WO2017111163A1 - 内視鏡用縫合糸結紮具 - Google Patents
内視鏡用縫合糸結紮具 Download PDFInfo
- Publication number
- WO2017111163A1 WO2017111163A1 PCT/JP2016/088727 JP2016088727W WO2017111163A1 WO 2017111163 A1 WO2017111163 A1 WO 2017111163A1 JP 2016088727 W JP2016088727 W JP 2016088727W WO 2017111163 A1 WO2017111163 A1 WO 2017111163A1
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- Prior art keywords
- tube
- loop
- ligation
- suture
- locking means
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/062—Needle manipulators
- A61B17/0625—Needle manipulators the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0483—Hand-held instruments for holding sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00278—Transorgan operations, e.g. transgastric
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/0057—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
- A61B2017/00646—Type of implements
- A61B2017/00663—Type of implements the implement being a suture
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00818—Treatment of the gastro-intestinal system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
- A61B2017/0488—Instruments for applying suture clamps, clips or locks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06004—Means for attaching suture to needle
- A61B2017/06042—Means for attaching suture to needle located close to needle tip
Definitions
- the present invention relates to an endoscopic suture ligation tool for ligating a suture for suturing an incision or the like formed in a lumen wall of a digestive tract or the like in transluminal endoscopic surgery.
- Transluminal endoscopic surgery has recently attracted attention as a minimally invasive surgery that does not create wounds on the body surface.
- the endoscope is used to reach the body cavity such as the abdominal cavity from the mouth or anus via the digestive tract or via the vagina or bladder.
- body cavity such as the abdominal cavity from the mouth or anus via the digestive tract or via the vagina or bladder.
- diagnostic techniques such as intraperitoneal observation and liver biopsy.
- a suturing device for suturing an incision portion (including a perforated portion and a defect portion) formed in a lumen wall of a digestive tract or the like is described in Patent Document 1 below. Things have been proposed.
- this device one end of the suture threaded over the bifurcated distal end portion of the arm penetrating the incision portion and disposed on the outer side (body cavity side) of the lumen is arranged on one side of the incision portion.
- the other end of the suture is similarly engaged with the tip of the needle punctured from the inside of the lumen to the other lumen wall of the incision, and then the needle is removed, The other end of the suture is guided through the lumen wall to the inside of the lumen, and both ends of the suture led to the inside of the lumen are ligated while being narrowed by a ligature tool.
- both ends of a wire are connected and formed into a substantially loop shape as described in Patent Document 1 below, and an intermediate portion of the wire is substantially parallel.
- a tube is slidably fitted to the close part so as to be close to each other.
- a loop formed on one side of the tube serves as a ligation loop for ligating a suture
- a loop on the other side serves as a connection loop connected to the ligation apparatus.
- the present invention has been made in view of these points, and an object of the present invention is to provide an endoscopic suture ligation tool capable of satisfactorily ligating sutures.
- An endoscopic suture ligation tool comprises: A ligation loop through which the suture is passed; A connecting loop to which the ligating device is connected; A connecting portion connecting the ligation loop and the coupling loop; A tube externally slidably fitted to the connecting portion so that the ligating loop is pulled into the lumen by sliding to the ligating loop side; Locking means for locking a part of the ligation loop so that the ligation loop does not come out of the tube.
- the endoscope suture ligation tool according to the present invention is provided with locking means for locking in the tube so that the ligation loop does not come out of the tube. For this reason, when the connecting loop is pulled with respect to the tube so that the ligating loop is pulled into the tube, the ligating loop pulls out of the lumen of the tube too much. This prevents the suture from being ligated satisfactorily.
- connection portion may be a columnar portion in which the ligation loop is connected to one end and the connection loop is connected to the other end. The deformation of the ligation loop and the coupling loop can be suppressed, and the form can be stabilized.
- a tube is externally fitted to the mutually opposing portions in the middle of a loop member made of an endless flexible wire, and formed on one side of the tube.
- the loop to be formed can be the ligation loop
- the loop formed on the other side of the tube can be the connection loop
- the portion where the tube is externally fitted can be the connection portion.
- the locking means may include a caulking member that is externally fitted to the tube so that a part of the lumen of the tube becomes thin.
- the locking means includes a first through hole through which a part of the coupling loop is slidably penetrated, and another part of the coupling loop is slid.
- the locking means includes a plate portion having a diameter larger than the inner diameter of the tube, and one end thereof integrally connected to a part of the plate portion. An intermediate portion thereof is passed through the ligation loop, the other end is integrally connected to the other part of the plate portion, and a substantially U-shaped connection loop is inserted into the lumen of the tube. Stops can be included.
- the locking means passes through the coupling loop, substantially along a side surface on one side of the tube, passes through the ligation loop, and passes through the other side of the tube.
- a retaining ring made of an endless wire wound around the tube may be included so as to substantially follow the side surface on the side.
- the locking means may include a protrusion formed integrally with the ligation loop.
- the locking means is formed integrally with the ligation loop, and includes a large-diameter portion that is thicker than the wire diameter of the other part of the ligation loop. be able to.
- the locking means has a size larger than the inner diameter of the tube, and is provided at an end portion of the ligation loop opposite to the connection portion.
- a locking portion can be included. Since the locking portion contacts the end face of the tube without entering the lumen of the tube, it is possible to reliably prevent the ligation loop from coming out of the lumen of the tube.
- FIG. 1 is a perspective view showing a configuration of an endoscope suture ligator according to a first embodiment of the present invention.
- FIG. 2 is a cross-sectional view showing a configuration of an endoscope suture ligation tool and its vicinity during ligation according to the first embodiment of the present invention.
- FIG. 3 is a perspective view showing a configuration of an endoscope suture ligator according to a second embodiment of the present invention.
- FIG. 4 is a cross-sectional view showing a configuration of an endoscope suture ligation tool and its vicinity during ligation according to the second embodiment of the present invention.
- FIG. 5 is a perspective view showing a configuration of an endoscope suture ligator according to a third embodiment of the present invention.
- FIG. 1 is a perspective view showing a configuration of an endoscope suture ligator according to a first embodiment of the present invention.
- FIG. 2 is a cross-sectional view showing a configuration of an endoscope suture lig
- FIG. 6 is a cross-sectional view showing a configuration of an endoscope suture ligation tool and its vicinity during ligation according to a third embodiment of the present invention.
