより被把持部材２９を位置決めしてもよい。
【００２３】
ここで、糸把持部材２８及び被把持部材２９による結合は、例えば、図１１に示すように、被把持部材２９を鏃形状に形成し、糸把持部材２８の先端面に把持凹部２８ａを設けてその内部に被把持部材２９と係合される貫通部３０ａを有するシリコン樹脂等の柔軟材で構成された留め具３０を配設する。
この結合では、図１１（ａ）に示すように、鏃形状の被把持部材２９が留め具３０の貫通部３０ａを貫通して把持凹部２８ａ内に一旦挿入されると、被把持部材２９を把持凹部２８ａ内から取り出そうとしても、図１１（ｂ）に示すように、被把持部材２９が留め具３０に引掛るので結合状態が維持される。
なお、この留め具３０の代わりに、図１２に示すように、把持凹部２８ａの内側に向かって延びて形成される突条部２８ｂを形成してもよい。
この場合も、図１２（ａ）に示すように、被把持部材２９を把持凹部２８ａ内に挿入すると、図１２（ｂ）に示すように被把持部材２９と突条部２８ｂとが係合されて結合状態が維持される。
【００２４】
また、留め具３０の代わりに、図１３（ａ）に示すように、径方向に伸縮可能なバネ部材３１を把持凹部２８ａの入口部２８ｃに設けてもよい。この場合、被把持部材２９を把持凹部２８ａ内に挿入する際は、図１３（ｂ）に示すように、被把持部材２９がバネ部材３１を外側へ広げながら挿入していく。そして、一旦把持凹部２８ａ内に挿入すると、図１３（ｃ）に示すように、径が元の大きさに戻ったバネ部材３１に被把持部材２９が引っ掛るので、両者の結合状態が維持される。
【００２５】
さらに、図１４（ａ）に示すように、被把持部材２９の先端部に板バネで構成される傘形状部２９ａを設けてもよい。
この場合、被把持部材２９を把持凹部２８ａ内に挿入させる際、把持凹部２８ａの入口部２８ｃを通過するときに一旦傘形状部２９ａが閉じた状態となるので、被把持部材２９の外径が入口部２８ｃの内径よりも小さくなった状態で入口部２８ｃを通過する。そして、被把持部材２９が把持凹部２８ａ内に挿入されると、図１４（ｂ）に示すように、傘形状部２９ａが元の形状に戻り被把持部材２９の外径が再び入口部２８ｃの内径よりも大きくなるため、入口部２８ｃに被把持部材２９が引っ掛ることによって結合状態が維持される。
また、傘形状部２９ａを把持する糸把持部材として、図１５（ａ）に示すような、輪部３２としてもよい。この場合も前述と同様に傘形状部２９ａが輪部３２内に挿入された後は、図１５（ｂ）に示すように、この輪部３２に傘形状部２９ａが引っ掛ることによって結合状態が維持される。
【００２６】
なお、上記の実施形態では、糸５は、第２の中空穿刺針２５内から挿通させているが、図１６（ａ）に示すように、両方の中空穿刺針から糸５を挿通させ、折返し部２３内に設けられた中間部材３３に結合して１本の糸として連通させてもよい。この場合、中間部材３３はコイル状に形成する。従って、中間部材３３内に被把持部材２９が挿入されると、図１６（ｂ）に示すように、中間部材３３に被把持部材２９が引っ掛るので、中間部材３３を介して糸５が１本の糸として結合される。
【００２７】
ここで、中間部材３３は、上記のコイル状に限られることはなく、図１７（ａ）に示すように、シリコン樹脂等の柔軟材で構成された樹脂チューブ３４Ａであっても構わない。また、図１７（ｂ）に示すように、チューブ端面３４ａのみチューブ径を小さくして、被把持部材２９をさらに抜けにくくさせた樹脂チューブ３４Ｂとしてもよい。さらに、図１７（ｃ）に示すように、側面にスリット部３５ａを設けて、側面の周方向の弾性変化を利用して被把持部材２９と結合しやすく、また、抜けにくくさせたチューブ３５としてもよい。
なお、このときの被把持部材２９の先端形状は、他の例として、図１８（ａ）及び（ｂ）に示す鏃形状でもよい。
【００２８】
次に、結紮方法について、以下、説明する。
巾着縫合する際に、挿通させた糸５を引き寄せるものとして、図１９（ａ）に示すように、結び目として例えばローダーズノット３６を予め第１の中空穿刺針２４又は第２の中空穿刺針２５の何れか一方に形成させておいてもよい。
このとき、糸５、第１の中空穿刺針２４、及び第２の中空穿刺針２５は、図１９（ｂ）に示す操作部Ｈ１に接続されている。
この操作部Ｈ１は、第１の中空穿刺針２４及び第２の中空穿刺針２５の基端側と接続され、それぞれを進退操作させる針進退部材３７、３８と、糸５の基端側と接続されて進退操作させる糸進退部材３９とを備えている。また、第１の中空穿刺針２４の外周にはローダーズノット３６を保持するノット落とし４０が設けられ、操作部Ｈ１に設けられたノット落とし進退部材４１に接続されている。
【００２９】
巾着縫合する際には、針進退部材３７、３８を先端側に進めて第１の中空穿刺針２４及び第２の中空穿刺針２５を前進させた後、糸進退部材３９を先端側に移動して糸５を押出して、図１９（ｃ）に示すように、中間部材３３の両端部に設けられた糸把持部材２８に被把持部材２９を挿入して糸５を連通させる。その後、図１９（ｄ）に示すように、第１の中空穿刺針２４側の糸進退部材３９を引いて糸５とともに中間部材３３を第１の中空穿刺針２４内に引き込み、図１９（ｅ）に示すように、ノット落とし進退部材４１を糸５の先端側に押出して第１の中空穿刺針２４の外側からローダーズノット３６を押出す。
こうして、針進退部材３７、３８を操作して中間部材３３とともに第１の中空穿刺針２４と第２の中空穿刺針２５とを引いて、糸進退部材３９を操作して糸５を引くことにより折返し部２３によって輪４２が形成され、この輪４２を狭めることによって巾着縫合が完成する。
【００３０】
また、糸把持部材２８及び中間部材３３等を設けなくてもよく、例えば、第１の中空穿刺針２４及び第２の中空穿刺針２５それぞれによって糸５を挿通した後、図２０に示すように、各糸５の先端部を結紮装置４３等によって結紮しても、糸５を１本の糸として連通させることができ巾着接合することができる。
この場合、結紮した際に糸５が抜け出さないようにするため、各糸５の先端部には、図２０（ａ）に示すように留部材１５を設けておく。なお、留部材１５の代わりに図２０（ｂ）に示すように、コブ状の結び目４４を形成しておいてもよく、図２０（ｃ）に示すように、被把持部材２９を装着させてもよい。
【００３１】
巾着縫合をする際には、図１９（ｂ）に示す操作部Ｈ１において針進退部材３７、３８を先端側に進めて第１の中空穿刺針２４及び第２の中空穿刺針２５を前進させた後、糸進退部材３９を先端側に移動して糸５を押出すとともに、結紮装置４３にて糸５の先端側を結合した後、ノット落とし進退部材４１を糸５の先端側に押出してローダーズノット３６を押出す。その後、糸進退部材３９を操作して糸５を引き寄せることによって巾着縫合を行う。
