Endoscope needle holder

Abstract

The needle holder for endoscope comprises: a longitudinal flexible tube (2); and a first holding member and a second holding member (3, 4), which are connected to the front end of the flexible tube (2) and can be opened and closed with respect to each other, wherein the first inner surface (3a) of the first holding member (3) has a pair of supporting parts (8) and a groove (10) formed between the pair of supporting parts (8), the groove (10) and the pair of supporting parts (8) extending in the direction along the longitudinal axis of the flexible tube (2), the second inner surface (4a) has a protrusion (9) opposite to the groove (10) and extending in the direction along the longitudinal axis, the top surface (9c) of at least a part of the protrusion (9) is inclined relative to the longitudinal axis, and has a front end side portion (9a) and a base end side portion (9b) facing the base end side and the front end side of the groove (10), respectively, and holds the suture needle between the pair of supporting parts (8), the front end side portion (9a) and the base end side portion (9b).

Description

Technical Field

[0001] The invention relates to an endoscope needle holder and an endoscope suturing method. Background Art

[0002] Conventionally, there are known laparoscopic or endoscopic needle holders for holding a suture needle for suturing body tissue (see, for example, Patent Documents 1 to 4).

[0003] Prior art literature

[0004] Patent Literature

[0005] Patent Document 1: U.S. Patent No. 5,951,587

[0006] Patent Document 2: U.S. Patent No. 6,063,096

[0007] Patent Document 3: U.S. Design Patent No. 773044

[0008] Patent Document 4: U.S. Patent No. 5,196,023 Summary of the Invention

[0009] Problems to be solved by the invention

[0010] To sew tissue under an endoscope, the needle holder holding the suturing needle must be moved to cause the needle tip to penetrate the tissue and protrude from the tissue, and then the needle holder holding the needle tip must be moved to remove the entire suturing needle from the tissue. In other words, when using a single needle holder to suturing tissue, the position of the suturing needle held by the needle holder must be changed.

[0011] As a method of simplifying the operation by eliminating the need for such changes in the holding position, an operation using two needle holders has been proposed. However, the movement of each needle holder inserted into the body via an endoscope is limited to forward and backward movement in the longitudinal direction and rotation around the longitudinal axis, and each needle holder cannot be moved in the lateral direction. In order to smoothly transfer the suture needle from one needle holder to another through such restricted movement, it is important for one needle holder to stably hold the suture needle in an appropriate posture. However, when using the needle holders of Patent Documents 1 to 4, the position and posture of the suture needle held by the needle holder are unstable, and it is not easy to transfer the suture needle from one needle holder to another.

[0012] The present invention has been made in view of the above-mentioned circumstances, and an object of the present invention is to provide an endoscopic needle holder and an endoscopic suturing method that can smoothly transfer a suture needle to another needle holder.

[0013] Solutions for solving problems

[0014] In order to achieve the above-mentioned object, the present invention provides the following solutions.

[0015] A technical solution of the present invention is a needle holder for an endoscope, comprising: a longitudinally elongated flexible tube, which is flexible; and a first holding member and a second holding member, which are connected to the front end of the flexible tube and can be opened and closed with respect to each other, the first holding member having a first inner surface, the second holding member having a second inner surface, the first inner surface and the second inner surface facing each other in a closed state in which the first holding member and the second holding member are closed, the first inner surface having a pair of supporting portions arranged in parallel with each other and a groove formed between the pair of supporting portions, A pair of support portions and the groove extend in the direction along the longitudinal axis of the flexible tube in the closed state, respectively. The second inner surface has a protrusion that is opposite to the groove and extends in the direction along the longitudinal axis in the closed state. The top surface of at least a portion of the protrusion has an inclined surface inclined relative to the longitudinal axis. The inclined surface has a front end side portion facing the base end side of the groove and a base end side portion facing the front end side of the groove. The suture needle is held between the pair of support portions, the front end side portion, and the base end side portion.

[0016] According to the present technical solution, the first holding member and the second holding member are closed to each other, thereby holding the suture needle between the protrusion and the pair of support portions. In the case of a directional curved suture needle, the pair of support portions supporting the radially outer side surface of the suture needle and the protrusion portion located between the pair of support portions in the circumferential direction of the suture needle and supporting the radially inner side surface of the suture needle can be used to maintain the suture needle in a posture along a plane that is orthogonal or substantially orthogonal to the longitudinal axis of the flexible tube.

[0017] In addition, the front end side portion and the base end side portion of the top surface of the projection are inclined in opposite directions. Thus, a suturing needle held by the projection and a pair of supporting portions can be positioned along the longitudinal axis at a position where the front end side portion and the base end side portion of the projection simultaneously contact the suturing needle.

