Suturing mechanism and medical system

Abstract

The suturing mechanism includes: a holding part having a first holding member and a second holding member connected in an openable and closable manner by a rotating shaft; a staple discharging part provided on the first holding member; and a staple receiving part provided on the second holding member. When the holding part is in a closed state, the staple discharging part and the staple receiving part face each other. The staple discharging part has a rotating member that discharges the stored staples toward the opposing staple receiving part by a rotating action.

Description

Technical Field

[0001] The present invention relates to a suturing mechanism and a medical system. Background Art

[0002] In recent years, a suturing mechanism such as a stapler has been used in operations for suturing the digestive tract or the like. By using an appropriate suturing mechanism, the operation of suturing the digestive tract or the like becomes easier, and the operation time can be significantly shortened.

[0003] The surgical stapler described in Patent Document 1 includes a suturing mechanism supported by a rigid endoscope. The suturing mechanism has a cartridge in which staples are stored in an array, and the staples are sequentially ejected by a sliding portion having a wedge moving forward.

[0004] Prior art documents

[0005] Patent documents

[0006] Patent Document 1: Japanese Unexamined Patent Application Publication No. 2017-159029 Summary of the Invention

[0007] Problems to be Solved by the Invention

[0008] However, in the case where the suturing mechanism is supported by a flexible member such as a flexible endoscope, since the connecting portion between the suturing mechanism and the flexible member is soft, the force for ejecting the staples may not be sufficiently transmitted to the suturing mechanism in some cases.

[0009] In view of the above circumstances, an object of the present invention is to provide a suturing mechanism that can be used while being supported by a flexible member such as a flexible endoscope and a medical system including the suturing mechanism.

[0010] Means for Solving the Problems

[0011] In order to solve the above problems, the present invention proposes the following means.

[0012] The suturing mechanism according to the first aspect of the present invention includes: a holding portion having a first holding member and a second holding member connected in an openable and closable manner by a rotation shaft; a staple discharging portion provided on the first holding member; and a staple receiving portion provided on the second holding member. When the holding portion is in a closed state, the staple discharging portion and the staple receiving portion face each other, and the staple discharging portion has a rotating member that discharges the stored staples toward the opposing staple receiving portion by a rotating action.

[0013] Effects of the Invention

[0014] The suturing mechanism and the medical system of the present invention can be used while being supported by a flexible member such as a flexible endoscope. Brief Description of the Drawings

[0015] Figure 1 This is a diagram showing a medical system equipped with the suture mechanism of the first embodiment of the present invention.

[0016] Figure 2 This is a perspective view of the suture mechanism of the first embodiment.

[0017] Figure 3 This is a front view of the cap of the suture mechanism of the first embodiment.

[0018] Figure 4 This is a perspective view of the suture mechanism of the first embodiment with the gripping part in the closed state.

[0019] Figure 5 This is a front view of the suture mechanism of the first embodiment with the gripping part in the closed state.

[0020] Figure 6 This is a perspective view of the suture mechanism of the first embodiment with the gripping part in the open state.

[0021] Figure 7 This is a front view of the suture mechanism of the first embodiment with the gripping part in the open state.

[0022] Figure 8 This is a side view of the suture mechanism of the first embodiment with the gripping part in the closed state.

[0023] Figure 9 This is a side view of the suture mechanism of the first embodiment with the gripping part in the open state.

[0024] Figure 10 This is a cross-sectional view of the gripping part including the staple discharge part.

[0025] Figure 11 This is a cross-sectional view of the gripping part with the release operation wire being pulled.

[0026] Figure 12 This is a diagram for explaining the operation of the suture mechanism of the first embodiment.

[0027] Figure 13 This is a diagram for explaining the operation of the suture mechanism of the first embodiment.

[0028] Figure 14 This is a diagram for explaining the operation of the suture mechanism of the first embodiment.

[0029] Figure 15 This is a diagram for explaining the operation of the suture mechanism of the first embodiment.

[0030] Figure 16 This is a side view of a modified example of the gripping part.

[0031] Figure 17 This is a perspective view of the suture mechanism according to the second embodiment of the present invention.

[0032] Figure 18 This is a schematic view of a modified example of the rotating member.

[0033] Figure 19 This is a schematic view of a modified example of the rotating member.

[0034] Figure 20 This is a schematic view of a modified example of the rotating member.

[0035] Figure 21A This is a schematic view of a modified example of the rotating member.

[0036] Figure 21B This is a schematic view of a modified example of the rotating member.

[0037] Figure 21C This is a schematic view of a modified example of the rotating member.

[0038] Figure 22 This is a perspective view of a modified example of the second gripping member.

[0039] Figure 23 This is a perspective view of a modified example of the second gripping member.

[0040] Figure 24 This is a cross-sectional view of a modified example of the linear movement member.

[0041] Figure 25 This is a cross-sectional view of a modified example of the linear movement member. Detailed Embodiment

[0042] (First Embodiment)

[0043] Refer to Figures 1 to 15 to describe the first embodiment of the present invention.