【００３２】
また、巾着縫合する際に、挿通させた糸５を引き寄せるものとしてのローダーズノット３６の代わりに、図２１（ａ）に示すように、第１の中空穿刺針２４及び第２の中空穿刺針２５に沿って中空形状の中空操作棒４５を新たに配設してもよい。
この場合、まず、第１の中空穿刺針２４及び第２の中空穿刺針２５の対向する外壁面に先端側から軸方向に延びるスリット２４ａ、２５ａが設けられたものを用意する。そして、第１の中空穿刺針２４及び第２の中空穿刺針２５それぞれの内部に挿通される各糸５をスリット２４ａ、２５ａからそれぞれ引き出した後、これらの他端部側を一つにまとめて中空操作棒４５の内部に挿通させるとともに、ローダーズノット３６の代わりのストッパーとしてシリコン樹脂等で構成されるチューブ４６を中空操作棒４５の先端側に挿入しておく。
このときの操作部Ｈ２は、図２１（ｂ）に示すように、ノット落とし進退部材４４の代わりに中間操作棒４５を進退操作させる中間進退部材４５Ａを備えている。
そして、図２１（ｃ）に示すように、糸５で輪４７を作った後、中間進退部材４５Ａを操作して中空操作棒４５を押出して輪４７側へチューブ４６を押出す。このとき、チューブ４６によって輪４７が狭まり巾着縫合させることができる。
【００３３】
この縫合装置２２によれば、１回の吸引で形成された複数の凸状部２ａに対して２列に糸５を挿通させることができる。また、糸５を挿通させる挿通孔路２０、２１が折返し部２３で接続されているので、挿通した糸５を折返し部２３を介して結合することができ、生体組織２を巾着縫合することができる。
【００３４】
なお、本発明の技術範囲は上記実施の形態に限定されるものではなく、本発明の趣旨を逸脱しない範囲において種々の変更を加えることが可能である。
例えば、上記実施形態では、処置本体に形成された凹部は、突状部１２によって複数の凹部９に仕切られて形成されているものとしている。これに対し、図２２に示すように、処置本体４８の処置面４９に複数の凹部となる孔部５０が並んで形成されているとともに、吸引チューブ１３に接続された主吸引孔５１と、この主吸引孔５１から分岐され各孔部５０に接続された分岐吸引孔５２とを備えるものとしてもよい。
この場合、生体組織を孔部５０内に吸引する際、何れかの分岐吸引孔５２が生体組織によって塞がれてしまっても、残りの分岐吸引孔５２から吸引を継続することができる。
【００３５】
【発明の効果】
以上説明した本発明においては以下の効果を奏する。
本発明の縫合装置によれば、１回の吸引に対して被縫合物の複数箇所に糸を同時に挿通することができ、縫合作業にかかる処置時間の短縮化を図ることができるとともに、被縫合物を１回の吸引操作で容易にかつ正確に巾着縫合することができる。
【図面の簡単な説明】
【図１】本発明の第１の実施形態に係る縫合装置を内視鏡とともに示す全体図である。
【図２】本発明の第１の実施形態に係る縫合装置を示す断面図である。
【図３】本発明の第１の実施形態に係る縫合装置を示す処置面側から見た平面を示す図である。
【図４】本発明の第１の実施形態に係る縫合装置による縫合方法を工程順に示す説明図である。
【図５】本発明の第１の実施形態に係る縫合装置の使用例及びその工程を順に示す説明図である。
【図６】本発明の第１の実施形態に係る縫合装置の他の使用例及びその工程を順に示す説明図である。
【図７】本発明の第２の実施形態に係る縫合装置による縫合方法を縫合装置の処置面側からの平面図によって工程順に示す説明図である。
【図８】本発明の第２の実施形態に係る縫合装置における折返し部での糸の結合方法を工程順に示す説明図である。
【図９】本発明の第２の実施形態に係る縫合装置による縫合方法のうち図７に示す以降の工程を順に示す説明図である。
【図１０】本発明の第２の実施形態に係る縫合装置により生体組織を縫合した状態を示す斜視図である。
【図１１】本発明の第２の実施形態に係る縫合装置における糸把持部材と被把持部材とによる糸の結合方法を工程順に示す説明図である。
【図１２】図１１において糸把持部材を他の例としたときの糸の結合方法を工程順に示す説明図である。
【図１３】図１１において糸把持部材をさらに他の例としたときの糸の結合方法を工程順に示す説明図である。
【図１４】図１１において糸把持部材及び被把持部材とをそれぞれ他の例としたときの糸の結合方法を工程順に示す説明図である。
【図１５】図１１において糸把持部材及び被把持部材とをそれぞれさらに他の例としたときの糸の結合方法を工程順に示す説明図である。
【図１６】本発明の第２の実施形態に係る縫合装置における中間部材を介する糸の結合方法を工程順に示す説明図である。
【図１７】図１６において中間部材の他の例を示す説明図である。
【図１８】図１６において被把持部材の他の例を示す説明図である。
【図１９】本発明の第２の実施形態に係る縫合装置における糸の巾着縫合方法を工程順に示す説明図である。
【図２０】図１９においてその他の結合方法による糸の巾着縫合方法を工程順に示す説明図である。
【図２１】図１９及び図２０に示す糸の巾着縫合方法の他の例を示す説明図である。
【図２２】本発明の各実施形態に係る縫合装置の処置本体の他の例を示す断面図である。
【符号の説明】
１、２２縫合装置
２生体組織（被縫合物）
３、１９、４８処置本体
４吸引機構
５糸
６中空穿刺針
８、４４処置面
９凹部
１０、２０、２１挿通孔路
２３折返し部
２４第１の中空穿刺針（中空穿刺針）
２５第２の中空穿刺針（中空穿刺針）
５０孔部（凹部）
５１主吸引孔
５２分岐吸引孔[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a suturing device used when a biological tissue is sutured with a thread as a surgical procedure.
[0002]
[Prior art]
