Endoscopic suture device

Abstract

To provide an endoscopic suture device that enables more reliable fixation operation of a suture needle to an arm part while using a wire for operation.SOLUTION: An endoscopic suture device is provided in a distal end of a tubular insertion part of an endoscope, includes a first arm part and a second arm part each including a holding part of a suture needle in one end side of the arm, and is configured to be able to switch the arm part that holds the suture needle when the arm one end side is opened and closed to suture a tissue. The endoscopic suture device includes: a pair of operation lines that is arranged along the tubular insertion part and whose one operation interlocks with the other operation to the opposite side; a first fixation part that, when one of the pair of operation lines is pulled to a proximal side with respect to a device body part, fixes the suture needle to the holding part of the first arm part; and a second fixation part that, when the other of the pair of operation lines is pulled to the proximal side with respect to the device body part, fixes the suture needle to the holding part of the second arm part.SELECTED DRAWING: Figure 5

Description

[Technical field]

[0001] The present invention relates to an endoscopic suturing device. [Background technology]

[0002] Conventionally, a technique for suturing an incision under an endoscope to reduce the risk of complications after incision has been known, and an endoscopic suturing device for suturing an incision under an endoscope has also been proposed. For example, Patent Document 1 discloses a suturing device that has a pair of arms that hold a suturing needle at the tip, and switches the arm that holds the suturing needle when opening and closing to perform suturing. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] JP 2019-107442 A Summary of the Invention [Problem to be solved by the invention]

[0004] In this type of endoscopic suturing device, the distal suturing device is operated via a long wire from an operating section provided on the proximal side of the endoscope. The transmission of force via the wire is relatively good when pulling the proximal side, but when applying a pushing force to the distal side to the wire, the transmission of force to the distal side decreases due to bending of the wire, etc. Therefore, the operation of fixing the suturing needle to the arm section has been relatively difficult.

[0005] Therefore, the present invention has been made in consideration of the above-mentioned circumstances, and has an object to provide an endoscopic suturing device that can more reliably fix a suturing needle to an arm portion while using a wire for operation. [Means for solving the problem]

[0006] One aspect of the present invention is an endoscopic suturing device provided at the distal end of a tubular insertion section of an endoscope. The endoscopic suturing device has a first arm section and a second arm section, each having a holder for a suturing needle at one end of the arm, and is configured to be able to switch the arm section that holds the suturing needle when opening and closing the one end of the arm to suture tissue. The endoscopic suturing device also includes a pair of operating wires arranged in parallel along the tubular insertion section, one of which is operated in conjunction with the other of which being operated in the opposite direction, a first fixing section that fixes the suturing needle to the holder of the first arm section when one of the pair of operating wires is pulled proximally relative to the device body, and a second fixing section that fixes the suturing needle to the holder of the second arm section when the other of the pair of operating wires is pulled proximally relative to the device body. Effect of the Invention

[0007] According to one aspect of the present invention, it is possible to provide an endoscopic suturing device that can more reliably fix a suturing needle to an arm portion while using a wire for operation. [Brief description of the drawings]

[0008] [Figure 1] FIG. 1 is a perspective view that illustrates a schematic diagram of an example of a suturing device according to a first embodiment. [Diagram 2] FIG. 2 is a plan view of the suturing device of FIG. 1. [Diagram 3] FIG. 2 is a side view of the suturing device of FIG. 1. [Figure 4] 3A and 3B are diagrams illustrating a configuration example of an opening and closing mechanism part according to the first embodiment. [Diagram 5] FIG. 2 is a diagram showing a needle fixing mechanism of the first embodiment; [Figure 6] 5A to 5C are diagrams illustrating an example of the operation of a first fixing portion and a second fixing portion in the first embodiment. [Figure 7] 5A to 5C are diagrams illustrating an example of the operation of the suturing device of the first embodiment. [Figure 8] This is a continuation of Figure 7. [Figure 9] FIG. 11 is a diagram showing a needle fixing mechanism according to a second embodiment; [Figure 10] 13A to 13C are diagrams illustrating an example of the operation of the needle fixing mechanism of the second embodiment. [Figure 11] FIG. 13 is a diagram showing a needle fixing mechanism according to a third embodiment; DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0009] Hereinafter, a configuration example of an endoscopic suturing device (hereinafter also referred to as a suturing device) according to an embodiment will be described with reference to the drawings. Note that the shapes, dimensions, etc. of each part in the drawings are shown schematically and do not represent the actual shapes, dimensions, etc.

[0010] In the following description, the side of the endoscope farther from the operator is referred to as the distal side, and the side closer to the operator is referred to as the proximal side. In the drawings, the longitudinal direction (axial direction) of the endoscope is indicated by an arrow Ax as appropriate. The direction approximately perpendicular to the longitudinal direction is defined as the radial direction, and the rotation direction around the longitudinal direction is defined as the circumferential direction.

[0011] (First embodiment) Fig. 1 is a perspective view showing a schematic example of a suturing device according to a first embodiment, Fig. 2 is a plan view of the suturing device of Fig. 1, Fig. 3 is a side view of the suturing device of Fig. 1.

[0012] The suturing device 1 is detachably provided at the distal end of a tubular insertion portion 2 of an endoscope that is inserted into a living lumen. Since the suturing device 1 is detachable from the tubular insertion portion 2 of the endoscope, maintenance such as replacement and sterilization is easy. The suturing device 1 may be supplied as a disposable product.

[0013] For example, an endoscope is a flexible scope having a bendable tubular insertion section 2, which is operated by an operator from the proximal side. An objective lens 3 of an imaging section, an illumination section 4, and a forceps port 5 are provided at the distal end of the tubular insertion section 2 of the endoscope.

