Surgical stapler

Abstract

A medical stapler includes: a detachable portion that is detachable with respect to a distal end portion of an endoscope; a holding portion that is disposed on a distal end side of the detachable portion, and that is capable of holding a target tissue to be stapled with a clip; and a feed-and-retract mechanism that links the holding portion to the detachable portion in a manner that the holding portion is capable of moving in a feed-and-retract manner with respect to the detachable portion.

Description

Technical Field

[0001] This invention relates to a medical suture device and a suturing method. Background Technology

[0002] In recent years, medical suture devices, such as suture instruments, have been used in surgeries involving the suturing of the digestive tract. By using appropriate medical suture devices, surgeries involving the suturing of the digestive tract become easier and can significantly shorten surgical time.

[0003] In the endoscopic suturing system described in Patent Document 1, the tissue retractor can advance relative to the suturing device, and the advancing tissue retractor is used to pull the suturing target tissue into the suturing device to suture the suturing target tissue.

[0004] Existing technical documents

[0005] Patent documents

[0006] Patent Document 1: U.S. Patent Application Publication No. 2018 / 0042603 Summary of the Invention

[0007] The problem the invention aims to solve

[0008] However, the endoscopic suturing system described in Patent Document 1 sometimes cannot adequately suture tissue in areas that are difficult to suture, such as those located in areas that are difficult to access with an endoscope.

[0009] Based on the above, the object of the present invention is to provide a medical suture device and suturing method capable of adequately suturing tissue located in areas that are difficult to suture.

[0010] Solution for solving the problem

[0011] To address the above problems, the present invention proposes the following solution.

[0012] The first technical solution of the present invention provides a medical suture device comprising: a disassembly and assembly part that can be disassembled and assembled relative to the front end of an endoscope; a holding part disposed at the front end of the disassembly and assembly part and capable of suturing the held tissue using staples; and an advance and retreat mechanism that connects the holding part to the disassembly and assembly part in a manner that allows it to move forward and backward relative to the disassembly and assembly part.

[0013] The second technical solution of the present invention includes a suturing method comprising the following steps: an installation step, in which a medical suture device comprising a first clamp member having a pin release portion and a second clamp member having a pin receiving portion is installed on the anterior end of an endoscope; an insertion step, in which the medical suture device and the endoscope are inserted into the body; a protrusion step, in which a treatment instrument protrudes from the anterior end of the endoscope; a holding step, in which the protruding treatment instrument is held through a through space provided in the second clamp member to hold the target tissue; a pull-in step, in which the treatment instrument is retracted relative to the first clamp member and the second clamp member, and the target tissue is pulled in until the target tissue passes through the through space; and a suturing step, in which the first clamp member and the second clamp member are closed, and the target tissue is sutured using the opposing pin release portions and the pin receiving portions.

[0014] The effects of the invention

[0015] The medical suture device and suturing method of the present invention can adequately suture tissue located in areas that are difficult to suture. Attached Figure Description

[0016] Figure 1 This is a diagram illustrating a medical system equipped with a medical suture device according to the first embodiment of the present invention.

[0017] Figure 2 This is a perspective view of the sheath operating section of the medical system according to the first embodiment.

[0018] Figure 3 This is a perspective view of the medical suture device according to the first embodiment.

[0019] Figure 4 This is a front view of the cap of the medical suture device according to the first embodiment.

[0020] Figure 5 This is a perspective view of a medical suture device with the holding part in a closed state according to a first embodiment.

[0021] Figure 6 This is a front view of a medical suture device with the gripping part in a closed state according to a first embodiment.

[0022] Figure 7 This is a perspective view of a medical suture device with the holding part in an open state according to a first embodiment.

[0023] Figure 8 This is a front view of a medical suture device with the holding part in the open state according to a first embodiment.

[0024] Figure 9This is a side view of a medical suture device with the gripping part in a closed state according to a first embodiment.

[0025] Figure 10 This is a side view of a medical suture device with the holding part in the open state according to a first embodiment.

[0026] Figure 11 It is a three-dimensional diagram showing the connection between the first gripping component and the cap.

[0027] Figure 12 It is a cross-sectional view of the holding part including the pin release part.

[0028] Figure 13 It is a cross-sectional view of the holding part where the operating line is pulled.

[0029] Figure 14 It is a cross-sectional view of the forward-moving grip and cap.

[0030] Figure 15 It is a cross-sectional view of the handle and cap in their forward-opening state.

[0031] Figure 16 This is a flowchart illustrating a surgical procedure performed by a surgeon using a medical suture device according to the first embodiment.

[0032] Figure 17 This is a diagram illustrating the operation of the medical suture device according to the first embodiment.

[0033] Figure 18 This is a diagram illustrating the operation of the medical suture device according to the first embodiment.

[0034] Figure 19 This is a diagram representing another form of the holding process.

