Endoscopic suture apparatus

Abstract

To provide an endoscopic suture apparatus which simplifies a switching operation between a locked state and an unlocked state of a suture needle.SOLUTION: The endoscopic suture apparatus provided at the distal end of a tubular insertion part of an endoscope comprises a pair of arm parts 12 respectively having holding parts 18 of a suture needle 17, and the arm parts 12 for holding the suture needle 17 in suturing a tissue by opening and closing an arm one-end side are switched. The suture needle 17 comprises an inner needle 31 and a tubular outer needle 32. Each holding part 18 comprises a needle receiving part 33 and a spring part 34. The needle receiving part 33 comprises: a groove 33b for guiding a blade 31c in an insertion direction; and a second cam face 33c which guides the blade 31c in a peripheral direction between a first position where the blade 31c is locked by the needle receiving part 33 and a second position where the blade 31c matches with the groove 33b and the suture needle 17 is withdrawal. In the endoscopic suture apparatus, the position of the blade 31c switches between the first position and the second position along the second cam face 33c.SELECTED DRAWING: Figure 7

Description

Technical Field

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

Background Art

[0002] Conventionally, a technique for suturing an incision under an endoscope to suppress the risk of occurrence of postoperative complications 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 having a pair of arm portions that hold a suture needle at the distal end, and performing suturing by switching the arm portions that hold the suture needle when opening and closing.

Prior Art Documents

Patent Documents

[0003]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0004] The switching between the fixed state and the released state of the suture needle in the arm portion of this type of endoscopic suturing device is operated via a long wire from an operation portion provided on the proximal side of the endoscope. Therefore, separately from the opening and closing operation of the arm portion, it is necessary to perform an operation for switching between the fixed state and the released state of the suture needle, so the operation of the endoscopic suturing device is relatively difficult during the procedure.

[0005] Therefore, the present invention has been made in view of the above situation, and an object thereof is to provide an endoscopic suturing device in which the operation for switching between the fixed state and the released state of the suture needle is simpler than before.

Means for Solving the Problems

[0006] One aspect of the present invention is an endoscopic suturing device provided at the distal end of a tubular insertion portion of an endoscope. The endoscopic suturing device has a pair of arm portions each having a holding portion for a suture needle at one end side of the arm, and is configured such that the arm portion that holds the suture needle can be switched when the one end side of the arm is opened and closed to suture tissue. The suture needle includes an inner needle and a tubular outer needle into which the inner needle is inserted such that it can rotate in the circumferential direction and slide in the axial direction. The inner needle has a needle portion that punctures tissue and a wing portion that is disposed on the proximal end side of the needle portion and protrudes in the radial direction of the inner needle. The outer needle has a first cam surface that can contact the wing portion and is formed with ridges and valleys alternately in the circumferential direction at its tip. The holding portion has an opening through which the suture needle can pass, and includes a needle receiving portion fixed to the arm portion and a spring portion that biases the wing portion of the suture needle that has passed through the needle receiving portion toward the needle receiving portion. The needle receiving portion is formed on the inner circumference of the opening and has a groove that guides the wing portion in the insertion direction of the suture needle, and a second cam surface that is annularly disposed around the opening on the opposing surface to the spring portion and guides the wing portion in the circumferential direction between a first position where the wing portion is locked to the needle receiving portion and a second position where the wing portion aligns with the groove and the suture needle can be inserted and removed. When the pair of arm portions are closed, the endoscopic suturing device causes the position of the wing portion to switch between the first position and the second position along the second cam surface due to the operation of the first cam surface in the insertion direction and the biasing of the spring portion.

[0007] Another aspect of the present invention is an endoscopic suturing device provided at the distal end of the tubular insertion portion of an endoscope. The endoscopic suturing device has a pair of arm portions each having a holding portion for a suture needle at one end side of the arm. The arm portion for holding the suture needle when suturing tissue by opening and closing one end side of the arm is configured to be switchable. The suture needle includes a needle portion for puncturing tissue, a stepped portion having a reduced diameter on the proximal end side of the needle portion, and a notch portion obtained by partially notching the needle portion in the circumferential direction. The holding portion includes an inner cylindrical portion, a first cylindrical cam portion disposed on the outer periphery of the inner cylindrical portion, a second cylindrical cam portion disposed on the outer periphery of the first cylindrical cam portion and fixed to the arm portion, and a spring portion for biasing the inner cylindrical portion toward the outside of the arm portion. The inner cylindrical portion has an opening shape corresponding to the shape of the needle portion including the notch portion, and has an opening through which the needle portion and the stepped portion can pass, and a fin portion formed on the outer periphery of the inner cylindrical portion and protruding in the radial direction. Further, the inner cylindrical portion is rotatably attached to the first cylindrical cam portion and the second cylindrical cam portion in the circumferential direction. The first cylindrical cam portion has a first cam surface on the inner side of the arm portion, in which ridges and valleys are alternately formed in the circumferential direction and which can abut against the fin portion. Further, the first cylindrical cam portion is slidable in the insertion direction together with the inner cylindrical portion. The second cylindrical cam portion has a groove for guiding the fin portion of the inner cylindrical portion in the insertion direction of the suture needle, and a second cam surface that is annularly disposed inside the arm portion and guides the fin portion in the circumferential direction between a first position where the suture needle is locked to the inner cylindrical portion and a second position where the fin portion coincides with the groove and the inner cylindrical portion is slidable in the insertion direction. When the pair of arm portions are closed, the endoscopic suturing device rotates the inner cylindrical portion so that the position of the fin portion switches between the first position and the second position along the second cam surface due to the operation of the first cam surface in the insertion direction and the biasing of the spring portion. In the first position, the position of the notch portion of the needle portion and the opening shape of the opening are shifted in the circumferential direction, and in the second position, the position of the notch portion of the needle portion and the opening shape of the opening coincide.

Advantages of the Invention

[0008] According to one aspect or another aspect of the present invention, it is possible to provide an endoscopic suturing device in which the switching operation between the fixed state and the released state of the suture needle is simpler than in the prior art.

Brief Description of the Drawings

[0009]

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Figure 10

Figure 11

Figure 12

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Figure 14

Figure 15

Figure 16

Figure 17

Mode for Carrying Out the Invention

[0010] Hereinafter, with reference to the drawings, a configuration example of an endoscopic suturing device (hereinafter also referred to as a suturing device) according to an embodiment will be described. Note that the shapes, dimensions, etc. of each part in the drawings are schematically shown and do not indicate actual shapes, dimensions, etc.

[0011] In the following description, the side farther from the operator of the endoscope 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 appropriately indicated by an arrow Ax. Also, a direction substantially orthogonal to the longitudinal direction is defined as the radial direction, and a rotational direction centered on the longitudinal direction is defined as the circumferential direction.

[0012] (First Embodiment) FIG. 1 is a perspective view schematically showing an example of the suturing device according to the 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.

[0013] The suturing device 1 is detachably provided at the distal end of a tubular insertion portion 2 that is inserted into a living body lumen in an endoscope. Since the suturing device 1 is detachable from the tubular insertion portion 2 of the endoscope, maintenance such as replacement and sterilization is easy. Note that the suturing device 1 may be supplied as a disposable product.

[0014] For example, the endoscope is a flexible endoscope with a bendable tubular insertion portion 2 and is operated by an operator from the proximal side. Also, at the distal end of the tubular insertion portion 2 of the endoscope, an objective lens 3 of an imaging unit, a lighting unit 4, and a forceps port 5 are provided.