[0044] Figure 1 This is a view showing the overall structure of the medical system 300 including the suture mechanism 100 according to this embodiment.

[0045] [Medical System 300]

[0046] The medical system 300 is used for surgeries such as suturing the digestive tract. The medical system 300 includes a suture mechanism 100, an endoscope 200, an opening / closing operation unit 250, a discharging operation unit 270, and a wire sheath 280. The opening / closing operation unit 250 is an operation unit that operates the suture mechanism 100 using an opening / closing operation wire 5. The discharging operation unit 270 is an operation unit that operates the suture mechanism 100 using a discharging operation wire 6.

[0047] [Endoscope 200]

[0048] The endoscope 200 is a well-known flexible endoscope, including a longitudinally elongated insertion portion 210 inserted into the body from the front end, an operation portion 220 provided at the proximal end portion of the insertion portion 210, and a universal cable 240.

[0049] A treatment instrument passage 230 through which an endoscope treatment instrument penetrates is formed in the insertion portion 210. A forceps port 214, which is the front end opening of the treatment instrument passage 230, is provided at the front end 212 of the insertion portion 210. The treatment instrument passage 230 extends from the front end 212 of the insertion portion 210 to the operation portion 220.

[0050] The front end portion 211 of the insertion portion 210 is provided with an imaging unit (not shown) having a CCD or the like. The objective lens 215 of the imaging unit is exposed at the front end 212 of the insertion portion 210.

[0051] A knob 223 for operating the insertion portion 210 and a switch 224 for operating the imaging unit and the like are provided on the proximal end side of the operation portion 220. The surgical operator can bend the insertion portion 210 in a desired direction by operating the knob 223.

[0052] A forceps insertion port 222 communicating with the treatment instrument passage 230 is provided on the front end side of the operation portion 220. The surgical operator can insert an endoscope treatment instrument from the forceps insertion port 222 into the treatment instrument passage 230.

[0053] The universal cable 240 connects the operation portion 220 and an external peripheral device. The universal cable 240 outputs, for example, an image captured by the imaging unit to an external device. The image captured by the imaging unit is displayed on a display device such as a liquid crystal display via an image processing device.

[0054] [Opening and closing operation portion 250]

[0055] The opening and closing operation portion 250 is an operation portion that opens and closes the suturing mechanism 100 by operating the opening and closing operation wire 5. As Figure 1 shown, the opening and closing operation portion 250 has an opening and closing operation portion main body 252 and an opening and closing operation slider 253. The proximal end of the opening and closing operation wire 5 is connected to the opening and closing operation slider 253. The surgical operator can move the opening and closing operation wire 5 forward and backward by moving the opening and closing operation slider 253 relative to the opening and closing operation portion main body 252 in the longitudinal axis direction.

[0056] [Ejection operation portion 270]

[0057] The ejection operation portion 270 is an operation portion that ejects staples S (refer to Figure 10 ) from the suturing mechanism 100 by operating the ejection operation wire 6. As Figure 1As shown, the ejection operation unit 270 includes an ejection operation unit main body 272 and an ejection operation slider 273. The base end of the ejection operation wire 6 is connected to the ejection operation slider 273. The surgical operator can move the ejection operation wire 6 forward and backward by moving the ejection operation slider 273 forward and backward relative to the ejection operation unit main body 272 in the longitudinal axis direction.

[0058] [Wire sheath 280]

[0059] The wire sheath 280 is a sheath through which the opening / closing operation wire 5 and the ejection operation wire 6 pass. As Figure 1 shown, the front end side of the wire sheath 280 is connected to the insertion portion 210 of the endoscope 200 by a strap 281.

[0060] [Suturing mechanism 100]

[0061] Figure 2 is a perspective view of the suturing mechanism 100.

[0062] The suturing mechanism 100 includes a cap 1, a holding portion 2, a staple ejection portion 3, a staple receiving portion 4, an opening / closing operation wire 5, and an ejection operation wire (power transmission member) 6. The suturing mechanism 100 can be detached from and attached to the front end portion 211 of the insertion portion 210.

[0063] Figure 3 is a front view of the cap 1. In Figure 3 the holding portion 2 is shown in perspective.

[0064] The cap 1 is a member that can be attached to the front end portion 211 of the endoscope 200. The cap 1 is formed in a substantially cylindrical shape and has a first through hole 11 that penetrates in the axial direction A and a second through hole 12 that penetrates in the axial direction A.

[0065] The first through hole 11 is a hole into which the front end portion 211 of the insertion portion 210 is inserted. The shape of the first through hole 11 is formed along the outer shape of the front end portion 211 of the insertion portion 210. Therefore, by inserting the front end portion 211 of the endoscope 200 into the first through hole 11, the cap 1 can be attached to the front end portion 211 of the endoscope 200.

[0066] As Figure 3 shown, the central axis O1 in the axial direction A of the first through hole 11 is eccentric with respect to the central axis O in the axial direction A of the cap 1. The direction in which the central axis O1 is eccentric with respect to the central axis O is defined as "upward B1".

