Traction device, suture traction method, and suturing method

Abstract

A traction tool for traction of a suture under a flexible endoscope, wherein the traction tool includes a shaft, a first holding portion provided at a front end of the shaft and capable of holding the suture or a suture needle attached to the suture, and a second holding portion provided at a position on a base end side of the shaft than the first holding portion and for hooking the suture, the second holding portion being capable of expanding in a radial direction of the shaft.

Description

TECHNICAL FIELD

[0001] The present application relates to a traction device, a suture line traction method, and a suturing method. BACKGROUND

[0002] In the past, a surgery of suturing a wound portion in a lumen organ such as a digestive tract under observation of an endoscope has been performed. In such a surgery, a device such as an endoscope needle holder that holds and operates a suture needle is used.

[0003] In Patent Literature 1, an endoscopic suture device is described. The suture device described in Patent Literature 1 stretches a tissue, and penetrates a suture needle into the stretched tissue. The endoscopic suture device sutures the tissue by hooking a suture line on the tip of the suture needle that penetrates the tissue and returning the suture needle to the original position.

[0004] Prior art documents

[0005] Patent documents

[0006] Patent Literature 1: U.S. Patent Application Publication No. 2018 / 042602 SUMMARY

[0007] PROBLEMS TO BE SOLVED BY THE INVENTION

[0008] However, the endoscopic suture device described in Patent Literature 1 is a large suture device, and is not necessarily the most suitable device for a suturing operation in a narrow lumen organ in which it is difficult to secure a space for pulling a suture line attached to a suture needle.

[0009] In view of the above circumstances, it is an object of the present application to provide a traction device, a suture line traction method, and a suturing method that can sufficiently tighten a wound portion by pulling a suture line attached to a suture needle in a suturing operation in a narrow lumen organ.

[0010] SOLUTION TO PROBLEM

[0011] In order to solve the above problem, the present application proposes the following solutions.

[0012] The traction device of the first technical solution of the present application is a traction device that pulls a suture line under a flexible endoscope, and includes a shaft, a first holding portion provided at a distal end of the shaft and capable of holding the suture line or a suture needle attached to the suture line, and a second holding portion provided at a position closer to a base end of the shaft than the first holding portion and for hooking the suture line, the second holding portion being capable of expanding in a radial direction of the shaft.

[0013] The suture thread pulling method of the second aspect of the present application uses the above-described pulling device, wherein the suture thread is wound around the second holding portion expanded in the radial direction and the suture thread is pulled in a state where the first holding portion holds the suture thread or the suture needle fixed to the suture thread.

[0014] The suture method of the third aspect of the present application uses a pulling device enclosed in a wound portion formed in a tube wall of a tubular organ, the pulling device including a shaft, a first holding portion provided at a front end of the shaft and capable of holding a suture thread or a suture needle attached to the suture thread, and a second holding portion provided at a position closer to a base end side of the shaft than the first holding portion and for hooking the suture thread, the second holding portion being expandable in a radial direction of the shaft, wherein the suture method includes the following steps: a first step in which the suture thread is hooked at a first edge portion of the wound portion; a second step in which the suture thread extending from the first edge portion is hooked at a second edge portion of the wound portion, the second edge portion being at a position facing the first edge portion with the wound portion interposed therebetween; and a third step in which, while holding the suture thread at a first portion extending from the second edge portion or the suture needle, a second portion of the suture thread extending between the suture needle and the second edge portion or between the first portion and the second edge portion is hooked to the second holding portion and wound around the shaft.

[0015] Effects of the Invention

[0016] With the pulling device, the treatment system, the suture thread pulling method, and the suture method of the present application, the suture thread attached to the suture needle can be pulled to sufficiently tighten the wound portion in a suture operation in a narrow tubular organ. BRIEF DESCRIPTION OF DRAWINGS

[0017] Figure 1 is a whole view of the treatment system of the first embodiment.

[0018] Figure 2 is a whole view of the pulling device of the treatment system.

[0019] Figure 3 is a cross-sectional view of a front end portion of the pulling device.

[0020] Figure 4 is a cross-sectional view taken along Figure 3 the X―X line shown in the figure.

[0021] Figure 5 is a view showing the balloon in a natural state.

[0022] Figure 6 is a view showing the balloon in a dilated state.

[0023] Figure 7 This is a cross-sectional view of the front end of the sheath of the traction device.

[0024] Figure 8 This is a perspective view showing the rigid parts and the gripping parts of the traction device.

[0025] Figure 9 This is a cross-sectional view showing the connection between the sheath and the operating part of the traction device.

[0026] Figure 10 This is a diagram representing suture lines.

[0027] Figure 11 This is a diagram illustrating the first and second steps of a surgical procedure using this traction device.

[0028] Figure 12 This diagram illustrates the third step of a surgical procedure using this traction device.

[0029] Figure 13 This diagram illustrates the third step of a surgical procedure using this traction device.

[0030] Figure 14 This diagram illustrates the fourth step of a surgical procedure using this traction device.

[0031] Figure 15 This diagram illustrates the fifth step of a surgical procedure using this traction device.

[0032] Figure 16 This diagram illustrates the fifth step of a surgical procedure using this traction device.

[0033] Figure 17 This diagram illustrates the fifth step of a surgical procedure using this traction device.