[0015] The endoscope captures an image of the inside of the living body lumen with the imaging unit through a wide-angle objective lens 3 and can display and output the image of the inside of the living body lumen in real time to a display device (not shown). Also, the lighting unit 4 illuminates the inside of the living body lumen with light guided from a light source by an optical fiber. Also, the forceps port 5 is provided for inserting and removing treatment tools such as forceps 6 and for collecting living tissue with the treatment tool. As shown in FIG. 3, the endoscope can advance and retract the forceps 6 in the longitudinal direction from the forceps port 5 of the tubular insertion portion 2 and grip the living tissue with the forceps 6.

[0016] The suturing device 1 includes a mounting portion 11, a pair of arm portions including a first arm portion 12 and a second arm portion 13, an opening / closing mechanism portion 14, and an opening / closing wire 15. The mounting portion 11, the first arm portion 12, the second arm portion 13, and the opening / closing mechanism portion 14 are disposed at the distal end of the tubular insertion portion 2.

[0017] The first arm portion 12 and the second arm portion 13 each have a holding portion 18 that holds a suture needle 17 at the distal end. Further, a needle fixing mechanism 30 for fixing the suture needle 17 to the arm portion is disposed at each holding portion 18 of the first arm portion 12 and the second arm portion 13. The configurations of the suture needle 17 and the needle fixing mechanism 30 will be described later.

[0018] The mounting portion 11 is an annular member corresponding 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 mounting portion 11 and held by the mounting portion 11. Further, the first arm portion 12 and the second arm portion 13 are attached to the outer periphery of the mounting portion 11 via the opening / closing mechanism portion 14.

[0019] The first arm portion 12 and the second arm portion 13 are supported by the opening / closing mechanism portion 14 in a V shape so as to protrude to the distal side of the mounting portion 11 and can be opened and closed in a direction substantially parallel to the tangential direction of the outer periphery of the endoscope. As shown in FIG. 3, when the suturing device 1 is attached to the tubular insertion portion 2, the tips of the first arm portion 12 and the second arm portion 13 are located on the distal side of the tubular insertion portion 2. Further, as shown in FIG. 3, the tips of the respective arm portions are disposed on the moving line of the forceps 6 when the respective arm portions are in a closed state.

[0020] The first arm portion 12 and the second arm portion 13 are attached such that the distal side is inclined radially inward relative to the proximal side. For example, each arm portion is attached at an inclination of 0.5° to 50°, more preferably 3° to 35°, from a position substantially parallel to the longitudinal direction, radially inward. By attaching each arm portion inwardly, the suturing device 1 is less likely to interfere with those on the radially outer side, and the passability when inserting the endoscope into an overtube or the body can be improved. Further, by attaching each arm portion inwardly, the tip of each arm portion approaches the center of the viewing angle of the imaging unit of the endoscope, and the visibility during suturing can be improved. Also, even if the endoscope moves, is located at a bending portion, or the arm position is slightly displaced after insertion, the arm portion is more likely to be reflected in the center of the field of view, and it becomes easy to confirm the entire arm portion under the endoscope.

[0021] In addition, the holding portion 18 provided at the tip of each arm portion is arranged within a range of 100% from the center of the viewing angle of the imaging unit of the endoscope. Specifically, with the distal end of the tubular insertion portion 2 as a reference, when the viewing angle of the imaging unit is θ1 and the range where the tip of each arm portion is arranged from the center of the viewing angle 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 arranging the tips of the respective arm portions under the above conditions, it is possible to suppress the suture site from deviating from the viewing angle of the imaging unit and the visibility during suturing from deteriorating due to the influence of aberration of the imaging unit.

[0022] In addition, for example, when performing suturing by largely enclosing biological tissue such as full-thickness suturing, it is necessary to sufficiently draw the biological tissue to be sutured by the forceps 6 of the endoscope toward the endoscope side. Therefore, a certain margin is required for the longitudinal dimension from the distal end of the tubular insertion portion 2 to the holding portion 18.

[0023] From this perspective, for example, the longitudinal dimension from the distal end of the tubular insertion portion 2 to the tip of each arm portion 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 setting the distance from the distal end of the tubular insertion portion 2 to the tip of each arm portion to 3 mm or more, the tip of the arm portion enters the field of view of the endoscope, making suturing under the endoscope easier. Also, by setting the distance from the distal end of the tubular insertion portion 2 to the tip of each arm portion to 60 mm or less, it becomes easier to insert the tip of the arm without catching it on the overtube.

[0024] The opening and closing wire 15 is arranged longitudinally along the tubular insertion portion 2, and the distal side is connected to the opening and closing mechanism portion 14. In the suturing device 1, by pulling the opening and closing wire 15 proximally, the first arm portion 12 and the second arm portion 13 that hold the suture needle 17 can be opened and closed via the opening and closing mechanism portion 14.

[0025] As the materials for the attachment portion 11, the first arm portion 12, the second arm portion 13, and the opening and closing mechanism portion 14, metals having biocompatibility, etc. can be applied respectively, and examples include stainless steel, titanium, nitinol, etc. Also, for the opening and closing wire 15, in addition to metal fine wires such as stainless steel, titanium, copper, nitinol, etc., fine wires of polymer fibers, fluorine tubes, polyethylene, polypropylene, nylon, etc. can be used.

[0026] FIG. 4 is a diagram schematically showing a configuration example of the opening and closing mechanism portion 14 of the first embodiment. Note that the opening and closing mechanism portion 14 is not limited to the configuration of FIG. 4, and it may be by another mechanism that can be opened and closed by pulling the opening and closing wire 15.

[0027] The opening and closing mechanism portion 14 of the first embodiment is a link mechanism that drives the first arm portion 12 and the second arm portion 13, and has a main body portion 21, a driving joint 22, a first intermediate joint 23, and a second intermediate joint 24. The link mechanism of the opening and closing mechanism portion 14 is line-symmetric on a plane with respect to the central axis C. Note that the central axis C includes a component inclined in the radial direction with respect to the longitudinal direction of the tubular insertion portion 2.

[0028] The main body portion 21 is a thin box-shaped housing that rotatably supports the first arm portion 12 and the second arm portion 13 and houses the elements of the link mechanism. The main body portion 21 also functions as a cover that covers the elements of the link mechanism. By covering the link mechanism with the main body portion 21, it is possible to suppress the possibility of malfunction of the link mechanism due to entanglement of the suture thread or adhesion of body fluid or the like. In FIG. 4, the main body portion 21 is drawn in a flat plate shape for easy understanding of the structure of the opening / closing mechanism portion 14.

[0029] The overall shape of the main body portion 21 is formed in a trapezoidal shape in which the distal side is longer than the proximal side, and the proximal side of the main body portion 21 is fixed to the attachment portion 11. As described above, the main body portion 21 is fixed to the attachment portion 11 so that the distal side is inclined toward the radially inner side (the depth side of the paper surface in FIG. 4) than the proximal side.

[0030] Further, on the distal side of the main body portion 21, the first arm portion 12 is attached to one end (the left side in FIG. 4), and the second arm portion 13 is attached to the other end (the right side in FIG. 4) with a space from the first arm portion 12. The proximal end side of the first arm portion 12 is rotatably supported by the main body portion 21 with the first support shaft 25. Also, the proximal end side of the second arm portion 13 is rotatably supported by the main body portion 21 with the second support shaft 26. Note that the first arm portion 12 and the second arm portion 13 are biased in the opening direction by a spring (not shown).

