Endoscopic suturing device

Abstract

To provide an endoscopic suturing device capable of reliably performing fixing operation of a suture needle to an arm part using a wire for the operation, and capable of coping with multiple types of suture needles with different diameters.SOLUTION: An endoscopic suturing device comprises a pair of arm parts each having a holding part of a suture needle at one end of the arm and is configured to be able to switch the arm parts that hold the suture needle when suturing tissues by opening and closing the one end of the arm. Each holding part includes: a base which is fixed inside the arm part; a gripping body which is arranged on one side of the base, positioned by the base and has a plurality of gripping pieces that grips the suture needle; a fastening portion which has an opening on one side through which the suture needle can be inserted and stores the gripping body therein; and an operation wire which is disposed along a tubular insertion portion, and changes the relative position between the gripping body and the fastening portion through pulling to the proximal side with respect to the device body. The fastening portion has a diameter-reducing section that narrows from the other side toward the one side of the holding part, and the diameter-reducing section tightens the gripping pieces in the radial direction to fix the suture needle.SELECTED DRAWING: Figure 7

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 by the wire is relatively good when pulling the proximal side, but when a force is applied to push the wire distally, the transmission of force to the distal side decreases due to bending of the wire. For this reason, the operation of fixing the suturing needle to the arm section is relatively difficult. Also, it is mechanically difficult to make one suturing device compatible with multiple types of suturing needles with different diameters.

[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, and that can accommodate multiple types of suturing needles with different diameters. [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 pair of arms each having a suture needle holder at one end of the arm, and is configured to be able to switch the arm that holds the suture needle when opening and closing the one end of the arm to suture tissue. Each holder includes a base fixed within the arm, a gripping body disposed on one side of the base and positioned by the base, having a plurality of gripping pieces for gripping the suture needle, a fastening section having an opening on one side through which the suture needle can be inserted and housing the gripping body therein, and an operating wire disposed along the tubular insertion section and changing the relative position of the gripping body and the fastening section by pulling the gripping section toward the proximal side with respect to the device main body. The fastening section has a reduced diameter section that narrows from the other side of the holder toward one side, and the reduced diameter section radially tightens the gripping pieces to fix the suture needle. Effect of the Invention

[0007] According to one aspect of the present invention, an endoscopic suturing device can be provided that can more reliably fix a suturing needle to an arm portion while using a wire for operation and can accommodate a plurality of types of suturing needles with different diameters. [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 the arrangement of a needle fixing mechanism and an operating wire in the first embodiment. [Figure 6] FIG. 6 is an enlarged view of the vicinity of the holding portion in FIG. 5. [Figure 7] 3A to 3C are diagrams illustrating a configuration example of a needle fixing mechanism according to the first embodiment. [Figure 8] FIG. 13 is a diagram showing the arrangement of a needle fixing mechanism and an operating wire in a second embodiment. [Figure 9] 13A to 13C are diagrams illustrating a configuration example of 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 section 2, and its distal side is connected to the needle fixing mechanism 30 of the first arm section 12. For simplicity, in Figs. 1 and 2, the operating wire 16a is depicted as a single wire, but as described below, the operating wire 16a connected to the first arm section 12 side may be composed of two operating wires (16a1, 16a2). Furthermore, operating wire 16b is disposed in the longitudinal direction along tubular insertion section 2, and its distal side is connected to needle fixing mechanism 30 of second arm section 13. For simplicity, operating wire 16b is depicted as a single wire in Figs. 1 and 2, but as described below, operating wire 16b connected to second arm section 13 may be composed of two operating wires (16b1, 16b2).

[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, the needle fixing mechanism 30 of the first embodiment will be described. Fig. 5 is a diagram showing the arrangement of needle fixing mechanism 30 and operating wires 16a, 16b in first arm portion 12 and second arm portion 13. Fig. 6 is an enlarged view of the vicinity of holder 18 in Fig. 5. Fig. 7 is a diagram showing an example configuration of needle fixing mechanism 30.

[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 section 12 and the second arm section 13. The holder 18 is a hole opened on the inner surface of each arm section, and can accommodate one end of the suture needle 17 to be inserted into the arm section. Here, the 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.