[0035] Figure 20 This is a diagram representing another form of the holding process.

[0036] Figure 21 This is a diagram illustrating the operation of the medical suture device according to the first embodiment.

[0037] Figure 22 This is a diagram illustrating the operation of the medical suture device according to the first embodiment.

[0038] Figure 23 This is a diagram illustrating the operation of the medical suture device according to the first embodiment.

[0039] Figure 24 This is a diagram showing a variation of the wire sheath.

[0040] Figure 25 This is a cross-sectional view showing another variation of the wire sheath. Detailed Implementation

[0041] (First Implementation)

[0042] Reference Figures 1 to 23 The first embodiment of the present invention will be described.

[0043] Figure 1 This is a diagram showing the overall structure of a medical system 300 that includes the medical suture device 100 of this embodiment.

[0044] [Medical System 300]

[0045] The medical system 300 is used in surgeries such as suturing the digestive tract. The medical system 300 includes a medical suture device 100, an endoscope 200, an opening / closing operation unit 250, a release operation unit 270, a suture sheath 280, a resin sheath 290, and a suture sheath operation unit 260. The opening / closing operation unit 250 operates the medical suture device 100 using an opening / closing operation line (first line) 5. The release operation unit 270 operates the medical suture device 100 using a release operation line (second line) 6.

[0046] [Endoscope 200]

[0047] Endoscope 200 is a well-known flexible endoscope, including a longitudinally elongated insertion section 210 inserted into the body from the tip, an operating section 220 located at the base of the insertion section 210, and a universal cable 240.

[0048] An instrument channel 230 is formed in the insertion portion 210 for an endoscopic instrument to pass through. A forceps jaw 214 is provided at the front end 212 of the insertion portion 210, which serves as the front opening of the instrument channel 230. The instrument channel 230 extends from the front end 212 of the insertion portion 210 to the operation portion 220.

[0049] The front end portion 211 of the insertion part 210 is equipped with an imaging unit (not shown) including a CCD or the like. The objective lens 215 of the imaging unit is exposed at the front end 212 of the insertion part 210. The front end portion 211 of the insertion part 210 has a rigid portion 211a on the front end side (see reference). Figure 14 , Figure 15 ).

[0050] The base of the operating section 220 is provided with a knob 223 for operating the insertion section 210 and a switch 224 for operating the camera unit, etc. The surgical operator can bend the insertion section 210 in the desired direction by operating the knob 223.

[0051] The operating section 220 has a forceps insertion port 222 that communicates with the instrument channel 230. The surgical operator can insert the endoscope instrument through the forceps insertion port 222 into the instrument channel 230.

[0052] A general-purpose cable 240 connects the operation unit 220 to external peripheral devices. For example, the general-purpose cable 240 outputs images captured by the camera unit to an external device. The images captured by the camera unit are then displayed on a display device such as a liquid crystal display via an image processing unit.

[0053] [Opening / closing operation unit 250]

[0054] The opening and closing operation unit 250 is an operation unit that opens and closes the medical suture device 100 by operating the opening and closing operation line 5. For example... Figure 1 As shown, the opening / closing operation unit 250 includes an opening / closing operation unit body 252 and an opening / closing operation slider 253. The base end of the opening / closing operation line 5 is connected to the opening / closing operation slider 253. The surgical operator can move the opening / closing operation line 5 forward and backward by moving the opening / closing operation slider 253 relative to the opening / closing operation unit body 252 in the longitudinal axis direction.

[0055] [Release Operations Department 270]

[0056] The release operation unit 270 releases the tack S from the medical suture device 100 by operating the release operation line 6 (see reference). Figure 12 The operating section of ) . For example Figure 1 As shown, the release operation unit 270 includes a release operation unit body 272 and a release operation slider 273. The base end of the release operation line 6 is connected to the release operation slider 273. The surgical operator can move the release operation line 6 forward and backward by moving the release operation slider 273 relative to the release operation unit body 272 in the longitudinal axis direction.

[0057] [Line sheath 280]

[0058] The wire sheath 280 is a sheath through which the opening / closing operating wire 5 and the discharging operating wire 6 pass. The wire sheath 280 is a metal coil sheath. However, the wire sheath 280 is not limited to a metal coil sheath and can also be other types of sheaths.

[0059] The online sheath 280 has two inner sheaths 282 (see reference). Figure 14 The opening / closing operation line 5 and the discharging operation line 6 are respectively inserted into the two inner sheaths 282. Alternatively, the two inner sheaths 282 can also be multi-lumen tubes with two lumens.

[0060] [Resin Sheath 290]

[0061] The resin sheath 290 is a sheath through which the cable sheath 280 can pass, allowing it to retract. The resin sheath 290 is formed of resin material. For example... Figure 1As shown, the front end of the resin sheath 290 is connected to the insertion portion 210 of the endoscope 200 by a band 291. The front end of the resin sheath 290 is fixed to the cap 1 of the medical suture device 100, and its base end is fixed to the suture sheath operating portion 260.