[0031] The driving joint 22 is an elongated rectangular member and is disposed in the main body portion 21 along the central axis C. The opening / closing wire 15 is connected to the proximal end portion of the driving joint 22. Also, the proximal end portions of the first intermediate joint 23 and the second intermediate joint 24 are respectively connected to the distal end portion of the driving joint 22. The driving joint 22 slides in the main body portion 22 along the central axis C by the traction of the opening / closing wire 15, and thereby relatively displaces in the longitudinal direction of the tubular insertion portion 2.

[0032] The first intermediate joint 23 and the second intermediate joint 24 are each an elongated rectangular member. The proximal ends of the first intermediate joint 23 and the second intermediate joint 24 are both rotatably supported by a pin 22a at the distal end of the driving joint 22.

[0033] Also, the distal end of the first intermediate joint 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 closer to the first support shaft 25 than the tip side of the arm.

[0034] Similarly, the distal end of the second intermediate joint 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 closer to the second support shaft 26 than the tip side of the arm.

[0035] Here, as described above, the first arm portion 12 and the second arm portion 13 are biased in the opening direction by the force of a spring (not shown). In a state where the opening and closing wire 15 is not pulled, since no closing force acts on the first arm portion 12 and the second arm portion 13, the stitching device 1 maintains a state where the arm portions are open (FIG. 4(a)).

[0036] When the opening and closing wire 15 is pulled from the above state, the driving joint 22 of the opening and closing mechanism portion 14 is displaced proximally in the longitudinal direction. Then, with the displacement of the driving joint 22, the positions of the proximal ends of the first intermediate joint 23 and the second intermediate joint 24 move proximally, and the first intermediate joint 23 and the second intermediate joint 24 are each drawn proximally.

[0037] The first arm portion 12 rotatably supported by the first support shaft 25 on the main body portion 21 rotates in the closing direction about the first support shaft 25 due to the displacement of the first intermediate joint 23. Similarly, the second arm portion 13 rotatably supported by the second support shaft 26 on the main body portion 21 rotates in the closing direction about the second support shaft 26 due to the displacement of the second intermediate joint 24. As described above, the arm portion of the sewing device 1 changes from the opened state to the closed state by the pulling of the opening / closing wire 15 (Fig. 4(b)).

[0038] The opening / closing mechanism portion 14 shown in Fig. 4 directly transmits the movement of the opening / closing wire 15 to the arm portion via the link mechanism, and can convert the displacement of the driving joint 22 due to the pulling of the opening / closing wire 15 into the opening / closing operation of the tip side of the arm portion. Therefore, the opening / closing mechanism portion 14 can open and close the arm portion with a strong force while suppressing the loss of force, and for example, can realize the sewing device 1 suitable for full-layer sewing. Further, the opening / closing mechanism portion 14 can switch the opening and closing of the arm portion by a simple operation of pulling the opening / closing wire 15.

[0039] Next, a configuration example of the holding portion 18 and the needle fixing mechanism 30 of the first embodiment will be described. Fig. 5 is a diagram showing the arrangement of the needle fixing mechanism 30 in the first embodiment. Fig. 6 is a diagram showing a configuration example of the sewing needle 17 in the first embodiment. Fig. 7 is an enlarged view of the needle fixing mechanism 30 of the first arm portion 12 shown in Fig. 5. Fig. 8 is a diagram showing a state in which the sewing needle 17 is inserted into the needle receiving portion 33 of the needle fixing mechanism 30.

[0040] At the tips (distal ends) of the first arm portion 12 and the second arm portion 13, holding portions 18 for the sewing needle 17 are respectively provided on the inner surfaces. The holding portion 18 is a hole opened on the inner surface of each arm portion, and can accommodate one end of the sewing needle 17 inserted into the arm portion.

[0041] As shown in Fig. 6, the sewing needle 17 is configured by combining a cylindrical outer needle 32 and a pair of inner needles 31. Further, the sewing needle 17 has a hole (not shown) for passing the sewing thread at the central portion of the outer needle 32.

[0042] The pair of inner needles 31 are arranged at both ends in the longitudinal direction of the sewing needle 17, and the main body portions 31a of the inner needles 31 are respectively inserted into the outer needle 32 in a nested manner. The inner needles 31 are each rotatable in the circumferential direction of the sewing needle 17 and slidable in the axial direction of the sewing needle 17 as shown in Fig. 6(b).

[0043] The inner needle 31 has a shaft-shaped main body portion 31a, a needle portion 31b, and a plurality of fin portions 31c. The needle portion 31b is formed on the tip side of the main body portion 31a and punctures the tissue. The fin portions 31c are disposed on the proximal side of the needle portion 31b and project radially outward from the main body portion 31a of the inner needle 31. The plurality of fin portions 31c are arranged at the same position in the axial direction of the main body portion 31a and are radially arranged at equal intervals in the circumferential direction of the main body portion 31a. In this embodiment, as shown in FIG. 6(c), an example in which three fin portions 31c are formed on the inner needle 31 is shown. However, for example, the number of fin portions 31c may be two or four or more.

[0044] The outer needle 32 is a cylindrical body that houses the main body portion 31a of the inner needle 31, and has first cam surfaces 32a in a zigzag shape at both axial ends (the tips of the outer needle 32). The first cam surface 32a has ridges protruding in the axial direction and valleys recessed in the axial direction alternately formed in the circumferential direction to form an annular shape, and the spaces between the ridges and the valleys are each connected by a straight line. The first cam surface 32a functions to contact the fin portion 31c of the inner needle 31 and guide the inner needle 31 in the circumferential direction.

[0045] Also, inside the first arm portion 12 and inside the second arm portion 13, a needle fixing mechanism 30 is disposed at the position of the holding portion 18, respectively. Each needle fixing mechanism 30 can alternately switch between a fixed state in which the suture needle 17 is fixed to the holding portion 18 and a fixed release state in which the suture needle 17 is not fixed to the holding portion 18 in accordance with the opening and closing operation of the arm portion. When the needle fixing mechanism 30 of the first arm portion 12 is in the fixed state, the needle fixing mechanism 30 of the second arm portion 13 is in the fixed release state, and when the needle fixing mechanism 30 of the first arm portion 12 is in the fixed release state, the needle fixing mechanism 30 of the second arm portion 13 is in the fixed state.

[0046] Here, the configurations of the needle fixing mechanisms 30 of the first arm portion 12 and the second arm portion 13 are common. Therefore, hereinafter, the configuration of the needle fixing mechanism 30 of the first arm portion 12 will be described, and redundant descriptions regarding the needle fixing mechanism 30 of the second arm portion 13 will be omitted.

[0047] As shown in FIG. 7, the needle fixing mechanism 30 has a needle receiving portion 33 and a spring portion 34. The needle receiving portion 33 has an opening 33a through which the outer needle 32 of the sewing needle 17 can pass, and is a cylindrical body arranged along the insertion direction of the sewing needle 17. One side (the right side in the figure) of the needle receiving portion 33 is fixed to one side of the arm portion at a position where the opening 33a of the needle receiving portion 33 faces the holding portion 18.

[0048] A plurality of grooves 33b having a size through which the blade portion 31c of the sewing needle 17 can pass are formed on the inner periphery of the opening of the needle receiving portion 33. Three grooves 33b of the needle receiving portion 33 are formed at equal intervals in the circumferential direction in accordance with the arrangement of the blade portions 31c, and each groove 33b extends in the insertion direction of the sewing needle 17. When the blade portion 31c of the sewing needle 17 coincides with the groove 33b of the needle receiving portion 33, the blade portion 31c does not interfere with the needle receiving portion 33. Therefore, when the blade portion 31c of the sewing needle 17 coincides with the groove 33b of the needle receiving portion 33, the blade portion 31c of the sewing needle 17 is guided by the groove 33b, and the sewing needle 17 can be inserted into and removed from the needle receiving portion 33.

