JPH09262242A - Needle carrier - Google Patents
Needle carrierInfo
- Publication number
- JPH09262242A JPH09262242A JP8097336A JP9733696A JPH09262242A JP H09262242 A JPH09262242 A JP H09262242A JP 8097336 A JP8097336 A JP 8097336A JP 9733696 A JP9733696 A JP 9733696A JP H09262242 A JPH09262242 A JP H09262242A
- Authority
- JP
- Japan
- Prior art keywords
- needle
- insertion rod
- surgical needle
- guide tube
- state
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
Landscapes
- Surgical Instruments (AREA)
- Endoscopes (AREA)
Abstract
Description
【０００１】[0001]
【発明の属する技術分野】本発明は、体腔内で縫合等の
処置を施すための手術針を保持して、それを遠隔操作す
るための持針器に関するものである。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a needle holder for holding a surgical needle for performing a procedure such as suturing in a body cavity and remotely operating the surgical needle.
【０００２】[0002]
【従来の技術】例えば、虫垂炎の手術その他の処置は、
非開腹状態で行うことができる。このために、トラカー
ルと呼ばれるガイド管を複数本用い、これらのトラカー
ルを腹部から腹腔内に差し込んでおき、このうちの１本
のガイド管内に内視鏡を挿入して、体腔内の観察を行う
ようになし、他のガイド管に、適宜の手術用の器具等を
挿入して、これらを操作することにより、手術等の処置
が施される。非開腹状態で手術を行えることは、患者に
対するダメージを最小限に抑制でき、かつ術後の回復も
早くなる等、様々な利点がある。2. Description of the Related Art For example, surgery for appendicitis and other treatments include
It can be performed without laparotomy. For this purpose, a plurality of guide tubes called trocars are used, these trocars are inserted into the abdominal cavity from the abdomen, and an endoscope is inserted into one of these guide tubes to observe the inside of the body cavity. In such a case, an appropriate surgical instrument or the like is inserted into another guide tube, and these are manipulated to perform a procedure such as surgery. Performing surgery in a non-laparotomy state has various advantages such as minimizing damage to the patient and accelerating postoperative recovery.
【０００３】手術等の所定の処置を施した後には、手術
用の糸を用いて、切開部分を縫合したり、血管や体内組
織の結紮を行うことになる。縫合や結紮を行うために、
手術針を用い、この手術針で糸を体内組織に縫い込むよ
うにするが、この手術針の操作は持針器を用いて、体腔
外から遠隔操作により行われる。持針器はガイド管を介
して体腔内に導かれることから、硬質の挿入杆の先端に
手術針を取り付けたものであって、この挿入杆を手元で
操作するために、その基端部にはグリップ部が設けられ
ている。After performing a predetermined procedure such as surgery, a surgical thread is used to sew the incised portion and ligate blood vessels and internal tissues. To perform sutures and ligations,
A surgical needle is used, and a thread is sewn into a body tissue with the surgical needle. The operation of the surgical needle is performed remotely from outside the body cavity using a needle holder. Since the needle holder is guided into the body cavity through the guide tube, a surgical needle is attached to the tip of a rigid insertion rod, and the proximal end portion of the insertion rod is used to operate this insertion rod at hand. Is provided with a grip portion.
【０００４】手術針は略Ｊ字状または略Ｕ字状の湾曲形
状をしており、先端部分が尖った針先となり、この針先
から湾曲部を経て直線状態になった基端側直線部を有す
るものである。そして、針先近傍の部位に糸を掛ける糸
掛け部を設け、基端側直線部の端部が挿入杆に着脱可能
に連結される。手術針は挿入杆に連結した状態でガイド
管を介して体腔内に導かれて、糸掛け部に糸の先端部分
を引っ掛けた状態で、針先から体内組織等に差し込ん
で、針先を組織表面に突出させることによって、縫合や
結紮をすべき個所に糸を通すようになし、組織表面から
突出した針先から糸の先端部を把持鉗子等を用いて脱着
させた後に、手術針を引き戻すようにして体内組織から
離脱させる。この操作を１乃至複数回繰り返し、さらに
糸の端部を結ぶことにより縫合や結紮等の処置が行われ
る。The surgical needle has a substantially J-shaped or U-shaped curved shape, and has a sharp tip at the distal end, and a straight line portion on the proximal end side which is straight from the needle tip through the curved portion. Is to have. Then, a thread hooking portion for hooking a thread is provided in the vicinity of the needle tip, and the end portion of the proximal end side linear portion is detachably connected to the insertion rod. The surgical needle is guided to the inside of the body cavity through the guide tube while being connected to the insertion rod, and while the tip of the thread is hooked on the thread hooking part, it is inserted from the needle tip into the body tissue, etc. By making the thread protrude through the surface, the thread is passed through the place where suture or ligation should be performed, and the tip of the thread is detached from the needle tip protruding from the tissue surface using a grasping forceps or the like, and then the surgical needle is pulled back. In this way, it is detached from the internal tissue. This operation is repeated one to a plurality of times, and the ends of the thread are further tied to perform a treatment such as suturing or ligation.
【０００５】ここで、縫合等の処置を行う際において
は、処置を行う部位や状態に応じて、種々の形状の手術
針が用いられる。例えば、血管を結紮する際等において
は、比較的小さい手術針を用いて、できるだけ血管の周
囲の組織を巻き込んだりしないようにして糸を血管に回
り込ませる。一方、傷口を縫合するに当って、その傷口
が大きく広がっている場合には、傷口の両側に位置する
組織間に糸を通すために大型の針が用いられる。Here, when performing a procedure such as suturing, surgical needles of various shapes are used depending on the site and the state to be treated. For example, when ligating a blood vessel or the like, a relatively small surgical needle is used to wrap the thread around the blood vessel so as not to wrap the tissue around the blood vessel as much as possible. On the other hand, in suturing a wound, if the wound is wide, a large needle is used to pass a thread between tissues located on both sides of the wound.