[0014] The endoscope can capture images of the inside of a living body lumen with an imaging section via a wide-angle objective lens 3, and can display and output the images of the inside of the living body lumen in real time on a display device (not shown). The illumination section 4 illuminates the inside of the living body lumen with light guided from a light source by an optical fiber. The forceps port 5 is provided for inserting and removing treatment tools such as forceps 6 and for collecting living body tissue with the treatment tool. As shown in FIG. 3, the endoscope can grasp living body tissue with the forceps 6 by moving the forceps 6 forward and backward in the longitudinal direction from the forceps port 5 of the tubular insertion section 2.

[0015] The suturing device 1 includes an attachment section 11, a pair of arms consisting of a first arm section 12 and a second arm section 13, an opening / closing mechanism section 14, an opening / closing wire 15, and operating wires 16a, 16b. The attachment section 11, the first arm section 12, the second arm section 13, and the opening / closing mechanism section 14 are disposed at the distal end of the tubular insertion section 2.

[0016] The first arm section 12 and the second arm section 13 each have a holder 18 at the distal end thereof for holding the suture needle 17. The first arm section 12 and the second arm section 13 each have an internal needle fixing mechanism 30 that can switch between a locked state in which the suture needle 17 is fixed to the holder 18 and an unlocked state in which the suture needle 17 is not fixed to the holder 18. The configuration of the needle fixing mechanism 30 will be described later.

[0017] The attachment portion 11 is an annular member that corresponds to the outer diameter of the tubular insertion portion 2. The distal end of the tubular insertion portion 2 is detachably inserted into the inside of the attachment portion 11 and held by the attachment portion 11. In addition, a first arm portion 12 and a second arm portion 13 are attached to the outer periphery of the attachment portion 11 via an opening / closing mechanism portion 14.

[0018] The first arm section 12 and the second arm section 13 are supported by the opening / closing mechanism section 14 in a V-shape so as to protrude distally from the attachment section 11, and can be opened and closed in a direction substantially parallel to the tangent direction of the outer periphery of the endoscope. As shown in Fig. 3, when the suturing device 1 is attached to the tubular insertion section 2, the tips of the first arm section 12 and the second arm section 13 are located distally of the tubular insertion section 2. Also, as shown in Fig. 3, the tip of each arm section is located on the line of movement of the forceps 6 when each arm section is closed.

[0019] The first arm 12 and the second arm 13 are attached with the distal side inclined radially inward from the proximal side. For example, each arm is attached with an inclination of 0.5° to 50°, more preferably 3° to 35°, radially inward from a position substantially parallel to the longitudinal direction. By attaching each arm with an inclination inward, the suturing device 1 is less likely to interfere with objects on the radial outside, and the passability when inserting the endoscope into the overtube or the body can be improved. In addition, by attaching each arm with an inclination inward, the tip of each arm approaches the center of the viewing angle of the imaging unit of the endoscope, and visibility during suturing can be improved. In addition, even if the endoscope moves or is located at a bent part, or the arm position is slightly shifted after insertion, the arm is more likely to be reflected in the center of the viewing field, making it easier to check the entire arm under the endoscope.

[0020] Moreover, the holding section 18 provided at the tip of each arm section is disposed within a range of 100% from the center of the viewing angle of the imaging section of the endoscope. Specifically, when the viewing angle of the imaging section is θ1 based on the distal end of the tubular insertion section 2 and the range from the center of the viewing angle where the tip of each arm section is disposed is θ2, it is preferable that θ2 is within 90% of θ1, more preferably θ2 is within 80% of θ1, and particularly preferably θ2 is within 70% of θ1. By disposing the tip of each arm section under the above conditions, it is possible to prevent the suturing point from being out of the viewing angle of the imaging section and the visibility during suturing from being reduced due to the influence of aberration of the imaging section.

[0021] Furthermore, when suturing by wrapping a large amount of biological tissue, such as in full-thickness suturing, it becomes necessary to sufficiently draw the biological tissue to be sutured toward the endoscope using the forceps 6 of the endoscope. For this reason, a certain margin is required in the longitudinal dimension from the distal end of the tubular insertion portion 2 to the holding portion 18.

[0022] From this viewpoint, for example, the longitudinal dimension from the distal end of the tubular insertion part 2 to the tip of each arm part is preferably, for example, 1 mm or more and 80 mm or less, and more preferably 3 mm or more and 60 mm or less. For example, by making the distance from the distal end of the tubular insertion part 2 to the tip of each arm part 3 mm or more, the tip of the arm part comes into the field of view of the endoscope, making suturing under the endoscope easier. Also, by making the distance from the distal end of the tubular insertion part 2 to the tip of each arm part 60 mm or less, it becomes easier to insert the tip of the arm without it getting caught on the overtube.

[0023] The opening and closing wire 15 is disposed in the longitudinal direction along the tubular insertion section 2, and its distal side is connected to the opening and closing mechanism 14. In the suturing device 1, the first arm 12 and the second arm 13 holding the suturing needle 17 can be opened and closed via the opening and closing mechanism 14 by pulling the opening and closing wire 15 proximally.

[0024] The operating wire 16a is disposed in the longitudinal direction along the tubular insertion portion 2, and its distal side is connected to the first arm portion 12 side of the needle fixing mechanism 30. In addition, the operating wire 16b is disposed in the longitudinal direction along the tubular insertion portion 2, and its distal side is connected to the second arm portion 13 side of the needle fixing mechanism 30.

[0025] By pulling operating wire 16b proximally, it is possible to switch between a state in which suturing needle 17 is fixed by holding portion 18 of first arm portion 12 and a state in which the lock is released. In addition, by pulling operating wire 16a proximally, needle fixing mechanism 30 of second arm portion 13 is operated, and it is possible to switch between a locked state in which suturing needle 17 is fixed by holding portion 18 of second arm portion 13 and a state in which the lock is released.

