JP5435453B2

JP5435453B2 - Medical suturing device

Info

Publication number: JP5435453B2
Application number: JP2009039773A
Authority: JP
Inventors: 寿光小林; 邦利池田; 万希生大石; 直幸内藤; 晃義松原
Original assignee: Hoya Corp; National Cancer Center Japan
Current assignee: Hoya Corp; National Cancer Center Japan
Priority date: 2009-02-23
Filing date: 2009-02-23
Publication date: 2014-03-05
Anticipated expiration: 2029-02-23
Also published as: JP2010193971A

Description

本発明は、ステープルを用いて対象部位を縫合する医療用縫合装置に関する。 The present invention relates to a medical suturing apparatus for suturing a target site using staples.

ステープルを用いて臓器などの対象部位を縫合する医療用縫合装置の従来技術としては、例えば特許文献１に開示されたものがある。
この医療用縫合装置は、軟性内視鏡の可撓性を有する挿入部の先端部にステープル（針）を収納し、かつ先端面からステープルを外部に排出可能な縫合器を設け、かつ挿入部の中間部に排出されたステープルを受けるアンビル部を設けたものである。
この縫合器付内視鏡は、その挿入部を患者の口から食道に通し、例えば挿入部の先端部を胃の内部に位置させて用いる。具体的には、湾曲した胃壁の表裏両面の一方にアンビル部を接触させ、さらに挿入部を湾曲操作することにより挿入部の先端面（縫合器の先端面）を胃壁の他方の面に接触させ、アンビル部と挿入部の先端面で該胃壁を挟み込む。そして、縫合器内のステープルを挿入部の先端面から胃壁側に排出し、胃壁を貫通したステープルをアンビル部に接触させる。すると、ステープルがアンビル部によって変形させられて閉じるので、ステープルによって当該胃壁が縫合される。 As a prior art of a medical suturing apparatus that sutures a target site such as an organ using staples, there is one disclosed in Patent Document 1, for example.
This medical suturing device is provided with a suturing device that houses a staple (needle) at the distal end portion of a flexible insertion portion of a flexible endoscope and can discharge the staple from the distal end surface to the outside. The anvil part which receives the staple discharged in the intermediate part of this is provided.
This endoscope with a suture instrument is used by passing the insertion portion from the patient's mouth to the esophagus, for example, by positioning the distal end portion of the insertion portion inside the stomach. Specifically, the anvil portion is brought into contact with one of both the front and back surfaces of the curved stomach wall, and the insertion portion is further bent to bring the distal end surface of the insertion portion (the distal end surface of the suture instrument) into contact with the other surface of the stomach wall. The stomach wall is sandwiched between the anvil part and the distal end surface of the insertion part. Then, the staple in the suture instrument is discharged from the distal end surface of the insertion portion to the stomach wall side, and the staple penetrating the stomach wall is brought into contact with the anvil portion. Then, since the staple is deformed and closed by the anvil portion, the stomach wall is sutured by the staple.

特表２００４−５２２４７３号公報JP-T-2004-522473 特開平８−２３８２５５号公報JP-A-8-238255 特開平８−３３６３９号公報JP-A-8-33639

しかし、特許文献１の医療用縫合装置は、挿入部を正確に曲げて挿入部の先端面とアンビル部を正確に対向させないと、挿入部の先端面とアンビル部で対象部位（胃壁）を正確に挟み込めない。しかも、対象部位にステープルを正確に打ち込めなくなるので、患者の体に無用のダメージを与えてしまう。しかしながら、挿入部の湾曲操作を正確に行うのは容易ではないので、このような問題が発生するおそれが高い。 However, the medical suturing device of Patent Document 1 does not accurately bend the insertion portion so that the distal end surface of the insertion portion and the anvil portion are accurately opposed to each other. Can't be caught in. In addition, since the staple cannot be accurately driven into the target site, unnecessary damage is caused to the patient's body. However, since it is not easy to accurately perform the bending operation of the insertion portion, such a problem is likely to occur.

これに対して特許文献２、３には別タイプの医療用縫合装置が開示されている。特許文献２、３のものは、硬性挿入部の先端部に一対の開閉部材からなる縫合器を設けたものである。一方の開閉部材の内部には、多数のステープルを収納した収納空間と、該開閉部材内を開閉部材（挿入部）の軸線に対して略直交する方向に移動することによりステープルを他方の開閉部材に向けて排出するステープルドライバと、が設けてあり、他方の開閉部材には排出されたステープルと接触するアンビル部が設けてある。従って、一対の開閉部材で患者の対象部位を挟み込んだ状態で一方の開閉部材からステープルを排出すれば、ステープルがアンビル部によって閉じられることにより該対象部位が縫合される。
しかし、この縫合器は一方の開閉部材の内部に上記方向に移動するステープルドライバを収納しているので、一方の開閉部材が大型化（特に該開閉部材の軸線直交方向に）してしまう。さらに、他方の開閉部材も、一方の開閉部材に合わせて大型になってしまう。そのため、特許文献２、３の構造の縫合器を特許文献１の軟性内視鏡の挿入部の先端部に設けることは技術的には可能ではあるが、これでは縫合器を患者の口から食道や胃に挿入できなくなってしまう。 In contrast, Patent Documents 2 and 3 disclose different types of medical suturing devices. In Patent Documents 2 and 3, a suture instrument comprising a pair of opening and closing members is provided at the distal end portion of the rigid insertion portion. One open / close member has a storage space for storing a large number of staples, and the inside of the open / close member moves in a direction substantially perpendicular to the axis of the open / close member (insertion portion) to move the staple to the other open / close member. And a staple driver for discharging toward the head, and the other opening / closing member is provided with an anvil portion that contacts the discharged staple. Accordingly, when the staple is discharged from one of the opening / closing members in a state where the target portion of the patient is sandwiched between the pair of opening / closing members, the target portion is sutured by being closed by the anvil portion.
However, since this suture instrument houses a staple driver that moves in the above direction inside one opening / closing member, one opening / closing member becomes large (particularly in the direction perpendicular to the axis of the opening / closing member). Furthermore, the other opening / closing member also becomes large in accordance with the one opening / closing member. Therefore, although it is technically possible to provide the suture device having the structure of Patent Documents 2 and 3 at the distal end portion of the insertion portion of the flexible endoscope of Patent Document 1, the suture device is inserted from the patient's mouth to the esophagus. And can not be inserted into the stomach.

また、この種の医療用縫合装置において、挿入部の内部に処置具挿通路を形成し、かつ挿入部の先端面に該通路の出口開口を形成すれば、ステープルによる縫合作業だけでなく処置具による処置をも行えるので便利である。
しかし、挿入部の先端部にまで延びる処置具挿通路を形成すると、縫合器が軸線直交方向に大型化してしまう。 Further, in this type of medical suturing apparatus, if a treatment instrument insertion passage is formed inside the insertion portion and an outlet opening of the passage is formed at the distal end surface of the insertion portion, not only a suture operation by staples but also a treatment tool. This is convenient because it can also be used for treatment.
However, when the treatment instrument insertion passage extending to the distal end portion of the insertion portion is formed, the suturing device is enlarged in the direction orthogonal to the axis.

本発明は、縫合器を小型化することが可能な医療用縫合装置を提供することを目的とする。 An object of the present invention is to provide a medical suturing device that can reduce the size of a suturing device.

本発明の医療用縫合装置は、対象物に挿入可能で可撓性を有する挿入部と、該挿入部の先端部に接続する、ステープルを上記対象物内の対象部位に打ち込むことが可能な縫合器と、を備え、上記縫合器が、一対の先端部が開放状態にある略コの字形状の上記ステープルを収納する収納空間、及び、該収納空間と連通するステープルの出口用開口を有する本体部と、上記出口用開口と対向する状態で上記収納空間内を上記挿入部の軸線に対して略直交する方向にスライド可能として上記本体部に支持した押出部材と、上記本体部に対して相対移動可能な受け部材と、を備え、上記押出部材が、上記収納空間内に位置するステープルが位置する平面と略平行な板状をなし、かつ上記出口用開口と対向する押込板を備え、該押込板が上記出口用開口に最も近づき、上記収納空間内に位置する上記ステープルを上記出口用開口を通して本体部の外部に押す押込位置と、該押込板が上記出口用開口から最も離れることにより上記押出部材の一部が上記本体部の外部に突出する退避位置との間をスライド可能であり、上記収納空間内に、上記押込板が上記押込位置に移動したときに、上記収納空間内に位置する上記ステープルを上記押込板の側面に接触するまで付勢し、上記押込板が上記退避位置まで移動したときに、上記ステープルを上記収納空間の内壁に接触するまで付勢して該押込板の上記出口用開口側の端面と上記出口用開口の間に位置させる付勢手段を設け、上記受け部材は、上記本体部の周面から離れることにより該本体部との間で上記対象部位を挟み込み、かつ、上記出口用開口から排出されて該対象部位を貫通したステープルの先端部と接触することにより、該ステープルの一対の先端部を閉じる方向に変形させることを特徴としている。 The medical suturing device of the present invention is a suture that can be inserted into a target object and has a flexible insertion part, and a staple that is connected to the distal end of the insertion part and can drive a staple into the target part in the target object. A main body having a storage space for storing the substantially U-shaped staple having a pair of distal ends opened, and a staple outlet opening communicating with the storage space. Relative to the main body portion and the push member supported by the main body portion so as to be slidable in a direction substantially orthogonal to the axis of the insertion portion in the storage space in a state of facing the outlet opening. A movable receiving member, and the push-out member has a plate shape substantially parallel to a plane on which staples located in the storage space are located, and a pushing plate facing the outlet opening, Pushing plate is the above opening for exit A pushing position where the staple located closest to the storage space is pushed to the outside of the main body through the outlet opening, and a part of the pushing member is moved away from the outlet opening so that a part of the pushing member is the main body. Slidable between the retracted position protruding outside the section, and when the push plate moves to the push position in the storage space, the staple located in the storage space is moved to the push plate. When the pushing plate moves to the retracted position, the staple is pushed until it comes into contact with the inner wall of the storage space, and the end surface of the pushing plate on the outlet opening side An urging means is provided between the outlet openings, and the receiving member sandwiches the target portion with the main body by separating from the peripheral surface of the main body, and the outlet opening By being et discharged contacts the staple tip penetrates the target site is characterized by deforming in the direction of closing the pair of the tip of the staple.