[0049] In addition, a second cam surface 33c for guiding the blade portion 31c of the sewing needle 17 in the circumferential direction is formed on the other side (the left side in the figure) of the needle receiving portion 33. The second cam surface 33c is annularly arranged around the opening 33a along the circumferential direction of the needle receiving portion 33. The second cam surface 33c has a shape in which two serrated ridges (a first ridge 33c1 and a second ridge 33c2) are arranged between one groove 33b and the other groove 33b of the needle receiving portion 33. As shown in FIGS. 9 and 10 to be described later, one groove 33b is connected to the other side of the inclined surface of the first ridge 33c1, and the other groove 33b is connected to one side of the inclined surface of the second ridge 33c2. In addition, one side of the first ridge 33c1 and the other side of the second ridge 33c2 are connected to form a step.

[0050] The spring portion 34 is a spring member fixed to the other side of the arm portion, and is disposed to face the second cam surface 33c of the needle receiving portion 33 in the insertion direction of the suture needle 17. The spring portion 34 functions to bias the flange portion 31c of the suture needle 17 that has passed through the needle receiving portion 33 toward the second cam surface 33c of the needle receiving portion 33. Note that the spring force of the spring portion 34 is adjusted such that it is hardly compressed when the suture needle 17 punctures the tissue, and compression occurs when the arm portion is closed.

[0051] FIGS. 9 and 10 are schematic diagrams for explaining an operation example of the needle fixing mechanism 30 in the first arm portion 12 of the first embodiment. In FIGS. 9 and 10, the positional relationship among the flange portion 31c of the inner needle 31 of the suture needle 17, the first cam surface 32a of the outer needle 32, and the groove 33b and the second cam surface 33c of the needle receiving portion 33 is shown by being developed on a plane. In FIGS. 9 and 10, the left - right direction in the figure corresponds to the circumferential direction, the upper side in the figure corresponds to the other side, and the lower side in the figure corresponds to the one side.

[0052] Also, in the following operation example, it is assumed that the suture needle 17 is held cantilevered by the holding portion 18 of the second arm portion 13, and the needle fixing mechanism 30 of the second arm portion 13 is in a fixed state.

[0053] FIG. 9(a) shows a state when the suture needle 17 is inserted into the needle receiving portion 33. In FIG. 9(a), the needle fixing mechanism 30 is in a state of releasing fixation, and the flange portion 31c of the suture needle 17 is at a second position where the position in the circumferential direction coincides with the groove 33b of the needle receiving portion 33. Thereby, the flange portion 31c of the suture needle 17 is guided by the groove 33b, and the suture needle 17 can be inserted into the needle receiving portion 33 toward the other side.

[0054] FIG. 9(b) shows a state in which the suture needle 17 has moved to the other side as the arm portion closes from the state of FIG. 9(a). In FIG. 9(b), as the suture needle 17 moves to the other side, the flange portion 31c and the first cam surface 32a move to the other side with respect to the needle receiving portion 33 compared to the state of FIG. 9(a).

[0055] On the other hand, in Fig. 9(b), the sewing needle 17 pushed into the other side contacts the spring portion 34, and the sewing needle 17 is biased to one side by the spring portion 34. At this time, the blade portion 31c of the sewing needle 17 is guided by the inclined surface facing the valley portion of the first cam surface 32a, and the inner needle 31 rotates in the circumferential direction before the blade portion 31c contacts the second cam surface 33c. As a result, the position of the blade portion 31c is shifted in the circumferential direction from the position of the groove 33b of the second cam surface 33c, and can come into contact with the inclined surface of the first ridge portion 33c1 of the second cam surface 33c.

[0056] Fig. 9(c) is a continuation of Fig. 9(b) and shows the fixed state of the needle fixing mechanism 30. In Fig. 9(c), since the sewing needle 17 is biased to one side by the spring portion 34, a force to one side acts on the inner needle 31 and the outer needle 32. As a result, the outer needle 32 having the first cam surface 32a moves to one side more than in the state of Fig. 9(b). Further, the blade portion 31c of the inner needle 31 contacts the first ridge portion 33c1 of the second cam surface 33c, and the blade portion 31c is guided by the first ridge portion 33c1 and the inner needle 31 rotates in the circumferential direction. Then, the blade portion 31c moves to the first position having a step connecting the one side of the first ridge portion 33c1 and the other side of the second ridge portion 33c2.

[0057] The blade portion 31c at the first position is caught by the step of the second cam surface 33c and is strongly pressed against the needle receiver portion 33 toward one side by the force of the spring portion 34. That is, the blade portion 31c of the inner needle 31 is sandwiched and locked between the spring portion 34 and the needle receiver portion 33, and the inner needle 31 is in a state of being positioned in the circumferential direction. Further, since the position of the blade portion 31c of the inner needle 31 is shifted from the groove 33b of the needle receiver portion 33, the blade portion 31c and the needle receiver portion 33 interfere with each other and the sewing needle 17 is prevented from coming off. As a result, the sewing needle 17 inserted into the holding portion 18 is fixed to the needle fixing mechanism 30. Thereafter, in the sewing device 1, an operation of opening the arm portion is performed.

[0058] Here, when the needle fixing mechanism 30 of the first arm portion 12 shifts from the unlocked state to the locked state, the needle fixing mechanism 30 of the second arm portion 13 shifts from the locked state to the unlocked state by the same operation as that shown in FIG. 10 described later. Therefore, when the arm portion of the sewing device 1 is opened after FIG. 9(c), the sewing needle 17 is held in a cantilevered manner by the holding portion 18 of the first arm portion 12.

[0059] FIG. 10(a) shows a state in which the arm portion is closed when the needle fixing mechanism 30 is in the locked state. In the state of FIG. 10(a), when the arm portion is closed, first, the outer needle 32 of the sewing needle 17 moves to the other side, and the blade portion 31c at the first position and the first cam surface 32a come into contact with each other.

[0060] FIG. 10(b) shows a state in which the sewing needle 17 further moves to the other side from the state of FIG. 10(a). In FIG. 10(b), when the sewing needle 17 moves to the other side, the blade portion 31c and the first cam surface 32a move to the other side with respect to the needle receiving portion 33 compared to the state of FIG. 10(a), and the blade portion 31c can overcome the step of the second cam surface 33c.

[0061] On the other hand, in FIG. 10(b), the sewing needle 17 pushed into the other side contacts the spring portion 34, and the sewing needle 17 is biased to one side by the spring portion 34. At this time, the blade portion 31c of the sewing needle 17 is guided by the inclined surface facing the valley portion of the first cam surface 32a, and the inner needle 31 rotates in the circumferential direction before the blade portion 31c contacts the second cam surface 33c. As a result, the position of the blade portion 31c is displaced in the circumferential direction from the first position of the second cam surface 33c, and can come into contact with the inclined surface of the second peak portion 33c2 of the second cam surface 33c.

[0062] FIG. 10(c) shows a state in which the suture needle 17 is biased to one side by the spring portion 34 from the state of FIG. 10(b). In FIG. 10(c), since the suture needle 17 is biased to one side by the spring portion 34, a force to one side acts on the inner needle 31 and the outer needle 32. As a result, the outer needle 32 having the first cam surface 32a moves to one side more than in the state of FIG. 10(b). Further, the blade portion 31c of the inner needle 31 abuts against the second peak portion 33c2 of the second cam surface 33c, and the blade portion 31c is guided by the second peak portion 33c2 and the inner needle 31 rotates in the circumferential direction.