【０００６】[0006]
【発明が解決しようとする課題】ところで、挿入杆に連
結した手術針は、ガイド管を介して体腔内に導かれるも
のであるから、手術針の大きさはガイド管の内径により
制約を受ける。手術針は体内組織等に食い込ませる必要
があり、この操作は手術針が連結されている挿入杆によ
り行われるものである。従って、手術針に対して十分な
推力を及ぼすには、手術針を挿入杆の前方に位置させる
のではなく、その軸線と直交する方向に延在させるよう
になし、挿入杆を軸回りに回動させる操作によって、体
内組織等に食い込ませるのが好ましい。しかしながら、
手術針が挿入杆の軸線と直交する状態になっていると、
手術針の形状によっては、ガイド管内に挿入できなくな
ることがある。例えば、湾曲部の曲率半径が大きい場合
や、基端側直線部の長さが長い場合にあっては、手術針
をガイド管の軸線方向に向けて挿入すれば、このガイド
管内に挿通できるにも拘らず、挿入杆に連結された状態
では、ガイド管への挿入が不能となってしまう場合があ
る。By the way, since the surgical needle connected to the insertion rod is guided into the body cavity through the guide tube, the size of the surgical needle is restricted by the inner diameter of the guide tube. The surgical needle needs to bite into internal tissue or the like, and this operation is performed by an insertion rod to which the surgical needle is connected. Therefore, in order to exert a sufficient thrust on the surgical needle, the surgical needle is made not to be positioned in front of the insertion rod but to be extended in the direction orthogonal to its axis, and the insertion rod is rotated about the axis. It is preferable to cause it to bite into internal tissue or the like by an operation of moving. However,
When the surgical needle is in a state orthogonal to the axis of the insertion rod,
Depending on the shape of the surgical needle, it may not be possible to insert it into the guide tube. For example, when the radius of curvature of the curved portion is large, or when the length of the proximal linear portion is long, the surgical needle can be inserted into the guide tube by inserting it in the axial direction of the guide tube. Nevertheless, in the state where it is connected to the insertion rod, the insertion into the guide tube may be impossible.
【０００７】このような場合には、ガイド管の内径を大
きくすれば、手術針の挿入が可能になるが、そうする
と、ガイド管を体表皮から体腔内に差し込む際の開口部
分を広くしなければならず、従って患者に対するダメー
ジがそれだけ大きくなってしまう。従って、挿入杆に連
結した手術針を用いず、手術針のみをガイド管から体内
に向けて落とし込んで、体腔内の手術針を把持鉗子等に
より拾い上げて、縫合等の処置を行わなければならなく
なる。このように、把持鉗子を用いて処置を行うのは、
非常に困難かつ面倒であり、しかも把持鉗子により手術
針を安定的に把持できない等の問題点がある。In such a case, the surgical needle can be inserted by increasing the inner diameter of the guide tube. However, if the guide tube is inserted from the body epidermis into the body cavity, the opening portion must be wide. Therefore, the damage to the patient is increased accordingly. Therefore, instead of using the surgical needle connected to the insertion rod, only the surgical needle must be dropped from the guide tube toward the body, and the surgical needle in the body cavity must be picked up by the grasping forceps or the like and sutures or the like must be performed. . In this way, the treatment using gripping forceps is
There are problems that it is very difficult and troublesome and that the surgical needle cannot be stably gripped by the gripping forceps.
【０００８】本発明は以上の点に鑑みてなされたもので
あって、その目的とするところは、大型の手術針であっ
ても、ガイド管内に円滑に挿入でき、しかも挿入杆の軸
線と直交する方向に延在させた状態で操作できるように
することにある。The present invention has been made in view of the above points, and it is an object of the present invention that even a large surgical needle can be smoothly inserted into a guide tube and is orthogonal to the axis of the insertion rod. It is to be able to operate in the state of extending in the direction.
【０００９】[0009]
【課題を解決するための手段】前述した目的を達成する
ために、本発明は、先端側が湾曲形状となった手術針の
基端部を挿入杆の先端に回動可能に連結し、この挿入杆
の基端部には、手術針が挿入杆の前方を向く状態と、挿
入杆と直交する方向に向く状態とに回動変位させる遠隔
操作手段を設ける構成としたことをその特徴とするもの
である。In order to achieve the above-mentioned object, according to the present invention, a proximal end portion of a surgical needle having a curved distal end side is rotatably connected to a distal end of an insertion rod, and the insertion is performed. It is characterized in that the proximal end portion of the rod is provided with a remote operation means for rotationally displacing the surgical needle in a state of facing the front of the insertion rod and in a state of being oriented in a direction orthogonal to the insertion rod. Is.
【００１０】[0010]
【発明の実施の形態】以下、本発明の実施の一形態を図
面を参照して詳細に説明する。縫合や結紮等の手術を行
うために、図１に示したように、トラカール等のガイド
管Ｇ１〜Ｇ３を用いる。これらガイド管Ｇ１〜Ｇ３は腹
部から腹腔内に差し込まれる。ここで、腹腔内で行われ
る手術等の処置をより円滑に行うために、腹腔内には気
腹ガスを封入する等によって膨出させる。ガイド管Ｇ１
内には、内視鏡Ｓが挿入される。この内視鏡Ｓによって
腹腔内を観察するが、この観察視野をできるだけ広くす
るために、内視鏡Ｓの挿入部Ｃは、少なくとも先端部分
がアングル操作可能なものを用いると良い。また、ガイ
ド管Ｇ２，Ｇ３に適宜の手術用器具等を挿入して、患部
の切除等の所要の手術等が行われる。BEST MODE FOR CARRYING OUT THE INVENTION An embodiment of the present invention will be described in detail below with reference to the drawings. In order to perform an operation such as suturing or ligation, as shown in FIG. 1, guide tubes G1 to G3 such as a trocar are used. These guide tubes G1 to G3 are inserted into the abdominal cavity from the abdomen. Here, in order to perform a procedure such as an operation performed in the abdominal cavity more smoothly, the abdominal cavity is inflated by insufflating gas. Guide tube G1
An endoscope S is inserted inside. The inside of the abdominal cavity is observed by the endoscope S. In order to widen the observation field of view, it is preferable that the insertion portion C of the endoscope S has at least a distal end portion that can be angle-operated. In addition, by inserting an appropriate surgical instrument or the like into the guide tubes G2 and G3, a required operation such as excision of the affected area is performed.