- FIG. 7 is a perspective view showing a configuration of an endoscope suture ligator according to a fourth embodiment of the present invention.
- FIG. 8 is a cross-sectional view showing a configuration of an endoscope suture ligation tool and its vicinity during ligation according to a fourth embodiment of the present invention.
- FIG. 9 is a perspective view showing a configuration of an endoscope suture ligator according to a fifth embodiment of the present invention.
- FIG. 10 is a perspective view showing a configuration of an endoscope suture ligator according to a sixth embodiment of the present invention.
- FIG. 10 is a perspective view showing a configuration of an endoscope suture ligator according to a sixth embodiment of the present invention.
- FIG. 11 is a top view which shows the structure of the suture ligation tool for endoscopes of 7th Embodiment of this invention.
- FIG. 12 is a plan view showing a state before the tube of the suture ligator for endoscope according to the seventh embodiment of the present invention is externally fitted.
- FIG. 13 is a partial cross-sectional view showing a state in which the suture is ligated by the endoscope suture ligation tool according to the seventh embodiment of the present invention.
- FIG. 14 is a diagram (part 1) illustrating the configuration of the suturing device and the suturing procedure according to the embodiment of the present invention.
- FIG. 15 is a view (No. 2) showing the suturing procedure according to the embodiment of the present invention.
- FIG. 16 is a diagram (No.
- FIG. 17 is a diagram (No. 4) illustrating the suturing procedure according to the embodiment of the present invention.
- FIG. 18 is a diagram (No. 5) illustrating the suturing procedure according to the embodiment of the present invention.
- FIG. 19 is a view (No. 6) showing a suturing procedure according to the embodiment of the present invention.
- FIG. 20 is a view (No. 7) illustrating the suturing procedure according to the embodiment of the present invention.
- FIG. 21 is a view (No. 8) showing the suturing procedure according to the embodiment of the present invention.
- FIG. 22 is a view (No. 9) showing the suturing procedure of the embodiment of the present invention.
- FIG. 23 is a view (No. 10) showing a suturing procedure according to the embodiment of the present invention.
- FIG. 24 is a view (No. 11) showing the suturing procedure of the embodiment of the present invention.
- FIG. 25 is a plan view showing the ligating apparatus according to the embodiment of the present invention.
- FIG. 1 is a perspective view showing a configuration of an endoscopic suture ligation tool according to a first embodiment of the present invention
- FIG. 2 is a cross-sectional view showing an endoscopic suture ligation tool and its vicinity at the time of ligation. is there.
- Endoscopic suture ligature tool 1A is formed in a substantially loop shape (endless shape) by joining both ends of a flexible wire to form a main body portion (loop member) 11 and an intermediate portion of main body portion 11. The parts are made close to each other so as to be substantially parallel, and a substantially cylindrical tube (clamping tube) 12 made of an elastic material is slidably fitted around the intermediate part.
- One side is a ligation loop 11a for ligating the suture thread 4 (details will be described later) with respect to the tube 12 of the main body 11, and the other side (right side in FIG. 1) is the ligation device 2 (details). It becomes the connection loop 11b connected to a later-described.
- a portion connecting the ligation loop 11a and the coupling loop 11b (a portion to which the tube 12 is externally fitted) is a connection portion in the present invention.
- the material of the main body 11 is not particularly limited as long as it has appropriate flexibility, but in this embodiment, a polyamide resin is used.
- the material of the tube 12 is not particularly limited as long as it has appropriate elasticity, but in this embodiment, a silicone elastomer is used.
- the tube 12 is slid to the ligation loop 11a side so that the ligation loop 11a is pulled into the tube 12 by using the ligation apparatus 2 in a state where both ends of the suture thread 4 are bundled and passed through the ligation loop 11a. (Or by pulling the connecting loop 11b with respect to the tube 12), the ligation loop 11a is press-fitted into the tube 12 together with the suture thread 4, and the folded portion, which is the tip of the ligation loop 11a, is inside the tube 12. The suture 4 is ligated by stopping the pulling in a state where it is pulled to the intermediate portion.
- the wire diameter of the wire constituting the main body 11 is set to 0.45 mm in this embodiment.
- the axial dimension of the tube 12 is set to 5.0 mm.
- the outer diameter of the tube 12 is set to 1.6 mm.
- the inner diameter of the tube 12 is set to 0.3 mm.
- a caulking member (annular member) 13 that is externally fitted to the tube 12 is provided so that a narrow-diameter portion 12 a that is thinner than the diameter of the lumen is formed in a part of the lumen of the tube 12.
- a substantially annular O-ring or C-ring made of metal having an outer diameter that is the same as or thinner than the outer diameter of the tube 12 is used. It can be installed by compression and caulking.
- the inner diameter of the small diameter portion 12a is set to 0.15 mm.
- the folded portion (tip portion) of the ligation loop 11a of the main body portion 11 has a size larger than that of the intermediate portion of the main body portion 11 arranged substantially parallel to each other, and the suture thread 4 passes inside the folded portion at the time of ligation. Therefore, when the tube 12 is slid to the ligation loop 11 a side and the ligation loop 11 a is pulled into the tube 12 together with the suture thread 4, the folded portion is brought into the lumen of the tube 12 by the caulking member 13. The small diameter portion 12a formed is interfered and locked. As a result, it is possible to prevent or suppress the ligation loop 11 a from being pulled too much into the tube 12 and the ligation loop 11 a from coming out of the tube 12.
- the ligating apparatus 2 includes a connecting hook (wing member) 21, a sheath (tube) 22, a drive wire (operation wire) 23, a base side lock member 25, and a sheath side lock member 26.
- An operation unit having a lock mechanism, a base unit 27, and a slider unit 28 is roughly provided.
- the sheath 22 is made of a flexible hollow tube.
- a simple tube made of resin or the like may be used, but in this embodiment, a coil tube is used.
- a coil tube As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used.
- a wire tube may be used as the sheath 22.
- the wire tube is a tube made of a hollow stranded wire formed by spirally twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like.
- a substantially cylindrical tip member 24 is integrally fixed to the distal end of the coil tube of the sheath 22, and the distal end surface of the tip member 24 abuts against the tube 12 of the ligature tool 1 ⁇ / b> A.
- the tip member 24 may not be provided from the viewpoint of cost reduction, the number of parts, and the like.