[0018] In this manner, since the posture and position of the suture needle gripped by the first gripping member and the second gripping member are stabilized, the suture needle gripped by the endoscopic needle holder of this embodiment can be smoothly transferred to another needle holder.

[0019] In the above technical solution, the front end portion of at least one of the first inner surface and the second inner surface may include a concave-convex surface having multiple convex portions or multiple concave portions, and the pair of support portions, the groove and the protrusion are arranged at a position closer to the base end side than the concave-convex surface.

[0020] The convex or concave portions of the concave-convex surface function as anti-slip features on the surface of the suture needle. By providing such a concave-convex surface at the front end of at least one inner surface, the suture needle can be securely held at the front end of the gripping member. In particular, the thin needle tip, which is difficult to hold using the protrusion and a pair of support portions, can be securely held at the front end of the gripping member.

[0021] In the above aspect, the front end portion of the first inner surface may have the concavo-convex surface, and the pair of support portions may be offset relative to the concavo-convex surface toward a side opposite to the second inner surface.

[0022] According to this structure, the suturing needle configured on a pair of supporting parts utilizes the step between the concavoconvex surface and the pair of supporting parts to stably stay on the pair of supporting parts.Thereby, it is possible to prevent the suturing needle from deviating from the operator's intention and coming off from the pair of supporting parts toward the concavoconvex surface side.

[0023] In the above technical solution, at least the front end portion of the side surface of one side of each of the first holding member and the second holding member may be a slope surface inclined relative to the longitudinal axis, and the slope surface may be inclined in a direction in which the width of the first holding member and the second holding member gradually decreases as it goes toward the front end side.

[0024] When the first and second gripping members grip the needle tip protruding from the tissue, the side surfaces of each of the first and second gripping members come into contact with the tissue. This can cause the tissue to bulge due to the suture needle pulling. Since the side surfaces of the front ends of the first and second gripping members are sloped, this prevents the first and second gripping members from forcefully contacting the bulging tissue.

[0025] In the above-mentioned technical solution, an opening restriction mechanism for preventing the first gripping member and the second gripping member from opening may be included.

[0026] According to this structure, the opening restriction mechanism prevents the first and second gripping members from opening against the operator's will. Thus, the operator can release their hands from the endoscopic needle holder while maintaining the first and second gripping members closed, gripping the suture needle. This allows, for example, a single operator to operate the endoscopic needle holder and other instruments.

[0027] Another technical solution of the present invention is an endoscopic suturing method, which inserts a first needle holder and a second needle holder into the body through an endoscope to suturing the tissue in the body under endoscope, wherein the suturing method includes the following processes: utilizing the action of the first needle holder that holds the suture needle to make the suture needle penetrate the tissue and make the needle tip of the suture needle protrude from the tissue; utilizing the second needle holder to hold the needle tip protruding from the tissue; utilizing the action of the second needle holder to pull the suture needle out of the tissue; and utilizing the action of the second needle holder to arrange a portion of the suture needle pulled out of the tissue on the track of the first needle holder.

[0028] According to this technical solution, after the suture needle is inserted into the tissue by grasping it with the first needle holder, the second needle holder grasps the needle tip and removes the needle from the tissue. The second needle holder then moves to position a portion of the suture needle on the track of the first needle holder. The movement of the first needle holder, inserted into the body through an endoscope, is limited to movement along and rotation about the longitudinal axis of the first needle holder. This allows for smooth transfer of the suture needle from the second needle holder to the first needle holder.

[0029] The above technical solution may also include the following process: after using the second needle holder to hold the needle tip, separating the first needle holder from the suture needle and moving the first needle holder back along the length direction; and using the first needle holder to hold a part of the suture needle arranged on the track.

[0030] According to this feature, when the suture needle is removed from the tissue by the movement of the second needle holder and when a portion of the suture needle is positioned on the track of the first needle holder by the movement of the second needle holder, the first needle holder can be placed on standby at a position where it does not interfere with the suture needle. This feature may further include a process of advancing the first needle holder after the portion of the suture needle is positioned on the track of the first needle holder.

[0031] In the above aspect, the process of placing a portion of the suture needle on the track by utilizing the movement of the second needle holder may include rotating the second needle holder around its longitudinal axis.

[0032] According to this feature, when the suture needle is a curved needle, a portion of the suture needle held by the second needle holder can be arranged on the track of the first needle holder by rotating the second needle holder about the longitudinal axis.

[0033] The above technical solution may further include the following process: after the suturing needle is pulled out of the tissue, when the second needle holder is rotated, the suturing needle is retracted to a position where the suturing needle held by the second needle holder does not interfere with the tissue.

[0034] According to this feature, when the second needle holder is rotated to arrange a portion of the suture needle on the track, interference between the suture needle and the tissue can be prevented.