When a living tissue is incised during a surgical procedure such as a surgical operation, the incision is rejoined, or a drug is placed on the tissue surface and embedded in order to penetrate the tissue. A treatment is performed in which the tissues are sutured through the thread. In order to perform such a suturing procedure, for example, when an intestinal tract or the like is sutured by laparotomy, a suturing device is proposed in which a needle with a thread is punctured into the tissue with a pair of jaws sandwiching the intestinal tract or the like. (For example, refer to Patent Document 1).
[0003]
However, in the case of the suturing device shown in Patent Document 1, a pair of jaws cannot sandwich a planar treatment site such as a stomach wall. Moreover, since operation from two directions is required when operating the jaw, it can be used only in open surgery or laparoscopic surgery. Therefore, in order to enable a suture treatment with a small burden on the patient even in a planar treatment site and in an endoscopic operation, a hollow needle is attached to a site where the sutured object is sucked into a convex portion. There has been proposed a suturing device that allows suturing by an operation from one direction by puncturing and inserting a thread through the inside of the hollow needle (see, for example, Patent Document 2).
[0004]
[Patent Document 1]
Japanese Patent Laid-Open No. 06-142107
[Patent Document 2]
Japanese National Patent Publication No. 10-500318
[0005]
[Problems to be solved by the invention]
However, in the conventional suturing device, only one point can be sucked with respect to one suction, so that the thread can only be inserted into one point. Therefore, for example, in the case where a thread is communicated and stitched to a plurality of adjacent places such as a purse string suture, the suction and insertion operations must be repeated a plurality of times, and the treatment time becomes enormous. It was.
The present invention has been made in view of the above circumstances, and an object of the present invention is to enable a thread to be continuously inserted into a plurality of locations with respect to one suction and to shorten a sewing time.
[0006]
[Means for Solving the Problems]
The present invention employs the following means in order to solve the above problems.
The present invention relates to a treatment main body that performs a suturing treatment in contact with an object to be sutured, a suction mechanism connected to the treatment main body, and a suture thread that can be inserted into the suture body to puncture the suture object. A hollow puncture needle to be inserted, wherein the treatment body has a treatment surface capable of being in close contact with the sutured object, a plurality of recesses formed side by side on the treatment surface, and the hollow puncture needle in the recesses And an insertion hole that is inserted so as to be continuously penetrated, and the suction mechanism is connected to the recesses so as to be able to suck the recesses.