- the distal end surface of the coil tube serves as a contact portion that contacts the tube 12 of the ligature tool 1A. .
- the drive wire 23 is made of a flexible wire, and a wire rope is used in this embodiment.
- the wire rope is a rope made of a stranded wire formed by twisting a plurality of wires (cables) made of, for example, metal (stainless steel) or the like.
- a wire made of a single wire may be used as the drive wire 23.
- the connecting hook 21 is integrally attached to the tip (distal end) of the drive wire 23.
- the connecting hook 21 has a pair of arms 21a, 21a arranged so as to open in a substantially C shape toward the tip, and claws formed by bending the tips of the arms 21a, 21a inward.
- the base portions of the arm portions 21a and 21a are integrated with each other and are integrally fixed to the distal end (distal end) of the drive wire 23 by welding or the like.
- connection hook 21 slides the drive wire 23 toward the distal end side with respect to the sheath 22 (that is, slides the sheath 22 toward the proximal end side with respect to the drive wire 23), thereby distant the sheath 22. On the contrary, it slides so that the drive wire 23 is drawn from the distal end side with respect to the sheath 22 (that is, the sheath 22 is driven to the drive wire). 23), the sheath 22 is buried in the distal end of the sheath 22 and closed.
- connection hook 21 one made of a metal such as stainless steel can be used.
- the proximal end (base end portion) of the sheath 22 through which the drive wire 23 is inserted is connected to the distal end of the base portion 27 via a luer lock mechanism having a base side lock member 25 and a sheath side lock member 26. It is fixed.
- a slider portion 28 is slidably attached to the base portion 27, and the proximal end of the drive wire 23 passes through the respective through holes of the sheath side lock member 26 and the base side lock member 25, and the slider portion 28, and is detachably fixed to the slider portion 28 via a lock screw 29.
- the connecting hook 21 provided at the distal end of the drive wire 23 is pushed out from the distal end of the sheath 22, and is substantially due to its own elasticity. Open the legs in a C shape.
- the connection hook 21 provided at the distal end of the drive wire 23 is buried from the distal end of the sheath 22. Housed inside the sheath 22.
- the suturing device 3 includes a pair of front and rear arms 31 and 32 and an arm moving unit 33 that operates the pair of front and rear arms 31 and 32.
- the suturing device 3 is used by being fixed to the endoscope by attaching the arm moving means 33 to the outside of the endoscope shaft (not shown) along the shaft. While confirming the movement of the pair of front and rear arms 31 and 32 using an endoscope camera (not shown), the incision formed in the digestive tract such as the stomach is sutured using the pair of front and rear arms 31 and 32. Can do.
- the arm moving means 33 is a long member extending in the axial direction, and has three tubes (or two tubes) having flexibility enough to bend following the bending of the shaft of an endoscope (not shown). Tube and wire). That is, the arm moving means 33 includes a case tube 33a, a rear arm moving tube 33b, and a front arm moving tube 33c (or a front arm moving wire).
- the case tube 33a is a hollow tube-like member that is fixed to an endoscope shaft (not shown) by a fixture (not shown), and the case tube 33a is not particularly limited.
- polyethylene or vinyl chloride is used. It can be made of any material.
- the rear arm moving tube 33b is a hollow tube-like member inserted into the case tube 33a, and is provided in the case tube 33a so as to be movable along the axial direction and rotatable about the axis. Yes.
- the rear arm 32 is connected to the tip of the rear arm moving tube 33b.
- the rear arm moving tube 33b is not particularly limited, but can be formed of, for example, a resin tube such as polyethylene or vinyl chloride, a wire tube made of a metal wire, or the like.
- the rear arm moving tube 33b is rotated to swing the rear arm 32, when the rear arm moving tube 33b is rotated on the hand side, the rear arm 32 is swung as much as the rotation amount.
- the wire tube is formed by a plurality of metal wires arranged so that the axial directions are parallel to each other and coaxially arranged to form the rear arm moving tube 33b, the above-described function can be realized. Can do.
- the front arm moving tube 33c is a tube inserted into the rear arm moving tube 33b, and is provided in the rear arm moving tube 33b so as to be movable along the axial direction and rotatable about the axis. Yes.
- the front arm 31 is connected to the tip of the front arm moving tube 33c.
- the front arm moving tube 33c is not particularly limited, but it is preferable to use a material that has a rigidity of about 10 mm at the tip and is softer on the proximal side than the tip but does not contract or expand in the forward / backward direction.
- the front arm moving tube 33c a rod-shaped portion having a high rigidity formed of metal or the like at the tip of about 10 mm and a portion other than that portion formed of a wire or the like.
- the front arm moving tube 33c is rotated to swing the front arm 31, when the front arm moving tube 33c is rotated on the hand side, the rear arm 32 is swung as much as the amount of rotation.
- Those that can be used are preferred.
- the proximal end of the front arm moving tube 33c and the proximal end of the rear arm moving tube 33b extend to the vicinity of an operation unit that operates a shaft of an endoscope (not shown). Therefore, by manipulating the base ends of the tubes 33b and 33c, the movements (advancement and retreat along the axial direction, rotation around the axis) of the tubes 33b and 33c can be manipulated.
- the pair of front and rear arms 31, 32 can be moved closer to and away from each other. Further, if the front arm moving tube 33c is rotated around its axis, the front arm 31 can be rotated around the axis of the front arm moving tube 33c, and the rear arm moving tube 33b can be rotated around the axis. For example, the rear arm 32 can be rotated around the axis of the rear arm moving tube 33b.
- the outer diameter of the arm moving means 33 (that is, the outer diameter of the case tube 33a) is such that an endoscope (not shown) to which the suturing device 3 of this embodiment is attached is inserted into the digestive tract (or the overtube).
- the outer diameter of the arm moving means 33 is preferably about 11 to 13 mm, more preferably about 11 to 12 mm, which is the sum of the outer diameters of the arm moving means 33 and the shaft of an endoscope (not shown).
- the rear arm 32 includes a strip member 32a formed in a substantially strip shape, and the rear arm 32 is connected to the tip of a rear arm moving tube 33b.
- the central axis of the rear arm moving tube 33b at the connecting portion of the rear arm moving tube 33b and the rear arm 32 is simply referred to as the central axis of the tip of the rear arm moving tube 33b.