[0026] The above-mentioned opening / closing wire 15 and operating wires 16a, 16b can be operated independently. By operating the opening / closing mechanism 14 and the needle fixing mechanism 30 with separate wires, the suturing device 1 can be operated precisely.

[0027] The attachment section 11, the first arm section 12, the second arm section 13, and the opening / closing mechanism section 14 may be made of a biocompatible metal, such as stainless steel, titanium, or nitinol. The opening / closing wire 15 and the operating wires 16a and 16b may be made of a thin metal wire, such as stainless steel, titanium, copper, or nitinol, or a thin polymer fiber wire, a fluorine tube, polyethylene, polypropylene, or nylon. The opening / closing wire 15 and the operating wires 16a and 16b may be made of the same material or different materials.

[0028] 4 is a diagram illustrating a configuration example of the opening / closing mechanism 14 of the first embodiment. The opening / closing mechanism 14 is not limited to the configuration in FIG. 4, and may be another mechanism capable of opening and closing by pulling the opening / closing wire 15.

[0029] The opening / closing mechanism 14 of the first embodiment is a link mechanism that drives the first arm 12 and the second arm 13, and has a main body 21, a driving link 22, a first intermediate link 23, and a second intermediate link 24. The link mechanism of the opening / closing mechanism 14 is line-symmetric on a plane based on the central axis C. The central axis C includes a component that is inclined radially with respect to the longitudinal direction of the tubular insertion section 2.

[0030] The main body 21 is a thin box-shaped housing that rotatably supports the first arm 12 and the second arm 13 and houses the elements of the link mechanism. The main body 21 also functions as a cover that covers the elements of the link mechanism. Covering the link mechanism with the main body 21 can reduce the possibility of malfunction of the link mechanism due to tangled sutures or adhesion of body fluids, etc. In FIG. 4, the main body 21 is drawn as a flat plate to make it easier to understand the structure of the opening / closing mechanism 14.

[0031] The overall shape of the main body 21 is formed into a trapezoid shape in which the distal side is longer than the proximal side, and the proximal side of the main body 21 is fixed to the attachment portion 11. As described above, the main body 21 is fixed to the attachment portion 11 so that the distal side is inclined radially inward (toward the depth of the paper surface in FIG. 4) more than the proximal side.

[0032] Furthermore, on the distal side of the main body 21, a first arm portion 12 is attached to one end (left side in FIG. 4), and a second arm portion 13 is attached to the other end (right side in FIG. 4) spaced apart from the first arm portion 12. The base end side of the first arm portion 12 is rotatably supported by the main body 21 via a first support shaft 25. The base end side of the second arm portion 13 is rotatably supported by the main body 21 via a second support shaft 26. The first arm portion 12 and the second arm portion 13 are biased in the opening direction by a spring (not shown).

[0033] The driver 22 is an elongated rectangular member, and is disposed within the main body 21 along the central axis C. The opening / closing wire 15 is connected to the proximal end of the driver 22. The proximal end of the first intermediate section 23 and the proximal end of the second intermediate section 24 are connected to the distal end of the driver 22. The driver 22 slides within the main body 22 along the central axis C by being pulled by the opening / closing wire 15, and is thereby displaced relatively in the longitudinal direction of the tubular insertion section 2.

[0034] The first intermediate link 23 and the second intermediate link 24 are each an elongated rectangular member. The proximal end of the first intermediate link 23 and the proximal end of the second intermediate link 24 are both rotatably supported on the distal end of the driving link 22 by a pin 22a.

[0035] Further, the distal end of the first intermediate link 23 is rotatably connected to the first arm portion 12 via a pin 27. The position of the pin 27 of the first arm portion 12 is disposed between the tip side of the arm and the first support shaft 25, and is located closer to the first support shaft 25 than the tip side of the arm.

[0036] Similarly, the distal end of the second intermediate link 24 is rotatably connected to the second arm portion 13 via a pin 28. The position of the pin 28 of the second arm portion 13 is disposed between the tip side of the arm and the second support shaft 26, and is located closer to the second support shaft 26 than the tip side of the arm.

[0037] As described above, the first arm unit 12 and the second arm unit 13 are biased in the opening direction by the force of a spring (not shown). When the opening / closing wire 15 is not being pulled, no force in the closing direction acts on the first arm unit 12 and the second arm unit 13, so the suturing device 1 maintains the arm units in the open state (FIG. 4(a)).

[0038] When the opening / closing wire 15 is pulled from the above state, the driver 22 of the opening / closing mechanism 14 is displaced proximally in the longitudinal direction. Then, in accordance with the displacement of the driver 22, the positions of the proximal end of the first intermediate link 23 and the proximal end of the second intermediate link 24 move proximally, and the first intermediate link 23 and the second intermediate link 24 are each retracted proximally.

[0039] The first arm portion 12, which is rotatably supported by the main body portion 21 via a first support shaft 25, rotates in the closing direction about the first support shaft 25 due to the displacement of the first intermediate link 23. Similarly, the second arm portion 13, which is rotatably supported by the main body portion 21 via a second support shaft 26, rotates in the closing direction about the second support shaft 26 due to the displacement of the second intermediate link 24. In this manner, the arm portion of the suturing device 1 changes from an open state to a closed state by pulling the opening / closing wire 15 (FIG. 4(b)).