[0062] [Line sheath operating section 260]

[0063] Figure 2 This is a perspective view of the line sheath operating section 260.

[0064] The wire sheath operating part 260 is an operating part that moves the wire sheath 280 forward and backward relative to the resin sheath 290. The wire sheath operating part 260 has an operating part body 261 and a clamp mounting part 264.

[0065] The main body 261 of the operating part is cylindrical and has a front opening 262 and a base opening 263. The base end of the resin sheath 290 is fixed to the front opening 262. The suture sheath 280 extends from the base opening 263. The surgical operator can move the suture sheath 280 relative to the resin sheath 290 by moving the suture sheath 280 forward and backward relative to the main body 261 of the operating part.

[0066] The clamp mounting part 264 is a component mounted on the operating part body 261 and has a clamp through hole 265. By mounting a clamp (not shown) through the clamp through hole 265 onto the endoscope 200, the operating part body 261 can be easily fixed to the endoscope 200. By fixing the operating part body 261 to the endoscope 200, the surgical operator can move the suture sheath 280 relative to the resin sheath 290 without holding the operating part body 261.

[0067] A rubber plug 266 is provided at the base opening 263 of the discharge sheath 280, which contacts the sheath 280. The friction generated between the sheath 280 and the rubber plug 266 can suppress accidental forward or backward movement of the sheath 280 during processing.

[0068] [Medical suture device 100]

[0069] Figure 3 This is a 3D view of the medical suture device 100.

[0070] The medical suture device 100 includes a cap 1, a holding part 2, a staple delivery part 3, a staple receiving part 4, an opening / closing operation line 5, and a delivery operation line 6. The medical suture device 100 can be attached to and detached from the front end 211 of the insertion part 210.

[0071] Figure 4 This is the main view of hat 1. Figure 4 The central perspective indicates the holding part 2.

[0072] The cap (removable part) 1 is a component that can be detached from the front end 211 of the endoscope 200. The cap 1 is formed in a generally cylindrical shape and has a first through hole 11, a second through hole 12, a third through hole 14, and a fourth through hole 15 that pass through along the axial direction A.

[0073] The first through hole 11 is a hole for inserting the front end portion 211 of the insertion portion 210. The shape of the first through hole 11 is formed along the outline 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 installed on the front end portion 211 of the endoscope 200.

[0074] like Figure 4 As shown, the central axis O1 of the first through hole 11 is eccentric relative to the central axis O of the axial direction A of the cap 1. The direction in which the central axis O1 is eccentric relative to the central axis O is defined as "upper B1".

[0075] The second through hole 12 is a hole for inserting the resin sheath 290. The inner diameter of the second through hole 12 is approximately the same as the outer diameter of the resin sheath 290. The front end of the resin sheath 290 passes through the second through hole 12 and is fixed therein. The wire sheath 280, the opening / closing operation line 5, and the release operation line 6, which pass through the resin sheath 290, extend through the second through hole 12 to the front end side.

[0076] like Figure 4 As shown, the central axis O2 of the second through hole 12 is eccentric relative to the central axis O of the cap 1. The direction of eccentricity of the central axis O2 relative to the central axis O is opposite to the direction of eccentricity of the central axis O1 relative to the central axis O (upper B1). The direction of eccentricity of the central axis O2 relative to the central axis O is defined as "lower B2". In this embodiment, upper B1 and lower B2 are along the vertical direction B.

[0077] When viewed from the main view along the axial direction A, the third through hole 14 and the fourth through hole 15 are formed on both sides, separated by the second through hole 12.

[0078] Figure 5 and Figure 6 These are perspective and front view views of a medical suture device 100 with the gripping part 2 in a closed state.

[0079] When the cap 1 is installed on the front end 211 of the endoscope 200, as Figure 5 and Figure 6As shown, the objective lens 215 and the forceps jaw 214 are exposed from the opening 13 on the front side of the first through hole 11 of the cap 1. The surgeon can observe the object being treated using the objective lens 215 even when the medical suture 100 is attached to the front end 211 of the endoscope 200.

[0080] Figure 7 and Figure 8 These are perspective and front views of the medical suture device 100 with the holding part 2 in the open state. Furthermore, Figure 9 This is a side view of a medical suture 100 with the holding part 2 in a closed state. Figure 10 This is a side view of a medical suture 100 with the holding part 2 in the open position.