[0035] In the above technical solution, a pair of holding members that can be opened and closed to each other may be provided at the front end portion of the second needle holder, and the front end portions of the pair of holding members are used to hold the needle tip protruding from the tissue, and the following process is also included: before a part of the suture needle is arranged on the track of the first needle holder by utilizing the action of the second needle holder, the position of holding the suture needle is changed from the front end portions of the pair of holding members to the base end portions of the pair of holding members.

[0036] When the inner surfaces of the distal ends of the pair of gripping members are provided with the aforementioned concavoconvex surfaces, and the inner surfaces of the proximal ends of the pair of gripping members are provided with the aforementioned protrusions and the pair of supporting portions, the concavoconvex surfaces can be used to securely grip a relatively thin needle tip. The proximal ends of the pair of gripping members can then be used to grip the suture needle in a predetermined posture, allowing the suture needle to be positioned on the track in the predetermined posture.

[0037] In the above technical solution, the tissue in the body may be tissue of a luminal organ.

[0038] Effects of the Invention

[0039] According to the present invention, there is an effect that a suture needle can be easily handed over to another needle holder. BRIEF DESCRIPTION OF THE DRAWINGS

[0040] Figure 1 This is an overall structural diagram of an endoscope needle holder according to one embodiment of the present invention.

[0041] Figure 2A yes Figure 1 A side view of the front end portion of an endoscopic needle holder.

[0042] Figure 2B yes Figure 2A A cross-sectional view of the distal end portion of the endoscopic needle holder taken along line II-II.

[0043] Figure 3A It is a cross-sectional view of the protrusion and the pair of support parts in a state of holding the suture needle, as seen from the front end side.

[0044] Figure 3BA pair of holding members is placed in Figure 3A The partial longitudinal sectional view taken along line III-III is a sectional view showing the protrusion and the pair of support parts in a state where the suture needle is held, as seen from the left side.

[0045] Figure 4A This is an example of an endoscopic image for explaining the first step of the endoscopic suturing method according to one embodiment of the present invention.

[0046] Figure 4B This is an example of an endoscopic image for explaining the second step of the endoscopic suturing method according to one embodiment of the present invention.

[0047] Figure 4C This is an example of an endoscopic image for explaining the second step of the endoscopic suturing method according to one embodiment of the present invention.

[0048] Figure 4D This is an example of an endoscopic image for explaining the third step of the endoscopic suturing method according to one embodiment of the present invention.

[0049] Figure 4E This is an example of an endoscopic image for explaining the third step of the endoscopic suturing method according to one embodiment of the present invention.

[0050] Figure 5 It is a figure explaining the usage method of the 1st holding member and the 2nd holding member which have a sloped surface.

[0051] Figure 6A This is a diagram showing a configuration example of an opening restriction mechanism provided in the operating portion.

[0052] Figure 6B This is a diagram showing another configuration example of the opening restriction mechanism provided in the operating portion.

[0053] Figure 7 This is a diagram showing an example of a mounting tool used in an endoscopic suturing method.

[0054] Figure 8A It is a diagram showing a modified example of the second needle holder used in the endoscopic suturing method.

[0055] Figure 8B It means using Figure 8A FIG2 is a diagram showing a state in which the second needle holder holds a suture needle. DETAILED DESCRIPTION

[0056] Hereinafter, an endoscopic needle holder 1 and an endoscopic suturing method according to an embodiment of the present invention will be described with reference to the drawings.

[0057] like Figures 4A to 4EAs shown, the endoscope needle holder 1 of this embodiment is used in an endoscopic suturing method for suturing tissue S within the body using a suture needle 22 and suture thread 23 under endoscopy. The endoscope is a soft endoscope comprising a flexible, longitudinally elongated insertion portion and a treatment instrument channel extending longitudinally through the insertion portion. The endoscope needle holder 1 is inserted into the body through the treatment instrument channel.

[0058] like Figure 1 As shown, the endoscope needle holder 1 includes a flexible, longitudinally elongated flexible tube 2, a pair of gripping members 3 and 4 connected to the distal end of the flexible tube 2 for gripping a suture needle 22, and an operating portion 5 connected to the proximal end of the flexible tube 2 and operated by an operator.

[0059] In the following description, the up-down direction is a direction perpendicular to the longitudinal axis A of the flexible tube 2 , and the left-right direction is a direction perpendicular to the longitudinal axis A and the up-down direction.