上記挿入部の基端部が接続する操作部に、上記押出部材を上記本体部に対してスライド操作するための押出部材操作手段を設けるのが好ましい。 It is preferable to provide an extrusion member operating means for sliding the extrusion member with respect to the main body portion at the operation portion to which the proximal end portion of the insertion portion is connected.

上記受け部材が、上記本体部の周面に対して接離可能であるのが好ましい。
この場合、上記挿入部の基端部が接続する操作部に、上記受け部材を上記本体部に対して移動操作するための受け部材操作手段を設けるのが好ましい。 It is preferable that the receiving member is capable of contacting and separating from the peripheral surface of the main body.
In this case, it is preferable that a receiving member operating means for moving the receiving member with respect to the main body is provided in the operating portion to which the proximal end portion of the insertion portion is connected.

上記挿入部が、処置具を挿通可能で、その端部が上記縫合器と対向する先端面において開口する内部管路を具備し、上記縫合器を上記挿入部の先端部に、接続機構によって相対移動可能に接続してもよい。 The insertion portion, capable inserted treatment置具, equipped with internal conduit whose ends open in the distal end surface opposed to the suture instrument, the suture instrument to the tip portion of the insertion portion, the connection mechanism You may connect so that relative movement is possible .

上記接続機構が、該挿入部の軸線と平行な対をなすリンク部材を有しており、対をなすリンク部材の両端部を上記縫合器と上記挿入部の先端部とに、該軸線に直交する回転軸回りに回転可能として接続するのが好ましい。
この場合は、対をなす上記リンク部材が平行リンク機構を構成するのが好ましい。 The connection mechanism has a pair of link members parallel to the axis of the insertion portion, and both ends of the pair of link members are perpendicular to the axis with the suture instrument and the distal end of the insertion portion. It is preferable to connect to be rotatable around the rotation axis.
In this case, it is preferable that the link members forming a pair constitute a parallel link mechanism.

さらに、上記挿入部の基端部が接続する操作部に、上記リンク部材の上記挿入部の軸線に対する傾斜角度を調整するためのリンク操作手段を設けるのが好ましい。 Furthermore, it is preferable to provide a link operation means for adjusting an inclination angle of the link member with respect to the axis of the insertion portion at the operation portion to which the proximal end portion of the insertion portion is connected.

また、外力が掛からないときは上記接続機構を上記縫合器の軸線が上記挿入部の軸線に対して側方にずれる状態にし、かつ外力が掛かることにより上記接続機構を上記縫合器の軸線が上記挿入部の軸線と一致する状態にする弾性制御部材を設けるのが好ましい。 When the external force is not applied, the connecting mechanism is set so that the axis of the suturing device is shifted laterally with respect to the axis of the insertion portion, and when the external force is applied, the connecting mechanism is connected with the axis of the suturing device. It is preferable to provide an elastic control member that matches the axis of the insertion portion.

請求項１の発明によれば、本体部と受け部材とで対象部位を挟み込んだ状態で、押出部材を本体部の出口用開口側に近づければ、収納空間に収納したステープルによって対象部位を縫合できる。
しかも、押出部材は本体部の内部に全体を収納しているわけではなく、押出部材を出口用開口から離したときに押出部材の一部が本体部の外部に突出するので、押出部材を出口用開口側に最も近づけた状態においては縫合器全体の寸法（特に挿入部の軸線に対して直交する方向の寸法）を小さくすることが可能である。そのため、縫合器を可撓性を有する挿入部と共に狭い対象物や、湾曲した対象物に円滑に挿入可能である。 According to the first aspect of the present invention, if the pushing member is brought close to the outlet opening side of the main body while the target portion is sandwiched between the main body and the receiving member, the target portion is sutured by the staple stored in the storage space. it can.
In addition, the entire pushing member is not housed inside the main body, and when the pushing member is separated from the outlet opening, a part of the pushing member protrudes to the outside of the main body. In the state closest to the opening side for use, the overall size of the suture instrument (particularly, the size in the direction perpendicular to the axis of the insertion portion) can be reduced. Therefore, the suturing device can be smoothly inserted into a narrow object or a curved object together with a flexible insertion portion.

請求項２のように構成すれば、押出部材の操作性が向上する。 If comprised like Claim 2, the operativity of an extrusion member will improve.

請求項３のように構成すれば、受け部材を本体部の周面に対して接触させることにより縫合器全体の寸法（特に挿入部の軸線に対して直交する方向の寸法）が小さくなるので、対象物への挿入がさらに容易になる。 If it comprises like Claim 3, since the dimension (especially dimension of the direction orthogonal to the axis line of an insertion part) of the whole suturing device will become small by making a receiving member contact with the surrounding surface of a main-body part, Insertion into the object is further facilitated.

請求項４のように構成すれば、受け部材の操作性が向上する。 If comprised like Claim 4, the operativity of a receiving member will improve.

請求項５のように構成すれば、収納空間内に複数のステープルを収納した場合に、押出部材の押込板によってステープルを一つずつ確実に排出できるので、連続した縫合作業を確実に行えるようになる。 According to the fifth aspect of the present invention, when a plurality of staples are stored in the storage space, the staples can be reliably discharged one by one by the pushing plate of the pushing member, so that a continuous stitching operation can be performed reliably. Become.

請求項６の発明によれば、接続機構を利用して縫合器を挿入部の先端部の軸線上からずらすことにより、挿入部の先端面の開口から処置具を外部に排出可能になる。そのため、ステープルによる縫合作業だけでなく、処置具による対象部位の処置を行なうことが可能である。 According to the sixth aspect of the invention, the treatment instrument can be discharged from the opening of the distal end surface of the insertion portion by displacing the suture device from the axis of the distal end portion of the insertion portion using the connection mechanism. Therefore, not only a stitching operation using staples but also treatment of a target site can be performed using a treatment tool.

請求項７のように構成すれば、接続機構を簡単な構造により実現できる。
さらに請求項８のように構成すれば、縫合器を挿入部に対して、挿入部の軸線に対して平行状態を維持しながら移動させられる。そのため、縫合器の挿入部に対する移動量が変化する毎に縫合器の挿入部の軸線に対する傾斜角度が変わる場合に比べて、縫合器を挿入部に対して側方に微小移動させることが可能である。 If comprised like Claim 7, a connection mechanism is realizable with a simple structure.
According to the eighth aspect of the present invention, the suturing device can be moved with respect to the insertion portion while maintaining a parallel state with respect to the axis of the insertion portion. Therefore, the suturing device can be moved slightly to the side with respect to the insertion portion as compared with the case where the inclination angle of the suturing device insertion portion with respect to the axis changes every time the amount of movement of the suturing device relative to the insertion portion changes. is there.

請求項９のように構成すれば、リンク部材の操作性が向上する。 If comprised like Claim 9, the operativity of a link member will improve.

接続機構を請求項１０のように構成すれば、接続機構を操作するための操作手段を設けなくても縫合器の軸線を挿入部の軸線に対して側方にずらすことができる。しかも、当該医療用縫合装置を狭い管路や湾曲した管路に挿入すると、弾性制御部材が弾性変形することにより縫合器が当該管路の形状に合わせて自動的に移動するので、当該管路に容易に挿入できる。 If the connection mechanism is configured as in the tenth aspect, the axis of the suture instrument can be shifted laterally with respect to the axis of the insertion portion without providing an operation means for operating the connection mechanism. In addition, when the medical suturing device is inserted into a narrow or curved conduit, the elastic control member is elastically deformed so that the suturing device automatically moves in accordance with the shape of the conduit. Easy to insert into.

本発明の一実施形態の医療用縫合装置の全体を示す側面図である。It is a side view showing the whole medical suturing device of one embodiment of the present invention. 医療用縫合装置の要部の平面図である。It is a top view of the principal part of a medical suturing device. 親内視鏡の内部管路に本発明の医療用縫合装置を挿入し、親内視鏡と医療用内視鏡の先端部を胃の内部に挿入したときの側面図である。It is a side view when the medical suturing device of the present invention is inserted into the inner duct of the parent endoscope, and the distal end portion of the parent endoscope and the medical endoscope is inserted into the stomach. 軟性挿入部の先端部と縫合器を拡大して示す底面図である。It is a bottom view which expands and shows the front-end | tip part and suture device of a soft insertion part. 受け部材を本体部から離間させたときの軟性挿入部の先端部と縫合器を拡大して示す側面図である。It is a side view which expands and shows the front-end | tip part and suturing device of a flexible insertion part when a receiving member is spaced apart from the main-body part. 縫合器を軟性挿入部に対して側方に移動させたときの図４と同様の底面図である。FIG. 5 is a bottom view similar to FIG. 4 when the suturing device is moved laterally with respect to the soft insertion portion. 縫合器の拡大分解斜視図である。It is an expansion exploded perspective view of a suture instrument. 側部カバーを省略し、一部を断面視して示す縫合器の拡大側面図である。FIG. 3 is an enlarged side view of the suturing device with the side cover omitted and shown partially in cross-section. 図８と反対側から見たときの縫合器の拡大側面図である。FIG. 9 is an enlarged side view of the suture instrument when viewed from the opposite side to FIG. 8. 受け部材を省略して示す縫合器の拡大平面図である。It is an enlarged plan view of a suture instrument with the receiving member omitted. 一部を断面視して示す縫合器の拡大側面図である。It is an enlarged side view of a suture instrument showing a partial cross-sectional view. 受け部材を本体部から平行をなすように離間させたときの図１１と同様の側面図である。FIG. 12 is a side view similar to FIG. 11 when the receiving member is separated from the main body so as to be parallel. 受け部材を本体部に対して回転させたときの図１１と同様の側面図である。It is a side view similar to FIG. 11 when a receiving member is rotated with respect to the main-body part. ステープルの側面図である。It is a side view of a staple. ステープルの正面図である。It is a front view of a staple. ステープル収納枠にステープルを収納したときの側面図である。It is a side view when the staple is stored in the staple storage frame. 本体部と受け部材で胃壁の一部を挟み込んだときの図８と同様の拡大側面図である。FIG. 9 is an enlarged side view similar to FIG. 8 when a part of the stomach wall is sandwiched between the main body and the receiving member. 図１７のXVIII−XVIII矢線に沿って片側のみを断面視して示す図である。FIG. 18 is a view showing only one side in section along the XVIII-XVIII arrow line of FIG. 17. 押出部材を退避位置まで移動させたときの図１７と同様の側面図である。FIG. 18 is a side view similar to FIG. 17 when the push member is moved to the retracted position. 図１９のXX−XX矢線に沿う図１８と同様の断面図である。It is sectional drawing similar to FIG. 18 which follows the XX-XX arrow line of FIG. 押出部材を本体部側に戻したときの図１７と同様の側面図である。FIG. 18 is a side view similar to FIG. 17 when the pushing member is returned to the main body side. 図２１のXXII−XXII矢線に沿う図１８と同様の断面図である。It is sectional drawing similar to FIG. 18 which follows the XXII-XXII arrow line of FIG. 押出部材を押込位置まで戻したときの図１７と同様の側面図である。FIG. 18 is a side view similar to FIG. 17 when the pushing member is returned to the pushing position. 図２３のXXIV−XXIV矢線に沿う図１８と同様の断面図である。It is sectional drawing similar to FIG. 18 which follows the XXIV-XXIV arrow line of FIG. 本体部と受け部材で胃壁の一部を挟み込み、かつ処置具用開口から処置具を突出させたときの状態を示す側面図である。It is a side view which shows a state when a part of stomach wall is pinched | interposed with a main-body part and a receiving member, and the treatment tool protrudes from the opening for treatment tools. 処置具によって胃壁を切断するときの状態を示す平面図である。It is a top view which shows a state when cut | disconnecting a stomach wall with a treatment tool. ステープルによる縫合と処置具による処置が完了した後の胃を示す平面図である。It is a top view which shows the stomach after the suturing by a staple and the treatment by a treatment tool are completed. 変形例の医療用縫合装置の要部を示す側面図である。It is a side view which shows the principal part of the medical suturing device of a modification. 別の変形例の図６と同様の底面図である。It is a bottom view similar to FIG. 6 of another modification. 同じく図４と同様の底面図である。FIG. 5 is a bottom view similar to FIG. 4.