- the rear arm 32 is formed with a through hole (not shown) penetrating vertically, so that the central axis of the tip of the rear arm moving tube 33b is substantially coaxial with the central axis of the through hole. It is arranged.
- a needle-like member 34 is provided at the tip of the strip member 32a of the rear arm 32.
- the needle-shaped member 34 has a large diameter portion 34a, a medium diameter portion 34b, a small diameter portion 34c, and a twisting portion 34d.
- the edge portion 34d is formed so that the outer diameter of the base end thereof is larger than the outer diameter of the distal end of the small diameter portion 34c, and a step is formed at the connecting portion with the small diameter portion 34c.
- the needle-like member 34 is attached to the strip member 32a of the rear arm 32 so that the tip thereof faces the front arm 31 and the center axis thereof is substantially parallel to the center axis of the tip of the rear arm moving tube 33b. It has been.
- the needle-shaped member 34 is moved while maintaining the central axis of the needle-shaped member 34 parallel to the central axis of the tip of the rear arm moving tube 33b.
- the rear arm moving tube 33b can be swung around the central axis at the tip.
- the needle-like member 34 has such a length and strength that it can pierce and pierce the object to be sutured, and can be pulled out of the object by moving the object in the reverse direction from the state of passing through the object.
- the material, length, and shaft diameter are not particularly limited.
- the length may be a length that can penetrate the stomach wall, and the material is preferably made of metal in terms of strength.
- the length of the needle-shaped member 34 is preferably about 7 to 20 mm, and more preferably about 7 to 10 mm.
- the shaft diameter of the large diameter portion 34a of the needle-like member 34 is about 1.5 to 3.0 mm
- the shaft diameter of the medium diameter portion 34b is about 1.0 to 2.0 mm
- the shaft diameter of the small diameter portion 34c is 0.00.
- the shaft diameter of the twisted portion 34d is preferably about 0.6 to 1.5 mm at the maximum.
- the above-described suture ligation tool 1A is attached to the large-diameter portion 34a of the needle-like member 34.
- the large-diameter portion 34a of the needle-like member 34 is obtained by sliding the tube 12 to the ligation loop 11a side in a state where the large-diameter portion 34a of the needle-like member 34 penetrates the ligation loop 11a. It is attached to.
- a bifurcated portion 31s formed in a substantially U shape (may be V-shaped or U-shaped) is provided at the front end portion of the front arm 31, and extends across the bifurcated portion 31s.
- the suture thread 4 is attached.
- Engagement members 4 a and 4 b formed in an annular shape are attached to both ends of the suture thread 4.
- a through hole (not shown) penetrating over the front surface (the lower surface in FIG. 13) and the rear surface (the upper surface in FIG. 13) is formed at each distal end portion of the bifurcated portion 31s of the front arm 31.
- a receiving space (not shown) in which the engaging members 4a and 4b can be engaged is formed on the rear surface side.
- the accommodation space has a diameter slightly larger than that of the through hole, and the engagement members 4a and 4b are arranged so that the through holes through which the engaging members 4a and 4b pass are substantially concentric with the through hole of the bifurcated portion 31s.
- the diameter is set such that the inner wall can be detachably engaged.
- the through-holes of the engagement members 4a and 4b can be inserted through the thread-like portion 34d of the needle-like member 34. However, when the screw-like-shaped portion 34d is completely inserted through the through-hole, the needle-like member 34 is engaged with the engagement member. 4a, 4b has a structure that does not fall out. Specifically, each of the engaging members 4a and 4b has an inner diameter smaller than the outer diameter of the handle portion 34d of the needle member 34, but the tip of the small diameter portion 34c of the needle member 34 (that is, The connecting portion is formed so as to be larger than the shaft diameter.
- a concave suture accommodating portion (not shown) that opens to the front surface (lower surface in FIG. 13) is provided at the center of the bifurcated portion 31s, and the suture 4 arranged over the bifurcated portion 31s is provided. The intermediate portion is accommodated in the suture accommodating portion.
- an endoscope shaft (not shown) to which the suturing device 3 is attached is inserted into the stomach and placed near the incision SH to be sutured. From this state, the front arm moving tube 33c of the arm moving means 33 is operated to insert only the front arm 31 into the incision SH.
- the rear arm moving tube 33b and the front arm moving tube 33c of the arm moving means 33 are operated so that one mouth edge portion Sa of the incision SH is moved by the one bifurcated portion 31s of the front arm 31 and the needle-like member 34.
- the front arm 31 and the rear arm 32 are arranged so as to be sandwiched.
- the front arm 31 is arranged such that the other fork portion Sb of the incision SH is sandwiched between the other bifurcated portion 31 s of the front arm 31 and the needle-like member 34. And the rear arm 32 is disposed.
- the pair of engaging members 4a and 4b, to which both ends of the suture thread 4 are fixed, are both engaged with a single needle-like member 34, and the needle-like member 34 (that is, stomach A ring is formed that penetrates the first perforation from the inside to the stomach and returns from the outer surface of the stomach to the needle-like member 34 (that is, the stomach) through the second perforation.
- the arm moving means 33 is operated to move the rear arm 31 (bifurcated portion 31s) into the stomach through the incision SH.
- the needle-like member 34 moves away from the incision SH, and both ends of the suture 4 move away from the incision SH.
- the part that penetrates the first perforation and the part that penetrates the second perforation are drawn together, and the end surfaces of the pair of mouth edges Sa and Sb of the incision SH are brought into contact with each other and joined.
- the suture 4 is subsequently ligated.
- the ligating apparatus 2 shown in FIG. 25 is used.
- the sheath 22 of the ligation apparatus 2 described above is inserted through a treatment instrument guide tube of an endoscope, and the distal end of the sheath 22 is attached to the large diameter portion 34a of the needle-like member 34. It is located in the vicinity of the connecting loop 11b.
- the slider portion 28 is slid toward the proximal end side with respect to the base portion 27, and the connecting hook 21 provided at the distal end of the drive wire 23 is buried from the distal end of the sheath 22. In a state of being accommodated in the sheath 22.
- the connecting loop 11b of the ligating tool 1A is brought close to a position where the pair of arms 21a, 21a of the connecting hook 21 can be gripped.
- the sheath 22 moves to the distal end side, and the sheath 22 moves far away.
- the pair of arm portions 21a, 21a of the connecting hook 21 protruding from the rear end are closed while being pulled into the inside.