[0060] The flexible tube 2 includes, for example, a coil sheath and has sufficient rigidity to transmit movement and force applied by the operator to the proximal end of the flexible tube 2 to the distal end of the flexible tube 2. Examples of such movement include movement along the longitudinal axis A and rotational movement about the longitudinal axis A. Thus, with the flexible tube 2 extending through the treatment instrument channel and the gripping members 3 and 4 protruding from the distal end face of the endoscope, the operator can advance or retract the pair of gripping members 3 and 4 by advancing or retracting the proximal end of the flexible tube 2 along the longitudinal axis A, and can rotate the pair of gripping members 3 and 4 about the longitudinal axis A by rotating the proximal end of the flexible tube 2 about the longitudinal axis A.

[0061] The pair of gripping members 3 and 4 are arranged in the vertical direction, and their base ends are connected to each other so as to be swingable around a swing axis extending in the left-right direction. The pair of gripping members 3 and 4 can be opened and closed in the vertical direction.

[0062] In the reference drawings, the pair of gripping members 3 and 4 are of a single-opening type in which the lower first gripping member 3 is fixed to the flexible tube 2 and the upper second gripping member 4 swings. However, they may also be of a double-opening type in which both the first gripping member 3 and the second gripping member 4 swing.

[0063] The operating portion 5 is connected to the second gripping member 4 via a longitudinally extending power transmission member, such as a wire, that passes through the interior of the flexible tube 2. The power transmission member transmits force applied by the operator to the operating portion 5 to the second gripping member 4, causing the second gripping member 4 to swing, thereby opening and closing the gripping members 3 and 4. For example, the operating portion 5 includes a shaft 5a extending along the longitudinal axis A and a slider 5b slidable along the shaft 5a. The operator can close the gripping members 3 and 4 by pulling the slider 5b toward the proximal end, and can open the gripping members 3 and 4 by pushing the slider 5b toward the distal end.

[0064] like Figure 2A and Figure 2B As shown, the first holding member 3 has a first inner surface 3a, and the second holding member 4 has a second inner surface 4a. The first inner surface 3a and the second inner surface 4a are opposite to each other in the upper and lower directions when the first holding member 3 and the second holding member 4 are closed.

[0065] The first and second gripping members 3 and 4 can grip the suture needle 22 in two ways: gripping the suture needle 22 with the concavoconvex surfaces 6 and 7 at the distal end and gripping the suture needle 22 with the pair of support portions 8 and the protrusion 9 at the proximal end.

[0066] Specifically, the front end portion of the first inner surface 3a has a concavo-convex surface 6, and the front end portion of the second inner surface 4a has a concavo-convex surface 7. The concavo-convex surfaces 6 and 7 have a plurality of convex portions or a plurality of concave portions that function as anti-slip members relative to the surface of the suture needle 22. For example, the concavo-convex surfaces 6 and 7 have a plurality of convex portions 6a and 7a formed by cutting a flat surface, and each convex portion 6a and 7a is formed into a quadrangular pyramid shape by, for example, diamond cutting.

[0067] Furthermore, the proximal end portion of the first inner surface 3a has a groove 10 and a pair of support portions 8, and the proximal end portion of the second inner surface 4a has a protrusion 9. The groove 10 and the pair of support portions 8 are provided on the proximal side of the first gripping member 3 relative to the concave-convex surface 6, and the protrusion 9 is provided on the proximal side of the second gripping member 4 relative to the concave-convex surface 7.

[0068] The groove 10 is formed between the pair of support portions 8. The groove 10 and the pair of support portions 8 extend in the direction along the longitudinal axis A and are arranged side by side in the left-right direction of the first inner surface 3a.

[0069] The protrusion 9 is opposite to the groove 10 in the closed state and extends in the direction along the longitudinal axis A. In the closed state, the distance between the protrusion 9 and each support 8 in the vertical direction is smaller than the diameter of the suture needle 22. Figure 3A As shown, the suture needle 22 can be grasped between the protrusion 9 and the pair of support portions 8 .

[0070] The suturing needle 22 is a curved needle that bends in one direction. The radially outer side surface 22b of the suturing needle 22 is supported by a pair of supporting portions 8 at two positions spaced apart from each other in the circumferential direction of the suturing needle 22. The radially inner side surface 22c of the suturing needle 22 is supported by a protrusion 9 at a position between the two positions in the circumferential direction. By supporting the outer surface of the suturing needle 22 at these three points, the posture of the suturing needle 22 is fixed to a posture along a plane that is orthogonal or substantially orthogonal to the longitudinal axis A.

[0071] like Figure 3A As shown, the protrusion 9 is formed in a protruding shape toward the first gripping member 3 when viewed from the front along the longitudinal axis A. Furthermore, the protrusion 9 has a top surface 9c that faces the first inner surface 3a and extends along the ridgeline of the protrusion 9. The top surface 9c is curved midway along the longitudinal direction of the protrusion 9 when viewed from the side, which is perpendicular to the longitudinal axis A and the opening and closing direction of the gripping members 3 and 4. In the closed state, the top surface 9c extends in an arched shape that protrudes upward, which is the side opposite the first inner surface 3a.