以下、添付図面を参照しながら本発明の一実施形態を説明する。
本実施形態の医療用縫合装置１０は照明機能や観察機能は備えていないが、その基本構成は軟性内視鏡と同じである。即ち、操作部１１と、操作部１１から延びる可撓性材料からなる挿入部１７と、挿入部１７の先端部に設けた平行リンク機構２３と、平行リンク機構２３を介して挿入部１７の先端部に接続する縫合器３０と、を具備している。挿入部１７の先端部近傍部は、操作部１１に設けた湾曲操作レバー１２の回転操作に応じて湾曲する湾曲部１８となっている。挿入部１７の先端部は硬質部材からなる（可撓性がない）先端硬質部１９となっており、先端硬質部１９の先端面には処置具出口用開口（図示略）が形成してある。さらに、挿入部１７の内部には処置具を挿通するための処置具挿通路（内部管路）２０（図２５、図２６参照）が設けてあり、処置具挿通路２０の基端側端部は操作部１１に形成した処置具挿入用突起１３の開口に接続している。図２に示すように、処置具挿入用突起１３の開口はゴム製の栓部材１４によって水密状態で塞いであり、栓部材１４にはスリットが形成してある。 Hereinafter, an embodiment of the present invention will be described with reference to the accompanying drawings.
The medical suturing device 10 of this embodiment does not have an illumination function or an observation function, but its basic configuration is the same as that of a flexible endoscope. That is, the operation unit 11, the insertion unit 17 made of a flexible material extending from the operation unit 11, the parallel link mechanism 23 provided at the distal end of the insertion unit 17, and the distal end of the insertion unit 17 via the parallel link mechanism 23 And a suturing device 30 connected to the section. The vicinity of the distal end portion of the insertion portion 17 is a bending portion 18 that bends in response to a rotation operation of the bending operation lever 12 provided in the operation portion 11. The distal end portion of the insertion portion 17 is a distal end hard portion 19 made of a hard member (not flexible), and a treatment instrument outlet opening (not shown) is formed on the distal end surface of the distal end hard portion 19. . Furthermore, a treatment instrument insertion passage (internal conduit) 20 (see FIGS. 25 and 26) for inserting the treatment instrument is provided inside the insertion portion 17, and the proximal end of the treatment instrument insertion path 20 is provided. Is connected to the opening of the treatment instrument insertion protrusion 13 formed in the operation portion 11. As shown in FIG. 2, the opening of the treatment instrument insertion protrusion 13 is closed in a watertight state by a rubber plug member 14, and a slit is formed in the plug member 14.

先端硬質部１９の先端部には互いに平行をなす４本の金属からなるリンク部材２２の一端が挿入部１７の軸線に対して直交する方向の金属製の回転接続ピン（回転軸）２４を介して回転可能に接続してある。各リンク部材２２は同一仕様であり、上側のリンク部材２２と下側のリンク部材２２どうしがそれぞれ対をなしており、それぞれの対が平行リンク機構（接続機構）２３を構成している。さらに、各リンク部材２２の先端硬質部１９と反対側の端部は縫合器３０の端部に上記回転接続ピン２４と平行な回転接続ピン２４を介して回転可能に接続している。このように先端硬質部１９と縫合器３０を２つの平行リンク機構２３によって接続しているので、図４に示すように各リンク部材２２の軸線が挿入部１７の軸線と平行をなすときは、縫合器３０の軸線が挿入部１７の軸線と一致する。一方、図６に示すように各リンク部材２２の軸線が挿入部１７の軸線に対して傾斜すると、縫合器３０の軸線が挿入部１７の軸線に対して平行をなしながら挿入部１７の軸線に対して側方に移動する。
図１及び図２に示すように、操作部１１の後端面には操作部１１の軸線回りに回転可能なリンク操作部材（リンク操作手段）１５が設けてある。さらに、リンク操作部材１５と一つのリンク部材２２の中間部とには操作部１１及び挿入部１７の内部を相対移動可能に貫通する金属製の連係ワイヤ２６の両端がそれぞれ固着してある。そのため、リンク操作部材１５を操作部１１に対して回転させると、連係ワイヤ２６が操作部１１側に引かれたり縫合器３０側に押し出されることにより、各リンク部材２２の挿入部１７の軸線に対する傾斜角度が変化する。 One end of a link member 22 made of four metals that are parallel to each other is connected to a distal end portion of the distal end hard portion 19 via a metal rotary connection pin (rotary shaft) 24 in a direction orthogonal to the axis of the insertion portion 17. It is connected so that it can rotate. Each link member 22 has the same specification, and the upper link member 22 and the lower link member 22 form a pair, and each pair constitutes a parallel link mechanism (connection mechanism) 23. Further, the end portion of each link member 22 opposite to the distal end hard portion 19 is rotatably connected to the end portion of the suturing device 30 via the rotation connection pin 24 parallel to the rotation connection pin 24. Since the distal end hard portion 19 and the suturing device 30 are connected by the two parallel link mechanisms 23 as described above, when the axis of each link member 22 is parallel to the axis of the insertion portion 17 as shown in FIG. The axis of the suture instrument 30 coincides with the axis of the insertion portion 17. On the other hand, as shown in FIG. 6, when the axis of each link member 22 is inclined with respect to the axis of the insertion portion 17, the axis of the suturing device 30 is aligned with the axis of the insertion portion 17 while being parallel to the axis of the insertion portion 17. Move to the side.
As shown in FIGS. 1 and 2, a link operation member (link operation means) 15 that can rotate around the axis of the operation unit 11 is provided on the rear end surface of the operation unit 11. Further, both ends of a metal linking wire 26 that penetrates the inside of the operation portion 11 and the insertion portion 17 so as to be relatively movable are respectively fixed to the link operation member 15 and an intermediate portion of one link member 22. Therefore, when the link operation member 15 is rotated with respect to the operation unit 11, the link wire 26 is pulled toward the operation unit 11 side or pushed out toward the suture device 30, thereby causing the link member 22 with respect to the axis of the insertion unit 17. The tilt angle changes.