[0034] Figure 18 This diagram illustrates the fifth step of a surgical procedure using this traction device.

[0035] Figure 19 An overall view of a modified version of the traction device.

[0036] Figure 20 This is a diagram showing the usage configuration of a modified version of the balloon.

[0037] Figure 21 It is along Figure 20 A cross-sectional view of the Y-Y line.

[0038] Figure 22 This is a diagram showing another variation of the balloon in use.

[0039] Figure 23 It is along Figure 22A cross-sectional view of the Z-Z line.

[0040] Figure 24 This is a diagram showing a modified example of the balloon.

[0041] Figure 25 This is a perspective view showing a modified example of the gripping part of the traction device.

[0042] Figure 26 This is a diagram showing another variation of the balloon.

[0043] Figure 27 This is a diagram showing another variation of the balloon.

[0044] Figure 28 This is a diagram showing the traction device of the treatment system according to the second embodiment.

[0045] Figure 29 This is a diagram showing the traction device with the enlarged diameter section. Detailed Implementation

[0046] (First Implementation)

[0047] Reference Figures 1 to 18 The processing system 300 of the first embodiment of the present invention will be described. Figure 1 This is an overall diagram of the processing system 300 of this embodiment.

[0048] [Disposal System 300]

[0049] like Figure 1 As shown, the treatment system 300 includes a flexible endoscope 200 and a traction device 100. The traction device 100 is inserted into the flexible endoscope 200 for use.

[0050] [Flexible endoscope 200]

[0051] like Figure 1 As shown, the flexible endoscope 200 includes an insertion part 202 that is inserted into the body from the front end and an operation part 207 that is mounted on the base end of the insertion part 202.

[0052] The insertion part 202 includes a camera part 203, a curved part 204, and a flexible part 205. The camera part 203, curved part 204, and flexible part 205 are arranged from the front end of the insertion part 202 in the following order: camera part 203, curved part 204, and flexible part 205. A channel 206 for inserting the traction device 100 is provided inside the insertion part 202. A front opening 206a of the channel 206 is provided at the front end of the insertion part 202.

[0053] The imaging section 203 includes, for example, a CCD, a CMOS, or the like, and is capable of imaging a site that is a target of treatment. The imaging section 203 is capable of imaging the grip section 7 of the traction tool 100 in a state in which the traction tool 100 protrudes from the front end opening section 206a of the channel 206.

[0054] The curved section 204 is bent in accordance with an operation performed by an operator on the operation section 207. The flexible section 205 is a tubular section having flexibility.

[0055] The operation section 207 is connected to the flexible section 205. The operation section 207 includes a handle 208, an input section 209, a base end opening section 206b of the channel 206, and a general-purpose cable 210. The handle 208 is a section that is held by an operator. The input section 209 accepts an operation input for causing the curved section 204 to bend. The general-purpose cable 210 outputs an image captured by the imaging section 203 to the outside. The general-purpose cable 210 is connected to a display device such as a liquid crystal display via an image processing device that includes a processor or the like.

[0056] [Traction tool 100]

[0057] Figure 2 is a general view of the traction tool 100.

[0058] The traction tool 100 includes a proximal shaft 1, a distal shaft 2, a balloon (second holding section) 3, a tube hub 4, and a needle holder 150.

[0059] Figure 3 is a cross-sectional view of a front end section of the traction tool 100.

[0060] The proximal shaft 1 is a longitudinal member that is inserted into a body cavity endoscopically. The proximal shaft 1 is capable of being inserted into the channel 206 of the flexible endoscope 200. The proximal shaft 1 has flexibility.

[0061] Figure 4 is a cross-sectional view along the X-X line shown in Figure 3 .

[0062] The proximal shaft 1 has a first lumen 11 and a second lumen 12. The first lumen 11 and the second lumen 12 pass through in the length direction of the proximal shaft 1. The first lumen 11 and the second lumen 12 are arranged side by side (double shaft type). The first lumen 11 can also be arranged in a manner that surrounds the outer peripheral section of the second lumen 12 (coaxial type).

[0063] The distal shaft 2 protrudes from the distal side end surface of the proximal shaft 1 at a position that is distal from the proximal shaft 1. The outer diameter of the distal shaft 2 is smaller than the outer diameter of the proximal shaft 1.

[0064] The proximal shaft 1 has a base end portion 1b having a larger outer diameter than other portions on the base end side. The base end portion 1b is not inserted into the channel 206 of the flexible endoscope 200, and the proximal shaft 1 has a connecting member 13 that connects the base end portion 1b and the operation portion 8 of the needle holder 150. The connecting member 13 is formed in a cylindrical shape.

[0065] The distal shaft 2 is a shaft-like member that is inserted into a body cavity endoscopically. The distal shaft 2 extends in the length direction of the proximal shaft 1. The distal shaft 2 has a third lumen 23. The third lumen 23 penetrates in the length direction of the distal shaft 2. The third lumen 23 communicates with the first lumen 11 of the proximal shaft 1. As shown in Figure 3 and Figure 4 The sheath 5 of the needle holder 150 penetrates the first lumen 11 and the third lumen 23.

