WO2021176635A1 - Endoscopic suturing method, endoscope cap, and suturing system - Google Patents

Endoscopic suturing method, endoscope cap, and suturing system Download PDF

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Publication number
WO2021176635A1
WO2021176635A1 PCT/JP2020/009321 JP2020009321W WO2021176635A1 WO 2021176635 A1 WO2021176635 A1 WO 2021176635A1 JP 2020009321 W JP2020009321 W JP 2020009321W WO 2021176635 A1 WO2021176635 A1 WO 2021176635A1
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WO
WIPO (PCT)
Prior art keywords
needle
tissue
endoscope
suture
holding
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PCT/JP2020/009321
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French (fr)
Japanese (ja)
Inventor
麗沙子 堀越
啓太 小澤
岡田　勉
智文 片山
森下　寛之
Original Assignee
オリンパス株式会社
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Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2020/009321 priority Critical patent/WO2021176635A1/en
Publication of WO2021176635A1 publication Critical patent/WO2021176635A1/en

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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

Definitions

  • the present invention relates to an endoscopic suturing method, an endoscopic cap and a suturing system.
  • the tissue is pulled by the suture needle in a state where the suture needle is passed through the tissue and the needle tip is projected from the tissue, and the suture needle receives a force from the tissue in the direction of pulling the needle tip back into the tissue. There is. Therefore, when the needle holder that grips the suture needle is released in this state, the needle tip portion may be pulled back into the tissue by the elastic force of the tissue and buried in the tissue.
  • the present invention has been made in view of the above circumstances, and provides an endoscopic suturing method, an endoscopic cap, and a suturing system capable of efficiently suturing tissues under an endoscope.
  • the purpose is to do.
  • a suture needle is passed through a tissue in the body, the tip of the suture needle is projected from the tissue, and the tip of the suture is projected from the tissue by an endoscope cap attached to the endoscope.
  • the needle tip protruding from the tissue is held by the endoscope cap. Therefore, even when the suture needle is not held by a holder or other instrument, the needle tip is held in a position protruding from the tissue without being pulled back into the tissue by the force from the tissue. As a result, after the needle tip is projected from the tissue, the suture needle can be smoothly held by the holder without causing an extra step such as passing the suture needle through the tissue again, and the suture needle can be smoothly held under the endoscope. The suturing work of the tissue can be performed efficiently.
  • holding the suture needle may be to hold an exposed portion of the suture needle located between the tissue and the endoscope cap. According to this configuration, the exposed portion of the suture needle can be reliably held by the holder. The entire suture needle can then be pulled out of the tissue by manipulating the retainer that holds the exposed portion.
  • the suture needle is further included to be pulled out from the tissue by the bending operation of the curved portion of the endoscope while the needle tip portion is held by the endoscope cap. After withdrawing from the tissue, the exposed portion may be retained. According to this configuration, by bending the curved portion while the needle tip portion is held by the endoscope cap, the needle tip portion further protrudes from the tissue and the exposed portion is increased. As a result, the needle tip portion can be more reliably prevented from being pulled back into the tissue, and the exposed portion can be more easily held by the holder.
  • passing the suture needle through the tissue is performed by operating the holder that holds the suture needle, and the needle tip is held by the endoscope cap while being held.
  • the tool may be separated from the suture needle and the suture needle may be pulled out from the tissue by the bending motion of the curved portion while pressing the tissue by the holder.
  • the suture needle can be more easily removed from the tissue by using a holder that does not need to hold the suture needle as a tool for holding the tissue.
  • the tissue in the body may be a tissue of a luminal organ.
  • a second aspect of the present invention is a fixing element fixed to the tip of the endoscope and a position in front of the tip of the endoscope in a state where the fixing element is fixed to the tip of the endoscope.
  • a needle holding element capable of holding and releasing the needle tip portion of the suture needle is provided, and the needle tip portion is held by the needle holding element when the needle tip portion is pierced by the needle holding element. It is an endoscope cap.
  • the endoscope cap of this embodiment is attached to the tip of the endoscope by fixing the fixing element to the tip of the endoscope. With the endoscope cap attached to the tip of the endoscope, the needle holding element is placed in front of the tip of the endoscope.
  • the needle tip protruding from the tissue is pierced into the needle holding element and held by the needle holding element to efficiently suture the tissue under the endoscope. You can do it well.
  • the needle holding element may be formed of an elastic material, and the needle tip portion may be held by the needle holding element by friction between the needle tip portion and the needle holding element. ..
  • the needle tip portion can be easily pierced into the needle holding element formed of the elastic material.
  • the inner surface of the hole formed in the needle holding element by the needle tip piercing the needle holding element is brought into close contact with the outer surface of the needle tip by the elastic restoring force of the needle holding element, and the inner surface of the hole and the needle tip The needle tip is held by the needle holding element by friction with the outer surface. In this way, the needle tip portion can be easily and stably held by the needle holding element.
  • the needle holding element may have a holding surface, and the needle tip portion may be pierced at an arbitrary position on the holding surface. According to this configuration, in order to hold the needle tip portion on the needle holding element, high positioning accuracy of the needle tip portion with respect to the needle holding element is not required, and the needle tip portion can be easily held by the needle holding element. ..
  • the holding surfaces may intersect in the circumferential direction around the longitudinal axis of the endoscope.
  • the trajectory of the needle tip protruding from the tissue is an arc shape extending in the circumferential direction parallel to or substantially parallel to the longitudinal axis of the endoscope.
  • the holding surface can be arranged at a position on the trajectory of the needle tip portion in a direction intersecting the trajectory, and the needle tip portion protruding from the tissue can be reliably pierced into the holding surface.
  • a third aspect of the present invention includes an endoscope cap according to any one of the above, a holder that is movable relative to the endoscope cap and is capable of holding and releasing a suture needle. It is a suturing system including.
  • the suture needle is passed through the tissue to protrude the needle tip portion from the tissue, and the needle tip portion is pierced into the needle holding element of the endoscope cap to pierce the needle holding element. Hold by.
  • the holder is separated from the suture needle while the needle tip is held by the needle holding element.
  • the needle tip is held at a position protruding from the tissue without being pulled back into the tissue by the force from the tissue. Therefore, after the needle tip is projected from the tissue, the next step can be performed without causing an extra step such as passing the suture needle through the tissue again, and the suturing work of the tissue under the endoscope is efficient. You can do it well.
  • FIG. 1 It is a block diagram of the suture system which concerns on one Embodiment of this invention.
  • FIG. It is a perspective view of an example of an endoscope cap which concerns on one Embodiment of this invention.
  • FIG. 1 It is a figure which shows an example of the endoscopic image explaining the 1st step of the endoscopic suturing method which concerns on one Embodiment of this invention.
  • FIG. 1 It is a figure which shows an example of the endoscopic image explaining the 2nd step of the endoscopic suturing method which concerns on one Embodiment of this invention.
  • the endoscopic suture method according to the present embodiment is a method of suturing the tissue S in the body endoscopically using a suture needle 11 and a suture thread 12, as shown in FIGS. 3A to 3H. ..
  • the endoscope and the holder 3 for holding the suture needle 11 are inserted into the body, and the holder 3 is operated while observing the tissue S in the body with the endoscope to obtain the tissue S.
  • Tissue S is, for example, tissue of a luminal organ such as the esophagus, stomach, small intestine or large intestine.
  • FIG. 1 shows an endoscopic cap 1 and a suturing system 100 used in an endoscopic suturing method.
  • the suture system 100 includes an endoscope cap 1 attached to the tip 2a of the endoscope 2 and a holder 3 for holding the suture needle 11.
  • the endoscope 2 is, for example, a flexible endoscope, which penetrates the tip portion 2a, the curved portion 2b provided on the proximal end side of the tip portion 2a, and the inside of the endoscope 2 along the longitudinal direction for endoscopy. It has a treatment tool channel 2c that opens to the tip surface of the mirror 2.
  • the endoscope 2 may be a general-purpose endoscope prepared separately from the suturing system 100, or may be provided as a part of the suturing system 100.
  • the endoscope cap 1 includes a cap body 4 having a mounting portion 4a and a cap portion 4b.
  • the mounting portion (fixing element) 4a has a cylindrical shape that is mounted on the outer peripheral surface of the tip end portion 2a of the endoscope 2, and constitutes a base end side portion of the cap body 4.
  • the cap portion 4b protrudes from at least a part of the annular tip surface of the mounting portion 4a along the longitudinal direction of the mounting portion 4a, and constitutes the tip end side portion of the cap body 4.
  • the material of the cap body 4 may be an elastomer such as acrylic elastomer or styrene elastomer, or may be plastic such as polycarbonate or polyvinyl chloride.
  • the material of the mounting portion 4a and the material of the cap portion 4b may be the same as each other or may be different from each other.
  • the mounting portion 4a has an inner diameter equal to or substantially equal to the outer diameter of the tip portion 2a, and the tip portion 2a fits into the mounting portion 4a.
  • the mounting portion 4a is fixed to the tip portion 2a by friction between the outer peripheral surface of the tip portion 2a and the inner peripheral surface of the mounting portion 4a.
  • the cap portion 4b projects from the tip of the endoscope 2 along the longitudinal direction of the endoscope 2. An appropriate distance is secured between the tip of the endoscope 2 and the tissue S by such a cap portion 4b, and the tissue S can be observed well by the endoscope 2.
  • the suturing work of the tissue S is performed in the lower part of the field of view of the endoscope 2.
  • the portion of the cap portion 4b arranged below the field of view of the endoscope 2 is open.
  • the cap portion 4b of FIGS. 1 to 3H has a substantially semi-cylindrical shape arranged on the upper side of the field of view.
  • the retainer 3 is an endoscopic instrument that is inserted into the body via the treatment instrument channel 2c and can hold and release the suture needle 11.
  • the holder 3 includes a long flexible tube portion 3a that can be inserted into the treatment tool channel 2c and a pair of gripping members 3b that are connected to the tip of the flexible tube portion 3a and can be opened and closed with each other. , 3c and a needle holder.
  • the needle holder 3 can grip the suture needle 11 between the pair of gripping members 3b, 3c by closing the pair of gripping members 3b, 3c, and the suture needle 11 by opening the pair of gripping members 3b, 3c. Can be released. Further, the flexible tube portion 3a in the treatment tool channel 2c can move in the longitudinal direction and rotate around the longitudinal axis with respect to the endoscope 2, and the needle holder 3 has the endoscope 2 and the tip portion. It is movable relative to the endoscope cap 1 attached to 2a.
  • the suture needle 11 is a substantially arc-shaped curved needle that curves in one direction.
  • a tip 11b is formed at the tip of the suture needle 11, and the tip of the suture thread 12 is connected to the base end of the suture needle 11.
  • the suture needle 11 is gripped between the pair of gripping members 3b and 3c so as to be arranged along a plane intersecting the longitudinal axis of the flexible tube portion 3a.
