JP2012165880A - Suturing device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a suturing device perfectly performing the full-thickness plication of gastrointestinal tract wall, retaining the high strength of the suture, and facilitating a suturing operation in an endoscopic operation.SOLUTION: This suturing device includes: a plurality of anchors that are superposedly disposed; a thread that penetrates through the plurality of anchors; an extrusion member for extruding the anchors; a hollow needle that stores the anchors and the extrusion member and is formed with a side hole for discharging the anchors; and a sheath member covering the needle member.

Description

  The present invention relates to a suturing device, and more particularly to a suturing device for suturing an incision in a transluminal endoscopic surgery (NOTES).

  Since NOTES incises the wall of the gastrointestinal tract and inserts the endoscope into the body cavity, it is necessary to securely close the incision after the operation is completed.

  Examples of techniques related to closing the incision include, for example, (1) “Resolution clips” in which the edge of the hole formed in the incision is sewn using a tool such as a clothespin, and (2) the incision "T tags" that pass through two threaded rods at the edge of the hole formed in the hole and squeeze by shrinking the thread, (3) Two threads attached to the edge of the hole formed in the incision “Purse string modified T tag”, in which a rod is placed and sutured in a purse-like manner, (4) “Egle Claw VII”, in which a curved needle is penetrated one by one in the same manner as in surgery, and (5) sew with a fine staple needle “Flexible endoscopic stapler”, (6) “Purse strings”, which is a purse-like stitch that is continuously threaded to the edge of the hole formed in the incision. turing device has a ", (7) surgery likewise sutured by penetrating one by one Chokuhari" Flexible Endostitch ".

  However, the above (1) “Resolution clip” has a problem that the entire layer of the digestive tract wall cannot be completely sewn, and the strength is weak because it is a single ligature. In addition, (2) “T tags” requires a two-channel endoscope, and the endoscope must be completely removed every time it is sewn. Therefore, there is a problem that the strength is weakened. Further, (3) “Purse string modified T tag” has a problem in that the strength is weak because the entire digestion wall cannot be sewn. Further, (4) “Eagle Claw VII” has a problem that it requires skill and cannot be easily performed because it is an operation of inserting a needle from the side like a surgical operation. Moreover, since it is a single ligature like said (1), there exists a subject that intensity | strength becomes weak, and also there exists a subject that an endoscope must be completely pulled out every time it sews once. In addition, (5) “Flexible endoscopic stapler” is large in machine, and is difficult to insert into the endoscope forceps hole. There is also a problem that the machine is very expensive. Further, (6) “Purse string constructing device” has a problem that the entire layer of the digestive tract wall cannot be completely sewn and the strength is weak. Further, (7) “Flexible Endostitch” has a problem that skill is required for the operation of inserting a needle from the side as in surgery.

  Therefore, in view of the above problems, the present invention can completely perform digestion wall full-layer stitching in endoscopic surgery, maintain a high suture strength, and perform a suture operation more easily. An object is to provide a suturing device.

  A suturing device according to a first means for solving the above problems includes a plurality of anchors arranged in a stacked manner, a thread passing through the plurality of anchors, an anchor and a side hole for discharging the anchor and discharging the anchor. A hollow needle member, a sheath member that covers the needle member, and an extrusion member that pushes out the anchor.

  As described above, according to the present invention, there is provided a suturing device that can completely perform gastrointestinal wall full-layer stitching in endoscopic surgery, maintain a high suturing strength, and perform a suturing operation more easily. be able to.

It is a figure for demonstrating the outline of the suturing device which concerns on embodiment. It is sectional drawing for demonstrating the outline of the suturing device which concerns on embodiment. It is a figure for demonstrating the outline of the anchor which concerns on embodiment. It is a figure for demonstrating the outline of the extrusion member which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the silicon tube used in the suturing method using the suturing device which concerns on embodiment. It is a figure for demonstrating the suturing method using the suturing device which concerns on embodiment.

  Embodiments of the present invention will be described below with reference to the drawings. However, the present invention can be implemented in many different modes and is not limited to the embodiments shown below.

(Embodiment 1)
FIG. 1 is a view for explaining an outline of the vicinity of the distal end of a suturing device (hereinafter referred to as “present device”) 1 according to the present embodiment. The suturing device 1 according to this embodiment is configured to have a needle member 3 in a sheath member 2.