[0063] FIG. 10(d) is a continuation of FIG. 10(c) and shows a state in which the needle fixing mechanism 30 has returned to the fixed release state. The blade portion 31c of the suture needle 17 in FIG. 10(d) is in a second position where the circumferential position coincides with the groove 33b of the needle receiving portion 33. As a result, the blade portion 31c of the suture needle 17 is guided by the groove 33b, and it becomes possible to pull out the suture needle 17 to one side with respect to the needle receiving portion 33.

[0064] Here, when the needle fixing mechanism 30 of the first arm portion 12 shifts from the fixed state to the fixed release state, the needle fixing mechanism 30 of the second arm portion 13 shifts from the fixed release state to the fixed state by the same operation as in FIG. 9. Therefore, when the arm portion is opened by the suturing device 1 after FIG. 10(d), the suture needle 17 is held in a cantilevered state by the holding portion 18 of the second arm portion 13. In the suturing device 1, the first arm portion 12 and the second arm portion 13 are opened and closed with the incision portion in the living body lumen sandwiched therebetween, and the above operation is repeated. Thereby, the incision portion can be sutured by alternately switching the arm portions that hold the suture needle 17.

[0065] Hereinafter, the effects of the suturing device 1 of the first embodiment will be described. The needle fixing mechanism 30 disposed in the holding portion 18 of the sewing device 1 holds the sewing needle 17 having the inner needle 31 and the outer needle 32. The sewing needle 17 includes an inner needle 31 having a blade portion 31c and a cylindrical outer needle 32 having a first cam surface 32a at its tip. The needle fixing mechanism 30 includes a needle receiving portion 33 and a spring portion 34. The needle receiving portion 33 has a groove 33b for guiding the blade portion 31c in the insertion direction, a first position where the blade portion 31c is locked to the needle receiving portion 33, and a second cam surface 33c for guiding the blade portion 31c in the circumferential direction between the second position where the blade portion 31c aligns with the groove 33b and the sewing needle 17 can be inserted and removed. When the sewing device 1 closes a pair of arm portions, the position of the blade portion 31c switches between the first position and the second position along the second cam surface 33c due to the operation of the first cam surface 32a in the insertion direction and the biasing force of the spring portion 34. As described above, in the needle fixing mechanism 30 of the first embodiment, the fixed state and the released state of the sewing needle 17 are switched by changing the position of the blade portion 31c according to the operation of opening and closing the arm portion. Therefore, in the sewing device 1 of the first embodiment, the sewing needle 17 can be fixed and released only by operating the opening and closing wire 15 for opening and closing the arm portion, and the operation of the sewing device 1 during the procedure can be made very simple.

[0066] (Second Embodiment) Next, with reference to FIGS. 11 to 17, the needle fixing mechanism 30a of the second embodiment will be described. Similar to the first embodiment, the needle fixing mechanism 30a of the second embodiment can alternately switch the fixed state and the released state of the sewing needle 17a along with the opening and closing operation of the arm portion.

[0067] Also, in the second embodiment, the configurations of the needle fixing mechanisms 30a of the first arm portion 12 and the second arm portion 13 are common. Therefore, hereinafter, the configuration of the needle fixing mechanism 30a of the first arm portion 12 will be described, and redundant descriptions regarding the needle fixing mechanism 30a of the second arm portion 13 will be omitted.

[0068] FIG. 11 is a diagram showing a configuration example of the needle fixing mechanism 30a of the second embodiment. FIG. 12 is a view of one end of the suture needle 17a of the second embodiment as seen from the insertion and extraction direction. FIG. 13 is an exploded view of the needle fixing mechanism 30a of the second embodiment. FIG. 14 is a diagram showing an assembled state of the inner cylinder portion 41, the first cylindrical cam portion 42, and the second cylindrical cam portion 43 of the needle fixing mechanism 30a.

[0069] The needle fixing mechanism 30a disposed in the holding portion 18 of the first arm portion 12 includes an inner cylinder portion 41 that receives the suture needle 17a, a first cylindrical cam portion 42, a second cylindrical cam portion 43, and a spring portion 44, and holds the suture needle 17a.

[0070] Here, the suture needle 17a has a shaft-shaped main body portion 51 and a pair of needle portions 52 formed at both ends of the main body portion 51 for puncturing tissue. The main body portion 51 has a hole (not shown) through which the suture thread passes at the central portion.

[0071] On both sides of the suture needle 17a, step portions 53 that are recessed in an annular shape in the circumferential direction and have a smaller diameter than the main body portion 51 are formed at positions on the proximal end side of the needle portions 52, respectively. The longitudinal dimension of the step portion 53 is set to a dimension corresponding to the thickness of the flange portion 41b of the inner cylinder portion 41 described later.

[0072] Also, as shown in FIG. 12, a plurality of notch portions 54 are formed in the needle portion 52 such that the outer periphery is partially cut out in an arcuate shape when viewed from the insertion and extraction direction of the suture needle 17a. For example, three notch portions 54 are formed at equal intervals in the circumferential direction of the needle portion 52, and are each located radially outside the outer diameter of the step portion 53. As a result, the projected shape of the needle portion 52 when viewed from the insertion and extraction direction has a substantially triangular shape with rounded corners.

[0073] The inner cylinder portion 41 of the needle fixing mechanism 30a has a cylindrical main body 41a, a flange portion 41b, and a plurality of blade portions 41c.

[0074] The cylindrical main body 41a of the inner cylinder part 41 is a cylindrical body with a larger diameter than the main body part 51 of the suture needle 17a, and is arranged along the insertion direction of the suture needle 17a. A flange part 41b is provided at one end (the right side in the figure) of the cylindrical main body 41a, and blade parts 41c are respectively provided on the other side (the left side in the figure) of the cylindrical main body 41a.

[0075] The flange part 41b is an example of a protrusion, and is formed by a disc-shaped member with a larger diameter than the cylindrical main body 41a. The disc-shaped member of the flange part 41b covers one side of the cylindrical main body 41a and is concentrically attached to the cylindrical main body 41a so as to protrude radially outward of the cylindrical main body 41a.

[0076] Also, an opening 41d through which the needle part 52 and the step part 53 of the suture needle 17a can pass is formed at the center of the disc-shaped member of the flange part 41b. The shape of the opening 41d of the flange part 41b corresponds to the shape of the needle part 52 having the notch part 54, and has a substantially triangular shape with rounded corners.

[0077] The plurality of blade parts 41c are arranged radially at equal intervals in the circumferential direction of the cylindrical main body 41a, and each blade part 41c protrudes radially outward from the outer periphery of the cylindrical main body 41a. In this embodiment, an example in which three blade parts 41c are formed on the inner cylinder part 41 is shown. However, for example, the number of blade parts 41c may be two, or may be four or more.

[0078] The first cylindrical cam part 42 is a cylindrical member that is inserted into the cylindrical main body 41a of the inner cylinder part 41 and is arranged in a nested manner outside the inner cylinder part 41. The first cylindrical cam part 42 is arranged sandwiched between the blade part 41c and the flange part 41b of the inner cylinder part 41, and is rotatable in the circumferential direction with respect to the inner cylinder part 41. The attachment of the first cylindrical cam part 42 to the inner cylinder part 41 may be performed, for example, by inserting the first cylindrical cam part 42 from one side of the cylindrical main body 41a and then fixing the disc-shaped member of the flange part 41b to the cylindrical main body 41a.

[0079] On the other end of the first cylindrical cam portion 42, a zigzag first cam surface 42a is formed. The first cam surface 42a has ridges protruding in the axial direction and valleys recessed in the axial direction formed alternately in the circumferential direction to form an annular shape, and the spaces between the ridges and valleys are connected by straight lines respectively. The first cam surface 42a functions to contact the blade portion 41c of the inner cylinder portion 41 and guide the inner cylinder portion 41 in the circumferential direction.