[0040] The opening / closing mechanism 14 shown in Fig. 4 directly transmits the motion of the opening / closing wire 15 to the arm section via a link mechanism, and can convert the displacement of the driving link 22 caused by the pulling of the opening / closing wire 15 into an opening / closing motion at the tip of the arm section. Therefore, the opening / closing mechanism 14 can open and close the arm section with a strong force while suppressing loss of force, thereby realizing a suturing device 1 suitable for full-thickness suturing, for example. In addition, the opening / closing mechanism 14 can switch between opening and closing the arm section with a simple operation caused by the pulling of the opening / closing wire 15.

[0041] Next, a configuration example of the needle fixing mechanism 30 of the first embodiment will be described. 5 is a schematic diagram of a needle fixing mechanism 30 of the first embodiment. Needle fixing mechanism 30 is assembled with first arm portion 12, second arm portion 13 and main body portion 21 as a casing.

[0042] A holder 18 for a suture needle 17 is provided on the inner surface of each of the tips (distal ends) of the first arm portion 12 and the second arm portion 13. The holder 18 is a hole opened on the inner surface of each arm portion, and can accommodate one end of the suture needle 17 to be inserted into the arm portion.

[0043] Here, suture needle 17 has needle tips 17a formed on both ends and a hole (not shown) in the center for passing a suture thread through. In addition, on both sides of suture needle 17, at a position inside needle tip 17a, there are formed constricted grooves 17b that extend in a direction intersecting the extension direction of suture needle 17 and are recessed in a circumferential ring shape.

[0044] Furthermore, in the needle fixing mechanism 30 of the first embodiment, the operating lines 16a, 16b are formed from a single linear member 16 that runs around the first arm portion 12 and the second arm portion 13, and are connected to each other.

[0045] The linear member 16 is slidably hooked to a first locking portion 19a provided at the tip of the first arm portion 12, a second locking portion 19b provided at the tip of the second arm portion 13, and a base end locking portion 19c provided in the main body portion 21. In the first arm portion 12, the first locking portion 19a is provided on the tip side relative to the position of the holding portion 18. Similarly, in the second arm portion 13, the second locking portion 19b is provided on the tip side relative to the position of the holding portion 18.

[0046] Within first arm portion 12, linear member 16 hooked to base end locking portion 19c is disposed in the longitudinal direction of first arm portion 12 along the inner surface of first arm portion 12 and is hooked to first locking portion 19a and folded back within first arm portion 12. Linear member 16 that is folded back from first locking portion 19a to the proximal side is disposed in the longitudinal direction of first arm portion 12 along the outer surface of first arm portion 12 and is drawn out from needle fixing mechanism 30 as operating wire 16a.

[0047] Meanwhile, within second arm portion 13, linear member 16 hooked to base end locking portion 19c is disposed in the longitudinal direction of second arm portion 13 along the inner surface of second arm portion 13 and is hooked to second locking portion 19b and folded back within second arm portion 13. Linear member 16 that is folded back from second locking portion 19b to the proximal side is disposed in the longitudinal direction of second arm portion 13 along the outer surface of second arm portion 13 and is drawn out from needle fixing mechanism 30 as operating wire 16b.

[0048] As described above, in the linear member 16 disposed around the first arm portion 12 and the second arm portion 13, the movement of the operating wire 16a is linked to the movement of the operating wire 16b in the opposite direction. For example, when the operating wire 16a is pulled proximally, a pulling force acts on the operating wire 16b in the distal direction. On the other hand, when the operating wire 16b is pulled proximally, a pulling force acts on the operating wire 16a in the distal direction.

[0049] Further, a first fixed portion 31a and a second fixed portion 31b are fixed to the linear member 16. Fig. 6 is a diagram showing an example of the operation of the first fixed portion 31a and the second fixed portion 31b in the first embodiment.

[0050] First fixing portion 31a is a plate-like member located at a position corresponding to holding portion 18 on the inner periphery of first arm portion 12, and is slidable in the longitudinal direction within first arm portion 12 by operating linear member 16. The thickness of first fixing portion 31a in the insertion / removal direction of suture needle 17 is formed to be smaller than the width of groove 17b of suture needle 17.

[0051] Second fixing portion 31b is a plate-like member located at a position corresponding to holding portion 18 on the inner periphery of second arm portion 13, and is slidable in the longitudinal direction within second arm portion 13 by operating linear member 16. The thickness of second fixing portion 31b in the insertion / removal direction of suture needle 17 is formed to be smaller than the width of groove 17b of suture needle 17, similar to first fixing portion 31a.

[0052] 6, first fixing portion 31a and second fixing portion 31b each have a hole 32 formed therein with a width dimension allowing suture needle 17 to be inserted and removed. A slit-shaped needle support portion 32a extending toward the tip side of the arm portion is formed in each hole 32. The width of needle support portion 32a is smaller than the outer diameter of suture needle 17 and is larger than the diameter of groove 17b of suture needle 17.

[0053] The first fixing part 31a and the second fixing part 31b can move the suture needle 17 in the insertion / removal direction when they are at the position of the hole 32. Furthermore, the first fixing part 31a and the second fixing part 31b engage with the suture needle 17 by inserting the needle support part 32a into the groove 17b of the suture needle 17. When the needle support part 32a is inserted into the groove 17b of the suture needle 17, the outer periphery of the suture needle 17 and the needle support part 32a interfere with each other, restricting the movement of the suture needle 17. This allows the suture needle 17 to be fixed to the holder 18 by the first fixing part 31a and the second fixing part 31b.

[0054] Furthermore, first fixing portion 31a and second fixing portion 31b are attached to linear member 16 in a positional relationship such that one of them, hole 32, overlaps with holding portion 18, and the other, needle support portion 32a, overlaps with holding portion 18.