- the connecting loop 11b is gripped by the pair of arm portions 21a, 21a (claw portions 21b, 21b) of the connecting hook 21 without shifting the position of the ligating tool 1A.
- the connecting loop 11b gripped by the pair of arm portions 21a and 21a is drawn inward from the distal end of the sheath 22.
- the distal end surface of the sheath 22 abuts on the end surface of the tube 12.
- the distal end portion of the sheath 22 to which the ligature tool 1A is connected is moved to the incision portion SH side (downward in FIG. 21), and the ligation loop 11a of the ligature tool 1A is moved.
- the both ends of the suture thread 4 are inserted inside.
- the suture thread 4 is squeezed.
- the base portion 27 is further slid to the distal end side with respect to the slider portion 28, the connecting loop 11b is further drawn into the sheath 22.
- the tube 12 is slid to the ligation loop 11a side by the distal end surface of the sheath 22, and both ends of the suture thread 4 are bundled.
- the sheath 22 moves to the proximal end side by sliding the base portion 27 toward the proximal end side with respect to the slider portion 28 while keeping the position of the slider portion 28 from changing. Then, the connecting hook 21 and the connecting loop 11b protrude (expose) from the distal end of the sheath 22, and the pair of arm portions 21a and 21a of the connecting hook 21 are opened by their own elasticity, and the connecting loop 11b. As shown in FIG. 23, the ligation apparatus 2 is separated from the ligation tool 1A in the ligated state.
- the suture thread 4 between the ligature tool 1A and the suturing device 3 is cut with an endoscopic scissors forceps called a loop cutter, and the ligature tool 1A.
- a series of procedures is completed by separating the suture device 3 from the suture device 3 and, if necessary, cutting and collecting the connecting loop 11b of the ligated tool 1A with a loop cutter or the like.
- a caulking member 13 that is externally fitted to the tube 12 is provided so that a part of the lumen of the tube 12 is narrowed. For this reason, the operator tries to ligate the suture thread 4 without loosening, so that the ligation loop 11 a is pulled too much into the tube 12, the ligation loop 11 a comes out of the tube 12, and the main body 11 is detached from the tube 12. This prevents the suture 4 from being ligated.
- the ligation tool 1 is entirely pulled into the tube 12 side of the ligation loop 11a, and the tube 12 outside the tube 12 on the side where the ligation loop 11a is located. Is provided with a locking means such that a part of the ligation loop 11a is locked in the tube 12 in a state in which the ligation loop 11a does not remain, so that the extra suture 4 can be removed during the ligation operation. It becomes easy to draw in the tube 12 and ligate the suture thread 4 without loosening.
- FIG. 3 is a perspective view showing a configuration of an endoscopic suture ligation tool according to a second embodiment of the present invention
- FIG. 4 is a cross-sectional view showing an endoscopic suture ligation tool and its vicinity at the time of ligation. is there.
- the same number is attached
- the tube 12 prevents the distal end portion (folded portion) of the ligation loop 11a from coming out of the lumen of the tube 12 when the suture 4 is ligated.
- a stopper 14 made of resin or the like is provided as locking means for locking inside.
- the stopper 14 includes a disc portion (plate portion) 14a formed to have a diameter larger than the inner diameter of the tube 12, and the disc portion so as to protrude toward the tube 12 at a substantially central portion of the disc portion 14a. 14a, and a protrusion 14b that is inserted into the lumen of the tube 12.
- the disk portion 14a is formed with a through hole 14c through which a part of the connecting loop 11b is slidably passed and a through hole 14d through which another part of the connecting loop 11b is slidably passed. ing.
- the connecting loop 11b of the main body portion (loop member) 11 is disposed through the through holes 14c and 14d of the disc portion 14a, the disc portion 14a has an outer peripheral surface.
- a pair of split grooves extending from the through holes 14c and 14d are formed.
- the connecting loop 11b can be fitted while the split groove portion is pushed open.
- the wire constituting the main body portion 11 may be inserted into the through holes 14c and 14d of the disc portion 14a and then coupled in a loop shape.
- the outer diameter of the disc part 14a is set to 4.0 mm in this embodiment.
- the thickness of the disc portion 14a is set to 0.5 mm.
- the inner diameters of the through holes 14c and 14d are set to be slightly larger than the wire diameter of the main body portion 11, and are set to 0.5 mm in the present embodiment.
- the length (height) of the protruding portion 14b is set to 2.0 mm.
- the outer diameter of the protrusion 14b is set to 1.5 mm.
- the distal end of the sheath 22 of the ligation apparatus 2 is configured such that the disk portion 14a is sandwiched between the ligation apparatus 2 and the tube 12 while the coupling loop 11b of the ligation tool 1B is gripped by the coupling hook 21 of the ligation apparatus 2.
- the end is abutted against the disc part 14a.
- the operator tries to ligate the suture thread 4 without loosening, so that the ligation loop 11a (main body part 11) is pulled too much into the tube 12 and the ligation loop 11a is surely pulled out of the tube 12. Can be prevented.
- FIG. 5 is a perspective view showing a configuration of an endoscopic suture ligation tool according to a third embodiment of the present invention
- FIG. 6 is a cross-sectional view showing an endoscopic suture ligation tool and its vicinity at the time of ligation. is there.
- the same number is attached
- the tube 12 prevents the distal end portion (folded portion) of the ligation loop 11a from coming out of the lumen of the tube 12 when the suture 4 is ligated.
- a stopper 15 is provided as locking means for locking inside.
- the stopper 15 includes a disk portion (plate portion) 15a formed with a diameter larger than the inner diameter of the tube 12, and a substantially U-shaped connection loop 15b.
- One end of the connection loop 15b is integrally connected to a part of the disk part 15a (a position slightly decentered from the center part), and the other end is connected to another part of the disk part 15a (slightly from the center part). It is integrally connected to an eccentric position that is substantially 180 degrees opposite to the one end.
- the outer diameter of the disc portion 15a is set to 4.00 mm.
- the thickness of the disc portion 15a is set to 0.50 mm.
- the length (height) of the connection loop 15b is set to 1.75 mm.
- the outer width of the connection loop 15b is set to 1.5 mm.
- the inner width of the connection loop 15b is set to 0.50 mm.
- the material of the stopper 15 is not particularly limited as long as at least the disc portion 15a is formed of a material having appropriate rigidity, but in this embodiment, the stopper 15 is entirely formed of stainless steel. is there.