  • the operator sutures in the field of view of the endoscope 2 by rotating the proximal end portion of the flexible tube portion 3a extending outward from the proximal end opening of the treatment tool channel 2c around the longitudinal axis of the flexible tube portion 3a.
  • the needle tip portion 11a which is the tip end portion of the needle 11, can be moved along the arcuate trajectory A as shown in FIG. 3A, and the suture needle 11 can be passed through the tissue S first from the needle tip portion 11a.
  • the endoscope cap 1 is further provided with a needle holding element 5 provided on the cap body 4 and capable of holding and releasing the needle tip portion 11a protruding from the tissue S.
  • the needle holding element 5 is provided on the cap portion 4b, and is located in front of the tip of the endoscope 2 in a state where the mounting portion 4a is fixed to the tip portion 2a.
  • the needle holding element 5 is a member formed of an elastic material and projecting inward from the inner peripheral surface 4c of the tip of the cap portion 4b toward the inside of the cap portion 4b.
  • the needle holding element 5 has a holding surface 5a that extends from the tip of the cap portion 4b toward the proximal end side and is pierced by the needle tip portion 11a protruding from the tissue S.
  • the holding surface 5a projects from the inner peripheral surface 4c toward the inside of the cap portion 4b and intersects the circumferential direction around the longitudinal axis of the endoscope 2.
  • Such a holding surface 5a is located on the orbit A of the needle tip portion 11a protruding from the tissue S, intersects the orbit A, and is preferably orthogonal or substantially orthogonal to the orbit A. As a result, the needle tip portion 11a moving along the trajectory A can be easily pierced into the holding surface 5a.
  • the holding surface 5a may be a flat surface or a curved surface.
  • the needle tip portion 11a protruding from the structure S and piercing the needle holding surface 5a is held by the needle holding element 5 by friction between the needle tip portion 11a and the needle holding element 5. Specifically, the needle tip portion 11a pierces the needle holding element 5 from the holding surface 5a to open a hole in the needle holding element 5. The inner surface of the hole is brought into close contact with the outer surface of the needle tip portion 11a by the elastic restoring force of the needle holding element 5, so that friction is generated between the outer surface of the needle tip portion 11a and the inner surface of the hole. After the needle tip portion 11a is held by the needle holding element 5, the needle tip portion 11a is pulled out from the needle holding element 5 by the reverse rotation of the flexible tube portion 3a, so that the needle tip portion 11a is released from the needle holding element 5. NS.
  • FIGS. 4A and 4B illustrate an example of the angle of the holding surface 5a with respect to the track A.
  • the arrow indicates the needle stick direction of the needle tip portion 11a with respect to the holding surface 5a.
  • the needle stick direction coincides with the tangent line of the trajectory A at the intersection of the trajectory A and the holding surface 5a.
  • the holding surface 5a is orthogonal to the needle piercing direction of the needle tip portion 11a or is oriented in the needle piercing direction.
  • the needle is inclined forward in the needle stick direction.
  • FIG. 4B when the holding surface 5a is inclined to the rear side of the needle sticking direction with respect to the needle sticking direction, the needle tip portion 11a advancing along the trajectory A is on the holding surface 5a. It becomes slippery.
  • the holding surface 5a has a uniform hardness, and the needle tip portion 11a can be pierced at an arbitrary position on the holding surface 5a. Since the needle holding element 5 is located inside the cap portion 4b, the needle holding element 5 can hold the needle tip portion 11a stuck in the holding surface 5a within the field of view of the endoscope 2, and the needle tip portion 11a can be held. Can be clearly observed.
  • a hole or notch having a diameter smaller than that of the needle tip portion 11a may be formed in the holding surface 5a so that the needle tip portion 11a can be easily pierced by the holding surface 5a.
  • the width of the hole or notch is widened by inserting the needle tip 11a into the hole or notch, but the inner surface of the hole or notch is brought into close contact with the surface of the needle tip 11a due to the elastic restoring force, and the needle tip 11a is held by friction.
  • the material of the needle holding element 5 may be the same as or different from the material of the cap portion 4b.
  • the cap portion 4b and the needle holding element 5 are manufactured by integral molding, or the needle is held by a partial deformation of the cap portion 4b. Element 5 is formed.
  • the material of the needle holding element 5 is different from the material of the cap portion 4b, for example, the cap portion 4b and the needle holding element 5 are manufactured by two-color molding, or the cap portion 4b and the needle holding are manufactured separately. The elements 5 are joined to each other.
  • the endoscopic suture method includes a first step of passing the suture needle 11 through the tissue S and projecting the needle tip portion 11a from the tissue S, and a needle tip portion 11a protruding from the tissue S. From the tissue S by the second step of holding the needle tip portion 11a by the endoscope cap 1 attached to the tip portion 2a of the endoscope 2 and the bending operation of the curved portion 2b while holding the needle tip portion 11a by the endoscope cap 1. The third step of pulling out the suture needle 11 and the fourth step of holding the suture needle 11 by the needle device 3 while holding the needle tip portion 11a by the endoscope cap 1 are included.
  • the operator pierces the tissue S with the needle tip portion 11a by rotating the needle holder 3 holding the base end portion of the suture needle 11, and inserts the suture needle 11 into the tissue S. Pass through organization S.
  • the operator further rotates the needle holder 3 to further move the needle tip portion 11a protruding from the tissue S along the trajectory A.
  • the needle tip portion 11a is pierced into the holding surface 5a on the track A. As a result, the needle tip portion 11a is held by the needle holding element 5.
  • a step of predicting the position where the needle tip portion 11a protrudes from the tissue S and moving the needle holding element 5 to the predicted position may be performed prior to inserting the suture needle 11 into the tissue S.
  • the movement of the needle holding element 5 to the predicted position is performed by, for example, the advance / retreat of the endoscope 2 or the bending motion of the bending portion 2b.
  • the operator separates the needle holder 3 from the base end portion of the suture needle 11 and moves the needle holder 3 into the tissue S in a direction corresponding to the needle stick direction of the suture needle 11.
  • the curved portion 2b is curved. In the case of the example of FIG. 3D, since the suture needle 11 is pierced into the tissue S from right to left, the curved portion 2b is curved to the left.
  • the tip portion 2a of the endoscope 2 and the needle holding element 5 move to the left side with respect to the tissue S, and the suture needle 11 in which the needle tip portion 11a is held by the needle holding element 5 also Moving to the left, at least a portion of the suture needle 11 including the needle tip 11a is pulled out of the tissue S.
  • the tissue S may move together with the suture needle 11.
  • the needle holder 3 since the needle holder 3 is not used for the operation of the suture needle 11, as shown by the alternate long and short dash line in FIG. 3D, the needle holder 3 holds the tissue S and bends the curved portion 2b.
  • the suture needle 11 may be pulled out from S.
  • the tissue S is prevented from being pulled together with the suture needle 11, and the suture needle 11 can be pulled out from the tissue S more easily.
  • the operator holds the exposed portion of the suture needle 11 arranged between the tissue S and the needle holding element 5 and exposed from the tissue S by the needle holder 3. Hold.
  • the third step is not always necessary. For example, after the second step, when the exposed portion of the suture needle 11 is sufficiently long, that is, when the suture needle 11 is held by the needle holding element 5, the distance between the needle holding element 5 and the tissue S is If sufficient, the exposed portion can be easily held by the needle holder 3 without performing the third step. In such a case, the third step may be omitted.
  • the needle tip portion 11a is pulled out from the needle holding element 5 by rotating the needle holder 3 in the direction opposite to the rotation of the needle holder 3 when passing the suture needle 11 through the tissue S in the first step. ..
  • the needle holder 3 may be rotated in the opposite direction while pressing the tissue S with the needle holder 3.
  • the needle tip 11a pierces the holding surface 5a while pulling the tissue S with the suture needle 11 as shown in FIG. 3G by the operation of the needle holder 3, for example, by advancing the needle holder 3.
  • the suture needle 11 is moved to a position where the suture needle 11 is not present, and the entire suture needle 11 is pulled out from the tissue S by the rotation of the needle holder 3.
  • FIG. 3H the entire suture needle 11 can be completely removed from the tissue S.
  • the method of pulling out the suture needle 11 from the tissue S is not limited to the above method.
  • the tissue S is moved forward or backward by the endoscope 2.
  • the suture needle 11 may be pulled out from the tissue S while slightly twisting.
  • the suture needle 11 is completely pulled out from the tissue S by the bending operation of the curved portion 2b while holding the tissue S with the needle holder 3, and then.
  • the needle tip portion 11a may be pulled out from the needle holding element 5 by rotating the needle holder 3 in the opposite direction. In this case, it is not necessary to move the suture needle 11 to a position where the needle tip portion 11a does not pierce the holding surface 5a due to the advancement of the needle holder 3.
  • the viscoelastic tissue S is pulled by the suture needle 11, and the suture needle 11 exerts a force in the direction of pulling the needle tip portion 11a back into the tissue S. Receive from.
  • the needle tip portion 11a is released from the needle holder 3 holding the base end portion of the suture needle 11 in a free state, the needle tip portion 11a is pulled back into the tissue S by the elastic restoring force of the tissue S and enters the tissue S. It may be buried.
  • the elastic restoring force is strong, it is difficult to keep the needle tip portion 11a in a free state protruding from the tissue S.
  • the suture needle 11 If the needle tip 11a is buried in the tissue S, the suture needle 11 must be passed through the tissue S again. Therefore, in order to efficiently proceed with the suturing work of the tissue S, it is important to prevent the needle tip portion 11a from being buried in the tissue S when the needle holder 3 is separated from the base end portion of the suture needle 11. ..
  • the needle tip portion 11a protruding from the tissue S is held by the needle holding element 5 of the endoscope cap 1, so that when the needle holder 3 is separated from the base end portion of the suture needle 11.
  • the needle tip portion 11a is prevented from being pulled back into the tissue S.
  • the suturing work of the tissue S under the endoscope can be efficiently performed.
  • the holding surface 5a of the needle holding element 5 is located on the trajectory A of the needle tip portion 11a and intersects the trajectory A. Therefore, the needle tip portion 11a can be easily pierced into the holding surface 5a at an angle perpendicular to or close to the holding surface 5a. If the holding surface 5a is arranged in the direction along the trajectory A, the needle tip portion 11a may slip along the holding surface 5a, making it difficult to pierce the holding surface 5a. Further, since the needle holding element 5 is arranged inside the cap body 4, the needle tip portion 11a stuck in the needle holding element 5 is located inside the cap body 4, and the needle tip portion 11a is located outside the cap body 4. Is prevented from sticking out. Therefore, the needle tip portion 11a stuck in the needle holding element 5 can be clearly observed by the endoscope 2.