[0080] Also, on the outer circumference of the first cylindrical cam portion 42, a plurality of protruding portions 42b protruding radially outward are provided at intervals in the circumferential direction. The protruding portions 42b are an example of a rotation control member, and each functions to contact the inner circumference of the second cylindrical cam portion 43 and restrict the circumferential movement of the first cylindrical cam portion 42.

[0081] The second cylindrical cam portion 43 is a cylindrical member disposed on the outer circumference of the first cylindrical cam portion 42. One side of the second cylindrical cam portion 43 is fixed to one side of the arm portion at a position facing the holding portion 18. Also, the inner cylinder portion 41 and the first cylindrical cam portion 42 are coaxially disposed inside the second cylindrical cam portion 43 with the blade portion 41c of the inner cylinder portion 41 positioned on the other side of the second cylindrical cam portion 43.

[0082] Also, on the other side of the second cylindrical cam portion 43, a plurality of grooves 43a for guiding the blade portion 41c of the inner cylinder portion 41 in the insertion direction of the suture needle 17a and a second cam surface 43b for guiding the blade portion 41c of the inner cylinder portion 41 in the circumferential direction are respectively formed.

[0083] The grooves 43a of the second cylindrical cam portion 43 have dimensions corresponding to the width of the blade portion 41c respectively, and extend from the other side of the second cylindrical cam portion 43 in the insertion direction of the suture needle 17a. Three grooves 43a are formed in the second cylindrical cam portion 43 at equal intervals in the circumferential direction according to the arrangement of the blade portions 41c of the inner cylinder portion 41.

[0084] The second cam surface 43b is annularly arranged along the circumferential direction of the second cylindrical cam portion 43. The second cam surface 43b has a shape in which two serrated ridges (the first ridge 43b1 and the second ridge 43b2) are arranged between one groove 43a and the other groove 43a of the second cylindrical cam portion 43. As shown in FIGS. 15 and 16 described later, one groove 43a is connected to the other side of the inclined surface of the first ridge 43b1, and the other groove 43a is connected to one side of the inclined surface of the second ridge 43b2. Also, one side of the first ridge 43b1 and the other side of the second ridge 43b2 are connected to form a step.

[0085] Here, while the second cylindrical cam portion 43 is fixed to the arm portion, the first cylindrical cam portion 42 and the inner cylinder portion 41 are slidable with respect to the second cylindrical cam portion 43 in the insertion direction of the suture needle 17a. For example, when the inner cylinder portion 41 is pressed from one side, the first cylindrical cam portion 42 is pressed from one side by the flange portion 41b of the inner cylinder portion 41 and slides to the other side together with the inner cylinder portion 41.

[0086] Also, due to the contact between the second cylindrical cam portion 43 and the protrusion 42b, the circumferential movement of the first cylindrical cam portion 42 with respect to the second cylindrical cam portion 43 is restricted. On the other hand, the inner cylinder portion 41 is rotatable in the circumferential direction with respect to the first cylindrical cam portion 42. Therefore, the inner cylinder portion 41 is rotatably attached to the first cylindrical cam portion 42 and the second cylindrical cam portion 43 in the circumferential direction, and rotates when the blade portion 41c is guided by the first cam surface 42a and the second cam surface 43b.

[0087] Also, since the second cylindrical cam portion 43 is located on one side of the blade portion 41c of the inner cylinder portion 41, the inner cylinder portion 41 and the first cylindrical cam portion 42 are prevented from coming off to one side due to the contact between the blade portion 41c and the second cylindrical cam portion 43. Also, when the blade portion 41c of the inner cylinder portion 41 and the groove 43a of the second cylindrical cam portion 43 coincide, the inner cylinder portion 41 is slidable in the insertion direction of the suture needle 17a along the groove 43a.

[0088] The spring portion 44 is a spring member fixed to the other side of the arm portion, and is disposed to face the fin portion 41c of the inner cylinder portion 41 and the second cam surface 43b of the second cylindrical cam portion 43 in the insertion direction of the suture needle 17a. The spring portion 44 functions to bias the fin portion 41c of the inner cylinder portion 41 toward the second cam surface 43b of the second cylindrical cam portion 43. Note that the spring force of the spring portion 44 is adjusted such that it is hardly compressed when the suture needle 17a pierces the tissue, and compression occurs when the arm portion is closed.

[0089] FIGS. 15 and 16 are schematic diagrams for explaining an operation example of the needle fixing mechanism 30a in the first arm portion 12 of the second embodiment. FIG. 17 is a diagram showing the positional relationship between the needle portion 52 and the opening 41d in the fixed release state and the fixed state in the needle fixing mechanism 30a of the second embodiment.

[0090] In FIGS. 15 and 16, the positional relationship among the fin portion 41c of the inner cylinder portion 41, the first cam surface 42a of the first cylindrical cam portion 42, the groove 43a of the second cylindrical cam portion 43, and the second cam surface 43b is shown by being developed on a plane. In FIGS. 15 and 16, the left - right direction in the figure corresponds to the circumferential direction, the upper side in the figure corresponds to the other side, and the lower side in the figure corresponds to the one side.

[0091] Also, in the following operation example, it is assumed that the suture needle 17 is held cantilever - style by the holding portion 18 of the second arm portion 13, and the needle fixing mechanism 30 of the second arm portion 13 is in a fixed state.

[0092] FIG. 15(a) shows a state when the suture needle 17a is inserted into the inner cylinder portion 41 of the needle fixing mechanism 30a. In FIG. 15(a), the needle fixing mechanism 30a is in a fixed release state, and the fin portion 41c of the inner cylinder portion 41 is at a second position where the circumferential position coincides with the groove 43a of the second cylindrical cam portion 43. Therefore, the inner cylinder portion 41 and the first cylindrical cam portion 42 are movable in the insertion direction along the groove 43a of the second cylindrical cam portion 43.

[0093] Figure 15(b) shows the state where the arm part is closed from the state of Figure 15(a). When closing the arm part, as shown in Figure 17(a), the sewing needle 17a is inserted into the inner cylinder part 41 with the position of the notch part 54 of the needle part 52 coinciding with the opening part 41d of the inner cylinder part 41. Then, the main body part 51 of the sewing needle 17a contacts the flange part 41b of the inner cylinder part 41, and the inner cylinder part 41 and the first cylindrical cam part 42 move to the other side under the force of closing the arm part. As a result, in the state of Figure 15(b), the wing part 41c and the first cam surface 42a move to the other side with respect to the second cam surface 43b compared to the state of Figure 15(a).

[0094] On the other hand, in Figure 15(b), the wing part 41c of the inner cylinder part 41 pushed to the other side receives the reaction force of the spring part 44, and the inner cylinder part 41 is biased to the one side. At this time, the wing part 41c of the inner cylinder part 41 is guided by the inclined surface facing the valley part of the first cam surface 42a, and the inner cylinder part 41 rotates in the circumferential direction before the wing part 41c contacts the second cam surface 43b. As a result, the position of the wing part 41c is displaced in the circumferential direction from the position of the groove 43a of the second cylindrical cam part 43 and becomes capable of abutting against the inclined surface of the first peak part 43b1 of the second cam surface 43b.