[0043] The needle fixing mechanism 30 is provided at the position of the hole of each of the holders 18 of the first arm portion 12 and the second arm portion 13. A pair of operating wires 16a1, 16a2 for operating the needle fixing mechanism 30 of the first arm portion 12 are arranged in parallel inside the first arm portion 12 and the main body portion 21. A pair of operating wires 16b1, 16b2 for operating the needle fixing mechanism 30 of the second arm portion 13 are arranged in parallel inside the second arm portion 13 and the main body portion 21. The operating wires 16a1, 16b1 are an example of a first operating wire, and the operating wires 16a2, 16b2 are an example of a second operating wire.

[0044] Needle fixing mechanisms 30 of first arm portion 12 and second arm portion 13 have a common configuration, except that operating lines 16a1, 16a2 of first arm portion 12 correspond to operating lines 16b1, 16b2, respectively, of second arm portion 13. Therefore, below, the configuration of needle fixing mechanism 30 of first arm portion 12 will be described, and a duplicated description of needle fixing mechanism 30 of second arm portion 13 will be omitted.

[0045] Needle fixing mechanism 30 is disposed within first arm portion 12 so as to extend in the insertion / removal direction (left-right direction in the figure) of suture needle 17. Needle fixing mechanism 30 is capable of gripping suture needle 17 on one side (right side in the figure) facing the hole of holder 18, and the other side (left side in the figure) is fixed within first arm portion 12.

[0046] As shown in FIG. 7, the needle fixing mechanism 30 has a base 31, a collet 32, and a cap 33. The base 31 is a columnar member extending in the direction in which the suture needle 17 is inserted and removed, and has the other side fixed inside the first arm portion 12. In addition, the base 31 has an external thread 31a formed on its outer periphery.

[0047] Collet 32 ​​is an example of a gripping body, extends in the insertion / removal direction of suture needle 17, is disposed on one side of base 31, and is positioned by base 31. Collet 32 ​​is cylindrical with one side tapered, and one side of collet 32 ​​is branched into multiple parts to form two or more gripping pieces 32a. This allows collet 32 ​​to grip suture needle 17 by sandwiching it between the multiple gripping pieces 32a. Note that, for example, four gripping pieces 32a are formed on collet 32, but the number of gripping pieces 32a of collet 32 ​​can be changed as appropriate within the range of two or more.

[0048] The cap 33 is an example of a fastening portion, and is a cylindrical body capable of accommodating the base portion 31 and the collet 32 ​​therein. An opening 33a is provided at one end of the cap 33, through which the suture needle 17 can be inserted. The cap 33 also has a reduced diameter portion 33b on one side, the inner diameter of which tapers from the other side to the one side. The inner diameter of the small diameter side of the reduced diameter portion 33b of the cap 33 is larger than the diameter of the end of the collet 32 ​​on one side, but is smaller than the outer diameter of the collet 32 ​​on the other side. This allows the reduced diameter portion 33b of the cap 33 to fasten the collet 32 ​​from the radially outer side when the cap 33 is moved to the other side relative to the collet 32.

[0049] A female thread 33c that screws into the male thread 31a of the base 31 is formed on the inner circumference on the other side of the cap 33. When the cap 33 rotates relative to the base 31 about the axis of the insertion / removal direction of the suture needle 17, the male thread 31a of the base 31 screws into the female thread 33c, causing the cap 33 to move back and forth in the insertion / removal direction of the suture needle 17.

[0050] 6, operating wires 16a1 and 16a2 are attached to the outer periphery of cap 33. Operating wires 16a1 and 16a2 are drawn out to opposite sides of cap 33 in the circumferential direction, and rotate cap 33 to the opposite side when pulled proximally. Operating wire 16a1 rotates cap 33 of first arm portion 12 counterclockwise when pulled proximally, and moves cap 33 to the other side relative to collet 32. On the other hand, operating wire 16a2 rotates cap 33 of first arm portion 12 clockwise when pulled proximally, and moves cap 33 to one side relative to collet 32.

[0051] Here, Fig. 7(a) shows an unlocked state in which the suture needle 17 is not fixed to the needle fixing mechanism 30, and Fig. 7(b) shows a locked state in which the suture needle 17 is fixed to the needle fixing mechanism 30. Also, Fig. 7(c) shows a state in which the suture needle 17 has been further tightened from the locked state of Fig. 7(b).