[0007]
In this suturing apparatus, the treatment body includes a plurality of recesses formed side by side on the treatment surface, and the suction mechanism is connected to each recess so as to be able to suck the inside of each recess. A plurality of convex portions can be formed at a time by taking the object to be sutured into the respective concave portions of the treatment main body by suction.
Further, since the hollow puncture needle is provided with an insertion hole path through which the hollow puncture needle is inserted so as to be continuously penetrated into each recess, each hollow puncture needle is continuously passed through the projection through the insertion hole path. A thread | yarn can be penetrated to a shape part and several places of a to-be-sewn object can be sewn at once.
[0008]
The present invention is the suturing device, wherein the treatment main body has a pair of the insertion hole paths from the proximal end side toward the distal end side, and these insertion hole paths are folded back on the distal end side. It is connected by the part.
Since this suturing device has a pair of the insertion hole paths from the proximal end side to the distal end side, the threads are arranged in two rows with respect to the plurality of convex portions formed by one suction. It can be inserted. In addition, since these insertion holes are connected at the turn-up portion on the distal end side, a new thread is inserted into the pair of inserts by joining the yarns inserted through the insertion holes using the turn-up portions. It can be formed in a hole, and the sutured object can be sewn on the purse by pulling this thread.
[0009]
The present invention is the suturing device, wherein the treatment main body includes a main suction hole connected to the suction mechanism, and a branch suction hole branched from the main suction hole and connected to the recesses. It is preferable.
In this suturing device, a main suction hole connected to the suction mechanism and a branch suction hole branched from the main suction hole are provided in each recess. Even if the branched suction holes are closed by the sutured object, the remaining branched suction holes can be sucked.
[0010]
DETAILED DESCRIPTION OF THE INVENTION
A first embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 1, the suturing device 1 according to the present embodiment is attached to the distal end portion along the insertion portion of the endoscope S, and is used when a biological tissue 2 that is a suture target is sutured to the purse. To do.
As shown in FIGS. 1 and 2, the suturing device 1 includes a treatment body 3 that contacts a living tissue 2 to perform a suture treatment, a suction mechanism 4 connected to the treatment body 3, and a suture thread inside. 5 includes a hollow puncture needle 6 that pierces the living tissue 2 and allows the thread 5 to pass therethrough, and an operation unit H that allows the thread 5 and the hollow puncture needle 6 to advance and retract.
[0011]
As shown in FIG. 3, the treatment body 3 is connected to the distal end portion of a flexible shaft member 7 and is formed in a rectangular parallelepiped shape that is long in the extending direction of the shaft member 7. One surface along the length direction is a treatment surface 8 that can be in close contact with the biological tissue 2, a plurality of recesses 9 formed side by side in the length direction of the treatment surface 8, and hollow punctures in these recesses 9 The needle 6 is provided with an insertion hole 10 through which insertion is continuously possible from one direction. The distal end 3 a of the treatment body 3 has a hole 11 through which the hollow puncture needle 6 can penetrate as a part of the insertion hole 10 and an air leak as a space communicating with the recess 9 through the hole 11. 11A of prevention parts are formed.
[0012]
Each recess 9 is opposed to one base recess 9A provided in the length direction of the treatment surface 8 from the side edge portions 8a on both sides in the width direction of the treatment surface 8 toward the treatment body center side. Each pair of protrusions 12 formed so as to extend is formed to be partitioned. The insertion hole path 10 is provided in the center of the base end portion 3 b of the treatment body 3 and is configured to communicate with each recess 9 and the hole 11.
The hole portion 11 is provided in a wall portion 11B that partitions the concave portion 9 and the air leakage prevention portion 11A, and communicates the both. The wall portion 11B has an air leakage prevention portion 11A side toward the concave portion 9 side. A tapered portion 11C that gradually decreases the size of the hole 11 is formed.
[0013]
As shown in FIGS. 1 and 2, the suction mechanism 4 includes a suction pump P and a suction tube 13 communicated with the suction pump P. The suction tube 13 communicates with a suction hole 14 formed in the proximal end portion 3 b of the treatment body 3 and is connected to each recess 9, and the inside of each recess 9 can be sucked by a suction pump P.
A rod-like retaining member 15 that is shorter than the size of the hole 11 and longer than the inner diameter of the hollow puncture needle 6 is fastened to the tip of the thread 5.
The retaining member 15 is accommodated along the axial direction of the hollow puncture needle 6 when in the hollow puncture needle 6.
[0014]
Next, the usage method of the suturing device 1 which concerns on this embodiment which consists of the above structure is demonstrated.
First, the suturing device 1 is inserted into the body together with the endoscope S shown in FIG. 1 from the natural opening of the human body. Then, as shown in FIG. 2, the treatment surface 8 is disposed on the living tissue 2 to be sutured, and then the treatment surface 8 is brought into close contact with the living tissue 2.
Subsequently, the suction pump P is driven, and the space formed by the living tissue 2 and the respective recesses 9 is sucked through the suction tube 13 to obtain a negative pressure. At this time, as shown in FIG. 4A, the surface of the living tissue 2 other than the portion pressed by the projecting portion 12 is sucked into the respective recesses 9 to simultaneously form a plurality of projecting portions 2a.