[0055] For example, when operating wire 16b is pulled proximally, linear member 16 moves proximally on the inner surface of first arm section 12, and linear member 16 moves distally on the inner surface of second arm section 13. Then, as shown in Fig. 6(a), needle support section 32a of first fixing section 31a overlaps with holding section 18 of first arm section 12, and hole 32 of second fixing section 31b overlaps with holding section 18 of second arm section 13. In the state of Fig. 6(a), suture needle 17 is fixed by needle support section 32a in first arm section 12, while suture needle 17 can be inserted into and removed from holding section 18 in second arm section 13.

[0056] Furthermore, when the operating wire 16a is pulled proximally, the linear member 16 moves distally on the inner surface of the first arm section 12, and moves proximally on the inner surface of the second arm section 13. Then, as shown in FIG. 6(b), the needle support section 32a of the second fixing section 31b overlaps with the holding section 18 of the second arm section 13, and the hole 32 of the first fixing section 31a overlaps with the holding section 18 in the first arm section 12. In the state of FIG. 6(b), the suture needle 17 is fixed by the needle support section 32a in the second arm section 13, while the suture needle 17 can be inserted into and removed from the holding section 18 in the first arm section 12. In both cases of FIG. 6(a) and (b), the hole 32 does not overlap with the holding section 18 in both arms at the same time, so that the suture needle 17 can be prevented from falling off the arm section.

[0057] An example of the operation of the suturing device 1 of the first embodiment will be described below with reference to FIGS. When suturing an incision in a living body lumen, a suturing needle 17 is held in a cantilever manner by one of the arms. Figure 7(a) shows a state in which the suturing needle 17 is initially held by the holding portion 18 of the first arm portion 12.

[0058] In Fig. 7(a), operating wire 16b is pulled proximally. As a result, in first arm portion 12, needle support portion 32a of first fixing portion 31a overlaps with holding portion 18. At this time, needle support portion 32a engages with groove 17b of suture needle 17 in holding portion 18 of first arm portion 12, and suture needle 17 is fixed to first arm portion 12. Meanwhile, in second arm portion 13, hole 32 of second fixing portion 31b overlaps with holding portion 18. At this time, in holding portion 18 of second arm portion 13, suture needle 17 can move in the insertion / removal direction.

[0059] Next, as shown in Figure 7(b), when the opening / closing wire 15 is pulled from the state shown in Figure 7(a) to close the first arm portion 12 and the second arm portion 13, the exposed needle tip 17a of the suture needle 17 is housed in the holding portion 18 of the other arm portion (the second arm portion 13).

[0060] Thereafter, in the state shown in Fig. 7(b), the operating wire 16a is pulled proximally. Then, as shown in Fig. 8(a), the linear member 16 moves, so that the hole 32 of the first fixing portion 31a overlaps with the holding portion 18 in the first arm portion 12, and the needle support portion 32a of the second fixing portion 31b overlaps with the holding portion 18 in the second arm portion 13. As a result, the needle support portion 32a engages with the groove 17b of the suture needle 17 in the holding portion 18 of the second arm portion 13, and the suture needle 17 is fixed to the second arm portion 13. Also, in the holding portion 18 of the first arm portion 12, the engagement between the first fixing portion 31a and the groove 17b of the suture needle 17 is released, and the suture needle 17 becomes movable in the insertion / removal direction.

[0061] When the pulling of the open / close wire 15 is stopped from the state shown in Fig. 8(a) and the open / close wire 15 is released, the first arm section 12 and the second arm section 13 are urged in the opening direction by the force of a spring (not shown), and the arms of the suturing device 1 are opened. As a result, as shown in Fig. 8(b), the suturing needle 17 is released from the holding section 18 of the first arm section 12, and the suturing needle 17 is held in a cantilevered manner by the holding section 18 of the second arm section 13. In the suturing device 1, the first arm section 12 and the second arm section 13 are opened and closed to sandwich the incision in the living body lumen, and the above operation is repeated. This allows the arm section holding the suturing needle 17 to be alternately switched to suture the incision.

[0062] The effects of the suturing device 1 of the first embodiment will be described below. Needle fixing mechanism 30 of suturing device 1 is configured with operating wires 16a, 16b formed of a single linear member 16 that passes through the distal end side of first arm section 12 and the distal end side of second arm section 13 and circles around the inside of the arm section. Fixed to linear member 16 are a first fixing portion 31a that fixes suturing needle 17 to holding portion 18 of first arm section 12 when operating wire 16b is pulled proximally, and a second fixing portion 31b that fixes suturing needle 17 to holding portion 18 of second arm section 13 when operating wire 16a is pulled proximally. In the first embodiment, the operating lines 16a, 16b are formed from a single linear member 16, so the movement of one of the operating lines 16a, 16b is linked to the movement of the other opposite side. Therefore, in the first embodiment, the suturing needle 17 can be fixed by pulling either of the operating lines 16a, 16b, regardless of the operation in the direction of pushing the operating lines 16a, 16b, which have low force transmission properties, so that the fixing operation of the suturing needle 17 can be performed more reliably.

[0063] Second embodiment 9 is a schematic diagram of a needle fixing mechanism 30a of the second embodiment. In the following description of each embodiment, elements common to the first embodiment are given the same reference numerals and duplicated description will be omitted as appropriate.

[0064] Needle fixing mechanism 30a is assembled with first arm portion 12, second arm portion 13 and main body portion 21 as a casing. In needle fixing mechanism 30a, operating lines 16a, 16b are formed of one linear member 16 and are connected to each other. Linear member 16 is hooked to base end locking portion 19c and folded back within main body portion 21 on the base end sides of first arm portion 12 and second arm portion 13. One side of linear member 16 is drawn outward on the first arm portion 12 side as operating line 16a, and the other side of linear member 16 is drawn outward on the second arm portion 13 side as operating line 16b.