[0052] 7(a), the reduced diameter portion 33b of the cap 33 is separated from the gripping piece 32a of the collet 32, and the collet 32 ​​housed within the cap 33 is not clamped in the radial direction by the cap 33. Therefore, with the needle fixing mechanism 30 in the unlocked state, the suture needle 17 can be inserted into the collet 32 ​​from one side through the opening 33a of the cap 33. Alternatively, with the needle fixing mechanism 30 in the unlocked state, the suture needle 17 that was gripped by the gripping piece 32a of the collet 32 ​​can be pulled out to the other side.

[0053] With the suture needle 17 inserted into the collet 32, when the operating wire 16a1 is pulled proximally from the unlocked state of Fig. 7(a), the cap 33 rotates counterclockwise and moves to the other side relative to the collet 32. This causes the needle fixing mechanism 30 to transition to the locked state of Fig. 7(b).

[0054] 7(b), the reduced diameter portion 33b of the cap 33 that has moved to the other side comes into contact with the gripping piece 32a of the collet 32, and the collet 32 ​​housed in the cap 33 is clamped from the radially outer side by the reduced diameter portion 33b of the cap 33. That is, in the locked needle fixing mechanism 30, a pressing force by the cap 33 is applied to each gripping piece 32a of the collet 32 ​​from the radially outer side. As a result, in the locked needle fixing mechanism 30, the suture needle 17 is sandwiched and fixed between the gripping pieces 32a, and cannot be pulled out to the other side.

[0055] Moreover, when the operating wire 16a1 is pulled further proximally from the locked state of FIG. 7(b), the cap 33 rotates counterclockwise and moves to the other side relative to the collet 32. This causes the needle fixing mechanism 30 to transition to the state of FIG. 7(c). In the state of FIG. 7(c), the reduced diameter portion 33b of the cap 33 moves further to the other side than in FIG. 7(b), so that each gripping piece 32a of the collet 32 ​​is pressed radially inward by the reduced diameter portion 33b of the cap 33, and the collet 32 ​​branched on one side is compressed radially inward. As a result, in the state of FIG. 7(c), a larger pressing force is applied from the radial outside to each gripping piece 32a of the collet 32 ​​than in the state of FIG. 7(b), and the suture needle 17 is more firmly fixed to the needle fixing mechanism 30.

[0056] In the needle fixing mechanism 30, the state of Figure 7(b) to Figure 7(c) can be appropriately selected by the operator by the degree to which the operating wire 16a1 is pulled proximally. In other words, in the needle fixing mechanism 30, the fixing strength of the suture needle 17 can be arbitrarily adjusted by the operator's operation of the operating wire 16a1.

[0057] On the other hand, when the fixing strength of the suture needle 17 in the needle fixing mechanism 30 is to be weakened, the operator pulls the operating wire 16a2 proximally. Then, the cap 33 rotates clockwise and moves to one side relative to the collet 32. When the reduced diameter portion 33b of the cap 33 moves to one side from the state of FIG. 7(b) or FIG. 7(c), the radial distance of the inner circumference of the cap 33 relative to the collet 32 ​​increases, and the clamping force of the collet 32 ​​radially inward by the cap 33 is weakened. Similarly, the needle fixing mechanism 30 can be shifted to the unlocked state shown in FIG. 7(a) by operating the operating wire 16a2 described above.

[0058] When an incision in a biological lumen is sutured with the suturing device 1 of the first embodiment, a suture needle 17 is held in a cantilevered manner by one of the arms (the first arm 12) as shown in Fig. 2. At this time, the needle fixing mechanism 30 of the one arm (the first arm 12) holding the suture needle 17 is in a locked state, and the suture needle 17 is fixed to the needle fixing mechanism 30. In addition, the needle fixing mechanism 30 of the other arm (the second arm 13) not holding the suture needle 17 is in an unlocked state, and the suture needle 17 can be inserted into the needle fixing mechanism 30 of the other arm.

[0059] When the opening / closing wire 15 is pulled from the above state 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 and needle fixing mechanism 30 of the other arm portion (the second arm portion 13).

[0060] Thereafter, the needle fixing mechanism 30 of the other arm (second arm 13) is shifted from the unlocked state to the locked state, and the needle fixing mechanism 30 of one arm (first arm 12) is shifted from the locked state to the unlocked state. As a result, the suture needle 17 is fixed to the other arm (second arm 13), and the fixation of the suture needle 17 to the one arm (first arm 12) is released, allowing the suture needle 17 to move in the insertion / removal direction.