[0066] The balloon (second holding portion) 3 is a thin-walled, cylindrical member. The balloon 3 is formed of an elastic raw material such as natural rubber. The balloon 3 has a first connecting portion 31, a second connecting portion 32, and a balloon main body 33. The inner space I of the balloon main body 33 communicates with the second lumen 12 of the proximal shaft 1. In the inner space I of the balloon main body 33, no opening that communicates with the outside is formed other than the second lumen 12. Therefore, a fluid can be supplied to the balloon 3 via the second lumen 12. When a fluid is supplied to the inner space I, the balloon 3 expands (dilates) in the radial direction of the distal shaft 2. The fluid can be either a liquid or a gas. The fluid is, for example, a contrast medium, helium gas, physiological saline, carbon dioxide (CO2) gas, oxygen (O2) gas, nitrogen (N2) gas, air, or the like.

[0067] In the following description, a state in which the balloon 3 is not inflated is defined as a "natural state" of the balloon 3. A state in which the balloon 3 is inflated and at least a part thereof is dilated from the natural state is defined as a "dilated state" of the balloon 3.

[0068] The first connecting portion 31 is cylindrical. The first connecting portion 31 is formed at the distal side end of the balloon 3. The first connecting portion 31 is liquid-tightly attached to the outer peripheral surface of the distal shaft 2 in a state of covering the distal side end of the distal shaft 2.

[0069] The joining means of the first connecting portion 31 and the distal shaft 2 is not particularly limited as long as they are liquid-tightly attached to each other. For example, the joining means of the first connecting portion 31 and the distal shaft 2 can be an adhesive or heat fusion.

[0070] The second connecting portion 32 is cylindrical. The second connecting portion 32 is formed at the proximal side end of the balloon 3. The second connecting portion 32 is liquid-tightly attached to the outer peripheral surface of the proximal shaft 1 in a state of covering the distal side end of the proximal shaft 1.

[0071] For the joining means of the second connecting portion 32 and the proximal shaft 1, there is no particular limitation as long as they are liquid-tightly attached to each other. For example, the joining means of the second connecting portion 32 and the distal shaft 2 can also be an adhesive or heat fusion.

[0072] The balloon body 33 is located between the first connecting portion 31 and the second connecting portion 32. That is, the balloon body 33 is sandwiched by the first connecting portion 31 and the second connecting portion 32. The balloon body 33 surrounds at least a portion of the distal shaft 2. When the balloon 3 is inflated, the inner peripheral surface of the balloon body 33 is away from the outer peripheral surface of the distal shaft 2.

[0073] The balloon body 33 preferably has a recessed portion 34 in the middle portion in the length direction, which has a smaller outer diameter in the expanded state than the other portions of the balloon body 33. Alternatively, the balloon body 33 can not have the recessed portion 34.

[0074] Figure 5 is a view of the balloon 3 in the natural state.

[0075] In a state where no fluid is supplied to the internal space I of the balloon body 33, the balloon body 33 is arranged in a state of being wound along the outer peripheral surface of the distal shaft 2. In the state where the balloon body 33 is wound around the outer peripheral surface of the distal shaft 2, the outer diameter of the balloon body 33 is approximately equal to the outer diameter of the proximal shaft 1. Therefore, in a state where no fluid is introduced into the balloon body 33, the distal shaft 2 can pass through the channel 206 of the flexible endoscope 200.

[0076] Figure 6 is a view of the balloon 3 in the expanded state.

[0077] When fluid is supplied from the second lumen 12 to the internal space I, the fluid is enclosed in the internal space I, and the balloon body 33 is inflated.

[0078] The tube hub 4 is a valve through which fluid passes. Fluid is supplied to the tube hub 4 from a fluid supply device (not shown). The fluid supply device is, for example, an inflator or the like, and can adjust the pressure of the fluid to be supplied. The fluid is pressurized by the fluid supply device to inflate the balloon 3.

[0079] A closed-circuit cock 41 is provided at the end portion on the proximal side of the tube hub 4. The fluid supply device can be connected to the tube hub 4 through the closed-circuit cock 41. The closed-circuit cock 41 opens and closes the flow path of the fluid.

[0080] A tube 42 is connected to the end portion on the distal side of the tube hub 4. The tube 42 can pass fluid therethrough. The proximal shaft 1 is connected to the end portion on the distal side of the tube 42. The internal space of the tube 42 communicates with the second lumen 12 of the proximal shaft 1. The fluid supplied from the tube hub 4 flows into the second lumen 12.

[0081] As Figure 2As shown, the needle holder 150 includes a sheath 5, a rigid part 6, a gripping part (first holding part) 7, an operating part 8, and an operating line 9 for operating the gripping part 7.

[0082] The sheath 5 is flexible and is a longitudinally elongated member extending from the front end 5a to the base end 5b. For example... Figure 2 As shown, a rigid part 6 is provided at the front end 5a of the sheath 5. A holding part 7 is provided at the rigid part 6. An operating part 8 is provided at the base end 5b of the sheath 5.

[0083] The sheath 5 is inserted into the connecting member 13, the first cavity tube 11, and the third cavity tube 23. The sheath 5 can rotate relative to the connecting member 13, the first cavity tube 11, and the third cavity tube 23 with the length axis Y1 of the sheath 5 as the center.

[0084] like Figure 1 As shown, with the distal shaft 2, through which the sheath 5 passes, inserted into the channel 206, the gripping part 7 can protrude and retract relative to the front opening 206a of the channel 206. The gripping part 7 can enter the field of view of the camera unit 203 of the flexible endoscope 200 and take pictures using the camera unit 203.