【００１１】手術等の処置が行われた後に患部の縫合や
結紮を行う。このために、持針器１と把持鉗子Ｆとを用
い、例えば図１に示したように、ガイド管Ｇ２内に持針
器１を挿通させ、またガイド管Ｇ３に把持鉗子Ｆを挿通
させて、それぞれ体腔内に導かれることになる。After a procedure such as surgery is performed, the affected area is sutured or ligated. For this purpose, the needle holder 1 and the grasping forceps F are used, for example, as shown in FIG. 1, the needle holder 1 is inserted into the guide tube G2, and the grasping forceps F is inserted into the guide tube G3. , Respectively, will be guided into the body cavity.
【００１２】図２乃至図６に持針器１の構成を示す。ま
ず、図２において、２は手術針であって、この手術針２
は先端が尖った針先２ａとなっており、この針先２ａ近
傍には糸を引っ掛ける糸掛け部２ｂが設けられている。
そして、糸掛け部２ｂを設けた部位から基端側は所定の
曲率でほぼ半円形に湾曲する湾曲部２ｃとなっており、
この湾曲部２ｃには直線形状となった基端側直線部２ｄ
が連設されている。ここで、針先２ａから湾曲部２ｃま
での部位は断面が略円形となし、基端側直線部２ｄは断
面が角形とするのが、後述する回動軸６への連結を強固
に行える。2 to 6 show the structure of the needle holder 1. First, in FIG. 2, 2 is a surgical needle, and the surgical needle 2
Has a pointed needle tip 2a, and a thread hooking portion 2b for hooking a thread is provided in the vicinity of the needle tip 2a.
Further, a curved portion 2c that is curved in a substantially semicircular shape with a predetermined curvature is provided on the base end side from the portion where the thread hooking portion 2b is provided,
The curved portion 2c has a straight line-shaped proximal end side linear portion 2d.
Are connected. Here, the portion from the needle tip 2a to the curved portion 2c has a substantially circular cross section, and the proximal linear portion 2d has a rectangular cross section, so that the connection to the rotating shaft 6 described later can be performed firmly.
【００１３】３は挿入杆を示し、この挿入杆３は、その
大半の部分は外形が円形をした杆状の部材であり、その
先端における軸線方向の所定長さ分には平坦部３ａが形
成されている。また、挿入杆３には、一端が平坦部３ａ
に開口し、他端が挿入杆３の基端部に開口する挿通孔４
が穿設されている。さらに、挿入杆３の基端部には、固
定把持部５ａと回動把持部５ｂとからなる把持部５が装
着されている。Reference numeral 3 denotes an insertion rod, and most of the insertion rod 3 is a rod-shaped member having a circular outer shape, and a flat portion 3a is formed at a predetermined length in the axial direction at the tip thereof. Has been done. In addition, the insertion rod 3 has a flat portion 3a at one end.
Insertion hole 4 opened at the other end and the other end opened at the base end portion of the insertion rod 3.
Are drilled. Further, a gripping portion 5 including a fixed gripping portion 5a and a rotating gripping portion 5b is attached to the base end portion of the insertion rod 3.
【００１４】挿入杆３の平坦部３ａには回動軸６が回動
自在に設けられており、この回動軸６は挿入杆３の軸線
と直交する方向において、平坦部３ａを貫通して下方に
延在されている。そして、手術針２は、その基端側直線
部２ｄが回動軸６の下端面から軸線方向に挿入されて、
ビス７により基端側直線部２ｄの平坦な面に押し付ける
ことにより着脱可能に固定されている。回動軸６には、
平坦部３ａ側の部位において、第１のリンク部材８が連
結されており、この第１のリンク部材８は枢支ピン９に
より第２のリンク部材１０に相対回動自在に連結されて
いる。第２のリンク部材１０は枢支ピン１１を介して伝
達軸１２に回動自在に連結されている。伝達軸１２は、
挿入杆３に設けた挿通孔４内に導かれており、その他端
は挿通孔４の基端側から所定長さ導出されて、作動駒１
３に連結されている。A rotary shaft 6 is rotatably provided on the flat portion 3a of the insertion rod 3, and the rotary shaft 6 penetrates the flat portion 3a in a direction orthogonal to the axis of the insertion rod 3. It extends downward. Then, the surgical needle 2 has its proximal end linear portion 2d inserted in the axial direction from the lower end surface of the rotating shaft 6,
It is detachably fixed by being pressed against the flat surface of the proximal end side linear portion 2d with the screw 7. The rotating shaft 6 has
The first link member 8 is connected to the flat portion 3a side, and the first link member 8 is connected to the second link member 10 by a pivot pin 9 so as to be relatively rotatable. The second link member 10 is rotatably connected to the transmission shaft 12 via a pivot pin 11. The transmission shaft 12 is
It is guided into the insertion hole 4 provided in the insertion rod 3, and the other end is led out from the base end side of the insertion hole 4 by a predetermined length, and the operating piece 1
3 is connected.