[0061] Then, when the pulling of the opening and closing wire 15 is stopped and the opening and closing 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, the suturing needle 17 is released from the holding section 18 of one arm section (the first arm section 12), and the suturing needle 17 is held in a cantilevered manner by the holding section 18 of the other arm section (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. As a result, the arm section holding the suturing needle 17 can be alternately switched to suture the incision.

[0062] The operation of the suturing device 1 of the first embodiment will be described below. The needle fixing mechanism 30 disposed in the holding part 18 of the suturing device 1 includes a base 31 fixed in the arm part, a collet (holding body) 32 disposed on one side of the base 31 and positioned by the base 31, having a plurality of holding pieces 32a for holding the suture needle 17, a cap (tightening part) 33 having an opening 33a on one side through which the suture needle 17 can be inserted and accommodating the collet 32 ​​therein, and operating wires 16a1, 16a2 (or operating wires 16b1, 16b2) disposed along the tubular insertion part 2 and changing the relative position of the collet 32 ​​and the cap 33 by pulling it proximally with respect to the device main body. The cap 33 has a reduced diameter part 33b whose inner diameter narrows from the other side of the holding part 18 to one side, and the reduced diameter part 33b radially tightens the holding pieces 32a to fix the suture needle 17. In the needle fixing mechanism 30 of the first embodiment, the suture needle 17 can be fixed by pulling the operating wire 16a1 proximally, without relying on an operation in a direction pushing the operating wire with low force transmission. Therefore, the fixing operation of the suture needle 17 can be performed more reliably. Furthermore, in the needle fixing mechanism 30 of the first embodiment, the gripping piece 32a gripping the suture needle 17 is radially tightened by the reduced diameter portion 33b to fix the suture needle 17. Therefore, the needle fixing mechanism 30 can fix the suture needle 17 regardless of the diameter of the suture needle 17, so one suturing device 1 can accommodate a plurality of types of suture needles 17 with different diameters. Furthermore, the needle fixing mechanism 30 of the first embodiment can fix the suture needle 17 without providing a slit or the like in the suture needle 17, so the manufacturing cost of the suture needle 17 used in the procedure can also be reduced.

[0063] In addition, the needle fixing mechanism 30 of the first embodiment includes operating lines 16a1, 16b1 (first operating lines) that rotate the cap 33 so that it moves to the other side relative to the base 31 when pulled proximally, thereby strengthening the tightening of the gripping piece 32a by the reduced diameter portion 33b, and operating lines 16a2, 16b2 (second operating lines) that rotate the cap 33 so that it moves to one side relative to the base 31 when pulled proximally, thereby weakening the tightening of the gripping piece 32a by the reduced diameter portion 33b. Therefore, in the needle fixing mechanism 30 of the first embodiment, the gripping piece 32a gripping the suture needle 17 can be tightened by pulling the operating wires 16a1, 16b1, and the gripping piece 32a can be loosened by pulling the operating wires 16a2, 16b2, allowing the fixing strength of the suture needle 17 to be adjusted as desired.

[0064] Second embodiment 8 is a diagram showing the arrangement of the needle fixing mechanism 30 and the operating wire in the suturing device 1 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.

[0065] The second embodiment is a modified example of the first embodiment, in which an operating line 16a1 for increasing the fastening force by the needle fixing mechanism 30 of the first arm portion 12 and an operating line 16b2 for decreasing the fastening force by the needle fixing mechanism 30 of the second arm portion 13 are connected in the main body portion 21. In the second embodiment, an operating line 16a2 for decreasing the fastening force by the needle fixing mechanism 30 of the first arm portion 12 and an operating line 16b1 for increasing the fastening force by the needle fixing mechanism 30 of the second arm portion 13 are connected in the main body portion 21. The operating lines 16a1 and 16b2 connected in the main body portion 21 are connected to the distal end of the operating line 16c arranged in the longitudinal direction along the tubular insertion portion 2. Similarly, the operating lines 16a2 and 16b1 connected in the main body portion 21 are connected to the distal end of the operating line 16d arranged in the longitudinal direction along the tubular insertion portion 2.