[0065] As a result, in the linear member 16 of the needle fixing mechanism 30a, the movement of the operating wire 16a is linked to the movement of the operating wire 16b in the opposite direction. For example, when the operating wire 16a is pulled proximally, a pulling force acts on the operating wire 16b in the distal direction. On the other hand, when the operating wire 16b is pulled proximally, a pulling force acts on the operating wire 16a in the distal direction.

[0066] Furthermore, needle fixing mechanism 30a has a first fixing portion 33a housed in first arm portion 12 and a second fixing portion 33b housed in second arm portion 13.

[0067] The first fixed portion 33a is a plate-like member that is disposed along the longitudinal direction of the first arm portion 12 and is slidable within the first arm portion 12. The thickness of the first fixed portion 33a in the insertion / removal direction of the suture needle 17 is formed to be smaller than the width of the groove 17b of the suture needle 17. In addition, the base end side of the first fixed portion 33a is connected to the linear member 16 on one side of the base end locking portion 19c.

[0068] The second fixed portion 33b is a plate-like member that is disposed along the longitudinal direction of the second arm portion 13 and is slidable within the second arm portion 13. The thickness of the second fixed portion 33b in the insertion / removal direction of the suture needle 17 is formed to be smaller than the width of the groove 17b of the suture needle 17. In addition, the base end side of the second fixed portion 33b is connected to the linear member 16 on the other side of the base end locking portion 19c.

[0069] 10, a needle support portion 34 that engages with groove 17b of suture needle 17 is formed on the tip side of each of first fixing portion 33a and second fixing portion 33b. Needle support portion 34 is formed in a slit shape by cutting out the central portion of first fixing portion 33a or second fixing portion 33b in the width direction intersecting with the longitudinal direction of the arm portion and the insertion / removal direction of suture needle 17. The cutout width of each needle support portion 34 is formed to a dimension larger than the diameter of groove 17b of suture needle 17 and smaller than the outer diameter of suture needle 17.

[0070] As shown in Fig. 10(a), when the first fixing part 33a and the second fixing part 33b are positioned on the tip side of the arm part, the needle support part 34 can be inserted into the groove 17b of the suture needle 17 housed in the holding part 18 to fix the suture needle 17. On the other hand, as shown in Fig. 10(b), when the first fixing part 33a and the second fixing part 33b are retracted to the proximal side, the engagement between the needle support part 34 and the groove 17b of the suture needle 17 is released, and the suture needle 17 can move freely in the insertion / removal direction.

[0071] Returning to FIG. 9(a), when the operating wire 16a is pulled proximally with the arms of the suturing device 1 closed, the first fixing part 33a retreats to the base end side. As a result, the first fixing part 33a of the first arm part 12 does not interfere with the suture needle 17 of the holding part 18, and the suture needle 17 can move freely in the insertion / removal direction in the first arm part 12. Meanwhile, the linear member 16 is retracted to one side, so that the second fixing part 33b slides toward the tip side. Then, in the holding part 18 of the second arm part 13, the needle support part 34 of the second fixing part 33b is inserted into and engaged with the groove 17b of the suture needle 17, and the suture needle 17 is fixed to the second arm part 13.

[0072] 9(b), when the operating wire 16b is pulled proximally while the arms of the suturing device 1 are closed, the second fixing part 33b retreats to the base end side. As a result, the second fixing part 33b of the second arm part 13 does not interfere with the suture needle 17 of the holding part 18, and the suture needle 17 can move freely in the insertion / removal direction in the second arm part 13. Meanwhile, the first fixing part 33a slides toward the tip side as the linear member 16 is pulled to the other side. Then, in the holding part 18 of the first arm part 12, the needle support part 34 of the first fixing part 33a is inserted into and engaged with the groove 17b of the suture needle 17, and the suture needle 17 is fixed to the first arm part 12.

[0073] As described above, in the needle fixing mechanism 30a of the second embodiment, the arm portion that holds the suturing needle 17 can be switched by pulling the operating wires 16a, 16b proximally. Also, in the needle fixing mechanism 30a of the second embodiment, the operating wires 16a, 16b are configured with a single linear member 16. The linear member 16 is fixed with a first fixing portion 31a that fixes the suturing needle 17 to the holding portion 18 of the first arm portion 12 when the operating wire 16b is pulled proximally, and a second fixing portion 31b that fixes the suturing needle 17 to the holding portion 18 of the second arm portion 13 when the operating wire 16a is pulled proximally. In the second embodiment, the operation lines 16a, 16b are formed from a single linear member 16, so that the movement of one of the operation lines 16a, 16b is linked to the movement of the other opposite line. Therefore, in the second embodiment, the suture needle 17 can be fixed by pulling either of the operation lines 16a, 16b, regardless of the operation in the direction of pushing the operation lines 16a, 16b, which have low force transmission properties, so that the operation of fixing the suture needle 17 can be performed more reliably.

[0074] Third embodiment FIG. 11 is a schematic diagram showing a needle fixing mechanism 30b according to the third embodiment. Needle fixing mechanism 30b is assembled into a casing consisting of first arm portion 12, second arm portion 13 and main body portion 21. Needle fixing mechanism 30b has a slider member 35, which is a flexible plate-like member, and a support body 36.

[0075] The slider member 35 is an example of a bending member, and has both ends disposed at the tip side of the first arm portion 12 and the tip side of the second arm portion 13, and is bent so as to be folded back within the main body portion 21 at the base end side of each arm portion. The slider member 35 is configured to be slidable in the longitudinal direction of the first arm portion 12 and the longitudinal direction of the second arm portion 13.

[0076] Further, a support 36 that receives the folded-back portion of slider member 35 on the proximal side is disposed in main body 21. Support 36 has curved portion 36a that is recessed toward the proximal side, and curved portion 36a receives slider member 35, which slides in the longitudinal direction of the arm portion. Support 36 guides slider member 35 within main body 21 and functions to allow slider member 35 to slide smoothly.