  • the needle holding element 5 is provided on the endoscope cap 1, in order to hold the needle tip portion 11a protruding from the tissue S, other than the needle holder 3 No need for endoscopic instruments. That is, the endoscope 2 having only one treatment tool channel 2c can be used, or one of the two treatment tool channels can be used for other purposes.
  • the needle holding element 5 is formed of an elastic material, but the material of the needle holding element 5 is not limited to this, and the needle tip portion 11a is pierced into the needle holding element 5. It may be any other material that can be used.
  • the needle holding element 5 is projected from the inner peripheral surface of the substantially semi-cylindrical cap portion 4b, but the form of the cap portion 4b and the needle holding element 5 is not limited to this. It can be changed as appropriate.
  • 5A and 5B show other configuration examples of the cap portion 4b and the needle holding element 5.
  • the cap portion 4b has a cylindrical shape extending over the entire circumference.
  • the needle holding element 5 is fixed to the inner surface of a thin protruding piece 4d that protrudes along the longitudinal direction of the cap portion 4b from a part of the annular tip surface of the cap portion 4b.
  • the cap portion 4b has a substantially semi-cylindrical shape arranged on the left side of the field of view of the endoscope 2.
  • the needle holding element 5 is formed by bending the tip end portion of the cap portion 4b.
  • the needle holding element 5 is a member that protrudes inward from the inner peripheral surface of the cap portion 4b, but instead, as shown in FIGS. 6A to 6C, on the track A.
  • a part of the cap portion 4b located at may be used as the needle holding element 5.
  • a part of the inner peripheral surface 4c of the cap portion 4b is the holding surface 5a.
  • the upper portion of the cap portion 4b functions as the needle holding element 5.
  • the cap portion 4b of FIG. 6A has a substantially semi-cylindrical shape arranged above the field of view of the endoscope.
  • the tip surface of the cap portion 4b in FIG. 6B is inclined with respect to the longitudinal axis of the cap portion 4b.
  • a hole or a notch 5b into which the needle tip portion 11a is inserted may be formed in a part of the cap portion 4b that functions as the needle holding element 5.
  • the suture needle 11 is used as the suture needle 11
  • a suture needle of a type other than the curved needle may be used.
  • the form of the holder for holding the suture needle may be changed according to the type of the suture needle.
  • 7A-7E show other examples of the suture needle 11 and the holder 3.
  • the suture needle 11 is a straight needle.
  • the holder 3 of FIGS. 7A to 7E holds the suture needle 11 in the direction along the longitudinal direction of the endoscope cap 1 with the needle tip portion 11a facing the tip surface of the endoscope cap 1, and holds the suture needle 11.
  • the needle holding element 5 is provided at the tip of the endoscope cap 1 and is arranged on the moving trajectory of the needle tip portion 11a.
  • the needle tip portion 11a is held by the needle holding element 5 to prevent the needle tip portion 11a from being pulled back into the tissue S when the suture tool 3 is separated from the suture needle 11. be able to.
  • FIG. 7D after the entire suture needle 11 is pulled out from the tissue S, the base end portion of the suture needle 11 can be held again by the suture tool 3 as shown in FIG. 7E.
  • the retainer 3 is an endoscopic instrument that is inserted into the body via the treatment tool channel 2c, but is inserted into the body via the outside of the endoscope 2. It may be an instrument.
  • the endoscopic suturing method of the present invention is not limited to the suturing work in the lumen, and the suture needle 11 is projected from the lumen into the abdominal cavity, or the suture needle is projected from the abdominal cavity into the lumen. It can also be applied to suturing work.

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Abstract

This endoscopic suturing method comprises passing a suture needle (11) through a tissue (S) and causing a needle tip portion (11a) of the suture needle (11) to protrude from the tissue (S), holding the needle tip portion (11a) protruded from the tissue (S) with an endoscope cap attached to an endoscope, and holding the suture needle (11) with a holding tool (3) while holding the needle tip portion (11a) with the endoscope cap.

Description

内視鏡下縫合方法、内視鏡キャップおよび縫合システムEndoscopic suturing method, endoscopic cap and suturing system
　本発明は、内視鏡下縫合方法、内視鏡キャップおよび縫合システムに関するものである。 The present invention relates to an endoscopic suturing method, an endoscopic cap and a suturing system.
　従来、内視鏡下で持針器を使用して体内の組織を縫合する内視鏡下縫合方法が知られている（例えば、特許文献１参照。）。 Conventionally, an endoscopic suturing method for suturing tissues in the body using a needle holder under an endoscope is known (see, for example, Patent Document 1).
国際公開第２０１７／１４５３３５号International Publication No. 2017/145335
　縫合針を組織に通して針先部を組織から突出させた状態において、組織は縫合針によって引っ張られており、縫合針は、組織の内部へ針先部を引き戻す方向の力を組織から受けている。したがって、この状態で縫合針を把持する持針器を離したときに、組織の弾性力によって針先部が組織の中に引き戻されて組織内に埋もれてしまう可能性が有る。 The tissue is pulled by the suture needle in a state where the suture needle is passed through the tissue and the needle tip is projected from the tissue, and the suture needle receives a force from the tissue in the direction of pulling the needle tip back into the tissue. There is. Therefore, when the needle holder that grips the suture needle is released in this state, the needle tip portion may be pulled back into the tissue by the elastic force of the tissue and buried in the tissue.
　本発明は、上述した事情に鑑みてなされたものであって、内視鏡下での組織の縫合作業を効率良く行うことができる内視鏡下縫合方法、内視鏡キャップおよび縫合システムを提供することを目的とする。 The present invention has been made in view of the above circumstances, and provides an endoscopic suturing method, an endoscopic cap, and a suturing system capable of efficiently suturing tissues under an endoscope. The purpose is to do.
　上記目的を達成するため、本発明は以下の手段を提供する。
　本発明の第１の態様は、縫合針を体内の組織に通し、前記縫合針の針先部を前記組織から突き出すことと、内視鏡に取り付けられた内視鏡キャップによって、前記組織から突き出した前記針先部を保持することと、前記針先部を前記内視鏡キャップによって保持しながら保持具によって前記縫合針を保持することと、を含む内視鏡下縫合方法である。 In order to achieve the above object, the present invention provides the following means.
In the first aspect of the present invention, a suture needle is passed through a tissue in the body, the tip of the suture needle is projected from the tissue, and the tip of the suture is projected from the tissue by an endoscope cap attached to the endoscope. This is an endoscopic suturing method including holding the needle tip portion and holding the suture needle by a holder while holding the needle tip portion by the endoscopic cap.
　本態様によれば、組織から突き出した針先部が内視鏡キャップによって保持される。したがって、縫合針が保持具または他の器具によって保持されていない状態においても、針先部は、組織からの力によって組織内に引き戻されることなく、組織から突き出した位置に保持される。これにより、針先部を組織から突き出した後、縫合針を組織に再度通す等の余計な工程を生じることなく、保持具による縫合針の保持を円滑に行うことができ、内視鏡下での組織の縫合作業を効率良く行うことができる。 According to this aspect, the needle tip protruding from the tissue is held by the endoscope cap. Therefore, even when the suture needle is not held by a holder or other instrument, the needle tip is held in a position protruding from the tissue without being pulled back into the tissue by the force from the tissue. As a result, after the needle tip is projected from the tissue, the suture needle can be smoothly held by the holder without causing an extra step such as passing the suture needle through the tissue again, and the suture needle can be smoothly held under the endoscope. The suturing work of the tissue can be performed efficiently.
　上記第１の態様において、前記縫合針を保持することが、前記組織と前記内視鏡キャップとの間に位置する前記縫合針の露出部分を保持することであってもよい。
　この構成によれば、縫合針の露出部分を保持具によって確実に保持することができる。そして、露出部分を保持する保持具の操作によって、縫合針の全体を組織から引き出すことができる。 In the first aspect, holding the suture needle may be to hold an exposed portion of the suture needle located between the tissue and the endoscope cap.
According to this configuration, the exposed portion of the suture needle can be reliably held by the holder. The entire suture needle can then be pulled out of the tissue by manipulating the retainer that holds the exposed portion.
　上記第１の態様において、前記針先部を前記内視鏡キャップによって保持しながら、前記内視鏡の湾曲部の湾曲動作によって前記組織から前記縫合針を引き出すことをさらに含み、前記縫合針を前記組織から引き出した後に、前記露出部分を保持することが行われてもよい。
　この構成によれば、針先部が内視鏡キャップによって保持された状態で湾曲部を湾曲させることによって、針先部が組織からさらに突き出し露出部分が増大する。これにより、針先部が組織内に引き戻されることをさらに確実に防止し、露出部分を保持具でより容易に保持することができる。 In the first aspect, the suture needle is further included to be pulled out from the tissue by the bending operation of the curved portion of the endoscope while the needle tip portion is held by the endoscope cap. After withdrawing from the tissue, the exposed portion may be retained.
According to this configuration, by bending the curved portion while the needle tip portion is held by the endoscope cap, the needle tip portion further protrudes from the tissue and the exposed portion is increased. As a result, the needle tip portion can be more reliably prevented from being pulled back into the tissue, and the exposed portion can be more easily held by the holder.
　上記第１の態様において、前記縫合針を前記組織に通すことが、前記縫合針を保持する前記保持具の操作によって行われ、前記針先部を前記内視鏡キャップによって保持しながら、前記保持具を前記縫合針から離し、前記湾曲部の湾曲動作によって前記組織から前記縫合針を引き出すことが、前記保持具によって前記組織を押さえながら行われてもよい。
　この構成によれば、湾曲部の湾曲動作によって縫合針を組織から引き出すときに、縫合針を保持する必要が無い保持具を組織を押さえる道具として利用することによって、縫合針をより容易に組織から引き出すことができる。
　上記第１の態様において、前記体内の組織が管腔器官の組織であってもよい。 In the first aspect, passing the suture needle through the tissue is performed by operating the holder that holds the suture needle, and the needle tip is held by the endoscope cap while being held. The tool may be separated from the suture needle and the suture needle may be pulled out from the tissue by the bending motion of the curved portion while pressing the tissue by the holder.
According to this configuration, when the suture needle is pulled out from the tissue by the bending motion of the curved portion, the suture needle can be more easily removed from the tissue by using a holder that does not need to hold the suture needle as a tool for holding the tissue. Can be pulled out.
In the first aspect, the tissue in the body may be a tissue of a luminal organ.
　本発明の第２の態様は、内視鏡の先端部に固定される固定要素と、該固定要素が前記内視鏡の先端部に固定された状態において前記内視鏡の先端の前方に位置し、縫合針の針先部を保持および解放可能な針保持要素と、を備え、該針保持要素に前記針先部が刺さることによって該針先部が前記針保持要素に保持される、内視鏡キャップである。 A second aspect of the present invention is a fixing element fixed to the tip of the endoscope and a position in front of the tip of the endoscope in a state where the fixing element is fixed to the tip of the endoscope. A needle holding element capable of holding and releasing the needle tip portion of the suture needle is provided, and the needle tip portion is held by the needle holding element when the needle tip portion is pierced by the needle holding element. It is an endoscope cap.