続いて縫合器３０の詳しい構造について説明する。縫合器３０は以下に説明する複数の部材からなるものである。
縫合器３０の金属からなる本体部３１は回転接続ピン２４によってリンク部材２２が接続する部材であり、その上面のほぼ全体は上部平坦面３２となっており、下面の前半部は上部平坦面３２と平行な下部平坦面３３となっている。また、本体部３１の前半部の左右両側部は上部平坦面３２及び下部平坦面３３に対して直交する側部平坦面３４となっている。また本体部３１には、本体部３１を上下方向に貫通する断面円形の案内孔３６が計４つ形成してある。
上部平坦面３２の後端部近傍には、下端が半円形状をなす左右一対の上下方向溝３７が下方に向けて凹設してあり、左右の上下方向溝３７の直後には対応する上下方向溝３７と連通すると共に後面が傾斜面となっている回転許容溝３８が凹設してある。左右の上下方向溝３７の一対の側壁間には左右方向に延びる回転支持軸３９が一体的に設けてある。そして、左右の上下方向溝３７には金属製の受け部材４０が相対移動可能に取り付けてある。受け部材４０は上部平坦面３２を覆う受け板４１と、受け板４１の下面の後端部から下方に向かって延びかつ側面形状が上下方向溝３７と略同一である左右一対の挿入片４２と、を具備しており、左右の挿入片４２は左右の上下方向溝３７内に挿入してあり、かつ挿入片４２に穿設した貫通長孔４３が対応する回転支持軸３９に相対移動可能に嵌合している。受け板４１の下面の前部の幅方向の中央部にはステープル受け溝４４が凹設してある。さらに、受け板４１の下面には本体部３１、挿入部１７及び操作部１１の内部を相対移動可能に通る金属製の連係ワイヤ４６の一端が固着してあり、連係ワイヤ４６の他端は操作部１１の側面に回転可能に設けたレバー（受け部材操作手段）Ｌ１に接続している。図１１〜図１３に示すように、本体部３１の内部には連係ワイヤ４６を移動案内するためのワイヤ案内溝４７が貫通溝として形成してある。従って、レバーＬ１が図１に示す初期位置に位置するとき、挿入片４２の下端部が上下方向溝３７の下端部内に位置するので、受け板４１はその下面の前部が上部平坦面３２に接触する接触位置（図１１の位置）に位置する。一方、レバーＬ１を図１の位置から回転させると、図１２に示すように連係ワイヤ４６の前端部が上部平坦面３２から上方に突出し、かつ左右の挿入片４２が上下方向溝３７に沿って貫通長孔４３の下端が回転支持軸３９に接触するまで上方にスライドするので、受け板４１は上部平坦面３２と平行状態を維持しながら上部平坦面３２から上方に離間する。そしてレバーＬ１をさらに回転させると、連係ワイヤ４６の端部がさらに上方に移動するので、左右の挿入片４２が回転支持軸３９回りに後方に回転し、受け板４１が図１３に示す全開位置まで回転する。この後にレバーＬ１を図１の初期位置まで戻せば、受け板４１は図１１に示す接触位置に復帰する。 Next, the detailed structure of the suturing device 30 will be described. The suturing device 30 is composed of a plurality of members described below.
The main body 31 made of metal of the suturing device 30 is a member to which the link member 22 is connected by the rotation connection pin 24, and almost the entire upper surface thereof is the upper flat surface 32, and the front half of the lower surface is the upper flat surface 32. The lower flat surface 33 is parallel to the horizontal plane. The left and right sides of the front half of the main body 31 are side flat surfaces 34 orthogonal to the upper flat surface 32 and the lower flat surface 33. The main body 31 is formed with a total of four guide holes 36 having a circular cross section penetrating the main body 31 in the vertical direction.
In the vicinity of the rear end portion of the upper flat surface 32, a pair of left and right vertical grooves 37 having a semicircular lower end are recessed downward. A rotation-allowing groove 38 that communicates with the direction groove 37 and has a rear surface that is an inclined surface is recessed. A rotation support shaft 39 extending in the left-right direction is integrally provided between the pair of side walls of the left and right vertical grooves 37. A metal receiving member 40 is attached to the left and right vertical grooves 37 so as to be relatively movable. The receiving member 40 includes a receiving plate 41 that covers the upper flat surface 32, and a pair of left and right insertion pieces 42 that extend downward from the rear end portion of the lower surface of the receiving plate 41 and have substantially the same side shape as the vertical groove 37. The left and right insertion pieces 42 are inserted into the left and right vertical grooves 37, and the through-holes 43 formed in the insertion pieces 42 are movable relative to the corresponding rotation support shafts 39. It is mated. A staple receiving groove 44 is provided in the center of the front surface of the lower surface of the receiving plate 41 in the width direction. Further, one end of a metal linking wire 46 that passes through the inside of the main body portion 31, the insertion portion 17 and the operation portion 11 is fixed to the lower surface of the receiving plate 41, and the other end of the linking wire 46 is operated. It is connected to a lever (receiving member operating means) L1 that is rotatably provided on the side surface of the portion 11. As shown in FIGS. 11 to 13, a wire guide groove 47 for moving and guiding the connecting wire 46 is formed as a through groove inside the main body 31. Therefore, when the lever L1 is located at the initial position shown in FIG. 1, the lower end portion of the insertion piece 42 is located within the lower end portion of the vertical groove 37, so that the front portion of the lower surface of the receiving plate 41 is directed to the upper flat surface 32. It is located in the contact position (position of FIG. 11) which contacts. On the other hand, when the lever L1 is rotated from the position of FIG. 1, the front end portion of the linkage wire 46 protrudes upward from the upper flat surface 32 and the left and right insertion pieces 42 extend along the vertical groove 37 as shown in FIG. Since the lower end of the through long hole 43 slides upward until it contacts the rotation support shaft 39, the receiving plate 41 is spaced upward from the upper flat surface 32 while maintaining a parallel state with the upper flat surface 32. When the lever L1 is further rotated, the end portion of the linkage wire 46 moves further upward, so that the left and right insertion pieces 42 rotate rearward around the rotation support shaft 39, and the receiving plate 41 is in the fully open position shown in FIG. Rotate until. Thereafter, when the lever L1 is returned to the initial position shown in FIG. 1, the receiving plate 41 returns to the contact position shown in FIG.

図７に示すように、本体部３１の左右の側部平坦面３４には互いに前後位置をずらして同一形状のステープル収納凹部（収納空間）５０が凹設してある。左右のステープル収納凹部５０の底面５０ａの４隅（角部）にはそれぞれストッパ５１が突設してある。
左右のステープル収納凹部５０には金属製のステープル収納枠５２がそれぞれ着脱可能に嵌合してある。ステープル収納枠５２は、矩形枠状の枠部５３と、枠部５３の前後２箇所から前方に向かって突出する枠部５３に比べて上下寸法が短い突片５４と、を有している。ステープル収納枠５２をステープル収納凹部５０に嵌合すると、ステープル収納枠５２の上縁部と下縁部が上部のストッパ５１と下部のストッパ５１にそれぞれ接触し、前後の突片５４とステープル収納凹部５０の底面５０ａとの間には隙間が形成される（図１０参照）。
ステープル収納枠５２の内部には、金属からなるステープル５５が３つ並べた状態で着脱可能として収納してある。ステープル５５は略コ字形状をなすものであり、被押圧部５６と、被押圧部５６の両端部から被押圧部５６に対して略直交する方向に延びる一対の針部５７と、を有している。ステープル５５の上下寸法と前後寸法は枠部５３の内面の対応寸法と略同一であり、３つのステープル５５の左右寸法の合計値はステープル収納枠５２の左右寸法（枠部５３と突片５４を合わせた寸法）より短い。また、一対の針部５７の先端部５７ａは内側方向にわずかに曲げてあり、かつ先端部５７ａの先端面はそれぞれ外側に下がる傾斜面としてある。
左右のステープル収納枠５２には、外側からステープル５５を内側に向かって押圧するための金属板である受圧板６０が挿入してある。受圧板６０はステープル収納枠５２及びステープル５５と略平行な板材であり、その上下寸法と前後寸法は枠部５３の内面の対応寸法と略同一である。
さらに、左右の側部平坦面３４には金属製の側部押さえ板６２が、左右の側部平坦面３４に接触した状態で被せてある。左右の側部押さえ板６２の内面には前後一対の板ばね（付勢手段）６３が一体的に形成してあり、この板ばね６３が対応する受圧板６０を他方の側部押さえ板６２側に向けて付勢（押圧）している。
さらに本体部３１の前部には、左右の側部押さえ板６２の外側面に接触する左右一対の側片６６と、左右の側片６６の前端同士を接続する前部連結片６７と、を備えるカバー部材６５が被せてあり、左右の側片６６が左右の側部押さえ板６２の本体部３１の側面からの脱落するのを規制している。前部連結片６７には方形の貫通孔６８が穿設してあり、この貫通孔６８を本体部３１の先端面に固定したねじ部３５が貫通している。そして、ねじ部３５の先端部にナット６９を螺合しナット６９の後面を前部連結片６７の前面に接触させることにより、カバー部材６５を本体部３１に固定している。 As shown in FIG. 7, staple storage recesses (storage spaces) 50 having the same shape are formed in the left and right side flat surfaces 34 of the main body 31 so as to be shifted from each other in the front-rear position. Stoppers 51 protrude from the four corners (corners) of the bottom surface 50a of the left and right staple storage recesses 50, respectively.
Metal staple storage frames 52 are detachably fitted in the left and right staple storage recesses 50, respectively. The staple storage frame 52 includes a rectangular frame-shaped frame portion 53 and a protruding piece 54 having a shorter vertical dimension than the frame portion 53 protruding forward from two front and rear positions of the frame portion 53. When the staple storage frame 52 is fitted into the staple storage recess 50, the upper and lower edges of the staple storage frame 52 come into contact with the upper stopper 51 and the lower stopper 51, respectively. A gap is formed between the bottom surface 50a of 50 (see FIG. 10).
Inside the staple storage frame 52, three staples 55 made of metal are stored in a detachable manner in an array. The staple 55 has a substantially U-shape, and includes a pressed portion 56 and a pair of needle portions 57 extending from both ends of the pressed portion 56 in a direction substantially orthogonal to the pressed portion 56. ing. The vertical dimension and the front-rear dimension of the staple 55 are substantially the same as the corresponding dimensions of the inner surface of the frame 53, and the total value of the left and right dimensions of the three staples 55 is the horizontal dimension of the staple storage frame 52 (the frame 53 and the protruding piece 54 Shorter than the combined dimensions). Moreover, the front-end | tip part 57a of a pair of needle part 57 is bent slightly inward, and the front-end | tip surface of the front-end | tip part 57a is each an inclined surface which falls outside.
In the left and right staple storage frames 52, pressure receiving plates 60, which are metal plates for pressing the staples 55 inward from the outside, are inserted. The pressure receiving plate 60 is a plate material substantially parallel to the staple storage frame 52 and the staple 55, and the vertical dimension and the longitudinal dimension thereof are substantially the same as the corresponding dimension of the inner surface of the frame portion 53.
Further, the left and right side flat surfaces 34 are covered with metal side pressing plates 62 in contact with the left and right side flat surfaces 34. A pair of front and rear leaf springs (biasing means) 63 are integrally formed on the inner surfaces of the left and right side pressing plates 62, and the pressure receiving plate 60 to which the leaf spring 63 corresponds corresponds to the other side pressing plate 62 side. Energizing (pressing) toward
Furthermore, at the front part of the main body part 31, a pair of left and right side pieces 66 that contact the outer side surfaces of the left and right side pressing plates 62, and a front connecting piece 67 that connects the front ends of the left and right side pieces 66 are provided. The cover member 65 provided is covered, and the left and right side pieces 66 are restricted from falling off from the side surface of the main body 31 of the left and right side pressing plates 62. A rectangular through hole 68 is formed in the front connecting piece 67, and a screw portion 35 that fixes the through hole 68 to the distal end surface of the main body portion 31 passes therethrough. Then, the cover member 65 is fixed to the main body portion 31 by screwing the nut 69 into the tip portion of the screw portion 35 and bringing the rear surface of the nut 69 into contact with the front surface of the front connecting piece 67.