[0077] A needle support portion 35a, which serves as an example of a first fixing portion and engages with the groove 17b of the suture needle 17, is formed at one end of the slider member 35 disposed within the first arm portion 12. Similarly, a needle support portion 35b, which serves as an example of a second fixing portion and engages with the groove 17b of the suture needle 17, is formed at the other end of the slider member 35 disposed within the second arm portion 13. The configurations of the needle support portions 35a and 35b are similar to those of the needle support portion 34 of the second embodiment.

[0078] In other words, when needle supports 35a, 35b are positioned on the tip side of the arm portion, they are inserted into groove 17b of suture needle 17 housed in holder 18 to fix suture needle 17. On the other hand, when needle supports 35a, 35b are retracted to the proximal side of the arm portion, the groove 17b of suture needle 17 is released from engagement therewith, allowing suture needle 17 to move freely in the insertion / removal direction.

[0079] The slider member 35 is connected to the operating wire 16a on one side (the first arm portion 12 side) of the support body 36, and is connected to the operating wire 16b on the other side (the second arm portion 13 side) of the support body 36. In other words, the operating wires 16a and 16b are connected to each other via the slider member 35, and the operation of the operating wire 16a is linked to the operation of the operating wire 16b on the opposite side.

[0080] For example, when operating wire 16a is pulled proximally, one end of slider member 35 retreats to the proximal side of first arm portion 12. At this time, slider member 35 abuts against curved surface portion 36a of support body 36 and is guided, and the other end of slider member 35 slides distally (toward the tip) within second arm portion 13. Then, a force pulling operating wire 16b connected to the other side of slider member 35 toward the distal side acts.

[0081] Furthermore, when operating wire 16b is pulled proximally, the other end of slider member 35 retreats to the proximal side of second arm portion 13. At this time, slider member 35 abuts against curved surface portion 36a of support body 36 and is guided, and one end of slider member 35 slides distally (toward the tip) within first arm portion 12. A force pulling the operating wire 16a connected to one side of slider member 35 toward the distal side acts on slider member 35.

[0082] 11(a), when the operating wire 16a is pulled proximally with the arms of the suturing device 1 closed, one end of the slider member 35 retreats to the proximal side of the first arm portion 12, and the other end of the slider member 35 slides toward the tip side. As a result, the needle support portion 35a of the first arm portion 12 does not interfere with the suture needle 17 of the holder portion 18, and the suture needle 17 can move freely in the insertion / removal direction in the first arm portion 12. Meanwhile, the needle support portion 35b of the second arm portion 13 is inserted into and engaged with the groove 17b of the suture needle 17, and the suture needle 17 is fixed to the second arm portion 13.

[0083] 11(b), when the operating wire 16b is pulled proximally with the arms of the suturing device 1 closed, the other end of the slider member 35 retreats to the proximal side of the second arm portion 13, and one end of the slider member 35 slides toward the tip side. As a result, the needle support portion 35b of the second arm portion 13 does not interfere with the suture needle 17 of the holder portion 18, and the suture needle 17 can move freely in the insertion / removal direction in the second arm portion 13. Meanwhile, the needle support portion 35a of the first arm portion 12 is inserted into and engaged with the groove 17b of the suture needle 17, and the suture needle 17 is fixed to the first arm portion 12.

[0084] As described above, in the needle fixing mechanism 30b of the third embodiment, the arm portion that holds the suture needle 17 can be switched by pulling the proximal side of the operating wires 16a, 16b connected to the slider member 35. Also, in the needle fixing mechanism 30b of the third embodiment, the slider member 35 has a needle support portion 35a that fixes the suture needle 17 to the holding portion 18 of the first arm portion 12 when the operating wire 16b is pulled proximally, and a needle support portion 35b that fixes the suture needle 17 to the holding portion 18 of the second arm portion 13 when the operating wire 16a is pulled proximally. In the third embodiment, the operation lines 16a, 16b are each connected to the slider member 35, so that the movement of one of the operation lines 16a, 16b is linked to the movement of the other opposite line. Therefore, in the third embodiment, the suture needle 17 can be fixed by pulling either of the operation lines 16a, 16b, regardless of the operation in the direction of pushing the operation lines 16a, 16b, which have low force transmission properties, so that the operation of fixing the suture needle 17 can be performed more reliably.

[0085] The present invention is not limited to the above-described embodiment, and various improvements and design changes may be made without departing from the spirit of the present invention.

[0086] In each of the above embodiments, an example has been described in which the needle support portion that engages with the groove 17b of the suture needle 17 is formed in a slit shape. However, the shape of the needle support portion may be other shapes as long as it can fix the suture needle 17 to the holding portion 18. For example, the needle support portion may be formed in a single-edged or needle shape that can be inserted into one side of the groove 17b, and the suture needle 17 may be sandwiched and fixed between the needle support portion and the holding portion 18. Alternatively, the needle support portion may be formed in a needle shape, and a hole that receives the engagement portion may be formed in the suture needle 17 to engage with the suture needle 17.

[0087] Furthermore, when the needle support part is formed in a slit shape, a portion narrower than the diameter of groove 17b of suture needle 17 may be formed on the tip side of the needle support part. In this case, the tip side of the needle support part is elastically deformed and widened so that the needle support part and groove 17b of suture needle 17 engage with each other, and the tip of the needle support part is narrowed by elastic deformation, making suture needle 17 even less likely to fall off.

[0088] In addition, the embodiments disclosed herein should be considered to be illustrative and not restrictive in all respects. The scope of the present invention is defined by the claims, not the above description, and is intended to include all modifications within the meaning and scope of the claims.