　本態様の内視鏡キャップは、固定要素を内視鏡の先端部に固定することによって、内視鏡の先端部に取り付けられる。内視鏡キャップが内視鏡の先端部に取り付けられた状態において、内視鏡の先端の前方に針保持要素が配置される。上記第１の態様に係る内視鏡下縫合方法において、組織から突き出した針先部を針保持要素に刺して針保持要素によって保持することで、内視鏡下での組織の縫合作業を効率良く行うことができる。 The endoscope cap of this embodiment is attached to the tip of the endoscope by fixing the fixing element to the tip of the endoscope. With the endoscope cap attached to the tip of the endoscope, the needle holding element is placed in front of the tip of the endoscope. In the endoscopic suturing method according to the first aspect, the needle tip protruding from the tissue is pierced into the needle holding element and held by the needle holding element to efficiently suture the tissue under the endoscope. You can do it well.
　上記第２の態様において、前記針保持要素が、弾性材料から形成され、前記針先部が、該針先部と前記針保持要素との間の摩擦によって該針保持要素に保持されてもよい。
　この構成によれば、弾性材料から形成される針保持要素に針先部を容易に刺すことができる。また、針先部が針保持要素に刺さることによって針保持要素に形成された穴の内面は、針保持要素の弾性復元力によって針先部の外面と密着し、穴の内面と針先部の外面との間の摩擦によって針先部が針保持要素に保持される。このように、針先部を容易にかつ安定的に針保持要素に保持させることができる。 In the second aspect, the needle holding element may be formed of an elastic material, and the needle tip portion may be held by the needle holding element by friction between the needle tip portion and the needle holding element. ..
According to this configuration, the needle tip portion can be easily pierced into the needle holding element formed of the elastic material. Further, the inner surface of the hole formed in the needle holding element by the needle tip piercing the needle holding element is brought into close contact with the outer surface of the needle tip by the elastic restoring force of the needle holding element, and the inner surface of the hole and the needle tip The needle tip is held by the needle holding element by friction with the outer surface. In this way, the needle tip portion can be easily and stably held by the needle holding element.
　上記第２の態様において、前記針保持要素が、保持面を有し、該保持面の任意の位置に前記針先部が刺さることができてもよい。
　この構成によれば、針先部を針保持要素に保持させるために、針保持要素に対する針先部の高い位置決め精度が不要であり、針先部を針保持要素に容易に保持させることができる。 In the second aspect, the needle holding element may have a holding surface, and the needle tip portion may be pierced at an arbitrary position on the holding surface.
According to this configuration, in order to hold the needle tip portion on the needle holding element, high positioning accuracy of the needle tip portion with respect to the needle holding element is not required, and the needle tip portion can be easily held by the needle holding element. ..
　上記第２の態様において、前記保持面が、前記内視鏡の長手軸回りの周方向に交差してもよい。
　縫合針が曲針である場合、組織から突き出す針先部の軌道は、内視鏡の長手軸に平行または略平行な軸回りの周方向に延びる円弧状となる。上記構成によれば、保持面を、針先部の軌道上の位置に軌道と交差する方向に配置することができ、組織から突き出す針先部を保持面に確実に刺すことができる。 In the second aspect, the holding surfaces may intersect in the circumferential direction around the longitudinal axis of the endoscope.
When the suture needle is a curved needle, the trajectory of the needle tip protruding from the tissue is an arc shape extending in the circumferential direction parallel to or substantially parallel to the longitudinal axis of the endoscope. According to the above configuration, the holding surface can be arranged at a position on the trajectory of the needle tip portion in a direction intersecting the trajectory, and the needle tip portion protruding from the tissue can be reliably pierced into the holding surface.
　本発明の第３の態様は、上記いずれかに記載の内視鏡キャップと、該内視鏡キャップに対して相対的に動作可能であり、縫合針を保持および解放可能である保持具と、を備える縫合システムである。
　本態様によれば、縫合針を保持する保持具の操作によって、縫合針を組織に通して針先部を組織から突き出し、針先部を内視鏡キャップの針保持要素に刺して針保持要素によって保持する。次に、針先部を針保持要素によって保持しながら、保持具を縫合針から離す。このときに、針先部は、組織からの力によって組織内に引き戻されることなく、組織から突き出した位置に保持される。したがって、針先部を組織から突き出した後、縫合針を組織に再度通す等の余計な工程を生じることなく、次の工程を行うことができ、内視鏡下での組織の縫合作業を効率良く行うことができる。 A third aspect of the present invention includes an endoscope cap according to any one of the above, a holder that is movable relative to the endoscope cap and is capable of holding and releasing a suture needle. It is a suturing system including.
According to this aspect, by operating the holder for holding the suture needle, the suture needle is passed through the tissue to protrude the needle tip portion from the tissue, and the needle tip portion is pierced into the needle holding element of the endoscope cap to pierce the needle holding element. Hold by. Next, the holder is separated from the suture needle while the needle tip is held by the needle holding element. At this time, the needle tip is held at a position protruding from the tissue without being pulled back into the tissue by the force from the tissue. Therefore, after the needle tip is projected from the tissue, the next step can be performed without causing an extra step such as passing the suture needle through the tissue again, and the suturing work of the tissue under the endoscope is efficient. You can do it well.
　本発明によれば、内視鏡下での組織の縫合作業を効率良く行うことができるという効果を奏する。 According to the present invention, there is an effect that the suturing work of the tissue under the endoscope can be efficiently performed.
本発明の一実施形態に係る縫合システムの構成図である。It is a block diagram of the suture system which concerns on one Embodiment of this invention. 本発明の一実施形態に係る内視鏡キャップの一例の斜視図である。It is a perspective view of an example of an endoscope cap which concerns on one Embodiment of this invention. 図１の縫合システムを使用した内視鏡下縫合方法において内視鏡によって観察される内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image observed by an endoscope in the endoscopic suturing method using the suturing system of FIG. 本発明の一実施形態に係る内視鏡下縫合方法の第１工程を説明する内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image explaining the 1st step of the endoscopic suturing method which concerns on one Embodiment of this invention. 本発明の一実施形態に係る内視鏡下縫合方法の第２工程を説明する内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image explaining the 2nd step of the endoscopic suturing method which concerns on one Embodiment of this invention. 本発明の一実施形態に係る内視鏡下縫合方法の第３工程を説明する内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image explaining the 3rd step of the endoscopic suturing method which concerns on one Embodiment of this invention. 本発明の一実施形態に係る内視鏡下縫合方法の第４工程を説明する内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image explaining the 4th step of the endoscopic suturing method which concerns on one Embodiment of this invention. 本発明の一実施形態に係る内視鏡下縫合方法の第４工程を説明する内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image explaining the 4th step of the endoscopic suturing method which concerns on one Embodiment of this invention. 第４工程における内視鏡の動作の例を説明する図である。It is a figure explaining the example of the operation of the endoscope in the 4th step. 本発明の一実施形態に係る内視鏡下縫合方法の第４工程を説明する内視鏡画像の一例を示す図である。It is a figure which shows an example of the endoscopic image explaining the 4th step of the endoscopic suturing method which concerns on one Embodiment of this invention. 内視鏡キャップの他の例を示す内視鏡画像である。It is an endoscope image which shows another example of an endoscope cap. 内視鏡キャップの他の例を示す内視鏡画像である。It is an endoscope image which shows another example of an endoscope cap. 内視鏡キャップの他の例の斜視図である。It is a perspective view of another example of an endoscope cap. 内視鏡キャップの他の例の斜視図である。It is a perspective view of another example of an endoscope cap. 内視鏡キャップの他の例の斜視図である。It is a perspective view of another example of an endoscope cap. 内視鏡キャップの他の例の側面図である。It is a side view of another example of an endoscope cap. 内視鏡キャップの他の例の斜視図である。It is a perspective view of another example of an endoscope cap. 内視鏡キャップおよび保持具の他の例の構成図である。It is a block diagram of another example of an endoscope cap and a holder. 図７Ａの保持具の動作を説明する図である。It is a figure explaining the operation of the holder of FIG. 7A. 図７Ａの保持具の動作を説明する図である。It is a figure explaining the operation of the holder of FIG. 7A. 図７Ａの保持具の動作を説明する図である。It is a figure explaining the operation of the holder of FIG. 7A. 図７Ａの保持具の動作を説明する図である。It is a figure explaining the operation of the holder of FIG. 7A.
　以下に、本発明の一実施形態に係る内視鏡下縫合方法、内視鏡キャップおよび縫合システムについて図面を参照して説明する。
　本実施形態に係る内視鏡下縫合方法は、図３Ａから図３Ｈに示されるように、内視鏡下において体内の組織Ｓを縫合針１１および縫合糸１２を使用して縫合する方法である。内視鏡下縫合方法において、内視鏡と縫合針１１を保持する保持具３とが体内に挿入され、体内の組織Ｓを内視鏡によって観察しながら保持具３を操作して組織Ｓを縫合する。組織Ｓは、例えば、食道、胃、小腸または大腸等の管腔器官の組織である。 Hereinafter, the endoscopic suturing method, the endoscopic cap, and the suturing system according to the embodiment of the present invention will be described with reference to the drawings.
The endoscopic suture method according to the present embodiment is a method of suturing the tissue S in the body endoscopically using a suture needle 11 and a suture thread 12, as shown in FIGS. 3A to 3H. .. In the endoscopic suture method, the endoscope and the holder 3 for holding the suture needle 11 are inserted into the body, and the holder 3 is operated while observing the tissue S in the body with the endoscope to obtain the tissue S. Suture. Tissue S is, for example, tissue of a luminal organ such as the esophagus, stomach, small intestine or large intestine.
　図１は、内視鏡下縫合方法に使用される内視鏡キャップ１および縫合システム１００を示している。図１に示されるように、縫合システム１００は、内視鏡２の先端部２ａに取り付けられる内視鏡キャップ１と、縫合針１１を保持する保持具３とを備える。
　内視鏡２は、例えば軟性内視鏡であり、先端部２ａと、先端部２ａの基端側に設けられた湾曲部２ｂと、内視鏡２内を長手方向に沿って貫通し内視鏡２の先端面に開口する処置具チャネル２ｃとを有する。内視鏡２は、縫合システム１００とは別に用意される汎用の内視鏡であってもよく、縫合システム１００の一部として提供されてもよい。 FIG. 1 shows an endoscopic cap 1 and a suturing system 100 used in an endoscopic suturing method. As shown in FIG. 1, the suture system 100 includes an endoscope cap 1 attached to the tip 2a of the endoscope 2 and a holder 3 for holding the suture needle 11.