[0067] The second through-hole 12 is a hole into which a wire sheath 280 is inserted. The wire sheath 280 allows the opening / closing operation wire 5 and the releasing operation wire 6 to pass therethrough. The inner diameter of the second through-hole 12 is substantially the same as the outer diameter of the wire sheath 280. The front end portion of the wire sheath 280 passes through the second through-hole 12 and is fixed. The opening / closing operation wire 5 and the releasing operation wire 6 passing through the wire sheath 280 extend to the front end side through the second through-hole 12.

[0068] As Figure 3 shown, the central axis O2 in the axial direction A of the second through-hole 12 is eccentric with respect to the central axis O in the axial direction A of the cap 1. The direction in which the central axis O2 is eccentric with respect to the central axis O is opposite to the direction (upper side B1) in which the central axis O1 is eccentric with respect to the central axis O. The direction in which the central axis O2 is eccentric with respect to the central axis O is set as "lower side B2". In the present embodiment, the upper side B1 and the lower side B2 are directions along the vertical direction B.

[0069] Figure 4 and Figure 5 are a perspective view and a front view of the suturing mechanism 100 in a state where the holding portion 2 is in a closed state.

[0070] When the cap 1 is attached to the front end portion 211 of the endoscope 200, as Figure 4 and Figure 5 shown, the objective lens 215 and the forceps port 214 are exposed from the opening 13 on the front end side of the first through-hole 11 of the cap 1. Even when the suturing mechanism 100 is attached to the front end portion 211 of the endoscope 200, the surgical operator can observe the treatment target using the objective lens 215.

[0071] Figure 6 and Figure 7 are a perspective view and a front view of the suturing mechanism 100 in a state where the holding portion 2 is in an open state. And, Figure 8 is a side view of the suturing mechanism 100 in a state where the holding portion 2 is in a closed state. Figure 9 is a side view of the suturing mechanism 100 in a state where the holding portion 2 is in an open state.

[0072] The holding portion 2 includes a first holding member 21, a second holding member 22, an opening / closing rotation shaft 23, and a movable pin 27. The first holding member 21 and the second holding member 22 are connected in a manner capable of opening and closing using the opening / closing rotation shaft 23. The opening / closing rotation shaft 23 is provided at a position closer to the front end side than the cap 1. The axial direction C of the opening / closing rotation shaft 23 is perpendicular to the axial direction A of the cap 1 and the vertical direction B. As Figure 7 shown, the holding portion 2 is formed symmetric with respect to the central axis O3 in the vertical direction B.

[0073] The first gripping member 21 is fixed to the front end side of the cap 1 in a non-rotatable manner. The first gripping member 21 is fixed to the cap 1 at a position below B2 with respect to the central axis O of the cap 1. As Figure 3 shown, the first gripping member 21 is disposed at a position overlapping the second through-hole 12 in a front view. On the other hand, as Figure 7 shown, the first gripping member 21 is disposed at a position not overlapping the objective lens 215 and the forceps port 214 of the endoscope 200 in a front view.

[0074] As Figure 6 shown, the first gripping member 21 has a first front end portion 21a and a first main body portion 21b, and is formed in a substantially T-shaped in a top view. The first front end portion 21a is disposed at a position closer to the front end side than the first main body portion 21b.

[0075] The first front end portion 21a is formed in a substantially rectangular parallelepiped shape. The first front end portion 21a is formed in a rectangular shape extending along the axial direction C of the opening and closing rotation axis 23 in a top view. A staple discharging portion 3 is provided in the first front end portion 21a. An opening 31a of the staple discharging portion 3 is provided on the surface (upper surface 21e) above B1 of the first front end portion 21a.

[0076] The first main body portion 21b is an elongated member extending along the axial direction A. The front end of the first main body portion 21b is fixed to the first front end portion 21a. The base end of the first main body portion 21b is fixed to the cap 1. The first main body portion 21b has an abutting pin 21c and a first engaging groove 21d (see Figure 8 , Figure 9 ).

[0077] The abutting pin 21c is provided at the base end of the first main body portion 21b, and abuts against the second gripping member 22 in a closed state to limit the movable range of the second gripping member 22.

[0078] As Figure 8 shown, the first engaging groove 21d is a groove penetrating along the axial direction C of the opening and closing rotation axis 23 in the first main body portion 21b. The first engaging groove 21d extends along the axial direction A.

[0079] The second gripping member 22 is rotatably mounted on the first gripping member 21 by an opening and closing rotation axis 23. The second gripping member 22 has a ring portion 22a formed in a substantially U shape and a second main body portion 22b that rotatably supports the ring portion 22a.

[0080] The ring portion 22a is formed in a substantially U shape, and its both end portions are connected to the second main body portion 22b, and the central portion is disposed on the front end side. The central portion has a second front end portion 22c (see Figure 6 ). The second front end portion 22c is formed in a substantially rectangular parallelepiped shape. A staple receiving portion 4 is provided in the second front end portion 22c.