- connection loop 15b of the stopper 15 When the ligation apparatus 2 is used for ligation, when the tube 12 is slid toward the ligation loop 11a and the ligation loop 11a is pulled into the tube 12 together with the suture thread 4, the connection loop 15b of the stopper 15 is It enters into the tube 12, and the disk portion 15 a interferes with the end surface of the tube 12 and is locked. Accordingly, it is possible to reliably prevent the surgeon from trying to ligate the suture thread 4 without loosening the ligation loop 11a with respect to the tube 12 and the ligation loop 11a to come out of the tube 12. it can.
- FIG. 7 is a perspective view showing a configuration of an endoscopic suture ligation tool according to a fourth embodiment of the present invention
- FIG. 8 is a cross-sectional view showing an endoscopic suture ligation tool and its vicinity at the time of ligation. is there.
- the same number is attached
- the tube 12 prevents the distal end portion (folded portion) of the ligation loop 11a from coming out of the lumen of the tube 12 when the suture 4 is ligated.
- a retaining ring 16 is provided as locking means for locking inside.
- the retaining ring 16 is made of a wire (thread) formed in a loop shape (endless shape), passes through the coupling loop 11b, substantially along the side surface on one side of the tube 12, passes through the ligation loop 11a, and passes through the tube 12
- This is a member made of an endless wire wound around the tube 12 so as to substantially follow the side surface on the other side.
- nylon can be used as the material of the retaining ring 16.
- the diameter of the strand which comprises the retaining ring 16 is set to 0.3 mm in this embodiment.
- the length (circumferential length) of the retaining ring 16 is set to 15 mm in this embodiment.
- the ligation device 2 When the ligation device 2 is used for ligation, when the tube 12 is slid to the ligation loop 11a side and the ligation loop 11a is pulled into the tube 12 together with the suture thread 4, a part of the retaining ring 16 is also formed therewith. It is pulled into the tube 12 and is locked by the tension of the retaining ring 16 at a position defined by the relationship with the length (circumferential length) of the retaining ring 16. Accordingly, it is possible to reliably prevent the surgeon from trying to ligate the suture thread 4 without loosening the ligation loop 11a with respect to the tube 12 and the ligation loop 11a to come out of the tube 12. it can.
- FIG. 9 is a perspective view showing a configuration of an endoscope suture ligator according to a fifth embodiment of the present invention.
- the same number is attached
- the tube 12 prevents the distal end portion (folded portion) of the ligation loop 11a from coming out of the lumen of the tube 12 when the suture 4 is ligated.
- a locking means for locking inside a plurality of projections 17 formed integrally with the ligation loop 11a of the main body (loop member) 11 are provided.
- the position where the protrusion 17 is provided is preferably in the vicinity of the folded portion (tip portion) of the ligation loop 11a.
- the height of the protrusion 17 is set to 0.2 mm in this embodiment.
- the number of the protrusions 17 is not particularly limited and may be one or more.
- FIG. 10 is a perspective view showing a configuration of an endoscope suture ligator according to a sixth embodiment of the present invention.
- the same number is attached
- the tube 12 prevents the distal end portion (folded portion) of the ligation loop 11a from coming out of the lumen of the tube 12 when the suture 4 is ligated.
- a large-diameter portion 18 is formed integrally with the ligation loop 11a of the main body 11 and is thicker than the wire diameter of the other part of the ligation loop 11a. .
- the position where the large-diameter portion 18 is provided is preferably the folded portion (tip portion) of the ligation loop 11a and the vicinity thereof.
- the outer diameter of the large diameter portion 18 is set to 0.6 mm.
- FIG. 11 is a plan view showing a configuration of an endoscope suture ligator according to an embodiment of the present invention
- FIG. 12 is a plan view showing a state before the tube of the endoscope suture ligator is similarly fitted externally
- FIG. 13 is a partial cross-sectional view showing a state in which the ligatures are ligated by the endoscope suture ligation tool.
- the same number is attached
- the endoscope suture ligature tool 1G includes a main body 11 and a tube 12.
- the main body 11 connects a ligation loop 11a through which a suture thread 4 to be described later is passed, a coupling loop 11b to which a ligation device 2 to be described later is coupled, and the ligation loop 11a and the coupling loop 11b.
- a connecting portion 11c is a columnar (or columnar) portion (or member) in which one end of the connecting portion 11c and one end of the connecting loop 11b are integrally connected to the other end.
- the tube 12 is slidably fitted to the connection portion 11c.
- the tube 12 is made of a substantially cylindrical member (clamping tube) made of an elastic material. By sliding the tube 12 from the connecting portion 11c toward the ligation loop 11a, the ligation loop 11a is drawn into the lumen. It has become.
- the ligation loop 11a is used as a locking means for locking a part of the ligation loop 11a so that the ligation loop 11a is not drawn too far into the lumen of the tube 12 and comes out of the tube 12. 19b).
- the material for the ligation loop 11a and the coupling loop 11b is not particularly limited as long as it has appropriate flexibility, and for example, polyamide resin, polypropylene resin, and styrene elastomer can be used.
- the entire body portion 11 including the ligation loop 11a, the coupling loop 11b, the connection portion 11c, and the locking portion 19 is made of the same material.
- the material of the tube 12 is not particularly limited as long as it has appropriate elasticity. For example, a silicone elastomer can be used.
- the tube 12 is slid to the ligation loop 11a side so that the ligation loop 11a is pulled into the tube 12 by using the ligation apparatus 2 in a state where both ends of the suture thread 4 are bundled and passed through the ligation loop 11a. (Or pulling the connecting loop 11b with respect to the tube 12).
- the ligation loop 11a and the neck portion 19b of the locking portion 19 are press-fitted into the tube 12 together with the suture thread 4, and the end portion on the opposite side of the connection portion 11c of the ligation loop 11a ( The portion provided with the locking portion 19) is drawn to the middle portion in the tube 12, and the suture 4 is ligated.
- the tube 12 When the ligation loop 11 a is press-fitted into the tube 12 together with the suture thread 4, the tube 12 expands to the outside by the pressure from the neck portion 19 b of the locking portion 19 and the suture thread 4, thereby restoring the tube 12.
- the suture 4, the ligation loop 11 a and the neck portion 19 b of the locking portion 19 are firmly held in the tube 12 by force (clamping force).