【００１５】従って、伝達軸１２を押し引き操作する
と、この伝達軸１２に連結して設けた第２のリンク部材
１０が枢支ピン１１を中心として回動し、またこれに連
動して第１のリンク部材８が回動することになり、第１
のリンク部材８に連結した回動軸６を回動させることに
なる。これによって、回動軸６に連結して設けた手術針
２は、図３及び図４に示したように、挿入杆３の前方側
に向く状態と、この状態から９０°回動して、図５及び
図６に示したように、挿入杆３の軸線と直交する方向に
向く状態との間に変位する。手術針２が前方に向く状態
は、ガイド管Ｇ２内に挿入する際における手術針２の挿
入姿勢であり、また挿入杆３の軸線と直交する方向に向
いた状態が手術針２を体内組織等に差し込む作動姿勢と
なる。Therefore, when the transmission shaft 12 is pushed and pulled, the second link member 10 connected to the transmission shaft 12 rotates about the pivot pin 11, and in conjunction with this, the first link member 10 is rotated. The link member 8 of the
The rotating shaft 6 connected to the link member 8 is rotated. As a result, the surgical needle 2 connected to the rotary shaft 6 is, as shown in FIGS. 3 and 4, a state of facing the front side of the insertion rod 3 and a 90 ° rotation from this state, As shown in FIGS. 5 and 6, the insertion rod 3 is displaced between the insertion rod 3 and the state of being oriented in a direction orthogonal to the axis. The state in which the surgical needle 2 faces forward is the insertion posture of the surgical needle 2 when it is inserted into the guide tube G2, and the state in which the surgical needle 2 is oriented in the direction orthogonal to the axis of the insertion rod 3 causes the surgical needle 2 to be a body tissue or the like. It will be in the operating position.
【００１６】手術針２を挿入姿勢と作動姿勢との間にお
ける変位は、把持部５の操作により行われる。このため
に、把持部５における固定把持部５ａは挿入杆３に固定
的に連結されており、これに対して可動把持部５ｂは、
支点ピン１４を用いて固定把持部５ａに回動可能に連結
されており、かつ可動把持部５ｂにはレバー部１５が連
設されて、このレバー部１５が連結ピン１６により押動
駒１３に枢支されている。従って、可動把持部５ｂを固
定把持部５ａに対して近接・離間する方向に回動操作す
ることによって、押動駒１３を軸線方向に変位させ、伝
達軸１２を後方に位置させると、手術針２は前方を向く
挿入姿勢となり、前方に押し出すと、手術針２は９０°
回動して作動姿勢となる。The displacement between the insertion posture and the operating posture of the surgical needle 2 is performed by operating the grip portion 5. For this purpose, the fixed grip portion 5a of the grip portion 5 is fixedly connected to the insertion rod 3, while the movable grip portion 5b is
It is rotatably connected to the fixed gripping portion 5a by using a fulcrum pin 14, and a lever portion 15 is connected to the movable gripping portion 5b, and the lever portion 15 is connected to the pushing piece 13 by the connecting pin 16. It is pivotally supported. Therefore, when the movable gripping portion 5b is rotated in the direction of approaching and separating from the fixed gripping portion 5a, the push piece 13 is displaced in the axial direction, and the transmission shaft 12 is positioned rearward. 2 is in the insertion posture facing forward, and when pushed forward, the surgical needle 2 is 90 °
It turns to the working posture.
【００１７】このように、伝達軸１２を押し引き操作す
ることにより手術針２が回動変位するが、固定把持部５
ａと可動把持部５ｂとの間には、手術針２が常時挿入姿
勢となるように付勢するために、一対の板ばね１７ａ，
１７ｂからなる付勢手段１７が架設されている。この付
勢手段１７を構成する板ばね１７ａ，１７ｂは、それぞ
れ支点ピン１８ａ，１８ｂにより可動把持部５ｂ及び固
定把持部５ａに固定されており、その先端側が相互に近
接する方向に湾曲されて、先端部を連結するように装着
され、この板ばね１７ａ，１７ｂの相互間の押し付け力
によって、可動把持部５ｂは固定把持部５ａから離間
し、伝達軸１２を引き戻した手術針２の挿入姿勢の状態
に保持される。把持部５を把持して握り力を加えると、
可動把持部５ｂは付勢手段１７の付勢力に抗して可動把
持部５ｂが固定把持部５ａに近接する方向に回動変位
し、これによって、作動駒１３及びこの作動駒１３に連
結した伝達軸１２が前進して、第１，第２のリンク部材
８，１０の作動により回動軸６が９０°回動して手術針
２が作動姿勢となるように変位する。As described above, the push-pull operation of the transmission shaft 12 causes the surgical needle 2 to be rotationally displaced.
Between the a and the movable grip portion 5b, in order to urge the surgical needle 2 so as to always be in the insertion posture, a pair of leaf springs 17a,
A biasing means 17 composed of 17b is installed. The leaf springs 17a and 17b forming the urging means 17 are fixed to the movable grip portion 5b and the fixed grip portion 5a by fulcrum pins 18a and 18b, respectively, and their tip ends are curved in a direction in which they approach each other. The movable gripping portion 5b is mounted so as to connect the distal end portions thereof, and the movable gripping portion 5b is separated from the fixed gripping portion 5a by the pressing force between the leaf springs 17a and 17b. Held in a state. When the grip portion 5 is gripped and a grip force is applied,
The movable gripping portion 5b is rotationally displaced in a direction in which the movable gripping portion 5b approaches the fixed gripping portion 5a against the biasing force of the biasing means 17, whereby the actuating piece 13 and the transmission coupled to the actuating piece 13 are caused. The shaft 12 moves forward and the rotary shaft 6 rotates 90 ° by the operation of the first and second link members 8 and 10, and the surgical needle 2 is displaced so as to be in the operating posture.