本体部３１の下部平坦面３３には金属からなる押出部材７１のベース板７２が被せてある。ベース板７２の内面は下部平坦面３３に接触する平面であり、ベース板７２の外面は本体部３１の後半部の外周面と連続する形状の湾曲面である。ベース板７２の上面には、本体部３１の前後のストッパ５１の対向面間寸法と略同じ前後寸法かつステープル収納凹部５０と略同一の上下寸法である押込板７３と押込板７４が互いの左右位置及び前後位置をずらして上向きに突設してある（押込板７３と押込板７４はステープル５５が位置する平面と略平行である）。さらに、ベース板７２の上面の４隅近傍には円柱形状の案内ロッド７５が上向きに突設してある。押込板７３と押込板７４は対応するステープル収納凹部５０の底面５０ａに接触しかつ前後のストッパ５１の間に位置する状態で対応するステープル収納凹部５０内に上下方向にスライド可能に挿入してあり、４本の案内ロッド７５は本体部３１の対応する案内孔３６にスライド可能に挿入してある。そのため押出部材７１は、押込板７３及び押込板７４の上端面が本体部３１の上部平坦面３２と連続する押込位置（図１１〜図１３、図１７、図１８、図２３、図２４の位置）と、側面視において押込板７３及び押込板７４の上端面がステープル５５の被押圧部５６より下方に位置する退避位置（図１９及び図２０参照）との間を本体部３１に対してスライド可能であり、押込位置に位置するときにベース板７２の上面は本体部３１の下部平坦面３３に接触し、退避位置に位置するときベース板７２の上面は下部平坦面３３から下方に離間する。
さらに、ベース板７２の上面には本体部３１、挿入部１７及び操作部１１の内部を相対移動可能に通る金属製の連係ワイヤ７７の一端が固着してあり、連係ワイヤ７７の他端は操作部１１の上面に回転可能に設けたレバー（押出部材操作手段）Ｌ２に接続している。図８及び図９に示すように、本体部３１の内部には連係ワイヤ７７を案内するためのワイヤ案内溝７８が貫通溝として形成してある。レバーＬ２が図２に示す初期位置に位置するときは押出部材７１は押込位置に位置し、レバーＬ２を図２の位置から回転させると連係ワイヤ７７の前端部が下部平坦面３３から下方に突出するのでベース板７２が下部平坦面３３から下方に離間する。そして、レバーＬ２を限界位置まで回転させると、押出部材７１は図１９及び図２０に示す退避位置に到達する。レバーＬ２を図２の初期位置まで戻せば押出部材７１は押込位置に復帰する。
そして、押出部材７１が押込位置に位置するときは、板ばね６３によって押圧された最も内側に位置するステープル５５が押込板７３と押込板７４の外側面にそれぞれ接触する（図１８参照。押込板７４についての図示は省略。図１７、図２１〜２４も同様）。一方、押出部材７１が退避位置に位置するときは、板ばね６３によって押圧された最も内側に位置するステープル５５が対応するステープル収納凹部５０の底面５０ａに接触する（図２０参照。押込板７４については図示せず）。 The lower flat surface 33 of the main body 31 is covered with a base plate 72 of a pushing member 71 made of metal. The inner surface of the base plate 72 is a flat surface that contacts the lower flat surface 33, and the outer surface of the base plate 72 is a curved surface that is continuous with the outer peripheral surface of the rear half of the main body 31. On the upper surface of the base plate 72, there are a pressing plate 73 and a pressing plate 74 that have substantially the same front-rear dimension as the front-rear dimension of the stopper 51 at the front and rear of the main body 31 and the vertical dimension substantially the same as the staple storage recess 50. The position and the front / rear position are shifted and project upward (the pushing plate 73 and the pushing plate 74 are substantially parallel to the plane on which the staples 55 are located). Further, cylindrical guide rods 75 project upward in the vicinity of the four corners of the upper surface of the base plate 72. The pushing plate 73 and the pushing plate 74 are slidably inserted vertically into the corresponding staple storage recess 50 while being in contact with the bottom surface 50a of the corresponding staple storage recess 50 and positioned between the front and rear stoppers 51. The four guide rods 75 are slidably inserted into the corresponding guide holes 36 of the main body 31. Therefore, the pushing member 71 has a pushing position where the upper end surfaces of the pushing plate 73 and the pushing plate 74 are continuous with the upper flat surface 32 of the main body 31 (the positions shown in FIGS. 11 to 13, 17, 18, 23, and 24). ) And a retracted position (see FIGS. 19 and 20) where the upper end surfaces of the pressing plate 73 and the pressing plate 74 are positioned below the pressed portion 56 of the staple 55 in a side view, with respect to the main body portion 31. The upper surface of the base plate 72 is in contact with the lower flat surface 33 of the main body 31 when positioned at the pushing position, and the upper surface of the base plate 72 is spaced downward from the lower flat surface 33 when positioned at the retracted position. .
Further, one end of a metal linking wire 77 that passes through the inside of the main body portion 31, the insertion portion 17 and the operation portion 11 is fixed to the upper surface of the base plate 72, and the other end of the linking wire 77 is operated. It is connected to a lever (extrusion member operating means) L2 that is rotatably provided on the upper surface of the portion 11. As shown in FIGS. 8 and 9, a wire guide groove 78 for guiding the connecting wire 77 is formed as a through groove inside the main body 31. When the lever L2 is located at the initial position shown in FIG. 2, the pushing member 71 is located at the pushing position. When the lever L2 is rotated from the position shown in FIG. 2, the front end of the connecting wire 77 protrudes downward from the lower flat surface 33. Therefore, the base plate 72 is separated downward from the lower flat surface 33. When the lever L2 is rotated to the limit position, the pushing member 71 reaches the retracted position shown in FIGS. When the lever L2 is returned to the initial position shown in FIG. 2, the pushing member 71 returns to the pushing position.
When the pushing member 71 is located at the pushing position, the innermost staple 55 pushed by the leaf spring 63 comes into contact with the pushing plate 73 and the outside surface of the pushing plate 74 (see FIG. 18; pushing plate). The illustration of 74 is omitted, and the same applies to FIGS. On the other hand, when the push-out member 71 is located at the retracted position, the innermost staple 55 pressed by the leaf spring 63 comes into contact with the bottom surface 50a of the corresponding staple storage recess 50 (see FIG. 20; Is not shown).

続いて、医療用縫合装置１０を利用した縫合と処置具を利用した処置の実施要領について説明する。
医療用縫合装置１０を患者（対象物）の体内に挿入する際には図３に示す親内視鏡１００を利用する。この親内視鏡１００は、医療用縫合装置１０より大型の軟性内視鏡であり、操作部（図示略）と、該操作部から延びる可撓性を有する挿入部１０１と、操作部から挿入部１０１と反対側に延びプロセッサ（光源装置兼画像処理装置）に接続するユニバーサルチューブ（図示略）と、を具備している。操作部及び挿入部の内部には内部管路が形成してあり、該内部管路の両端部は操作部と挿入部の先端面において開口している。また、挿入部の先端面には照明レンズと対物レンズが設けてあり、挿入部の先端部内には対物レンズの直後に位置する撮像素子が設けてある。従って、親内視鏡１００の挿入部１０１を患者の口から食道を通して体内に挿入すると、プロセッサ内部の光源が発した光が照明レンズを通して外部に射出されることにより体内が照明され、かつ対物レンズで観察された像が撮像素子によって撮像され、撮像された画像が上記プロセッサに接続したテレビモニタ（図示略）に表示される。
例えば、図３に示すように医療用縫合装置１０によって胃（対象部位）Ａを縫合及び処置する場合は、挿入部１０１の先端部を胃Ａの内部に位置させた後に、医療用縫合装置１０の操作部１１を親内視鏡１００の操作部の外部（患者の体外）に位置させた上で挿入部１７を親内視鏡１００の操作部の開口から上記内部管路に通し、挿入部１０１の先端面に形成した開口から挿入部１０１の外部（胃Ａの内部）に突出させる。この際、平行リンク機構２３は先端硬質部１９（挿入部１７）の軸線と平行な状態にしておき、さらに受け板４１とベース板７２を本体部３１に接触させておく。そして、上記テレビモニタの画像を見ながら挿入部１７の挿入部１０１からの突出量を調整したり、湾曲操作レバー１２を回転操作して湾曲部１８を湾曲することにより、縫合器３０を胃Ａの内壁に出来た患部Ｂに接近させる。 Next, a procedure for performing a suture using the medical suturing apparatus 10 and a treatment using the treatment tool will be described.
When the medical suturing device 10 is inserted into the body of a patient (object), a parent endoscope 100 shown in FIG. 3 is used. The parent endoscope 100 is a soft endoscope that is larger than the medical suturing device 10, and is inserted from an operation unit (not shown), a flexible insertion unit 101 extending from the operation unit, and the operation unit. A universal tube (not shown) extending to the opposite side of the unit 101 and connected to a processor (light source device / image processing device). An internal pipe line is formed inside the operation part and the insertion part, and both end parts of the internal pipe line are opened at the distal end surfaces of the operation part and the insertion part. In addition, an illumination lens and an objective lens are provided on the distal end surface of the insertion portion, and an imaging element located immediately after the objective lens is provided in the distal end portion of the insertion portion. Therefore, when the insertion part 101 of the parent endoscope 100 is inserted into the body through the esophagus from the patient's mouth, the light emitted from the light source inside the processor is emitted to the outside through the illumination lens, and the body is illuminated, and the objective lens The image observed in (1) is picked up by the image pickup device, and the picked-up image is displayed on a television monitor (not shown) connected to the processor.
For example, as shown in FIG. 3, when the stomach (target site) A is sutured and treated by the medical suturing device 10, the medical suturing device 10 is positioned after the distal end portion of the insertion portion 101 is positioned inside the stomach A. The operation unit 11 is positioned outside the operation unit of the parent endoscope 100 (outside the patient's body), and the insertion unit 17 is passed through the internal conduit from the opening of the operation unit of the parent endoscope 100. It projects from the opening formed in the distal end surface of 101 to the outside of the insertion portion 101 (inside the stomach A). At this time, the parallel link mechanism 23 is set in a state parallel to the axis of the distal end hard portion 19 (insertion portion 17), and the receiving plate 41 and the base plate 72 are brought into contact with the main body portion 31. Then, the amount of protrusion from the insertion portion 101 of the insertion portion 17 is adjusted while watching the image on the television monitor, or the bending portion 18 is bent by rotating the bending operation lever 12 to thereby turn the suturing device 30 into the stomach A. Approach the affected area B on the inner wall of