[0081] The second main body portion 22b is rotatably mounted on the first main body portion 21b of the first gripping member 21 by means of an opening / closing rotation shaft 23. A guiding groove 22d (see Figure 6 ) for inserting the first main body portion 21b is formed in the second main body portion 22b. Second engaging grooves 22e are formed on both side portions of the guiding groove 22d of the second main body portion 22b.

[0082] The second engaging groove 22e is a groove formed in the second main body portion 22b. The second engaging groove 22e is a groove penetrating along the axial direction C. The second engaging groove 22e is formed on the side opposite to the staple receiving portion 4 with respect to the opening / closing rotation shaft 23 when viewed from the side. The second engaging groove 22e is symmetric with respect to the central axis O3 of the second gripping member 22.

[0083] As Figure 6 shown, the second gripping member 22 has a viewing space 25 penetrating along the opening / closing direction R between the staple receiving portion 4 on the front end side and the opening / closing rotation shaft 23 on the base end side. In the present embodiment, the viewing space 25 is a space surrounded by an annular portion 22a formed in a substantially U shape.

[0084] As Figure 8 shown, the movable pin 27 engages with the first engaging groove 21d and the second engaging groove 22e and advances and retreats along the axial direction A along the first engaging groove 21d. The front end of the opening / closing operation wire 5 is mounted on the movable pin 27. When the opening / closing operation wire 5 advances toward the front end side, as Figure 9 shown, the movable pin 27 rotates the second gripping member 22 about the opening / closing rotation shaft 23, and the gripping portion 2 is in an open state. When the opening / closing operation wire 5 retreats toward the base end side, as Figure 8 shown, the movable pin 27 rotates the second gripping member 22 about the opening / closing rotation shaft 23, and the gripping portion 2 is in a closed state.

[0085] When the gripping portion 2 is in the closed state, as Figure 5 shown, the staple discharging portion 3 and the staple receiving portion 4 face each other. When the gripping portion 2 is in the closed state, a minute gap is formed between the staple discharging portion 3 and the staple receiving portion 4. When the gripping portion 2 is in the closed state, as Figure 4 , Figure 5 and Figure 8 shown, the optical axis A1 of the objective lens 215 passes through the outside of the first gripping member 21 and the outside of the second gripping member 22. Further, when the gripping portion 2 is in the closed state, the central axis A2 of the forceps mouth 214 is in a position that does not overlap with the first gripping member 21 but overlaps with the second gripping member 22 when viewed from the front.

[0086] When the gripping portion 2 is in the open state, as Figure 9As shown, the staple receiving portion 4 is disposed at a position closer to the proximal end side than the opening and closing rotation shaft 23. When the holding portion 2 is in the open state, as Figure 6 , Figure 7 and Figure 9 shown, the staple discharging portion 3 and the staple receiving portion 4 are disposed on both sides across the optical axis A1 of the objective lens 215. When the holding portion 2 is in the open state, the optical axis A1 of the objective lens 215 passes through the field of view space 25. Further, when the holding portion 2 is in the open state, the central axis A2 of the forceps mouth 214 passes through the field of view space 25.

[0087] Figure 10 is a cross-sectional view of the holding portion 2 including the staple discharging portion 3.

[0088] The staple discharging portion 3 is provided at the first front end portion 21a of the first holding member 21 (see Figure 8 ), and is capable of accommodating and discharging the staple S. The staple discharging portion 3 includes a staple accommodating portion 31, a rectilinear movement member 32, and a rotating member 33.

[0089] The staple accommodating portion 31 is a space for accommodating the staple S provided at the first front end portion 21a of the first holding member 21. As Figure 6 shown, two staple accommodating portions 31 are formed side by side in the axial direction C of the first holding member 21, and are capable of accommodating two U-shaped staples S.

[0090] The staple accommodating portion 31 opens in the vertical direction B at an opening 31a on the upper surface 21e provided at the first front end portion 21a. The staple S is accommodated in the staple accommodating portion 31 from the opening 31a. The staple S is accommodated in the staple accommodating portion 31 with the tip S1 of the staple S facing upward B1.

[0091] When viewed from above, the staple accommodating portion 31 is formed in a rectangular shape with the short side extending in the axial direction A and the long side extending in the axial direction C. The tips S1 at both ends of the staple S accommodated in the staple accommodating portion 31 are arranged in the axial direction C.

[0092] The rectilinear movement member 32 is a member accommodated in the staple accommodating portion 31 and is capable of moving in the vertical direction B within the internal space of the staple accommodating portion 31. The rectilinear movement member 32 has a concave portion 32a for supporting the staple S at the upper side B1. The staple S accommodated in the staple accommodating portion 31 is fitted into the concave portion 32a.