【００１８】次に、１９は手術針２の作動姿勢の状態に
保持するためのラチェット部材である。ラチェット部材
１９は角棒状の部材からなり、その一端部は固定把持部
５ａに連設したブラケット２０に回動軸２１を介して連
結されて、手指等でこの回動軸２１を中心として回動で
きる。そして、ラチェット部材１９の一側面には、多数
の歯を所定のピッチ間隔をもって刻設することによりラ
チェット歯２２が形成され、このラチェット歯２２に
は、可動把持部５ｂの先端に延設した係合部２３が係合
可能となっている。これによって、把持部５を握持する
と、その握り力により可動把持部５ｂが支点ピン１４を
中心として固定把持部５ａに近接する方向に回動変位
し、その間に、この可動把持部５ｂに連設した係合部２
３がラチェット歯２２上を移動し、握り力を解除したと
きには、係合部２３はこのラチェット歯２２における所
定の位置の歯と係合した状態に保たれて、可動把持部５
ｂは、所定の角度位置で係止される。即ち、このラチェ
ット部材１９のラチェット歯２２と可動把持部５ｂの係
合部２３との作用により、手術針２を任意の角度位置に
固定することができる。Next, 19 is a ratchet member for holding the operating needle 2 in the operating posture. The ratchet member 19 is made of a rectangular rod-like member, and one end of the ratchet member 19 is connected to a bracket 20 connected to the fixed grip portion 5a via a rotation shaft 21, and the ratchet member 19 is rotated around the rotation shaft 21 by a finger or the like. it can. Then, ratchet teeth 22 are formed on one side surface of the ratchet member 19 by engraving a large number of teeth at a predetermined pitch interval, and the ratchet teeth 22 extend to the tip of the movable grip portion 5b. The mating portion 23 can be engaged. As a result, when the gripping portion 5 is gripped, the gripping force causes the movable gripping portion 5b to be rotationally displaced about the fulcrum pin 14 in the direction of approaching the fixed gripping portion 5a, and during this period, the movable gripping portion 5b is connected to the movable gripping portion 5b. Engagement part 2 provided
When 3 moves on the ratchet teeth 22 and releases the gripping force, the engaging portion 23 is kept engaged with the tooth of the ratchet teeth 22 at a predetermined position, and the movable gripping portion 5
b is locked at a predetermined angular position. That is, the surgical needle 2 can be fixed at an arbitrary angular position by the action of the ratchet teeth 22 of the ratchet member 19 and the engaging portion 23 of the movable grip portion 5b.
【００１９】さらに、２４は挿入杆３の先端部近傍に装
着され、先端に手術針２を取り付けた挿入杆３をガイド
管Ｇ２内に挿入する際に、手術針２がガイド管Ｇ２の内
壁に当接しないように保護するために、ガイド管Ｇ２の
内径より僅かに小さい外径を有する保護筒である。この
保護筒２４は、挿入杆３に対して偏心した位置に配置さ
れ、挿入杆３に対して、相対回動が可能で、軸線方向に
も移動可能となっている。そして、保護筒２４に操作ロ
ッド２５を連結しておき、この操作ロッド２５をガイド
管Ｇ２から外部に延在させて、この操作ロッド２５を押
し引き操作することによって、保護筒２４を挿入杆３に
対して任意の位置に移動させることができる。なお、こ
の保護筒２４を手術針２の針先２ａの保護機能に加え
て、気密保持機能を発揮させる構成することも可能であ
る。この場合には、保護筒２４の内部に隔壁を設ける。
また、挿入杆３に対して固定的に連結するか、または相
対回動のみが可能な状態に連結することも可能である。Further, numeral 24 is mounted in the vicinity of the distal end portion of the insertion rod 3, and when the insertion rod 3 having the surgical needle 2 attached to the distal end is inserted into the guide tube G2, the surgical needle 2 is placed on the inner wall of the guide tube G2. The protective tube has an outer diameter slightly smaller than the inner diameter of the guide tube G2 in order to protect it from abutting. The protection cylinder 24 is arranged at a position eccentric with respect to the insertion rod 3, is rotatable relative to the insertion rod 3, and is also movable in the axial direction. Then, the operating rod 25 is connected to the protective cylinder 24 in advance, the operating rod 25 is extended from the guide tube G2 to the outside, and the operating rod 25 is pushed and pulled, whereby the protective cylinder 24 is inserted. It can be moved to any position with respect to. The protective cylinder 24 may be configured to exert an airtight holding function in addition to the function of protecting the needle tip 2a of the surgical needle 2. In this case, a partition is provided inside the protective cylinder 24.
Further, it is also possible to connect the insertion rod 3 fixedly, or connect the insertion rod 3 in such a state that only relative rotation is possible.
【００２０】以上のように構成することによって、手術
針２としては、ガイド管Ｇ２の軸線方向に向けた時に、
このガイド管Ｇ２内に挿通できるが、ガイド管Ｇ２と直
交する方向に向けた時には、内部に挿通できない形状の
ものであったとしても、挿入杆３の先端において、手術
針２を挿入姿勢を取らせることによって、ガイド管Ｇ２
内に挿入できる。With the above construction, the surgical needle 2 has the following features when it is oriented in the axial direction of the guide tube G2:
The surgical needle 2 can be inserted into the guide tube G2, but when it is oriented in a direction orthogonal to the guide tube G2, the surgical needle 2 is inserted at the tip of the insertion rod 3 even if it has a shape that cannot be inserted inside. The guide tube G2
Can be inserted in.
【００２１】即ち、手術針２は、湾曲部２ｃを半円形状
にして、針先２ａが湾曲部２ｃの端部を構成しており、
湾曲部２ｃには基端側直線部２ｄが連設されて、この基
端側直線部２ｄが回動軸６に固定されている。従って、
この手術針２をガイド管Ｇ２の軸線と直交する方向に配
置した場合には、湾曲部２ｃの曲率半径がガイド管Ｇ２
の内径の曲率半径以下であれば、針先２ａから湾曲部２
ｃまでの部分はガイド管Ｇ２内に挿入できるが、基端側
直線部２ｄ及びこの基端側直線部２ｄが連結されている
回動軸６の部分をガイド管Ｇ２内に挿入することはでき
ない。これに対して、手術針２をガイド管Ｇ２の軸線方
向に向けると、図４に示したように、回動軸６の先端か
ら手術針２の湾曲部２ｃの方向転換部に至るまでの高さ
寸法がガイド管Ｇ２の内面側の直径以下であれば、湾曲
部２ｃの曲率半径がガイド管Ｇ２の内径に規制されな
い。That is, in the surgical needle 2, the curved portion 2c has a semicircular shape, and the needle tip 2a constitutes an end portion of the curved portion 2c.
A base end side linear portion 2d is connected to the curved portion 2c, and the base end side linear portion 2d is fixed to the rotating shaft 6. Therefore,
When the surgical needle 2 is arranged in a direction orthogonal to the axis of the guide tube G2, the radius of curvature of the curved portion 2c is the guide tube G2.