次いで、レバーＬ１を操作することにより受け部材４０を全開位置まで移動させ、本体部３１の上部平坦面３２と受け板４１の間に胃Ａの縫合対象部分（胃Ａの患部Ｂの周囲に位置する部分）を位置させ、さらにレバーＬ１を操作することにより受け部材４０を接触位置側に戻す。すると、図１７及び図１８に示すように上部平坦面３２と受け板４１によって胃Ａの縫合対象部分が挟持される。次いで、図１９及び図２０に示すように、レバーＬ２を操作することによりベース板７２を退避位置まで移動させる。すると図２０に示すように、押込板７３及び押込板７４の上端面がステープル５５の被押圧部５６より低い位置まで移動するので、板ばね６３及び受圧板６０によって押圧された各ステープル５５がステープル収納凹部５０の底面５０ａ側に移動し、ステープル収納凹部５０の底面５０ａと対向するステープル５５が該底面５０ａに接触する。このようにステープル５５が押込板７３及び押込板７４と収納凹部５０の上部開口（出口用開口。押込板７３及び押込板７４と対向する開口部）の間に位置する状態でレバーＬ２を操作することによりベース板７２を押込位置側に移動させると、押込板７３及び押込板７４の上端面がステープル収納凹部５０の底面５０ａに接触しているステープル５５の被押圧部５６を上方に押圧するので、該ステープル５５の前後の針部５７が収納凹部５０の上部出口用開口を通って上部平坦面３２の上部に突出し、先端面が傾斜面となっている先端部５７ａが上部平坦面３２と受け板４１によって挟持された胃Ａの縫合対象部分を円滑に貫通する（図２１及び図２２参照）。そして、図２３及び図２４に示すようにベース板７２が押込位置に達すると、押込板７３によって受け板４１側に押圧されたステープル５５の前後の針部５７の先端部５７ａが対応するステープル受け溝４４に接触する。すると、内側にわずかに曲げてある前後の先端部５７ａは、ステープル受け溝４４によって内側に円滑かつ確実に曲げられ（閉じ）る。さらに、一対の針部５７の先端部５７ａが互いに重なるので、当該ステープル５５によって胃Ａの縫合対象部分が確実に縫合される。
本体部３１の左右のステープル収納凹部５０には予め３本のステープル５５をそれぞれ収納してあるので、縫合器３０を胃Ａの縫合対象部分に対して縫合器３０の軸線方向に位置をずらした上で押出部材７１の上記スライド動作をあと２回行えば、図２７に示すように胃Ａの縫合対象部分を６本のステープル５５によって２列に渡って縫合できる。この際、図２７に示すように一方の列の隣り合うステープル５５の間に形成される隙間と他方の列のステープル５５を対向させれば、該隙間部分において対向する胃Ａの縫合対象部分の内壁同士が離間するのが防止されるので好ましい。 Next, by operating the lever L1, the receiving member 40 is moved to the fully open position, and a portion to be sutured (positioned around the affected area B of the stomach A) between the upper flat surface 32 of the main body 31 and the receiving plate 41. The receiving member 40 is returned to the contact position side by operating the lever L1. Then, as shown in FIGS. 17 and 18, the suture target portion of the stomach A is held between the upper flat surface 32 and the receiving plate 41. Next, as shown in FIGS. 19 and 20, the base plate 72 is moved to the retracted position by operating the lever L2. Then, as shown in FIG. 20, since the upper end surfaces of the pressing plate 73 and the pressing plate 74 move to a position lower than the pressed portion 56 of the staple 55, each staple 55 pressed by the leaf spring 63 and the pressure receiving plate 60 is stapled. The staple 55 that moves to the bottom surface 50a side of the storage recess 50 and faces the bottom surface 50a of the staple storage recess 50 comes into contact with the bottom surface 50a. In this way, the lever L2 is operated in a state in which the staple 55 is positioned between the pushing plate 73 and the pushing plate 74 and the upper opening of the storage recess 50 (exit opening. The opening facing the pushing plate 73 and the pushing plate 74). As a result, when the base plate 72 is moved to the pressing position side, the upper end surfaces of the pressing plate 73 and the pressing plate 74 press the pressed portion 56 of the staple 55 contacting the bottom surface 50a of the staple storage recess 50 upward. The front and rear needle portions 57 of the staple 55 protrude through the upper outlet opening of the storage recess 50 and protrude to the upper portion of the upper flat surface 32, and the front end portion 57a having the inclined front end surface receives the upper flat surface 32. The portion to be sutured of the stomach A sandwiched between the plates 41 is smoothly penetrated (see FIGS. 21 and 22). Then, as shown in FIGS. 23 and 24, when the base plate 72 reaches the pushing position, the front end portions 57a of the needle portions 57 before and after the staple 55 pressed against the receiving plate 41 side by the pushing plate 73 correspond to the staple receiving portions. Contact the groove 44. Then, the front and rear front end portions 57a slightly bent inward are smoothly and reliably bent (closed) inward by the staple receiving groove 44. Further, since the distal end portions 57a of the pair of needle portions 57 overlap each other, the portion to be sutured of the stomach A is reliably sutured by the staple 55.
Since the three staples 55 are previously stored in the left and right staple storage recesses 50 of the main body 31, the position of the suturing device 30 is shifted in the axial direction of the suturing device 30 with respect to the suture target portion of the stomach A. If the slide operation of the pushing member 71 is performed two more times, the portion to be sutured of the stomach A can be sutured in two rows by the six staples 55 as shown in FIG. At this time, as shown in FIG. 27, if the gap formed between the adjacent staples 55 in one row and the staple 55 in the other row are made to face each other, the stitching target portion of the stomach A facing the gap portion is changed. It is preferable because the inner walls are prevented from being separated from each other.

このようにしてステープル５５を胃Ａの縫合対象部分に打ち込んだら、図２５及び図２６に示すようにリンク操作部材１５を回転操作することにより各リンク部材２２の軸線を挿入部１７の軸線に対して傾斜させ、縫合器３０の軸線を挿入部１７の軸線に対して側方にずらす。この状態で栓部材１４に形成したスリットから可撓性を有する長尺状の処置具８０を処置具挿通路２０に挿入し、処置具８０の先端部を先端硬質部１９の先端面に形成した上記処置具出口用開口から突出させると、処置具８０の先端部に形成した一対の開閉刃８１が本体部３１に接触することなく患部Ｂに接近する。そして、患者の体外に位置する処置具８０の基端部に設けた操作レバーを操作することにより一対の開閉刃８１を開き、一対の開閉刃８１の間に胃Ａの縫合対象部分を位置させた上で該操作レバーにより一対の開閉刃８１を閉じれば、一対の開閉刃８１によって胃Ａの縫合対象部分を切断できる。従って、レバーＬ１を操作して受け板４１と上部平坦面３２による胃Ａの縫合対象部分の挟持を解除した上で処置具８０の代わりに把持鉗子等を挿入し、胃Ａから切り取られた患部Ｂを該把持鉗子等で摘みながら、親内視鏡１００の挿入部１０１を医療用縫合装置１０及び把持鉗子等と共に患者の体外に引き抜けば、切り取った患部Ｂを体外に取り出すことができる。 When the staple 55 is driven into the suture target portion of the stomach A in this way, the axis of each link member 22 is rotated with respect to the axis of the insertion portion 17 by rotating the link operation member 15 as shown in FIGS. The axis of the suturing device 30 is shifted laterally with respect to the axis of the insertion portion 17. In this state, a long treatment instrument 80 having flexibility is inserted into the treatment instrument insertion passage 20 from the slit formed in the plug member 14, and the distal end portion of the treatment instrument 80 is formed on the distal end surface of the distal end hard portion 19. When projecting from the treatment instrument outlet opening, the pair of open / close blades 81 formed at the distal end of the treatment instrument 80 approaches the affected part B without contacting the main body 31. Then, a pair of open / close blades 81 are opened by operating an operation lever provided at the proximal end portion of the treatment instrument 80 located outside the patient's body, and the suture target portion of the stomach A is positioned between the pair of open / close blades 81. Further, if the pair of opening / closing blades 81 is closed by the operation lever, the portion to be sutured of the stomach A can be cut by the pair of opening / closing blades 81. Accordingly, the lever L1 is operated to release the clamping portion of the stomach A by the receiving plate 41 and the upper flat surface 32, and then a grasping forceps or the like is inserted in place of the treatment instrument 80, and the affected part is cut from the stomach A. If the insertion portion 101 of the parent endoscope 100 is pulled out of the patient's body together with the medical suturing device 10 and the grasping forceps while picking B with the grasping forceps or the like, the cut out affected portion B can be taken out of the body.