The endoscope 2 is, for example, a flexible endoscope, which penetrates the tip portion 2a, the curved portion 2b provided on the proximal end side of the tip portion 2a, and the inside of the endoscope 2 along the longitudinal direction for endoscopy. It has a treatment tool channel 2c that opens to the tip surface of the mirror 2. The endoscope 2 may be a general-purpose endoscope prepared separately from the suturing system 100, or may be provided as a part of the suturing system 100.
　内視鏡キャップ１は、装着部４ａおよびキャップ部４ｂを有するキャップ本体４を備える。
　装着部（固定要素）４ａは、内視鏡２の先端部２ａの外周面に装着される円筒状であり、キャップ本体４の基端側部分を構成している。キャップ部４ｂは、装着部４ａの円環状の先端面の少なくとも一部分から装着部４ａの長手方向に沿って突出し、キャップ本体４の先端側部分を構成している。 The endoscope cap 1 includes a cap body 4 having a mounting portion 4a and a cap portion 4b.
The mounting portion (fixing element) 4a has a cylindrical shape that is mounted on the outer peripheral surface of the tip end portion 2a of the endoscope 2, and constitutes a base end side portion of the cap body 4. The cap portion 4b protrudes from at least a part of the annular tip surface of the mounting portion 4a along the longitudinal direction of the mounting portion 4a, and constitutes the tip end side portion of the cap body 4.
　キャップ本体４の材質は、アクリルエラストマまたはスチレンエラストマ等のエラストマであってもよく、ポリカーボネートまたはポリ塩化ビニル等のプラスチックであってもよい。装着部４ａの材質とキャップ部４ｂの材質は、相互に同一であってもよく、相互に異なっていてもよい。 The material of the cap body 4 may be an elastomer such as acrylic elastomer or styrene elastomer, or may be plastic such as polycarbonate or polyvinyl chloride. The material of the mounting portion 4a and the material of the cap portion 4b may be the same as each other or may be different from each other.
　装着部４ａは、先端部２ａの外径と等しい、または略等しい内径を有し、先端部２ａが装着部４ａ内に嵌合する。先端部２ａの外周面と装着部４ａの内周面との間の摩擦によって、装着部４ａは先端部２ａに固定される。装着部４ａが先端部２ａに固定された状態において、キャップ部４ｂは、内視鏡２の先端から内視鏡２の長手方向に沿って突出する。このようなキャップ部４ｂによって、内視鏡２の先端と組織Ｓとの間に適切な距離が確保され、内視鏡２によって組織Ｓを良好に観察することができる。 The mounting portion 4a has an inner diameter equal to or substantially equal to the outer diameter of the tip portion 2a, and the tip portion 2a fits into the mounting portion 4a. The mounting portion 4a is fixed to the tip portion 2a by friction between the outer peripheral surface of the tip portion 2a and the inner peripheral surface of the mounting portion 4a. In a state where the mounting portion 4a is fixed to the tip portion 2a, the cap portion 4b projects from the tip of the endoscope 2 along the longitudinal direction of the endoscope 2. An appropriate distance is secured between the tip of the endoscope 2 and the tissue S by such a cap portion 4b, and the tissue S can be observed well by the endoscope 2.
　図３Ｂから図３Ｈに示されるように、内視鏡２の視野内の下部において組織Ｓの縫合作業が行われる。組織Ｓの観察および縫合作業のための空間を確保するために、キャップ部４ｂの内視鏡２の視野の下側に配置される部分は、開放されている。図１から図３Ｈのキャップ部４ｂは、視野の上側に配置される略半円筒状である。 As shown in FIGS. 3B to 3H, the suturing work of the tissue S is performed in the lower part of the field of view of the endoscope 2. In order to secure a space for observing the tissue S and suturing work, the portion of the cap portion 4b arranged below the field of view of the endoscope 2 is open. The cap portion 4b of FIGS. 1 to 3H has a substantially semi-cylindrical shape arranged on the upper side of the field of view.
　保持具３は、処置具チャネル２ｃ内を経由して体内に挿入され、縫合針１１の保持および解放が可能な内視鏡用器具である。本実施形態において、保持具３は、処置具チャネル２ｃ内に挿入可能である長尺の可撓管部３ａと、可撓管部３ａの先端に接続され相互に開閉可能な一対の把持部材３ｂ，３ｃとを備える持針器である。 The retainer 3 is an endoscopic instrument that is inserted into the body via the treatment instrument channel 2c and can hold and release the suture needle 11. In the present embodiment, the holder 3 includes a long flexible tube portion 3a that can be inserted into the treatment tool channel 2c and a pair of gripping members 3b that are connected to the tip of the flexible tube portion 3a and can be opened and closed with each other. , 3c and a needle holder.
　持針器３は、一対の把持部材３ｂ，３ｃを閉じることによって一対の把持部材３ｂ，３ｃ間に縫合針１１を把持することができ、一対の把持部材３ｂ，３ｃを開くことによって縫合針１１を解放することができる。また、処置具チャネル２ｃ内の可撓管部３ａは、内視鏡２に対して長手方向の移動および長手軸回りの回転が可能であり、持針器３は、内視鏡２および先端部２ａに取り付けられた内視鏡キャップ１に対して相対的に動作可能である。 The needle holder 3 can grip the suture needle 11 between the pair of gripping members 3b, 3c by closing the pair of gripping members 3b, 3c, and the suture needle 11 by opening the pair of gripping members 3b, 3c. Can be released. Further, the flexible tube portion 3a in the treatment tool channel 2c can move in the longitudinal direction and rotate around the longitudinal axis with respect to the endoscope 2, and the needle holder 3 has the endoscope 2 and the tip portion. It is movable relative to the endoscope cap 1 attached to 2a.
　図３Ａに示されるように、縫合針１１は、一方向に湾曲する略円弧状の曲針である。縫合針１１の先端には尖端１１ｂが形成され、縫合針１１の基端に縫合糸１２の先端が接続されている。縫合針１１は、可撓管部３ａの長手軸に交差する平面に沿って配置されるように一対の把持部材３ｂ，３ｃ間に把持される。操作者は、処置具チャネル２ｃの基端開口から外側に延びる可撓管部３ａの基端部を可撓管部３ａの長手軸回りに回転させることによって、内視鏡２の視野内で縫合針１１の先端部である針先部１１ａを図３Ａに示されるような円弧状の軌道Ａに沿って移動させ、縫合針１１を針先部１１ａから先に組織Ｓに通すことができる。 As shown in FIG. 3A, the suture needle 11 is a substantially arc-shaped curved needle that curves in one direction. A tip 11b is formed at the tip of the suture needle 11, and the tip of the suture thread 12 is connected to the base end of the suture needle 11. The suture needle 11 is gripped between the pair of gripping members 3b and 3c so as to be arranged along a plane intersecting the longitudinal axis of the flexible tube portion 3a. The operator sutures in the field of view of the endoscope 2 by rotating the proximal end portion of the flexible tube portion 3a extending outward from the proximal end opening of the treatment tool channel 2c around the longitudinal axis of the flexible tube portion 3a. The needle tip portion 11a, which is the tip end portion of the needle 11, can be moved along the arcuate trajectory A as shown in FIG. 3A, and the suture needle 11 can be passed through the tissue S first from the needle tip portion 11a.
　図３Ｂおよび図３Ｃに示されるように、組織Ｓを通る縫合針１１の針先部１１ａは組織Ｓから突き出す。図２に示されるように、内視鏡キャップ１は、キャップ本体４に設けられ、組織Ｓから突き出す針先部１１ａを保持および解放可能である針保持要素５をさらに備える。針保持要素５は、キャップ部４ｂに設けられており、装着部４ａが先端部２ａに固定された状態において内視鏡２の先端の前方に位置する。 As shown in FIGS. 3B and 3C, the needle tip portion 11a of the suture needle 11 passing through the tissue S protrudes from the tissue S. As shown in FIG. 2, the endoscope cap 1 is further provided with a needle holding element 5 provided on the cap body 4 and capable of holding and releasing the needle tip portion 11a protruding from the tissue S. The needle holding element 5 is provided on the cap portion 4b, and is located in front of the tip of the endoscope 2 in a state where the mounting portion 4a is fixed to the tip portion 2a.
　針保持要素５は、弾性材料から形成され、キャップ部４ｂの先端部の内周面４ｃからキャップ部４ｂの内方に向かって突出する部材である。針保持要素５は、キャップ部４ｂの先端から基端側へ延び、組織Ｓから突き出した針先部１１ａが刺さる保持面５ａを有する。保持面５ａは、内周面４ｃからキャップ部４ｂの内方に向かって突出し、内視鏡２の長手軸回りの周方向に交差している。このような保持面５ａは、組織Ｓから突き出す針先部１１ａの軌道Ａ上に位置し、軌道Ａと交差し、好ましくは軌道Ａと直交または略直交する。これにより、軌道Ａに沿って移動する針先部１１ａが保持面５ａに容易に刺さるようになっている。保持面５ａは、平坦面であってもよく、曲面であってもよい。 The needle holding element 5 is a member formed of an elastic material and projecting inward from the inner peripheral surface 4c of the tip of the cap portion 4b toward the inside of the cap portion 4b. The needle holding element 5 has a holding surface 5a that extends from the tip of the cap portion 4b toward the proximal end side and is pierced by the needle tip portion 11a protruding from the tissue S. The holding surface 5a projects from the inner peripheral surface 4c toward the inside of the cap portion 4b and intersects the circumferential direction around the longitudinal axis of the endoscope 2. Such a holding surface 5a is located on the orbit A of the needle tip portion 11a protruding from the tissue S, intersects the orbit A, and is preferably orthogonal or substantially orthogonal to the orbit A. As a result, the needle tip portion 11a moving along the trajectory A can be easily pierced into the holding surface 5a. The holding surface 5a may be a flat surface or a curved surface.
　組織Ｓから突き出し保持面５ａに刺さった針先部１１ａは、針先部１１ａと針保持要素５との間の摩擦によって針保持要素５に保持される。具体的には、針先部１１ａが保持面５ａから針保持要素５に刺さることによって針保持要素５に穴が開く。穴の内面が、針保持要素５の弾性復元力によって針先部１１ａの外面に密着することで、針先部１１ａの外面と穴の内面との間に摩擦が生じる。
　針保持要素５によって針先部１１ａが保持された後、可撓管部３ａの逆回転によって針先部１１ａを針保持要素５から引き抜くことによって、針先部１１ａは針保持要素５から解放される。 The needle tip portion 11a protruding from the structure S and piercing the needle holding surface 5a is held by the needle holding element 5 by friction between the needle tip portion 11a and the needle holding element 5. Specifically, the needle tip portion 11a pierces the needle holding element 5 from the holding surface 5a to open a hole in the needle holding element 5. The inner surface of the hole is brought into close contact with the outer surface of the needle tip portion 11a by the elastic restoring force of the needle holding element 5, so that friction is generated between the outer surface of the needle tip portion 11a and the inner surface of the hole.