[0085] Figure 7 This is a cross-sectional view of the front end 5a of the sheath 5.

[0086] The sheath 5 has a first coil sheath 51 through which the operating wire 9 passes and a second coil sheath 52 through which the first coil sheath 51 passes.

[0087] The first coil sheath 51 is a so-called single-strip coil sheath formed by tightly winding a single metal wire in a loop. The first coil sheath 51 has compression resistance relative to the through-running operating wire 9, and can properly transmit the opening and closing operation of the gripping part 7 performed by the operating part 8 to the gripping part 7. Furthermore, the first coil sheath 51 is not limited to a coil sheath, but can also be a resin tube with excellent compression resistance, such as PEEK.

[0088] The second coil sheath 52 is a so-called multi-strand type coil sheath formed by arranging multiple metal wires radially and tightly winding them in a loop. The second coil sheath 52 properly transmits the operation for rotating the rigid part 6 to the rigid part 6.

[0089] like Figure 7 As shown, the first coil sheath 51 is formed of a metal wire with a rectangular cross-section. The second coil sheath 52 is formed of a metal wire with a circular cross-section. However, the cross-sectional shape of the metal wires in the first coil sheath 51 and the second coil sheath 52 is not limited to these shapes and can be appropriately selected according to the design values ​​of the sheath 5.

[0090] Figure 8is a perspective view showing the hard portion 6 and the holding portion 7.

[0091] The hard portion 6 is formed in a substantially cylindrical shape. The hard portion 6 is formed of a hard material such as stainless steel (SUS).

[0092] The hard portion 6 is provided at the front end of the sheath 5. As shown in Figure 7 , the front end 51A of the first coil sheath 51 is fixed to the base end of the hard portion 6 by laser welding, brazing, or the like.

[0093] The base end side of the hard portion 6 is formed in a cylindrical shape, and has an outer surface 6A to which the second coil sheath 52 is fixed. The outer surface 6A of the base end side of the hard portion 6 is fixed to the second coil sheath 52 by laser welding, brazing, or the like.

[0094] The front end 62A of the second coil sheath 52 fixed to the outer surface 6A of the hard portion 6 is not rotatable with respect to the hard portion 6 about the axis, and is not relatively movable with respect to the first coil sheath 51 in the axial direction.

[0095] In addition, the connection form of the hard portion 6 and the sheath 5 is not limited to the above-described form. For example, it can be configured such that the second coil sheath 52 is fixed to the outer surface and the first coil sheath 51 is fixed to the inner surface of the base end side of the hard portion 6 formed in a cylindrical shape. In addition, the shape of the portion of the hard portion 6 to which the sheath 5 is fixed can not be cylindrical.

[0096] As shown in Figure 7 and Figure 8 , the holding portion (first holding portion) 7 has a first holding member 71, a second holding member 72, and a link mechanism 76. The first holding member 71 and the second holding member 72 are configured to be capable of opening and closing movement. Figure 7 The holding portion 7 shown in

[0097] The first holding member 71 is a portion of the front end portion of the hard portion 6. The first holding member 71 extends along the length axis Y1 of the sheath 5. In the present embodiment, the first holding member 71 is integrally formed with the hard portion 6.

[0098] The second holding member 72 is linked to the hard portion 6 in a manner capable of opening and closing movement with respect to the first holding member 71. By inserting a link shaft 77 into a through-hole 78 formed in the second holding member 72 and a through-hole 79 formed in the hard portion 6, the second holding member 72 is linked to the hard portion 6 in a manner capable of rotation. The second holding member 72 is rotatable about the length axis Y2 of the link shaft 77.

[0099] The first gripping member 71 has a first protruding portion 711 and a second protruding portion 712. The first protruding portion 711 and the second protruding portion 712 are provided at the front end portion of the first gripping member 71 and protrude in a direction intersecting the length axis (central axis) Yl. The first protruding portion 711 and the second protruding portion 712 are provided as a pair across the length axis Yl of the sheath 5, and in the closed state of the first gripping member 71 and the second gripping member 72, the front end portion of the second gripping member 72 is positioned between the first protruding portion 711 and the second protruding portion 712.

[0100] The link mechanism 76 is composed of a first link member 76a, a first joint member 76b, a second link member 76c, and a second joint member 76d. The first link member 76a is connected to the second link member 76c by the first joint member 76b. The second link member 76c is connected to the second gripping member 72 by the second joint member 76d.

[0101] Figure 9 is a view showing the connecting portion of the sheath 5 and the operation portion 8 as a cross-sectional view.

[0102] The operation portion (handle) 8 has an operation portion main body 80, a first slider 81, a locking member (round plate) 83, and a sliding member (key) 84.

[0103] The base end of the link member 13 is fixed to the front end of the operation portion main body 80. The front end of the link member 13 is fixed to the base end portion lb of the proximal shaft 1. Therefore, the relative positional relationship between the proximal shaft 1 and the needle holder 150 is constant.

[0104] The base end 52C of the second coil sheath 52 is fixed to the sliding member 84 inside the operation portion main body 80. The base end 51B of the first coil sheath 51, which protrudes from the second coil sheath 52, is fixed to the locking member 83.