[0066] In the suturing device 1 of the second embodiment, by pulling the operating wire 16c proximally with the arms closed, the operating wire 16a1 of the first arm portion 12 and the operating wire 16b2 of the second arm portion 13 are simultaneously pulled proximally. This allows the needle fixing mechanism 30 of the first arm portion 12 to transition to a locked state and the needle fixing mechanism 30 of the second arm portion 13 to transition to an unlocked state simultaneously. Similarly, in the suturing device 1 of the second embodiment, by pulling the operating wire 16d proximally with the arms closed, the operating wire 16a2 of the first arm portion 12 and the operating wire 16b1 of the second arm portion 13 are simultaneously pulled proximally. This allows the needle fixing mechanism 30 of the first arm portion 12 to transition to the unlocked state and the needle fixing mechanism 30 of the second arm portion 13 to transition to the locked state simultaneously.

[0067] As described above, in the suturing device 1 of the second embodiment, the operation of fixing the suturing needle 17 with one arm portion and the operation of releasing the fixation of the suturing needle 17 with the other arm portion can be linked by a single operating line, making it possible to simplify the operation of the operator compared to the first embodiment.

[0068] Third embodiment 9 is a diagram showing a configuration example of the needle fixing mechanism 30a in the suturing device 1 of the third embodiment. The needle fixing mechanism 30a in the third embodiment is provided in the holder 18 of each arm portion, similar to the first embodiment, and the configuration of the needle fixing mechanism 30a in each arm portion is common to all. Therefore, the configuration of the needle fixing mechanism 30a of the first arm portion 12 will be described below, and a duplicated description of the needle fixing mechanism 30a of the second arm portion 13 will be omitted.

[0069] Needle fixing mechanism 30a is disposed within first arm portion 12 so as to extend in the insertion / removal direction (left-right direction in the figure) of suture needle 17. Needle fixing mechanism 30 is capable of gripping suture needle 17 on one side (right side in the figure) facing the hole of holder 18, and the other side (left side in the figure) is fixed within first arm portion 12.

[0070] Needle locking mechanism 30 a includes a collet 32 ​​, a base 34 , and a clamping spring 36 . The collet 32 ​​extends in the insertion / removal direction of the suture needle 17, and is disposed on one side of the base 34 so as to be slidable in the insertion / removal direction of the suture needle 17. The collet 32 ​​is cylindrical with one side tapered like in the first embodiment, and one side of the collet 32 ​​is branched into multiple parts to form two or more gripping pieces 32a. An operating wire 16a is connected to the other end of the collet 32.

[0071] Base 34 is a cylindrical member extending in the direction in which suture needle 17 is inserted and removed, and the other side is fixed inside first arm 12. The other side of collet 32 ​​is slidably inserted into one side of base 34. As a result, collet 32 ​​is guided by cylindrical base 34 and positioned inside the arm.

[0072] A disk-shaped stopper 34a is provided on the inner periphery of base 34. A coil spring 35 that biases collet 32 ​​to one side is disposed between stopper 34a of base 34 and the other end of collet 32. In addition, operating wire 16a connected to collet 32 ​​is drawn out to the outside of needle fixing mechanism 30a through the center of coil spring 35 and the opening of stopper 34a, and disposed within first arm portion 12.

[0073] The clamping spring 36 is an example of a clamping portion and a diameter-reducing portion, and is composed of a plurality of leaf springs arranged opposite each other across the collet 32, with the other end of each spring fixed to the holding portion 18, as shown in FIG. 9. Each of the clamping springs 36 is arranged at an incline so that one end of each spring approaches the collet 32, and the clamping springs 36 arranged opposite each other are tapered in diameter from the other side to one side. The end of each of the clamping springs 36 on one side comes into contact with the gripping piece 32a of the collet 32 ​​and presses the gripping piece 32a radially inward. As a result, the collet 32 ​​is accommodated on the other side of the clamping spring 36 in the holding portion 18, and the gripping piece 32a is tightened in the radial direction by the clamping spring 36 arranged opposite each other. In addition, an opening through which the suture needle 17 can pass is formed between the ends of the clamping springs 36 arranged opposite each other.

[0074] Here, FIG. 9(a) shows a locked state in which the suture needle 17 is fixed to the needle fixing mechanism 30a, and FIG. 9(b) shows an unlocked state in which the suture needle 17 is not fixed to the needle fixing mechanism 30a.