After the needle tip portion 11a is held by the needle holding element 5, the needle tip portion 11a is pulled out from the needle holding element 5 by the reverse rotation of the flexible tube portion 3a, so that the needle tip portion 11a is released from the needle holding element 5. NS.
　図４Ａおよび図４Ｂは、軌道Ａに対する保持面５ａの角度の例を説明している。図４Ａおよび図４Ｂにおいて、矢印は、保持面５ａへの針先部１１ａの針刺方向を示している。針刺方向は、軌道Ａと保持面５ａとの交点における軌道Ａの接線と一致する。
　図４Ａに示されるように、針先部１１ａが保持面５ａに刺さることを確実にするために、保持面５ａは、針先部１１ａの針刺方向と直交するか、または、針刺方向に対して該針刺方向の前側に傾斜していることが好ましい。
　図４Ｂに示されるように、保持面５ａが、針刺方向に対して該針刺方向の後側に傾斜している場合、軌道Ａに沿って前進する針先部１１ａが保持面５ａ上を滑り易くなる。 4A and 4B illustrate an example of the angle of the holding surface 5a with respect to the track A. In FIGS. 4A and 4B, the arrow indicates the needle stick direction of the needle tip portion 11a with respect to the holding surface 5a. The needle stick direction coincides with the tangent line of the trajectory A at the intersection of the trajectory A and the holding surface 5a.
As shown in FIG. 4A, in order to ensure that the needle tip portion 11a pierces the holding surface 5a, the holding surface 5a is orthogonal to the needle piercing direction of the needle tip portion 11a or is oriented in the needle piercing direction. On the other hand, it is preferable that the needle is inclined forward in the needle stick direction.
As shown in FIG. 4B, when the holding surface 5a is inclined to the rear side of the needle sticking direction with respect to the needle sticking direction, the needle tip portion 11a advancing along the trajectory A is on the holding surface 5a. It becomes slippery.
　保持面５ａは均一な硬さを有し、針先部１１ａは、保持面５ａの任意の位置に刺さることができる。針保持要素５はキャップ部４ｂの内側に位置するので、針保持要素５は、保持面５ａに刺さった針先部１１ａを内視鏡２の視野内に保持することができ、針先部１１ａを鮮明に観察することができる。 The holding surface 5a has a uniform hardness, and the needle tip portion 11a can be pierced at an arbitrary position on the holding surface 5a. Since the needle holding element 5 is located inside the cap portion 4b, the needle holding element 5 can hold the needle tip portion 11a stuck in the holding surface 5a within the field of view of the endoscope 2, and the needle tip portion 11a can be held. Can be clearly observed.
　針先部１１ａが保持面５ａにより容易に刺さるようにするために、保持面５ａに針先部１１ａよりも小径の穴または切り込みが形成されていてもよい。穴または切り込みへの針先部１１ａの挿入によって穴または切り込みの幅は広がるが、弾性復元力によって穴または切り込みの内面が針先部１１ａの表面に密着し、針先部１１ａが摩擦によって保持される。 A hole or notch having a diameter smaller than that of the needle tip portion 11a may be formed in the holding surface 5a so that the needle tip portion 11a can be easily pierced by the holding surface 5a. The width of the hole or notch is widened by inserting the needle tip 11a into the hole or notch, but the inner surface of the hole or notch is brought into close contact with the surface of the needle tip 11a due to the elastic restoring force, and the needle tip 11a is held by friction. NS.
　針保持要素５の材質は、キャップ部４ｂの材質と同一であってもよく、異なっていてもよい。
　針保持要素５の材質がキャップ部４ｂの材質と同一である場合、例えば、キャップ部４ｂおよび針保持要素５は一体成型によって製造されるか、または、キャップ部４ｂの一部の変形によって針保持要素５が形成される。
　針保持要素５の材質がキャップ部４ｂの材質とは異なる場合、例えば、キャップ部４ｂおよび針保持要素５は２色成型によって製造されるか、または、別々に製造されたキャップ部４ｂおよび針保持要素５が相互に接合される。 The material of the needle holding element 5 may be the same as or different from the material of the cap portion 4b.
When the material of the needle holding element 5 is the same as the material of the cap portion 4b, for example, the cap portion 4b and the needle holding element 5 are manufactured by integral molding, or the needle is held by a partial deformation of the cap portion 4b. Element 5 is formed.
When the material of the needle holding element 5 is different from the material of the cap portion 4b, for example, the cap portion 4b and the needle holding element 5 are manufactured by two-color molding, or the cap portion 4b and the needle holding are manufactured separately. The elements 5 are joined to each other.
　次に、本実施形態に係る内視鏡下縫合方法について説明する。
　図３Ｂから図３Ｅに示されるように、内視鏡下縫合方法は、縫合針１１を組織Ｓに通し針先部１１ａを組織Ｓから突き出す第１工程と、組織Ｓから突き出した針先部１１ａを内視鏡２の先端部２ａに取り付けられた内視鏡キャップ１によって保持する第２工程と、針先部１１ａを内視鏡キャップ１によって保持しながら湾曲部２ｂの湾曲動作によって組織Ｓから縫合針１１を引き出す第３工程と、針先部１１ａを内視鏡キャップ１によって保持しながら縫合針１１を持針器３によって保持する第４工程と、を含む。 Next, the endoscopic suturing method according to the present embodiment will be described.
As shown in FIGS. 3B to 3E, the endoscopic suture method includes a first step of passing the suture needle 11 through the tissue S and projecting the needle tip portion 11a from the tissue S, and a needle tip portion 11a protruding from the tissue S. From the tissue S by the second step of holding the needle tip portion 11a by the endoscope cap 1 attached to the tip portion 2a of the endoscope 2 and the bending operation of the curved portion 2b while holding the needle tip portion 11a by the endoscope cap 1. The third step of pulling out the suture needle 11 and the fourth step of holding the suture needle 11 by the needle device 3 while holding the needle tip portion 11a by the endoscope cap 1 are included.
　図３Ｂに示されるように、第１工程において、操作者は、縫合針１１の基端部を保持する持針器３を回転させることによって、針先部１１ａを組織Ｓに刺し縫合針１１を組織Ｓに通す。
　次に、図３Ｃに示されるように、第２工程において、操作者は、持針器３をさらに回転させることによって、組織Ｓから突き出した針先部１１ａを軌道Ａに沿ってさらに移動させて針先部１１ａを軌道Ａ上の保持面５ａに刺す。これにより、針先部１１ａが針保持要素５に保持される。 As shown in FIG. 3B, in the first step, the operator pierces the tissue S with the needle tip portion 11a by rotating the needle holder 3 holding the base end portion of the suture needle 11, and inserts the suture needle 11 into the tissue S. Pass through organization S.
Next, as shown in FIG. 3C, in the second step, the operator further rotates the needle holder 3 to further move the needle tip portion 11a protruding from the tissue S along the trajectory A. The needle tip portion 11a is pierced into the holding surface 5a on the track A. As a result, the needle tip portion 11a is held by the needle holding element 5.
　必要に応じて、組織Ｓに縫合針１１を刺すことに先立ち、針先部１１ａが組織Ｓから突き出す位置を予測し、針保持要素５を予測された位置に移動させる工程が行われてもよい。予測された位置への針保持要素５の移動は、例えば、内視鏡２の進退または湾曲部２ｂの湾曲動作によって行われる。 If necessary, prior to inserting the suture needle 11 into the tissue S, a step of predicting the position where the needle tip portion 11a protrudes from the tissue S and moving the needle holding element 5 to the predicted position may be performed. .. The movement of the needle holding element 5 to the predicted position is performed by, for example, the advance / retreat of the endoscope 2 or the bending motion of the bending portion 2b.
　次に、図３Ｄに示されるように、第３工程において、操作者は、持針器３を縫合針１１の基端部から離し、組織Ｓへの縫合針１１の針刺方向と対応する方向へ湾曲部２ｂを湾曲動作させる。図３Ｄの例の場合、右から左へ縫合針１１を組織Ｓに刺しているので、湾曲部２ｂを左側へ湾曲させる。湾曲部２ｂの湾曲動作によって、内視鏡２の先端部２ａおよび針保持要素５が組織Ｓに対して左側へ移動し、針保持要素５に針先部１１ａが保持されている縫合針１１も左側へ移動し、少なくとも針先部１１ａを含む縫合針１１の一部が組織Ｓから引き出される。 Next, as shown in FIG. 3D, in the third step, the operator separates the needle holder 3 from the base end portion of the suture needle 11 and moves the needle holder 3 into the tissue S in a direction corresponding to the needle stick direction of the suture needle 11. The curved portion 2b is curved. In the case of the example of FIG. 3D, since the suture needle 11 is pierced into the tissue S from right to left, the curved portion 2b is curved to the left. Due to the bending motion of the curved portion 2b, the tip portion 2a of the endoscope 2 and the needle holding element 5 move to the left side with respect to the tissue S, and the suture needle 11 in which the needle tip portion 11a is held by the needle holding element 5 also Moving to the left, at least a portion of the suture needle 11 including the needle tip 11a is pulled out of the tissue S.
　湾曲部２ｂを湾曲させたときに、縫合針１１と一緒に組織Ｓも移動してしまうことがある。第３工程において、持針器３は縫合針１１の操作に使用されないので、図３Ｄに２点鎖線で示されるように、持針器３で組織Ｓを押さえながら湾曲部２ｂの湾曲動作によって組織Ｓから縫合針１１を引き出してもよい。持針器３で組織Ｓを押さえることによって縫合針１１と一緒に組織Ｓが引っ張られることが阻止され、縫合針１１をより容易に組織Ｓから引き出すことができる。 When the curved portion 2b is curved, the tissue S may move together with the suture needle 11. In the third step, since the needle holder 3 is not used for the operation of the suture needle 11, as shown by the alternate long and short dash line in FIG. 3D, the needle holder 3 holds the tissue S and bends the curved portion 2b. The suture needle 11 may be pulled out from S. By pressing the tissue S with the needle holder 3, the tissue S is prevented from being pulled together with the suture needle 11, and the suture needle 11 can be pulled out from the tissue S more easily.
　次に、図３Ｅに示されるように、第４工程において、操作者は、組織Ｓと針保持要素５との間に配置され組織Ｓから露出する縫合針１１の露出部分を持針器３によって保持する。
　なお、第３工程は、必ずしも必要ではない。例えば、第２工程の後、縫合針１１の露出部分が十分に長い場合、すなわち、縫合針１１が針保持要素５に保持されたときに、針保持要素５と組織Ｓとの間の距離が充分にある場合、第３工程を行わずとも露出部分を持針器３によって容易に保持することができる。このような場合には、第３工程を省略してもよい。 Next, as shown in FIG. 3E, in the fourth step, the operator holds the exposed portion of the suture needle 11 arranged between the tissue S and the needle holding element 5 and exposed from the tissue S by the needle holder 3. Hold.