  The sheath member 2 is used to store the needle member 3 and an anchor 4 (described later) disposed inside the needle member 3, and has a hollow tubular shape. A user of the device (hereinafter simply referred to as “user”) can perform a suturing operation by causing the needle member 3 to protrude from the sheath member 2 and then discharging an anchor 4 or the like described later. The material of the sheath member 2 is not limited as long as it has this function, but for example, metal, plastic, or the like can be employed. The inner diameter of the sheath member 2 can be adjusted as appropriate according to the total number of the needle members 3, but is preferably in the range of 1 mm to 10 mm, and more preferably 5 mm or less.

  The needle member 3 is inserted through the edge of the hole formed in the incision portion in order to sew the incision portion. In addition, the needle member 3 in the present embodiment is hollow, the side hole 31 is formed, and a plurality of anchors 4 and anchor contact portions 51 of the extrusion members 5 are provided in the hollow portion.

  As will be described in detail later, the side hole 31 of the needle member 3 according to the present embodiment is formed to discharge the anchor 4, and a spring 32 is formed as an urging means inside the vicinity thereof. Has been. FIG. 2 shows a schematic cross-sectional view of the suturing device according to the present embodiment. As shown in this figure, the spring 32 is convex on the side where the anchors are stacked, generates a force to push the anchor back, and when the anchor approaches the side wall and passes through a certain position, this time, the side hole The force to be discharged from 31 to the outside of the needle member can be generated. By attaching the urging means to the needle member 3 in this way, the anchors 4 can be discharged into the body one by one.

  In the present embodiment, the anchor 4 is a columnar or cylindrical member, and has a through hole 43 through which the thread 6 passes. By arranging a plurality of anchors 4 in the body, the anchor 4 can be used as a stitching point, and the incision can be reliably stitched. The cross-sectional shape is not particularly limited, but a substantially circular shape is preferable from the viewpoint of not unnecessarily damaging the body tissue. Note that the “substantially circular shape” as used herein is a concept that includes a shape that can be said to be substantially circular, although it includes a complete circle, but has undergone deformation to the extent of manufacturing error. The anchor 4 may be columnar as long as the thread 6 can be passed through, but it is preferable that the anchor 4 be cylindrical from the viewpoint of weight reduction and reduction of the burden on the patient. In FIG. 3, the schematic of the anchor 4 which concerns on this embodiment is shown. Further, in the present embodiment, the number of anchors can be appropriately adjusted according to the number of points to be stitched, and about 10 is generally sufficient, but the number is not limited.

  In the present embodiment, the one surface 41 of the anchor 4 is preferably a flat surface, and the other surface 42 is preferably provided with irregularities. By making one side flat, it can be stably laminated in one direction, and by attaching unevenness to one side, it can prevent anchors from sticking to each other and put it in the vicinity of the wall on the edge of the incision When installing as a stitching point, there is an advantage that it can be installed in a stable state in accordance with a non-flat body wall. In particular, among the plurality of anchors 4 in the present embodiment, the anchor 4 disposed at the most distal end is fixed to the thread, but the anchor 4 disposed below the anchor 4 is not fixed to the thread.

  Further, in the present embodiment, the material of the anchor 4 is not particularly limited, but is preferably composed of a material that can be bioabsorbed, biodegradable, or biocompatible, such as a metal including titanium. Even plastic or ceramic may be used.

  In the present embodiment, the thread 6 penetrates the plurality of anchors 4 as described above. The thread 6 is not limited as long as it can penetrate and connect to a plurality of anchors. For example, the thread 6 is preferably made of a material that is bioabsorbable, biodegradable, or biocompatible, The use of glycolic acid is a preferred example.

  The device further includes an extruding member 5 for extruding the anchor. A schematic configuration of a cross section of the extruded member 5 is shown in FIG.

  In the present embodiment, the pushing member 5 is not limited as long as the anchor can be pushed out, but the anchor contact portion 51, the node member 52 provided with a plurality of nodes 521, the node member 52 and the anchor. A repulsive force is applied to the connecting portion 53 for connecting the contact portion 51, the first hook member 54 for hooking the node 521, the second hook member 55, and the first hook member 54 and the second hook member 55. And a repelling member 56 to be generated.

  In this embodiment, the anchor contact portion 51 is a member that is disposed inside the needle member 3, contacts the anchor 4 at the end, and pushes the anchor 4. In addition, it is a preferable example that this anchor contact part 51 is also hollow and the thread 6 can pass therethrough.

  In the present embodiment, the node member 52 is a member for reliably discharging the anchors 4 one by one in cooperation with the first hook member 54, the second hook member 55, and the repulsion member 56. In this embodiment, the node member 52 is a rod-shaped member, and a plurality of triangular-tooth-shaped nodes 521 provided with barbs 5211 are formed along the extending direction. The interval between the nodes is not limited, but is preferably about the length of each anchor 4 (the length from one surface to the other surface (the front end portion of the unevenness when there is an unevenness)). By doing so, one anchor 4 can be discharged each time one node is moved.