以上説明したように本実施形態の医療用縫合装置１０は、本体部３１の内部に収納したステープル５５によって患者の対象部位（胃Ａの上記縫合対象部分）を自動的に縫合できる。
しかも、押出部材７１を本体部３１の内部に完全に収納するのではなく、押出部材７１のベース板７２を本体部３１の外部に位置させ、さらに押出部材７１を退避位置に移動させた際には押出部材７１の本体部３１からの突出量が増大するようにしているので、ベース板７２及び受け板４１を本体部３１に接触させた状態においては縫合器３０全体の寸法（特に挿入部１７及び縫合器３０の軸線に対して直交する方向の寸法）を小さくすることが可能である。そのため、縫合器３０を挿入部１７と共に狭い対象物（例えば食道）や、湾曲した対象物（例えば食道）に円滑に挿入できる。
さらに、患者の体外に位置するレバーＬ１とレバーＬ２によって受け部材４０と押出部材７１を遠隔操作可能なので、受け部材４０と押出部材７１の操作性は良好である。しかも、板ばね６３及び受圧板６０によってステープル収納凹部５０のステープル５５をステープル収納凹部５０の底面５０ａ側に押圧することにより押込板７３、押込板７４によるステープル５５の確実な排出を可能にしているので、各ステープル５５を利用した連続的な縫合作業を確実に行える。
しかも、接触位置に位置する受け板４１を上部平坦面３２に対して一端平行移動させた後に全開位置まで回転させているので、全開位置まで移動させたときの受け板４１の上部平坦面３２に対する角度が小さくなる。そのため、受け板４１を平行移動させずに回転させる場合に比べて、ステープル受け溝４４によるステープル５５（針部５７）の曲げ効果を確実に得ることができる。 As described above, the medical suturing device 10 according to the present embodiment can automatically suture the target site of the patient (the suture target portion of the stomach A) with the staple 55 housed in the main body 31.
Moreover, when the pushing member 71 is not completely housed in the main body 31, the base plate 72 of the pushing member 71 is positioned outside the main body 31, and the pushing member 71 is moved to the retracted position. Since the protruding amount of the pushing member 71 from the main body 31 is increased, the overall size of the suturing device 30 (especially the insertion portion 17) when the base plate 72 and the receiving plate 41 are in contact with the main body 31. And the dimension in the direction orthogonal to the axis of the suture instrument 30) can be reduced. Therefore, the suturing device 30 can be smoothly inserted into the narrow object (for example, the esophagus) and the curved object (for example, the esophagus) together with the insertion portion 17.
Furthermore, since the receiving member 40 and the pushing member 71 can be remotely operated by the levers L1 and L2 located outside the patient's body, the operability of the receiving member 40 and the pushing member 71 is good. Moreover, the staple 55 can be reliably discharged by the pressing plate 73 and the pressing plate 74 by pressing the staple 55 of the staple storing recess 50 toward the bottom surface 50a of the staple storing recess 50 by the leaf spring 63 and the pressure receiving plate 60. Therefore, a continuous stitching operation using each staple 55 can be reliably performed.
In addition, since the receiving plate 41 located at the contact position is once translated in parallel with the upper flat surface 32 and then rotated to the fully open position, the upper 41 of the receiving plate 41 is moved to the fully open position. The angle becomes smaller. Therefore, the bending effect of the staple 55 (needle portion 57) by the staple receiving groove 44 can be reliably obtained as compared with the case where the receiving plate 41 is rotated without being translated.

また、患者の体外に位置するリンク操作部材１５によってリンク部材２２（平行リンク機構２３）を先端硬質部１９の軸線に対して傾斜させることにより、縫合器３０の軸線を挿入部１７（先端硬質部１９）の軸線に対して側方にずらせるようにしているので、先端硬質部１９の上記処置具出口用開口から突出させた処置具８０を縫合器３０に接触させることなく円滑に操作可能である。しかも、縫合器３０を先端硬質部１９に対して平行状態を維持したまま移動させられるので、縫合器３０の先端硬質部１９に対する移動量が変化する毎に縫合器３０の先端硬質部１９の軸線に対する傾斜角度が変わる場合に比べて、縫合器３０を先端硬質部１９に対して側方に微小移動させることが可能である。 Also, the link member 22 (parallel link mechanism 23) is tilted with respect to the axis of the distal hard portion 19 by the link operation member 15 located outside the patient's body, whereby the axis of the suture instrument 30 is inserted into the insertion portion 17 (hard distal portion). 19), the treatment tool 80 projected from the treatment tool outlet opening of the distal end hard portion 19 can be smoothly operated without contacting the suturing device 30. is there. Moreover, since the suturing device 30 can be moved while maintaining a parallel state with respect to the distal end hard portion 19, the axis of the distal end hard portion 19 of the suturing device 30 changes every time the amount of movement of the suturing device 30 relative to the distal end hard portion 19 changes. Compared with the case where the inclination angle with respect to changes, the suturing device 30 can be minutely moved laterally with respect to the distal end hard portion 19.

以上、上記実施形態に基づいて本発明を説明したが、本発明は様々な変更を施しながら実施可能である。
例えば、図２８に示すように、医療用縫合装置１０からリンク操作部材１５、レバーＬ１、レバーＬ２を省略した医療用縫合装置１０’に３つの操作具９０を接続してもよい。操作部１１の後端部に接続する各操作具９０は、基部９１と、基部９１に対して基部９１の軸線方向にスライド可能なスライダ９２と、基部９１から延びて操作部１１に接続する可撓性チューブ９３と、を具備している。一つの操作具９０の可撓性チューブ９３の内部には連係ワイヤ２６が移動自在に設けてあり、別の操作具９０の可撓性チューブ９３の内部には連係ワイヤ４６が移動自在に設けてあり、さらに別の操作具９０の可撓性チューブ９３の内部には連係ワイヤ７７が移動自在に設けてあり、連係ワイヤ２６、連係ワイヤ４６、連係ワイヤ７７は対応するスライダ９２に接続している。さらに、基部９１の端部には指掛け孔９４が形成してあり、スライダ９２には一対の指掛け孔９５が形成してある。この変形例では、術者が一方の手での指を指掛け孔９４と指掛け孔９５に掛けた上でスライダ９２を基部９１に対してスライドさせると、当該スライダ９２に接続する連係ワイヤ２６、連係ワイヤ４６または連係ワイヤ７７がその軸線方向に移動するのでリンク部材２２（平行リンク機構２３）、受け部材４０、押出部材７１が作動する。 As mentioned above, although this invention was demonstrated based on the said embodiment, this invention can be implemented, giving various changes.
For example, as shown in FIG. 28, three operating tools 90 may be connected from the medical suturing device 10 to the medical suturing device 10 ′ from which the link operating member 15, the lever L1, and the lever L2 are omitted. Each operation tool 90 connected to the rear end of the operation unit 11 includes a base 91, a slider 92 slidable in the axial direction of the base 91 with respect to the base 91, and extends from the base 91 to connect to the operation unit 11. And a flexible tube 93. The linkage wire 26 is movably provided inside the flexible tube 93 of one operation tool 90, and the linkage wire 46 is movably provided inside the flexible tube 93 of another operation tool 90. In addition, a linking wire 77 is movably provided inside a flexible tube 93 of another operation tool 90, and the linking wire 26, the linking wire 46, and the linking wire 77 are connected to the corresponding slider 92. . Further, a finger hooking hole 94 is formed at the end of the base 91, and a pair of finger hooking holes 95 are formed in the slider 92. In this modification, when the operator slides the slider 92 with respect to the base portion 91 after placing a finger with one hand on the finger hooking hole 94 and the finger hooking hole 95, the link wire 26 connected to the slider 92, the link Since the wire 46 or the connecting wire 77 moves in the axial direction, the link member 22 (parallel link mechanism 23), the receiving member 40, and the pushing member 71 operate.

また、例えば図２９及び図３０に示す医療用縫合装置１０’’のように、リンク操作部材１５及び連係ワイヤ２６を省略した上で、後部が先端硬質部１９の内部に相対移動可能に固着されると共に前部が一つのリンク部材２２の中間部に固着された弾性制御部材９７によって先端硬質部１９と一つのリンク部材２２を接続してもよい。この変形例では、縫合器３０に外力が及ばない場合は図２９に示すように、緊張状態にある弾性制御部材９７の張力によってリンク部材２２は図示の状態となる（リンク部材２２の先端硬質部１９に対する傾斜角度はこれ以上大きくならない）。従って、先端硬質部１９の上記処置具出口用開口から突出させた処置具８０（図２９では図示略）を縫合器３０に接触させることなく円滑に操作可能である。一方、医療用縫合装置１０’’の挿入部１７を、挿入部１７の側面と縫合器３０の該側面と反対側の側面の間の幅（図２９のＷの距離）より狭くかつ挿入部１７及び縫合器３０の幅より広い体腔（例えば食道）に通すと、該体腔の内壁によって縫合器３０が押圧され弾性制御部材９７がさらに伸びることにより、縫合器３０は図３０に示すように挿入部１７と同軸状態になる。このように体腔の形状に合わせてリンク部材２２が自動的に移動するので、挿入部１７及び縫合器３０を体腔に容易に挿入できる。 Further, as in the medical suturing device 10 ″ shown in FIGS. 29 and 30, for example, the link operation member 15 and the link wire 26 are omitted, and the rear portion is fixed to the inside of the distal end hard portion 19 so as to be relatively movable. In addition, the distal end hard portion 19 and one link member 22 may be connected by an elastic control member 97 whose front portion is fixed to an intermediate portion of one link member 22. In this modification, as shown in FIG. 29, when the external force is not exerted on the suturing device 30, the link member 22 is brought into the illustrated state by the tension of the elastic control member 97 in the tension state (the hard end portion of the link member 22). The inclination angle with respect to 19 does not increase any more). Therefore, the treatment instrument 80 (not shown in FIG. 29) protruding from the treatment instrument outlet opening of the distal end hard portion 19 can be smoothly operated without contacting the suture instrument 30. On the other hand, the insertion portion 17 of the medical suturing device 10 '' is narrower than the width (the distance W in FIG. 29) between the side surface of the insertion portion 17 and the side surface opposite to the side surface of the suturing device 30. When the suture device 30 passes through a body cavity (for example, esophagus) wider than the width of the suture device 30, the suture device 30 is pressed by the inner wall of the body cavity and the elastic control member 97 is further extended. 17 and a coaxial state. Thus, since the link member 22 automatically moves according to the shape of the body cavity, the insertion portion 17 and the suture instrument 30 can be easily inserted into the body cavity.

また、医療用縫合装置１０、１０’、１０’’のリンク部材２２を非平行のリンク機構としたり、レンズや撮像素子を内蔵させることにより観察機能や撮像機能をもたせてもよい。
さらに、リンク部材２２を利用したリンク機構とは別の接続機構（例えば、上記処置具出口用開口が外周側に位置する蛇腹など）によって医療用縫合装置１０、１０’、１０’’の先端硬質部１９と縫合器３０を接続してもよい。
さらに、押出部材７１が押込位置に位置するときにベース板７２を本体部３１の内部に位置させる収納凹部を本体部３１に形成してもよい。
また、板ばね６３の変わりに他の付勢手段（例えば圧縮コイルばね）を用いても良い。 Further, the link member 22 of the medical suturing device 10, 10 ′, 10 ″ may be a non-parallel link mechanism or may have an observation function or an imaging function by incorporating a lens or an imaging device.
Further, the distal end of the medical suturing device 10, 10 ′, 10 ″ is hardened by a connection mechanism different from the link mechanism using the link member 22 (for example, the bellows having the treatment instrument outlet opening positioned on the outer peripheral side). The portion 19 and the suture device 30 may be connected.
Further, a housing recess for allowing the base plate 72 to be positioned inside the main body 31 when the pusher member 71 is located at the pushing position may be formed in the main body 31.
Further, instead of the leaf spring 63, other urging means (for example, a compression coil spring) may be used.