[0105] The first slider 81 is connected to the operation portion main body 80 in a manner that it can advance and retreat relative to the operation portion main body 80, and can advance and retreat in the axial direction of the operation portion main body 80. The operation wire 9, which protrudes from the first coil sheath 51, is connected to the first slider 81 inside the operation portion main body 80.

[0106] The locking member (round plate) 83 is formed in a substantially cylindrical shape. The locking member 83 and the base end 51B of the first coil sheath 51, which is fixed to the locking member 83, are installed in a manner that they can rotate around the axis relative to the operation portion main body 80 but cannot relatively move in the axial direction.

[0107] The sliding member (key) 84 is a member that slides in the length direction inside the operation portion main body 80, and has a through-hole 84a through which the first coil cover 51 is inserted. The sliding member 84 and the base end 52C of the second coil cover 52 fixed to the sliding member 84 are attached in a manner that cannot rotate around the axis relative to the operation portion main body 80 but can relatively move in the axial direction relative to the operation portion main body 80 and the first coil cover 51.

[0108] When the operation portion main body 80 is rotated around the axis, the sliding member 84 and the second coil cover 52 also rotate around the axis together with the operation portion main body 80.

[0109] The operation wire 9 is disposed inside the cover 5 along the length axis Y1 of the cover 5. The operation wire 9 is a soft wire that can transmit the operation force from the first slider 81.

[0110] As shown in Figure 7 , the front end of the operation wire 9 is fixed to the first link member 76a of the link mechanism 76. The base end of the operation wire 9 is connected to the first slider 81 of the operation portion 8. That is, the front end of the operation wire 9 and the second gripping member 72 are connected to each other via the link mechanism 76. The operation force for operating the opening and closing action of the second gripping member 72 relative to the first gripping member 71 is transmitted from the first slider 81 to the second gripping member 72 via the operation wire 9 and the link mechanism 76.

[0111] By advancing and retreating the first slider 81 relative to the operation portion main body 80, the operation wire 9 can be advanced and retreated along the length axis Y1 of the cover 5, and the gripping portion 7 can be operated to open and close. For example, by moving the first slider 81 to the base end side relative to the operation portion main body 80, the operation wire 9 can be pulled to the operation portion 8 side.

[0112] By the operation wire 9 being pulled to the operation portion 8 side, the second gripping member 72 is moved to the closing direction relative to the first gripping member 71. On the other hand, by the operation wire 9 being pushed out to the gripping portion 7 side, the second gripping member 72 is moved to the opening direction relative to the first gripping member 71.

[0113] [Method of using the treatment system 300]

[0114] Next, the surgery performed using the treatment system 300 of the present embodiment (the method of using the treatment system 300) will be described with reference to Figures 11 to 17 . Specifically, the surgery of suturing the wound portion W formed in the tube wall T in the lumen organ such as the digestive tract using the traction device 100 will be described. Figures 11 to 17 is a view showing the method of using the traction device 100.

[0115] Figure 10 is a view showing the suture S.

[0116] The suture S used in the following described procedure has a plurality of barbs SB arranged along a length axis, and only allows the suture S to move in a direction in which the suture needle N is installed in a state in which the suture S has passed through the living tissue. Since the plurality of barbs SB are caught in the living tissue, the suture S cannot move in the opposite direction. In addition, in the drawings other than Figure 10 The barbs SB of the suture S are omitted from illustration.

[0117] The operator inserts the soft endoscope 200 into the lumen organ before the holding portion 7 of the traction tool 100 protrudes from the front end opening portion 206a of the channel 206 of the soft endoscope 200. The operator holds the suture needle N with the holding portion 7 by retracting the first slide 81. In addition, the suture needle N can be held with the holding portion 7 instead of the suture S installed in the suture needle N.

[0118] The operator inserts the soft endoscope 200 into the lumen organ from the natural opening of the patient. The suture needle N or the suture S is introduced into the lumen organ in a state held by the holding portion 7 protruding from the front end opening portion 206a.

[0119] The operator temporarily places the suture needle N on the tube wall T in a case where the orientation and position of the suture needle N held by the holding portion 7 are not held in the desired orientation and position, and reholds the suture needle N with the holding portion 7. In a case where the suture needle N is held while the suture S is introduced into the digestive tract, the suture needle N can be temporarily placed on the tube wall T, and the suture needle N is reheld with the holding portion 7. The operator holds the suture needle N with the holding portion 7 by moving the first slide 81 to the base end side along the operation portion main body 80.

[0120] [First Step]

[0121] Figure 11 is a drawing that describes the first step and the second step.

[0122] The operator, in the first step, while holding the suture needle N with the holding portion 7 protruding from the front end opening portion 206a, pierces the suture needle N into the first edge portion E1 of the wound portion W formed by the tube wall T in the lumen organ, and hooks the suture S to the first edge portion E1.

[0123] [Second Step]

[0124] The operator of the surgery, while holding the suture needle N with the holding portion 7 in the second step, pierces the suture needle N into a second edge portion E2 of the wound portion W formed in the wall T of the digestive tract, and hooks the suture thread S extending from the first edge portion El to the second edge portion E2. The second edge portion E2 is at an edge portion of the wound portion W and is at a position facing the first edge portion El with the wound portion W interposed therebetween.