If it is not more than the radius of curvature of the inner diameter of the
The part up to c can be inserted into the guide tube G2, but the base end side linear portion 2d and the part of the rotating shaft 6 to which the base end side linear portion 2d is connected cannot be inserted into the guide tube G2. . On the other hand, when the surgical needle 2 is oriented in the axial direction of the guide tube G2, as shown in FIG. 4, the height from the tip of the rotating shaft 6 to the turning portion of the curved portion 2c of the surgical needle 2 is increased. The radius of curvature of the curved portion 2c is not restricted by the inner diameter of the guide tube G2 as long as the dimension is equal to or less than the diameter on the inner surface side of the guide tube G2.
【００２２】而して、挿入杆３に対して手術針２を挿入
姿勢を取らせた状態で、ガイド管Ｇ２に挿通させるが、
挿入杆３にはガイド管Ｇ２の内径より僅かに小さい外径
を有する保護筒２４が装着されているから、この保護筒
２４をガイド管Ｇ２に挿入することにより、挿入杆３を
安定させることができ、手術針２がみだりに振れたりし
て、針先２ａがガイド管Ｇ２内面と摺接して損傷する等
のおそれはない。ただし、手術針２の針先２ａがガイド
管Ｇ２に摺接しても、格別損傷等を来すおそれがない場
合には、保護筒２４を設ける必要はない。Then, the surgical needle 2 is inserted into the guide tube G2 in a state where the surgical needle 2 is in the inserted posture with respect to the insertion rod 3.
Since the insertion rod 3 is equipped with the protective cylinder 24 having an outer diameter slightly smaller than the inner diameter of the guide tube G2, the insertion rod 3 can be stabilized by inserting the protective cylinder 24 into the guide tube G2. Therefore, there is no possibility that the surgical needle 2 will shake suddenly and the needle tip 2a will be in sliding contact with the inner surface of the guide tube G2 and be damaged. However, if the needle tip 2a of the surgical needle 2 is brought into sliding contact with the guide tube G2 and there is no possibility of causing special damage, it is not necessary to provide the protective cylinder 24.
【００２３】挿入杆３の先端部をガイド管Ｇ２から所定
長さ突出させて、手術針２が体腔内に位置する状態にな
ると、把持部５を握持することにより回動把持部５ｂを
連結ピン１６を中心として回動させる。これによって、
レバー部１５が回動して、作動駒１３を押し出す方向に
変位させ、この押動駒１３に連結した伝達軸１２を押し
出す。これによって、第１，第２のリンク部材８，１０
が作動して回動軸６が回動し、手術針２が９０°回動変
位することになって、挿入杆３の軸線に対して直交する
方向に向いた作動姿勢となる。そして、ラチェット部材
１９におけるラチェット歯２２を係合部２３に係合させ
ることによって、把持部５の回動把持部５ｂを、その位
置で固定することにより、手術針２は挿入杆３に対して
直交する姿勢状態に維持できる。When the distal end portion of the insertion rod 3 is projected from the guide tube G2 by a predetermined length and the surgical needle 2 is positioned in the body cavity, the gripping portion 5 is gripped to connect the rotary gripping portion 5b. Rotate around the pin 16. by this,
The lever portion 15 rotates to displace the operating piece 13 in the pushing direction, and pushes out the transmission shaft 12 connected to the pushing moving piece 13. Thereby, the first and second link members 8, 10
Is operated to rotate the rotating shaft 6, and the operating needle 2 is rotated and displaced by 90 °, and the operating position is oriented in a direction orthogonal to the axis of the insertion rod 3. Then, by engaging the ratchet teeth 22 of the ratchet member 19 with the engaging portion 23 to fix the rotating grip portion 5b of the grip portion 5 at that position, the surgical needle 2 is inserted into the insertion rod 3. The posture can be maintained in the orthogonal position.
【００２４】以上の状態で、手術針２の糸掛け部２ｂに
手術用の糸の先端部分を引っ掛ける。ここで、糸は予め
糸掛け部２ｂに引っ掛けておいても良いが、例えば把持
鉗子Ｆに把持させて、体腔内に挿入する等も可能であ
る。そして、針先２ａを縫合や結紮等を行うべき部位に
向けるようにして、挿入杆３の基端部を軸回りに回動さ
せる。これにより、手術針２の針先２ａが体内組織に差
し込まれる。挿入杆３の回動操作により手術針２を体内
組織に食い込ませるから、手術針２に対して確実に推力
を及ぼさせることができ、その操作性が極めて良好にな
る。そして、針先２ａを体内組織から突出させて、把持
鉗子Ｆにより糸を糸掛け部２ｂから脱着させて、挿入杆
３を反対方向に回動させることによって、手術針２を体
内組織から離脱させる。In the above state, the distal end portion of the surgical thread is hooked on the thread hooking portion 2b of the surgical needle 2. Here, the thread may be hooked on the thread hooking portion 2b in advance, but, for example, the thread may be gripped by the gripping forceps F and inserted into the body cavity. Then, the base end portion of the insertion rod 3 is rotated around the axis so that the needle tip 2a is directed to a site where suturing, ligation or the like should be performed. As a result, the needle tip 2a of the surgical needle 2 is inserted into the internal tissue. Since the surgical needle 2 is made to bite into the body tissue by the turning operation of the insertion rod 3, a thrust force can be reliably exerted on the surgical needle 2, and its operability becomes extremely good. Then, the needle tip 2a is projected from the body tissue, the thread is detached from the thread hooking portion 2b by the grasping forceps F, and the insertion rod 3 is rotated in the opposite direction, whereby the surgical needle 2 is detached from the body tissue. .