- the wire diameter of the wire constituting the ligation loop 11a and the coupling loop 11b can be set in a range of 0.3 to 0.8 mm, for example.
- the dimension of the connecting portion 11c in the axial direction can be set in the range of 3 to 20 mm, for example.
- the axial dimension of the tube 12 can be set in the range of 3 to 10 mm, for example.
- the outer diameter of the tube 12 can be set, for example, in the range of 1 to 2 mm.
- the inner diameter of the tube 12 can be set in the range of 0.1 to 0.8 mm, for example.
- the distal end portion (end portion opposite to the connection portion 11 c) of the ligation loop 11 a passes through the lumen of the tube 12 and does not come out of the lumen.
- a locking portion 19 is provided as a locking means for locking in the tube 12.
- the locking part 19 includes a head part 19a and a neck part 19b.
- the neck portion 19b is a substantially cylindrical portion, and is set to a diameter that can be inserted or press-fitted into the lumen of the tube 12 (a diameter that is the same as or slightly larger than the lumen of the tube 12).
- the head portion 19a is a substantially disc-shaped portion, and is set to a diameter (larger than the diameter of the head portion 19b) that cannot be inserted into or pressed into the lumen of the tube 12.
- the head portion 19a is not limited to a substantially disc shape, and may have another shape.
- the head portion 19 a only needs to have a size that part or all of the head portion 19 a is larger than the inner diameter of the tube 12 so that the head portion 19 a cannot be inserted into or pressed into the lumen of the tube 12.
- the outer diameter of the head 19a can be set in the range of 0.8 to 2.0 mm, for example.
- the length (dimension) of the neck portion 19b in the axial direction can be set in the range of 1 to 5 mm, for example.
- the diameter of the neck portion 19b can be set in the range of 0.6 to 1.6 mm, for example.
- the ligation loop 11a, the coupling loop 11b, the connection portion 11c, and the locking portion 19 (the head portion 19a and the neck portion 19b) constituting the main body portion 11 are formed integrally with each other after being partially or entirely formed. However, from the viewpoint of ease of production, cost reduction, etc., it is preferable to use the same material and to integrally mold all together by injection molding.
- connection portion 11c is a substantially cylindrical portion or member, and the ligation loop 11a is provided at one end and the connection loop 11b is provided at the other end.
- the present invention is not limited to this.
- the tube 12 is externally fitted to the mutually opposing portions in the middle of the loop member made of an endless flexible wire, and one of the tubes 12 is The loop formed on the side may be the ligation loop 11a, the loop formed on the other side of the tube 12 may be the coupling loop 11b, and the portion where the tube 12 is externally fitted may be the connection portion 11c.
- a sufficient loop shape (a circular shape having sufficient space on the inside or this) May not be able to be secured, and it may be difficult to perform installation work or connection work.
- the configuration of the seventh embodiment (the configuration in which the connecting portion 11c is a substantially cylindrical portion or member, the ligation loop 11a is provided at one end, and the coupling loop 11b is provided at the other end. ) Is excellent in the stability of the form (shape) of the ligation loop 11a and the coupling loop 11b, so that the ligation tool 1G is attached to the needle-like member 34 (see FIG. 14) of the suturing device 3 described above, or ligation.
- a sufficient loop shape (a circular shape having a sufficient space on the inside or a shape close to this) can be ensured, and an attaching operation and a connecting operation can be easily performed.
- the seventh embodiment described above as a locking means for locking in the tube 12 so that the distal end portion (folded portion) of the ligation loop 11a does not come out of the tube 12 during the ligation work of the suture thread 4,
- the locking portion 19 (head portion 19a, neck portion 19b) is provided at the end of the ligation loop 11a opposite to the connection portion 11c. For this reason, the operator tries to ligate the suture thread 4 without loosening, so that the ligation loop 11 a is pulled too much into the tube 12, the ligation loop 11 a comes out of the tube 12, and the main body 11 is detached from the tube 12. This prevents the suture 4 from being ligated.