[0081] The holding part 2 is located on the front end side of the cap 1, and can be used with the clip S (refer to...) Figure 12 The object of the suture is held. The holding part 2 has a first holding member (first clamping member) 21, a second holding member (second clamping member) 22, an opening and closing rotation shaft 23, and a movable pin 27 (see reference). Figure 9 , Figure 10 The first gripping member 21 and the second gripping member 22 are connected in an openable and closable manner via an opening and closing rotation axis 23. The first gripping member 21 and the second gripping member 22 rotate relative to each other to grip the object. The opening and closing rotation axis 23 is located at a position closer to the front end of the cap 1. The axial direction C of the opening and closing rotation axis 23 is perpendicular to the axial direction A and the vertical direction B of the cap 1. Figure 8 As shown, the gripping part 2 is formed symmetrically with respect to the central axis O3 in the vertical direction B.

[0082] Figure 11 This is a perspective view showing the connection between the first gripping member 21 and the cap 1.

[0083] The first gripping member 21 (first clamping member) is connected to the front end of the cap 1 in a retractable manner. The first gripping member 21 is connected to the cap 1 at a position B2 below the central axis O of the cap 1. Two support members 26 extending towards the base end in the axial direction A are mounted on the first gripping member 21.

[0084] The two support members 26 are rigid, longitudinally elongated members that support the first gripping member 21 in a manner that allows it to move forward and backward relative to the cap 1. The two support members 26 are respectively inserted into the third through hole 14 and the fourth through hole 15 in a manner that allows them to move forward and backward along the axial direction A. That is, the two support members 26, the third through hole 14, and the fourth through hole 15 constitute the forward and backward movement mechanism of the first gripping member 21.

[0085] The first gripping member 21 is supported by two support members 26 arranged in the width direction C, and therefore does not rotate about the axial direction A. Furthermore, the two support members 26 have the effect of preventing the sheath 280 from deflecting during the tissue insertion step, thus supporting the first gripping member 21 of the gripping part 2 in a manner that prevents it from deviating from the central axis O2. Alternatively, if the rigidity of the support member 26 is sufficient, there may be only one support member 26.

[0086] like Figure 11 As shown, the front end of the sheath 280 through which the opening / closing operation line 5 and the release operation line 6 pass is fixed to the first gripping member 21. If the sheath 280 moves forward or backward relative to the resin sheath 290, the first gripping member 21 connected to the sheath 280 moves forward or backward relative to the cap 1.

[0087] like Figure 4 As shown, the first gripping member 21 is positioned overlapping the second through hole 12 in the main view. On the other hand, as... Figure 8 As shown, the first gripping member 21 is positioned in the main view that does not overlap with the objective lens 215 and the forceps jaw 214 of the endoscope 200.

[0088] like Figure 7 As shown, the first gripping member 21 has a first front end portion 21a and a first main body portion 21b, and is generally T-shaped when viewed from above. The first front end portion 21a is positioned at a position closer to the front end than the first main body portion 21b.

[0089] The first front end portion 21a is generally rectangular. When viewed from above, the first front end portion 21a is a rectangular shape extending along the axial direction C of the opening and closing rotation axis 23. A latch release portion 3 is provided in the first front end portion 21a. An opening 31a of the latch release portion 3 is provided on the surface (upper surface 21e) above the first front end portion 21a on the surface B1.

[0090] 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 abutment pin 21c and a first engaging groove 21d.

[0091] An abutment pin 21c is provided at the base end of the first main body 21b, and abuts against the second gripping member 22 in the closed state to limit the movable range of the second gripping member 22.

[0092] like Figure 9 As shown, the first engaging groove 21d is a groove in the first main body 21b that extends along the axial direction C of the opening and closing rotation axis 23. The first engaging groove 21d extends along the axial direction A.

[0093] The second gripping member (second clamping member) 22 is rotatably mounted to the first gripping member 21 via an opening and closing rotation shaft 23. The second gripping member 22 has a U-shaped member 22a formed in a generally U-shape and a second main body 22b that supports the U-shaped member 22a in a rotatable manner.

[0094] The U-shaped member 22a is formed in a generally U-shape, with its two ends connected to the second main body 22b, and its central portion disposed on the front end side. The central portion has a second front end portion 22c. The second front end portion 22c is formed in a generally cuboid shape. A clip receiving portion 4 is provided at the second front end portion 22c.

[0095] The second main body 22b is rotatably mounted to the first main body 21b of the first gripping member 21 via an opening and closing rotation shaft 23. A guide groove 22d is formed in the second main body 22b for insertion of the first main body 21b. Second engaging grooves 22e are formed on both sides of the guide groove 22d in the second main body 22b.

[0096] The second engaging groove 22e is a groove formed in the second main body portion 22b. The second engaging groove 22e is a groove that extends along the axial direction C. When viewed from the side, the second engaging groove 22e is formed on the side opposite to the clasp receiving portion 4, separated by the opening and closing rotation axis 23. The second engaging groove 22e is symmetrical with respect to the central axis O3 of the second holding member 22.