[0072] Specifically, if Figure 3B As shown, at least a portion of the top surface 9c of the protrusion 9 has an inclined surface inclined relative to the longitudinal axis A. This inclined surface includes a leading portion 9a facing the proximal end of the groove 10 and a proximal portion 9b facing the distal end of the groove 10. The leading portion 9a and the proximal portion 9b are inclined in opposite directions relative to the longitudinal axis A. For example, the distance from the groove 10 to the leading portion 9a gradually increases as it moves from the distal end toward the proximal end, while the distance from the groove 10 to the proximal portion 9b gradually decreases as it moves from the distal end toward the proximal end. Thus, the suture needle 22 is held between the leading portion 9a, the proximal portion 9b, and the pair of support portions 8. The held suture needle 22 is restricted from distal movement by the leading portion 9a and from proximal movement by the proximal portion 9b. Consequently, the suture needle 22 is positioned along the longitudinal axis A at a position where both the leading portion 9a and the proximal portion 9b are in contact with the outer surface of the suture needle 22. The cross-sectional shape of the suture needle 22 is preferably an oblong shape having radially inner and radially outer sides that are parallel to each other.

[0073] like Figure 2A As shown, the pair of support portions 8 are offset downward relative to the concavo-convex surface 6, and a step in the vertical direction is formed between the pair of support portions 8 and the concavo-convex surface 6. As a result, the suture needle 22 placed on the pair of support portions 8 stays stably on the pair of support portions 8, and the suture needle 22 can be prevented from slipping out of the pair of support portions 8 toward the concavo-convex surface 6 against the operator's intention.

[0074] Next, refer to Figures 4A to 4E An endoscopic suturing method for suturing tissue S in the body using the endoscopic needle holder 1 will be described.

[0075] The endoscopic suturing method of the present embodiment is a method of suturing tissue S while observing the tissue S with the endoscope using an endoscope and two needle holders 1 and 21 having two treatment instrument channels. Tissue S is, for example, tissue of a tubular organ such as the esophagus, stomach, small intestine, or large intestine. The first needle holder 21 is any needle holder commonly used for suturing tissue S under an endoscope, and the second needle holder (needle holder for endoscope) 1 is a needle holder for endoscope 1. The first needle holder 21 and the second needle holder 1 are inserted into the body through the respective treatment instrument channels. The two treatment instrument channels do not necessarily have to be provided inside the endoscope. For example, one treatment instrument channel may be installed on the outside of the endoscope.

[0076] The endoscopic suturing method includes a first step of using a first needle holder 21 to penetrate a suture needle 22 into a tissue S and protrude a needle tip 22a from the tissue S, a second step of using a second needle holder 1 to pull out the suture needle 22 from the tissue S, and a third step of transferring the suture needle 22 from the second needle holder 1 to the first needle holder 21.

[0077] like Figure 4A As shown, in the first step, the operator grasps the suture needle 22 using a pair of gripping members 21a, 21b of the first needle holder 21 protruding from the distal end face of the endoscope, with the suture needle 22 positioned along a plane perpendicular or substantially perpendicular to the longitudinal axis of the first needle holder 21. The operator then rotates the first needle holder 21 about its longitudinal axis to insert the needle tip 22a into the tissue S, rotating the first needle holder 21 until the needle tip 22a protrudes from the tissue S. In the first step, the second needle holder 1 is retracted to a position where it does not interfere with the needle tip 22a protruding from the tissue S.

[0078] Then, if Figure 4B As shown, in the second step, the operator advances the second needle holder 1 and uses the distal ends of the pair of gripping members 3 and 4 of the second needle holder 1 to grip the needle tip 22a protruding from the tissue S. Because the inner surfaces of the distal ends of the gripping members 3 and 4 are formed as concave and convex surfaces 6 and 7, even when the thin needle tip 22a protrudes only slightly from the tissue S, the distal ends of the pair of gripping members 3 and 4 can firmly grip the needle tip 22a.

[0079] Then, if Figure 4C As shown, the operator separates the first needle holder 21 from the suture needle 22 and retracts it. Then, the operator rotates the second needle holder 1 about the longitudinal axis A to pull the entire suture needle 22 out of the tissue S.

[0080] At this time, the curved portion of the endoscope may be moved in a direction to pull the suture needle 22 out of the tissue S (in the direction of the curved portion). Figure 4B and Figure 4CBy using the bending action of the bending portion, the pair of gripping members 3, 4 and the suture needle 22 gripped by the pair of gripping members 3, 4 can be moved to easily remove the suture needle 22 from the tissue S.