[0125] The operator of the surgery repeatedly performs the first step and the second step a plurality of times in accordance with the size of the wound portion W. Figure 11 The illustrated wound portion W shows a state in which the first step and the second step are performed three times.

[0126] [Third Step]

[0127] Figure 12 and Figure 13 is a view that illustrates the third step.

[0128] The operator of the surgery operates the tube hub 4 before the third step to supply fluid to the interior space I of the balloon 3 from the fluid supply device. As a result, the balloon 3 becomes a dilated state.

[0129] The operator of the surgery, while holding the suture thread S extending from the second edge portion E2 or the suture needle N with the holding portion (first holding portion) 7 in the third step, hooks the second portion S2 of the suture thread S extending between the suture needle N and the second edge portion E2 or between the first portion SI and the second edge portion E2 to the balloon (second holding portion) 3 and winds it around the distal shaft 2. The operator of the surgery rotates the second coil sheath 52 by rotating the operation portion body 80 about the axis. As a result, the hard portion 6 and the holding portion 7 rotate about the length axis Yl of the sheath 5. The distal shaft 2, since it is connected to the operation portion body 80 via the proximal shaft 1 and the connecting member 13, rotates about the length axis Yl of the sheath 5 together with the hard portion 6 and the holding portion 7.

[0130] As illustrated in Figure 12 and Figure 13 , the second portion S2 of the suture thread S is hooked to the balloon (second holding portion) 3 and wound around the distal shaft 2 by the holding portion 7 rotating about the length axis Yl of the sheath 5. The operator of the surgery is able to properly wind the suture thread S around the distal shaft 2 by hooking the second portion S2 of the suture thread S to the recess 34 of the balloon 3.

[0131] [Fourth Step]

[0132] Figure 14 is a view that illustrates the fourth step.

[0133] The operator of the surgery pulls the suture S in the fourth step by retreating the traction tool 100 along the length axis Yl of the sheath 5. Specifically, the operator of the surgery moves the traction tool 100 to the proximal end side with respect to the flexible endoscope 200. The balloon (second holding portion) 3 that has the suture S caught moves in a direction away from the second edge portion E2. As a result, the suture S is given a tension, and the first edge portion El and the second edge portion E2 are tied. In addition, the operator of the surgery can also move the balloon (second holding portion) 3 in a direction away from the second edge portion E2 by advancing the traction tool 100 along the length axis Yl of the sheath 5 in the fourth step.

[0134] The operator of the surgery advances the retreated traction tool 100. As a result, the tension given to the suture S is released. The suture S maintains the state in which the first edge portion El and the second edge portion E2 are tied due to the plurality of barbs SB.

[0135] Figures 15 to 18 is a view that explains the fifth step.

[0136] The operator of the surgery discharges fluid from the closed stopcock 41 to the fluid supply device by operating the closed stopcock 41 before the fifth step. As a result, as shown in Figure 15 and Figure 16 , the balloon 3 discharges fluid from the internal space I and returns to the natural state.

[0137] The operator of the surgery opens the first holding member 71 and the second holding member 72 in the fifth step and releases the first portion SI of the suture S or the suture needle N. As shown in Figure 17 and Figure 18 , the operator of the surgery holds the inside of the loop S3 of the suture S formed by the winding on the distal shaft 2 by retreating the holding portion 7 along the length axis Yl of the sheath 5. The operator of the surgery holds the suture needle N with the holding portion 7 when the first step is performed again.

[0138] The operator of the surgery repeatedly performs the first step to the fifth step a plurality of times in accordance with the size of the wound portion W and sutures the wound portion W that is not sutured. The operator of the surgery cuts the suture S and takes the cut suture S and the suture needle N out to the outside of the body and ends the surgery.

[0139] The traction tool 100 of the present embodiment and the surgery (use method) using the traction tool 100, for example, in the suturing work in a narrow lumen organ such as a stomach, can sufficiently tighten the wound portion by winding the suture S mounted on the suture needle N on the distal shaft 2 and pulling the suture S.

[0140] The traction tool 100 according to the present embodiment and the surgery (use method) using the traction tool 100 can increase the amount of pulling of the suture S compared to a case where the suture S is directly wound around the distal shaft 2 because the suture S is wound around the balloon 3 having a diameter that is expanded.

[0141] The first embodiment of the present application has been described in detail above with reference to the drawings, but the specific structure is not limited to this embodiment and design changes and the like within a range not departing from the gist of the present application are also included. Furthermore, it is also possible to configure by appropriately combining the constituent elements shown in the above-described embodiments and modified examples.

[0142] (Modified Example 1)

[0143] In the above-described embodiment, the operation portion main body 80 and the proximal shaft 1 are linked by the link member 13. However, the form of the traction tool 100 is not limited to this. Figure 19 is a whole view of a traction tool 100A that is a modified example of the traction tool 100. The traction tool 100A does not have the link member 13. Therefore, even in a case where the surgery operator rotates the operation portion main body 80 around the axis, the proximal shaft 1 and the distal shaft 2 do not rotate. On the other hand, the sheath 5 and the grip portion 7 that are linked to the operation portion main body 80 in a non-rotatable manner by the sliding member 84 rotate.

[0144] The surgery operator can rotate the sheath 5 and the grip portion 7 without rotating the balloon 3 attached to the proximal shaft 1 and the distal shaft 2 by rotating the operation portion main body 80 around the axis.