【００２５】以上の操作において、手術針２は挿入杆３
と直交する状態ではガイド管Ｇ２内に挿入できない程度
の大型のものを用いることができる。従って、広い範囲
にわたる縫合や結紮等の処置を行う操作を極めて容易に
行うことができる。ここで、手術針２は、体内組織にお
ける縫合乃至結紮を行うべき位置に正確に位置決めする
必要がある。このためには、操作ロッド２４を引き出し
て、保護筒２４をガイド管Ｇ２から離脱させることによ
って、挿入杆３をガイド管Ｇ２内で自由に動かせる状態
にすれば良い。In the above operation, the surgical needle 2 is inserted into the insertion rod 3
It is possible to use a large-sized one that cannot be inserted into the guide tube G2 in a state orthogonal to. Therefore, it is possible to extremely easily perform an operation for performing a procedure such as suturing or ligating over a wide range. Here, the surgical needle 2 needs to be accurately positioned at a position in the body tissue where suturing or ligation should be performed. For this purpose, the operating rod 24 may be pulled out and the protective cylinder 24 may be detached from the guide tube G2 so that the insertion rod 3 can be freely moved within the guide tube G2.
【００２６】手術針を挿入姿勢と作動姿勢との間に変位
させる機構としては、前述した構成のものの他、図７乃
至図９に示した構成とすることも可能である。そこで、
これらの図において、前述の実施の形態と同一または均
等な部材については、同一の符号を付して、その説明は
省略する。As the mechanism for displacing the surgical needle between the insertion posture and the operating posture, the structure shown in FIGS. 7 to 9 can be used in addition to the structure described above. Therefore,
In these figures, the same or equivalent members as those in the above-described embodiment are designated by the same reference numerals, and the description thereof will be omitted.
【００２７】この実施の形態においても、把持部５に連
結した挿入杆３の先端に手術針３０が回動自在に装着さ
れており、把持部５における可動把持部５ｂを操作する
ことによって、手術針３０が回動して、挿入杆３の軸線
方向の前方に位置する挿入姿勢と、この挿入姿勢から略
９０°回動した作動姿勢との間に変位させることができ
る構成としている。Also in this embodiment, the surgical needle 30 is rotatably attached to the tip of the insertion rod 3 connected to the grip portion 5, and the operation is performed by operating the movable grip portion 5b of the grip portion 5. The needle 30 is rotated so that the needle 30 can be displaced between an insertion posture that is located in front of the insertion rod 3 in the axial direction and an operation posture that is rotated approximately 90 ° from the insertion posture.
【００２８】手術針３０は、針先３０ａの近傍に糸掛け
部３０ｂが設けられ、この糸掛け部３０ｂから湾曲部３
０ｃを経て直線状態の基端側直線部３０ｄを有するが、
この手術針３０を保持して、回動させるために、リンク
部材３１が用いられる。このリンク部材３１は、略Ｌ字
状の部材からなり、リンク板部３１ａは挿入杆３の平坦
部３ａに配置されて、回動軸３２によりこの平坦部３ａ
に回動自在に連結されている。そして、リンク部材３１
には、リンク板部３１ａの先端部に挾持部３１ｂが垂設
されている。この挾持部３１ｂの下端部から途中位置ま
でスリット３３が形成されており、手術針３０の基端側
直線部３０ｄがこのスリット３３内に挿入されて、止め
ねじ３４により着脱可能に固定される。なお、基端側直
線部３０ｄの少なくともスリット３３への連結部は、ス
リット３３と平行な方向の面取りを行うか、または角形
とすることによって、この手術針３０をスリット３３内
に強固に固定できる。The surgical needle 30 is provided with a thread hooking portion 30b in the vicinity of the needle tip 30a, and from the thread hooking portion 30b to the bending portion 3b.
Although the base end side linear portion 30d in a linear state is provided via 0c,
A link member 31 is used to hold and rotate the surgical needle 30. The link member 31 is formed of a substantially L-shaped member, and the link plate portion 31a is arranged on the flat portion 3a of the insertion rod 3 and is rotated by the rotating shaft 32.
Is rotatably connected to. And the link member 31
A holding portion 31b is vertically provided at the tip of the link plate portion 31a. A slit 33 is formed from the lower end of the holding portion 31b to an intermediate position, and the proximal linear portion 30d of the surgical needle 30 is inserted into the slit 33 and detachably fixed by a set screw 34. In addition, at least the connecting portion of the proximal end side linear portion 30d to the slit 33 can be firmly fixed in the slit 33 by chamfering in a direction parallel to the slit 33 or by making it square. .
【００２９】そして、リンク部材３１には、ピン３５が
立設されており、このピン３５に、挿入杆３の挿通孔４
に挿通した伝達軸１２の先端が連結されている。従っ
て、図８に示した手術針３０を挿入杆３の前方に位置さ
せた挿入姿勢の状態から、把持部５の可動把持部５ｂを
回動させると、伝達軸１２が押し出される。この結果、
伝達軸１２の先端に連結したリンク部材３１のリンク板
部３１ａが回動軸３２を中心として回動して、図９に示
したように、手術針３０を挾持する挾持部３１ｂが９０
°回動して、この手術針３０は挿入杆３の軸線に対して
直交する方向に変位して作動姿勢となる。A pin 35 is erected on the link member 31, and the pin 35 has an insertion hole 4 for the insertion rod 3.
The tip end of the transmission shaft 12 inserted through is connected. Therefore, when the movable grip portion 5b of the grip portion 5 is rotated from the state of the insertion posture in which the surgical needle 30 shown in FIG. 8 is positioned in front of the insertion rod 3, the transmission shaft 12 is pushed out. As a result,
The link plate portion 31a of the link member 31 connected to the tip of the transmission shaft 12 rotates about the rotation shaft 32, and as shown in FIG. 9, the holding portion 31b that holds the surgical needle 30 is 90 degrees.
When rotated, the surgical needle 30 is displaced in the direction orthogonal to the axis of the insertion rod 3 to be in the operating posture.
【００３０】以上のように構成すると、ガイド管Ｇ２の
内径に規制されるのは、手術針３０のうち、実質的に湾
曲部３０ｃの曲率半径のみとなる。従って、湾曲部３０
ｃの曲率半径がガイド管Ｇ２の内面の半径以下であれ
ば、針先２ａや基端側直線部３０ｄの長さ等を自由に設
定できるようになる。With the above construction, the radius of curvature of the curved portion 30c of the surgical needle 30 is restricted by the inner diameter of the guide tube G2. Therefore, the bending portion 30
If the radius of curvature of c is equal to or less than the radius of the inner surface of the guide tube G2, the length of the needle tip 2a or the proximal end side linear portion 30d can be freely set.