[0081] After the suture needle 22 is removed from the tissue S and before the third step is performed, the suture needle 22 may be retracted from the tissue S to a position where the suture needle 22 held by the second needle holder 1 does not interfere with the tissue S, if necessary, by rotating the second needle holder 1 while operating the endoscope. For example, the second needle holder 1 holding the suture needle 22 may be moved to a position away from the suture site of the tissue S by bending the bending portion of the endoscope. This prevents the suture needle 22 from interfering with the tissue S due to the rotation of the second needle holder 1 in the subsequent third step.

[0082] Furthermore, during the process of withdrawing the suture needle 22, the position of the suture needle 22 held by the second needle holder 1 can be changed from the needle tip 22a to a position closer to the base end than the needle tip 22a, as needed. In this case, the position of the suture needle 22 held by the second needle holder 1 is changed from between the concave and convex surfaces 6 and 7 at the front end to between the pair of support portions 8 and the protrusion 9 at the base end.

[0083] Then, if Figure 4D As shown, in the third step, the operator rotates the second needle holder 1 about the longitudinal axis A in a direction opposite to the rotation direction of the second needle holder 1 in the second step, thereby positioning the portion of the suture needle 22 suitable for being grasped by the first needle holder 21 on the track B of the first needle holder 21. The track B is a path for the first needle holder 21 to advance and retreat, and is aligned or substantially aligned with an extension of the longitudinal axis of the treatment instrument channel into which the first needle holder 21 is inserted.

[0084] Here, as described above, the operator changes the position of holding the suture needle 22 from the front end portion of the pair of holding members 3 and 4 to the base end portion of the pair of holding members 3 and 4 before rotating the second needle holder 1. That is, the state of holding the suture needle 22 by the concave-convex surfaces 6 and 7 is switched to the state of holding the suture needle 22 by the protrusion 9 (the front end side portion 9a and the base end side portion 9b) and the pair of support portions 8. As a result, the suture needle 22 is maintained in a posture along a plane that is orthogonal or approximately orthogonal to the longitudinal axis A by the protrusion 9 and the pair of support portions 8. In addition, since the top surface 9c of the protrusion 9 is arched when viewed from the side, the suture needle 22 is positioned relative to the pair of holding members 3 and 4 in the direction along the longitudinal axis A, preventing the suture needle 22 from shaking in the direction along the longitudinal axis A.

[0085] Then, if Figure 4EAs shown, the operator advances the first needle holder 21 toward the portion of the suture needle 22 disposed on the track B, and grasps a portion of the suture needle 22 with the first needle holder 21. At this time, since the two needle holders 1 and 21 protrude approximately parallel to each other from the front end of the endoscope, the suture needle 22 grasped by the base ends of the pair of grasping members 3 and 4 is maintained in a posture along a plane that is orthogonal or approximately orthogonal to the longitudinal axis of the first needle holder 21. In addition, the suture needle 22 grasped by the base ends of the pair of grasping members 3 and 4, that is, the protrusion 9 and the pair of support portions 8, does not wobble in the direction along the longitudinal axis A and is stably held in a constant position. Therefore, the suture needle 22 can be easily grasped in an appropriate posture using the first needle holder 21.

[0086] The movement of the first needle holder 21, inserted into the body through the treatment instrument channel, is restricted to advance and retreat along the longitudinal axis and rotation about the longitudinal axis. Similarly, the movement of the second needle holder 1, inserted into the body through another treatment instrument channel, is restricted to advance and retreat along the longitudinal axis A and rotation about the longitudinal axis A. Therefore, when transferring the suture needle 22 from the second needle holder 1 to the first needle holder 21, the position and posture of the suture needle 22 relative to the first needle holder 21 must be adjusted solely by advancing and retreating and rotating the second needle holder 1 relative to the first needle holder 21.

[0087] According to this embodiment, the pair of support portions 8 and protrusions 9 provided at the base ends of the pair of gripping members 3 and 4 of the second needle holder 1 stably hold the suture needle 22 in a constant position along a plane perpendicular or substantially perpendicular to the longitudinal axis of the first needle holder 21. Furthermore, rotation of the second needle holder 1 causes a portion of the suture needle 22 to be positioned on the track B of the first needle holder 21. This allows for smooth transfer of the suture needle 22 from the second needle holder 1 to the first needle holder 21.

[0088] In this embodiment, it is also possible to Figure 5 As shown, at least the front end of the right side surface of each gripping member 3, 4 has a sloped surface 3b, 4b that is inclined relative to the longitudinal axis A. The sloped surfaces 3b, 4b are inclined in a direction such that the width of the gripping members 3, 4 in the left-right direction gradually decreases toward the front end. The sloped surfaces 3b, 4b may also be provided along the entire longitudinal length of the gripping members 3, 4. In a plan view from above or below, the sloped surfaces 3b, 4b may be either flat or convex.