[0095] Figure 15(c) is a continuation of Figure 15(b) and shows the fixed state of the needle fixing mechanism 30a. In Figure 15(c), since the inner cylinder part 41 is biased to the one side by the spring part 44, a force to the one side acts on the inner cylinder part 41 and the first cylindrical cam part 42. As a result, the first cam surface 42a and the wing part 41c move to the one side compared to the state of Figure 15(b). Also, the wing part 41c of the inner cylinder part 41 abuts against the first peak part 43b1 of the second cam surface 43b, and the wing part 41c is guided by the first peak part 43b1 and the inner cylinder part 41 rotates in the circumferential direction. Then, the wing part 41c moves to the first position with a step connecting the one side of the first peak part 43b1 and the other side of the second peak part 43b2.

[0096] The blade portion 41c at the first position is caught by the step of the second cam surface 43b and is strongly pressed against the second cylindrical cam portion 43 toward one side by the force of the spring portion 44. That is, the blade portion 41c of the inner cylinder portion 41 is sandwiched and locked between the spring portion 44 and the second cylindrical cam portion 43, and the inner cylinder portion 41 is in a state of being positioned in the circumferential direction.

[0097] Also, as the inner cylinder portion 41 rotates in the circumferential direction as described above, in the fixed state of the needle fixing mechanism 30a, as shown in FIG. 17(b), the position of the notch portion 54 of the needle portion 52 is shifted with respect to the opening portion 41d of the inner cylinder portion 41. That is, in the fixed state of the needle fixing mechanism 30a, the needle portion 52 inserted into the inner cylinder portion 41 and the flange portion 41b interfere with each other, and the sewing needle 17a is prevented from coming off. Thereby, the sewing needle 17a inserted into the holding portion 18 is fixed to the needle fixing mechanism 30a. Thereafter, in the sewing apparatus 1, an operation of opening the arm portion is performed.

[0098] Here, when the needle fixing mechanism 30a of the first arm portion 12 shifts from the fixed release state to the fixed state, the needle fixing mechanism 30a of the second arm portion 13 shifts from the fixed state to the fixed release state by the same operation as that shown in FIG. 16 described later. Therefore, when the arm portion of the sewing apparatus 1 is opened after FIG. 15(c), the sewing needle 17 is held in a cantilevered state by the holding portion 18 of the first arm portion 12.

[0099] FIG. 16(a) shows a state when the arm portion is closed from the state of FIG. 15(c) (fixed state of the needle fixing mechanism 30). In FIG. 16(a), when the arm portion is closed, the inner cylinder portion 41 and the first cylindrical cam portion 42 are pressed toward the other side. As a result, the blade portion 41c and the first cam surface 42a move toward the other side with respect to the second cam surface 43b compared to the state of FIG. 15(c), and the blade portion 41c can overcome the step of the second cam surface 43b.

[0100] On the one hand, in Fig. 16(a), the blade portion 41c of the inner cylinder portion 41 pushed into the other side receives the reaction force of the spring portion 44, and the inner cylinder portion 41 and the first cylindrical cam portion 42 are biased to one side. At this time, the blade portion 41c of the inner cylinder portion 41 is guided by the inclined surface facing the valley portion of the first cam surface 42a, and the inner cylinder portion 41 rotates in the circumferential direction before the blade portion 41c contacts the second cam surface 43b. As a result, the position of the blade portion 41c is displaced in the circumferential direction from the first position of the second cam surface 43b and can come into contact with the inclined surface of the second peak portion 43b2 of the second cam surface 43b.

[0101] Fig. 16(b) shows the state in which the inner cylinder portion 41 is biased to one side by the spring portion 44 from the state of Fig. 16(a). In Fig. 16(b), since the inner cylinder portion 41 is biased to one side by the spring portion 44, a force acting on one side is applied to the inner cylinder portion 41 and the first cylindrical cam portion 42. As a result, the first cylindrical cam portion 42 having the first cam surface 42a moves to one side more than in the state of Fig. 16(a). Further, the blade portion 41c of the inner cylinder portion 41 comes into contact with the second peak portion 43b2 of the second cam surface 43b, and the blade portion 41c is guided by the second peak portion 43b2 and the inner cylinder portion 41 rotates in the circumferential direction.

[0102] Fig. 16(c) is a continuation of Fig. 16(b) and shows the state in which the needle fixing mechanism 30a has returned to the fixed release state. The blade portion 41c of the inner cylinder portion 41 in Fig. 10(d) is at the second position where the circumferential position coincides with the groove 43a of the second cylindrical cam portion 43. Then, as shown in Fig. 17(a), the position of the notch portion 54 of the needle portion 52 coincides with the opening portion 41d of the inner cylinder portion 41. As a result, the needle portion 52 of the sewing needle 17a no longer interferes with the flange portion 41b, and the sewing needle 17a can be pulled out to one side.

[0103] Here, when the needle fixing mechanism 30a of the first arm portion 12 shifts from the fixed state to the fixed release state, the needle fixing mechanism 30a of the second arm portion 13 shifts from the fixed release state to the fixed state by the same operation as in Fig. 15. Therefore, when the arm portion is opened by the sewing device 1 after Fig. 16(c), the sewing needle 17 is held in a cantilevered manner by the holding portion 18 of the second arm portion 13. In the suturing device 1, the first arm portion 12 and the second arm portion 13 are opened and closed with the incision in the living body lumen being sandwiched therebetween, and the above-described operation is repeated. As a result, the arm portions holding the suture needles 17 can be alternately switched to suture the incision.

[0104] As described above, also in the needle fixing mechanism 30a of the second embodiment, the position of the blade portion 41c changes according to the operation of opening and closing the arm portion, so that the fixed state and the released state of the suture needle 17a are switched. Therefore, also in the suturing device 1 of the second embodiment, it is possible to fix and release the suture needle only by operating the opening and closing wire 15 that opens and closes the arm portion, and the operation of the suturing device 1 during the procedure can be made very simple.

[0105] The present invention is not limited to the above-described embodiments, and various improvements and design changes may be made without departing from the spirit of the present invention. In addition, the embodiments disclosed this time should be considered to be illustrative in all respects and not restrictive. The scope of the present invention is indicated by the claims rather than the above description, and it is intended that all changes within the meaning and scope equivalent to the claims are included.