[0097] like Figure 7 As shown, the second gripping member 22 has a field of view (through space) 25 that extends along the opening and closing direction R between the pin receiving part 4 on the front end side and the opening and closing rotation axis 23 on the base end side. In this embodiment, the field of view 25 is the space surrounded by the edge of the U-shaped member 22a, which is formed into a roughly U-shape.

[0098] 27 movable pins (reference) Figure 9 , Figure 10 It engages with the first engaging groove 21d and the second engaging groove 22e, and moves forward and backward along the axial direction A along the first engaging groove 21d. The front end of the opening / closing operation line 5 is installed on the movable pin 27. It advances towards the front end via the opening / closing operation line 5, as... Figure 10 As shown, the movable pin 27 causes the second gripping member 22 to rotate about the opening / closing rotation axis 23, and the gripping part 2 is in the open state. It retracts towards the base end via the opening / closing operation line 5, as... Figure 9 As shown, the movable pin 27 causes the second gripping member 22 to rotate about the opening / closing rotation axis 23, and the gripping part 2 is in a closed state. That is, the opening / closing operation line 5 is a component that transmits the power to rotate the first gripping member 21 and the second gripping member 22 relative to each other, thereby causing the gripping part 2 to grip the object.

[0099] When the gripping part 2 is in the closed state, such as Figure 6 As shown, the pin delivery part 3 and the pin receiving part 4 are opposite each other. When the gripping part 2 is in the closed state, a small gap is formed between the pin delivery part 3 and the pin receiving part 4. When the gripping part 2 is in the closed state, as... Figure 5 , Figure 6 and Figure 9 As shown, the optical axis A1 of the objective lens 215 passes through the outer side of the first gripping member 21 and the outer side of the second gripping member 22. Furthermore, when the gripping part 2 is in the closed state, the central axis A2 of the clamp jaw 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 main view.

[0100] When the gripping part 2 is in the open state, such as Figure 10 As shown, the pin receiving part 4 is positioned closer to the base end than the opening / closing rotation shaft 23. When the holding part 2 is in the open state, as... Figure 7 , Figure 8 and Figure 10 As shown, the pin release part 3 and the pin receiving part 4 are arranged on both sides of the objective lens 215, separated by the optical axis A1. When the holding part 2 is in the open state, the optical axis A1 of the objective lens 215 passes through the field of view 25. Furthermore, when the holding part 2 is in the open state, the central axis A2 of the clamp jaw 214 passes through the field of view 25.

[0101] Figure 12 It is a cross-sectional view of the holding part 2 including the pin release part 3.

[0102] The pin release part 3 is provided at the first front end 21a of the first holding member 21, and is capable of receiving and releasing the pin S. The pin release part 3 has a pin receiving part 31, a straight-in member 32, and a rotating member 33.

[0103] The clip storage section 31 is a space provided at the first front end portion 21a of the first holding member 21 for storing clips S. For example... Figure 7 As shown, the first holding member 21 has two pin storage parts 31 arranged along the axial direction C, which can store two U-shaped pins S.

[0104] The clip storage part 31 opens vertically in the direction B at the opening 31a on the upper surface 21e of the first front end 21a. The clip S is stored in the clip storage part 31 through the opening 31a. The clip S is stored in the clip storage part 31 with the tip S1 of the clip S facing upwards B1.

[0105] When viewed from above, the clip storage section 31 is roughly rectangular in shape, with the shorter side extending along the axial direction A and the longer side extending along the axial direction C. The tips S1 of the clips S stored in the clip storage section 31 are arranged along the axial direction C.

[0106] The straight-through member 32 is a member housed in the tack holder 31 and is movable in the vertical direction B within the internal space of the tack holder 31. The straight-through member 32 has a recess 32a at the top B1 for supporting the tack S. The tack S housed in the tack holder 31 is inserted into the recess 32a.

[0107] The first pulley 34 and the second pulley 36, which are rotating members 33, are rotatably mounted inside the first gripping member 21. Rotation of these pulleys causes the straight-line member 32 to move vertically in the direction B. The first pulley 34 is connected to the front end of the release operation line 6. By pulling the release operation line 6, the first pulley 34 can be rotated.

[0108] The second pulley 36 is rotatably mounted inside the first gripping member 21, and the first pulley 34 is positioned at a position closer to the front end 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 along the axial direction C and are substantially parallel to the opening and closing rotation axis 23 of the gripping part 2. The first pulley 34 has a protrusion (abutment portion) 38 at its front end side that supports the straight-through member 32 from below B2.

[0109] The front end of the release operation line 6 is connected to the portion of the first pulley 34 located above the rotating shaft 35 at point B1. The release operation line 6 extends from the first pulley 34, through the second pulley 36, through the second through hole 12, and to the release operation section 270. The reason for providing the second pulley 36 is to adjust and reduce the frictional resistance when guiding the release operation line 6 to the second through hole 12. Therefore, even if only the first pulley 34 is used as the rotating member 33, the same effect can be achieved by providing a component with better sliding properties (friction reduction component) with a rounded corner shape instead of the second pulley 36.