[0015]
And as shown in FIG.4 (b), the hollow puncture needle 6 equipped with the thread | yarn 5 inside is inserted from the base end part 3b side of the treatment main body 3, and each convex-shaped part 2a is continuously penetrated, The tip is inserted to a position where it passes through the hole 11 and protrudes into the air leakage prevention part 11A.
Subsequently, when the thread 5 is pushed out from the hollow puncture needle 6 by an unillustrated pushing device, the tip of the thread 5 jumps out of the hollow puncture needle 6 together with the retaining member 15.
Thereafter, the hollow puncture needle 6 is retracted again, the suction pump P is stopped to stop the suction, and the treatment body 3 is separated from the living tissue 2.
In this way, as shown in FIG. 4C, the thread 5 can be simultaneously inserted into the plurality of convex portions 2a. Further, as shown in FIG. 4D, when the thread 5 is pulled, the retaining member 15 is hooked on the convex portion 2a, so that each convex portion 2a is pulled and stitched.
[0016]
An example of suturing using the suturing device 1 will be described below.
FIG. 5 shows the case where the incision is sutured to the purse.
After the incision, it is difficult to suck this portion due to air leakage from the incision site 16 and the like, so the suture 5 is pre-stitched around the incision site 16 by the suturing device 1 as shown in FIG. .
Next, as shown in FIG. 5B, an incision is made, and a treatment tool 17 is inserted from the incision site 16 to perform various treatments in the body cavity.
And as shown in FIG.5 (c), the incision site | part 16 is sewn on the purse-string by pulling the both ends of the thread | yarn 5 together.
Next, FIG. 6 shows a case where the drug 18 is embedded in the tissue after treatment.
Also in this case, as shown in FIG. 6A, the periphery around which the medicine 18 is embedded is previously sutured with the thread 5 by the suturing device 1.
Then, after the drug 18 is placed, the end of the thread 5 is drawn, whereby the drug 18 is wrapped and embedded in the surface of the living tissue 2 as shown in FIGS.
[0017]
According to the suturing device 1, a plurality of convex portions 2 a can be formed by taking the biological tissue 2 into each concave portion 9 of the treatment body 3 by one suction by the suction mechanism 4. Moreover, the thread | yarn 5 can be penetrated to each convex-shaped part 2a by making the hollow puncture needle 6 penetrate the convex-shaped part 2a continuously through the penetration hole path 10, and it can sew several places simultaneously.
[0018]
Next, a second embodiment according to the present invention will be described with reference to FIGS. In the following description, the same reference numerals are given to the components described in the above embodiment, and the description thereof is omitted.
The second embodiment is different from the first embodiment in that, in the first embodiment, one insertion hole 10 is formed in the treatment body 3, whereas in the second embodiment, the treatment is treated. This is that a pair of insertion holes 20 and 21 are formed in the main body 19 side by side.
[0019]
As shown in FIG. 7A, the suturing device 22 according to the present embodiment has a configuration similar to that of the suturing device 1 according to the above-described embodiment, and each recess 9 is formed on the treatment surface 19A of the treatment body 19. Each pair of protrusions 12 is formed to be partitioned. Further, the treatment main body 19 is provided with a pair of insertion hole paths 20 and 21 side by side from the base end part 19b side to the distal end part 19a side, and these insertion hole paths 20 and 21 are provided at the distal end part 19a. It is connected by a folded portion 23 provided on the side.
The suturing device 22 includes two hollow puncture needles, a first hollow puncture needle 24 and a second hollow puncture needle 25, and is arranged so as to be inserted into the insertion holes 20 and 21, respectively. ing.
As shown in FIG. 8A, the first hollow puncture needle 24 includes a thread guide member 26 that is formed in a linear shape and has flexibility. The thread guiding member 26 further includes a linear main body 27 and a thread gripping member 28 attached to the distal end portion of the linear main body 27, and the inside of the first hollow puncture needle 24 is operated by the operation unit H. It can be extruded or retracted.
The second hollow puncture needle 25 has a thread 5 inside, and a gripped member 29 that is gripped and coupled to the thread gripping member 28 is provided at the tip of the thread 5.
As shown in FIG. 8 (b), the second hollow puncture needle 25 includes an extruding member 25 A that extrudes a grasped member 29. The extruding member 25 A is The hollow puncture needle 25 can be pushed out or retracted.
[0020]
Next, a method of using the suturing device 22 according to the present embodiment having the above configuration will be described.
First, the suturing device 22 is inserted into the body together with the endoscope S shown in FIG. 1 from the natural opening of the human body. Then, similarly to the first embodiment, the living tissue 2 brought into contact with the treatment surface 19A is sucked into the recesses 9 to simultaneously form a plurality of convex portions 2a.
Then, as shown in FIG. 7B, the first hollow puncture needle 24 and the second hollow puncture needle 25 are inserted into the treatment main body 19 from the proximal end portion 19b side of the treatment main body 19, respectively, To reach the position of the turn-back portion 23.
[0021]
Subsequently, as shown in FIGS. 8A and 8B, the thread guide member 26 is pushed out from the inside of the first hollow puncture needle 24 to the outside and the second hollow puncture needle 25 is The pushing member 25A is operated from the inside, and the thread 5 is pushed out together with the grasped member 29.