[0106] Note that the disclosure of the above embodiments includes the following technical ideas. (1) An endoscopic suturing device provided at the distal end of a tubular insertion portion of an endoscope, having a pair of arm portions each having a holding portion for a suture needle at one end side 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 side of the arm to suture tissue. The suture needle includes a needle portion that punctures the tissue, a stepped portion having a reduced diameter on the proximal side of the needle portion, and a notch portion obtained by partially notching the needle portion in the circumferential direction. The holding portion includes an inner cylindrical portion, a first cylindrical cam portion disposed on the outer circumference of the inner cylindrical portion, a second cylindrical cam portion disposed on the outer circumference of the first cylindrical cam portion and fixed to the arm portion, and a spring portion that biases the inner cylindrical portion toward the outside of the arm portion. The inner cylindrical portion has an opening shape corresponding to the shape of the needle portion including the notch portion, has an opening through which the needle portion and the stepped portion can pass, and has a fin portion formed on the outer circumference of the inner cylindrical portion and protruding in the radial direction. The inner cylindrical portion is rotatably attached to the first cylindrical cam portion and the second cylindrical cam portion in the circumferential direction. The first cylindrical cam portion has a first cam surface that can contact the fin portion and in which ridges and valleys are alternately formed in the circumferential direction on the inner side of the arm portion, and is slidable in the insertion direction together with the inner cylindrical portion. The second cylindrical cam portion has a groove that guides the fin portion of the inner cylindrical portion in the insertion direction of the suture needle, and a second cam surface that guides the fin portion in the circumferential direction between a first position where the suture needle is locked to the inner cylindrical portion and a second position where the fin portion aligns with the groove and the inner cylindrical portion is slidable in the insertion direction, and is annularly disposed inside the arm portion. When closing the pair of arm portions, the operation of the first cam surface in the insertion direction and the biasing of the spring portion rotate the inner cylindrical portion so that the position of the fin portion switches between the first position and the second position along the second cam surface. At the first position, the position of the notch portion of the needle portion and the opening shape of the opening are displaced in the circumferential direction, and at the second position, the position of the notch portion of the needle portion and the opening shape of the opening coincide. An endoscopic suturing device. (2) The suture needle includes the needle part having the notch part and the step part at both axial ends respectively. The pair of arm parts has a first arm part and a second arm part. When the pair of arm parts is closed and the vane part switches to the first position by the first arm part, the vane part switches to the second position by the second arm part. When the pair of arm parts is closed and the vane part switches to the second position by the first arm part, the vane part switches to the first position by the second arm part. The endoscopic suturing device according to (1) above. (3) The inner cylinder part further has a protrusion that protrudes radially and interferes with the first cylindrical cam part at a position on the side opposite to the vane part with the first cylindrical cam part interposed therebetween. The endoscopic suturing device according to (1) or (2) above. (4) The first cylindrical cam part is in contact with the inner circumference of the second cylindrical cam part and has a rotation control member on its outer circumference that restricts the circumferential movement of the first cylindrical cam part. The endoscopic suturing device according to any one of (1) to (3) above. (5) The endoscopic suturing device is detachable from the tubular insertion part of the endoscope. The endoscopic suturing device according to any one of (1) to (4) above.

Explanation of Reference Numerals

[0107] 1... Suturing device, 2... Tubular insertion part, 3... Objective lens, 4... Lighting part, 5... Forceps port, 6... Forceps, 11... Mounting part, 12... First arm part, 13... Second arm part, 14... Opening and closing mechanism part, 15... Opening and closing wire, 17, 17a... Suture needle, 18... Holding part, 30, 30a... Needle fixing mechanism, 31... Inner needle, 31c... Vane part, 32... Outer needle, 32a... First cam surface, 33... Needle receiving part, 33b... Groove, 33c... Second cam surface, 34... Spring part, 41... Inner cylinder part, 41c... Vane part, 42... First cylindrical cam part, 42a... First cam surface, 43... Second cylindrical cam part, 43a... Groove, 43b... Second cam surface, 44... Spring part, 52... Needle part, 53... Step part, 54... Notch part

Claims

1. An endoscopic suturing device provided at a distal end of a tubular insertion portion of an endoscope, comprising: a pair of arm portions each having a holding portion for a suture needle at one end side of the arm, and configured such that the arm portion for holding the suture needle can be switched when the one end side of the arm is opened and closed to suture tissue; the suture needle includes an inner needle and a cylindrical outer needle into which the inner needle is inserted so as to be rotatable in the circumferential direction and slidable in the axial direction; the inner needle has a needle portion for puncturing the tissue and a wing portion disposed on the proximal end side of the needle portion and protruding in the radial direction of the inner needle; the outer needle has a mountain portion and a valley portion alternately formed in the circumferential direction, and has a first cam surface at a tip portion that can abut against the wing portion; the holding portion has an opening through which the suture needle can pass, and includes a needle receiving portion fixed to the arm portion and a spring portion that biases the wing portion of the suture needle that has passed through the needle receiving portion toward the needle receiving portion; the needle receiving portion a groove formed on an inner circumference of the opening for guiding the wing portion in an insertion direction of the suture needle; a second cam surface that is annularly disposed around the opening on a surface facing the spring portion, and guides the wing portion in the circumferential direction between a first position where the wing portion is locked to the needle receiving portion and a second position where the wing portion aligns with the groove and the suture needle can be inserted and removed; when the pair of arm portions are closed, the operation of the first cam surface in the insertion direction and the biasing of the spring portion cause the position of the wing portion to switch between the first position and the second position along the second cam surface; An endoscopic suturing device.

2. the suture needle has the first cam surfaces of the inner needle and the outer needle at both axial ends thereof, respectively; the pair of arm portions include a first arm portion and a second arm portion; when the pair of arm portions are closed and the wing portion switches to the first position in the first arm portion, the wing portion switches to the second position in the second arm portion; when the pair of arm portions are closed and the wing portion switches to the second position in the first arm portion, the wing portion switches to the first position in the second arm portion; The endoscopic suturing device according to Claim 1.

3. An endoscopic suturing device provided at a distal end of a tubular insertion portion of an endoscope, comprising: a pair of arm portions each having a holding portion for a suture needle at one end side of the arm, and configured such that the arm portion for holding the suture needle can be switched when the one end side of the arm is opened and closed to suture tissue; The suture needle includes a needle portion that punctures the tissue, a stepped portion that has a reduced diameter on the proximal end side of the needle portion, and a notch portion that partially notches the needle portion in the circumferential direction. The holding portion includes an inner cylinder portion, a first cylindrical cam portion disposed on the outer periphery of the inner cylinder portion, a second cylindrical cam portion disposed on the outer periphery of the first cylindrical cam portion and fixed to the arm portion, and a spring portion that biases the inner cylinder portion toward the outside of the arm portion. The inner cylinder portion has an opening shape corresponding to the shape of the needle portion including the notch portion, has an opening through which the needle portion and the stepped portion can pass, and has a blade portion formed on the outer periphery of the inner cylinder portion and protruding in the radial direction, and is rotatably attached to the first cylindrical cam portion and the second cylindrical cam portion in the circumferential direction. The first cylindrical cam portion has a first cam surface on the inner side of the arm portion where ridges and valleys are alternately formed in the circumferential direction and can contact the blade portion, and is slidable in the insertion direction together with the inner cylinder portion. The second cylindrical cam portion a groove that guides the blade portion of the inner cylinder portion in the insertion direction of the suture needle an annularly disposed on the inner side of the arm portion, having a first cam surface that guides the blade portion in the circumferential direction between a first position where the suture needle is locked to the inner cylinder portion and a second position where the blade portion aligns with the groove and the inner cylinder portion is slidable in the insertion direction. When the pair of arm portions are closed, the operation of the first cam surface in the insertion direction and the biasing of the spring portion rotate the inner cylinder portion so that the position of the blade portion switches between the first position and the second position along the second cam surface. In the first position, the position of the notch portion of the needle portion and the opening shape of the opening are circumferentially offset, and in the second position, the position of the notch portion of the needle portion and the opening shape of the opening coincide. Endoscopic suturing device.

4. The suture needle includes the needle portion having the notch portion and the stepped portion at both axial ends respectively. The pair of arm portions include a first arm portion and a second arm portion. When the pair of arm portions are closed and the blade portion switches to the first position at the first arm portion, the blade portion switches to the second position at the second arm portion. When the pair of arm portions are closed and the blade portion switches to the second position at the first arm portion, the blade portion switches to the first position at the second arm portion. The endoscopic suturing device according to claim 3.

5. The inner cylinder part further has a protrusion that protrudes radially at a position on the side opposite to the blade part with the first cylindrical cam part interposed therebetween and interferes with the first cylindrical cam part. The endoscopic suturing device according to claim 3.

6. The first cylindrical cam part has a rotation control member on its outer periphery that abuts against the inner periphery of the second cylindrical cam part and restricts the circumferential movement of the first cylindrical cam part. The endoscopic suturing device according to claim 3.

7. The endoscopic suturing device is detachable from the tubular insertion part of the endoscope. The endoscopic suturing device according to any one of claims 1 to 6.

Images