[0110] Figure 13 It is a cross-sectional view of the holding part 2 that pulls the operation line 6.

[0111] By being pulled by the release operation line 6, the upper B1 portion of the first pulley 34 rotates towards the base end, and the lower B2 portion of the first pulley 34 rotates towards the front end. As a result, the protrusion 38 of the first pulley 34 pushes the straight-in member 32 upward B1, releasing the stored clasp S from the opening 31a upward B1. That is, the release operation line 6 is the member that transmits the power to release the clasp S from the holding part 2.

[0112] A pin receiving portion 4 is provided on the lower surface 22f of the second front end portion 22c of the second gripping member 22. The pin receiving portion 4 is provided with multiple grooves 41 capable of receiving pins S released from the pin dispensing portion 3. In this embodiment, since two U-shaped pins are released from the pin dispensing portion 3, four grooves are provided in the pin receiving portion 4. When the gripping portion 2 is in the closed state, as... Figure 12 As shown, the opening 31a of the release pin S and the groove 41 of the release pin part 3 are opposite each other.

[0113] Figure 14 This is a cross-sectional view of the forward-moving gripping part 2 and the cap 1.

[0114] Even when the gripping part 2 is in the forward position, it remains connected to the opening / closing operation line 5 and the release operation line 6 of the through-wire sheath 280. Even with the gripping part 2 in the forward position, the surgical operator can move the opening / closing operation line 5 and the release operation line 6 forward and backward.

[0115] Figure 14 The gripping part 2 shown is positioned at its maximum extent relative to the cap 1. The length Y1 of the front end portion 285 of the wire sheath 280, which can protrude from the second through hole 12 of the cap 1 toward the front end, is less than or equal to the length Y2 of the rigid part 211a of the front end portion 211 of the endoscope 200.

[0116] Figure 15 This is a cross-sectional view of the holding part 2 and the cap 1 in their forward-opening state.

[0117] Figure 15 The gripping part 2 shown is positioned at its maximum forward position relative to the cap 1. The length Y3 from the pin release part 3 of the gripping part 2 at its maximum forward position to the objective lens 215, the distance X from the optical axis A1 of the objective lens 215 to the opening 31a of the pin release part 3, and the angle of view θ of the objective lens 215 are preferably related by formula (1). When the above parameters satisfy formula (1), the objective lens 215 can capture the sewing position regardless of the forward or backward position of the gripping part 2.

[0118] X / tan(θ / 2)≤Y3 (1)

[0119] [Operation of Medical Suture Device 100]

[0120] Next, the operation of the medical suture device 100 will be explained. Figure 16 This is a flowchart illustrating the surgical procedure performed by a surgical operator using a medical suture device 100. Figures 17-23 This is a diagram illustrating the operation of the medical suture device 100.

[0121] The surgeon attaches the medical stapler 100 to the front end 211 of the endoscope 200 (attachment step S11). The surgeon inserts the medical stapler 100 and the endoscope 200 into the body (insertion step S12).

[0122] The surgeon brings the tip 211 of the endoscope 200, equipped with a medical stapler 100, close to the object T (an example of the object tissue). The surgeon advances the opening / closing line 5 by operating the opening / closing operating part 250, thereby opening the gripping part 2. Since the optical axis A1 of the objective lens 215 passes through the field of view 25, the surgeon can observe the object T using the imaging unit of the endoscope 200. Furthermore, since the central axis A2 of the forceps jaws 214 passes through the field of view 25, the surgeon can observe the object T. Figure 17 As shown, the surgical operator can protrude the holding forceps G (disposal instrument) from the forceps jaw 214 to dispose of the object T (protrusion step S13).

[0123] like Figure 12 As shown, a chamfer 20 is applied to the position of the protruding gripping forceps G in the gripping part 2, which is easy to hook. Therefore, the surgeon can smoothly perform the action of protruding the gripping forceps G.

[0124] When the patient T is located in an area that is difficult for an endoscope 200 to access, such as Figure 18 As shown, the surgeon advances the gripping part 2 by advancing the suture sheath 280 (advancement step S14). The surgeon then uses the gripping forceps G to protrude from the field of view (through space) 25 of the advanced gripping part 2 to grip the object being treated (gripping step S15).

[0125] Figure 19 and Figure 20 This is a diagram representing another form of the holding step S15.

[0126] The grasping step S15 includes pulling the separated mucosa M closer and grasping it. In this case, a grasping forceps G1 (treatment device) including a fixing forceps piece g10, a first forceps piece g11, and a second forceps piece g12 is used. The first forceps piece g11 and the second forceps piece g12 are provided on both sides of the fixing forceps piece g10 in a manner that allows them to rotate independently. Figure 19 As shown, the surgeon uses the fixing forceps g10 and the first forceps g11 to hold a mucosa M. Then, as... Figure 20 As shown, the surgeon uses the fixation forceps g10 and the second forceps g12 to hold another mucosa M.