[0075] The locked state in FIG. 9(a) is a state in which the operating wire 16a is not pulled to the proximal side. In the needle fixing mechanism 30a in the locked state, the collet 32 ​​is biased to one side by the coil spring 35, and the collet 32 ​​approaches the tightening spring 36 arranged on one side of the collet 32. As a result, the tightening spring 36 comes into contact with a portion on the other side of the collet 32, which has a larger diameter than the tip, and is compressed. As a result, each gripping piece 32a receiving the reaction force of the tightening spring 36 is pressed from the radially outer side, and the pressing force of the tightening spring 36 is applied to each gripping piece 32a toward the radially inner side. As a result, in the needle fixing mechanism 30a in the locked state, the suture needle 17 is sandwiched and fixed between the gripping pieces 32a, and cannot be pulled out to the other side.

[0076] On the other hand, in the unlocked state of FIG. 9(b), the operating wire 16a is pulled proximally, and the collet 32 ​​is moved to the other side compared to the locked state of FIG. 9(a). In the unlocked needle fixing mechanism 30a, the tightening spring 36 comes into contact with the tip of the collet 32, which has a smaller diameter, compared to the locked state of FIG. 9(a). That is, in the unlocked needle fixing mechanism 30a, the compression of the tightening spring 36 is smaller than in the locked state of FIG. 9(a), and the pressing force of the tightening spring 36 applied to each gripping piece 32a is also smaller. Therefore, in the unlocked needle fixing mechanism 30a, the gripping pieces 32a are not tightened in the radial direction, and the suture needle 17 can be inserted into the collet 32 ​​from one side. Alternatively, in the unlocked needle fixing mechanism 30a, the suture needle 17 gripped by the gripping piece 32a of the collet 32 ​​can be pulled out to the other side.

[0077] In addition, when the pulling of the operating wire 16a toward the proximal side is released in the above-mentioned unlocked state, the collet 32 ​​is biased to one side by the coil spring 35, and the needle fixing mechanism 30a returns to the locked state.

[0078] According to the needle fixing mechanism 30a of the third embodiment, the gripping piece 32a gripping the suture needle 17 is tightened radially by the tightening spring 36 to fix the suture needle 17. Therefore, the needle fixing mechanism 30a can fix the suture needle 17 regardless of the diameter of the suture needle 17, so that one suturing device 1 can accommodate a plurality of types of suture needles 17 with different diameters. Furthermore, the needle fixing mechanism 30a of the third embodiment can fix the suture needle 17 without providing a slit or the like in the suture needle 17, so that the manufacturing cost of the suture needle 17 used in the procedure can be reduced. Furthermore, in the needle fixing mechanism 30a of the third embodiment, the suture needle 17 can be switched between fixed and unlocked by operating one operating line per arm portion, simplifying the operation by the operator. Furthermore, in the needle fixing mechanism 30a of the third embodiment, the fixation of the suture needle 17 can be released by pulling the operating wire 16a proximally, without relying on an operation in a direction pushing the operating wire, which has low force transmission properties. Therefore, the operation of the suture needle 17 can be performed more reliably.

[0079] 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.

[0080] In the above-described first embodiment, an example was described in which a first operating wire for tightening the gripping piece 32a by the reduced diameter portion 33b and a second operating wire for loosening the gripping piece 32a by the reduced diameter portion 33b are disposed for each arm of the needle fixing mechanism 30. However, in the needle fixing mechanism 30 of the first embodiment, a spring mechanism (not shown) for biasing the cap 33 in either the clockwise or counterclockwise direction may be provided, and either the first operating wire or the second operating wire may be omitted.

[0081] 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.