[0145] (Modified Example 2)

[0146] In the above-described embodiment, as shown in Figure 3 , the center axis Al of the distal shaft 2 coincides with the center axis O of the length direction of the balloon 3. However, the form of the balloon 3 is not limited to this. Figure 20 is a view showing a use form of a balloon 3B that is a modified example of the balloon 3. Figure 21 is a cross-sectional view along the Y-Y line of Figure 20 . The center axis A2 of the distal shaft 2 is eccentric from the center axis O of the balloon 3B. Therefore, a first outer peripheral portion Cl that is shorter in distance from the distal shaft 2 to the outer peripheral portion of the balloon 3B than other portions is formed. As shown in Figure 20 , the surgery operator can easily observe the wound portion W with the imaging portion 203 of the endoscope 200 by arranging the first outer peripheral portion Cl toward the wound portion W.

[0147] (Modified Example 3)

[0148] Figure 22 is a view showing a use form of a balloon 3C that is another modified example of the balloon 3.Figure 23 is a cross-sectional view along the Z-Z line of Figure 22 The center axis A3 of the distal shaft 2 is substantially coincident with the center axis O of the balloon 3C. As shown in Figure 23 , the balloon 3C is asymmetrically expanded in diameter with respect to the center axis O of the balloon 3C. As shown in Figure 23 , the outer peripheral portion of the balloon 3C has a first expanded portion Dl and a second expanded portion D2. In the expanded state of the balloon 3C, the distance from the distal shaft 2 to the first expanded portion Dl is shorter than the distance from the distal shaft 2 to the second expanded portion D2. As shown in Figure 22 , the operator easily observes the wound portion W with the imaging portion 203 of the endoscope 200 by arranging the first expanded portion Dl toward the wound portion W.

[0149] (Modified Example 4)

[0150] In the above embodiment, the balloon 3 has the recess 34 formed in the middle portion in the length direction, and the operator hooks the suture S to the recess 34 of the balloon 3 or the like and winds the suture S around the distal shaft 2. However, the shape of the balloon 3 and the method of using the balloon 3 are not limited thereto. Figure 24 is a view showing a balloon 3D as a modified example of the balloon 3. The balloon 3D is formed in a spherical shape in the expanded state. The operator hooks the suture S to the entire balloon 3D and directly winds the suture S around the proximal shaft 1. The operator can perform the same surgery as in the above embodiment using the balloon 3D having a simpler shape than the balloon 3.

[0151] (Modified Example 5)

[0152] In the above embodiment, the holding portion 7 is opened and closed to hold the suture needle N or the like. However, the shape of the holding portion 7 is not limited thereto. Figure 25 is a perspective view showing a holding portion 7B as a modified example of the holding portion 7. The holding portion (first holding portion) 7B has a first holding member 71B and a second holding member 72B. The second holding member 72B is provided at a position on the proximal end side of the first holding member 71B and is capable of advancing and retreating with respect to the first holding member 71B. The holding portion (first holding portion) 7B is capable of holding the suture needle N or the suture S by being sandwiched with the first holding member 71B and the second holding member 72B.

[0153] (Modified Example 6)

[0154] In the above embodiment, the balloon 3 is a compliant balloon that is expanded and contracted in diameter by elastic deformation. However, the shape of the balloon 3 is not limited thereto. Figure 26 is a view showing a balloon 3E as a modified example of the balloon 3. The balloon 3E is a non-compliant balloon formed of a non-elastic raw material such as nylon. As shown in Figure 26As shown, the balloon 3E is wound in a folded state around the distal end shaft 2. By supplying fluid to the inner space I of the balloon 3E, the balloon 3E becomes a diameter-expanded state.

[0155] (Variation 7)

[0156] In the above-described embodiment, the balloon 3 does not have a convex portion that can hook the suture S in a natural state. However, the configuration of the balloon 3 is not limited to this. Figure 27 is a view that shows a balloon 3F that is a variation of the balloon 3. The balloon 3F has a convex portion 39 that can hook the suture S in a natural state. In the case of using the balloon 3F, the operator easily winds the second portion S2 of the suture S around the distal end shaft 2 before expanding the balloon 3F in the third step.

[0157] (Second Embodiment)

[0158] Reference Figures 28 to 29 A treatment system of a second embodiment of the present application will be described. In the following description, the same reference numerals are attached to the structures common to those already described, and the repeated description is omitted.

[0159] Figure 28 is a view that shows a traction tool 100G.

[0160] The treatment system of the second embodiment includes a flexible endoscope 200 and the traction tool 100G. The traction tool 100G is inserted into the flexible endoscope 200 to be used. The traction tool 100G includes a resin sheath 3G, a sheath (shaft) 5, a hard portion 6, a gripping portion (first holding portion) 7, an operation portion 8G, and an operation wire 9.

[0161] The resin sheath 3G is a tubular member formed of resin, and the sheath 5 penetrates the inside thereof. The front end portion 37 of the resin sheath 3G is fixed to the front end 5a of the sheath 5 by heat shrinkage, an adhesive, or the like. The front end portion 37 of the resin sheath 3G can also be fixed by being clamped between the metal wires of the second coil sheath 52 at the front end 5a of the sheath 5. The base end portion 38 of the resin sheath 3G is attached to the operation portion 8G in a manner that can be advanced and retracted.