[0127] like Figure 21As shown, the surgeon, while holding the object T with the forceps G, retracts the forceps G. The surgeon pulls the object T in until the tip of the forceps G passes through the field of view (through space) 25 by retracting the forceps G until the object T passes through the field of view (through space) 25. As a result, the object T is positioned near the base of the tack release part 3. The surgeon can also pull the object T in by advancing the gripping part 2 relative to the forceps G. That is, the forceps G is retracted relative to the gripping part 2 to pull the object T in (pulling-in step S16).

[0128] like Figure 21 As shown, because the first gripping member 21 presses down on the periphery of the object to be treated T, the surgeon can easily pull the object to be treated T in using the gripping forceps G.

[0129] Furthermore, the forward step S14 can be performed either before the holding step S15 or before the pulling step S16. In either case, the first holding member 21 can press down on the periphery of the object being processed T during the pulling step S16.

[0130] like Figure 22 As shown, the surgical operator retracts the opening / closing operation line 5 by operating the opening / closing operation part 250, thereby closing the gripping part 2. The object T is clamped by the pin release part 3 of the first gripping member 21 and the pin receiving part 4 of the second gripping member 22.

[0131] When the gripping part 2 is in the closed state, a portion of the object to be disposed of, T, held by the gripping pliers G, can be stored in the space (field of view 25) formed by the U-shaped member 22a of the second gripping member 22 and the second main body part 22b. Therefore, it is not easy for the object to be disposed of, which is clamped by the pin release part 3 and the pin receiving part 4, to come off.

[0132] When the gripping part 2 is in the closed state, such as Figure 9 As shown, the optical axis A1 of the objective lens 215 passes through the outer side of the first holding member 21 and the outer side of the second holding member 22. Therefore, the surgeon can observe the object T with the aid of the camera unit of the endoscope 200 even when the holding part 2 is closed.

[0133] With the patient T held between the stab release section 3 and the stab receiving section 4, the surgeon operates the release operation section 270 to pull out the operation line 6, thereby releasing the stored stab S toward the stab receiving section 4. The tip S1 of the stab S (refer to...) Figure 12 The needle penetrates the object being treated (T) and bends by contacting the groove 41 of the rivet receiving part 4. As a result, the object being treated (T) is sewn (sewing step S17).

[0134] like Figure 23 As shown, the surgeon operates the opening / closing mechanism 250 to open the gripping part 2 again. The surgeon releases the object T with the gripping forceps G to complete the suturing procedure. The surgeon then removes the medical suture device 100 and the endoscope 200 from the body (removal step S18).

[0135] In addition, during the insertion step S12 and the withdrawal step S18, the surgical operator positions the holding part 2 in the position with its maximum retraction to facilitate the passage of the medical suture device 100 into the body.

[0136] According to the medical suture device 100 of this embodiment, since the holding part 2 can be advanced, it is possible to adequately suture the object T located in a region difficult to access by the endoscope 200. The medical suture device 100 facilitates suturing of the object T located in a region difficult to access by the endoscope 200.

[0137] According to the medical suture device 100 of this embodiment, since the object to be treated T can be pulled in relative to the advanced gripping part 2 using the gripping forceps G, therefore... Figure 22 As shown, the stassels S can be used to suture deeper into the object T. Therefore, the sutured stassels S are less likely to detach from the object T.

[0138] The first embodiment of the present invention has been described in detail above with reference to the accompanying drawings. However, the specific structure is not limited to this embodiment, and design changes that do not depart from the spirit of the present invention are also included. Furthermore, the constituent elements shown in the above embodiments and variations can be appropriately combined to form a configuration.

[0139] (Variation Example 1)

[0140] For example, in the above embodiment, the first gripping member 21 is supported by the support member 26 in a way that allows it to move forward and backward. However, the form in which the first gripping member 21 is supported is not limited to this. Figure 24 This diagram shows a modified example of the wire sheath 280, namely the wire sheath 280B. The front end portion 285 (length Y1) of the wire sheath 280B, protruding from the second through hole 12 of the cap 1, is harder than the other portions on the base end side. Therefore, the forward and backward gripping part 2 can be supported solely by the wire sheath 280B, eliminating the need for the support member 26.

[0141] The length Y1 of the tip 285 is shorter than the length Y2 of the rigid portion 211a of the tip 211 of the endoscope 200. Therefore, even when the gripping portion 2 retracts and the rigid tip 285 moves towards the base, it will not move to a position closer to the base than the rigid portion 211a. Therefore, regardless of the forward or backward position of the tip 285, the tip 285 does not affect the bending motion of the endoscope 200.