[0089] The left side surface of each gripping member 3 , 4 is parallel or substantially parallel to the longitudinal axis A. Therefore, the gripping members 3 , 4 have an asymmetric shape with respect to the longitudinal axis A in a plan view seen from above or below.

[0090] With the needle tip 22a protruding from the tissue S, the tissue S is pulled by the needle tip 22a, causing it to bulge. When the second needle holder 1 is advanced toward the needle tip 22a to grasp the needle tip 22a with the pair of gripping members 3 and 4, the slopes 3b and 4b on the right side surfaces of the gripping members 3 and 4 advance along the surface of the bulging tissue S. Furthermore, the force exerted by the slopes 3b and 4b from the tissue S causes the distal end of the flexible tube 2 to bend to the left, the side opposite the tissue S. This allows the second needle holder 1 to grasp the suture needle 22 protruding further to the left in the endoscopic image, and prevents the gripping members 3 and 4 from strongly contacting the bulging tissue S.

[0091] In the present embodiment, the needle holder 1 for an endoscope may further include an opening restriction mechanism for preventing the pair of gripping members 3 and 4 from opening to each other.

[0092] In surgeries using an endoscope and two needle holders 1 and 21, as in the present embodiment, one doctor typically operates the endoscope, while two assistants operate the two needle holders 1 and 21. Providing an opening restriction mechanism on the second needle holder 1 facilitates operation of both the endoscope and the second needle holder 1 by a single doctor. Specifically, while the opening restriction mechanism maintains the pair of gripping members 3 and 4 holding the suture needle 22 in a closed position, the doctor can release his hand from the operating portion 5 of the needle holder 1 and operate the endoscope. Alternatively, a single assistant can easily operate both needle holders 1 and 21 simultaneously. Thus, the endoscopic suturing method of the present embodiment can be performed by a single doctor and an assistant.

[0093] Figure 6A and Figure 6B The opening restriction mechanism is provided on the operation portion 5 and prevents the slider 5b from moving toward the distal end corresponding to the opening direction of the pair of gripping members 3 and 4 when the operator does not apply force to the slider 5b.

[0094] Figure 6A The opening restriction mechanism includes a biasing member 11 for biasing the slider 5b toward the proximal end, corresponding to the closing direction of the pair of gripping members 3 and 4. The biasing member 11 is, for example, a compression spring disposed within the shaft 5a and compressible in a direction along the longitudinal axis A. Reference numeral 13 denotes a power transmission member connecting the slider 5b and the second gripping member 4. The operator overcomes the biasing force of the biasing member 11 and moves the slider 5b toward the distal end, thereby opening the pair of gripping members 3 and 4.

[0095] Figure 6BThe opening restriction mechanism is a ratchet mechanism that restricts the movement of the slider 5b only in the direction toward the proximal end, corresponding to the closing direction of the pair of gripping members 3 and 4. This mechanism includes a plurality of teeth 12a formed on the outer circumference of the shaft 5a, a button 12b provided on the slider 5b, a movable member 12d fixed to the button 12b and having a claw 12c, and an urging member 12e for urging the movable member 12d in the direction in which the claw 12c engages with the groove between the teeth 12a. The plurality of teeth 12a are arranged along the longitudinal axis A and have a shape that allows the claw 12c to move toward the proximal end while locking the claw 12c from moving toward the distal end.

[0096] When the button 12b is not pressed, the operator can move the slider 5b toward the base end side to close the pair of gripping members 3 and 4. In addition, by pressing the button 12b, the operator can move the movable member 12d in the direction in which the claw 12c is disengaged from between the teeth 12a, overcoming the biasing force of the biasing member 12e, thereby switching the slider 5b to a state in which it can move freely in both directions along the longitudinal direction of the shaft 5a.

[0097] In order to allow the doctor to easily operate both the endoscope and the second needle holder 1, a mounting member for mounting the base end of the second needle holder 1 on the endoscope may be used. Figure 7 As shown, a C-shaped hook is used as the attachment member 30. The C-shaped hook 30 is attached to the operating portion 5 of the second needle holder 1, for example, the front end portion of the shaft 5a.

[0098] In this embodiment, both the first inner surface 3a and the second inner surface 4a have the concavo-convex surfaces 6 and 7. However, instead, only one of the first inner surface 3a and the second inner surface 4a may have the concavo-convex surface 6 or the concavo-convex surface 7. By providing at least one of the inner surfaces 3a and 4a with the concavo-convex surface 6 or the concavo-convex surface 7, the thin needle tip 22a can be firmly grasped.

[0099] In the endoscopic suturing method of this embodiment, a general-purpose needle holder is used as the first needle holder 21. However, an endoscopic needle holder 1 may be used instead. That is, two endoscopic needle holders 1 may be used to perform the endoscopic suturing method.