The extruded thread guide member 26 is inserted through the turn-up portion 23 to reach the distal end position of the second hollow puncture needle 25, and as shown in FIG. 8C, the thread gripping member 28 is supported by the extruded member 25A. The pressed member 29 is pushed and coupled.
[0022]
Next, as shown in FIG. 8 (d), the thread guiding member 26 is pulled toward the first hollow puncture needle 24. At this time, the thread 5 moves along with the thread guide member 26 in the folded portion 23 toward the first hollow puncture needle 24.
Thus, as shown in FIGS. 8 (e) and 9 (a), one yarn is inserted through the turn-back portion 23.
Thereafter, as shown in FIG. 9 (b), the first hollow puncture needle 24 and the second hollow puncture needle 25 are retracted again, and the suction pump P is stopped to stop the suction, and then the suturing device 22 is stopped. Is removed from the living tissue.
Thus, as shown in FIG. 10, the periphery of the living tissue 2 is sutured with a single thread 5.
In addition, as shown in FIG. 8 (f) which is an AA cross section of FIG. 8 (e), a slit 23a through which the thread 5 can enter and exit is provided on the inner side surface of the folded portion 23.
Further, when the thread gripping member 28 and the gripped member 29 are coupled, as shown in FIG. 8 (f), a step portion 25a is provided on the inner wall of the second hollow puncture needle 25 in place of the pushing member 25A. The grasped member 29 may be positioned by supporting the grasped member 29 with the step portion 25a.
[0023]
Here, for example, as shown in FIG. 11, the thread gripping member 28 and the gripped member 29 are joined by forming the gripped member 29 in a hook shape and providing a gripping recess 28a on the distal end surface of the thread gripping member 28. A fastener 30 made of a flexible material such as silicon resin having a through portion 30a engaged with the grasped member 29 is disposed therein.
In this connection, as shown in FIG. 11 (a), once the bowl-shaped gripped member 29 passes through the through portion 30a of the fastener 30 and is once inserted into the gripping recess 28a, the gripped member 29 is gripped. Even if it tries to take out from the inside of the recessed part 28a, as shown in FIG.11 (b), since the to-be-gripped member 29 is hooked on the fastener 30, a coupling | bonding state is maintained.
Instead of the fastener 30, as shown in FIG. 12, a ridge 28b formed extending toward the inside of the gripping recess 28a may be formed.
Also in this case, as shown in FIG. 12A, when the gripping member 29 is inserted into the gripping recess 28a, the gripping member 29 and the protrusion 28b are engaged as shown in FIG. 12B. The combined state is maintained.
[0024]
Instead of the fastener 30, as shown in FIG. 13A, a spring member 31 that can be expanded and contracted in the radial direction may be provided at the inlet 28c of the gripping recess 28a. In this case, when the member 29 to be gripped is inserted into the gripping recess 28a, the member 29 to be gripped is inserted while spreading the spring member 31 outward, as shown in FIG. 13B. Once inserted into the gripping recess 28a, the gripped member 29 is caught by the spring member 31 whose diameter has returned to the original size as shown in FIG. The
[0025]
Furthermore, as shown in FIG. 14A, an umbrella-shaped portion 29 a made up of a leaf spring may be provided at the tip of the grasped member 29.
In this case, when inserting the grasped member 29 into the grasping recess 28a, the umbrella-shaped portion 29a is once closed when passing through the inlet 28c of the grasping recess 28a. It passes through the inlet portion 28c in a state where it is smaller than the inner diameter of the inlet portion 28c. When the grasped member 29 is inserted into the grasping recess 28a, as shown in FIG. 14B, the umbrella-shaped portion 29a returns to its original shape, and the outer diameter of the grasped member 29 is again at the inlet portion 28c. Since it becomes larger than the inner diameter, the coupled state is maintained by the gripped member 29 being caught by the inlet 28c.
Further, as a thread gripping member that grips the umbrella-shaped portion 29a, a ring portion 32 as shown in FIG. Also in this case, after the umbrella-shaped portion 29a is inserted into the ring portion 32 as described above, the combined state is established by the umbrella-shaped portion 29a being hooked on the ring portion 32 as shown in FIG. Maintained.
[0026]
In the above embodiment, the thread 5 is inserted through the second hollow puncture needle 25. However, as shown in FIG. 16 (a), the thread 5 is inserted through both hollow puncture needles and turned back. You may connect with the intermediate member 33 provided in the part 23, and you may make it communicate as one thread | yarn. In this case, the intermediate member 33 is formed in a coil shape. Accordingly, when the grasped member 29 is inserted into the intermediate member 33, the grasped member 29 is caught by the intermediate member 33 as shown in FIG. Combined as a book thread.
[0027]
Here, the intermediate member 33 is not limited to the above-described coil shape, and may be a resin tube 34 </ b> A made of a flexible material such as silicon resin, as shown in FIG. 17A. Alternatively, as shown in FIG. 17B, only the tube end surface 34a may be a resin tube 34B in which the diameter of the tube is reduced and the gripped member 29 is further prevented from being pulled out. Further, as shown in FIG. 17 (c), a slit 35a is provided on the side surface, and the tube 35 is easily coupled to the grasped member 29 using the elastic change in the circumferential direction of the side surface, and is difficult to come off. Also good.