【００３１】[0031]
【発明の効果】以上説明したように、本発明は、挿入杆
の先端に、遠隔操作により手術針が挿入杆の前方を向く
状態と、挿入杆と略直交する方向に向く状態とに回動変
位に設ける構成としたので、大型の手術針であっても、
ガイド管内に円滑に挿入でき、しかも挿入杆の軸線と直
交する方向に延在させた状態で操作できる等の効果を奏
する。As described above, according to the present invention, the distal end of the insertion rod is rotated by a remote operation such that the surgical needle faces the front of the insertion rod and the state in which the surgical needle faces in a direction substantially orthogonal to the insertion rod. Because it is configured to be installed in the displacement, even with a large surgical needle,
The effect that it can be smoothly inserted into the guide tube and that it can be operated in a state where it is extended in the direction orthogonal to the axis of the insertion rod is exhibited.
【図１】本発明の実施の一形態を示すものであって、持
針器により患部等の縫合や結紮を行う状態を示す説明図
である。FIG. 1 shows an embodiment of the present invention, and is an explanatory view showing a state in which suture or ligation of an affected area or the like is performed by a needle holder.
【図２】持針器の全体構成を示す外観図である。FIG. 2 is an external view showing an overall configuration of a needle holder.
【図３】持針器の先端部分の断面図である。FIG. 3 is a sectional view of a tip portion of a needle holder.
【図４】図３の平面図である。FIG. 4 is a plan view of FIG. 3;
【図５】図３とは異なる作動状態を示す持針器の先端部
分の左側面図である。FIG. 5 is a left side view of the tip portion of the needle holder showing an operating state different from that in FIG.
【図６】図５の平面図である。FIG. 6 is a plan view of FIG. 5;
【図７】本発明の他の実施の形態を示す持針器の先端部
分の外観図である。FIG. 7 is an external view of a tip portion of a needle holder according to another embodiment of the present invention.
【図８】図７の正面図である。FIG. 8 is a front view of FIG. 7;
【図９】図７とは異なる作動状態を示す左側面図であ
る。9 is a left side view showing an operating state different from that in FIG. 7. FIG.
１ 持針器 ２，３０ 手術針 ２ａ，３０ａ 針先 ２ｂ，３０ｂ 糸掛け部 ２ｃ，３０ｃ 湾曲部 ２ｄ，３０ｄ 基端側直線部 ３ 挿入杆 ４ 挿通路 ５ 把持部 ６，３２ 回動軸 ８ 第１のリンク板 １０ 第２のリンク板 １２ 伝達軸 １３ 作動駒 １５ レバー部 ３１ リンク部材 ３１ａ リンク板部 ３１ｂ 挾持部 1 Needle holder 2,30 Surgical needle 2a, 30a Needle tip 2b, 30b Thread hooking part 2c, 30c Curved part 2d, 30d Base end side linear part 3 Insertion rod 4 Insertion passage 5 Grasping part 6,32 Rotating shaft 8th 1 link plate 10 2nd link plate 12 transmission shaft 13 operating piece 15 lever part 31 link member 31a link plate part 31b holding part
Claims (3)
部を挿入杆の先端に回動可能に連結し、この挿入杆の基
端部には、手術針が挿入杆の前方を向く状態と、挿入杆
と略直交する方向に向く状態とに回動変位させる遠隔操
作手段を設ける構成としたことを特徴とする持針器。1. A surgical needle having a curved distal end is rotatably connected to a distal end of an insertion rod, and the surgical needle faces the front of the insertion rod at the proximal end of the insertion rod. A needle holder characterized in that it is provided with a remote operation means for rotationally displacing it into a state in which it is oriented in a direction substantially orthogonal to the insertion rod.
動軸を回動駆動する伝達軸を挿入杆に装着して、前記遠
隔操作手段はこの伝達軸を押し引き操作する操作レバー
であることを特徴とする持針器。2. An operation for connecting the surgical needle to a rotary shaft, mounting a transmission shaft for rotationally driving the rotary shaft on an insertion rod, and pushing and pulling the remote shaft by the remote operation means. A needle holder characterized by being a lever.
の動きを回転方向の動きに変換する機構を介装する構成
としたことを特徴とする請求項２記載の持針器。3. The needle holder according to claim 2, wherein a mechanism for converting axial movement into rotational movement is interposed between the transmission shaft and the rotary shaft. .
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP8097336A JPH09262242A (en) | 1996-03-28 | 1996-03-28 | Needle carrier |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP8097336A JPH09262242A (en) | 1996-03-28 | 1996-03-28 | Needle carrier |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| JPH09262242A true JPH09262242A (en) | 1997-10-07 |
Family
ID=14189652
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP8097336A Pending JPH09262242A (en) | 1996-03-28 | 1996-03-28 | Needle carrier |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JPH09262242A (en) |
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2007029722A (en) * | 2005-07-19 | 2007-02-08 | Ethicon Endo Surgery Inc | Surgical instrument with laterally moved shaft actuator coupled to pivoting articulation joint |
| JP2008142571A (en) * | 2000-09-29 | 2008-06-26 | Shoshi Sho | Suture device for endoscope |
| CN103462658A (en) * | 2012-12-05 | 2013-12-25 | 北京林业大学 | Needle holder capable of adjusting three-dimensional postures of arc-shaped suture needle |
-
1996
- 1996-03-28 JP JP8097336A patent/JPH09262242A/en active Pending
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2008142571A (en) * | 2000-09-29 | 2008-06-26 | Shoshi Sho | Suture device for endoscope |
| JP2007029722A (en) * | 2005-07-19 | 2007-02-08 | Ethicon Endo Surgery Inc | Surgical instrument with laterally moved shaft actuator coupled to pivoting articulation joint |
| CN103462658A (en) * | 2012-12-05 | 2013-12-25 | 北京林业大学 | Needle holder capable of adjusting three-dimensional postures of arc-shaped suture needle |
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