[0093] As the rotating member 33, the first pulley 34 and the second pulley 36 are rotatably mounted inside the first holding member 21, and by rotating, the rectilinear movement member 32 is moved in the vertical direction B. The front end of the release operation wire 6 is connected to the first pulley 34. By pulling the release operation wire 6, the first pulley 34 can be rotated.

[0094] The second pulley 36 is rotatably mounted inside the first gripping member 21, and the first pulley 34 is disposed at a position closer to the front end side than the second pulley 36. The rotation axis 35 of the first pulley 34 and the rotation axis 37 of the second pulley 36 extend in the axial direction C and are substantially parallel to the opening / closing rotation axis 23 of the gripping portion 2. The first pulley 34 has a convex portion (abutting portion) 38 that supports the straight advancing member 32 from below B2 on the front end side.

[0095] The front end of the release operation wire 6 is connected to a portion of the first pulley 34 above the rotation axis 35 on the B1 side. The release operation wire 6 passes through the second through hole 12 via the second pulley 36 from the first pulley 34 and extends to the release operation portion 270. The reason for providing the second pulley 36 is to reasonably guide the release operation wire 6 to the position of the second through hole 12 and reduce the frictional resistance when guiding the release operation wire 6 to the second through hole 12. Therefore, even if only the first pulley 34 is used as the rotating member 33 and a member with a better sliding property (friction reducing member) having a rounded shape is provided instead of the second pulley 36, the same effect can be obtained.

[0096] Figure 11 It is a cross-sectional view of the gripping portion 2 where the release operation wire 6 is pulled.

[0097] When the release operation wire 6 is pulled, the portion of the first pulley 34 above the B1 side rotates toward the proximal end side, and the portion of the first pulley 34 below the B2 side rotates toward the front end side. As a result, the convex portion 38 of the first pulley 34 pushes the straight advancing member 32 upward on the B1 side, and the stored staple S is released upward on the B1 side from the opening 31a.

[0098] The staple receiving portion 4 is provided on the lower surface 22f of the second front end portion 22c of the second gripping member 22. A plurality of grooves 41 capable of receiving the staple S released from the staple releasing portion 3 are provided in the staple receiving portion 4. In the present embodiment, since two U-shaped staples are released from the staple releasing portion 3, four grooves are provided in the staple receiving portion 4. When the gripping portion 2 is in the closed state, as Figure 10 shown, the opening 31a for releasing the staple S and the groove 41 of the staple releasing portion 3 are opposed to each other.

[0099] [Operation of the stitching mechanism 100]

[0100] Next, the operation of the stitching mechanism 100 will be described. Figures 12 to 15 It is a diagram for explaining the operation of the stitching mechanism 100.

[0101] The surgeon brings the distal end portion 211 of the endoscope 200 equipped with the suture mechanism 100 close to the treatment target T. The surgeon advances the opening / closing operation wire 5 by operating the opening / closing operation unit 250, thereby bringing the holding portion 2 into an open state. Since the optical axis A1 of the objective lens 215 passes through the field of view space 25, the surgeon can observe the treatment target T with the imaging unit of the endoscope 200. In addition, since the central axis A2 of the forceps jaws 214 (see Figure 8 , Figure 9 ) passes through the field of view space 25, as shown in Figure 12 , the surgeon can cause the holding forceps G to protrude from the forceps jaws 214 to treat the treatment target T.

[0102] As shown in Figure 13 , the surgeon retracts the holding forceps G while holding the treatment target T with the holding forceps G. The surgeon retracts the holding forceps G so that the tip of the holding forceps G is disposed at a position closer to the proximal end side than the staple discharging portion 3.

[0103] As shown in Figure 14 , the surgeon retracts the opening / closing operation wire 5 by operating the opening / closing operation unit 250, thereby bringing the holding portion 2 into a closed state. The treatment target T is clamped between the staple discharging portion 3 of the first holding member 21 and the staple receiving portion 4 of the second holding member 22.

[0104] When the holding portion 2 is in the closed state, a part of the treatment target T held by the holding forceps G can be accommodated in the space (field of view space 25) formed by the ring portion 22a and the second main body portion 22b of the second holding member 22. Therefore, there is an effect that it is difficult for the treatment target T clamped by the staple discharging portion 3 and the staple receiving portion 4 to come off.

[0105] When the holding portion 2 is in the closed state, as shown in Figure 8 , the optical axis A1 of the objective lens 215 passes through the outside of the first holding member 21 and the outside of the second holding member 22. Therefore, the surgeon can also observe the treatment target T with the imaging unit of the endoscope 200 when the holding portion 2 is in the closed state.

[0106] The surgeon pulls the discharge operation wire 6 by operating the discharge operation unit 270 while the treatment target T is clamped by the staple discharging portion 3 and the staple receiving portion 4, thereby discharging the stored staple S toward the staple receiving portion 4. The tip S1 of the staple S penetrates the treatment target T and bends by contacting the groove 41 of the staple receiving portion 4. As a result, the treatment target T is sutured.