The third step is not always necessary. For example, after the second step, when the exposed portion of the suture needle 11 is sufficiently long, that is, when the suture needle 11 is held by the needle holding element 5, the distance between the needle holding element 5 and the tissue S is If sufficient, the exposed portion can be easily held by the needle holder 3 without performing the third step. In such a case, the third step may be omitted.
　次に、第１工程での縫合針１１を組織Ｓに通すときの持針器３の回転とは逆方向に持針器３を回転させることによって、針先部１１ａを針保持要素５から引き抜く。このときに、図３Ｆに示されるように、持針器３で組織Ｓを押し付けながら、持針器３を逆方向に回転させてもよい。
　次に、持針器３の動作によって、例えば持針器３を前進させることによって、図３Ｇに示されるように、縫合針１１で組織Ｓを引っ張りながら、針先部１１ａが保持面５ａに刺さらない位置へ縫合針１１を移動させ、持針器３の回転によって縫合針１１の全体を組織Ｓから引き出す。その結果、図３Ｈに示されるように、縫合針１１の全体を組織Ｓから完全に抜くことができる。 Next, the needle tip portion 11a is pulled out from the needle holding element 5 by rotating the needle holder 3 in the direction opposite to the rotation of the needle holder 3 when passing the suture needle 11 through the tissue S in the first step. .. At this time, as shown in FIG. 3F, the needle holder 3 may be rotated in the opposite direction while pressing the tissue S with the needle holder 3.
Next, the needle tip 11a pierces the holding surface 5a while pulling the tissue S with the suture needle 11 as shown in FIG. 3G by the operation of the needle holder 3, for example, by advancing the needle holder 3. The suture needle 11 is moved to a position where the suture needle 11 is not present, and the entire suture needle 11 is pulled out from the tissue S by the rotation of the needle holder 3. As a result, as shown in FIG. 3H, the entire suture needle 11 can be completely removed from the tissue S.
　なお、組織Ｓから縫合針１１を引き抜く方法は、上記の方法に限らず、例えば、持針器３によって縫合針１１の露出部分を保持した後に、内視鏡２の前進または後退動作によって組織Ｓを少し捻りながら組織Ｓから縫合針１１を引き抜いてもよい。
　また、針保持要素５および組織Ｓから縫合針１１を引き抜く手順は、例えば、持針器３で組織Ｓを押さえながら湾曲部２ｂの湾曲動作によって組織Ｓから縫合針１１を完全に引き抜き、その後に、持針器３の逆方向の回転によって針先部１１ａを針保持要素５から引き抜いてもよい。この場合、持針器３の前進等によって針先部１１ａが保持面５ａに刺さらない位置へ縫合針１１を移動させる必要はない。 The method of pulling out the suture needle 11 from the tissue S is not limited to the above method. For example, after holding the exposed portion of the suture needle 11 with the needle holder 3, the tissue S is moved forward or backward by the endoscope 2. The suture needle 11 may be pulled out from the tissue S while slightly twisting.
Further, in the procedure for pulling out the suture needle 11 from the needle holding element 5 and the tissue S, for example, the suture needle 11 is completely pulled out from the tissue S by the bending operation of the curved portion 2b while holding the tissue S with the needle holder 3, and then. , The needle tip portion 11a may be pulled out from the needle holding element 5 by rotating the needle holder 3 in the opposite direction. In this case, it is not necessary to move the suture needle 11 to a position where the needle tip portion 11a does not pierce the holding surface 5a due to the advancement of the needle holder 3.
　縫合針１１が組織Ｓを通っている状態において、粘弾性を有する組織Ｓは縫合針１１によって引っ張られており、縫合針１１は、針先部１１ａを組織Ｓ内に引き戻す方向の力を組織Ｓから受ける。縫合針１１の基端部を保持する持針器３を針先部１１ａが自由な状態で離した場合、組織Ｓの弾性復元力によって針先部１１ａが組織Ｓ内に引き戻され組織Ｓ内に埋まってしまうことがある。特に厚い組織Ｓの場合、弾性復元力が強いため、自由な状態の針先部１１ａを組織Ｓから突き出したままに保つことが難しい。針先部１１ａが組織Ｓ内に埋まってしまった場合、縫合針１１を組織Ｓに再度通さなければならない。したがって、組織Ｓの縫合作業を効率良く進めるためには、持針器３を縫合針１１の基端部から離したときに針先部１１ａが組織Ｓに埋もれないようにすることが重要である。 In the state where the suture needle 11 passes through the tissue S, the viscoelastic tissue S is pulled by the suture needle 11, and the suture needle 11 exerts a force in the direction of pulling the needle tip portion 11a back into the tissue S. Receive from. When the needle tip portion 11a is released from the needle holder 3 holding the base end portion of the suture needle 11 in a free state, the needle tip portion 11a is pulled back into the tissue S by the elastic restoring force of the tissue S and enters the tissue S. It may be buried. Especially in the case of a thick tissue S, since the elastic restoring force is strong, it is difficult to keep the needle tip portion 11a in a free state protruding from the tissue S. If the needle tip 11a is buried in the tissue S, the suture needle 11 must be passed through the tissue S again. Therefore, in order to efficiently proceed with the suturing work of the tissue S, it is important to prevent the needle tip portion 11a from being buried in the tissue S when the needle holder 3 is separated from the base end portion of the suture needle 11. ..
　本実施形態によれば、組織Ｓから突き出した針先部１１ａが内視鏡キャップ１の針保持要素５によって保持されるので、持針器３を縫合針１１の基端部から離したときに針先部１１ａが組織Ｓ内に引き戻されることが阻止される。これにより、内視鏡下での組織Ｓの縫合作業を効率良くに行うことができる。 According to the present embodiment, the needle tip portion 11a protruding from the tissue S is held by the needle holding element 5 of the endoscope cap 1, so that when the needle holder 3 is separated from the base end portion of the suture needle 11. The needle tip portion 11a is prevented from being pulled back into the tissue S. As a result, the suturing work of the tissue S under the endoscope can be efficiently performed.
　また、針保持要素５の保持面５ａが、針先部１１ａの軌道Ａ上に位置し、かつ、軌道Ａに交差している。したがって、針先部１１ａを保持面５ａに垂直または垂直に近い角度で当該保持面５ａに容易に刺すことができる。仮に、保持面５ａが軌道Ａに沿う方向に配置されている場合、針先部１１ａが保持面５ａに沿って滑ってしまい、針先部１１ａを保持面５ａに刺すことが難しいことがある。
　また、針保持要素５がキャップ本体４の内側に配置されているので、針保持要素５に刺さった針先部１１ａはキャップ本体４の内側に位置し、キャップ本体４の外側に針先部１１ａが突き出すことが防止される。したがって、針保持要素５に刺さっている針先部１１ａを内視鏡２によって鮮明に観察することができる。 Further, the holding surface 5a of the needle holding element 5 is located on the trajectory A of the needle tip portion 11a and intersects the trajectory A. Therefore, the needle tip portion 11a can be easily pierced into the holding surface 5a at an angle perpendicular to or close to the holding surface 5a. If the holding surface 5a is arranged in the direction along the trajectory A, the needle tip portion 11a may slip along the holding surface 5a, making it difficult to pierce the holding surface 5a.
Further, since the needle holding element 5 is arranged inside the cap body 4, the needle tip portion 11a stuck in the needle holding element 5 is located inside the cap body 4, and the needle tip portion 11a is located outside the cap body 4. Is prevented from sticking out. Therefore, the needle tip portion 11a stuck in the needle holding element 5 can be clearly observed by the endoscope 2.
　また、本実施形態によれば、内視鏡キャップ１に針保持要素５が設けられているので、組織Ｓから突出する針先部１１ａを保持するために、持針器３以外の他の内視鏡用器具が不要である。すなわち、処置具チャネル２ｃが１つのみである内視鏡２を使用することができるか、または、２つの処置具チャネルの内の一方を他の用途に使用することができる。 Further, according to the present embodiment, since the needle holding element 5 is provided on the endoscope cap 1, in order to hold the needle tip portion 11a protruding from the tissue S, other than the needle holder 3 No need for endoscopic instruments. That is, the endoscope 2 having only one treatment tool channel 2c can be used, or one of the two treatment tool channels can be used for other purposes.
　上記実施形態において、針保持要素５が弾性材料から形成されることとしたが、針保持要素５の材質は、これに限定されるものではなく、針先部１１ａを針保持要素５に刺すことができる他の任意の材質であってもよい。 In the above embodiment, the needle holding element 5 is formed of an elastic material, but the material of the needle holding element 5 is not limited to this, and the needle tip portion 11a is pierced into the needle holding element 5. It may be any other material that can be used.
　上記実施形態において、略半円筒状のキャップ部４ｂの内周面から針保持要素５が突出することとしたが、キャップ部４ｂおよび針保持要素５の形態はこれに限定されるものではなく、適宜変更可能である。図５Ａおよび図５Ｂは、キャップ部４ｂおよび針保持要素５の他の構成例を示している。
　図５Ａにおいて、キャップ部４ｂは、全周にわたって延びる円筒状である。針保持要素５は、キャップ部４ｂの円環状の先端面の一部からキャップ部４ｂの長手方向に沿って突出する細い突出片４ｄの内面に固定されている。
　図５Ｂにおいて、キャップ部４ｂは、内視鏡２の視野の左側に配置される略半円筒状である。針保持要素５は、キャップ部４ｂの先端部を折り曲げることによって形成されている。 In the above embodiment, the needle holding element 5 is projected from the inner peripheral surface of the substantially semi-cylindrical cap portion 4b, but the form of the cap portion 4b and the needle holding element 5 is not limited to this. It can be changed as appropriate. 5A and 5B show other configuration examples of the cap portion 4b and the needle holding element 5.
In FIG. 5A, the cap portion 4b has a cylindrical shape extending over the entire circumference. The needle holding element 5 is fixed to the inner surface of a thin protruding piece 4d that protrudes along the longitudinal direction of the cap portion 4b from a part of the annular tip surface of the cap portion 4b.
In FIG. 5B, the cap portion 4b has a substantially semi-cylindrical shape arranged on the left side of the field of view of the endoscope 2. The needle holding element 5 is formed by bending the tip end portion of the cap portion 4b.