１０１０’ １０’’ 医療用縫合装置
１１操作部
１２湾曲操作レバー
１３処置具挿入用突起
１４栓部材
１５リンク操作部材（リンク操作手段）
１７挿入部
１８湾曲部
１９先端硬質部
２０処置具挿通路（内部管路）
２２リンク部材
２３平行リンク機構（接続機構）
２４回転接続ピン（回転軸）
２６連係ワイヤ
３０縫合器
３１本体部
３２上部平坦面
３３下部平坦面
３４側部平坦面
３５ねじ部
３６案内孔
３７上下方向溝
３８回転許容溝
３９回転支持軸
４０受け部材
４１受け板
４２挿入片
４３貫通長孔
４４ステープル受け溝
４６連係ワイヤ
４７ワイヤ案内溝
５０ステープル収納凹部（収納空間）
５０ａ底面
５１ストッパ
５２ステープル収納枠
５３枠部
５４突片
５５ステープル
５６被押圧部
５７針部
６０受圧板
６２側部押さえ板
６３板ばね（付勢手段）
６５カバー部材
６６側片
６７前部連結片
６８貫通孔
６９ナット
７１押出部材
７２ベース板
７３７４押込板
７５案内ロッド
７７連係ワイヤ
７８ワイヤ案内溝
８０処置具
８１開閉刃
９０操作具
９１基部
９２スライダ
９３可撓性チューブ
９４９５指掛け孔
９７弾性制御部材
１００親内視鏡
１０１挿入部
Ａ胃（対象部位）
Ｂ患部
Ｌ１レバー（受け部材操作手段）
Ｌ２レバー（押出部材操作手段） 10 10 ′ 10 ″ Medical suturing device 11 Operation section 12 Bending operation lever 13 Treatment instrument insertion protrusion 14 Plug member 15 Link operation member (link operation means)
17 Inserting portion 18 Bending portion 19 Tip hard portion 20 Treatment instrument insertion path (internal conduit)
22 Link member 23 Parallel link mechanism (connection mechanism)
24 Rotating connection pin (Rotating shaft)
26 Connecting wire 30 Suture device 31 Main body 32 Upper flat surface 33 Lower flat surface 34 Side flat surface 35 Screw portion 36 Guide hole 37 Vertical groove 38 Rotation allowance groove 39 Rotation support shaft 40 Receiving member 41 Receiving plate 42 Insertion piece 43 Through long hole 44 Staple receiving groove 46 Linking wire 47 Wire guide groove 50 Staple storage recess (storage space)
50a Bottom 51 Stopper 52 Staple storage frame 53 Frame portion 54 Projection piece 55 Staple 56 Pressed portion 57 Needle portion 60 Pressure receiving plate 62 Side pressing plate 63 Leaf spring (biasing means)
65 Cover member 66 Side piece 67 Front connecting piece 68 Through hole 69 Nut 71 Extruding member 72 Base plate 73 74 Pushing plate 75 Guide rod 77 Linking wire 78 Wire guide groove 80 Treatment tool 81 Opening / closing blade 90 Operating tool 91 Base 92 Slider 93 Flexible tube 94 95 Finger hole 97 Elastic control member 100 Parent endoscope 101 Insertion part A Stomach (target site)
B affected part L1 lever (receiving member operating means)
L2 lever (extrusion member operation means)

Claims

対象物に挿入可能で可撓性を有する挿入部と、
該挿入部の先端部に接続する、ステープルを上記対象物内の対象部位に打ち込むことが可能な縫合器と、
を備え、
上記縫合器が、
一対の先端部が開放状態にある略コの字形状の上記ステープルを収納する収納空間、及び、該収納空間と連通するステープルの出口用開口を有する本体部と、
上記出口用開口と対向する状態で上記収納空間内を上記挿入部の軸線に対して略直交する方向にスライド可能として上記本体部に支持した押出部材と、
上記本体部に対して相対移動可能な受け部材と、
を備え、
上記押出部材が、上記収納空間内に位置するステープルが位置する平面と略平行な板状をなし、かつ上記出口用開口と対向する押込板を備え、該押込板が上記出口用開口に最も近づき、上記収納空間内に位置する上記ステープルを上記出口用開口を通して本体部の外部に押す押込位置と、該押込板が上記出口用開口から最も離れることにより上記押出部材の一部が上記本体部の外部に突出する退避位置との間をスライド可能であり、
上記収納空間内に、上記押込板が上記押込位置に移動したときに、上記収納空間内に位置する上記ステープルを上記押込板の側面に接触するまで付勢し、上記押込板が上記退避位置まで移動したときに、上記ステープルを上記収納空間の内壁に接触するまで付勢して該押込板の上記出口用開口側の端面と上記出口用開口の間に位置させる付勢手段を設け、
上記受け部材は、上記本体部の周面から離れることにより該本体部との間で上記対象部位を挟み込み、かつ、上記出口用開口から排出されて該対象部位を貫通したステープルの先端部と接触することにより、該ステープルの一対の先端部を閉じる方向に変形させることを特徴とする医療用縫合装置。 A flexible insertion part that can be inserted into an object;
A suturing device connected to the distal end of the insertion portion and capable of driving a staple into a target site in the target;
With
The suturing device is
A storage space for storing the substantially U-shaped staples having a pair of leading ends open, and a main body having an exit opening for staples communicating with the storage space;
An extrusion member that is supported by the main body so as to be slidable in a direction substantially orthogonal to the axis of the insertion portion in the storage space in a state of facing the outlet opening;
A receiving member movable relative to the main body,
Equipped with a,
The push-out member has a plate shape substantially parallel to a plane on which staples located in the storage space are located, and includes a push plate facing the exit opening, and the push plate comes closest to the exit opening. A pushing position for pushing the staple located in the storage space to the outside of the main body through the outlet opening, and a part of the pushing member is moved away from the outlet opening so that a part of the pushing member of the main body It can slide between the retracted position protruding outside,
In the storage space, when the push plate moves to the push position, the staple located in the storage space is urged until it contacts the side surface of the push plate, and the push plate is moved to the retracted position. A biasing means for biasing the staple until it comes into contact with the inner wall of the storage space and moving the staple plate between the end surface on the outlet opening side of the pushing plate and the outlet opening;
The receiving member is separated from the peripheral surface of the main body portion so as to sandwich the target portion with the main body portion, and comes into contact with the leading end portion of the staple that is discharged from the outlet opening and penetrates the target portion. By doing so, the medical suturing apparatus is characterized in that the pair of distal ends of the staple is deformed in a closing direction .

請求項１記載の医療用縫合装置において、
上記挿入部の基端部が接続する操作部に、上記押出部材を上記本体部に対してスライド操作するための押出部材操作手段を設けた医療用縫合装置。 The medical suturing device according to claim 1,
A medical suturing apparatus in which an operation member to which the proximal end portion of the insertion portion is connected is provided with an extrusion member operation means for sliding the extrusion member with respect to the main body portion.

請求項１または２記載の医療用縫合装置において、
上記受け部材が、上記本体部の周面に対して接離可能である医療用縫合装置。 The medical suturing device according to claim 1 or 2,
A medical suturing device in which the receiving member is capable of coming into contact with and separating from the peripheral surface of the main body.

請求項３記載の医療用縫合装置において、
上記挿入部の基端部が接続する操作部に、上記受け部材を上記本体部に対して移動操作するための受け部材操作手段を設けた医療用縫合装置。 The medical suturing device according to claim 3,
A medical suturing apparatus in which a receiving member operating means for moving the receiving member relative to the main body is provided on an operating portion to which a proximal end portion of the insertion portion is connected.

請求項１から４のいずれか１項記載の医療用縫合装置において、
上記挿入部が、処置具を挿通可能で、その端部が上記縫合器と対向する先端面において開口する内部管路を具備し、
上記縫合器を上記挿入部の先端部に、接続機構によって相対移動可能に接続した医療用縫合装置。 The medical suturing device according to any one of claims 1 to 4,
The insertion portion, capable inserted treatment置具, equipped with internal conduit whose ends open in the distal end surface opposed to the suture instrument,
A medical suturing device in which the suturing device is connected to a distal end portion of the insertion portion so as to be relatively movable by a connection mechanism.

請求項５記載の医療用縫合装置において、The medical suturing device according to claim 5,
上記接続機構が、該挿入部の軸線と平行な対をなすリンク部材を有しており、 The connection mechanism has a link member that makes a pair parallel to the axis of the insertion portion;
対をなすリンク部材の両端部を上記縫合器と上記挿入部の先端部とに、該軸線に直交する回転軸回りに回転可能として接続した医療用縫合装置。 A medical suturing device in which both end portions of a pair of link members are connected to the suturing device and the distal end portion of the insertion portion so as to be rotatable about a rotation axis orthogonal to the axis.

請求項６記載の医療用縫合装置において、The medical suturing device according to claim 6,
対をなす上記リンク部材が平行リンク機構を構成する医療用縫合装置。 A medical suturing apparatus in which the pair of link members constitutes a parallel link mechanism.

請求項６または７記載の医療用縫合装置において、The medical suturing device according to claim 6 or 7,
上記挿入部の基端部が接続する操作部に、上記リンク部材の上記挿入部の軸線に対する傾斜角度を調整するためのリンク操作手段を設けた医療用縫合装置。 A medical suturing apparatus, wherein a link operating means for adjusting an inclination angle of the link member with respect to an axis of the insertion portion is provided on an operation portion to which a proximal end portion of the insertion portion is connected.

請求項５記載の医療用縫合装置において、The medical suturing device according to claim 5,
外力が掛からないときは上記接続機構を上記縫合器の軸線が上記挿入部の軸線に対して側方にずれる状態にし、かつ外力が掛かることにより上記接続機構を上記縫合器の軸線が上記挿入部の軸線と一致する状態にする弾性制御部材を設けた医療用縫合装置。 When an external force is not applied, the connection mechanism is placed in a state where the axis of the suturing device is shifted laterally with respect to the axis of the insertion portion, and when the external force is applied, the axis of the suturing device is inserted into the insertion portion. A medical suturing device provided with an elastic control member that matches the axis of the medical device.