[0107] As shown in Figure 15 , the surgeon operates the opening / closing operation unit 250 to bring the holding portion 2 into an open state again. The surgeon releases the treatment target T with the holding forceps G to complete the suture treatment.

[0108] The suturing mechanism 100 according to the present embodiment can be supported on an endoscope 200 which is a flexible endoscope and used. Since the suturing mechanism 100 discharges the staple S by the rotational movement of the rotating member 33, even when it is mounted on the distal end portion 211 of the flexible endoscope 200, it is easy to output the force required to drive the staple S. In addition, due to the rotational movement of the rotating member 33, the size in the longitudinal direction can be shortened compared with the conventional suturing mechanism.

[0109] As described above, the first embodiment of the present invention has been described in detail with reference to the drawings, but the specific structure is not limited to this embodiment, and also includes design changes and the like within the scope not departing from the gist of the present invention. In addition, the constituent elements shown in the above-described embodiment and modification examples can be appropriately combined and configured.

[0110] (Modification Example 1)

[0111] Figure 16 It is a side view of a holding portion 2B which is a modification of the holding portion 2. The holding portion 2B has a first holding member 21B, a second holding member 22B, an opening / closing rotation shaft 23, and a movable pin 27. The first holding member 21B and the second holding member 22B are connected in an openable / closable manner by the opening / closing rotation shaft 23.

[0112] Compared with the first holding member 21 of the first embodiment, the shape of the first distal end portion 21Ba of the first holding member 21B is different. In the upper surface 21Be of the first distal end portion 21Ba of the first holding member 21B, a first inclined surface 21Bs inclined with respect to the central axis O is provided on the front end side.

[0113] Compared with the second holding member 22 of the first embodiment, the shapes of the second distal end portion 22Bc and the ring portion 22Ba of the second holding member 22B are different. In the lower surface 22Be of the second distal end portion 22Bc of the second holding member 22B, a second inclined surface 22Bs inclined with respect to the central axis O is provided on the front end side. The ring portion 22Ba of the second holding member 22B has a concave portion 22Bf which is located on the inner side opposite to the first holding member 21B when the holding portion 2B is in the closed state. The concave portion 22Bf is recessed from the inner side toward the outer side which is the opposite side of the inner side.

[0114] As Figure 16As shown, when the gripping portion 2B is in a closed state, the first inclined surface 21Bs and the second inclined surface 22Bs form a slope surface TS that expands toward the distal end side. When the surgical operator grips the treatment object T using the gripping portion 2B, the object member T is gripped in a manner along the slope surface TS. Therefore, the gripping portion 2B can grip the treatment object T more reliably, and it is not easy for the treatment object T to escape from the gripping portion 2B.

[0115] Since the gripping portion 2B has the concave portion 22Bf, when the surgical operator grips the treatment object T using the gripping portion 2B, the space for the gripping portion 2B to accommodate the treatment object T is spacious. In addition, the treatment object T is hooked on the second distal end portion 22Bc provided with the staple receiving portion 4, and it is possible to suppress the treatment object T from detaching. Therefore, the gripping portion 2B can grip the treatment object T more reliably, and it is not easy for the treatment object T to escape from the gripping portion 2B.

[0116] (Second Embodiment)

[0117] Refer to Figure 17 The second embodiment of the present invention will be described. In the following description, the same reference numerals are given to the structures common to those already described, and the repeated description is omitted. The suturing mechanism 100B of the second embodiment is different in the installation object compared with the suturing mechanism 100 of the first embodiment.

[0118] Figure 17 FIG. is a view showing a medical system 300B in which the suturing mechanism 100B is installed at the distal end portion 411 of the cannula 400 and used. The medical system 300B is used for surgeries such as suturing the digestive tract. The medical system 300B includes a suturing mechanism 100B, an endoscope 200, an opening / closing operation portion 250, a discharging operation portion 270, a wire sheath 280, and a cannula 400.

[0119] The suturing mechanism 100B installed at the distal end portion 411 of the cannula 400 includes, as in the suturing mechanism 100 of the first embodiment, a cap 1, a gripping portion 2, a staple discharging portion 3, a staple receiving portion 4, an opening / closing operation wire 5, and a discharging operation wire (power transmission member) 6.

[0120] The internal space of the cannula 400 communicates with the first through hole 11 of the cap 1. The surgical operator can pass the endoscope 200 through the internal space of the cannula 400 and expose the distal end 212 of the endoscope 200 from the first through hole 11.

[0121] The cap 1 of the suturing mechanism 100B may be integrally formed with the distal end portion 411 of the cannula 400.

[0122] The suturing mechanism 100B according to the present embodiment can be used while being supported by a flexible cannula 400. Since the suturing mechanism 100B discharges the staple S by the rotational movement of the rotating member 33, even when it is attached to the distal end portion 411 of the flexible cannula 400, it is easy to transmit the force required to drive the staple S to the suturing mechanism 100B.

[0123] As described above, the second embodiment of the present invention has been described in detail with reference to the drawings. However, the specific structure is not limited to this embodiment, and also includes design changes and the like within the scope not departing from the gist of the present invention. In addition, the constituent elements shown in the above embodiments and modification examples can be appropriately combined to form.