　上記実施形態において、針保持要素５がキャップ部４ｂの内周面から内方に突出する部材であることとしたが、これに代えて、図６Ａから図６Ｃに示されるように、軌道Ａ上に位置するキャップ部４ｂの一部分を針保持要素５として利用してもよい。この場合、キャップ部４ｂの内周面４ｃの一部分が保持面５ａである。図６Ａおよび図６Ｂにおいて、キャップ部４ｂの上側の一部分が針保持要素５として機能する。
　図６Ａのキャップ部４ｂは、内視鏡の視野の上側に配置される略半円筒状である。図６Ｂのキャップ部４ｂの先端面は、キャップ部４ｂの長手軸に対して傾斜している。図６Ｃに示されるように、針保持要素５として機能するキャップ部４ｂの一部分に、針先部１１ａが挿入される穴または切り込み５ｂが形成されていてもよい。 In the above embodiment, the needle holding element 5 is a member that protrudes inward from the inner peripheral surface of the cap portion 4b, but instead, as shown in FIGS. 6A to 6C, on the track A. A part of the cap portion 4b located at may be used as the needle holding element 5. In this case, a part of the inner peripheral surface 4c of the cap portion 4b is the holding surface 5a. In FIGS. 6A and 6B, the upper portion of the cap portion 4b functions as the needle holding element 5.
The cap portion 4b of FIG. 6A has a substantially semi-cylindrical shape arranged above the field of view of the endoscope. The tip surface of the cap portion 4b in FIG. 6B is inclined with respect to the longitudinal axis of the cap portion 4b. As shown in FIG. 6C, a hole or a notch 5b into which the needle tip portion 11a is inserted may be formed in a part of the cap portion 4b that functions as the needle holding element 5.
　上記実施形態において、縫合針１１として曲針を使用する場合について説明したが、曲針以外の種類の縫合針を使用してもよい。また、縫合針の種類に応じて、縫合針を保持する保持具の形態を変更してもよい。
　図７Ａから図７Ｅは、縫合針１１および保持具３の他の例を示している。 In the above embodiment, the case where the curved needle is used as the suture needle 11 has been described, but a suture needle of a type other than the curved needle may be used. Further, the form of the holder for holding the suture needle may be changed according to the type of the suture needle.
7A-7E show other examples of the suture needle 11 and the holder 3.
　図７Ａから図７Ｅにおいて、縫合針１１は直針である。図７Ａから図７Ｅの保持具３は、針先部１１ａを内視鏡キャップ１の先端面に向けて内視鏡キャップ１の長手方向に沿う方向に縫合針１１を保持し、縫合針１１を長手方向に移動させる縫合具である。針保持要素５は、内視鏡キャップ１の先端に設けられ、針先部１１ａの移動軌道上に配置されている。図７Ｃに示されるように、針先部１１ａを針保持要素５によって保持することで、縫合具３を縫合針１１から離したときに針先部１１ａが組織Ｓ内に引き戻されることを阻止することができる。そして、図７Ｄに示されるように、縫合針１１の全体を組織Ｓから引き抜いた後、図７Ｅに示されるように、縫合針１１の基端部を縫合具３によって再度保持することができる。 In FIGS. 7A to 7E, the suture needle 11 is a straight needle. The holder 3 of FIGS. 7A to 7E holds the suture needle 11 in the direction along the longitudinal direction of the endoscope cap 1 with the needle tip portion 11a facing the tip surface of the endoscope cap 1, and holds the suture needle 11. A suture tool that moves in the longitudinal direction. The needle holding element 5 is provided at the tip of the endoscope cap 1 and is arranged on the moving trajectory of the needle tip portion 11a. As shown in FIG. 7C, the needle tip portion 11a is held by the needle holding element 5 to prevent the needle tip portion 11a from being pulled back into the tissue S when the suture tool 3 is separated from the suture needle 11. be able to. Then, as shown in FIG. 7D, after the entire suture needle 11 is pulled out from the tissue S, the base end portion of the suture needle 11 can be held again by the suture tool 3 as shown in FIG. 7E.
　上記実施形態において、保持具３が、処置具チャネル２ｃ内を経由して体内に挿入される内視鏡用器具であることとしたが、内視鏡２の外側を経由して体内に挿入される器具であってもよい。
　本発明の内視鏡下縫合方法は、管腔内の縫合作業に限らず、管腔内から腹腔内に縫合針１１を突き出したり、腹腔内から管腔内に縫合針を突き出したりするような縫合作業にも適用することができる。 In the above embodiment, the retainer 3 is an endoscopic instrument that is inserted into the body via the treatment tool channel 2c, but is inserted into the body via the outside of the endoscope 2. It may be an instrument.
The endoscopic suturing method of the present invention is not limited to the suturing work in the lumen, and the suture needle 11 is projected from the lumen into the abdominal cavity, or the suture needle is projected from the abdominal cavity into the lumen. It can also be applied to suturing work.
１　内視鏡キャップ
２　内視鏡
２ａ　先端部
２ｂ　湾曲部
３　保持具、持針器
４　キャップ本体
４ａ　装着部（固定要素）
４ｂ　キャップ部
５　針保持要素
５ａ　保持面
１１　縫合針
１１ａ　針先部
１００　縫合システム
Ａ　軌道
Ｓ　組織 1 Endoscope cap 2 Endoscope 2a Tip 2b Curved part 3 Holder, needle holder 4 Cap body 4a Mounting part (fixing element)
4b Cap part 5 Needle holding element 5a Holding surface 11 Suture needle 11a Needle tip 100 Suture system A Orbit S Tissue

Claims (10)

  1. 　縫合針を体内の組織に通し、前記縫合針の針先部を前記組織から突き出すことと、
    　内視鏡に取り付けられた内視鏡キャップによって、前記組織から突き出した前記針先部を保持することと、
    　前記針先部を前記内視鏡キャップによって保持しながら保持具によって前記縫合針を保持することと、を含む内視鏡下縫合方法。     Passing the suture needle through the tissue in the body and protruding the needle tip of the suture needle from the tissue,
    The endoscope cap attached to the endoscope holds the needle tip protruding from the tissue, and
    An endoscopic suturing method comprising holding the suture needle with a holder while holding the needle tip portion with the endoscopic cap.
  2. 　前記縫合針を保持することが、前記組織と前記内視鏡キャップとの間に位置する前記縫合針の露出部分を保持することである、請求項１に記載の内視鏡下縫合方法。 The endoscopic suturing method according to claim 1, wherein holding the suture needle holds an exposed portion of the suture needle located between the tissue and the endoscopic cap.
  3. 　前記針先部を前記内視鏡キャップによって保持しながら、前記内視鏡の湾曲部の湾曲動作によって前記組織から前記縫合針を引き出すことをさらに含み、
    　前記縫合針を前記組織から引き出した後に、前記露出部分を保持することが行われる、請求項２に記載の内視鏡下縫合方法。     Further comprising pulling out the suture needle from the tissue by the bending motion of the curved portion of the endoscope while holding the needle tip portion by the endoscope cap.
    The endoscopic suturing method according to claim 2, wherein the exposed portion is held after the suture needle is pulled out from the tissue.
  4. 　前記縫合針を前記組織に通すことが、前記縫合針を保持する前記保持具の操作によって行われ、
    　前記針先部を前記内視鏡キャップによって保持しながら、前記保持具を前記縫合針から離し、
    　前記湾曲部の湾曲動作によって前記組織から前記縫合針を引き出すことが、前記保持具によって前記組織を押さえながら行われる、請求項３に記載の内視鏡下縫合方法。     Passing the suture needle through the tissue is performed by operating the retainer that holds the suture needle.
    While holding the needle tip portion by the endoscope cap, the holder is separated from the suture needle.
    The endoscopic suture method according to claim 3, wherein the suture needle is pulled out from the tissue by the bending motion of the curved portion while the tissue is held down by the holder.
  5. 　前記体内の組織が管腔器官の組織である請求項１に記載の内視鏡下縫合方法。 The endoscopic suturing method according to claim 1, wherein the tissue in the body is a tissue of a luminal organ.
  6. 　内視鏡の先端部に固定される固定要素と、
    　該固定要素が前記内視鏡の先端部に固定された状態において前記内視鏡の先端の前方に位置し、縫合針の針先部を保持および解放可能な針保持要素と、を備え、
    　該針保持要素に前記針先部が刺さることによって該針先部が前記針保持要素に保持される、内視鏡キャップ。     A fixed element fixed to the tip of the endoscope,
    A needle holding element, which is located in front of the tip of the endoscope in a state where the fixing element is fixed to the tip of the endoscope and can hold and release the needle tip of the suture needle, is provided.
    An endoscope cap in which the needle tip portion is held by the needle holding element when the needle tip portion is pierced by the needle holding element.
  7. 　前記針保持要素が、弾性材料から形成され、
    　前記針先部が、該針先部と前記針保持要素との間の摩擦によって該針保持要素に保持される、請求項６に記載の内視鏡キャップ。     The needle holding element is formed of an elastic material and
    The endoscope cap according to claim 6, wherein the needle tip portion is held by the needle holding element by friction between the needle tip portion and the needle holding element.
  8. 　前記針保持要素が、保持面を有し、該保持面の任意の位置に前記針先部が刺さることができる、請求項７に記載の内視鏡キャップ。 The endoscope cap according to claim 7, wherein the needle holding element has a holding surface, and the needle tip portion can be pierced at an arbitrary position on the holding surface.
  9. 　前記保持面が、前記内視鏡の長手軸回りの周方向に交差する、請求項８に記載の内視鏡キャップ。 The endoscope cap according to claim 8, wherein the holding surface intersects in the circumferential direction around the longitudinal axis of the endoscope.
  10. 　請求項６に記載の内視鏡キャップと、
    　該内視鏡キャップに対して相対的に動作可能であり、縫合針を保持および解放可能である保持具と、を備える縫合システム。     The endoscope cap according to claim 6 and
    A suture system comprising a retainer that is movable relative to the endoscope cap and is capable of holding and releasing the suture needle.
PCT/JP2020/009321 2020-03-05 2020-03-05 Endoscopic suturing method, endoscope cap, and suturing system WO2021176635A1 (en)

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JP2007229472A (en) * 2006-02-28 2007-09-13 Olympus Medical Systems Corp Cap mountable to tip of endoscope
JP2011509121A (en) * 2008-01-03 2011-03-24 ウィルソン−クック・メディカル・インコーポレーテッド Medical device, instrument and method for suturing a hole using an endoscope
JP2011524238A (en) * 2008-06-17 2011-09-01 アポロ エンドサージェリー，インコーポレイティド Endoscopic suture system

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2004041733A (en) * 2002-07-11 2004-02-12 Olympus Corp Suturing apparatus for endoscope
JP2007229472A (en) * 2006-02-28 2007-09-13 Olympus Medical Systems Corp Cap mountable to tip of endoscope
JP2011509121A (en) * 2008-01-03 2011-03-24 ウィルソン−クック・メディカル・インコーポレーテッド Medical device, instrument and method for suturing a hole using an endoscope
JP2011524238A (en) * 2008-06-17 2011-09-01 アポロ エンドサージェリー，インコーポレイティド Endoscopic suture system

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