- the ligation tool 1G is pulled into the entire tube 12 side of the ligation loop 11a, and outside the tube 12 on the side where the ligation loop 11a of the tube 12 is located.
- the extra suture thread 4 is removed from the tube 12 during ligation work. It becomes easy to ligate the suture thread 4 without loosening by being pulled in.
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Abstract
Description
縫合糸が通される結紮用ループと、
結紮装置が連結される連結用ループと、
前記結紮用ループと前記連結用ループとを接続する接続部と、
前記結紮用ループ側にスライドさせることにより、該結紮用ループがその内腔に引き込まれるように、前記接続部にスライド可能に外嵌されたチューブと、
前記結紮用ループが前記チューブ内から抜け出さないように、該結紮用ループの一部を係止する係止手段と、を有する。
(内視鏡用縫合糸結紮具)
図1は本発明の第1実施形態に係る内視鏡用縫合糸結紮具の構成を示す斜視図、図2は同じく結紮時における内視鏡用縫合糸結紮具およびその近傍を示す断面図である。内視鏡用縫合糸結紮具1Aは、可撓性を有する線材の両端を結合して略ループ状(無端状)に成形して本体部(ループ部材)11とするとともに、本体部11の中間部分を略平行するように互いに近接させて、該中間部分に、弾性を有する素材からなる略円筒状のチューブ(締め付けチューブ)12をスライド可能に外嵌して構成されている。
結紮装置2は、図25に示されているように、連結フック(羽部材)21、シース(チューブ)22、駆動ワイヤ(操作ワイヤ)23、ベース側ロック部材25およびシース側ロック部材26を有するロック機構、ベース部27およびスライダ部28を有する操作部を概略備えて構成されている。
縫合装置3は、図14に示されているように、前後一対のアーム31,32と、この前後一対のアーム31,32を作動させるアーム移動手段33とを備えている。この縫合装置3は、アーム移動手段33を不図示の内視鏡のシャフトの外側に該シャフトに沿って取り付けることによって、内視鏡に固定して使用される。不図示の内視鏡のカメラによって前後一対のアーム31,32の動きを確認しながら、前後一対のアーム31,32を使用して、胃などの消化管に形成された切開部を縫合することができる。
1.0~2.0mm程度、小径部34cの軸径は0.5~1mm程度、やじり状部34dの軸径は最大径で0.6~1.5mm程度が好ましい。
以下、上述した縫合糸結紮具1A、結紮装置2、縫合装置3および縫合糸4を使用した切開部の縫合作業を、図14~図24を参照して説明する。なお、以下では、胃壁に形成された切開部を縫合する場合を例として説明する。
図3は本発明の第2実施形態に係る内視鏡用縫合糸結紮具の構成を示す斜視図、図4は同じく結紮時における内視鏡用縫合糸結紮具およびその近傍を示す断面図である。なお、上述した第1実施形態と実質的に同一の構成部分については同一の番号を付し、その説明の一部または全部を省略する。
図5は本発明の第3実施形態に係る内視鏡用縫合糸結紮具の構成を示す斜視図、図6は同じく結紮時における内視鏡用縫合糸結紮具およびその近傍を示す断面図である。なお、上述した第1実施形態と実質的に同一の構成部分については同一の番号を付し、その説明の一部または全部を省略する。
図7は本発明の第4実施形態に係る内視鏡用縫合糸結紮具の構成を示す斜視図、図8は同じく結紮時における内視鏡用縫合糸結紮具およびその近傍を示す断面図である。なお、上述した第1実施形態と実質的に同一の構成部分については同一の番号を付し、その説明の一部または全部を省略する。
図9は本発明の第5実施形態に係る内視鏡用縫合糸結紮具の構成を示す斜視図である。なお、上述した第1実施形態と実質的に同一の構成部分については同一の番号を付し、その説明の一部または全部を省略する。
図10は本発明の第6実施形態に係る内視鏡用縫合糸結紮具の構成を示す斜視図である。なお、上述した第1実施形態と実質的に同一の構成部分については同一の番号を付し、その説明の一部または全部を省略する。
図11は本発明の実施形態に係る内視鏡用縫合糸結紮具の構成を示す平面図、図12は同じく内視鏡用縫合糸結紮具のチューブを外嵌する前の状態を示す平面図、図13は同じく内視鏡用縫合糸結紮具によって結紮糸を結紮した状態を示す一部断面図である。なお、上述した第1実施形態と実質的に同じ構成部分または同じ機能を果たす部分には同一の番号を付している。
11…本体部(ループ部材)
11a…結紮用ループ
11b…連結用ループ
11c…接続部
12…チューブ
13…かしめ部材(係止手段)
14…止め具(係止手段)
14a…円板部(板部)
14b…突起部
14c、14d…貫通孔
15…止め具(係止手段)
15a…円板部(板部)
15b…接続用ループ
16…止め輪(係止手段)
17…突起部(係止手段)
18…太径部(係止手段)
19…係止部(係止手段)
19a…頭部
19b…首部
2…結紮装置
21…連結フック
21a…アーム部
21b…爪部
22…シース
23…駆動ワイヤ
25…ベース側ロック部材
26…シース側ロック部材
27…ベース部
28…スライダ部
3…縫合装置
31…前側アーム
31s…二股部
32…後側アーム
33…アーム移動手段
33a…ケースチューブ
33b…後側アーム移動チューブ
33c…前側アーム移動チューブ
34…針状部材
34a…大径部
34d…やじり状部
4…縫合糸
4a,4b…係合部材
SH…切開部
Sa,Sb…口縁部
Claims (10)
- 縫合糸が通される結紮用ループと、
結紮装置が連結される連結用ループと、
前記結紮用ループと前記連結用ループとを接続する接続部と、
前記結紮用ループ側にスライドさせることにより、該結紮用ループがその内腔に引き込まれるように、前記接続部にスライド可能に外嵌されたチューブと、
前記結紮用ループが前記チューブ内から抜け出さないように、該結紮用ループの一部を係止する係止手段と、を有する内視鏡用縫合糸結紮具。 - 前記接続部は、その一端に前記結紮用ループが他端に前記連結用ループが接続された柱状の部位である請求項1に記載の内視鏡用縫合糸結紮具。
- 無端状の可撓性を有する線材からなるループ部材の中間の互いに対向する部分にチューブを外嵌して、該チューブの一方の側に形成されるループを前記結紮用ループとし、該チューブの他方の側に形成されるループを前記連結用ループとし、該チューブが外嵌された部分を前記接続部とした請求項1に記載の内視鏡用縫合糸結紮具。
- 前記係止手段は、前記チューブの内腔の一部が細くなるように該チューブに外嵌されたかしめ部材を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結紮具。
- 前記係止手段は、前記連結用ループの一部が摺動可能に貫通する第1貫通孔および該連結用ループの他の一部が摺動可能に貫通する第2貫通孔を有する板部と、前記板部の略中央部分であって前記チューブ側に突出するように該板部に一体的に形成され、前記チューブの内腔に挿入される突起部とを有する止め具を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結紮具。
- 前記係止手段は、前記チューブの内径よりも大径に形成された板部と、その一端が該板部の一部に一体的に接続され、その中間部分が前記結紮用ループに通され、その他端が該板部の他の一部に一体的に接続され、前記チューブの内腔に挿入される略U字状の接続用ループを有する止め具を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結紮具。
- 前記係止手段は、前記連結用ループを通り、前記チューブの一方の側の側面に略沿い、前記結紮用ループを通り、前記チューブの他方の側の側面に略沿うように、前記チューブに周回された無端状の線材からなる止め輪を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結紮具。
- 前記係止手段は、前記結紮用ループに一体的に形成された突起部を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結紮具。
- 前記係止手段は、前記結紮用ループに一体的に形成され、前記結紮用ループの他の部分の線径よりも太い太径部を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結具。
- 前記係止手段は、前記チューブの内径よりも大きい寸法を有し、前記結紮用ループの前記接続部とは反対側の端部に設けられた係止部を含む請求項1~3のいずれかに記載の内視鏡用縫合糸結紮具。
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WO2019172430A1 (ja) * | 2018-03-09 | 2019-09-12 | 日本ゼオン株式会社 | 縫合装置 |
WO2019172429A1 (ja) * | 2018-03-09 | 2019-09-12 | 日本ゼオン株式会社 | 縫合装置 |
JP2020163011A (ja) * | 2019-03-29 | 2020-10-08 | 日本ゼオン株式会社 | 内視鏡用縫合糸結紮具 |
JP7504412B2 (ja) | 2020-10-16 | 2024-06-24 | 邁磊醫療器材股▲分▼有限公司 | 縫合に使用可能なノッティング構造 |
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