[0124] (Modification Example 2)

[0125] For example, in the above embodiment, the rotating member 33 is a pulley, but the form of the rotating member 33 is not limited thereto. Figure 18 FIG. is a schematic view of a link mechanism 33B applied as a modification example of the rotating member 33. By pulling the release operation wire 6 in the axial direction A (proximal end side), the second link member 33Bb is rotated about the rotation axis 35 by the first link member 33Ba. The rotational movement of the second link member 33Bb is converted into a linear movement of the linear member 32 in the vertical direction B. The link mechanism 33B is not particularly limited as long as it performs the above-described action change, and a link mechanism appropriately selected from well-known link mechanisms can be used.

[0126] (Modification Example 3)

[0127] For example, in the above embodiment, the rotation axis 35 of the second link member 33Bb extends in the axial direction C, but the form of the rotating member 33 is not limited thereto. Figure 19 FIG. is a schematic view of a rotating member 33C as a modification example of the rotating member 33. The rotating member 33C has a rotation axis 39 extending in the vertical direction B. The release operation wire 6 is attached to the outer periphery of the rotating member 33C. By pulling the release operation wire 6 in the axial direction A (proximal end side), the rotating member 33C rotates about the rotation axis 39. A spiral groove 33g extending in the direction of the rotation axis 39 is formed on the outer peripheral surface of the rotating member 33C. The linear member 32 has an engagement convex portion 32b that engages with the groove 33g. As the rotating member 33C rotates about the rotation axis 39, the engagement convex portion 32b that engages with the groove 33g advances and retreats in the vertical direction B. The rotating member 33C converts the rotational movement about the rotation axis 39 extending in the vertical direction B into an advancing and retreating movement of the linear member 32 in the vertical direction B.

[0128] (Modification Example 4)

[0129] For example, in the above-described embodiment, the rotating member 33 is a pulley, but the form of the rotating member 33 is not limited thereto. Figure 20 , Figure 21A , Figure 21B and Figure 21C are schematic views of a rotating member 33D which is a modification of the rotating member 33. The rotating member 33D is a cam mechanism that converts the rotational motion of the operation wire 6 about the axial direction A into the reciprocating motion of the straight member 32 in the up-and-down direction B.

[0130] (Modification Example 5)

[0131] For example, in the above-described embodiment, the rotating member 33 releases the staple S via the straight member 32, but the form of the staple releasing portion 3 is not limited thereto. The rotating member 33 may also directly push up the staple S without using the straight member 32. In this case, a releasing support member that replaces the straight member 32 may be installed on the rotating member or integrally formed with the rotating member to replace the straight member 32.

[0132] (Modification Example 6)

[0133] For example, in the above-described embodiment, the second holding member 22 is formed with a viewing space 25 surrounded by a ring portion 22a formed in a substantially U-shape, but the form of the second holding member 22 is not limited thereto. Figure 22 and Figure 23 are perspective views showing a second holding member 22C which is a modification of the second holding member 22. The second holding member 22C has an L-shaped member 22Ca formed in a substantially L-shape and a second main body portion 22Cb that rotatably supports the L-shaped member 22Ca. A staple receiving portion 4 is provided at the front end of the L-shaped member 22Ca. The proximal end of the L-shaped member 22Ca is attached to the second main body portion 22Cb. In this case, the viewing space 25 is a space surrounded by the L-shaped member 22Ca formed in a substantially L-shape. As Figure 23 shown, when the second holding member 22C is in an open state, the surgical operator can also observe the treatment target T with the imaging unit of the endoscope 200, and can protrude the grasping forceps G from the forceps opening 214 to treat the treatment target T.

[0134] (Modification Example 7)

[0135] Figure 24 is a cross-sectional view of a straight member 320 which is a modification of the straight member 32. Figure 24The first pulley 34 shown has a convex portion 380 as a modified example of the convex portion (abutment portion) 38. The linear movement member 320 has a flat portion 320a extending in the axial direction A below the lower side B2 in the vertical direction B. The convex portion 380 of the first pulley 34 is formed in a semi-cylindrical shape extending in the axial direction C, and a curved surface portion 380a is formed at a portion in contact with the flat portion 320a of the linear movement member 320. Regardless of the rotation angle of the first pulley 34, the curved surface portion 380a of the convex portion 380 is always in contact (line contact) with the flat portion 320a of the linear movement member 320. Therefore, the convex portion 380 can reliably convert the rotational movement of the first pulley 34 into the forward and backward movement of the linear movement member 320 in the vertical direction B. In addition, when the curved surface portion 380a of the convex portion 380 is formed into a spherical surface, the same effect is also obtained.