[0089] The disclosure of the above embodiment encompasses the following technical ideas. (1) An endoscopic suturing device provided at the distal end of a tubular insertion section of an endoscope, the endoscopic suturing device having a first arm section and a second arm section each having a holding section for a suturing needle at one end of the arm, the arm section being configured to be switchable for holding the suturing needle when opening and closing the one end of the arm to suture tissue, the endoscopic suturing device comprising: a pair of operating wires arranged in parallel along the tubular insertion section, one of which is linked to the operation of the other in the opposite direction; a first fixing section that fixes the suturing needle to the holding section of the first arm section when one of the pair of operating wires is pulled proximally relative to a device body section, and a second fixing section that fixes the suturing needle to the holding section of the second arm section when the other of the pair of operating wires is pulled proximally relative to a device body section. (2) An endoscopic suturing device as described in (1) above, wherein the pair of operating wires are composed of a single linear member that passes through one arm end side of the first arm section and one arm end side of the second arm section and circles within the arm section, the first fixing part is fixed to the linear member within the first arm section, and the second fixing part is fixed to the linear member within the second arm section. (3) The pair of operating wires is composed of a single linear member folded back at the base end side of the first arm portion and the second arm portion, the first fixed portion is a member connected to the other side of the folded back linear member and capable of sliding in the longitudinal direction of the first arm portion, and the second fixed portion is a member connected to one side of the folded back linear member and capable of sliding in the longitudinal direction of the second arm portion. An endoscopic suturing device as described in (1) above. (4) An endoscopic suturing device as described in (1) above, further comprising a bending member whose both ends are arranged on one arm end side of the first arm section and one arm end side of the second arm section and arranged to be folded back on the base end side of the first arm section and the second arm section, wherein the first fixing part is provided on the first arm section side of the bending member and the second fixing part is provided on the second arm section side of the bending member, one of the pair of operating wires is connected to the second arm section side of the folded back bending member and the other of the pair of operating wires is connected to the first arm section side of the folded back bending member, and the bending member slides the first arm section and the second arm section by pulling any of the operating wires proximal to the device main body. (5) The endoscopic suturing device according to (4) above, wherein a support for receiving a folded-back portion of the bending member is disposed on the base end side of the first arm portion and the second arm portion. (6) The endoscopic suturing device according to any one of (1) to (5) above, wherein the pair of operating wires can be operated independently of an opening / closing wire that opens and closes the arm portion. (7) The endoscopic suturing device according to any one of (1) to (6) above, which is detachable from a tubular insertion portion of the endoscope. [Explanation of symbols]

[0090] 1...suturing device, 2...tubular insertion portion, 3...objective lens, 4...illumination portion, 5...forceps port, 6...forceps, 11...mounting portion, 12...first arm portion, 13...second arm portion, 14...opening / closing mechanism portion, 15...opening / closing wire, 16a, 16b...operation wire, 17...suture needle, 17a...needle tip, 17b...groove, 18...holding portion, 30, 30a, 30b...needle fixing mechanism, 31a, 33a...first fixing portion, 31b, 33b...second fixing portion, 32...hole, 32a, 32b, 34, 35a, 35b...needle support portion, 35...slider member, 36...support

Claims

1. An endoscopic suturing device provided at a distal end of a tubular insertion section of an endoscope, comprising: The surgical instrument has a first arm portion and a second arm portion each having a holder for a suture needle at one end side of the arm, and is configured to be able to switch the arm portion that holds the suture needle when opening and closing the one end side of the arm to suture tissue, A pair of operating wires arranged in parallel along the tubular insertion portion, one of which is operated in response to the other being operated in the opposite direction; a first fixing portion that fixes the suturing needle to the holding portion of the first arm portion when one of the pair of operating wires is pulled proximally relative to the device body portion; a second fixing portion that fixes the suturing needle to the holding portion of the second arm portion when the other of the pair of operating wires is pulled proximally relative to the device body portion. Endoscopic suturing device.

2. the pair of operating wires are formed of a single linear member that passes through one arm end side of the first arm portion and one arm end side of the second arm portion and goes around inside the arm portion, the first fixed portion is fixed to the linear member within the first arm portion, The second fixing portion is fixed to the linear member within the second arm portion.

2. An endoscopic suturing device according to claim 1.

3. the pair of operating wires are formed of a single linear member that is folded back at the base end sides of the first arm portion and the second arm portion, the first fixed portion is a member connected to the other side of the folded linear member and slidable in a longitudinal direction of the first arm portion, The second fixed portion is a member connected to one side of the folded linear member and slidable in the longitudinal direction of the second arm portion.

2. An endoscopic suturing device according to claim 1.

4. a bending member, both ends of which are disposed on the arm one end side of the first arm portion and the arm one end side of the second arm portion, and which is disposed so as to be folded back on the base end side of the first arm portion and the second arm portion, the first fixing portion is provided on the first arm portion side of the bending member, the second fixing portion is provided on the second arm portion side of the bending member, One of the pair of operating wires is connected to the second arm portion side of the folded bending member, the other of the pair of operating wires is connected to the first arm portion side of the folded bending member, The bending member slides the first arm portion and the second arm portion by pulling any one of the operation lines toward a proximal side of the device body portion.

2. An endoscopic suturing device according to claim 1.

5. A support body is disposed on the base end side of the first arm portion and the second arm portion to receive the folded portion of the bending member.

5. An endoscopic suturing device according to claim 4.

6. The pair of operating wires can be operated independently of an opening / closing wire that opens and closes the arm portion. An endoscopic suturing device according to any one of claims 1 to 5.

7. The endoscopic suturing device is detachable from the tubular insertion portion of the endoscope. An endoscopic suturing device according to any one of claims 1 to 5.

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