[0142] The front end 285 of the sheath 280B has a D-shaped anti-rotation member 286 with a cross-section perpendicular to the axial direction A. Furthermore, the second through hole 12B of the cap 1 (a variation of the second through hole 12) also has a D-shaped cross-section perpendicular to the axial direction A, corresponding to the anti-rotation member 286. Therefore, even without the support member 26, the first gripping member 21 will not rotate about the axial direction A.

[0143] (Variation Example 2)

[0144] Figure 25 This is a cross-sectional view showing a wire sheath 280C, which is another variation of the wire sheath 280. The wire sheath 280C is a sheath with a covering layer 281 made of resin or the like on the outer periphery of the wire sheath 280, which serves as a coil sheath. Since the wire sheath 280 is a coil sheath, it is susceptible to stretching and breakage during forward and backward movements. By providing the covering layer 281, breakage of the wire sheath 280 can be properly prevented.

[0145] Industrial availability

[0146] This invention can be applied to medical suture devices such as suture machines.

[0147] Explanation of reference numerals in the attached figures

[0148] 300. Medical system; 100. Medical suture device; 200. Endoscope; 210. Insertion part; 211. Front end part; 214. Forceps jaw; 215. Objective lens; 1. Cap (removal part); 11. First through hole; 12. Second through hole; 13. Opening; 2. Holding part; 21. First holding member (first forceps member); 22. Second holding member (second forceps member); 22a. U-shaped member; 23. Opening and closing rotation axis; 25. Field of view (through space); 26. Support member; 3. Snap pin release part; 31. Snap pin storage part; 33. Rotating member; 34. First pulley; 35. Rotating axis; 36. Second pulley; 37. Rotating axis; 4. Snap pin receiving part; 41. Groove; 5. Opening and closing operation line (first line); 6. Release operation line (second line).

Claims

1. A medical suture device, wherein, The medical suture device includes: The disassembly / assembly section is detachable from the front end of the endoscope. The holding part, disposed at the front end of the disassembly part, has a clip dispensing part for dispensing clips and a clip receiving part for receiving clips; and The retractable mechanism connects the gripping part to the disassembly / assembly part in a manner that allows it to move forward and backward relative to the disassembly / assembly part. The advancing and retracting mechanism has a wire sheath that passes through a through hole formed in the disassembly / assembly part. The front end of the wire sheath is fixed to the gripping part. The gripping part moves to the front end by moving the sheath of the wire towards the front end.

2. The medical suture device according to claim 1, wherein, The gripping part has a first clamping member and a second clamping member that are connected in an openable and closable manner via a rotating shaft. The first clamping member and the second clamping member rotate relative to each other to hold the object organization.

3. The medical suture device according to claim 2, wherein, When the gripping part is in the closed state, the pin release part provided on the first clamp member and the pin receiving part provided on the second clamp member are opposite each other.

4. The medical suture device according to claim 2, wherein, The disassembly / assembly section has an opening that exposes the forceps jaws of the endoscope. The second clamping member has a through space extending along the opening and closing direction. When the gripping part is in the open state, the central axis of the pliers jaws passes through the through space.

5. The medical suture device according to claim 1, wherein, The medical suture device includes: The first line, which penetrates the sheath, transmits power to the gripping part to hold the object; and The second line, which runs through the sheath, transmits the power that causes the gripping part to release the latch.

6. The medical suture device according to claim 1, wherein, The retraction mechanism also includes a support member that supports the gripping part in a manner that allows it to retract relative to the disassembly part.

7. The medical suture device according to claim 1, wherein, The length of the front end portion of the sheath that protrudes from the through hole of the disassembly section toward the front end is less than or equal to the length of the rigid portion of the front end of the endoscope.

8. The medical suture device according to claim 7, wherein, The front end of the wire sheath is harder than the rest of the wire sheath.

9. The medical suture device according to claim 7, wherein, The front end of the sheath has an anti-rotation element.

10. The medical suture device according to claim 1, wherein, The disassembly / assembly section has an opening that exposes the objective lens of the endoscope. The objective lens is capable of capturing images of the gripping part that has advanced to its maximum extent relative to the disassembly / assembly part.

11. The medical suture device according to claim 1, wherein, The medical suture device also includes a suture sheath operating part for advancing and retracting the suture sheath. The wire sheath penetrates the resin sheath, the front end of which is fixed to the disassembly / assembly part, and the base end of which is fixed to the wire sheath operating part.

12. The medical suture device according to claim 11, wherein, The sheath operating part has a rubber plug that contacts the sheath at the opening for discharging the sheath.

13. The medical suture device according to claim 4, wherein, The gripping part has a pressing part that presses the periphery of the object tissue when the object tissue is pulled in until it passes through the through space.

14. The medical suture device according to claim 1, wherein, A covering layer is provided on the outer periphery of the line sheath.

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