[0100] In the endoscopic suturing method of this embodiment, the second needle holder may also use other needle holders instead of the endoscope needle holder 1. For example, Figure 8AAs shown, a multi-legged forceps 40 having multiple legs is used as the second needle holder. Multi-legged forceps 40 comprises a tubular, longitudinally elongated sheath 40a and multiple legs 40b disposed within sheath 40a. The legs 40b are capable of independent movement relative to sheath 40a. The distal end of each leg 40b is bent radially outward from sheath 40a and elastically deforms into a straight shape within sheath 40a. Consequently, by protruding from the front end of sheath 40a, the distal ends of the legs 40b can be extended radially outward.

[0101] Therefore, it is possible to Figure 8B As shown, the needle tip 22a protruding from the tissue S is grasped between multiple legs 40b or between a leg 40b and the distal end of the sheath 40a. In this embodiment, since the suture needle 22 is grasped by the advancement and retraction of the legs 40b, the second needle holder 1 is easily positioned relative to the needle tip 22a protruding from the tissue S. Furthermore, although a multi-legged forceps 40 is shown as an example, the number of legs 40b does not necessarily need to be multiple; a single leg 40b is also possible. Since the needle tip 22a can be grasped between a single leg 40b and the distal end of the sheath 40a, even when the second needle holder has only one leg 40b, the second needle holder is easily positioned relative to the needle tip 22a protruding from the tissue S, similar to the multi-legged forceps 40.

[0102] In this embodiment, a case where a curved needle having an oblong cross-sectional shape is used as the suture needle 22 is described. However, a curved needle having another cross-sectional shape such as a circular or elliptical shape can also be used in the endoscope needle holder 1 .

[0103] Description of Reference Numerals

[0104] 1. Endoscope needle holder, second needle holder; 2. Flexible tube; 3. First gripping member; 3a. First inner surface; 3b, 4b. Slope surface; 4. Second gripping member; 4a. Second inner surface; 5. Operating portion; 6, 7. Concave and convex surfaces; 6a, 7a. Protrusions; 8. Support portion; 9. Protrusion; 10. Groove; 11. Force-applying member, opening limiting mechanism; 12a, 12b, 12c, 12d, 12e. Opening limiting mechanism; 13. Power transmission member; 21. First needle holder; 22. Suture needle; 23. Suture thread; 30. Multi-legged forceps, second needle holder; A. Length axis of flexible tube; B. Track; S. Tissue.

Claims

1. A needle holder for endoscope, wherein: The endoscope needle holder includes: a longitudinal flexible tube having flexibility; and The first holding member and the second holding member are connected to the front end of the flexible tube and can be opened and closed with each other. The first holding member has a first inner surface, and the second holding member has a second inner surface, and the first inner surface and the second inner surface are opposite to each other in a closed state in which the first holding member and the second holding member are closed. The first inner surface has a pair of supporting portions arranged side by side with each other and a groove extending between the pair of supporting portions. The second inner surface has a protrusion protruding toward the groove at a position opposite to the groove, The top surface of at least a portion of the protrusion has an inclined surface inclined relative to the longitudinal axis of the flexible tube in order to restrict movement of the suture needle between the top surface of at least a portion and the pair of support portions. A concavo-convex surface having a plurality of convex portions or a plurality of concave portions is formed on the first inner surface at a position closer to the front end side than the pair of support portions. The pair of support portions are offset relative to the concavo-convex surface toward a side opposite to the second inner surface.

2. The endoscope needle holder according to claim 1, wherein The groove and the protrusion are provided on a base end side relative to the concavo-convex surface.

3. The needle holder for endoscope according to claim 1, wherein At least the front end portion of the side surface of each of the first holding member and the second holding member is a sloped surface inclined with respect to the longitudinal axis. The slope surface is inclined in a direction in which the widths of the first gripping member and the second gripping member gradually decrease toward the distal end side.

4. The needle holder for endoscope according to claim 1, wherein This needle holder for an endoscope includes an opening restriction mechanism for preventing the first gripping member and the second gripping member from opening.

5. The needle holder for endoscope according to claim 1, wherein The pair of support portions and the groove extend in directions along the longitudinal axis of the flexible tube, respectively. The inclined surface has a front end portion facing the base end side of the groove and a base end portion facing the front end side of the groove. The suture needle is gripped between the pair of support portions, the distal end portion, and the proximal end portion.

6. The needle holder for endoscope according to claim 1, wherein A concavo-convex surface having a plurality of convex portions or a plurality of concave portions is formed at a position of the second inner surface facing the concavo-convex surface of the first inner surface.

7. The needle holder for endoscope according to claim 1, wherein The suture needle is a curved needle.

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