  In the present embodiment, a connection portion 53 that connects the node member 52 and the anchor contact portion 51 is provided. By doing in this way, it becomes possible to arrange the node member 52 as close to the hand as possible, and the anchor contact portion 51 can be pushed by the amount pushed and the anchor 4 can be pushed out.

  Further, in the present embodiment, the first hook member 54 is a hollow cylindrical member, has a cylindrical portion 541 that covers the entire node member 52, and is provided with a hook 542, and the node 521 of the node member 52 is provided. It is comprised so that the return 5211 can be hooked. In addition, it is preferable that the hook 542 has a flexibility that can be expanded so that it does not become an obstacle when the node member 52 moves forward. By doing in this way, the node member 52 can be advanced only in one direction.

  On the other hand, in the present embodiment, the second hook member 55 is disposed inside the first hook member 54 and has a hollow cylindrical portion 551 that can cover a part of the node member 52, and the hook 552. have. The hook 552 is arranged in accordance with the barb 5211 so that the barb 5211 of the node 521 of the node member 52 can be pushed. That is, the node member 52 can be advanced by pressing the return 5211. In addition, it is preferable that the hook 552 has a flexibility that can be expanded so as not to be caught when the second hook member 55 is pulled. By doing in this way, the node member 52 can be advanced only in one direction.

  In the present embodiment, the second hook member 55 includes a shaft member 553 for pressing the tube portion 551 and a pressing portion 554. By doing in this way, while being able to make it easy to push the cylinder part 551 and the hook 552, the repulsion member 56 can be made easy to arrange | position.

  Further, in the present embodiment, the repulsion member 56 can generate an appropriate repulsive force between the first hook member 54 and the second hook member 55. Although not limited to this, in the present embodiment, a helical spring disposed around the shaft member 553 of the second hook member 55 is adopted, and the cylindrical portion 541 of the first hook member 54 and the first hook member 54 are connected. A repulsive force is generated between the pressing portion 554 of the second hook member. By doing in this way, while being able to make the hook hooked on the node member by the repulsive force, the node member can be pushed out in one direction by pressing the pressing portion 554.

  Here, a suturing method using the suturing device according to the present embodiment will be described. 5 to 13 are diagrams showing an outline of the suturing method.

  First, the user projects the needle member 3 from the sheath member 2 and inserts it into the digestive tract wall. Since a blade is formed at the tip of the needle, it can be easily inserted (FIG. 5).

  After inserting the needle member 3 into the digestive tract wall, one anchor 4 is discharged by the pressing member (FIG. 6), and the needle member 3 is pulled out. Since the digestive tract wall has elasticity, if the hole is about the size of the blade of the needle part 3, the needle member 3 is pulled out to naturally close the hole, and the anchor 4 is placed in the digestive tract wall. It can be hooked and held (FIG. 7).

  Then, this operation is repeated a plurality of times at a position where it is desired to sew, thereby arranging a plurality of anchors. This state is shown in FIGS. 8 and 9 are views when the digestive tract wall is viewed from the inside and the outside. And the thread | yarn 6 can be pulled and the hole formed in the incision part can be sewn completely. This figure is shown in FIGS. 10 and 11 are views when the digestive tract wall is viewed from inside and outside.

  Then, the user pulls out the suture member, moves, for example, the silicon tube 7 shown in FIG. 12 through the thread 6 to the binding end, cuts it with small scissors, connects the cut part, and binds the thread. This state is shown in FIG.

  As described above, according to the suturing device according to the present embodiment, since the suturing operation can be performed with one thread in endoscopic surgery, the entire digestive tract wall can be sewn and the strength of suturing can be maintained high. Furthermore, since it can be realized simply by making improvements to a conventional instrument (needle), it is inexpensive and can be sutured by simple operations such as pushing and pulling, and without removing the endoscope. The stitching operation can be performed very easily.

  The present invention has industrial applicability as a suturing device.

Claims (3)

A plurality of anchors arranged in layers;
A thread that penetrates the plurality of anchors;
A hollow needle member that houses the anchor and is formed with a side hole for discharging the anchor;
A sheath member covering the needle member;
A pushing device for pushing out the anchor.   The suturing device according to claim 1, wherein the anchor has corrugated irregularities on one surface. The suturing device according to claim 1, wherein a spring is attached to an inner side of the needle near the side hole.