Note that the tip shape of the grasped member 29 at this time may be a saddle shape shown in FIGS. 18A and 18B as another example.
[0028]
Next, the ligation method will be described below.
As shown in FIG. 19 (a), for example, a loader's knot 36 is preliminarily connected to the first hollow puncture needle 24 or the second hollow puncture needle 25 as a knot, as shown in FIG. You may make it form in any one of these.
At this time, the thread 5, the first hollow puncture needle 24, and the second hollow puncture needle 25 are connected to the operation portion H1 shown in FIG.
The operation portion H1 is connected to the proximal end sides of the first hollow puncture needle 24 and the second hollow puncture needle 25, and is connected to needle advancement / retraction members 37 and 38 for making the respective advance / retreat operations and the proximal end side of the thread 5 And a thread advance / retreat member 39 that is advanced and retracted. A knot drop 40 for holding a loader's knot 36 is provided on the outer periphery of the first hollow puncture needle 24, and is connected to a knot drop advance / retreat member 41 provided on the operation portion H1.
[0029]
When the purse string is sutured, the needle advancement / retraction members 37 and 38 are advanced to the distal end side to advance the first hollow puncture needle 24 and the second hollow puncture needle 25, and then the thread advancement / retraction member 39 is moved to the distal end side. Then, the thread 5 is extruded, and as shown in FIG. 19C, the grasped member 29 is inserted into the thread gripping members 28 provided at both ends of the intermediate member 33 so that the thread 5 communicates. Thereafter, as shown in FIG. 19 (d), the thread advancement / retraction member 39 on the first hollow puncture needle 24 side is pulled, and the intermediate member 33 is pulled into the first hollow puncture needle 24 together with the thread 5, and FIG. ), The knot dropping advancement / retraction member 41 is pushed out toward the distal end side of the yarn 5 and the loader's knot 36 is pushed out from the outside of the first hollow puncture needle 24.
In this way, by operating the needle advancement / retraction members 37, 38 to pull the first hollow puncture needle 24 and the second hollow puncture needle 25 together with the intermediate member 33, the thread advancement / retraction member 39 is operated to pull the thread 5. A loop 42 is formed by the folded portion 23, and the purse string suture is completed by narrowing the ring 42.
[0030]
Further, the thread gripping member 28 and the intermediate member 33 may not be provided. For example, after the thread 5 is inserted through the first hollow puncture needle 24 and the second hollow puncture needle 25, respectively, as shown in FIG. Even if the tip end of each yarn 5 is ligated by the ligating device 43 or the like, the yarn 5 can be communicated as a single yarn, and the purse-joining can be performed.
In this case, in order to prevent the yarn 5 from coming out when ligated, a retaining member 15 is provided at the tip of each yarn 5 as shown in FIG. Instead of the retaining member 15, a knot-shaped knot 44 may be formed as shown in FIG. 20 (b), and the grasped member 29 is attached as shown in FIG. 20 (c). Also good.
[0031]
When purse-string suture is performed, the first hollow puncture needle 24 and the second hollow puncture needle 25 are advanced by advancing the needle advancing / retracting members 37 and 38 toward the distal end side in the operation portion H1 shown in FIG. 19B. Thereafter, the yarn advance / retreat member 39 is moved to the front end side to push out the yarn 5 and, after the front end side of the yarn 5 is joined by the ligating device 43, the knot dropping advance / retreat member 41 is pushed out to the front end side of the yarn 5 to load the loader. Znot 36 is extruded. Thereafter, the purse string suture is performed by operating the thread advance / retreat member 39 to draw the thread 5.
[0032]
In addition, instead of the loader's knot 36 that pulls the thread 5 inserted through the purse string suture, as shown in FIG. 21 (a), the first hollow puncture needle 24 and the second hollow puncture needle A hollow operation rod 45 having a hollow shape may be newly disposed along the line 25.
In this case, first, the first hollow puncture needle 24 and the second hollow puncture needle 25 are provided with slits 24a, 25a extending in the axial direction from the distal end side on the opposing outer wall surfaces. And after each thread | yarn 5 inserted in the inside of each of the 1st hollow puncture needle 24 and the 2nd hollow puncture needle 25 is each pulled out from slit 24a, 25a, these other end side is put together into one. The tube 46 is inserted into the hollow operation rod 45 and a tube 46 made of silicon resin or the like is inserted into the distal end side of the hollow operation rod 45 as a stopper instead of the loader's knot 36.
As shown in FIG. 21B, the operation unit H2 at this time includes an intermediate advance / retreat member 45A that causes the intermediate operation rod 45 to advance / retreat instead of the knot dropping advance / retreat member 44.
Then, as shown in FIG. 21 (c), after forming the ring 47 with the thread 5, the intermediate advance / retreat member 45A is operated to push out the hollow operation rod 45 and push the tube 46 toward the ring 47 side. At this time, the ring 47 is narrowed by the tube 46, and the purse string can be sewn.
[0033]
According to the suturing device 22, the threads 5 can be inserted into two rows with respect to the plurality of convex portions 2a formed by one suction. Further, since the insertion holes 20 and 21 through which the thread 5 is inserted are connected by the folded-back portion 23, the inserted thread 5 can be coupled via the folded-back portion 23, and the living tissue 2 can be sewn on the purse-string. it can.