[0082] 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 portion of an endoscope, the endoscopic suturing device having a pair of arms each having a suture needle holder on one end of the arm, and configured to be able to switch the arm portion that holds the suture needle when opening and closing the one end of the arm to suture tissue, each of the holders including a base fixed within the arm, a gripping body that is disposed on one side of the base and positioned by the base, the gripping body having a plurality of gripping pieces that grip the suture needle, a fastening portion that has an opening on one side through which the suture needle can be inserted and that houses the gripping body therein, and an operating wire that is disposed along the tubular insertion portion and changes the relative positions of the gripping body and the fastening portion by pulling the fastening portion proximally with respect to a device main body, the fastening portion having a reduced diameter portion that narrows from the other side of the holding portion toward one side, and the fastening portion radially fastens the gripping pieces to fix the suture needle. (2) An endoscopic suturing device as described in (1) above, wherein the base has a thread on its outer periphery, and the fastening portion has a female thread on the other side that is threadedly engaged with the thread of the base, and the threaded engagement of the screw and the female thread radially fastens the gripping piece at the reduced diameter portion to fix the suturing needle. (3) The endoscopic suturing device described in (2) above, wherein the operating lines of each of the holding parts include a first operating line that rotates the tightening portion so that the tightening portion moves to the other side relative to the base when pulled proximally, thereby strengthening the tightening of the gripping piece by the reduced diameter portion, and a second operating line that rotates the tightening portion so that the tightening portion moves to one side relative to the base when pulled proximally, thereby weakening the tightening of the gripping piece by the reduced diameter portion. (4) The pair of arm portions has a first arm portion and a second arm portion, the first operating wire of the first arm portion and the second operating wire of the second arm portion are simultaneously connected to the proximal side so as to be retractable, and the second operating wire of the first arm portion and the first operating wire of the second arm portion are simultaneously connected to the proximal side so as to be retractable. An endoscopic suturing device as described in (3) above. (5) An endoscopic suturing device as described in (1) or (2) above, wherein the reduced diameter portion is composed of a spring that biases the gripping piece so as to tighten it in the radial direction, and the operating wire moves the gripping body to the other side by pulling toward the proximal side, thereby weakening the tightening of the gripping piece by the reduced diameter 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]

[0083] 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, 18...holding portion, 30, 30a...needle fixing mechanism, 31, 34...base portion, 31a...male thread, 32...collet, 32a...gripping piece, 33...cap, 33a...opening, 33b...reduced diameter portion, 33c...female thread, 36...tightening spring

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 pair of arm sections each having a suture needle holder at one end thereof, and is configured to be capable of switching the arm section that holds the suture needle when opening and closing the one end of the arm to suture tissue, Each of the holding portions includes: a base portion fixed within the arm portion; a gripping body disposed on one side of the base and positioned by the base, the gripping body having a plurality of gripping pieces for gripping the suture needle; a clamping portion having an opening on one side through which the suture needle can be inserted and accommodating the gripping body therein; An operating wire is provided along the tubular insertion portion and configured to change the relative position of the gripping body and the fastening portion by pulling the gripping body toward the proximal side relative to the device body, The fastening portion has a reduced diameter portion that narrows from the other side of the holding portion toward one side, and the reduced diameter portion radially fastens the gripping piece to fix the suture needle. Endoscopic suturing device.

2. The base has a thread on an outer periphery, The fastening portion has a female thread on the other side that is screwed into the screw of the base portion, and the gripping piece is fastened in the radial direction by the reduced diameter portion by screwing the screw and the female thread together, thereby fixing the suture needle.

2. An endoscopic suturing device according to claim 1.

3. The operating wire of each of the holding parts is A first operating line that rotates the fastening portion so that the fastening portion moves to the other side relative to the base portion by pulling toward the proximal side, thereby strengthening the fastening of the gripping piece by the reduced diameter portion; and a second operating line for rotating the fastening portion so that the fastening portion moves to one side relative to the base portion by pulling the fastening portion toward the proximal side, thereby weakening the fastening of the gripping piece by the reduced diameter portion.

3. An endoscopic suturing device according to claim 2.

4. The pair of arms includes a first arm portion and a second arm portion, The first operating wire of the first arm portion and the second operating wire of the second arm portion are simultaneously connected to the proximal side so as to be able to be pulled, The second operating wire of the first arm portion and the first operating wire of the second arm portion are simultaneously connected to the proximal side so as to be able to be pulled.

4. An endoscopic suturing device according to claim 3.

5. The reduced diameter portion is formed of a spring that biases the gripping piece so as to tighten the gripping piece in the radial direction, The operating wire moves the gripping body to the other side by pulling the gripping piece toward the proximal side, thereby weakening the clamping force of the gripping piece by the reduced diameter portion.

2. An endoscopic suturing device according to claim 1.

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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