[0136] (Modified Example 8)

[0137] Figure 25 It is a cross-sectional view of a linear movement member 321 which is a modified example of the linear movement member 32. Figure 25 The first pulley 34 shown has a convex portion 380 in the same manner as in the above-described modified example 7. The linear movement member 321 has an inclined surface portion 321a below the lower side B2 in the vertical direction B. The inclined surface portion 321a is inclined with respect to a direction perpendicular to the moving direction of the linear movement member. Figure 25 The inclined surface portion 321a of the linear movement member 321 shown extends obliquely upward toward the B1 side from the front end side toward the base end side. In addition, the linear movement member 321 has a side surface 321c in contact with the wall surface 311d of the staple accommodating portion 31. The force applied by the convex portion 380 to the inclined surface portion 321a acts in the direction of pressing the wall surface 311d against the side surface 321c of the linear movement member 321 at a certain ratio with respect to the driving force of the staple S, regardless of the rotation angle of the first pulley 34. At this time, since the linear movement member 321 moves in the driving direction (moving direction) of the staple S while being pressed against the wall surface 311d, a frictional force is generated between the linear movement member 321 and the wall surface 311d. By adjusting the angle of the inclined surface portion 321a, the magnitude of this frictional force can be adjusted. By appropriately performing this adjustment, the driving speed of the staple S can be adjusted, and misfiring can be prevented.

[0138] Industrial Applicability

[0139] The present invention can be applied to a suturing mechanism such as a stapler.

[0140] Explanation of Reference Numerals

[0141] 300, 300B, Medical system; 100, 100B, Suture mechanism; 200, Endoscope; 210, Insertion portion; 211, Front end portion; 214, Forceps jaws; 215, Objective lens; 400, Cannula; 411, Front end portion; 1, Cap; 11, First through hole; 12, Second through hole; 13, Opening; 2, Grasping portion; 21, First grasping member; 22, 22B, 22C, Second grasping member; 22a, Ring portion; 23, Opening and closing rotation shaft; 25, Field of view space; 3, Staple releasing portion; 31, Staple storage portion; 33, 33B, 33C, 33D, Rotating member; 34, First pulley; 35, Rotation shaft; 36, Second pulley; 37, Rotation shaft; 4, Staple receiving portion; 41, Groove; 5, Opening and closing operation wire; 6, Releasing operation wire (power transmission member).

Claims

1. A suturing mechanism, wherein, the suturing mechanism comprises: a gripping part having a first gripping member and a second gripping member connected in an openable and closable manner by a rotating shaft; a staple discharging part provided on the first gripping member; and a staple receiving part provided on the second gripping member, when the gripping part is in a closed state, the staple discharging part and the staple receiving part face each other, the staple discharging part has a rotating member that discharges the stored staples toward the opposing staple receiving part by a rotating action, the staple discharging part has a linear advancing member that is linked to the rotating action of the rotating member and linearly advances to discharge the staples toward the staple receiving part.

2. The suturing mechanism according to claim 1, wherein, the rotating member has an abutting part that abuts against the linear advancing member and moves the linear advancing member as the rotating action occurs.

3. The suturing mechanism according to claim 1, wherein, the suturing mechanism further has a power transmission member that rotates the rotating member.

4. The suturing mechanism according to claim 3, wherein, the power transmission member is a wire wound around the rotating member, and the rotating member is rotated by pulling the wire.

5. The suturing mechanism according to claim 1, wherein, the rotating shaft of the rotating member is substantially parallel to the rotating shaft of the gripping part.

6. The suturing mechanism according to claim 1, wherein, the rotating member is a pulley.

7. The suturing mechanism according to claim 1, wherein, the rotating member is a link mechanism.

8. The suturing mechanism according to claim 1, wherein, the rotating member is a cam mechanism.

9. The suturing mechanism according to claim 2, wherein, the linear advancing member has a planar part that abuts against the abutting part, and the abutting part has a curved surface part that abuts against the planar part.

10. The suturing mechanism according to claim 9, wherein, the planar part is an inclined surface inclined with respect to a direction perpendicular to the moving direction of the linear advancing member, and the abutting part presses the linear advancing member against the wall surface of the staple accommodating part that accommodates the linear advancing member while moving the linear advancing member in the moving direction.

11. The suturing mechanism according to claim 1, wherein, the gripping part is mounted on a cap that can be mounted on the front end of a flexible endoscope or the front end of a flexible cannula.

12. The suturing mechanism according to claim 1, wherein, the rotating member has a rotating shaft extending along the staple driving direction, a helical groove advancing along the driving direction is formed on the outer peripheral surface of the rotating member, the linear advancing member has an engaging convex part that engages with the groove, by rotating the rotating member about the rotating shaft, the engaging convex part engaged with the groove advances and retreats along the driving direction, and the rotating member converts the rotational motion about the rotating shaft into the linear movement of the linear advancing member.

13. The suturing mechanism according to claim 3, wherein, The power transmission member is a wire connected to the rotating member, and by rotating the wire about the axial direction of the wire, the rotating member is rotated.

14. A medical system, wherein, the medical system includes: the suturing mechanism according to claim 11; and the flexible endoscope or the cannula.

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