[0034]
The technical scope of the present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the present invention.
For example, in the said embodiment, the recessed part formed in the treatment main body shall be divided and formed in the some recessed part 9 by the protruding part 12. FIG. On the other hand, as shown in FIG. 22, the treatment surface 49 of the treatment body 48 is formed with a plurality of holes 50 serving as recesses, and a main suction hole 51 connected to the suction tube 13. A branch suction hole 52 branched from the main suction hole 51 and connected to each hole portion 50 may be provided.
In this case, when the biological tissue is sucked into the hole 50, even if any of the branch suction holes 52 is blocked by the biological tissue, the suction can be continued from the remaining branch suction holes 52.
[0035]
【The invention's effect】
The present invention described above has the following effects.
According to the suturing device of the present invention, it is possible to simultaneously insert a thread into a plurality of locations of an object to be sutured with respect to one suction, and to shorten the treatment time required for the suturing operation. The purse string can be sutured easily and accurately with a single suction operation.
[Brief description of the drawings]
FIG. 1 is an overall view showing a suturing device according to a first embodiment of the present invention together with an endoscope.
FIG. 2 is a cross-sectional view showing the suturing device according to the first embodiment of the present invention.
FIG. 3 is a diagram showing a plane viewed from the treatment surface side showing the suturing device according to the first embodiment of the present invention.
FIG. 4 is an explanatory view showing a suturing method by the suturing device according to the first embodiment of the present invention in the order of steps.
FIGS. 5A and 5B are explanatory views sequentially showing an example of use and steps of the suturing device according to the first embodiment of the present invention. FIGS.
FIGS. 6A and 6B are explanatory views sequentially showing another example of use and the process of the suturing device according to the first embodiment of the present invention. FIGS.
FIG. 7 is an explanatory view showing the suturing method by the suturing device according to the second embodiment of the present invention in the order of steps by a plan view from the treatment surface side of the suturing device.
FIGS. 8A and 8B are explanatory diagrams showing a method of joining threads at a turn-back portion in a suturing device according to a second embodiment of the present invention in order of steps. FIGS.
FIG. 9 is an explanatory view sequentially showing the subsequent steps shown in FIG. 7 in the suturing method by the suturing device according to the second embodiment of the present invention.
FIG. 10 is a perspective view showing a state in which a living tissue is sutured by the suturing device according to the second embodiment of the present invention.
FIG. 11 is an explanatory view showing a method of joining threads by a thread gripping member and a gripped member in the suturing device according to the second embodiment of the present invention in order of steps.
FIG. 12 is an explanatory diagram showing a method of joining yarns in the order of steps when the yarn gripping member is another example in FIG. 11;
FIG. 13 is an explanatory view showing a method of joining yarns in the order of steps when the yarn gripping member is still another example in FIG. 11;
FIG. 14 is an explanatory diagram showing a method of joining yarns in the order of steps when the yarn gripping member and the gripped member are other examples in FIG. 11;
FIG. 15 is an explanatory view showing a method of joining yarns in the order of steps when the yarn gripping member and the gripped member are further different from each other in FIG. 11;
FIGS. 16A and 16B are explanatory views showing a method of joining a thread through an intermediate member in the suturing device according to the second embodiment of the present invention in order of steps. FIGS.
FIG. 17 is an explanatory view showing another example of the intermediate member in FIG.
FIG. 18 is an explanatory view showing another example of a member to be grasped in FIG.
FIG. 19 is an explanatory view showing a suture purse string sewing method in the order of steps in the suturing device according to the second embodiment of the present invention.
FIG. 20 is an explanatory view showing the purse string stitching method of the yarn by another joining method in FIG. 19 in the order of steps.
FIG. 21 is an explanatory view showing another example of the suture purse string sewing method shown in FIGS. 19 and 20;
FIG. 22 is a cross-sectional view showing another example of the treatment main body of the suturing device according to each embodiment of the present invention.
[Explanation of symbols]
1,22 Suture device
2 Living tissue (to be sutured)
3, 19, 48 Treatment body
4 Suction mechanism
5 Yarn
6 Hollow puncture needle
8,44 Treatment surface
9 recess
10, 20, 21 Insertion passage
23 Folding part
24 First hollow puncture needle (hollow puncture needle)
25 Second hollow puncture needle (hollow puncture needle)
50 holes (recesses)
51 Main suction hole
52 Branch suction hole

Claims

A treatment main body for performing a suture treatment in contact with an object to be sutured;
A suction mechanism connected to the treatment body;
A hollow puncture needle through which a suture thread can be inserted and punctured into the sutured object to insert the thread;
The treatment body is capable of being in close contact with the object to be sutured, and a plurality of recesses formed side by side on the treatment surface;
An insertion hole through which the hollow puncture needle is continuously inserted into these recesses,
A suturing apparatus, wherein the suction mechanism is connected to the recesses and is capable of sucking the recesses.

The treatment body has a pair of insertion holes arranged in a direction from the proximal side to the distal side, and these insertion holes are connected by a folded portion on the distal side. The suturing device according to claim 1.

A main suction hole connected to the suction mechanism;
The suturing device according to claim 1 or 2, further comprising a branch suction hole branched from the main suction hole and connected to each of the recesses.