[0162] The resin sheath 3G has a diameter-expanded portion 35 at a position on the base end side from the front end portion 37. The diameter-expanded portion (second holding portion) 35 is formed by providing four slits 36 in the resin sheath 3G. The four slits 36 extend along the length direction of the resin sheath 3G and are arranged equally in the circumferential direction of the resin sheath 3G. The diameter-expanded portion 35 is a belt-shaped member that is sandwiched by the circumferentially adjacent slits 36. Note that the number of slits 36 is not limited to four.

[0163] The operation section 8G has an operation section main body 80, a first slider 81, a second slider 82, a locking member (round plate) 83, and a sliding member (key) 84.

[0164] The second slider 82 is linked to the operation section main body 80 so as to be able to advance and retreat relative to the operation section main body 80, and is able to advance and retreat along the axial direction of the operation section main body 80. The base end portion 38 of the resin sheath 3G is connected to the second slider 82 through the inside of the operation section main body 80.

[0165] Figure 29 is a view showing the dilator 100G with the enlarged diameter portion 35 enlarged in diameter.

[0166] The surgical operator advances the resin sheath 3G relative to the sheath 5 by moving the second slider 82 forward along the operation section main body 80. As a result, as shown in Figure 29 , the enlarged diameter portion 35 is flexed to the outside in the radial direction, and expands (enlarges in diameter) in the radial direction. When the surgical operator returns the second slider 82 to the base end side along the operation section main body 80, the enlarged diameter portion 35 returns to the original shape. The surgical operator is able to enlarge and reduce the diameter of the enlarged diameter portion 35 by advancing and retreating the second slider 82.

[0167] The surgical operator is able to perform surgery using the dilator 100G to pull the suture S as with the dilator 100 of the first embodiment. The surgical operator hooks the second portion S2 of the suture S extending between the suture needle N and the second edge portion E2 or between the first portion S1 and the second edge portion E2 to the enlarged diameter portion 35 that has been enlarged in diameter and winds the suture S around the sheath (shaft) 5 while holding the first portion S1 of the suture S extending from the second edge portion E2 or the suture needle N with the holding portion (first holding portion) 7 in the third step. The surgical operator pulls the suture S by retreating the dilator 100G along the length axis Y1 of the sheath 5 in the fourth step.

[0168] The dilator 100G of the present embodiment and the surgery (use method) using the dilator 100G are able to sufficiently tighten a wound portion, for example, in a suturing operation in a narrow lumen organ such as a stomach, by winding the suture S attached to the suture needle N around the sheath (shaft) 5 and pulling the suture S.

[0169] Industrial Applicability

[0170] The present application can be applied to medical equipment for suturing a wound portion in a lumen organ or the like.

[0171] Explanation of Reference Signs

[0172] 300, treatment system; 200, flexible endoscope; 100, 100G, traction tool; 150, needle holder; 1, proximal shaft; 11, first lumen; 12, second lumen; 2, distal shaft; 23, third lumen; 3, 3B, 3C, 3D, 3E, 3F, balloon (second holding portion); 31, first connection portion; 32, second connection portion; 33, balloon main body; 34, recess; 3G, resin sheath; 35, diameter expansion portion (second holding portion); 4, tube hub; 5, sheath; 51, first coil sheath; 52, second coil sheath; 6, hard portion; 7, 7B, gripping portion (first holding portion); 71, 71B, first gripping member; 72, 72B, second gripping member; 76, link mechanism; 8, 8G, operation portion (handle); 80, operation portion main body; 81, first slide; 82, second slide; 9, operation wire.

Claims

1. A traction tool which pulls a suture under a flexible endoscope, wherein the traction tool comprises: a shaft; a first holding portion provided at a distal end of the shaft and capable of holding the suture or a suture needle attached to the suture; and a second holding portion provided at a position closer to a proximal end of the shaft than the first holding portion and configured to wind the suture, the second holding portion being capable of expanding in a radial direction of the shaft to increase a pulling amount of the suture as compared to a case where the suture is directly wound on a distal end portion of the shaft.

2. The traction tool according to claim 1, wherein the second holding portion is a balloon which is joined to an outer circumferential surface of the shaft.

3. The traction tool according to claim 2, wherein a central axis of the shaft is eccentric from a central axis of the balloon.

4. The traction tool according to claim 2, wherein a central axis of the shaft is substantially coincident with a central axis of the balloon, and the balloon expands in diameter asymmetrically with respect to the central axis of the balloon.

5. The traction tool according to claim 1, wherein the second holding portion is an expanded diameter portion of a resin sheath which is penetrated by the shaft, a distal end portion of the resin sheath is fixed to the shaft, and the expanded diameter portion expands in diameter by moving a proximal end portion of the resin sheath toward the distal end side.

6. The traction tool according to claim 2, wherein the balloon has a concave portion with a smaller outer diameter in an expanded diameter state than other portions of the balloon at a middle portion in a length direction.

7. The traction tool according to claim 2, wherein the balloon is a compliant balloon.

8. The traction tool according to claim 2, wherein the balloon has a convex portion which is capable of hooking the suture in a natural state.

9. The traction tool according to claim 5, wherein the expanded diameter portion is formed by providing a slit in the resin sheath. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​

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